CRIOSPHINX STELA FROM TELL HEBOUA - NORTH SINAI

[En] A rectangular stela was found in the vicinity of Tell Heboua I by accident early 2020. The stela was uncovered 500 m to the west of the fortification walls of Heboua I, during a land reclamation project which is going on at the western vicinity of Tell Heboua I. Our well-trained guard Hassan al-Masody, recognized the limestone slab on top of the embankment of a small drainage canal. When turning this recognizable piece of stone, he found it to be decorated of a limestone stela. Inscribed materials that were discovered at Heboua area are still limited compared to the long history of the site and the extensive and continuous archaeological work done. This obviously due to the scarcity of the stone at this sandy remote area. In addition, every piece of stone in the North Sinai archeological sites was taken from its original place and reused along the history till now. [Ar] لوحه من تل حبوة-شمال سيناء لوحة مستطيلة الشكل عثر عليها مصادفة فى أوائل عام 2020. وذلك على بعد 500 متر إلى الغرب من الجدران المحصنة لمدينة ثارو - حبوة 1 ، واللوحة من الحجر الجيري الابيض تم العثور عليها مكسورة الى قطعتين من المنتصف ، وكانت فى حالة سيئة وتم ترميمها مبدئيا فى الموقع. ظهر اللوحة خشن به العديد من علامات الأزميل المحفورة. تم تزيين اللوحة بنقوش غائرة. تمثل زخرفة اللوحة أحد العناصر الرئيسية التى تشير إلى صورة أسد راقد برأس كبش criosphinx مع حامل قرابين فى المقدمة. يمكن التعرف على الكبش على أنهOvis platyura aegyptiaca بناءً على القرون المنحنية للأمام. كبش بلاتيورا ، المخلوق المقدس البارز لآمون ، أصبح أحد أكثر الحيوانات قداسة فى مصر القديمة من خلال ارتباطه بالإله آمون ، الذي كان ، مثل آمون رع ، الإله البدائى والإله الأعلى للآلهة المصرية ، تاجه يرمز إلى السماء ، ويتكون من تاج يعلوه ريشتان مرتفعتان. لا يوجد نص على اللوحة ؛ يمكن تصنيفها على أنها لوحة نذرية ، وهى لا تحتوى على صورة الشخص الذى وهبها ولكن مثل عليها الاله فقط. ومن المرجح طبقا لما عثر عليه فى منطقة تل حبوة 1 انها تؤرخ بعصر الدولة الحديثة

Assessing Bottled Unfortified Natural Yogurt Product Quality of Different Brands or Unbranded Sold in New Valley Governorate, Egypt

Consumers have been more concerned about maintaining a healthy diet. This behavior has affected the dairy products processing industries. Therefore, this study was conducted in the laboratories of the Dairy Departments, Faculty of Agriculture of New Valley University and Assuit University. The aim of this study was to evaluate the physical properties, chemical composition, microbiological parameters, and organoleptic indices of branded yogurt samples (produced from large industrial companies) and unbranded yogurt samples (produced from homemade or small industrial units) offered on the market.The obtained results indicated significant differences in physical properties, chemical composition, microbiological properties and organoleptic indices of physiochemical properties, microbiological parameters, and organoleptic indices of branded unfortified natural yogurt samples and unbranded yogurt samples offered on the market in New Valley Governorate. The microbiological quality of some homemade yogurt being sold and consumed in New Valley Governorate; Egypt is poor. There is a need for the Government to sponsor educational programs for producers so that they can be sensitized on the different branded and unbranded yogurt types found in the market so that there can be uniformity in the end products

Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic

Effect of hemodiafiltration on sclerostin level and bone specific alkaline phosphatase in comparison with high flux dialysis

 Background: Sclerostin (sScl), an osteocyte-derived glycoprotein acts as a soluble inhibitor of the Wnt signaling pathway and bone formation. Its serum levels increase with the progression of CKD. The present study investigated the effect of hemodiafiltration (HDF) on sScl and bone specific alkaline phosphatase (BS-AP) in comparison with high flux hemodialysis (HF-HD). Methods: a prospective study was conducted upon 32 ESRD patients; 16 on regular HF-HD and 16 shifted to 3 months of HDF. Results: There was a significant reduction of predialysis sScl and BS-AP with a significant increase in sScl reduction ratio in the HDF group after 3months. SScl had a significant positive correlation with total but not BS-AP. Conclusion: sScl and BS-AP significantly decrease but are poorly correlated with each other in HDF. So either sScl reduction does not translate into better bone turnover or the BS-AP is not a suitable biomarker to assess bone turnover in HDF.

Prevalence of Female Sexual Dysfunction among Psoriatic Females: a Cross Sectional Case Controlled Study

Introduction: Sexual relationships are an integral part of females psychological and physiological wellbeing. Objectives: The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis. Methods: This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls. Results: Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group. Conclusions: Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially