Residual breast cancer or post operative changes: Can Diffusion-weighted magnetic resonance imaging solve the case?

AbstractObjectiveTo evaluate the ability of Diffusion weighted MR imaging (DWI), as a non-invasive sequence to differentiate between accepted post operative sequel and residual malignancy in breast cancer patients following different surgical procedures.Patients and methodsDWI in addition to the routine post contrast MRI was performed for follow up of 170 post operative breasts (6–24months). DWI acquired using b values: 0, 850, 1000 and 1500. Analysis considered signal intensity (SI) at b 1000 and the ADC map and the mean ADC values.ResultsPost operative changes were: Edema (n=17, 10%), skin thickening (n=25, 15.9%), seroma (n=17, 10%), hematoma (n=5, 3%), fat necrosis (n=13, 7.6%), fibrosis (n=8, 4.7%), and combined (n=83, 48.8%). Residual malignancy found in 16.5% (n=28) of cases.No significant difference was noted between DWI SI at b 850 versus 1000 and b 1000 versus 1500 (P>0.05). Also no difference (P>0.05) was noted between the mean ADC values of residual malignant masses and post operative sequel of fibrosis and fat necrosis. ADC map showed low SI in 30% of cases. Statistical analysis yielded sensitivity, specificity and accuracy of 92.8%, 75.6% and 78% for contrast MRI and 92.8%, 82.6% and 83.4% for DWI respectively.ConclusionDWI enhanced the diagnostic performance of MRI in differentiating residual malignancy from post operative changes

Effect of Spraying with some Antioxidants on Growth, Yield, Fruit Quality and Nutritional Status of Navel Orange Trees

This study was carried out through two consecutive seasons 2016 and 2017 to investigate the effect of spraying with some antioxidants on vegetative growth, yield, fruit quality and nutritional status of twelve years old Navel orange trees on sour orange rootstock grown in a private orange orchard in Qalubia Governorate, Egypt cultivated in a silty clay loam soil. This experiment involved three antioxidant materials named (salicylic acid, citric acid and folic acid) and each one spraying by three levels of each of with (250, 500 and 1000 ppm) from each salicylic, citric and folic acid plus control treatment so the experiment included ten treatments. Selected trees were spraying three times (at the beginning of the growth cycle in March, just after fruit setting in May and just after June drop in July) by aqueous solution of salicylic acid, citric acid and folic acid until the point of runoff. The highest values of vegetative growth were obtained by spraying 500 ppm salicylic acid, 1000 ppm citric acid and 500 ppm folic acid. Regarding to yield, results pointed out that the foliar spraying with 500 ppm salicylic acid, 500 ppm citric acid and 250 ppm folic acid gave the highest values of yield. Treatments 500 ppm salicylic acid, 250 ppm citric acid and 250 ppm folic acid gave the highest values of physical and chemical fruit properties. In respect to nutrients content, the highest values of macronutrients were obtained by spraying 250 ppm folic acid, while that spraying 1000 ppm salicylic acid and 250 ppm folic acid gave the highest values of micronutrients. Therefore, using treatments 500 ppm salicylic acid, 500 ppm citric acid and 250 ppm folic acid may be recommended from economical point of view and as good treatments for enhancing Navel orange growth, yield, fruit quality and nutritional status especially under old citrus orchards

EFFECT OF SPRAYING WASHINGTON NAVEL ORANGE TREES WITH SELENIUM ON VEGETATIVE GROWTH, PRODUCTIVITY AND FRUIT QUALITY

ve seasons, 2012 and 2013 in a private orchard in Barshom vallage located at El-Kalubia Governorate Egypt. Washington Navel Orange trees (Citrus Sinensis) budded on sour orange rootstock (Citrus aurantium, L.) were 7- years- old and planted at 5 x 5 meters under basin irrigation system. This investigation aimed to study the effect of selenium (Se) levels (0, 20, 40, 80 and 160 ppm)  as foliar spray on growth, yield, fruit quality, leaf mineral content and enzymes activity of Washington Navel orange trees. The obtained data showed that, selenium had a significant promotive effect on growth, yield, fruit quality, leaf mineral content and enzymes activity of Washington Navel orange trees. Results indicated that treatment of Se at 40 ppm gave the highest significant results, whereas, treatment 160 ppm gave the highest fruit selenium content

Efficacy of Zinc Foliar Application from Different Sources on Productivity and Fruit Quality of Wonderful Pomegranate trees

Nanoparticles (NPs), especially from micronutrients, are recently motivated for replacing their common mineral counterparts. To evaluate their comparative efficacy, this investigation was conducted to estimate the impact of foliar application of zinc through different sources on productivity, fruit quality and improve marketable fruit of “Wonderful” pomegranate trees. The field experiment was performed during two seasons (2017 and 2018) on seven - year old pomegranate trees “Wonderful” cv., cultivated in a private “Hegazi” farm located at 57 km. from Cairo on the road to Alex., Egypt. Four sources of zinc named “Zinc Sulphate, Zinc mannitol complex, Bio-Nano zinc (Bio Zn NPs) and Zinc Oxide nanoparticle (ZnO NPs) with four rates from each other were sprayed twice (the first before one week from full bloom and the second after a month from the first). So the experiment included seventeen treatments in a sample study spread in a randomized complete block design by five replicates. Results explicated that the greatest significant values of fruit set% were recorded by Bio Nano Zinc (Bio Zn NPs) treatments especially (400 ppm Bio-Nano Zinc (Bio Zn NPs)). Spraying with (3000, 4000 ppm Zn mannitol complex) and (300, 400 ppm Bio-Nano Zinc (Bio Zn NPs)) showed significantly the greatest values of productivity, improves marketable fruits and fruit quality of “Wonderful” pomegranate trees. So it could be recommended by spraying “Wonderful” pomegranate trees by 3000 ppm Zinc mannitol complex or 300 ppm Bio-Nano zinc (Bio Zn NPs). Another important point is that the application of Bio Zn NPs fertilizer at around 10% from the commercial dose of zinc sulphate resulted in the same results without any change in the productivity, further researches are needed to study a further low level of Zinc Oxide nanoparticle (ZnO NPs) below (100 ppm Zinc Oxide nanoparticle (ZnO NPs)) which may be improving yield and fruit qualit

Evaluation of knowledge, experiences, and fear toward prescribing and dispensing corticosteroids among Egyptian healthcare professionals: A cross-sectional study

Background: Corticosteroids (CS) are essential drugs in the treatment of several medical conditions. Assuming different roles, physicians and pharmacists play a primary role in prescribing and dispensing these medications to optimize patients' clinical management. The data on assessing knowledge and experience of healthcare professionals toward CS is scarce. Therefore, this study aimed to assess and compare knowledge, experience, and fears towards CS among Egyptian physicians and pharmacists. Methods: A cross-sectional, self-administrated, validated online questionnaire was used to collect the data from Egyptian healthcare professionals. The questionnaire consisted of four sections with multiple choice questions: sociodemographic (7 questions), knowledge about CS (13 questions), experience with CS prescription/dispensing (5 questions), and fears and preferences toward CS prescription/dispensing (13 questions). Descriptive and inferential statistics were used to analyze the data. Results: A total of 600 responses were analyzed in this study. The study sample was almost two-half of healthcare providers: 303 (50.5%) pharmacists and 297 (49.5%) physicians. Pharmacists had marginally higher knowledge scores as compared to those recorded for physicians (11.29 versus 10.16, respectively; P = 0.047). Physicians had more experience choosing corticosteroids in treatment plans based on their experience (51.8% vs 38.5%) and guideline recommendations (72.8% vs 50.9%) than pharmacists. However, pharmacists had more experience dealing with corticosteroid use based on patients' preferences (19.5% vs 4.9%) and showed a broader scope of experiencing side effects of corticosteroids with their patients. The two professions demonstrated high levels of fear, with pharmacists acknowledging significantly lower concerns about CS than physicians (3.72 versus 4.0, respectively; P = 0.003). Conclusion: Discrepancies exist among healthcare professionals in knowledge and experience, favoring better scientific knowledge of pharmacists related to corticosteroids. Based on these findings, the interprofessional collaborative efforts would provide comprehensive, patient-centered care that maximizes the benefits of CS while minimizing their risks

The intraperitoneal ondansetron for postoperative pain management following laparoscopic cholecystectomy: A proof-of-concept, double-blind, placebo-controlled trial

Background Pain after laparoscopic cholecystectomy remains a major challenge. Ondansetron blocks sodium channels and may have local anesthetic properties. Aims To investigate the effect of intraperitoneal administration of ondansetron for postoperative pain management as an adjuvant to intravenous acetaminophen in patients undergoing laparoscopic cholecystectomy. Methods Patients scheduled for elective laparoscopic cholecystectomy were randomized into two groups (n = 25 each) to receive either intraperitoneal ondansetron or saline injected in the gall bladder bed at the end of the procedure. The primary outcome was the difference in pain from baseline to 24-h post-operative assessed by comparing the area under the curve of visual analog score between the two groups. Results The derived area under response curve of visual analog scores in the ondansetron group (735.8 ± 418.3) was 33.97% lower than (p = 0.005) that calculated for the control group (1114.4 ± 423.9). The need for rescue analgesia was significantly lower in the ondansetron (16%) versus in the control group (54.17%) (p = 0.005), indicating better pain control. The correlation between the time for unassisted mobilization and the area under response curve of visual analog scores signified the positive analgesic influence of ondansetron (rs = 0.315, p = 0.028). The frequency of nausea and vomiting was significantly lower in patients who received ondansetron than that reported in the control group (p = 0.023 (8 h), and 0.016 (24 h) respectively). Conclusions The added positive impact of ondansetron on postoperative pain control alongside its anti-emetic effect made it a unique novel option for patients undergoing laparoscopic cholecystectomy

Disparities in prevalence and barriers to hypertension control: a systematic review

Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases—ScienceDirect, PubMed, and Google Scholar—were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions

Assessment of Academic Resilience and its associated factors among Pharmacy Students in Twelve Countries

Objective Academic resilience, a critical determinant of academic achievement, is affected by various factors. There is a paucity of large-scale international assessments of academic resilience among pharmacy students. Therefore, this study aimed to assess academic resilience among pharmacy students in 12 countries and to evaluate factors associated with their academic resilience levels. Methods A cross-sectional online survey-based study was conducted among randomly selected pharmacy students in 12 countries: Egypt, Türkiye, Indonesia, Pakistan, Bangladesh, Iraq, Jordan, Nigeria, Malaysia, Saudi Arabia, Sudan, and the United Arab Emirates. After pilot testing, the validated 30-item academic resilience scale (ARS) was used for the assessment. The data were collected between November 1, 2022 and April 15, 2023. Descriptive and inferential statistics were performed, as appropriate. Results A total of 3950 were received from the 12 participating countries. The mean age was 21.68 ± 2.62 years. About two-thirds of the responses were from female participants and those studying for Bachelor of Pharmacy degrees. Overall, the findings show moderate academic resilience, which varied across countries. The median (IQR) of the total ARS-30 was 114 (103−124). Females exhibited lower negative affective and emotional response subscale levels than males. There were significant cross-country variations in the ARS-30 and all subscales. The highest overall levels were reported for Sudan, Pakistan, and Nigeria and the lowest were reported for Indonesia and Türkiye. Students in private universities tended to have higher overall ARS levels than public university students. Higher academic performance was significantly associated with ARS levels, whereas those with excellent performance exhibited the highest ARS levels. Students with exercise routines had higher ARS levels than those without exercise routines. Finally, students who were engaged in extracurricular activities had higher ARS levels than those who did not participate in these activities. Conclusion The study offers insights into the factors affecting academic resilience in pharmacy students across several countries. The findings could guide interventions and support activities to improve resilience and academic outcomes