The Northern Lakes and Surrounding Plains in the Nile Delta, Egypt: How Are They Now and How Will They Are in Light of Climate Changes

In addition to the consensus of scientists, environmental experts, fisheries and beach research in Egypt about the pollution of the northern lakes in the Egyptian delta and the collapse of its ecosystem as a result of using these lakes as a permanent drain for agricultural, health and industrial wastewater - untreated - for the delta governorates surrounding the lakes - the continuous drying processes in the Manzala lakes Burullus, Mariout and Idku, which the government undertakes on the one hand, and individuals on the other hand, have caused a change in the morphology of the lakes and a reduction in their areas, ranging between 46% and 83% of their original areas. Drying and filling works are still going on for these lakes, without taking into account the new climatic conditions that have hit the world, which in turn will lead to a rise in the global sea level (MGSL) during this century by an amount that may reach a maximum of one meter. This will result in the invasion of all the northern lakes of the Nile Delta, in addition to the surrounding dry low plains along the northern coast of the delta, and then the invasion of all the areas that were previously deducted and drained from the lakes with their urban, agricultural and industrial projects, as well as the remaining submerged areas of these lakes, which in turn will lose their characteristics to become part of the Mediterranean. This study aims to determine the quantitative and qualitative size of the certain risks that will face the northern lakes and the plains surrounding them in the Nile delta as a result of the global rise in sea level during this century, the coastal threat sources and the traditional defensive policies that must be followed to avoid all these risks

Groundwater Sapping Process and Runoff of Old River Systems in the Great Sand Sea and the Gilf El Kebir Plateau, Western Desert of Egypt

The present work delineates two main patterns of drainage in the Western Province of the Western Desert. The first pattern was formed by runoff of old river systems and has a restricted geographic distribution on the top surface and slopes of the scarps of the Gilf El Kebir Plateau but it is generally low, intermittent, having a limited duration in the westernmost part of the Great Sand Sea along the Egyptian-Libyan borders. The second pattern was and still formed by groundwater sapping process which has a widespread distribution along the slopes of the Gilf El Kebir Plateau, the Nubia Sandstone hills distributed in the Dakhla Basin and the slopes of the widely distributed longitudinal Nubia Sandstone ridges in the Great Sand Sea between the Gilf El Kebir in the south and Siwa Oasis in the north. The phenomenon of lateral flowing of groundwater and its emergence as seeps at the edges of the scarps was and still today the main erosion process that produces major landforms with unique characteristics in the Great Sand Sea. It causes disintegration and breakdown of the Nubia Sandstone bedrock and erosion of the sandstone from the slopes, causing the slopes to be undermined and undergo mass wasting. It is also the predominant mechanism of the growth of the amphitheater-headed valleys, and the flat-topped surfaces of the upraised plateaus as well as the exploitation of joints and fractures in the Nubia Sandstone bedrock. In addition it is responsible of formation of different types of alcoves in headwalls, spring sites and seepage zones in many valley flanks. Moreover, vast areas of the Nubia Sandstone bedrock of the flat-topped plateaus, flat tracks and depressions are found to be eroded, well exposed, clean, and covered by silica debris as a result of intense erosion by the groundwater seepage

Anatomical variations of hepatic artery using the multidetector computed tomography angiography

Background: The frequency of normal and aberrant hepatic arteries differs among ethnicities. The aim of our work was to study the frequency of normal and aberrant hepatic arteries among Egyptians using multidetector computed tomography (MDCT) and to compare our prevalence with the prevalence of other nationalities. In addition, the gender differences of such variations were clarified. Moreover, the arterial feeding of hepatic segment IV was determined. Materials and methods: The present study was carried out on 500 patients (409 males and 91 females). Abdominal CT was performed using two MDCT systems, a 64-row, and a 256-slice system. Results: According to Michel’s classification, the normal anatomy (type I) was observed in 369 (73.8%) cases, while anomalous hepatic arterial pattern was detected in 131 (26.2%) cases. These anomalies were distributed as follows: type II in 36 (7.2%) cases, type III in 60 (12%) cases, types IV and V in 5 cases for each (1% each), type VI in 14 (2.8%) and types VIII and IX in a single case for each (0.2% each). Neither type VII nor type X was detected. Nine (1.8%) unclassified cases were observed. According to Hiaat’s classification, the anomalies were distributed as follows: type II in 41 (8.2%) cases, type III in 74 (14.8%) cases, type IV in 6 (1.2%) cases, type V in a single case (0.2%) and type VI in 2 (0.4%) cases. Finally, 7 (1.4%) unclassified cases were observed. Common hepatic artery (CHA) originated from coeliac trunk in 98% (79.8% males and 18.2% females). It originated from the abdominal aorta in 0.4% and from the superior mesenteric artery (SMA) in 0.4%. It was absent in 1.2%. Right hepatic artery (RHA) originated from the CHA in 86.6% (69.8% males and 16.8% females) and from the SMA in 13.2% (11.8% males and 1.4% females) and from the abdominal aorta in 0.2% (a single male case). Left hepatic artery (LHA) originated from the CHA in 91.2% and from the left gastric artery (LGA) in 8.8%. The most common origin of the segment IV blood supply was the LHA in 60.8%, followed by the RHA in 35%. Less commonly, blood supply derived from the hepatic artery proper (HAP) in 1%. Combined supply derived from RHA and LHA in 0.8%, from the LHA and HAP in 2% and the least encountered was from the RHA and HAP in 0.4%. Conclusions: Hepatic artery variations among Egyptians have a different distribution when compared to such variations among other species. The normal hepatic arterial pattern was observed in 73.8%, while the anomalous was detected in 26.2%. The CHA originated from the coeliac trunk in 98%, the RHA originated from the CHA in 86.6% and the LHA originated from the CHA in 91.2%. The most common arterial supply of the hepatic segment IV is derived from the LHA (60.2%)

Prevalence of Prediabetes in Patients with Acute Coronary Syndrome and Its Relation to In-Hospital Clinical Outcome

Background: Diabetes mellitus is one of the leading causes of vascular disease. The caseload is expected to reach 350 million by the year 2030, and it is estimated that up to 30% of patients are undiagnosed. Objective: The aim of the study was to explore the prevalence of prediabetes in patients admitted with acute coronary syndromes (ACS) who were not known to have diabetes and to determine the impact of prediabetes on in-hospital clinical outcomes versus non-diabetic patients. Patients and methods: This prospective study was conducted on 60 patients with acute coronary syndrome who were admitted to the intensive care unit (ICU), Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from September 2019 to March 2020. All studied subjects were subjected to full history taking complete clinical examination, complete blood count, glycosylated haemoglobin (HbA1c), lipid profile, serum creatinine and oral glucose tolerance test (OGTT), ECG and ECHO. Results: There was a statistical significant difference between the studied groups regarding acute coronary syndrome types, glycated haemoglobin (HbA1c), serum creatinine, and high-density lipoproteins cholesterol. There was statistically significant difference between the studied patients grouped according to the clinical outcome regarding ACS types. Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Pre-diabetic patients had worse in-hospital clinical outcomes compared with patients without diabetes. Pre-diabetic patients with ACS have greater  prevalence of cardio-metabolic risk factors (abdominal obesity, and hypertension) as compared to non-diabetic patients

IMPACT OF CUSTOMER RELATIONSHIP MANAGEMENT ON FOOD AND BEVERAGE SERVICES QUALITY: THE MEDIATING ROLE OF EMPLOYEES SATISFACTION

Purpose of the study: This study is carried out to investigate the mediating role of employee satisfaction in the relationship between customer relationship management and food and beverage services quality in the 5-stars hotels in Jordan. Methodology: The survey method was used, which includes the use of the field method for collecting data from 5-stars hotels in Jordan, which employees numbered 9,657 and the number of 5-stars hotels is 33in Amman, 352 were effective for analysis and after analyzing the data using the statistical program AMOS. Main Findings: The most important findings were as follows: There is a significant impact of employee satisfaction on the relationship between customer relationship management and food and beverage services quality. Applications of this study: This study comes out to help hotel managers understand the impact of their actions on the ES in their hotels to raise the efficiency of the services provided in the field of FBSQ and to recommended researchers to do more studies in the field of food and beverage and link them in the behavior of employees and customer, which is a result of hotels profit, and also entertains them to the return on the local economy. Novelty/Originality of this study: Food and beverages services are one of the essential services which business managers should consider if they have to retain their customers and improve the image of their business so this study came out to investigate the mediate role of employee’s satisfaction in the relationship between customer relationship management and food and beverage services quality in the 5-stars hotels

Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study

<p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality. Primary care physicians (PCPs) care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies suggest that PCPs and nephrologists deliver suboptimal CKD care. One strategy to improve disease awareness and treatment is estimated glomerular filtration rate (eGFR) reporting. We examined PCP and nephrologist CKD practices before and after routine eGFR reporting.</p> <p>Methods</p> <p>We conducted a retrospective cohort study of patients with CKD 3b-4 (eGFR < 45) seen at a university-based, outpatient primary care clinic. Using a chi-square or Fisher's exact test, we compared co-management rates, renal protective strategies, CKD documentation, and laboratory processes of care in 274 patients and 266 patients seen in a 6-month period prior to and following eGFR implementation, respectively.</p> <p>Results</p> <p>CKD co-management increased from 22.6% pre-eGFR to 48.5% post-eGFR (P < 0.0001). eGFR reporting did not improve angiotensin converting enzyme inhibitor or angiotensin receptor blocker use or quantitative urinary testing. However, non-steroidal anti-inflammatory drug avoidance (pre-eGFR 81.8% vs. post- eGFR 90.6%, P = 0.003) and phosphorus and parathyroid hormone testing improved (pre-eGFR vs. post-eGFR: 32.5% vs. 51.5%, P < 0.0001; 12.4% vs. 36.1%, P < 0.0001 respectively).</p> <p>Conclusions</p> <p>A marked increase in CKD co-management was observed following eGFR implementation. Although some improvements in processes of care were noted, this did not include angiotensin converting enzyme inhibitor or angiotensin receptor blocker use. Overall care remained suboptimal despite eGFR reporting; further strategies are needed to improve PCP and nephrologist CKD care.</p

Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures

Introduction: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries. Materials and Methods: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head. Results: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker’s ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value < 0.001. Conclusion: The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value ≤ 25 mm could potentially protect against lag screw cut-out in trochanteric hip fractures

Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study.

BackgroundGiven the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD.Study designMixed methods study.Settings and participantsCommunity-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA.MethodologyWe used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care.Analytic approachWe conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team.ResultsOf 32 participating PCPs, 31 (97%) had been in practice for &gt;10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care.ConclusionsPCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD