The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial

Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes

The Effect of Operating Conditions on the Performance of a Vacuum Membrane Distillation Unit Using PES Flat Sheet Membrane

The desalination of seawater is considered a promising source of potable water in Egypt. Vacuum Membrane Distillation (VMD) is a new separation technology based on the evaporation of saline water through hydrophobic porous membranes by applying vacuum pressure on the permeate side of the membrane to desalinate brackish or seawater. A lab scale experimental model was constructed and operated using hydrophobic polyethersulfone flat sheet membrane (PES) with effective area of 0.049 m2, pore size 0.2-0.4 µm and thickness 120-160 µm. Salt concentration ranging from 5000 ppm to 35000 ppm aqueous NaCl. Resultant permeate flux was measured for the following operating conditions: feed flow temperature (40-50-60-70 °C), flowrate (1-1.2-1.4-1.6 L/min), and vacuum pressure (0.2-0.3-0.4-0.5 Bar). Results showed an increase in permeate flux due to increased temperature, flow rate and vacuum pressure, while it decreased with the increase in salt concentration. The flux value obtained reached 15 kg/m2.hr at T= 40°C, vacuum pressure= 0.4 bar, TDS= 5000ppm, and flow rate 1 L/min, while it reached 29 kg/m2.hr at  T= 70°C, vacuum pressure= 0.5 bar, TDS= 35,000 ppm, and flow rate 1.6 L/min. Electric power consumed by the system reached 0.612 Kwh at  T=70°C, TDS =5000ppm, vacuum pressure = 0.4 bar, and feed flow rate 1 L/min. Keywords: VMD, desalination, vacuum pressure, hydrophobic membrane

Correlation between Micronutrient plasma concentration and disease severity in COVID-19 patients

Objectives: Coronavirus Disease 2019 (COVID-19) is caused by a new strain of betacoronavirus called SARS-CoV-2, which leads to mild to severe symptoms. Micronutrients in blood serum, namely, zinc, iron, copper, and selenium, play essential roles in the human body’s various organs. This study investigates the association between micronutrient levels and the severity of symptoms in SARS-CoV-2 infected patients.Methods: A cross-section study was conducted during June–August 2020 in Riyadh city among 80 patients with confirmed SARS-CoV-2 infection. Within 24 hours of hospital admission, patients have been divided into non-severe and severe cases, and blood samples were drawn from each patient to measure the serum levels of copper, iron “in the form of ferritin,” selenium, and zinc.Results: In both study groups, the mean copper and selenium serum levels were within the normal range, while the mean zinc and iron serum levels were elevated. A statistically significant difference was recorded between non-severe and severe cases regarding serum levels of iron and selenium (331.24 vs. 1174.95 ng/ml and 134 vs. 162 mcg/L, respectively, P &lt; 0.0001). On the other hand, no significant difference was detected between both studied groups regarding serum level of zinc and copper (124.57 vs. 116.37 mcq/L and 18.35 vs. 18.2 mcmol/ L, respectively, P &gt; 0.05).Conclusions: There was a significant elevation of selenium and iron serum levels among severe cases compared to non-severe cases of COVID-19. High levels of iron and selenium could be correlated with the disease severity during infection with SARS-CoV-2

The Ishraq Program for out-of-school girls: From pilot to scale-up

In response to the needs of adolescent girls in Egypt for improved schooling, health, and livelihood prospects, Ishraq (sunrise)—a multidimensional program for 12–15-year-old out-of-school girls—was launched in 2001 by the Population Council in collaboration with CEDPA, Save the Children, Caritas, and local nongovernmental organizations. The program combined traditional tested program elements (literacy, life skills, nutrition) with more innovative ones (sports, financial education). It focused on building a multilayered platform to support and institutionalize the program by educating and mobilizing communities around issues of importance to adolescent girls; forging partnerships between international NGOs, government institutions, and local NGOs; and building capacities of local facilitators and partners to implement the program. This report identifies ways to continue expanding Ishraq, for which community demand remains high, including a new generation of girls’ programs to support graduates in exercising their rights and becoming active members of the community; and notes many important lessons on recruitment strategy, program structure and implementation, capacity-building, and partnerships

Benign versus malignant focal liver lesions: Diagnostic value of qualitative and quantitative diffusion weighted MR imaging

AbstractBackground and objectiveDiffusion-weighted imaging has an emerging role for assessment of focal and diffuse liver diseases. The aim of this study was to evaluate the diagnostic performance of DWI for characterization of focal liver lesions (FLLs).Patients and methodsThis prospective study included 40 consecutive patients with 64 focal liver lesions, who underwent MRI of the liver. All patients had one or more hepatic focal lesion of diameter more than 1cm. DWI was reviewed (b values of 0, 50 and 600s/mm2) and the mean ADC was calculated.ResultsQuantitative assessment using ADC map was more accurate (87.5%) than qualitative assessment using DWI (75%) in characterization of FLLs. Mean ADC values of malignant lesions (0.94+0.32×10−3mm2/s) were significantly lower than those of benign lesions (2.64+0.46×10−3mm2/s), (P<0.001). Using an ADC value above 1.6×10−3mm2/s offered the best accuracy in differentiation of malignant from benign lesions (86%).ConclusionDWI is a useful tool for FLLs characterization. Because of its known pitfalls and limitations, mainly the considerable overlap of ADCs values between solid benign and malignant lesions, it should be interpreted in combination with clinical data and conventional MRI sequences

Behçet’s disease: Spectrum of MDCT chest and pulmonary angiography findings in patients with chest complaints

AbstractObjectiveThe aim of the work was directed to evaluate the value of multi-detector computed tomography pulmonary angiography study in evaluation of known patients with Behcet’s disease.Materials and methodsThis study was done retrospectively and included eighteen known patients with Behcet’s disease and referred for MDCT pulmonary angiography.ResultsPulmonary artery aneurysm was the most common finding as it was found in 16 patients, followed by pulmonary embolism which was found in 14 patients, 12 patients with pulmonary hypertension, right ventricular strain in 6 patients, intracardiac thrombus in 4 patients, dilated bronchial arteries in 8 patients, venous occlusion in 4 patients, mosaic attenuation of the lung in 12 patients, pulmonary infarcts in 4 patients, and pleural effusion in 4 patients.ConclusionMDCT pulmonary angiography is an important diagnostic imaging tool for diagnosis of vascular complications in patients with Behcet’s disease

Adrenomedullin in patients with type 2 diabetes and kidney disease

Secreting vasoactive factors such asadrenomedullin (AM) has been intensivelyinvestigated due to its vascular protective propertiesand promising potential as a therapeutic target. Therelationship between adrenomedullin and type (2)diabetes needs to be elucidated as it is associatedwith significant elevation in plasma adrenomedullinlevels.The aim of this study was to evaluate therole of adrenomedullin in the development ofvasculopathy and its significance as a markerdenoting renal affection in type 2 diabetic patients.Materials and Methods: This study was conductedon 60 diabetic patients, 20 without nephropathy, 20with nephropathy &amp; 20 with diabetic nephropathy(DN) on haemodialysis as well as 20 age- and sex matchedhealthy controls. All were subjected to fullhistory, Echocardiography, lipid profile analysisand plasma adrenomedullin using ELISA method.Results: plasma AM concentration was elevated inall groups of diabetic patients and increment wasdependent on the severity of DN (P&lt;0.0001,P&lt;0.0001, P&lt;0.0001 respectively). There werepositive correlation between adrenomedullin andleft ventricular internal dimensions both in diastole&amp; systole (P&lt;0.001, P&lt;0.005) and negativecorrelation between AM and ejection fraction (EF)P&lt;0.0001. There was positive correlation betweenadrenomedullin and cholesterol, triglycerides andLDL (p&lt;0.002, p&lt;0.001and p&lt;0.003 respectively)and a negative correlation with HDL (P&lt;0.004).Conclusion: Adrenomedullin is supposed to play arole in the pathogenesis of diabeticmicrovasculopathy in renal patients. So it can beused to identify high-risk subjects and modulatingits action would have therapeutic potential in theprevention of diabetic nephropathy