Short Term Outcome of Management of Early Breast Cancer Patients in COVID-19 Era. Ain Shams University Experience

Introduction: COVID-19 implied that a great number of infected individuals were hospitalized and possibly admitted to intensive care units. Cancer centers have rapidly changed models of care by delaying non-urgent surgeries. Breast surgeries were delayed for early breast cancer patients forcing clinicians to potentially alter treatment recommendations by neoadjuvant chemotherapy until appropriate conditions were established. Aim of the work: to assess conservative breast cancer surgery after neo-adjuvant therapy in early breast cancer patients in COVID-19 era as regard surgical outcome, complications and early recurrence comparing results with previous results when patients underwent primary conservative breast surgery. Patients and Methods: This is a cohort study that was conducted 52 patients with early breast cancer stage I and II a. Patients were divided into two groups (A) and (B). Group A included 26 patients who underwent primary conservative breast surgery. Group B included 26 patients who underwent conservative breast surgery after neo-adjuvant therapy during COVID-19 era. Results: Intra-operative re-excision was done in 5 patients (19.2%) in group A and 3 patients (11.5%) in group B. Two patients (7.7%) in group A and 1 patient (3.8%) in group B were converted to modified radical mastectomy. Sentinel lymph node (SLN) was done in all 26 patients in group A while only 25 patients in group B with 1 patient undergoing axillary dissection from the start. SLN was positive in 8 patients (30.8%) in group A & 6 (24 %) patients in group B. Consequently, 8 patients (30.8%) in group A and 7 patients (26.9%) in group B underwent axillary dissection. Conclusion: Conservative breast cancer surgery after neo-adjuvant therapy in early breast cancer patients in COVID-19 era has comparable results to primary conservative breast surgery. Thus, the obligatory decision to delay primary surgery during COVID-19 era by giving neoadjuvant chemotherapy was effective. Copyright © Celsius Publishing House.

Impact of Atrial Fibrillation and Flutter on the in-Hospital Outcomes of Patients with Covid-19: A Nationwide Retrospective Cohort Study

Background: Atrial fibrillation and/or flutter is a common comorbidity in hospitalized patients with COVID-19. Objective(s): We aimed to assess the effect of atrial fibrillation and/or flutter on the outcomes of COVID-19 patients in a nationally representative sample. Method(s): We conducted a population-based analysis utilizing data from the national inpatient sample database. Hospitalized adults >= 18 years who were hospitalized with COVID-19 during the year 2020 were included. We used multivariate logistic regression models to investigate the outcomes in patients who had atrial fibrillation or flutter. Result(s): Among 1,018,115 (Nationally weighted sample) admissions with COVID-19, 154795 cases (15.2%) had atrial fibrillation and/or flutter. Patients with atrial fibrillation and/or flutter had significantly higher adjusted odds of all-cause in-hospital mortality (Odds Ratio [OR], 1.78 [confidence interval (CI), 1.75-1.80]), acute stroke (OR, 1.96 [CI, 1.85-2.07]), acute coronary syndrome (OR, 1.43 [CI, 1.37-1.48]), acute heart failure (OR, 4.24 [CI, 4.15-4.34]), cardiogenic shock (OR, 3.07 [CI, 2.85-3.30]), need for vasopressors (OR, 2.14 [CI, 2.06-2.22]), cardiac arrest (OR, 1.95 [CI, 1.89-2.02]), need for mechanical ventilation (OR, 1.79 [CI, 1.77-1.82]), acute kidney injury (OR, 1.25 [CI, 1.23-1.27]), major bleeding (OR, 1.82 [CI, 1.73-1.92]) compared to those patients without atrial fibrillation or flutter. On subgroup analysis, the risk for mortality was highest among atrial flutter (OR, 2.91), followed by atrial flutter and fibrillation group (OR, 2.38), followed by only atrial fibrillation group (OR, 1.71) (P value <0.001 for all) when compared to non-atrial fibrillation, non-atrial flutter in patients with COVID-19. Conclusion(s): Atrial fibrillation and flutter are associated with higher inpatient mortality and worse outcomes in COVID-19 patients. [Formula presented]Copyright © 2023

Effect of COVID-19 on the freight forwarding industry in Egypt: An empirical study on agility Egypt

The freight forwarding industry is an important player in the maritime transport industry that facilitates shipping processes by providing various value-added services such as securing bookings, transporting cargo, and preparing shipping documents. However, due to COVID-19 outbreak, the freight forwarding industry faced many challenges like port congestion, container shortages, and blank sailings. Therefore, this study examines COVID-19 effect on the freight forwarding industry and the challenges that the freight forwarders faced especially in Egypt, which is a logistics hub due to its strategic location. The case provides researchers and practitioners with an overview of the challenges that affected both maritime transport and freight forwarding industries in Egypt and investigates the challenges that Agility Egypt encountered due to COVID-19 restrictive safety measures. Also, it presents the solutions undertaken to deal with those challenges. Data were collected through interviews with various operation managers, executives, and specialists in Agility Egypt for shipping and freight. © 2023 by IGI Global. All rights reserved.

The impact of some economic variables on agricultural labor in Egypt

The main problem of this research is decreasing of agricultural labor wages during the study period 2007-2020 which is reaching about 11.05 thousand pounds in 2020 compared to the agricultural wages of workers in 2007, which contributes about 17.87 thousand pounds, while the worker's wages are increased in The construction sector (as an alternative sector of the agricultural sector) during the study period, so the migration of workers from the agricultural sector to the construction sector is increased, and according to previous, the crop intensification rate is decreased during the study period (especially in the second period) due to decreasing the unit of farm area due to Encroachment on agricultural lands and increasing the inflation rate, and agricultural investments are decreasing in the agricultural sector, and consequently the percentage of agricultural GDP to total GDP is decreasing from 14.10% in 2007 to 12.10% in 2020. So this study aims to study the most important economic variables affecting on the size of agricultural labor during the study period (2000-2020).by dividing the study to two periods 2007-2013, and 2014-2020, and compare with them by (T test) and estimating growth rate, using multiple regression models to identify the most important variables which was affecting on the size of agricultural labor. Simple regression models were also used to estimate the powers function and write it in its linear form [double logarithmic], after testing data stability by the unit root test using the Augmented Dickey-Fuller test (ADF), and processing them before estimating And the graphical signature of the correlation coefficients of these variables to determine whether they are inactive [correlogram] to know if the model was suffering self- correlation problem or not before obtained the results. It was shown from results that: (1) The economic and social changes which were followed by the political events which were happened in the first period of the revolutions (January 2011, June 2013) were never in the interest of agricultural labor, so government should reconsider the set of procedures and policies that would restructure agricultural activity to ensure Stability in the situation of agricultural labor, especially seasonal labor, and benefiting from skilled labor from it, which led to have decreasing agricultural labor wages.(2) It was also found that the average percentage of total contribution Agricultural wages in relation to the total variable production costs of the most important strategic crops under study account for a large proportion of the total variable costs by up to 50%. Because of increasing inflation rate, which was affecting on high prices of agricultural commodity, production inputs. and the policy of floating the Egyptian pound that is not commensurate with the prices of agricultural crops, also the economic impact of Covid 19 on the most important of strategy crops to variable costs during the first period average 2007-2013. This led to rising labor migration from the agricultural sector to other sectors. (3) By studying the most important factors affecting on size of agricultural labor, it was found that there is a positive and significant relationship between the size of agricultural labor (in million workers) and total agricultural investments (million pounds). Which means that the increase in the agricultural of labor productivity leads to decreasing the numbers of labor, because of the decision of the investor or producer to dispense with the extra labor because the existing labor maintains the same amount of output. (4) The increase in the state's tendency to export and economic efficiency over the marginal propensity to import in the second period 2014-2020 and the decrease in the state's desire to import, in contrast to the first period, which is characterized by a high marginal propensity to export and import.

A DEEP LEARNING BASED LOCATION AWARE ENCODING NETWORK ARCHITECTURE FOR LUNG CANCER SEGMENTATION

Lung cancer (LC) is one of the most common malignant tumors, with rapid growth and early spread. LC is one of the most common malignant tumors. Lung cancer is a deadly disease, and early detection is essential. To achieve more precise diagnoses, cancer segmentation aids clinicians in determining the extent and location of cancer. But manually segmenting lung tumors from large medical images is a time-consuming and difficult task. A convolutional neural network (CNN)-based encoding network with position awareness is proposed in this study for automatically segmenting LC from computed tomography images. It is our model's design philosophy to change the usual link net architecture so that we can properly identify cancer. Our innovation resides in the manner we connect each encoder with decoder, in contrast to previous neural network topologies used for segmenting. During the encoder's many downsampling processes, spatial information is lost. By employing simply the encoder's down sampled output, it is impossible to retrieve this lost information Through the use of untrainable indices, the encoder and decoder are connected together. The output of an encoder may also be sent straight into a decoder, which can then execute segmentation on it.To conduct this study, a spatial attention-based encoder and a decoder that bypasses each encoder's input to the output of its related decoder were employed. Decoding and upsampling procedures will benefit from the spatial information that is recovered in this manner. With each layer of encoded information, the decoding process may require less parameter space, making it more efficient. Lung Image Database Consortium image collecting dataset obtained 98.5 percent accuracy in verifying the suggested system's performance. According to the study mentioned, a subjective comparison between the suggested approach and certain current methodologies is also carried out. Experiments have shown that the suggested method outperformed current technologies, allowing radiologist to more precisely locate a lung tumour while using it.

Impact of Salt Intake and Renin-Angiotensin-Aldosterone System Blockade on Lung Severe Acute Respiratory Syndrome Coronavirus 2 Host Factors.

INTRODUCTION: The angiotensin-converting enzyme 2 (ACE2) as well as the transmembrane protease serine type 2 (TMPRSS2) have been found to play roles in cell entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19). SARS-CoV-2 infection risk and severity of COVID-19 might be indicated by the expression of ACE2 and TMPRSS2 in the lung. METHODS: A high-salt diet rat model and renin-angiotensin-aldosterone system (RAAS) blockade were used to test whether these factors affect ACE2 and TMPRSS2 expression in the lung. A normal (0.3% NaCl), a medium (2% NaCl), or a high (8% NaCl) salt diet was fed to rats for 12 weeks, along with enalapril or telmisartan, before examining the lung for histopathological alteration. Using immunofluorescence and qRT-PCR, the localization as well as mRNA expression of ACE2 and TMPRSS2 were investigated. RESULTS: The findings provide evidence that both TMPRSS2 and ACE2 are highly expressed in bronchial epithelial cells as well as ACE2 was also expressed in alveolar type 2 cells. High-salt diet exposure in rats leads to elevated ACE2 expression on protein level. Treatment with RAAS blockers had no effect on lung tissue expression of ACE2 and TMPRSS2. CONCLUSIONS: These findings offer biological support regarding the safety of these drugs that are often prescribed to COVID-19 patients with cardiovascular comorbidity. High salt intake, on the other hand, might adversely affect COVID-19 outcome. Our preclinical data should stimulate clinical studies addressing this point of concern.

In vitro Anti SARS-CoV-2 Activity and Docking Analysis of Pleurotus ostreatus, Lentinula edodes and Agaricus bisporus Edible Mushrooms.

Background: Fungi are rich source of biologically active metabolites aimed for the improvement of human health through the prevention of various diseases, including infections and inflammatory disorders. Aim: We aimed to in vitro examine the anti-SARS CoV-2 activity of the aqueous extract of each Pleurotus (P.) ostreatus, Lentinula (L.) edodes and Agaricus (A.) bisporus edible mushroom followed by docking analysis of certain metabolites against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-main protease (protease Mpro). Methods: Antiviral and cytotoxic effects were tested on hCoV-19/Egypt/NRC-3/2020/Vero-E6 cells and analyzed via (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide Assay (MTT) assay. Ligand-protein and protein-protein docking studies were performed to explore the interaction of different mushroom extracts at the binding site of protease Mpro. Molecular dynamics (MD) simulations were performed on the most promising ligand-target complexes to investigate their dynamic properties and confirm docking results. Results: Substantial antiviral activities with an IC50 of 39.19, 26.17, and 10.3.3 µg/mL and a selectivity index (SI) of 4.34, 3.44, and 1.5 for P. ostreatus, L. edodes and A. bisporus, were observed, respectively. Docking analysis revealed that, catechin from three mushroom isolates, chlorogenic acid from A. bisporus, kamperferol of P. ostreatus and quercetin from L. edodes, with a C-DOCKER interaction energy in the range of 22.8-37.61 (Kcal/mol) with protease compared to boceprevir ligand of 41.6 (Kcal/mol). Docking of superoxide dismutase, catalase from the three mushrooms, tyrosinase from A. bisporus showed ligand contact surface area with the protein as 252.74 Å2 while receptor contact surface area was 267.23 Å2. Conclusion: P. ostreatus, L. edodes and A. bisporus have potential and remarkable in vitro antiviral activities against SARS-CoV-2. Quercetin from L. edodes, Kaempferol from P. ostreatus, chlorogenic acid and ascorbic acid, catechin, superoxide dismutase and catalase of the three mushrooms extracts were effectively bounded to Mpro of SARS-CoV-2 as conferred by docking analysis.

Does SARI Score Predict COVID-19 Positivity? A Retrospective Analysis of Emergency Department Patients in a Tertiary Hospital

Effectively triaging incoming patients while preventing coronavirus disease 2019 (COVID-19) spread in any emergency department (ED) is a demanding and critical task that places a huge burden on frontline healthcare workers. The ED at our tertiary hospital utilized a slightly modified version of a formerly efficacious severe acute respiratory infections (SARI) screening tool for triaging patients presenting to the ED with respiratory illness. We conducted a retrospective chart review and included patients who were screened using the SARI screening tool and underwent a combined nasopharyngeal and oropharyngeal reverse transcription polymerase chain reaction swab for severe acute respiratory syndrome- related coronavirus 2 to determine COVID-19 positivity. Results from our study show that it may be warranted to remove the gastrointestinal symptoms (nausea, vomiting, and diarrhea) from the SARI screening tool and potentially adjusting the weights of the components in the screening tool. However, as data from additional studies become available, the current SARI screening tool could continue to be used as a screening tool to predict COVID-19 positivity and in triaging patients.

An Approximate Numerical Methods for Mathematical and Physical Studies for Covid-19 Models

The advancement in numerical models of serious resistant illnesses is a key research territory in different fields including the nature and the study of disease transmission. One of the aims of these models is to comprehend the elements of conduction of these infections. For the new strain of Covid-19 (Coronavirus), there has been no immunization to protect individuals from the virus and to forestall its spread so far. All things being equal, control procedures related to medical services, for example, social distancing or separation, isolation, and travel limitations can be adjusted to control this pandemic. This article reveals some insights into the dynamic practices of nonlinear Coronavirus models dependent on the homotopy annoyance strategy (HPM). We summon a novel sign stream chart that is utilized to depict the Coronavirus model. Through the numerical investigations, it is uncovered that social separation of the possibly tainted people who might be conveying the infection and the healthy virus-free people can diminish or interrupt the spread of the infection. The mathematical simulation results are highly concurrent with the statistical forecasts. The free balance and dependability focus for the Coronavirus model is discussed and the presence of a consistently steady arrangement is demonstrated. © 2022 CRL Publishing. All rights reserved.

Blocking Toll-like receptor 9 attenuates bleomycin-induced pulmonary injury.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is one of the most common complications in coronavirus disease 2019 patients suffering from acute lung injury (ALI). In ARDS, marked distortion of pulmonary architecture has been reported. The pulmonary lesions in ARDS include hemodynamic derangements (such as alveolar edema and hemorrhage), vascular and bronchiolar damage, interstitial inflammatory cellular aggregations, and eventually fibrosis. Bleomycin induces ARDS-representative pulmonary damage in mice and rats; therefore, we used bleomycin model mice in our study. Recently, Toll-like receptor 9 (TLR9) was implicated in the development of ARDS and ALI. METHODS: In this study, we evaluated the efficiency of a TLR9 blocker (ODN2088) on bleomycin-induced pulmonary damage. We measured the apoptosis rate, inflammatory reaction, and fibroplasia in bleomycin- and bleomycin + ODN2088-treated mice. RESULTS: Our results showed a significant amelioration in bleomycin-induced damage to pulmonary architecture following ODN2088 treatment. A marked decrease in pulmonary epithelial and endothelial apoptosis rate as measured by cleaved caspase-3 expression, inflammatory reaction as indicated by tumor necrosis factor α expression, and pulmonary fibrosis as demonstrated by Van Gieson staining and α-smooth muscle actin immunohistochemistry were observed following ODN2088 treatment. CONCLUSIONS: All these findings indicate that blocking downstream TLR9 signaling could be beneficial in prevention or mitigation of ARDS through hemodynamic derangements, inflammation, apoptosis, and fibrosis.

Public Perceptions Concerning Community Pharmacy Services in Jouf Region, Kingdom of Saudi Arabia in Reference to COVID-19 Pandemic

Aim/Background: The present study was aimed at investigating the public perceptions about extended services by community pharmacists in Jouf region of Saudi Arabia during COVID-19 pandemic. Design: Institutional based cross sectional prospective survey. The sample size was calculated by an online sample size calculator named Raosoft®️. The calculated sample for this study was 945 with a 5% error margin, confidence interval of 95%, the population size fixed at 200000. Study instrument: A 34-item self-administered questionnaire developed by an in-depth literature review and approved by the subject experts (professor, associate professor, assistant professor and lecturer) after suggestions and modification in the questionnaire, pretested to a small sample of thirty participants. The reliability scale applied to determine the alpha value of pretested sample. Results: Majority of the participants 83.6% were females, the frequency (1-3 times) of visit is highest (52.4%) for the participants with the main reason for visiting a particular pharmacy is close location (52.3%). The participants had positive perceptions towards the role of the pharmacist regarding feeling comfortable asking advice from the pharmacist, getting comprehensive consultation, having sufficient discussion time, communication with the pharmacist, getting answers for their questions, medication labeling and information about medication interactions and side effects. However, the participants had negative attitudes towards the medications prices and the diagnostic services such as lab tests provided by the community pharmacists. Public are of the opinion that the pharmacists are well aware of the COVID-19 pandemic playing a good role in counselling about the COVID-19, without any change in their behavior in the current situation. Conclusion: The study showed that there was positive public perceptions about the role of the community pharmacists and the practices and services offered by them. The study recommended increasing the public awareness about the role of the community pharmacists and the range of the services offered in the community pharmacies.

Clinical, laboratory and radiological predictors of unfavorable hospital admission course for diabetic patients with covid-19

Background: Patients with diabetes mellitus infected with the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are at risk of high morbidity and mortality. Objective: Our study aimed to address the clinical, laboratory and radiological predictors of hospital admission course for patients with diabetes mellitus with COVID19 infection at the time of admission. Patients and Methods: This was a single center, retrospective study of patients with diabetes mellitus (DM) admitted with COVID-19 infection. Patients with unfavorable admission course were compared with those of favorable course regarding patient characteristics, clinical presentation, results of laboratory investigations and chest CT severity score. Univariate and multivariate analysis associated with the unfavorable course was performed. Results: Among 141 patients with DM admitted with COVID19, 44 patients had unfavorable course. Those with the favorable course were significantly younger (53.3±16.4) vs (67.3 ±15.8) in the unfavorable course group, multivariate analysis revealed that age more than 65, presence of hypertension, CT severity scoring, high HBA1c, AST, IL6, oxygen saturation less than 93% and low lymphocyte count were the independent predictors of the unfavorable hospital admission course. Conclusions: Our finding suggests that old age, presence of hypertension, hypoxia at presentation, in addition to high HBA1c, AST, IL6, CT severity scoring and low lymphocyte count were significant predictors of unfavorable admission course in COVID19 patients with diabetes. © 2021, Ain Shams University Faculty of Medicine. All rights reserved.

The Role of Technology in COVID-19 Pandemic Management and Its Financial Impact

A pandemic caused by the novel coronavirus (COVID-19) is causing an unprecedented situation for the world's health services. Health, local communities, and government are adversely affected by the COVID-19 pandemic. Moreover, on January 21, 2020, the WHO Emergency Committee declared a global health emergency because of increasing numbers of COVID-19 case notifications from countries overseas. While the pandemic caused grave damage to socioeconomic phenomena and multiple global phenomena such as commodity prices, remittances, trade, tourism, significant job loss, and drastically lower wages, the pandemic has also negatively affected multiple global phenomena. The advent of technology has spurred significant changes in many aspects of our lives and improved the exchange of information, the presentation of data, and the management of medical resources through telemedicine. In this article, we present a mathematical data visualization approach for analyzing pandemic data behaviors, such as exponential growth and deviations using the data related to COVID-19 events. Furthermore, this article will include studies on the implications of the COVID-19 pandemic on finance sector.

Impact of nutritional intervention on serum level of interferon gamma and insulin resistance in obese women: Considerations during the covid-19 crisis

BACKGROUND: Obesity represents a major epidemic worldwide;it is accompanied by increased oxidative stress and reduction in immune efficacy. AIM: The objective was to assess the impact of a healthy balanced hypocaloric diet with two dietary supplements on obesity related metabolic disorders and interferon gamma production. SUBJECTS AND METHODS: Sixty obese women participated in the study that lasted for 8 weeks. They were divided into two groups, 30 subjects in each group, one group consumed a daily supplement in the form of cookies prepared mainly from corn flour, wheat germ and thyme, and the other consumed a blend composed mainly of barley flour, cocoa powder and ginger powder. All participants have followed a low caloric balanced regimen (1000-1200 KCal/ day). Follow-up was performed with anthropometric measurements, dietary recall, and biochemical parameters. RESULTS: After intervention, the results showed a significant reduction in the anthropometric parameters, the obesity related metabolic disorders criteria with significant elevation in total antioxidant and interferon gamma. Positive significant correlations were detected between total antioxidant and interferon gamma and negative significant correlations were detected between interferon gamma with triglycerides, body mass index, percent body fat mass, and hip circumferences. CONCLUSION: All these issues have a very important role in decreasing the infection with covid-19. © 2021 Hend A. Essa, Salwa M. El Shebini, Maha I. A. Moaty, Nihad H. Ahmed, Magda S. Mohamed, Salwa T. Tapozada.

Dynamical behaviors of nonlinear coronavirus (COVID-19) model with numerical studies

The development of mathematical modeling of infectious diseases is a key research area in various fields including ecology and epidemiology. One aim of these models is to understand the dynamics of behavior in infectious diseases. For the new strain of coronavirus (COVID-19), there is no vaccine to protect people and to prevent its spread so far. Instead, control strategies associated with health care, such as social distancing, quarantine, travel restrictions, can be adopted to control the pandemic of COVID-19. This article sheds light on the dynamical behaviors of nonlinear COVID-19 models based on two methods: the homotopy perturbation method (HPM) and the modified reduced differential transform method (MRDTM). We invoke a novel signal flow graph that is used to describe the COVID-19 model. Through our mathematical studies, it is revealed that social distancing between potentially infected individuals who are carrying the virus and healthy individuals can decrease or interrupt the spread of the virus. The numerical simulation results are in reasonable agreement with the study predictions. The free equilibrium and stability point for the COVID-19 model are investigated. Also, the existence of a uniformly stable solution is proved. © 2021 Tech Science Press. All rights reserved.