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Objectives To determine risk factors associated with the recurrence of renal cell carcinoma (RCC), either local recurrence or distant metastasis, and to characterize a contemporary cohort of patients with non-clear RCC (ncRCC) in terms of cancer-free survival (CFS) and time to such recurrence. Methods A retrospective review of prospectively collected data was performed for consecutive patients undergoing partial and radical nephrectomy at a tertiary care center in Saudi Arabia. Data collection included patients and tumor characteristics, perioperative parameters, and histopathological patterns. Multivariate logistic regression determined the predictors of tumor recurrence while Kaplan-Meier analyses assessed CFS and the time to recurrence. Results A total of 214 patients were analyzed, including 150 (70.1%) ccRCC and 64 (29.9%) ncRCC, with a mean age of 54.8 ± 1.7 years and tumor size of 6.9 ± 0.7 (1.2–24.0) cm. After a median follow-up of 47.6 ± 12.4 months, 32(14.9%) patients developed recurrence. In multivariate regression, tumor recurrence was significantly associated with tumors ≥ 6.9 cm [aOR (95% CI): 2.85 (1.67–5.43)], renal vein or inferior vena cava vascular invasion [aOR: 1.92 (1.32–4.21)], pathological staging ≥ 2b [aOR: 2.66 (1.95–5.34)] (8th edition of the AJCC Cancer Staging Manual, 2017), and positive lymph nodes in the specimen [aOR: 3.28 (2.97–5.15)]. The recurrence-free status was 85% at 5 years, while the mean time to recurrence was 9 (6–42) months. Patients with ncRCC had comparable recurrence rates to those with ccRCC (12.5% vs. 16.0% p  = 0.64), respectively. The 5-year CFS was 62.8% (95% CI: 54.2–68.7) for ncRCC and 76.8% (95% CI: 67.4–87.2) for ccRCC ( p  = 0.77). Conclusion Compared to clear cell RCC, patients with non-clear cell RCC showed no significant differences in demographic, tumor, or perioperative characteristics. In our cohort, both histopathological subtypes demonstrated comparable recurrence rates and 5-year cancer-free survival.

This research aims to explain the content of the divine discourse of the Prophet (PBUH) by describing the message and the prophet hood as well as directives and rules within the (call) khiṭâb for the Prophet and his ummah. The method used in this research is the inductive approach by restricting the verses in which the call is described by explaining the message and prophethood in the Holy Quran and listing the sayings of scholars and interpreters. Next, the descriptive and analytical methods are used to derive some judgments related to the verses. The research has reached conclusions that the call to describe the message and prophet hood in the Quran included on a number of rulings, including his amusement, in some places, and his command to communicate the call of God The Almighty. Some of them are related to the legislation of fighting, jihad, the rulings of prisoners, and some of them were in the matter of husbands and wives of the believers in general.   

Background The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar offset of the femur (the offset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. Methods On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the offset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefficient (ICC) was used to test the interrater agreement. Results Both offsets and the lateral offset ratio were larger in males ( p  < 0.001), the medial offset ratio, and the medial slope in females ( p from < 0.001 to 0.007), whereas the lateral slope was sex-free ( p  = 0.41). Irrespective of sex, however, the medial offset with its ratio, and the medial slope were larger than their counterparts ( p  < 0.001). Our means of the offsets, their ratios, and the slopes mostly differed from those of other ethnicities ( p from ≤ 0.001 to 0.004). ICCs > 0.8 proved MRI’s precision was high. Conclusion There was a sexual dimorphism of both the offset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these differences in order to improve postoperative range of motion and patients’ satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.

Background Persistent pain after total hip arthroplasty (THA) is a real concern for the surgeon and is a significant cause of patient dissatisfaction; periprosthetic joint infection (PJI), aseptic loosening, and instability are among the common causes of painful THA. However, few rare causes have been reported in the literature; the complex regional pain syndrome (CRPS) was reported to occur after primary hip and knee arthroplasties. Case presentation: We present a female patient who had bilateral hip resurfacing when she was 28 years old after being diagnosed with bilateral hip avascular necrosis; over 16 years, she was satisfied. She started developing pain in her right hip in 2019, diagnosed as aseptic loosening, and a revision using a cementless THA was performed. Six months later, she was diagnosed with PJI, which was treated in two stages; after the first-stage revision THA, the patient complained of persistent pain in her lower leg with a burning sensation and change in skin color, not responding to conservative lines. During the second-stage revision THA and after receiving spinal anesthesia, the skin color of the right lower limb changed to normal. The postoperative diagnosis was made as CRPS, treated effectively with sympathetic block. At six months postoperative, the patient was pain-free, and the implants showed proper position. Conclusions: Although rare, CRPS could cause persistent pain after repeated hip surgeries, and the diagnosis is reached mainly by exclusion.

Kesandingan, one of the rituals in Probolinggo, East Java, is a cultural phenomenon that mingles with religious elements of society. It is something sacred and mystical that parents do when a toddler (an infant under three years old) experiences heat illness for days, tends to be fussy, cries a lot, and cannot sleep at night. This research aims to explain the process of symbolic communication of kesandingan ritual and to understand the symbolic meaning behind the ritual. It is a descriptive-qualitative study through observation, in-depth interviews, and documentation. The data analysis uses a qualitative-naturalistic technique. The result demonstrates that the symbolic communication process of kesandingan ritual in Mentor, Sumberasih, Probolinggo, comprises seven series: burning incense, wiping incense smoke on the child's face, giving the child holy water to drink, wiping the child with floral water, preparing food, making a wish on the child's bed, and distributing food. Meanwhile, the symbolic meaning of kesandingan ritual refers to divine, social and personal dimensions. Ritual kesandingan merupakan salah satu ritual masyarakat Probolinggo Jawa Timur yang sudah menjadi fenomena budaya yang berbaur dengan unsur religi masyarakat. Ritual kesandingan merupakan sesuatu yang sakral dan mistis yang dilakukan orang tua saat anak batita (bawah tiga tahun) mengalami sakit panas berhari-hari, rewel, kerap menangis dan tidak bisa tidur terutama malam hari. Tujuan penelitian ini untuk menjelaskan proses komunikasi simbolik ritual kesandingan dan memahami makna simbolik dibalik ritual tersebuat. Penelitian ini merupakan penelitian deskriptif-kualitatif, pengumpulan datanya melalui observasi, wawancara mendalam, dan dokumentasi. Sedangkan analisis datanya menggunakan teknik analisa data kualitatif-naturalistik. Sebagai hasilnya, diketahui bahwa proses komunikasi simbolik ritual kesandingan di desa Mentor Kecamatan Sumberasih Kabupaten Probolinggo meliputi tujuh rangkaian yaitu: membakar kemenyan, mengusap asap kemenyan ke wajah anak, memberi minuman kepada anak dengan air doa, mengusap wajah anak dengan air bunga, menyiapkan makanan, memanjatkan doa ditempat tidur anak, dan membagikan makanan. Sedangkan makna simbolik ritual kesandingan mencakup tiga dimensi, yaitu: dimensi ketuhanan, sosial, dan personal.

Purpose We aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome. Materials and methods We retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients’ demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more. Results The urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively. Conclusions Unfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

[...]our inferences are limited to the a priori thresholds and study design. Because our analysis plan centered on predefined thresholds, any re-analysis at alternative values would be exploratory and should be interpreted as such. 2. In other disease sites, for example, breast cancer, Soliman and Yussif [4] reported using a Ki-67 index of ~15% for risk stratification in defined contexts, underscoring that “optimal” values are context-dependent rather than fixed.

Introduction: The identification of bladder detrusor muscle invasion in urothelial cancer is essential for prognosis and management. We studied the clinical, histological, and immunohistochemical expression of p16, p53, and Ki-67 in urothelial detrusor muscle-invasive bladder cancer (MIBC) and urothelial non-detrusor muscle-invasive bladder cancer (NMIBC) in Egyptian patients. Methods: Sixty-two bladder urothelial cancer cases obtained through TURBT were included and divided into two groups: (MIBC, stage T2) and NMIBC (T1). Tissue blocks were recut and re-examined microscopically; then, the immunostaining of p16, p53, and Ki-67 was performed to compare both groups and evaluate the 13% cut-off for Ki-67, 20% for p53, and p16 intensity in various conditions aided by telepathology technology. Results and conclusion: Hematuria was the main clinical first presentation, with no significant difference between either group. The mean age was 61.6 years, with male predominance (52 males and 10 females). The absence of papillary histological pattern was associated with a higher stage, including detrusor muscle invasion (p = 0.000). The overall average percent of p53 immunostaining was 12.9%, revealing no significant difference between MIBC and NMIBC when a cut-off of 20% was implicated. The Ki-67 expression was correlated with higher grade and muscle invasion; however, no association was found with the other two markers’ expression. The negative immunostaining of p16 was associated with low grade and NMIBC in the case of the preservation of the papillary pattern. We recommend further studies on the cut-off of widely used markers and more immunohistochemical and genetic studies on the p16(INK4A), taking into consideration the histological pattern of conventional carcinomas.

Background Knee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees’ anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs. Methods Two hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated. Results A significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 ( P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 ( P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 ( P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 ( P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population. Conclusion A significant difference was found between males’ and females’ knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage. Trial registration ClinicalTrials.gov identifier: NCT03622034 , registered on July 28, 2018.

In 2018, the Egyptian government initiated a massive hepatitis C screening and treatment program. The Ministry of Health set the goal of screening all adults (target population, 62.5 million) within 1 year and provided treatment paid for by the government. Nearly 50 million people participated in screening, and approximately 1 million patients were treated for HCV infection.