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Introduction Valsalva maneuvers are the initial line in management of paroxysmal supraventricular tachycardia in hemodynamically stable children. This study aimed to compare the efficacy of modified versus standard Valsalva maneuvers on the clinical outcomes and satisfaction of children with paroxysmal supraventricular tachycardia. Methods The study used randomized controlled trial and recruited ninety children with paroxysmal supraventricular tachycardia from Pediatric Emergency Department and Pediatric Cardiac Intensive Care Unit at Tanta University Hospitals, El-Gharbia Governorate, Egypt. The researchers divided the studied children into three equal groups of thirty. A control group that received conventional hospital care, an intervention group I that received modified Valsalva maneuver plus conventional hospital care, and an intervention group II that received standard Valsalva maneuver plus conventional hospital care. The primary outcome was the return to sinus rhythm within the first 5 min of admission and the secondary outcomes were decreased dyspnea, decreased antiarrhythmic therapy use, length of stay time in hospital as well as children’s satisfaction. Results More than half (53.3%) of the children who received the modified Valsalva maneuver returned to sinus rhythm within the first five minutes post-implementation compared to 33.3% of the children who received the standard Valsalva maneuver. Children within modified Valsalva maneuver group had a mean satisfaction score of 25.56 ± 1.67 that was significantly higher than those in the standard Valsalva maneuver group’s score of 20.10 ± 2.57 ( P  = 0.0001). Conclusion The modified version of the Valsalva maneuver was significantly more effective than the standard Valsalva maneuver in terminating supraventricular tachycardia and improving children’s clinical outcomes. This included a decrease in the degree of dyspnea within the first minute from severe to moderate and reducing the need for administering antiarrhythmic drugs for management of SVT episodes. Additionally, children in the MVM group had a higher mean satisfaction score than those in the SVM group, with highly statistically significant differences. Trial registration PACTR202407479098909. Registered 15/07/2024.

This research delves into the dynamics of perceived service quality, customer satisfaction, and loyalty in the context of business-to-business (B2B) interactions within the Radiology Domain in Egypt. Adopting a quantitative approach, the study employs structural equation modeling (SEM) for data analysis. The research population comprises B2B customers within the healthcare sector, focusing on radiology imaging centers, hospitals, and medical equipment procurement authorities. Data collection involves structured questionnaires, and the study measures perceived service quality using the INDSERV model and adapts scales for customer loyalty and satisfaction. AMOS software is utilized for statistical analysis. The results affirm positive relationships between perceived service quality and customer loyalty and satisfaction. The study recommends strategies for radiology imaging suppliers, emphasizing service quality enhancement and customer satisfaction initiatives. While the study acknowledges limitations such as industry specificity and a cross-sectional design, it lays the groundwork for future research directions. The findings contribute valuable insights for B2B interactions within the Radiology Domain and offer practical implications for strategic decision-making in customer centric approaches.

Background Hepatocellular carcinoma (HCC) is the most common primary liver cancer characterized by dysregulation of several crucial cellular signaling pathways such as PI3K/p-Akt/mTOR/NF-κB and VEGF/VEGFR2 pathways. Novel therapies targeting these pathways have been discovered such as regorafenib which is small molecular multi-kinase inhibitor mainly targets VEGF/VEGFR2. Catalpol is an iridoid glycoside richly found in rehmannia glutinosa which is a fundamental herb used extensively in traditional Chinese medicine. It is evidenced that catalpol has many pharmacological effects on nervous and cardiovascular systems, in addition to exhibiting hypoglycemic, anti-inflammatory, anti-proliferative and anti-tumour activities. However, its effect on HCC isn’t clear enough. So, this study aimed to investigate the anti-tumour effects of catalpol either alone or in combination with regorafenib on HCC. Methods and results In vitro experiments were performed using HepG2 and HUH-7 hepatocellular carcinoma cell lines. MTT assays evaluated anti-proliferative effects of catalpol and/or regorafenib. Combination index was calculated via compusyn software to detect synergism. Tumour biomarkers were measured using ELISA technique. Results showed that catalpol has anti-tumour effects against HCC via targeting PI3K/p-Akt/mTOR/NF-κB and VEGF/VEGFR2 pathways. In addition, results revealed that our novel combination of catalpol and regorafenib showed potent synergistic anti-tumour effect via suppressing both of PI3K/p-Akt/mTOR/NF-κB and VEGF/VEGFR2 signaling pathways and their downstreams. Conclusion Catalpol and/or regorafenib markedly suppressed PI3K/p-Akt/mTOR/NF-κB and VEGF/VEGFR2 signaling pathways and consequently showed potent anti-tumour effects against HCC. Results encourage further pre-clinical and clinical studies of this novel combination as a promising targeted therapy for HCC management. Graphic abstract

Surgery is the main line of treatment of endometriosis. Patients with stage IV endometriosis have more extensive adhesions, which make the surgery difficult. There are no accurate non-invasive predictive preoperative parameters of stage IV endometriosis and no consensus has been reached. In the present study, we included 150 females admitted for surgical removal of endometriosis. We scored and classified endometriosis into four stages according to the revised ASRM classification. We compared between baseline characteristics of patients with different stages of endometriosis, and then we selected the best combination of diagnostic and predictive parameters of stage IV endometriosis. Predictors of stage IV endometriosis and indicators for safety surgery were as follows: VAS [greater than or equal to] 4 (p < 0.001), fixed uterus (p = 0.005), fixed ovarian cysts (p < 0.001), tender uterosacral ligament nodule (p < 0.001), tender rectovaginal septum nodule (p = 0.003), bilateral endometriosis (p < 0.001), and sum of sizes of endometriotic nodules (p < 0.001). Fixed uterus, fixed ovarian cysts, tender uterosacral ligament nodule, tender rectovaginal septum nodule, bilateral endometriosis, and indications for surgery were significantly considered adequate predictive markers for stage IV endometriosis.

Many studies and organizations described bases of pregnancy timing after bariatric surgeries, but there is still a need for uniform scientific evidence for accurate timing. We included 200 pregnant females who previously performed different bariatric surgeries. All pregnant females were divided into three groups: early group of patients who were conceived [less than or equal to] 12 months from bariatric surgery included 50 patients (25.0%), middle group of patients who were conceived from 12 to 24 months from bariatric surgery included 50 patients (25.0%) and late group of patients who were conceived > 24 months from bariatric surgery included 100 patients (50.0%). There is a more liability to preterm deliveries in the early group in comparison with the middle and late group (P = 0.064). Gestational weight gain in the early group was lower than the middle and the late group (P = 0.002). Females in the early group have a more liability to inadequate gestational weight gain in comparison with in the middle and late group P < 0.001). We supported recommendations of postponing pregnancy for more than 12 months after performing bariatric surgery which allowed stabilization of maternal weight, allowing adequate gestational weight gain, better fetal and maternal health later on.

Background Overactive bladder (OAB) is the most prevalent lower urinary tract dysfunction among children. Refractory OAB lacks response to the first line treatments, including anticholinergic, and it is a major clinical challenge. This study aims to compare the efficacy of para-sacral transcutaneous electric nerve stimulation (PS-TENS) in the treatment of primary and refractory OAB among children. Methods A prospective, randomized clinical study included 64 children aged 5–12 years with OAB divided equally into two groups: group (1) included 32 children with treatment-naive OAB, while group (2) included 32 children with refractory OAB who failed complete course of anticholinergics. Both groups received PS-TENS three times weekly for 12 weeks. Detailed medical history, voiding diary, ultrasound, and uroflowmetry with EMG were performed at baseline and after 12 weeks of treatment. Filling cystometry was performed for children with refractory OAB before and after PS-TENS. Results After the end of treatment the number of children with urge incontinence decreased significantly among the two groups: from 25 to 13 and 27 to 15 for the primary and refractory groups, respectively. Micturition frequency per 24 h decreased significantly among children with primary OAB. Bladder capacity increased significantly and the resting detrusor pressure decreased significantly among children with refractory OAB. Conclusions PS-TENS is an effective and safe treatment option for children with OAB. The magnitude of improvement is higher among children with primary as compared to refractory OAB.

Background Major depression can negatively affect different domains in patients’ psychosexual life. Many females with depression have sexual dysfunction which goes under diagnosed leading to reduced sexual and overall health quality of life. The aim of this study is to evaluate the risk of sexual dysfunction, sexual quality of life, and general health quality of life in a sample of Egyptian females diagnosed with major depression compared to a control group. Results The sample consisted of 100 participants recruited by convenience sampling, divided into a case group (50 female patients diagnosed with major depression enrolled from our institute’s outpatient clinic) and a control group (50 apparently healthy matched females enrolled from employees working in the university hospitals). Patients answered The Structured Clinical Interview for DSM-IV Axis I Disorders, the Female Sexual Function Index, the Sexual Quality Of Life-Female, and the WHO Quality of Life. Descriptive data analysis showed that all patients with major depression had a higher risk of sexual dysfunction compared to 36% in the control group, with higher rates of marital conflicts, unemployment, positive psychiatric family history and lower monthly income than those in controls. Correlation analysis showed a positive correlation between the sexual quality of life in the case group and the psychosexual feelings (emotional intimacy), self-worthlessness and the total score domains of the FSFI, and a positive correlation with psychosexual feelings, sexual relationship satisfaction, and self-worthlessness domains in the control group. Female sexual functioning scores were positively correlated with most of the WHO quality of life domains in the case group. Conclusions Female patients with major depression are distinctly prone to sexual dysfunction and marital problems that can lead to both defective sexual and overall health quality of life. This mandates thorough screening of the psychosocial risks of sexual dysfunction in patients with depression for early management and more satisfactory quality of life.

To compare different types of macular holes regarding the anatomic and functional success following pars plana vitrectomy (PPV) and internal limiting membrane (ILM) removal. A retrospective review of all patients with macular holes treated by PPV, ILM removal with gas tamponade from January 2014 to July 2017 in Magrabi Eye Hospital. One hundred fifty-seven eyes of 153 patients were analyzed. The eyes were classified according to the etiology of macular hole into four groups: 79 eyes with idiopathic macular hole (IMH), 51 eyes with traumatic macular hole (TMH), 16 eyes with macular hole in diabetic patients (DMH) and 11 eyes with myopic macular hole (MMH). We classified the IMH group based on the International Vitreomacular Traction Study Classification according to size into 3 subgroups; subgroup 1: ≤250µ, subgroup 2: >250 to 400µ and subgroup 3: ≥400 µ. All types of macular hole showed statistically significant postoperative improvement in BCVA compared to the baseline except cases with MMH. Anatomic postoperative hole closure was achieved in 86.1%, 60.7%, 43.65%, an 45.46% of eyes with IMH, TMH, DMH and MMH, respectively. In eyes with IMH, closure rate in subgroup 1 was significantly higher than in subgroups 2, and 3. PPV, ILM peel and C2F6 technique yielded variable anatomic and functional outcomes in different types of macular holes. Anatomic results were most favorable in IMH and least favorable in MMH. The smaller the diameter of the hole the better the results. The underlying pathogenetic mechanisms that lead to different types of macular holes are pivotal in determining the final outcome.

Bee venom (BV) is widely used as a traditional China medicine to treat various conditions, including rheumatoid arthritis (RA). The aim of the present study was to evaluate the effects of systemic BV (60 mg/kg) as an anti-arthritic natural product, compare it with Methotrexate and determine the possible underlying mechanisms of BV action using complete Freund's adjuvant-induced arthritic rats. The development of signs of RA signs (knee joint circumference and arthritis scoring index) was evaluated. Erythrocyte sedimentation rate, serum tumor necrosis factor-α (TNF-α) and serum interleukin-1β (IL-1β) levels were measured at the end of the study. Histopathological examination followed by immunostaining of NF-κB (P65) was performed on the affected knee joints. Additionally, in vitro cyclooxygenase (COX) inhibition activity, carrageenan paw edema test and acetic acid writhing tests were performed to evaluate the anti-inflammatory and analgesic effects of the assessed dose and compared with diclofenac. An acute toxicity test was performed to establish the safety of BV at high doses. The results of the present study highlighted the potential of systemic BV on preventing the development of signs of RA. BV also significantly reduced serum levels of TNF-α, IL-1β and NF-κB in the affected joints. In addition to its potent analgesic activity, BV exhibited favorable inhibitory activity of the COX pathway in both in vivo and in vitro models. Therefore, high dose administration of systemic BV displayed safe and promising anti-arthritic, anti-inflammatory and analgesic properties through regulation of different mechanisms associated with the pathogenesis of RA.

Bullying is one of the most prominent terms recently circulated among people and on social media. This term is not modern; rather, it is as old as man, as it is one of the negative behaviours that some people follow. The phenomenon of bullying is present at all levels of life, and is not limited to one side without the other. It appears in the work environment as in life in general, where some employees are exposed to different forms of occupational bullying. Many researchers have examined the phenomenon of bullying in the work environment. Due to its significant impact on employees and their performance, and therefore on work and performance of tasks. So, the study relied on adopting a quantitative research with deductive approach and using mono method quantitative (field survey) over a structured questionnaire form filled by 578 employees from travel agents and hotels in Egypt. Statistical analyses were accomplished by using Statistical Package for Social Sciences (SPSS version 23) and IBM Amos ver. 25. The findings of this study achieved that workplace bullying effect on organizational commitment, job performance. The study recommends the following: The necessity of taking legal measures against people who have characteristics of bullying. Treating employees with respect, working in a team spirit and forming a work team to accomplish the required tasks. Holding seminars on workplace bullying and its negative impact on society, and spread a culture of respect for others.