Background/aim Obesity, insulin resistance (IR), dyslipidemia, and decreased consumption of essential micronutrients are factors that can compromise the immune response to coronavirus disease 2019 (COVID-19) infection, leading to increased morbidity and mortality among children. The aim of this study was a detection of possible risk factors that may play a role in augmenting the liability and intensity of COVID-19 infection in Egyptian obese and normal-weight children. Patients and methods This study was a retrospective observational cross-sectional review including 120 obese children (group 1), in addition to 61 age-matched and sex-matched controls (group 2) from children attending ‘the Management of Visceral Obesity and Growth Disturbances Unit’ at the Medical Research Excellence Center (MERC), National Research Centre, Egypt. All children were exposed to medical assessment, anthropometric evaluation, and a three 24-h dietary recall for assessment of micronutrient intake. Laboratory assessment of fasting serum blood glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein was done and IR was calculated. Results Obese children showed higher significant values than the control group regarding all anthropometric measurements with increased blood pressure, waist circumference, and waist-to-hip ratio. Laboratory assessment revealed elevated fasting levels of glucose and Homeostatic Model Assessment for Insulin Resistance denoting IR together with the presence of triglycerides and high-density lipoprotein levels within the high-risk range showing tendency toward dyslipidemia. The intake of vitamins A, D, folic acid, and calcium was lower than the recommended dietary allowances in both groups. Conclusion Obesity and its consequent complications, including dyslipidemia and IR together with decreased consumption of vitamins A, D, folic acid, and calcium, were the most prominent risk factors found among the studied sample of Egyptian children that can affect their immune response and predispose to increased severity of COVID-19 infection.

Background/aim Although both BMI and waist circumference (WC) estimate the level of fatness, WC may be more crucial because of its deep relationship to cardiovascular diseases. As WC is not ascertained regularly in clinical practice, this study intended to develop and substantiate an easy to use WC prognostic equation based on either BMI or body weight, appropriate for Egyptian women. Patients and methods A cross-sectional study included 505 Egyptian women, aged 20–60 years. Anthropometric measurements (body weight, height, and WC) were evaluated and BMI was estimated. A total of 329 women were used for construction of simplified prediction equations (learning sample) and another 176 women for assessing their legality (validation sample). Pearson’s correlation coefficient, the calibration slope, and R² for the regression of the measured WC versus the predicted WC were used to assess execution of the equations in the validation sample. Results There were insignificant differences between the two samples in the measurements and BMI classification. The preponderance of the two samples were suffering from obesity (84.5 vs. 79.5%) and overweight (11.9 vs. 17.0%), respectively. The following simple equations were obtained to predict WC of Egyptian women: WC=48.44+(1.471×BMI) or WC=57.53+(0.487×weight). There were insignificant differences in means±SD of the measured versus predicted WC among both samples. Conclusions These equations precisely estimate WC. It should be helpful for medical care practitioners and public health personnel who like to detect persons and populations at risk for cardiovascular disease when the WC data are unobtainable.

Background/aim Obesity and osteoporosis are progressive diseases with complex etiology. They constitute a major public health concern nowadays. This study aimed to assess the prevalence of osteoporosis, vitamin D profile, and its relation to obesity, bone markers, and leptin among a sample of Egyptian women indoor workers and employees at the National Research Centre. Patients and methods A cross-sectional study that included 116 Egyptian women aged 25–60 years. Anthropometric measurements (body weight, height, and BMI), dual-energy radiograph absorptiometry [bone mineral density (BMD) and its T score at both lumbar spines and neck of the femur], and laboratory investigations (leptin, calcium, vitamin D, and C-terminal peptide) were done for all participants. They were classified according to their BMI and BMD-T scores at lumbar spines and femur neck. Results Osteoporosis was diagnosed among 11.2, 25.2, and 6.8% of participants using the BMD-T score at lumbar spines, femur neck, and at the two sites respectively; osteopenia was diagnosed among 44.8, 51.3, and 25%, respectively. Osteoporosis was significantly more frequent among normal weight women than overweight/obese ones. Normal weight osteoporotic women had significantly higher values of vitamin D and C-terminal peptide, and lower values of leptin and BMI than the nonosteoporotic ones. Among osteoporotic women, BMI had a significant negative correlation with vitamin D. BMI had significant positive correlations with BMD at both lumbar spines and femur neck and their T scores among nonosteoporotic women and total sample. BMI had a significant positive correlation with the C-terminal peptide among the osteoporotic, nonosteoporotic, and total sample, with leptin and age among the osteoporotic and total sample. Conclusion BMI had a significant positive correlation with hypovitaminosis D, C-terminal peptide, leptin, and age. It had a significant positive correlation with BMD among nonosteoporotic women, but not among osteoporotic ones. Obesity protects from osteoporosis. Dual-energy radiograph absorptiometry at lumbar spines underestimate the diagnosis of osteoporosis and osteopenia.

Background/aim Chronic lung sepsis is one of the major causes of chronic respiratory symptoms such as chronic cough and pus formation. It has received very little attention over recent decades. In addition, failure of its characterization in immunocompromised patients such as diabetics has led to under-recognition and lack of early management. Patients and methods In this study, 61 patients with symptoms and signs of chronic lung disease were enrolled from Ahmed Maher Teaching Hospital in Egypt. Of them, 32 fulfilling the criteria of chronic lung sepsis were classified into two groups: diabetic (17 patients) and nondiabetic (15 patients). All of the patients were subjected to detailed medical history, thorough clinical examination, laboratory investigations, sputum culture and sensitivity, and high-resolution computed tomography of the chest. Results A total of 23 cases were diagnosed as bronchiectasis, four cases were diagnosed as lung abscess, two cases were pyopneumothorax, whereas there was one case each of infected cyst, empyema, and infected emphysematous bullous. Sputum culture showed that gram-negative organisms were more evident in the diabetic group. The management of cases of chronic lung sepsis showed the use of double or triple antimicrobial therapy in the diabetic group. Conclusion Targeting good control of pneumonia in patients with type II diabetes mellitus using double or triple antimicrobial therapy is essential to inhibit the progression of pulmonary infections to chronic lung sepsis.

Background/Aim Among Angle’s classification, skeletal class III is the most difficult to treat. Treatment using the TMA spring intraoral appliance was investigated in the late mixed dentition and showed desirable effects. The present work aimed to investigate, biomechanically, the TMA spring appliance in the early mixed-dentition stage with specifically outlined force direction, duration, and magnitude in order to provide solid results that can be relied upon clinically. Patients and methods The sample consisted of 20 patients with an age range 8–10 years and an average of 8.6 years. Lateral cephalograms were taken and analyzed before treatment (T1), posttreatment (T2), and postretention (T3). The patients were instructed to wear the TMA spring appliance 12–16 h/day for 9 months, followed by 6 months of retention. The appliance delivered a force of 400 g/per side as measured with the force gauge. Results Comparing T1–T2 and T1–T3, there was a significant difference between sexes in points U6/S perpendicular; P=0013 and P=0.0159, SNA (P=0.0122, P=0.0371), and ANB (P=0.0491) at T1–T2. There was a significant difference in the whole sample for all the skeletal, dental, and soft-tissue measurements; P value less than 0.05, regarding treatment and retention changes. Conclusions The TMA spring appliance enhanced the cooperation of the patients, resulted in forward movement and clockwise rotation of the maxilla. Mandibular clockwise rotation and dentoalveolar changes also contributed to the overall correction of class III.

Background/aim Assortment of denture-based materials and their various curing methods have a great impact on their physical and biological properties. However, esthetics is the most significant parameter in prosthodontics, which is highly deteriorated by water sorption, solubility, and porosity. Moreover, porosity has a great effect on both bacterial and fungus colonization on its surface. This study aimed to assess and compare some physical and biological properties of both heat-cured and microwave-cured acrylic denture-based resins. Patients and methods This study was divided into two parts, in vitro and in vivo parts. The heat-cured and microwave-cured acrylic resin materials were used. Both were utilized for specimens’ fabrication in different dimensions according to ADA specifications to assess their physical and biological criteria. Stereo light microscope aided in determining porosity, while both water sorption and solubility were calibrated by employing an electronic-balance device, besides a specific formula for every test individually. In addition, complete dentures were fabricated for 12 edentulous patients from both materials (n=6). Candida albicans colonization was assessed by employing both chromogenic candida agar and laboratory-incubator device. Results The microwave-cured acrylic denture resin exhibited the lower significant mean value than the conventional heat-cured one in water sorption, corrected water sorption and porosity tests as P value more than or equal to 0.05. Furthermore, it had a significant lower mean value in C. albicans colonization during all visits as P value less than 0.05. Conclusion The microwave-cured acrylic resin proved to be better as compared with conventional heat-cured denture resin a regarding porosity, water sorption, and solubility, and it had the least affinity to C. albicans colonization.

Background/aim Cap micro-movement may affect load transfer to the osseointegrated implant/bone interface, which in turn may affect the selection of attachment type to ensure the least amount of bone loss, fewer maintenance periods, and longer lifetime of the entire implant/attachment system. This study aimed to evaluate the cap micro-movement effect using various implant angulations on the selection of the best attachment system for each individual case. Materials and methods Six finite element models were prepared and were equally divided between locator attachment and ball attachment. Every three models simulate vertical implant and inclined implants by 10° and 20° of angulation, respectively. Meanwhile, frictional contact enabling cap micro-movement at the cap/attachment interface was implemented. Results Nonlinear static analysis results showed that implant and locator attachment body received very low stresses in comparison to the ball attachment. Nylon cap life expected to be longer in the case of 20° angulated implant with ball attachment, while all other cases indicated locator attachment superiority. Cortical bone received less stresses under locator attachment, while the gap in stress values in comparison to ball attachment will be reduced by increasing implant angulation. Conclusions Locator attachment seems to be more superior to ball attachment. However, increasing implant angulation up to 20° may result in showing a similar behavior with both attachment types.

Background/aim JSPH pH wireless capsule is a radio-telemetric capsule that attaches to the lower end of esophageal mucosa and measures pH and sends data to a wireless receiver. The aim of the study was to assess the clinical efficacy and safety of the JSPH pH wireless capsule in Kuwaiti patients with symptoms suggestive of gastroesophageal reflux disease (GERD). Patients and methods Patients with symptoms suggestive of GERD were included in the study. The JSPH-2 pH wireless capsule-recorded data were automatically analyzed by pH capsule data analyze software with pH tracings of day 1, day 2, and total 48-h test periods. Results A total of 63 patients from Jahra Hospital, Kuwait, were included in this study. A total of 43 (68.2%) patients had recorded parameters suggestive of GERD, whereas 20 (31.8%) patients were defined as non-GERD. On comparison of different recorded parameters suggestive of GERD between day 1 and day 2, the number of refluxes (P=0.048), total fraction time pH less than 4 (P=0.042), meal fraction time pH less than 4 (P=0.047), and DeMeester score (P=0.047) were statistically significant on day 1. On day 2, only five (11.6%) patients with GERD had been identified with abnormal pH data, whereas nine (20.9%) patients had been identified with an abnormal DeMeester score. A total of 14 (22.2%) patients reported mild to moderate disturbance of normal daily activities, diet, and sleeping during the monitoring period. A total of 32 (57.1%) patients experienced foreign body sensation, 15 (23.8%) showed chest discomfort, and seven (11.1%) had nausea. Conclusion The JSPH pH monitoring system is safe and well tolerated and can be used in clinical practice for diagnosis and monitoring of patients with GERD.

Background/aim While interleukin (IL)-35 has been identified as a novel immunosuppressive and anti-inflammatory cytokine, IL-27 has both inflammatory and anti-inflammatory functions. Allergen-specific immunotherapy is the most excellent form for custom-tailored treatment of allergic diseases. The aim of this study is to determine the role of IL-35 and IL-27 and the protective role of allergen-specific immunotherapy in allergic conjunctivitis alone or associated with other allergies. Patients and methods The present study enrolled 30 patients who were referred to the Allergy Lab, at the Research Institute of Ophthalmology, Giza, Cairo, Egypt. Patients were divided into two groups (15 each); patients complaining of allergic conjunctivitis alone (group 1) and patients who were suffering from allergic conjunctivitis associated with allergic rhinitis and/or allergic bronchitis (group 2). In addition, 15 healthy individuals served as a control group (group 3). Allergen SIT was prepared from natural allergenic extracts from some different crude materials causing allergy, such as pollens, animal hairs, house dust, molds, nicotine, and feathers. Group 1 was treated with local conjunctival immunotherapy as eye drops, while group 2 was treated with subcutaneous immunotherapy for 36 months. Serum levels of IL-35 and IL-27 were measured using the enzyme-linked immunoassay technique before and after immunotherapy. Results The present results showed significant decreases in serum levels of IL-35 and IL-27 (146.4 and 13.2 pg/ml, respectively) in all 30 allergic patients before immunotherapy than controls (235.0 and 50.4 pg/ml). However, IL-35 and IL-27 showed a significant increase (478.8 and 42.6 pg/ml, respectively) in all patients after receiving their immunotherapy either as eye drops or as subcutaneous injections when compared before starting immunotherapy. Moreover, insignificant changes were obtained between local and subcutaneous immunotherapy in the level of IL-35, while IL-27 showed a significant increase (P<0.05) in the subcutaneous group than the eye drops group. The present results showed a positive excellent correlation between IL-35 and IL-27 after immunotherapy (r=0.709, P<0.001), while no correlation before immunotherapy (r=0.334, P=0.063). Conclusions Allergic diseases are associated with significant lowered serum levels of IL-35 and IL-27. Allergen-specific immunotherapy significantly increases serum levels of IL-35 and IL-27 confirming the role of IL-35 and IL-27 in allergic diseases and proved that allergen-specific immunotherapy increases their induction.

Background/aim Sufficient levels of vitamins in the periconceptual period are important for embryonic and fetal development. It is well known that periconceptual folic acid supplementation prevents neural tube defects; however, evidence suggests that periconceptual supplement uptake is suboptimal. The aim of the study was to investigate the uptake of periconceptual supplements in women. The secondary aims were to characterize preconceptual supplement users by age, parity, level of education, ethnicity, first language, and presence of chronic health problems and to identify types of supplements used. Patients and methods This was a descriptive cross-sectional survey. A total of 180 women aged 16 years or older in their first trimester of pregnancy attending for their dating scan in Birmingham, UK. Percentages and 95% confidence intervals (CIs) of periconceptual supplement users were calculated. Statistical tests were carried out to examine the association of age, ethnicity, first language, parity, level of education, and presence of chronic health problems with preconceptual supplement use. Information about types of supplements used was also gathered. Results Supplements were taken preconceptually by 39.0% (95% CI: 32.1–46.2) of participants. However, 11.5% started using supplements in the first trimester of pregnancy, and 89 (49.4%, 95% CI: 42.2 to 56.7) participants had not used any supplements. Disparities in the use of preconceptual supplements were seen across a range of characteristics, although none of the differences were statistically significant. Conclusion Despite recommendations, periconceptual supplement uptake remains suboptimal. Strategies to improve supplement uptake might include active participation from primary health care professionals targeting all women of reproductive age, education campaigns, and population-based food folic acid fortification.

Background/aim Knee osteoarthritis is a common degenerative disease affecting the joint, causing progressive loss of cartilage and inflammation. Its main symptoms are pain and stiffness. Medications such as NSAIDs have little benefit and are usually accompanied by serious adverse effects. The aim of this study was to evaluate the efficiency of laser acupuncture in the management of stage 2 or 3 knee osteoarthritis. Patients and methods The study was carried out on 30 patients (24 females and six males) diagnosed as having stage 2 or 3 knee osteoarthritis. The patients were recruited from the Complementary and Alternative Medicine Clinic at the Medical Centre of Excellence, National Research Centre, Cairo, Egypt. The patients were subjected to low-power laser (gallium-aluminum-arsenide 905 nm) with touch sensor guide light, power output of 100 mill watts, beam area of 1 cm², 1-min irradiation time, frequency 10 000 Hz, duty cycle 100%, total energy per point 6 J, energy density 6 J/cm², and irradiance 0.1 W/cm², for 3 days/week for a duration of 4 weeks (12 session), directed at various acupuncture points (ST 35, ST 36, Sp 9, Sp 10, GB 34, Sp 6, and liv3). Clinical and laboratory parameters were assessed before and after laser therapy. Results Pain on visual analog scale, number of tender points, tenderness score, angle of knee flexion, heel to hip distance, Western Ontario McMaster Universities Osteoarthritis Index scale score, and Lequesne Index showed significant improvement after treatment (P<0.05). Timed up and go test result was decreased after laser sessions, but its improvement was insignificant statistically. Significant improvement and increase of enkephalin and immunoglobulin (IL-4) were recorded after treatment. Conclusion Laser acupuncture showed efficacy in the management of stage 2 or 3 knee osteoarthritis.

Migraine is a chronic neurological condition that places a huge burden on patients and the society. Frequent headaches affect patients’ quality of life and interfere with their daily activities. Evidence suggests that migraine with aura can be associated with increased risk of having a stroke and other neurological complications; therefore, patients with migraine presenting with atypical symptoms present a complex medical challenge that would need further assessment in a hospital to exclude neurological conditions such as stroke or transient ischemic attack. We describe a case of a man who was evaluated at South Tees University Hospital, UK, and known to have chronic migraine with aura for 10 years. He presented to his general practitioner with new transient neurological symptoms and a different type of headache. This case reflects the level of diagnostic complexity and symptom overlap in patients presenting with atypical migraine, transient ischemic attack, and stroke.