Breast cancer with cartilaginous and/or osseous metaplasia is considered a rare disease, but seve... more Breast cancer with cartilaginous and/or osseous metaplasia is considered a rare disease, but several cases have been reported recently. We report a case of breast cancer with cartilaginous and/or osseous metaplasia that was Stage IV, (T4bNOMlb (PUL)), on the basis of the Japanese General Rules for Clinical and Pathological Recording of Breast Cancer, which responded well to chemotherapy. A 58-year-old women visited our hospital with a chief complaint of a palpable breast mass that had increased in size in March 2002. It was 20 • 15 x 14 cm and occupied the entire fight breast. Chest computed tomography (CT) demonstrated multiple lung metastases. Histology of the biopsy specimens revealed a spindleshaped cell carcinoma. It was ER (-), PgR (-), and HER2/neu Score 0. CAF was given to the patient as preoperative chemotherapy. Five cycles of treatment yielded improvement at the primary site and improvement of the metastatic lung lesions, which was judged as a partial response. Subsequently, one cycle of weekly paclitaxel 80 mg/m 2 and oral administration of 5'-DFUR 800 mg/day were given. In November 2002, the patient underwent a fight simple mastectomy with whole-layer skin grafting from the abdomen. The final pathological diagnosis was a rare type of breast cancer with cartilaginous and/or osseous metaplasia. Preoperative chemotherapy had caused necrosis in most of the tumor cells, and the efficacy was judged as Grade 2. From the third week postoperatively, weekly paclitaxel (80 mg/m 2) was given. Six months after the operation, the multiple lung metastases were completely eliminated and new metastasis to liver or bone or local recurrence have not been observed.
Background: Osteoarthritis (OA); the most common joint disease, is not only characterized by cart... more Background: Osteoarthritis (OA); the most common joint disease, is not only characterized by cartilage destruction; but also by alteration of bone and synovial tissue metabolism, though their relative importance in the initiation and progression of OA is still debated. To identify patients with a high risk for destructive OA, more sensitive techniques than plain X-rays are needed. Aim of the work: To study the diagnostic and prognostic value of some biochemical markers serum hyaluronic acid (HA) and serum cartilage oligomeric matrix protein (COMP), high sensitive C-reactive protein (hs-CRP) in the included patients had early OA knees and their relation to disease progression. Patients and methods: Sixty patients had early knee OA and 20 control subjects were included. WOMAC index, laboratory investigations (COMP, HA, hs-CRP) and radiological evaluation (Kellgren and Lawrence grading scale and Thomas compartmental score) were performed for each patient at baseline and after one year. Results: HA was significantly higher in patients than controls (p > 0.001) with the highest specificity and positive predictive value. It was significantly correlated with COMP at baseline and after one year (p = 0.01). The levels of HA at baseline correlated with its levels after one year (p > 0.001). It also correlated with K-L grading score (p = 0.02). COMP was significantly higher in patients than controls (p > 0.001).
Aim of the work: To determine sonographic features suggestive of amyloidosis in hemodialysis pati... more Aim of the work: To determine sonographic features suggestive of amyloidosis in hemodialysis patients complaining of shoulder pain, and to study their relations to serum beta2-microglobulin (b2M). Patients and methods: Clinical examination, skeletal survey, musculoskeletal ultrasonography of the shoulder joints, and serum b2M were done for 32 patients with end stage renal disease, who were regular on hemodialysis. Results: Serum b2M levels were markedly raised in all patients, and increased with increasing duration of dialysis (r = 0.91, p < 0.001). Twenty-five patients had a non homogeneous thickening of the supraspinatus tendon >7 mm, and thickening of the biceps tendon >4 mm, 30 had synovial deposits, 27 had subdeltoid bursa effusion, 25 had thickened subacromial bursa, 7 had supraspinatus tendon tear, and 17 had bony erosions. Serum b2M levels significantly correlated with thickened supraspinatus tendon (>7 mm) and supraspinatus tendon tear (r = 0.41, p = 0.03 and r = 0.42, p = 0.01 respectively). Long time on hemodialysis was the significant independent determinant for supraspinatus tendon tear and humeral head erosions (p = 0.001 for each). Conclusion: Elevated serum b2M levels and sonographic features suggestive of dialysis-related amyloidosis (DRA) were found in all hemodialyzed patients complaining of shoulder pain either with or without clinical and/or radiological features suggestive of DRA. So, for diagnosis of DRA, sonographic features should correspond to the presence of clinically or radiologically evident b2M amyloid, and we should exclude other causes of non-amyloid changes. Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Rheumatic Diseases.
Abstract Aim of the work To evaluate serum levels of vitamin D in ankylosing spondylitis (AS) pat... more Abstract Aim of the work To evaluate serum levels of vitamin D in ankylosing spondylitis (AS) patients in relation to bone mineral density, bone metabolism, and disease activity, functional status, spine mobility and extent of enthesitis. Patients and methods Sixty AS patients and 60 controls were included. Bath AS disease activity index (BASDAI), functional index (BASFI), metrology index (BASMI), AS disease activity score (ASDAS), and Maastricht AS enthesitis score (MASES) were assessed. Serum levels of vitamin D3, carboxy-terminal telopeptide of type-I collagen (CTX-1), alkaline phosphatase (ALP) and bone alkaline phosphatase (bALP) were measured. Dual-energy X-ray absorptiometry (DXA) was assessed. Results Patients mean age was 31.7 ± 9.1 years, disease duration 7.8 ± 4.4 years and were 46 males and 14 females. The mean BASDAI was 3.9 ± 1.02, ASDAS 2.7 ± 0.98, BASFI 3.6 ± 2.1, BASMI 4.5 ± 1.6 and MASES 4.4 ± 3.2. Patients had significantly (p = 0.001) lower levels of vitamin D (13 ± 7.8 vs 29.9 ± 9.5 ng/mL) and higher CTX-1 (547.5 ± 130.1 vs 230.1 ± 34.9 pg/mL), ALP (195.8 ± 100.8 vs 120.8 ± 10 IU/L) and bALP (48.4 ± 7.3 vs 21.03 ± 3.2 IU/L) compared to controls. Vitamin D significantly correlated with BMD (p = 0.04), inversely with CTX-1 (r = −0.22,p Conclusion Serum vitamin D levels were decreased in patients with AS and were more deficient in relation to disease activity and bone turnover. Vitamin D may play a role in the pathogenesis and progression of AS in Egyptian patients which should be more comprehensively investigated.
A s per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM)... more A s per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM) has increased from 6.45 to 7.5% in children under 5 years of age in India [1]. Malnutrition is believed to contribute 61% of diarrheal deaths and 53% of pneumonia deaths in India [2]. Electrolyte imbalance is one of the prognostic factors in severe malnutrition [3]. In malnourished children, excess body sodium and chloride exists (although plasma sodium and chloride may be low) and deficiency of potassium and magnesium exists which require supplementation over weeks [3,4]. Children with SAM are categorized into "complicated and uncomplicated cases" based on clinical criteria. SAM children with complications require inpatient management and those without complications can be treated on a community basis. World Health Organization (WHO) states this as a strong recommendation with low-quality evidence [5] As per the WHO, serum electrolytes are measured and supplemented (potassium and magnesium) only in SAM children with complications. SAM children without complications are managed in community with Ready to Use Therapeutic Food (RUTF) which is enriched with minerals and micronutrients [6]. In our country, as RUTF is not available, children are advised home-based energy dense food along with micronutrient supplements. Hence, their diet may still be deficient in minerals. Hence, we wanted to know the serum electrolytes in SAM children without complications so that those with electrolyte disturbance can be referred for inpatient care or supplemented with suitable electrolytes when treated on a community basis. MATERIALS AND METHODS This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. After obtaining Institutional Ethical Clearance and informed parental consent, children between the ages of 1 month and 5 years who met the WHO criteria for SAM were included in the study. The WHO criteria for SAM include any one of the following: Weight for height <−3 standard deviation, visible severe wasting, bilateral pitting pedal edema, and mid-upper arm circumference <11.5 cm (in children >6 months age). Children with SAM were categorized into: Group 1-SAM children with any of these complications [5,6] Presence of any emergency signs, edema, persistent vomiting, very weak, apathetic, fever (axillary temperature >38.5°C), fast breathing, chest in drawing, cyanosis, extensive skin lesions, eye lesions, post-measles states, diarrhea with dehydration based on history and clinical signs, severe anemia, purpura or bleeding ABSTRACT Objective: Children with severe acute malnutrition (SAM) are categorized into "complicated and uncomplicated cases" based on clinical criteria alone. Electrolyte imbalance is one of the prognostic factors in severe malnutrition. We aimed to study serum electrolytes in complicated and uncomplicated SAM children. Methods: This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. Children between the ages of 1 month and 5 years who met the World Health Organization criteria for SAM were included in the study. Serum electrolytes were estimated with an automated analyzer by ion selective electrode method. Results: Among 113 SAM children included, 71 had complications and 42 were without complications. The mean value of serum sodium was 134.58±5.45 meq/L, potassium was 4.29±0.75 meq/L, and chloride was 103.31±7.16 meq/L. Hyponatremia was seen in 43.4% and hypokalemia in 7.1% of children. There was no statistically significant difference in the mean values of serum electrolytes and frequency of hyponatremia and hypokalemia between groups. Conclusion: Dyselectrolytemia occurs in SAM children with and without complications. Serum electrolyte levels may need to be measured in all SAM cases to detect asymptomatic hyponatremia and hypokalemia. This will help in triaging those with asymptomatic hyponatremia and hypokalemia to inpatient care.
The present study seeks to investigate the changes in the elemental composition of pigments due t... more The present study seeks to investigate the changes in the elemental composition of pigments due to consolidation. Therefore, the effect of the consolidation of hydroxypropyl cellulose (Klucel G) of different concentrations and its mixture with zinc oxide (ZnO) nanoparticles on the black, red, and ochre pigments applied on chalk-based preparation layers before and after aging were studied. Additionally, the role of ZnO nanoparticles in protecting the pigments after UV aging has been examined. The color change due to consolidation solutions was measured by the spectrophotometer, scanning electron microscopy with energy dispersive X-ray (SEM–EDX), and laser-induced breakdown spectroscopy (LIBS). Interestingly, the results revealed that all the painted samples treated with Klucel G (1%) and nano-ZnO (1%), as additives, showed the least color change values. Moreover, SEM–EDX and LIBS analyses prove the ability of ZnO nanoparticles to enhance the durability of consolidants and coatings toward aging.
Bulletin of Egyptian Society for Physiological Sciences, 2012
Objective: The present study was designed to evaluate the possible association of three different... more Objective: The present study was designed to evaluate the possible association of three different HSP70; HSPA1A, HSPA1B and HSPA1L; gene polymorphisms with pre-eclampsia and the possible correlation with serum levels of HSP70. Method: The study included 46 women with pre-eclampsia as group I (GI) and twenty two normotensive pregnant controls representing group II (GII). All candidates of the study were subjected to the following: Measurement of human HSP70 concentrations in serum, molecular analysis for PCR amplification of the HSPA1A G (190)C regions, HSPA1B A(1267)G regions, HSPA1L T(2437)C regions. Results: Serum HSP70 was found to be significantly increased in pre-eclamptic patients when compared to normal pregnancy. HSPA1A (190) GC and HSPA1B (1267) GG genotypes occurred more frequently in pre-eclamptic patients compared to healthy controls (p < 0.03). Significant difference was found in the distribution of HSPA1B (1267) AG genotype between the pre-eclamptic and control group (p < 0.004). Distribution of HSPA1L T(2437)C gene was found similar in the Pre-eclamptic and control group. Cases with HSPA1A G(190)C had a mean serum level of HSP70 that is 1.4 ng/ml more than those without HSPA1A G(190)C polymorphism. A significant negative association was noted between maternal age and serum Hsp70 concentration in both preeclampsia and healthy pregnant women. Conclusion: Elevated serum HSP70 level in pre-eclamptic patients seems to reflect the burden of oxidative stress taking place im pre-eclampsia. HSP70 polymorphism may affect the serum level as proved by increase in the mean serum level of HSP70 by 1.4 ng/ml in those with HSPA1A G(190)C polymorphism .
providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and po... more providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and posterior ocular structures. Objectives: To evaluate the retina and choroidal vascular structures in axSpA patients by using the advantage of OCT and to compare the changes (if any) with healthy control subjects. Methods: In total 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic-and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects were included in the analysis. All patients underwent a detailed ophtalmalogic examination by the same opthtalmologist. All individuals with significant refractive errors (>3 diopters of spherical equivalent refraction) and intraocular pressure !21 mmHg were excluded from the analysis. Choroidal thicknes (ChT), macula, and the ganglion cell complex (GCC) were measured by spectral domain optic coherence tomography (SD-OCT) by the same experienced operator. Results: Mean (± SD) BASDAI score was 3.6 ± 2.5, BASFI score was 3.4 ± 2.9, ASDAS-CRP was 2.6 ± 1.3 in axSpA patients and 14% of them has a history of AAU and 61% ever treated with TNFi agents. There was no significant difference between groups regarding refractive error (P=0.640), intraocular pressure (P=0.815) and BMI (P=0.124) that could affect the OCT measurements. ChT (P<0.001) were increased and GCC thickness (P<0.001) were decreased in axSpA patients however both layer thicknesses were similar between r-and nr-axSpA patients (P=780 and P=0.677) (Table). History of uveitis was not associated with ChT and GCC. Although GCC was further decreased in TNFi treated patients (105.8 vs 113.3) this difference did not reach significance (P=0.058). Education level was associated both ChT and GCC measurement. GCC thickness was also releted with BMI and sex in univarite analysis. Other disease related characteristics including the ones related with disease activity were not related with posterior segment measurements. Conclusion: Our results showed that beside anterior segment inflammation, posterior segment of the eye could be affected in both r-and nr-axSpA patients. Retina and choroidal vascular network forms the posterior segment of the eye. The thinning of GCC which form the inner neural layer of the retina is a good indicative of micro-neurotoxicity in axSpA. Elevation of the ChT may be an important indicator of inflammation.
providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and po... more providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and posterior ocular structures. Objectives: To evaluate the retina and choroidal vascular structures in axSpA patients by using the advantage of OCT and to compare the changes (if any) with healthy control subjects. Methods: In total 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic-and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects were included in the analysis. All patients underwent a detailed ophtalmalogic examination by the same opthtalmologist. All individuals with significant refractive errors (>3 diopters of spherical equivalent refraction) and intraocular pressure !21 mmHg were excluded from the analysis. Choroidal thicknes (ChT), macula, and the ganglion cell complex (GCC) were measured by spectral domain optic coherence tomography (SD-OCT) by the same experienced operator. Results: Mean (± SD) BASDAI score was 3.6 ± 2.5, BASFI score was 3.4 ± 2.9, ASDAS-CRP was 2.6 ± 1.3 in axSpA patients and 14% of them has a history of AAU and 61% ever treated with TNFi agents. There was no significant difference between groups regarding refractive error (P=0.640), intraocular pressure (P=0.815) and BMI (P=0.124) that could affect the OCT measurements. ChT (P<0.001) were increased and GCC thickness (P<0.001) were decreased in axSpA patients however both layer thicknesses were similar between r-and nr-axSpA patients (P=780 and P=0.677) (Table). History of uveitis was not associated with ChT and GCC. Although GCC was further decreased in TNFi treated patients (105.8 vs 113.3) this difference did not reach significance (P=0.058). Education level was associated both ChT and GCC measurement. GCC thickness was also releted with BMI and sex in univarite analysis. Other disease related characteristics including the ones related with disease activity were not related with posterior segment measurements. Conclusion: Our results showed that beside anterior segment inflammation, posterior segment of the eye could be affected in both r-and nr-axSpA patients. Retina and choroidal vascular network forms the posterior segment of the eye. The thinning of GCC which form the inner neural layer of the retina is a good indicative of micro-neurotoxicity in axSpA. Elevation of the ChT may be an important indicator of inflammation.
Background: Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMA... more Background: Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMARDs). It can be used as a monotherapy or in combination with other DMARDs to inhibit the production of inflammatory cells and accordingly reduce inflammation. Objectives: CLEAR is a multi-centric study that aims to assess the clinical efficacy and safety of leflunomide as first-line and/or add-on therapy to other DMARDs with or without steroids in Egyptian patients with active Rheumatoid Arthritis (RA). Methods: Egyptian patients with active RA for whom leflunomide was prescribed at physicians’ discretion were observed for 12 weeks. Clinical Disease Activity Index (CDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score were acquired thrice during this period. This study was registered on clinicaltrials.gov (NCT03599986). Results: Interim analysis of the data collected from 337 patients (in 21 centers) showed a statistically significant decrease in the mean total...
Uludağ Üniversitesi Eğitim Fakültesi Dergisi, 2016
De nos jours, l'erreur qui était auparavant évaluée négativement est devenue un repère positif po... more De nos jours, l'erreur qui était auparavant évaluée négativement est devenue un repère positif pour les enseignants. Cette étude vise à proposer une solution à des erreurs fondamentales résultant de l'influence de la langue maternelle. Ce travail analyse 335 erreurs, dues à l'interférence de leur langue maternelle, le turc. L'échantillon se compose des phrases sélectionnées dans 180 devoirs des étudiants apprenant le français à l'université Atatürk dans le cours de l'expression écrite entre les années académiques 2000-2010. Tout en sachant qu'il y a de différents types de classification, on a choisi celle de Hurrydeo Beefun qui a classifié les erreurs telles que les erreurs lexicales/grammaticales, morphologiques et syntaxiques. On a observé que les erreurs lexicales/grammaticales sont celles qui sont répétées le plus souvent par les participants parmi les erreurs catégorisées selon l'étude analytique.
The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis w... more The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Participants and methods Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. Results In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P = 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). Conclusion MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis
A novel chloroindium(III) phthalocyanine network polymer (4) was prepared and characterized by en... more A novel chloroindium(III) phthalocyanine network polymer (4) was prepared and characterized by energy dispersive X-ray spectrometry, proton nuclear magnetic resonance, Fourier transform infrared spectroscopy, thermal gravimetric analysis (TGA) and absorption and emission spectroscopies. The non-linear optical (NLO) profile of the prepared phthalocyanine (Pc) network polymer, derived from a nanosecond open-aperture Z-scan technique at 532 nm, shows a clear reverse saturable absorption and a high non-linear absorption coefficient ( α2) of 9.7 × 10−7 cm W−1. Optical limiting investigations indicated that the prepared Pc network polymer has a relatively low limiting threshold of 900 mJ cm−2. According to these results, the prepared Pc polymer is a promising material for many NLO applications.
ABSTRACT A pulsed laser-assisted in liquid environment method has been developed successfully to ... more ABSTRACT A pulsed laser-assisted in liquid environment method has been developed successfully to synthesize size-tunable (5–12 nm) and different shapes (sphere, rod, rope) of nano II–VI semiconductor (cadmium sulfide). This method can be carried out in two ways; the first one is the top-down technique, which has been discussed in publications in the last few decades, and the other one is the bottom-up technique, which appears for the first time in this paper. X-ray diffraction, ultraviolet-visible spectroscopy, and transmission electron microscopy confirm that the nanoparticles are crystalline. The methods lead to the production of nanomaterials, which are important for photonics and biosensing applications. Both synthesized methods can be applied in all materials because of their ability to ablate almost all kinds of materials due to the ultrahigh energy density and control over the growth process by manipulating the process parameters such as intensity, wavelength, and so on.
The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloart... more The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis. Patients and methods A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups-axial subgroup (19 patients) and peripheral subgroup (11 patients)-and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography. Results A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score. Conclusion Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients.
Polyvinyl butyral (PVB) was prepared by condensation reaction of butyral with polyvinyl alcohol (... more Polyvinyl butyral (PVB) was prepared by condensation reaction of butyral with polyvinyl alcohol (PVA) in aqueous phase containing an acid as a catalyst and an emulsifying agent. Properties of the polymer were a function of the relative amounts of the three randomly distributed units of acetal, acetate and vinyl alcohol groups, and the molecular weight. In this work, some effective factors in synthesis of PVB have been investigated by Taguchi method. The percent of the acetalization has been determined according to the ASTM D1396, and the polymer was characterized by IR, TG, and DTG techniques. V
Objective: To investigate the effect of different types and methods of delivery of hormone replac... more Objective: To investigate the effect of different types and methods of delivery of hormone replacement therapy (HRT) on peripheral vascular flow velocity in postmenopausal women.
Breast cancer with cartilaginous and/or osseous metaplasia is considered a rare disease, but seve... more Breast cancer with cartilaginous and/or osseous metaplasia is considered a rare disease, but several cases have been reported recently. We report a case of breast cancer with cartilaginous and/or osseous metaplasia that was Stage IV, (T4bNOMlb (PUL)), on the basis of the Japanese General Rules for Clinical and Pathological Recording of Breast Cancer, which responded well to chemotherapy. A 58-year-old women visited our hospital with a chief complaint of a palpable breast mass that had increased in size in March 2002. It was 20 • 15 x 14 cm and occupied the entire fight breast. Chest computed tomography (CT) demonstrated multiple lung metastases. Histology of the biopsy specimens revealed a spindleshaped cell carcinoma. It was ER (-), PgR (-), and HER2/neu Score 0. CAF was given to the patient as preoperative chemotherapy. Five cycles of treatment yielded improvement at the primary site and improvement of the metastatic lung lesions, which was judged as a partial response. Subsequently, one cycle of weekly paclitaxel 80 mg/m 2 and oral administration of 5'-DFUR 800 mg/day were given. In November 2002, the patient underwent a fight simple mastectomy with whole-layer skin grafting from the abdomen. The final pathological diagnosis was a rare type of breast cancer with cartilaginous and/or osseous metaplasia. Preoperative chemotherapy had caused necrosis in most of the tumor cells, and the efficacy was judged as Grade 2. From the third week postoperatively, weekly paclitaxel (80 mg/m 2) was given. Six months after the operation, the multiple lung metastases were completely eliminated and new metastasis to liver or bone or local recurrence have not been observed.
Background: Osteoarthritis (OA); the most common joint disease, is not only characterized by cart... more Background: Osteoarthritis (OA); the most common joint disease, is not only characterized by cartilage destruction; but also by alteration of bone and synovial tissue metabolism, though their relative importance in the initiation and progression of OA is still debated. To identify patients with a high risk for destructive OA, more sensitive techniques than plain X-rays are needed. Aim of the work: To study the diagnostic and prognostic value of some biochemical markers serum hyaluronic acid (HA) and serum cartilage oligomeric matrix protein (COMP), high sensitive C-reactive protein (hs-CRP) in the included patients had early OA knees and their relation to disease progression. Patients and methods: Sixty patients had early knee OA and 20 control subjects were included. WOMAC index, laboratory investigations (COMP, HA, hs-CRP) and radiological evaluation (Kellgren and Lawrence grading scale and Thomas compartmental score) were performed for each patient at baseline and after one year. Results: HA was significantly higher in patients than controls (p > 0.001) with the highest specificity and positive predictive value. It was significantly correlated with COMP at baseline and after one year (p = 0.01). The levels of HA at baseline correlated with its levels after one year (p > 0.001). It also correlated with K-L grading score (p = 0.02). COMP was significantly higher in patients than controls (p > 0.001).
Aim of the work: To determine sonographic features suggestive of amyloidosis in hemodialysis pati... more Aim of the work: To determine sonographic features suggestive of amyloidosis in hemodialysis patients complaining of shoulder pain, and to study their relations to serum beta2-microglobulin (b2M). Patients and methods: Clinical examination, skeletal survey, musculoskeletal ultrasonography of the shoulder joints, and serum b2M were done for 32 patients with end stage renal disease, who were regular on hemodialysis. Results: Serum b2M levels were markedly raised in all patients, and increased with increasing duration of dialysis (r = 0.91, p < 0.001). Twenty-five patients had a non homogeneous thickening of the supraspinatus tendon >7 mm, and thickening of the biceps tendon >4 mm, 30 had synovial deposits, 27 had subdeltoid bursa effusion, 25 had thickened subacromial bursa, 7 had supraspinatus tendon tear, and 17 had bony erosions. Serum b2M levels significantly correlated with thickened supraspinatus tendon (>7 mm) and supraspinatus tendon tear (r = 0.41, p = 0.03 and r = 0.42, p = 0.01 respectively). Long time on hemodialysis was the significant independent determinant for supraspinatus tendon tear and humeral head erosions (p = 0.001 for each). Conclusion: Elevated serum b2M levels and sonographic features suggestive of dialysis-related amyloidosis (DRA) were found in all hemodialyzed patients complaining of shoulder pain either with or without clinical and/or radiological features suggestive of DRA. So, for diagnosis of DRA, sonographic features should correspond to the presence of clinically or radiologically evident b2M amyloid, and we should exclude other causes of non-amyloid changes. Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Rheumatic Diseases.
Abstract Aim of the work To evaluate serum levels of vitamin D in ankylosing spondylitis (AS) pat... more Abstract Aim of the work To evaluate serum levels of vitamin D in ankylosing spondylitis (AS) patients in relation to bone mineral density, bone metabolism, and disease activity, functional status, spine mobility and extent of enthesitis. Patients and methods Sixty AS patients and 60 controls were included. Bath AS disease activity index (BASDAI), functional index (BASFI), metrology index (BASMI), AS disease activity score (ASDAS), and Maastricht AS enthesitis score (MASES) were assessed. Serum levels of vitamin D3, carboxy-terminal telopeptide of type-I collagen (CTX-1), alkaline phosphatase (ALP) and bone alkaline phosphatase (bALP) were measured. Dual-energy X-ray absorptiometry (DXA) was assessed. Results Patients mean age was 31.7 ± 9.1 years, disease duration 7.8 ± 4.4 years and were 46 males and 14 females. The mean BASDAI was 3.9 ± 1.02, ASDAS 2.7 ± 0.98, BASFI 3.6 ± 2.1, BASMI 4.5 ± 1.6 and MASES 4.4 ± 3.2. Patients had significantly (p = 0.001) lower levels of vitamin D (13 ± 7.8 vs 29.9 ± 9.5 ng/mL) and higher CTX-1 (547.5 ± 130.1 vs 230.1 ± 34.9 pg/mL), ALP (195.8 ± 100.8 vs 120.8 ± 10 IU/L) and bALP (48.4 ± 7.3 vs 21.03 ± 3.2 IU/L) compared to controls. Vitamin D significantly correlated with BMD (p = 0.04), inversely with CTX-1 (r = −0.22,p Conclusion Serum vitamin D levels were decreased in patients with AS and were more deficient in relation to disease activity and bone turnover. Vitamin D may play a role in the pathogenesis and progression of AS in Egyptian patients which should be more comprehensively investigated.
A s per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM)... more A s per National Family Health Survey (NFHS)-4, the prevalence of severe acute malnutrition (SAM) has increased from 6.45 to 7.5% in children under 5 years of age in India [1]. Malnutrition is believed to contribute 61% of diarrheal deaths and 53% of pneumonia deaths in India [2]. Electrolyte imbalance is one of the prognostic factors in severe malnutrition [3]. In malnourished children, excess body sodium and chloride exists (although plasma sodium and chloride may be low) and deficiency of potassium and magnesium exists which require supplementation over weeks [3,4]. Children with SAM are categorized into "complicated and uncomplicated cases" based on clinical criteria. SAM children with complications require inpatient management and those without complications can be treated on a community basis. World Health Organization (WHO) states this as a strong recommendation with low-quality evidence [5] As per the WHO, serum electrolytes are measured and supplemented (potassium and magnesium) only in SAM children with complications. SAM children without complications are managed in community with Ready to Use Therapeutic Food (RUTF) which is enriched with minerals and micronutrients [6]. In our country, as RUTF is not available, children are advised home-based energy dense food along with micronutrient supplements. Hence, their diet may still be deficient in minerals. Hence, we wanted to know the serum electrolytes in SAM children without complications so that those with electrolyte disturbance can be referred for inpatient care or supplemented with suitable electrolytes when treated on a community basis. MATERIALS AND METHODS This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. After obtaining Institutional Ethical Clearance and informed parental consent, children between the ages of 1 month and 5 years who met the WHO criteria for SAM were included in the study. The WHO criteria for SAM include any one of the following: Weight for height <−3 standard deviation, visible severe wasting, bilateral pitting pedal edema, and mid-upper arm circumference <11.5 cm (in children >6 months age). Children with SAM were categorized into: Group 1-SAM children with any of these complications [5,6] Presence of any emergency signs, edema, persistent vomiting, very weak, apathetic, fever (axillary temperature >38.5°C), fast breathing, chest in drawing, cyanosis, extensive skin lesions, eye lesions, post-measles states, diarrhea with dehydration based on history and clinical signs, severe anemia, purpura or bleeding ABSTRACT Objective: Children with severe acute malnutrition (SAM) are categorized into "complicated and uncomplicated cases" based on clinical criteria alone. Electrolyte imbalance is one of the prognostic factors in severe malnutrition. We aimed to study serum electrolytes in complicated and uncomplicated SAM children. Methods: This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. Children between the ages of 1 month and 5 years who met the World Health Organization criteria for SAM were included in the study. Serum electrolytes were estimated with an automated analyzer by ion selective electrode method. Results: Among 113 SAM children included, 71 had complications and 42 were without complications. The mean value of serum sodium was 134.58±5.45 meq/L, potassium was 4.29±0.75 meq/L, and chloride was 103.31±7.16 meq/L. Hyponatremia was seen in 43.4% and hypokalemia in 7.1% of children. There was no statistically significant difference in the mean values of serum electrolytes and frequency of hyponatremia and hypokalemia between groups. Conclusion: Dyselectrolytemia occurs in SAM children with and without complications. Serum electrolyte levels may need to be measured in all SAM cases to detect asymptomatic hyponatremia and hypokalemia. This will help in triaging those with asymptomatic hyponatremia and hypokalemia to inpatient care.
The present study seeks to investigate the changes in the elemental composition of pigments due t... more The present study seeks to investigate the changes in the elemental composition of pigments due to consolidation. Therefore, the effect of the consolidation of hydroxypropyl cellulose (Klucel G) of different concentrations and its mixture with zinc oxide (ZnO) nanoparticles on the black, red, and ochre pigments applied on chalk-based preparation layers before and after aging were studied. Additionally, the role of ZnO nanoparticles in protecting the pigments after UV aging has been examined. The color change due to consolidation solutions was measured by the spectrophotometer, scanning electron microscopy with energy dispersive X-ray (SEM–EDX), and laser-induced breakdown spectroscopy (LIBS). Interestingly, the results revealed that all the painted samples treated with Klucel G (1%) and nano-ZnO (1%), as additives, showed the least color change values. Moreover, SEM–EDX and LIBS analyses prove the ability of ZnO nanoparticles to enhance the durability of consolidants and coatings toward aging.
Bulletin of Egyptian Society for Physiological Sciences, 2012
Objective: The present study was designed to evaluate the possible association of three different... more Objective: The present study was designed to evaluate the possible association of three different HSP70; HSPA1A, HSPA1B and HSPA1L; gene polymorphisms with pre-eclampsia and the possible correlation with serum levels of HSP70. Method: The study included 46 women with pre-eclampsia as group I (GI) and twenty two normotensive pregnant controls representing group II (GII). All candidates of the study were subjected to the following: Measurement of human HSP70 concentrations in serum, molecular analysis for PCR amplification of the HSPA1A G (190)C regions, HSPA1B A(1267)G regions, HSPA1L T(2437)C regions. Results: Serum HSP70 was found to be significantly increased in pre-eclamptic patients when compared to normal pregnancy. HSPA1A (190) GC and HSPA1B (1267) GG genotypes occurred more frequently in pre-eclamptic patients compared to healthy controls (p < 0.03). Significant difference was found in the distribution of HSPA1B (1267) AG genotype between the pre-eclamptic and control group (p < 0.004). Distribution of HSPA1L T(2437)C gene was found similar in the Pre-eclamptic and control group. Cases with HSPA1A G(190)C had a mean serum level of HSP70 that is 1.4 ng/ml more than those without HSPA1A G(190)C polymorphism. A significant negative association was noted between maternal age and serum Hsp70 concentration in both preeclampsia and healthy pregnant women. Conclusion: Elevated serum HSP70 level in pre-eclamptic patients seems to reflect the burden of oxidative stress taking place im pre-eclampsia. HSP70 polymorphism may affect the serum level as proved by increase in the mean serum level of HSP70 by 1.4 ng/ml in those with HSPA1A G(190)C polymorphism .
providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and po... more providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and posterior ocular structures. Objectives: To evaluate the retina and choroidal vascular structures in axSpA patients by using the advantage of OCT and to compare the changes (if any) with healthy control subjects. Methods: In total 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic-and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects were included in the analysis. All patients underwent a detailed ophtalmalogic examination by the same opthtalmologist. All individuals with significant refractive errors (>3 diopters of spherical equivalent refraction) and intraocular pressure !21 mmHg were excluded from the analysis. Choroidal thicknes (ChT), macula, and the ganglion cell complex (GCC) were measured by spectral domain optic coherence tomography (SD-OCT) by the same experienced operator. Results: Mean (± SD) BASDAI score was 3.6 ± 2.5, BASFI score was 3.4 ± 2.9, ASDAS-CRP was 2.6 ± 1.3 in axSpA patients and 14% of them has a history of AAU and 61% ever treated with TNFi agents. There was no significant difference between groups regarding refractive error (P=0.640), intraocular pressure (P=0.815) and BMI (P=0.124) that could affect the OCT measurements. ChT (P<0.001) were increased and GCC thickness (P<0.001) were decreased in axSpA patients however both layer thicknesses were similar between r-and nr-axSpA patients (P=780 and P=0.677) (Table). History of uveitis was not associated with ChT and GCC. Although GCC was further decreased in TNFi treated patients (105.8 vs 113.3) this difference did not reach significance (P=0.058). Education level was associated both ChT and GCC measurement. GCC thickness was also releted with BMI and sex in univarite analysis. Other disease related characteristics including the ones related with disease activity were not related with posterior segment measurements. Conclusion: Our results showed that beside anterior segment inflammation, posterior segment of the eye could be affected in both r-and nr-axSpA patients. Retina and choroidal vascular network forms the posterior segment of the eye. The thinning of GCC which form the inner neural layer of the retina is a good indicative of micro-neurotoxicity in axSpA. Elevation of the ChT may be an important indicator of inflammation.
providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and po... more providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and posterior ocular structures. Objectives: To evaluate the retina and choroidal vascular structures in axSpA patients by using the advantage of OCT and to compare the changes (if any) with healthy control subjects. Methods: In total 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic-and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects were included in the analysis. All patients underwent a detailed ophtalmalogic examination by the same opthtalmologist. All individuals with significant refractive errors (>3 diopters of spherical equivalent refraction) and intraocular pressure !21 mmHg were excluded from the analysis. Choroidal thicknes (ChT), macula, and the ganglion cell complex (GCC) were measured by spectral domain optic coherence tomography (SD-OCT) by the same experienced operator. Results: Mean (± SD) BASDAI score was 3.6 ± 2.5, BASFI score was 3.4 ± 2.9, ASDAS-CRP was 2.6 ± 1.3 in axSpA patients and 14% of them has a history of AAU and 61% ever treated with TNFi agents. There was no significant difference between groups regarding refractive error (P=0.640), intraocular pressure (P=0.815) and BMI (P=0.124) that could affect the OCT measurements. ChT (P<0.001) were increased and GCC thickness (P<0.001) were decreased in axSpA patients however both layer thicknesses were similar between r-and nr-axSpA patients (P=780 and P=0.677) (Table). History of uveitis was not associated with ChT and GCC. Although GCC was further decreased in TNFi treated patients (105.8 vs 113.3) this difference did not reach significance (P=0.058). Education level was associated both ChT and GCC measurement. GCC thickness was also releted with BMI and sex in univarite analysis. Other disease related characteristics including the ones related with disease activity were not related with posterior segment measurements. Conclusion: Our results showed that beside anterior segment inflammation, posterior segment of the eye could be affected in both r-and nr-axSpA patients. Retina and choroidal vascular network forms the posterior segment of the eye. The thinning of GCC which form the inner neural layer of the retina is a good indicative of micro-neurotoxicity in axSpA. Elevation of the ChT may be an important indicator of inflammation.
Background: Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMA... more Background: Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMARDs). It can be used as a monotherapy or in combination with other DMARDs to inhibit the production of inflammatory cells and accordingly reduce inflammation. Objectives: CLEAR is a multi-centric study that aims to assess the clinical efficacy and safety of leflunomide as first-line and/or add-on therapy to other DMARDs with or without steroids in Egyptian patients with active Rheumatoid Arthritis (RA). Methods: Egyptian patients with active RA for whom leflunomide was prescribed at physicians’ discretion were observed for 12 weeks. Clinical Disease Activity Index (CDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score were acquired thrice during this period. This study was registered on clinicaltrials.gov (NCT03599986). Results: Interim analysis of the data collected from 337 patients (in 21 centers) showed a statistically significant decrease in the mean total...
Uludağ Üniversitesi Eğitim Fakültesi Dergisi, 2016
De nos jours, l'erreur qui était auparavant évaluée négativement est devenue un repère positif po... more De nos jours, l'erreur qui était auparavant évaluée négativement est devenue un repère positif pour les enseignants. Cette étude vise à proposer une solution à des erreurs fondamentales résultant de l'influence de la langue maternelle. Ce travail analyse 335 erreurs, dues à l'interférence de leur langue maternelle, le turc. L'échantillon se compose des phrases sélectionnées dans 180 devoirs des étudiants apprenant le français à l'université Atatürk dans le cours de l'expression écrite entre les années académiques 2000-2010. Tout en sachant qu'il y a de différents types de classification, on a choisi celle de Hurrydeo Beefun qui a classifié les erreurs telles que les erreurs lexicales/grammaticales, morphologiques et syntaxiques. On a observé que les erreurs lexicales/grammaticales sont celles qui sont répétées le plus souvent par les participants parmi les erreurs catégorisées selon l'étude analytique.
The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis w... more The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Participants and methods Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. Results In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P = 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). Conclusion MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis
A novel chloroindium(III) phthalocyanine network polymer (4) was prepared and characterized by en... more A novel chloroindium(III) phthalocyanine network polymer (4) was prepared and characterized by energy dispersive X-ray spectrometry, proton nuclear magnetic resonance, Fourier transform infrared spectroscopy, thermal gravimetric analysis (TGA) and absorption and emission spectroscopies. The non-linear optical (NLO) profile of the prepared phthalocyanine (Pc) network polymer, derived from a nanosecond open-aperture Z-scan technique at 532 nm, shows a clear reverse saturable absorption and a high non-linear absorption coefficient ( α2) of 9.7 × 10−7 cm W−1. Optical limiting investigations indicated that the prepared Pc network polymer has a relatively low limiting threshold of 900 mJ cm−2. According to these results, the prepared Pc polymer is a promising material for many NLO applications.
ABSTRACT A pulsed laser-assisted in liquid environment method has been developed successfully to ... more ABSTRACT A pulsed laser-assisted in liquid environment method has been developed successfully to synthesize size-tunable (5–12 nm) and different shapes (sphere, rod, rope) of nano II–VI semiconductor (cadmium sulfide). This method can be carried out in two ways; the first one is the top-down technique, which has been discussed in publications in the last few decades, and the other one is the bottom-up technique, which appears for the first time in this paper. X-ray diffraction, ultraviolet-visible spectroscopy, and transmission electron microscopy confirm that the nanoparticles are crystalline. The methods lead to the production of nanomaterials, which are important for photonics and biosensing applications. Both synthesized methods can be applied in all materials because of their ability to ablate almost all kinds of materials due to the ultrahigh energy density and control over the growth process by manipulating the process parameters such as intensity, wavelength, and so on.
The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloart... more The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis. Patients and methods A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups-axial subgroup (19 patients) and peripheral subgroup (11 patients)-and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography. Results A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score. Conclusion Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients.
Polyvinyl butyral (PVB) was prepared by condensation reaction of butyral with polyvinyl alcohol (... more Polyvinyl butyral (PVB) was prepared by condensation reaction of butyral with polyvinyl alcohol (PVA) in aqueous phase containing an acid as a catalyst and an emulsifying agent. Properties of the polymer were a function of the relative amounts of the three randomly distributed units of acetal, acetate and vinyl alcohol groups, and the molecular weight. In this work, some effective factors in synthesis of PVB have been investigated by Taguchi method. The percent of the acetalization has been determined according to the ASTM D1396, and the polymer was characterized by IR, TG, and DTG techniques. V
Objective: To investigate the effect of different types and methods of delivery of hormone replac... more Objective: To investigate the effect of different types and methods of delivery of hormone replacement therapy (HRT) on peripheral vascular flow velocity in postmenopausal women.
Uploads
Papers by Ayman Darwish