Background and aims Colorectal cancer screening programmes, targeting one of the most common cancers worldwide are widely spread, however, well known for facing challenges due to low participation. Using decision aids (DAs), often accessible online including disease related information, information about the screening procedure, benefit and harms with screening and value clarification exercises, in connection to a treatment- or screening decision helps people to make informed decision about screening. This study pertains the design of a DA, including views and concerns lay people have when invited to CRC screening, to shed light on their information- and support needs. Therefore, the aim of study was to explore the calling patterns to the Screening of Swedish Colons (SCREESCO) study’s helpline. Method A descriptive study using a cross sectional design with data from documented telephone calls to a CRC screening helpline. Results More than 2000 calls (women 58.5%; colonoscopy 59%) were analyzed. Reasons for calling were: unsubscribing from screening (25%), confirmation of participation (24%), logistical concerns about the screening procedure (20%), counseling (19%), and FIT screening difficulties or in need of a new FIT test (10%). Co-morbidity was the most frequent reason for unsubscribing (14%) and most of the counselling calls included questions about the FIT test or the colonoscopy (56%). Conclusions Since the helpline mainly was used for informational purposes – we conclude that the information provided was unclear or should be presented in alternative ways. Still, Interaction possibilities with health care professionals are, important in case of ambiguity anxiety or by individual preference. The planned decision aid (DA) should provide knowledge generated information with respect to the individual’s needs, health- and digital literacy with a possibility to interact with health care professionals.

Objectives: Iron deficiency anemia (IDA) is most common in children under the age of five. Many studies have shown that the prevalence of vitamin D deficiency (VDD) is high in a similar age group. An association between IDA and VDD has been reported. Our study aimed to determine whether there is a relationship between VDD and IDA in Turkish children under five. Methods: Children aged four months to five years were included in a case-control study. Two groups were formed: children with IDA (group I) and healthy controls without IDA (group II). Serum 25(OH) vitamin D levels lower than 20 ng/mL were considered deficient. Results: Group I (n=211, 24.8±17.5 months, 45% male) and group II (n=149, 26.4±17.7 months, 44% male) mean ages were similar (p>0.05). The median vitamin D level was lower in group I (22.5 ng/ml) than group II (32.3 ng/mL) (p=0.001). The frequency of VDD was 38.5% in group I and 14.5% in group II (p<0.001). Sixteen children had signs of subclinical rickets (All <36 months); 14 of them were in group I (p=0.034). Conclusions: VDD is more common in young children with IDA than in healthy controls. Most of the children who showed signs of subclinical rickets had concomitant IDA. Doctors should keep in mind that VDD and even subclinical rickets in children younger than 36 months may be associated with IDA. Key Words: Children, Iron deficiency anemia, Subclinical rickets, Vitamin D deficiency

Aims: Renal Cell Carcinoma (RCC) incidence is increasing with common using of imaging modalities. The kidney may lose some of its functional nephrons after surgical treatment. Therefore, functional results also important with oncological outcomes. The aim of this study is determination of predictor factors for Chronic Kidney Disease (CKD) development after surgical treatment. Methods: Patients with eGFR above 60 ml/min/1.73m2 who underwent partial or radical nephrectomy were included in the study. Demographic information, surgical features, eGFR values and some comorbidities of patients were recorded. Patients were evaluated regarding to CKD development after surgery. Results: One hundred and sixty six patients underwent radical nephrectomy or partial nephrectomy were included to study. According to comparing analysis, age, type of surgery, tumors size and preoperative eGFR are statistically significant clinical factor for CKD development. Conclusion: CKD is an important disease that causes morbidity and mortality. Age, type of surgery and preoperative eGFR are an independent risk factor for CKD development.

Abstract Aim: An LC-MS/MS method to quantify drug in dried cervicovaginal secretions from flocked swab was developed and validated using the antiretroviral efavirenz as example. Methods: Cervicovaginal swabs (CVS) were prepared by submerging flocked swabs in efavirenz-spiked matrix. Time to full saturation, weight uniformity, recovery and room temperature stability were evaluated. Chromatographic separation was on a reverse-phase C18 column by gradient elution using 1mM ammonium acetate in water/acetonitrile at 400 µL/min. Detection and quantification were on a TSQ Quantum Access triple quadrupole mass spectrometer operated in negative ionisation mode. The method was used to quantify efavirenz in CVS samples from HIV-positive women in the VADICT study (NCT03284645). Results: Swabs were fully saturated within 15 seconds, absorbing 128 µL of matrix with coefficient of variation (%CV) below 1.3%. The method was linear with a weighting factor (1/X) in the range of 25-10000 ng/mL with inter- and intra-day precision (% CV) of 7.69-14.9%, and accuracy (% bias) of 99.1-105.3%. Mean recovery of efavirenz from CVS was 83.8% (%CV, 11.2) with no significant matrix effect. Efavirenz remained stable in swabs for at least 35 days after drying and storage at room temperature. Median (range) CVS efavirenz AUC0-24h was 16370 ng*h/mL (5803-22088), Cmax was 1618 ng/mL (610-2438) at a Tmax of 8.0 h (8.0-12), and Cmin was 399 ng/mL (110-981). Efavirenz CVS:plasma AUC0-24 ratio was 0.41 (0.20-0.59). Conclusion: Further application of this method will improve our understanding of the pharmacology of other therapeutics in the female genital tract, including in low- and middle-income countries.

Anti-adhesion surfaces capable of repelling various liquids would have broad technological implications. However, the on-site application of such surfaces has been limited by the need for complex processes and extra equipment. Here we have created a solvent-free mixture containing miscible silicon precursors, which can be readily sprayed, dipped, or painted onto virtually any substrate to prepare flat anti-adhesion coatings. By embedding the lubricating silicon segments on surfaces via the novel synergetic reactions that spontaneously occur at room temperature, we can fabricate coatings that are readily applicable on-site to cover large objects, and which offer excellent repellency against various liquids (water, hydrocarbons, crude oil, and oily-ink) as well as viscoelastic and sticky adhesives. These coatings are transparent, flexible, and durable. We believe these coatings can be utilized in many commercial and residential situations to address a wide range of undesirable interfacial adhesion issues such as smudge, drag, and blockage.

In this article, we utilize the finite Sine-Fourier transform (FSFT) and the Laplace transform (LT) for solving fractional partial differential equations with regularized Hilfer-Prabhakar derivative. These transforms are used to get analytical solutions for the time fractional heat conduction equation (TFHCE) with the regularized Hilfer-Prabhakar derivative and with heat absorption in spherical coordinates. Two cases of Dirichlet boundary conditions are considered with obtaining analytical solution in each case. The effect of the parameters of the regularized Hilfer-Prabhakar derivative on the heat transfer inside the sphere is discussed using some figures.

In this paper, we propose and analyze a higher-order stochastically perturbed two-species Lotka-Volterra competition system in a patchy environment. We establish sufficient conditions for the existence and uniqueness of an ergodic stationary distribution of positive solutions to the system by constructing a series of suitable Lyapunov functions. Moreover, we also obtain the asymptotic behavior of the solutions around the boundary equilibrium of the deterministic system.

In this paper, we establish a new composition theorem for (ω,c)-asymptotically periodic functions. Then, we use the Banach contraction principle to investigate the existence and uniqueness of (ω,c)-asymptotically periodic mild solutions to the fractional integro-differential equation u’(t)=\frac{1}{\Gamma(\alpha-1)}\int_{0}^{t}(t-\tau)^{\alpha-2}Au(\tau)d\tau+F(t,u_t), t≥0 and u_0=\phi \in \mathcal{B}(\mathbb{X}), where \mathcal{B}(\mathbb{X}) is a linear space of functions defined from (-∞,0] \longrightarrow \mathbb{X} and A is a closed but not necessarily bounded linear operator of sectorial type \varpi<0.

Objectives: Acute invasive fungal rhinosinusitis has been associated with high mortality rates. We aimed to explore the contribution of novel detection and treatment methods on the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis. Design: Retrospective observational cohort study. Setting: A tertiary children’s hospital. Participants: The records of all children with a hematologic or oncologic disease who developed AIFR between 2005-2020 were reviewed. Results: Thirty-four patients were included. Aspergillosis and mucormycosis were diagnosed in 20 patients (59%) and 12 patients (35%), respectively. Panfungal polymerase chain reaction (PCR) was associated with a change of treatment in 36% of patients. Aggressive surgical approach was adopted and 71% of the patients underwent multiple surgical procedures. Overall, 26% of patients died of disease, however no disease-specific death occurred since 2012. Diagnosis using panfungal PCR (p=.04) and treatment with novel antifungal medications (p=.017) were significantly associated with disease-specific survival. Conclusions: Enhanced fungal detection using panfungal PCR and treatment with novel antifungal agents, combined with rapid diagnosis and treatment, aggressive surgical approach and better control over the underlying oncological disease, may significantly improve the outcome of immunosuppressed children with acute invasive fungal rhinosinusitis.

Abstract Introduction Mucosal melanoma (MM) is a rare disease, accounting for approximately 1.4% of all melanomas and only 0.03% of all new cancer diagnoses [1]. Traditionally, it is associated with a poor prognosis with an overall 5-year survival rate of less than 25%[1]. Progress in treatment has been hindered by rarity and lack of evidence. Studies however of treatment of subcutaneous melanoma with immunotherapy have demonstrated a significant improvement in survival rates and have become a core part of oncological strategy. This paper will discuss revision of the evidence for the use of immunotherapy in the Head and Neck. Design A systematic review was conducted on 19/01/2019. Medline and Embase databases were searched. 509 articles were collated, of which 52 met the inclusion criteria. Results Results were shown as a comparison of yearly survival rates following different treatment modalities (immunotherapy vs non-immunotherapy) at 2 years, 3 years, and 5 years respectively. Conclusions Immunotherapy outcomes in small studies have shown good data for increasing survival rates at all yearly intervals in MM of the head and neck. Larger clinical trials should be done to accurately distinguish efficacy and survival outcomes of immunotherapy when compared to treatment modalities excluding immunotherapy. The ability to perform larger trials are, however, limited by the rarity of MM of the head and neck.

Metronidazole has a benign side effect profile during normal therapeutic use. An 84-year-old woman presented with recurrence of Clostridium difficile infection (CDI). She had received oral vancomycin 5 weeks ago and was prescribed oral metronidazole. There was progressive neutropaenia from day 1 of treatment. Metronidazole was stopped on day 8 and vancomycin was prescribed. Causality assessment via Naranjo algorithm demonstrated a probable adverse effect (8/10) in favour of metronidazole. Very severe neutropaenia on day 16 prompted administration of granulocyte colony stimulating factor (GCSF) for 72 hours. This resulted in transient neutrophilia which confirmed bone marrow integrity and supported a diagnosis of drug-induced myelosuppression. The neutrophil count slowly recovered to normal levels after 4 weeks. To our knowledge, this is the 4th report of metronidazole induced severe neutropenia (levels <1 x10⁹/L). Unlike previous reports, we confirmed bone marrow integrity using GCSF. Unique to our case are the degree of neutrophil suppression and slow recovery of marrow function with a reversed neutrophil/lymphocyte ratio for >21 days.

This first RCT of hypertonic saline use in pediatric non-CF bronchiectasis patients uses a cross over design and demonstrates an improvement in predicted FEV1 and FVC. Limitations include lack of blinding and risk of information bias, as well as reduced precision due to absence of within subject comparisons.

Background: Myasthenia gravis (MG) is an autoimmune disease. Evidence has shown that the function of the lymphocyte immune can be regulated by microRNAs (miRNAs). This study aimed to explore whether miR-155-5p can regulate the activation and suppressive function of T-regulating cells (Tregs) in MG. Methods: Blood samples of patients with MG were collected to evaluate the levels of miR-155-5p, BCL10, and the proportion of Tregs. The correlation between the level of miR-155-5p and BCL10 was evaluated in humans. The levels of miR-155-5p and the proportion of Tregs were further detected in the experimental model of autoimmune myasthenia gravis (EAMG). The dual-luciferase reporter assay was used to verify whether miR-155-5p can target BCL10. To reveal the regulatory function of BCL10 to Tregs, CD4+CD25+Tregs were transfected with either si-BCL10 or miR-155-5p inhibitors, and detected by measuring anti-inflammatory cytokines and transcription factors. Results: The level of miR-155-5p significantly increased in MG patients compared to the control group (P<0.001), while the level of BCL10 significantly decreased in MG patients (P<0.001). There was a negative correlation between the level of miR-155-5p and BCL10 (r=0.3292, P=0.0253). The proportion of Tregs significantly decreased in MG patients and the spleen of EAMG rats compared to the control groups (P<0.001; P<0.05, respectively). The dual-luciferase reporter assay showed that miR-155-5p can target BCL10. BCL10 contributed to the activation and immunosuppressive function of Tregs. Conclusions: miR-155-5p inhibits the activation and immunosuppressive function of Tregs by targeting BCL10, which may be a potential target in the treatment of MG.

A document by Borja Navas-Diaz. Click on the document to view its contents.

Clinical trial participants are a vital part of drug development research and there are many rules to help and ensure the safety and ethics of clinical trials. Managing patient safety during clinical trials is a critical component throughout the drug development life-cycle. As the first step towards ensuring patient safety, all the involved parties in drug development need to be respectful and responsive towards patient’s needs, comfort, and preferences i.e. ensuring a patient-centric approach. In this paper blockchain technology is embedded in the Quality by Design (QbD) systematic approach to boost data integrity among the activities, and to promote participants’ safety in clinical trials. First, blockchain-enabled QbD architecture is proposed and the interactions among the enablers and peers are highlighted. Then, a prototype of the proposed architecture is developed and the data of a pilot trial is used to justify the applicability of the architecture. The results showed that the proposed architecture is efficient, and hence it is feasible to adopt into a clinical trial.

Background: The electrical activation patterns in pacemaker rhythm, type B Wolff-Parkinson-White syndrome, and premature ventricular complexes originating from the right ventricular outflow tract are similar to those of the complete left bundle branch block and can be considered as LBBB patterns. Methods: Two-dimensional speckle tracking was used to evaluate peak value and time to peak value of the LV twist, LV apex rotation, and LV base rotation in patients with PM, B-WPW, RVOT-PVC, CLBBB, and in age-matched control subjects. The apical-basal rotation delay was calculated as the index of LV dyssynchrony. Results: The LV motion patterns were altered in all patients compared to the control groups. Patients with PM and CLBBB had a similar LV motion pattern with a reduced peak value of LV apex rotation and LV twist. Patients with B-WPW demonstrated the opposite trend in the reduction of LV rotation peak value, which was more dominant in the basal layer. The most impairment in the LV twist/rotation peak value was identified in patients with RVOT-PVC. Compared to the control group, the apical-basal rotation delay was prolonged in patients with CLBBB, followed by those with B-WPW, RVAP, and RVOT-PVC. Conclusions: The LV motion patterns were different among patients with different patterns of LBBB. CLBBB and PM demonstrated a reduction in LV twist/rotation that was pronounced in the apical layer, B-WPW showed a reduction in the basal layer, and RVOT-PVC in both layers. CLBBB had the most pronounced LV apical-basal rotation dyssynchrony.

Global climate change has led to a warmer world, changing the migratory and breeding behaviors of many species, and short-distance migrants may benefit from climate change. With climate change leading to an increasingly disordered climate, we show here that a disordered spring climate disturbs the migration and breeding of a short-distance anadromous fish. In 2020, on the Qinghai-Tibetan Plateau, an abnormally low temperature in April delayed the migration rhythm of Gymnocypris przewalskii by nearly 10 days, while the gonadal development rhythm of the breeding population was almost normal. The phenology mismatch decreased the migrating populations by 30–70%, reducing the larval flux by nearly 80%. This case reveals that for short-distance migrants, different phenologies within the same species respond to disordered climates differently, which leads to phenology mismatches and then threatens the species. Along with increasing local extreme weather and climate events, short-distance migrants need more attention and conservation actions.

Biogeographic history is an under-appreciated factor influencing the ecology of biological communities and their macroecological patterns. We show how contrasting biogeographic histories of tropical savannas in Australia, Brazil and Africa have led to functionally distinct ant faunas that display contrasting responses to environmental stress and disturbance. Australian savannas evolved in association with a desert biome and its fauna is strongly arid adapted; high diversity is maintained with increasing aridity and communities are highly resilient to frequent fire. Brazilian savannas evolved surrounded by rainforest and has a forest-derived; diversity declines with increasing aridity and communities are far more sensitive to fire. Africa has a highly generalized ant fauna that is resilient to fire but diversity declines with increasing aridity. Such intercontinental differences have important implications for understanding biodiversity responses to land management, because the same management action can have different consequences in different regions. It also means that communities in different regions are likely to have markedly different responses to climate change. Our analysis of savanna ants suggests that biogeographic history should be given more attention in comparative studies of community ecology and macroecology.

Background The use of large vaginal meshes for the treatment of pelvic organ prolapse (POP) in combination with poor surgical experience are the dominating risk factors for serious postoperative complications. The main goal of this study is not only to select a safe and effective method of POP surgery, but also to form a standardized teamwork algorithm aimed at diagnosing, treating and postoperative management of patients with subsequent monitoring of their condition. Methods A retrospective study of 5031 medical history was used to evaluate the effectiveness of the quality improvement intervention. We evaluated the following indicators: type of surgery performed, duration of surgery, duration of postoperative bed-day. Interventions From 2012 to 2019, seven types of surgical techniques with the use of the mesh material were consistently used, differing in the volume of the implanted mesh material, the presence and type of simultaneous native tissue reconstructive surgery, the method of mesh fixation and the number of fixation points. Results Patients who underwent technique number “7” showed the highest result in the mean scores (33±15 scores PISQ12, 51±30 scores PFDI20) of the questionnaires, which was statistically significant in comparison with other techniques (p<0,001). The number of postoperative complications were statistically significantly higher in techniques “1” to “6” compared to “7” (p<0.001). There was no difference in supportation rate between all techniques (p=0.12). Conclusions Three-level hybrid pelvic floor reconstruction is a safe and effective procedure that can be replicated in any hospital with the appropriate skill level of the surgeo

Objective: To evaluate the diagnostic capacity of bedside capillary lactate (CLact), capillary Hemoglobin (CHb), and Shock index (SI) for severe postpartum haemorrhage (SPPH), at diagnosis 15 minutes and 30 minutes post-diagnosis Design: A prospective cohort study. Setting: A reference hospital in San Luis Potosi Mexico from February 2020 to March 2021 Population: Sixty women in vaginal labour or c-section who presented bleeding ≥500ml Methods: SI, CLact, and CHb concentration were analyzed at diagnosis, 15 minutes, and 30 minutes time intervals. T-test or Wilcox test was used to compare the group of severe vs non-severe. A Receiver Operating Curve was done to determine their cut points, Sensitivity, specificity, and performance Main Outcome Measures: SPPH defined as bleeding ≥2000ml measured by gravimetric method. Results SI at the diagnosis was significantly differentiate between severe from non-severe group (0.70 + 0.20 vs 0.90 + 0.38 P-value 0.0228) with al cut-point of 1.17 AUC of 0.76 sensitivity of 0.43 and specificity of 0.98. A capillary lactate measurement at 30 minutes was also significantly different between the groups (4.0 +1.90 vs 4.8 + 1.15 P-value < 0.001, with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85, and specificity of 0.62. Capillary haemoglobin was not able to significantly differentiate the groups Conclusions: Shock index is an early sign of severe haemorrhage; Capillary lactate can significantly identify severe haemorrhage after 30 min. Capillary haemoglobin is not an early detector of severe haemorrhage.

In this study, specific energy potential of PRO process using L-DOPA+TiO2 (0.5 and 1 wt%) modified BW30-LE membrane was evaluated on synthetic and real water samples at 5, 10 and 15 bar pressures and 10°C and 20°C and 30°C degrees. Water flux increased by improvement of the surface hydrophilicity and increased roughness on the membrane surface by incorporation of TiO2 nanoparticles with L-DOPA. The maximum specific power was observed as 1.6 W/m2 for L-DOPA+1 wt% TiO2 modified BW30-LE membrane at 15 bar pressure. Mediterranean and Aegean, Black Sea water samples were used as draw solution and Seyhan, Ceyhan, Buyuk Menderes, Gediz, Yesilirmak, and Kizilirmak Rivers were used as feed solution. The highest osmotic power density of 0.70 W/m2 was obtained by using BW30-LE/L-DOPA+1 wt% TiO2 membrane with the Ceyhan River-Mediterranean Sea couple at 10 bar pressure at 30 ± 5°C.

Aim: Present study is design to investigate the effect of hydroalcoholic extract of Centella asiatica (HA-CA) in 3-nitro propionic acid induced Huntington’s disease in adult zebrafish. Material and method: In current study, adult zebrafish (approximately 5-6 months old), weighing from 470-530 mg were used and treated with 3-NP (5 mg/kg i.p). The animals received HA-CA (80, and 100 mg/l) daily up to twenty eight days in water. Tetrabenazine (TBZ) (3 mg/kg i.p.) was used as standard drug. The body weight and behavior were performed before 3-NP administration on every 4th day. Then animal were sacrificed for biochemical analysis using UV-spectrophotometer. Inflammatory markers were measured by using zebrafish ELISA kits. Neuronal damage in the brain was examined by using Hematoxylin and eosin (H&E) staining. Results: 3-NP treated zebrafish showed marked reduction in body weight, cognition, and locomotion activity accompanied by progressive striatal dysfunction. HA-CA treated group significantly reversed 3-NP induced increase level of LPO, AChEs, Nitrite, and decrease level of GSH. Administration of HA-CA (80, 100 mg/l) significantly ameliorates 3-NP induced alteration in body weight and behavior, restored antioxidant enzymes level, decrease ROS production and neuroinflammation. HA-CA significantly decreases TNF-α, and IL-1β levels in the brain. Moreover, HA-CA significantly reversed 3-NP induced neuronal loss in the brain. Conclusion: HA-CA exhibits protective effect against 3-NP induced decrease locomotor activity, increase in oxidative stress, neuroinflammation, and neuronal loss in HD model of zebrafish, which is associated with its antioxidant activity. Keywords: 3-nitropropionic acid, Centella asiatica, oxidative stress, neurotoxicity, neuroinflammation, zebrafish

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary artery development anomalies disease. We reported a 15-year-old male who presented loss of consciousness and cardiogenic shock after strenuous exercise. After Veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon counter-pacing pump (IABP), continuous renal replacement (CRRT) and other comprehensive treatments were given immediately, the patient’s condition gradually improved and was diagnosed as “abnormal coronary origin with acute subendocardial myocardial infarction” by coronary computed tomography angiography (CTA) and cardiac magnetic resonance (CMR). Such diseases progress rapidly and are at high risk of sudden death. Clinicians need to give life supports in time to improve the prognosis of patients.

Abstract Background: Non-alcoholic fatty liver disease (NAFLD) spectrum ranges from simple hepatic steatosis to non-alcoholic steatohepatitis. Considering the restrictions of liver biopsy, various serological biomarkers have recently emerged for non-invasive diagnosis of NAFLD. Aim of work: Evaluating the association between serum neuregulin 4 and NAFLD and the use serum Neuregulin 4 (Nrg4) as a non-invasive marker for diagnosis of NAFLD. Patients and Methods: Sixty-three Egyptian NAFLD patients and 63 control subjects were enrolled Detailed history taking, thorough clinical examination including anthropometric measures (Body mass index (BMI) and waist circumference) and laboratory investigations including complete blood count, lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides), serum albumin, transaminases, bilirubin levels, hepatitis markers (anti-HCV antibodies and HBsAg), anti-nuclear antibodies and anti-smooth muscle antibody were performed. Measurement of serum Neuregulin 4 (Nrg4) by ELISA and non-invasive NAFLD scores such as NAFLD fibrosis score and FIB4 score were applied to all patients. Results: There was a statistically significant difference between cases and controls regarding the BMI, waist circumference, haemoglobin level, total leucocytic count, total cholesterol, LDL-C, HDL-C, and serum triglycerides levels. Nrg4 was significantly decreased in NAFLD patients as compared to controls. Moreover, Nrg4, total cholesterol, LDL-C levels were statistically significant independent predictors of NAFLD. No significant differences were observed between Nrg4 level and the variable stages of hepatic fibrosis by NAFLD fibrosis score. Conclusion: Decreased serum Nrg4 level is frequent in NAFLD patients and is an independent predictor of NAFLD suggesting that Nrg4 might have a potential role in prevention and treatment of NAFLD. Keywords: Neuregulin-4, Non-alcoholic fatty liver disease, Non-invasive biomarker, Egyptian patients.