Pediatric nurses carry heavy emotional and clinical demands that leave them vulnerable to burnout. Trauma-Informed Care (TIC) has helped ease burnout in the workplace, but psychological factors like Impostor Syndrome (IS) may weaken these benefits. Whether IS mediates the TIC-burnout link has not been well studied. To examine the mediating effect of impostor syndrome on the association of trauma-informed care with burnout in pediatric nurses. A descriptive cross-sectional study was conducted in six hospitals of Mansoura City, Egypt, between October 2024 and January 2025, with a sample size of 251 pediatric critical care nurses (96.5% response rate). Instruments included Trauma-Informed Care Scale, Maslach Burnout Inventory, and Clance Impostor Syndrome Scale. Data were analyzed by means of Pearson correlation, multiple linear regression, and mediation analysis through PROCESS macro with 5000 bootstrap samples. Impostor syndrome was the strongest predictor of burnout (β = 0.383, p < .001), followed by attitude toward TIC (β = 0.234, p = .047). Female nurses reported lower burnout, though only IS acted as a mediator. IS partially mediated the association of TIC with burnout (indirect effect = 0.15, 95% CI (0.06, 0.24)), with the model explaining 50.3% of burnout variance. Impostor syndrome has the potential to alter the work requirements of TIC into further vulnerability to burnout. Comprehensive support for pediatric nurses should incorporate trauma-informed practices alongside programs and strategies to ameliorate the experience of self-doubt, thus improving well-being and care quality.
We present the updated recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) regarding radiation dose constraints for organs at risk in adult patients, with the aim of supporting clinical decision-making in contemporary radiotherapy practice. These guidelines address a wide range of clinical scenarios, including normofractionation, hypofractionation, stereotactic radiotherapy, and reirradiation. Dose constraints are essential to ensure both the safety and efficacy of radiotherapy, especially with the growing use of advanced techniques such as intensity-modulated radiotherapy and stereotactic body radiotherapy. However, given the wide range of existing dose constraints and the lack of harmonization across different practices, this work aims to provide a unified and updated framework adapted to modern radiotherapy techniques. Moreover, many of these constraints are still based on data derived from three-dimensional conformal radiotherapy, which necessitates cautious application when extrapolated to more advanced techniques. Clinical judgment remains crucial, particularly in complex cases such as re-irradiation or treatments using altered fractionation schedules. These updated consensus aim to provide a practical and evidence-based framework to help radiation oncologists and medical physicists minimize the risk of toxicity to normal tissues. By consolidating and adapting current knowledge to modern radiotherapy techniques, they serve as a useful tool in daily clinical practice.
This study evaluates the efficacy and outcomes of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) as a primary treatment for hydrocephalus associated with Chiari II malformation in infants. This retrospective study analyzed 53 infants, all under 12 months of age and post-myelomeningocele repair, who presented with hydrocephalus (Evans' Index > 0.3 or Frontal occipital horn ratio (FOHR) > 0.4). All patients underwent Endoscopic third ventriculostomy (ETV) and bilateral choroid plexus cauterization (CPC) using a rigid endoscope. Success was defined as shunt-free survival with clinical and radiological improvement over a 12-month follow-up period. The cohort of 53 infants (28 males, 25 females) had a mean age of 3.4 months, with 36% consanguinity. Patients were stratified into three age groups: < 3 months (n = 13), 3-6 months (n = 19), and 6-12 months (n = 21). The ETV + CPC success rate showed a positive correlation with age: 54% in the youngest group, 63% in the middle group, and 67% in the oldest group. Of the 20 failures, 14 required ventriculoperitoneal shunts (VPS), and 6 were managed with re-endoscopy for stoma closure. Meningitis was the most common complication (15%), with all affected patients eventually requiring a VP shunt. ETV + CPC offers an effective, safe, and durable alternative to traditional VPS for infants with Chiari II-associated hydrocephalus. It significantly reduces shunt dependency and its associated long-term complications. Success rates improve with advancing age, making it a viable first-line surgical option in pediatric neurosurgery, particularly in resource-limited settings.
In the present study, samples (hepatopancreas and muscles) from 100 cultured shrimp (Penaeus indicus) were collected. The water samples (n = 30) were obtained from the same shrimp aquaculture farms located at Damietta Governorate in Egypt. An additional 30 samples of human stool were also taken from fish workers who consumed or handled shrimp in the farms. Traditional and regular molecular methods were used for the isolation of Vibrio spp. The investigation identified 165 (63.5%) Vibrio spp. with predominance of V. fluvialis (41.2%), V. alginolyticus (31.5%) and V. parahaemolyticus (7.9%). Findings of large-scale multidrug resistance (77.5% of isolates) and also of the presence of carbapenemase genes (blaKPC, blaNDM) and extended-spectrum beta-lactamase genes (blaCTX-M, blaTEM) were important discoveries. This strong resistance, due to the fact that a lot of pressure has been exerted on the aquaculture through the use of antibiotics, demonstrates the ineffectiveness of antibiotics in combating vibriosis in shrimp farming. The clinical signs observed in shrimps were red and fragile shells, and pale hepatopancreas. Histopathological analyses corroborated the presence of sloughed hepatopancreas epithelium, vacuolation, oedema and hemocytic infiltration. Regarding sequence similarity, the gyrB gene was sequenced, and all of the shrimp hepatopancreas isolates showed 100% sequence identity with the human stool isolates, which indicates potential genetic relatedness of V. fluvialis isolates. However, because of the conserved nature of gyrB, higher resolution tools are needed to verify transmission (e.g., MLST or WGS). The results of this study show that ecological management strategies and improved farm hygiene practices can be more effective intervention strategies than antibiotic use, providing valuable insights for sustainable shrimp aquaculture and public health interventions.
Surgical excision of salivary gland (SG) tumors frequently results in glandular tissue loss and long-term functional impairment. Human dental pulp stem cells (hDPSCs) and their derived Exosomes (hDPSCs-Exos) have emerged as promising regenerative strategies. Therefore, the present study aimed to compare the regenerative capacity of hDPSCs versus their Exos on surgically induced defects in rats' submandibular SGs. Seventy-two male Sprague Dawley rats were randomly assigned to four groups (n=18). Group I (negative control): no surgical intervention. The remaining rats underwent a circular defect preparation on the right submandibular SG, then the dissected areas were injected circumferentially with different treatments according to group assignment. Group II (positive control): 1ml phosphate buffered saline (PBS). Group III (hDPSCs group): 1×105 hDPSCs suspended in 1ml PBS, and group IV (hDPSCs-Exos): hDPSCs-Exos (20µg/ml) suspended in 1 ml PBS. Six rats from each group were euthanized at 3, 7, and 14 days postoperatively. Histological evaluation, immunohistochemical analysis (IHC) of Collagen-I (COL-I), and quantitative real time polymerase chain reaction (qRT-PCR) for aquaporin-5 (Aqua-5) gene expression were performed, followed by relevant statistical analyses. The positive control group showed marked acinar disorganization and fibrosis. The hDPSCs-treated group demonstrated partial regeneration, whereas the exosome-treated group showed near-normal architecture by day 14. Statistical analysis showed significant differences between groups as COL-I expression decreased significantly over time, with the lowest levels in the exosome group indicating tissue regeneration without fibrosis. Aqua-5 expression increased significantly, showing superior molecular restoration in the exosome group approaching negative control baselines by day 14 that raises hope toward functional recovery followed by hDPSCs and finally positive control groups. Both hDPSCs and their exosomes promote regeneration of surgically injured submandibular glands. The exosomes-treated group demonstrated superior structural and molecular recovery approaching normal architecture, supporting their potentiality as a safer and effective cell-free regenerative therapy.
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To compare milrinone versus dobutamine for right ventricular (RV) dysfunction after cardiopulmonary bypass (CPB). Randomized, open-label, parallel-group controlled trial. A tertiary cardiac surgery center. Adults (N = 88) with new RV systolic dysfunction (tricuspid annular plane systolic excursion [TAPSE] ≤17 mm) post-CPB. Milrinone (loading 50 µg/kg over 10 minutes, then 0.3-0.8 µg/kg/min) or dobutamine (2-10 µg/kg/min). The co-primary outcomes were duration of mechanical ventilation (clinical) and change in TAPSE over 24 hours (echocardiographic). Secondary outcomes included RV fractional area change, pulmonary artery systolic pressure (PASP), left ventricular outflow tract velocity-time integral, intensive care unit stay, arrhythmias, hypotension, and vasopressor need. Both groups had similar baseline characteristics. TAPSE improved significantly over 24 hours in both groups (p < 0.001). After adjustment for baseline TAPSE and left ventricular ejection fraction, milrinone was associated with modestly higher TAPSE at 24 hours (adjusted difference 1.82 mm, 95% CI 0.72-2.92, p = 0.001), though the clinical significance of this difference is uncertain. Milrinone required more norepinephrine than dobutamine (93.2% v 72.7%, p = 0.021). Other clinical outcomes did not differ significantly. In an exploratory subgroup analysis of patients with baseline post-CPB PASP >40 mmHg (n = 30), milrinone produced greater TAPSE improvement at 1, 6, and 24 hours (p < 0.05 for each), with a statistically significant interaction (p = 0.010); norepinephrine use was similar between groups in this subgroup (93.8% v 85.7%, p = 0.586). In patients with PASP ≤40 mmHg (n = 58), the drugs were equivalent. Milrinone and dobutamine provide comparable overall RV recovery, though milrinone was associated with modestly higher adjusted TAPSE at 24 hours of uncertain clinical significance and increased norepinephrine requirements. An exploratory subgroup analysis suggests milrinone may provide superior RV functional recovery in patients with elevated post-CPB PASP (>40 mmHg), though this hypothesis-generating finding requires prospective validation.
Compounds 3a,b, 6a-d, 8a,b, 10a,b, and 13a-f represent novel heterocycles incorporating phenoxyacetamide moieties. These fourteen derivatives were synthesized and screened for α-glucosidase inhibitory activity. Derivatives 6c and 13d exhibited the highest potency, outperforming the reference drug acarbose. Preliminary antioxidant activity, assessed via DPPH assay, identified 6d, 6a, 8a, 13e, and 13f as the most effective, surpassing ascorbic acid. In streptozotocin-induced diabetic mice, compound 6c lowered fasting blood glucose levels, alleviated oxidative stress, and improved hepatic and renal biomarkers, as confirmed by histopathological analysis. Molecular docking studies corroborated these results, demonstrating strong interactions with critical α-glucosidase residues. Overall, these phenoxyacetamide-based heterocycles have emerged as promising scaffolds for developing antidiabetic agents.
Hypertension is increasingly recognized, especially in vascular remodeling and target-organ injury, as elevated arterial pressure accompanied by chronic low-grade vascular inflammation. Endothelial dysfunction, vascular smooth muscle cell remodeling, immune activation, oxidative stress, and extracellular matrix stiffening reinforce one another in hypertensive vascular disease. The NLRP3 inflammasome is an important mediator of sterile inflammation through caspase-1 activation, IL-1β/IL-18 maturation, and gasdermin D-dependent pyroptosis. Although canonical biochemical triggers of NLRP3 are well characterized, the contribution of the hypertensive mechanical environment remains incompletely defined. Hypertensive vessels are exposed to elevated circumferential stretch, disturbed shear stress, pulse-related strain, and matrix stiffening, which are sensed through integrins, focal adhesions, mechanosensitive ion channels, junctional complexes, and cytoskeletal networks. Direct vascular evidence, indirect mechanobiology evidence, and inflammasome cell-biology evidence are consistent with a testable mechanical licensing model of NLRP3 activation in hypertensive vasculature. In this model, chronic mechanical load may prime vascular cells through integrin-FAK/Src-RhoA/ROCK, Piezo1-Ca2 + , YAP/TAZ, ROS, and NF-κB-associated pathways, while cytoskeletal remodeling could create intracellular conditions that favor NLRP3-ASC proximity and caspase-1 activation in the presence of canonical triggers. Mechanical inputs are not substitutes for canonical danger signals; instead, they may lower the activation threshold for inflammasome assembly, cytokine release, endothelial dysfunction, and vascular remodeling. Mechanotransduction, cytoskeletal remodeling, and inflammasome signaling therefore may represent convergent mechanistic nodes in hypertensive vascular inflammation.
This study experimentally and numerically investigated the shear behavior of UHPFRC deep beams with internal-opening reinforcement, focusing on how internal-opening reinforcement detailing can mitigate opening-induced shear capacity loss. The test program included eight simply supported UHPFRC deep beams tested under four-point loading and arranged into two groups with different geometries. Group I comprised five beams with an a/d ratio of 0.61, including one solid reference beam and four beams with a square opening within the shear span, and intersected the load path. Group II comprised three beams with an a/d ratio of 0.79 and different opening sizes. Three internal opening reinforcement techniques with different ratios were examined: (1) additional vertical and horizontal bars around the opening (µav = µah = 2.7% or 2.4%), (2) additional stirrups (ρva = 4.2% or 5.6%) with vertical and horizontal bars around the opening (µav = µah = 2.7% or 2.4%), and (3) diagonal cross-bars around the opening (µax = 1.8%). The results showed that the unreinforced opening reduced the cracking load by 41.4% and the ultimate load by 40.4%, compared with the solid beam. Techniques (1), (2), and (3) increased ultimate shear capacity by 16.5%, 69.2%, and 25.3%, respectively, versus the unreinforced opening beam, achieving approximately 54.6%, 79.4%, and 58.8% recovery of the solid-beam capacity. A 3D numerical model using concrete damage plasticity reproduced damage and load-deflection responses, with mean experimental-to-numerical ratios of 1.08 for ultimate shear load and 1.30 for midspan deflection, supporting the model's predictive reliability for deep beams with internal opening reinforcement.
Lead is a widespread environmental contaminant that induces multi-organ toxicity primarily through oxidative damage and inflammatory responses. Salivary glands particularly the parotid are increasingly recognized as vulnerable targets of metal-induced injury, with significant implications for oral and digestive health. This study investigated the protective effect of silymarin, a flavonolignan antioxidant extracted from milk thistle seeds, against lead acetate-induced parotid gland damage in rats. Forty adult male Wistar rats were allocated into four groups: untreated controls, silymarin only (100 mg/kg), lead acetate only (50 mg/kg), and a combined treatment group receiving silymarin (100 mg/kg) and lead acetate (50 mg/kg). Treatments were administered orally for six consecutive weeks. Parotid tissues were evaluated using histology, immunohistochemistry, ELISA, qRT-PCR, and transmission electron microscopy (TEM). Lead acetate exposure caused extensive tissue injury, including acinar vacuolation, ductal dilation, and vascular congestion, accompanied by elevated lipid peroxidation, depletion of endogenous antioxidant enzymes, activation of inflammatory signaling pathways, and upregulation of pyroptotic, apoptotic, and ferroptotic markers. TEM revealed swollen mitochondria with fragmented cristae in lead-exposed glands, hallmarks of ferroptosis. Fibrotic remodeling with collagen accumulation was also evident. Silymarin co administration was associated with significant attenuation of these pathological alterations, correlating with enhanced antioxidant defenses, reduced inflammatory mediators, lowered expression of markers linked to multiple programmed cell death pathways, and decreased fibrosis. TEM confirmed silymarin preserved mitochondrial cristae integrity. In summary, these findings suggest that silymarin may exert broad cytoprotective effects against lead induced parotid gland injury, potentially involving coordinated effects on oxidative stress, inflammation, cell death pathways, and fibrotic responses. This points to its potential therapeutic value in heavy metal toxicity, pending further validation.
The rapid emergence of antibiotic resistance represents a critical global health challenge, particularly in biofilm-associated infections caused by Pseudomonas aeruginosa (P. aeruginosa). Quorum sensing plays a pivotal role in regulating bacterial virulence and biofilm formation. Consequently, targeting quorum sensing-regulated virulence factors represents a promising anti-virulence strategy to combat antibiotic resistance. In this study, the FDA-approved drugs vardenafil, valsartan, and olmesartan did not significantly affect the growth of ten clinical P. aeruginosa isolates. At sub-inhibitory concentrations, these drugs significantly reduced the production of key virulence factors, including hemolysin, proteases, pyocyanin, lipases, as well as impairing swarming motility, and biofilm formation. Gene expression analysis confirmed marked downregulation of quorum sensing-associated genes in five selected isolates. In vivo experiments revealed a substantial reduction in bacterial pathogenicity following treatment. Molecular docking analyses further supported these findings, revealing favorable interactions of the tested drugs with key quorum sensing regulatory proteins. Collectively, these results highlight the anti-quorum sensing, anti-virulence, and antibiofilm potential of these repurposed drugs and suggest their possible application in topical formulations as adjunctive therapies to conventional antibiotics for managing severe pseudomonal infections.
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Circulating cell-free epigenetic and epitranscriptomic modifications (epimarks) are emerging as minimally invasive biomarkers for cancer detection and therapeutic monitoring. Their clinical utility in non-small cell lung cancer (NSCLC), particularly in the context of EGFR-targeted therapies, remains to be fully established. Ten circulating epimarks encompassing cfRNA methylation, histone post-translational modifications on circulating nucleosomes, and cfDNA methylation were quantified in plasma samples from healthy donors and metastatic NSCLC patients with mutant or wild-type EGFR. Longitudinal analyses were performed in EGFR-mutant patients treated with tyrosine kinase inhibitors (TKIs). Functional relevance was assessed using in vitro and in ovo models of Osimertinib-sensitive and -resistant NSCLC cells combined with targeted epigenetic inhibitors. Distinct epimark signatures accurately discriminated healthy donors from NSCLC patients and distinguished EGFR-mutant from EGFR-wild-type tumors. cfRNA methylation marks (m1A, m6A, m5C, and m7G) showed excellent diagnostic performance, with a composite methyl-cfRNA score robustly distinguishing EGFR-mutant NSCLC. Disease progression under TKI therapy was characterized by increased m1A-cfRNA, H3K23Ac- and H4R3me2-circulating nucleosomes and decreased 5mC-cfDNA, with m1A-cfRNA alone reliably tracking progression. High m6A-cfRNA levels at diagnosis were strongly associated with shorter progression-free survival. Functionally, Osimertinib resistance promoted tumor growth and metastatic dissemination. Combination therapies targeting METTL3, KAT6A, or PRMT5 with Osimertinib reduced tumor burden and metastasis through miRNA-dependent regulation of histone acetylation and methylation. Circulating epimarks represent promosing diagnostic and prognostic biomarkers and provide a mechanistic basis for epigenetic combination therapies in EGFR-driven NSCLC.
A rapid, environmentally friendly, in situ deep eutectic solvent (DES) based liquid-liquid microextraction method was proposed for the preconcentration and determination of Fast Green (FG) and Erythrosine (ER) in food and pharmaceutical samples. The DES, which was synthesized in situ without the need for disperser liquids or prior preparation, was composed of thymol and tetrabutylammonium bromide (1:2). Key extraction parameters, including pH, DES ratio, extraction time, temperature, ionic strength, and centrifugation time, were adjusted to achieve maximum efficiency. The interaction mechanism between the dyes and DES was investigated using FT-IR and UV-Visible spectroscopy. Under optimal conditions, the method showed good linearity over 30-1200 µg L⁻¹ for FG and 48-2000 µg L⁻¹ for ER, with detection limits of 9.0 and 13.9 µg L⁻¹ for FG and ER, respectively. The method exhibited high precision (RSD < 4%) and satisfactory recoveries (97.5-99.9%) in spiked samples. Greenness assessment and applicability of the method were assessed using AGREEprep and Click Analytical Chemistry Index tools.
Uncinate process dissection and superior mesenteric artery (SMA) control represent critical steps in robotic pancreatoduodenectomy (RPD). However, the conventional right-sided uncinate-first approach may be technically demanding in patients with unfavorable anatomy, such as visceral obesity or bulky tumors. This multimedia article presents a video-based demonstration of a left-sided uncinate-first approach in robotic pancreatoduodenectomy. Two illustrative operative scenarios are used to demonstrate technical nuances of SMA exposure and uncinate process dissection in challenging anatomic conditions. The right-sided approach for a morbidly obese patient demonstrated limited SMA exposure due to increased operative depth and visceral adiposity, requiring substantial traction to identify the correct dissection plane. Conversely, the left-sided approach enabled early vascular control through creation of a mesenteric window, providing direct access to the SMA and facilitating a controlled medial-to-lateral uncinate dissection along a relatively avascular plane. This approach reduced traction on the superior mesenteric vein (SMV) and improved visualization of the posterior dissection plane. In all cases, R0 resection was achieved. The left-sided approach represents a feasible technical adjunct in robotic pancreatoduodenectomy. It may enhance SMA exposure and facilitate safer uncinate dissection in selected patients with challenging anatomy, particularly in obesity or bulky tumors. This strategy should be considered within the armamentarium of advanced robotic hepatopancreatobiliary surgery.
The present study aimed to evaluate the impact of intracanal medicaments-calcium hydroxide (CH) and calcium hydroxide/nano-chitosan (CH/NC)-on the push-out bond strength (POBS) of AH Plus (AHP) and NeoSEALER Flo (NSF). Nano-chitosan (NC) characterization was done using transmission electron microscopy (TEM), dynamic light scattering (DLS) and zeta potential analysis. Sixty extracted maxillary central incisors were instrumented up to X5 (50/0.06). Based on intracanal medicament used, specimens were allocated into three groups (n = 20): Group I; no intracanal medicament (control), Group II; (CH), and Group III; (CH/NC). Intracanal medicaments were removed after one week of incubation. Each group was subdivided based on sealer used (n = 10): subgroup A (AHP) and subgroup B (NSF). Obturation was performed with cold lateral compaction. After one week of incubation, roots were sectioned and a universal testing machine was used to evaluate POBS. Three-way ANOVA and Chi-square tests were conducted at 0.05 significance level. TEM showed mostly spherical NC particles with diameters less than 50 nm. DLS analysis revealed a hydrodynamic Z-average diameter of 62.4 nm with a polydispersity index of 0.195. Zeta potential analysis demonstrated a positive surface charge of + 47.57 mV. The "medication" factor, "medication/sealer", "medication/root level" and "sealer/root level" interactions significantly affected POBS (P < 0.05). Neither "sealer" nor "root level" factors significantly affected POBS (P > 0.05). Pooled POBS data revealed that: IA and IB subgroups were significantly higher than IIA, IIB, IIIA and IIIB subgroups (P < 0.05). Regarding failure mode, tested subgroups showed no significant difference (P > 0.05). Under the conditions of this study, prior application of CH or CH/NC reduced POBS for both sealers compared with controls. The addition of NC to CH did not provide a statistically significant improvement in POBS compared to CH alone. Overall, AHP and NSF demonstrated comparable POBS to root canal dentin.
Cisplatin is a prevalent anti-tumor agent despite its association with DNA damage, oxidative stress, myelosuppression, and hepatotoxicity, which may limit its use. The current study aims to assess the mitigating effect of selenium on cisplatin-induced hepatotoxicity. Thirty-two adult albino rats were evenly divided into four groups: the control group received normal saline, the CIS group was IP injected with a single dose of cisplatin (7.5 mg/kg BW) on the 22nd day, the SE group received selenium (1 mg/kg BW, orally) for 21 days, and the SE + CIS group received selenium daily followed by a single IP dose of cisplatin. Samples were collected for hemogram, liver function tests, hepatic redox status, expression of pro- and anti-inflammatory cytokines, and evaluation of pro-apoptotic proteins. In the CIS group, hepatobiliary enzymes, bilirubin, cholesterol, triglycerides, blood glucose, hepatic MDA, and TNF-α mRNA expression increased significantly (P ≤ 0.001) and correlated positively (r = 0.99-0.80) with hepatocyte necrosis, pro-apoptotic Bax, and Caspase-3 markers immunoreactivity. Total protein, albumin, globulin, SOD, CAT, GSH, and IL-10 expression significantly decreased (P ≤ 0.001) and correlated negatively (r = -0.99 to -0.80) with hepatopathies and pro-apoptotic marker expression. Indeed, hepatic damage scores and immunoreactivity for the pro-apoptotic markers Bax and caspase-3 were significantly ameliorated in the SE + CIS group. These mitigations showed strong correlations with improved liver function panel results, antioxidant capacity, and hepatocyte expression of IL-10 and TNF-α. Pretreatment with selenium mitigates cisplatin-induced hepatocellular toxicity by promoting IL-10 expression, quenching free radicals, and activating downstream Bax/Caspase-3 apoptotic signaling cascades.
Antiphospholipid syndrome (APS) is a complex autoimmune thrombo-inflammatory disorder characterized by diverse clinical manifestations and heterogeneous antibody profiles. We aimed to characterize the demographic, clinical, laboratory features, and treatment patterns of primary (PAPS) and secondary antiphospholipid syndrome (SAPS) patients in Egypt. A total of 510 APS patients were recruited from 14 rheumatology centers. Data on demographics, clinical manifestations, serologic findings, and medications were analyzed. The cohort included 406 females and 104 males (mean age: 32.0 ± 8.7 years); 42.4% had PAPS and 57.6% SAPS. SAPS patients had an earlier disease onset (p = 0.008). Thrombotic events and pregnancy morbidity were more common in PAPS (40.7% and 83.8%) than SAPS (19% and 47.3%) (p < 0.0001). In contrast, mucocutaneous symptoms, arthritis, oral ulcers, gastrointestinal, pulmonary, renal, and cardiovascular involvement, as well as ANA, anti-dsDNA positivity, and complement consumption, were significantly more frequent in SAPS (p < 0.0001). Antiphospholipid (APL) antibodies positivity was more common in PAPS (p < 0.0001). Ocular and CNS manifestations, along with APL positivity, were notably higher in males (p = 0.002, p = 0.02, and p < 0.0001, respectively). A lupus like presentation was seen in 10.6% of PAPS, All ANA and anti dsDNA positive. Seronegative PAPS constituted 7.9% of cases and had higher thrombotic rates (p = 0.004). PAPS and SAPS share several key features but exhibit clinical and serological profiles. Male APS patients more frequently present with ocular, and CNS involvement, and are more likely to be APL positive. Subsets of PAPS, including lupus like and seronegative forms, require further investigation.
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