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Levels of electrically evoked stapedial reflex thresholds (eESRTs) are frequently used as most comfortable levels (MCL) in cochlear implant fitting. The problem of routine one-channel-technique of reflexometry is long duration of this procedure. In order to “compress the time” we suggest method of consecutive stimulation of all electrodes of implant with simultaneous registration of stapedial reflexes-SWEEP-session. Practical implementation of the SWEEP-session is described here. This method has been successfully used in several hundred CI patients. Registration of evoked electrical stapedial reflex thresholds (eESRTs) during CI fitting is long procedure. In order to “compress the time” we suggest our SWEEP-session method. Practical implementation of this SWEEP-session is described here in accordance with the patent of Russian Federation.

To facilitate understanding some issues of cochlear implantation for new beginners we wrote 1- “The Instruction for audiologists and cochlear implanted patients” and created 2-Demo-program MIMIC. Here are opinions of readers of “The Instruction” and participants of MIMIC. All the ratings are from positive to enthusiastic.

Subglottic hemangioma is the most common vascular tumor of the larynx of pediatrics; in contrast, it is relatively uncommon, accounting for an estimated 1.5% of congenital laryngeal anomalies [1].

Water deficit is a fundamental factor in public health and economic growth. Water supply and population growth are directly linked to water demand. The physio-chemistry and microbiology analysis of water is utmost significance in dietary requirements. Drinking water has the main concern especially it affects food security. This study includes a number of representative sites where 24 water samples (from wells, reservoirs and tap water) were analysed. These sites are located in the western villages of Baalbeck, the main city of the Bekaa Plain in Lebanon where the analysed water is used mainly for domestic needs and for irrigation. This study  investigates the physiochemical and microbiological properties. Among the selected sites, Hawsh Barada site shows a strong contamination by nitrate. At the Nabi Rashaded (tap), Beit Shema and Bednayel (borehole and tap), contamination above the norm by zinc ion was noted. From a microbiological point of view, Hawsh barada, Nabi-Rashadeh, Hawsh-bay, and Beit shema are markedly polluted and do not meet the standard for drinking water. Hence, water quality in Hawsh barada, Nabi-Rashadeh, Hawsh-bay, Beit shema and Bednayel are not suitable for drinking, and this must be informed to decision makers who can act implementing environmental controls for health protection in the studied region.

It is known today that psycho-trauma and PTSD cause different levels of mental and social dysfunction. Human spirituality and capacity to meet further life difficulties become severely damaged. There is wide accepted attitude today that in holistic approach in process of healing PTSD and psycho-trauma is necessary to include other professionals from community resource regarding needs of trauma victims. In Bosnia and Herzegovina after very severe war (1992-1995) as mental health professionals, we are faced with increasing number of different mental health disorders as result of severe trauma experiences. Regarding community based care orientation it is necessary to include and religion professionals. According national and religious background of majority of our population in Tuzla Canton that is Muslim, we meet spiritual needs of our clients as needs for Islamic explanation of life and death meaning. Our clients need to talk about spiritual issues in daily therapy and to practice daily religious rituals. Regarding that in this paper we tried to interface Islamic principles and it’s beneficial toward psycho-trauma and PTSD, as well as Muslim perspectives in attempt to apply spiritual practice in therapeutic tools for better efficacy in spiritual healing of mental dysfunction’s of believers who survived severe trauma, especially war trauma.

The physiological removal of foreign bodies in the horse’s external ear canal is best achieved by head-shaking. However, external otitis in the horse induces moderate to severe pain: therefore, the horse does not shake his head. The causes of external otitis are dust, water in the external ear canal, keratin, and ceruminous debris. The clinical symptoms are ear discharge, skittishness, facial nerve paresis, and/or head tilt. After the horse has been sedated, the most important diagnostic procedure is the endoscopy of the cartilaginous and osseous part of the external ear canal, including the evaluation of the transparency of the tympanic membrane. The clinical complications of external otitis are hearing loss, facial nerve paresis, head tilt, hypertrophy of the tympanostylohyoideum, and corneal ulcers. The most important treatment is soaking up the exudate in the osseous part of the external ear canal using small cotton balls which are held by the foreign body forceps of the endoscope. Based on the results of the culture of exudate and the antibiogram, an antibacterial drug must be administered orally for 3 to 4 weeks. At this time, an endoscopy of the external ear canals and guttural pouches also has to be done. Based on the outcome of the endoscopy, endoscopic and clinical investigations have to be performed six months later as well. Only 7/19 horses had a normal osseous part of the external ear canal with a transparent tympanic membrane, including normal hearing measured by the brainstem auditory-evoked response after one month of treatment.

Background: WHO grade II Low-grade gliomas (LGGs) need multi-disciplinary treatment from different specialties, directed by new molecular classifications and prognostic markers. Yet regional practice patterns and obstacles are not reported, especially in MENA countries.Method: A cross-sectional survey of physicians from MENA countries (including neurosurgeons, radiation oncologists, and medical oncologists) was conducted. An electronic anonymous survey, including clinical scenarios and evidence-based treatment choices, was distributed at professional conferences. The feedback included responses regarding surgical interventions, adjuvant treatment preferences, and barriers to adoption of IDH-mutant inhibitors.Results: 137 physicians (37.23% neurosurgery, 32.85% radiation oncology, 29.93% medical oncology). Most had 6–15 years of experience (56.21%) and worked in government (51.82%) or academic hospitals (25.55%). Maximal safe resection (MSR), if applicable, was preferred over biopsy (89.05% vs. 10.95%). For residual Astrocytoma, concurrent radiotherapy (RT) with temozolomide (TMZ) (42.34%) was the preferred adjuvant, while 44.53% prefer observation after gross total resection (GTR). For residual Oligodendroglioma, RT followed by PCV (45.99%) was preferred, with 59.85% offered observation post-GTR. Most (96.35%) agreed that resection extent impacts outcomes, while 72.99% objected to extending TMZ beyond six cycles. High-risk stratification varied: 46.72% used age ≥40 years, and 88.32% prioritized residual tumor volume. Although 64.96% supported IDH-mutant inhibitors, 58.39% cited limited availability as a barrier, followed by cost (40.88%) and insufficient long-term data (31.39%). Specialty-specific differences emerged: radiation oncologists tend more to provide adjuvant radiotherapy in the context of persistent seizure post-operatively (χ² = 20.50, p < 0.05), and medical/radiation oncologists more often used age ≥40 for high-risk stratification (χ² = 10.10, p = 0.038).Conclusion: There is a wide variation in the WHO grade II LGGs management among physicians in MENA Countries. These data highlight the importance of locally derived guidelines, the increased availability of molecularly directed therapies, and ongoing collaboration between multiple disciplines to ensure optimal patient outcomes.Key points:•    Maximal safe resection (89.05%) is the dominant surgical approach for WHO grade II LGGs, taking into consideration the location and extent of infiltration, among specialists in MENA Countries, reflecting global consensus on resection extent impacting outcomes (96.35% agreement).•    Adjuvant therapy preferences vary: concurrent RT+TMZ for astrocytomas (42.34%) and sequential RT+PCV for oligodendrogliomas (45.99%), with 59.85% observing post-GTR in oligodendrogliomas.•    IDH-mutant inhibitors (e.g., Vorasidenib) are supported by 64.96% of oncologists, but limited availability (58.39%) and cost (40.88%) hinder adoption.Importance of the study: This multicenter survey is the first to evaluate real-world management trends and barriers for WHO grade II low-grade gliomas (LGGs) among physicians in MENA Countries. While all specialists align with international guidelines in surgical strategies (e.g., maximal safe resection), significant heterogeneity exists in adjuvant therapy choices, particularly for astrocytomas versus oligodendrogliomas. Crucially, we identify systemic barriers—such as limited access to molecular therapies (IDH inhibitors) and cost constraints—that disproportionately affect WHO grade II LGGs care in the MENA Countries. Our findings underscore the urgent need for regionally adapted guidelines and multidisciplinary collaboration to standardize practices aligned with international guidelines. By highlighting disparities in resource availability and specialty-specific decision-making (e.g., radiation oncologists prioritizing post-resection seizures, p < 0.05), this study provides a roadmap for optimizing WHO grade II LGGs management in resource-limited settings and advocates for the inclusion of Arab populations in global trials of novel agents like Vorasidenib.

This study aims to make a database of the birds in the area of Elssuki, Sinnar state - Sudan. The period of study spanning from 2008 to 2023 with a mix of methods used to identify bird species in many sites in the locality, these methods include road count, line transects, and direct count besides registering every strange, rare, or unusual single species seen in the area. All these methods are used by different researchers and applied in such studies in Sudan.The study revealed that the area is one of the important areas enriched of birds in Sinnar state of 19 orders 53 families. The total number of species is 129 species. It included all birds; water birds, tree birds, diving birds, dabbling birds, swimming birds, small waders, and passerines which the most. The study concluded that there is a need for comprehensive and regular studies and short and long-term monitoring to identify, classify, and establish a database for Sudan Birds Atlas.

Purpose: To determine trends in breast imaging services utilization among privately and government-insured patients at a national radiology practice.Method: Monthly breast imaging volume data from January 2019 to September 2022 were analyzed across five insurance types: three commercial carriers (Com1-Com3), Medicaid, and Medicare. Primary analysis involved calculating quarterly volumes and standard errors of the mean, followed by a joinpoint regression to identify trend inflection points and quarterly percentage changes (QPC). In the secondary analysis, the entire period trend was obtained and measured as the average quarterly percentage change (AQPC).Results: Between 2019 Q1 and 2022 Q3, a total of 4,640,619 breast imaging services were accessed, including 2,034,833 2D screening mammograms, 1,640,689 screening digital breast tomosynthesis, 497,592 diagnostic mammograms, 452,549 breast ultrasounds, and 14,956 breast MRIs. AQPC values for imaging modalities varied across insurance types. Medicare and Medicaid patients showed the highest rates of utilization increases, particularly for modalities other than screening breast tomosynthesis, where private insurers dominated. Variations were observed between different commercial payors.Conclusion: Breast imaging utilization increased among patients insured by Medicare and Medicaid from 2019 to 2022, outpacing that of those with private insurance. These findings contrast previous research suggesting better access and utilization among privately insured individuals, highlighting increased access for government-insured patients in this study.

Iatrogenic ureteral injury is an uncommon but potentially severe complication of abdominopelvic surgery. When not identified intraoperatively, it may present days to weeks later with flank pain, fever, urinary tract infection, and imaging evidence of obstruction. Early recognition and timely urinary diversion are essential to prevent sepsis and preserve renal function.A 65-year-old patient underwent elective resection of an abdominal mass; pathology confirmed schwannoma. On postoperative day 15, the patient developed left flank pain and fever. Laboratory tests showed leukocytosis (WBC 15,000/mm³) and elevated C-reactive protein (150 mg/L); urine culture grew Escherichia coli. Contrast-enhanced CT demonstrated left hydronephrosis without stones, suggesting postoperative ureteral obstruction. Retrograde double-J stenting was attempted but failed. Urgent percutaneous nephrostomy achieved decompression with clinical improvement under targeted antibiotics. Definitive exploration revealed a 1 cm stricture of the lumbar ureter, managed by segmental resection and tension-free spatulated termino-terminal ureteroureterostomy over an internal stent. Postoperative recovery was uncomplicated; the stent was removed after 3 weeks. Follow-up ultrasound showed no persistent pelvicalyceal dilatation.Delayed ureteral obstruction should be suspected in postoperative patients presenting with flank pain, fever, and hydronephrosis. When retrograde stenting fails in the setting of infection, percutaneous nephrostomy provides rapid decompression and source control, allowing delayed definitive reconstruction. For short-segment proximal or mid-ureter strictures, ureteroureterostomy remains a reliable option when performed according to reconstructive principles.