Background: Vascular calcification (VC) represents one of the major complications associated with progressive renal impairment. Matrix Gla-protein (MGP) is a vitamin Kdependent protein that acts as a powerful inhibitor of vascular calcification. Despite this fact, it remains unknown whether supplementation with vitamin K can lead to reduction or reversal of vascular and heart valve calcification. Our study aims primarily to investigate the effect of oral vitamin K1 three times weekly for a total duration of 6 months on the serum levels of dephosphorylated-uncarboxylated MGP (dp-ucMGP) as well as aortic calcification score and severity of aortic and mitral valve lesions. As secondary objectives, we investigated the association between hyperphosphatemia or dialysis duration and the radiologic aortic calcification or the severity of aortic and mitral valve lesions. Methods: One hundred and twenty end-stage kidney disease (ESKD) patients on regular HD for > 6months with a high level of Serum dp-ucMGP were enrolled and were supplemented with 5 mg of vitamin K1 3 times /week for 6 months after each HD session. Serum dp-ucMGP, echocardiography, Plain lateral abdominal x-ray were performed before and 6 months after vitamin K1 supplementation. Results: We found a significant difference in the baseline dp-ucMGP (pM) in relation to severity of aortic or mitral valve lesions at baseline (p <0.001; p = 0.001, respectively), so that severe aortic and mitral valve lesions were associated with higher dpucMGP levels. Compared with baseline levels, serum dp-ucMGP was about 8 times lower after supplementation with vitamin K1 for 6 months (p<0.001). Despite this decrease, we found no significant change in the radiologic aortic calcification score (p = 0.083), or the severity of aortic and mitral valve lesions compared to the baseline evaluation (p=0.059 and 0.083, respectively). Conclusion: our findings suggest that hemodialysis patients show increased serum levels of dp-ucMGP which might occur subsequent to the progressive vascular and heart valvular calcification. Although vitamin K supplementation in hemodialysis patients leads to activation of dp-ucMGP into pcMGP, this might not be sufficient on the short run to drive a significant reduction in aortic calcification score or in the severity of aortic or mitral valve lesions. Keywords: Vitamin K, ESRD, Vascular calcification, Hemod

Streptococcus pneumoniae remains an important bacterial pathogen, particularly for young children in low- and middle-income countries. A systematic review was conducted of peer-reviewed literature from PubMed published as of May 13, 2020, to identify articles relevant to invasive pneumococcal disease, pneumonia, otitis media (OM), nasopharyngeal carriage (NPC), antimicrobial resistance (AMR), and vaccination coverage in Egypt, with particular focus on children B 18 years of age. A total of 16 relevant articles spanning three decades were included in this review. Among studies reviewed, S. pneumoniae was the causative agent of meningitis in 21–30% of cases among hospitalized children between 1983 and 2003. One study showed that serotypes 6A and 6B predominated among meningitis cases of pediatric patients aged\5 years. This review also revealed that S. pneumoniae was the most commonly identified bacterial pathogen of acute mastoiditis, a severe complication of acute OM, among children aged 9 months to 11 years. NPC studies showed that approximately 30% of Egyptian children were carriers of S. pneumoniae. AMR, especially to penicillin, continues to be a growing concern in low- and middle-income countries, including among Egyptian children. Several predominant serotypes were identified to be associated with penicillin resistance, such as 6B, 1, 19A, 23F, and 6A. Currently available pneumococcal vaccines (PCVs) such as PCV10 and PCV13 may provide coverage against the most prevalent circulating serotypes among Egyptian children. Comprehensive disease surveillance and immunization programs are needed to ensure that this vulnerable population is sufficiently protected against pneumococcal disease

The aim of this prospective study was to evaluate the correlation of primary tumor metabolic activity parameters; maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) with clinical, histopathological and molecular characteristics of initial staging breast cancer (BC) patients using 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan. Forty female patients with newly diagnosed BC were enrolled in our study, age ranging from 31-78 years (mean 50.5 +/- SD11.7). All the primary tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of primary tumor was higher in premenopausal , stage III and IV, Estrogen Receptors negative( ER-), Progesterone Receptors negative(PR-), Human epidermal growth factor receptor 2 positive ( Her2neu+) patients, high nuclear grade (GIII), triple negative molecular subgroup (TN) and positive axillary lymph node (ALNs) metastasis,(P= 0.003, 0.017, 0.113, 0.089 0.01 ,0.002 , 0.007 and 0.016 respectively). The mean/median TLR values was higher in premenopausal ,Her2neu+, GIII, TN molecular subtype patients, stage III and IV and in patients with positive ALNs , ER- and PR - patients (P= 0.002, 0.0476 , 0.005 , 0.018 , 0.039 and 0.022, 0.095 and 0.129 respectively). SUVmax of the primary lesion and TLR were moderately negatively correlated with the age of the patients (P= 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the primary tumor (P= 0.019 and 0.036 respectively). TLR was predictive of nodal involvement AUC= 0.612 (95% CI: 0 …