Search

Background: Ascites are pathological conditions characterized by the accumulation of fluids in the peritoneal cavity. Ascites are among the most common complications of different diseases in pediatrics, such as renal diseases, cardiac diseases, and hepatic diseases. The pediatric group is considered a vulnerable category needing special care, so assessing the management of ascites in pediatrics needs to be addressed. Aim: The study was conducted to assess ascites' management in pediatrics in Jafar Ibn Auf pediatric hospital. Methods: A descriptive retrospective study was conducted at Jafar Ibn Auf pediatric hospital, Khartoum, Sudan. All medical files of pediatrics with ascites from 1 month to 18 years old during the period between 2017-2020 were included. Data were collected from file records using a predesigned data collection sheet and analyzed using the statistical package for the social sciences (SPSS) version 23. Results: A total of 143 medical records were included in this study. The majority of the group were males. The most affected patients were within the age group of ˂ 6 years old. Grade I was the most common presentation. Hepatic diseases and gastrointestinal diseases were the main etiological factors for ascites and represented in 62.2% and 15.4%, respectively. Regarding ascites management, the most frequent method of managing ascites used was medications with liver support. Moreover, 63.2% of the patients were treated by combining spironolactone with furosemide. Out of the 143 patients, 92.3% of patients were discharged from the hospital, while the remaining were referred to other hospitals. Statistically, there was a strong association between the grade of ascites, management of ascites, and the patient's discharge (P = 0.001). Conclusion: The results showed that liver diseases were the most common etiological cause of ascites in pediatrics. The majority of patients were treated properly managed in term of dose, and the combination of spironolactone and furosemide were the most frequently used medications in this study. The proper diagnosis and appropriate management of ascites is critical to prevent related morbidity and mortality in pediatrics.

Introduction As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear. Materials and Methods We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC. Results Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): −0.042 (−0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer’s disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness. Conclusions Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.

Cerebral Palsy (CP) is a disabling condition that affects a child's life and his/her family irreversibly. It is usually a non-progressive condition but improvement over time is rarely seen. The condition can be due to prenatal hypoxia, metabolic, genetic, infectious, traumatic or other causes. It is therefore a heterogeneous group that results in functional motor disability associated with different degrees of cognitive abnormalities. There are no treatments that can cure or even improve CP and the best available approach aims at functional, social and nutritional supportive care and counseling. In this paper, we report 17 sequential patients with CP treated with intrathecal administration of Bone Marrow Mononuclear Cells (BMMC). All patients had an uneventful post-injection course with 73% of the evaluable patients treated having a good response using the Gross Motor Function Classification System (GMFCS). The average improvement was 1.3 levels on the GMFCS with cognitive improvements as well.

Tree seedlings loaded with nutrients during nursery production have shown increased growth and survival relative to standard seedlings upon outplanting. We examined outplanting performance of nutrient loaded and standard trembling aspen (Populus tremuloides) seedlings, along with composition and cover of competing vegetation, on a boreal oil sands reclamation site with two different soil types (forest floor mineral mix and peat mineral mix) and four different broadcast fertilizer applications [250 kg/ha immediately available fertilizer (IAF), 500 kg/ha IAF, 670 kg/ha controlled release fertilizer, and an unfertilized control]. Average height growth across all treatments was 19 % greater for nutrient loaded aspen seedlings than standard seedlings after two growing seasons. With respect to soil types, aspen growth was greater on peat mineral mix and seedlings growing in this soil type showed a greater response to both nutrient loading and fertilization; however, this could partially be attributed to greater cover by competing vegetation on the forest floor mineral mix. In the first growing season, trees treated with immediately available fertilizer showed the greatest growth response but in the second growing season only the controlled release fertilizer application resulted in growth rates greater than the controls. Fertilizer regime had similar effects on total cover of competing vegetation, although fertilization additionally promoted increased cover of grasses in the forest floor mineral mix. Overall, we clearly show that nutrient loaded trembling aspen seedlings can be used to offset early field fertilization needs at forest reclamation sites.

We tested whether direct placement of forest floor material (FFM: litter, fibric, humus layers and surface mineral horizons) and sowing of a cover crop (Melilotus officinalis) could facilitate the establishment of native forest understory species at a reclaimed coal mine in Alberta, Canada. FFM was salvaged at two depths (15 and 40 cm) from a recently harvested native aspen forest and immediately placed at the same depths on the reclamation site. Total richness (approximately 61 species in 96 subplots) was similar in each of 3 years post-placement; total richness for all 3 years combined was 87 including 34 typical boreal forest understory species plus 30 other natives. The deeper treatment reduced cover of all species, native and non-native species in year 1. In year 3, the deeper treatment still had lower cover of non-native species but had higher cover of forest understory species in years 2 and 3. The deeper treatment also resulted in lower species richness per plot, but only in year 1. In year 2 (when the biennial clover was at its tall stage), the cover crop treatment was associated with lower cover of non-native species but did not affect the cover of native forest understory species. Direct placement of FFM can help facilitate establishment of a diverse native boreal forest understory in a reclaimed landscape. Although richness and cover may be initially higher with shallower salvage and placement, deeper salvage may ultimately be better for encouraging establishment of native forest understory species.

Most data in the literature include frequencies of these antigens in European and American countries. In this study for the first time we have reported frequencies of these antigens in the Thi-Qar of Iraq.The aim of the present study was to record the various blood groups among the population of Thi-Qar and to compare it with other populations.To determine the prevalence of different blood groups and Rh factors in a random population sample from urban and rural areas of Thi-qar of Iraq.Blood group and Rh factor determination was carried out by the antigen-antibody agglutination test. The frequency of each type was calculated.Out of 2841 subjects 4804 (59.1%) were male subjects and 1963 (40.9%) were female. The overall phenotypic frequencies of ABO blood in three groups in the total sample was O>A>B>AB.The frequencies of ABO and Rh phenotypes in Thi-Qar are similar to those reported from most areas in the Arabian region

Diabetes mellitus type II considers as inflammatory disease, which it associated with increasing level of sensitive inflammatory proteins, Adult patients with DM type II may progress a slowly failure of Beta-cells. Some patients show an autoimmune nature of the disease, our Present study aimed toevaluatethe relationship between autoantibodies which includes islet cell antibodies and insulin autoantibodies along with some inflammatory sensitive proteins like Ceruleplasminand Transferrinin type II diabetes mellitus of recent onset disease in an Iraqi population. A total of 50 patients with type II diabetes mellitus were studied as well as 31 control healthy individuals,the individuals in each group were divided into sub groups according to the presence of autoantibodies. The present study tested the presence of both autoantibodies against islet cells in both patients and control groups, the results show the presence of at least one type of autoantibodies and the coexistence of two types of autoantibodies where observed in three patients, therefore, the individuals in each group were divided into sub groups according to the presence of autoantibodies. Serum Ceruloplasmin level showed significant increasing between negative patients group and negative control group, but this increasing is non-significant between positive patients group and positive control group. Positive control group showed significant increasing in serum Ceruloplasmin level compared to negative control group and thatincreasing made serum Ceruloplasmin level in positive control group closely related to its level in positive patient group, while positive patient group showednon- significant increasing compare to negative patient group. Transferrin showed non-significant decreasing level in patient group compared with control for both groups of autoantibody. Present results may refer to inflammatory aspects of disease which associated with autoimmunity markers, moreover, the presence of autoantibodies increased the serum Ceruloplasmin level and decreased level of Transferrin even in healthy individuals. Present conclusion could help in the diagnosis and provide protection from developing disease.

Early diagnosis of sepsis is a very critical matter especially for soldiers in battle field; on the other hand, Procalcitonin is a new promising biomarker for fast and accurate diagnosis of sepsis. The aim of this study is to investigate the ability of Procalcitonin (PCT) to indicate sepsis earlier than blood culture and other traditional biomarkers and then get use of this in early diagnosis of sepsis.Procalcitonin concentration was measured in 44 sera of Iraqi wounded soldiers who were admitted to GHAZI AL-HARIRI Hospital for surgery, using ELISA kit of BioRay/USA, along with blood culture and other infection biomarker like C-reactive protein, ESR, W.B.C. count. Six patients had elevated PCT and 3 of them had positive blood culture, two of these three died. PCT has good correlation with other inflammatory biomarkers. It is our recommendation to accredit PCT as a very early biomarker of sepsis in Iraqi hospitals along with blood culture but earlier than it, and to use the quick test of PCT in battlefield to determine the priority of transmission of wounded soldiers to hospitals.

BACKGROUND: The phase III PAOLA-1/ENGOT-ov25 study (NCT02477644) showed that addition of olaparib to bevacizumab maintenance improved progression-free survival (PFS) in patients with newly diagnosed advanced ovarian cancer. We evaluated maintenance olaparib plus bevacizumab in older patients in PAOLA-1. METHODS: Baseline clinical and molecular data, and PFS, were compared between older (aged ≥65 years) and younger patients (

BACKGROUND: PAOLA-1/ENGOT-ov25 (NCT02477644) demonstrated a significant progression-free survival (PFS) benefit with maintenance olaparib plus bevacizumab versus placebo plus bevacizumab in newly diagnosed, advanced ovarian cancer. We report the prespecified main second progression-free survival (PFS2) analysis for PAOLA-1. METHODS: This randomised, double-blind, phase III trial was conducted in 11 countries. Eligible patients had newly diagnosed, advanced, high-grade ovarian cancer and were in response after first-line platinum-based chemotherapy plus bevacizumab. Patients were randomised 2:1 to olaparib (300 mg twice daily) or placebo for up to 24 months; all patients received bevacizumab (15 mg/kg every 3 weeks) for up to 15 months. Primary PFS end-point was reported previously. Time from randomisation to second disease progression or death was a key secondary end-point included in the hierarchical-testing procedure. RESULTS: After a median follow-up of 35.5 months and 36.5 months, respectively, median PFS2 was 36.5 months (olaparib plus bevacizumab) and 32.6 months (placebo plus bevacizumab), hazard ratio 0.78; 95% confidence interval (CI) 0.64-0.95; P = 0.0125. Median time to second subsequent therapy or death was 38.2 months (olaparib plus bevacizumab) and 31.5 months (placebo plus bevacizumab), hazard ratio 0.78; 95% CI 0.64-0.95; P = 0.0115. Seventy-two (27%) patients in the placebo plus bevacizumab group received a poly(ADP-ribose) polymerase inhibitor as first subsequent therapy. No new safety signals were observed for olaparib plus bevacizumab. CONCLUSION: In newly diagnosed, advanced ovarian cancer, maintenance olaparib plus bevacizumab provided continued benefit beyond first progression, with a significant PFS2 improvement and a time to second subsequent therapy or death delay versus placebo plus bevacizumab. ispartof: EUROPEAN JOURNAL OF CANCER vol:174 pages:221-231 ispartof: location:England status: published

OBJECTIVES: Adding maintenance olaparib to bevacizumab provided a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the randomized, double-blind PAOLA-1/ENGOT-ov25 trial (NCT02477644). We analyzed PFS by clinical risk and biomarker status. METHODS: Patients received olaparib 300 mg twice daily for up to 24 months plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total, or placebo plus bevacizumab. This post hoc exploratory analysis evaluated PFS in patients classified as higher risk (stage III with upfront surgery and residual disease or neoadjuvant chemotherapy; stage IV) or lower risk (stage III with upfront surgery and no residual disease), and by biomarker status. RESULTS: Of 806 randomized patients, 74% were higher risk and 26% were lower risk. After a median 22.9 months of follow-up, PFS favored olaparib plus bevacizumab versus placebo plus bevacizumab in higher-risk patients (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.49-0.74) and lower-risk patients (0.46; 0.30-0.72). Olaparib plus bevacizumab provided a substantial PFS benefit versus bevacizumab alone in the homologous recombination deficiency (HRD)-positive subgroup (higher risk: HR 0.39; 95% CI 0.28-0.54 and lower risk: 0.15; 0.07-0.30), with 24-month PFS rates in lower-risk patients of 90% versus 43%, respectively (Kaplan-Meier estimates). CONCLUSIONS: In PAOLA-1, maintenance olaparib plus bevacizumab provided a substantial PFS benefit in HRD-positive patients with a reduction of risk of progression or death of 61% in the higher-risk group and of 85% in the lower-risk group compared with bevacizumab alone. ispartof: GYNECOLOGIC ONCOLOGY vol:164 issue:2 pages:254-264 ispartof: location:United States status: published

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. We report the final prespecified analysis for overall survival (OS), along with updated progression-free survival (PFS) and objective response rate (ORR), and safety from the open-label, randomized, phase III Study 309/KEYNOTE-775. In total, 827 patients with advanced, recurrent, or metastatic endometrial cancer (EC) were randomly assigned to receive lenvatinib 20 mg orally once daily plus pembrolizumab 200 mg intravenously once every 3 weeks (n = 411) or chemotherapy of the treating physician's choice (doxorubicin 60 mg/m2 intravenously once every 3 weeks or paclitaxel 80 mg/m2 intravenously once weekly [3 weeks on; 1 week off] [n = 416]). Efficacy was reported for patients with mismatch repair proficient (pMMR) tumors and all-comers, and by subgroups (histology, prior therapy, MMR status). Updated safety was also reported. Lenvatinib plus pembrolizumab showed benefits in OS (pMMR HR, 0.70; 95% CI, 0.58 to 0.83; all-comer HR, 0.65; 95% CI, 0.55 to 0.77), PFS (pMMR HR, 0.60; 95% CI, 0.50 to 0.72; all-comer HR, 0.56; 95% CI, 0.48 to 0.66), and ORR (pMMR patients, 32.4% v 15.1%; all-comers, 33.8% v 14.7%) versus chemotherapy. OS, PFS, and ORR favored lenvatinib plus pembrolizumab in all subgroups of interest. No new safety signals were observed. Lenvatinib plus pembrolizumab continued to show improved efficacy versus chemotherapy and manageable safety in patients with previously treated advanced EC.

Background: In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. Patients and methods: Patients were randomized 2: 1 to olaparib (300 mg twice daily; up to 24 months) plus bevacizumab (15 mg/kg every 3 weeks; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. Results: After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the intention-to-treat population [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.76-1.12; P = 0.4118]. Subsequent poly(ADP-ribose) polymerase inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR 0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR 0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. Conclusions: Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving poly(ADP-ribose) polymerase inhibitors after progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure. in press