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Urinary tract infections (UTIs) are the most prevalent type of kidney transplant (KT) recipients. We aimed to investigate the incidence, causes, and clinical impact of early recurrent UTI post-living donor KT and to examine the role of behavioral education program in management.This retrospective cohort chart-review study included all KT recipients with recurrent UTI necessitating hospital admission between September 2017 and August 2021. All patients with recurrent UTI were subjected to behavioral education for a month.UTI was found in 14 of 145 patients (9.6%), with recurrent UTI in 11 (7.6%). A total of 93% of UTIs occurred during the first 6 months post-transplant and represented 52% of KT readmissions during the same period. A total of 64.3% of patients were older than 50 years. The mean (SD) length of hospital stay was 5 (2.5) days, with an equal incidence in both sexes. The most common bacterial isolates in early recurrent UTI were Escherichia coli in 80.9%. Both Extended-spectrum beta-lactamases and multidrug-resistant organisms (resistance in ≥3 drugs) were seen in 82.4% of isolates. Furthermore, the most effective antibiotic was meropenem, with 86.7% effectiveness. A total of 65% of UTIs were managed with a single antibacterial course. A total of 64.3% of patients were older than 50 years. In patients who developed UTI, the mean (SD) serum creatinine was 1.31 (0.52) mg/dL, with a mean increase in serum creatinine of 0.19 mg/dL on having the episodes; at 1 year post-transplant, serum creatinine declined to 1.23 (0.43) mg/dL. Four patients (36%) had no recurrence of UTI after behavioral education.The multidrug-resistant bacterial isolates account for 82.4% of the UTIs. Therefore, antibiotic prescription should follow the antimicrobial stewardship guidelines. Behavioral education significantly reduced the incidence of recurrent UTI.

to investigate the effects of a successful KT on EF in male patients with ESRD.A single-center cross-sectional prospective study to assess the erectile dysfunction in male patients one month before and one year after KT. We adopted a validated, self-administered translated International Index of Erectile Function (IIEF-15) questionnaire. A sub-analysis was performed by categorizing the cohort into 2 age groups:50 and ≥50 yr.Between September 2017 and February 2021, 68 ESRD patients underwent kidney transplantation (KT), with a mean age of 48.9 ± 12.9 years. Thirty-one patients were below 50 years (Group I). The median hemodialysis duration was 12 months. Sixty-three patients (92.6%) had ED. The mean total IIEF-15 score before and after was 46.8/75 ±12.7 and 55.5 ±13, respectively (P.001). Forty-six patients (67.6%) reported improved erectile function, 22 (32.4%) did not demonstrate any change, and no patient reported deterioration. Moreover, after KT, sexual desire, orgasm, and overall patient satisfaction improved significantly. Before KT, 83.8% and 100% of groups I and II patients had ED, which dropped to 22.6% and 86.5%, respectively, after KT. IIEF-15 scores improved in both groups. However, the improvement in ED was observed significantly in young patients with mild ED.KT positively impacts sexual function and improves erectile dysfunction, especially among young patients. The duration of dialysis before kidney transplantation had no impact on ED improvement after transplantation. The positive effect of transplantation on ED could encourage ESRD patients to undergo KT.

Background Novel oral anticoagulants (NOACs) are widely used alternatives to warfarin, because they do not require routine monitoring and have better safety profile. There is limited experience for NOACs in organ transplant recipients. Methods This study assessed NOAC safety and efficacy among renal transplant recipients in a single center. A retrospective matched cohort study was conducted among the adult renal transplant recipients concomitantly administered calcineurin inhibitors (tacrolimus or cyclosporin) and NOACs between November 2015 and December 2019. Results The study included 16 patients divided into 2 equal groups on NOACs and warfarin. Male patients constitute 50% and 75% of the NOAC group and warfarin group, respectively, and 75% and 87.5% of cases are post living donor transplants in the NOAC group and warfarin group, respectively. In the NOAC group, the most common indication for anticoagulation was atrial fibrillation (62.5%), followed by deep vein thrombosis (37.5%), whereas in the warfarin group, the most common indication was atrial fibrillation (50%), followed by valve replacement (25%). In the NOAC group, 6 patients (75%) received rivaroxaban, 1 patient (12.5%) received dabigatran, and 1 patient (12.5%) received apixaban; 68.75% of patients were on a tacrolimus-based regimen. There were no thromboembolic events, rejection episodes, bleeding, or admissions due to NOAC adverse events. There were 3 cases of bleeding in the warfarin group. Calcineurin inhibitor levels and estimated glomerular filtration rate did not change significantly in the NOAC group (P = .34 and .96, respectively). Conclusions Compared to warfarin, NOACs are well tolerated and effective for preventing and treating thromboembolic events in renal transplant recipients. A larger randomized controlled study is required.

To assess the efficacy of endovascular venous sinus stenting (EVSS) in treating pulsatile tinnitus (PT) caused by dural venous sinus stenosis (DVSS), and to determine whether it is an adequate remedy in cases with concurrent venous anomalies.Seventeen patients (13 female and four male) with PT due to DVSS were treated using EVSS. The trans-stenotic pressure gradient (PG) was measured before and after stenting. The effect of stenting on the tinnitus was evaluated by questioning the patients at day 0, and at 3, 6, and 9 months after stenting.Except for one patient who continued to complain of PT, all of the patients, including two with concomitant sinus diverticula, described complete resolution of the tinnitus immediately following stenting. The post-stenting PG was significantly lower than the pre-stenting PG (p0.0001). No procedure related complications occurred and no recurrence was recorded during the follow-up period.EVSS is a safe and successful treatment for PT due to DVSS even in cases with coexistent sinus diverticula.

Rationale and Objectives Although computed tomography (CT) guided radiofrequency ablation (RFA) is accepted as the gold standard treatment for osteoid osteoma (OO) in extremities, most researchers have omitted OO in critical sites. We aimed to evaluate the efficacy and safety of CT-guided RFA in the management of OO in atypical sites. Materials and Methods A prospective interventional study conducted on 34 patients (12 women and 22 men; mean age, 22.3 ± 3.5 years; range, 12–48 years) with OO in atypical sites. All patients were treated with CT-guided RFA. All procedures were performed under general anesthesia using a single straight, rigid RF electrode for 6 minutes at 90°C. All patients were followed up; technical and clinical successes of treatment were evaluated. The severity of pain was assessed on a visual analogue scale (VAS). Results CT-guided RFA was performed in all patients with 100% technical success and 100% primary clinical success. All patients had complete pain relief and returned to their quality of life without further analgesics within 1 month after the procedure. All procedures were successfully completed without any major complications. The mean preprocedure VAS score dropped to zero by the end of the first week with a highly statistically significant difference (p Conclusion CT-guided RFA is a safe and effective procedure in the management of OO in atypical sites with 100% primary success rate, 0% long-term recurrence rate, and very low complication rate.

Hereditary angioedema (HAE), a potentially life-threatening genetic disorder due to C1 inhibitor deficiency in most cases, is characterized by sudden and/or recurrent attacks of angioedema (subcutaneous/submucosal swellings). The global World Allergy Organization (WAO)/European Academy of Allergy and Clinical Immunology (EAACI) International guideline for HAE management is comprehensive, but the implementation of this guideline may require regional adaptation considering the diversity in disease awareness, type of medical care systems, and access to diagnostics and treatment. The aim of this Delphi initiative was to build on the global guideline and provide regional adaptation to address the concerns and specific needs in the Middle East.The Consensus panel comprised 13 experts from the Middle East (3 from the United Arab Emirates, 3 from Saudi Arabia, 2 from Lebanon, 2 from Kuwait, 2 from Oman and 1 from Qatar) who have more than 2 decades of experience in allergy and immunology and are actively involved in managing HAE patients. The process that was carried out to reach the consensus recommendation included: 1.) A systematic literature review for articles related to HAE management using Ovid MEDLINE. 2.) The development of a questionnaire by an internationally acclaimed expert, with 10 questions specific to HAE management in the Middle East. 3.) Experts received the questionnaire via email individually and their answers were recorded (email/interview). 4.) A virtual consensus meeting was organized to discuss the questionnaire, make amends if needed, vote, and achieve consensus.The questionnaire comprised 10 questions, each with 2 or more statements/recommendations on which the regional experts voted. A consensus was reached based on a 70% agreement between the participants. The key highlights include: 1) HAE experts in the Middle East emphasized the importance of a positive family history for arriving at a diagnosis of HAE. 2) The number of episodes per month or per 6-month period and severity should be used, together with other markers, to determine the need for prophylaxis. 3) Disease status should be monitored by periodic visits and the use of patient-reported outcome measures such as the angioedema activity score and the angioedema control test. 4) Attenuated androgens and tranexamic acid may be considered for long-term prophylaxis, if lanadelumab, C1-Inhibitor or berotralstat are not available.This consensus recommendation may help to educate healthcare practitioners in the Middle East and unify their approach to the diagnosis and management of HAE.

BACKGROUND Race-related differences in clinical features, presentation, treatment and outcomes of patients with various cardiovascular diseases have been reported in previous studies. However, the long-term outcomes in black versus white patients with popliteal and/or infra-popliteal peripheral arterial disease (PAD) undergoing percutaneous peripheral vascular interventions (PVI) are not well known. METHODS AND RESULTS We retrospectively evaluated long-term outcomes in 696 patients (263 blacks and 433 whites) who underwent PVI for popliteal and/or infra-popliteal PAD at our institution between 2007 and 2012. When compared to white patients, black patients were younger (70 ± 11 vs. 72 ± 11; P = 0.002) and had more comorbidities: higher creatinine (2.04 ± 2.08 vs. 1.33 ± 1.16; P

Objectives\ud \ud To identify clinical and psychosocial predictors of oral health-related quality of life (OHRQoL) in children with molar incisor hypomineralisation (MIH) following aesthetic treatment of incisor opacities.\ud \ud \ud Methods\ud \ud Participants were 7- to 16-year-old children referred to a UK Dental Hospital for management of incisor opacities. Prior to treatment (To), participants completed validated questionnaires to assess OHRQoL and overall health status (C−OHIP-SF19), and self-concept (Harter’s Self-Perception Profile for Children [SPPC]). Interventions for MIH included microabrasion, resin infiltration, tooth whitening or composite resin restoration. Children were reviewed after six months (T1) when they re-completed the C−OHIP-SF19 and SPPC questionnaires. The relationships of predictors with improvement of children’s OHRQoL (T1-To) and children’s overall health status at T1 were assessed using linear and ordinal logistic regression respectively, guided by the Wilson and Cleary’s theoretical model.\ud \ud \ud Results\ud \ud Of 103 participants, 86 were reviewed at T1 (83.5 % completion rate). Their mean age was 11-years (range = 7−16) and 60 % were female. Total and domain OHRQoL scores significantly increased (improved OHRQoL) following MIH treatment. There was a significant positive change in SPPC physical appearance subscale score between To and T1. A higher number of anterior teeth requiring aesthetic treatment were associated with poor improvement of socio-emotional wellbeing at T1 (Coef =-0.43). Higher self-concept at To was associated with greater improvement of socio-emotional wellbeing at T1 (ß = 3.44). Greater orthodontic treatment need (i.e. higher IOTN-AC score) at T0 was linked to worse overall oral health at T1 (OR = 0.43).\ud \ud \ud Conclusions\ud \ud Psychosocial factors and dental clinical characteristics were associated with change in children’s OHRQoL following minimal interventions for incisor opacities.\ud \ud \ud \ud Clinical significance\ud \ud MIH is a common condition and clinicians should be aware of the negative impacts some children experience, particularly those with multiple anterior opacities, poor tooth alignment and low self-concept. However, simple, minimally invasive treatments can provide good clinical and psychosocial outcomes and should be offered to children reporting negative effects.

Honeybees have a limited capacity to control their body temperature when exposed to thermal changes in the atmosphere. Environmental changes, such as thermal climate change, have an adverse effect on honeybee survival. Insects can be pre-heat-treated (rapid heat hardening) with a mild heat stressor to induce Hsp gene expression and protect them from future stresses. Sixty accepted mother queen (MQ) larvae at the age of 7 days were selected and divided into two incubation treatment groups (n = 30). The control group (non-heat-treated mother queens, nH-T MQ) was maintained at 34.5 °C for 15 min and 70% relative humidity (RH), and the pre-heat-treated (pre-heat-treated mother queens, pH-T MQ) group was subjected to 41 °C for 15 min and 70% RH. To evaluate the effect of larval pre-heat-treatment on thermotolerance acquisition of daughter workers, about 500 workers were collected from brood combs of each treatment group. The worker bees in their cages were incubated in digital-controlled thermo-incubators for 1 h under each of the following temperatures: 35, 40, 45, 50, 55, and 60 °C. The expression of Hsp40, Hsp60, Hsp70, HSC70-3, HSC70-4, HSC70-5, Hsp83, and Hsp90 genes in both head and thorax were evaluated by relative quantitative real-time qPCR (RT-qPCR). In general, the pH-T MQ workers exhibited a higher ability to tolerate temperature than nH-T MQ workers under extreme conditions. Furthermore, we reported for the first time that pre-heat treatment of the mother queen's larvae alters the basal and dynamic expression of heat shock proteins (Hsp40, Hsp60, Hsp70, and Hsp90) and heat shock factor (HSF) during thermoneutral conditions and during heat stress of daughter workers, probably indicating a substantial improvement of honeybees' thermotolerance acquisition in arid and semi-arid regions, and improvement of honeybee longevity and management strategies.

This study presents the buckling response of functionally graded (FG) “sandwich plate” on a viscoelastic foundation and exposed to hygrothermal conditions. An accurate solution is developed using higher-order shear deformation theory (HSDT), with only four unknowns being placed to reach the solution. The displacement fields first utilize an indeterminate integral accompanied by a sinusoidal shape function to simulate the transverse shear deformation theory. The foundation’s mathematical model followed the two-Pasternak coefficient model, with one more term being added to represent the damping effect. The sandwich plate is essentially composed of three layers. This study presented three different FG sandwich plate geometric analytical solutions regarding layer orders and composition. The equations of motion were generated according to Hamilton’s principle. Thereafter, the analytical solution was based on Navier’s principle to solve the buckling temperature of a simply supported FG sandwich plate seated on a viscoelastic foundation. This paper shows a parametric study of the effect of the damping coefficient along with the aspect ratio, moisture condition, power-law index, and temperature variation over the buckling temperature of the FG “sandwich plate” on the viscoelastic foundation.

Immune checkpoint inhibitors (ICIs) have significantly advanced colorectal cancer treatment in recent years. Antibodies that target the proteins programmed cell death-1 (PD-1), programmed cell death-1 ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are among the ICIs that are currently being used in clinical practice. However, in colorectal cancer, ICI's effectiveness is limited to a fraction of patients with microsatellite instability-high (MSI-H), which only accounts for about 5% of advanced cases. The tumor microenvironment and intrinsic changes in tumor cells are just a couple of the many mechanisms that play a role in ICI primary or secondary resistance. In order to advance precision medicine and broaden the population benefiting from ICI, this paper highlights the main underlying mechanisms of ICIs resistance and suggested techniques to overcome it.