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Children with sickle cell disease (SCD) are at a high risk for neurocognitive impairment. We aim to quantitatively measure cerebral tissue R2* to investigate the brain iron deposition in children and young adults with SCD in comparison to beta thalassemia major (BTM) and healthy controls and evaluate its impact on neurocognitive functions in patients with SCD. Thirty-two SCD, fifteen BTM, and eleven controls were recruited. Multi-echo fast-gradient echo sequence brain MRI was performed, and brain R2* values of both caudate and thalamic regions were calculated. SCD patients were examined for the neurocognitive functions. SCD had high iron overload 0.30 ± 0.12 mg/kg/day. 68.9% of SCD had under-threshold IQ, 12.5% had moderate to severe anxiety, and 60.8% had depression. There were no differences between SCD, BTM, and controls in brain MRI except that left thalamus R2* higher in BTM than both SCD and controls (p = 0.032). Mean right caudate R2* was higher in female than male (p = 0.044). No significant association between brain R2* and LIC or heart R2* values in SCD. Left caudate R2* directly correlate with age and HbS%, and negatively correlate with HbA% while right thalamus R2* negatively correlate with transfusion index and among SCD patients.Conclusion: Neurocognitive dysfunction in SCD could not be explained solely by brain iron overload. What is Known: • Children with sickle cell disease are at great risk of brain damage due to their irregularly shaped red blood cells that can interrupt blood flow to the brain. • There are a number of factors that have negative brain effects that result in learning difficulties, and this not only due to increase brain iron content. What is New: • Assessment of quantitative brain iron content using MRI R2* in children and young adults with SCD in comparison to beta thalassemia major and healthy controls. • Impact of brain iron content on neurocognitive functions of children and young adults with SCD.

We consider intermittently connected vehicular networks (ICVNs) in which base stations (BSs) are installed along a highway to connect moving vehicles with internet. Due to the deployment cost, it is hard to cover the entire highway with BSs. To minimize the outage time in the uncovered area (UA), several store-carry-forward (SCF) schemes have been proposed in which a vehicle is selected to act as a relay by buffering data to be relayed to a target vehicle in the UA. In this paper, we propose a full-duplex (FD) SCF scheme that exploits the relay's ability to simultaneously receive and transmit in order to improve the effective communication time (ECT) with the target vehicle and accordingly deliver more data to it in the UA. The optimal power allocation (PA) that maximizes the ergodic capacities of the links is determined and the amount of data that can be buffered inside the BS coverage and can be delivered by each relay candidate to the target vehicle in the UA is found. Since the relay cannot deliver more data in the UA than what can be buffered inside the coverage, the performance of each relay candidate is limited by the minimum of the two amounts and hence is used as a relay selection (RS) criteria. To reduce the computational complexity, an alternative RS scheme that selects the relay candidate that offers the highest ECT is proposed. As compared to half-duplex SCF schemes, simulation results show that the proposed FD schemes are capable of delivering significantly higher amount of data to the target vehicle in the UA.

Background Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about I in every 5 deaths. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD of the utmost importance. The recent years showed an overall increase in the use of CT for imaging of the heart and coronary arteries, coronary CT angiography is a rapidly growing technique that offers distinct advantages over traditional imaging techniques. However, because of rapid growth of this technique, radiation dose safety has been placed under the spotlight. Integration of dosesaving techniques will go a long way in maintaining diagnostic image quality and improving patient safety. Objectives The purpose of our study is the assessment of coronary artery disease by 320 MDCT and its capabilities of maintaining the quality of images and dose reduction improving patient safety. Patients and Methods This study was performed at New Cairo Police Hospital (Radiology department) and at Center in East Cairo, From October 2018 to October 2019, a total of 39 patients who had referred for CTCA for suspicion of coronary artery disease enrolled in our prospective study. Results In this study we used MDCT 64 with retrospective ECG-gating in 25.6% of patients (10 patients) and MDCT 320 with Retrospective ECG-gating was used in 25.6% (10 patients) and with Prospective ECG-gating in 48.8% (19 patients).we compared the radiation dose between prospective ECG-gating and retrospective ECG-gating acquisition techniques among all study population by the effective dose (ED) which is calculated from the DLP of the coronary scan. The effective radiation dose (ED) median was significantly lower in the prospective ECG-gating technique (7 msv) in comparison to retrospective ECG-gating technique (23 msv). We also compared the difference in radiation dose between MDCT 320 and 64 using retrospective ECG gating acquisition technique, the median (ED) was significantly lower in the 320 MI)CT technique (20 msv) in comparison to 64 MDCT (26 msv). The last comparison was the difference Of radiation dose between patients who underwent through MDCT 320 using two different techniques (prospective and retrospective), the median effective dose was lower in the prospective ECG-gating technique (7 msv) in comparison to retrospective ECG-gating technique (20 msv) this difference is also of high statistical significant value. Conclusion Prospective ECG-Gated CT coronary angiography protocol impressively reduces effective radiation doses in comparison to retrospective ECG-gated technique on 320 MDCT and is still sensitive for diagnosing significant coronary stenosis for patients with suspected CAD. Retrospective Coronary CT angiography can be performed with 320-MDCT with less radiation doses compared to 64-MDCT.

Background: Gut microbiota cluster into three enterotypes named the Bacteroides, Prevotella and Ruminococcus. While each person’s microbial “fingerprint” is unique, there are specific patterns seen in those that are healthy and those that have specific illnesses. The aim of the present study is to identify the enterotypes that are likely related to Multiple Sclerosis Egyptian patients as well as their possible role in the course of the disease. Subjects & Methods: Thirty patients with remitting relapsing multiple sclerosis, who presented to the MS Clinic of Alexandria University Hospital were enrolled in our study. These were diagnosed according to according to McDonnald 2017 criteria. A cross matching control group of 20 healthy subjects of similar age and sex were included. Stool specimens were taken from each. Quantitative SYBR Green Real-Time PCR was done for the identification and quantitation of Bacteroides, Prevotella and Ruminococcus which constitute the core of the three major enterotypes. Results: Enterotype 1 is the most common enterotype detected in MS and control cases (80% versus 65%). For Enterotype 3, it was not detected in any of the 20 control cases while detected in multiple sclerosis case (16.7%). However, by comparing the multiple sclerosis and control cases Enterotype 2 is significantly less in multiple sclerosis than control (3.3% versus 35%). Conclusion: Although Enterotype 2 is significantly less in multiple sclerosis patients, collapsing the whole microbiome variations into dominant enterotypes was not appropriate to identify disease association or to be used as a disease biomarker.

Medical thoracoscopy (MT) has changed how we manage exudative pleural effusion. It is a minimally invasive procedure used as a diagnostic and therapeutic tool in pleural disease. Here, we report a case of a lymphocytic exudative pleural effusion that needed a pleural biopsy for diagnosis. Medical thoracoscopy was performed, a biopsy was taken, and adhesiolysis was performed. Medical thoracoscopy has been practiced for a while worldwide, but it has not been utilized in the Kingdom of Saudi Arabia and as we believe that it is useful in diagnosing exudative pleural effusions. It limits patients in hospital-stay and it may be less costly than surgical procedures. It is especially helpful in diagnosing and treating pleural effusions in elderly patients with multiple comorbidities. Such procedures are needed to ease ongoing financial constraints, and with the 2019 coronavirus disease (COVID-19) pandemic, less time in the hospital means better utilization of beds during the pandemic. Spreading the knowledge about this procedure and its availability in the country will improve the health services provided to the patients.

BACKGROUND: Left ventricular (LV) volumes and ejection fraction (EF) is Strong prognostic indicators for DCM. Cardiac MRI (CMRI) is a preferred technique for LV volumes and EF assessment due to high spatial resolution and complete volumetric datasets. Three-dimensional echocardiography is a promising new technique under investigations. AIM: Evaluate 3D echocardiography as a tool in LV assessment in DCM children about CMRI. PATIENTS AND METHODS: A group of 20 DCM children (LVdiastolic diameter < 2 Z score, LVEF < 35%) at Children s Hospital, Ain-Shams University (gp1) (mean age 6.6 years) were compared to 20 age and sex-matched children as controls (gp2). Patients were subjected to: clinical examination, conventional echocardiography, automated 3D LV quantification, 3D speckle tracking echocardiography (3D-STE) (VIVID E9 Vingmed, Norway) and CMRI (Philips Achieva Nova, 1.5 Tesla scanner) for LV end systolic volume (LVESV), LVend diastolic volume (LVEDV) that were indexed to body surface area, EF% and wall motion abnormalities assessment. RESUTS: No statistically significant difference was found between automated 3D LV quantification echocardiography, 3D-STE, and CMRI in ESV/BSA and EDV/BSA assessment (p = 1, 0.99 respectively), between automated LV quantification echocardiography and CMRI in EF% assessment (p = 0.99) and between CMRI and 3D-STE in LV Global hypokinesia detection (P = 0.255). As for segmental hypokinesia CMRI was more sensitive [45% of patients vs. 40%, (P = 0,036), basal septal hypokinesia 85% vs. 75%, (p = 0.045), mid septal hypokinesia 80% vs. 65%, (p = 0.012) and lateral wall hypokinesia 75% vs. 65%, (p = 0.028)]. CONCLUSION: Automated 3D LV quantification echocardiography and 3D-STE are reliable tools in LV volumetric and systolic function assessment about CMRIas a standard method. 3D speckle echocardiography is comparable to CMRI in global wall hypokinesia detection but less sensitive in segmental wall hypokinesia which mandates further studies.

Objective: of this study is to set standard values for the native T1 values in both normal and diseased myocardium on a 3 tesla MRI machine. Methodology: this study was carried out in Misr Radiology Center. 31 patients were divided into normal group (control) including 10 patients and diseased group including 21 patients. Result: The native T1 values on the healthy myocardium ranged from 1110 to 1300 msec, with ECV values ranging from 25 to 33 % with variable elevations of the native T1 and ECV values according to the pathology affecting the myocardium. We concluded that the above values are the reference values for the 3 T MRI machine.

Background The reciprocal of multiecho gradient-echo (ME–GRE) T2* magnetic resonance imaging (MRI) R2*, rises linearly with tissue iron concentration in both heart and liver. Little is known about renal iron deposition in β-thalassemia major (β-TM). Aim To assess renal iron overload by MRI and its relation to total body iron and renal function among 50 pediatric patients with β-TM. Methods Serum ferritin, serum cystatin C, urinary albumin creatinine ratio (UACR), and urinary β2-microglobulin (β2 M) were measured with calculation of β2 M/albumin ratio. Quantification of liver, heart and kidney iron overload was done by MRI. Results Serum cystatin C, UACR and urinary β2 microglobulin as well as urinary β2m/albumin were significantly higher in β-TM patients than the control group. No significant difference was found as regards renal R2* between Patients with mean serum ferritin above 2500 μg/L and those with lower serum cutoff. Renal R2* was higher in patients with poor compliance to chelation therapy and positively correlated to indirect bilirubin, LDH, cystatin C and LIC but inversely correlated to cardiac T2*. Conclusion kidney iron deposition impairs renal glomerular and tubular functions in pediatric patients with β-TM and is related to hemolysis, total body iron overload and poor compliance to chelation.

Objective A comparative study of manual and automated post processing software tools to measure CT parameters before Transcatheter Aortic Valve Implantation (TAVI). Patients and methods 51 patients were included; all admitted to the Cardiology Department with clinically established severe aortic stenosis, in whom TAVI was the treatment of choice. All patients underwent CT angiography (CTA) pre-TAVI. The CT images were post processed and the needed CT parameters were calculated using both manual and automated methods. The results were compared for statistical analysis. Results Only 43 patients completed the study, with mean age 65 years old. The automated software provided accurate almost similar results as the manual method, especially for aortic annulus area and aortic circumference measurements (p-value = 1 and 0.548) and was accepted for left and right coronary artery ostium height (p-value = 0.191 and 0.635). However, there was a statistically significant difference for the minor diameter axis and mean annular diameter (p-value = 0.001 and 0.021). Conclusion The automated software introduced rapid, accurate and reliable measurements for the aortic annulus in cases prepared for TAVI and can be used as a standard method. Also, it can be performed by junior staff with avoidable human errors.

Background: The principal goal of the assessment of myocardial viability is to identify patients whose symptoms, exercise capacity, and long-term prognosis may improve after revascularization. Contrast enhanced cardiac MRI has devel-oped as a promising imaging modality for the assessment of myocardial viability which provides direct imaging of necrotic tissue with high contrast and high spatial resolution. Aim of the work was to assess role of cardiac MRI as a non-invasive tool in the evaluation of myocardial viability in patients with coronary artery disease.Aim of Study: To assess the role of cardiac MRI as a non-invasive tool in the evaluation of myocardial viability in patients with coronary artery disease.Material and Methods: The study included 25 patients diagnosed as having Coronary Artery Disease (CAD), (age range, 28-68 years ±11.29). All selected patients were subjected to cardiac MRI examination using 1.5-T MR system for studying myocardial function and viability. Comparison was made between echocardiography and cardiac MRI regarding segmental wall motion using the 17-segment model of the American Heart Association for assessment of myocardial function. Delayed-enhancement MRI was performed to deter-mine myocardial viability and scarring while black blood T2W sequence with fat suppression was done to detect cases with acute infarction. Microvascular occlusion was diagnosed using early Gadolinium enhancement sequence.Results: Good agreement between cardiac MRI and echocardiography regarding segmental wall motion with p-value of 0.065. Sensitivity and specificity of cardiac MRI for detecting SWMA were 93.6%, and 44.4% respectively. Myo-cardial viability was evaluated by cardiac MRI with the use of end-diastolic wall thickness, imaging of early and late enhancement after contrast administration. Late gadolinium enhancement allowed assessing state of myocardium and visualizing myocardial scar with its quantification. Two segments showed 1-25% transmural extent of myocardial wall infarction, while 120 segments showed 71-100% extent and 261 segments showed no enhancing scar.Conclusion: Cardiac MR imaging is an effective and reliable method for the evaluation of myocardial function as compared to echocardiography. Also it is effective and reliable method for the evaluation of myocardial viability being able to assess both the infarct size and trans-murality and accord-ingly helps to predict functional recovery after revasculariza-tion.

Treatment of arrhythmias by catheter ablation targeting the anatomical foci of arrhythmias by radiofrequency has evolved dramatically in recent years. A road map for the relevant heart structures is an important asset for the success of the procedure and should be obtained before the intervention. This can be achieved by intra-cardiac echocardiography, conventional angiographic methods, multidetector CT, or MRI. The electrophysiological technique comprises a diagnostic procedure and an interventional – therapeutic – procedure. Electrocardiographic-gated multidetector CT is important in the diagnostic session to evaluate the anatomical details in combination with electric activity mapping. This combined protocol provides a unique view of the propagation of electrical activity, either normal or abnormal, over cardiac structures and allows a precise functional and anatomical evaluation to be obtained. In this review, we evaluate the role of electrocardiographic-gated multidetector CT in roadmapping arrhythmias in the paediatric age group, focussing on its strengths; we also evaluated some additional aspects that need further improvement in the future.

The aim of this study is to assess the correlation between cardiac and hepatic T2* MRI findings with the endocrine and exocrine pancreatic functions in known patients with β-thalassaemia major (β-TM). A total of 50 adolescent patients with β-TM and 44 healthy controls were investigated via: serum amylase, lipase, triglyceride index, oral glucose tolerance test and T2* MRI, to assess iron content in the heart and liver. Diabetes was found in 20%, and 40% of patients had impaired fasting glucose (IFG). Cardiac T2* was less than 10 ms in 22% indicating heavy load with iron in cardiac tissues. There was a significant decrease in median serum amylase (63.5 vs 87.5 IU/L, p=0.003) and lipase (63 vs 90 IU/L, p=0.017) among patients in comparison with the control group. Patients with β-TM and diabetes had lower serum amylase (32 vs 68 IU/L), lipase (28 vs 79 IU/L), cardiac and hepatic T2* MRI (7 vs 25.5 ms; 3 vs 6 ms, p

Purpose: To emphasis the role of MSCT utilizing the remodeling index in assessment of positive coronary remodeling which was associated with plaque rupture and vulnerability. Methods and material: Studied group included 35 patients with positive coronary remodeling. One lesion per patient was assessed, either a solitary lesion or the most significant one. All patients were subjected to history taking and radiological evaluation using a contrast-enhanced 64 MSCT then post processed. Assessment of the plaque causing positive remodeling regarding the site, number (single, kissing, or multiple), relative composition and predominant type in H.U. was performed. Specific measurements at the reference and remodeling segment were taken. Calculation of remodeling index was done. Two comparative groups were made between subjects with remodeling index (RI)

This paper introduces a new architectural framework, known as input fast-forwarding, that can enhance the performance of deep networks. The main idea is to incorporate a parallel path that sends representations of input values forward to deeper network layers. This scheme is substantially different from “deep supervision”, in which the loss layer is re-introduced to earlier layers. The parallel path provided by fast-forwarding enhances the training process in two ways. First, it enables the individual layers to combine higher-level information (from the standard processing path) with lower-level information (from the fast-forward path). Second, this new architecture reduces the problem of vanishing gradients substantially because the fast-forwarding path provides a shorter route for gradient backpropagation. In order to evaluate the utility of the proposed technique, a Fast-Forward Network (FFNet), with 20 convolutional layers along with parallel fast-forward paths, has been created and tested. The paper presents empirical results that demonstrate improved learning capacity of FFNet due to fast-forwarding, as compared to GoogLeNet (with deep supervision) and CaffeNet, which are \(4{\times }\) and \(18{\times }\) larger in size, respectively. All of the source code and deep learning models described in this paper will be made available to the entire research community (https://github.com/aicentral/FFNet).

Purpose: To assess the role of 64-row multidetector computed tomography virtual hysterosalpingography (MDCT VHSG) in the evaluation of the female reproductive tract in infertile patients and compare it with conventional X-ray hysterosalpingography (HSG). Methods and material: The studied group included 25 patients with infertility. All patients were evaluated with 64-row MDCT VHSG and X-ray HSG. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both examinations for uterine pathology, fallopian tube pathology and per lesion pathology were calculated. The duration for both examinations, patient discomfort and patient effective dose were documented. Results: The mean duration for MDCT VHSG and X-ray HSG was 6.5 ± 1.9 and 26.9 ± 2.9 min respectively, MDCT VHSG has a significantly less median patient discomfort and mean patient effective dose. Sensitivity, specificity, PPV and NPV for uterine pathology were 100%, 100%, 100% and 100% respectively for MDCT VHSG and 90%, 93.3%, 90% and 93.3% respectively for X-ray HSG, the inter-method agreement for uterine pathology was k = 0.83. Sensitivity, specificity, PPV and NPV for the detection of fallopian tube pathology were 100%, 93%, 91 and 100% respectively for MDCT VHSG and 100%, 86%, 85% and 100% respectively for X-ray HSG and k = 0.76. Sensitivity, specificity, PPV and NPV for per patient pathology were 100%, 91%, 93% and 100% respectively for MDCT VHSG and 87%, 80%, 87% and 80% respectively for X-ray HSG and k = 0.75. Conclusion: MDCT VHSG could be an excellent new alternative diagnostic procedure in the infertility assessment workup.

Purpose: To emphasis the role of cardiac magnetic resonance compared to echocardiog- raphy in evaluating patients with ischemic cardiomyopathy to accurately assess global and regional Left ventricular function which is essential for prognosis and for evaluating therapeutic responses. Methods and materials: The studied group included 37 patients already diagnosed as having ische- mic cardiomyopathy. All patients were subjected to full history taking and radiological evaluation using a 1.5-T MR system and echocardiography. Comparison was made between echocardiography and cardiac magnetic resonance regarding segmental wall motion by using the 17-segment model of the American Heart Association. Agreement regarding segmental wall motion was assessed by using Cohen's Kappa statistics. Also ejection fraction measurement by both modalities was com- pared. Detection of transmural extent of myocardial scar was also performed. Results: Poor agreement between cardiac magnetic resonance and echocardiography regarding seg- mental wall motion with Cohen's Kappa is 0.195, P value of

Background and purposeDTI is an MR imaging measure of brain tissue integrity. It gives precise information about the involvement and integrity of the white matter tracts in the immediate region surrounding tumors. The purpose of our study is to evaluate the role of DTI in characterization and preoperative assessment of brain neoplasm.Materials and methods32 patients with intracranial neoplasm were included in this study which was conducted during a 2year period. Conventional MRI before and after IV Gadolinium administration was done followed by DTI and diffusion tensor tractography, with FA and ADC value measurements of different white matter tracts in direct relation to the tumor. The values obtained were compared to the normal unaffected tract in the contralateral side.ResultsWhite matter involvement by a tumor was classified according to the criteria of displacement, infiltration, disruption or edema. Patients were classified into two main groups according to the tumor type: benign and malignant groups. Prevalence of tract displacement was higher among benign group in comparison to the malignant group with significant difference in between by using chi-square test (P value

This paper describes a dataset containing small images of text from everyday scenes. The purpose of the dataset is to support the development of new automated systems that can detect and analyze text. Although much research has been devoted to text detection and recognition in scanned documents, relatively little attention has been given to text detection in other types of images, such as photographs that are posted on social-media sites. This new dataset, known as COCO-Text-Patch, contains approximately 354,000 small images that are each labeled as “text” or “non-text”. This dataset particularly addresses the problem of text verification, which is an essential stage in the end-to-end text detection and recognition pipeline. In order to evaluate the utility of this dataset, it has been used to train two deep convolution neural networks to distinguish text from non-text. One network is inspired by the GoogLeNet architecture, and the second one is based on CaffeNet. Accuracy levels of 90.2% and 90.9% were obtained using the two networks, respectively. All of the images, source code, and deep-learning trained models described in this paper will be publicly available (https://aicentral.github.io/coco-text-patch/).

Introduction: Anal sphincter trauma during childbirth represents the most important risk factor for development of fecal incontinence in women. Overt anal sphincter injury may be identified by clinical examination in 1-3% of vaginal deliveries, but the incidence is much higher when abnormalities are specifically sought using endoanal ultrasound and anal manometry. Aim of work: The aim of this study is to assess risk factors for sphincter damage during vaginal delivery in primiparous patients, and to assess the relationship of anal manometry and endosonography to anorectal complaints in patients who had demonstrated anal sphincter injury during vaginal delivery. Patients & methods: This was a prospective, observational study conducted over 130 healthy primiparous females with intact anal sphincter without history of either anorectal complaints or previous anorectal surgery. The patients were divided into: Group I: 100 patients without clinically recognized third- to fourth-degree intrapartum perineal tears. Group II: 15 primiparous patients who delivered by normal vaginal delivery, with clinically recognized third-degree perineal tears, who were examined following surgical repair by the overlapping technique. Group III: 15 primiparous patients who delivered by instrumental delivery, with clinically recognized third-degree perineal tears, who were examined following surgical repair. All patients were followed up by combined endoanal ultrasonography and anal manometry. Results: The risk factors for the anal sphincter damage during vaginal delivery include the length of 2nd stage if •75 min, absence of episiotomy, presence of shoulder dystocia, and the mode of delivery. In patients with anal sphincter damage, the maximal anal resting pressure (MARP) was significantly lower (P 0.05). Instrumental delivery (P

Background:Osteoporosis is a major problem in beta thalassemia major (TM) patients. Increased oxidative stress and its controlling genes were linked to osteoporosis. Glutathione S-transferase P1 (GSTP1),Ile105 Val variant is a functional mutation with reduced ant-oxidative property .No data are available about this variant or its association with osteoporosis among thalassemia patients yet. Objectives: The aim of this study was to investigate Ile105Val polymorphism and its possible association with bone mineral density (BMD) values in a group of TM children. Methods:Thirty five TM patients and 30 age and sex matched healthy controls were included. Liver and renal functions, serum ferritin, calcium, phosphorous, alkaline phosphatase and osteocalcin were assayed. BMD was determined by DXA with calculation of Z-scores at lumbar spine (Ls) and femoral neck (Fn).Height for age z- score (HAZ) adjusted BMD Z-scores were considered . GSTP1 Ile105Val polymorphism was studied by polymerase chain reaction-restriction fragment length polymorphism. Results:The relative frequency of 105 Val allele was significantly higher in TM patients than the controls (P

Background The duration of the supraclavicular brachial plexus block is limited by the duration of action of local anesthetic used for the block. Many adjuvants are used to prolong the duration of the block. Few studies were carried on evaluate the effects of using midazolam as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Aim The aim of the study was to evaluate the anesthetic characteristics of adding midazolam to bupivacaine during ultrasound-guided supraclavicular brachial plexus block. Patients and methods The study was carried out on 96 patients scheduled for upper limb surgeries. They were divided into three equal groups to receive ultrasound-guided supraclavicular brachial plexus block using 30 ml bupivacaine 0.5% in group I, 30 ml bupivacaine 0.5% and 30 µg/kg midazolam in group II, and 30 ml bupivacaine 0.5% in addition to 30 µg/kg intravenous midazolam in group III. Results The onset of sensory and motor block were significantly faster, and the durations were significantly longer in group II compared with groups I and III; furthermore, postoperative analgesia was significantly prolonged in group II (P Conclusion Midazolam is a valuable adjuvant to bupivacaine during ultrasound-guided supraclavicular brachial plexus block, which requires further evaluation.

The focus of this paper is off-line analysis of handwriting for the purpose of identifying a writer's gender. An example application of such identification is forensic analysis, in which gender could be combined with other biometric attributes for identification or exclusion. Studies have shown that handwriting by males and females tend to exhibit distinctive characteristics, even across different languages and cultures. We have explored these differences by developing classifiers based on support vector machines (SVM). These were trained using a database in which 282 individuals provided handwriting samples in both Arabic and English. The paper compares results obtained using local features and global features. For classifiers using global features trained using handwriting samples for both languages, an accuracy of 81% was observed. When local features were also used, however, an accuracy of 94.7% was observed. These results highlight the importance of local feature analysis for gender identification from handwriting.

This paper is concerned with off-line handwriting analysis for the purpose of identification of the writer's gender. Such identification is a useful tool in forensic handwriting analysis. Previous studies have indicated that handwriting by males and females tend to exhibit distinctive characteristics, even across different languages and cultures. We have investigated the hypothesis of language independence by applying machine-learning techniques to handwriting samples in two languages. The two languages, Arabic and English, are representative of other languages that use the same character sets. In particular, Arabic uses the same characters as Urdu and Persian, while English is based on the same character set as French, Spanish, Italian, and other Latin languages. Using a database in which 282 individuals provided handwriting samples in both Arabic and English along with gender information, several classifiers were implemented and compared. Each classifier utilized support vector machines (SVM) to identify the gender of the writer. For classifiers that were trained separately for the two languages, an accuracy of 68.6% was observed for Arabic, while an accuracy of 85.7% was observed for English. When trained using handwriting samples for both languages, an accuracy of 74.3% was observed. These results indicate that language-independent analysis can eventually be employed in forensic analysis.

Aim The aim of this study was to evaluate the impact and safety of neonatal circumcision under a uniform hospital policy using a Gomco clamp and its complication and parents' satisfaction. Patients and methods A prospective analysis of 300 consecutive cases of neonatal and infant circumcisions performed with a Gomco clamp at Al Omooma Private Hospital, Kuwait, during the period from March 2012 through March 2015, was carried out. Outcome measures for the study were the number and type of complications in terms of procedure, the adequacy of circumcision, and parents' satisfaction with the final appearance. Results An overall 10.6% of cases suffered from intraoperative bleeding, most of which were controlled by means of chemical hemostasis or bipolar diathermy, whereas 2.6% of cases needed vicryl plus 5/0 stitches. All of them were older than 2 weeks. Two cases (0.67%) returned on the same day of discharge with surface oozing; both cases were sutured with vicryl plus 5/0 stitches. The overall percentage of postoperative bleeding that needed sutures was 3.3% (10 cases). All cases of significant bleeding requiring stitches were older than 14 days (mean age, 38 days). Four parents (1.3%) came during the follow-up period complaining of inadequate circumcision; only one of them needed a redo after 6 months of follow-up. 0.67% of cases suffered from frenulum ulcer and only 1% of patients. Conclusion Circumcision with a Gomco clamp is a safe and effective technique with satisfactory cosmetic results, provided care is taken in exact marking of the site on the foreskin for excision and selecting a correct size of the clamp. Gomco clamp is a bloodless, sutureless, simple, and safe method of circumcision in the neonatal period and in early infancy. The use of the Gomco clamp for circumcision beyond early infancy (3 months of age) has substantial morbidity.

Objective: Axillary lymph node (LN) sampling is important for breast cancer staging and can be performed using fine needle aspiration (FNA). The aim of this study is to review the axillary LN FNAs performed at our institution prior to treatment, and to correlate their results with the available LN histology in order to evaluate the diagnostic utility of FNA. Study Design: A total of 130 cases were retrospectively identified over a 1-year period and reviewed. The FNA findings were correlated with the histological findings in 65 (50%) LN core biopsies, 43 (33%) sentinel LN biopsies, and 22 (17%) axillary dissections. Results: One hundred and thirteen FNA cases (89%) correlated with the histology, while 14 cases (11%) did not correlate, including 1 false positive and 13 false negatives. Of the false-negative cases, metastases in the biopsy ranged from isolated tumor cells to 5 mm in the greatest dimension. The overall sensitivity was 85%, specificity 98%, positive predictive value 99%, and negative predictive value 75%. Conclusion: Pretherapy staging of breast cancer by FNA is a useful diagnostic modality with a high specificity and positive predictive value. Due to false-negative diagnoses, a negative FNA should be followed up with further LN sampling.

Background Pulmonary tuberculosis (PTB) is an increasing global health problem that continues to cause significant morbidity and mortality. The impact of PTB has been measured in terms morbidity and mortality and little attention has been paid to continuing respiratory disability in those who were cured. Pulmonary hypertension (PHT) is a serious respiratory disability that results from structural lung damage and chronic hypoxia. This study was conducted to investigate the presence of PHT in a cohort of treated PTB patients who presented with shortness of breath. Methods This is a cross-sectional study that included 14 consecutive patients who were cured of PTB and presented with shortness of breath. Demographic and clinical data were recorded for all patients. PHT was diagnosed using Doppler echocardiography. Results Fourteen patients who were treated for PTB and were found to have PHT were studied. All patients were sputum smear negative at the time of the study. The mean age (SD) was 43.1 (13.6) and half of the patients were males. The mean number of years since PTB was diagnosed (SD) was 9.4 (10.9). All patients had abnormal chest x-rays. The commonest radiological abnormality was fibrocavitation which occurred in 50% of patients. Estimated pulmonary artery systolic pressure (PASP) of 51 to 80 mm/Hg was found in 9 patients (64.3%) whereas PASP of 40 to 50 mm/Hg was found in 4 patients (28.6%) and one patient had PASP more than 80 mm/Hg. Conclusions Different grades of PHT occurred in this cohort of treated PTB patients on average about 9 years after cure. The findings of this study support implementation of strategies for early detection and prevention of PTB. For those who were cured from PTB, longer periods of disability should be implemented in assessment of disease burden.

Purpose In pediatric population with SNHL, a radiological presurgical mapping exam is usually performed, purpose of this study is to improve the inter-rater agreement giving different imaging modalities using MDCT and MRI to facilitate identifying patients in need for surgical modification before cochlear implant. Methods and material 120 pediatric patients ranging between 1 and 12 years with an average age of 5 years diagnosed with congenital or acquired SNHL and requiring cochlear implant (CI) after proper surgical selection were included in the study. All patients underwent combined 64 detector MDCT using pediatric low dose protocol with sagittal, Stenvers views in addition to standard axial and coronal plane reconstruction from single acquisition volume. In the same session, 3D DRIVE MRI axial plane reformatted into sagittal plane for the IAC and inner ear as well as axial T2WI/FLAIR for the whole brain. Two different head and neck radiologists blindedly reported the inner ear, cochlear nerve development, temporal bone anatomy, operative window, as well as normal variants that could hinder implantation as well as causes of central hearing loss. Findings were compared with operative findings. Results Patients were categorized into four groups; according to the capability of electrode implant, modification of surgical techniques and expected response with high intra-observer was noted with a PABAK value of 0.96 for observer A and of 0.93 for observer B. Lower inter observer agreement was observed on an individual usage of radiological techniques for reaching diagnosis (conventional CT, MRI, or Stenvers/sagittal oblique techniques alone) with a PABAK value of 0.93, 0.78 and 0.73, respectively. A higher inter observer agreement was met on combining all these radiological modalities together (PABAK value of 0.96). Conclusion Stenvers view efficiently makes pre-surgical mapping for the intra-cochlear electrode pathway by identifying the cochlear turns, round and oval window, vestibule and SCC as well as facial nerve canal in one view helping the surgeon in optimizing the technique. MRI identifies the fibrous labyrinthitis ossificans not detected by CT and evaluates the cochlear nerve development and integrity of central auditory pathway. Combined MDCT/MRI imaging protocol helps the clinician in proper patient categorization, optimize their surgical approach and the type of electrode. Clinical relevance/application SNHL is a malfunction of the inner ear, vestibulocochlear nerve or central auditory pathway. Imaging helps to establish treatment regimens that improve auditory function.