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Background: Insersion of subcutaneous poracath is im-portant in some cancer cases for whom chemotherapy isindicated. It is done either through image guided techniquein Intrerventional Departement or through blind technique inthe Surgical Departement.Aim of Study: We aimed in our study to to evaluate thecomplications and advantages of the two methodes used forportacath insertion (image-guided inserion and anatomicallandmark blind technique) and compare both to detect thebetter one should be used for the pateints.Patients and Methods: 110 adult cancer patients referredfrom the Medical Oncology Department outpatient clinics forsubcutaneous port catheter insertion in the period from January2019 to January 2020. 55 pateints underwent image-guidedinserion technique, while the other 55 pateints underwent theanatomical landmark blind technique. Data were collectedand analyzed. We campared the feasibility, advantages andcomplications of each technique.Results: The results showed obvious decreased complica-tions in image guided port catheter insertion compared toanatomical landmark blind technique in adult cancer patientsindicated for chemotherapy.Conclusion: Image guided portacath insertion is moresafe than anatomical landmark blind insertion.

Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan. Keywords: Fungal prosthetic joint infection, fungal infection, total knee replacement, total knee replacement complication.

Background Up to 30% of patients with sickle cell disease (SCD) develop chronic liver disease via etiologies including sickle cell hepatopathy, acquired viral hepatitis, or secondary hemochromatosis. It is unclear how many patients with SCD ultimately undergo liver transplantation (LT) and what factors are associated with survival after LT. In this study, we examined LT outcomes in these patients by reviewing the Scientific Registry of Transplant Recipients (SRTR) and our institutional experience. Methods Analysis of the SRTR identified 23 LT recipients and five simultaneous liver and kidney transplantation (SLKT) recipients with SCD. Patient demographics and graft and patient survival were analyzed. Two patients with SCD at our institution underwent SLKT. Results Review of the SRTR revealed that recipients with SCD had significantly higher model for end-stage liver disease scores (33 versus 21, P = 0.004), preoperative intensive care unit admission (43.5% versus 19.1%, P = 0.007), preoperative dialysis (17.4% versus 4.9%, P = 0.009), and were more likely to be status 1 (26.1% versus 12.1%, P = 0.041) when compared with the reference population of African American LT recipients. Despite being higher risk at the time of LT, patients with SCD had equivalent posttransplant graft and patient survival when compared with the reference population (P = 0.5 and P = 0.2, respectively) and a 2:1 propensity score–matched group (P = 0.5 and P = 0.2, respectively). Two recent SLKT recipients with SCD from our institution have performed well with stable allograft function. Conclusions Data from the SRTR demonstrate that patients with SCD can expect equivalent graft and patient survival after LT despite exhibiting more comorbidities at the time of LT. The low number of patients with SCD who underwent LT in the SRTR in comparison with the rate of chronic liver disease in this population raises the question as to whether a disparity in access to LT exists for this complex population.

Standard prone position (PP) during percutaneous nephrolithotomy (PNL) has multiple drawbacks. We aimed to compare PNLs performed in split-leg (SL) modified lateral position (MLP) and those performed in standard PP. A prospective, randomized, unblind, double arm trial was conducted at a tertiary care academic medical center in Egypt, between November 2017 and October 2019. Adult patients with renal stones undergoing PNL were included. According to renal anatomy and stone complexity, stratified randomization was performed and study participants were allocated into either SL-MLP group or PP group. The stone free rate (SFR), total operative time, track formation time, fluoroscopy time, auxiliary procedures, and complications were compared. There were 61 patients in SL-MLP group and 63 patients in PP group. Both groups had similar baseline characteristics. The SFR was comparable between groups: 75.4% in SL-MLP group and 77.8% in PP group (p = 0.755). The mean total operative time was shorter and mean track formation time was longer in SL-MLP group (55.33 ± 20.73 vs. 98.49 ± 9.23, p

Background Many medications (including most antihypertensives) and physiological factors affect the aldosterone/renin ratio (ARR) when screening for primary aldosteronism (PA). We sought to validate a novel equilibrium angiotensin II (eqAngII) assay and compare correlations between the aldosterone/angiotensin II ratio (AA2R) and the current ARR under conditions affecting the renin-angiotensin system. Methods Among 78 patients recruited, PA was excluded in 22 and confirmed in 56 by fludrocortisone suppression testing (FST). Peripheral levels of eqAngII, plasma renin activity (PRA) and direct renin concentration (DRC) were measured. Results EqAngII showed good consistency with DRC and PRA independent of PA diagnosis, posture, and fludrocortisone administration. EqAngII showed close (P Conclusions Dynamic changes of eqAngII and the AA2R show good consistency and close correlations with renin and the ARR. The eqAngII assay shows better sensitivity than DRC and PRA assays, especially at low concentrations. Whether the AA2R can reduce the impact of some factors that influence the diagnostic power of the ARR warrants further study.

Aims Due to the significant value held by medical records in terms of influencing patient care and medico-legal cases, this study aimed to investigate the quality of surgical notes and their improvement through periodic auditing during a six-year period at a major tertiary hospital. Methodology This study retrospectively evaluated surgical records of patients undergoing elective orthopedic surgeries at Jordan University Hospital from 2016 to 2021 using the Surgical Tool for Auditing Records (STAR) validated questionnaire. This questionnaire is composed of six distinct sections aimed to quantify the quality of medical records and demonstrate their associated deficiencies. Pre- and post-audit STAR scores were analyzed using the two independent sample t-test on Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp. Armonk, NY). Results A total of 454 records were randomly selected and evaluated using the STAR questionnaire. There was an overall significant trend of improvement in the quality of records in all evaluated years compared to the 2016 baseline. The most pronounced improvements were in the records of 2021 as compared to the 2016 baseline (97.4 ± 0.7 vs. 94.3 ± 1.6; p

Aim of the Work To compare visual acuity, refractive and topographic outcome between small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK) in patients with myopic astigmatism. Patients and methods This prospective, non-randomized, comparative clinical study included 60 eyes of 30 patients with simple or compound myopic astigmatism presenting for refractive error correction. Femtosecond assisted LASIK group included 30 eyes and SMILE group included 30 eyes. The following tests were done for all patients preoperatively and at 3 months postoperatively: full ophthalmological examination, manifest refraction, UDVA, CDVA, corneal topography using combined schimflug and placcido disc imaging namely Pentacam. (Oculus Inc.) and wavefront analysis using ATLAS 9000 (Carl Zeiss Meditec) Main Outcome Measures: Uncorrected distance visual acuity (UDVA), corrected disctance visual acuity (CDVA), manifest refraction, Efficacy, safety, predictability, corneal higher order aberrations. Results At 3 months, the mean manifest refractive spherical equivalent (MRSE) in SMILE group was -0.33 ± 0.34 D and the mean MRSE in FS- LASIK group was 0.23 ± 0.35 D and there was a statistically significant difference between both groups (P < 0.05). mean postoperative cylinder was -0.56 ± 0.28 D in SMILE group and -0.53 ± 0.38D in FS-LASIK with statistically significant difference ( P = 0.254 ) 93% and 93% of eyes in the SMILE and FS-LASIK groups were within ± 0.5 D; 96.67% and 100% of eyes in the SMILE and FS-LASIK groups, respectively, were within ± 1 D. There were 86.66% of treated eyes in the SMILE group, and 93.33% treated eyes in the FS-LASIK group that had 20/25 or better UDVA. Regarding safety, the CDVA in the SMILE group, 20 eyes (66.67%) showed no change, 8 eyes (27%) gained 1 line, 2 eyes (7%) lost 1 line, and no eyes lost more than 1 line. whereas in the FS-LASIK group, 27 eyes (90%) exhibited no change, 2 eyes (6.66%) gained 1 line, 1 eye (3.33%) lost 1 line, and no eyes lost more than 1 line and There was no statistically significant difference between both groups (P = 0. 554 ). Regarding corneal asphericity, both procedures increased Q-value with no statistically significant difference between both groups (P = 0. 052). Regarding corneal higher order aberrations, both procedures significantly increased total corneal aberrations but there was no statistically significant difference in the change in RMS of total corneal higher order aberration (P = 0.434) .but SMILE increased RMS of coma aberration significantly more than FS-LASIK (P = 0. 029). Conclusion both SMILE and FS-LASIK procedures have shown excellent efficacy, safety, and predictability for the correction of myopia and myopic astigmatism. SMILE was closer to emmetropia regarding sphere and spherical equivalent, However, astigmatic undercorrection was noted after both surgeries with increased astigmatism. Both procedures increased the total corneal higher order aberrations with no statistically significant difference between both groups. A higher vertical coma was found in SMILE than WFG FS-LASIK.

Background Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of anemia of renal disease, the primary cause is the inadequate production of erythropoietin by the damaged kidneys. Aim of the work to assess hepcidin level in non dialysis patients (CKD stage 4 &5) treated from Hepatitis C virus and its relation to iron parameters. Patients and Methods This study was conducted on 20 CKD patients (stage 4 and 5) treated from hepatitis C virus. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, renal chemistry, HCVAb, serum iron, total iron binding capacity, TSAT%, ferritin and hsCRP. Serum hepcidin was analyzed by ELISA technique. Results Serum hepcidin was 26.35±7.26; 40% in stage III, 37.8% in stage IV and 22.2% in stage V. There was statistically significant difference between GFR stages according to Hb., Drug intake ACE inhibitor/ARB, Plt., Creatinine, BUN, Iron, TIBC, Ferritin, T SAT%, CRP and Serum Hepcidin. We showed significant correlations between serum hepcidin and TIC, Iron, TIBC, Ferritin and TSAT%. Conclusion Median hepcidin value is elevated in nondialysis CKD patients due to increased inflammation and decreased clearance of hepcidin. Furthermore, iron status modifies serum hepcidin level and its association with Hb. Increased hepcidin level leads to iron-restricted erythropoiesis and recombinant human EPO (rhEPO) resistance by inhibiting iron absorption from gut and iron recycling from macrophages. Hence, elevated hepcidin can predict need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin.

Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI. This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT “in-out” fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12 months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables. There were 81 patients in group I and 83 in group II. Median follow-up duration was 12 months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024). Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.

The authors theoretically propose a design for electrically tuning a metasurface based on piezoelectric actuation. The design comprises 2D gap-plasmon elements arranged periodically on a piezoelectric substrate which controls the period between them. The technique is numerically studied for a metasurface that anomalously reflects an incident p-polarised wave by 30° at the optical communication wavelength, 1550 nm. The dynamic behaviour of the system is investigated for two main applications; (a) steering the reflection angle and (b) retrieving the reflection angle for an incident wave of a shifted wavelength. It is demonstrated that a reflected beam can cover an angle of ~3° upon a strain of

Leaf rust disease of wheat, caused by Puccinia triticina, is one of the most severe fungal diseases on wheat leaves and it causes severe yield losses in Egypt. The aim of this study is to investigate the effect of some eco-friendly materials like waste agriculture extracts in order to reduce uses of chemical fungicides and to maintain sustainable development. Three experiments were conducted in the Laboratory, Greenhouse and Field. Neem cake, orange peels and rice straw were used to obtain eco-friendlynaturalfungicides while Sumi-8 was used as a chemical fungicide and as a control. Three species from wheat cultivars, T.S.S, Morocco and Misr1 were used. Eco-friendlynaturalfungicides were applied as soak, foliar and applied together at the same time. Greenhouse and field experiments data showed that all natural extracts inhibited spore germination. Maximum inhibition reached to 100% by using neem cake and rice straw extracts followed with orange peels extract. In field experiments data showed that wheat yield was the highest using neem extract as soak + foliar application. The increase in wheat yield reached to 41.3% compared to Sumi-8 fungicide as healthy control. Also the results showed an increase in the percentage of carbohydrates, proteins, and wheat gluten, which is one of the main characteristics of the wheat quality. In conclusion these extracts can be used instead of chemical fungicide to cost effective, use safe and non-polluting environment.

Background: UROLOGIC pelvic surgery is the integration of surgical activities for the pelvis, the colon, urogenital, and gynecological organs primarily for the treatment of obstructions, dysfunction, malignancies, and inflammatory diseases.Aim of Study: To evaluate the efficacy of extracorporeal shock wave therpy on male coccydenia after urological surgery.Subjects: Thirty male patients who complain from coc-cydenia after urological surgery, their age range from 40-60 years old, choosen from El-Sahel Teaching Hospital and Police Hospital in Agoza, Cairo, Egypt during the period of June-2017 to November-2017.Methods: Patients assigned randomly into two groups of equal numbers, Group (A) control group which include 15 patients received routine medication only (anti-inflammatory drugs or NSAID), and Group (B) study group received shock wave therapy one session per week up to four weeks each session took 10 minutes the patients were received 2000 shots of ESWT in the coccyx, the frequency was 5Hz and the pressure was 3-4 bar in addition to traditional medications routine (anti-inflammatory drugs). Both groups were assessed pre and post-treatment for pain level by Visual Analogue Scale (VAS).Results: There was a significant decrease in the median values of visual analogue scale post-treatment of study group compared with control group (p=0.002) in favor of study group.Conclusion: Shock wave therapy is effective as a physical therapy program on improving coccydenia.

PURPOSE OF REVIEW: To review the indications for extra-corporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients and their optimal management on ECMO. RECENT FINDINGS: Recent studies have reported a 30–40% survival rate among LT recipients that receive ECMO. Increasingly, case reports have documented successful outcomes of LT performed for patients on pre-operative ECMO. Outcomes appear to be superior with patients in the immediate peri-LT period with reversible causes of severe, acute respiratory and/or cardiovascular collapse. Mortality is most commonly secondary to infection. Volume optimization with CRRT may improve outcomes and perfusion to the graft, especially for patients on veno-arterial (VA) ECMO. There is little consensus on management of anti-coagulation in these patients, but it can likely be held temporarily while the patient is coagulopathic and/or experiencing bleeding complications. SUMMARY: ECMO should be considered in the peri-LT period for patients with severe, acute, and reversible causes of respiratory and/or cardiovascular collapse, with acceptable outcomes in patients that would otherwise not be expected to survive. Management of the post-LT patient on ECMO is challenging with a slowly enlarging body of literature to inform decision making.

Aberrant CXCR4/CXCL12 signaling is involved in many pathophysiological processes such as cancer and inflammatory diseases. A natural fragment of serum albumin, named EPI-X4, has previously been identified as endogenous peptide antagonist and inverse agonist of CXCR4 and is a promising compound for the development of improved analogues for the therapy of CXCR4-associated diseases. To generate optimized EPI-X4 derivatives we here performed molecular docking analysis to identify key interaction motifs of EPI-X4/CXCR4. Subsequent rational drug design allowed to increase the anti-CXCR4 activity of EPI-X4. The EPI-X4 derivative JM#21 bound CXCR4 and suppressed CXCR4-tropic HIV-1 infection more efficiently than the clinically approved small molecule CXCR4 antagonist AMD3100. EPI-X4 JM#21 did not exert toxic effects in zebrafish embryos and suppressed allergen-induced infiltration of eosinophils and other immune cells into the airways of animals in an asthma mouse model. Moreover, topical administration of the optimized EPI-X4 derivative efficiently prevented inflammation of the skin in a mouse model of atopic dermatitis. Thus, rationally designed EPI-X4 JM#21 is a novel potent antagonist of CXCR4 and the first CXCR4 inhibitor with therapeutic efficacy in atopic dermatitis. Further clinical development of this new class of CXCR4 antagonists for the therapy of atopic dermatitis, asthma and other CXCR4-associated diseases is highly warranted., Graphical abstract Dysregulation of CXCR4/CXCL12 signaling is associated with many inflammatory diseases. EPI-X4 is an endogenous peptide antagonist of CXCR4. Molecular docking and mutational analysis allowed to increase its anti-CXCR4 activity. The optimized EPI-X4 JM#21 derivative prevented inflammatory responses in mouse models of atopic dermatitis and allergen-induced asthma.Image 1

The objective of this study is to compare the endothelial safety of femtosecond laser (FSL) energy at two different dissection depths in FSL-assisted deep anterior lamellar keratoplasty (FSDALK) for keratoconus. This prospective double-armed interventional study included 25 eyes from 21 patients with advanced keratoconus who underwent FSDALK (big bubble technique) at a trephination depth of 110 µm in group I (11 eyes) and 80 µm in group II (14 eyes)—all of which were anterior to the Descemet’s membrane (DM). Visual acuity measurement, anterior and posterior segment examination, corneal tomography, and specular microscopy were performed preoperatively and at 3, 6, and 12 months, postoperatively. Endothelial cell density, coefficient of variation, percentage of cell hexagonality, and pachymetry were used to evaluate endothelial safety. No statistically significant difference in any of the endothelial safety parameters was found between the two groups. The mean 12-month postoperative endothelial cell loss rate was 17.46% and 12.91% in group I and II, respectively (P = 0.345). Most of the endothelial cell loss occurred during the first 3 months after surgery. Group II showed statistically greater improvement in the mean keratometry values at all follow-up visits. The endothelial safety profiles of lamellar FSL cuts at 110 µm and 80 µm anterior to the DM are comparable. Cuts as deep as 80 µm anterior to the DM can be safely applied without causing significant injury to the endothelium. Further studies are needed to compare the endothelial safety profiles of different FSL platforms available in the market. Trial registration PACTR201901615323963. Registered 24 November 2018—retrospectively registered.

Cognitive load refers to the used amount of working memory. It is very hard to be detected, especially in on-line and computer-supported learning. Thus, it is one of the most important challenges for educational technologists and instructional designers to address. Electroencephalogram (EEG) is a methodology that monitors the electric activity in the brain. EEG has been effective in detecting subjects’ emotional and cognitive states. In this paper, an approach for detecting the basic cognitive states that affect learning outcomes using EEG signals is proposed. Detected states include engagement, instantaneous attention, focused attention, working memory, planning, shifting and visual perception. The proposed approach consists of the following. First, 127 students in their undergraduate university-level studies undergo scientifically-validated cognitive assessment tests that evoke and measure their full cognitive profiles while putting on a 14-channel wearable EEG headset. Then, the collected data are used to train deep models as well as shallow classifiers to automatically predict the analyzed cognitive states. Although the main advantage of the deep learning models is avoiding the hand-crafted features needed for the shallow classifiers, the shallow classifiers outperformed the deep learning-based ones with a minimum accuracy of 92% as compared to the deep models with a maximum obtained accuracy of 78%.

Chronic knee dislocation is rare and debilitating for patient. Treatment for chronic knee dislocation is still debatable. There are two opposing goals of treatment which are obtaining stability and obtaining range of motion. We presented 2 patients with good clinical outcome using a gradual hexapodalic correction with Ortho-SUV system.

Plasmonic single nanoantennas and metasurfaces can both enhance and manipulate emission from potential quantum emitters while their layer-like nano thick structure renders them integrable into quantum and nano-devices. Here we proposed an Asymmetric Star Nanoantenna design, which when coupled to a single quantum dot emitter, offered unique resonant enhancements in both single and array arrangements. This enhancement was most established with the array, where 3 main polarization tunable behavioral states were identified, ones we described as double, single and steady mode patterns. This polarization driven functionality could offer a much-needed means of control over quantum emitters.

Background Transcatheter arterial chemoembolization is one of the effective therapeutic options for hepatocellular carcinoma (HCC). Ultraselective chemoembolization is an alternative approach to improve local control, and is associated with a reduced incidence of adverse effects. Objective It was to evaluate the sensitivity of cone beam computed tomography (CBCT) in detecting HCC tumors and their feeding vessels during transarterial chemoembolization (TACE). Patients and Methods All patients were suspected of having or confirmed to have HCC on the basis of clinical history, underlying liver disease and/or viral infection, the diagnosis of HCC was made by imaging findings. Between January 2016 and January 2018, Dyna CT was retrospectively used in 19 consecutive patients with HCC tumor with HCC tumor. Results The detectability of the tumor with DSA obtained at the common, proper, right, or left hepatic artery (i.e., nonselective DSA) and cone-beam CT was compared as taking pre imaging as a gold standard. Tumor stain and feeding branches were evaluated. The detectability of the tumor-feeding branch with non-selective DSA and Dyna CT HA images was compared. Conclusion Tumor detectability on cone-beam CT was significantly greater than on non-selective. Cone beam HA taking pre imaging as a gold standard was (94.4%) and its specificity (71.6%) with accuracy (76.97%). The sensitivity of DSA in detection of additional tumor as taking the pre imaging (CT/MRI) as a gold standard was (88.9%) and its specificity (84.5%) with accuracy (85.53%). Cone-beam CT has satisfactory ability to detect tumors; the detectability of tumor-feeding branches with Dyna CT was significantly higher than that with nonselective DSA (P less than 0.001). We believe the technical success rates of ultraselective transcatheter arterial chemoembolization may be improved by chemoembolization guidance software that uses cone-beam CT technology.

Background Lymphoid neoplasms are broadly divided into Hodgkin disease (HD) and non-Hodgkin’s lymphoma (NHL). Non-Hodgkin lymphoma accounts for about 5% of all cases of cancer with greater predilection to disseminate to extra-nodal sites. Extranodal lymphoma describes that there is neoplastic proliferation at sites other than the expected native lymph nodes or lymphoid tissue. Lymphomas that initially appear to have the bulk of the disease at extranodal sites are described as primary extranodal lymphoma and categorized as Stage I or II. In secondary extranodal lymphoma, there is secondary involvement of the extranodal sites from primary nodal disease, which is categorized as Stage III or IV. Aim and Objectives To assess the added value of hybrid Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the evaluation of extranodal involvement in patients with non-Hodgkin lymphoma in comparison to contrast-enhanced CT (CECT). Patients and Methods All patients had Non-Hodgkin lymphoma, proved by histopathological and immunophenotyping examinations. They underwent CECT and F-18 FDG PET–CT studies. Results This study included 76 patients with pathologically confirmed lymphoma who underwent PET/CT study. The patients' ages ranged between 20 and 78 years old (mean age 51 ± 14.7 years). This study included 51 males and 21 females. Diffuse large B-cell lymphoma subtype had the highest prevalence 53% (40/76), whereas mucosa-associated lymphoid tissue lymphoma was the least prevalent 4%. The Spleen was the most common site as it was involved in 20 patients followed by bone and bone marrow 15 patients, lung 13, Liver 9, Nasopharynx 4, Muscular and Cutaneous Nodules 4 patients each, CNS, Adrenal, Renal and Pleural Affection 3 patients each, Tonsillar, stomach, Pancreas and Prostate 2 patients each, and finally only one patient had salivary gland, thyroid, breast, and testicular involvement. The overall sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT are 97%, 20%, 94.5%, 33.3%, 91, 6 % and 87.3%, 60 %, 93.9%, 10% and 87.5%, respectively. Conclusion Combined PET/CT using 18F-FDG is the best oncologic imaging modality at present time with indispensable role and valuable application in monitoring and management of the extranodal lymphoma. It can detect metabolically active lesions without CT structural changes and identify a viable tumor in normal size lymph nodes. PET/CT is more effective than CECT in evaluating extranodal Lymphomatous infiltration, especially in spleen, bone, and bone marrow.

Background: This study was conducted to evaluate the efficacy of whole-body vibration on strength of calf and quadriceps muscles post burn.Patients and Methods: Thirty patients (male and female) had second degree burn of lower limb with surface area about (20-35%) suffering from weakness of quadriceps and calf muscles. Their ages ranged between (20-35) years were participated in this study. The study conducted during the period between March and July (2017) at Makka Hospital and Al-Nada Hospital.They were assigned randomly into two Groups (A and B) equal in number: Group (A) Fifteen patients had received vibration training on vibration platform plus traditional physical therapy program (eight weeks, three times a week). Group (B) fifteen patients had received the same traditional physical therapy program only.Evaluation: Evaluations of both Groups (A and B) were done before starting the treatment and at the end of study after eight weeks using hand held dynamometer and manual muscle test.Treatment: Started immediately post wound closure. This study showed a statistically significant increase in calf and quadriceps muscle strength after eight weeks of receiving whole body vibration in addition to home based physical therapy program, compared with Group B who received traditional physical therapy program only.Results: Comparison between both Groups (A and B) before starting the study revealed that there was a statistically nonsignificant difference in calf and quadriceps muscle force between them. At the end of the study, there was a significant increase in the muscle force in the study group (Group A) compared with control groups (Group B).Conclusion: Participation in Whole Body Vibration (WBV) program resulted in a greater improvement in quadriceps and calf muscle strength in adults with healed thermal burn compared to base line values; a WBV program is an effective for strength gain in rehabilitation of burned patients.

Context Current threshold values for primary aldosteronism (PA) diagnostic testing are based on measuring aldosterone (PAC) using immunoassays. Quantification of PAC by liquid chromatography-tandem mass spectrometry (LC-MS/MS) yields lower values. Objective To compare aldosterone measurement by radioimmunoassay (RIA) with LC-MS/MS and evaluate performances of proposed LC-MS/MS–specific cutoffs for PA screening and confirmatory testing. Patients and Intervention Forty-one patients underwent aldosterone/renin ratio (ARR) testing to screen for, and fludrocortisone suppression testing (FST) to confirm or exclude, PA. Renin (DRC) was measured by chemiluminescent immunoassay. Results Median serum PACLC-MS/MS was 27.8% lower (P < 0.05) than plasma PACRIA in 164 pairs of FST samples. A positive correlation (Spearman coefficient, 0.894, P < 0.01; Pearson r coefficient, 0.861, P < 0.01) was observed between the two assays. Thirty-seven patients showed consistent FST diagnoses (29 positive, 8 negative), whereas four showed inconsistent FSTs by the two assays. Good agreement (κ coefficient, 0.736; P < 0.01) was observed between the current FST diagnostic PACRIA cutoff of 165 pmol/L and the proposed PACLC-MS/MS cutoff of 133 pmol/L. Among 37 patients with consistent FST results, no differences were observed in sensitivity (89.7% vs 93.1%) or specificity (87.5% vs 87.5%) for PA screening between the current ARR cutoff of 70 pmol/mU (PACRIA/DRC) and the proposed cutoff of 55 pmol/mU (PACLC-MS/MS/DRC). Conclusions Adjustment of the current cutoffs for PA diagnostic testing is necessary if PAC is measured by LC-MS/MS. Our preliminary results suggest that the proposed LC-MS/MS cutoffs for ARR and FST perform as well as current RIA cutoffs.

Supplemental Digital Content is Available in the Text., Purpose: To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus. Methods: Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up. Results: The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus. Conclusions: CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.

Background: Plasma aldosterone/renin ratio (ARR) is the most popular screening test for primary aldosteronism (PA). Because both estrogen and progesterone (including in oral contraceptive agents) affect aldosterone and renin levels, we studied the effects of combined hormonal replacement therapy (HRT) on ARR; renin was measured as both direct renin concentration (DRC) and plasma renin activity (PRA). Methods: Fifteen normotensive, healthy postmenopausal women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline and after 2 weeks and 6 weeks of treatment with combined HRT (conjugated estrogens 0.625 mg and medroxyprogesterone 2.5 mg daily). Results: Combined HRT was associated with statistically significant increases in aldosterone [median (range): baseline, 150 (85 to 600); 2 weeks, 230 (129 to 790); 6 weeks, 434 (200 to 1200) pmol/L; P < 0.001 (Friedman test)] and PRA [2.3 (1.2 to 4.3), 3.8 (1.4 to 7.0), 5.1 (1.4 to 10.8) ng/mL/h, respectively; P < 0.001] but decreases in DRC [21 (10 to 31), 21 (10 to 39), and 14 (8.0 to 30) mU/L, respectively; P < 0.01], leading to increases in ARR calculated by DRC [7.8 (3.6 to 34.8), 11.4 (5.4 to 48.5), and 30.4 (10.5 to 90.2), respectively; P < 0.001]. The ARR calculated by DRC exceeded the cutoff value (70) in three patients after 6 weeks. There were no significant changes in ARR calculated by PRA [79 (26 to 184), 91 (23 to 166), and 88 (50 to 230), respectively; P = 0.282], plasma electrolytes and creatinine, or any urinary measurements. Conclusion: The combined oral HRT used in this study is capable of significantly increasing ARR with a risk of false-positive results during screening for PA but only if DRC (and not PRA) is used to calculate the ratio.

Background: The most popular screening test for primary aldosteronism is the plasma aldosterone/ renin ratio (ARR). Medications, dietary sodium, posture, and time of day all affect renin and aldosterone levels and can result in false-negative or false-positive ARRs if not controlled. Most antihypertensive medications affect the ARR and can interfere with interpretation of results. To our knowledge, no study has been undertaken to evaluate the effects of moxonidine on the ARR. Methods: Normotensive, nonmedicated male volunteers (n = 20) underwent measurement (seated, midmorning) of plasma aldosterone (by high-performance liquid chromatography-tandem mass spectrometry), direct renin concentration (DRC), plasma renin activity (PRA), cortisol, electrolytes and creatinine; and urinary aldosterone, cortisol, electrolytes and creatinine at baseline and after 1 week of moxonidine at 0.2 mg/d and a further 5 weeks at 0.4 mg/d. Results: Compared with baseline, despite the expected significant falls in both systolic and diastolic blood pressure, levels of plasma aldosterone [median, 134 (range, 90 to 535) pmol/L], DRC [20 (10 to 37) mU/L], PRA [2.2 (1.0-3.8) ng/mL/h], and ARR using either DRC [8.0 (4.4 to 14.4)] or PRA [73 (36 to 218)] were not significantly changed after either 1 [135 (98-550) pmol/L, 20 (11-35) mU/L, 2.0 (1.2-4.1) ng/mL/h, 8.8 (4.2 to 15.9), and 73 (32-194), respectively] or 6 weeks [130 (90-500) pmol/L, 22 (8 to 40) mU/L, 2.1 (1.0 to 3.2) ng/mL/h, 7.7 (4.3 to 22.4), and 84 (32 to 192), respectively] of moxonidine. There were no changes in any urinary measurements. Conclusion: Moxonidine was associated with no significant change in the ARR and may therefore be a good option for maintaining control of hypertension when screening for primary aldosteronism.

Signal denoising remains to be one of the main problems in the field of signal processing. Various signal denoising algorithms using wavelet transforms have been introduced. Wavelets show superior signal denoising performance due to their properties such as multiresolution and windowing. This study focuses on denoising of phonocardiogram (PCG) signals using different families of discrete wavelet transforms, thresholding types and techniques, and signal decomposition levels. In particular, we discuss the effect of the chosen wavelet function and wavelet decomposition level on the efficiency of the denoising algorithm. Denoised signals are compared with the original PCG signal to determine the most suitable parameters (wavelet family, level of decomposition, and thresholding type) for the denoising process. The performance of our algorithm is evaluated using the signal-to-noise ratio, percentage root-mean-square difference, and root-mean-square error. The results show that the level of decomposition and thresholding type are the most important parameters affecting the efficiency of the denoising algorithm. Finally, we compare our results with those from other studies to test and optimize the performance of the proposed algorithm.

Objective: We aim to quantify the magnitude of setup errors in intensity-modulated radiotherapy (IMRT) treated Head and Neck cancer patients and recommend appropriate PTV margin. Methods: 60 patients with head and neck cancer required bilateral neck irradiation were planned and treated by simultaneous integrated boost IMRT technique either treated radically or postoperative. Patients undergoing image-guided radiotherapy (IGRT) each with once weekly scheduled cone beam computed tomography (CBCT). The 3D displacements, systematic and random errors were calculated. The appropriate PTV expansion was determined using Van Herk’s formula. Results: Mean 3D displacement was 0.16 cm in the vertical direction, 0.14 cm in the horizontal direction and 0.16 cm in the longitudinal direction. Conclusion: Use of weekly CBCT allows the planning target volume (PTV) expansion to be reduced according to our setup. The appropriate clinical target volume (CTV)-PTV margin for our institute is 0.30 cm, 0.38 cm, and 0.33 cm in the horizontal, vertical, and longitudinal directions, respectively.

Aim: To keep the cervical canal dilated after the fi rst high dose rate (HDR) brachytherapy fraction to avoid general anesthesia during subsequent applications.

According to new European guidelines, first-line anti-hypertensive therapies include either an ACE inhibitor (ACEi) or an angiotensin receptor blocker (ARB) in a single pill combination with a calcium channel blocker (CCB) or a diuretic. Insufficient therapeutic effects could be caused by various factors ranging from compliance issues, patient specific PK/PD profiles, or secondary forms of hypertension resulting in blood pressure control rates in the range of 50% of patients on therapy. RAAS Triple-A testing is based on a high-throughput mass-spectrometry assay for quantification of Angiotensin I (Ang I), Angiotenisn II (Ang II) and Aldosterone in standard serum or plasma samples by RAAS equilibrium analysis. Obtained hormone levels are used to calculate markers for plasma-renin-activity (PRA-S), plasma angiotensin-converting-enzyme activity (ACE-S) and adrenal function (AA2-Ratio). The diagnostic performance of the AA2-Ratio in screening for primary aldosteronism (PA) has been compared to the aldosterone-to-renin ratio (ARR) as putative gold standard in resistant hypertensive patients, revealing major advantages of the AA2-Ratio especially in terms of usability and drug interference. A diagnostic scheme for the stratification of first-line non-responding hypertensive patients has been developed to improve the control rates for hypertension and to provide an easy-to-handle diagnostic tool for physicians involved in first-line treatment of hypertension. RAAS Triple-A analysis for the first time provides insights into a patient’s RAAS at the level of effector hormones, molecular regulation and patient specific pharmacologic responses to anti-hypertensive therapies and has the potential to result in significant changes in hypertension care in clinical practice by introducing personalized treatments based on an easy and effective diagnostic tool.

Angiotensin-converting-enzyme-inhibitors (ACEi) are widely used for treating hypertension and cardiovascular diseases and block Angiotensin-II (Ang-II) formation from Angiotensin-I (Ang-I). The therapeutic response to ACE inhibition critically depends on in vivo pharmacologic efficacy and affected by dosing, patient compliance and patient specific compensatory mechanisms, all being relevant topics for the clinical management of hypertension. Samples were collected from 19 hypertensive patients and 7 confirmed primary aldosteronism (PA) patients. Hypertensive patients were investigated at baseline and after 4 weeks on therapy with a single daily dose of perindopril. PA patients were sampled before and after 14 day administration of ramipril. All samples were analysed by LC-MS/MS based RAAS Triple-A testing which involves the calculation of ACE-S, the ratio between plasma equilibrium levels of Ang-II and Ang-I as a novel marker for circulating ACE activity. ACE activity was further measured by analyzing the time dependent conversion of spiked Ang-I (LC-MS/MS) and by performing a clinical colorimetric ACE assay. Treatment adherence was confirmed by quantification of plasma drug levels. ACE-S was significantly lower in all patients on perindopril or ramipril therapy compared to baseline (MEDIANS: 0.35 vs. 2.75 pM/pM, p The novel angiotensin based marker ACE-S can be used to monitor pharmacologic efficacy of ACE inhibitors independent of their chemical structure. As part of the RAAS Triple-A test that is currently validated in screening for secondary forms of hypertension, ACE-S has the potential to support the clinical management of first-line non-responders in terms of optimizing ACEi dosing and visualizing patient specific compensatory mechanisms, thereby improving the overall control rates in hypertension.

Background Tracheal intubation is the second most dangerous procedures reflected in the ICU. It includes passing a plastic tube named endotracheal tube (ET) through the vocal cords into the trachea. Errors of this procedure like the placement of ET in the oesophagus or advancing the ET too far into one of the two lungs are life threatening. Objectives This work was designed to provide cheap and quick technique to confirm proper ET tube placement by utilizing simple video laryngoscopy and using dogs as an animal model. Materials and methods This study was conducted on 20 dogs divided into two equal group (n = 10). The first group, in which a semi-flexible video laryngoscope (VLS) fitted with endotracheal tube was introduced and placed into the trachea of the experimental dogs. In the second group, dogs were intubated through soft and flexible video laryngoscope (VLS) fitted with the endotracheal tube. Number and time of the first attempt for introduction of ET were recorded. Results The number of attempts was significantly (P

Background: Cadmium is used in everyday life aspects. Hippocampus plays important role in the memory process and could be affected by cadmium exposure. L-carnitine is antioxidant, its role in neuroprotection is still not known. Aim of work: To assess effects of pre- and postnatal cadmium exposures on structure of principle cells (pyramidal and granular) of hippocampus in albino rats, and the potential role of L-carnitine. Material and methods: Pregnant female albino rats were used and divided into two major groups: I- Pregnancy and II- Lactation, each was further equally subdivided into 4 subgroups: Group Ia- Control. Group Ib- received cadmium from pregnancy day (PD)10 until delivery. Group Ic- received L-carnitine from PD7 until delivery. Group Id- received both L-carnitine from PD7 + cadmium from PD10 until delivery. Group IIa- Control. Group IIb- received cadmium from day 0-21. Group IIc- received L-carnitine from day 0-21. Group IId- received both L-carnitine+cadmium from day 0-21. Cadmium chloride was given orally by gastric lavage 4 mg/kg bodyweight/day. L-carnitine dose was given as 200 mg/kg/day orally by gastric lavage. The hippocampal specimens were collected from twelve male offspring of both age subgroups (newborn and 21 day old; 96 rats total) and were processed for light, electron microscopy and morphometry. Results: In cadmium received rats principle cells showed degenerative changes as pyknosis, cytoplasmic vacuoles, damaged mitochondria, indentation of nuclear membrane, and the morphometric data showed highly significant reduction in principle cells number and decreased principle cell layer thickness as compared to control. In cadmium+L-carnitine received rats the principle cells showed a very few swollen cells with little vacuoles, mildly dilated rough endoplasmic reticulum, and the morphometric results were improved approaching those of the control. Conclusion: cadmium damaged principle cells of dentate gyrus, CA3 and CA1 fields of the rat hippocampus. L-carnitine reduced the cadmium-induced neuronal damage.

Cognitive computing has become one of the most promising fields, especially in education, where building adaptive learning systems that provide different learning paths and material based on learners’ states and needs are developed. One of the most challenging issues in designing such systems is to correctly identify the factors that will influence the learning experience, especially when these factors highly differ from one learner to another. In addition, for one particular learner, the values of these factors change with time. In this paper, we present an approach that adapts to the most influential factors in learning in a way that varies from one learner to another and in different learning settings, including individual and collaborative learning. The approach utilizes reinforcement learning (RL) for building an intelligent environment that, not only does it provide a method for suggesting suitable learning materials, but it also provides a methodology for accounting for the continuously-changing students’ states and acceptance of the technology. We evaluate our system through simulations. The obtained results are promising and show the feasibility of the proposed approach. In addition, we propose a “rich” personalized learning system that relies on RL as its backend, while utilizing big data tools and learning analytics to continuously feed the system with new generated states.

Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects.Thirty consecutive adult (15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff.One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p 0.001) and perioperative billed charges cost by 54% (779 USD) (p 0.001), and shorter total hospital stay (36.5 days; p 0.001), inpatient postsurgical care duration (6.4 days; p 0.001), operating time (4.3 h; p 0.001) and fewer scrub staff (2.2 persons; p 0.001).These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects.

Purpose: To describe the effect of prolonging the standard suction duration during laser-assisted in-situ keratomileusis (LASIK) and its effect on flap thickness and hinge length using sub-Bowman keratomileusis (SBK) microkeratome. Methods: Fifty-six eyes (28 patients) were included and divided into 2 groups; Group-A: eyes with flatter corneas (36 eyes, 18 patients) and mean keratometric readings ranging from 40.13 to 43.71 diopters (D). Group-B: eyes with steeper corneas (20 eyes, 10 patients) with mean keratometric readings ranging from 43.85 to 46.72 D. One-Use-Plus SBK microkeratome was used for flap creation. For right eyes, flap was created immediately once suction was built up. In left eyes, the surgeon waited for 10 s after suction was built up before flap creation. Flap hinge length and flap thickness were measured using surgical caliper and ultrasonic pachymetry, respectively. Results: Statistically significant differences were observed in corneal flap hinge size between right eyes versus left eyes, with a mean of 3.98 ± 0.48 vs. 3.78 ± 0.55 mm (p

Aim This study evaluated the survival outcome, pattern of failure and prognostic factors in cervix uteri cancer patients. Methods We reviewed the data of 60 patients with stages IB-IVA cancer who were treated between January 2004 and December 2010. Results Most patients (n = 50; 83%) had squamous cell carcinoma. Stage IIB was the most common presentation (n = 41; 68%). Forty-seven patients (78%) received Cisplatin concurrent with radiotherapy (CRT). The 2- and 4-year overall survival (OS) was 82% and 79%, respectively. Prolongation of the overall treatment time (OAT) for greater than 56 days, advanced stage and pretreatment hemoglobin (Hb) levels (

Scalds are the most common type of burn in children, and one way to treat them is with xenografts with no topical antimicrobials in line with the recommendations of a recent review. However, this treatment has not been examined in detail. Our aim was to describe the treatment of such children when biological dressings (xenografts) were used without local antimicrobials. We reviewed the medical records of all children admitted to a Swedish National Burn Centre during the period 2010-2012 with scalds who were treated with xenografts. Percentage TBSA injured, age, length of hospital stay, number of operations, antibiotics given, duration of antibiotic treatment, and pain score during the first 3 days, application of xenografts, and clinical notes of wound infection were recorded. We studied 67 children, (43 of whom were boys), with a median (interquartile range [IQR]) age of 1 (1-2) year and median (IQR) TBSA% 6.2 (4-11). Twenty children (30%) required operation. Twelve (18%) developed a wound infection, 29 (43%) had other infections, and 26 (39%) were free from infection. The median (IQR) duration of systemic antibiotics was 10 (6-13) days. On the day that the xenografts were applied 10 of the children had a Face, Legs, Activity, Cry, and Consolability (FLACC) score between 3 and 7, and during the following 2 days, only four children scored in this range. The remaining 57 children had scores amp;lt;3 on the day that xenografts were applied and on the following 2 days. Median (IQR) length of stay/TBSA% was 0.7 (0.4-1.0). Treatment with xenografts was associated with median length of stay/TBSA% amp;lt; 1 and low pain scores. Despite a high rate of prescription of systemic antibiotics, most were for reasons other than wound infection. Funding Agencies|Department of Hand Surgery, Plastic Surgery and Burns, Linkoping University Hospital, Sweden

Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal disease, with a median survival of ∼2–5 years. The main target of treatment was to stabilize or reduce the rate of disease progression. Nintedanib and pirfenidone are new drugs that could be considered a breakthrough in the management of IPF as anti-inflammatory and antifibrotic agents. Aim The aim was to evaluate the efficacy, tolerability, and adverse effects of pirfenidone and nintedanib in the management of IPF. Patients and methods A total of 50 patients (38 males and 12 females) were included in our study. IPF diagnosis was established according to the international guidelines. The patients were started on antifibrotic therapy with either pirfenidone or nintedanib. Clinical, functional, and radiological follow-ups were done for all patients prospectively at baseline, at 6 months, and at 12 months of therapy. Result The mean age of nintedanib group was significantly higher (78.41±6.8 vs 62.34±6.3 years for pirfenidone group; P

Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) should be considered when conventional mechanical ventilation failed to maintain adequate gas exchange. ECMO improved gas exchange and thus preventing hypoxia and ventilator-induced lung injury. Aim To compare between VV-ECMO and conventional mechanical ventilatory support with protective lung strategy in patients with acute respiratory distress syndrome regarding selection of patients, efficacy, complications, and outcome. Patients and methods We retrospectively studied 83 patients referred for VV-ECMO consideration to ECMO center in the ICU in Chest Disease Hospital in Kuwait between January 2015 and October 2018. We had two groups: ECMO group (N=38) and conventional mechanical ventilation group (control group) (N=45). We excluded from ECMO all patients with contraindication to ECMO. After 7 days, five patients shifted to rescue ECMO owing to worsening of their condition. Clinical, laboratory, ventilator parameters, complications, and survival rate were compared between both groups. Result The clinical, laboratory, and ventilator parameters of the patients on randomization were very bad for both groups. After 5 days, significant improvement was recorded among ECMO group. At the end point of the study, weaning from ECMO was successful in 32 (74.4%) of the 43 patients, whereas in the control group, 28 (70%) patients were weaned successfully. Mortality was nonsignificantly higher in the control group (30 vs. 25.6% for ECMO group). The most common fatal complication among ECMO group was bleeding (63.6%), whereas it was respiratory failure among the control group (75%). Advanced age, long duration of mechanical ventilation before ECMO, immunocompromised state, higher blood lactate level and higher Acute Physiology and Chronic Health Evaluation II score, and the underlying lung disease before ECMO were associated with poor outcome. Conclusion VV-ECMO can be considered as an alternative therapy for patients with severe but potentially reversible acute respiratory distress syndrome when conventional ventilation failed. ECMO reduced the risk of ventilator-induced lung injury. ECMO significantly improved most of the clinical, laboratory, and ventilator parameters within days after ECMO application. ECMO had more favorable outcome and lower rate of mortality but with higher complications.

Negative pressure therapy plays an important role in the healing process of different types of wounds.this study aimed to compare between modified and traditional method of vacuum wound closure for chronic wounds.Thirty participants with chronic ulcers completed the study, their ages ranged from 47 to 65 years, from Benha city, divided randomly into two groups, it was carried out from December 2017 to March 2019.The first group treated by the traditional method of vacuum assisted wound closure for 8 weeks; dressing was changed 3 times weekly, at 125 mmHg. The mode of 2 min off and 5 min on was used. The second group treated by the modified method by switching off the device at the fifth week and applying traditional dressing for one week then ended by three weeks of vacuum wound closure. Assessment was performed before and after the study. Student t-test was used for analysis.Paired t-test showed a significant improvement in wound surface area as well as volume for pre and post treatment in each group (p 0.05). On the other hand independent t-test revealed a non-significant difference between the two groups pre as well as post treatment (p 0.05).There is no significant difference between the two programs on healing of chronic ulcers.NCT03701152 - at Clinicaltrials.gov.

RAAS Triple-A testing is a novel mass spectrometry based approach providing a comprehensive biochemical evaluation of the circulating renin-angiotensin-system (RAS) on the basis of equilibrium angiotensin levels and circulating aldosterone levels. In contrast to previous technologies involving complex sampling procedures, RAS-Equilibrium-Analysis combines the robustness and accuracy of LC-MS/MS based quantification with the versatility of serum sampling to generate a highly accurate readout containing multiple layers of information regarding the biochemical features of the circulating RAAS. Equilibrium Angiotensin I (Ang I), Angiotensin II (Ang II) and Aldosterone were simultaneously quantified in 500μl of standard collected serum samples from healthy volunteers or hypertensive patients receiving different anti-hypertensive first-line therapies. Stable-isotope labeled internal standards were used to control for analyte recovery. Following analyte extraction, samples were subjected to UPLC-MS/MS analysis and diagnostic ratios were calculated. ACE inhibitor therapy resulted in a significant reduction of the Ang II-to-Ang I-Ratio in equilibrium analysis, which was accompanied by an up-regulation of renin, as expected. Surprisingly, PRA showed a high correlation with the sum of equilibrium Ang I and Ang II, which was independent of ACE inhibitor treatment. While the ARR was strongly suppressed in the presence of ACE inhibitor treatment, the Aldosterone-to-Angiotensin II-Ratio (AA2-Ratio) was not affected, suggesting superior applicability in screening for primary aldosteronism (PA). RAAS Triple-A testing is a mass spectrometry based multiplex assay combining Ang I, Ang II and Aldosterone to diagnostic values that draw a comprehensive picture of a patient’s "RAAS Status". While the sum of Ang I and Ang II serves as a strong PRA surrogate marker, ACE activity and ACE inhibitor therapy efficacy can be monitored using the Ang II/Ang I-Ratio. On top, the AA2-Ratio serves as an advanced diagnostic marker for PA that might pave the way for patient screening without the need of withdrawing anti-hypertensive therapies.

Failure of plasma aldosterone suppression during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). Aldosterone is often higher upright than recumbent in PA; upright levels are used during FST. In a pilot study (24 patients with PA), seated saline suppression testing (SSST) was more sensitive than recumbent saline suppression testing (RSST).The current validation study involved 100 patients who underwent FST, RSST, and SSST, eight before and after unilateral adrenalectomy. Of the 108 FSTs, 73 confirmed and 18 excluded PA. Four patients with inconclusive FST lateralized on adrenal venous sampling, making a total of 77 with PA.The area under the receiver operating characteristic (ROC) curve was greater for SSST than RSST (0.96 vs. 0.80; P0.01). ROC analysis predicted optimal cutoff aldosterone levels of 162 pmol/L for SSST and 106 pmol/L for RSST. At these cutoffs, SSST showed high sensitivity for PA (87%) that markedly exceeded that for RSST (38%; P0.001) but similar specificity (94 vs. 94%; not significant). SSST was more sensitive than RSST in detecting both unilateral (n = 28, 93% vs. 68%, P0.05) and bilateral (n = 40, 85% vs. 20%, P0.001) forms of PA. Only three SSST (vs. 9 RSST and 17 FST) results were inconclusive.SSST is highly sensitive and superior to RSST in identifying both unilateral and bilateral forms of PA and has a low rate of false positives and inconclusive results. It therefore offers a reliable and much less complicated and expensive alternative to FST for confirming PA.

Purpose The purpose of this study was to conduct a matched-pair analysis to determine the effect of prior lumbar spine surgery (LSS) on clinical outcomes of hip arthroscopy. Methods Data were prospectively collected on all patients undergoing hip arthroscopy during the study period from April 2008 to December 2012. Patients were excluded if they had previous hip conditions or had undergone prior hip surgery. Patients in the LSS group (history of LSS) were matched in a 1:1 ratio to a control group (no history of LSS) according to age ±5 years, gender, body mass index categories, Tonnis grade, and labral treatment. The following outcomes were recorded in each group: modified Harris Hip Score, Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale, Hip Outcome Score–Activities of Daily Living, and visual analogue scale (VAS) score for pain, patient satisfaction, and rates for revision hip arthroscopies and conversion to total hip arthroplasty (THA). Results During the study period, 1,405 hip arthroscopies were performed with 1,017 eligible for matching. A total of 873 (85.8%) patients had a minimum 2-year follow-up. Fifty-seven patients were matched in each group. Both groups demonstrated significant improvement in patient-reported outcome (PRO) and VAS scores. The LSS group had a lower mean for all preoperative PRO scores. There was no significant difference for the postoperative mean PRO score and change in the PRO score compared with the control group except for NAHS. The mean change in the NAHS demonstrated a greater magnitude of improvement in the LSS group. There was no significant difference between mean VAS scores, patient satisfaction, and rates for revision arthroscopy and conversion to THA between the groups. Conclusions Prior LSS does not adversely affect outcomes of hip arthroscopy at a minimum 2-year follow-up. These patients have lower preoperative scores but similar magnitude of improvement and revision/THA rates compared with a matched comparative group of patients without prior LSS. Level of Evidence Level II, retrospective analysis of prospectively collected data.

Aim: Acute kidney injury (AKI) is a major health problem with poor patient prognosis. We evaluated the clinical characteristics, risk factors, associated comorbidities, and outcomes of AKI patients. Methodology: A single-center prospective observational study. The patients were admitted in Mansoura Nephrology and Dialysis Unit over a period of 1 year from January to December, 2016. Patients were diagnosed as AKI or AKI in addition to chronic kidney disease according to the creatinine criteria of KDIGO 2013. All patients were subjected to complete history taking, physical examination, and full laboratory and pelvi-abdominal ultrasound investigations. The study outcomes were all-cause hospital mortality, and recovery of renal function. Predictors of mortality were assessed using multivariate logistic regression analysis. The study was reviewed and approved by local Ethical Committee of IBR. Results: We evaluated 199 (96 males plus 103 females) aged between 18 and 88 years old. Dehydration was the commonest precipitating factor for AKI in our patients (68.8%) and Oliguria was the commonest symptom present in 47.7% of patients. Intravenous fluids were received by 79.9% of patients, 22.6% of patients received diuretics, and 33.7% received renal replacement therapy in the form of intermittent hemodialysis. Death occurred in 25 patients (13.16%) and 69 (36.32%) showed no renal recovery. Shock and sepsis were the most significant predictors of mortality. Conclusion: Community acquired AKI is a major health problem with high morbidity and mortality.