Search

Introduction Benign vocal fold lesions (BVFLs) disrupt the superficial lamina propria, impacting vocal fold pliability. Investigating the diagnostic competency of ear, nose, and throat (ENT) residents in identifying BVFLs, we hypothesize that factors such as residency year, subspecialty focus, and training center influence diagnostic accuracy.

Abstract This study aimed to examine the validity and reproducibility of strain elastography (SE) for detecting prostate cancer (PCa) in patients with elevated prostate-specific antigen (PSA) levels. The study included 107 patients with elevated PSA levels. All eligible patients underwent transrectal ultrasound (TRUS) with real-time elastography (RTE) to detect suspicious lesions. Two readers independently evaluated the lesions and assigned a strain ratio and elastography score to each lesion. Histopathology was used as a reference standard to estimate the validity of RTE in predicting malignant lesions. An intraclass correlation (ICC) was performed to detect reliability of the strain ratios and elastography scores. TRUS-guided biopsy detected malignancies in 64 (59.8%) patients. TRUS with RTE revealed 122 lesions. The strain ratio index (SRI) cut-off values to diagnose malignancy were 4.05 and 4.35, with sensitivity, specificity, and accuracy of 94.7%, 91.3%, and 93.4%, respectively. An elastography score > 3 was the best cut-off value for detecting malignancy. According to readers, the sensitivity, specificity, and accuracy were 91.3–94.7%, 89.5–93.4%, and 91.3–90.9%, respectively. Excellent inter-reader agreement was recorded for SRI and elastography scores, with ICC of 0.937 and 0.800, respectively. SE proves to be an efficient tool for detecting PCa with high accuracy in patients with elevated PSA levels.

Abstract Floorplan energy assessments present a highly efficient method for evaluating the energy efficiency of residential properties without requiring physical presence. By employing computer modelling, an accurate determination of the building’s heat loss or gain can be achieved, enabling planners and homeowners to devise energy-efficient renovation or redevelopment plans. However, the creation of an AI model for floorplan element detection necessitates the manual annotation of a substantial collection of floorplans, which poses a daunting task. This paper introduces a novel active learning model designed to detect and annotate the primary elements within floorplan images, aiming to assist energy assessors in automating the analysis of such images–an inherently challenging problem due to the time-intensive nature of the annotation process. Our active learning approach initially trained on a set of 500 annotated images and progressively learned from a larger dataset comprising 4500 unlabelled images. This iterative process resulted in mean average precision score of 0.833, precision score of 0.972, and recall score of 0.950. We make our dataset publicly available under a Creative Commons license.

Abstract There is a lack of epidemiological data on fascioliasis in Egypt regarding disease characteristics and treatment outcomes across different governorates. We aimed to identify the demographic, epidemiologic, clinical, laboratory, and radiological characteristics and treatment outcomes of patients diagnosed with fascioliasis in Egypt. Data on human fascioliasis were collected retrospectively from patients’ medical records in the period between January 2018 and January 2020. The study included 261 patients. More than 40% of enrolled patients were in the age group of 21–40 years old. Geographically, 247 (94.6%) were from Assiut Governorate with 69.3% were from rural areas. The most frequent symptoms were right upper quadrant pain (96.9%), and fever (80.1%). Eosinophilia was found in 250 cases (95.8%). Hepatic focal lesions were detected in 131 (50.2%); out of them 64/131 (48.9%) had a single lesion. All patients received a single dose of 10 mg/kg of triclabendazole, 79.7% responded well to a single dose, while in 20.3% a second ± a third dose of treatment was requested. After therapy, there was a reduction in leucocytes, Fasciola antibodies titer, eosinophilic count, bilirubin, and liver enzymes with an increase in hemoglobin level. According to our findings, a high index of suspicion should be raised in cases with fever, right upper abdominal pain, and peripheral eosinophilia, and further imaging workup is mandated to detect hepatic focal lesions. Prompt treatment by triclabendazole can serve as a standard-of-care regimen even for suspected cases.

Abstract Throughout computational science, there is a growing need to utilize the continual improvements in raw computational horsepower to achieve greater physical fidelity through scale-bridging over brute-force increases in the number of mesh elements. For instance, quantitative predictions of transport in nanoporous media, critical to hydrocarbon extraction from tight shale formations, are impossible without accounting for molecular-level interactions. Similarly, inertial confinement fusion simulations rely on numerical diffusion to simulate molecular effects such as non-local transport and mixing without truly accounting for molecular interactions. With these two disparate applications in mind, we develop a novel capability which uses an active learning approach to optimize the use of local fine-scale simulations for informing coarse-scale hydrodynamics. Our approach addresses three challenges: forecasting continuum coarse-scale trajectory to speculatively execute new fine-scale molecular dynamics calculations, dynamically updating coarse-scale from fine-scale calculations, and quantifying uncertainty in neural network models.

[This corrects the article DOI: 10.1371/journal.pone.0300550.].

Egypt is among the world's largest producers of sugarcane. This crop is of great economic importance in the country, as it serves as a primary source of sugar, a vital strategic material. The pre-cutting planting mode is the most used technique for cultivating sugarcane in Egypt. However, this method is plagued by several issues that adversely affect the quality of the crop. A proposed solution to these problems is the implementation of a sugarcane-seed-cutting device, which incorporates automatic identification technology for optimal efficiency. The aim is to enhance the cutting quality and efficiency of the pre-cutting planting mode of sugarcane. The developed machine consists of a feeding system, a node scanning and detection system, a node cutting system, a sugarcane seed counting and monitoring system, and a control system. The current research aims to study the pulse widths (PW) of three-color channels (R, G, and B) of the RGB color sensors under laboratory conditions. The output PW of red, green, and blue channel values were recorded at three color types for hand-colored nodes [black, red, and blue], three speeds of the feeding system [7.5 m/min, 5 m/min, and 4.3 m/min], three installing heights of the RGB color sensors [2.0 cm, 3.0 cm, and 4.0 cm], and three widths of the colored line [10.0 mm, 7.0 mm, and 3.0 mm]. The laboratory test results s to identify hand-colored sugarcane nodes showed that the recognition rate ranged from 95% to 100% and the average scanning time ranged from 1.0 s to 1.75 s. The capacity of the developed machine ranged up to 1200 seeds per hour. The highest performance of the developed machine was 100% when using hand-colored sugarcane stalks with a 10 mm blue color line and installing the RGB color sensor at 2.0 cm in height, as well as increasing the speed of the feeding system to 7.5 m/min. The use of IoT and RGB color sensors has made it possible to get analytical indicators like those achieved with other automatic systems for cutting sugar cane seeds without requiring the use of computers or expensive, fast industrial cameras for image processing.

The current electric vehicles (EVs) market is experiencing significant expansion, underscoring the need to address challenges associated with the limited driving range of EVs. A primary focus in this context is the improvement of the wireless charging process. To contribute to this research area, this study introduces a circular spiral coil design that incorporates transceiver coils. First, an in-depth analysis is conducted using Ansys Maxwell software to assess the effectiveness of the proposed solution through the magnetic field distribution, inductance properties, and mutual inductance between receiver and transmitter coils. In the next step, a direct shielding technique is applied, integrating a ferrite core bar to reduce power leakage and enhance power transmission efficiency. The ferrite magnetic shielding guides magnetic field lines, resulting in a significant reduction in flux leakage and improved power transmission. Lastly, a magnetic resonance series (SS) compensation wireless system is developed to achieve high coupling efficiency and superior performance. The system's effectiveness is evaluated through co-simulation using Ansys Simplorer software. The results confirm the effectiveness of the proposed solution, showing its ability to transmit 3.6 kilowatts with a success rate approaching 99%. This contribution significantly advances the development of wireless charging systems for electric vehicles, addressing concerns and promoting global adoption.

Prenatal alcohol exposure (PAE) refers to fetal exposure to alcohol during pregnancy through placental barrier transfer from maternal blood. The postnatal outcomes of PAE differ among exposed individuals and range from overt (serious) alcohol-related behavioral and neurophysiological impairments to covert (silenced) symptoms. The aims of the present investigation were to assess the postnatal neurobehavioral disturbances, particularly, motor coordination and sensory-motor function in mice with PAE. Female mice with positive vaginal plugs were divided into three groups: group 1: Et + Pyr: received two i.p injections of ethanol (1 g/kg) followed by pyrazole (100 mg/kg). Group 2: Pyr: received an i.p injection of pyrazole (100 mg/kg). Group 3: C: of saline controls received, in equal volume, saline solution (NaCl 0.9%). After birth, mice pups were weighed and subjected to behavioral tests for motor function screening using the motor ambulation test, cliff aversion, surface righting, and negative geotaxis, while at the adult stage, mice were subjected to the open field, rotarod, parallel bars, and static rods tests. Our data show an obvious decrement of body weight from the first post-natal day (P1) and continues over the adult stage. This was accompanied by an obvious impaired sensory-motor function which was maintained even at the adult stage with alteration of the locomotor and coordination abilities. The current data demonstrate the powerful neurotoxic effect of prenatal ethanol exposure on the sensory-motor and coordination functions, leading to suppose possible structural and/or functional neuronal disturbances, particularly the locomotor network.

Abstract This work investigates the effectiveness of solar heating using clear polyethylene bags against rice weevil Sitophilus oryzae (L.), which is one of the most destructive insect pests against many strategic grains such as wheat. In this paper, we aim at finding the key parameters that affect the control heating system against stored grain insects while ensuring that the wheat grain quality is maintained. We provide a new benchmark dataset, where the experimental and environmental data was collected based on fieldwork during the summer in Canada. We measure the effectiveness of the solution using a novel formula to describe the amortising temperature effect on rice weevil. We adopted different machine learning models to predict the effectiveness of our solution in reaching a lethal heating condition for insect pests, and hence measure the importance of the parameters. The performance of our machine learning models has been validated using a 10-fold cross-validation, showing a high accuracy of 99.5% with 99.01% recall, 100% precision and 99.5% F1-Score obtained by the Random Forest model. Our experimental study on machine learning with SHAP values as an eXplainable post-hoc model provides the best environmental conditions and parameters that have a significant effect on the disinfestation of rice weevils. Our findings suggest that there is an optimal medium-sized grain amount when using solar bags for thermal insect disinfestation under high ambient temperatures. Machine learning provides us with a versatile model for predicting the lethal temperatures that are most effective for eliminating stored grain insects inside clear plastic bags. Using this powerful technology, we can gain valuable information on the optimal conditions to eliminate these pests. Our model allows us to predict whether a certain combination of parameters will be effective in the treatment of insects using thermal control. We make our dataset publicly available under a Creative Commons Licence to encourage researchers to use it as a benchmark for their studies.

Abstract The main objective of this study is to model the concentration of ozone in the winter season on air quality through machine learning algorithms, detecting its impact on population health. The study area involves four monitoring stations: Ate, San Borja, Santa Anita and Campo de Marte, all located in Metropolitan Lima during the years 2017, 2018 and 2019. Exploratory, correlational and predictive approaches are presented. The exploratory results showed that ATE is the station with the highest prevalence of ozone pollution. Likewise, in an hourly scale analysis, the pollution peaks were reported at 00:00 and 14:00. Finally, the machine learning models that showed the best predictive capacity for adjusting the ozone concentration were the linear regression and support vector machine.

β- thalassemia major (β-TM) is one of the most common inherited single gene disorder .Children with Thalassemia frequently have poor growth and delayed pubertal development. Selenium and manganese are factors responsible for growth and puberty disorders in thalassemic patients. Assessment of serum levels of selenium and manganese in patients with β thalassemia major in Pediatric Haematology Clinic in Beni Suef University Hospital. Blood was taken from 50 pediatric patients with b thalassemia major, and 50 normal children as controls . All children were age and sex matched . all children were subjected to full history taking and full clinical examination and investigation was done in the form of CBC, serum Ferritin , serum Selenium and Manganese were measured using spectrophotometer.Patients with β- thalassemia major have high serum manganese level as compared to normal controls with P value of (0.000), while serum selenium level is insignificant as compared to normal controls with P value of (0.119)

Background: Bone marrow failure is a group of disorders characterized by the inability of bone marrow to produce sufficient blood cells. They can be divided into inherited disorders, acquired disorders and diseases infiltrating bone marrow. Acute leukemia is a serious cause of bone marrow failure which needs early diagnosis and management . Purpose: To study for registry, and clinical spectrum of bone marrow failure in Beni-Suef university hospital to detect the magnitude of the problem . Patients and methods: It is cross sectional study over a period of six months from January 2019 to June 2019, in which patients with bone marrow failure (monocytopenia, bicytopenia or pancytopenia) from pediatric age group (0-13 years) who were admitted in the pediatric department in Beni-Suef university hospital were included and followed up. They were subjected to a detailed history, full examination and laboratory investigation; complete blood count, reticulocyte cont, bone marrow aspirate & biopsy, virology study and accordingly other investigations were done such as flow cytometry for cd55 & cd59, glucocerebrosidase enzyme assay, chromosomal breakage analysis and imaging. Results: Out of 22000 outpatients and 1700 inpatients,55 patients had diagnosed as bone marrow failure during six months duration with percentage of o.23%. The most frequent diagnosis of bone marrow failure was acute Leukemia (30.9 %), followed by Idiopathic aplastic anemia (27.3%) then Fanconi anaemia (21.8%). Conclusion: Bone marrow failure is not rare ,acute Leukemia should be considered strongly in the diagnosis of any case of bone marrow failure.

The aim of current study was to detect prevalence and clinical presentation of iron deficiency anemia (IDA) in primary school children in Beni-Suef and to assess their risk factors. This cross-sectional survey was conducted on randomly selected primary school children with microcytic hypochromic anemia of both genders aged from 6 years – 12 years in Beni- suef governorate. The prevalence of IDA was 26.6% among children 6-12 years of age. Socioeconomic factors (such as mother education, residence, nutritional status, parasitic infection and recurrent infection) and poor dietary habits are the main contributing factors of IDA among the children studied. It is alarming that the prevalence of IDA is high among children 6–12years of age. Screening for IDA should be directed at high-risk groups and school programs should be implemented to improve awareness of healthy food habits.

Infections with Mycoplasma gallisepticum (MG) in poultry are associated with a wide range of disease conditions, including those affecting the respiratory and reproductive systems. The purpose of this study was to endorse the more sensitive diagnostic scheme for MG infection and identify the best molecular marker for MG phylogenetic analysis using six housekeeping genes: mgc2, mraW, atpG, ugpA, DUF31196, and lgT. For these purposes, 55 poultry flocks of different species were screened using either qRT-PCR or PCR techniques analogous to conventional culturing from non-cultured and cultured swabs on PPLO broth. The rate of MG positivity was the highest when using qRT-PCR from cultured broth (89.0%) and the lowest when using conventional culturing (34.5%). Compared to qRT-PCR from broth, statistical analysis using the Roc curve in MedCalc statistical software showed that the PCR schemes (qRT-PCR from swabs and PCR from swabs and broth) performed better than conventional culturing in terms of sensitivity, accuracy, and area under the curve (AUC), suggesting that they may be more reliable schemes. Further support was added by Cohen’s kappa test, showing moderate agreement between the molecular approaches. Among the six screened genes, mgc2 and mraW had the highest detection rates (69% and 65.4%, respectively). The comparative phylogenetic analysis revealed that mgc2 or atpG gene sequences distinguished MG isolates into different clades with high discriminatory power.

Due to their simplicity, cheapness, and ease of maintenance, induction motors (IMs) are the most widely used motors in the industry. However, if they are not properly controlled, the load torque and motor speed will fluctuate in an unsatisfactory fashion. To effectively control the load torque and speed of these IMs, it is necessary to use specialized drives. The entire system (IMs + Drives) will experience uncertainty, nonlinearities, and disruptions, which calls for an outstanding performance control structure. The sensorless sliding mode predictive torque control (SSM-PTC) for both AC-DC converter and DC-AC inverter, which are utilized for feeding the IM, is investigated in this work. The AC-DC converter is controlled using the SSM-PTC method in order to follow the DC-link reference voltage throughout any changes in the operating point of the IM. While the DC-AC inverter is controlled using a sensorless predictive power control (SPPC). Within a unity power factor, this SPPC regulates the reactive power flow between the motor and the supply to account for the undesirable harmonic components of the grid current. In addition, an experimental performance improvement of SSM-PTC of IM supplied by a 5-leg AC-DC-AC power converter using extended Kalman filter (EKF) without weighting factor (WF) is also studied in this work. Design and implantation of the suggested control systems are performed using a dSPACE 1104 card. The experimental results of the proposed converter control demonstrate that the suggested approach effectively regulated the DC link, reducing load torque and speed fluctuations. In the context of inverter control, a prompt active power response yields a motor current waveform that resembles a sinusoidal pattern, exhibiting minimal levels of harmonic distortion.

Solar energy, a prominent renewable resource, relies on photovoltaic systems (PVS) to capture energy efficiently. The challenge lies in maximizing power generation, which fluctuates due to changing environmental conditions like irradiance and temperature. Maximum Power Point Tracking (MPPT) techniques have been developed to optimize PVS output. Among these, the incremental conductance (INC) method is widely recognized. However, adapting INC to varying environmental conditions remains a challenge. This study introduces an innovative approach to adaptive MPPT for grid-connected PVS, enhancing classical INC by integrating a PID controller updated through a fuzzy self-tuning controller (INC-FST). INC-FST dynamically regulates the boost converter signal, connecting the PVS's DC output to the grid-connected inverter. A comprehensive evaluation, comparing the proposed adaptive MPPT technique (INC-FST) with conventional MPPT methods such as INC, Perturb & Observe (P&O), and INC Fuzzy Logic (INC-FL), was conducted. Metrics assessed include current, voltage, efficiency, power, and DC bus voltage under different climate scenarios. The proposed MPPT-INC-FST algorithm demonstrated superior efficiency, achieving 99.80%, 99.76%, and 99.73% for three distinct climate scenarios. Furthermore, the comparative analysis highlighted its precision in terms of control indices, minimizing overshoot, reducing rise time, and maximizing PVS power output.

Due to the unpredictability of the majority of green energy sources (GESs), particularly in microgrids (μGs), frequency deviations are unavoidable. These factors include solar irradiance, wind disturbances, and parametric uncertainty, all of which have a substantial impact on the system's frequency. An adaptive load frequency control (LFC) method for power systems is suggested in this paper to mitigate the aforementioned issues. For engineering challenges, soft computing methods like the bat algorithm (BA), where it proves its effectiveness in different applications, consistently produce positive outcomes, so it is used to address the LFC issue. For online gain tuning, an integral controller using an artificial BA is utilized, and this control method is supported by a modification known as the balloon effect (BE) identifier. Stability and robustness of analysis of the suggested BA+BE scheme is investigated. The system with the proposed adaptive frequency controller is evaluated in the case of step/random load demand. In addition, high penetrations of photovoltaic (PV) sources are considered. The standard integral controller and Jaya+BE, two more optimization techniques, have been compared with the suggested BA+BE strategy. According to the results of the MATLAB simulation, the suggested technique (BA+BE) has a significant advantage over other techniques in terms of maintaining frequency stability in the presence of step/random disturbances and PV source. The suggested method successfully keeps the frequency steady over I and Jaya+BE by 61.5% and 31.25%, respectively. In order to validate the MATLAB simulation results, real-time simulation tests are given utilizing a PC and a QUARC pid_e data acquisition card.

The integration of renewable sources (RSs) and the widespread deployment of electric vehicles (EVs) has transitioned from a luxury to a necessity in modern power systems. This results from the sharp increase in electric power demand and public awareness of switching to green energy. However, in addition to load fluctuations and changes in system parameters, these RSs and EVs negatively impact the load frequency (LF). This work presents a LF control for a modern multi-area power system incorporating photovoltaic (PV) and EV chargers. The proposed controller primarily utilizes EV chargers within modern power systems. This approach offers the advantage of using the already present components instead of introducing new ones. The proposed controller comprises the ecological optimization approach (ECO) and the integral controller (I). Both of these components are designed for autonomous vehicle-to-grid (V2G) devices. The proposed control technique is applied to a three-area power system, where the V2G scheme is located in Area-1. Variations in the load, PV power generated, and system parameters are considered to evaluate the effectiveness of the proposed (I+ECO+V2G) controller for controlling the LF. To assess the performance of the proposed I+ECO+V2G system, a comparative analysis is conducted to compare its performance with both the I+ECO system and the standard I-controller. The simulation findings demonstrate that implementing the I+ECO and the proposed I+ECO+V2G strategies results in enhanced system stability and decreased LF fluctuations compared to the conventional I-control approach. Furthermore, while comparing the I+ECO control technique to the suggested control strategy I+ECO+V2G, it was seen that the latter reaches steady state values more quickly. The results validate the robustness and effectiveness of the proposed controller in mitigating the impacts of load disturbances, uncertainties, and nonlinearities within the system. These simulations were performed using MATLAB/SIMULINK. To validate the outcomes of the simulation results, an experimental setup consisting of a real-time dSPACE DS1103 connected to another PC via QUARC pid_e data acquisition card was used. The experimental findings have substantiated the accuracy of the simulation findings about the superiority of the I+ECO+V2G methodology compared to both the I+ECO and I-control methodologies concerning system performance and LF control.

Biometric technology is becoming increasingly prevalent in several vital applications that substitute traditional password and token authentication mechanisms. Recognition accuracy and computational cost are two important aspects that are to be considered while designing biometric authentication systems. Thermal imaging is proven to capture a unique thermal signature for a person and thus has been used in thermal face recognition. However, the literature did not thoroughly analyse the impact of feature selection on the accuracy and computational cost of face recognition which is an important aspect for limited resources applications like IoT ones. Also, the literature did not thoroughly evaluate the performance metrics of the proposed methods/solutions which are needed for the optimal configuration of the biometric authentication systems. This paper proposes a thermal face-based biometric authentication system. The proposed system comprises five phases: a) capturing the user’s face with a thermal camera, b) segmenting the face region and excluding the background by optimized superpixel-based segmentation technique to extract the region of interest (ROI) of the face, c) feature extraction using wavelet and curvelet transform, d) feature selection by employing bio-inspired optimization algorithms: grey wolf optimizer (GWO), particle swarm optimization (PSO) and genetic algorithm (GA), e) the classification (user identification) performed using classifiers: random forest (RF), k-nearest neighbour (KNN), and naive bayes (NB). Upon the public dataset, Terravic Facial IR, the proposed system was evaluated using the metrics: accuracy, precision, recall, F-measure, and receiver operating characteristic (ROC) area. The results showed that the curvelet features optimized using the GWO and classified with random forest could help in authenticating users through thermal images with performance up to 99.5% which is better than the results of wavelet features by 10% while the former used 5% fewer features. In addition, the statistical analysis showed the significance of our proposed model. Compared to the related works, our system showed to be a better thermal face authentication model with a minimum set of features, making it computational-friendly.

The operation of the system's frequency can be strongly impacted by load change, solar irradiation, wind disturbance, and system parametric uncertainty. In this paper, the application of an adaptive controller based on a hybrid Jaya-Balloon optimizer (JBO) for frequency oscillation mitigation in a single area smart μG system is studied. The proposed adaptive control approach is applied to control the flexible loads such as HPs and EVs by using the JBO which efficiently controls the system frequency. The suggested technique uses the power balance equation to provide a dynamic output feedback controller. The main target is to regulate the frequency and power of an islanded single area μG powered by a PV and a diesel generator with integrations of smart bidirectional loads (HPs and EVs) that are controlled by the proposed adaptive controller in presence of electrical random loads. Moreover, the JBO is designed to minimize the effect of the system load disturbance and parameter variations. For a better assessment, the proposed controller using JBO technique is compared with two other methods which are the coefficient diagram method (CDM) and adaptive one using classical the Jaya technique. In the obtained results, the frequency deviation is found as 0.0015 Hz, which is fully acceptable and in the range of the IEEE standards. The MATLAB simulation results reveal that the suggested technique has a substantial advantage over other techniques in terms of frequency stability in the face of concurrent disturbances and parameter uncertainties. The real-time simulation tests are presented using a dSPACE DS1103 connected to another PC via QUARC pid_e data acquisition card and confirmed the MATLAB simulation results.

Abstract This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients’ demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Abstract Objective MG-63 cells that have osteoblastic and adipogenic differentiation potential were evaluated for internalization, and adipogenic differentiation in the presence and absence of the covalently functionalized aryl gold nanoparticles (AuNPs-C6H4-4-COOH). Results Inductively coupled plasma, flow cytometry and confocal microscopy analyses confirmed that gold nanoparticles were easily internalized by MG-63 cells. The MG-63 cells were differentiated into adipocytes without gold-aryl nanoparticles and with the gold-aryl nanoparticles at 5 µM concentration in both induction and maintenance media. The lipid content assay and the relative expressions of PPAR-γ, ADR1, GLUT1 and GLUT4 genes showed no significant variation with and without the gold nanoparticles treatment. Differential phosphorylation levels of 43 kinases phosphorylation sites were evaluated using the human phospho-kinase array to assess the effect of the gold nanoparticles on the signaling pathways during the differentiation. No kinase phosphorylation site was differentially phosphorylated with two or more folds after the nanoparticles treatment after the first day as well as at the end of MG-63 cells differentiation. The gold-aryl nanoparticles do not affect MG-63 cells differentiation into adipocytes neither do they affect any key signaling pathway. These properties make these gold nanoparticles suitable for future drug delivery and medical applications.

Cardiac hydatid cyst is very a rare manifestation of hydatid disease. It is potentially life threatening, and characterized by its clinical polymorphism, thus making an early preoperative diagnosis challenging. The sole curative treatment of this disease is surgery, and it should be done as emergent as possible after diagnosis, in order to minimize the risk of serious complications like embolism and anaphylaxis.We report a case of a 22 years old male who had multivesicular cyst formation in the left ventricle free wall, which was measuring 14 × 8 cm. The patient underwent surgery in order to remove this hydatid cyst, by using the cardiopulmonary bypass, and his postoperative course was unremarkable. Resumen: El quiste hidatídico cardiaco es una manifestación muy rara de la enfermedad hidatídica y potencialmente mortal, caracterizada por su polimorfismo clínico, lo que dificulta su diagnóstico preoperatorio temprano. La cirugía sigue siendo el único tratamiento curativo del quiste hidatídico cardiaco. Este debe ser tratado lo más pronto posible después del diagnóstico, ya que minimiza el riesgo de complicaciones graves como embolia y anafilaxia.Presentamos el caso de un varón de 22 años que presenta una formación de quiste multivesicular en la pared libre del ventrículo izquierdo de 14 × 8 cm. El paciente fue intervenido quirúrgicamente mediante bypass cardiopulmonar para extirpar el quiste hidatídico de la pared libre del ventrículo izquierdo, con un resultado satisfactorio para el curso postoperatorio.

The goal of this study is to assess the effectiveness of phytoestrogen with clomiphene citrate for ovulation induction in women with polycystic ovarian syndrome to overcome the antiestrogenic effect of clomiphene citrate on endometrium, were randomly grouped into two groups, 50 in each group. Group 1: receiving CC 100 mg twice daily from third day of cycle for five days and group 2: receiving CC from 3rd of cycle for 5 days plus phytoestrogen (Klimadynon(®), Bionorica, Neumarkt i.d.OBf., Germany) (20mg of cimifuga racemosa from day 1to12). Women receiving CC plus phytoestrogen have an increase number of dominant follicles, endometrial thickness with an improvement of both ovulation rate and pregnancy rate.

In humid and temperate areas, Septoria nodorum blotch (SNB) is a major fungal disease of common wheat (Triticum aestivum L.) in which grain yield is reduced when the pathogen, Parastagonospora nodorum, infects leaves and glumes during grain filling. Foliar SNB susceptibility may be associated with sensitivity to P. nodorum necrotrophic effectors (NEs). Both foliar and glume susceptibility are quantitative, and the underlying genetics are not understood in detail. We genetically mapped resistance quantitative trait loci (QTL) to leaf and glume blotch using a double haploid (DH) population derived from the cross between the moderately susceptible cultivar AGS2033 and the resistant breeding line GA03185-12LE29. The population was evaluated for SNB resistance in the field in four successive years (2018-2021). We identified major heading date (HD) and plant height (PH) variants on chromosomes 2A and 2D, co-located with SNB escape mechanisms. Five QTL with small effects associated with adult plant resistance to SNB leaf and glume blotch were detected on 1A, 1B, and 6B linkage groups. These QTL explained a relatively small proportion of the total phenotypic variation, ranging from 5.6 to 11.8%. The small-effect QTL detected in this study did not overlap with QTL associated with morphological and developmental traits, and thus are sources of resistance to SNB.

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.

The mammalian circadian timing system and metabolism are highly interconnected, and disruption of this coupling is associated with negative health outcomes. Krüppel-like factors (KLFs) are transcription factors that govern metabolic homeostasis in various organs. Many KLFs show a circadian expression in the liver. Here, we show that the loss of the clock-controlled KLF10 in hepatocytes results in extensive reprogramming of the mouse liver circadian transcriptome, which in turn alters the temporal coordination of pathways associated with energy metabolism. We also show that glucose and fructose induce Klf10, which helps mitigate glucose intolerance and hepatic steatosis in mice challenged with a sugar beverage. Functional genomics further reveal that KLF10 target genes are primarily involved in central carbon metabolism. Together, these findings show that in the liver KLF10 integrates circadian timing and sugar metabolism-related signaling, and serves as a transcriptional brake that protects against the deleterious effects of increased sugar consumption.

Background and aims: Monitoring oral diseases is needed to allocate resources, plan health services and train dental workforce. Caries is one of the oral diseases most commonly included in oral health surveillance systems. The present study assessed (1) caries data availability in the administrative regions of Saudi Arabia and (2) factors associated with this availability. Methods: We collected caries data in the period 2008–2018 in Saudi Arabia (outcome variable). The explanatory variables included region-level factors: (a) socio-economic indicators (percentage of individuals with university education, percentage of category A governorates, percentage of owned houses, households with computers, internet and smart phones) and, (b) oral health research potential indicators (number of Dental Public Health (DPH) specialists, Ministry of Health (MoH) dentist to population ratio and number of dental schools). ArcGIS was used for data visualization and logistic regression was used for analysis. Results: Twenty-two studies provided caries data for 46.2% of the regions which were inhabited by 84.7% of the population. Region-level data availability was associated with the number of dental schools (OR = 1.63) with 61.5% of the regions correctly classified. More regions were correctly classified when population to MoH dentist ratio (76.9%) and the number of DPH specialists (92.3%) were included. Conclusions: Caries data were available for half of the administrative regions in Saudi Arabia and data availability was associated with higher number of dental schools. The presence of DPH specialist provided the critical mass to collect caries data. Keywords: Data collection, Information dissemination, Epidemiological monitoring, Geographic information systems, Schools, dental, Saudi Arabia

The fungal nasal septum abscess is a rare localized invasive form of fungal rhinosinusitis. Rare cases have been described in the literature. In this article, we intend to describe a new case of fungal nasal septum abscess caused by Aspergillus flavus in diabetic patient after sinonasal surgery. A 53-year-old woman with a history of uncontrolled type 2 diabetes and asthma developed a nasal septum abscess after a sinonasal endoscopic surgery which was performed for nasal polyposis. Needle aspiration of the abscess was performed and the pus cultures were positive for Aspergillus flavus. The patient was treated with antifungal drugs and surgical drainage of the abscess. A clinical and biological improvement was observed. Her case has been followed up for 18 months, and there hasn’t been any recurrence of the infection. The fungal nasal septum abscess should be suspected in patients who do respond adequately to standard treatment of nasal septum abscess, especially patients with risk factors of fungal rhinosinusitis.

INTRODUCTION: In otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery. METHODS: eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13. RESULTS: there were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82)mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36)mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00)mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by = 10mmHg. CONCLUSION: ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.

The aim of this study is to characterize the antimicrobial resistance of Campylobacter jejuni recovered from diarrheal patients in Belgium, focusing on the genetic diversity of resistant strains and underlying molecular mechanisms of resistance among Campylobacter jejuni resistant strains isolated from diarrheal patients in Belgium. Susceptibility profile of 199 clinical C. jejuni isolates was determined by minimum inhibitory concentrations against six commonly-used antibiotics (ciprofloxacin, nalidixic acid, tetracycline, streptomycin, gentamicin, and erythromycin). High rates of resistance were observed against nalidixic acid (56.3%), ciprofloxacin (55.8%) and tetracycline (49.7%); these rates were similar to those obtained from different national reports in broilers intended for human consumption. Alternatively, lower resistance rates to streptomycin (4.5%) and erythromycin (2%), and absolute sensitivity to gentamicin were observed. C. jejuni isolates resistant to tetracycline or quinolones (ciprofloxacin and/or nalidixic acid) were screened for the presence of the tetO gene and the C257T mutation in the quinolone resistance determining region (QRDR) of the gyrase gene gyrA, respectively. Interestingly, some of the isolates that displayed phenotypic resistance to these antimicrobials lacked the corresponding genetic determinants. Among erythromycin-resistant isolates, a diverse array of potential molecular resistance mechanisms was investigated, including the presence of ermB and mutations in the 23S rRNA gene, the rplD and rplV ribosomal genes, and the regulatory region of the cmeABC operon. Two of the four erythromycin-resistant isolates harboured the A2075G transition mutation in the 23S rRNA gene; one of these isolates exhibited further mutations in rplD, rplV and in the cmeABC regulatory region. This study expands the current understanding of how different genetic determinants and particular clones shape the epidemiology of antimicrobial resistance in C. jejuni in Belgium. It also reveals many questions in need of further investigation, such as the role of other undetermined molecular mechanisms that may potentially contribute to the antimicrobial resistance of Campylobacter.

Immunosuppression management in clinical transplantation aims to balance delivery of efficacy against adverse reactions using therapeutic drug monitoring. Adherence to posttransplant immunosuppressive medications and minimizing variability in drug exposure are important considerations in preventing rejection and maximizing overall transplant outcomes. The availability of once-daily tacrolimus may add a potential benefit by simplifying immunosuppressive regimens, though improving compliance among transplant recipients. The aim of our study is to investigate the safety and efficacy of the once-daily formulation of tacrolimus (Advagraf) against the usually used twice daily tablets (Prograf). A prospective randomized trial 1:2 was designed for 99 consecutive live-related renal transplant recipients who received their grafts at a single center (study group, Advagraf, 33 recipients and control group, Prograf, 66 recipients). The demographic data were homogeneous among both groups regarding donors and patients’ characteristics. Posttransplant hypertension, infection, malignancy, and diabetes mellitus were comparable among both groups. Renal function and rejection episodes showed no statistical significance among recipients of both groups. Despite slight higher Advagraf unit doses, there was no statistical difference regarding the tacrolimus trough levels, between the two groups. Our singlecenter experience revealed that the availability of once-daily tacrolimus formulation could give potential benefit of improved medication compliance and better allograft outcomes by decreasing pill burden and thereby simplifying dosing schedule, Advagraf was non-inferior to twice-daily tacrolimus regarding safety and efficacy. Although being nonsignificant, a trend for better kidney function was noted in this short-term study in the Advagraf group, so long-term follow-up is needed to verify this.

Recent reports of thrombosis following AstraZeneca COVID-19 vaccine in young females (

Abstract The exposure of the Earth’s surface to the energetic input of rainfall is one of the key factors controlling water erosion. While water erosion is identified as the most serious cause of soil degradation globally, global patterns of rainfall erosivity remain poorly quantified and estimates have large uncertainties. This hampers the implementation of effective soil degradation mitigation and restoration strategies. Quantifying rainfall erosivity is challenging as it requires high temporal resolution(

The newer and potent immunosuppressive agents have successfully reduced the risk of rejection after kidney transplantation, but the development of cardiovascular diseases, infections, and malignancy is major factors limiting their success. Posttransplantation malignancy is the second most common cause of death in renal transplant recipients after cardiovascular disease; it is expected that mortality due to malignancy may become the most common cause of death within the next two decades. This study is designed to evaluate the incidence, risk factors, and types of malignancies occurring after renal transplantation and their impact on patient and graft survival. A total of 2288 patients underwent living donor renal allotransplantation in the Urology and Nephrology Center, Mansoura University, during the period between 1975 and 2011. Among these patients, 100 patients developed posttransplantation malignancy. Patients were categorized into five major groups according to their type of malignancy; Kaposi’s sarcoma (KS), non-Kaposi’s skin tumors (non-KS), posttransplant lymphoproliferative disorders (PTLD), solid tumors, and genitourinary and reproductive system (GU and RS). Overall, the incidence of cancer in renal transplant recipients was 4%. There were 83 male (83%) and 17 female patients (17%). The most frequent cancer was KS seen in 33 patients (33%). The lowest median time to development of cancer was observed in KS (35 months). The highest median time to development of cancer was observed in PTLD (133 months). The best graft survival was observed in PTLD and the worst in non-KS tumors. The best patient survival was observed in KS and the worst in GU and RS tumors. Azathioprine-based regimen was associated with a higher rate of cancer. The number of patients who died was 65 (65%). Our results indicate that the occurrence of malignancy has an important impact on short- and long-term graft and patient survival.

L´hypothyroïdie sévère est une cause rare de myxœdème des voies aéro-digestives supérieures. C´est une urgence nécessitant une prise en charge multidisciplinaire. L´objectif de cette étude était de présenter les difficultés du diagnostic et de la prise charge du myxœdème des voies aériennes supérieures. Un homme âgé de 60 ans, diabétique type II, avait présenté un mois avant son admission une infiltration de la région cervicale associée à une dysphonie, qui s´est compliquée d´une dyspnée inspiratoire persistante. L´examen clinique à l´admission a révélé une infiltration cervicale et un œdème de l´étage sus-glottique du larynx, qui réduisait la filière respiratoire. Cet aspect a été confirmé à la tomodensitométrie cervicale et une trachéotomie en urgence a été réalisée. Un complément de bilan a montré un épanchement pleuro-péricardique de moyenne abondance. Un dosage de la « thyroid stimulating hormone » (TSH) et de la thyroxine (T4) a confirmé le diagnostic de myxœdème des voies aéro-digestives supérieures sur hypothyroïdie. Le patient était mis sous corticoïde injectable et la levothyroxine orale à dose progressivement croissante. L´évolution était marquée par une amélioration partielle. Cependant, l´apparition d´une embolie pulmonaire a causé le décès du patient. Le myxœdème des voies aéro-digestives supérieures semble une cause exceptionnelle de dyspnée laryngée a évoquée même en absence de goitre. Son diagnostic est à la fois endoscopique, radiologique et biologique et sa prise en charge est médico-chirurgicale.

Le pseudomyxome péritonéal (PMP) ou l'ascite gélatineuse est une entité rare, décrite pour la première fois par R. Wyerth en 1884. Il correspond à une atteinte péritonéale diffuse, composée d'une ascite mucineuse et d'implants épithéliaux mucineux multifocaux. Cette maladie touche essentiellement les femmes. Son incidence est estimée à 2 cas par un million d'habitants. Le pseudomyxome péritonéal peut rester asymptomatique, découvert lors d'une laparotomie. Le symptôme le plus fréquent est représenté par une distension abdominale associée à des douleurs abdominales diffuses. Le scanner abdominal constitue le moyen diagnostique le plus spécifique. Il met en évidence des signes pathognomoniques de l'ascite gélatineuse. Les tumeurs mucineuses de l'appendice sont la cause la plus fréquente du pseudomyxome péritonéal avec 90% des cas. L'origine ovarienne en constitue une cause très rare. Il existe essentiellement deux types de traitement du PMP: premièrement le « debulking » chirurgical multiple et deuxièmement la chirurgie de cytoréduction avec chimiothérapie intra-péritonéale péri-opératoire consistant en une chimiothérapie hyperthermique intrapéritonéale avec ou sans chimiothérapie intrapéritonéale post opératoire immédiate. Nous rapportons un cas de pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire gauche.

INTRODUCTION : l'Insuffisance Cardiaque Aiguë (ICA) correspond à une entité syndromique spécifique, regroupant plusieurs tableaux cliniques hétérogènes; fréquemment rencontrées aux urgences. L'objectif de cette étude a été de décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ICA.Méthodes: nous avons mené une étude prospective descriptive dans un service d'accueil des urgences qui a inclus tous les patients admis pour ICA. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients.Résultats: nous avons inclus 180 patients pour ICA ayant entrainé une hospitalisation dans le service d'urgence. Le sexe ratio a été de 1,27. L'âge moyen a été de 66±12 ans. Quatre vingt deux pour cent des patients étaient hypertendus et 69% étaient diabétiques connus. Les étiologies de décompensation étaient essentiellement une poussée hypertensive chez 61,7% des patients, un syndrome coronaire aigu chez 24%. Le support respiratoire a été assuré essentiellement par la CPAP (Continuous Positive Airway Pressure) dans 73,3% des cas. Le traitement pharmacologique a été à base de dérivés nitrés dans 70% et de diurétique dans 40,5% des cas. Le taux de récidive de l'insuffisance cardiaque aiguë à un mois a été de 21,7% (n=39 patients), et celui de la mortalité à 3 mois a été de 13,3%.Conclusion: l'ICA vue au niveau des urgences est essentiellement sous forme hypertensive. Le traitement est basé essentiellement sur la CPAP, les vasodilatateurs et les diurétiques. Le taux de récidive était important, et la mortalité était aussi élevée.

Heparin induced thrombocytopenia (HIT) is a rare but potentially life threatening adverse drug reaction. We report an unusual case of concomitant subacute coronary stent and femoral artery thrombosis secondary to HIT. In the current era of extensive growth of heparin use and percutaneous coronary interventions, it’s important for clinicians to remember that such complication might occur and should be prevented.

The genetic gain in yield and quality are two major targets of wheat breeding programs around the world. In this study, a high density genetic map consisting of 10,172 SNP markers identified a total of 43 genomic regions associated with three quality traits, three yield traits and two agronomic traits in hard red spring wheat (HRSW). When compared with six grain shape and size traits, the quality traits showed mostly independent genetic control (~18% common loci), while the yield traits showed moderate association (~53% common loci). Association of genomic regions for grain area (GA) and thousand-grain weight (TGW), with yield suggests that targeting an increase in GA may help enhancing wheat yield through an increase in TGW. Flour extraction (FE), although has a weak positive phenotypic association with grain shape and size, they do not share any common genetic loci. A major contributor to plant height was the Rht8 locus and the reduced height allele was associated with significant increase in grains per spike (GPS) and FE, and decrease in number of spikes per square meter and test weight. Stable loci were identified for almost all the traits. However, we could not find any QTL in the region of major known genes like GPC-B1, Ha, Rht-1, and Ppd-1. Epistasis also played an important role in the genetics of majority of the traits. In addition to enhancing our knowledge about the association of wheat quality and yield with grain shape and size, this study provides novel loci, genetic information and pre-breeding material (combining positive alleles from both parents) to enhance the cultivated gene pool in wheat germplasm. These resources are valuable in facilitating molecular breeding for wheat quality and yield improvement.

L'invagination intestinale est une affection très fréquente en pédiatrie, alors que chez l'adulte, elle reste une entité clinique rare et ne représente que 10% de l'ensemble des invaginations et 4% des occlusions intestinales. Un lymphome colique révélé par invagination intestinale est une entité très rare. Nous rapportons le cas d'une femme de 21 ans, admise aux urgences de l'hôpital Militaire Mouly Ismail à Meknes, Maroc pour une subocclusion intestinale. Le scanner abdominal a montré la présence du boudin d'invagination ainsi que la cause organique au niveau colique. La résection chirurgicale était le traitement choisi, avec un examen anatomopathologique de la pièce opératoire qui montre la présence d'un lymphome B de type diffus à grandes cellules. Après la chirurgie, une chimiothérapie est indiquée dans le but d'améliorer le pronostic et d'éviter une éventuelle rechute.

Le cancer colorectal est classé parmi les cancers les plus fréquents au monde (3ème rang après le cancer du sein et celui de la prostate), deuxième cancer digestif au Maroc après celui de l'estomac. Cependant son incidence dans notre pays reste moins élevée que celle des pays occidentaux (2.5 à 3.3/100 000 ha) mais rejoint celle des pays du Maghreb dont ce cancer touche les sujets jeunes dans 27% des cas. Le cancer colorectal (CCR) est un des meilleurs exemples du processus multi étape de cancérogenèse. La connaissance des caractéristiques anatomopathologique du CCR conditionnera certainement nos attitudes thérapeutiques. Nous avons mené une étude rétrospective épidémiologique et anatomopathologique au service de chirurgie viscérale de l'hôpital militaire Moulay Ismail à Meknès sur une période de 5 ans allant du mois de janvier 2012 au mois de Décembre 2016 (36 cas: 14 femmes et 22 hommes). À la lumière de cette étude, l'objectif de ce travail est d'analyser le profil épidémiologique et les aspects anatomopathologiques des cancers colorectaux. L'analyse de nos résultats montre un profil épidémiologique particulier qui se caractérise par un âge plus jeune, une répartition selon le sexe en faveur des hommes, les carcinomes sporadiques sont largement prédominants avec une répartition topographique recto sigmoïdienne fréquemment observée. Sur le plan pronostique, le faible degré de différenciation des adénocarcinomes et le type mucineux sont corrélés à un stade TNM et d'Aster Coller avancés, avec un statut ganglionnaire péjoratif. Cette approche multidisciplinaire sera une première nationale, rendant ainsi notre structure de pratique et de recherche médicale l'une des plateformes de prise en charge multidisciplinaire du cancer colorectal au Maroc.

L'arrêt cardiaque au bloc opératoire est un événement redoutable, ces étiologies sont multiples. Nous rapportons le cas d'une patiente de 53 ans sans antécédents pathologiques particuliers, programmée pour cure chirurgicale d'une tumeur de l'intestin grêle. 20 minutes après l'induction anesthésique la patiente a présenté une asystolie rapidement réversible après les mesures de réanimation, l'association d'un rush cutané du visage et du thorax a fait suspecter une réaction anaphylactoïde tardive. L'amélioration rapide de la patiente a permis l'autorisation d'une reprise de l'intervention. Le début de la manipulation tumorale a occasionné une deuxième bradycardie extrême rapidement résolutive après 0,5 mg d'atropine, une réapparition du rush cutané au niveau du visage et du thorax a été observée, cette deuxième complication a rapidement fait suspecter une crise carcinoïde conduisant à l'administration du sandostatine. Aucun incident n'a été signalé ultérieurement, la patiente a passée 24 heures en réanimation sous une perfusion de sandostatine. Les valeurs du 5-HIAA urinaire étaient très élevées et l'examen histologique de la pièce opératoire a confirmé la nature carcinoïde de la tumeur. Nous soulignons la rareté de cette entité et l'intérêt de penser à une crise carcinoïde devons la survenue de complications peropératoires au cours d'une anesthésie pour tumeur de l'intestin grêle.

La laryngoscopie directe en suspension est un geste chirurgical diagnostique et/ou thérapeutique des lésions endo-laryngées. Sa gestion anesthésique est compliquée. Différentes techniques anesthésiques peuvent être proposées. Malgré les contraintes, les curares gardent tout leur intérêt. L'association rocuronium et sugammadex est envisageable, elle permet une inversion rapide du bloc neuromusculaire profond et par conséquent une réduction de la morbidité postopératoire. Nous rapportons un cas d'une laryngoscopie directe en suspension réalisée sous anesthésie générale dont l'utilisation de l'association rocuronium-sugammadex a permis une facilité du geste chirurgicale, une sécurité pour le patient et un confort pour l'anesthésiste.

BACKGROUND:Atrial fibrillation (AF) is a mechanistically heterogeneous disorder, and the ability to identify sub-phenotypes ("endophenotypes") of AF would assist in the delivery of personalized medicine. We used the clinical response to pulmonary vein isolation (PVI) to identify a sub-group of patients with non-PV mediated AF and sought to define the clinical associations. METHODS:Subjects enrolled in the Vanderbilt AF Ablation Registry who underwent a repeat AF ablation due to arrhythmia recurrence were analyzed on the basis of PV reconnection. Subjects who had no PV reconnection were defined as "non-PV mediated AF". A comparison group of subjects were identified who had AF that was treated with PVI-only and experienced no arrhythmia recurrence >12 months. They were considered a group enriched for "PV-mediated AF". Univariate and multivariable binary logistic regression analysis was performed to investigate clinical associations between the PV and non-PV mediated AF groups. RESULTS:Two hundred and twenty nine subjects underwent repeat AF ablation and thirty three (14%) had no PV reconnection. They were compared with 91 subjects identified as having PV-mediated AF. Subjects with non-PV mediated AF were older (64 years [IQR 60,71] vs. 60 [52,67], P = 0.01), more likely to have non-paroxysmal AF (82% [N = 27] vs. 35% [N = 32], P

Objectives: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.Methods: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.Results: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.Conclusion: Impairment in the quality of life can be significantwhen suffering from AS, affecting mental health more than physicalhealth. Among disease parameters, functional impairment,disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

Primary non-Hodgkins lymphoma (NHL) of the bladder is a rare entity. The clinical, radiological and endoscopic signs are not specifics. The diagnosis is exclusively histological. Chemotherapy, radiotherapy and surgery are the different therapeutic options used either alone or in combination. We report a 57 years old patient treated with chemotherapy (6 cycles of R-CHOP) for primary NHL of the bladder with a complete response while discussing the different specificities of this disease.