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Abstract BackgroundTranscatheter aortic valve replacement (TAVR) is a commonly used treatment for severe aortic stenosis. As degenerative aortic stenosis is primarily a disease afflicting older adults, a frailty assessment is essential to patient selection and optimal periprocedural outcomes. ObjectiveThis study aimed to enhance frailty assessments of TAVR candidates by integrating real-world structured and unstructured data. MethodsThis study analyzed data from 14,000 patients between January 2018 and December 2019 to assess frailty in TAVR patients at the University of Florida. Frailty was identified using the Fried criteria, which includes weight loss, exhaustion, walking speed, grip strength, and physical activity. Latent Dirichlet allocation for topic modeling and Extreme Gradient Boosting for frailty prediction were applied to unstructured clinical notes and structured electronic health record (EHR) data. We also used least absolute shrinkage and selection operator regression for feature selection. Model performance was rigorously evaluated using nested cross-validation, ensuring the generalizability of the findings. ResultsModel performance was significantly improved by combining unstructured clinical notes with structured EHR data, achieving an area under the receiver operating characteristic curve of 0.82 (SD 0.07), which surpassed the EHR-only model’s area under the receiver operating characteristic curve of 0.64 (SD 0.08). The Shapley Additive Explanations analysis found that congestive heart failure management, back problems, and atrial fibrillation were the top frailty predictors. Additionally, the latent Dirichlet allocation topic modeling identified 7 key topics, highlighting the role of specific medical treatments in predicting frailty. ConclusionsIntegrating unstructured clinical notes and structured EHR data led to a notable enhancement in predicting frailty. This method shows great potential for standardizing frailty assessments using real-world data and improving patient selection for TAVR.

Background: Pain has a wide spectrum of effects on the body and inadequate management of postoperative pain outcomes in multiple physiological and psychological consequences; and increases morbidity. The use of opioid-based analgesia in high doses can have multiple adverse effects including respiratory depression, nausea, and vomiting. Objectives: Our aim was to evaluate the efficacy of analgesic and safety of both techniques (transversus abdominis plane block [TAPB] and erector spinae plane block [ESPB]) in cases having lower abdominal surgery through laparotomy. Materials and Methods: This randomized trial was performed on 62 cases who underwent laparotomy for lower abdominal surgery under general anesthesia were recruited. Subjects were equally distributed into either TAPB or ESPB. The primary outcome was total morphine intake postoperatively for 24 h. Other variables were intraoperative fentanyl consumption, delay to first morphine demand, and intraoperative morphine consumption, the number of patients who needed rescue analgesia by morphine, perioperative heart rate and mean blood pressure, numerical rating score (NRS), postoperative nausea and vomiting, and block-related complications. Results: ESPB patients consumed less total postoperative morphine than the TAPB group (5.35 ± 2.65 vs. 8.52 ± 3.35 mg; P < 0.001). Patients who received ESPB showed less postoperative pain scores and, thus, needed rescue medication after a longer period than the TAPB group (12.50 ± 7.31 h vs. 7.72 ± 5.69 h; P = 0.008). In addition, ESPB patients needed less intraoperative fentanyl doses than TAPB (138.71 ± 35.85 vs. 203.23 ± 34.00 mcg; P < 0.001). ESPB group demonstrated statistically significant lower scores of NRS at rest and at movement. Conclusions: Ultrasound (US)-guided ESPB provides more safe and effective analgesia in lower abdominal surgeries compared with US-guided TAPB.

Abstract Background Studies evaluating the role of midodrine as an adjunctive therapy to liberate patients with shock from intravenous (IV) vasopressors have yielded mixed results. The aim of our study was to evaluate the efficacy and safety of midodrine as an adjunctive therapy to liberate patients with shock from IV vasopressors. Methods Electronic searches of the MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) that evaluated the use of midodrine versus control in patients with shock and a low dose of IV vasopressors. The primary outcome was total IV vasopressor time, while the secondary outcomes included time-to-IV vasopressor discontinuation, IV vasopressor restart, intensive care unit (ICU) length of stay (LOS), hospital LOS, and incidence of bradycardia. Results The final analysis included four RCTs with a total of 314 patients: 158 in the midodrine group and 156 in the control group, with a weighted mean age of 64 years (54.2% men). There was no significant difference in the total IV vasopressor time between the midodrine and control groups (standardized mean difference [SMD] − 0.53; 95% confidence interval [CI] − 1.38 to 0.32, p = 0.22; I 2 = 92%). Also, there were no significant differences between the two groups in the time-to-IV vasopressor discontinuation (SMD − 0.05; 95% CI − 0.57 to 0.47, p = 0.09), IV vasopressor restart (19.3 vs. 28.3%; risk ratio [RR] 0.74; 95% 0.25–2.20, p = 0.59), ICU LOS (SMD − 0.49; 95% CI − 1.30 to 0.33, p = 0.24), and hospital LOS (SMD 0.01; 95% CI − 0.27 to 0.29, p = 0.92). However, compared with the control group, the midodrine group had a higher risk of bradycardia (15.3 vs. 2.1% RR 5.56; 95% CI 1.54–20.05, p = 0.01). Conclusions Among patients with vasopressor-dependent shock, midodrine was not associated with early liberation of vasopressor support or shorter ICU or hospital length of stay. Adding midodrine increased the risk of bradycardia. Further large RCTs are needed to better evaluate the efficacy and safety of midodrine in liberating patients from IV vasopressors.

Abstract The study is carried out at the wastewater treatment plant (WWTP) of an agricultural cooperative that operates according to the activated sludge process. Dairy industry is enlisted as one of the top-most industries in the food industry. Dairy wastewater treatment is a big issue as dairy wastewater releases a high amount of chemical oxygen demand, inorganic and organic particles, biological oxygen demand, and nutrients. But, these processes partly degrade wastewater containing fats and nutrients as dairy wastewater. The aim of this study was to evaluate the purification performance of this treatment process. The qualitative analysis of decanted raw wastewater (DRWW) and purified wastewater (PWW) shows that the concentration of orthophosphate, nitrate and sulfate ions is slightly higher. Such contaminated water if not handled appropriately, it pollutes water bodies and largely affects our ecosystem and biodiversity. Hence, our proposal is to improve the WWTP performances by using the adsorption process onto dried Carpobrotus edulis as an inert biomaterial. This adsorption process is recognized as one of the best water treatment techniques, more and more works are oriented towards the search for new materials, cheaper and having a good adsorbent potential. This study opens the path for the use of natural and abundant local material to remove orthophosphate, nitrate and sulfate ions using the C. edulis plant particles shred. The surface micromorphology of the biomaterial was investigated using a scanning electron microscope; while the qualitative element composition was analyzed using energy dispersive X-ray and infrared spectroscopies. The found results of DRWW was about 57% for orthophosphates, 67% for sulfates and 73% for nitrates ions. For PWW, the percentage removal was found to be 62%, 73% and 84% for orthophosphates, sulfates and nitrates respectively. These results indicate that dried C. edulis plant, as an environmentally friendly adsorbent could be recommended for the removal of mineral pollutants. In conclusion, the C. edulis adsorbent can be integrated into the activated sludge process for wastewater treatment after identifying the optimal hydraulic loads, associated sizes, and shapes in continuous operations.

Background: The epiphora is the most common manifestation of obstruction of the nasolacrimal duct, which is treated by dacryocystorhinostomy either by external or internal endoscopic endonasal approach. With the advance of the nasal endoscope, the endoscopic dacryocystorhinostomy became well established. Aim of the work: To evaluate the efficacy and safety of intranasal endoscopic dacryocystorhinostomy [DCR] in the management of patients with acquired nasolacrimal duct obstruction. Patients and Methods: This is a retrospective study of patients with acquired obstruction of the nasolacrimal duct who underwent intra-nasal endoscopic dacryocystorhinostomy [EDCR] at Al-Azhar University Hospitals from September 2012 to October 2015. Forty-five procedures were done where primary endoscopic DCR was done on forty patients and revision endoscopic DCR was done on failed five patients. The outcome is measured by subjective improvement of epiphora. Results: The patients were followed up for three years, improvement of 35 patients with epiphora from 40 patients [the rate of success was 86.7%] and the remaining five failed cases undergoing revision EDCR with the improvement of four from them. The success was confirmed with the subjective improvement of epiphora. The rate of minor complications reported was 28.8% and managed conservative, and only one major complication occurred in one patient. Conclusion: The endoscopic intranasal DCR is an effective and safe procedure in the management of acquired obstruction of the nasolacrimal duct and gives a high success rate.

Background: Otitis media with effusion is a prevalent disease of pediatrics. It is usually a self-limiting disease. However, it may be complicated by serious consequences. The early detection and the determination of actual prevalence could help in planning for preventive interventions. Aim of the work: To determine prevalence of otitis media with effusion and the risk factors associated with this disease. Patients and methods: The study included all patients younger than 16 years of age, who attended the outpatient clinic of otorhinolaryngology department (Al-Azhar Faculty of Medicine, New Dameitta), during the period from August 2016 to August 2018. In this work, 2338 patients were included (1351 males and 987 females). For each child, the demographic data were collected and documented. All attended children were submitted to an ear, nose and throat examination; both ears were examined by an otoscope (pneumatic) and tested with tympanometry by the same investigator. Results: The disease was diagnosed in 124 children (5.3%). The mean age of studied children was 9.13±2.83 years (range 4-15). The most common affected age was 4 years (15%) followed by 6 years (13.1%), then 15 years (6.3%). The condition was significantly associated with low socioeconomic class, smoking exposure and past frequent upper respiratory tract infection. Conclusion: The prevalence of OME in 4-15 years old children in Damietta Governorate was 5.3%, elevated to 15% at the age of 4 years. The low social state, exposure to smoking and frequent infections of upper airway were the most common associated risk factors.

Background: Otitis media [OM] is the second most common disease of childhood after upper respiratory tract infection. There was no consensus on the ideal treatment modality yet. Aim of the work: To compare the use of trans-tympanic T tube [TTTT] and subannular T tube [SATT] in recurrent otitis media, recurrent otitis media with effusion or tympanic membrane retraction. Patients and Methods: This is a prospective controlled study, which was conducted at Al-Azhar university hospital [Damietta]. It included 40 patients that were randomly divided into two groups A and B: Group A: include 20 patients who were submitted to trans-tympanic T-tube. Group B included 20 patients who were submitted to sub annular T-tube. Patient data and outcome were documented and compared. Results: The duration that TTTTs and SATTs remained in place ranged from 4 to 19 months with a mean of 10.62 and there was a significant decrease of duration in TTTT in comparison to SATT groups [7.28 vs 14.80 respectively]. Besides, in 14 cases in the SATT group, the tube is still in place. Extrusion was reported in 10 cases [8 in the TTTT group and 2 in the SATT group] and finally removal was reported in 6 patients [2 in TTTT group and 4 in the SATT group. Conclusion: The use of SATTs for long term middle ear ventilation is safe and more efficient than V-T Grommet TTTTs for maintaining middle ear ventilation and prevention of recurrent interventions in children with less otorrhea and plugged tubes.

BackgroundGaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. ObjectiveThe aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. MethodsWe conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). ResultsWe identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). ConclusionsThere is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization.

Background: Aortic corrected flow time (FTc) is easily measured by Doppler techniques. Recent data using transesophageal Doppler suggest that it may predict fluid responsiveness in critical care. This use of FTc has not previously been evaluated in septic shock, and only one preliminary study has incorporated transcutaneously measured FTc, denoting its importance in prediction of fluid responsiveness in septic patient. Furthermore, no comparison has been made between transesophageal FTc and central venous pressure (CVP). Objective: The aim of our study was to compare the impact of using FTc versus CVP as a guide for fluid resuscitation in septic shock on stroke volume denoting cardiac responsiveness for fluid administration. Methods: This was a prospective study of 46 consecutive adult septic shock patients (in sinus rhythm). 44 patients were mechanically ventilated, treated with intravenous fluid challenge (500 mL over 15 min), guided with CVP in control group and guided by FTC in Doppler group assessment incorporating transesophageal aortic Doppler (CardioQ®) measurements in a surgical tertiary intensive care unit. Stroke volume (SV), mechanical ventilation days, length of stay and mortality of both groups were recorded. Results: Fourty one patients demonstrated an increase in stroke volume (SV) by more than 10% (fluid responders) while five patients were non responders. There were statistically significant increases in SV after 1 h post resuscitation in the Doppler group as the values were 63.87 ± 25.87 & 81.39 ± 35.02 in the control group and the Doppler group respectively (p value = 0.034). There were statistically significant differences in FTc values after 1 h [397.00 (390.00–404.00) & 362.00 (351.00–377.00)] between non-responders and responders respectively (p value was 0.003) and after 6 h [377.00 (376.00–378.00) & 330.00 (314.00–353.00)] between non-responders and responders respectively (p value was 0.007). Conclusion: Transesophageal aortic Doppler is a simple, non-invasive tool of guiding fluid therapy in patients with severe sepsis and septic shock. FTC change was a better predictor of fluid responsiveness than CVP in septic shock. There was higher significant difference in SV after resuscitation when using FTC as guidance.

Objective: Evaluation of the effect of different concentrations of fentanyl added to the local anesthetic mixture on the onset and duration of globe anesthesia, after peribulbar block, with the least side effects. Design: Double blinded randomized controlled clinical trial. Setting: Kasr Al Aini hospital, Cairo University. Methods: 60 patients with cataract grade 1–3 in the age group 40–70 years, with American Society of Anesthesiologists (ASA) grade I, II and III, scheduled for elective cataract surgery under regional anesthesia. They were randomly divided into four groups: in Group 1 (Control Group), patients received Lidocaine 2% and Hyaluronidase 15 IU/ml; in Groups 2, 3 and 4 (Fentanyl Groups), the patients received Lidocaine 2% and Hyaluronidase 15 IU/ml in addition to Fentanyl 1 μg/ml, 2 μg/ml and 3 μg/ml respectively. The onset and duration of lid and globe akinesia were assessed. Postoperative Visual Analogue Score was recorded each hour up to 6 h. Results: No statistical significant difference was observed between the four groups in the onset and duration of lid and globe akinesia. There was a significant difference between the control group and the fentanyl groups as regards the duration of analgesia that was significantly prolonged in the groups that received fentanyl at concentrations of 2 μg/ml and 3 μg/ml in these group patients required analgesia after 116 ± 19 min and 144 ± 11 min respectively compared to the control group and the group that received fentanyl at a concentration of 1 μg/ml group who required analgesia after 100–103 min. Conclusion: Adding Fentanyl at concentrations ⩾ 2–3 μg/ml to the local anesthetic mixture (Lidocaine and Hyaluronidase) for regional peribulbar block provides safe and effective method in improving postoperative analgesia in patients undergoing cataract surgery.

Infective endocarditis (IE) is a serious and life-threatening cardiac condition, most commonly caused by staphylococci, Streptococcus viridans, and enterococci. However, in special settings, IE can be caused by rare organisms. Here we present a case of IE caused by Aerococcus urinae in a 75-year-old man with a bioprosthetic aortic valve. Aerococcus urinae is a gram-positive, catalase-negative microorganism and is usually an isolate of complicated urinary tract infections in the elderly male population. Improvements in diagnostic testing including use of matrix-assisted laser desorption ionization– a time of flight mass spectrometry (MALDI-TOF MS) have played an important role in recognition of Aerococcus urinae.

Background: Hyperglycemia is common among critically ill patients and is associated with increased morbidity and mortality and there is no clear answer to the question: which to apply tight or conventional glycemic control? Objective: Evaluation and comparison of the effects of tight versus conventional glycemic control on critically ill patients in our surgical intensive care unit (ICU). Design: Prospective randomized controlled trial. Methods: 120 Patients were divided into two groups: group (I) received intensive insulin therapy targeting blood glucose level between 80 and 110 mg/dl, who referred to as intensive treatment group, and group (II) received conventional insulin therapy targeting blood glucose level between 150 and 200 mg/dl, and referred to as conventional treatment group. Results: 120 Patients were enrolled in the study, the incidence of hypoglycemia (blood glucose

BackgroundGlobally, approximately 70 million people suffer from epilepsy. Infants constitute a significant percentage of these cases. Hence, there is a significant need for better understanding of the pathophysiology of epilepsy through laboratory and radiological methods for early detection and optimized management. Interleukin enhancer binding factor 3 antisense RNA l (ILF3AS1) is a long non-coding RNA (lncRNA) that enhances the expressions of matrix metalloproteinase 3 (MMP3) and matrix metalloproteinase 9 (MMP9), which are considered to be epileptogenic.AimWe aimed to assess the serum expressions of the lncRNAs ILF3AS1, MMP3, and MMP9 along with microRNA-212 (miRNA-212) as predictive biomarkers in children with epilepsy; we also assessed their correlations with magnetic resonance imaging (MRI) findings.Subjects and MethodsFifty children with epilepsy and fifty healthy controls were considered in this study. Serum expressions of the lncRNA ILF3AS1 and miRNA-212 were estimated by quantitative real-time polymerase chain reaction (qPCR). Serum concentrations of MMP3 and MMP9 were estimated by enzyme-linked immunosorbent assay (ELISA) in parallel with MRI findings and different baseline biochemical parameters of all the subjects.ResultsThe results showed significantly higher levels of lncRNAs ILF3AS1, MMP3, and MMP9 as well as lower levels of miRNA-212 in children with epilepsy compared to the controls. The fold-change of miRNA-212 was a significant negative predictor (odds ratio = 0.153, p = 0.000). The receiver operating characteristic curves (Roc) showed that the areas under the curves for MMP3, MMP9, and lncRNA ILF3AS1 as well as the fold-change for miRNA-212 were 0.659, 0.738, 0.656, and 0.965, respectively. Brain lesions were detected in 15 patients (30%) with epilepsy, whereas the remaining 35 patients (70%) had normal results.ConclusionSerum levels of the lncRNA ILF3AS1 among children with epilepsy were higher than those in the control group and were associated with upregulation of both MMP3 and MMP9 as well as downregulation of miRNA-212 expressions, suggesting their predictive utility in monitoring the development of epilepsy; this also means that a treatment plan focusing on the ILF3AS1/miRNA-212/MMP3/MMP9 axis could be an effective strategy for treating epilepsy.

Abstract Background Electrical stimulation of the central and peripheral nervous systems is a common tool that is used to improve functional recovery after neuronal injury. Methods Here we described a new configuration of electrical stimulation as it was tested in anesthetized control and spinal cord injury (SCI) mice. Constant voltage output was delivered through two electrodes. While the negative voltage output (ranging from -1.8 to -2.6 V) was delivered to the muscle via transverse wire electrodes (diameter, 500 μm) located at opposite ends of the muscle, the positive output (ranging from + 2.4 to +3.2 V) was delivered to the primary motor cortex (M1) (electrode tip, 100 μm). The configuration was named dipolar cortico-muscular stimulation (dCMS) and consisted of 100 pulses (1 ms pulse duration, 1 Hz frequency). Results In SCI animals, after dCMS, cortically-elicited muscle contraction improved markedly at the contralateral (456%) and ipsilateral (457%) gastrocnemius muscles. The improvement persisted for the duration of the experiment (60 min). The enhancement of cortically-elicited muscle contraction was accompanied by the reduction of M1 maximal threshold and the potentiation of spinal motoneuronal evoked responses at the contralateral (313%) and ipsilateral (292%) sides of the spinal cord. Moreover, spontaneous activity recorded from single spinal motoneurons was substantially increased contralaterally (121%) and ipsilaterally (54%). Interestingly, spinal motoneuronal responses and muscle twitches evoked by the test stimulation of non-treated M1 (received no dCMS) were significantly enhanced as well. Similar results obtained from normal animals albeit the changes were relatively smaller. Conclusion These findings demonstrated that dCMS could improve functionality of corticomotoneuronal pathway and thus it may have therapeutic potential.

Abstract Background From the onset to the chronic phase of spinal cord injury (SCI), peripheral axons and muscles are subjected to abnormal states of activity. This starts with very intense spasms during the first instant of SCI, through a no activity flaccidity phase, to a chronic hyperactivity phase. It remains unclear how the nature of this sequence may affect the peripheral axons and muscles. Methods We set out to investigate the changes in excitability of the sciatic nerve and to characterize the properties of muscle contractility after contusive injury of the mouse thoracic spinal cord. Results The following changes were observed in animals after SCI: 1) The sciatic nerve compound action potential was of higher amplitudes and lower threshold, with the longer strength-duration time constant and faster conduction velocity; 2) The latency of the onset of muscle contraction of the triceps surae muscle was significantly shorter in animals with SCI; 3) The muscle twitches expressed slower rising and falling slopes, which were accompanied by prolonged contraction duration in SCI animals compared to controls. Conclusion These findings suggest that in peripheral nerves SCI promotes hyperexcitability, which might contribute to mechanisms of spastic syndrome.

Infective endocarditis (IE) is a serious and life-threatening cardiac condition, most commonly caused by staphylococci, Streptococcus viridans, and enterococci. However, in special settings, IE can be caused by rare organisms. Here we present a case of IE caused by Aerococcus urinae in a 75-year-old man with a bioprosthetic aortic valve. Aerococcus urinae is a gram-positive, catalase-negative microorganism and is usually an isolate of complicated urinary tract infections in the elderly male population. . Improvements in diagnostic testing including use of matrix-assisted laser desorption ionization– a time of flight mass spectrometry (MALDI-TOF MS) have played an important role in isolating Aerococcus.

Infective endocarditis (IE) is a serious and life threatening cardiac condition, most commonly caused by staphylococci, streptococci, enterococci and rarely by HACEK organisms ( Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella corrodens and Kingella). Here, we present a case of IE caused by Aerococcus urinae in a 75-year-old man with a bioprosthetic aortic valve. Aerococcus urinae is a gram-positive, catalase negative microorganism, and is usually an isolate of complicated urinary tract infections in the elderly male population. It is associated with high morbidity and mortality. Awareness of this organism as a cause of IE is important, since failure to recognize the condition may lead to adverse clinical outcomes and significant complications with even fatal outcome, as in this case.