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Background This study aimed to compare the duration of postoperative analgesia using intraperitoneal bupivacaine plus neostigmine or bupivacaine alone. In this randomized controlled trial, we included 56 adult patients scheduled for elective laparoscopic cholecystectomy operation. Patients were randomly allocated into two groups bupivacaine group (B group) who received 50 ml bupivacaine 0.25% alone and bupivacaine-neostigmine group (BN group) who received 500 μg neostigmine added to 50 ml bupivacaine 0.25%. The study drug was instilled intraperitoneal according to group allocation before the start of the surgery. Primary outcome was the duration of analgesia. Other outcome included total dose of postoperative analgesic consumption and postoperative nausea and vomiting. Results Patients in BN group showed longer duration of analgesia after surgery and longer time for 1st analgesic dose than the patients in B group. Total dose of postoperative pethidine and the incidence of postoperative nausea and vomiting were lower in number in the BN group than in the B group. Conclusions Intraperitoneal instillation of neostigmine as an adjunct to bupivacaine in elective laparoscopic cholecystectomy increased the duration of postoperative analgesia. Also, it might reduce postoperative pain and analgesic requirements as compared to bupivacaine 0.25% alone. Trial registration Name of the registry: Clinical trial Clinical Trial registration number: NCT04244097 Date of registration: 28 January 2020 URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04244097

Global overpopulation, industrial expansion, and urbanization have generated massive amounts of wastes. This is considered as a significant worldwide challenge that requires an urgent solution. Additionally, remarkable advances in the field of biomedicine have impacted the entire spectrum of healthcare and medicine. This has paved the way for further refining of the outcomes of biomedical strategies toward early detection and treatment of different diseases. Various nanomaterials (NMs) have been dedicated to different biomedical applications including drug delivery, vaccinations, imaging modalities, and biosensors. However, toxicity is still the main factor restricting their use. NMs recycled from different types of wastes present a pioneering approach to not only avoid hazardous effects on the environment, but to also implement circular economy practices, which are crucial to attain sustainable growth. Moreover, recycled NMs have been utilized as a safe, yet revolutionary alternative with outstanding potential for many biomedical applications. This review focuses on waste recycled NMs, their synthesis, properties, and their potential for multiple biomedical applications with special emphasis on their role in the early detection and control of multiple diseases. Their pivotal therapeutic actions as antimicrobial, anticancer, antioxidant nanodrugs, and vaccines will also be outlined. The ongoing advancements in the design of recycled NMs are expanding their diagnostic and therapeutic roles for diverse biomedical applications in the era of precision medicine.

Background: Acute lymphoblastic leukemia (ALL) is a neoplastic disease of immature lymphocytes or lymphocyte progenitor cells either the B- or T-cell lineage. It is the most common malignancy diagnosed in patients younger than 15 years, and account for approximately 25-30% of adult acute leukemia. Objective: To evaluate some antioxidants as zinc, selenium, vitamin A (retinol) and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia and to compare it to that of a control population. Patients and methods: This case-control study was carried out at Oncology Unit of Pediatrics Department and Medical Biochemistry Department, Faculty of Medicine, Zagazig University Hospitals. This study consisted of two groups: Patients’ group (30 children patients with newly diagnosed ALL). As regard control group, it included 30 healthy children who were matched well with patients’ age and sex. Fasting levels of serum zinc, selenium, retinol and tocopherol were measured. Results: There was a high statistically significant decrease of vitamin E, selenium and zinc among all cases than their controls. While, there was a significant increase of vitamin A among all cases. Zinc level was statistically significantly increased with increased risk of disease, while no statistically significant relation between disease risk and other levels of serum antioxidant. Conclusion: Some antioxidants as zinc, selenium and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia are lower compared to that of a control population.

Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and

This article aims to investigate in a different way the concomitant relations of conjugality - here from the moment it is formalized matrimonialized as to its conformation as a situation of fact, not Authorized and not Islamic Law. The Brazilian and Islamic legal systems admit and protect polygamous relationships? The conclusion is that the right of reply is the right of police expression manifested in polygamy. In Brazil, the laws are not of the world of facts, being inclusive, in some cases, those of the right to the right, but there is still a strong tendency to legalize the legalization of polygamy, for strictly moral/religious reasons. Thus, contrary to common sense, it may be said that the Muslim is more monogamous than the Brazilian is. Still, it can be affirmed that, although Brazil declares itself secular, in practice there is no demarcated separation between State and religion. The Islamic communism is the rights of human religion. Paradoxically, would Brazil then be cloaked in the veil of Islam? The methodology used is exploratory, from a comparative perspective, taking the necessary precautions to differentiate between the two systems.

Objectives Living donor liver transplant is the gold standard therapy for patients with terminal hepatic disorders for whom no alternative therapy is available. The primary aim was to assess different intraoperative factors that may predict early death after adult-to-adult living donor liver transplant. The secondary aim was to assess the effect of small-for-size syndrome on mortality. Materials and methods This retrospective multicenter cohort study was performed on records from 145 adults with cirrhosis who had received a right lobe living donor liver transplant. Patients were divided according to the occurrence of short-term mortality (death within the first month after transplant). The primary intraoperative parameters included graft weight, surgical duration, mean blood pressure, serum lactate and sodium bicarbonate, transfusions, durations of cold and warm ischemia and anhepatic phase, input and output during surgery, and portal venous pressures. Results There were statistically significant variations between both cohorts for number of units of packed red blood cells, durations of cold and warm ischemia and anhepatic phase, preclamp and postreperfusion portal venous pressures, average urine output, mean serum lactate, mean blood pressure, and surgical duration (P ⟨ .001). Also, there were significant differences in the number of platelets, units of fresh frozen plasma, and mean sodium bicarbonate (P = .025, .003, and .035, respectively). Of the 25 patients who died within the early postoperative period, 20 had developed small-for-size syndrome (P ⟨ .001). Conclusions A variety of intraoperative risk factors may affect early posttransplant mortality, which suggests the high complexity of living donor liver transplants and the need for well-trained experienced teams to perform these surgeries.

We aimed to evaluate the efficacy of superior hypogastric plexus (SHP) block in pain relief among women undergoing hysterectomy. Cochrane Library, PubMed, ISI web of science, and Scopus were searched from inception to May 2021 for the available randomized clinical trials (RCTs). We included RCTs that compared SHP block (intervention group) to saline (control group) in hysterectomy. Our primary outcomes were pain scores at different time intervals using the Visual Analog Scale (VAS). Our secondary outcomes were postoperative opioid consumption within 24 hours and postoperative nausea and vomiting incidence. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. Four RCTs with a total number of 289 patients met our inclusion criteria. The VAS pain scores were significantly declined at post-anesthesia care unit (PACU), 2, 6, and 12 hours postoperatively among SHP block group (

Background: Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Sepsis is a common complication in the neonatal intensive care unit. It is caused by various organisms invading the blood stream, which may be by bacterial, viral, fungal and protozoal infections. Objective: The aim of this study was to diagnose neonatal sepsis early in order to reduce morbidity and mortality of newborn. Patients and methods: This study was a case-control study that included 132 participants divided into two groups, each group included 66 patients. 1st group included neonatal sepsis and 2nd group was control group without sepsis. They were admitted at Neonatal Unit of Pediatric Department at Zagazig University Hospitals during the period from 11/2019 to 11/2020.Investigations done for all these neonates, and included complete blood count [PLT, PDW, MPV and Platelet-large cell ratio (P-LCR)], CRP, ESR, blood culture, urine culture and chest x-ray. Results: There was statistically significant difference between the septic cases and control group regarding platelets distribution width (PDW) where 87.9% of the septic cases had elevated PDW while 45.5% of control group had elevated PDW. There was statistically significant negative correlation between platelets count with CRP, platelets distribution width, mean platelet volume and P-LCR (increased platelets count is associated with decrease in CRP, platelets distribution width, mean platelet volume and P-LCR) among the control group. Conclusion: Platelet indices, as part of a routine automated cell count, are cheap and readily available tests that can be used as valuable clues in the diagnosis of neonatal sepsis.

Combined laparoscopic splenectomy and cholecystectomy (CLSC) seems to be the appropriate solution in children that require splenectomy for various pathologies and also have cholelithiasis. This study aimed to evaluate the efficacy, safety and feasibility of CLSC in pediatrics through four ports. Nineteen pediatric patients with hematological disorders underwent CLSC by a 4-port technique, from December 2018 to November 2020. The patients were initially positioned in a right lateral position. The first port was inserted at the umbilicus, the second in the subxiphoid region to the left side of the falciform ligament, the third midway between the umbilical port and the subxiphoid port, and the fourth in the left sub-umbilical region. The operating table was tilted to the right to first perform the splenectomy, after which it was tilted to left to perform the cholecystectomy. For the cholecystectomy, the subxiphoid port was passed through the falciform ligament to the right side. The mean age of the patients was 9.96 years and the mean splenic volume was 327.54 cm3. The mean total operative time was 128.71 min. There was no intra-operative visceral or vascular injury. All procedures were completed without conversions. The mean post-operative hospital stay was 2.28 days. During the follow-up period, no complications were detected. CLSC using four ports is a safe and a feasible procedure, with better cosmetic results, and easy to perform in well-trained hands. PACTR201901796143495.

Background: Chronic ankle pain is considered a diagnosticchallenge because of variable causes including traumatic andnon-traumatic causes. MRI is considered an excellent methodof diagnosis of soft tissue abnormalities around ankle joint.Ultrasonography also can detect normal anatomic structureand assess ligamentous abnormalities, and provide dynamicevaluation of the soft tissues. Ultrasonography is more avail-able, cheap, fast, and safe method of diagnosis.Aim of Study: Was toevaluate the accuracy of both ultra-sonography and magnetic resonance imaging in diagnosis ofdifferent causes of chronic ankle pain.Patients and Methods: A comparative study conductedupon attendants referred from orthopedics clinic who com-plained of ankle pain.Results: In this study ultrasound successfully diagnosedand characterized 35 out of 40 patients (85%) while MRIdiagnosed and characterized 36 patients (87.5%). MRI is themodality of choice for optimal detection of most of osseousand; soft-tissue disorders of ankle with higher axial resolutionand multiplanar capabilities while ultrasound proved to beexcellent cost-benefit widely available imaging technique thathas high spatial resolution making it helpful tool in diagnosingmost of ankle soft tissue disorders with high diagnosticaccuracies almost equal to MRI values.Conclusion: Ultrasonography and MRI are two methodsof investigations with the former being used as primary toolof investigation and the latter done to confirm diagnosis andthe extent of the lesion especially when surgery is planned.

Background: The use of adjuvants in intravenous regional anesthesia [IVRA] for upper limb surgeries seems to increase efficacy and reduce side effects. Trials are continued to reach the ideal combination. Aim of the work: The study aimed to evaluate the efficacy and safety of IVRA for upper arm surgery using different adjuvants [atracurium and dexmedetomidine]. Patients and methods: 120 patients scheduled for elective upper limb surgeries were included. Patients were divided randomly into four equal groups. Group I received 40 ml lignocaine 0.5% alone, group II: received 40 ml [lignocaine 0.25% plus dexmedetomidine 50 μg], group III received 40 ml [lignocaine 0.25% plus atracurium 2 mg], and group IV received 40 ml [[lignocaine 0.25% plus dexmedetomidine 50 μg and atracurium 2 mg]. surgery duration, quality of anesthesia, postoperative analgesia, and hemodynamics were monitored. Results:The onset of sensory and motor block was significantly shorter in groups II and IV than in group I or III. Also, both sensory and motor block were significantly shorter in group IV when compared to group II [2.53±0.57, 3.60±0.62 vs. 3.33±0.54 and 5.20±0.84 respectively]. Besides, the pain was significantly lower in groups II and IV than groups I or III after deflation at 5, 15, 30, 60 minutes, and up to 8 hours. The need for postoperative analgesia was significantly higher among groups I and III when compared to groups II and IV [56.7%, 63.3% vs. 30.0% and 20.0%, respectively]. No major adverse events were reported. Conclusion: The use of dexmedetomidine as an adjuvant had a significantly better postoperative analgesia, longer duration of sensory and motor block, and earlier onset of action. In addition, the use of atracurium besides dexmedetomidine improves the quality of IVRA.

Purpose The aim of this study was to evaluate the effect of adding ketorolac to peribulbar anesthesia versus conventional peribulbar anesthesia in cataract surgery. Patients and methods This is a prospective randomized comparative study that recruited patients with visually significant cataract and no other ocular or systemic conditions that may influence the ocular sensation. Patients were scheduled for phacoemulsification. They were randomly assigned into three groups. In the first group (GI), an anesthetic mixture of lignocaine, bupivacaine, hyaluronidase, and ketorolac was utilized. In the second group (GII), a mixture of lignocaine, bupivacaine, and hyaluronidase was used, whereas in the third group (GIII), a mixture of lignocaine, bupivacaine, and ketorolac was used. The onset of globe anesthesia and akinesia and the duration of globe akinesia were recorded. In addition, intraoperative pain and postoperative pain experienced by the participants were assessed using the numerical rating scale after patient instructions. Results The study included 114 patients. The onset of globe anesthesia was significantly faster in GI (6.5±1.3 min) compared with GII and GIII (8.1±1.5 and 8.8±1.9 min, respectively, P

This study aimed to compare the superimposed clinical value of topical tranexamic acid (TXA) application when it is simultaneously combined with intravenous (IV) administration versus the use of either IV TXA alone or IA TXA alone during primary total knee arthroplasty (TKA) in patients with moderate-to-high risk of bleeding. We hypothesized that the combined administration approach will result in a more adequate reduction in the perioperative blood loss and blood transfusion rate. Ninety-four patients undergoing primary TKA were randomly allocated into intra-articular (IA) alone, IV alone, and combined group. We used 2 g of IV TXA in the IV TXA alone and combined groups 10 minutes before tourniquet deflation. However, we applied 1.5 g TXA in 100 mL isotonic saline half topically before arthrotomy closure and half retrogradely after wound closure through the drain. Follow-up period was 6 weeks. The primary outcome measures included the drainage blood volume, total blood loss, hidden blood loss, intraoperative blood loss, and the allogenic transfusion rate. Secondary outcomes included postoperative hemoglobin drop, amount of transfused blood units, thromboembolism, and wound complications. Combined administration of TXA provided significantly better results in terms of blood volume collected by the drain, total blood loss, and hidden blood loss (p 0.05). The subgroup analysis revealed that a combined IA and IV TXA administration significantly reduced the total blood loss in patients with either moderate or high risk of bleeding. Moreover, the degree of hemoglobin drop was significantly lesser with the combined approach. No thromboembolic complications or wound infection occurred. In conclusion, the combined use of topical and IV tranexamic acid resulted in a significant reduction in postoperative blood loss and hemoglobin level following TKA but did not influence the rate of allogeneic blood transfusion. This is a Level I, therapeutic study.

Recently the issue of the Sharie‘a courts has been drawing the attention of the Western media, especially in Europe, Canada, and the United States. Legal scholars and legal activists are quite reluctant to contribute to the discourse held mostly by reporters, religious figures and politicians. This could be why the matter is covered cursorily resting upon emotional, prejudiced and politically inspired debates and valuations. Moreover, the Sharie‘a court’s jurisdiction is not always obviously specified and fundamentally various issues of these courts get mixed and sometimes led to the conflict of laws (choice of law) questions.

Background Amyand’s hernia (AH) is defined as protrusion of the vermiform appendix within the sac of the inguinal hernia and usually misdiagnosed as obstructed hernia. It is more common in pediatric patients but there are controversies about dealing with the normally looking appendix in AH. The aim of this study is to present our experience in the management of AH and highlights the difference in dealing with normally looking appendix between pediatric and adult patients. Patients’ demographics, intraoperative, and postoperative outcome were reported and analyzed. Results This is a retrospective analysis of 12 pediatric patients aged between 15 days and 5 years presented with AH and operated in tertiary referral hospital over 10 years. This study included 10 males and 2 females. The median age at the operation was 7 months. Eleven patients were operated using conventional technique, and only one patient was operated using laparoscopy. In 11 patients, the appendix was looking normal and was reduced without appendectomy, and the hernia was repaired. Appendectomy was done in one patient presented with AH containing inflamed appendix. The postoperative course was uneventful in all cases. Conclusions There is a difference in the management of pediatric and adult patients presenting with AH, and appendectomy is not mandatory in normally looking appendix in pediatric patients.

Background Healthcare workers (HCWs) should have an active role in measles control. Objective This study aimed to assess the HCWs' measles immune status and its influencing factors; to measure their knowledge, attitude, and practice toward measles infection/vaccination; and to identify factors predicting their vaccination status. Methods Data were collected using a semi-tailored questionnaire. Immunoglobulin G against measles was measured. Regression analysis for measles vaccination was performed. Results Approximately 97 HCWs (93.3%) were seropositive, 79 (76.0%) were vaccinated, 18 (17.3%) were previously infected, and 9 (8.7%) were both vaccinated and previously infected. One previously vaccinated participant was seronegative. The immune status was associated with marital status, residence, work duration, infection control training, and wearing personal protective equipment. Positive attitudes and practices were reported. Marital status and infection control training were predictors for measles vaccination. Conclusion HCWs showed readiness to control the spread of measles. National policies for compulsory HCWs' vaccination and immune status check before training and employment are required.

In this study, we aimed to compare three inspiratory pressures during facemask ventilation in paralysed patients regarding the subsequent incidence of gastric insufflation and the adequacy of lung ventilation.In this randomised controlled trial, we included adult patients undergoing elective surgery under general anaesthesia. The patients were randomly allocated to receive positive inspiratory pressure (PIP) of 10, 15, or 20 cmHWe analysed data from 36 patients in each group. The number of patients with gastric insufflation was the lowest in the PIP 10 group (0/36 [0%]) in comparison with PIP 15 (2/36 [19%] and PIP 20 36/36 [100%] groups (P-values of 0.019 and0.001, respectively). The probability of adequate ventilation at any time point was the highest in PIP 10, followed by PIP 15, and was the lowest in the PIP 20 group.An inspiratory pressure of 10 cmH

Background: MV is an important part of NICU care today. MV, nevertheless, is linked to higher risks of VAP. The 2nd most frequent hospital acquired infection is VAP, which develops in mechanically ventilated cases after 2 days of MV. Aim: The aim of this study was to determine the incidence of VAP and to assess risk factors of VAP in neonatal intensive care unit in Al-Ahrar teaching hospital. Methods: This study was a prospective observational study which conducted at the neonatal intensive care unit in Al-Ahrar teaching hospital on 84 neonates on MV. All patients were subjected to full history taking. Full Clinical Examination and Laboratory Investigations were done and included complete blood count (CBC), C-reactive protein (CRP), liver function tests, kidney function tests, serum albumin level and blood culture. Chest radiograph was done on admission and repeated as required. Results: the percentage of the VAP was (54.8 %). There was a statistically significant decrease in gestational age, weight, and serum albumin among VAP than non-VAP cases. Conclusion: The high prevalence of VAP in the intubated neonates poses a serious risk. Diagnosis, risk factor identification, precautions, and empirical treatments are all important strategies for VAP. VAP was found in a high percentage of mechanically ventilated newborns.

The Regulation of Transnational Bribery by Kevin E. Davis, strips out the universal character of illegitimate payments used to bribe public officials of foreign countries in the milieu of international business which has been known for years. The manuscript deals with various definitions of bribery as a transaction in which an official misuse his or her office “as a result of considerations of personal gain, which need not be monetary”. The book highlights the current debate about prohibiting transnational bribery. Such a debate is not about the practicality or desirability of the United States’ FCPA, which at one time was the only law in the world that efficiently banned transnational bribery.

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) emergence and dissemination, is an important healthcare concern due to its limited therapeutic options. Ceftazidime/avibactam (CAZ/AVI) is a recently approved antibiotic combination that may be effective in treating these resistant infections. The aim of the current study was to determine the prevalence of CRKP amongclinical isolates from neonatal intensive care unit (NICU) and to evaluate the in-vitro activity of CAZ/AVI against them. Methods: A total of 255 clinical samples were collected from neonates with suspected sepsis. All Klebsiella pneumoniae isolates were identified by standard methods. Antibiotic susceptibility testing, screening for Extended-spectrum β lactamase (ESBL) production, carbapenem resistance, carbapenemase production and susceptibility to CAZ/AVI were done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the 255 neonates clinically suspected as neonatal sepsis, only 136 (53.3%) had positive culture results, out the 136 culture-proven cases, 72 (52.9%) were positive for Klebsiella pneumoniae, of them ESBL producers were 92% (n=66) and CRKP were 32% of isolates (n=23). All of the CRKP were carbapenamase producers (39% serine-type and 61% metallo-β-lactamases (MBL) type). Serine carbapenamase and MBL producers showed high resistance against CAZ/AVI with a percentage of 77.8% and 100% respectively. Conclusion: The prevalence of CRKP is alarming in our NICU especially in the presesnce of neonatal risk factors like; neutropropenia, central line fixation and premature rapture of membranes. Ceftazidime/avibactam is an unsuitable option for the treatment of this type of resistant bacteria because of its high resistance.

Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis.Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP > 24 mmHg, IAP > 20 cmH2O (15 mmHg), APP 15cmH2O.Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49–52 mmHg. The range of IAP (IVP) was 15–20 cmH2O (11–15 mmHg), the range of PIP was 22–25 cmH2O, the range of CVP was 13–15 cmH2O, and the range of urine output was 1–1.5 ml/kg/h.Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH2O (15 mmHg), APP > 50 mmHg, and CVP ≤ 15cmH2O.

Posterior fracture/dislocation of the shoulder is a rare injury that is frequently missed on initial assessment. It is frequently associated with reverse Hill–Sachs impression fracture. Several orthopaedics procedures have been described on the literature for reconstructable reverse Hill–Sachs lesion. The McLaughlin’s procedure and its modifications, anatomic bone grafting procedures, rotational osteotomies, and the remplissage technique were reported by many authors. We advocated a new “dual subscapularis procedure” that consists of the Hawkins lesser tuberosity transfer with addition of filling the remainder of the defect with a part of subscapularis tendon. In the period between January 2013 to December 2017, 12 patients (13 shoulders) suffering from a delayed managed posterior fracture dislocation were managed. Our inclusion criteria were adult patients less than 60 years presented with reverse Hill–Sachs impression defects from 20 to 50% with or without fractures. For all patients, the dual subscapularis procedure was done. UCLA score was used for postoperative functional assessment. After a minimum follow-up of 6 months, the results of UCLA score were excellent/good in eight patients and fair/poor in five patients. All patients were found stable after open reduction ± internal fixation with no reported complications. There was a significant correlation of the UCLA score and non-abuse or lower doses of tramadol and the shorter interval between trauma and procedure. Twelve patients were satisfied after the operation. Reconstructing the reverse Hill–Sachs defect with the dual subscapularis technique provides adequate stability, pain relief, and function in patients with locked chronic posterior shoulder fracture/dislocation. The used technique has the merit of versatility with different fracture patterns, improved fixation of the tendon and increasing the tendon’s footprint that ensures extra-articular location of the defect. II.

Background. Allergic rhinitis (AR) is an inflammatory state categorized by a disturbance of immunoregulatory mechanisms. MicroRNA-155 (miRNA-155) has an essential role in regulating gene expression and can mediate the allergic TH2 process. Objective. In this study, we aimed to evaluate the role of miR-155 as a biomarker in AR and correlate its level with the total nasal symptom score (TNSS) and the levels of serum interleukin-4 (IL-4). Methods. This study included 90 children: 45 with pollen-induced AR and 45 healthy controls. Serum miR-155 expression levels were measured using quantitative real-time PCR. Human IL-4 ELIZA kits were used for the semiquantitative detection of the serum levels of IL-4. Receiver operating characteristic (ROC) curves were used to determine the best cutoff values for the studied parameters for the diagnosis of AR. Results. The demographic characteristics of the two groups were matched with respect to age and sex. The AR case group included 23 (51.1%) males and 22 (48.9%) females, while the control group included 24 (53.3%) males and 21 (46.7%) females. The miR-155 level was increased in the serum of children with pollen-induced AR compared with controls (mean difference = 2.8, p < 0.001 ). A significant positive correlation between the serum expression level of miR-155 and TNSS in children with AR was detected (r = 0.494, p < 0.001 ). However, no significant correlation was identified between the expression of miR-155 and that of IL-4. At a cutoff value of 1.09, the sensitivity of miR-155 as a biomarker for AR was 100%, and the specificity was 71.1%. Conclusion. MiR-155 expression levels were elevated in the serum of AR children. Therefore, miR-155 could be used as a biomarker in AR diagnosis.

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p

Cardiac iron overload is secondary to chronic blood transfusion in patients with sickle cell disease (SCD). Iron overload cardiomyopathy is a restrictive cardiomyopathy associated with systolic and diastolic dysfunction. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases responsible for tissue remodeling. Many studies offer strong evidence for the role of MMP-9 in LV remodeling. We aimed to detect plasma levels of MMP-9 in patients with SCD and its correlation to myocardial iron overload. A case control study was carried out on 50 patients with SCD and 50 age and sex matched healthy controls. Assessment of cardiac iron overload in patients by MRI T2* was performed. Plasma MMP-9 levels were measured for patients and controls using ELISA. SCD patients had significantly higher levels of MMP-9 than controls. There was highly significant correlation between plasma levels of MMP-9 and serum ferritin. Patients with vaso-occlusive crises (VOC) > 5/year had significantly higher levels of MMP-9 than those with VOC ≤ 5 /year. No significant correlation was found between MMP-9 and cardiac T2*. MMP-9 seems to be a useful marker in SCD patients. Patients with serum ferritin > 1000 ng/ml, recurrent VOC > 5 /year had significantly higher MMP-9 serum levels than others.

Klinefelter syndrome (KS) is the most frequent sex chromosomal anomaly that occurs in about 85–223 males per 100,000 live-born males and occurs mostly due to meiotic nondisjunction. The clinical presentation of KS patients varies according to the age of the patient and his phenotypic expression that manifests as a variety of symptoms due to androgen deficiency that characterize the syndrome. In addition to compromised testicular function and hypogonadism, KS patients are also at an increased risk of metabolic disturbances, such as type 2 diabetes mellitus and cardiovascular disease. They also present with cognitive and psychiatric disturbances. However, it is estimated that only 25–40% of the subset of patients with KS are ever diagnosed and only around 10% of these patients are identified during their childhood and adolescent years. The reason behind the underdiagnosis of KS can be explained by the wide variability in its presentation requiring a great deal of conjecture from the clinician caring for such patients. A multidisciplinary approach toward the management of KS patients is essential to encounter the multiple features of the disease. The hypogonadism in KS patients needs to be treated by testosterone replacement (TRT) at some point during the course of the therapy. Cryopreservation of sperm is offered to the adolescent KS patients who are able to provide a semen sample. Pharmacological therapy with aromatase inhibitors prior to microsurgical testicular sperm extraction has the highest sperm retrieval rates in azoospermic men.

Brazil is facing one of its most severe political crises since 2016, with several impacts in its gradual process of democratization. In this context, the main argument in this work is that many of the ghosts that scary the Brazilian society in the Twenty-First century are direct heirs of an unresolved (pre-constitutional) past, whose risks can be strongly perceived and whose solution is an urgent task. Every time there is political turmoil and a disturbance to the rule of law in the country, the support for democracy seems to dwindle. In this vein, this article aims to explore such contradictions and difficulties and how they still represent a threat to the Brazilian democracy through an analysis dedicated to the complex and ambiguous relation that the Constitution (and various of the Brazilian institutions, like the Supreme Court) has (have) established with the military dictatorship that lasted from 1964 until 1985. The authoritarian ghosts that up until now haunts the Brazilian reality, though inevitable due to the compromises that underpin it and the practices that stubbornly replicate the past into the very present, have at least to be disclosed and, as such, challenged by a learning process that only a militant memory is capable of making us aware of. Resumo O Brasil enfrenta uma de suas crises políticas mais severas desde 2016, com vários impactos em seu processo gradual de democratização. Neste contexto, o principal argumento neste trabalho é que muitos dos fantasmas que assustam a sociedade brasileira no século XXI são heranças diretas de um passado não-resolvido (pré-constitucional), cujos riscos podem ser fortemente percebidos e cuja solução é uma tarefa urgente. Toda vez que há turbulência política e uma perturbação do Estado de Direito no país, o apoio à democracia parece diminuir. Nesse sentido, este artigo tem como objetivo explorar tais contradições e dificuldades e como elas ainda representam uma ameaça à democracia brasileira através de uma análise dedicada à relação complexa e ambígua que a Constituição (e várias das instituições brasileiras, como o Supremo Tribunal Federal) estabeleceu com a ditadura militar que durou de 1964 a 1985. Os fantasmas autoritários que até agora assombram a realidade brasileira, embora inevitáveis devido aos compromissos que a sustentam e às práticas que teimosamente replicam o passado no presente, precisam ao menos ser revelados e, a partir disso, desafiados por um processo de aprendizagem que apenas uma memória militante é capaz de nos tornar conscientes.

Ethics management globally is a swiftly growing reality with various countries placing substantial emphasis on anti-corruption initiatives. International organizations, including the United Nations (“UN”), Transparency International (“TI”), and the Organization for Economic Cooperation and Development (“OECD”) have created a number of anti-corruption creativities, for instance, the UN, promulgated an International Code of Conduct for Public Officials in 1996 . Moreover, the United Nations International Centre for Crime Prevention has established an Anti-Corruption Tool kit to ‘help U.N. Member States and the public to understand the insidious nature of corruption, the potential damaging effect it can have on the welfare of entire nations and suggest measures used successfully by other countries in their efforts to uncover and deter corruption and build integrity . In the same vein, TI, the only global non-governmental organization dedicated to battling corruption, seeks via education and information to dishearten corrupt activities and fraudulent performances as well as foster integrity and liability to achieve better governance

Virtual Reality technology has made it possible for people to visit places and enjoy different exciting experiences while remaining at home. It gives an opportunity to enjoy the past at its best. Virtual Reality was introduced in 1929 with interactive training devices that simulated fighter planes. In 1957, the Sensorama simulator was designed which could generate city smells and wind sensations. The need for tourism to become virtual becomes more urgent than ever before. Virtual Reality applications provide this chance, not only in place, but in time as well. This paper presents a guide to the heritage applications' builders and marketers to reach more online users. The paper helps the builder to understand the consumer behaviour for marketing research. The paper illustrates eight levels, with each one leading to the next. The author named the eight levels A.C.H.I.L.L.E.S. Each letter represents a level; beginning with the awareness and ending with the sustainability. ACHILLES represents a sequence that shows three main phases of mobile application usage. It aims for a better management for the online visitors' engagement. This aim can be accomplished through the understanding of the different stages that the online visitors go through. In addition, it shows the correlation between the users and the mobile application.