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Background: Burn victims have higher levels of cell free DNA (cfDNA), which allows its use as a direct indicator of cellular damage and burn vitality. Aim: Determination of cfDNA levels in burn patients and their correlation with total body surface area burned percent (TBSA%). Subjects and methods: Burn cases were evaluated to determine the prevalence of age and sex variations, period of admission, TBSA%, and the etiology and manner of burns. The plasma cfDNA concentration was measured within 24 hours of the burn injury in 40 burn cases and 20 control subjects. Results: The mean age of the cases was 34.38 years (median 33 years). Most patients were males (62.5%). Burning by flame or scalding represented 50% of the cases. Accidental burns were the most predominant. The mean of admission periods was 36.55 days while the mean value of TBSA% of the cases was 16.68%. There was a statistically significant difference in cfDNA values between cases and control subjects (p = 0.001). A positive correlation was found between cfDNA levels and TBSA% (r = 0.7; p < 0.001). Conclusion and recommendations: Levels of cfDNA were significantly different between burn cases and controls.

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.

Background The Modified Low Back Pain Disability Questionnaire (MLBPDQ) is used for evaluating the functional disability in patients with low back pain (LBP). However, the measurement characteristics of the MLBPDQ among Arab patients are unknown. In this study, we aimed to translate and cross-culturally adapt the MLBPDQ into Arabic and evaluate its psychometric properties. Methods An Arabic version of the MLBPDQ was developed through forward translation, translation synthesis, and backward translation. Sixty-eight patients (55 males and 13 females) with a mean age 37.01 ± 7.57 years were recruited to assess its psychometric properties. Reliability was evaluated using internal consistency (Cronbach’s α), test retest reliability (utilizing intraclass correlation coefficient [ICC]), standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC95%), and 95% limits of agreement (LOA). The construct validity was investigated by correlating the new translation with four other measures of LBP (using Spearman’s rho). Finally, receiver operating characteristic curve was constructed to compute the sensitivity, using the area under the curve (AUC), and the minimum important change (MIC). An alpha level of 0.05 was set for statistical tests and all the psychometric values were tested against a priori hypotheses. Results The culturally aligned MLBPDQ showed good internal consistency (Cronbach’s α = 0.85). The ICC, SEM, MDC95%, and LOA between baseline and two days later were 0.98, 1.60, 4.43, and -4.23 to 7.70, respectively, while the values between baseline and 14 days later were 0.94, 2.77, 7.67, and -6.59 to 13.53, respectively. The scale also demonstrated moderate to excellent correlation (rho = 0.54–0.86) with the other four questionnaires. The AUC value of the Arabic-MLBPDQ was 0.68, and the MIC was 3 points. Conclusion The Arabic version of the MLBPDQ demonstrates adequate psychometric properties and can be used to assess disability level in patients with LBP in Arabic-speaking communities.

Highlights • Biliary reconstruction is a cornerstone of LDLT. • The use of trans-anastomotic biliary catheters is controversial. • We describe a rare case of intestinal obstruction due to internal herniation around biliary catheter. • Awareness of this complication plus early surgical intervention can prevent postoperative morbidity and mortality., Introduction Biliary reconstruction is a cornerstone of living-donor liver transplantation (LDLT). The routine uses of trans-anastomotic biliary catheters in biliary reconstruction had been a controversial issue. We describe a rare complication related to the use of trans-anastomotic biliary catheter after LDLT. In this case, intestinal obstruction occurred early after LDLT due to internal herniation of the small bowel around trans-anastomotic biliary catheter. Presentation A 42 years male patient with end stage liver disease underwent LDLT utilizing a right hemi-liver graft. Biliary reconstruction was done by single duct-to-duct anastomosis over trans-anastomotic biliary catheter. The patient was doing well apart from early postoperative ascites that was managed medically. Three weeks after surgery, the patient developed severe agonizing central abdominal pain not responding to anti-spasmodics and analgesics. The decision was to proceed for surgical exploration. Exploration revealed internal herniation of the small bowel loops around the trans-anastomotic biliary catheter without strangulation. Reduction of the internal hernia was done by releasing the fixation of the biliary catheter from the anterior abdominal wall. Small bowel resection was not required. The patient had smooth postoperative course and was discharged 10 days after surgery. Discussion Awareness regarding this rare complication plus early surgical intervention can prevent the development of postoperative morbidity and mortality. To the best of our knowledge this is the first report to describe such are complication after LDLT. Conclusion We report the first case of internal herniation of small bowel around biliary catheter early after LDLT.

Background Living donor liver transplantation (LDLT) is considered a safe alternative to deceased donor liver transplantation (DDLT). In Egypt, DDLT program is still awaited, making LDLT the only hope for patients with end-stage liver disease, mainly due to chronic hepatitis C virus (HCV) infection. The current study is conducted to evaluate our experience of LDLT and discuss the lessons learned from 500 consecutive cases in HCV area. Methods We reviewed the data of patients who underwent LDLT at Gastrointestinal Surgery Center, Mansoura University during the period between May 2004 and March 2017. Results During the study period, 500 cases underwent LDLT at our unit. The median age was 51 years, and most of our cases were males (446, 89.2%) and had HCV infection (453, 90.6%). The median MELD score was 15. Median ICU stay was 5 days, and hospital stay was 22 days. Postoperative morbidities occurred in 220 cases (44%). Early mortality occurred in 69 patients (13.8%), and late mortality occurred in 45 patients (9%). The 1-, 3-, 5-, and 7-year overall survival rates of all cases were 80.9%, 78.2%, 75.7%, and 75%, respectively. Preoperative creatinine, worm ischemia, blood transfusion, ICU stay, postoperative morbidities, and small for size syndrome were independent predictors for overall survival. Conclusions In countries lacking DDLT, LDLT is the only effective alternative. LDLT requires a teamwork to achieve successful outcomes. LDLT should only be performed in centers with the adequate experience to avoid and decrease the hazards related to this procedure.

Background There has been uncertainty until recently whether OSA, is sufficient to cause persistent daytime pulmonary hypertension and right ventricular dysfunction. Objectives The aims of this study, were to investigate whether OSA by itself without any other cardiac or lung disease can lead to pulmonary hypertension, and to assess the effect of CPAP therapy on pulmonary artery pressure. Subjects and methods The study was performed on 54 OSA patients. All patients were subjected to thorough history taking including Epworth sleepiness scale and Berlin questionnaire, physical examinations, calculation of BMI, plain chest X-ray pulmonary function tests, polysomnography and echocardiography. Ten patients out of 24 patients of OSA with PH have been treated with CPAP for six months. Results Pulmonary hypertension (PH) was present in (44.4%) of OSA patients. There were significantly higher PASP and mPAP in severe OSA patients versus non severe OSA patients. There were significant higher BMI, neck circumference, AHI and ODI in OSA patients with PH compared to OSA patients without PH. Awake SaO 2 and minimum SaO 2 were significantly lower in OSA patients with PH compared to OSA patients without PH. There were significant reduction in both mPAP and PASP after 6 months of CPAP treatment ( p = 0.007, 0.005 respectively). Conclusion OSA is associated with pulmonary hypertension, improvement of pulmonary hypertension through controlling OSA by CPAP therapy signifies that OSA plays a crucial role in the pathogenesis of pulmonary hypertension. Recommendations CPAP therapy should be advised to all OSA patients with pulmonary hypertension.

In this study, Aspergillus terreus was irradiated by a 7.3 mW He-Ne laser in the presence of crystal violet, toluidine blue O and hematoporphyrin as photosensitizers. Xylanases recovered from non-irradiated and irradiated fungi were purified and characterized. The maximum production of xylanase (42.2 U/ml) was obtained after 5 min of laser irradiation in the absence of the photosensitizer. The irradiation of the sensitized fungus diminished the production of xylanase. On purification using G-100, the specific activity of xylanase recovered from the irradiated fungus was 292 U/mg protein representing a 37-fold purification over the crude extract compared with 95.6 U/mg protein representing the 12.8-fold for the enzyme recovered from the non-irradiated fungus. The enzyme recovered from the irradiated fungus had lower molecular weight as compared with that recovered from the non-irradiated one. Characterization of the purified enzymes revealed that the enzyme recovered from the irradiated fungus was more thermostable and had a wider range of optimum reaction temperature (60-70 degrees C) and pH (4.0-12.0), compared to the non-irradiated one.