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Objectives: The aim of this systematic review and meta-analysis was to evaluate the current literature on the effect of implant surface characteristics on peri-implant marginal bone levels (MBL), soft tissue periodontal parameters, peri-implantitis, and implant failure rates. Materials and Methods: Randomized controlled trials were searched in electronic databases. Risk of bias within the selected studies was assessed using the Risk of Bias Tool 2. Meta-analyses were performed using Review Manager software for studies with similar comparisons reporting same outcome measures. Results: Ten randomized control trials were included in the present review. The primary outcome of changes in peri-implant MBL favoured implants with machined surfaces, however, the difference was not statistically significant (P = .18). The changes in probing pocket depths significantly favoured the use of machined surfaces (P = .01), while the implant failure rates favoured roughened surface implants. However, the difference was not statistically significant (P = .09). Conclusion: Machined surface implants were favoured in terms of lesser peri-implant MBL, though the difference was not significant. The analysis also demonstrated limited favourable outcomes in terms of periodontal parameters for machined surfaces, with slightly significantly better outcomes in terms of probing pocket depths. However, rough surface implants tended to display a lower implant failure.

Abstract Neuromuscular diseases (NMD) are a group of neurological diseases that manifest with various clinical symptoms affecting different components of the peripheral nervous system, which play a role in voluntary body movements control. The primary objective of this study is to explore the diagnostic efficacy of a combined genetic and biochemical testing approach for patients with neuromuscular diseases with diverse presentations in a population with high rate of consanguinity. Genetic testing was performed using selected Next Generation Sequencing (NGS) gene panels and whole exome sequencing on the peripheral blood sample from the patients. The study results revealed that the majority of patients in our cohort had a history of consanguinity (83%). Genetic testing through gene panels and Whole Exome Sequencing yielded similar result. Out of the patients tested, 66% underwent gene panels testing, 56% had Whole Exome Sequencing, 32% received array Comparative Genomic Hybridization (CGH) assays, and 40% underwent metabolic testing. Overall, 58 patients (61%) received definitive results after following all tests. Among the remaining 36 patients, 19 exhibited variants of unknown significance (VOUS) (21%).

Abstract Non-contact anterior cruciate ligament (ACL) rupture is a common serious orthopaedic disease in humans and dogs. Familial risk has been recognized in both species but interactions between genetic effects and environmental risk are not understood. We investigated ACL rupture heritability, genetic architecture, selection pressure, sharing of risk genes and biological pathways, and polygenic risk score (PRS) prediction of disease risk. In both species, ACL rupture has moderate heritability, is likely under negative selection, and has a highly polygenic architecture where thousands of variant effects act together to influence disease risk. In dogs, we found hotspots of regional heritability. We also confirmed sharing of multiple risk genes. Our findings challenge the dogma that non-contact ACL rupture is predominantly due to a single overload injury event. Our results also suggest that accurate PRS prediction of ACL rupture risk is an achievable goal in both species, enabling identification of individuals for personalized medical care.

Paediatric Femoral Neck Fracture (PFNF) is rare, and its repair is challenging for orthopaedists. Surgical treatment should be performed, as soon as, possible with anatomical repair to avoid postoperative complications, including Avascular Head Necrosis (AVN) and bone deformity. In the present case scenario, a 14-year-old male patient presented to the Orthopaedic Emergency Department with hip pain and an inability to bear weight or move his right lower extremity. He arrived at the hospital at night and was examined immediately. The patient reported a fall from the second floor two days prior. Due to the unavailability of some necessary surgical instruments at the time of the emergency surgery, orthopaedic surgeons adopted a new procedure for treating a PFNF. The fracture reduction was maintained under general anaesthesia, and the incision site was properly sterilised before using a 3 mm Kirschner wire (K-wire). The 3 mm K-wire was removed before compressing the fracture site with screws. The wires were cut to a length that allows them to be bent over the femoral shaft and secured to the shaft using ligature wires. This is a modification of the Wagner technique, which involves passing the ligature wire around the femoral shaft.

Abstract Background Acute respiratory infections are a common presentation in clinical practice and medical interns must learn proper diagnosis and antibiotic prescribing. Traditional lecture-based teaching may not provide sufficient opportunities for students to apply their knowledge in realistic scenarios, whereas computer case-based simulations offer an alternative approach that allows active learning and decision-making in simulated patient cases. This study investigated the effectiveness of computer case-based reasoning simulation versus traditional lectures for medical interns teaching of diagnosis and antibiotic prescribing for acute respiratory infections. Methods This comparative quasi-experimental study was conducted from 2020 to 2022 in the Department of Infectious Diseases at Shahid Beheshti Hospital, affiliated to Kashan University of Medical Sciences. The samples were selected using a convenience method and assigned to the intervention and control groups using a permuted block randomization approach. Over a period of ten months (Each month, an average of eight medical interns), a total of 40 medical interns received traditional lecture-based teaching, while another 40 medical interns were taught using a Computer Case-based Reasoning simulation. The medical interns’ knowledge in both groups was assessed using pre- and post-tests. The collected data from the pre- and post-tests were then analyzed statistically using paired t-tests, independent t-tests, and ANCOVA. Results The posttest scores of the medical interns in both groups were significantly higher than the pretest scores (P 0.21). The results of the ANCOVA, after controlling for pre-test scores, showed no statistically significant difference between the two teaching methods in their effect on medical interns’ diagnostic and antibiotic prescribing performance (P > 0.33). Conclusion The study found that both computer case-based reasoning simulation and traditional lectures were effective in improving medical interns’ knowledge of diagnosis and antibiotic prescribing practices for acute respiratory infections. However, no statistically significant differences were observed between the two teaching methods. Thus, computer- based simulation could replace face-to-face teaching when this method is impractical or computerized methods are more cost-effective.

Abstract Antibiotics become less effective in treating infectious diseases as resistance increases. Staphylococcus aureus is a global problem due to its ability to form biofilms and resistance mechanisms. Phage endolysin is one of the most promising methods for combating antibiotic resistance. ZAM-MSC chimeric endolysin has three domains derived from SAL1 and lysostaphin, which target the peptide bridge of peptidoglycan. In this study purified ZAM-MSC (with yield of 30 mg/lit) had bactericidal activity against methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) at low concentrations (2.38 μg/ml and 1.88 μg/ml, respectively). The antibacterial spectrum revealed that ZAM-MSC was active against diverse Staphylococci. it has maintained 100% stability after 24 h incubation in pH 5 to 10 against S. aureus, as well as demonstrated significant thermostability and maintained nearly its full activity at different temperatures (4–42 °C) up to 1 day of incubation. The anti-biofilm activity of various concentrations of ZAM-MSC against MSSA and MRSA biofilms was not dose-dependent, and antibiofilm activity was observed even at low concentrations (14 μg/ml). Further, the molecular dynamics simulations demonstrated that the ZAM-MSC chimer and its parent proteins remained dynamically stable, showing similar flexibility despite the size and hydrogen bond number differences. In conclusion, the study reveals that chimeric ZAM-MSC is a distinctive enzyme with exceptional biochemical properties and rapid lytic activity against Staphylococci.

Background Fungal rhinosinusitis is subdivided into two subtypes, invasive and noninvasive variants, with allergic fungal rhinosinusitis (AFRS) being the most prevalent noninvasive variant. The most common clinical features of AFRS are nasal polyposis, rhinorrhea, facial pressure, and periorbital edema.Objective This study aimed to report a rare clinical presentation and serious complications of AFRS.Method and result The patient was presented to the Otorhinolaryngology Department of Qatif Central Hospital, Eastern Region, Saudi Arabia. We reported a rare presentation of a patient diagnosed with untreated AFRS complicated by basilar artery thrombosis. The patient was urgently managed with endoscopic sinus surgery, postoperative antifungal, and local nasal steroids.Conclusion Allergic fungal rhinosinusitis is a chronic disorder associated with significant morbidity that requires early diagnosis and management. The treatment protocol was based on surgical debridement of the paranasal sinuses from the fungal material and postoperative steroid therapy. Allergic fungal sinusitis with granuloma was more aggressive and needed to be treated cautiously by adding antifungal treatments.

Abstract Liquid biopsies have the potential to revolutionize cancer care through non-invasive early detection of tumors. Developing a robust liquid biopsy test requires collecting high-dimensional data from a large number of blood samples across heterogeneous groups of patients. We propose that the generative capability of variational auto-encoders enables learning a robust and generalizable signature of blood-based biomarkers. In this study, we analyze orphan non-coding RNAs (oncRNAs) from serum samples of 1050 individuals diagnosed with non-small cell lung cancer (NSCLC) at various stages, as well as sex-, age-, and BMI-matched controls. We demonstrate that our multi-task generative AI model, Orion, surpasses commonly used methods in both overall performance and generalizability to held-out datasets. Orion achieves an overall sensitivity of 94% (95% CI: 87%–98%) at 87% (95% CI: 81%–93%) specificity for cancer detection across all stages, outperforming the sensitivity of other methods on held-out validation datasets by more than ~ 30%.

Abstract Background Infections caused by biofilm-forming bacteria have significantly linked to dental plaque and caries. The aim of this study is to assess efficacy of some natural compounds in inhibition and eradication of biofilm formed by bacterial isolates from dental infections. Results Bacterial isolates were recovered from dental plaque/caries and identified using standard microbiological tests and 16S rDNA sequencing. The isolated bacterial strains include Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. The antibiotic susceptibility was determined by disk diffusion method and revealed that the majority of isolates showed high antibiotic resistance, and 61% of isolates were found to be multidrug resistant. The biofilm formation capacity of isolates was investigated using microtiter plate assay. Among the 77 bacterial isolates, seventeen showed moderate biofilm formation capacity, twenty-two showed near-moderate, thirty-four had weak biofilm-forming capacity, and four were non-biofilm producers. The antibiofilm activity of tested compounds (rose and jasmine oils, propolis, vanillin, and vinegar) was evaluated against isolates with highest biofilm-forming capacity. The in vitro antibiofilm ability of tested substances were investigated alone or in combination with each other to evaluate their ability to prevent biofilm formation or destroy preformed single-/multispecies biofilms. Finally, antibiofilm ability of tested combination was evaluated ex vivo on natural teeth. Our results showed that vanillin in combination with rose or jasmine oils showed promising biofilm inhibition and biofilm eradication activities in both the in vitro and ex vivo models. Conclusions Dental plaque and caries can be successfully prevented using combination of vanillin with rose or jasmine oils, and these compounds can be incorporated in new anticaries dental formulations.

Abstract This research explores the challenges posed by variations in cystic duct anatomy during laparoscopic cholecystectomy and the potential use of stapler devices to address such complexities. It aims to assess the safety and efficacy of stapler devices, particularly in cases involving short, and wide cystic duct. The study, conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2021 and 2023. The study design involved a retrospective cohort approach, and the sample size encompassed all cases meeting the inclusion criteria during the study period. Data was analyzed using SPSS program. The study involving 568 patients, with the predominant technique for ligation being clipping (89.3%). The primary indication for using the Endo GIA stapler was a wide cystic duct (6.2%). Analysis revealed a significant association between stapler device use and hypertension (p = 0.042), diabetes (p = 0.001), CKD (p = 0.011), and obstructive jaundice (p = 0.006). Multivariate regression demonstrated that older patients were 2.1 times more likely to use stapler devices (AOR = 2.125; p = 0.039), while those with obstructive jaundice had a 2.2 times higher likelihood (AOR = 2.168; p = 0.049). Throughout the years, metal clips have shown the best prognosis compared to any other method for securing the cystic duct during closure in laparoscopic cholecystectomy. However, to avoid incomplete sealing of wide, short, or inflamed ducts, other instruments have emerged as possible alternatives for such conditions. Use of Endo-GIA is a safe and effective method for patients with wide, short cystic duct. Selective usage of endo-GIA is considered cost effective and may add a positive impact in decreasing post operative biliary leak.

This article examined student experiences before and after an essay writing assignment that required the use of ChatGPT within an undergraduate engineering course. Utilizing a pre-post study design, we gathered data from 24 participants to evaluate ChatGPT's support for both completing and grading an essay assignment, exploring its educational value and impact on the learning process. Our quantitative and thematic analyses uncovered that ChatGPT did not simplify the writing process. Instead, the tool transformed the student learning experience yielding mixed responses. Participants reported finding ChatGPT valuable for learning, and their comfort with its ethical and benevolent aspects increased postuse. Concerns with ChatGPT included poor accuracy and limited feedback on the confidence of its output. Students preferred instructors to use ChatGPT to help grade their assignments, with appropriate oversight. They did not trust ChatGPT to grade by itself. Student views of ChatGPT evolved from a perceived "cheating tool" to a collaborative resource that requires human oversight and calibrated trust. Implications for writing, education, and trust in artificial intelligence are discussed.

Depressive illness, influenced by social, psychological, and biological factors, is a significant public health concern that necessitates accurate and prompt diagnosis for effective treatment. This study explores the multifaceted nature of depression by investigating its correlation with various social factors and employing machine learning, natural language processing, and explainable AI to analyze depression assessment scales. Data from a survey of 520 Bangladeshi university students, encompassing socio-personal and clinical questions, was utilized in this study. Eight machine learning algorithms with optimized hyperparameters were applied to evaluate eight depression assessment scales, identifying the most effective one. Additionally, ten machine learning models, including five BERT-based and two generative large language models, were tested using three prompting approaches and assessed across four categories of social factors: relationship dynamics, parental pressure, academic contentment, and exposure to violence. The results showed that support vector machines achieved a remarkable 99.14% accuracy with the PHQ9 scale. While considering the social factors, the stacking ensemble classifier demonstrated the best results. Among NLP approaches, BioBERT outperformed other BERT-based models with 90.34% accuracy when considering all social aspects. In prompting approaches, the Tree of Thought prompting on Claude Sonnet surpassed other prompting techniques with 75.00% accuracy. However, traditional machine learning models outshined NLP methods in tabular data analysis, with the stacking ensemble model achieving the highest accuracy of 97.88%. The interpretability of the top-performing classifier was ensured using LIME.

Abstract Background Sex disparities in cardiovascular disorders are well‐documented, but data on hospitalization and readmission outcomes in the context of sex for Complete Heart Block (CHB) remains limited. Methods We analyzed the 2016–2020 Nationwide Readmission Database to identify patients with a principal diagnosis of CHB. Men served as the control group, while women comprised the study cohort. The primary outcome was mortality. Secondary outcomes included odds of cardiac arrest, ventricular tachycardia, heart failure, mechanical ventilation use, all‐cause 30‐day readmission, total and early pacemaker use, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models adjusted for confounders. Results Among 175,257 patients with CHB, 45% were female. Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.42, 95% CI 1.3–1.55) compared to males. Additionally, females had higher odds of cardiac arrest (aOR 1.13, 95% CI 1.06–1.2), ventricular tachycardia (aOR 1.1, 95% CI 1.05–1.17), heart failure (aOR 1.18, 95% CI 1.14–1.22), mechanical ventilation use (aOR 1.1, 95% CI 1.03–1.17), and all‐cause 30‐day readmission (aOR 1.1, 95% CI 1.03–1.14). Women also had lower odds of total pacemaker use (aOR 0.92, 95% CI 0.88–0.96) and early pacemaker use (aOR 0.89, 95% CI 0.86–0.82). Female patients exhibited longer LOS (4.13 days vs. 3.86 days, p

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). The WHO International Agency for Research on Cancer has classified welding fumes as carcinogenic to humans (Group 1). A previous systematic review and meta-analysis from the WHO/ILO Joint Estimates reported that there was “sufficient evidence of harmfulness” that compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk of developing trachea, bronchus, and lung cancer. It concluded that WHO/ILO Joint Estimates could be produced of the attributable burden of trachea, bronchus, and lung cancer. However, occupational exposure to welding fumes must be considered in greater detail, as there may be differences in risk between those with regular occupational exposure to welding fumes and those with occasional occupational exposure, the latter of which has previously been estimated to be highly prevalent. Regular and occasional occupational exposure to welding fumes have not previously been considered in a systematic review. Here, we present a supplementary analysis to our previous systematic review and meta-analysis, providing parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to regular and to occasional occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates of this burden of disease. Objectives: We sought to systematically review and meta-analyse estimates of the effect of regular occupational exposure to welding fumes and of occasional occupational exposure to welding fumes, compared with no (or very rare) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (three outcomes: prevalence, incidence, and mortality). Data sources: We developed and published a protocol for our previous systematic review, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CENTRAL and CISDOC, up until 27 May 2024. We also searched grey literature databases, internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. Study eligibility and criteria: We included studies of working-age workers (≥15 years) in the formal and informal economy in any Member State of WHO and/or ILO but excluded studies of children (

Background: Few studies in Saudi Arabia have comprehensively assessed chronic conditions among migrant workers, although they make up one-third of the population. We aimed to assess the prevalence of chronic conditions (i.e., asthma, chronic obstructive pulmonary disease, diabetes, eczema, heart disease, hypertension, obesity, and peptic ulcers) and evaluate the associations between the chronic conditions and other factors (i.e., age, sex, occupation, nationality, and lifestyle) in a sample of migrant workers. Methods: A cross-sectional study of 2123 migrant workers who represented seven occupation groups was conducted in Al-Qassim, Saudi Arabia. Chronic conditions were self-reported or assessed with physical/biological measurements or validated screening questionnaires. Covariates were assessed with standard questions. A multinomial logistic regression identified the significantly associated factors. Results: The mean age of the participants was 35 ± 9 years; 85.3 % were men, and 65 % were from the Indian subcontinent. We found the following chronic condition prevalence estimates: hypertension = 28.4 %, obesity = 17 %, diabetes = 7.1 %, eczema = 5.7 %, peptic ulcer = 4.0 %, asthma = 2.1 %, chronic obstructive pulmonary disease = 0.9 %, and heart disease = 0.8 %. Nearly a third (31.3 %) of participants had one chronic condition, and 16 % had ≥2 chronic conditions. The factors significantly associated with having ≥2 chronic conditions were female gender (odds ratio [OR] 2.9, 95 % confidence interval [CI] 1.62–5.19), a university education (OR 2.4, 95 % CI 1.28–4.42), being a past smoker (OR 4.2, 95 % CI 2.26–7.83), and inactivity (OR 2.4, 95 % CI 1.46–3.84). Conclusion: A significant portion of migrant workers in Saudi Arabia are afflicted with chronic conditions.

Psoriasis, a chronic inflammatory skin disease, is connected to psoriatic arthritis, a chronic inflammatory arthritis. Recent studies have also linked psoriasis and psoriatic arthritis to various renal disorders. This research aims to determine the prevalence and association of renal disorders in adult patients with psoriasis and compare those findings with adult patients with psoriatic arthritis. This retrospective cross-sectional study included 485 participants with psoriasis. The study evaluated demographics, psoriasis type, the presence of psoriatic arthritis, and related comorbidities, excluding individuals under the age of 18 or those with no verified diagnosis. Medical records were reviewed for renal problems, and a multivariate logistic regression was used to investigate the relationship between psoriasis and psoriatic arthritis. Overall, 10.1% of psoriatic individuals had psoriatic arthritis. The mean age at diagnosis was 41.59±15.58 years, with 54.2% female. Plaque psoriasis was identified in 87.2% of patients, with 46% classified as obese (BMI≥30). Chronic renal failure was seen in 6.2% of psoriasis patients, and 6.1% of psoriatic arthritis patients. In our study, chronic renal failure rates were similar in psoriasis and psoriatic arthritis. Psoriatic arthritis was associated with an increased risk of acute kidney damage, transplantation, and dialysis.

Purpose: To compare the prosthetic outcomes of screw-retained monolithic zirconia (Zr) single crowns supported by either narrow-diameter (3.3 mm) or standard-diameter (4.1 mm) tissue-level titanium-zirconia (TiZr) implants in posterior sites. Materials and Methods: A total of 18 participants, each with a missing molar or premolar tooth requiring an implantsupported single crown, were randomly assigned to either the test or control group. All participants received screwretained monolithic Zr single crowns supported by single tissue-level TiZr implants. Test group participants received narrow-diameter implants (3.3 mm), whereas control group participants received standard-diameter implants (4.1 mm). A modified version of the United States Public Health Service (USPHS) criteria was used to assess the prosthetic outcome across 12 parameters after 1 year of function. Data were analyzed descriptively, and statistical analysis was performed using a statistical software (SPSS, Version 28.0; IBM) with the level of significance set at P < .05. Results: Of the 18 single crowns delivered, 16 were available for review at the 1-year follow-up, including 7 in the test group and 9 in the control group. Patient characteristics and crown site distribution were similar, with no significant differences observed between the two groups (chi-square test; P < .05). There were no crown failures, meaning a crown survival rate of 100% was achieved after 1 year. The prosthetic outcome based on USPHS criteria was comparable between the two groups with no significant differences observed (chi-square test; P < .05). There were 19 prosthetic events in total (10 in the test group and 9 in the control group), with no significant differences between the groups (chi-square test; P < .05). Loss of proximal contact was the dominant event, with a total of eight events (three in the test group and five in the control group). Patient satisfaction after 1 year was high in both treatment groups, with no significant differences detected. Conclusions: Screw-retained monolithic Zr single crowns supported by either narrow- or standard-diameter tissue-level TiZr implants in posterior sites have comparable prosthetic outcomes after 1 year. Long-term results from well-designed trials are still needed to validate the findings of the present study. [ABSTRACT FROM AUTHOR]

The research was conducted at the Department of Agronomy and Agricultural Extension, Rajshahi University, from December 2021 to April 2022. The objective was to develop a fuzzy expert system for site-specific N fertilisation using leaf colour code (RGB) and irrigation frequencies for maize yield. The experiment encompassed two primary factors: nitrogen fertiliser application rates (N1: 100%, N2: 75%, N3: 50% of conventional rates) and irrigation frequencies (I1: 100%, I2: 75%, I3: 50% of pan evaporation). A completely randomised design (CRD) with three replications was used to arrange the experimental pots, each receiving recommended doses of phosphorus, potassium, and sulfur, with urea applied per treatment instructions. Results revealed significant chlorophyll content and grain yield differences among the various nitrogen fertiliser rates. The highest grain yield (219.27 g.pot-1) was observed with N1, whereas the lowest (186.6 g.pot-1) was with N3. Similarly, irrigation frequencies significantly influenced chlorophyll content and cob characteristics, with I1 resulting in the highest grain yield (211.27 g.pot-1) and I3 the lowest (184.6 g.pot-1). Furthermore, the interaction between fertiliser application rates and irrigation frequencies had notable effects on various parameters, leading to the highest grain yield of 227.62 g.pot-1 with the combination of N1 and I1 and the lowest (168.00 g.pot-1) with N3 I3. The agricultural experiments were facilitated using the Matlab fuzzy toolbox, employing the Mamdani inference method. Fuzzy rules were delineated for nitrogen application rates and irrigation frequencies, with three fuzzy sets each. Membership functions were developed utilising Matlab's fuzzy interface system (FIS) editor and membership function editor, optimising leaf chlorophyll content, evaporation rate as input tiger N fertilisation, and irrigation frequencies as output for precise maize production in Bangladesh.

Background: Hyperhidrosis is unnecessary sweating afar the body needs for cooling down the body temperature. It affects nearly 2-3% of the population with equal gender predominance. Both medical and surgical interventions have been utilized to treat primary hyperhidrosis. Over 80% of patients with palmar hyperhidrosis (PH) also experience plantar hyperhidrosis (PLH). An interesting observation in surgically treated patients with PH is that PLH symptoms tend to decrease after undergoing Video-assisted thoracoscopic surgery (VATS). Objectives: The aim of the present study was to evaluate the efficacy, safety and drawbacks of VATS sympathectomy at thoracic levels (R2-3) versus (R2-4) on PLH associated with primary PH. Patients and methods: this single center, parallel randomized controlled study involved 72 eligible patients presented with primary palmoplantar hyperhidrosis, where 36 patients underwent VATS sympathectomy at thoracic levels R2-3 (Group A) versus other 36 patients at thoracic level R2-4 (Group B). Both groups underwent bilateral two-port tubeless VATS sympathectomy with the use of electrocautery under general anesthesia in semi-fowler position. Results: Following surgery, both groups showed improvement in PLH, but group B had a significantly higher incidence of improvement compared to group A. In group A, 77.7% of patients were satisfied, while in group B, 88.8% of patients reported satisfaction. Conclusion: VATS sympathectomy is the preferred treatment for effectively curing PH. There is a significant correlation between VATS sympathectomy performed at the R2 to R4 levels and the alleviation of PLH.

Purpose The aim of this study was to describe six surgical principles that were applied for safe excision of superotemporal dermolipomas. Patients and methods This retrospective interventional clinical study included 32 dermolipomas (in 29 patients) that presented to the Orbit Clinic of Assiut University Hospital, Assiut, Egypt and were subjected to surgical excision. The six surgical principles applied for safe dermolipoma excision were: conjunctival incision at the junction between normal and abnormal conjunctiva sparing as much bulbar conjunctiva as possible, hooking the lateral rectus muscle and dissecting the lesion free from the muscle and the covering Tenon’s capsule, eversion of the upper lid using Descemar’s retractor, incision at the upper bulbar conjunctiva, and dissection of the superior surface of the lesion away from the levator muscle, dissection of the lateral surface of the lesion from its attachment to the lateral canthus sparing a stump of the conjunctiva, dissection of the deep part of the lesion from the underlying normal orbital tissue, and suturing the bulbar conjunctiva to the preserved conjunctival stump at the lateral canthus. The follow up ranged from 3 to 35 months (mean=21±3.2 months) during which the patients were assessed for improvement in the presenting manifestations as well as for the presence of complications such as ptosis, dry eye, strabismus, limitation of ocular motility, or symblepharon. Results The surgery was successful in all patients without permanent dry eye, blepharoptosis, or permanent strabismus. Temporary limitation of adduction was observed in two patients that resolved spontaneously within 1 month. Conclusion Adherence to the six surgical principles outlined in the study allowed the authors to safely excise the dermolipomas without damaging the lateral rectus, levator complex, and lacrimal gland ductules. Thus, postoperative squint, ptosis, and dry eye were avoided. In addition, preserving the forniceal conjunctiva and suturing the bulbar conjunctiva prevented symblepharon formation and restricted mobility.