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Abstract Background and aims The Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the scores that is used most frequently for determining the likelihood of mortality in patients undergoing emergency laparotomy. National Emergency Laparotomy Audit (NELA) presents a novel and validated score. Therefore, we aimed to compare the performance of the NELA and P-POSSUM mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy. Methods Between August 2020 and October 2022, this cohort study was undertaken at Menoufia University Hospital. We compared the P-POSSUM, preoperative NELA, and postoperative NELA scores in patients undergoing emergency laparotomy. All variables needed to calculate the used scores were collected. The outcomes included the death rates at 30 and 90 days. By calculating the area under the curve (AUC) for every mortality instrument, the discrimination of the various methods was evaluated and compared. Results Data from 670 patients were included. The observed risk of 30-day and 90-day mortality was 10.3% (69/670) and 13.13% (88/670), respectively. Concerning 30-day mortality, the AUC was 0.774 for the preoperative NELA score, 0.763 for the preoperative P-POSSUM score, and 0.780 for the postoperative NELA score. Regarding 90-day mortality, the AUCs for the preoperative NELA score, preoperative P-POSSUM score, and postoperative NELA score were 0.649 (0.581–0.717), 0.782 (0.737–0.828), and 0.663 (0.608–0.718), respectively. There was noticeable difference in the three models' capacity for discrimination, according to pairwise comparisons. Conclusions The probability of 30-day and 90-day death across the entire population was underestimated by the NELA and P-POSSUM scores. There was discernible difference in predictive performance between the two scores.

Article accepted. The article will be published here soon. Pending final quality checks.

Background Patients with diabetic kidney disease (DKD) are at increased risk to develop post-contrast acute kidney injury (AKI). Diabetic patients under dipeptidyl peptidase 4 inhibitors (DPP4Is) experience a lower propensity to develop AKI. We speculated that linagliptin as a single agent or in combination with allopurinol may reduce the incidence of post-contrast AKI in stage 3–5 chronic kidney disease (CKD) patients with underlying DKD.Methods Out of 951 DKD patients eligible for this study, 800 accepted to sign informed consent. They were randomly allocated to 4 equal groups that received their prophylaxis for 2 days before and after radiocontrast. The first control group received N-acetyl cysteine and saline, the 2nd received allopurinol, the 3rd group received linagliptin, and the 4th received both allopurinol and linagliptin. Post-procedure follow-up for kidney functions was conducted for 2 weeks in all patients.Results 20, 19, 14, and 8 patients developed post-contrast AKI in groups 1 through 4, respectively. Neither linagliptin nor allopurinol was superior to N-acetyl cysteine and saline alone. However, the combination of the two agents provided statistically significant renal protection: post-contrast AKI in group 4 was significantly lower than in groups 1 and 2 (p

Abstract Background Children with spastic cerebral palsy have motor deficits that can lead to joint contractures. Ankle equinus deformity is the most common foot deformity among children with CP. It is caused by spasticity and muscular imbalance in the gastrocnemius-soleus complex. Exercise enhances ankle function, improves gait in children with CP, and prevents permanent impairment. Therefore, there is a need to investigate the effectiveness of different types of exercise used in equine management. The aim of this review is to assess the evidence of the effectiveness of exercise training on equinus deformity in children with cerebral palsy. Methodology The American Academy for Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology were used to conduct this systematic review. Four databases (PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar) were searched till January 2022 using predefined terms by two independent reviewers. Randomized controlled trials published in English were included. This review included seven studies with 203 participants ranging in age from 5 to 18 years. Methodological quality was assessed using AACPDM, PEDro scale; also, levels of evidence adopted from modified Sacket’s scale were used for each study. Primary outcomes were dorsiflexion angle, plantar flexion angle, and plantar flexors strength. Results The quality of studies ranged from good (six studies) to fair (one study). The level of evidence was level 1 (six studies) and level 2 (one study) on modified Sacket’s scale. There is a low risk of bias in the included studies. Meta-analysis revealed a non-significant difference in plantar flexor strength, plantar flexion angle, and dorsiflexion angle between the study and control group. Conclusions There is a need for high-quality studies to draw a clear conclusion as the current level of evidence supporting the effectiveness of various types of exercises on equinus deformity in children with cerebral palsy is still weak.

Background: Meniscal lesions are the commonest lesions in the knee, and usually caused by athletic activities. Meniscal lesions diagnosis may need costly imaging modalities like magnetic resonance imaging [MRI]. However, MRI is not available in all medical facilities, especially peripheral and rural continents. Thus, there is a need for a readily available imaging tool. Knee ultrasound may be used as diagnostic modality as it is devoid of economic burden of MRI.Aim of the work: The current work aimed to estimate the diagnostic accuracy of knee ultrasound and to correlate it with the results of MRI for diagnosis of knee meniscal lesions.Patients and methods: Fourty patients with acute or chronic knee pain, swelling or movement restrictions were included. All were assessed by referral physician and submitted to knee ultrasound and MRI. Then results of ultrasound were correlated with that of MRI and diagnostic accuracy measures of ultrasound were calculated [sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and overall accuracy].Result: Out of included patients, 28 were males. Their mean age was 36.7 ± 14.4 years [ranged from 15 to 60 years]. The ultrasound detected meniscal tear in 90%, degeneration in 47.5%, Para-meniscal cyst in 25% and discoid meniscus in 40%. The MRI detected meniscal tear in 80%, degeneration in 65%, para-meniscal cyst in 25% and discoid meniscus in 37.5%. For meniscal tear, the ultrasound had 83.3% sensitivity, 50.0% specificity, 93.7% PPV, 25.0% NPV and overall accuracy of 80.0%. Otherwise, the overall accuracy was 75.0% for degenerative changes and 95.0% for para meniscal cyst. Finally, it was 67.5% for discoid meniscus.Conclusion: Ultrasound has shown reasonable diagnostic accuracy in detecting meniscal lesions. It could be used as a screening tool to prevent unnecessary and costly MRI.

BACKGROUND: Periorbital hyperpigmentation (POH) is a therapeutic problem. Platelet-rich plasma (PRP) has been successfully used in some pigmentary disorders including POH. Proper evaluation of treatment in POH can be difficult. OBJECTIVE: To assess the efficacy and safety of PRP injections for POH in skin phototypes III and IV by multiple clinical tools. METHODS: A clinical trial included 30 patients with POH, skin phototypes III and IV. Three sessions of intradermal PRP injections were used in periorbital area every month. Treatment was assessed on different clinical levels 1 month after the last session by POH severity grading, blinded photographic assessment, and patient satisfaction. Adverse effects of PRP were evaluated. RESULTS: A significant improvement in POH was documented by disease severity grading, patient satisfaction, and to a lesser extent by photographic evaluation. Grade II-POH showed the best improvement. More than half of the cases were satisfied and very satisfied. Lower disease grades, constitutional POH, and epidermal pigmentation showed significant improvement. Side effects were mostly tolerated. CONCLUSION: The present results confirmed the beneficial role of PRP in improving POH. Multiple clinical tools are preferred for a more reliable assessment of treatment. Certain clinical types and grades of POH are suggested to respond more to PRP therapy. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients with sepsis have a high incidence of vitamin D deficiency. Vitamin D promotes the synthesis of human cathelicidin antimicrobial peptide, a precursor of LL-37, which is a part of the innate immune system. This study investigated the effectiveness and safety of the early administration of high-dose enteral vitamin D3 in comparison with low-dose vitamin D3 in patients with sepsis requiring mechanical ventilation (MV). Methods: Eighty adult patients with sepsis requiring MV with known vitamin D deficiency were randomly assigned to receive either an enteral 50 000 IU (Group I) or 5000 IU (Group II) vitamin D supplementation. Clinical and laboratory parameters were evaluated at baseline and on days 4 and 7 between the study groups. The change in serum procalcitonin (PCT) levels on day 7 was the primary outcome, while the change in serum LL-37 levels on day 7, changes in sequential organ failure assessment (SOFA) score, and clinical pulmonary infection score on day 7, MV duration, and hospital length of stay (LOS) were the secondary outcomes. Results: The (day 7-day 0) change in serum PCT and LL-37 levels and SOFA score were significantly different in Group I (P =.010, P <.001, and P <.001, respectively). The SOFA score was significantly different on days 4 and 7 in Group I (P <.001 and P <.001, respectively). The incidence of early ventilator-associated pneumonia was significantly different between both treatment groups (P =.025). The hospital LOS was shorter in Group I (P <.001). No 25-hydroxyvitamin-D toxicity was observed in either group. Conclusions: Early enteral administration of high-dose vitamin D3 in critically ill patients with sepsis requiring MV along with standard treatment for sepsis decreased serum procalcitonin levels, increased serum LL-37 levels, and ameliorated illness severity scores. [ABSTRACT FROM AUTHOR]

The need for energy has significantly increased in the world in recent years. Various research works were presented to develop Renewable Energy Sources (RESs) as green energy Distributed Generations (DGs) to satisfy this demand. In addition, alleviating environmental problems caused by utilizing conventional power plants is diminished by these renewable sources. The optimal location and size of the DG-RESs significantly affect the performance of Radial Distribution Systems (RDSs) through the fine bus voltage profile, senior power quality, low power losses, and high efficiency. This paper investigates the use of PV (photovoltaic) and (Wind Turbine) WT systems as a DG source in RDSs. This investigation is presented via the optimal location and size of the PV and WT systems, which are the most used DG sources. This optimization problem aims to maximize system efficiency by minimizing power losses and improving both voltage profile and power quality using White Shark Optimization (WSO). This algorithm emulates the attitude of great white sharks when foraging using their senses of hearing and smell. It confirms the balance between exploration and exploitation to discover optimization that is considered as the main advantage of this approach in attaining the global minimum. To assess the suggested approach, three common RDSs are utilized, namely, IEEE 33, 69, and 85 node systems. The results prove that the applied WSO approach can find the best location and size of the RESs to reduce power loss, ameliorate the voltage profile, and outlast other recent strategies. Adding more units provides a high percentage of reducing losses by at least 93.52% in case of WTs, rather than 52.267% in the case of PVs. Additionally, the annual saving increased to USD 74,371.97, USD 82,127.257, and USD 86,731.16 with PV penetration, while it reached USD 104,872.96, USD 116,136.57, and USD 155,184.893 with WT penetration for the 33, 69, and 85 nodes, respectively. In addition, a considerable enhancement in the voltage profiles with the growth of PV and WT units was confirmed. The ability of the suggested WSO for feasible implementation was validated and inspected by preserving the restrictions and working constraints.

Background: Chronic subdural hematoma (CSDH) is a collection of blood, blood degradation products, and fluid that accumulate on the surface of the brain between its arachnoid and dural coverings. This study is to evaluate the efficacy of subgaleal drain (SGD) versus subgaleal dissection without drainage as adjuncts to burrhole evacuation of CSDH. Methods: A retrospective study was conducted utilizing the data of 60 patients operated for symptomatic CSDH. Patients were divided into two groups, each thirty consecutive patients: Group I, in which a SGD was inserted after CSDH evacuation through a burr-hole; and Group II, the hematoma was evacuated as in the Group I, but with no SGD insertion but instead a subgaleal pocket was created for drainage. Results: The neurological improvement at 24 h, discharge, 2 weeks, and 6 months after surgery was comparable in both groups. The overall recurrence was 4 cases (4/60, 6.7%). The rate of recurrence and surgical infection rate were comparable in both groups. Both groups showed similar incidences of postoperative seizures, bleeding, rates of medical complications, and neurological deficits. The overall postoperative mortality was five cases (5/60, 8.3%) with no significant difference between groups. Conclusion: Blunt dissection to open the subgaleal space and closure without a drain is a safe and efficient alternative to the insertion of a drain after the burr-hole evacuation of CSDH. [ABSTRACT FROM AUTHOR]