Search

Background: The advent of Virtual Reality technologies presents new opportunities for enhancing current surgical practice. Studies suggest that current techniques in endoscopic surgery are prone to disturbance of a surgeon's visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The Microsoft® HoloLens is a novel head-mounted display that has not been explored within surgical innovation research. This study aims to evaluate the HoloLens as a potential alternative to conventional monitors in endoscopic surgery.Materials and Methods: This prospective, observational and comparative study recruited 72 participants consisting of novices (n = 28), intermediate-level (n = 24) and experts (n = 20). Participants performed ureteroscopy, within an inflatable operating environment, using a validated training model and the HoloLens mixed-reality device as a monitor. Novices also completed the assigned task using conventional monitors; whilst the experienced groups did not, due to their extensive familiarity. Outcome measures were procedural completion time and performance evaluation (OSATS) score. A final evaluation survey was distributed amongst all participants.Results: The HoloLens facilitated improved outcomes for procedural times (absolute difference, - 73 s; 95% CI - 115 to - 30; P = 0.0011) and OSAT scores (absolute difference, 4.1 points; 95% CI 2.9-5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% CI 4.5-4.8). Furthermore, 95% of participants agreed or strongly agreed that the HoloLens is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% CI 4.2-4.5).Conclusion: This study demonstrates that the device facilitated improved outcomes of performance in novices and was widely accepted as a surgical visual aid by all groups. The HoloLens represents a feasible alternative to the conventional setup, possibly by aligning the surgeon's visual-motor axis. [ABSTRACT FROM AUTHOR]

A total of 80 specimens of the European eel Anguilla anguilla were collected during the period from February 2013 to March 2014 at the coast of the Gulf of Suez (Red Sea, Egypt). A new species of parasitic nematodes was recovered and described as Cucullanus egyptae. It was found in the eel's intestine with a prevalence of 68.7 %. The morphology of the recovered parasite was studied by light and scanning electron microscopy. The adult worms had a wide cephalic extremity with a slit-like oral aperture being surrounded by a cuticular ring and delimited internally by a row of small teeth in addition to four sub-median cephalic papillae and one pair of lateral amphids. Body measurements showed that the male worms were smaller than females measuring 7.5-8.9 mm (8.3 ± 0.2) in length and 1.6-1.9 mm (1.8 ± 0.1) in width. Females measured 12.9-13.5 mm (13.1 ± 0.2) in length and 2.9-3.2 mm (3.1 ± 0.1) in width. The posterior end of the males is provided with ten pairs of caudal papillae and two long spicules which are slightly sclerotized, equal in size measuring 0.59-0.65 mm (0.62 ± 0.01) in length. Comparing the present worms with other species of the genus Cucullanus, several similarities were observed. However, peculiar new characteristics such as the precloacal sucker (especially the spicula length), the arrangement and the distribution of the post-cloacal papillae, and the position of the excretory pore make it reasonable to describe a new species. The sequence data of the small subunit (SSU) ribosomal DNA (rDNA) obtained from the present nematode supported its taxonomic position within the genus Cucullanus. The new species is closely related to the first clade of Spirurina and even more closely related to Cucullanus dodsworthi as a sister taxon with a high percentage of identity. The sequence of the recorded SSU rDNA of this parasite is deposited in the GenBank with the accession no. KF681520. It is proposed to name the new species C. egyptae as the first representative of Cucullanidae in Egypt with a new host record. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic retinopathy (DR) is still a leading cause of blindness. The role of miRNAs in diabetic retinopathy still needs more research. We aimed at validating the role of circulating miRNAs: 21,181C and 1179 in early detection, dynamic monitoring, and management of DR. Methods: Whole blood samples were collected from 180 diabetic patients and 60 normal individuals as control. The diabetic patients were subdivided into 60 subjects without retinopathy, 60 with non-proliferative diabetic retinopathy (NPDR), and 60 with proliferative diabetic retinopathy (PDR). Gene expression of miR-21, miR-181c, and miR-1179 were estimated in each sample using two-step reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Results: MicroRNA 181c and miRNA 1179 were significantly higher among PDR group compared to NPDR,W DM and control groups, while no significant difference was detected regarding miRNA 21. The areas under the receiver operating characteristic (ROC) curves of the validated two-serum miRNAs were 0.983 and 0.927 respectively. Combination of miRNA 1179 and miRNA 21 improved the accuracy rate to 90%. Combination of miR-181c and miR-1179 possessed high ability to discriminate between PDR and NPDR with an accuracy rate of 100%. Conclusion: MicroRNAs play a role in pathogenesis of diabetic retinopathy. In our study, miR-181c and miR-1179 were significantly high in PDR patients compared to NPDR and controls hence can be used to anticipate and follow up the progression. MicroRNA antagonists or mimics can be tried as new medications to modify DR by reducing the rate of progression, and subsequent blindness. [ABSTRACT FROM AUTHOR]

Abstract  Head lice are an emerging social problem, not only in economically poor countries but also in practically all other societies. Several of the common anti-louse products have lost—at least in part—their efficacy due to increasing resistance of lice against insecticides such as permethrin or allethrin. Other compounds, like lindan, were redrawn or banned due to high toxicity. Some recently developed products are based on dimethicones or cyclomethicones and turned out to be easily inflammable. Other styled medicinal products are based on plant extracts—some were proven of high efficacy—others of ineffectivity. The present study investigated in in vitro tests the anti-head louse efficacy of 13 products, the contents of which are used worldwide: Aesculo®-Gel L, EtoPril®, Goldgeist® Forte, InfectoPedicul®, Jacutin® Pedicul Fluid, K.Laus®, Liberalice®, Licatack®, Mosquito® Läuse-Shampoo, Nyda®, Paranix®, Picksan® Louse Stop, and Wash Away Louse®. It turned out that several of them are easily inflammable, and therefore, they endanger users (InfectoPedicul®, Paranix®, EtoPril®, Nyda®, Goldgeist® Forte, and K.Laus®, see Table 1). Others have to remain for many hours on the hair in order to reach efficacy (Table 4). During such long periods, highly dosed oils may become inhaled and thus may become dangerous for the user''s lung epithelia by covering them. When incubating the lice for 3 or 10 min in vitro, only the following products killed all lice exposed to these products: InfectoPedicul®, Paranix®, Jacutin® Pedicul Fluid, Nyda®, K.Laus®, Picksan® Louse Stop, Licatack®, and Wash Away Louse®. When evaluating the possible dangers for the users, the last three products, especially, derived from plant extracts, are safe and highly effective at the same time. Furthermore, they had been tested dermatologically as “very good”. [ABSTRACT FROM AUTHOR]

Background and aims: Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. Methods: A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). Results: The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. Conclusion: The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate health related quality of life (HRQOL) in Egyptian children with systemic lupus erythematosus (SLE) using 3 different tools. Methods: In this questionnaire-based study, 100 children with SLE were included. HRQOL was assessed using the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL™ 4.0 GCS), PedsQL™ 3.0 Rheumatology Module (PedsQL3-RM) and the Simple Measure of the Impact of Lupus Erythematosus in Youngsters (SMILEY). SLE disease activity index (SLEDAI) was used to evaluate activity and SLE International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) was used to evaluate chronic damage. Results: All mean scores of PedsQLTM4.0 GCS domains in SLE patients were lower than published normative data and previously published results of Egyptian healthy controls (p < 0.001). All mean scores of PedsQL-3RM domains were significantly lower than published normative data except for the treatment and pain and hurt domains (p = 0.1, 0.2 respectively). SMILEY scores were low and the lowest domain scores was "Burden of SLE". Longer duration of illness, higher cumulative steroid doses, higher SLEDAI and SDI scores and presence of obesity were associated with lower scores for all 3 tools (p < 0.001). Conclusion for Practice: The Arabic copies of PedsQL™ 4.0 GCS, PedsQL3-RM and SMILEY are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children. Significance: This is the first study to evaluate HRQOL scores in Egyptian children with SLE which were found to be lower than published data with long disease duration, high cumulative disease activity, use of steroids and presence of obesity are the main influential factors related to low QoL scores. Generic and disease specific questionnaires are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children. [ABSTRACT FROM AUTHOR]

Background: The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group. Methods: Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale. Results: The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04–2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064–2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145–6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616–6.136, P-value = ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3–7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2–5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1–6). Conclusion: The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Objective: To compare diagnostic performance and agreement between CT, MRI and combined CT/MRI in reference to LI-RADS classification system to categorize hepatic observations detected in hepatic patients during screening ultrasound.Methods: 240 patients with 296 liver observations detected during ultrasound surveillance underwent hepatic CT and MRI examinations, histopathology, and clinical and radiological follow-up. Using LI-RADS v2014, six radiologists evaluated the observations independently and assigned a LI-RADS category to each observation using CT, MRI and combined CT/MRI.Results: Combined CT and MRI in LI-RADS yielded better accuracy (91.29 %), sensitivity (90.71 %) and specificity (92.31 %) for hepatocellular carcinoma (HCC) diagnosis than using MRI or CT alone; accuracy, sensitivity and specificity decreased to 85.37 %, 86.34 %, and 83.65 %, respectively, for MRI and 67.6 %, 54.10 % and 91.35 %, respectively, for CT. The intraclass agreement of the LI-RADS scores between CT, MRI and combined CT/MRI was excellent (κ=0.9624 (95 % CI: 0.9318-0.9806)).Conclusion: CT and MRI are complementary to each other. Combined CT/MRI enabled a more precise determination of LI-RADS category of hepatic observations; however, due to the expense and minor increase in accuracy, the combined methodology should only be utilized in cases of suspected HCC.Key Points: • Hepatic observation may be categorized differently depending on the imaging modality used. • We compared LI-RADS categorization between CT, MRI and combined CT/MRI. • MRI produces higher accuracy and sensitivity, while CT produces higher specificity. • Combining CT and MRI improves LIRADS categorization reports. • Considering additional cost, combined methodology could be restricted to challenging cases. [ABSTRACT FROM AUTHOR]

Introduction: Infected nonunion of the tibial diaphysis poses one of the most challenging scenarios. There is no clear cut guidelines for cases of infected diaphyseal nonunion with bony defects of ≤6 cm.Materials and Methods: A retrospective comparative study was conducted on 30 patients who sustained resistant infected tibial diaphyseal nonunion with bony defect of ≤6 cm. The 30 patients were the sum of two groups; group I (16 patients, mean age 33.6 years) which included all patients, who underwent two stage reconstructions, and Group II patients (14 patients, mean age 29.5 years) who were managed by application of Ilizarov ring external fixator in a single stage surgery. Union was judged both clinically and radiologically. A scoring system comprising dual functional and bony grading was employed to evaluate the final results of both groups.Results: The results of both groups regarding the size of the resultant bony defect, the time to union, and the postoperative limb length discrepancy showed no statistically significant differences. Group II patients needed postoperative plastic reconstruction procedures significantly more than group I patients (p = 0.019). Similarly, group II patients exhibited more complications than group I patients (p = 0.003). Regarding both clinical and bony grading, the results of group I showed superiority to group II results with the only significant difference being the preservation of the preoperative range of motion of both ankle and subtalar joints (p = 0.072).Conclusions: The use of two stage reconstruction in cases of resistant infected tibial diaphyseal nonunion gives comparable results to the Ilizarov ring external fixator in cases associated with bony defects within the confines of 6 cm with superiority in preservation of ankle and subtalar joints range of motion. [ABSTRACT FROM AUTHOR]