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PURPOSE International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios. METHODS A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response. RESULTS Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. CONCLUSION The treatment recommendations for most topics addressed differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC.

PURPOSE To present a summary of the recommendations for the treatment and follow-up for the biochemical recurrence of castration-resistant prostate cancer (PCa) as acquired through a questionnaire administered at the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 27 questions were identified as relating to this topic. Responses from the clinician were tallied and are presented in percentage format. Topics included the use of imaging in staging, treatment recommendations across different patient scenarios of life expectancy and prostate-specific antigen (PSA) doubling time, and follow-up for nonmetastatic castration-resistant PCa. RESULTS A consensus agreed that in optimal conditions, positron emission tomography-computed tomography with prostate-specific membrane antigen would be used although in limited resource situations the combined use of CT of the abdomen and pelvic (or pelvic MRI), a bone scan, and a CT of the thorax or chest x-ray was recommended. In cases when PSA levels double in < 10 months, more than 90% of clinicians agreed on the use of apalutamide or enzalutamide, regardless of life expectancy. With a doubling time of more than 10 months, > 54% of experts recommended no treatment independent of life expectancy. More than half of the experts, regardless of resources, recommended follow-up with a physical examination and PSA levels every 3-6 months and imaging only in the case of symptoms. CONCLUSION The voting results and recommendations presented in this document can be used by physicians to support management for biochemical recurrence of castration-resistant PCa in areas of limited resources. Individual clinical decision making should be supported by available data.

Introduction: Referral rates and patterns to specialists by family physicians have a significant impact on numerous aspects of medical care, including the quality and cost of care provided. The aim of this study was to examine the referral rate and pattern of family physician practices associated with a large academic health center. Methods: We conducted a retrospective chart review of referrals for patients seen in the family medicine clinics associated with a large academic institution. Basic demographic information was collected. The primary outcome was the monthly referral rate, measured as the proportion of patient visits that resulted in a consult to a specialist outside of the referring family medicine clinic. Binomial and γ generalized linear mixed models were fit to determine the associations between high/medium/low referral rate clinics and patient demographics. Results: The average monthly referral rate for all of the clinics was 20.3%, and the rate varied significantly between clinic groups. Patient gender, race, and being in a committed relationship were noted to be associated with lower referral rate. Discussion: Referral rates among family physician practices differ widely and are associated with gender, race, and relationship status of patients. Referrals to several specific specialties are common among family physicians.

Background Diffuse intrinsic pontine glioma (DIPG) remains a clinico-radiologic diagnosis without routine tissue acquisition. Reliable imaging distinction between DIPG and other pontine tumors with potentially more favorable prognoses and treatment considerations is essential. Methods Cases submitted to the International DIPG registry (IDIPGR) with histopathologic and/or radiologic data were analyzed. Central imaging review was performed on diagnostic brain MRIs (if available) by two neuro-radiologists. Imaging features suggestive of alternative diagnoses included nonpontine origin, Results Among 286 patients with pathology from biopsy and/or autopsy, 23 (8%) had histologic diagnoses inconsistent with DIPG, most commonly nondiffuse low-grade gliomas and embryonal tumors. Among 569 patients with centrally-reviewed diagnostic MRIs, 40 (7%) were classified as non-DIPG, alternative diagnosis suspected. The combined analysis included 151 patients with both histopathology and centrally-reviewed MRI. Of 77 patients with imaging classified as characteristic of DIPG, 76 (99%) had histopathologic diagnoses consistent with DIPG (infiltrating grade II-IV gliomas). Of 57 patients classified as likely DIPG with some unusual imaging features, 55 (96%) had histopathologic diagnoses consistent with DIPG. Of 17 patients with imaging features suggestive of an alternative diagnosis, eight (47%) had histopathologic diagnoses inconsistent with DIPG (remaining patients were excluded due to nonpontine tumor origin). Association between central neuro-imaging review impression and histopathology was significant (p < 0.001), and central neuro-imaging impression was prognostic of overall survival. Conclusions The accuracy and important role of central neuro-imaging review in confirming the diagnosis of DIPG is demonstrated.

The purpose of this study was to examine the effect of a 40-min nap opportunity (N40) on performance during, markers of muscle damage and inflammation, and the perception of fatigue and recovery, in response to a 5-m shuttle run test (5msrt). Fifteen male amateur athletes performed the 5msrt under two conditions: N40 and no-nap condition (NN). Blood biomarkers were collected at rest and after the 5msrt to measure muscle damage (i.e., creatinine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT)) and inflammation (i.e., C-reactive protein (CRP)). RPE was determined immediately after each repetition of the test and PRS and DOMS were determined 5 min, thereafter. Compared to NN, N40 improved the highest distance (p

Objective Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery. Methods We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed. Results There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P Conclusions Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.

The emergence of the novel coronavirus disease 2019 has created an unprecedented strain on healthcare systems. Outpatient clinics have had to significantly modify the way they deliver patient care. With prolonged stay-at-home orders and priority to limit overall exposure to the virus, the use of telehealth has gained momentum in the plight to safely deliver care. Many clinics, at least in the short term, shifted some or all of their practice from in-person to virtual platforms. This study documents how Texas clinics transitioned to telehealth during the initial months of the coronavirus disease 2019 pandemic (March–June 2020), focusing on the use of, barriers to, and reimbursement for telehealth. Supplemental digital content is available in the text., Objectives Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels. Methods Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers). Results A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%). Conclusions These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.

We report a rare case of thyrolipoma-thyrolipomatosis' association. A 48-year-old patient, with a past history of high blood pressure and chronic renal failure secondary to AA amyloidosis, presented with a midline neck swelling increasing in size since one year. Ultrasound showed a multinodular goiter, the worst nodule was left-lobar and categorized as EU-TIRADS 4. Grossly, cut section of the thyroid specimen showed a yellow-tan left-lobar nodule measuring 2.5cm, the surrounding tissue had a diffuse yellow-brown appearance with scattered whitish areas. Histopathologic examination revealed that the nodule corresponded to a follicular adenoma.Thyroid fat infiltration was noticed both within the nodule and in the neighboring parenchyma. Thus, the diagnosis of an association thyrolipoma-thyrolipomatosis was rendered. The association of thyrolipoma-thyrolipomatosis is a very rare occurrence of unclear pathogenesis. To the best of our knowledge, this report describes the second case in the literature. The diagnosis is retained on the basis of certain histological features, revealing mature adipose tissue within thyroid gland as a combined nodular and diffuse pattern.

Study Objective Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Design Secondary analysis of a cluster-randomized provider educational trial. Setting Forty US-based reproductive health centers. Participants We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. Interventions The parent study assessed the effect of provider training on evidence-based contraceptive counseling. Main Outcome Measures We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Results Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). Conclusion In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.

Patients with advanced endometrial cancer had generally a poor prognostic with a median survival often less than one year. Isolated bone metastases as the first sign of the disease of endometrial cancer was a very exceptional situation rarely described in the literature. The goal of this report is to describe the management of this rare site of metastases and to reviewed Clinic pathological features and prognosis of isolated bone metastases. We present a case of a 56-year-old woman treated for endometrial cancer with isolated ribs bone metastases. She was complaining about progressive right rib pain as a first sign of the disease of endometrial cancer. She had a biopsy of the lesion in the last right thoracic rib. This has proved a metastatic adenocarcinoma compatible with an endometrial primary cancer. An endometrial biopsy showed moderately differentiated endometrioid adenocarcinoma. Imagery did not reveal any other sites of metastatic disease. The patient underwent bilateral salpingo-oophorectomy and hysterectomy, peritoneal washing, omentectomy, bilateral pelvic and par aortic lymphadenectomy. In addition, a right thoracotomy was carried out and complete surgical excision of the rib mass was successfully performed. Adjuvant chemotherapy was administrated. The patient is clinically free of disease 10 months following diagnosis. Single-bone extrauterine metastatic site and local disease limited to the uterus had better survival outcomes than Stage IVb endometrial cancer with multiple metastatic sites. Therefore, the patient treated with surgery with a clear margin continued to behave as early-stage endometrial cancer.

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

The present study aimed to investigate the effect of walnut consumption on lipid profile, steroid hormones and inflammation in trained elderly men performing concurrent (resistance and endurance) training. Twenty healthy elderly males were divided into two matched groups, in a randomized controlled trial, that trained three sessions per week: concurrent training + dietary walnut consumption (15 g/day for six weeks, CTW: n = 10); concurrent training + control diet (CT: n = 10). Fasting blood samples were taken 48 hours before and after intervention for biochemical assessments. levels of high-density lipoprotein (HDL) increased only in CTW compared to baseline (19.8%, p < 0.01). Total cholesterol (TC), low-density lipoprotein (LDL) and triglyceride (TG) levels significantly decreased only for CTW (i.e., 13%, 18%, and 18.5% at p < 0.01 for all). Testosterone (T) increased after the training compared to pre-training for CTW and CT (10.3%, p < 0.01, 4.27% p < 0.05, respectively), but the increase was significantly higher in CTW (p < 0.05). Serum cortisol (C) was lower for CTW compared to CT (p < 0.01). C-reactive protein (CRP) decreased in CTW in comparison with CT. The present study revealed that 6-week moderate walnut supplementation (15 g/day) improved lipid profile, steroid hormones and systematic inflammation in aged men performing concurrent training. These findings could be attributable to the potential effect of polyunsaturated fatty acids (PUFA) contained in walnut (linoleic acid, n-6; linolenic acid, n-3).

A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, appetite and weight loss. Chest X-ray revealed an opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. Because of the absence of fluid return even after ultrasound-guided thoracentesis, a Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated with extensive encysted fluid collection in the right hemithorax. A video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thymus with a cystic wall lined by squamous epithelium and sebaceous gland composed of respiratory tissue, adipose tissue, cartilage, smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma. The patient was discharged 7 days after surgery, with no recurrence on follow-up.

The current study was carried out to estimate the protective effect of methanolic extract of Chaetomorpha gracilis (MECG) against High Cholesterol Diet (HCD) induced erythrocyte damage in mice. The results of the in vitro assay showed that MECG have higher antioxidant capacities in the DPPH, TAC, ABTS, NBT, NO. inhibition assays. The HPLC analysis confirmed that this potential antioxidant seems to be due to the active compounds, in particular polyphenols, flavonoids. HCD promoted oxidative stress with a rise the level of malonaldehyde (MDA), advanced oxidation protein product (AOPP) levels and a significant decrease of the Vitamin C content, as well the antioxidant enzyme activities such as superoxide dismutase and glutathione peroxidase. In addition, HCD treatment caused significant lipid profile disorders via increase the cholesterol, triglycerides and LDL levels and reduction HDL-Ch level. A statistically significant decrease of Mg2+ and Ca2+ ATPase activities accompanied with a severe damage in the erythrocytes structure and hematological parameters alterations were also noted in hypercholesterolemic mice. Pre-treatment with MECG significantly restored biochemical markers and pathological lesions. It can be suggest that supplementation of MECG displays high potential to quench free radicals and attenuates high cholesterol diet induced erythrocytes oxidative stress and related damages.

Background Given the high recurrence and progression rates and the absence of reliable markers for early detection and prognosis prediction of patients with urothelial bladder cancer (BCa), the exploration of new biomarkers with high specificity is imperative. Mainly, microRNAs (miRNAs), which are involved in the initiation and the progression of BCa. Herein, the expression patterns of miR-182, miR-205, miR-27a and miR-369 were evaluated in patients with urothelial BCa. Methods and results The expression levels of the miRNAs were investigated in 90 FFPE tissue samples (23 LG NMIBC, 44 HG NMIBC, 23 MIBC) and 10 non tumoral bladder tissues using TaqMan based RT-qPCR. Data analysis was performed using 2-??CT method. Correlation to clinical characteristics of the patients was performed using descriptive statistics and the receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic value of all miRNAs. MiR-27a, miR-205 and miR-369 were down-regulated whereas miR-182 was up-regulated in patients compared to controls (p < 0.001). MiR-205 and miR-182 positively segregate between NMIBC and MIBC (p = 0.002 and p = 0.000 respectively) whereas the distribution of miR-27a's expression among these tumor groups was almost significant (p = 0.05) and that of miR-369's expression was irrelevant (p = 0.618). Interestingly, miR-182 was discriminative between LG NMIBC and HG NMIBC (p < 0.001) and Ta/T1 tumors (p = 0.000). Furthermore, high levels of miR-182 were potentially predictive of progression in NMIBC patients (p = 0.01). Conclusion Collectively, a selection of miRNAs was found to be aberrantly expressed in BCa suggesting a potential diagnostic value in BCa. In addition, the clinical value of miR-182 and miR-205 as potential prognosis biomarkers was highlighted. Indeed, our data provide additional insights into cancer biology. Further functional or target studies are mandatory to strengthen these findings.

Aim of the work: To assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables. Patients and methods: Forty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed. Results: Mean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p

The present study aimed to investigate the effects of melatonin (MEL) intake on systemic inflammation and immune responses during intradialytic exercise. Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized-crossover study. Immunological responses were monitored in four HD sessions at different conditions: [Exercise (EX) + MEL], [EX + Placebo (PLA)], [Control (CON) + MEL] and [CON + PLA]. MEL (3 mg) or PLA was ingested 1 h before starting exercise or the equivalent time in CON condition. During all sessions, peripheral blood samples were collected to assess c-reactive protein, complete blood count, and immune cells phenotypes before HD (T0), immediately after exercise (T1) and 1 h after exercise (T2) or at corresponding times in the CON condition. HD therapy induced a significant decrease in natural killer (NK) (p = 0.001, d = 0.85; p

Brucellar spondylodiscitis (BS) is the most common form of musculoskeletal brucellosis. The isolation of Brucella spp from blood, other body fluids or tissue cultures is the gold standard for definitive diagnosis of BS. BS shows a large histopathological spectrum of lesions with non-specific and granulomatous forms, and its histopathological features are not widely reported. This case series study reported the histopathological features of a series of 21 BS. Ten cases revealed nonspecific forms of BS. Lymphocytes were the predominant inflammatory cells in this group. In one case neutrophils were predominant. The eleven remaining were granulomatous. The 11 exhibited histiocytic type granulomas. Ten were non-necrotizing. One case, taken from abscess wall, contained minimal deposition of caseous like necrotic material. This case and 2 others corresponding to abscess wall biopsies, showed histiocytic granulomas mixed with small aggregates of epithelioid cells without well-formed epithelioid granuloma nor giant cell. The histopathological diagnosis of BS is challenging. Nonspecific forms of BS, mimiking pyogenic spondylodiscitis, are observed in about half of the cases. Although nonspecific forms of BS are characterized by the predominance of lymphocytes and plasmocytes, BS forms with predominant neutrophil cell infiltration do exist. Histiocytic granuloma is highly suggestive of BS. Purely epithelioid forms of BS were not observed in the present series. Caseous like necrosis suggestive of tuberculosis is a possible feature of BS.

BackgroundA high-sugar or/and high-fat diets is a major risk factors for obesity. However, increased fruit and vegetable intake has been recently linked to obesity prevention. The aim of the present study was to investigate the preventive effects of pomegranate leaves (PL), juice (PJ) and peel (PP) extracts, on insulin resistance and oxidative stress in high fat and high fructose diet-induced obese rats.MethodsObesity in rats was induced by consumption of diet high in saturated fat and fructose (HFD) for a long period (12 weeks).ResultsCompared to the control group (CG) fed chow died, the high fat and high fructose diet (HFD) group showed a significant increase in the fasted plasma levels of glucose (29.8%), insulin (45%), amylase (70%) and lipase (54%). Moreover, HFD feeding has increased lipid peroxidation and protein carbonylation and decreased antioxidant enzymes levels. However, PL, PJ and PP treatment markedly prevents glucose intolerance, insulin resistance and oxidative stress and decrease amylase and lipase levels.ConclusionThese findings highlight that a long-term intake of pomegranate extracts might be a potential alternative strategy for the prevention of a HFD induced insulin resistance and oxidative stress.

The COVID-19 pandemic exacerbates existing health inequities, including gender disparities, and we must learn from previous global public health threats to build a gender-responsive, intersectional approach to address immediate and long-term consequences. While a narrow gender focus alone can reinforce binary and competing understandings of disease burden by gender, an intersectionality approach encourages understanding of the dimensions of power, historical structural inequalities, and the role of social determinants and lived experience to inform a multidimensional, gender-informed response to this and future emerging infectious diseases. We provide specific, actionable recommendations for critical healthcare, public health, and policy to use an intersectional approach to COVID-19 pandemic preparedness, response and resiliency.

A total of forty adult Sprague-Dawley male rats were used to study the ameliorative effects of moderate exercise on reproductive function in male rats doped with a high dose of anabolic steroids. Rats were randomly assigned into 4 groups; sedentary, sedentary doped (I/M 25 mg/kg BW per week), moderately exercised (20 minutes/day for five days every week along one month) and moderately exercised doped groups. The results clarified that the moderate exercise significantly increased sperm motility (91.67%±1.67); live sperm and sperm count percentages (93.33%±1.67 & 115.33%±7.51 respectively) and lowered sperm abnormalities (11.0±3.61). On contrary, doping induced via testosterone administrations in both sedentary and moderately exercised rats significantly decreased the previously mentioned sperm parameters (63.33%±3.33, 53.33%±3.33 & 65.33%±9.45 respectively) while increasing sperm abnormalities (53.33±11.50); although amelioration via exercise was noticed in these parameters. Serum free testosterone levels were significantly increased with both sedentary doped or moderately exercised doped groups. Moreover, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) activities were significantly elevated with moderate exercise (52.05±6.67, 39.25±7.09 and 69.17±7.69 respectively). While, malondialdehyde (MDA) levels were increased with doping of male rats (86.5±9.99). Furthermore, StAr gene expression was significantly (P≤0.01) up-regulated with moderate exercise and significantly (P≤0.01) down-regulated with doping of male rats. In addition, HSD17B3 gene expression was significantly (P≤0.01) up-regulated in both moderately exercise and moderately exercise doped groups. On contrary, HSD17B3 gene expression was significantly (P≤0.01) down-regulated in sedentary doped group Overall, these results suggest a beneficial and protective effect of moderate treadmill exercise on male fertility especially in steroid abuse models.

Wilms tumor (WT) with an inferior Vena cava (IVC) malignant thrombus comprises 4–10% of all WT cases. This retrospective analysis included 51 pediatric patients presenting at Children Cancer Hospital Egypt-57357 from July 2007 to December 2016 with the diagnosis of WT with malignant IVC thrombus. Median age at presentation = 4.4 years and 28 cases (55%) were females. Twenty-five patients (49%) were metastatic and 4 patients (7.8%) had bilateral disease. Forty-seven cases (92.2%) had favorable histology with no evidence of anaplasia. Level of thrombus extension at presentation was classified as infra-hepatic, retro-hepatic, supra-hepatic and intra-cardiac in 33, 9, 6 and 3 patients, respectively. Fifty patients started neoadjuvant chemotherapy (CTH) with 16 patients showing complete resolution of thrombus after 6 weeks of CTH. None of the patients developed thrombus progression after neoadjuvant CTH; one patient had stationary intra-cardiac thrombus, while remaining patients showed partial regression of their thrombus and had nephrectomy with en-bloc thrombectomy. The mean cranio-caudal dimension of IVC thrombi at initial presentation was 6.5 cm, and 3.6 cm post 6th week of CTH. The 5-year OS and EFS were 75.9% and 71.1%, respectively. There was no significant correlation of initial levels of thrombus extension with survival. Neoadjuvant chemotherapy followed by radical nephrectomy with en-bloc thrombectomy and radiotherapy seems a successful approach for management of patients with WT and IVC tumor thrombus. Measurement of the cranio-caudal dimension of thrombus and its response to treatment should be considered in the surgical planning.

Phytoestrogens, with a wide range of beneficial effects, prevent bone loss caused by oestrogen deficiency.The purpose of this study was to evaluate the effect of Medicago sativa ethanol extract compared to 17β-oestradiol on osteoporosis in ovariectomized mice.The study was carried out on female mice, divided into five groups: control mice (GI), Medicago sativa treated mice (0.75 g/kg BW/day) (GII), ovariectomized mice (GIII) and ovariectomized mice treated either with Medicago sativa (GIV) or with 17β-oestradiol (50 µg/Kg BW/day) (GV).Our results showed that Medicago sativa or 17β-oestradiol treatments significantly attenuated perturbations of mineral levels, histological changes and oxidative stress in the femurs of ovariectomized mice.Medicago sativa prevented bone loss induced by oestrogen deficiency, which could be attributed to its richness in kaempferol, syringic acid, naringenin and myrictin. Its effects were more beneficial or similar compared to 17β-oestradiol.

Resume Objectif Identifier les facteurs de risque de mortalite hospitaliere au cours de l’embolie pulmonaire en milieu de pneumologie. Materiel et methode Etude retrospective, analytique portant sur des dossiers de malades hospitalises pour embolie pulmonaire entre 2014 et 2019 au service de pneumologie de l’hopital Habib-Bourguiba Medenine. Resultats Cent patients ont ete inclus dont 62 % etaient de sexe feminin, avec un âge moyen de 63 ± 16 ans. Des antecedents respiratoires etaient notes dans 18 % des cas domines par la fibrose pulmonaire (8 %). A l’admission, le « Simplified Pulmonary Embolism Severity Index score » moyen etait de 1,46 ± 1,05. La duree moyenne d’hospitalisation etait de 10,6 ± 7 jours. Le taux de mortalite hospitaliere etait de 12 %. Les facteurs de risque independants de mortalite intrahospitaliere etaient l’hypotension arterielle (OR : 6,13 ; IC 95 % : 2,88–14,35 ; p = 0,001), le cancer (OR : 2,66 ; IC 95 % : 1,22–9,54 ; p = 0,026), un ratio VD/VG a l’echographie cardiaque > 0,9 (OR : 1,84 ; IC 95 % : 1,06–7,69 ; p = 0,039) et l’hypoxemie severe (OR : 4,86 ; IC 95 % : 2,19–11,34 ; p = 0,006). Conclusion La mortalite par embolie pulmonaire en milieu de pneumologie reste elevee malgre l’amelioration de la prise en charge diagnostique et therapeutique. Il est important pour notre pays de prendre en consideration ces resultats pour mettre en place une meilleure prise en charge des patients hospitalises pour embolie pulmonaire et ainsi d’ameliorer leur survie.

Hypoxic hepatitis may occur due to hemodynamic mechanisms of hypoxia secondary to anemia without any context of reduced blood flow, respiratory failure, or shock state. Etiology of anemia should be investigated in order to avoid recurrence.

Objectives: The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. Our objective was to assess toxicities, local control (LC) rate and survival data in patients with ultra-central lung tumours treated with SBRT. Methods: We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose planning target volume overlapped one of the following organs at risk (OARs): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. Results: Median follow-up was 25 months. Two patients (2.7%) showed Grade 3 toxicity. No Grade 4 or 5 toxicity was observed. 11% of patients experienced primary local relapse. LC rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival was 12 months. Median overall survival was 31 months. Conclusion: SBRT for ultra-central tumours remains safe and effective as long as protecting organs at risk is treatment-planning priority. Advances in knowledge: The present study is one of the rare to describe exclusively ultra-central tumours through real-life observational case reports. Globally, literature analysis reveals a large heterogeneity in ultra-central lung tumours definition, prescribed dose, number of fractions. In our study, patients treated with SBRT for ultra-central lung tumours experienced few Grade 3 toxicities (2.7%) and no Grade 4 or 5 toxicities, due to the highest compliance with dose constraints to OARs. LC remained efficient.

BACKGROUND This study aimed to assess neuromuscular fatigue after heavy resistance exercise in rugby players. METHODS Twelve male rugby players performed five sets of knee extension exercise lifting 80% of their one repetition maximum until failure, with 3min of rest in-between. Maximal voluntary contraction (MVC) and surface electromyographic activity from quadriceps muscles, as well as ions (i.e., Na+, K+, and Cl-) and metabolic responses (i.e., blood lactate and ammonia concentrations) were measured before and after exercise. Maximum repetitions performance and both peripheral (RPE p ) and overall body (RPE o ) rating of perceived exertion were recorded following each set. RESULTS The number of maximum repetitions decreased significantly across sets (P p and RPE o increased significantly across sets (P p values after each set (P p (r=-0.98, P o (r=-0.99, P

Hepatitis C virus (HCV) infection is a major public health concern worldwide, raising important medical and economic issues. HCV-related end-stage liver disease is one of the most common indications for hepatic transplantation. Chronic hepatitis C is also assimilated to a systemic disease because of multiple extrahepatic manifestations, including lymphoproliferative disorders. The revolution of HCV treatment with the advent of direct-acting antivirals has significantly improved the management with high antiviral efficacy and good safety profile compared with old regimens, thus allowing good outcomes on hepatic and extrahepatic symptoms. However, with the widespread use of these new agents, controversial concerns about unexpected increasing cases of hepatocellular carcinoma were reported. We now report the case of a patient presenting with HCV-related cirrhosis, treated with direct-antiviral therapy and diagnosed with primary hepatic lymphoma shortly after the end of the treatment.

Background: Diffuse intrinsic pontine glioma (DIPG) is one of the most devastating diseases among children with cancer, thus novel strategies are urgently needed. Aims: We retrospectively evaluated DIPG patients exposed to the carbohydrate restricted ketogenic diet (KD) with regard of feasibility, safety, and overall survival (OS). Methods and results: Searches of MEDLINE and Embase identified five hits meeting the search criteria (diagnosis of DIPG and exposure to KD). One additional case was identified by contact with experts. Individual patient data were extracted from publications or obtained from investigators. The inclusion criteria for analysis of the data were defined as DIPG patients who were exposed to the KD for ≥3 months. Feasibility, as described in the literature, was the number of patients able to follow the KD for 3 months out of all DIPG patients identified. OS was estimated by the Kaplan-Meier method. Five DIPG patients (males, n = 3; median age 4.4 years; range, 2.5-15 years) meeting the inclusion criteria were identified. Analysis of the available data suggested that the KD is generally relatively well tolerated. Only mild gastro-intestinal complaints, one borderline hypoglycemia (2.4 mmol/L) and one hyperketosis (max 7.2 mmol/L) were observed. Five out of six DIPG patients identified adhered for ≥3 months (median KD duration, 6.5 months; range, 0.25-2 years) to the diet. The median OS was 18.7 months. Conclusion: Our study provides evidence that it may be feasible for pediatric DIPG patients to adhere for at least 3 months to KD. In particular cases, diet modifications were done. The clinical outcome and OS appear not to be impacted in a negative way. KD might be proposed as adjuvant therapy when large prospective studies have shown feasibility and safety. Future studies might ideally assess the impact of KD on clinical outcome, quality of life, and efficacy.

Background NAD (P) H: quinone oxidoreductase (1) (NQO1‐HGNC: 2874) and myeloperoxidase (MPO ‐HGNC: 7218) are two enzymes involved in phase II of the xenobiotic metabolism pathway. Methods In this study, a case–control analysis was conducted to investigate the relationship between genetic variations in the NQO1 (C609T, rs1800566; IVS1‐27 C >G, rs689452) and MPO (G463A, rs2333227) genes and the risk for bladder cancer among Tunisian population. Results We have found that the MPO 463GA genotype was associated with a decreased risk of developing bladder cancer (p = 0.049; OR = 0.696; 95% CI 0.484–0.999). In contrast, we have found that the NQO1 609CT genotype could increase the risk of bladder cancer patients (p = 0.0039; OR = 1.454; 95% CI = 1.017–2.078). Moreover, patients with “NQO1 609 CT/IVS1‐27 CG” genotype show a 2.180‐fold increasing risk for developing bladder cancer in comparison to the control group with wild genotype. This OR is estimated at 5.6‐fold in smokers patients with “NQO1 609 CT/IVS1‐27 CG” genotype. Lastly, study findings suggest that the NQO1 IVS‐27 *CG genotype (rs689452) is associated with a risk of progression to muscle invasive bladder cancer. Conclusion Our study suggests that environmental risk factors in association to NQO1 genotypes (NQO1 609 CT/IVS1‐27 CG) play an important role in the development of bladder cancer in Tunisian population., The present study suggests that diplotypes of the NQO1 gene play an important role in the development of bladder cancer. There is also an additive interaction between smoking, exposition to professional risk factors, and polymorphisms in the NQO1 gene for the risk development of bladder cancer in Tunisian population.

While obesity blunts the ability of muscle to mount a protein synthetic response to an amino acid infusion in older adults, it is unclear if this insensitivity to nutrition persists long term and in response to complete foods is unknown. To address this, young (2 months old) and old (17–20 months old) Brown Norway rats were randomized to receive either chow or a 12 wk diet of calorie-dense human foods. At wk 10 drinking water was supplemented with 2% heavy water, followed 2 weeks later by a flooding dose of [2H5]-phenylalanine and an oral leucine bolus, allowing the short and long-term effects of age and diet on muscle protein synthesis rates to be determined. The experimental diet increased energy intake in both young (7.4 ± 0.9%) and old (18.2 ± 1.8%) animals (P < 0.01), but only led to significant increases in body weight in the former (young: 10.2 ± 3.0% (P < 0.05) and old: 3.1 ± 5.1% (NS) vs. age-matched controls). Notably, energy expenditure in response to the cafeteria diet was increased in old animals only (chow: 5.1 ± 0.4; cafe: 8.2 ± 1.6 kcal.kg b.w−1.h−1; P < 0.05). Gastrocnemius protein fractional synthetic rates in response to either an acute leucine bolus or two weeks of feeding were equivalent across groups irrespective of age or diet. Rodents in old age appear capable of preventing weight gain in response to a calorie-dense diet by increasing energy expenditure while maintaining the anabolic sensitivity of muscle to nutrition; the mechanisms of which could have important implications for the aging obese human.

Introduction: The coronavirus disease (COVID-19) continues to pose a serious health threat in 2021 with several impacts, especially for patients being managed for lung cancer. The aim of our work is to study the psychological and health care impact of COVID-19 on lung cancer patients in our center. Methods: This is a comparative cross-sectional study including lung cancer patients, who were accepted for routine anticancer treatment before the covid-19 pandemic (group 1 (G1): patients treated on Mars 2018) and other patients treated in December 2020 and January 2021 (group 2 (G2): patients followed during the coronavirus pandemic). Pain was assessed before and after treatment (EVA and DN4 questionnaire). Patients responded to the anxiety-depression questionnaire (HAD). Results: A total of 137 cases of lung cancer were included (G1: 77 cases, G2: 60 cases). The median age was 63.38 years old (G1: 64.87, G2: 61.64 years, p=0,035). The average time to consultation was 176.7 days for G1 versus 47.43 days for G2(p= 0,00). For the G2 patients, the mean time to diagnosis was 39.58 days and the average time between diagnosis and treatment was 25.64 days. The most frequent cancer stage was stage IV (G1: 69.7%, G2: 61.7%, p=0,14). Sixty-six percent of G2 patients suffered from anxiety (versus 26%of G1 patients) and 51.7% suffered from depression (versus 25% of G1 patients) (p=0,008). Conclusion: The exceptional health situation linked to the covid-19 pandemic has required a deep and fast adaptation of our practices in Oncology care. This study demonstrates the significant impact of the COVID-19 crisis on oncological care, indicating the need for more psycho-oncological support during this pandemic and continued follow-up.

Background & Aims Next-generation sequencing (NGS) was recently approved by the United States Food and Drug Administration to detect microsatellite instability (MSI) arising from defective mismatch repair (dMMR) in patients with metastatic colorectal cancer (mCRC) before treatment with immune checkpoint inhibitors (ICI). In this study, we aimed to evaluate and improve the performance of NGS to identify MSI in CRC, especially dMMR mCRC treated with ICI. Methods CRC samples used in this post hoc study were reassessed centrally for MSI and dMMR status using the reference methods of pentaplex polymerase chain reaction and immunohistochemistry. Whole-exome sequencing (WES) was used to evaluate MSISensor, the Food and Drug Administration-approved and NGS-based method for assessment of MSI. This was performed in (1) a prospective, multicenter cohort of 102 patients with mCRC (C1; 25 dMMR/MSI, 24 treated with ICI) from clinical trials NCT02840604 and NCT033501260, (2) an independent retrospective, multicenter cohort of 113 patients (C2; 25 mCRC, 88 non-mCRC, all dMMR/MSI untreated with ICI), and (3) a publicly available series of 118 patients with CRC from The Cancer Genome Atlas (C3; 51 dMMR/MSI). A new NGS-based algorithm, namely MSICare, was developed. Its performance for assessment of MSI was compared with MSISensor in C1, C2, and C3 at the exome level or after downsampling sequencing data to the MSK-IMPACT gene panel. MSICare was validated in an additional retrospective, multicenter cohort (C4) of 152 patients with new CRC (137 dMMR/MSI) enriched in tumors deficient in MSH6 (n = 35) and PMS2 (n = 9) after targeted sequencing of samples with an optimized set of microsatellite markers (MSIDIAG). Results At the exome level, MSISensor was highly specific but failed to diagnose MSI in 16% of MSI/dMMR mCRC from C1 (4 of 25; sensitivity, 84%; 95% confidence interval [CI], 63.9%–95.5%), 32% of mCRC (8 of 25; sensitivity, 68%; 95% CI, 46.5%–85.1%), and 9.1% of non-mCRC from C2 (8 of 88; sensitivity, 90.9%; 95% CI, 82.9%–96%), and 9.8% of CRC from C3 (5 of 51; sensitivity, 90.2%; 95% CI, 78.6%–96.7%). Misdiagnosis included 4 mCRCs treated with ICI, of which 3 showed an overall response rate without progression at this date. At the exome level, reevaluation of the MSI genomic signal using MSICare detected 100% of cases with true MSI status among C1 and C2. Further validation of MSICare was obtained in CRC tumors from C3, with 96.1% concordance for MSI status. Whereas misdiagnosis with MSISensor even increased when analyzing downsampled WES data from C1 and C2 with microsatellite markers restricted to the MSK-IMPACT gene panel (sensitivity, 72.5%; 95% CI, 64.2%–79.7%), particularly in the MSH6-deficient setting, MSICare sensitivity and specificity remained optimal (100%). Similar results were obtained with MSICare after targeted NGS of tumors from C4 with the optimized microsatellite panel MSIDIAG (sensitivity, 99.3%; 95% CI, 96%–100%; specificity, 100%). Conclusions In contrast to MSISensor, the new MSICare test we propose performs at least as efficiently as the reference method, MSI polymerase chain reaction, to detect MSI in CRC regardless of the defective MMR protein under both WES and targeted NGS conditions. We suggest MSICare may rapidly become a reference method for NGS-based testing of MSI in CRC, especially in mCRC, where accurate MSI status is required before the prescription of ICI.

COVID-19 is an exceptional public healthcare emergency that affected all countries. The corona virus pandemic has made the treatment of all cancers difficult. This international phenomenon represents an outbreak in medicine and this situation is a major issue for all patients, whether they are infected with the virus or not. Colorectal cancer is one of the most common malignant tumors of the digestive tract which needs special multidisciplinary care. Treatment modalities including chemotherapy and targeted therapies can weaken the immune system and then cause serious or lethal coronavirus infections. This document gives an idea about how we dealt to protect patients with colorectal cancer at Salah Azaiez Institute during COVID 19 pandemic.

Background Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery. Objectives To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research. Search strategy We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods. Selection criteria Research and programmatic articles describing service provision in addition to female genital fistula surgery were included. Data collection and analysis Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed. Main results Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub‐Saharan Africa. Improvements were noted in physical and psychosocial health. Conclusions Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes., Holistic adjunct reintegration programming accompanying female genital fistula surgery is recommended; however, efforts to develop robust evidence on best reintegration practices are necessary.

We report a case of invasive mucormycosis in 52 year-old woman. CT-scan and magnetic resonance imaging found a partial right sinus thrombosis associated with homolateral ethmoidal and maxillary sinusitis with submucosal inflammation. Histopathological examination of excised tissue was positive for mucormycosis. Our patient was treated by surgical debridement and a combination of amphotericin B and caspofungin, with a good outcome. Keywords: Mucormycosis, Amphotericin B, Caspofungin, Combine therapy

We investigated the effects of sub-chronic exposure to Kalach 360 SL (KL), glyphosate-based herbicide used in Tunisia, on liver and hematological system in different groups of female rats. Group 1 was used as a control, while animals of groups 2 and 3 received orally 0.07 mL and 0.175 mL of KL, respectively (126 and 315 mg of glyphosate/kg), for 60 days. As a result, the KL-exposed groups exhibited hypochromic microcytic anemia, systemic inflammation, cytolysis, decrease in hepatic enzyme activity, and cholestasis. Exposure to different doses of KL could induce erythrocyte destruction (hemolysis) in hematopoietic organs (bones). Moreover, lipid peroxidation contents and protein oxidation markers significantly increased in exposed groups, while enzymatic and non-enzymatic antioxidant activities decreased considerably, in both erythrocytes and liver tissues, compared with those in controls. Liver histological studies confirmed the presence of inflammatory reaction with pathology involving the damage or necrosis of hepatocytes, however, without fibrosis remodulation. Thus, KL sub-chronic exposure caused hepatonecrosis, systemic inflammation, and hemolysis.

Purpose:The effect of playing surface on physical performance during a repeated-sprint ability (RSA) test and the mechanisms for any potential playing-surface-dependent effects on RSA performance are equivocal. The purpose of this study was to investigate the effect of natural grass (NG) and artificial turf (AT) on physical performance, ratings of perceived exertion, feeling scale, and blood biomarkers related to anaerobic contribution (blood lactate [Lac]), muscle damage (creatine kinase and lactate dehydrogenase), inflammation (C-reactive protein), and immune function (neutrophils [NEU], lymphocytes [LYM], and monocytes) in response to an RSA test.Methods:A total of 9 male professional football players from the same regional team completed 2 sessions of RSA testing (6 × 30 s interspersed with a 35-s recovery) on NG and AT in a randomized order. During the RSA test, total (sum of distances) and peak (highest distance covered in a single repetition) distance covered were determined using a measuring tape, and the decrement in sprinting performance from the first to the last repetition was calculated. Before and after the RSA test, ratings of perceived exertion, feeling scale, and Lac, creatine kinase, lactate dehydrogenase, C-reactive protein, NEU, LYM, and monocytes were recorded in both NG and AT conditions.Results:Although physical performance declined during the RSA blocks on both surfaces (P = .001), the distance covered declined more on NG (15%) than on AT (11%;P = .04; effect size [ES] = −0.34; 95% confidence interval [CI], −1.21 to 0.56) with a higher total distance covered (+6% [2%]) on AT (P = .018; ES = 1.15; 95% CI, 0.16 to 2.04). In addition, lower ratings of perceived exertion (P = .04; ES = −0.49; 95% CI, −1.36 to 0.42), Lac, NEU, and LYM (P = .03; ES = −0.80; 95% CI, −1.67 to 0.14; ES = −0.16; 95% CI, −1.03 to 0.72; and ES = −0.94; 95% CI, −1.82 to 0.02, respectively) and more positive feelings (P = .02; ES = 0.81; 95% CI, −0.13 to 1.69) were observed after the RSA test performed on AT than on NG. No differences were observed in the remaining physical and blood markers.Conclusion:These findings suggest that RSA performance is enhanced on AT compared with NG. This effect was accompanied by lower fatigue perception and Lac, NEU, and LYM and a more pleasurable feeling. These observations might have implications for physical performance in intermittent team-sport athletes who train and compete on different playing surfaces.

Background Neurogenic tumors of the mediastinum are rare tumors located mainly in the posterior mediastinum. The aim of this study was to report a single-institution experience of these tumors. Methods This study was conducted between 2005 and 2017. Bivariate analysis was performed to assess correlations between the cellularity, mitotic index, presence of a capsule, and potential for malignancy of peripheral nerve sheath tumors. Results There were 86 patients enrolled in the study. The mean age was 42.51 years. Nineteen patients were asymptomatic and their tumors were discovered incidentally. Microscopic diagnosis confirmed a schwannoma in 45 cases, neurofibroma in 12, malignant peripheral nerve sheath tumor in 9, ganglioneuroma in 14, ganglioneuroblastoma in 4, and neuroblastoma in 2. Bivariate analysis showed a significant correlation between the absence of a capsule, the degree of atypia, a high mitotic index, and high cellularity with the potential for malignancy ( p Conclusion Even if radiologic means are helpful in suggesting the diagnosis, a positive diagnosis of neurogenic tumors is based on microscopic features. High mitotic activity and cellularity, and severe cytonuclear atypia are the features most suggestive of malignancy.

Background Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. Purpose We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care. Methods Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients. Results Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery. Conclusion The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.

In the present study, the effect of nickel and the ameliorating effect of methanolic extract of Dunaliella sp. (DE) on growth performance, meat quality, and the liver and kidneys of New Zealand male rabbits were studied. Four groups of adult male rabbits were used in the in vivo experiment: (C) control, (Ni) Ni-treated, (DE) DE treated and (Ni+DE) both Ni and DE treated. Our investigation evaluated the antioxidant activity of DE using both DPPH and superoxide anion scavenging tests. Administration of nickel (Ni) resulted in a decrease of meat protein and carbohydrate contents and accelerated generation of renal and hepatic lipids peroxidation levels (TBARS), accompanied by increased superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities with a dramatic rise in serum markers of the liver and kidneys function. DE treatment (50 mg kg−1 day−1) to Ni dose, improved meat quality and reduced oxidative stress levels. The histopathological alterations were also improved. Remarkably, there was a prevention of the rise in serum parameter levels in liver and kidneys elicited by the metal. This study suggests that Dunaliella-extract has potential to ameliorate growth performance, meat quality and protect against toxicity induced by nickel in animals.

Background: Cynodon dactylon is a herbal medicine of interest in Iranian traditional medicine, which is used in cardiovascular diseases such as atherosclerosis and heart failure. The purpose of this study was to evaluate the effects of total extract of C. dactylon rhizomes on myocardial infarction and on post myocardial infarction (MI) heart tissue injuries. Methods: Isoproterenol (100 mg/kg) was injected subcutaneously for two consecutive days for induction of MI in rats and C. dactylon extract was administered orally twice daily started before isoproterenol injection for 4 consecutive days. Results: Histopathological analysis showed a marked increase in myocardial necrosis in rats with MI (p