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Summary Background The landscape of dermatology services, already rapidly evolving into an increasingly digital one, has been irretrievably altered by the COVID‐19 (SARS‐CoV‐2) pandemic. Data are needed to assess how best to deliver virtual dermatology services in specific patient subgroups in an era of ongoing social distancing and beyond. Initial studies of teledermatology in paediatric populations suggest that many of the problems experienced in adult telemedicine are more apparent when treating children and come with additional challenges. Aim To evaluate the efficacy of a virtual paediatric dermatology telephone clinic in comparison to traditional face‐to‐face (FTF) clinics, both from the clinician and patient/parental perspective. Methods We carried out a prospective service evaluation examining a single centre cohort of paediatric dermatology patients managed during the COVID‐19 pandemic via a telephone clinic supported by images. The study period covered June–September 2020. Data on outcomes were collected from clinicians and a qualitative patient/parental telephone survey was undertaken separately. A five‐point Likert scale was used to assess both satisfaction and levels of agreement regarding whether a telephone clinic was more convenient than an FTF clinic. Results Of 116 patients included, 24% were new and 76% were follow‐up patients, with a mixture of inflammatory dermatoses (75%) and lesions (25%). From the clinician's perspective, most consultations (91%) were successfully completed over the telephone. However, qualitative patient and parent feedback paradoxically illustrated that although nearly all (98%) respondents had no outstanding concerns, 52% felt highly unsatisfied and only 22% agreed that telephone clinics were more convenient. Most (65%) preferred FTF follow‐up in the future. Statistical analysis using χ² test showed that among those with established follow‐ups, the preference for future consultation type was independent of specific reasons for follow‐up. Conclusions Our study demonstrates a clear discrepancy between the practical successes of a virtual service from the clinician’s perspective compared with the patient/parental perspective. Parental anxiety appears to be less effectively allayed virtually than with FTF. This raises the question of whether there is a role for virtual paediatric telephone clinics in the postpandemic future, which may be better left to patients/parents to decide on an individual basis.

Purpose The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure. Method A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared. Results From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 ± 1.8 cm and 3.6 ± 1.4 cm, respectively, and the mean BMI was 30.1 ± 5.2 kg/m2. The mean operating time was 67 ± 28 min and was longer for IPOM-pb (71 ± 27 min), less for IPOM-plus (63 ± 28 min), and least for sIPOM (61 ± 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21). Conclusion IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.

Seromas are a common and unavoidable complication following lymphadenectomy, and often become clinically significant with superseded infection requiring re-admission for prompt intervention. However, there is no consensus as to whether a formal surgical incision and drainage (ID), ultrasound (US)-guided aspiration or intravenous (IV) antibiotics alone is the most efficacious method of managing an infected seroma, the investigation of which formed the rationale for this study.This retrospective cohort study included a consecutive series of patients readmitted for infected seroma following a lymphadenectomy for melanoma at Leeds Teaching Hospitals Trust (LTHT) from 2006 to 2017. Details on management, length of hospital stay, length of follow-up and number of clinical appointments required were examined.Seventy-one cases of infected seroma were identified from the cohort of 1691 lymphadenectomies. Initially, 21 patients (29.5%) were managed by IV antibiotics alone (failure rate of 52.4%); 18 (25.4%) with US-guided aspiration (failure rate 27.8%) and 32 (45.1%) with surgical ID, which was 100% effective. Ultimately, 62.5% of the cohort required surgical management. Patients who underwent surgical ID were discharged significantly faster following the procedure (3 versus 5 days for US-guided aspiration, p = 0.002) and spent fewer days in hospital overall (p = 0.022). The overall average cost was comparable across the three treatment groups.Surgical management seemed preferential to conservative approaches in terms of efficacy and was not significantly more expensive overall; but carries anaesthetic risk. There may be a clinically significant difference in outcome depending on management; however, more evidence is required to investigate this.

The medical literature on health aspects of Ramadan fasting (RF) is widely spread in many journals of varying access, making it less readily available to those interested in the subject. We performed a nonsystematic review of the international literature from a major online database (PubMed in 1 year [2020]). The search term “Ramadan fasting” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. The publications spanned fundamental, clinical, ethical, professional, cultural, and advocacy facets. The publications predictably crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the emerged themes depending on the retrieved literature. This year, the basic coverage included changes in physiology, nutrition during Ramadan. However, the clinical issues included a more comprehensive range such as the impact of RF on the liver and gut, and endocrine conditions such as hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease, maternal health and fetal well-being, cardiovascular medicine, nature and function of eyes, and neurological conditions, especially epilepsy. Sports medicine and athletes' well-being received somewhat prominent coverage. Other researchers focused on documenting patients' and health-care professionals' perceptions, attitudes, and practices during Ramadan. Health aspects of RF received a sustained academic interest with a broad spectrum in 2020. This narrative provides a scoping overview to help researchers and clinicians catch up quickly with state-of-the-art science today.

Repeated traumatic brain injuries (TBIs) cause debilitating effects. Without understanding the acute effects of repeated TBIs, treatment options to halt further degeneration and damage cannot be developed. This study sought to examine the acute effects of blood–brain barrier (BBB) dysfunction, edema, inflammation and behavioral changes after either a single or double TBI using a C57BL/6 mouse model. We examined the effects of one or two TBIs, of either a mild or moderate severity. Double injuries were spaced 7 days apart, and all analysis was performed 24 h post-injury. To examine edema and inflammation, protein levels of glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B, interleukin-6, and matrix metallopeptidase 9 (MMP9) were analyzed. Aquaporin-4 (AQP4) and zonula occludens-1 (ZO-1) were analyzed to observe BBB dysfunction. Ionized calcium-binding adapter molecule 1 (IBA1) was analyzed to observe microglial activation. Rotarod, beam walking, and grip strength tests were used to measure changes in physical behavior post-injury. A sample size of ≥5 was used for all analysis. Double injuries led to an increase in BBB breakdown, as indicated by altered MMP-9, AQP4, and ZO-1 protein expression. Single injuries showed an increase in microglial activation, astrocyte activation, and BBB breakdown. Behavioral tasks showed no significant differences between injured and control groups. Based on our findings, we suggest that behavioral studies should not be used as the sole clinical indicator on brain tissue recovery. Analysis of markers such as IBA1, GFAP, MMP-9, AQP4, and ZO-1 provide valuable insight on pathophysiological response to injury.

Dermoid cysts account for only a small fraction of intracranial masses, with extradural dermoid cysts being considered a much rarer entity than those located intradurally. Intracranial dermoid cysts vary in clinical presentations: some maybe asymptomatic whilst others harbor features of raised intracranial pressure, neurological deficits, or even aseptic meningitis. Dermoid cysts may also present with cutaneous lesions. Herein, we report a rare case of a 1-year-old female presenting with a midline, scalp abscess. Brain MRI revealed an intracranial, extradural tumor, with features suggestive of a dermoid cyst, unusually located in the crista galli, and complicated by the formation of two cutaneous sinus tracts. After identification and characterization by MRI, bitemporal craniotomy was performed with complete excision of the mass and sinus tracts. Histological analysis confirmed dermoid cyst as the final diagnosis. Postoperatively, the patient recovered fully and had no evidence of recurrence in subsequent visits. The case mentioned above highlights the rarity of such a presentation for an intracranial extradural dermoid cyst and the vitality of early imaging for midline cutaneous lesions for identification of intracranial extensions and avoidance of detrimental consequences.

The literature on health aspects of Ramadan fasting (RF) is widely spread in many journals, making it not readily accessible to those interested in the subject. We aimed to provide a narrative overview of the global literature production in 1 year (2020) on diabetes and RF. This was a narrative, nonsystematic review of the international literature from a single major medical online database (i.e., PubMed) during the year 2020. The search term “Ramadan fasting AND Diabetes” was used, and the relevant literature was narrated in a concise thematic account. The publications spanned a vast array of topics related to RF, including assessments of safety and efficacy profiles of older and newer diabetes therapies, modes of insulin delivery, evaluating the role of utilizing advanced technology for the treatment, and monitoring of blood glucose during RF. Increased interest was evident in capturing patients' perspectives and healthcare professionals' perceptions, attitudes, and practices during Ramadan. Fasting by high-risk groups was studied. Not surprisingly, some reports covered COVID-19 and Ramadan and the role of telemedicine in ramadan. The current literature review presents this year's research data on the safety of fasting practices, care models, and patients' experiences and perspectives. It emphasizes the need for more comprehensive interventions for high-risk patients, promoting newer antidiabetic medicines, and advanced technology for safer fasting practices.

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this randomized clinical trial was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

Introduction Hormonal therapy with tamoxifen and aromatase inhibitors reduces breast cancer recurrence and mortality but represents a risk factor for thromboembolic events. Therefore, most surgeons discontinue hormonal agents before microvascular surgery and for a variable period thereafter. There are no guidelines regarding when therapy should be stopped (preoperatively) or when it should be resumed (post-operatively). We, therefore, audited our hospital practice with the objective of making recommendations for microvascular breast reconstruction patients. Patients and methods A review was performed of all free flap breast reconstructions between 2014 and 2019. Patients were classified according to hormone medication status at operation. Timings of drug cessation and recommencement were recorded. Thrombotic events, namely flap microvascular thrombosis, deep vein thrombosis, superficial vein thrombosis and pulmonary embolism, were compared. Results A total of 240 patients had 275 free flaps over five years with 36 receiving hormone therapy within one month prior to surgery, which was discontinued 8.5 days (range: 0–28 days) before surgery. Intraoperative microvascular thromboses (HT 2.0%, NHT 0%, and p = 0.869) and post-operative microvascular complications/flap re-explorations (HT 6.6%, NHT 0%, and p = 0.234) were comparable between the two groups. Systemic venous thromboembolic events were also similar (HT 8.3%, NHT 6.1%, and p = 0.893). Age, BMI, smoking status and preoperative chemotherapy did not influence the incidence of thrombotic complications. Conclusion Hormone therapy did not significantly increase the risk of thromboembolic events. Despite the widespread practice of withholding it for 2 weeks prior to reconstructive surgery, this study does not support such practice being beneficial in terms of thromboembolic events and flap viability. Large-scale trials are needed to establish definitive protocols.

For people diagnosed with a mental illness, psychiatric hospitalization is one step in a long journey, consisting of clinical recovery such as removal of symptoms, and social reintegration involving resuming social roles and responsibilities, overcoming stigma and self-maintenance of the condition. Both clinical recovery and social reintegration need to go hand-in-hand for the overall well-being of individuals. However, research exploring social media for mental health has considered narrower, disjoint conceptualizations of people with mental illness - either as a patient or as a support-seeker. In this paper, we combine medical records with social media data of 254 consented individuals who have experienced a psychiatric hospitalization to address this gap. Adopting a theory-driven, Gaussian Mixture modeling approach, we provide a taxonomy of six heterogeneous behavioral patterns characterizing peoples' mental health status transitions around hospitalizations. Then we present an empirically derived framework, based on feedback from clinical researchers, to understand peoples' trajectories around clinical recovery and social reintegration. Finally, to demonstrate the utility of this taxonomy and the empirical framework, we assess social media signals that are indicative of individuals' reintegration trajectories post-hospitalization. We discuss the implications of combining peoples' clinical and social experiences in mental health care and the opportunities this intersection presents to post-discharge support and technology-based interventions for mental health.

BACKGROUND AND STUDY AIM Bile duct injuries are not infrequently seen during hepatobiliary surgery, particularly after liver transplantation and cholecystectomy. The current study aims to figure out the frequency of postcholecystectomy biliary injuries (PCBI) and the role of early versus late endoscopic retrograde cholangiopancreatography (ERCP) in their management. PATIENTS AND METHODS Totally 960 cases operated by both laparoscopic and open cholecystectomy were evaluated in the current study. In total, 942 cases were operated in our institutes, by both laparoscopic (n = 925) and open (n = 17) cholecystectomy, and the frequency of PCBI among patients operated in our institutes was (9/942) 0.95%. Additional 18 cases of PCBI referred to our centers were included in the study. One patient was treated by repair during the surgery, in the remaining 26 patients, ERCP management was attempted. The full details of the 26 patients regarding ERCP management were discussed. RESULTS The overall success rate of ERCP management was 88.46% (23/26), whereas 11.54% of cases were treated surgically by choledochal-jejunal anastomosis due to complete common bile duct ligation. There were no differences between patients treated by early (first week) versus late (after the first week) ERCP regarding the needed interventions, type of PCBI, type and diameter of the inserted stents, and the overall success. There were no adverse events associated with ERCP management. CONCLUSIONS ERCP was valuable in the treatment of 88.46% of injured cases. There were no differences between early and late ERCP in the treatment of PCBI. Furthermore, ERCP management was not associated with adverse events.

Introduction: Literature on the health aspects of Ramadan fasting (RF) is widespread in many journals, making it less readily available to those interested in the subject. Materials and Methods: This is a narrative, nonsystematic review of international literature from two major online databases (viz., Scopus and PubMed) in 1 year (2019). The search term “RF” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. Results: The publications spanned the fundamental, clinical, ethical, professional, cultural, and advocacy facets of the subject. The publications crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The content is presented under relevant themes depending on the available literature. Basic coverage included changes in physiology, nutrition, and metabolism during Ramadan. Clinical aspects such as the impact of RF on kidney function, pregnancy outcome, fetal life, structure and function of eyes, and athletes' well-being received comparatively prominent coverage by researchers in 2019. Gut, liver, skin, skeleton, and blood were also covered. Other workers focused on documenting the perception, attitudes, and practices of both patients and health-care professionals during Ramadan. Conclusions: The health aspects of RF received sustained academic interest with a wide spectrum in 2019. We provided a scoping overview to help researchers and clinicians catch up quickly with the state-of-the-art today.

The modified Sgarbossa criteria have been established to aid in the diagnosis of ST-elevation myocardial infarction in patients with left bundle branch block. Thus far, the sensitivities and specificities of the Sgarbossa signs have only been evaluated retrospectively in cohorts of patients with and without occlusive myocardial infarctions. These statistical analyses were based on correlating ST abnormalities with serum markers of myocardial injury and/or results of emergent cardiac catheterization. We present a patient with acute cardiovascular emergency where electrocardiograms revealed intermittent left bundle branch block. In serial ECGs, highly dynamic ST abnormalities on the narrow QRS beats were associated with similarly dynamic ST changes in the left bundle branch block beats. Our findings provided direct and real-time confirmation of the usefulness of the Sgarbossa and the modified Sgarbossa criteria in the diagnosis of acute ST elevation in patients with left bundle branch block.

Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is a commonly performed treatment modality for concomitant gallbladder stones and common bile duct stones (CBD stones). There has been a debate about the appropriate timing of laparoscopic cholecystectomy after ERCP. The present study aimed to comprehensively compare early and delayed laparoscopic cholecystectomy after ERCP for concomitant gallbladder stones and common bile duct stones using unique parameters like the Nassar scale with clarification of the benefits of the appropriate timing. In a randomized controlled trial, adult patients with concomitant gallstones and CBD stones were randomly assigned after ERCP to one of two equal groups; early and delayed laparoscopic cholecystectomy. The early cholecystectomy group underwent surgery within 72 h of ERCP while the delayed group underwent surgery after 6 weeks of ERCP. Operative parameters included the operative time, the grading of adhesions, the difficulty of dissection in Calot’s triangle, bleeding, and conversion to open cholecystectomy. We also used the Nassar scale (for grading of operative difficulty in laparoscopic cholecystectomy) in the comparison between the two groups and predicting the surgery outcome. The delayed cholecystectomy group was associated with significantly higher rates of acute cholecystitis while waiting for surgery, higher grades of the Nassar scale, more adhesions, more operative difficulties, difficult dissection of Calot’s triangle, and longer operative time. Early laparoscopic cholecystectomy was better as it significantly had less operative time, less intraoperative difficulties, and fewer interval complications between ERCP and surgery. NCT04475796. https://clinicaltrials.gov/ct2/show/NCT04475796

Background Sacrococcygeal pilonidal sinus disease (PSD) is an infection of the skin and subcutaneous tissue at the upper part of the natal cleft of the buttocks. Excision and healing by granulation “lay-open” method is still more preferable than other methods of midline closure or using flaps but the healing time is lengthy. The present study was performed to assess the healing promotion effect of platelet-rich plasma (PRP) on the pilonidal sinus wounds treated by the lay-open method. Methods One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method, at General surgery department, Kafr El-Sheik University hospital, Egypt, during the period from December 2018 to December 2019. Group (A) was adopted the regular dressing postoperatively, while group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days. Results Accelerated rate of wound healing was detected in group (B) in day 10, with a significant difference detected in days 15, 20, 25 and 30 postoperative, with a mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001 which indicates considerable effect in the treated group. Conclusions PRP injection is an effective new technique in accelerating the healing of pilonidal wound after surgery, with a significant decrease in post-operative pain, complications and an early return to work. Trial registration retrospectively registered. Trial registration number: 12/35/1016 issued on December 2018 from the Institution Review Board at Kafr El Sheikh University. ClinicalTrials.gov identifier: NCT04430413

Although zinc deficiency increases the risk of oxidative DNA damage, data regarding the association between zinc and oxidative DNA damage in diabetes are controversial. In this article, we focus on serum zinc levels and its relation to an established biomarker of oxidative DNA damage (8-hydroxy-2-deoxyguanosine) in patients with type 2 diabetes, and to ascertain the beneficial effects of zinc supplementation on the level of oxidative DNA damage. The study consisted of 2 interrelated parts: The first part was a cross-sectional study conducted on patients with type 2 diabetes (n = 297) and healthy individuals (n = 188). The second part was an interventional study that enrolled 38 diabetic patients with low zinc status and high DNA damage. The demographic parameters including age, gender, and body mass index were recorded, and DNA damage marker through 8-hydroxy-2-deoxyguanosine levels, and zinc status of serum zinc, was measured. Significantly higher 8-hydroxy-2-deoxyguanosine levels (P

Introduction: Appropriate dose adjustments of glucocorticoids replacement therapy for adrenal insufficiency (AI) is vital. Objective: We sought to scope physicians’ perceptions, and practices regarding Ramadan fasting (RF) impact on the management of AI. Methods: A web-based survey of a convenience sample of endocrinologists. Results: Nearly two-thirds of 145 respondents (64.1%) were adult endocrinologists and almost half (49%) saw more than 10 hypoadrenal patients per year. Most respondents (78.6%) prescribed hydrocortisone, while the minority prescribed other preparations. The glucocorticoid doses were reportedly divided twice daily by 70.8% and thrice daily by 22.2% of respondents. Respondents recognized RF as having potential consequences in adrenal insufficiency patients included causing hypoglycaemia, undue tiredness, and fatigue, hypotension, feeling dizzy, and light-headedness. Symptoms of under-replacement were thought to happen in the late afternoon by 59.3% of respondents. Almost half (45.5%) of respondents thought that RF has some probable or definite impact on glucocorticoid therapy that certainly warrants specific concern and possible action. Three quarters (76.4%) of respondents confirmed providing specific management recommendations during RF. The most frequently reported recommendation was taking in the usual morning dose of hydrocortisone just before pre-dawn meal (Suhor) (57.8%). A third switch patients from hydrocortisone to prednisolone/prednisone. Half reported providing patients with specific recommendations regarding breaking their fast and/or seeking help if hypoadrenal symptoms occur. Conclusions: There is a remarkable variation in the physicians’ perceptions and practices regarding the management of AI during Ramadan. This warrants professional effort to increase the awareness and dissemination of evidence-based guidelines.

Prior research has identified perceived discrimination as being a contributing factor in health and mental health disparities. However, there is little research on the relationship between perceived discrimination and behaviors such as hazardous alcohol and illicit substance use and risky sexual behaviors that put people at risk for negative health consequences including HIV. The current research explores the role that cultural factors may play in a tendency for individuals to engage in unhealthy behaviors or an ability to avoid them. A total of 266 college students who self-identified as Black or African American were surveyed on measures of familial ethnic socialization, perceived discrimination, emotion regulation, substance use, and risky sexual behaviors. Findings indicate that perceived discrimination and emotion regulation-suppression were associated with higher levels of hazardous alcohol use, and that emotion regulation-cognitive reappraisal was associated with lower levels of illicit substance use. Implications for intervention and prevention in African American college students are discussed.

Aim: To determine the association of left main stem disease with diabetes and hypertension in STEMI patients underwent coronary angiography Methodology: This study was conducted at Department of Cardiology, Sheikh Zayed Hospital, Lahore during January to June 2019 where 220 patients with age ranging from 40-70 years whether male or female, presenting with STEMI, In Exposed Group: Patients presenting with STEMI having diabetes and hypertension and Unexposed Group: Patients of STEMI without diabetes and hypertension. We excluded all cases with recurrent MI or undergoing recurrent PCI (on medical record), valvular heart disease, and cardiogenic shock. Then two groups were formed i.e. exposed group with diabetes and hypertension and unexposed group without diabetes and hypertension. All patients underwent angiography by a senior consultant cardiologist with assistance of researcher. On angiography, presence of LMS disease was ≥50% occlusion (stenosis) in LMS artery. Angiography reports were assessed and LMS disease was noted labeled. Patients with LMS disease was managed as per hospital protocol. Results: In this study risk of LMS was higher among exposed group as compared to un exposed group. i.e. exposed: 19.1% & Unexposed: 5.5%, RR=3.50 The risk of LMS among exposed group was higher for patients in the age group 51-60 years (RR=8.00), for male patients (RR=5.76) risk for LMS was higher as compared to female patients in exposed group, patients with normal BMI (RR:2.20) and patients with shorter duration of STEMI in exposed group had higher risk for LMS (1-4 weeks: RR=7.54). Conclusion: Results of this study showed that hypertensive and diabetic patients presenting with STEMI had higher risk for LMS disease. Keywords: Left main stem, Diabetes, Hypertension, Coronary, Angiography

Aim: To determine the frequency of hydrocephalus in cases of Tuberculous meningitis Methods: This was a cross sectional study conducted during 01-07-16 to 31-12-2017 at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar Khan. The cases of tuberculosis meningitis of age range of 15 to 50 years of either gender with tuberculous meningitis were included in this study. The diagnosis of TBM was made on the basis of combination of clinical symptoms and laboratory data. The symptoms were fever, weight loss and neck rigidity with or without fits. These cases then underwent CSF analysis under aseptic measures. The findings to label TBM on CSF were low glucose (< 40 mg/dl), increased protein content (> 100 mg/dl) and high WBC count with predominance of lymphocytes. The cases of TBM were divided according to standard BMRC scale into three stages. The cases with bacterial meningitis, having any SOL in brain and those with any previous history of neurosurgery were excluded from this study. Then these cases underwent CT brain in the same institute and diagnosis of Hydrocephalus was made when any of the ventricle is dilated more than 25% of the baseline. Results: In this study there were total 93 cases of TBM with mean age of 37.11±08.67years. There were 54(58.06%) males and 39(41.94%) females. Maximum cases were seen in stage II of TBM which affected 65 (69.89%) cases. Hydrocephalus was seen in 61(65.59%) of the cases as shown in figure 01. Hydrocephalus was significantly high in male gender as compared to females where it affected 39(72.22%) of cases with p value of 0.03. It was also more common in cases that had age group 15-29 years affecting 40(67.79%) of cases with p= 0.86. Hydrocephalus was also significantly high in cases with stage II and III of TB affecting 66.15% and 77.27% of cases respectively with p= 0.01. Conclusion: Hydrocephalus is very common in cases of TBM and it is significantly high in male gender and stage II and III of TBM. Key words: TBM, Hydrocephalus

Objective To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees. Methods Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20). Main Outcomes/Measures Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression. Results The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p

Prostate cancer (PCa) is the major cause of the death of men population globally. Multiple factors are involved in the initiation and progression of PCa. This study aimed to evaluate different metabolic parameters in the serum of PCa patients. Males of 50 years and above age with the recent diagnosis of PCa (digital rectal examination, and elevated serum prostate-specific antigen (PSA) level) were included in the study. Glucose and serum electrolytes level, lactate dehydrogenase activity, parameters of lipid metabolism and liver and kidney functioning were measured on a fully automated analyzer using standard reagent kits. Oxidative stress was evaluated by measuring MDA, CAT, GSH, and SOD in serum. Detection of C-reactive protein (CRP), insulin-like growth factor (IGF-1) and vascular endothelial growth factor (VEGF) was performed by immunoassay. It was shown that serum glucose and HDL levels were lower while total cholesterol, LDL and triglyceride levels were significantly higher in PCa group than in the control group. PCa patients had an elevated level of liver and kidney functional markers. Comparison of the oxidative stress markers in patient and control groups showed significant difference. It was detected that serum levels of CRP, IGF-1 and VEGF were significantly higher in PCa group, compared the control to group (P < 0.05). Low level of glucose and dyslipidemia indices in prostate cancer patients indicated metabolic changes and demonstrated the importance of multiple parameters analysis

Methotrexate (MTX) is mainly used as antimetabolite agents in cancer therapy. It causes serious side effects such as nephrotoxicity, hepatotoxicity, and anemia. Nigella sativa (NS) is a medicinal herb that has protective effects against the MTX-related side effects. The study aimed to determine the optimal concentration of the combination of NS-MTX mixture to improve the anti-tumor effects of MTX and reduce its related adverse effects. In this study, in vitro evaluation of anti-tumor and anti-angiogenic activities of NS, MTX, or their mixture in different concentrations using liver hepatocellular carcinoma and endothelial cells were performed. The protective effects of NS on normal hepatic and kidney cells against the risks of MTX treatment was also tested in vitro. Moreover, for in vivo evaluation, male Wistar rats were treated with MTX or a combination of MTX and NS. Hematological and serological, biochemical, functional, and histopathological studies were performed. The results showed that the low concentration of NS enhanced the anti-tumor and anti-angiogenic effects of MTX. Moreover, it had protective effects on normal hepatic and kidney cells against toxicity induced by MTX treatments. The in vivo results showed significant improvements in the blood condition and liver functional parameters in MTX-intoxicated rats after treating with NS. NS reduced the oxidative stress indices in both kidney and liver tissues. The histopathological examinations showed that NS reduced degenerative changes and necrosis in both kidney and liver. These results suggested that NS in low concentration could improve the efficacy and the safety of MTX treatment.

In dogs, splenectomy is mandatory as an emergency following splenic rupture with resultant hemoperitoneum and hypotensive shock. The present work aimed to evaluate the Doppler ultrasonographic parameters of brachial and femoral veins in splenectomized dogs and to investigate the effect of splenectomy on the coagulation and lipid profiles. A total number of 9 dogs underwent clinical, abdominal ultrasonographic and laboratory examinations prior to the surgical operation and kept for 60-day observation period post-splenectomy. Follow-up ultrasonography revealed no serious complications post-splenectomy. Both brachial and femoral veins were imaged medial to their corresponding arteries. Doppler ultrasonographic parameters of both veins showed no significant changes throughout the study period (P > 0.05). Haematological analysis revealed development of anemia, leukocytosis, and thrombocytosis in dogs post-splenectomy. Coagulation profile exhibited no significant variations in prothrombin and activated partial thromboplastin times (P > 0.05). In comparison with their baseline values, the mean concentrations of total cholesterol, low-density lipoprotein, and triglycerides were significantly increased 30-day post-splenectomy. In conclusion, it may seem that open splenectomy has no influence on the Doppler ultrasonographic indices of brachial and femoral veins with no evidence of deep vein thrombosis in dogs. However, persistent leukocytosis and thrombocytosis, as well as altered lipid profile may increase the risk of vascular complications with the long run. Therefore, a further long-term study may be required.

BACKGROUND Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.

Background: post endoscopic retrograde cholangiopancreatography (ERCP) bleeding is a common complication and the incidence varies from 1% to 48%. It can be challenging to manage or localize the bleeder through a sideviewing endoscope. Objective: this study aimed to evaluate the risk factors of post ERCP bleeding and efficacy of endoscopic intervention therapies. Patients and Methods: this prospective randomized clinical trial was carried out on 100 consecutive patients at General Surgery Department Al-Azhar University Hospitals (Cairo) Egypt. All patients underwent ERCP, between January 2016 and August 2018, All ES procedures were performed by experienced surgeons and the decision to perform sphincterotomy was based on clinical, endoscopic, and radiologic findings. Results: comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray and pancreatitis was higher in patients who received electrocoagulation. Conclusion: clinically, endoscopic hemostasis therapy is very effective to manage post ERCP bleeding but increases the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each therapeutic modalities and appropriate management of different levels of bleeding are important.

Objectives: \ud Current knowledge and research on diabetes and Ramadan form the basis for evidence-based clinical practice. In this context, we aimed to explore physicians' perceptions of current knowledge gaps about research fasting (RF), barriers to, and foreseeable directions for advancement of the field.\ud \ud Methods: \ud We conducted an online survey of a convenience sample of 260 physicians from 27 countries. The survey questionnaire addressed three main domains: perceived current knowledge gaps and unmet needs in research about RF and diabetes, barriers to the conduct of research, and future directions for furthering the evidence in this field.\ud \ud Results: \ud Majority of respondents (65.7%) were senior physicians in adult endocrinology/diabetes (45.9%) working at tertiary centers (65.2%). The majority (67.3%) reported seeing an average of 20+ patients with diabetes weekly and felt “very or fairly confident” in managing diabetes during RF (67.7%). The knowledge gaps identified were the management of high-risk patients with diabetes (54.1%), such as renal impairment (59.8%), and pregnancy (61.5%). The main barriers to research were lack of adequate funding to academic centers (75.7%) and lack of interest of institutions in the subject (64.6%). Future efforts should be directed at the conduct of large epidemiological studies (49.5%) or double-blinded, placebo-controlled clinical trials (48.6%) to address the former gaps. Research findings should be widely disseminated via hands-on workshops (recommended by 70.3% of respondents) or international conferences (61.2%).\ud \ud Conclusions: \ud There is a wide agreement regarding the knowledge gaps in the management of diabetes during RF. Future efforts should focus on addressing these critical deficiencies.

Context: Total pancreatectomy (TP) with islet-cell auto transplantation (IAT) is an option for pain management for patients with chronic pancreatitis (CP). IAT allows the preservation of beta cell function to reduce or prevent long-term diabetes. Objective: We performed a follow-up study up to 12 years after TPIAT surgery with an off-site isolation laboratory, to determine the efficacy and durability of the procedure. Methods: Data (August 2008 to August 2020) were obtained from a TPIAT database which included information from medical records, clinic visits, questionnaires, and follow-up telephone calls. Patient demographics were collected. Additionally, each patient was assessed with a 4-hour mixed meal tolerance test for metabolic measurements, serial glycosylated hemoglobin (HbA1c), and insulin requirements prior to surgery and during their most recent follow-up appointment. Results: Seventy-seven patients with a median age of 45.0 years underwent TP-IAT for CP due to different etiologies. At a median follow-up time of 422.5 days 12 patients were insulin independent and 65 patients were on at least one insulin injection a day. Post-operative C-peptide area under the curve (AUC) measurements (P=0.008) were a better indicator of procedure success compared to the number of islet cells transplanted (P=0.225). Patients who were insulin-dependent post-surgery demonstrated increased insulin resistance prior to surgery, by their median pre-surgery insulin AUC; insulin-independent, 626 (241, 3803); insulin-dependent, 1591 (325, 4803), HOMA-IR values 9.02. Conclusions: TPIAT improves intractable pain for patients with CP. IAT decrease insulin requirement and improve blood glucose control after TP. Insulin resistance prior to surgery may be a predictor for insulin-dependence. Intervention studies using insulin sensitizer prior surgery may be considered in evaluating long-term outcomes for these patients. Disclosure S. U. Lad: None. K. F. Ali: None. P. C. Johnston: None. V. San martin: None. Y. Lin: None. R. Bottino: None. M. Walsh: None. T. Stevens: Speaker’s Bureau; Self; AbbVie Inc. B. Hatipoglu: None.

Background Portable accelerometer-based navigation devices (PAD) in total knee arthroplasty (TKA) have been proposed to combine the alignment precision of computer navigation with the efficiency of conventional instrumentation (CON). The aim of this study was to determine if PAD was more effective than CON in TKA in improving clinical outcomes at medium term follow-up. Methods Participants undergoing primary TKA were randomly assigned to either PAD or CON. The primary outcome was the mean between-group difference in the four subscales of the Knee injury and Osteoarthritis Outcome Score (∆KOOS4 ) between preoperative status and latest follow-up. Secondary outcomes included analysis of between-group differences in all KOOS subscales, Western Ontario and McMaster Universities Osteoarthritis Index (∆WOMAC) scores, complications and reoperation rates. Results Of the 178 participants allocated to a treatment arm, 159 (89.3%) completed follow-up at a mean of 4.3 years (range 3.2-5.8 years). There was no statistically significant or clinically meaningful difference in ∆KOOS4 between preoperative status and latest follow-up (PAD = 41, CON = 43; p = 0.5). There was no difference in mean ∆WOMAC scores (PAD = 39, CON = 41; p = 0.9) or ∆KOOS subscales between groups. In addition, there were no differences in complications or reoperations between groups. Conclusions PAD was not superior to CON in improving patient-reported outcomes or reducing complications and reoperation rates at medium term follow-up. The use of PAD in TKA to improve clinical outcomes alone cannot be justified based on the results of this study.

Hadron therapy with protons and carbon ions is widely attracting interest as a potential competitor of conventional photon radiotherapy. Exquisite dose distribution of charged particles allows for a higher local control of the tumor and lower probability of damage to nearby healthy tissues. Heavy ions have presumed biological advantages rising from their high-linear energy transfer (LET) characteristics, including greater cell-killing effectiveness and reduced heterogeneity dependence of radiation response. Although these advantages are clear and supported by data, only 18.0% of proton and carbon ion radiotherapy (CIRT) facilities in Europe are treating breast cancers. This review summarizes the physical and radiobiological properties of charged particles, clinical use of particle beam for breast cancer, and suggested approaches to overcome technical and financial challenges.

B-cell activation is increasingly linked to numerous fibrotic lung diseases, and it is well known that aggregates of lymphocytes form in the lung of many of these patients. Activation of B-cells by pattern recognition receptors (PRRs) drives the release of inflammatory cytokines, chemokines, and metalloproteases important in the pathophysiology of pulmonary fibrosis. However, the specific mechanisms of B-cell activation in patients with idiopathic pulmonary fibrosis (IPF) are poorly understood. Herein, we have demonstrated that B-cell activation by microbial antigens contributes to the inflammatory and profibrotic milieu seen in patients with IPF. B-cell stimulation by CpG and β-glucan via PRRs resulted in activation of mTOR-dependent and independent pathways. Moreover, we showed that the B-cell–secreted inflammatory milieu is specific to the inducing antigen and causes differential fibroblast migration and activation. B-cell responses to infectious agents and subsequent B-cell–mediated fibroblast activation are modifiable by antifibrotics, but each seems to exert a specific and different effect. These results suggest that, upon PRR activation by microbial antigens, B-cells can contribute to the inflammatory and fibrotic changes seen in patients with IPF, and antifibrotics are able to at least partially reverse these responses.

Background Little is known about the internet search activity of people with suicidal thoughts and behaviors (STBs). This data source has the potential to inform both clinical and public health efforts, such as suicide risk assessment and prevention. Objective We aimed to evaluate the internet search activity of suicidal young people to find evidence of suicidal ideation and behavioral health–related content. Methods Individuals aged between 15 and 30 years (N=43) with mood disorders who were hospitalized for STBs provided access to their internet search history. Searches that were conducted in the 3-month period prior to hospitalization were extracted and manually evaluated for search themes related to suicide and behavioral health. Results A majority (27/43, 63%) of participants conducted suicide-related searches. Participants searched for information that exactly matched their planned or chosen method of attempting suicide in 21% (9/43) of cases. Suicide-related search queries also included unusual suicide methods and references to suicide in popular culture. A majority of participants (33/43, 77%) had queries related to help-seeking themes, including how to find inpatient and outpatient behavioral health care. Queries related to mood and anxiety symptoms were found among 44% (19/43) of participants and included references to panic disorder, the inability to focus, feelings of loneliness, and despair. Queries related to substance use were found among 44% (19/43) of participants. Queries related to traumatic experiences were present among 33% (14/43) of participants. Few participants conducted searches for crisis hotlines (n=3). Conclusions Individuals search the internet for information related to suicide prior to hospitalization for STBs. The improved understanding of the search activity of suicidal people could inform outreach, assessment, and intervention strategies for people at risk. Access to search data may also benefit the ongoing care of suicidal patients.

Introduction Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. Materials and methods All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan–Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. Results A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0–93.7%), 75.5% (95% CI 67.5–84.5%) and 68.9% (95% CI 59.7–79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61–1.63), (p = 0.99, HR=1.00; 95% CI 0.61–1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02–5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12–2.41). Conclusion In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

Prior research has identified associations between social media activity and psychiatric diagnoses; however, diagnoses are rarely clinically confirmed. Toward the goal of applying novel approaches to improve outcomes, research using real patient data is necessary. We collected 3,404,959 Facebook messages and 142,390 images across 223 participants (mean age = 23.7; 41.7% male) with schizophrenia spectrum disorders (SSD), mood disorders (MD), and healthy volunteers (HV). We analyzed features uploaded up to 18 months before the first hospitalization using machine learning and built classifiers that distinguished SSD and MD from HV, and SSD from MD. Classification achieved AUC of 0.77 (HV vs. MD), 0.76 (HV vs. SSD), and 0.72 (SSD vs. MD). SSD used more (P P P P P P P

Introduction The literature on health aspects of Ramadan fasting is widely spread in many journals making it not readily available to those interested in the subject. Materials and Methods A narrative, non-systematic review of the international literature from two major online databases (viz. Scopus, PubMed) in one year (2019). The search term “Ramadan fasting AND Diabetes” was used, and relevant literature was narrated in a concise thematic account. Results Research design included qualitative, quantitative, and mixed methods. Articles included controlled trials, critical appraisals, literature narrations, and systematic reviews, and meta-analyses. The publications spanned a vast array of topics related to Ramadan fasting, including assessments of current safety and efficacy profiles of newer diabetes therapies, modes of insulin delivery, and utilization of advanced technology for the treatment and monitoring of blood glucose during Ramadan fasting. Increased interest was particularly evident in capturing the experience element manifested by perceptions, attitudes, and practices of both patients and healthcare professionals during Ramadan. The current literature consolidates previous data on the safety of fasting practices amongst the well-controlled. On the other hand, it emphasizes the need for more aggressive interventions for high-risk patients, promoting the usage of newer anti-diabetic agents and advanced glucose monitoring technology for safer fasting practices. Conclusions The volume of global literature production related to Ramadan fasting and Diabetes remains modest. Observational studies of small size prevail. Greater improvements in both quality and quantity of research on Ramadan are needed.

Background Social media is one of the most rapid and impactful ways of obtaining and delivering information in the modern era. Objective The aim of this study was to rapidly obtain information on public perceptions, knowledge, and behaviors related to COVID-19 in order to identify deficiencies in key areas of public education. Methods Using a cross-sectional study design, a survey web link was posted on the social media and messaging platforms Instagram, Twitter, and WhatsApp by the study investigators. Participants, aged ≥18 years, filled out the survey on a voluntary basis. The main outcomes measured were knowledge of COVID-19 symptoms, protective measures against COVID-19, and source(s) of information about COVID-19. Subgroup analyses were conducted to determine the effects of age, gender, underlying illness, and working or studying in the health care industry on the perceived likelihood of acquiring COVID-19 and getting vaccinated. Results A total of 5677 subjects completed the survey over the course of 1 week. “Fever or chills” (n=4973, 87.6%) and “shortness of breath” (n=4695, 82.7%) were identified as the main symptoms of COVID-19. Washing and sanitizing hands (n=4990, 87.9%) and avoiding public places and crowds (n=4865, 85.7%) were identified as the protective measures most frequently used against COVID-19. Social media was the most utilized source for information on the disease (n=4740, 83.5%), followed by the World Health Organization (n=2844, 50.1%). Subgroup analysis revealed that younger subjects ( Conclusions Our results are indicative of a relatively well-informed cohort implementing appropriate protective measures. However, key knowledge deficiencies exist with regards to vaccination against COVID-19, which future efforts should aim at correcting.

Pancreatic islet transplantation is a rapidly evolving field. It has been increasingly regarded as a promising approach for the correction of dysglycemia associated with type 1 diabetes mellitus (allogenic islet transplantation), or the prevention of surgical diabetes in chronic pancreatitis subjects undergoing total pancreatectomy (autologous islet transplantation). In this review, we discuss the latest literature pertaining to metabolic outcomes of autologous and allogenic islet transplantation, shedding close light on our own latest experience in the autologous islet transplantation setting.

The radiation exposure of individuals has been on the rise due to an increased amount of radiation use, e.g., in medicine for diagnostic imaging and treatment procedures, industrial applications including military defense activities and nuclear power plants, and in academics for educational and scientific research. Space exploration missions and space tourism are additional areas of protracted low dose exposure situations with radiation types not present on the Earth. In contrast to high doses of ionizing radiation, cancer risk assessment of the more commonly encountered or protracted radiation exposure is still under debate and uncertainty making it fuzzy area. A major challenge lies in providing a scientific basis to estimate low dose radiation carcinogenesis risks. In this review we aim, through the collected epidemiological and experimental studies' data, to address the central questions in radiological protection; including quantification of the risks and uncertainties from low doses of ionizing radiation and what is a sound scientific consensus to advise on risk perception for low dose radiation exposure.

The current work was undertaken to evaluate the toxicologic effect of manganese chloride (MnCl2) and potential therapeutic effect of curcumin on male albino rats. Ninety-six rats were divided into three groups. MnCl2 toxicity group (I) included 32 rats were administered (MnCl2) at a dose of 5 mg/ml daily in drinking water orally for 8 weeks. Curcumin-treated group (II) included 32 rats were given (MnCl2) in the same dose and route as the first group. Each rat of this group was treated by oral administration of curcumin in a daily dose 100 mg/kg b.w. The control group (III) included 32 rats. Eight rats were randomly selected from groups I, II and III and sacrificed at (2, 4, 6, and 8 weeks) of experiment. Tissue samples from cerebellum and midbrain of all groups were collected for histopathological examination, and neuromorphometrical analysis as well as blood samples were taken for complete blood picture. The histopathological examination in group I showed Purkinje cell loss in the cerebellum with degeneration of motor neurons in midbrain. In group II, curcumin caused significant increase in number of healthy Purkinje cells in cerebellum with prevalence of healthy motor neurons and minimal vascular alterations in midbrain. The hematological results revealed that animals in group I showed a significant increase in WBCs and platelets compared to other groups, while RBCs count significantly decreased. The number of poikilocyts increased in group I compared to group II and group III. In conclusion, curcumin therapy has a powerful neuroprotective effect in Mncl2 toxicity.

Background Nowadays, immuno-stimulants have great importance in improving the immune system and minimising the effect of infectious diseases in poultry flocks. This study was designed to demonstrate the impact of using different immune-stimulants on the reduction of the harmful implications of virulent ND virus through evaluation of histopathological lesion scores on bursa and trachea of vaccinated and infected broiler chickens with Newcastle disease (ND). Results Eighty Ross breed broiler chicks at the age of 1 day were randomly divided into four groups, each group formed of 20 birds. Group I was vaccinated against AI, ND and IBD and used as a control. Groups II, III and IV were immunised as group I and also had immuno-stimulant supplement, Imutrix® (oregano oils plus ß-glucan), Evit liquid® (Vitamin E plus selenium) and Immunair 17.5 (Propionibacterium acnes and E. coli lipopolysaccharides), respectively. All groups were experimentally infected with virulent ND virus at the age of 28 days. The morbidity rates for groups I, II, III and IV were 15%, 5%, 5% and 10% respectively. Histopathological examination of bursa revealed hyperplasia of lymphoid follicles in group I which became more evident in groups II, III and IV. Group III showed hyperplasia of tracheal epithelium with lymphocytes and heterophils infiltration in lamina propria. CD79A-positive cells were significantly higher in bursa of group III in comparison to other groups during an immunohistochemical examination. Conclusion It was concluded that Evit liquid® (vitamin E plus selenium) supplementation might have potent immunomodulatory effect in chickens.

Objective: Titration of desmopressin can be challenging during complex, lengthy surgical procedures in patients with chronic central diabetes insipidus (DI). Arginine vasopressin (AVP) may be the preferred treatment modality in these settings. No data currently exist on the use of AVP during lengthy operations.Methods: We report a novel AVP infusion protocol for the management of chronic DI during a 27-hour total facial transplantation surgery.Results: A 21-year-old woman was admitted for a total facial transplantation surgery. Her medical history was significant for severe facial injuries and panhypopituitarism, both secondary to a ballistic trauma sustained 3 years prior. For the management of her chronic central DI during the complex surgery, a unique AVP infusion protocol was developed. Intraoperatively, the infusion was adjusted hourly following an internally developed algorithm with pre-specified goal parameters for urine output (50 to 200 mL/hour) and serum sodium levels (136 to 144 mmol/L; reference range: 136 to 144 mmol/L). The short half-life of AVP provided ease of dose titration. Under this protocol, the patient's hemodynamic values and serum sodium levels remained stable throughout the 27-hour transplantation surgery.Conclusion: We describe the successful use of a novel AVP infusion protocol for the management of DI during a 27-hour facial transplantation surgery. This protocol may also be effective in managing other patients with chronic central DI during lengthy intraoperative periods.Abbreviations: AVP = arginine vasopressin; DDAVP = 1-deamino-8-D-arginine vasopressin; DI = diabetes insipidus

Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany. We investigated whether the TM-score (comprising six parameters), Face Arm Speech Time test, and individual patient characteristics were able to differentiate cerebrovascular disease from stroke mimic patients. Results We included 423 patients (299 (70.7%) cerebrovascular disease and 124 (29.3%) stroke mimic) in the final analysis. A TM-score > 30 indicated a high probability of a cerebrovascular disease and a score ≤15 of a stroke mimic. The TM-score performed well to identify stroke mimics (area under the curve of 0.74 under receiver-operating characteristic curve analysis). The cerebrovascular disease patients were older (74.8 vs. 69.8 years, p = 0.001), had more often severe strokes (NIHSS > 14 25.8% vs. 11.3%, p = 0.001), presented more often with weakness of the face (70.9% vs. 42.7%, p = 0.001) or arm (60.9% vs. 33.9%, p = 0.001), dysarthria (59.5% vs. 40.3%, p Conclusions The TM-score and certain patient characteristics can help paramedics and emergency physicians in the field to identify stroke mimic patients and select the most appropriate hospital destination.

Background: Varicocele is generally considered to be the most common correctable cause of male infertility.Testicular disproportion is considered to be the most important sign of testicular damage in absence of the possibility to do routine semen analysis in adolescent.Aim of the Study: The aim of our work is to evaluate the feasibility, recurrence rate and postoperative complications of laparoscopic varicocelectomy with preservation of the testicular artery in adolescents.Patients and Methods: Our prospective clinical study was done between May 2016 and May 2017 at pediatric surgery unit, General Surgery Department, Tanta University Hospital. The study included twenty patients presented with symptomatic varicocele. Then, laparoscopic varicocelectomy with preser-vation of the testicular artery were done for these cases. The operation time, the success rate, the incidence of complications, the length of the hospital stay and conversion to open varic-ocelectomy and data of follow-up were recorded.Results: Total Operation time ranged between 10 and 40 minutes which was statistically significant in correlation with bilateral cases. There were testicular catch up growth in 5 cases and we had no testicular atrophy in the other cases Recurrence occurred in 2 cases in the period of follow-up (6 months).Conclusions: Laparoscopic approach had advantages of minimal surgical trauma, lower morbidity and time sparing, faster recovery and better microscopic dissection with pres-ervation of the spermatic artery.

Background: A significant percentage of terminally ill patients are discharged to hospice care following a devastating stroke. Objective: We sought to determine the factors associated with hospital discharge to hospice care in a large cohort of patients with stroke. Methods: Using the institutional Get With The Guidelines-Stroke database, all consecutive patients with acute ischemic stroke (AIS) who were alive at discharge, from January 2009 until July 2015, were analyzed. Univariate and multivariable statistical analyses were performed to determine the factors associated with discharge to hospice care. Results: Of 2446 patients with AIS, 3.4% died and were excluded of remaining 2363 patients, and 4.2% were discharged to hospice care. Univariate analysis identified patients who were discharged to hospice care to be older, caucasian, Medicare or private insurance, have atrial fibrillation, heart failure and less often had diabetes mellitus or smoked. Altered mentation at presentation and urinary tract infection were more common in patients discharged to hospice. On multivariable analysis, patients transferred to hospice care were older (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.07; P < .001), had a high National Institute of Health Stroke Scale (NIHSS; OR: 1.15, 95% CI: 1.10-1.20; P < .001), and altered mental status at presentation (OR: 2.42, 95% CI: 1.29-4.55; P < .001). Conclusion: In our study, elderly patients with high NIHSS and altered mental status were identified as factors associated with transition to hospice care following AIS. Prospective studies on the optimal timing of initiation of these consults are needed.

Obsessive-compulsive disorder (OCD) has a genetic and environmental pathogenesis. The immunologic changes in OCD have been proven in many studies, but those tackling cytokine in OCD are still limited. The present study aims to evaluate the diagnostic performance of IL-6, IL-10, and the IL-6/IL-10 ratio in the OCD patient group, and to show their correlation with the clinical parameters of OCD. Eighty subjects (60 OCD patients and 20 matched controls) were participating in this study. The enzyme-linked immunosorbent assay was run to quantify the IL-6 and IL-10. Serum IL-6 exhibited a higher result in OCD patients than controls (p = 0.002) but serum IL-10 levels had no significant difference (p > 0.05). IL-6/IL-10 ratio showed significantly higher values in OCD patients than controls (p

BackgroundChronic suppurative otitis media is a massive public health problem in numerous low- and middle-income countries. Unfortunately, few low- and middle-income countries can offer surgical therapy.MethodsA six-month long programme in Cambodia focused on training local surgeons in type I tympanoplasty was instigated. Qualitative educational and quantitative surgical outcomes were evaluated in the 12 months following programme completion. A four-month long training programme in mastoidectomy and homograft ossiculoplasty was subsequently implemented, and the preliminary surgical and educational outcomes were reported.ResultsA total of 124 patients underwent tympanoplasty by the locally trained surgeons. Tympanic membrane closure at six weeks post-operation was 88.5 per cent. Pure tone audiometry at three months showed that 80.9 per cent of patients had improved hearing, with a mean gain of 17.1 dB. The trained surgeons reported high confidence in performing tympanoplasty. Early outcomes suggest the local surgeons can perform mastoidectomy and ossiculoplasty as safely as overseas-trained surgeons, with reported surgeon confidence reflecting these positive outcomes.ConclusionThe training programme has demonstrated success, as measured by surgeon confidence and operative outcomes. This approach can be emulated in other settings to help combat the global burden of chronic suppurative otitis media.

Purpose To determine the risk factors, intraoperative and postoperative complications, therapeutic interventions, and visual outcomes for persistent postoperative inflammation in primary resident-performed cataract surgeries. Setting Ben Taub General Hospital, Houston, Texas, USA. Design Retrospective case series. Methods Primary resident-performed cataract surgeries from January 2012 to June 2015 were analyzed for persistent postoperative inflammation, defined as persistent anterior chamber inflammatory reaction after a standard 1-month topical corticosteroid and nonsteroidal antiinflammatory drug (NSAID) drops taper. Preoperative characteristics, operative complications, therapeutic modalities, and duration of therapy were analyzed. The primary outcome measures were duration of corticosteroid and NSAID therapy, treatment modalities, and postoperative visual outcomes at the 1-month postoperative visit. Results The study assessed 1290 primary resident-performed cataract surgeries. Persistent postoperative inflammation occurred in 82 eyes (6.6%). The presumed etiology was classified as idiopathic persistent postoperative inflammation, nonadherence to topical therapy, and complicated cataract surgery. Patients with persistent postoperative inflammation were more likely of African American descent, had hypertension, or used aspirin, anticoagulants, or prostaglandins (P = .019, P = .027, P = .028, P = .020, respectively). The complicated cataract subgroup required a longer duration of therapy (P = .021) and was the only subgroup to require injections or systemic corticosteroids. There was no significant difference in postoperative corrected distance visual acuity (CDVA) when comparing patients with persistent postoperative inflammation with those without inflammation or between the subgroups. Conclusions The idiopathic and nonadherent subgroups were successfully treated with topical antiinflammatory therapy; the complicated subgroup required longer duration and multiple modalities of treatment. Visual outcomes were comparable to the general cataract population with no differences in postoperative CDVA.