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

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

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

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

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

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

Context Intrapleural adhesions and pleural fluid loculation is a common clinical problem. Several options are available to manage the intrapleural adhesions. MESNA has recently been used as a fibrinolytic agent and due to its efficacy and safety it is an option in treating intrapleural adhesions instead of other intrapleural fibrinolytics. Aims To assess the efficacy and safety of MESNA as a fibrinolytic agent in the management of loculated pleural effusions. Settings and design A prospective case series study at the Chest Department, Assiut University Hospital from October 2017 to March 2020. Patients and methods A prospective case series study has been conducted on 25 patients, who were admitted at the Chest Department, Assiut University Hospital. Patients presented with complex septated pleural effusion and their symptoms were anticipated to improve by pleural fluid drainage . MESNA was given daily for 3 consecutive days at a dose of 1800 mg diluted with 20 ml of normal saline and injected into the pleural cavity through the chest tube. The amount of drained fluid, chest ultrasound, and chest radiograph were used to evaluate the improvement of patients, assess the safety of MESNA, and detect any adverse effects. Results After installation of MESNA there is an increase in the amount of the fluid drained through the intercostal tube with significant difference before and after installation of MESNA (P

The aim of the work to detect the level of Cyclophilin-D in psoriasis and its correlation with disease severity. Samples included 84 persons divided into 2 groups (42) patients having psoriasis and (42) apparently healthy age and sex-matched individuals. All individuals included in the study were subjected to full history, full clinical examination, 3 cm of blood had been taken from patients of psoriasis and matched controls and centrifuged for serum separation which kept frozen at -80c till analysis of Cyclophilin-D by ELISA technique.

Abstract Background Pulmonary embolism (PE) is the third most common acute cardiovascular syndrome. Percutaneous catheter directed hydro-mechanical defragmentation (HMD) is one of the recommended treatment options for PE in patients with contraindications to thrombolytic therapy or failed systemic thrombolysis (ST). We aimed to identify the safety and outcomes of catheter directed HMD in patients with high-risk PE. This nonrandomized controlled trial enrolled all patients with confirmed diagnoses of high- and intermediate-high-risk PE from October 2019 till January 2021. Fifty patients were included and divided into two groups by the PE response team according to the presence or absence of a contraindication for ST. Group B (ST) consists of 25 patients and group A (HMD) of 25 patients who cannot receive ST. Results The two groups were comparable regarding baseline clinical characteristics with mean age 51 ± 13 years. In group A, systolic blood pressure (BP) and oxygen saturation increased after 24 h (p = 0.002) and 48 h (p

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

In nuclear facilities, the reading of the sensors is very important in the assessments of the system state. The existence of an abnormal state could be caused by a failure in the sensor itself instead of a failure in the system. So, being unable to identify the main cause of the “abnormal state” and take proper actions may end in unnecessary shutdown for the nuclear facility that may have expensive economic consequences. That is why, it is extremely important for a supervision and control system to identify the case where the failure in the sensor is the main cause for the existence of an abnormal state. In this paper, a system based on a wireless sensor network is proposed to monitor the radiation levels around and inside a nuclear facility. A new approach for validating the sensor readings is proposed and investigated using the Castalia simulator.

Background Studies propose that lack of oxygen in the blood experienced by patients with obstructive sleep apnea (OSA) during sleep leads to the liberation of several inflammatory mediators that modify the blood and produce hypercoagulable status. Objective The objective of this research was to evaluate the risk of hypercoagulability in individuals with OSA. Patients and methods The current study was conducted as a case–control study during the period from January 2018 to July 2019 at Assiut University Hospital. Markers measured for assessing the risk of hypercoagulability in OSA were red cell distribution width, mean platelet volume, platelet distribution width (PDW), and platelet count (PC). Results Our findings indicate a statistically significant difference between patients with OSA and healthy controls regarding red cell distribution width, mean platelet volume, PDW, and PC. However, there was no significant difference between patients with moderate and severe degree of OSA regarding these indices. A positive statistically significant correlation of apnea/hypopnea index was found with PC and PDW. Conclusion Our results suggest that patients with OSA are risky for hypercoagulability; however, further larger studies are required to confirm this conclusion.

Abstract Background Postoperative pain after total knee arthroplasty (TKA) is known to range from moderate (30% of patients) to severe (60% of patients). Inadequate management for postoperative pain may induce various immobility-related complications, muscle weakness, and chronic pain. Therefore, post-TKA analgesia is crucial, not only for patients’ satisfaction, but for improving surgical outcomes and reducing complications. The present study aims to compare the effect of ultrasound-guided adductor canal block ACB (saphenous nerve block) versus incremental dose of intravenous morphine after total knee arthroplasty surgery. Results The results of this study revealed no difference between group A and group B as regards postoperative quadriceps muscle strength; maximal knee flexion, total distance ambulated, and postoperative vital data (heart rate per minute and respiratory rate per minute). However, group A showed better postoperative pain control, lower doses of intravenous morphine consumption and lower incidence of nausea and vomiting. Conclusion Continuous adductor canal block (saphenous nerve block) is superior to intravenous morphine in decreasing postoperative pain and decreasing total morphine consumption and adverse effects as nausea and vomiting, but both are equivalent in preserving quadriceps muscle power.

Abstract Background Hyperbaric oxygen therapy (HBOT) for the treatment of acute stroke has been under the radar for a long time. Previous studies have not been able to prove efficacy. Several factors might have contributed to such inconsistent results. The timing of delivering the hyperbaric oxygen in relation to the stage of stroke evolution may be an important factor. This was not taken into account in the previous studies as there was no feasible and standardized method to assess the penumbra in the acute phase. Now with the perfusion scan appearing as a key player in the acute stroke management, precise stroke patient selection for hyperbaric oxygen therapy deserves a second chance similar to mechanical thrombectomy. Case presentation A 62-year-old female patient who presented with acute large vessel stroke was not eligible for chemical or mechanical thrombectomy. There was a large penumbra on imaging. She got treated with several sessions of hyperbaric oxygen over a 2-week period immediately after stroke. The patient showed significant improvement on the follow-up perfusion imaging as well as some clinical improvement. The more impressive radiological improvement was probably due to the presence of relatively large core infarction at baseline affecting functional brain areas. The patient continued to improve clinically on her 6-month follow up visit. Conclusion Our case demonstrates immediate stroke-related penumbra improvement associated with HBOT. Based on that, we anticipate a potential role for HBOT in acute stroke management considering precise patient selection. Future randomized controlled trials are needed and should take that in consideration.

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

Abstract Background A rapid, highly sensitive, and qualitative diagnostic test will significantly reduce the incidence of tuberculosis (TB). GeneXpert test is the test that is supposed to play this role with those specifications. Objective Our goal was to assess the precision of the GeneXpert test in the diagnosis of pulmonary TB. Patients and methods This cross-sectional analytic study was carried out at Assiut University Hospital in collaboration with Assiut Chest Hospital, Assiut, Egypt. A total of 67 patients of suspected pulmonary TB were included. For microbiological examination, two sputum samples were obtained from each patient within the same day. One sample was collected at Assiut University Hospital and subjected to smear microscopy by Ziehl—Neelsen staining and culture on Lowenstein—Jensen media. The other sample was taken at Assiut Chest Hospital to be processed for GeneXpert Mycobacterium tuberculosis/rifampicin assay. The culture was applied as a confirmatory test to evaluate the Xpert Mycobacterium tuberculosis/rifampicin assay test. Results GeneXpert had 95.9% sensitivity and 94.4% specificity in diagnosing pulmonary TB with the area under the curve of 0.95 and overall diagnostic accuracy of 95.5%. Ziehl—Neelsen examination had 65.3% sensitivity and 100% specificity with the area under the curve of 0.83 and overall diagnostic accuracy of 74.6. For smear-negative, culture-positive cases, GeneXpert showed sensitivity of 94.1%. False-positive GeneXpert for TB was recorded in just one patient. Conclusion The GeneXpert test is accurate in diagnosing pulmonary TB and its greatest benefit is clearly demonstrated in smear-negative TB cases. However, the test is not free from some fallacies, even if they are a few, which draws our attention to the importance of the conventional culture for TB and the clinical correlation.

Abstract The strength of sequence-related amplified polymorphism (SRAP) in comparison to random amplified polymorphic DNA (RAPD) in determining the genetic polymorphism among seven species of entomopathogenic nematodes (Steinernematidae) was tested. Nine RAPD and 12 SRAP primer pair’s combinations were used. The number of polymorphic bands and the polymorphism percentages was high in SRAP analysis (97 out of 107 bands were polymorphic (90.6%)) compared to RAPD (65 out of 89 bands were polymorphic (73%)). The highest number of RAPD bands was recorded for OPE-A-07 primer (14 band) while OPE-D-20 was scored the lowest band number (7 bands). The SRAP primers Me3-em2 registered the highest number of bands (13 bands) while Me3-em3and Me2-em2 showed the lowest band number (6 bands). The genotype-specific SRAP and RAPD markers for the different ENP species were recorded. The highest number of SRAP specific markers (7 markers) was scored for Steinernema glaseri, then 4 markers for S. abbasi 2 followed by S. riobrave (3 markers), 1 marker for S. abbasi 1, S. riobrave recorded the highest number of specific RAPD marker (4 specific markers) followed by S. carpocapsae DD 136 and S. glaseri (two specific markers), then only 1 specific marker for S. abbasi 1. Based on the data obtained from RAPD and SRAP analysis, the dendrogram was created to clarify the genetic distances among different species of the studied entomopathogenic nematodes. The present study indicated that SRAP was more powerful than RAPD analysis for detecting the genetic polymorphism among closely related species of nematodes. The genotype-specific markers detected from both RAPD and SRAP can be used in future biological control programs.