A Long-Term Follow-up Study for the Treatment of Snoring after Using Patterned Non-Ablative Erbium: YAG 2,940 nm Laser

Abstract Introduction Laser uvulopalatoplasty is an established operation for the treatment of snoring with good results on a short-term basis, while long-term follow-up studies, in addition to their scarcity, had conflicting results regarding recurrence, the change of snoring quality, and complications. Objective To assess the long-term follow-up results of using nonablative 2,940 nm Erbium: YAG for the treatment of snoring regarding outcomes and recurrence. Methods This 2-year follow-up study was conducted on 76 patients operated upon by non-ablative 2940 nm Erbium: yttrium-aluminum-garnet (YAG) using a PS01 patterned headpiece. Subjective evaluation of the treatment was performed relying on a smartphone application to record snoring in addition to a questionnaire specially designed to report recurrence and change in the quality of snoring reported by a patient's spouse. The objective evaluation was done by computed tomography (CT) imaging of the soft palate. The patients were evaluated preoperatively, 6 weeks postoperatively and after a 2-year follow-up period. Results Six week after the procedure, there was a significant improvement in 52 patients (68.4%). Out of the 52 patients, only 43 completed the 2-year follow-up; however, 15 of them complained of recurrence. Nevertheless, the patients who suffered from recurrence showed subjective improvement in snoring quality. Conclusions The nonablative mode of Erbium: YAG 2,940 nm laser proved to be efficient in soft palate tightening for the management of snoring. However, there was recurrence in 34.8% of the patients who presented objective and subjective improvement of the complaints, 6 weeks postoperatively and after a 2-year follow-up period.

Global epidemiology of Equine Influenza viruses: "A possible emerging zoonotic threat in future" an extensive systematic review with evidence / Epidemiologia global dos vírus da Gripe Equina: "Uma possível ameaça zoonótica emergente no futuro" uma extensa revisão sistemática com evidências

There are different opinions around the World regarding the zoonotic capability of H3N8 equine influenza viruses. In this report, we have tried to summarize the findings of different research and review articles from Chinese, English, and Mongolian Scientific Literature reporting the evidence for equine influenza virus infections in human beings. Different search engines i.e. CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med, and Web of Knowledge yielded 926 articles, of which 32 articles met the inclusion criteria for this review. Analyzing the epidemiological and Phylogenetic data from these articles, we found a considerable experimental and observational evidence of H3N8 equine influenza viruses infecting human being in different parts of the World in the past. Recently published articles from Pakistan and China have highlighted the emerging threat and capability of equine influenza viruses for an epidemic in human beings in future. In this review article we have summarized the salient scientific reports published on the epidemiology of equine influenza viruses and their zoonotic aspect. Additionally, several recent developments in the start of 21st century, including the transmission and establishment of equine influenza viruses in different animal species i.e. camels and dogs, and presumed encephalopathy associated to influenza viruses in horses, have documented the unpredictable nature of equine influenza viruses. In sum up, several reports has highlighted the unpredictable nature of H3N8 EIVs highlighting the need of continuous surveillance for H3N8 in equines and humans in contact with them for novel and threatening mutations.

Existem diferentes opiniões em todo o mundo a respeito da capacidade zoonótica dos vírus da influenza equina H3N8. Neste relatório, tentamos resumir os resultados de diferentes pesquisas e artigos de revisão da literatura científica chinesa, inglesa e mongol relatando as evidências de infecções pelo vírus da influenza equina em seres humanos. Diferentes mecanismos de busca, como CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med e Web of Knowledge geraram 926 artigos, dos quais 32 atenderam aos critérios de inclusão para esta revisão. Analisando os dados epidemiológicos e filogenéticos desses artigos, encontramos uma considerável evidência experimental e observacional de vírus da influenza equina H3N8 infectando seres humanos em diferentes partes do mundo no passado. Artigos publicados recentemente no Paquistão e na China destacaram a ameaça emergente e a capacidade dos vírus da influenza equina para uma epidemia em seres humanos no futuro. Neste artigo de revisão, resumimos os relatórios científicos relevantes publicados sobre a epidemiologia dos vírus da influenza equina e seu aspecto zoonótico. Além disso, vários desenvolvimentos recentes no início do século 21, incluindo a transmissão e estabelecimento de vírus da influenza equina em diferentes espécies animais, ou seja, camelos e cães, e presumida encefalopatia associada aos vírus da influenza em cavalos, documentaram a natureza imprevisível dos vírus da influenza equina. Em suma, vários relatórios destacaram a natureza imprevisível de H3N8 EIVs destacando a necessidade de vigilância contínua para H3N8 em equinos e humanos em contato com eles para novas mutações ameaçadoras.

Global epidemiology of Equine Influenza viruses; A possible emerging zoonotic threat in future an extensive systematic review with evidence

Abstract There are different opinions around the World regarding the zoonotic capability of H3N8 equine influenza viruses. In this report, we have tried to summarize the findings of different research and review articles from Chinese, English, and Mongolian Scientific Literature reporting the evidence for equine influenza virus infections in human beings. Different search engines i.e. CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med, and Web of Knowledge yielded 926 articles, of which 32 articles met the inclusion criteria for this review. Analyzing the epidemiological and Phylogenetic data from these articles, we found a considerable experimental and observational evidence of H3N8 equine influenza viruses infecting human being in different parts of the World in the past. Recently published articles from Pakistan and China have highlighted the emerging threat and capability of equine influenza viruses for an epidemic in human beings in future. In this review article we have summarized the salient scientific reports published on the epidemiology of equine influenza viruses and their zoonotic aspect. Additionally, several recent developments in the start of 21st century, including the transmission and establishment of equine influenza viruses in different animal species i.e. camels and dogs, and presumed encephalopathy associated to influenza viruses in horses, have documented the unpredictable nature of equine influenza viruses. In sum up, several reports has highlighted the unpredictable nature of H3N8 EIVs highlighting the need of continuous surveillance for H3N8 in equines and humans in contact with them for novel and threatening mutations.

Resumo Existem diferentes opiniões em todo o mundo a respeito da capacidade zoonótica dos vírus da influenza equina H3N8. Neste relatório, tentamos resumir os resultados de diferentes pesquisas e artigos de revisão da literatura científica chinesa, inglesa e mongol relatando as evidências de infecções pelo vírus da influenza equina em seres humanos. Diferentes mecanismos de busca, como CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med e Web of Knowledge geraram 926 artigos, dos quais 32 atenderam aos critérios de inclusão para esta revisão. Analisando os dados epidemiológicos e filogenéticos desses artigos, encontramos uma considerável evidência experimental e observacional de vírus da influenza equina H3N8 infectando seres humanos em diferentes partes do mundo no passado. Artigos publicados recentemente no Paquistão e na China destacaram a ameaça emergente e a capacidade dos vírus da influenza equina para uma epidemia em seres humanos no futuro. Neste artigo de revisão, resumimos os relatórios científicos relevantes publicados sobre a epidemiologia dos vírus da influenza equina e seu aspecto zoonótico. Além disso, vários desenvolvimentos recentes no início do século 21, incluindo a transmissão e estabelecimento de vírus da influenza equina em diferentes espécies animais, ou seja, camelos e cães, e presumida encefalopatia associada aos vírus da influenza em cavalos, documentaram a natureza imprevisível dos vírus da influenza equina. Em suma, vários relatórios destacaram a natureza imprevisível de H3N8 EIVs destacando a necessidade de vigilância contínua para H3N8 em equinos e humanos em contato com eles para novas mutações ameaçadoras.

Distribution and abundance of dinoflagellates from the coastal waters of Karachi, Pakistan, northern part of the Arabian Sea / Distribuição e abundância de dinoflagelados nas águas costeiras de Karachi, Paquistão, parte norte do Mar da Arábia

The present study reports on seasonal and spatial variations in diversity, distribution and abundance of dinoflegellates and indicates the presence of HAB species in Pakistan waters. A total of 179 taxa, recorded in this study from offshore and near-shore waters, belong to 41 genera in 26 families and 10 orders. The high species count (149 species) was recorded from Manora Island offshore station (MI-1) and 105 spp, 109 spp and 115 spp were encountered from the Mubarak village offshore station (MV-1), Manora near shore station (MI-2) and Mubarak Village near-shore station (MV-2) respectively. Tripos furca was the dominant and frequently occurring species (> 1 x103 to > 25 x103 cells L-1 from coastal and >1x 105 cells L-l from near-shore stations) in addition to less abundant Alexandrium catenella, Alexandrium sp., Alexandrium minutum, and Prorocentrum micans (>103 to 25x 103cells/L). Another 44 species occurred in relatively low numbers (<103 cell L-l). Seventy species were found throughout the study period at all four stations. High number of species in three genera (Tripos (38), Protoperidinium (34) and Prorocentrum (20) was recorded. Potently toxic (16 genera 43 species) and HAB related (19 genera and 30 species) dinoflagellate taxa were also recorded. The percent contribution of dinoflagellates in total phytoplankton population generally remained below 20% except for a few instances. Manora Island stations had comparatively higher Shannon index and equitability and slightly lower dominance index. The PCA plot showed strong positive correlation among chlorophyll-a concentration, dissolved oxygen, total number of phytoplankton and dinoflagellates.

O presente estudo relata variações sazonais e espaciais na diversidade, na distribuição e na abundância de dinoflegelados e indica a presença de espécies de HAB nas águas do Paquistão. Um total de 179 táxons, registrados nesse estudo de águas offshore e próximas à costa, pertence a 41 gêneros em 26 famílias e 10 ordens. A alta contagem de espécies (149 espécies) foi registrada na estação offshore da Ilha de Manora (MI-1) e 105 spp., 109 spp. e 115 spp. foram encontrados na estação offshore da vila de Mubarak (MV-1), Manora perto da estação costeira (MI- 2) e estação próxima à costa da Vila de Mubarak (MV-2), respectivamente. Tripos furca foi a espécie dominante e de ocorrência frequente (> 1 x103 a > 25 x103 células L-1 da costa e > 1x 105 células Ll de estações próximas à costa), além de Alexandrium catenella menos abundante, Alexandrium sp., Alexandrium minutum e Prorocentrum micans (> 103 a 25x 103 células/L). Outras 44 espécies ocorreram em números relativamente baixos (< 103 células L-1). Setenta espécies foram encontradas durante o período de estudo em todas as quatro estações. Foi registrado um alto número de espécies em três gêneros (Tripos (38), Protoperidinium (34) e Prorocentrum (20). Potencialmente tóxicos (16 gêneros e 43 espécies) e HAB relacionados (19 gêneros e 30 espécies), táxons de dinoflagelados também foram registrados. A contribuição percentual de dinoflagelados na população fitoplanctônica total geralmente permaneceu abaixo de 20%, exceto em alguns casos. As estações da Ilha de Manora tinham índice de Shannon comparativamente mais alto e equitabilidade e índice de dominância ligeiramente mais baixos. O gráfico de PCA mostrou forte correlação positiva entre concentração de clorofila-a e oxigênio dissolvido, número total de fitoplânctons e dinoflagelados.

Distribution and abundance of dinoflagellates from the coastal waters of Karachi, Pakistan, northern part of the Arabian Sea

Abstract The present study reports on seasonal and spatial variations in diversity, distribution and abundance of dinoflegellates and indicates the presence of HAB species in Pakistan waters. A total of 179 taxa, recorded in this study from offshore and near-shore waters, belong to 41 genera in 26 families and 10 orders. The high species count (149 species) was recorded from Manora Island offshore station (MI-1) and 105 spp, 109 spp and 115 spp were encountered from the Mubarak village offshore station (MV-1), Manora near shore station (MI-2) and Mubarak Village near-shore station (MV-2) respectively. Tripos furca was the dominant and frequently occurring species (> 1 x103 to > 25 x103 cells L-1 from coastal and >1x 105 cells L-l from near-shore stations) in addition to less abundant Alexandrium catenella, Alexandrium sp., Alexandrium minutum, and Prorocentrum micans (>103 to 25x 103cells/L). Another 44 species occurred in relatively low numbers ( 103 cell L-l). Seventy species were found throughout the study period at all four stations. High number of species in three genera (Tripos (38), Protoperidinium (34) and Prorocentrum (20) was recorded. Potently toxic (16 genera 43 species) and HAB related (19 genera and 30 species) dinoflagellate taxa were also recorded. The percent contribution of dinoflagellates in total phytoplankton population generally remained below 20% except for a few instances. Manora Island stations had comparatively higher Shannon index and equitability and slightly lower dominance index. The PCA plot showed strong positive correlation among chlorophyll-a concentration, dissolved oxygen, total number of phytoplankton and dinoflagellates.

Resumo O presente estudo relata variações sazonais e espaciais na diversidade, na distribuição e na abundância de dinoflegelados e indica a presença de espécies de HAB nas águas do Paquistão. Um total de 179 táxons, registrados nesse estudo de águas offshore e próximas à costa, pertence a 41 gêneros em 26 famílias e 10 ordens. A alta contagem de espécies (149 espécies) foi registrada na estação offshore da Ilha de Manora (MI-1) e 105 spp., 109 spp. e 115 spp. foram encontrados na estação offshore da vila de Mubarak (MV-1), Manora perto da estação costeira (MI- 2) e estação próxima à costa da Vila de Mubarak (MV-2), respectivamente. Tripos furca foi a espécie dominante e de ocorrência frequente (> 1 x103 a > 25 x103 células L-1 da costa e > 1x 105 células Ll de estações próximas à costa), além de Alexandrium catenella menos abundante, Alexandrium sp., Alexandrium minutum e Prorocentrum micans (> 103 a 25x 103 células/L). Outras 44 espécies ocorreram em números relativamente baixos ( 103 células L-1). Setenta espécies foram encontradas durante o período de estudo em todas as quatro estações. Foi registrado um alto número de espécies em três gêneros (Tripos (38), Protoperidinium (34) e Prorocentrum (20). Potencialmente tóxicos (16 gêneros e 43 espécies) e HAB relacionados (19 gêneros e 30 espécies), táxons de dinoflagelados também foram registrados. A contribuição percentual de dinoflagelados na população fitoplanctônica total geralmente permaneceu abaixo de 20%, exceto em alguns casos. As estações da Ilha de Manora tinham índice de Shannon comparativamente mais alto e equitabilidade e índice de dominância ligeiramente mais baixos. O gráfico de PCA mostrou forte correlação positiva entre concentração de clorofila-a e oxigênio dissolvido, número total de fitoplânctons e dinoflagelados.

Therapeutic Effect Of Silver Nanoparticles Against Diethyl Nitrosamin And Carbon Tettrachloride-Induced Hepatocellular Carcinoma In Rats

Objective: Hepatic cancer is known as primary liver cancer and hepatocellular carcinoma (HCC). Newly silver nanoparticles gained importance due to its advantages and multiple potential such as molecular imaging agent, antimicrobial, wound healing, anti-inflammatory and anticancer activity. The current study deals to assess therapeutic property silver nanoparticles (AgNPs) against diethylnitrosamine (DENA), and carbon tetrachloride (CCL4) induced hepatic cancer. Methods: Thirty male albino rats (200-250g) were distributed into four groups and hepatic cancer was induced with a single intraperitoneal dose of 200 mg/kg body weight of DENA. Two weeks later, animals received subcutaneous injections of CCl4 once a week in a dose of 3 ml/kg body weight for 6weeks. Serum biomarkers, antioxidants enzymes, inflammatory markers were evaluated to find the anti-proliferative potential of silver nanoparticles. Histological evaluation and microscopic reports were also done to document the results of the current work. Results: AgNPs significantly recover the serum marker enzymes of hepatic parameter AST, ALT, ALP, and total bilirubin and also decreased the levels of NO, IL-6 and TNF-α. Histopathological features also exhibited recovery of a hepatic architecture in cancer-induced rats. Moreover, the immunohistochemical investigation demonstrated that the levels of PCNA, and Caspase-3, which are hepatocarcinogenic markers, were significantly improved by AgNPs. Conclusion: These results concluded that AgNPs showed promising curing effects on hepatocellular ailments.

Evaluation of new technique of mesh fixation in laparoscopic inguinal hernia repair

Background: Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work was to evaluate a new technique for mesh fixation by Zein method of suturing and compare it with stapled mesh fixation in laparoscopic inguinal hernia repair transabdominal preperitoneal approach.Methods: The study is a randomized, prospective single group study. The study was conducted after the approval of the ethical committee of the surgical department, Menoufia University. It was conducted in Menoufia University Hospital on 50 patients with inguinal hernia who were operated upon between September 2018 and September 2019 with a minimal follow-up of 6 months.Results: Age of studied patients ranged from 27 to 55 years with mean 42.82±7.90 age/years. Regarding sex of studied patients, more than half (74%) of studied patients were males and (26%) were females. Regarding comparsion between high and low overall cost burden on the patient, it was interestingly found that high cost is associated with presence of complication like hematoma, prolonged stay in the hospital and prolonged use of antibiotics.Conclusions: Both the use of sutures and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.

Assessment of genetic variability of chilli in Western Himalayan Region

Aim: The present study was conducted with the aim to collect and evaluate the available genetic diversity of chilli (Capsicum annuum L.) in order to identify promising accessions for cultivation as well as use in crop improvement. Methodology: A total 78 accessions of chilli were collected from Western himalayan region, i.e., Kashmir valley of India. Collected germplasm was evaluated at one location for fifteen quantitative traits of horticultural importance. Results: With ample diversity in these traits, a high coefficient of variation was found. Principal Component Analysis (PCA) revealed that first five principal components possessed eigen value > 1, cumulatively contributed > 65.2 percent of total variability. All the genotypes were grouped into five clusters showing non parallelism between geographic and genetic diversity. Interpretation: The genotypes grouped in different clusters may be utilized for hybridization programme to produce more heterotic recombinants.

The state of emergency medical technician education in Ghana

Objective: The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. Methods: A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. Results: Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). Conclusion: The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning

Burden of care perceived by the principal caregivers of autistic children and adolescents visiting health facilities in Lucknow City

Background: Autism is extraordinarily difficult for families to cope with for various reasons. Perceived burden and care for the child with autism, available forms of social support, and the interactions between the autistic child and other family members are areas of significant concern for families. Objective: The objective of this study was to determine the burden of care perceived by the principal caregivers of autistic children or adolescent visiting health facilities in Lucknow city. Methods: The cross-sectional study was conducted from October 2016 to September 2017 with a sample of 90 principal caregivers (aged <60 years) of autistic children and adolescents aged 3–19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India. Validated tools were used to assess the burden of care and disability level of autistic children. Data were analyzed using the software SPSS version 16. Results: The caregivers of autistic children and adolescents perceived the burden of care in different domains in varying extent with “caregiver's routine” and “taking responsibility” domains affected the most. The burden perceived was found to be affected by the permanent residence of caregiver, rural/urban dwelling, type of family, socioeconomic status, age at which diagnosis was made, knowledge about autism and the severity of autism. Conclusions: Availability and easy accessibility of autism treatment facilities must be the most probable reason for less burden perceived in three domains, by caregivers of urban settings and those belonging to Lucknow. Furthermore, better knowledge on autism and family and friends' support led to decrease in the burden perceived by the caregivers in various domains. Thus, it was found that the burden perceived can be reduced by universal availability of evidence-based early diagnosis and treatment of autism and improving the knowledge of caregivers about autism.

Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial

Background: The current study aims to compare the use of tamoxifen and oral contraceptive pills in women using implanon and complain with irregular uterine bleeding.Methods: Women attended family planning clinic using implanon presented by bleeding were invited to participate in the study. They were randomized into two groups: Group A: 100 women received Tamoxifen 10 mg twice daily for 10 days taken at the onset of an episode of bleeding or spotting episode. Group B: 100 women received Combined oral contraceptive pills (microcept) once daily for 21 days take at the onset of an episode of bleeding or spotting episode.Results: No difference regarding the baseline criteria of both groups. No difference between both groups regarding the duration of irregular bleeding in the implanon users (p=0.090). Additionally, the number of bleeding days and spotting in the last month was similar in both groups (p=0.554). The percentage of women who stopped bleeding during the period of treatment is 84% in the tamoxifen group and 92% in the COCs group, but the COCs needs longer treatment time, where the mean of days required to stop bleeding is 5.03±1.8 days in the tamoxifen group and 6.5±2.5 in the COCs group. Headache and nausea were the most prominent adverse effects found in the COCs group (p=0.000).Conclusions: Oral administration of tamoxifen 10 mg twice daily for 10 days is effective on stopping bleeding attacks in implanon users.

Prevalence and risk factors of asthma symptoms in Saudi university students in Najran, southern border region of Saudi Arabia

Background: Asthma prevalence in adults is globally increasing with variations between and within countries. Data are lacking regarding the prevalence of asthma among adults in Najran area , the southern region of Saudi Arabia. Objectives: The study aimed at estimating the prevalence and risk factors for asthma symptoms in Najran University students. Materials and Methods: A cross-sectional study was performed in Najran University Saudi students during the academic year 2017–2018. A modified translated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was distributed to Najran University Saudi students, males and females aged 18 and above living in Najran for more than 1 year. Samples were taken using multistage random sampling. Results: A total of 418 participants (269 males and 149 females) with a mean age of 21.05 ± 1.56 were included in the study. The prevalence of asthma depending on the wheezing symptom in the past 12 months was 27% and physician-diagnosed asthma was 13.6%. Most of the asthmatic subjects (>85%) have intermittent symptoms. The first-degree family history, active tobacco smoking, allergic rhinitis (AR), dust, and smoke are the major risk factors for asthma symptoms. Conclusions: The study revealed a high prevalence of self-reported asthma symptoms among adults in Najran University associated with a high prevalence of AR, which needs particular attention by the health stakeholders.

Patients risk factors as predictors of surgical wound infection following open heart surgery

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1­2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA.Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection

Left ventricular function as an independent prognostic factor for coronary artery bypass surgery

Background : Studies have suggested that patients with severe impairment of left ventricular function had a poor outcome following CABG surgery. Objectives: Evaluation of the role of pre-operative left ventricular function on the early post-operative mortality and morbidity following CABG. Patients and methods: This study was carried out from August 2016 to January 2017 including 40 patients undergoing CABG surgery. Patients were divided into two equal groups each containing 20 patients. Group A contained 20 patients with pre-operative ejection fraction > 50%, while group B contained 20 patients with pre-operative ejection fraction < 50%. Results: Mortality was 2 patients in group A (10%) compared to 5 patients in group B (25%) (P value = 0.031). The mean ICU stay in group A was 3.29 ± 1.49 days compared to 4.22 ± 1.98 days in group B (P value = 0.028). Pre-operative renal dysfunction improved in 2 patients (10%) from group A, compared to 1 patient (5%) in group B (P value = 0.555). Conclusion: Left ventricular function as an independent factor is a good prognostic factor regarding the early postoperative outcome in coronary artery bypass grafting including mortality, operative times, ICU stay and hospital stay

Incisional negative pressure wound therapy (INPWT) for coronary artery bypass grafting patients

Background: Surgical site infections are major complications of coronary artery bypass grafting using bilateral internal thoracic arteries. In this study we reviewed the results of using INPWT for high risk patients with coronary artery bypass grafting (CABG) using bilateral internal mammary arteries. Patients and methods: From January 2013 to December 2016, patients with coronary artery bypass grafting using bilateral mammary arteries were enrolled in this study. Patients were from Kasr El-Einy, Beni-Suef and Fayoum University Hospitals. The total number was 427 patients, where INPWT was used in 161 patient, and conventional sterilized dressing was done in 266 patients. 2 groups were matched for statistical analysis, the first group was the control and the second group was where INPWT was used. Results: The results related to sternal wound infections were similarly attributed to the conventional group (10.9%) and the INPWT group (10.2%) (P=1.00). Patients treated with INPWT had less rate of infection than those with conventional dressing (5.5% versus 10.2%, P= 0.210), this difference was not statistically significant. Interaction tests also showed comparable results for SSI (surgical site infections) among patients with or without significant co-morbidities. Conclusion: This study suggests that the use of INPWT did not decrease the incidence of sternal wound infections in patients who had CABG surgery using bilateral internal mammary harvesting (BIMA). A larger randomized study is needed to evaluate the efficacy of this technique

Antibiotic resistance profile in relation to virulence genes fimH, hlyA and usp of uropathogenic E. coli isolates in Lahore, Pakistan

@#Uropathogenic E. coli (UPEC) is the major etiological agent of urinary tract infections. The objectives of this study were to evaluate E. coli isolates from these patients for the phenotypic pattern of antibiotic resistance and to detect the genes responsible for virulence namely fimH, hlyA and usp. A total of 110 E. coli isolates were studied and 30 antibiotics were applied for susceptibility testing. PCR detection of the genes fimH, hlyA and usp was done followed by sequencing and phylogenetic analysis. The results showed that the isolates were highly resistant to cephalaxin (100%) and cephradine (100%) but displayed high sensitivity to amikacin (96.27%), Imipenem (92.63%) and Meropenem (92.63%). The prevalence of fimH, hlyA and usp was 86%, 83% and 16%, respectively. The sequencing showed 99% similarity with previously reported sequences in NCBI GenBank database. The co-existence of multiple drug-resistant bodies and virulent genes has important implications for the treatment of patients with urinary tract infection. This study provides information about treating drug-resistant E. coli and the relationship of virulent genes with phenotypic resistance patterns.

Lower Levels of Serum Adiponectin and the T Allele of rs1501299 of the ADIPOQ Gene Are Protective against Polycystic Ovarian Syndrome in Jordan / 가정의학회지

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive disorder. Obesity, which is linked with lower adiponectin levels, increases a woman's risk of developing PCOS; however, the association between adiponectin and PCOS is controversial. Adiponectin levels could be affected by single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. This study aimed to test the relationship between serum adiponectin and PCOS in Jordan and the association between the rs2241766, rs1501299, and rs266729 SNPs in the ADIPOQ gene and PCOS. METHODS: One hundred and fifty-four women with PCOS and 149 age- and body mass index–matched normally menstruating controls were recruited. Serum adiponectin levels were measured using enzyme-linked immunosorbent assay. Genotyping was performed using polymerase chain reaction–restriction fragment length polymorphism analysis. RESULTS: Serum adiponectin levels were significantly lower (P=0.0064) in PCOS women and rs1501299 (+276 G/T) genotype distributions were significantly different (P=0.01) between them and normally menstruating women. Multivariate analysis revealed that adiponectin levels remained significantly lower in PCOS women (P=0.001; odds ratio [OR], 0.9; 95% confidence interval [CI], 0.84–0.96). The GT genotype of rs1501299 increased the risk of PCOS (P < 0.001; OR, 5.46; 95% CI, 2.42–12.33) and increased the risk of PCOS by three-fold (P < 0.001; OR, 3.00; 95% CI, 1.36–6.60) relative to the TT genotype. The GG genotype increased the risk of PCOS as well (P < 0.001; OR, 3:00; 95% CI, 1.36–6.60). CONCLUSION: PCOS is associated with lower serum adiponectin levels independent of age and body mass index. The T allele of the rs1501299 (+276 G/T) SNP of the ADIPOQ gene protects against PCOS.

RIGHT SIDED CONGENITAL DIAPHRAGMATIC HERNIA OF MORGAGNI TYPE IN ADULTS: A RARE ENTITY

@#Congenital diaphragmatic hernia (CDH) is an anomaly of infants. It is associated with other anomalies, including pulmonary hypoplasia, malrotation of the gut and patent ductus arteriosus (PDA). Hence it is essential that it is diagnosed early. Sometimes, it can remain unrecognized till adulthood, if no other associated developmental anomalies, like pulmonary hypoplasia, occur. In adults, it is diagnosed when intestinal contents herniate into the thorax causing pulmonary and intestinal complications. It is mostly present on the left side because of late fusion of the pleuro-peritoneal membranes, and the absence of the liver on the left side. Moreover, it is commonly due to trauma in adults. A case report of a right sided diaphragmatic hernia of Morgagni type in an adult was discussed

Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt

This study was conducted in the neonatal intensive care unit of Benha University Hospital, Egypt from 1 August 2012 to the 31 January 2013 to identify medical errors and to determine the risk factors and consequences of these errors. Errors were detected by follow-up of neonates and review of reports including nursing follow-up sheets, resident progression notes and investigation reports. We detected 3819 errors that affected 97% of neonates. Types of errors included 403 medication errors [10.55% of total errors], 652 errors in daily routine procedures [17.07%], 1042 errors in invasive procedures [27.28%], 68 errors in nutrition [1.78%], 63 equipment errors [1.64%], 260 administration errors [6.8%], 656 staffing errors [17.18%], 107 environmental errors [2.8%], 448 infection control errors [11.73%] and 120 nosocomial infection errors [3.14%]. Medical errors were high in low birth weight, low gestational age neonates and increased with duration of admission

Effect of Flaxseed Extract on the Liver Histological Structure in Streptozotocin Induced Diabetic Rats

Introduction: Diabetes mellitus has become a serious warning to mankind health all over the world. The management goal of diabetes is to keep blood glucose levels as close as possible to healthy individuals. Medications used to treat diabetes are usually associated with complications and may cause different side effects. Many traditional anti-diabetic plants have become popular in the management of diabetes mellitus. Flaxseed has been used as traditional medicine for centuries. Objective: This study aimed to evaluate the hepatoprotective effects of flaxseed extract in streptozotocin (STZ)-induced diabetic rats. Methods: Diabetes mellitus was induced in Sprague-Dawley rats using a single injection of streptozotocin (60 mg/kg i.p.). The rats were divided into five groups of 8 rats each. Group NC, normal control rats; Group NF, normal rats treated with flaxseed extract (400 mg/kg); Group DC, diabetic control rats; Group DG, diabetic rats treated with glibenclamide (0.6 mg/kg); Group DF, diabetic rats treated with flaxseed extract (400 mg/kg); for 4 weeks. Results: There were significant increase in relative liver weight, blood glucose levels in DC group comparing to NC group (p<0.05). The disturbance of these parameters was ameliorated in DF and DG groups. Histological observation revealed congestion of central veins, degeneration of hepatocytes, and reduced glycogen granules in DC group. These pathological changes were ameliorated in the flaxseed extract and glibenclamide treated rats. Conclusion: Flaxseed extract may represent a candidate alternative treatment to control diabetes mellitus and its related hepatopathy.