Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

The prognostic roles of PYCR2 and ZBTB18 expression in tissues of colorectal carcinoma and non-neoplastic tissues: an immunohistochemical study

Background: It is important to detect novel biomarkers responsible for the progression and spread of colorectal cancer (CRC) to better evaluate the prognosis of the patients, provide better management, and foster the development of therapeutic targets. In humans, pyrroline-5-carboxylate reductase 2 (PYCR2) is encoded on chromosome 1q42.12, and its metabolic activity has been linked to oncogenesis in many cancers. Zinc finger and broad-complex, tramtrack, and bric-à-brac (BTB) domain-containing protein 18 (ZBTB18), a zinc finger transcriptional repressor, has been found to have a tumor-suppressor role and to be methylated in CRCs. To date, the prognostic roles of PYCR2 and ZBTB18 in CRC patients have not been thoroughly studied. Objective: To evaluate the tissue protein expression of PYCR2 and ZBTB18 in CRC and adjacent non-neoplastic intestinal tissues, to detect their roles in CRC carcinogenesis, progression and metastases. Patients and methods: After applying the inclusion criteria, 60 CRC patients were included in the study. Tissue samples from the tumor and the adjacent non-neoplastic tissues were stained with PYCR2 and ZBTB18. The patients were followed up for about 30 months (range: 10 to 36 months). We performed a correlation regarding the expression of the markers, and clinicopathological and prognostic parameters. Results Upregulation of PYCR2 and downregulation of ZBTB18 were found to be higher in CRC tissue than in the adjacent non-neoplastic colonic mucosa (p = 0.026 and p < 0.001 respectively). High expression of PYCR2 and low expression of ZBTB18 were positively correlated with large tumor size, higher tumor grade, advanced tumor stage, presence of spread to lymph nodes, and presence of distant metastases (p < 0.001). High PYCR2 and low ZBTB18 expressions were significantly associated with poor response to therapy (p = 0.008 and 0.0.17 respectively), as well as high incidence of progression and recurrence (p = 0.005), and unfavorable overall survival (OS) rates (p = 0.001). Conclusion: High expression of PYCR2 and low expression of ZBTB18 were independent predictors of CRC, progression, poor prognosis and unfavorable patient OS and progression-free survival (PFS) rates. (AU)

Surgical roles in the management of metachronus para-aortic lymph node recurrence and synchronous para-aortic lymph node metastasis in colorectal cancer patients

Background: The relative rarity of synchronous para-aortic lymph node (PALN) metastasis (SPM) and metachronous PALN recurrence (MPR) in colorectal carcinoma (CRC) patients leads to a limited number of studies on patient management, and no treatment guidelines have been established to date. Objective: To assess the prognostic, predictive roles, and long-term outcomes of different management strategies for isolated MPR and SPM in CRC patients to establish the best one. Materials and Methods: We included 35 CRC patients with isolated MPR and 25 patients with isolated SPM who underwent curative R0 resection. We performed PALN dissection (PALND) in 15 cases in MPR group and in 10 cases in the SPM group; all remaining patients in both groups underwent chemoradiotherapy (CRT) without further surgical intervention. During the study period of about 5 years, we compared the patients who underwent PALND and those who underwent CRT. Results: The overall survival and recurrence-free survival rates were significantly longer in patients who underwent PALND (p = 0.049 and 0.036 respectively). (AU)

A comparison between different management surgical approaches in the treatment of splenic flexure colon cancer

Background: There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective: In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results: We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion: We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure. (AU)

The Sanitary Conditions of Bakeries and Food Safety Practices Assessment of Bakers in Tamale Metropolis, Ghana

There is a lack of research on the safety of bread in Ghana, although it is one of the foods consumed by most Ghanaians daily. The study, therefore, assessed the sanitary conditions of bakeries in the Tamale Metropolis and further evaluated the food safety practices of bakers in these bakeries. The study employed the use of a questionnaire to collect data in 24 carefully selected bakeries and then the food safety practices of bakers in these bakeries. Results showed that 91.7% of the bakeries had bakers wearing protective gears while working. All (100%) the bakeries were free of domestic animals and a visible presence of insects, rodents or vectors. However, 6(25%) bakeries placed their solid waste containers in the bakery premises. Also, 89.5% of the bakers indicated that they always wash their hands with soap and water before working or handling baking ingredients and materials. All (100%) bakers indicated that they check the expiry dates of their bakery ingredients before using them. 29.8% of the bakers, however, did not make it a practice of refrigerating bakery ingredients that require to be stored in the fridge when not in use. In conclusion, most bakeries had good sanitary conditions and were managed in a manner that ensure food safety. Bakers also exhibited a good level of food safety adherence. Managers should continue to ensure that good sanitary standards are followed and food risk analysis concepts like HACCP are implemented in the bakery to check new and complex food safety threats.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Fracture resistance and strain analysis of zirconia copings with vertical knife edge and three horizontal finish line designs; chamfer, deep chamfer and shoulder with two cementation techniques / Resistência à fratura e análise de deformação de copings de zircônia com término cervical em lâmina de faca e três términos horizontais; chanfro, chanfro largo e ombro com duas técnicas de cimentação

Objective: The purpose of this in vitro study is to evaluate the effect of four finish line configurations and two cement types on the fracture resistance of zirconia copings. Material and Methods: Forty yttrium tetragonal zirconia polycrystals copings were manufactured on epoxy resin dies with four preparation designs: knife edge, chamfer, deep chamfer 0.5, 1 mm and shoulder 1 mm. The copings were cemented with two cement types (glass ionomer and resin cement); (n = 5). Two strain gauges were attached on each coping before they were vertically loaded till fracture with a universal testing machine. Data were analyzed by 2-way analysis of variance ANOVA (p < .05). Fractured specimens were examined for mode of failure with digital microscope. Results: Knife edge showed the highest mean fracture resistance (987.04 ± 94.18) followed by Chamfer (883.28 ± 205.42) followed by Shoulder (828.64 ± 227.79) and finally Deep chamfer finish line (767.66 ± 207.09) with no statistically significant difference. Resin cemented copings had higher mean Fracture resistance (911.76 ± 167.95) than glass ionomer cemented copings (821.55 ± 224.24) with no statistically significant difference. Knife edge had the highest strain mean values on the buccal (374.04 ± 195.43) and lingual (235.80 ± 103.46) surface. Shoulder finish line showed the lowest mean strain values on the buccal (127.47 ± 40.32) and lingual (68.35 ± 80.68) with no statistically significant difference. Resin cemented copings had higher buccal (295.05 ± 167.92) and lingual (197.38 ± 99.85) mean strain values than glass ionomer copings (149.14 ± 60.94) and (90.27 ± 55.62) with no statistically significant difference. Conclusion: Vertical knife edge finish line is a promising alternative and either adhesive or conventional cementation can be used with zirconia copings (AU)

Objetivo: O objetivo deste estudo in vitro é avaliar o efeito de quatro configurações de términos cervicais e dois tipos de cimentos na resistência à fratura de copings de zircônia. Material e Métodos: Quarenta copings de zircônia tetragonal policristalina estabilizada por ítrio foram confeccionados em matrizes de resina epóxi com quatro tipos de términos cervicais: lâmina de faca, chanfro, chanfro largo 0,5, 1 mm e ombro 1 mm. Os copings foram cimentados com dois tipos de cimento (ionômero de vidro e cimento resinoso); (n = 5). Dois extensômetros foram fixados em cada coping antes de serem carregados verticalmente até a fratura com uma máquina de teste universal. Os dados foram analisados por análise de variância ANOVA 2 fatores (p < 0,05). Os espécimes fraturados foram examinados quanto ao modo de falha com microscópio digital. Resultados: A Lâmina de faca apresentou a maior média de resistência à fratura (987,04 ± 94,18) seguida pelo Chanfro (883,28 ± 205,42), pelo Ombro (828,64 ± 227,79) e finalmente o Chanfro largo (767,66 ± 207,09), sem diferença estatisticamente significativa. Os copings cimentados com cimento resinoso apresentaram maior média de resistência à fratura (911,76 ± 167,95) em relação aos copings cimentados com ionômero de vidro (821,55 ± 224,24), sem diferença estatisticamente significativa. A lâmina de faca apresentou os maiores valores médios de deformação na superfície vestibular (374,04 ± 195,43) e lingual (235,80 ± 103,46). O término em ombro apresentou os menores valores médios de deformação na superfície vestibular (127,47 ± 40,32) e lingual (68,35 ± 80,68), sem diferença estatisticamente significativa. Os copings cimentados com resina apresentaram maiores valores médios de deformação na superfície vestibular (295,05 ± 167,92) e lingual (197,38 ± 99,85) do que os copings cimentados com ionômero de vidro (149,14 ± 60,94) e (90,27 ± 55,62), sem diferença estatisticamente significativa. Conclusão: O término cervical em lâmina de faca é uma alternativa promissora e a cimentação adesiva ou convencional pode ser usada na cimentação de copings de zircônia. (AU)

Granulocyte-Macrophage colony stimulating factor in asthmatic patients infected with respiratory syncytial virus

@#Introduction: It is estimated that at least 30 to 40% of asthma attacks in adults are related to respiratory infections with viruses. The majority of asthma-related viruses include respiratory syncytial virus (RSV), rhinovirus, and parainfluenza. Inflammatory cytokines are supposed to play a vital role in causing inflammation of the respiratory tract as regulators of proliferation, chemotaxis, and activation of inflammatory cells. Objectives: The aim of this study is to assess the role of Granulocyte Macrophage-Colony Stimulating Factor (GMCSF) in asthmatic airway hyper-responsiveness associated with RSV infections. Materials and Methods: Forty five asthmatic cases and 45 healthy individuals were studied in a cross-sectional design. All asthmatics underwent symptom score assessment.GMCSF concentrations in sputum and RSV-IgM/IgG in serum samples were measured for all participants by Enzyme Linked Immuno-Sorbent Assay (ELISA). Results: The GM-CSF concentration level was significantly higher in asthmatics (270.27± 194.87pg/mL) especially among moderate and severe disease with mean concentration of 197.33±98.47 and 521.08± 310.04 respectively, compared to healthy controls (22.20±21.27 pg/ mL) (p=0.0001). The sputum level of GM-CSF in asthmatics is highly significant associated with positive anti-RSV IgG sera which represents 35/45(77.8%) with mean GM-CSF concentration of (276.99± 86.42) compared with controls at about 31/45 (68.9%) with GM-CSF mean concentration of (22.84±23.47). On the other hand, positive anti-RSV IgM in asthma cases was 8 out of 45(17.8 %) with GM-CSF mean concentration of (307.25± 306.65). Furthermore, GM-CSF sputum level was significantly correlated with eosinophil count especially in moderate and severe asthma. Conclusions: This study revealed that GM-CSF level is associated with eosinophilia and indicates asthma severity that might be evident during RSV infection .The distinctive GM-CSF features observed in the sputum from asthmatics with RSV may be useful as a diagnostic methods to help match patients with antibody therapy.

Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

@#Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Insuffisance mitrale aigue ischémique place de l'angioplastie coronaire. A propos d'un cas / Acute ischemic mitral insuffi ciency instead of coronary angioplasty. About a case report

Introduction. L'insuffi sance mitrale ischémique est une complication fréquente et représente un facteur de mauvais pronostic. Sa prise en charge thérapeutique est diffi cile. L'objectif de ce travail est de réévaluer l'intérêt de la revascularisation par angioplastie en cas d'insuffi sance mitrale ischémique importante. Observation et conclusion. Nous rapportons le cas d'un patient âgé de 48 ans ayant comme facteurs de risque cardiovasculaire ; une hypertension artérielle non suivie et un tabagisme actif (20 Paquets/année) qui s'était présentait pour un syndrome coronaire aigu compliqué d'une insuffi sance mitrale sévère et d'une insuffi sance cardiaque gauche avec une altération de la fraction d'éjection ventriculaire gauche à l'échocardiographie. La coronarographie montrait une atteinte tritronculaire. La revascularisation complète par angioplastie a permis une bonne évolution à cinq (5) ans

Prevalence and Determinants of Toxoplasma Seropositivity among Women Who had Spontaneous Abortion in Gombe, North-Eastern Nigeria

Aim: To determine the seroprevalence and determinants of Toxoplasma IgG and IgM seropositivity among women with spontaneous abortion in Gombe.Materials and Methods: Thiswas a cross-sectional study of 302 pregnant women with spontaneous abortion, presenting at the gynaecological emergency units of Federal Teaching Hospital Gombe and State Specialist Hospital Gombe. An interviewer-administered questionnaire was used to collect data, and a venous blood sample was drawn from each participant and tested for Toxoplasma IgG and IgM by ELISA technique. Results: Toxoplasma seroprevalence was 62(20.5%) and was higher in women that owned cats (24% vs 20.1%, OR 1.3, 0.5-3.1) and ate grilled meat (suya) (21.0% vs 11.8%, OR 2.0, 0.4-9.0), but lower in those that washed fruits and vegetables before consumption (OR 0.6, 0.2-1.4).Conclusion:Seroprevalence of Toxoplasmosis in Gombe is high and may be influenced by cat ownership cooking and eating habit.

Subtipo Persecutorio Del Trastorno Delirante: Estudio De Series De 129 Casos / Persecutory Subtype Of Delusional Disorder. Descriptive Study Of 129 Cases

Resumen Objetivo. El objetivo de este estudio es conocer las características demográficas, factores ambientales, factores de riego psicosociales, y clínicas del subtipo persecutorio en un grupo de pacientes con trastorno delirante (TD). Metodología. Estudio epidemiológico retrospectivo sobre un Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 129 casos presentaban el subtipo persecutorio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Variables de los datos sociodemográficos y generales. II. Variables de los Factores de riesgo del TD (familiares y personales). III. Variables del Cuadro Clínico y el Diagnostico del TD (Presentación, sintomatología delirante, funcionalidad y discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso). Resultados. La proporción hombres versus mujeres en el subtipo persecutorio fue de 1,04. Solo el 5,4% de estos pacientes tenía estudios primarios. Un 65,9%, al realizar la primera consulta psiquiátrica, se encontraba casado y el 50,4% convivían en el hogar. Un 14,7% consumió previamente alcohol y un 0,8% otras sustancias. Las ideas de referencia y de persecución se presentaron el 98,4% y en el 99,2% de los casos respectivamente. Conclusiones. Son necesarios futuros estudios prospectivos para investigar los factores de riesgo del subtipo persecutorio del TD.

Objective. The objective of this study is to investigate the demographic, environmental, psychosocial and clinical characteristics of the persecutory subtype in a group of patients with delusional disorder (DD). Methodology. Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV-TR criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria; of them 129 cases has persecutory subtype. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution). Results. The proportion of males versus females of the persecutory subtype was of 1.04. Only 5.4% of patients had primary level of education. At the first visit of the psychiatry clinic, 65.9% of the patients were married and about half of them shared home. About 14.7% of patients had a past history of alcohol consumption, and only 0.8% consumed other drugs. Ideas of reference and of persecution were found in 98.4% and 99.2% respectively. Conclusions. It is necessary to conduct future prospective studies to investigate the risk factors associated with the persecutory subtype of DD.

Multidetector computed tomography evaluation of synchronous lymphoma and other solid malignancies

Objective: The objective of this study is to review the multidetector computed tomography (MDCT) findings of synchronous lymphoma and other solid malignancies. Patients and Methods: This retrospective study included 18 patients confirmed with diagnosis of lymphoma and other solid malignancies. They were 8 women and 10 men (mean age, 62.5 year; range, 44–73 years). CT scanning was performed on one of the two systems: 64 MDCT in 11 patients and 6 MDCT in 7 patients. All 36 malignancies were underwent pathological evaluation. Results: All cases were confirmed pathologically. Lymphomas were Hodgkin disease ( n = 5 patients) and non-Hodgkin lymphoma ( n = 13 patients). Hepatocellular carcinoma was detected in five patients. Bronchogenic carcinoma was detected in two patients. Renal cell carcinoma was detected in two patients. Breast carcinoma was detected in two patients. Prostatic carcinoma was detected in two patients. Gastric carcinoma was detected in two patients. Endometrial carcinoma was detected in one patient. Colonic carcinoma was detected in one patient. Thyroid carcinoma was detected in one patient. Conclusions: MDCT scanning is accurately imaging modality for the evaluation of synchronous lymphoma and other solid malignancies. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon, and may lead to a new treatment strategy for synchronous lymphoma and other solid malignancies

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants' weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ?0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ?0.05).Conclusions: Factors that could affect DAI were infant's weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians' compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

Areas Of Investment In Omani Sport

@#Omani sport is still searching for new methods to identify its problems and achieve a vision regarding the economic problems in sport, the short-term solutions to revitalize it, and long-term solutions to maintain its stability. It hopes to rise and find an end to its funding problems in order to take off toward international winners’ podiums, especially after the good results achieved lately in several sports. Therefore, the researcher deems it necessary to identify the areas of investment in Omani sport, as potential for investment in the presence of self-finance that covers its financial needs. The researcher used the descriptive method as it is suitable to the nature of the study, and a sample of 273 subjects representing the research population. He used a questionnaire as a data collection instrument, and rank, frequency, percentage in statistical treatment. The main finding of the research was a list of the areas of investment in Omani sport in the following order: launching sports channels, TV streaming, sports professionalism, establishing sporting camps centers, academies of different games, and investment in sporting facilities. The main recommendations were to authorize Omani sporting authorities to launch TV channels to stream their matches, be based on competition with each other, and according to the rules stipulated by the Ministry of Sports Affairs and the Public Authority for Radio and Television

Does a Gradient-Adjusted Cardiac Power Index Improve Prediction of Post-Transcatheter Aortic Valve Replacement Survival Over Cardiac Power Index?

Purpose@#Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. @*Materials and Methods@#We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO× MAP)/[451×body surface area (BSA)] (W/m2). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. @*Results@#The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62–0.72], 0.65 (95% CI, 0.60–0.70), 0.66 (95% CI, 0.61–0.71), and 0.63 (95% CI 0.58–0.68), respectively. @*Conclusion@#GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.

Pressure-induced left ventricular hypertrophy in canine model of aortic stenosis using nylon tie

The aim of this study was to develop an experimentally-induced canine model of left ventricular hypertrophy through banding of the ascending aorta using nylon ties. Seven clinically normal dogs free of cardiovascular disease were used. Nylon tie was used in banding the mid-ascending aorta. Clinical, radiographic and echocardiographic evaluations were done at 1.5, 3 and 6 months. Dogs were euthanized at 6 months for post mortem and histopathological evaluation. Clinically, dogs did not exhibit any signs of cardiovascular disease at 1.5 or 3 months, while at 6 months two dogs (28.6 %) exhibited mild weight loss, exercise intolerance and heart murmurs. Radiographic evaluation revealed significant increase in cardiac size only at 6 months based on measurement of the cardiothoracic area evaluation. Echocardiography revealed increased left ventricular wall thickness starting from 1.5 month, although this increase was statistically significant at 3 and 6 months (p > 0.05). Left ventricular hypertrophy was confirmed by post mortem examination. Histopathological sections of left ventricle in all dogs demonstrated myocyte hypertrophy and interstitial fibrosis. This model simulates the naturally occurring ventricular hypertrophy using a rapid and economic technique. Such models are required to understand pathogenesis of heart disease and to develop effective treatment strategy.

Glomerular filtration rate in homozygous sickle cell disease children in steady state and healthy Nigerian children: a comparative study in north-eastern Nigeria

Background: Homozygous sickle cell disease (HSCD) is the most common inherited blood disorder of public health importance worldwide, with Sub-Saharan Africa accounting for a third of the global burden. The effect of HbS on the kidneys results in sickle cell nephropathy, which contributes to increased mortality among HbSS patients beyond third decade of life. Glomerular filtration rate (GFR) is an important renal function test for evaluating progress of sickle cell nephropathy, however, this is seldom done to HbSS patients especially in the insurgency that devastated the North-eastern part of Nigeria, where displacement of people has led to increase in diarrhoeal diseases with its complications which also contributes to renal diseases, hence the need for this study. Objective: To determine the baseline glomerular filtration rate of homozygous SCD in steady state and compare same with normal controls. Methods: This is a prospective comparative study conducted at the University of Maiduguri Teaching Hospital (UMTH). The study population consisted of age and sex matched HbSS subjects in steady state and children with haemoglobin AA genotypeaged 3-14 years. The study was conducted over a period of 6 months. Anthropometry and serum creatinine of the subjects were determined and GFR calculated using Schwartz formula. Results: Two hundred and twenty children consisting 110 HbSS and 110 controls were enrolled. This consist of 106 males and 114 females with M:F ratio of 0.9:1. Mean ages of HbSS patients and HbAA subjects were 8.2years and 7.9 years respectively. The mean GFR (SD) was 125.9 (31.9) ml/min/1.73m2 and 93.0 (16.1) ml/min/1.73m2 for the HbSS and HbAA controls, the difference between the means was significant (P<0.001). The normal GFR range for the controls was 77 to 109 ml/min/1.73m2. Sixty-seven (61%) casesand 86 (78%) controls had GFRs within normal range. There was statistically significant difference for GFRs above and below the normal range (Z-score=6.2 & -2.9, p<0.001 & p<0.004). Conclusion: About a third of HbSS children in steady state have elevated GFR, this suggests the presence of moderate renal pathology. Regular monitoring of these children will lead to improvements in management of sickle cell nephropathy and their quality of life

Efficacy of olibanum and propolis medicinal extracts versus metronidazole in Giardia lamblia experimentally infected mice

Giardiasis is a common intestinal infection, recently included by the World Health Organization in the 'Neglected Diseases Initiative'. Despite the efficacy of nitroimidazoles; the main antigiardial chemotherapeutics, adverse effects and resistance enforced developing non-chemical alternatives. The present study aimed to assess the therapeutic efficacy of ethanol extract of olibanum (OL), propolis (PR), and their combination versus metronidazole (MTZ) against G. lamblia infection. Sixty Swiss male albino mice were randomly divided into 6 groups; 10 mice each,: Group I: normal control (non-treated; non-infected). Group II: infected with G. lamblia cysts, non-treated. On the 6th day postinfection (dPI), the remaining 4 infected groups were treated orally with: Group III: (OL). Group IV: (PR). Group V: combination of (OL+PR). Group VI: (MTZ). These mice were subjected to direct parasitological diagnosis of Giardia trophozoite in intestinal exudate, immunochromatographic test for antigen detection and histopathological studies. After 7 days therapy, complete clearance of Giardia trophozoites were in the combination of (OL+PR) and MTZ groups therapy. Lower percentages of reduction (91%) & (83%) were recorded in PR and OL-treated groups, respectively. Histopathological examination showed marked healing of intestinal mucosa using non-chemical combination and different degrees of dysplasia using MTZ, while partial healing was observed using olibanum and propolis separately. Olibanum, propolis and their combination were proved to enhance the clearance of Giardia trophozoites; with progressive improvement of the histopathological changes of jejunal mucosa, making good non-chemical alternative antigiardial therapeutics sidestepping the obstacles of metronidazole like dysplasia and teratogenicity

Bone marrow invasion by aspergillus specie in a sickle cell trait patient with invasive aspergillosis: a fatal case in association with disseminated intravascular coagulation

Background: Invasive aspergillosis has been predominantly associated with pulmonary infection, particularly amongst immunocompromised individuals. Extrapulmonary infections with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, haematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. The most frequently involved specie is Aspergillus fumigatus that constitutes over 90% of cases, followed by Aspergillus flavus, usually associated with a primary skin infection. Haematogenous spread to the bone causing osteomyelitis is the commonest form of disseminated aspergillosis and a surprisingly high proportion of these patients have no immunosuppression. We present a rare case of bone marrow invasion by Aspergillusspp. in a 3-year-old patient with sickle cell trait and chronic Aspergillosis. Case report: A 3-year-old patient with sickle cell trait was brought to the paediatric unit with recurrent diarrhoea, abdominal distention, weight loss and persistent cough. The child was severely wasted with generalised peripheral lymphadenopathy. She had marked respiratory distress and hepatosplenomegaly but no demonstrable ascites. Haematologic examination revealed leukaemoid reaction (leukocyte count of 44.0 x 109/L) with monocytosis (10%) and thrombocytopenia (platelet count of 97,000/mm3); no blast cells were seen on blood film. The bone marrow was hypercellular with a myeloid/erythroid ratio of 20:1, consistent with infection. Bone Marrow culture yielded Aspergillus spp. and other results of sepsis work up were negative. Conclusion: Cases of extrapulmonary invasive aspergillosis have been reported rarely in both immunocompetent and immunocompromised patients. Haematogenous spread to the bone is the commonest form of disseminated disease