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Background@#and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. @*Methods@#We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. @*Results@#Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). @*Conclusion@#LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.
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Background: Polycystic Ovary Syndrome [PCOS] is one of the most common causes of anovulatory infertility. Currently, clomiphene citrate [CC] is considered the first-line therapy for ovulation induction for women with PCOS and infertility. Aromatase inhibitors [AIs] have been introduced as a new treatment option that could challenge CC for ovulation induction
Aim of the Work: The present study was designed to compare the efficacy of combined aromatase inhibitor [Letrozole] with metformin versus CC with metformin in PCOS patients
Patients and Methods: This study was done on 100 documented PCOS cases. They were divided into two groups, The 1st group received CC 50 mg twice daily from the 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with CC and continued for 3 cycles. The 2nd group received aromatase inhibitor [Letrozole] 2.5 mg twice daily from 3rd day of cycle for 5 days and repeated for 3 cycles with metformin 500 mg 3 times daily as an adjunct with letrozole and continued for 3 cycles. These cases were followed up for three cycles by transvaginal ultrasound folliculometry to document ovulation [size and number of follicles]
Results: The results of the present study revealed both lines of treatment were effective in treatment of PCOS patients, with slight favorability in letrozole group but without statistically significant difference founded between CC group and letrozole group as regard ovulation rate, number of follicles at the end of first, second or third cycles, or as regard the diameter of follicles, i.e., both regimens showed efficacy to the same extent
Conclusion: both CC and letrozole are equally effective in treatment of infertility in PCOS patients, when combined with metformin treatment
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Background: Postoperative vitreous hemorrhage [VH] following pars plana vitrectomy [PPV] for proliferative diabetic retinopathy [PDR] is a common event, with a reported incidence of 29% to 75%.This complication delays visual rehabilitation, interferes with fundus examination, and may necessitate additional surgical procedures. Vascular endothelial growth factor [VEGF] is an angiogenic mitogen, and the involvement of VEGF in PDR has been suggested by studies that have demonstrated that VEGF concentrations were markedly elevated in both vitreous and aqueous fluids of patients with active PDR compared with samples from patients without diabetes, with NPDR, or with quiescent PDR. Bevacizumab [Avastin[R], Genentech, Inc., South San Francisco, CA] is a full-length recombinant humanized monoclonal antibody that binds to all isoforms of VEGF
Aim of the Work: to evaluate the safety and efficacy of intravitreal bevacizumab [IVB] at the end of vitrectomy operation for prevention of postoperative rebleeding in patients with diabetic vitreous hemorrhage
Patients and Methods: The study included 20 eyes of 20 patients undergoing PPV for severe non-clearing vitreous hemorrhage for more than 1 month. Eligible eyes were randomly assigned to one of two groups: Group A [10 eyes] did not receive any intravitreal injection and Group B [10 eyes] received 1.25 mg IVB injection at the end of surgery. All patients were subjected to complete history taking and full ophthalmic examination including best-corrected visual acuity, anterior segment examination, fundus examination and B-scan ultrasonography was performed. All patients underwent three-port pars plana vitrectomy using 23-gauge instrumentation under local anesthesia. At the end of surgery, fluid-air exchange was performed and the intraocular air is left as tamponade in selected cases. The follow up period occurred over 1 week, 1 month and 3 months. The main outcome measures were occurrence of vitreous hemorrhage and BCVA
Results: At 1 month after surgery, the incidence of early postoperative VH was 30% and 20% in Group A and B, respectively [p = 0.641]. Mild vitreous hemorrhage [grade 1] was the major component of early VH at 1 month [20% of 30% and 10% of 20%, in Group A and B, respectively]. Analysis of changes in the mean BCVA at 1 month after surgery showed significant improvement from the preoperative BCVA in all study groups, the mean differences between pre-BCVA [Log MAR] and post BCVA [Log MAR] among the studied groups was 0.865 +/- 0.351 with statistically significant difference between the two groups [p = 0.000].the mean differences between pre-BCVA [Log MAR] and post BCVA [Log MAR] among the studied groups was 0.865 +/- 0.351 with statistically significant difference between the two groups [p = 0.000]. At 3 months after surgery, the incidence of late postoperative VH was 20.0% and 0.00% in Group A and B, respectively, with no significant difference between the two groups[P=0. 237]. Again, analysis of changes in the mean BCVA at 3 months after surgery showed significant improvement to 1.080 +/- 0.2098 and 0.870 +/- 0.17767 in Group A and B, respectively, with statistically significant difference between the two groups [p >0.027]
Conclusion: The incidence of late postoperative vitreous hemorrhage is lower than that of early postoperative vitreous hemorrhage and is not affected by intraoperative intravitreal bevacizumab injection and Adjunctive use of intravitreal bevacizumab with pars plana vitrectomy for complications of PDR is safe and well-tolerated with no serious ocular or systemic adverse events
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Deviated Nasal Septum [DNS] is considered as one of the risk factors affecting the osteomeatal complex. Some authors considered that middle turbinate changes especially concha bullosa a fixed coincident event with septal deviation. This study aims at assessment of the concomitant variations and changes in the Osteomeatal Unit [OMU] and its adjacent structures with septal deviation. One hundred and nineteen adult cases with DNS and chronic sinusitis were submitted to C.T imaging. The angle of septal deviation was measured in each case and the data were correlated with changes of OMU, middle turbinate, bulla ethmoidalis and Uncinate Process [UP]. All data were tabulated and analyzed. Our results showed significant increase incidence of anatomical and pathological changes in OMU, middle turbinate, bulla ethmoidalis and UP with severe septal deviation. It can be concluded that attention has to be directed to high septal deviation as well as obstructing low deviation and C.T. imaging is highly indicated in those patients to assess the concurrent changes at the level of middle turbinate and OMU. The septal deviation and the concurrent structural changes could be the cause of persistent and recurrent sinusitis
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Humanos , Masculino , Femenino , Sinusitis/diagnóstico , Enfermedad Crónica , Tomografía Computarizada por Rayos XRESUMEN
In this study 75 E-coli pools isolated from 120 rectal swab taken from infants suffering from watery diarrhea were studied together with 18 E-coli pools isolated from healthy controls of the same age group. All these E-coli pools were tested for enteropathogenic serotypes, enterotoxigenicity, invasion,presence of colonisation factor antigen and colicine production. Comparing E-coli pools isolated from diarrheal - cases and controls; the incidence of colicinogenic E-coli pools were equally distributed in patients and control groups. The incidence of enterotoxigenic and of enteropathogenic serotypable E coli pools in diarrheal cases were about twice their incidence in the control group. The incidence of colonisation factor antigen in diarrheal E-coli pools was about seven times that in control group. The most commonly associated characters, were toxin production and colonisation factor antigen being three times as much as that in the control group [17.3%, 5.6%] respectively, this shows the importance of detection of colonisation factor antigen by mannose resistant haemagglutination of adult chicken red cells as a simple easily performed screening test for detection of enteropathogenic E-coli in infantile diarrheal cases