Early hemodynamic profile after aortic valve replacement - a comparison between three mechanical valves

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.

Assessment of human epidermal growth factor receptor 2/neu gene amplification and expression as a biomarker for radiotherapy and hormonal-treated breast cancer patients in upper Egypt

Background: Breast cancer plays major public health in Egyptian women. In upper Egypt, There is an increase in the incidence of breast cancer compared to other Egyptian areas without know the reasons. In this study, we aimed to evaluate the potential of HER-2/neu status as one of the important markers to classify the women suffering from breast cancer in upper Egypt and monitoring the responsiveness to different therapies. Settings and Design: The present study was performed on 67 female breast cancer patients in the South Egypt Cancer Institute to evaluate HER-2/neu gene amplification and expression. Patients and Methods: Tissue samples were used for immunohistological analysis of endocrine receptors, HER-2/neu, and HER-2/neu gene amplification. In addition, the blood samples were also used to determine HER-2/neu gene expression. Statistical Analysis: All statistical analyses were performed using Chi-square test. The statistical difference is considered statistically significant at P < 0.05. Results: There was a statistically significant association between HER-2/neu gene expression and the age of patients. There is decrease in the level of HER-2/neu mRNA expression in group treated with chemotherapy and group treated with chemotherapy and radiotherapy compared to each group baseline level of HER-2/neu mRNA expression before treatment. On the contrary, the group treated with chemotherapy, radiotherapy, and hormonal therapy revealed increase on the level of HER-2/neu mRNA expression when compared with their baseline for the same patients before treatment. Conclusion: We need further studies on the large group of upper Egypt breast cancer patients to confirm that the level of HER-2/neu mRNA expression can be used as a marker for classified them and their response to different treatment

Study of thyroid dysfunction in postpartum psychosis

Background Becoming a mother of newborn involves adaptation to may changes socially and physiologically. Some risk factors are responsible for the development of postpartum psychosis including postpartum hormonal changes. Objectives: was to study the role of thyroid dysfunction in development of early postpartum psychosis among a sample of Egyptian women. Subjects and Methods: A total of 60 female patients with postpartum psychosis during the first four weeks after delivery not suffering from any previous psychiatric disorders (Case Group) and 30 female patients within the first four weeks after delivery not suffering any psychiatric disorders (Control Group) were subjected to clinical psychiatric assessment using structured psychiatric interview of DSM -V, BPRS, HDRS and measuring plasma level of thyroid hormones e.g., free triiodothyronine, free tetra-iodothyronine and thyroid stimulating hormone. Results: There were higher significant difference regarding thyroid dysfunction in patients with postpartum psychosis than in controls. Patients with postpartum psychosis with thyroid dysfunction have a higher significant score on BPRS and HDRS than patients with postpartum psychosis without thyroid dysfunction. Conclusion: There is significant association between thyroid dysfunction in first four weeks after delivery and postpartumpsychosis

Phytochemical, antioxidant and hepatoprotective effects of different fractions of Moringa oleifera leaves methanol extract against liver injury in animal model

Objective:To evaluate the potential antioxidant and hepatoprotective effects of n-hexane, dichloromethane(DCM), ethyl acetate(EtOAc), n-butanol and aqueous fractions of Moringa oleifera(M. oleifera) leaves methanol extract against carbon tetrachloride(CClMethods:These fractions were prepared from the M. oleifera leaves methanol extract by solubilization in water and partitioning in n-hexane, EtOAc, DCM and n-butanol. Their phyto-components were identified by GC-MS analysis. The in vitro antioxidant effect of these fractions was carried out by assessment of 1,1-diphenyl-2-picrylhydrazyl scavenging activity. A total of 40 Sprague Dawley rats were allocated into 8 equal groups: group 1 given olive oil (1 mL/kg b.wt.), group 2 injected with CClResults:The GC-MS analysis of different fractions of the M. oleifera leaves methanol extract revealed that n-hexane, DCM, EtOAc, n-butanol, and aqueous fractions contained 17, 22, 23, 19 and 32 compounds, respectively. The percent and the molecular structure of each component in each fraction were identified. The n-butanol and EtOAc fractions exhibited the strongest in vitro antioxidant activity against 1,1-diphenyl-2-picrylhydrazyl. CClConclusions:n-hexane, DCM, and aqueous fractions have the highest effectiveness against CCl

Phytochemical, antioxidant and hepatoprotective effects of different fractions of Moringa oleifera leaves methanol extract against liver injury in animal model

Objective: To evaluate the potential antioxidant and hepatoprotective effects of n-hexane, dichloromethane(DCM), ethyl acetate(EtOAc), n-butanol and aqueous fractions of Moringa oleifera(M. oleifera) leaves methanol extract against carbon tetrachloride(CCl

Correlation between central corneal thickness and degree of myopia

Aim of the work: this study aimed to determine the relationship between central corneal thickness [CCT] and myopia

Methods: one hundred and eight [108] Egyptian subjects were included in this study. They were not presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting the inclusion criteria was 108 [216 eyes] 87 were myopes and 21 were emmetrope. They were categorized into two main groups: myopic group [Group I] and the control group [Group II]. The CCT was measured with the pentacam

Results: the present study comprised 59 males [54.6 %] and 49 females [45.4%]. Their age ranged between 19 and 58 years. The mean CCT was 538.2 right eye and 536.3 left eye in group Ia, 522.3 right eye and 523.7 left eye in group Ib, 542.0 right eye and 550.3 left eye in group Ic, and 529.0 right eye and 526.8 left eye in the control group [Group II]

Conclusion: this clinical study showed that there was no difference in CCT between emmetropic and myopic eyes. CCT did not correlate with the degree of myopia

The cosmetic outcome of external dacryocystorhinostomy scar and factors affecting it.

Purpose: To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it. Patients and Methods: Prospective randomized interventional study included forty patients who were treated by 40 Ex-DCRs. In twenty patients, medial canthal vertical incision was used and in the other twenty cases, subciliary incision was used. The skin was closed using vicryl 6-0 or prolene 6-0 interrupted sutures, and each one was randomly used in twenty patients (10 patients of each incision type). Cosmetic outcome was evaluated 6 months postoperative by the patients and by an oculoplastic surgeon on a four grades scale. Cosmetic results and its correlation to patients’ age, sex, skin complexion, type of incision, and type of skin sutures were studied. Results: The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients’ and examiner’s assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients’ age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients’ and examiner’s assessment. Conclusion: Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.

Portal hypertension treatment with candesartan plus propranolol for nine months restores normal portal circulation hemodynamic pattern

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow [PVF] and intrahepatic resistances [IHR]. PVF is partially controlled by using both specific and non-specific beta blockers [NSBBs] that have insignificant effects on IHR. Angiotensin receptor blockers [ARBs] inhibit the activated hepatic stellate cell [HSC] contraction and thought to reduce the dynamic portion of MR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension [PH]. Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices [OV], were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index [DI], pulse Pulsatility index [PT], Portal Venous Flow [PVF] Volume, Portal Venous Peak Velocity [PVPV], and Portal Vein Diameter [PVD] were evaluated once every third month. Our study concluded that combined therapy [Propranolol + Candesartan] induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume and PVPV overtime compared to monotherapy regimens [P>0.001]. Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension

Knowledge and attitude of the population toward cancer prostate Riyadh, Saudi Arabia

The aim of the following study is to assess the knowledge and attitude of men, in our region, regarding cancer prostate and its screening practices. The field work was conducted in Riyadh City, during the period February through July 2011. It was a population - based cross-sectional study comprising 400 men over 40 years. In addition to socio-demographic data, history of the present and past medical illness, history of prostatic diseases and examination, family history of cancer prostate; participants were inquired about their knowledge and attitude toward prostate cancer [PC] and screening behavior using through two different Likert scales. Only 10% of the respondents had practiced a regular PC examination checkup. Their knowledge about PC was poor and their attitude toward examination and screening was fair, where the mean of total correct knowledge score was 10.25 +/- 2.5 [51.25%], while the mean of total attitude score was 18.3 +/- 4.08 [65.3%]. The respondents identified the physicians as the main sources of this information [62.4%], though they were not the main motives for a regular checkup. Knowledge represented the only significant predictor for participants' attitude. Beliefs and attitudes have a great impact, at every stage of the cancer continuum, this attitudes depends mainly on level of knowledge and quantity of information provided to patients and their families. Such attitudes should rely on a solid background of proper information and motivation from physicians to enhance and empower attitudes toward PC screening behavior

Assessment of lower urinary tract symptoms in Saudi men using the international prostate symptoms score

Benign prostatic hyperplasia-related lower urinary tract symptoms [LUTS] are common among older men, the incidence and prevalence are increasing rapidly, and they are associated with diminished health-related quality-of-life [QOL]. The aim was to describe the prevalence of LUTS in Saudi population and its relation to some other parameters. Saudi men over the age of 40 were invited to participate in the study; in Riyadh city from August 2012 through March 2013. All participants were assessed for the serum level of prostate-specific antigen [PSA] and digital rectal examination. Participants were given a linguistically validated Arabic version of the International Prostate Symptom Score [IPSS]. Demographic and other medical comorbidities were assessed. Based on the IPSS, a subdivision of men into three symptoms classes has been proposed, resulting in groups with mild [1265, 58.3%], moderate [505, 27.3%], and severe symptoms [81, 4.4%] and the prevalence of moderate to severe was 31.7%. There was a weak, but significant correlation between the total IPSS and age, total prostate volume, and PSA. Severity of symptoms is increasing with increased age. Multiple regression analysis reported that prostate volume and all individual items of IPSS except straining were significant predictors of QOL and patient satisfaction, where frequency and incomplete emptying had the heaviest impact on patient's QOL. LUTS were common among men in Saudi population over 40, the prevalence increases with age and most of them were unpleased because of their urinary symptoms, poor QOL was mainly determined by individual symptoms; mainly frequency and incomplete emptying

Evaluation of infections related to the different types of dialysis accesses in patients with end stage renal disease

Introduction: Infection is considered a common life threating complication of vascular access and causing morbidity, access failure, and it is the second leading cause of death after cardiovascular event. It accounts approximately 15% to 36% of morbidity and mortality [Jacob, 2011]. Peritonitis, subcutaneous tunnel and exit site infection are the most common complication in Continuous Ambulatory Peritoneal Dialysis [CAPD] patients and accounts for 18% of mortality [Johnson DW, 2009]

Aim of the work:1. To identify the most common pathogenic microorganisms in different types of dialysis accesses in suspected patients in hemodialysis and patients screened for Tenckhoff catheter infection in CA PD. 2. Common risk factors responsible for infection, 3. Most common sensitive antibiotic, and,.4. Strategy for management and prevention of infection in the dialysis units of Assiut governorate, Egypt

Material and methods: A total 88 patients with End Stage Renal Disease on regular dialysis. Divided into two main groups: Group [A]: 63 patients on hemodialysis with suspected infected vascular accesses. They were sub-divided into: 27 patients with Permanent accesses including [15 patients with AV fistula and 12 patients with tunneled catheters], and 36 patients with suspected infected temporary catheters including 12 patients for each of jugular, subclavian and femoral catheters in the dialysis unit in Assiut university hospital. Group [B]: 25 patients on Continuous Ambulatory Peritoneal Dialysis [CA PD] screened for Tenckhoff catheter infection in dialysis unit of Alexandria Students Hospital

Results: the positive cultures form colonized permanent accesses were 100% in AV fistula and 58.3% :n tunneled, regarding to CVCs, positive cultures were 75% in suhclavian, 83.3% in jugular and 100% in femoral so femoral vein catheters were the highest frequency of colonization, while in CAPD patients, the frequency of colonization were 12%.the most frequent organisms in the colonized permanent accesses and temporary non tunneled catheters were mixed infections [53.3% in AV fistuIa,.57.1% in tunneled, 60% in jugular and 75% in femoral, while the most common organism in subclavian was non- pathogenic staphylococci by 55.6%, and in CAPD patients, 100% of positive cultures were staphylococcus aureus. Our results demonstrate that, Vancomycin was the most sensitive antibiotic by 93.3% in arterio-venous fistula, 100% in tunneled, 75% in subclavian, 93.8% in Jugular and 87.5% in femoral catheter infections

Conclusion: Mixed infection with non- pathogenic staphylococci and candida were the most frequent pathogens in our centers, most sensitive antibiotics were Vancomcin, Amikacin, Niturofurantoin, and this should be combined with systemic antifungal

Evaluation of ozone therapy in thalassemia children attending Alexandria university children's hospital hematology clinic

Objective: The aim of the present study was to evaluate the effectiveness of ozone therapy on haemoglobin level and transfusion requirements in children with thalassemia in Alexandria University Children's Hospital

Methods:A total of 30 patients were included in this study. Each of the included patients were subjected to a thorough history taking, clinical examination and laboratory investigations. Each patient received 36 sessions during 3 months period via rectal route

Results: The mean age of studied children was 6.70 +/- 1.52 years and they were 50% males, and 50% female. There was no significant statistical difference between the patients regarding age, sex and other socio-demographic parameters such as family history of thalassemia and the age of diagnosis. There was significant increasing in the interval between PRBCs transfusion and improvement in Hb level during and after ozone therapy. There was significant reduction in reticulocytic count during and after the zone therapy which means significant improvement in it. There were no significant change in serum ferritin level and liver function tests [ALT and AST] before, during and after the ozone therapy

Conclusions: The current study shows that ozone therapy is, at all times, an additive [adjuvant or complementary] therapy, in combination with the other conventional methods of treatment. The treatment of ozone via rectal insufflation [RI] route is easy and cheap. Ozone therapy can improve the interval and frequency of blood transfusion in these patients and also can improve the reticulocytic count. Ozone therapy had no effect on serum ferritin level or on liver function tests

Morphometry and body mass index to assess health condition in captive population of Greek tortoise, Tesudo greaca

Body mass and morphometric data from a sample of captive Greek tortoise, Testudo greaca were collected to assess body condition based on linear association. Mass- length linear relationship differed between the sexes where mass-straight carapace length was strongly associated in males while mass- curved carapace length was strongly associated in females compared with other morphometric measures. Females were heavier, deeper and longer than males. Mass-length linear relationship was used to calculate the condition index log [M/m], where [M] is the observed mass and [m] is the predicted mass. The loss in body condition was recorded in 47% of females and 50% of males. The percentage of body condition loss ranged between 1.5 to 13% and 2.7 to 15.9% in females and males, respectively. The mass-length technique is a useful means of evaluating health and growth in tortoises

Prevalence in some pathogens in a population of zoo animals

Zoos unintentionally provide pathogens with a high diversity of species of different origins. Zoo practices of mixing reservoir species with other susceptible species can provide opportunities for pathogens to spread beyond normal hosts. This paper describes some pathogens of bacterial, parasitological and viral origin that were identified in some bovines [five species], caprines [two species], cervids [two species], primates [two species] and felines [two species] groups. Bacterial examination of fecal samples revealed the detection of E.coli, Salmonella spp., Pasteurella spp., Klebseilla spp., Campylobacter spp. Streptococci spp., and Staphylococci spp., with 52% overall prevalence of infection. Parasitological investigation using floatation and sedimentation technique of fecal samples indicated the occurrence of Isopora spp., Trichuris spp., Ascarids spp., Toxocara spp., Trichostrongyloid spp., and Nematodirus spp. with 19% prevalence of infection of the examined samples. Sarcoptic mange was only identified in olive baboon, Papio anubis through examination of skin scrapings. Antibodies against bovine viral diarrhea [BVD] and bovine herpes virus-1 [BHV-1] in antelopes and feline corona virus [FCoV] in felines were detected using specific Enzyme-linked immune assay [ELISA test]. The seroprevalence of BVD and BHV-1 in the examined antelopes was 5.3% and 6.7%, respectively. Antibodies against FCoV were detected in both lions and cheetahs where cheetahs had higher seroprevalence rate [100%] than lions [50%]. There is a need for zoo veterinarians to review and update the current preventive and management policies to identify sources of infection and control diseases of exotic species in future

Behavioral impact of sickle cell disease in young children with repeated hospitalization

Sickle cell disease [SCD] in children with a history of repeated hospitalization is distressing for children as well as their parents leading to anxiety and has negative effects on the psychological state of children and their families. The aim of the study was to determine the overall effect of SCD on the behavior of young children age 1½ to 5 years old who had repeated history of hospitalization, compared to a control group of healthy children attended a vaccination clinic. Thirty-five children of age 1½ to 5 years who have SCD and repeated history of hospitalization were recruited from pediatric clinic as the study group and matched with same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist [CBCL] 1½ to 5 years and diagnostic and statistical [DSM]-oriented scale. Behavior data were collected through a semi-structured questionnaire. Children who have SCD had statistically significant behavioral changes on CBCL compared to the control group: Anxiety/depression [65.2 vs. 55.1; P < 0.001], somatic complaint [66.7 vs. 54.4; P < 0.001] withdrawn [63.4 vs. 53.2; P < 0.001], aggressive behavior [60.4 vs. 56; P=0.04], and internalizing symptoms [64.7 vs. 51.5; P< 0.001], respectively. The DSM scale showed that children with SCD scored significantly higher in pervasive developmental disorder compared to the control group [60.9 vs. 53.9; P < 0.001] respectively. Children with SCD who had history of repeated hospitalization are at an increased risk of developing behavioral problems. Psychological counseling, social support, and proper pain management could minimize these behavioral consequences

OUTCOMES OF APLASTIC ANEMIA PATIENTS IN ASSUIT UNIVERSITY HOSPITAL, ONE YEAR STUDY

Aplastic anemia is a disorder in which the bone marrow fails to make enough blood cells. to identify the various aetiological factors that stands behind aplastic anemia as a common hematological problem and the various outcomes of those patients along one year. The study included 80 patients with aplastic anemia who were admitted to the Clinical Hematology Unit of Assuit University Hospital from November 2011 to October 2012. All patients were recruited for careful history and meticulous investigations to detect predisposing factors. Results: 42.5% of all studied aplastic anemia patients had any definite etological or predesposing factor, so considered as idiopathic group while, 57.5% were secondry to chmicels and/or insecticides [22.5%], hepatitis C[15%], systemic lupus erythematosis[SLE] [12.5%] and rheumatoid arthritis[7.5%]. The observed outcomes showed that complete recovery in 39%t of the secondry aplastic anemia patients [P<0.001], chronicity in 22% while 39% died. However, none of the idiopathic aplastic anemia' patients reached recovry, 59% become chronic [P<0.001] and 41% died [P<0.05]. Secondary aplastic anemia patients have a chance for recovery by correcting the primary etiology that is not an option in idiopathic patients. The hope for not recovered aplastic anemia patients is dependency on transfusional support and immunosupressive therapy waiting for a chance in allogeneic stem cell transplantation. The expected outcome of most of unrecovered patients is death unless find early chance for transplantation.So, there is a very potential need for stem cell transplantation center in Assuit University as an important referral center in Upper Egypt

Dietary Fat Intake, Serum Estrogen Level and Obesity as Risk Factors of Breast Cancer in Saudi Females: A Case-Control Study.

Aims: The aim of our study was to examine the associations of dietary fat intake, serum estrogen level and obesity with the risk of breast cancer in a case-control study among Saudi females including newly diagnosed breast cancer patients. Study Design: Case-control study. Place and Duration of Study: King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the period between 1st February and 30th May, 2008 Methodology: Dietary histories were collected 40 newly diagnosed female breast cancer cases and 82 randomly selected control subjects matched for age, parity, gravidity, number of children, breast feeding practice and age at marriage. A modified food frequency questionnaire (FFQ).was applied. Anthropometric measurements and blood tests that measured LDL, HDL, triglycerides (TGs) and estrogen levels were performed. Significance was considered at P≤0.05. Results: Breast cancer was significantly associated with overall obesity based on BMI (OR = 3.10, 95%, CI = 1.17–8.25, P=0.02) and central obesity based on WC (OR = 3.95, 95%, CI = 1.27–12.28, P=0.01). Cases exhibited significantly higher fat mass (39.6 vs. 36.9 kg, p=0.04) and significantly lower Fat intake (46.0±27.5 vs 59.0±38.9 g/day, P=0.034) than did the control group. The mean levels of TGs (2.9±1.1vs.1.8±1.1 mmol/L, P<0.0001) and estradiol (131.0 vs 70.6 pmol/L, P≤0.008) were significantly higher in the study patients compared with the control subjects, whereas the mean level of low density lipoprotein (LDL-C) was significantly higher in the control subjects (3.1±0.8 vs. 1.6±1.0 mmol/L, P≤0.0001) compared with the study patients. Conclusion: Both overall obesity and central obesity were significantly associated with breast cancer. Higher fat mass and lower fat intake and increased estrogen level were significantly associated with breast cancer cases. Further prospective studies on the Saudi population are recommended to explore the mechanisms of these findings.

Predictors of outcome in patients with diabetic foot ulcer at Assiut university hospital

Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline, In this study data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009 and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie: loss of sensation in the foot] [P<0.0001], colour changes in the foot [P<0.0001], duration of ulcer [>3 months] [P<0.0001], HbA1c [> 12%] and Texas classification class D Older age [P<0.004], presence of hypertension [P< 0. 02] nephropathy [P< 0.005] ,smoking, presence of PAD as ABI < 0.9 [P< 0.02] and absent pedal pulses [P<0.0001] ,ulcer size [> 5 cm[2]]., ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Duration of diabetes > 10 years [P<0.0001], negative neuropathic symptoms [ie: loss of sensation in the foot] [P<0.01], colour changes in the foot due to presence of PAD [P<0.01], duration of ulcer > 3 months [P<0.04], HbA1c > 12% [P<0.001] and Texas classification stage D [P<0.01] were considered a major independent predictors of unhealing of diabetic foot ulceration

Environmental and hormonal control of induced spawning in thin-lipped grey mullet, Liza ramada [Risso]

The reproductive cycle can be controlled by either placing the fish in an appropriate environment or by changing the internal regulating factors of the fish with injected hormones or other substances. The present work was designed to determine the suitable environmental and hormonal requirements for induced spawning of thin-lipped grey mullet, reared in freshwater fish farms. The application of a high-potency synthetic analogue of luteinizing hormone-releasing hormone agonists [LHRH-a] and human chorionic gonadotropin [HCG] for inducing the final stages of maturation, ovulation, and spawning in mullets was investigated in ripe spawners, reared in freshwater fish farms, with average egg diameters of 0.600 mm or more, in suitable water temperature and salinity. Two hormonal injection strategies were used. The first involved the use of HCG as a priming injection, followed, 24 h later, by a resolving injection of HCG. The second strategy followed the same time frame but the priming injection was HCG and the resolving injection was luteinizing hormone-releasing hormone agonists alone or in combination with HCG. The use of pregnyl [HCG] as a priming injection at a dose of 20 000 IU/kg body weight, followed by a second injection of 40 000 IU HCG/kg body weight 24 h later proved to be effective in inducing final oocyte maturation, ovulation, and spawning in Liza ramada at 44-50 h after hormonal injection. The optimum water temperature and salinity was 19° and 35%, respectively. Translucent ovulated eggs had coalesced lipid and yolk masses. The fertilized eggs had one or more oil globules gathered in the upper space of the egg. The blastodisc was situated on the bottom side of the floating egg. HCG is very useful for inducing and synchronizing spawning in L. ramada ripe spawners, reared in freshwater fish farms, in combination with suitable environmental factors