Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review

Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established.It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction.Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans.

The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant / 医学前沿

In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.

Patient Satisfaction and Pink Esthetics of PEEK Versus Zirconium Abutments in the Esthetic Zone (A Randomized Controlled Trial) / Satisfação do paciente e estética rosa dos pilares PEEK versus Zircônia na zona estética (um ensaio clínico randomizado)

Objective: This study was performed to evaluate the use of PEEK abutments versus zirconium abutments with lithium disilicate superstructure on the esthetic acceptance and peri-implant clinical parameters. Zirconium abutments were found to have high surface roughness even after polishing. This causes a remarkable collapse of the soft tissue papilla that is a primary factor in the Pink Esthetic Score(PES), resulting in failed esthetic restoration in the anterior esthetic zone. Material and Methods:Twenty patients who needed a single implant restoration in the esthetic zone were included in this study. Eighteen patients completed screening, baseline, three-month, six-month, and twelve-month follow-up visits. At the screening visit, the patients were randomly allocated into two groups: Zirconia abutments (A) Group, and PEEK abutments (B) Group, both of which were restored with IPS e.max CAD superstructure. Patients Satisfaction was assessed by visual analogue scale (VAS). Pink esthetics score (PES), modified plaque index (mPI) and modified gingval index (mGI) were also assessed. Results: All implants were successfully osseo-integrated with a 100% survival rate over one year. Patient satisfaction was significantly higher for the PEEK group than the zirconium group. The pink esthetic score showed no statistical significance between both groups. The modified plaque index was significantly lower for the PEEK group than the zirconium group. The modified gingival index showed no statistical difference between both groups. Conclusion: PEEK revealed to be a versatile material to replace zirconium for implant abutments, due to its lower plaque affinity and higher patient satisfaction (AU)

Objetivo: Este estudo foi realizado para avaliar o uso de pilares PEEK versus pilares de zircônia com estrutura de dissilicato de lítio quanto a aceitação estética e parâmetros clínicos peri-implantares. Os pilares de zircônia apresentam alta rugosidade superficial, mesmo após o polimento. Isso causa um colapso notável da papila do tecido mole, que é um fator primário no índice estético rosa (Pink Esthetic Score - PES), resultando em falha na restauração estética na zona estética anterior. Materiais e Métodos:Vinte pacientes que precisavam de um implante unitário na zona estética foram incluídos neste estudo. Dezoito pacientes completaram a triagem, a consulta inicial e as visitas de acompanhamento de três, seis e doze meses. Durante a triagem, os pacientes foram aleatoriamente divididos em dois grupos: Grupo Pilares de Zircônia (A) e Grupo de Pilares PEEK (B), ambos foram restaurados com IPS e.max CAD. A satisfação dos pacientes foi avaliada pela escala visual analógica (VAS). O PES, o índice de placa modificado (mPI) e o índice gengival modificado (mGI) também foram avaliados. Resultados: Todos os implantes foram osseointegrados com sucesso, com uma taxa de sobrevivência de 100% ao longo de um ano. A satisfação do paciente foi significativamente maior para o grupo PEEK quando comparado com o grupo de pilares de zircônia. O índice da estética rosa não apresentou significância estatística entre os dois grupos. O índice de placa modificado foi significativamente menor para o grupo PEEK quando comparado com o grupo de pilares de zircônia. Conclusão: O PEEK revelou-se um material versátil para substituir a zircônia em pilares de implante, devido a sua menor afinidade de placa e maior satisfação do paciente. (AU)

Disaster Coping Strategy Practiced by the Affected People for their Livelihood Due to Climate Change

The purpose of the study were to (i) determine the disaster coping strategy practiced by the affected people (ii) assess the socio-economic profile of the respondents, (iii) ascertain the contribution of selected characteristics of the people and (iv) identify the constraints of disaster coping strategy practiced by the affected people. The study was conducted at Gangachara Upazila of Rangpur District. Data were collected from a sample of 302 respondents, randomly selected from disaster affected population. Age, education, family size, farm size, disaster affected land, annual income, training received, extension media contact, knowledge on disaster coping strategy, environmental awareness, household assets, credit facilities, IGAs, water and sanitation condition, risk orientation, awareness about SSNP, perception of Climate Change (CC), perception of disasters and scope of work in vulnerable situation constituted the independent variables, while disaster coping strategy practiced was the dependent variable. For measuring the disaster coping strategy practices, a 4-point rating scale was used against 50 items taking 10 items from each of five components of human needs e.g. 1) food preservation, collection and management, 2) agricultural products protection, 3) maintaining social network, 4) safeguard of health and sanitation, and 5) protection of housing and shelter. Numerical values and scales were used to measure the personal attributes. Regression and path analysis were employed to determine the contribution among the variables. For exploring relationship between the two variables Pearson’s Product Moment Correlation (r) was used. The majority (77.8 per cent) of the respondents had regular coping strategies compared to 22.2 per cent were found to have occasional coping strategies in the study area. Among 19 independent variables 16 were found significant relationship with the dependent variable. Stepwise multiple regression revealed that six variables namely education (23 per cent), participation in IGAs (3.6 percent), awareness of SSNPs (2.9 percent), disaster affected land (1.2 percent), farm size (1.9 percent) and perception of CC (1 percent) were the important contributing variables which combined explained 33.6 of the total variation of practice of coping strategy. Path analysis indicated that disaster affected land (0.589) had the highest positive direct effect while farm size (0.643) had the highest positive indirect effect to the disaster coping strategy practice. The major constraints for practicing disaster coping strategy in the study area were ‘Lack of knowledge and skills of affected people‘, ‘Lack of relief materials during disaster‘, ‘Lack of technologies‘, ‘Weak weather forecasting‘, ‘Less motivation’, ‘Low sanitation & health coverage’ and ‘Lack of communication during disasters’,. To cope up with the challenges of the disasters, the people used reduction of food intake per meal, putting goods above flood level, keeping women and children in safer places, using boiled and tube well water, providing health care support to the sick family members, transfer important documents to the safer places, increasing level of homestead with soil, taking relief, credit, religious fasting, using mosque/temple as campaigning center, borrowing principal food from neighbor, use savings, migration, livestock sell, and social interconnectedness as the major coping strategies to survive the situation and improve their livelihood.

Monitorización de la capacidad de degradación de las nuevas bacterias haloalcalifílicas resistentes a cloruro de tributiltina (TBTCl) en una ubicación contaminada por butiltina / Monitoring the degradation capability of novel haloalkaliphilic tributyltin chloride (TBTCl) resistant bacteria from butyltin-polluted site

Tributyltin (TBT) is recognized as a major environmental problem at a global scale. Haloalkaliphilic tributyltin (TBT)-degrading bacteria may be a key factor in the remediation of TBT polluted sites. In this work, three haloalkaliphilic bacteria strains were isolated from a TBT-contaminated site in the Mediterranean Sea. After analysis of the 16S rRNA gene sequences the isolates were identified as Sphingobium sp. HS1, Stenotrophomonas chelatiphaga HS2 and Rhizobium borbori HS5. The optimal growth conditions for biodegradation of TBT by the three strains were pH 9 and 7% (w/v) salt concentration. S. chelatiphaga HS2 was the most effective TBT degrader and has the ability to transform most TBT into dibutyltin and monobutyltin (DBT and MBT). A gene was amplified from strain HS2 and identified as TBTB-permease-like, that encodes an ArsB-permease. A reverse transcription polymerase chain reaction analysis in the HS2 strain confirmed that the TBTB-permease-like gene contributes to TBT resistance. The three novel haloalkaliphilic TBT degraders have never been reported previously.

Se considera a la tributiltina (TBT) como un problema medioambiental serio a escala global. Las bacterias haloalcalifílicas degradadoras de TBT pueden constituir un factor clave para remediar áreas contaminadas con dicho xenobiótico. En este estudio se aislaron 3 cepas de bacterias haloalcalifílicas procedentes de un sitio contaminado con TBT en el mar Mediterráneo. Tras analizar las secuencias del gen de 16S del ARNr, se identificaron los aislados como Sphingo-bium sp. HS1, Stenotrophomonas chelatiphaga HS2 y Rhizobium borbori HS5. Las condiciones de crecimiento óptimas para la biodegradación de TBT por parte de las 3 cepas fueron pH 9 y 7% (p/v) de concentración de sal. S. chelatiphaga HS2 fue el degradador de TBT más efectivo, con capacidad de transformar la mayor parte de ese compuesto en dibutiltina y monobutiltina (DBT y MBT). Se amplificó un gen de la cepa HS2, que fue identificado como tipo TBTB-permeasa, que codifica para una ArsB permeasa. Un análisis de la cepa HS2 por reacción en cadena de la polimerasa con transcriptasa inversa (RT PCR) confirmó que el gen TBTB-permeasa contribuye a la resistencia al TBT. Estos 3 nuevos degradadores haloalcalifílicos de TBT no habían sido reportados previamente.

Correlation between dyslipidiemia and the severity of coronary artery disease using SYNTAX scoring system

Background: the relationship between hyperlipidiemia and an increased risk of coronary heart disease has been well documented and has served as a motivating factor for research into lipoproteins structure, function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex and diabetes also have been found to be associated with an increased risk of coronary artery disease (CAD). This cross-sectional study was aimed to investigate the association of Dyslipidemia as an atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score. Patients and Methods: the current study included 535 patients who presented during 2015 with chest pain to Dar Al Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent coronary angiography either using femoral or radial approach, and the resulting angiographic study was used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX score into low risk, intermediate risk and high risk group. Results: in this study, triglycerides, total cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased vessels. Higher HCL-C levels were also found in subjects with normal coronaries. Conclusion: there was no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides, total cholesterol or LDL-C

Correlation between dyslipidiemia and the severity of coronary artery disease using SYNTAX scoring system

Background: the relationship between hyperlipidiemia and an increased risk of coronary heart disease has been well documented and has served as a motivating factor for research into lipoproteins structure, function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex and diabetes also have been found to be associated with an increased risk of coronary artery disease [CAD]. This cross-sectional study was aimed to investigate the association of Dyslipidemia as an atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score

Patients and Methods: the current study included 535 patients who presented during 2015 with chest pain to Dar Al Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent coronary angiography either using femoral or radial approach, and the resulting angiographic study was used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX score into low risk, intermediate risk and high risk group

Results: in this study, triglycerides, total cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased vessels. Higher HCL-C levels were also found in subjects with normal coronaries

Conclusion: there was no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides, total cholesterol or LDL-C

Physico-chemical evaluation of Gastroretentive Ranitidine Hydrochloride: An Anti-Ulcer Drug

Background  and  Objectives:  The  prevention  and  treatment  of  peptic  ulcers  has  become  an important challenge in the current medicine  world.   Modern progress in novel drug delivery system aims to improve the efficacy of the drug molecule by formulating a dosage form of RHCL. One of the most feasible approaches for achieving a prolonged and predictable drug delivery profile in GI tract is to control the gastric residence time.  Therefore, a multi-unit gastro retentive dosage form of RHCL capable of floating on simulated gastric fluid for more than 12 hours was formulated and evaluated.Materials  and  Methods:  Nine  batches  of  the  light  liquid  paraffin  entrapped  emulsion  gel  beads were  prepared  by  a  new  emulsion  gelation  technique  using  sodium  alginate  and  xanthan  gum  as polymers.  The  polymeric  solution  was  extruded  into  Calcium  chloride  solution  by  the  use  of  21G needles.  Morphology  of  beads,  drug  content,  drug  entrapment  efficiency,  floating  lag  time  and buoyancy were studied. Compatibility study of Ranitidine HCl with polymers used in the formulation was performed using DSC and FT-IR.Results:  Mean  surface  diameter  were  between  1.220  ±  2.259%  (F1)  to  1.230  ±  2.316%  (F9)  and floating lag time were between 6 minute (F9) to 11 minute (F1). All formulations were buoyant for more than 12 hours in simulated gastric  fluid  at  37ºC.  The  drug  content  and  drug  entrapment efficiency  among  the  formulations  were  between  17.48%~19.68%  and  71.06%  ~84.32% respectively. Formulation F1 showed lowest drug content and drug entrapment efficiency while F9 showed highest drug content and drug entrapment efficiency. F4 showed most acceptable sustained drug release profile.Conclusion:  The gastro retentive drug delivery system designed as floating beads was found to be satisfactory drug delivery system for Ranitidine HCl to improve the bioavailability of the drug.

Plasma levels of transforming growth factor -B[1], connective tissue growth factor; soluble factor related apoptosis and urinary levels of desmosine in childhood interstitial lung diseases

This study aimed to evaluate fibrosis and elastin destruction in childhood interstitial lung disease [chILD] patients and to correlate findings with clinical characteristics. Fifty-six patients and apparently healthy twenty children were recruited in this study. Participants were subjected to thorough history taking and clinical examination. All participants provided midstream urine and venus blood samples. Plasma levels of transforming growth factor [TGF]-/ll, connective tissue growth factor [CCN2] and soluble factor related apoptosis [sFas] and urinary desmosome /urinary creatinine [UDes/UCr] were measured by ELISA kits. In patients, clinical findings were crepitation [1.00 %], tachypnea [67. 90%], cardiomegaly [46.40%], digital clubbing [44.60%], cough [33.90%], cyanosis [28.60%], hepatomegaly [28.60%] and wheezes [23.30%]. Fan chILD clinical score was mostly score 3 [n= 20, 35.70%] then score 5 [n= 16, 28.60%], score 2 [n = 9, 16.10%], score 1 [n =8, 14.30% and score [4] [n=3, 5.40%]. TGF-PI, CCN2, sFas and UDes/UCr levels were significantly higher in patients than controls [P =0.0001]. In patients, significant positive correlations were found between TGF-PI and CCN2, sFas and UDes/UCr; between CCN2 and both sFas and UDes/UCr; between UDes/UCr and both sFas and mortality rate. Morbidity and mortality rates were 48.20% and 10.70%.Conclusions: Markers of fibrosis [TGF-B sFas, CCN2] and elastin destruction [UDes/UCr] were increased in chILD. So blockage of their pathways signals may offer novel therapeutic targets

Gasless laparoscopic anatomy and renal biopsy of the kidney in the standing mare / Anatomía laparoscópica sin gas y biopsia renal de los riñones de la yegua de pie

The current study aimed to provide the topography and renal biopsy of the standing mare kidneys by laparoscopy w ithout CO2 insufflation and to compare between the use of biopsy needle and forceps. Five clinically healthy adult nonpregnant mares weighing 250­300 Kg and aging 7­9 years were used in the current work. The gasless laparoscopic renal biopsy appeared simple, safe, reliable, minimal invasive, timesaving and economical technique. The parallel biopsy portals provided easy and accessible biopsy procedure than dorsal or ventral portals. The biopsies taken from the lateral surface were less hemorrhagic than those taken from the caudal pole. This study recommended the laparoscopic forceps because the biopsy forceps provided satisfactory and representative specimens with minimal hemorrhage than Tru-cut needle.

El presente estudio tuvo como objetivo proporcionar la topografía y la biopsia renal de los riñones en la yegua de pie, por laparoscopía sin insuflación de CO2, y comparar entre el uso de la biopsia con aguja y pinzas. Fueron utilizadas en este studio cinco yeguas adultas no gestantes clínicamente sanas con un peso de 250­300 Kg y edad de 7­9 años. La biopsia renal laparoscópica sin gas es un método seguro, confiable y mínimamente invasivo, económico y permite además ahorrar tiempo. Los portales de biopsia paralelas permiten un procedimiento de biopsia de fácil acceso. Las biopsias tomadas de la superficie lateral fueron menos hemorrágicas que aquellas obtenidas desde el polo caudal. Este estudio recomienda las pinzas laparoscópicas debido a que, a diferencia de la aguja Tru-cut, demostraron ser satisfactorias con una hemorragia mínima.

Evaluation of volume-targeted versus pressure-limited ventilation for Preterm Neonates with respiratory distress

Objectives: To evaluate the efficiency of volume targeted versus pressure-limited ventilation for preterm infants with respiratory distress

Methods: 60 newborn infants with gestational age 28-34 weeks in the NICU at Alexandria University Children's Hospital randomly divided in to 2 groups ventilated with either volume targeted ventilation [VTV] or pressure limited time cycled ventilation [PLV] as primary mode or secondary to failure of NCPAP using SLE 4000 or 5000 ventilators

Results: The demographic and clinical characteristics, values of tidal volume [VT], peak inspiratory pressure [PIP], mean airway pressure [MAP], fraction of inspired oxygen [Fio2], alveolar arterial oxygen gradient [A-aDo2], carbon dioxide tension, and pH were similar for all participating infants initially. During the follow-up, the PIP, MAP and FIO2 levels were significantly decreasing in the VTV group during the first 48 hrs. Moreover, The VTV group showed significantly lower incidence of hypocarbia and non-permissible hypercarbia. The VTV group showed significantly shorter duration of ventilation. There was no statistical significant difference between both groups as regards IVH, air leaks BPD, PDA or nosocomial infection

Conclusion: The use of VTV achieves adequate gas exchange using lower MAP and with less variability in tidal volume reducing the risk of hypocarbia and non-permissible hypercarbia. The use of VTV also shortens the duration of ventilation in premature infants with respiratory distress

Surgical managment of foreign bodies in stomach and intestine of some foreign breed dogs

The present study aimed to throw a light on presence of foreign bodies in some foreign breed dogs, under Egyption condition, with special reference to their diagnosis and treatement. The study is carried out on 53 dogs of Rotwieller, German sheepared and Golden retriver breeds. The weights ranged from 15-85 kgs and age ranged from 1-5 years. All dogs were subjected to thorough clinical examination including recording heart rate, respiratory rate and body temperature, beside abdominal palpation to detect the site of foreign bodies [when possible]. Radiographic examination was performed to confirm the diagnosis. Higher incidence of foreign bodies in stomach and intestine was observed in stomach [41.51%] and jejunium [33.97%]. Types of foreign bodies included; stones [38.30%], rubber object [15.09%], plastic objects [11.32%] and metal objects [11.32%]. The mortality rate due to foreign bodies in dogs proved higher in old dogs and in female than male dogs. The best method for treatment of foreign bodies in dogs was the surgical interference. The intestinal intussusception and perforation were surgically treated through end to end anastomosis after resection of the necrotic part

Multi-drug resistance 1 genetic polymorphisms gene expression and prediction of chemotherapy response in breast cancer Egyptian patients

Although anthracycline-based chemotherapy is a crucial treatment for breast cancer, its outcome is limited by the multidrug resistance MDR. Overexpression of P-glycoprotein [Pgp] a transmembrane active efflux transporter of various drugs and carcinogenic substrate, may result in MDR. The impact of MDR1 polymorphisms on MDR1 expression and risk of breast cancer, and whether it can alter chemotherapeutic agents response in breast cancer is unclear. The present work studied the relevance between MDR1 C3435T, C1236T, G2677T/A polymorphisms and MDR1 gene expression and susceptibility to breast carcinoma as well as sensitivity to anthracyine-based chemotherapy in Egyptian females with breast cancer [BC]. We determined mRNA levels of MDR1 in breast tumor specimens [n=190] by real-time rt-PCR. Blood samples from BC female patients and healthy controls were obtained for genotyping. ARMS-PCR assay was used for detection of C3435T, C1236T and G2677T/A Polymorphisms. This study revealed that C3435 TT patients showed a significant decrease in MDR1 mRNA level compared -with CC genotypes. No association was found between the MDR1 C1236T, G2677T/A polymorphisms and MDR1 mRNA expression. The frequency of C3435 TT genotype and T allele were significantlyhigher in BC patients compared to the controls [P < 0.05]. C3435 TT and C3435 CT had odds ratio [p-value] 5.6 [0.001] and 2.28 [0.01] for response to anthracycline-based chemotherapy, respectively, compared to CC genotype. No statistically significant differences were observed between patients and control regarding the allelic and genotypic frequencies of MDR1 C1236T, G2677T/A polymorphisms as well as no correlation was detected to the response rate to anthracycline-based chemotherapy. Our results suggested that C3435T, but not C1236T or G2677T/A, was associated with changes in MDR1 gene expression and hence alters the response after anthracyclin based chemotherapy

Evaluating laboratory key performance using quality indicators in alexandria university hospital clinical chemistry laboratories

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement [March-May 2012]; an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement [June 2012]; and phase II, which included data collection for evaluation of the process after improvement [July 2012-September 2012]. In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items [P< 0.001] with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error [TE] exceeded total error allowable [Tea], with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of [5.11%], whereas in phase II it was reduced to 2.48% [P<0.001]. For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement [P< 0,001]. The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor [8.24%], wrong patient identification [1.0%], lack of reporting by lab doctor [1.11%], and finally, lack of reporting by the lab technician [1.03%]. Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories

Using of polypropylene mesh for hernioplasty in calves

In this study polypropylene mesh was used to facilitate reconstruction of large tissue defects by tension-free repair in 5 crossbred calves with hernial ring sizes ranging from 4-9 cm. The mesh was anchored subcutaneously to strong supportive musculature with interrupted pattern using No. 3 polypropylene sutures. The results revealed that polypropylene mesh proved alternative for hernial repair when fixed subcutaneous in large hernial ring in male and female calves without complications. Therefore, prosthetic mesh represents a safely procedure in large hernial ring to avoid over-stretching on the edges of the wound which hinders wound healing

Role of multidetector computed tomography in the diagnosis of congenital thoracic vascular anomalies

Congenital vascular anomalies of the thorax represent an important group of entities that can occur either in isolation or in association with different forms of congenital heart diseases. CT scan is a non invasive and rapid technique used for evaluation of the pediatric vascular disease as an alternative to conventional angiography. To assess the role of MDCT scan in evaluation and its ability to diagnose congenital thoracic vascular anomalies as well as to recognize these anomalies early for proper treatment and post operative follow up. The studied group included 80 patients, who underwent MDCT angiography and had diagnosed of congenital thoracic vascular anomalies, post operative follow up or asymptomatic [incidentally discovered] were included in this study. CT angiography can diagnosis about 13% [n=6] of cases not seen very well by echocardiography [inconclusive] and 26% [n=12] of cases appear as different findings by CT scan than echocardiography. Three dimensions [3D] images allow excellent display of vascular anomalies that can be used as a vascular road map by surgeons. MDCT provides reliable diagnostic information on the normal anatomy of the aorta, pulmonary and vena cava as well as congenital anomalies in pediatric and adult patients. MPR and 3D VR images have increased the diagnostic value of CT. Furthermore, coronal and sagittal views of the vessels facilitate the orientation of a surgeon, and thus aid in planning surgery

Prevalence and effect of a combined treatment on pneumocystitis pneumonia

Pneumocystitis may cause fatal pneumonia in premature, seriously ill infants at intensive care units. The present study evaluated the routine treatment applied at Sohag pediatrics department for neonatal and infantile pneumonia [in NICU and PICU] on PCP and to compare between the stained slides and real time-PCR in diagnosing Pneumocystis jirovecii. Sucked sputum from 21 pneumonic infants was collected, some for Giemsa stain and microscopic examination and the rest for PCR. The same procedure was done after regression of the symptoms and before release from the units. Serum samples were also collected on admission and discharge for CRP readings which was also used as an indicative of the healing process. Out of 21 pneumonic neonates and infants examined, 12 [57.1%] showed P. jirovecii in sputum samples with a significant difference between both groups [p=0.2]. 10 of them [83.3%] became negative for p. jirovecii under the routine regimen of treatment. Also 2 cases were infected with microspora, both improved at the end of treatment. While real time PCR was negative in all cases pre and post treatment. CRP levels regressed after treatment in all cases except 2 as one showed post treatment P. jirovecii in the sputum

Bone disease in upper Egyptian transfusion dependent pediatric B-thalassemia major

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities within this population. Forty two transfusion-dependent beta thalassemic subjects 5-19 years old in Assiut, Egypt, participated in this cross-sectional study. Medical history by interview and review of medical records, physical examinations including anthropometric measures and puberty assessment, and bone densitometry using DEXA and height adjustment were performed. The incidence of underweight and short stature was 73.8% and 69%, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density [BMD Z-scores < -2] was detected in the lumbar spine and femoral region in 54.7% and 95.2% of subjects, respectively. But after height adjustment they became 11.9% and 64.3%, respectively. Forty-seven percent of patients had a history of fractures and the cumulative risk for which increased almost with age. Seventy-eight percent of patients reported bone pain, whilst back/hip pain was present in 69% of thalassemic children and adolescents. Genu valgus deformity and scoliosis were seen in 40.5% and 11.9% of patients. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies

Study of neurological soft signs in attention deficit hyperactivity disorder

This study was performed to provide data on the prevalence of neurological soft signs in children with Attention Deficit hyperactivity Disorder [ADHD] and detect its correlation with intellectual function and age of the child. Fifty patients with ADHD according to the DSM-IV criteria [mean age, 9.3 years, SD= 1.51 years] participated in the study. They were referred from the outpatient clinic of psychiatry at Assiut University hospital and from the private clinics of the staff members of neuropsychiatry, were evaluated with the Cambridge Neurological Inventory to assess neurological soft signs and Stand ford Binet 4th edition to assess the intellectual and cognitive functions. Fifty healthy controls matched with patients groups in Age, sex and socioeconomic state were assessed using the same tools. A significantly high incidence of neurological soft signs was fund in the patient's group and statistically insignificant among ADHD subtypes with significant negative correlation with IQ and age of the child. The Spearman correlation coefficient between NSS score and IQ and age are 0.672 and 0.283 respectively [p=<0. 001, 0.009]. Presence of neurological soft signs in ADHD is a non-specific marker of neurological abnormality but indicate poor intellectual and cognitive Junctions of ADHD

Haemostatic activation in acute coronary syndrome patients in relation to physical exercise

Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease [CAD], Platelets are known to play a fundamental role in acute coronary syndromes [ACS]. After atherosclerotic plaque rupture, platelets can form pathogenic, occlusive thrombi leading to acute ischemic events. The precise mechanisms of platelet activation in acute coronary syndromes are still under investigation. Physical activity could regulate the development of ACS via effects on platelet function. Several studies have shown that acute physical exercise increases platelet reactivity, typically assessed by aggregation assays, in both healthy individuals and in patients with cardiovascular disease. The aim of this study was to investigated the effect of moderate and strenuous exercise on arterial thrombus formation. Assay of some hemostatic marker as Platelet activation, thrombin generation [TF[pg/ml],TAT_ micro g/l and dimerand tPA concentration] von Willebrand factor, platelet aggregation tests, Coronary Angiography. haemostatic parameters in patients with ACS correlated with other clinical parameters under physical exercise Patients with ACS showed higher values for fibrinogen, tPA, TAT_, as indicators for a thrombin synthesis, and a marker for prothrombotic conditions, was elevated in patients with ACS,. Von Willebrand factor and D-dimer showed no statistical significant differences during rest., Exercise increased hemostatic parameters in an strenuous physical exercise in ACS Patients[< 0.05]. Exercise also increased plasma levels of fibrinogen and von Willebrand factor ,but there was an increase in the generation of T-AT complexes,. [P < 0.05]. Exercise did not affect platelet aggregation regardless of its intensity when triggered by the agonists ADP or collagen. Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers