Postnatal imaging of conjoined twins: a customized multimodality approach.

Medical imaging plays a crucial role in the management of conjoined twins. The role of imaging is to explore the anatomy, outline the shared organs and determine whether surgery is feasible. It also serves as a roadmap for successful separation. Additionally, imaging helps with counseling parents about prognosis. This review aims to illustrate recent advances in different imaging modalities and their role in the management of the various types of conjoined twins with an emphasis on relevant tips for optimal imaging.

Relationship of inflammatory mediators and sex-related parameters in Jordanian adult men patients with Covid-19.

Background: Recent epidemiological data suggest that Co - ro navirus disease 2019 (COVID-19) has a gender predisposition, with men being more seriously affected than women. Furthermore, older men accounting for most deaths. Therefore, this study aimed to investigate the serum testosterone, inhibin B, intrleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-a) levels in different age groups of Jordanian males with SARS-CoV2 infection and to evaluate the correlation of these markers in male patients with COVID-19. Methods: This study was performed on 157 selected individuals divided into two groups; COVID-19 patients and healthy controls. The participants of each group were further divided into two subgroups based on the age (20-50 years and 51-80 years age groups). The biochemical tests that were performed in this research are testosterone, inhibin-B, TNF-a, and IL-6. Results: The levels of IL-6 were significantly higher in COVID-19 patients than healthy individuals (7.63 ± 6.30 vs. 5.54 ± 2.10, P=0.006). Similarly, the difference between the levels of TNF-a in the study groups were statistically significant (P=0.001). The mean testosterone levels in COVID-19 patients and healthy controls were 1.53 ± 1.24 and 3.87 ± 1.44, respectively (P<0.001), whereas the mean inhibin B levels in COVID-19 patients (54.29 ± 7.33) were lower than in healthy controls (64.14 ± 37.66) with P = 0.011. TNF-a was significantly and positively correlated with age (r = 0.263, P=0.018) and IL-6 (r = 0.245, P=0.027). Inhibin B had a significant, but negative correlation with TNF-a (r = -0.326, P = 0.003). Conclusions: It can be concluded that most men seeking medical attention with symptomatic COVID-19 had low testosterone and inhibin B levels with increased both IL-6 and TNF-a, which are independent of age conforming the deleterious effects of SARS-CoV-2 infection on testicular function and immune response induction.

Response Surface Methodology (RSM) Optimization of the Physicochemical Quality Attributes of Ultraviolet (UV-C)-Treated Barhi Dates.

Barhi date fruit is one of the most important fruits that has high consumer preference and market value at the Khalal maturity stage. However, this stage is very short and the fruit is vulnerable to decay and the ripening process under improper handling and storage conditions. Thus, the purpose of this study was to evaluate the feasibility of utilizing ultraviolet (UV-C) as a method to preserve the qualitative features of Barhi dates under various storage circumstances. The core of this study was defining the best conditions for UV-C treatment of Barhi dates, which was accomplished using a response surface methodology (RSM) model with a central composite, rotating four-factors-mixed-levels design (CCRD). The impacts of independent variables [UV-C exposure time (1, 2, 3, 4 min), UV-C dose (1, 3, 5, 7 kJ/m2), storage time (1, 6, 11, 16, 21 days) and storage temperature (1, 5, 15, 25 °C)] on the moisture content (MC), total soluble solids (TSS), total color changes (E), firmness, total phenolic content (TPC), total viable count (TVC), DPPH antiradical activity, fructose and glucose were investigated. The results revealed that the optimum UV-C treatment and storage settings for keeping the quality features of the dates were the UV-C exposure period and dosage of 1 min and 2.07 kJ/m2, and the storage time and temperature of 18 days and 12.36 °C, respectively. At the optimum conditions, the values of 59.66% moisture content, 38.24% TSS, 60.24 N firmness value, 48.83 ΔE, 0.07 log CFU/g TVC, 5.29 mg GAE/g TPC, 56.32% DPPH antiradical activity, 6.87 g/100 g fructose and 14.02 g/100 g glucose were comparable predicted values demonstrating the suitability of the used RSM models. Overall, the perfect UV-C treatment and storage circumstances for extending the storability and shelf life and maintaining the quality features of Barhi dates were identified in this study.

Extending the Shelf Life of Fresh Khalal Barhi Dates via an Optimized Postharvest Ultrasonic Treatment.

The Barhi date is a high-quality date cultivar whose fruits (dates) are plucked and eaten fresh when they reach the Khalal maturity stage due to their sweetness, crispiness, and yellow skin color. After harvesting, Khalal Barhi fruits rapidly matured to the Rutab stage, where their tissues become soft and their skin color browner. This results in a decrease in their market value and customer demand. This study aims at investigating the effectiveness of the postharvest ultrasonic treatment in conserving the physical, microbial, and nutritional quality of Barhi fruits and extending their shelf life. To achieve the goals of the present work, the response surface methodology (RSM) was used for the optimization of the ultrasonic intensity (50, 100, 150, and 200 W/cm2) and application time (5, 10, 15, and 20 min) to preserve the Barhi dates high quality features for varied storage temperatures (1, 5, 15, and 25 °C) and duration (1, 6, 16, and 21 days). In RSM, a four-factors-mixed-levels central composite rotatable design (CCRD) was applied to optimize the ultrasound treatment and storage environments for better-quality physical [total soluble solids (TSS), firmness, and total color changes (ΔE)], microbial [total viable count (TVC)], nutritional [total phenolic content (TPC), DPPH antiradical activity, glucose, and fructose] features of Barhi dates. The outcomes showed that ultrasound intensity and its application time, storage temperature, and storage period influence the physical, microbial, and nutritional quality attributes in different magnitudes. The ideal settings for lessening the changes in the physical attributes, eliminating the microbial growth, and improving the nutritional quality attributes were 140 W/cm2, 5.2 min, 20.9 °C, and 21 days for ultrasound intensity, ultrasound exposure duration, storage temperature, and storage duration, respectively. In conclusion, this study proved the potential application of ultrasound for persevering the excellence aspects of Barhi dates and identified the ideal ultrasound environments for maintaining the physical, microbial, and nutritional quality features of Barhi dates during extended storing.

Borderzone Infarction and Small Vessel Disease in a Sample of Egyptian Stroke Patients: Differences and Similarities.

BACKGROUND: The anatomical location of white matter hyperintense lesions in small vessel disease are apparently similar to those of borderzone infarction. The objective of this study is to find clinical and radiological points of differentiation between the two vascular disorders in a sample of Egyptian patients which might have an impact on primary and secondary prevention. METHODS: Ischemic stroke patients with white matter lesions were categorized into two groups: small vessel disease and borderzone infarctions. NIHSS was done on admission. Risk factor profile was reported, and investigations done including: HbA1C, lipid profile, CRP, ECG, echocardiography, carotid duplex, brain MRI, MRA and MR perfusion study. RESULTS: 46 patients completed the study, 29 with SVD and 17 with BZI. Smoking, hypertension and recurrent stroke were more common in borderzone infarctions, but only diabetes was significantly higher (p = 0.047). Limb shaking was more observed in borderzone infarctions (p = 0.049). Radiologically: lacunar pattern was observed more in small vessel disease, while rosary pattern was more in borderzone infarctions (p = 0.04). FLAIR symmetrical lesions and microbleeds were more significant in small vessel disease (p = <0.001; 0.048, respectively). Perfusion study time to peak denoted evidence of significant hypoperfusion in all regions of interest in borderzone infarctions. CONCLUSION: Limb shaking, retinal claudication or syncope, with MRI showing rosary pattern of white matter hyperintensity, few microbleeds and markedly impaired perfusion favor the diagnosis of borderzone infarctions. On the other hand, presence of lacunae, FLAIR showing symmetrical WMH and microbleeds with minimal or no perfusion deficit suggests the diagnosis of small vessel disease.

Fruit properties during the harvest period of eleven Indian jujube (Ziziphus mauritiana Lamk.) cultivars.

The geometric attributes and physical, mechanical, and chemical properties were determined for 11 Indian jujube (Ziziphus mauritiana Lamk.) cultivars grown in Saudi Arabia including Zaytoni, Kashmiri, Komethry, Um-Sulaem with spines, Toffahy, Um-Sulaem without spines, Abdel-Sattar, Pu-Yun, Pu-Pineau, seedy ber, and buddling ber. The geometric mean diameter, surface area, sphericity, and shape index of the fruits ranged from 20.61 to 42.48 mm, 1339.58-5666.92 mm2, 71.39-96.80%, and 110.25-275.18%, respectively. The fruit physical properties, i e fruit weight, fruit volume, stone weight, flesh weight, true fruit density, and pulp-stone ratio varied from 4.71 to 39.02 g, 4.78 to 42.75 cm3, 0.11 to 2.35 g, 4.61 to 36.67 g,0.913 to 1.055 g/cm3, and 7.90 to 43.11, respectively. In addition, the mean color value of L*, a* and b* for the fruits ranged from 64.48 to 96.33, 2.65-4.05, and 6.32-84.36, respectively. The mechanical properties, including elastic range, bioyield force, modulus of elasticity, plastic range, and rupture force ranged from 2.31 to 8.86 mm, 21.64-325.77 N, 14.15-124.09 N/s, 0.83-3.45 mm, 56.42-364.21 N, and 107.77-480.91 N/s, respectively. The greatest rupture force belonged to the Pu-Pineau cultivar and the smallest belonged to the Um-Sulaem without spines cultivar at the horizontal orientation of both cultivars. The fruit chemical analysis values for total soluble solids, titratable acidity, total soluble solids/titratable acidity ratio, and vitamin C ranged from 13.43 to 23.55%, 0.48-1.27%, 14.24-39.85%, and 55.27-164.47 mg/100 g, respectively. The relevant data obtained for the 11 varieties of Indian jujube are valuable for developing and designing machines for processing operations, transportation, separating, packing, sorting, and harvesting. Additionally, the findings revealed considerable variation in chemical content, physical and mechanical characteristics among the tested cultivars.

The value of CSF flow studies in the management of CSF disorders in children: a pictorial review.

CSF flow disorders are frequently encountered in children. The advent of MR technology with the emergence of new pulse sequences allowed better understanding of CSF flow dynamics. In this pictorial review, we aim to conduct a comprehensive review of the MR protocol used to study CSF flow disorders and to discuss the utility of each pulse sequence in the adopted protocol. We will focus on the key anatomical structures that should be examined to differentiate hydrocephalus form ventricular dilatation ex-vacuo. The MR features of obstructive and communicating hydrocephalus will be discussed, in addition to the manifestations of CSF disorders associated with posterior fossa malformations (Dandy-Walker malformation, Chiari, and Blake's pouch cyst). Moreover, the value of MRI in the assessment of patients following interventional procedures (ventriculoperitoneal shunt and third ventriculostomy) will be addressed.

Nasal carriage of methicillin-resistant Staphylococcus aureus and the effect of tea extracts on isolates.

OBJECTIVES: This study aimed to determine the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients, healthcare workers (HCWs), and community individuals, as well as to test the effect of tea extracts on detected S. aureus isolates. MATERIALS AND METHODS: This cross-sectional study that was followed by an experimental study included a total of 1021 nasal swab samples that were collected from 470 community cases, 191 HCWs, and 360 patients. Isolation of S. aureus and MRSA was carried out on mannitol salt agar plates. S. aureus isolates were identified according to standard microbiological methods. Methicillin resistance was determined by disc-diffusion method according to the Clinical and Laboratory Standard Institute recommendations. A total of six tea samples (black and green) were purchased from different markets in Alexandria and were extracted. The antibacterial effects of these tea extracts were tested against identified MRSA isolates using agar gel diffusion method. RESULTS: The overall S. aureus nasal carriage rate was 12.5%, distributed as 7.9% MRSA and 4.6% methicillin-susceptible S. aureus. The rates of MRSA nasal carriage among HCWs, patients, and community cases were 10.5, 8.1, and 6.8%, respectively. Green tea had a strong effect on more than half of the isolates (55%) and an intermediate effect on 45% of them. It had no weak effect on any of the MRSA isolates. CONCLUSION: Among all tested individuals, HCWs had the highest percentage of MRSA nasal carriage. Green tea had a significantly stronger inhibitory effect than black tea on almost all tested isolates.

Glutaric aciduria type 1: neuroimaging features with clinical correlation.

BACKGROUND: Glutaric aciduria type 1 is a rare neurometabolic disease with high morbidity. OBJECTIVE: To describe the MR imaging abnormalities in glutaric aciduria type 1 and to identify any association between the clinical and imaging features. MATERIALS AND METHODS: MRI scans of 29 children (mean age: 16.9 months) with confirmed diagnosis of glutaric aciduria type 1 were retrospectively reviewed. Gray matter and white matter scores were calculated based on a previously published pattern-recognition approach of assessing leukoencephalopathies. Hippocampal formation and opercular topography were assessed in relation to the known embryological basis. MRI scores were correlated with morbidity score. RESULTS: The most consistent MRI abnormality was widened operculum with dilatation of the subarachnoid spaces surrounding underdeveloped frontotemporal lobes. Incomplete hippocampal inversion was also seen. The globus pallidus was the most frequently involved gray matter structure (86%). In addition to the central tegmental tract, white matter abnormalities preferentially involved the central and periventricular regions. The morbidity score correlated with the gray matter abnormality score (P = 0.004). Patients with dystonia had higher gray matter and morbidity scores. CONCLUSION: Morbidity is significantly correlated with abnormality of gray matter, rather than white matter, whether secondary to acute encephalopathic crisis or insidious onset disease.

Effect of plasminogen activator inhibitor-1 and tissue plasminogen activator polymorphisms on susceptibility to type 2 diabetes in Malaysian subjects.

Elevated activity of plasminogen activator inhibitor-1 (PAI-1) and decreased tissue plasminogen activator (tPA) activity are considered to be important risk factors for type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The aim of this study was to investigate the association of the PAI-1 4G/5G and tPA Alu-repeat I/D polymorphisms with T2DM in Malaysian subjects. Serum insulin, coronary risk panel, plasma glucose, and PAI-1 4G/5G and tPA Alu-repeat I/D polymorphisms were studied in 303 T2DM subjects (227 with MetS and 76 without MetS) and 131 normal subjects without diabetes and MetS. Statistical analysis showed that the dominant and additive models of PAI-1 4G/5G polymorphism showed a weak association with T2DM without MetS (OR = 2.35, P = 0.045; OR = 1.67, P = 0.058). On the other hand, the recessive model of the tPA Alu-repeat I/D polymorphism showed an association with T2DM with MetS (OR = 3.32, P = 0.013) whereas the dominant and additive models of the tPA Alu-repeat I/D polymorphism were not associated with T2DM either with or without MetS.

Plasminogen activator inhibitor-1 4G/5G polymorphism is associated with metabolic syndrome parameters in Malaysian subjects.

The plasminogen activator inhibitor-1 4G/5G and tissue plasminogen activator Alu-repeat insertion/deletion polymorphisms might be genetic determinations of increased or decreased of their plasma activities. The aim of this study was to investigate the association of plasminogen activator inhibitor-1 4G/5G and tissue plasminogen activator Alu-repeat I/D polymorphisms with metabolic syndrome parameters in normal Malaysian subjects and to assess the impact of these polymorphisms on their plasma activities and antigens. The genetic polymorphisms were genotyped in 130 normal subjects. In addition, the plasma activities and antigens of plasminogen activator inhibitor-1 and tissue plasminogen activator as well as levels of insulin, glucose, and lipid profile at fasting state were investigated. The subjects with homozygous 4G/4G showed association with an increased triglyceride (p = 0.007), body mass index (p = 0.01) and diastolic blood pressure (p = 0.03). In addition, the plasminogen activator inhibitor-1 4G/5G polymorphism modulates plasma plasminogen activator inhibitor-1 activity and antigen and tissue plasminogen activator activity (p = 0.002, 0.014, 0.003) respectively. These results showed that, the plasminogen activator inhibitor-1 4G/5G polymorphism is associated with metabolic syndrome parameters, plasminogen activator inhibitor-1 and tissue plasminogen activator activities in Malaysian subjects, and may serve to increase the risk of type 2 diabetes and cardiovascular disease in Malaysian subjects.

KCNQ1 variants associate with type 2 diabetes in Malaysian Malay subjects.

INTRODUCTION: Type 2 diabetes (T2D) candidate gene: potassium voltage-gated channel, KQT-like subfamily, member 1 (KCNQ1) was suggested by conducting a genome wide association study (GWAS) in Japanese population. Association studies have been replicated among East Asian populations; however, the association between this gene and T2D in Southeast Asian populations still needs to be studied. This study aimed to investigate the association of KCNQ1 common variants with type 2 diabetes in Malaysian Malay subjects. MATERIALS AND METHODS: The KCNQ1 single nucleotide polymorphisms (SNPs): rs2237892, rs2283228, and rs2237895 were genotyped in 234 T2D and 177 normal Malay subjects. RESULTS: The risk allele of the rs2283228 (A) was strongly associated with T2D (OR = 1.7, P = 0.0006) while the rs2237892 (C) was moderately associated with T2D (OR = 1.45, P = 0.017). The recessive genetic models showed that rs2283228 was strongly associated with T2D (OR = 2.35, P = 0.00005) whereas rs2237892 showed a moderate association with T2D (OR = 1.69, P = 0.01). The haplotype block (TCA), which contained the protective allele, correlated with a protection from T2D (OR = 0.5, P = 0.003). Furthermore, the diplotype (CAA-TCA) that contained the protective haplotype was protected against T2D (OR = 0.46, P = 0.006). CONCLUSION: The KCNQ1 SNPs, haplotypes and diplotypes are associated with T2D in the Malaysian Malay subjects.

Association of plasminogen activator inhibitor-1 and tissue plasminogen activator with type 2 diabetes and metabolic syndrome in Malaysian subjects.

BACKGROUND: Increased plasma plasminogen activator inhibitor-1 (PAI-1) activity and decreased tissue plasminogen activator (tPA) activity could be considered a true component of the metabolic syndrome (MetS) associated with an increased risk of developing cardiovascular diseases (CVD) and fibrinolytic abnormalities. The aim of this study was to investigate the association of tPA and its inhibitor PAI-1 with type 2 diabetes (T2D) and MetS and interrelationship between PAI-1 and tPA activities and antigens in Malaysian T2D and normal subjects. METHODS: The plasma activities and antigens of PAI-1 and tPA and the levels of the tPA/PAI-1 complex as well as serum insulin, parameter of the coronary risk panel and plasma glucose at fasting state were studied in 303 T2D subjects (227 with MetS and 76 without MetS), 131 normal non-diabetic non-metabolic subjects and 101 non-diabetic MetS subjects. RESULTS: The PAI-1 activity was higher in subjects with T2D with MetS (P = 9.8 × 10⁻¹9) and non-diabetic subjects with MetS (P = 3.0 × 10⁻¹5), whereas the tPA activity was lower in T2D with MetS (P = 0.003) as compare to normal subjects. Plasma tPA antigen levels were higher in subjects with T2D with MetS (P = 8.9 × 10⁻²4), T2D without MetS (P = 1.3 × 10⁻¹³) and non-diabetic MetS subjects (P = 0.002). The activity and antigen of PAI-1 in normal subjects were related to insulin resistance (P = 2.2 × 10⁻4; 0.007). Additionally, the PAI-1 activity was associated with an increased waist circumference (P = 2.2 × 10⁻4) and decreased HDL-c (P = 0.005), whereas the tPA activity was associated with decreased FBG (P = 0.028). The highest correlation was between PAI-1 activity and its antigen (R² = 0.695, P = 1.1 × 10⁻³6) in diabetic subjects. The tPA activity negatively correlated with its antigen (R² = -0.444, P = 7.7 × 10⁻¹³) in normal subjects and with the PAI-1 activity and antigen (R² = -0.319, P = 9.9 × 10⁻¹²; R² = -0.228, P = 3.4 × 10⁻6) in diabetic subjects. CONCLUSIONS: PAI-1 and tPA activities and antigens were associated with diabetes and MetS parameters in Malaysian subjects.

Wound healing activities of rafflesia hasseltii extract in rats.

The effects of topical application of Rafflesia hasseltii buds and flowers extract on the rate of wound healing and histology of healed wound were assessed. Four groups of adult male Sprague Dawley rats were experimentally wounded in the posterior neck area. A thin layer of blank placebo was applied topically to wounds of Group 1 rats. Wounds of experimental animals (Group 2 and 3) were treated with placebo containing 5% and 10% R. hasseltii buds extract, respectively. A thin layer of Intrasite gel was applied topically to wounds of Group 4 animals as reference. Macroscopically, wounds treated with placebo containing 5% and 10% R. hasseltii buds extract or Intrasite gel have been significantly accelerated the rate of wound healing compared to placebo-treated wounds. Histological analysis of healed wounds has confirmed this effect. Wounds treated with placebo containing 5%, 10% R. hasseltii buds extract or Intrasite gel showed markedly less scar width at wound enclosure and granulating tissue contained markedly more collagen and proliferating fibroblasts, but with the absence of inflammatory cells compared to wounds treated with blank placebo. In conclusion, the findings of increased rate of wound closure and contraction together with the histological findingssuggest that Rafflesia hasseltii buds extract is very effective in accelerating the wound healing process.

N(epsilon)-(Carboxymethyl)lysine and Coronary Atherosclerosis-Associated Low Density Lipoprotein Abnormalities in Type 2 Diabetes: Current Status.

In comparison to the general population, individuals with diabetes suffer a 3- to 4-fold increased risk for developing complications of atherosclerosis and vascular insufficiency. This fact should be taken into account to develop a suitable determinant for the early detection of these complications and subsequently reduce the adverse effect of type 2 diabetes. In vitro experiments have shown that the products of glucose auto-oxidation and Amadori adducts are both potential sources of N(epsilon)-(carboxymethyl)lysine (CML). Excessive formation of CML on low density lipoprotein (LDL) has been proposed to be an important mechanism for the dyslipidemia and accelerated atherogenesis observed in patients with type 2 diabetes. It has been postulated that the uptake of CML-LDL by LDL receptors is impaired, thereby decreasing its clearance from the blood circulation. Alternatively, the uptake of these modified LDL particles by scavenger receptors on macrophages and vascular smooth muscle cells (SMCs) and by AGE receptors on endothelial cells, SMCs, and monocytes is highly enhanced and this, in turn, is centrally positioned to contribute to the pathogenesis of diabetic vascular complications especially coronary artery disease. The present review summarizes the up-to-date information on effects and mechanism of type 2 diabetes-associated coronary atherosclerosis induced by CML-LDL modification.