Clinical significance of viral markers testing by ELISA and Individual Donation Nucleic Acid Testing (ID-NAT) for blood screening in blood bank: Single center study in Egypt.

Prevention of transfusion-transmitted viral infections and insurance of safe blood transfusion are the main goals of all blood banks worldwide. Despite the high sensitivity and specificity of currently used enzyme linked immunosorbent assay (ELISA) for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) testing, viral transmission could still occur during the window period. Introducing viral individual donation nucleic acid testing (ID-NAT) can greatly decrease such risk providing an additional layer in securing blood transfusion. We aimed to assess the clinical significance of viral markers testing by ELISA and ID-NAT for blood screening in the Blood Bank of Suez Canal University Hospital. We studied all donations (2132) collected during a two-months period. Blood donor samples were screened by ELISA and ID-NAT tests for HBV, HCV, and HIV. Serological testing results for HCV by ELISA revealed 2,122 (99.5 %) negative donations compared to 2,131 (99.95 %) negative donations by ID-NAT testing. Of the positive ELISA samples, only one was NAT positive. For HBV ELISA testing, 2,115 (99.2 %) donations were negative, also by ID-NAT testing 2,115 (99.2 %) donations were HBV DNA negative. Out of the negative ELISA samples, two samples were ID-NAT reactive donors which were missed by serology assay being in the window period. HIV ELISA testing revealed negative 2,130 (99.9 %) donations while ID-NAT testing showed 2,131 (99.95 %) negative donations and one positive donation. In conclusion, this is the first study carried out in the Suez Canal and Sinai region, Egypt to assess the importance of ID-NAT implementation. The introduction of ID-NAT in blood banks is an effective method for increasing safety of the blood transfusion.

Intraoperative mechanical power and postoperative pulmonary complications in low-risk surgical patients: a prospective observational cohort study.

BACKGROUND: Inadequate intraoperative mechanical ventilation (MV) can lead to ventilator-induced lung injury and increased risk for postoperative pulmonary complications (PPCs). Mechanical power (MP) was shown to be a valuable indicator for MV outcomes in critical care patients. The aim of this study is to assess the association between intraoperative MP in low-risk surgical patients undergoing general anesthesia and PPCs. METHODS: Two-hundred eighteen low-risk surgical patients undergoing general anesthesia for elective surgery were included in the study. Intraoperative mechanical ventilatory support parameters were collected for all patients. Postoperatively, patients were followed throughout their hospital stay and up to seven days post discharge for the occurrence of any PPCs. RESULTS: Out of 218 patients, 35% exhibited PPCs. The average body mass index, tidal volume per ideal body weight, peak inspiratory pressure, and MP were significantly higher in the patients with PPCs than in the patients without PPCs (30.3 ± 8.1 kg/m2 vs. 26.8 ± 4.9 kg.m2, p < 0.001; 9.1 ± 1.9 ml/kg vs. 8.6 ± 1.4 ml/kg, p = 0.02; 20 ± 4.9 cmH2O vs. 18 ± 3.7 cmH2O, p = 0.001; 12.9 ± 4.5 J/min vs. 11.1 ± 3.7 J/min, p = 0.002). A multivariable regression analysis revealed MP as the sole significant predictor for the risk of postoperative pulmonary complications [OR 1.1 (95% CI 1.0-1.2, p = 0.036]. CONCLUSIONS: High intraoperative mechanical power is a risk factor for developing postoperative pulmonary complications. Furthermore, intraoperative mechanical power is superior to other traditional mechanical ventilation variables in identifying surgical patients who are at risk for developing postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03551899; 24/02/2017.

Ratio of oxygen saturation index for predicting high-flow nasal cannula outcomes in emergency department for COVID-19 patients with severe hypoxemia: A retrospective study.

OBJECTIVES: High-flow nasal cannula (HFNC) oxygen therapy has been used as an initial ventilatory support for coronavirus disease 2019 (COVID-19) patients with mixed levels of acute hypoxemic respiratory failure (AHRF). However, the effectiveness of HFNC when used as initial ventilatory support in COVID-19 patients with severe AHRF exclusively is not well documented. Ratio of oxygen saturation (ROX) index (ROX = [SpO2/fraction of inspired oxygen]/respiratory rate) was shown to predict the outcome of HFNC in intensive care unit patients. Our study aimed to evaluate the utility of the ROX index for predicting HFNC therapy success/failure in COVID-19 patients with severe AHRF when HFNC is used as the first line of ventilatory support. METHODS: Retrospective study in 67 COVID-19 patients with severe AHRF receiving HFNC in the emergency department at a tertiary care academic medical center. ROX index was determined at 0, 2, 6, 12, and 24 h of HFNC onset. The need to escalate to noninvasive or invasive ventilatory support was documented. The receiver operating characteristic curves were performed and areas under the curves (AUCs) were calculated to evaluate the accuracy of ROX index for differentiating between patients who will succeed or fail HFNC therapy. RESULTS: HFNC therapy was successful in 19 patients (28.1%) and failed in 48 patients (71.6%). ROX index after 6 h of HFNC initiation had the best predictive capacity for the outcome of HFNC therapy (AUC = 0.78). ROX index >4.4 at 6 h of HFNC onset was significantly associated with HFNC success/failure. CONCLUSION: ROX index at 6 h after initiating HFNC therapy in COVID-19 patients with severe AHRF has a good predictive capacity for HFNC success/failure.

The effect of the addition of nefopam to intraoperative ketoprofen and acetaminophen on postoperative morphine requirements after laparoscopic cholecystectomy: a randomized controlled trial.

BACKGROUND: Few studies investigated the use of nefopam for pain control after laparoscopic cholecystectomy in the context of multimodal analgesia. The aim of this study was to evaluate the effect of adding nefopam to ketoprofen and acetaminophen given before the end of laparoscopic cholecystectomy. METHODS: In this double-blind, controlled study, 90 patients undergoing laparoscopic cholecystectomy during sevoflurane-dexmedetomidine-based anesthesia were randomized to receive either ketoprofen and acetaminophen or nefopam, ketoprofen, and acetaminophen for postoperative pain control before the end of surgery. The primary outcome was total morphine consumption in the Postanesthesia Care Unit (PACU). RESULTS: PACU morphine consumption was significantly lower in the experimental group compared to the control group (0.9±1.8 mg vs. 2.3±2.4 mg, respectively; P=0.004, Cohen's d=0.63). In the experimental group, a smaller proportion of patients received morphine in PACU (24% vs. 60%, respectively; P=0.001), morphine during the first 24 hours after surgery (47% vs. 77%, respectively; P=0.004), and acetaminophen on the floor (76% vs. 93%, respectively; P=0.039) compared with the control group. The average pain score during PACU stay was also significantly lower in the experimental group (1.7±2.0 vs. 2.7±2.0, P=0.01). Median time to first morphine requirement (44.0 minutes, 95% CI [(31.96 to, 52.21)] was shorter in the control group than in the experimental group (higher than the 90 minutes-last time point taken in PACU). CONCLUSIONS: Adding nefopam to ketoprofen and acetaminophen before the end of laparoscopic cholecystectomy provides a reduction in morphine consumption with superior analgesia in PACU.

Conservative Management of Dentigerous Cysts Associated With Mixed Dentition: A Retrospective Cohort Study.

Objectives The pediatric dentigerous cysts might vary by region and population group. Large cystic lesions are typically treated with marsupialization before enucleation in order to decompress the lesion and reduce its volume; however, in pediatric cystic lesions, conservative marsupialization and decompression can be used to manage the condition without additional enucleation. The current study's objectives were to present a case series of pediatric dentigerous cysts and discuss the conservative management of these cystic lesions associated with mixed dentition. Methods A retrospective cohort analysis of patients diagnosed with cystic lesions between 2016 and 2023 was identified. Data on clinical, radiological, pathological, and odontogenic causes were collected. The marsupialization approach was performed in all cases. Patient demographic information was also examined, and a literature review was carried out to identify comparable cases. Results Sixteen young patients were diagnosed with dentigerous cysts, and this was confirmed by clinical, radiological, and pathological examinations. Females comprised 56.2% of the cases, with the right side predominating (62.5%). Deciduous teeth related to the lesion could be extracted normally in all cases. All associated permanent teeth erupted rapidly after the intervention. Conclusion The marsupialization technique used in the current cases of dentigerous cysts associated with mixed dentition was highly successful, and all permanent impacted teeth erupted without any cystic recurrence.

Screening for SARS-CoV-2 IgM and IgG antibodies among healthcare workers: A single-center study in Egypt.

Coronavirus disease 2019 (COVID-19) pandemic has become a global public health disaster, spreading throughout the world. In order to accurately determine the extent of the pandemic, it is important to accurately identify the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers (HCWs). This study intended to determine the prevalence of SARS-CoV-2 infection among HCWs and examine its correlation with the demographic characteristics of the study participants prior to the implementation of the vaccination campaign. In this cross-sectional study included 431 HCWs from Suez Canal University Hospital in Ismailia, Egypt. Their sera were screened for SARS-CoV-2 antibodies using a one-step novel coronavirus (COVID-19) IgM/IgG antibody test from Artron, Canada. Positive cases were then confirmed using nasal swab real-time reverse transcriptase PCR from Viasure, Spain. Of the 431 study participants, 254 (58.9%) were males and 177 (41.1%) females. The majority of participants, 262 (60.8%), were younger than 30 years old, 150 (34.8%) between 30 and 40 years old, and only 19 (4.4%) older than 40 years old. Out of the total samples, 26 (6%) tested positive for SARS-CoV-2 IgM, while 19 (4.4%) tested positive for both IgM and IgG. The majority of the samples, 386 (89.6%), tested negative for both IgG and IgM. There was no association between the prevalence of SARS-CoV-2 and either sex or age of study participants. In conclusion, during the study period, the prevalence of SARS-CoV-2 infection among healthcare workers at Suez Canal University Hospital in Egypt was relatively low. Additionally, there was no significant correlation observed between the prevalence of positive cases and either age or sex.

COVID-19 anti immunoglobulin G antibodies serum levels among health care workers post COVID -19 vaccination: A single center study.

Coronavirus disease 2019 (COVID-19) pandemic has urged the scientific community internationally to find answers in terms of therapeutics and vaccines to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The post vaccination immune response differs between individuals especially health care workers who are the first line of defense to combat this disease. Our aim was to measure levels of anti-IgG antibodies titer post COVID-19 vaccination among health care workers in Suez Canal University Hospital. The study included 141 healthcare workers. Of these, 54 were physicians, 80 nurses, 6 health service workers, and one security guard. We used the Roche Elecsys Anti-SARS-CoV-2 assay for serological detection of IgG. Seropositive was found in 96.5% of the participants, and 43.3% of them had evidence of the prior history of COVID-19 infection. The highest titers of IgG in sera were found in the youngest age groups (20 - <35) years with a mean of 335.1 U/ ml. Participants who received the Sinovac vaccine had the highest mean IgG titer, 354.6U/ml; followed by Sinopharm (mean 352.15 U/ml) then Pfizer and Moderna (311.7U/ml) and AstraZeneca vaccine had the least mean level (267.31U/ml). Fatigue was the most significant short side effect occurring with 34% of the participants. In conclusion, there was a significant rising in serum IgG titer post-vaccine, and better antibody response in those previously infected with COVID-19. The post-COVID-19 vaccine serum IgG titers were affected by age, prior history of COVID-19 infection, and type of vaccine while short side effects post-vaccination may be affected by age and type of the vaccine.

Comparison of human immunodeficiency virus and syphilis results in pooled sera versus individual samples of blood donors attending suez canal university hospital.

Egypt is one of the countries where sexually transmitted diseases like human immunodeficiency virus (HIV) and syphilis are least prevalent. HIV and syphilis count less than one percent of total Egyptian population. An ELISA protocol for pooling serum samples is simple and may provide a way to reduce the cost and time needed for analysis. This study aimed to investigate the applicability and reliability of testing pooled sera of blood donors for HIV and syphilis compared to testing their individual sera and to assess the cost-effectiveness of this procedure. The study included 75 sera from randomly selected blood donors attending Suez Canal University hospital. Sera were screened by two ELISA kits, HIV Ag-Ab ELISA kit, and syphilis total antibody ELISA kit. Screening protocols were done by two sequential steps. At first, samples in pools of five were screened for both HIV and syphilis then, samples in positive pools were individually retested. There was no significant difference between the mean optical density for samples tested HIV and syphilis positive either individually or in pooled sera. There was no difference between the number of individual sera, tested positive for both HIV and syphilis and their pooled sera results (100 % positivity). There was significant decrease of the mean cost in one pool of 5 samples (16.5 L. E) in comparison to 5 individual samples (82.5 L. E) by HIV ELISA. Also, there was significant decrease of the mean cost in one pool of 5 samples (16 L.E) in comparison to 5 individual samples (80 L.E) by syphilis ELISA. In conclusion, the studied pooling protocol appeared reliable and can save up to 80 % of the cost for testing either HIV or syphilis by regular procedures.

Study of some immunological signatures and their association with COVID-19 in a sample of recovered Iraqi patients.

Since its emergence about two years ago, the novel coronavirus has continued to be a challenge and threat to public health, struck most parts of the world, leaving more than half a billion cases of infection and more than five million deaths. Immune response abnormalities post-infection with SARS-CoV-2 have been reported, and the mechanisms that lead to them are still ambiguous. This study was conducted to evaluate some immunological markers in the serum samples of COVID-19 convalescent patients and investigate the association of these immunological signatures with their age and sex. The serum levels of immunoglobulin G, interleukin-1 beta, and interferon lambda-1 of 75 patients and 50 healthy control group members were measured, with 55 % males and 45 % females participating and ages ranging from 20 to 80 years. The measurement of the immunological signatures was performed using the enzyme-linked immunosorbent assay (ELISA). The result revealed highly significant elevated levels of the serum immunological signatures of the convalescent group in comparison to the control group, with P-values of 0.00001 for each signature. Moreover, age was observed to have an association with an elevated level of the immunological signatures as it increased in the elderly, whereas no association with sex was detected. The findings strongly suggest that COVID-19 infection results in a persistent inflammatory response, which leads to prolonged post-recovery symptoms. Post-COVID-19 syndrome necessitates additional research to clarify its pathophysiology, pathogenesis, and long-term implications.

Respiratory Adverse Events After LMA® Mask Removal in Children: A Randomized Trial Comparing Propofol to Sevoflurane.

BACKGROUND: The removal of the laryngeal mask airway (LMA®) in children may be associated with respiratory adverse events. The rate of occurrence of these adverse events may be influenced by the type of anesthesia. Studies comparing total intravenous anesthesia (TIVA) with propofol and sevoflurane are limited with conflicting data whether propofol is associated with a lower incidence of respiratory events upon removal of LMA as compared to induction and maintenance with sevoflurane. We hypothesized that TIVA with propofol is superior to sevoflurane in providing optimal conditions and improved patient's safety during emergence. METHODS: In this prospective, randomized, double-blind clinical trial, children aged 6 months to 7 years old were enrolled in 1 of 2 groups: the TIVA group and the sevoflurane group. In both groups, patients were mechanically ventilated. At the end of the procedure, LMAs were removed when patients were physiologically and neurologically recovered to a degree to permit a safe, natural airway. The primary aim of this study was to compare the occurrence of at least 1 respiratory adverse event, the prevalence of individual respiratory adverse events, and the airway hyperreactivity score following emergence from anesthesia between the 2 groups. Secondary outcomes included ease of LMA insertion, quality of anesthesia during the maintenance phase, hemodynamic stability, time to LMA removal, and incidence of emergence agitation. RESULTS: Children receiving TIVA with propofol had a significantly lower incidence (10.8.% vs 36.2%; relative risk, 0.29; 95% CI [0.14-0.64]; P = .001) and lower severity ( P = .01) of respiratory adverse outcomes compared to the patients receiving inhalational anesthesia with sevoflurane. There were no statistically significant differences in secondary outcomes between the 2 groups, except for emergence agitation that occurred more frequently in patients receiving sevoflurane ( P < .001). CONCLUSIONS: Propofol induction and maintenance exerted a protective effect on healthy children with minimal risk factors for developing perioperative respiratory complications, as compared to sevoflurane.

Genetic Diversity, Analysis of Some Agro-Morphological and Quality Traits and Utilization of Plant Resources of Alfalfa.

Alfalfa (Medicago sativa L.) is one of the most important perennial forage crops to build effective diets for livestock producers. Forage crop improvement depends largely on the availability of diverse germplasms and their efficient utilization. The present investigation was conducted at Ismailia Agricultural Research Station to assess twenty-one alfalfa genotypes for yield components, forage yield and quality traits during 2019/2020 and 2020/2021. The genotypes were evaluated in field experiments with three replicates and a randomized complete block design, using analysis of variance, estimate of genetic variability, estimate of broad sense heritability (hb2) and cluster analysis to identify the inter relationships among the studied genotypes as well as principal component analysis (PCA) to explain the majority of the total variation. Significant differences were found among genotypes for all studied traits. The general mean of the studied traits was higher in the second year than the first year. Moreover, the combined analysis showed highly significant differences between the two years, genotypes and the year × gen. interaction for the traits studied. The genotype F18 recorded the highest values for plant height, number of tiller/m2, total fresh yield and total dry yield, while, the genotype F49 ranked first for leaf/stem ratio. The results showed highly significant variation among the studied genotypes for crude protein %, crude fiber % and ash %. Data revealed that the genotypes P13 and P5 showed the highest values for crude protein %, whereas, the genotype F18 recorded the highest values for crude fiber % and ash content. The results revealed high estimates of genotypic coefficient and phenotypic coefficient of variation (GCV% and PCV%) with high hb2, indicating the presence of genetic variability and effective potential selection for these traits. The cluster analysis exhibited considerable genetic diversity among the genotypes, which classified the twenty one genotypes of alfalfa into five sub-clusters. The genotypes F18, F49, K75, S35, P20, P5 and P13 recorded the highest values for all studied traits compared with other clusters. Furthermore, the PC analysis grouped the studied genotypes into groups and remained scattered in all four quadrants based on all studied traits. Ultimately, superior genotypes were identified can be utilized for crop improvement in future breeding schemes.

Reduction of Nonoperative Time Using the Induction Room, Parallel Processing, and Sugammadex: A Randomized Clinical Trial.

BACKGROUND: An important variable in the operating room is the nonoperative time (NOT), the time between skin closure on a previous case and skin incision on the following case. Mismanagement of NOT can result in significant financial losses and delays in the operating room (OR) schedule, which can negatively impact efficiency and patient, surgeon, and staff satisfaction. NOT includes general anesthesia induction time (IT), emergence time (ET), and turnover time (TOT), and can be calculated by adding the 3 components. OR efficiency can be increased by applying parallel processing for general anesthesia induction and OR cleaning and reversal of neuromuscular blockade with sugammadex to reduce the 3 components of NOT without compromising patient safety. METHODS: This is a prospective, randomized study of 111 patients 18 to 75 years of age, American Society of Anesthesiologists (ASA) I-III, undergoing surgery requiring general anesthesia and muscle relaxation. Patients were randomly assigned to the control group (traditional linear processing for induction of anesthesia and OR cleaning and neuromuscular blockade reversal with neostigmine/glycopyrrolate) and the active group (parallel processing for induction of anesthesia and OR cleaning and neuromuscular blockade reversal with sugammadex). The primary outcome measured is the difference in the NOT. The secondary outcomes are surgeon and patient satisfaction. RESULTS: NOT was significantly shorter in patients who underwent the parallel processing strategy and received sugammadex compared to the patients in the control group (25.0 [18.0-44.0] vs 48.0 [40.0-64.5] minutes; Cliff' delta = 0.57; P < .001). After excluding the cases in the experimental group that were put into sleep in the OR (ie, the first case of the room), IT, ET, TOT, and NOT were further reduced and remained statistically significantly lower than the control group. Satisfaction scores from surgeons were significantly higher in the active group than in the control group (P < .001). There was no significant difference in the satisfaction scores of patients between the 2 groups. CONCLUSIONS: Our study showed that interventions, such as parallel processing during induction of anesthesia and room cleaning instead of linear processing and the use of the faster-acting sugammadex instead of the combination of neostigmine and glycopyrrolate for the reversal of rocuronium-induced neuromuscular blockade, resulted in shorter IT, ET, TOT, and therefore NOT, in addition to higher surgeon's satisfaction.

Automated versus conventional perioperative glycemic control in adult diabetic patients undergoing open heart surgery.

BACKGROUND: Intraoperative glycemic variability is associated with increased risks of mortality and morbidity and an increased incidence of hyperglycemia after cardiac surgery. Accordingly, clinicians tend to use a tight glucose control to maintain perioperative blood glucose levels and therefore the need to develop a less laborious automated glucose control system is important especially in diabetic patients at a higher risk of developing complications. METHODS: Patients, aged between 40 and 75 years old, undergoing open heart surgery were randomized to either an automated protocol (experimental) or to the conventional technique at our institution (control). RESULTS: We showed that the percentage of patients maintained between 7.8-10 mmol.l-1 was not statistically different between the two groups, however, through an additional analysis, we showed that the proportion of patients whose glucose levels maintained between a safety level of 6.7-10 mmol.l-1 was significantly higher in the experimental group compared to control group, 14 (26.7%) vs 5 (17.2%) P = 0.025. In addition, the percentage of patients who had at least one intraoperative hyperglycemic event was significantly higher in the control group compared to the experimental group, 17 (58.6%) vs 5 (16.7%), P < 0.001 with no hypoglycemic events in the experimental group compared to two events in the control group. We also showed that longer surgeries can benefit more from using the automated glucose control system, particularly surgeries lasting more than 210 min. CONCLUSION: We concluded that the automated glucose control pump in diabetic patients undergoing open heart surgeries maintained most of the patients within a predefined glucose range with a very low incidence of hyperglycemic events and no incidence of hypoglycemic events. TRIAL REGISTRATION: Registered with clinicaltrials.gov (NCT # NCT03314272 , Principal investigator Roland Kaddoum, date of registration: 19/10/2017).

Assessment of angiotensin converting enzyme gene polymorphism in patients with psoriasis.

Psoriatic patients had diversity of clinical presentations and complications. Psoriasis can have significant interference with the patient's quality of life, recovery, and outcome. Some evidences suggest that the angiotensin converting enzyme (ACE) is present in the skin of psoriatic patients. This study intended to assess the patterns of ACE insertion/deletion (ACE ID) polymorphism and the levels of serum ACE among psoriatic patients in comparison to normal controls. The study included two groups: 20 patients with psoriasis and 20 apparently healthy adults with negative family history of psoriasis as a control group. Psoriasis area and severity index (PASI) was used to measure of severity of psoriasis. In both groups, ACE ID gene polymorphism was assessed by quantitative real-time polymerase reaction and serum ACE levels was evaluated using an enzyme-linked immunosorbent assay. ACE ID genotype was significantly higher among the psoriatic group in comparison to the control group (40.0% versus 15.0%, respectively, p=0.016). D allele was significantly higher among the psoriatic group than the control group (25.0% versus 7.5%, respectively, p=0.034). ACE ID genotype carried significantly higher risk in psoriatic group versus control group (OR=3.8). The D allele carried higher risk in psoriatic group versus control group (OR=4.1). ACE serum levels were significantly higher among the psoriatic group compared to the control group (87.4±7.03 versus 2.3±0.7, respectively; p < 0.001). We concluded that ACE ID gene polymorphism may be considered as a risk factor for developing psoriasis.

Predictors of postoperative pain, opioid consumption, and functionality after arthroscopic shoulder surgery: A prospective observational study.

PURPOSE: This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols. STUDY DESIGN: Observational cohort study. METHODS: One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery. RESULTS: Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption. CONCLUSION: Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.

Convalescent plasma in COVID-19: renewed focus on the timing and effectiveness of an old therapy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has strained health care systems worldwide and resulted in high mortality. The current COVID-19 treatment is based on supportive and symptomatic care. Therefore, convalescent plasma (CP), which provides passive immunization against many infectious diseases, has been studied for COVID-19 management. To date, a large number of randomized and non-randomized clinical trials as well as many systematic reviews have revealed conflicting results. This article summarizes the basic principles of passive immunization, particularly addressing CP in COVID-19. It also evaluates the effectiveness of CP as a therapy in patients with COVID-19, clinical trial reports and systematic reviews, regulatory considerations and different protocols that are authorized in different countries to use it safely and effectively. An advanced search was carried out in major databases (PubMed, Cochrane Library, and MEDLINE) and Google Scholar using the following key words: SARS-CoV-2, COVID-19, convalescent plasma, and the applied query was "convalescent plasma" AND "COVID-19 OR SARS-CoV-2". The results were filtered and duplicate data were removed. Collective evidence indicates that two cardinal players determine the effectiveness of CP use, time of infusion, and quality of CP. Early administration of CP with high neutralizing anti-spike IgG titer is hypothesized to be effective in improving clinical outcome, prevent progression, decrease the length of hospital stay, and reduce mortality. However, more reliable, high quality, well-controlled, double-blinded, randomized, international and multicenter collaborative trials are still needed.

Pathological Features of Recovery or Progression in Acute Tubular Necrosis: Single Centre Study.

Acute tubular necrosis (ATN) is the most important and frequent cause of acute kidney injury (AKI). Controversy exists concerning the role of renal biopsy in the evaluation of ATN prognosis. We aim in our study to evaluate the role of renal biopsy for the detection of recovery and progression and rate of recovery of ATN. The study was designed to include all biopsies with the diagnosis in ATN in adults >21-year-old, from January 2016 to December 2018. Biopsies were recruited retrospectively and were reviewed by three pathologists and quantitated. Four histological ATN features were evaluated. Flattening cells, distension or dilatation, debris, and vacuolation and for each a score were attributed as follows: 0 = less than 5% of section, 1 = 6%-25%, 2 = 26%-50%, 3 = >50%. Thirty-five patients with 35 renal biopsies were analyzed. Flattening was seen <5% in nine patients, 6%-25% in 15 patients, 26%-50% in six patients. and >50% in five patients. Dilatation was seen <5% in 11 patient, 6%-25% in 10 patients, 26%-50% seen in six patients, and >50% in eight patients. The presence of debris was seen in <5% in 12 patients, 6%-25% in 12 patients, 26%-50% seen in six patients, and >50% seen in five patient. Vacuolation was seen in 5% in eight patients, 6%-25% in 14 patients, 26%-50% in seven patients, and >50% in six patients. It was found that flattening <5% and dilatation <5% and dilatation >50% in renal biopsy are the good indicators for recovery and good prognosis of cases of ATN, in addition debris <5% and >50% and vacuolation <5% are also good indicators for recovery and good prognosis of cases of ATN. On the other hand, flattening from 6% to 25% and from 26% to 50%, dilatation from 6% to 25%, debris from 26% to 50% and vacuolation >50% are also indicators for delayed recovery and poor prognosis of cases of ATN. Renal biopsy in AKI with the diagnosis of ATN with scoring system of flattening, dilatation, debris, and vacuolation can point to indication of recovery or progression of these cases.

Does Setting Matter? An Exploratory Examination of Victimization Risk Reduction Strategies Among Female College Students Studying Abroad.

This exploratory project assessed whether female college students studying abroad engage in more risk reduction strategies (RRSs) when abroad than in their community of origin and whether changes in students' use of RRSs while abroad are related to a variety of factors (e.g., fear of victimization, year of study). Results revealed that students engaged in significantly more RRSs while abroad and that students studying in Africa were more likely to increase their use of RRSs. Seniors engaged in fewer RRSs. Results extend the RRS literature by confirming that the employment of strategies is location dependent and associated with other factors.

Assessment of human parvovirus B19 infection in Egyptian hemodialysis patients.

INTRODUCTION: Parvovirus B19V has been shown to be associated with end-stage renal disease (ESRD) with increased risk of post-infection anemia, especially in hemodialysis (HD) patients. This effect may be due to immunosuppression, insufficient erythropoietin, or short lifespan of red blood cells. Therefore, parvovirus infection should be investigated in this group of patients suffering from anemia or pancytopenia. We assessed the frequency of parvovirus B19 in HD patients attending Suez Canal University Hospital and analyzed the correlation of this infection with hematological parameters in those patients compared with normal individuals. METHODS: We recruited 80 ESRD patients on hemodialysis and 70 healthy controls. History-taking, full examination, and complete blood count (CBC) were performed for all study subjects. Parvovirus B19 detection was performed through polymerase chain reaction (PCR), which included the QIAamp DNA Mini Kit for extracting DNA, which was amplified using TaqMan Universal Master Mix and detected using TaqMan MGB probes by real-time PCR using Rotor Gene Analyzer (6000). FINDINGS: HD patients had a significantly higher frequency of B19V infection than the control group (p = .02). We also found that parvovirus B19-infected HD patients had significantly lower CBC values than uninfected patients. CONCLUSION: The frequency of parvovirus B19 was significantly higher in HD patients and was associated with lower hematological parameters than in uninfected patients, suggesting a significant role of this virus in the pathogenesis of anemia and/or pancytopenia in ESRD.