Role of urinary NGAL and microalbuminuria in the detection of subclinical acute kidney injury in pediatric intensive care unit and diabetic children.

Subclinical Acute Kidney Injury (AKI) describes patients who did not fulfill the classical criteria for AKI diagnosis but showed elevated levels of new biomarkers reflecting tubular injury. One of these biomarkers is Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study is to investigate the role of urinary NGAL and microalbuminuria as non-invasive biomarkers in the detection of subclinical AKI. Analysis of urinary NGAL and microalbuminuria in 91 subjects [30 pediatric intensive care unit (PICU) patients, 31 diabetic patients and 30 healthy controls] recruited from Cairo University Pediatric Hospital was done. Our study revealed that urinary NGAL was significantly higher in the PICU group followed by the diabetic group and lowest in the controls group (p=0.022). A positive correlation was found between urinary NGAL and microalbuminuria in the PICU group (Rvalue= 0.585, p-value=0.001). In diabetic group, a positive correlation was found between urinary NGAL and fasting blood glucose, 2 hours post prandial and HbA1C (R-value=0.421; pvalue= 0.021; R-value=0.426; p-value=0.019; R-value=0.438; pvalue= 0.018 respectively). Urinary NGAL may be a potential biomarker to detect subclinical AKI before actual functional renal damage leading to early intervention and reduction of mortality.

Proposed ANFIS Based Approach for Fault Tracking, Detection, Clearing and Rearrangement for Photovoltaic System.

In the last few decades, photovoltaics have contributed deeply to electric power networks due to their economic and technical benefits. Typically, photovoltaic systems are widely used and implemented in many fields like electric vehicles, homes, and satellites. One of the biggest problems that face the relatability and stability of the electrical power system is the loss of one of the photovoltaic modules. In other words, fault detection methods designed for photovoltaic systems are required to not only diagnose but also clear such undesirable faults to improve the reliability and efficiency of solar farms. Accordingly, the loss of any module leads to a decrease in the efficiency of the overall system. To avoid this issue, this paper proposes an optimum solution for fault finding, tracking, and clearing in an effective manner. Specifically, this proposed approach is done by developing one of the most promising techniques of artificial intelligence called the adaptive neuro-fuzzy inference system. The proposed fault detection approach is based on associating the actual measured values of current and voltage with respect to the trained historical values for this parameter while considering the ambient changes in conditions including irradiation and temperature. Two adaptive neuro-fuzzy inference system-based controllers are proposed: (1) the first one is utilized to detect the faulted string and (2) the other one is utilized for detecting the exact faulted group in the photovoltaic array. The utilized model was installed using a configuration of 4 × 4 photovoltaic arrays that are connected through several switches, besides four ammeters and four voltmeters. This study is implemented using MATLAB/Simulink and the simulation results are presented to show the validity of the proposed technique. The simulation results demonstrate the innovation of this study while proving the effective and high performance of the proposed adaptive neuro-fuzzy inference system-based approach in fault tracking, detection, clearing, and rearrangement for practical photovoltaic systems.

Vitamin D supplementation and improvement of pneumonic children at a tertiary pediatric hospital in Egypt: A randomized controlled trial.

BACKGROUND: Despite the well-recognized effect of vitamin D in metabolism and homeostasis, there is now growing interest in its probable association with pneumonia. This study aims to supply vitamin D3 (Cholecalciferol) (100,000 IU) to pneumonic children to minimize the duration of illness and improve their outcome. METHODS: A double-blinded, randomized, placebo-controlled trial was conducted in a Pediatric Cairo University affiliated hospital. An intervention arm (93 children) and a control arm (98 children), who had pneumonia with an insufficient or deficient level of vitamin D and whose parental permission was obtained, were enrolled in the trial. All children were treated with antibiotics according to WHO guidelines. Children were given a single injection of 1 mL of 100,000 IU of vitamin D3 or placebo. Clinical data were recorded every eight hours for all children. Outcomes were assessed 7 days after vitamin D injection.The primary outcome variable was the change in serum level of 25(OH)D, while the secondary outcomes were the medical state of the assigned cases (improvement or death) and duration between enrollment and hospital discharge for improved cases. RESULTS: In the supplementation group, the percentage of patients who suffered either deficient (38.7%) or insufficient levels (61.3%) of 25 (OH)D at day one had significantly decreased in the seventh day to (11.8%) and (52.7%), respectively. Kaplan--Meier plots highlighted that the median time to recover of the placebo group was significantly longer than that of the supplementation group (Log Rank P value < .001). CONCLUSION: VDD was detected in pediatric critical care children. In pneumonic children with high VDD, it is illustrated that Vitamin D supplementation is accompanied by lowered mortality risk and pSOFA scores, reduced time to recover, and improved PaO2/FiO2. TRIAL REGISTRATION: Trial Identifier number: NCT04244474. Registered on 27 January 2020- Retrospectively registered at ClinicalTrials.gov https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JXO&selectaction=Edit&uid=U0004UO8&ts=152&cx=9cceq6.

Insulin resistance linked to subtle myocardial dysfunction in normotensive Turner syndrome young patients without structural heart diseases.

Background Turner syndrome (TS) patients have increased cardiovascular risk. This cardiovascular risk is famously attributed to structural abnormalities of the left side of the heart such as aortic stenosis and aortic coarctation. However, due to insulin resistance and subsequent pathogenic mechanisms, normotensive TS patients without structural abnormalities may develop varying degrees of myocardial dysfunction. The aim of this research was to examine the role of speckle tracking echocardiography in early detection of Turner cardiomyopathy and to correlate this myocardial dysfunction with measures of insulin resistance. Methods This cross-sectional case control study included 30 children with TS and 30 age-matched healthy controls. TS patients were excluded if: hypertensive, with major structural abnormalities of the heart or other systemic diseases that may affect myocardial function. Conventional speckle tracking echocardiography and glucose-insulin ratio were performed for all study subjects. Results Routine echocardiographic parameters of left ventricular systolic function were similar in cases and controls while global longitudinal and circumferential strain (GLS and GCS) were lower in patients with TS than controls: (-13.2±1.1 vs. -18.3±2.4, p-value<0.000) and (-11.3±1.1 vs. -16.3±2.1, p-value<0.000), respectively. Fasting glucose:insulin ratio (FGIR) proved to be the best predictor of myocardial dysfunction in TS patients by multivariate analysis. Conclusions This study points towards the potential role of two-dimensional (2D) speckle tracking echocardiography in early detection of subtle systolic myocardial dysfunction in TS patients. It also points towards the implication of insulin resistance in precipitation of the observed dysfunction in TS patients.

Diagnostic indicator of acute lung injury for pediatric critically ill patients at a tertiary pediatric hospital.

Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months. Total of 68 pediatric patients following inclusion criteria were classified into: patients with ALI; with both ALI and sepsis; with sepsis and control patients. They were prospectively followed and their laboratory and immunological workup (at days 1 and 9) was done to measure serum sRAGE levels and detect (sRAGE) genotypes.The age of the included children ranged from 8 to 84 months. Plasma level of sRAGE was significantly higher in plasma from patients with ALI regardless of associated sepsis. Plasma sRAGE levels were positively correlated with lung injury score. When assessing sRAGE genotypes, TA and TT genotypes were significant in most of the ALI with and without sepsis patients.Monitoring levels of sRAGE and genotypes can significantly affect the survival of ALI children.

Serum adipokines and vitamin D levels in patients with type 1 diabetes mellitus.

INTRODUCTION: Adiponectin, leptin and resistin are adipokines that play important roles in the regulation of lipid and carbohydrate metabolism in type 2 diabetes (T2DM). However, their influence in type 1 diabetes mellitus is still unknown. The aim of this study was to measure serum adiponectin, leptin and resistin levels and to investigate their relationships with vitamin D and other clinical and laboratory parameters in patients with type 1 diabetes. MATERIAL AND METHODS: Fifty subjects with type 1 diabetes and 50 healthy age- and sex-matched subjects were selected from the Endocrinology Outpatient Clinic of Cairo University Pediatrics Hospital. Enzyme-linked immunosorbent assay was used to measure the levels of leptin, adiponectin and resistin. Vitamin D levels were measured using electro-chemiluminescence immunoassay. RESULTS: There were no significant differences in adiponectin and leptin levels between diabetic and control subjects (p = 0.6 and p = 0.5 respectively). Resistin levels were significantly higher in the diabetic group compared to controls (p < 0.001) and in postpubertal patients compared to prepubertal patients (p < 0.04). Serum resistin in type 1 diabetes showed a negative correlation with vitamin D (p < 0.001) and a positive correlation with glycated hemoglobin (HbA1c) (p = 0.006), while other adipokines were not interrelated. CONCLUSIONS: These results strongly support a role of resistin and vitamin D deficiency in the pathophysiology of type 1 diabetes. Vitamin D may be involved in resistin regulation through an unknown mechanism. Further studies are recommended to understand resistin regulation in type 1 diabetes.

Synthesis and biological evaluation of thiophene derivatives as acetylcholinesterase inhibitors.

A series of new thiophene derivatives has been synthesized using the Gewald protocol. The acetylcholinesterase inhibition activity was assayed according to Ellman's method using donepezil as reference. Some of the compounds were found to be more potent inhibitors than the reference. 2-(2-(4-(4-Methoxyphenyl)piperazin-1-yl)acetamido)-4,5,6,7-tetrahydrobenzo[b]thiophene-3-carboxamide (IIId) showed 60% inhibition, compared to only 40% inhibition by donepezil.

Synthesis of new indole derivatives structurally related to donepezil and their biological evaluation as acetylcholinesterase inhibitors.

New series of indole derivatives analogous to donepezil, a well known anti-Alzheimer and acetylcholinesterase inhibitor drug, was synthesized. A full chemical characterization of the new compounds is provided. Biological evaluation of the new compounds as acetylcholinesterase inhibitors was performed. Most of the compounds were found to have potent acetylcholinesterase inhibitor activity compared to donepezil as standard. The compound 1-(2-(4-(2-fluorobenzyl) piperazin-1-yl)acetyl)indoline-2,3-dione (IIId) was found to be the most potent.

Third-generation mobile phones (UMTS) do not interfere with permanent implanted pacemakers.

AIMS: Third-generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. METHODS AND RESULTS: The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T-Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single-chamber and 77 dual-chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a "worst-case scenario," which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 +/- 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. CONCLUSION: Third-generation mobile phones are safe for patients with permanent pacemakers. This is due to the high-frequency band for this system (1,800-2,200 MHz) and the low power output between 0.01 W and 0.25 W.

Gaseous emboli during off-pump surgery with T-graft technique, two different mechanisms.

OBJECTIVES: Gaseous embolism is a possible complication during off-pump coronary surgery with the use of a blower and can cause ischemic injuries. We describe two different possible mechanisms of carbon-dioxide embolization. METHODS: Out of 2196 coronary bypass surgeries, between 1 January 2007 and 31 December 2009, there were 977 off-pump operations. Two off-pump cases (0.2%) had gaseous (carbon-dioxide) emboli that migrated against blood stream proximally through T-anastomoses and then into the native coronary vessels. These emboli caused a temporary haemodynamic deterioration in other territories. Two types of T-anastomoses were included [saphenous vein on left internal thoracic artery (LITA) or right internal thoracic artery (RITA) on LITA]. RESULTS: Simple procedures and measurements were necessary but enough to regain haemodynamic stability. There was no effect on the postoperative outcome. CONCLUSION: We have concluded that carbon-dioxide emboli can also cause massive but temporary haemodynamic deterioration during off-pump surgery despite higher solubility in blood. The blower should be used only when a bull-dog clamp is applied on the graft. Also, proper de-airing and flushing of grafts is very important and avoids consequences of the trapped small emboli.

123I-metaiodobenzylguanidine (MIBG) scintigraphy for the detection of adrenal and extra-adrenal phaeochromocytomas: CT and MRI correlation.

CONTEXT: Evidence regarding the accuracy of [(123)I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series. OBJECTIVE: We present the largest series of primary phaeochromocytomas in which the performance of [(123)I]MIBG has been evaluated and correlated with cross-sectional imaging. DESIGN: We identified 76 patients with both preoperative [(123)I]MIBG and cross-sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra-adrenal tumours in 23 patients (2 patients had both adrenal and extra-adrenal tumours). Phaeochromocytoma metastases were not evaluated. MAIN OUTCOME MEASURE(S): [(123)I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [(123)I]MIBG result. RESULTS: The overall sensitivity of [(123)I]MIBG was 75%. Tumour detection was lower for extra-adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0.005). For extra-adrenal tumours, [(123)I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [(123)I]MIBG uptake for adrenal (P = 0.009) but not extra-adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [(123)I]MIBG negativity, although two large [(123)I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage. CONCLUSIONS: Extra-adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [(123)I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [(123)I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [(123)I]MIBG result.

Nucleic acid components and their analogues: a novel and efficient method for the synthesis of a new class of bipyridyl and biheterocyclic-nitrogen thioglycosides from pyridine-2(1H)-thiones.

A novel synthesis of a new class of bipyridyl and biheterocyclic-nitrogen thioglycosides utilizing the reactions of heterocyclic substituted pyridine-2(1H)-thiones and alpha-bromoglucose or alpha-bromogalactose tetraacetate as starting components is described.