Antidotal Effects of the Antihistamine Diphenhydramine Against Cholinesterase Inhibitor Poisoning: A Meta-Analysis of Median Lethal Doses in Experimental Animals.

The H1-antihistamine diphenhydramine antagonizes cholinesterase inhibitor poisoning in various animal species. One aspect of acute antidotal actions of diphenhydramine is increasing the median lethal doses (LD50) of toxicants. The objective of this meta-analysis was to assess the antidotal action of diphenhydramine against short-term toxicity (LD50) of cholinesterase inhibitors in experimental animals. The experimental studies selected were according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. They were conducted in laboratory animals (mice, rats, and chicks) to determine acute LD50 values of cholinesterase inhibitors (organophosphates, carbamates, and imidocarb) under the influence of diphenhydramine vs. controls. Twenty-eight records were selected from 12 studies on mice (n= 242), rats (n= 27), and young chicks (n= 128). The forest plot of randomized two-group meta-analysis assessed effect size, subgroup analysis, drapery prediction, heterogeneity, publication bias-funnel plot as well as one-group proportions meta-analysis of percent protection. Diphenhydramine significantly increased the combined effect size (i.e. increased LD50) in intoxicated experimental animals in comparison to controls (-3.71, standard error (SE) 0.36, 95%CI -4.46, -2.97). The drapery plot proposed a wide range of confidence intervals. The I2 index of heterogeneity of the combined effect size was high at 81.03% (Q= 142.3, p < 0.0001). Galbraith regression also indicated data heterogeneity; however, the normal quantile plot indicated no outliers. Subgroup analysis indicated significantly high heterogeneity with organophosphates (I2 = 63.72%) and carbamates (I2 = 76.41%), but low with imidocarb (I2 = 51.48%). The funnel plot and Egger regression test (t= -13.7, p < 0.0001) revealed publication bias. The median of the diphenhydramine protection ratio was 1.655, and the related forest plot of one group proportion meta-analysis revealed a statistically high level of protection (0.594, SE 0.083, 95%CI 0.432, 0.756), with high heterogeneity (I2= 99.86). The risk of bias assessment was unclear, while the total score (16 out of 20) of each study leaned towards the side of the low risk of bias. In conclusion, the meta-analysis of LD50 values indicated that diphenhydramine unequivocally protected experimental animals from the acute toxicity of cholinesterase inhibitors. The drug could be an additional antidote against acute poisoning induced by cholinesterase inhibitors, but a word of caution: it is not to be considered as a replacement for the standard antidote atropine sulfate. Further studies are needed to examine the action of diphenhydramine on adverse chronic effects of cholinesterase inhibitors.

Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq.

Since December 2019, the World Health Organization (WHO) has encouraged National Tuberculosis Programs to deprioritize the use of injectable-containing regimens and roll-out all-oral bedaquiline-containing regimens for rifampicin-resistant tuberculosis (RR-TB) treatment. Consequently, Iraq gradually replaced the injectable-containing regimen with an all-oral regimen, including bedaquiline. To assess treatment enrolment and outcomes of both regimens during a transitioning phase in Iraq, where health system services are recovering from decades of war, we conducted a nationwide retrospective cohort study using routinely collected programmatic data for patients enrolled between 2019-2021. We describe treatment enrolment and use logistic regression to identify predictors of unfavorable treatment outcomes (failure, death, or lost to follow-up), including regimen type. Nationwide, a total of 301 RR-TB patients started treatment, of whom 167 concluded treatment. The proportion of patients enrolled on the all-oral regimen increased from 53.2% (50/94) in 2020, to 75.5% (80/106) in 2021. Successful treatment was achieved in 82.1% (32/39) and 63.3% (81/128), for all-oral and injectable-containing regimens respectively. Moreover, the proportion of lost to follow-up was lower among those treated with the all-oral versus the long injectable-containing regimen; respectively 2.6% (1/39) versus 17.9% (23/128: p = 0.02). Unfavorable treatment outcome was associated with male gender (aOR 2.12, 95%CI:1.02-4.43) and age <15 years (vs 30-49 years, aOR 5.80, 95%CI:1.30-25.86). Regimen type (aOR 2.37, 95%CI: 0.91-6.13) was not significantly associated with having an unfavorable treatment outcome. In Iraq, the use of bedaquiline-containing all-oral regimen resulted in a high treatment success and reduced lost to follow-up.

Chemical compounds, antioxidant and scolicidal potencies of Thymus fontanesii essential oil.

Medicinal plants have become a source of new drugs to treat various diseases due to their low cost, few side effects, and wide accessibility. Among these, essential oils are promising natural compounds for use in scolicidal activity. The targets of our current work were to assess the chemical composition, antioxidant and protoscolicidal activities of Thymus fontanesii essential oil. The essential oil was extracted by hydrodistillation, and chemical compounds were quantified by GC-MS/GC-FID. The in vitro antioxidant activity was determined by DPPH radical scavenging assay and ferric reducing power. Three concentrations of essential oil (4.625, 9.25, and 13.875 mg/ml) were tested for 5, 10, and 15 min against E. granulosus protoscoleces and their viability was assessed by eosin staining essay. The yield of the essential oil was 2.06 ± 0.41 % (w/w). Carvacrol (59.68 %) was the main compound of Thymus fontanesii essential oils. Moreover, Thymus fontanesii essential oil has an antioxidant activity IC50 of 346.08 µg/ml and EC50 of 869.82 µg/ml. Furthermore, 100 % mortality of protoscoleces was observed at the doses of 9.25 mg/ml and 13.875 mg/ml after 5 min of exposure. Our findings show a potency of antioxidant and protoscolicidal activities against protoscoleces of E. granulosus.

Association of Reduced Maternal Plasma Cholinesterase Activity With Preeclampsia: A Meta-Analysis.

Blood butyrylcholinesterase (BChE) activity has been found to decrease during pregnancy and reportedly decrease even more in preeclampsia (PE). The purpose of the present meta-analysis was to answer a specific question of whether BChE activity (in the plasma, serum, or whole blood) is reduced in pregnant women suffering from PE compared to those with normal pregnancy. The meta-analysis included 15 studies with 20 records of BChE activity in 608 women compared to 569 healthy pregnant (control) ones. The studies were subjected to quality assessment using the Newcastle-Ottawa Scale (NOS). Using the Meta-Essentials software program 1.5, the one-group random effects model and forest plot revealed that the percentage of BChE activity in pregnant women with PE was 84.84% of the control value, with a standard error of 4.09 and 95% C.I. of 76.28, 93.41, indicating a significant 15.16% reduction in BChE activity in comparison to healthy pregnancy. No significant heterogeneity was seen in the analyzed data and the funnel plot did show publication bias. Subgroup (mild, severe, and unclassified PE) forest plot analysis revealed that the % BChE activities in PE compared to respective healthy pregnancies were 96.28%, 97.08%, and 76.62%, respectively with no heterogeneity. The median NOS score of the 15 studies included in the meta-analysis was 7, ranging from 5 to 8 (medium to high quality), and the forest plot showed an effect size of 0.735. This meta-analysis shows that BChE activity is reduced in PE compared with normal pregnancy and its value as a biomarker warrants further clinical studies.

Impact of vaccination and risk factors on COVID-19 mortality amid delta wave in Libya: A single center cohort study.

INTRODUCTION: The Delta variant has led to a surge in COVID-19 cases in Libya, making it crucial to investigate the impact of vaccination on mortality rates among hospitalized patients and the critically ill. This study aimed to explore the risk factors for COVID-19 mortality and the mortality rates among unvaccinated and vaccinated adults during the Delta wave who were admitted to a single COVID-19 care center in Tripoli, Libya. METHODS: The study involved two independent cohorts (n = 341). One cohort was collected retrospectively from May 2021-August 2021 and the second cohort was prospectively collected from August 2021-October 2021. Most of the patients in the study became ill during the Delta wave. The two cohorts were merged and analysed as one group. RESULTS: Most patients were male (60.5%) and 53.3% were >60 years old. The vast majority of patients did not have a previous COVID-19 infection (98.9%) and were unvaccinated (90.3%). Among vaccinated patients, 30 had received one dose of vaccine and only 3 had received two doses. Among patients who received one dose, 58.1% (18/31) died and 41.9% (13/31) survived. Most patients (72.2%) had a pre-existing medical condition. A multivariable prediction model showed that age >60 years was significantly associated with death (odds ratio = 2.328, CI 1.5-3.7, p-value = <0.0001). CONCLUSION: Our results indicate that previous infection or full vaccination against COVID-19 significantly reduces hospitalization and death. However, a single vaccine dose may not be adequate, especially for older individuals and those with underlying medical conditions. High-risk older patients with comorbidities should be fully vaccinated and offered up to date bivalent COVID-19 booster doses.

Artificial Intelligence Role in Subclassifying Cytology of Thyroid Follicular Neoplasm.

OBJECTIVE: Fine needle aspiration cytology has higher sensitivity and predictive value for diagnosis of thyroid nodules than any other single diagnostic methods.  In the Bethesda system for reporting thyroid, the category IV, encompasses both adenoma and carcinoma, but it is not possible to differentiate both lesions in the cytology practice and can be only differentiated after resection. In this work, we aim at exploring the ability of a convolutional neural network (CNN) model to sub-classifying cytological images of Bethesda category IV diagnosis into follicular adenoma and follicular carcinoma. METHODS: We used a cohort of cytology cases n= 43 with extracted images n= 886 to train CNN model aiming to sub-classify follicular neoplasm (Bethesda category IV) into either follicular adenoma or follicular carcinoma. RESULT: In our study, the model subclassification of follicular neoplasm into follicular adenoma (n = 28/43, images n = 527/886) from follicular carcinoma (n = 15/43, images n= 359/886), has achieved an accuracy of 78%, with a sensitivity of 88.4%, and a specificity of 64% and an area under the curve (AUC) score of 0.87 for each of follicular adenoma and follicular carcinoma. CONCLUSION: Our CNN model has achieved high sensitivity in recognizing follicular adenoma amongest cytology smears of follciualr neoplasms, thus it can be used as an ancillary technique in the subcalssification of Bethesda Iv category cytology smears.

Deep learning for Arabic healthcare: MedicalBot.

Since the COVID-19 pandemic, healthcare services, particularly remote and automated healthcare consultations, have gained increased attention. Medical bots, which provide medical advice and support, are becoming increasingly popular. They offer numerous benefits, including 24/7 access to medical counseling, reduced appointment wait times by providing quick answers to common questions or concerns, and cost savings associated with fewer visits or tests required for diagnosis and treatment plans. The success of medical bots depends on the quality of their learning, which in turn depends on the appropriate corpus within the domain of interest. Arabic is one of the most commonly used languages for sharing users' internet content. However, implementing medical bots in Arabic faces several challenges, including the language's morphological composition, the diversity of dialects, and the need for an appropriate and large enough corpus in the medical domain. To address this gap, this paper introduces the largest Arabic Healthcare Q &A dataset, called MAQA, consisting of over 430,000 questions distributed across 20 medical specializations. Furthermore, this paper adopts three deep learning models, namely LSTM, Bi-LSTM, and Transformers, for experimenting and benchmarking the proposed corpus MAQA. The experimental results demonstrate that the recent Transformer model outperforms the traditional deep learning models, achieving an average cosine similarity of 80.81% and a BLeU score of 58%.

First meta-analysis study of cholinesterase inhibition in experimental animals by organophosphate or carbamate insecticides under the influence of diphenhydramine.

Background and Aim: Diphenhydramine is an H1-antihistamine that counteracts the toxic effects of organophosphate and carbamate insecticides that inhibit cholinesterase (ChE) activity. This meta-analysis aimed to investigate the effects of diphenhydramine on ChE inhibition induced by these insecticides in the plasma, erythrocytes, or whole brain of experimental animals. Materials and Methods: A data search was performed on erythrocyte, plasma, and brain ChE inhibition caused by organophosphate and carbamate insecticides in experimental animals (mice, rats, and chicks) treated with the antihistamine diphenhydramine in accordance with preferred reporting items for systematic reviews and meta-analysis, which was done by the two-group random-effects model meta-analysis. The meta-analysis included 18 records extracted from six studies that, appeared from 1996 to 2022. Results: Using the random-effects model, a two-group meta-analysis revealed that the combined effect size (ChE inhibition) was significantly more favorable in the control group than in the diphenhydramine intervention, as shown by a forest plot. The combined effect size (standardized mean difference) was 0.67, with a standard error of 0.3, a lower limit of 0.04, and an upper limit of 1.29 (p = 0.025). The heterogeneity was moderate, as I2 of the combined effect size was 74%, with a significant Cochrane Q-test result (Q = 65, p < 0.0001). Subgroup analysis indicated that, with brain ChE inhibition, the heterogeneity (I2) became 5%, which was lower than ChE inhibition in plasma (84%) and erythrocytes (78%). No publication bias was identified using the funnel plot and Egger's test. Conclusion: This meta-analysis suggests that, in addition to its documented antidotal action against ChE-inhibiting insecticides, diphenhydramine can also reduce the extent of ChE inhibition, especially in the brain, which is the main site of toxicity of these insecticides. There is a need for additional studies to assess such enzyme inhibition in different parts of the brain.

A meta-analysis of normal human blood cholinesterase activities determined by a modified electrometric method.

Measurements of blood cholinesterase (ChE) activities, including those of erythrocytes (EChE), plasma or serum (PChE), and whole blood (WBChE), are used to assess exposure to ChE-inhibiting pesticides. The purpose of this review was to report normal reference ChE activities in the blood of healthy adult humans, as determined by a modified electrometric method. We performed a systematic review following PRISMA guidelines. Single-group meta-analysis of means of PChE, EChE, and WBChE activities of adult healthy subjects was conducted using the random effects model. The programs used were Open-Meta Analyst and Meta-Essentials Version 1.5. Studies selected for analysis comprised 21, 19, and 4 reports of normal reference/baseline PChE, EChE, and WBChE activities in 690, 635, and 121 healthy adult males and/or females, respectively. The meta-analysis showed normal reference values of the means (effect sizes) with 95% CI of PChE, EChE, and WBChE activities of healthy adult subjects, which were 1.078 (1.015, 1.142), 1.075 (1.024, 1.125) and 1.331 (1.226, 1.436), respectively. By the subgroup analysis, heterogeneity (I2>89%) was considerably reduced in females to 4.4% and 30.1% for PChE and EChE, respectively. Funnel plots indicated no publication bias. However, Egger's regression confirmed the symmetry of the data points for PChE and WBChE activities with a significant effect on EChE. This meta-analysis showed normal reference values of PChE, EChE, and WBChE activities, measured by a modified electrometric method, in healthy adult humans.

Monitoring Porcelain Insulator Condition Based on Leakage Current Characteristics.

Insulator monitoring using leakage current characteristics is essential for predicting an insulator's health. To evaluate the risk of flashover on the porcelain insulator using leakage current, experimental investigation of leakage current indices was carried out. In the first stage of the experiment, the effect of contamination, insoluble deposit density, wetting rate, and uneven distribution pollution were determined on the porcelain insulator under test. Then, based on the laboratory test results, leakage current information in time and frequency characteristics was extracted and employed as assessment indicators for the insulator's health. Six indicators, namely, peak current indicator, phase shift indicator, slope indicator, crest factor indicator, total harmonic distortion indicator, and odd harmonics indicator, are introduced in this work. The obtained results indicated that the proposed indicators had a significant role in evaluating the insulator's health. To evaluate the insulator's health levels based on the extracted indicator values, this work presents the naïve Bayes technique for the classification and prediction of the insulator's health. Finally, the confusion matrix for the experimental and prediction results for each indicator was established to determine the appropriateness of each indicator in determining the insulator's health status.

The dairy biorefinery: Integrating treatment process for Tunisian cheese whey valorization.

In order to set up a cost-efficient biorefinery in a Tunisian dairy industry, the production unit effluents are recovered. The main objective is to develop an optimum method for the production of bioethanol from whey. An energy analysis as well as environmental and economic analyses are performed for a bioethanol production plant. Four production scenarios are examined in order to determine the most provident as well as the less polluting ones. The process and cost models were developed using SuperPro Designer software which a simulation program that is able to estimate both process and economic parameters. This software uses energy and mass balances. The model can be used to assess the efficiency, the resources consumption, the profitability and the environmental impact of each scenario. The results demonstrate that the third scenario, in which a reverse osmosis procedure is added to concentrate the whey, a continuous stoichiometric reaction procedure is integrated to model the biotransformation in the fermenter and where streams are added in order to recycle the biomass, produces the highest amount of bioethanol with 1.65 MT/year but the second one (where no streams were added) is the most profitable one with revenues as high as 570 000 $/year. The corresponding cost of ethanol production is 0.271 US $ ethanol per liter. The net present value (NPV) and the return on investment (ROI) of each scenario are positive. Such result indicates that all these investments could be undertaken in order to find an eco-friendly issue for the dairy industry effluents. Cheese whey could serve as an alternative raw material for producing ethanol.

Spent Coffee Grounds Valorization in Biorefinery Context to Obtain Valuable Products Using Different Extraction Approaches and Solvents.

The valuable products that can be isolated from spent coffee ground (SCG) biomass consist of a high number of bioactive components, which are suitable for further application as raw materials in various production chains. This paper presents the potential value of the SCG obtained from large and local coffee beverage producers, for the production of valuable, biologically active products. Despite its high potential, SCG has not been utilized to its full potential value, but is instead discarded as waste in landfills. During its decomposition, SCG emits a large amount of CO2 and methane each year. The main novelty of our work is the implementation of sequential extraction with solvents of increased polarity that allows for the maximal removal of the available extractives. In addition, we have compared different extraction techniques, such as conventional and Soxhlet extraction, with more effective accelerated solvent extraction (ASE), which has seen relatively little use in terms of SCG extraction. By comparing these extraction methods and highlighting the key differences between them in terms of extraction yield and obtained extract composition, this work offers key insights for further SCG utilization. By using sequential and one-step accelerated solvent extraction, it is possible to obtain a significant number of extractives from SCG, with a yield above 20% of the starting biomass. The highest yield is for coffee oil, which is obtained with n-hexane ranging between 12% and 14% using accelerated solvent extraction (ASE) according to the scheme: n-hexane→ethyl acetate→60% ethanol. Using single-stage extraction, increasing the ethanol concentration also increases the total phenolic content (TPC) and it ranges between 18.7-23.9 Gallic acid equivalent (GAE) mg/g. The iodine values in the range of 164-174 using ASE and Soxhlet extraction shows that the hexane extracts contain a significant amount of unsaturated fatty acids; coffee oils with a low acid number, in the range of 4.74-6.93, contain few free fatty acids. The characterization of separated coffee oil has shown that it mainly consists of linoleic acid, oleic acid, palmitic acid, stearic acid and a small number of phenolic-type compounds.

Acaricidal and Repellent Effects of Essential Oils against Ticks: A Review.

Tick control is a priority in order to prevent the transmission of vector-borne diseases. Industrial chemical acaricides and repellents have been the most efficient tools against hard ticks for a long time. However, the appearance of resistances has meant the declining effectiveness of the chemicals available on the market. The trend today is to develop alternative control methods using natural products to replace nonefficient pesticides and to preserve the efficient ones, hoping to delay resistance development. Traditional in vitro evaluation of acaricidal activity or resistance to synthetic pesticides have been reviewed and they mainly focus on just one species, the one host tick (Rhipicephalus (Boophilus) microplus (Acari: Ixodidae)). Recent reports have called for the standardization of natural product components, extraction techniques, and experimental design to fully discover their acaricidal potential. This study reviews the main variables used in the bibliography about the efficiency of natural products against ticks, and it proposes a unification of variables relating to ticks, practical development of bioassays, and estimation of ixodicidal activity.

A snapshot of Plasmodium falciparum malaria drug resistance markers in Sudan: a pilot study.

OBJECTIVES: Malaria infection is still known to be a worldwide public health problem, especially in tropical and sub-tropical African countries like Sudan. A pilot study conducted to describe the trend of P. falciparum drug resistance markers in 2017-2018 in comparison to CQ and AS/SP eras in Sudan. The Pfcrt, Pfmdr-1, Pfdhfr, and Pfdhps genes were investigated. Data deposited by the worldwide antimalarial resistance network was consulted, and the molecular markers previously reported from Sudan were analyzed. RESULTS: Drug molecular markers analysis was successfully done on 20 P. falciparum isolates. The Pfcrt K76 showed high frequency; 16 (80%). For the Pfmdr-1, 9 (45%) isolates were carrying the N86 allele, and 11 (55%) were 86Y allele. While the Y184F of the Pfmdr-1 showed a higher frequency of 184F compared to Y184; 16 (80%) and 4 (20%), respectively. In the Pfdhfr, 51I allele showed higher frequency compared to N51; 18 (90%) and 2 (10%), respectively. For S108N, 18 (90%) were 108 N and 2 (10%) were S108. In the Pfdhps, all isolates were carrying the mutant alleles; 437G and 540E. The frequency distribution of the Pfcrt, Pfmdr-1, Pfdhfr, Pfdhps was significantly different across the whole years in Sudan.

An enhanced deep learning approach for brain cancer MRI images classification using residual networks.

Cancer is the second leading cause of death after cardiovascular diseases. Out of all types of cancer, brain cancer has the lowest survival rate. Brain tumors can have different types depending on their shape, texture, and location. Proper diagnosis of the tumor type enables the doctor to make the correct treatment choice and help save the patient's life. There is a high need in the Artificial Intelligence field for a Computer Assisted Diagnosis (CAD) system to assist doctors and radiologists with the diagnosis and classification of tumors. Over recent years, deep learning has shown an optimistic performance in computer vision systems. In this paper, we propose an enhanced approach for classifying brain tumor types using Residual Networks. We evaluate the proposed model on a benchmark dataset containing 3064 MRI images of 3 brain tumor types (Meningiomas, Gliomas, and Pituitary tumors). We have achieved the highest accuracy of 99% outperforming the other previous work on the same dataset.

Management of patients with disk displacement without reduction of the temporomandibular joint by arthrocentesis alone, plus hyaluronic acid or plus platelet-rich plasma.

BACKGROUND: Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. OBJECTIVES: The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. MATERIAL AND METHODS: A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. RESULTS: The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. CONCLUSIONS: Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.

Data on learners emotional states, mental responses and fuzzy learning flows during interaction with learning environment.

The emotional state of the learner is an important factor that must be taken into consideration during evaluating learning process and managing learning flows in computer based learning environments. This factor has a significant impact on the process of interaction between the learner and the learning environment. Enriching this type of interaction make the learning flow more dynamic based on emotional and mental responses of the learners. This approach can manage various learning flows based on learner's capabilities which lead to enhance the learning process outcome. This article provides data on learners' emotional states during their interaction with learning environment and other data that describe their learning activities and learning flows. The learning activities data is a combination of data that represents summary of learners' emotional states and data that represents the mental responses per learning session. All of emotional states data and mental responses data are used to provide the next learning level for each learner using fuzzy rules. The datasets are hosted in the Mendeley Dataset Repository (Megahed, 2019).

Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population.

The purpose of this randomized study was to compare clinical and surgical outcomes of total knee replacements (TKRs) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner. Forty-two knees each were operated using midvastus approach and the medial parapatellar approach. Clinical parameters that were evaluated included Knee Society score (KSS); knee pain using visual analogue scale (VAS) on day 1, 1 week, and 1 month; time required to straight leg raise (SLR); patellar tracking; mean extensor lag at 1 week and 1 month; and time of discharge from the hospital. Surgical parameters that were evaluated included tourniquet time, incidence of lateral retinacular release, estimated blood loss, and any complications during the surgery. KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group; though similar at 3 months, 6 months, and 1 year. The patients in midvastus group required fewer number of lateral retinacular releases; achieved SLR earlier; had less mean extensor lag at 1 week; had less mean VAS score at day 1, 1 week, and 1 month; and had shorter hospital stay. There was no significant difference in the mean tourniquet time and estimated blood loss. One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group. Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach.

Prevalence of rotavirus (GARV) and coronavirus (BCoV) associated with neonatal diarrhea in calves in western Algeria

<p><b>OBJECTIVE</b>To study the prevalence of bovine group A rotavirus (GARV) and bovine coronavirus (BCoV) in diarrheic feces from calves and the sensitive's parameters such as age group and sex.</p><p><b>METHODS</b>Feces samples from 82 diarrheic dairy calves from farms around Tiaret (Western Algeria) were collected. These samples were tested by ELISA assay.</p><p><b>RESULTS</b>The results showed that the prevalence of rotavirus and coronavirus infection are 14.63% (12.2% alone and 2.43% associated with bovine coronavirus) and 20.73% (18.3% alone and 2.43% associated with GARV), respectively.</p><p><b>CONCLUSIONS</b>The present study demonstrates that the both BCoV and GARV are involved in the neonatal calves' diarrhea, where the frequency of BCoV is clearly higher than that of GARV.</p>

Accessory renal vessels.

Knowledge of the variations of the renal artery has grown in importance with increasing of renal transplants, vascular reconstructions and various surgical and radiologic techniques performing in recent years. We report the presence of unilateral doubled renal vessels, discovered on routine dissection of a male cadaver, on the right side; additional renal artery originated from the abdominal aorta. In addition the right suprarenal gland received arteries from right renal and inferior phrenic arteries only. The right inferior phrenic originated from the right renal artery.