Outcome and complications of outpatient parenteral therapy in pediatric emergency utilizing only peripheral vascular access: A retrospective descriptive study.

OBJECTIVES: To describe the cure and complication rates of outpatient parenteral therapy (OPT) utilizing only peripheral vascular access. METHODS: Using a retrospective descriptive study design, we reviewed the medical charts for children aged up to 15 years old who had been discharged from the emergency department into the care of the OPT unit from January 2018 to April 2019. The primary outcomes were cure and complication rates. RESULTS: Out of 814,150 visits, 2,788 (0.34%), accounting for 2,126 patients, were managed in the OPT unit. The majority had 2 days of symptoms, and 26.4% had comorbidities. Most patients started the treatment for suspected sepsis and suspected or confirmed urinary tract infections. The total days of therapy for all patients were 3,663. Cephalosporins were used for 75%, mostly ceftriaxone. Most patients completed the IV therapy within 2 days, 2.8% of cases required a change of antibiotics. Readmission avoidance and full recovery were achieved in 99.3%, and 0.7% needed readmission. All patients had peripheral vascular access. Complications occurred in 21%. Most were related to vascular access, but more than 80% were managed by one-time IV cannula re-insertion, and only 0.5% had treatment modification because of these complications. CONCLUSION: For carefully selected patients in the pediatric emergency, outpatient parenteral therapy seems effective, safe with manageable complications, and may result in less family disturbance than hospital admission.

The Role of Immunity in the Pathogenesis of SARS-CoV-2 Infection and in the Protection Generated by COVID-19 Vaccines in Different Age Groups.

This study aims to review the available data regarding the central role of immunity in combating SARS-CoV-2 infection and in the generation of protection by vaccination against COVID-19 in different age groups. Physiologically, the immune response and the components involved in it are variable, both functionally and quantitatively, in neonates, infants, children, adolescents, and adults. These immunological differences are mirrored during COVID-19 infection and in the post-vaccination period. The outcome of SARS-CoV-2 infection is greatly dependent on the reaction orchestrated by the immune system. This is clearly obvious in relation to the clinical status of COVID-19 infection, which can be symptomless, mild, moderate, or severe. Even the complications of the disease show a proportional pattern in relation to the immune response. On the contrary, the commonly used anti-COVID-19 vaccines generate protective humoral and cellular immunity. The magnitude of this immunity and the components involved in it are discussed in detail. Furthermore, many of the adverse effects of these vaccines can be explained on the basis of immune reactions against the different components of the vaccines. Regarding the appropriate choice of vaccine for different age groups, many factors have to be considered. This is a cornerstone, particularly in the following age groups: 1 day to 5 years, 6 to 11 years, and 12 to 17 years. Many factors are involved in deciding the route, doses, and schedule of vaccination for children. Another important issue in this dilemma is the hesitancy of families in making the decision about whether to vaccinate their children. Added to these difficulties is the choice by health authorities and governments concerning whether to make children's vaccination compulsory. In this respect, although rare and limited, adverse effects of vaccines in children have been detected, some of which, unfortunately, have been serious or even fatal. However, to achieve comprehensive control over COVID-19 in communities, both children and adults have to be vaccinated, as the former group represents a reservoir for viral transmission. The understanding of the various immunological mechanisms involved in SARS-CoV-2 infection and in the preparation and application of its vaccines has given the sciences a great opportunity to further deepen and expand immunological knowledge. This will hopefully be reflected positively on other diseases through gaining an immunological background that may aid in diagnosis and therapy. Humanity is still in continuous conflict with SARS-CoV-2 infection and will be for a while, but the future is expected to be in favor of the prevention and control of this disease.

Novel PEEK Retentive Elements versus Conventional Retentive Elements in Mandibular Overdentures: A Randomized Controlled Trial.

Background: Many patients suffer from lack of retention of conventional mandibular overdentures due to loss of clip retention over time. Computer-aided design-computer-aided manufacturing (CAD-CAM) milled polyether ether ketone (PEEK) materials may be used for the construction of retentive housing and clips for improving retention of implant-supported overdentures. Objective: To compare retention and patient satisfaction of implant-supported mandibular overdentures retained by conventional nylon clip and metal housings for ball attachments versus PEEK clip and housings. Methods: Twenty-two participants were divided into 2 equal groups (n = 11). The conventional group received implant-supported mandibular overdentures retained by metal housings and nylon retentive elements, while the PEEK group received implant-supported mandibular overdentures retained by PEEK retentive elements and housings. The PEEK retentive elements were made using computer-aided design and computer-aided manufacturing (CAD-CAM). The evaluation included measuring the retention by applying a gradual pulling up force by force meter and patient satisfaction with a 7-point visual analog scale (VAS) at overdenture insertion and 3, 6, and 12 months subsequently by a research interviewer. Results: The PEEK group showed statistically significantly increased retention force (P < 0.05) at the time of insertion (37.6/17.79) and after 3 months (33.9/16.78), 6 months (32.7/15.97), and 12 months (31.65/13.05). The conventional group had a statistically significantly higher mean overall satisfaction (P < 0.05) at the time of insertion (65/82.18). No statistically significant difference was found after 3 months (87.81/84.72). The PEEK group showed statistically significantly higher mean overall satisfaction (P < 0.05) after 6 months (86.36/80.18) and 12 months (85.45/79.54). Conclusions: According to the results of this study, the PEEK retentive material provided more retention than did the conventional material and led to improved patient satisfaction. The study was registered at clinical trials.gov (https://clinicaltrials.gov/ct2/show/NCT05079048).

Critical analysis of pyeloplasty role in adults with late diagnosis of ureteropelvic junction obstruction-a comparative study.

PURPOSE: Due to the data paucity about the functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with a preoperative age above the age of 45 years and according to the elderly definition (age ≥ 65 years), we conducted this study to clarify the different outcomes in adults presented with late hydronephrosis. METHODS: We included patients who were managed by pyeloplasty with a preoperative age ≥ 45 years. We further subdivided those patients into; group (A) patient's age ≥ 65 years and group (B) patient's age ≥ 45 and < 65 years. Split renal function (SRF) difference was evaluated by the changes between the last follow-up and the baseline renogram, where 5% change was considered a significant change. Functional outcomes and factors predicting the functional recoverability post pyeloplasty were evaluated. RESULTS: A total of 119 patients were included. The mean age was 62.3 ± 16.4 years. Group (A) and group (B) included 47 and 72 patients, respectively. After 24 months, GFR and SRF were increased at the last follow-up (P = 0.32 and 0.57, respectively). No significant functional changes were noted between both groups. Sixty two, 7 and 13 patients showed static, decreased and improved renal function. Lower preoperative SRF was the only predictor for poor functional recoverability in patients with age ≥ 45 years who were managed by pyeloplasty. CONCLUSION: Elderly patients should not be excluded from the corrective surgery for UPJO. Lower preoperative SRF was the only predictor for renal function deterioration post pyeloplasty.

A Summary of the SARS-CoV-2 Vaccines and Technologies Available or under Development.

Since the beginning of 2020, the world has been in a race to develop vaccines that can control the COVID-19 pandemic. More than 250 projects have been initiated for this purpose, but only 14 of them have been authorized for use, despite being in phase 3 clinical trials. More than 40 other vaccines are also in phase 1/2 clinical trials and show promising outcomes. Regarding the appropriate choice of vaccines for each country or region, we reviewed the currently used vaccines in light of the different influencing parameters. These factors include the mode of action, dosage protocol, age group of the vaccinee, side effects, storage conditions, mounted immune response, and cost. Technically, there are seven types of vaccines developed against SARS-CoV-2: messenger RNA (mRNA), nonreplicating and replicating vectors, inactivated viruses, protein subunits, viral-like particles, DNA vaccines, and live attenuated vaccines. The mRNA type is being used for the first time in humans. Unfortunately, mutated variants of SARS-CoV-2 have started to appear worldwide, and researchers are investigating the effects of the currently used vaccines on them. There are many concerns regarding the long-term protection afforded by these vaccines and their side effects, and whether they require future modifications to be effective against the mutated variants. The development of new vaccines using more advanced technology is paramount for overcoming the difficulties in controlling the COVID-19 pandemic across the world.

Position and integrity of uterine scar are determined by degree of cervical dilatation at time of Cesarean section.

OBJECTIVE: Abnormal placental invasion is more common after an elective Cesarean delivery, suggesting that prelabor Cesarean section (CS) increases the likelihood of the CS scar being above the internal cervical os and predisposing to a scar pregnancy in the future. The aim of this study was to assess the location and integrity of the CS scar in postpartum women delivered by CS at different stages of labor. METHODS: This was a prospective cohort study of women at term who underwent a CS for the first time. In all women, cervical dilatation was determined by digital examination at the time of the CS. All patients had a transvaginal ultrasound examination to assess the location of the CS scar in relation to the internal cervical os, as well as the presence of a scar niche. RESULTS: A total of 407 pregnant women were recruited into the study: 103 with cervical dilatation ≤ 2 cm, 261 with cervical dilatation 3-7 cm and 43 with cervical dilatation ≥ 8 cm at the time of the CS. A statistically significant correlation was observed between cervical dilatation at the time of the CS and the position of the CS scar. The scar was positioned in the uterus above the internal cervical os in 97.1% (100/103) of women delivered at a cervical dilatation of 0-2 cm, whereas the scar was located at or below the internal cervical os in 97.7% (42/43) of cases delivered at a cervical dilatation of 8-10 cm (P < 0.001). A uterine-scar defect (niche) was observed in 38.1% (64/168) of women with the scar located above, compared with 18.0% (43/239) of those with the scar situated at or below, the internal cervical os (P < 0.001). CONCLUSIONS: Prelabor and early-labor Cesarean delivery are associated with an increased prevalence of a scar in the uterine cavity as well as a scar niche. CS in late labor is associated with the uterine scar being situated in the endocervical canal and with a lower incidence of a niche. The position and integrity of the CS scar after prelabor and early-labor Cesarean delivery explain the predisposition to abnormal placental invasion in subsequent pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Supranormal differential renal function in adults with ureteropelvic junction obstruction: Does it really exist?

INTRODUCTION: Some patients with ureteropelvic junction obstruction (UPJO) have supranormal differential renal function (snDRF). We aimed to study the outcomes of pyeloplasty in adult patients with UPJO and either snDRF or normal differential renal function (nDRF) and to identify preoperative factors responsible for the snDRF phenomenon. MATERIALS AND METHODS: We retrospectively retrieved data for all patients who underwent pyeloplasty and had snDRF (differential renal function [DRF] ≥55%) and nDRF (DRF between 45 and 55%) preoperatively. Preoperative radiological data using computed tomography or magnetic resonance imaging were correlated with the presence of snDRF phenomenon. In addition, scintigraphic findings pre- and post-operatively were also assessed to evaluate the functional outcomes. RESULTS: Of a total of 856 patients, 31 had snDRF (group 1) and 42 had nDRF (group 2). After a mean of 37 months' follow-up in Group 1, 22 patients developed DRF reduction with non-obstructive pattern. Mean DRF % decreased from 59 ± 2.8 to 48 ± 13 (P < 0.0001). However, in Group 2, five patients had DRF decrease. Four patients developed snDRF phenomenon postoperatively. Increased renal pelvis volume ≥50 mm3 and increased anteroposterior pelvic diameter (APD) ≥37 mm were found to predict snDRF phenomenon. The same findings, in addition to preoperative snDRF, correlated with postoperative DRF decrease. CONCLUSION: SnDRF function could be expected in patients with increased renal pelvis volume and APD. The absolute value or changes in DRF are not reliable to judge treatment failure.

Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population.

OBJECTIVES: To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population. MATERIALS AND METHODS: We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was <30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy). RESULTS: Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P<.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P <.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P <.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up. CONCLUSION: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.

Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center.

Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can vary among different ethnic and racial groups. Objective The objective of this paper is to study the prevalence of various manifestations of SLE in a sample of the Egyptian population. Patients and methods Information in this study was derived from the medical records of SLE patients who sought medical advice at a private clinic in Cairo from January 1980 to June 2016. Results This study included 1109 SLE patients, of whom 114 (10.3%) were males and 995 were females (89.7%). Mean age of onset was 25.89 ± 10.81 years, while the median of disease duration from the onset of the disease till the last recorded visit was 26 months. The most common cumulative manifestations were arthritis (76.7%), malar rash (48.5%), leukopenia (45.7%), and photosensitivity (45.6%). A total of 33.1% of the patients had nephritis, and neuropsychiatric lupus was present in 6.4% of the patients. Secondary antiphospholipid syndrome was present in 11.5% of the patients. Antinuclear antibody and anti-double-stranded deoxyribonucleic acid were present in 1060/1094 (96.9%) and 842/1062 (79.3%) of the patients, respectively. Antiphospholipid antibodies were present in 266/636 (41.8%) of the patients, anti-Smith in 54/240 (22.5%), anti-SSA/Ro in 61/229 (20.4%), and anti-SSB/La in 32/277 (11.6%) of the patients. Male patients had a statistically higher prevalence of nephritis ( p = 0.01), whereas arthritis and alopecia were statistically higher in females ( p = 0.012 and p = 0.006, respectively). Patients with juvenile onset had a statistically higher prevalence of nephritis and seizures ( p < 0.001 and p = 0.012, respectively). Conclusions Arthritis and malar rash represented the most common clinical manifestations. Male and juvenile-onset patients had a predilection toward a more severe disease. These results are in agreement with many studies conducted in the Middle East and worldwide. On the other hand, major organ involvement was exceptionally low, which is contradictory to several reports from the Middle East and across the globe.

Prosthetic versus surgical rehabilitation in patients with maxillary defect regarding the quality of life: systematic review.

PURPOSE: To assess the ability of prosthetic rehabilitation versus surgical rehabilitation in improving the QOL for patients with maxillary defects. MATERIAL AND METHODS: A systematic search of PubMed, Scopus data base, Cochrane database, Ovid database, and Latin America & Caribbean database for articles published before September 2017 was performed by two independent reviewers. A manual search of articles published from January 2000 to September 2017 was also conducted. Only English studies were included which evaluate the QoL in patients with head and neck cancers. Any confusion between the two independent reviewers was resolved by means of a moderated discussion between the reviewers. RESULTS: Five studies fulfilled the inclusion criteria for this study. Many parameters were used regarding evaluation of QOL as the EORTC Head and Neck 35 assessment, UW-QOL, OHIP-14, VAS, OFS, MHI, HAD, Body Satisfaction Scale, Oral symptom check list, Swallowing, Diet consist, Pain control, Postoperative complication, and Speech. Two studies supported the surgical line of treatment for improving the QOL as compared to the prosthetic one; another two studies showed a statistically insignificant improvement in the patients' QOL with the surgical line, while only one revealed insignificant difference in QoL with both lines of treatment. CONCLUSIONS: Surgical rehabilitation provides a better line of treatment in improving the QOL for patients with maxillary defects. On the other hand, prosthetic has proved effectiveness in the immediate post-surgical times as temporary strategy, and it has represented a good alternative when the surgical obturation is compromised.

A Retrospective Study looking at Admissions Characteristics of Patients admitted to an Oncology Ward in Luxembourg.

Our study set out to monitor all admissions admitted to an oncology ward over a period of 60 days between 20/10/14 and 18/12/14. We wanted to analyse the reasons for admission, in order to identify treatment related complications and other preventable causes for inpatient admission.

Antiherpetic efficacy of aqueous extracts of the cyanobacterium Arthrospira fusiformis from Chad.

Natural substances offer interesting pharmacological perspectives for antiviral drug development with regard to broad spectrum antiviral properties and novel modes of action. Drugs currently used to treat cutaneous or genital herpetic infections are effective in limiting disease, but the emergence of drug-resistant viruses in immunocompromised individuals can be problematic. A nontoxic cyanobacterium Arthrospira strain from Chad has been characterized by sequence analysis of the intergenic spacer region of the phycocyanin gene. This cyanobacterium was identified as Arthrospira fusiformis by phylogenetic tree analysis. The antiherpetic activity of crude aqueous extracts from the Chad A. fusiformis isolate was determined. Antiviral efficacy against herpes simplex virus of cold water extract, hot water extract and phosphate buffer extract was assessed in plaque reduction assays and their mode of antiherpetic action was analysed. In virus suspension assays, cold water extract, hot water extract and phosphate buffer extract inhibited virus infectivity by 54.9%, 64.6%, and 99.8%, respectively, in a dose-dependent manner. The mode of antiviral action was determined by addition of cyanobacterial extracts separately at different time periods during the viral infection cycle. Extracts of A. fusiformis strain clearly inhibited herpesvirus multiplication before and during virus infection of host cells. The phosphate buffer extract of the A. fusiformis strain affected free herpes simplex virus prior to infection of host cells and inhibited intracellular viral replication. It is concluded, that Arthrospira compounds warrant further investigation to examine their potential role in the treatment of herpetic infections.

Molecular authentication and characterization of the antiherpetic activity of the cyanobacterium Arthrospira fusiformis.

In recent years there has been an increasing interest for application of natural products as antiinfectives and concerns about the safety of synthetic compounds have encouraged more detailed studies of natural resources. Two different strains of the nontoxic cyanobacterium Arthrospira from the United States and Egypt have been characterized by sequence analysis of the intergenic spacer region of the phycocyanin gene. Both cyanobacteria were identified as Arthrospira fusiformis by phylogenetic tree analysis. The antiherpetic activity of crude aqueous extracts from the US and the Egyptian A. fusiformis isolates was determined. Antiviral activity against herpes simplex virus of cold water extracts, hot water extracts and phosphate buffer extracts from the American and the Egyptian strains was assessed in plaque reduction assays and their mode of antiherpetic action was analysed. In virus suspension assays, all extracts of the American cyanobacterium and the phosphate buffer extract of the Egyptian cyanobacterium inhibited virus infectivity by > 90% in a dose-dependent manner. Phosphate buffer extract and hot water extract of the US cyanobacterium demonstrated the highest antiviral activity at low extract concentrations with high selectivity indices of 7464 and 542, respectively. The mode of antiviral action has been determined by addition of cyanobacterial extracts separately at different time periods during the viral infection cycle. Two extracts of the US A. fusiformis strain clearly inhibited herpesvirus multiplication before and after virus infection of host cells. In contrast, extracts of the Egyptian A. fusiformis strain affected only free herpes simplex virus prior to infection of host cells by direct inactivation of virus particles. In this study different Arthrospira crude extracts showed a significant antiviral effect and might be applied in recurrent herpetic infections.

Antiviral activity of Rhus aromatica (fragrant sumac) extract against two types of herpes simplex viruses in cell culture.

We report on the antiviral potency of an aqueous extract of root/stem bark of Rhus aromatica (fragrant sumac extract) against herpes simplex virus type 1 and type 2 in cell culture (RC-37 cells) using a plaque reduction assay. The extract exhibited a high level of anti-HSV activity with IC50-values of 0.0005% for HSV-1 and 0.0043% for HSV-2 as well as high selectivity indices (SI) of 5400 for HSV-1 and 628 for HSV-2. In order to determine the mode of antiviral action, the fragrant sumac extract was added at different times to the cells or viruses during the viral infection cycle. At maximum non-cytotoxic concentration (0.25%), plaque formation was significantly reduced by more than 99% when herpes simplex viruses were pretreated with the plant extract for 1 h prior to cell infection. When the host cells were pretreated with the fragrant sumac extract for 1 h prior to virus infection, the infectivity of viruses was reduced by 50% for HSV-1 but only moderately for HSV-2. No antiviral effect was seen when the plant extract was added to already infected host cells. Based on these findings the plant extract seems to interact not only with the viral envelope but also with the surface of the host cells impairing the ability of herpes simplex viruses to adsorb to and penetrate into the host cells. In conclusion, the aqueous fragrant sumac extract revealed a strong antiviral activity against HSV-1 and HSV-2 in vitro.

Chemical constituents from the seeds of Trifolium alexandrinum.

The ethanolic extract of the seeds of Trifolium alexandrinum afforded a new naturally occurring compound identified as methyl-alpha-glucose. The known compounds quercetin, kaempferol, apigenin 7-O-beta-D-glucoside and the nucleoside xanthosine were also isolated. The isolated compounds were identified by spectroscopic (UV, (1)H-, (13)C-NMR, DEPT, HMQC and HMBC) and spectrometric (ESI-MS/MS) analyses. The spectroscopic data of the isolated nucleoside were reported for the first time as a natural isolate.

Two new flavonoids from Origanum vulgare.

In addition to the major constituents apigenin, luteolin, salvagenin, cirsimartin, diosmetin, desmethoxycentauridin, 5-hydroxy-6,7,3',4'-tetramethoxy-abigenin, apigenin 7-O-glucoside, luteolin 7-O-glucoside, luteolin 7-O-glucoside-6''-methylester, two new flavonoids were isolated, in minor concentration, and identified as luteolin 7-O-alpha-L-rhamnoside-4'-O-beta-D-glucoside and quercetin 3-O-beta-D-glucoside-4'-O-alpha-L-rhamnoside from the methanolic extract of Origanum vulgare L. The structures were determined by conventional analytical methods and confirmed by MS and NMR spectral analysis.

A functional cardiovascular model with disorders.

This paper introduces a functional model of the cardiovascular system that is capable of describing its behavior in normal as well as pathologic cases. The developed model includes all the main compartments of the circulatory system and also the baroreflex-feedback regulatory mechanism. The model response to the incorporation of two critical cardiovascular disorders namely hypertension and acute congestive heart failure is realistic and within the expected range of the results of the literature experimental data.

ESR dosimetric properties of some biomineral materials.

Dosimetric properties of g-irradiated modern coral and bioactive glass (Bio-G) samples analyzed with electron spin resonance (ESR) have been separately reported (Hassan et al., 2004; Sharaf and Hassan, 2004) and compared with alanine. These are combined here to allow a three-way comparison between these materials.

A new ESR dosimeter based on bioglass material.

Bioglass (Bio-G) samples were irradiated with 60Co gamma-rays to study radicals for dosimetric materials with electron spin resonance (ESR). The ESR spectrum of Bio-G is characterized by two main signals. The first signal at g approximately = 4.3 corresponds to Fe3+ impurities and the second signal at g approximately = 2.0130 with line-width 10.85 G is ascribed as a hole center. The gamma-ray dose response and thermal stability were studied to establish the suitability of bioglass as an ESR dosimeter. A radical formation efficiency, G-value, of 0.53 +/- 0.11 was obtained. The lifetime of radicals and the activation energy were estimated from Arrhenius plots to be approximately 255 +/- 46 days and 0.71 eV, respectively.