Diagnostic utility of apparent diffusion coefficient in preoperative assessment of endometrial cancer: are we ready for the 2023 FIGO staging?

BACKGROUND: Although endometrial cancer (EC) is staged surgically, magnetic resonance imaging (MRI) plays a critical role in assessing and selecting the most appropriate treatment planning. We aimed to assess the diagnostic performance of quantitative analysis of diffusion-weighted imaging (DWI) in preoperative assessment of EC. METHODS: Prospective analysis was done for sixty-eight patients with pathology-proven endometrial cancer who underwent MRI and DWI. Apparent diffusion coefficient (ADC) values were measured by two independent radiologists and compared with the postoperative pathological results. RESULTS: There was excellent inter-observer reliability in measuring ADCmean values. There were statistically significant lower ADCmean values in patients with deep myometrial invasion (MI), cervical stromal invasion (CSI), type II EC, and lympho-vascular space involvement (LVSI) (AUC = 0.717, 0.816, 0.999, and 0.735 respectively) with optimal cut-off values of ≤ 0.84, ≤ 0.84, ≤ 0.78 and ≤ 0.82 mm2/s respectively. Also, there was a statistically significant negative correlation between ADC values and the updated 2023 FIGO stage and tumor grade (strong association), and the 2009 FIGO stage (medium association). CONCLUSIONS: The preoperative ADCmean values of EC were significantly correlated with main prognostic factors including depth of MI, CSI, EC type, grade, nodal involvement, and LVSI.

Transient efficacy of buparvaquone against Theileria haneyi in chronically infected horses.

BACKGROUND: Theileria haneyi is one of the three known causative agents of equine piroplasmosis. While imidocarb is generally effective in the clearance of the highly pathogenic Theileria equi, it is ineffective in the treatment of T. haneyi. Moreover, co-infection with T. haneyi has been shown to impede the successful treatment of T. equi. Furthermore, tulathromycin and diclazuril have demonstrated inefficacy in eradicating T. haneyi. The absence of an effective therapeutic agent against this parasite represents a significant obstacle in managing equine piroplasmosis. METHODS: To address this issue, we evaluated the efficacy of buparvaquone in the treatment of T. haneyi in chronically infected horses. RESULTS: Our findings showed that treatment of horses with the recommended dose of 2.5 mg/kg of buparvaquone led to a rapid abatement of T. haneyi levels, to a level where the parasites were not detectable by nested PCR. Following treatment, the horses remained PCR negative for a minimum of seven weeks until recrudescence occurred. Subsequent re-administration of buparvaquone at an increased dosage of 6 mg/kg upon recrudescence failed to exert a theilericidal effect on T. haneyi. Throughout the treatment regimen, the hematological parameters of the horses and most components of the chemistry panel remained within the normal range, except for blood urea nitrogen levels, which fell below the normal range in certain instances. CONCLUSIONS: BPQ at 2.5 mg/kg and 6 mg/kg had a robust theilericidal effect but was ineffective in the clearance of the T. haneyi infection in persistently infected animals.

An entropy and machine learning based approach for DDoS attacks detection in software defined networks.

Software-defined networks (SDNs) have been growing rapidly due to their ability to provide an efficient network management approach compared to traditional methods. However, one of the major challenges facing SDNs is the threat of Distributed Denial of Service (DDoS) attacks, which can severely impact network availability. Detecting and mitigating such attacks is challenging, given the constantly evolving range of attack techniques. In this paper, a novel hybrid approach is proposed that combines statistical methods with machine-learning capabilities to address the detection and mitigation of DDoS attacks in SDN environments. The statistical phase of the approach utilizes an entropy-based detection mechanism, while the machine-learning phase employs a clustering mechanism to analyze the impact of active users on the entropy of the system. The k-means algorithm is used for clustering. The proposed approach was experimentally evaluated using three modern datasets, namely, CIC-IDS2017, CSE-CIC-2018, and CICIDS2019. The results demonstrate the effectiveness of the system in detecting and blocking sudden and rapid attacks, highlighting the potential of the proposed approach to significantly enhance security against DDoS attacks in SDN environments.

Transient efficacy of buparvaquone against the US isolate of Theileria orientalis Ikeda genotype in sub-clinically infected cattle.

Introduction: Theileria orientalis, an economically significant tick-borne hemoparasite, infects cattle globally. The T. orientalis Ikeda genotype, transmitted by Haemaphysalis longicornis ticks, is associated with clinical manifestations characterized by anemia, abortions, and mortality, although subclinical infections prevail. Despite the common occurrence of subclinical infections, therapeutic interventions targeting T. orientalis Ikeda in such cases are currently lacking, impeding effective parasite control measures. To address this critical knowledge gap, we assessed the efficacy of buparvaquone (BPQ) in eliminating the T. orientalis Ikeda, US isolate, in sub-clinically infected cattle. Methods: Twelve sub-clinically infected calves, identified by the presence of T. orientalis in peripheral blood alongside the absence of fever and anemia, were enrolled in the study. Six calves received two treatments of the BPQ label dose (2.5 mg/kg) at a 48-h interval, while additional three calves received the drug at a dosage of 6 mg/kg following the same regimen. Three untreated calves served as controls. Results and discussion: Endpoint and quantitative PCR analyses revealed that BPQ exerted a transient effect on T. orientalis parasitemia. Parasites remained undetectable in peripheral blood until weeks 4 and 11 post-treatment in animals administered 2.5 mg/kg and 6 mg/kg of BPQ, respectively. Intriguingly, following recrudescence, administering 6 mg/kg to animals previously treated with 2.5 mg/kg did not result in a reduction in parasite load. Pharmacokinetic analysis data suggested that escalating the dosage led to a less than proportional increase in serum concentrations of BPQ. Moreover, a significant yet reversible decrease (p < 0.05) in blood urea nitrogen was observed in animals treated with the drug, irrespective of the dosage. Despite parasitemia relapse, animals treated with 6 mg/kg BPQ exhibited a noteworthy decrease (p < 0.05) in IgG levels specific to the T. orientalis major piroplasm surface protein compared to controls and animals treated with 2.5 mg/kg of the drug. Conclusion: BPQ did not demonstrate efficacy in clearing subclinical T. orientalis Ikeda infection. Future investigations are warranted to explore innovative therapeutic modalities that, in synergy with vaccines and diagnostic assays, can facilitate the development of comprehensive programs aimed at controlling and eradicating this parasite.

Isolated left axillary nodal metastasis from endometrial carcinosarcoma: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Non-mammary metastases to the breast and axilla are rare instances, and isolated axillary lymph node metastases are especially rare. We present a rare case of left axillary lymph node metastasis from a primary endometrial carcinosarcoma. CASE PRESENTATION: We report a case of a 73-year-old woman who presented with a left breast tail palpable mass. Sonomammography and breast MRI revealed multiple enlarged left axillary lymph nodes (LN) showing malignant criteria without any suspected malignancy in either breast on imaging. The patient underwent a nodal excisional biopsy that diagnosed axillary lymph node metastasis from a gynecologic origin. Complementary abdominopelvic CT revealed a suspicious endometrial mass that was confirmed on MRI. She underwent D&C and the pathology revealed endometrial carcinosarcoma. CLINICAL DISCUSSION: Accurate detection of extramammary primary sites is crucial as their management and outcome differ significantly from primary breast cancer. To the best of our knowledge, our case could be the first reported case of isolated metastatic axillary LN from uterine carcinosarcoma presenting as the initial symptom without pelvic or abdominal LN involvement. CONCLUSION: For these patients to avoid needless surgical procedures and therapies, a proper diagnosis made by a multidisciplinary team with precise radiologic and pathologic correlation is essential.

Highly differentiated follicular carcinoma of the ovary with omental and peritoneal spread in a 22-year-old girl; A diagnostic and counseling challenge.

INTRODUCTION AND IMPORTANCE: Highly differentiated follicular carcinoma of the ovary (HDFCO) is a rare type of thyroid carcinoma originating from struma ovarii, consisting of benign-appearing thyroid follicles spread outside the ovarian tissue. CASE PRESENTATION: We present a 22-year-old girl who underwent left salpingo-oophorectomy, omental, and peritoneal biopsies for a complex left ovarian mass. Microscopic examination and Immunohistochemical staining led to the diagnosis of HDFCO with tumor deposits affecting the omental and peritoneal biopsies. The patient was counseled about the nature of her disease and the recommended treatment. Thyroidectomy was performed later, revealing a normal thyroid gland. The patient received an ablative dose of radioactive iodine (150 mci) and a suppressive dose of levothyroxine. This is one of the youngest reported patients ever. CLINICAL DISCUSSION: To our knowledge, the patient presented in this case report is one of the youngest patients ever reported in the literature. In the recent WHO Classification of Female Genital Tumors, the term highly differentiated follicular carcinoma arising from struma ovarii (HDFCO) was introduced, to emphasize its low-grade malignant behavior. Due to its rare incidence, there is no standard treatment strategy, but a plan based on surgical intervention is suggested. CONCLUSION: Malignant struma ovarii should be put in the differential diagnosis in young patients with suspicious ovarian masses. Adequate patient counseling remains a cornerstone in the journey of management.

Discrepancy between clinical and pathological staging of laryngeal carcinoma: a dilemma to be solved.

OBJECTIVES: The aim of this study was to investigate the degree of discrepancy between the clinical and pathological staging of laryngeal carcinoma, and the potential impact of this discrepancy on the outcomes and prognosis. METHODS: This study was conducted on 127 patients who underwent total laryngectomy over five years (October 2016-October 2021). Data collected from pretherapeutic clinical staging regarding the extent of the tumor affection of different laryngeal subsites was compared to the postsurgical pathological assessment. RESULTS: Overall, 12 out of 127 patients (9.4%) in the current study, were clinically over-staged from T3 to T4 due to radiological diagnosis of tumor infiltration of laryngeal cartilages that proved pathologically to be free of tumor. Additionally, discordance in the N stage was found in 12.6% (n = 16). However, stage discrepancy did not have a significant impact on the prognosis and survival. CONCLUSION: Discordance between clinical and pathological TNM staging of laryngeal carcinoma may affect the decision making and the choice of the treatment options. Some improvement can be probably achieved with advancements and higher accuracy of the preoperative diagnostic tools.

A U.S. Isolate of Theileria orientalis Ikeda Is Not Transstadially Transmitted to Cattle by Rhipicephalus microplus.

Theileria orientalis Ikeda has caused an epidemic of bovine anemia and abortion across several U.S. states. This apicomplexan hemoparasite is transmitted by Haemaphysalis longicornis ticks; however, it is unknown if other North American ticks are competent vectors. Since the disease movement is largely determined by the host tick range(s), the prediction of the T. orientalis spread among U.S. cattle populations requires determination of additional competent tick vectors. Although Rhipicephalus microplus has mostly been eradicated from the U.S., outbreaks in populations occur frequently, and the U.S. remains at risk for reintroduction. Since R. microplus is a vector of Theileria equi and T. orientalis DNA has been detected in R. microplus, the goal of this study was to determine whether R. microplus is a competent vector of T. orientalis. Larval R. microplus were applied to a splenectomized, T. orientalis Ikeda-infected calf for parasite acquisition, removed as molted adults, and applied to two T. orientalis naïve, splenectomized calves for transmission. After 60 days, the naïve calves remained negative for T. orientalis by PCR and cytology. Additionally, T. orientalis was not detected in the salivary glands or larval progeny of acquisition-fed adults. These data suggest that R. microplus is not a competent vector of the U.S. T. orientalis Ikeda isolate.

Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial.

BACKGROUND: The present study aims to compare the hemodynamic profile of lidocaine and fentanyl during propofol induction of general anesthesia. METHODS: This randomized controlled trial included patients aged above 60 years undergoing elective non-cardiac surgery. The included patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl (n = 50) based on total body weight with propofol induction of anesthesia. Patient's hemodynamics were recorded every minute for the first 5 min then every 2 min until 15 min after induction of anesthesia. Hypotension (mean arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included norepinephrine requirements (primary), the incidence of postinduction hypotension, MAP, heart rate, intubation condition, and postoperative delirium via the cognitive assessment method. RESULTS: Forty-seven patients in the lidocaine group and 46 patients in the fentanyl group were analyzed. None in the lidocaine group experienced hypotension, while 28/46 (61%) of patients in the fentanyl group developed at least one episode of hypotension requiring a median (25th and 75th quartiles) norepinephrine dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was lower in the fentanyl group than in the lidocaine group at all time points after anesthesia induction. The average heart rate was comparable between the two groups nearly at all time points after anesthesia induction. The overall intubation condition was comparable between the two groups. None of the included patients developed postoperative delirium. CONCLUSION: Lidocaine-based regimen for induction of anesthesia reduced the risk of postinduction hypotension in older patients compared to the fentanyl-based regimen.

Prognostic value of androgen receptor expression in different molecular types of breast cancer in women.

BACKGROUND: Breast cancer is a common women's disease. Usually, oestrogen is blamed in the aetiology and correlated with the prognosis; however, androgens are recently raising concern about its role in the breast cancer treatment and prognosis. METHODS: In this study we retrieved archival paraffin blocks of breast cancer patients and stained it for androgen. Thereafter, we compared clinico-epidemiologic parameters, histopathology, neoadjuvant response and recurrence rate and pattern among patients with and without androgen receptor (AR) expression. RESULTS: In total, 119 patients fulfilled enrolment criteria; AR expression were present in 77.3% of the patients. AR expression was associated with less grade III (6.8% versus 36.4%), and less triple negative (6.2% versus 25%), but similar overall recurrence rate (25% versus 22.2%). However, distant recurrence was significantly higher in androgen positive patients (91.3% versus 33.3% of all recurrences). CONCLUSION: Androgen expression appears to be common among breast cancer, but with no clear implication in tumour aggressiveness or effect on the rate of recurrence. However, being commonly associated with distant spread may have an impact on survival of the patients.

Interleukin 16 polymorphism and susceptibility of rheumatoid arthritis disease in Egyptian population.

Rheumatoid arthritis (RA) is a systemic and multiple-stage disorder characterized by chronic inflammation with extensive synovitis. The genetic and environmental factors are associated with the risk for RA development. In RA, the induced IL-16 may play a role in initiating, sustaining and increasing the inflammatory response and development of synovitis, nevertheless IL-16's actual role in RA pathogenesis must be studied further. This study intended to investigate the association of IL-16 gene polymorphism and RA disease, to determine the genetic role of IL-16 polymorphism and predict the risk of RA development and clinical disease activity. One hundred and Fifty RA patients and 150 apparently healthy control subjects were included in this case-control study. RA disease activity and functional status were evaluated for all RA patients. IL-16 gene polymorphism (SNP rs11556218 T/G) was genotyped using real-time polymerase chain reaction. The difference in IL-16 (rs11556218 T/G) genotype frequencies between RA patients and controls was not statistically significant. However, the G allele was frequently presented in RA patients as compared to controls (p=0.047). Moreover, G allele carriers had two times more risk to develop RA disease than T allele carriers (OR=2.598; 95%CI=1.078-6.825) with dominant genetic association. Alternatively, the G/G genotype was associated with high CDAI, RADAS-5 and HAQ disability index in comparing to other genotypes (T/T-T/G). In conclusion, there was an association between allele G of IL-16 polymorphism (rs11556218 T/G) and risk of RA disease development. In addition, there was an association between genotype G/G and increased clinical disease activity and health disability.

Interventional, Quasi-Experimental Study of a Chronic Obstructive Pulmonary Disease Education Care Plan for Hospital Discharge.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality, and reduced quality of life for patients. Proper use of inhaler devices is critical for effective drug delivery and prevention of COPD progression. The primary endpoint of this study was a mean percent increase in correct steps associated with inhaler technique after pharmacist education. The co-primary endpoint was a 25% increase in the proportion of patients correctly identifying the appropriate use of short-acting versus long-acting inhaler types. This was an interventional quasi-experimental study of patients hospitalized at a 491-bed tertiary academic medical center with a COPD exacerbation to assess a pharmacist-led COPD care plan. Eligible patients included general floor, adult patients admitted with a primary diagnosis of COPD exacerbation. The primary investigator recorded initial inhaler technique scores through a paper checklist, and provided education about device types and usage. Patients were reassessed within 48 h to determine if pharmacist education improved inhaler knowledge. A total of 67 patients received the COPD care plan before hospital discharge. At baseline, patients scored a median of 81.8% (67.5-97.0) of steps correct across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% (90.9-100.0) (p < 0.0001). The proportion of patients correctly identifying when to use short-acting versus long-acting inhalers increased from 73.1% to 98.5% (p < 0.0001). Implementation of a pharmacist-led care plan for patients admitted for COPD exacerbation was associated with an increase in correct steps for appropriate inhaler technique and understanding of inhaler device types after pharmacist education.

A case report: insights into reducing plastic waste in a microbiology laboratory.

Single-use plastics have often replaced more sustainable materials in microbiology laboratories. Keeping in mind that one of the objectives of the United Nations Sustainable Development Goals is responsible consumption and production, we wanted to document how many single-use plastic items could be saved by taking reduction and reuse approaches in a microbiology laboratory. After taking 4 weeks to document the baseline levels of single-use plastic waste being generated in our laboratory and identifying ways to reduce our reliance on them, we implemented various reduction and reuse approaches and then documented our plastic use over a 7-week period. Reduction approaches included moving to sustainable materials, such as reusable wooden sticks for patch plating and metal loops for inoculation. Reuse approaches focused on reusing plastic tubes via a chemical decontamination station and autoclaving, facilitating the reduction of single-use plastics and a decrease in the amount of waste generated. By utilizing reduction and reuse strategies, which could be implemented in other microbiology laboratories, substantial single-use plastic savings were achieved. These savings had an impact on the amount of biohazard waste being autoclaved and incinerated, as well as generating substantial cost savings for the research institute. The reductions in waste documented in this study could act as a benchmark for others wanting to implement the changes described.

Hybrid renewable energy/hybrid desalination potentials for remote areas: selected cases studied in Egypt.

For many socio-economic and demographic issues, majority of the Egyptian population live near the Nile River for thousands of years. Shortage of freshwater resources at remote and rural areas is limiting population settlement and development. Therefore, it is necessary to find alternative solutions including saline water desalination processes to assist obtaining fresh water for domestic and industrial purposes in these remote areas. The energy needed for the desalination process represents another challenge due to the available fossil fuel limitation, increasing prices and their negative impacts on the environment. These challenges may be tackled by applying hybrid renewable energy (RE) resources such as solar and wind energies as the driving power for the desalination technologies. Many studies are conducted in Egypt, Middle East region and worldwide investigating the possibilities of different desalination systems driven by RE. This article presents a recent review of the global desalination processes with a focus on membrane desalination systems such as reverse osmosis (RO), membrane distillation (MD), hybrid desalination technologies and processes as well as advanced plasmonic nanomaterials for water distillation derived by RE suitable for remote and isolated areas. Some recent activities for coupling desalination systems with hybrid RE carried-out by the co-authors will be highlighted.

Diabetic Mastopathy: Reporting an Unusual Scenario of a Rare Disease.

Diabetic mastopathy is a rare, benign breast disease that presents with fibrous breast lumps usually induced by the hyperglycemic state in diabetic patients and often associated with type 1 or 2 diabetes mellitus. Clinical and radiographic appearances are usually confusing and pathologic confirmation is essential for diagnosis mainly to rule out malignancy. However, a specialized breast pathologist often utilizes patient's history of diabetes as a guide to solve this diagnostic dilemma. We report a challenging scenario in which a case of diabetic fibrous mastopathy was pathologically identified with no previous given history of diabetes. This benign breast entity should be included in the differential diagnosis of breast lumps even without history of diabetes that may be overlooked before surgery.

Mixed-Method Study of Utilizing Portfolios to Document and Assess Co-Curricular Activities: Student and Advisor Perceptions.

Background: Development of professional behaviors must occur in tandem with clinical skills to ensure graduates provide quality care. Portfolios have been widely utilized as a medium to document and reflect on experiences related to professional skills. Methods: Students were required to complete a series of co-curricular activities and document them via paper or electronic portfolios, which were shared with their advisors for feedback and review. To gather perception data, student surveys were administered twice: once for the electronic cohort and once for the paper cohort after their first-year experience with the platform, and focus groups were conducted a year later. Faculty advisors were also asked to complete surveys. Results: Both students and advisors felt that electronic portfolios resulted in a greater understanding of the educational outcomes and was the preferred method for recording co-curricular requirements. Several technical challenges arose with the use of the electronic portfolio and many students and advisors felt they needed more education regarding mapping of activities. Conclusions: The electronic portfolio was found to be more sustainable as compared with paper portfolios, as it helped students adhere to the criteria and self-assessment process. Further research is needed to evaluate long-term benefit of documenting and assessing co-curricular experiences within an electronic platform.

Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT).

BACKGROUND: Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. METHODS: This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 µg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. RESULTS: Group C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6), which were comparable to each other. The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. CONCLUSIONS: Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine. TRIAL REGISTRATION: Clinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727 ; January 2018, "retrospectively registered".

Students' perceptions of biostatistics following integration into an evidence-based medicine course series.

BACKGROUND AND PURPOSE: Student pharmacists are expected to demonstrate an understanding of commonly employed statistical tests. This study describes the integration of biostatistics in an evidence-based medicine course series using a learner-centered model tailored to students' needs and interests. EDUCATIONAL ACTIVITY AND SETTING: This course series included thirteen two-hour biostatistics sessions focused on interpreting results and critiquing statistical methods. Three lab sessions were also included, which focused on producing summary reports from clinical data. Journal club presentations were the key method of assessing knowledge. A survey to evaluate students' perceptions of the course and their level of confidence in applying biostatistical concepts was administered twice to measure change over time within two student cohorts. FINDINGS: Results of the survey showed that a significantly higher proportion of students agreed they understood the analyses covered in class (97% vs. 44%, p < 0.001) and felt more confident interpreting results (82% vs. 41%, p < 0.001) in their third year compared to the second year. Students who agreed that they learned important skills for future practice had a significantly higher mean exam score (82.5% vs. 76.2%, p = 0.001). SUMMARY: The results indicate an improvement in the students' perceptions over time with regards to knowledge and usefulness of the course content. Although, integrating biostatistics in a literature-evaluation course is common, this is the first study that evaluated teaching it in more than one semester beyond inclusion in assessment rubrics.

Biochemical Analysis of C-X-C Motif Chemokine Ligand 10 (CXCL10) as a Biomarker in Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is characterized by chronic inflammation and synovial hyperplasia that eventually leads to the destruction of the joints. CXCL10 has been originally identified as a pro-inflammatory chemokine that mediate leukocyte trafficking and modulate innate and adaptive immune responses. It plays a critical role in the inflammatory response and is involved in several biological processes. The aim of the study was to assess the diagnostic efficacy of serum CXCL10 levels in early RA patients. Patients and methods: The study included 60 RA patients; 30 of them were early diagnosed, and 30 longstanding RA and 30 healthy controls. Clinical examination was done for all patients. Measurement of serum CXCL10 level was done by ELISA, while assessment of disease activity in patients was done using disease activity score (DAS-28). Serum levels of CXCL10 were significantly higher in RA patients than controls (P < 0.001), and was more elevated in early diagnosed than longstanding RA patients, with a a significant positive correlation with DAS-28 ESR (r=0.361, P=0.005), number of tender joint (r=0.319, P=0.013), and number of swollen joint (r=0.280, P=0.030). A cutoff at 470.0 pg/ml was able to recognize longstanding RA with a sensitivity of 88.3% and a specificity of 90% , while a cutoff of 793 pg/ml was able to diagnose early RA with 65% sensitivity and 77% specificity (P=0.009). in conclusion, serum CXCL10 may be a useful biomarker for diagnosis of early RA and determination of disease activity.

Caudal Analgesia for Hypospadias in Pediatrics: Comparative Evaluation of Adjuvants Dexamethasone and Dexmedetomidine Combination versus Dexamethasone or Dexmedetomidine to Bupivacaine: A Prospective, Double-Blinded, Randomized Comparative Study.

BACKGROUND: Caudal block is the most commonly used regional anesthetic technique in pediatric surgeries; different additives have been used for better and safer outcome. AIM: The aim of this study is to compare the combination of dexamethasone and dexmedetomidine as adjuvants to bupivacaine versus using each agent solely with bupivacaine in pediatric caudal block as regards their efficiency in pain relief (the duration of postoperative analgesia, first time to request analgesia, and modified objective pain score [MOPS]). STUDY DESIGN: This was a prospective, double-blinded, randomized study. PATIENTS AND METHODS: Patients and Methods: Sixty-three children scheduled for hypospadias surgery wererandomized into three groupsaccording to the adjuvant drug added to caudal bupivacaine : Group I (n = 21): dexamethasone 0.1 mg/kg + 0.5 mg/kg bupivacaine 0.25%, Group II (n = 21): dexmedetomidine0.01 µg/kg + 0.5 mg/kg bupivacaine 0.25% and Group III (n = 21): dexamethasone 0.1 mg/kg + dexmedetomidine 0.01 µg/kg + 0.5 mg/kgbupivacaine 0.25%. Intraoperative and postoperative hemodynamics were recorded. In postoperative anesthesia care unit and then the ward, MOPS and sedation score were recorded at 30 min and 1, 2, 3, 6 and 12 h. Further, the time of first analgesic request and side effects were recorded. STATISTICAL ANALYSIS: Categorical data were presented as frequencies (%) and analyzed using Chi-square test. Continuous data were presented as mean (standard deviation) and median (quartiles). Continuous data were analyzed using one-way analysis of variance for single measures and two-way mixed model for repeated measures. Kaplan-Meier analysis was performed for the duration of analgesia. RESULTS: In Group III, MOPS was lower than Groups I and II at the study times. Further, Group III had prolonged time for first request of analgesic. Sedation scores were prolonged in Group III and Group II than in Group I. There was a reduction in heart rates in Group III more than Group I and Group II but with no significant difference. However, there was a significant reduction in mean arterial blood pressure 30 min intraoperatively and postoperatively in Group III as compared to Groups I and II. CONCLUSION: The addition of combined dexmedetomidine at a dose of 1 µg/kg and dexamethasone 0.1 mg/kg to caudal bupivacaine seemed to be an attractive alternative to each drug if used alone with more prolonged analgesia and almost no adverse effects.