A rare case of carpal boss lesion with an overlying ganglion cyst: case report and literature review.

Carpal boss is a bony protrusion on the dorsal aspect of wrist quadrangular joint. The exact cause and prevalence are not well understood. Most of the patients are asymptomatic, although some experience pain, bony prominence, restricted mobility, and joint instability in sever neglected cases. We are presenting a case of a 24-year-old male had chronic dorsal wrist pain with bony prominence appearance underwent surgical excision of a carpal boss lesion in concomitant with soft tissue ganglion cyst over the carpal boss after failed conservative management, resulting in significant symptom improvement and restored range of motion. Carpal boss lesion is a common condition that can be undiagnosed due to asymptomatic presentation or the presence of overlying soft tissue pathology as ganglion cyst. Although conservative treatment is helpful in some patients, most symptomatic carpal boss lesion patients eventually need surgical excision.

Biceps Pulley Lesions: Diagnostic Accuracy of Nonarthrographic Shoulder MRI and the Value of Various Diagnostic Signs.

BACKGROUND: There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions. PURPOSE: To assess the accuracy of nonarthrographic MRI for detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions. STUDY TYPE: Retrospective. POPULATION: 84 patients (32 in BP-lesion group and 52 in BP-intact group-as confirmed by arthroscopy). FIELD STRENGTH/SEQUENCE: 1.5-T, T1-weighted turbo spin echo (TSE), T2-weighted TSE, and proton density-weighted TSE spectral attenuated inversion recovery (SPAIR) sequences. ASSESSMENT: Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter-reader agreement (IRA) between radiologists was determined. STATISTICAL TESTS: Student's t-tests, Chi-squared, and Fisher's exact tests, and 4-fold table test were used. The IRA was calculated using Kappa statistics. A P-value <0.05 was considered statistically significant. RESULTS: The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%-78.1%, 90.4%-92.3%, and 81%-86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%-86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%-100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76-0.98). DATA CONCLUSION: Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Prevalence, Predictors, and Outcomes of Resistant Hypertension in Egyptian Population.

Background: Hypertension is a leading problem; it affects around thirty million adult Egyptians, according to the last national registry. The exact prevalence of resistant hypertension (RH) in Egypt wasn't spotted before. The purpose of this study was to determine the prevalence, predictors, and impact on adverse cardiovascular outcomes among adult Egyptians with RH. Methods: The present study examined a cohort of 990 hypertensive patients who were divided into two groups based on their blood pressure control; group I (n = 842) patients who achieved blood pressure control and group II (n = 148) patients who met the RH definition criteria. All patients underwent a close follow-up for one year to evaluate the major cardiovascular events. Results: The prevalence of RH was 14.9%. The main predictors impacting the cardiovascular outcomes of RH were advanced age (≥65 years), the presence of chronic kidney diseases, a BMI ≥ 30 kg/m2, and NSAID use. After one year of follow-up, the RH group displayed noticeably higher rates of major cardiovascular events, including new-onset atrial fibrillation (6.8% vs. 2.5%, P = 0.006), cerebral stroke (4.1% vs. 1.2%, P = 0.011), myocardial infarction (4.7% vs. 1.3%, P = 0.004), and acute heart failure (4.7% vs. 1.8%, P = 0.025). Conclusion: The prevalence of RH in Egypt is moderately high. Patients with RH have a far higher risk of cardiovascular events than those whose blood pressure is within control.

The Value of Intermittent Fasting and Low Carbohydrate Diet in Prediabetic Patients for the Prevention of Cardiovascular Diseases. / Papel do Jejum Intermitente e da Dieta Restrita em Carboidratos na Prevenção de Doenças Cardiovasculares em Pacientes Pré-Diabéticos.

BACKGROUND: Prediabetic patients are at increased risk for cardiovascular diseases and the development of microvascular and macrovascular complications. Intermittent fasting (IF) and low-carbohydrate diet (LCD) are promising dietary plans. OBJECTIVES: Our aims to analyze the benefits of IF combined with LCD on microvascular and macrovascular outcomes in prediabetic patients. METHODS: The study included 485 prediabetic patients with no history of cardiovascular diseases divided into group I: (n = 240 patients) who underwent IF (16 h IF 3-4 days per week) combined with LCD (<130 g of carbohydrate per day), and group II: (n = 245 patients) with ad libitum calorie intake. The two groups were followed-up for two years for assessment of micro and macrovascular complications. A p-value < 0.05 was considered statistically significant. RESULT: There was a significant reduction in body weight, body mass index, waist circumference, body fat percentage and glycated hemoglobin in group I. The incidence of progression from prediabetes to diabetes was significantly lower in group I (2.1% vs. 6.9% in group II, p = 0.010). In addition, a significant increase in the incidence of microvascular and macrovascular complications was observed in group II, including retinopathy, neuropathy and unstable angina. Multivariate regression analysis revealed that increased body weight, fasting glucose, glycated hemoglobin and low-density lipoprotein were independent risk factors impacting microvascular and macrovascular outcomes. CONCLUSIONS: In prediabetic patients, IF, combined with LCD, was associated with lower progression to diabetes mellitus and lower incidence of microvascular and macrovascular complications.

FUNDAMENTOS: Pacientes pré-diabéticos têm alto risco de doenças cardiovasculares e complicações microvasculares e macrovasculares. O Jejum Intermitente (JI) e a dieta restrita em carboidratos (dieta low-carb, DLC) são estratégias dietéticas promissoras nesse grupo. OBJETIVOS: Analisar os benefícios da combinação do JI com DLC sobre desfechos microvasculares e macrovasculares em pacientes pré-diabéticos. MÉTODOS: O estudo incluiu 485 pacientes pré-diabéticos sem história de doença cardiovascular. Os pacientes foram divididos em dois grupos: grupo I (n = 240) submetidos ao JI (16 horas de JI, F 3-4 dias por semana) combinado com DLC (<130 g de carboidratos por dia), e grupo II (n = 245) que consumiram alimentos à vontade (grupo controle). Os dois grupos foram acompanhados por dois anos para avaliação de complicações macrovasculares e microvasculares. Um valor p < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Houve uma redução significativa no peso corporal, índice de massa corporal, porcentagem de gordura corporal e hemoglobina glicada no grupo I. A incidência de progressão de pré-diabetes para diabetes foi significativamente menor no grupo I (2,1%) que no grupo II (6,9%) (p = 0,010). Ainda, um aumento significativo na incidência de complicações microvasculares e macrovasculares foi observado no grupo II, incluindo retinopatia, neuropatia e angina instável. A análise de regressão multivariada revelou que peso corporal aumentado, e níveis elevados de glicemia de jejum, hemoglobina glicada e lipoproteína de baixa densidade foram fatores de risco independentes de desfechos microvasculares e macrovasculares. CONCLUSÕES: Em pacientes pré-diabéticos, o JI, combinado com DLC, associou-se com menor progressão para diabetes mellitus e menor incidência de complicações microvasculares e macrovasculares.

Papel do Jejum Intermitente e da Dieta Restrita em Carboidratos na Prevenção de Doenças Cardiovasculares em Pacientes Pré-Diabéticos / The Value of Intermittent Fasting and Low Carbohydrate Diet in Prediabetic Patients for the Prevention of Cardiovascular Diseases

Resumo Fundamentos: Pacientes pré-diabéticos têm alto risco de doenças cardiovasculares e complicações microvasculares e macrovasculares. O Jejum Intermitente (JI) e a dieta restrita em carboidratos (dieta low-carb, DLC) são estratégias dietéticas promissoras nesse grupo. Objetivos: Analisar os benefícios da combinação do JI com DLC sobre desfechos microvasculares e macrovasculares em pacientes pré-diabéticos. Métodos: O estudo incluiu 485 pacientes pré-diabéticos sem história de doença cardiovascular. Os pacientes foram divididos em dois grupos: grupo I (n = 240) submetidos ao JI (16 horas de JI, F 3-4 dias por semana) combinado com DLC (<130 g de carboidratos por dia), e grupo II (n = 245) que consumiram alimentos à vontade (grupo controle). Os dois grupos foram acompanhados por dois anos para avaliação de complicações macrovasculares e microvasculares. Um valor p < 0,05 foi considerado estatisticamente significativo. Resultados: Houve uma redução significativa no peso corporal, índice de massa corporal, porcentagem de gordura corporal e hemoglobina glicada no grupo I. A incidência de progressão de pré-diabetes para diabetes foi significativamente menor no grupo I (2,1%) que no grupo II (6,9%) (p = 0,010). Ainda, um aumento significativo na incidência de complicações microvasculares e macrovasculares foi observado no grupo II, incluindo retinopatia, neuropatia e angina instável. A análise de regressão multivariada revelou que peso corporal aumentado, e níveis elevados de glicemia de jejum, hemoglobina glicada e lipoproteína de baixa densidade foram fatores de risco independentes de desfechos microvasculares e macrovasculares. Conclusões: Em pacientes pré-diabéticos, o JI, combinado com DLC, associou-se com menor progressão para diabetes mellitus e menor incidência de complicações microvasculares e macrovasculares.

Abstract Background: Prediabetic patients are at increased risk for cardiovascular diseases and the development of microvascular and macrovascular complications. Intermittent fasting (IF) and low-carbohydrate diet (LCD) are promising dietary plans. Objectives: Our aims to analyze the benefits of IF combined with LCD on microvascular and macrovascular outcomes in prediabetic patients. Methods: The study included 485 prediabetic patients with no history of cardiovascular diseases divided into group I: (n = 240 patients) who underwent IF (16 h IF 3-4 days per week) combined with LCD (<130 g of carbohydrate per day), and group II: (n = 245 patients) with ad libitum calorie intake. The two groups were followed-up for two years for assessment of micro and macrovascular complications. A p-value < 0.05 was considered statistically significant. Result: There was a significant reduction in body weight, body mass index, waist circumference, body fat percentage and glycated hemoglobin in group I. The incidence of progression from prediabetes to diabetes was significantly lower in group I (2.1% vs. 6.9% in group II, p = 0.010). In addition, a significant increase in the incidence of microvascular and macrovascular complications was observed in group II, including retinopathy, neuropathy and unstable angina. Multivariate regression analysis revealed that increased body weight, fasting glucose, glycated hemoglobin and low-density lipoprotein were independent risk factors impacting microvascular and macrovascular outcomes. Conclusions: In prediabetic patients, IF, combined with LCD, was associated with lower progression to diabetes mellitus and lower incidence of microvascular and macrovascular complications.

Adrenomedullin Mitigates Doxorubicin-Induced Nephrotoxicity in Rats: Role of Oxidative Stress, Inflammation, Apoptosis, and Pyroptosis.

Doxorubicin (DOX) is an anticancer antibiotic which has various effects in human cancers. It is one of the commonly known causes of drug-induced nephrotoxicity, which results in acute renal injury. Adrenomedullin (ADM), a vasodilator peptide, is widely distributed in many tissues and has potent protective effects. Therefore, the current study aimed to examine the protective potential mechanisms of ADM against DOX-induced nephrotoxicity. A total of 28 male Wistar rats were randomized into four groups: control group, doxorubicin group (15 mg/kg single intraperitoneal injection of DOX), adrenomedullin + doxorubicin group (12 µg/kg/day intraperitoneal injection of ADM) 3 days prior to DOX injection and continuing for 14 days after the model was established, and adrenomedullin group. Kidney function biomarkers, oxidative stress markers, and inflammatory mediators (TNF-α, NLRP3, IL-1ß, and IL-18) were assessed. The expressions of gasdermin D and ASC were assessed by real-time PCR. Furthermore, the abundances of caspase-1 (p20), Bcl-2, and Bax immunoreactivity were evaluated. ADM administration improved the biochemical parameters of DOX-induced nephrotoxicity, significantly reduced oxidative damage markers and inflammatory mediators, and suppressed both apoptosis and pyroptosis. These results were confirmed by the histopathological findings and revealed that ADM's antioxidant, anti-inflammatory, anti-apoptotic, and anti-pyroptotic properties may have prospective applications in the amelioration of DOX-induced nephrotoxicity.