A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery.

OBJECTIVE: To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN: Prospective, double-blind, randomized controlled. SETTING: University hospitals. METHODS: Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS: Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS: The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.

The Ratio of Serum Progesterone (P4) to the Number of Follicles (P4/follicle) is a More Objective Parameter for Euploidy Rate as Compared to Systemic Progesterone Levels.

Does the late follicular phase progesterone (P4) and the P4-to-follicle-ratio affect the ploidy state of the biopsied embryos? A retrospective observational study conducted at ART Fertility Clinics Abu Dhabi and Muscat, including all stimulation cycles performed between January 2015 and December 2019. In total, 975 cycles were considered for this study. Inclusion criteria were ovarian stimulation due to primary/secondary infertility, patient's age between 18 and 45 years, ICSI as fertilization method, and patients undergoing preimplantation genetic testing for aneuploidies (PGT-A). Patients with testicular sperm extraction (TESE) and warmed oocytes were excluded. Our results have shown that progesterone had no effect on the euploid rate (p = 0.371). However, when adding the ratio of P4 to the number of follicles that were bigger than 10 mm in the last scan, a negative effect on the euploid rate (p < 0.05) was observed. This study was able to show that the use of only P4 is unable to predict ploidy outcomes. However, by including the number of follicles > 10 mm, a clear association was observed between P4/Foll ratio and euploid rate per cycle. The use of both parameters could aid clinicians in their decision to trigger a patient or continue stimulation. Further prospective studies are warranted to confirm those results.

Hydrophobic Effect of Soil Stabilization for a Sustainable Subgrade Soil Improvement.

The chemical process of using additives to stabilize soils is to improve soil that lacks strong engineering properties. In particular, the moisture susceptibility of subgrade soil through seasonal rains is still questionable. The presence of water in the construction is the cause of deterioration and premature distress of pavements and their supporting geotechnical structures. In this work, the chemical use of hydrophobic caltite (HC) in various amounts (ranging from 3%, 5%, to 7%) and 5% of cement to enhance laterite soils is investigated. The investigation includes the evaluation of soil properties, such as, unconfined compressive strength (UCS) by curing in air and under water, flexural strength (FS), and California Bearing Ratio (CBR) soaked and unsoaked. The addition of caltite with cement increases the strength characteristics with the UCS values of 2078-2853 kPa during the early curing stages (7th day), and 4688-4876 kPa after 90 days of curing. The added caltite in the cement soil samples shows a reduction index of strength loss underwater with the UCS values of 3196, 3334, and 3751 kPa for caltite cemented soil when compared with cement soil alone. FS results suggest that the inclusion of caltite in cement means that post-peak behavior can be enhanced, reducing the brittleness and increasing the ductility. The successful reaction with soil additives occurred in the curing period of 7 days. In terms of the microstructural analysis, results show that HC with cement reduces the porosity, voids, and cracking of laterite soils. Furthermore, new polymer globules, products from the reaction, appeared on the clay particle surfaces, thereby reducing the water absorption. The addition of hydrophobic-caltite to the soil-cement mixture results in increased strength and reduced water absorption in a soil-cement mix, thus achieving a given strength value.

Prevalence of Health Problems Targeted by the National School-Based Screening Program among Primary School Students in Saudi Arabia, 2019.

The Saudi Ministry of Health (MOH) established a National School-Based Screening Program (NSBSP) for health screening of schoolchildren. Students from specific grades were systematically screened for several health problems, including obesity, visual and auditory problems, dental cavities, scoliosis, and attention-deficit/hyperactivity disorder (ADHD). This cross-sectional study aimed to determine the prevalence of these health problems among primary school students based on secondary data obtained from the NSBSP. We included 444,259 screened school children from the first and fourth grades of 50% of the selected schools (both private and public) across the Kingdom of Saudi Arabia (KSA) during the academic year 2018-2019. Among them, the most prevalent health problems identified were dental cavities (38.7%), eye refractory errors (10.9%), and overweight and obesity (10.5%); the less prevalent problems included ADHD (2.81%), auditory problems (0.6%), and scoliosis (0.48%). A greater prevalence of most health problems was observed in girls more than boys. The NSBSP successfully aided the detection of health conditions with high and low prevalence among primary school students in the KSA, and thus, the identification of health problems of specific concern. Implementation of effective school health services for the prevention, early detection, diagnosis, and treatment of these health problems are imperative.

Novel Approach to the Treatment of Gypseous Soil-Induced Ettringite Using Blends of Non-Calcium-Based Stabilizer, Ground Granulated Blast-Furnace Slag, and Metakaolin.

Gypseous soil is one type of expansive soil that contains a sufficient amount of sulphate. Cement and lime are the most common methods of stabilizing expansive soil, but the problem is that lime-treated gypseous soil normally fails in terms of durability due to the formation of ettringite, a highly deleterious compound. Moisture ingress causes a significant swelling of ettringite crystals, thereby causing considerable damage to structures and pavements. This study investigated the suitability of various materials (nano-Mg oxide (M), metakaolin (MK), and ground granulated blast-furnace slag (GGBS)) for the stabilization of gypseous soil. The results showed soil samples treated with 20% M-MK, M-GGBS, and M-GGBS-MK to exhibit lower swelling rates (<0.01% change in volume) compared to those treated with 10% and 20% of lime after 90 days of curing. However, soil samples stabilized with 10% and 20% binder of [(M-MK), (M-GGBS), and (M-GGBS-MK)] exhibited higher strengths after 90 days of soaking (ranging from 0.96-12.8 MPa) compared to those stabilized with 10% and 20% lime. From the morphology studies, the SEM and EDX analysis evidenced no formation of ettringite in the samples stabilized with M-MK-, M-GGBS-, and M-GGBS-MK. These results demonstrate the suitability of M-MK, M-GGBS, and M-GGBS-MK as effective agents for the stabilization of gypseous soil.

Characterization of Biofilm Producer Nanobacteria Isolated from Kidney Stones of Some Egyptian Patients.

<b>Background and Objective:</b> Nanobacteria (NB) appear to contribute to many calcifying diseases including kidney stones which represent a common problem with inadequate prevention exist. NB framing itself with a mineral coat that assists as a primary defence shield against the immune system, antibiotics. This study aims to collect and detect nanobes from different kidney stones from patients with active urolithiasis then investigated the anti-nano-bacterial activity of some antibiotics alone or in combination with extracts of irradiated herbs of certain medicinal plants which will represent a new approach to therapy for patients with kidney stones. <b>Materials and Methods:</b> Total of 32 nanobes were isolated from 54 kidney stones. Fourier Transforms Infrared Spectroscopy (FTIR) revealed that calcium and phosphate are the main components of stones. Scanning Electron Microscopy (SEM) with Energy-dispersive X-ray spectroscopy (EDX) and Transmission Electron Microscope (TEM), showed that nanobes were Gram-ve cocci with size ranged from (375:600 nm). The biofilm production ability of nanobes was estimated qualitatively and quantitatively. <b>Results:</b> The results revealed that all were strong biofilm producers. Further, the antibiotic susceptibility test indicates their resistance towards most of the tested antibiotics. Molecular identification of the strong biofilm producer isolates by ribosomal ribonucleic acid (rRNA) revealed that it is indicated by 85.37% to <i>Bartonella apis</i> strain PEB0122. <b>Conclusion:</b> The findings of the current study evidenced that combination treatment between Doxycycline (DO) and water extract of khella exhibited a significant reduction in biofilm formation ability of the strongest producers nanobes. Therefore, this treatment can play a role in enhancing public health, especially with patients who suffer from recurrent kidney stone formation.

Whole-genome sequencing of SARS-COV-2 reveals a substantially lower frequency of the UK variant than previously announced in Libya

Alpha (B.1.1.7) SARS-COV-2 variant was detected in September 2020 in minks and humans in Denmark and UK. This variant has several mutations in the spike region (S) which could increase the transmissibility of the virus 43-90% over previously circulating variants. The National Center for Disease Control (NCDC) announced on 24th February 2021 a 25% frequency of B.1.1.7 strain in Libya using a reverse-transcriptase quantitative PCR assay. This assay relies on the specific identification of the H69-V70 deletion in S gene which causes its failure of amplification (SGTF). This deletion is not specific for B.1.1.7; but is also characteristic of two other SARS-COV-2 variants. This study aimed to estimate the frequency of B.1.1.7 and identify other variants circulating in Libya in February 2021. We performed whole genome sequencing of 67 positive SARS-COV-2 samples collected on 25th February 2021 in Libya which were also tested by RT-qPCR for SGTF. Our results showed that 55% of samples had mutations specific to B.1.525 strain and only [~]3% of samples belonged to B.1.1.7. These findings suggested that B.1.525 was spreading widely in Libya. The use of such RT-qPCR assay although useful to track some variants, it cannot discriminate between variants with H69-V70 deletion. RT-qPCR assays could be multiplexed to identify multiple variants and screen samples prior to sequencing. We emphasize on the need for providing whole-genome sequencing to the main COVID-19 diagnostic laboratories in Libya as well as establishing international collaboration for building capacity and advancing research in this time of the pandemic.

Time scale performance of rapid antigen testing for SARS-COV-2: evaluation of ten rapid antigen assays

There is a great demand for more rapid tests for SARS-COV-2 detection to reduce waiting time, boost public health strategies for combating disease, decrease costs, and prevent overwhelming laboratory capacities. This study was conducted to assess the performance of 10 lateral flow device viral antigen immunoassays for the detection of SARS-CoV-2 in nasopharyngeal swab specimens. We analyzed 231 nasopharyngeal samples collected from October 2020-December 2020, from suspected COVID-19 cases and contacts of positive cases at Biotechnology Research Center laboratories, Tripoli, Libya. The performance of 10 COVID-19 Antigen (Ag) rapid test devices for the detection of SARS-CoV-2 antigen was compared to RT-qPCR. In this study 161 cases had symptoms consistent with COVID-19. The mean duration from symptom onset was 6.6 {+/-}4.3 days. The median cycle threshold (Ct) of positive samples was 25. Among the 108 positive samples detected by RT-qPCR, the COVID-19 antigen (Ag) tests detected 83 cases correctly. All rapid Ag test devices used in this study showed 100% specificity. While tests from 6 manufacturers had an overall sensitivity range from 75-100%, the remaining 4 tests had sensitivity of 50-71.43%. Sensitivity during the first 6 days of symptoms and in samples with high viral loads (Ct<25), was 100% in all but 2 of the test platforms. False negative samples had a median Ct of 34 and an average duration of onset of symptoms of 11.3 days (range=5-20 days). Antigen test diagnosis has high sensitivity and specificity in early disease when patients present less than 7 days of symptom onset. Patients are encouraged to test as soon as they get COVID-19 related symptoms within 1 week and to seek medical advice within 24 hrs. if they develop disturbed smell/taste. The use of rapid antigen tests is important for controlling COVID-19 pandemic and reducing burden on molecular diagnostic laboratories.

Altered Metabolic Flexibility in Inherited Metabolic Diseases of Mitochondrial Fatty Acid Metabolism.

In general, metabolic flexibility refers to an organism's capacity to adapt to metabolic changes due to differing energy demands. The aim of this work is to summarize and discuss recent findings regarding variables that modulate energy regulation in two different pathways of mitochondrial fatty metabolism: ß-oxidation and fatty acid biosynthesis. We focus specifically on two diseases: very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) and malonyl-CoA synthetase deficiency (acyl-CoA synthetase family member 3 (ACSF3)) deficiency, which are both characterized by alterations in metabolic flexibility. On the one hand, in a mouse model of VLCAD-deficient (VLCAD-/-) mice, the white skeletal muscle undergoes metabolic and morphologic transdifferentiation towards glycolytic muscle fiber types via the up-regulation of mitochondrial fatty acid biosynthesis (mtFAS). On the other hand, in ACSF3-deficient patients, fibroblasts show impaired mitochondrial respiration, reduced lipoylation, and reduced glycolytic flux, which are compensated for by an increased ß-oxidation rate and the use of anaplerotic amino acids to address the energy needs. Here, we discuss a possible co-regulation by mtFAS and ß-oxidation in the maintenance of energy homeostasis.

Does diabetes mellitus affect the parotid ductal system? A sialendoscopic evaluation.

OBJECTIVE: The aim of this study was to assess the existence of ductal changes in diabetics using sialendoscopy. STUDY DESIGN: Twenty patients and 10 volunteers received bilateral parotid diagnostic sialendoscopy. Group I included 10 patients with uncontrolled diabetes (UCD); group II, 10 patients with controlled diabetes (CD); and group III, 10 nondiabetic controls (CG). Expected ductal changes were examined in 3 proposed distinct zones. A χ2 test was used to compare groups. RESULTS: Ductal pathologic conditions were significantly higher in diabetic patients in all zones. Abnormalities were classified as stenosis, hyperemia, or others. In UCD, stenosis percentage was 55%, 90%, and 100% in zones 1, 2, and 3, respectively, compared with 30%, 40%, and 55% in CD and 5%, 5%, and 0% in CG (P < .01). Hyperemic changes in UCD were 90%, 90%, and 40% compared with 50%, 50%, and 20% in CD (P < .01) and 0% in CG. Comparing zones in UCD and CD indicated that stenosis increased significantly toward the proximal end, whereas hyperemia prevailed toward the distal end. CONCLUSIONS: Significant ductal abnormalities were detected in the parotids of UCD and CD patients compared with CG. Ductal changes were higher in UCD compared with CD.

Optic chiasma involvement secondary to allergic fungal rhinosinusitis.

Optic chiasma compression is a very rare complication of allergic fungal rhino sinusitis. Here we report the rare case of a 35-year-old female suffering from unilateral visual loss presented with allergic fungal sinusitis with sphenoid sinus involvement. Examination showed nasal polyposis and unilateral hemianopia. Computerized tomography and magnetic resonance imaging showed bilateral nasal polyposis with intracranial extension; however, the optic nerve was free. The patient underwent functional endoscopic surgery and medical management in the form of steroids and oral antifungal therapy, resulting in complete recovery of the visual field loss. Patient was started on immunotherapy according to the skin prick test. No clinical nor radiological recurrence of the disease was evident within 2 years. Immediate management both surgically and medically is important. Immunotherapy is an essential part for long term control.