Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum.

INTRODUCTION: Quadrilateral plate (QLP) is a relatively thin bony structure located below the pelvic brim proximal to the hip joint, so management of its fractures is challenging. OBJECTIVES: Evaluation of the functional and radiological outcomes of internal fixation of quadrilateral plate acetabular fractures; comparison of two methods of fracture fixation. PATIENTS AND METHODS: A prospective multicentric study including 30 patients who underwent open reduction and internal fixation of QLP fractures through modified Stoppa approach. Patients were divided into two groups according to the method of fixation (anatomical QLP plate vs suprapectineal and infrapectineal plates). Post-operative quality of reduction was evaluated using Matta score. Radiographical assessment according Matta's grading criteria and clinical outcome assessment using the Harris Hip Score (HHS) were repeated at follow-up and at one year to assess displacement. RESULTS: Mean age of patients was 34.9 ± 12.1 years. After one year follow-up, clinically mean HHS was 88. ± 5.74. Radiologically post-operative reduction quality was anatomical in 21 (70%) patients, satisfactory in eight (26.7%) patients and unsatisfactory in one (3.3%) patient. Matta's grading at the last follow-up was excellent in 21 (70%) patients, good in six (20%), fair in two (6.7%) patients and poor in one (3.3%) patient. No significant difference was recorded between the two groups in terms of radiographical and clinical results and rate of complications. CONCLUSION: Accurate reduction of quadrilateral plate fracture with secure fixation through modified Stoppa approach provides good and reproducible outcomes with few complications regardless the type of the implant.

The outcome of endovenous intervention for acute iliofemoral deep venous thrombosis with and without inferior vena cava filter.

BACKGROUND: Catheter-directed thrombolysis (CDT) for acute iliofemoral deep venous thrombosis (DVT) is an endovenous interventional therapy that can quickly remove the acute thrombus, thereby improving the clinical outcomes of proximal DVT. However, instrumentation of extensive fresh thrombus may be associated with iatrogenic pulmonary embolism (PE). Therefore, we aimed to compare CDT's safety, complications, and perioperative embolic (PE) insults for acute iliofemoral DVT, with and without an IVC filter. METHODS: One hundred twenty patients having acute proximal DVT for less than 14 days and undergoing endovenous therapy were included and presented to the vascular surgery department of Al-Azhar University Hospitals, Egypt. The patients were randomized into two equal groups, Groups A and B, each having 60 patients. Group A was treated with IVC filter insertion, while Group B was treated without a filter. The anticoagulation and CDT procedures were similar between the two groups. RESULTS: The sample included 96 females (80%) and 24 males (20%), with a mean age of 32.6 ± 7.2 years. Clinically no clinical PE occurred in both groups. However, radiologically, new lesions in multislice CT pulmonary angiogram and V/Q scan were noted in two of 60 patients (3.33%) of the IVC filter group, compared with three patients (5 %) in the non-filtered group. CONCLUSION: Endovenous intervention in the form of CDT for acute iliofemoral DVT without an IVC filter is safe and not associated with an increased risk of pulmonary embolization than filter usage. The routine use of IVC filters should not be used mandatorily during CDT.

Infected femoral artery pseudoaneurysm ligation and revascularisation: A case report.

Key Clinical Message: Although ligating femoral pseudoaneurysm is a safe procedure, some cases require revascularization, and the appropriate treatment should be tailored to the patient. Abstract: In this case report, we highlight the challenge in treating infected femoral artery pseudoaneurysm. The patient, a 37-year-old male intravenous drug abuser, presented to the emergency department with a 2-month history of a progressively growing lump over his right groin. Two days before the presentation the swelling became hot and painful. After physical examination, it was revealed that the localized swelling is about 15 × 15 cm in size. It is pulsating, expanding in all directions, moving from side to side, and has been reduced in size due to proximal artery compression with the inflamed overlying skin causing slight flexion of the right hip joint and there was serosanguineous discharge as well. The affected leg was warm with intact motor and sensory function, palpable femoral, and popliteal arterial pulses, but non-palpable left posterior tibial and anterior tibial arterial pulses, both of which had triphasic wave signals on a portable hand-held Doppler (there was below knee marked edema). CT angiography (CTA) revealed a large well-defined heterogeneous cystic structure at the right groin with an average diameter of 11 × 10 × 9 cm, with a connection with the common femoral artery. After proximal and distal control, excision of the infected femoral pseudoaneurysm, a swab was taken, and ligation of the common femoral artery superficial femoral artery, and profunda femoral artery. No signals were detected on the posterior or anterior tibial arteries by hand-held Doppler and oxygen saturation on the big toe was markedly decreased, so we did an extra-anatomic lateral ilio-femoral anastomosis using silver-impregnated vascular graft.

Outcomes of Alprostadil As an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization.

BACKGROUND: This study was carried out to assess the effectiveness of alprostadil (prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia (CLI) after the failure of direct revascularization (DR). METHODS: At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with CLI underwent a failed trial of DR procedure, all revascularization procedures were endovascular. Median follow-up was 2 years and 2.5 years for patients with and without diabetes mellitus (DM). In the alprostadil group, the mean age was 63.41 ± 12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention alprostadil was administrated immediately postoperatively by intravenous infusion of 40 µg alprostadil diluted in 100 ml of normal saline, over 2 hr every 12 hr for 6 days. RESULTS: In the alprostadil group, the mean ± standard deviation (SD) of the baseline ankle-brachial index (ABI) was 0.45 ± 0.175, while the mean ± SD of ABI at the end of our study was 0.65 ± 0.216 with a difference from the baseline of 0.2 ± 0.041 (P value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3- and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68 ± 0.22, while the mean ± SD of ABI at the end of our study was 0.69 ± 0.23 with a difference from the baseline of 0.01 ± 0.01 (P value >0.05 meaning that it is nonsignificant) 1-month patency rate was 89%, while 3- and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention in the alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation before the study ended. CONCLUSIONS: Our results show the efficacy and safety of alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to CLI.

Femoral vein stenting versus endovenectomy as adjuncts to iliofemoral venous stenting in extensive chronic iliofemoral venous obstruction.

PURPOSE: To compare femoral endovenectomy with the creation of an arteriovenous fistula (FE + AVF), versus iliofemoral endovenous stenting with the concurrent extended femoral vein (FV-S) stenting in patients with chronic iliofemoral venous obstruction (IFVO). MATERIALS AND METHODS: In a randomized prospective single-center study, 48 received (FV-S), while the other 54 had (FE + AVF). RESULTS: There were no statistically significant differences in the primary outcomes between the two groups (FV-S) and (FE + AVF) (59% vs 56.8%, 75% vs 79.1%, respectively). At a median of 13 months after the treatment. However, the FV-S group's patients experienced fewer postoperative problems (p = .012), shorter procedures (p = .001), and shorter stays in the hospital (p = .025). CONCLUSION: There is no difference between the efficacy and symptomatic resolution of the FV-S group and the FE + AVF group at the same time, FV-S has lower postoperative complications and a shorter procedure duration and hospital stay.

Outcomes of Cyanoacrylate Closure Versus Radiofrequency Ablation for the Treatment of Incompetent Great Saphenous Veins.

BACKGROUND: Evaluation of the efficacy and safety of cyanoacrylate closure (CAC) for treating incompetent great saphenous veins (GSVs) compared to radiofrequency ablation (RFA). METHODS: In this prospective, randomized controlled study, 248 symptomatic subjects with incompetent GSVs were assigned to either CAC or RFA. The primary end point, complete closure of the target GSV, was determined using a duplex ultrasound examination. RESULTS: In this study, 248 patients (mean age 33.64 ± 8.06 years including 71% women) were treated with either CAC (n = 128) or RFA (n = 120) between August 2018 to May 2022. As a follow-up, after a 1-month duration, the closure rates were 128/128 at the CAC and 154/158 at the RFA. At month 24, closure rates were 122/128 at CAC and 146/158 at RFA. Apart from phlebitis and pigmentation, the incidences of bruising, skin burn, and paresthesia were lower in the CAC group compared to the RFA group. The mean procedural times were shorter for CAC. The satisfaction level with the treatment was moderately higher among CAC patients than RAF patients. CONCLUSIONS: This study suggests that Cyanoacrylate glue closure of the GSV and RFA are effective techniques for managing primary varicose veins. Cyanoacrylate glue closure of the GSV appears to have a lower rate of complications and higher satisfaction levels, rapid return to normal activities, and improved procedure time without the need for perivenous tumescent anesthesia and postprocedure compression stockings when compared to RFA.

Development of standards for assessing water quality in marine coastal waters of Bahrain.

Marine coastal waters of Bahrain are under pressure due to human activities and climate change. We used marine monitoring data (2005-2020) from 27 sites to establish baseline conditions and develop standards for assessments of water quality. Five hydrodynamic regions were identified: Oyster Beds, North, West, East, East (Coastal). Data from Oyster Beds sites, likely to be less impacted by human activities, were used to determine baseline conditions. For most parameters, candidate thresholds were based on 50 % and 100 % variation from baseline and 95th percentiles. Comparisons of data against different thresholds showed different outcomes. Overall, results indicate good water quality, with potential concerns in East (Coastal). Trend analyses showed some significant trends in all regions: downward (favourable) for some parameters (e.g. turbidity: North) and upward for others (e.g. nitrate: Oyster Beds, East and East (Coastal)). Future work requires greater understanding around optimum guidelines that protect and mitigate any adverse ecological impacts.

Evaluating online health information quality using machine learning and deep learning: A systematic literature review.

Background: Due to the large volume of online health information, while quality remains dubious, understanding the usage of artificial intelligence to evaluate health information and surpass human-level performance is crucial. However, the existing studies still need a comprehensive review highlighting the vital machine, and Deep learning techniques for the automatic health information evaluation process. Objective: Therefore, this study outlines the most recent developments and the current state of the art regarding evaluating the quality of online health information on web pages and specifies the direction of future research. Methods: In this article, a systematic literature is conducted according to the PRISMA statement in eight online databases PubMed, Science Direct, Scopus, ACM, Springer Link, Wiley Online Library, Emerald Insight, and Web of Science to identify all empirical studies that use machine and deep learning models for evaluating the online health information quality. Furthermore, the selected techniques are compared based on their characteristics, such as health quality criteria, quality measurement tools, algorithm type, and achieved performance. Results: The included papers evaluate health information on web pages using over 100 quality criteria. The results show no universal quality dimensions used by health professionals and machine or deep learning practitioners while evaluating health information quality. In addition, the metrics used to assess the model performance are not the same as those used to evaluate human performance. Conclusions: This systemic review offers a novel perspective in approaching the health information quality in web pages that can be used by machine and deep learning practitioners to tackle the problem more effectively.

Influence of diet quality on nutritional status of school-aged children and adolescents in Zanzibar, Tanzania.

BACKGROUND: Malnutrition among young children and adolescents poses a serious health challenge in developing countries which results in many health problems during adulthood. Poor diet quality is known as the root cause of malnutrition which is caused by unhealthy food choices and bad eating habits among young children and adolescents. However, limited evidence is available on diet quality and its association with nutrition status among young children and adolescents in Zanzibar. This study examined the diet quality and its relationship with the nutritional status of school-aged children and adolescents in Zanzibar. METHODS: Data for this study was obtained from the cross-sectional survey of School Health and Nutrition (SHN) conducted in Zanzibar. The survey recruited children aged 5-19 years from 93 schools in Zanzibar. A seven-day food frequency questionnaire (FFQ) was used to assess dietary intake. Prime Dietary Quality Score (PDQS) consisted of 21 food groups was then constructed to assess the diet quality of school-aged children and adolescents. Body mass index (BMI-for-age Z-score) was used as the indicator of nutrition status. Both linear and logistic regression analysis techniques were used to determine the associations between BMI and PDQS. RESULTS: A total data of 2,556 children were enrolled in the survey. The prevalence of thinness was 8.1%, normal 82.1%, overweight 7.2% and obesity 2.6%. The mean (SD) PDQS score was 18.8 (3.2) which ranged from 8 to 33. Consumptions of green leafy vegetables (49.3%), yellow or red fruits (37.8%), legumes (38.3%), fish (36.3%), and vegetable oil (31.5%) were up to three times per week, whereas consumptions of white vegetables (77.3%), cooked vegetables (32.6%), citrus fruits (66.8%), other types of fruits (66.2%), nuts (46.4%), poultry (49.6%), whole grains (61%) and eggs (67.8%) were less than once per week. In terms of unhealthy foods, eating fried foods was reported by 26.3% up to three times per week, and 31.5% reported consuming sweets and ice cream up to three times in the past week. High PDQS was significantly associated with a reduction in BMI of children (p< 0.005). For each unit increase in the consumption of unhealthy foods such as fried foods, cooked vegetables and refined grains there is a significant increase in BMI. The odds of being obese decrease significantly as diet quality increases from the first to third quintile of PDQS (AOR = 0.2, 0.04-0.89 95% CI, p = 0.035). CONCLUSION: Consumption of high quality diet was found to be associated with a reduction in excessive weight among school-aged children and adolescents in Zanzibar. There is a need for interventions targeting to reduce unhealthy food consumption in school environment. Further research should be conducted to assess diet quality using PDQS among young children and adolescents.

Utility of a microRNA panel in diagnosis and prognosis of hepatitis C-associated hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and the leading cause of cancer mortality. Various studies have linked dysregulated microRNA expression to liver cancers, but those related to viral hepatitis-related HCC are limited. METHODS: We investigated the diagnostic and prognostic roles of circulating miR-331-3p, miR-23b-3p, and miR-3194-5p in EDTA-treated blood samples of 50 hepatitis C virus (HCV) HCC patients, 50 HCV cirrhotic patients, and 50 healthy controls using quantitative real-time polymerase chain reaction. RESULTS: We found that miR-23b-3p and miR-3194-5p were significantly downregulated, whereas miR-331-3p was upregulated in HCC patients compared with controls. Also, these miRNAs were significantly dysregulated in HCC compared with cirrhotic patients. For the diagnosis of HCC, miR-331-3p and the combined miRNAs panel had the highest area under the curve (AUC), followed by miR-3194-5p. The highest AUC for differentiating metastatic from nonmetastatic patients was shown by miR-331-3p and the combined miRNAs panel, followed by miR-23b-3p. Dysregulation of miRNAs was associated with poor clinicopathological manifestations. Finally, miR-331-3P was found to be an independent risk factor for metastatic lesions in HCC. CONCLUSION: Overall, the assessed miR-331-3p, miR-23b-3p, and miR-3194-5p were significantly associated with poor clinicopathological features of HCC and could be used to discriminate HCV-related HCC patients from cirrhosis and differentiating metastatic from nonmetastatic patients, primarily miR-331-3p along with combined miRNAs. Moreover, miR-331-3p was found to be an independent factor for metastatic lesions.

Bioaccumulation of trace metal ions in the blue swimmer crab tissues Portunus pelagicus (Linnaeus, 1758) in Bahrain, Arabian Gulf.

The blue swimmer crab, Portunus pelagicus, is an edible abundant crustacean found in many seas around the world, including the Arabian Gulf. In this study, the concentrations of six metal ions in the white and brown meats of P. pelagicus from four sites in Bahrain were determined. P. pelagicus was found to accumulate Zn2+ and Cu2+ higher than other metal ions in the order of Zn2+ > Cu2+ > Cd2+ > Ni2+ > Cr3+, while Pb2+ was not detected. The overall average concentrations of Zn2+, Cu2+, Cr3+, Ni2+, and Cd2+ in white meat were 236.2, 69.5, 0.109, 0.159, and 0.273 mg/kg, while in brown meat, they were 235.4, 199.2, 0.133, 1.25, and 4.87 mg/kg based on dry weight, respectively. Concentrations of Pb2+ and Cd2+ were safe according to Bahrain's and European Commission guidelines. The estimated weekly intake (EWI) values of Zn2+, Cu2+, Pb2+, and Cd2+ via consumption of crab's white meat (edible tissue) were 102.1, 30.1, 0.042, and 0.12 µg/kg/week, respectively, which are far lower than the maximum recommended values established by the FAO/WHO. The hazard quotient (HQ) values of individual trace metal ions and the synergistic effects of total trace metal ion (hazard index) were below 1, indicating that there is no potential health risk on the consumption of crab edible tissues (white meat). However, elevated levels of Cd2+ (0.05-1.73 mg/kg wet weight) in the brown meat (hepatopancreas) were detected. The female P. pelagicus accumulated high levels of Zn2+ and Cu2+ in the white meat, as well as Cu2+ in the brown meat compared to males. Additionally, it was found that Cu2+ and Cd2+ were significantly higher (p < 0.05) in brown meat compared to white meat. Higher concentrations (p < 0.05) of Zn2+, Cu2+, and Cd2+ were observed in crabs collected from sites that have harsher environmental conditions.

The potential role of insulin resistance in predicting outcome from intravenous thrombolytic therapy.

BACKGROUND: The potential impact of insulin resistance on stroke prognosis after IV thrombolysis is poorly understood. This study aimed to assess the effect of insulin resistance and metabolic syndrome on the outcome of IV thrombolysis in non-diabetic patients with acute ischaemic stroke. METHODS: This prospective observational study was conducted on 70 non-diabetic acute ischaemic stroke patients who received rt-PA within 3 h of stroke onset. Patients were subjected to baseline and follow-up NIHSS measurements at 24 h and 3 months post-treatment. Stroke outcome was assessed after 3 months using the Modified Rankin Scale (mRS). The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated for the included patients at stroke onset. RESULTS: The mean age of included patients was 57.04 ± 14.39 years. Patients with unfavourable outcome had a significantly higher frequency of insulin resistance and metabolic syndrome, higher values of baseline NIHSS, insulin, HOMA-IR, uric acid and lower levels of HDL than those with favourable outcome (P value = 0.035, 0.007, ≤ 0.001, 0.001, ≤ 0.001, 0.002, 0.033, respectively). Each point increase in NIHSS before rt-PA increased the odds of an unfavourable outcome by 2.06 times (95% CI 1.22 - 3.478). Also, insulin resistance increased the odds of the unfavourable outcome by 11.046 times (95% CI 1.394-87.518). There was a statistically significant improvement in NIHSS 3 months after receiving rt-PA in all patients, significantly higher in patients who did not have insulin resistance or metabolic syndrome. CONCLUSION: Insulin resistance and metabolic syndrome were associated with worse functional outcomes in non-diabetic stroke patients after receiving rt-PA.

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics.

BACKGROUND & OBJECTIVES: Studying comorbidities with migraine aids in a better understanding of its pathophysiology and potential therapeutic targets. This case-control study aimed to study the impact of insulin resistance and metabolic syndrome on the characteristics of migraine headache attacks. METHODS: A case-control study was conducted on 30 migraine patients and 30 healthy controls. The following data were assessed in migraine patients: type of migraine, duration of attacks, Migraine Severity Scale (MIGSEV), and Headache Impact Test-6 (HIT-6). Both groups were assessed for waist circumference and underwent the following tests: fasting blood glucose, fasting insulin, high-density lipoprotein cholesterol level, and triglycerides, and homeostasis model assessment-insulin resistance (HOMA-IR) was applied. RESULTS: This study included age and sex-matched patients and controls. Migraine patients had significantly higher waist circumference, higher mean values of serum insulin, HOMA-IR and higher frequency of insulin resistance and metabolic syndrome than the control group (P-value = 0.005, 0.049, 0.01, 0.012, 0.024, respectively). Migraine patients with insulin resistance had significantly higher intensity and tolerability scores, MIGSEV total score, and HIT-6 total score compared to those without (P-value = 0.005, 0.005, 0.002, 0.018, respectively). There was a significantly positive correlation between the MIGSEV and HIT-6 scores and fasting insulin levels, and HOMA-IR value (P-value = 0.006, ≤ 0.001, 0.017, ≤ 0.001, respectively). CONCLUSION: Insulin resistance and metabolic syndrome are more common in migraine patients than in healthy controls. The severity and impact of migraine attacks are higher in patients with insulin resistance than in those without.

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones.

BACKGROUND: Choledocholithiasis develops in up to 20% of patients with gall bladder stones. The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) is accurate in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region. AIM: To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP. METHODS: Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included. The presence of choledocholithiasis was evaluated by MRCP and EUS, and then results were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones, the size, and the number of detected stones. RESULTS: Ninety out of 100 involved patients had choledocholithiasis, while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination. In choledocholithiasis patients, the mean age was 52.37 ± 14.64 years, and 52.2% were males. Most patients had biliary obstruction (74.4%), while only 23 (25.6%) patients had unexplained pancreatitis. The overall prevalence of choledocholithiasis was 83.3% by EUS, 41.1% by MRCP, and 74.4% by ERCP. Also, the number and size of CBD stones could be detected accurately in 78.2% and 75.6% by EUS and 41.1% and 70.3% by MRCP, respectively. The sensitivity of EUS was higher than that of MRCP (98.51% vs 55.22%), and their predictive value was statistically different (P < 0.001). Combination of both tools raised the sensitivity to 97.22% and specificity to 100%. CONCLUSION: EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP. However, its usefulness depends on its availability and the experience of the local centers.

Aortic root pseudoaneurysm after blunt trauma to chest - an interesting case.

Acquired pseudoaneurysms of the aortic root involving the sinus of Valsalva are rare and serious complications arising from trauma, infection, or following cardiac surgery or intervention. We describe the surgical treatment of a patient who had acquired sinus of Valsalva pseudoaneurysm following blunt trauma to chest; wherein pericardial patch closure of the orifice of the pseudoaneurysm without aortic valve replacement or coronary artery bypass grafting. The management of these sinus of Valsalva pseudoaneurysms depends on the underlying mechanism causing symptoms such as compression or thrombosis of coronary artery; or the defective anatomy involving sinus of Valsalva, aortic valve or the coronary artery.

Circulating microRNA 9-3p and serum endocan as potential biomarkers for hepatitis C virus-related hepatocellular carcinoma.

BACKGROUND: The high mortality rate of hepatocellular carcinoma (HCC) in Egypt is due mainly to the increasing prevalence of hepatitis C virus infection (HCV) and late diagnosis of the carcinoma. MicroRNAs (miRNA), which regulate tumor proliferation and metastasis in HCC, may serve as a useful diagnostic approach for the early detection of HCC, thus decreasing its mortality. Meanwhile, endocan is a protein with angiogenic and inflammatory properties that are associated with tumor progression and poor outcomes. AIM: To analyze the levels of miRNA 9-3p and endocan in HCV-infected HCC patients and correlate them with clinicopathological parameters. METHODS: We compared levels of endocan and circulating miRNA 9-3p from 35 HCV-related HCC patients to 33 patients with HCV-induced chronic liver disease and 32 age and gender matched healthy controls recruited from inpatient and outpatient clinics of the National Liver Institute, Menoufia University, Egypt in the period from January to March 2021 in a case-control study. Serum samples from all groups were analyzed for HCV. Endocan was measured by enzyme-linked immunosorbent assays, and the expression levels of circulating miRNA 9-3p were measured by real-time quantitative reverse transcriptase PCR. RESULTS: The levels of circulating miRNA 9-3p were significantly lower in the HCC group compared to the chronic liver disease (P < 0.001) and control (P < 0.001) groups, while levels in the chronic liver disease were significantly lower than those in the control group (P < 0.001). The levels of serum endocan were significantly higher in the HCC group compared to the chronic liver disease (P < 0.001) and control (P < 0.001) groups. Moreover miRNA 9-3p and endocan performed better than α-fetoprotein in discriminating HCC patients from cirrhosis and healthy patients. The levels of miRNA 9-3p were significantly inversely correlated to vascular invasion (P = 0.002), stage of advancement of Barcelona Clinical Liver Cancer (P < 0.001) and the metastatic site (P < 0.001) of the HCC group. CONCLUSION: Circulating miRNA 9-3p and endocan can be used as novel biomarkers for the early diagnosis of HCV-related HCC.

Prevalence and Determinants of Anemia among Children in Zanzibar, Tanzania: Analysis of Cross-Sectional Population Representative Surveys.

The aim of this study was to assess the prevalence of anemia and its determinants among children aged 6-59 months in Zanzibar, Tanzania, from 2005 to 2015. We used secondary data from the Tanzania Demographic and Health Surveys from three different periods: 2005, 2010, and 2015. A sample of 3502 child-mother pairs from three survey datasets was used to analyze the overall prevalence of anemia and reveal its determinants. Hierarchical logistic regression was used to demonstrate the prevalence odds ratio of factors, both from the mothers and children, for anemia prevalence. The study indicated a significant decrease in anemia prevalence from 76.1% in 2005 to 65.4% in 2015 (p < 0.001). Hierarchical logistic regression between variables and anemia showed a significant association (p = 0.02) with households that improperly disposed of stool, children with minimum dietary diversity (p = 0.041), children in low age quartiles (p = < 0.001), and underweight children (p = 0.025). Maternal, household characteristics, and child factors were associated with childhood anemia in Zanzibar, Tanzania. Despite the significant decrease of anemia in Zanzibar, the overall prevalence rate is still a significant public health concern. Designing and strengthening comprehensive interventions to address anemia in the general population and different categories should be given special consideration.

Design and validation of a food frequency questionnaire to assess the dietary intake for adults in pastoral settings in Northern Tanzania.

OBJECTIVE: Food frequency questionnaires are widely used as a dietary assessment tool in nutritional epidemiology to determine the relationship between diet and diseases. In Tanzania, there are several cultural variations in food intake which makes it necessary to design and validate a culture-specific food frequency questionnaire (CFFQ). Therefore, we designed a 27-items CFFQ and examine its validity in pastoral communities. Validity of CFFQ was assessed by comparing nutrient intake estimated from the CFFQ against the average from two 24-h diet recall (2R24). Spearman's correlation coefficients, cross classification and Bland-Altman's methods were used to assess the validity of CFFQ. RESULTS: A total of 130 adults aged 18 years and above completed both CFFQ and 2R24. Correlation coefficients between CFFQ and 2R24 ranged from low (r = - 0.07) to moderate (r = 0.37). The correlation coefficients were moderately significant for kilocalories (r = 0.31, p < 0.001), carbohydrate (r = 0.33, p < 0.001), magnesium (r = 0.37, p < 0.001), and iron (r = 0.34, p < 0.001). On average, about 69% of participants were correctly classified into the same or adjacent quartile of energy and nutrient intake, while 9% were misclassified by the CFFQ. Bland-Altman's plot demonstrated that the CFFQ had acceptable agreement with the 2R24.

Vitamin D Deficiency and Insufficiency Among University Students: Prevalence, Risk Factors, and the Association Between Vitamin D Deficiency and Episodes of Respiratory Tract Infections.

BACKGROUND: Vitamin D deficiency (VDD) and insufficiency (VDI) is a public health problem worldwide. Low blood levels of vitamin D have been associated with many illnesses, including respiratory tract infections (RTIs). This study aims to evaluate the prevalence of VDD and VDI among university students, assess the correlation with demographic and anthropometric factors, and determine the effect of VDD on the respiratory tract infection (RTI) incidence. METHODS: A cross-sectional and prospective design was used. Our sample consisted of 287 students aged 18-24 years from the University of Sharjah-UAE. Participants were tested for serum 25(hydroxyvitamin)D levels, Body mass index (BMI) was calculated, and the survey was completed. The association between VDD, VDI with the participant's characteristics, and the incidents of RTIs were examined. RESULTS: VDD and VDI were highly prevalent among 85% of the students. The median serum 25(OH) D level was 15.8 ng/dl (19.5±11.6). The mean BMI was (24.32±6.3) kg/m. The results showed a significant positive correlation between VDI and VDD with gender and students who were previously diagnosed with VDD (P < 0.05); however, they were not statistically significant (P < 0.05) with other factors. The tonsillitis incidents were significantly associated with VDD (P = 0.027), while no significant correlation with other incidences of RTIs was found. CONCLUSION: VDD and VDI represent a significant problem across the university students specifically with the female gender. VDD is associated with tonsillitis infection incidence. Both the health and higher education authorities' attention is needed, exploring the causes of VDD and VDI, regular 25(OH)D serum level examination, and educational programs on VDD risks are required.

Acute Effects of Ketamine Infusion on Postoperative Mood Scores in Patients Undergoing Dilation and Curettage: A Randomized Double-Blind Controlled Study.

BACKGROUND: Emotional and psychological effects following abortion are more common than physical side effects and can range from mild regret to more serious complications such as depression. In the last decade, it has been suggested that low dose of ketamine is a fast-acting antidepressant. PURPOSE: The aim of this study was to investigate the impact of intraoperative ketamine infusion on postoperative mood score in patients undergoing Dilation and Curettage (D&C) under spinal anesthesia. We hypothesized that a single low-dose administration of ketamine infusion during D&C surgery can improve mood scores in the immediate postoperative period. METHODS: A prospective, randomized, double-blind, parallel-group, placebo-controlled trial. The study included a total of 60 patients, ≥18 years, physical status ASA II, with up to 12-week gestation undergoing elective D&C surgery. Patients were divided randomly into a ketamine group (group K) and a control group (group C). In group K, 0.4 mg/kg ketamine was given as a continuous infusion over 20 min intraoperatively. Main Outcome Measure. Profile of Mood States (POMS) was recorded preoperatively and 2 hours postoperatively. RESULTS: There were no differences in preoperative POMS between the two groups. Mean postoperative POMS of group K was lower than that of group C indicating mood improvement. Ketamine group patients showed higher sedation score and increased, although self-limiting, psychedelic phenomena than the control group. CONCLUSION: Observed data here support an acute effect of ketamine on mood but any further claim will be speculative. Further future studies exploring postoperative mood scores after 24 hours post-infusion are needed. This trial is registered with PACTR201907779292947.