The effect of Empagliflozin on echocardiographic parameters in diabetic patients after acute myocardial infarction: A systematic review and meta-analysis with trial sequential analysis.

Patients with diabetes mellitus (DM) are at higher risk of cardiovascular events, particularly acute myocardial infarction (MI). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can improve cardiac outcomes among heart failure individuals, however, the effects on acute myocardial infarction remain unclear. This meta-analysis investigates the impact of empagliflozin in diabetic patients following acute myocardial infarction. We comprehensively searched PubMed, Scopus, Cochrane, and Web of Science through August 10th, 2023. We included studies comparing empagliflozin versus placebo in diabetes patients with acute myocardial infarction. We used Revman to report the data as mean difference (MD) and 95% confidence interval (CI), and our effect size with a random effects model. Additionally, we performed Trial Sequential Analysis (TSA) to test the robustness of the results. The study protocol was published on PROSPERO with ID: CRD42023447733. Five studies with a total of 751 patients were included in our analysis. Empagliflozin was effective to improve LVEF% (MD: 1.80, 95% CI [0.50, 3.10], p = 0.007), left ventricular end-diastolic volume (LVEDV) (MD: -9.93, 95% CI [-16.07, -3.80], p = 0.002), and left ventricular end-systolic volume (LVESV) (MD: -7.91, 95% CI [-11.93, -3.88], p = 0.0001). However, there was no difference between empagliflozin and placebo groups in terms of NT-pro BNP (MD: - 136.59, 95% CI [-293.43, 20.25], p = 0.09), and HbA1c (MD: -0.72, 95% CI [-1.73, 0.29], p = 0.16). Additionally, empagliflozin did not prevent hospitalization due to heart failure (RR: 0.59, 95% CI [0.16, 2.24], p = 0.44, I-squared = 0%), and mortality (RR: 1.34, 95% CI [0.15,11.90], p = 0.79, I-squared = 25%). Empagliflozin initiation in diabetic patients following acute MI may improve echocardiographic parameters. However, empagliflozin might not be effective in heart failure prevention and optimal glycemic control in this patient population. Further large-scale trials are warranted to ascertain our findings.

Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan-Meier Curves with Trial Sequential Analysis.

PURPOSE: The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively. METHODS: A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence. RESULTS: A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan-Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank P = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank P = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], I2) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], I2), was associated with a lower risk of AF recurrence. CONCLUSIONS: SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.

Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis.

BACKGROUND AND AIM: Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS: PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS: Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION: Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION: CRD42023417362.

A comprehensive guide on the optimal timing of PCI in the setting of acute coronary syndrome: An updated meta-analysis.

BACKGROUND: Invasive revascularization is recommended for cohorts of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the optimal timing of invasive revascularization is still controversial and no defined consensus is established. We aim to give a comprehensive appraisal on the optimal timing of invasive strategy in the heterogenous population of ACS. METHODS: Relevant studies were assessed through PubMed, Scopus, Web of science, and Cochrane Library from inception until April 2023. Major adverse cardiovascular events (MACE) and all-cause mortality were our primary outcomes of interest, other secondary outcomes were cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding. The data was pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random effect model using STATA 17 MP. RESULTS: A total of 26 studies comprising 21,443 patients were included in the analysis. Early intervention was favor to decrease all-cause mortality (OR = 0.79, 95% CI: 0.64 to 0.98, p = 0.03), when compared to delayed intervention. Subgroup analysis showed that early intervention was significantly associated with all-cause mortality reduction in only NSTE-ACS (OR = 0.83, 95% CI [0.7 to 0.99], p = 0.04). However, there was no significant difference between early and delayed intervention in terms of MACE, cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding. CONCLUSION: An early intervention was associated with lower mortality rates compared to delayed intervention in NSTE-ACS with no significant difference in other clinical outcomes. PROSPERO registration: CRD42023415574.

Potential induction of hyperkeratosis in rats' cervi by gentamicin via induction of oxidative stress, inflammation and apoptosis.

The present study aimed to identify the possible effect of gentamicin (GEN) in Rats' Cervi. Estradiol Valerate (EV) was used to induce cervical hyperkeratosis. GEN was administered in absence of EV. Serum and cervical GEN concentration were determined. Levels of malondialdehyde (MDA), total nitrites/nitrate (NOx), reduced glutathione (GSH), tumor necrosis factor-α (TNF-α), sirtuin type 1 (Sirt1) and nuclear factor (erythroid-derived 2)-like-2 factors (Nrf2) were measured in cervix tissue. Expression of BAX and Bcl2 were determined. Cervical histopathological examination was done. EV and GEN significantly increased MDA, NOx, TNF-α and BAX/Bcl2 ratio with decrease in GSH, Nrf2 and Sirt1 levels in cervical tissue. Histopathological picture of diffuse and marked hyperkeratosis was detected in EV and GEN groups. In conclusion, GEN-induced cervical hyperkeratosis via induction of oxidative stress, inflammation and apoptosis.

Empagliflozin Protects against Haloperidol Experimentally-Induced Ovarian Toxicity.

The present experiment aimed to identify the potential protective role of empagliflozin (EMPA) on haloperidol (HAL)-induced ovarian damage in female rats because of its anti-inflammatory, antioxidant, and antiapoptotic effects. EMPA was administered in the presence and absence of HAL. Thirty-two adult female albino rats were divided into four groups. Control group, EMPA group: received EMPA (10 mg/kg/day) p.o., HAL group: received HAL (2 mg/kg/day) p.o., HAL + EMPA group: HAL (2 mg/kg/day) combined with EMPA for 28 days. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-mullerian hormone (AMH) levels were measured. Ovarian oxidative stress parameters, besides inflammatory and apoptotic biomarkers, and ovarian Sirtuin-1 (Sirt-1) were evaluated. Ovarian histopathological examination and heat shock protein 70 (Hsp70) immunohistochemical study were performed. HAL significantly increased serum levels of FSH, LH, and ovarian inflammatory, apoptotic, and oxidative stress biomarkers and decreased serum AMH levels and Sirt-1 expression. Histopathological findings of ovarian damage and high Hsp70 immunoexpression were detected. EMPA significantly normalized the distributed hormonal levels, oxidative stress, inflammatory, and apoptotic biomarkers with a prompt improvement in the histopathological picture and a decrease in Hsp70 immunoexpression. Accordingly, EMPA protected against HAL-induced ovarian toxicity by modulating the Sirt-1/Hsp70/TNF-α/caspase-3 signaling pathway.

Relationship between vitamin D status and caries experience in a group of Egyptian children: a cross-sectional study.

BACKGROUND: Dental caries is one of the most common diseases of childhood. Evidence suggests that malnutrition and vitamin deficiency may increase the risk to dental caries. AIM: This study aimed to determine the relationship between vitamin D and dental caries experience in children and whether vitamin D deficiency is a risk factor for tooth decay. PARTICIPANTS AND METHODS: A cross-sectional study was performed on 51 Egyptian children, aged from three to five years and diagnosed from Abo El-Resh Children's Hospital as 'Sufficient', 'Insufficient' or 'Deficient' in vitamin D. Children were divided into 3 equal groups. A structured questionnaire, formed of four sections, was answered by the parents. Dental examination was performed under natural daylight. Caries index (dmf), for each group, was calculated then compared. The study was conducted from July 2019 to January 2020. Associations between dmf and different variables were assessed using independent t-test. Correlation between age and dmf was assessed using Spearman's rank order correlation coefficient. Multiple linear regression model was used to study the effect of different variables on caries. RESULTS: There was a weak positive correlation between age and dmf scores (ß = 2.00; 95%CI, 0.73:3.26). Children playing outside experienced higher dmf (ß = 1.29; 95%CI, -0.35:2.94) than those with no outside play. Children with 25(OH) D below 20 ng / ml had the highest dmfs (ß = 1.01; 95%CI, -0.74:2.76). There was a significant association with teeth brushing; children not brushing their teeth showed significantly higher dmf (ß = -2.21; 95%CI, -4.14:-0.28) than their counterparts. There were no significant associations of sex (ß = -1.05; 95%CI, -2.68:0.59), fluoride tablets intake (ß = 2.19; 95%CI, -1.25:5.63), dental visits (ß = -1.43; 95%CI, -3.09:0.23), mothers' vitamin D intake during pregnancy (ß = 0.71; 95%CI, -1.13:2.56), snacking (ß = -1.18; 95%CI, -4.62:2.26) and parental education (ß = 0.62; 95%CI, -1.18:2.42) with caries experience among the study population. CONCLUSION: Vitamin D deficiency does not seem to be associated with dental caries experience of 3-5 years old Egyptian children. Out of the indicator variables, age and tooth brushing contributed significantly to the occurrence of dental caries among the study population.

Functional Quality and Radical Scavenging Activity of Selected Watermelon (Citrullus lanatus (Thunb.) Mansfeld) Genotypes as Affected by Early and Full Cropping Seasons.

Growing conditions and seasonal fluctuations are critical factors affecting fruit and vegetable nutritional quality. The effects of two partially overlapping cropping seasons, early (ECS; January-May) and full (FCS; March-July), on the main carpometric traits and bioactive components of different watermelon fruits were investigated in the open field. Four watermelon genotypes, comprising of three commercial cultivars 'Crimson Sweet', 'Dumara', 'Giza', and the novel hybrid 'P503 F1', were compared. The carpometric traits varied significantly between genotypes. Soluble solids and yield were higher under FCS than ECS. The variation affecting colour indexes between the two growing seasons exhibited a genotype-dependent trend. The antioxidant components and radical scavenging activity of watermelon fruits were also significantly affected by differences in received solar energy and temperature fluctuations during the trial period. The average citrulline, total phenolics and flavonoid contents were 93%, 71% and 40% higher in FCS than in ECS. A genotype-dependent variation trend was also observed for lycopene and total vitamin C between cropping seasons. The hydrophilic and lipophilic radical scavenging activities of the pulp of ripe watermelon fruits of the different genotypes investigated varied between 243.16 and 425.31 µmol Trolox Equivalent (TE) of 100 g-1 of fresh weight (fw) and from 232.71 to 341.67 µmol TE of 100 g-1 fw in FCS and ECS, respectively. Our results, although preliminary, show that the functional quality of watermelon fruits is drastically altered depending on the environmental conditions that characterize the ECS and LCS.

MicroRNAs and cytokines as potential predictive biomarkers for COVID-19 disease progression.

Host microRNAs can influence the cytokine storm associated SARS-CoV-2 infection and proposed as biomarkers for COVID-19 disease. In the present study, serum MiRNA-106a and miRNA-20a were quantified by real time-PCR in 50 COVID-19 patients hospitalized at Minia university hospital and 30 healthy volunteers. Profiles of serum inflammatory cytokines (TNF-α, IFN-γ, and IL-10) and TLR4 were analyzed by Eliza in patients and controls. A highly significant decrease (P value = 0.0001) in the expressions of miRNA-106a and miRNA-20a was reported in COVID-19 patients compared to controls. A significant decrease in the levels of miRNA-20a was also reported in patients with lymphopenia, patients having chest CT severity score (CSS) > 19 and in patients having O2 saturation less than 90%. Significantly higher levels of TNF-α, IFN-γ, IL-10 and TLR4 were reported in patients compared to controls. IL-10 and TLR4 levels were significantly higher in patients having lymphopenia. TLR-4 level was higher in patients with CSS > 19 and in patients with hypoxia. Using univariate logistic regression analysis, miRNA-106a, miRNA-20a, TNF-α, IFN-γ, IL-10 and TLR4 were identified as good predictors of disease. Receiver operating curve showed that the downregulation of miRNA-20a in patients having lymphopenia, patients with CSS > 19 and patients with hypoxia could be a potential biomarker with AUC = 0.68 ± 0.08, AUC = 0.73 ± 0.07 and AUC = 0.68 ± 0.07 respectively. Also, ROC curve showed accurate association between the increase of serum IL-10 and TLR-4 and lymphopenia among COVID-19 patients with AUC = 0.66 ± 0.08 and AUC = 0.73 ± 0.07 respectively. ROC curve showed also that serum TLR-4 could be a potential marker for high CSS with AUC = 0.78 ± 0.06. A negative correlation was detected between miRNA-20a with TLR-4 (r = - 0.30, P value = 0.03). We concluded that, miR-20a, is a potential biomarker of COVID-19 severity and blockade of IL-10 and TLR4 may constitute a novel therapy for COVID-19 patients.

Cyclosporine Ameliorates Silica-Induced Autoimmune Hepatitis in Rat Model by Altering the Expression of Toll-Like Receptor-4, Interleukin-2, and Tumor Necrosis Factor-α.

BACKGROUND: Autoimmune hepatitis (AIH) is an inflammatory liver disease that is characterized histologically by interface hepatitis, biochemically by elevated transaminase levels, and serologically by the presence of autoantibodies. Toll-like receptor (TLR)-4 is a TLR family member that, upon activation in hepatocytes, initiates a cascade of events. Interleukin-2 (IL-2) and tumour necrosis factor α (TNF-α) are potent inflammatory cytokines secreted in AIH, playing an important role in the early development of inflammation and hepatocyte damage. OBJECTIVES: This study examined the role of cyclosporine in AIH and illustrated its actions on altered hepatic function in the silica-induced AIH model. METHODS: AIH was induced in Wistar rats using sodium silicate. The rats were divided into four groups: the control group, silica-AIH group, cyclosporine-treated group, and prevention group. TLR-4 and IL-2 mRNA expressions in liver tissues were tested by RTPCR. RESULTS: AIH was associated with up-regulation of liver enzymes, IL-2 and TLR-4 gene expression, while cyclosporine significantly down-regulated the expression of both. The relative quantity of TLR-4 mRNA was 1±0, 13.57±1.91, 4±0.38, and 2±0 in control, AIH, cyclosporine, and prevention groups, respectively (p<0.001). Also, the relative quantity of IL-2 mRNA was 1±0, 14.79±1.42, 7.07±0.96, and 3.4±0.55 in control, AIH, cyclosporine, and prevention groups, respectively (p<0.001). Additionally, immunohistochemical staining for TNF-α in liver sections was increased in the silica-AIH group but was found to decrease in the cyclosporine-treated and prevention groups. CONCLUSION: This study advocates the therapeutic role of cyclosporine in treating immune-mediated hepatic diseases. Cyclosporine improves histological alterations in the liver and inhibits the production of proinflammatory cytokines.

Rivastigmine ameliorates gentamicin experimentally induced acute renal toxicity.

The current experiment aimed to identify the possible protective role of rivastigmine (RIVA) in gentamicin (GNT)-induced acute kidney injury (AKI) in rats. RIVA was administered in the presence and absence of GNT. Kidney function markers and serum and renal GNT concentrations were measured. Renal oxidative stress parameters as well as inflammatory and apoptotic biomarkers were evaluated. Renal histopathological assessment and nuclear factor kappa-B (NF-κB) immunohistochemical study were performed. GNT administration increased serum creatinine, urea, and cystatin C concentrations. RIVA ameliorated these changes via mitigating GNT-induced increases of renal oxidative stress, inflammation, and apoptotic parameters. RIVA showed a prompt improvement in the histopathological renal damage and a decrease in NF-κB immunoexpression. In conclusion, RIVA protective effects against GNT-induced AKI are mediated by decreasing GNT concentration in renal tissue and other effects like antioxidant and antiapoptotic effects possibly through its cholinergic anti-inflammatory action.

Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial.

BACKGROUND: Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage. METHODS: This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management. RESULTS: One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively). CONCLUSION: Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

Success rate of three capping materials used in pulpotomy of primary molars: A randomized clinical trial.

BACKGROUND: Carious primary molars, symptomless, or with reversible pulpitis are most frequently treated with pulpotomy to maintain arch integrity, otherwise they would be extracted. The present study was conducted to assess clinically and radiographically the success rate of three capping materials: Nanohydroxyapatite (NHA), Mineral Trioxide Aggregate (MTA), and Formocresol (FC) in pulpotomy of primary molars. METHODS: A clinical trial was carried out on healthy, four to eight years old children, with 72- second primary molars indicated for pulpotomy. Molars were divided into 3 equal groups (24 teeth each) designated to NHA (group 1), MTA (group 2), and FC (group 3) as pulp medicaments. Treated teeth were finally restored with stainless steel crowns. Subjects were monitored clinically and radiographically after three, six, and twelve months. Statistical analysis was presented as intended to treat analysis. Categorical data were analyzed using Fisher's exact test. The significance level was set at p ≤ 0.05. Statistical analysis was performed using SPSS, version 26. RESULTS: By the end of the twelve months, the number and percentages of successfully treated molars for Group (1), Group (2) and Group (3) were 10 (41.7%), 19 (79.2%) and 18 (75.0%) respectively; with (NHA) group showing a significantly lower rate of success, (p = 0.019). CONCLUSIONS: MTA is still the material of choice for pulpotomy in primary molars. TRIAL REGISTRATION: This trial was registered on Clincal.Trial.gov (https://clinicaltrials.gov), on February 8, 2019 (Retrospectively registered). The protocol ID is 181053. The Identifier is NCT03833557.

Knowledge, attitude and practice of Saudi women in Najran area towards breastfeeding during Ramadan.

Breastfeeding is the gold standard for infant feeding practice. Many factors influence breastfeeding, one of them is breastfeeding during Ramadan. The objective of our study was to assess the knowledge, practice and attitude of breastfeeding among women in Najran area, Saudi Arabia, during month of Ramadan. A descriptive cross-sectional study using a self-administrated questionnaire was conducted in June and July 2015. A total of 169 breastfeeding women visiting the Gynaecology Clinic in Najran University hospital were randomly recruited. Data were analysed by using statistical package for the social sciences version 20.0. Of the study population, 89.9% showed that they used to practice breastfeeding while fasting during the day in Ramadan (p < 0.000). The study revealed that 85.8% of the participants thought that fasting does not alter the nutritional composition of breast milk (p < 0.001). Around 80.5% stated that fasting has no adverse effect on the volume of breast milk and the growth of the infants during Ramadan. Women's knowledge about fasting and infant growth was significantly associated with their age and education (p value =0.011 and 0.031, respectively). To conclude, majority of the study population had positive knowledge, attitude and practice towards breastfeeding in Ramadan. Breastfeeding promotion programs are needed to provide support and advice to women regarding breastfeeding during Ramadan and improve their breastfeeding attitudes and knowledge which will lead to short- and long-term benefits for infants, mothers, environment, economy and the entire society.

Staged Hybrid Single Lumen Reconstruction (TIGER) in Management of Chronic Symptomatic Complex Type B Aortic Dissection, Techniques, and Literature Review.

BACKGROUND: Endovascular intervention for chronic symptomatic type B aortic dissection (CS-TBAD) induces aortic wall stress with negative hemodynamic cardiovascular consequences. CS-TBAD risks increased morbidity and mortality due to septum maturation with significant impact on false lumen modulation, and partial lumen thrombosis conveying the worst outcome. The aim of the TIGER technique is total aortic remodeling with true lumen expansion, false lumen regression and complete thrombosis, and stabilization of overall aortic diameter. METHODS: We report 5 cases of aortic dissection with a mean follow-up of 16 months (6-28 months). All had aneurysmal dilation, with 3 having acute pan aortic dissection and 2 having CS-TBAD. All were managed by sTaged HybrId sinGle lumEn Reconstruction (TIGER). Our first approach was to create one single lumen from the supraceliac, infradiaphragmatic aorta to both common iliac arteries with open surgical patching of the visceral arteries; then, we performed a TEVAR 3 months later. RESULTS: Three patients required a left subclavian artery chimney graft and one required bilateral subclavian to carotid artery transposition. No spinal drainage was required, and all patients had intraoperative transesophageal echo for wire guidance. We had no aortic rupture or retrograde type A dissection, and we experienced no renal, visceral, cardiac, pulmonary, or spinal complications. All patients, but one, went off their antihypertensive medication. All patients had normal estimated glomerular filtration rate postoperatively, and they all demonstrated accelerated aortic modulation. CONCLUSIONS: TIGER was not only effective at the semiacute stage to initiate remodeling and prevent malperfusion, it also facilitated a straightforward TEVAR at stage 2, which was made easier by avoiding visceral branch stenting. Moreover, it decreased the length of aortic segment, which was stented, thereby avoiding critical shattering, branch dislodgment, and visceral compromise; spinal ischemia; and negative cardiovascular consequences.

Estimated dietary intake of essential elements from four selected staple foods in Najran City, Saudi Arabia.

The estimated dietary intake (EDI) of essential elements selenium (Se), zinc (Zn), manganese (Mn) and copper (Cu) has not been previously investigated for Najran city, Saudi Arabia. This type of information can be valuable for protecting public health. The aim of this study was to estimate the EDI of these elements. A food frequency questionnaire (FFQ) was completed by the study participants (n = 80) to obtain dietary intake of selected staple foods (rice, wheat, meat and chicken). The concentrations of Se, Zn, Mn and Cu in these staple foods were determined using inductively coupled plasma-mass spectrometry (ICP-MS). The ranges of concentrations (mg/kg, wet weight) were as follows: Se (0.07-0.24), Zn (3.91-20.89), Mn (0.63-14.69) and Cu (0.69-2.41). The calculated ranges of EDIs (mg/kg bw/day) for the essential elements were as follows: Se 9.55 × 10-5-5.75 × 10-4, Zn 1.33 × 10-2-5.83 × 10-2, Mn 1.49 × 10-3-3.31 × 10-2, Cu 1.65 × 10-3-5.42 × 10-3. The highest EDI for Cu and Mn came from wheat. In the case of Se and Zn, the foods that contributed the highest EDI were chicken and meat, respectively. The lowest EDIs were found for Se in wheat, Zn in rice and both Mn and Cu in chicken. The percentages (%) of provisional maximum tolerable daily intake (PMTDI) for Se, Zn, Mn and Cu were 13%, 11%, 14% and 3.4%, respectively when contributions from all the four classes of foods were combined. The percentage of the recommended daily allowance (RDA) derived from these foods were 80%, 20%, 17% and 5.6% for Se, Zn, Mn and Cu were, respectively. This raises the possibility of Cu deficiency in the Najran population. However, a total diet study and human biomonitoring study is needed in the future to fully assess if people in Najran city are at risk of deficiency or excessive exposure to trace elements.

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study.

BACKGROUND: Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations. METHODS: 64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase. RESULTS: Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile. CONCLUSION: Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase. TRIAL REGISTRATION: Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.

A return to the genetic heritage of durum wheat to cope with drought heightened by climate change.

The objective of this work was to perform a comparative analysis of the physiological, biochemical and agronomical parameters of recent and heritage durum wheat cultivars (Triticum durum Desf.) under water-deficit conditions. Five cultivars were grown under irrigated (control) and rainfall (stressed) conditions. Different agro-physiological and biochemical parameters were studied: electrolyte leakage, relative water content, chlorophyll fluorescence, proline, soluble sugars, specific peroxidase activity, yield and drought stress indices. It was revealed that a water deficit increased proline content, electrolyte leakage, soluble sugars and specific peroxidase activity and decreased relative water content, fluorescence and grain yield. According to these parameters and drought stress indices, our investigation indicated that old cultivars are the best-adapted to local conditions and showed characteristics of drought tolerance, while recent cultivars showed more drought susceptibility. Therefore, local cultivars of each country should be kept by farmers and plant breeders to preserve their genetic heritage.

Estimated Dietary Intakes of Toxic Elements from Four Staple Foods in Najran City, Saudi Arabia.

Exposure of the inhabitants of Najran area in Saudi Arabia to the toxic elements As, Cd, Cr, and Pb through foods has not been previously investigated. Exposure to such elements is an important public health issue, so the study described here was performed with the aim of determining estimated dietary intakes (EDIs) for these metals in Najran area. The As, Cd, Cr, and Pb concentrations in four staple foods (rice, wheat, red meat, and chicken) were determined by inductively coupled plasma-mass spectrometry. A food frequency questionnaire (FFQ) was completed by 80 study participants. These data were used to estimate dietary intakes of the metals in the four staple foods. The mean As, Cd, Cr, and Pb EDIs in the four food types were 1.1 × 10-6-2.6 × 10-5, 1.42 × 10-5-2.2 × 10-4, 3.4 × 10-4-8.0 × 10-4, and 2.3 × 10-5-2.1 × 10-3 mg/kg bw day, respectively. Hazard Quotients (HQ) for all elements did not exceed one. The highest Pb concentration was found for chicken and the source of this toxic element in this food needs to be investigated in the future. The lowest As concentration was found for wheat highest in rice. The EDIs for all elements in the four food types were below the provisional tolerable weekly intakes set by the World Health Organization (WHO).

Discrete multi-physics: A mesh-free model of blood flow in flexible biological valve including solid aggregate formation.

We propose a mesh-free and discrete (particle-based) multi-physics approach for modelling the hydrodynamics in flexible biological valves. In the first part of this study, the method is successfully validated against both traditional modelling techniques and experimental data. In the second part, it is further developed to account for the formation of solid aggregates in the flow and at the membrane surface. Simulations of various types of aggregates highlight the main benefits of discrete multi-physics and indicate the potential of this approach for coupling the hydrodynamics with phenomena such as clotting and calcification in biological valves.