Toward a computational role for locus coeruleus/norepinephrine arousal systems.

Brain and behavior undergo measurable changes in their underlying state and neuromodulators are thought to contribute to these fluctuations. Why do we undergo such changes, and what function could the underlying neuromodulatory systems perform? Here we examine theoretical answers to these questions with respect to the locus coeruleus/norepinephrine system focusing on peripheral markers for arousal, such as pupil diameter, that are thought to provide a window into brain wide noradrenergic signaling. We explore a computational role for arousal systems in facilitating internal state transitions that facilitate credit assignment and promote accurate perceptions in non-stationary environments. We summarize recent work that supports this idea and highlight open questions as well as alternative views of how arousal affects cognition.

Nutritional rehabilitation of malnourished children detected by Screening Tool for Assessment of Malnutrition in Pediatric: Urban versus rural settings.

BACKGROUND: Malnutrition presents a major global health burden. In Egypt, it remains an important issue in children under 5 years especially in rural communities. AIM OF THE STUDY: The aim of the study was to screen 2-5 years old children enrolled from Egyptian hospitals in rural and urban areas for the risk of malnutrition using Screening Tool for Assessment of Malnutrition in Pediatric (STAMP) and to evaluate the effectiveness of nutritional intervention programs. SUBJECTS AND METHODS: This cross-sectional study was conducted on 90 patients recruited from two hospitals in urban and rural Cairo, Dietary history and anthropometric measurements were assessed. Patients at intermediate and severe risk of malnutrition according to STAMP were given tailored nutritional programs. RESULTS: In the rural hospital, 4.4% of the screened children were underweight, 22.2% were marginally underweight, and 73.3% had normal weight. Regarding the urban hospital, 15.6% were marginally underweight, 84.4% had normal weight and no underweight patients. Among the rural group 35.6% were at high risk according to STAMP score results compared to 20% in the urban group. Nevertheless, the only significant differences were the more stunting and higher BMI in rural hospital patients. After nutritional intervention, high-risk category patients decreased in both groups coupled by significant improvement in the anthropometric parameters and nutrition data with no significant differences between them. CONCLUSION: Nutritional education and prompt implementation of nutritional rehabilitation program for malnourished children detected by screening tools result in improvement in their nutritional status disregards their location whether urban or rural.

Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study.

The impact of urine calcium on kidney, bone, and cardiovascular systems in osteoporosis is not well-known. In this 7-year-follow-up study, high urine calcium did not affect kidney function but increased risk of kidney stones, while low urine calcium increased cardiovascular diseases. Maintaining normal urine calcium is beneficial for bone health. PURPOSE: Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients' health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis. METHODS: Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients' outcomes. RESULTS: Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). CONCLUSION: UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.

[Morphological and functional diagnostics of coronary artery disease by computed tomography]. / Morphologische und funktionelle Diagnostik der koronaren Herzkrankheit mittels Computertomographie.

Computed tomography coronary angiography (cCTA) is a safe option for the noninvasive exclusion of significant coronary stenoses in patients with a low or moderate pretest probability for coronary artery disease (CAD). Furthermore, it also allows functional and morphological assessment of coronary stenoses. The European Society of Cardiology (ESC) guidelines on the diagnosis and management of chronic coronary syndrome published in 2019 have strengthened the importance of cCTA in this context and for this reason it has experienced a considerable upgrade. The determination of the Agatston score is a clinically established method for quantifying coronary calcification and influences the initiation of drug treatment. With technologies, such as the introduction of electrocardiography (ECG)-controlled dose modulation and iterative image reconstruction, cCTA can be performed with high image quality and low radiation exposure. Anatomic imaging of coronary stenoses alone is currently being augmented by innovative techniques, such as myocardial CT perfusion imaging or CT-fractional flow reserve (FFR) but the clinical value of these methods merits further investigation. The cCTA could therefore develop into a gatekeeper with respect to the indications for invasive coronary diagnostics and interventions.

Real-world Treatment Patterns and Outcomes in Stage III Non-small Cell Lung Cancer: Middle East and Africa - KINDLE Study.

INTRODUCTION: The Middle East and Africa (MEA)-KINDLE, as part of a real-world global study, evaluated treatment patterns and survival outcomes in stage III non-small cell lung cancer (NSCLC) in the MEA. MATERIALS AND METHODS: Retrospective data were analyzed from 33 centers for patients diagnosed between January 01, 2013, and December 31, 2017. Descriptive analyses included clinical-demographics and treatment patterns; inferential statistics evaluated an association of first-line treatment with progression-free survival (PFS) and overall survival (OS). RESULTS: Of 1,046 patients enrolled, the median (range) age was 61.0 years (24.0-89.0); 83.2% were men, 80.8% were current or past smokers, 58.9% had stage IIIA disease, 47.8% had adenocarcinoma and 20.0% of tested (35/175) had epidermal growth factor receptor mutations. Of 86.0% of patients receiving an initial therapy, about 16% underwent surgical resection. Concurrent chemoradiotherapy (cCRT) (32.3%) was the most frequent treatment modality followed by chemotherapy (CT) alone (19.6%) and sequential CRT (12.1%). Median PFS and OS (months, 95% CI) were 11.8 (10.6, 12.4) and 22.9 (21.2, 26.3), respectively for the overall MEA subset. OS (months) was highest with surgery-based therapies for stage IIIA (IIIA: 37.3, IIIB: 24.1) followed by cCRT (IIIA: 28.9, IIIB: 24.4). Female gender, adenocarcinoma, and cCRT or Sx+CRT in first-line were associated with higher OS (P < .05). CONCLUSIONS: The data reveal an unmet need in stage III NSCLC with worse PFS and OS in the MEA subset than in the global cohort. Better access to newer therapies and quality care will be crucial in improving patient outcomes in the MEA.

A novel approach to myringotomy simulation.

OBJECTIVE: In the wake of the 2019 coronavirus disease pandemic, elective cases and opportunities for clinical application have decreased, and the need for useful simulation models has become more apparent for developing surgical skills. A novel myringotomy with ventilatory tube insertion simulation model was created. METHODS: Residents across all levels at our institution participated in the simulation. Participants were evaluated in terms of: time of procedure, microscope positioning, cerumen removal, identification of middle ear effusion type, canal wall trauma, tympanic membrane damage and tube placement. RESULTS: Eleven residents participated. Scores ranged from 14 to 34, out of a maximum of 40. The average score among junior and senior residents was 24 and 31, respectively. The simulation was felt to be representative of the operating theatre experience. CONCLUSION: This study demonstrates a low-cost simulation model that captures several important, nuanced aspects of myringotomy with tube insertion, often overlooked in previously reported simulations.

Modified Atkins diet for drug-resistant epilepsy and the risk of urolithiasis.

BACKGROUND: Ketogenic diet (KD) is widely used for drug-resistant epilepsy (DRE). The study was designed to evaluate one of the risk factors for development of renal calculi with KD. METHODS: Twenty patients with DRE on Modified Atkins diet (MAD) were subjected to full history and laboratory investigations, including microscopic urine analysis, urinary calcium after overnight fasting, and calcium/creatinine ratio, as well as pelviabdominal ultrasound. Frequency and severity of seizures assessed by Chalfont severity score were recorded. All assessment measures were repeated after 3 and 6 months of KD therapy. RESULTS: There were significant reductions in both frequency and severity of seizures, yet 2 patients (10%) developed renal stones after 6 months on KD. Gross hematuria was reported in 1 of those 2 patients (50%), but microscopic hematuria was detected in both patients. The urine calcium and the urine calcium/creatinine ratio were elevated in both patients having renal calculi after 6 months. CONCLUSIONS: KD increases the risk of renal stones with hypercalciuria among the causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with regular urinary studies including calcium/creatinine ratio and renal ultrasound for patients with symptoms. IMPACT: KD has been increasingly used in epilepsy management and beyond. The potential side effects of such diet should be highlighted while valuing the merits. KD increases the risk of renal stones because of hypercalciuria among other causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with estimation of urinary calcium/creatinine ratio and renal ultrasound in patients with relevant symptoms.

Antibacterial and cytotoxicity evaluation of Arum hygrophilum Bioss.

OBJECTIVE: Arum hygrophilum Bioss is a plant native to Asia, Europe, and Northern Africa. It is consumed as beverages, spices, or cooked leaves to cure gastrointestinal infections and cancer. This study aims to determine the antibacterial and anticancer effectivenesss of A. hygrophilum Bioss. MATERIALS AND METHODS: Using the well-diffusion method, the antimicrobial activity of the plant's aqueous extract and five other organic extracts were evaluated against bacteria often associated with food poisoning. The assessment of the antiproliferative activity by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was done on five cancerous cell lines and on fibroblasts as a reference cell line. RESULTS: The growth of L. monocytogenes was significantly inhibited by the aqueous and ethanolic extracts. Both extracts had a minimum inhibitory concentration (MIC) of 62.5 mg/mL. The inhibition caused by the methanolic extract had a MIC of 500 mg/mL. The growth of S. aureus and MRSA were inhibited by the aqueous extract with a MIC of 500 mg/mL, while the inhibition caused by the ethanolic extract had a MIC of 250 mg/mL on MRSA and 500 mg/mL on S.aureus. Both strains of S.aureus were also inhibited by the 3-pentanon extract, while the butanol extract only exhibited a moderate growth inhibition against MRSA. The MTT assay showed that the aqueous extract had not affected the proliferation of cancer cell lines. The cytotoxicity of the ethanolic and methanolic extracts had no concentration-inhibition relationship and the IC50 values were above 800 µg/mL for all extracts. CONCLUSIONS: L. monocytogenes, S. aureus, and methicillin-resistant Staphylococcus aureus (MRSA) were inhibited by different Arum extracts. The antibacterial activity of Arum hygrophilum Bioss against foodborne pathogens makes it safe to use as a natural food preservative, and as a source for sanitizers and antimicrobials. Further investigation is recommended to determine the cytotoxicity of the plant against additional cancer cell lines.

Contemporary Ross procedure outcomes: medium- to long-term results in 214 patients.

OBJECTIVE: Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate. METHODS: We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997-2009) and era 2 (2010-2019). RESULTS: Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15-38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148-202) and 202 (IQR 182-244) min. The median postoperative stay was 6 days (2-77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9-13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5-17.4) and 4.8 (IQR 2.5-7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation. CONCLUSIONS: The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.

The internal pudendal artery turnover (IPAT) flap: A new, simple and reliable technique for perineal reconstruction.

Perineal defects can be a reconstructive challenge following abdomino-perineal excision of the rectum, pelvic exenteration or the excision of severe pilonidal disease. These defects often involve large perineal cavities and pelvic dead space with often poorly mobile soft tissues due to neoadjuvant chemoradiation. Because of the inherent challenges of wound healing in the perineal region, well vascularised and robust reconstruction is mandated. In this paper, we describe a novel perforator-based turnover flap for perineal reconstruction - the internal pudendal artery turnover flap (IPAT flap). The flap requires no visualisation or dissection of perforating vessels, has a reliable vasculature, is quick and straightforward to perform and allows for the effective reconstruction of deep three-dimensional defects following perineal excisions. This is a retrospective study. A cohort of 38 consecutive patients who underwent various reconstructions with the IPAT flap under a single surgeon were included between 2012 and 2019. At three months, 37 flaps were fully healed. There were no flap failures or partial flap losses. Complications were seen in 10 of 38 patients with nine of these being minor and one that requires a return to the theatre for washout secondary to a urinary leak. The Internal Pudendal Artery Turn Over Flap allows us to reconstruct three-dimensional defects following perineal surgery, achieving more significant mobilisation of the flap to fill deep dead space without the added complexity and additional operative time associated with perforator dissection. The IPAT flap can be used in several common perineal reconstructive challenges expeditiously - often at the end of lengthy oncological resections - with minimal donor site morbidity, and in our experience, yields reliable outcomes.

COVID-19 Mortality in Transplant Recipients.

BACKGROUND: Organ transplant recipients are vulnerable to multiple infectious agents and in a world with a circulating SARS-CoV-2 virus, it would be expected that patients who are immunosuppressed would have higher mortality. OBJECTIVE: To determine the COVID-19 mortality in transplant recipients. METHODS: We conducted a search in PubMed and Google scholar databases using the keywords for COVID-19 and transplantation. All related studies between January 1, 2020 and May 7, 2020 were reviewed. All relevant published articles related to COVID-19 in transplant recipients were included. RESULTS: 46 articles were included; they studied a total of 320 transplant patients-220 kidney transplant recipients, 42 liver, 19 heart, 22 lung, 8 HSCT, and 9 dual organ transplant recipients. The overall mortality rate was 20% and was variable among different organs and different countries. 65 transplant recipients died of complications attributable to COVID-19; 33 were males (15% of males in this cohort), 8 females (8% of females in this cohort), and 24 whose sex was not determined. They had a median age of 66 (range: 32-87) years. The median transplantation duration was 8 years (range: 30 days to 20 years). The most frequent comorbidity reported was hypertensions followed by diabetes mellitus, obesity, malignancy, ischemic heart disease, and chronic obstructive pulmonary disease. The most frequent cause of death reported was acute respiratory distress syndrome. CONCLUSION: Transplant recipients in our cohort had a high mortality rate. However, outcomes were not the same in different countries based on outbreak settings. Mortality was noted in elder patients with comorbidities.

Dentists' perceptions of their professional roles regarding referrals within primary dental care in England: a qualitative study.

OBJECTIVE: To describe dentists' perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England. BASIC RESEARCH DESIGN: Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed. PARTICIPANTS: Ten general dental practitioners (GDPs) and 12 community dentists working in England. RESULTS: Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and 'no man's land'. This final theme described a notional gap between GDPs' and community dentists' responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. 'Entrepreneurs' felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. 'Altruistic carers' were committed to caring for exceptionally deserving patients. 'Pragmatic carers' tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers. CONCLUSION: Dentists' perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics.

OBJECTIVE: Middle East Respiratory Syndrome Coronavirus-(MERS-CoV) infection is an evolving worldwide health crisis. The early diagnosis and management of the disease remains a major challenge. This study designed to discuss the epidemiology, pathogenesis and clinical appearances of MERS-CoV infections. MATERIALS AND METHODS: We conducted a broad search of the English-language literature in "PubMed" "Medline" "Web of knowledge", "EMBASE" and "Google Scholar" World Health Organization-WHO" using the key words "Middle East Respiratory Syndrome", "MERS", "MERS-CoV" "Epidemiology" "Transmission" "Pathogenesis" "Clinical Characteristics". We reviewed the literature on epidemiology, pathogenesis and clinical appearances of MERS-CoV infection and the required information was documented. RESULTS: The global prevalence of MERS-CoV infection from June 2012 to April 2018 is 2206 people. The number of cases reported from Saudi Arabia is 1831 (83%) with mortality rate of 787 (35.67%). The main clinical manifestations are fever, chills, generalized myalgia, cough, shortness of breath, nausea, vomiting and diarrhea. The age-allied prevalence of MERS-CoV was highest amongst elderly people with chronic debilitating diseases such as pulmonary diseases, end-stage renal illness, diabetes mellitus and malignancy. CONCLUSIONS: MERS-CoV infection is an emerging global health concern, affected people in 27 countries in the various continents. MERS-CoV infection has been identified mainly in the Middle East, Europe, Africa, Asia and North America. Early detection and management of MERS-CoV infection is of critical importance to minimize the burden of the disease.

Reducing the interval of a growth QTL on chromosome 4 in laying hens.

In our previous research, we identified a QTL with an interval of 3.4 Mb for growth on chicken chromosome (GGA) 4 in an advanced intercross population of an initial cross between the New Hampshire inbred line (NHI) and the White Leghorn inbred line (WL77). In the current study, an association analysis was performed in a population of purebred white layers (WLA) with White Leghorn origin. Genotypic data of 130 SNPs within the previously identified 3.4-Mb region were obtained using a 60K SNP chip. In total, 24 significant SNPs (LOD ≥ 4.44) on GGA4 were detected for daily weigh gain from 8 to 14 weeks and two SNPs (LOD ≥ 4.80) for body weight at 14 weeks. The QTL interval was reduced by 1.9 Mb to an interval of 1.5 Mb (74.6-76.1 Mb) that harbors 15 genes. Furthermore, to identify additional loci for chicken growth, a genome-wide association study (GWAS) was carried out in a WLA population. The GWAS identified an additional QTL on GGA6 for body weight at six weeks (19.8-21.2 Mb). Our findings showed that by using a WLA population we were able to further reduce the QTL confidence interval previously detected using a NHI × WL77 advanced intercross population.

Global seasonal occurrence of middle east respiratory syndrome coronavirus (MERS-CoV) infection.

OBJECTIVE: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an evolving global health crisis. Despite recent efforts, there are numerous notable gaps in the understanding of MERS-CoV seasonal diversity. We aimed at investigating the global seasonal occurrence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreaks. MATERIALS AND METHODS: We obtained the data on the prevalence and occurrence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection from the World Health Organization (WHO) for all the MERS cases reported from the various countries and their allied ministries. We also recorded the research documents published in various global scientific journals on the seasonal occurrence of MERS-CoV infection during the period 2012-2017. RESULTS: Worldwide 2048 laboratory confirmed cases of MERS-CoV infection were reported from June 2012 to the Dec 2017. 1680 (82.03%) cases were from the Saudi Arabia and 368 (17.96%) cases were reported from the other countries of the world. The maximum number of cases reported in June was 474 (23.14%). 287 (14.01%) cases were reported from Saudi Arabia and remaining 187 (9.13%) cases were reported from all over the world. The number of cases reported from April to June was 396 (19.33%) while the cases encountered from October to December were 231 (11.27%). CONCLUSIONS: The highest global seasonal occurrence of Middle East Respiratory Syndrome coronavirus-MERS-CoV outbreak cases were found in the month of June, while the lowest was found in the month of January during the period of 2012 to 2017. The pattern of MERS-CoV infections has been observed to have seasonal variations. It is suggested that the health officials should highlight the seasonal occurrence of MERS-CoV outbreak and take better preventive measures to minimize the disease burden nationally and globally.

CRISPR technology: new paradigm to target the infectious disease pathogens.

OBJECTIVE: Infectious diseases are one of the prime causes of death worldwide. An innovative sequence specific editing technology "Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)" has been tested on a broad range of microorganisms to target and destroy invading foreign DNA to human cells or tissues. This study aimed to discuss the mechanism and therapeutic usage of CRISPR/Cas9 genome editing technology in the management of various infectious disease pathogens. MATERIALS AND METHODS: We conducted a broad search of the English-language literature in "PubMed" using the search terms "CRISPR", "Cas-9", "Genome editing", "Gene therapy", "infectious disease pathogens". All the articles were reviewed and required information was recorded. RESULTS: CRISPR technology is used to modify and modulate the gene expression in biomedical research and therapeutic development. This technology facilitates the understanding of fundamental biology and broadens the horizon of treatments of germ-laden conditions. CONCLUSIONS: The applications of CRISPR technology are widely established in the diagnosis and treatment of various bacterial, viral, fungal and parasitic infectious diseases. CRISPR technology is a simple, efficient and tested on a broad range of microorganisms to rectify disease-associated genetic defects and destroy invading foreign DNA to human cells or tissues.

Prevalence, Attitude, Knowledge, and Practice of Anabolic Androgenic Steroid (AAS) Use Among Gym Participants.

BACKGROUND: Anabolic steroids (AS) are synthetic testosterone derivatives that last longer than physiological androgens in the body. Anabolic-androgenic steroid (AAS) abuse is spreading among athletes. The aim of this study is to assess the knowledge, attitudes, and practices of gym participants in Saudi Arabia. METHODS: A cross-sectional survey was carried out among gym users from February 2017 to May 2017. The questionnaire included information on demographics related to the use of AAS and lifestyle habits. Any willing male gym participant could be included. RESULTS: A total of 4860 male gym participants with a mean age of 28.6 ± 6.2 years were included. A majority were single, with a bachelor's degree or higher. Moreover, 9.8% of the participants used AAS, of which 76.7% reported improved fitness. Friends were the main source of AAS-related information, but only 38.0% of AAS users sought medical consults. The oral route was most common, and testosterone enanthate was the AAS most used. CONCLUSION: Also, 9.8% of gym participants used AAS and were more likely to be involved in risky habits, such as smoking and growth hormone abuse. They were less aware of potential complications of AAS, with gym trainers being the predominant source of AAS substances.

Experience with MAD on children with epilepsy in Egypt after classic KD failure.

BACKGROUND AND AIM: Modified Atkins diet (MAD) is a less restrictive type of ketogenic diet (KD) as compared to the classic one. The aim of this study was to evaluate the impact of 9 months MAD treatment on the growth and seizure control in patients with intractable epilepsy as well as the quality of life (QoL) of their mothers. SUBJECTS AND METHODS: The study included 15 patients with intractable epilepsy who could not tolerate their classic KD management plan. From the 15 recruited cases, only seven patients completed this nine months prospective study. After neurological reassessment, the patients were prescribed MAD tailored from the local Egyptian ingredients. Arabic translation of the WHO Quality of life Instruments (WHOQOL-BREF) scale was calculated for the mothers initially and 9 months later. Daily seizure frequency with severity assessment by Chalfont scale was recorded as well as monthly weight and length throughout the study period. RESULTS: Mothers 'QoL in all WHOQOL-BREF domains significantly improved (P < .001) after nine months follow-up coupled by significant decrease in Chalfont scores from 51.00 ± 15.45 to 20.57 ± 21.45 and daily seizure frequency from 13.29 ± 6.99 to 2.71 ± 3.68. Regarding anthropometric data, there was significant increase in patients' weight and length as well as in the z-score for weight and length. CONCLUSION: After nine months of MAD, growth and seizure parameters significantly improved in the intractable epilepsy patients as well as their mothers& QoL. We thus recommend MAD as a more flexible alternative in intractable epilepsy patients who can not tolerate classic KD.

Velocity of lateral drying fronts in film formation by drying of colloidal dispersions. A 2D simulation.

Drying of colloids is always heterogeneous and proceeds by progression of drying fronts in various directions at various velocities. The fundamental mechanisms at the origin of appearance and motion of drying fronts are still not totally understood. This article addresses these questions in the case of lateral drying fronts by using the new simulation tool based on cellular automata we recently developed (Langmuir 2015 and 2017). For the first time, a 2D simulation is proposed. Silica dispersions were used as model colloids to test the simulation. Film profiles were measured during drying by optical profilometry as well as front velocities by image processing. In the cases of non-circular deposits (squares and rectangles), drying fronts in the plane of the film (x,y plane, x being the longest side in the case of a rectangle) do not move at the same speed along sides and diagonals, the velocity order being diagonal >x (longest side) >y (shortest side). The velocity contrast (difference between x and y sides) increases with the aspect ratio of the rectangle. This behavior is explained and accounted for by the 2D simulation presented in this article. Experimental results reasonably well validate the simulation.