Mccleery’s Syndrome the Overlooked Cause of Swollen Upper Limb, Completion Venoplasty is The Key Word for Successful Surgical Decompression

Background: Venous thoracic outlet syndrome (VTOS) is the second most presenting pattern of thoracic outlet syndrome (TOS). Non thrombotic VTOS swollen upper limb is usually overlooked by many surgeons. When there is chronic intermittent arm swelling that is associated with discoloration that worsen with overhead arm movement, McCleery’s syndrome is more likely. Objective: We present the results of our treatment strategy of McCleery’s syndrome consisting of para-clavicular approach for thoracic outlet decompression (PCA-TOD), external venolysis, and combined surgical decompression withor without routine completion venoplasty. Patients and methods: A retrospective analysis of the data of twenty-three patients who presented from January 2016 to February 2021 with chronic intermittent arm swelling, we divided the patients into two groups, group (A): 13 patients who underwent surgical decompression alone and follow up. Group (B): 10 patients who underwent surgical decompression associated with Intraoperative venography and balloon angioplasty. Results: In group (A) complete symptomatic resolution was achieved in 6/13 (46.2%) patients, secondary endovenous intervention was required in 7 (53.8%) patients due to residual symptoms, postoperative average residual arm circumference difference was 0.92 ± 0.86 cm with a statistically significant difference in favor to group (B) (P value = 0.0274). In group (B) complete symptomatic cure achieved in 10/10 (100%) patients with statistically highly significant difference favoring to group (B) (P value = 0.0075). Conclusion: From our results, completion angioplasty of surgically decompressed axillo-subclavian venous segment added a significant cure and symptoms improvement for patients with McCleery’s syndrome and could be considered as a primary therapy in conjunction with surgical decompression

Screening of Dyslipidemia and Obesity among Children in Zagazig University Hospitals

Background: Westerners are well aware of plasma lipid problems, which are becoming increasingly important in the Middle East. The European Expert Panel has advocated universal screening as a preferable approach of hypercholesterolemia screening as a part of the primary preventive effort. Objective: To assess the relation between dyslipidemia and its risk factors; age and body mass index. Patients and Methods: A cross-sectional study that included 357 of children who visited the Pediatrics General Outpatient Clinic at Zagazig University Hospitals. All subjects were subjected to full history taking, general examination, anthropometric measurements, blood pressure, and laboratory investigations including: non-fasting and fasting lipid profiles. Results: Non-fasting total cholesterol (TC) of ≥ 200 was (14.3%) and < 200 was (85.7%). Non-fasting (LDL) of ≥ 130 was (16.8%) and <130 was (83.2%). HDL category of < 40 was (61.3%) and ≥ 40 was (38.7%). There was no statistically significant difference between age, sex and lipid profiles. There was statistically significant positive correlation between non-fasting triglycerides (TG) and non-fasting HDL and non-fasting non-HDL-C. Conclusion: Obesity was associated with the prevalence of at least one abnormal lipid level. This highlights the importance of paying greater attention to the prevention of cardiovascular disease and obesity in children from an early age

Malaria As An Important Cause Of Maternal Mortality In Sudan

This study was performed to highlight the role of malaria in pregnancy as  an important cause  of maternal mortality. It reviewed the previous studies, conference presentations and postgraduate thesis . Malaria found to be the cause of death of 10.26% to 46.7% of MM. The 1998 to 2003 records of maternal deaths of Wad Medani Obstetrics and gynaecology  teaching hospital (WMOGTH) was retrospectively studies (malaria caused death of 8.82% to 39.7% The mean age was 27.57years , most of them were primigravidae and from rural areas.  37.8% of the deaths occured at 28-36 weak of gestation . The mean duration of stay in hospital was (3.22) days. 32.4% of deaths stayed for less than 24 hours This indicated  severe and serious clinical presentations. The main causes of death due to malaria or its complication  were anemae heart failure  (24.3%), cerebral malaria (21.6%) and  circulatory failure (8.1%). Others were pulmonary edema , hyperpyrexia  , puerperal psychosis , abortion , severe epistaxes , cardiac  arrest , black water fever, electrolyte imbalance, and hepatic failure. The study recommended effective prevention of malaria and an intensive care approach in its management

Malaria and Maternal Mortality In Gezira-Sudan

The objectives of this study include:(1) to identify the magnitude of malaria as a cause of maternal mortality (MM) (2) to study the demographic characteristics of MM cases caused by malaria and (3) to identify the actual cause of MM due to malaria. Methods: This is a six years hospital based retrospective review of hospital records of ladies died due to malaria in Wad Medani Teaching Hospital for Obstetrics and Gynaecology (WMTHOG), form1 January 1998 to 31 December 2003. Results: malaria caused 10% to 40% of MM per year. The mean age was 27.57 years, most of them were primigravidae and from rural areas. 37.8% of the deaths occurred between 28 and 36 weak of gestation. The median duration of stay in hospital was two days. However 32.4% of deaths stayed for less than 24 hours that indicated severe and serious clinical presentations. The main causes of death due to malaria or its complication were: anaemia (24.3), cerebral malaria (21.6%), circulatory failure (12.51 ) and renal failure (8.1%). Others were pulmonary oedema , hyperpyrexia  , puerperal psychosis , abortion , severe epistaxis , cardiac  arrest , black water fever, electrolyte imbalance, and hepatic failure. The study recommended effective prevention of malaria and an intensive care approach in its management

Implementing a Three-Tier Data Warehouse

This paper aims at developing a 3-tier inter-universities data warehouse prototype for the Egyptian universities. The implementation scope is restricted to the student enrollment process. The bottom-up approach and the multi-tier (3-tier) client/server architecture were used to implement the proposed prototype. The implementation required a number of steps to be undertaken. First, a star schema data warehouse was built based on an operational database of a public university. Second, another star schema data warehouse was built based on an operational database of a private university. Third, data from the two warehouses were abstracted to formulate the inter-universities data warehouse (tier 3). Hence, a data cube based on the resulting interuniversities data warehouse was developed using an OLAP server (tier 2). The data cube is then accessed by a client tool (tier 1) for the purpose of query and analysis. Although two universities were used to implement the interuniversities data warehouse, this scenario could be applied with any number of universities in a quite similar way. This inter-universities prototype is scalable and flexible to retain more than two universities regardless of the size of the operational databases. The interuniversities prototype fosters the coordination between participating universities and supports the decision making process. The proposed system could be used to generate a variety of strategic reports

Left atrial and left atrial appendage functional recovery after cardioversion in patients with recent atrial fibrillation: Serial echocardiographic study

Background: The aim of this study is to point out timing of left atrium and its appendage functional recovery after cardioversion (CV) in recent onset atrial fibrillation (AF). Methods: Fifty patients; 27 within 48-h (group I) and 23 after 48-h (group II), of AF onset, who had successful CV underwent transthoracic echocardiography (TTE), before and im­mediately after CV, then 15, 30 and 90 days later. Transesophageal echocardiography (TEE) was performed for group II before and for all patients immediately after CV and 1 month later. Mitral peak A velocity and left atrial (LA) reversal (Ar) velocity, tissue Doppler imaging (TDI) of septal mitral annular velocity (A1) and LA free wall velocity (A3) were recorded. Absence or peak A velocity < 50 cm/s was taken as a cut off value for atrial stunning. Intra-atrial conduction time (IACT) was measured. LA appendage late emptying (LAALE) velocity was measured by TEE-pulsed TDI of LA appendage. Results: Post CV, all group II and 34% of group I experienced stunning. In both groups, peak A, Ar, A1, A3 and LAALE velocities increased (p = 0.000), while IACT decreased (p = 0.000) progressively over time. Partial recovery occurred after 15 and 30 days, while full recovery occurred 30 and 90 days post CV in groups I and II, respectively. IACT1 and IACT2 correlated with LA diameter (r = 0.2778 and r = 0.227, respectively, p < 0.01). Conclusions: Stunning and functional recovery of the LA and its appendage are strongly determined by the duration being in AF. Serial IACT by TDI was a good new parameter for detection of functional recovery of LA and LA appendage

The Effect Of Temperature On Age Estimation Of Semen Stains On Porous Versus Non-Porous Surfaces Using Messenger Ribonucleic Acid Measurement

Background: While mRNA can be used to identify the type of a body fluid, its degradation can also give some indication of the time interval since it was deposited. This study was conducted to evaluate the effect of temperature on the age estimation of human semen stains using mRNA deposited on porous versus non-porous surfaces at different time intervals. Methods: Ten semen samples were applied on two different media (glass and cotton) and exposed to three different temperatures (4°C, room temperature, 40°C) and examined at three time intervals (0, 45, and 90 days). The semen-specific mRNA markers PRM1 and PRM2 were quantitatively assessed along with a reference gene, beta-actin, using reverse transcription-quantitative polymerase chain reaction. Results: Mean Cq values of mRNA markers (PRM1 and PRM2) and the reference gene (beta-actin) increased with time of storage at different temperatures on both examined media. The mean quantification cycle (Cq) values of PRM2 were lower than PRM1, indicating that the levels of PRM2 marker in semen stain were higher than those of PRM1 marker. However, the mean Cq values of PRM2 at each time interval were not significantly different between temperatures, while PRM1 showed statistically significant differences in mean Cq values between temperatures at day 45 on both media. Conclusion: These results indicate that PRM2 can serve as a reliable mRNA marker to estimate the time since deposition of semen stain at different temperatures on two different media

Garlic bioactive substances and their therapeutic applications for improving human health: a comprehensive review

Garlic (Allium sativum L.) is a widely abundant spice, known for its aroma and pungent flavor. It contains several bioactive compounds and offers a wide range of health benefits to humans, including those pertaining to nutrition, physiology, and medicine. Therefore, garlic is considered as one of the most effective disease-preventive diets. Many in vitro and in vivo studies have reported the sulfur-containing compounds, allicin and ajoene, for their effective anticancer, anti-diabetic, anti-inflammatory, antioxidant, antimicrobial, immune-boosting, and cardioprotective properties. As a rich natural source of bioactive compounds, including polysaccharides, saponins, tannins, linalool, geraniol, phellandrene, β-phellandrene, ajoene, alliin, S-allyl-mercapto cysteine, and β-phellandrene, garlic has many therapeutic applications and may play a role in drug development against various human diseases. In the current review, garlic and its major bioactive components along with their biological function and mechanisms of action for their role in disease prevention and therapy are discussed

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020