Les facteurs associés à la rémission des crises dans l’épilepsie réfractaire

Introduction: Patients with intractable epilepsy show variable course of the disease. They may show remissions followed by relapses. Little is known about factors associated with remissions in patients with intractable epilepsy Participants and methods: This is a retrospective study of 200 patients diagnosed with intractable epilepsy who entered into a remission. We probed their clinical, electrophysiological and neuroimaging data. The cohort was followed for two outcomes, 1-complete seizure remission for ≥ 12 months and 2, age at which the patient entered into remission. The study outcomes were estimated using Kaplan-Meier analysis. Results: female gender, mental subnormality, early onset seizure, localization related epilepsies (especially temporal lobe epilepsy), presence of abnormal neurological examination and high seizure frequency were associated with older age and shorter duration of remission respectively. Conclusion: remissions during the course of intractable epilepsy can happen. Factors such as gender, onset of seizure and associated brain lesions could predict the occurrence of these remissions.Introduction: Les patients atteints d’épilepsie réfractaire montrent des évolutions variables de la maladie. Ils peuvent présenter des rémissions suivies de rechutes. On connaît peu les facteurs associés aux rémissions chez les patients atteints d’épilepsie réfractaire. Participants et méthodes: Il s’agit d’une étude rétrospective portant sur 200 patients ayant une épilepsie réfractaire avec rémission. Nous avons colligé leurs données cliniques, électrophysiologiques et de la neuro-imagerie. La cohorte a été suivie de deux résultats, remises de saisie 1 -complet pour ≥ 12 mois et 2 ans au cours de laquelle le patient est en rémission. Les résultats de l’étude ont été estimés en utilisant une analyse de Kaplan- Meier. Résultats: le sexe féminin, détérioration intellectuelle, épilepsies liées à la localisation (épilepsie du lobe temporal notamment), examen neurologique anormal et nombre important de crises épileptiques ont été associés à un âge avancé et à une durée plus courte de la rémission respectivement. Conclusion : La rémission au cours de l’épilepsie réfractaire peut se produire. Des facteurs tels que le sexe, l’apparition de la crise épileptique et des lésions cérébrales associées pourraient prédire la survenue de ces rémissions

The economic impact of COVID-19 pandemic on physicians/health care work force in Egypt

The COVID-19 pandemic has impacted healthcare workers physically, psychologically, and economically. The industry has struggled financially with the cancellation of elective procedures and hesitancy from patients to seek medical help. Thus, this study aimed to assess the economic and work burden of COVID-19 on the health workforce in Egypt. Methods a cross-sectional survey was conducted in Egypt from October 2020 to May 2021. A purposive sample of 763 healthcare workers (HCWs) from Egyptian governorates was included. HCWs were asked to fill out a self-administered questionnaire on Google Forms and printed copies. The questionnaire link was shared on social media forums. Results a total of 763 HCWs responded. Females were 88.2% and more than half were 33 or less years old. Physicians constituted 42.5%, while paramedics 57.5%. The governmental sector represented 61.2%, private sector 14.7% and those who combined both 24.1%. Regarding specialties affected, pediatricians, dermatologists, and nephrologists reported a considerable drop in their regular private work rate, while radiologists were not affected regarding workload or income by the closure. The HCWs acknowledge that COVID-19 has put extreme stress on the healthcare workforce physically, mentally, and financially in a pre-existing challenging environment. The results can help evidence-based decisions by policymakers in Egypt

Incidence and Outcome of the Radial Nerve Injury following Open Fracture of the Humerus

Background: Radial nerve injury is the most common peripheral nerve injury associated with humeral shaft fracture and can result in significant motor impairment of the arm and the wrist.Objectives: To evaluate the incidence, pattern and outcome of the radial nerve injury following open fracture of the humerus.Material and Methods: This is a multicentre cross-sectional descriptive study. It included all patients with radial nerve injuries following open fracture of the humerus presented to orthopaedic departments of the major hospitals in Khartoum State, Sudan during the period June 2009 - June 2013. Collected data were processed using SPSS computer package version 17.Result: A total of 48 patients were included, 34 males and 14 females (ratio 1.5: 1). Mean age ± standard error of mean of 30.71 ± 1.78 years (ranged 4 – 64 years). About 60.4% of injuries were due to gunshot and 24 (50.0%) patients were from conflict areas. Most of the injuries were in left side in about 68.8% of patients. The common patterns of the humeral fractures associated with radial nerve injury were open comminuted and transverse of middle or distal part. Neurapraxia was common type of radial nerve injury in about 89.6%. About 91.7% of the patients were treated conservatively and 81.3% of them recovered completely.Conclusions: Most of the radial nerve injuries following open fracture of the humerus were caused by gunshot injury in male soldiers mainly in the distal and middle parts. The fractures were mainly displaced comminuted and transverse types. The commonest type of radial nerve palsy was neurapraxia in 89.6% of cases. Most of the patients were treated conservatively and 81.3% of them recovered spontaneously after the first two months.Keywords: Neurapraxia, Repair, Recovery, Gun shot, Sudan

ISOLATION AND IDENTIFICATION OF ANTIBIOTIC PRODUCING PSEUDOMONAS FLUORESCENS NBRC-14160 FROM DELTA SOIL IN EGYPT

Pseudomonas fluorescens is one of plant Growth Promoting Rhizobacteria (PGPR) members which has a major role in the biological control of bacterial and fungal pathogens. A research was conducted at the Laboratory of Microbiology, Faculty of Agriculture, Ain Shams University, Qalubyia governorate intended for isolating Pseudomonas fluorescens isolate, efficient in antibiotic production. For isolation, soil samples, collected from Faculty of agriculture farm soil at depth of 10 cm, were screened for Ps. fluorescens isolates by cultivating the samples on King’s medium. Out of 30 isolates obtained, one was selected based on its high lipid content, because of the lipid’s correlation to antibiotic production and inhibitory activity. The selected isolate was characterized by morphological, physiological, biochemical tests then confirmed its identity by 16S rRNA gene sequence analysis and named Pseudomonas fluorescens NBRC-14160 16srRNA. Morphological features showed that Ps. fluorescens NBRC-14160 has large colonies, with irregular surface, opaque, producing green fluorescent pigments. Cells are short rods, Gram negative. Physiological features indicated that Ps. fluorescens NBRC-14160 is capable of producing several exoenzymes including lipase, phospholipase, protease and chitinase and incapable of producing amylase and cellulase. Carbohydrate fermentation tests were positive for fructose, glucose, D-glucose, and galactose, forming acids after 24 hrs. of incubation at 30˚C. However, it loses the ability to ferment inositol, mannose, xylose, mannitol, raffinose and rhamnose sugars. It’s lipid content was 607 mg/g. Inhibitory activity was studied by the method of disc diffusion test against nine pathogenic bacterial and fungal strains. Staphylococcus aureus was the most sensitive bacterial pathogen towards P. fluorescens NBRC-14160 with a 4.5 cm zone of inhibition, while Serratia marscens had 0.95 cm zone. Aspergillus niger and Alternaria solani were the most sensitive fungal pathogens towards P. fluorescens NBRC-14160 with 2.55 and 2.5 cm of inhibition zone, respectively. However, the most resistant fungus was Fusarium oxysporum with 1.3 cm inhibition zone

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

Nerve Conduction Studies in Patients with Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation

Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conduction study parameters (latency, amplitude, and conduction velocity) between the patients group and the control group. There was significant prolongation in H-reflex latency of both symptomatic and asymptomatic side in the patients group compared to the control group (P<0.05). Also, F-wave latencies (F minimum, F maximum, and F mean) of the tibial nerve were significantly prolonged (P<0.05) compared to control. Conclusion. Prolonged H-reflex latency was the commonest encountered abnormality in our study followed by F-wave latencies of the tibial nerve

Correlation between Findings in Physical Examination, Magnetic Resonance Imaging, and Nerve Conduction Studies in Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation

Purpose. The aim of this study was to find out the correlation between magnetic resonance imaging (MRI) and nerve conduction studies’ (NCS) findings in patients with lumbosacral radiculopathy caused by lumbar intervertebral disc herniation. In addition, the study aimed at finding the correlation between the clinical manifestations of lumbosacral radiculopathy and both MRI and NCS. Patients and Methods. The study was a cross-sectional analytic study which included thirty patients with a history suggestive of lumbosacral radiculopathy. Inclusion criteria were as follows: patients who had an MRI confirmed L4/5 and/or L5/S1 intervertebral disc prolapse in addition to one or more of the following (dermatomal distribution of symptoms appropriate with MRI level, presence of motor weakness, sensory impairment, absent ankle jerk, or positive straight leg raising test). All patients underwent clinical assessment and NCS, and their MRI examination was reviewed. The Chi-Squared/Fisher’s exact test was used to test the correlation. Results. There was a statistically significant correlation between abnormal physical findings and nerve root compression in MRI. Statistically significant correlation was neither found between abnormal physical examination findings and abnormal NCS nor between nerve root compression in MRI and abnormal NCS findings. Conclusion. Abnormal neurological examination findings can be used to predict nerve root compression in MRI examination. On the contrary, positive findings of physical examination do not predict abnormal NCS, as well as negative findings do not exclude abnormal NCS; therefore, it is useful to add NCS when MRI findings do not match clinical examination findings or when no neuroimaging abnormalities can be identified

The Expression of Circulating miR-497 and Metadherin in Hepatocellular Carcinoma: Relation to the Tumor Characteristics and Patients’ Survival

Objectives: This study aimed to evaluate the prognostic significance and relationship of miR-497 and metadherin to hepatocellular carcinoma (HCC) tumor characteristics and patients’ survival. Methods: This study enrolled 120 (60 HCC patients and 60 healthy) subjects. Serum miR-497 and metadherin mRNA relative expression were analyzed by real-time quantitative reverse transcription polymerase chain reaction. The overall survival (OS) of HCC patients was assessed using the Kaplan–Meier curve and log-rank test. Results: Serum miR-497 showed statistically significant downregulation in HCC patients compared to controls (p &lt; 0.001). Serum metadherin mRNA relative expression was significantly upregulated in HCC patients compared to controls (p &lt; 0.001). Both serum miR-497 and metadherin mRNA expression were significantly associated with the number of tumor foci (p = 0.028 and 0.001, respectively), tumor size (p = 0.022 and &lt;0.001, respectively), nodal metastasis (p = 0.003 and 0.003, respectively), distant metastasis (p = 0.003 and 0.003, respectively), vascular invasion (p = 0.040 and &lt;0.001, respectively), and BCLC staging (p = 0.043 and 0.004, respectively). The overall survival was lower in patients with low miR-497 expression (p = 0.046) and in patients with high metadherin expression (p &lt; 0.001). Conclusions: The expression levels of miR-497 showed downregulation in HCC patients, but metadherin expression showed upregulation. Both markers were inversely related and closely correlated with tumor characteristics and patients’ survival