Platelet activating factor and monocyte chemoattractant protein-1 in children with refractory epilepsy

Background: Epilepsy is an important common and diverse group of symptom complexes characterized by recurrent spontaneous seizures. It is estimated that about 5-10% of all cases of epilepsy eventually become refractory. It has been suggested that inflammation plays a role in epilepsy. In refractory epilepsy, an inflammatory response is produced that leads to rapid release of pro-inflammatory cytokines as platelet activating factor (PAF) and monocyte chemoattractant protein-1 (MCP-1). Objective: The aim of the present study was to evaluate the plasma levels of the monocyte chemoattractant protein-1 (MCP-1) and platelet activating factor (PAF) in children with refractory epilepsy to explore their role in the pathogenesis of refractory epilepsy. Methods: The present study was carried out in Tanta University Hospital, Pediatric Department, Neurology unit. Forty (40) children with idiopathic refractory epilepsy (25 males and 15 females) their age ranging between 4-15 years were included in the study. The control group consisted of thirty healthy children, 20 males and 10 females aged 5 years to 13 years. The serum levels of MCP-1 and PAF were measured for children with refractory epilepsy and the control children. Results: Children with refractory epilepsy had significantly higher serum levels of PAF (P < value 0.001) and significantly higher serum level of MCP-1 (P < value 0.001) in comparison to the control children. Also there was a significant correlation between the duration of refractory epilepsy and the serum levels of PAF and MCP-1. Conclusion: Higher serum levels of the proinflammatory cytokines PAF and MCP-1 in children with refractory epilepsy suggest that both, PAF and MCP-1, may play a role in the pathogenesis of refractory epilepsy. Keywords: Platelet activating factor, Monocyte chemoattractant protein-1, Neuroinflammation, Refractory epilepsyEgypt J Pediatr Allergy Immunol 2012;10(1):13-1

Fiberoptic bronchoscopic cryo-ablation of central bronchial lung cancer

AbstractBackgroundRadiotherapy and chemotherapy are the standard palliative treatments in patients with inoperable carcinoma of the lung present with obstruction of the central airway but have limited effectiveness in reopening obstructed airways. Cryosurgery is one of the several techniques that can be used to reopen an obstructed tracheobronchial lumen.ObjectiveThe aim of this study was to evaluate safety and clinical efficacy of flexible cryoprobe as an important option to treat the patients with inoperable obstructive central bronchial lung tumors.Patients and methodsThis study was conducted on 38 patients with central endobronchial malignant tumor. A flexible cryoprobe was used during flexible bronchoscopy. The endobronchial tumors and symptoms were assessed 2 and 6weeks after cryotherapy.ResultsAfter 6weeks, the endobronchial lesions were completely removed in 32/38 patients (∼85%), partly removed in 4/38 patients (∼10%), and could not be removed in 2/38 patients (∼5%), with a symptomatic improvement in dyspnea, cough and hemoptysis 78%, 63.0%, 85% after 2weeks and up to 89%, 84.0%, 100% after 6weeks respectively.ConclusionCryotherapy using fiberoptic bronchoscopy is a safe with a high efficacy technique in treating endobronchial malignant obstructive lesions

Serum level of interleukin-10 with its gene polymorphism can be predictors of response to treatment in Egyptian patients with chronic hepatitis C virus

Purpose: The aim of this study was to demonstrate the role of interleukin-10 (IL-10) gene polymorphism and its serum level in predicting response to treatment in patients with chronic hepatitis C virus.Patients and methods: This study was carried out on 35 Egyptian patients with chronic HCV (Hepatitis C Virus) and 15 age- and sex-matched healthy subjects as control. They were divided as follows: Group I: 35 chronic HCV patients. They were subdivided according to their response to combination therapy of pegylated interferon alpha 2b and ribavirin into: Group I (a): 21 responder patients. Group I (b): 14 non responder patients. Group II: 15 healthy subjects as a control group. IL-10 serum level was assessed by ELISA (Enzyme Linked Immunosorbent Assay) before, during and after treatment. IL-10 gene polymorphism and genotype were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Results: A significant higher level of serum IL-10 was detected in HCV patients compared to the control group. A significant reduction was detected during treatment and a persistent decrease was found in patients with SVR. Low serum level of IL-10 pretreatment was associated with high treatment response. High pretreatment of the serum level of IL-10 was associated with the severity of chronic necroinflammation and non  response to treatment. A positive correlation was found between IL-10 and serum ALT. The frequency of IL-10 592 genotype polymorphism was higher in HCV patients compared to control. A significant higher frequency of the IL-10 592 C/C polymorphism was found in the responder group compared to non responder. No correlation was observed between IL-10 polymorphism and liver histopathology.Conclusion: Serum IL-10 level pretreatment is useful for predicting treatment response in HCV patients. IL-10 may be a useful marker to assess necroinflammation and to monitor the evolution of liver damage. IL-10 gene polymorphism has no relation to liver histopathology. IL-10 592 C/C genotype was more frequent in responder patients

Clinical Outcome of Breast Cancer Occurring after Treatment for Hodgkin's Lymphoma: Case-Control Analysis

Background: To evaluate diagnosis, management and outcome of breast cancer (BC) occurring after irradiation for Hodgkin's lymphoma (HL). Methods: 39 cases of BC in 28 HL survivors were retrospectively reviewed. 21 patients were included in a case-control analysis. Results: The median age at diagnosis of HL and BC was 25.3 and 45.3 years, respectively. The median interval to develop BC was 16.1 years. Eleven women (39.2%) had bilateral disease. Mode of detection of the index breast cancers was by mammographic screening in 17 patients (60.7%), palpable lump in 8 patients (28.6%), clinical examination in two patients (7.1%), and unknown in one patient (3.6%). Case-control analysis showed that histological features and prognosis of BC after HL were similar to those of primary BC, however, for BC after HL, mastectomy was the predominant surgery (P = .001) and adjuvant radiotherapy and anthracycline-based chemotherapy were less frequently used as compared to primary BC (P < .001 and .003, respectively). Conclusion: The previous history of HL does not appear to be a poor prognostic factor for BC occurring thereafter

Clinical outcome of breast cancer occurring after treatment for Hodgkin's lymphoma: case-control analysis

<p>Abstract</p> <p>Background</p> <p>To evaluate diagnosis, management and outcome of breast cancer (BC) occurring after irradiation for Hodgkin's lymphoma (HL).</p> <p>Methods</p> <p>39 cases of BC in 28 HL survivors were retrospectively reviewed. 21 patients were included in a case-control analysis.</p> <p>Results</p> <p>The median age at diagnosis of HL and BC was 25.3 and 45.3 years, respectively. The median interval to develop BC was 16.1 years. Eleven women (39.2%) had bilateral disease. Mode of detection of the index breast cancers was by mammographic screening in 17 patients (60.7%), palpable lump in 8 patients (28.6%), clinical examination in two patients (7.1%), and unknown in one patient (3.6%). Case-control analysis showed that histological features and prognosis of BC after HL were similar to those of primary BC, however, for BC after HL, mastectomy was the predominant surgery (<it>P </it>= .001) and adjuvant radiotherapy and anthracycline-based chemotherapy were less frequently used as compared to primary BC (<it>P </it>< .001 and .003, respectively).</p> <p>Conclusion</p> <p>The previous history of HL does not appear to be a poor prognostic factor for BC occurring thereafter.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Computer assisted total knee arthroplasty using patient specific templates

Current techniques used for total knee arthroplasty (TKA) rely on conventional instrumentation (CI) systems that violate the intramedullary canals. The accuracy of these systems is questionable, and set up and assembly of their numerous pieces is time consuming. Navigation techniques are more accurate, but their broad application is limited by cost and complexity. The aim of this study was to prove a new concept of computer assisted preoperative planning to provide patient-specific templates (PST) that can replace conventional instruments. Computed tomography based planning was used to design two virtual templates. Using rapid prototyping technology, virtual templates were transferred into physical templates (cutting blocks) with surfaces that matched the distal femur and proximal tibia. Forty five TKA procedures were performed on 16 cadaveric and 29 plastic knees using the PST technique. Six out of 29 TKA procedures were included in a comparative trial against 6 procedures performed using CI systems. Computer assisted analysis of 6 random postoperative CT scans was performed to evaluate the accuracy of this technique. A reliability test was performed, in which five observers positioned the templates on a plastic knee model and a navigation system was used to measure alignment and the level of bone cutting for the planned tibial and femoral cuts. Each observer repeated the test 5 times. Errors in placement of the templates as well as intraobserver and interobserver variations were measured. The study showed that it was possible to perform all 45 TKA procedures without CI systems. There was no need for intramedullary perforation, tracking or registration. The mean time for bone cutting was 9 minutes (15 minutes for CI systems), when the surgeon had an assistant and 11 minutes (30 minutes for CI systems), when the surgeon was unassisted. Postoperative CT scans showed mean errors of 1.70 and 0.8 mm (maximum 2.30 and 1.2 mm) for alignment and bone resection respectively. The reliability test had a mean alignment error of 0.670(maximum 2.50). The mean error for bone resection was 0.32 mm (maximum 1 mm). The positioning of the templates was reliable, as there was no significant intraobserver and interobserver variation. This study proved the concept of patient-specific templating for TKA. It also showed a satisfactory level of accuracy and reliability of this technique. In conclusion, the PST technique has several advantages over conventional instrumentation and it is a simple alternative to navigation and robotic techniques for TKA. Further clinical validation is required before recommending this technique for new users

Study of combustion behaviors for dimethyl ether as an alternative fuel using CFD with detailed chemical kinetics

In the present analysis, the dissemination of dimethyl ether (DME) as an alternative fuel with the charged air inside the HCCI engine chamber until accomplishing the burning procedure have been numerically expected by utilizing CFD with detailed chemical kinetics mechanism. The physical technique of the ignition and pollution arrangement in the engine barrel with DME fuel is examined with a developed hydrocarbon reaction mechanism at various HCCI engine loads. The mechanism is including 81 chemical species and 362 basic chemical reactions. Along these lines, the used CFD/discipline code predicts the admittance of the fuel spray, ignition, and pollutant development of DME as a biodiesel fuel. The split injection technique has been used to inject the dimethyl ether remotely at the engine admission tube. The in-cylinder flow field enhances farther the engine chamber fuel/air distribution. The outcomes showed that the blend of DME fuel with charged air is exact and efficient to accomplish the in-barrel blend homogeneity. It is anticipated that, under every engine working condition the production of the methyl radical is considered as imperative part in dimethyl ether pyrolysis and oxidation. In the meantime, the formaldehyde sub-component is a huge division of the general dimethyl ether (DME) ignition system. Keywords: HCCI engine, Alternative fuels, CFD/chemistry, KIVA-3Vr2 code, Zero-dimensional chemistry code, Dimethyl ether, Biodiese