The Predictive Value of Vanin-1 in Pediatric Immune Thrombocytopenia

Background: Immune thrombocytopenia (ITP) has oxidative stress-related pathway as one of its possible mechanisms. Vanin-1 (VNN1) is an oxidative stress sensitive sensor. Objective: The present study was conducted to assess the clinical significance of VNN1 in pediatric ITP patients. Patients and Methods: A total of 50 kids with ITP have been involved in this work; 25 newly diagnosed, 25 chronic patients with ITP more than 12 months (15 responders and 10 non responders to treatment) and 25 apparently healthy children. All groups had their serum VNN-1 levels checked using a two-antibody sandwich enzyme-linked immunosorbent test. Results: The serum VNN1 level was significantly higher in ITP group than control group (p˂0.001). The level of serum VNN1 was significantly very high in newly diagnosed ITP group (p˂0.001) in comparison to chronic responders and chronic non responders ITP groups. Moreover, there was a significant increase in serum VNN1 level in chronic non responders ITP group (p˂0.001) compared to chronic responders group. In newly diagnosed ITP group, both age (r=-0.62, p=0.006) and the platelet count (r=-0.46, p=0.01) had a significant negative connection with serum VNN1 level. A cut-off value lower than 0.6 ng/ml for serum VNN1 could be used to distinguish the chronic non-responders ITP from chronic responders patients with 100 percent specificity and 90 percent sensitivity. Conclusion: From our current results, it is hypothesized that high VNN1 level plays a role in the pathogenesis and progress of pediatric ITP

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

Serum uric acid and its association with hypertension, early nephropathy and chronic kidney disease in type 2 diabetic patients

Abstract Introduction: Early detection diabetic nephropathy (DN) is important. Whether serum uric acid (SUA) has a role in the development of DN is not known. Objective: To study the relationship between SUA and hypertension, early nephropathy and progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM). Methods: The total number of the study was 986 participants, according to presence and duration of diabetes were classified into three groups. Group I; including 250 healthy participants. Group II; including 352 with onset of diabetes 5 years. All participants were submitted to complete clinical examination, anthropometric measurements, laboratory investigations, including glycosylated hemoglobin (HbA1C), as well triglycerides to high-density lipoprotein ratios (TG/HDL-C), SUA, urinary albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Results: SUA, BP, HbA1c, TG/HDL-C ratio, and ACR levels were significantly higher in group III than group I, II and in II than I. eGFR significantly lower in group III than group I, II and in II than I (p 6.1 mg/dl, > 6.2 mg/dl and > 6.5 mg/dl had a greater sensitivity and specificity for identifying hypertension, early nephropathy and decline eGFR respectively. Conclusion: Even high normal SUA level, was associated with the risk of hypertension, early nephropathy and decline of eGFR. Moreover SUA level may identify the onset of hypertension, early nephropathy and progression of CKD in T2DM

Percutaneous transcatheter vascular embolization for life threatening hemoptysis

The aim of this study was to retrospectively evaluate 47 patients (37 males and 10 females, aged 37–72 years) with life threatening hemoptysis treated by bronchial artery embolization. Between April 2007 and April 2012 at the Assuit University Hospital, the cause of hemoptysis was tuberculosis and post TB bronchiectasis in 29 patients, bronchiectasis in 11, 3 arteriovenous malformation, 3 post infective fibrosis and one patient with chronic renal failure. Recurrence of hemoptysis after embolization occurred in 2 patients within the 6 month follow-up period, these cases underwent re-embolization with successful control of hemoptysis. There were no procedure-related major complications. Bronchial artery embolization is a safe and effective palliative treatment for patients with massive hemoptysis

Association between adenosine receptor gene polymorphism and response to caffeine citrate treatment in apnea of prematurity; An Egyptian single-center study

Background: Caffeine citrate is the methyl-xanthine of choice used in controlling apnea of prematurity (AOP). Caffeine central effect is mediated via non-selective (A1) and selective (A2a) adenosine receptors antagonism. Variability in caffeine response had been frequently noticed in AOP, suggesting underlying genetic predisposition. Aim of the study: We evaluated the role of adenosine receptor A1 [ADORA1] and adenosine receptor A2a [ADORA2a] gene polymorphisms in the variability of caffeine response among Egyptian preemies with AOP. Patient and methods: In this case-control study, 43 preterm neonates with AOP were eligible as cases and 43 preterm babies free from apnea were taken as controls. Preterm neonates with AOP were further divided according to response to caffeine treatment into caffeine responder (n = 18) and caffeine non-responders (n = 25). ADORA1 [716 T > G] and ADORA2a [1976C > T] gene polymorphisms were genotyped by mean of PCR-based RFLP-assay. Results: There were significant increase in frequency distribution of ADORA2a [1976C > T] CT (62.7% vs 23.3%), TT (14% vs 4.7%) genotypes and T allele (34.3% vs 16.3%) in cases compared to controls with significant increased risk of AOP development with OR (95%CI); P-value of 8.37(3.03–23.1), P = 0.000; 9.3(1.61–53.61), P = 0.005 and 4.27(2.09–8.70), P = 0.000 respectively. Further, caffeine non-responders were associated with significant increase frequency of ADORA2a CT (80% vs 38.9%) and TT (16% vs 11.1%) genotypes and T allele (56% vs 30.6%) with OR (95%CI) and P-value of 21.38 (2.31–197.8), P = 0.001; 18 (1.24–260.9); P = 0.005 and 2.89(1.17–7.13), P = 0.019 respectively, when compared to caffeine responders. Patients with AOP who had ADORA2a CT and TT genotypes were associated with significant increase in duration of hospital stay and poor outcome. Genotype distribution frequency of studied polymorphisms did not deviate from Hardy Weinberg (HW) equilibrium among controls. Conclusion: ADORA2a [1976C > T] polymorphism has a significant role in AOP development and variation in caffeine response among preterm babies. Keywords: ADORA2a polymorphism, Adenosine receptor, Apnea of prematurity, Caffeine citrate, Caffeine respons

Vascular access complications and risk factors in

Background: Morbidity related to vascular access is the leading cause of hospitalization for chronic hemodialysis patients and is associated with high cost. Since data on vascular access complications are scarce, this study was designed to focus on vascular access complications in hemodialysis patients. Methods: 119 patients with End Stage Renal Disease (ESRD) on regular hemodialysis were recruited for the study, They were subjected to the following Laboratory blood tests: Kidney function tests, CBC, KT/V, serum albumin, fasting blood sugar, swab culture and sensitivity from the skin over the vascular access and blood culture and sensitivity from both central and peripheral samples, In addition, radiological Doppler ultrasound was done for all patients to evaluate the vascular access. Results: 27 out of 119 patients (22%) have positive blood culture, 64 (53.7%) patients have positive swab culture, 68 (57%) patients have stenosis, 25 patients (21%) have athermanous plaques and 44 (36.9%) patients have aneurysmal dilatation. There was a significant low Kt/V in patients with stenosis and aneurysmal dilatation (p < 0.001). Low Kt/V, low serum albumin level and low BMI were significant in patients with central blood infection (p < 0.008, <0.008 and <0.001 respectively). There was significant increase in the risk of infection in male patients, patients with low BMI, increased BUN and increased duration of HD session (p < 0.046, <0.008, <0.002 and <0.009 respectively). Stenosis was the most common risk factor for vascular failure as it occurred in (29%) of patients. Diabetes was the second common risk factor for vascular failure as it occurred in (17%) of patients. Conclusion: Stenosis and infection are the most common complications of the vascular access. DM is an important risk factor for the incidence of infection. Other risk factors for dialysis CRBSI include older age, low serum albumin, high BUN and decreasing the duration of dialysis

NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin’s lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially