Relation between nasal eosinophilia and airway resistance in patients with persistent rhinitis

Background Bronchial hyper-responsiveness (BHR) is a feature of asthma which can also be found in patients with allergic or nonallergic rhinitis although the exact mechanism is not clear. Objective The aim was to investigate the relationship between nasal eosinophilia and BHR in patients with allergic rhinitis. Patients and methods A total of 26 patients with rhinitis were divided into two groups based on positive exercise challenge test for BHR. Nasal smears and blood samples were obtained to test for nasal eosinophilia and total serum immunoglobulin E, respectively. Results A higher percentage (50%) of patients with BHR demonstrated nasal eosinophilia compared with the group of patients with no BHR (17%). Conclusion This study demonstrates further evidence of the tight relationship between upper and lower respiratory tract in allergic disease

Potential impact of tomosynthesis on the detection and diagnosis of breast lesi

Objective: The aim of this study was to evaluate the clinical performance of 3D tomosynthesis in comparison with Full Field Digital Mammography (FFDM) in the detection and diagnosis of breast lesions. Material and methods: 132 patients underwent standard digital mammography and tomosynthesis and the likelihood of malignancy was categorized according to (ACR) BI-RADS. Results: Tomosynthesis images had significantly increased the number of cases with BI-RAD 1 or 2 (normal/benign) to 62 (42.7%) compared to 39 (26.8%) at mammogram (p < 0.005). Tomosynthesis helped also in more clarification of benign characters. Tomosynthesis images had significantly decreased the number of indeterminate/suspicious lesions (BI-RADS 3 and 4) from 90 (62%) cases to 39 (26.8%) (p < 0.005). In a total of 40 lesions (27.5%) assigned to BI-RADS 5 at tomosynthesis, the tomosynthesis showed better performance in assessment of tumor extension and higher level in detection of clusters of micro-calcifications. The accuracy, specificity, sensitivity and positive and negative predictive values (%) of mammography alone versus when combined with the tomosynthesis were as follows: 59.3, 62.8, 55.2, 56 and 62 versus 91.7, 92.3, 91, 91, and 92.3 respectively (Table 4). Tomosynthesis significantly improved the detection of the breast lesions on mammography images especially in the dense breast with significantly higher accurate BI-RADS scoring (P value <0.005). Conclusion: Breast tomosynthesis is a promising technology that offers improved diagnostic and screening accuracy, fewer recalls as well as 3D lesion localization. Lesion conspicuity is improved using DBT compared with FFDM with a more confidence in making clinical decisions

The clinical value of ultrasound elastography in predicting malignant thyroid nodules

Objective: This study aims to evaluate the clinical value of ultrasound elastography (USE) in providing information on the nature of the thyroid nodules. This was performed using the elastography score and strain ratio in differentiating thyroid benign and malignant nodules and the histopathological examination was used as the diagnostic standard of reference. Methods: We examined 84 thyroid nodules in 62 patients with ultrasound elastography. Elastography score was assigned based on a four-point scale according to the classification proposed by Itoh et al. with a score of 1 (low stiffness over the entire nodule) to a score of 4 (high stiffness over the entire nodule). Thyroid strain ratio (normal tissue to lesion strain ratio) was calculated. Histopathological results were the standard reference. The area under the curve (AUC) and the best cut-off point were both obtained using receiver-operating characteristic (ROC) curve analysis. The sensitivity, specificity, and accuracy of both techniques were calculated. Results: Fifty-four of the 84 nodules had scores of 1 and 2, and 50 of these nodules were diagnosed histopathologically as benign. Thirty of the 84 nodules had a score of 3 and 4, and 21 of these nodules were diagnosed histopathologically as malignant. The scores of 1 and 2 with Itoh criteria were significantly seen in benign nodules, whereas, scores of 3 and 4 were significantly seen in malignant nodules (p < 0.05) with sensitivity 84%, specificity 84.7%, PPV 70%, NPV 92.6% and accuracy 84.5%. The mean SR for the benign nodules and malignant ones was significantly different (2.92 ± 0.96 vs. 4.53 ± 0.82, p < 0.001). With ROC analysis, the best cut-off strain ratio point was 3.5 for differentiating benign and malignant nodules with area under the curve (AUC) = 0.87 (0.8–0.95). The sensitivity of the strain ratio was 88%, while the specificity was 86.4%, PPV = 73.3%, NPV = 94.4% and accuracy = 86.9%. Conclusions: Both the elastographic score and strain ratio are higher in malignant nodules than those in benign ones. Ultrasound elastography can provide quantitative information on thyroid nodule helping in differentiating benign and malignant ones

الأشجار والشجيرات المتزاجدة في الحرم الرئيس للجامعة الإسلامية بغزة، قطاع غزة، فلسطين

The Gaza Strip, which has a population of about 2.0 million and an area of about 365 km2, has many higher education institutions. The green quadrates, corridors and gardens of these institutions are commonly cultivated with many horticultural plants including trees and shrubs that provide many environmental, health, and aesthetic values. The Palestinian universities of the Gaza Strip have never been studied for the composition and numbers of their trees and shrubs. Therefore, the current study aims at identifying and recording the trees and shrubs prevailing and enhancing the ecology and environmental health aspects of the main campus of the Islamic University of Gaza (MC-IUG). Frequent surveys and observations were carried out during a six-month study extended from February, 2018 to July, 2018 in order to identify and totally count the trees and shrubs existing at MC-IUG. A total number of 2248 trees and shrubs belonging to 53 species, 25 families and 16 orders were identified and recorded at the MC-IUG. The Gymnosperms included 5 species (9.43%) only, while the Angiosperms was represented by 48 species (90.57%), of which the monocots were 9 species (16.98%) and the dicots were 39 species (73.59%). Rosales was the biggest order and comprised 9 (16.98%) of the recorded species. It was followed by Lamiales and Myrtales which comprised 5 (9.43%) for each. The orders Pinales, Arecales, Asparagales and Malpighiales were represented by 4 species (7.55%) for each. Moraceae was the biggest family and comprised 8 (15.09%) of the recorded species. It was followed by the two families Arecaceae and Asparagaceae, which comprised 5 species (9.43% for each). Six tree and shrub species (11.32%) of MC-IUG were found to exceed the threshold of 100 individuals for each. These comprised 1657 individuals (73.71%) of the 2248 counted. The Chinese Hibiscus (Hibiscus rosa-sinensis) was, by far, the most common species. It comprised 31.98% of the individuals counted. This was followed by the Benjamin Fig (Ficus benjamina) (10.45%), Hopbush (Dodonea viscose) and Moringa (Moringa oleifera) (8.63% for each), Dwarf Umbrella Tree (Schefflera arboricola) (8.19%) and Weeping Fig (Ficus nitida) (5.82%). The majority of tree and shrub species 49 (92.45%) recoded in the current study are exotic, while the native ones are restricted to only 4 species (7.55%). Finally, the current study recommends the selection of tree and shrub species corresponding with the local prevailing environmental conditions in order to ensure the ecological and environmental health values needed by the university community.The Gaza Strip, which has a population of about 2.0 million and an area of about 365 km2, has many higher education institutions. The green quadrates, corridors and gardens of these institutions are commonly cultivated with many horticultural plants including trees and shrubs that provide many environmental, health, and aesthetic values. The Palestinian universities of the Gaza Strip have never been studied for the composition and numbers of their trees and shrubs. Therefore, the current study aims at identifying and recording the trees and shrubs prevailing and enhancing the ecology and environmental health aspects of the main campus of the Islamic University of Gaza (MC-IUG). Frequent surveys and observations were carried out during a six-month study extended from February, 2018 to July, 2018 in order to identify and totally count the trees and shrubs existing at MC-IUG. A total number of 2248 trees and shrubs belonging to 53 species, 25 families and 16 orders were identified and recorded at the MC-IUG. The Gymnosperms included 5 species (9.43%) only, while the Angiosperms was represented by 48 species (90.57%), of which the monocots were 9 species (16.98%) and the dicots were 39 species (73.59%). Rosales was the biggest order and comprised 9 (16.98%) of the recorded species. It was followed by Lamiales and Myrtales which comprised 5 (9.43%) for each. The orders Pinales, Arecales, Asparagales and Malpighiales were represented by 4 species (7.55%) for each. Moraceae was the biggest family and comprised 8 (15.09%) of the recorded species. It was followed by the two families Arecaceae and Asparagaceae, which comprised 5 species (9.43% for each). Six tree and shrub species (11.32%) of MC-IUG were found to exceed the threshold of 100 individuals for each. These comprised 1657 individuals (73.71%) of the 2248 counted. The Chinese Hibiscus (Hibiscus rosa-sinensis) was, by far, the most common species. It comprised 31.98% of the individuals counted. This was followed by the Benjamin Fig (Ficus benjamina) (10.45%), Hopbush (Dodonea viscose) and Moringa (Moringa oleifera) (8.63% for each), Dwarf Umbrella Tree (Schefflera arboricola) (8.19%) and Weeping Fig (Ficus nitida) (5.82%). The majority of tree and shrub species 49 (92.45%) recoded in the current study are exotic, while the native ones are restricted to only 4 species (7.55%). Finally, the current study recommends the selection of tree and shrub species corresponding with the local prevailing environmental conditions in order to ensure the ecological and environmental health values needed by the university community

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

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