When You are About to Diagnose Chronic Hemolytic Uremic Syndrome, Please Think More Deep

Antiphospholipid syndrome is one type of immunological diseases which may be primary or secondary characterized by repeated thrombosis that it may be called “sticky blood syndrome”. Although a well-known disease in gynecology, there is no sufficient data in pediatrics field; so we see that it is important to discuss this interesting case

Application of multilevel concepts for uncertainty quantification in reservoir simulation

Uncertainty quantification is an important task in reservoir simulation and is an active area of research. The main idea of uncertainty quantification is to compute the distribution of a quantity of interest, for example oil rate. That uncertainty, then feeds into the decision making process. A statistically valid way of quantifying the uncertainty is a Markov Chain Monte Carlo (MCMC) method, such as Random Walk Metropolis (RWM). MCMC is a robust technique for estimating the distribution of the quantity of interest. RWM is can be prohibitively expensive, due to the need to run a huge number of realizations, 45% - 70% of these may be rejected and, even for a simple reservoir model it may take 15 minutes for each realization. Hamiltonian Monte Carlo accelerates the convergence for RWM but may lead to a large increase computational cost because it requires the gradient. In this thesis, we present how to use the multilevel concept to accelerate convergence for RWM. The thesis discusses how to apply Multilevel Markov Chain Monte Carlo (MLMCMC) to uncertainty quantification. It proposes two new techniques, one for improving the proxy based on multilevel idea called Multilevel proxy (MLproxy) and the second one for accelerating the convergence of Hamiltonian Monte Carlo is called Multilevel Hamiltonian Monte Carlo (MLHMC). The idea behind the multilevel concept is a simple telescoping sum: which represents the expensive solution (e.g., estimating the distribution for oil rate on finest grid) in terms of a cheap solution (e.g., estimating the distribution for oil rate on coarse grid) and `correction terms', which are the difference between the high resolution solution and a low resolution solution. A small fraction of realizations is then run on the finer grids to compute correction terms. This reduces the computational cost and simulation errors significantly. MLMCMC is a combination between RWM and multilevel concept, it greatly reduces the computational cost compared to the RWM for uncertainty quantification. It makes Monte Carlo estimation a feasible technique for uncertainty quantification in reservoir simulation applications. In this thesis, MLMCMC has been implemented on two reservoir models based on real fields in the central Gulf of Mexico and in North Sea. MLproxy is another way for decreasing the computational cost based on constructing an emulator and then improving it by adding the correction term between the proxy and simulated results. MLHMC is a combination of Multilevel Monte Carlo method with a Hamiltonian Monte Carlo algorithm. It accelerates Hamiltonian Monte Carlo (HMC) and is faster than HMC. In the thesis, it has been implemented on a real field called Teal South to assess the uncertainty

Assessment the Knowledge of the New Trends in Obesity Treatment among Female Students of Applied Medical Sciences in Umm Al-Qura University-Makkah

Obesity is associated with numerous diseases and metabolic abnormalities. Treatment should begin with lifestyle changes that focus on behavioral modification, diet, and exercise. When lifestyle modification schemes are unsuccessful, drug therapy is an attractive option. Food and Drug Administration (FDA) regulates dietary supplements, including those promoted for weight loss. Weight-loss supplements differ from over-the-counter or prescription medications in that the FDA does not classify them as drugs. In this study we Assess the knowledge and beliefs of students in Faculty of Applied Medical Sciences about new methods used for weight reduction.  The present study was conducted on 70 interviewed of students. Specific questionnaire was used to collect data about methods used for weight control. Statistical analysis was performed by using SPSS software version 19. The obtained data showed that student’s preferred physical activity and diet they have awareness about detox water but little awareness about Conjugated linoleic acid  and blood group diet.  The present study suggested that Healthcare professionals must make efforts to educate themselves and public about new methods used for weight control. Keywords: Obesity, blood group diet, detoxes water and Conjugated linoleic acid

Surgical treatment for locally advanced lower third rectal cancer after neoadjuvent chemoradiation with capecitabine: prospective phase II trial

<p>Abstract</p> <p>Introduction</p> <p>Treatment of rectal cancer requires a multidisciplinary approach with standardized surgical, pathological and radiotherapeutic procedures. Sphincter preserving surgery for cancer of the lower rectum needs a long-course of neoadjuvant treatments to reduce tumor volume, to induce down-staging that increases circumferential resection margin, and to facilitate surgery.</p> <p>Aim</p> <p>To evaluate the rate of anal sphincter preservation in low lying, resectable, locally advanced rectal cancer and the resectability rate in unresectable cases after neoadjuvent chemoradiation by oral Capecitabine.</p> <p>Patients and methods</p> <p>This trial included 43 patients with low lying (4–7 cm from anal verge) locally advanced rectal cancer, of which 33 were resectable. All patients received preoperative concurrent chemoradiation (45 Gy/25 fractions over 5 weeks with oral capecitabine 825 mg/m²twice daily on radiotherapy days), followed after 4–6 weeks by total mesorectal excision technique.</p> <p>Results</p> <p>Preoperative chemoradiation resulted in a complete pathologic response in 4 patients (9.3%; 95% CI 3–23.1) and an overall downstaging in 32 patients (74.4%; 95% CI 58.5–85). Sphincter sparing surgical procedures were done in 20 out of 43 patients (46.5%; 95% CI 31.5–62.2). The majority (75%) were of clinical T₃disease. Toxicity was moderate and required no treatment interruption. Grade II anemia occurred in 4 patients (9.3%, 95% CI 3–23.1), leucopenia in 2 patients (4.7%, 95% CI 0.8–17) and radiation dermatitis in 4 patients (9.3%, 95% CI 3–23.1) respectively.</p> <p>Conclusion</p> <p>In patients with low lying, locally advanced rectal cancer, preoperative chemoradiation using oral capecitabine 825 mg/m², twice a day on radiotherapy days, was tolerable and effective in downstaging and resulted in 46.5% anal sphincter preservation rate.</p

The Impact of Big Data Analytics on Investment Efficiency and Financial Performance: Evidence from Saudi Stock Market

The paper investigates the determinants of adopting big data analytics (BDA) in the Saudi environment according to vision 2030, in addition to the impact of BDA on both investment efficiency and financial performance, we analyzed the academic accounting literature and provide a theoretical framework for each variable. Furthermore, to achieve our research objectives we developed three hypotheses and tested them through an empirical study based on three statistical models; our sample consisted of the largest 50 companies operating in the Saudi stock market for five years (2017-2021). Going further, our findings illustrated that (1) Firm Size, Cash Flows, Growth Opportunities, and Dividend Policy have a positive significant impact on the adoption of big data analytics (2) Leverage and Working Capital have a positive significant impact on the adoption of big data analytics (3) There is a positive impact of the adoptions of big data analytics on investment efficiency (4) There is a positive impact of the adoptions of big data analytics on the financial performance

Clinical and electrophysiological study of peripheral and central neuromuscular changes in connective tissue diseases in children

AbstractIntroductionChildren with juvenile connective tissue diseases (JCTDs) may have a wide variety of clinical features ranging from fever or a simple arthritis to complex multisystem autoimmune diseases.Aim of the workTo study clinical and electrophysiological peripheral and central neuromuscular changes in children with connective tissue diseases.Patients and methodsThirty children with different JCTDs were enrolled. Clinical and neurological examination and laboratory investigations were done. Electrophysiological evaluation was performed and included: peripheral nerve conduction studies, late responses, somatosensory evoked potential and electromyography.ResultsTwenty patients had juvenile idiopathic arthritis (JIA) (66.7%), 8 patients had juvenile systemic lupus erythematosus (JSLE) (26.7%), one patient had juvenile systemic sclerosis (JSScl), and one patient had juvenile overlap syndrome (JSScl and polymyositis). Clinical neurologic abnormalities were present in 3 patients (ulnar neuropathy, median neuropathy and polymyositis). Electrophysiological abnormalities were detected in 18 patients (clinical in 3 and subclinical in 15 patients) and included ulnar entrapment neuropathy, median axonal neuropathy, demyelinating sensory motor polyneuropathy, deep peroneal nerve entrapment at the ankle (anterior tarsal tunnel syndrome), prolonged posterior tibial somatosensory evoked potential latency and prolonged H reflex latency not explained by peripheral neuropathy, increased H/M ratio and myopathic motor units. The most common electrophysiological abnormalities were present in patients with JSLE.ConclusionClinical neurological abnormalities are not common in JCTDs whereas subclinical neurological abnormalities are common findings. Juvenile systemic lupus erythematosus had the most common abnormalities among JCTDs. Polyneuropathy in JIA is commonly of demyelinating type. Entrapment neuropathy is less frequent than in adults

Association between Serum Adiponectin and Insulin Resistance in Children and Adolescents with Type 1 Diabetes: A Cross-Sectional, Single Center Study from Egypt

Objective: To determine the serum level of adiponectin and its relation to insulin resistance (IR) in children andadolescents with type 1 diabetes (T1D). Materials and methods: Over a 3-month period, 65 children diagnosed with T1D who were followed up at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU) at Cairo University Children’s Hospital. Demographics, clinical data, investigations, and management details were collected from the patient’s medical records and evaluated for the serum level of adiponectin. Results: Mean age of the study population was 12.6 ± 2 years. About 40% of participants had low serum adiponectin, with a mean value of 2.4 ± 3.6. Sixty-one (93.8%) of participants had dyslipidemia. The mean estimated glucose disposal rate (eGDR) was 6.9 ± 2.1. Multivariate linear regression was performed to adjust for possible confounders in correlation between serum adiponectin and eGDR; it wasn’t significant asp-value = 0.875. There was a statistically significant difference between patients with normal and low adiponectin regarding the age of diagnosis of diabetes, body mass index, the occurrence of microalbuminuria, and LDL level, with p-values of 0.04, 0.015, 0.022, and 0.011, respectively. Conclusions: There was also an association between lower adiponectin levels in children with type 1 diabetes and the occurrence of microalbuminuria and dyslipidemia. However, there is no reported association between its level and IR

Sustainable release of propranolol hydrochloride laden with biconjugated-ufasomes chitosan hydrogel attenuates cisplatin-induced sciatic nerve damage in in vitro/in vivo evaluation

Peripheral nerve injuries significantly impact patients’ quality of life and poor functional recovery. Chitosan–ufasomes (CTS–UFAs) exhibit biomimetic features, making them a viable choice for developing novel transdermal delivery for neural repair. This study aimed to investigate the role of CTS–UFAs loaded with the propranolol HCl (PRO) as a model drug in enhancing sciatica in cisplatin-induced sciatic nerve damage in rats. Hence, PRO–UFAs were primed, embedding either span 20 or 60 together with oleic acid and cholesterol using a thin-film hydration process based on full factorial design (2(4)). The influence of formulation factors on UFAs’ physicochemical characteristics and the optimum formulation selection were investigated using Design-Expert(®) software. Based on the optimal UFA formulation, PRO–CTS–UFAs were constructed and characterized using transmission electron microscopy, stability studies, and ex vivo permeation. In vivo trials on rats with a sciatic nerve injury tested the efficacy of PRO–CTS–UFA and PRO–UFA transdermal hydrogels, PRO solution, compared to normal rats. Additionally, oxidative stress and specific apoptotic biomarkers were assessed, supported by a sciatic nerve histopathological study. PRO–UFAs and PRO–CTS–UFAs disclosed entrapment efficiency of 82.72 ± 2.33% and 85.32 ± 2.65%, a particle size of 317.22 ± 6.43 and 336.12 ± 4.9 nm, ζ potential of −62.06 ± 0.07 and 65.24 ± 0.10 mV, and accumulatively released 70.95 ± 8.14% and 64.03 ± 1.9% PRO within 6 h, respectively. Moreover, PRO–CTS–UFAs significantly restored sciatic nerve structure, inhibited the cisplatin-dependent increase in peripheral myelin 22 gene expression and MDA levels, and further re-established sciatic nerve GSH and CAT content. Furthermore, they elicited MBP re-expression, BCL-2 mild expression, and inhibited TNF-α expression. Briefly, our findings proposed that CTS–UFAs are promising to enhance PRO transdermal delivery to manage sciatic nerve damage

Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma

<p>Abstract</p> <p>Introduction</p> <p>Almost 30% of patients with pancreatic cancer have locally advanced tumours in absence of distant metastasis. Surgical resection is often contraindicated. The combination of gemcitabine with concurrent radiation therapy is a promising new approach that is being investigated for treating patients' unresectable pancreatic cancer. This work aims at assessing the efficacy of preoperative gemcitabine based chemo-radiotherapy in increasing the resectability rate for patients' locally advanced pancreatic cancer.</p> <p>Patients and methods</p> <p>From March 2006 to November 2007, 25 patients with locally advanced non metastatic pancreatic cancer were treated by preoperative gemcitabine based chemo-radiotherapy. The radiation dose was 54 Gray in 30 fractions over 6 weeks prescribed to the isocenter. Gemcitabine (300 mg/m2) was given through a 30 minute intravenous infusion. This was done 30 minutes before the radiation sitting on a weekly basis throughout the radiotherapy course.</p> <p>Approximately 6 weeks after the completion of chemo radiation, an evaluation was performed regarding tumour response and resectability as well as acute toxicity. Pancreaticoduodenectomy was performed for operable patients with surgical reconstruction.</p> <p>Results</p> <p>Patients who achieved complete resection (CR) numbered 2 (8%), while those achieving partial resection (PR) totalled 11 (44%); six of these patients were considered ro be operable. Thus Pancreaticoduodenectomy was performed on 8 patients (2 with CR and 6 with PR) with surgical reconstruction. Patients who had a stable disease numbered 4 (16%), and those with progressive diseases included a group of eight (32%). The postoperative 30 day mortality occurred only in one patient (12.5%). Acute toxicity of chemoradiation occurred in the form of grade I leucopoenia and thrombocytopenia. Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively. The postoperative 30 day mortality occurred only in 1 patient. Also, minor biliary leakage and leakage from gastrointestinal anaestomosis both occurred in a single patient. Out of the 8 patients who underwent radical surgical resection, only one developed local recurrence and simultaneous liver metastasis during the follow up period. The median survival of all patients was 12 months.</p> <p>Conclusion</p> <p>Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.</p

Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt

Introduction: the prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to  quantify the incidence, risk factors and outcome of patients harboring XDR-GNB. Methods: a one year prospective study was done by collecting all the bacteriological reports  for cultures sent from the surgical intensive care unit, Cairo university teaching hospital.  XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of  antimicrobial agents .Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance. Results: during one-year study period, a total of 152 samples (65%) out of 234 gram negative  bacilli samples developed extensively drug resistant infection. XDR strains were significantly  higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%),  Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%).Relaparotomy was the only significant risk factor for acquisition of XDR infection. Conclusion: extensively drug-resistant gram negative infections are frequent in our ICU. This  is an alarming health care issue in Egypt which emphasizes the need to rigorously implement  infection control practices