Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Nerve conduction studies (NCS) is the most valid way of diagnosing CTS in combination of these clinical symptoms together with positive signs by physical examination. Ultrasonography is a useful non-invasive diagnostic method for CTS and there is considerable correlation between the electrophysiological tests and the measurements of cross-sectional area (CSA) by ultrasonography. Many studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycemic control. Although diabetes mellitus is a risk factor for CTS, reports about median nerve CSA measurements between CTS patients with and without DM are scant. This prospective study aimed to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM-CTS patients. To correlate the diagnostic results in both DM and non-DMCTS patients.Patients and methods: Thirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography (US).Results: High mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups. Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients.Conclusion: The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. Mean electro-diagnostic parameters were not significant predictors of CTS in patients with diabetes. The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.Keywords: Carpal tunnel syndrome (CTS), Diabetes mellitus (DM), Diabetic polyneuropathy (DPN), Electrophysiological and ultrasonography (US

BIM Role within the Conceptual Design Phase: A Case Study of a UK Construction Project

The application of building information modelling (BIM) during the construction cycle of any development varies. Systematically, the way BIM’s applied during the initial phase will have a direct influence on phases that follow afterwards. Previous research focused on the application of BIM and concentrated on various aspects, which included sustainability or how to overcome the loss of data/information. However, it limited its focus on the application during a specific phase of the project. Analysis outlined both the benefits and barriers of applying BIM during the conceptual design phase. The study suggests that an informed evaluation of the application of BIM during any particular phase should take in consideration different stakeholders’ roles and responsibilities

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Consider Long Head of Biceps Tendon for Reconstruction of Massive, Irreparable Rotator Cuff Tear

Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT’s origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint

Optimal Allocation of Multiple Types of Distributed Generations in Radial Distribution Systems Using a Hybrid Technique

In recent years, the integration of distributed generators (DGs) in radial distribution systems (RDS) has received considerable attention in power system research. The major purpose of DG integration is to decrease the power losses and improve the voltage profiles that directly lead to improving the overall efficiency of the power system. Therefore, this paper proposes a hybrid optimization technique based on analytical and metaheuristic algorithms for optimal DG allocation in RDS. In the proposed technique, the loss sensitivity factor (LSF) is utilized to reduce the search space of the DG locations, while the analytical technique is used to calculate initial DG sizes based on a mathematical formulation. Then, a metaheuristic sine cosine algorithm (SCA) is applied to identify the optimal DG allocation based on the LSF and analytical techniques instead of using random initialization. To prove the superiority and high performance of the proposed hybrid technique, two standard RDSs, IEEE 33-bus and 69-bus, are considered. Additionally, a comparison between the proposed techniques, standard SCA, and other existing optimization techniques is carried out. The main findings confirmed the enhancement in the convergence of the proposed technique compared with the standard SCA and the ability to allocate multiple DGs in RDS

Modeling the potential risk factors of bovine viral diarrhea prevalence in Egypt using univariable and multivariable logistic regression analyses

Aim: The present cross-sectional study was conducted to determine the seroprevalence and potential risk factors associated with Bovine viral diarrhea virus (BVDV) disease in cattle and buffaloes in Egypt, to model the potential risk factors associated with the disease using logistic regression (LR) models, and to fit the best predictive model for the current data. Materials and Methods: A total of 740 blood samples were collected within November 2012-March 2013 from animals aged between 6 months and 3 years. The potential risk factors studied were species, age, sex, and herd location. All serum samples were examined with indirect ELIZA test for antibody detection. Data were analyzed with different statistical approaches such as Chi-square test, odds ratios (OR), univariable, and multivariable LR models. Results: Results revealed a non-significant association between being seropositive with BVDV and all risk factors, except for species of animal. Seroprevalence percentages were 40% and 23% for cattle and buffaloes, respectively. OR for all categories were close to one with the highest OR for cattle relative to buffaloes, which was 2.237. Likelihood ratio tests showed a significant drop of the -2LL from univariable LR to multivariable LR models. Conclusion: There was an evidence of high seroprevalence of BVDV among cattle as compared with buffaloes with the possibility of infection in different age groups of animals. In addition, multivariable LR model was proved to provide more information for association and prediction purposes relative to univariable LR models and Chi-square tests if we have more than one predictor

Exogenous Application of Alpha-Lipoic Acid Mitigates Salt-Induced Oxidative Damage in Sorghum Plants through Regulation Growth, Leaf Pigments, Ionic Homeostasis, Antioxidant Enzymes, and Expression of Salt Stress Responsive Genes

In plants, α-Lipoic acid (ALA) is considered a dithiol short-chain fatty acid with several strong antioxidative properties. To date, no data are conclusive regarding its effects as an exogenous application on salt stressed sorghum plants. In this study, we investigated the effect of 20 µM ALA as a foliar application on salt-stressed sorghum plants (0, 75 and 150 mM as NaCl). Under saline conditions, the applied-ALA significantly (p ≤ 0.05) stimulated plant growth, indicated by improving both fresh and dry shoot weights. A similar trend was observed in the photosynthetic pigments, including Chl a, Chl b and carotenoids. This improvement was associated with an obvious increase in the membrane stability index (MSI). At the same time, an obvious decrease in the salt induced oxidative damages was seen when the concentration of H2O2 and malondialdehyde (MDA) was reduced in the salt stressed leaf tissues. Generally, ALA-treated plants demonstrated higher antioxidant enzyme activity than in the ALA-untreated plants. A moderate level of salinity (75 mM) induced the highest activities of superoxide dismutase (SOD), guaiacol peroxidase (G-POX), and ascorbate peroxidase (APX). Meanwhile, the highest activity of catalase (CAT) was seen with 150 mM NaCl. Interestingly, applied-ALA led to a substantial decrease in the concentration of both Na and the Na/K ratio. In contrast, K and Ca exhibited a considerable increase in this respect. The role of ALA in the regulation of K+/Na+ selectivity under saline condition was confirmed through a molecular study (RT-PCR). It was found that ALA treatment downregulated the relative gene expression of plasma membrane (SOS1) and vacuolar (NHX1) Na+/H+ antiporters. In contrast, the high-affinity potassium transporter protein (HKT1) was upregulated

Exogenous Application of Alpha-Lipoic Acid Mitigates Salt-Induced Oxidative Damage in Sorghum Plants through Regulation Growth, Leaf Pigments, Ionic Homeostasis, Antioxidant Enzymes, and Expression of Salt Stress Responsive Genes

In plants, α-Lipoic acid (ALA) is considered a dithiol short-chain fatty acid with several strong antioxidative properties. To date, no data are conclusive regarding its effects as an exogenous application on salt stressed sorghum plants. In this study, we investigated the effect of 20 µM ALA as a foliar application on salt-stressed sorghum plants (0, 75 and 150 mM as NaCl). Under saline conditions, the applied-ALA significantly (p ≤ 0.05) stimulated plant growth, indicated by improving both fresh and dry shoot weights. A similar trend was observed in the photosynthetic pigments, including Chl a, Chl b and carotenoids. This improvement was associated with an obvious increase in the membrane stability index (MSI). At the same time, an obvious decrease in the salt induced oxidative damages was seen when the concentration of H2O2 and malondialdehyde (MDA) was reduced in the salt stressed leaf tissues. Generally, ALA-treated plants demonstrated higher antioxidant enzyme activity than in the ALA-untreated plants. A moderate level of salinity (75 mM) induced the highest activities of superoxide dismutase (SOD), guaiacol peroxidase (G-POX), and ascorbate peroxidase (APX). Meanwhile, the highest activity of catalase (CAT) was seen with 150 mM NaCl. Interestingly, applied-ALA led to a substantial decrease in the concentration of both Na and the Na/K ratio. In contrast, K and Ca exhibited a considerable increase in this respect. The role of ALA in the regulation of K+/Na+ selectivity under saline condition was confirmed through a molecular study (RT-PCR). It was found that ALA treatment downregulated the relative gene expression of plasma membrane (SOS1) and vacuolar (NHX1) Na+/H+ antiporters. In contrast, the high-affinity potassium transporter protein (HKT1) was upregulated

In vitro and in silico biopotentials of phytochemical compositions and antistaphylococcal and antipseudomonal activities of volatile compounds of Argania spinosa (L.) seed oil

Active components in medicinal plants provide unlimited useful and traditional medicines. Antimicrobial activities are found in secondary metabolites in plant extracts such as argan oil. This experimental investigation aims to determine argan oil’s volatile compounds and examine their in vitro antimicrobial properties. In silico simulations, molecular docking, pharmacokinetics, and drug-likeness prediction revealed the processes underlying the in vitro biological possessions. Gas chromatography–mass spectrometry (GC/MS) was used to screen argan oil’s primary components. In silico molecular docking studies were used to investigate the ability of the selected bioactive constituents of argan oil to act effectively against Pseudomonas aeruginosa and Staphylococcus aureus (S. aureus) isolated from infections. The goal was to study their ability to interact with both bacteria’s essential therapeutic target protein. The 21 chemicals in argan oil were identified by GC/MS. Docking results for all compounds with S. aureus and P. aeruginosa protease proteins ranged from −5 to −9.4 kcal/mol and −5.7 to −9.7 kcal/mol, respectively, compared to reference ligands. Our docking result indicates that the 10-octadecenoic acid, methyl ester was the most significant compound with affinity scores of −9.4 and −9.7 kcal/mol for S. aureus and P. aeruginosa proteins, respectively. The minimal bactericidal concentration (MBC) and minimal inhibitory concentration (MIC) of argan oil were 0.7 ± 0.03 and 0.5 ± 0.01 for S. aureus and 0.4 ± 0.01 and 0.3 ± 0.02 for P. aeruginosa, respectively. We confirmed the antimicrobial properties of argan oil that showed significant growth inhibition for S. aureus and P. aeruginosa