Prevalencija i kardiovaskularni ishodi kod dijabetičke kardiomiopatije u egipatskih bolesnika s dijabetesom tipa 2: presječna multicentrična studija u bolničkom okružju

A multicenter study to evaluate the prevalence and cardiovascular outcomes of diabetic cardiomyopathy in type II diabetic patients. Two hundred participants with type II diabetes mellitus (DM) were included, while participants with coronary artery disease (CAD), valvular heart disease, or history of alcohol or drug abuse were excluded. Participants were subjected to history taking for age, gender, body mass index, smoking, dyslipidemia, medications, DM, Framingham diagnostic criteria of heart failure (HF), comprehensive clinical examination, 12 leads resting electrocardiogram, transthoracic echocardiography and one of the following laboratory investigations: glycated hemoglobin, random blood sugar, fasting blood sugar, or 2-hour 75-gram oral glucose tolerance test. The prevalence of diabetic cardiomyopathy versus (vs) no diabetic cardiomyopathy, left ventricular (LV) diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the study population was 23.0% vs 77.0%, 18.5%, 5.0%, and 8.0%, respectively. There was a highly significant difference between LV diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the diabetic cardiomyopathy group vs no diabetic cardiomyopathy group, with an absolute risk increase of 80%, 22%, and 35% in the diabetic cardiomyopathy group, respectively. There was a highly significant difference between the mean ejection fraction (EF) in the diabetic cardiomyopathy group vs the no diabetic cardiomyopathy group. The mean EF for the diabetic cardiomyopathy group was 5.5% lower than the mean EF for the no diabetic cardiomyopathy group. The prevalence of HF and pre-clinical HF in the diabetic cardiomyopathy group was 65% and 35%, respectively. The mean age for HF was 4.1 years older than the mean age for pre-clinical HF in the diabetic cardiomyopathy group. Smoking was significantly and strongly associated with HF vs pre-clinical HF in the diabetic cardiomyopathy group. Diabetic cardiomyopathy was prevalent in an Egyptian type II diabetic patient population and could be considered a primary myocardial disease predisposing to HF in type II DM.Cilj: Proveli smo multicentričnu studiju kako bismo odredili prevalenciju i kardiovaskularne ishode kod dijabetičke kardiomiopatije (DCM) u bolesnika s dijabetesom tipa 2. Metode: U istraživanje je bilo uključeno dvjesto ispitanika s dijabetesom tipa 2 (DM). Isključeni su ispitanici s koronarnom bolesti srca (CAD), valvularnom bolesti srca ili anamnestičkim podatcima o zlouporabi droga ili alkohola. Nakon anamnestičkih podataka utvrđeni su indeks tjelesne mase, učestalost pušenja, dislipidemije, DM-a, uporaba lijekova te su provedeni procjena dijagnostičkih kriterija zatajivanja srca (HF) prema Framinghamskoj studiji, klinički pregled, 12-kanaln elektrokardiogram u mirovanju, transtorakalna ehokardiografija te jedna od laboratorijskih varijabli: HbA1c, nasumične ili natašte izmjerene vrijednost glukoze u krvi ili rezultat dvosatnog testa oralne podnošljivosti glukoze. Rezultati: Prevalencija u usporedbi s odsutnošću DCM-a, dijastolička disfunkcija lijeve klijetke (LV) II. i III. stupnja, sistolička disfunkcija i hipertrofija u istraživanoj skupini iznosile su, redom: 23,0 % prema 77,0 %, 18,5 %, 5,0 % i 8,0 %. U skupini s DCMom postojala je značajna razlika u učestalosti dijastoličke disfunkcije LV-a II. i III. stupnja, sistoličke disfunkcije i hipertrofiji u usporedi sa skupinom ispitanika bez DCM-a, s apsolutnim povećanjem rizika u skupini s DCM-om za ta stanja od, redom, 80 %, 22 % i 35 %. Pronađena je i signifikantna razlika u prosječnoj vrijednosti ejekcijske frakcije (EF) između skupina s DCM-om i bez DCM-a. Prosječna EF u skupini s DCM-om bila je za 5,5 % niža nego u skupini bez DCM-a. Zastupljenost HF-a i pretkliničke HF u skupini s DCM-om iznosila je 65 % i 35 %. U skupni s DCM-om prosječna je dob kod HF-a bila 4 ,1 godinu viša nego prosječna dob za pretklinički HF. Pušenje je bilo izrazito i značajno povezano s HF-om u odnosu prema predkliničkom HF-u u skupni s DCM-om. Zaključci: DCM je bio zastupljen u egipatskih bolesnika s dijabetesom tipa 2 te se može smatrati primarnom miokardijalnom bolešću koja uzrokuje predispoziciju za HF kod dijabetesa tipa 2

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Tectonogeomorphological and satellite image analysis of the Red Sea passive margin at the latitude of Wadi Siatin, Northern Quseir, Egypt

Remote sensing has become an essential tool to improve data collection and spatial analysis in the geosciences. Identification of passive margin structures that are exposed along the Egyptian coast of the Red Sea, and their control on landforms has been hampered by limited data resolution and restricted access to this arid and inaccessible region. A major challenge lies in distinguishing features in the landscape that formed due to long-term tectonic activity and erosion from those features that modified the landscape recently. The goals of this thesis were to determine to what degree the study area is currently tectonically active, and what major hazards might affect the touristically developing coastal region. This study deals with the structural and geomorphological evolution of the rift-related structures and their impact on the sediment distribution and landforms variation in the northern Quseir area. In such a remote desert area, field and remote morphostructural analysis are needed to understand the structural and geomorphological evolution. The current study is mainly based on high-resolution QuickBird image analysis and field investigation. Field mapping was limited to one season, owing to acute safety concerns in the Eastern Desert. In the study area, the pre-rift stratigraphy includes Pan-African basement rocks overlain by pre-rift clastic and carbonate successions that range in age from Cambrian to Eocene. Syn-rift clastic and carbonate rocks range in age from Late Oligocene to recent and show depositional patterns controlled by fault systems. The field area exposes a section of a tectonically uplifted, amagmatic sedimentary sequence, which formed due to passive-margin-related rifting of the Red Sea: the Mesozoic and Tertiary sedimentary units that fill the 7-km wide coastal strip are perfectly exposed as tilted fault blocks. The results of my field mapping and structural analysis show that the fault architecture of the area is dominated by a large NW-SE-striking fault system. A series of SE-dipping normal faults are consistent in cross-section with listric fault geometry, rooting into an E-dipping detachment at depth. Our mapping also revealed that left-steps in at least one of the major NS- striking faults are accommodated by a flower structure, but not by SW-NE-oriented cross faults as previously proposed in a neighboring area. Thus seismic activity is more likely to occur on the large NW-striking normal faults, leading to potentially larger Magnitude earthquakes than previously recognized in the area. The left-step may act as a barrier to rupture propagation and should be examined in more detail. The northwestern Red Sea coast is part of the straight coastal segment that is generally characterized as seismically inactive. However, during the geological field mapping, I found evidence for Plio-/Pleistocene vertical coastal uplift, likely due to earthquake-related coastal and offshore faulting. Pliocene marine deposits emerged recently due to sea level-drop and earthquake-related uplift. Even the presence of up to five distinct Pleistocene coral terraces implies that at least some of the coastal uplift was seismogenic, because terraces of the same age can be found at different elevations along strike. Presumably, some of the seawarddipping, N-S-striking normal faults are active today, despite the lack of recent instrumental seismicity. These findings imply long recurrence intervals for active faults in the northern Quseir area. These results differ from previously published results for the adjacent Quseir-Um Gheig sub-basin area, were E-W-striking strike-slip faults were mapped to offset the N-Sstriking faults, and had been inferred as earthquake-generating faults by Abd El-Wahed et al. (2010). Based on our mapping, we postulate that the large rift-parallel normal faults are seismogenic. Drainage network evolution within the study area is often structurally controlled and the nature of these controls was examined in this study. The Wadi Siatin stream channel network is classified in a relatively simple way, based on the high-resolution satellite data, with dendritic, and rectangular considered the most fundamental channel geometries. It was possible to distinguish the different morphological elements of the network, as well as the anomalies that affect the patterns. This analysis revealed, in the northern Red Sea area basins, the existence of old structures whose successive reactivations have left their mark on the drainage network. Comparison of joint systems direction with the directions of the main trunk stream channel of Wadi Siatin shows that the channel is highly affected by tectonic jointing. First-order channels follow easily erodable faults. Investigations concerning the relationship of stream-flow orientation with geological structure in the Wadi Siatin Basin shows that, generally, the least influenced flows are those of first-order which are governed simply by the valley side slopes on which they developed. However, in certain geological and geomorphological situations, there are clear exceptions to this generalization. Certainly, locally, geological control of these small streams may be even higher than in many streams of higher order. In the peripheral parts of the Basin, expansion of drainage into the available space has obviously been easiest along lines of weakness and, as a consequence of this, streams of the first order come to exhibit a high degree of adjustment to the underlying structure. The maximum structural control is reached by the streams of the third order. Towards the higher orders, the influence of local structure becomes weaker

Bioactivity and pH of Nano-White MTA versus NeoMTATM Plus® and MTA Angelus® as root repair materials: An in vitro study

Objective: This study compared the bioactivity and pH of Nano-white mineral trioxide aggregate (NWMTA), Neo-mineral trioxide aggregate plus (NeoMTA Plus), and Mineral trioxide aggregate angelus (MTA-A) as root repair materials. Methods: A total of 60 discs made from the three materials (20 discs each) were prepared according to the manufacturer’s instructions. These discs were packed into plastic molds and allowed to set before testing. For bioactivity study, ten discs of each material were immersed in Hanks\u27 Balanced Salt Solution (HBSS) for 28 days, and analyzed with scanning electron microscope with energy dispersive X-ray (SEM/EDX). Ten discs of each material were used to assess the pH changes by the pH meter at 3 h, 24 h, 72 h, and 168 h. All data were statistically analyzed. Results: After 28 days of immersing in HBSS, the crystals of Nano WMTA, NeoMTA Plus and MTA were covered with calcium phosphate precipitates with no statistically significant difference (P=0.908). The three tested materials induced alkalization of the deionized water after 3 h of immersion and started to decrease at 3 days continuing until the last test at 7 days. Conclusion: The Nano WMTA, NeoMTA Plus and MTA have similar bioactivity and strong alkalizing activity

Characterization of the heat behavior of amiodarone hydrochloride

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Etiological and prognostic values of procalcitonin in hospital-acquired pneumonia

Background: Biological markers such as procalcitonin, may be helpful for the diagnosis of HAP. Procalcitonin has greater diagnostic accuracy than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein and ESR. The aim of the study was to assess the etiological and prognostic values of procalcitonin in adult patients with hospital acquired pneumonia (HAP). Methods: 15 Patients with a strong suspicion of hospital acquired pneumonia. The diagnosis of HAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. Complete blood picture, sputum culture and sensitivity, ESR, CRP and PCT were obtained at admission and repeated after 2 weeks. PCT was determined with Elecsys BRAHMS PCT in serum of studied patients. Results: Serum PCT above 0.5 μg/L was considered highly positive for diagnosis of HAP. It was significantly higher at admission (2.72 ± 1.72 μg/L) than after two weeks (1.0 ± 1.91 μg/L). There was a statistical significant decrease in serum levels of procalcitonin (P = 0.002) in response to antibiotic therapy. Also the PCT was significantly higher in patients with bad outcome (2.11–6.0 μg/L) than patients with good outcome (1.76 ± 0.69 μg/L). Procalcitonin was significantly higher among patients with pseudomonas (5.53 ± 0.50 μg/L) and acinetobacter (2.67 ± 0.49 μg/L) and lesser among patients with Escherichia coli (1.38 ± 0.06 μg/L) and MRSA (1.09 ± 0.13 μg/L). Conclusion: Procalcitonin was a good etiological and prognostic marker in hospital acquired pneumonia. PCT is the most specific biomarker and has a number of advantages over previous markers

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims: The Acute Cardiac Care Association (ACCA)-European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results: Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients' outcomes. Patients will be followed for 1 year after admission. Conclusion: The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI