Predictors of Angio access failure in end stage renal disease patients in Southern Egypt

Background: Hemodialysis (HD) seems to be the most often used Renal Replacement Therapy (RRT) modality worldwide, and it is the primary modality in the majority of instances with extended RRT. The ability to provide our patients with high-quality HD treatment while also increasing their chances of survival is heavily reliant on the functionality of the vascular access (VA). Despite the fact that it is a very necessary component of all clinical practise standards, it is the most expensive individual component of RRT.Objectives: This study was aimed at comparing between the group with Angio access failure and group without Angio access failure and predicting Angio access failure among end stage renal failure patients in Southern Egypt.Subjects and Methods: a prospective cohort study among 125 patients with end stage renal failure at Aswan University. The research comprised patients who had NCVA placement [intra-atrial catheter (IAC) and trans-lumbar catheter (TLC)] between January 1, 2020, and December 31, 2020.Results: The duration of previous RRT was significantly higher among the Angio access failure than the group without Angio access failure. In multivariate analysis using logistic regression, the age, duration of previous RRT, diabetes, IHD (ischemic heart disease), PVD (peripheral vascular disease) and CVD (cardiac vascular disease) were significantly direct predictors of the Angio access failure in the first one year.Conclusion: In conclusion the failure of Angio access was positively associated with age, previous RRT and other comorbidities

Endovenous Laser Ablation, Radiofrequency Ablation and Flebogrif versus Conventional Surgery in Treatment of Primary Varicose Vein of the Lower Limb: Prospective Randomized Controlled Study

Background: Endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) of primary varicose vein are thought to minimise postoperative morbidity and reduce work loss compared with the conventional surgical procedure. Objective: To determine, whether endovenous ablation methods (radiofrequency, laser and mechanochemical) have any advantages or disadvantages in comparison with conventional surgery, in the treatment of primary varicose vein. Patients and Methods: This was a prospective randomized study, conducted on forty patients presented at Vascular Outpatient Clinic for management of chronic venous insufficiency. All patients underwent clinical examination and duplex ultrasonography. Ten (10) patients were treated with ligation and stripping of the great saphenous vein (GSV). Ten (10) patients were treated with radiofrequency ablation. Ten (10) patients were treated with endovenous laser ablation. Ten (10) patients were treated with Flebogrif. Results: Compared with conventional surgery, endovenous ablation methods reduced postoperative discomfort and pain, with a lower complication rate after treatment for avoidance of a groin incision and dissection at the saphenofemoral confluence. Cosmetic demands were also better satisfied. Non-controlled clinical trials have shown that the ablation rate of GSV after EVLA is over 90%. However, risks of EVLA, RFA and Flebogrif remain in terms of recanalization and neoreflux via junctional tributaries. Conclusion: RFA, EVLA, and Flebogrif are minimally invasive procedures. Their potential early benefits, by avoiding groin dissection and GSV stripping, have been confirmed by the findings from this trial. Current evidence based on randomized trials consistently demonstrates significant early benefits after RFA, EVLA and Flebogrif in suitable patients with varicose veins

CXC ligand 13 in rheumatoid arthritis and its relation to secondary Sjögren’s syndrome

AbstractAim of the workThe aim of the present study was to measure the level of the chemokine CXC ligand 13 protein (CXCL13) in the plasma and unstimulated saliva of rheumatoid arthritis (RA) patients in order to find out its role in the disease activity and its relation to secondary Sjögren’s syndrome (sSS).Patients and methodsThe study was conducted on thirty rheumatoid arthritis patients attending the Outpatient Clinic of Rheumatology and Rehabilitation department of Ain shams University Hospitals. The patients’ group had been classified into group (1) which included fifteen RA patients associated with sSS diagnosed according to the American–European Consensus Group Classification Criteria and group (2) which included fifteen RA patients not associated with sSS. Ten healthy subjects were included as a control group. Patients were subjected to full history taking, clinical examination, and laboratory detection of CXCL13 level in the plasma and saliva of patients as well as the control groups using ELISA technique. Assessment of disease activity in RA patients was done using the disease activity score (DAS28).ResultsPlasma levels of CXCL13 were significantly higher in RA patients than control group (p<0.001). Plasma levels of CXCL13 were significantly correlated with the RA disease activity (r=0.677, p<0.001) and disease duration (r=0.406, p<0.05), while the salivary levels were higher in those with sSS and correlated with sSS disease duration (r=0.536, p<0.05). A highly significant correlation was found between salivary CXCL13 and severity of sSS (r=0.816, p<0.001). Salivary levels of CXCL13 above 110pg/ml may diagnose sSS with sensitivity 80% and specificity 84%.ConclusionThe results of this preliminary study point out the importance of CXCL13 as a marker for RA disease activity, its role in diagnosing sSS, and estimation of sSS severity

PERFORMANCE EXAMINATION OF AES ENCRYPTION ALGORITHM WITH CONSTANT AND DYNAMIC ROTATION

ABTRACT Lately, the Rijndael algorithm has been standardized by the NIST as the Advanced Encryption Standard (AES). This makes AES an essential and necessary data-protection mechanism for federal agencies in the US and other countries. In AES, rotation occurs in key expansion, ciphering, and deciphering. Rotation is vital for confusion and diffusion, which play an important role in any cryptography technique. Confusion and diffusion make breaking the key complex and difficult. This paper studies the effect of reconfiguring the structure of AES, especially replacing constant rotation with variable rotation. The resulting twin cipher is called Dynamic Rotation for Advanced Encryption Standard (DRAES). DRAES with variable rotation increases the complexity of the algorithm, and thus, increases the time consumed for brute-force attacks. We measured the diffusion of AES and DRAES algorithms. DRAES reached acceptable level of diffusion faster than AES

Crystal structure of 4,6-di­methyl-2-{[3,4,5-trihy­dr­oxy-6-(hy­dr­oxy­meth­yl)tetra­hydro-2H-pyran-2-yl]sulfan­yl}nicotino­nitrile

In the title compound, C14H18N2O5S, the C—S bond lengths are unequal, with S—Cglucose = 1.8016 (15) Å and S—Cpyrid­yl = 1.7723 (13) Å. The hydro­philic glucose residues lie in the regions z ≃ 0.25 and 0.75. Four classical hydrogen bonds link the mol­ecules to form layers parallel to the ab plane, from which the pyridyl rings project; pyridyl ring stacking parallel to the a axis links adjacent layers

Myocardial Deformation Imaging Meta-Analysis in Two Cohorts of Patients from UAE and Heart Hospital Hamadmedical Corporation: A Potential Role in Assessment of Coronary Artery Disease Severity and Myocardial Viability

Introduction: The increasing prevalence of heart failure (HF) in coronary artery disease (CAD) urgently requires the establishment of new imaging techniques for early diagnosis and also to guide treatment of patients presented with acute coronary syndromes (ACS). Conventional echocardiography (CE) and electrocardiogram (ECG) are the gold standard methods in assessing myocardial ischemia (MI) and the function of the heart in patients with coronary artery disease (CAD). The lack of ST elevation by ECG and regional wall motion abnormalities by CE in non-ST segment elevation myocardial infarction (NSTEACS) in ACS patients reflect limited sensitivity of ECG and CE in identifying patients with acute coronary occlusion (ACO) and proper assessment of myocardial viability. Aim of this study: This study now evaluates the ability of strain parameters in grading the severity of CAD to detect myocardial viability in ACS through a comparative meta-analysis in two cohorts of patients living in the UAE and Qatar. The study investigates the diagnostic accuracy of left ventricular longitudinal systolic strain function (GLS) by 2D-speckle tracking echocardiography (2D-STE), Territorial Longitudinal Strain (TLS) analysis and post systolic strain (PSS) in ACS patients admitted at the emergency departments. All the patients had acute chest pain which is highly suggestive of NSTEACS along with coronary angiography (CA). Methods: The study recruited two groups, comprising of 347 patients, who were presented with acute coronary syndrome (NSTEACS) at the emergency department. The first group had 214 consecutive patients who had acute chest pain and high-risk profile and they were admitted to the emergency department at Eastern Emirates Hospitals, El-Fujairah-Dibba (EEEH), UAE. The second group consisted of 133 from emergency department at Heart Hospital- Hamad Medical Corporation (HHHMC), Qatar. In both groups, 85% of the patients were men with ages from 32 to 65 years (mean ± SD: 49.4 ± 9.5 years). Significant CAD was defined as having at least one epicardial vessel with ≥ 70% or left main>50% stenosis. All patients enrolled in this study underwent basic echocardiography, speckle tracking analysis, and coronary angiography. In 70 patients, PSS was calculated and myocardial perfusion imaging (MPI) was utilized as gold standards for the assessment of myocardial viability in patients with documented NSTEACS. The sensitivity, specificity, positive and negative predictive values of peak longitudinal systolic strain (2D-STE) and PSS were calculated. Left ventricular systolic strain was displayed as bull’s eye plot and territorial longitudinal strain (TLS) in the territory of the infarct-related artery. They were obtained within 24 hours from admission. Coronary angiography (CA) was performed within 24 hours from admission and used as a reference tests to assess the severity of CAD. Results: Echocardiogram obtained from the patients showed any no wall motion abnormalities at rest, although speckle tracking analysis was abnormal in 167 patients. In the first group of patients from the UAE, GLS showed a high sensitivity of 80% and a very high specificity of 93% for detection of significant CAD. In addition, PSS demonstrated a high sensitivity of 80% with an average specificity of 57%. The combination of GLS and PSS showed a further increase in sensitivity, specificity with positive and negative predictive values of 98%, 91%, 99% and 97%, respectively. Therefore, a very high correlation of GLS and PSS with coronary angiography was demonstrated: =0.90, p<0.0001 and R=0.88, p<0.0001, respectively. Furthermore, PSS showed a very high concordance with MPI scan (stress-rest-re injection studies) in detection of ischemic viable myocardium with very high sensitivity of 85%, r=0.79. In the Qatari (HHHMC) patients, a multi-vessel disease or left main disease (MV) was documented in 53.6%, and those with single vessel disease (SV) in 46.4%. LAD, circumflex and RCA lesions were found in 65, 50 and 39 patients, respectively. A control group of 129 cases was selected from outpatients referred to the echocardiography unit. The results showed that in comparison to CA, GLS sensitivity and specificity were 84% and 70%, respectively in all the patients. The sensitivity of GLS was 87% in MV and 80% in SV. Territorial strain sensitivity was 50%, 74% and 84.6% for the left anterior descending artery (LAD), circumflex and right coronary artery (RCA), respectively compared to specificity values of 64%, 65% and 61.7%, respectively. Conclusion: It is concluded that GLS by speckle tracking analysis is definitely an accurate method in early diagnosis of the severity of CAD in patients presenting with NSTE ACS. The combined use of GLS and PSS showed very high diagnostic accuracy for the identification of significant CAD in these patients. Strain imaging by STE may be applied to diagnose the severity of myocardial ischemia by showing reduction in peak systolic strain. Moreover, it is equally important to demonstrate post-systolic shortening which is a characteristic feature of ischemic viable myocardium after ACS requiring revascularization

Preterm Small Gestational Age Newborns: Impact on Renal Size and Function

OBJECTIVE: The objective of the study was to evaluate the size and function of the kidney in high-risk premature small gestational age (PT/SGA) newborns. Furthermore, estimation of the glomerular filtration rate (GFR) was done by comparing Cystatin C-based method with the creatinine –based method in those preterm newborns. PATIENTS AND METHODS: The study included 20 PT/SGA and controls (20 preterm appropriate for gestational age [PT/AGA] and 20 full-term [FT] newborns). Serum creatinine, blood urea nitrogen, and cystatin C were determined on days 3 and 7 of the study for all newborn infants. GFR was assessed by cystatin C-based method and creatinine-based method. Evaluation of the renal size by ultrasound was done on day 7 of neonatal life. RESULTS: A significant difference was found in the length and transverse diameter of both kidneys, comparing PT/SGA group with PT/AGA and FT group. Cystatin C on day 3 of PT/SGA group had a significant difference than PT/AGA and FT group. Estimation of GFR (eGFR) calculated by filler Zappitelli, Grubb, Larsson, and Dorum formulae of PT/SGA group had a significant difference comparing with PT/AGA and FT group on days 3 and 7. CONCLUSION: PT/SGA newborns have reduced renal size and immature renal function. Cystatin C is a marker for renal function superior to creatinine as it is not affected by body mass index, gestational age, and birth weight. Cystatin C-based eGFR is more accurate and more sensitive to minor changes in GFR than creatinine-based equation

Advanced Carotid Atherosclerosis and the Risk of Subsequent Major Cardiovascular Events: Carotid Ultrasound Study

Introduction: Very little is known about the role of atherosclerotic carotid plaque morphology, vulnerability, and Total Plaque Area (TPA) in the development of Major Cardiovascular Events (MCVE). Aim of this study: To assess the role of carotid atherosclerosis and the plaque morphology in the prediction of MCVE. Importance of the study: A better understanding of the role of detection of atherosclerosis and unstable plaque morphology can help to improve strategies for prevention of Acute Cardiovascular Events (ACVE) worldwide. Methods: This study analyzed the medical records of 452 patients with 2.5-years follow-up. The primary outcomes were the composite of first occurrence of stroke, cardiovascular death, and Acute Coronary Syndromes (ACS) hospitalization. Results: The results show that carotid atherosclerosis was present in 44% of patients (n=103) and this was associated with increasing conventional cardiovascular risk factors and extent of symptomatic vascular disease. During 2.5 years follow-up, 10% of patients experienced ≥ 2 MCVE. After adjustment for cardiovascular risk factors, the risk of ACS and stroke increased by 23% (95% Confidence Interval [CI]), and 45% (95% confidence interval), respectively in patients with carotid ultrasonic (US) evidence of advanced carotid atherosclerosis in comparison to control (P<0.001). The relative increase of cerebrovascular events was 22% in patients with carotid US evidence of vulnerable plaque morphology versus benign morphology. The high risk for all-cause and cardiovascular death of these patients remained significant after adjustment for various established cardiovascular risk factors in multivariable regression analysis (adjusted hazard ratio 2.4, P<0.001; compared to patients without US evidence of advanced carotid atherosclerosis features). Conclusion: It is concluded that carotid TPA and features of vulnerability were associated with an increased risk of MCVE

Modulation of steroidogenesis by Actaea racemosa and vitamin C combination, in letrozole induced polycystic ovarian syndrome rat model : promising activity without the risk of hepatic adverse effect

Background: Complementary remedies such as the Chinese herb 'Sheng Ma' (Black cohosh; Actaea racemosa 'AR') are being sought to overcome the shortcomings of conventional hormonal and surgical therapies developed for the treatment of polycystic ovary syndrome (PCOS). However, AR-induced hepatotoxicity necessitates a cautionary warning to be labeled on its products as recommended by the United States Pharmacopeia, where four out of seven hepatotoxic cases in Sweden were possibly associated with black cohosh products. Methods: We investigated the effects, safety, and molecular targets of black cohosh ethanolic extract and/or vitamin C on ovarian functionality and oxidative response in hyperandrogenism-induced PCOS rats. A well-established rat model using oral letrozole, daily, for 21 days was employed. The rats then received the AR extract with and without vitamin C for 28 days. The hormonal evaluation, antioxidant status, histopathological examination, immunohistochemical analysis, cell proliferation, and the expression ratio of the aromatase (Cyp19α1) gene were evaluated. Additionally, holistic profiling of the AR arsenal of secondary metabolites was performed using ultra-high-performance liquid chromatography (UHPLC) coupled with quadrupole high-resolution time of flight mass spectrometry (QTOF-MS). Results: Beneficial effects were exerted by AR in PCOS rats as antioxidant status, hormonal profile, lipid profile, glucose level, liver functions, and the induced Ki-67 expression in the granulosa, theca cell layers and interstitial stromal cells were all improved. Notably, the combination of AR with vitamin C was not only more effective in reversing the dysregulated levels of testosterone, luteinizing hormone, and mRNA level of Cyp19α1 gene in the PCOS rat, but also safer. The combination regulated both ovarian and hepatic malondialdehyde (MDA) and glutathione (GSH) levels with histological improvement observed in the liver and ovaries. In addition, the untargeted metabolomic profiling enabled the identification of 61 metabolites allocated in five major chemical classes. Conclusion: This study demonstrated the benefit of the combinatorial effects of AR and vitamin C in mitigating the reproductive and metabolic disorders associated with PCOS with the elimination of AR hepatotoxic risk