Oropharyngeal and otorhinological changes in end stage renal patients undergoing hemodialysis

The study aimed to assess oropharyngeal and otorhinolaryngological changes in end stage renal disease (ESRD) patients undergoing hemodialysis and correlate the findings to renal functions. This case-control study compared oral and otorhinolaryngologica

Surgical Intervention for Moderate Ischemic Mitral Regurge During Coronary Revascularization (Comparative Study)

Abstract: Background: Ischemic mitral regurgitation is a common clinical problem of coronary artery disease (CAD), developing acutely after myocardial infarction in up to 19 % of patients. For patients with ischemic mitral regurgitation (IMR), it is not clear whether adjunctive mitral valve (MV) repair at the time of coronary artery bypass graft surgery (CABG) is beneficial. Objective: To compare the outcome of patients with moderate ischemic mitral regurgitation , those surgically corrected at time of coronary artery bypass grafting either by repair or replacement, versus those treated by coronary artery bypass grafting alone. Patients and methods: Between October 2009 and October 2011, a cohort of sixty patients with ischemic heart disease associated with moderate ischemic mitral regurgitation. The study was carried out in the department of cardiothoracic surgery of Al Azhar University and Nasr Institute. All patients had CAD with moderate IMR and were admitted for CABG combined with mitral repair versus CABG alone. Results: After our study evaluation, we found that patients who were offered the combined approach of CABG with repair, showed more improvement as regard to clinical and echocardiographic parameters, compared to those who were offered the CABG alone procedure. We also found that a worse preoperative left ventricle (LV) function is a risk factor to the persistence or progression of the IMR grades in the CABG only patients. Conclusion: We concluded that the MV repair procedure done in our first group patients offered some protection against the persistence or progression of the IMR grades

Study of microRNAs-21/221 as potential breast cancer biomarkers in Egyptian women

microRNAs (miRNAs) play an important role in cancer prognosis. They are small molecules, approximately 17–25 nucleotides in length, and their high stability in human serum supports their use as novel diagnostic biomarkers of cancer and other pathological conditions. In this study, we analyzed the expression patterns of miR-21 and miR-221 in the serum from a total of 100 Egyptian female subjects with breast cancer, fibroadenoma, and healthy control subjects. Using microarray-based expression profiling followed by real-time polymerase chain reaction validation, we compared the levels of the two circulating miRNAs in the serum of patients with breast cancer (n = 50), fibroadenoma (n = 25), and healthy controls (n = 25). The miRNA SNORD68 was chosen as the housekeeping endogenous control. We found that the serum levels of miR-21 and miR-221 were significantly overexpressed in breast cancer patients compared to normal controls and fibroadenoma patients. Receiver Operating Characteristic (ROC) curve analysis revealed that miR-21 has greater potential in discriminating between breast cancer patients and the control group, while miR-221 has greater potential in discriminating between breast cancer and fibroadenoma patients. Classification models using k-Nearest Neighbor (kNN), Naïve Bayes (NB), and Random Forests (RF) were developed using expression levels of both miR-21 and miR-221. Best classification performance was achieved by NB Classification models, reaching 91% of correct classification. Furthermore, relative miR-221 expression was associated with histological tumor grades. Therefore, it may be concluded that both miR-21 and miR-221 can be used to differentiate between breast cancer patients and healthy controls, but that the diagnostic accuracy of serum miR-21 is superior to miR-221 for breast cancer prediction. miR-221 has more diagnostic power in discriminating between breast cancer and fibroadenoma patients. The overexpression of miR-221 has been associated with the breast cancer grade. We also demonstrated that the combined expression of miR-21 and miR-221can be successfully applied as breast cancer biomarkers

Pelvic exenteration and composite sacral resection in the surgical treatment of locally recurrent rectal cancer

AbstractBackgroundThe incidence of rectal cancer recurrence after surgery is 5–45%. Extended pelvic resection which entails En-bloc resection of the tumor and adjacent involved organs provides the only true possible curative option for patients with locally recurrent rectal cancer.AimTo evaluate the surgical and oncological outcome of such treatment.Patients and methodsBetween 2006 and 2012 a consecutive series of 40 patients with locally recurrent rectal cancer underwent abdominosacral resection (ASR) in 18 patients, total pelvic exenteration with sacral resection in 10 patients and extended pelvic exenteration in 12 patients. Patients with sacral resection were 28, with the level of sacral division at S2–3 interface in 10 patients, at S3–4 in 15 patients and S4–5 in 3 patients.ResultsForty patients, male to female ratio 1.7:1, median age 45years (range 25–65years) underwent extended pelvic resection in the form of pelvic exenteration and abdominosacral resection. Morbidity, re-admission and mortality rates were 55%, 37.5%, and 5%, respectively. Mortality occurred in 2 patients due to perineal flap sepsis and massive myocardial infarction. A R0 and R1 sacral resection were achieved in 62.5% and 37.5%, respectively. The 5-year overall survival rate was 22.6% and the 4-year recurrence free survival was 31.8%.ConclusionExtended pelvic resection as pelvic exenteration and sacral resection for locally recurrent rectal cancer are effective procedures with tolerable mortality rate and acceptable outcome. The associated morbidity remains high and deserves vigilant follow up

Occurrence of unusual non-fermentative gram negative bacilli in intensive care units of a university hospital, Egypt

Non-fermentative Gram-negative bacilli (NFGNB) other than Pseudomonas and Acinetobacter species have emerged as nosocomial pathogens. No much data is currently available concerning the occurrence of these types of bacteria in Zagazig University Hospitals (ZUHs). In this study, the occurrence as well as the antimicrobial susceptibility pattern of unusual NFGNB obtained from clinical samples collected from intensive care units (ICUs) of ZUHs was assessed. Additionally, the genetic relatedness among the most prevalent unusual NFGNB species was studied.Results: Out of 516 non-repeated clinical sample, 97 NFGNB (18.7%) were isolated. Among them, 17 unusual NFGNB were identified by API 20NE, accounting for 17.5% of NFGNB and 3.3% of all tested samples. Within the unusual NFGNB, Burkholderiacepaciacomplex (Bcc) was the most prevalent species accounting for 94.1% of NFGNB and 3.1% of total samples. This was followed by Burkholderia pseudomallei (B. pseudomallei) which accounted for 5.9% of NFGNB and 0.2% of all obtained specimens. Tigecycline antibiotic was the most effective antibiotic against Bcc isolates (68.8% susceptibility) in disc diffusion method. After random amplified polymorphic DNA (RAPD) testing, the obtained Bcc isolates were found to be genetically diverse. This highlights Bcc as an emerging nosocomial pathogen in ICUs of ZUHs. Continuous monitoring of the occurrence of Bcc in ICU as well as in other hospital wards is warranted.Keywords: ʺUnusualʺ, ʺNon-fermentativeʺ, ʺgram-negative bacilliʺ, ʺintensive care unit

PATHOPHYSIOLOGY, INVESTIGATIONS, AND TREATMENT OF PATIENTS WITH BICUSPID AORTIC VALVE

Bicuspid aortic valve is a congenital anomaly of the heart in which the aortic valve has two loops instead of the normal three. It causes valve degeneration and is associated with dilation of the aorta. This exercise discusses the role of inter-professional team in improving the management of patients with bicuspid aortic valves and describes the diagnosis and management of this problem. The purpose of this review article is to describe the epidemiology of bicuspid aortic valve, describe the presentation of patients with bicuspid aortic valve, summarize the use of electrocardiogram and echocardiogram in bicuspid aortic valve evaluation, and explain the importance of collaboration and communication. Interprofessional team to improve care coordination for patients with bicuspid aortic valve

ETIOLOGY, INVESTIGATIONS, AND TREATMENT IN CASES OF CONSTRICTIVE PERICARDITIS

The fibroelastic sac that covers the heart is known as the pericardium. It has an effect on cardiac hemodynamics and serves as a protective barrier. Constrictive pericarditis is a condition in which the pericardium grows granulation tissue, causing a loss of pericardial elasticity and ventricular filling limitation. Although it is usually a chronic condition, subacute, transient, and occult variants have been reported. The pathogenesis, symptoms, and diagnosis of constrictive pericarditis, as well as the role of the interprofessional team in its treatment, are covered in this exercise. This review article aims to describe the pathophysiology of constrictive pericarditis, review a patient's presentation with constrictive pericarditis, summarise constrictive pericarditis options for treatment, and discuss the importance of improving care coordination among interprofessional team members to enhance constrictive pericarditis patient outcomes. The 10-year survival rate for patients who get a pericardiectomy is around 50%. Medical treatment alone results in a short lifespan

PATHOPHYSIOLOGY, INVESTIGATIONS, AND MANAGEMENT OF UNSTABLE ANGINA: A REVIEW

Unstable angina pectoris is a phenomenon that disrupts the early recovery phase of acute myocardial infection, the emergence of new ischemic symptoms, the development of more severe pain, usually at rest, or the formation of intermittent ischemic events. ۔ Acute myocardial infarction is the most serious complication of unstable angina pectoris, which can affect up to 25% of patients within three months of the onset of symptoms. Physically, changes in ECG and hemodynamics usually occur before the onset of pain. The following hemodynamic changes and an increase in oxygen demand in the already ischemic heart respond positively, leading to further instability in unstable angina. Hemodynamic changes may be the result of abnormal stress response or excessive chemotherapeutic discharge. While coronary spasm may play a role in the pathogenesis of unstable angina, other factors such as bleeding in the wall of the atherosclerotic plaque, peripheral embolization, alteration, or platelet aggregation in the coronary artery from nearby soft cholesterol "abscess". Feedback should also be considered. Along with medications such as nitrates, calcium antagonists, and warnings, beta-adrenergic blockers are used to stimulate coronary and peripheral vasodilation and reduce cardiac effort. Treatment with aortic counter-pulsating balloons is recommended for those who have failed to respond to pharmacological treatment. Emergency surgery should be performed voluntarily. The full clinical and pathological compatibility of unstable angina pectoris is still unknown. Future issues will revolve around further investigations into entity procedures, treatment and prevention. The purpose of this review is to explain the pathophysiology of unstable angina, highlight changes in ECG in the assessment of unstable angina, and improve the outcome of patients with unstable angina. Consider the need to strengthen the coordination of care within the team

A REVIEW ON MITRAL REGURGITATION: PATHOPHYSIOLOGY, INVESTIGATIONS AND TREATMENT

Background: The retrograde movement of blood from the left ventricle (LV) into the left atrium (LA) through the mitral valve (MV) causes a systolic murmur heard best at the apex of the heart with radiation to the left axilla. MR is the most common valvular anomaly in the globe, affecting around 2% of the population and increasing in incidence with age. This activity examines the diagnosis and treatment of mitral regurgitation, emphasizing the importance of the healthcare team in assessing and treating patients with this illness. Conclusion: The goal of this review article is to identify the etiology and epidemiology of mitral regurgitation medical conditions and emergencies, review the proper history, physical, and evaluation of mitral regurgitation, outline the treatment and management options for mitral regurgitation, and describe interprofessional team strategies for improving care coordination and communication to advance mitral regurgitation and improve outcomes