Radiologic Management of Vascular Malformations’ Interventional, Classification and Diagnosis

This study aimed at analyzing the diverse group of congenital vascular malformations, with respect to their place within the broader classification of vascular anomalies and their pathologic, clinical, and radiologic diagnosis and management. And the study discuss some of the techniques, agents, and approaches used in the interventional treatment of this difficult group of lesions. The researchers are aware and acknowledge that there are several different techniques and agents that can be used to treat these lesions. The techniques and agents described in this article have been used for years by the experts with good results. The aim of this study is to share experience in the management of vascular malformations with these techniques at Jordanian hospitals, and to assess the patient satisfaction levels by the evaluation of the follow-up of patients with vascular malformations treated in the Interventional Radiology Unit from January 2016 to December 2016. Patients were classified according to the hemodynamics of the lesions (high- vs. low-flow)

P73 Preliminary results of the Study of Acute Liver Transplant (SALT): NSAID exposure and risk of acute liver failure leading to transplantation in 7 European countries

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Pediatric Dermatology In Family Medicine: Common Conditions And Management Strategies

Among the most prevalent disorders are those related to the skin.  However, in medical education and training, this class of illnesses is frequently disregarded. The first line of defence for the treatment of common dermatological diseases is a family physician. The purpose of our study was to evaluate the particular identification, management, encountering, and referral practices related to dermatological illnesses in family care. We also looked into the challenges and opportunities that family doctors experience in family medicine and saw a few of the paediatric dermatological diseases that family doctors may encounter.  Finding areas of weakness in the clinical therapy of certain dermatological disorders, however, will be aided by assessing how family doctors treat particular ailments. Thus, this needs assessment might serve as a foundation for future research on the efficacy of family medicine in treating common paediatric dermatological problems as well as aid in the development of evidence-based training for family physicians in the area

Reduced microvascular density in omental biopsies of children with chronic kidney disease

Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD.Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2.Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01).Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease

ОПРОКИНУТАЯ ЭОЦЕН-НИЖНЕПЛИОЦЕНОВАЯ АЛЛЮВИАЛЬНАЯ ТОЛЩА НА ЮЖНОМ БЕРЕГУ ОЗ. БАЙКАЛ И ЕЕ НЕОТЕКТОНИЧЕСКОЕ ЗНАЧЕНИЕ

The study is focused on a section of sediments exposed on the right bank of Mishikha River, Russia. These sediments have a wide range of ages, from the Eocene to the Lower Pliocene. The stratigraphic subdivision of the section is based on the lithogeochemical data and X-ray phase analysis of the mineral compositions. The particle-size analysis shows the alluvial origin of the deposits. Their ages are constrained by spore-pollen spectra in three palynozones: I – Eocene – Oligocene, II – Early – Middle Miocene (subzone a – Tsuga, Picea in the lower part, and Quercus, Taxodiaceae, Momipites, Carya in the upper part; subzone b – Fagus, Quercus, Tsuga), and III – the Late Miocene – beginning of the Pliocene (subzone ν – Ulmus, Juglans, Carya; subzone g – Carya, Alnus). The section shows a combination of normal and overturned sedimentary layers. The tectonic displacement of the block with its flip was accompanied by the entry into contact of the unlithified Pliocene sediments with a rigid bed and the development of a landslide. The lower age limit of deformations is constrained from the youngest (beginning of the Pliocene) spore and pollen spectrum extracted from deformed layers. It is suggested that the overturned layers result from strike-slip deformations of the sediments at the beginning of the late orogenic stage of the Baikal rift development. The regional correlations of the sedimentary strata give grounds to conclude that the Mishikha section is characteristic of alluvial sedimentation that dominated at the eastern end of the Tankhoi tectonic step (Mishikha-Klyuevka paleovalley), in contrast to the Tankhoi block in the central part of the step, wherein a thick Lower Miocene stratum of swampy-oxbow sediments accumulated. The stratons of the Mishikha section correlate with sedimentary units detected by drilling in the Selenga delta at the central part of the South Baikal basin.Разрез осадочных отложений широкого (эоцен-нижнеплиоценового) возрастного диапазона вскрыт и изучен на правобережье р. Мишиха. Стратиграфическое расчленение разреза основано на данных литогеохимии и рентгенофазового анализа минерального состава отложений. По результатам гранулометрического анализа сделан вывод об аллювиальном происхождении отложений. Их возраст определен по спорово-пыльцевым спектрам, которые отнесены к трем палинозонам: I – эоцена – олигоцена, II – раннего и среднего миоцена (подзона a – в нижней части Tsuga, Picea, в верхней части Quercus, Taxodiaceae, Momipites, Carya; подзона b – Fagus, Quercus, Tsuga) и III – позднего миоцена – начала плиоцена (подзона ν – Ulmus, Juglans, Carya; подзона g – Carya, Alnus). В разрезе установлено сочетание нормального и опрокинутого залегания осадочных слоев. Тектоническое смещение блока с его переворотом сопровождалось вхождением в контакт нелитифицированных плиоценовых осадков с жесткой подложкой и развитием оползня. Нижний предельный возраст деформаций определен по наиболее молодому (начало плиоцена) спорово-пыльцевому спектру, полученному в деформированных слоях. Предполагается, что в опрокинутом залегании реализованы присдвиговые деформации отложений в начале позднеорогенного этапа развития Байкальского рифта. Из региональных корреляций толщ сделан вывод о том, что Мишихинский разрез характеризует аллювиальное осадконакопление, которое доминировало на восточном окончании Танхойской тектонической ступени, в Мишихинско-Клюевской палеодолине, в отличие от Танхойского блока центральной части ступени, в котором обнажена мощная нижнемиоценовая толща болотно-старичной фации. Стратоны Мишихинского разреза коррелируются со стратонами, вскрытыми скважинами в дельте р. Селенги в центральной части Южно-Байкальской впадины

Chlorhexidine versus Povidone-Iodine for the prevention of ‎Surgical Site ‎Infections: A review.‎

BackgroundSurgical Site Infections (SSIs) are the third most frequently reported health care-associated ‎infection‎ and it remain a major clinical problem despite improvements in prevention, as they ‎are associated with ‎significant mortality and morbidity. Prevention strategies for SSIs are based ‎on reducing the risk of infection by bacteria, So many antiseptic agents are ‎used, the most ‎common one are Chlorhexidine and Povidone-Iodine.‎AimsTo discuss the ‎findings of RCTs that compare Chlorhexidine versus Povidone-Iodine in the prevention of ‎Surgical ‎Site ‎Infections (SSIs).‎Methods This systematic review was carried out, including PubMed, Google Scholar, and EBSCO that ‎examining randomized trials of Chlorhexidine and Povidone-Iodine to summarize the major ‎RCT that compare Chlorhexidine versus Povidone-Iodine in the prevention of Surgical Site ‎Infections (SSIs).‎Results The review included six randomized studies that compare between Chlorhexidine and Povidone-‎Iodine for the prevention of SSIs. The findings showed that many studies prefer using ‎Chlorhexidine over Povidine-Iodine to reduce SSIs, few studies prefer using PVI as antiseptic ‎and other studies reported that there is no significant difference between both. ConclusionMajority of results prefer using Chlorhexidine than Povidone-Iodine‎ as antiseptics but ‎there were few findings prefer ‎PVI and other studies reported that there was no significant ‎difference between using them as ‎antiseptics.

Five Nuclear Loci Resolve the Polyploid History of Switchgrass (Panicum virgatum L.) and Relatives

Polyploidy poses challenges for phylogenetic reconstruction because of the need to identify and distinguish between homoeologous loci. This can be addressed by use of low copy nuclear markers. Panicum s.s. is a genus of about 100 species in the grass tribe Paniceae, subfamily Panicoideae, and is divided into five sections. Many of the species are known to be polyploids. The most well-known of the Panicum polyploids are switchgrass (Panicum virgatum) and common or Proso millet (P. miliaceum). Switchgrass is in section Virgata, along with P. tricholaenoides, P. amarum, and P. amarulum, whereas P. miliaceum is in sect. Panicum. We have generated sequence data from five low copy nuclear loci and two chloroplast loci and have clarified the origin of P. virgatum. We find that all members of sects. Virgata and Urvilleana are the result of diversification after a single allopolyploidy event. The closest diploid relatives of switchgrass are in sect. Rudgeana, native to Central and South America. Within sections Virgata and Urvilleana, P. tricholaenoides is sister to the remaining species. Panicum racemosum and P. urvilleanum form a clade, which may be sister to P. chloroleucum. Panicum amarum, P. amarulum, and the lowland and upland ecotypes of P. virgatum together form a clade, within which relationships are complex. Hexaploid and octoploid plants are likely allopolyploids, with P. amarum and P. amarulum sharing genomes with P. virgatum. Octoploid P. virgatum plants are formed via hybridization between disparate tetraploids. We show that polyploidy precedes diversification in a complex set of polyploids; our data thus suggest that polyploidy could provide the raw material for diversification. In addition, we show two rounds of allopolyploidization in the ancestry of switchgrass, and identify additional species that may be part of its broader gene pool. This may be relevant for development of the crop for biofuels

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely