Positive susceptibility vessel sign on SWI-MRI sequence imaging might differentiate patients had silent brain ischemia among apparently neurologically-free patients

Background: The susceptibility-weighted imaging (SWI) is an essential MRI sequence in the assessment of acute ischemic stroke. Silent cerebrovascular disease is five times more prevalent than symptomatic brain infarcts and is associated with future risk for stroke and dementia.Objectives: Evaluation of the diagnostic performance of susceptibility-weighted magnetic resonance sequence imaging (SWI) for early diagnosis of silent brain infarction (SBI) in apparently neurologically-free patients presented by transient neurological manifestations.Patients and Methods: The study included 218 patients who were clinically evaluated for demographic, clinical data concerning presence of chronic medical diseases, presenting symptoms and its frequency and severity. Routine lab investigations and lipid profile were performed and the plasma atherogenic index (PAI) for oncoming cardiovascular insults was calculated. MRI scan was performed using 1.5 T MRI scanner (Toshiba Vantage) with a head coil. Results: 102 patients (46.8%) had chronic medical diseases and hypertension (HTN) and diabetes mellitus (DM) are the most common. The commonest complaint was occasional amnesia, slurred speech and weak handgrip. PAI defined 53 patients at high, 101 patients at intermediate and 64 patients at low risk of cardiovascular insults. Susceptibility vein sign (SVS)+ were detected in 78 SWI scans and showed positive significant correlation with smoking, multiple co-morbidities, presence of chronic kidney disease, DM, hypertension and with PAI.Conclusion: The presence of SVS in SWI during MRI examination is pathognomonic sign for the presence of SBI. The incidence of SBI on SWI scans of apparently neurologically free patients who presented by transient neurological manifestations is high and was found to be associated with the presence of chronic medical diseases especially in obese dyslipidemic patients

The role of transcranial grayscale and Doppler ultrasound examination in diagnosis of neonatal hypoxic-ischemic encephalopathy

Background: The role of transcranial grayscale ultrasound (TC-GSUS) and transcranial color Doppler (TCD) in the diagnosis and prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) is still questionable.Objective: This study targeted to evaluate the role of TC-GSUS and TCD in diagnosis and prediction of the outcome of neonates with suspected HIE in comparison to Sarnat's clinical scoring.Patients and methods: 26 neonates with suspected HIE were clinically evaluated and the severity of HIE was categorized according to Sarnat's clinical staging. Then, all neonates underwent sonographic examinations. TC-GSUS was performed at levels of anterior, mastoid, and posterior fontanelles and the level of the temporal window.Results: Cranial biometry had negative and positive rates for HIE of 7.7% and 92.3%, respectively. Using TC-GSUS, periventricular leukomalacia, intraventricular hemorrhage, brain edema, and hydrocephalus were detected in 17, 19, 14, and 16 patients, respectively. According to the resistive index (RI) of intracranial vessels, TCD excluded HIE in 11 patients and assured diagnosis of HIE with varying severity in 15 patients. Five neonates died and four developed neurological affection during follow-up. The outcome was correlated with Sarnat’s scoring, ventricular-hemispheric ratio, and abnormalities of RI. Statistical analyses defined severity of HIE as judged by RI as the significant predictor for mortality and abnormal RI of anterior cerebral (ACA) and internal carotid arteries (ICA) are the most significant predictors of outcomes.Conclusion: TCD can diagnose HIE in neonates with high sensitivity and specificity and abnormal RI of ICA and ACA might be used as valuable diagnostic and prognostic tests

Mild Cognitive Impairment among Type II Diabetes Mellitus Patients Attending University Teaching Hospital

BACKGROUND: Type II diabetes mellitus (TIIDM) has been associated with structural and functional changes in the brain. TIIDM is commonly associated with obesity, insulin resistance, hypertension, and dyslipidemia, all of which can have negative impact on brain. AIM: The aim of the study was to study the risk of mild cognitive impairment (MCI) among both diabetics and non-diabetics and to identify risk factors to MCI among both groups. METHODS: Two comparative cross-sectional studies were carried out enrolling 100 diabetics and 100 age, sex, and education matching non-diabetics. Cognitive function was assessed using Montreal Cognitive Assessment (MoCA) test and risk factors for MCI were assessed. RESULTS: The subjective complaint of memory impairment among diabetics was significantly higher (34%) compared to non-diabetics (13.0%), p < 0.05. The mean of objective MoCA score was significantly lower among diabetics (25.9 ± 2.5) compared to non-diabetics (27.4 ± 2.4), p < 0.001. The rate of MCI was significantly higher among TIIDM patients (22%) compared to non-diabetics (9%), p < 0.01 and odds ratio (OR) 2.8 (95% confidence interval 1.2–6.5). Among the two studied groups, the rate of MCI was significantly higher among those aged over 50 years compared to younger age as well as among hypertensive compared to non-hypertensive persons, (p < 0.05). Among diabetics, the MCI was significantly higher among those with secondary education, having heart diseases, longer duration of DM, or repeated hypoglycemia attack, p < 0.05. A healthy diet, brain training, and social activities were found to be significantly associated with normal cognition. Logistic analysis revealed that diabetics aged above 50 was the only significant predicting factor for MCI with an OR 2.9 (95% CI: 3.8–123.3), p < 0.001. CONCLUSION: TIIDM is significantly associated with 3-times increasing risk of having MCI compared to non-diabetics. The age, hypertension, cardiovascular diseases, duration of diabetes, and frequency of hypoglycemic episodes are risk factors for cognitive impairment. A healthy diet, brain training, and social activities were associated with better cognitive function

SIGNIFICAN ENHANCEMENT OF OPTICAL PROPERTIES THROUGH METHYLCELLULOSE (MC) / GADOLINIUM OXIDE COMPOSITES

In the present work, Methylcellulose (MC) with Gd2O3 composite films were prepared to study the optical properties. and investigate the effect of adding Gd2O3 nanoparticles with MC in linear optical investigation.W.I.A. and I.I.N. thank Department, Faculty of Science, Tanta University, for financial support

RADIATION SHIELDING PROPERTIES OF METHYLCELLULOSE (MC)/GADOLINIUM OXIDE COMPOSITES

In the present work, the influence of weight percentages of Gd2O3 content (10%-30%) of reinforced MC composites in their photon absorption capabilities for photon energies, ranging from 0.01 to 3 MeV, were investigated. MC with Gd2O3 composite films was prepared via a solution casting method

Evaluation of Antimicrobial bioactive compounds from Endophytic Fungi Isolated from Moringa oleifera

Endophytic fungi are microorganisms that inhabit the living tissues of their host plants without causing any host loss. They are considered as a continuous natural source of novel bioactive secondary metabolites with potential application in medicine, which are almost same to their host plant. In this study a total of nine endophytic fungal isolates were collected from leaves and stems of Moringa oleifera. Based on the colonization frequency (CF) results, the highest number of isolates was obtained from plant stem, while the least was from leaves. The nine isolates were identified by keeping track of morphological and microscopic observations. Identification of the two antimicrobial potent strains was confirmed by 18S rDNA-based molecular analysis. The nine isolates were found belonging to Chaetomium, Alternaria, Fusarium, Aspergillus, Mycelia, Penicillium and Nigrospora taxa. Among them, Chaetomium taxon was included the highest CF) 40% (. Evaluation of antimicrobial activity documented ethyl acetate fungal extract as the highest effective inhibitor against Gram-negative and Gram-positive bacteria, and Aspergillus fumigatus. Minimum inhibitory concentration (MIC) was examined for the two most potent antimicrobial effective extracts, from Chaetomium laterale and Chaetomium interruptum; it was ranged from 12.5 to 0.39 mg/ml

Structure, Morphology and Electrical/Magnetic Properties of Ni-Mg Nano-Ferrites from a New Perspective

Using the auto combustion flash method, Ni1−x+2 Mg+2xFe+32O4 (x = 0, 0.2, 0.6, 0.8 and 1) nano-ferrites were synthesized. All samples were thermally treated at 973 K for 3 h. The structural analysis for the synthesized samples was performed using XRD, high-resolution transmission electron microscopy (HRTEM), and FTIR. Scanning electron microscopy (SEM) was undertaken to explore the surface morphology of all the samples. The thermal stability of these samples was investigated using thermogravimetric analysis (TGA). XRD data show the presence of a single spinel phase for all the prepared samples. The intensity of the principal peak of the spinel phase decreases as Mg content increases, showing that Mg delays crystallinity. The Mg content raised the average grain size (D) from 0.084 µm to 0.1365 µm. TGA shows two stages of weight loss variation. The vibrating sample magnetometer (VSM) measurement shows that magnetic parameters, such as initial permeability (µi) and saturation magnetization (Ms), decay with rising Mg content. The permeability and magnetic anisotropy at different frequencies and temperatures were studied to show the samples’ magnetic behavior and determine the Curie temperature (TC), which depends on the internal structure. The electrical resistivity behavior shows the semi-conductivity trend of the samples. Finally, the dielectric constant increases sharply at high temperatures, explained by the increased mobility of charge carriers, and decreases with increasing frequency. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Princess Nourah Bint Abdulrahman University, PNU: PNURSP2022R28The authors express their gratitude to Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2022R28), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe