The Relationship between Serum Procalcitonin and Dialysis Adequacy in Hemodialysis Patients

Introduction: In hemodialysis (HD) patients procalcitonin (PCT) considered as an early predictor of acute infection. It represents a new and potential marker of inflammation and may correlate with dialysis adequacy. This makes procalcitonin a potential biomarker for obesity-related low-grade inflammation.Objective: The aim of the work was to assess procalcitonin level in obese prevalent hemodialysis patients and its relation to hemodialysis adequacy. Patients and Methods: A cross sectional study was conducted on 90 patients divided into 3 groups, 40 obese (BMI ≥ 30 Kg/m2) ESRD patients on regular hemodialysis (group A), 40 non obese (BMI < 25 Kg/m2) ESRD patients on regular hemodialysis (group B) attending at Dialysis Unit, El-Sahel Teaching Hospital and 10 healthy individuals with BMI < 25 Kg/m2 as a control group (group C). All patients were subjected to detailed history taking and general examination. All patients were laboratory investigated for CBC, serum urea, creatinine, CRP, urea reduction ratio (URR), equilibrated Kt/v. All controls were subjected to written informed consent, full history, examination and CRP level. Procalcitonin level was done by ELISA technique for all patients and controls.Results: In our study, we found that there was a higher level of procalcitonin (PCT) in obese hemodialysis patient than non-obese. We also found that there was no correlation between PCT and hemodialysis adequacy in our study population.Conclusion: It could be concluded that procalcitonin is a potential biomarker for obesity-related low-grade inflammation, but not related to hemodialysis adequacy

Value of dimeglio scoring system during ponseti correction of congenital talipes equinovarus deformity

Background: When it comes to assessing the severity of an isolated clubfoot deformity and its response to therapy, the Dimeglio scoring system is universally accepted.Objective: The aim of the current work was to increase the knowledge about application of dimeglio scoring system during Ponseti correction of clubfoot.Patients and Methods: On the basis of a Randomized clinical research, at Zagazig University Hospital Orthopedic Department, and Alhawary general hospital, Benghazi, Libya, we recruited 12 patients aged lower than 1 year having idiopathic clubfoot treated using ponseti technique in duration from January 2021 to October 2021.Results: There was a statistically significant decreases in Demiglio score among cases did not need tenotomy compared to cases needed it at all times of follow up. Also, there was a statistically significant decrease in score when comparing 1st & last read in cases needed tenotomy by 89.03% and in cases did not need by 94.26 percent. The different readings of Demiglio score had accuracy 100%, 100%. 91%, 83.3% & 100% respectively in prediction of not needing tenotomy among the studied cases.Conclusion: It could be concluded that in terms of dependability, the Dimeglio scoring system is clinically relevant and may be simply used in clinical practice. The Dimeglio score is practical, easy to use, and applicable in children also above the age of 1.5 years old

Evaluation of Adding Desmopressin to Alpha Blockers in Treatment of Nocturia in Cases of Benign Prostatic Hyperplasia: A Prospective Randomized Clinical Study

Background: Nocturia is one of the most bothersome symptom of lower urinary tract symptoms in males with Benign Prostatic Hyperplasia (BPH). Alpha blockers has good effect in relieving bladder outlet obstruction.Objective: The aim of the present study was to provide best available medical treatment for nocturia in patients of BPH.Patients and methods: This prospective study was carried out on 44 male patients complaining of lower urinary tract symptoms (LUTS) of BPH with nocturia, were enrolled in this prospective randomized study for 12 weeks. They were divided randomly into 2 groups, each group included 22 patients. Group A: the patient received oral desmopressin added to tamsulosin once daily. Group B, the patient received oral tamsulosin daily.Results: The mean serum Na of patients at group A was 142.35. No significant difference regarding in-between groups before treatment but at after  12 week of treatment; group A was (mean of Na=137.68±2.033) significantly lower than  group B and significantly decreased from before to after treatment. There was no significant difference between groups in both nocturnal void and nocturnal volume before treatment and after treatment as group A was significantly lower and both groups significantly changed and improved from before to after treatment. No significant difference was found at before treatment regarding total International Prostate Symptom Score (IPSS) but group A was significantly lower regarding total IPSS after treatment and both groups significantly decreased after treatment (6.36±2.59 in group A and 10.55±4.13 in group B).Conclusion: Addition of desmopressin to α-blockers is an active therapy for men with BPH and suffering nocturia and is preferred than α-blockers therapy alone

Hearing Loss After COVID-19 Vaccines: A Systematic Review and Meta-Analysis

ABSTRACT. Background: Hearing loss is generally classified as conductive hearing loss (CHL) and sensory-neural hearing loss (SNHL). It has been reported that COVID-19 infection may affect the vestibular-hearing system causing dizziness, tinnitus, vertigo, and hearing impairment. However, other studies reported that COVID-19 did not lead to significant hearing impairment. Many studies in the literature have reported hearing loss as a complication of COVID-19 vaccines. However, no systematic review or meta-analysis summarizes the literature on this topic.   Method: We performed a comprehensive search for the following databases: PubMed, Cochrane (Medline), Web of Science, and Scopus. All studies published in English till October 2022 were included. These include case reports, case series, prospective and retrospective observational studies, and clinical trials reporting hearing loss following COVID-19 vaccines. Newcastle Ottawa scale (NOS) was used to assess the risk of bias for observational studies. NIH tools were used for non-controlled before and after clinical trials and case reports and case series. A third author solved any disagreements. We analyzed the data using SPSS Software version 26.   Results: A total of 630 patients were identified, with a mean age of 57.3 that ranged from 15 to 93 years old. The majority of the patients were females, 339 (53.8%). In addition, 328 out of 609 vaccinated patients took the Pfizer-BioNTech BNT162b2 vaccine, while 242 (40%) took the Moderna COVID-19 vaccine. The mean time from vaccination to hearing impairment was 6.2, ranging from a few hours to one month after the last dose. Most patients reported unilateral sensorineural hearing loss post-vaccination 593 (94.1%). In order to report the fate of cases, a follow-up was initiated with a mean of 15.6 and a range of 2 to 63 days after the initiation of the treatment. A total of 20 patients were fully recovered, and 11 reported no response. Three out of 328 patients who took the Pfizer-BioNTech BNT162b2 vaccine fully recovered, while five reported partial recovery. According to the chi-squared test, there is a statistically significant difference between patients in terms of fate and the type of COVID-19 vaccination (P-value = 0.001) while reporting no significant difference in dose number prior to the onset of the symptoms (P-value = 0.65) and gender (P-value = 0.4). The ANOVA test was conducted to compare vaccine types and the number of doses in terms of mean time from vaccination to hearing impairment onset. The results found a significant difference between vaccine types (P-value < 0.000) while showing no significance in terms of the number of doses prior to the onset (P-value = 0.6).   Conclusion: There is a statistically significant difference between patients in terms of fate and the type of COVID-19 vaccination while reporting no significant difference in dose number prior to the onset of the symptoms and gender. Further, we concluded that there is a significant difference between vaccine types while showing no significance in terms of the number of doses prior to the onset

Surgical management of fracture both bone forearm in pediatric using elastic stable intramedullary nail

Background: In children, forearm fractures are among the most prevalent types of fractures Operative procedures such as, pinning with K-wires, plate osteosynthesis as well as elastic-stable intramedullary nailing (ESIN) are necessary for these fractures.Objective: This study aimed to assess treating and outcomes of pediatric forearm fractures with elastic stable intramedullary nailing (ESIN).Patients and methods: At Orthopedic Departments of Zagazig University Hospital and Tripoli University Hospital, 8 skeletally immature patients with diaphyseal forearm fractures were studied in prospective cohort research. The study was carried out from November 2020 to May 2021. Pre-operative X-ray and CT were done and the patient was prepared for surgery. Elastic-stable intramedullary nailing technique was done to all patients, all patients were regularly followed clinically and radiographically for 1 week and then 2, 4, 6, 12 week after end of surgery.Results: we found that all patients progressed to union without the need for any further surgical intervention with good functional outcome as regards forearm rotation. One case had residual radius angulation more than 20 degree, no case had residual ulna angulation, 2 cases had superficial infection, 1 case had superficial radial nerve palsy and 1 case had elbow joint stiffness.Conclusion: Intramedullary fixation by flexible intramedullary nails (ESIN) is successful treatment option and recommended for pediatric patients with 4-14 years of age or older because it is simple safe and minimally invasive procedure and effective method of treatment that provides many biological and mechanical advantages

Efficient framework for brain tumor detection using different deep learning techniques

The brain tumor is an urgent malignancy caused by unregulated cell division. Tumors are classified using a biopsy, which is normally performed after the final brain surgery. Deep learning technology advancements have assisted the health professionals in medical imaging for the medical diagnosis of several symptoms. In this paper, transfer-learning-based models in addition to a Convolutional Neural Network (CNN) called BRAIN-TUMOR-net trained from scratch are introduced to classify brain magnetic resonance images into tumor or normal cases. A comparison between the pre-trained InceptionResNetv2, Inceptionv3, and ResNet50 models and the proposed BRAIN-TUMOR-net is introduced. The performance of the proposed model is tested on three publicly available Magnetic Resonance Imaging (MRI) datasets. The simulation results show that the BRAIN-TUMOR-net achieves the highest accuracy compared to other models. It achieves 100%, 97%, and 84.78% accuracy levels for three different MRI datasets. In addition, the k-fold cross-validation technique is used to allow robust classification. Moreover, three different unsupervised clustering techniques are utilized for segmentation

Pulse Pressure Variation-Guided Fluid Therapy during Supratentorial Brain Tumour Excision: A Randomized Controlled Trial

BACKGROUND: Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated. AIM: In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection. METHODS: Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids guided by pulse pressure variation) and control group (received standard care). Both groups were compared according to the following: brain relaxation scale (BRS), mean arterial pressure, heart rate, urine output, intraoperative fluid intake, postoperative serum lactate, and length of hospital stay. RESULTS: Demographic data, cardiovascular data (mean arterial pressure and heart rate), and BRS were comparable between both groups. GDFT group received more intraoperative fluids {3155 (452) mL vs 2790 (443) mL, P = 0.002}, had higher urine output {2019 (449) mL vs 1410 (382) mL, P < 0.001}, and had lower serum lactate {0.9 (1) mmol versus 2.5 (1.1) mmol, P = 0.03} compared to control group. CONCLUSION: In conclusion, PPV-guided fluid therapy during supratentorial mass excision, increased intraoperative fluids, and improved peripheral perfusion without increasing brain swelling

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe