Recombinant Factor VIIa for The Management of Uncontrollable Bleeding Following The Repair of Acute Type A Aortic Dissection

Background: Bleeding is a serious complication after surgical repair of acute type A aortic dissection. Recombinant factor VIIa (rFVIIa) could be used for the management of severe bleeding; however, it could lead to thromboembolic events. We aimed to report our experience in using rFVIIa in the management of severe bleeding following the surgical repair of acute type A aortic dissection. Methods:  We performed a retrospective study, including patients who had surgery for acute aortic dissection type A and received rFVIIa, in the period between January 2012 and January 2019. We reported the amount of bleeding 4 hours before and after the administration of rFVIIa, the number of blood products transfused before and after the use of rFVIIa, thrombosis of the central venous line, as well as the presence of disseminated intravascular coagulation. Results: There were ten patients (2 females and 8 males) out of 120 patients with acute type A aortic dissection, who required the use of rFVIIa for severe postoperative bleeding. The mean age was 67.7±10.5 years. The amount of drainage decreased from 889±585.6 ml during the 4 hours prior to the infusion, to 165±73.5 ml during the following 4 hours (p<0.001). The patients received 2752±1362.9 ml, and  618±483.3 ml packed RBCs before and after rFVIIa administration, respectively (p< 0.001). The patients received 1601±693.4 and 246±419.6 ml of fresh frozen plasma before and after the use of rFVIIa, respectively (p< 0.001). The prothrombin time decreased after the infusion of rFVIIa (42.7±32 and 17.1±8 seconds, p= 0.001). There were no clinical signs of thromboembolism after its use. Mortality occurred in five patients (50%). Conclusion: In the life-threatening situation of uncontrollable bleeding following surgical repair of type A acute aortic dissection, rFVIIa may have benefits to control bleeding. Furthers studies are recommended

Mitral valve annuloplasty with a homemade single-sized polytetrafluoroethylene band in degenerative mitral regurgitation

Background: Although mitral annuloplasty is an essential component of mitral repair, there remains little agreement on the ideal device to be used or the ideal sizing method.Objectives: The purpose of this study was to report the early clinical and echocardiographic outcomes of patients undergoing repair for degenerative mitral regurgitation using a homemade single-sized (65 mm) Polytetrafluoroethylene band, and comparing it to the use of commercially available complete rigid rings.Patients and methods: This is a retrospective study including 106 patients, who underwent mitral repair for degenerative mitral regurgitation at Cairo University Hospitals between February 2013 and July 2019. These patients were divided into 2 groups. Group (A) included 69 patients who underwent repair with a single-sized band, and group (B) included 37 patients whose repair included the use of a commercial rigid ring. The primary endpoint was freedom from significant mitral regurgitation at one-year follow-up. Secondary endpoints included mean mitral valve gradient measured postoperatively, and freedom from reoperation at one year.Results: There was no statistically significant difference between both groups in any of the above-mentioned endpoints being examined.Conclusion: The use of a single-sized Polytetrafluoroethylene band for annuloplasty in degenerative mitral disease showed satisfactory results comparable to the commercial rigid rings. Further studies with longer follow-up are needed to confirm the durability of mitral repair using this technique

Giving in Transition and Transitions in Giving: Philanthropy in Egypt, Libya and Tunisia 2011-2013

This publication explores how shifts in the sociopolitical environment in Egypt, Libya and Tunisia manifested themselves in the philanthropic realm during an uncertain mid-point in the transitions. To what extent have both institutional and informal philanthropy evolved to keep up with the pace of escalating needs and expectations of the people? As those shifts continue in all three countries, with variations to be explored in each country chapter, the report encourages actors in the sector to take bolder steps from diagnostics to action

An Automatic Modern Standard Arabic Text Simplification System: A Corpus-Based Approach

This thesis brings together an overview of Text Readability (TR) about Text Simplification (TS) with an application of both to Modern Standard Arabic (MSA). It will present our findings on using automatic TR and TS tools to teach MSA, along with challenges, limitations, and recommendations about enhancing the TR and TS models. Reading is one of the most vital tasks that provide language input for communication and comprehension skills. It is proved that the use of long sentences, connected sentences, embedded phrases, passive voices, non- standard word orders, and infrequent words can increase the text difficulty for people with low literacy levels, as well as second language learners. The thesis compares the use of sentence embeddings of different types (fastText, mBERT, XLM-R and Arabic-BERT), as well as traditional language features such as POS tags, dependency trees, readability scores and frequency lists for language learners. The accuracy of the 3-way CEFR (The Common European Framework of Reference for Languages Proficiency Levels) classification is F-1 of 0.80 and 0.75 for Arabic-Bert and XLM-R classification, respectively and 0.71 Spearman correlation for the regression task. At the same time, the binary difficulty classifier reaches F-1 0.94 and F-1 0.98 for the sentence-pair semantic similarity classifier. TS is an NLP task aiming to reduce the linguistic complexity of the text while maintaining its meaning and original information (Siddharthan, 2002; Camacho Collados, 2013; Saggion, 2017). The simplification study experimented using two approaches: (i) a classification approach and (ii) a generative approach. It then evaluated the effectiveness of these methods using the BERTScore (Zhang et al., 2020) evaluation metric. The simple sentences produced by the mT5 model achieved P 0.72, R 0.68 and F-1 0.70 via BERTScore while combining Arabic- BERT and fastText achieved P 0.97, R 0.97 and F-1 0.97. To reiterate, this research demonstrated the effectiveness of the implementation of a corpus-based method combined with extracting extensive linguistic features via the latest NLP techniques. It provided insights which can be of use in various Arabic corpus studies and NLP tasks such as translation for educational purposes

Tricuspid valve repair by DeVega technique versus ring annuloplasty in patients with functional severe tricuspid regurge

AbstractBackgroundRepairing the tricuspid valve in patients undergoing left heart valve surgery is still controversial. Severe Tricuspid regurge is repaired by most surgeons, while moderate regurge is frequently unaddressed. Another controversy is the technique of repair. DeVega technique is widely used; still, the longevity of this repair is still questioned. The risk of its early failure and subsequent recurrence of significant regurge requiring redo surgery has led many surgeons to adopt the use of annuloplasty rings. The aim of our study was to assess the short term results (1 year) of tricuspid repair with or without ring annuloplasty.Patients and methods80 patients who had tricuspid repair concomitantly with mitral valve surgery at Cairo University Hospitals over 5 years were studied by echocardiography at discharge and at 1 year after surgery.Results62 patients had repair using the DeVega annuloplasty (group A) while 18 had ring annuloplasty (group B). The mean age was 33 ± 6 years and 37 ± 8 years for group A and B respectively. The cardiopulmonary bypass (CPB) time was relatively longer in group B. There was only one mortality in group A. Echocardiography done for all patients of both groups at discharge and at 1 year postoperatively showed no significant difference between both groups.ConclusionTricuspid repair using ring annuloplasty has good results but with no significant benefits over DeVega annuloplasty at one year

Niosomal 5-Flourouracil gel for effective treatment of skin cancer; In-vitro and In-vivo evaluation

This study was designated to form core-enriched 5-flourouracil (5-FU) niosomes and apply it to skin as a niosomal gel for topical treatment of skin cancer. Different molar ratios of the two surfactants used namely; sorbitan monostearate (Span 60), sorbitan monolaurate (Span 20) to cholesterol were employed, in addition; sodium deoxycholate was used a co-surfactant. The drug was successfully entrapped in niosomes with entrapment efficiency reached up to 67.08 ± 2.53 mg % (w/w). The produced niosomes had particle size below 300 nm, zeta potential values between -15 ± -1.6 and -37.73 ± -2.53 mV and polydispersity index between 0.09 ± 0.06 and 0.20 ± 0.02. Transmission electron microscopy showed the formation of spherical niosomes with closed bilayer structure. Formula N8 had more than two fold increase in amount permeated compared to free drug in in-vitro permeation study. The niosomal gel formulae had better permeation parameters compared to formulae containing free drug. Niosomal gel formula composed of sodium carboxymethyle cellulose (Na CMC) had the best permeation parameters among the produced gel formulae. Histopathological studies showed that niosomal 5-FU gel was able to penetrate more readily into deep layers of skin to treat tumor as indicated by the reduction in inflammatory reaction and hemorrhage signs observed in animals treated by niosomal 5-FU gel.

Effect of Task Specific Exercises, Gait Training, and Visual Biofeedback on Equinovarus Gait among Individuals with Stroke: Randomized Controlled Study

Background and Purpose. Equinovarus foot is a common sign after stroke. The aim of this study is to investigate the effect of task specific exercises, gait training, and visual biofeedback on correcting equinovarus gait among individuals with stroke. Subjects and Methods. Sixteen subjects with ischemic stroke were randomly assigned to two equal groups (G 1 and G 2 ). All the patients were at stage 4 of motor recovery of foot according to Chedoke-McMaster Stroke Assessment without any cognitive dysfunction. E-med pedography was used to measure contact time, as well as force underneath hind and forefoot during walking. Outcome measures were collected before randomization, one week after the last session, and four weeks later. Participants in G 1 received task specific exercises, gait training, and visual biofeedback and a traditional physical therapy program was applied for participants in G 2 for 8 weeks. Results. Significant improvement was observed among G 1 patients ( ≤ 0.05) which lasts one month after therapy termination. On the other hand, there were no significant differences between measurements of the participants in G 2 . Between groups comparison also revealed a significant improvement in G 1 with long lasting effect. Conclusion. The results of this study showed a positive long lasting effect of the task specific exercises, gait training, and visual biofeedback on equinovarus gait pattern among individuals with stroke

10 A noninvasive approach for the early detection of diabetic retinopathy

This chapter introduces one of the most critical problems in ophthalmology, specifically the diagnosis and detection of diabetic retinopathy (DR). Developing a fast, accurate, and reliable method for the early detection of DR is of great clinical importance to prevent blindness in patients. For this reason, various methods for early detection of DR have been investigated and used such as a dilated eye examination, tonometry, fluorescein angiography, optical coherence tomography, and ultrawide-field retinal imaging. With the increased popularity of machine learning, researchers have formulated their own algorithms and methods to detect DR with various rates of success. This chapter overviews past and current diagnostic methods that have been developed for DR. In addition, this chapter addresses new methodologies being developed/researched and some challenges that researchers face in developing fast, accurate, and reliable diagnosis

As healthy as invasive: Charybdis natator shell extract reveals beneficial metabolites with promising antioxidant and anti-inflammatory potentials

Crabs of the genus Charybdis are some of the world’s most aggressive and voracious marine invasive crustaceans. They are found in a wide variety of ecosystems in the Red Sea. Their near ubiquity in diverse marine habitats, however, makes them a possible resource for novel marine-derived bioactive products. To provide an important insight into the potential for C. natator as a beneficial product, its shell methanolic extract was chromatographically analyzed for identification of potential bioactive ingredients. Additionally, two different doses, i.e. a low and a high dose, of this extract were tested for their ability to protect against copper-induced oxidative stress and proinflammatory response in adult zebrafish Danio rerio. Gene expression levels of transcripts of proinflammatory mediators, i.e. nf-κβ and tnf-α; antioxidant enzymes, i.e. sod, cat, and gpx; and lipid-metabolizing enzymes, i.e., acox1 and fasn, were determined. The results showed that C. natator shell is rich in potential bioactive metabolites, including diverse unsaturated fatty acids, alkanes, flavonoids, and phenolic acids. Most antioxidant and proinflammatory transcripts in the protected groups were restored to levels that were lower than those in the CuSO4-stressed group. The low dose showed special success in inducing these effects. Also, the low-dose-protected group showed significantly elevated acox1 and decreased fasn, suggesting the capability of crab shell extract at a low dose to assist lipolysis and inhibit lipogenesis. The abundant presence of saturated fatty acids in the shell extract can be the reason for the inadequacy of the high dose to promote the antioxidant and anti-inflammatory activities. These results suggest that there is a potential to develop therapeutic industrial uses for C. natator shell, instead of considering it as a discard. Its wealth of bioactive metabolites may contribute to the market for natural products to combat inflammatory and oxidative stress, the origin of many diseases in the modern world

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London