Microalbuminuria and glycated hemoglobin in children with type 1 diabetes mellitus

Diabetic nephropathy (DNP) is a microvascular complication that occurs in 20–40% of patients with type 1 diabetes (T1D). The main modifiable DNP initiation and progression factors in susceptible individuals may be sustained hyperglycemia and hypertension. The aim of the present work was to study glycemic control in children with T1D and the risk of microalbuminuria (MA) expressed as the urinary albumin/creatinine ratio (ACR).Subjects and methods: Forty children with T1D attending the diabetes clinic at the Alexandria University Children’s Hospital with a duration of diabetes of 3 years or more were included in the study and twenty apparently normal children were taken as controls. Clinical examination and blood pressure measurements were performed for all cases. Urine samples were collected within a 3–6 month period. The ACR in 2 of 3 specimens should be >30 mg/g before considering a patient to have microalbuminuria. HbA1c was measured and the mean of the last 4 readings was calculated.Results: 77.5% of patients had ACR >30 mg/g in two different samples. 88.8% of patients with poor glycemic control had MA compared to 53.8% with accepted glycemic control. The difference was more statistically significant among the adolescent age group (P = 0.001). MA was found in 77.2% of children with duration of T1D less than 5 years but the highest proportion was found when the disease duration was more than 10 years. There was no significant difference in systolic and diastolic blood pressure among diabetic children with and without MA (P = 0.556 and 0.781).Conclusion: Microalbuminuria in children with T1 DM is not limited to those with diseaseduration of 5 years or more and it may occur earlier. MA is significantly associated with poor glycemic control especially in adolescents. Other factors that may contribute to MA are not yet fully understood, further research is needed to clarify these factors

Epidemiologic pattern of falls among inpatients in Ain Shams University Hospitals in Cairo, Egypt

Background. Patient falls and injuries during hospitalization is a good quality indicator of safety of inpatients. Data on inpatients falls are deficient in Egyptian hospitals. Ain Shams university hospitals do not have any recording system for falls. Aim. This study aimed at estimating the incidence density of falls and describing pattern and risk factors contributing to falls in Ain shams university hospitals. Subjects and methods. A prospective follow up study was conducted on inpatients admitted to Ain Shams university hospitals. Patients were followed up for a maximum of two weeks for the occurrence of fall. An interview questionnaire addressed to in-patients was designed to investigate the incident of fall. Type of fall, provisional cause, consequences, night or day timing of fall, walking condition in hospital and past history of fall were among the factors investigated in the incident of fall. Questionnaire assessing the basic and instrumental daily activities for the elderly (? 60 years) was completed. Results. 1779 patients were included in the study in eight different wards with a mean age of 41.8 years. The incidence density of falls was 9 per 1000 patient days. Logistic regression analysis identified male gender, walking difficulties in-hospital and history of falls before hospitalization as independent risk factors for falls among below 60 years patients. Conclusion. Incidence of falls is relatively high among the studied university hospitals. Identified risk factors differed among adults compared to elderly. Recommendations. Measuring, monitoring and assessing fall rates are strongly recommended using a valid and reliable tool to improve quality of health services

The Time Course of Segmentation and Cue-Selectivity in the Human Visual Cortex

Texture discontinuities are a fundamental cue by which the visual system segments objects from their background. The neural mechanisms supporting texture-based segmentation are therefore critical to visual perception and cognition. In the present experiment we employ an EEG source-imaging approach in order to study the time course of texture-based segmentation in the human brain. Visual Evoked Potentials were recorded to four types of stimuli in which periodic temporal modulation of a central 3° figure region could either support figure-ground segmentation, or have identical local texture modulations but not produce changes in global image segmentation. The image discontinuities were defined either by orientation or phase differences across image regions. Evoked responses to these four stimuli were analyzed both at the scalp and on the cortical surface in retinotopic and functional regions-of-interest (ROIs) defined separately using fMRI on a subject-by-subject basis. Texture segmentation (tsVEP: segmenting versus non-segmenting) and cue-specific (csVEP: orientation versus phase) responses exhibited distinctive patterns of activity. Alternations between uniform and segmented images produced highly asymmetric responses that were larger after transitions from the uniform to the segmented state. Texture modulations that signaled the appearance of a figure evoked a pattern of increased activity starting at ∼143 ms that was larger in V1 and LOC ROIs, relative to identical modulations that didn't signal figure-ground segmentation. This segmentation-related activity occurred after an initial response phase that did not depend on the global segmentation structure of the image. The two cue types evoked similar tsVEPs up to 230 ms when they differed in the V4 and LOC ROIs. The evolution of the response proceeded largely in the feed-forward direction, with only weak evidence for feedback-related activity

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices

Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Cardioprotective activity of polysaccharopeptides extracted from pleurotus ostreatus mycelium in a doxorubicin-rat model

The present study was undertaken to investigate the possibleabatement of doxorubicin-induced cardiomyopathy in the rat bypolysaccharopeptides extracted from the culture broth of Pleurotusostreatus mycelium. It was found that polysaccharopeptides given asprotection before doxorubicin intoxication normalized the levels of serumtotal creatine kinase, aspartate aminotransferase and lactatedehydrogenase activities, in addition to malondialdehyde, reducedglutathione, as well as superoxide dismutase and catalase activities in theheart tissue. Nitric oxide and tumor necrosis factor-á concentrations werepersistently reduced in the heart tissue, while interferon-ã concentrationwas insignificantly changed, compared to controls. Light microscopicexamination of haematoxylin and eosin-stained sections of the leftventricles showed normal structure of the cardiac myocytes, except for aslight but significant decrease in their thickness, compared to controls. Inconclusion, pretreatment with mycelial polysaccharopeptides provided apotential protective effect against doxorubicin-induced oxidative stress inrats.Keywords: Pleurotus ostreatus mycelium, Polysaccharopeptides,Doxorubicin, Heart function tests, Antioxidant enzymes, Nitric oxide,Interferon-ã, Tumor necrosis factor-á, Histological studies