Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft

Sixteen patients underwent minimally invasive subtalar arthrodesis through a mini-invasive approach with posterior iliac graft between 2004 and 2006. No hardware was used to transfix the arthrodesis and partial weight bearing was allowed immediately. The primary indication for surgery was the squeal of fracture os calcis in terms of subtalar joint arthritis, loss of heel height, malalignment of the hindfoot, and pain with weight bearing. There were 12 male and 4 female patients with a mean age of 30 (range 17–52). Patients were followed up for a period of 40.8 months (range 36–48 months). The mean interval from injury to fusion was 2 (+0.6) years ranging from 6 months to 6 years post fracture. The average clinical rating scale based on the American Orthopaedic Foot and Ankle Society (AOFAS) improved from 36 preoperatively to 78 at the latest follow-up (P < 0.05). Union rate was 94%. Radiographic evaluation revealed a mean increase in calcaneal inclination of 6.25 + 8.3° (P < 0.07) and a mean increase in the lateral talocalcaneal angle of 7.42 + 10.2° (P < 0.08). Complications were graft nonunion in 1 patient and transient tendoachilles tendinitis in another. This technique can be used to decrease the morbidity associated with the late complications of os calcis fractures by aligning the hindfoot, restoring the heel height and correcting calcaneal and talar inclination. It offers the advantage of early weight bearing while avoiding hardware complications

The correlation between increasing Body Mass Index and the incidence of local recurrence and distant metastasis in breast cancer patients

OBJECTIVE: Patients with breast cancer (BC) who are obese or overweight at the time of diagnosis have a low survival rate and a high death rate. We aimed to investigate if having a higher body mass index (BMI) at diagnosis raised the risk of local recurrence (LR) and distant metastasis. PATIENTS AND METHODS: Patients were divided into three categories based on their BMI. The patient's BMI was determined by dividing his weight in kilograms by his height in square meters (kg/m2). The WHO defines normal weight as 18.5 ≤ BMI < 25 kg/m2, overweight as 25 ≤ BMI < 30 kg/m2, and obesity as BMI ≥ 30 kg/m2. RESULTS: The mean BMI was 30.27±6.06 kg/m2. Out of 250 patients, 60 (24.0%), 73 (29.2%) and 117 (46.8%) patients had normal, overweight and obese BMI respectively. No significant difference between BMI and estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2) was found, but there was an association between tumor (T) stage and lymph vascular invasion (LVI) (p<0.05). Obese patients had poorer disease-free survival (DFS) and overall survival (OS) than normal and overweight categories (35.38 ±1.72 vs. 42.38 ± 2.79 and 37.82 ± 2.27 months) (39.65±1.65 vs.45.70 ± 2.53 and 44.31 ± 2.04 months) (p<0.001). LR occurs more prevalent in over-weight and obese patients than normal (p<0.03) but there is no significant difference for distant metastasis. CONCLUSIONS: There is a strong negative association between increased BMI and BC prognosis and patient survival; controlling of this phenomenon may improve the response to treatment and survival, therefore health awareness programs should be implemented

Evaluation of health-related quality of life and muscular strength in children with beta thalassemia major

Background: Thalassemia is an inherited blood disorder that requires repeated blood transfusions and chelation regimes. This may lead to restrictions in physical activities, social participation as well as decreased muscle strength.Aim: The aim of this study was to evaluate the health-related quality of life (HRQoL), muscular strength and pain in children with β-thalassemia major.Patients and method: One hundred and twenty children (60 with β-thalassemia major and 60 age-matched healthy) were participated in a cross-sectional study from both sexes (57 girls and 63 boys) with ages ranging from two to twelve years. HRQoL (physical, emotional, social and school functioning), muscular strength and pain were evaluated for all children by using the pediatric quality of life inventoryTM (PedsQLTM) 4.0 generic core scale, hand-held dynamometer and visual analogue scale (VAS) respectively.Results: Children with β-thalassemia major showed a significant decrease in all domains of health-related quality of life and handgrip strength with a significant increase in VAS score (p ≤ 0.0001).Conclusions: The study concluded that thalassemia as a chronic disease has a negative impact on HRQoL and muscle strength of children in different age group.Keywords: Beta thalassemia, Quality of life, Handgrip strength, childre

Candidate malaria susceptibility/protective SNPs in hospital and population-based studies: the effect of sub-structuring

Background: Populations of East Africa including Sudan, exhibit some of the highest indices of genetic diversity in the continent and worldwide. The current study aims to address the possible impact of population structure and population stratification on the outcome of case-control association-analysis of malaria candidate-genes in different Sudanese populations, where the pronounced genetic heterogeneity becomes a source of concern for the potential effect on the studies outcome. Methods: A total of 72 SNPs were genotyped using the Sequenom iPLEX Gold assay in 449 DNA samples that included; cases and controls from two village populations, malaria patients and out-patients from the area of Sinnar and additional controls consisting of healthy Nilo-Saharan speaking individuals. The population substructure was estimated using the Structure 2.2 programme. Results &amp; Discussion: The Hardy-Weinberg Equilibrium values were generally within expectation in Hausa and Massalit. However, in the Sinnar area there was a notable excess of homozygosity, which was attributed to the Whalund effect arising from population amalgamation within the sample. The programme STRUCTURE revealed a division of both Hausa and Massalit into two substructures with the partition in Hausa more pronounced than in Massalit; in Sinnar there was no defined substructure. More than 25 of the 72 SNPs assayed were informative in all areas. Some important SNPs were not differentially distributed between malaria cases and controls, including SNPs in CD36 and NOS2. A number of SNPs showed significant p-values for differences in distribution of genotypes between cases and controls including: rs1805015 (in IL4R1) (P=0001), rs17047661 (in CR1) (P=0.02) and rs1800750 (TNF-376) (P=0.01) in the hospital samples; rs1050828 (G6PD+202) (P=0.02) and rs1800896 (IL10-1082) (P=0.04) in Massalit and rs2243250 (IL4-589) (P=0.04) in Hausa. Conclusions: The difference in population structure partly accounts for some of these significant associations, and the strength of association proved to be sensitive to all levels of sub-structuring whether in the hospital or population-based study

Parents’ Acceptance to Alveolar and Nasoalveolar Molding Appliances during Early Cleft Lip and Palate Care: A Call for High-Quality Research

AIM: Acceptance and compliance of the parents are an essential pillar in the success of pre-surgical infant orthopedic (PSIO) treatment. The aim of this systematic review is to evaluate the burden of care associated with the alveolar molding (AM) and nasoalveolar molding (NAM) appliances as experienced by the parents with unilateral complete cleft lip and palate (UCLP) infants. METHODS: An electronic search was carried on by two reviewers in eight search engines, as well as a manual search till July 2019. Randomized controlled trials (RCTs) comparing AM/NAM appliances to controls in infants with UCLP were selected. Risk of bias was evaluated using Cochrane risk of bias assessment tool for RCTs. RESULTS: One RCT was included in the qualitative analysis. Non-significant differences were found in the amount of mothers’ satisfaction between the intervention and control groups. CONCLUSIONS: Insufficient low-quality evidence is available regarding the effects of AM and NAM on parents’ satisfaction and burden of care. No conclusions can be withdrawn from the existing studies. High-quality research is needed to elucidate the degree of parents’ acceptance to the molding appliances. PROSPERO registration number: CRD42016043174

The prognostic significance of minimal residual disease in adult Egyptian patients with precursor acute lymphoblastic leukemia

AbstractBackgroundMinimal residual disease (MRD) studies in adult acute lymphoblastic leukemia (ALL) give highly significant prognostic information superior to other standard criteria as age, gender and total leucocytic count (TLC) in distinguishing patients at high and low risk of relapse.ObjectivesWe aimed to determine the value of MRD monitoring by flowcytometry (FCM) in predicting outcome in adult Precursor ALL patients.Patients and methodsBone marrow (BM) samples were analyzed by 4-color FCM collected at diagnosis and after induction therapy (MRD1) to correlate MRD positivity with disease free survival (DFS) and overall survival (OS).ResultsStudy included 57 adult ALL patients (44 males and 13 females) with a median age of 22years (18–49). DFS showed no significant difference with age, gender and initial TLC (p=0.838, 0.888 and 0.743, respectively). Cumulative DFS at 2years was 34% for B-lineage ALL (n: 35) and 57% for T-lineage ALL (n: 18) (p=0.057). Cumulative DFS at 2years was 7% for MRD1 positive (high risk, HR) versus 57% for MRD1 negative patients (Low risk, LR) (p<0.001). Cumulative DFS at 2years was 29% for HR patients (n: 26) versus 55% for LR (n: 27) according to GMALL classification (p=0.064). Cumulative OS did not differ according to age, gender and TLC (p=0.526, 0.594 and 0.513, respectively). Cumulative OS at 2years was 36% for B ALL (n: 39) versus 77% for TALL (n: 18) (p=0.016) and was 49% for Philadelphia chromosome (Ph) negative patients versus 0% for Ph-positive patients (p<0.001). Regarding MRD1, OS at 2years was 18% for MRD1 HR (n: 17) versus 65% for MRD1 LR (n: 38) (p<0.001). OS was 35% for high-risk patients (n: 30) and 62% for low-risk patients (n: 27) classified according to GMALL risk stratification (p=0.017).ConclusionMRD by FCM is a strong independent predictor of outcome in terms of DFS and OS and is a powerful informative parameter in guiding individual treatment in ALL patients

Bilosomes as a promising nanoplatform for oral delivery of an alkaloid nutraceutical:improved pharmacokinetic profile and snowballed hypoglycemic effect in diabetic rats

Diabetes mellitus is a life-threatening metabolic disease. At the moment, there is no effective treatment available to combat it. In this study, we aimed to develop berberine-loaded bilosomes (BER-BLS) to boost the oral bioavailability and therapeutic efficacy of berberine, a natural antidiabetic medication. The BER-BLS was fabricated using a thin-film hydration strategy and optimized using a central composite design (face-centered). The average vesicle size, entrapment efficiency, and surface charge of the optimized BER-BLS preparation were 196.5 nm, 89.7%, (−) 36.4 mV, respectively. In addition, it exhibited higher stability and better-sustained release of berberine than the berberine solution (BER-SOL). BER-BLS and BER-SOL were administered to streptozocin-induced diabetic rats. The optimized BER-BLS formulation had a significant hypoglycemic impact, with a maximum blood glucose decrease of 41%, whereas BER-SOL only reduced blood glucose by 19%. Furthermore, the pharmacological effect of oral BER-BLS and BER-SOL corresponded to 99.3% and 31.7%, respectively, when compared to subcutaneous insulin (1 IU). A pharmacokinetic analysis found a 6.4-fold rise in the relative bioavailability of berberine in BER-BLS when compared to BER-SOL at a dosage of 100 mg/kg body weight. Histopathological investigation revealed that BER-BLS is suitable for oral administration. Our data demonstrate that BLS is a potential nanocarrier for berberine administration, enhancing its oral bioavailability and antidiabetic activity

Designing large-scale antenna array using sub-array

Antenna array of large scale have been examined for different applications including 5G technology. To get better data rate or a reliable link substantial number of antenna arrays have been utilized to provide high multiplexing gains as well as array gains with high directivity. In this paper a simple but efficient implementation technique of using sub-arrays for the improvement of large-sized uniform arrays. By repeating a small sub-array multiple times large arrays can be designed. This implication of utilizing small array simplifies the design of a larger array which allows the designer to concentrate on the smaller sub-array before assembling larger arrays. So, by investigating the sub arrays the performance and radiation characteristics of large arrays can be anticipated. The array-factor for a planar sub-array of 2x2 (4 elements) is analyzed using Mat-lab software and then a large array is formed by placing the 2x2 sub-array indifferent configurations in a rectangular arrangements up to 8x8 planar array. And then the results are validated with CST (Computer simulation technology) simulation results.In this way the array-factors, directivities, HPBWs, and side lobes of the constructed large arrays are analyzed and associated with the small sub-array

Effect of Female Sex Hormones on Cardiorespiratory System: Theoretical Review

This study aimed at analyzing the effect of the female sex hormones upon  the cardiorespiratory system. And the results showed that the cardiac output measurement showed no significant increase during both phases of menstrual cycle before exercise but there was an insignificant increase soon after exercise owing to sympathetic over activity. The observed increase in the peripheral blood flow during mid-follicular phase before and after exercise revealed that influence of estrogen increases the arterial distensibility. The observed increase in the respiratory efficiency test during early luteal phase before and soon after exercise revealed the influence of progesterone, which is considered to be a potent stimulator of respiration, and added up effect of hormones and exercise-induced changes