Clinical and echocardiographic evaluation of patients undergoing total leaflets preservation during mitral valve replacement; Does it make a difference?

Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes.Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study.Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group.Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement

Acute vascular rejection after kidney transplantation outcome and effect of different therapeutic modalities

Background: Steroid resistant acute vascular rejection (AVR) is a great obstacle in successful renal transplantation (KTx). The aim of this work was to evaluate the outcome of histologically confirmed acute vascular rejection - which occurred in severe aggressive form in 39 patients following kidney transplantation as well as to study the outcome of therapy. These cases were chosen from 1000 renal allograft recipients who underwent kidney transplantation in the period between March, 1976 and April 1997 in Urology-Nephrology Center, Mansoura, Egypt.Methods: Statistical analysis of risk factors leading to AVR was carried out. The outcome of different rescue therapies used for AVR as well as graft survival functions were also analyzed.Results: Survival analysis for grafts with AVR revealed 60%, 53%, 30 %, 0% graft survival at 1, 2, 5, 10 yrs respectively after Tx. A statistically significant difference was found in comparison to patients who only experienced acute cellular rejection (90%, 84%, 71%, 46% graft survival at 1, 2, 5, 10 years post- KTx respectively) or patients who passed without rejection in their post-transplantation follow up (95%, 91.3%, 83.3%, 65.5% graft survival at 1, 2, 5, 10 yrs respectively). No statistically significant difference on the overall graft survival between the different modalities of therapy was noted. Steroid pulses + plasma exchange were given for 14 patients with AVR, whereas ATG, MAB ± plasma exchange were added to steroid resistant cases (25 patients). Logistic regression analysis of these data showed that prior blood transfusion, donor-recipient consanguinity, retransplantation are the most significant variables related to occurrence of AVR after kidney transplantation. At last follow up, 14 patients 35.9%) were living with functioning grafts, 16 patients (41%) were living on dialysis, 5 patients died with functioning grafts (12.8%) and 4 patients (10.25%) died with failed grafts.In conclusion: AVR remains a major obstacle for renal transplantation as it markedly impaired graft survival and responded poorly to therapy. Prior blood transfusion decreased the incidence of AVR whereas retransplantation and unrelated donation account significantly to the occurrence of AVR after renal Tx

GEOCHEMISTRY, URANIUM, THORIUM AND RARE EARTH ELEMENTS OF TRACHYTE DYKES OF UMM SALATIT MOUNTAIN AREA, CENTRAL EASTERN DESERT, EGYPT

Umm Salatit Mountain area is a part of the Central Eastern Desert of Egypt. It is composed of ophiolitic mélange, older granitoids, biotite granites, muscovite granites and post granitic dykes and veins. Purpose of the work. The present work deals with the detailed investigations of the geology, petrography, geochemistry and spectrometric prospecting of the studied trachyte dykes as a possible source of uranium mineralization. Research methods. This work involves both field work (Construction of geological map with the structural features, scale 1 : 50,000, Spectrometric measurements of the different rock units using a portable gamma-ray spectrometer RS-230) and laboratory work (preparation of thin sections for petrographic studies by polarizing microscope), Atomic Emission Spectroscopy (AES), and Mass-Spectrometer with Inductively Coupled Plasma (ICPMS). Results. Petrographically, trachyte dykes consist mainly of K-feldspar with relatively minor amount of plagioclase, iron oxides, quartz and biotite. Secondary minerals are represented by sericite, muscovite, chlorite, carbonates and epidote. Accessory minerals are represented by opaque minerals. Trachytic textures are the main characteristic feature in trachyte. Geochemically, the investigated trachyte dykes were originated from an alkali magmarich in total alkalis, and the tectonic setting is continental basalt. Trachyte dykes have steep LREEs, nearly flat HREEs and a negative Eu anomaly. The negative Eu anomaly is either due to the partitioning of Eu into feldspar during fractionation, which is an important process in developing alkalinity, or the presence of residual feldspar in the source. Another alternative explanation for the negative Eu anomaly is based on the high oxygen fugacity in the melt due to volatile saturation. In general, all trachyte samples show moderate enrichment of most large ion lithophile elements (LILE) and high field strength elements (HFSE) and depletion of P, Ti and K. The depletion of Ti and p is ascribed to fractionation of titanomagnetite and apatite. The determination of equivalent uranium, thorium (ppm), potassium % and dose rate (m Sv/y) radiometrically by using portable RS-230 indicates that the dose rate in the trachyte dykes ranges from 0.5 to 1.5 with an average of 1.2 (m Sv/y). The radiometric data of the radioelements for them show a wide variation in eU and eTh contents. The eU content ranges from 2 to 14 ppm with an average of 6.6 ppm and the eTh content ranges from 4 to 37 ppm with an average of 18.03 ppm. Both U and Th correlate similarly with other major and trace elements, reflecting their geochemical coherence during the crystallization of the magma

Role of Imaging and AI in the Evaluation of COVID-19 Infection: A Comprehensive Survey

Coronavirus disease 2019 (COVID-19) is a respiratory illness that started and rapidly became the pandemic of the century, as the number of people infected with it globally exceeded 253.4 million. Since the beginning of the pandemic of COVID-19, over two years have passed. During this hard period, several defies have been coped by the scientific society to know this novel disease, evaluate it, and treat affected patients. All these efforts are done to push back the spread of the virus. This article provides a comprehensive review to learn about the COVID-19 virus and its entry mechanism, its main repercussions on many organs and tissues of the body, identify its symptoms in the short and long terms, in addition to recognize the role of diagnosis imaging in COVID-19. Principally, the quick evolution of active vaccines act an exceptional accomplishment where leaded to decrease rate of death worldwide. However, some hurdels still have to be overcome. Many proof referrers that infection with CoV-19 causes neurological dis function in a substantial ratio of influenced patients, where these symptoms appear severely during the infection and still less is known about the potential long term consequences for the brain, where Loss of smell is a neurological sign and rudimentary symptom of COVID-19. Hence, we review the causes of olfactory bulb dysfunction and Anosmia associated with COVID-19, the latest appropriate therapeutic strategies for the COVID-19 treatment (e.g., the ACE2 strategy and the Ang II receptor), and the tests through the follow-up phases. Additionally, we discuss the long-term complications of the virus and thus the possibility of improving therapeutic strategies. Moreover, the main steps of artificial intelligence that have been used to foretell and early diagnose COVID-19 are presented, where Artificial intelligence, especially machine learning is emerging as an effective approach for diagnostic image analysis with performance in the discriminate diagnosis of injuries of COVID-19 on multiple organs, comparable to that of human practitioners. The followed methodology to prepare the current survey is to search the related work concerning the mentioned topic from different journals, such as Springer, Wiley, and Elsevier. Additionally, different studies have been compared, the results are collected and then reported as shown. The articles are selected based on the year (i.e., the last three years). Also, different keywords were checked (e.g., COVID-19, COVID-19 Treatment, COVID-19 Symptoms, and COVID-19 and Anosmia)

Emerging Anthelmintic Resistance in Poultry: Can ethnopharmacological approaches offer a solution?

Limited pharmacological studies have been conducted on plant species used against poultry helminths. The objective of this study was to provide a basis for plant based anthelmintics as possible alternatives against poultry anthelmintic resistance. The study justified the need for alternative anthelmintics. The study places emphasis on the increasing anthelmintic resistance, mechanism of resistance, and preparational protocols for plant anthelmintics and their associated mechanism of action. Pharmaceutical studies on plants as alternative therapies for the control of helminth parasites have not been fully explored especially in several developing countries. Plants from a broad range of species produce a wide variety of compounds that are potential anthelmintics candidates. Important phenolic acids have been found in Brassica rapa L. and Terminalia avicenniodes Guill. and Perri that affect the cell signaling pathways and gene expression. Benzo (c) phenanthridine and isoquinoline alkaloids are neurotoxic to helminths. Steroidal saponins (polyphyllin D and dioscin) interact with helminthic mitochondrial activity, alter cell membrane permeability, vacuolation and membrane damage. Benzyl isothiocyanate glucosinolates interfere with DNA replication and protein expression, while isoflavones from Acacia oxyphylla cause helminth flaccid paralysis, inhibit energy generation, and affect calcium utilization. Condensed tannins have been shown to cause the death of nematodes and paralysis leading to expulsion from the gastro-intestinal tract. Flavonoids from Chenopodium album L and Mangifera indica L act through the action of phosphodiesterase and Ca(2+)-ATPase, and flavonoids and tannins have been shown to act synergistically and are complementary to praziquantel. Artemisinins from Artemisia cina O. Berg are known to disrupt mitochondrial ATP production. Terpenoids from Cucurbita moschata L disrupt neurotransmission leading to paralysis as well as disruption of egg hatching. Yeast particle encapsulated terpenes are effective for the control of albendazole-resistant helminths

Annona Muricata L. extract restores renal function, oxidative stress, immunohistochemical structure, and gene expression of TNF-α, IL-β1, and CYP2E1 in the kidney of DMBA-intoxicated rats

Introduction: 7,12-dimethylbenz (a) anthracene (DMBA) is a harmful polycyclic aromatic hydrocarbon derivative known for its cytotoxic, carcinogenic, and mutagenic effects in mammals and other species. Annona muricata, L. (Graviola; GRV) is a tropical fruit tree traditionally well-documented for its various medicinal benefits. This investigation is the first report on the potential antioxidant and antinfammatory reno-protective impact of GRV against DMBA-induced nephrotoxicity in rats.Methods: Forty male albino rats were allocated into four equal groups (n = 10). The 1st group served as the control, the 2nd group (GRV) was gastro-gavaged with GRV (200 mg/kg b.wt), the 3rd group (DMBA) was treated with a single dose of DMBA (15 mg/kg body weight), and the 4th group (DMBA + GRV) was gastro-gavaged with a single dose of DMBA, followed by GRV (200 mg/kg b.wt). The GRV administration was continued for 8 weeks.Results and Discussion: Results revealed a significant improvement in renal function, represented by a decrease in urea, creatinine, and uric acid (UA) in the DMBA + GRV group. The antioxidant potential of GRV was confirmed in the DMBA + GRV group by a significant decline in malondialdehyde (MDA) and a significant increase in catalase (CAT), superoxide dismutase (SOD), glutathione S transferase (GST), and reduced glutathione (GSH) compared to DMBA-intoxicated rats; however, it was not identical to the control. Additionally, the antiinflammatory role of GRV was suggested by a significant decline in mRNA expression of cytochrome P450, family 2, subfamily e, polypeptide 1 (CYP2E1), tumor necrosis factor-alpha (TNF-α), and interleukin 1 beta (IL-1β) in the DMBA + GRV group. Moreover, GRV improved the histopathologic and immunohistochemical expression of TNF-α, CYP450, and IL1β in DMBA-intoxicated kidney tissue. Conclusively, GRV is a natural medicinal product that can alleviate the renal injury resulting from environmental exposure to DMBA. The reno-protective effects of GRV may involve its anti-inflammatory and/or antioxidant properties, which are based on the presence of phytochemical compounds such as acetogenins, alkaloids, and flavonoids

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

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 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