Outcome and prognosis of middle cerebral artery occlusive disease in a sample of egyptian patients: A prospective hospital-based study

Background and purpose:  Changes of the flow velocities of transcranial color coded duplex ultrasound (TCCD) in symptomatic middle cerebral artery (MCA) occlusive disease may be related to the occurrence of further vascular events after stroke. The objective of this study was to investigate the outcome and the prognosis of the MCA occlusive disease. Methods:  Initial TCCD was done to detect MCA stenosis or occlusion in patients with MCA territory infarction. We repeated TCCD examinations 3 months later and recorded any TIA, cerebral stroke or acute coronary syndrome events during this period. The changes of MCA flow velocities were categorized as normalized, regressive, persistent and progressive groups, according to the changes of MCA velocities at 3 months. Results: We studied 31 patients with MCA territory infarction classified according to the initial TCCD results into normal MCA flow velocity group (15 patients), and abnormal MCA flow velocity group (16 patients). Eleven patients of the abnormal MCA group were re-evaluated by TCCD after 3 months as 5 patients died within the 3 months of the follow up. Two patients (18.2%) were normalized, 4 patients (36.4%) had persistent degree of stenosis, and 5 patients (45.5%) showed regression. The number of clinical events showed significant difference (p=0.037) between the normal and abnormal MCA groups. Only 1 patient (6.7%) of the normal MCA group had further cerebral stroke, while 7 patients (43.8%) of the abnormal MCA group suffered of further cerebral stroke. Conclusions:  Symptomatic MCA stenosis is associated with higher risk of recurrent cerebral stroke.   French title: Resultats et pronostic de la maladie occlusive de l'artere cerebrale moyenne chez un echantillon de patients Egyptiens. Étude prospective en milieu hospitalier Introduction:  Les variations des vitesses d'écoulement au Doppler transcrânien (DT) dans la maladie occlusive de l'artère cérébrale moyenne (ACM) symptomatique peuvent être liées à la survenue d'autres événements vasculaires après un AVC. L'objectif de cette étude était d'étudier le résultat et le pronostic de la maladie occlusive de l’ACM. Méthodes:  Le DT initial a été réalisé pour détecter la sténose ou l'occlusion de l’ACM chez les patients atteints d'infarctus du territoire de l’ACM Nous avons répété les examens DT 3 mois plus tard et enregistré tout AIT, accident vasculaire cérébral ou syndrome coronarien aigu au cours de cette période. Les changements des vitesses d'écoulement de l’ACM ont été classés en groupes normalisés, régressifs, persistants et progressifs, selon les changements des vitesses de l’ACM à 3 mois. Résultats:  Nous avons étudié 31 patients atteints d'infarctus du territoire de l’ACM classés selon les résultats initiaux du DT dans le groupe de vitesse d'écoulement de l’ACM normale (15 patients) et le groupe de vitesse d'écoulement de l’ACM anormale (16 patients). Onze patients du groupe ACM anormal ont été réévalués par DT après 3 mois car 5 patients sont décédés dans les 3 mois de suivi. Deux patients (18,2%) ont été normalisés, 4 patients (36,4%) avaient un degré de sténose persistant et 5 patients (45,5%) ont présenté une régression. Le nombre d'événements cliniques a montré une différence significative (p = 0,037) entre les groupes ACM normaux et anormaux. Seul 1 patient (6,7%) du groupe MCA normal a eu un autre AVC, tandis que 7 patients (43,8%) du groupe ACM anormal ont souffert d'un autre AVC. Conclusions:  La sténose symptomatique de l'ACM est associée à un risque plus élevé de récidive d’AVC

MANAGEMENT AND ASSESSMENT OF DEHYDRATION IN PEDIATRICS

The level of fluid deficit may be difficult to scientifically quantify and there is no laboratory worth that is either delicate or details to approximate the degree of dehydration in children. Rehydration may take place by means of oral, subcutaneous, or IV paths. We performed a search using electronic databases; MEDLINE, science-direct, and EMBASE, through October, 2018. Dehydration related to gastroenteritis makes up a considerable worry of disease worldwide. Most of dehydration is amenable to ORT; only the treatment of severe dehydration needs IVF. Prior pilot data on the superiority of rapid IVF administration for rehydration has actually been refuted. Nevertheless, a new research suggests that initial rehydration with glucose including IVF trends toward lowering the return visits and decreasing the admission rates. More data on the efficiency and safety and security of antiemetics has actually been produced. Antiemetics have been proven well tolerated without masking severe alternate diagnoses, efficacious in improving the success of ORT, and affordable. These brand-new data supporters highly for the consolidation of antiemetics right into the scientific guidelines. Variability in guideline conformity has been shown, with doctors mentioning troubles in evaluating dehydration and scientific judgment as factors for variation

African Linguistics in Central and Eastern Europe, and in the Nordic Countries

Non peer reviewe

A comparative study between interlaminar nerve root targeted epidural versus infraneural transforaminal epidural steroids for treatment of intervertebral disc herniation

Background: Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. Purpose: The aim of our study is to compare between the efficacy of infraneural transforaminal ESI and lumbar paramedian nerve root targeted interlaminar steroid injection in reduction of unilateral radicular pain secondary to disc prolapse. Patients and Methods: This prospective double-blind randomized study was performed on 40 patients randomized into two equal groups, each of 20: the infraneural transforaminal ESI (IN group) and the interlaminar parasagittal ESI (IL group). Patients with backache without leg radiation, or with focal motor neurological deficit, previous spine surgery, S1 radiculopathy, lumbar ESI in the past month, systemic steroid used recently within 4 weeks before the procedure, allergy to any medication or addiction to opioids, and pregnancy were excluded from the study. The duration and efficacy of pain relief (defined as ≥40% reduction of pain perception) by 0–10 visual analog scale (VAS) is the primary outcome. Functional assessment using Modified Oswestry Disability Questionnaire (MODQ) and possible side effects and complications are the secondary outcomes. Results: The VAS and MODQ scores were significantly lower in both groups in comparison with the basal values. There was also a lower VAS in the infraneural group than the parasagittal (IL) group up to 6 months after injection. Conclusion: The infraneural (IN) epidural steroid is more favorable than the parasagittal (IL) interlaminar epidural steroid owing to its long-term improvement in physical function than the parasagittal technique with no serious side effects

Neutron Activation Analysis for Geochemical Characterization of Rocks from Gold Mines in Egypt

The present work was carried out to determine the elemental composition of granitoid rock samples from three gold mines (Sukari, Hamash, and Um Hagalig) in the South-eastern part of Egypt and quantification of the extent of the elemental enrichment. A total of 37 samples from the mines were subjected to neutron activation analysis, and the mass fractions of the elements were measured in mg/kg. The results show a dominance of K (76.9%), Fe (11.0%), Ca (8.7%), and Na (3.1%) for Sukari mine; Na (31.2%), Ca (28.5%), K (23.1%), and Fe (9.9%) for the Hamash mine; and for the Um Hagalig mine Na (31.1%), K (22%), Ca (21.7%), and Fe (20.8%). In addition, significant mass fractions of uranium, thorium and rare earth elements were found in Hamash and Um Hagalig. The average mass fractions of U in the investigated areas are measured to be 59.7, 48.2, and 30.8 mg/kg for Hamash, Sukary, and Um Hagalig, respectively. Furthermore, the average mass fractions of Th were significant and measured to be 3905, 1673, and 7 mg/kg for Hamash, Um Hagalig, and Sukary, respectively. Multiple ratio indicators and discrimination diagrams were used to better understand the origin of the elements in the samples studied. The indicators suggest that the provenance of the elements is mainly from metavolcanic and volcanic rocks. The findings should make an important contribution to the study of ores and minerals and thus represent an important area for environmental studies

Effect of Intravenous Cyclophosphamide Pulse Therapy on Renal Functions and Histopathology in Patients with Severe Lupus Nephritis

Despite the wide use of intravenous cyclophosphamide (IC) in lupus nephritis (LN), there are few published studies showing the effect of this treatment on renal histology. In this prospective study, we report the effect of IC on the evolution of histopathologic features in successive renal biopsies in patients with LN. Thirty patients with class IV or V LN were started on IC (10-15 mg/kg) administered once every month for six months followed by three monthly for another six doses making a total of two years of therapy. The clinical course of the disease, serum creatinine and 24 hours urinary protein and creatinine clearance were tested at entry and subsequently during each follow-up visit. Repeat renal biopsy was performed after completion of two years of therapy. The mean serum creatinine of the study patients was 166.3 <u> &#x002B;</u> 42 tmol/L at entry which decreased to 104 &#x002B; 46.4 tmol/L at two years (P &lt; 0.01). The mean 24 hours proteinuria decreased from 2.81 <u> &#x002B;</u> 2.4 g at entry to 1.39 <u> &#x002B;</u> 1.54 g at two years (P &lt; 0.003) and the mean creatinine clearance increased from 58 <u> &#x002B;</u> 31 ml/min at the start of treatment to 64 <u> &#x002B;</u> 32 ml/min at two years of therapy (P &lt; 0.05). Nine patients had serum creatinine of &gt; 200 tmol/L, of whom six progressed to variable degrees of chronic renal failure. Repeat renal biopsy was performed in 21 patients. The original biopsy of these patients showed class IV in 17 and class V in four patients. On repeat biopsy, five of class IV disease had progressed to advanced sclerosis, four to class V, and five remained unchanged. The remaining three patients with class IV LN changed to one each of class I, II and III. Of the four patients with class V, one progressed to advanced sclerosis, one changed to class III and two remained the same. There was a significant decrease (P &lt; 0.05) in the activity index although there was a significant increase in the chronicity index (P &lt; 0.001). Multivariat analysis for possible risk factors for progression to chronic renal failure showed initial high serum creatinine to be a powerful predictor of renal failure. In conclusion, IC pulse therapy is effective in improving or stabilizing renal function in patients with class IV or V LN. The only poor prognostic determinant observed was higher initial serum creatinine value