Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging

Background: Triangular fibrocartilage complex (TFCC) may be assessed using ultrasound (US) because of its wide availability, mobility, low cost, and lack of radiation. When it comes to TFCC imaging, MRI is the gold standard, although US can provide a more detailed picture of the disease. Objective: Comparing and contrasting the use of ultrasound (US) and magnetic resonance imaging (MRI) in the detection of triangular fibrocartilaginous complex injuries of the wrist. Patients and Methods: The study was conducted at the Radiodiagnosis Department, Zagazig University Hospital, Egypt. Wrist discomfort or reduced wrist mobility was reported by 35 individuals with a mean age of 39 ± 13.18 years old. Both radiologists who performed the ultrasound and the MRI were blinded to each other's results in order to minimize bias. Results: 82.9 % of patients showed normal ulnar variance while 11.4 % of patients showed positive variance and 5.7% with negative variance. The ultrasound detected 18 positive cases with TFCC injury with a percentage of 51.4%. The MRI detected 24 positive cases with TFCC injury with a percentage of 68.6%. The ultrasound detected TFCC cases with a sensitivity of 75%, specificity 100%, PPV 100 and NPV 64.7. Conclusion: It is very suggested that tendons and inflammation of the wrist could be examined by ultrasonography. In recent investigations, it was shown that US had the ability to identify injuries in the TFCC and intrinsic ligament

Methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms in rheumatoid arthritis patients: Correlation with serum osteopontin levels and disease activity

AbstractBackgroundRheumatoid arthritis (RA) is a systemic, chronic inflammatory disease with genetic predisposition. Osteopontin (OPN) is overexpressed in RA and plays a key role in the perpetuation of synovitis. Not all RA patients show the same level of response to methotrexate (MTX) suggesting genetic variations in the drug-metabolizing enzymes.Aim of the workTo detect methylene-tetra-hydrofolate reductase (MTHFR) 677C/T and 1298A/C gene polymorphisms in RA patients treated with MTX and to investigate the relationship with serum OPN levels and disease activity.Patients and methods62 RA patients and 21 healthy controls were included. Serum OPN was measured using ELISA. Genotyping of MTHFR gene was carried out by polymerase chain reaction-restriction fragment length polymorphism. Disease activity score in 28 joints (DAS28) and the modified health assessment questionnaire (MHAQ) were assessed.ResultsThe patients’ age was 42.7±12.7years, F:M (4.6:1) and a disease duration of 5.7±4.6years. Their DAS28 was 4.1±1.6 and the MHAQ (median 1; range 0–2.3). Serum OPN levels in RA patients (median 8.8; range 4–44.5ng/ml) were significantly higher than in control (5.6; 2.1–10.9) (p=0.002). In RA patients, serum OPN significantly correlated with the duration of morning stiffness (p=0.009), ESR (p<0.0001) and DAS28 (p<0.0001). MTHFR (677C>T) polymorphisms significantly correlated with MHAQ (p=0.012) while (1298A>C) polymorphisms significantly correlated with tender joint count (p=0.04). OPN levels were higher among patients with MTHFR (1298A/C) AC genotype (8.9; 4.1–33.9ng/ml), while in those with (677C>T) polymorphisms it was higher among those with CT genotype (8.9; 4.1–44.5).ConclusionSerum OPN level relates with the degree of rheumatoid activity

Cytotoxic effect of nanoparticles synthesized from Salvia officinalis L. and Ricinus communis aqueous extracts against vero cell line and evaluation of their antioxidant activities

The development of safe carriers for the use of plant extracts in industrial and health fields constitute a matter of serious concern. The development of plant derived nanoparticles may help to overcome such barriers. However, the major concern is still the safety of these carriers. The present study describes the synthesis of nanoparticles derived from Salvia officinalis L. and Ricinus communis and the evaluation of their cytotoxic and antioxidant effects. It is shown in this study that the aqueous extracts of S. officinalis L. and R. communis have the potentials to reduce silver nitrate ions to silver nanoparticles. The biosynthesized nanoparticles were analyzed by spectrophotometer and granulometric tests. The biological activities of these extracts and nanoparticles were carried out. S. officinalis L. leaf extract had the strongest antioxidant activity, followed by R. communis leaf and fruit extracts. Altogether, the synthesized nanoparticles were safe and may serve as antioxidant products in many fields.Key words: Plant material, biosynthesis of nanoparticle, cytotoxicity, cell culture, free radicals

Brain tumor visualization for magnetic resonance images using modified shape-based interpolation method

3D visualization plays an essential role in medical diagnosis and setting treatment plans especially for brain cancer. There have been many attempts for brain tumor reconstruction and visualization using various techniques. However, this problem is still considered unsolved as more accurate results are needed in this critical field. In this paper, a sequence of 2D slices of brain magnetic resonance Images was used to reconstruct a 3D model for the brain tumor. The images were automatically segmented using a wavelet multi-resolution expectation maximization algorithm. Then, the inter-slice gaps were interpolated using the proposed modified shape-based interpolation method. The method involves three main steps; transferring the binary tumor images to distance images using a suitable distance function, interpolating the distance images using cubic spline interpolation and thresholding the interpolated values to get the reconstructed slices. The final tumor is then visualized as a 3D isosurface. We evaluated the proposed method by removing an original slice from the input images and interpolating it, the results outperform the original shape-based interpolation method by an average of 3% reaching 99% of accuracy for some slice images

Various Factors Affecting Students Performances In A Saudi Medical School

Objective: There are various demographic and educational factors that affect the academic performance of undergraduate medical students. The objective of this study is to identify these factors and correlate them to the GPA of the students. Methods: A cross-sectional study design utilizing grade point averages (GPAs) of two cohorts of students in both levels of the pre-clinical phase. In addition, self-administered questionnaire was used to evaluate the effect of these factors on students with poor and good cumulative GPA. Results: Among the various factors studied, gender, marital status, and the transportation used to reach the faculty significantly affected academic performance of students. Students with a cumulative GPA of 3.0 or greater significantly differed than those with a GPA of less than 3.0 being higher in female students, in married students, and type of transportation used to reach the college. Factors including age, educational factors, and type of transportation used have shown to create a significant difference in GPA between male and females. Conclusion: Factors such as age, gender, marital status, learning resources, study time, and the transportation used have been shown to significantly affect medical student GPA as a whole batch as well as when they are tested for gender

Processus d'émergence des territoires ruraux dans les pays méditerranéens.

Ce rapport de recherche propose une analyse croisée des processus d'émergence des territoires ruraux dans les pays du pourtour méditerranéen. La contribution d'équipes de recherche de 10 pays permet une analyse originale qui mobilise des approches nationales et des études de terrain issues de l'ensemble de ces pays. Les questions des formes de gouvernance, de décentralisation ou encore les trajectoires de développement sont mises en perspective.Développement territorial, Méditerranée, Maghreb, Territoire, Gouvernance, Décentralisation, Ressource territoriale.

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised