Familial testicular torsion in siblings of different age groups: A case report

The acute scrotum (AS) is one of the urologic emergencies, where testicular torsion (TT) represents 20–30% of it. In the peri-puberty period, TT is not uncommon, yet there are very few reports of familial testicular torsion worldwide.This case report highlights a man who experienced TT and had a family history of TT.TT should be considered one of the leading causes of AS. We avoid any delay in the diagnosis of TT, where the signs, symptoms, family history of TT, physical examination, and color Doppler ultrasound (CDU) are helpful in earlier diagnosis and management to salvage the twisted testicle

Feasibility of transcaval access for the delivery of mechanical circulatory support in cardiogenic shock

Background: Vascular access for the delivery of mechanicalcirculatory support (MCS) in patients who present with cardiogenic shock (CS) is often challenging due to peripheral arterial disease and systemic vasoconstriction. Transcaval access for the delivery of MCS may serve as an alternative access in such patients. The Impella 5.0 device has previously been exclusively inserted via surgical techniques; however, we present the frst case series implanting this device through a percutaneous strategy via transcaval access. Methods: Between December 2015 and June 2017, ten selected patients with progressive or refractory cardiogenic shock underwent percutaneous implantation of MCS with an Impella 5.0 via a transcavalaccess. Demographic, clinical, pre-and post-procedural variables, along with in-hospital outcomes were retrospectively collected and presented. Results: Patients were predominately female (60%) with mean age of 54 + 12 years. MCS was indicated in the setting of cardiogenicshock secondary to idiopathic non-ischemic cardiomyopathy (n=4), myocarditis (n=2), ischemic cardiomyopathy (n=2), post-heart transplant rejection (n=1), and unknown etiology (n=1). Mean duration of support was 85.2 + 53.2 hours. Survival to device explant occurred in seven patients (70%) with successful caval-aortic site closure in six patients and one patient with sheath left in place due to close proximity to renal arteries. Survival to hospital discharge occurred insix patients (60%). Among the survivors, 5 patients (83%) had recovery of native cardiac function and 1 patient (17%) required implantation of a durable left ventricular assist device. Transcaval access was obtained, and delivery ofMCS was successful in all patients without major complication. Conclusion: Transcaval access for the deliveryof MCS in patients without adequate femoral access, or those who may potentially need long-term support, is feasible in patients who present with cardiogenic shock

Transcaval access for the emergency delivery of 5.0 liters per minute mechanical circulatory support in cardiogenic shock

OBJECTIVES: The purpose of this study was to describe the feasibility and early outcomes of transcaval access for delivery of emergency mechanical circulatory support (MCS) in cardiogenic shock. BACKGROUND: Vascular access for implantation of MCS in patients with cardiogenic shock is often challenging due to peripheral arterial disease and vasoconstriction. Transcaval delivery of MCS may be an alternative. We describe a series of patients we implanted an Impella 5.0 device, on-table without CT planning, through a percutaneous transcaval access route. METHODS: Ten patients with progressive or refractory cardiogenic shock underwent Impella 5.0 implantation via transcaval access. Demographic, clinical and procedural variables and in-hospital outcomes were collected. RESULTS: All ten underwent emergency implantation of the 7 mm diameter Impella 5.0 device via transcaval access. Six were women, with median age of 55.5 years (range, 29-69). Cardiogenic shock was attributed to idiopathic nonischemic cardiomyopathy (n = 4), myocarditis (n = 2), ischemic cardiomyopathy (n = 2), heart transplant rejection (n = 1), and unknown etiology (n = 1). Median duration of support was 92.1 hr (range, 21.2-165.4). Seven (70%) survived to device explant, with six (60%) surviving to access port closure and discharge. Among survivors, five recovered heart function and one received destination therapy left ventricular assist device. CONCLUSIONS: Transcaval access is feasible for emergency nonsurgical implantation of the Impella 5.0 device in cardiogenic shock with small or diseased iliofemoral arteries. This allows early institution of higher-flow MCS than conventional femoral artery implantation of the 3.5 L Impella CP device, and enables a bridge-to-recovery or bridge-to-destination strategy

Transcaval access for the emergency delivery of mechanical circulatory support in cardiogenic shock

Background: Vascular access for the delivery of mechanical circulatory support (MCS) in patients with cardiogenic shock is often challenging due to peripheral arterial disease and vasoconstriction. Transcaval delivery of MCS may offer an alternative option. We describe the first series of patients in whom we implanted an Impella 5.0 device, without prior CT planning, through a percutaneous transcaval access route. Hypothesis: We hypothesize that transcaval access for the delivery of higher-flow MCS in cardiogenic shock is a feasible alternative in patients with peripheral arterial disease or profound shock needing increased support. Methods: Between December 2015 and June 2017, ten patients with progressive or refractory cardiogenic shock underwent transcaval Impella 5.0 implantation via a transcaval access. Demographic, clinical and procedural variables, along with in-hospital outcomes were collected. Results: All ten patients underwent emergency implantation of the 7mm diameter Impella 5.0L device via transcaval access, without prior CT-based planning. Six were women, with median age of 55.5 years (range, 29 - 69). Cardiogenic shock was attributed to idiopathic non-ischemic cardiomyopathy (n=4), myocarditis (n=2), ischemic cardiomyopathy (n=2), post-heart transplant rejection (n=1), and unknown etiology (n=1). Median duration of support was 92.1 hours (range, 21.2 - 165.4). Seven (70%) survived to device explant, with six (60%) surviving to transcaval access port closure and discharge. One transcaval sheath left in place for hemodynamic monitoring during a planned terminal wean in the setting of progressive clinical decline. Among survivors to discharge, five recovered heart function and one underwent left ventricular assist device as destination therapy. Conclusion: Transcaval access for the delivery of MCS is a feasible alternative for emergency non-surgical implantation of the Impella 5.0 device in patients with peripheral arterial disease or those with profound cardiogenic shock. This approach allows earlier institution and longer duration of higher-flow MCS, and may enable a bridge-torecovery or bridge-to-destination strategy

Vitamin D Levels in Children with Recurrent Acute Tonsillitis in Jordan: A Case-Control Study

Background: Vitamin D is essential for many functions of the body. In addition to its primary function of regulating the absorption of calcium in the small intestine, its role in the immune system has recently been studied. The current study aimed to test the impact of vitamin D deficiency on the rate of recurrent acute tonsillitis in children. Methods: According to Paradise criteria, two hundred forty-two children with recurrent acute tonsillitis were recruited. A group of healthy children (n = 262) was also recruited as controls. Poisson regression was run to predict the number of tonsillitis episodes per year based on vitamin D levels. The mean vitamin D level in the study group was lower than in the control group (p < 0.0001). Poisson regression of the rate of recurrent tonsillitis and vitamin D level (OR = 0.969 (95% CI, 0.962–0.975)) showed that for every single unit increase in vitamin D level, there was a 3.1% decrease in the number of tonsillitis episodes per year (p < 0.0001). Conclusions: Vitamin D deficiency is associated with higher rates of recurrent acute tonsillitis. Future controlled trials should investigate the role of vitamin D supplementation in reducing the rate of recurrent tonsillitis

Proceedings of First Conference for Engineering Sciences and Technology: Vol. 1

This volume contains contributed articles of Track 1, Track 2 & Track 3, presented in the conference CEST-2018, organized by Faculty of Engineering Garaboulli, and Faculty of Engineering, Al-khoms, Elmergib University (Libya) on 25-27 September 2018. Track 1: Communication and Information Technology Track 2: Electrical and Electronics Engineering Track 3: Oil and Chemical Engineering Other articles of Track 4, 5 & 6 have been published in volume 2 of the proceedings at this lin