Validity of Glasgow Coma Scale - Pupil Age Charts in Predicting The Outcome for Patients with Traumatic Brain Injury

Context: Glasgow Coma Scale (GCS) is considered a cornerstone of neurological assessment to distinguish the prognosis of traumatic brain injury patients. Aim: This study aimed to examine the validity of the Glasgow coma scale - Pupil Age charts in predicting outcomes for patients with traumatic brain injury. Methods: Descriptive exploratory research design was utilized to conduct this study at El-Fayoum University Hospitals and EL-Nabawi Mohandas General hospital in the Neurosurgical intensive care unit and neurosurgical inpatients ward. This research included a purposive sample of 100 adult patients with Traumatic Brain Injury using three tools for assessment. They were the patient's profile data form, the Glasgow Coma Scale - Pupil Age Charts, and the Glasgow outcome scale. Criterion validity with its two types of predictive validity and concurrent validity was used to validate GCS-Pupil Age charts. Results: The study shows that the Glasgow Coma Scale-Pupil Age Chart is valid in predicting outcomes in patients with traumatic brain injury patient with the best cut-off value of <10.50, a sensitivity of 91.5%, and a specificity of 98.1%, while the Glasgow Coma Scale with the best cut off value <9.50, sensitivity 87.2%, and specificity of 94.3%. Glasgow Coma Scale-Pupil Age Charts and Computed tomography findings are valid in predicting outcomes following traumatic brain injury. Conclusion: Glasgow Coma Scale-Pupil Age Charts and computed tomography finding chart are valid in predicting outcomes following traumatic brain injury. The current study recommended developing an educational program for nurses working in intensive care units about GCS and GCS- PA charts to assess traumatic brain injured patients. Besides, encouraging the use of GCS- PA charts in the emergency unit and neurosurgical intensive care unit to predict patient outcomes and plan the care for traumatic brain injury patients. Designing the clinical pathway for traumatic brain-injured patients from admission until discharge considering age, pupil reactivity response, and CT findings

The potential cytoprotective effect of Vitamin C and Vitamin E on monosodium glutamate-induced testicular toxicity in rats

Background: Monosodium glutamate (MSG) has been recognized as flavor enhancer that adversely affects male reproductive systems. Objective: The study was conducted to explore the conceivable protective effects of vitamin C and/or vitamin E on testicular toxicity induced by MSG in rats. Materials and Methods: Thirty male Wistar albino rats were divided (six per group) into: control, MSG, MSG + Vitamin C, MSG + Vitamin E and MSG + Vitamin C + Vitamin E groups. The duration of the study was three weeks. Assessment of serum testosterone, leuteinizing hormone (LH), malondialdehyde (MDA), glutathione peroxidase (GPX), interleukin-10 (IL-10) ,and tumor necrosis factor (TNF-α) were done. Histopathological examination of the testes of the rats was performed using histological, histochemical (Periodic Acid Schiff reaction (PAS)), and immunohistochemical (Proliferating cell nuclear antigen (PCNA), androgen receptors (ARs), Caspase-3) techniques. Results: MSG-group was associated with significant decrease in serum testosterone, LH, GPX, and IL-10 (P < 0.05) and significant increase in serum MDA and TNF-α (P < 0.05) when compared with control group. MSG-group revealed many histopathological changes in the testis including degeneration of the germinal epithelium, absence of sperms in the lumina of tubules, widened vacuolated interstitium, marked deposition of the collagen fibers, very strong PAS reaction and marked immunohistochemical changes. Administration of vitamin C or vitamin E significantly reduced these changes; however, the combination of vitamin C and vitamin E provided more potent protection against the toxic effect of MSG than using each vitamin alone. Also, there was insignificant difference (P > 0.05) between MSG +Vitamin C and MSG +Vitamin E groups. Conclusion: Vitamin C and Vitamin E act synergistically in reducing MSG-induced testicular toxicity via antioxidant, anti-inflammatory and antiapoptotic effects of both vitamins

Autophagy and mTOR Pathways Mediate the Potential Renoprotective Effects of Vitamin D on Diabetic Nephropathy

Introduction. Not only is diabetic nephropathy (DN) the most common cause of end-stage renal disease worldwide, but it also increases the risk of mortality up to fourteen times compared to normoalbuminuric diabetic patients. Aim. The aim of the current study was the evaluation of the renoprotective effects of vitamin D in DN and the possible interplay between autophagy and mTOR pathways. Materials and Methods. Fifty male Wistar albino rats were divided (10/group) into control, DN group, insulin-treated DN group, vitamin D-treated DN group, and combined insulin and vitamin D-treated DN group. Assessments of systolic blood pressure, albuminuria, creatinine clearance, serum glucose, insulin, urea, creatinine, inflammatory cytokines, oxidative stress markers, and rat kidney gene expression of mTOR were performed. Histopathological and immunohistochemical assessments of autophagy marker LC3 in rat kidneys were also performed. Results. DN was associated with significant increases in SBP, urinary albumin, serum glucose, urea, creatinine, inflammatory cytokines, MDA, and mTOR gene expression (P0.05). Conclusion. It has been concluded that vitamin D is a potent adjuvant therapy in treatment of DN via downregulation of mTOR gene expression, stimulation of autophagy, and antioxidant, anti-inflammatory, and hypotensive effects

The Potential Utility of Circulating Oncofetal H19 Derived miR-675 Expression versus Tissue lncRNA-H19 Expression in Diagnosis and Prognosis of HCC in Egyptian Patients

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Interestingly, lncRNA-H19 acts independently in HCC and influences miR-675 expressions. We aimed to assess the potential utility of tissue lncRNA-H19 versus miR-675 expressions as a non-invasive biomarker for HCC diagnosis and prognosis in Egyptian patients. Ninety-one HCC patients and 91 controls included in this study were investigated for expression of lncRNA-H19 and miR675 using RT-qPCR. Our results showed that the expression of lncRNA-H19 and microRNA-675 were higher in patients than in controls (p p p < 0.001, 0.001, respectively). Oncofetal H19-derived miR-675 expression could be considered a potential noninvasive diagnostic and prognostic biomarker, outstanding the performance of the expression of tissue lncRNA-H19 for HCC

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

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