The value of b0 images obtained from diffusion-weighted echo planar sequences for the detection of intracranial hemorrhage compared with GRE sequence

AbstractPurposeOur aim was to evaluate the clinical utility of b0EPI images obtained from diffusion sequence for the detection of the intracranial hemorrhagic lesions, especially acute intracerebral bleeds thereby shorten the scan time particularly in the critical acute cases of stroke.Materials and methodsAmong all consecutive MR brain studies performed in our department last year, we retrospectively selected those who followed the following criteria: (1) clinically suspected or radiographically confirmed acute infarction or hemorrhage. (2) MRI imaging including DWI and T2∗ images. Sensitivity of hemorrhage detection, conspicuity of lesions, and diagnostic certainty were compared between the b0EPI and GRE sequences.ResultsThere were 77 hemorrhagic lesions with a variety of pathogeneses in various locations. 76/77 (98.7%) of these lesions were hemorrhagic (hypointense) on the GRE sequences, whereas 61 (79.2%) were characterized as hemorrhagic on b0EPI images, and 16 (20.8%) were not detected. The overall difference in hemorrhage conspicuity/diagnostic certainty between GRE and b0EPI sequences was statistically significant (P<.05).Conclusionb0EPI sequence, although shorter in acquisition time, was inferior to GRE imaging in the detection of acute and chronic intracerebral hemorrhage

Effects of feeding rate and formula fineness degree of ring die pellet mill on mechanical property, physical quality, energy requirements, and production cost of poultry diets

The effect of a machine feeding rate (FR; 1, 1.5 and 2 Mg/h) and/or three levels of selected fineness degree (FD; 3, 5 and 7 mm) on machine performance, pellet physical parameters, required energy and production cost of three main types of broilers diets were examined in this experiment. The examined broiler diets were formulated to meet the Ross 308 strain requirements. A complete factorial design (3×3×3) was used to identify the effects of studied factors on the pellet mill machine and pellet production. The obtained results indicated that the pellet mill productivity significantly (p˂0.001) improved through increased pellet mill feeding rate level. In addition, the machine pelleting efficiency was found to be significantly affected by all studied variables and their interactions. While the total power consumption of the machine showed no variations under the impact of the tested factors or with any of their combinations. Regarding the pellet physical quality indices, all broiler diets with all selected FD and lower FR had the maximum durability and bulk density levels. Furthermore, lower feeding rates were associated with higher hardness degrees. The lowest production costs were substantially correlated with high FR and intermediate FD (5 mm). Furthermore, production costs were determined to be reduced in finisher broiler diets under different feeding rates. Moreover, manufacturing costs of finisher broiler meals were observed to decrease in several feeding rates. Overall, these findings indicate the capabilities of producing high-quality pellets and reducing the needed production costs by optimizing feeding rates to 2 Mg/h and 2 mm fineness in broiler diets

Diffusion-weighted MR imaging and ADC measurement in normal prostate, benign prostatic hyperplasia and prostate carcinoma

Purpose: Our aim was to investigate the diffusion-weighted Imaging (DWI) appearance and apparent diffusion coefficient (ADC) values of normal prostatic gland, prostate carcinoma (PCa) and benign prostate hyperplasia (BPH) and to determine the utility of DWI in their characterization. Materials and methods: During a period of 16 months, 40 consecutive patients, with elevated PSA level and 12 healthy volunteers with no clinical symptoms or history of prostate disease were prospectively evaluated with DWI of the prostate. MRI was performed using a 1.5T MR scanner equipped with a pelvic phased array coil. For anatomical imaging, T2W FSE in the three orthogonal planes, and T1WI in axial plane were obtained. DWI with b values of 0, 300, 500 and 800 s/mm2 were performed in axial plane. The results were confirmed by TRUS-guided biopsy or prostatectomy. Results: Patients ranged in age from 45 to 85 years (mean 66.6 ± 7.9 year). Twenty patients were confirmed to have BPH, whereas 20 patients had PCa. The mean and SD of ADC values for the peripheral zone (PZ), central gland (CG), BPH nodules and PCa were 1.839 ± 0.233, 1.469 ± 0.239, 1.359 ± 0.201 and 0.87 ± 0.13 respectively. The mean ADC value of PCa was significantly lower than that of CG, PZ, and BPH nodule, with p value <0.05. Conclusion: DW MR imaging characteristics and ADC values can differentiate PCa and BPH. DWI with ADC may be used as a complementary method to conventional MRI in diagnosis of PCa and BPH

Predicting grade of cerebral gliomas using Myo-inositol/Creatine ratio

Purpose: Our aim was to determine the diagnostic accuracy of MI/Cr ratio in determining the grade of glioma. Materials and methods: Twenty-two patients (14 males and 8 females), ranging in age from 15–63 years (mean 34.4 years) were prospectively recruited for this study. All had a brain tumor recently diagnosed by MRI and had received no previous treatment, except for steroids. They were referred for MRS examination before surgical biopsy and/or resection or radiotherapy. Ratios for MI/Cr, Cho/Cr, and Cho/NAA were obtained for each lesion and compared with the grade of the lesion. Results: The levels of MI/Cr were higher (2.14 ± 1.4) in patients with low-grade astrocytoma, and lower in patients with anaplastic astrocytoma (0.39 ± 0.11) and GBM (0.025 ± 0.06). 21 out of the 22 patients were correctly classified using MI/Cr ratio, one patient was misdiagnosed as high grade glioma and the biopsy revealed grade II glioma. The diagnostic accuracy, sensitivity and specificity of MI/Cr ratio for the grading of glioma was 95.4%, 100%, and 92.8%, respectively. Conclusion: MRS has proven to be an important complementary tool saving the patient from unnecessary biopsy taking when it is conclusive thus altering the treatment planning. This study had demonstrated that MI level and MI/Cr ratio are important in presurgical grading of brain tumors

Association between Chronic Pain and Diabetes/Prediabetes: A Population-Based Cross-Sectional Survey in Saudi Arabia

Background. Diabetes is a debilitating chronic health condition that is associated with certain pain syndromes. The present study sought to evaluate chronic pain and its association with diabetes mellitus at a population level. Methods. A population-based cross-sectional questionnaire survey study was conducted in Al-Kharj, Saudi Arabia, from January 2016 to June 2016. Participants from both private and governmental institutions were selected following a multistage sampling technique and using a cluster sampling method. Anthropometric measurements were taken, including body weight, height, body mass index (BMI) and waist circumference. A blood sample was also drawn from each respondent for fasting blood sugar, HbA1c, and fasting lipid profile. A P value of less than 0.05 indicated statistical significance. Results. A total of 1003 subjects were included for final analysis. Compared to prediabetic and nondiabetic individuals, diabetic subjects had a higher prevalence of lower limb pain (11.1%), back pain (8.9%), abdominal pain (6.7%), and neck pain (4.4%) (X2 = 27.792, P=0.015). In a multiple logistic regression model, after adjusting for age, gender, education level, cholesterol, and smoking status, diabetic/prediabetic patients had a significantly higher prevalence of chronic pain ((OR) = 1.931 (95% CI = 1.536–2.362), P=0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010–1.054, P=0.004). Conclusion. Results of this study found a significant association between diabetes and prediabetes and chronic pain symptoms. Prospective studies are needed to explore temporality of such association

Lean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation

Nonalcoholic fatty liver disease (NAFLD) affects a quarter of the adult population. A significant subset of patients are lean, but their underlying pathophysiology is not well understood. We investigated the role of bile acids (BAs) and the gut microbiome in the pathogenesis of lean NAFLD. BA and fibroblast growth factor 19 (FGF19) levels (a surrogate for intestinal farnesoid X receptor [FXR] activity), patatin-like phospholipase domain-containing 3 (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2) variants, and gut microbiota profiles in lean and non-lean NAFLD were investigated in a cohort of Caucasian patients with biopsy-proven NAFLD (n = 538), lean healthy controls (n = 30), and experimental murine models. Patients with lean NAFLD had a more favorable metabolic and histological profile compared to those with non-lean NAFLD (P &lt; 0.05 for all). BA levels were significantly higher in NAFLD with advanced compared to earlier stages of liver fibrosis. Patients with lean NAFLD had higher serum secondary BA and FGF19 levels and reduced 7-alpha-hydroxy-4-cholesten-3-one (C4) levels (P &lt; 0.05 for all). These differences were more profound in early compared to advanced stages of fibrosis (P &lt; 0.05 for both). Lean patients demonstrated an altered gut microbiota profile. Similar findings were demonstrated in lean and non-lean murine models of NAFLD. Treating mice with an apical sodium-dependent bile acid transporter inhibitor (ASBTi) (SC-435) resulted in marked increases in fgf15, a shift in the BA and microbiota profiles, and improved steatohepatitis in the lean model. CONCLUSION: Differences in metabolic adaptation between lean and non-lean NAFLD patients, at least in part, explain the pathophysiology and provide novel options for therapy. This article is protected by copyright. All rights reserved

Diagnosis, treatment, and prevention of community-acquired pneumonia in children: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

Abstract Background We recently adapted a guideline for Community-Acquired Pneumonia (CAP) in children to the Egyptian health system. Adaptation of evidence-based clinical practice guidelines to the local healthcare context is a valid alternative to de novo development that can upgrade their application without enforcing a major burden on resources. The objective of this manuscript is to elucidate diagnosis, treatment, and prevention of CAP as well as methods used for the adaptation process to produce the 1st National Guideline for Community-Acquired Pneumonia in children in Egypt using Adapted ADAPTE method. The full process was described extensively with all three phases of set up, adaptation, and finalization. An adaptation group and an external review including clinical content experts and methodologists conducted the process. Results The authors adapted 10 principal categories of recommendations from three source Clinical Practice Guidelines. Recommendations incorporate; common clinical manifestations, indications for hospitalization and intensive care unit admission, indications for laboratory investigations and radiology in diagnosis, choice of empiric antibiotic therapy in the outpatient and hospitalized children with non-complicated CAP and the duration of therapy, the role of influenza antiviral therapy, follow-up anticipated response to therapy, management of non-responding pneumonia, criteria of safe discharge, and prevention of CAP. Many tools were gathered and established to improve implement ability containing two clinical algorithms for management of non-complicated CAP and for non-responding pneumonia in children, pathway for assessment of severity of CAP in primary care facilities, medication tables, simplified Arabic patient information, PowerPoint slide presentation lecture for management of CAP, and online resources. Conclusion The final clinical guideline supports pediatricians and related healthcare workers with evidence-based applicable guidance for managing community-acquired pneumonia in Egypt. This work demonstrated the efficiency of Adapted ADAPTE and highlighted the importance of a cooperative clinical and methodological professional group for adaptation of national guidelines

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes