Extraforaminal Intraradicular Disc Herniation. Case Report

Background data: The intraradicular penetration of a disc fragment was first reported in 1984 and is much less frequent than the intradural disc herniation. Both types of disc herniation are predominantly found in lumbar spine and rarely in the thoracic and cervical spine. The pathogenesis of lumbar intradural disc herniation is most likely related to dense adhesions between the ventral dura mater and the posterior longitudinal ligament. The adhesions can apparently result either from repeated minor trauma or from prior surgery.Purpose: In this report, the authors presented the first case of extraforaminal intraradicular disc herniation, which was at first misdiagnosed as a schwannoma, and suggested a new classification for the intradural disc herniations.Study design: Case report.Methods: Clinical and radiological examination of a case of extraforaminal intraradicular disc herniation is presented.Results: In our case the MRI had shown an extraforaminal lesion at the region of L3. As the possibility of extraforaminal intraradicular disc herniation is very remote, the diagnosis of schwannoma was made. However, the diagnosis was then proved by histopathology to be intraradicular disc herniation. Because of this new category of intraradicular disc herniation, we modified the classification of intradural disc herniation into type A: intradural disc herniation (IDH); type B: Intraforaminal intraradicular disc herniation (IIDH); and type C: Extraforaminal intraradicular disc herniation (EIDH).Conclusions: When the diagnosis is suspected of an extraforaminal nerve root tumor,we should not forget the possibility of intraradicular disc herniation and the removed material should be sent to the histopathological examination to confirm the diagnosis. (2012ESJ001

Flood Prediction using Artificial Neural Networks: Empirical Evidence from Mauritius as a Case Study

Artificial Neural Networks (ANN) has been well studied for flood prediction. However, there is not enough empirical evidence to generalize ANN applicability to small countries with microclimates prevailing in a small geographical space. In this paper, we focus on the climatic conditions of Mauritius for which we seek to investigate the accuracy of using ANN to predict flooding using locally collected data from 11 meteorological stations spread across the country. The ANN model for flood prediction presented in this work is trained using 20,000 climate data records, collected over a period of two years for Mauritius. Our input climate features are minimum temperature, maximum temperature, rainfall and humidity and our output decision is „flood‟ or „no flood‟. Using ANN, we achieved an accuracy of 98% for flood prediction and hence, we conclude that ANN is indeed a good predictor for flood occurrence even for regions with predominantly microclimatic conditions

The relationship between serum osteopontin level and parameters of Chronic Kidney Disease – mineral bone disease in patients on regular hemodialysis

Background: Chronic Kidney Disease (CKD) is becoming a major health concern worldwide. For many patients, CKD is associated with substantial morbidity and mortality. Osteopontin (OPN) is an extracellular matrix protein first identified in bone tissue and has pleiotropic functions due to its common expression in the main organs and apparatuses. It is a phosphorylated glycophosphoprotein composed of 314 amino acids, involved in biomineralization and remodeling.Objective: This research aimed to assess the serum level of osteopontin in patients with end-stage renal disease (ESRD) on regular haemodialysis and to correlate osteopontin level in patients with ESRD on hemodialysis with other biomarkers CKD-MBD.Patients & Methods: This Study was conducted on 160 participants that were divided into two groups. Control group included 80 healthy subjects of both sexes, and patients group that included 80 ESRD patients on regular hemodialysis of both sexes. All studied groups were subjected to osteopontin level by enzyme-linked immunosorbent assay (ELISA).Results: Serum osteopontin levels were higher in ESRD patients on regular dialysis than in healthy individuals, where it might have a higher predictive value for CKD development. Also, they were positively correlated with serum phosphorus, serum alkaline phosphatase and serum parathyroid hormone, which are parameters of chronic kidney disease-mineral and bone disorder.Conclusion: Osteopontin may be considered an early marker of chronic kidney disease

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Instrumented Posterior Lumbar intervertebral bone cement Interposition: indications and results

Background data: The presence of osteoporosis renders the PLIF not ideal for the treatment of lumbar instability and lumbar canal stenosis. Decortication of the bony end plates weakens the weight bearing functions of the vertebrae. Avoiding decortications of the bony end plates and using bone cement to fill the intervertebral space would theoretically overcome these mechanical disadvantages. Purpose of our study was to evaluate the results of instrumented intervertebral bone cement interposition in osteoporotic patients presented with lumbar instability and/or lumbar canal stenosis. Study Design: Prospective study. Material and Methods: 30 consecutive patients with a mean age of 70.3 years were operated upon using this technique. The study included 39 lumbar segments. Selective posterior decompression was done according to the extent and severity of the stenosis. The disc was removed together with the cartilaginous end plates without traumatizing the bony end plates. The disc space was filled with bone cement. The construct was augmented with transpedicular screw rod fixation of the affected segment(s). The mean follow up period was 32.07 months. The Visual Analogue Scale (VAS) for back and leg pain together with Oxford Claudication Score (OCS) were used to assess the patients pre- and post-operatively. Results: No neurological complications were encountered. The mean operative time was 84.67 minutes and the mean blood loss was 390 ml. The VAS for back and leg pain improved from 7.1 and 3 preoperatively to 1.6 and 0.4 at the end of follow up respectively. OCS also improved from (30.3) preoperatively to (15.8) at the end of follow up. Conclusion: Bone cement interposition after discectomy when combined with transpedicular fixation is a reasonable treatment option for elderly patients suffering from lumbar instability and/or stenosis. (2014ESJ072

Low-dose warfarin in high-risk pregnant patients with mechanical valves: A randomized clinical trial

Low-dose Warfarin (LDW) throughout pregnancy was suggested to provide safe and effective anticoagulation in pregnant patients with mechanical heart valve prosthesis (MHVP). We aimed to study its rate of failure in achieving target INR of those patients. Methods: Group A: 100 pregnant patients with mitral (+aortic; 24%) MHVP were randomized in a 3:1 ratio, to either receive LDW (<5 mg/day) or phenindione (<100 mg/day) throughout pregnancy; respectively. Group B: 100 females in the child-bearing period with mitral (+aortic; 19%) MHVP were randomized similarly and followed same dosage limits. Both groups targeted an INR of 2.5–3.5. Patients failing to reach this target were shifted to the other oral anticoagulant (OA). Aspirin (100 mg/day) was supplemented on the 2nd trimester / 4th follow-up month (Group B). Results: Primary outcome: 20 patients in Group A (26.7%; 16.7–36.7%; P = 0.003) and 4 patients in Group B (5.3%; 0.23–10.37%; P = 0.5) failed to achieve target INR; all being on LDW. Secondary outcomes: Group A received larger doses of either OA (P < 0.0001) achieved lower INR values (P < 0.0001) and had higher failure rates, compared to Group B (relative risk: 5; 1.8–13.9); (P = 0.001). We had no patient mortality or fetal embryopathy but 9 spontaneous abortions and 2 stillbirths related to insignificantly higher OA doses and lower INR achieved (P = 0.039). Conclusions: LDW may be insufficient to reach INR target, especially in high-risk pregnant patients with MHVP. Phenindione can offer an effective and probably safe alternative. NCT01758640

Chat / Audio / video Android application

It’s a good i dea to devel op a customized tool between peopl e usi ng the common and wi del y used technology of smart phones.Communication between people is very important, so social media came to life. Social media applications like Facebook, WhatsApp, Facetime...etc., facilitate the communication between people in which they can call each other through video/audio call freely without being restricted by mobile networks, and share their moments with each other. The proposed system is Chat/Audio/Video Application that allows people to call each other freely and share images and location. Using advanced protocols like XMPP, SIP and specific newly developed server applications like Openfire and Asterisk we could develop our app in our own way. And in our future work we aim to make the system more secured, to add more features to facilitate the communication between people and provide more luxury