Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature.

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy). Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification. Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% (95% confidence interval [CI]: 7.4%-13.1%). For types A and B, the successful recanalization rate was 95.4% (95% CI: 86.5%-100%), with a 13.7% (95% CI: 2.3%-27.4%) complication rate. For type C, the success rate for ET was 45.7% (95% CI: 17.8%-70.7%), with a complication rate of 46.0% (95% CI: 20.0%-71.4%) for ET and for the HS technique 87.6% (95% CI: 80.9%-94.4%), with a complication rate of 14.0% (95% CI: 7.0%-21.8%). For type D, the success rate of recanalization was 29.8% (95% CI: 7.8%-52.8%), with a 29.8% (95% CI: 6.1%-56.3%) complication rate. Successful recanalization resulted in a symmetrical perfusion between both cerebral hemispheres, resolution of penumbra, normalization of the mean transit time, and improvement in Montreal Cognitive Assessment (MoCA) score (ΔMoCA = 9.80 points; P = 0.004). Conclusions: Type A and B occlusions benefit from ET, especially in the presence of a large penumbra. Type C occlusions can benefit from HS. Unfortunately, we did not identify an intervention to help patients with type D occlusions. A phase 2b randomized controlled trial is needed to confirm these findings

Plasma and intracellular (platelet) zinc levels in chronic renal failure (CRF) patients under different treatment modalities

The causes and degree of zinc (Zn) deficiency in uraemia are still controversial. The effect of different treatment modalities are still unsettled. Plasma Zn represents only a small part of the total body Zn (about 0.5%). Thus determination of intracellular Zn in the peripheral blood cells might be more reliable. The present study was designed to assess the actual Zn status in uraemia and to find whether the treatment modalities of CRF (conservative and dialytic) could influence Zn status. Also to determine the elfeet of single dialysis session, type of dialysis and dialysate buffer on the Zn status.This study included ten healthy controls and fourty CRF patients divided in three subgroups on different treatment modalities (10 conservative treatment, 15 on intermittent perioneal dialysis ((IPD) and 15 on haemedialysis (HD). Zinc was measured by atomic absorption spectrophotometry in plasma and platelets. Statistically significant decrease of plasma Zn and significant increase of platelet Zn were found in CRF patients on different treatment modalities as compared to controls (P<0.01), but there was no significant difference in this respect hetween the three uraemic subgroups. There was no difference as regard serum protein and albunun levels in uraemic subgroups compared to controls. Moreover plasma Zn was significantly increased (still less than control) and platelet Zn was significantly decreased (P<0.01) after a single dialysis session in both IPD and HD subgroups, but the changes of both parameters (before and after dialysis) were insignificant in IPD patients compared to HD patients.Significant negative correlation was found between platelet Zn and creatinine clearance in the three uraemic subgroups (r = -0.81 P<0.01 in conservative patients, r= -0.72 P<0.01 in IPD and r= -0.76 P<0.01 in HD) while no correlation could be detected between the duration of dialysis and each of platelet & plasma Zn and between plasma Zn and each of platelet Zn, serum creatinine and clearance. Plasma Zn showed transient significant rise in HD patients using bicarbonate (11.6 ± 1.1 umol/L) as compared to those using acetate buffer (9.1 ± 1.3 umol/L), P<0.01. We can conclude that intracellular measurements of Zn (platelet) is of value in diagnosis and monitoring of Zn status in uraemics. Different treatment modalities does not influence Zn haernostasis. with no superiority of particular type of dialysis in this respect. The effect of a single dialysis session and the use of bicarbonate versus acetate buffer was just a transient rise of plasma Zn due to haemoconcentration and better correction of acidosis during dialysis

Plasma Soluble Human Elastin Fragments as an Intra-Aneurysmal Localized Biomarker for Ruptured Intracranial Aneurysm

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of elastin fragments were measured using an ELISA-based method. Mean plasma level of soluble human elastin fragments was significantly greater in ruptured aneurysms when compared with nonruptured aneurysms (102.0±15.5 versus 39.3±9.6 ng/mL; P\u3c0.001). Mean plasma level of soluble human elastin fragments did not have significant correlation with age, sex, size, or aneurysm location. Conclusions—The present study revealed that a significantly higher concentration of soluble human elastin fragments in the lumen of ruptured intracranial aneurysms when compared with nonruptured ones. © 2018 The Authors

Role of Assistive Devices on Gait in Patients with Incomplete Spinal Cord Injury: Systematic Review

Background: People with incomplete spinal cord injury disabilities can be able to live a healthy, productive, and dignified life by using Assistive devices as their role in improving gait. Facilitate locomotion rehabilitation. And enable people with incomplete SCI to ambulate in an upright position. Objective: This systematic review aimed to examine the effectiveness of the role of using assistive devices in gait rehabilitation in patients with incomplete SCI. Material and Methods: Studies were identified from 2000 to 2020 by electronic search using PubMed, Cochrane Database of Systematic Reviews, Google Scholar, and Physiotherapy Evidence Database (Pedro). They were reviewed if they were randomized control trials focused on the effectiveness of Assistive Devices on Gait in Patients in age more than 18 years with incomplete Spinal Cord Injury being published in English. Eight studies were selected according to inclusive and exclusive criteria and descriptive analysis was conducted due to heterogeneity. Results: Eight trials were identified with good quality methodology. Descriptive analysis was applied for three studies that supported the use of assistive devices for those patients and meta-analysis was applied for five studies. The mean difference across all the five studies is -0.69 (95% CI -0.93, -0.45). According to AACPDM, there is level II evidence that supports the use of the assistive device as a method to be able to live a healthy, productive, and dignified life. Conclusion: The current level of evidence supports the effectiveness of assistive devices in improving gait in patients with incomplete spinal cord injury

THE EFFECTS OF DIABETES MELLITUS ON THE RESPONSE TO PEGINTERFERON-ALPHA IN COMBINATION WITH RIBAVIRIN THERAPY IN EGYPTIAN CHRONIC HEPATITIS C PATIENTS

Objective:The present study aimed to determine whether type 2 diabetes mellitus influences the response to antiviral therapy with peg-interferon alpha plus ribavirin in Egyptian patients with chronic hepatitis C. Methods:All patients were treated with peginterferon alpha 2 b (1.5 μg/Kg/body weight) subcutaneously plus oral ribavirin application in a dose ranging from 800-1200 mg/day and followed after 12 w of therapy. Results: The present study indicated that, non-significant changes were observed in liver function, kidney function, thyroid function tests, tumor marker, immunological analysis, hematological parameters, viral load and degree of cirrhosis between both groups’ baselines, while the only significant difference was regarded in glucose level. However, diabetic group showed a significant decrease in response to antiviral therapy as compared to non-diabetic hepatitis C virus (HCV) patients. Furthermore, significant decrease in serum liver enzymes activity and total bilirubin level as compared to baseline levels in both groups, while there were a significant increase in alanine transaminase (ALT) activity and total bilirubin level in diabetic group as compared to non-diabetic HCV group after treatment. Also, significant decreases in hemoglobin concentration, white blood cells and platelet counts, in both groups after treatment as compared to there before treatment while diabetic group showed significant decreases in hemoglobin concentration and white blood cells count when compared with non-diabetic HCV group after treatment. Conclusion: Type 2 diabetes mellitus influence the response to antiviral therapy with peginterferon plus ribavirin in Egyptian patients with chronic hepatitis C

The rise in stunting in relation to avian influenza and food consumption patterns in Lower Egypt in comparison to Upper Egypt: results from 2005 and 2008 Demographic and Health Surveys

Background A 2006 avian influenza (AI) outbreak resulted in mass removal of chickens in Lower Egypt, which decreased the household supply of poultry. Poultry, a key animal-source food, contains nutrients critical for child growth. This paper examines determinants of stunting between 2006 and 2008 in children 6 to 59 months of age within the context of the AI outbreak. Methods The 2005 and 2008 nationally representative Egypt Demographic and Health Surveys (EDHS) were used to analyse anthropometric data from 7,794 children in 2005 and 6,091 children in 2008. Children, 6–59 months of age, with length for age Z-score \u3c −2 S.D. were categorized as stunted. Predictors of stunting were examined by bivariate and multivariable analyses, focusing on Lower Egypt, where a rise in stunting occurred, and Upper Egypt, where stunting declined. Results Between 2005 and 2008, Upper Egypt experienced a significant decline in stunting (28.8 to 21.8%, P \u3c 0.001). Lower Egypt experienced a significant rise in stunting (16.6 to 31.5%, P \u3c 0.001), coinciding with the 2006 AI outbreak. In Lower Egypt (2008), households owning poultry were 41.7% less likely to have a stunted child [aOR 0.58; 95% CI (0.42, 0.81) P = 0.002], and 12–47 month old children were 2.12-2.34 times [95% CI (1.39 – 3.63) P ≤ 0.001] more likely to be stunted than 6–11 month old children. Older children were likely affected by AI, as these children were either in-utero or toddlers in 2006. In Upper Egypt, stunting peaked at 12–23 months [aOR 2.62, 95% CI (1.73-3.96), P \u3c 0.001], with lowered risk (22-32%) of stunting in 24–47 month old children [aOR1.65, 95% 1.07-2.53, P = 0.022, 24–35 month old] and [aOR 1.57, 95% CI 1.01-2.43, P = 0.043 36–47 months old]. A two-fold increase in child consumption of sugary foods between 2005 and 2008 was found in Lower Egypt (24.5% versus 52.7%; P \u3c .001). Conclusions Decreased dietary diversity, reduced poultry consumption, substitution of nutritious foods with sugary foods paralleled a reduction in household raising of birds, following the AI outbreak in Lower Egypt and not Upper Egypt. Increased feeding of sugary foods due to fear of illness or greater penetration of these foods may be related to stunting. Advice on infant and young child feeding is needed to improve dietary intake and reduce sugary food consumption

Combining Evolutionary Algorithms and Average Overlap Metric Rules for Medical Image Segmentation

Abstract: In this paper, we explore a new algorithm based on evolutionary algorithms and fusion concepts for improving medical image segmentation. The proposed approach starts by finding seeds that cover the image using genetic algorithm (GA). This initial partition is used as the seed to a computationally efficient region growing method to produce the closed regions. The average overlap metric (AOM) is used to classify these regions into groups based on the similarity criterion. The fusion modules are applied to each group to find the points that label the suite membership values. The different fusion rules will be applied to these groups to produce a set of chromosomes to select the best data in each chromosome to represent the final segment. To prove the efficiency of the proposed algorithm, the proposed algorithm will be applied to challenging applications: MRI datasets, 3D simulated MRIs, and gray matter/white matter of brain segmentations

Beneficial therapeutic effects of Nigella sativa and/or Zingiber officinale in HCV patients in Egypt

Hepatitis C is a major global health burden and Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. The current study was designed to evaluate the beneficial therapeutic effects of ethanolic extracts of Nigella sativa, Zingiber officinale and their mixture in Egyptian HCV patients. Sixty volunteer patients with proven HCV and fifteen age matched healthy subjects were included in this study. Exclusion criteria included patients on interferon alpha (IFN-α) therapy, infection with hepatitis B virus, drug-induced liver diseases, advanced cirrhosis, hepatocellular carcinoma (HCC) or other malignancies, blood picture abnormalities and major severe illness. Liver function enzymes, albumin, total bilirubin, prothrombin time and concentration, international normalized ratio, alpha fetoprotein and viral load were all assessed at baseline and at the end of the study. Ethanolic extracts of Nigella sativa and Zingiber officinale were prepared and formulated into gelatinous capsules, each containing 500 mg of Nigella sativa and/or Zingiber officinale. Clinical response and incidence of adverse drug reactions were assessed initially, periodically, and at the end of the study. Both extracts as well as their mixture significantly ameliorated the altered viral load, alpha fetoprotein, liver function parameters; with more potent effect for the combined therapy. In conclusion, administration of Nigella sativa and/or Zingiber officinale ethanolic extracts to HCV patients exhibited potential therapeutic benefits via decreasing viral load and alleviating the altered liver function, with more potent effect offered by the mixture

Condiciones óptimas para la degradación enzimática de proteínas de semillas oleaginosas

Soybean, sesame seed, and rice bran meal proteins were hydrolyzed with two enzymes, namely, papain and bromelain. Experiments were carried out to elucidate the optimum condition for each enzyme when acting on each substrate seperately. Results revealed that the highest relative activities for papain were achieved with E/S 0.06 , 0.29, 0.19 and pH 7.2, 7.0, 7.0 for soybean, sesame,and rice bran meal proteins, respectively. Optimum temperature for papain while hydrolysing the three substrates was 50 ºC. When using bromelain optimum E/S resulting in highest relative activities were 0.067, 0.058 and 0.21 for soybean, sesame,and rice bran meal protein, respectively. Optimum pH was 6.0 and optimum temperature was 45 ºC for bromelain when hydrolysing the protein of the three substrates. A numerical correlation of enzymatic behaviour for the different substrates was calculated.Proteínas de haba de soja, semilla de sésamo y harina de germen de arroz se hidrolizaron con dos enzimas, denominadas, papaina y bromelaina. Se han llevado a cabo experimentos para determinar las condiciones óptimas de cada enzima cuando actúan separadamente sobre cada sustrato. Los resultados mostraron que las mayores actividades relativas para la papaina se consiguieron con una E/S 0,06, 0,29, 0,19 y un pH 7.2, 7.0, 7.0 para las proteínas de haba de soja, sésamo y harina de germen de arroz, respectivamente. La temperatura óptima para la papaina durante la hidrólisis de los tres sustratos fue de 50 ºC. Cuando se usa bromelaina las relaciones E/S óptimas que proporcionaron mayor actividad relativa fueron 0.067, 0.058 y 0.21 para las proteínas de habas de soja, sésamo y harina de germen de arroz respectivamente. El pH óptimo fue 6.0 y la temperatura óptima 45 ºC para la bromelaina cuando se hidroliza la proteína de los tres sustratos. Con estos datos se hizo una correlación numérica del comportamiento enzimático para los diferentes sustratos

A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term