The prevalence of accessory heads of the flexor pollicis longus and the flexor digitorum profundus muscles in Egyptians and their relations to median and anterior interosseous nerves

Entrapment neuropathy in the forearm is not uncommon. Surgical interference for nerve decompression should be preceded by accurate diagnosis of the exact cause and site of the nerve entrapment. The aim of the present study was to investigate the prevalence of accessory heads of the flexor pollicis longus and flexor digitorum profundus muscles (FPLah) and (FDPah) in Egyptians and their topographical relationship with both the median nerve and its anterior interosseous branch. A total of 42 upper limbs of embalmed cadavers, 36 from males and 6 from females, were examined to elucidate the prevalence of both the FPLah and the FDPah muscles, their origin, insertion, nerve supply and morphology. The distribution of these two muscles in the right and left male and female upper limbs and their relationship to the anterior interosseous and median nerves were recorded. The total lengths of both accessory muscles and the lengths of their fleshy bellies and tendons were also measured. The FPLah was found to be present more frequently (61.9%) than it was absent, whereas the FDPah was observed in only 14.24% of the specimens examined. The combination of the accessory muscles in the same forearm was noticed in 9.52% of cases. As regards side, the FPLah appeared in 77.7% of the right forearms and in 50% of the left, while the FDPah was found in only 25% of the left forearms. The accessory muscles showed no single morphology, as the FPLah appeared fusiform in 53.8%, slender in 30.8% and voluminous fusiform in 15.4%, while the FDPah was slender in 66.6% and triangular in 33.3% of specimens. The FPLah arose mainly from the under surface of flexor digitorum superficialis, while the FDPah took its origin from the under surface of flexor digitorum superficialis or from the medial epicondyle. The insertion of the FPLah was mainly into the upper third of the FPL tendon, while the FDPah tendon joined the tendons of the flexor digitorum profundus muscle to the index or middle and ring fingers. The FPLah was found between the median nerve anteriorly and the anterior interosseous nerve posteriorly. Both FPLah and FDPah took their nerve supply mainly from the anterior interosseous nerve and, less frequently, from the median nerve. The mean values of the total lengths of FPLah and FDPah were 74.66 mm and 208.33 mm, respectively. Cadaveric dissection in this study confirmed the prevalence of the FPLah and FDPah in Egyptians and demonstrated the relationship of the FPLah to the median nerve and its anterior interosseous branch. These findings may provide the surgeon with information for the differential diagnosis of the causes and sites of anterior interosseous nerve syndrome and entrapment neuropathy of the median nerve in the forearm (Folia Morphol 2008; 67: 63-71)

The Role of Value Engineering in Government Housing Projects in Developing Countries to Improve Value

Government housing projects are among the complex issues facing developing countries’ governments. There have been many attempts to solve problems related to this issue and a lot of effort has been made in this direction. The main problem is lowering the cost of lodging, without sacrificing its quality and the effectiveness by which it fulfills the needs of its occupants. This became possible upon the use of the value engineering technique. Value engineering is an effective tool used to solve problems related to housing, by lowering cost on one hand and sustaining or even ameliorating quality and performance.The purpose of this study is to try to identify a series of proposed solutions and value indicators and to describe their role in improving value in government housing projects. This process may assist the designer in choosing and managing, value indicators during the creative phase, using references from the literature and the analysis of case studies.The literature review identified the reasons for high costs and poor performance, which are often a result of a misunderstanding of the fundamental principles of design criteria and value indicators, followed in government housing projects. The review also pinpointed the most important considerations that improve value.Results obtained in this study feature the positive effects of methods under the umbrella of value engineering, applied in government housing projects. It was found that savings of 15% to 40% can be achieved in the total cost of a certain project, using this technique. Generating ideas in the creative phase is one of the most important stages in value engineering studies. A set of value indicators and proposed solutions in the form of a checklist were derived and can be used in the future, during the creative phase of value engineering studies in the initial design stage of government housing projects

Predictive value of P-wave and QT interval dispersion in children with congenital heart disease and pulmonary arterial hypertension for the occurrence of arrhythmias

Objectives: To evaluate P-wave dispersion (PWD) and QT dispersion (QTd) in children with congenital heart disease and pulmonary arterial hypertension (PAH-CHD) and to investigate the predictive value of both PWD and QTd for prediction of arrhythmias in such children. Materials and methods: We included 40 children with PAH-CHD as Group I. Forty other children with CHD and no PAH were included as Group II. Forty healthy children of matched age and sex served as a Control group. Electrocardiography was performed to determine PWD and QTd. Furthermore, 24-hour Holter monitoring was performed to detect the presence of arrhythmias. Echocardiographic evaluation was also performed. Results: QTd and PWD were significantly higher in Group I than in Group II and Control group. A significant positive correlation was present between both QTd and PWD and mean pulmonary artery pressure, right ventricular diameter, pulmonary vascular resistance (PVR), and PVR to systemic vascular resistance ratio. QTd showed 93% sensitivity, 80% specificity, and 85% accuracy for prediction of occurrence of arrhythmias in patients with PAH-CHD at a cutoff point of 61 ms, whereas PWD showed 87% sensitivity, 80% specificity, and 85% accuracy for prediction of arrhythmias at a cutoff point of 32.5 ms in such patients. Logistic regression analysis showed that both QTd and PWD were good predictors for the occurrence of arrhythmias in children with PAH-CHD (p = 0.003 and p = 0.01, respectively). Conclusions: PWD and QTd were good predictors for the occurrence of various arrhythmias in children with PAH-CHD. Keywords: Children, Prediction, Pulmonary hypertension, P-wave dispersion, QT dispersio

Clinical Course and Nutritional Management of Propionic and Methylmalonic Acidemias

Propionic and methylmalonic acidemias result in multiple health problems including increased risk for neurological and intellectual disabilities. Knowledge regarding factors that correlate to poor prognosis and long-term outcomes is still limited. In this study, we aim to provide insight concerning clinical course and long-term complications by identifying possible correlating factors to complications. Results. This is a retrospective review of 20 Egyptian patients diagnosed with PA (n = 10) and MMA (n = 10) in the years 2014–2018. PA patients had lower DQ/IQ and were more liable to hypotonia and developmental delay. The DQ/IQ had a strong negative correlation with length of hospital stay, frequency of PICU admissions, time delay until diagnosis, and the mode ammonia level. However, DQ/IQ did not correlate with age of onset of symptoms or the peak ammonia level at presentation. Both the growth percentiles and albumin levels had a positive correlation with natural protein intake and did not correlate with the total protein intake. Additionally, patients on higher amounts of medical formula did not necessarily show an improvement in the frequency of decompensation episodes. Conclusion. Our findings indicate that implementation of NBS, vigilant and proactive management of decompensation episodes, and pursuing normal ammonia levels during monitoring can help patients achieve a better neurological prognosis. Furthermore, patients can have a better outcome on mainly natural protein; medical formula should only be used in cases where patients do not meet 100–120% of their DRI from natural protein

Serum levels of N-terminal-pro B-type natriuretic peptide as a diagnostic marker for left ventricular dysfunction in children with end-stage renal disease on hemodialysis

The objective of this study was to determine the diagnostic cutoff value of N-terminal-pro B-type natriuretic peptide (NT-pro BNP) as a marker of left ventricular (LV) dysfunction in children with end-stage renal disease (ESRD) on regular hemodialysis (HD). The study was carried out on thirty children with ESRD on regular HD and thirty healthy controls. Echocardiographic studies were done, including a conventional mode for ejection fraction, fractional shortening, tissue Doppler imaging, and longitudinal global strain by speckle tracking. Serum levels of NT-pro BNP were measured in venous blood samples before and about 30 min after HD by ELISA. Volume status was assessed by calculating interdialytic weight gain %. There were significant higher serum NT-pro BNP levels before HD (mean: 702.3 ± 274.3 ng/L) compared to controls (mean: 365.55 ± 76.5 ng/L) (P <0.001) and these levels decreased significantly after the HD session (mean: 625.1 ± 117.69 ng/L) (P = 0.031). Echocardiographic studies showed a significant impairment of LV function of the patients compared to controls. Patients with LV dysfunction had significant higher serum concentrations of NT-pro BNP compared to patients without dysfunction both before (P = 0.003) and after dialysis (P <0.001). Receiver operating curve demonstrated better prediction of LV dysfunction by NT-pro BNP levels after HD compared to its levels before HD (area under the curve was 0.9 and 0.73, respectively). Using a cutoff value of 630 ng/L, serum NT-pro BNP levels after dialysis were a diagnostic predictor of LV dysfunction with a sensitivity of 86.6%, specificity of 93.3%, positive predictive value of 92.8%, and negative predictive value of 87.5%. Serum NT-pro BNP levels were strongly correlated with the parameters of LV dysfunction in children with ESRD on regular HD. A postdialysis cutoff value of 630 ng/L could serve as a biochemical marker of LV dysfunction in those children regardless of chronic fluid overload

Propionic and Methylmalonic Acidemias: Initial Clinical and Biochemical Presentation

PA and MAA have numerous nonspecific presentations, potentially leading to delayed diagnosis or misdiagnosis. In this paper, we present the clinical and biochemical characteristics of MMA and PA patients at initial presentation. Results. This is a retrospective review of 20 patients with PA (n=10) and MMA (n=10). The most observed symptoms were vomiting (85%) and refusing feeding (70%). Ammonia was 108.75±9.3 μmol/l, showing a negative correlation with pH and bicarbonate and positive correlation with lactate and anion gap. Peak ammonia did not correlate with age of onset (r=0.11 and p=0.64) or age at diagnosis (r=0.39 and p=0.089), nor did pH (r=0.01, p=0.96; r=−0.25, p=0.28) or bicarbonate (r=0.07, p=0.76; r=−0.22, p=0.34). There was no correlation between ammonia and C3 : C2 (r=0.1 and p=0.96) or C3 (r=0.23 and p=0.32). The glycine was 386±167.1 μmol/l, and it was higher in PA (p=0.003). There was a positive correlation between glycine and both pH (r=0.56 and p=0.01) and HCO3 (r=0.49 and p=0.026). There was no correlation between glycine and ammonia (r=−0.435 and p=0.055) or lactate (r=0.32 and p=0.160). Conclusion. Clinical presentation of PA and MMA is nonspecific, though vomiting and refusing feeding are potential markers of decompensation. Blood gas, lactate, and ammonia levels are also good predictors of decompensation, though increasing levels of glycine may not indicate metabolic instability

Synergistic Differential DNA Demethylation Activity of <i>Danshensu</i> (<i>Salvia miltiorrhiza</i>) Associated with Different Probiotics in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a major hepatic disorder occurring in non-alcohol-drinking individuals. Salvianic acid A or Danshensu (DSS, 3-(3, 4-dihydroxyphenyl)-(2R)-lactic acid), derived from the root of Danshen (Salvia miltiorrhiza), has demonstrated heart and liver protective properties. In this work, we investigated the antioxidant activity and hepatoprotective activity of Danshensu alone and in combination with different agents, such as probiotic bacteria (Lactobacillus casei and Lactobacillus acidophilus), against several assays. The inhibition mechanism of the methylation gene biomarkers, such as DNMT-1, MS, STAT-3, and TET-1, against DSS was evaluated by molecular docking and RT-PCR techniques. The physicochemical and pharmacokinetic ADMET properties of DSS were determined by SwissADME and pkCSM. The results indicated that all lipid blood test profiles, including cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were reduced after the oral administration of Danshensu combined with probiotics (L. casei and L. acidophilus) that demonstrated good, efficient free radical scavenging activity, measured using anti-oxidant assays. ADMET and drug-likeness properties certify that the DSS could be utilized as a feasible drug since DSS showed satisfactory physicochemical and pharmacokinetic ADMET properties