Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Background: Redo mitral valve replacement (redo-MVR) remains a challenge despite advances in surgical techniques. Little is known about the outcomes of redo-MVR in patients with rheumatic heart disease. We aimed To evaluate the in-hospital outcomes and associated risk factors for mortality and morbidity after re-operative mitral valve replacement in patients with initial rheumatic heart disease. Methods: This retrospective cohort study included 214 patients, 96 males (44.9%) and 118 females (55.1%), who underwent redo-MVR between January 2015 and December 2020. The mean age was 41.87±11.7 years. European Heart Surgery Risk Assessment System II (EuroSCORE II), Age, Creatinine, Ejection Fraction (ACEF) scores were used for risk stratification. The primary endpoints were in-hospital mortality, major morbidity (renal failure, prolonged ventilation, stroke, reoperation, or deep sternal wound infection), and the composite outcome of mortality and/or morbidity). Results: Major morbidities occurred in 31.8% of patients, and the in-hospital mortality rate was 19.6%. Predictors of mortality were New York Heart Association class (NYHA) III/IV (OR: 5.4; p˂ 0.001), cardiogenic shock (OR: 13.74, p˂0.001), low left ventricular ejection fraction (LVEF) (OR: 4.36; p= 0.01), and perioperative intra-aortic balloon pump (OR: 6.79; p= 0.01). The significant predictors of mortality and/or major morbidity were NYHA III/IV (OR: 2.39; p˂0.001), low LVEF (OR: 4.44; p= 0.001), active endocarditis (OR: 2.4; p=0.04), and perioperative IABP (OR: 3.88; p= 0.045). EuroSCORE II had better accuracy than the ACEF score to predict adverse outcomes (AUC: 0.70 [95% CI: 0.63-0.78] versus 0.58 [95% CI: 0.50-0.66], p= 0.01) . Conclusion: Advanced NYHA class and low LVEF could be associated with poor outcomes after redo-MVR in patients with primary surgery for rheumatic mitral valve disease. EuroSCORE II is a helpful tool for risk stratification during redo-MVR

Empires and Emporia: Fictions of the Department Store in the Modern Mediterranean.

Empires and Emporia: Fictions of the Department Store in the Modern Mediterranean examines the function of nineteenth-century Egyptian and French department stores as urban spaces and literary symbols which shaped and contested the concept of citizenship in both nations. I offer a new reading of these spaces by contextualizing narratives about them within the modern history of the Mediterranean, divided as it was among the British, French and Ottoman empires. I trace the historiography of the modern Mediterranean to the vision developed by the French utopianist Saint-Simon (1760-1825). Saint-Simon imagined the modern Mediterranean as a “mother sea” bringing together Orient and Occident, connected by networks of trade and transport. Such a vision would later be realized through projects promoted by his disciples, such as the Suez Canal and the urban planning of Cairo. French and Egyptian department stores, inspired by the Saint-Simonian project, assumed a key role in modern Mediterranean culture, as they formed commercial and cultural networks in a transnational, colonial, and postcolonial context. Drawing on archival documentation as well as literary works, and invoking theories of human geography and cultural memory, I reconstruct the urban and cultural history of the Parisian and Cairene department stores to examine their role as urban and cultural landmarks, which influenced the city dwellers’ notions of gender, class and race. Through a study of Emile Zola’s Au bonheur des dames, Huda Shaarawi’s Arabic memoirs and her newspaper L’Egyptienne, Jacqueline Kahanoff’s Jacob’s Ladder, and a selection of contemporary works — Latifa el Zayat’s Al-Bab Maftuh (The Open Door), Paula Jacques’s Lumière de l’oeil and Gilda Stambouli souffre et se plaint, Robert Solé’s Le tarbouche, Waguih Ghali’s Beer in the Snooker Club, Victor Teboul’s La Longue découverte de l’étrangeté, Samir Raafat’s Cairo, the early years, and Ilios Yannakakis’s Alexandria 1860-1960 —, I reveal how the Francophilia, Egyptomania and Orientalism sustained by department stores led Egyptian and French writers to use the stores as a strategic literary symbol in rewriting a critical moment of their nation’s history, to reinvent their national identity, and to interrogate issues of modernity, cosmopolitanism, Levantinism, and social equality.PHDComparative LiteratureUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102450/1/atkamal_1.pd

Brain Tumor Radiogenomic Classification

The RSNA-MICCAI brain tumor radiogenomic classification challenge aimed to predict MGMT biomarker status in glioblastoma through binary classification on Multi parameter mpMRI scans: T1w, T1wCE, T2w and FLAIR. The dataset is splitted into three main cohorts: training set, validation set which were used during training, and the testing were only used during final evaluation. Images were either in a DICOM format or in Png format. different architectures were used to investigate the problem including the 3D version of Vision Transformer (ViT3D), ResNet50, Xception and EfficientNet-B3. AUC was used as the main evaluation metric and the results showed an advantage for both the ViT3D and the Xception models achieving 0.6015 and 0.61745 respectively on the testing set. compared to other results, our results proved to be valid given the complexity of the task. further improvements can be made through exploring different strategies, different architectures and more diverse datasets.Comment: 6 Pages with 4 Tables, 4 Figures and 4 Image

Cryptanalysis of Álvarez et al. key exchange scheme

Álvarez et al., Information Sciences 179 (12) (2009) proposed a new key exchange scheme where the secret key is obtained by multiplying powers of block upper triangular matrices whose elements are defined over Zp. In this note, we show that breaking this system with security parameters (r,s,p) is equivalent to solving a set of 3(r+s)2 linear equations with 2(r+s)2 unknowns in Zp, which renders this system insecure for all the suggested practical choices of the security parameters

Study of obesity associated proopiomelanocortin gene polymorphism: Relation to metabolic profile and eating habits in a sample of obese Egyptian children and adolescents

AbstractBackgroundMelanocortinergic system represents a known system involved in the central regulation of body weight with the central proopiomelanocortin (POMC) neurons forming a potent anorexigenic network. Polymorphisms in the POMC gene locus are associated with obesity phenotypes.AimTo assess the contribution of the POMC gene 9-bp insertional polymorphism in the susceptibility to obesity and its relation to body mass index (BMI) and adiposity-related co-morbidities in obese children and adolescents; as well as binge eating behavior.Patients and methodsFifty obese children and adolescents with simple obesity were screened for Binge Eating Disorder (BED) by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), they were compared to 50 age, sex and pubertal stage-matched non obese controls. Anthropometric measurements, blood pressure, abdominal ultrasound for fatty liver, measurement of fasting lipid profile, fasting insulin, fasting blood glucose and assessment of POMC gene 9-bp insertional polymorphism were done.ResultsObese patients had significantly higher anthropometric measurements, blood pressure percentiles, fasting glucose, fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and fasting lipid profiles, and higher frequency of occurrence of non alcoholic fatty liver disease and BED. Allelic frequencies of POMC gene 9bp insertional polymorphism were comparable in patients and controls (p=0.956). Fasting insulin levels were significantly higher in the heterozygous cases having the polymorphism than in wild homozygous cases; whereas no difference was observed among the controls.ConclusionThis polymorphism was associated with higher fasting insulin levels in the obese patients only. These findings support the hypothesis that the melanocortin pathway may modulate glucose metabolism in obese subjects indicating a possible gene-environment interaction. POMC variant may be involved in the natural history of polygenic obesity, contributing to the link between type 2 diabetes and obesity

Ultrasound-Guided Erector Spinae Plane Block: A Comparative Study to Assess its Analgesic Efficacy in Pediatric Patients Undergoing Aortic Coarctation Repair

Background: Effective postoperative analgesia is an important aspect of both anesthetic practice and postoperative outcomes. Thoracotomy for the repair of coarctation of the aorta is a painful surgical procedure; inadequate postoperative analgesia may result in postoperative respiratory complications with the possible prolonged need for oxygen therapy. In addition, paradoxical hypertension is a well-recognized complication of repair. We hypothesize that erector spinae plane block (ESPB) by providing adequate analgesia and blocking sympathetic stimulation may reduce opioid consumption, accelerate weaning of oxygen therapy, and reduce the incidence of early postoperative paradoxical hypertension. Material and methods: Open-labeled randomized controlled trial carried out on 40 patients divided into two groups. Group (B) received ESPB before the skin incision and group (C), the control group received no block. Results: Patients who received ESPB had significantly less intraoperative fentanyl consumption than the control group (P-value<0.001), and significantly less postoperative fentanyl consumption by 50% than the control group in the first 12 hours 2.025 ±0.273 μg/kg and 4.05 ±0.527 μg/kg respectively (P-value<0.001). while there was no statistically significant difference between both groups regarding the incidence of postoperative vasodilator infusion for paradoxical hypertension (P-value=0.054), the pediatric anesthesia emergence delirium (PAED) (P-value=0.06) nor the time to wean oxygen supply (P-value=0.49).  Conclusion: Erector spinae plane block effectively reduces postoperative pain in pediatric patients undergoing repair of coarctation of the aorta. However, it did not significantly accelerate weaning from oxygen therapy nor reduce the incidence of vasodilator use for postprocedural hypertension

Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

Objective. This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. \ud \ud \ud Methods. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. \ud \ud \ud Results. Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). \ud \ud \ud Conclusion. Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic arthritis\u

Association of the Pro12Ala Polymorphism with the Metabolic Parameters in Women with Polycystic Ovary Syndrome

AIM: To investigate the association of peroxisome proliferator-activated receptor gamma (PPARG) Pro12Ala polymorphism with polycystic ovary syndrome (PCOS) and its effect on the metabolic parameters in PCOS women.METHODS: The study used PCR to identify the presence of the PPARG Pro12Ala polymorphism in 100 PCOS women and 120 age-matched healthy women. All participants were subjected to anthropometry, biochemical and metabolic evaluation.RESULTS: Significant difference in the genotypes distributions of PPARG Pro12Ala polymorphism was observed among PCOS women and controls (p = 0.03). The frequency of the polymorphic allele Ala was significantly higher in PCOS cases than that in the controls (OR = 2.01, p = 0.01). The carries of the variant allele Ala in PCOS women showed significant higher values in body mass index (BMI), systolic and diastolic blood pressure, waist circumference, waist to hip ratio, sum of skin folds, fasting blood glucose, fasting blood insulin, HOMA-IR, fasting triglycerides, total cholesterol and low-density lipoprotein than non-carriers.CONCLUSION: The PPARG Pro12Ala polymorphism might contribute to the risk of PCOS and abnormal metabolic parameters and could be considered as a biomarker for early diagnosis and clinic prediction of metabolic complications

Immunohistochemical evaluation of human epidermal growth factor receptor 2 and estrogen and progesterone receptors in breast carcinoma in Jordan

INTRODUCTION: Although breast carcinoma (BC) is the most common malignancy affecting Jordanian females and the affected population in Jordan is younger than that in the West, no information is available on its biological characteristics. Our aims in this study are to evaluate the expression of estrogen receptor (ER) and progesterone receptor (PR) and Her-2/neu overexpression in BC in Jordan, and to compare the expression of these with other prognostic parameters for BC such as histological type, histological grade, tumor size, patients' age, and number of lymph node metastases. METHOD: This is a retrospective study conducted in the Department of Pathology at Jordan University of Science and Technology. A confirmed 91 cases of BC diagnosed in the period 1995 to 1998 were reviewed and graded. We used immunohistochemistry to evaluate the expression of ER, PR, and Her-2. Immunohistochemical findings were correlated with age, tumor size, grade and axillary lymph node status. RESULTS: Her-2 was overexpressed in 24% of the cases. The mean age of Her-2 positive cases was 42 years as opposed to 53 years among Her-2 negative cases (p = 0.0001). Her-2 expression was inversely related to ER and PR expression. Her-2 positive tumors tended to be larger than Her-2 negative tumors with 35% overexpression among T3 tumors as opposed to 22% among T2 tumors (p = 0.13). Her-2 positive cases tended to have higher rates of axillary metastases, but this did not reach statistical significance. ER and PR positive cases were seen in older patients with smaller tumor sizes. CONCLUSION: Her-2 overexpression was seen in 24% of BC affecting Jordanian females. Her-2 overexpression was associated with young age at presentation, larger tumor size, and was inversely related to ER and PR expression. One-fifth of the carcinomas were Her-2 positive and ER negative. This group appears to represent an aggressive form of BC presenting at a young age with large primary tumors and a high rate of four or more axillary lymph node metastases