Keeping the mitral smile: is it durable? A comparative study of mid-term outcomes of mitral valve repair and mechanical mitral valve replacement in rheumatic heart patients

Background: Rheumatic heart disease is a significant cause of morbidity and mortality in endemic countries. Traditionally, mechanical valve replacement has been the preferred surgical approach for treating rheumatic mitral valve disease due to its favorable short-term outcomes and low incidence of postoperative complications. However, its midterm results are suboptimal due to increased risks of thrombosis and bleeding. This study compared the midterm outcomes of mitral valve surgeries, repair versus replacement, in rheumatic patients. Methods: A comparative retrospective clinical study was conducted from January 2016 to December 2018. The study included 203 patients who underwent mitral valve surgery for rheumatic heart disease. The patients were divided into two groups: Group A (n=107) had mitral valve repair, and Group B (n=96) had mitral valve replacement. Results: In Group A, the mean age was 45.5 ± 5.2 years, and 49% of the patients were male. While in Group B, the mean age was 46.2 ± 5.35 years, and 54.75% of the patients were males. The two groups had no significant difference regarding cardiac dimensions or function preoperatively. In Group A, the mean cardiopulmonary bypass time was 89 ± 9 minutes, and the mean cross-clamp time was 81 ± 7 minutes; in Group B, the mean cardiopulmonary bypass time was 77±12 min, and the mean cross-clamp time was 81 ± 7 min. The two groups had highly significant differences concerning cardiopulmonary bypass and cross-clamp times (p<0.001). Survival at 5 years was 98.5% for Group A vs. 93.15% for Group B (0.09). The reoperation rate was 9.0% in Group A vs. 4% in Group B (p= 0.261). The thromboembolism incidence was 0.47% in Group A vs. 7.3% in Group B (p= 0.03), and the bleeding-related complications were 0.94% in Group A vs. 7.3% in Group B (p= 0.03). Conclusion: The outcomes of mitral valve repair could be comparable to replacement in patients with rheumatic heart disease. Mitral valve replacement were associated with higher bleeding and thromboembolic complications compared to mitral valve repair

Health Related Quality of Life in Egyptian Children and Adolescents with Epilepsy

Background: Childhood epilepsy is one of the most significant and prevalent neurological condition in the developing years. The aim of the study was to explore the current status of health related quality of life (HR-QOL) in Egyptian children and adolescents with epilepsy using (WHOQOL-BREF) questionnaire. Patients and Methods: This case control study was carried out in Pediatric Neurology Unit and Outpatient Clinic in Department of Pediatrics  at Zagazig University Children's Hospital on 110 children, divided into 2 groups, case group included 55 children with epilepsy and control group included 55 apparently healthy children without epilepsy of matched age, sex and social class. All the children were subjected to history taking, clinical examination and assessment of QOL. Results: There was a significant decrease in all domains and total score of WHOQOL-Bref questionnaire in the case group. There was a significant  –ve correlation between age and psychological domain score, also between number of school failure  and both psychological and environmental  domain. Disease duration and treatment duration were negatively significantly correlated with all QOL domains. A significant +ve correlation was  found between social class score and  both general and environmental domain. There was a significant decrease in general and environmental  domain score  between cases with generalized and partial seizers compared to cases with absent seizers. Conclusion: Diminished  QOL is common in children with epilepsy than other children. Patients with epilepsy had lower mean scores of all domains of QOL, especially those with frequent fits, those with long duration, and in patients with generalized fits

Predictors of Long-term Disability in Multiple Sclerosis: Real World Data from a Cohort of Egyptian Patients

Background: Specification of prognostic factors in multiple sclerosis (MS) is crucial for clinicians to guide therapeutic protocols. This study aimed to identify demographic, clinical, and radiological factors associated with disability on a long-term basis in relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS).Methods: This was a retrospective study conducted on patients with RRMS and SPMS with a disease duration of at least 10 years. Demographic, clinical, and radiological parameters were collected from the medical records.Results: During the study period, 217 patients were recruited with a mean disease duration of 14.9 ± 4.6 (range: 10-35) years. Regression analysis revealed that age (B = 0.071, CI: 0.00-0.132, P = 0.025), male sex (B = –0.825, CI: –1.444 to –0.206, P = 0.009), duration between first 2 attacks (B = -0.007, CI: -0.015-0.000, P = 0.037), and involvement of pyramidal (B = 0.754, CI: 0.051-1.457, P = 0.036) or cerebellar domains (B = 1.355, CI: 0.542-2.168, P = 0.001) at disease onset were the only parameters that had an independent effect on EDSS.Conclusion: Predictors of long-term disability in our cohort were closely similar, but not typically identical to predictors reported in the literature. Age, male sex, short duration between first 2 relapses pyramidal and cerebellar affection were the strongest predictors of disability in patients with RRMS and SPMS

Impact of Culture Media Composition, Nutrients Stress and Gamma Radiation on Biomass and Lipid of the Green Microalga, Dictyochloropsis splendida as a Potential Feedstock for Biodiesel Production

يعتمد إنتاج الديزل الحيوي من الطحالب الدقيقة على إنتاج الكتلة الحيوية ومحتوى الدهون. يتم التحكم في زياده انتاج الكتلة الحيوية و تراكم الدهون بواسطة عدة عوامل.فى هذا العمل تم دراسة تأثيرات ثلاث اوساط غذائيه خاصة بزراعة الطحالب ( BG11, BBM, Urea media) وايضا بعض المغذيات)النيتروجين والفوسفورو المغنيسيوم والكربون) واشعة جاما على نمو وانتاج الدهون لطحالب Dictyochloropsis splendida. تم الحصول علي أعلي انتاج للكتله الحيويه والدهون لطحلب Dictyochloropsis splendida  عندما تم زراعة الطحلب على الوسط الغذائي BG11 . علاوة على ذلك كان اعلى انتاجية للكتله الحيويه عند 3000 مليجرام / لتر نيتروجين او 160 مليجرام / لتر فوسفور او 113 مليجرام/لتر مغنسيوم او 20 مليجرام/ لتر كربونات.  بينما عند غياب المغذيات فان تراكم الدهون زاد. من ناحية اخرى فان المحتوى الدهنى للطحلب وصل الى 18.26% عندما تعرضت خلايا الطحلب لجرعة 25 جراى من اشعة جاما. وكانت  الدهون المستخلصة من الطحلب تتكون من نسبة عالية من الاحماض الدهنية المشبعة (SFAs, 63.33% ) والاحماض الدهنية الغيرمشبعة (UFAs, 37.02%) وكانت السيادة لحمض البالمتيك (C16:0) ثم حمض اللينوليك (C18:2) فحمض بنتاديكانويك (C15:0) وحمض بالميتوليك (C16:1). و تمثل الاحماض الدهنية المستخلصه من طحلب Dictyochloropsis splendida بهذا التركيب مواد خام واعدة لانتاج الديزل الحيوي.Biodiesel production from microalgae depends on the biomass and lipid production. Both biomass and lipid accumulation is controlled by several factors. The effect of various culture media (BG11, BBM, and Urea), nutrients stress [nitrogen (N), phosphorous (P), magnesium (Mg) and carbonate (CO3)] and gamma (γ) radiation on the growth and lipid accumulation of   Dictyochloropsis splendida were investigated. The highest biomass and lipid yield of D. splendida were achieved on BG11 medium. Cultivation of D. splendida in a medium containing 3000 mg L−1 N, or 160 mg L−1 P, or 113 mg L−1 Mg, or 20 mg L-1 CO3, led to enhanced growth rate. While under the low concentrations of nutrients caused a marked increase in the lipid content. Cultures exposure to 25 Gy of γ-rays, led to an increase in lipid content up to 18.26 ± 0.81 %. Lipid profile showed the maximum presence of saturated fatty acids (SFAs, 63.33%), and unsaturated fatty acids (UFAs, 37.02%). Fatty acids (FAs) recorded the predominance of C16:0, C18:2, C15:0 and C16:1, which strongly proved D. splendida is a promising feedstock for biodiesel production.        

Flood hazard mapping using a GIS-based morphometric analysis approach in arid regions, a case study in the Red Sea Region, Egypt

Flash floods are a major threat to life and properties in arid regions. In recent decades, Egypt has experienced severe flash floods that have caused significant damage across the country, including the Red Sea region. The aim of this study is to map the flood hazards in flood-prone areas along the Red Sea region using a Geographic Information System (GIS)-based morphometric analysis approach. To evaluate the flood hazard degree, the adopted methodology considers various morphometric parameters such as basin area, slope, sinuosity index, shape factor, drainage intensity, circularity ratio, and curve number. GIS techniques were employed to delineate the watershed and the drainage network. The delineated watershed was used together with the digitized maps of soil and land use types to estimate the curve number and the morphometric parameters for each subbasin. The flood hazard degrees are calculated based on the considered morphometric parameters and distinguished based on a five-degree scale ranging from very low to very high. Results indicate that 47% of the study area has a very high flood hazard degree. Furthermore, morphometric analysis results align with the runoff results simulated by a hydrological model, where, for example, basins with a high to very high hazard degree exhibited high runoff. This suggests the influence of physical characteristics on the hydrological behavior of the watershed and further validates the morphometric analysis presented in this work. The results presented here can help policy planners and decision-makers develop appropriate measures to mitigate flash floods and achieve sustainable development in arid regions

Combined Elastic Stable Intramedullary Nail and External Fixation Versus Elastic Stable Intramedullary Nail Alone in the Management of Length-Unstable Pediatric Femoral Fractures: A Prospective Randomised Controlled Clinical Study

Background: Femoral shaft fractures account for approximately 1.6% of fractures in the pediatric population. However, the optimal treatment modality for length-unstable fractures is still controversial. Objectives: Our study aims to compare combined elastic stable intramedullary nail (ESIN) and external fixation (EF) versus ESIN alone in the management of length-unstable femur fractures in pediatric patients in terms of surgical, functional, and radiological outcomes. Patients and Methods: Forty patients (20 in each group) with length-unstable femur fractures. First group was managed by ESIN and EF, and the other group was managed by ESIN alone. Both groups were compared in terms of surgical, functional, and radiological outcomes. Results: The mean follow-up period was 8.4 ± 1.2 months in the ESIN group and 9.1 ± 1.6 months in the ESIN/EF group. Radiological outcomes, as measured by Beaty’s criteria, have shown a statistically significant difference between groups. However, both groups has similar functional outcomes and rate of postoperative complications. Conclusion: This study has demonstrated superiority of ESIN/EF over ESIN alone in terms of radiological outcomes with no significant differences as regards functional outcomes and postoperative complications

MicroRNA-146a expression as a potential biomarker for rheumatoid arthritis in Egypt

AbstractBackgroundMicroRNAs (miRNAs) are small non-coding RNAs, whose role in regulating diverse immune functions, suggests they might play a role as biomarkers for immune mediated disorders. Studies showed that miRNA-146a (miR-146a) expression is increased by proinflammatory cytokines and is an important modulator of differentiation and function of cells of innate and adaptive immunity.Aim of the workThe current study aimed to evaluate the expression of miR-146a as a potential biomarker for diagnosis of rheumatoid arthritis (RA) and to explore its association with disease activity.Subjects and methodsThe study enrolled 50 Egyptian subjects divided into a patient group, which comprised 25 RA patients, and a control group which comprised 25 healthy individuals. The disease activity for the patients’ group was determined by simplified disease activity index. Relative quantification of miR-146a expression in whole blood was determined using reverse transcriptase quantitative real time polymerase chain reaction.ResultsThere were highly significant statistical differences between patients and healthy controls as regards miR-146a relative expression, erythrocyte sedimentation rate (ESR) and anti-cyclic citrullinated peptide (anti-CCP) (p<0.001). Highly significant statistical differences (p<0.001) were also found between different patients’ subgroups as regards miR-146a relative expression and ESR. miR-146a levels correlated positively with those of ESR, C-reactive protein and anti-CCP (p<0.001).miR-146a illustrated best performance in diagnosing RA, showing the highest sensitivity and specificity (96% and 100%, respectively) (AUC: 0.992 at a cut off value of ⩾2.16) compared to anti-CCP (sensitivity: 68%, specificity: 100% and AUC: 0.87 at a cut off value of ⩾22U/ml) and RF (sensitivity: 56%, specificity: 80% and AUC: 0.992 at a cut off value of ⩾13U/ml).ConclusionThis study demonstrated that miR-146a expression was highly significantly elevated in whole blood of patients with RA. Its diagnostic performance was better than anti-CCP and RF and its level of expression correlates with disease activity