Bicycle ergometer versus treadmill on balance and gait parameters in children with hemophilia

Background and purpose: Children with hemophilia often bleed inside the joints andmuscles, which may impair postural adjustments. These postural adjustments are necessary to control gait and postural balance during daily activities. The inability to quickly recover postural balance could elevate the risk of bleeding. So, the purpose of this study was to compare between the effects of bicycle ergometer and treadmill on balance and gait parameters in children with hemophilia.Materials and methods: Thirty hemophilic boys with the ages ranging from 10 to 14 years had participated in this study. They were assigned randomly into two equal study groups. Group A received a designed physical therapy program and aerobic exercise training by bicycle ergometer. While group B received the same physical therapy program in addition to aerobic exercise training by the treadmill. Both groups received treatment sessions three times per week for three successive months. Stability indices and kinematic gait parameters were evaluated before and after three successive months of treatment.Results: There were non significant differences between the pre-treatment mean values of all measuring variables for the two groups. Significant improvement was observed in the two groups when comparing their pre and post treatment mean values. Also, significant differences were recorded when comparing the post treatment results of the two groups in favor of the study group B.Conclusion: Aerobic exercise, in the form of treadmill training for children with hemophilia, is an excellent supplement to regularly scheduled physical therapy intervention. It improves the degree of stability and gait parameters for those patients

Terlipressin versus norepinephrine to counteract intraoperative paracentesis induced refractory hypotension in cirrhotic patients

AbstractBack groundSome of tense ascitic patients with end stage liver disease and portal hypertension were presented to our emergency department with surgical acute abdomen that required urgent abdominal surgery which might be associated with inevitable rapid and relatively complete evacuation of this ascitic fluid with possible occurrence of post-paracentesis-induced hypotension. The aims of this study were to compare between the intraoperative use of terlipressin versus norepinephrine for the management of paracentesis induced refractory hypotension not responding to colloid resuscitation or ephedrine in patients with end-stage liver disease during emergency abdominal surgery.Patients and methodThirty-four patients experienced refractory hypotension during or shortly after the paracentesis process were randomized to receive either bolus dose of terlipressin (1mg over 30min) followed immediately by a continuous infusion of 2μg/kg/h (T group, n=17) or norepinephrine infusion at starting dose of 0.1μg/kg/min (N group, n=17).MeasurementsHemodynamic parameters, cardiac output, systemic vascular resistance, blood gases, lactic acid, liver and kidney functions.ResultsAll patients of both groups showed significant decreases in MAP during or immediately after the paracentesis process to reach mean values of 57±1.4 and 58±1.8mmHg in terlipressin or norepinephrine groups respectively. This was associated with drop in the SVR that reached mean values of 445±28 and 425±20 dynes/sec/cm5 in both terlipressin and norepinephrine groups respectively. At the 2nd day post operative there was significant increase in serum creatinine values in the norepinephrine group.ConclusionTerlipressin and norepinephrine successfully counteracted the post-paracentesis refractory hypotension and the drop of the systemic vascular resistance. It also showed the renal protective effects of terlipressin in the immediate postoperative period

Evaluation of Neonatal Sepsis Based on Measurement of Red Cell Distribution Width

Background: Infant morbidity as well as mortality are frequently caused by neonatal sepsis. Neonatal sepsis can be predicted using the red cell distribution width (RDW), according to several researches. Objective: To determine if RDW can be employed as a marker for the evaluation of newborn sepsis and the assessment of its severity. Patients and Methods: 40 newborns, 20 of whom were infected and the other 20 of whom were non infected, participated in this case-control research. Patients and controls were collected from neonatal intensive care unit (NICU), Zagazig University Hospitals. Full history was taken from all participants parent, with clinical and laboratory examination were done; complete blood picture, and creatinine, blood culture, and serum level of C-reactive protein(CRP). Results: We revealed significant link between RDW and all of total leukocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), CRP, procalcitonin, severity of sepsis, and mortality. RDW and platelet count, on the other hand, have a strong negative association. With a sensitivity of 83.3 percent, specificity of 50 percent, a positive predictive value (PPV) of 71.4 percent, and a negative predictive value (NPV) of 66.7 percent, accuracy of 70 percent (p>0.05), the best RDW cutoff for diagnosing newborn sepsis severity was ≥17.9. Conclusion: Predictors of illness severity and death in newborn sepsis may be accurately predicted using baseline RDW measurements, which is critical for treatment of neonates who are at great risk of sepsis

Simple Efficient Routes for the Preparation of Pyrazoleamines and Pyrazolopyrimidines: Regioselectivity of Pyrazoleamines Reactions with Bidentate Reagents

Simple and efficient routes for the preparation of 2-amino-5-phenyl-4,5-dihydrofuran-3-carbonitrile (12), 2-oxo-5-phenyl-tetrahydrofuran-3-carbonitrile (13) and the 3,5-diaminopyrazole derivative 2h were developed. The results of the reactivity profiles of 12 and 2h are reported and the previously investigated reaction of pyrazole-3,5-diamine (2b) with acrylonitrile to yield compound (31), a N-1 acylation product, is currently justified by using X-ray crystallographic analysis. Taken together, the observation of alkenes and alkynes substitution when reacting with 3,5-diaminopyrazole derivative 2h is explained by the terminal electron withdrawing group. This pattern of substitution is attributed to involvement of sterically unhindered electrophiles primarily at the N-1 position. This work is licensed under a Creative Commons Attribution 4.0 International License

Smart Touch Radiofrequency Catheter Ablation versus Cryoballoon Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

AIM: Evaluation of the safety and efficacy of pulmonary veins isolation in patients with paroxysmal atrial fibrillation (AF) using two new different technologies, cryoballoon (CB) ablation and radiofrequency ablation with contact force (CF)-sensing catheters. METHODS: Prospective single-center evaluation, carried out from January 2016 to June 2018 in Critical Care Medicine Department – Cairo University, comparing CF radiofrequency (Thermocool® SmartTouch, Biosense Webster, Inc.) (CF group) with CB ablation (Arctic Front Advance 28 mm CB, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 50 consecutive patients were enrolled (25 in each group). RESULTS: The characteristics of patients of both the groups were similar (46.9 ± 11.2 years, the proportion of women 36%, mean documented AF duration 3 ± 2.3 years, mean CHA2DS2-VASc score 1.4 ± 1.3, and mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CB group (171.7 ± 15.24 vs. 199.3 ± 18.94 min, p = 0.002), with a longer duration of fluoroscopy and X-ray exposure in the CB group than the CF group but statistically non-significant difference (58.60 ± 11.57 vs. 48.7 ± 13.86 min and 6273 ± 4934 cGy cm² vs. 6853 ± 5069 cGy cm², p = 0.1 and p = 0.2, respectively). Overall complication rate was similar in both groups: 2 (8%) in each group. At 12 months, AF recurrence occurred in 7 patients (28%) in the CF group and in 9 patients (36%) in the CB group (log rank p = 0.682). CONCLUSION: Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 12 months with similar overall complication rate

Target Therapy in Neuroblastoma

Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is the most common solid tumor in infants and the most frequent extracranial solid tumor in children. Neuroblastoma accounts for 10% of childhood malignancies with 75% occurring in children <4 years. Stage, age, clinical and tumor genomic features are the principal criteria for determining treatment policy. Treatment modalities traditionally employed in the management of neuroblastoma are surgery, chemotherapy, and radiotherapy. Intensive multimodal treatment in patients with neuroblastoma has resulted in improved survival rates. However, there is a considerable percentage of patients with refractory and relapsed disease. Targeted therapy for neuroblastoma involves treatment aimed at molecular targets that have a unique expression in this childhood cancer. A large number of molecular targets have been identified for the treatment of high-risk and relapsed neuroblastoma. Treatment in this way aims at providing a more selective way to treat the disease and decreasing toxicities associated with the conventional treatment regimen

β-Thalassemia: Genotypes and Phenotypes

β-Thalassemias are extremely heterogeneous at the molecular level. More than 200 disease-causing mutations have been identified. The majority of mutations are single nucleotide substitutions. Rarely, β-thalassemia results from gross gene deletion. The degree of globin chain imbalance is determined by the nature of the mutation of the β-gene. β0 refers to the complete absence of production of β-globin on the affected allele. β+ refers to alleles with some residual production of β-globin (around 10%). In β++, the reduction in β-globin production is very mild. The broad spectrum of β-thalassemia alleles can produce a wide spectrum of different β-thalassemia phenotypes. In this chapter, we review the molecular basis of the marked heterogeneity of the thalassemia syndromes or in other words the genotype-phenotype relationship in β-thalassemia

Nonalcoholic Fatty Liver Disease and the Risk of Atrial Fibrillation

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is now the factor behind the development of liver cirrhosis, liver cell failure, and liver transplantation in many cases. However, its relation to atrial fibrillation (AF) could not be cleared up. AIM: The purpose of the study was to evaluate prevalence of AF in the setting of NAFLD; the association between them, and to evaluate risk factors of AF in this category of patients. METHODS: This cross-sectional study was performed on 400 patients between January 2018 and June 2019. These patients were analyzed for the presence of NAFLD and presence of persistent or chronic AF. RESULTS: There were 138 patients with NAFLD, and 20 patients with persistent or permanent AF. Factors associated with AF were old age, male gender, and high values of aspartate aminotransferase, alanine-aminotransferase, γ-glutamyltranspeptidase, and serum uric acid. The participants with AF had a significantly greater prevalence of NAFLD than those without AF. CONCLUSION: Incidence and prevalence of atrial fibrillation in NAFLD patients were high. Severity of liver disease was an important predictor of new-onset atrial fibrillation

Nutritive Value of the Dromedary Camel Meat

The current study was conducted to spotlight on the nutritive value of the dromedary camel meat from different ages in Egypt. A total of 50 samples were randomly collected over a period of 10 months from the hindquarter (glutobicepis) muscle of male camel carcasses slaughtered at Assiut and Sharkia Governorates. The samples were divided into two groups according to the age: Group "A" for young age (1≤5 years) and Group "B" for old ages (5-8 years). All samples were subjected to a proximate analysis (moisture, protein, fat, ash, and carbohydrate). Only 16 samples from each age were analyzed for some minerals content (Ca, Fe, K, P, Na, and Mg) and for cholesterol, caloric value and conjugated linoleic acid (CLA) contents. The statistical analysis of the results declared the presence of a significant increase (p<0.01) in fat, ash, carbohydrate, energy, calcium, phosphorus, magnesium, iron, cholesterol and conjugated linoleic acid contents of the camel meat samples with an increasing age. Camel meat from different ages has high nutritive value and it contains considerable amount of protein, which is nearly similar or sometimes higher than other red meat. Pointing to cholesterol and conjugated linoleic acid (CLA) content of camel meat, the obtained mean values in young and old ages were 31.11, 3.19 and 50.63, 5.99 mg/100gm fat, respectively. In conclusion, meat from young camels could be healthier due to its lower fat and cholesterol content