Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

To study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after direct Actin antiviral drugs (DAAS). Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing DAAS into three arms: arm 1 with Non-EV, arm 2grad1&2 EV (Small Vriceal arm), and arm 3 grade 3&4 EV (Large Variceal arm). medical history, physical examination, standard laboratory tests, abdominal ultrasound, and sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) at cut-off (CO) ≤ 1121.43 cu/mm, then high SPI at CO >3.98 cm /sec then high FIB4 at CO > 2.68 then high APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then high SI at CO > 89.7 and lastly Child’s – Pugh’s score at CO > 6 respectively.. The Non Invasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then high APRI at CO > 1.4 then high FIB4 at CO > 7,6 then high SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post-C after DAA

Assessment of autoimmune rheumatic diseases activity during pregnancy

Background:Autoimmune rheumatic diseases (ARDs) are chronic problems that disproportionately impact females of childbearing age. Objective: To evaluate the effect of pregnancy on rheumatic disease activity Patients and Methods: This prospective study was conducted on (70) pregnant patients aged from 18 to 35 years old. They were divided into four groups; (30) with Rheumatoid arthritis, (20) with SLE, (10) with Systemic Sclerosis and (10) with Ankylosing Spondylitis. Routine baseline investigations, auto antibodies and imaging. Results: There were significant differences between the current study groups as regards the history of hormonal therapy (p<0.001); family history of rheumatic disease (p=0.037). There was statistically significant higher RBCs (p<0.001), Hb (p=0.006), WBCs (p<0.001), platelets count (p<0.001) and HCT (p<0.001) value in RA patients versus other patients groups. The acute phase reactant was significant in AS patients; also both ALT and AST were significantly higher in AS patients (p<0.001). RA patients had (Anti-CCP + ) and (RF +) in 80% of cases and other 20% were negative , SLE had (ANA+ ) in all cases , Low (C3-C4) in 87.5% , (RF + ) in 12.5% of cases , in SS all cases had (ACA +) ,(Anti-SCL70 + ) and in AS all cases had (HLA-B27 +) . Conclusion: The present study pointed to the importance of tight disease control and diagnosis before and during pregnancy as well as the importance of disease activity assessmen

Prevalence of Neospora caninum and Toxoplasma gondii Antibodies and DNA in Raw Milk of Various Ruminants in Egypt.

The prevalence of Neospora caninum and Toxoplasma gondii antibodies in raw milk samples was estimated in different ruminants and Egyptian governorates. Of 13 bulk milk samples tested by ELISA, five (38.5%) were positive for antibodies to N. caninum, and two samples were additionally positive for antibodies to T. gondii, resulting in a seroprevalence of 15.4% for both T. gondii and co-infection. In individual milk samples (n = 171) from the same bulks, antibodies to N. caninum were detected in 25.7%, to T. gondii in 14%, and 3.5% had antibodies to both parasites. A strong correlation between the OD values of the bulk samples and of the relevant individual milk samples was found for T. gondii (Pearson r = 0.9759) and moderately strong for N. caninum (Pearson r = 0.5801). Risk factor assessment for individual milk samples revealed that antibodies to T. gondii were significantly influenced by animal species, while no risk factors were detected for N. caninum antibodies. Additionally, DNA of N. caninum was detected in a bulk milk sample of cattle for the first time in Egypt, and DNA of T. gondii was found in bulk milk samples of cattle, sheep and goats. This is the first study in Egypt in which bulk milk samples of different ruminants were tested for the presence of N. caninum and T. gondii antibodies and DNA. Both individual and bulk milk samples are useful tools for monitoring antibody response to N. caninum and T. gondii infections in different ruminants in Egypt

Studi su indoli Beta-dichetoacidi come inibitori dell'HIV-1 integrasi: progettazione, sintesi, studi SAR, cristallografia e docking

Di recente, una categoria di composti recanti uno spezzone Beta-dichetoacido (I) è stata indipendentemente individuata da ricercatori della Shionogi e della Merck come una nuova classe di inibitori selettivi dell'HIV- 1 IN ad attività antivirale. In questo lavoro è stato confermato che il farmacoforo Beta-dichetoacido è importante per la selettività verso lo strand transfer ma che questa non è sufficiente per l'attività  antivirale. E' stato inoltre dimostrato che la porzione aromatica gioca un ruolo di particolare importanza nell'attività inibitoria

Impact of Folic Acid in Modulating Antioxidant Activity, Osmoprotectants, Anatomical Responses, and Photosynthetic Efficiency of Plectranthus amboinicus Under Salinity Conditions

Salinity is a major threat to the sustainability of agricultural production systems. Salt stress has unfavorable implications on various plant physio-morphological and biochemical reactions, causing osmotic and ionic stress. Exogenously applied folic acid (FA) may at least provide one mechanism to evade the injurious stress effects of saline irrigation water on Plectranthus amboinicus. In this regard, two pot trials were performed during the 2018–2019 and 2019–2020 seasons in an open greenhouse of an experimental farm (29°17'N; 30°53'E) in Fayoum, Egypt. We tested four levels of saline irrigation water (SW): 34, 68, and 102 mM NaCl, plus tap water as the control = 0), combined with FA at three concentrations (25 and 50 μM, plus spray with distilled water as the control = 0). The growth parameters, biochemistry, physiology, elemental leaf status, essential oil content, and anatomical responses were assessed. Salt markedly reduced photosynthetic productivity [Fv/Fm and performance index (PI)], total chlorophyll [soil plant analysis development (SPAD)], and leaf osmoprotectant compounds, i.e., total soluble sugars (TSS), free amino acids, proline, and total phenolics, thus hampering P. amboinicus growth and essential oil yield. However, the addition of FA as a foliar spray to P. amboinicus irrigated with saline water induced increases in Fv/Fm, SPAD, and PI. These were linked with enriched stem anatomical structures, leaf osmoprotectant compounds, and enhanced leaf enzymatic activity, e.g., superoxide dismutase, catalase, ascorbate peroxidase, glutathione reductase, glutathione, ascorbic acid, and antioxidant content. Under salt stress, supplementation of 25 and 50 μM FA increased the growth and production of essential oil by 27.8 and 55.6%, respectively, compared with no applied FA. The highest growth characteristics and elemental leaf contents were obtained when P. amboinicus was irrigated with 0 mM saline water and treated foliarly with 50 μM of FA compared with non-treated plants. Overall, these data showed that foliar spraying with FA reduces the impact of salt stress on P. amboinicus irrigated with saline water

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)