Full Examination Research Articles

Serum Interleukin 4 Level in Asthma Patient in Relation to Body Mass Index (BMI)

Abstract Background The association between obesity and bronchial asthma has been demonstrated by many studies, either observational or interventional studies in both children and adults. The interrelationship between obesity and asthma derives from a complex interplay of biologic, physiologic, and environmental factors. Obesity considered as an important risk factor for asthma development and this mediated by release of proinflammatory mediators, such as interleukin (IL-6) (IL-4), tumor necrosis factor-alpha, and leptin, into the circulation, while release of anti-inflammatory adipokines, such as adiponectin, is decreased. Aim To determine relation between serum interleukin (IL-4) level and body mass index (BMI) in asthmatic patients. Methods This study was conducted on 86 individuals. They were equally classified into two groups: group 1 (overweight and obese asthmatics) group 2 (average weight asthmatics) all of them were subjected to full history and examination, chest x ray, measurement of BMI, CBC, serum total IgE level, serum IL-4 level and pulmonary function test. Results Serum IL-4 level is significantly elevated in group 1(overweight and obese asthmatics) rather than group 2(average weight asthmatics) at p-value 0.000. There was no statistically significant difference between the two groups as regard eosinophils, total igE level, FEV1, FVC and FEV1/FVC%. Conclusion IL-4 level is significantly elevated in overweight and obese asthmatics rather than average weight asthmatics this may be indicate a pathogenic role in development of asthma in overweight and obese asthmatics.

Structural and Functional Optic Nerve Changes in Patients on Amiodarone Therapy

Purpose To investigate the structural and functional optic nerve changes in patients on amiodarone therapy. Methods A total of 30 eyes were examined were divided into two groups, study group of patients included (15 eyes) of cardiac patients on amiodarone therapy for more than four consecutive months, and control group included (15 eyes) of age- and sex-matched healthy participants. Both groups have underwent full ophthalmological examination, optical coherence tomography examination for optic nerve head scan, electrophysiological studies included (pattern visual evoked potential). Results Electrophysiological studies were the tool for the assessment of the functionality of the ocular structure in our study, the pattern visual evoked potential results have shown to be of no statistically significant difference between the N75 latency (ms) (P-value=0.972), P100 latency (ms) (P-value 0.547) and N75-P100 amplitude (µV) (P-value =0.18), in the numeric values between the control and cases groups. And for qualitative structural assessment we have performed optical coherence tomography scan imaging for the optic nerve head for all the participants in this study, and the results revealed no statistically significant differences in the obtained values regarding NFL thickness map. This agrees with the obtained electrophysiological tests results to be both within normal limits Conclusion The current study revealed normal electrophysiological as well as optical coherence tomography measurements in the included sample of patients on chronic amiodarone therapy. All the included patients had good, best corrected visual acuity (BCVA) and none complained of any visual symptoms. None had clinically suspected optic nerve affection and this was confirmed by the detailed imaging and electrophysiological assessment for both macula and optic nerve.

Study of Pentraxin-3 as an Early Marker of Diabetic Vascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus

Background Vascular complications are the major cause of morbidity and mortality in diabetic patients. These can result from interactions between systemic metabolic abnormalities, such as hyperglycemia, dyslipidemia, genetic and epigenetic modulators, and local tissue responses to toxic metabolites. Aim of the Work To assess the role of PTX3 as an early marker of vascular complications in children and adolescents with type 1 diabetes mellitus and its correlation with metabolic control and its relation to hsCRP level. Patients and Methods Fifty adolescents with type 1 diabetes mellitus and 40 age and sex matched control group, Detailed history taking, full systemic examination were done, Patients also were investigated using HbA1c, lipid profile, ALT, Alb/Cr ratio in urine, PTX3, hsCRP and carotid intima media thickness (CIMT). An informed consent was obtained from patients, controls or their legal guardians before enrollment in the study. Inclusion criteria Patients with type 1 diabetes their age ranging from 5 to 18 years old with at least 5 years disease duration and on regular clinic visits and multiple daily insulin therapy . Exclusion criteria Patients with proven vascular complications and those with any clinical evidence of infection, hematological diseases, tumors, liver dysfunction, urinary tract disorders, connective tissue disease, or other autoimmune diseases, also patients with morbid obesity were excluded. Results PTX3 and hsCRP were significantly higher in patients compared to control group. A significant positive correlation between serum PTX3 and level of HbA1c%, level of Triglycerides (TG), level of Total Cholesterol was observed. Additionally, PTX3 and hsCRP levels were elevated in patients with elevated lipid profile (TG and Cholesterol) and high HbA1c% level in comparison with those with normal lipid profile and those with controlled HbA1c% level (p < 0.001). No significant difference was found between patients and control groups as regard CIMT. Conclusion . The increased levels of PTX3 and hsCRP in patients with uncontrolled diabetes even before development of both microvascular and macrovascular complications add a promising tool for their follow up and applying early protective measures.

Vitamin D Level in Children with Acute and Relapsing Demyelinating Disorders of the Nervous System

Background Vitamin D has recently gained increased attention owing to its immunomodulatory role. Epidemiological evidence demonstrates that deficiency of Vitamin D is a relevant risk for acute acquired immune-mediated inflammatory demyelinating diseases in childhood, such as Multiple sclerosis (MS). Exact mechanism remains widely unexplored. Aim to measure the serum level vitamin D-25(OH) in pediatric patients diagnosed with acquired central and peripheral demyelinating diseases, and to compare these to levels found in healthy age and gender matched controls. Patients and Methods Twenty children (patients’ group) diagnosed with acute demyelinating diseases (Acute Disseminated Encephalomyelitis (ADEM, n = 7), Acute Necrotizing Encephalopathy of Childhood (ANEC, n = 3), Autoimmune Encephalitis (AE, n = 3), Transverse Myelitis (TM, n = 3), Guillain-Barre syndrome (GBS, n = 4)) and 40 healthy age and gender matched children (control group), were enrolled in the study. All patients were subject to full history, examination and measurement of serum levels of 25 (OH) vitamin D3 in both cases and control group. Results The mean level of vitamin D in cases was 4.4 ± 11.14 ng/ml, and it was deficient in 75% of the cases and insufficient in 15% of cases. The mean vitamin d level in cases was significantly lower than that in controls (27.18 ± 7.8 ng/ml). Conclusion Serum levels of 25 (OH) Vitamin D3 in pediatric acute acquired demyelinating diseases of the nervous system are significantly lower than levels in healthy controls, raising a possibility that vitamin D deficiency may be a risk factor for the development of various autoimmune neurological diseases.

Effect of Contrast Agent on Renal Functions in Patients with Renal Impairment Undergoing Percutaneous Coronary Intervention

Abstract Background Contrast induced nephropathy is one of the most important clinical complications associated with IV administration of radio-contrast media. This prospective study evaluating incidence and predictors of contrast induced nephropathy after administration of contrast agent in patients with renal impairment undergoing percutaneous coronary intervention. Objective To predict the effect of contrast agents on renal functions in patients with renal impairment undergoing percutaneous coronary intervention. Patients and Methods A prospective study that included 120 patients who underwent percutanous coronary intervention with glomerular filtration rate below 90 ml/min. All patients were subjected to full history, examination and investigation. Results were recorded using serum creatinine and glomerluar filtration rate before and 72 hours after procedure. Results CIN had occurred in 26.67% of studied group where these was high incidence of occurrence of CIN with elderly (p = 0.009), obese patients (p = 0.039), hypertensive (p = 0.004), Diabetics (p = 0.000) and amount of dye received (p = 0.000). 50% of patients who developed CIN where males and 50% where females which was non significant with p = 0.165. Conclusion CIN in patients with preexisting renal damage or risk factors for the development of kidney dysfunction is a potentially serious complication after PCI with increased short and longterm morbidity and mortality. Appropriate management of patients at risk is crucial for the prevention of CIN. Although a specific treatment for CIN is not available removal of modifiable risk factors and implementation of periprocedural measures such as CM reduction and intravenous hydration can significantly lower the risk of CIN in selected patients.

Outcomes of COPD Patients in RICU Ain Shams University Hospital and ICU Mansura

Abstract Background Chronic obstructive pulmonary disease (COPD) is a disease characterized by progressive, persistent, expiratory airflow limitation that is not fully reversible. In the United States, COPD annually accounts for $29.5 billion in direct health care costs, 750,000 hospitalizations, and 1.5 million emergency visits. Globally it is now ranked as the fifth leading cause of death. An exacerbation of COPD is characterized by an acute worsening of a patient's respiratory symptoms that result in change in treatment and increased utilization of health care resources. Objective the aim of this work was to evaluate the characteristics and clinical outcomes of COPD patients admitted to RICU in Ain Shams University Hospital and ICU Mansoura Chest Diseases Hospital. Patients and Methods This was an observational study conducted on a total of 100 patients admitted to ICU with acute exacerbation of Chronic Obstructive Pulmonary Disease at RICU in Ain Shams University Hospital and ICU Mansoura Chest Diseases Hospital within the period from November 2019 to April 2020. We excluded patients with obstructive lung disease other than COPD, Restrective lung disease, Malignancy and TB. The all cases were subjected to Full detailed medical history and full thorough clinical examination. We assessed the outcomes in regard to Length of stay (LOS) and MV duration. Assessment of the outcome which was be either death or discharge to chest ward, home or referral to any other department to complete the treatment. Results The study demonstrated that, the prevalence was 78% survival versus 22% mortality. there was a statistically significant difference among survivors and dead in terms of the cause of admission, there was statistically significant increase among dead cases compared to the survivors regarding APACHE II score, there was there was highly statistically significant decrease in terms of all PH measurements and all PCO2 measurements but there were no statistically significant differences among dead cases and survivors regarding all PO2 measurements, all HCO3 measurements and all SaO2 measurements. Conclusion Mortality was demonstrated to be correlated with several factors such as presence of co-morbidity, original cause of admission, APACHE II score, ABG parameters, WBCs, neutrophils, creatinine, urea, Reintubation, and complications of invasive ventilation.

Screening of Oral Tamoxifen Ocular Toxicity in Breast Cancer Patients

Background Breast cancer is one of the leading cancer types among females worldwide. Prevalence of breast cancer is reported to be the second most common among women. Several treatment lines were prescribed in treatment of breast cancer besides surgical, radiological interventions. Tamoxifen is one of the medical treatments used in postsurgical prophylaxis of breast cancer. Various visual problems were reported with tamoxifen therapy. These include posterior subcapsular cataracts, color vision changes, optic neuritis, and intra-retinal crystals. Aim of the Work The aim of the work was to screen for ocular toxicity of tamoxifen used for treatment of breast cancer patients having no ophthalmic complains and treated with tamoxifen for at least 2 years with dose (20mg per day). Patients and Methods We included 50 female patients with breast cancer treated with Tamoxifen therapy for at least 2 years then we divided them into two groups regarding duration of tamoxifen intake from (2-4) years group and from (5-8) years group, all subjects underwent complete careful history taking and full ophthalmological examination, BCVA was measured using Snellen chart with conversion to log. MAR notation for statistical analysis. Results There was significant correlation between duration of tamoxifen intake and RPE mottling, no other significant correlations were detected, there was no significant difference in mean of BCVA, IOP, cup values, disc parameters, GCC thickness, RNFL zones between the two groups except for (inferior quadrant), macular thickness except in (superior quadrant), OCT layers thinning shows RNFL affection in (34%) of cases, GCC affection in (48%) of cases and macula affection in (64%) of cases, color vision defects was found in (12%) and electrophysiological test changes found in few cases. Conclusion Tamoxifen therapy causes minimal affection on the ocular structure and function, OCT layers thinning (34-64% of cases) preceed the clinical changes this highlights the importance of OCT examination in those patients to evaluate tamoxifen toxicity and further studies will be needed to evaluate reversibility of these changes after stoppage of therapy, main ocular complications associated with tamoxifen therapy were correlated to duration of treatment.

Assessment of orbital hemodynamic changes in primary open angle glaucoma by color Doppler imaging

To assess changes in orbital vessels by Color Doppler Imaging (CDI) in patients with Primary Open Angle Glaucoma (POAG). This cross-sectional study included 120 subjects-60patients with POAG and 60controls, all of whom underwent full ophthalmological examinations and orbital CDI. The Ophthalmic Artery (OA), Central Retinal Artery (CRA) and Ciliary Arteries (CA) were identified, and for each of them, we measured Peak Systolic Velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). The PSV of the OA and CRA were significantly lower in patients with POAG compared to normal controls (P<0.0001, <0.009 respectively). The EDV in the OA, CRA and CA were significantly lower than in normal controls (P<0.0001). The RI of the OA, CRA and CA were significantly higher in patients with POAG compared to controls (P<0.0001). The EDV of the OA showed significant negative correlation with duration of glaucoma (r=-0.37, P<0.042). The EDV of the CA showed significant negative correlation with intraocular pressure (IOP) (r=-0.86 and P value 0.0001). The PSV and EDV of the CRA showed significant negative correlation with IOP (r=-0.45, r=-0.73, P values 0.011, and 0.0001 respectively), and the RI of the CRA showed significant positive correlation with IOP (r=0.42 and P value 0.021). CDI is a feasible, noninvasive, safe tool for the assessment of hemodynamic changes in the orbital arteries of POAG patients. The orbital arteries showed significantly lower flow velocities and increased resistivity indices in patients with POAG compared to the control group, and these changes were correlated with glaucoma duration and IOP.

Assessment of Serum Chitinase-3-Like Protein 1 (YKL-40) in Lichen Planus

Abstract Introduction Lichen planus (LP) is a papulosquamous inflammatory disease of unknown etiology. Chitinase-3-like protein 1 (YKL-40) is proinflammatory multifunctional protein with significant role in immunity, inflammation and regulation of proliferation, differentiation and apoptosis of cell. Aim of the Study To investigate whether YKL-40 protein has any role in the pathogenesis of LP and to estimate its level in different LP patients with different degrees of severity in an attempt to reach a novel role of it in the pathogenesis of this disease in an attempt for better understanding and treatment of LP. Patients and Methods 38 patients with LP and 32 controls were included. Full history recording and physical examination were performed. Assessment of LP severity was done by LPAASI score and VAS score. Measurement of YKL-40 was done using ELISA. Results Assessment of serum YKL-40 revealed higher serum YKL-40 level in LP cases compared to controls with excellent discriminative power and sensitivity and specificity of 100%. A significant positive correlation was demonstrated between the YKL-40 level and LPAASI and pruritis scores. Conclusion Serum YKL-40 revealed significant high levels in LP patients compared to control subjects.

SARS-CoV-2 Prediction Strategy Based on Classification Algorithms from a Full Blood Examination.

A fast and efficient diagnosis of serious infectious diseases, such as the recent SARS-CoV-2, is necessary in order to curb both the spread of existing variants and the emergence of new ones. In this regard and recognizing the shortcomings of the reverse transcription-polymerase chain reaction (RT-PCR) and rapid diagnostic test (RDT), strategic planning in the public health system is required. In particular, helping researchers develop a more accurate diagnosis means to distinguish patients with symptoms with COVID-19 from other common infections is what is needed. The aim of this study was to train and optimize the support vector machine (SVM) and K-nearest neighbors (KNN) classifiers to rapidly identify SARS-CoV-2 (positive/negative) patients through a simple complete blood test without any prior knowledge of the patient's health state or symptoms. After applying both models to a sample of patients at Israelita Albert Einstein at São Paulo, Brazil (solely for two examined groups of patients' data: "regular ward" and "not admitted to the hospital"), it was found that both provided early and accurate detection, based only on a selected blood profile via the statistical test of dependence (ANOVA test). The best performance was achieved by the improved SVM technique on nonhospitalized patients, with precision, recall, accuracy, and AUC values reaching 94%, 96%, 95%, and 99%, respectively, which supports the potential of this innovative strategy to significantly improve initial screening.

Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) study in Southern India.

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrollment, (ii) basic eye examination (BEE) at household one-year post-enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long-term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource-limited settings.

Evaluating the relation between serum apolipoprotein B (apo B), apolipoprotein A (apo A) and apo B/apo A ratio with diabetic retinopathy in a sample of type 2 Egyptian diabetic patient

BackgroundDiabetic retinopathy (DR) is a chronic progressive, ocular disease affecting the retinal microvasculature accompanied by hyperglycaemia and different situations related to diabetes mellitus (DM) such as hypertension (HTN). Till now, the majority of researches demonstrated an insignificant correlation between lipid profile parameters and DR. Novel serum lipid markers (apolipoproteins) which are the protein portion of lipoproteins were recently linked to DR, and observed that the increased apo B and high apo B/apo A ratio accompanied by a higher possibility of proliferative DR.AimTo assess the relation between novel serum lipid markers and various grades of DR in a sample of type 2 Egyptian diabetic cases.MethodsThis study comprised 80 cases with type 2 diabetes mellitus (T2DM) divided into 3 groups: T2DM cases with proliferative diabetic retinopathy (PDR) (group I), T2DM cases with non-PDR (group II) and T2DM cases without DR as a control group (group III). Fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2hpp), haemoglobinA1c (HbA1c), cholesterol (chol), triglycerides (TG), LDL, HDL and serum apolipoprotein A and B level. Complete medical history was taken from entire cases with a special focus on the duration of HTN and diabetes and full clinical examination (including BP and BMI).ResultsThere was a significant difference regarding serum apo B, apo B/apo A ratio, TG, total chol, LDL (p<0.001*), DM duration (p=0.002), HTN duration (p=0.014), SBP (p=0.006), DBP (p=0.013), BMI (p=0.050) and HbA1c (p=0.025), being higher in group I than group II than group III; also, there was a significant difference between them with regard to serum apo A (p=0.010), and HDL (p=0.047) being higher in group III than group II than group I.On comparing group I with group II using Post hock Tukey’s test there was a significant difference regarding serum apo B (p=.023) and apo B/apo A ratio (p=.002).There was a statistically significant positive correlation between serum apo B/apo A ratio and diabetic duration (r=0.248), HTN d (r=0.4), HbA1c (r=.47), LDL (r=0.68), triglycerides (r=0.52), cholesterol (r=0.70) and a statistically significant negative correlation between serum apo B/apo A ratio and HDL (r=0.37) in all subjects. In addition, HTN duration was demonstrated to be the most independent factor affecting B/A ratio.ConclusionSerum apo B and serum apo B/apo A ratio in diabetic cases are higher in the presence of retinopathy, triglycerides, total cholesterol, LDL, and HDL, and it is also higher in proliferative than non-proliferative diabetic retinopathy. The current study emphasizes on the potential correlation between the high serum apo B, serum apo B/apo A ratio and the advancement of DR.

The influence of smoking on retinal ganglion cell-inner plexiform layer complex in male diabetes

Purpose This study aims to evaluate the influence of smoking on ganglion cell-inner plexiform layer complex (GC-IPL) thickness and central macular thickness (CMT) measured by spectral domain optical coherence tomography (OCT) in male diabetes. Methods 90 smoking and 90 never-smoking male subjects were included in this study. They were divided into six groups based on the diagnostic criteria for diabetes and the Early Treatment Diabetic Retinopathy Study (ETDRS) classification: smoking healthy subjects (SH, n = 20), non-smoking healthy subjects (NSH, n = 20), smoking diabetic patients without diabetic retinopathy (SNDR, n = 40), non-smoking diabetic patients without diabetic retinopathy (NSNDR, n = 40), smoking diabetic patients with diabetic retinopathy (SDR, n = 30), and non-smoking diabetic patients with diabetic retinopathy (NSDR, n = 30). After a full ophthalmologic examination, GC-IPL thickness and central macular thickness (CMT) were measured by OCT. Statistical analysis was performed to compare GC-IPL thickness and CMT between groups. Multiple linear regression equations were constructed to explore the potential risk factors of mean GC-IPL thickness. Results There were no significant differences in GC-IPL thickness and CMT between SH and NSH (all p > 0.05). Mean, superonasal, superior, superotemporal, inferonasal, inferior GC-IPL (p＜0.001, p＜0.001, p＜0.001, p = 0.003, p = 0.001, and p = 0.005, respectively) were thinner in the SNDR than NSNDR except for inferotemporal GC-IPL thickness and CMT (p = 0.066, p = 0.605, respectively). Mean, superonasal, superior, and inferonasal GC-IPL were thinner in the SDR than NSDR (p = 0.019, p = 0.045, p = 0.037, and p = 0.049, respectively). Multiple regression analysis demonstrated that age (β [SE], −0.141 [0.060]; p = 0.020) and smoking (β [SE], −4.470 [1.015]; p＜0.001) were the most important determinants for mean GC-IPL thickness. Conclusion Smoking is associated with reduced retinal GC-IPL thickness in male diabetes. Smoking behavior and age are important determinants of mean GC-IPL thickness.

Sarcopenia and Related Functional Outcomes Following Hip Surgery Among Egyptian Geriatric Patients With Hip Fracture.

Background Sarcopenia is highly prevalent among elderly patients with hip fracture. Studies reported a significant association between sarcopenia and clinical outcomes in patients with hip fractures. The current study aimed to determine the prevalence of sarcopenia among elderly patients with hip fracture and its effect on short-term functional outcomes, highlighting predictors of postoperative functional decline. Methods This is a cross-sectional study followed by a prospective cohort. Elderly patients (60 years and above) with hip fractureswere recruited from the orthopedic department. Patients were followed by the ortho-geriatric team in the perioperative period and for three postoperative months. Patients were subjected to comprehensive geriatric assessment including a full history and physical examination. In the preoperative state and after three months of follow-up the following were assessed:functional independence using the Barthel index (BI); nutritional state using a checklist named DETERMINE Your Nutritional Health;sarcopeniausing the SARC-F questionnaire assessing strength, ambulation, rising from a chair, climbing stairs, and fall history. Perioperative risk assessment and post-discharge care were obtained through medical records and by questioning patients or families. Preoperative sarcopenia was confirmed using the Ishii equation which is an equation that includes (age, calf circumference, and hand grip strength). Results Preoperative sarcopenia screening showed that 29.3% of patients suffered sarcopenia by SARC-F questionnaire and 28.6% by Ishii equation score. At the end of the follow-up, 57.9% of patients suffered sarcopenia by SARC-F questionnaire. There was a marked post-fracture decline in independence level; 52.1% had slight dependence in function, 27.1% had moderate dependence in function, and 20.7% had total dependence in function. Conclusion This study gives us the chance for a greater understanding of the negative effects of sarcopenia on the outcomes following hip fracture surgery in the geriatric population. It shows a prevalence of sarcopenia among the elderly with hip fractures at 29.3%. The elderly experience a marked post-fracture decline in their level of independence concerning basic activities of daily living. Those with older age, higher comorbidities, cognitiveimpairment, and functional dependence with poor nutritional state are more vulnerable to functional decline. Other perioperative risks includedelayed surgery, surgery type, postoperative complications, longer hospital stays, lack of planned rehabilitative and nutritional plans, and postoperative depression. Early detection of sarcopenia helpsestablish early interventional plans to reverse such poor outcomes.

Comparison of Live and Remote Video Ratings of the Scale for Assessment and Rating of Ataxia.

Video recordings of neurological examinations are often used in clinical trials. The Scale for Assessment and Rating of Ataxia (SARA) is a widely used clinical scale for ataxic patients. Despite several advantages of video ratings, correlation between live ratings and remote video-ratings has not been systematically investigated. To compare live and remote video assessment of SARA. Full SARA examinations of 69 patients with cerebellar ataxia were recorded on video. Live rating from site investigators were compared with remote video rating of three experienced ataxia clinicians using Bland-Altman analysis. Live and remote video ratings showed a high level of agreement for the complete score (bias = 0.09, with standard deviation = 2.00) and all single SARA items (bias <0.20 for all items). Remote video ratings of SARA are a reliable means to assess severity of ataxia.

Are foundation doctors equipped with the skills necessary for the assessment and referral of the patient presenting with a suspected facial skin malignancy?

The incidence of Skin Cancer (SC) has increased in recent years with it being the most common cancer within the UK. The management of SC requires a multi-disciplinary approach involving dermatologists and surgical specialities. The current study aimed to assess the confidence of current foundation trainees (FT) in the assessment of facial skin cancers and referral for surgical management and reconstruction. An online survey was distributed via social media and completed by 142 FT across 13 deaneries. Two higher training respondents were excluded. 50% of trainees had only examined one or two SC patients and 25% had no experience in SC assessment. Most FTs were not confident in performing a full skin examination (90%), formulating differential diagnoses for a pigmented facial lesion (45%), or investigating a facial SC (87%). Facial defects requiring reconstruction (87%) were more likely to be referred to PS. Foundation trainees were not confident in performing full skin examinations nor formulating diagnoses for pigmented lesions. This is concerning given that the majority of FT will enter general practise and therefore exposure to SC will be common. This may in turn place greater burden on secondary care services such as dermatology and allied surgical specialities resulting in a greater caseload on an already stretched service. The integration of the British Association of Dermatology undergraduate syllabus into the medical school curriculum will improve confidence in the detection and management of SC at both undergraduate and postgraduate levels.

Relationship between left ventricular mechanical dyssynchrony with cardiac resynchronization therapy response in chronic heart failure patients with left bundle branch block

Aim. To investigate the relationship between left ventricular (LV) mechanical dyssynchrony with cardiac resynchronization therapy (CRT) response in chronic heart failure (CHF) pts with left bundle branch block.Methods. Forty-nine pts (male - 34 [69.4%], average age 58.3±11.4 years) with sinus rhythm, permanent left bundle branch block with QRS duration ≥150 ms and New York Heart Association (NYHA) II-III functional class of CHF were included in the study. In addition to full examination, myocardial perfusion scintigraphy (MPS) and gated blood pool single-photon emission computed tomography (gBPS) were performed before and 6 months after CRT devices with cardioverter-defibrillator function implantation. Pts were considered as responders to CRT if they fulfilled after 6-month follow-up the following combined criteria: NYHA FC improvement ≥1 class + LV end systolic volume decrease &gt;15% or NYHA FC improvement ≥1 class + LV ejection fraction improvement &gt;5%.Results. The 1st and 2nd groups included 35 (71.4%) and 14 (28.6%) pts with and without response to CRT respectively. Groups were comparable in terms of pre-CRT implantation clinical and instrumental parameters, except for MPS and gBPS parameters. The multivariate logistic regression had shown that only ∆interventricular dyssynchrony (adjusted odds ratio [OR] 1,0349; 95% confidence interval [CI] 1.0075-1,0631; р=0.01) and phase standard deviation of the anterior LV wall (OR 1.0669; 95% CI 1.0118-1.1251; p=0.01) were independently related with CRT response. An increase in the prognostic coefficient, calculated using the ∆interventricular dyssynchrony and phase standard deviation of the anterior LV wall, more than 0.67 was a predictor of CRT response (area under the curve 0.918; sensitivity 85.71; specificity 85.71; p &lt;0.001).Conclusion. The mechanical dyssynchrony assessed by MPS and gBPS is associated with CRT response. According to our predictive model, an increase in prognostic coefficient more than 0.67 is a predictor of CRT response.

Cardioprotective effect of propofol in cardioplegia compared to systemic propofol in heart valves surgery; a randomized controlled trial

BackgroundMyocardial protection is still a focus of ongoing research. Propofol is used widely during the induction of anaesthesia in cardiac surgery. So, this triggers us to investigate the cardioprotective effect of the propofol when added to the cardioplegia compared to systemic propofol by measuring the troponin T level.MethodsThis clinical randomized controlled trial was carried out on 150 patients operated for elective valvular heart surgery. Patients were assigned into three equal groups: Group 1: received propofol in the cardioplegia, Group 2: received propofol injection in the aortic line before and after the aortic cross-clamp, and Group 3 (control group): patients without propofol in the cardioplegia or aortic line. All patients were subjected to full medical histories, physical examinations, routine tests, and echocardiography. Cardiac troponin T was measured before surgery and 4 times postoperatively.ResultsIn group 1, there was a significant improvement in troponin T level at the last reading compared with the control group (mean ± SD. of group 1 was 246.4 ± 131.4, mean ± SD. of group 3 was 317.0 ± 117.9, p = 0.031), denoting propofol's cardioprotective effect when added as a cardioplegia additive. In group 2, there was a significant improvement of troponin T level at the last reading compared with the group 1 and control group (mean ± SD. of group 2 was 202.54 ± 156.03, mean ± SD. of group 3 was 317.0 ± 117.9, p < 0.001), denoting propofol's more cardioprotective effect when used systemically during cardiopulmonary bypass than when added as a cardioplegia additive.ConclusionsIn valvular cardiac surgery, propofol has an additional cardioprotective effect and a superior cardiac outcome when administered systematically during cardiopulmonary bypass rather than added to cardioplegia.Trial registrationPan African Clinical Trials Register PACTR201907764652028. Registered on 01 July 2019, retrospectively registered, https://pactr.samrc.ac.za/ TrialDisplay.aspx?TrialID = 5726.

Systolic third sound associated with systolic anterior motion of the mitral valve in cats with obstructive hypertrophic cardiomyopathy.

Third heart sounds in cats frequently are associated with hypertrophic cardiomyopathy (HCM) but their exact characterization and timing within the cardiac cycle remains unknown. Characterize third heart sounds in cats by phonocardiography and test the ability of 3 observers with different levels of experience and training to recognize third systolic heart sounds in cats. Fifty client-owned cats of different breeds presented for heart screening. Cats were prospectively assessed using an electronic stethoscope (with digital recording) and then underwent full conventional echocardiographic examination. Audio recordings were blindly assessed in a random order by 3 observers: the cardiologist who collected clinical data, as well as a trained and an untrained junior veterinarian. Cohen's kappa coefficients were calculated to quantify agreement between the opinion of each observer and the echocardiography results (considered the gold standard). Twenty cats had a third systolic sound on phonocardiography and an obstructive HCM phenotype with systolic anterior motion of the mitral valve (SAM) on echocardiography. Agreement with echocardiography was very good for the experienced cardiologist, substantial for the trained junior veterinarian, and poor for the untrained junior veterinarian (kappa of 0.92, 0,64, and 0.08, respectively). We describe here a new auscultatory abnormality in cats with obstructive HCM. It could help a trained non-cardiologist veterinarian in suspecting obstructive HCM in cats based on auscultation only.

Dysregulation of IL-6 and Iron Biomarkers as Potential Diagnostic Markers for Polycystic Ovary Syndrome

Polycystic Ovary Syndrome is one of the most common endocrinopathies in women of reproductive age group. A Case-control study is carried out in Kirkuk city from 10th of November 2022 to 10th of March 2023 for determination the relationship of ferritin, serum iron and interleukin-6 among PCOS women. The number of PCOS women under study were 60 women whose ages were between 15-45 years old. These patients admitted to obstetrics and gynecology unit at Gynecological and Pediatric Hospital in Kirkuk city. In addition, the control group consisted of 30 healthy volunteer females with regular menstrual cycles aged between 15 to 45 years. All PCOS patients and healthy control underwent full physical examination and anthropometric measurements including weight, height, and were asked to complete a general questionnaire. Body Mass Index (BMI) was calculated by using the formula: weight (Kg)/height (meters2). Blood samples collected from each women for measurement of interleukin-6 by Enzyme linked immunosorbent assay (ELISA), and serum ferritin, by immunofluorescence and serum iron by manual biochemistry procedures. The average IL-6 level in PCOS women was (279.8±77.8 pg/ml), whereas the control group had a level of( 92.5±11.54 pg/ml). Based on the study findings, women with PCOS had significantly higher average serum iron levels compared to the control group (223.5±57.3 and 129.144.9 g/dl), serum ferritin levels were significantly elevated in women with PCOS (279.9±44.9 and 189.5 57.3 ng/ml), The Mean of IL-6 in PCOS women with BMI&gt;25 (kg/m2) was (293.1± 81.8pg/ml) which is significantly higher than in PCOS women with normal BMI (231.9±18.9 pg/ml). The study showed that the serum iron and ferritin were elevated significantly in obese PCOS women (151.72±44.85 g/dl and 247.4±147.4 ng/ml) respectively as compared with non-obese PCOS women (140.61±35.08 g/dl and 228.7±38.2 ng/ml). High levels of iron, ferritin and IL-6 were observed in PCOS women as compared with healthy women specialty obese women with PCOS which highlight the importance of inflammation in PCOS and suggest that IL-6 levels could potentially serve as a biomarker for the condition. Additionally, exploring the relationship between IL-6 and other factors, such as hormonal imbalances and metabolic abnormalities, can provide a more comprehensive understanding of the pathophysiology of PCOS.