Acute diverticulitis of the appendix.

Acute diverticulitis of the appendix (ADA), though uncommon, often presents similarly to acute appendicitis but carries a higher risk of complications such as perforation and malignancy. We report the case of a male patient in his 50s with acute right iliac fossa abdominal pain, diagnosed via CT scan with ADA. Urgent laparoscopic appendicectomy was performed, and the patient was discharged without further issues. This case highlights the importance of promptly identifying and managing such conditions to minimise complications and improve outcomes. Despite the overlap in symptoms between appendiceal diverticulitis and acute appendicitis, accurate diagnosis is crucial for appropriate treatment. Healthcare providers should maintain a high index of suspicion, particularly in older patients presenting with an acute appendicitis, like clinical picture to ensure timely intervention and optimal patient care.

Coronary Intra-orbital Atherectomy Complications and Procedural Failure: Insight From the Manufacturer and User Facility Device Experience (MAUDE) Database.

BACKGROUND: The Diamondback 360® Coronary Orbital Atherectomy System (Cardiovascular Systems Inc., St. Paul, MN) is the first and only orbital atherectomy system approved by the US FDA for the treatment of severely calcified lesions. While the device has proven to be safe in clinical trials, real-world data are minimal. METHODS: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports on the Diamondback 360® Coronary from January 2019 to January 2022. RESULTS: A total of 566 events were reported during the study period. After the exclusion of duplicate reports, the final cohort included 547 reports. The most common mode of failure was break or separation of a device part (40.4%, n = 221) mainly due to breaking in the tip of the ViperWire (66.1%), driveshaft (22.7%), or crown (12.2%). The most common vessel associated with events was the left anterior descending artery (31.4%), followed by the right coronary artery (26.9%), left circumflex (21.6%), and left main coronary artery (6.4%). The most common clinical adverse outcome was perforation (33.0%, n = 181) with 23.7% resulting in cardiac tamponade. Most perforation cases were treated by covered stent (44.2%), surgery (30.5%), stent (98%), and balloon angioplasty (9%). There were 89 (16.3%) events of death with 67% due to perforation (p < 0.001). CONCLUSION: Our study provided a glimpse of real-world adverse outcomes and common modes of failure due to orbital atherectomy. The most common mode of failure was the break or separation of a device part and the most common complication was perforation according to the MAUDE database. It will help physicians to anticipate complications and escalate care appropriately.

CD4+ and CD8+ preimplantation endometrial population in women with unexplained recurrent miscarriage.

Introduction: The aim of this study is to assess the secretory-phase endometrial leucocytes in women with 2 or more unexplained abortions and in healthy controls. Material and methods: This cross-sectional study was performed in 3 tertiary centres: Ain Shams University, Al-Azhar, and October 6 University Maternity Hospitals. The study included 50 women who consented to participate in this study. Women were divided in 2 groups; the first group consisted of 25 non-pregnant women with unexplained recurrent pregnancy loss, while the second group (n = 25) included non-pregnant women as a control group who had no history of recurrent pregnancy loss. Endometrial biopsies were taken from all participants around the expected time of implantation (one week after induction of ovulation by human chorionic gonadotrophins) to elucidate the T lymphocyte population, CD4+ (helper-T) and CD8+ (suppressor-T) markers. Results: Women with 2 or more unexplained abortions had significantly less endometrial CD8+ (p < 0.05), and consequently their endometrial CD4/CD8 ratio was higher in relation to the controls. There was no significant difference in endometrial CD4+ in relation to controls (p > 0.05). Conclusions: From the results we can conclude that CD8 is more valuable than CD4 in women with recurrent spontaneous miscarriage. CD8 is better positive than negative in such patients.

Promoted glucose electrooxidation at Ni(OH)2/graphene layers exfoliated facilely from carbon waste material.

Nowadays, the glucose electro-oxidation reaction (GOR) is considered one of the most important solutions for environmental pollution. The GOR is the anodic reaction in direct glucose fuel cells and hybrid water electrolysis. In this study, the GOR is boosted using a carbon support modified with Ni(OH)2 as a non-precious catalyst. The carbon support, with in situ generated graphene nanosheets having a large surface area, grooves, and surface functional groups, is prepared via a simple electrochemical treatment of the carbon rods of an exhausted zinc-carbon battery. Ni(OH)2 is electrodeposited on the surface of the functionalized exfoliated graphite rod (FEGR) via the dynamic hydrogen bubbling technique (DHBT) and tested for GOR. The thus-prepared Ni(OH)2/FEGR electrode is characterized by SEM, mapping EDX, HR-TEM, XRD, and XPS characterization tools. Ni(OH)2/FEGR displays an onset potential of 1.23 V vs. the reversible hydrogen electrode (RHE) and attains high current densities at lower potentials. Additionally, Ni(OH)2/FEGR showed prolonged stability toward GOR by supporting a constant current over a long electrolysis time. The enhanced catalytic performance is attributed to the superb ionic and electronic conductivity of the catalyst. Importantly, ionic conductivity increased, due to (i) a large surface area of in situ generated graphene layers, (ii) enhanced distribution of active material during deposition using DHBT, and (iii) increased hydrophilicity of the underlying substrate. Therefore, the Ni(OH)2/FEGR electrode can be used efficiently for GOR as a low-cost catalyst, achieving low onset potential and high current densities at low potentials.

Diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) and MOG Antibody-Associated Disease (MOGAD). / Diagnostik der Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) und der MOG-Antikörper-assoziierten Erkrankung (MOGAD).

Aquaporin-4 antibody-seropositive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD; also termed MOG encephalomyelitis) are autoimmune diseases of the central nervous system. The typical initial manifestations in adult patients are optic neuritis and myelitis. Patients often present with additional involvement of the brain and brainstem, more so in the later stages of the disease. While NMOSD commonly follows a relapsing course, MOGAD can sometimes be monophasic. Differential diagnosis is challenging and relies particularly on radiological and serological findings. It is very important to distinguish these rare diseases from the more common neuroinflammatory disease, multiple sclerosis (MS), since treatment and long-term prognoses for NMOSD, MOGAD and MS differ greatly. The diversity of the symptoms and the extent of the diagnostic work-up necessitate close collaboration between ophthalmology, neurology, and radiology. This article provides an overview of the typical MRI findings and serological antibody diagnostics for NMOSD and MOGAD, supplemented with two exemplary case reports from clinical practice.

A Triplex Ultrasound Evaluation of Preclinical Changes in Type 2 Diabetes in Foot Arteries.

BACKGROUND AND OBJECTIVE:  Type 2 diabetes mellitus (T2DM) is a significant health problem that is becoming more prevalent worldwide. This study aimed to assess hemodynamic and morphological parameters in diabetic patients' foot arteries and compare them to those obtained in asymptomatic control group. MATERIALS AND METHODS:  This is a cross-sectional case-control study. B-mode ultrasound, color Doppler, and pulse wave Doppler were conducted to assess the dorsalis pedis arteries (DPAs) and posterior tibial arteries (PTAs). The morphological, total vascular diameter, wall thickness, and flow Doppler indices were measured. A total of 200 hundred participants were selected randomly using a random sampling technique. One hundred diabetic patients and 100 non-diabetic persons were determined. RESULTS: In diabetic patients, the overall grayscale diameter and wall thickness of foot arteries were statistically significantly larger than the asymptomatic group in the right DPA (p<0.01), left DPA (p<0.001), right PTA (p<0.001), and left PTA (p<0.001). In the diabetic group, the level of hemoglobin A1c (HbA1c) was positively correlated with blood flow resistive index (RI) in the right DPA (r=0.839; p<0.001), left DPA (r=0.801; p<0.001), right PTA (r=0.801; p<0.001), and left PTA (r=0.801; p<0.001). No significant differences were noted in both groups in blood flow Doppler parameters - pulsatility index (PI) and resistive index (RI). CONCLUSION:  Overall grayscale diameters of foot arteries are larger in the diabetes group than in the control group, indicating arterial wall thickening as an early indicator of diabetes-related alterations. PI of both DPA and RI of right DPA were increased in diabetic patients more than the control group. The level of glycosylatedhemoglobin A1c (HbA1c) was strongly linked with the blood flow resistive index in diabetes patients.

Comparing Diagnosis and Treatment of Pulmonary Hypertension Patients at a Pulmonary Hypertension Center versus Community Centers.

Once patients are diagnosed with pulmonary hypertension it is important to identify the correct diagnostic group as it will have implications on the disease state management. Pulmonary hypertension is increasingly diagnosed and treated in general medical practices; however, evidence-based guidelines recommend evaluation and treatment in pulmonary hypertension centers for accurate diagnosis and appropriate treatment recommendations. We conducted a retrospective cohort study of 509 random patients 18 years and older who were evaluated in our pulmonary hypertension clinic from January 2005 to December 2018. 68.4% (n = 348) had their diagnostic group clarified or changed. Pulmonary hypertension was deemed an incorrect diagnosis in 12.4% (n = 63). A total of 114 patients (22.4%) had been initiated on pulmonary hypertension specific treatment prior to presentation. Pulmonary hypertension specific medication was stopped in 57 (50.0%) cases. The estimated monthly saving of the stopped medication based on wholesale acquisition costs was USD 396,988.05-419,641.05, a monthly saving of USD 6964.70-7362.12 per patient. Evaluation outside of a pulmonary hypertension center may lead to misdiagnosis and inappropriate or inadequate treatment. Pulmonary arterial hypertension directed therapy improves median survival, but inappropriate therapy may cause harm; therefore, patients benefit from a specialized center with multiple resources to secure an accurate diagnosis and tailored treatment for their condition.

Safety and Efficacy of Mesenchymal Stem Cells for the Treatment of Evolving and Established Bronchopulmonary Dysplasia: A Systematic Literature Review.

Bronchopulmonary dysplasia (BPD) is a frequent sequela of modern medicine when infants are born prematurely. Currently, there is no single treatment or combination of treatments to prevent or fully treat BPD. Mesenchymal stem cells (MSCs) have promising properties that could aid in the reversal of lung injury, as seen in patients with BPD. This study reviews the available evidence regarding the safety and efficacy of the use of MSCs for the treatment of evolving and established BPD. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We found eight studies that fulfilled the inclusion and exclusion criteria. While all studies proved the safety and efficacy of MSCs administered intravenously and intratracheally, the only available randomized controlled trial (RCT) failed to demonstrate the benefit of MSC administration in the early treatment of BPD. The remaining studies varied between phase I clinical trials and case reports, but all seemed to show some evidence that MSCs may be of benefit in the late treatment of established BPD. Considering some of the studies have less evidence, early treatment to prevent lung fibrosis may be more successful, particularly in the younger gestational ages where lung development is more immature, and research should focus on this.

The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis.

INTRODUCTION: Gastroesophageal reflux plays a significant role in idiopathic pulmonary fibrosis (IPF). Given the morbidity and mortality associated with IPF, understanding the mechanisms responsible for reflux is essential if patients are to receive optimal treatment and management, especially given the lack of clear benefit of antireflux therapies. Our aim was to understand the inter-relationships between esophageal motility, lung mechanics and reflux (particularly proximal reflux-a prerequisite of aspiration), and pulmonary function in patients with IPF. METHODS: We prospectively recruited 35 patients with IPF (aged 53-75 years; 27 men) who underwent high-resolution impedance manometry and 24-hour pH-impedance, together with pulmonary function assessment. RESULTS: Twenty-two patients (63%) exhibited dysmotility, 16 (73%) exhibited ineffective esophageal motility (IEM), and 6 (27%) exhibited esophagogastric junction outflow obstruction. Patients with IEM had more severe pulmonary disease (% forced vital capacity: P = 0.032) and more proximal reflux (P = 0.074) than patients with normal motility. In patients with IEM, intrathoracic pressure inversely correlated with the number of proximal events (r = -0.429; P = 0.098). Surprisingly, inspiratory lower esophageal sphincter pressure (LESP) positively correlated with the percentage of reflux events reaching the proximal esophagus (r = 0.583; P = 0.018), whereas in patients with normal motility, it inversely correlated with the bolus exposure time (r = -0.478; P = 0.098) and number of proximal events (r = -0.542; P = 0.056). % forced vital capacity in patients with IEM inversely correlated with the percentage of reflux events reaching the proximal esophagus (r = -0.520; P = 0.039) and inspiratory LESP (r = -0.477; P = 0.062) and positively correlated with intrathoracic pressure (r = 0.633; P = 0.008). DISCUSSION: We have shown that pulmonary function is worse in patients with IEM which is associated with more proximal reflux events, the latter correlating with lower intrathoracic pressures and higher LESPs.

Splenic haematoma: a rare complication of colonoscopy.

Colonoscopy is the gold-standard tool to investigate the colon which also allows to biopsy or treat intraluminal pathologies. About 900 000 colonoscopies are performed annually in UK. It is considered a relatively safe procedure; however, some serious complications might take place. The common complications of colonoscopy are bleeding and perforation. Splenic injury is a rare complication of colonoscopy which can be fatal. Our case report describes a grade two subscapular splenic haematoma after routine colonoscopy that has been managed conservatively.

In situ generation of exfoliated graphene layers on recycled graphite rods for enhanced capacitive performance of Ni-Co binary hydroxide.

A functionalized exfoliated graphite rod (FEGR), with a high surface area, is produced for use as a promising substrate for supercapacitors, via controlled oxidative treatment of a recycled graphite rod of exhausted zinc-carbon batteries. SEM, EDX, XPS, FT-IR, Raman, and contact angle measurements are carried out to disclose the surface characteristics of the FEGR. The surface of the FEGR is characterized by in situ generated grooves, together with graphene layers which are directly attached to the underlying graphite base. The FEGR electrodes enhance the capacitive performance of Ni(OH)2 and binary Ni-Co(OH)2. The Ni-Co(OH)2/FEGR electrode displays a superb specific capacity value (2552.6 C g-1) at a current density of 5 A g-1 and this value is retained to 70.8% at a high current density of 50 A g-1 indicating the outstanding rate performance of this electrode material. This enhanced behavior is attributed to the facile interaction of electrolyte species, even at high current density, with the active sites of the redox catalyst layer (distributed over a larger fraction of the underlying substrate with enhanced hydrophilicity). Moreover, the excellent electrical conductivity of the in situ surface generated graphene layers is another promoting factor.

Concomitant transobturator tape and anterior colporrhaphy versus transobturator subvesical mesh for cystocele-associated stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) and cystocele often occur concomitantly and thus may potentially be treated via a single surgical procedure. This study evaluated the efficacy and safety of concomitant transobturator tape (TOT) with anterior colporrhaphy versus subvesical transobturator mesh (TOM) for cystocele-associated SUI. METHODS: This prospective, clinical trial included women with cystocele-associated SUI. Patients were randomly allocated into either group I (anterior colporrhaphy with concomitant TOT "in-out" fixation) or group II (implantation of a subvesical four-armed TOM). All patients were followed up at 1, 3, 6, 9, and 12 months postoperatively. Statistical tests were performed to compare the group outcomes based on objective, subjective, and anatomical variables. RESULTS: There were 81 patients in group I and 83 in group II. Median follow-up duration was 12 months. The demographic data and baseline clinical characteristics of both groups were comparable. There were no significant differences between groups regarding the success rates of SUI and cystocele repair. Groups I and II had similar cure rates of SUI (82.9 and 88.4%, respectively; p = 0.369) and incidences of successful cystocele repair (85.4 and 97.7%, respectively; p = 0.055). No urethral or bladder injuries or mesh erosions were reported. Both groups had comparable postoperative complications, except the greater incidence of micturition difficulty in group I than group II, during the early follow-up (12.2% vs. 0.0%; p = 0.024). CONCLUSIONS: Transvaginal mesh was not superior to native tissue repair. Anterior colporrhaphy and TOT may be an appropriate alternative to four-armed TOM application for concomitant correction of SUI and cystocele.

Offspring sex ratios among male tobacco smokers in Khartoum, Sudan.

OBJECTIVES: To explore any association between paternal tobacco smoking and the offspring secondary sex ratio, as well as the effect of duration and intensity of smoking on gender ratio. METHODS: The cross-sectional study was conducted around major public areas within Khartoum, Sudan, between August and September 2008 and involved 458 married Sudanese males with offsprings. The sample consisted of 111 (24.2%) smokers and 347 (75.8%) non-smokers who were evaluated using a questionnaire on their offspring gender. Data on duration and intensity of smoking was also collected from the smokers' group. SPSS 16 was used for statistical purposes. Chi-square test was used to test for significance of associations between variables. Analysis of variance (ANOVA) was used to test for significance between ratios. RESULTS: The number of cigarettes smoked in males increases the likelihood of having a male offspring. The gender ratio in non-smokers was 1.11, while it was 1.15 in smokers. CONCLUSION: Paternal smoking increases the offspring sex ratio.

Rigid ureteroscopy for ureteral stones: factors associated with intraoperative adverse events.

PURPOSE: To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy. PATIENTS AND METHODS: We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables. RESULTS: Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications. CONCLUSIONS: Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.