Isolation and characterization of Streptococcus agalactiae inducing mass mortalities in cultured Nile tilapia (Oreochromis niloticus) with trials for disease control using zinc oxide nanoparticles and ethanolic leaf extracts of some medicinal plants.

BACKGROUND: Streptococcus agalactiae (Group B streptococcus, GBS) induces a serious infection that can harm not only aquatic life but also humans and other animals. In a fish farm in southern Egypt, Nile tilapia (Oreochromis niloticus) has developed an epidemic with clinical symptoms resembling piscine streptococcosis. RESULTS: Initial microscopic inspection of the affected fish brain and kidney indicated the presence of Gram-positive cocci. S. agalactiae was effectively isolated and identified using nucleotide homology of the 16S rRNA and species-specific PCR. The partial 16S rRNA sequence was deposited in the GenBank database at the NCBI and given the accession number MW599202. Genotyping using RAPD analysis indicated that the isolates in the present study belonged to the same genotypes and had the same origin. The challenge test, via immersion (9.2 × 107, 9.2 × 106, and 9.2 × 105 CFU/ml for 1 h) or intraperitoneal injection (4.6 × 107, 4.6 × 106, and 4.6 × 105 CFU/fish), elicited clinical symptoms resembling those of naturally infected fish with a mortality rate as high as 80%. The ability to create a biofilm as one of the pathogen virulence factors was verified. Zinc oxide nanoparticles and the ethanolic leaf extracts of nine medicinal plants demonstrated considerable antibacterial activities against the tested S. agalactiae strain with low minimum bactericidal concentrations (MBC) and minimum inhibitory concentrations (MIC). The ethanolic leaf extracts from Lantana camara and Aberia caffra showed potent antibacterial activity with MBC values of 0.24 and 0.485 mg/ml, and MIC values of 0.12 & 0.24 mg/ml, respectively. CONCLUSION: This study isolated S. agalactiae from O. niloticus mortalities in a fish farm in Assiut, Egypt. The pathogen persists in fish environments and can escape through biofilm formation, suggesting it cannot be easily eliminated. However, promising findings were obtained with in vitro control employing zinc oxide nanoparticles and medicinal plant extracts. Nevertheless further in vivo research is needed.

Review article: Diagnosis and management of enlarged extraocular muscles.

Extraocular muscle (EOM) enlargement may be due to a variety of causes. These causes can be classified in three ways: according to pathogenesis and histopathological features, according to the site, and according to the clinical features. Diagnosis of the cause is dependent upon history, clinical examination, and investigations. Imaging with computed tomography or magnetic resonance imaging and muscle biopsy is typically necessary to make the correct diagnosis. Treatment of the patient must be directed toward the specific cause. This review emphasizes important clinical and pathological guidelines for appropriate diagnosis and treatment of patients with EOM enlargement.

Synthesis of a resorcinol-based derivative as a corrosion inhibitor for low-carbon steel in 0.5 mol L-1 HCl medium: chemical, electrochemical, and theoretical aspects.

This work illustrated the synthesis of a new simple resorcinol derivative, 4,6-dimethoxyisophthalohydrazide (DMIH) and confirmed its structure using 1H-NMR spectroscopy. The inhibiting performance of the DMIH compound in resisting the pitting action of a 0.5 mol L-1 HCl solution on low-carbon steel (LCS) was assessed. The newly synthesized compound had a simple structure and was dissolved in acidic media. The efficiency of the inhibitor was examined using chemical and electrochemical methods. The DMIH compound significantly decreased the rate of dissolution of LCS in HCl solution by adsorption. The adsorption was based on the Langmuir model. The DMIH compound is adsorbed on LCS via both chemisorption and physisorption. The DMIH compound is a mixed-type inhibitor. An inhibition efficiency (IE) of 83.8% was obtained using 300 ppm of the DMIH compound at 298 K. The IE decreased to 72% as the temperature increased to 328 K. When the concentration of DMIH increased from 50 to 300 ppm, the charge transfer resistance (R ct) increased from 134.7 to 404.8 ohm cm2, and the capacitance of the adsorbed layer decreased from 38 × 10-6 to 11 × 10-6 F cm-2. The high IE of the synthesized inhibitor was validated by the quantum characteristics. Monte Carlo (MC) simulations revealed that the DMIH compound adsorbed to the LCS quite well. The presence of a protective film on the LCS specimen was verified by the scanning electron microscopy (SEM) and atomic force microscopy (AFM) results. DMIH has significant potential to function as a corrosion inhibitor, as indicated by the comparative study between its performance and that of previously reported compounds. Although the structure of the DMIH compound is simpler than that of other inhibitors, it has been proven to be more effective.

Dissipation behavior, residue distribution, and exposure risk assessment of tebufenpyrad and milbemectin acaricides in strawberries under open field conditions.

Strawberries are a favorite fruit for most people, but the residues of pesticides on strawberries might be risky to human health. Tebufenpyrad and milbemectin are broad-spectrum acaricides with insecticide properties authorized for use on strawberries in Egypt. As a result, it is crucial to investigate their residues in the final product to ensure customers' safety. Consequently, field trials were conducted following the Good Agricultural Practices (GAPs) to study the dissipation rate and terminal residues of tebufenpyrad and milbemectin on strawberries. Tebufenpyrad and milbemectin residues in strawberries declined due to first-order decay process, showing significant degradation (88.5% and 94.7%, respectively) after 14 days. Risk assessment study was carried out by comparing the national estimated daily intake (NEDI) to the acceptable daily intake (ADI). The results demonstrated that the dietary risk posed by the residues of tebufenpyrad and milbemectin in strawberry fruits was acceptable for consumers. It is envisaged that the current study's findings would support the safe application of tebufenpyrad and milbemectin to strawberries and perhaps other crops in Egypt and other countries with similar climatic conditions.

Hypocalcemia in Patients With Osteoporosis and Normal Renal Function, Treated With Denosumab, a Retrospective Analysis.

Objective: The reported hypocalcemia in postmenopausal women with osteoporosis who received Denosumab was low (0.05%-1.7% to 7.4%). The major prediction factors were vitamin D and calcium levels and renal function. The objective is to evaluate the incidence of hypocalcemia in patients with osteoporosis, normal renal function, and vitamin D who received Denosumab. Method: A retrospective analysis was conducted using the medical records (2022-2023). We looked for hypocalcemia (albumin-adjusted calcium lower than 2.2 mmol/L). Results: Two hundred one postmenopausal women diagnosed with osteoporosis and received denosumab treatment were included. All patients received vitamin D3 capsules and calcium supplementation. The mean age of the patient was 75.7 ± 7.0 years (56-91 years). Hypocalcemia was observed in 46 (23%) patients following a subcutaneous dose of Denosumab 60 mg. Median calcium was 2.25 mmol/L (minimum: 0.890 mmol/L, maximum: 2.6 mmol/L). Fourteen (30.4%) patients had severe hypocalcemia (<1.8 mmol/L) and required parenteral correction. A comparison between hypocalcemia and patients with normal calcium indicated that the significant predictor of hypocalcemia was pretreatment parathyroid hormone levels (9.9 ± 11.8vs 7.6 ± 2.56 pmol/L, respectively; P < .005). The prognostic role of parathyroid hormone for the denosumab-associated hypocalcemia was assessed using ROC curve analysis. For the cut-off value of Parathyroid hormone = 6.8 pmol/L, giving serum parathyroid measurement an AUC of 0.668 (0.599-0.737) - P = .0007; sensitivity 85%; specificity 52%. Conclusion: Hypocalcemia induced by the denosumab treatment is more prevalent than previously shown in patients with osteoporosis receiving adequate calcium and vitamin D supplements. An elevated parathyroid hormone predicts hypocalcemia related to denosumab therapy in patients with normal calcium and vitamin D levels.

The role of creatine kinase in distinguishing generalized tonic-clonic seizures from psychogenic non-epileptic seizures (PNES) and syncope: a retrospective study and meta-analysis of 1300 patients.

BACKGROUND/AIM: As the clinical differentiation between epileptic seizures, psychogenic non-epileptic seizures (PNES), and syncope depends mainly on a detailed report of the event, which may not be available, an objective assessment of a potential biochemical analysis is needed. We aimed to investigate whether serum creatine kinase (CK) could be used to differentiate epileptic seizure from PNES and syncope and to assess the strength of evidence present. METHODS: We directed a retrospective cohort study coupled with a systematic review and meta-analysis of studies that measured CK in patients with epilepsy, PNES, syncope, and healthy controls. RESULTS: The cohort study, which traced 202 patients, showed that the CK level was significantly higher 48 h after the event in the epilepsy group versus patients with syncope (p < 0.01) Along with 1086 patients obtained through a database search for meta-analysis, CK level compared to different types of seizures from PNES was higher in epileptic seizure patients with a mean difference of 568.966 mIU/ml (95% CI 166.864, 971.067). The subgroup analysis of CK showed that it was higher in GTCS compared to syncope with a mean difference of 125.39 mIU/ml (95% CI 45.25, 205.52). DISCUSSION: Increased serum levels of CK have been associated mainly with epileptic seizures in relation to non-epileptic events. However, further studies would try to explore the variation in measurements and any other potential diagnostic marker. CONCLUSION: The cohort study shows that the CK level in epilepsy seizures is higher after 48 h from the event compared to syncope. Moreover, the meta-analysis results show the present diagnostic utility of CK and its importance to be used in accordance with a detailed report of the event.

Necrotizing fasciitis following gastrostomy tube placement, detected by point-of-care ultrasound, case report.

INTRODUCTION: Necrotizing fasciitis is a recognized rare complication of gastrostomy tube replacement, but if it occurs and is not discovered early, a lethal outcome is possible. CASE PRESENTATION: We present a woman in her 80s who was known to have chronic atrial fibrillation with ischemic heart disease. She was fed through percutaneous endoscopic gastrostomy after brain injury. Erythema was observed around the stoma of the gastrostomy tube, which was later removed, and erythema extended to the left anterior abdomen. The patient was diagnosed with cellulitis. Point-of-care ultrasound examination suspected necrotizing fasciitis and, confirmed later by computerized tomography of the abdomen. The case was managed surgically. DISCUSSION: Patients with a high clinical suspicion of necrotizing fasciitis should undergo early surgical debridement with antibiotic administration. Necrotizing fasciitis starts with a clinical picture indistinguishable from other skin infections, such as cellulitis, and imaging modalities are important for confirmation and early diagnosis. We present a case of necrotizing fasciitis after gastrostomy tube replacement for which point-of-care ultrasound played a pivotal role in confirming the diagnosis early. CONCLUSION: Point-of-care ultrasound is a useful adjunct tool for clinical evaluation and assessment in diagnosing early critically ill patients with life-threatening necrotizing infections.

The impact of Bacillus subtilis DSM32315 and L-Threonine supplementation on the amino acid composition of eggs and early post-hatch performance of ducklings.

Poultry requires Threonine, an essential amino acid, and its metabolites for proper metabolic function. Threonine is crucial in the biosynthesis of mucin, which is essential for intestinal health and nutrient absorption. Bacillus subtilis (B. subtilis) is a potential substitute for antibiotic growth promoters in the poultry industry. The current study was designed to evaluate the simultaneous effect of L-Threonine (Thr) and B. subtilis DSM32315 supplementation on laying duck breeders in order to maximize performance. A total number of 648 female 23-week-old Longyan duck breeders were assigned to a 3 × 2 factorial design with six replicates of 18 birds per replicate. L-Thr was added to the control diet at concentrations of 0, 0.7, and 1.4 g/kg, equating to 3.9, 4.6, and 5.3 g Thr/kg, with or without B. subtilis strain DSM 32315 (0.0 and 0.5 g/kg). Increasing Thr concentrations improved egg production and ducklings' hatchling weight (p < 0.05). In addition, L-Thr supplementation resulted in a tendency for decreased feed conversion ratio without affecting egg quality. There was no significant effect (p > 0.05) of the dietary Thr levels on egg yolk and albumen amino acid concentrations. In contrast, the addition of B. subtilis decreased the concentrations of amino acids, excluding proline, in the egg white (albumen) and the egg yolk (p < 0.05). Furthermore, the supplementation of B. subtilis decreased (p < 0 0.001) the hatching weight of ducklings. The addition of B. subtilis without L-Thr decreased (p < 0.05) the hatchability of fertile eggs and the hatching weight of ducklings compared to those of ducks fed dietary L-Thr along with B. subtilis (p < 0.001). The combining L-Thr at 0.7 g/kg with B. subtilis DSM 32315 at 0.5 g/kg could increase eggshell quality, hatchability, and hatching weight. The current study revealed that the combination supplemented of L-Thr and B. subtilis DSM 32315 is recommended due to its positive effects on the eggshell percentage, hatchability and the body weights of newly hatched ducklings when dietary Thr was added at a rate of 0.7 g/kg and B. subtilis DSM 32315 at 0.5 g/kg. In addition, adding L-Thr separately at 0.7 g/kg could improve the egg production of duck breeders. Further studies are required to find the proper dosages of B. subtilis DSM 32315 with co-dietary inclusion of limiting amino acids in the diets of duck breeders. The findings of these trials will support feed additive interventions to transition into antibiotic-free diets.

The gametogenic cycle and spawning of the short-necked clam, Paphia undulata Born, 1778 (Bivalvia: Veneridae) from Timsah Lake, Suez Canal, Egypt.

BACKGROUND: Paphia undulata, The Short-Necked Clam, is an edible marine bivalve that is consumed internationally and locally in Egypt. Overfishing and pollution have caused population declines in Egyptian fisheries during the last decade. Accurate reproductive biology knowledge is critical for designing long-term exploitation strategy for this resource. P. undulata spawning and gametogenic cycle research were carried out from January to December 2020 along Timsah Lake, Suez Canal, Egypt. RESULTS: These clams are functionally dioecious with a very low incidence of hermaphroditism. The sex ratio of the clam population was 1.0:1.07:0.04 for male, female and hermaphrodite respectively. The shell lengths of the collected clams were 4.64 ± 0.83 cm in males, 4.55 ± 0.9 cm in females and 4.19 ± 0.3 cm in hermaphrodite clams. The sizes at the onset of sexual maturity in both males and females were 2.1 cm and 2.5 cm respectively. CONCLUSIONS: Reproductive studies revealed that this species has a prolonged spawning season that is not restricted to a specific period.

Effects of Hot Arid Environments on the Production Performance, Carcass Traits, and Fatty Acids Composition of Breast Meat in Broiler Chickens.

The high environmental temperature is one of the main factors challenging the broiler industry during the hot seasons due to it causing more thermal stress. This study aimed to find the effects of heat stress under hot arid environments on the growth performance, carcass traits, and nutritional composition of breast meat in broiler chickens. A total of 240 broiler chickens were allocated into two groups: (1) a control group (thermoneutral environment (TN); 24 ± 0.17 °C) and (2) a heat stress (HS) group, with 30 replicates in each environment. From d 25 to 35 of age, the broiler chickens in the HS group were exposed to 8 h/day of thermal stress (34 ± 0.71 °C) from 8:00 am to 4:00 pm, while the actual recorded value of ambient temperature was 31 °C on average with a relative air humidity (RH) between 48 and 49% for 10 consecutive days (d 25-35 of age). The live body weight (BW), weight gain, and feed intake significantly deteriorated (p < 0.05), and the feed conversion ratio tended to deteriorate (p = 0.055) in the HS group. The hot and cold carcass yields increased (p < 0.05), while the relative heart and liver weights decreased (p < 0.05) in the broiler chickens exposed to HS. The breast meat yield tended to decrease (p = 0.057), while wing meat yields increased significantly (p = 0.050) in heat-stressed broiler chickens. The shrinkage of the carcass percentage increased during chilling (p < 0.001) in the HS group. The ultimate pH values; cooking loss; and contents of moisture, crude protein, and fat of breast meat showed no response (p > 0.05) between the TN and HS groups. The heat-stressed broiler chickens presented lower levels of arachidonic acid (C20:4 (n-6)) (p = 0.01) and eicosadienoic acid (C20:2 (n-6)) (p = 0.050) in the breast meat, while the variations in n-3 polyunsaturated fatty acid were insignificant (p > 0.05) between the groups. In conclusion, our findings confirmed that the hot arid environments could reduce the production performance of broiler chickens and increase carcass shrinkage during chilling, but did not compromise the n-3 polyunsaturated fatty acid and cooking loss in the breast meat.

Outcomes Following Type C Distal Humeral Fracture Fixation Using Two Different Osteosynthesis Techniques.

BACKGROUND: Distal humeral fractures are notorious injuries, and they require surgical fixation. The reliability of reconstruction devices has been a subject of debate. Our primary outcome was to detect differences, if any, between two different groups of patients using the patient-reported outcomes measurement information system (PROMIS) Global-10 form and to compare it with the Mayo elbow performance score (MEPS) results. Other secondary outcomes included the difference in union time between patients who received a reconstruction plate vs those who received a pre-contoured anatomical plate. MATERIAL AND METHODS: It is a prospective randomised study which included a total of 30 cases equally distributed into two groups. RESULTS: The mean PROMIS and MEPS scores for group A were 31.5 SD 6.6 and 77.7, respectively, compared to 33.7 SD 6.66 and 73, respectively, for the other group. Time to union was 13.4 weeks for group A and 12.6 weeks for the other group. There was no statistically significant difference between the groups regarding union and function. However, reconstruction plates were more cost effective. The correlation between the MEPS and PROMIS G scores in both groups was statistically significant. CONCLUSION: 1. Recon plates continue to be a cost-effective method of treatment in simple intra-articular fractures. 2.PROMIS is a valuable tool to be used along with other scores in future studies.

Betaine as an alternative feed additive to choline and its effect on performance, blood parameters, and egg quality in laying hens rations.

This research aimed to evaluate how using betaine levels as a choline substitute affects productive performance, egg quality parameters, fatty acids profile, and antioxidant status in laying hens. One hundred and forty brown chickens, 45 wk old, were divided into 4 groups, each group of 7 replicates with 5 chickens per replicate. The first group of diets with choline has control (A) 100% choline, the second group (B) 75% choline + 25% betaine, the third group (C) 50% choline + 50% betaine, and the fourth group (D) received 100% betaine. No significant effects were observed in final body weight (BW), body weight gain (BWG), egg production (EW), and feed intake (FI) for laying hens. In the diet in which betaine was replaced choline, egg mass (EM) and egg weight (EW) increased compared to the control group (P < 0.05). Also, after 12 wk of feeding, the egg quality parameters were not influenced; however, yolk color was increased significantly compared with the control group. Serum total cholesterol, LDL-lipoprotein, HDL-lipoprotein, triglyceride, glucose, aspartate transaminase (AST), and alanine transaminase (ALT) were not affected by replacing choline with betaine. Furthermore, liver malondialdehyde (MDA) content, yolk vitamin E, and fatty acid levels were not significantly affected by replacing choline with betaine. Moreover, hens fed betaine displayed an increased antibody titer of the Newcastle disease (ND) virus. EW and EM were increased by 3.50% and 5.43% in 100% betaine group (D) when compared to the control group. Isthmus weight was decreased by 48.28 % in 50% choline + 50% betaine group (C) when compared to the control group. ND was increased by 26.24% in 100% betaine group when compared to the control group. In conclusion, betaine supplementation positively affected productive performance, egg quality measurements, and immunity response in Bovans brown laying hens.

Comparative genome analyses of three serotypes of Lactococcus bacteria isolated from diseased cultured striped jack (Pseudocaranx dentex).

Lactococcosis, caused by members of the genus Lactococcus, represents a devastating disease inducing mass mortalities and economic losses in many fish species worldwide. The present work aimed to compare the whole genome sequences of three different serotypes of Lactococcus garvieae isolated from diseased cultured striped jack (Pseudocaranx dentex) in Ehime prefecture, Japan. The three serotypes showed different virulence in the challenge test using Japanese amberjack (Seriola quinqueradiata). The genome sequencing revealed that two of the strains (serotype I and serotype III) were identified as L. garvieae, while the third strain (serotype II) was identified as L. formosensis. The chromosome sizes of the three serotypes ranged from 1.9 to 2.0 Mb; the GC content ranges were 38.2 to 38.9%; and the numbers of predicted protein-coding sequences (CDSs) were from 1922 to 1959. Only the serotype II harbours two plasmids, sizes of around 14 kb and 9 kb. The detected virulence factors varied among the different serotypes with some shared factors like adherence, anti-phagocytosis, secretion system, toxin (haemolysin), serum resistance, antimicrobial resistance and others. The genomes also contained factors responsible for resistance to toxic compounds. The genome of the serotype III tended to encode more prophage regions than the other serotypes.

Effects of protected complex of biofactors and antioxidants on growth performance, serum biochemistry, meat quality, and intestinal antioxidant and immunomodulatory-related gene expressions of broiler chickens.

One-day-old male broiler chickens (Ross 308) were assigned to 3 dietary treatments in a completely randomized design with 8 replicates per treatment, and 4 birds per replicate. The control group was fed a basal control diet, and the 2 test groups were fed the basal control diet supplemented with 150 and 300 mg/kg of protected complex of biofactors and antioxidants [P(BF+AOX)], respectively. The P(BF+AOx) is a combination of vitamins, L-tryptophan and biofactors such as fermentation extracts (Jefo Nutrition Inc., Saint-Hyacinthe, QC, Canada). Dietary P(BF+AOX) did not affect growth performance and breast meat quality (water holding capacity, cooking loss, shear force, and texture profile analysis), but the addition of 150 mg/kg of P(BF+AOX) decreased the relative weight of liver, heart, and spleen (P < 0.05). The addition of 150 mg/kg of P(BF+AOX) tended to increase (P = 0.051) the cold carcass yield. The addition of 150 and 300 mg/kg of P(BF+AOX) decreased (P = 0.002) the cooler carcass shrink, but the relative weight of fat pad increased (P = 0.032) in chickens fed 300 mg/kg P(BF+AOx) than in those of birds fed the control diet. On the other hand, the addition of 300 mg/kg of P(BF+AOX) decreased (P = 0.041) the serum level of uric acid compared with those of birds fed the basal diet. Broiler chickens fed diets supplemented with 150 mg/kg of diet had higher (P < 0.05) mRNA expressions of jejunal SOD1 and interleukins 6 and 10 (IL-6, IL-10). The findings suggest that P(BF+AOX) could be considered as a functional nutrient in broiler diets up to a concentration of 150 mg/kg because of its favorable effects on maintaining intestinal barrier function as well as carcass traits, while excess levels (300 mg/kg) had exhibited superior effect on the serum level of uric acid compared with those of birds fed the control diet.

Effect of Ramadan fasting on chronic inflammation markers and gut bacterial endotoxins among Egyptian hemodialysis patients.

BACKGROUND: Chronic kidney disease (CKD) is associated with a state of chronic inflammation. This study aimed to investigate effects of Ramadan fasting on the markers of chronic inflammation and gut bacterial endotoxin levels in maintenance hemodialysis. METHOD: A prospective self-controlled observational study included 45 patients. Serum levels of High Sensitive CRP (hsCRP), indoxyl sulfate, and trimethylamine-n-levels were measured within a week before and a week after Ramadan fasting. RESULTS: Twenty-seven patients have fasted more than 15 days (29 ± 2.2 days). The levels of high sensitive C-reactive protein (hsCRP) (median of 62 mg/L vs. 91 mg/L), trimethylamine-n-oxide (TMAO) (median of 4.5 µmoL/L vs. 17 µmoL/L), platelet-to-lymphocyte ratio (PLR) (mean of 98.9 mg/L vs. 111.8 mg/L) and neutrophil-to-lymphocyte ratio (NLR) (median of 1.56 vs. 1.59) were significantly lower after Ramadan fasting with p < 0.001, p < 0.001, p < 0.001, and p = 0.04, respectively. CONCLUSION: A beneficial effect of Ramadan fasting on levels of bacterial endotoxins and markers of chronic inflammation in hemodialysis patients was observed.

Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study.

BACKGROUND: Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion. METHODS: In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups. RESULTS: In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications. CONCLUSION: Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.

Role of transcranial Doppler in assessment of cerebral blood flow in full term neonates with extreme unconjugated hyperbilirubinemia.

PURPOSE: To evaluate the difference in cerebral blood flow in neonates with and without extreme unconjugated hyperbilirubinemia. METHODS: Transcranial Doppler parameters of 26 full term newborns with extreme unconjugated hyperbilirubinemia (UCH) were compared to 13 postnatal age and sex matched normal healthy neonates serving as controls. Resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV) were measured in the middle cerebral, internal carotid and posterior cerebral arteries on both sides by transcranial color Doppler ultrasound. RESULTS: An increase in cerebral blood flow (decreased RI, PI and increased PSV) was observed in the extreme unconjugated hyperbilirubinemia (UCH) group. There was positive correlation between total serum bilirubin level and peak systolic velocity and vice versa with resistivity and pulsatility indices. Eight neonates developed clinical features of acute bilirubin encephalopathy and showed significantly increased peak systolic velocity in the right middle cerebral artery compared to those with normal outcome. Resistivity index and pulsatility index were lower in patients managed by exchange transfusion compared to those managed with phototherapy. CONCLUSION: An increase in cerebral blood flow was observed in neonates with UCH compared to those without hyperbilirubinemia. By assessing the cerebral blood flow velocity, resistivity index (RI), and pulsatility index (PI) of particular intracranial arteries, the transcranial Doppler can identify the at-risk neonates, for development of neurological affliction in extreme unconjugated hyperbilirubinemia.

Endovascular Therapy in Acute Isolated Posterior Cerebral Artery Occlusion : Systematic Review and Meta-analysis.

PURPOSE: Patients with isolated posterior cerebral artery occlusion (iPCAO) represent up to 6% of all acute ischemic stroke patients. Acute revascularization therapies for these patients were not tested in randomized controlled trials. The aim of this study was to evaluate outcomes of iPCAO patients who undergo endovascular treatment (EVT). METHODS: A systematic search of MEDLINE, Web of Science, CENTRAL, Scopus (inception-03/2022) was conducted for studies reporting 3­month outcome, symptomatic intracranial hemorrhage (sICH) and/or successful recanalization in iPCAO patients who underwent EVT. Random effect meta-analyses for pooled proportions were calculated. Double-arm meta-analyses for comparison of outcomes of iPCAO patients treated with EVT with age-, sex- and NIHSS-matched iPCAO patients treated with best medical treatment only were performed. RESULTS: Fifteen studies reporting a total of 461 iPCAO patients who underwent EVT were included. Excellent and favorable 3­month outcome proportions were 36% (95% confidence interval, CI 20-51%) and 57% (95% CI 40-73%), respectively. The 3­month mortality was 9% (95% CI 5-13), sICH occurred in 1% (95% CI 0-2%), successful recanalization was achieved in 79% (95% CI 71-86%). No significant differences in favorable and excellent 3­month outcomes, 3­month mortality and symptomatic intracerebral hemorrhage were found between the groups of patients who underwent EVT and the group of patients who received best medical treatment only. CONCLUSION: These results support the feasibility and safety of EVT in iPCAO, but do not show an outcome benefit with EVT compared to best medical treatment. Randomized trials are needed to evaluate treatment benefit of EVT in these patients.

Modified Bilateral V-Y Rotation Advancement Flap for Coverage of Fingertip Amputations.

Background: The use of homodigital antegrade flow flaps is an appealing option for coverage of fingertip injuries with exposed bone as it provides good padding, sensation and colour match with no need for splinting or secondary procedure for flap separation. V-Y flaps presented by Atasoy and Kutler have limited ability of distal advancement. We used two separate V flaps each based on a separate neuro-vascular bundle to allow better advancement while keeping good vascularity and sensation. Methods: We used a modified bilateral V-Y rotation advancement flap for coverage of fourteen fingertip injuries with bone exposed in 11 adult patients. Time to complete healing and return to work was recorded. Range of motion of injured finger as well as fingertip sensation using two-point discrimination were assessed and compared to non-injured contralateral finger 6 months after surgery. Fingertip hypersensitivity, cold intolerance and hooked nail deformity were assessed as well. Results: All flaps survived, and all patients resumed their activities after a mean period of 5 weeks. The mean two-point discrimination was 3.9 mm and was comparable to non-injured side. All patients regained full range of motion and were satisfied by the result. Two cases suffered from hypersensitivity that resolved at 3 months post-operative. Hooked nail deformity and cold intolerance were not recorded in our study. Conclusions: This modified bilateral V-Y rotation advancement flap technique presents a simple and single step procedure that provides good padding of fingertip with cosmetically pleasant contour and normal sensation. Level of Evidence: Level IV (Therapeutic).