Efficacy of Repeated Low-Level Red Light (RLRL) therapy on myopia outcomes in children: a systematic review and meta-analysis.

BACKGROUND: Myopia is the most prevalent form of refractive error that has a major negative impact on visual function and causes blurring of vision. We aimed to determine if Repeated Low-Level Red Light (RLRL) treatment is beneficial in treating childhood myopia in terms of axial length (AL), spherical equivalent refraction (SER), and sub foveal choroidal thickness (SFCT). METHODS: This systematic review was performed on RLRL for treatment of myopia in children compared to single vision spectacles (SVS). We employed the search strategy with key terms myopia and low-level light therapy then we searched PubMed, Scopus, Cochrane, and Web of Science databases. The mean differences (MD) were used to evaluate the treatment effects. Heterogeneity was quantified using I2 statistics and explored by sensitivity analysis. RESULTS: Five randomized controlled trials (RCTs) were included in our meta-analysis with a total of 833 patients, 407 in treatment group and 426 in control group. At a 3 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.16; 95% CI [-0.19, -0.12], SER (MD = 0.33; 95% CI [0.27, 0.38]), and SFCT (MD = 43.65; 95% CI [23.72, 45.58]). At a 6 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.21; 95% CI [-0.28, -0.15]), SER (MD = 0.46; 95% CI [0.26, 0.65]), and SFCT (MD = 25.07; 95% CI [18.18, 31.95]). At a 12 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.31; 95% CI [-0.42, -0.19]) and SER (MD = 0.63; 95% CI [0.52, 0.73]). CONCLUSION: This is the first systematic review and meta-analysis investigating only RCTs evidence supporting the efficacy of 650 nm RLRL for myopia control in the short term of 3, 6, and 12 months follow up. The present review revealed the clinical significance of RLRL as a new alternative treatment for myopia control with good user acceptability and no documented functional or structural damage. However, the effect of long-term RLRL treatment and the rebound effect after cessation require further investigations.

Expert consensus on the role of supplementation in obstetrics and gynecology using modified delphi method.

PURPOSE: To reach a consensus among obstetrics and gynecology experts on the effects of micronutrient supplementation on fertility and pregnancy to aid clinicians in decision-making and create a unified approach to managing micronutrient deficiencies in women, by performing a modified Delphi study. METHODS: A three-round modified Delphi process was conducted among a Delphi panel of 38 Egyptian experts to define recommendations regarding the role of supplementation on fertility and pregnancy in women of reproductive age. A literature review was performed and supporting evidence was graded to help guide the recommendations based on available evidence. RESULTS: A total of 62 statements were developed for discussion and voting. Out of the 62 statements, 60 statements reached expert consensus. Statements were divided into two domains. The first domain discussed the role of supplementation in fertility: optimizing natural fertility, polycystic ovary syndrome (PCOS), in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), unexplained infertility, and endometriosis, whereas the second domain was concerned with the role of supplementation in pregnancy during the prenatal, antenatal, and postnatal periods. CONCLUSION: In this work, a modified Delphi methodology was implemented to reach a consensus on the use of micronutrient supplementation in women of reproductive age. These recommendations can help clinicians in their practice, guide future research, and identify gaps in the market for the pharmaceutical industry. This clinical guidance can be extrapolated to similar communities.

Establishment of an In Bacterio Assay for the Assessment of Carbon Storage Regulator A (CsrA) Inhibitors.

Polymicrobial infections involving various combinations of microorganisms, such as Escherichia, Pseudomonas, or Yersinia, can lead to acute and chronic diseases in for example the gastrointestinal and respiratory tracts. Our aim is to modulate microbial communities by targeting the posttranscriptional regulator system called carbon storage regulator A (CsrA) (or also repressor of secondary metabolites (RsmA)). In previous studies, we identified easily accessible CsrA binding scaffolds and macrocyclic CsrA binding peptides through biophysical screening and phage display technology. However, due to the lack of an appropriate in bacterio assay to evaluate the cellular effects of these inhibitor hits, the focus of the present study is to establish an in bacterio assay capable of probing and quantifying the impact on CsrA-regulated cellular mechanisms. We have successfully developed an assay based on a luciferase reporter gene assay, which in combination with a qPCR expression gene assay, allows for the monitoring of expression levels of different downstream targets of CsrA. The chaperone protein CesT was used as a suitable positive control for the assay, and in time-dependent experiments, we observed a CesT-mediated increase in bioluminescence over time. By this means, the cellular on-target effects of non-bactericidal/non-bacteriostatic virulence modulating compounds targeting CsrA/RsmA can be evaluated.

Proactive Glucose Screening Tool Effective for Time-sensitive Identification of Hyperglycemia in Childhood Cancer Patients.

Approximately 4% to 35% of pediatric patients undergoing treatment for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy) develop drug-induced hyperglycemia. Though hyperglycemia is associated with poor outcomes, no guidelines for identifying drug-induced hyperglycemia currently exist, and the time course for developing hyperglycemia remains relatively uncharacterized after induction therapy. The present study evaluated a hyperglycemia screening protocol that was implemented to identify hyperglycemia more promptly, examined predictors of hyperglycemia during ALL and LLy therapy, and described the timeline for developing hyperglycemia. A retrospective review of 154 patients diagnosed with ALL or LLy at Cook Children's Medical Center between March 2018 and April 2022 was performed. Predictors of hyperglycemia were examined with Cox regression. The hyperglycemia screening protocol was ordered for 88 (57%) patients. Fifty-four (35%) patients developed hyperglycemia. In multivariate analyses, age 10 years or older (hazard ratio = 2.50, P = 0.007) and weight loss (vs gain) during induction (hazard ratio = 3.39, P < 0.05) were associated with hyperglycemia. The present study identified a population of patients at risk of developing hyperglycemia and identifies strategies for hyperglycemia screening. In addition, the present study showed that some patients developed hyperglycemia after induction therapy, which highlights the importance of continued blood glucose monitoring in at-risk patients. Implications and suggestions for further research are discussed.

Intracranial Relapse in Pediatric Sarcoma.

Advances in local control techniques, chemotherapy regimens, and imaging modalities have led to improvements in both morbidity and mortality in pediatric sarcoma patients. However, approximately one-third of patients develop disease relapse and intracranial metastasis was considered rare. The incidence of sarcoma brain metastasis is thought to have increased and is associated with grim outcomes. This was a retrospective study of 3 deidentified patient charts illustrating the possibility of the central nervous system as a potential site for pediatric sarcoma relapse and investigate the patterns of such relapses. We note this is the first report of infantile fibrosarcoma brain metastasis and a rare report of sarcoma lymph node metastasis. In addition, each patient was treated with targeted therapies, including entrectinib, Ruxolitnib, and pazopanib. Caregivers in cases 2 and 3 reported new-onset neurological manifestations before identification of new brain metastasis, indicating a lag in detection of new intracranial relapse in asymptomatic sarcoma patients. We suggest implementing a brief review of systems screening tool focused on concerning neurological manifestations to screen for new brain metastasis.

Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls.

Pygopagus twin is a rare congenital malformation with a worldwide incidence of 1in 200,000. Few literature reports are published regarding the matter. In some cases, neuromonitoring is essential for safe surgical separation. We believe it is important to share our challenges and nuances in order to minimize obstacles one might encounter. We utilized neuromonitoring during our separation of both twins, and we planned a multidisciplinary approach and efficient communication system with the other teams in order to plan a successful, safe, and timely separation of the twins. We seek to highlight not our success but rather the obstacles and challenges we encountered during the separation of pygopagus twins in our institute using neuromonitoring for future reference.

Knowledge, awareness, and perception of digital dentistry among Egyptian dentists: a cross-sectional study.

BACKGROUND: Digital dentistry has revolutionized the way dental treatment is offered to patients. It became essential for dental practitioners to be well-informed about this technology to improve the quality of care offered and increase patient satisfaction. This study aimed to assess the level of knowledge, awareness, and perception of Egyptian dentists toward digital dentistry. METHODS: An online-based cross-sectional study was conducted using social media platforms from November 2022 to March 2023. Our study sample included dentists with different levels of experience, specialties, and working in different health sectors in Egypt. A questionnaire arranged in 4 sections and 23 questions was used as the study data collection tool. The data were tabulated and analyzed using SPSS software. RESULTS: A total of 402 participants filled out this questionnaire. 50.7% of which were females, 42.8% were between 20-29 years old and 42.3% were general practitioners. Furthermore, the main practice of 27.6% was in governmental dental clinics. Moreover, 47.3% and 64.2% of participants had Moderate knowledge and awareness respectively. While 75.9% of them had a high perception of practicing digital dentistry. Females and practitioners in governmental clinics had significantly lower awareness scores, while faculty teaching staff had significantly higher scores (P ≤ 0.05). On the other hand, practicing in the Great Cairo region and urban areas was associated with significantly higher knowledge scores (P ≤ 0.05). Similarly, Prosthodontists, periodontists, and restorative dentists had significantly higher scores when compared with general dentists (P ≤ 0.05). CONCLUSIONS: About half of the study participants had Moderate knowledge and awareness levels, while about three-quarters of them had a high level of perception toward practicing digital dentistry. Therefore, more attention should be given to providing dental education programs in this important field at both the undergraduate and postgraduate levels by policymakers.

How dentists in Egypt perceive their knowledge, attitudes, and barriers they face in providing oral healthcare to geriatric patients: a cross-sectional study.

BACKGROUND: Geriatric dentistry is an understudied area in dental schools in Egypt. Our study aimed to assess the knowledge and attitudes of Egyptian dentists regarding geriatric oral health and identify barriers to delivering dental care to geriatric patients. METHODS: We conducted an anonymous online cross-sectional study in November and December 2022, targeting dentists with varying levels of experience working in different Egyptian institutions. A 30-item questionnaire assessed the respondent's views on geriatric oral health, perceived knowledge, attitudes, and barriers. The Google form was distributed through emails and commonly used social media platforms. RESULTS: A total of 421 dentists responded to this online questionnaire. Of the respondents, 44.9% were male, 45.0% were between 20 and 29 years old, and 31.5% worked in more than one dental setting. Multivariate analysis revealed that female sex negatively affected attitude ß = -1.72 [95%CI,-2.43 - -1.11]. The proportion of older patients who visited the respondents' clinics per day (11-30%) and more than 30% increased perceived knowledge [ß = 1.01 (95%CI, 0.41 -1.62), ß = 1.50 (95%CI, 0.71-2.22)] and attitude [ß = 0.70 (95%CI, 0.06-1.40), ß = 0.73 (95%, 0.13-1.61)] while decreased the perceived barriers [ß = -1.10 (95%CI, -1.91 - -0.32)] respectively. On the other hand, years of experience increased perceived knowledge only after 5-10 years [ß = 1.02 (95%CI, 0.04-2.10)] and after more than 10 years [ß = 1.30 (95%CI, 0.21-2.70)]. Governmental work only increased perceived barriers [ß = 1.33 (95%CI, 0.10-2.54)], while living in the middle and west delta decreased perceived barriers [ß = -0.91 (95%CI, -2.12 - -0.01 and ß = -1.33, (95%CI, -2.22 - -0.40) respectively]. CONCLUSIONS: Our study highlights the need to improve the knowledge and attitudes of young dentists towards geriatric dentistry. Furthermore, working conditions in dental facilities, particularly in the government sector and Upper Egypt, need to be improved to reduce barriers to delivering dental care to geriatric patients.

Maximum Entropy Exploration in Contextual Bandits with Neural Networks and Energy Based Models.

Contextual bandits can solve a huge range of real-world problems. However, current popular algorithms to solve them either rely on linear models or unreliable uncertainty estimation in non-linear models, which are required to deal with the exploration-exploitation trade-off. Inspired by theories of human cognition, we introduce novel techniques that use maximum entropy exploration, relying on neural networks to find optimal policies in settings with both continuous and discrete action spaces. We present two classes of models, one with neural networks as reward estimators, and the other with energy based models, which model the probability of obtaining an optimal reward given an action. We evaluate the performance of these models in static and dynamic contextual bandit simulation environments. We show that both techniques outperform standard baseline algorithms, such as NN HMC, NN Discrete, Upper Confidence Bound, and Thompson Sampling, where energy based models have the best overall performance. This provides practitioners with new techniques that perform well in static and dynamic settings, and are particularly well suited to non-linear scenarios with continuous action spaces.

[Double to avoid trouble? An experience of double Memokath(tm) 044TW stents insertion for multiple anterior urethral stricture in hospital universiti sains Malaysia].

For the past two decades urethral stenting became more popular for treatment of urethral stricture. However, urethral stents still not widely used in view of good outcome from urethroplasty surgery. The MemokathTM stent is the most popular in this field. It is manufactured from a biocompatible alloy of nickel and titanium. Most of the studies have been limited to single stent insertion, and no studies done for double stents insertion. An 81-year-old man with history of multiple anterior urethral strictures since 2013. He underwent internal urethrotomy in the same year but failed and was on urinary catheter since then. The MemokathTM 044TW was the option due to patient has multiple comorbidities. The micturating cystourethrogram (MCUG) and ascending urethrogram showed multiple anterior urethral strictures. He underwent direct visual internal urethrotomy and two MemokathTM stents inserted in the whole length of urethral. However, one year after procedure, he had recurrent lower urinary tract symptoms and ultimately developed acute urinary retention (AUR). Patients stents were removed endoscopically. During endoscopic removal, he had encrustation of both stents that causing obstructive symptoms. He is under our follow-up with no recurrent urinary retention or urosepsis with satisfactory uroflowmetry. Stent encrustation is known to be a common late complication of urethral stents. Stent encrustation should be suspected if patient comes with obstructive symptoms. Endoscopic is shown to be the best method to detect the cause of obstructed stent.

Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results.

BACKGROUND: To delineate the clinical characteristics and surgical outcomes of large angle sensory exotropia in pediatric patients. METHODS: The medical records of 54 large angle exotropia ≥40 PD patients aged from 1 to 18 years who were operated on between 2018 and 2021 and were followed up for 1 year were reviewed and contacted. Clinical characteristics and surgical outcomes were analyzed retrospectively. Patients were divided into two groups, group S patients had supermaximum recession resection and group E had augmented recession by lateral rectus muscle elongation with an autograft from the resected medial rectus muscle in the same eye. The clinical characteristics and results of both groups were compared. RESULTS: The mean age of the studied patients with sensory exodeviation at the time of surgery was 8.3 ± 4.2 years. Mean of the duration of exotropia was 6.9 ± 2.2 years, and the mean of postoperative follow-up was 14.3 ± 4.2 months. Surgical success was achieved in 73.07% of group S and 82.14% of group E. Recurrence was more common with anterior segment pathology. Larger post-operative distant angles were strongly related to poorer visual acuities P = 0.001 and not related to the age of onset or the duration. Narrowing of the palpebral fissure improved in both groups at the last follow up P = 0.336. The limitation of abduction in both groups improved in the last follow up P = 0.145. CONCLUSION: The outcome of monocular surgery for sensory exotropia in children is satisfactory with no significant differences in results between lateral rectus muscle tendon autograft elongation technique and supermaximum recession resection. Recurrence is more common with anterior segment pathology. Larger post-operative distant angle of deviation is strongly related to poorer visual acuity. CLINICAL TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov (ID: NCT04286945) on 25-2-2020.

Double trouble - management of perinephric hematoma and renal vein thrombosis post percutaneous renal biopsy.

BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. CASE PRESENTATION: We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. CONCLUSION: Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.

The Role of l-Carnitine in Mitochondria, Prevention of Metabolic Inflexibility and Disease Initiation.

Mitochondria control cellular fate by various mechanisms and are key drivers of cellular metabolism. Although the main function of mitochondria is energy production, they are also involved in cellular detoxification, cellular stabilization, as well as control of ketogenesis and glucogenesis. Conditions like neurodegenerative disease, insulin resistance, endocrine imbalances, liver and kidney disease are intimately linked to metabolic disorders or inflexibility and to mitochondrial dysfunction. Mitochondrial dysfunction due to a relative lack of micronutrients and substrates is implicated in the development of many chronic diseases. l-carnitine is one of the key nutrients for proper mitochondrial function and is notable for its role in fatty acid oxidation. l-carnitine also plays a major part in protecting cellular membranes, preventing fatty acid accumulation, modulating ketogenesis and glucogenesis and in the elimination of toxic metabolites. l-carnitine deficiency has been observed in many diseases including organic acidurias, inborn errors of metabolism, endocrine imbalances, liver and kidney disease. The protective effects of micronutrients targeting mitochondria hold considerable promise for the management of age and metabolic related diseases. Preventing nutrient deficiencies like l-carnitine can be beneficial in maintaining metabolic flexibility via the optimization of mitochondrial function. This paper reviews the critical role of l-carnitine in mitochondrial function, metabolic flexibility and in other pathophysiological cellular mechanisms.

Neuroendocrine Effects of Carnitines on Reproductive Impairments.

Carnitines are quaternary amines involved in various cellular processes such as fatty acid uptake, ß-oxidation and glucose metabolism regulation. Due to their neurotrophic activities, their integrative use has been studied in several different physio-pathological conditions such as anorexia nervosa, chronic fatigue, vascular diseases, Alzheimer's disease and male infertility. Being metabolically active, carnitines have also been proposed to treat reproductive impairment such as functional hypothalamic amenorrhea (FHA) and polycystic ovary syndrome (PCOS) since they improve both hormonal and metabolic parameters modulating the neuroendocrine impairments of FHA. Moreover, they are capable of improving the lipid profile and the insulin sensitivity in patients with PCOS.

Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post-Mastectomy Pain, a Preliminary Report: 6-Month Results.

AIM: Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS). METHODS: Patients with PMPS randomized to Group TS (n = 33) received radiofrequency thoracic sympathectomy, and those randomized to Group Sham (n = 33) received no radiofrequency current. Postoperative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the proportion of patients who showed >50% reduction in their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during the 6-month follow-up period. RESULTS: A significantly higher proportion of patients experienced >50% reduction in pain in Group TS (Group TS 25/30 [83.3%] vs. Group Sham 18/31 [58%], P = 0.032); the proportion of patients who experienced >50% reduction in their pain without analgesics was significantly higher in Group TS (Group TS 10/25 [40%] vs. Group Sham 0/18 [0%], P = 0.001). Furthermore, the proportion of patients treated with tramadol + duloxetine + pregabalin who experienced >50% reduction in their pain was significantly lower in Group TS (Group TS 0/25 [0%] vs. Group Sham 13/18 [75%], P = 0.001). The VAS pain score was significantly lower in Group TS at 2 weeks and at 1, 2, 3, and 6 months following the procedure. The GPE was significantly higher in Group TS (Group TS median GPE [interquartile range]) 7 [5, 7] vs. Group Sham median GPE [interquartile range]) 5 [4, 6]) P < 0.001). CONCLUSIONS: Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain scores and reduced the need for anti-neuropathic drugs, particularly opioid medications, and provided better patient satisfaction.

Rupture Risk of Small Unruptured Intracranial Aneurysms in Japanese Adults.

Background and Purpose- Therapeutic decision making for small unruptured intracranial aneurysms (<10 mm) is difficult. We aimed to develop a rupture risk model for small intracranial aneurysms in Japanese adults, including clinical, morphological, and hemodynamic parameters. Methods- We analyzed 338 small unruptured aneurysms; 35 ruptured during the observation period, and 303 remained stable. Clinical, morphological, and hemodynamic parameters were considered. Computational fluid dynamics was used to calculate hemodynamic parameters based on computed tomography images of all aneurysms in their unruptured state. Differences between the ruptured and unruptured groups were tested by the Mann-Whitney U or Fisher exact tests. Multivariate logistic regression was applied to obtain a rupture risk model. Its predictive ability was investigated by receiver operating characteristic analysis. Results- The risk model revealed that rupture may be more likely to in younger patients (odds ratio [OR], 0.92 for each age increase of 1 year [95% CI, 0.88-0.96] P<0.001) with multiple aneurysms (OR, 2.58 [95% CI, 1.07-6.19] P=0.03), located at a bifurcation (OR, 5.45 [95% CI, 1.87-15.85] P=0.002), with a bleb (OR, 4.09 [95% CI, 1.42-11.79] P=0.009), larger length (OR, 1.91 for each increase of 1 mm [95% CI, 1.42-2.57] P<0.001), and lower pressure loss coefficient (OR, 0.33 for each decrease of 1 unit [95% CI, 0.14-0.77] P=0.01). The sensitivity, specificity, and area under the curve were 0.800, 0.752, and 0.826 (95% CI, 0.739-0.914) respectively. Conclusions- Younger age, presence of multiple aneurysms, location at a bifurcation, presence of a bleb, larger length, and lower pressure loss coefficient were identified as risk factors for rupture of small intracranial aneurysms. The risk model should be validated in further studies.

Chlorella vulgaris microalgae and/or copper supplementation enhanced feed intake, nutrient digestibility, ruminal fermentation, blood metabolites and lactational performance of Boer goat.

The associative effects of Chlorella vulgaris microalgae and copper (Cu) supplementation on feed utilisation and lactational performance in goats were evaluated. Thirty-two lactating Boer goats (34.8 ± 1.7 kg body weight) were used to evaluate the supplementation of C. vulgaris microalgae at 10 g/day (AL treatment), 9 mg of Cu/kg diet (CU treatment) or a mixture of both AL and CU treatments (ALCU treatment) on feed intake, nutrient digestibility, ruminal fermentation, blood metabolites and lactation performance of Boer goat milk yield and composition. Treatments did not affect feed intake; however, AL, ALCU and CU treatments increased (p < .001) nutrient digestibility. Treatment effect on ruminal pH, ammonia-N or propionate was marginal, but AL and ALCU treatments increased (p < .01) acetate, acetate/propionate ratio and total volatile fatty acids. Treatments increased (p < .001) serum glucose and Cu concentrations. Additionally, ALCU and AL treatments increased (p < .001) daily milk yield, energy corrected milk production, concentrations of ash, energy content, fat, lactose, solids not fat, total solids and milk (feed) efficiency. Conversely, the CU treatment decreased (p < .001) the concentration of all milk components, without affecting milk (feed) efficiency. Additionally, AL and ALCU treatments decreased (p < .05) the concentrations of saturated fatty acids by 2.4% and 4%, respectively, but increased (p < .05) the concentrations of total unsaturated fatty acids (UFAs) by 5.4% and 9.8%, respectively, mono-UFA by 5.2% and 9.8%, respectively, and conjugated linoleic acid concentrations by 9.3% and 7.4% respectively. In conclusion, supplementation of the diet of lactating Boer goats with C. vulgaris microalgae with or without copper enhanced nutrient digestibility, ruminal fermentation, milk production, milk efficiency and milk nutritive value. Copper supplementation had minimal effects; therefore, its use as a supplement in the presence of C. vulgaris microalgae to the diet of lactating Boer goats is recommended.

A highly sensitive colorimetric assessment of hexavalent chromium using a digital camera.

Simple, low-cost, and sensitive methods for the assessment of hexavalent chromium as an important environmental pollutant are highly desirable, especially under resource-limited settings. Therefore, herein we propose an original approach for the simple, low-cost, selective, and extremely sensitive assessment of Cr(VI) utilizing its catalysis of the micellar sensitized o-dianisidine (DA)-hydrogen peroxide reaction. The initial rate of the amended reaction is monitored by tracing the oxidation product, either by a digital camera video recording or spectrophotometrically at 440 nm, for 120 s from mixing the reactants. The optimized reaction conditions were 5 mmol L-1 DA, 0.6 mol L-1 H2O2, 2.0 v/v% Tween 20, and 10 mmol L-1 chloroacetate buffer (pH 4.5 ± 0.1), at 30 °C. The linear calibration graph extends to 90.0 ng mL-1 Cr(VI) with detection limits (3Sb) of 0.8 and 1.0 ng mL-1, for the video recording and spectrophotometric procedures, respectively. The amended method was successfully applied to the assessment of Cr(IV) in natural and polluted industrial wastewaters. The analytical data were in excellent statistical harmony with those of the standard ETAAS method. The proposed method is two orders of magnitude more sensitive than the diphenylcarbazide standard spectrophotometric method.Graphical abstract.

Treatment for displaced Tillaux fractures in adolescent age group.

BACKGROUND: Around age 11-15 years, a forced external rotation of the foot in a supination or a medial rotation of the leg on the fixed foot usually is responsible for an avulsion injury to the anterolateral epiphysis, known as Tillaux fracture. Ligamentous injuries are rare in children because ligaments are stronger than is the growth plate that frequently is injured. OBJECTIVE: The aim of this study was to present the clinical outcome until the end of growth after surgical treatment for displaced adolescent Tillaux fractures. PATIENTS AND METHODS: 13 patients with Tillaux fractures in the adolescent age group. Patient`s age ranged (12-17 years) with an average 13.4 years. Of those 13 patients, there were 9 females and 4 males. RESULTS: Fracture union was obtained in all cases (100%) and was assed radiologically when X-ray check-ups in all projections showed the significant presence of trabeculation crossing the fracture, without pain and functionally using the American Orthopedic Foot and Ankle Society (AOFAS) score of the ankle joint. Overall average score was 97 ranged 95-100. There was no recorded post-operative complication. CONCLUSION: The plain radiographs of patients with an avulsion injury of anterolateral tubercle (Tillaux fragment) should be carefully examined for evidence of syndesmotic widening. If there is any doubt, CT scans is helpful. If fracture displacement was greater than 2 mm, a surgical intervention is recommended to restore the normal anatomy of the ankle joint. Anatomically reduced Tillaux fractures at adolescent age group either by closed or opened means, followed by post-operative plaster cast immobilization will lead to excellent results.

Effect of Intrathecally Administered Ketamine, Morphine, and Their Combination Added to Bupivacaine in Patients Undergoing Major Abdominal Cancer Surgery a Randomized, Double-Blind Study.

Objective: Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design: Prospective, randomized, double-blind. Setting: Academic medical center. Patients and Methods: Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 mL volume and 0.3 mg morphine in 1 mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1 mL volume instead of morphine. The morphine + ketamine group (group K + M) received both 0.3 mg morphine and 0.1 mg/kg ketamine in 1 mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results: Total PCA morphine was significantly decreased in group M + K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M + K compared with group K (P < 0.001). VAS in group M + K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M + K compared with group M until six hours postoperation. No other side effects were observed. Conclusions: Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.