Effectiveness of greenhouse gas mitigation intervention for health-care systems: a systematic review.

Objective: To identify evidence-based interventions that reduce greenhouse gas emissions in health-care systems in low- and middle-income countries and explore potential synergies from these interventions that aid climate change adaptation while mitigating emissions. Methods: We systematically searched 11 electronic databases for articles published between 1990 and March 2023. We assessed risk of bias in each article and graded the quality of evidence across interventions in health-care operations, energy and supply chains. Findings: After screening 25 570 unique records, we included 22 studies published between 2000 and 2022 from 11 countries across six World Health Organization regions. Identified articles reported on interventions spanning six different sources of emissions, namely energy, waste, heating and cooling, operations and logistics, building design and anaesthetic gases; all of which demonstrated potential for significant greenhouse gas emission reductions, cost savings and positive health impacts. The overall quality of evidence is low because of wide variation in greenhouse gas emissions measuring and reporting. Conclusion: There are opportunities to reduce the greenhouse gas emissions from health-care systems in low- and middle-income countries, but gaps in evidence were identified across sources of emissions, such as the supply chain, as well as a lack of consideration of interactions with adaptation goals. As efforts to mitigate greenhouse gas intensify, rigorous monitoring, evaluation and reporting of these efforts are needed. Such actions will contribute to a strong evidence base that can inform policy-makers across contexts.

Perioperative trends in neck and leg fluid volume in surgical patients: a prospective observational proof-of-concept study.

PURPOSE: The severity of obstructive sleep apnea (OSA) may increase postoperatively. The changes in segmental fluid volume, especially neck fluid volume, may be related to increasing airway collapsibility and thus worsening of OSA in the postoperative period. Our objective was to evaluate the feasibility of performing bioelectrical impedance analysis (BIA) and to describe the trend and predictors of changes in segmental fluid volumes in patients receiving general anesthesia for noncardiac surgery. METHODS: We conducted a prospective observational proof-of-concept cohort study of adult patients undergoing elective inpatient noncardiac surgery. Patients underwent a portable sleep study before surgery, and segmental fluid volumes (neck fluid volume [NFV], NFV phase angle, and leg fluid volume [LFV]) were measured using BIA at set time points: preoperative period (preop), in the postanesthesia care unit (PACU), the night following surgery at 10 pm (N 0), and the following day at 10 am (POD 1). Linear regression models were constructed to evaluate for significant predictors of overall segmental fluid changes. The variables included in the models were sex, preoperative apnea-hypopnea index (AHI), fluid balance, body mass index (BMI), cumulative opioids, and the timepoint of measurement. RESULTS: Thirty-five adult patients (20/35 females, 57%) were included. For the feasibility outcome, measure of recruitment was 50/66 (76%) and two measures of protocol adherence were fluid measurements (34/39, 87%) and preoperative sleep study (35/39, 90%). There was a significant increase in NFV from preop to N 0 and in LFV from preop to PACU. Neck fluid volume also increased from PACU to N 0 and PACU to POD 1, while LFV decreased during the same intervals. The overall changes in NFV were associated with the preop AHI, BMI, and opioids after adjusting for body position and pneumoperitoneum. CONCLUSIONS: This proof-of-concept study showed the feasibility and variability of segmental fluid volumes in the perioperative period using BIA. We found an increase in NFV and LFV in the immediate postoperative period in both males and females, followed by the continued rise in NFV and a simultaneous decrease in LFV, which suggest the occurrence of rostral fluid shift. Preoperative AHI, BMI, and opioids predicted the NFV changes. STUDY REGISTRATION: ClinicalTrials.gov; NCT02666781, registered 25 January 2016; NCT03850041, registered 20 February 2019.

RéSUMé: OBJECTIF: La gravité de l'apnée obstructive du sommeil (AOS) peut augmenter en période postopératoire. Les changements dans le volume segmentaire de fluides, en particulier le volume liquidien du cou, peuvent être liés à l'augmentation de la collapsibilité des voies aériennes et donc à l'aggravation d'une AOS en période postopératoire. Notre objectif était d'évaluer la faisabilité de réaliser une analyse d'impédance bioélectrique (AIB) et de décrire la tendance et les prédicteurs des changements dans les volumes de fluides segmentaires chez des patients recevant une anesthésie générale pour une chirurgie non cardiaque. MéTHODE: Nous avons réalisé une étude de cohorte observationnelle prospective de démonstration de faisabilité chez des patients adultes bénéficiant d'une chirurgie non cardiaque non urgente en milieu hospitalier. Les patients ont subi une étude du sommeil grâce à un appareil portable avant la chirurgie, et les volumes de fluides segmentaires (volume de fluides du cou, angle de phase VLC et volume de fluides des jambes) ont été mesurés à l'aide d'une AIB à des moments définis : période préopératoire (préop), en salle de réveil, la nuit suivant la chirurgie à 22 h (N 0) et le lendemain à 10 h (JPO 1). Des modèles de régression linéaire ont été construits pour évaluer les prédicteurs significatifs de changements globaux des fluides segmentaires. Les variables incluses dans les modèles étaient le sexe, l'indice d'apnée-hypopnée préopératoire (IAH), l'équilibre hydrique, l'indice de masse corporelle (IMC), les opioïdes cumulés et le point de mesure temporel. RéSULTATS: Trente-cinq patients adultes (20/35 femmes, 57 %) ont été inclus. En ce qui concerne le critère de faisabilité, la mesure du recrutement était de 50/66 (76 %) et deux mesures de l'observance du protocole étaient les mesures liquidiennes (34/39, 87 %) et une étude préopératoire du sommeil (35/39, 90 %). Il y a eu une augmentation significative du volume de fluides du cou entre la période préopératoire et N 0 et du volume de fluides des jambes de la période préopératoire à la salle de réveil. Le volume de fluides du cou a également augmenté de la salle de réveil à N 0 et de la salle de réveil au JPO 1, tandis que le volume de fluides des jambes a diminué au cours des mêmes intervalles. Les changements globaux de volume de fluides du cou ont été associés à l'IAH préopératoire, à l'IMC et aux opioïdes après ajustement pour tenir compte de la position du corps et du pneumopéritoine. CONCLUSION: Cette étude de preuve de concept a démontré la faisabilité de l'évaluation et la variabilité des volumes de fluide segmentaire dans la période périopératoire en utilisant l'IAB. Nous avons constaté une augmentation du volume liquidien du cou et des jambes en période postopératoire immédiate chez les hommes et les femmes, suivie d'une augmentation continue du volume liquidien du cou et d'une diminution simultanée du volume liquidien des jambes, ce qui laisserait penser à la survenue d'un déplacement du liquide rostral. L'indice d'apnée-hypopnée préopératoire, l'IMC et les opioïdes étaient des prédicteurs de changements du volume liquidien du cou. ENREGISTREMENT DE L'éTUDE: ClinicalTrials.gov; NCT02666781, enregistré le 25 janvier 2016; NCT03850041, enregistré le 20 février 2019.

CD44, CD90 and CD96 expression in immune thrombocytopenia purpura (ITP) patients.

Studying the expression of hematopoietic stem cell markers from different sources might be useful in understanding stem cell biology in different niche conditions. The study aimed to assess the difference in cell surface markers (CD44, CD90, CD96) on hematopoietic stem cells in three different niche conditions; umbilical cord blood (UCB), normal bone marrow (NBM) and bone marrow samples from idiopathic (immune) thrombocytopenic purpura (IBM). This study was conducted on 300 cases divided into three study groups; 100 umbilical cord blood units collected from mothers undergoing cesarian section in gynecology and obstetrics department, 100 bone marrow samples from idiopathic (immune) thrombocytopenic purpura patients collected from university children hospital and 100 normal bone marrow samples with no evidence of disease in bone marrow tissue. CD44 was significantly elevated in UCB and NBM groups compared to IBM group (<0.001). There was also a significant elevation of CD90 and CD96 in IBM group compared to NBM group and UCB (<0.001). CD90 and CD96 play a role in the pathogenesis of ITP disorder and could be applied as a targeted therapy to improve the outcome of this disease.

Assessment of RACGAP1 as a Prognostic and Immunological Biomarker in Multiple Human Tumors: A Multiomics Analysis.

Several recent studies have pointed out that arc GTPase activating protein 1 (RACGAP1) is a putative oncogene in many human tumors. However, to date, no pan-cancer analysis has been performed to study the different aspects of this gene expression and behavior in tumor tissues. Here, we applied several bioinformatics tools to perform a comprehensive analysis for RACGAP1. First, we assessed the expression of RACGAP1 in several types of human tumors and tried to correlate that with the stage of the tumors analyzed. We then performed a survival analysis to study the correlation between RACGAP1 upregulation in tumors and the clinical outcome. Additionally, we investigated the mutation forms, the correlation with several immune cell infiltration, the phosphorylation status of the interested protein in normal and tumor tissues, and the potential molecular mechanisms of RACGAP1 in cancerous tissue. The results demonstrated that RACGAP1, a highly expressed gene across several types of tumors, correlated with a poor prognosis in several types of human cancers. Moreover, it was found that RACGAP1 affects the tumor immune microenvironment by influencing the infiltration level of several immune cells. Collectively, the current study provides a comprehensive overview of the oncogenic roles of RACGAP1, where our results nominate it as a potential prognostic biomarker and a target for antitumor therapy development.

Impact of global health crisis and oil price shocks on stock markets in the GCC.

This study examines the impact of global COVID-19 cases and oil price shocks on the stock markets in the GCC. Using the Kalman filter to generate the unexpected oil price shocks, we find that, with the exception of Oman, the GCC markets responded to positive and negative oil price shocks before and during the pandemic, with impacts of higher magnitude since March 11, 2020. We also find that the spread of global COVID-19 cases had in itself no meaningful impact on the GCC stock markets.

Prognostic Relevance of Concordant Expression CD69 and CD56 in Response to Bortezomib Combination Therapy in Multiple Myeloma Patients.

OBJECTIVE: Multiple myeloma is an incurable hematological malignancy. Currently, the use of proteasome inhibitors could be superior to chemotherapy-based regimen in the treatment of this disease. However, resistance to bortezomib combination therapy still occurs in some patients. So, this research work aims to assess CD69 and CD56 expression in these cases and their relation to the response to therapy. MATERIALS AND METHODS: Immunophenotyping by 4-color multi-parameter flow cytometry was carried out on 98 multiple myeloma cases. Clonal plasma cells were gated by co-expression of CD38 with CD138 with low SSC, negative or dim CD45. RESULTS: Double negative CD69 and CD56 (47.9%) multiple myeloma cases were associated with high serum ß2 microglobulin, creatinine, calcium and low serum albumin. There was also a significant correlation between the absence of these markers with osteolytic lesions and unfavorable cytogenetic t (4;14) (p < 0.001). Moreover, there was a highly significant correlation between CD69- and CD56- with non-response to bortezomib combination therapy in multiple myeloma patients (p < 0.0001). Regression analysis for the prediction of non- response to treatment in these cases using different prognostic indicators revealed that high serum ß2 microglobulin, unfavorable cytogenetic, advanced stage, and low expression of CD69 and CD56 were poor predictors of non-response. CONCLUSION: CD69 in association with CD56 could be an independent prognostic factor in multiple myeloma cases. It could be used in the routine laboratory assessment for refining stratification and timely therapeutic decision for highly cost therapy in developing countries.

Serum Golgi protein 73 as a sensitive biomarker for early detection of hepatocellular carcinoma among Egyptian patients with hepatitis C virus-related cirrhosis.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Early detection of HCC is always a challenging task for physicians. Serum Golgi protein 73 (GP73) is considered a potential tumor marker for the detection of HCC. However, the diagnostic value of GP73 for the HCC diagnosis is still controversial. This research was designed to assess the diagnostic efficacy of GP73 as a diagnostic tool for HCC in cases with hepatitis C virus-related cirrhosis. METHODS: Eighty-seven subjects were allocated into four different groups in this prospective research (HCC, liver cirrhosis, chronic hepatitis C, and healthy control group). Serum alpha-fetoprotein (AFP) and GP73 were tested for all subjects in the study. Detection of focal hepatic lesions was based on imaging by abdominal ultrasonography and triphasic computed tomography. RESULTS: The cut-off values for GP73 and AFP were 534.5 ng/L and 32 ng/mL, respectively. The specificity of GP73 was 87%, and the sensitivity was 88%, while the specificity and sensitivity of AFP levels were 80% and 72%, respectively. The negative predictive value of GP73 was 87.5%, and the positive predictive value of GP73 was 84.6%, while the same parameters of AFP were 73.1% and 75%, respectively. CONCLUSION: Serum Golgi protein 73 could be a valuable biomarker and a useful diagnostic tool for the early diagnosis of HCC in cases of hepatitis C virus-related cirrhosis.

A Neighboring Aromatic-Aromatic Amino Acid Combination Governs Activity Divergence between Tomato Phytoene Synthases.

Carotenoids exert multifaceted roles to plants and are critically important to humans. Phytoene synthase (PSY) is a major rate-limiting enzyme in the carotenoid biosynthetic pathway. PSY in plants is normally found as a small enzyme family with up to three members. However, knowledge of PSY isoforms in relation to their respective enzyme activities and amino acid residues that are important for PSY activity is limited. In this study, we focused on two tomato (Solanum lycopersicum) PSY isoforms, PSY1 and PSY2, and investigated their abilities to catalyze carotenogenesis via heterologous expression in transgenic Arabidopsis (Arabidopsis thaliana) and bacterial systems. We found that the fruit-specific PSY1 was less effective in promoting carotenoid biosynthesis than the green tissue-specific PSY2. Examination of the PSY proteins by site-directed mutagenesis analysis and three-dimensional structure modeling revealed two key amino acid residues responsible for this activity difference and identified a neighboring aromatic-aromatic combination in one of the PSY core structures as being crucial for high PSY activity. Remarkably, this neighboring aromatic-aromatic combination is evolutionarily conserved among land plant PSYs except PSY1 of tomato and potato (Solanum tuberosum). Strong transcription of tomato PSY1 likely evolved as compensation for its weak enzyme activity to allow for the massive carotenoid biosynthesis in ripe fruit. This study provides insights into the functional divergence of PSY isoforms and highlights the potential to rationally design PSY for the effective development of carotenoid-enriched crops.

Repercussions of the COVID-19 pandemic on the well-being and training of medical clerks: a pan-Canadian survey.

BACKGROUND: The COVID-19 pandemic has been an unprecedented and potentially stressful event that inserted itself into the 2019-2020 Canadian medical curriculum. However, its impact on stress and subsequent professional pathways is not well understood. This study aims to assess the impact of the COVID-19 pandemic on the mental well-being, training, and career choices of Canadian medical clerks within the first three months of the pandemic. It also aims to assess their use of university support systems and their appreciation of potential solutions to common academic stressors. METHODS: An electronic survey composed of four sections: demographics, stressors experienced during the pandemic, World Health Organization (WHO) well-being index, and stress management and resources was distributed to Canadian clerks. RESULTS: Clerks from 10 of the 17 Canadian medical faculties participated in this study (n = 627). Forty-five percent of clerks reported higher levels of stress than usual; 22% reconsidered their residency choice; and 19% reconsidered medicine as a career. The factors that were most stressful among clerks were: the means of return to rotations; decreased opportunities to be productive in view of residency match; and taking the national licensing exam after the beginning of residency. The mean WHO well-being index was 14.8/25 ± 4.5, indicating a poor level of well-being among a considerable proportion of students. Clerks who reconsidered their residency choice or medicine as a career had lower mean WHO well-being indices. Most clerks agreed with the following suggested solutions: training sessions on the clinical management of COVID-19 cases; being allowed to submit fewer reference letters when applying to residency; and having protected time to study for their licensing exam during residency. Overall, clerks were less concerned with being infected during their rotations than with the impact of the pandemic on their future career and residency match. CONCLUSION: The COVID-19 pandemic had a considerable impact on the medical curriculum and well-being of clerks. A number of student-identified solutions were proposed to reduce stress. The implementation of these solutions throughout the Canadian medical training system should be considered.

Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT.

PURPOSE: To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD). METHODS: In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour]. RESULTS: All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05). CONCLUSION: Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.

Awareness and Attitude of University Students About Screening and Testing for Hemoglobinopathies: Case Study of the Aseer Region, Saudi Arabia.

Hemoglobinopathies can disturb a patient's life style leading to community problems. Premarital screening is an important tool to control and minimize hemoglobinopathies. This study aimed to assess and improve the awareness and attitude of King Khalid University (KKU) [Abha, Kingdom of Saudi Arabia (KSA)] students in the Aseer Region, regarding hemoglobinopathies and the National Premarital Screening Programme (NPMS) in addition to screening for hemoglobin (Hb) variants of students who agreed to participate. This study was an interventional educational prospective study of electronic-lectures (e-lectures) that addressed some important issues of hemoglobinopathies and premarital screening. Six hundred and eleven students were interviewed during the academic year 2017/2018, using closed-ended questionnaires that distributed before and after intervention. Blood samples were taken from 114 students who agreed to check their Hb type by the D-10 Hemoglobin Testing System. The results revealed significant changes in knowledge and attitude of students toward hemoglobinopathies and premarital counseling after intervention. These results reflected the need for easily accessible and continuous health education programs for students to increase their awareness and attitude toward hemoglobinopathies. Laboratory results for 114 students revealed seven cases with microcytic hypochromic anemia (6.1%); they were all females. Blood screening for Hb variants revealed another two females (1.75%) with sickle cell trait (Hb AS). Electronic-health (E-health) is an efficient tool for improving the awareness and attitude of the community toward hemoglobinopathies. Screening blood tests for detection of hemoglobinopathies should be provided to young adults at an earlier stage (before marriage) to decrease the incidence of hereditary diseases in the community.

Lower limb coronal malalignment correction by percutaneous osteotomy and schanz screws fixation.

Pediatric knee deformities are common, and the classic treatment is corrective osteotomy. The aim of this study to assess the safety and efficacy of percutaneous low-energy osteotomy and casting with shanz screws fixation in treatment of Genu varum in children equal or younger than 7 years. This is a prospective nonrandomized case series study was conducted. A total of 38 patients (total of 60 limbs: 36 varus and 24 valgus) were treated by percutaneous low-energy osteotomy and casting with shanz screws fixation and observed over 2-5 years. Clinical and radiological outcomes were evaluated at the end of follow-up period by standing scanogram which enabled tibiofemoral angles and the mechanical axis to be measured and the rate of complications. There was a statistically significant improvement of the radiographic parameters in the form of tibiofemoral angle and MAD. Clinically, all the cases were completely corrected just one patient (two limbs) complicated by over-correction but statically non-significant and. pin tract infection in shanz screws fixation was noticed in one Patient. Percutaneous low-energy osteotomy and casting with shanz screws fixation is a simple, safe, and effective method in dealing with 7 years and younger children with pathological knee deformities. Level of evidence: Therapeutic level IV.

Influence of fullerene content on the properties of polyurethane resins: A study of rheology and thermal characteristics.

The effect of different contents of fullerene on the properties of polyurethane resins (PUs), including rheology and thermal properties, was investigated. Polyurethane resins were prepared through polyaddition reactions using different isocyanate monomers such as isophorone diisocyanate (IPDI), methylene diphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), and different polyols, such as poly(oxytetramethylene) glycol (PTMG), the triol trade name FA-703, and polypropylene glycols (PPG), at an NCO/OH ratio 0.94 and a temperature of 100 °C. IR spectroscopy was used to control the polymerization of PUs through the shifting of NCO peaks. The results showed that the rheology and thermal properties of the prepared PU resins depend on the type of isocyanates and fullerene used. Based on the type of isocyanates, the PU resin prepared by MDI has the highest viscosity and thermal stability compared to the other isocyanates investigated. On the other hand, the PU resins prepared by IPDI mixed with fullerene had the highest viscosity and thermal stability. However, the initial decomposition temperature (T onset) of the PUs decreased with the addition of fullerene without affecting the maximum decomposition temperature (PDT max) of the PU resin.

The effect of epidural steroid injection during surgery on surgical site infections following lumbar fusion.

Background: Intraoperative epidural steroid injections (ESIs) have been suggested to limit pain following lumbar fusions. However, the frequency of resultant surgical site infections has not been fully investigated. Methods: We retrospectively followed two groups of patients; 23 patients were the control group, while the other 23 patients received, in addition to the spinal fusions, intraoperative ESI. Results: Patients in the latter ESI/fusion treatment group had significantly increased rates of superficial and deep infections (i.e., superficial infections 17.4% and 4.3% deep infections) versus control patients (i.e., 8.6% superficial and 0% deep) undergoing fusions alone. Conclusion: We observed an increased risk of postoperative surgical site infections among patients who underwent intraoperative ESI in addition to their lumbar fusions.

Mini-laparotomy in-situ pyeloplasty for repair of the ureteropelvic junction obstruction: Outcome of 150 cases.

OBJECTIVE: To evaluate the functional and cosmetic outcomes of using the mini-laparotomy technique In Situ pyeloplasty to repair UPJ obstruction in young infants less than 6 months. MATERIALS AND METHODS: Between January 2014 and March 2020, 150 young infants (less than 6 months) diagnosed with unilateral ureteropelvic junction obstruction (UPJO) and treated by mini-laparotomy In Situ pyeloplasty were included in this analysis. Once the UPJ has been identified, it was grasped by an Allis forceps for gentle traction. Two facing transverse incisions were made in the dilated pelvis facing the upper ureter. The transverse ureteric incision was then opened longitudinally. An anastomosis was done between the most dependent part of the lower lip of the pelvis and the apex of ureteric spatulation using 6/0 polyglactin (Vicryl®) sutures in the direction of "out-in-in-out." Follow-up was scheduled for 1 month and then every 3 months for a year with abdominal ultrasonography. DTPA was done for all patients 1 year after repair. RESULTS: The mean age was 3 ± 0.5 months, and the mean follow-up was 1.5 ± 0.3 years. Our technique was done in all included patients with a functional success of 96% (all patients restored normal function, and no obstruction was reported). Parents were satisfied with the cosmetic appearance of the wound in 91% of cases. Major complications occurred in 4% of cases. CONCLUSION: Successful repair of ureteropelvic junction obstruction in young infants can be achieved by using mini-laparotomy In Situ pyeloplasty technique with satisfactory functional and cosmetic outcomes.

Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease.

BACKGROUND: The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait. AIM: To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease. METHODS: From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness. RESULTS: The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05. CONCLUSION: Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

Risk factors and prognosis of pediatric rhegmatogenous retinal detachment in Egypt: a university hospital based study.

AIM: To study and compare the predisposing factors and clinical features of pediatric, adult, and elderly rhegmatogenous retinal detachment (RRD). METHODS: This is an observational analytic cross-sectional study in which patients with RRD admitted for surgery during 6mo period were divided into 3 age groups: pediatric (<18y), adult (18-60y), and elderly (>60y). Patients' demographic data, clinical features, RRD predisposing factors/features including myopia (axial length ≥26.5 mm), aphakia/pseudophakia, blunt trauma, peripheral retinal degenerations, history of RRD in the fellow eye, and surgical interventions/findings were recorded and analyzed. RESULTS: Totally 142 patients (142 eyes) were studied: 26 (18.31%) pediatrics, 86 (60.56%) adults, and 30 (21.13%) elderly. Elderly patients had a significantly higher intraocular pressures and cataracts compared to the other 2 groups (P=0.04). The RRD extent was larger in pediatric group (mostly 4 quadrants) compared to adults and elderly (mostly 2 quadrants), but it was not statistically insignificant (P=0.242). There were not statistically significantly differences in proliferative vitreoretinopathy (PVR) rate, posterior vitreous detachment (PVD) rate, number, site, shape, and size of breaks in three groups. All three groups had macular detachment in all eyes. Myopia and peripheral retinal degenerations were found to be more significant in adults (P=0.049, P=0.035, respectively), while blunt trauma was higher but insignificant in pediatric eyes (P=0.052). Pars plana vitrectomy (PPV) with silicone oil as a tamponade was the most used surgery in all groups. CONCLUSION: There are no significant difference in PVR rate in pediatric eyes but a significant higher rate of total RRD. Blunt trauma is more frequent in pediatrics eyes while myopia and/or peripheral retinal degenerations are more frequent in older ages. The rate of PPV as a choice for surgery is similar among all age groups.

Colibacillosis in lambs and kids in Egypt: Prevalence, serogroups, antibiogram profile, virulence genes distribution and antimicrobial resistance genes.

Background: Small ruminants have a socioeconomic impact on Egypt's production of meat, milk, and wool. Hence, every effort should be taken to prevent infections. Aim: To elucidate the prevalence and serogrouping of Escherichia coli (E. coli) strains from diarrheic lambs and kids, determine their antibiotic susceptibility and associated risk factors affecting the occurrence of the disease, and establish the most common virulence genes marker and major antimicrobial resistance genes. Methods: A total of 150 diarrheic animals (95 lambs and 55 kids) at different ages and seasons were subjected to clinical examination. Rectal swabs were collected from 150 diarrheic animals for isolation and biochemical identification of E. coli. Results: The bacteriological examination revealed that 62/95 lambs and 26/55 kids with percentages of 65% and 47%, respectively, showed infection with E. coli. Serotyping of 88 isolates of E. coli revealed the strains belonging to O2(8), O55(17), O84(5), O17(4), O6(8), O91(17), O26(9), O103(5), O126(5), O124(6), and O159(4). A total of 21 isolates were examined by multiplex polymerase chain reaction assay for detection of virulence and resistance genes. All examined isolates possessed a combination between intimin gene and heat-stable toxin (100%), the serine protease (pic) gene on 8/21 isolates of O55, O2, O6 (38%), and α-hemolysin gene on 8/21 isolates of O26, O91(38%) while adherent invasive gene (invA) gene on 3/21 isolates of O124, O159 (14%) which divided diarrheagenic E. coli into four types assigned to be atypical enteropathogenic E. coli (48%), atypical enterohemorrhagic E. coli 35%), atypical enterotoxigenic E. coli (6%), and atypical enteroinvasive E. coli (11%). On the other hand, the results of antimicrobial susceptibility testing revealed high resistance to ampicillin, erythromycin, and tetracycline (100%) and amoxicillin/clavulanic acid (92%) but were highly sensitive to gentamicin, imipenem, norfloxacin, ciprofloxacin, chloramphenicol, and amikacin (100%). Concerning to ß lactams antibiotic resistance genes of examined isolates had blaSHV (100%) and blaCTX-M (43%). For tetracycline, we detected the tetA in all examined isolates. Conclusion: The wide spread of atypical E. coli strains among diarrheic lambs and kids with marked resistance to several antibiotics of interest and the detection of major resistance genes assess the potential risk of this pathogen to animal and public health.