Symphyseal plate with trans-symphyseal cross-screws for fixation of tile-type B1 pelvic ring injuries: radiological and functional evaluation.

INTRODUCTION: Failure to neutralize the different physiological forces acting on the inferior as well as the superior regions of the pubic symphysis, the long healing time, is blamed for the repeated failures of conventional superior symphyseal plating. MATERIAL AND METHODS: A three years prospective case series study between January 2017 and December 2019 was done, to evaluate the radiological and the functional outcomes, using Matta/Tornetta and Majeed criteria respectively, of the combination of trans-symphyseal cross-screws configuration and superior symphyseal plate in Tile-type B1 pelvic injuries. RESULTS: Thirty patients, 18 with anteroposterior compression type II and 12 with type III, with a mean follow-up of 20 months ±5 were included. Radiologically, 26 (86.6%) cases showed an excellent, one (3.3%) good and three (10%) fair outcome. Clinically, excellent outcome in 26 (86.6%) cases, good in two (6.6%) cases, and fair in two (6.6%). Intra-operative drill bit breakage occurred in three (10%) cases and was the only reported technical complication. Significant re-displacement was reported in three (10%) cases. CONCLUSION: The open trans-symphyseal cross-screws for fixation of the superior symphyseal plate is a simple, efficient, and safe technique with the biomechanical advantages of an extra-fixation point to the inferior symphysis together with a long and a strong bony anchorage.

Evaluation of Cs-137 and natural radionuclides on different marine biota (crustacean and fishes) along Beheira governorate Coast-Egypt: RESRAD biota.

PURPOSE: This work will focused on the environmental and radio-ecological impacts occurred on an Egyptian coastal region, based on the radiochemical measurement of 238U, 137Cs, 232Th, 40K. The novelty of the study was cleared by the using of new technique showing the integration of two biological RESRAD models, lead to a probabilistic estimation of the radionuclides bioaccumulation in different consumed marine organisms and determination the probability of human cancer risk at different ages. MATERIAL AND METHODS: The 20 water samples were collected and mounted into clean containers, and their decay products, were measured in Bq.L-1, using different quality assurance tools. The study will used different statistical analysis and different RESRAD modeling codes were used in the study to predict the degree of environmental and radio-ecological impacts at the studied area, this will be helpful in order to define the impacts resulted from the transferring and accumulation of different radionuclides. RESULTS: showed that the highest human dose conversion factor values of (5, 10, 15, with adult ages) were measured in Th-232 (mrem/pCi) while the lowest ingestion conversion factors values were observed in artificial 137Cs. On the other hand the highest values of external risk factor in case of (5, 10, 15 with adult age) were observed in artificial Cs-137(mrem/pCi), while the lowest value of external risk factor with the same ages were observed in U-238. This will lead to continual monitoring of artificial Cs-137 in different marine coastal regions. The arrangement of the bioaccumulation value (BIV) in Bq.kg-1 which being calculated by using RESRAD-Biota in case of crustacean animals will be as follow: U-238 > Th-232 > Cs-137, while the arrangement of BIV in case of fish animals will be: Cs-137 > U-232 > Th-232. On the other hand the arrangement of Internal Dose Conversion factors in case of crustacean animals will be: U-238 > Th-232 > Cs-137. While the arrangement of Internal Dose Conversion factors in case of fish animals will be: Cs-137> Th-232 > U-238. CONCLUSION: RESRAD code's results showed that the arrangement of the bioaccumulation and Dose Conversion factors were depend on the type of marine living organism. RESRAD code also showed that there are increments of the calculated external risk factor values which resulted from the adult than all the infants (5,10 and 15 ages) ages this may be related to the continuous replacement of new human's body cells during the growth stages. The study results showed that, environmental bioaccumulation impacts of the artificial Cs-137 were very effective in both marine living organisms and human as this will support the relation between the ingestion Cs-137 in the body(inside the soft tissues), and the probability of the human cancer risk. On the other hand, study results showed the importance of using RESRAD BIOA code for the EIA's ecological and radiological studies which should be done for any future industrial coastal .projects.

Validity of Airway Ultrasound in Correlation with Cormack-Lehane Grading in Obese Patients: A Cross-Sectional Study.

Background: Ultrasound (US) of the upper airway has the potential to be a valuable addition to traditional clinical evaluation methods. Objectives: This work aimed to assess the validity of US in correlation with Cormack-Lehane grading (CLG) in obese patients. Methods: This cross-sectional work was performed on 78 patients ranging in age between 21 and 60 years, both genders with the American Society of Anesthesiologists (ASA) II-III individuals and body mass index (BMI) 30 kg/m² or more, under general anesthesia with endotracheal tube placement. Each separate finding by the US and conventional clinical airway assessment methods before anesthesia induction correlated to the CLG of the same patient after the induction of anesthesia. Grades III and IV are categorized as difficult laryngoscopy. Results: A significant positive association existed among CLG and duration of US measures, pre-epiglottis spaces (Pre-E) ratios, to the distance between a point mid away vocal cords and epiglottis, Pre-E, ratio of hyomental distance extension/hyomental distance neutral and Mallampati; however, there was a significant negative correlation with skin to anterior commissure, hyomental distance extension, hyomental distance neutral, sternomental distance, and thyromental distance (P < 0.05). The ratio between Pre-E over the distance between the epiglottis and a point midway through the vocal cords at cut-off > 2.23 can discriminate difficult laryngoscopy with sensitivity 100% and specificity 100% and area under the curve of 1. Conclusions: The sonographic assessment of the upper airway aids in predicting individuals who might have challenges with airway management. A reliable indicator of a challenging laryngoscopy was the sonographic parameter ratio of Pre-E to the distance between the vocal cords' midway point and the epiglottis.

Effects of magnesium taurate on the onset and progression of galactose-induced experimental cataract: in vivo and in vitro evaluation.

Cataract, a leading cause of blindness, is characterized by lenticular opacities resulting from denaturation of lens proteins due to activation of calcium-dependent enzyme, calpain. Magnesium (Mg(2+)) plays an important role not only in maintaining a low lenticular calcium (Ca(2+)) and sodium concentration but also in preserving the lens redox status. Taurine has also been shown to reduce lenticular oxidative stress. Present study evaluated the anticataract effects of magnesium taurate in vivo and in vitro. Among the five groups of 9 Sprague Dawley rats each, two groups received 30% galactose diet with topical (GDMT) or oral treatment (GDMO) with magnesium taurate. Two groups received 30% galactose diet with topical (GDT) or oral vehicle (GDO). Remaining 1 group received normal diet (ND). Weekly slit lamp examination was done during 21 days experimental period and then all rats were sacrificed; Ca/Mg ratio and antioxidant parameters including reduced glutathione (GSH), catalase and superoxide dismutase (SOD) activities were measured in the isolated lenses using ELISA. In the in vitro study, 2 groups of 10 normal rat lenses were incubated in Dulbecco's Modified Eagle's Medium (DMEM) with galactose while 1 similar group was incubated in DMEM without galactose. In one of the groups, galactose containing medium was supplemented with magnesium taurate. After 48 h of incubation, lenses were photographed and Ca(2+)/Mg(2+) ratio and antioxidant parameters were measured as for in vivo study. The in vivo study, at the end of experimental period, demonstrated delay in the development of cataract with a mean opacity index of 0.53 ± 0.04 and 0.51 ± 0.03 in GDMO (p < 0.05 versus GDO) and GDMT (p < 0.01 versus GDT) respectively. Histopathological grading showed a lower mean value in treated groups, however, the differences from corresponding controls were not significant. Lenticular Ca(2+)/Mg(2+) ratio with a mean value of 1.20 ± 0.26 and 1.05 ± 0.26 in GDMO and GDMT was significantly lower than corresponding controls (p < 0.05) and in GDMT no significant difference was observed from ND. Lenticular GSH and catalase activities were significantly lower and SOD activity was significantly higher in all galactose fed groups. However, in GDMT, GSH and catalase were significantly higher than corresponding control with mean values of 0.96 ± 0.30 µmol/gm lens weight and 56.98 ± 9.86 µmol/g lens protein respectively (p < 0.05 for GSH and p < 0.01 for catalase). SOD activity with mean values of 13.05 ± 6.35 and 13.27 ± 7.61 units/mg lens protein in GDMO and GDMT respectively was significantly lower compared to corresponding controls (p < 0.05) signifying lesser upregulation of SOD due to lesser oxidative stress in treated groups. In the in vitro study, lenses incubated in magnesium taurate containing medium showed less opacity and a lower mean Ca(2+)/Mg(2+) ratio of 1.64 ± 0.03, which was not significantly different from lenses incubated in DMEM without galactose. Lens GSH and catalase activities were restored to normal in lenses incubated in magnesium taurate containing medium. Both in vivo and in vitro studies demonstrated that treatment with magnesium taurate delays the onset and progression of cataract in galactose fed rats by restoring the lens Ca(2+)/Mg(2+) ratio and lens redox status.

Bioaccumulation of natural radio-nuclides in aquatic, riparian and terrestrial animals along Suez-Azzafrana coastline, Egypt: insights from RESRAD-BIOTA.

PURPOSE: The protection of endogenous species is one of the important ecological issues in which all the World Environmental Agreements are searching for. The purpose of the study is to calculate the bioaccumulation impacts of some natural radio-nuclides as: Ra-226, K-40 and Th-232 in the selected Egyptian Endogenous Aquatic Red Sea Fusileer fish, Red sea Riparian Turtle and the Red sea Terrestrial Lizard by using RESAD BIOTA version 1.8. MATERIAL AND METHODS: Ten water and sediments samples were collected from different 10 sites, along the inshore of the Egyptian Suez bay beach till El-Zafarna coastal region, as these samples were taken from subsurface (20 cm-1 m). The radioactivity concentrations of some natural radioactivity radionuclides as; 226Ra, 232Th and 40K, which were measured, using gamma-ray spectrometer based on high-purity germanium (HPGe) detector of 40% relative efficiency. RESULTS: The results of the study showed that the radioactivity of some selected natural radionuclides in the selected 10 sites of Suez costal samples were arranged as: K-40 > Th-232 > Ra-226, as this was related to the characteristics of soil and rock precipitation in this zone besides the industrial activates along the selected coastal line zone of Suez bay till Al-Zafrana. On the other hand, it was observed that all the calculated Biota contamination Guide (BCG) values of the selected Egyptian endangerous species (Aquatic, Riparian and terrestrial) animals in the 10 selected sites samples were below the recommended (BCG), as the result, no radioactivity increment being detected at these selected sites. On the other hand, the BCG values of Ra-226 in both water and sediment samples for the selected Egyptian endangerous Aquatic Sea Fusileer Fish were higher than the recommended BCG values in water, while were comply with BGC values of the sediment, while in case of Egyptian endangerous Red Sea Turtle's BCG values were comply with the recommended BCGs in water while were higher than the recommended BCGs values of sediment. In case of the selected Egyptian endangerous terrestrial Lizard its BCG values of Ra-226 were higher than the recommended BCGs in both water and sediment media. While in case of Th-232 it was observed that the BCG values of selected endangerous Red Sea Fusileer Fish were higher than the recommended BCGs in both water and sediment and also the BCG values of selected endangerous Riparian Turtle were also higher than the recommended BCGs of both water and sediment, these results may increase the suitability of the selected Egyptian endangerous Marine, Riparian and Terrestrial species to the different radiological risks. The results showed also the decrement of the radioactivity values of the measured radionuclides in the internal tissue of the Egyptian selected endangerous Red Sea Lizard (Uromastyx aegyptia) than both the selected endangerous Red Sea Turtle and Red Sea Fish species, support the reptiles, which are cold blood animals, and is less affected by gamma radiation than other terrestrial animals.

The Incidence of Sudden Sensorineural Hearing Loss (SSNHL) in COVID-19 Patients in Tertiary Care Referral Units.

COVID-19 is a new pandemic infectious disease that emerged in Wuhan, China, at the end of 2019. We aimed to evaluate the sudden sensorineural hearing loss (SSNHL) prevalence after COVID-19 infection or even vaccination. This is a two-center retrospective, observational cross-sectional study performed at tertiary care referral Audiovestibular Medicine Units at the period between August 1, 2020, and October 31, 2021. All SSNHL patients diagnosed in a period of a month with COVID-19 or vaccinated with a COVID-19 vaccine were included in this study. Fifty-three cases with confirmed COVID-19 and one patient vaccinated with a COVID-19 vaccine 1 week before, who reported sudden sensory neural hearing loss, were included in this study. Forty-eight patients had unilateral hearing loss and 6 patients had bilateral hearing loss. Forty-nine patients had typical COVID-19 symptoms; one patient discovered them after complaining of anosmia and ageusia and one patient after COVID-19 vaccination; and three patients were complaining only from hearing loss and had a PCR test for nasopharyngeal swabs to prove infection. Different degrees of SSNHL ranged from mild to severe and most of the patients had severe hearing loss. With more patients, COVID-19 may be a potential factor in sudden sensorineural hearing loss. It should be kept in mind that SSNHL may be the only indicator used to identify COVID-19 cases.

Prognostic Significance of the Dynamic Change of Programmed Death-ligand 1 Expression in Patients with Multiple Myeloma.

Background The inhibition of programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) signaling pathway has been shown to be an effective targeted therapy in fighting both solid organ cancers and hematological malignancies. PD-L1 expression also serves as a prognostic marker in various cancers. However, the expression of PD-L1 and its prognostic significance in multiple myeloma remains largely unknown. Methods Immunohistochemistry staining of PD-L1 was performed in bone marrow biopsy samples (total of 85 samples) in 32 myeloma patients receiving autologous stem cell transplant (ASCT) at various time points: before ASCT, post-ASCT, and/or at relapse after ASCT. More than 1% of myeloma cells with PD-L1 staining was considered a positive expression of PD-L1. A correlation analysis was performed between post-ASCT overall survival (OS) and the status of PD-L1 expression. Results In this pilot study, a total of 11 patients (34%) out of our cohort (32 patients) were positive for PD-L1 expression at least once during the course of the disease. A dynamic change of PD-L1 expression was noted in three patients converting from negative (before ASCT) to positive (post-ASCT) and two patients converting from positive (before ASCT) to negative (post-ASCT). Patients with positive PD-L1 expression persisting or occurring post-ASCT had shorter post-ASCT overall survival than those with negative PD-L1 expression post-ASCT (median survival: 13 vs 23 months, p<0.05). No significant differences were detected in the known prognostic factors between these two groups at the time of ASCT. Pre-transplant PD-L1 expression status, however, showed no significant impact on post-ASCT overall survival. Furthermore, a few patients switching from positive PD-L1 expression before ASCT to negative PD-L1 expression post-ASCT had a relatively good post-ASCT overall survival (n=2, overall survival of 29 and 56 months, respectively). Conclusion Immunohistochemistry can be reliably used for measuring PD-L1 expression in decalcified marrow core biopsy materials. Our results suggest that positive PD-L1 expression persisting/occurring post-ASCT could be an adverse prognostic marker for post-ASCT OS. Additionally, PD-L1 expression appears to be dynamic and is subjected to change after ASCT. Our findings suggest that periodically monitoring PD-L1 expression in patients with multiple myeloma post-ASCT is warranted. Further studies are needed to confirm our initial observation and to evaluate if timely intervention with PD-L1 blockade can improve post-ASCT outcomes in myeloma patients.