Literature review of lupus nephritis From the Arabian Gulf region.

INTRODUCTION: The severity of lupus nephritis (LN) varies between different ethnicities. However, there are limited data regarding disease severity for LN in patients from the Arabian Gulf region; moreover, there are no treatment guidelines developed specifically for this population. The objective of this review was to characterise the incidence of LN, current treatment practices, the severity of LN, and the pathophysiology and biomarkers associated with LN in the Arabian Gulf region. METHODS: A literature search using EMBASE was conducted in October, 2021 to identify publications reporting on the incidence, treatment practices, severity, pathophysiology or biomarkers associated with LN, from countries in the Arabian Gulf region (including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). Additional relevant publications were provided by collaborators. A manual review of the publications was conducted to determine their relevance and data on the outcomes of interest were extracted. RESULTS: Of 3705 publications, 54 publications were identified as relevant. LN is one of the most commonly diagnosed renal diseases within the Arabian Gulf and approximately 10%-36% of all renal biopsies are for LN. Treatment patterns within the region appear to vary and generally follow treatment guidelines recommended by the Asia Pacific League of Associations for Rheumatology (APLAR), the European Alliance of Associations for Rheumatology (EULAR) and Kidney Disease Improving Global Outcomes (KDIGO). The majority of patients receive cyclophosphamide for induction therapy, whilst others receive mycophenolate mofetil. Most studies showed that the most frequently diagnosed class of LN within the Arabian Gulf region was Class IV (up to 63% of patients with LN). Sustained or increased levels of serum creatinine and proteinuria; and depressed levels of complement C3/C4 were commonly seen among patients with LN from the Arabian Gulf region. CONCLUSIONS: This review identified that LN may manifest more severely among patients from the Arabian Gulf region than in other populations, such as Caucasian populations. A greater understanding of LN and the treatment practices within the region, as well as the development of more specific treatment guidelines for this population may help improve outcomes for patients with LN in the Arabian Gulf region.

Country data on AMR in Kuwait in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BACKGROUND: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES: To review AMR in Kuwait and initiatives underway addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Kuwait and to improve patient outcomes. METHODS: National initiatives to address AMR, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from a clinician in Kuwait were sought to contextualize this information. CONCLUSIONS: In Kuwait there have been some initiatives addressing AMR such as annual campaigns for proper use of antibiotics. Antibiotic use is high but there appears to be a low understanding in the general public about their appropriate use. However, there is legislation in place prohibiting over-the-counter purchase of antibiotics. Only international guidelines for CA-RTIs are used. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Kuwait, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical patient outcomes.

Maternal and neonatal safety outcomes after SAR-CoV-2 vaccination during pregnancy: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: More than five million individuals died because of problems connected to COVID-19. SARS-Cov-2 poses a particular challenge to expectant mothers, who comprise one of the most vulnerable segments of the population. Our aim is to demonstrate the maternal and neonatal safety of the COVID-19 vaccine during pregnancy. METHODS: We searched PubMed, Cochrane Library, Scopus, Web of Science (WOS), Embase, Ovid, MedRxiv, and BioRxiv databases from inception till December 2021 and then updated it in April 2022. Additionally, we searched ClinicalTrials.gov, Research Square and grey literature. Cohort, case-control studies, and randomized controlled trials detecting the safety of the Covid-19 vaccine during pregnancy were included. We used the Cochrane tool and Newcastle-Ottawa Scale to assess the risk of bias of the included studies and the GRADE scale to assess the quality of evidence. A meta-analysis was conducted using review manager 5.4. RESULTS: We included 13 studies with a total number of 56,428 patients. Our analysis showed no statistically significant difference in the following outcomes: miscarriage (1.56% vs 0.3%. RR 1.23; 95%CI 0.54 to 2.78); length of maternal hospitalization (MD 0.00; 95%CI -0.08 to 0.08); puerperal fever (1.71% vs 1.1%. RR 1.04; 95%CI 0.67 to 1.61); postpartum hemorrhage (4.27% vs 3.52%. RR 0.84; 95%CI 0.65 to 1.09); instrumental or vacuum-assisted delivery (4.16% vs 4.54%. RR 0.94; 95%CI 0.57 to 1.56); incidence of Apgar score ≤ 7 at 5 min (1.47% vs 1.48%. RR 0.86; 95%CI 0.54 to 1.37); and birthweight (MD -7.14; 95%CI -34.26 to 19.99). CONCLUSION: In pregnancy, the current meta-analysis shows no effect of SAR-CoV-2 vaccination on the risk of miscarriage, length of stay in the hospital, puerperal fever, postpartum hemorrhage, birth weight, or the incidence of an Apgar score of ≤ 7 at 5 min.

Characterizing the Mitochondrial Diversity of Arbi Goats from Tunisia.

Arbi is one of the main local goat breeds in Tunisia, representing an important economic resource in arid and hot areas where cattle and sheep cannot thrive successfully. In the current work, we have characterized the mitochondrial diversity of 26 Arbi goats by partially sequencing the mitochondrial D-loop region. These sequences plus 10 retrieved from GenBank were analyzed with the DnaSP v.5.10.1, evidencing the existence of 12 different haplotypes. Nucleotide and haplotype diversities were 0.02 and 0.96. Moreover, median-joining network analysis showed that all D-loop sequences from Arbi goats correspond to haplogroup A and that in general they do not cluster with sequences from other goat breeds. The high diversity that has been observed in North African goats is compatible with the maritime diffusion of the Neolithic package 10,000-7000 YBP. Moreover, there are evidences that local Tunisian breeds have been extensively crossed with highly productive transboundary breeds in order to improve meat and milk yields. These uncontrolled crossing practices may lead to the loss of alleles that play key roles in the adaptation of Tunisian local breeds to a harsh environment.

Variation of Chemical Composition in Flowers and Leaves Essential Oils Among Natural Population of Tunisian Glebionis coronaria (L.) Tzvelev (Asteraceae).

The aim of this study was to assess the percentage and constituents variations in flowers and leaves essential oil of three Glebionis coronaria (L.) Tzvelev population, growing wildly in three different ecotypes (Utique, M'saken, and Sahara Lektar) in Tunisia. The chemical compositions of these essential oils were analyzed by the GC and GC/MS systems. Qualitative and quantitative differences were recorded between essential oils extracted from plants collected from the three geographical provinces and between organs of the same plant (leaves and flowers). In fact, 161 components representing 87.2 - 96.5% of the whole oils were identified. Myrcene (3.2 - 35.7%), (Z)-ß-ocimene (0.6 - 23.0%), camphor (0.6 - 17.2%), cis-chrysanthenol (0 - 6.9%), cis-chrysanthenyl acetate (1.1 - 17.9%), isobornyl acetate (1.6 - 3.5%), (E)-ß-farnesene (0 - 6.0%), germacrene D (0 - 8.7%), and (E,E)-α-farnesene (0.7 - 12.4%) were the predominant components in the oils. These major constituents occur in different amounts depending on the organs (leaves or flowers) and the geographical origin of the plant. The chemotaxonomic usefulness of these data was discussed according to results of principal component analysis (PCA). The scores, together with the loadings, revealed a different chemical pattern for each population.

Prognostic value of preoperative diffusion restriction in glioblastoma.

INTRODUCTION: Although glioblastoma (GBM) has a very poor prognosis, overall survival (OS) in treated patients shows great difference varying from few days to several months. Identifying factors explaining this difference would improve management of patient treatment. AIM: To determine the relevance of diffusion restriction in newly diagnosed treatment-naïve GBM patients. METHODS: Preoperative magnetic resonance scans of 33 patients with GBM were reviewed. Regions of interest including all the T2 hyperintense lesion were drawn on diffusion weighted B0 images and transferred to the apparent diffusion coefficient (ADC) map. For each patient, a histogram displaying the ADC values within in the regions of interest was generated. Volumetric parameters including tumor regions with restricted diffusion, parameters derived from histogram and mean ADC value of the tumor were calculated. Their relationship with OS was analyzed. RESULTS: Patients with mean ADC value < 1415x10-6 mm2/s had a significantly shorter OS (p=0.021). Among volumetric parameters, the percentage of volume within T2 lesion with a normalized ADC value <1.5 times that in white matter was significantly associated with OS (p=0.0045). Patients with a percentage>23.92% had a shorter OS. Among parameters derived from histogram, the 50th percentile showed a trend towards significance for OS (p=0.055) with patients living longer when having higher values of 50th percentile. A difference in OS was observed between patients according to ADC peak of histogram but this difference did not reach statistical significance (p=0.0959). CONCLUSION: Diffusion magnetic resonance imaging may provide useful information for predicting GBM prognosis.

Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results.

BACKGROUND: Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. METHODS: To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. RESULTS: On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. CONCLUSIONS: The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.

Biochemical and histological effects of gibberellic acid on Locusta migratoria migratoria fifth instar larvae.

Experiments were conducted to assess the effect of gibberellic acid (GA3), a plant growth regulator, on Locusta migratoria migratoria fifth instar larvae. Newly emerged larvae were exposed to various concentrations of GA3 administered by topical application or by forced ingestion. Results showed that treated insects exhibited toxic symptoms with a dose-dependent mortality. GA3 toxicity was also demonstrated by perturbation of the moult processes. In fact, we noted that treated insects present exuviations difficulties due to the impossibility to reject the old integuments causing mortality in the 5th instar larvae. Histological study of proventriculus revealed alterations in the epithelial cells and absence of apolysis phenomenon. Data also showed that GA3 induced significant quantitative variation of haemolymph metabolites. These changes result in a significant decrease in the total concentration of proteins and carbohydrates and an increase in the total concentration of haemolymph lipids.

Budget Impact Analysis of Single-Inhaler Fluticasone Furoate/Umeclidinium/Vilanterol in Patients with Asthma in the Dubai Academic Healthcare Corporation.

Purpose: Asthma is a common, chronic respiratory disorder associated with substantial societal and economic burden globally, despite the availability of different treatment modalities. GSK has developed a once-daily single-inhaler triple therapy (SITT), comprised of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI); a combination of inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting ß2-agonist for patients with uncontrolled asthma. A budget impact analysis was conducted to determine the financial impact of introducing FF/UMEC/VI SITT from the perspective of the Dubai Academic Healthcare Corporation (DAHC). Methods: A budget impact model was constructed using an epidemiology-based approach and used to estimate the expected 5-year budget impact of including FF/UMEC/VI for the treatment of eligible patients within the DAHC in the United Arab Emirates (UAE). The model included both pharmacy and efficacy-related costs. The perspective of the DAHC healthcare payer was adopted, thus only direct payer costs were included in the analysis. A one-way sensitivity analysis was conducted to test the robustness of the model structure, assumptions, and input parameters. Results: The total budget impact was estimated to save 1 million United States Dollars (USD) over 5 years, with budget impacts of 0.08 million USD in Year 1; 0.14 million USD in Year 2; 0.22 million USD in Year 3; 0.28 million USD in Year 4; and 0.33 million USD in Year 5. The overall budget impact per patient was estimated to save 12.2 USD over 5 years. In one-way sensitivity analyses, the budget impact was most sensitive to changes in the market uptake of FF/UMEC/VI. Conclusion: Healthcare payers may consider FF/UMEC/VI in the management of uncontrolled asthma which would save costs and reduce healthcare resource use in the UAE.

Assessment of Genetic and Health Management of Tunisian Holstein Dairy Herds with a Focus on Longevity.

In Tunisia, the recognition of the possibility of including longevity and disease resistance in dairy cattle selection objectives has been hypothesized as a useful strategy by both researchers and producers. However, in this paper, the state of the art, with a focus on health and longevity, is reviewed. Along the same lines, the heritability for the milk traits, fertility traits, and longevity of Tunisian Holstein dairy cows complies with the literature. Therefore, the influence of genetics on some diseases of the dairy cow was investigated. In addition, a decreasing efficiency in cow fertility has been observed over the last few years. The results showed that the risk of culling increased with common diseases. When analyzed with the Weibull model, functional lifespan was strongly influenced by milk yield; therefore, the risk increased with a reduced milk yield. In her first three lactations, the relative risk of selection increased gradually with lactation. Thus, the risk of thinning is highest at the beginning and end of the first feeding and the end of her second feeding. In conclusion, the risk of culling was reduced in parity. The factors that influence the life of the herd, such as health, husbandry, environmental conditions, and management, are often ignored when evaluating longevity.

Recent progress in high-performance environmental impacts of the removal of radionuclides from wastewater based on metal-organic frameworks: a review.

The nuclear industry is rapidly developing and the effective management of nuclear waste and monitoring the nuclear fuel cycle are crucial. The presence of various radionuclides such as uranium (U), europium (Eu), technetium (Tc), iodine (I), thorium (Th), cesium (Cs), and strontium (Sr) in the environment is a major concern, and the development of materials with high adsorption capacity and selectivity is essential for their effective removal. Metal-organic frameworks (MOFs) have recently emerged as promising materials for removing radioactive elements from water resources due to their unique properties such as tunable pore size, high surface area, and chemical structure. This review provides an extensive analysis of the potential of MOFs as adsorbents for purifying various radionuclides rather than using different techniques such as precipitation, filtration, ion exchange, electrolysis, solvent extraction, and flotation. This review discusses various MOF fabrication methods, focusing on minimizing environmental impacts when using organic solvents and solvent-free methods, and covers the mechanism of MOF adsorption towards radionuclides, including macroscopic and microscopic views. It also examines the effectiveness of MOFs in removing radionuclides from wastewater, their behavior on exposure to high radiation, and their renewability and reusability. We conclude by emphasizing the need for further research to optimize the performance of MOFs and expand their use in real-world applications. Overall, this review provides valuable insights into the potential of MOFs as efficient and durable materials for removing radioactive elements from water resources, addressing a critical issue in the nuclear industry.

A comprehensive study for the potential removal of 152+154Eu radionuclides using a promising modified strontium-based MOF.

A facile modification of a strontium-based MOF using oxalic acid was carried out to prepare MTSr-OX MOF, which was used as a potential substance for eliminating 152+154Eu radioisotopes. Various analytical techniques were used to characterize MTSr-OX-MOF. The prepared MOF had a rod-like structure with a BET surface area of 101.55 m2 g-1. Batch sorption experiments were used to investigate the sorption performance of MTSr-OX-MOF towards 152+154Eu radionuclides where different parameters like pH, contact time, initial 152+154Eu concentration, ionic strength, and temperature were scrutinized to determine the optimum conditions for 152+154Eu removal. MTSr-OX-MOF showed superior effectiveness in the elimination of 152+154Eu with a maximum sorption capacity of 234.72 mg g-1 at pH 3.5. Kinetics fitted with the pseudo-second-order model and the Langmuir model correctly described the sorption mechanism. The thermodynamic variables were carefully examined, demonstrating that the 152+154Eu sorption was endothermic as well as spontaneous. The MTSr-OX-MOF has been found to be a significantly more effective sorbent towards 152+154Eu than that of many other adsorbents. When applied to real active waste, MTSr-OX-MOF demonstrated excellent removal performance for a wide range of radionuclides. As a result, the MTSr-OX-MOF can be recognized as an attractive solution for the 152+154Eu purification from active waste.

Oncoplastic versus conventional breast-conserving surgery in breast cancer: a pooled analysis of 6941 female patients.

BACKGROUND: Breast cancer is the most prevalent cancer in women. In the past few years, surgical interventions for breast cancer have experienced massive changes from radical excision to conserving approaches. In this study, we aim to compare the two breast surgery interventions, including conventional breast-conserving surgery (CBCS) versus oncoplastic breast-conserving surgery (OPBCS). METHODS: We searched on PubMed, Web of Science (WOS), Scopus, Embase, and Cochrane till 2 October 2021. All relevant randomized controlled trials (RCTs) and observational studies were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). RESULTS: The pooled meta-analysis of the included studies showed that OPBCS was significantly superior to CBCS in most of the outcomes. Re-excision significantly favoured CBCS (RR = 0.49, 95% CI [0.37, 0.63], P < 0.00001). However, local recurrence (RR = 0.55, 95% CI [0.27, 1.09], P = 0.09), close surgical margins (RR = 0.37, 95% CI [0.14, 1.00], P = 0.05) and end up to the risk of mastectomy (RR = 0.73, 95% CI [0.54, 97], P = 0.06) showed no significant difference between both techniques. Notably, while performing a sensitivity analysis, other outcomes as local recurrence, significantly showed favourable results towards OPBCS. In terms of safety outcomes, there was no significant difference between OPBCS and CBCS. CONCLUSION: We recommend the oncoplastic approach rather than the conventional one in females with breast cancer. Re-excision rates showed better results following OPBCS.

Case report: Severe brain hypoxic damages after acute methanol poisoning.

Methanol poisoning is a challenging clinical situation with irreversible neurologic complication mainly encountered in developed countries. We report a case of a 50-year-old patient who presented with methanol poisoning, symptomatic of respiratory and neurologic failure. In this context, cerebral magnetic resonance imaging concluded entangled injury mechanisms leading to neurologic failure.

A novel strontium-based MOF: synthesis, characterization, and promising application in removal of 152+154Eu from active waste.

Removal of hazardous radioactive materials such as 152+154Eu from active waste using the batch approach has attracted attention nowadays. In this work, a novel melamine-terephthalic strontium metal-organic framework (MTSr-MOF) was prepared via a hydrothermal method. The MTSr-MOF was characterized by various analytical techniques such as FT-IR, 1H/13C-NMR, mass spectroscopy, XPS, XRD, TGA, BET, FE-SEM/EDX, TEM, and UV. The obtained data revealed that MTSr-MOF exhibited brick-like building blocks that were bridged together by the linkers, and each block had a thickness of ∼120 nm. The BET surface area was 74.04 m2 g-1. MTSr-MOF was used for the removal of 152+154Eu radionuclides from active waste. Further functionalization using various modifiers, including oxalic acid, EDTA, sulfuric acid, and sodium hydroxide was carried out to improve the sorption efficiency of MTSr-MOF towards 152+154Eu radionuclides. Among them, MTSr-MOF modified with oxalic acid (MTSr-OX-MOF) demonstrated a superior removal efficiency toward 152+154Eu radionuclides when compared to MTSr-MOF or other published reports, with a removal efficiency of more than 96%. The higher sorption efficiency of the MTSr-OX-MOF indicates that it could be a promising candidate for the removal of 152+154Eu radionuclides from radioactive waste.

Effect of dipping and nondipping pattern of blood pressure on subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking in hypertensive patients.

OBJECTIVE: The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension. METHODS: One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively. RESULTS: Of 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (-22.45 ± 3.26 vs. -18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (-24.23 ± 3.56 vs. -19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by -3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by -2.499 (P = 0.381). CONCLUSION: The nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.

Uncertainty quantification of granular computing-neural network model for prediction of pollutant longitudinal dispersion coefficient in aquatic streams.

Discharge of pollution loads into natural water systems remains a global challenge that threatens water and food supply, as well as endangering ecosystem services. Natural rehabilitation of contaminated streams is mainly influenced by the longitudinal dispersion coefficient, or the rate of longitudinal dispersion (Dx), a key parameter with large spatiotemporal fluctuations that characterizes pollution transport. The large uncertainty in estimation of Dx in streams limits the water quality assessment in natural streams and design of water quality enhancement strategies. This study develops an artificial intelligence-based predictive model, coupling granular computing and neural network models (GrC-ANN) to provide robust estimation of Dx and its uncertainty for a range of flow-geometric conditions with high spatiotemporal variability. Uncertainty analysis of Dx estimated from the proposed GrC-ANN model was performed by alteration of the training data used to tune the model. Modified bootstrap method was employed to generate different training patterns through resampling from a global database of tracer experiments in streams with 503 datapoints. Comparison between the Dx values estimated by GrC-ANN to those determined from tracer measurements shows the appropriateness and robustness of the proposed method in determining the rate of longitudinal dispersion. The GrC-ANN model with the narrowest bandwidth of estimated uncertainty (bandwidth-factor = 0.56) that brackets the highest percentage of true Dx data (i.e., 100%) is the best model to compute Dx in streams. Considering the significant inherent uncertainty reported in the previous Dx models, the GrC-ANN model developed in this study is shown to have a robust performance for evaluating pollutant mixing (Dx) in turbulent environmental flow systems.

Acquired pial arteriovenous fistula secondary to cerebral cortical vein thrombosis: A case report and review of the literature.

Pial arteriovenous fistulas (AVFs) are rare neurovascular malformations. They differ from arteriovenous malformations (AVMs) in that they involve single or multiple feeding arteries, draining directly into a dilated cortical vein with no intervening nidus. Pial and dural AVFs differ in blood supply, as the first originate from pial or cortical arteries and the latter from outside the dural leaflets. Unlike dural AVFs, most of the pial AVFs are supratentorial. The vast majority are congenital, manifesting during infancy. Acquired pial AVFs are significantly rarer and occur after vasculopathy, head trauma, brain surgery, or cerebral vein thrombosis. We describe a unique case of an acquired pial AVF in a 50-year-old man secondary to a cortical vein thrombosis manifesting as a focal-onset seizure with secondary generalization. A cerebral digital subtraction angiography revealed a low-flow pial AVF fed by a postcentral branch of the left middle cerebral artery draining to the superior sagittal sinus via a cortical vein. It also showed a collateral venous circulation adjacent to the previously thrombosed left parietal vein. There was no evidence of an associated dural AVF or venous varix. Endovascular treatment was scheduled three months later, but the angiogram preceding the embolization showed spontaneous and complete closure of the malformation. To our knowledge, this is the first case illustrating acquired pure pial AVF unaccompanied by a dural component following cortical vein thrombosis, eventually resulting in an unprompted closure.

Coronary Artery Stent Dislodgement and Loss in the Bloodstream: A Case Report and Management Options.

BACKGROUND Coronary stent dislodgement is rare but carries serious complications like thrombosis, myocardial infarction, disruption of the systemic circulation, and coronary dissection, which can lead to sudden death. Thus, rapid evaluation and intervention are needed to restore blood flow to vital organs. CASE REPORT A 46-year-old woman with no relevant past medical history except for smoking, presented to the Emergency Department (ED) with left-sided chest pain. The physical exam was unremarkable. EKG showed ST segment elevation, and troponin was 4.03. She underwent cardiac catheterization, which showed 100% occlusion of the left anterior descending coronary artery (LAD). A drug-eluting stent (DES) was placed. Later, she had chest pain similar to the initial episode. EKG showed 1-mm elevation at ST segment in leads V1 and V2 and T wave inversion in leads V2, V3, V4, and V5. She underwent a repeat heart catheterization, which revealed a dissection in the middle LAD distal to the initial stent placement. She was treated with another stent overlapping the proximal stent. While attempting to cross the proximal stent, the stent came off the balloon, slipped from the wire, and went down into the descending aorta. CONCLUSIONS Coronary artery stent dislodgement is a rare event that can lead to significant complications during PCI. Patient restlessness and small-sized, severely angulated, and previously stented coronary arteries are associated risk factors. The main treatment option is stent retrieval, either surgically or using other available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.

Management of patients with cardiovascular diseases during Ramadan.

During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?