External validation of a paediatric Smart triage model for use in resource limited facilities.

Models for digital triage of sick children at emergency departments of hospitals in resource poor settings have been developed. However, prior to their adoption, external validation should be performed to ensure their generalizability. We externally validated a previously published nine-predictor paediatric triage model (Smart Triage) developed in Uganda using data from two hospitals in Kenya. Both discrimination and calibration were assessed, and recalibration was performed by optimizing the intercept for classifying patients into emergency, priority, or non-urgent categories based on low-risk and high-risk thresholds. A total of 2539 patients were eligible at Hospital 1 and 2464 at Hospital 2, and 5003 for both hospitals combined; admission rates were 8.9%, 4.5%, and 6.8%, respectively. The model showed good discrimination, with area under the receiver-operator curve (AUC) of 0.826, 0.784 and 0.821, respectively. The pre-calibrated model at a low-risk threshold of 8% achieved a sensitivity of 93% (95% confidence interval, (CI):89%-96%), 81% (CI:74%-88%), and 89% (CI:85%-92%), respectively, and at a high-risk threshold of 40%, the model achieved a specificity of 86% (CI:84%-87%), 96% (CI:95%-97%), and 91% (CI:90%-92%), respectively. Recalibration improved the graphical fit, but new risk thresholds were required to optimize sensitivity and specificity.The Smart Triage model showed good discrimination on external validation but required recalibration to improve the graphical fit of the calibration plot. There was no change in the order of prioritization of patients following recalibration in the respective triage categories. Recalibration required new site-specific risk thresholds that may not be needed if prioritization based on rank is all that is required. The Smart Triage model shows promise for wider application for use in triage for sick children in different settings.

Acute carotid stenting plus aspirin during thrombectomy of tandem occlusions: A matched case-control study.

BACKGROUND AND PURPOSE: Acute carotid artery stenting (CAS) for ischemic stroke patients with anterior circulation tandem occlusion requires periprocedural antiplatelet therapy to prevent stent thrombosis. However, due to the lack of randomized trials and inconsistent published results, there is no reliable information regarding the safety of additional antiplatelet treatment. Therefore, we compared the safety and functional outcomes of patients treated with acute CAS plus Aspirin during tandem occlusions thrombectomy with isolated intracranial occlusions patients treated with thrombectomy alone. METHODS: Two prospectively acquired mechanical databases from August 2017 to December 2021 were reviewed. Patients were included if they had carotid atherosclerotic tandem occlusions treated with acute CAS and Aspirin (intravenous bolus 250 mg) during thrombectomy. Any antiplatelet agent was added after thrombectomy and before the 24-h control imaging. This group was compared with a matched group of isolated intracranial occlusions treated with thrombectomy alone. RESULTS: A total of 1557 patients were included and 70 (4.5%) had an atherosclerotic tandem occlusion treated with acute CAS plus Aspirin during thrombectomy. In exact coarse matched weight adjusted analysis, the rate of symptomatic intracerebral hemorrhage was similar in both groups (OR, 3.06; 95% CI, 0.66-14.04; P = 0.150), parenchymal hematoma type 2 (OR, 1.15; 95% CI, 0.24-5.39; P = 0.856), any intracerebral hemorrhage (OR, 1.84; 95% CI, 0.75-4.53; P = 0.182), and 90-day mortality (OR, 0.79; 95% CI, 0.24-2.60; P = 0.708). Rates of early neurological improvement and 90-day modified Rankin Scale score 0-2 were comparable. CONCLUSIONS: Acute CAS plus Aspirin during thrombectomy for tandem occlusion stroke appears safe. Randomized trials are warranted to confirm these findings.

Self-reported psychological disorders among the mothers of children with autism spectrum disorder, type 1 diabetes mellitus, and typically developed children.

BACKGROUND: To assess the prevalence of symptoms of depression, anxiety, and stress among mothers of children with autism spectrum disorders (ASD), type 1 diabetes (DM), and typical development (TD), in a geographical area where such data are lacking METHOD: A descriptive study with the three groups of parents of children with and without a condition was conducted (ASD n=126, group 1; DM n=43, group 2; and TD n= 116, comparative group). Measures of depression, anxiety, and stress were collected to examine the prevalence of factors, difference between groups, and their association with demographic characteristics. RESULTS: On the DASS-21, both groups 1 and 2 had higher mean scores for depression (37.86), anxiety (4.58), and stress (29.81) than the control group (P=0.015). On the PSS-14, the mean score was higher in group 2 (28.63) than in group 1 (27.61) and the comparison group (25.87) (P=0.004). On the DASS 21, group 1 scored higher in the depression domain (P=0.046), whereas group 2 scored higher in the anxiety domain (P=0.034) and stress domain (P=0.009) than the TD group. CONCLUSION: Mothers of children with ASD should be assessed for the presence of depression following diagnosis. Mothers of children with type 1 diabetes require careful monitoring for the effects of anxiety and stress on their mental health and therefore their ability to cope with diabetes management plans. TRIAL REGISTRATION: Not applicable.

Preparation, deproteinization, characterization, and antioxidant activity of polysaccharide from Medemia argun fruit.

In this study, the crude polysaccharide from argun palm (Medemia argun) fruit was extracted with hot water and deproteinized by four different methods. Its structure characterization, thermal property and antioxidant activity were investigated by FT-IR spectroscopy, Scanning electron microscope, Congo-red, I2-KI, DPPH• assay, ABTS•+ assay, TGA and DSC analysis. It indicated that the NaCl method was the best method in deproteinization. The argun fruit polysaccharide linked by the ß-glycosidic bonds. The molecular weight of polysaccharide deproteinized with NaCl was 4.46 × 105 Da. It showed that the polysaccharide from argun palm fruit consisted of fructose, arabinose, rhamnose, galactose, glucose, xylose, and galacturonic acid. The result of TGA and DSC assay indicated that argun fruit polysaccharide has a favorable thermal stability. It was proved that, the argun fruit polysaccharide possessed high antioxidant activity and would be a new natural antioxidant.

Microencapsulation of fingered citron extract with gum arabic, modified starch, whey protein, and maltodextrin using spray drying.

The aim of this study was to investigate the characteristics of the Fingered citron extract (FCE) microcapsules powders with different formulations of the encapsulation carrier agents [gum arabic (GA), maltodextrin (MD), modified starch (MS), and whey protein (WP)], which are obtained through spray drying. Encapsulation yield, encapsulation efficiency, moisture content, hygroscopicity, water activity, density properties, Carr's index, cohesiveness, flowability, porosity, wettability, solubility, color, particle size, thermal behavior, relative crystallinity, and micrographs were analyzed. Moreover, chemical structure of the microcapsule powder was identified using Fourier transform infrared spectroscopy (FT-IR). Best results were achieved when Fingered citron extract was encapsulated using gum arabic/maltodextrin/modified starch (GMS) formulation as carrier agents, where it had the highest encapsulation yield (89.39%) and encapsulation efficiency (87.20%). Furthermore, it achieved the best result in density properties, flowability, porosity, wettability, and relative crystallinity. These results have shown that using gum arabic/maltodextrin/modified starch formulation was superior for production of the Fingered citron extract microcapsules powders.

Serum Arginase II level can be a novel indicator for erectile dysfunction in patients with vasculogenic erectile dysfunction: a comparative study.

PURPOSE: The purpose of the study was to compare serum level of Arginase II in patients with vasculogenic erectile dysfunction (ED) versus healthy controls and to assess if its level is affected by severity of ED. METHODS: This is a prospective study that compared Arginase II in 40 patients with ED versus 40 healthy controls. Patients were excluded if they had any pelvic trauma or pelvic surgery, hormonal disorders, Peyronie's disease, smoking, drug addiction or systemic illnesses. ED was evaluated by the validated Arabic version of the abbreviated five-item form of the international index of erectile function (IIEF-5). Serum arginase II level was assayed using ELIZA. Mann-Whitney, Kruskal-Wallis and Chi-square tests and Spearman correlation were used as appropriate and confirmed by logistic regression model. RESULTS: 22 (55%) patients had DM. 15 (37.5%), 7 (17%), 6 (15%) and 12 (30%) patients suffered from severe, moderate, mild to moderate and mild ED, respectively. The level of serum Arginase II was significantly higher in patients than controls (p < 0.001) and confirmed by multivariate logistic regression analysis. It also correlated significantly with age (r2 = 0.22; p < 0.001) and IIEF-5 score (r2 = 0.8; p < 0.001). Serum Arginase II increased significantly with more severe ED (p < 0.001). Arginase II was also significantly higher in diabetic patients (p < 0.001). CONCLUSION: Serum level of Arginase II is significantly higher in patients with vasculogenic ED compared to healthy controls. It correlates significantly with age and IIEF-5 and was significantly affected by the severity of ED.

Serum Level of IL17a among Cirrhotic Hepatitis C Virus Infected Patients with Incidence of Diabetes Mellitus.

IL17a is the key inflammatory cytokine of TH17 and contributes to the pathogenesis of diabetes mellitus which is a common endocrine disorder associated with HCV infection. Herein, 183 cirrhotic HCV infected patients were screened for ANA by ELISA and positive cases (n=40) were screened for ICA by Immunofluorescence and IL17a serum levels were measured by ELISA and compared to a control group (n=24). Out of 40 cirrhotic HCV, ANA (+) infected patients, 16 patients (40 %) were type 2 diabetic and 13 (32.5%) were non-diabetic. On the other hand, 17 positive ICA (42.5%) and 23 negative ICA (57.5%) patients were reported. IL17a serum level was significantly elevated in cirrhotic HCV infected patients who were positive for ICA than negative ICA (P < 0.0001) and was significantly higher in type 2 diabetic than both non-diabetic patients (P=0.04) and controls (P=0.0005). In conclusion, IL17 serum levels were elevated in diabetic HCV infected patients.

Moderate consumption of beer reduces liver triglycerides and aortic cholesterol deposit in LDLr-/- apoB100/100 mice.

This study was designed to address the effects of a moderate consumption of beer on serum and liver lipid parameters and on the development of aortic lesions in a mouse model associated with a human atherogenic lipoprotein profile. LDLr(-/-) apoB(100/100) mice received each day during 12 weeks either water, mild beer (0.570g of ethanol/kg of body weight) or ethanol-free beer in a single pure dose. Serum and liver lipid parameters were analyzed and atherosclerotic lesions were estimated in heart and aorta through their total cholesterol content. mRNA levels of enzymes and receptors involved in lipoprotein uptake, in fatty acid esterification and oxidation, and in reverse cholesterol transport were also measured in the liver. Serum glucose, triglyceride (TG) and cholesterol levels were altered neither by ethanol-free beer nor by mild beer. Nevertheless, both beer treatments significantly increased HDL-cholesterol (HDL-C) and VLDL-C levels by reference to controls with no change in LDL-C levels. Liver TG contents were significantly decreased by either beer treatment. Cholesterol accumulation was attenuated in the whole aorta of mice treated with mild beer at p<0.05 and not significantly with ethanol-free beer. Heart cholesterol contents were comparable in the three series. Among the genes studied, only scavenger receptor-B1 was downregulated by both beer-based beverages. LDL receptor related protein, lecithin-cholesterol acyltransferase and sterol regulatory element-binding protein 2 were downregulated only by mild beer. The expression of other genes assayed was not altered. When administered in chronic and moderate dose, unidentified components of beer may exert beneficial effects towards atherosclerosis development through alteration of lipoprotein metabolism in LDLr(-/-) apoB(100/100) mice. This effect was slightly amplified by the presence of ethanol in beer.

Can Low Level Laser Therapy Benefit Bone Regeneration in Localized Maxillary Cystic Defects? - A Prospective Randomized Control Trial.

AIM: The aim of the study was to evaluate the effect of Low-Level Laser Therapy (LLLT) on bone formation in cystic defects following cyst enucleation. PATIENTS AND METHODS: The sample was composed of sixteen patients with enucleated maxillary bony cystic lesions. With an age range from 20 - 44 grouped as eight Laser and eight Control patients. Laser group was subjected to low intensity diode laser immediately after surgery and then for three times per week for two weeks using a therapeutic laser irradiation. Group B (control group): patients were not subjected laser therapy. RESULTS: The predictor variable was exposure of bone defect to LLLT or none. The outcome variable was bone density changes measured by digital radiographs at day 1 and days 90 postoperatively. Descriptive and bivariate statistics were computed. There were no statistically significant differences between the 2 groups for the bone density at day 1. There was a statistically significant difference in bone density changes in each group at day 90: Significant at P ≤ 0.05. After adjusting for differences in day 1 for bone density, the estimated mean change in bone density changes at day 90 was significantly larger for Laser compared with control. CONCLUSION: The results of this study suggested that LLLT can enhance bone healing in maxillary cystic defects. This can serve as an adjunct method in preventing possible delayed healing and pathological fractures This also will be helpful for more researchers in early loading in case of dental implants to accelerate osseointegration.

Efectividad del tratamiento osteopático en el abordaje de la fibromialgia / No disponible

INTRODUCCIÓN: La fibromialgia es una enfermedad caracterizada por dolor musculoesquelético difuso generalizado. Su etiología permanece desconocida, por lo que el tratamiento se enfoca a nivel sintomático. Actualmente son de especial interés los tratamientos no farmacológicos. La osteopatía es un sistema de tratamiento no farmacológico que pone el énfasis principal sobre la integridad estructural del cuerpo interconectando los diferentes sistemas que pueden repercutir sobre la patología. OBJETIVOS: Comprobar la efectividad del tratamiento osteopático sobre el dolor y otros síntomas en enfermos de fibromialgia, además de concretar sobre cuál de estos síntomas presentan mayor efecto y cuáles de las diferentes técnicas osteopáticas presenta mayor evidencia para su aplicación en estos pacientes. MATERIAL Y MÉTODOS: Se revisaron en las bases de datos PubMed,CENTRAL, Google Scholar, PEDro, Scielo, y Osteopathic Research Web, la bibliografía existente sobre la aplicación de técnicas osteopáticas en sus diferentes abordajes: liberación miofascial, manipulación osteopática, técnicas craneosacras, técnicas funcionales, rolfing, o creeping, entre otras. Se incluyeron ensayos clínicos aleatorizados que aplicaran alguna de las diferentes técnicas propias de la osteopatía, y fueran publicados en inglés, francés, italiano, portugués o español, entre 2004 y la actualidad. Fueron excluidos los estudios cuya puntuación según la escala PEDro fuera menor de 5 puntos, los que la intervención se contemplara como tratamiento quiropráctico o como parte de otra técnica no osteopática, y los que incluyeran pacientes menores de 16 años. RESULTADOS: Se seleccionan siete artículos que reúnen las características necesarias para nuestra revisión, sumando un total 519 pacientes, todos de entre 18 y 65 años. Todos los pacientes presentaron mejoras en la percepción de dolor. CONCLUSIONES: El abordaje osteopático de la fibromialgia, desde sus diferentes técnicas, ofrece beneficios sobre algunos de los síntomas de la fibromialgia, en especial sobre el dolor, siendo la liberación miofascial la técnica con más evidencia publicada

No disponible

The effects of dexmedetomidine on airway-related complications during emergence from general anesthesia in nasal and paranasal surgeries

Background: Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed by special technique or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine has sedative and analgesic effects, without affecting respiratory status. Objectives: To evaluate the effects of dexmedetomidine on airway-related complications during emergence from general anesthesia (GA) in nasal and paranasal surgeries. Patients and Methods: This prospective randomized clinical study was included 90 patients of both sexes, admitted for elective nasal and paranasal sinus surgery. They were randomly allocated into three groups 30 patients each, Group A: Standard awake extubation technique. Group B: fully awake "no stimulation extubation" technique. Group C: Dexmedetomidine­group, who received intravenous (I.V) dexmedetomidine 0.5-1 µg/kg bolus in 100 ml of normal saline over 10 minutes before the end of surgery by 10 minutes, The dexmedetomidine bolus was followed by 0.2 µg/kg/hr which was stopped immediately when extubation was done. Results: The following parameters were assessed between the three groups: hemodynamics, airway-related complications, extubation time. Group C: was associated with a significant increase in extubation quality compared with group A and group B regarding hemodynamics, airway-related complications, extubation time. Conclusion: This study showed that the dexmedetomidine group associated with minimal circulatory reflexes and airway-related complications further to the advantage of short extubation time compared with the "no stimulation" extubation technique

Upregulation of liver VLDL receptor and FAT/CD36 expression in LDLR-/- apoB100/100 mice fed trans-10,cis-12 conjugated linoleic acid.

This study explores the mechanisms responsible for the fatty liver setup in mice fed trans-10,cis-12 conjugated linoleic acid (t10c12 CLA), hypothesizing that an induction of low density lipoprotein receptor (LDLR) expression is associated with lipid accumulation. To this end, the effects of t10c12 CLA treatment on lipid parameters, serum lipoproteins, and expression of liver lipid receptors were measured in LDLR(-/-) apoB(100/100) mice as a model of human familial hypercholesterolemia itself depleted of LDLR. Mice were fed t10c12 CLA over 2 or 4 weeks. We first observed that the treatment induced liver steatosis, even in the absence of LDLR. Mice treated for 2 weeks exhibited hypertriglyceridemia with high levels of VLDL and HDL, whereas a 4 week treatment inversely induced a reduction of serum triglycerides (TGs), essentially through a decrease in VLDL levels. In the absence of LDLR, the mRNA levels of other proteins, such as VLDL receptor, lipoprotein lipase, and fatty acid translocase, usually not expressed in the liver, were upregulated, suggesting their involvement in the steatosis setup and lipoprotein clearance. The data also suggest that the TG-lowering effect induced by t10c12 CLA treatment was attributable to both the reduction of circulating free fatty acids in response to the severe lipoatrophy and the high capacity of liver to clear off plasma lipids.