Antihypertensive efficacy and safety of a standardized herbal medicinal product of Hibiscus sabdariffa and Olea europaea extracts (NW Roselle): A phase-II, randomized, double-blind, captopril-controlled clinical trial.

Hypertension is a public health concern that needs immediate attention upon diagnosis. The demand for natural alternatives is on the rise; Hibiscus sabdariffa and Olea europaea are traditionally used for hypertension management in Egypt. In this study, we aimed to investigate the antihypertensive efficacy and safety of two doses of an herbal product of Hibiscus sabdariffa calyxes and Olea europaea leaves (NW Roselle) in Egyptian patients with grade 1 essential hypertension. We equally randomized 134 patients to receive captopril 25 mg, low-dose NW Roselle, or high-dose NW Roselle BID for 8 weeks. No significant decrease was found in systolic blood pressure or diastolic blood pressure when we compared low-dose NW Roselle and high-dose NW Roselle to captopril (p > .05). In all groups, mean reduction in BP at 8 weeks was significant; 16.4/9.9 mmHg (p < .0001), 15.4/9.6 mmHg (p < .0001), and 14.9/9.4 mmHg (p < .0001) with captopril, low-dose NW Roselle, and high-dose NW Roselle respectively. In addition, low-dose NW Roselle induced a significant reduction in the mean level of triglycerides (17.56 mg/dL; p = .038). In conclusion, NW Roselle had comparable antihypertensive efficacy and safety to captopril in Egyptian patients with grade 1 essential hypertension.

Very long versus overlapping drug eluting stents for the management of long coronary artery lesions.

BACKGROUND: The prevalence of long diffuse coronary artery disease (CAD) is increasing nowadays due to increase prevalence of multiple risk factors and population ageing. We aimed in our study to show the differences clinically or angiographically (guided by IVUS) between the use of single long stent versus overlapping stents in very long coronary lesions (≥40 mm) in patients presented with chronic coronary syndromes. METHODS: 550 patients presenting with chronic coronary syndromes were included: 320 treated with a single long stent (≥40 mm) and 230 patients with two or more overlapping stents. Angiographic follow-up (guided by IVUS) 6 months after PCI was performed only in 50 patients. We assessed the procedural characteristics and the occurrence of major adverse cardiovascular events (MACE) after a median follow-up of 24 months. RESULTS: Total stent length was 56.16 ± 14.85 mm and mean diameter was 3.05 ± 0.36 mm. At the end of follow-up, MACE rate in the single long stent group was 4.1% vs. 7.8% in the overlapping stents group, with higher incidence in overlapping stents group but non-statistically significant (p value = 0.059). PCI using overlapping stents consumed more contrast volume (248 ± 85.36 vs 164.5 ± 70.43 ml, p < 0.001), and higher fluoroscopy time (23.65 ± 9.19 vs 19.72 ± 9.19 min, p < 0.001). Regarding IVUS subgroup follow-up, there was no significant difference between both groups regarding in-stent restenosis and MACE. CONCLUSIONS: We can conclude that long or overlapping stents are both acceptable therapeutic choices for patients with long CAD. There was no difference between both strategies regarding angiographic follow-up guided by IVUS after 6 months.

A Chromosome-Length Assembly of the Hawaiian Monk Seal (Neomonachus schauinslandi): A History of "Genetic Purging" and Genomic Stability.

The Hawaiian monk seal (HMS) is the single extant species of tropical earless seals of the genus Neomonachus. The species survived a severe bottleneck in the late 19th century and experienced subsequent population declines until becoming the subject of a NOAA-led species recovery effort beginning in 1976 when the population was fewer than 1000 animals. Like other recovering species, the Hawaiian monk seal has been reported to have reduced genetic heterogeneity due to the bottleneck and subsequent inbreeding. Here, we report a chromosomal reference assembly for a male animal produced using a variety of methods. The final assembly consisted of 16 autosomes, an X, and portions of the Y chromosomes. We compared variants in this animal to other HMS and to a frequently sequenced human sample, confirming about 12% of the variation seen in man. To confirm that the reference animal was representative of the HMS, we compared his sequence to that of 10 other individuals and noted similarly low variation in all. Variation in the major histocompatibility (MHC) genes was nearly absent compared to the orthologous human loci. Demographic analysis predicts that Hawaiian monk seals have had a long history of small populations preceding the bottleneck, and their current low levels of heterozygosity may indicate specialization to a stable environment. When we compared our reference assembly to that of other species, we observed significant conservation of chromosomal architecture with other pinnipeds, especially other phocids. This reference should be a useful tool for future evolutionary studies as well as the long-term management of this species.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome.

BACKGROUND: Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. RESULTS: We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1-3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). CONCLUSION: 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

RETRACTED: Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial.

RETRACTED ARTICLE: To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30-60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.

Genome maps across 26 human populations reveal population-specific patterns of structural variation.

Large structural variants (SVs) in the human genome are difficult to detect and study by conventional sequencing technologies. With long-range genome analysis platforms, such as optical mapping, one can identify large SVs (>2 kb) across the genome in one experiment. Analyzing optical genome maps of 154 individuals from the 26 populations sequenced in the 1000 Genomes Project, we find that phylogenetic population patterns of large SVs are similar to those of single nucleotide variations in 86% of the human genome, while ~2% of the genome has high structural complexity. We are able to characterize SVs in many intractable regions of the genome, including segmental duplications and subtelomeric, pericentromeric, and acrocentric areas. In addition, we discover ~60 Mb of non-redundant genome content missing in the reference genome sequence assembly. Our results highlight the need for a comprehensive set of alternate haplotypes from different populations to represent SV patterns in the genome.

Evaluation of biocompatibility of veneered Bio HPP and veneered lithium disilicate crowns in anterior zone (Randomized controlled clinical trial) / Avaliação da biocompatibilidade de coroas de Bio HPP e coroas de dissilicato de lítio na região anterior (ensaio clínico controlado randomizado)

Objective: Evaluation of the biocompatibility of Bio-High Performance Polymer (Bio HPP) crowns veneered with Visio-Ling versus e.max crowns veneered with e.max veneering system. Material and Methods: 42 full-coverage crowns were fabricated for maxillary anterior teeth. A swap was obtained using a sterile paper cone to determine bacterial count and type. Pocket depth (PD) was determined using a William Periodontal probe. Measurements were repeated after 3, 6, 9 and 12 months respectively. Patients were randomly divided into: Group A fabricated from IPS e.max crowns and Group B fabricated from Bio HPP crowns. The preparations were standardized with an equi-gingival, finish line. Fisher's test was used to compare between the two groups. The significance level was set at P ≤ 0.05. Statistical analysis was performed with Windows, Version 23.0. (IBM SPSS Statistics) Armonk, NY: IBM Corp. Results: Bio HPP and e.max showed no statistically significant difference in bleeding on probing and PD except after 9and 12 months; Bio HPP showed statistically significantly higher PD than e.max (P-value = 0.027, Effect size = 0.245) and (P-value = 0.011, Effect size = 0.310), respectively. Fisher's test showed there was no statistically significant difference between total bacterial counts and the type of the two materials. Conclusion: Both e.max and Bio HPP crowns revealed successful biological behavior. No significant difference between the materials regarding the bacterial count and type as well as the pocket depth, however after 9 and 12 months, Bio HPP showed a higher significant difference PD than e.max. (AU)

Objetivo: Avaliação da biocompatibilidade de coroas de Polímero Bio-High Performance (Bio HPP) estratificadas com Visio-Ling versus coroas e.max estratificadas com sistema de estratificação e.max. Material e Métodos: 42 coroas totais foram confeccionadas para dentes anteriores superiores. Uma amostra foi obtida usando um cone de papel estéril para determinar a contagem e o tipo de bactérias. A profundidade de bolsa (PD) foi determinada usando uma sonda periodontal de William. As medições foram repetidas após 3, 6, 9 e 12 meses, respectivamente. Os pacientes foram divididos aleatoriamente em: Grupo A fabricado com coroas IPS e.max e Grupo B fabricado com coroas Bio HPP. As preparações foram padronizadas com uma linha de término no nível da gengiva marginal. O teste de Fisher foi usado para comparação entre os dois grupos. O nível de significância foi estabelecido em P ≤ 0,05. A análise estatística foi realizada com Windows, versão 23.0. (IBM SPSS Statistics) Armonk, NY: IBM Corp. Resultados: Bio HPP e e.max não mostraram nenhuma diferença estatisticamente significativa no sangramento à sondagem e PD, exceto após 9 e 12 meses; Bio HPP mostrou PD estatisticamente significativa maior do que e.max (valor P = 0,027, tamanho do efeito = 0,245) e (valor P = 0,011, tamanho do efeito = 0,310), respectivamente. O teste de Fisher mostrou que não houve diferença estatisticamente significativa entre as contagens bacterianas totais e o tipo dos dois materiais. Conclusão: As coroas e.max e Bio HPP revelaram comportamento biológico bem-sucedidos. Não houve diferença significativa entre os materiais em relação à contagem e tipo de bactérias, bem como à profundidade da bolsa, no entanto, após 9 e 12 meses, o Bio HPP apresentou uma diferença significativamente mais elevada de PD do que e.max. (AU)

Midline nasofrontal dermoids in children: A review of 29 cases managed at Mansoura University Hospitals.

OBJECTIVES: Nasal dermoids are congenital anomalies constituting 3.7-12.6% of dermoids in the head and neck. Most of lesions are superficial but there is always a risk that it may end blindly within the deep structures of the nose or extend intracranially. Complete excision, regardless of extension, is essential and must be balanced against cosmoses. This study reviews the clinical characteristics and imaging findings as well as the appropriate surgical approach adopted for 29 cases managed at Mansoura University Hospitals. METHODS: A retrospective analysis was performed in 29 patients admitted for management of nasal dermoid between Jan 2001 and Jan 2015 at the Otolaryngology department of our tertiary referral university hospital. Recorded data included patient's demographics, complaint, lesion's site, pre-operative radiological findings, surgical technique, intra-operative findings, and post-operative squeal. RESULTS: This series included 12 (41%) female and 17 (59%) male children, with a mean age of 2.5 years. Twenty seven children presented with a nasofrontal swelling of which 20 had an apparent sinus. Other presentations included a swelling in the inner canthum (1), nasal tip and columella (1). Nine (31%) patients had a history of infection and two patients gave a positive history of meningitis. Intracranial extradural extension was identified in 10 patients (34.5%) during preoperative imaging. Surgical modalities included local excision and direct closure (12), open rhinoplasty (7), bicoronal excision and craniotomy (10). In 9 cases, the tract was adherent to the dura but was carefully dissected and in one case resection required excision of a segment of dura and reconstruction. In a follow up period of 1-8 years, recurrence was detected in one case and the cosmetic results were satisfactory. CONCLUSIONS: Those lesions are rare and require early precise surgical planning to achieve complete en bloc excision. This study reports a low morbidity associated with management of nasal dermoids with intracranial extension.

Serum tumor necrosis factor-α level and uterine artery Doppler indices at 11-13 weeks' gestation for preeclampsia screening in low-risk pregnancies: a prospective observational study.

Preeclampsia affects 1-2% of human pregnancies with no effective screening test. Studies have found some association between cytokines/other biomarkers and the later onset of preeclampsia. The challenge has been to find indicators with sufficient positive predictive value. A prospective observational study recruiting 500 low-risk pregnant women was carried out. Serum TNF-α and uterine artery Doppler were measured at 11-13 weeks. TNF-α cut-off value ≥ 1 4 pg/mL had a sensitivity of 67.8% and a specificity of 98% in predicting PE with PPV of 79.4% and NPV of 96.4%. Mean uterine artery PI ≥ 1.7 had a 100% sensitivity and 84.4% specificity in predicting PE, with a PPV of 41.7% and NPV of 100%. When combining both parameters together we had 88.6% sensitivity and 100% specificity in predicting PE with a PPV of 100% and NPV of 98.6%. Serum TNF-α assay improves the performance of mean uterine artery PI at 11-13 weeks for PE screening and the combination of both tests can rule out PE in the case of normal results.

Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision.

OBJECTIVE: To determine whether closed subcutaneous drainage systems were efficacious in reducing the rate of wound breakdown of Pfannenstiel incision after cesarean section (CS) in obese females. DESIGN: Prospective controlled clinical trial. PARTICIPANTS: 118 obese pregnant females with a body mass index >32 undergoing CS were divided into two groups: group I (n = 78) with closed subcutaneous drainage system and group II (n = 40) without drainage system. Incision closure technique was standardized. Prophylactic antibiotics were given routinely to both groups. OUTCOME MEASURES: Primary outcomes were the incidence of wound breakdown in both groups together with rate of hematoma formation and occurrence of fever. Secondary outcomes were amount of fluid drained, need for redressing. RESULTS: Wound breakdown occurred in 9 cases in group I (11.5%), while it happened in 5 cases in group II (12.5%) (p > 0.05). Relative risk was 0.92 (95% CI 0.26-3.75). Hematoma formation was observed in only 1 case in the nondrainage group (group II). Fever was observed in 18 cases in group I (23.1%) in the first 24 h postoperative while in group II, 13 cases developed fever (32.5%) (p > 0.05). The need for redressing within the first 24 h was only in 2.5% of cases in group I while it was 17.9% in group II (p < 0.05). CONCLUSION: We found no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown in obese pregnant females undergoing CS as long as they received a prophylactic antibiotic.