Quetiapine Versus Haloperidol in the Management of Hyperactive Delirium: Randomized Controlled Trial.

BACKGROUND: In the population of patients in the intensive care unit (ICU), most studies compared the use of atypical antipsychotics, such as quetiapine, with the use of traditional haloperidol in patients with delirium of various forms and etiologies. The role of such agents in patients with hyperactive delirium is not fully understood. This study compares the effectiveness of quetiapine with haloperidol in treating the hyperactive form of delirium in terms of their effects on the Delirium Rating Scale-Revised-98 (DRS-R-98), length of stay in the ICU, and mortality in critically ill patients. METHODS: One hundred adult patients diagnosed with hyperactive delirium were randomly assigned to receive either oral quetiapine (25-50 mg/day) or haloperidol (1-2 mg/day). The response, defined as "a DRS-R-98 severity score reduction from baseline of 50% or more" and a DRS-R-98 severity score of 12 or less without relapse, was the primary outcome. RESULTS: The mean age of all patients was 68 ± 6 years. The study population's overall response rate was 92%. Response rates for the two groups were remarkably equal (p = 0.609). Secondary outcomes were comparable in both groups, such as ICU mortality (p = 0.496), in-hospital mortality (p = 0.321), in-hospital stay (p = 0.310), and the need for mechanical ventilation (p > 0.99). But the quetiapine group showed a statistically reduced mean ICU stay (10.1 ± 2.0 vs. 11.7 ± 2.6 days, p = 0.018) and increased sleeping hours per night (p = 0.001). CONCLUSIONS: Quetiapine may be equally as effective as haloperidol in treating the symptoms of hyperactive delirium in critically ill patients, with no mortality benefit.

Is bulbospongiosus muscle botox injection safe and effective in treating lifelong premature ejaculation? Randomized controlled study.

PURPOSE: To evaluate the safety and efficacy of botulinum-A toxin injections into the bulbospongiosus muscle for cases of lifelong drug-resistant premature ejaculation (PE). METHODS: Ninety-eight outpatients diagnosed with lifelong PE were randomly assigned to two groups: the botulinum-A toxin group comprising forty-nine patients and the placebo (saline) group also consisting of forty-nine patients. A 100 U botulinum-A toxin was diluted into 10 cc of saline, with 5 cc injected into one side of the muscle (botulinum-A toxin group) guided by ultrasound to distribute across most muscle fibers. The same technique was applied using the same volume of saline injected into the bulbospongiosus muscle. Intravaginal ejaculatory latency time (IELT), scores from the premature ejaculation profile (PEP), Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function (IIEF), and recording of any complications were obtained. Follow-ups occurred at 1-, 3-, and 6-month post-procedure. RESULTS: Cases receiving injections of botulinum-A toxin into the bulbospongiosus muscle showed notably extended intravaginal ejaculatory latency times compared to their initial performance after treatment. In addition, there were enhancements in PEP scores, and notably, no significant complications were reported. Conversely, the bilateral injection of saline into the bulbospongiosus muscle did not demonstrate any impact on ejaculation latencies. CONCLUSION: Our study demonstrated that the injection of botulinum-A toxin into the bulbospongiosus muscle can serve as a safe and effective option for treating PE. Nonetheless, its clinical application warrants further studies involving larger sample sizes and longer follow-up periods.

Renal arterial resistive index versus novel biomarkers for the early prediction of sepsis-associated acute kidney injury.

Acute kidney injury (AKI) is a critical complication of sepsis. There is a continuous need to identify and validate biomarkers for early detection. Serum and urinary biomarkers have been investigated, such as neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C), but their reliability in the intensive care unit (ICU) remains unknown. Renal hemodynamics can be investigated by measuring the renal resistive index (RRI). This study aimed to compare the performance of RRI, serum NGAL (sNGAL), urinary NGAL (uNGAL), and serum Cys C levels as early predictors of the diagnosis and persistence of sepsis-associated AKI. A total of 166 adult patients with sepsis syndrome were enrolled immediately after ICU admission. Biomarkers were measured directly (T1) and on day 3 (T3). RRI was measured directly (T1) and 24 h later (T2). Patients were categorized (according to the occurrence and persistence of AKI within the first 7 days) into three groups: no AKI, transient AKI, and persistent AKI. The incidence rate of sepsis-associated AKI was 60.2%. Sixty-six patients were categorized as in the no AKI group, while another 61 were in transient AKI and only 39 were in persistent AKI. The RRI value (T1 ≥ 0.72) was the best tool for predicting AKI diagnosis (area under the receiver operating characteristic curve, AUROC = 0.905). Cys C (T1 ≥ 15.1 mg/l) was the best tool to predict the persistence of AKI (AUROC = 0.977). RRI (T1) was the best predictive tool for sepsis-associated AKI, while Cys C was the best predictor of its persistence and 28-day mortality.

High-Throughput Analysis of Leaf Chlorophyll Content in Aquaponically Grown Lettuce Using Hyperspectral Reflectance and RGB Images.

Chlorophyll content reflects plants' photosynthetic capacity, growth stage, and nitrogen status and is, therefore, of significant importance in precision agriculture. This study aims to develop a spectral and color vegetation indices-based model to estimate the chlorophyll content in aquaponically grown lettuce. A completely open-source automated machine learning (AutoML) framework (EvalML) was employed to develop the prediction models. The performance of AutoML along with four other standard machine learning models (back-propagation neural network (BPNN), partial least squares regression (PLSR), random forest (RF), and support vector machine (SVM) was compared. The most sensitive spectral (SVIs) and color vegetation indices (CVIs) for chlorophyll content were extracted and evaluated as reliable estimators of chlorophyll content. Using an ASD FieldSpec 4 Hi-Res spectroradiometer and a portable red, green, and blue (RGB) camera, 3600 hyperspectral reflectance measurements and 800 RGB images were acquired from lettuce grown across a gradient of nutrient levels. Ground measurements of leaf chlorophyll were acquired using an SPAD-502 m calibrated via laboratory chemical analyses. The results revealed a strong relationship between chlorophyll content and SPAD-502 readings, with an R2 of 0.95 and a correlation coefficient (r) of 0.975. The developed AutoML models outperformed all traditional models, yielding the highest values of the coefficient of determination in prediction (Rp2) for all vegetation indices (VIs). The combination of SVIs and CVIs achieved the best prediction accuracy with the highest Rp2 values ranging from 0.89 to 0.98, respectively. This study demonstrated the feasibility of spectral and color vegetation indices as estimators of chlorophyll content. Furthermore, the developed AutoML models can be integrated into embedded devices to control nutrient cycles in aquaponics systems.

Evaluation of the (Baha) technique of scleral indentation using a self-retained scleral indenter during vitrectomy surgery: a randomized trial.

AIMS: The current study compared a novel technique of scleral indentation using the self-retaining Leyla retractor to the conventional scleral self-indentation with the chandelier light. METHODS: Patients with rhegmatogenous retinal detachment were randomized on a 1:1 basis to either have the (Baha) indentation using a tip of a thimble scleral indenter welded to the support for the Leyla retractor system or to have the conventional scleral indentation while using a 25-gauge chandelier light. A video was recorded for the surgery of all the cases and reviewed by another consultant masked to the type of indentation. The indentation duration (i.e., the time in seconds between the first appearance of a hump due to scleral indentation in the recorded video until its final disappearance) was measured for every case. RESULTS: The current study included 60 eyes of 60 adults with a mean age of 59.6 ± 9.8 years. Thirty-nine of the eyes were phakic and 21 were pseudophakic. The mean indentation time was 618 ± 87 and 696 ± 72 s in (Baha) indentation and conventional indentation groups, respectively. The difference was not statistically significant (p = 38). There was a positive correlation between the vertical palpebral fissure height and the indentation duration for both (Baha) indentation (r = 0.58) and conventional indentation groups (r = 0.42). Readjustment of the chandelier endo-illumination was required in 19 cases (63.3%) in the conventional indentation group. Iatrogenic breaks or accidental crystalline lens touch did not occur in any case. CONCLUSION: The (Baha) technique is effective and safe, especially in patients with a larger palpebral fissure.

From digital voices to vaccine choices: increasing female vaccine acceptance in Sudan through social listening.

The early COVID-19 vaccine rollout in Sudan experienced a gender disparity in vaccine uptake, with women accounting for less than 40% of vaccinations after four months of vaccine access. Initial analysis revealed that demand generation approaches were not sufficiently tailored to address the challenges and concerns of women. Using real-time social media monitoring, also known as social listening, to understand this inequity, we used an analytical tool called "Talkwalker" to track public sentiment and engagement regarding vaccination on social media platforms. The data captured subsequently informed a gender-responsive messaging campaign on social media that directly addressed specific concerns of Sudanese women. Within one week of the campaign's onset in September 2021, we observed a 144% increase in women's COVID-19 related social media engagement. Subsequent campaigns further enhanced women's engagement from 31% to between 35%-47%. Two subsequent campaigns in January and February/March 2022 were complemented with in-person activities, such as group meetings with community members and home visits by health promoters. Women's vaccination rates increased by 9% while the first two campaigns were live. System constraints hindered data linkages for the third campaign. These findings demonstrate the value of integrating real-time feedback with large-scale social media campaigns and the potential of linking online and offline strategies to further refine interventions, particularly in a conflict-prone and low-income country context. Our experience reinforces the notion that "one size does not fit all" when it comes to health-related communication. Responses should be tailored, contextualized, and person-centered, particularly in addressing concerns unique to women.

Development and international validation of custom-engineered and code-free deep-learning models for detection of plus disease in retinopathy of prematurity: a retrospective study.

BACKGROUND: Retinopathy of prematurity (ROP), a leading cause of childhood blindness, is diagnosed through interval screening by paediatric ophthalmologists. However, improved survival of premature neonates coupled with a scarcity of available experts has raised concerns about the sustainability of this approach. We aimed to develop bespoke and code-free deep learning-based classifiers for plus disease, a hallmark of ROP, in an ethnically diverse population in London, UK, and externally validate them in ethnically, geographically, and socioeconomically diverse populations in four countries and three continents. Code-free deep learning is not reliant on the availability of expertly trained data scientists, thus being of particular potential benefit for low resource health-care settings. METHODS: This retrospective cohort study used retinal images from 1370 neonates admitted to a neonatal unit at Homerton University Hospital NHS Foundation Trust, London, UK, between 2008 and 2018. Images were acquired using a Retcam Version 2 device (Natus Medical, Pleasanton, CA, USA) on all babies who were either born at less than 32 weeks gestational age or had a birthweight of less than 1501 g. Each images was graded by two junior ophthalmologists with disagreements adjudicated by a senior paediatric ophthalmologist. Bespoke and code-free deep learning models (CFDL) were developed for the discrimination of healthy, pre-plus disease, and plus disease. Performance was assessed internally on 200 images with the majority vote of three senior paediatric ophthalmologists as the reference standard. External validation was on 338 retinal images from four separate datasets from the USA, Brazil, and Egypt with images derived from Retcam and the 3nethra neo device (Forus Health, Bengaluru, India). FINDINGS: Of the 7414 retinal images in the original dataset, 6141 images were used in the final development dataset. For the discrimination of healthy versus pre-plus or plus disease, the bespoke model had an area under the curve (AUC) of 0·986 (95% CI 0·973-0·996) and the CFDL model had an AUC of 0·989 (0·979-0·997) on the internal test set. Both models generalised well to external validation test sets acquired using the Retcam for discriminating healthy from pre-plus or plus disease (bespoke range was 0·975-1·000 and CFDL range was 0·969-0·995). The CFDL model was inferior to the bespoke model on discriminating pre-plus disease from healthy or plus disease in the USA dataset (CFDL 0·808 [95% CI 0·671-0·909, bespoke 0·942 [0·892-0·982]], p=0·0070). Performance also reduced when tested on the 3nethra neo imaging device (CFDL 0·865 [0·742-0·965] and bespoke 0·891 [0·783-0·977]). INTERPRETATION: Both bespoke and CFDL models conferred similar performance to senior paediatric ophthalmologists for discriminating healthy retinal images from ones with features of pre-plus or plus disease; however, CFDL models might generalise less well when considering minority classes. Care should be taken when testing on data acquired using alternative imaging devices from that used for the development dataset. Our study justifies further validation of plus disease classifiers in ROP screening and supports a potential role for code-free approaches to help prevent blindness in vulnerable neonates. FUNDING: National Institute for Health Research Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and the University College London Institute of Ophthalmology. TRANSLATIONS: For the Portuguese and Arabic translations of the abstract see Supplementary Materials section.

Prevalence of diabetic retinopathy in patients with diabetes in Alexandria and North-West Delta, Egypt.

PURPOSE: The purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region. METHODS: All diabetic patients attending the general ophthalmology clinics (Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders. Adjudication by a consultant was done when needed. RESULTS: Out of 11,033 screened patients, 10,811 had a gradable fundus photograph in at least one eye and were included. The numbers of cases in groups 1, 2 and 3 were 3940, 2826, and 4045, respectively. Males represented 38.35% of the cases. Mean age was 55 ± 12.63. For the whole sample, groups 1, 2 and 3, the DR prevalence was 32.49, 46.4%, 29.13%, and 21.29%, respectively. The prevalence of proliferative DR (grade R4) was 6.16%, 11.83%, 5.02%, and 1.45%, respectively, and of referable maculopathy (Grade M2) was 19.95%, 31.42%, 15.92%, and 11.59%, respectively. In univariate analysis, older age, higher random blood glucose, and longer DM duration were associated with a higher risk of both DR and referable diabetic maculopathy. This association was maintained in multivariate analysis for the high random blood glucose level and the longer duration of DM (but not for the older age). CONCLUSION: A significantly higher prevalence of DR, grades R4 and M2 was found in the hospital-recruited patients than in diabetics from the local communities.

Dialysis catheter-related sepsis resulted in infective endocarditis, septic pulmonary embolism and acute inferolateral STEMI: a case report.

Background: Embolic myocardial infarction is an uncommon but increasingly recognized complication of infective endocarditis (IE). Although the incidence is low and ranges from 1% to 10%, the mortality rate is high (64%). The characteristics of septic embolism on presentation are nonspecific and usually are unrecognized by clinicians. This case report aims to build a high index of suspicion among clinicians for IE presenting with the complication of embolic myocardial infarction especially in patients with indwelling venous catheters. Case Summary: A 62-year-old woman with end-stage renal disease on haemodialysis presented with shortness of breath and desaturation. Her history was significant for end-stage renal disease managed with regular haemodialysis by a right-sided double-lumen tunnelled catheter. An initial diagnosis was made of pulmonary embolism, and management with intravenous heparin was initiated. She subsequently developed inferolateral ST-elevation myocardial infarction, and treatment with percutaneous coronary intervention to the posterior descending artery failed. Then, the patient developed complete heart block, aortic valve vegetation, acute severe aortic regurgitation, and shock. Discussion: Acute coronary syndrome is usually an early and uncommon complication of IE and the risk of embolism decreases after antibiotic therapy is initiated. Due to the low incidence of coronary events in IE, only case reports have been published. Most patients with septic pulmonary embolism have a presentation similar to that for pneumonia. The diagnosis is therefore often delayed, which consequently influences prognosis. Our case report presents an example of IE-related multiple systemic embolization with poor patient outcome due to delayed diagnosis.

Introduction of Spring-Assisted Cranioplasty for Sagittal Craniosynostosis in a Craniofacial Service: A Report of Early Experience.

Spring-assisted cranioplasty (SAC) for the treatment of craniosynostosis uses internal springs to produce dynamic changes in cranial shape over several months before its removal. The purpose of this study was to report the first Egyptian experiences with SAC in the treatment of children with sagittal synostosis and evaluate the preliminary outcome. A total of 17 consecutive patients with scaphocephaly underwent SAC with a midline osteotomy along the fused sagittal suture and insertion of 3 springs with bayonet-shaped ends across the opened suture. Operative time, blood transfusion requirements and length of ICU, total hospital stay, and complications graded according to Oxford protocol classification were recorded. Spring removal was performed once re-ossification of the cranial defect occurred. All patients successfully underwent SAC without significant complications. The mean age at surgery was 6.8 months. The mean time of the spring insertion surgery was 63 minutes (SD 9.7). Blood transfusion was needed in less than half of the patients (41.2%).The mean duration of hospital stay was 3.2 days. The mean timing of spring removal was 5.5 months (SD 0.4). The mean time of the second surgery (spring removal) was 22.8 minutes (SD 3.6). In conclusion, SAC can easily be incorporated into the treatment armamentarium of craniofacial surgeons. The technique offers a safe and minimally invasive option for the treatment of sagittal craniosynostosis with the benefit of limited dural undermining, minimal blood loss, operative time, anesthetic time, ICU stay, and hospital stay.

The Role of The National Early Warning Score (NEWS) in Identifying Critically Ill Patients at Risk of Mortality in Nigeria. A Retrospective Record Review.

Background: Clinical deterioration in critically ill patients is a common phenomenon that can occur several hours before an adverse outcome. Early detection of subtle changes in vital signs, such as alterations in pulse rate and blood pressure, is crucial for preventing adverse events. However, these are not often recognized early enough to prompt quick intervention. The use of warning scores or assessment systems in the management of the critically ill in Nigeria has not been well evaluated. We assessed the association between the National Early Warning Score (NEWS) system and outcomes particularly mortality among the critically ill at the Jos University Teaching Hospital (JUTH), Nigeria. Methodology: This study is a retrospective study involving adults admitted to the medical and surgical wards between January 2021 and July 2021. Patient medical records were used to obtain data such as socio-demographics, and vital signs, which were used to compute the NEWS variable, diagnosis, length of stay, outcomes, and complications. Patients were classified as low, medium, and high-risk based on their NEWS scores within the first 24 hours of admission and 24 hours prior to the outcome of interest (death or discharge). Results: A total of 405 patients were included in this study. Patients with low, medium, and high-risk NEWS scores within the first 24 hours of admission, had an 11.1%, 9%, and 17% chance of death respectively. In the NEWS score high-risk group 24 hours prior to outcome (death or discharge), the risk of mortality increased to 20.6% and there was a four-fold increase in odds of death. Conclusion: Our results showed that the NEWS score predicted outcome and may suggest that the implementation of the NEWS score as a routine tool for monitoring inpatients at the Jos University Teaching Hospital could help to detect patients at risk of adverse events.

Potential impact of fluorescein angiography as a primary imaging modality in the management of diabetic retinopathy.

Purpose: To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management. Methods: Cross-sectional survey conducted in Egypt amongst practicing ophthalmologists. Results: The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non-proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one-year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045. Conclusion: Given that FA detects significantly greater pathology than CI, and that treatment and follow-up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs.

Validation and comparison between two warfarin dosing clinical algorithms and warfarin fixed dosing in specialized heart center: cross-sectional study.

Background: Warfarin is well known as a narrow therapeutic index that has prodigious variability in response which challenges dosing adjustment for the maintenance of therapeutic international normalized ratio. However, an appreciated population not on new oral anticoagulants may still need to be stabilized with warfarin dosing. Objective: The current study's main objective was to validate and compare two models of warfarin clinical algorithm models namely the Gage and the International Warfarin Pharmacogenetics Consortium (IWPC) with warfarin 5 mg fixed standard dosing strategy in a sample of Sudanese subjects. Method: We have conducted a cross-sectional study recruited from the out-patient clinic at a tertiary specialized heart center. We included subjects with unchanged warfarin dose (stabilized), and with therapeutic international normalized ratio. The predicted doses of warfarin in the two models were calculated by three different methods (accuracy, clinical practicality, and the clinical safety of the clinical algorithms). Main outcome measure: The primary outcomes were the measurements of the clinical (accuracy, practicality, and safety) in each of the two clinical algorithms models compared to warfarin 5 mg fixed standard dose strategy. Results: We have enrolled 71 Sudanese subjects with mean age (51.7 ± 14 years), of which (49, 69.0%) were females. There was no significant difference between the warfarin 5 mg fixed standard dose strategy and the predicted doses of the two clinical algorithm models (MAE 1.44, 1.45, and 1.49 mg/day [P =0.4]) respectively. In the clinical practicality, all of the three models had a high percent of subjects (95.0%, 51.9%, and 66.7%) in the ideal dose range in middle dose group (3-7 mg/ day) for warfarin 5 mg fixed standard dosing strategy, Gage, and IWPC clinical algorithm models respectively. However, a small percent of subjects was exhibited in the warfarin low dose group ≤ 3 mg/day (0.0%, 15.0%, and 10.0%) and warfarin high dose group ≥ 7 mg/day (0.0%, 33.3%, and 33.3%) for warfarin 5 mg fixed standard dosing strategy, Gage, and IWPC clinical algorithms respectively. In terms of clinical safety, the percent of subjects with severely over-prediction were 28.2%, 22.5%, and 22.5% for warfarin 5 mg fixed standard dosing, Gage, and IWPC, respectively. While the percent of severely under-prediction was 12.7%, 7.0%, and 5.6% for the warfarin 5 mg fixed standard dosing, Gage, and IWPC, respectively. Conclusion: The Gage and IWPC clinical algorithm models were accurate, more clinically practical, and clinically safe than warfarin 5 mg standard dosing in the study population. The cardiologist can use either models (Gage and IWPC) to stratify subjects for accurate, practical, and clinically safe warfarin dosing..

Pediatric Keratoconus in A Tertiary Eye Center in Alexandria: A Cross-sectional Study.

PURPOSE: To describe the clinical presentation, risk factors, and treatment choices documented in a pediatric keratoconus population treated at a tertiary referral center in Alexandria, Egypt. METHODS: : A cross-sectional study of 80 patients with keratoconus aged 18 years or younger referred to the cornea clinic at the Alexandria University Main Hospital between July 2018 and October 2019 was included. Patients' history, initial presentation, best spectacle corrected visual acuity (BSCVA), clinical signs, topographic data, and treatment were recorded. RESULTS: Thirty patients were younger than 14 years and 50 were 14 years or older. Elements of the initial presentation included decreased vision in 26 patients, itching in 20 patients, both visual impairment and itching in 16 patients, accidental discovery during vision screening at school in 15 patients, and hydrops in three patients. All patients had bilateral keratoconus, except for four patients who had previously been treated by keratoplasty (n = 156 eyes). The mean logMAR BSCVA was 0.79 ± 0.63. The mean of the average keratometry (AveK), maximum keratometry (Kmax), central corneal thickness (CCT) and thinnest pachymetry reading were 51.16 ± 7.31 D, 59.18 ± 10.38 D, 458.44 ± 55.87 µ 440.08 ± 60.18 µ, respectively. 57 eyes (36%) had stage 1 disease, 43 eyes (28%) had stage 2 disease, 17 eyes (11%) had stage 3 disease and 39 eyes (25%) had stage 4 disease, respectively. No statistically significant differences in the LogMAR BSCVA, keratometry values, CCT, thinnest pachymetry reading, and the Amsler-Krumeich (AK) staging existed between the two age groups or between boys and girls. Crosslinking was indicated in 69 eyes (44%), while keratoplasty was the only viable solution for 39 eyes (25%), with three patients requiring keratoplasty in both eyes. CONCLUSION: Keratoconus in children can result in severe loss of vision. Keratoconus screening programs in elementary schools should be considered in populations with a high incidence of keratoconus for early detection and adequate intervention.

The Postnatal Growth and Retinopathy of Prematurity Model: A Multi-institutional Validation Study.

PURPOSE: The G-ROP model was proposed to improve the retinopathy of prematurity (ROP) screening efficiency. It is based on gestational age, birth weight and postnatal weight gain. The current study aimed to validate the G-ROP model's ability to predict ROP in cohorts of premature infants from Egypt and the United Kingdom (UK). METHODS: We retrospectively reviewed the records of preterm infants born between 1st of January and 30th of June 2018 with a known outcome for ROP screening and regular weight measurements until day 39 after birth. We applied the G-ROP model to the study group and calculated the sensitivity of the model for detecting Early Treatment of ROP (ETROP) study type 1 ROP and for any ROP and calculated the reduction of the number of infants requiring ROP screening by the model application. RESULTS: We applied the G-ROP model on 605 infants (504 from Egypt and 101 from the UK). The model successfully predicted all type 1 ROP cases (100% sensitivity) in both cohorts (95% confidence interval [CI], 91.1-100% in the Egyptian cohort and 65.5-100% in the UK cohort). The model reduced the number of infants requiring screening by 14.1% in the Egyptian cohort and 21.8% in the UK cohort. CONCLUSIONS: The G-ROP model was successfully validated for detecting type 1 ROP and in both cohorts from Egypt and the UK.

Role of ascorbic acid infusion in critically ill patients with transfusion-related acute lung injury.

INTRODUCTION: In critically ill patients, transfusion-related acute lung injury (TRALI) remains the leading cause of transfusion-related fatalities in critical care settings and is associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high-dose intravenous ascorbic acid (VC) in critically ill patients. OBJECTIVE: The aim of this trial was to investigate the effect of high-dose intravenous VC as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin [IL]-8, IL-1ß, C-reactive protein), anti-inflammatory (IL-10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2 /FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7-day mortality and 28-day mortality. METHODS: Eighty critically ill patients with TRALI (n = 80) were randomized to receive 2.5 g/6 h intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed up to measure the outcomes initially (T0) and at the end of treatment (T96). RESULTS: When compared to the control group, the ASTRALI group at T96 showed significantly higher median of IL-10 (31.6 ± 25.8 vs 17.7 ± 12.0 pg/mL, P < .0001) levels and superoxide dismutase (12 876 ± 4627 U/L vs 5895 ± 6632 U/L, P < .0001) activities, and lower median C-reactive protein (76 ± 50 vs 89 ± 56 mg/L, P = .033), IL-8 (11.8 ± 7.3 vs 35.5 ± 19.8 pg/mL, P < .0001) and malondialdehyde (0.197 ± 0.034 vs 0.234 ± 0.074 µM/L, P = .002) levels. CONCLUSION: High-dose ascorbic acid was associated with significantly reduced oxidative stress, reduced pro-inflammatory markers except IL-1ß, elevated anti-inflammatory marker and elevated plasma VC levels.

Hepatic Pseudolipoma: A Rare Case.

Pseudolipoma, also known as pseudolipoma of the Glisson's capsule, is an encapsulated lesion that contains degenerated fat and is enveloped by the liver capsule. In this report, we discuss a 37-year-old male presenting with dysuria and microscopic hematuria who revealed an incidental finding of a pseudolipoma on a CT scan of the abdomen.

Prognostic value of systematic lymphadenectomy in patients with ovarian cancer: A systematic review and meta-analysis.

OBJECTIVE: To appraise clinical outcomes of systematic lymphadenectomy in women with ovarian cancer based on stage, control group and type of chemotherapy. STUDY DESIGN: A literature search was conducted on SCOPUS, PUBMED, COCHRANE, MEDLINE, and WEB OF SCIENCE databases. All comparative studies that assess outcomes of systematic lymphadenectomy in patients with ovarian cancer were eligible. Overall survival was analyzed by pooling log hazard ratio (HR) and standard error of multivariable Cox regression models. MOGGE Meta-analysis Matrix is a novel illustration tool that was used to demonstrate multiple subgroup analyses of included studies. RESULTS: Twenty-two studies were eligible. Systematic lymphadenectomy was associated with better overall survival, that was close to significance, compared to control group (HR 0.93, 95 %CI 0.86-1.00). Among women treated with adjuvant chemotherapy, overall survival improved in women with stage IIB-IV who underwent systematic lymphadenectomy (HR 0.91, 95 %CI 0.84-0.99) and was most significant among patients with stage III to IV (HR 0.85, 95 %CI 0.73-0.99). Systematic lymphadenectomy did not improve survival in women who received neoadjuvant chemotherapy (HR 0.97, 95 %CI 0.73-1.29). Systematic lymphadenectomy was associated with improved progress-free survival compared to control group (HR 0.88, 95 %CI 0.79-0.99). CONCLUSION: Although data from clinical trials do not support role of systematic lymphadenectomy in advanced ovarian cancer, overall data conveys stage-specific survival benefit. Further clinical trials may be warranted to assess substage survival outcomes in women with advanced stages.

Efficient VANET safety message delivery and authenticity with privacy preservation.

Vehicular ad-hoc networks (VANETs) play an essential role in the development of the intelligent transportation system (ITS). VANET supports many types of applications that have strict time constraints. The communication and computational overheads are minimal for these computations and there are many security requirements that should be maintained. We propose an efficient message authentication system with a privacy preservation protocol. This protocol reduces the overall communication and computational overheads. The proposed protocol consists of three main phases: the group registration phase, send/receive messages phase, and the leave/join phase. For cryptography algorithms, we combined symmetric and asymmetric key algorithms. The symmetric key was generated and exchanged without using the Diffie-Hellman (DH) protocol. Furthermore, we used an efficient version of the RSA algorithm called CRT-RSA. The experimental results showed that the computational overhead in the registration phase was significantly reduced by 91.7%. The computational overhead for sending and receiving the non-safety message phase was reduced by 41.2% compared to other existed protocols. Moreover, our results showed that the time required to broadcast a safety and non-safety group message was below 100 ms and 150 ms, respectively. The average computational time of sending and receiving a one-to-one message was also calculated. The proposed protocol was also evaluated with respect to performance and security and was shown to be invulnerable to many security attacks.

Association between FSHR and ESR1 gene variants and ovarian response to gonadotropin in Egyptian women undergoing ICSI treatment.

The unpredictable variability in patients' responses to gonadotropins represents one of the most intractable IVF treatment problems. Identifying the genetic variants associated with ovarian responses to gonadotropins is an important step towards developing individualised pharmacogenetics protocols for ovarian stimulation. The purpose of the current study was to evaluate correlations between FSHR rs6165, FSHR rs616, and ESR1 rs2234693 gene variants and the degree of ovarian response to gonadotropin in Egyptian women undergoing ICSI treatment. Two hundred and eighty Egyptian women (mean age of 20-35) undergoing ICSI treatment were enrolled in a cross-sectional study conducted between January 2017 and May 2019. The women were classified into three groups based on ovarian response: normal responders (retrieved oocytes = 4-15) (n = 80), poor responders (retrieved oocytes < 4) (n = 92), and high responders (retrieved oocytes> 15) (n = 108). Genomic DNA was extracted from blood samples, and PCR and DNA sequencing were performed to identify genetic variations in the different study groups. FSHR and ESR1 genetic variants were then compared in normal, poor, and high responders. DNA sequencing results showed significant differences in the frequencies of FSHR rs6166 and ESR1 rs2234693 genotypes in poor responders compared with normal responders (P ≤ 0.001 and P ≤ 0.001, respectively). In contrast, no significant differences in the frequencies of FSHR rs6166, FSHR rs6165, or ESR1 rs2234693 genotypes were observed in high responders compared with normal responders (P ≤ 0.074, P ≤ 0.353, and P ≤ 0.060, respectively). These results suggest that FSHR and ESR1 gene variants could predict the degree of ovarian response to Controlled ovarian hyperstimulation in Egyptian women.