The role of colchicine in the management of COVID-19: a Meta-analysis.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has robustly affected the global healthcare and economic systems and it was caused by coronavirus-2 (SARS-CoV-2). The clinical presentation of the disease ranges from a flu-like illness to severe pneumonia and death. Till September 2022, the cumulative number of cases exceeded 600 million worldwide and deaths were more than 6 million. Colchicine is an alkaloid drug that is used in many autoinflammatory conditions e.g., gout, familial Mediterranean fever, and Behçet's syndrome. Colchicine inhibits the production of superoxide and the release of interleukins that stimulate the inflammatory cascade. Colchicine decreases the differentiation of myofibroblast and the release of fibrotic mediators including transforming growth factor (TGF-ß1) that are related to the fibrosis. Moreover, colchicine has been used to traet viral myocarditis caused by CMV or EBV, interstitial pneumonia, and pericarditis resulting from influenza B infection. Additionally, colchicine is considered safe and affordable with wide availability. OBJECTIVE: The aim of the current study was to assess the evidence of colchicine effectiveness in COVID-19 treatment. METHODS: A comprehensive review of the literature was done till May 2022 and yielded 814 articles after ranking the articles according to authors and year of publication. Only 8 clinical trials and cohort studies fulfilling the inclusion criteria were included for further steps of data collection, analysis, and reporting. RESULTS: This meta-analysis involved 16,488 patients; 8146 patients in the treatment group and 8342 patients in the control group. The results showed that colchicine resulted in a significant reduction in the mortality rate among patients received colchicine in comparison with placebo or standard care (RR 0.35, 95%CI: 0.15-0.79). Colchicine resulted in a significant decrease in the need for O2 therapy in patients with COVID-19 (RR 0.07, 95%CI 0.02-0.27, P = 0.000024). However, colchicine had no significant effect on the following outcomes among COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation, and hospital discharge rate. Among the PCR confirmed COVID-19 patients, colchicine decreased the hospitalization rate (RR 0.75, 95%CI 0.57-0.99, P = 0.042). However, colchicine had no effect on mortality and the need for mechanical ventilation among this subgroup. CONCLUSION: Colchicine caused a significant clinical improvement among COVID-19 patients as compared with the standard care or placebo, in terms of the need for O2, and mortality. This beneficial effect could play a role in the management of COVID-19 especially severe cases to decrease need for oxygen and to decrease mortality among these patients.

Multi-Modality Imaging in Vasculitis.

Systemic vasculitides are a rare and complex group of diseases that can affect multiple organ systems. Clinically, presentation may be vague and non-specific and as such, diagnosis and subsequent management are challenging. These entities are typically classified by the size of vessel involved, including large-vessel vasculitis (giant cell arteritis, Takayasu's arteritis, and clinically isolated aortitis), medium-vessel vasculitis (including polyarteritis nodosa and Kawasaki disease), and small-vessel vasculitis (granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis). There are also other systemic vasculitides that do not fit in to these categories, such as Behcet's disease, Cogan syndrome, and IgG4-related disease. Advances in medical imaging modalities have revolutionized the approach to diagnosis of these diseases. Specifically, color Doppler ultrasound, computed tomography and angiography, magnetic resonance imaging, positron emission tomography, or invasive catheterization as indicated have become fundamental in the work up of any patient with suspected systemic or localized vasculitis. This review presents the key diagnostic imaging modalities and their clinical utility in the evaluation of systemic vasculitis.

Long-Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians.

Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis. However, the long-term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality of life in nonagenarians after TAVR. This is a multicenter, retrospective analysis on patients with severe aortic stenosis who underwent TAVR. Patients were divided into 2 groups: nonagenarians (age ≥90 years) and age <90 years. The Kansas City cardiomyopathy questionnaire (KCCQ) and New York Heart Association (NYHA) scores were compared before and after TAVR. All-cause mortality was compared between both groups at 30 days, 1 year, and 5 years after TAVR using the Cox proportional hazard model. A total of 6,896 patients were included, of whom 591 were nonagenarians. Nonagenarians had a higher Society of Thoracic Surgeons perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p <0.001) before TAVR. Both groups were similar in KCCQ and NYHA scores at baseline. At 1 year after TAVR, there was no significant difference in improvement in the KCCQ overall score between those aged <90 years and nonagenarians (-4.76, 95% confidence interval [CI] -11.4 to 1.9, p = 0.161). Similarly, there was no statistically significant difference in improvement in NYHA class between the 2 groups at 1 year (odds ratio 1.07, 95% CI 0.85 to 1.25), p = 0.526). The unadjusted 30-day (3.2% vs 2.7%, hazard ratio 1.11, 95% CI 0.70 to 1.80, p = 0.667) and 5-year (28.0% vs 26.6%, hazard ratio 1.05, 95% CI 0.89 to 1.24, p = 0.60) all-cause mortality were similar between the 2 groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5 years after TAVR in nonagenarians, comparable to patients younger than 90 years. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1 year after TAVR.

Proportion and Risk Factors of Silent Vertebral Fractures Among Egyptian Females With Fragility Hip Fracture Presenting to the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture. Objective The aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture. Patients and methods A cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures. Results During the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females. Conclusion Osteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.

Expert opinion on management of moderate-to-severe atopic dermatitis in Qatar.

Atopic dermatitis (AD), a chronic-relapsing inflammatory skin disorder, manifests with intense itching and eczematous lesions impairing quality of life. A heterogeneous population, and regional clinical practices for treating AD warrant the development of guidelines in Qatar. Therefore, guidelines for the management of moderate-to-severe AD in Qatar have been developed and discussed. Experts, including dermatologists and immunologists, used the Delphi technique for developing guidelines. Consensus was defined as ≥75% agreement or disagreement. AD is highly prevalent in primary and tertiary dermatology centers. AD-associated foot eczema and psoriasiform eczema are more frequent in Qatar than in Europe or USA. SCORing Atopic Dermatitis Index quantifies disease severity and itch. Dermatology Life Quality Index assesses the quality of life. Atopic Dermatitis Control Tool assesses long-term disease control. Moderate-severe AD benefits from new topicals like Janus-kinase-inhibitors or PDE4-inhibitors combined with phototherapy. Currently approved systemic agents are dupilumab, baricitinib, abrocitinib, and upadacitinib. New anti-IL-13 and anti-IL-31 therapies will soon be available. Patient education, allergy testing, and comorbidity consideration are critical in the management of AD. The expert panel established a comprehensive and pragmatic approach to managing moderate-to-severe AD, thereby assisting clinical decision-making for healthcare professionals in Qatar.

Using Artificial Intelligence in Predicting Ischemic Stroke Events After Percutaneous Coronary Intervention.

BACKGROUND: Ischemic stroke (IS) is an uncommon but severe complication in patients undergoing percutaneous coronary intervention (PCI). Despite significant morbidity and economic cost associated with post PCI IS, a validated risk prediction model is not currently available. AIMS: We aim to develop a machine learning model that predicts IS after PCI. METHODS: We analyzed data from Mayo Clinic CathPCI registry from 2003 to 2018. Baseline clinical and demographic data, electrocardiography (ECG), intra/post-procedural data, and echocardiographic variables were abstracted. A random forest (RF) machine learning model and a logistic regression (LR) model were developed. The receiver operator characteristic (ROC) analysis was used to assess model performance in predicting IS at 6-month, 1-, 2-, and 5-years post-PCI. RESULTS: A total of 17,356 patients were included in the final analysis. The mean age of this cohort was 66.9 ± 12.5 years, and 70.7% were male. Post-PCI IS was noted in 109 patients (.6%) at 6 months, 132 patients (.8%) at 1 year, 175 patients (1%) at 2 years, and 264 patients (1.5%) at 5 years. The area under the curve of the RF model was superior to the LR model in predicting ischemic stroke at 6 months, 1-, 2-, and 5-years. Periprocedural stroke was the strongest predictor of IS post discharge. CONCLUSIONS: The RF model accurately predicts short- and long-term risk of IS and outperforms logistic regression analysis in patients undergoing PCI. Patients with periprocedural stroke may benefit from aggressive management to reduce the future risk of IS.

Characterization of a novel peptide mined from the Red Sea brine pools and modified to enhance its anticancer activity.

Drug resistance is a major cause of the inefficacy of conventional cancer therapies, and often accompanied by severe side effects. Thus, there is an urgent need to develop novel drugs with low cytotoxicity, high selectivity and minimal acquired chemical resistance. Peptide-based drugs (less than 0.5 kDa) have emerged as a potential approach to address these issues due to their high specificity and potent anticancer activity. In this study, we developed a support vector machine model (SVM) to detect the potential anticancer properties of novel peptides by scanning the American University in Cairo (AUC) Red Sea metagenomics library. We identified a novel 37-mer antimicrobial peptide through SVM pipeline analysis and characterized its anticancer potential through in silico cross-examination. The peptide sequence was further modified to enhance its anticancer activity, analyzed for gene ontology, and subsequently synthesized. To evaluate the anticancer properties of the modified 37-mer peptide, we assessed its effect on the viability and morphology of SNU449, HepG2, SKOV3, and HeLa cells, using an MTT assay. Additionally, we evaluated the migration capabilities of SNU449 and SKOV3 cells using a scratch-wound healing assay. The targeted selectivity of the modified peptide was examined by evaluating its hemolytic activity on human erythrocytes. Treatment with the peptide significantly reduced cell viability and had a critical impact on the morphology of hepatocellular carcinoma (SNU449 and HepG2), and ovarian cancer (SKOV3) cells, with a marginal effect on cervical cancer cell lines (HeLa). The viability of a human fibroblast cell line (1Br-hTERT) was also significantly reduced by peptide treatment, as were the proliferation and migration abilities of SNU449 and SKOV3 cells. The annexin V assay revealed programmed cell death (apoptosis) as one of the potential cellular death pathways in SNU449 cells upon peptide treatment. Finally, the peptide exhibited antimicrobial effects on both gram-positive and gram-negative bacterial strains. The findings presented here suggest the potential of our novel peptide as a potent anticancer and antimicrobial agent.

Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning.

BACKGROUND: Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM. AIM: To apply machine learning to be used to predict pre-procedural risk for PPM. METHODS: A retrospective study of 1200 patients who underwent TAVR (January 2014-December 2017) was performed. 964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis. After the exclusion of variables with near-zero variance or ≥ 50% missing data, 167 variables were included in the random forest gradient boosting algorithm (GBM) optimized using 5-fold cross-validations repeated 10 times. The receiver operator curve (ROC) for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year. RESULTS: Of 964 patients included in the 30-d analysis without prior PPM, 19.6% required PPM post-TAVR. The mean age of patients was 80.9 ± 8.7 years. 42.1 % were female. Of 657 patients included in the 1-year analysis, the mean age of the patients was 80.7 ± 8.2. Of those, 42.6% of patients were female and 26.7% required PPM at 1-year post-TAVR. The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model (0.66 and 0.72) was superior to that of the PPM risk score (0.55 and 0.54) with a P value < 0.001. CONCLUSION: The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.

What is the prevalence of chronic kidney disease among hypertensive non-diabetic Egyptian patients attending primary healthcare?

BACKGROUND: Although chronic kidney disease (CKD) is considered the major cause of morbidity and mortality in hypertension, the recognition and prevention of CKD remain deficient. CKD is one of the major health challenges in Egypt. CKD affects approximately 13% of the adult population, resulting in significant morbidity, mortality, and health care costs. Patients with more progressive stage 3 or stage 4 CKD experience a high rate of cardiovascular events and death compared to earlier stages of CKD. AIM: This study was performed to determine the prevalence and risk factors of CKD among hypertensive non-diabetic patients attending primary health care (PHC) centers in Cairo. METHODOLOGY: The study type is a cross-sectional study. Study setting: Two PHC centers: Saraya El-kobba and El-Sharabya. Sampling method: Recruitment of participants was done in one day weekly. Any known essential hypertensive patients aged 18 or more registered in the two PHC centers in Cairo. RESULTS: The prevalence of CKD was 33% among the hypertensive non-diabetic patients. Among CKD participants, the prevalence is more common in females (59.7%) than males (40.3%), in those who completed primary education and in the illiterates and low socioeconomic class. Surprisingly, it is more common in patients with positive family history of CKD and patients with ischemic heart disease and the antihypertensive drugs use. CONCLUSION: CKD has a high prevalence among hypertensive non-diabetic patients, and it has a significant morbidity and mortality among those patients.

Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis.

BACKGROUND: Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI). AIM: To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS. METHODS: We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity. RESULTS: Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I 2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I 2 = 0.0%). CONCLUSION: Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

A novel model for hands-on laparoscopic pelvic surgery training on Genelyn-embalmed body: an initial feasibility study.

The human donor body provides a well-accepted ex vivo model for laparoscopic surgical training. Unembalmed, or fresh-frozen, bodies comprise high-fidelity models. However, their short life span and high cost relatively limit the hands-on training benefits. In contrast, soft embalmed body of donors has a relatively longer usability without compromising tissue flexibility. This study reports the initial experience of the utility and feasibility of human donor Genelyn-embalmed body as a novel soft-embalmed cadaveric model for laparoscopic surgical training. An expert laparoscopic surgeon, who organised many fresh-frozen body donor courses, performed deep laparoscopic pelvic dissection and laparoscopic surgical tasks including suturing and electrosurgery on a single Genelyn-embalmed body. The three sessions were performed over a course of 3 weeks. The body was fully embalmed using the Genelyn technique. The technique consisted of a single-point closed arterial perfusion of embalming solution via the carotid artery with no further exposure to or immersion in embalming fluids thereafter. The donor's Genelyn-embalmed body provided a feasible model for laparoscopic surgical training. Initial experience shows evidence of this model being feasible and realistic. There was reproducibility of these qualities across a minimum of 3 weeks in this single-donor study. Initial experience shows that donor's Genelyn-embalmed body provides a novel model for laparoscopic surgical training, which possesses fidelity and is feasible for laparoscopic training. While further studies are needed to validate these findings, this technical note provides perspectives from an expert trainer regarding this model and provides a photographic and videographic atlas of this model's use in laparoscopy.

Nutritional rehabilitation of malnourished children: are nutritional supplements a must?

OBJECTIVE: Malnutrition threatens children worldwide. The objective of the current study was to highlight the role of nutritional screening, evaluate the effectiveness of nutritional intervention program, and whether nutritional supplements have surplus benefit. PATIENTS AND METHODS: Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) was used to screen 3640 clinically stable 2-5 years old children recruited from the outpatient clinics, Children's Hospital, Ain Shams University. A total of 100 patients at high risk of malnutrition were enrolled. Full nutritional assessment was done and according to the distribution of the calories in the daily meal plan, the patients were randomly divided into two groups each comprised 50 patients. Group A received tailored nutritional dietary rehabilitation plan including dietary supplements, while Group B received only dietary advice. Anthropometric measurements, laboratory tests, as well as STAMP scoring were reassessed after the nutritional rehabilitation programs. RESULTS: Nutritional screening revealed that 5.14% were at high risk of malnutrition. Both studied groups showed significant improvement in caloric intake and all anthropometric measurements upon nutritional rehabilitation, except for the height z scores. Patients who received nutritional supplements showed significantly better changes regarding weight, BMI, caloric intake, and hemoglobin. Regarding STAMP categories during follow up, Group A had only 6% of the patients still in the high-risk category and 76% were at low risk compared to 14% high risk and only 54% were at low risk in Group B. CONCLUSIONS: Nutritional screening in pediatric outpatient facilities can lead to implementing prompt nutritional rehabilitation, which can reflect on the patients' overall health. Tailored nutritional plan can accomplish good response in terms of improvement of caloric intake, anthropometric measurements and laboratory parameters. Adding a nutritional supplement to the dietary plan during nutritional rehabilitation isn't a must but it ensures superior goal achievement.

Proportion of Hidden Vertebral Fractures Among Egyptian Males With Fragility Hip Fractures in the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures are linked to significant costs for society as well as significant pain and suffering, disability, and even death. It is well-recognized that osteoporosis-related fragility fractures raise the risk of subsequent fragility fractures. One of the most frequent osteoporotic fractures brought on by low bone mineral density and other risk factors is vertebral fractures. Considering that most vertebral fractures are asymptomatic and not clinically identified, proactive screening could stop additional impairment. Objective The current study aims to determine the prevalence and risk factors of hidden vertebral fractures in Egyptian males who have fragility hip fractures. Patients and methods A cross-sectional case-control study examining the correlation of risk factors between cases (fragility hip fracture and vertebral fractures) and a control group (fragility hip fracture without vertebral fracture) was carried out from September 2020 to September 2021 on patients visiting the orthopedic emergency department of a university hospital in Cairo, Egypt. Males who presented to the emergency room (ER) with fragility hip fractures and were 40 years of age or older met our inclusion criteria. For every patient who presented with a fragility hip fracture, standard lateral and anteroposterior radiographs of the dorso-lumbar spine were taken. Results A total of 43,935 patients visited the orthopedic emergency room (ER) throughout the study period; 13,034 of those patients were men, accounting for 29.7% of all orthopedic ER visits. Our inclusion criteria for fragility hip fractures were met by 132 male participants. The screening lumbosacral plain X-rays identified 27 (20.5%) of the 132 patients as having concomitant vertebral fractures in addition to the fragility hip fractures. Concomitant hidden vertebral fractures among Egyptian males with other fragility fractures, particularly fragility hip fractures, are predicted by the number of co-morbid diseases, hypertension, and continuous use of steroids and anti-epileptics. Conclusion Most fragility fractures are avoidable. Because one fragility fracture increases the likelihood of others, early detection is crucial. To prevent complications and mortality, it is important to identify and manage individuals who have a fragility hip fracture as they frequently have concurrent hidden vertebral fractures. Predictive risk factors for fragility vertebral fractures include hypertension, the number of concomitant illnesses, and chronic drugs (anti-epileptics and steroids).

Awareness and attitude of primary healthcare patients towards telehealth in Cairo, Egypt.

BACKGROUND: Telehealth is delivering health care services remotely from healthcare facilities using telecommunications and virtual technology. Egypt is aiming to reach Universal Health Coverage; this increases the demand for telehealth in routine health services. Telehealth helps in increasing access to areas with no available medical services as patients can be monitored remotely. OBJECTIVE: To measure the awareness of telehealth among attendees of primary health care units and their acceptance of applying telehealth. METHODOLOGY: This was a cross-sectional study among attendees of primary health units. Ethical issues were considered. RESULTS: A sample size was calculated to be 162 and 170 valid Arabic interview questionnaires were filled by attendees. The awareness percentage of telehealth among attendees was 64.7% while the willingness to implement telehealth was 78%. Both awareness and willingness were significantly associated with age groups, residence, socioeconomic status, and presence of computer with internet access. Age, residence, and possession of a PC were the only adjusted predictive factors for knowledge about telehealth among patients in the multivariable analysis. CONCLUSION: Large percentages of attendees to primary health care centers are aware of telehealth and are willing to implement it. The major cause of refusal to implement telehealth was ignorance of using telecommunication devices and the desire to be in close contact with the physicians.

Validation of a modified cow's milk-related symptom score (CoMISS) for screening of lactose intolerance in adults.

INTRODUCTION: Lactose intolerance (LI) is the failure to digest foods and beverages containing the lactose present in milk. LI can present by many digestive symptoms. OBJECTIVE: To validate the modified CoMiSS score for prediction of LI, that was confirmed by a stool acidity test. PATIENTS AND METHODS: A cross-sectional study, was conducted at Ain Shams University Hospitals/Gastrointestinal Clinics, and included one hundred adult participants during the period from December 2018 to December 2019. Enrolled patients had one or more gastrointestinal symptoms and were subjected to a stool acidity test (fecal PH test) as a reference test and modified CoMiSS as an index test. RESULTS: The mean age of participants was 35.30 ± 10.714 years old; 55% were females, and their mean body mass index (BMI) was 23.08 ± 2.080 kg/m2, with no significant relation between LI and patients` gender or BMI. Out of the studied participants 24% had positive stool PH, LI diagnosed according to modified CoMISS was present among 19% of them. The mean value of modified CoMISS Score was significantly higher in positive cases (12.37) compared to negative LI participants (2.33) as p < .001. Area under ROC Curve was 0.998, at the selected cut-off value 8, the sensitivity was 89.5% and specificity was 100% thus, levels of questionnaire scoring of 8 or higher would indicate presence of lactose intolerance. CONCLUSION: Modified CoMiSS is a simple, fast, and easy-to-use tool that can predict LI, with a cut-off value of >8, the Area under the ROC Curve was 0.998, sensitivity 89.5%, and specificity was 100%.

Transtibial versus independent femoral tunnel drilling techniques for anterior cruciate ligament reconstruction: evaluation of femoral aperture positioning.

BACKGROUND: Femoral tunnel can be drilled through tibial tunnel (TT), or independent of it (TI) by out-in (OI) technique or by anteromedial (AM) technique. No consensus has been reached on which technique achieves more proper femoral aperture position because there have been evolving concepts in the ideal place for femoral aperture placement. This meta-analysis was performed to analyze the current literature comparing femoral aperture placement by TI versus TT techniques in ACL reconstruction. METHODS: We performed a comprehensive systematic review and meta-analysis of English-language literature in PubMed, Cochrane, and Web of Science databases for articles comparing femoral aperture placement by TI versus TT techniques with aperture position assessed by direct measurement or by postoperative imaging, PXR and/or CT and/or MRI. RESULTS: We included 55 articles with study population of 2401 knees of whom 1252 underwent TI and 1149 underwent TT techniques. The relevant baseline characteristics, whenever compared, were comparable between both groups. There was nonsignificant difference between TI and TT techniques in the distance from aperture center to footprint center and both techniques were unable to accurately recreate the anatomic footprint position. TI technique significantly placed aperture at more posterior position than TT technique. TI technique significantly lowered position of placed aperture perpendicular to Blumensaat's line (BL) than TT technique, and modifications to TT technique had significant effect on this intervention effect. Regarding sagittal plane aperture placement along both AP anatomical axis and BL, there was nonsignificant difference between both techniques. CONCLUSION: Modifications to TT technique could overcome limitations in aperture placement perpendicular to BL. The more anterior placement of femoral aperture by TT technique might be considered, to some extent, a proper position according to recent concept of functional anatomical ACL reconstruction.

Umbelliferone ameliorates oxidative stress and testicular injury, improves steroidogenesis and upregulates peroxisome proliferator-activated receptor gamma in type 2 diabetic rats.

OBJECTIVES: Diabetes mellitus (DM) is a chronic disease associated with serious complications, including male infertility. Umbelliferone (UMB) is a coumarin with promising antioxidant, anti-inflammatory and other beneficial effects. This study investigated the ameliorative effect of UMB against testicular injury, oxidative stress and altered steroidogenesis in rats with type 2 DM. METHODS: Rats received a high fat diet for 4 weeks followed by a single injection of streptozotocin. Diabetic rats were treated with UMB or pioglitazone (PIO) for 6 weeks and samples were collected for analysis. KEY FINDINGS: Diabetic rats exhibited hyperglycemia, insulin resistance and dyslipidemia associated with increased serum pro-inflammatory cytokines, and decreased gonadotropins and testosterone. UMB significantly ameliorated metabolic alterations, decreased pro-inflammatory cytokines, and increased gonadotropins and testosterone levels. UMB prevented testicular injury, suppressed lipid peroxidation and nitric oxide and increased antioxidants in diabetic rats. In addition, UMB upregulated testicular gonadotropins receptors, steroidogenesis markers (steroidogenic acute regulatory protein, cytochrome P450 family 17 subfamily A member 1 [CYP17A1], 3ß-hydroxysteroid dehydrogenase [3ß-HSD] and 17ß-hydroxysteroid dehydrogenase [17ß-HSD]), and peroxisome proliferator-activated receptor gamma (PPARγ) expression. CONCLUSIONS: UMB prevents testicular injury by preventing metabolic alterations, suppressing oxidative damage and inflammation, and boosting antioxidant defenses in diabetic rats. UMB enhanced pituitary-gonadal axis and steroidogenesis and upregulated testicular PPARγ in diabetic rats. Thus, UMB may represent a protective agent against testicular injury and sexual dysfunction associated with chronic hyperglycemia.

The "new normal" for medical education during and post-COVID-19.

After outbreaks in more than 110 countries, the World Health Organization declared COVID-19 a global pandemic on the March 11, 2020, heralding unprecedented challenges in medical education. Our aim is to provide a descriptive overview of the impact of COVID-19 on medical education worldwide and to assess its future repercussions. Worldwide, medical students were removed from clerkship training. Clinical skills and practical procedure training transitioned to being online, and in some cases, postponed. Medical educators scrambled to convert the curriculum into online formats. Access to Internet, technology, and computer education posed resource allocation challenges in developing countries and further widened the disparities in medical education. Even in countries where the framework and funding were available to support the online transition, debatably, this arrangement can lead to disparities in clinical skills, bedside manner, and field experience among pre- and post-COVID-19 medical graduates. Challenges extend beyond undergraduate medical education to include the medical licensing process of international and national postgraduates. The international community of medical educators needs to collaborate to drive the future of medical education, as the world adapts to the "new normal."

Analyses of MADS-box Genes Suggest HvMADS56 to Regulate Lateral Spikelet Development in Barley.

MADS-box transcription factors are crucial regulators of inflorescence and flower development in plants. Therefore, the recent interest in this family has received much attention in plant breeding programs due to their impact on plant development and inflorescence architecture. The aim of this study was to investigate the role of HvMADS-box genes in lateral spikelet development in barley (Hordeum vulgare L.). A set of 30 spike-contrasting barley lines were phenotypically and genotypically investigated under controlled conditions. We detected clear variations in the spike and spikelet development during the developmental stages among the tested lines. The lateral florets in the deficiens and semi-deficiens lines were more reduced than in two-rowed cultivars except cv. Kristina. Interestingly, cv. Kristina, int-h.43 and int-i.39 exhibited the same behavior as def.5, def.6, semi-def.1, semi-def.8 regarding development and showed reduced lateral florets size. In HOR1555, HOR7191 and HOR7041, the lateral florets continued their development, eventually setting seeds. In contrast, lateral florets in two-rowed barley stopped differentiating after the awn primordia stage giving rise to lateral floret sterility. At harvest, the lines tested showed large variation for all central and lateral spikelet-related traits. Phylogenetic analysis showed that more than half of the 108 MADS-box genes identified are highly conserved and are expressed in different barley tissues. Re-sequence analysis of a subset of these genes showed clear polymorphism in either SNPs or in/del. Variation in HvMADS56 correlated with altered lateral spikelet morphology. This suggests that HvMADS56 plays an important role in lateral spikelet development in barley.

Comparison of hemoglobin level and neutrophil to lymphocyte ratio as prognostic markers in patients with COVID-19.

BACKGROUND: Anemia can negatively affect the outcome of many diseases, including infections and inflammatory conditions. AIM: To compare the prognostic value of hemoglobin level and the neutrophil/lymphocyte ratio (NLR) for prediction of coronavirus disease 2019 (COVID-19) severity. METHODS: In this retrospective cohort study, clinical data from patients with laboratory-confirmed COVID-19 were collected from hospital records from 10 April 2020 to 30 July 2020. RESULTS: The proportions of patients with mild, moderate, and severe COVID-19 differed significantly in association with hemoglobin levels, neutrophil counts, lymphocyte counts, NLR, and total leukocyte counts. Patients with severe COVID-19 had significantly lower hemoglobin levels than those with moderate or mild COVID-19. There were statistically significant negative associations between hemoglobin and D-dimer, age, and creatinine. The optimal hemoglobin cut-off value for prediction of disease severity was 11.6 g/dL. Using this cut-off value, hemoglobin had higher negative predictive value and sensitivity than NLR (92.4% and 51.3%, respectively). The specificity of hemoglobin as a prognostic marker was 79.3%. CONCLUSION: Both NLR and hemoglobin level are of prognostic value for predicting severity of COVID-19. However, hemoglobin level displayed higher sensitivity than NLR. Hemoglobin level should be assessed upon admission in all patients and closely monitored throughout the disease course.