Chronic Stress Indicator: A Novel Tool for Comprehensive Stress Analysis.

Extensive research has highlighted the strong association between chronic stress and negative health outcomes. This relationship is influenced by various factors, including sociobehavioral, environmental, and genetic and epigenomic forces. To comprehensively assess an individual's stress levels, we propose the development of the Chronic Stress Indicator (CSI), a novel comprehensive multifaceted tool that incorporates key biological, anthropometric, behavioral, and socioeconomic factors. The objective of this study is to assess the effectiveness of the CSI compared to Allostatic Load (AL), a type of chronic stress, in identifying health issues related to stress. The objective of this research is to evaluate the performance of the Chronic Stress Indicator (CSI) versus Allostatic Load (AL) in detecting adverse health outcomes within the U.S. demographic aged 20-49. The information used for this study was sourced from the National Health and Nutrition Examination Survey (NHANES), carried out from 2001 to 2004. Logistic regression modeling was employed to calculate odds ratios and confidence intervals. The Wilcoxon rank-sum test was employed to assess differences in means, whereas the chi-square test, accompanied by Cramer's V statistic, was used to examine the association among categorical variables. Additionally, the relationship between continuous variables was analyzed using Pearson's correlation coefficient. Our association tests show that the length of occupation activity and health status were among the strongest associations to CSI risk. Based on our logistic regression models, age and sex were found to be significant factors in determining AL. We also found that age, smoking, and longest occupation activity were significant factors of CSI risk. These findings suggest a need for individuals to limit smoking as it may lead to higher overall stress despite its common use as a coping mechanism for stress. We should also review the level of occupational activity a job has before continuously working on it as this may also lead to higher cumulative stress.

Association of Combined Metals and PFAS with Cardiovascular Disease Risk.

This study sought to investigate the impact of exposure to metals and per- and polyfluoroalkyl substances (PFASs) on cardiovascular disease (CVD)-related risk. PFASs, including PFOA, PFOS, PFNA, and PFHxS, as well as metals such as lead (Pb), cadmium (Cd), and mercury (Hg), were analyzed to elucidate their combined effects on CVD risk. METHODS: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2014, this investigation explored the effects of PFASs and metals on CVD risk. A spectrum of individual CVD markers, encompassing systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides, was examined. Additionally, comprehensive CVD risk indices were evaluated, namely the Overall Cardiovascular Biomarkers Index (OCBI), including the Framingham Risk Score and an Overall Cardiovascular Index. Linear regression analysis was employed to probe the relationships between these variables. Furthermore, to assess dose-response relationships between exposure mixtures and CVD while mitigating the influence of multicollinearity and potential interaction effects, Bayesian Kernel Machine Regression (BKMR) was employed. RESULTS: Our findings indicated that exposure to PFAS and metals in combination increased CVD risk, with combinations occurring with lead bringing forth the largest impact among many CVD-related markers. CONCLUSIONS: This study finds that combined exposure to metals and PFASs significantly elevates the likelihood of CVD risk. These results highlight the importance of understanding the complex interplay between multipollutant exposures and their potential implications for cardiovascular health.

Competitive integrated employment for youth with disabilities: Aligning measurement with conceptualization using latent growth curve modeling.

PURPOSE: Although existing research has generated a wealth of information related to employment for individuals with disabilities, a major limitation is that common measurements of employment do not fully capture the scope of the optimal outcome specified in public policies, namely, competitive integrated employment. Therefore, we aimed to describe the change and stability in multiple aspects of employment for youth with disabilities from high school age to mid-30s under the structural equation modeling framework. METHODS: We identified a sample of 1,921 youth with disabilities who were at least 18 years old in 2003 from the National Longitudinal Survey of Youth- 1997. We estimated a series of latent growth curve models to assess trajectories of job quality, indicated by hourly pay, and stability, indicated by weekly work hours, over a period of 15 years. RESULTS: Trajectories of job quality and stability did not covary or load on a common factor, but there was substantial variability within the sample in both the intercept and slope of these two constructs, which were best captured by a cubic growth curve, and partially explained by health condition and several demographic variables. CONCLUSIONS: Competitive integrated employment comprises of multiple components which should ideally be considered along a time dimension. Future studies need to assess validity of the measurement model with a different sample and incorporate another important component of competitive integrated employment, that is, whether work is carried out at an integrated setting.

The Association of Toxoplasma gondii with the Combination of Cardiovascular Disease, Chronic Kidney Disease, or Chronic Liver Disease: A Preliminary Study.

Toxoplasma gondii is a protozoan parasite widespread worldwide, with over 40 million individuals in the United States. It may infect vital organs such as the heart, kidneys, and liver, resulting in chronic infections. The main objective of this study is to investigate the association of Toxoplasma infection with the combination of cardiovascular disease, chronic kidney disease (CKD), or chronic liver disease (CLD). The National Health and Nutrition Examination Survey (NHANES 2009-2010) data were used, and the association of infection with chronic disease was assessed with biomarkers and indexes using statistical modeling. The percentage of participants with a combination of CLD and CKD was higher among Toxoplasma positive participants compared to the negative participants (2.76 vs. 1.26). Furthermore, exposure to T. gondii may increase the odds of cardiovascular disease, CKD, or CLD, or vice versa.

Association of Per- and Polyfluoroalkyl Substances with Allostatic Load Stratified by Herpes Simplex Virus 1 and 2 Exposure.

Herpes Simplex Virus (HSV) 1 and 2 are persistent infections that affect a significant percentage of United States (US) adults, with 48% having HSV-1 and 12% having HSV-2. Using data stratified by HSV-1 and HSV-2 exposures, this study investigated the association of per- and polyfluoroalkyl substances (PFAS), a group of toxic synthetic organofluorine chemical compounds found in environmental, occupational, and home settings, with allostatic load (AL), an index of chronic physiological stress. Descriptive statistics, multivariable logistic regression, and Bayesian Kernel Machine Regression (BKMR) modeling were used to assess the effects of multi-PFAS exposures on AL using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014. Results indicated participants not exposed to PFAS exhibited 77% to 97% lower odds of higher AL (p < 0.001). For example, PFOS per unit increase brought forth a 2% odds increase in higher AL (OR: 1.02; 95% CI: 1.00, 1.05; p < 0.05). Participants exposed to PFAS had reduced odds of higher AL (77%-79%), regardless of their HSV-1 and HSV-2 status. PFAS exposure was more prevalent in those with HSV-1 (60%) than in those with HSV-2 (20%) infection, while AL levels were comparable in both groups (17%). BKMR revealed a nonlinear PFAS-AL association and confirmed interactions among PFAS. In summary, PFAS exposure increased the likelihood of higher AL among those with persistent HSV infections. Our study enhances the current understanding of the complex dynamics involving PFAS, persistent infections, and AL, which hold significant implications for public health and clinical intervention strategies.

The Association of Cytomegalovirus and Allostatic Load by Country of Birth and Length of Time in the United States.

BACKGROUND: Cytomegalovirus (CMV) is a highly prevalent virus with a worldwide distribution. It typically remains dormant in most individuals until reactivation. Immunocompromised states are known to be potential causes for CMV reactivation. Current research has shown a link in the decline of immigrant health among those living in the US for an extended period, though the impact of CMV on this is not clear. METHODS: This study investigated the association between country of birth, duration of US residency, allostatic load, and latent cytomegalovirus infection (CMV IgG) in a sample of US adults aged 20-49. The data utilized for our analysis was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Allostatic load, an index measuring the cumulative physiological strain on the body as it strives to regain stability in the presence of chronic stress, provided a valuable approach to assess stress within the context of CMV exposure. Logistic regression modeling was employed to estimate odds ratios and confidence intervals for the analysis. The chi-square test of association and Cramer's V statistic were used to assess the correlation among categorical variables, while Pearson's correlation coefficient was applied to evaluate the relationship between continuous variables. The results revealed that individuals born outside the US and those with less than 20 years of residency in the US exhibited significantly higher proportions of positive CMV IgG compared to individuals born in the US. Specifically, individuals born outside the US had more than triple the odds of CMV IgG when adjusting for the AL index (OR = 3.69, p-value = 0.0063). A similar trend was observed when examining AL risk based on the duration of US residency. Furthermore, age and sex were identified as significant predictors (p-value < 0.05) of AL risk, considering the individual's country of birth. In summary, the findings of this study significantly enhance our comprehension of the intricate interplay between cytomegalovirus (CMV) and allostatic load (AL). The investigation sheds light on how CMV and AL interact within specific demographic contexts, providing valuable insights into the underlying risk factors for CMV infection.

An Analysis of the COVID-19-Induced Flexible Grading Policy at a Public University.

To help students cope with the challenges of the COVID-19 pandemic, higher education institutions offered students flexible grading policies that blended traditional letter grades with alternative grading options such as the pass-fail or credit-no credit options. This study conducted an in-depth analysis of the flexible grading policy at a medium-sized university in the USA. We studied the differential selection of flexible grading options by course characteristics and students' sociodemographics and academic profiles between Spring 2020 and Spring 2021. We also examined the impacts of the policy on sequential courses. Our analysis utilized administrative and transcript data for undergraduate students at the study institution and employed a combination of descriptive statistics and regression models. The analysis revealed that the flexible grading policy was utilized differently depending on course characteristics, with core courses and subjects like mathematics, chemistry, and economics having higher rates of usage. Additionally, sociodemographic and academic profile factors led to varying degrees of utilization, with males, urban students, freshmen, and non-STEM majors using the policy more frequently. Furthermore, the analysis suggested that the policy may have disadvantaged some students as they struggled in subsequent courses after using the pass option. Several implications and directions for future research are discussed.

Effect of 17-Hydroxyprogesterone Caproate on Interleukin-6 and Tumor necrosis factor-alpha in expectantly managed early-onset preeclampsia.

The study aimed to evaluate the effect of 17 hydroxy progesterone (17-OHPC) on interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in expectantly managed early-onset preeclampsia (PE). A randomized open-label controlled study included women who were diagnosed as early-onset PE if they assigned to expectant management according to the American College of Obstetricians and Gynecologists (ACOG) 2013 criteria for diagnosis of severity of PE. Patients were randomized into Group A (40 patients) received 17-OHPC 250 mg intra-muscular at admission and every 7 days thereafter and Group B (40 patients) was given the usual conservative measures of early-onset PE as a control group. Blood samples were obtained from all participants for measurements of TNF-α and IL-6 levels at admission and repeated at termination of pregnancy. The primary outcome was the mean difference between TNF-α and IL-6 levels before and after treatment in both groups. TNF-α and IL-6 levels at admission were not different between the two groups. However, there was a significant difference concerning these inflammatory biomarkers within the same group at admission and at termination (p < 0.001), with significant decline of IL-6 and TNF-α level in the 17-OHPC treated group and significant rise of IL-6 and TNF-α in the control group. There was a strong positive correlation between systolic blood pressure (SBP) at admission and TNF-α level (r= 0.867, p=0.017), and moderately positive significant correlation between diastolic blood pressure (DBP) at admission and TNF-α (r=0.610, p < 0.001). There was a mild positive significant correlation between IL-6 levels and SBP (r= 0.231, p=0.039), and DBP (r= 0.203, p= 0.041) at admission. In conclusion, 17-OHPC has no effect in improving maternal or neonatal outcomes in conservatively managed early onset PE, although it alters the inflammatory markers levels (IL-6 and TNF-α) that could improve the pathogenesis of PE.

The Association of Toxoplasma gondii IgG and Liver Injury in US Adults.

BACKGROUND: Toxoplasma gondii (T. gondii) is a ubiquitous obligatory intracellular parasite which infects over 40 million Americans and causes toxoplasmosis. Inside the human body, T. gondii can damage tissues and invade vital organs. METHODS: This study evaluated the association of T. gondii infection and liver disease using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, with a sample size of 3371 participants (age 20-80 years). Toxoplasma infection was determined by the level of T. gondii IgG antibody in serum samples. Liver disease was assessed by liver injury biomarkers and the Fatty Liver Index (US-FLI). The evaluation of the association between T. gondii infection and liver disease included the calculation of the Mantel-Haenszel risk ratio (RRMH), Rho-Scott chi-square bivariate analyses, design-based t-tests, and linear and logistic regression models which were adjusted for demographic and anthropometric covariates. RESULTS: Mean levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly more elevated in the T. gondii IgG-positive (IgG+) participants as compared to T. gondii-negative (IgG-) participants, p = 0.0435 and 0.0310, respectively. In linear regression analysis, exposure to T. gondii IgG+ had statistically significant positive associations with AST (p = 0.0211), alanine aminotransferase (ALT) (p = 0.0221), and gamma-glutamyl transferase (GGT) (p = 0.0258) after adjusting for BMI, age, gender, and race. T. gondii exposure was associated with an elevated relative risk of chronic liver disease (CLD) (RRMH = 1.26, 95% CI: 1.05-1.51). This association was more pronounced in certain occupations, such as construction, agriculture, forestry, and fishing, where Toxoplasma infection is more common (p = 0.0477). Moreover, Toxoplasma infection increased the odds of nonalcoholic fatty liver disease (NAFLD) (OR = 6.99, 95% CI = 1.85-26.32, p = 0.0237). CONCLUSION: T. gondii IgG+ antibody was significantly associated with liver injury biomarkers (ALT, AST, GGT, and ALP) and an increased risk of CLD and NAFLD. Moreover, the association of Toxoplasma with CLD was more evident in specific occupations where the prevalence of Toxoplasma was high. The findings of this study provide insight into utilizing liver biomarkers and US-FLI to assess the health complications of Toxoplasma when imaging tests are not accessible.

The impact of COVID-19 induced emergency remote instruction on students' academic performance at an HBCU.

The outbreak of the COVID-19 pandemic early in 2020 forced universities to shut down their campuses and transition to emergency remote instruction (ERI). Students had to quickly adapt to this new mode of instruction while dealing with all other distractions caused by the pandemic. This study integrates extensive data from students' institutional records at a large Historically Black College and University (HBCU) institution with data from a students' survey about the impact of COVID-19 on learning during the Spring 2020 semester to examine the impact of the transition to ERI on students' performance and identify the main factors explaining variations in students' performance. The main findings of our analysis are: (a) students' university experience was positively correlated with performance (continuing students who spent at least one academic year at the university prior to the outbreak had better performance than freshman and new transfer students), (b) students' perceived change in performance after the transition was positively associated with actual performance (students who perceived a decline in their performance after transition to ERI had significantly worse performance than other students), and (c) students' prior online learning experiences and students' emotional experiences with the COVID-19 disease were not significantly associated with performance. These results suggest that the approaches adopted by higher education institutions to support students during times of crisis should pay special attention to certain groups of students.

The Association of Toxoplasma gondii IgG Antibody and Chronic Kidney Disease Biomarkers.

BACKGROUND: Toxoplasma gondii (T. gondii) is a parasite that infects more than 40 million Americans and causes toxoplasmosis. Most cases of toxoplasmosis are asymptomatic; however, T. gondii is capable of invading organs like the kidney, causing chronic infections and cell destruction. METHODS: This study focused on evaluating the association between T. gondii exposure and chronic kidney disease (CKD) using data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). T. gondii exposure was assessed using Toxoplasma gondii IgG antibody status, and the status of CKD was assessed using the CKD biomarkers. The evaluation of risk rate and population prevalence was performed. In addition, multivariable regression models were used to further investigate this association after adjusting for sociodemographic, anthropometric, behavioral, and clinical covariates commonly associated with kidney dysfunction. RESULTS: The positive T. gondii IgG antibody participants had significantly higher levels of CKD biomarkers, including second albumin-to-creatinine ratio (p = 0.0376), second albuminuria (p = 0.0005), and persistent albuminuria (p < 0.0001) compared to the negative participants. Furthermore, there were statistical associations between T. gondii exposure and the status of CKD (negative vs. positive) (p = 0.0001), and between T. gondii exposure and the CKD stage (negative, stage 1, …, stage 5) (p = 0.0004). Without adjusting for age, the positive T. gondii participants had a significantly higher risk (27% higher) of having CKD than the negative participants (RRcrude = 1.27, 95% CI: 1.09-1.49). The age-adjusted prevalence of CKD was higher among Toxoplasma-positive participants compared to the Toxoplasma-negative participants (10.45 vs. 8.99). T. gondii infection was significantly associated with CKD (OR = 1.40, 95% CI = 1.06-1.84, p = 0.00447) after adjusting for age, gender, race/ethnicity, and BMI. Age was positively associated with CKD (OR = 8.89, 95% CI = 6.31-12.51, p < 0.0001) with the participants 45+ years old being 8.89 times more likely to have CKD than those who are <45 years old, after adjusting for T. gondii infection, gender, race/ethnicity, and BMI. Moreover, positive T. gondii increased the odds of CKD progression (OR = 1.41, 95% CI = 1.07-1.86, p = 0.0424). CONCLUSIONS: Positive T. gondii IgG antibody is associated with CKD and the progression of CKD stages. This association is more apparent among older people. Further investigations are needed to examine these findings in different geographical locations and among differentially exposed populations.

The Association of Toxoplasma gondii IgG and Cardiovascular Biomarkers.

Background: Toxoplasma gondii (T. gondii) is a protozoan parasite with high prevalence worldwide. More than 40 million individuals in the United States carry this parasite. T. gondii infection causes toxoplasmosis, which is the leading cause of death associated with foodborne diseases in the United States. T. gondii infects humans through different routes, and it is capable of invading a wide range of tissues in the human body following the infection. Methods: The main objective of this study was to investigate the prevalence of T. gondii among adults in the United States and its association with cardiovascular health using data from the National Health and Nutrition Examination Survey (NHANES 2009-2010). Considering the limitation of studies investigating the relationship between T. gondii and cardiovascular biomarkers, this study was focused on assessing the association of T. gondii to nine cardiovascular biomarkers. First, those biomarkers were investigated individually using several statistical tests and models. Second, we developed an overall cardiovascular biomarker index (OCBI) from eight critical biomarkers to better explain the T. gondii potential cumulative effect on the cardiovascular system. These analyses were adjusted for demographic, behavioral, and anthropometric factors. Results:T. gondii IgG antibody-positive participants had significantly higher systolic blood pressure (p = 0.0022), triglycerides (p = 0.0399), C-reactive protein (p = 0.0422), gamma glutamyl transferase (p = 0.0400), and fasting glucose (p = 0.0213) than the negative participants. In addition, the positive participants had significantly lower high-density lipoprotein cholesterol (p = 0.0431) than the negative participants. Adjusting for age, T. gondii positive had a significant negative association with high-density lipoprotein cholesterol (p = 0.0026) and a significant positive association with low-density lipoprotein cholesterol (p = 0.0179), triglycerides (p = 0.0154), and gamma glutamyl transferase (p = 0.0026). With the exception of the low-density lipoprotein, these associations remained statistically significant when adjusting for demographic, behavioral, and anthropometric factors. These results potentially indicate the role of T. gondii in driving cardiovascular-related biomarkers toward dysfunction. The analysis also revealed a significant difference in the OCBI among positive and negative participants (p = 0.0020), with the (cumulative) odds of positive participants having a higher level of OCBI being 0.71 times lower than the odds for negative participants (OR = 0.29). Conclusions: Positive T. gondii IgG antibody was significantly associated with adverse effects on cardiovascular-related biomarkers, including systolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and gamma glutamyl transferase. T. gondii-positive individuals were more likely to have a lower cardiovascular biomarkers index than the negative individuals. Finally, the prevalence of toxoplasmosis among U.S. adults was associated with demographic characteristics including age, ethnicity, country of birth, and occupation.

Combined preoperative HRCT parameters for prediction of round window visibility in pediatric cochlear implant patient.

OBJECTIVE: To evaluate the add value of combined analysis of high resolution computed tomography (HRCT) temporal bone parameters in accurate prediction of round window (RW) visibility through posterior tympanotomy. PATIENTS AND METHODS: a retrospective observational study was held in a tertiary center, conducted on 45 cochlear implant pediatric candidates between January 2017 and September 2019. Candidates were referred for CT temporal bone. They were classified into fully visible RW cases and partially or non-visible RW cases. Radiological measurements were compared between the two groups for prediction of RW visibility separate and in combination. RESULTS: 45 patients were included in the study (26 males (57.8%) and 19 females (42.2%)). Their median age was 4 years (2-12 years). There were 38 (84.4%) fully visible and 7 (15.6%) partially or non-visible RW cases. Kashio posterior line (n:32/3), fascial recess width (FRW) (mean: 4.9 (3.5-7.5)/4.2 (4-4.7) mm) and round window location (RWL) (3 (1-4)/2.8 (1-3)mm) measurements significantly differentiated between the two groups; (P value 0.034, 0.012 & 0.025 respectively). Posterior kashio line and cut off values of ≥4.75 mm of FRW & 2.95 mm of RWL were showed sensitivity 84.2%, 63.2% & 65.8%, and accuracy 80%, 68.9% &68.9% in prediction of RW visibility respectively. Combination of Kashio prediction line with cut off value ≥ 7.45 mm (sum of FRW & RWL) showed P value 0.003 with further improve in the sensitivity and overall accuracy in prediction of RW visibility from 84.2% to 80% up to 91.4% and 88.6% respectively. CONCLUSION: combined parameters using Kashio line with FRW and RWL increases sensitivity and overall accuracy in prediction of RW visibility rather than single parameter.

Effects of 5-Aminolevulinic Acid as a Supplement on Animal Performance, Iron Status, and Immune Response in Farm Animals: A Review.

Efforts directed toward enhancing animals' productivity are focused on evaluating the effects of non-traditional feed additives that are safer than antibiotics, which have been banned because of their health hazards. Many studies used an amino acid that contributes to heme biosynthesis, known as 5-aminolevulinic acid (5-ALA), to promote the productivity of farm animals. However, these studies demonstrate inconsistent results. In order to develop a clear understanding of the effects of 5-ALA in farm animals, we comprehensively searched PubMed and Web of Science for studies evaluating 5-ALA effects on the performance, iron status, and immune response of different farm animals. The search retrieved 1369 publications, out of which 16 trials were relevant. The 5-ALA-relevant data and methodological attributes of these trials were extracted/evaluated by two independent researchers, based on a set of defined criteria. Samples were comprised of pigs, chickens, and dairy cows. The 5-ALA doses ranged from 2 mg to 1 g/kg of feed, and treatment duration ranged from 10 to 142 days. Overall, 5-ALA improved iron status in most studies and increased white blood cells count in 3 out of 10 studies, in addition to improving animals' cell-mediated immune response following immune stimulation with lipopolysaccharide. Inconsistent findings were reported for growth performance and egg production; however, a combination of 10 mg/kg of 5-ALA with 500 mg/kg of vitamin C promoted the highest egg production. In addition, 5-ALA improved milk protein concentration. In conclusion, 5-ALA can enhance farm animals' iron status and immune response; however, the heterogeneity of the reviewed studies limits the generalizability of the findings. Standard procedures and outcome measures are needed to confirm the benefits of 5-ALA. Attention should also be paid to any adverse effects.

Foley's catheter balloon for induction of mid-trimester missed abortion with or without traction applied: a randomized controlled trial.

Objective: To determine whether the traction placed on a transcervical Foley catheter balloon inserted for the induction of mid-trimester missed abortion results in faster time of abortion.Study design: It was randomized clinical trial conducted at Assiut Woman's Health Hospital, Egypt, from September 2016 to August 2017 on women with missed abortion in the mid-trimester. Participants were randomly assigned to transcervical Foley catheter balloon insertion with or without traction. The primary outcome of this study was insertion to abortion time. The secondary outcomes included insertion to catheter expulsion time, vaginal bleeding, and pain associated with insertion. The outcome variables were analyzed using Mann-Whitney U and chi-square tests. A logistic regression model was utilized to examine the association between patient's characteristics and the failure of Foley catheter balloon expulsion within 24 hours.Results: Two hundred women were recruited (100 women in each group). The insertion to abortion time was significantly shorter in group I (traction group) than group II (no traction group) (16.49 ± 2.59 versus 18.24 ± 3.30 hours; p = .000). Insertion to balloon expulsion time in group I was also significantly short (7.92 ± 0.86 versus 9.12 ± 1.19 hours; p = .000). However, a significantly higher rate of vaginal bleeding and a higher degree of pain were reported by the women in group I (p = .008, p = .000; respectively). The nulliparity, longer interpregnancy interval (>22 months), smaller gestational age (<14 weeks) and lower Bishop Score before insertion (<2) were significantly associated with a higher likelihood of Foley catheter balloon expulsion failure within 24 hours.Conclusion: The small time advantage of traction does not compensate for the downsides of traction, mainly pain, analgesic use, and vaginal bleeding.

IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: a comparative study with direct estimation of CVP.

PURPOSE: To compare the bedside ultrasound estimation of internal jugular vein (IJV)-collapsibility index with inferior vena cava (IVC)-collapsibility index and invasively monitored central venous pressure (CVP) in ICU patients. DESIGN: prospective observational study. SETTING: The study was carried out in the ICU of Al Wakra and Al Khor hospitals of the Hamad Medical Corporation, Qatar. The patients were enrolled from November 2013 to January 2015. PATIENTS: Patients admitted to the ICU with central venous catheter were included. MATERIAL AND METHODS: The A-P diameter, cross-sectional area of the right IJV, and diameter of IVC were measured using bedside USG, and their corresponding collapsibility indices were obtained. The results of the IJV and IVC indices were compared with CVP. The sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the IJV collapsibility index in predicting the CVP. RESULTS: Seventy patients were enrolled, out of which 12 were excluded. The mean age was 54.34±16.61 years. The mean CVP was 9.88 mmHg (range =1-25). The correlations between CVP and IJV-CI (collapsibility index) at 0° were r=-0.484 (P=0.0001), r=-0.416 (P=0.001) for the cross-sectional area (CSA) and the diameter, respectively, and, at 30°, the most significant correlation discovered was (r=-0.583, P=0.0001) for the CSA-CI and r=-0.559 (P=0.0001) for the diameter-CI. In addition, there was a significant and negative correlation between IVC-CI and CVP (r=-0.540, P=0.0001). CONCLUSION: The IJV collapsibility index, especially at 30° head end elevation, can be used as a first-line approach for the bedside non-invasive assessment of CVP/fluid status in critical patients. IVC-CI can be used either as an adjunct or in conditions where IJV assessment is not possible, such as in the case of a neck trauma/surgery.

Efficacy of ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia with pregnancy: a randomized double-blind clinical trial.

Objective: The aim of this study is to compare the efficacy and tolerability of oral ferrous bis-glycinate versus ferrous glycine sulfate in the treatment of iron deficiency anemia (IDA) with pregnancy.Methods: A randomized double-blind clinical trial (NCT02590224) conducted at a tertiary University Hospital in the period between 1 January 2016 and 31 July 2017 included pregnant women at 14-18 weeks of gestation with mild to moderate IDA. Patients were randomized into two groups: (Group I) received oral ferrous bis-glycinate tablets once daily for eight consecutive weeks and (Group II) received oral ferrous glycine sulfate capsules in the same dose and duration. The primary outcome of the study was the rate of increase of hemoglobin (HB) level after 8 weeks of iron treatment.Results: The study included 187 women in the final analysis. The mean increase in HB level after 8 weeks of treatment in ferrous bis-glycinate group was 2.48 ± 0.12 g/dL versus 1.32 ± 0.18 g/dL in ferrous glycine sulfate group (p ≤ .0001). The percentage of women with HB level more than 11 g/dL after 8 weeks of treatment was 89.2% in ferrous bis-glycinate group versus 71.3% in ferrous glycine sulfate group (p < .0001). The rate of adverse effects was significantly higher in ferrous glycine sulfate group (p = .001).Conclusions: Pregnant women with second trimester IDA could be supplied with ferrous bis-glycinate which is more efficient in increasing HB level. Moreover, it has tolerable adverse effects and high compliance than ferrous glycine sulfate.

Comparative study between mini-incision and conventional surgical approaches for carpal tunnel release

Background: Conventional approach is an effective method for carpal tunnel release, however it causes scar discomfort, pillar pain and cosmetic complaints. Several mini-incision techniques were introduced to avoid such complications. Aim of the study The aim of this study is to compare the results of two surgical techniques, the conventional longitudinal incision over the transverse carpal ligament (TCL), and the mini-incision at the distal wrist crease and near the proximal border of the TCL for carpal tunnel release. Patients and Methods: This study included 20 patients with carpal tunnel syndrome. 10 were operated upon by classical open palmar incision (group A) and 10 through mini-incision technique at distal wrist crease (group B). Follow up was after 2 weeks, 1, 3 and 6 months. Incisional pain, pillar pain using Visual Analog Scale (VAS), Levine symptom and function severity scores were evaluated at 3rd and 6th months postoperatively. Patients' satisfaction about surgery and cosmetic results were evaluated using Visual Analog Patient Satisfaction Scale (VAPSS). Patients graded their cosmetic results from poor to excellent. Results: There were no intraoperative complications. Group B showed significantly less incisional and pillar pain. Patients were significantly more satisfied about cosmetic results in group B. There was no significant difference between both groups regarding time taken to return to daily life activities. Conclusion: Conventional and mini-incision surgical approaches are both safe effective methods for carpal tunnel release. Mini-incision technique provided smaller and less painful scar, hidden in the wrist crease

Green Nanoparticles Engineering on Root-knot Nematode Infecting Eggplants and Their Effect on Plant DNA Modification.

BACKGROUND: Root-knot nematodes are known to cause significant damage to eggplants. New approaches by green silver nanoparticles (GSN) are used to control plant-parasitic nematode to avoid chemical nematicide hazards. OBJECTIVES: Analyses of the incorporation of different concentrations of nanoparticles on two different algae (Ulva lactuca and Turbinaria turbinata) were carried out. Furethermore, the effect of GSN on the eggplant DNA profile was studied using RAPD and EST molecular markers. MATERIALS AND METHODS: Green Silver Nanoparticles (GSN) have been synthesized and characterized using the algal extract solution prepared from two algal genera. Nematicidal effect of the GSN was evaluated in greenhouse on eggplants (Solanum melongena cv. Login). Genomic DNA was extracted for use in molecular analysis. Both RAPD and EST molecular markers were used to study the GSN effect on eggplant DNA modification. RESULTS: GSN (17 mg.mL-1) obtained from U. lactuca was more effective in reducing second-stage juveniles (J2s) of M. javanica (69.44%) population in soil. All treatments improved eggplants growth parameters. Change in DNA profile using of both RAPD and EST markers was noted. CONCLUSIONS: GSN (12.75 mg.100 mL-1) were effective on controlling the root-knot nematode (both T. turbinata and U. lactuca algae), similar to chemical control in eggplants. GSN did not cause any phototoxicity in eggplants under treatment.

Topical mitomycin C as an adjunct to surgical debulking and medical treatment in rhinoscleroma.

BACKGROUND: Rhinoscleroma is a chronic granuloma that is endemic in Egypt and is caused by gram-negative bacilli (Klebsiella rhinoscleromatis). The nasal mucosa is affected in almost all cases, which causes nasal obstruction, anosmia, and epistaxis. The disease usually passes through an atrophic stage (atrophic rhinitis) and a granulomatous stage before ending in the fibrotic stage, with possible bone destruction. OBJECTIVE: This study assessed the effect of topical mitomycin C (MMC) on reducing the recurrence of granulation tissue and intranasal adhesions after endoscopic debulking and continuous medical treatment of nasal rhinoscleroma. MATERIALS AND METHODS: This double-blind randomized clinical trial was performed with 30 patients who had rhinoscleroma (granulomatous and fibrotic stages). At the end of endoscopic debulking, meshes impregnated with MMC was placed in one nasal cavity for 5 minutes, while another meshes impregnated with saline solution were placed in the opposite side. Repeated meshes with MMC were placed in the same side during the follow-up period. Patients were followed up for 1 year. The recurrence of granulation tissue and the degree of intranasal adhesions were recorded and compared according to the Lund-Kennedy score. RESULTS: At 12 months' follow-up, among the total 30 patients, 30 MMC sides were compared with 30 control sides: 69% of MMC sides versus 32% of control sides had no recurrence of granulation tissue (p = 0.01) and 65% of MMC sides versus 24% of control sides had no recurrence of intranasal adhesions (p = 0.03). The Lund-Kennedy score decreased from 2.1 ± 0.64 to 0.8 ± 0.41 and from 2.3 ± 0.33 to 1.9 ± 0.20 in the MMC sides and control sides, respectively, with a nonstatistically significant lower incidence of intranasal adhesions in the MMC sides. CONCLUSION: Topical MMC may reduce granulation tissue and intranasal adhesion formation in patients with rhinoscleroma. Further studies with a larger number of samples and longer follow-up periods are recommended.