Fabrication of environmentally safe antifouling coatings using nano-MnO2/cellulose nanofiber composite with BED/GMA irradiated by electron beam.

Marine biofouling, undesirable growth of organisms on submerged surfaces, poses significant challenges in various industries and marine applications. The development of environmentally safe antifouling coatings employing nano-MnO2/cellulose nanofiber (CNF) composite with bisphenol A epoxy diacrylate/glycidyl methacrylate (BED/GMA) irradiated by electron beam (T1) has been achieved in the current work. The physico-chemical characteristics of the fabricated coatings have been studied using Fourier transforms infrared spectroscopy, scanning electron microscope, water contact angle, and X-ray diffraction. The efficacy of T1 formulation and pure BED/GMA polymer (T2) in inhibiting biofouling formation was investigated in seawater of Alexandria Eastern Harbour by examining biofilm development morphologically and biochemically. In addition, regular analyses of seawater physicochemical parameters were conducted monthly throughout study. Results provide valuable information on coating performance as well as the complex interactions between coatings, biofilms, and environmental factors. The T1 formulation exhibited strong anti-fouling and anticorrosion properties over 2 months. However, after four months of immersion, all coated steel surfaces, including T1, T2, and T0, were heavily covered with macro-fouling, including tubeworms, barnacles, and algae. Biochemical analysis of extracellular polymeric substances (EPS) showed statistically significant variations in carbohydrates content between the coated surfaces. The T1 formulation showed decreased protein and carbohydrate content in EPS fractions after 14 days of immersion indicating less biofouling. Moreover, elemental analysis showed that carbon, oxygen, and iron were the predominant elements in the biofilm. Other elements such as sodium, silicon, chloride, and calcium were in lower concentrations. T2 and T0 surfaces revealed higher calcium levels and the appearance of sulphur peaks if compared with T1 surface. Diatoms and bacteria were detected on T1, T2, and T0 surfaces. The observed warming of seawater and nutrient-rich conditions were found to promote the growth of fouling organisms, emphasizing the importance of considering environmental factors in biofouling management strategies.

Impaction bone grafting for contained acetabular defects in total hip arthroplasty.

BACKGROUND: Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. METHODS: In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. RESULTS: This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. CONCLUSIONS: IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. LEVEL OF EVIDENCE: Level IV.

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis / 대한소아소화기영양학회지

No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA).A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08–0.33; I2 =46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00–63.63; I2 =96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01–0.73; I2 =80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00–0.62; I2 =69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00–3.22; I2 =86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00–175.21; I2 =94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has affected routine endoscopy service across the gastroenterology community. This led to the suspension of service provision for elective cases. AIM: To assess the potential barriers for resuming the endoscopy service in Egypt. METHODS: A national online survey, four domains, was disseminated over a period of 4 wk in August 2020. The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s). RESULTS: A hundred and thirteen Egyptian endoscopy centers participated in the survey. The waiting list was increased by ≥ 50% in 44.9% of areas with clusters of COVID-19 cases (n = 49) and in 35.5% of areas with sporadic cases (n = 62). Thirty nine (34.8%) centers suffered from staff shortage, which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis. In multivariate analysis, the burden of cases in the unit locality, staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice (P = 0.029, < 0.001 and 0.02, respectively) and Odd's ratio (0.15, 1.8 and 0.16, respectively). CONCLUSION: The COVID-19 pandemic has led to restrictions in endoscopic volumes. The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery. Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.

Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy

ImportanceThe analysis of lung tissues of patients with COVID-19 may help understand pathogenesis and clinical outcomes in this life-threatening respiratory illness. ObjectiveTo determine the histological patterns in lung tissue of patients with severe COVID-19. Design and participantsLungs tissues of 38 cases who died for COVID-19 in two hospital of Northern Italy were systematically analysed. Hematoxylin-eosin staining, immunohistochemistry for the inflammatory infiltrate and cellular components, electron microscopy were performed. ResultsThe features of the exudative and proliferative phases of Diffuse Alveolar Disease (DAD) were found: capillary congestion, necrosis of pneumocytes, hyaline membrane, interstitial oedema, pneumocyte hyperplasia and reactive atypia, platelet-fibrin thrombi. The inflammatory infiltrate was composed by macrophages in alveolar lumens and lymphocytes mainly in the interstice. Electron microscopy revealed viral particles in the cytoplasm of pneumocytes. Conclusions and relevanceThe predominant pattern of lung lesions in COVID-19 patients is DAD, as described for the other two coronavirus that infect humans, SARS-CoV and MERS-CoV. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequently found. The main relevant finding is the presence of platelet-fibrin thrombi in small arterial vessels; this important observation fits into the clinical context of coagulopathy which dominates in these patients and which is one of the main targets of therapy.

An integrated water quality assessment of Damietta and Rosetta branches (Nile River, Egypt) using chemical and biological indices.

Rosetta and Damietta are the main branches of the Nile River in Egypt. They provide the required freshwater for different usage for about 20 million people. In the present study, chemical and biological indices were used to assess the water quality and provide a full image of the environmental status in the investigated area. Generally, the chemical parameters, except the dissolved oxygen, were at higher levels in Rosetta Branch when compared to Damietta Branch. Also, Damietta Branch frequently showed the presence of the macroinvertebrate families that are bioindicators of moderate and good water quality. Contrarily, the most resistant species to pollution were frequently recorded in the Rosetta Branch. According to Canadian WQI, the water of Rosetta Branch is classified from "marginal" to "poor" for the drinking and aquatic life uses and "fair" to "good" for irrigation usage. On the other side, the water quality of Damietta Branch is classified as "fair" with respect to drinking water and "good" to aquatic life and irrigation. Based on using macroinvertebrate families as bioindicators, the Biological Monitoring Working Party (BMWP) index and the Nile Biotic Pollution Index (NBPI) indicated that the water quality of the Damietta Branch was within "moderate" class, while Rosetta Branch is categorized from "very polluted" to "extremely polluted" classes. The results proved that both BMWP and NBPI have coincided with the CWQI for the drinking and aquatic life indices (p < 0.0001) indicating the validity of BMWP and NBPI to assess the water quality of the investigated area.

Prognostic value of different cardiac magnetic resonance imaging derived parameters in Egyptian patients with ST-elevation myocardial infarction after successful reperfusion by primary percutaneous intervention.

BACKGROUND: Cardiac magnetic resonance (CMR) is an extremely accurate and useful modality that can give much data about myocardial damage after acute myocardial infarction and consequently can give a good idea about long-term prognosis. Unfortunately, this modality is still underused in Egypt. We tried to assess the prognostic significance of different parameters derived from CMR in Egyptian patients presenting with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous intervention (PPCI). Twenty-five patients who presented with acute STEMI and were successfully reperfused by PPCI within 12 h from symptoms onset were included. CMR was performed 2-4 days after PPCI. Six months of long-term follow-up for major adverse cardiovascular events (re-infarction, new-onset heart failure and cardiac death) was done. CMR-derived parameters (edema volume, area at risk, infarction volume, infarction percentage, microvascular obstruction volume, microvascular obstruction percentage, myocardial salvage and myocardial salvage index) were analyzed in relation to incidence of major adverse cardiovascular events (MACE). RESULTS: Seven patients suffered from MACE. Univariate logistic regression analysis showed a significant correlation between edema volume (P = 0.04), area at risk (P = 0.05), infarction percentage (P = 0.05) and the occurrence of MACE. Multivariate logistic regression analysis showed that infarction percentage (P = 0.05) is the best parameter that can predict MACE. CONCLUSION: Infarction percentage is potentially the most important prognosticator derived from CMR in Egyptian patients with acute STEMI successfully reperfused by PPCI.

Peritoneal Dialysis in Adult Patients with Permanent Suprapubic Catheter: A Single-Center Experience and Literature Review.

BACKGROUND: The aim of this paper was to review the feasibility of peritoneal dialysis (PD) in the presence of a permanent suprapubic catheter over a long follow-up period. METHODS: Twelve patients with automated PD and permanent suprapubic catheters were studied for complications over a period of 10 years. RESULTS: In all 12 patients, PD went smoothly. Two of our patients required removal of the PD catheter due to peritonitis. The overall rate of exit-site infection throughout the study was 41.7/patient-month and the difference between patients 60 years or older and those 25 years or younger was not significant (p = 0.3673). The overall peritonitis rate for all patients was 38.3 episode/patient-month, and none of the patients with ventriculoperitoneal shunt (VPS) had peritonitis. All patients with episodes of infection responded well to the proper antibiotics. CONCLUSIONS: The available data supported the feasibility of PD in patients with permanent suprapubic catheters; however, a greater number of patients with a longer follow-up period need to be studied to support our results.

Teaching clinical reasoning through hypothetico-deduction is (slightly) better than self-explanation in tutorial groups: An experimental study.

BACKGROUND: Self-explanation while individually diagnosing clinical cases has proved to be an effective instructional approach for teaching clinical reasoning. The present study compared the effects on diagnostic performance of self-explanation in small groups with the more commonly used hypothetico-deductive approach. METHODS: Second-year students from a six-year medical school in Saudi Arabia (39 males; 49 females) worked in small groups on seven clinical vignettes (four criterion cases representing cardiovascular diseases and three 'fillers', i.e. cases of other unrelated diagnoses). The students followed different approaches to work on each case depending on the experimental condition to which they had been randomly assigned. Under the self-explanation condition, students provided a diagnosis and a suitable pathophysiological explanation for the clinical findings whereas in the hypothetico-deduction condition students hypothesized about plausible diagnoses for signs and symptoms that were presented sequentially. One week later, all students diagnosed eight vignettes, four of which represented cardiovascular diseases. A mean diagnostic accuracy score (range: 0-1) was computed for the criterion cases. One-way ANOVA with experimental condition as between-subjects factor was performed on the mean diagnostic accuracy scores. RESULTS: Students in the hypothetico-deduction condition outperformed those in the self-explanation condition (mean = 0.22, standard deviation = 0.14, mean = 0.17; standard deviation = 0.12; F(1, 88) = 4.90, p = 0.03, partial η2 = 0.06, respectively). CONCLUSIONS: Students in the hypothetico-deduction condition performed slightly better on a follow-up test involving similar cases, possibly because they were allowed to formulate more than one hypothesis per case during the learning phase.

[Coronary artery bypass graft in adolescent suffering from homozygous familial hypercholesterolemia resistant to probucol therapy]. / Pontage aorto-coronarien chez un adolescent souffrant d'une hypercholesterolemie familiale homozygote resistante au probucol.

Homozygous familial hypercholesterolemia is a rare hypercholesterolemia representing 1 to 2% of hypercholesterolemia. It is a metabolic disorder coming from genetic trouble with a bad prognostic. Its probucol's therapy in an adolescent is subject of controversy. The authors report a new case diagnosed in an adolescent of 15-year-old followed after CABG in the Thoracic and cardiovascular surgery Department of National Heart Institute Imbaba-Cairo (Egypt).

Effect of natamycin on the enumeration, genetic structure and composition of bacterial community isolated from soils and soybean rhizosphere.

Natamycin is commonly used to control fungal growth on agar media used for bacterial enumeration or strain isolation. However, there is no conclusive report on the possible effect of this antibiotic on bacterial growth or on the diversity of the recovered soil bacteria. Therefore, the possible effects of natamycin on the numbers of bacteria isolated at 12 degrees C from three different soils and soybean rhizosphere soil were investigated using natamycin concentrations ranging from 0 to 200 mg l(-1). Our results demonstrate that natamycin concentrations, which inhibit the growth of fungi on the media, have a small but significant inhibitory effect on the number of bacterial colony forming units. A natamycin concentration of 50-200 mg l(-1) is required for an efficient control of fungal growth on media in our experimental conditions depending on the soil type. Bacterial community structure was assessed on culturable cells (cells washed from enumeration plates: plate-wash approach) obtained at 12 degrees C from soybean rhizosphere soil by performing Ribosomal Intergenic Spacer Analysis (RISA) fingerprinting. We demonstrate that all natamycin concentrations used alter the structure of the recovered, culturable bacterial community, compared to control without natamycin. Using ARDRA (amplification of the 16S rDNA gene and restriction analysis) genotyping of individual isolates, some differences were observed between the bacterial isolates obtained in the presence or absence of natamycin. Bacterial isolates recovered in the presence of natamycin are more tolerant (maximal growth rate and lag phase) to this compound than those isolated without natamycin, indicating a possible selection of resistant strains. Therefore, high concentration of natamycin cannot be used for isolation of bacterial strains with the aim of studying biodiversity and could bias a selection of strains for practical applications.

Hormonal versus genetic factors in limb and heart anomalies.

Three men, aged 18, 21 and 27 years, underwent surgery for atrial septal defect of the ostium secundum. All had bilateral absence of the forearm and thumb, with the rest of the hand directly attached to the upper arm. The patients had been exposed to synthetic progestogens during early intrauterine development. The oldest patient is described, together with a 6-year-old boy with limb reduction and Fallot's tetralogy who was exposed to the contraceptive pill during the first 2 months of gestation. During surgery he was found to have atrial septal defect of the ostium secundum. The most plausible diagnosis in such cases is the Holt-Oram syndrome, but the teratogenic effect of the synthetic hormones may be an important aetiological factor. Both hypotheses are discussed.