Is Elastic Stable Intramedullary Nailing a Viable Treatment Option for Diaphyseal Fractures of the Humerus in Adults? A 29-case Series Prospective Study.

BACKGROUND: Humerus shaft fractures are common in orthopaedic practice. The emphasis in treatment has shifted from prolonged immobilisation to early mobilisation and internal fixation when needed for a quicker return to normal function. Internal fixation methods include plate osteosynthesis and intramedullary nailing. This study specifically evaluated the effectiveness of flexible intramedullary nails in treating diaphyseal humeral fractures. MATERIAL AND METHODS: Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) with diaphyseal humeral fractures. Treatment involved closed reduction and percutaneous fixation using two flexible nails. Patients, aged 17 to 65 with a mean age of 32, were included if they did not have pathological fractures, were above 16 years old, and were medically suitable. Causes included pedestrian vehicle accidents (17 cases) and falls or sports-related activities (12 cases). Surgical intervention occurred 1 to 8 days after the injury. RESULTS: Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) for diaphyseal humeral fractures using closed reduction and percutaneous fixation with two flexible nails. Patients, aged 17 to 65, were monitored for an average of 18 months. Radiographic assessments showed complete union in nineteen fractures within 13 to 21 weeks. One patient experienced non-union but was successfully treated with bone grafting and plating. There were no significant intraoperative complications. Notably, four patients with preoperative radial nerve injuries recovered within 6 to 8 weeks. Evaluation using the Stewart and Hundley Scoring technique showed excellent outcomes for 60% of patients, good outcomes for 30%, fair outcomes for 5%, and poor outcomes for 5%. CONCLUSIONS: 1.The Elastic Stable Intramedullary Nailing (ESIN) technique shows promise in the treatment of humeral shaft fractures. 2. However, the success of treatment may depend on various factors, including patient age, fracture characteristics, and the presence of complications such as open fractures and radial nerve palsy. 3. Careful consideration of these factors is necessary when selecting a treatment approach for humeral shaft fractures.

Is Simultaneous Bilateral Knee Replacement a Safe Approach for Patients with Bilateral Knee Osteoarthritis? A Prospective Case-control Study.

BACKGROUND: Total knee arthroplasty (TKA) is the standard treatment for terminal knee osteoarthritis. Simultaneous bilateral total knee arthroplasty (STKA) can be a cost-effective and practical option for patients with degenerative joint disease affecting both knees. The purpose of this study was to assess complication rates and functional outcomes following simultaneous versus staged bilateral total knee replacement. MATERIAL AND METHODS: Approximately 60 individuals who experienced debilitating knee osteoarthritis were enrolled in a prospective study with a randomized comparative design. Out of these, 30 patients underwent simultaneous total knee arthroplasty (STKA), while the remaining 30 individuals underwent two separate surgeries with a gap of 3-6 months between each procedure for both knees. After excluding 7 patients from both groups, a total of 53 patients were included in the study and followed up for at least 12 months. RESULTS: Pre-operative demographic parameters were equated between both groups. The overall number of systemic complications was higher in the simultaneous group compared with the stagedone. Systemic complications were correlated with the elderly and high-risk populations. However, simultaneous procedures were safe in a low-risk group with shorter hospitalization and operative times. CONCLUSIONS: 1. Simultaneous bilateral total knee arthroplasty (TKA) is considered safe and feasible mainly for younger individuals with ASA 1 or 2 health status. 2. Patients undergoing simultaneous bilateral TKA experience significantly reduced hospital stays. 3. The procedure may not be advisable for elderly patients at a higher risk of systemic complications.

Developing a Chromatographic 99mTc Generator Based on Mesoporous Alumina for Industrial Radiotracer Applications: A Potential New Generation Sorbent for Using Low-Specific-Activity 99Mo.

The commercial low-pressure column chromatographic 99Mo/99mTc generator represents a reliable source of onsite, ready-to-use 99mTc for industrial applications. These generators use fission-produced 99Mo of high specific activity, posing serious production challenges and raising proliferation concerns. Therefore, many concepts are aimed at using low-specific-activity (LSA) 99Mo. Nonetheless, the main roadblock is the low sorption capacity of the used alumina (Al2O3). This study investigates the feasibility of using commercial alumina incorporated with LSA 99Mo to develop a useful 99Mo/99mTc generator for industrial radiotracer applications. First, the adsorption profiles of some commercial alumina sorbents for LSA 99Mo were tested under different experimental conditions. Then, the potential materials to develop a 99Mo/99mTc generator were selected and evaluated regarding elution yield of 99mTc and purity. Among the sorbents investigated in this study, mesoporous alumina (SA-517747) presented a unique sorption-elution profile. It demonstrated a high equilibrium and dynamic sorption capacity of 148 ± 8 and 108 ± 6 mg Mo/g. Furthermore, 99mTc was eluted with high yield and adequate chemical, radiochemical, and radionuclidic purity. Therefore, this approach provides an efficient and cost-effective way to supply onsite 99mTc for radiotracer applications independent of fission-produced 99Mo technology.

Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old.

BACKGROUND: The aim of this study was to assess the safety and efficacy of chronic subdural hematoma (CSDH) evacuation by two burr-hole craniostomies under local versus general anesthesia (GA) in elderly patients over 70 years. METHODS: This retrospective study included 45 patients with CSDH aged over 70 years old treated from March 2018 to April 2020. The cases were subdivided into Group A (n = 22) that underwent evacuation under local anesthesia and Group B (n = 23) that was treated under GA. Patients' demographics and history of comorbidities were recorded. Variables including pre- and post-operative neurological status and Markwalder's score, complication rate, operative time, and length of hospital stay were evaluated. RESULTS: The mean and standard deviation of patients' age of groups (A) and (B) were 74.3 ± 2.5 and 73.2 ± 1.7 years, respectively. Postoperative Glasgow Coma Scale of group (A) was statistically higher than Group B at postoperative day 1 (P = 0.01). Operative time was statistically shorter in Group A than B (P < 0.0001). The length of hospital stay was found to be longer in group (B) than (A) (P = 0.0001). The complication rate was found to be higher in group (B) than (A) (P = 0.044). CONCLUSION: Evacuation of CSDH under local anesthesia in elderly patients over 70 years is effective, safe, and economic with less complication rate than the traditional technique with GA.

Dietary Cinnamon Successfully Enhanced the Growth Performance, Growth Hormone, Antibacterial Capacity, and Immunity of European Sea Bass (Dicentrarchus labrax).

Dietary cinnamon has several bioactive compounds with growth-promoting and immunomodulation potential and is suggested for finfish species. This study evaluated the inclusion of cinnamon at 0, 10, 15, and 20 g/kg in European sea bass (Dicentrarchus labrax) diets. After 90 days, the highest final weight, weight gain, specific growth rate, protein efficiency ratio, and the lowest feed conversion ratio were seen in fish treated with 10 g/kg (p < 0.05). Further, the measured growth hormone in the blood indicated that fish treated with 10 g/kg had a higher level than fish 0 and 20 g/kg. After the feeding trial, fish treated with cinnamon at varying levels had higher lipid content than fish before the feeding trial (p < 0.05). Lower Vibrio spp. and Faecal Coliform counts were observed in fish treated with cinnamon than fish fed a cinnamon-free diet (p < 0.05). The hematocrit level was markedly (p < 0.05) increased in fish fed cinnamon at 10 g/kg compared to the control without significant differences with fish fed 15 and 20 g/kg. Hemoglobin was significantly increased in fish treated with cinnamon at 10, 15, and 20 g/kg compared to fish fed a cinnamon-free diet (p < 0.05). Red and white blood cells (RBCs and WBCs) were meaningfully (p < 0.05) increased in fish treated with cinnamon compared with the control. Markedly, fish treated with cinnamon had higher serum total lipids than the control with the highest value in fish treated with 15 g/kg (p < 0.05). The lysozyme activity was markedly higher in fish treated with 15 g cinnamon/kg than fish fed 0, 10, and 20 g/kg (p < 0.05). Moreover, phagocytic activity was significantly higher in fish treated with cinnamon at 10, and 15 g/kg than fish fed 0 and 20 g/kg (p < 0.05). In conclusion, dietary cinnamon is suggested at 10-15 g/kg for achieving the high production and wellbeing of European sea bass.

Virtual Handover of Patients in the Pediatric Intensive Care Unit During the Covid-19 Crisis.

OBJECTIVE: A key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians' experience using an online video-conferencing application for handover during the COVID-19 pandemic. DESIGN: Qualitative content analysis. SETTING: PICU at a university hospital in Riyadh, Saudi Arabia. SUBJECTS: PICU Physicians. INTERVENTIONS: Due to the pandemic, the hospital's PICU used Zoom® as a remote conferencing application instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (1 Jul 2020 to 14 Jul 2020). MEASUREMENTS: An online survey was conducted using open-ended questions to capture demographic data and the perceived efficacy of remote handovers. Thematic framework analysis process included open coding, creating categories, and abstraction. MAIN RESULTS: All 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. While 20 (54.1%) physicians reported attending 1-5 Zoom handovers by the time of the study, some (n. 6, 16.2%) had more than ten virtual handovers. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote handover. Most found that Situation-Background-Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. CONCLUSION: Video-conferencing applications for online handovers could supplement traditional face-to-face intensive care unit patient handover during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users' experience.

The Impact of Dietary Curcumin on the Growth Performance, Intestinal Antibacterial Capacity, and Haemato-Biochemical Parameters of Gilthead Seabream (Sparus aurata).

The need to replace antibiotics in aquafeed is increasing, and alternative safe substances are now encouraged for sustainable aquaculture activity. Curcumin is regarded as a multifunctional feed additive with growth-promoting and immunostimulant potential. Thus, this study evaluated dietary inclusion of curcumin at rates of 0, 1.5, 2, 2.5, and 3% in the diets of Gilthead seabream for 150 days. The results showed an improved final body weight, weight gain, specific growth rate, and feed conversion ratio in fish treated with curcumin, in a dose-dependent manner. The highest growth performance was observed in fish fed a diet supplemented with 3% curcumin. The results also showed lowered activity of pathogenic bacteria (Vibrio spp. and Faecal coliform) in the intestines of Gilthead seabream fed a diet with curcumin inclusion, in a dose-dependent manner. The hematological indices were within the normal range for healthy fish, without meaningful effects except for hematocrit, hemoglobin, red blood cells (RBCs), and white blood cells (WBCs), which were markedly increased by dietary curcumin. Phagocytic activity was obviously enhanced by dietary curcumin, compared with the control. The biochemical blood metabolites related to liver function (alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT)), renal tissue (urea), and total cholesterol were within the normal values, without significant differences. Overall, the inclusion of curcumin at a rate of 2-3% improved the growth performance and well-being of Gilthead seabream.

Endoscopic treatment of brain abscess.

BACKGROUND: Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients. METHODS: This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months. RESULTS: There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14-15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation. CONCLUSION: Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.

Neurosurgical education during COVID-19: challenges and lessons learned in Egypt.

BACKGROUND: The coronavirus pandemic (COVID-19) has disrupted the routine neurosurgical education and practice worldwide and so more in developing countries. Continuing the neurosurgical training while maintaining the well-being of our residents should be the primary concern of leaders of training programs. OBJECTIVES: The aim of this cross-sectional study was the evaluation of the impact of COVID-19 on neurosurgical residency programs and neurosurgical practice in five tertiary medical centers in our country. We also aimed at detecting the shortcomings in training programs and provide solutions. METHODS: An online questionnaire-based survey was prepared and sent to 73 neurosurgery residents in 5 tertiary centers in 4 governorates by social networks. The questions focused on the evaluation of clinical and surgical activities before and after the pandemic. Safety precautions, education, and residents' mental health were also evaluated. RESULTS: Fifty residents responded to our survey. We identified a significant reduction in surgical cases, inpatient services, and working hours per week during the pandemic comparing to the pre-pandemic era. We also identified a significant increase in research hours and changes in educational methods from in-person methods to virtual ones. Seventy-four percent reported that personal protective equipment was not adequate for their duties. Sixty-eight percent experienced burnout symptoms. Unavailability of personal protective equipment, negative concerns regarding the surgical career, and financial strains significantly affected the mental health of residents. CONCLUSIONS: The survey highlighted the negative impact of COVID-19 on neurosurgical practice and education. Being in a developing country, this negative effect was amplified due to financial reasons and weak infrastructure. Inadequate personal protective equipment increased the risk of infection and work-related stress among neurosurgery residents. We lacked telemedicine services in our country. Online education gained more visibility and awareness.

Delayed recovery from paraplegia following resections of thoracic meningiomas.

BACKGROUND: In this retrospective study, we evaluated the patterns of postoperative recovery for patients who were initially paraplegic before the excision of thoracic spine meningiomas. We also determined how the various prognostic factors impacted outcomes. METHODS: Twenty patients with paraplegia underwent surgical excision of thoracic spine meningiomas at 2016- 2019. Patients' demographics, clinical, radiological data, operative details, histopathology, and postoperative complications were recorded; patients were reassessed at 6 months and 1 year postoperatively. RESULTS: Fourteen patients improved postoperatively, becoming, ambulatory with/without assistance; only six remained paraplegic. Poor prognostic factors for postoperative motor recovery included larger tumor size, longer duration of preoperative symptoms/paraplegia, and greater severity of sensory loss. CONCLUSION: For 6/20 patients with thoracic meningiomas, poor postoperative recovery of motor function correlated with larger tumor size, longer duration of preoperative symptoms/paraplegia, and more severe sensory loss.

Doctor-patient distancing: an early experience of telemedicine for postoperative neurosurgical care in the time of COVID-19.

BACKGROUND: Telemedicine remains an important tool of healthcare services delivery especially in the era of the COVID-19 pandemic. Its advantages include saving the time and money of the patients and the prevention of infection among healthcare providers. OBJECTIVES: In this study, we aim to evaluate the effectiveness and safety of telemedicine visits in providing postoperative care of neurosurgical patients. MATERIALS AND METHODS: We conducted this prospective study on 30 neurosurgical patients who were evaluated after surgery via telemedicine visits for 30 days. During the virtual visits, we discussed the clinical progress of patients, wound status, treatment modification, the time of return to work, postoperative complications, and the radiological data of the patients. All the patients were given an emergency number to call in case of urgent issues. The satisfaction of patients and doctors was measured with the aid of two questionnaires. RESULTS: The patients' age ranged from 18 to 65 years. Twenty patients were male and 10 patients were female. We performed 20 cranial operations and 10 spinal operations. Most patients needed more than 4 h to reach the hospital. The total number of telemedicine visits was 67 visits. We received about 62 emergency calls. Pain management, seizures control, wound infection, and hydrocephalus is among issues that were evaluated and managed via telemedicine visits. The overall satisfaction rate among patients and doctors was 90% and 95%, respectively. CONCLUSION: Virtual outpatient clinics seem to be a safe and effective way of postoperative care especially in the time of the COVID-19 pandemic.

circRNAs (hsa_circ_00156, hsa_circ _000224, and hsa_circ _000520) are novel potential biomarkers in hepatocellular carcinoma.

Circular RNAs (circRNAs) are a newly validated type of noncoding RNAs recently found to be deregulated in several human cancers. More accurate and specific noninvasive biomarkers are strongly needed for better diagnosis and prognosis of hepatocellular carcinoma (HCC). We performed a bioinformatics analysis to retrieve a novel panel of circRNAs potentially relevant to HCC. We examined their expression in the sera of 68 patients with HCC, 60 patients with chronic hepatitis C, and 36 healthy controls using quantitative polymerase chain reaction. We examined the performance characteristics of the selected circRNA biomarker panel in comparison with alpha-fetoprotein (AFP). In addition, we performed a survival analysis to correlate between their expression levels and patient survival. The circRNAs hsa_circ _00224 and hsa_circ _00520 showed a strong biomarker potential with relatively high sensitivities and specificities compared with AFP. The combined panel including the three circRNAs showed superior performance characteristics relative to those of AFP. The median follow-up period was 26 months. hsa_circ_00520 expression has been shown to be associated with relapse-free survival (P < 0.005). circRNAs hsa_circ_00156, hsa_circ_000224, and hsa_circ_000520 are novel potential biomarkers of high sensitivity and specificity, which could potentially be used in the diagnosis of HCC.

Managing military penetrating brain injuries in the war zone: lessons learned.

OBJECTIVEManaging penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.METHODSThis study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.RESULTSThere were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.CONCLUSIONSManaging military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.

Spinal meningeal melanocytoma in a 5-year-old child: a case report and review of literature.

BACKGROUND: Meningeal melanocytoma is considered a rare lesion arising from leptomeningeal melanocytes. Nearly two thirds of meningeal melanocytomas were reported in the intracranial compartment and the remaining one third in the spine. Spinal melanocytomas can be extradural or intradural, with extradural variant being more common, and the majority of cases have been single reports. METHODS: A 5-year-old male presented with a 4-month history of non-radiating low back pain persistent at rest, with otherwise non-remarkable medical history. The patient was neurologically intact with no deficits. Preoperatively, routine laboratory investigations were non-remarkable. MRI imaging was done and showed a lesion at the level of T11 to L4, hyperintense on T1 and hypointense on T2 with homogenous contrast enhancement. Intraoperatively, the lesion was hemorrhagic, brownish, and rubbery in consistency attached to the ventral dura. Microscopic picture revealed dense cytoplasmic brown melanin pigments, with no significant mitoses or nuclear atypia. What is unique about our case is the age of the patient (5 years). RESULTS: To the best of our knowledge, after reviewing the literature, this is the youngest case to be reported. CONCLUSIONS: SMM is an extremely rare tumor with a benign course. Complete surgical excision should be attempted. Age of presentation may be as young as in our case and the diagnosis of such a tumor should never be excluded in this early age group with persistent low back ache.

Epigenetic regulation of immune checkpoints: another target for cancer immunotherapy?

Epigenetic changes in oncogenes and tumor-suppressor genes contribute to carcinogenesis. Understanding the epigenetic and genetic components of tumor immune evasion is crucial. Few cancer genetic mutations have been linked to direct correlations with immune evasion. Studies on the epigenetic modulation of the immune checkpoints have revealed a critical interaction between epigenetic and immune modulation. Epigenetic modifiers can activate many silenced genes. Some of them are immune checkpoints regulators that turn on immune responses and others turn them off resulting in immune evasion. Many forms of epigenetic inheritance mechanisms may play a role in regulation of immune checkpoints including: covalent modifications, noncoding RNA and histone modifications. In this review, we will show how the potential interaction between epigenetic and immune modulation may lead to new approaches for specific epigenome/immunome-targeted therapies for cancer.

Gene expression profiling in organ transplantation.

Aim of Review. Huge effort is being made among the transplant community investigating novel biomarkers that enable transplant clinicians to identify patients at risk for allograft rejection or those who will develop tolerance so that immunosuppression could be safely minimized or even ideally withdrawn. Despite the important advances achieved in the identification of several potential biomarkers of tolerance, rejection, or both, validation and demonstration of their clinical utility still needs to be tested, which will need international cooperative networks. It is important to note that the reproducibility of differently expressed genes might be affected by many factors such as gene ranking and selection methods, inherent differences between types, and the choice of thresholds. However, because microarray analyses are expensive and time consuming and their statistical evaluation is often very difficult, gene expression analysis using the RTPCR method is nowadays recommended. Conclusions. In the field of organ transplantation, gene-expression-based decision might help in improving patient and graft outcome and there are a multitude of studies showing that gene-expression profiling is feasible.

Dilemma of HCV infection in renal transplant recipients.

Hepatitis C virus, which usually starts during dialysis therapy, is currently the main cause of chronic liver disease in such population. The majority of patients acquired the disease through intravenous drug use or blood transfusion, with some risk factors identified. In this review we are dealing with the effect of renal transplantation on HCV infection and HCV-related complications after renal transplantation. Moreover, we are discussing the therapeutic options of HCV infection before and after renal transplantation, the best immunosuppressive protocol and lastly graft and patient survival in patients who underwent pretransplant management vs. those who were transplanted without treatment.