Assessment of Nasal Obstruction Symptoms and Pulmonary Function Following Functional Endoscopic Sinus Surgery (FESS) in Chronic Rhinosinusitis with Nasal Polyps.

The upper and lower airways are typically subjected to identical inflammatory stimuli and comprise a single organ that is functionally connected. 40 patients with chronic rhinosinusitis with nasal polyps who had failed medical treatment and undergone FESS participated in our study. Prior to surgery and three months after surgery, nasal obstruction symptoms were measured using the NOSE score system and pulmonary function tests were evaluated using spirometry. The mean Nose Score was 70 before surgery but dropped to 4 afterward, with a p value < 0.001 showing a statistically significant improvement in the nasal symptoms following FESS. The mean pre-operative FVC, FEV1, and FEV1/FVC% values were 3.19, 2.53, and 78.81%, respectively, while the mean post-operative values were 3.14, 2.5, and 79.01%. Following FESS, there wasn't a statistically significant change in lung function tests. Our study showed that percentage of change of total NOSE score has a statistically significant Negative correlation with percentage of change of pulmonary function tests parameters. This study demonstrates the positive effects of FESS on nasal polyposis patients' quality of life and nasal obstruction symptoms without having any negative impacts on the lower airways.

Assessment of post-traumatic stress disorder and health-related quality of life among patients recovered from mild-to-moderate COVID-19 and their close contacts: A cross-sectional study.

The pandemic of COVID-19 is a traumatic event with distressing implications for mental health and several aspects of life. This study aimed to assess Post-traumatic Stress Disorder (PTSD) and Health-Related Quality of Life (HRQoL) among patients who experienced mild-to-moderate COVID-19 and their household contacts. This cross-sectional descriptive study was conducted between May 2020 and November 2020, in Ismailia and Suez governorates. A convenient sampling method was used. The sample size was calculated according to the prevalence of PTSD in COVID-19 patients to be 200 adult participants from both sexes, 100 patients with history of recent COVID-19 infection (up to 2 months after recovery) and their close family. COVID-19 was confirmed by a nasal swab sample tested by PCR in addition to suggestive symptoms and/or positive computed tomography lung findings. Data was collected by using the Arabic version of the Post-Traumatic Stress disorder checklist 5 (PCL5-PTSD) and the Arabic version of Health-Related Quality of Life (HRQoL). The questionnaire was collected through interviews at the Endemic and Infectious diseases and Family medicine outpatient clinics. Of the 200 studied participants, evidence of PTSD was found in 112 (56%) participants; all COVID-19 cases and 12 of their close-contact relatives. Impaired HRQoL was evident in 107 (53.5%) participants; all the COVID-19 cases and 7 contacts. The mean values total scores of the PTSD and HRQoL and its domains were significantly higher among cases compared to their contacts. The most frequently impaired domain was social (55%), psychological (54.5%), impairment (53.5%) followed by physical (48.5%) and the least was health perception (33.5%). The mean values of PTSD, HRQoL and their domains were significantly higher among participants who recalled respiratory symptoms and who had comorbid illness. The odds ratio of PTSD and HRQoL was 0.27 (95% CI: 0.2-0.36) and 0.3 (95% CI: 0.23-0.39) in participants who had more than a case of COVID-19 within their families. All the studied COVID-19 participants showed PTSD and impaired HRQoL, compared to 12% and 7% of their contacts, respectively. Past COVID-19 was associated with impairment of all domains of HRQoL and the most affected were the physical, psychological and impairment domains.

Effect of Carbonyl Iron Particle Types on the Structure and Performance of Magnetorheological Elastomers: A Frequency and Strain Dependent Study.

Magnetorheological elastomers (MREs) are smart viscoelastic materials in which their physical properties can be altered when subjected to a varying magnetic field strength. MREs consist of an elastomeric matrix mixed with magnetic particles, typically carbonyl iron particles (CIPs). The magnetic field-responsive property of MREs have led to their wide exposure in research. The potential development and commercialization of MRE-based devices requires extensive investigation to identify the essential factors that can affect their properties. For this reason, this research aims to investigate the impact of CIPs' type, concentration and coating on the rheological and mechanical properties of MREs. Isotropic MREs are fabricated with four different CIP compositions differing between hard or soft, and coated or uncoated samples. Each MRE composition have three different concentrations, which is 5%, 10%, and 20% by volume. The dynamic properties of the fabricated samples are tested by compression oscillations on a dynamic mechanical analyzer (DMA). Frequency and strain dependent measurements are performed to obtain the storage and loss modulus under different excitation frequencies and strain amplitudes. The emphasis is on the magnetorheological (MR) effect and the Payne effect which are an intrinsic characteristics of MREs. The effect of the CIPs' type, coating, and concentration on the MR and Payne effect of MREs are elucidated. Overall, it is observed that, the storage and loss modulus exhibit a strong dependence on both the frequency excitations and the strain amplitudes. Samples with hard and coated CIPs tend to have a higher MR effect than other samples. A decrease in the storage modulus and non-monotonous behavior of the loss modulus with increasing strain amplitude are observed, indicating the Payne effect. The results of this study can aid in the characterization of MREs and the proper selection of CIPs grades based on the application.

Development of a Performance-Enhanced Hybrid Magnetorheological Elastomer-Fluid for Semi-Active Vibration Isolation: Static and Dynamic Experimental Characterization.

Magnetorheological elastomers (MREs) are a class of emerging smart materials in which their mechanical and rheological properties can be immediately and reversibly altered upon the application of a magnetic field. The change in the MRE properties under the magnetic field is widely known as the magnetorheological (MR) effect. Despite their inherent viscoelastic property-change characteristics, there are disadvantages incorporated with MREs, such as slow response time and the suspension of the magnetic particles in the elastomer matrix, which depress their MR effect. This study investigates the feasibility of a hybrid magnetorheological elastomer-fluid (MRE-F) for longitudinal vibration isolation. The hybrid MRE-F is fabricated by encapsulating MR fluid inside the elastomer matrix. The inclusion of the MR fluid can enhance the MR effect of the elastomer by providing a better response to the magnetic field and, hence, can improve the vibration isolation capabilities. For this purpose, an MRE-based coupling is developed, and isolation performance is investigated in terms of the linear transmissibility factor. The performance of the hybrid MRE-F was compared against two different MRE samples. The results show that further enhancement of MR-effect in MREs is possible by including MR fluid inside the elastomer. The hybrid MRE-F exhibited better stiffness change with the current increase and recorded the highest value of 55.911 N/mm. The transmissivity curves revealed that the MRE-F contributed to a broader shift in the natural frequency with a 7.2 Hz overall shift at 8.9 mT. The damping characteristics are higher in MRE-F, recording the highest percentage increase in damping with 33.04%. Overall, the results reveal the promising potential of hybrid MRE-F in developing MRE-based coupling for longitudinal vibration isolation.

Genotypic detection of metronidazole and clarithromycin resistance in dyspeptic patients with helicobacter pylori.

In Egypt, antibiotic sensitivity analysis for Helicobacter pylori is not routinely performed. We aimed to identify the clarithromycin and metronidazole resistance directly from gastric biopsies for better guide treatment regimens. This cross-sectional descriptive study included 75 adult dyspeptic patients referred to the upper endoscopy unit in Suez Canal University Hospital, Ismailia, Egypt. Gastric biopsies were taken for rapid urease test (RUT) and cultured on brucella agar with antibiotic supplements. Genomic DNA was extracted directly from the specimen, and PCR was performed for direct detection of H. pylori. Also, to explore clarithromycin and metronidazole resistance, mutations in the 23S rRNA gene and the rdxA gene were investigated. We found that 60 samples were positive to RUT (80%), and only 4 samples were positive by culture. UreC gene was detected in 45 specimens. Meanwhile, 26 isolates were contained mutations at positions 2142 and 2143. Amplification of the metronidazole rdx gene was performed by conventional PCR. Out of 45 isolates, DNA sequence analysis of PCR product showed the wild type (ACA) in 9 isolates, while the mutant type (ATA) was detected in 28 isolates. We found a significant proportion of clarithromycin and metronidazole resistance among H. pylori infected patients in our region.

Inflammatory markers in chronic kidney disease and end stage renal disease patients.

BACKGROUND: Chronic kidney disease (CKD) is condition characterized by a gradual loss of kidney function, patient with CKD suffering from a variety of immune system defects. METHODS: This study looked at Fas, T cell, BCl2, and P53 activity in people with CKD, end stage renal disease (ESRD), and stable controls. RESULTS: The CD4+ and CD8+ levels in ESRD patients' peripheral blood were slightly lower than those in CKD patients. The CKD and ESRD groups had slightly higher Fas and FasL mRNA expression and slightly lower BCl2 mRNA gene expression than the normal control group (P < 0.05). P53 mRNA gene expression was shown to be higher in the patients than in the controls (P < 0.01). CONCLUSIONS: ESRD patients have a significantly lower number of T-cell subsets than CKD patients this is related to a higher degree of apoptosis in these cells.

Genotyping of Helicobacter pylori Virulence Genes cagA and vacA: Regional and National Study.

Helicobacter pylori (H. pylori) plays a crucial role in the pathogenesis of gastritis, peptic ulcer, and gastric cancer. The presence of pathogenicity islands (PAI) genes contributes to the pathogenesis of many gastrointestinal disorders. Cytotoxin-associated gene A (cagA) and vacuolating cytotoxin gene (vacA) are the most known virulence genes in H. pylori. So, our aim was to study H. pylori virulence genes' role in gastric disorders pathogenesis. Our study included 150 adult patients who suffered dyspeptic symptoms and were referred to the GIT endoscopy unit. Gastric biopsies were attained for rapid urease test (RUT) and histopathological examination, and multiplex PCR technique for detection of virulence genes was performed. It was found that 100 specimens were (RUT) positive, of which sixty samples (60%) were PCR positive for H. pylori ureC gene. The vacA and cagA genes were identified in 61.6% and 53% of H. pylori strains, respectively. Only 5 cases were vacA-positive and cagA-negative. The most virulent vacA s1 allele existed in 56.6% of cases. Out of the 60 H. pylori strains, 66% had at least one virulence gene and 34% did not show any virulence gene. H. pylori infection showed significant increase with age. H. pylori are prevalent amid dyspeptic patients in our region. The main genotype combinations were vacA+/cagA+ of s1m1 genotype and they were frequently associated with peptic ulcer diseases, gastritis, and gastroesophageal reflux disease.

Role of Krebs von den Lungen-6 (KL-6) in Assessing Hypersensitivity Pneumonitis.

BACKGROUND: Hypersensitivity pneumonitis (HP) is an increasingly recognized form of diffuse parenchymal lung disease. Krebs von den Lungen-6 (KL-6) is now classified as a human MUC1 mucin protein, and regenerating type II pneumocytes are the primary cellular source of KL-6/MUC1 in the affected lungs of patients with interstitial lung diseases (ILD). Serum KL-6/MUC1 levels have been demonstrated to be useful for the evaluation of various ILD. To determine the role of circulating KL-6 in evaluating the disease activity and management of HP. METHODS: An observational cross-sectional study was conducted on 51 patients with HP and 20 healthy controls. Serum KL-6 levels were measured in both groups. Patients were further assessed based on chest high-resolution computed tomography (HRCT), pulmonary function test, 6-minute walk test, echocardiography, bronchioalveolar lavage, and/or transbronchial biopsy. Patients were divided into the fibrotic and non-fibrotic groups according to the HRCT findings. RESULTS: The median serum KL-6 levels were significantly higher in HP patients as compared to the control group. The median serum KL-6 levels were found to be higher in the non-fibrotic HP group (1,900 IU/mL) as compared to the fibrotic group (1,200 IU/mL). There was a significant inverse correlation between serum KL-6 serum level and the dose of steroids as well as the duration of steroid therapy. CONCLUSION: The presence of higher KL-6 levels in the non-fibrotic HP group implies its enhanced production by regenerating pneumocytes in response to alveolar injury. The significant association between serum KL-6 levels and the dose and the duration of steroid therapy emphasizes the significant role of steroids in the stabilization of the disease.

Pattern and interpretation of hepatitis B virus markers among pregnant women in North East Egypt.

INTRODUCTION: Hepatitis B vaccination of newborns (HBV) and surveillance of pregnant women during antenatal care are complementary to prevent mother to child transmission (MTCT) of HBV infection. AIM: The aim was to identify the prevalence and pattern of HBV infection in pregnant women born before and after implementing HBV vaccination of newborn in Egypt. METHODS: The study included 600 women attended antenatal clinic of the Suez Canal University Hospital, Ismailia, Egypt. All were inquired about risk factors of HBV infection, vaccination, and screened for hepatitis markers. HBsAg carriers were tested for HBeAg, HBeAb, ALT, and HBV DNA. Participants were divided into group 1 of 285 (47.5%) vaccinated women ≤ 25 years, and 315 (52.5%) non-vaccinated > 25 years. RESULTS: The prevalence of HBcAg, HBsAg, and HBsAb were 18.3%, 5.0%, and 30.7%. Of the 110 women exposed to infection, 40 (36.4%) cleared infection, 30 (27.2%) were HBsAg carriers, and 40 (36.4%) showed isolated HBcAb. HBsAg carriers were HBeAg negative, HBeAb positive, and HBV-DNA positive and had high ALT. Group 1 had significantly higher frequency of vaccination-related immunity, lower frequency of isolated HBcAb, and susceptibles than group 2 (44.9%, 3.5%, and 38.6% vs. 4.1%, 9.5%, and 75.9% ). The prevalence of HBV exposure and chronic HBsAb carriers in both groups were close (4.9% and 16.5% for group 1 vs. 5.1% and 20% for group 2, p > 0.05). CONCLUSION: Although the outcomes of HBV infection were favorable in vaccinated group, chronic HBV represents a potential risk for MTCT that necessitates screening during pregnancy in all public health care settings.

Percutaneous trans-abdominal external looped needle with two holes in the trocar sheath for port-site closures in difficult obese cases.

INTRODUCTION: Port closure is essential after successful laparoscopic surgery to prevent incisional hernia. However, good fascial closure still represents a problem, especially in obese patients and when the port wound is oblique. We report a novel technique for port-site closures in such cases. METHODS: This study involved 67 obese patients who underwent laparoscopic surgery. We used a novel technique for port-site closure that employed a looped needle passed through two holes in the port sheath. RESULTS: The method was used in 67 patients (45 laparoscopic cholecystectomies, 22 laparoscopic hernia repairs), with a mean BMI of 35.7 kg/m2 . No intraoperative incidents or port-site hernias were reported during follow-up (mean, 22 months). CONCLUSION: Our procedure is safe, easy, and effective for fascial port site closures, especially in cases of difficult obese patients and oblique port wounds.

Paraduodenal herniation: An internal herniation in a virgin abdomen.

INTRODUCTION: A paraduodenal hernia is an uncommon hernia that results from an abnormal rotation of the midgut. Commonly, these hernias are congenital in nature, and are reported to cause 1.5-5.8% of intestinal obstructions. These hernias occur when a part of the jejunum herniates through the posterior portion of the ligament of Treitz. Diagnosing these hernias preoperatively has been shown to be difficult, despite the studies that are available. Early diagnosis is imperative to the patient in order to avoid strangulation of the bowel, which is associated with a high mortality. PRESENTATION OF CASE: In this case, we present a case of a left-sided paraduodenal hernia in a virgin abdomen in a 38-year-old African American male with a herniation of a loop of jejunum through a defect of the posterior portion of the ligament of Treitz. The patient also had a volvulized segment of the proximal jejunum, and part of this bowel was found to be ischemic. DISCUSSION: Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. A literary search of PubMed between 1980 and 2012 indicated only 44 cases of intestinal obstruction secondary to a left paraduodenal hernia. CONCLUSION: The patient underwent exploratory laparotomy, and the herniated bowel was found to be ischemic. The hernia was reduced, and the ischemic bowel resected. The defect was closed, and the patient had a non-complicated recovery.

Minilaparoscopic appendectomy using a new spiral needle.

BACKGROUND: Acute appendicitis is the most frequent abdominal disease and requires urgent surgery. At the present time, laparoscopic appendectomy is a well-accepted emergency procedure at most centers. In this study, we used a new spiral needle to facilitate the procedure, making it easy, minimally invasive, and cost effective. METHODS: The study included 70 patients of both sexes with acute appendicitis that was treated by laparoscopic appendectomy using a new spiral needle. These cases were treated at the General Surgery Department, Zagazig University, Egypt, from May 2012 to August 2013. In the procedure we used only two ports (a 10-mm port directly below the umbilicus for the camera and a 5-mm port at the left iliac fossa at the midclavicular line). The new spiral needle was used to hold the appendix during the procedure and was inserted into the right iliac fossa depending on the site of the appendix. RESULTS: The mean age of the patients was 27.3 years, mean operative time was 40 min, and mean hospital stay was 1.3 days. Ten patients (14%) had minimal bleeding at the site of needle passage into the mesoappendix. Wound infection at the site of umbilical port occurred in four patients (5.7%) postoperatively. CONCLUSION: Laparoscopic appendectomy using our new spiral needle is easy, minimally invasive, and cost effective.

St George's Vascular Institute Protocol: an accurate and reproducible methodology to enable comprehensive characterization of infrarenal abdominal aortic aneurysm morphology in clinical and research applications.

PURPOSE: To define the reproducibility of a protocol for the analysis of infrarenal abdominal aortic aneurysm (AAA) morphology for clinical and research purposes. METHODS: A protocol for the comprehensive assessment of preoperative AAA morphology based on formal systematic review and expert opinion featured 114 morphological parameters (maximum and minimum diameters, cross-sectional areas, vessel lengths, volumes, angulation, and calcification and tortuosity indices) in each of 3 regions: the neck, sac, and access vessels. To validate the protocol, 4 observers measured these variables on the preoperative computed tomographic angiograms from 50 patients (45 men; mean age 75 years, range 52-89) scheduled for endovascular aneurysm repair using software for 3-dimensional image reconstruction. One observer performed repeated measurements. The intra- and interobserver variabilities were calculated for all parameters; measurement time for all 114 features was recorded. RESULTS: Aortoiliac diameter, length, volume, area, and tortuosity index measurements showed good inter/intraobserver agreement. Aortic neck and aortoiliac angle measurements displayed high intra/interobserver repeatability coefficients (28%-43% and 29%-61%, respectively). Calcification measurements had the highest variability within and between observers: 39%-65% and 44%-96%, respectively. The measurement protocol was completed in a mean 105 minutes (range 55-420). CONCLUSION: Accurate 3-dimensional analysis of AAA morphology can be performed reliably within a reasonable time. Measurements that relied on consistent anatomical landmarks were most reproducible. Assessment of angulation and calcification required a number of subjective judgments, increasing the potential for variation. Automated methods are likely to be more suitable for certain measurements.

Glomus tumor and glomangioma of the nerve. Report of two cases.

As a rule, normal human nerve does not contain glomus bodies. Nonetheless, rare examples of glomus tumors do arise in peripheral nerves of various sizes. Their pathobiological characteristics are poorly understood, but reported examples have been small and clinically benign. The authors identified in 1 patient each a glomus tumor and a glomangioma involving nerve. Clinical histories as well as imaging and surgical findings were reviewed. All available H & E-stained slides were examined in both cases. Immunohistochemical stains and electron microscopy, as appropriate, were also performed. The lesions were subtotally and completely resected, respectively. An uneventful postoperative recovery was noted in both patients. Glomus tumors and glomangiomas can involve major nerves on rare occasions. They seem to follow a favorable clinical course, and conservative resection can be of benefit.

Parenteral iron therapy in treatment of anemia in end-stage renal disease patients: a comparative study between iron saccharate and gluconate.

BACKGROUND: Anemia in hemodialysis patients is a complex syndrome. The impetus of this study was to assess the safety and efficacy of iron saccharate complex (ISC) and sodium ferric gluconate complex (SFGC) in treating anemia in hemodialysis patients. METHODS: Forty-eight adult anemic patients of both genders (33 males and 15 females) who had an adequate level of both hemodialysis and nutrition status and received neither EPO nor parenteral iron therapy during the preceding 6 months were randomized to 2 groups. The first group comprised 22 patients who were treated with parenteral ISC, 100 mg twice weekly for 2 months and once weekly thereafter. The second group included 26 patients who received SFGC, 62.5 mg twice weekly for 2 months and once weekly thereafter. The patients were followed up for 6 months. RESULTS: This head-to-head study showed that iron stores were adequately repleted by the use of both drugs. Repletion of iron stores was associated with a significant rise in both hemoglobin and hematocrit in both groups at the end of the follow-up period in comparison to their initial values at the start of the study (p < 0.001). Both parenteral iron therapy preparations were tolerated without a statistical difference between both groups. CONCLUSION: This head-to-head study confirmed that both parenteral iron preparations are effective for adequate repletion of iron stores and constituted a step forward in the management of anemic hemodialysis patients without noticeable adverse effects related to the administration of both iron preparations.

Sciatic nerve entrapment in the upper thigh caused by an injury sustained during World War II at the battle of Anzio. Case report.

The authors present an unusual case of sciatic nerve entrapment due to a World War II shrapnel injury to the left thigh suffered during the battle of Anzio in 1943. The patient presented for evaluation of left lower-extremity pain in the sciatic nerve distribution. Magnetic resonance imaging of the lumbosacral spine revealed a disc bulge at L5-S1 that would not explain severe sciatica. A positive Tinel sign was present in the posterior aspect of the upper thigh at the site of a scar resulting from a World War II shrapnel injury. The patient underwent exploratory external neurolysis of the area, and the sciatic nerve was released from fibrous adhesive entrapment. The patient improved dramatically following surgery. During a 3-year follow-up period, no recurrence of symptoms was noted.