Adult vaccination against respiratory infections in Egypt: a review of expert opinions.

INTRODUCTION: Lower respiratory tract infection is one of the leading causes of morbidity and mortality all over the world, with a substantial impact on healthcare costs. In Egypt, local consensus on its burden, diagnosis, and vaccination is scarce. This expert opinion is the first to address the local recommendations for vaccinating adults against respiratory infection. It sheds light on the growing need to understand the barriers and underpublicized concept of adult vaccination in Egypt. AREAS COVERED: A collaborative multidisciplinary panel from Egypt developed an expert opinion-based suggestions/points, including epidemiology, microbiology, and highlights on vaccination in Egypt, as well as challenges and recommendations regarding adult vaccination. EXPERT OPINION: Adult vaccinations against respiratory infections are now recommended for high-risk people by all healthcare regulatory bodies. However, it was acknowledged that there may be hesitancy and concerns among patients; in addition, healthcare professionals' awareness about vaccination guidelines and benefits needs improvement. There are several strategies that could be implemented to enhance vaccine adherence in Egypt. These approaches encompass conducting community education programs, addressing the concerns of patients, and enhancing awareness among healthcare professionals through education, policy changes, and periodical reminders in each healthcare setting.

Predictors of moderate to severe obstructive sleep apnea in patients with lung cancer.

BACKGROUND AND OBJECTIVES: OSA is a known medical condition that is associated with several comorbidities and affect patients' quality of life. The association between OSA and lung cancer remains debated. Some studies reported increased prevalence of OSA in patients with lung cancer. We aimed to assess predictors of moderate-to-severe OSA in patients with lung cancer. METHODS: We enrolled 153 adult patients who were newly diagnosed with lung cancer. Cardiorespiratory monitoring was performed using home sleep apnea device. We carried out Univariate and multivariate logistic regression analysis on multiple parameters including age, gender, smoking status, neck circumference, waist circumference, BMI, stage and histopathology of lung cancer, presence of superior vena cava obstruction, and performance status to find out the factors that are independently associated with a diagnosis of moderate-to-severe OSA. RESULTS: Our results suggest that poor performance status is the most significant predictor of moderate to severe OSA in patients with lung cancer after controlling for important confounders. CONCLUSION: Performance status is a predictor of moderate to severe OSA in patients with lung cancer in our population of middle eastern ethnicity.

Burden of obstructive sleep apnea in patients with lung cancer and its effect on performance status.

The association between lung cancer and obstructive sleep apnea has remained a matter of debate for years. Obstructive sleep apnea is thought to increase the incidence of lung cancer due to intermittent hypoxaemia and sleep fragmentation. The aim of this study is to assess the prevalence of obstructive sleep apnea in patients with lung cancer and its effect on those patients' performance status. This is a prevalence study that was conducted at Chest Diseases Department, Alexandria Main University Hospitals. We enrolled 153 patients with lung cancer. All patients underwent cardiorespiratory monitoring using a home sleep-testing device. Performance status was assessed using Karnofsky performance status scale. The study included 120 (78.4%) males and 33 (21.6%) females newly diagnosed with lung cancer. The mean age was 59.98 ± 11.11 years. Obstructive sleep apnea (apnea-hypopnea index ≥ 5) was present in 134 (87.6%) patients. Eighty-five (63.4%) patients had mild obstructive sleep apnea, 39 (29.1%) patients had moderate obstructive sleep apnea, and 10 (7.46%) patients had severe obstructive sleep apnea. Prolonged nocturnal oxygen desaturation as demonstrated by time of oxygen saturation spent below 90% (T90%) during total sleep time > 30% was present in 25 (16.3%) patients. There was a significant difference in the median value of Karnofsky performance status scale between patients with lung cancer and associated obstructive sleep apnea and those without obstructive sleep apnea. In conclusion, obstructive sleep apnea is highly prevalent among patients with lung cancer. Performance status is worse among patients with lung cancer in the presence of obstructive sleep apnea. Screening patients with lung cancer for obstructive sleep apnea is important regardless of the presence of classical symptoms of obstructive sleep apnea.

Can Incidental Gastric GISTs During Bariatric Surgeries Change the Primary Plan of Surgery? A Single Team Experience and a Systematic Review of Literature.

As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy.

Lymphatic Chyle Duct Injury and Identification During Laparoscopic Sleeve Gastrectomy Preventing Postoperative Chylous Ascites.

We present a case of intraoperative detection of an iatrogenic chyle duct injury during laparoscopic sleeve gastrectomy. The chyle duct injury was identified and managed by ligature, preventing postoperative chylous ascites.

Post-cholecystectomy bile duct injuries: a retrospective cohort study.

BACKGROUND: Bile duct injury (BDI) is still a major worrisome complication that is feared by all surgeons undergoing cholecystectomy. The overall incidence of biliary duct injuries falls between 0.2 and 1.3%. BDI classification remains an important method to define the type of injury conducted for investigation and management. Recently, a Consensus has been taken to define BDI using the ATOM classification. Early management brings better results than delayed management. The current perspective in biliary surgery is the laparoscopic role in diagnosing and managing BDI. Diagnostic laparoscopy has been conducted in various entities for diagnostic and therapeutic measures in minor and major BDIs. METHODS: 35 cases with iatrogenic BDI following cholecystectomy (after both open and laparoscopic approaches) both happened in or were referred to Alexandria Main University Hospital surgical department from January 2019 till May 2022 and were analyzed retrospectively. Patients were classified according to the ATOM classification. Management options undertaken were mentioned and compared to the timing of diagnosis, and the morbidity and mortality rates (using the Clavien-Dindo classification). RESULTS: 35 patients with BDI after both laparoscopic cholecystectomy (LC) (54.3%), and Open cholecystectomy (OC) (45.7%) (20% were converted and 25.7% were Open from the start) were classified according to ATOM classification. 45.7% were main bile duct injuries (MBDI), and 54.3% were non-main bile duct injuries (NMBDI), where only one case 2.9% was associated with vasculobiliary injury (VBI). 28% (n = 10) of the cases were diagnosed intraoperatively (Ei), 62.9% were diagnosed early postoperatively (Ep), and 8.6% were diagnosed in the late postoperative period (L). LC was associated with 84.2% of the NMBDI, and only 18.8% of the MBDI, compared to OC which was associated with 81.3% of the MBDI, and 15.8% of the NMBDI. By the Clavien-Dindo classification, 68.6% fell into Class IIIb, 20% into Class I, 5.7% into Class V (mortality rate), 2.9% into Class IIIa, and 2.9% into Class IV. The Clavien-Dindo classification and the patient's injury (type and time of detection) were compared to investigation and management options. CONCLUSION: Management options should be defined individually according to the mode of presentation, the timing of detection of injury, and the type of injury. Early detection and management are associated with lower morbidity and mortality. Diagnostic Laparoscopy was associated with lower morbidity and better outcomes. A proper Reporting checklist should be designed to help improve the identification of injury types.

A pH-sensitive silica nanoparticles for colon-specific delivery and controlled release of catechin: Optimization of loading efficiency and in vitro release kinetics.

Catechin is a naturally occurring flavonoid of the flavan-3-ol subclass with numerous biological functions; however, these benefits are diminished due to several factors, including low water solubility and degradation in the stomach's harsh environment. So, this study aimed to develop an intelligent catechin colon-targeting delivery system with a high loading capacity. This was done by coating surface-decorated mesoporous silica nanoparticles with a pH-responsive enteric polymer called Eudragit®-S100. The pristine wormlike mesoporous silica nanoparticles (< 100 nm) with high surface area and large total pore volume were effectively synthesized and modified with the NH2 group using the post-grafting strategy. Various parameters, including solvent polarity, catechin-carrier mass ratio, and adsorption time, were studied to improve the loading of catechin into the aminated silica nanoparticles. Next, the negatively charged Eudragit®-S100 was electrostatically coated onto the positively charged aminated nanocarriers to shield the loaded catechin from the acidic environment of the stomach (pH 1.9) and to facilitate site-specific delivery in the acidic environment of the colon (pH 7.4). The prepared nanomaterials were evaluated using several methods, including The Brauner-Emmett-Teller, surface area analyzer, zeta sizer, Field Emission Scanning Electron Microscope, Powder X-Ray Diffraction, Fourier Transform Infrared Spectroscopy, Energy-Dispersive X-ray Spectroscopy, and Differential Scanning Calorimetry. In vitro dissolution studies revealed that Eudragit®-S100-coated aminated nanomaterials prevented the burst release of the loaded catechin in the acidic environment, with approximately 90% of the catechin only being released at colonic pH (pH > 7) with a supercase II transport mechanism. As a result, silica nanoparticles coated with Eudragit®-S100 would provide an innovative and promising approach in targeted nanomedicine for the oral delivery of catechin and related medicines for treating diseases related to the colon, such as colorectal cancer and irritable bowel syndrome.

A Successful Central Gastrectomy and Gastro-Gastric Anastomosis for a Large Gastric GIST.

PURPOSE: Partial gastrectomy is always the preferred technique for GIST resection. Central gastrectomy is a practical technique that can be employed in many situations during the resection of both subepithelial stromal tumors and gastric tumors. CASE PRESENTATION: A 53-year-old Egyptian female patient with a 15 × 19 cm large fungating gastric GIST managed by central gastrectomy. Central gastrectomy and gastro-gastric anastomosis were performed with negative resection margins, and the patient received post-operative imatinib, achieving disease control throughout an 8-month post-operative follow-up. CONCLUSION: Central gastrectomy is an effective method of partial gastrectomy that can be considered in GIST resection; however, more studies are needed to evaluate the efficiency of central gastrectomy in terms of long-term follow-up and terms of R0 respectability in gastric cancer.

Post-cesarean section laparoscopic cholecystectomy: a case report.

BACKGROUND: Laparoscopic cholecystectomy at the time of cesarean section is novel in medicine. It is safe, feasible, and cost-effective. CASE PRESENTATION: A 29-year-old G3P2 + 0 woman had two previous cesarean sections. She was pregnant at 32 weeks. The fetus had anencephaly. She had acute cholecystitis. Laparoscopic cholecystectomy done at the time of termination of pregnancy by cesarean section. CONCLUSIONS: In a critical period, such as acute cholecystitis, the combination of laparoscopic cholecystectomy immediately post cesarean section is effective if the surgeon is highly qualified and experienced.

Entropy optimization and response surface methodology of blood hybrid nanofluid flow through composite stenosis artery with magnetized nanoparticles (Au-Ta) for drug delivery application.

Entropy creation by a blood-hybrid nanofluid flow with gold-tantalum nanoparticles in a tilted cylindrical artery with composite stenosis under the influence of Joule heating, body acceleration, and thermal radiation is the focus of this research. Using the Sisko fluid model, the non-Newtonian behaviour of blood is investigated. The finite difference (FD) approach is used to solve the equations of motion and entropy for a system subject to certain constraints. The optimal heat transfer rate with respect to radiation, Hartmann number, and nanoparticle volume fraction is calculated using a response surface technique and sensitivity analysis. The impacts of significant parameters such as Hartmann number, angle parameter, nanoparticle volume fraction, body acceleration amplitude, radiation, and Reynolds number on the velocity, temperature, entropy generation, flow rate, shear stress of wall, and heat transfer rate are exhibited via the graphs and tables. Present results disclose that the flow rate profile increase by improving the Womersley number and the opposite nature is noticed in nanoparticle volume fraction. The total entropy generation reduces by improving radiation. The Hartmann number expose a positive sensitivity for all level of nanoparticle volume fraction. The sensitivity analysis revealed that the radiation and nanoparticle volume fraction showed a negative sensitivity for all magnetic field levels. It is seen that the presence of hybrid nanoparticles in the bloodstream leads to a more substantial reduction in the axial velocity of blood compared to Sisko blood. An increase in the volume fraction results in a noticeable decrease in the volumetric flow rate in the axial direction, while higher values of infinite shear rate viscosity lead to a significant reduction in the magnitude of the blood flow pattern. The blood temperature exhibits a linear increase with respect to the volume fraction of hybrid nanoparticles. Specifically, utilizing a hybrid nanofluid with a volume fraction of 3% leads to a 2.01316% higher temperature compared to the base fluid (blood). Similarly, a 5% volume fraction corresponds to a temperature increase of 3.45093%.

Regulatory B Cells Evaluation in Systemic Lupus Erythematosus Patients with Subclinical Atherosclerosis and Secondary Antiphospholipid Syndrome.

Objectives: The current knowledge of human studies that address B cells in Systemic Lupus Erythematosus (SLE) patients with subclinical atherosclerosis remains insufficient. We aimed to evaluate the contribution of Breg cells in SLE and secondary antiphospholipid syndrome (APS) patients taking into consideration its relation to subclinical atherosclerosis and the disease activity. Methods: Thirty SLE patients and 23 controls were included. Systemic Lupus Erythematosus Disease Activity Index-2000 was estimated. Evaluation of Breg cells percentage using flow cytometry was done. All participants underwent carotid doppler ultrasound examination for measurements of the intima-media thickness of the common carotid artery (cIMT). The coronary artery calcium scoring was calculated using the Agatston method. Results: The mean± SD of age was 32.60±8.34 years, while of the age of onset was 28.27±7.60 years. Twenty-three patients (76.7%) had subclinical atherosclerosis. There was a highly significant difference in Breg cells between SLE and APS patients with subclinical atherosclerosis and controls (P= 0.001, 0.005). SLE and APS patients had significantly higher mean cIMT than control (P=0.01, 0.050). Breg cells had 70% sensitivity and 87% specificity for diagnosing of SLE (P=0.01). Multivariate regression analysis indicated that low Breg cells were predictive for the disease activity (OR=1.76, 95% CI=1.21- 2.85; P= 0.01). Conclusion: SLE patients had a high frequency of subclinical atherosclerosis, those and patients with secondary APS had a high risk of plaque formation. We found a contribution of Breg cells in SLE patients with subclinical atherosclerosis. Breg cells are considered a good predictor of diagnosis of SLE.

Challenges and recommendations for the management of asthma in the Middle East and Africa.

Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting ß-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.

Relation of pharmacopenile duplex ultrasonography parameters and glycated hemoglobin (HbA1c) in diabetic patients with erectile dysfunction / Relación de los parámetros de la ecografía dúplex fármaco-penile y el nivel de hemoglobina glicosilada (HbA1c) en los pacientes diabéticos con disfunción eréctil

Introduction and objectives: Erectile dysfunction (ED) is one of the main threats in diabetic patients. This research aimed to assess the relationship between glycated hemoglobin (HbA1c) level and pharmacopenile duplex ultrasonography (PPDU) indices in diabetic patients with ED.Materials and methods: A total of 130 males with ED were recruited (100 had diabetes mellitus (DM) and 30 did not as control). The International Index of Erectile Function (IIEF) was used to evaluate patients for ED. Measurement of HbA1c, lipid profile and assessment of erectile function using PPDU were performed. All participants were assessed to take the medical history.Results: The mean age±SD was 53.8±8.9 and 53.6±2.8 years for patients and controls, respectively. Patients had variable grades of ED: mild in 20%, mild to moderate in 32.3%, moderate in 35.3%, and severe in 12.3%. A significant association was found between the existence of DM and a deprived response to intracorporeal injection (ICI), rising end-diastolic velocity (EDV), and reducing resistance index (RI) values. Comparing all diabetic groups according to HbA1c with controls, a significant relationship was found in; severity of IIEF-5 score, poor response to ICI, decreased peak systolic velocity (PSV) at 10min, increased EDV at 10, 20min and decreased RI at 10, 20min. A significant relationship was found between smoking, dyslipidaemia, and decreased PSV at 10, 20min and decreased increment ratio. However, a non-significant relationship was observed between age, type of DM and PPDU parameters.Conclusion: Poor glycaemic control of DM is associated with an increase in EDV and decrease in RI, and PSV of PPDU. (AU)

Introducción y objetivos: La disfunción eréctil (DE) es una de las principales amenazas en los pacientes diabéticos. El objetivo de este estudio fue evaluar la relación entre el nivel de hemoglobina glicosilada (HbA1c) y los índices de la ecografía dúplex fármaco-penile (PPDU) en los pacientes diabéticos con DE.Materiales y métodos: Se reunió a un total de 130 varones con DE (100 con diabetes mellitus [DM] y 30 no diabéticos como control). Se utilizó el Índice Internacional de Función Eréctil (IIEF) para evaluar la DE en los pacientes. Se midieron los valores de HbA1c, perfil lipídico y evaluación de la función eréctil utilizando PPDU. Se evaluó a todos los participantes para realizar la historia médica.Resultados: La edad±DE fue de 53,8±8,9 y 53,6±2,8 años para los pacientes y controles, respectivamente. Los pacientes tenían grados variables de DE: leve en el 20% de los casos, de leve a moderado en el 32,3%, moderado en el 35,3% y grave en el 12,3%. Se encontró una asociación significativa entre la existencia de DM y la ausencia de respuesta a la inyección intracorpórea (ICI), incremento de la velocidad diastólica final (VDF) y reducción de los valores del índice de resistencia (IR). Con arreglo a la HbA1c, la comparación entre todos los grupos diabéticos y los controles arrojó una relación significativa en cuanto a: gravedad de la puntuación IIEF-5, mala respuesta a la ICI, reducción de la velocidad sistólica pico (VSP) a los 10min, incremento de VDF a los 10 y 20min y reducción de IR a los 10 y 20min. Se encontró una relación significativa entre tabaquismo, dislipidemia y reducción de VSP a los 10 y 20min y reducción del ratio de incremento. Sin embargo, se observó una relación no significativa entre la edad, tipo de DM y parámetros PPDU.Conclusión: Un mal control glucémico en la DM está asociado al incremento de VDF y a la reducción del IR y de la VSP de PPDU. (AU)

Analysis of outcomes of endovascular embolisation: A cross-sectional two-center study on 46 visceral artery pseudoaneurysms.

PURPOSE: Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs. MATERIALS AND METHODS: This is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients' presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure. RESULTS: The overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%. CONCLUSION: Transarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.

Temporospatial characterization of the bronchus associated lymphoid tissue (BALT) of the one humped camel (Camelus dromedarius).

BACKGROUND: Bronchial-associated lymphoid tissue (BALT) is responsible for the local immune response of the lung against airborne infections. The structure of this tissue varies according to species and age. AIM: The aim of this study was to describe the possible age-related structural variation of the BALT of the one humped camel. MATERIAL AND METHODS: Fresh specimens from both lungs of 15 clinically healthy male camels (10 months-12 years) were studied with light and electron microscopes. RESULTS: The BALT in the camel was variable from few lymphocytes to well-organized lymphoid tissue with a clear germinal center. The BALT of the bronchi is a constant lymphoid tissue in young and adult camels which may be of the large size with clear germinal center in response to repeated immune reaction and involutes in old age. The BALT of the bronchioles may be induced and develops mainly due to an immune reaction and showed great morphological variations and observed in different ages. High endothelial venules were associated with BALT in the bronchi but not with that of the bronchioles. The BALT-associated epithelium was tall pseudostratified columnar ciliated epithelium with goblet cells in the extrapulmonary bronchi changed to pseudostratified columnar ciliated epithelium mucous secreting cells in the intrapulmonary bronchi and simple columnar ciliated to simple cuboidal epithelium with Clara cells without goblet cells or mucous secreting cells in the bronchioles. CONCLUSIONS: The BALT of the bronchi is a constant lymphoid tissue in young and adult camels and involutes in old age. The BALT of the bronchioles may be induced and develops mainly due to an immune reaction and observed in different ages.

Evaluation of brain changes in systemic sclerosis (SSc) patients using two different techniques of MRI: Is it really worthy? / Evaluación de los cambios cerebrales en pacientes con esclerosis sistémica que utilizan 2 técnicas diferentes de resonancia magnética: ¿es realmente valiosa?

Background: Systemic sclerosis (SSc) is a rare chronic multi-system autoimmune disease of unknown cause and a complex pathogenesis. The hallmark of the disease is microvascular vasculopathy which results in tissue ischemia with recurrent episodes of reperfusion. Diffusion-weighted (DW) Magnetic Resonance imaging (MRI) is an excellent tool for the detection of activity of any vascular or inflammatory lesions. Objectives: Detect brain changes in systemic sclerosis patients with asymptomatic CNS manifestations using fluid attenuation inversion recovery (FLAIR) weighted sequence and diffusion-weighted (DW) sequence MRI. Methods: Fifteen systemic sclerosis female patients aged 27–60 years old with disease duration of 1–20 years with no CNS clinical manifestations were included. A controlled group of 14 clinically normal persons, age and sex matched. Both groups were subjected to brain MR examination at 1.5T; a FLAIR weighted sequence and a DW sequence. SPSS (version 20) was used for statistical analysis. Results: 37 white matter hyperintense lesions (≤2 to ≥ 5mm in diameter) were detected in patient group using FLAIR weighted MRI while diffusion-weighted MRI failed to detect the same lesions. A non-significant relation (P=.259) between the presence of white matter hyperintense lesions and the severity of peripheral vascular affection of the disease was observed.(AU)ConclusionsAsymptomatic central nervous system vasculopathy is detected in systemic sclerosis using FLAIR MRI, while diffusion MRI failed to detect such lesions. These findings suggest a non-inflammatory form of central nervous system microvasculopathy in SSc patients.(AU)

Fundamento: La esclerosis sistémica (SSc) es una rara enfermedad crónica autoinmune multisistémica de causa desconocida y una patogénesis compleja. El sello distintivo de la enfermedad es la vasculopatía microvascular que se traduce en isquemia tisular con episodios recurrentes de reperfusión. La resonancia magnética (RM) ponderada por difusión (DW) es una excelente herramienta para la detección de la actividad de cualquier lesión vascular o inflamatoria. Objetivos: Detectar cambios cerebrales en pacientes con SSc con manifestaciones del sistema nervioso central (SNC) asintomáticas utilizando FLAIR y DW-RM. Métodos: Quince pacientes con SSc sin manifestaciones del SNC incluidos. Un grupo de 14 personas sanas estandarizadas por edad y sexo en el grupo de pacientes como grupo de control. La RM cerebral se hizo para obtener ambos grupos (pacientes y control) en 1,5T. La prueba de Chi-cuadrado y la prueba de correlación de Spearman SPSS® (versión 20) se utilizaron para el análisis estadístico. Resultados: Se detectaron 37 lesiones hiperintensas de materia blanca (≤2-≥5mm de diámetro) en el grupo de pacientes que utilizaron RM ponderada con FLAIR, mientras que la DW-RM no detectó las mismas lesiones. Se observó una relación no significativa (p=0,259) entre la presencia de lesiones hiperintensas de la materia blanca y la severidad del afecto vascular periférico de la enfermedad. Conclusiones: La vasculopatía del SNC asintomática se detecta en la SSc mediante la RM de FLAIR, mientras que la RM de difusión no detectó tales lesiones. Estos hallazgos sugieren una forma no inflamatoria de la microvasculopatía del SNC en pacientes con SSc.(AU)

Evaluation of Laparoscopy Virtual Reality Training on the Improvement of Trainees' Surgical Skills.

Background and objectives: The primary objective was to evaluate the benefit of training with virtual reality simulation. The secondary objective was to describe the short-term skill acquisition obtained by simulation training and to determine the factors affecting its magnitude. Materials and Methods: We prospectively performed a three-stage evaluation: face, constructive, and predictive to evaluate the training with a laparoscopic simulator with haptic feedback. The participants (n = 63) were divided according to their level of experience into three groups: 16% residents; 46% specialists and 38% were consultants. Results: Face evaluation demonstrates the acceptance of the design and realism of the tasks; it showed a median score of eight (IQR 3) on a Likert scale and 54% of participants (n = 34) gave the tissue feedback a moderate rating. Constructive evaluation demonstrates the improvement of the participants in the training session and the ability of the designed task to distinguish the experienced from the inexperienced surgeon based on the performance score, at task I (transfer of pegs) and II (laparoscopic salpingectomy). There was an improvement in both tasks with a significant increase in score and reduction in time. The study showed that those with a high score at the pre-test recorded a high score post-test, showing a significant pair-wise comparison (Z) and correlation (p) showing a significant statistical significance (p < 0.001). The predictive evaluation demonstrates the beneficiary effect of training four weeks afterward on the practice of surgeons addressed with five questions. It showed an improvement regarding implementation into daily routine, performance of procedure, suturing, shortening of the operative time, and complication management. Conclusions: Virtual reality simulation established high ratings for both realism and training capacity, including clinical relevance, critical relevance, and maintaining training enthusiasm.

Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction.

Smokers without airflow obstruction have reduced exercise capacity, but the underlying physiological mechanisms are not fully understood. We aimed to compare quadriceps function assessed using nonvolitional measures and ventilatory requirements during exercise, between smokers without airway obstruction and never-smoker controls. Adult smokers (n = 20) and never-smoker controls (n = 16) aged 25-50 yr with normal spirometry, underwent incremental cycle cardiopulmonary exercise testing to exhaustion with measurement of symptoms and dynamic lung volumes. Quadriceps strength and endurance were assessed nonvolitionally using single and repetitive magnetic stimulation. Quadriceps bulk was assessed using ultrasound, as rectus-femoris cross-sectional area. Physical activity level was quantified using the SenseWear armband worn for 5 days. Smokers had lower peak exercise workload, peak oxygen consumption, and anaerobic threshold than controls (170 ± 46 vs. 256 ± 57 W, 2.20 ± 0.56 vs. 3.18 ± 0.72 L/min, 1.38 ± 0.33 vs. 2.09 ± 0.7 L/min, respectively; P < 0.01 for all). Quadriceps endurance was lower in smokers (Δforce-time integral 54.9% ± 14.7% vs. 40.4% ± 14.7%; P = 0.007), but physical activity, quadriceps strength, and bulk were similar between groups. Smokers displayed higher ventilation (120 W: 52.6 ± 11.8 vs. 40.7 ± 6.0 L/min; P < 0.001), decreased ventilatory efficiency (higher V̇e/V̇co2), and were more breathless with greater leg fatigue at iso-workloads and iso-ventilation levels compared with never-smoker controls. Smokers showed no mechanical constraints on tidal volume expansion during exercise or ventilatory limitation at peak exercise. Adult smokers without airflow obstruction have reduced skeletal muscle endurance and ventilatory efficiency compared with never-smoker controls, despite similar daily physical activity levels, which contributed to reduced peak exercise capacity.NEW & NOTEWORTHY In adult smokers without airflow obstruction, the contributions of pulmonary and skeletal muscle functions to reduced exercise capacity are unclear. We found that non-COPD smokers had decreased exercise capacity and muscle endurance although strength was preserved compared with never-smoking controls. Exercise endurance was associated with quadriceps endurance and CO transfer factor. Despite similar physical activity levels, smokers developed leg fatigue, breathlessness, and displayed increased ventilation with reduced ventilatory efficiency at lower workloads, without exhibiting ventilatory constraint.