Fluctuations in Planar Magnetotransport Due to Tilted Dirac Cones in Topological Materials.

Fluctuations in planar magnetotransport are ubiquitous in topological HgTe structures, in both tensile (topological insulator) and compressively strained layers (Weyl semimetal phase). We show that the common reason for the fluctuations is the presence of tilted Dirac cones combined with the formation of charge puddles. The origin of the tilted Dirac cones is the mix of the Zeeman term due to the in-plane magnetic field and quadratic contributions to the dispersion relation. We develop a network model that mimics the transport of tilted Dirac fermions in the landscape of charge puddles. The model captures the essential features of the experimental data. It should be relevant for the interpretation of planar magnetotransport in a variety of topological and small band gap materials.

Effects of dietary supplementation with benthic diatom Amphora coffeaeformis on blood biochemistry, steroid hormone levels and seed production efficiency of Nile tilapia Oreochromis niloticus broodstock.

Aquafeed additive quality and quantity remain pivotal factors that constrain the sustainability and progress of aquaculture feed development. This study investigates the impact of incorporating the benthic diatom Amphora coffeaeformis into the diet of Nile tilapia (Oreochromis niloticus) broodstock, on the blood biochemistry, steroid hormone (SH) levels and seed production efficiency. Broodstock females displaying mature ovary indications were initially combined with males at a ratio of three females to one male. A total of 384 adult Nile tilapia (288 females and 96 males) were used, with 32 fish (24 females and eight males) assigned to each of 12 concrete tanks (8 m³; 2 m × 4 m × 1 m), with three replicate tanks for each dietary treatment, throughout a 14-day spawning cycle until egg harvest. Fish were fed one of four different dietary treatments: AM0% (control diet), and AM2%, AM4% and AM6% enriched with the diatom A. coffeaeformis at levels of 20, 40 and 60 g/kg of diet respectively. At the trial's conclusion, total protein, albumin, triglyceride and creatinine), SHs (follicle-stimulating hormone, luteinizing hormone, free testosterone, total testosterone, progesterone and prolactin) and seeds production efficiency of Nile tilapia improved significantly (p < 0.05) in alignment with the increment of A. coffeaeformis supplementation. The findings propose that including A. coffeaeformis at levels ranging from 4% to 6% could be effectively employed as a feed additive during the Nile tilapia broodstock's spawning season.

Analgesic efficacy of ultrasound guided quadratus lumborum block versus ilioinguinal/iliohypogastric nerve block following pediatric open inguinal hernia repair: A prospective randomized controlled trial.

Background and Aims: Inguinal hernia repair is a common surgical procedure. We compared the analgesic efficacy of ultrasound-guided anterior quadratus lumborum (QL) block versus ilioinguinal/iliohypogastric (II/IH) nerve block in pediatric patients undergoing open inguinal hernia repair. Material and Methods: It was a prospective randomized study in which 90 patients of 1-8 years of age were randomly assigned into control (general anesthesia only), QL block, and II/IH nerve block groups. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), perioperative analgesic consumptions, and time to first analgesic request were recorded. The normally distributed quantitative parameters were analyzed by one-way ANOVA with post-hoc Tukey's HSD test while parameters that did not follow a normal distribution and the CHEOPS score were analyzed using the Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferonni correction for post-hoc analysis. Results: In the 1st 6h postoperative, the median (IQR) CHEOPS score was higher in the control group than II/IH group (P = 0.000) and QL group (P = 0.000) while comparable between the latter two groups. CHEOPS scores were significantly lower in the QL block group than the control group and II/IH nerve block group at 12 and 18h. The intraoperative fentanyl and postoperative paracetamol consumptions in the control group were higher than II/IH and QL groups while lower in QL than II/IH group. Conclusion: Ultrasound-guided QL and II/IH nerve blocks provided effective postoperative analgesia in pediatric patients undergoing inguinal hernia repair with lower pain scores and less perioperative analgesic consumptions in the QL block group compared to II/IH group.

Electron-Hole Scattering Limited Transport of Dirac Fermions in a Topological Insulator.

We have experimentally investigated the effect of electron temperature on transport in the two-dimensional Dirac surface states of the three-dimensional topological insulator HgTe. We have found that around the minimal conductivity point, where both electrons and holes are present, heating the carriers with a DC current results in a nonmonotonic differential resistance of narrow channels. We have shown that the observed initial increase in resistance can be attributed to electron-hole scattering, while the decrease follows naturally from the change in Fermi energy of the charge carriers. Both effects are governed dominantly by a van Hove singularity in the bulk valence band. The results demonstrate the importance of interband electron-hole scattering in the transport properties of topological insulators.

Potential effects of dietary seaweeds mixture on the growth performance, antioxidant status, immunity response, and resistance of striped catfish (Pangasianodon hypophthalmus) against Aeromonas hydrophila infection.

Striped catfish (Pangasianodon hypophthalmus) is one of the important fish species in the world, which is widely cultured in several countries worldwide including Egypt. Aeromonas hydrophila infection showed a high prevalence in the farmed striped catfish negatively affecting its production causing economic loss. Therefore, the finding of functional feed supplements with antimicrobial activity is urgently needed. The use of marine seaweeds as feed supplements has produced satisfactory results as antibacterial agents. Accordingly, the present study was designed to evaluate the dietary effects of seaweeds mixture (Ulva lactuca, Jania rubens, and Pterocladia capillacea) extract (SME) on the growth performance, haemato-chemical parameters, antioxidant capacity, immune indices, and resistance of striped catfish fry against A. hydrophila infection. Four isonitrogenous (30% crude protein) diets were prepared to contain 0.0% (control), 1%, 2%, and 3% SME and were fed to striped catfish fry (1.7 ± 0.1 g) up to apparent satiety three times a day for 60 days. After the feeding trial, fish of each treatment were intraperitoneally injected with a virulent A. hydrophila strain and the relative percentage of survival (RPS) was recorded. The growth-stimulating activity of dietary SME was observed especially at 2% and 3% SME treatments. Similarly, haematological parameters (red blood cells, haemoglobin, haematocrit, and white blood cells) and serum protein profile (total protein, albumin, and globulin) were significantly (P < 0.05) improved, meanwhile serum alanine and aspartate aminotransferases were significantly (P < 0.05) decreased in fish fed with 2 and 3% SME diets. Serum creatinine and uric acid levels revealed no significant (P > 0.05) differences among the experimental groups. Hepatic malondialdehyde and serum nitrous acid levels were significantly decreased; meanwhile hepatic superoxide dismutase, catalase, and glutathione peroxidase levels were significantly increased in all SME-treated groups than the control one. Also, SME supplementations significantly increased the serum lysozyme, total immunoglobulin, and complement C3 activities with highest values at 2% and 3% SME treatments. Interestingly, after bacterial challenge, fish fed SME-supplemented diet were more resistant with the lowest fish mortality (15%) at the 3% SME diet, which exhibit the highest RPS (81.9%). Meanwhile the control group showed highest mortality (85%). According to the regression fitting curve, the current study recommends using the dietary SME with optimum levels of 2.25-2.5% to improve the growth performance, welfare status, and resistance of striped catfish fry against A. hydrophila infection.

The Novel Use of Point-of-Care Ultrasound to Predict Resting Energy Expenditure in Critically Ill Patients.

OBJECTIVES: Accurate estimation of a critically ill patient's caloric requirements is essential for a proper nutritional plan. This study aimed to evaluate the use of point-of-care ultrasound (US) to predict the resting energy expenditure (REE) in critically ill patients. METHODS: In 69 critically ill patients, we measured the REE using indirect calorimetry (REE_IC), muscle layer thicknesses (MLTs), and cardiac output (CO). Muscle thickness was measured at the biceps and the quadriceps muscles. Patients were randomly split into a model development group (n = 46) and a cross-validation group (n = 23). In the model development group, a multiple regression analysis was applied to generate REE using US (REE_US) values. In the cross-validation group, REE was calculated by the REE_US and the resting energy expenditure using the Harris-Benedict equation (REE_HB), and both were compared to the REE_IC. RESULTS: In the model development group, the REE_US was predicted by the following formula: predicted REE_US (kcal/d) = 206 + 173.5 × CO (L/min) + 137 × MLT (cm) - 230 × (women = 1; men = 0) (R2  = 0.8; P < .0001). In the cross-validated group, the REE_IC and REE_US values were comparable (mean difference, -66 [-3.3%] kcal/d; P = .14). However, the difference between the mean REE_IC and the mean REE_HB was 455.8 (26%) kcal/d (P < .001). According to a Bland-Altman analysis, the REE_US agreed well with the REE_IC, whereas the REE_HB did not. CONCLUSIONS: Resting energy expenditure could be estimated from US measurements of MLTs and CO. Our point-of-care US model explains 80% of the change in the REE in critically ill patients.

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial.

BACKGROUND: Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound-guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. METHODS: A total of 60 patients aged 18 to 65 years with a body mass index (BMI) of ≥ 40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20 mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24-hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. RESULTS: Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] µg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] µg) (P < 0.001). The median (IQR) cumulative 24-hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P < 0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. CONCLUSION: Ultrasound-guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group.

Diabetes and CYP2C19 Polymorphism Synergistically Impair the Antiplatelet Activity of Clopidogrel Compared With Ticagrelor in Percutaneous Coronary Intervention-treated Acute Coronary Syndrome Patients.

Diabetes and CYP2C19 loss of function (LOF) alleles are associated with the variable antiplatelet activity of the prodrug clopidogrel. We conducted a randomized trial (NCT03613857) to compare the combined and individualized effects of diabetes and CYP2C19 polymorphisms on the antiplatelet reactivity of clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Patients (948, 1 year follow-up 943) were randomly allocated in a 1:1 ratio to receive either clopidogrel or ticagrelor, after PCI; patients were subdivided into 8 subgroups according to the diabetes and/or CYP2C19 allele status. The study outcomes were recurrent ACS, maximum platelet aggregation (MPA), high platelet reactivity index (PRI), and incidence of major bleeding events. Diabetic patients with LOF alleles taking clopidogrel had the highest recurrent ACS rate (6 of 33 patients) versus all other study groups (P < 0.05). However, both drugs had similar proportions of recurrent ACS in all other subgroups. Similarly, both PRI and MPA were significantly higher in the diabetic patients having LOF alleles and receiving clopidogrel versus all their study groups (P < 0.05). Nevertheless, ticagrelor caused higher rates of major bleeding versus clopidogrel (P < 0.001). PCI-treated ACS patients with diabetes and CYP2C19 LOF alleles are at a higher risk of recurrent ACS and high PRI/MPA, when treated with clopidogrel versus ticagrelor, but almost comparable outcomes are recorded in the absence of 1 or the 2 risk factors.

Effects of dietary Nannochloropsis oculata on growth performance, serum biochemical parameters, immune responses, and resistance against Aeromonas veronii challenge in Nile tilapia (Oreochromis niloticus).

The current work was planned to assess the effects of dietary microalga, Nannochloropsis oculata (NP) on the growth indices, serum biochemistry, non-specific immunity, and resistance of Nile tilapia (Oreochromis niloticus) juveniles against challenge with pathogenic Aeromonas veronii. Fish (10.21 ± 0.28 g) were randomly divided into four treatments in triplicates and were fed on diets supplemented with different levels of NP (0, 5, 10, and 15%) for eight weeks. The results showed that the dietary 5% NP significantly improved the growth parameters (final body weight, weight gain, specific growth rate, and total feed intake) (P < 0.05). Meanwhile, the feed conversion ratio was significantly decreased in NP-supplemented groups with respect to the control group. The serum protein profile (total protein, albumin, globulin, and albumin/globulin ratio) was significantly decreased by 15% NP supplemented group. Meanwhile, liver enzymes (alanine transaminase, and aspartate transaminase) activities were not significantly affected by NP dietary supplementation (P < 0.05). Serum lysozyme activity, nitric oxide (NO), and nitroblue tetrazolium (NBT) levels were significantly enhanced only in 5% NP supplemented group (P < 0.05). Interestingly, the hepatopancreatic and intestinal tissues had apparently normal histomorphology of Nile tilapia fed at 5% NP-supplemented diets. Significant upregulation of cytokines [interleukin 1beta (IL-1ß), interleukin 8 (IL-8), interferon-gamma (IFN-γ), transforming growth factor-beta (TGF- ß), and tumor necrosis factor-alpha (TNF-α)], with significant downregulation of the antioxidant gene [superoxide dismutase (SOD)] in 10% and 15% NP supplemented groups. Attractively, the relative level of protection (RLP) against challenge with pathogenic A. veronii was significantly elevated in 10% and 15% NP supplemented groups. Conclusively, the obtained results reflect the beneficial roles of dietary NP to improve growth and boost the immune responses of Nile tilapia.

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study.

BACKGROUND: Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6-T9). METHODS: Sixty patients 18-65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively. RESULTS: At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P < .001; 95% CI, 1.8-3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 µg [0-0 µg]) compared to that of the control group (94 µg [74-130 µg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0-33 mg]) compared to that of the control group (83 mg [64-109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001). CONCLUSIONS: Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.

Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: A prospective randomized controlled trial.

BACKGROUND: Many analgesic modalities have been investigated in pediatrics. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in pediatric patients undergoing open midline splenectomy. METHODS: Sixty patients aged 3-10 years were randomly assigned into two groups: Control group received general anesthesia with bilateral sham erector spinae plane block using 0.3 mL/kg normal saline on each side. Erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block using 0.3 mL/kg bupivacaine 0.25% (on each side) with a maximum dose of 2 mg/kg. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), total consumption of intraoperative fentanyl (1 µg/kg IV in case of inadequate analgesia), time to first rescue analgesic administration, and postoperative paracetamol consumption were recorded over the first 24 hours postoperatively. RESULTS: The median (IQR) postoperative CHEOPS score at 1 hour was lower in erector spinae plane block group (5.0 (4.75 -5.25)) than the control group (7.0 (6.0-10.0)) (P < .001, 95% CI: 1.0; 5.0). The CHEOPS scores for the first eight postoperative hours were lower in the erector spinae plane block group (5.0 (5.0-6.0)) than the control group (6.0 (6.0 -10.0)) (P Ë‚ .001, 95% CI: 1.0; 2.0). Intraoperative fentanyl administration was higher in the control group 40.0 (21.5-50.0) µg compared to erector spinae plane block group 0.0 (0.0-0.0) µg (P Ë‚ .001, 95% CI: 23.0; 48.0). The total postoperative paracetamol consumption was higher in the control group (37.5 ± 17.1 mg/kg) compared to erector spinae plane block group (8.5 ± 10.9 mg/kg) (P Ë‚ .001, 95% CI: 21.57; 36.43). The time to the first postoperative rescue analgesic requirement was longer in the erector spinae plane block group. CONCLUSION: Ultrasound-guided erector spinae plane block reduced CHEOPS score for the first eight hours postoperatively with the reduction of intraoperative fentanyl and postoperative paracetamol consumptions.

Historical descriptions of physicians' personal pathologies.

There were many instances in the history of medicine when doctors reported on their suffering from diseases or injuries and how they were managed. Orthopaedic surgery saw many examples of such self-reports. Do surgeons describe their own pathologies in the same way they do those of their patients? Also what did such self reports change in the orthopaedic practice of their times and thereafter? The aim of this paper is to review some historical self-reports in which eminent general and orthopaedic surgeons reported their own orthopaedic ailments. Many such reports broke prevalent myths and made significant changes in the orthopaedic thought and methodology.

Ultrasound-guided distal glossopharyngeal nerve block for post-tonsillectomy pain relief in adults: a prospective randomized study.

BACKGROUND: We aimed to evaluate the safety and efficacy of the novel distal approach of ultrasound (US)-guided glossopharyngeal nerve (GPN) block at the pharyngeal wall for enhancing the quality of analgesia in patients undergoing tonsillectomy. METHODS: Fifty patients, both male and female, between the ages of 21 and 65, categorized as ASA I-II by the American Society of Anesthesiologists (ASA) and who were scheduled for tonsillectomy, were enrolled in the study. Patients were randomly assigned to receive general anesthesia with either bilateral US-guided distal GPN block (GPN group) or no block (control group). The time for first request of analgesics, postoperative pain scores, the total amount of rescue analgesic medication consumed within a 24-hour period, and the occurrence of any adverse events were all noted. RESULTS: The onset of first analgesic request was significantly prolonged in GPN group than the control group (P=0.013). Pain scores at 30 min, two and six hours postoperative were found to be significantly lower in GPN group than the control group both at rest (adjusted P=0.005, 0.000, and 0.020 respectively) and during swallowing (adjusted P=0.002, 0.000, and 0.015 respectively), with significantly less morphine consumption at 24 hours postoperative in GPN group compared with the control group (P=0.002). No significant postoperative block-related complications were observed. CONCLUSIONS: In patients having tonsillectomy, pre-emptive application of US-guided distal GPN block at the pharyngeal wall enhanced the quality of analgesia and decreased the need for rescue analgesics with no major adverse effects.

Posterior tibial nerve stimulation versus desmopressin in treating children with primary mono-symptomatic nocturnal enuresis. A randomized clinical trial.

Objective: Assessment of the efficacy of Posterior Tibial Nerve Stimulation (PTNS) versus Desmopressin in treating Primary Mono-symptomatic Nocturnal Enuresis (PMNE). Patients and methods: This randomized clinical trial was conducted at the Urology department of Abo Elreesh pediatric hospital, Cairo University on 80 children, aged between 5 and 13 years old, diagnosed to have PMNE between June 2020 and November 2020. Children were divided into two equal groups; those who underwent PTNS (as one session per week for 12 weeks) (Group A) and those who received Desmopressin 0.2 mg. single evening dose for 12 weeks (Group B). Both groups were constructed to adhere to behavioral therapy and were statistically evaluated regarding the frequency of nocturnal enuresis (NE) before, after treatment, and after 1 month of follow-up. Results: Both groups showed statistically significant improvement in the frequency of NE before and after treatment (p < 0.001), but there were no statistically significant differences between them (p = 0.763). There was a statistically significant relapse of NE frequency after 1 month of follow-up after completion of treatment in both groups (p < 0.001), with no statistically significant differences between the two groups (p = 0.075). Conclusion: Posterior tibial nerve stimulation and Desmopressin are viable treatment options for children with primary mono-symptomatic nocturnal enuresis. However, relapse in some responders with time suggests the need for maintenance therapy.

An Unusually Massive Hemorrhagic Superficial Infrapatellar Bursa Excised in a One-stage Procedure: Case Report.

Introduction: Superficial infrapatellar bursitis may be traumatic, inflammatory, or infectious. It rarely attains massive dimensions. Open excision can be performed as a one-stage or a two-stage procedure, and endoscopy can be an alternative. We report a chronic, unusually massive, hemorrhagic infrapatellar bursa which we resected totally in a single stage procedure with no significant complications. Case Report: A 65-year-old male farmer presented with a chronic massive swelling in front of the right knee which first appeared 4 years earlier and had no effect on his general condition. The mass was excised in a one-stage procedure and it was found to be a hemorrhagic bursitis. The wound healed uneventfully and, on follow-up 7 weeks later, the patient was able to perform full flexion and extension of the knee. Conclusion: Two-stage procedures for excision are effective, but one-stage procedures are equally effective in chronic cases, provided the dissection is performed meticulously and atraumatically.

Detection and Diagnosis of Cardiac Amyloidosis in Egypt.

Cardiac amyloidosis is a life-threatening disease that occurs when amyloid proteins, most commonly immunoglobulin light chain or transthyretin, mutate or become unstable, misfold, deposit as amyloid fibrils, and accumulate in the myocardium. Early diagnosis of cardiac amyloidosis is hindered by insufficient awareness, specifically regarding clinical red flags and diagnostic pathways. Cardiac amyloidosis diagnosis comprises two important phases, clinical suspicion (phase one) followed by definitive diagnosis (phase two). Each phase is associated with specific clinical techniques. For example, clinical features, electrocardiography, echocardiography, and cardiac magnetic resonance imaging serve to raise suspicion of cardiac amyloidosis and facilitate early diagnosis, whereas laboratory tests (i.e., blood or urine electrophoresis with immunofixation), biopsy, scintigraphy-based nuclear imaging, and genetic testing provide a definitive diagnosis of cardiac amyloidosis. In Egypt, both the lack of cardiac amyloidosis awareness amongst healthcare providers and the unavailability of clinical expertise for the use of diagnostic techniques must be overcome to improve the prognosis of cardiac amyloidosis in the region. Previously published diagnostic algorithms for cardiac amyloidosis have amalgamated techniques that can raise clinical suspicions of cardiac amyloidosis with those that definitively diagnose cardiac amyloidosis. Though such algorithms have been successful in developed countries, diagnostic tools like echocardiography, scintigraphy, and cardiac magnetic resonance imaging are not ubiquitously available across Egyptian facilities. This review presents the current state of knowledge regarding cardiac amyloidosis in Egypt and outlines a new diagnostic algorithm which leverages regional nuclear imaging expertise. Importantly, the proposed diagnostic algorithm guides accurate amyloid-typing to mitigate misdiagnosis and erroneous treatment selection and improve the cardiac amyloidosis diagnostic accuracy in Egypt.

Diagnostic algorithms are useful tools for guiding clinical diagnosis by summarizing diagnostic approaches and defining the patient pathway. The diagnostic algorithms for cardiac amyloidosis amalgamate techniques that raise suspicion of the disease with those that can definitively diagnose the disease. These algorithms, for the early detection and diagnosis of cardiac amyloidosis, are designed in accordance with developed healthcare systems that have the resources and infrastructure for diagnostic equipment and clinical expertise. There are limited financial resources across healthcare facilities in Egypt for diagnostic equipment like echocardiograms (ECHO), scintigraphy, and cardiac magnetic resonance imaging (cMRI), and the required clinical training for the diagnosis of cardiac amyloidosis. This reduces the possibility of early diagnosis of the disease and subsequent early intervention. Evidently, there is a significant unmet clinical need to develop an algorithm for the diagnosis of cardiac amyloidosis in accordance with the Egyptian healthcare system. This review article details the current awareness regarding the diagnosis of cardiac amyloidosis and the associated challenges in Egypt. Accordingly, a diagnostic algorithm that leverages nuclear imaging expertise to guide accurate amyloid-typing in order to mitigate misdiagnosis and erroneous treatment, and also improve the diagnostic accuracy of cardiac amyloidosis, has been proposed.

Xylariaceae on the fringe.

The Xylariaceae is one of the best-known pyrenomycete families (Ascomycota) and is distributed throughout the world. The majority are wood inhabitants and are prevalent in tropical and subtropical regions. Halorosellinia oceanicum is the most widely distributed in mangroves and can be regarded as truly manglicolous being frequently recorded as the dominant member of the family in such environments in S.E. Asia. In Malaysian mangroves, members of the Xylariaceae have been found to be numerically important with up to 9% present in one mangrove ecosystem. A further twelve xylariaceous genera are reported as occurring as their teleomorphs in mangrove forest and their immediate surroundings including Anthostomella, Astrocystis, Biscogniauxia, Camillea, Daldinia, Fasciatispora, Hypoxylon, Kretzschmaria, Nemania, Nipicola, Rosellinia and Xylaria. Furthermore, the presence of species from a number of these taxa, especially species of Anthostomella and Xylaria, are regularly isolated as endophytes from a variety of mangrove plant species. Mangrove Xylariaceae are also well known for their ability to produce novel and often bioactive metabolites.

The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study.

OBJECTIVE: This study aimed to evaluate the ability to use opioid-free anesthesia (OFA) technique in morbid obese patients. DESIGN: A prospective randomized double-blinded study. SETTING: This study was carried out at Tanta University Hospitals (tertiary hospitals). PATIENTS: Eighty morbid obese patients scheduled for laparoscopic bariatric surgeries. INTERVENTION: Patients were allocated randomly into two groups: Group C, in which fentanyl was used during induction and maintenance of anesthesia, and group OFA, in which dexmedetomidine, ketamine, magnesium, and lidocaine were started before the induction of anesthesia and continued throughout the surgery. MAIN OUTCOME MEASURE: The post-operative morphine consumption in the first 24 hours (primary outcome) and the intraoperative fentanyl consumption (secondary outcome). RESULTS: In comparison to the control group, OFA technique significantly decreased the post-operative morphine consumption (p = 0.003; 95 percent CI: 0.505; 2.396), shortened the time for the first request of rescue analgesia (p < 0.0001; 95 percent CI: 54.14; 99.11), decreased the post-operative pain score 4 and 6 hours after surgery (p < 0.05), and decreased the post-operative nausea and vomiting (PONV) impact scale (p = 0.022). Furthermore, it significantly decreased the intraoperative fentanyl consumption (p < 0.0001) with the improvement of all parameters of the recovery profile (p < 0.05). CONCLUSION: OFA in patients undergoing bariatric surgeries significantly decreased the post-operative morphine consumption, the post-operative pain score, the intraoperative fentanyl consumption, and the PONV impact scale with the improvement of the recovery profile.

Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis?

BACKGROUND: Coronary tortuosity (C-Tor) is a common finding in coronary angiography (CAG). There are conflicting data about its link to atherosclerosis: one study found a negative relationship with coronary artery disease (CAD), although it had been linked to age and hypertension (HTN), which are CAD risk factors. Carotid intima-media thickness (C-IMT) is a measure of early atherosclerosis and a surrogate for CAD, diastolic dysfunction is also associated with CAD risk factors. In this retrospective case-control study, we investigated the relationship between C-Tor, C-IMT, diastolic dysfunction, and the other risk factors in patients undergoing CAG in a tertiary hospital between July 2017 and June 2018, after excluding patients with significant CAD. C-Tor was defined as the presence of ≥ 3 bends (≥ 45°) along the trunk of at least one main coronary artery in CAG. RESULTS: After excluding 663 patients due to exclusion criteria, 30 patients with C-Tor were compared with age and gender-matched controls. HTN was significantly more common in the C-Tor group (86.7% vs. 30%, p < 0.002); other clinical characteristics were similar. The C-IMT was abnormal in the C-Tor group only (p: 0.007). The diastolic dysfunction parameters differed between the two groups: the E/A ratio was < 1 in the C-Tor group and > 1 in the normal group (p: < 0.001); the E velocity and deceleration time were significantly lower in the C-Tor group (p: 0.001 and < 0.001 respectively); the E/E' ratio, A, and A' velocities were significantly higher (p: 0.005, < 0.001, < 0.001 respectively); while the S' velocity was similar in the 2 groups (p: 0.078). The C-Tor group had higher total cholesterol and LDL (p: 0.003 and 0.006 respectively). All C-Tor patients undergoing stress tests had positive results. The only independent C-Tor predictors in a regression analysis were HTN, total cholesterol, A-wave velocity, and deceleration time (DT) (odds ratio: 14.7, 1.03, 1.15, and 0.95, all p: < 0.05). A-wave velocity had the best area under the curve, sensitivity, and specificity for C-Tor prediction (0.88, 73.3%, and 96.7% respectively) followed by DT (0.86, 66.67%, and 96.6% respectively). CONCLUSION: C-Tor is associated with increased C-IMT, HTN, hyperlipidemia, and left ventricular diastolic dysfunction; all contributing to an ongoing atherosclerotic process. A-wave velocity and DT were independent predictors of C-Tor. C-Tor may cause microvascular ischemia that merits further investigation.