Ginger and its constituents in asthma: a mini-review.

OBJECTIVE: The primary objective of this review is to focus on research findings that aim to determine the immunomodulatory action of ginger's active components and the molecular mechanisms that reduce asthma. The study aims to provide an overview of the scientific literature available on ginger's efficacy in treating allergic asthma. DATA SOURCE: The mouse model of asthma has been used to investigate the actions of ginger and its active compounds on allergies and asthma. Various studies and scientific literature on ginger's health-improving qualities and its traditional use have been examined. RESULTS: The findings indicate that ginger and its active ingredients have anti-asthmatic features and a suppressive impact on mast cell production of histamine. Animals given ginger and compounds derived from ginger demonstrate a notable reduction in allergic response, suggesting a significant role in lowering the allergic reaction. CONCLUSION: While ginger shows promise as a potential treatment for allergies and asthma due to its anti-inflammatory, antibacterial, antidiabetic, anticancer, and antioxidant effects, further examination, extrapolation, and confirmation of these results are necessary before utilizing ginger and its active components in human treatments. This review highlights the need for additional research and provides an overview of the current scientific literature on ginger's efficacy in treating allergic asthma.

Giant left atrium associated with massive thrombus formation.

Giant left atrium is a condition characterized by huge enlargement of the left atrium with a diameter exceeding 65mm. It is most commonly associated with long standing rheumatic mitral valve disease. We present a 45-year-old female patient with rheumatic mitral stenosis associated with giant left atrium occupied by an 11 × 10 × 5 cm thrombus weighing 500 gms. The patient underwent successful mitral valve replacement and thrombectomy through an inverted T-shaped biatrial incision.

Double-balloon valvuloplasty of calcified bioprosthetic pulmonary valve twenty-three years after implantation.

Balloon valvuloplasty to dilate stenotic bioprosthetic valves is rarely used, but has been applied successfully to dilate bioprosthetic mitral, aortic, tricuspid and, to a lesser extent, pulmonary valves. The case is reported of a 45-year-old male patient with right-sided heart failure who underwent a successful dilatation of a stenotic, calcific bioprosthetic pulmonary valve using double-balloon valvuloplasty.

Prospective Comparison of Hepatocellular Carcinoma Behavior and Survival of Patients who Did or Did not Receive HCV Direct-Acting Antivirals.

BACKGROUND & AIMS: The safety and efficacy of hepatitis C (HCV) direct-acting antivirals (DAAs) have been established in several real-world trials; however, some reports have claimed an association between DAAs and hepatocellular carcinoma (HCC) occurrence or aggressive behavior. We aimed to prospectively examine differences in de-novo HCC tumor behavior and overall survival (OS) in DAAs-treated versus HCV-untreated patients as measured by BCLC progression during a two-year follow-up period. METHODS: This multicenter cohort study recruited 523 patients with de-novo HCV-related HCC. After exclusion criteria were applied, 353 patients were placed into; Group 1, including 236 patients without a history of DAAs therapy, and Group 2 including 117 patients with de-novo HCC developed after receiving DAAs. Patients were then stratified in each group according to BCLC staging (Liver, 2018). All patients received standard of care management and were followed until death or a maximum of 2 years. RESULTS: No statistically significant differences were observed between the two groups regarding tumor characteristics (number and size of lesions) and criteria for aggressiveness upon presentation. Among all BCLC stages, DAAs treated patients showed significantly lower baseline Fib4 values than DAA untreated patients in BCLC-0 stage (4.1 vs 7.7, p 0.019). No statistically significant differences were evident in HCC progression in the different BCLC stages at 12 and 24 months follow up periods (p 0.0718 and 0.279 respectively). Significantly better survival was recorded in Group 1 compared to Group 2 patients for BCLC stages C and D (p = 0.003 and 0.01, respectively). CONCLUSION: HCC may develop at an earlier stage of liver disease after DAAs therapy. No defensive role was found for DAAs treatment in delaying HCC progression that occurs after viral eradication.
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Chloride-binders and their effect on the physico-mechanical properties of sulfate-resisting cement (SRC) hardened pastes upon exposure to sea water attack.

In Egypt, the national strategic plan for population redistribution supports the establishment of new towns and urban settlements across the coastal zones to relieve the pressure on the packed Nile Valley and Delta and encourages internal migration to new urban coastal communities. Since reinforced concrete has a poor service record in these areas, this situation urged us to design a research program in which a new route has been followed for confronting the concomitant effect of sulfate and chloride attack. Therefore, sulfate-resisting cement (type V) has been used for preparing concrete. The cement has been blended with a chloride-binder for fixing free chloride into an insoluble (or poorly soluble) reaction product. As to the steel reinforcement, the research program will investigate steel protection by an innovative inhibited cement slurry coating. The current-first part-of the research program has been concentrated for determining the influence of a chloride-binder [lead oxide (PbO)] as well as a novel proposed chemical compound [lead nitrate: Pb(NO3)2], as chloride-binders, on the physico-mechanical properties of hardened SRC pastes upon exposure to sea water. The investigation disclosed that these compounds marginally delay the setting time relative to the chloride-binder-free pastes, yet they improve workability, maintain alkalinity (hence carbonation resistance), and yield better compressive strength.

The COVEG score to predict severity and mortality among hospitalized patients with COVID-19.

INTRODUCTION: COVID-19 severity and mortality predictors could determine admission criteria and reduce mortality. We aimed to evaluate the clinical-laboratory features of hospitalized patients with COVID-19 to develop a novel score of severity and mortality. METHODOLOGY: This retrospective cohort study was conducted using data from patients with COVID-19 who were admitted to five Egyptian university hospitals. Demographics, comorbidities, clinical manifestations, laboratory parameters, the duration of hospitalization, and disease outcome were analyzed, and a score to predict severity and mortality was developed. RESULTS: A total of 1308 patients with COVID-19, with 996 (76.1%) being moderate and 312 (23.9%) being severe cases, were included. The mean age was 46.5 ± 17.1 years, and 61.6% were males. The overall mortality was 12.6%. Regression analysis determined significant predictors, and a ROC curve defined cut-off values. The COVEG severity score was defined by age ≥ 54, D-dimer ≥ 0.795, serum ferritin ≥ 406, C-reactive protein ≥ 30.1, and neutrophil: lymphocyte ratio ≥ 2.88. The COVEG mortality score was based on COVEG severity and the presence of cardiac diseases. Both COVEG scores had high predictive values (area under the curve 0.882 and 0.883, respectively). CONCLUSIONS: COVEG score predicts the severity and mortality of patients with COVID-19 accurately.

Sofosbuvir/ledipasvir in combination or nitazoxanide alone are safe and efficient treatments for COVID-19 infection: A randomized controlled trial for repurposing antivirals.

BACKGROUND AND STUDY AIMS: Currently, there is no therapy approved for COVID-19. We evaluated the efficacy and safety of sofosbuvir/ledipasvir and nitazoxanide for the treatment of patients with COVID-19 infection. PATIENTS AND METHODS: A multicenter, open-label randomized controlled trial included one hundred and ninety patients with non-severe COVID-19 infection. Patients were randomized into three groups. All groups received standard care treatment (SCT). In addition, group 1 received sofosbuvir/ledipasvir, and group 2 received nitazoxanide. Follow-up by reverse-transcriptase polymerase chain reaction (RT-PCR) was done at intervals of 5, 8, 11, and 14 days. The primary endpoint was viral clearance. RESULTS: Viral clearance was significantly higher in the sofosbuvir/ledipasvir and nitazoxanide groups compared to the SCT group in all follow-up intervals (p < 0.001). In the sofosbuvir/ledipasvir arm, 36.9% showed early viral clearance by day 5. By day 14, 83.1% of the sofosbuvir/ledipasvir group, 39.7% of the nitazoxanide group, and 19.4% of the SCT group tested negative for SARS-CoV-2. Sofosbuvir/ledipasvir and nitazoxanide treatment were the only significant factors in Cox regression of negative RT-PCR with the highest OR (17.88, 95% CI: 6.66-47.98 and 2.59, 95% CI: 1.11-6.07, respectively). No mortality or serious adverse events were recorded. CONCLUSION: The addition of sofosbuvir/ledipasvir or nitazoxanide to the SCT results in an early and high viral clearance rate in mild and moderate patients with COVID-19. These drugs represent a safe and affordable treatment for COVID-19.

Management of life-threatening acute respiratory syndrome and severe pneumonia secondary to COVID-19 in pregnancy: A case report and literature review.

Evidence-based treatment involving multidisciplinary decision making is warranted to treat COVID-19 in pregnancy. This case presents the management of a critically ill pregnant women infected with SARS-CoV-2.

Clinical features and laboratory characteristics of patients hospitalized with COVID-19: single centre report from Egypt.

INTRODUCTION: The recently discovered novel coronavirus disease (COVID-19) has emerged in Wuhan, China, since January 2020. Egypt reported a low incidence of infection when compared with other countries. The aim of the study was to assess the characterization of COVID-19 infection among the Egyptian population. METHODOLOGY: Data were collected from a single COVID-19 quarantine hospital in Cairo. A total number of 195 cases were included with their clinical, laboratory, and radiological data. RESULTS: Three different age groups behaved differently for COVD-19 infection. The pediatric age group was asymptomatic entirely, the middle age group (18-50 years) were asymptomatic in 53.3% of cases, while 77.9% of those above 50 years were symptomatic (p ≤ 0.001). The latter group had a high incidence of COVID-pneumonia in (83.1%), and moderate to critical presentations were encountered in 66.3% of them. Neutrophil to lymphocyte (N/L) ratio correlated directly with the age and case severity. C-reactive protein (CRP) and computed tomography scan chest (CT-chest) had added value on COVID-19 diagnosis in suspected cases. CONCLUSIONS: In Egypt, patients above 50 years are at a higher risk for symptomatic COVID-19 infection and leaner for moderate to critical COVID-19 presentation. The triad of CT-chest, CRP, and N/L ratio could be an integrated panel for assessing disease severity.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

BACKGROUND: Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. METHODS: Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. RESULTS: Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. CONCLUSION: PMV achieves comparable results to CSC both in the short and long term.

Conventional hemorrhoidectomy versus ligasure hemorrhoidectomy: a comparative study

Background: Hemorrhoidal disease is one of the most common anorectal diseases and surgical hemorrhoidectomy remains one of the most common operations in general surgery. Milligan-Morgan Described the conventional hemorrhoidectomy since about 70 years ago, then surgical hemorrhoidectomy had changed little over years until the introduction of LigaSure hemorrhoidectomy

Aim of the work: Is to compare between conventional [Milligan-Morgan] hemorrhoidectomy and LigaSure hemorrhoidectomy in treating patients with 3[rd] and 4[th] degree internal piles

Patients and methods: This randomized control clinical trial was done at Mounira General Hospital over a period from April 2017 to March 2018 on the basis of: It included 40 adult patients with 3[rd] and 4[th] degree hemorrhoids divided randomly into 2 equal groups: Group A [n: 20 patients] underwent LigaSure hemorrhoidectomy. Group B [n: 20 patients] underwent Conventional hemorrhoidectomy

Results: There was a highly significant difference between the two study groups as regard the operative time, in the LigaSure hemorrhoidectomy group the mean operative time was 11.15 +/- 2.68 minutes, while in the conventional technique group the mean time was 28.75 +/- 4.20 minutes. As regards the post-operative pain, in the 1[st] day, there was a highly significant difference between the two study groups; in the LigaSure hemorrhoidectomy group the mean post-operative pain was 3.80 +/- 1.54; while in the conventional technique it was 5.95 +/- 0.99. Regarding the post-operative pain, in the 1[st] week, the LigaSure hemorrhoidectomy group mean was 2.60 +/- 1.27; while in the conventional method was 4.80+/-0.89. As regard the intra-operative estimated blood loss, a significant difference between the two study groups was present. In ligaSure hemorrhoidectomy group 40% had almost no bleeding, 20% had minimal blood loss, 20% had mild loss and 20% had moderate blood loss in comparison with conventional method group patients; 0% with no blood loss, 15% with minimal loss, 55% with mild loss and 30% with moderate blood loss. As regards duration of wound healing, in the LigaSure group, the mean time was 2.65 +/- 0.74 weeks while in the in the conventional technique group, it was 4.60 +/- 0.82 weeks which was statistically highly significant. With LigaSure hemorrhoidectomy only 6 patients out of 20 needed anal packing, in contrast with conventional method group that needed an anal pack for the whole 20 patients

Conclusion: We conclude that LigaSure hemorrhoidectomy is better than conventional [Milligan-Morgan] hemorrhoidectomy in terms of less operative time, less intra-operative blood loss, less post-operative pain, less post-operative analgesics and earlier wound healing and return to daily work hence higher patient satisfaction. Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this work

Comparison of ultrasonic [harmonic scalpel] hemorrhoidectomy versus milligan-morgan hemorrhoidectomy for hemorrhoidal disease

Background: Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third and fourth-degree hemorrhoids. The resulting mucosal defect is then left open

Objectives: The purpose of this study was to compare techniques of hemorrhoid excision using the Harmonic Scalpel versus the routine Milligan-Morgan technique

Methods: From August 2017 to May 2018, 30 patients underwent surgical excision of complex grade III or grade IV hemorrhoids via the Harmonic Scalpel another 30 patients operated with the traditional Miligian Morgan technique. Data collected about patient clinical condition and perioperative details including operative time and blood loss then post-operative acute pain and delayed pain and other complications then the quality of life after returning to routine life including degree of satisfaction of the patients were recorded in a master sheet and short form survey for documentation and statistical analysis

Results: Both groups were comparable in terms of patient demographics and type of anesthesia. There were no late complications. Mean follow-up was 4.9 [range, 4-6] months

Conclusion: hemorrhoidectomy with Harmonic Scalpel significantly reduces perioperative time, blood loss and thus postoperative pain, without diminishing quality of life

Comparison between pre-operative fine needle aspiration cytology and intra-operative frozen section biopsy in the diagnosis of solitary thyroid nodule

Controversy continues to exist concerning the diagnosis of solitary thyroid nodule. Even today there is a wide spread disagreement as to the best method of establishing a definitive diagnosis. Fine needle aspiration cytology [FNAC] is a standard diagnostic procedure for patients with solitary thyroid nodule and the necessity for frozen section [FS] intraoperative biopsy has been the subject of discussion. The purpose of this study is to compare between preoperative FNAC and intraoperative FS biopsy in the diagnosis of solitary thyroid nodule. Twenty patients [17 women and 3 men with mean age 36.5, range 23-64 years] suffering from solitary thyroid nodule were admitted to hospital. Combined preoperative FNAC and intraoperative FS examination were assessed in all patients. In the benign cytology, the diagnostic accuracy was 78.6% for FNAC and 100% for FS biopsy. In those with suspicious cytology [cellular FNAC diagnosis], the diagnostic accuracy was 15% for FNAC and 95% for FS biopsy. In those with malignant cytology, the diagnostic accuracy was 50% for preoperative FNAC and 83.3% for intraoperative FS biopsy