All Articles in May, 2019

Background and objectives: New AKI biomarkers (on the top of it NGAL biomarker) have demonstrated better performance for prediction of AKI in critically ill patients with heterogeneous illness. Renal angina index was recently reported to enhance prediction of severe AKI at the time of intensive care unit admission. This study tested the hypothesis that incorporation of uNGAL in patients with renal angina improves the prediction of severe AKI. Design, setting, participants & measurements: In our study 53critically ill children admitted to the pediatric intensive care unit in Zagazig university hospital, Measurement of urine neutrophil gelatinase– associated lipocalin (uNGAL) was determined individually by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Statistical analysis was done for these data. Results: Individual uNGAL demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.877), little higher than prediction by RAI (AUC=0.847). Incorporation of uNGAL significantly added to the renal angina index AKI prediction (AUC=0.847, increased to 0.893). Conclusion: This study shows that incorporation of uNGAL into the RAI improves detection ability of severe AKI in critically ill children.

Assuming that the road infrastructure has been implemented in accordance with specifications and standards, poor adhesion between the two layers of asphalt mix can be a significant cause of pavement problems. The general problem observed with the weak adhesion between the layers is the slip failure. Slipping disruption in areas where transport acceleration increases, in areas where acceleration decreases or may occur in bumps. One of the criteria and a test method for measuring adhesion resistance between the hot mix asphalt layers is needed to improve the surface finish. The main objective of this study is to determine the effect of reducing the coefficient of friction between asphalt layers in the displacement of asphaltic layers. Because performing experimental experiments in the country is a deterrent to this goal, the use of analytical and numerical methods has been shown to play an important role in conducting studies. Therefore, in this paper, using vehicle simulation in ABAQUS software and analyzes, it has been found that decreasing the coefficient of friction (adhesion reduction) increases the interlayer deformation, which causes the surface of the pavement to fail. Three different thicknesses for asphalt cladding, including 4, 6, and 7 centimeters, and three different thicknesses for roller concrete layers of 18, 20 and 22 centimeters are used. Modeling and analysis of pavements with finite element method has been performed and the depth of the asphalt and tensile strain slope is calculated at the maximum level. The results show that the type of asphalt mix has a high impact on the amount of sloping and tensile strain at the maximum level. So that under different conditions it is estimated to be about 2-3 times in the amount of rotation at the surface. Also, the amount of groove and strain in the middle of the procedure is increased by a thickness of 11% the thickness of the roller concrete thickness has not changed, but the surface strain has been reduced by 9%.

Background: The use of a custom-made orthotic plantar device is referenced as a true sensor-motor facilitation tool for the control of the postural orthostatic and orthodynamic position in patients with Parkinson’s disease. Aim: To outline the postural and kinematic effect of a pro-ergonomic multilayer foot insole versus a custom-made carbon-kevlar dynamic foot insole in a cohort of patients affected by extrapyramidal disease. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: A sample of 8 patients (mean age of 82.6), of whom 4 affected by Parkinson’s disease (P) and 4 by Parkinsonism (PS) were recruited for the aim of this study. In line with our inclusion criteria (clinical-functional diagnosis of Parkinson’s disease or Parkinsonism, Webster scale ≤ 20, Mini-mental State Examination (MMSE) ≥ 18), the study design developed in 2 times: a. time T1 (or evaluation time), in which recruited patients affected by Parkinson’s disease or Parkinsonism were evaluated at the Hospital and Noble Resting House Paolo Richiedei through an accurate functional (Conley scale, Barthel Index scale, Tinetti scale and the Berg Balance Scale), postural evaluation (VPA) and walking examination (VGA, baropodometric evaluation, kinematic gait evaluation through WIVA system); to each group of patients of our study were therefore entrusted 4 foot-insoles, of which 2 synthetic and 2 carbon-kevlar custom-made foot-insoles called PRODYNAMIC; at the end of this step, patients started with our integrated rehabilitative treatment course. b. time T2 (or experimental time; 90 days from T1), a new clinical-instrumental evaluation of each patient was performed, repeating the clinical-functional and instrumental evaluation performed at the time T1 in a specular way; this assessment was performed in FW condition, with personal footwear and previously acquired foot-insoles used during the evaluation at the T1 time. Results: Most of our patients have been able to find benefit from the use of the plantar orthosis and integrated rehabilitation treatment so as to bring some modifications within personal postural attitude, recording an improvement but not uniform change within the sample. The results obtained by comparing the VPA at time T1 and at time T2 explain how patients affected by both clinical forms tend to establish incorrect postural attitudes due to stiffness and appearance of hypertonic plasticity, which become then structured and only partially modifiable. There was a general performance improvement in line with the VGA: within the P.B group, we observed with the use of the Prodynamic insole a partial or even complete normalization of the dynamic heel-contact phase, a better alignment of the COP in its excursion from the 1st to the 2nd rocker phase of the step, a notable facilitation to the inertial thrust in progress in the 3rd and 4th rocker phase, an improvement in the eccentric control of the patellofemoral alignment in the acceptance phase of the so-called load-response in stance and, finally, the acquisition of a more physiological propulsion structure of the trunk basin unit with an improvement of the clearance and fixation skills in the sequential phases of the step. This trend was evident but not uniform in the other groups considered. Analysis of the evolution of the degree of functionality in the daily life activities expressed by the Barthel index, passing from time T1 to the time T2, showed an improvement and consistent change in all groups considered within our study that we can find in a more or less way for the other clinical outcome data. An objective time-related and intra-group comparison of the raw static and dynamic baropodometric data acquired in our 4 study conditions showed different time-related trends for the two groups taken into consideration. A specific WIVA profile was found for each pathology group, highlighting different trends passing from time T1 to time T2 in particular of the gait cadence and gait speed. In particular, in the “Prodynamic” study condition the gait cadence shows in the Parkinson group a significant increase from time T1 to time T2, passing respectively from an average value of 41.9 ± 11.7 to 54.9 ± 1.1; patients of the Parkinsonism group showed a value of the average gait cadence at time T1 higher than the other study conditions at the same evaluation time, with an increase of this data from T1 to T2, passing from 43.1 ± 11.8 to 47.4 ± 4.4. If we consider the gait speed time-related trend, in the “Prodynamic” study condition at T1 the gait speed in Parkinson patients is similar to that recorded in the “shoe” study condition; in Parkinsonism the gait speed recorded at time T1 is higher than that recorded in the other study conditions; at time T2 there is a less evident increase in speed compared to that observed in patients with Parkinson’s. Conclusion: In today’s management of the profile of complexity of extrapyramidal pathology, the association of several health figures is of fundamental importance, with professional profiles and diversified skills, in such a way as to be able to guarantee a comprehensive management of the patient. From this point of view, the figure of the orthopedic technician will be able to play a new role within the rehabilitation team, which will be responsible for the best possible functional response (deriving from an optimal integration between orthotic and rehabilitation treatment) of patients with Parkinson’s disease.

Study Design: Prospective Observational Study. Background: Physical therapy is one of the primary treatment options for these patients, however, we were unable to identify previously published research that objectively assesses the impact of taping on joint range of motion or on pain levels in patients with SAIS. This gap in the literature motivated the present study. Objectives: To describe the results of the application of neuromuscular taping in patients with subacromial impingement syndrome (SAIS), with respect to their pain levels, joint range of motion, and acromiohumeral distance, assessed via ultrasound. Methods: A prospective series of cases was evaluated at the Hospital Italiano de Buenos Aires between April and September of 2018. Twenty-four patients from age 25 to 65 were invited to participate (9 men and 15 women), all of whom had been diagnosed with rotator cuff tendinopathy, impingement syndrome, or bursitis with positive signs of impingement in the affected shoulder and anterior shoulder pain in flexion. Result: Significant changes in AHD (Figure 2), pain, and anterior flexion were registered after taping. Superficial dermatitis was detected in only two patients, but this did not affect the assessment. Conclusion: In the results obtained by this study, it has been observed that the application of neuromuscular taping using the method described above significantly increases AHD, leading to short-term improvements in pain and joint range of motion.

Tropical forests have long been of interest to biologists because of their high species diversity and their complicated patterns of community organization. The recent ecological studies which have demonstrated that tropical trees are diverse in their reproductive biology and dynamic population structure. Asynchronous flowering among the clones in a clonal seed orchard is an inherent problem resulting in poor seed and fruit set in them. These results in the complete defeat of the prime objective of establishment of clonal seed orchards (CSOs) i.e. abundant quality seed production poor flowering and asynchronous flowering between the clones are a major bottleneck in higher seed set in these clonal seed orchards across the country. Asynchrony found between clones may be attributed to the origin of clones, which are collected from different zonal populations as revealed by isoenzyme and DNA markers studies. This article reviews the work done in CSOs across the world and suggests an alternate strategy in designing the clonal seed orchards of the future.

NMDA receptor encephalitis is a rare disease first described in 2007. Anti-NMDA receptor encephalitis affects mostly young women as neoplasms, mostly ovarian teratomas, are the underlying cause. The disease is caused by antibodies binding to extracellular epitopes of neuronal cell-surface, which leads to an internalization of NMDA-receptors. The characteristic syndrome of patients with anti-NMDAR as well as its recovery follows a certain pattern. Treatment includes immunotherapy and removal of the immunologic trigger. This case report describes a young woman with anti-NMDA receptor encephalitis caused by an ovarian teratoma. 

Introduction and aim: Idiopathic nephrotic syndrome (INS) is the most common type of this disease during childhood. Minimal change nephrotic syndrome (MCNS) is the most common histopathological lesion (80 – 90%) of INS in children and about 90% of patients are steroid responsive, while congenital nephrotic syndrome is disorder that may be caused by several diseases. Intrauterine infections, especially CMV infection, have frequently been incriminated as etiological factors of secondary CNS. The aim of this research was to evaluate the frequency of CMV infection children with active nephrotic syndrome in our pediatric nephrology unit Patients and methods: This descriptive (cross sectional) study was conducted in pediatric nephrology unit, Zagazig University Hospitals and included 60 patients WITH NS in activity; Participants were subjected to, Full history taking, Clinical examination; general & local, Routine laboratory investigations and Serum samples were tested for HCMV specific immunoglobulin G (IgG) and immunoglobulin M (IgM) using ELISA Kit. Results: We found 100% of cases were IgG positive and 7/60 cases were IgM positive, There were no statistically significant differences between IgM positive-patients vs IgM-negative patients according to age, sex and first attack or relapsed NS, There were statistically significant differences between IgM positive-patients vs IgM-negative patients in blood laboratory data in decreases in HB (P=0.024) and serum urea nitrogen (P=0.04) Conclusion: We concluded that serofrequency of cytomegalovirus infection in pediatric nephrology unit, Zagazig university hospitals during follow-up was 12% for cmv IgM and 100% for cmv IgG at ns children patients

Hyperglyceridemia induced pancreatitis in pregnancy accounts for 4% of all cases of acute pancreatitis. Though rare, hypertriglyceridemia induced pancreatitis may lead to fatal maternal and fetal complications, even maternal death. Its management during pregnancy remains a challenge for many physicians. Management options are limited in pregnancy. In the refractory cases, management options and timing of delivery is debatable. Here we report a case of hyperglyceridemia induced pancreatitis and the challenges faced in the management.

The research concerning a preventive treatment of an osteoporitic femoral neck fracture started in 1990 because the surgical procedure of unstable femoral neck fractures is difficult. After effects are frequent and their number will increase in the next decade. The goal is to reinforce the femur with a biomaterial acting as a bone graft. Natural coral is bioresorbable and biocompatible. It acts as an autofocus bone graft for reconstruction of either cortex or cancellous bone and increases their mechanical resistance. This work shows evidence of new bone formation in an osteoporotic unbroken femoral neck femur. Consequently, the preventive surgical treatment of osteoporosis should be taken in consideration [1]. The purpose of this work is to show the results on the mineralization of the cancellous bone of an upper femoral metaphyses when a natural biomaterial is set in an unbroken osteoporotic femoral neck. Summary: Mrs. L is an 84 years old lady. Her osteoporotic unbroken right hip was grafted preventively with a biomaterial in order to prevent the high risk of break in case of fall. The biomaterial used is beads of natural coral. The reasons of this preventive treatment is discussed, as well as the choice of the biomaterial. The results are shown including a two years follow up. Brief History: Before going further, few words of history. Three centuries BC, an Aristote’s follower, Théophraste thinks that Natural coral is a petrified plant. For Ovide natural coral is a soft alga air-hardening. Al Biruni classes it among animals, because that respond to touch. At the beginning of the XVIIth century, Marsigli thinks that they are flowers which open out there in aquarium. The French Jean-André Peyssonnel, a young naturalist, says as Biruni, that in fact, corals are animals. At last, Buffon claims: These marine plants, were classified first in the rank of minerals, then in those of plants, and finally in that of animals. Natural coral is obviously an animal. After the Second World War, coral samples were analyzed by American scientists. Among 800 corail species, 3 where specially analyzed: Acropora, Porites and Libophylia. Mrs Nane Guillemin did in France her PHD on natural coral and with her team made a complete fundamental analysis (physical, chemical and biological properties) of the material, while the American scientists worked on the chemical bone’s properties. In France, Pr Ohayoun and his team worked on the surgical application in the dental field, Dr. Yves Cirotteau in the orthopedic surgery, specifically for osteoporotic disease and for the traumatologic field

Before discussing the crux of the matter, it is important to understand what “wild” signifies and the characteristics that define a wild animal. As contrasted to domesticated animals, a wild animal can be defined as an animal living freely in his natural habitat, independently of Man. These animals are only exposed to variations in the biological equilibrium, to the imperatives of their genetic program and live in a habitat that gives them the possibility of expressing it themselves. However, this definition is very narrow as there exist a number of species of wild animals that don’t live freely in their natural habitat. These animals are constrained by Man, who by creating a relationship of dependence, controls them and in turn becomes responsible for their sustenance. In such a situation, their habitat is no more their natural habitat but than which has been imposed on them by Man; such animals are said to be “held in captivity” or even “tamed”. In short, when talking about law and ethics related to wild animals, there are two things to be taken into account: wild animals that live in the wild and wild animals that live held in captivity by Man.

Cellular Angiofibroma is a rare benign mesenchymal tumor without gender preference. It is usually a small (<3cm), well-circumscribed, mostly asymptomatic and typically slow growing. Surgical removal of the mass with its capsule is the preferred treatment, not only helps guarantee complete excision and prevent its recurrence but also minimize blood loss. We present the case of a 76-year-old woman with a giant vulvar mass. 

Introduction: Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches. Aims: To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used. Methods: This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed. Results: There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet. During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling. Conclusion: Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach.

Purpose: Medical coverage of the 29th “Tour du Faso” primarily aimed to report the experience of the medical coverage of the 2016 International Cycling Tour of Burkina Faso. Methods: This is a prospective study of the medical coverage of the 2016 International Cycling Tour of Burkina Faso. Results: During the 12 days of medical coverage, 216 consultations were recorded. The complaints were diversified. From simple asthenia to severe malaria. There were cases of indigestion, gastroenteritis and food allergies. Conclusion: The medical coverage of a cycling competition requires knowledge of the discipline, expertise in sport and emergency medicine.

Introduction: Abdominal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera. In particular, internal hernias (IH) represents about 0.2-0.9% of all cases with para- duodenal hernias while obturator hernias accounting for only 0.07% of all hernias. Methods: We reported the case report of 79 year old women who was admitted to Internal Medicine Department of our Hospital for lung failure and after few days transferred to our Surgery Department for abdominal pain. Conclusion: Obturator hernia is rare type of hernia and it is more frequent in older women with history of multiple pregnancy, chronic cough, and habitual constipation. In our patients, detailed physical examination and MRI preoperative imaging studies, have induce to the successful diagnosis.

Background: Pure red cell aplasia is characterized by anemia, reticulocytopenia and diminished bone marrow erythroid precursors. It has multifactorial etiology and consequently several therapeutic interventions. Case: In August 2017, a young patient was diagnosed to have pure red cell aplasia. She was given immunosuppressive therapy for approximately two months but this treatment was stopped due to intolerance. Later on she developed herpes zoster infection that was treated with valacyclovir. Subsequently, it was noted that the patient became blood transfusion independent due to normalization of her hemoglobin and regeneration of the erythroid precursors in the bone marrow. Discussion: Varicella zoster virus behaves differently from other members of the herpes group of viruses such as cytomegalovirus and Epstein-Barr virus. Two retrospective studies, performed in patients with malignant hematological disorders and bone marrow failure, have shown that infection with the virus may cause stimulation of the three cell lines in the bone marrow and superior overall survival. Conclusion: The outcome of the patient presented confirms the findings of the two studies showing long-term beneficial effects of varicella zoster virus infections in immunocompromised individuals.

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. Aim of our study was to assess the clinical and the cytogenetic characteristics in longlivers with osteoarthritis from Precarpathian region (Ukraine). Methods: Cytogenetic, Clinical Results: All of the subjects were separated into three groups: І group - 146 longlivers patients who had hypertension and osteoarthritis (ОА); II group - 93 longlivers patients only with ОА. The control (third) group included 130 patients aged 90-102 years without osteoarthritis and hypertension in anamnesis. In the age group more than 95 years, men and women of both groups were significant difference (p<0,05) to be compared with control. Cytogenetic characteristics of the long-livers with on osteoarthritis showed that most there is a tendency for a higher frequency of chromosomal aberrations in male long-livers and tere are significant difference among control (p<0,05). The number of chromosomes associated in a single cell was significantly higher (p<0,05) in both groups compared to control. Conclusion: The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Ukraine was analyzed and assessed.

Outbreaks of Ebola virus can cause substantial mortality in affected countries. The largest outbreak of Ebola to date is currently underway in West Africa, with 3944 cases reported as of September 5, 2014. For the sake of deriving a better understanding of the Ebola transmission dynamics, we have undertaken to revisit data from the initial spark of origin of the Ebola virus, which occurred in 1976 in Zaire (now Democratic Republic of Congo). By fitting a mathematical process to time series stratified by disease onset, outcome and source of infection, we have managed to estimate several epidemiological quantities, previously admitted to be too challenging to measure, including hospital and infected community contribution infection to the widespread transmission.