'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps

BACKGROUND

Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes.

METHODS

STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis.

RESULTS

Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%).

CONCLUSIONS

This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.

Performance and satisfaction during the E-learning transition in the COVID-19 pandemic among psychiatry course medical students

Background

In the field of medical education, students faced significant challenges during the COVID-19 pandemic. Abrupt alterations were made in the form of preventative precautions. Virtual classes replaced onsite classes, clinical placements were canceled, and social distance interventions prevented face-to-face practical sessions. The present study aimed to assess students' performance and satisfaction before and after the transition of a psychiatry course from onsite to entirely online during the COVID-19 pandemic.

Methods

A retrospective, non-clinical, and non-interventional comparative educational research study included all students registered in the psychiatric course for the academic year 2020 (pre-pandemic/onsite) and 2021 (during the pandemic/online).To assess students' satisfaction, we utilized the National Commission for Academic Accreditation and Assessment (NCAAA) students' satisfaction survey used by the academic quality unit at KSU, College of Medicine.Satisfaction was assessed in six domains: course organization, learning resources, faculty experiences, clinical teaching, practical sessions, and overall satisfaction. The reliability of the questionnaire was measured using Cronbach's alpha test.To assess their performance, students' grades from both periods were obtained from the exam center.

Results

A total of 193 medical students enrolled in the study; 80 received onsite learning and assessment, while another 113 received full online learning and assessment. The students' mean indicators of course satisfaction for the online courses exceeded their corresponding indicators significantly compared to the onsite courses. These indicators included students' satisfaction in terms of course organization, p < 0.001; medical learning resources, p < 0.050; faculty experience, p < 0.050; and overall course, p < 0.050. There were no significant differences regarding satisfaction in both practical sessions, p > 0.050, and clinical teaching, p > 0.050. The students' performance mean was significantly higher in the online (M = 91.76) compared to the onsite courses (M = 88.58) (p < 0.001), and the Cohen's D statistic showed there was a medium level of enhancement in students' overall grades (Cohen's d = 0.41).

Conclusion

Students perceived the switch to online delivery methods very favorably. Students' satisfaction significantly improved regarding the themes of course organization, faculty experience, learning resources, and overall course satisfaction, while a similar level of adequate student satisfaction was maintained in terms of clinical teaching and practical sessions during the transition of the course to e-learning. In addition, the online course was associated with a trend toward higher students' grades. However, the assessment of the achievement of course learning outcomes and the maintenance of this positive impact warrants further investigation.

Impact of bariatric surgery on early-onset colorectal cancer risk: a systematic review and meta-analysis

The aim of this meta-analysis is to determine the impact of bariatric surgery on the risk of early-onset colorectal neoplasia. This systematic review was conducted according to PRISMA recommendations. It was registered in the PROSPERO international database. A comprehensive search was conducted in electronic databases (MEDLINE, EMBASE, and Web of Science) for completed studies until May 2022. The Search was made using a mixture of indexed terms and title, abstract and keywords. The search included terms: obese, surgical weight loss intervention, colorectal cancer, and colorectal adenomas. Studies that included bariatric intervention patient's vs non-surgical obese patients younger than 50 years were considered. Inclusion criteria were patients with BMI more than 35 kg/m² who underwent a colonoscopy. Studies with follow-up colonoscopy performed in less than 4 years after bariatric surgery and those that evaluated patients with a mean age difference of 5 or more years between groups were excluded. Outcomes analyzed in obese patients with surgical treatment vs control patients included colorectal cancer incidence. From 2008 to 2021, a total of 1536 records were identified. Five retrospective studies that included 48,916 patients were analyzed. Follow-up period ranged from 5 to 22.2 years. 20,663 (42.24%) patients underwent bariatric surgery and 28,253 (57.76%) were part of the control patients. Roux-en-Y gastric bypass was performed in 14,400 (69.7%) individuals. The intervention and control group were similar in age range, proportion of female participants and initial body mass index (35-48.3 vs 35-49.3, respectively). 126/20663 (0.61%) patients in the bariatric surgery group and 175/28253 (0.62%) individuals in the control group presented CRC. In this meta-analysis, we were unable to demonstrate a significant impact of the Bariatric Surgery on EOCRC risk. Prospective trials with longer follow-up periods should be done to prove the colorectal cancer risk reduction.

Experience of Sudden Shift from Traditional to Virtual Problem-Based Learning During COVID-19 Pandemic at a Medical College in Saudi Arabia

Background

COVID-19 pandemic has resulted in a sudden shift to online education. PBL was one of the components that was transformed to online. The aim of the present study was to investigate the impact of the sudden shift to virtual PBL during COVID-19 pandemic in achieving the intended learning objectives of the PBL and to explore the students' perception of the virtual versus traditional PBL.

Methods

This is a retrospective study that was conducted in the college of medicine, King Saud University. We compared the perception of third year students who participated in traditional face-to-face PBL in 2019-2020 and in the virtual PBL in 2020-2021. We compared the performance of the students in the traditional face-to-face and in virtual PBL. An online survey was distributed from October to December 2021. The survey contained 7 sections. Each section included several questions comparing virtual and traditional PBL in that aspect.

Results

Out of 284 third year medical students, 124 students responded with a response rate of 43.66%. More than half of the students (n = 77, 63%) felt significantly motivated to actively participate in PBL sessions in a virtual learning environment, motivated to learn and support group work and gained critical thinking skills (mean = 3.54 ± 0.12 versus 3.59 ± 0.14, p < 0.001). The majority of students (n = 82, 66%) felt significantly more satisfied about their learning during the virtual PBL versus traditional PBL (mean = 3.48 ± 0.42 versus 3.91 ± 0.59, p < 0.001). There was no significant difference in the students' performance in traditional versus virtual PBL (mean = 4.77 ± 0.22 versus 4.79 ± 0.29, p = 0.2).

Conclusion

The results of this study showed that students were significantly more satisfied with the experience in the virtual versus traditional PBL. Medical students' performances in virtual PBL were comparable to the traditional face-to-face approach.

Students, faculty perceptions and effectiveness of the early introduction of clinical skills teaching in the medical curriculum

Objective

We hypothesized that the early introduction of clinical skills (CS) would help students to develop and apply clinical skills appropriately during the clinical years. Evaluating the perceptions of medical students and faculty regarding the early introduction of CS teaching and its effectiveness are important.

Methods

The CS curriculum was designed by integration with the system-oriented problem-based curriculum in years 1 and 2 at the College of Medicine, KSU, from January 2019 to December 2019. Students and faculty questionnaires were also designed. The impact of CS teaching effectiveness was assessed by comparing OSCE results for year-3 students who received early CS sessions with those who did not. The total number of student respondents was 461/598; and 259 (56.2%) were male and 202 (43.8%) were female. The first- and second-year respondents were 247 (53.6%) and 214 (46.4%), respectively. The number of faculty respondents was 35/43.

Results

The majority of students and faculty were satisfied that the early introduction of CS increased student confidence when dealing with real patients, provided the opportunity to master skills, consolidated theoretical knowledge and clinical skills, motivated learning, and increased the enthusiasm of students to become doctors. The third-year students who received CS teaching in years 1 and 2 (during 2017-2018 and 2018-2019) showed a significant increase in mean grades (p value; 0.00) in OSCE tests during their courses in surgery (from 32.6 to 37.4 for females; 35.2 to 35.7 for males) and medicine (31.2-34.1 for females; 34.3 to 37.7 for males), respectively, when compared to students who did not receive CS teaching during the academic year 2016-2017 (in surgery, 22.2 and 23.2; in medicine 25.1 and 24.2) for females and males respectively.

Conclusion

Early exposure of medical students to CS is a positive intervention that bridges the gap between basic sciences and clinical practice.

The impact of mobile phone fitness applications on the level of physical fitness and psychological well-being during covid-19: The case of university students

BACKGROUND

The impact of Coronavirus Disease-19 on peoples' life has become evident. Recently, sport activities are important in improving individual health and their well-being. The aim of this study is to investigate the effect of using mobile phone fitness applications on some characteristics of physical fitness and psychological well-being of female university students.

MATERIALS AND METHODS

A descriptive study design was implemented using a survey which was adapted to collect data from a sample of 50 female participants within the age of 18 to 19 years. As for the results, the participants indicated that they used physical fitness application by smart phone regularly during COVID-19.

RESULTS

The results also illustrate that there was a significant difference on the study variables based on the study groups and test time. The study results extend literature concerning sport activities participation and promoting positive well-being during COVID-19 pandemic.

CONCLUSION

The study indicated a significant difference of the application on physical fitness and psychological well-being among the participants. Based on the results, the study recommended to organize several sport activities among students and encourage them to use smart phones for positive purposes. Finally, practical implications are outlined.

Evaluation of the Experience of Peer-led Mock Objective Structured Practical Examination for First- and Second-year Medical Students

BACKGROUND

The objective structured practical examination (OSPE) is used as an assessment tool of laboratory practical sessions. This study described the design and implementation of peer-led mock OSPE for first- and second-year medical students, investigated the perception of the students of the peer-led mock OSPE and the impact of attending the mock OSPE on the performance.

METHODS

This is a cross-sectional study. Two mock OSPEs were designed and conducted by third-, fourth- and fifth- year medical students for year one and two. Each mock OSPE involved six stations. Thirty-three medical students facilitated the OSPE. The OSPEs were conducted prior to the summative end of block exams. Following the mock OSPEs, an online survey was sent to the participants to assess their satisfaction, quality and benefits of the mock OSPE. The study also evaluated the impact of the mock OSPE on students' performance.

RESULTS

Out of 313 first-year students, 279 (89.1%) attended the mock OSPE and out of 298 second-year students, 213 (71.5%) attended. A total of 192 (68.8%) first-year medical students and 102 (47.9%) second-year medical students completed the questionnaire. There was no significant difference between attending and non-attending the mock OSPE in the students' performance in the summative OSPE. The majority of students felt more confident, less anxious, and lowered the levels of stress after attending the mock OSPE. More than half of the students felt that attending the mock OSPE helped in easing the steps, better preparation, provided sufficient orientation, well explained the materials and helped them to learn the concept of the final OSPE. The majority of students found the mock OSPE stimulating.

CONCLUSION

Attending the mock OSPE did not affect the students' performance in the summative OSPE. However, the peer-assessed mock OSPE improved the medical students' confidence and lowered the anxiety associated with OSPE.

Primary retrograde urinary drainage using image and endoscopy guidance via urostomies

AIM

To report the technical success of image and endoscopy-guided retrograde trans-urostomy urinary drainage as a primary catheter placement method performed by interventional radiology (IR).

MATERIALS AND METHODS

Nine patients (15 attempted drain placements) with ureteric obstruction following radical cystectomy and urostomy creation were included. The patients were referred to IR for urinary drainage. All patients underwent primary image and endoscopy-guided retrograde trans-urostomy urinary drainage.

RESULTS

Primary image and endoscopy-guided retrograde trans-urostomy urinary drainage was successful in 13/15 (86.6%) attempts. The proposed technique had a limited complication rate omitting the percutaneous nephrostomy access step.

CONCLUSION

Primary image and endoscopy guided retrograde trans-urostomy urinary drainage should be considered before percutaneous nephrostomy in all patients with a urostomy.

A Dermoscopic Evaluation of Melasma Treated with Tranexamic Acid

Background: Melasma is a great challenge to the dermatologist. Choosing the proper treatment and the evaluation method are hard issues. Tranexamic acid [TA] injections showed promising results. The dermoscope is a non -invasive hand held tool Objective: To evaluate the efficacy of TA injections in the management of melasma and to assess a new dermoscopic score for assessment of melasma severity. Patients & Methods: Twenty-seven patients were enrolled in the study. They were assessed clinically, and by dermoscopy. An intradermal tranexamic acid was injected on the melasma. Melasma Area and Severity Index [MASI] was used to assess the melasma. Results: high significant difference was found between pre [4.700±2.1213] and post [2.811±2.0870] treatment values of MASI score [p= 0.0001]. Clinically TA treatment showed a dramatic improvement in MASI. Conclusion: The intradermal usage of TA can actually decrease improved the melasma. This was confirmed by the MASI scores and the dermoscope. The dermoscope could be considered as a useful objective score for melasma.

Improving Nurses’ Knowledge about Prevention of Catheter Acquired Urinary Tract Infections in Intensive Care Units

BACKGROUND: Lack of knowledge about causes and strategies to prevent catheter-acquired urinary tract infections (CAUTIs) requires an intervention that focuses on providing all evidence-based information to decrease the incidence of CAUTIs in admitted intensive care units (ICU) patients. Improving the nurses’ knowledge will eventually help in the reduction of CAUTIs. AIM: We aimed to investigate the improving nurses’ knowledge about prevention of catheter acquired urinary tract infections in intensive care units. METHODS: The present study is a h ealth system-operational research, pre-test–post-test design with a control arm study. The study was conducted in two ICU units in one of the University hospitals, Cairo, Egypt, involving a total sample of 42 nurses. Self-administered questionnaires were used to assess nurses’ knowledge about CAUTIs. The intervention was implemented through on job educational training sessions to nursing staff. Cochran Q was used to test the effect of the intervention on a satisfactory level of knowledge. RESULTS: Knowledge score improved from 61.4 ± 14.1 in pre-test to 90.5 in the early post-test (EP) test done after 1 week to 91.3 in late post-test ( LP) done after 1 month among nurses of the intervention ICU (p < 0.001). The percentage of nurses reporting a satisfactory level of knowledge significantly increased from 13.3% in the pre-test to 90% and 93.3% in follow-up (EP and LP, respectively) in the intervention ICU (p < 0.05) CONCLUSION: The implemented training and education strategy used were effectively improved ICU nurses’ knowledge concerning CAUTI.

ECG changes in psychiatric patients on psychotropic medications

Funding Acknowledgements

Type of funding sources: None.

Background

Suicide and euthanasia accounts for 14.3% of deaths in those with psychiatric conditions. The rest are attributed to preventable causes such as cardiovascular disease, respiratory disease, and infections. Several psychotropic medications have been associated with sudden death due to their effect on prolonging QT interval, resulting in the development of a polymorphic ventricular arrhythmia, Torsades de Pointes (TdP). TdP may be self-limiting or lead to sudden cardiac arrest and death.

Purpose

This study aims to evaluate the cardiotoxic effects of psychotropic medications.

Method

This is a descriptive retrospective study of patients submitted to the local psychiatric wards within one year. Patients with psychotropic drug prescriptions were included while patients below 18 years old, pregnant, or did not have ECG performed were excluded. The control group consisted of sex- and age- matched patients with ECG conducted for occupational health purposes. Multiple regression models were conducted to investigate the predictors of significant ECG differences.

Result

Of the 154 psychiatric inpatients admitted, exclusions were 44 patients due to exclusion criteria and 19 patients due to difficulty in physical file access. The study population (n = 91) had a mean age of 36.7 years old with 40.7% female and 59.3% male. The predominant diagnoses were schizophrenia and delusional disorders (58.2%). 86 psychiatric patients (94.5%) were prescribed antipsychotic drugs (APD).

A significantly higher proportion of psychiatric patients has a history of smoking (p &lt; 0.001), alcohol consumption (p = 0.001), and illicit drug use (p &lt; 0.001). They also exhibited significantly more co-morbid illnesses including hypertension (p = 0.022), hyperlipidaemia (p = 0.013), diabetes (p = 0.026) and thyroid disease (p = 0.023) than the control population.

Psychiatric patients had a significantly higher mean heart rate (79.9 vs 69.6 ms; p &lt; 0.001) and QTc interval (452.2 vs 418.6ms; p &lt; 0.001). Mean QTc interval was significantly longer for psychiatric patients in both male (454.2 vs 414.5ms; p &lt; 0.001) and female (449.3 vs 425.6 ms; p = 0.029) gender. Psychotropic drug use is a significant predictor for both prolonged heart rate (p &lt; 0.001) and prolonged QTc interval (p &lt; 0.001). Electrolyte imbalance is a significant predictor of prolonged QTc interval only (p = 0.036). One year follow of both groups detected only 1 psychiatric patient with palpitation.

Conclusion

Psychiatric patients on psychotropic medications have a longer baseline heart rate and QTc interval, which was not associated with MACE at 1 year. None of the underlying comorbidities and lifestyle choices were significant predictors of this. Electrolyte abnormalities and psychotropic drug use significantly predicted QTc prolongation. However, these findings were largely driven by APD use. A follow-up study of a longer period is recommended to investigate whether patients with prolonged QTc interval are of higher risk of MACE occurrence.

Pulsed dye laser versus Nd:YAG laser in the treatment of recalcitrant plantar warts: an intraindividual comparative study

Plantar warts are common cutaneous lesions caused by the human papillomavirus. Treatment of recalcitrant plantar warts stays a continuous challenge, and they are more refractory to treatment than common warts. To compare the efficacy of Long-Pulsed neodymium: yttrium-aluminum-garnet (Nd:YAG) laser versus pulsed dye laser (PDL) on the therapy of multiple recalcitrant plantar warts. Thirty patients with recalcitrant plantar warts were included in the current study. Half the number of warts were treated by PDL in each patient, while the other half were treated by Nd:YAG. Laser sessions were applied every 2 weeks for a maximum of six sessions. Patients were followed up both clinically and using dermoscopy. There was a complete clearance of warts in 20 patients (66.7%) with Nd:YAG laser and 19 patients (63.3%) with PDL with no statistically significant difference between both types of lasers. Pain during laser sessions was higher with Nd:YAG laser PDL and it was statistically significant (p = .0001). Both Nd:YAG laser and PDL showed efficacy and safety for the treatment of recalcitrant plantar warts. The use of dermoscopy adds great value in evaluating treatment response and in decreasing the incidence of recurrence.

Low Level Laser versus Platelet-rich Plasma in Treatment of Alopecia Areata: A Randomized Controlled Intra-patient Comparative Study

Abstract                                                                                                           Background: Non-scarring alopecia areata (AA) is a disease that is mediated through autoimmunity. Recently, autologous platelet-rich plasma (PRP) and photobiomodulation (PBM), commonly known as low-level laser (or light, LLLT) have been suggested to provide a valuable role in stimulating the growth of hair follicles (HF) Aim: Compare between the significance and wellbeing of PRP and LLLT in the management of AA. Patients & methodology: Thirty patients, each having three patches of AA participated in the study. Patches were assigned randomly to have one of the two treatments: PRP or LLLT. The third patch served as a control and received placebo treatment. PRP was done once weekly whereas LLLT was done 3 sessions per week for a maximum of 6 weeks. Patients were followed up at one month and three months. The thickness and density of hair were evaluated by the folliscope. Results: A noteworthy higher improvement was detected in the thickness and the density of hair in the PRP treated patches as evaluated by the folliscope and patients satisfaction. The obtained outcomes were sustained during the 12 week follow-up period in most of patients. Conclusion: PRP and LLLT could be considered as efficacious alternatives for the treatments of  AA with the least morbidity in addition to a little cost profit ratio. KEYWORDS: Alopecia areata, platelet-rich plasma, folliscope, photobiomodulation, low level laser therapy.  

Pulsed-dye Laser Versus Intralesional Steroid in the Management of Nail Psoriasis: A Randomized, Intra-patient, Comparative, Controlled Study

BACKGROUND

Intralesional injection of corticosteroid (ILIS) and pulsed-dye laser (PDL) have been used in nail psoriasis treatment with variable outcomes.

OBJECTIVE

We sought to compare the efficacy of ILIS to PDL for the treatment of psoriatic fingernails using a dermoscope in the assessment and follow-up.

METHODS

This study included 30 patients with bilateral nail psoriasis. The fingernails of one hand were treated with PDL, whereas ILIS was used to treat the fingernails of the other hand. One psoriatic nail was left alone as a control. Every patient received four treatment sessions once every month. Efficacy was recorded clinically using the Nail Psoriasis Severity Index (NAPSI) and by a dermoscope before treatment (baseline) and at eight, 24, and 36 weeks after treatment.

RESULTS

The assessment by NAPSI revealed improvements of 22.24% and 24.11% occurred in the laser group and the intralesional steroid group, respectively. Also, the dermoscopic assessments revealed an improvement of 18.33% in the laser group versus that of 21.69% in the ILES. No significant difference was found between the two groups.

CONCLUSION

Both PDL and ILIS are considered safe treatments for nail psoriasis, yielding nearly equal results. The dermoscope is a reliable tool for the diagnosis and follow-up of nail psoriasis treatment.

A split face comparative study between intradermal tranexamic acid and Erbium-YAG laser in treatment of melasma

BACKGROUND

Although there are different treatment modalities of melasma, it remains a challenging problem. Erbium-YAG laser proved its efficacy in melasma improvement with minimal downtime. Tranexamic acid (TA) is a new promising treatment of melasma.

OBJECTIVE

The first objective is to compare between the efficacy of intradermal injection of TA and Erbium-YAG laser in the treatment of melasma. The second objective is to use the dermoscope as an objective evaluation method.

PATIENTS AND METHODS

A split face study was conducted on 28 patients. One side of the face received intradermal TA injection. The other side was treated with laser. Melasma Area and Severity Index (MASI) and the dermoscope were used for evaluation of treatment.

RESULTS

The MASI scores showed a significant decrease in TA treated side. The dermoscope assessment showed no significant difference in both treatment modalities.

CONCLUSION

A promising results were obtained by both intradermal TA and Erbium:YAG laser; however, the TA yields a higher patient satisfaction because of its high efficiency and low cost.

COVID-19 vs influenza viruses: A cockroach optimized deep neural network classification approach

Among Coronavirus, as with many other viruses, receptor interactions are an essential determinant of species specificity, virulence, and pathogenesis. The pathogenesis of the COVID-19 depends on the virus's ability to attach to and enter into a suitable human host cell. This paper presents a cockroach optimized deep neural network to detect COVID-19 and differentiate between COVID-19 and influenza types A, B, and C. The deep network architecture is inspired using a cockroach optimization algorithm to optimize the deep neural network hyper-parameters. COVID-19 sequences are obtained from repository 2019 Novel Coronavirus Resource, and influenza A, B, and C sub-dataset are obtained from other repositories. Five hundred ninety-four unique genomes sequences are used in the training and testing process with 99% overall accuracy for the classification model.

Optimal design of robust resilient automatic voltage regulators

Uncertainties in the plant model parameters and perturbations in the controller gains imposed by implementation errors represent a challenge to ensure robust stability and controller non-fragility simultaneously. Optimal design of robust non-fragile proportional-integral-derivative (PID) controller is presented for an automatic voltage regulator (AVR). The PID design relies basically on Kharitonov theorem and optimization by future search algorithm (FSA). The proposed algorithm has low computational complexity and fast convergence rate because it utilizes both local and global search methods. Further, FSA can improve the exploration characteristic and prevent trapping in local optima by updating its random initial. The PID controller is optimized by FSA to cope with expected parametric uncertainties of the plant model and tolerate its gain perturbations such that robust stability and controller non-fragility are simultaneously met. An interval plant model is suggested to account for model uncertainties where only eight extreme plants derived by Kharitonov theorem are considered in design. FSA-based PID optimization is constrained by the stability conditions of Kharitonov's plants derived using Routh-Hurwitz. A new figure-of-demerit (FoD) based performance index is suggested to enforce simultaneous minimization of the time domain specifications. The suggested objective function is represented by a weighted sum of FoD of nominal response and the sum of reciprocals of the perturbation radii of PID gains. The output results of the recommended design are compared to that of artificial bee colony (ABC) algorithm and teaching-learning based optimization (TLBO) algorithm, multi-objective extremal optimization (MOEO), and non-dominated sorting genetic algorithm II (NSGA II). The results can confirm better response of the suggested technique measured up to other techniques where robustness and non-fragility are simultaneously ensured.

Comparative Study between Nd-YAG laser, fractional CO2 Laser, and combined Nd-YAG with fractional CO2 Laser in the Management of keloid: clinical and molecular Study

BACKGROUND

Fractional CO2 laser and Nd-YAG laser have been reported to have promising results in the management of keloids. So far, there have been no comparative studies between these laser modalities.

AIMS

The study aimed to compare the efficacy of fractional CO2, Nd-YAG, and a combination of both in the management of keloids.

PATIENTS AND METHODS

Forty-five keloid patients were divided into 3 equal groups: the first received fractional CO2 only, the second received Nd-YAG only, and the third received a combination of both lasers. Each group received its designated treatment every 4 weeks for 4 sessions. The improvement was evaluated by the "Patient and Observer Scar Assessment Scale" (POSAS). Detection of procollagen I mRNA by RT-PCR analysis was done.

RESULTS

The assessment by POSAS showed the most significant clinical improvement in the combination group and a less significant improvement in the fractional CO2 group, while the least improvement was seen in the Nd-YAG group. Molecular assessment via procollagen I yielded matching results.

CONCLUSION

The study showed that the combination of fractional CO2 and Nd-YAG lasers has a synergistic effect being the most effective in the management of keloids, fractional CO2 being more effective than ND-YAG and Nd-YAG being the least effective.

Relation of pharmacopenile duplex ultrasonography parameters and glycated hemoglobin (HbA1c) in diabetic patients with erectile dysfunction

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.

Defying challenges: mid-term outcomes of international collaborations for a successful heart transplantation program in the middle east

Introduction

Heart transplantation (HTx) is a successful treatment strategy for advanced heart failure. Survival rates exceed those achieved by medical therapy alone. Lack of suitable donors and cultural perception remain obstacles for receiving this novel therapy.

Methods

Overcoming challenges we adopted a first-of-a-kind multicenter HTx program, collaborating between Cardiac Centers in India and the United Arab Emirates (UAE). Patients were worked up as part of our newly established HTx program in the UAE, then referred to India for successful HTx. All post HTx follow-up care was continued in the UAE thereafter.

Results

We assessed 10 HTx recipients, [90% male; mean age 34 yrs]. Five patients required inotropes while one LVAD support pre transplant. Our data outline short waiting-list time and excellent 3 years clinical outcomes.

All patients are maintained on Tacrolimus and Mycophenolate Mofetil. Two patient developed acute rejection (celluar and humoral) with graft dysfunction within 18 months.

Seventy percent had non-ischemic cardiomyopathy pre-transplant. Three acquired donor transmitted coronary vascular disease. One patient developed aggressive allograft vasculopathy requiring coronary artery bypass grafting. Acute kidney injury requiring renal replacement therapy occurred in 1 patient.

Conclusion

Defying logistic challenges, donor availability and long HTx waiting list times, we have established a successful multi-center new concept HTx program with excellent mid-term outcome result. Diverse genetic background is evident in the presence of early coronary vascular disease in young donor hearts, requiring extra care in donor screening. This international collaboration has a promising future for new programs in the Middle East.

Funding Acknowledgement

Type of funding source: None

A case of vaping-induced acute respiratory distress syndrome requiring extracorporeal life support

INTRODUCTION

An upsurge of e-cigarette, or vaping, product use-associated lung injury has been reported in the United States. The potential role of extracorporeal life support in e-cigarette, or vaping, product use-associated lung injury merits consideration.

CASE REPORT

We present a case of vaping-induced severe acute respiratory distress syndrome that was salvaged with extracorporeal life support and had excellent recovery.

DISCUSSION

The mechanistic reasons for the sudden outbreak of e-cigarette, or vaping, product use-associated lung injury are under active investigation. A predominantly diffuse, bilateral pattern of lung injury has been reported, with some cases meeting the criteria for severe acute respiratory distress syndrome. To date, 68 deaths from e-cigarette, or vaping, product use-associated lung injury have been confirmed by the centers of disease control. However, resolution of lung injury has been reported in most cases, thereby justifying candidacy for extracorporeal life support, if required.

CONCLUSION

Extracorporeal life support can be successfully utilized as a bridge to recovery in vaping-induced severe acute respiratory distress syndrome.

Contrasting the efficacy of pulsed dye laser and photodynamic methylene blue nanoemulgel therapy in treating acne vulgaris

The treatment of acne remains a challenge for dermatologists. A variety of conventional therapies are available for acne treatment such as topical and systemic medications. Although many of these traditional acne treatments are effective, the wide-spread nature of the disease and its sometimes resistant nature delineate the need for alternative therapies. Therefore, over the past decade, phototherapy has been introduced for the treatment of acne, such as pulsed dye lasers (PDLs) and photodynamic therapy (PDT). The aim of this study was to compare the safety and efficacy of PDL and methylene blue-mediated photodynamic therapy (MB-PDT) in the treatment of mild to moderate acne. Split-face clinical trial including fifteen patients presenting with mild to moderate acne were treated with 585 nm PDL on the right side of the face and MB-PDT with 665-nm diode laser on the left side. The photosensitizer MB was prepared in nanoemulgel formulation, and the treatment was carried out for three sessions maximum at 2-weeks intervals. Results revealed that both PDL and MB-PDT were effective therapies in the treatment of acne, as manifested by the reduction of inflammatory and non-inflammatory lesions throughout the treatment period. However, the latter therapy was proven more potent in the reduction of acne severity, and in terms of patients' tolerance. Therefore, it can be concluded that MB in the nanoemulgel form is a promising treatment approach for acne, and can be further experimented in the treatment of other dermatological diseases.

Brassinosteroid seed priming with nitrogen supplementation improves salt tolerance in soybean

This study was conducted to evaluate the influence of brassinosteroid (24-epibrassinolide, EBL) seed priming and optimal nitrogen (N) supply in improving salt tolerance in soybean. The experimental treatments were (a) control (nutrient solution without N and without EBL priming), (b) nutrient solution without N and EBL seed priming, (c) N supplemented nutrient solution without EBL priming and (d) EBL seed priming + N supplemented nutrient solution under optimal (0 mM NaCl) and salt stress (0 mM NaCl) conditions. Salt stress caused significant reduction in growth and biomass accumulation of soybean. However, EBL seed priming and application of N improved the soybean performance under optimal and salt stress conditions. In this regard, treatments receiving both EBL and N were more effective. EBL priming and N, alone and in combination, triggered the accumulation of osmolytes including proline, glycine betaine and sugars resulting in better photo-protection through maintenance of tissue water content. Antioxidant activity and osmolyte accumulation significantly increased due to combined treatment of N and EBL under normal as well as salt stress conditions. In conclusion, salt stress caused reduction in growth and biomass soybean due to oxidative damage and osmotic stresses. However, soybean performance was improved by seed priming with EBL. Supplementation of N further improved the effectiveness of EBL treatment in improving salt tolerance in soybean.

Exogenous Nitric Oxide Mitigates Nickel-Induced Oxidative Damage in Eggplant by Upregulating Antioxidants, Osmolyte Metabolism, and Glyoxalase Systems

Nitric oxide (NO) at optimal levels is considered beneficial to plant functioning. The present study was carried out to investigate the role of exogenously applied NO (100 and 150 µM sodium nitropurusside, SNP) in amelioration of nickel (Ni)-mediated oxidative effects in eggplant. Ni stress declined growth and biomass production, relative water content (RWC), and chlorophyll pigment synthesis, thereby affecting the photosynthetic efficiency. Exogenously applied SNP proved beneficial in mitigating the Ni-mediated growth restrictions. NO-treated seedlings exhibited improved photosynthesis, stomatal conductance, and chlorophyll content with the effect of being apparent at lower concentration (100 µM SNP). SNP upregulated the antioxidant system mitigating the oxidative damage on membranes due to Ni stress. The activity of superoxide dismutase, catalase, glutathione S-transferase, ascorbate peroxidase, and glutathione reductase was upregulated due to SNP which also increased the ascorbate and reduced glutathione content. SNP-supplied seedlings also showed higher proline and glycine betaine accumulation, thereby improving RWC and antioxidant system. Glyoxalase I activity was induced due to SNP application declining the accumulation of methylglyoxal. NO-mediated mitigation of Ni toxicity was confirmed using NO scavenger (PTIO, 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide), which reversed the influence of SNP almost entirely on the parameters studied. Uptake of nitrogen (N), potassium (K), and calcium (Ca) was increased due to SNP application and Ni was reduced significantly. Therefore, this study revealed the efficiency of exogenous SNP in enhancing Ni stress tolerance through upregulating antioxidant and glyoxalase systems.

Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients

BACKGROUND

Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle.

AIM

This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring.

METHODS

A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention.

RESULTS

There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants' behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants.

CONCLUSION

lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.

Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients

BACKGROUND: Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM: This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS: A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS: There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants’ behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants CONCLUSION: lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.

Malignant deep brain stimulator withdrawal syndrome

Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic potentially fatal emergency that mimics neuroleptic malignant syndrome. It commonly presents as systemic inflammatory response syndrome, acute onset worsening of muscular rigidity, autonomic instability, hyperpyrexia, confusion, diaphoresis and high creatine phosphokinase. The most common trigger for PHS is reduction or withdrawal of anti-Parkinson’s medications, especially levodopa. It was also reported in a few cases following deep brain stimulation of the subthalamic nucleus surgery shortly after anti-Parkinson’s medications were discontinued. Rare causes of PHS include deep brain stimulator (DBS) malfunction due to battery depletion. To the best of our knowledge, PHS following DBS battery depletion was reported only in three occasions. Here, we report a case of PHS due to DBS battery depletion presented as sepsis and was successfully treated with the administration of dopamine agonists, intravenous fluids and changing the DBS battery.

Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: Image analysis system evaluation

BACKGROUND

Fractional CO2 laser and platelet-rich plasma (PRP) treatments have been used in the treatment of acne scars. However, an objective method of assessment has been lacking.

OBJECTIVE

To evaluate the efficacy of CO2 laser versus the combination of PRP and fractional CO2 laser in treatment of acne scar.

PATIENTS AND METHODS

Thirty patients with atrophic acne scar lesions were included in this study. Patients were randomized to receive fractional CO2 laser therapy to one side of the face while the other side of the face was treated with fractional CO2 laser followed by intradermal PRP injection. Follow-up using the skin analysis camera system and photography was done for three months.

RESULTS

A dramatic improvement was observed in the scar depth on both sides of the face. However, the combined fractional CO2 laser and PRP showed more significant improvement. Improvements in the scar appearance and skin texture were reported by the patients. Although 70% of our patients were of a dark skin type, no hyperpigmentation was reported.

CONCLUSION

The combined use of fractional CO2 laser and PRP achieved better results. It reduced the downtime of the fractional CO2 laser. The use of the skin analysis camera provided an objective assessment of the results.

Rare complication of milk-alkali ingestion: severe pancreatitis and acute kidney injury in a chronic hypocalcaemic patient with DiGeorge's syndrome

Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of hypercalcaemia and related complications. We present a case of acute pancreatitis in a chronic hypocalcaemic patient of DiGeorge's syndrome. The patient came into the ED with sepsis syndrome, right upper quadrant and epigastric pain and no obvious source of infection. Lab results and imaging were indicative of acute pancreatitis. There was severe renal dysfunction. The patient needed haemodialysis and had a prolonged stay in intensive care. The medical history was negative for biliary duct pathology or alcohol use. The patient had vomiting and diarrhoea in the nursing home for about a week, but she continued to receive her regular medications that included the calcium supplements and thiazide diuretics. It is likely that a complex interplay between calcium supplementation, dehydration and thiazide diuretics resulted in the development of acute pancreatitis and severe renal dysfunction in a chronic hypocalcaemic patient.