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    An Incidental finding: Duodeno-jejunal transient invagination

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    Invagination or intussusception is the protrusion of proximal intestinal segments through the distal segments, Transient Intussusception can be easily diagnosed by Abdominal CT.In this report, an incidentally found ‘’Duodeno-jejunal Invagination’’ tilted case, was presented with CT images

    Percutaneous Atrial Septal Defect (ASD) closure technique in case of association with an azygos continuation of the inferior vena cava “case report”

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    Introduction: Atrial Septal Defect (ASD) is the most common congenital heart disease, accessible to percutaneous closure in 90% of cases. The closure procedure is performed usually under local anesthesia and TTE by femoral access. The association of OS-ASD with an azygos continuation of the inferior vena cava is very rare (< 0.1/1000 births) making femoral access impossible. Only a few cases are mentioned in the literature, here we describe the procedure as faithfully as possible. Important clinical finding: We present a case of a 32-years-old female candidate for percutaneous closure of OS-ASD with right cavity dilatation who present during her procedure an unusual guidewire path suspecting an azygos continuation of the inferior vena cava, confirmed by CT angiography, making impossible the closure via the femoral approach. Therapeutic intervention: After being confronted with the categorical patient refusal of the surgery, we performed successfully the procedure; one month later; under general sedation by internal jugular approach. We finished with manual compression before extubating the patient. Outcomes: The follow-up was favorable at the cost of a hematoma at the puncture site and brachial plexus compression, which regressed after 3 days. Conclusion: We opted for general anesthesia and intubation to guide the procedure by TEE. We placed it in the aorta, which gave us good stability to continue successfully the procedure. We underestimated the risk of complication at the puncture site, which could have been avoided by using a vascular suture device or more prolonged compression. Main takeaway lesson: Percutaneous closure is the reference treatment for OS-ASD. In case of is associated with an azygos continuation of the inferior vena cava, the right internal jugular vein remains a reasonable approach; it requires discussion and rigorous preparation by the whole team. The management of the puncture site in this situation remains delicate and requires great concentration.&nbsp

    The role of denial on emotional correlates of childhood trauma in a non-clinical population

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    Background: A large body of evidence suggests that child abuse and neglect by a caregiver is a recurrent event linked to increased psychopathology symptoms. The Childhood Trauma Questionnaire (CTQ) is commonly used to assess abuse/neglect during childhood. However, even though the Minimization-Denial (MD) subscale was originally designed to assess response bias (i.e., underreporting of childhood maltreatment), it is possible that the scale may reflect coping strategies that play an effective role in the relationship between childhood trauma and their negative outcomes. Also, even though MD has been associated with decreased psychopathology symptoms, it is also strongly associated with other scales of the CTQ. Method: This study (n = 133) examined whether (1) the MD-scale is negatively associated with alexithymia, emotion dysregulation and psychopathology, if (2) these associations will hold when adjusting for different subtypes of abuse and neglect and (3) and the role of MD as a possible moderator in these relationships. Results: The analyses showed that, although MD scores have relatively strong and (mostly) significant (negative) associations with the CTQ, emotion dysregulation strategies and psychopathology symptoms, these associations were weak and failed to remain significant when adjusting for the effect of CTQ. Conclusion: Our findings suggest that the MD scores should be viewed as an accurate reflection of the absence (or little) of exposure to childhood abuse/neglect.&nbsp

    The smart agriculture applications (current and future)

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    Smart agriculture applications (monitoring, sensing, automation and control) of micro-climate and environmental conditions for different agriculture production sectors and scales, decision-makers and researchers need to take it into consideration to strengthen the efforts of mitigation and adaption of climate change impacts as well as maximize the natural resources use efficiencies and food production. Motivate the farmers to implement smart agriculture applications, especially in developed and poor countries, strong cooperation for technology transfer and build up the technology infrastructure of information and communication (ICT) plus the internet of things (IoT)

    A case of allergic bronchopulmonary aspergillosis complicated by nocardiosis and staphylococcus aureus infection

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    Nocardia is a ubiquitous organism and often causes serious fatal infections in immuno-compromised individuals. Staphylococcus aureus infection stimulates an inflammatory response that causes lung damage and facilitates subsequent chronic infection. Patients of allergic bronchopulmonary aspergillosis (ABPA) on steroids and immunosuppressants are particularly at risk of these infections. We present the case of a middle-aged man who was diagnosed to have ABPA by serological and radiographic criteria. He presented with fever, cough, and mucopurulent sputum. Subsequent sputum culture for bacteria and fungus revealed the growth of Staphylococcus aureus and Nocardia spp. respectively

    Spontaneous pneumomediastinum: case report

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    Pneumomediastinum is the presence of free air within the mediastinum. As a general rule, it occurs in the presence of underlying lung disease and if it does not exist, it is called spontaneous pneumomediastinum. We present a case of a 53 years old asthmatic patient which further investigation revealed to be consistent with spontaneous pneumomediastinum. He underwent medical treatment with relative rest, oxygen therapy, and prophylactic antibiotic therapy, in addition to his usual asthma treatment. There was a clinical and radiological improvement with complete passive reabsorption of air and the patient was discharged on the 4th day and referred to the pulmonology department for consultation. During 2 months follow-up period, there were no signs of recurrence

    An update in the utilization of N-acetyl cysteine & vitamin c for tackling the oxidative stress in acute kidney injury secondary to robust sepsis - A systematic review

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    The commonest etiology of acute kidney injury (AKI) is Sepsis that results in an escalation of morbidity and mortality in the hospital intensive care units. Existentially, the therapy of septic AKI rather than being definitive or curative is just supportive, without tackling the pathophysiology. Usually, Sepsis gets correlated with systemic inflammation, along with the escalated generation of Reactive oxygen species (ROS), in particular superoxide. Simultaneously liberation of nitric oxide (NO) subsequently reacts with the superoxide, thus, resulting in the generation of reactive nitrogen species (RNS), that is mostly peroxynitrite. This sepsis stimulated generation of ROS in addition to RNS might cause a reduction in the bioavailability of NO that modulates microcirculation aberrations, localized tissue hypoxia as well as mitochondrial impairment, thus starting a vicious cycle of cellular damage which results in AKI. Here we conducted a systematic review utilizing search engine PubMed, Google scholar; Web of science; Embase; Cochrane review library utilizing the MeSH terms like septic AKI; ROS; inducible nitric oxide synthase (iNOS); nicotinamide adenine nucleotide phosphate(NADPH)oxidase complex; Oxidative stress; Renal medullary hypoxia; Hypoxia inducible factor1; hypoxia responsive enhancer A; mitochondrial impairment; Intrarenal oxygenation; urinary oxygenation; erythropoietin gene; RRT; NAC; Vitamin C from 1950 to 2021 till date. We found a total of 6500 articles out of which we selected 110 articles for this review. No meta-analysis was done. Thus here we detail the different sources of ROS, at the tie of sepsis, besides their pathophysiological crosstalk with the immune system, microcirculation as well as mitochondria that can result in the generation of AKI. Furthermore, we detail the therapeutic utility of N-acetylcysteine (NAC), besides the reasons for its success in ovine as well as porcine models of AKI. Moreover, we discuss preclinical along with clinical for evaluation of Vitamin C’s antioxidant effects as well as pleiotropic effects as a stress hormone that might aid in abrogation of septic AKI

    Time within therapeutic range: A comparison of three tacrolimus formulations in renal transplant recipients

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    Background: Currently there are three available formulations of tacrolimus in the United States; these include immediate-release capsules (TAC-IR), extended-release capsules (TAC-XL),and extended-release tablets (TAC-XR). Previous studies have demonstrated non-inferiority between the three formulations in terms of efficacy. The purpose of this study was to compare three formulations of tacrolimus (TAC) and assess differences in time within the therapeutic range (TTR) and variability in levels. Results: Renal transplant recipients from January 2013 to October 2017 were retrospectively identified for analysis. Deviation from standard TAC protocol or formulation changes excluded patients. The primary outcome compared percent TTR (TTR %) among 3 TAC formulations over the first 90 days post-transplant. TTR was calculated using the Rosendaal method. Secondary outcomes included differences in TAC levels, TAC dose, eGFR, rejection, patient and graft survival between the TAC formulations. TAC-XR demonstrated a significantly higher TTR % compared to TAC-IR and TAC-XL (62.8% vs. 53.3% vs. 60.9%, p = 0.048). In post-hoc analysis, TAC-XR had a higher TTR % compared to TAC-IR (p = 0.065), which approached statistical significance. Average TAC levels, weight-normalized TAC doses, median dose-normalized TAC levels, rejection rates, eGFR, and graft or patient survival were similar among groups. Conclusion: In the early transplant period, TTR was significantly different among the groups. TAC-XR demonstrated numerically superior time within the therapeutic range. Patient-specific factors such as race, obesity, genetic polymorphisms may impact this variability and clinical outcomes. Further analysis is necessary to understand the effect of each patient-specific factor on TAC exposure

    Nematicides in Egypt

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    Plant-parasitic nematodes (PPNs) are famous aggressive pests that attack several crops worldwide. A lot of farmers are suffering from nematode diseases which cause critical crop losses. At the same time, the most of available solutions for this problem are depending on synthetic nematicides. These chemical nematicides not only cause environmental and health problems but also may cause resistance in nematodes. Despite the occurrence of resistance in nematodes under field conditions still less clear. Therefore, this note is about the registered nematicides in Egypt which may help those who are interested in nematicides. Also, the chemical group and mode of action of nematicides were mentioned according to the insecticide resistance action committee (IRAC) [1] and fungicide resistance action committee (FRAC)

    The identification of the true nature of pseudofungus structures as polyurethane catheter fragments

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    Pseudofungus structures in lymph node tissues have been reported on multiple occasions. Despite a variety of investigative tests including histochemical special stains and energy dispersive spectral analysis, the underlying nature and origin of these pseudofungus structures has never been clearly defined. The most common hypothesis suggests that they represent collagen fibers that become coated with iron and calcium. Herein, evidence is given that the pseudofungus structures identified in the lymph node tissues represent fragments of polyurethane catheters. The evidence includes both a comparison of these pseudofungus structures to fragments of polyurethane well documented in the literature and a comparison of polyurethane catheter scrapings to the pseudofungus structures identified in the literature. In both of these comparisons, the morphology of the polyurethane fragments are identical to the pseudofungus structures. This is the first definitive report identifying polyurethane catheter fragments as representing the true nature and etiology of pseudofungus structures in lymph node tissues

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