Depressive disorders are associated with the highest probability of suicide. Different cognitive factors raise the probability of suicide. Sleep disorders are closely related to depression and may play a role in suicide.

Bony and soft-tissue impingement syndromes are now increasingly being recognized as significant causes of chronic ankle pain.

Objective

To compare the diagnostic efficacy of MR arthrography with conventional MRI in evaluation of ankle impingement in correlation with clinical and arthroscopic findings.

Patients and methods

This study reviewed 23 patients who had preoperative MR imaging and MR arthrography and then underwent arthroscopy (as a gold standard), in the period from May 2019 till August 2021. The study is approved by the ethical committee of Faculty of Medicine of Assiut University.

Results

Conventional MRI and MR arthrography showed sensitivity, specificity, and an accuracy of 100.0% in diagnosing bony impingement. For diagnosing soft tissue impingement; MR arthrography was shown to be more superior to conventional MRI with a sensitivity of 88.2%, a specificity of 100.0%, and an accuracy of 94.4%.

Conclusion

MR arthrography is highly beneficial in diagnosing bony and soft impingement that expands the functionality of conventional MR imaging by taking advantage of the natural benefits of joint effusion.

Early Rehabilitation Program and Weaning outcomes In Critically Ill Chronic Obstructed airway disease :randamised trail

A randomise trial comparing the effects of electrical stimulation of the quadriceps muscle and decreased trigger sensitivity plus exercise breathing after discharge on

Background Gastrointestinal bleeding (GIB) is considered a dangerous trouble, an important etiology for hospital admissions, and has a rate of mortality of about 6%–10% for bleeding from the upper GI tract (GIT) and about 4% for bleeding from the lower GIT. It needs combined efforts involving gastroenterology, endoscopy, surgery, and radiology departments. Aim of the work To assess the role of multidetector computed tomography (CT) in diagnosing acute nonvariceal bleeding from the GI tract. Patients and methods Fifty patients presented by acute nonvariceal GIT bleeding after exclusion of cases that had impaired renal functions or with terminal liver failure, pregnancy, patients who have sensitivity to contrast medium, and patients who were diagnosed as variceal bleeding; they underwent Multi slice computed tomography (MSCT) angiography after resuscitation of patients with shock, monitoring for unstable patients. Images were acquired with slice thickness 5 mm for unenhanced phase and 1.25 mm for arterial phase and portovenous phases, pitch 1.375, 300 MA, 120 kVp, and rotation time 0.7 s. Images acquired were reconstructed for sagittal, coronal, Maximum intensity projection (MIP), and volume-rendering images. Results MSCT helped in the diagnosis of the source and/or the cause of bleeding in 66% of examined cases (n = 33), whereas CT could not detect the cause of bleeding in 34% of cases (n = 17). Conclusion CT angiography (CTA) can act as a good first‑line screening method in the localization and detection of GIB sites. CTA can be used to triage patients with active GIB and give an idea for required further examination. Keywords: computed tomography angiography, endoscopy, gastrointestinal hemorrhage/diagnosis, occult blood

Abstract:

Context:

 Patients in the intensive care unit (ICU) are at risk not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients.   Indeed, diagnosis of ventilator associated pneumonia (VAP) requires a high clinical suspicion combined with bedside examination, radiographic examination, microbiologic analysis of respiratory secretions, and blood test.

Aims: This study aimed to evaluate the effectiveness and accuracy of lung ultrasound for VAP diagnosis and follow-up.

Settings and Design: A prospective cohort study was done on 74 patients, with total number of 54 with high likelihood of VAP and 20 with low likelihood of VAP

Methods and Material:Mechanically ventilated patients for 48 hours or more were included. We calculated Clinical pulmonary infection score and Lung Ultrasound was performed within 24 hours.

Statistical analysis used:Data were collected and analyzed by using SPSS (Statistical Package for the Social Science, version 20, IBM, and Armonk, New York). Quantitative data were expressed as mean ± standard deviation (SD) and compared with Student t test. Nominal data were given as number (n) and percentage (%). Chi₂ test was implemented on such data.

Results:

Based on Clinical pulmonary infection score (CPIS) with cutoff point (≥ 6), the sensitivity of transthoracic ultrasound was 81.5%, the specificity was 82% and the accuracy was 81.6%. Regarding sonographic signs, the highest sensitivity was for sub-pleural dots of consolidation 82%, then B-lines 56%, followed by pleural effusion and air bronchogram both 19%. Highest specificity was for air bronchogram 100%, then B-lines and pleural effusion both 90%, followed by sub-pleural dots of consolidation 80%. Positive predictive value for transthoracic ultrasound was 92%, Area under the receiver operation characteristics (ROC) curve (AUC) for total ultrasound score was 0.82.

Conclusions: Transthoracic ultrasound is an easy bedside tool for diagnosis and follow up of ventilator associated pneumonia.

Key-words: Ventilator associated pneumonia, Clinical pulmonary infection score, Lung Ultrasounds, intensive care unit

Key Messages: 

Transthoracic ultrasound is a useful and convenient bed-side tool for diagnosis and follow up of ventilator associated pneumonia. It should be established as a reasonable tool in early diagnosis due to its availability, being easy to use and low cost. This helps in starting early treatment with antimicrobial therapy.

Background: Diffuse large B-cell lymphoma (DLBCL) is considered the most common lymphoid malignancy that represented about 35% of adult non-Hodgkin lymphomas (NHL). Although most patients can be cured with the Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone (R-CHOP) regimen, many patients die due to relapsed disease. In this study, we aim to assess the clinicopathological characteristics of relapsed DLBCL, not otherwise specified (NOS).

Methods: This is a retrospective study conducted on 16 cases of relapsed DLBCL (relapsed group). Meanwhile, 27 cases with DLBCL who capable of attaining complete remission (CR) for 36 months were used as control (CR group).

Results: clinically, most patients in the relapsed group were male (62.5%). The relapsed group had a significant difference in comparison to the CR group as regard bone marrow involvement (P= 0.003), serum lactate dehydrogenase (LDH) level (P= 0.005), B symptoms (P= 0.007), performance status (PS)(P= 0.008), international prognostic index (IPI)(P= 0.000) and age-adjusted IPI (P= 0.017). Pathologically, relapsed DLBCL was associated with negative CD10 expression (P= 0.001), negative BCL6 expression (P= 0.047), and nongerminal center B-cell (non-GCB) phenotype (P= 0.018). Conclusions: patients with bone marrow involvement, abnormal serum LDH level, B symptoms, poor PS, intermediate to high IPI & AA-IPI, non-GCB phenotype, lower CD10, and BCL6 expression are more likely to relapse.

Cisplatin (CDDP) is an effective chemotherapeutic drug that has been used successfully in treating various tumors. Although its higher antineoplastic agent activity, CDDP exhibited severe side effects that limit its use. CDDP-induced toxicity is attributed to oxidative stress and inflammation. Apocynin (APO) is a bioactive phytochemical with potent antioxidant and anti-inflammatory properties. However, pharmaceutical experts face significant hurdles due to the limited bioavailability and quick elimination of APO. Therefore, we synthesized a chitosan (CTS)-based nano delivery system using the ionic gelation method to enhance APO bioactivity. CTS-APO-NPs were characterized using different physical and chemical approaches, including FTIR, XRD, TGA, Zeta-sizer, SEM, and TEM. In addition, the protective effect of CTS-APO-NPs against CDDP-induced nephrotoxicity, hepatotoxicity, and cardiotoxicity in rats was evaluated. CTS-APO-NPs restored serum biomarkers and antioxidants to their normal levels. Also, histopathological examination was used to assess the recovery of heart, kidney, and liver tissues. CTS-APO-NPs attenuated the oxidative stress mediated by Nrf2 activation while it dampened inflammation mediated by NF-κB suppression. CTS-APO-NPs is a potentially attractive target for more therapeutic trials.

background: There is a rise in the importance of evaluating the negative impact of illnesses on quality of life from the patient’s perspective. The burdens of refractive error (RE) on perceived visual functions have not been yet explored among Egyptian youth. The study aimed to determine the prevalence of self-reported RE and its association with perceived vision-related quality of life among Egyptian university students.
Methods: A cross-sectional study was conducted on 821 students at Assiut University, Upper Egypt. Data was collected using a questionnaire filled by students. It composed of personal criteria, a self-report of RE and its type, the used visual aids for RE, and the visual function questionnaire (VFQ -25). Ishihara’s test was used for the assessment of color vision.
Results: About 25% reported having a refractive error, and the most reported RE type was myopia. Among students with RE, nearly 76% used visual aids, and eyeglasses were used by most of students for their visual aid (90.6%). Adjusted by age and gender, RE significantly predicts low scores of perceived general health, ocular pain, mental health, dependency, role difficulties, both near and distant activities, and peripheral vision. No significant association was detected between RE and social functioning, driving ability or colored vision.
Conclusions:
Refractive error is a prevalent illness especially myopia among Egyptian university students. RE negatively affects vision-related quality of life. Accurate correction of RE and provision of subsidized visual aids may help to mitigate the adverse effect of RE on the perceived visual functions.