Libyan Journal of Medicine最新文献

The utility of carotid artery Doppler flow velocity (CADFV) over mortality is not well known. This study investigated the utility of bedside ultrasound in assessing volume status and predicting mortality in patients with septic shock with CADFV, the inferior vena cava collapse index, and the central venous pressure (CVP). This prospective observational study included adults admitted to the ED with septic shock, defined by hypotension (SBP < 90 mmHg or MAP < 65 mmHg) and evidence of end-organ hypoperfusion. Patient demographics, CVP, CADFV, inferior vena cava (IVC) diameter, inferior vena cava collapsibility index (IVCCI), and outcomes were recorded. Measurements are compared in terms of mortality. The mean age was 67 years, with a 57% mortality rate. ROC analysis revealed that CADFV predicted mortality with a sensitivity of 72% and a specificity of 68% at a cutoff of 50 cm/s. The IVCCI had 93% sensitivity and 85% specificity at a cutoff of 54.5%. The CVP had 61% sensitivity and 71% specificity at a cutoff of 1.5 mm H₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The deceased patients had a mean IVCCI of 63% and a mean CVP of 1.62 mmH₂O, whereas discharged patients had a mean IVCCI of 55% and a mean CVP of 3.45 mmH₂O. CADFV, IVCCI, and CVP can be used in evaluating the volume status and predicting mortality in septic shock. These noninvasive measures provide alternatives to invasive methods and facilitate timely intervention in emergency care.

In-depth knowledge of the anatomical structure of the root canal system is fundamental for successful endodontic treatment. This research aimed to evaluate the root canal structures of lower premolars in the Saudi western demographic via Cone Beam Computed Tomography (CBCT) scans. 760 CBCT scans were reviewed, which incorporated 2747 mandibular premolar teeth. SPSS was employed for descriptive statistics and Pearson chi-square tests. The Kappa tests were executed for intra- and inter-observer consistency. The number of roots, canals, and canal configurations based on Vertucci's classification were assessed. The study further explored the prevalence, patterns, and variations of the root canal systems, considering gender-based variations and bilateral resemblance. Predominantly, mandibular premolars possessed a single root, though a minority displayed two or three roots. The occurrence of multiple canals was also on the lower side, with the type I canal pattern emerging predominantly. Gender-based distinctions were evident, as males exhibited a higher frequency of two-rooted premolars and multiple canals than females. It was noted that the anatomical differences were more in the mandibular first premolars than in the second premolars. A significant bilateral consistency was observed, with most teeth showcasing consistent root and canal numbers. This research offers essential perspectives on the diverse nature and variability of root canal anatomy within the Saudi Western cohort, facilitating better understanding and treatment planning in endodontics.

Balance issues have been reported to be common among females with overweight or obesity with associated fall risks. Despite the increasing reports of the negative impacts of obesity on balance and cognition, there is a scarcity of research aimed at evaluating effective interventions. To examine the effects of rebound exercises on cognition and balance among females with overweight and obesity. This Quasi-experimental study used the purposive sampling method to recruit 20 female students (aged 17-35 years) with overweight and obese at the Evangel University Akaeze, Ebonyi State Nigeria. Rebound exercise intervention was administered to all participants at the gym for 30 minutes in each session, three times a week for six weeks, while their cognitive performances, stationary balance, and dynamic balance were measured pre-and post-trial using Trail Marking Test Apparatuses, Unilateral Pedal Tests, and Meter Backward Walk Test respectively. There was a significant (p < 0.001) difference in the participants' cognition values across weeks 1, 3, and 6 with a progressive improvement over time. There was also a significant (p < 0.05) difference in the participants' static and dynamic balance values across weeks 1, 3, and 6 with a progressive improvement in balance performance over time. Rebound exercise significantly improved the cognition and balance of females with overweight or obese. This finding suggests a promising intervention to improve balance and cognitive-related problems in this population. Registered retrospectively in the Pan African Clinical Trial Registry, identification number for the registry is PACTR202405746557031. Dated 2 May 2024.

The cornerstone of asthma management is the stepwise approach recommended by both national and international guidelines. In this study, we aim to investigate physicians' attitudes and approaches towards step-down treatment in asthma management in Turkey. In this cross-sectional study, questionnaire-based data were gathered from pulmonologists, immunology and allergy specialists and immunology and allergy fellows in November-December 2024. Of the 225 physicians, the median years of service in their speciality was 5 (min1-max51) years. Nearly 35% of survey participants rarely step down asthma medication (12.9% and 52.4% of participants always and frequently, respectively). The two most selected barriers were 'I am afraid the patient will get worse' (50.9%) and 'patients don't want to' (29.9%). Participants whose primary concern regarding step-down asthma treatment was fear of patient deterioration were found to use step-down approaches less frequently (66.7%, p < 0.001). Working in educational and research hospitals, the fear that the patient may worsen, and infrequent adherence to guideline updates were significantly associated with the rare implementation of step-down treatment in asthma management. Our study identified that the fear of potential disease worsening and infrequent adherence to updated guidelines were significantly associated with the limited implementation of step-down treatment in asthma management.

To evaluate the predictive role of serum amyloid A (SAA) levels and their association with antiphospholipid antibodies (APA) and coagulation markers such as lupus anticoagulants (LA), anti-cardiolipin (ACA), protein C (PC) deficiency, protein S (PS) deficiency, and antithrombin III (ATIII) deficiency in recurrent pregnancy loss (RPL). This prospective case-control study comprised two groups: the study group (n = 88) included women with recurrent pregnancy loss at Mansoura University Hospital between January 2019 and December 2020, and the control group (n = 52) included women without obstetric or medical complications. Demographic, clinical, and laboratory data, including serum samples collected at 10 weeks of gestation, were collected from all participants. The study measured SAA levels, lupus anticoagulants, anti-cardiolipin, protein C, protein S, and antithrombin III levels. The SAA level was significantly elevated in the recurrent pregnancy loss group compared to that in the control group. Lupus anticoagulant positive, anti-cardiolipin positive Immunoglobulin M (IgM), and deficiencies in protein C, protein S, and antithrombin III were significantly observed in patients with RPL (p < 0.05). The SAA levels were significantly elevated in both LA-positive and ACA-positive IgM patients. The receiver operating characteristic (ROC) curve analysis demonstrated that at SAA > 24.8 for the prediction of recurrent pregnancy loss, sensitivity was 98.86%, and specificity was 92.31%. Positive and negative predictive values were 95.6% and 98.0%, respectively. The area under the curve = 0.971 (0.927-0.992). SAA is associated with recurrent pregnancy loss and may therefore serve as a potential predictor of this condition. The observed elevation in SAA levels could be primary or secondary to the inflammatory response that promotes thrombotic activity in RPL patients at risk of APA, Protein S, Protein C, and ATIII deficiencies. Implementing SAA screening during pregnancy may facilitate the identification of individuals who could potentially benefit from novel treatment strategies.

Organ donation from brain-dead patients is a major advancement in transplantation medicine. However, challenges remain in identifying and managing potential donors. In Tunisia, low donation rates reflect both medical limitations and significant sociocultural barriers, with limited national data addressing these factors. This study aimed to describe the epidemiological, clinical, and paraclinical profiles of patients with severe coma in Tunisian intensive care units (ICUs), and to identify factors associated with progression to brain death (BD) and subsequent organ donation outcomes. A pilot prospective multicenter study was conducted over one year (November 2022 - October 2023) in three Tunisian university hospitals: Sahloul and Farhat Hached (Sousse), and Mohamed Taher Maamouri (Nabeul). All ICU patients with severe coma (i.e.; Glasgow coma scale≤8) requiring invasive mechanical ventilation were included. Patients were followed until BD confirmation or ICU discharge. The transplant coordination team approached families of confirmed BD patients for donation consent. Among 104 patients (mean age: 47years; 76% male), 26 (25%) progressed to BD, mainly due to haemorrhagic stroke (57.7%) and traumatic brain injury (30.8%). BD was significantly associated with male sex (odds ratio (OR)=2.63; p=0.047), comorbidities such as arterial hypertension and/or diabetes mellitus (OR=2.63; p=0.041), traumatic causes (5.76; p<0.001), haemorrhagic stroke (OR=13.83; p<0.001), and prolonged ICU stay defined as a stay exceeding 14days (OR=12.54; p=0.014). Of the 17 confirmed BD cases, families of 12 were approached, with consent obtained in five (41.6%). Refusals (58.3%) were mainly due to concerns about body integrity, religious beliefs, and family influence. Improved donor management, family communication, and public awareness are crucial to increasing donation rates. Registration. This study protocol was registered on ClinicalTrials.gov (Identifier: NCT06948669).

Sperm motility, a key determinant of male fertility, is often impaired by genetic variations affecting flagellar formation. The glutamine-rich protein 2 (QRICH2) gene encodes a protein essential for sperm flagella biogenesis and structural integrity. This study investigates genetic variations within exon 3 of the QRICH2 gene, identifying novel heterozygous variants associated with sperm tail-specific abnormalities and motility impairments. Among 34 individuals diagnosed with asthenozoospermia (ASZ) and 26 individuals with normal sperm parameters (NZ) from Jordan, eight unique heterozygous variants (c.123 G>T, c.133 G>C, c.138A>G, c.170A>C, c.189C>G, c.190T>C, c.195A>T, and c.204A>T) were exclusive to the ASZ group, while four variants (c.136 G>A, c.145A>C, c.179T>G, and c.180T>G) were found only in NZ. These variants were absent from major genetic databases, suggesting their potential novelty, while two variants (c.206C>T and c.189C>T) were linked to known SNP cluster IDs rs73996306 and rs1567790525, respectively. Four non-synonymous SNPs (c.136 G>A, c.145A>C, c.170A>C, and c.204A>T) were predicted to be functionally and structurally damaging, underscoring their significance. Additionally, five variants overlapped with previously reported mutation sites, indicating potential mutation hotspots. Statistical analysis revealed a significant association between QRICH2 mutations and tail defects (p < 0.021). These findings highlight the critical role of heterozygous QRICH2 mutations in mild-to-moderate ASZ, even in NZ individuals. Despite some carriers meeting WHO criteria for NZ, notable morphological abnormalities suggest the need for refined diagnostic benchmarks. Screening for QRICH2 mutations is essential for accurate molecular diagnosis and should be integrated into genetic counseling, particularly in regions like Jordan. Further research into the cumulative effects of heterozygous mutations and their environmental interactions is needed to expand our understanding of idiopathic male infertility and to enhance diagnostic and therapeutic strategies for male infertility.

Osteoporosis is defined by a BMD ≤ 2.5 SD below the young adult reference population. Standard dual-energy X-ray absorptiometry (DXA) scans for osteoporosis involve the femoral neck and lumbar spine, but alternative sites like the one-third radius (1/3 R) are only used when these sites are inaccessible. This study assessed the correlation and level of agreement between BMD at the 1/3 R, femoral neck, and lumbar spine to evaluate its diagnostic utility. Data from 43,801 patients referred for DXA scans in northwest England were analysed. Of these, 437 underwent 1/3 R scans. Demographic comparisons between patients with and without forearm scans were conducted. The primary analysis included patients with scans at the 1/3 R, lumbar spine, and bilateral femoral regions;(n = 183). Spearman's correlation assessed BMD relationships, Cohen's kappa analysed osteoporosis classification agreement, and Bland-Altman plots evaluated measurement bias. The cohort had a mean age of 65.7 years (SD 12.9), with 83.3% female and 41.2% reporting fractures. Patients who underwent 1/3 R scans (n = 437) were older, heavier, and had a higher body mass index (BMI). Correlation analysis showed only moderate associations between 1/3 R and femoral/lumbar spine BMD ;(r = 0.29 to 0.36, p < 0.001). Cohen's kappa demonstrated only slight agreement for 1/3 R, femoral neck and lumbar spine T-scores (κ = 0.14-0.29). Bland-Altman analysis revealed that 1/3 R scans systematically underestimated BMD relative to femoral and lumbar sites, with mean biases of -0.7 for femoral sites and -1.53 for lumbar spine. The 1/3 R BMD showed poor agreement and systematic underestimation compared to central sites, limiting its reliability for osteoporosis diagnosis. Future research should explore alternative peripheral weight-bearing sites and novel diagnostic technologies to assess BMD where central sites cannot be scanned.

Giant cell tumor of bone (GCTB) is generally considered a benign tumor, but it can exhibit locally aggressive behavior. The two main surgical treatment options for GCTB are intralesional curettage and en-bloc resection. This study examined the long-term GCTB recurrence rates among Tunisian patients after surgery. A study including 36 patients diagnosed with GCTB was conducted. These patients underwent surgical procedures, specifically intralesional curettage and in bloc resection. Subsequently, we monitored these patients for a two-year post-operative period. Statistical analyses, including Kaplan-Meier survival analysis, Cox proportional hazards regression, and chi-square tests, were performed to identify and evaluate factors associated with local recurrence. Our analysis showed a significant association between surgical treatment and the occurrence of local recurrence (p < 0.01). Interestingly, the rate of local recurrence was notably higher among patients who underwent intralesional curettage (13 out of 21; 61%) compared to those who received en bloc resection (2 out of 15; 13%) (all p < 0.01). En-bloc resection is a reliable treatment choice for GCTB, demonstrating a lower risk of recurrence compared to intralesional curettage. These findings highlight the importance of selecting the appropriate surgical approach to minimize recurrence and improve patient outcomes.