Outcomes of endoscopic retrograde cholangiopancreatography performed in the AM versus PM: does procedural timing matter?

Background: ERCP is a technically demanding procedure that carries a high cumulative adverse event (AE) rate of >10%. Identifying risk factors for adverse events is paramount. Procedure timing, as a surrogate for endoscopist fatigue, has been shown to influence key quality metrics in colonoscopy, but data on this relationship in ERCP is sparse.

Imaging of electric-field-induced domain structure in DyMnO nanocrystals.

Multiferroic materials that exhibit interacting and coexisting properties, like ferroelectricity and ferromagnetism, possess significant potential in the development of novel technologies that can be controlled through the application of external fields. They also exhibit varying regions of polarity, known as domains, with the interfaces that separate the domains referred to as domain walls. In this study, using three-dimensional (3D) bragg coherent diffractive imaging (BCDI), we investigate the dynamics of multiferroic domain walls in a single hexagonal dysprosium manganite (h-DyMnO ) nanocrystal under varying applied electric field.

Imaging in-operando LiCoO nanocrystallites with Bragg coherent X-ray diffraction.

Although the LiCoO (LCO) cathode material has been widely used in commercial lithium ion batteries (LIB) and shows high stability, LIB's improvements have several challenges that still need to be overcome. In this paper, we have studied the in-operando structural properties of LCO within battery cells using Bragg Coherent X-ray Diffraction Imaging to identify ways to optimise the LCO batteries' cycling. We have successfully reconstructed the X-ray scattering phase variation (a fingerprint of atomic displacement) within a  ≈ (1.

Three-dimensional domain identification in a single hexagonal manganite nanocrystal.

The three-dimensional domain structure of ferroelectric materials significantly influences their properties. The ferroelectric domain structure of improper multiferroics, such as YMnO, is driven by a non-ferroelectric order parameter, leading to unique hexagonal vortex patterns and topologically protected domain walls. Characterizing the three-dimensional structure of these domains and domain walls has been elusive, however, due to a lack of suitable imaging techniques.

Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure.

Background: The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known.

Methods: We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D).

Efficacy and safety of supraclavicular and pectoralis nerve blocks as primary peri-procedural analgesia for cardiac electronic device implantation: A pilot study.

Background: Cardiac implantable electronic devices (CIEDs) are routinely implanted using intravenous drugs for sedation. However, some patients are poor candidates for intravenous sedation.

Objective: We present a case series demonstrating the safety and efficacy of a novel, ultrasound-guided nerve block technique that allows for pre-pectoral CIED implantation.

Evaluation of parameters used in echocardiography and ultrasound protocol for the diagnosis of shock etiology in emergency setting.

Background: Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them.

A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation.

A woman with type 1 myotonic dystrophy received an implantable cardioverter-defibrillator using a novel combination of ultrasound-guided supraclavicular nerve and pectoral nerve blocks. The entire procedure was completed without any procedural sedation or local anesthetic, and the patient did not experience any pain during or after the procedure. ().

Antimesenteric sleeve tapering enteroplasty with end-to-end anastomosis versus primary end-to-side anastomosis for the management of jejunal/ileal atresia.

Background/objective: Small bowel atresia commonly causes neonatal intestinal obstructions. Technical problems are associated with the surgical management of atresia using primary end-to-end anastomosis. Furthermore, the significantly dilated proximal loop may be associated with the stasis of intestinal fluid, thus increasing pressure on the anastomosis and prolonging fasting time before initiation of oral intake.

Accuracy of echocardiography and ultrasound protocol to identify shock etiology in emergency department.

Background: Early diagnosis and appropriate management of shock aimed at prevention of prolonged hypoperfusion has shown to decrease morbidity and mortality in patients with undifferentiated shock. However, there is often a challenge in emergency department (ED) - where diagnosis is mainly based on clinical signs and standard monitoring parameters. Early use of point of care ultrasound could reduce the diagnostic time and improve diagnostic accuracy.

Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery.

Background: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events.

Periodontal diseases and potential risk factors in Egyptian adult population-Results from a national cross-sectional study.

Background: Despite the interdependence of general and periodontal health, there is paucity of national representative data on the prevalence of periodontal diseases and their associated risk factors in Egyptian population. This cross-sectional study, thus, aimed to assess the prevalence of periodontitis and tooth loss among Egyptian adults and investigate the association between potential risk factors and periodontal diseases.

Methods: A total of 5,954 adults aged ≥ 20 years were included in this study as a subsample from Egypt's national oral health survey.

Blown Wide Open: An Unusual Case of Torrential Mitral Regurgitation Resolving With a Cough.

Mitral regurgitation can have varying hemodynamic parameters dependent on factors such as pressure gradients, exercise, and/or provocative maneuvers. We present a case of unusual dynamic mitral regurgitation resolved by coughing in a patient with hypertrophic cardiomyopathy. ().

Outcomes and risk factors for death in patients with coronavirus disease-2019 (COVID-19) pneumonia admitted to the intensive care units of an Egyptian University Hospital. A retrospective cohort study.

Background: The characteristics, outcomes, and risk factors for in-hospital death of critically ill intensive care unit (ICU) patients with coronavirus disease-2019 (COVID-19) have been described in patients from Europe, North America and China, but there are few data from COVID-19 patients in Middle Eastern countries. The aim of this study was to investigate the characteristics, outcomes, and risk factors for in-hospital death of critically ill patients with COVID-19 pneumonia admitted to the ICUs of a University Hospital in Egypt.

Methods: Retrospective analysis of patients with COVID-19 pneumonia admitted between April 28 and July 29, 2020 to two ICUs dedicated to the isolation and treatment of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Cairo University Hospitals.

Predicting acute kidney injury following nonemergent cardiac surgery: A preoperative scorecard.

Objective: To determine the predictors of postoperative acute kidney injury (AKI) following nonemergent cardiac surgery among patients with variable preoperative estimated glomerular filtration rate (eGFR) levels.

Methods: A retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures was performed between January 2006 and November 2015. The procedures included isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG and AVR.

Serum Level of CD48 and Its Expression on Blood Leukocytes in Persistent Asthmatic Patients.

CD48 is a surface receptor (mCD48) expressed on most hematopoietic cells, as well as in a soluble form (sCD48). It seems to play a major role in asthma through the interactions of mast cells with eosinophils via its ligand CD244. Hence, this study was done to evaluate the role of CD48, in its membrane and soluble forms, as a novel biomarker in asthma with various degrees of severity.

COVID-19 and Myocarditis: What Do We Know So Far?

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in patients with COVID-19, accounting for 7%-23% of cases, and is associated with a higher rate of morbidity and mortality.