Noncompliance of pediatric cancer patients with chemotherapy: A single-center experience in a lower-middle income country

Noncompliance with therapy is a big obstacle to successful therapy. We aimed to evaluate the prevalence and risk factors affecting the compliance of pediatric cancer patients with therapy in a tertiary care center far away from the capital in a lower-middle income country (LMIC). A retrospective cohort study of reports of all pediatric cancer patients who were diagnosed and started treatment between 2006 and 2010 at South Egypt Cancer Institute (SECI) was done. The following data were collected: Age, sex, diagnosis, compliance with therapy, and data on potential risk factors that might affect compliance, including time duration of travel from the patient's home to SECI, time lag between the first symptom until the first visit to SECI and until the start of treatment, results of reevaluation after the initial course of therapy, and therapy-related severe adverse events. Noncompliance with therapy was defined as when patients missed their determined therapy appointment for one week or more or abandoned therapy. This study included 510 patients. Eighty-three (16.3%) were non-compliant, as forty patients missed their therapy appointment (7.8%), and 43 abandoned further therapy (8.4%). Noncompliance was found to be more prevalent among patients with solid tumors. Non-compliant patients suffered a significantly higher relapse rate (47.7% vs. 11.2% in compliant patients, p < .001). Unfortunately, 75% of the abandoned patients who returned for further therapy suffered a relapse. Noncompliance with treatment is still a big problem facing cancer management in LMICs.

Exploring grandparents' psychosocial responses to childhood cancer: A qualitative study

OBJECTIVE

A childhood cancer diagnosis is a traumatic experience for patients and their families. However, little is known about the effect on grandparents. We aimed to investigate the negative psychosocial impact, coping strategies, and positive outcomes of grandparents of childhood cancer patients in Switzerland.

METHODS

We collected data using a semi-structured interview guide and applied qualitative content analysis.

RESULTS

We conducted 20 interviews with 23 grandparents (57% female; mean age = 66.9 years; SD = 6.4; range = 57.0-82.4) of 13 affected children (69% female; mean age = 7.5 years; SD = 6.1; range = 1.0-18.9) between January 2022 and April 2023. The mean time since diagnosis was 1.0 years (SD = 0.5; range = 0.4-1.9). Grandparents were in shock and experienced strong feelings of fear and helplessness. They were particularly afraid of a relapse or late effects. The worst part for most was seeing their grandchild suffer. Many stated that their fear was always present which could lead to tension and sleep problems. To cope with these negative experiences, the grandparents used internal and external strategies, such as accepting the illness or talking to their spouse and friends. Some grandparents also reported positive outcomes, such as getting emotionally closer to family members and appreciating things that had previously been taken for granted.

CONCLUSIONS

Grandparents suffer greatly when their grandchild is diagnosed with cancer. Encouragingly, most grandparents also reported coping strategies and positive outcomes despite the challenges. Promoting coping strategies and providing appropriate resources could reduce the psychological burden of grandparents and strengthen the whole family system.

Clinical outcome of pediatric medulloblastoma patients with Li-Fraumeni syndrome

BACKGROUND

The prognosis for Li-Fraumeni syndrome (LFS) patients with medulloblastoma (MB) is poor. Comprehensive clinical data for this patient group is lacking, challenging the development of novel therapeutic strategies. Here, we present clinical and molecular data on a retrospective cohort of pediatric LFS MB patients.

METHODS

In this multinational, multicenter retrospective cohort study, LFS patients under 21 years with MB and class 5 or class 4 constitutional TP53 variants were included. TP53 mutation status, methylation subgroup, treatment, progression free- (PFS) and overall survival (OS), recurrence patterns, and incidence of subsequent neoplasms were evaluated.

RESULTS

The study evaluated 47 LFS individuals diagnosed with MB, mainly classified as DNA methylation subgroup "SHH_3" (86%). The majority (74%) of constitutional TP53 variants represented missense variants. The 2- and 5-year (y-) PFS were 36% and 20%, and 2- and 5y-OS were 53% and 23%, respectively. Patients who received postoperative radiotherapy (RT) (2y-PFS: 44%, 2y-OS: 60%) or chemotherapy before RT (2y-PFS: 32%, 2y-OS: 48%) had significantly better clinical outcome then patients who were not treated with RT (2y-PFS: 0%, 2y-OS: 25%). Patients treated according to protocols including high-intensity chemotherapy and patients who received only maintenance-type chemotherapy showed similar outcomes (2y-PFS: 42% and 35%, 2y-OS: 68% and 53%, respectively).

CONCLUSIONS

LFS MB patients have a dismal prognosis. In the presented cohort use of RT significantly increased survival rates, whereas chemotherapy intensity did not influence their clinical outcome. Prospective collection of clinical data and development of novel treatments are required to improve the outcome of LFS MB patients.

Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country

BACKGROUND

Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC).

METHODS

A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors.

RESULTS

The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma.

CONCLUSIONS

Outcome differences were associated with different causes of death and other less prominent factors.

Arabic version of the intermittent and constant osteoarthritis pain questionnaire (ICOAP-Ar): translation, cross-cultural adaptation, and measurement properties

BACKGROUND

Pain is the most incapacitating symptom of knee osteoarthritis (OA), with intermittent and/or continuous nature as described by the patients. Accuracy of pain assessment tools across different cultures is important. This study aimed to translate and culturally adapt the Intermittent and Constant OsteoArthritis Pain (ICOAP) measure into Arabic (ICOAP-Ar) and evaluate its psychometric properties in patients with knee OA.

METHODS

The ICOAP was cross-culturally adapted following the recommended guidelines from English. Knee OA patients from outpatient clinics were recruited to assess the structural (confirmatory factor analysis) and construct validity (Spearman's correlation coefficient - rho) to assess the relationship between the ICOAP-Ar and the pain and symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), in addition to internal consistency (Cronbach's alpha and the corrected item-total correlation). A week later, test-retest reliability (intraclass correlation coefficient (ICC)) was evaluated. Following four weeks of physical therapy treatment, the ICOAP-Ar responsiveness was evaluated using the receiver operating characteristic curve.

RESULTS

Ninety-seven participants were recruited (age = 52.97 ± 9.9). A model with single pain construct showed acceptable fit (Comparative fit index = 0.92). The ICOAP-Ar total and subscales had a strong to moderate negative correlation with the KOOS pain and symptoms domains, respectively. The ICOAP-Ar total and subscales demonstrated satisfactory internal consistency (α = 0.86-0.93). The ICCs were excellent (ICCs = 0.89-0.92) with acceptable corrected item total correlations (rho = 0.53-0.87) for the ICOAP-Ar items. The ICOAP-Ar responsiveness was good with moderate effect size (ES = 0.51-0.65) and large standardized response mean (SRM = 0.86-0.99). A cut-off point of 51.1/100 was determined with moderate accuracy (Area under the curve = 0.81, sensitivity = 85%, specificity = 71%). No floor or ceiling effects were found.

CONCLUSIONS

The ICOAP-Ar exhibited good validity, reliability, and responsiveness after physical therapy treatment for knee OA, which renders it reliable for evaluating knee OA pain in clinical and research settings.

Psychometric properties of the Arabic version of the Mini-Balance Evaluation Systems Test in patients with neurological balance disorders

OBJECTIVE

This study aimed to translate and cross-culturally adapt the Mini-Balance Evaluation Systems Test (Mini-BESTest) to Arabic (Mini-BESTest-Ar) and evaluate its psychometric properties in patients with neurological balance disorders.

PATIENTS AND METHODS

The translation and adaptation followed the established guidelines. Validity, internal consistency, test-retest reliability, standard error of measurement (SEM), minimal detectable change (MDC95), and limits of agreement (LOA) were examined in 56 patients. The sensitivity was investigated using the receiver operating characteristic curve.

RESULTS

The Mini-BESTest-Ar significantly correlated with the Berg balance scale (BBS) (r = 0.80; p < 0.001) and dynamic gait index (DGI) (rho = 0.75; p < 0.001). All domains showed moderate to very good correlations with BBS (r = 0.62-0.81; p < 0.001) and fair to very good correlations with DGI (rho = 0.4 -0.79; p < 0.05). The internal consistency and test-retest reliability of the total score and all domains were excellent (Cronbach's α = 0.96-0.81, ICC = 0.95-0.81, and r = 0.92-0.68). The SEM, MDC95, and MDC% for total score and domains were 1.19-0.31, 3.29-0.86 points, and 16.5%-66.8% respectively. The LOA revealed no systematic error. A cut-off point of 21.5/28 (Area under the curve = 0.85, sensitivity = 75%, specificity = 75%) was specified.

CONCLUSIONS

The Mini-BESTest-Ar has appropriate psychometric properties supporting its usefulness for research and clinical purposes.

The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: a randomized controlled trial

BACKGROUND

Flatfoot is a musculoskeletal problem associated with dysfunctional active and passive supporting structures of the normal foot curvature. Strengthening of the intrinsic foot muscles or using shoe orthosis are recommend treatment approaches. However, investigating the effect of combining both approaches is still warranted.

AIM

To examine the effect of applying short foot exercises (SFE) combined with shoe insole versus shoe insole alone on foot pressure measures, pain, function and navicular drop in individuals with symptomatic flexible flatfoot.

DESIGN

Prospective, active control, parallel-group, assessor-blinded, randomized controlled trial and intention-to-treat analysis.

SETTING

Outpatient physical therapy clinic of a university teaching hospital.

POPULATION

Forty participants with symptomatic flexible flatfoot.

METHODS

A six-week treatment protocol of SFE (three sets of 10 repetitions a day) in addition to shoe insole (eight hours a day) (experimental group, N.=20) or shoe insole only (eight hours a day) (control group, N.=20). Clinic visits were made at baseline and every two weeks for monitoring and follow-up. The static and dynamic foot area, force and pressure measures, pain, lower extremity function, and navicular drop were assessed at baseline and postintervention.

RESULTS

Forty participants joined the study and 37 (92.5%) completed the six-week intervention period. Foot pressure, pain and function showed a significant interaction (P=0.02 - <0.001) and time (P<0.001) effects with a non-significant group effect in favor of the experimental group. Post-hoc analysis revealed that the experimental group had lesser pain (P=0.002) and better function (P=0.03) than the control group at six weeks. Navicular drop decreased equally in both groups.

CONCLUSIONS

Implementation of shoe insole and SFE for six weeks improved pain and function and altered foot pressure distribution greater than shoe insole alone in patients with symptomatic flatfoot.

CLINICAL REHABILITATION IMPACT

Wearing shoe insole is an easy, but passive, treatment approach for a flatfoot problem. This study provided evidence regarding the added benefit of SFE. It is recommended that rehabilitation practitioners implement a comprehensive treatment protocol including both shoe insole and SFE for at least six weeks to achieve better results for their flatfoot patients.

Revision of Vertical Banded Gastroplasty to Roux-En-Y Gastric Bypass with Two Years Follow Up

Background Due to weight regain and GIT symptoms associated with Vertical banded gastroplasty (VBG) revisional surgery is necessary, Roux-en-Y gastric bypass (RYGB) is one of the best options as a revision procedure but comes with a high complication rate. Methods This prospective study included eighty patients undergoing Roux-en-Y gastric bypass surgery at Ain Shams University Hospitals after failed VBG surgery, with up to 2 years of follow-up. Results Eighty patients underwent RYGB correction after VBG. The mean age was 42 ±6.45 (39-58) years and the mean preoperative body mass index (BMI) was 45.46±4.135 (38-55) kg/m2. The median length of hospital stay for the patients was 4.78 ±1.84 days. The early postoperative complication rate was 8.7% and the reoperation rate within thirty days was 3.75%. with no Mortality. Leakage and bowel injury was in two patients. After an average follow-up of two years, the percentage of EWL was 64.47±19.3, and complete resolution of VBG-related GIT symptoms was achieved in approximately all patients. Late complications occurred in 7.5% of patients, of whom 3.75% required surgery. Conclusion conversion to RYGB is feasible with a limited short-term complication and reoperation rate, long term results show a nearly complete resolution of VBG-related symptoms and a statistically significant positive impact on weight loss.

Impact of the COVID-19 pandemic on physical therapy practice in Saudi Arabia

PURPOSE

The new Coronavirus (COVID-19) pandemic has caused significant impact on the medical sector worldwide, including physical therapy (PT). The purpose of this study was to investigate the impact of the COVID-19 pandemic on the PT services, and the associated psychological distress endured by PT practitioners in Saudi Arabia.

METHODS

A cross-sectional study was conducted to survey on-duty PT practitioners using a web-based questionnaire. Licensed PT practitioners working in Saudi Arabia (n = 265) participated and completed all the survey questions. The questionnaire comprised 30 questions covering the sociodemographic data and the outcome measures, which included the impact of the pandemic on the PT practice, use of telerehabilitation, administrative response during the pandemic, and PT practitioners' anxiety measured by the General Anxiety Disorder-7 scale.

RESULTS

During the lockdown, disruptive impact on the PT practice was reported by most of the participants (80%). The majority of PT clinics/departments were either partially (43.8%) or completely (31.3%) shutdown, and therapists treated patients less than usual. Around 30% of participants reported using a telerehabilitation approach during the pandemic to communicate with patients, and about 33% received online courses and webinars to adapt the PT practice in response to the pandemic. About 21% of participants endured moderate to severe levels of anxiety, which was more pronounced among females.

CONCLUSION

The COVID-19 pandemic significantly impacted the PT services in Saudi Arabia. Consequently, the number of patients treated was reduced, and therapists suffered notable psychological stress. Furthermore, although implemented, adaptive administrative measures were inadequate. Physical therapy practitioners and administrative authorities are encouraged to prioritize training and implementation of telerehabilitation as a likely prospective approach of PT practice.

P-119 Oxidative stress in the native semen versus strict sperm morphology as predictors of fertilization in couples undergoing IVF

Study question

Is oxidative stress in the native semen a better predictor of fertilization that strict sperm morphology in couples undergoing IVF?

Summary answer

Compared to strict sperm morphology, oxidative stress in the native semen is a better predictor of fertilization than strict sperm morphology in couples undergoing IVF

What is known already

Oxidative stress (OS) in native semen was studied before by measuring oxidative-reductive potential (ORP) and was found to be a good predictor of fertilization in-vitro with a cut-off point of 1.34 mV/106 sperm/mL below which the fertilizing capacity of the sperm is diminished. Similarly, strict sperm morphology (SM) was shown to be a good predictor of fertilization with a cut-off point around 4%. However, the superiority of either of these parameters as a better predictor of fertilization needs to be determined and one of the best methods to test this theory is in the IVF model (not the ICSI model).

Study design, size, duration

This prospective cohort study was conducted between September 2017 and December 2018. Couples with unexplained infertility were treated for one cycle of combined IVF/ICSI if 12 oocytes or more were retrieved. If good embryos resulted from IVF, 2 were transferred. If no fertilization occurred from IVF, 2 embryos resulting from ICSI were transferred. All remaining embryos were frozen. A total of 108 couples were enrolled but only 25 fulfilled the criteria and completed the study.

Participants/materials, setting, methods

A total of 575 oocytes were retrieved from the 25 patients (mean ± SD = 20.5 ± 5.6 oocyte/cycle) but only 3 to 5 oocytes per patient were inseminated by conventional IVF and the rest with ICSI. OS was determined in native semen by measuring oxidative reduction potential (ORP) using the MiOXYS system and the results correlated with the fertilization rate (FR) in the IVF-fertilized oocytes. Strict morphology of the same sample was also determined.

Main results and the role of chance

Out of the 108 oocytes inseminated with conventional IVF, 36 reached the 2PN stage (FR = 33.3%). The mean (± SD) ORP in the native semen in couples with = &gt;50% IVF fertilization was 1.02 ± 0.1 mV/106 sperm/mL which is significantly lower than in couples with &lt;50% fertilization (2.05 ± 0.7 mV/106 sperm/mL) (P &lt; 0.02). The sensitivity, specificity, PPV, NPV, +LR and –LR of the ORP assay in predicting = &gt;50% fertilization were 70.0%, 60.0%, 53.8%, 75.0%, 0.80 and 0.20 respectively. On the contrary, the mean (± SD) SM in the native semen in couples with = &gt;50% IVF fertilization was 9.0 ± 4.74 which is slightly (but insignificantly) higher than in couples with &lt;50% fertilization (8.5333 ± 5.25) (P &gt; 0.5). The sensitivity, specificity, PPV, NPV, +LR and –LR of SM in predicting = &gt;50% IVF fertilization were 40.0%, 80.0%, 57.1%, 66.7%, 2.00 and 0.75 respectively. The AUC for ORP was equal to 0.854167 with a cut-off point at 1.5692 mV/106 sperm/ml. On the contrary, the AUC for SM was equal to 0.5367 with a cut-off point at 8, denoting that ORP in the native semen is a better predictor of fertilization in IVF compared to SM.

Limitations, reasons for caution

The small sample size of this study can be considered a limitation but these early results can be further confirmed by larger prospective studies involving couples with various causes of infertility, although the criteria required for the recruitment of these couples are not easy to fulfill.

Wider implications of the findings

Measurement of ORP in semen should be added as a parameter to evaluate the fertilizing capacity of the sperm in routine sperm analysis. This can help clinicians treating couples with unexplained or male factor infertility determine whether anti-oxidant therapy, IUI, IVF or ICSI is the best management option.

Trial registration number

No applicable

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study

Background

Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed.

Methods

Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire.

Results

80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores.

Conclusions

In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).

Multimodal Treatment of Nasopharyngeal Carcinoma in Children, Adolescents and Young Adults-Extended Follow-Up of the NPC-2003-GPOH Study Cohort and Patients of the Interim Cohort

Simple Summary

Multimodal treatment of nasopharyngeal carcinoma (NPC) in children and young adults with induction chemotherapy, followed by radiochemotherapy and interferon-β (IFN-β) maintenance, has been successfully applied in studies NPC-91 and NPC-2003 of the German Society of Pediatric Oncology and Hematology (GPOH). We, here, present updated survival rates of the NPC-2003 study cohort after longer follow-up and include 21 additional patients recruited after closure of the study and treated as per the NPC-2003 study protocol (interim cohort) in our survival analysis. Survival rates remain high after extended follow-up and in the larger cohort with EFS and OS of 94% and 97%, respectively, reinforcing the high antitumor efficacy of this multimodal treatment concept. Seven patients with CR after induction therapy received a reduced radiation dose of 54 Gy, and none of them relapsed. Thus, the reduction of radiation dose seems feasible and has the potential to reduce treatment-related late effects in this vulnerable population.

Abstract

Nasopharyngeal carcinoma (NPC) in children and young adults has been treated within two consecutive prospective trials in Germany, the NPC-91 and the NPC-2003 study of the German Society of Pediatric Oncology and Hematology (GPOH). In these studies, multimodal treatment with induction chemotherapy, followed by radio (chemo)therapy and interferon-beta maintenance, yielded promising survival rates even after adapting total radiation doses to tumor response. The outcome of 45 patients in the NPC-2003 study was reassessed after a median follow-up of 85 months. In addition, we analyzed 21 further patients after closure of the NPC-2003 study, recruited between 2011 and 2017, and treated as per the NPC-2003 study protocol. The EFS and OS of 66 patients with locoregionally advanced NPC were 93.6% and 96.7%, respectively, after a median follow-up of 73 months. Seven patients with CR after induction therapy received a reduced radiation dose of 54 Gy; none relapsed. In young patients with advanced locoregional NPC, excellent long-term survival rates can be achieved by multimodal treatment, including interferon-beta. Radiation doses may be reduced in patients with complete remission after induction chemotherapy and may limit radiogenic late effects.

The effect of knee angle and subject position on plantar flexors isokinetic performance and muscular activity

BACKGROUND: Assessment of the plantar flexion (PF) isokinetic performance has been greatly diverse and based on personal preferences rather than standardized guidelines. OBJECTIVE: To examine the performance of the plantar flexors under different settings including knee joint angle and subject position. METHODS: Thirteen women and 20 men took part in this study. The isokinetic protocol (60∘/s) was set to ankle movement between 10∘ dorsiflexion to 30∘ PF. Participants performed three repetitions of concentric PF in randomly-ordered knee angles; 15∘, 45∘ and 90∘, and in seated and supine positions. Surface electromyography (EMG) data were collected from the Soleus (SOL) and Gastrocnemius. RESULTS: Knee angle impacted the PF moment (P⩽ 0.001–0.026) and work (P⩽ 0.05) measures in both genders. The moment and work measures were significantly less in the 90∘ than those in the 45∘ and 15∘ positions. The 45∘ position had the highest values, particularly in sitting in the male participants. Only the GL EMG data was significantly impacted (P= 0.017) by the subject position. However, the difference was trivial (1.6%). The SOL muscle showed a consistent pattern of increased activity when the knee was in flexion. CONCLUSION: The 45∘ position seems to be optimal for obtaining the highest isokinetic PF scores.

Is Serum-Ascites Vitamin D Gradient a Valid Marker for Diagnosing Spontaneous Bacterial Peritonitis in Patients with Cirrhotic Ascites?

OBJECTIVE

Spontaneous bacterial peritonitis (SBP) is considered the paradigmatic model of infection in patients with liver cirrhosis. Therefore, there is a need for an accurate and rapid method for SBP diagnosis. The aim of this study was to evaluate the validity of serum-ascites 25-hydroxyvitamin D (25-OH vitamin D) gradient (SADG) as a marker for diagnosing SBP in patients with cirrhotic ascites.

METHODS

We conducted a cross-sectional analytic study of 88 patients with portal hypertensive ascites resulting from liver cirrhosis of any etiology. The demographic, clinical, and laboratory characteristics of the patients were recorded. The level of 25-OH vitamin D in serum and ascitic fluid was measured using high-performance liquid chromatography autoanalyzer. The SADG was calculated with the formula: 25-OH vitamin D in serum - 25-OH vitamin D in ascites.

RESULTS

Vitamin D deficiency was detected in 89.8% of the studied patients. The SADG values ranged between 0 and 69.2 ng/mL, with a median value of 5.58 ng/mL. It was significantly lower in patients with SBP than in those without SBP (P = .004). The area under the curve for SADG in exclusion of SBP was 0.67 at a cutoff value of ≥5.57 ng/mL.

CONCLUSION

We found that SADG may be a valid marker of SBP in patients with cirrhotic ascites.

Letter to the Editor

Reply to the Letter to the Editor concerning “Cross-Cultural Adaptation and Validation of the Arabic Version of the Intermittent and Constant Osteoarthritis Pain Questionnaire” Sports Med Int Open 2020; 4(01): E8–E12; DOI: 10.1055/a-1031-0947

Plasma-derived Factor X therapy for treatment of intracranial bleeding in a patient with Factor X deficiency: a case report

BACKGROUND

Factor X (FX) deficiency (FXD) is an extremely rare autosomal recessive hereditary hematologic disorder, affecting approximately one in 1,000,000 of the general population.

CASE REPORT

This case report describes an infant with hereditary severe FXD who presented with a spontaneous, life-threatening intracranial hemorrhage and was treated with the first licensed plasma-derived FX (pdFX) concentrate. On admission, laboratory assays showed severe coagulopathy of unknown cause; the patient was empirically treated using a multimodal hemostatic approach with prothrombin complex concentrate, fresh-frozen plasma, and tranexamic acid. Subsequent single-factor coagulation and genetic analyses confirmed the hereditary FXD diagnosis, and the therapeutic regimen was changed to a targeted regimen of 250 IU pdFX daily. Based on careful monitoring of the coagulation profile, pdFX administration frequency was increased to twice daily, followed by a reduction to once every 18 hours. The patient was discharged after 7 weeks of hospitalization in good clinical condition and now receives prophylactic pdFX three times weekly.

Habitual Use of High-Heeled Shoes Affects Isokinetic Soleus Strength More Than Gastrocnemius in Healthy Young Females

BACKGROUND

Habitual use of high-heeled shoes (HHS) has been reported to negatively impact different body structures. However, few studies have investigated its effect on plantarflexor performance. The aim of this study was to investigate the effect of habitual wear of HHS and knee joint position (to isolate the function of the gastrocnemius) on the isokinetic performance of the plantarflexors and ankle joint range of motion (ROM).

METHODS

A high-heel (HH) group included 12 women (25.4 ± 4.8 y) who have been wearing HHS for ≥40 hours/wk and for at least a year. A control group (CTRL) had 12 women (21.3 ± 0.5 y) who have occasionally been wearing HHS for <10 hours/wk. Participants performed isokinetic (60 degrees/s) plantarflexion movements through a range set between 15 degrees dorsiflexion and 30 degrees plantarflexion. Ankle joint ROM and average peak plantarflexion torque and power were recorded in 2 knee joint positions, extension and 90 degrees flexion.

RESULTS

Overall, torque was significantly affected by knee position (P = .04) and habitual use of HHS (P < .001), whereas power was impacted by knee position only (P < .001). Within each group, flexing the knee reduced isokinetic measurements. However, the reduction was greater for the HH group (torque: 54 Nm, power: 35.6 W) compared with the CTRL group (torque: 42 Nm, power: 32.5 W). Ankle joint ROM was significantly different between groups in knee flexion only.

CONCLUSION

Flexing the knee limited the plantarflexor muscular performance and the limitation was more significant in habitual users of HHS compared to nonusers. Thus, it is concluded that habitual use of HHS impacts the contractile properties of soleus more than gastrocnemius.

CLINICAL RELEVANCE

The soleus is important for walking and anterior cruciate ligament protection. Thus, HHS users could be susceptible to injury and may need longer and more intensive posttraumatic rehabilitation. Therefore, clinicians should consider knee position when examining the plantarflexors of habitual HHS users.

The use of r-hFSH in treatment of idiopathic male factor infertility before ICSI

OBJECTIVE

To evaluate the efficacy of pre-treatment of idiopathic oligozoospermic patients with r-hFSH to improve the clinical results of ICSI.

PATIENTS AND METHODS

82 infertile couples due to male factor who attended our center were included in the study. Thirty-six were randomized to the treatment group (group A) and forty-six to the control group (group B). The male partners in group A were treated with recombinant human FSH (r-hFSH; Gonal F®) 150 IU subcutaneously three times a week for a 3-months period. The control group (group B) did not receive any treatment. After the treatment couples of both groups underwent a cycle of ICSI.

RESULTS

The fertilization rate was comparable in both groups. However, in the treatment group (group A), the clinical pregnancy rate was significantly higher (42%) compared to the control group (group B) (20%) (p < 0.02). Also, the implantation rate was significantly higher in treatment group (26%) compared to the control (15%) (p < 0.04). Miscarriage rate was lower (15.7%) in the treatment group than in the control (43.7%), and this difference was statistically significant (p < 0.05).

CONCLUSIONS

Treatment of idiopathic male factor infertility with r-hFSH before ICSI improves clinical pregnancy rate, increases implantation rate and decreases the early pregnancy loss.

Recombinant HCG for triggering ovulation increases the rate of mature oocytes in women treated for ICSI

PURPOSE

To conduct a prospective randomized study in order to investigate the effect of recombinant HCG (rHCG) on oocyte nuclear and cytoplasm maturity compared to urinary HCG (uHCG), for inducing ovulation in women treated with ICSI for male factor infertility.

MATERIALS AND METHODS

We compared 89 patients randomly assigned to one of the two study groups. Group A consisted of 42 women who received a subcutaneous (s.c.) injection of 250 microg rHCG and group B consisted of 47 patients receiving an intramuscular (i.m.) injection of 10,000 IU uHCG.

RESULTS

Patients treated with rHCG showed a rate of metaphase II oocytes, a number of metaphase II oocytes with mature cytoplasm and a rate of metaphase II oocytes with mature cytoplasm calculated from total MII oocytes statistically higher than in patients treated with uHCG. However this differences were not associated with a significantly better clinical outcome.

CONCLUSION

Our data show that in women treated with ICSI for male factor infertility, rHCG increases the rate of metaphase II oocytes, the number and the rate of MII oocytes with mature cytoplasm compared to uHCG. A larger study comparing transfer cycles of embryos all derived from oocytes with mature cytoplasm and transfer cycles of embryos all derived from oocytes with immature cytoplasm may be needed to clarify clinical correlations.

The use of a modified hypo-osmotic swelling test for the selection of viable ejaculated and testicular immotile spermatozoa in ICSI

A modified hypo-osmotic solution was used to select viable ejaculated and testicular spermatozoa to perform intracytoplasmic sperm injection (ICSI) in 27 treatment cycles from patients with total absence of sperm motility. The treatment cycles consisted of 15 cycles in which ejaculated spermatozoa were used and 12 cycles in which testicular spermatozoa were used. The hypo-osmotic solution consisted of 50% culture medium and 50% deionized water and was shown in previous in-vitro studies to be superior to the original solution used in the classical hypo-osmotic swelling test. Fertilization was achieved in 37.3% of the oocytes injected. Embryos were replaced in 70.4% of the cycles with a mean of 2.0 embryos per cycle. There were no statistically significant differences between the ejaculated sperm group and the testicular sperm group in the fertilization rate (42.7 versus 30.1%) or in the cleavage rate (92.7 versus 77.3%). Four pregnancies resulted, two in the ejaculated sperm group and two in the testicular sperm group, a pregnancy rate of 14.8%. All pregnancies were singletons but one pregnancy in each group had an early miscarriage. There were no statistically significant differences between both groups in the pregnancy rates (13.3 versus 16.7%), in the implantation rates (5.3 versus 11.8%) or in the delivery/ongoing pregnancy rates (6.7 versus 8.3%). It is concluded that the use of this solution to select viable but immotile spermatozoa for ICSI is a simple and practical method and is associated with acceptable fertilization and pregnancy rates.

Prevalence of Alzheimer's disease and other dementing disorders: Assiut-Upper Egypt study

The aim of this study was to determine the prevalence rate of Alzheimer's disease (AD) and other types of dementias among the population over the age of 60 years in Assiut governorate. A 3-phase cross-sectional population-based study was carried out to screen 2, 000 subjects residing in 11 different locations representing the sociocultural status of the area. We subjected each proband to a modified form of the Mini Mental State Examination test. Subjects scored 21 or less were investigated according to a standardized protocol. We found 90 demented subjects yielding a crude prevalence ratio (case per 100 population over the age of 60) of 4.5. A diagnosis of subtypes of dementia was reached in 83 cases. Prevalence ratios for dementia subtypes were 2.2 for AD, 0.95 for multi-infarct dementia. 0.55 for mixed dementias and 0.45 for secondary dementias. Age-specific prevalence tends to be doubled every 5 years. Occupation, level of education and residence did not affect the prevalence or severity of dementia. Comparison with other studies suggests that dementia of all types is as frequent in Assiut governorate as elsewhere.

Ultrasonographic prediction of esophageal varices in Schistosomiasis mansoni

Bleeding from esophageal varices is a common and serious problem in Schistosomiasis mansoni. A simple and accurate method of detection would facilitate measurement of individual and community morbidity and allow institution of preventive measures. An ultrasonographic scoring system grading periportal fibrosis, portal vein diameter, spleen size, and portasystemic anastomoses was evaluated as a predictor of esophageal varices and a past history of upper gastrointestinal hemorrhage in 43 patients with hepatosplenic schistosomiasis. Ultrasonographic variceal score correlated (r = 0.86, p < 0.001) with the endoscopic variceal grade. Patients with a sonographic score of 5 or greater were highly likely (21 of 23) to have varices of grade II or greater (sensitivity, 91.3%; specificity, 94.7%). Only those with sonographic scores of 5 or greater (15 of 23) had bled from esophageal varices. The ultrasonographic score provided a simple, inexpensive, accurate, and noninvasive means of screening individuals with hepatosplenic schistosomiasis for esophageal varices, and correlated strongly with prior gastrointestinal hemorrhage. It is not known whether a similar score would be useful in hepatic cirrhosis.

Grading of hepatic schistosomiasis by the use of ultrasonography

Forty-three subjects with pure hepatic schistosomiasis having ultrasonographic assessment of periportal fibrosis were grouped according to the thickness of their portal tracts: grade I = 3-5 mm, grade II = greater than 5-7 mm, and grade III = greater than 7 mm. A history of hematemesis, blood transfusion, sclerotherapy, and lower limb edema correlated with the ultrasonographic grade of periportal fibrosis. With increasing grade, the average liver size was smaller and the average spleen size was larger, as determined by physical examination and by ultrasonography. Abnormalities in serum enzyme levels were more frequent in those with thicker portal tracts. Greater diameters of the portal and splenic veins and ultrasonographically detectable collateral blood vessels were associated with increasing thickness of portal tracts. The grade of endoscopically determined esophageal varices was highly correlated with the grade of periportal fibrosis. We concluded that this method of grading accurately reflects the hemodynamic changes and provides a good estimate of the clinical status of patients who have periportal fibrosis due to schistosomiasis mansoni. Where available, it should replace clinical grading based upon the liver and spleen size as detected by physical examination.