Background Insulin resistance (IR) means the requirement of a higher insulin concentration to produce the expected biological effect. It was proposed that triglycerides–glucose index (TY G) and triglycerides–high-density lipoprotein cholesterol ratio (TG/HDL) were dependable, applicable, and less-expensive markers of IR. However, their results varied significantly among different ethnic groups. Aim To assess the eligibility of TY G and TG/HDL as IR indices among overweight and/or obese Egyptians. Patients and methods The participants in this cross-sectional study were 328 overweight and/or obese Egyptians. Their fasting blood glucose, TG, HDL, and fasting insulin blood concentrations were estimated. Homeostasis model assessment-insulin resistance (HOMA-IR), TY G, and TG/HDL were calculated. Results A statistically significant positive correlation between HOMA-IR and both TY G (r = 0.688; P < 0.001) and TG/HDL (r = 0.590; P < 0.001) was identified. Four quartiles had been set up for HOMA-IR across which both indices showed trends of consistent increase. Analysis of the receiver-operating characteristic curves revealed that TY G [area under the curve = 0.858 (95% confidence interval 0.819–0.897) (P < 0.001)] is a better marker for IR than TG/HDL [area under the curve = 0.796 (95% confidence interval 0.750–0.843) (P < 0.001)] and demonstrated more than or equal to 8.22 and more than or equal to 1.82 as their respective cutoff values. Conclusion TY G and TG/HDL demonstrated significant association with HOMA-IR and might be applied as eligible indices of IR among overweight and/or obese Egyptians.

Background Lateral epicondylitis (LE) is the most common condition of elbow pain. Multiple intralesional steroid injections help in the treatment. Prolotherapy is a traditional injection method recently categorized as regenerative treatment. However, there is scarcity of literature that compares its effectiveness with steroids. Objective The aim was to compare the effectiveness of dextrose prolotherapy (DP) against local steroid injection in patients with LE in relieving pain and improving dysfunction. Participants and methods This parallel, randomized controlled trial was conducted at Outpatient Department, National Institute for Locomotor Disabilities (Divyangjan), (erstwhile National Institute for the Orthopaedically Handicapped) Kolkata, from January 2016 to January 2017. Patients with the clinical diagnosis of LE (in clinical stages 2, 3, and 4) were allocated to receive either DP (group A) or local steroid injection (group B). A total of 34 participants aged between 18 and 60 years who had symptoms for greater than or equal to 4 weeks was included. Injections were given to each patient at 0, 4, and 8 weeks. Data were collected at baseline and followed up at the fourth, eighth, and 16^th weeks. The two interventions' differential response was recorded in terms of pain [visual analog scale (VAS)], upper-extremity activities (DASH; disabilities of the arm, shoulder and hand scale), and the pain-free grip strength (PFGS). Results Both groups A and B showed significant improvement (P < 0.05) in VAS, DASH, and PFGS at follow-ups compared with baseline. Compared with group B, at 4 weeks, group A had no statistically significant differences in the VAS (53.6 ± 12.6 vs 51.3 ± 15.5, P = 0.65), DASH score (26.2 ± 14.6 vs 26.7 ± 15.6, P = 0.93), and PFGS (16.3 ± 8.7 vs 12.3 ± 5.4, P = 0.14). Compared with group B, at 8 weeks, no statistically significant differences in the VAS (n = 15, difference of mean 0.4, 95% confidence interval [−7.4 to 8.2], P = 0.9), DASH (n = 15, 3.5 [−5.2 to 12.2], P = 0.4), and PFGS (n = 15, 4.7 [−0.8 to 10.2], P = 0.1) were noted between two groups. However, at 16 weeks, compared with group B, group A patients showed significant better improvement in VAS (n = 15, 14.0 [7.0–20.9], P = 0.0001) and PFGS (n = 15, 8.4 [2.3–14.5], P = 0.009) but not in DASH (n = 15, 8.4 [2.3–14.5], P = 0.4). Conclusions DP showed superiority in reducing LE pain and improving the grip strength as compared with local steroid injection. However, prolotherapy was associated with increased pain around the injection site in the first 48 h and transient weakness of wrist extensors (about 10 min) because of local spread of lignocaine in the common extensor-origin muscles, which was conservatively managed.

Introduction Robust data are available for C-reactive protein (CRP) in bacterial infection, and it can be used in this coronavirus disease 2019 (COVID-19) pneumonia pandemic for initial assessment before planning of treatment in indoor settings in comparison with other inflammatory markers and computed tomography (CT) severity. Materials and methods A prospective, observational, follow up study was conducted that included 1000 COVID 19 cases confirmed with RT PCR. All cases were assessed with lung involvement documented and categorized based on high resolution computed tomography (HRCT) thorax, oxygen saturation, and inflammatory markers such as CRP at the entry point and follow up. Age, sex, comorbidities, use of BIPAP/NIV (Bi-level positive airway pressure/Non-invasive ventilation), and outcomes such as with or without lung fibrosis as per HRCT severity were key observations. Statistical analysis was done using χ² test. Results Age (<50 and >50 years) and sex (male versus female) had a significant association with CRP in predicting severity (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with CRP level had a significant correlation (P < 0.00001). CRP level had a significant association with duration of illness (P < 0.00001). Comorbidities had a significant association with CRP level (P < 0.00001). CRP level had a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement during hospitalization had a significant association with CRP level (P < 0.00001). Timing of BIPAP/NIV requirement had a significant association with CRP level. (P < 0.00001). Follow-up CRP titer during hospitalization as compared with the entry point normal and abnormal CRP levels showed a significant association in post-COVID lung fibrosis (P < 0.00001). Conclusion CRP is an easily available and universally acceptable inflammatory marker and documented to play a very crucial role in predicting timings of interventions and post-COVID lung fibrosis.

Background The first few hours after birth are very critical for newborns to adapt to the extrauterine environment. However, respiratory distress syndrome (RDS) is very common in newborns, particularly in those with shorter gestation ages, sepsis, and fewer platelet counts. The evaluation of respiratory management with current noninvasive ventilation (NIV) support strategies in preterm infants present within the neonatal intensive care unit, as well as drawbacks of NIV modes including nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and high-flow nasal cannula, is also critical for those patients. This study aimed to compare different modes of NIV to highlight the preferred respiratory support model for preterm infants with RDS and to assess the advantages of NIV such as decreasing ventilator-induced lung injury to highlight the best model for NIV. Patients and methods A total of 120 babies were randomly divided into three equal groups in four neonatal intensive care units. Each group was treated with one type of NIV immediately after birth. Demographic data and clinical, laboratory, and radiographic measures were collected. Moreover, the use of surfactant/caffeine, optimum humidification, and appropriate nasal interface were recorded. Results The nasal intermittent positive pressure ventilation mode revealed a higher preference with different risk factors; however, a significant association between better survival and heated humidified high-flow nasal cannula mode was also revealed. Moreover, intubation decreased in neonates with feeding intolerance, abdominal distention, and pressure necrosis by about 27, 87, and 13%, respectively (P > 0.05).

Background Sepsis is the most frequent cause of neonatal deaths globally, varying in incidence between different countries. Sepsis is a burden on families and health care resources. Objectives To identify prevalence, type of organism, and outcome of early-onset sepsis (EOS) and late-onset sepsis (LOS). Patients and methods A cross-sectional study was conducted at the neonatal ICU of Mataria Teaching Hospital from November 2018 to October 2019. Demographic, clinical, and laboratory data of proved septic neonates were collected. Classification of cases according to the onset of sepsis: EOS (group I), in which sepsis is presented clinically before the third day of life, and LOS (group II), in which sepsis presented clinically after the third day of life. The LOS is subsequently divided into hospital-acquired infection (nosocomial infection) (group IIa) and community-acquired infection group (group IIb). Results A total of 51 neonates were diagnosed as having sepsis, with a prevalence of 2.8% of total admitted neonates for EOS and 4.4% for LOS (3.7% for nosocomial and 0.7% for community-acquired infection). Vomiting, poor feeding, and respiratory distress were the commonest presenting symptoms in EOS and LOS. Blood transfusion is needed mostly in EOS. Gram-negative organisms were common in EOS and nosocomial infection, whereas gram-positive organisms were the commonest in community-acquired infection. Klebsiella was the commonest responsible organism for neonatal sepsis, which is sensitive to meropenem, imipenem, and ciprofloxacin. The total mortality rate was 25%, with no difference among the three groups. Conclusion Late onset sepsis (LOS) has a higher prevalence than early-onset one. Klebsiella was the commonest responsible organism for neonatal sepsis in our unit, and the most sensitive antibiotics are imipenem, meropenem, and ciprofloxacin regardless the onset of sepsis. Still neonatal sepsis has a high mortality rate irrespective of the onset of sepsis.

Background Preeclampsia, a pregnancy disease marked by high blood pressure and proteinuria, affects 2–8% of all pregnancies. Preeclampsia can be life-threatening for both the mother and the fetus and is still a significant cause of maternal and neonatal morbidity and mortality. The goal of this study was to assess if there was a link between maternal serum vitamin D3 levels and the severity of preeclampsia. Patients and methods A case–control study was conducted on 70 pregnant women at Shebin El Kom Teaching Hospital. All pregnant women were divided into two groups: group A included 30 apparently healthy pregnant women (control group) and group B included 40 pregnant patients with preeclampsia (patient group). Results The serum vitamin D levels of patients with preeclampsia were considerably lower than those of the control group. The serum level of vitamin D in patients with mild preeclampsia was substantially higher than in patients with severe preeclampsia. Conclusion Vitamin D deficiency in the mother is a significant risk factor for preeclampsia. Vitamin D deficiency was found to be associated with a higher risk of preeclampsia.

Background Prolonged myocardial contraction and QT interval duration may be found in ischemic viable myocardium, yet it is unclear if noninvasive examination of regional nonhomogeneous myocardial mechanics and QT duration may detect patients with significant coronary artery disease (CAD). Aim To assess the ability of cardiac mechanical and QTc dispersions to identify significant CAD in patients having chest pain with no prior myocardial infarction. Patients and methods We examined 125 patients who had chest pain and evaluated by coronary angiography. They are divided into two groups. CAD group included 75 patients with significant CAD, and control group included 50 patients without significant CAD. We used echocardiographic speckle tracking to calculate longitudinal strain. We measured cardiac contraction duration as the time between the ECG first deflection in QRS complex and longitudinal strain peak within every segment of the 17-segments left ventricular model. We measured mechanical dispersion by calculating the SD of 17-time intervals (dispersionSD17) or by subtracting the shortest contraction duration from the longest one (dispersion-delta). QTc dispersion was defined as the difference between the shortest and the longest QTc intervals as measured in the 12-lead ECG. We compared CAD group and control group regarding mechanical and QTc dispersions. Results The CAD group had longer average contraction duration than the control group (436.13 ± 51.97 vs. 417.79 ± 40.76 ms, P = 0.036), and the contraction duration was significantly associated with QTc interval (r = 0.501, P < 0.001). Mechanical dispersion had an independent correlation with CAD (P < 0.001), but QTc dispersion and duration did not exhibit a significant association with CAD. Mechanical dispersion exhibited an incremental value over global longitudinal strain, wall motion score index, and conventional risk factors in identifying significant CAD. Conclusions In individuals with no prior myocardial infarction, the myocardial mechanical and QTc dispersions can predict the existence of significant CAD. Cardiac mechanical dispersion has an incremental value on global longitudinal strain for identification of patients with significant CAD.

Background Inflammatory processes have a role in the pathogenesis of acute myocardial infarction (AMI), left ventricular remodeling, and repair. Infarct size (IS) is a strong predictor of prognosis following AMI. Several tools are used to predict IS, but most of them are expensive and inaccessible all the time. So, neutrophil-to-lymphocyte ratio (NLR) as a marker of inflammation is an easy and cheap tool to predict IS. Aim To assess if post-percutaneous coronary intervention (PCI) NLR can predict IS in patients with AMI. Patients and methods The study included 11 125 patients with AMI treated with primary PCI. We used cardiovascular magnetic resonance imaging following PCI to measure IS. We performed a full blood cell count within 1 day before PCI and after it. Patients were classified into two groups regarding NLR by using a cutoff value of 3.88. Patients were divided into high-NLR group (n = 48) or low-NLR group (n = 77). IS was our primary outcome. Results The high-NLR group had significantly higher IS than the low-NLR group (24.82 ± 11.33 vs. 17.20 ± 9.37, P < 0.001). We found that post-PCI NLR more than or equal to 3.88 was associated with large-sized infarction (odds ratio 2.997, 95% confidence interval 1.782–5.026, P < 0.001). The high-NLR group had significantly higher major adverse cardiac events risk than the low-NLR group (P = 0.015, 16.7 vs. 7.8%, hazard ratio 2.678, 95% confidence interval 1.246–5.768). Conclusions Post-PCI NLR may be used to predict IS and prognosis of patients with AMI revascularized by PCI.

Introduction With improvements in percutaneous coronary intervention and the advent of novel adjunctive pharmacotherapy agents (such as GP 2b/3a inhibitors, new antiplatelet agents, and intensive statin regimens), the safety and efficacy of early Percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) has improved significantly (1). Therefore, the current guidelines recommend a routine invasive strategy (angiography and revascularization if applicable) (2) in high-risk patients with non-'ST'-elevation ACS (NSTE-ACS). Aim The aim was to compare the results of early versus late intervention in patients with high-risk NSTE myocardial infarction (MI). Patients and methods This study was carried out on 60 patients who presented to the Emergency Department in the National Heart Institute with high-risk NSTEMI with GRACE score greater than 140 during the time period from December 2020 to July 2021. The patients fulfilled the following criteria: they had typical chest pain; they had ECG changes in the form of 'ST'-segment depression, 'T'-wave inversion, or even with normal ECG; they had elevated cardiac biomarkers; their estimated GRACE score was greater than 140. The eligible patients were divided into two groups: (there were no specific selection criteria for early or late intervention, but the selection was done randomly). Group A: included 30 patients with early treatment strategy as the angiography was performed as early as possible and within 12 h from the ischemic pain. Group B: included 30 patients with delayed treatment strategy as the angiography was performed after 48 h of intensive medical treatment. Conclusion Based on individual and careful patient and lesion assessments, early intervention in high-risk non-STEMI patients reduced the risk of in-hospital mortality and minor bleeding and consequently the time of hospital stay. It also decreased the occurrence of refractory angina, recurrent MI, and hospitalization for cardiac cause. It also helped to improve the ejection fraction.

Background Increased cardiovascular risk factors are associated with adverse outcome in patients with coronavirus disease-2019 (COVID-19). In this study, the authors assessed the prevalence of cardiovascular risk factors in patients with COVID-19 and studied the impact of these cardiovascular risk factors on the final outcome in these patients. Aim The authors aimed to study the prevalence of cardiovascular risk factors in patients with COVID-19 as well as the impact of these cardiovascular risk factors on the final outcome in these patients. Patients and methods The study included 200 patients who were admitted in Al-Sahel teaching hospital with COVID- 19-positive PCR. These patients have at least one of these cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking). Results Bad outcome was associated with the presence of multiple cardiovascular risk factors and the most common cardiovascular risk factors were hypertension and diabetes mellitus. There were 121 hypertensive patients (60.5%), 98 diabetic patients (49.0%), 106 patients were smokers (53.0%), and 54 obese patients (27.0%) and 42 patients (21.0%) had dyslipidemia. In total, 181 patients survived (90.5%), while 19 patients (9.5%) died among patients with COVID-19. Conclusions The presence of cardiovascular risk factors, especially hypertension and diabetes mellitus, is associated with bad outcome in patients with COVID-19.

Background In recent years, minimally invasive surgical techniques have become increasingly popular in heart surgery. The most common incisions used in minimally invasive mitral valve replacement are ministernotomy and minithoracotomy. It is still up for dispute whether one incision is superior to the other. Patients and methods The results of 60 patients who had solitary mitral valve replacement were studied using a prospective comparative analysis. In group A (n = 30), a minimally invasive right anterior minithoracotomy technique was performed, whereas in group B (n = 30), a partial upper ministernotomy procedure was used. Results The results in both groups reveal no statistically significant difference. However, the hospital stay, ventilation time, and blood loss had better results in right minithoracotomy group, whereas in the upper ministernotomy group, postoperative pain had better results. In group A, blood loss was 325.3 ± 164.2, whereas in group B, it was 413.3 ± 159.3. In group B, postoperative pain was 1.9 ± 0.8 days better than group A (2.3 ± 0.7 days). Group A had a significantly longer operative time (295 ± 22.7) than group B (213 ± 28.4). In both groups, inotropes were determined to be negligible. Conclusion The results of a right anterior minithoracotomy and an upper ministernotomy approach in patients undergoing isolated mitral valve repair (MVR) are similar, with no notable differences. However, a right anterior minithoracotomy reduces (not significantly) the need for blood transfusions, assisted ventilation time, and hospital stay, whereas an upper ministernotomy reduces postoperative pain. Furthermore, the cross-clamping and the total operative time is highly significantly increased in the right anterior minithoracotomy approach.

Background Minimally invasive surgical methods have lately become popular in heart surgery. Ministernotomy and minithoracotomy are the most commonly used incisions in minimally invasive aortic valve replacement. It is still debated if one incision is better than the other. Patients and methods A prospective comparative analysis was used to examine the outcomes of 30 patients who underwent isolated aortic valve replacement. A minimally invasive right anterior minithoracotomy approach was used in group A (n = 15), whereas a mini-upper sternotomy method was used in group B (n = 15). Results The results in both groups reveal no statistical difference. However, the hospital stay, ventilation time, and blood loss had better results in the right minithoracotomy group, whereas in the upper-ministernotomy group, postoperative pain had better results. In group A, blood loss was 335.3174.5, while in group B, it was 433.3 ± 169.5. In group B, postoperative pain was 1.7 ± 0.7, which is better than group A 2.5 ± 0.6. Group B had a longer total hospital stay (7.2 ± 1.3 days) than group A (5.6 ± 0.6 days). In both groups, inotropes were determined to be negligible. Conclusion The results of a right anterior minithoracotomy and an upper-ministernotomy approach in patients undergoing isolated Aortic valve replacement (AVR) are similar, with no notable differences. However, a right anterior minithoracotomy reduces the need for blood transfusions, assisted ventilation time, and hospital stay, while an upper-ministernotomy reduces postoperative pain. Furthermore, the cross-clamping and total operative time is highly significantly increased in right anterior minithoracotomy approach.

An 18-year-old boy with no significant perinatal history presented with insidious onset of slowly progressive flaccid paraparesis with muscle wasting in thighs. On examination, the patient had flaccid motor quadriparesis and partial atrophy of proximal thigh muscles. This was accompanied by pseudohypertrophy of calf muscles and extensor muscles in the dorsum of foot. Investigations revealed very high levels of creatinine phosphokinase in the patient (6495 IU/l in contrast to normal range of 55–170 IU/l) and in his sister (718 IU/l). Echocardiography showed dilated cardiomyopathy with severe left ventricular dysfunction. The multiplex ligation-dependent probe amplification revealed deletion of exons 3 to 7 in the short arm of X chromosome (Xp21). Based on the clinical features and investigation reports, a diagnosis of intermediate phenotype of Duchenne and Becker muscular dystrophy was made.