Background: Trigger finger (TF) is a painful disorder that hinders the use of the entire hand. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US); however, no randomized control trial has investigated the use of US in the treatment of TF. The objective of this trail is to determine the effect of therapeutic US on pain intensity and the frequency of daily finger clicking in patients with TF. Materials and Methods: A single-blind, randomized (1:1), placebo-controlled, clinical trial was conducted at a physiotherapy outpatient clinic at Alahrar Teaching Hospital in Zagazig, Egypt. Twenty TF patients (group A) received daily US treatment for 6 sessions (continuous,1 W/cm2, 1 MHz and 5 min). Twenty TF patients (group B) received a sham US (3 min) plus oral anti-inflammatory medication. Results: There was a significant decrease in pain after treatment compared to before treatment within group A (P=0.001) and group B (P=0.046). Moreover, there was a significant decrease in clicking after treatment compared to before treatment within group A (P=0.002), while group B showed a nonsignificant decrease in clicking (P=0.083). These significant decreases in pain and clicking post treatment are favorable for patients in group A compared with group B. Additionally, group A experienced decreases in pain and clicking of 60.00% and 65.39%, respectively, compared with group B, which had decreases of 3.97% and 4.54%. Conclusion: Our results suggest that daily application of therapeutic US for 6 sessions may be a favorable treatment option for trigger finger, providing greater pain relief and potentially reducing clicking more effectively than anti-inflammatory drugs.
Background: Congenital cardiac interventions are progressing at a rapid pace. In the last few years, techniques such as stent placement for pulmonary artery stenosis, right ventricle outflow tract and ductal stenting showed great advances. Surgery over stents are increasing in complexity. Left pulmonary artery and right ventricle outflow tract sites account for more than half of stent handling. Percutaneous devices are not an ‘‘enemy’’ for the surgeon, but a tool for continuing the development of our surgical strategies. In this study, we describe the short-term outcome of patients who underwent surgical repair after pulmonary interventions for congenital heart diseases at our institute. Methods and results: We are presenting this observational study of 17 patients who had operated over the last seven years, between 2017 and 2024. Those patients had previous catheter interventions in the form of stent implantations at different pulmonary sites. Most of these interventions had done in pediatric cardiology department at our institute. Five patients obtained interventions in left pulmonary artery (LPA), three had stent in right pulmonary artery (RPA), and two patients had right ventricle outflow tract (RVOT) stenting. Six patients had ductus arteriosus stenting and one patient had bilateral LPA and RPA stenting. The surgical procedures performed in the 17 patients were as follows: Cavopulmonary connection in two patients, completion Fontan in one patient, total correction of Tetralogy of Fallot in nine patients, MBT shunt in three patients, one patient had Rastelli type repair for VSD + pulmonary atresia and one patient had RV- PA conduit replacement and bilateral pulmonary arterial replacement. All Patients of this series had discussed in a multidisciplinary heart team(MDT) prior to surgical intervention to ensure a comprehensive and individualized plan for each patient and dealing with the stents intraoperatively based on individual case by case scenario either: external ligation of the stent, partial removal or complete removal. Three of our series had single ventricular pathway, while the rest had biventricular pathway, two cases required deep hypothermic arrest due to emergent situation in the distal arch of the aorta at the site of ductus insertion. In this series, we had one operative mortality in a patient who had previous PDA stenting for initial management of severe form tetralogy of Fallot and pulmonary hypoplasia, patient had total correction and reconstruction of the left pulmonary artery. Patient died one day post-operative from massive bleeding in the ICU. Conclusion: As the field of intervention expands greatly in adult cardiology, the same had occurred in congenital cardiac interventions. This should expand the horizon of cardiac surgeons. As surgeons gain experience in the management of patients with previous congenital intervention, interventionists may be encouraged to do complexity that is highly advanced.
Background: In older adults, frailty is a complex condition marked by diminished functional reserves and heightened susceptibility to stressors. It is a more accurate predictor of unfavorable postoperative outcomes in the context of surgical operations than a patient's age or preexisting medical problems. Objectives: This study aimed to investigate the effects of frailty, as assessed by the Clinical Frailty Scale (CFS) and the 5-item Modified Frailty Index (MFI-5), on important clinical outcomes, including length of stay in the intensive care unit (ICU), hospitalization mortality, and the chance of readmission within 30 days, in older adults undergoing major abdominal surgeries. Methods: A prospective observational study was conducted involving 90 elderly patients (mainly ≥70 years) undergoing abdominal surgery. Frailty was assessed preoperatively using both CFS and MFI-5. Postoperative outcomes were recorded, including mortality, ICU stay duration, and readmission. Statistical analysis included logistic regression, chi-square, and ROC curve evaluation to determine predictive performance. Results Frailty was significantly associated with increased ICU length of stay, complications, and mortality. The CFS (cutoff ≥6.5) demonstrated superior sensitivity (91.7%) and accuracy (92.8%) compared to MFI5 (cutoff ≥3.5), which had high specificity (93.9%) but lower sensitivity (54.2%). The presence of comorbidities such as diabetes and hypertension amplified the adverse impact of frailty on surgical outcomes. Conclusion: Frailty is a robust independent predictor of poor outcomes in elderly ICU patients, particularly following emergency surgery. The CFS outperforms MFI5 as a screening tool and should be incorporated into routine preoperative and critical care assessments. Early identification and multidisciplinary optimization of frail patients are essential to improving outcomes.
Background Dexmedetomidine, is used in cardiac surgeries for its sedation, anxiolysis, and analgesic properties, with minimal respiratory depression. It may improve clinical outcomes in CABG surgery by reducing inflammatory responses, providing neuroprotection, and enhancing hemodynamic stability. Aim To assess the efficacy and safety of perioperative dexmedetomidine in improving clinical outcomes in CABG surgery. Methods This prospective, randomized controlled trial involved 160 patients undergoing elective on-pump CABG surgery. Participants were divided into two groups: 80 received dexmedetomidine, and 80 received a placebo. Key outcomes measured included the incidence of postoperative complications, duration of mechanical ventilation, and ICU stay. Results The dexmedetomidine group experienced a lower incidence of renal failure (2.5% vs. 5%, p = 0.016), stroke (3% vs. 5%, p = 0.043), and postoperative delirium (7.5% vs. 12.5%, p = 0.035) compared to the placebo group. Additionally, the dexmedetomidine group had shorter mechanical ventilation (6 vs. 8hours, p = 0.028) and ICU stays (2.5 vs. 3,5 days, p = 0.037). CK-MB and CRP levels were significantly reduced at postoperative periods (p < 0.05). Conclusion Perioperative dexmedetomidine effectively reduces postoperative complications and improves recovery metrics in CABG surgery, supporting its use in perioperative management protocols.
Background In anovulatory infertility Polycystic ovary syndrome (PCOS) plays a leading role, characterized by endocrine and metabolic disturbances. While metformin is usually used to decrease insulin resistance and restore ovulation, myoinositol has emerged as a promising alternative with fewer side effects. This study aimed to evaluate and compare the effectiveness of metformin and myoinositol as adjuvant treatments in infertile women with PCOS in ovulation induction cycles. Patient and methods This prospective cohort study included 192 women diagnosed with PCOS-related infertility, divided into two groups (n = 96 each) receiving either metformin or myoinositol for 3 months prior to ovulation induction. Clinical, biochemical, and hormonal parameters were recorded at baseline and post-treatment. Ovulation and conception rates were assessed across three induction cycles. Results Both groups showed significant improvements in cycle regularity, hormonal profiles (LH, testosterone, SHBG, and insulin sensitivity (fasting insulin, HOMA-IR). Metformin was associated with a greater reduction in BMI (p < 0.001), cycle length (p < 0.001), fasting insulin level and HOMA-IR index (p < 0.001), as well as higher ovulation rates in the second (44.1% vs. 28.7%, p = 0.029) and third cycles (64.1% vs. 47.6%, p = 0.035). Myoinositol demonstrated a more favorable impact on HDL and LDL cholesterol levels. Conception rates were comparable between groups across all cycles (p > 0.05). Conclusion Both metformin and myoinositol effectively improved reproductive and metabolic parameters in PCOS women through ovulation induction cycles. Metformin showed superior efficacy in enhancing ovulation and insulin resistance, whereas myoinositol may offer benefits in lipid metabolism and is better tolerated. Personalized treatment decisions should consider metabolic profiles, patient preferences, and treatment tolerance.
Attention deficit hyperactivity disorder is one of the neurodevelopmental disorders which characterized by: inattention and impulsivity as well as apparent deficits in executive functioning and impulse control. Auditory-linguistic areas and primary reading skills as early literacy skills were found to be lower than normal in ADHD. Other researches considered that the reading difficulties are in the areas of fluency, comprehension, and sustained attention during reading tasks. The aim of the study is to evaluate the phonological awareness abilities skills in children with attention deficit hyperactive disorder (ADHD), being contributors for early reading acquisition. Phonological awareness (PA) is the precise recognition of the abstract components that make up spoken words. It is the auditory ability which helps to identify and process phonological units, and how to manipulate it. PA represents a vital stepping stone toward the mastery of reading. Thirty children diagnosed with ADHD aged 5y 6m to 8y 6m and 30 normally developing children (control group) were recruited in the study. They were tested for 3 PA skills. Results: No significant differences were found between the ADHD group and the control group across the three age subgroups in the three phonological awareness skills assessed. Conclusion: The phonological awareness of children with ADHD was determined to be at levels equivalent to those of the typically developing children, which contradicts previous assumption that PA skills crucial for early reading are impaired in this population.
Background It is well-known that chemotherapy medicines can cause cardiomyopathy and left ventricular dysfunction as adverse effects. There is scant evidence concerning the effects of chemotherapeutic drugs on the integrity & functionality of the right ventricle (RV). Aim To study the impact of cardiotoxic systemic therapy on right ventricular function in nonmetastatic breast cancer cases, particularly evaluating the efficacy of modern echocardiographic procedures for the early recognition of RV cardiomyopathy. Patient and Method A total of 104 women diagnosed with breast cancer participated in this prospective trial. Two therapy groups were established for the cases: 42 patients received anthracycline therapy, while 62 patients received a combination of anthracycline & trastuzumab. Results Patients treated with anthracycline and/or trastuzumab had more marked changes in RV function, RV FAC and pulmonary artery pressure, regardless of laterality. Right ventricular function was significantly impaired following anthracycline-based therapy, with more pronounced effects observed in cases receiving the combination of anthracycline and trastuzumab. The incidence of pulmonary hypertension increased significantly, with significant change in RVSP and TAPSE across the cohort. The study found that global RV strain was more negative during therapy (around -20.5% to - 20.9%) for both left- sided and right-sided groups. After therapy, global strain improved slightly, showing recovery. There was no significant difference in the global strain among the left- sided & right- sided groups post-therapy (around -22.8% to -23.4%). Conclusion Chemotherapy using anthracyclines and trastuzumab adversely impacts right ventricular function, resulting in a reduction of RVEF, RVFAC, RV Global Strain, and LVEF.
Background: It appears that mild and hidden Hepatic Encephalopathy (HE) is present in up to 50% of patients with chronic liver disease. Tools that can predict when HE episodes would occur may enable early detection and clinically relevant preventative treatment. The brain's magnetic resonance spectroscopy (MRS) is considered a useful technique for providing a range of structural and functional assessments. Objective: To evaluate the role of brain magnetic resonance spectroscopy in assessment of metabolic changes in patients with chronic liver disease and minimal hepatic encephalopathy for better diagnosis and thus prevention of decline in cognitive functions and health related quality of life. Methods: This is prospective study included 29patients (age ranging from 19to70 years) recruited from Gastroenterology and Hepatology Department to Radiodiagnosis Department of National Hepatology and Tropical Medicine Research Institute. All patients had minimal hepatic encephalopathy. Each patient was subjected to full history taking, routine laboratory investigations. Clinical examination includes neurological examination, MRI&MRS of the brain with detection of the levels of metabolites. Results: The study showed that the mean age of the studied group was 60.79±9.26 years. Regarding sex 51.7% of the studied group were males and 48.3% of them were females.glutamax(GLX)was positive in 65.5% of the studied group, choline was positive in 13.8%, NAA was positive in 13.8%, manganese was positive in 41.4% of the studied group, and cortical edema was positive in 65.5% of the studied group. Conclusion:MR spectroscopy is a promising noninvasive technique that can trace brain changes associated with minimal hepatic encephalopathy, such as the manganese, glutamax and other depositions in addition to the development of cerebral edema that lead to impairment in brain function.
Aim of the work: To assess and contrast dermapen, glycolic acid (GA) peel, and a combination of the two therapys' safety and effectiveness in treating acne scars. Cases and methods: Thirty cases with acne scars participated in this trial. Ten cases each were divided into three cohorts at random; cohort I had dermapen therapy, whereas cohort II received glycolic peel therapy. Both procedures were administered to Cohort III. Six sessions were given to each case at intervals of two weeks. The quartile grading scale, the degree of case satisfaction, and the qualitative global scar grading system before and after therapy served as the foundation for the clinical evaluation. Results: The degree of acne scars before and after therapy with the dermapen and glycolic acid peel cohorts did not significantly improve, according to either research. The degree of improvement did not differ statistically significantly between the cohorts. The severity of the acne scar was improved following dermapen and glycolic acid peel therapy. Conclusion: When it came to treating atrophic acne scars, neither dermapen nor glycolic acid peel worked as a monotherapy. However, the severity of the acne scar significantly improved when combined with one another.
Background: Cardioplegia is crucial in cardiac surgery for myocardial protection. Modified del Nido cardioplegia, initially used in paediatric patients, is now employed in adult cardiac surgeries for its prolonged protection with a single dose. Aim: To compare the efficacy of conventional crystalloid cardioplegia and modified del Nido cardioplegia in patients undergoing coronary artery bypass graft surgery (CABG) for multivessel coronary artery disease (CAD). Methods: A randomized controlled trial included 94 adult patients undergoing elective CABG. Patients were randomly assigned to receive either conventional crystalloid cardioplegia or modified Del Nido cardioplegia. Data collected included CPB and cross-clamp times, cardioplegia volume, postoperative cardiac biomarkers (CK-MB, Troponin I), and clinical outcomes (ICU stay, complications). Results: The modified del Nido cardioplegia group had significantly shorter CPB (mean 92.5±35.94 vs. 105 ±38.3 minutes, p > 0.001) and cross-clamp times (mean 58.3 ±19.86 vs. 63.2 ±18.6 minutes, p > 0.001) and required fewer doses of cardioplegia solution (mean volume 1400 vs. 1500 mL, p < 0.001). Postoperative CK-MB levels were lower in the del Nido group at 1, 12, and 24 hours (p < 0.001), as were Troponin I levels at 24 hours (mean 5.7 ±1.2 vs. 6.2 ±0.7μg/L, p < 0.05). The del Nido group also had shorter ICU stays (mean 2.51 ±0.83 vs. 3.04 ±1.18 days, p < 0.05) and reduced ventilation time (mean 6.59 ±0.65 vs. 6.91 ±0.62 hours, p < 0.05). There were no significant differences in overall hospital stay or postoperative complications between the groups. Conclusion: Modified del Nido cardioplegia offers superior myocardial protection in CABG for multivessel CAD, with shorter operative times, reduced cardiac biomarker levels, and shorter ICU stays, making it a safe and effective alternative for myocardial protection in complex cardiac surgeries.
Background: Non-communicated hydrocephalus secondary to aqueductal stenosis is common, for which endoscopic third ventriculostomy (ETV) has emerged as an effective surgical management. Objective: To evaluate the clinical outcomes of ETV in patients with obstructive hydrocephalus due to aqueductal stenosis in patients over 2 years of age. Methods: This retrospective study was conducted at our institution and included 57 patients older than 2 years who underwent ETV between 2017 and 2024. Demographic data, clinical presentation, and follow-up outcomes were analysed. ETV was considered successful if the patient remained shunt-free during the follow-up period. Results: The mean age was 22.8 ± 10.5 years (range: 2–42 years). Follow-up period was 18.6 ± 4.5 months (range: 12–30 months), ETV was successful in 50 patients (87.7%), while 7 patients eventually required VP shunt. Complications occurred in 11 patients (19.3%), most commonly subcutaneous CSF collections ± leak (5), followed by subdural hygromas (2), transient oculomotor palsy (2), transient mutism (1), and wound infection (1). All were transient or manageable; no permanent neurological deficits or procedure-related mortality were observed. Conclusions:ETV is a safe and effective first-line treatment for aqueductal stenosis related hydrocephalus in patients older than two years, with high long-term success and a favourable safety profile.
Background Breast cancer, which makes up 30.4% of newly diagnosed tumors, is one of the most common cancers among young girls. Every woman who is 20 years of age or older is thought to be at risk of getting breast cancer. This research is crosssectional. The Shebin-Elkom Teaching Hospital served as the study's site. Randomized sampling was used to enroll five hundred women for this study. To collect information, a self-administration questionnaire was employed. Objective:. to evaluate the women who visited the surgery clinic at Shebin El Kom Teaching Hospital's knowledge of breast cancer, BSE, and its function in early breast cancer diagnosis. Methods Five hundred women participated in an institutional cross-sectional survey using a self-administered, pre-tested questionnaire. The data was cleaned and analyzed using SPSS version 23, and descriptive statistics, logistic regression, and linear regression were used. The odds ratio was used to determine the potential predictors with a 95% confidence level. From December 2024 to March 2025, Shebin El Kom Teaching Hospital carried out an institutional cross-sectional study. Results: Women's BSE knowledge and practice were out of proportion, according to this survey. Ongoing community-based education programs are necessary to ensure that all women understand and apply BSE, which assists in raising awareness of any abnormal changes in the breasts and promotes early medical action.
Background Type 1 diabetes mellitus (T1DM) is a chronic endocrine disorder of autoimmune origin with a predisposition to the development of further autoimmune diseases, including autoimmune adrenal insufficiency (Addison’s disease). Although uncommon and frequently underdiagnosed, it can coexist with T1DM, causing life-threatening complications if undiagnosed. Aim To assess the frequency of autoimmune adrenal insufficiency in children with T1DM and its association with other autoimmune diseases. Methods A cross-sectional study was conducted on 110 children with type 1 diabetes mellitus (T1DM) and 100 age- and sex-matched healthy controls. All participants underwent a full clinical evaluation and laboratory testing, including serum cortisol, adrenocorticotropic hormone, sodium, potassium, glucose, HbA1C, blood gases, and anti-21-hydroxylase antibodies. Thyroid and celiac screening was obtained from the regular follow-up records. Results Anti-21-hydroxylase antibodies were detected in 3.56% of the T1DM group and in none of the controls (p < 0.05). All antibody-positive patients had a diabetes duration exceeding five years and concomitant autoimmune thyroid or celiac disease. These children exhibited higher ACTH levels and lower basal cortisol compared with antibody-negative peers. Mean sodium was lower and potassium relatively higher among diabetic children, though within normal limits. Two cases of overt Addison’s disease were identified. Conclusion Subclinical autoimmune adrenal involvement occurs in a small but notable proportion of pediatric T1DM patients, particularly those with long disease duration and additional autoimmune conditions. Early detection enables timely prevention of adrenal crisis. Longitudinal multicenter studies are recommended for evaluating the disease progression from subclinical to overt clinical Autoimmune adrenal insufficiency.
Background Severe community-acquired pneumonia (SCAP) remains a critical public health issue and a leading cause of childhood mortality and morbidity, especially in developing countries. Identifying predictors of death in children with SCAP and early recognition of high-risk patients could significantly improve survival rates. Objective This study aims to identify possible predictors of mortality in pediatric SCAP, facilitating the early recognition of high-risk children. Patients and Methods This retrospective observational study included 120 children under the age of five who were admitted with SCAP, based on World Health Organization (WHO) guidelines. Demographic data, clinical characteristics, laboratory findings, and hospital outcomes were collected and analyzed to identify risk factors for mortality. Results Of the enrolled SCAP patients, the mortality rate was found to be 9.2%. Risk factors, including underweight status (P=0.044), altered consciousness level at admission (P=0.038), requirement for mechanical ventilation (P=0.016), and development of complications during hospitalization (P=0.034), were identified to be significant predictors for death among under-five children hospitalized with SCAP. Conclusion Under-five children with SCAP had low survival, particularly those who were underweight, had altered consciousness level upon admission, had complications, or required mechanical ventilation during hospitalization. Therefore, under-five children with SCAP require special attention, particularly those with identified predictors for death.
For both the initial evaluation and follow-up in suspected COVID-19 cases, chest CT is strongly recommended. Additionally, the disease and its severity might be suspected using basic laboratory investigations. Better clinical results and appropriate management may result from all of this. Aim to evaluate the relation between the clinical outcome of COVID-19 patients, laboratory data, and the severity of CT chest findings. Methods 90 individuals who were referred to the radiodiagnosis department from the National Hepatology and Tropical Medicine Research Institute's Internal Medicine Department after PCR confirmed that they had COVID-19 were included in this retrospective study. Each patient was subjected to complete history taking, routine laboratory investigations including PCR, CT chest without contrast is done at day 0, day 10 and day 21, correlated the CT findings with their laboratory and clinical data. Results The mean age of the studied group was 48.94 ± 14.36 years, regarding gender 58.9% of the studied group were females. The studied group had patchy shape in CT scan, 100% of the had GGO, 70% had smooth IL septal thickening, 56.7% had lymph nodes, 45.6% had consolidation, 25.6% of the studied group had nodules, 6.7% of them had pleural effusion and only 4.4% of them had cavitation. The study showed a correlation between the clinical outcomes, laboratory investigations of COVID-19 patients and CT chest results. Conclusion When estimating the outcome of SARS-CoV-2 patients, a CT chest scan can be useful in assessing the degree and severity of the disease. These results are correlated with laboratory results.
Uncorrected refraction is the major cause of visual morbidity among children and can result in the development of strabismus. Although several studies have investigated the risk factors for intermittent exotropia, uncorrected astigmatism, which is critical for prevention and treatment, has not been well estimated. Objectives: To evaluate the association between uncorrected astigmatism and intermittent exotropia in children. Methods: This retrospective, analytical, cross-sectional, population-based study included 90 children with intermittent exotropia X(T) who were followed up for two years; the children were aged from 6 to 12 years old. Patients were retrospectively reviewed to determine the prevalence of astigmatism and amblyopia accompanied by X(T). Data were recorded, including visual acuity measurements, manifest refraction, eye examinations, and strabismus examination. Results: There was a significant correlation between uncorrected myopic astigmatism and intermittent exotropia; however, no correlation was found between the angle of deviation in intermittent exotropia and cylindrical diopters. There was a progressive reduction in the angle of deviation for intermittent exotropia after correction for myopic astigmatism. A significant correlation exists between uncorrected myopia and intermittent exotropia; however, there is no correlation between the angle of deviation in X(T) and the diopteric power of myopia. Conclusion: Intermittent exotropia and uncorrected myopic astigmatism are strongly correlated. The younger the patient with X(T) who has corrected refractive error, the better the fusional control and reduction in the angle of deviation of intermittent exotropia.
It was discovered that cryotherapy was just as effective as the loop electrosurgical excision process (LEEP) for removing the cervical intraepithelial neoplasia (CIN2+) lesion. In the majority of high-income nations, LEEP is now the accepted course of therapy. This study's objective was to examine the two methods for treating cervical premalignant lesions: cryotherapy versus loop electrosurgical excision as regard safety, efficacy and cost of the two approaches and assess their application. 90 female patients with cervical premalignant lesions, ages 30 to 55, participated in this prospective comparative randomized controlled research. Two equal groups of patients were created: group I received cryotherapy, while group II received loop excision. While operation duration, cost, postoperative discomfort, spotting, and recovery time were considerably decreased in group I than group II (P
Background Fecal incontinence (FI) in children is a challenging condition with significant impacts on quality of life (QoL). Multiple therapeutic approaches, including neuromodulation techniques such as sacral nerve stimulation (SNS), biofeedback therapy, botulinum toxin (Botox) injections, and transcutaneous functional electrical stimulation (TFES), have been explored. This systematic review evaluates the efficacy and safety of these interventions in pediatric patients. Methods A thorough investigation was performed in PubMed, Scopus, Web of Science, and the Cochrane Library databases up to February 2025. Studies assessing the effectiveness and safety of SNS, biofeedback, Botox injections, and other interventions in pediatric FI were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs). Results A total of 12 studies were included, comprising RCTs and observational cohort studies. Biofeedback therapy demonstrated consistent improvements in incontinence scores, anorectal pressures, and QoL. SNS was effective in refractory cases but was linked to an increased incidence of complications. Botox injections showed promising short-term benefits, particularly in Hirschsprung’s disease, while TFES exhibited potential as a noninvasive alternative. Comparisons between interventions highlighted the need for individualized treatment selection based on patient characteristics and response to initial therapy. Conclusion Neuromodulation techniques and adjunctive therapies provide effective management options for pediatric FI. Biofeedback and TFES serve as viable first-line therapies, while SNS and Botox injections are effective in refractory cases. Further high-quality, long-term studies are needed to refine treatment algorithms and optimize patient outcomes.
Background Rickets is a deficiency in the mineralization of developing bone. Infant temperament comprises a collection of qualities that define individual behavior. The objective of this work was to determine if there were variations in temperamental qualities between ricketic and normal babies and toddlers, and whether such differences varied by sex. Methods This cross-sectional work had been conducted on 100 children aged from 6 to 24 months both sexes, with rickets (Group 1), and 100 normal sex- and age-matched children as a control group (Group 2). All patients underwent evaluation of temperamental traits. The assessment of psychological aspects for both groups was conducted in a single session via a 30-minute interview with parents. Results Soothability, vocal reactivity, surgency/extraversion and orienting/regulation of infant behavior questionnaire (IBQ)-revised scores were substantially greater in ricketic girls than ricketic boys (P
Background: The concurrent repair of functional tricuspid regurgitation (TR) is typically recommended during left-sided heart valve surgery. Several surgical techniques are available, each targeting long-term effectiveness and clinical success. Objective: This study sought to assess the mid-term outcomes of two widely used tricuspid valve repair (TVr) methods: flexible band annuloplasty (FA) and rigid ring annuloplasty (RA). Methods: This retrospective study involved 85 patients who underwent TVr along with left-sided valve surgery. Of these, 53 patients were assigned to the FA group (Group A), and 32 patients to the RA group (Group B). Transthoracic echocardiography was performed at hospital discharge and after a follow-up period of 3.5 ± 0.5 years. Results: The two groups were similar in terms of age, sex, comorbidities, and New York Heart Association functional classification. In Group A, 40 patients received mitral valve replacement (MVR), while 23 patients in Group B underwent the same procedure. Combined mitral and aortic valve replacement (MVR + AVR) was performed in 8 patients in Group A and 6 patients in Group B, while mitral valve repair (MVr) was done in 5 and 3 patients in Groups A and B, respectively. At discharge, moderate residual TR (grade 2) was observed in 11.3% of Group A and 9.4% of Group B. During the mid-term follow-up, TR recurrence (≥ grade 2) was noted in 24.2% of the FA group and 18.6% of the RA group. Univariable analysis indicated that female sex was a predictor of recurrence. Both univariable and multivariable analyses identified residual TR at discharge and the severity of pulmonary hypertension as significant predictors of mid-term recurrence. Conclusion: Both FA and RA annuloplasty are safe and effective techniques for the surgical management of functional TR, demonstrating similar mid-term clinical outcomes and durability.
