This study evaluated the efficacy of the commercial phytogenic product (Herb-All COOL) in alleviating heat stress and improving performance and health in dairy cows in Italy, Egypt, and Mexico. Heat stress was quantified using the temperature-humidity index (THI). In all three countries, cows supplemented with Herb-All COOL showed higher milk yield compared with non-supplemented controls under similar THI conditions. In Italy, Herb-All COOL the daily milk yields was increased up to 4.8 kg/cow/day during the hot summer associated with the reduction in somatic cell count (SCC) across lactation. Similarly, the average milk yield increased by 3.1 kg/cow/day with Herb-All COOL supplementation in Egyptian dairy cows. In Mexico, although the volume of milk production was reduced, however, the decline in milk yield during periods of heat stress was less obvious in the supplemented group. Beside the milk production, various fertility parameters could also be improved, such as higher first-service conception rate, higher overall conception rate, shorter days to confirmed pregnancy, improved estrus expression, and conception rate. Post-parturient need for medication per cow was also reduced, resulting in a marked decrease in the number of culled cows in the Herb-All COOL groups at the end of the season. These findings indicate that Herb-All COOL can mitigate negative effects of heat stress on productivity, fertility, and health in high-producing dairy cows across different climatic zones.

Background:Restoration of active motion in children with upper-limb paralysis or muscle loss remains challenging. Free functional muscle transfer (FFMT) is a reconstructive option when local muscle donors are unavailable, but uncertainties persist regarding optimal timing, donor nerve selection, and long-term effects of growth and secondary deformities. This study reports a single-institution experience addressing these issues. Methods:A retrospective review was conducted of 35 children (<18 years) who underwent upper-limb FFMT with a minimum follow-up of 24 months. All reconstructions used the gracilis muscle to restore finger flexion, elbow flexion, elbow extension, or combined functions. Donor nerves included the anterior interosseous nerve (AIN) with or without median nerve fascicles, intercostal nerves, spinal accessory nerve, and phrenic nerve. Outcomes included time to muscle activation, range of motion, Medical Research Council (MRC) strength, secondary procedures, complications, bimanual use, and patient or caregiver-reported satisfaction. Pre- and postoperative outcomes were compared using paired and groupwise statistical tests. Results:Mean age at surgery was 7.6 years, with a mean follow-up of 68 months (range, 24-166 months). Flap survival was 100%. Initial muscle activation occurred at a mean of 4.1 months. Significant improvements in motion and strength were observed across all functions (p < 0.001). MRC grade ≥4 strength was achieved in 80.0% of elbow-flexion reconstructions and 78.3% of finger-flexion reconstructions. Finger-flexion reconstructions demonstrated higher bimanual use and more consistent recovery than elbow-flexion reconstructions. In construct-level analysis, single-function transfers showed clearly superior finger-flexion outcomes, whereas elbow-flexion results differed by endpoint: single-function transfers achieved greater ROM, while all dual-function elbow-flexion transfers reached MRC grade ≥4 in this small subgroup. Secondary procedures were required in 51.4% of patients. Overall satisfaction was reported by 71.4% and correlated more strongly with final strength and completion of reconstruction than with range of motion. Conclusions:Gracilis FFMT provides durable restoration of active motion and strength in children. Outcomes are influenced by indication and reconstructed function rather than donor nerve selection alone. Strength recovery and functional integration are primary determinants of bimanual use and satisfaction. Findings support the use of FFMT as part of a staged reconstructive strategy in pediatric patients.

BACKGROUND:Reconstructive options for high radial nerve injuries include tendon transfer (TT) and nerve transfer (NT), each with distinct advantages and limitations. This prospective, randomized clinical trial compared the outcomes of TT and NT in 21 patients with isolated radial nerve injuries. METHODS:Patients were randomly assigned to the NT group (11 patients) or the TT group (10 patients). Nerve transfer involved transferring the distal anterior interosseous nerve to the extensor carpi radialis brevis motor branch and the flexor carpi radialis motor branch to the posterior interosseous nerve. Tendon transfer used the Boyes tendon transfer technique. RESULTS:At an average follow-up of 20 months for NT and 15 months for TT, NT resulted in significantly better wrist flexion (51° vs 27°), wrist extension (54° vs 34°), metacarpophalangeal hyperextension (15° vs 8°), and thumb radial abduction (44° vs 37°). Nerve transfer also resulted in significantly higher muscle power grades for finger and thumb extension, with higher proportions of patients achieving grades M4+ and M5. Both groups showed significant improvements in Disabilities of the Arm, Shoulder, and Hand scores and grip strength, but with no significant differences between both groups. Tendon transfer offered faster functional recovery (4.30 ± 1.49 months) compared with NT (5.72 ± 1.34 months). CONCLUSIONS:Nerve transfer provided better long-term muscle strength and range of motion, while TT allowed quicker rehabilitation. The choice between NT and TT should consider individual patient factors, balancing early functional recovery with long-term outcomes. Further studies with larger cohorts are recommended to validate these results and refine treatment guidelines.

Abstract Background: Inflammatory polyps in patients with Inflammatory Bowel Disease (IBD) pose a significant risk for colorectal cancer (CRC). Dietary interventions targeting anti-tumor immunity are crucial in mitigating this risk. Aim: We investigated saffron's anti-inflammatory effects in IBD patients due to the high prevalence of polyps, aiming to prevent CRC. Methods: The study retrospectively evaluated 485 colitis patients (70 IBD, 415 NIC) from Howard University Hospital, through colonoscopy, pathology, and clinical reports evaluations. At Howard University, three UC patients received 50mg of saffron twice daily for 8 weeks, with two cycles. Inflammatory markers, stool calprotectin, and cytokines were assessed. Similar saffron trials were conducted at Yazd University (30 UC patients) and Egypt University (11 UC patients). Results: Patients with inflammatory bowel disease (IBD) were found to have a 15.7% prevalence of polyps compared to 8.2% in Non-inflammatory colitis patients. Among IBD patients, those with ulcerative colitis had more polyps (27%) than those with Crohn's disease (5%). In a multisite clinical trial, Saffron treatment improved various health indicators, including Partial MayoScore and quality of life. In the study (HU site), pro-inflammatory cytokines decreased, anti-inflammatory markers increased, and fecal calprotectin levels dropped significantly after saffron treatment. Saffron also led to changes in gut bacteria composition. Importantly, no adverse events were reported in the study participants. In one group of patients (Yazd study), saffron treatment led to significant improvements in depression scores, disease severity, and inflammation markers. In another site (Egypt study), 50% of saffron-treated patients showed improvement in markers related to disease severity, inflammation, and quality of life. Conclusion: Saffron supplementation, alongside standard treatments, shows promise in reducing local and systemic inflammation in IBD patients and may reduce the risk of developing inflammatory polyps and hence CRC. This safe and feasible intervention warrants further exploration as an inflammation-driven CRC preventive strategy. Citation Format: Hassan Ashktorab, Roham Salmanroghani, Hassan Salmanroghani, Reza Oskrochi, Mudasir Rashid, Adeyinka Laiyemo, Suryanarayana Reddy Challa, Philip Oppong-Twene, Nasrin Farjana, Angesom Kibreab, Holden Maeker, Amr Amin, Amal Ahmed Mohamed, Amr Elsayed, Zaki Mohamed Zaki, Omima Mohamed, Alshymaa Hassnine, Salma Saed, Soha Hassanin, Farshad Aduli, Lakshmi Gayathri Chirumamilla, Hassan Brim. Interventional dietary saffron drives antitumor immunity inInterventional dietary saffron drives antitumor immunity in high risk colorectal cancer IBD Patients, A Multisite Clinical Trial Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7462.

Abstract Background Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation. Materials and methods This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results. Results The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%). Conclusion Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction.

Aim of the study: Liver fibrosis affects progression of fatty liver. Epidemiological data about fibrosis in overweight/obese Egyptian patients undergoing bariatric surgery are limited. We aimed to assess hepatic steatosis and fibrosis in patients with metabolic associated fatty liver disease (MAFLD) before bariatric surgery via noninvasive tools and liver biopsy. Material and methods: A cross-sectional study of overweight/obese MAFLD patients undergoing bariatric surgery in the Hepatogastroenterology Hospital was performed. For all recruited cases, the history was taken and clinical examination, laboratory testing, intra-operative laparoscopic liver biopsies and histopathological evaluation were conducted. Fibrosis-4 (FIB-4), NAFLD Fibrosis Score (NFS), and AST to platelet ratio (APRI) were calculated. Results: The final number of patients with significant fibrosis was 85; of these, 24/85 (28.2%) met the MAFLD criteria (F2), 11/85 (12.9%) had advanced fibrosis (F3-F4), and 50/85 (58.8%) had no significant fibrosis (F0-F1). Fibrosis was significantly higher in the elderly, smokers, and those with diabetes, hypertension, or chronic hepatitis C virus (HCV) infection. Degree of fibrosis was positively correlated with body mass index (BMI), waistserum uric acid, fasting blood sugar (FBS), and HbA1c levels, and negatively with platelet level. Regression analysis indicated that smoking, elevated BMI, presence of diabetes and hypertension, decreased platelet level and elevated serum uric acid are predictors of significant fibrosis. Non-invasive models, such as FIB-4, NFS, and APRI provided greater accuracy for predicting significant fibrosis. Conclusions: Significant fibrosis (F >= 2) was detected in > 1/3 of patients with MAFLD undergoing bariatric surgery. Presence of smoking, diabetes, hypertension, high WHR, elevated serum uric acid, advanced age, and low platelet level are risk factors for significant fibrosis (F >= 2). Noninvasive models, FIB-4, NFS, and APRI can be used to identify significant liver fibrosis in bariatric surgery patients.

COVID-19 is one of the deadliest epidemics. This pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the role of dogs in spreading the disease in human society is poorly understood. This review sheds light on the limited susceptibility of dogs to COVID-19 infections which is likely attributed to the relatively low levels of angiotensin-converting enzyme 2 (ACE2) in the respiratory tract and the phylogenetic distance of ACE2 in dogs from the human ACE2 receptor. The low levels of ACE2 affect the binding affinity between spike and ACE2 proteins resulting in it being uncommon for dogs to spread the disease. To demonstrate the role of dogs in spreading COVID-19, we reviewed the epidemiological studies and prevalence of SARS-CoV-2 in dogs. Additionally, we discussed the use of detection dogs as a rapid and reliable method for effectively discriminating between SARS-CoV-2 infected and non-infected individuals using different types of samples (secretions, saliva, and sweat). We considered the available information on COVID-19 in the human–dog interfaces involving the possibility of transmission of COVID-19 to dogs by infected individuals and vice versa, the human–dog behavior changes, and the importance of preventive measures because the risk of transmission by domestic dogs remains a concern.

Introduction and importance: Pelvis reconstruction after tumor resection poses a challenge, especially in younger patients where preserving the patient's function and mobility is paramount. Case presentation: A 16 years old female presented in March 2019 with vague right iliac area pain, diagnosed as pelvic Ewing's sarcoma after imaging studies (MRI and MSCT scan) and obtaining an incisional biopsy. After initial chemotherapy cycles, the tumor decreased in size, and surgical intervention in two stages was performed. The first stage was in October 2019 and consisted of pelvic resection type I and II according to Enneking and Dunham classification, proximal femur upshifting to compensate for the pelvic bone defect, and a cement spacer to fill the space of the resected proximal femur. The second stage was performed after two months and consisted of implanting a total hip arthroplasty using Megaprostheses and a cementless dual mobility acetabular cup. No local recurrence or distant metastases were detected during follow-ups. At the final follow up after 36 months, the patient showed acceptable functional outcomes (HHS score 83, and MSTS score 23 (76.7 %) points), and the radiographs showed proper implant positioning and stability. Clinical discussion: Treating pelvic Ewing's sarcoma requires a multidisciplinary team. After surgical resection, the pelvic reconstruction options include using allografts or autografts, femur upshifting, and hemipelvis prostheses, which should be chosen considering patients and tumor characteristics as well as surgical team efficiency. Conclusion: Reconstructing the pelvic defect after bone tumor resection by proximal femoral upshifting is a valid biological option with acceptable outcomes.

Introduction: Metabolic associated fatty liver disease (MAFLD) is now a leading cause of chronic liver disease worldwide. The global prevalence of MAFLD among the obese individuals is 6.3–33 %, increasing up to 75.8 % and even surpassing 96 %. Diagnosis of MAFLD depends on the presence of steatosis detected by liver biopsy or ultrasound. Aim of the study: Our aim was to assess the prevalence of hepatic steatosis in obese patients before bariatric surgery in our locality. Materials& Methods: This is a cross sectional study conducted in endemic medicine department Minia university hospital in the period from May to December 2022.It included 49 patients (≥18 years) with BMI ≥ 25 undergoing bariatric surgery , where clinical examination, anthropometric measurements, biochemical tests, ultrasonography and liver biopsy were taken at the same day of operation. Results: The study included 8 males and 41 females, with the mean age of 38 years and a range from 18 to 59 years. the prevalence of steatosis by liver biopsy were 27 case (55.11%) while by ultrasonography was 100 % Conclusion: hepatic steatosis is a common finding in obese patients undergoing bariatric surgery and can be detected by abdominal ultrasonography and liver biopsy.

Purpose The role of primary surgery in delayed presenting cases of brachial plexus birth injury is still debated. The purpose of this study was to evaluate the results of brachial plexus reconstruction performed at the age of >12 months.Methods Twenty-nine cases were included. Five cases had upper (C5-6) palsy, 4 had upper/ middle (C5-7), and 20 had total (C5-8 and T1) palsy.Results The age at the time of primary surgery was an average of 15.6 months. The brachial plexus was formally explored and neurolysis, grafting, and neurotization were used in different combinations. Exploration revealed that 27% of the roots were avulsed and 32% were ruptured. The follow-up was an average of 7.9 years. Generally, the best functional recovery was elbow flexion followed by shoulder external rotation. Satisfactory shoulder abduction (>6 on the Toronto Active Movement Scale [TAMS]) was achieved in 31% of cases. The abduction range was an average of 79 & DEG; & PLUSMN; 35 & DEG;; 50 & DEG; in upper palsy, 103 & DEG; in upper/ middle palsy, and 82 & DEG; in total palsy. Shoulder external rotation >6 on the TAMS was ach-ieved in 62% of cases. External rotation range was an average of 58 & DEG; & PLUSMN; 29 & DEG;; 78 & DEG; in upper palsy, 68 & DEG; in upper/middle palsy, and 52 & DEG; in total palsy. Elbow flexion and extension of >6 on the TAMS were achieved in 69% and 58% of cases, respectively. Wrist flexion and finger flexion of >6 on the TAMS were achieved in 35% and 12.5%, whereas wrist and finger extension of >6 on the TAMS were achieved in 25% and 4% of cases, respectively.Conclusion In the delayed presentation of brachial plexus birth injury, brachial plexus recon-struction results in good functional recovery of elbow flexion and shoulder external rotation but modest functional recovery of finger flexion and wrist extension. The rate of functional recovery of the elbow flexion was similar following nerve grafting and transfer. Nerve transfer for shoulder external rotation should be considered even in infants with available roots for grafting. (J Hand Surg Am. 2023;48(2):126-133. Copyright & COPY; 2023 by the American Society for Surgery of the Hand. All rights reserved.)Type of study/level of evidence Therapeutic IV.

In the post-genomic era, the data provided by complete genome sequencing could not answer several fundamental questions about the causes of many noninfectious diseases, diagnostic biomarkers, and novel therapeutic approaches. The rapidly expanding understanding of epigenetic mechanisms, as well as widespread acceptance of their hypothesized role in disease induction, facilitated the development of a number of novel diagnostic markers and therapeutic concepts. Epigenetic aberrations are reversible in nature, which enables the treatment of serious incurable diseases. Therefore, the interest in epigenetic modulatory effects has increased over the last decade, so about 60,000 publications discussing the expression of epigenetics could be detected in the PubMed database. Out of these, 58,442 were published alone in the last 10 years, including 17,672 reviews (69 historical articles), 314 clinical trials, 202 case reports, 197 meta-analyses, 156 letters to the editor, 108 randomized controlled trials, 87 observation studies, 40 book chapters, 22 published lectures, and 2 clinical trial protocols. The remaining publications are either miscellaneous or a mixture of the previously mentioned items. According to the species and gender, the publications included 44,589 human studies (17,106 females, 14,509 males, and the gender is not mentioned in the remaining papers) and 30,253 animal studies. In the present work, the role of epigenetic modulations in health and disease and the influencing factors in epigenetics are discussed.

explain the potential risk factors that may affect patients suffering from nasal polyps with allergic fungal sinusitis (AFS)local anatomical variants or general illnesses.

Although the currently available pharmacological assays can cure most pathological disorders, they have limited therapeutic value in relieving certain disorders like myocardial infarct, peripheral vascular disease, amputated limbs, or organ failure (e.g. renal failure). Pilot studies to overcome such problems using regenerative medicine (RM) delivered promising data. Comprehensive investigations of RM in zebrafish or reptilians are necessary for better understanding. However, the precise mechanisms remain poorly understood despite the tremendous amount of data obtained using the zebrafish model investigating the exact mechanisms behind their regenerative capability. Indeed, understanding such mechanisms and their application to humans can save millions of lives from dying due to potentially life-threatening events. Recent studies have launched a revolution in replacing damaged human organs via different approaches in the last few decades. The newly established branch of medicine (known as Regenerative Medicine aims to enhance natural repair mechanisms. This can be done through the application of several advanced broad-spectrum technologies such as organ transplantation, tissue engineering, and application of Scaffolds technology (support vascularization using an extracellular matrix), stem cell therapy, miRNA treatment, development of 3D mini-organs (organoids), and the construction of artificial tissues using nanomedicine and 3D bio-printers. Moreover, in the next few decades, revolutionary approaches in regenerative medicine will be applied based on artificial intelligence and wireless data exchange, soft intelligence biomaterials, nanorobotics, and even living robotics capable of self-repair. The present work presents a comprehensive overview that summarizes the new and future advances in the field of RM.

Sesamol is a lignan of sesame seeds and a natural phenolic molecule that has emerged as a useful medical agent. Sesamol is a non-toxic phytoconstituent, which exerts certain valuable effects in the management of cancer, diabetes, cardiovascular diseases, neurodegenerative diseases (NDs), etc. Sesamol is known to depict its neuroprotective role by various mechanisms, such as metabolic regulators, action on oxidative stress, neuroinflammation, etc. However, its poor oral bioavailability, rapid excretion (as conjugates), and susceptibility to gastric irritation/toxicity (particularly in rats' forestomach) may restrict its effectiveness. To overcome the associated limitations, novel drug delivery system-based formulations of sesamol are emerging and being researched extensively. These can conjugate with sesamol and enhance the bioavailability and solubility of free sesamol, along with delivery at the target site. In this review, we have summarized various research works highlighting the role of sesamol on various NDs, including Alzheimer's disease, Huntington's disease, Amyotrophic lateral sclerosis, and Parkinson's disease. Moreover, the formulation strategies and neuroprotective role of sesamol-based nano-formulations have also been discussed.

Background and study aims:A novel severe acute respiratory syndrome corona virus (SARS COV2) outbreak resulting in corona virus disease (COVID-19) which is known as a pandemic infectious disease.Chronic hepatitis C virus (HCV) is a well-known major cause of chronic liver disease and its subsequent major complications.Telemedicine refers to the remote practice of medical care for patients when the provider and patient are not physically present with each other.We aim to assess use of telemedicine in the follow up of chronic HCV patients during treatment by direct antiviral therapy in this era of COVID-19. Patients and Methods:this study included cross matched 300 patients consulted for HCV treatment.150 patients were treated in 2019 and followed by routine classic visits (routine classical group).Another 150 patients were treated in 2020 and followed up via virtual visits by telemedicine (telemedicine group).Results: There is no significant statistical difference between the two groups regarding the sustained virological response (SVR) and the recorded side effects during treatment (P= 0.275, P= 0.523) respectively. Conclusion:Use of telemedicine in the follow up of chronic HCV patients during treatment is as effective as the classic way and safer especially in the era of pandemic COVID19.

Background: Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel habit. Recent studies have shown that vitamin D can influence numerous pathways involved in the development of IBS. The actual pathophysiologic processes involving IBS patients are still unknown. The aim of this study is to assess vitamin D level in patients with irritable bowel syndrome and estimate whether there is correlation between serum level of vitamin D and IBS. Methods: total of 113 people was studied, 45 subjects who diagnosed as irritable bowel syndrome according to ROME IV criteria, 23 met the exclusion criteria and 45 healthy subjects as a control group. Blood sample was taken to measure vitamin D in serum (25-hydroxyvitamin D) Results : vitamin D deficiency was found to be higher in the IBS group (76.6%) compared to control group (46.7%). When different subtypes were analyzed IBS-C subtype (62.2%) was more common than IBS-D subtype (20%) and IBS-M subtype (17.8%). Conclusion: Vitamin D, which plays a role in inflammatory processes, may also be of relevance in the pathophysiology of IBS. Vitamin D plays a crucial role in intestinal health by strengthening the mucosal barrier, regulating immune responses, and acting as an antimicrobial itself. In this study we found that vitamin D deficiency was found to be higher in the IBS group, so there is relation between vitamin d deficiency and irritable bowel syndrome.

Since thousands of years, herbal products were used for medical purposes in old cultures. The present trend to re-discover the medical potential of herbs started to grow with the general awareness of the medical hazards of several chemical pharmaceutical preparations. Similarly, for several decades, antibiotics, Coccidiostat and other chemical feed additives were massively used in animal husbandry. However, due to their negative impact on consumer health, they were banned in many countries. The present work discusses some natural alternative available for use in human and veterinary medical fields. The number of commercially available herbal products increases rapidly in the markets worldwide and are expected to overtake the number of pharmaceuticals of chemical origin in food sector in the future. ـــــــــــــــــــــــــــــــــــــــــ

INTRODUCTION In brachial plexus injuries, useful recovery of arm function has been documented in most patients after phrenic nerve transfer after variable follow-up durations, but there is not much information about long-term functional outcomes. In addition, there is still some concern that respiratory complications might become manifest with aging. The aim of this study was to report the outcome of phrenic nerve transfer after a minimum follow-up of 5 years. PATIENTS AND METHODS Twenty-six patients were reviewed and evaluated clinically. Age at surgery averaged 25.2 years and follow-up averaged 9.15 years. RESULTS Shoulder abduction and external rotation achieved by transfer of phrenic to axillary nerve (or posterior division of upper trunk), combined with spinal accessory to suprascapular nerve transfer, were better than that achieved by transfer of phrenic to suprascapular nerve, combined with grafting the posterior division of upper trunk from C5, 52.3 and 45.5 degrees versus 47.5 and 39.4 degrees, respectively. There was no difference in abduction when the phrenic nerve was transferred directly to the posterior division of upper trunk or to the axillary nerve using nerve graft. Elbow flexion (≥M3 MRC) was achieved in 5 (83.3%) of 6 cases. Elbow extension M4 MRC or greater was achieved in 4 (66.6%) of 6 cases. All patients, including those who exceeded the age of 45 years and those who had concomitant intercostal nerve transfer, continued to have no respiratory symptoms. CONCLUSIONS The long-term follow-up confirms the safety and effectiveness and of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries.

Coronavirus disease 2019 (COVID-19) has become a challenging public health catastrophe worldwide. The newly emerged disease spread in almost all countries and infected 100 million persons worldwide. The infection is not limited to the respiratory system but involves various body systems and may lead to multiple organ failure. Tissue degenerative changes result from direct viral invasion, indirect consequences, or through an uncontrolled immune response. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads to the brain via hematogenous and neural routes accompanied with dysfunction of the blood–brain barrier. The involvement of the central nervous system is now suspected to be among the main causes of death. The present review discusses the historical background of coronaviruses, their role in previous and ongoing pandemics, the way they escape the immune system, why they are able to spread despite all undertaken measures, in addition to the neurological manifestations, long-term consequences of the disease, and various routes of viral introduction to the CNS.

Abstract Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.