BACKGROUND AND AIM OF THE STUDY: Despite advances in mitral valve repair techniques, including robotic surgeries, few studies are available on predicting mitral annuloplasty ring size using echocardiography. Furthermore, these studies either had limited accuracy or else required the use of three-dimensional transesophageal echocardiography (3D-TEE), an expensive and semi-invasive tool. The study aim was to predict the mitral annuloplasty ring size preoperatively using real-time, three-dimensional transthoracic echocardiography (RT3D-TTE), which is a cheaper, non-invasive technique.

METHODS: This prospective study included 47 consecutive patients scheduled for elective mitral valve surgery. All participants underwent preoperative RT3D-TTE. The mitral annular transverse diameter during early systole and the maximum height of the A2 scallop were measured in the multiplanar reconstruction mode. The surgeon, who was blinded to the echocardiographic measurements, also measured these two variables intraoperatively. A Pearson correlation coefficient was used to assess the association between the echocardiographic and operative measurements. A linear regression analysis was used to predict the annuloplasty ring size.

RESULTS: A total of 34 patients (72.3%) underwent mitral valve repair. The echocardiographic measurements of the mitral annular transverse diameter were well correlated with the operative measurements (r = 0.64, p < 0.001). A moderate correlation was observed between the echocardiographic and operative measurements of A2 height (r = 0.59, p < 0.001). Linear regression analysis yielded an equation that predicted the annuloplasty ring size (R = 0.828, p < 0.001).

CONCLUSION: RT3D-TTE was used successfully to predict the mitral annuloplasty ring size. This technique may potentially aid surgical planning, particularly before robotic procedures are performed.

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BACKGROUND: Patients in pediatric intensive care units (PICUs) are susceptible to infections with gram-negative bacteria (GNB).

METHODS: A prospective observational study was conducted in 2 PICUs at Cairo University Hospitals to determine the incidence and outcome of GNB infections over 1 year. Variables of interest included age, gender, isolated organism, susceptibility to antibiotics, and final outcome.

RESULTS: During the study period, 1420 patients were admitted to the PICU; of these, 291 developed GNB infections. The median age of the studied GNB patients was 50 months (interquartile range [IQR], 22-80 months). The mortality rate was 37.1%. Organisms were isolated from blood in the majority (86.6%) of patients, with Klebsiella (36.0%) being the most frequently isolated organism. Among patients with GNB infection, 235 patients, one had a multidrug-resistant (MDR) infection. The length of hospital stay was statistically significantly longer in the MDR group (25 days; IQR, 20-30) than in the non-MDR group (15 days; IQR, 10-20) (P < .01). Mortality was similar in both groups (37.4% vs 35.7% in the MDR and non-MDR groups, respectively; P = .88).

CONCLUSION: This study highlights high rates of pediatric MDR-GNB infections and emphasizes the need for a continuous surveillance system in the management of these critically ill children.

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BACKGROUND Conducting high throughput -omics research requires high quality, data-rich biospecimens to unravel factors underlying childhood cancers; this is an extra burden in a limited resources country. For this purpose, Children's Cancer Hospital (CCHE), the largest pediatric cancer hospital worldwide, established a cutting-edge Biorepository and Biospecimen Research Facility (CCHE-BBR). OBJECTIVE To present a step-by-step guide to establishing a hospital-based biorepository with limited resources, and working in collaboration with different hospital facilities to supply the research community with high quality data-rich biospecimens fit for a wide range of research purposes. This approach will foster research in the era of personalized precision medicine. METHODS CCHE-IRB approved the collection and storage of biospecimens from patients and parents for future research. We focused on staff training, recruiting qualified scientists, and establishing the infrastructure. The CCHE Biorepository developed strict standardized procedures for sample acquisition, processing, annotation, storage, and distribution based on ISBER Best Practices and CAP-accreditation guidelines. We collect samples at different clinical time points (e.g., at remission and/or relapse) as well as parents' samples for genetic studies. Using CaTissue®, an electronic storage management system, allowed sample annotation and full integration with clinical data and the cancer registry. RESULTS In 2 years, we succeeded in establishing a well-designed biorepository within our regulations, bylaws, and SOPs, and with a minimal budget. We store high quality blood derivatives, CSF, and malignant/normal tissue samples. CONCLUSION Building a high quality biorepository with minimal-resources to encourage research is possible. Having the suitable infrastructure with a significant number of clinically annotated samples can play a major role in international research projects, sharing samples and/or data with other groups.

Background Micro-ribonucleic acids (miRNA) are key regulators for the expression of related target genes and their aberrant expression has a substantial role across many pathways within autoimmunity. Aim of the work To evaluate the expression of miRNA-146a-5p in systemic lupus erythematosus (SLE) patients and to assess its relation to the disease activity and various disease parameters with specific focus on the ocular manifestations. Patients and methods 42 female SLE patients and 39 matched healthy individuals were enrolled in this study. The serum level of miRNA146a-5p was evaluated by a quantitative real-time polymerase chain reaction (PCR) (Taqman technology). Results The mean age of the patients was 29 ± 9.1 years. The serum level of miRNA146a-5p was significantly higher in SLE cases (3.21 ± 4.47 fold change) compared to the controls (1.54 ± 1.66 fold change) (p = 0.001). A significant negative association was found between the serum level of miRNA146a-5p and C4 level (p = 0.018). Expression levels of miRNA146a-5p were significantly decreased in patients with photosensitivity (p = 0.006). Regarding ocular manifestations, a lower level of miRNA146a-5p was detected in patients suffering from dry eyes, cataract, keratitis and drusen compared to patients without and a higher level was found in those suffering from retinopathy. Serum miRNA146a-5p at a cut off value of 1.36 could discriminate patients from controls (95%CI: 0.61–0.84; p = 0.001) at a sensitivity of 69% and specificity of 64.1%. Conclusion These findings suggest that miR-146a-5p could be a potential diagnostic biomarker in SLE and may implicate a functional role in the pathophysiology of the ocular manifestations in the disease.

OBJECTIVE:
Periodontitis is one of the most important chronic inflammatory dental diseases arising from the destructive actions caused by a variety of pathogenic organisms presented in the oral cavity. The aim of this study is the preparation and in vitro evaluation of films for the local treatment of periodontal pockets.
METHODS:
The prepared films contained either metronidazole (Mtr), for its antimicrobial effect in periodontal diseases, using a mixture of polymers namely hydroxypropyl methyl cellulose, Carbopol 934 or locally applied Pentoxifylline (PTX), for its anti-inflammatory activity, using chitosan. All films were prepared using solvent casting technique and were evaluated for their physical characteristics, drug content uniformity, surface pH, swelling behavior, mechanical properties and in vitro release. Further characterization was done on the selected formulations using differential scanning calorimetry and scanning electron microscopy for surface structure. Clinical evaluation tests were also performed.
RESULT:
Appropriate physical characteristics and mechanical properties for most formulations and their suitability for periodontal application were observed. In vitro drug release from most films showed a burst release rate for both Mtr and PTX during the first 2 h after which the release rate was markedly decreased. Clinical trials on patients revealed the advantageous use of Mtr and PTX as an adjunct treatment with traditionally used dental techniques.