Objectives Vascular access (VA) dysfunction, typically associated with progressive stenosis with subsequent failure, is a major problem associated with significant morbidity in hemodialysis (HD) patients and increased health care expenditure. The study aim was to report VA patency outcomes after intervention for flow dysfunction detected by duplex ultrasonography (DUS) surveillance associated with the presence of clinical indicator(s).

Patients and methods This prospective observational study was conducted in a tertiary university hospital (October 2018–October 2020). Patients with end-stage renal disease with newly created VAs underwent routine DUS surveillance every 3 months. Identified cases fulfilling at least one clinical indicator were included and underwent preemptive interventions. Thrombosed VA and asymptomatic lesions were excluded. Surveillance was subsequently performed using clinical, DUS and HD criteria to detect a failing/failed access. Patient follow-up and access-related events were analyzed.

Results The median age of the study group was 51 years, and 59.4% were male. Native VA was the predominant one. The mean access age was 13.9 months. Arm swelling was the major clinical presentation (32.9%). Most lesions were stenotic (86.5%), and juxta-anastomotic (42.9%) was the most common site. Balloon angioplasty +/− venous stent was used in all included patients. Multivariate analysis revealed that decreased access age, occlusive, multiple lesions, and lesion length more than5cm were significant predictors of primary patency loss.

Conclusion This study highlights the role of regular surveillance to stay ahead of the anticipated access dysfunction and to intervene in a timely manner. Integrated and efficient team work between HD providers and the vascular surgeons is crucial.

Keywords: surveillance, vascular access, vascular access dysfunction.

Background:  Obesity has become a prevalent issue worldwide, leading to various complications such as hyperlipidemia, diabetes, and cardiovascular problems. Statins, as FDA approved anti-hyperlipidemic drugs still pose some concerns upon their administration. Recently, researchers have looked for natural products as an alternative to manage hyperlipidemia and obesity. Aim: This work aimed to study the hypolipidemic effect of Lepidium sativum garden cress (GC) from differen preparations; orally administered seeds, and hydrogel, in comparison to atorvastatin. Methods:  GC hydrogel was prepared from the GC aqueous extract and pharmaceutically evaluated for it pH, spreadability, seeds content, homogeneity, rheology, and in vitro release. The rat’s body weight, bloo glucose levels, total lipid profile, and liver biomarkers were evaluated on obese rats for one month. In addition, the histopathology study was also performed. Results: GC hydrogel had acceptable pharmaceutical properties and showed a sustained release performance over 24h. Oral and topical GC significantly reduced the lipid profiles, blood sugar and AT, AST level than the negative control group and comparable to atorvastatin. It was found that oral GC showed significant effect on the percentage decrease in the rat’s body weight than the applied hydrogel. Histopathology study revealed a better outcome in the histological structure of pancreas and liver compared with rats feed on high fat diet post-treatment for one month. Conclusion:  GC orally administered, or topically applied hydrogel could be a promising, safe alternative formulation to atorvastatin in managing hyperlipidemia and normalizing body weight of obese rats

Background: Newly designed COVID-19 vaccines were approved and administrated worldwide. However,
the interaction between parasitic infections and COVID-19 vaccines and their efficacy is still obscure.
Objective: To correlate cytokines (TNF-α and IL-4) levels with COVID-19 vaccine administration in
patients with concomitant parasitic infections. A secondary objective is to assess the impact of parasitic
infections on COVID-19 efficacy.
Subjects and Methods: The study included 128 patients divided into 2 groups according to an answered
questionnaire, and routine laboratory investigations (stool, urine and blood film examination). Both
groups included vaccinated (received full doses of COVID-19 vaccine within 6 months of sample collection),
and non-vaccinated. A third matching group was recruited as control apparently health participants, i.e.,
neither parasitic infected nor received COVID-19 vaccines. Molecular detection of cytokines (TNF-α, and
IL-4) gene expression was performed for all study samples using real-time PCR.
Results: In comparison to the control group, there was up-regulation of TNF-α in patients with parasitic
infection, whether vaccinated or not. According to parasitism, IL-4 showed different gene expression.
In case of helminthic infections, it was up regulated in non-vaccinated patients, and down regulated in
vaccinated patients. Meanwhile, it was down regulated in patients with protozoal infections whether
vaccinated or not.
Conclusion: COVID-19 vaccinated patients with concomitant helminthic infections are susceptible to
reduced vaccine efficacy. Generally speaking, parasitism however, could provoke cytokine storm syndrome