Aims/Introduction: Peripheral artery disease (PAD) serves as a risk factor for diabetic foot ulcers (DFUs). PAD pathology involves atherosclerosis and impaired immunity. Non‐classical monocytes are believed to have an anti‐inflammatory role. 1,25‐Dihydroxy vitamin D (vitamin D₃) is claimed to have immune‐modulating and lipid‐regulating roles. Vitamin D receptor is expressed on monocytes. We aimed to investigate if circulating non‐classical monocytes and vitamin D₃ were implicated in DFUs associated with PAD.Materials and Methods: There were two groups of DFU patients: group 1 (n = 40) included patients with first‐degree DFUs not associated with PAD, and group 2 (n = 50) included patients with DFU with PAD. The monocyte phenotypes were detected using flow cytometry. Vitamin D₃ was assessed by enzyme‐linked immunosorbent assay.Results: DFU patients with PAD showed a significant reduction in the frequency of non‐classical monocytes and vitamin D₃ levels, when compared with DFU patients without PAD. The percentage of non‐classical monocytes positively correlated with vitamin D₃ level (r = 0.4, P < 0.01) and high‐density lipoprotein (r = 0.5, P < 0.001), whereas it was negatively correlated with cholesterol (r = −0.5, P < 0.001). Vitamin D₃ was negatively correlated with triglyceride/high‐density lipoprotein (r = −0.4, P < 0.01). Regression analysis showed that a high vitamin D₃ serum level was a protective factor against PAD occurrence.Conclusions: Non‐classical monocytes frequency and vitamin D₃ levels were significantly reduced in DFU patients with PAD. Non‐classical monocytes frequency was associated with vitamin D₃ in DFUs patients, and both parameters were linked to lipid profile. Vitamin D₃ upregulation was a risk‐reducing factor for PAD occurrence.

Background: The link between immune system and type 2 diabetes mellitus (T2DM) pathogenesis attracted attention to demonstrate the role of immune cells and their secreted cytokines in T2DM development and its subsequent foot complications. Objective: To investigate the relation between T Natural killer cell (TNK) %, Interleukin 4 (IL4) and Interferon gamma (IFN-γ) and diabetic foot infection (DFI) development in patients with diabetic foot ulcer (DFU). Patients and Methods: Ninety patients with diabetes were included in this work, divided as T2DM group (n=30), DFU group (n=30), and DFI group (n=30). TNK% was detected using flow cytometry. Serum IL4 and IFN-γ were measured by ELISA. Diabetes biochemical parameters were also analyzed. Results: Significant decrease was detected in TNK% and IFN-γ in DFI group compared to other 2 groups (P< 0.001). Significant decrease was detected in serum levels of IL4 in DFI group compared to T2DM group (P=0.006). IFN-γ/IL4 was significantly decreased in DFI compared to DFU group (P=0.020). There was a significant correlation of TNK% with both IL4 and IFN-γ (r=0.385, P< 0.001; r=0.534, P< 0.001, respectively). Significant negative correlation of TNK% with HbA1c and LDL was revealed (r=− 0.631, P< 0.001; and r=− 0.261, P=0.013, respectively), while a positive correlation was seen with HDL (r=0.287, P=0.006). A significant negative correlation of IL4 with HbA1c was found (r=− 0.514, P< 0.001;. As for IFN-γ, a significant negative correlation with HbA1c and LDL was detected (r=− 0.369, P< 0.001; r=− 0.229, P=0.030). TNK % and IFN-γ level showed negative correlations with disease duration/year (r=− 0.546, P< 0.001; r=− 0.338, P=0.001,respectively). Conclusion: Decline in TNK frequency has essential role in T2DM pathogenesis and subsequent foot complications. Downregulation of TNK% and IFN-γ level have potential roles in predicting infection of diabetic ulcer and are correlated with disease duration.

Background and Aim: Deep venous thrombosis (DVT) of the lower extremities is common in Covid-19 patients. Interleukin (IL)-6 and P-selectin were found to be elevated in Covid-19 patients. The current study aimed to evaluate P-selectin and IL6 in Covid-19 patients with DVT and to explore its relation to clinical and laboratory parameters in those patients. Patients and methods: The present retrospective study included 150 hospitalized COVID-19 patients diagnosed on the basis of a positive result of reverse-transcriptase polymerase chain reaction (RT-PCR) test. Laboratory assessments were included for IL-6 and P selectin assessments via enzyme-linked immunosorbent assay. The primary outcome of the present study was the development of DVT detected by Doppler ultrasound (DU) evaluation of the lower extremities during the admission. Results: The present study included 150 hospitalized Covid-19 patients. DVT was developed in 59 patients (39.3%). DVP patients had significantly higher levels of P selectin [76.0 (63.0– 87.0) versus 63.0 (54.3– 75.0), p < 0.001] and IL-6 [37.0 (27.0– 49.0) versus 18.5 (13.5– 31.5), p < 0.001]. ROC curve analysis revealed good performance of P selectin [AUC (95% CI): 0.72 (0.64– 0.81)] and IL-6 [AUC (95% CI): 0.79 (0.71– 0.86)] in identification of DVT. Logistic regression analysis identified the presence of severe disease [OR (95% CI): 9.016 (3.61– 22.49), p < 0.001], elevated P selectin [OR (95% CI): 1.032 (1.005– 1.059), p = 0.018] and elevated IL-6 [OR (95% CI): 1.062 (1.033– 1.091), p < 0.001] as significant predictors of DVT development in multivariate analysis. Conclusion: The present study identified a probable role of elevated P-selectin and IL-6 levels in the DVT development in hospitalized Covid-19 patients.

Objective: To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients. Methods: This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk. Results: All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion. Conclusions: Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.

Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. Patients and methods: A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. Results: Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month followup: 77.7% vs 53.1% (p < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (p = 0.063), respectively. In addition, BGs required more interventions to preserve patency. Conclusions: AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs.

Purpose: The present study aimed to provide our experience with patch closure (PAC) and primary closure (PRC) after carotid endarterectomy (CEA). Materials & methods: The present retrospective comparative study included 106 patients submitted to elective CEA. They comprised 50 patients in PRC group and 56 patients in PAC group. Patients were followed perioperatively, at three months and at one year for surgical complications, stroke, and restenosis. Results: Postoperatively, no significant differences were found between the studied groups regarding rates of stroke (6.0% versus 3.6%, p=0.740), infection (0.0% versus 3.6%, p=0.520), hematoma (2.0% versus 1.8%, p=0.940), pseudoaneurysm (0.0% versus 3.6%, p=0.520), cranial nerve injury (2.0% versus 1.8%, p=0.940), and cardiac events (2.0% versus 1.8%, p=0.940). At three months, three patients in PRC group and four in PAC group were lost to follow up. No significant differences were found between the studied groups regarding rate of restenosis at three months (2.1% versus 0.0%, p=0.960). At one year, patients in PRC group experienced significantly higher rate of restenosis (14.9% versus 1.9%, p=0.046). None of the studied patients died. Conclusions: CEA combined with patch angioplasty may be associated with lower restenosis rate.