Clinical impact of open versus laparoscopic approach on the outcome in cases of congenital duodenal obstruction: A comparative study

Introduction Congenital duodenal atresia/partial duodenal obstruction/duodenal stenosis is one of the most common variants of intestinal atresia, occurring 1 in 2500–5000 live births. The aim of this study was to compare between both the laparoscopic and open approaches for repair of congenital duodenal obstruction regarding their effects on outcome.Patients and methods A total of 20 cases diagnosed with congenital duodenal obstruction (atresia, web, and stenosis) in the neonatal and pediatric surgical units of Cairo University Specialized Pediatric Hospital were studied. All cases underwent either laparoscopic or open repair. Cases associated with malrotation or multiple atresias were excluded. Patients’ characteristics, including age, sex, presenting symptoms, associated anomalies, preoperative investigations, intraoperative details, and postoperative outcomes, were documented.Results A total of 20 cases of duodenal obstruction were included in this study over 1 year, from January 2017 to January 2018. We did duodenoduodenostomy in 15 cases (web in the second part of duodenum, types II and III) and excision of the web in the first part of duodenum in five cases. Laparoscopic repair was done in 11 (55%) cases (diamond-shaped duodenoduodenostomy in nine cases and web excision in two cases) whereas open technique was performed in nine (45%) cases (diamond duodenoduodenostomy in six cases, and excision of the web in three cases). The average operative time in cases of laparoscopic duodenoduodenostomy was 120 min whereas in the cases of open technique was 90 min. The average time needed until full feeding to be achieved was 6–7 days in cases done  laparoscopically, whereas other group was 10–20 days. In this cohort, no stricture or leakage or wound dehiscence was found in both groups. Laparoscopic group afforded a better cosmesis and more parent satisfaction.Conclusion Use of the laparoscope in duodenal obstruction in either neonates or children is a safe and easy technique, and despite being a lengthier operation, feeding could be established earlier. Keywords: duodenal atresia, laparoscopic, TPN

Effect of Body Weight on Pattern of Coronary Lesions in Patients Undergoing Coronary Angiography at Sohag University Hospital

Background: Obesity is related to multiple risk factors of cardiovascular disease (CVD) including hypertension, diabetes mellitus (DM), metabolic syndrome, and dyslipidemia, while also likely being an independent risk factor for CVD. Through multiple pathways including increased angiotensin, circulating blood volume, and total peripheral resistance, excess weight increases hypertension (HTN) risk.Objective: This study aimed to reveal the relationship between body weight and the severity of coronary artery disease (CAD) in patients referred for coronary angiography at Sohag University Hospital.Patients and methods: This was a cross-sectional hospital-based study performed on 200 patients, at Sohag University Hospital. Mean age was 56.94 ± 10.30 years. Among them, there were 175 patients (87.5%) who were overweight or obese with higher prevalence of HTN, hyperlipidemia, and diabetes. Normal weight patients were 25 (12.5%) with lower prevalence of HTN, hyperlipidemia, and diabetes.Results: According to BMI in our study, 175 patients (87.5 %) were overweight or obese, 162 patients (92.57%) of the overweight had significant coronary artery disease. 162 patients (81%) had significant coronary angiography findings (> 70% stenosis in any of the coronary arteries). They were classified to 63 patients (31.5%) had single vessel diseased, 53 patients (26.5%) had two vessels diseased, and 46 patients (23%) had three vessels diseased.Conclusion: Obesity, diabetes, hypertension, hyperlipidemia, aging and male gender were correlated with severity of CAD. Thus, reduction of weight, stoppage of smoking and control of diabetes, hypertension and hyperlipidemia will improve outcome of coronary artery disease

Maximum-largest weighted delay first algorithm for heterogeneous traffic in 4G networks

Real time applications with strict QoS like delay sensitive applications require an advanced technology to adopt them. This is where Long Term Evolution-Advanced (LTE-A) fulfills this requirement. With this ever evolving technology the need for improvements is required. Packet scheduling is one of the important key features of LTE-A, where it dictates user selection and transmission of those user’s packets based on the priority of the users to reach the receiver correctly. Packet scheduling is one mean to achieve those QoS requirements that real-time applications require. Such algorithms are HARQ Aware Scheduling Algorithm (HAS), Retransmission Aware Proportional Fair Algorithm (RAPF), Chase Combining Based Max C/I Scheduling and Maximum- Largest WeightedDealy First algorithm (M-LWDF). In this paper, M-LWDF is one of the best algorithms in LTE-A which was chosen for further investigated to support QoS in high mobility environment. Packet Loss Ratio (PLR), and Mean User Throughput performance measures were used to validate the performance of M-LWDF algorithm against other algorithms using similar mobile environment. Simulation results indicate the capability of M-LWDF algorithm within the threshold of the performance measures against other benchmarks where it has demonstrated more efficiency to support and improve the performance of real-time multimedia traffic

Role of Urinary Catheter in Post-Partum Urinary Retention and Genitourinary Infections in Caesarean Deliveries

Background: Urethral catheterization is done as a routine procedure in cesarean section. It is thought to be associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. The aim of our study were to determine the feasibility and safety of cesarean section without urethral catheterization. Subjects and Methods: A prospective, randomized controlled trial was carried out in Beni-Suef General Hospital from April 1, 2014 to April 1, 2015April. Among 100 patients who had undergone cesarean section 50 were catheterized and 50 were uncatheterized. Results: The study showed that the catheterized group took longer time till first voiding 7.80+ 2.88 hours versus 6.72+ 2.27 hours for the uncatheterized group (p value = 0.04*) and also took longer time till first ambulation 8.64+ 2.62 hours versus 6.10+ 1.94 hours for the uncatheterized group (p value = 0.001*). Further ,the females who were catheterized stayed for much longer period at hospital 30.56+6.19 hours versus 20.46+2.92 hours for the uncatheterized group (p value = 0.001*). The catheterized group had much higher numbers of UTI among its females, 36 female compared to only 15 females of the uncatheterized group (p value= 0.001*). Fmales who were subjected to catheterization were more likely to show urinary retention (p value = 0.039*). Conclusion: Cesarean section can be done safely without urethral catheterization with reduced morbidities. Keywords: Cesarean section, Urethral catheterization, Urinary tract infection, Urinary retentio

Maximum-Largest Weighted Delay First Algorithm for Heterogeneous Traffic in 4G Networks

Real time applications with strict QoS like delay sensitive applications require an advanced technology to adopt them. This is where Long Term Evolution-Advanced (LTE-A) fulfills this requirement. With this ever evolving technology the need for improvements is required. Packet scheduling is one of the important key features of LTE-A, where it dictates user selection and transmission of those user’s packets based on the priority of the users to reach the receiver correctly. Packet scheduling is one mean to achieve those QoS requirements that real-time applications require. Such algorithms are HARQ Aware Scheduling Algorithm (HAS), Retransmission Aware Proportional Fair Algorithm (RAPF), Chase Combining Based Max C/I Scheduling and Maximum- Largest WeightedDealy First algorithm (M-LWDF). In this paper, M-LWDF is one of the best algorithms in LTE-A which was chosen for further investigated to support QoS in high mobility environment. Packet Loss Ratio (PLR), and Mean User Throughput performance measures were used to validate the performance of M-LWDF algorithm against other algorithms using similar mobile environment. Simulation results indicate the capability of M-LWDF algorithm within the threshold of the performance measures against other benchmarks where it has demonstrated more efficiency to support and improve the performance of real-time multimedia traffic

A Packet Scheduling Scheme for Improving Real-time Applications Performance in Downlink LTE–advanced

Quality of Service based packet scheduling is a key-feature of LTE-A mandating selection and transmission of individual user packets based on their priority. HARQ Aware Scheduling, Retransmission Aware Proportional Fair, Chase Combining Based Max C/I Scheduling and Maximum- Largest Weighted First (M-LWDF) are popular Packet Scheduling Algorithms (PSAs) developed to meet QoS requirements. In highly erroneous LTE-A cannel, M-LWDF is considered to be one of best PSA. To validate the performance of M-LWDF for the LTE-A channel, Mean User Throughout, and Fairness performance measures were evaluated for 3 different PSAs designed based on M-LWDF algorithm in this paper. A C++ based simulation results indicate the superiority of the PSA3 algorithm within the threshold of the performance measures against benchmarks. It has shown more efficiency and the performance of RTA traffic was enhanced. Results show that PSA3 is superior to its benchmark PSA2 by 12% in Mean User Throughput and 11% in Fairness. PSA2 performed the worst because it prioritizes new users and it allocated all available RBs to the scheduled user leaving the rest to wait in the buffer. PSA3 maintians good Mean User Throughput and fairnessdue to scheduling each user on its RB which leads to multi-user diversity

Group B streptococcal carriage, antimicrobial susceptibility, and virulence related genes among pregnant women in Alexandria, Egypt

Background and aim: Group B Streptococcus (GBS) has emerged as a leading cause of illness and death among neonates. The study was conducted to estimate the prevalence of recto-vaginal carriage of GBS among pregnant women at 35–37 weeks, gestation, to describe GBS antimicrobial susceptibility profile and to investigate selected virulence genes by PCR.Subjects and methods: Two-hundred pregnant women at 35–37 weeks of gestation attending antenatal clinic at Al-Shatby University Hospital were enrolled in the study. Both vaginal and rectal swabs were collected from each subject. Swabs were inoculated onto CHROMagarTM StrepB and sheep blood agar plates. All GBS isolates were subjected to antimicrobial susceptibility testing using disc diffusion. Disc approximation test was performed to detect erythromycin resistance phenotype (MLSB). GBS virulence genes scpB, bac, bca, and rib were identified by PCR.Results: Among the 200 pregnant women, 53 (26.5%) were identified as GBS carriers. All carriers had vaginal colonization (100%), four (7.5%) had combined recto-vaginal colonization. None of the carriers had rectal colonization alone. All isolates (100%) were susceptible to penicillin, ampicillin, ceftriaxone, cefotaxime, cefepime, vancomycin, and linezolid. On the other hand, 43.4%, 28.3%, 22.6%, and 15% of isolates were resistant to levofloxacin, azithromycin, erythromycin, and clindamycin respectively. Out of 12 erythromycin resistant isolates, six isolates had constitutive while two had inducible MLSB resistance. scpB was identified in 100%, rib in 79.2%, and bac in 35.8% of GBS isolates. None of the isolates possessed the bca gene.Conclusion: Introduction of GBS screening in Egyptian pregnant women is recommended. Penicillin or ampicillin is still the antibiotic of choice for intrapartum prophylaxis.Keywords:  Group B streptococci, Rib gene, Penicillin susceptibility, Vaginal carriag

Modified Bianchi pyloromyotomy versus laparoscopic pyloromyotomy for patients with infantile hypertrophic pyloric stenosis: Intraoperative considerations and parents’ satisfaction

Introduction Infantile hypertrophic pyloric stenosis is a common cause of persistent nonbilious vomiting during infancy. Ramstedt pyloromyotomy through right upper quadrant transverse incision is the conventional treatment. The laparoscopic and Tan-Bianchi approaches were introduced to improve the cosmesis and decrease postoperative morbidity. In this study, we compared between laparoscopic and modified Bianchi approaches regarding intraoperative technical considerations and postoperative outcomes.Patients and methods The study included 40 patients with infantile hypertrophic pyloric stenosis. Overall, 20 patients underwent laparoscopic pyloromyotomy (LP) and the other 20 patients underwent modified Bianchi pyloromyotomy (MBP). Patients’ characteristics, including age, sex, gestational age, and associated  comorbidities, were documented. Intraoperative details and complications and postoperative outcomes were recorded.Results The operative time and intraoperative complications including mucosal perforation and bleeding did not significantly differ between both the groups. From the laparoscopic group, one (5%) case was complicated by mucosal perforation and converted to open and another case (5%) developed hypercapnia. There was no statistically significant difference between the two groups regarding time till full feed (P=0.648) and postoperative hospital stay (P=0.082). In addition, there was no statistically significant difference between the two groups regarding postoperative complications, with one (5%) case from the laparoscopic group underwent incomplete myotomy and required redo-operation and another case (5%) developed wound infection. MBP had a significantly more parent satisfaction regarding cosmesis than LP (P=0.016).Conclusion MBP is comparable to LP regarding intraoperative complications and postoperative outcomes; however, the modified Bianchi approach offered more parent satisfaction than laparoscopic approach.  Keywords: laparoscopic, modified Bianchi, pyloric stenosis, pyloromyotom

Evaluation of Antioxidants Status at Diagnosis in Childhood Acute Lymphoblastic Leukemia

Background: Acute lymphoblastic leukemia (ALL) is a neoplastic disease of immature lymphocytes or lymphocyte progenitor cells either the B- or T-cell lineage. It is the most common malignancy diagnosed in patients younger than 15 years, and account for approximately 25-30% of adult acute leukemia. Objective: To evaluate some antioxidants as zinc, selenium, vitamin A (retinol) and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia and to compare it to that of a control population. Patients and methods: This case-control study was carried out at Oncology Unit of Pediatrics Department and Medical Biochemistry Department, Faculty of Medicine, Zagazig University Hospitals. This study consisted of two groups: Patients’ group (30 children patients with newly diagnosed ALL). As regard control group, it included 30 healthy children who were matched well with patients’ age and sex. Fasting levels of serum zinc, selenium, retinol and tocopherol were measured. Results: There was a high statistically significant decrease of vitamin E, selenium and zinc among all cases than their controls. While, there was a significant increase of vitamin A among all cases. Zinc level was statistically significantly increased with increased risk of disease, while no statistically significant relation between disease risk and other levels of serum antioxidant. Conclusion: Some antioxidants as zinc, selenium and vitamin E (tocopherol) status at diagnosis of childhood acute lymphoblastic leukemia are lower compared to that of a control population

Reverse Transcription Recombinase Polymerase Amplification Assay for Rapid Detection of Avian Influenza Virus H9N2 HA Gene

The H9N2 subtype of avian influenza A virus (aIAV) is circulating among birds worldwide, leading to severe economic losses. H9N2 cocirculation with other highly pathogenic aIAVs has the potential to contribute to the rise of new strains with pandemic potential. Therefore, rapid detection of H9 aIAVs infection is crucial to control virus spread. A qualitative reverse transcription recombinase polymerase amplification (RT-RPA) assay for the detection of aIAV subtype H9N2 was developed. All results were compared to the gold standard (real-time reverse transcription polymerase chain reaction (RT-PCR)). The RT-RPA assay was designed to detect the hemagglutinin (HA) gene of H9N2 by testing three pairs of primers and a probe. A serial concentration between 106 and 100 EID50 (50% embryo infective dose)/mL was applied to calculate the analytical sensitivity. The H9 RT-RPA assay was highly sensitive as the lowest concentration point of a standard range at one EID50/mL was detected after 5 to 8 min. The H9N2 RT-RPA assay was highly specific as nucleic acid extracted from H9 negative samples and from other avian pathogens were not cross detected. The diagnostic sensitivity when testing clinical samples was 100% for RT-RPA and RT-PCR. In conclusion, H9N2 RT-RPA is a rapid sensitive and specific assay that easily operable in a portable device for field diagnosis of aIAV H9N2