Measurement of (IL-11 ) Levels in Patients with Rheumatoid Arthritis

     التهاب المفاصل الروماتويدي (RA) هو مرض مناعي ذاتي التهابي مزمن يصيب المفاصل بشكل أساس  ، ويعد التهاب الغشاء المفصلي والغضاريف وتآكل العظام من أبرز الأعراض للمرض . مراحل تطور هذا المرض معقدة للغاية ، يتم خلالها تكاثر الخلايا الزليليّة التي تتلف وتشكل التهاب الغشاء الزليلي ، يليه الغضاريف وتدهور العظام.  السيتوكينات هي بروتينات تلعب دورًا حاسمًا في ظهور المرض وتطوره. كان الهدف من هذا البحث معرفة المزيد عن الإنترلوكين -11 ، وهو سايتوكين ينتجه الجهاز المناعي ، والانترليوكين -11 ينتمي إلى عائلة إلانترلوكين -6 ، والتي لها إمكانات مؤيدة ومضادة للالتهابات وعلاقتها بالمرض عن طريق القياس لمستوى تركيز (IL-11).   طرق العمل: اشتملت الدراسة الحالية على 45 مريضًا مصابًا بـ (RA) ، بالإضافة إلى 45 (يبدو أنهم أصحاء) كمجموعة ضابطة للدراسة. جمعت هذه العينات من مستشفى المرجان بمحافظة بابل (وحدة المفاصل) خلال الفترة من 1/11/2021  إلى 15/3/2022. تم فحص امصال جميع المرضى والمجموعة الضابطة لتحديد مستوى تركيز IL-11 باستخدام مقياس الممتز المناعي المرتبط بالإنزيم (ELISA). الاستنتاجات: ، كشفت نتائج الدراسة عن انخفاض كبير في مستوى IL-11  عند مستوى احتمالية (P≤0.05) للمرضى الذين يعانون من (الروماتيزم الرثوي) عند مقارنة معدلات نفس المعايير لمجموعة السيطرة.Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects the joints principally. Synovitis , cartilage and bone erosion are the most prominent symptoms of (RA).  Stages of development of this disease are very complex, Synovial cells that rupture and form inflammation in the synovium, followed by cartilage and bone deterioration. Cytokines are proteins that play a crucial role in the onset arise causing and progression of the disease. This research aims to learn more about interleukin-11, which is a protein produced by the immune system. A cytokine belongs to the interleukin-6 family. It has pro- and anti-inflammatory potentials and its relationship to the disease can be determined by measuring the level of (IL-11) concentration. Materials and Methods: The current study included 45 patients with (RA), in addition to 45 (apparently healthy) subjects as a control group of the study.  These samples were collected from Marjan Hospital in Babylon Governorate (joints unit) during the period from 1/11/2021 to 3/15/2022.  The sera of all patients and control group were examined for determination of IL-11 concentration level, using enzyme-linked immunosorbent assays, which are a type of immunoassay in which the enzyme is coupled to (ELISA). Results: At the likelihood level, the study's findings have revealed a considerable decrease in IL-11 level (P≤0.05) for patients with (RA), when comparing the rates of the same criteria for the control group. Conclusion: The concentration of interleukin 11 in the sera of rheumatoid arthritis patients was found to be less than in the control group in the current investigation

Measuring the level of IL-4 and IL-25 in the serum of eczema patients

Eczema is an inflammatory skin disease and may be the result of environmental factors, genetic factors, and immune factors. Itching, persistent scratching, skin redness, and dryness are the primary signs of the illness. Many Cytokines are essential to the pathophysiology of disease, including the role of interleukin-4 and interleukin-25 as major players in the immune pathogenesis of eczema. This study was conducted with the aim of evaluating some seromic criteria that clarify the effect of some immune and inflammatory factors on the pathological condition in eczema patients and comparing them with the healthy group. This can help determine whether there is a relationship between the level of interleukin-4 and the high level of interleukin-25 and the clinical symptoms of the disease. The current study was conducted in Marjan Medical City in Babylon Governorate. Samples of (50) patients with eczema were collected after being diagnosed by dermatologists, and samples of (50) ostensibly healthy people were collected as a control group. The enzyme-associated immuno-absorption method (Elisa) was used to measure the level of interleukin-4 and interleukin-25 in the serum of all patients and the control group Serum levels of interleukin-4 and interleukin-25 are significantly higher in eczema patients at the probability level (P <0.05), while they decrease in the control group for the same criteria rates According to the results of the current investigation, patients with eczema reported higher levels of interleukin-4 and interleukin-25 in the serum than the control group

Assessment of the specificity and stability of Micro-RNAs as a forensic gene marker

Background: Forensic investigations depend on bodily fluid analysis to identify the perpetrators. Identifying perpetrators requires knowledge about suspects' body fluids. Due to their durability and tissue-specific expression patterns, miRNAs may be forensic indicators. However, miRNA expression patterns in various bodily fluids are seldom compared. This study examined miR-372, miR-135p, miR-124-3p, miR-16, and miR-10b expression in seminal fluids, blood stains, and vaginal secretions using quantitative PCR using SNORD-47 as a reference gene. This research compared miRNA expression levels in diverse body fluids to assess their potential as forensic biomarkers. MicroRNAs were isolated from forensic blood, seminal fluids, and vaginal mixed stains. Methods: Quantitative PCR measured miR-372, miR-135p, miR-124-3p, miR-16, and miR-10b gene expression. Normalization utilized SNORD-47. These miRNAs were compared in various bodily fluids. Results: The analysis of the results revealed that three bodily fluids have unique miRNA expression patterns. Seminal fluids expressed considerably more miR-135b and miR-10b than vaginal secretions. Vaginal fluids expressed more miR-372 and miR-124-3p than seminal fluids. Blood fluids expressed more miR-126 and miR-16 than seminal and vaginal fluids. Conclusion: MiR-126, miR-16, miR-372, and miR-124-3p were considerably more significant than SNORD-47 in blood, vaginal secretions, and seminal fluids

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally