Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: A randomized comparative study

Objective: To compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children.Patients and methods: A randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications.Results: Finally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient’s demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value = 0.5).Conclusion: Stone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy.Keywords: Pediatric urolithiasis; Minimal invasive stone management; Flexible URS; ESW

Modifying the design of pond production systems can improve the health and welfare of farmed Nile tilapia, Oreochromis niloticus

Infected fish have been known to recover from mild illness when they are able to locate to warmer water. This study aimed to replicate this 'behavioural fever' effect in an aquaculture setting by artificially heating a section of a fish pond (thereby introducing a thermal gradient) and effectively modifying pond design. This was achieved through the construction of a 'greenhouse' type structure above a section of the pond. Over the length of the production cycle at three typical Nile tilapia (Oreochromis niloticus) farms, the study collected data on water quality and fish growth and at the end of the cycle, blood samples were taken and total production was recorded. At each farm, fish were divided into two identical ponds, one with a greenhouse covering 3% of the pond surface area and one without. Results showed that greenhouse was effective in warming the surface of the water immediately below it. Oxygen levels were also higher under the greenhouse than outside of it and higher than in the control pond. Fish reared in the greenhouse ponds tended to be larger than the control ponds and had improved physiological and immune status (i.e., better liver and kidney function, higher antioxidant activity and lysozyme count; p < 0.05). The results of this study suggest that low-cost interventions that introduce thermal gradients in aquaculture systems may hold promise for improving health and welfare status of farmed fish in developing countries

Modifying the design of pond production systems can improve the health and welfare of farmed Nile tilapia, Oreochromis niloticus

Infected fish have been known to recover from mild illness when they are able to locate to warmer water. This study aimed to replicate this 'behavioural fever' effect in an aquaculture setting by artificially heating a section of a fish pond (thereby introducing a thermal gradient) and effectively modifying pond design. This was achieved through the construction of a 'greenhouse' type structure above a section of the pond. Over the length of the production cycle at three typical Nile tilapia (Oreochromis niloticus) farms, the study collected data on water quality and fish growth and at the end of the cycle, blood samples were taken and total production was recorded. At each farm, fish were divided into two identical ponds, one with a greenhouse covering 3% of the pond surface area and one without. Results showed that greenhouse was effective in warming the surface of the water immediately below it. Oxygen levels were also higher under the greenhouse than outside of it and higher than in the control pond. Fish reared in the greenhouse ponds tended to be larger than the control ponds and had improved physiological and immune status (i.e., better liver and kidney function, higher antioxidant activity and lysozyme count; p < 0.05). The results of this study suggest that low-cost interventions that introduce thermal gradients in aquaculture systems may hold promise for improving health and welfare status of farmed fish in developing countries.Article Information Received 26 September 2022 Revised 05 November 2022 Accepted 28 November 2022; O n l i n e F i r s t A r t i c l

Comparison of phytoplankton diversity and succession between two small man-made lakes in Serdang, Selangor

Information on the relations between phytoplankton communities and the environment is limited for the man-made lakes in Malaysia. This paper presents the results of a study on the diversity and seasonal succession of phytoplankton in Seri Serdang Lake and Faculty of Engineering Lake conducted between November 2013 and February 2014. A total of 27 species from four phyla (Chlorophyta, Euglenophyta, Cyanobacteria, Bacillariophy ta) and 33 species belonging to Cyanobacteria, Chlorophyta, Bacillariophyta, Euglenophyta and Dinophyta were identified from Seri Serdang Lake and the Faculty of Engineering Lake, respectively. Chlorophyta were most dominant in both lakes. Highest number of species recorded was Monoraphidium sp. in Seri Serdang Lake and Pediastrum tetras in Faculty of Engineering Lake. Seri Serdang Lake had lower phytoplankton density (20 cells ml–1 to 396 cells ml–1) as compared to the Faculty of Engineering Lake (250 cells ml–1 to 300 cells ml–1). Although the distance between the two lakes is short, they do not share the same tributary probably leading to the observed differences in water quality, species diversity and succession pattern

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Molluscicidal and Mosquitocidal Activities of the Essential oils of Thymus capitatus Hoff. et Link. and Marrubium vulgare L.

Steam distillation of essential oils of aerial parts of Thymus capitatus and Marrubium vulgare L. collected at North cost of Egypt yielded 0.5% and 0.2%, respectively. Results of Gas chromatography-mass spectrometry analyses of the two samples identified 96.27% and 90.19% of the total oil composition for T. capitatus and M. vulgare, respectively. The two oil samples appeared dominated by the oxygenated constituents (88.22% for T. capitatus and 57.50% for M. vulgare), composed of phenols, mainly carvacrol (32.98%) and thymol (32.82%) in essential oil of T. capitatus, and thymol (34.55%) in essential oil of M. vulgare. It was evaluated the molluscicidal activity of T. capitatus and M. vulgare essential oils on adult and eggs of Biomphalaria alexandrina as well as their mosquitocidal activity on Culex pipiens. The LC50 and LC90 of T. capitatus essential oil against adult snails was 200 and 400 ppm/3hrs, respectively, while for M. vulgare it was 50 and 100 ppm/3hrs, respectively. Moreover, M. vulgare showed LC100 ovicidal activity at 200 ppm/24 hrs while T. capitatus oil showed no ovicidal activity. It was verified mosquitocidal activity, with LC50 and LC90 of 100 and 200 ppm/12hrs respectively for larvae, and 200 and 400 ppm/12hrs respectively for pupae of C. pipiens

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe