Different Methods to Decrease Seroma Formation Post Hernioplasty of Ventral Hernias

Background: Wounds can become infected associated with serous collection in the wound dead space in a condition known as seroma. After abdominal wall hernias correction, a variety of treatments have been tried to decrease seroma formation. Objective: To assess the rule of different modalities used in prevention of seroma formation post abdominal wall hernias repair. Patients and Methods: At Zagazig University Faculty of Medicine's General Surgery Department we carried out a clinical trial investigation. Transverse incisions and suction drains have been inserted in all patients undergoing hernioplasty and onlay mesh repair. The patients were divided into 4 groups: Group A: Classic hernioplasty for ventral hernia. Group B: Applying of histoacryl intraoperative after onlay mesh fixation. Group C: Applying of fibrin glue intraoperative after onlay mesh fixation. Group D: block closure of dead space after onlay mesh fixation. The patients were followed up in inpatients wards for 24 hours then discharged to continue their care and follow up in outpatient clinic at 1, 2, and 4 weeks. Results: When it came to the reduction of seroma production or other postoperative outcomes, there was no statistically significant difference between the groups. Conclusion: Fluid buildup can be avoided with the use of sclerotherapy, a minimally-invasive procedure that eliminates empty space. Chemical agents, tetracyclines, and talc were used satisfactorily with minimal complication rates

Evaluation of the level of gamma radiation dose on some immune system parameters against cancer

The positive impact of exposure to low-dose gamma irradiation (LDR) on tumor regression and immune response has recently been emphasized. The present study aimed to investigate the T-helper 1 / T-helper 2 (Th1/ Th2) cytokine balance, serum protein changes in male BALB/c Ehrlich Ascites Carcinoma (EAC) bearing mice exposed to two low doses(0.4Gy or 0.8Gy) of gamma irradiation. Seventy two male BALB/C mice were divided into six groups. Group1: normal control; Group2&3:mice were exposed to γ-irradiation at 0.4 and 0.8 Gray, respectively two times weekly for 3 weeks; Group4 (malignant control):mice were injected subcutaneously with 2×106 Ehrlich Ascites Carcinoma (EAC) cells/mouse; Group5&6: mice were injected by EAC cells and exposed to γ-irradiation at 0.4 and 0.8 Gray, respectively two times weekly for 3 weeks, eight days after tumor transplantation. Data from the present study reported that two low-doses of γ- irradiation significantly increase the levels of serum IL2, IL6 and TNFα and a decrease the serum IL10 level in comparison to malignant control mice. The IL2 /IL-10,IL-6/IL-10 and TNFα/IL-10 (Th1/Th2 balance), were significantly increased in all tested groups when compared with control (P<0.05). Exposure to 0.8 Gy dose, however, induced significant elevation in all ratios in comparison to exposure to 0.4 Gy dose. This was associated with significant reduced tumor growth in mice implanted with Ehrlich Ascites Carcinoma, which was more pronounced in mice exposed to 0.8 Gy than mice exposed to 0.4 Gy dose. In conclusion, the present study suggests a possible immunomodulatory role of LDR as it was associated with Th1 cytokine polarization response, and 0.8 Gy have more positive effect than 0.4 Gy. It also reinforces the beneficial effect of accumulated dose of total body irradiation (0.4Gy or 0.8Gy) in the regression of implanted Ehrlich Ascites Carcinomain BALB/c mice

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (&gt; 5&nbsp;cm) with severe GERD (DeMeester score &gt;100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Calcareous Marine Algae, Sodium Bicarbonate and Magnesium Oxide Mixture for Curing Lactic Acidosis in Goats

This study was designed to evaluate the therapeutic efficacy of calcareous marine algae (AcidBuf), sodium bicarbonate and magnesium oxide mixture for the treatment of lactic acidosis in goats. In this study, a total of 57 goats were diagnosed with lactic acidosis and subjected to a therapeutic trial of 4g AcidBuf plus 10 g Na-bicarbonate plus 4g magnesium oxide/head once daily for three days. Before and 72 h after treatment, a clinical examination and blood and ruminal fluid samples were taken. Within 72 h of the therapeutic trial, the clinical signs of lactic acidosis gradually improved and resolved and the rumen pH increased significantly from 5.16±0.460 to 6.54±0.246. Rumen contraction, rumen fluid physical properties (color, odor and consistency), protozoal motility and ruminal microflora differed significantly toward the normal of healthy goats. Regarding haemgasometry and hematobiochemical parameters, a highly significant decrease in Hb, HCT% , TLC, ALT, AST, creatinine and lactate values and a highly significant increase in blood pH, HCO3-, pCO2, serum urea, total antioxidant capacity (TAC) and β-hydroxybutyric acid (βHBA) were recorded compared to the pre-treatment values. The current study concluded that calcareous marine algae, sodium bicarbonate and magnesium oxide mixture is very helpful in minimizing the severity of ruminal lactic acidosis in goats and could be used as the therapy of choice

Obstructive urolithiasis in buffalo calves (Bubalus bubalis): Serum changes of Vitamins A and D and efficacy of surgical management using tube cystostomy

Background and Aim: Obstructive urolithiasis is one of the major health problems in livestock animals, mainly in young calves. The present study was designed first to investigate the changes in the serum levels of Vitamins A and D in buffalo calves (Bubalus bubalis) with obstructive urolithiasis and second to investigate the efficacy of tube cystostomy technique in management of such condition. Materials and Methods: One hundred and forty-nine buffalo calves of variable ages ranged from 3 to 7 months with a history of retained urine were examined clinically and ultrasonographically. Then, they were subjected to surgical treatment using the tube cystostomy technique. The serum levels of Vitamins A and D were investigated in retained urine calves in addition to 10 clinically healthy calves of the same age used as a control group. Results: Based on clinical and ultrasonographic findings, the calves were diagnosed as obstructive urolithiasis with intact bladder (n=64 calves) or with bladder rupture (n=85 calves) with the peak incidence in winter months. Tube cystostomy was an efficient and quick surgical technique for the management of such condition and 95.3% of calves returned their normal urination within 7–14 days after surgery. Significant hypovitaminoses A and D were found between retained urine calves and control ones (p= 0.01 and 0.002, respectively). Conclusion: Hypovitaminoses A and D suggested predisposing obstructive urolithiasis in buffalo calves, but further clinical studies are recommended for more confirmation. Surgical treatment using tube cystostomy technique is recommended for the management of obstructive urolithiasis in buffalo calves

Clinical and histopathological studies on neurodegeneration and dysautonomia in buffalo calves during foot-and-mouth disease outbreaks in Egypt

Background and Aim: Signs of dysautonomia were frequently observed in calves that died during foot-and-mouth disease (FMD) virus (FMDV) outbreaks in Egypt from 2015 to 2018. This study aimed to describe the clinical and histopathological features of the central nervous system in malignant cases of FMD and excluding possible concurrent bacterial, and bovine herpes virus 4 (BHV4) infections or both. Materials and Methods: In this study, 335 FMDV-infected buffalo calves aged 1-22 months were clinically examined and followed until recovery or death. Of the 335 calves, 134 died (malignant group) and 201 recovered after exhibiting classic symptoms of FMD (recover group). The calves were subjected to clinical examination. For the malignant group, several laboratory trials were conducted to assess the possible cause/s of dysautonomia-related viral, bacterial, or concurrent infections. Koch's postulates and polymerase chain reaction were employed. Postmortem and histopathological examinations of nervous tissue were performed. Results: In the malignant group, signs of dysautonomia were observed before death, including partial or complete gut dysfunction, loss of anal sphincter tone, rapid breathing sounds, fluctuating body temperature, and cardiac arrhythmias. In the malignant group, histopathological examination of the spinal cord, pons, medulla oblongata, hypothalamus, cerebellum, and cerebrum revealed demyelination, neuronal degeneration, and focal areas of malacia and gliosis. The nervous tissue and heart samples from malignant cases were positive for serotype O FMDV. Conclusion: Findings revealed in this study support the existence of neurodegeneration induced by FMDV infection in buffalo calves

Serological and Molecular Characterization of <i>Mycobacterium avium</i> Subsp. <i>paratuberculosis</i> (MAP) from Sheep, Goats, Cattle and Camels in the Eastern Province, Saudi Arabia

The objectives of the present study were to characterize Mycobacterium avium subsp. paratuberculosis (MAP) infection using serological and molecular tools and investigate the distribution and molecular characterization of MAP strains (cattle (C) and sheep (S) types) in sheep, goat, cattle, and camel herds in Eastern Province, Saudi Arabia. Serum and fecal samples were collected from all animals aged >2 years old in 31 herds (sheep = 8, goats = 6, cattle = 8 and camels = 9) from January to December 2019. Serum samples were tested by ELISA for the detection of MAP antibodies. Fecal samples were tested by PCR for the detection of MAP IS900 gene and the identification of MAP strains. MAP antibodies were detected in 19 (61.3%) herds. At the animal level, antibodies against MAP were detected in 43 (19.5%) sheep, 21 (17.1%) goats, 13 (19.7%) cattle and 22 (9.1%) camels. The IS900 gene of MAP was detected in 23 (74.2%) herds and was directly amplified from fecal samples of 59 (26.8%) sheep, 34 (27.6%) goats, 20 (30.3%) cattle and 36 (15.0%) camels. The S-type was the most prevalent MAP type identified in 15 herds, and all were identified as type-I, while the C-type was identified in only 8 herds. The IS900 sequences revealed genetic differences among the MAP isolates recovered from sheep, goats, cattle and camels. Results from the present study show that MAP was prevalent and confirm the distribution of different MAP strains in sheep, goat, cattle and camel herds in Eastern Province, Saudi Arabia