Role of Latissimus Dorsi Island Flap in Coverage of Mutilating Upper Limb Injuries in Pediatric Age Group

Background/Purpose: Latissimus dorsi muscle (LDM) is one of the most versatile muscles that is commonly used in different reconstructive procedures. Severe mutilating injuries of the upper limb in children represent a great challenge to reconstructive surgeons especially when important structures become exposed. Materials & Methods: we utilized LDM as an island flap to cover extensive soft tissue defects in the upper limb of pediatric patients. This work included 17 children (13 males and 4 females). All of them had extensive soft tissue loss of the upper limb with exposure of important structures. The cause of injury was road traffic accident in all patients. We analyzed the operative time, need for multi-stage surgery and the recorded complications. Finally, we recorded the ultimate functional and aesthetic outcome after a period of two years of follow up. Results: From the harvested seventeen flaps, none of them was lost. Split thickness skin graft was done one week after flap harvesting and insetting to cover the muscle flap. There were four cases with partial loss of the skin graft secondary to infection. Those four cases needed re-grafting after eradication of infection that needed almost two weeks of local wound care and dressing. Re-grafting was successful in the four cases. Conclusion: For complex upper extremity wounds in the pediatric age group, we advice aggressive debridement and early reconstruction with LDM pedicle flap with a split-thickness skin graft cover over it. The technique is reliable, with minimal donor site morbidity and very accepted functional and cosmetic outcome.Index Word: Latissimus dorsi muscle flap, complex trauma, pediatric age group

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Thermostable cellulase biosynthesis from Paenibacillus alvei and its utilization in lactic acid production by simultaneous saccharification and fermentation

Cellulosic date palm wastes may have beneficial biotechnological applications for eco-friendly utilization. This study reports the isolation of thermophilic cellulase-producing bacteria and their application in lactic acid production using date palm leaves. The promising isolate was identified as Paenibacillus alvei by 16S rRNA gene sequencing. Maximum cellulase production was acquired using alkaline treated date palm leaves (ATDPL) at 48 h and yielded 4.50 U.mL-1 FPase, 8.11 U.mL-1 CMCase, and 2.74 U.mL-1 β-glucosidase. The cellulase activity was optimal at pH 5.0 and 50°C with good stability at a wide temperature (40-70°C) and pH (4.0-7.0) range, demonstrating its suitability in simultaneous saccharification and fermentation. Lactic acid fermentation was optimized at 4 days, pH 5.0, 50°C, 6.0% cellulose of ATDPL, 30 FPU/ g cellulose, 1.0 g. L-1 Tween 80, and 5.0 g. L-l yeast extract using Lactobacillus delbrueckii. The conversion efficiency of lactic acid from the cellulose of ATDPL was 98.71%, and the lactic acid productivity was 0.719 g. L-1 h-1. Alkaline treatment exhibited a valuable effect on the production of cellulases and lactic acid by reducing the lignin content and cellulose crystallinity. The results of this study offer a credible procedure for using date palm leaves for microbial industrial applications

Application of ZnO-nanoparticles to manage Rhizopus soft rot of sweet potato and prolong shelf-life

A reduction in crop spoilage and an increase in shelf-life is the goal of effective disease control methods. This study aimed to assess ZnO-nanoparticles (ZnO-NPs) as a safe, new protectant against Rhizopus soft rot of sweet potato. ZnO-NPs had a fungicidal effect against Rhizopus stolonifer when used at concentrations above 50 ppm. The results showed that tubers treated with ZnO-NPs exhibited fewer fungal populations (1.2 CFU per segment) than those that did not receive the treatment. Tubers infected with Rhizopus stolonifer and treated with ZnO-NPs showed no visible decay for up to 15 days, indicating that ZnO-NPs act as a coating layer on tuber surface. The greatest weight loss after 15 days of storage was reported in infected tubers (8.98%), followed by infected tubers treated with ZnO (6.54%) and infected tubers treated with ZnO-NPs (3.79%). The activity of cell-wall degrading enzymes, α-amylase and cellulase, were significantly increased in both infected tubers and those treated with ZnO, compared to the tubers treated with ZnO-NPs. These results confirm that coating with ZnO-NPs is an effective method of protecting sweet potato tubers from infection, maintaining their quality and increasing their shelf-life for up to 2 months in storage

Induction of defense mechanisms involved in disease resistance of onion blight disease caused by Botrytis allii

Abstract Botrytis umbel blight caused by Botrytis allii is a major disease that attacks onion crop. In vitro, Trichoderma viride, Penicillium chrysogenum, and Saccharomyces cerevisiae and extract of bitter apple fruits (Citrullus colocynthis) showed antagonistic effect and inhibited the mycelial growth of B. allii. Gas chromatography–mass spectrometry (GC-MS) analysis of bitter apple fruits showed the existence of 37 compounds and their derivatives. Among them, 10 compounds constituted 58.66% of the total analyses. Greenhouse experiment approved that the extract of bitter apple fruits was the most effective in reducing disease incidence and severity, followed by P. chrysogenum, when they were applied 2 days pre-inoculation with the pathogen. All treatments significantly increased the total phenolic contents than the untreated control, but the highest increase was obtained when S. cerevisiae and P. chrysogenum were applied. A positive correlation was found between the activity of bioagents and improvement of peroxidase and phenylalanine ammonia-lyase enzymes in onion plants to resist infection with the pathogen. P. chrysogenum caused the highest increase in polyphenoloxidase activity in infected onion plants, while S. cerevisiae showed the lowest level of this enzyme. The study approved that application of the bioagents not only protected the onions against Botrytis disease but also enhanced the content of antioxidant compounds in onions. This encourages the application of such preparations to manage the production of onion crop, especially in the organic farming that bans the application of any chemicals

Molecular Characterization of Virulence Genes among MDR and XDR Avian Pathogenic E. coli

One of the most costly diseases is avian colibacillosis. Virulence genes determine E. coli pathogenicity. This study was undertaken to explore the existence of some virulence-associated genes and resistant configurations of Escherichia coli recovered from broiler chicks. Thirteen E. coli isolates were exposed to an investigation of antimicrobial susceptibility profile against 17 antimicrobial agents that exhibited the highest resistance found against amoxicillin, florfenicol, penicillin, amoxicillin clavulanate, tetracycline, meropenem, sulfamethoxazole-trimethoprim, and chloramphenicol in the percentage of 100%, 100%,100%, 92.3%, 76.9%, 69.2%, 61.5%, and 61.5%, respectively while the isolates exhibited highest sensitivity found to fosfomycin, imipenem, azetronam and ciprofloxacine in the percentage of 100%,92.3%,76.9% and 69.2%, respectively. Moreover, the thirteen E. coli isolates were exposed to the revealing of some virulence genes (iss, omp-T, hlyF, iroN, iuta, iucD, papC, cva, astA, tsh, and irp2) by polymerase chain reaction (PCR). The results showed that the percentages rates were 84.6, 76.9, 76.9, 76.9, 61.5, 53.8, 38.4, 30.7, 23, 15.3 and 15.3%, respectively. A significant correlation between most antimicrobial-resistant phenotypes and virulence genes in E. coli isolates. Antimicrobial use in chickens should be reasonable to prevent antibiotic-resistant microorganisms, according to our findings

Effects of Co-Exposure of Nanoparticles and Metals on Different Organisms: A Review

Wide nanotechnology applications and the commercialization of consumer products containing engineered nanomaterials (ENMs) have increased the release of nanoparticles (NPs) to the environment. Titanium dioxide, aluminum oxide, zinc oxide, and silica NPs are widely implicated NPs in industrial, medicinal, and food products. Different types of pollutants usually co-exist in the environment. Heavy metals (HMs) are widely distributed pollutants that could potentially co-occur with NPs in the environment. Similar to what occurs with NPs, HMs accumulation in the environment results from anthropogenic activities, in addition to some natural sources. These pollutants remain in the environment for long periods and have an impact on several organisms through different routes of exposure in soil, water, and air. The impact on complex systems results from the interactions between NPs and HMs and the organisms. This review describes the outcomes of simultaneous exposure to the most commonly found ENMs and HMs, particularly on soil and aquatic organisms