Evaluation of new scoring system predicting the occurrence of deep infection in open fractures patients

Background: Open fractures of long bones incidence is 11.5 per 100,000 person per year. The management of open fractures had been improved by early adequate surgical debridement and various types of fracture fixation. The Gustilo classification is commonly used for treatment decisions and comparison. Although it had a good prediction power for deep infection but the variability among the inter observer was a problem. Yokoyama et al., 2009 he had advised a new scoring system based on three items of HFS-98 to predicting significant deep infections in open upper and lower extremity fractures.Methods: This study was conducted at Emergency Department Suez Canal University Hospital on 233 Patients with open fractures of long bones from April 2014 till November 2015. The patients were classified according to the criteria proposed by Gustilo classification & Yokoyama’s new scoring system. The relationship between the new score three items were investigated by categorical regression multivariate analysis.Results: In this study, we had 233 Patients with open fractures of long bones. Road traffic accidents were the mechanism of injury in (44.6%). Deep infection was positive in 70/233 patients with Gustilo GI. The cut-off point of application of Yokoyama’s new scoring system was 30, Sensitivity; 63.3%, Specificity; 89%, significant P-value <0.001.Conclusions:The cut-off point of the new Yokoyama’s new scoring application in this study was slit different from the reported applicable values before. This revised scoring system was thought to be useful for predicting deep. Further prospective trial is needed for advising new scoring system.

Prospective Randomized Study Comparing the Intra-Operative and Postoperative Outcomes of Bipolar Enucleation of the Prostate Versus Thulium Laser Enucleation

Background: Benign prostatic hyperplasia (BPH) is an age-dependent patho-physiological condition. Bipolar enucleation of prostate (BipolEP) is now considered a rather effective method for the management of BPH patients. Aim and objectives: to assess the functional outcome of patients post plasma-kinetic enucleation in patients with large size prostate glands more than 80 cc as measured by Trans-rectal ultrasound. Patient and method: Our study involved 40 patients with symptomatic BPH who underwent endoscopic enucleation of the prostate using bipolar energy. Result: As regard the intraoperative complications our study showed that there were two patients (6.7%) complicated by small bladder perforation during morcellation and four patients (13.3%) had intra-operative bleeding necessitating blood transfusion and in the early postoperative period (the first 48 hours); one patient (3.33%) developed postoperative hematuria. After one month follow up we found that: 12 patients (30%) developed urge incontinence, 7 patients (17.5%) developed stress urinary incontinence and 5 patients (12.5%) developed mixed incontinence one with predominant urge and the other with predominant stress Conclusion: Bipolar enucleation (BipoLEP) is very effective for managing patients with symptomatic or complicated BPH with large gland size above 80 cc, having a high safety profile and low complications rate. Bipolar enucleation proved to be a very effective technique of endoscopic enucleation of the prostate and can stand out as a strong alternative to laser enucleation whenever laser facilities are not available with comparable results

Diffusion tensor magnetic resonance imaging in the gradingof liver fibrosis associated with congenital ductal plate malformations

Purpose: Liver biopsy is still the standard method for the diagnosis of ductal plate malformations (DPM). However, it is an invasive tool. Magnetic resonance imaging (MRI) has shown its accuracy in the diagnosis of this pathology. Herein, a study was conducted to elucidate the role of diffusion MRI parameters in predicting the degree of hepatic fibrosis. Material and methods: This prospective study included 29 patients with DPM and 20 healthy controls. Both groups underwent diffusion tensor magnetic resonance imaging (DT-MRI), and its parameters were compared between patients and controls, and then they were correlated with the degree of liver fibrosis in the patient group. Results: All patients with DPM, whatever its type, expressed a significantly lower hepatic apparent diffusion coefficient (ADC) compared to controls. However, fractional anisotropy (FA) showed no significant difference between them. The ADC value of 1.65 × 10-3 mm2/s had sensitivity and specificity of 82.1% and 90%, respectively, in differentiating DPM patients from healthy controls. It was evident that patients with higher fibrosis grades had significantly lower hepatic ADC, indicating a negative correlation between ADC and the grade of hepatic fibrosis; rs = -0.901, p < 0.001. Conclusions: DT-MRI showed good efficacy in the diagnosis of congenital DPM. Moreover, ADC could be applied to monitor the degree of liver fibrosis rather than the invasive liver biopsy. No significant correlation was noted between the FA and the grades of liver fibrosis

Portal Venous Pressure as a Predictor of Mortality in Child’s A Cirrhotic Patients Undergoing Elective Surgery: A Prospective Study

BACKGROUND: Recently, portal venous pressure (PVP) exhibited high sensitivity and specificity in anticipating death in cirrhotic cases submitted to emergency operations. AIM: The current prospective work aimed to evaluate the utility of PVP in predicting 1st month post-operative death in Child’s A cirrhotic cases who underwent elective operations. METHODS: One-hundred and twenty cirrhotic cases that were planned to undergo elective surgery were enrolled in the current prospective work. The intraoperative (I.O) PVP and central venous pressure (CVP) were measured. The statistical analysis was performed using the SPSS version 22.0. The receiver operative curve was plotted to measure the predictive value of PVP. Multivariate analysis was done using logistic regression method for the significant variables impacting mortality on univariate analysis. RESULTS: Twenty-nine patients died in the current work. Patients who survived had statistically considerably lower PVP than patients who died (8.2 ± 1.5 vs. 12.5 ± 1.6 mmHg, respectively, p &lt; 0.001). Similarly, patients who died had significantly higher I.O CVP (p &lt; 0.001), body mass index (p &lt; 0.001), and were more likely to have model for end-stage liver disease score between 9 and 16 (p = 0.003). At a cutoff value ≥10.5 mmHg, the PVP had a sensitivity of 82.8% and specificity of 93.4% for the prediction of mortality. The logistic regression analysis showed that only PVP (odds ratio [OR] =3.1, 95% confidence interval [CI] 1.25–7.5) and CVP (OR = 2.8, 95% CI 1.2–6.5) were the only independent predictors of mortality. CONCLUSION: PVP is a significant predictor of death in Child’s A cirrhotic cases submitted to elective operations

Efficacy of Naltrexone/Bupropion in Treatment of Binge Eating: A Systematic Review and Meta-Analysis

Background: As the most widespread eating disorder in the world now, binge eating disorder (BED) is a mental condition characterized by recurrent periods of excessive food consumption and an inability to regulate one’s portion sizes. The utilization of a bupropion–naltrexone (NB) combination has been suggested as a potential therapeutic approach for BED. Assessing the effectiveness of NB in the treatment of BED and its accompanying obesity is the purpose of this research. Methods: A comprehensive search was conducted in order to obtain any pertinent articles. PubMed, Scopus, Web of Science, and Cochrane Clinical Trials were consulted against in the databases that were searched. In our final meta-analysis, we incorporated interventional or observational studies that documented the effects of NB therapy for binge eating in adults. We also examined the difference in the mean change between the NB and placebo groups, as well as the disparity in outcomes before and after treatment. Results: This study shows that the use of an NB combination is associated with a statistically significant reduction in the weight, BMI, and Binge Eating Scale (BES) of the patients compared to their weight before treatment with MD: −8.52 (95% CI: −10.01–−6.94, p &lt; 0.00001), MD: −4.95 (95%CI: −9.72–−0.17, p = 0.04), and MD: −7.66 (95%CI: −14.36–0.96, p = 0.02), respectively. The absolute mean change was statistically significantly higher in the drug combination group compared to the placebo group. Conclusions: NB showed efficacy in the improvement of the weight and psychiatric symptoms associated with BED and this provides a promising treatment option

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

Investigation of the Ameliorating Effect of Copper Albumin Complex on Lysyl oxidase in monosodium iodoacetate -Induced Knee Osteoarthritis in Rats

Knee osteoarthritis (KOA) is a common type of joint degeneration which causes progressive damage of the joint structure and has less therapeutic options. It has been found that oral consumption of Copper Albumin Complex as anti-inflammatory drug has a positive effect on the treatment of joint deterioration. The present study aimed to investigate the effect of oral administration of Copper Albumin Complex (cu-albumin complex) on Lysyl oxidase (LOX) which acts as a protective factor in KOA. Fifty adult albino rats were divided into 3 groups: negative control (10 normal rats); positive control (20 rats with KOA which left without induction treatment); and treated group (20 rats with KOA which treated with administration of copper albumin complex). Treated and untreated arthritic groups were subdivided equally into mild and severe groups (10 rats for each) according to the severity of clinical signs. KOA was induced by intra-articular injection of monosodium iodoacetate (MIA). At the experimental end, the joints were examined histopathologically and immunohistochemically after cervical dislocation of rats. It was observed that the treatment with CU- was effective in reducing disease severity and in improvement of Lysyl oxidase KOA. It was concluded that Copper albumin complex has a positive effect in the improvement of LOX of Knee joint cartilages of rats affected by osteoarthritis (OA)

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study

Background: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. Aim: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. Methods: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. Results: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. Conclusion: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD

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