Continuous Serratus - Intercostal Plane Block for Perioperative Analgesia in Upper Abdominal Surgeries: A Prospective Randomized Controlled Study

Objective:Acute pain management after open abdominal surgeries is an essential goal in perioperative management.. Recently, serratus-intercostal plane block (SIPB) was suggested as an analgesic technique for upper abdominal surgeries.Methods:This prospective, randomized, controlled study included sixty adult patients scheduled for open upper abdominal surgeries. Patients were allocated into two equal groups: SIPB group (S group, n = 30) and control group (the C group, n = 30). In the S group, SIPB was performed in the midaxillary line at the eighth rib level followed by continuous infusion of local anaesthetic for the first postoperative day. In the C group, no block was done. The primary objective of the study was to control postoperative pain on the first postoperative day as assessed by the numerical rating scale (NRS). Secondary outcomes included perioperative hemodynamics, total postoperative analgesic consumption, number of analgesic requests, and incidence of postoperative nausea and vomiting.Results:The mean postoperative NRS reported in group S was statistically lower than that in group C (2.4±0.7, 3.9±0.31, P < 0.001). The postoperative morphine consumption was lower in the S group than in the C group [(0 (0-4), 3 (1-4), respectively, P < 0.001]. The incidence of PONV was significantly lower in the S group than in the C group (16.7% and 40%, P < 0.045).Conclusion:SIPB was associated with a better analgesic profile compared with the control group after upper abdominal surgeries. Further studies are recommended to determine block safety in special patient groups, including bariatric and laparoscopic surgeries

Safety and efficacy of percutaneous nephrolithotripsy in comorbid patients: A 3 years prospective observational study

Purpose: To report the result of percutaneous nephrolithotripsy (PCNL) via standard nephrostomy tract in a single training institution. The perioperative complications in relation to the comorbid state are particularly assessed. Patients and methods: A prospective interventional study between January 2019 to November 2022, included 210 patients scheduled for PCNL. The average age was 40.3 ± 11.8 years (range 18- 67 years). Patients were categorized into two groups. The first group comprised 146 cases (69 .5%) with no associated co-morbidities while the second group 64 (30.5%) had co-morbidities such as obesity in 4 cases (1.9%), hypertension (HTN) in 24 cases (11.4%) cases, diabetes mellitus (DM) in 17 (8.1%) cases, history of recurrent stone surgery in 11 (5.2%) cases and more than one in 8 cases (3.8%). Co-morbidities, stone burden, location of stone, time of surgery, stay in the hospital, further operations, and negative events were among the reported data. Complications and the stone-free rate were the main outcome indicators. Results: Intraoperative complications were reported in 40 (18.8%) patients (18 group 1 and 22 group 2) during PCNL. Bleeding occurred in 22 (10.5%) patients (9 group 1 and 13 group 2), blood transfusions were needed in 4 (1.9%) (2 group 1 and 2 group 2), extravasation was observed in 11 patients (5.2%) (6 group 1 and 5 group 2) and cardiac arrhythmia in 3 (1.4%) (1 group 1 and 2 group 2) patients. Postoperative complications occurred in 61 patients (29%) (24 group 1 and 37 group 2) in the form of fever in 10 patients (4.8 %) (3 group 1 and 7 group 2) and prolonged leakage in 50 patients (23.8%) (21 group 1 and 29 group 2). One patient of group 2 died from postoperative sepsis. Extravasation and postoperative leakage were higher in diabetic patients than in non-diabetics. Stonefree rate was 60.5% (127 of 210). Clinically significant residual fragments (CSRFs) found in 70 cases (33.3%) (33 group 1 and 37 group 2). In 13 cases (6.2%) (5 group 1 and 8 group 2), clinically insignificant residual fragments (CIRFs) were found. In 8 (3 group 1 and 5 group 2) of the 13 cases, spontaneous stone passage was observed within 4-6 weeks of surgery. Residual stones in three cases (1 group 1 and 2 group 2) were asymptomatic and 4 mm or less, whereas stones increased in two cases of group 2. Among all factors studied, stone burden was significantly correlated to both intraoperative and postoperative complications. The occurrence of postoperative fever increased with large stone burden. Conclusions: PCNL is a therapeutic modality that is effective, feasible, and safe for a wide range of patients with concurrent medical issues. A steep curve is required to reduce intraoperative and postoperative complications

HER2/neu expression status of post BCG recurrent non-muscle-invasive bladder urothelial carcinomas in relation to their primary ones

Background: Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. Objective: To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). Materials and methods: HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. Results: HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). Conclusions: The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor

Development of molecular analytical methods for in situ detection of marine organisms using microfluidic biological sensor technologies

Healthy seas are crucial for the protection of public health and to maximise the economic benefit from the use of the ocean for food production (including from aquaculture), resources, pharmaceuticals, and tourism. Sporadic occurrences of marine harmful algal blooms (HABs), however, can bring calamity to both the health and economic well-being of communities and businesses. In particular, toxigenic blooms can lead to significant harm to marine species and ecosystems, as well as human health and maritime industries. Pseudo-nitzschia is a genus of marine microalgae, belonging to the diatom group, which have been identified as a significant risk to human health and a contributor to ecological degradation from HABs. This is due to the production of domoic acid, a potent neurotoxin that is toxic to marine organisms and mammals. Early detection of domoic acid-producing blooms is necessary to minimise exposure. However, existing methods for discerning Pseudo-nitzschia abundance and the associated risks are long and protracted, labour-intensive and expensive. Pseudo-nitzschia blooms. Subsequently, a suite of novel isothermal assays targeting the dabD gene of Pseudo-nitzschia spp., which is linked to toxin biosynthesis, were designed utilising the LAMP and RPA chemistries. The LAMP assay outperformed the RPA assay in sensitivity and specificity, and its potential use for statutory algal surveillance was demonstrated by measuring Pseudo-nitzschia DNA in seawater samples collected over six months from a known HAB hotspot. To support the potential integration of the novel assays with fieldable instrumentation, a novel ‘Vitrification’ technique was developed for the simple and fast preservation and dry storage of complete reaction mixtures. The ‘shelf-life’ of the preserved reactions was at least six months at room temperature and represents a host of improvements upon existing methods. There were no significant differences in quantification performance between the dry-preserved reagents and freshly prepared reactions that relied on cold- chain-dependent, wet reagents. Finally, a new LOC system referred to as "LAMPTRON" was designed and fabricated from scratch, and developed for real-time detection and quantification of P. multistriata cells in a semi-autonomous fashion. LAMPTRON demonstrates a proof-of-concept for integrating automated DNA extraction with fully preserved DNA analysis, enabling the sensitive detection of toxigenic P. multistriata in a comparable timeframe to the leading commercial systems. These advances offer a faster, more sensitive, and simplified molecular analysis compared to existing statutory surveillance methods, which rely on costly reagents, sophisticated equipment, highly skilled personnel, and centralised laboratories. The ability to detect and quantify Pseudo-nitzschia cells using LOC technology could be modified towards a plethora of microbiological and eDNA targets for the surveillance and early warning of biohazards in aquatic environments. Implementing an early warning system using the state of the art in analytical methods will improve response times, improve accuracy and reduce cost; ultimately this will mitigate risk. Molecular analytical techniques, particularly those based on nucleic acid (DNA or RNA) sequence amplification, are widely adopted in food and water quality assessment, public health protection, and environmental monitoring. These methods can be coupled with portable or deployable instrumentation to provide high integrity, laboratory-quality or better metrology in resource-limited settings. In particular, microfluidic 'lab-on-a-chip' (LOC) technology is at the forefront of de-centralised nucleic acid testing and offers advantages such as reduced reagent and energy consumption, ease of use, rapidity, and stability, all while maintaining high levels of specificity, sensitivity, and precision. Automation of these systems makes analysis possible for non-specialist end-users, increasing their scope of application. This study was undertaken to explore new methods and technology for nucleic acid-based detection of Pseudo-nitzschia towards the provision of an integrated early warning system. It began with the design and testing of novel qPCR-based assay for Pseudo-nitzschia spp. detection and quantification. Then, the assay was combined with a reverse transcription step to investigate RNA-based (gene expression) responses in nutrient-depleted P. multistriata cells to the addition of essential nutrients phosphate, nitrate, and silicate. Nutrient availability was found to significantly influence domoic acid production, highlighting the relationship between nutrient availability and the toxic threat posed by Pseudo-nitzschia blooms. Subsequently, a suite of novel isothermal assays targeting the dabD gene of Pseudo-nitzschia spp., which is linked to toxin biosynthesis, were designed utilising the LAMP and RPA chemistries. The LAMP assay outperformed the RPA assay in sensitivity and specificity, and its potential use for statutory algal surveillance was demonstrated by measuring Pseudo-nitzschia DNA in seawater samples collected over six months from a known HAB hotspot. To support the potential integration of the novel assays with fieldable instrumentation, a novel ‘Vitrification’ technique was developed for the simple and fast preservation and dry storage of complete reaction mixtures. The ‘shelf-life’ of the preserved reactions was at least six months at room temperature and represents a host of improvements upon existing methods. There were no significant differences in quantification performance between the dry-preserved reagents and freshly prepared reactions that relied on cold- chain-dependent, wet reagents. Finally, a new LOC system referred to as "LAMPTRON" was designed and fabricated from scratch, and developed for real-time detection and quantification of P. multistriata cells in a semi-autonomous fashion. LAMPTRON demonstrates a proof-of-concept for integrating automated DNA extraction with fully preserved DNA analysis, enabling the sensitive detection of toxigenic P. multistriata in a comparable timeframe to the leading commercial systems. These advances offer a faster, more sensitive, and simplified molecular analysis compared to existing statutory surveillance methods, which rely on costly reagents, sophisticated equipment, highly skilled personnel, and centralised laboratories. The ability to detect and quantify Pseudo-nitzschia cells using LOC technology could be modified towards a plethora of microbiological and eDNA targets for the surveillance and early warning of biohazards in aquatic environments. <br/

Experimental investigation of methyl-orange removal using eco-friendly cost-effective materials raw fava bean peels and their formulated physical, and chemically activated carbon

The discharge of effluents from dye industries into water streams poses a significant environmental and public health risk. In response, eco-friendly adsorbents derived from agricultural waste, such as Fava Bean Peels (R–FBP), have been investigated as potential materials for the removal of such pollutants. In this study, R–FBP and their corresponding physical and chemically activated carbon (P-RFB-AC and C-FBP-AC) were synthesized using H3PO4 acid and characterized using FT-IR, and SEM analyses. An optimization process was conducted to determine the optimum conditions for achieving high Methyl Orange (M. Orange) removal efficiencies using the prepared materials, namely R–FBP, P-RFB-AC, and C-FBP-AC. The adsorption mechanism was examined by analyzing the isotherm and kinetics. The results revealed that the physical raw-activated carbon exhibited the highest removal efficiency of 96.8% compared to other materials. This outcome was achieved through the use of ANN combined with Moth Search Algorithm (MSA), which was found to be the most effective model for achieving the highest M. Orange removal efficiency from Physical raw fava bean activated carbon. Under parameters of 1000 mg/l M. Orange concentration, 2 g/l dose, 15 min contact time, and 120 rpm shaking, the best experimental and predicted removal efficiencies for physical-activated carbon fava bean rind were 96.8 RE%, 96.01 indicated RSM RE%, and 95.75 predicted ANN RE%. The highest experimental and predicted removal efficiencies for the H3PO4 chemical activated carbon fava bean peel were 94%RE. This study aimed to develop an economical solution for treating industrial wastewater contaminated with anionic M. Orange dye using raw fava bean peel and their generated activated carbon, in both physical and chemical forms. The Temkin and Langmuir isotherm models were found to best fit the data for raw fava bean peel, while Temkin agreed well with the data from physical-activated carbon. Temkin and Freundlich's models were fitted with the H3PO4 chemical activated carbon. Pseudo-second-order kinetics was identified as the most suitable model for both physically and chemically activated carbons. Future research may explore the capacity of the produced activated carbon-based algae to extract a wider range of contaminants from contaminated wastewater. In summary, this work contributes to the development of eco-friendly and cost-effective methods for removing dyes, specifically M. Orange, from industrial effluents. By synthesizing and characterizing R–FBP and their relative activated carbon, the adsorption mechanism was studied, and the optimum conditions for achieving high M. Orange removal efficiencies were determined. The results showed that physical raw-activated carbon exhibited the highest removal efficiency, and pseudo-second-order kinetics was the most suitable model for both physically and chemically activated carbon

Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases

Introduction. The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation. Material and Methods. A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients’ demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients. Results. Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time, P < 0.0005; intraoperative blood loss, P < 0.0005; preoperative renal impairment, P = 0.001; and graft-to-recipient weight ratio (as a negative predictor), P < 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of <0.91. Conclusion. In this study, prolonged operative time and small graft-to-recipient weight ratio were independent predictors of chronic kidney disease at 1 year after living-donor liver transplantation

Enhanced removal of crystal violet using rawfava bean peels, its chemically activated carbon compared with commercial activated carbon

Crystal violet is a basic dye that is widely used by various industries, such as textiles and paints. These industries discharge their effluents, contaminated with crystal violet, into water streams, and these effluents have an adverse effect on aquatic organisms, the environment, and human health. Crystal violet is a basic dye that is widely used by various industries, such as textiles and paints. These industries discharge their effluents, contaminated with crystal violet, into water streams, and these effluents have an adverse effect on aquatic organisms, the environment, and human health. Hence, this paper is directed at studying the removal of crystal violet using environmentally friendly, cost-effective adsorbent materials such as raw fava bean (RFP-H3F), and chemically activated carbon (H3F) in comparison to commercial activated carbon (CAC).Various characterization techniques are applied, such as XRD, FT-IR,and SEM analyses. Then, the process of optimizing is shown through some preliminary experiments and a Response Surface Methodology (RSM) experiment to find the best conditions for removing crystal violet efficiently. Results revealed that the raw fava bean peels and the commercial activated carbon have the maximum removal efficiency of 95 %, and 83 % respectively, after 180 min of contact time. It is hypothesized that raw fava bean peels (RFP) and chemically activated carbon using phosphoric acid RFP-H3F will exhibit comparable efficiency in removing crystal violet when compared to commercial activated carbon (CAC). Various characterization techniques, including X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR),and scanning electron microscopy (SEM), are applied to analyze the properties of the adsorbent materials. Afterwards, the optimization process is displayed through some preliminary experiments followed by a Response Surface Methodology (RSM) experiment to obtain the optimum conditions, which achieve high crystal violet removal efficiency. The results demonstrate that both raw fava bean peels and commercial activated carbon exhibit significant removal efficiencies, with raw fava bean peels achieving a maximum removal efficiency of 95 % and commercial activated carbon achieving 83 %

Automated control of end-tidal sevoflurane in living donor hepatectomy, a prospective, randomized, controlled study

Background: Reduction of anesthesia cost has become a necessity, especially in developing countries. Recently, automated control of end-tidal sevoflurane concentration (EtSev) has been proposed as a new technique with both cost-effectiveness and safety profiles. In this study, sevoflurane consumption (primary outcome variable) was evaluated during living donor hepatectomy using automated control of EtSev (EtC) at fresh gas flow (FGF) of 0.5 and 2 L/min compared to manual control (MC) technique at FGF of 2 L/min. Materials and methods: Prospective, randomized, controlled trial including 60 Potential donors scheduled for living donor right hepatectomy. patients were randomized into 3 equal groups (according to target control of sevoflurane), MC group, EtC-2L group, and EtC-0.5L group. In MC group: FGF was set to 2 L/min, inspired concentration of Sevoflurane (FiSev) was set to 1.5–2% in 0.4 fractional inspired oxygen concentration (FiO2), while in EtC-2L group: FGF was set to 2 L/min, EtSev was set to 1–1.5% with end tidal oxygen concentration (EtO2) target of 0.35. In EtC-0.5L group, FGF was set to minimal flow and EtSev target to 1–1.5% and EtO2 target of 0.35. Anesthetic gases consumption (sevoflurane ml, Oxygen L, and air consumption L) per anesthesia hour were recorded at the end of surgery. Other recorded data included intraoperative hemodynamics, the number of user adjustments, and extubation time. Results: Significant reduction in sevoflurane consumption when EtC-0.5L is used (4.2 ± 1.3 ml/h, 12.6 ± 2.6 ml/h, and 15 ± 2.9 ml/h respectively, p. 0.001). Also, a significant decrease in overall numbers of user adjustments between the three groups (8 times for EtC-0.5L group, 7 times in EtC-2L group, 22 times for MC group, p. 0.008) was observed. Conclusion: automated control of EtSev during anesthesia of living donor hepatectomy significantly lowers sevoflurane consumption and decreases required user interventions without deleterious effect on patient safety

Urethral advancement and glanuloplasty versus tubularized incised plate urethroplasty for distal hypospadias repair: a prospective randomized study

Abstract Background About one in 200 to one in 300 male births has hypospadias. The prevalence of this congenital anomaly varies worldwide. The meatus is located distally in approximately 70% of cases. Several surgical techniques were described for distal hypospadias repair; despite this, there is no ideal approach. This study compares urethral advancement &glanuloplasty, and TIP techniques in terms of feasibility, duration of operation, and complications. Patients and. Methods This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for eligibility. Among them, seven cases were excluded due to the presence of severe chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups using a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to urethral advancement and glanuloplasty, and the rest were subjected to tubularized incised plate (TIP) urethroplasty. Results The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or sub-coronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups regarding duration of operation, postoperative pain, and postoperative hospital stay. In addition, both groups did not differ significantly in late complications (meatal stenosis, meatal retraction, fistula, and glans dehiscence). Conclusions Both urethral advancement &glanuloplasty, and TIP urethroplasty have comparable short-term outcomes. Urethral advancement and glanuloplasty is preferred in certain conditions, especially in circumcised children or those with a narrow urethral plate. Trial registration The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) on (29/11/2022). All procedures were performed per the Helsinki Declaration

Quantitative polymerase chain reaction for the estimation of toxigenic microalgae abundance in shellfish production waters

Certain species of marine microalgae produce potent biotoxins that pose a risk to human health if contaminated seafood is consumed, particularly filter feeding bivalve shellfish. In regions where this is likely to occur water and seafood produce are regularly monitored for the presence of harmful algal cells and their associated toxins, but the current approach is flawed by a lengthy delay before results are available to local authorities. Quantitative Polymerase Chain Reaction (qPCR) can be used to measure phytoplankton DNA sequences in a shorter timeframe, however it is not currently used in official testing practices. In this study, samples were collected almost weekly over six months from three sites within a known HAB hotspot, St Austell Bay in Cornwall, England. The abundance of algal cells in water was measured using microscopy and qPCR, and lipophilic toxins were quantified in mussel flesh using LC-MS/MS, focusing on the okadaic acid group. An increase in algal cell abundance occurred alongside an increase in the concentration of okadaic acid group toxins in mussel tissue at all three study sites, during September and October 2021. This event corresponded to an increase in the measured levels of Dinophysis accuminata DNA, measured using qPCR. In the following spring, the qPCR detected an increase in D. accuminata DNA levels in water samples, which was not detected by microscopy. Harmful algal species belonging to Alexandrium spp. and Pseudo-nitzschia spp. were also measured using qPCR, finding a similar increase in abundance in Autumn and Spring. The results are discussed with consideration of the potential merits and limitations of the qPCR technique versus conventional microscopy analysis, and its potential future role in phytoplankton surveillance under the Official Controls Regulations pertaining to shellfish