Bearing Capacity of Driven Open-Ended Pipe Piles in Weak Soil Formations

Steel pipe piles have been increasingly used as deep foundations for offshore or onshore structures in weak soil formations. These piles are usually open-ended and installed to their final level using suitable hammers or vibrators relying on the subsurface conditions. Simultaneously, the soil plug (SP) forms inside the employed pipe pile during driving or installation. Moreover, it affects bearing behavior and total pile resistance. The experimental tests have been performed on a single tube pile. All tube piles were tested using the well-graded sand collected from the Egyptian desert, and the sand was prepared at medium density using a raining technique. The outcomes of the model pile tests showed that the value of plug resistance in open-ended pipe pile (OEPP) is typically on the order of 50% to 70% of the total pile load of OEPP, and it is influenced by pile thickness, pile diameter, pile length, and submerged state. Simultaneously, the plugging influence of OEPP increased with increasing pile thickness and embedded pile length. However, the plugging influence decreased with increasing pile diameter. The total pile load of OEPP increased with increasing the embedded pile length. It must be noted that the influence of pile length on the total pile load is greater than the influence of pile diameter; this refers to the pile length having a significant effect on the total pile load. This is due to an increase in the influence of SP

In vitro Anti-Leishmania Activity and Safety of Newly Synthesized Thiazolo Pyrimidine Derivatives Augmented with Interleukine-12 (IL-12) in BALB/c Mice Experimentally- Infected with Cutaneous Leishmaniasis

Purpose: To synthesize a series of novel thiazolo pyrimidine derivatives and evaluate them in vitro and in vivo for their safety and anti-leishmanial activity using BALB/c mice.Methods: Substituted pyrazolopyrimidine and pyrazolopyrazole were synthesized by reacting amino group of 2-amino-4-cyano-pyrazol]naphthalino[1,2-d]thiazole with a variety of formamide or hydrazine hydrate. The synthesized compounds were characterized by nuclear magnetic resonance spectroscopy (1H-NMR) and mass spectroscopy (MS). The purity of the compounds was determined by elemental analysis. Safety and anti-leishmanial activity of the compounds were determined in vitro by i) viability assessment of leishmania-infected macrophages, relative abundance of IL-12p40 mRNA gene expression and levels of IL10 /IL-12 determination in supernatants of cultured macrophages treated with 2.5 and 10 μM of the compounds, using microscope cell counting, reverse transcriptase polymerase chain reaction (RT-PCR) and enzyme linked immunosorbent assay (ELISA), respectively. ii) cytotoxicity of the compounds evaluated by determination the safety index as IC50 of the compound in macrophages/IC50 of the compound in amastigotes. iii) bioassay at 16 weeks post-infection of mice treated with the reference drug, the tested compound alone and both the compound with IL-12. Disease progression and footpad thickness were evaluated regularly during treatment.Results: Compound 4 emerged as the most active anti-protozoal compound of the series against Leishmania viability (activity 60 %) compared with the reference drug (activity 65 %). When it was combined with IL-12, the activity reached 90 %.Conclusion: Compound 4 can serve as a lead molecule for further development to a clinically useful novel class of agents.Keywords: Thiazolopyrimidine, Synthesis, Leishmaniasis, Mice, Immunotherap

PRONE VENTILATION IN INTUBATED COVID-19 PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION: Prone ventilation is a well-established strategy in patients with severe ARDS as it has been shown to improve survival and mortality. However, in intubated patients with COVID-19 pneumonia, the data are limited, with no substantial evidence supporting its use. This meta-analysis is the first to examine the mortality benefit of prone ventilation in intubated COVID-19 patients. METHODS: A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in Medline, Embase, and Web of Science databases was conducted in January 2022 for published studies assessing the mortality benefit of prone ventilation in intubated COVID-19 patients. RESULTS: Four hundred sixty-seven studies were identified. Of those, five studies met the inclusion criteria studies were included. The total number of patients included in the studies was 4247 patients. In four studies, ARDS prevalence was reported. The prone group had a higher prevalence of severe ARDS rates than the supine group. No significant difference was found between prone or supine groups in ICU mortality (OR: 1.39; 95%CI: 0.80-2.43; p=0.24). Regarding overall mortality, No difference was detected between the prone or the supine groups (OR: 1.04; 95%CI: 0.57-1.87; p = 0.9), with significant heterogeneity (I2= 93; p \u3c 0.001). The length of hospital stay (LOS) was reported in two studies. Our analysis showed that LOS did not differ between the prone and supine groups (SMD: 0.77; 95%CI: -0.33-1.86; p=0.17). CONCLUSIONS: Prone ventilation in intubated COVID-19 patients does not offer a mortality benefit. Randomized controlled trials are warranted to confirm this finding and clarify whether specific subpopulations may benefit from prone ventilation

Prone Vs. Supine Position Ventilation in Intubated COVID-19 Patients: A Systematic Review and Meta-Analysis

Whether prone positioning of patients undergoing mechanical ventilation for COVID-19 pneumonia has benefits over supine positioning is not clear. We conducted a systematic review with meta-analysis to determine whether prone versus supine positioning during ventilation resulted in different outcomes for patients with COVID-19 pneumonia. We searched Ovid Medline, Embase, and Web of Science for prospective and retrospective studies up through April 2023. We included studies that compared outcomes of patients with COVID-19 after ventilation in prone and supine positions. The primary outcomes were three mortality measures: hospital, overall, and intensive care unit (ICU). Secondary outcomes were mechanical ventilation days, intensive care unit (ICU) length of stay, and hospital length of stay. We conducted risk of bias analysis and used meta-analysis software to analyze results. Mean difference (MD) was used for continuous data, and odds ratio (OR) was used for dichotomous data, both with 95% CIs. Significant heterogeneity (I(2)) was considered if I(2) was \u3e50%. A statistically significant result was considered if the p-value was \u3c0.05. Of 1787 articles identified, 93 were retrieved, and seven retrospective cohort studies encompassing 5216 patients with COVID-19 were analyzed. ICU mortality was significantly higher in the prone group (OR 2.22, 95% CI 1.43-3.43; p=0.0004). No statistically significant difference was observed between prone and supine groups for hospital mortality (OR, 0.95; 95% CI, 0.66-1.37; p=0.78) or overall mortality (OR, 1.08; 95% CI, 0.72-1.64; p=0.71). Studies that analyzed primary outcomes had significant heterogeneity. Hospital length of stay was significantly higher in the prone than in the supine group (MD, 6.06; 95 % CI, 3.15-8.97; p\u3c0.0001). ICU length of stay and days of mechanical ventilation did not differ between the two groups. In conclusion, mechanical ventilation with prone positioning for all patients with COVID-19 pneumonia may not provide a mortality benefit over supine positioning

Impact of the follicular fluid Coenzyme Q10 level in women undergoing intracytoplasmic sperm injection (ICSI) on the pregnancy rate

Background: The most crucial problem with in vitro fertilization (IVF) cycles is still oocyte quality. The women age and the condition of their ovarian reserve are the primary determinants of oocyte quality. Objectives: to assess the effects of intracytoplasmic sperm injection (ICSI) on the result of pregnancies and the coenzyme Q10 (CoQ10) value in follicular fluid (FF) in the women who had the procedure. Patients and methods: this cohort investigation was conducted on 81 infertile patients (age between 20-42 years, both normal or poor responders’ patients and patients with unexplained infertility) who underwent ICSI cycles. Results: patients were divided into two groups: the pregnant group (n= 32) and the non-pregnant group (n= 49).There was a statistically insignificant difference in antral follicle count (AFC), number of retrieved oocytes, number of embryos, number of metaphase II (MII) oocytes, and maturation index between pregnant and non-pregnant females. CoQ10 level in FF was substantially greater in pregnant than non-pregnant females. Conclusion: FF CoQ10 levels were positively correlated with eventual embryo quality and rates of conception. Our findings might be in favour of CoQ10 supplementation in women undergoing IVF for enhancement of the ovum and embryo quality

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 years; 78.2% included were male with a median age of 37 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

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

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

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks