Persistent Mullerian duct syndrome: the hidden normal or abnormal anatomy and the value of laparoscopy

Persistent Mullerian duct syndrome (PMDS) is a rare disorder of male sexual development. It is characterized by the presence of a uterus, fallopian tubes, and upper vagina in an otherwise phenotypically and genotypically normal male. This malformation is usually an incidental finding during the operative treatment of other more common abnormalities such as inguinal hernia or undescended testes. Not uncommonly, it is seen in association with transverse testicular ectopia. This report describes a case of PMDS in association with transverse testicular ectopia diagnosed at the time of laparoscopy for undescended testes. Physicians caring for these patients should be aware of this and surgeons should be familiar with the different surgical options. PMDS should be considered in all cases of bilateral undescended testes. Aspects of diagnosis and management are also discussed. Keywords: inguinal hernia, laparoscopy, persistent mullerian duct syndrome, transverse testicular ectopia, undescended teste

Abnormalities of intestinal rotation and congenital intrinsic duodenal obstruction

Background Congenital duodenal obstruction (CDO) is a unique anomaly with variable presentation depending on the site, type of obstruction, as well as the presence ofassociated anomalies. This is a review of our experience with 51 infants and children with CDO, stressing on the importance of associated rotational abnormalities of the gut.Methods Over a period of 18 years (January 1993– December 2011), 51 infants and children with CDO were treated at our hospital. Their medical records were reviewed retrospectively for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment, and outcome.Results Fifty-one (27 boys and 24 girls) infants and children with intrinsic CDO were treated. Their birth weight ranged from 1.38 to 3.8 kg (mean 2.3 kg). Sixteen (31.4%)were premature. The mean maternal age was 25 years (range 18–40 years). Seven presented at 5 months, 18 days, 3.5 years, 1.8 years, 18 days, 1.5 years, and 2 months of age, respectively. Associated anomalies were observed in 34 (66.7%) of them. Sixteen (31.4%) had Down’s syndrome and 11 (21.6%) had congenital heart disease. Nine (17.6%) had rotational abnormalities of the gut, including two with situs inversus. The site of duodenal obstruction was located in the second part of duodenum in 48 (94%) of them. In two, the site of obstruction was in the fourth part of duodenum, whereas in the third it was located in the third part of duodenum. The causes of obstruction were duodenal atresia in 20 (39.2%), without a gap in eight (15.7%) and with a gap in 12 (23.5%), duodenal stenosis in 11 (21.6%), and duodenal diaphragm in 20 (39.2%). In 14 (27.5%) patients, an annular pancreas was observed. The different operative procedures were as follows: duodenoduodenostomy in 26; excision of the duodenal diaphragm and duodenoplasty in 12; Ladd’s procedure, excision of the duodenal diaphragm, duodenoplasty, and appendectomy in four; Ladd’s procedure, appendectomy, and duodenoduodenostomy in two; and duodenojejunostomy in seven. Two underwent reduction duodenoplasty to decrease the size of the duodenum. Three required reoperations, two because of an anastomotic leak and another because of duodenal dysfunction. Sixteen (31.4%) required total parenteral nutrition. Four died, resulting in an overall survival of 92.2%.Conclusion CDO is classified as intrinsic and extrinsic depending on the cause. Rotational abnormalities including situs inversus are among the rare but interesting anomalies associated with intrinsic CDO. The presence of malrotation or nonrotation with congenital bands does not exclude the presence of an associated intrinsic cause, which should be looked for intraoperatively. This is to obviate the possibility of further subsequent operative treatment. Keywords: congenital duodenal obstruction, duodenal diaphragm, malrotation, situs inversu

Morbidity and Mortality in Esophageal Atresia and Tracheoesophageal Fistula: A 20-Year Review

Background: The outcome of newborns with esophageal atresia (EA) and tracheoesophageal fistula (TEF) has improved considerably. At present, the overall survival rates reported from developed countries are between 85 and 95%. This, however, is not the case from developing countries, where several factors contribute to higher morbidity and mortality rates. This study is an analysis of our experience with 158 patients of EA and TEF, with emphasis on factors contributing to morbidity and mortality.Patients and methods: This is a retrospective study of 158 patients with EA and TEF treated over a period of 20 years (between January 1992 and December 2011). Their records were reviewed, the study period was divided into two equal periods, and the results were analyzed accordingly.Results: A total of 158 patients (89 boys and 69 girls) with EA/TEF were treated. Their mean birth weight was 2.4 kg (700–3800 g). Their ages at diagnosis ranged from newborn to 8 months. Their gestational age ranged from 32 weeks to 41 weeks. Contrast study was used in 45 (28.5%) patients. Aspiration pneumonia was detected in 34.8% patients. The distribution of the number of patients according to the type of EA/TEF was as follows: 132 (83.5%) patients had EA with distal TEF, 14 (8.9%) had pure EA, five (3.2%) had EA with proximal and distal TEF, five (3.2%) had H-type TEF, and two (1.3%) had EA with proximal TEF. Forty-one (22.2%) patients had long-gap EA/TEF. Associated anomalies were seen in 82 (51.9%) patients, and 17 (10.8%) patients had severe anomalies. The postoperative complications included: anastomotic leak in 20 patients (12.7%), stricture in 22 (13.9%),gastroesophageal reflux in 18 (11.4%), tracheomalacia in two (1.3%), and recurrent TEF in one (0.6%). However, there was a marked decrease both in mortality and morbidity during the second period of the study. In our study, the overall mortality rate was 20.9%, but if those with severe associated anomalies were excluded, our postoperative mortality rate was 8.4%. Sepsis was the main cause of death.Conclusion: This is a relatively large series from a developing country. Although our postoperative complication rates were similar to those from developed countries, the overall mortality was higher. There was, however, a marked improvement during the second period of the study. This is attributed to a better understanding, early diagnosis, prompt referral, and better surgical techniques. Prematurity, sepsis, and associated severe malformations were the main causes of death. Once major anomalies responsible for death were excluded, our postoperative mortality rate was 8.4%. Sepsis continues to be a major cause of death, and several factors contribute to this, including prematurity and delayed diagnosis with increased incidence of aspiration pneumonia. To decrease the mortality rate, these factors should be addressed, and every effort should be made to overcome them. Patients with long-gap EA/TEF continue to be a management challenge, and every attempt should be made to preserve the native esophagus. Delayed primary repair and/or esophageal stretching are at present the preferred techniques with good long-term functional results.Keywords: Complications, Esophageal Atresia, Morbidity and Mortality, Tracheoesophageal Fistul

Empathic skills training as a means of reducing cyberbullying among adolescents: an empirical evaluation

Cyberbullying is a form of aggression in which electronic communication such as e-mails, mobile phone calls, text messages, instant messenger contacts, photos, social networking sites and personal webpages are used to threaten or intimidate individuals. Cognitive-behavioral therapy (CBT) counselling based on empathic training may reduce cyberbullying among adolescents. The present study investigated the impact of developing empathy skills in reducing cyberbullying among a sample of adolescents using two groups (i.e., an experimental group and control group). The experimental group received counselling intervention based on CBT with special focus on improving empathy whereas the control group received CBT general counselling. The participants comprised 217 adolescents (experimental group = 98 adolescents, control group = 119 adolescents) with a mean age of 15.1 years (SD ± 1.5). The measures included the Toronto Empathy Questionnaire (TEQ) and the Bullying, Cyberbullying Scale for Adolescents (BCS-A). Results showed that there were statistically significant differences on TEQ scores and BCS-A scores in the experimental and control groups after the intervention but more so in favor of the experimental group in terms of reduced levels of cyberbullying (both victimization and perpetration). Positive gains among the experimental group in both empathy and reduced cyberbullying remained at two-month follow-up. It is recommended that teachers and school counselors tackling cyberbullying should use empathy training as part of their cyberbullying prevention programs

Post-Harvest Enhancing and Botrytis cinerea Control of Strawberry Fruits Using Low Cost and Eco-Friendly Natural Oils

This is the final version. Available from MDPI via the DOI in this record.This work investigates an experimental study for using low-cost and eco-friendly oils to increase the shelf life of strawberry fruit. Three natural oils were used: (i) Eucalyptus camaldulensis var obtuse, (ii) Mentha piperita green aerial parts essential oils (EOs), and (iii) Moringa oleifera seeds n-hexane fixed oil (FO). Furthermore, a mixture of EOs from E. camaldulensis var obtusa and M. piperita (1/1 v/v) was used. The treated fruits were stored at 5 °C and 90% relative humidity (RH) for 18 days. HPLC was used to analyse the changes in phenolic compounds during the storage periods. The effects of biofumigation through a slow-release diffuser of EOs (E. camaldulensis var obtusa and M. piperita), or by coating with M. oleifera FO, were evaluated in terms of control of post-harvest visual and chemical quality of strawberry fruits. The post-harvest resistance of strawberry fruits to Botrytis cinerea fungal infection was also evaluated. As a result, the EO treatments significantly reduced the change in visual and chemical quality of strawberry fruit. Additionally, changes in the titratable acidity of moringa FO-coated strawberry fruits were delayed. EO treatments improved total soluble solids, total phenols, ascorbic acid, antioxidants and peroxidase. E. camaldulensis var obtusa and M. piperita (1/1 v/v) EO-vapour fruit exhibited a slower rate of deterioration, compared to other treatments in all tested, in two experiments. The lowest colour change (ΔE) was observed inthe fruit treated with E. camaldulensis var obtusa EO and M. oleifera FO. HPLC showed changes in phenolic compounds’ concentration, where p-coumaric acid, caffeic acid, gallic acid, ferulic acid and ellagic acid were mostly identified in the fruits treated with the oils. SEM examination confirmed the potential decrease in fungal growth as the fruits were treated with EOs. In conclusion, the treatment of EOs during different storage periods showed promising characterisations for strawberry fruit quality.Deanship of Scientific Research, King Saud Universit

Low Spigelian hernia in a 6-year-old boy presenting as an incarcerated inguinal hernia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.</p> <p>Case presentation</p> <p>We discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.</p> <p>Conclusion</p> <p>Although Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.</p

Consanguinity and reproductive health among Arabs

Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity

Neglected Tropical Diseases of the Middle East and North Africa: Review of Their Prevalence, Distribution, and Opportunities for Control

The neglected tropical diseases (NTDs) are highly endemic but patchily distributed among the 20 countries and almost 400 million people of the Middle East and North Africa (MENA) region, and disproportionately affect an estimated 65 million people living on less than US$2 per day. Egypt has the largest number of people living in poverty of any MENA nation, while Yemen has the highest prevalence of people living in poverty. These two nations stand out for having suffered the highest rates of many NTDs, including the soil-transmitted nematode infections, filarial infections, schistosomiasis, fascioliasis, leprosy, and trachoma, although they should be recognized for recent measures aimed at NTD control. Leishmaniasis, especially cutaneous leishmaniasis, is endemic in Syria, Iran, Iraq, Libya, Morocco, and elsewhere in the region. Both zoonotic (Leishmania major) and anthroponotic (Leishmania tropica) forms are endemic in MENA in rural arid regions and urban regions, respectively. Other endemic zoonotic NTDs include cystic echinococcosis, fascioliasis, and brucellosis. Dengue is endemic in Saudi Arabia, where Rift Valley fever and Alkhurma hemorrhagic fever have also emerged. Great strides have been made towards elimination of several endemic NTDs, including lymphatic filariasis in Egypt and Yemen; schistosomiasis in Iran, Morocco, and Oman; and trachoma in Morocco, Algeria, Iran, Libya, Oman, Saudi Arabia, Tunisia, and the United Arab Emirates. A particularly noteworthy achievement is the long battle waged against schistosomiasis in Egypt, where prevalence has been brought down by regular praziquantel treatment. Conflict and human and animal migrations are key social determinants in preventing the control or elimination of NTDs in the MENA, while local political will, strengthened international and intersectoral cooperative efforts for surveillance, mass drug administration, and vaccination are essential for elimination

Influence of leaf trichome type, and density on the host plant selection by the greenhouse whitefly, Trialeurodes vaporariorum (Hemiptera: Aleyrodidae)

Host selection by adult greenhouse whitefly Trialeurodes vaporariorum (Westwood) was assessed on two pelargonium plant cultivars, Pelargonium x domesticum (regal) and P. x hortorum (zonal) using Petri dish bioassay chambers in choice and no-choice tests. Plant characteristics which could influence the oviposition preference of the whitely i.e., type and density of trichomes on the abaxial leaf surface was determined. A strong host preference was observed for the regal compared to the zonal pelargonium by the adult whiteflies. In no-choice tests, adults laid a significantly higher number of eggs on regal than on zonal leaves both at 24 and 48 hours post-exposure, respectively. After exposure to the adult whitefly, the number of 42 eggs in choice tests were similar between cultivars at 24 hours, but were higher for regal at 48 and 72 hours. The total number of trichomes (sng: straight non-glandular + sg: straight glandular) per 0.50 cm2 44 was significantly less on regal (Mean ± SE sng + sg; 43.1 ± 1.5) than on zonal leaves (60.5 ± 1.2); however, the sng trichomes were significantly higher on the zonal (49.4 ± 0.96) than the regal leaves (28.6 ± 1.00). Also, the number of sg trichomes was slightly higher for the regal cultivar leaves compared to the zonal, being 14.4 ± 1.2 and 11.2 ± 0.5, respectively. Results suggest that the trichome density, type and the ability to express glandular exudates can affect adult whitefly Pelargonium cultivar preference and plays an important role in their host plant selection for oviposition