EFFICACY OF DICLOFENAC SODIUM VERSUS SOMATOSTATIN FOR THE PREVENTION OF PANCREATITIS IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure performed with a side view scope that can be either diagnostic or therapeutic. Endoscopic procedure as with other medical procedures has both minor and major complications. The most common major complication of ERCP is pancreatitis, with a prevalence of 1% to 40%. Aim: to assess the efficacy of diclofenac sodium versus somatostatin for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: the present study was carried out as an interventional study on 75 patients with evidence of biliary obstruction accepted for ERCP, divided into 3 groups. Group I included 25 patients as control group, group II included 25 patients who were administered 100 mg of diclofenac sodium administered rectally 30 minutes before ERCP and group III included 25 patients who were administered a single bolus injection of 250 mcg somatostatin 30 minutes before ERCP and these groups were compared regarding efficacy of diclofenac sodium versus somatostatin for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Results: there was no statistically difference between the study groups as regards the occurrence of post-ERCP pancreatitis. The incidence of post-ERCP pancreatitis was 13.3%. Post-ERCP pancreatitis occurred in 5 cases (20%) of the first group, 2 cases (8%) of the second group, 3 cases (12%) of the third group. No risk factors for post-ERCP pancreatitis were statistically significant. Conclusion: there was no statistically difference between the study groups as regards the occurrence of post-ERCP pancreatitis

Management of hepatitis C virus genotype 4: recommendations of an international expert panel.

HCV has been classified into no fewer than six major genotypes and a series of subtypes. Each HCV genotype is unique with respect to its nucleotide sequence, geographic distribution, and response to therapy. Genotypes 1, 2, and 3 are common throughout North America and Europe. HCV genotype 4 (HCV-4) is common in the Middle East and in Africa, where it is responsible for more than 80% of HCV infections. It has recently spread to several European countries. HCV-4 is considered a major cause of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation in these regions. Although HCV-4 is the cause of approximately 20% of the 170 million cases of chronic hepatitis C in the world, it has not been the subject of widespread research. Therefore, this document, drafted by a panel of international experts, aimed to review current knowledge on the epidemiology, natural history, clinical, histological features, and treatment of HCV-4 infections

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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Essentials of Abdominal Ultrasound

Abdominal ultrasound is a bedside diagnostic tool that helps to discover many abdominal problems. It is a safe and painless procedure that has proven extremely useful for patient workup and diagnosis. This book illustrates the use of ultrasound for all the various organs of the abdomen. Each chapter covers a different organ and presents the latest knowledge and techniques of imaging. The content contained within is relevant across many specialties, including radiology and internal medicine, and is useful for physicians and medical residents and students alike

A randomized controlled trial for comparing the results of early endoscopic retrograde cholangiopancreatography and conservative treatment in patients with acute gallstone pancreatitis

Introduction: Gallstone pancreatitis is one of the most dangerous complications of gallstone disease with a high risk of complications and death. Therefore, accurate diagnosis and timely management of acute gallstone pancreatitis are very important. Most guidelines recommend urgent ERCP in cases of biliary obstruction with cholangitis. However, the best time to perform an ERCP in patients suffering from acute gallstone pancreatitis without cholangitis is not universally agreed upon. Aim: The purpose of this study was to compare the outcomes of early ERCP versus conservative management in patients with acute gallstone pancreatitis in terms of complications, mortality, and length of hospital stays. Materials and Methods: A randomized controlled trial was carried out at the Suez Canal University Hospitals between January 2020 and January 2022. After meeting the inclusion criteria, forty patients were enrolled in this study and were allocated randomly into ERCP and Conservative groups. A written informed consent form was taken from all patients. Patient demographics, symptoms, and a detailed history were all collected. Laboratory tests were performed and reported. ERCP's findings were reported. A total of 40 patients were included in the study. The average age was 42 years in the ERCP group and 39 in the conservative group

Correlation between diabetes mellitus and the clinical outcome of acute variceal bleeding in cirrhotic patients in Suez Canal University Hospital, Ismailia, Egypt

Variceal bleeding is one of the major complications of portal hypertension. Gastro-esophageal varices are present 40-60% of patients with cirrhosis; bleeding occurs in 25-35% of patients and account for 80-90% of bleeding episodes in these patients. Hepatic venous pressure gradient (HVPG) > 20 mmHg is associated with early re-bleed and failure to control bleeding (83%) with high mortality (64%) In the last two decades variceal re-bleeding has decreased from 47% to 13% with the use of pharmacological, endoscopic, and radiological intervention.DM co-existing with cirrhosis is considered to be one of the factors in the genesis of variceal bleeding. This may be due to an increase in portal blood flow. is to determine the correlation between DM as a risk factor and failure to control variceal bleeding and re-bleeding in cirrhotic patients. This study is a case-control study, sixty cirrhotic patients with variceal bleeding with or without DM were included in the study. The patients were divided into two groups: Group 1 (diabetic group): this group included 30 cirrhotic patients with variceal bleeding and had a history of DM. Group 2 (control group): this group included 30 cirrhotic patients with variceal bleeding and had no history of DM. All Patients were subjected to the following:-Complete clinical evaluation (history and physical examination) with Laboratory and imaging investigations. Tthere were significantly higher frequency of unstable course and mean times of previous admission in diabetic patients than control patients (73.3% and 1.6 times versus 36.6% and 1.3 times, respectively). Other variables showed insignificant differences between both groups (p>0.05). There were significantly higher mean numbers of attacks of hematemesis and melena and times of previous admission with these attacks in diabetic patients than control patients. [Med-Science 2017; 6(2.000): 338-46

Hybrid Model of Power Transformer Fault Classification Using C-set and MFCM – MCSVM

This paper aims to increase the diagnosis accuracy of the fault classification of power transformers by introducing a new off-line hybrid model based on a combination subset of the et method (C-set) & modified fuzzy C-mean algorithm (MFCM) and the optimizable multiclass-SVM (MCSVM). The innovation in this paper is shown in terms of solving the predicaments of outliers, boundary proportion, and unequal data existing in both traditional and intelligence models. Taking into consideration the closeness of dissolved gas analysis (DGA) data, the C-set method is implemented to subset the DGA data samples based on their type of faults within unrepeated subsets. Then, the MFCM is used for removing outliers from DGA samples by combining highly similar data for every subset within the same cluster to obtain the optimized training data (OTD) set. It is also used to minimize dimensionality of DGA samples and the uncertainty of transformer condition monitoring. After that, the optimized MCSVM is trained by using the (OTD). The proposed model diagnosis accuracy is 93.3%. The obtained results indicate that our model significantly improves the fault identification accuracy in power transformers when compared with other conventional and intelligence models

Transient Liquid Phase Bonding of Ti-6Al-4V and Mg-AZ31 Alloys Using Zn Coatings

Ti-6Al-4V and Mg-AZ31 were bonded together using the Transient Liquid Phase Bonding Process (TLP) after coating both surfaces with zinc. The zinc coatings were applied using the screen printing process of zinc paste. Successful bonds were obtained in a vacuum furnace at 500 °C and under a uniaxial pressure of 1 MPa using high frequency induction heat sintering furnace (HFIHS). Various bonding times were selected and all gave solid joints. The bonds were successfully achieved at 5, 10, 15, 20, 25, and 30 min. The energy dispersive spectroscopy (EDS) line scan confirmed the diffusion of Zn in both sides but with more diffusion in the Mg side. Diffusion of Mg into the joint region was detected with significant amounts at bonds made for 20 min and above, which indicate that the isothermal solidification was achieved. In addition, Ti and Al from the base alloys were diffused into the joint region. Based on microstructural analysis, the joint mechanism was attributed to the formation of solidified mixture of Mg and Zn at the joint region with a presence of diffused Ti and Al. This conclusion was also supported by structural analysis of the fractured surfaces as well as the analysis across the joint region. The fractured surfaces were analyzed and it was concluded that the fractures occurred within the joint region where ductile fractures were observed. The strength of the joint was evaluated by shear test and found that the maximum shear strength achieved was 30.5 MPa for the bond made at 20 min