The role of immunohistochemical markers in detecting Helicobacter Pylori

Helicobacter pylori is one of the most common bacterial pathogens that affect humans. It causes chronic gastritis in its active and inactive forms and has an important role in various gastric disorders  .   Gastric endoscopical biopsy   is the main diagnostic method for detecting H. pylori. This study aims to find the best methods for detecting H. pylori by using IHC markers and comparing it with the modified Giemsa stain which is routinely used in laboratories. The study was conducted on 170 gastric biopsies that were taken by upper gastrointestinal endoscopy and received at the department of pathology in Tishreen University Hospital in Lattakia. Sections of the samples were stained with H&E, modified Giemsa stains, and HP IHCl marker. The histological study determined the patterns and degrees of gastritis. H. pylori-positive cases were identified using Giemsa staining and IHC  markers in all forms of gastritis. The study showed that the number of positive cases detected with IHC was higher by 36% (60 cases more) than the number of cases stained with modified Giemsa. When assessing these cases, it was found that H. pylori might present with a few small oval or coccoid forms and it could be scattered in uncommon sites which prevented it from being detected with routine Giemsa stain. The study concluded the necessity of using IHC  markers in the diagnosis of H. pylori in gastric biopsies that showed histological signs of inflammation with negative H.pylori results when stained with modified Giemsa stain.   الملتوية البوابية هي من أكثر الجراثيم التي تصيب البشر , تسبب التهابات المعدة المزمنة بشكليها الفعالة وغير الفعالة ولها دور هام في مختلف اعتلالات المعدة من قرحات , حؤول معوي , عسر تصنع , لمفوما معدية , وتشكل عامل خطورة رئيسي في حدوث السرطانات الغدية . الخزعة المعدية التنظيرية هي الوسيلة الرئيسية   لكشف الملتوية البوابية في مخاطية المعدة . غيمزا المعدل المتبع بشكل روتيني في أغلب المخابر . أجريت الدراسة على 170 خزعة  معدية مأخوذة بالتنظير الهضمي العلوي الواردة الى مخبر التشريح المرضي في مشفى تشرين الجامعي باللاذقية. لونت مقاطع من العينات بـ H&E وبملون غيمزا المعدل وبالواسم المناعي HP . حددت بالدراسة النسيجية  أنماط الالتهابات المعدية ودرجاتها . حددت الحالات الإيجابية لوجود الملتوية البوابية بتلوين غيمزا وبالتلوين المناعي النسيجي عند كل شكل من أشكال الالتهابات المعدية. بينت الدراسة أن الحالات الإيجابية للملتوية البوابية   بالواسم  المناعي  تزيد عن ملون غيمزا 60 حالة بنسبة 36% من الحالات المدروسة . لدى تقييم هذه الحالات تبين أن الملتوية البوابية تأخذ أشكال شاذة مكورة, بيضوية صغيرة جدا أو تكون نادرة جدا أو متوضعة في أماكن غير مألوفة مما سبب فشل اكتشافها بملون غيمزا. خلصت الدراسة الى ضرورة استعمال التلوين المناعي النسيجي في تشخيص الملتوية البوابية على الخزع المعدية التي تبدي وجود علامات نسيجية التهابية وسلبية لوجود الملتوية البوابية حسب تلوين غيمزا

Optimization of Residential Load Consumption during Energy Peaks using Smart Metering

Abstract. Recently smart demand side management (DSM) is a very important tool that permits customers to take right decisions for their energy consumption and helps the energy utilities to decrease the over load demand and reshape the load curve. This paper proposes an optimized DSM technique based on smart metering uses different techniques such as load shifting and peak clipping to minimize domestic power consumption especially during load peaks. A new optimization technique (Bat Algorithm) is applied on proposed system and then compares results with other optimization techniques (Genetic Algorithm and Interior point Algorithm) to optimize the minimum consumption during peak hours according to load type. A control algorithm is applied to the proposed system to achieve the load shifting and load clipping according to the optimization results

The Mediterranean region under climate change

This book has been published by Allenvi (French National Alliance for Environmental Research) to coincide with the 22nd Conference of Parties to the United Nations Framework Convention on Climate Change (COP22) in Marrakesh. It is the outcome of work by academic researchers on both sides of the Mediterranean and provides a remarkable scientific review of the mechanisms of climate change and its impacts on the environment, the economy, health and Mediterranean societies. It will also be valuable in developing responses that draw on “scientific evidence” to address the issues of adaptation, resource conservation, solutions and risk prevention. Reflecting the full complexity of the Mediterranean environment, the book is a major scientific contribution to the climate issue, where various scientific considerations converge to break down the boundaries between disciplines

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease