Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It ́s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome

“One-Pot” Synthesis and Photocatalytic Hydrogen Generation with Nanocrystalline Ag(0)/CaTiO₃ and in Situ Mechanistic Studies

We describe a previously not reported “one-pot” synthesis of nanocrystalline Ag(0)/CaTiO₃ in aqueous suspension and the following in situ photocatalytic testing in the same suspension to generate hydrogen. The Ag(0)/CaTiO₃ showed an enhancement of photocatalytic hydrogen generation rate vs CaTiO₃ precursor. The obtained Ag(0)/CaTiO₃ photocatalyst was ex situ characterized by XPS, XRD, UV–vis diffuse reflectance spectroscopy (DRS), and photoluminescence (PL) spectroscopy, and concluded to have metallic silver nanoparticles on the surface of calcium titanate nanocrystals. The three photocatalytic mechanisms in Ag(0)/CaTiO₃ were considered: (a) bandgap narrowing in CaTiO₃, (b) enhanced electron–hole separation in CaTiO₃, and (c) excitation of surface plasmon resonance (SPR) in metallic Ag nanoparticles. In mechanistic studies, photocatalytic suspensions with CaTiO₃ precursor, with silver precursor, and with both CaTiO₃ and Ag precursors to form Ag(0)/CaTiO₃ were illuminated, flash-frozen to 77 K, and characterized by in situ “conventional” PL spectroscopy and in situ synchronous luminescence spectroscopy. On the basis of the complementary ex situ and in situ studies, an enhanced electron–hole separation in Ag(0)/CaTiO₃ is suggested

Brain infarction following elective laparoscopic cholecystectomy in a patient with sickle cell disease and previously undetected Moyamoya syndrome

Objective: We report a 7 year-old boy, known case of sickle cell disease, who underwent laparoscopic cholecystectomy for gallstones. He sustained brain insult due to undiagnosed MoyaMoya syndrome. The purpose of this report is to familiarize the healthcare community with similar events and discuss possible plans/recommendations for future similar cases. Method: Case report and review of the English-language literatures (using PubMed, Ovid, and Proquest databases). Results: Case of complicated MoyaMoya syndrome sustained brain insult postoperatively in a 7 year-old boy, with sickle cell disease and gallstones. Conclusion: Early onset of MoyaMoya syndrome related stroke postoperatively after laparoscopic cholecystectomy is difficult to be assessed immediately. Acute stroke is an infrequent disease of pediatric age group patients. MoyaMoya is a rare cerebrovascular disease of unknown etiology. Our patient is 7 year-old male child who presented immediately postoperatively with abnormal movement of right upper and lower limbs and right upper limb weakness, and no history of MoyaMoya syndrome, which is rare, but important cause of stroke in children. Cerebral revascularization surgery leads to favorable outcome. The present case highlights the importance of considering ''MoyaMoya syndrome'' in sickle cell disease patients who are going for surgery irrespective of their age group. Keywords: Sickle cell disease, Cholecystectomy, Uneventfully, Brain infarction, MoyaMoya syndrome, Hemiparesi

Hemophagocytic Lymphohistiocytosis: Single-Center Series of 12 Cases from Saudi Arabia

Background Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease that commonly appears in infancy, although it has been reported in adults. Chemoimmunotherapy-based treatments have improved the survival of patients with HLH; however, overall survival is still poor. We retrospectively analyzed the data of 12 HLH patients who were admitted between 2005 and 2014. All patients were Saudi Arabia in origin with a female predominance (75%) and a median age of onset of 9.5 months. The consanguinity rates were significantly high (75%) with a positive family history in 41% of cases. Of the 12 patients, nine were defined as primary HLH patients and three were confirmed to be secondary HLH patients. All patients fulfilled the 2004 diagnostic criteria for HLH and received HLH-2004 treatment. Six of these patients showed a good response to chemotherapy, while the remainder of the patients showed partial or no response to chemotherapy. Five patients in this cohort received stem cell transplant, and these patients are currently in remission. The mortality rate of this cohort is currently 50%. Genetic mutational analysis showed a positive STX11 mutation in five patients and a PRF1 ( perforin ) mutation in two patients. To the best of our knowledge, this is the first case series of HLH from Saudi Arabia

Routine Preoperative Coagulation Tests in Children Undergoing Elective Surgery or Invasive Procedures: Are They Still Necessary?

Introduction: Preoperative coagulation screening tests in pediatric patients was once routine clinical practice globally and still used as standard practice in some countries before surgical procedures to assess of perioperative bleeding risk. Objective: The study aimed to evaluate unselected routine preoperative coagulation testing in children undergoing elective or invasive surgery to predict abnormal perioperative bleeding. The study also aimed to provide a rational approach of determining bleeding and family history of coagulation disorders as a predictive risk for bleeding. Methods: This retrospective study conducted between 2014 and 2015 (1 year) on normal healthy children aged under 15 years admitted to the hospitals for elective mild to intermediate surgery or invasive procedures. We reviewed and collected the details of the clinical history, previous surgery, trauma, family history, detail of anti-thrombotic medication and coagulation tests performed (prothrombin time (PT), the activated partial prothrombin time (APTT), and international normalized ratio (INR)) at the time of admission. Results: Among 2078 cases, 1940 cases had normal coagulation tests (93.4%), 77 cases had abnormal coagulation results (3.7%), and 61 patients underwent surgery without preoperative coagulation screening (2.9%). In 15 of 77 patients, coagulation tests were normal on repeat testing. A total of 52 were confirmed to have abnormal screening testing. Among these 52 cases, 45 had normal factors assay; where seven patients had abnormal factors assay. Postoperative bleeding occurred only in three cases (0.14%), two cases due to surgical procedures with normal preoperative testing and one due to hemophilia A which was detected postoperatively as no preoperative testing was performed. Conclusions: Routine coagulation screening before surgery or invasive procedures to predict perioperative bleeding in unselected patients is not recommended. Our study emphasizes that selective preoperative testing is more appropriate. Selective criteria for consideration of the latter includes physical examination, type of surgery, family and bleeding history, and concomitant use of antiplatelet and anti-thrombotic therapy

Synthesis of New Naphthyl Aceto Hydrazone-Based Metal Complexes: Micellar Interactions, DNA Binding, Antimicrobial, and Cancer Inhibition Studies

In the present study, naphthyl acetohydrazide (HL) ligand was prepared and used for the synthesis of new six amorphous transition metal (Co(II), Ni(II), Cu(II), Zn(II), Pb(II), Cd(II)) complexes. All the compounds were characterized by elemental analysis, UV-vis, FT-IR, 1H- and 13C-NMR, and Matrix-Assisted Laser Desorption Ionization (MALDI). The solubilization study was carried out by estimating the interaction between the metal complexes with surfactants viz. sodium stearate (SS) and Cetyltrimethylammonium bromide (CTAB). UV-Visible spectroscopy was employed to determine partitioning and binding parameters, whereas electrical conductivity measurements were employed to estimate critical micellar concentration (CMC), the extent of dissociation, and free energy of micellization. The CT-DNA interaction of synthesized compounds with DNA represents the major groove binding. The synthesized ligand and metal complexes were also tested against bacterial and fungal strains and it has been observed that Cu(II) complex is active against all the strains except Candida albicans, while Cd(II) complex is active against all bacterial and fungal strains except Pseudomonas. Among all compounds, only the Pd(II) complex shows reasonable activity against cervical cancer HeLa cell lines, representing 97% inhibition

Clinicopathological features of rare bleeding disorders in high consanguinity population; A retrospective analysis from two tertiary hospitals in Saudi Arabia

BACKGROUND: Rare bleeding disorder (RBDs) encompasses a deficiency of one or more of FXIII, FXI, FX, FVII, FV, FII, and FI clotting factors, leading to bleeding disorders with variable presentations and outcomes ranging from none or minimal to life-threatening events. RBDs are still underdiagnosed and underreported, especially in Saudi population with a high prevalence of consanguinity. OBJECTIVES: The study aimed to determine the frequency of RBDs, grading of their bleeding severity, and assessment of clinical manifestations and management of RBDs in tertiary Saudi Arabian hospitals. DESIGN AND SETTINGS: This retrospective study of RBDs describes the clinicopathological features of refereed cases to both Prince Sultan Military Medical City and King Khaled University Hospital in Riyadh, Saudi Arabia, from September 2018 to September 2021. Any patient who had already been diagnosed or suspected to have RBDs was enrolled in the study. PATIENTS AND METHODS: Patient's medical records were reviewed for demographic data, clinical presentations, bleeding and family history, consanguinity, treatment outcomes, and molecular testing. Samples were run in specialized coagulation laboratories. Patients with liver dysfunction or acquired factor deficiency were excluded. Patients were categorized into four groups according to the severity of bleeding episodes: asymptomatic, Grade I, Grade II, and Grade III. RESULTS: A total of 26 cases with RBDs were identified during the study period. Most of the included patients are males and pediatrics (<14 years) representing 15 (57.7%) and 14 (53.8%), respectively. FVII was the most common factor deficiency encountered in 9 (35%) patients, followed by FXIII in 5 (19%), FXI in 4 (15%), FX in 3 (11.5%), FV in 3 (11.5%), and combined factor deficiency in 2 (8%) patients. 17 (65.4%) RBD patients presented with bleeding manifestation either with Grade I (9%), Grade II (39%), or Grade III (15%), whereas 47% were asymptomatic. CONCLUSION: The study emphasizes on importance of establishing a national registry of RBDs in Saudi Arabia and the need for further genetic studies to clarify the genotype/phenotype relationships