Combined (physical and medical treatment) therapy versus physical treatment alone and medical treatment alone in the management of chronic pelvic inflammatory disease

Context Pelvic inflammatory disease (PID) is the inflammation of the upper genital tract involving the fallopian tubes as well as the ovaries. Symptoms of PID are fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine and adnexal tenderness, and irregular menstruation. Aim The aim was to determine the therapeutic efficacy of combined shortwave diathermy and medical treatment in the management of chronic PID in comparison to either therapy alone. Materials and methods Sixty participants were recruited and diagnosed as chronic PID for more than 6 months by history, clinical examination, cervical swab, and ultrasonography. They were divided into three groups: Statistical analysis Descriptive and analytic study by SPSS version 16 on IBM compatible computer. Results There was a statistically highly significant clinical improvement regarding itching, discharge and pain relief, laboratory improvement regarding the number of pus cells in cervical swab, and radiological improvement regarding US parameters in the first group of patients with PID compared with the baseline and compared with other groups. Conclusion The greatest therapeutic efficacy can be obtained from combined physical and medical treatment compared with each line alone in the treatment of chronic PID

Study the relationship between vitamin A deficiency, T helper 17, regulatory T cells, and disease activity in patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease with activation of the innate and adaptive immune systems. Vitamin A deficiency causes imbalance of T helper 17 (Th17) and regulatory T cell (Treg), deteriorating the progression of SLE. Aim To determine the relationship between vitamin A levels and Th17 and Treg level in patients with SLE and its relation to disease activity. Patients and methods A total of 45 female patients with SLE diagnosed according to the American College of Rheumatology criteria and 45 healthy age-matched and sex-matched patients as control group were included. Full assessment was done including medications, clinical examination (pain evaluation by visual analogue scale and assessment of disease activity by SLE disease activity index), laboratory investigations, and albumin–creatinine ratio. Serum levels of vitamin A were measured by a human KAMIYA kits, and flow cytometry was used for measuring Th17 and Treg percentages. Results There was a significant deficiency of vitamin A level in patients with SLE compared with controls (P=0.001). There was a significant negative correlation between vitamin A and Th17 (P=0.001) and positive correlation between vitamin A and Treg percentages (P=0.001). There was a negative correlation between vitamin A levels and albumin–creatinine ratio in patients with SLE (R=−0.255). A positive correlation between serum levels of vitamin A and C3 and C4 was found (P=0.001). Conclusion Vitamin A deficiency is a bad prognostic factor in patients with SLE, affecting Th17/Treg balance. Routine use of retinoic acid may be a promising supplementary agent in patients with SLE, improving its prognosis

The role of surface electromyography in confirming the effect of blepharoplasty on strength of levator palpebrae superioris muscle in congenital blepharoptosis

Abstract Background Blepharoptosis is an abnormal drooping of the upper eyelid margin with the eye in the primary gaze position. The clinical evaluating tests of upper eyelid muscle function lack objectivity, while surface electromyography (SEMG) is an objective evaluating tool of muscle power. We aimed to confirm the effect of blepharoplasty on levator muscle power after its shortening via levator aponeurosis resection surgery in cases of congenital ptosis through electrophysiological and clinical studies. The study included 40 patients aged ≥ 10 years with congenital blepharoptosis from the ophthalmology department of our university hospital, along with 40 age- and sex-matched healthy controls. All participants were subjected to clinical and electrophysiological assessment of levator muscle before and after blepharoplasty. Results There was a significant improvement in clinical and electrophysiological findings among cases post-surgery compared with preoperative parameters. We recorded clinical improvement in 90% of patients postoperatively regarding eyelid morphology, symmetry, and visual field. Meanwhile, 82.5% of patients showed improvement in their muscle power using SEMG parameters in terms of improved muscle amplitude and firing characters compared with preoperative measures. Conclusion SEMG provides a standardized, objective method of analysis of upper eyelid muscle power. It confirms that levator muscle shortening via levator aponeurosis resection surgery could increase its power based on its pre-surgical power and electrophysiological characteristics; so, it could be considered an indicator of post-operative improvement of ptosis based on electrophysiological measurements before surgery. The relatively short follow-up period and lack of quantitative analysis of EMG were limitations of this study

Mapping and interpreting a decision-making framework for the implicit managerial theory in the Arab Gulf States

This article developed an empirical design to examine the direct effects of four dimensions of the strategic decision-making process (SDMP) on the organizational innovation in the context of cultural value characteristics of executive managers in Qatar. The study used the cultural relativity theory to explain and advance hypotheses regarding the associations between SDMP dimensions, culture attributes, and innovation performance in an input-process-outcome model. To test the raised research hypotheses of the proposed framework, the methodology of structural equation models was used. Based on quantitative evidence of 140 Qatari public and private organizations, the results demonstrated the following three major issues: (1) strategic decision-making practices have a direct and more significant impact on process innovation performance than product/service innovation performance, (2) innovation performance is both process and context specific, and (3) certain contextualizing constructs verify a particular cultural orientation. The Author(s) 2014.Scopu

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit