Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study

Background: In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). Methods: This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results: There were no differences in demographics, peri-operative complications 4 (4) vs. 4 (4), P = 1), conversion rate (10.6 vs. 11.5; P = 0.825) and procedure time (83 vs. 81 minutes, P = 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 ± 1.12 vs. 10.35 ± 1.76, P < 0.001). Conclusion: Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate. © 2020 The Author(s) Biological sciences; Health sciences; Surgery; Internal medicine; Acute biliary pancreatitis; Laparoscopic cholecystectomy; Mild to moderate acute biliary pancreatitis. © 2020 The Author(s

Effect of pimecrolimus on postoperative peritoneal adhesions in rat: An experimental study

Introduction: Postoperative peritoneal adhesions (PPAs) is a common complication of abdominal surgeries causing significant morbidity and mortality. The inflammatory response to damaged peritoneal tissue is a speculated culprit. The aim of this study is to investigate the protective effect of pimecrolimus, an anti-inflammatory and immunomodulator agent, in formation of PPAs in rats. Methods: Complied with the Animal Research Reporting In Vivo Experiments (ARRIVE) Guidelines Checklist, 50 Albino rats underwent laparotomy and were allocated into 5 groups. In groups 1 to 3, topical pimecrolimus (25, 50 and 100 concentration, respectively) was applies on a scratched area of peritoneum. In group 4, only topical Eucerin was used and group 5, was the control group. On postoperative days 7 and 28, five rats from each group were randomly selected and the tensile strength and adhesiveness of intraabdominal fibrotic bundles were assessed. Results: There was no significant difference in tensile strength and adhesiveness, between the groups on postoperative day 7. On postoperative day 28, however, the tensile strength was significantly lower in pimecrolimus groups than in Eucerin (<0.001) and control (<0.001) groups. Groups with higher concentrations of pimecrolimus (group 2 and 3) developed significantly less adhesions than group 1, in which lower pimecrolimus concentration was used. Conclusion: Administration of topical pimecrolimus decrease adhesions and their tensile strength on postoperative day 28 in rats. © 2020 The Author

Blunt Traumatic Hernia of Diaphragm With Late Presentation

Background: Diaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition. Objectives: We aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm. Patients and Methods: In this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed. Results: Six patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%). Conclusions: Late presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ

Antimicrobial Effects of Lactobacillus Plantarum and Lactobacillus Paracasei Isolated from Honey against Staphylococcus Aureus

BACKGROUND AND OBJECTIVE: Lactobacilli are gram positive, catalase-negative, and found in a variety of fermented foods such as honey, as well as human normal flora. The aim of this study was to identify lactobacillus Plantarum and lactobacillus Paracasei in Iranian honey samples and to investigate the probiotic and antimicrobial properties of them against Staphylococcus aureus. METHODS: This cross-sectional study investigated 88 honey samples from different areas in Iran at 6 months, from May to September, 2016. Samples were cultured in MRS broth and after were cultured on MRS agar. Sequencing of 16S rDNA gene was used to detect lactobacillus isolates. Then probiotic capacity (acid and bile resistance) of isolates was measured. Antimicrobial activity of lactobacillus isolates was investigated by diffusion method from wells and antibiotic resistance by disc diffusion method. FINDINGS: From 88 honey samples, 39 Lactobacillus isolates were isolated, four L. plantarum and two L. paracasei were identified by molecular technique. Every six isolates tolerated acidity but were sensitive to bile salt. Five isolates inhibited the growth of S. aureus. The most antibiotic resistance of Lactobacillus strains was seen to vancomycin(100%), nalidixic acid(100%) and streptomycin(100%). CONCLUSION: Iranian honey samples can be a source for different Lactobacillus species as L. plantarum and L. Paracasei which some of these species could have wonderful inhibitory effects against pathogen bacteria like S. aureus

Routine Chest Computed Tomography and Patient Outcome in Blunt Trauma

Background: Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma. Objectives: In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma. Patients and Methods: After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test. Results: No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups. Conclusions: Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome and does not decrease the in-hospital stay and ICU admission time. It seems that performing the routine chest CT in these patients may lead to overtreatment of nonsignificant injuries. The decision about performing routine CT scan in a trauma center should be made cautiously, considering the detriments and benefits

Combination adjunctive nebulized furosemide and salbutamol versus single agent therapy in COPD patients: A randomized controlled trial

Background: COPD patients often require multiple therapies to enhance their lung function and reduce their symptoms in exacerbations. This study aimed to investigate the relative effects of combination adjunctive nebulized furosemide and salbutamol therapy versus single agent treatment in COPD patients. Methods: Sixty-nine COPD patients were randomly divided into two groups. The first group (G1, 34 cases) received salbutamol in their first episode. The second group (G2, 35 cases) received furosemide in their first episode. Spirometry indices (FEV1, FVC, and FEV1/FVC), mMRC and BORG (COPD assessment) were assessed and recorded for all patients. To study the efficacy of combination adjunctive therapy, in 2nd episodes, the nebulized furosemide was added to nebulized salbutamol in the G1, and nebulized salbutamol was added to nebulized furosemide in G2. The aforementioned indices were then re-assessed. Results: The mean age was (64.92 ± 11.71 years, 55 males. The use of nebulized furosemide and salbutamol as single agents slightly improved the spirometeric parameters, but it was not noteworthy compared to the significant improvement of the FEV1, FVC, FEV1/FVC, mMRC, and Borg parameters with combination therapy (p-value 0.1), so furosemide is considered as effective as nebulized salbutamol. Also, the results of sequential drugs administration, in the two groups was similar. Conclusion: Conjunction of nebulized furosemide and salbutamol is more effective than single therapy and can be considered as preferred drug regimen without any reported side effect in the treatment of COPD. © 202

Melatonin and non-small cell lung cancer: New insights into signaling pathways

Non-small-cell lung cancer (NSCLC) is a type of malignancy with progressive metastasis having poor prognosis and lowered survival resulting from late diagnosis. The therapeutic approaches for the treatment of this incurable cancer are chemo- and radiotherapy. Since current treatments are insufficient and because of drug-induced undesirable side effects and toxicities, alternate treatments are necessary and critical. The role of melatonin, produced in and released from the pineal gland, has been documented as a potential therapy for NSCLC. Melatonin prevents tumor metastasis via inducing apoptosis processes and restraining the autonomous cell proliferation. Moreover, melatonin inhibits the progression of tumors due to its oncostatic, pro-oxidant and anti-inflammatory effects. As a result, the combined treatment with melatonin and chemotherapy may have a synergistic effect, as with some other tumors, leading to a prolonged survival and improved quality of life in patients with NSCLC. This review summarizes the available data, based on the molecular mechanisms and related signaling pathways, to show how melatonin and its supplementation function in NSCLC. © 2019 The Author(s)

Thermoelectric energy harvesting from single-walled carbon nanotube alkali-activated nanocomposites produced from industrial waste materials

A waste-originated one-part alkali-activated nanocomposite is introduced herein as a novel thermoelectric material. For this purpose, single-walled carbon nanotubes (SWCNTs) were utilized as nanoinclusions to create an electrically conductive network within the investigated alkali-activated construction material. Thermoelectric and microstructure characteristics of SWCNT-alkali-activated nanocomposites were assessed after 28 days. Nanocomposites with 1.0 wt.% SWCNTs exhibited a multifunctional behavior, a combination of structural load-bearing, electrical conductivity, and thermoelectric response. These nanocomposites (1.0 wt.%) achieved the highest thermoelectric performance in terms of power factor (PF), compared to the lower SWCNTs’ incorporations, namely 0.1 and 0.5 wt.%. The measured electrical conductivity (σ) and Seebeck coefficient (S) were 1660 S·m−1 and 15.8 µV·K−1, respectively, which led to a power factor of 0.414 µW·m−1·K−2 . Consequently, they have been utilized as the building block of a thermoelectric generator (TEG) device, which demon-strated a maximum power output (Pout ) of 0.695 µW, with a power density (PD) of 372 nW·m−2, upon exposure to a temperature gradient of 60 K. The presented SWCNT-alkali-activated nanocomposites could establish the pathway towards waste thermal energy harvesting and future sustainable civil engineering structures

Effect of reinforced audit and feedback intervention on physician behaviour: a multifaceted strategy for targeting medical record documentation

We investigated the effects of reinforced audit and feedback on the medical record documentation (MRD) of 35 surgical residents at a tertiary university hospital. In three phases (pre intervention, 3 and 9-month post intervention), 525 medical records were assessed. An educational guideline assisting residents to record more accurate MRD was developed. The MRD rate in the pre-intervention and immediate post-intervention phases had changed significantly. The MRD rate in the pre-intervention and 9 months after cessation of intervention was not statistically significant. Reinforced audit and feedback had only a short term effect on MRD. To achieve long lasting change, we suggest residents’ MRD behaviour must be integrated in their periodic clinical performance evaluation and reinforced through positive feedback including incentive mechanisms

Effects of right hepatic artery ligation

Abstract Background: Injury to right hepatic artery (RHA) may occur during hepatobiliary operative procedures. Although it may not be detected and is clinically silent in most of the cases, liver abscess, bleeding, hemobilia, and right hepatic lobe ischemia needing surgical excision have been reported. The aim of this study was a more detailed evaluation of hepatic consequences following RHA injury in an animal model. Methods: This study was conducted on 20 New Zealand rabbits 6 months of age. Blood samples for the measurement of hepatic enzymes was obtained from the rabbits before ligation of the hepatic artery. After 10 days, blood sampling was repeated and the animals were killed and 0.5 × 2 cm liver wedge biopsy was prepared from right lateral lobe, the distribution area of RHA. P values of < 0.05 were considered significant. Results: Laboratory data before and after surgical intervention showed serum bilirubin of 0.133 ± 0.044 and 0.135 ± 0.042, respectively (P value = 0.47). Serum alkaline phosphatase (ALP) was 122.4 ± 44.12 and 122.8 ± 44.43, (P value = 0.36) respectively. Serum glutamic-pyruvic transaminase (SGPT) was 31.2 ± 5.34 and 86.2 ± 33.9, (P value = 0.001) respectively. Serum glutamic oxaloacetic transaminase (SGOT) was 30.13±8.46 and 69.4±47.7, respectively (P value = 0.001). Laparotomy showed no considerable change in median lobe of livers, except mild necrosis in one (5%) rabbit. Severe necrosis was found in the right lateral lobe of 15 rabbits (75%), moderate necrosis in 3 (15%), and mild necrosis in 2 (10%) cases. No abscess or gangrene was found. The Gall bladder was intact in all animals. Conclusions: The RHA obliteration causes an increase in liver enzymes and considerable right lateral hepatic lobe necrosis (75%) but no liver abscess, gangrene or gall bladder abnormality. © 2017, Trauma Monthly