Current management of Hirschsprung’s disease in Egypt: A survey of members of the Egyptian Pediatric Surgical Association

Background/purpose Significant progress has been made in the management of  Hirschsprung’s disease (HD). The choice of the management plan, surgical  approach, and operative details is still variable among pediatric surgeons. This survey aims to determine the current preferences of Egyptian pediatric surgeons in the management of HD.Materials and methods A survey was circulated individually to the members of the Egyptian Pediatric Surgical Association  (EPSA) during the General Assembly Meeting. An electronic form of the survey was sent by e-mail to all Egyptian consultant  pediatric surgeons registered to EPSA through the ‘EPSA online’ e-mail group. A second round of e-mails was sent 2 weeks later.Results Responses were received from 112 surgeons; seven responses were  excluded (incomplete and duplicate responses), yielding 105 survey charts for  analysis. The 105 responses represent 80.7% of the 130 fully trained pediatric surgeons  currently working in Egypt. A total of 76.2% of responders use both  contrast enema and rectal biopsy for the preoperative diagnosis of HD. Contrast enema alone is used by 13 (12.4%). A further 11.4% combine this with anorectal manometry. Intraoperative frozen section tissue diagnosis is used routinely by only 4.8% of the responders. Surgery is preferred to be  performed during the neonatal period by 21.9% of the responders, from 1 to 3 months (28.6%), or after the third month of life  (49.5%). A definitive one-stage colonic pullthrough is always used by 59%, whereas 7.6% are still using staged operations. The rest of the responders had no specific predilection. The preferred surgical technique for rectosigmoid HD is transanal endorectal pull-through (68.5%), Soave transabdominal endorectal  pull-through (19.0%), laparoscopic-assisted pull-through (9.5%), and Duhamel with GIA staplers (2.9%). The Soave operation is preferred for HD extending to the right side and total colonic HD (45.7%) and redo surgery (37.1%).Conclusion The EPSA survey indicated that most surgeons are moving toward a one-stage pull-through using transanal endorectal pull-through for patients with rectosigmoid HD. There are large variations in preference for the age at  pull-through. There is a need for a routine practice of intraoperative frozen section tissue diagnosis, and popularizing laparoscopic surgery for patients with long segment disease.Keywords: diagnosis, Hirschsprung’s disease, management, surve

Reduction glossectomy for macroglossia in children

Background/aim: Although several surgical techniques have been described for reduction glossectomy in children, many general pediatric surgeons are still skeptical about the treatment of patients with macroglossia because of potential surgical complications. The aim of this study was to describe our initial surgical experience with reduction glossectomy in a series of eight patients with macroglossia.Materials and methods: A retrospective file review was carried out for all patients who underwent reduction glossectomy during the period from October 2009 to December 2014. Charts were designed to collect the following data from the patients’ files: age; etiology of macroglossia; and full clinical examination including the functional respiration, deglutition, phonation deficit, and dental occlusion alterations.Results: The records of eight patients were retrieved. Five patients, in whom macroglossia affected the tongue width and length, underwent peripheral glossectomy, whereas two patients, in whom macroglossia affected the tongue in all directions, underwent key-hole glossectomy. In one patient in whom only half the tongue was affected, a central longitudinal strip was excised. Motor and sensory  functions, especially taste sensation, were not affected by resection. Speech articulation errors were corrected in cases that stared speech. One complication occurred in one patient who had undergone a key-hole glossectomy: wound infection, followed by partial wound disruption.Conclusion: Partial glossectomy for macroglossia in children is both feasible and safe. It results in minimal complications. Many clinical problems caused by the pathology improve after surgery repair. The recommended surgical technique should be based on the extent of involvement of the tongue.Keywords: Beckwith–Wiedemann syndrome, macroglossia, reduction glossectom

Urethral mobilization and advancement for distal hypospadias

Background/purpose Despite the existence of numerous techniques for the repair of distal penile hypospadias, none of them is completely satisfactory. Advancing the  urethra without mobilization for repair of glanular hypospadias has the advantage of avoiding a common problem occurring with other techniques: urethrocutaneous fistula. This study aims at evaluation of our experience with this technique for repair of distal hypospadias.Materials and methods A prospective study was conducted on patients with glanular, coronal and subcoronal hypospadias during the period from December 2012 to December 2014. Recurrent cases were excluded. Feasibility of the technique and postoperative complications were recorded.Results A total of 30 boys between 9 months and 7 yearsof age were included in the study. They underwent repair of  glanular (five), coronal (10), and subcoronal (15) hypospadias. The urethra was mobilized to the proximal shaft in almost all cases. Three cases developed postoperative hematoma, which were managed conservatively and resolved spontaneously. Two cases  developed wound infection and were managed with antibiotics and daily dressing until infection resolved. None of the patients had major complications such as dehiscence, urethral stricture, or fistula. Three patients developed meatal stenosis; two of them responded to repeated dilatation twice weekly for 2 weeks; and one needed meatoplasty. In one patient, the most distal of the glans approximation sutures disrupted, leading to a minor detachment in the glans. There was no recurrent chordee. Two patients underwent meatal retraction, wherein the urethra migrated proximally but still within the glans; only one of these patients required a second procedure.Conclusion The urethral mobilization technique seems tobe a good method for the repair of distal hypospadias with or without chordee with satisfactory cosmetic and functional results. The procedure has the advantage of avoiding the need for a second layer of tissue covering during repair. Moreover, there is no chance for the development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques creating a neourethra. Postoperative management is simple and a brief hospital stay is sufficient.Keywords: distal hypospadias, hypospadias repair, urethral mobilizatio

The versatility of the transumbilical approach for laparotomy in infants

Background/purpose Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants.Patients and methods All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome.Results A total of 141 infants underwent transumbilicallaparotomy during the period from June 2008 to December  2013. The  primary pathology was hypertrophic pyloric stenosis (n= 65), duodenal, small-intestinal atresia/stricture (n =22), colonic atresia (n= 2), malrotation with/without volvulus (n= 10), ovarian cysts (n= 12), intussusception (n= 9), spontaneous intestinal   perforation (n =7), remnants of vitellointestinal duct (n =4), mesenteric cysts (n= 3), patent urachus (n= 3), postoperative  complications of strangulated inguinal hernia (n= 3), and complications in ventriculoperitoneal shunts (n= 1). Their age ranged  from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the  wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications  (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome.Conclusion The transumbilical approach is both afeasible and a safe approach for a broad spectrum of  surgical procedures in neonates and infants. The cosmetic results are excellent.Keywords: abdominal masses, infants, laparotomy, transumbilical approac

Low-cost laparoscopic appendectomy in pediatric patients

Background/purpose: Laparoscopic appendectomy is widely practiced worldwide and has become one of the commonly performed procedures in pediatric surgery practice. However, the cost effectiveness of the procedure remains a major concern. The present study aimed to evaluate the safety and effectiveness of the operative techniques used to reduce the cost of the procedure.Patients and methods: A prospective study was conducted on patients undergoing laparoscopic appendectomy over a period of 2 years. The techniques used to reduce the cost of laparoscopic appendectomy were as follows: (i) using reusable trocars instead of disposable ones; (ii) using monopolar electrogoagualtion to seal the mesoappendix instead of staplers, LigaSure, or Harmonic scalpels; and (iii) using a handmade loop to secure the base of the appendix instead of using endoloops.Results: This study included 39 boys and 21 girls. The median age was 10 years. The mean duration of the operation was 56.5 min. No intraoperative complications  were encountered. Two cases developed pelvic hematoma and were managed conservatively with success. The mean hospitalization stay was 2 days.Conclusion: Division of the mesoappendix using monopolar electrocautry and closing the base of appendix using handmade endloops during laporoscopic appendectomy appears to be a simple, effective, safe, and cost-efficient technique. Therefore, the use of more costly instruments, such as the endostapler, LigaSure, or Harmonic scalpel, seems unwarranted.Keywords: cost reduction, laparoscopic appendectomy, pediatric ag

PREVALENCE OF LEPTOSPIROSIS AMONGST SLAUGHTERHOUSE WORKERS AND BUTCHERS IN SANA'A CITY-YEMEN

Objective: Zoonotic infections can be work-related risks to people who labor in nearby connection with animals. The goals of present study were to find out the prevalence of leptospira antibodies and impact factors of leptospirosis among this risk groups in Sana'a city.  Methods: A 267 serum samples were assembled from the study groups and a written record was completed for all workers to record individual and behavioral information. The sera were tested for leptospirosis IgG antibodies by commercial ELISA technique. The acquired data illustrated that 100% of individuals did not employ at all personal protective equipments (masks, gloves, overalls and boots) and 100% of participants had absolutely not used disinfectants to their blades and hands, while 10% be aware of they were at risk of zoonotic infections like leptospirosis only. Results: The seroprevalence of leptospirosis was 41.3%.  There was highly significant associated between positive of IgG antibodies and older age (median>27 years) (OR= 3 times, PV<0.001), work history median > 8 years (OR=2.8 times, PV<0.001) and history of >5 times cut in the last year (OR=3.7, PV<0.001). Conclusion: In conclusion: the present of leptospira IgG antibodies among slaughter-house workers and butchers in Sana'a city is relatively common, similar to that reported previously from Yemen, and from neighboring countries among risk groups. Encouraging universities in Yemen to undertake active disease surveillance because these efforts will eventually allow policy makers and other authorities to convert knowledge into policy by set appropriate evidence foundation priorities in the field of leptospirosis disease control and prevention. Peer Review History: Received 2 May 2018;   Revised 7 May; Accepted 11 May, Available online 15 May 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:        Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Dr. Mohamed Derbali, Faculty of Pharmacy, Monastir, Tunisia, [email protected] Dr. Mohamed Salama, Modern University for Technology & Information, Egypt, [email protected] Similar Articles: PREVALENCE OF HBV AND HCV; AND THEIR ASSOCIATED RISK FACTORS AMONG PUBLIC HEALTH CENTER CLEANERS AT SELECTED PUBLIC HEALTH CENTERS IN SANA'A CITY-YEME

BACTERIAL CAUSES AND ANTIMICROBIAL SENSITIVITY PATTERN OF EXTERNAL OCULAR INFECTIONS IN SELECTED OPHTHALMOLOGY CLINICS IN SANA’A CITY

Objectives: The aim of the current study was to reveal the bacterial profile and pattern of sensitivity to antibiotics for external ocular infections for patients who attended selected ophthalmology clinics in the city of Sana’a. Methods: A cross-sectional study design was used from September 2016 to October 2017 where a total of 197 patients with infection of external eye were included in the study which included conjunctivitis, keratitis, blepharitis and Blepharoconjunctivitis. Samples were collected and transferred to the National Center of Public Laboratories (NCPHL), in Sana'a. Possible bacterial pathogens have been isolated and identified using regular laboratory techniques, and microbial sensitivity testing has been carried out using a disc diffusion method. Results: A total of 197 ocular samples were obtained for microbiological evaluation, of these 146 (74.1%) have bacterial growth. Bacteria of Gram positive accounted for 52.1% and the prevalent isolation was S. aureus (30.1%). Gram negative bacteria made up 47.9% and the predominant isolation was Pseudomonas aeruginosa (26.7%). The majority of Gram-positive bacteria were sensitive to ciprofloxacin (90% - 100%), vancomycin (86% - 100%) and Gram-negative isolates sensitive for amikacin (100%) and ciprofloxacin (63% - 100%). Conclusion: These results revealed that Gram-positive bacteria were the generally common bacteria isolated from infections of external eye and were more susceptible to vancomycin and ciprofloxacin while Gram-negative isolates were more susceptible to ciprofloxacin and amikacin.  The high rate of resistance for most antibiotics in Yemen, leaves ophthalmologists with very few options of drugs to treat eye infections. Large-scale ongoing studies in the future should also be conducted in order to monitor the antimicrobial resistance of the external ocular bacterial isolates.                                   Peer Review History: Received 20 May 2020; Revised 25 June; Accepted 4 July, Available online 15 July 2020   Academic Editor: Dr. Asia Selman Abdullah, Al-Razi university, Department of Pharmacy, Yemen, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewer(s) detail: Dr. Jucimary Vieira dos Santos, Hemonorte Dalton Barbosa Cunha, Brazil, [email protected] Dr. Sabah Hussien El-Ghaiesh, Tanta University, Egypt, [email protected]  Similar Articles: EPIDEMIOLOGY, BACTERIAL PROFILE, AND ANTIBIOTIC SENSITIVITY OF LOWER RESPIRATORY TRACT INFECTIONS IN SANA’A AND DHAMAR CITY, YEME

Influence of microclimatic ammonia levels on productive performance of different broilers' breeds estimated with univariate and multivariate approaches

Background and Aim: Birds litter contains unutilized nitrogen in the form of uric acid that is converted into ammonia; a fact that does not only affect poultry performance but also has a negative effect on people's health around the farm and contributes in the environmental degradation. The influence of microclimatic ammonia emissions on Ross and Hubbard broilers reared in different housing systems at two consecutive seasons (fall and winter) was evaluated using a discriminant function analysis to differentiate between Ross and Hubbard breeds. Materials and Methods: A total number of 400 air samples were collected and analyzed for ammonia levels during the experimental period. Data were analyzed using univariate and multivariate statistical methods. Results: Ammonia levels were significantly higher (p0.05) were found between the two farms in body weight, body weight gain, feed intake, feed conversion ratio, and performance index (PI) of broilers. Body weight; weight gain and PI had increased values (p0.05). Test of significance of discriminant function analysis did not show a classification based on the studied traits suggesting that they cannot been used as predictor variables. The percentage of correct classification was 52% and it was improved after deletion of highly correlated traits to 57%. Conclusion: The study revealed that broiler's growth was negatively affected by increased microclimatic ammonia concentrations and recommended the analysis of broilers' growth performance parameters data using multivariate discriminant function analysis

Economic Analysis of Stand-Alone Hybrid Wind/PV/Diesel Water Pumping System: A Case Study in Egypt

The design and evaluation of a stand-alone hybrid renewable energy system for pumping underground water for small farm irrigation is presented. Given environmental conditions, system specifications and daily load demand data, the optimal size of main system components is obtained using a sizing algorithm. Different renewable energy systems are compared using yearly simulations, on hourly base via specialized commercial software simulation packages PVSYST and HOMER, to simulate the system performance and to reach the optimum configurations based on the objective criteria. The criteria used in economic optimization are the net present cost and the cost of energy, with the percent of the capacity shortage. The following systems can be compared: PV only, PV with horizontal axis wind turbine, PV with vertical axis wind turbine, and PV with horizontal axis wind turbine and diesel generator and diesel generator only. The simulation also was carried out for different load patterns for optimum operation. The study was illustrated for climatic conditions of an isolated area in El-Tour City, Sinai, Egypt. The installed 3.42 kW PV water pumping system for irrigation purposes in the same site was also described

HPLC DETERMINATION OF DIMETHYL-4,4′-DIMETHOXY-5,6,5′,6′ DIMETHYLENE DIOXYBIPHENYL-2,2′-DICARBOXYLATE (DDB) AND CO-ADMINSTERED DIURETICS AS AN EXTEMPORANEOUS MIXTURE IN HUMAN PLASMA

Diuretics are co-adminstered with hepatoprotectant drugs for the treatment of oedema and ascitis inpatients suffering from hepatic cirrhosis.This work presents an accurate and simple method for the in vivo analysisof Dimethyl-4,4'-dimethoxy-5,6,5',6'-dimethylenedioxybiphenyl-2,2'-dicarboxylate (DDB), a hepatoprotectantdrug, with hydrochlorothiazide (HCT) and amiloride hydrochloride (AM) diuretics in human plasma using HPLC.Methodology/Principal Findings: The separation was achieved on Spheri-5 RP-8 (5μ) and Spheri-5 RP-18 (5μ)columns (220 × 4.6 mm i.d.) using 0.02 M disodium hydrogen phosphate, 0.12% w/v sodium laurylsulfate, 0.1%v/v triethylamine adjusted to pH 4 and acetonitrile in a ratio 65:35 v/v as mobile phase. The separation was carriedout at ambient temperature with a flow rate of 1.0 mL min-1. Quantitation was achieved with UV detection at 278nm based on peak area with linear calibration curves at concentration ranges 0.03–30 μg mL-1 for HCT and 0.05–30 μg mL-1 for both AM amd DDB. Conclusions: The proposed method was successfully applied to thedetermination of the investigated drugs in human plasma sample obtained from a healthy male volunteer fourhours after single oral dose administration of the three drugs. The proposed method was validated in terms oflinearity, accuracy, precision, limits of detection and quantitation and other aspects of analytical validation