Right heart thrombus-in-transit with pulmonary embolism in a patient with primary hypercoagulable state

A 25 year-old female with a history of Caesarian section ten weeks ago presented with symptoms suggestive of pulmonary embolism. Transthoracic echocardiography revealed a free- -floating large thrombus traversing the right atrial cavity. Transesophageal echocardiography confirmed the presence of an unattached thrombus that originated from the most proximal part of the inferior vena cava. Multi-slice computed tomography of the chest and abdomen revealed the thrombus to start from the intra-hepatic part of the inferior vena cava and extend through the right atrium. It also demonstrated multiple thrombi in the pulmonary vasculature, the largest being in the right main pulmonary artery and its lower lobe branch. The patient was triaged for surgical embolectomy under cardio-pulmonary bypass. Follow-up trans-thoracic and transesophageal echocardiography confirmed adequate removal of the thrombus. By genetic examination, she proved to have factor V ’Leiden’ gene and two thrombophilia genes, all of which were positive in the heterozygous state. She had also a high serum homocysteine. (Cardiol J 2010; 17, 4: 408-411

REUSE OF WASTE DRAINAGE WATER AFTER ITS TREATMENT USING PGPRS TO IRRIGATE SOME HORTICULTURAL CROPS

Natural sources of water are limited in Egypt. The rapidly growing populations necessitate continuous expansion of the cultivated area. This means an increase of the gap between the demands of water for irrigation and the limited water supply. Looking for other sources such as low quality water like (industrial effluent, drainage and sewage) must be used in irrigation of some garden and wood plants. This investigation was conducted on agricultural drainage wastewater from El Mohete drain (Marioteya Canal) west of Cairo; the samples were collected from different places during (Summer and Winter seasons). The wastewater contaminated with pathogenic microorganisms, the excess of fertilizers (inorganic & organic), heavy metals, and the residuals of pesticides. Plant Growth Promoting Rhizobacteria (PGPR) could remediate the wastewater as biological bioremediation to remove some pollutants such as pathogenic microorganisms, heavy metals and pesticides. Chemical remediation was used as nitrification inhibitor to stop transformation of ammonia to nitrate. This work was conducted to study the ability of PGPR strains e.g. Bacillus megaterium, Bacillus subtillis, Bacillus circulans, Paenibacillus polymyxa, Pseudomonas floresense, Serratia sp. and Azotobacter chroococcum 5, 9 and 23 to treat the drainage water for irrigation the Mentha viridis cv. and Gladiolas grandiflorus cv. plants.                 Two pot experiments were conducted in greenhouse. The treatments were applied as follows; Natural water, treated water and drainage water to irrigate the plant. Use the PGPR as inoculants and thiourea as nitrification inhibitor, Heavy metal treated was (Copper, Cobalt, Zinc, Cadmium and Mercury) the result showed us heavy metals removal by PGPR from drainage water. The characterizations of PGPRs as shown in the obtained results are they could enhance plant growth by using their own metabolism (solublizing phosphate, producing hormones or fixing nitrogen) as well as correlation of them with the potenit of effects on the growth of plants in unfavorable conditions in order to improve the efficiency of phytoremdiation of contarinated soils. The removal of heavy metals and the elimination of pesticides residues were markedly noticed in this investigation. Results also confirmed the ability of PGPRs in suppressing the effect of pathogenic bacteria like Salmonellasp and E.coli. These abilities are of great importance in terms of plant and soil health. Consequently, the role of PGPRs bacteria associated with plant rhizosphere in remediation of water and soil contaminations due to its biochemical activity and thus, stimulate plant growth is a great important subject in phytoremediation process nowadays

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic