The supraorbital keyhole approach for clipping of anterior circulation ruptured aneurysms

Introduction. The supraorbital approach has been demonstrated to be useful, particularly in minimization of brain retraction and exposure to air, decreases blood loss, surgical trauma, operative time and infection rates. While its shortcomings include   difficult control of frontal air sinus, narrower surgical view and limited exposure of sylvian fissure. Patients and methods. We retrospectively reviewed the files of patients who underwent clipping of anterior circulation aneurysms through the supraorbital keyhole approach at Neurosurgery Department, Mansoura University between Jan 2014 and May 2016. Results. Twenty-five consecutive patients harbouring aneurysm at anterior circulation underwent clipping through the supraorbital keyhole approach, sixteen A-com artery aneurysms and nine cases of ICA aneurysms Table 1 show the location of aneurysms. Eleven patients were males, and 14 were females. The ages ranged from 44 to 69 with a mean age of 61.9 years. All patients were presented with subarachnoid haemorrhage due to rupture of aneurysms in anterior circulation The Hunt and Hess grade was (1.50 ± 0.65) and Fisher grade was (1.67 ± 0.45). The average operative time was 3.32 ± 1.14 hours. Follow-up ranged from 1 to 16 months with a mean of 7 months Conclusion. Surgical clipping of some selected aneurysms of anterior circulation can be operated through minimally invasive supraorbital approach which minimize the dissection and retraction of the brain, reduce operative time and blood loss with small incision and good cosmetic results

Evaluation of Combined Use of Temocillin Disk and Mastdisks Inhibitor Combination Set Against Polymerase Chain Reaction for Detection of Carbapenem-Resistant Enterobacteriaceae

AIMS: To evaluate the diagnostic performance of MDI and temocillin disk (30 μg) for detection of carbapenem-resistant Enterobacteriaceae in comparison to real-time PCR.METHODS AND RESULTS: Fifty specimens submitted to the Microbiology Laboratory of Ain Shams University Hospitals and showed resistance to carbapenem drugs through routine culture and susceptibility testing, were assessed by both temocillin disk (30 μg) and MDI set to detect carbapenem-resistant Enterobacteriaceae. Results were compared to real-time PCR for detection of carbapenemase genes blaKPC, blaNDM, blaOXA–48-like, blaVIM, and blaIMP. Our work revealed that most of the CPE isolates were Klebsiella species (62%) followed by E. coli (24%), Serratia (10%) and Citrobacter (4%). Phenotypic detection of carbapenem-resistant classes revealed OXA - 48 in 96% of isolates, followed by MBLs (82%), and KPC (34%).  All isolates were negative for AmpC.  Detection of the genes by real-time PCR showed that the predominance was for the blaOXA-48 gene (96%) then blaVIM (94%) followed by blaNDM (54%), blaKPC (46%) and finally blaIMP (40%). Evaluation of the MDI set against PCR showed sensitivity (82.1%) and specificity (70%). The temocillin disk had 97.9% sensitivity and 50% specificity.  The evaluation of Temocillin disk and MDI in combination for detection of carbapenem-resistant Enterobacteriaceae showed 99.7% sensitivity and 35% specificity.CONCLUSIONS: Adding Temocillin disk to Mastdisks ID inhibitor combination set provides a simple, easy, rapid and highly sensitive test that can be used for screening and classification of carbapenem-resistant Enterobacteriaceae. However, it still needs confirmation by molecular techniques

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Comparison between the toxicity of nano and bulk formulations of imidacloprid against wheat aphid, bird cherry-oat aphid, Rhopalosiphum padi L

Recently, nano-insecticide formulations and new insecticide application methods are promised in pest control improvement. Wheat crop is infested by many sucking pests, such as cereal aphids in Upper Egypt. The toxicity of the recommended dose of imidacloprid (70% WS GAUCHO®) as positive control, the full and half recommended dose of nano and bulk imidacloprid 25% WP (BEST®) formulations were investigated under laboratory and field conditions against bird cherry-oat aphid, Rhopalosiphum padi L. The leaf-dip bioassay results indicated that the nano-imidacloprid formulations had higher potency ratio than the bulk formulations by 2.53 to 7.17 folds. Significant reduction percentage of aphids was recorded in seed treatments of field wheat crops, the aphid reductions reached 95% after 60 days. All insecticide treatments showed significant increasing in grain yield ranging from 10.55% to 22.02% higher than the control. The results concluded that the nano-imidacloprid formulation is promising formulation in cereal aphid control. Moreover, the seed-treatment is better than foliar treatment as a pest control tool for protecting the wheat seedling against sucking insect pests

Synthesis of Some New Condensed Heterocycles from Diethyl 2,5-Dioxocyclohexane-1,4-dicarboxylate

Continuing earlier studies designed to obtain derivatives of pharmacological interest, some novel compounds 2-10,12,13,15,17 and 21 were prepared using diethyl 2,5-dioxocyđohexane-l,4-dicarboxylate (1) and aminoazoles, hydrazines, 1,2-phenylenediamine and guanidine hydrochloride. The structures of the hitherto unknown ring system has been confirmed by IR, *H- NMR and mass spectral data

Seasonal incidence and efficacy of nano-thiamethoxam on tomato leaf miner, Liriomyza trifolii (Burgess) (Diptera: Agromyzidae)

Seasonal incidence of tomato leaf miner, Liriomyza trifolii (Burgess) (Diptera: Agromyzidae), and evaluation of the new nano-formulation of thiamethoxam insecticide under climatic factors that supplying the vital knowledge for successful integrated pest management (IPM) programs. This study was conducted in two successive seasons 2017-18/ 2018-19 on variety (no. 765) of tomato that cultivated at the plant protection experimental Farm, Faculty of Agriculture, Assiut University, Assiut, Egypt. The numbers of mines on the tomato leaf were recorded from the first of November to the first of the February in the two seasons. The highest peak of mines was 28.34 mines/ plant in the 13th of December, 2018, while, it was 41.8/ plant in the January1st, 2019. Further, the climatic factor analysis during the two studied seasons demonstrated that the relative humidity was the most efficient factor (52.49 % out of 91.46 %), while the temperature was the least effective one (8.67% out of 91.46%). The nano thiamethoxam at the recommended dose (1x) of neonicotinoid insecticide significantly reduced the mines compared to traditional thiamethoxam. Furthermore, the half recommended dose of nano thiamethoxam in the two tested seasons was equal in the efficacy to the traditional thiamethoxam (1x). The reduction percentages were 86.87, 75.81 and 68.67 for nano-thiamethoxam (1x), thiamethoxam (1x), and nano- thiamethoxam (½ x), respectively, in 2017-18 for the first spray. In the same corresponding treatments, the values recorded were 78.94, 65.61and 62.75% in the second spray. Results of the second season (2018-19) were in the same line, where, the reduction percentages were 84.23, 76.43 and 62.43% at first spray, while the second spray were 72.95, 65.40 and 59.31% for nano-thiamethoxam (1x), thiamethoxam (1x) and nano- thiamethoxam (½ x), respectively. These results suggested that, the relative humidity was the main climatic factor effect on the mines population of Lirimyza trifolii. The nano-thiamethoxam was significantly reduced the pest population. Results of this study highly recommend using nano formulation in applying of IPM leaf miner programs