Ureterorectostomy as a continent urinary diversion for complicated bladder exstrophy in children by using a modified Duhamel procedure: A case series

AbstractIntroductionWhatever the method and timing of surgery, a high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence. They face the options of urinary diversion to an external stoma or construction of a neobladder from bowel. This study describes a modified Duhamel's rectal pouch with a ureterorectostomy was carried out on 11 children who had a failed repair of bladder exstrophy.Materials and methodsTen boys and one girl, aged from 4 to 7years (mean 5.5), had several unsuccessful operations for bladder exstrophy. All selected to have good renal function and no other anomalies, but were incontinent of urine and had a small contracted or prolapsed bladder. They underwent urinary diversion to the rectum using the Duhamel pullthrough technique, where the sigmoid colon was opened into the back of the anal canal above the dentate line, creating a rectal bladder and making use of the anal sphincter to control urine and stool. All were followed up for 24months (18–27months).ResultsIn this selected group of patients there were no major operative or postoperative complications. Follow-up for 2years revealed no deterioration in renal function, or electrolytes disturbance. They can hold up to 300ml of urine and all patients are continent during the daytime with an emptying frequency of 3–5 times. Nocturnal wetting occur some 4–8 times per month with significant decrease with time. Two cases developed pyelonephritis but this was controlled with medical treatment.ConclusionEleven children achieved effective urinary continence by ureteric diversion to the rectum using a modified Duhamel pullthrough technique. Two years follow up showed no complications, except bed wetting, but long term assessment is warranted

Accuracy of Gray‑scale and Three‑dimensional Power Doppler Ultrasound Parameters in the Diagnosis of Morbidly Adherent Placenta

Background: Morbidly adherent placenta (MAP) is usually associated with excess blood loss, bladder injuries, and hysterectomies.Aim: This study was designed to evaluate the accuracy of grayscale and three-dimensional (3D) power Doppler ultrasound parameters in the diagnosis of MAP. Subjects and Methods: Fifty pregnant women ≥28 weeks’ gestation with suspected MAP were included randomly in this prospective study. Two-dimensional (2D) transabdominal gray-scale ultrasound and 3D power Doppler scans were done for studied women to confirm placental location and findings suggestive of MAP. Intraoperative findings and histopathology results of removed uteri in the cases were managed by hysterectomies compared to preoperative sonographic findings using Student’s t-test and Mann–Whitney U-test for quantitative data, Chi-square test for qualitative data to detect the accuracy of 2D transabdominal gray-scale ultrasound and 3D power Doppler parameters in the diagnosis of MAP. Results: Best 2D gray scale ultrasound parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa– bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% positive predictive value (PPV), and 84.1% negative predictive value [NPV]). Best 3D power Doppler parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa–bladder interface (90.9% sensitivity, 68.8% specificity, and 47% PPV) and crowded vessels over peripheral subplacental zone (93.2% NPV). Conclusion: 3D power Doppler is a useful complementary tool to 2D gray-scale ultrasound for antenatal diagnosis of MAP. Crowded vessels over peripheral sub-placental zone and disruption of uterine serosa–bladder interface were the best 3D power Doppler parameters for the detection of difficult placental separation, considerable intraoperative blood loss, and emergency hysterectomies in the studied cases.KEY WORDS: Three‑dimensional power Doppler, gray-scale, morbidly adherent placent

Phytochemical analysis and biological activities of three wild Mesembryanthemum species growing in heterogeneous habitats

The objective of this study was to analyze the phytochemicals and to determine the antioxidant, antibacterial and allelopathic potential of three wild Mesembryanthemum species (M. crystallinum L., M. forsskaolii Hochst. Ex Boiss and M. nodiflorum L.). The phytochemical composition of the methanolic extract of studied species revealed the considerable quantities that might be responsible for their powerful antioxidant activity. The IC50 values were 386.51, 592.97, and 752.23µg/ml for M. nodiflorum, M. crystallinum and M. forsskaolii extracts respectively. The antibacterial activity index was calculated for each extract in comparison with the standard antibiotics. M. nodiflorum showed higher potency than ampicillin and penicillin G against against Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Bacillus subtilis. The allelopathic potential showed that the studied Mesembryanthemum species expressed a significant phytotoxic activity against Chenopodium murale weed in a dose dependent manner. M. nodiflorum sample showed the most phytotoxic effect among the studied species

Optimized D-α-tocopherol polyethylene glycol succinate/phospholipid self-assembled mixed micelles: A promising lipid-based nanoplatform for augmenting the antifungal activity of fluconazole

Fluconazole (FLZ) is the most widely used antifungal agent for treating cutaneous candidiasis. Although oral FLZ has been proved to be effective, the incidence of side effects necessitates the development of an effective formulation that could surpass the pitfalls associated with systemic availability. Accordingly, this research aimed at developing a self-assembled mixed micelles topical delivery system to enhance the topical delivery of the drug. Self-assembled mixed micelles were developed using D-α-tocopheryl polyethylene glycol 1000 succinate and phospholipids and optimized using Box-Behnken design. The optimized formulation with minimized size was then tested in vivo for the antifungal activity against C. albicans in immunocompromised mice. Treatment with the optimized formulation led to decreased peripheral erythema as well as lesions due to fungal infection in comparison to raw FLZ loaded gel. Therefore, the developed formulation was found to be a promising vehicle for the treatment of cutaneous candidiasis

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Obesity and eating habits among college students in Saudi Arabia: a cross sectional study

Abstract Background During the last few decades, the Kingdom of Saudi Arabia (KSA) experienced rapid socio-cultural changes caused by the accelerating economy in the Arabian Gulf region. That was associated with major changes in the food choices and eating habits which, progressively, became more and more "Westernized". Such "a nutritional transition" has been claimed for the rising rates of overweight and obesity which were recently observed among Saudi population. Therefore, the objectives of the current work were to 1) determine the prevalence of overweight and obesity in a sample of male college students in KSA and 2) determine the relationship between the students' body weight status and composition and their eating habits. Methods A total of 357 male students aged 18-24 years were randomly chosen from College of Health Sciences at Rass, Qassim University, KSA for the present study. A Self-reported questionnaire about the students' eating habits was conducted, and their body mass index (BMI), body fat percent (BF%), and visceral fat level (VFL) were measured. Data were analyzed using SPSS statistical software, and the Chi-square test was conducted for variables. Results The current data indicated that 21.8% of the students were overweight and 15.7% were obese. The total body fat exceeded its normal limits in 55.2% of the participants and VFL was high in 21.8% of them. The most common eating habits encountered were eating with family, having two meals per day including breakfast, together with frequent snacks and fried food consumption. Vegetables and fruits, except dates, were not frequently consumed by most students. Statistically, significant direct correlations were found among BMI, BF% and VFL (P Conclusions Our findings suggest the need for strategies and coordinated efforts at all levels to reduce the tendency of overweight, obesity and elevated body fat, and to promote healthy eating habits in our youth.</p

Polyelectrolyte membranes based on phosphorylated-PVA/cellulose acetate for direct methanol fuel cell applications: synthesis, instrumental characterization, and performance testing

Abstract Designing and synthesis of cost-effective and improved methanol permeable and proton conductive membranes are the main challenges for preparation of polymeric electrolyte membrane (PEM). Herein, a cost-effective PEM membrane based on phosphorylated polyvinyl alcohol (PVA)-grafted-cellulose acetate (CA) was prepared by a solution-casting technique. Water and methanol uptakes of phosphorylated PVA/CA membranes were characterized as function with the molar ratio of CA. Additionally, structure and morphology of phosphorylated PVA/CA (Ph-PVA/CA) membranes were verified by FT-IR analysis, SEM investigation. Furthermore, ion exchange capacity (IEC), proton conductivity and methanol permeation of Ph-PVA/CA membranes were examined based on the concentration of OPA basically. The results manifested a perceptible improvement in proton conductivity from 0.035 to 0.05 S/cm at 25 and 70 °C, respectively using 600 μL of OPA, and IEC of 2.1 meq/g using 400 μL of OPA at ambient temperature. On the other hand, methanol permeability (P = 1.08 × 10–10 cm2/s) was lower than Nafion 117 admirably. The optimum OPA concentration was 200 μL according to conductivity measurements (at 10% PVA, 150 μL GA, and CA 7%). Finally, prepared Ph-PVA/CA membranes exhibited enhancement in critical natures such as proton conductivity and IEC combined with its low-cost materials, which make them excellent candidate as PEM for DMFCs application