Emergency small- vs large-tube thoracostomy in chest trauma patients

Background: Therapeutic drainage is used to treat pleural disorders such as pneumothorax, hemothorax, empyema, chylothorax, and malignant effusions. This study aimed to conduct a comparative analysis of small (24-26 Fr) versus large (30-32 Fr) tube thoracostomy in terms of the efficacy of drainage due to concerns about obstruction (in the case of hemothorax) or inadequate drainage (in the case of hemothorax, pneumothorax, or hemopneumothorax), pain score, repositioning, and the need for thoracotomy. Methods: This randomized prospective study included 112 chest trauma patients who experienced significant hemothorax, pneumothorax, or a combination of these conditions in a trauma unit (reception, inpatient, or ICU) between December 2021 and December 2022. Patients were randomly divided into two groups. Group I included 56 patients who underwent small (24–26 Fr) tube thoracostomy and 56 patients in Group II, in which a large (30-32 Fr) tube thoracostomy was performed. We investigated the differences between the two groups in terms of pain score, complication rate, duration of tube insertion, and need for another chest tube or thoracotomy. Results: There was no statistically significant difference between the two groups concerning the mode of trauma, chest trauma, or effect of trauma (p= 0.781, 0.622, >0.99, and >0.99, respectively). The two groups had a highly statistically significant difference regarding the pain score (p<0.001). There was no statistically significant difference between the two groups regarding the duration of tube insertion (P<0.001). There were no statistically significant differences between the two groups regarding outcomes (drainage efficacy, tube repositioning, tube replacement, or the need for thoracotomy) (p= 0.315, 0.344, and 0.814, respectively). Conclusion: Increasing the tube size might not affect the efficacy of drainage, the duration of tube insertion, the need for another tube, or the need for thoracotomy. Small (24-26 Fr) tube thoracostomies could also have favorable pain score outcomes

Therapeutic activity of crude ethanolic extract of Artemisia herba alba against Trypanosoma evansi in rabbits

The present work was conducted to evaluate the antitrypanosomal efficacy of crude ethanolic extract (CEE) of the aerial parts of Artemisia herba alba against Trypanosoma evansi infection in an animal model. The results indicated low levels of parasitaemia in rabbits administered with crude ethanolic extract (CEE) compared to those from the negative control group. Similarly, there was also haematologically significant difference (p<0.05) where low mean levels of packed cell volume (PCV) was observed in Groups 1-4 respectively. In contrast, there was no statistically significant difference in almost all investigated parameters between positive control and treatment groups of animals. In conclusion, both CEE of A. herba-alba and Berenil® showed relatively a parasitaemia and normal haematological values in infected rabbits, thereby confirming their antiparasitic properties

Assessment of Antiviral Activity for Ethanolic Chlorella vulgaris Extract Against Newcastle Disease Virus (NDV) Infection in Sasso Chicken

Newcastle disease (ND) is an extremely viral disease that has tremendous impacts on poultry production worldwide. Increasing and repeating ND outbreaks and suspecting of fifth pandemic occurrence demonstrated the need for novel medicines to control the disease. Chlorella vulgaris (CV) microalgae have recently emerged as natural alternatives with antiviral activity, in current study, ethanolic Chlorella vulgaris) ECV) extract was prepared and evaluated as an effective antioxidant and antiviral agent against Newcastle disease virus (NDV) in vitro and in vivo stages. The effect of ECV extract with three concentrations (50µL, 100µL, and 200µL) was estimated on embryonated chicken eggs (ECEs). The data revealed that 100 µL of ECV extract is a nontoxic dose, as evidenced by the absence of embryo deaths, and has effective antiviral activity by using a mixture of 0.2 mL of NDV with 108.5 EID50/ml with 0.2 mL of ECV extract, which led to decrease of viral titer to 103.4EID50/ml with complete inhibition of NDV replication and loss of haemagglutination (HA) activity. Later on, in vivo study was applied in 28 days old Sasso chickens to evaluate the activity of ECV extract at 1 g/kg concentration according to invitro assessment as it is nontoxic effective antiviral dose in the drinking water before and after the NDV challenge. The used assessment parameters in this study were clinical signs, post-mortem (PM) lesions and histopathological pictures and it showed the effective role of ECV extract in viral replication inhibition in the treated groups when compared to control ones. Also, Real-time PCR was conducted to estimate NDV titer after challenge, in the group (III) and group (IV) showed a decrease in viral shedding at 3rd and 5th day post challenge (dpc) and a complete absence of viral titer at 7th dpc in the prophylactic group (III) in comparison with the positive control (II). These findings illustrated the potential role of ECV extract in overcoming NDV infection under field conditions and advised using it as an antiviral agent

Synthesis of functionaly substituted pyridine and thiophene derivatives

399-40

Tradition, modernity and gender in the Arab home: a study from Tripoli (Libya)

This socio-spatial study explores the meaning of home in an Arab context in terms of the response of residents to three case study sites that reflect different eras of development and involve different house types- traditional courtyard houses in the Medina and two collective housing estates. Based upon the triadic distinctions of Lefèbvre, a mixed methodology is applied to these case study sites, with relevant information coming from interviews and focus groups with architects and residents, a satisfaction survey and a space syntax analysis. Unlike many previous studies, the interviews and focus groups document the experience and views of female residents. The results highlight the continuing impact of religion and culture on the meaning of the home. The Arab-Libyan home constitutes a family and a feminine ideal, based on gender segregation and female privacy. The traditional courtyard house offers a suitable house type, but not the only possible type that meets the practices and preferences of Arab Libyan families

Microscopic and molecular detection of piroplasms among sheep in Upper Egypt

IntroductionBlood parasites pose a significant threat to livestock production in southern Egypt, yet there is a scarcity of information regarding their circulation and epidemiology in sheep in this region. This study aimed to investigate the seroprevalence of blood parasite infections in sheep in Assiut governorate, Upper Egypt.MethodsA total of 400 blood samples were collected from sheep of varying ages and genders. The preliminary screening for the presence of piroplasms, mainly Babesia and Theileria spp., via microscopic examination, followed by investigation of the potential risk factors linked with the exposure to infection. Moreover, molecular identification of both parasites on some of positive samples was performed using PCR targeting Babesia 18S rRNA and Theileria annulata Tams1 gene.ResultsThe microscopic examination revealed that among the examined sheep, there was an overall prevalence of blood parasites at 44% (176 out of 400), with Babesia spp. observed in 14% (56 out of 400) and Theileria spp. in 30% (120 out of 400). Furthermore, the infection rate was non-significantly higher in young animals (50%) compared to adults (38.5%) (P = 0.246). Male sheep exhibited a significantly higher vulnerability to both parasites' infection (63.3%) compared to females (35.7%) (P = 0.011). Interestingly, the prevalence of both blood parasites was significantly higher during the cold season (66.1%) compared to the hot season (15.9%) (P = &lt; 0.001). The molecular analysis identified the presence of Babesia ovis and Theileria annulata among a subsample of the positive sheep's bloods films. The identified species were recorded in the GenBank™ databases and assigned specific accession numbers (OQ360720 and OQ360719 for B. ovis), and (OP991838 for T. annulata).ConclusionsTaken together, this study confirms a high prevalence of piroplasmosis and offers epidemiological and molecular insights into blood parasites in sheep from Upper Egypt, highlighting the importance of detecting these parasites in various hosts and their competent vectors (ticks)

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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