The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures : a systematic review and meta-analysis

The aim of the present study was to test whether there is a significant difference in the clinical outcomes between standard and three-dimensional (3D) miniplate fixation in the management of mandibular angle fractures (MAFs). An electronic search without date and language restrictions was performed in October 2013. Inclusion criteria were studies in humans including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. Six studies were included. The meta-analyses revealed statistically significant differences for the incidence of hardware failure and postoperative trismus. There were no significant differences in the incidence of postoperative infection, malocclusion, wound dehiscence, non-union/malunion, or paresthesia. The cumulative odds ratio was 0.42, meaning that the use of 3D miniplates in the fixation of MAFs decreases the risk of the event (postoperative complication) by 58%. The results of this meta-analysis showed lower postoperative complication rates with the use of 3D miniplate fixation in comparison with the use of standard miniplate fixation in the management of MAFs

Incidence and predictors of post-catheterization femoral artery pseudoaneurysms

Background: Femoral artery pseudoaneurysm (FAP) is a troublesome complication after transfemoral catheter procedures. The incidence and predictors of FAP as a separate entity have not been extensively studied. Aim: Detect prospectively the incidence and predictors of post catheterization FAP. Methods: From June 2009 till June 2011, we prospectively included all patients who underwent catheterization from the femoral approach. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 200 randomly selected patients. We performed univariate analysis and a logistic regression model for multivariate analysis. Results: The incidence of FAP was 3.42%. Eighty FAPs (66.7%) were related to a diagnostic catheterization while 40(33.3%) were related to an interventional procedure. The mean age of patients with FAP was 55.36 ± 10.68 yrs; 57.5% were females. At diagnosis 81.66% of the patients were on antiplatelet therapy, 35% were on heparin or warfarin and 16.66% were on both, with mean value of INR for patients on warfarin 2.2 ± 0.76. FAPs were connected to the common femoral artery in 29.1% of patients, to the SFA in 54.1% and to the profunda in 16.6%. Female gender, obesity and hypertension significantly enhanced the risk for FAP. Also diagnostic angiography, low puncture, multiple punctures and the use of dual antiplatelet and/or anticoagulant therapy were independent procedure-related risk factors for FAP. Conclusion: Femoral artery pseudoaneurysms are not uncommon. Female gender, obesity, hypertension, the use of antiplatelet and/or anticoagulant therapy and faulty puncture techniques are independent risk factors for FAPs

HR LC-MS/MS metabolomic profiling of Yucca aloifolia fruit and the potential neuroprotective effect on rotenone-induced Parkinson's disease in rats.

Yucca aloifolia L. fruit (Yucca or Spanish bayonet, family Asparagaceae) is recognized for its purplish red color reflecting its anthocyanin content, which has a powerful antioxidant activity. This study aimed to investigate yucca (YA) fruit extract's protective effect on Parkinson's disease (PD). In vitro study, the anti-inflammatory activity of yucca fruit extracts was explored by measuring tumor necrosis factor receptor 2 (TNF-R2) and nuclear factor kappa B (NF-KB) to choose the most effective extract. Afterward, a detailed in vivo investigation of the protective effect of the most active extract on rotenone-induced PD was performed on male albino Wister rats. First, the safety of the extract in two different doses (50 and 100 mg/kg in 0.9% saline orally) was confirmed by a toxicological study. The rats were divided into four groups: 1) normal control (NC); 2) rotenone group; and third and fourth groups received 50 and 100 mg/kg yucca extract, respectively. The neurobehavioral and locomotor activities of the rats were tested by rotarod, open field, and forced swim tests. Striatal dopamine, renal and liver functions, and oxidative stress markers were assessed. Western blot analysis of brain tissue samples was performed for p-AMPK, Wnt3a, and β-catenin. Histopathological examination of striatal tissue samples was performed by light and electron microscopy (EM). The metabolites of the active extract were characterized using high-resolution LC-MS/MS, and the results showed the prevalence of anthocyanins, saponins, phenolics, and choline. Biochemical and histopathological tests revealed a dose-dependent improvement with oral Yucca extract. The current study suggests a possible neuroprotective effect of the acidified 50% ethanol extract (YA-C) of the edible Yucca fruit, making it a promising therapeutic target for PD

Pentoxifylline Effects on Hospitalized COVID-19 Patients with Cytokine Storm Syndrome: A Randomized Clinical Trial

COVID-19 is a fatal, fast-spreading pandemic, and numerous attempts are being made around the world to understand and manage the disease. COVID-19 patients may develop a cytokine-release syndrome, which causes serious respiratory diseases and, in many cases, death. The study examined the feasibility of employing legally available anti-inflammatory pentoxifylline (PTX), a low toxicity and cost medication, to mitigate the hyper-inflammation caused by COVID-19. Thirty adult patients who tested positive for SARS-CoV2 were hospitalized owing to the cytokine storm syndrome. They were given 400 mg of pentoxifylline orally TID according to the standard COVID-19 protocol of the Egyptian Ministry of Health. Besides this, a group of thirty-eight hospitalized COVID-19 patients who received the standard COVID-19 protocol was included in the study as a control group. The outcomes included laboratory test parameters, clinical improvements, and number of deaths in both groups. After receiving PTX, all patients showed a significant improvement in C reactive protein (CRP), and interleukin-6 (IL-6) levels at p p = 0.004, respectively, while there was an increase in total leukocyte count (TLC) and neutrophil-to-leucocyte ratio (NLR) at p p < 0.01, while showing no statistically significant difference in the control group. The median initial ALT (42 U/L) in the treatment group showed a decrease compared to the control group (51 U/L). No statistical significance was reported regarding clinical improvement, length of stay, and death percentages between the two groups. Our results showed no significant improvement of PTX over controls in clinical outcomes of hospitalized COVID-19 patients. Nevertheless, PTX displayed a positive effect on certain inflammatory biomarkers

Phenol Biodegradation and Bioelectricity Generation by a Native Bacterial Consortium Isolated from Petroleum Refinery Wastewater

Phenolic compounds are highly toxic, along with being one of the most persistent substances in petroleum refinery effluents. The most potent solution is through phenol bioremediation to produce demi-water and bioenergy, which are two effective outcomes for a single process. Fifteen genetically identified native bacterial strains were isolated from the effluents of the petrochemical industry plant (AMOC, Egypt) and were investigated for potential phenol biodegradation activity and energy bioproduction individually and as a consortium in a batch culture. Successful and safe phenol biodegradation was achieved (99.63%) using a native bacterial consortium after statistical optimization (multifactorial central composite design) with bioelectricity generation that reached 3.13 × 10−6 mW/cm3. In conclusion, the native consortium was highly potent in the bioremediation process of petroleum refinery wastewater, protecting the environment from potential phenol pollution with the ability to generate an electrical current through the bioremediation process

Phenol Biodegradation and Bioelectricity Generation by a Native Bacterial Consortium Isolated from Petroleum Refinery Wastewater

Phenolic compounds are highly toxic, along with being one of the most persistent substances in petroleum refinery effluents. The most potent solution is through phenol bioremediation to produce demi-water and bioenergy, which are two effective outcomes for a single process. Fifteen genetically identified native bacterial strains were isolated from the effluents of the petrochemical industry plant (AMOC, Egypt) and were investigated for potential phenol biodegradation activity and energy bioproduction individually and as a consortium in a batch culture. Successful and safe phenol biodegradation was achieved (99.63%) using a native bacterial consortium after statistical optimization (multifactorial central composite design) with bioelectricity generation that reached 3.13 &times; 10&minus;6 mW/cm3. In conclusion, the native consortium was highly potent in the bioremediation process of petroleum refinery wastewater, protecting the environment from potential phenol pollution with the ability to generate an electrical current through the bioremediation process

The impact of smartphone addiction on attention control and sleep in Egypt—an online survey

Abstract Background The widespread use of smartphones makes it imperative for researchers to study the adverse effect of smartphone addiction. We aimed to study the risk factors of smartphone addiction, insomnia, and attention deficit among smartphone users among a sample of Egyptian adolescents and adults. Methods An online survey was disseminated among Egyptian social media groups. Participants were requested to complete Smartphone Addiction Scale-Short Version (SAS-SV), Insomnia Severity Index (ISI) scale, and attention control scale (ACS). Results Two-thousand seven-hundred sixteen responded to our survey with a mean age of 31.4 ± 10.3 years. Smartphone addiction was documented in 2386 (87.8%) participants, with a median daily time for smartphone use of 5 h (IQR: 3–7). A significant association was found between smartphone addiction and younger age, higher educational levels, and urban residency (unadjusted or adjusted). Binary logistic regression analysis showed that the only factor affecting the probability of moderate to severe insomnia was the higher SAS-SV score, either unadjusted (OR = 1.1, 95% CI: 1.08–1.1) or adjusted (OR = 1.09, 95% CI: 1.08–1.11). Multiple linear regression analysis showed that higher scores on SAS-SV (P < 0.001) and ISI (P < 0.001), being female (P < 0.001), and being of rural residency (P = 0.025) were associated with lower total scores on ACS. On the other hand, older age (P < 0.001) and longer intervals between smartphone cessation and bedtime (P = 0.004) were found to increase the attention score. Conclusion Smartphone addiction is prevalent in Egypt, which deserves special concern as it may have negative consequences such as insomnia and poor attention control, particularly in younger age groups

Table_1_Determination of morpho-physiological and yield traits of maize inbred lines (Zea mays L.) under optimal and drought stress conditions.DOCX

Globally, climate change could hinder future food security that concurrently implies the importance of investigating drought stress and genotype screening under stressed environments. Hence, the current study was performed to screen 45 diverse maize inbred lines for 18 studied traits comprising phenological, physiological, morphological, and yield characters under optimum and water stress conditions for two successive growing seasons (2018 and 2019). The results showed that growing seasons and water regimes significantly influenced (p < 0.01) most of the studied traits, while inbred lines had a significant effect (p < 0.01) on all of the studied traits. The findings also showed a significant increase in all studied characters under normal conditions compared to drought conditions, except chlorophyll content, transpiration rate, and proline content which exhibited higher levels under water stress conditions. Furthermore, the results of the principal component analysis indicated a notable distinction between the performance of the 45 maize inbred lines under normal and drought conditions. In terms of grain yield, the drought tolerance index (DTI) showed that Nub60 (1.56), followed by Nub32 (1.46), Nub66 (1.45), and GZ603 (1.44) were the highest drought-tolerant inbred lines, whereas Nub46 (0.38) was the lowest drought-tolerant inbred line. These drought-tolerant inbred lines were able to maintain a relatively high grain yield under normal and stress conditions, whereas those drought-sensitive inbred lines showed a decline in grain yield when exposed to drought conditions. The hierarchical clustering analysis based on DTI classified the forty-five maize inbred lines and eighteen measured traits into three column- and row-clusters, as inbred lines in cluster-3 followed by those in cluster-2 exhibited greater drought tolerance in most of the studied traits. Utilizing the multi-trait stability index (MTSI) criterion in this study identified nine inbred lines, including GZ603, as stable genotypes in terms of the eighteen studied traits across four environments. The findings of the current investigation motivate plant breeders to explore the genetic potential of the current maize germplasm, especially in water-stressed environments.</p