Role of Prostaglandin E2 in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Background: Spontaneous bacterial peritonitis (SBP) is the most frequent bacterial infection in patients who suffer from liver cirrhosis and ascites. Prostaglandin E2 (PGDE2) is considered a simple and accurate tool for diagnosing systemic inflammation and has a relevant impact on prognosis in cirrhotic patients.Objective: We tried to detect the role of PGDE2 in serum and ascitic fluid as a diagnostic marker for eradication of SBP.Patients and methods: This clinical-based prospective cohort study involved patients with liver cirrhosis, ascites and spontaneous bacterial peritonitis referred to the Internal Medicine Department, Faculty of Medicine, Zagazig University during the period from June 2020 to March2021. Patients with ascites were divided equally into: (a) case group included cirrhotic patients with SBP); and (b) control group included cirrhotic patients without SBP. All patients were subjected to complete clinical and laboratory examination. Serum and ascitic PGDE2 were estimated before and after five days of treatment. Results: There was statistically significant difference between the studied groups regarding Child score and presence of HCC. Serum and ascitic PGDE2 was elevated in all cirrhotic groups; both of case and control had more than normal. However, PGDE2 level was lower in case group before treatment in comparison with control group, and after treatment PGDE2 levels was elevated.Conclusion: Serum and ascitic fluid PGDE2 can be used as a diagnostic marker for SBP diagnosis and eradication. Serum PGDE2 is preferred due to its less invasiveness and minimal risk of complications

BlockCampus: A Blockchain-Based DApp for enhancing Student Engagement and Reward Mechanisms in an Academic Community for E-JUST University

In today's digital age, online communities have become an integral part of our lives, fostering collaboration, knowledge sharing, and community engagement. Higher education institutions, in particular, can greatly benefit from dedicated platforms that facilitate academic discussions and provide incentives for active participation. This research paper presents a comprehensive study and implementation of a decentralized application (DApp) leveraging the blockchain technology to address these needs specifically for E-JUST (Egypt-Japan University of Science and Technology) students and academic staff

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Multislice CT coronary angiography and coronary artery calcium scoring, correlation with Heart Score

Abstract Background Coronary atherosclerosis is the number one leading cause of death. According to estimates, if all primary cardiovascular diseases (CVDs) had been eradicated, life expectancy could increase by nearly seven years. Long asymptomatic latent phases of coronary heart disease allow for early preventive measures. Egypt has a high prevalence of premature Coronary Artery Disease (CAD). Aim of study We aimed to evaluate the correlation between the cardiovascular risk assessed by the Systematic COronary Risk Evaluation (HeartScore) and Coronary Artery Calcium Score (CACS) versus the actual extent of atherosclerotic CAD affection among a sample of Egyptian patients assessed by Multislice Computed Tomography (MSCT) due to chest pain complaints. Methods An observational cross section study included one hundred studied cases: aged 40 to 69 years old, of which 63% were males, 63% were hypertensive, 39% were diabetic, and 28% were smokers. Those patients presented with symptoms suggestive of coronary artery disease (chest pain). All studied cases had been subjected to history and examination, electrocardiograph (ECG), kidney functions, lipid profile, SCORE calculation, and coronary MSCT scan. Results Our observational study found a moderately significant positive relationship between the HeartScore and CACS and CAD; having a higher score carries a higher probability of having CAD. Having a very low score is a good negative test for exclusion. Also, there is a weak relationship between HeartScore, CACS, and the number of diseased coronaries, i.e. these cannot differentiate single vessel disease (SVD) from Multivessel Disease (MVD). In addition, both scores could not determine Obstructive Coronary Artery Disease (OCAD) and Nonobstructive Coronary Artery Disease (Non-OCAD). Conclusions From the clinical point of view, our research suggests that HeartScore and CACS have moderate value in predicting CAD

Breast cancer involvement of the nipple-areola complex and implications for nipple-sparing mastectomies: a retrospective observational study in 137 patients

Abstract Introduction Nipple-sparing mastectomy (NSM) has gained much attention by enhancing the aesthetic outcome in breast carcinoma patients. The aim of this study was to assess the prevalence of malignant affection of the nipple-areola complex (NAC) in breast carcinoma patients and its correlation with prognostic factors for breast cancer. Patients and methods This study included 137 female patients diagnosed with breast carcinoma at different disease stages who were admitted to our surgical oncology unit at Suez Canal University Hospital from June 15, 2014 to January 25, 2017. We excluded patients with evidence of nipple involvement as ulceration or patients with previous breast surgery with periareolar incisions. This study was designed to test the hypothesis that the NAC can be spared in certain selected patients. All studied participants provided a full history and underwent general and local clinical examinations, pre-operative laboratory tests, and radiological and pathological evaluations. Results The mean age of the study population was 47.39 ± 8.01 years. Among the patients, the NAC was affected in 12 (11.40%) patients. Patients with NAC involvement showed a significantly larger tumor size of more than 4 cm and a shorter tumor-nipple distance of less than 2 cm (p = 0.000). Lymph node metastasis was associated with NAC involvement (p = 0.001), with increased risk when more than 10 lymph nodes were involved (p = 0.007). Lymphovascular invasion was a significant predictor of NAC involvement (p = 0.014). Multifocal as well as multicentric tumors were significantly associated with NAC involvement (p = 0.016 and 0.003, respectively). NAC involvement was more likely in Estrogen receptor (ER) and Progesterone receptor (PR) patients than in ER+ and PR+ patients (p = 0.000), while Human epidermal receptor (HER+) patients were more likely to have NAC involvement than HER patients (p = 0.000). Additionally, stage ΙΙΙ cancer was significantly associated with NAC involvement (p = 0.041), and histological grade III disease carried a greater risk than grade I disease of NAC involvement (p = 0.008). Conclusion The incidence of NAC affection among breast carcinoma patients who underwent mastectomy and axillary clearance was associated with important parameters, such as tumor size, areola edge-tumor distance, lymph node affection, hormonal receptor status and lymphovascular invasion. Accordingly, NAC-preserving surgeries could be tailored to patients with favourable tumor characteristics