Postoperative Outcomes after Laparoscopic Cholecystectomy in Elderly Patients

Background: Age is a critical factor influencing the death and morbidities afterward cholecystectomy. It was revealed that laparoscopic cholecystectomy (LC) in the elderly has similar security and effectiveness to those in young people. The gold-standard in the management of cholelithiasis is LC. Objectives: This work was aimed to assess post-operative outcomes of LC between elderly cases and for comparing the post-operative outcome of LC among ages groups >60yrs and <60yrs. Patients and Methods: This prospective study conducted among 68 cases who experienced LC at Damanhur Medical National Institute Hospital. Cases were allocated into 2 groups according to ages: elderly (≥60yrs, n= 38) and young (<60 yrs, n= 35). Results: 68 cases divided into two groups. The mean age is 68.4± 5.7 and 49.1± 10.5 among elderly and younger groups. There is significant difference between groups regarding age and comorbidities. The mean operative time was 62.8± 21.2 and 59.5± 18.7 among elderly and young groups. There is no statistically significant difference between two groups regarding intraoperative data. There is nonsignificant change regarding postoperative outcomes after LC. Conclusion: It could be concluded that laparoscopic cholecystectomy in elderly cases is similar with young cases. Consequently, LC is secure even in the elderly

Surgical Management and Outcome of Patients with Thyroid Diseases during the COVID-19 Pandemic

Background: Globally, healthcare authorities have reacted by restricting medical care to emergency cases and postponing elective surgical procedures of all types. Elective surgeries have been almost totally postponed keeping to a minimum the risk of transmission of SARS-CoV-2 and to allow a better allocation of resources. Since thyroid surgery usually does not cover immediate surgical interventions, during this pandemic nearly all the patients who require thyroid surgery care are experiencing delays in the operation planning procedure. Objective: The aim of the work was to investigate the impact of COVID-19 pandemic on thyroid surgery.Subjects and methods: We conducted prospective study from August 2020 to February 2021 among all patients who attended to Damanhur Medical National Institute Hospital. Total sample size was 60 patients and patients with positive COVID-19 were enrolled in group 1 (cases) and those who were negative COVID-19 were enrolled in group 2 (controls). Results: A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). The mean age 39.5± 9.5 years. There is no statistically significant difference between patients with COVID-19 and patients without COVID-19 regarding developing complications from thyroid surgeries.Conclusion: The COVID-19 pandemic has created a complicated set of issues for patients with endocrine-related cancers. Most thyroid cancers are indolent and so postponement of surgery in the era of COVID-19. There is no significant association between COVID-19 and complications of surgery

Homoclinicity in the dynamics of forced fluidized bed catalytic reactors

The dynamic behaviour of the non-isothermal oscillating fluidized bed catalytic reactor subjected to high and low frequency forcing is investigated. Resonance horns and period doubling loci inside the horns are constructed, using efficient algorithms, for different positions of the centre of forcing relative to the homoclinical orbit (infinite period orbit) of the autonomous (unforced) system. The analysis shows that the reactor behaviour is very sensitive to the position of the centre of forcing relative to the homoclinical orbit. For high frequency forcing (ω/ω0 = 5/1) with centre of forcing close to the homoclinical orbit, the system shows period doubling to chaos at very small amplitudes. For low frequency forcing (ω/ω0 = 2/1), incomplete period doubling not leading to chaos is observed in some cases and the new period adding bifurcation is also uncovered for other cases. The interactions between different resonance horns are investigated and the resulting bistabilities are elucidated. Quantitative methods proved that the strange attractors encountered are chaotic with one positive Lyapunov exponent and a Lyapunov fractal dimension between 1 and 2

Green Synthesis, Characterization, Antimicrobial and Anticancer Screening of New Metal Complexes Incorporating Schiff Base

A Schiff base ligand of o-vanillin and 4-aminoazobenzene and its transition metal complexes of Ni(II), Co(II), Zn(II), Cu(II), Mn(II), and Zr(IV) were prepared under microwave irradiation as a green approach compared to the conventional method. The structures of new compounds have been characterized and elucidated via elemental and spectroscopic analyses. In addition, magnetic susceptibility, electron spin resonance, and electronic spectra of the synthesized complexes explained their geometrical structures. The thermal stability of Cu(II), Zn(II), and Zr(IV) complexes was studied by thermo-gravimetric analyses (TGA). Coats–Redfern and Horowitz–Metzger equations were used to calculate the thermal and dehydration decomposition activities of proposed structures kinetically. Surface morphologies of the solid compounds were imaged by scanning electron microscopy (SEM). The particle size of prepared complexes was measured by using a particle size analyzer at a diffraction angle of 10.9°. The geometry structures of the synthesized compounds were verified utilizing electronic spectra, ESR spectrum, and magnetic moment value. The newly synthesized compounds were screened for antimicrobial activity. Also, the anticancer activity of the free Schiff base ligand and its metal complexes were studied against two cell lines: human colon (HCT-116) and human liver cancer cells (HepG-2). The obtained results showed that the Cu(II) complex displayed the highest cytotoxic activity (IC50 = 18 and 22 μg/mL for HepG-2 and HCT, respectively) compared to the free Schiff base ligand.publishedVersio

Antifungal activity of eco-safe nanoemulsions based on Nigella sativa oil against Penicillium verrucosum infecting maize seeds: Biochemical and physiological traits

The main goals of the present investigation were to develop O/W nanoemulsion fungicides based on cold-pressed Nigella sativa (black seed) oil to prevent Penicillium verrucosum infection of maize seeds and to test their antifungal activity against this fungus. Additionally, the effect of these nanoemulsions on plant physiological parameters was also investigated. Two nonionic surfactants namely Tween 20 and Tween 80 were used as emulsifying agents in these formulations. The effect of sonication time and surfactant type on the mean droplet size, polydispersity index (PDI), and zeta potential of the nanoemulsions were determined by dynamic light scattering (DLS). Results indicated that both sonication time and emulsifier type had pronounced effects on the stability of O/W nanoemulsions with a small particle size range (168.6–345.3 nm), acceptable PDI (0.181–0.353), and high zeta potential (−27.24 to –48.82 mV). Tween 20 showed superior stability compared to Tween 80 nanoemulsions. The in vitro results showed that complete inhibition of P. verrucosum-growth was obtained by 10_T80 and 10_T20 nanoemulsions at 100% concentration. All nanoemulsions had increment effects on maize seed germination by 101% in the case of 10_T20 and 10_T80 compared to untreated seeds or the chemical fungicide treatment. Nanoemulsions (10_T20 and 10_T80) were able to stimulate root and shoot length as compared to the fungicide treatment. Seed treatment with 10_T80 nanoemulsion showed the highest AI and protease activity by 75 and 70%, respectively, as compared to the infected control. The produced nanoemulsions might provide an effective protectant coating layer for the stored maize seeds

Hemorrhage control, infection prevention and application on anesthetics in exodontia of natal teeth

Introduction: The teeth that appear at the time of birth are called Natal teeth. The exact cause of its appearance is unknown, but possible causes for this condition include infections, trauma, hormonal stimulation etc. There is a possibility to aspirate the tooth and difficulty with feeding. Case report: A one day old baby born with teeth in the lower jaw was referred to our dental department, Thumbay Hospital, Dubai, UAE. The crown structure was attached to the gums with grade 2 mobility (Millers classification). The shell like crown was removed with a periodontal curette and care was taken not to injure the underlying tooth. Vitamin K injection 1mg IM was given in the anterolateral thigh 2hours before the procedure. Conclusion: The appearance of natal teeth is a rare case however it is not uncommon in the newborns. Extraction as the first treatment choice should be performed as soon as possible considering all possible complications. Vitamin K administration is a mandatory step in the treatment

Chapter 14 Electrical Properties of Soils

This chapter discusses the electric and electromagnetic methods that are used to evaluate the electrical properties of soils. Electric techniques exploit the flow of a steady-state current in the subsurface, while electromagnetic methods rely on the phenomenon of electromagnetic induction and the wave character of the electromagnetic field. The electrical techniques and associated properties are: (a) spontaneous potential methods in which the formation of water resistivity is determined; (b) resistivity methods in which the apparent resistivity can be calculated using Wenner, Schlumberger, and dipole-dipole arrays; and (c) specific conductivity methods in which the soil-specific conductivity is calculated by incorporating in the analysis of soil geometric factors, such as fabric anisotropy, tortuosity, resistance to solid matrix, bulk fluid phase, and electric double layer. Various parameters that influence the measured electrical properties are also presented, such as the nature of the soil composition (particle size distribution, mineralogy), soil structure (porosity, pore size distribution, connectivity, and anisotropy), moisture content, temperature, concentration of dissolved species in the pore-solution, wet-dry cycles, age of contaminants, and mineral formation due to biodegradation. Finally, the extraction of aquifer hydraulic properties such as porosity and hydraulic conductivity, from the measured electrical properties is discussed

BM-MSCs alleviate diabetic nephropathy in male rats by regulating ER stress, oxidative stress, inflammation, and apoptotic pathways

Introduction: Diabetic nephropathy (DN), a chronic kidney disease, is a major cause of end-stage kidney disease worldwide. Mesenchymal stem cells (MSCs) have become a promising option to mitigate several diabetic complications.Methods: In this study, we evaluated the therapeutic potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) in a rat model of STZ-induced DN. After the confirmation of diabetes, rats were treated with BM-MSCs and sacrificed at week 12 after treatment.Results: Our results showed that STZ-induced DN rats had extensive histopathological changes, significant upregulation in mRNA expression of renal apoptotic markers, ER stress markers, inflammatory markers, fibronectin, and intermediate filament proteins, and reduction of positive immunostaining of PCNA and elevated P53 in kidney tissue compared to the control group. BM-MSC therapy significantly improved renal histopathological changes, reduced renal apoptosis, ER stress, inflammation, and intermediate filament proteins, as well as increased positive immunostaining of PCNA and reduced P53 in renal tissue compared to the STZ-induced DN group.Conclusion: In conclusion, our study indicates that BM-MSCs may have therapeutic potential for the treatment of DN and provide important insights into their potential use as a novel therapeutic approach for DN

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

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