Penetrating chest trauma: A prospective study of prognostic factors for worse outcome after emergency surgery

Background: Even though chest penetrating injuries are common as well as challenging to treat, most of the time they can be dealt without surgery. This study aimed to evaluate contemporary outcome following emergent surgical interventions for penetrating chest trauma and possible factors associated with poor prognosis. Methods: This prospective study included 100 cases admitted to benha university hospital with either Stab Wound or Gunshot wound to the chest, with systolic blood pressure ≤90 mmHg and who underwent through Thoracotomy or sternotomy within duration of one hour of arrival. Results: This study included 81 patients (77 stabbings, 4 gunshots) underwent a thoracotomy and 19 underwent median sternotomy within 60 minutes after the penetrating trauma, the mean period of surgery was 3 ±0.9, There were 94 male and 6 female cases and their mean age was 25 ±10.14 years, the mean Intensive care unit stay was 2 ±0.83 days in addition mean hospital stay was 6 ±1.06 days, the individuals who died had trauma at mid-clavicular line of the chest (100%) compared to survivors (5.5%), lesser systolic blood pressure on presentation in the emergency room (71 ±11 mmHg) equated with those who survived (90 ±9 mmHg, P<0.001) and lower hemoglobin level (6.4 ±0.5) compared with those who survived (8.4 ±1, P<0.001). As a whole, the mortality rate was 9% (n=9). individuals' Death Rates with stab wounds was 5/96 (5.2%) compared with 4/4 (100%) for patients with gunshot wounds. Right ventricular injury (P=0.03) was associated with mortality. Conclusion: Early referral, within one hour, to emergency surgery results in acceptable postoperative mortality in patients with penetrating chest trauma. Anterior location of injury, initial hemodynamic instability, and gunshot wounds associated with poor prognosis

Occult pneumothorax, revisited

Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation), missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax

INFLUENCE OF DIETARY THREONINE AND TRYPTOPHAN SUPPLEMENTATIONS ON BROILER PRODUCTIVITY TRAITS UNDER EGYPTIAN SUMMER CONDITIONS

A study was conducted to investigate the effects of feeding different levels of threonine and tryptophan on growth performance, some serum parameters and carcass traits of broiler chicks under Egyptian summer conditions. Three hundred and sixty Ross 308, one-day-old broiler chicks were randomly allocated into nine treatments with 4 replicates of 10 chicks each. Three levels of threonine (100, 150 or 200 %) and three levels of tryptophan (100, 150 or 200%) according to dietary requirements for Ross 308 chick's guidebook were used in a factorial design arrangement to obtain nine experimental treatments. Two periodical diets were used (starter phase 1-21 days and finisher phase 22-35 days). Growth performance traits including live body weight (LBW), Body weight gain (BWG), feed consumption (FC) and feed conversion ratio (FCR) were recorded at the end of each week. Carcasses were manually eviscerated and weighed. Components of total protein, albumin, cholesterol, and triglycerides were analyzed by using commercial kits. The results showed that chicks fed diet containing 200 % threonine had an improvement in live body weight, body weight gain and feed conversion ratio. The performance index increased with the addition of threonine and tryptophan in the broiler diets. Serum total protein and globulin concentrations were affected by supplemental threonine and tryptophan. Dietary threonine, tryptophan did not affect serum albumin and triglycerides. Total cholesterol was increased with supplementation of threonine, tryptophan and interaction between them. Chicks fed 100% dietary threonine had the significantly better results in terms of the relative weights of carcass, edible parts and bursa compared to the chicks fed other dietary threonine levels, although tryptophan amino acid had not any significant effect on the above-mentioned traits. Giblets, liver, and heart weights percentage increase with increasing tryptophan level in the broiler diets. The relative weight of gizzard reduced with increasing level of both amino acids in the diets.In this study, it concluded that supplementation of threonine and tryptophan improves productive performance and health status of broiler chicks without imposing any toxicity as all blood components were in normal range

Microfluidic-Based Formulation of Essential Oils-Loaded Chitosan Coated PLGA Particles Enhances Their Bioavailability and Nematocidal Activity

In this study, poly (lactic-co-glycolic) acid (PLGA) particles were synthesized and coated with chitosan. Three essential oil (EO) components (eugenol, linalool, and geraniol) were entrapped inside these PLGA particles by using the continuous flow-focusing microfluidic method and a partially water-miscible solvent mixture (dichloromethane: acetone mixture (1:10)). Encapsulation of EO components in PLGA particles was confirmed by Fourier transform infrared spectroscopy, thermogravimetric analysis, and X-ray diffraction, with encapsulation efficiencies 95.14%, 79.68%, and 71.34% and loading capacities 8.88%, 8.38%, and 5.65% in particles entrapped with eugenol, linalool, and geraniol, respectively. The EO components’ dissociation from the loaded particles exhibited an initial burst release in the first 8 h followed by a sustained release phase at significantly slower rates from the coated particles, extending beyond 5 days. The EO components encapsulated in chitosan coated particles up to 5 μg/mL were not cytotoxic to bovine gut cell line (FFKD-1-R) and had no adverse effect on cell growth and membrane integrity compared with free EO components or uncoated particles. Chitosan coated PLGA particles loaded with combined EO components (10 µg/mL) significantly inhibited the motility of the larval stage of Haemonchus contortus and Trichostrongylus axei by 76.9%, and completely inhibited the motility of adult worms (p < 0.05). This nematocidal effect was accompanied by considerable cuticular damage in the treated worms, reflecting a synergistic effect of the combined EO components and an additive effect of chitosan. These results show that encapsulation of EO components, with a potent anthelmintic activity, in chitosan coated PLGA particles improve the bioavailability and efficacy of EO components against ovine gastrointestinal nematodes

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

AMELIORATIVE EFFECTS OF ARTEMISIA JUDAICA L. EXTRACT AGAINST ALLOXAN-INDUCED BIOCHEMICAL ALTERATIONS IN MALE WISTAR RATS

Objective: The current study aims to evaluate the potential of crude leaf extract of Artemisia judaica L. (AJE) in reducing the biochemical abnormalities accompanied to alloxan-induced diabetes in male Wistar rats.Methods: Thirty male albino rats (100-110 g) were divided equally into three groups including control, diabetic and diabetic+AJE. Diabetes was induced by using a single dose of alloxan (120 mg/kg of body weight). Serum biochemical parameters, including insulin, glucose, triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL), total proteins, albumin, globulin, renal markers (creatinine, urea, uric acid), activities of aspartate transaminase (AST), alanine transaminase (ALT) and gamma-glutamyltransferase (ɤGT) were measured in all groups. Also, values of homeostasis model assessment of insulin resistance (HOMA-IR) and ratios of albumin: globulin (A: G), TC/HDL (risk factor-1), LDL/HDL (risk factor-2) were calculated for each group.Results: Diabetic rats showed reduction in body weight and marked decline in the values of serum insulin, protein profile indices and HDL accompanied with marked elevation in values of glucose, HOMA_IR, triglycerides, TC, LDL, VLDL, TC/HDL, LDL/HDL, renal markers and activities of the estimated enzymes. Supplementation of diabetic rats with AJE, twice daily for 30 days, significantly ameliorated most of the estimated biochemical parameters.Conclusion: The current results demonstrate that AJE possesses a hypoglycemic effect and acts as a protective factor against metabolic abnormalities induced by diabetes mellitus.Â

Correlation Between Fecal (Calprotectin and Lactoferrin) Results and Colonoscopic Findings in Chronic Diarrhea and Recurrent Abdominal Pain in Children and Adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn's disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using&nbsp; both&nbsp; of&nbsp; fecal markers (calprotectin and&nbsp; lactoferrin) in patients presenting with chronic diarrhea&nbsp; and&nbsp; recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope&nbsp; unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein &amp; Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001