A pulmonary artery false aneurysm after right middle lobectomy: a case report

Pulmonary artery false aneurysm is a rare condition, reported to complicate interventional procedures. We report a case of a false aneurysm of the interlobar pulmonary artery following a right middle lobectomy for lung cancer. This is probably the first reported case

Portal Venous Pressure as a Predictor of Mortality in Child’s A Cirrhotic Patients Undergoing Elective Surgery: A Prospective Study

BACKGROUND: Recently, portal venous pressure (PVP) exhibited high sensitivity and specificity in anticipating death in cirrhotic cases submitted to emergency operations. AIM: The current prospective work aimed to evaluate the utility of PVP in predicting 1st month post-operative death in Child’s A cirrhotic cases who underwent elective operations. METHODS: One-hundred and twenty cirrhotic cases that were planned to undergo elective surgery were enrolled in the current prospective work. The intraoperative (I.O) PVP and central venous pressure (CVP) were measured. The statistical analysis was performed using the SPSS version 22.0. The receiver operative curve was plotted to measure the predictive value of PVP. Multivariate analysis was done using logistic regression method for the significant variables impacting mortality on univariate analysis. RESULTS: Twenty-nine patients died in the current work. Patients who survived had statistically considerably lower PVP than patients who died (8.2 ± 1.5 vs. 12.5 ± 1.6 mmHg, respectively, p < 0.001). Similarly, patients who died had significantly higher I.O CVP (p < 0.001), body mass index (p < 0.001), and were more likely to have model for end-stage liver disease score between 9 and 16 (p = 0.003). At a cutoff value ≥10.5 mmHg, the PVP had a sensitivity of 82.8% and specificity of 93.4% for the prediction of mortality. The logistic regression analysis showed that only PVP (odds ratio [OR] =3.1, 95% confidence interval [CI] 1.25–7.5) and CVP (OR = 2.8, 95% CI 1.2–6.5) were the only independent predictors of mortality. CONCLUSION: PVP is a significant predictor of death in Child’s A cirrhotic cases submitted to elective operations

2-Amino-4-phenyl-4H,10H-1,3,5-triazino[1,2-a]benzimidazol-3-ium chloride

2-Guanidinobenzimidazole condenses with benzaldehyde in the presence of hydro­chloric acid to form 2-amino-3,4-dihydro-4-phenyl-1,3,5-triazino[1,2-a]benzimidazole, which was isolated as its hydro­chloride, C15H14N5 +·Cl−. The positive charge of the cation is formally placed on the double-bonded N atom of the dihydro­triazine ring. The six-membered dihydro­triazine that is fused with the benzimidazole ring system is relatively flat (r.m.s. deviation = 0.106 Å), with the methine C atom deviating most [0.164 (1) Å] from the mean-square plane. The phenyl ring connected to the methine C atom is disordered over two positions in a 0.558 (1):0.442 (1) ratio; the two orientations are aligned at 85.1 (1) and 89.6 (1)° with respect to the dihydro­triazine ring. In the crystal, adjacent cations and anions are linked by N—H⋯N and N—H⋯Cl hydrogen bonds, generating a double chain running along the b axis

Pseudomonas aeruginosa - Modified Hodge Test (PAE-MHT) and ChromID Carba Agar for Detection of Carbapenemase Producing Pseudomonas Aeruginosa Recovered from Clinical Specimens

AIMS: This study aims to evaluate the ability of ChromID Carba agar, and Pseudomonas aeruginosa modified Hodge test (PAE-MHT) for detection of carbapenemase-producing P. aeruginosa and to determine the associated carbapenemase gene classes by PCR. METHODS: One hundred Carbapenem-resistant P. aeruginosa (CRPA) isolates were tested for: i) carbapenemases production by ChromID carba agar, Modified Hodge test (MHT) and (PAE-MHT) and ii) detection of some carbapenemase genes by PCR. RESULTS: All (100%) of the isolates showed growth on ChromID Carba agar with 100% sensitivity. Using MHT, 54% of isolates were positive, 3% were indeterminate, and 43% were negative, demonstrating 58.9% sensitivity and 80% specificity. On performing PAE-MHT, 91% of the strains were positive, 3% were intermediate, and 6% were negative, demonstrating 97.9% sensitivity and 80% specificity. The most prevalent gene was blaKPC (81%), followed by blaVIM (74%); blaIMP was detected in only one isolate, and blaOXA-48 in 34% of the isolates. CONCLUSIONS: We conclude that PAE-MHT and ChromID Carba are sensitive, specific, simple and cost-effective screening tests for detection of CRPA isolates compared to the traditional MHT

Delayed presentation of an isolated gallbladder rupture following blunt abdominal trauma: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The taxation of electronic commerce activities

La question de cette étude est de savoir si les activités électroniques peuvent être soumises à l'impôt ou non. Si la réponse est positive, cela pose un autre problème : quel cadre fiscal pour les activités de commerce électronique ? Il est à mentionner que la politique fiscale américaine repose sur une règle qui ne soumet pas les activités du commerce électronique à l'impôt. Ces activités ont pour caractéristique d'être dématérialisées, ce qui pose plusieurs difficultés en matière de l'établissement de l'impôt. Tout d'abord, la nature dématérialisée des activités du commerce électronique peut poser le problème de la localisation des parties et par conséquent la difficulté d'identification du contribuable et des transactions électroniques. Or, cette nature dématérialisée et transfrontalière soulève un problème de détermination des règles de territorialité applicables. Ensuite, cette étude souhaite démontrer si les principes généraux d'imposition, soit en droit français soit en droit égyptien, peuvent être appliqués aux activités du commerce électronique. Enfin, et après avoir exposé tous les problèmes relatifs à l'établissement de l'impôt sur les activités du commerce électronique, cette étude propose un certain nombre de moyens permettant de résoudre les difficultés liées à l'imposition des activités de commerce électronique.The question of this study is that if these electronic activities can be submitted to the tax or not. If the answer is positive, it poses another problem is how the taxation framework for electronic commerce activities is. It is worth mentioning that American fiscal policy rested on a rule whose e-commerce activities do not subject to tax. These activities are characterized as being dematerialized, which poses several difficulties in establishing the tax. First, the nature of paperless electronic commerce activities may pose the problem of localization of parts and later the difficulty in identifying the taxpayer and electronic transactions. Yet such is a cross-border paperless and difficulty of determining the rules of territoriality applicable. Second, this study requires showing whether the general principles of tax law either Egyptian law or French law can be applied to electronic commerce activities or not. Finally, and after exposing all the problems relating to the establishment of tax e-commerce activities, the methodology of this research leads the researcher to address the means to solve these problems

Extraction of Solar Module Parameters using a Novel Optimization Technique

The parameters of a Photovoltaic (PV) model are pivotal in gauging its efficiency under varying sunlight irradiances, temperatures, and different load scenarios. Determining these PV model parameters poses a complex non-linear optimization challenge. This study is based on a new metaheuristic optimization algorithm called the Pelican Optimization Algorithm (POA) to discern the unknown parameters of the PV model. The suggested POA algorithm underwent testing using a monocrystalline panel, encompassing its single-diode configuration. The objective function is designed to minimize the root of the mean squared errors between the predicted and actual current values, adhering to specific parameter constraints. Various statistical error metrics were utilized to emphasize the performance of the proposed algorithm. A comparative analysis with other well-established algorithms was conducted, indicating that POA stands out as highly competitive since it showcases superior efficiency in parameter identification compared to its counterparts