Laparoscopic Hernia Repair in Infancy and Childhood; Evaluation of Two Different Techniques

Background/Purpose: There are many techniques available for laparoscopic hernia repair in infancy and childhood. The objective of this study is to compare two different laparoscopic techniques as regards operative time, recurrence rate, hydrocele formation and post operative cosmetic results. Materials & Methods: A prospective randomized controlled study was carried out in the Pediatric Surgery Unit of Al- Azhar University Hospitals, over three years period. ne-hundred and fifty patients with congenital inguinal hernia were randomized into two equals groups; (n = 75). Group A was subjected to purse-string suture around the internal inguinal ring (IIR) using two needle holders (TNH). Group B was subjected to laparoscopic hernia repair of inguinal hernia by Reverdin Needle (RN). Inclusion criteria included; bilateral inguinal hernia, recurrent hernia, hernia in obese child, incarcerated hernia and hernia on ipsilateral with questionable contralateral side. Exclusion criteria included; unilateral inguinal hernia, and hernia with undescended testicles. The main outcome measurements were; operative time, hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results: There were no significant differences as regard age, sex and mode of presentation between both groups. All cases were completed successfully without conversion. There were significant statistical differences in the operative time between the studied groups, while there were no significant statistical differences in the hospital stay, post operative hydrocele formation and recurrence rate. The cosmetic result is excellent in group B. Conclusion: Laparoscopic hernia repair by RN is an effective line of hernia repair in infancy and childhood. It resulted in marked reduction of operative time and excellent cosmetic results with low recurrence. Index Word: Laparoscopic, Reverdin Needle, Purse-string, Intracorporeal sutures

Prevalence and characterization of plasmid-mediated quinolone resistance genes in Proteus species isolated from different patients

Proteus spp. are widely distributed opportunistic pathogens that can cause various human infections. A total of 361 clinical specimens were obtained from patients who were attending to different hospitals in El-Minia governorate, Egypt. Approximately 23 % of the samples belong to Proteus spp. isolates which were obtained from various clinical sources. After biochemical identification, 42.1 % of isolates were found to belong to Proteus vulgaris and 57.8 % to P. mirabilis. The urine samples collected from catheterized patients represented 32.6 % of all the clinical specimens, and the majority of the recorded isolates were Proteus spp. The antibacterial sensitivity of the Proteus spp. was examined using 16 different antibiotics from various families. The most effective antibiotics were Amikacin; Levofloxacin, and Meropenem, recording 68.6 %, 66.2 %, and 62.2 % of the isolates sensitivity to each of these antibiotics, respectively. Using the ureR-based PCR, 48 % of the isolates were identified as P. mirabilis. Moreover, the Qnr genes (i.e., qnrA, qnrB, qnrS, qnrD, and qnrC) and the aac (6')-Ib-cr gene had been identified in 40 % of P. mirabilis isolates. The aims of the study were to investigate the prevalence of Proteus spp. in El-Minia, Egypt; determine the antibacterial susceptibility pattern of these isolates, and characterize the PMQR genes in Proteus spp. Quinolone resistance in P. mirabilis isolates might have been brought on by mechanisms other than qnr and aac (6')-Ib genes. Finally, since Proteus spp. are widespread in the environment; healthcare facilities must uphold stringent sanitation standards to reduce the incidence of the nosocomial infections

External quality assessment of the molecular diagnostics and genotyping of meticillin-resistant Staphylococcus aureus

Two multicentre external quality assessments (EQA) for the molecular detection and genotyping of meticillin-resistant Staphylococcus aureus (MRSA) were arranged. Firstly, 11 samples containing various amounts of inactivated MRSA strains, meticillin-susceptible S. aureus (MSSA), meticillin-resistant coagulase-negative staphylococci (MRCoNS) or Escherichia coli were distributed to 82 laboratories. Samples containing 102 or 103 MRSA cells were correctly scored in only 16 and 46% of the datasets returned, respectively. Two of the used MSSA strains contained an SCCmec cassette lacking the mecA gene. There was a marked difference in the percentage of correct results for these two MSSA strains (37 and 39%) compared to the MSSA strain lacking the SCCmec cassette (88%). Secondly, a panel for MRSA genotyping, consisting of ten samples (two identical, three genetically related and five unique strains) was distributed to 19 laboratories. Seventy-three percent of the datasets recorded all samples correctly. Most pulsed-field gel electrophoresis (PFGE) protocols proved to be suboptimal, resulting in inferior resolution in the higher or lower fragment regions. The performance of molecular diagnostics for MRSA shows no significant changes since our first EQA in 2006. The first molecular typing results are encouraging. Both assessments indicate that programme expansion is required and that major performance discrepancies continue to exist

Improving the melting performance in a triple-pipe latent heat storage system using hemispherical and quarter-spherical fins with a staggered arrangement

Data availability statement: The original contributions presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author.This study aims to evaluate the melting characteristics of a phase change material (PCM) in a latent heat storage system equipped with hemispherical and quarter-spherical fins. A vertical triple-pipe heat exchanger is used as the PCM-based heat storage unit to improve the melting performance compared with a double-pipe system. Furthermore, the fins are arranged in inline and staggered configurations to improve heat transfer performance. For the quarter-spherical fins, both upward and downward directions are examined. The results of the system equipped with novel fins are compared with those without fins. Moreover, a fin is added to the heat exchanger’s base to compensate for the natural convection effect at the bottom of the heat exchanger. Considering similar fin volumes, the results show that the system equipped with four hemispherical fins on the side walls and an added fin on the bottom wall has the best performance compared with the other cases with hemispherical fins. The staggered arrangement of the fins results in a higher heat transfer rate. The downward quarter-spherical fins with a staggered configuration show the highest performance among all the studied cases. Compared with the case without fins, the heat storage rate improves by almost 78% (from 35.6 to 63.5 W), reducing the melting time by 45%.King Khalid University Deanship of Scientific Research Large Groups [Project under grant number (RGP. 2/142/43)]; Brunel University London

A Sustainable Cold Mix Asphalt Mixture Comprising Paper Sludge Ash and Cement Kiln Dust

Concerns about the environment, the cost of energy, and safety mean that low-energy cold-mix asphalt materials are very interesting as a potential replacement for present-day hot mix asphalt. The main disadvantage of cold bituminous emulsion mixtures is their poor early life strength, meaning they require a long time to achieve mature strength. This research work aims to study the protentional utilization of waste and by-product materials as a filler in cold emulsion mixtures with mechanical properties comparable to those of traditional hot mix asphalt. Accordingly, cold mix asphalt was prepared to utilize paper sludge ash (PSA) and cement kiln dust (CKD) as a substitution for conventional mineral filler with percentages ranging from 0–6% and 0–4%, respectively. Test results have shown that the incorporation of such waste materials reflected a significant improvement in the mixture’s stiffness and strength evolution. The cementitious reactivity of PSA produces bonding inside the mixtures, while CKD is used as an additive to activate the hydration process of PSA. Therefore, based on the results, it will be easier to build cold mixtures by shortening the amount of time needed to reach full curing conditions

The Prevalence and Risk Factors of Trichosporonosis at King Abdulaziz University Hospital

Ghassan J Alboloshi,1 Asif A Jiman-Fatani,2,3 Dalya Attallah,3 Jawahir A Mokhtar,2– 4 Nabeela Abdullah Al-Abdullah,5,6 Khalil Alkuwaity,4,7 Reham Kaki,6,8 Mohammed W Al-Rabia,2 Abdelbagi Alfadil,2,9 Karem Ibrahem,2 Addisu D Teklemariam,10,11 Steve Harakeh12,13 1Department of Medical Laboratories, King Abdullah Medical Complex Jeddah, Ministry of Health, Jeddah, Saudi Arabia; 2Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Clinical and Molecular Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 4Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Public Health, College of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia; 6Department of Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 7Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 9Center of Research Excellence for Drug Research and Pharmaceutical Industries, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 10Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 11Department of MIVP, College of Veterinary Medicine and Agriculture, Addis Ababa University, Addis Ababa, Ethiopia; 12King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 13Yousef Abdul Latif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi ArabiaCorrespondence: Abdelbagi Alfadil, Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, P.O. Box 80205, King Abdulaziz University, 21589, Saudi Arabia, Tel +96612 6952000 Ext 21062, Email [email protected]: Fungal infections, especially those caused have emerged as a significant medical concern over the past three decades, particularly among immunocompromised patients. However, recent studies have highlighted the increasing prevalence of fungal infections resembling yeast other than Candida, such as trichosporonosis, especially among immunosuppressed individuals worldwide. Trichosporon has been identified as a significant contributor to superficial and invasive infections. Invasive trichosporonosis, primarily affecting immunocompromised patients, poses a significant threat with high mortality rates.Purpose: The current study aimed to explore the clinical epidemiology of Trichosporon spp at King Abdulaziz University Hospital (KAUH) in Saudi Arabia.Methods: This retrospective study aimed to assess the clinical epidemiology of Trichosporon spp. infections in microbiology cultures obtained from KAUH in Saudi Arabia. The study analyzed data from patients over a five-year period, focusing on demographic, clinical, and microbiological characteristics.Results: This study encompassed 21 participants, categorized into four distinct age groups. Moreover, this study indicated T. asahii as the predominant species isolated, accounting for 90.5% of infections, followed by T. mucoides (9.5%). ICU hospitalization, diabetes mellitus, taking immunosuppressive drugs, and antifungal drugs, and the use of invasive medical equipment were identified as prominent risk factors for trichosporonosis. Urinary tract infections were the most common clinical presentation, particularly among male and elderly patients. Mortality rates were high, especially among older individuals.Conclusion: This study contributes valuable epidemiological insights into trichosporonosis, highlighting the need for enhanced surveillance and preventive strategies in healthcare settings. Further research is warranted to optimize treatment approaches and infection control measures, ultimately reducing the burden of Trichosporon infections on patient outcomes.Keywords: fungal infection, trichosporonosis, Trichosporon spp, Trichosporon asahii, invasive, risk factor

Cten Is Targeted by Kras Signalling to Regulate Cell Motility in the Colon and Pancreas

CTEN/TNS4 is an oncogene in colorectal cancer (CRC) which enhances cell motility although the mechanism of Cten regulation is unknown. We found an association between high Cten expression and KRAS/BRAF mutation in a series of CRC cell lines (p = 0.03) and hypothesised that Kras may regulate Cten. To test this, Kras was knocked-down (using small interfering (si)RNA) in CRC cell lines SW620 and DLD1 (high Cten expressors and mutant for KRAS). In each cell line, Kras knockdown was mirrored by down-regulation of Cten Since Kras signals through Braf, we tested the effect of Kras knockdown in CRC cell line Colo205 (which shows high Cten expression and is mutant for BRAF but wild type for KRAS). Cten levels were unaffected by Kras knockdown whilst Braf knockdown resulted in reduced Cten expression suggesting that Kras signals via Braf to regulate Cten. Quantification of Cten mRNA and protein analysis following proteasome inhibition suggested that regulation was of Cten transcription. Kras knockdown inhibited cell motility. To test whether this could be mediated through Cten, SW620 cells were co-transfected with Kras specific siRNAs and a Cten expression vector. Restoring Cten expression was able to restore cell motility despite Kras knockdown (transwell migration and wounding assay, p<0.001 for both). Since KRAS is mutated in many cancers, we investigated whether this relationship could be demonstrated in other tumour models. The experiments were repeated in the pancreatic cancer cell lines Colo357 & PSN-1(both high Cten expressors and mutant for KRAS). In both cell lines, Kras was shown to regulate Cten and forced expression of Cten was able to rescue loss of cell motility following Kras knockdown in PSN-1 (transwell migration assay, p<0.001). We conclude that, in the colon and pancreas, Cten is a downstream target of Kras and may be a mechanism through which Kras regulates of cell motility

Chronic hepatitis c genotype-4 infection: role of insulin resistance in hepatocellular carcinoma

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatocellular carcinoma (HCC) and different HCV genotypes show characteristic variations in their pathological properties. Insulin resistance (IR) occurs early in HCV infection and may synergize with viral hepatitis in HCC development. Egypt has the highest reported rates of HCV infection (predominantly genotype 4) in the world; this study investigated effects of HCV genotype-4 (HCV-4) on prevalence of insulin resistance in chronic hepatitis C (CHC) and HCC in Egyptian patients.</p> <p>Methods</p> <p>Fifty CHC patients, 50 HCC patients and 20 normal subjects were studied. IR was estimated using HOMA-IR index and HCV-4 load determined using real-time polymerase chain reaction. Hepatitis B virus was excluded by enzyme-linked immunosorbent assay. Standard laboratory and histopathological investigations were undertaken to characterize liver function and for grading and staging of CHC; HCC staging was undertaken using intraoperative samples.</p> <p>Results</p> <p>HCC patients showed higher IR frequency but without significant difference from CHC (52% vs 40%, p = 0.23). Multivariate logistic regression analysis showed HOMA-IR index and International Normalization Ratio independently associated with fibrosis in CHC; in HCC, HbA1c, cholesterol and bilirubin were independently associated with fibrosis. Fasting insulin and cholesterol levels were independently associated with obesity in both CHC and HCC groups. Moderate and high viral load was associated with high HOMA-IR in CHC and HCC (p < 0.001).</p> <p>Conclusions</p> <p>IR is induced by HCV-4 irrespective of severity of liver disease. IR starts early in infection and facilitates progression of hepatic fibrosis and HCC development.</p

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112