Right thoracotomy approach for patients with congenital tracheoesophageal fistula associated with right-sided aortic arch: a multicentric study

Background: A right-sided aortic arch (RAA) occurs in 5% of patients with esophageal atresia (EA). Its presence has significant surgical implications. Repair of the atresia has been considered difficult with the usual approach through the right chest. We hereby report our experience with cases of EA and RAA treated over the past 13 years in three pediatric surgical departments to determine the optimal surgical approach.Patients and methods: This is a retrospective study, which included all patients having EA with tracheoesophageal fistulas (TEFs) treated between January 2000 and September 2013 at four pediatric surgery departments (Zagazig University Hospital, Egypt; Assir Central Hospital, Kingdom of Saudi Arabia; MCH Najran, Kingdom of Saudi Arabia; Soba University Hospital, Sudan). The study compared a group of 22 patients who had EA with TEFs with RAA and no associated congenital disorder with another group of 22 patients who had the same condition but with normally situated left-sided aortic arch.Results: A total of 44 patients having EA with fistula were included into this study. They were divided into two groups on the basis of the side of aortic arch; 22 patients had leftsided aortic arch (group L), and the other 22 patients had RAA (group R). All patients were treated through right  thoracotomy. It was possible to achieve successful, although difficult management, in all patients with RAA through right thoracotomy. There was significant difference between the two groups of patients with regard to the operative time (104± 9.8 vs. 149 ±15.4 min). Twenty patients (45%) developed postoperative complications, with a morbidity rate of 41 and 50%, respectively, with no significant difference between the two groups. No mortality was recorded.Conclusion: Repair of congenital TEF associated with RAA can be performed through right thoracotomy safely but with some difficulty and longer time.Keywords: congenital tracheoesophageal fistula, right-sided aortic arch, right thoracotom

Exploring the relationship between accreditation and patient satisfaction – the case of selected Lebanese hospitals

Background: Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods: An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. Results: The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion: This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction

Adaptation to Blue Light in Marine Synechococcus Requires MpeU, an Enzyme with Similarity to Phycoerythrobilin Lyase Isomerases

Marine Synechococcus has successfully adapted to environments with different light colors, which likely contributes to this genus being the second most abundant group of microorganisms worldwide. Populations of Synechococcus that grow in deep, blue ocean waters contain large amounts of the blue-light absorbing chromophore phycourobilin (PUB) in their light harvesting complexes (phycobilisomes). Here, we show that all Synechococcus strains adapted to blue light possess a gene called mpeU. MpeU is structurally similar to phycobilin lyases, enzymes that ligate chromophores to phycobiliproteins. Interruption of mpeU caused a reduction in PUB content, impaired phycobilisome assembly and reduced growth rate more strongly in blue than green light. When mpeU was reintroduced in the mpeU mutant background, the mpeU-less phenotype was complemented in terms of PUB content and phycobilisome content. Fluorescence spectra of mpeU mutant cells and purified phycobilisomes revealed red-shifted phycoerythrin emission peaks, likely indicating a defect in chromophore ligation to phycoerythrin-I (PE-I) or phycoerythrin-II (PE-II). Our results suggest that MpeU is a lyase-isomerase that attaches a phycoerythrobilin to a PEI or PEII subunit and isomerizes it to PUB. MpeU is therefore an important determinant in adaptation of Synechococcus spp. to capture photons in blue light environments throughout the world\u27s oceans

Triple malignancy in a single patient including a cervical carcinoma, a basal cell carcinoma of the skin and a neuroendocrine carcinoma from an unknown primary site: A case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>The occurrence of multiple primary cancers is rare. Only a few cases and patient reviews of an association of triple malignancy have been reported.</p> <p>Case presentation</p> <p>We report here a case of a 78-year-old Moroccan woman presenting initially with a synchronous double malignancy, the first in her cervix and the second in her skin. Our patient was treated with radiation therapy for both tumors and remained in good control for 17 years, when she developed a metastatic disease from a neuroendocrine carcinoma of an unknown primary site.</p> <p>Conclusions</p> <p>Although the association of multiple primary cancers can be considered a rare occurrence, improving survival in cancer patients has made this situation more frequent.</p

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

Exploring the Relationship between Accreditation and Patient Satisfaction – The Case of Selected Lebanese Hospitals

Background: Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods: An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. Results: The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion:This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction

DESALINATION SYSTEM POWERED BY A HYBRID WASTE HEAT AND SOLAR ENERGY

Abstract Various thermal power systems emit flue of gases containing significant amounts of waste energy. The aim of the present research work is to recover that energy to develop a highly efficient desalination system. coupled with solar energy of simple construction, applicable of fresh water production that are constructed near these thermal sites. The study of the performance of this solar collector has been conducted experimentally under actual insolation in Alqassim district in Saudi Arabia, where there is brackish underground water The overall daily potable water productivity of the proposed system was about 160 L/day for a corresponding waste energy varying from 170 to 500 MJ/day and a global solar radiation on a horizontal surface ranging from 15 to 29 MJ/m2 day. [2] F. Mousa, and H. Hashem, &quot;Gas turbine exhaust gas heat recovery at South Baghdad (Iraq) power plant&quot;, Heat Recovery Systems and CHP, Volume 9, Issue 6, 1989, PP. 547-552. Keywords [3] P.K. Nag, and S. De, &quot;Design and operation of a heat recovery steam generator with minimum irreversibility&quot;, Appl. Therm. Eng. 17 (1997) 385-391. Theoretical investigation of solar humidification-dehumidification desalination system using parabolic trough concentrators Abstract This paper deals with the status of solar energy as a clean and renewable energy applications in desalination. The object of this research is to theoretically investigate the principal operating parameters of a proposed desalination system based on air humidification-dehumidification principles. A parabolic trough solar collector is adapted to drive and optimize the considered desalination system. A test setup of the desalination system was designed and a theoretical simulation model was constructed to evaluate the performance and productivity of the proposed solar humidification-dehumidification desalination system. The theoretical simulation model was developed in which the thermodynamic models of each component of the considered were set up respectively. The study showed that, parabolic trough solar collector is the suitable to drive the proposed desalination system. A comparison study had been presented to show the effect of the different parameters on the performance and the productivity of the system. The productivity of the proposed system showed also an increase with the increase of the day time till an optimum value and then decreased. The highest fresh water productivity is found to be in the summer season, when high direct solar radiation and long solar time are always expected. The production time reaches a maximum value in the summer season, which is 42% of the day