Implementation of a bowel management program in the treatment of incontinence in children for primary healthcare providers

Objectives: Our surgical team has devised a bowel management program (BMP) as a basic approach for primary healthcare providers with the least use of resources.Background: Soiling in children is a major problem that has a serious impact on the child’s social and psychological life. Causes vary from idiopathic constipation to postoperative or neuropathic causes as meningomyelocele.Participants and methods: Seventy five children suffering from fecal incontinence were assessed and divided into true incontinence and pseudoincontinence groups. The BMP was applied to both categories in the form of proper diet control, enemas, drugs, and bowel habit alteration. The program was fashioned according to the age, type, severity, and response of each case. A fecal incontinence scoring system was used to assess the results.Results: All cases with pseudoincontinence attained 50% or more improvement in incontinence score whereas the true incontinence cases attained excellent results except in post high anorectal malformation repairs and neurologic groups.Conclusion: Most of the cases suffering from constipation with pseudoincontinence can be treated properly by BMPs, whereas the minority suffering from true incontinence need multidisciplinary work to achieve acceptable results.Keywords: anorectal malformations, bowel management program, chronic idiopathic constipation, fecal incontinence, Hirschsprung’s disea

Intraoperative Corneal Thickness Changes during Pulsed Accelerated Corneal Cross-Linking Using Isotonic Riboflavin with HPMC.

Purpose. To evaluate corneal thickness changes during pulsed accelerated corneal cross-linking (CXL) for keratoconus using a new isotonic riboflavin formula. Methods. In this prospective, interventional, clinical study patients with grades 1-2 keratoconus (Amsler-Krumeich classification) underwent pulsed accelerated (30 mW/cm(2)) CXL after application of an isotonic riboflavin solution (0.1%) with HPMC for 10 minutes. Central corneal thickness (CCT) measurements were taken using ultrasound pachymetry before and after epithelial removal, after riboflavin soaking, and immediately after completion of UVA treatment. Results. Twenty eyes of 11 patients (4 males, 7 females) were enrolled. Mean patient age was 26 ± 3 (range from 18 to 30 years). No intraoperative or postoperative complications were observed in any of the patients. Mean CCT was 507 ± 35 μm (range: 559-459 μm) before and 475 ± 40 μm (range: 535-420 μm) after epithelial removal (P < 0.001). After 10 minutes of riboflavin instillation, there was a statistically significant decrease of CCT by 6.2% from 475 ± 40 μm (range: 535-420 μm) to 446 ± 31 μm (range: 508-400) (P < 0.005). There was no other statistically significant change of CCT during UVA irradiation. Conclusions. A significant decrease of corneal thickness was demonstrated during the isotonic riboflavin with HPMC application while there was no significant change during the pulsed accelerated UVA irradiation

Synthesis, characterization and molecular modeling of new ruthenium(II) complexes with nitrogen and nitrogen/oxygen donor ligands

Ru(II) complexes with some dinitrogen ligands; 3,4-diamino benzoic acid (DABA), 2-hydazinopyridine (hzpy), 2,2′-bipyridyl (bipy) and anthranilic acid (anth) have been synthesized and characterized by using IR, mass, and UV–Vis spectrometry and thermal analysis. The thermodynamic parameters (ΔE, ΔH, ΔS and ΔG) have been calculated by using Coats–Redfern and Horowitz–Metzger methods. The electrochemical properties of these complexes have been studied by using cyclic voltammetry. The evaluated energies of the HOMO and LUMO are in the range of −4.94 to −4.85 eV and −2.86 to −2.68 eV, respectively. The complexes have been proven to have an octahedral geometry with DABA, hzpy and bipy as N2 donor ligands and NSC as monodentate ligand. The structure of the Ru(II) complexes has been geometrically optimized by using parameterized PM3 semiempirical method. © 2015 The Author

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Diagnostic utility and complications of flexible fiberoptic bronchoscopy in Assiut University Hospital: A 7-year experience

Background: Few studies with small number of patients reported their experience with flexible fiberoptic bronchoscopy (FFB). We aimed to report our 7-year experience with the diagnostic yield and complications of FFB at Assiut University Hospital. Materials and methods: A retrospective review of bronchoscopy reports and corresponding patients’ charts over 7 years from January 2006 to December 2012 performed at the Department of Chest Diseases, Assiut University Hospital, was done. Indication for procedures, suspected diagnosis, final diagnosis, and complications were reported. Results: Of 3980 bronchoscopies, 3660 (92%) were diagnostic. Mean age was 45 ± 18 years and 68% were males. Malignancy and infection, including tuberculosis (TB), were the 2 main indications for FFB (47% and 23.8%). The overall diagnostic yield was 67%. A total of 1690 bronchoalveolar lavage (BAL), 1303 brushing, 188 transbronchial biopsies (TBB), and 645 bronchial biopsies (BB) were performed. Malignancy was confirmed in 70% of suspected cases. Tuberculosis was diagnosed in 58.5% of suspected cases, whereas bacterial pneumonia was diagnosed in 48.5%. Bronchoscopy diagnosed 38.4% of patients with interstitial lung disease. The diagnostic yield was 55% for sarcoidosis and 33% for usual interstitial pneumonia. The overall complication rate was 1.61%. Mortality rate was 0.05%. Conclusions: Our results confirm that flexible fiberoptic bronchoscopy is a valuable diagnostic tool, with a low rate of complications, particularly in patients with lung cancer. The diagnostic yield in our locality is almost similar to that reported in other series

Performance enhancing of porcelain insulators using low cost micro additives

Porcelain have been widely utilized in electrical power system. The enhancement of its properties has positively influenced its behavior thence on overall power system. Nano/Micro technologies are influential field used for developing different characteristics of porcelain insulators. In this work, three weight percentages of fly ash micro-particles were admixed to neat porcelain. Characterization and morphological features for prepared samples were scrutinized using XRD and SEM. BDV, relative permittivity, and dissipation factor were measured. Moreover, porosity, bulk density, and water absorption were measured. COMSOL Software was used to simulate the electric field distribution on the samples. This study indicated, fly ash promoted the electrical characteristics of porcelain. Inclusion of 6 % fly ash along the porcelain sample increases BDV from 22.5 kV to 56.7 kV. The presence of fly ash inside porcelain not only decreased relative permittivity but also dissipation factor. The optimum sintering temperature gives lowest porosity and highest bulk density was 1200 °C

Reactive spectrum handoff combined with random target channel selection in cognitive radio networks with prioritized secondary users

Cognitive radio aims at improving spectrum utilization by allowing secondary users to access primary user’s spectrum. The delay time of secondary users due to multiple interruptions from primary users is considered a crucial issue. In this work, to reduce secondary user delay time, we propose a mixed preemptive/non-preemptive resume priority model where secondary user priority increases with each interruption by the primary user. We consider reactive spectrum handoff combined with random target channel selection for the case of all-busy channels. We derive closed form expressions of the average cumulative delay time and the extended data delivery time for each secondary user class. Numerical results show that the proposed approach reduces the secondary user delay time per class compared to other models in case of light loaded networks. Keywords: Cognitive radio, Spectrum handoff, Queueing theory, Priority scheme