The impact of Oligo-miocene basaltic intrusions on the petroleum system in Gulf of Suez rift basin, Egypt: new insights into tikhermal maturity and reservoir quality

In recent years, the petroleum industry has prioritized the exploration of new and unconventional petroleum reservoirs. As a result, this study assessed the significance of basaltic intrusions from two key aspects: their impact on the thermal maturity of pre-rift source rocks and their potentiality as reservoirs. The present study attempts to integrate surface field investigations of basaltic dykes in Wadi Nukhul and Wadi Matulla as surface analogs with petroleum system modeling of pre-rift source rocks containing subsurface basaltic intrusions in the Abu Rudeis-Sidri field. Therefore, the fracture networks were observed in Wadi Nukhul and Wadi Matulla, suggesting that both the basaltic dykes and host rocks have interconnected fractures, which is critical for a high-quality reservoir of the dykes and efficient oil expulsion. As a result, the analysis of burial history, temperature, maturity, generation, transformation ratio, and expelled oil quantity revealed a significantly high value for basaltic intrusions. Moreover, the Abu Rudeis-Sidri field had a good petroleum system with thermally mature source rocks by basaltic intrusions. Furthermore, the fractured basaltic intrusions presented a high-quality oil reservoir well-sealed by the thick Rudeis Formation. Oil production has doubled since the discovery of this reservoir. This study introduces a novel approach to understanding the distribution pattern of basaltic intrusions in subsurface and surface analogs, which can serve as a model for exploring new potential unconventional basaltic reservoirs in the Gulf of Suez rift basin

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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&lt;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&lt;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

Applying a Hybrid Model of Markov Chain and Logistic Regression to Identify Future Urban Sprawl in Abouelreesh, Aswan: A Case Study

Urban sprawl has become a very complex process, because it has many factors affecting its directions and values. The study of relative research shows that the driving forces that lead and redirect future urban sprawl require the application of a statistical method. In our study, logistic regressions were used to analyze and class the driving forces for urban sprawl. Identifying the driving forces, which is the most important step in predicting the future of urban sprawl in 2037, was performed using the cellular automata models. This study takes the Aswan area as a case study in the period from 2001 to 2013 by analyzing the official detailed plan and Google Earth historical imagery. Almost all data was prepared for logistic regression analysis using ArcGIS software and IDRISI® Selva. In our study, a hybrid model of the Markov chain and logistic regression models was applied to identify future urban sprawl in 2037. The findings of this paper simulate the increase in urban area over 24 years from 1.85 to 2.59 km2. These findings highlight the growing risks of urban sprawl and the difficulties opposing the sustainable urban development plans officially proposed for this area

New approach into human health risk assessment associated with heavy metals in surface water and groundwater using Monte Carlo Method

Abstract This study assessed the environmental and health risks associated with heavy metals in the water resources of Egypt's northwestern desert. The current approaches included the Spearman correlation matrix, principal component analysis, and cluster analysis to identify pollution sources and quality-controlling factors. Various indices (HPI, MI, HQ, HI, and CR) were applied to evaluate environmental and human health risks. Additionally, the Monte Carlo method was employed for probabilistic carcinogenic and non-carcinogenic risk assessment via oral and dermal exposure routes in adults and children. Notably, all water resources exhibited high pollution risks with HPI and MI values exceeding permissible limits (HPI > 100 and MI > 6), respectively. Furthermore, HI oral values indicated significant non-carcinogenic risks to both adults and children, while dermal contact posed a high risk to 19.4% of samples for adults and 77.6% of samples for children (HI > 1). Most water samples exhibited CR values exceeding 1 × 10–4 for Cd, Cr, and Pb, suggesting vulnerability to carcinogenic effects in both age groups. Monte Carlo simulations reinforced these findings, indicating a significant carcinogenic impact on children and adults. Consequently, comprehensive water treatment measures are urgently needed to mitigate carcinogenic and non-carcinogenic health risks in Siwa Oasis

Dietary feeding lycopene, citric acid, and Chlorella alleviated the neurotoxicity of polyethylene microplastics in African Catfish (Clarias gariepinus)

A few studies assessed how natural products can protect fish from the neurotoxic effects of Microplastics (MPs). Therefore, the goal of this study was to look into the neurotoxicity of PE-MPs on the brain tissue of African catfish (C. gariepinus), and whether dietary feeding on Chlorella, citric acid, and lycopene could help alleviate their toxicity. Five groups of fish were used: The first group received a standard diet (control). The second group was fed 500 mg/kg PE-MP. The third group was fed PE-MP + lycopene (500 mg/kg diet). The fourth group was fed PE-MP + citric acid (30 g/kg diet). And the fifth group was fed PE-MP + Chlorella (50 g/kg diet) for 15 days. The activities of Acetylcholinesterase (Ach), Monoamine Oxidase (MAO), Aldehyde Oxidase (AO), and Nitric Oxide (NO), and the histological effect on brain tissues were then assessed. The activity of the four neurological biomarker enzymes investigated was altered significantly in fish subjected to PE-MP alone compared with the control group. For fish exposed to PE-MP with lycopene, citric acid, or Chlorella, the activities of these neurological enzymes significantly improved particularly with Chlorella compared with fish fed PE-MP individually. Histological investigations illustrated that being subjected to PE-MPs effected cellular alterations in the telencephalon, including diffuse distorted and degraded neurons, encephalomalacia, aggregated neuroglial cells (gliosis), as well as deformed and necrotic neurons, neuropil vacuolation (spongiosis), aggregated neuroglial cells (gliosis), pyknotic neurons, and shrunken Purkinje cells which were found in the cerebellum. Most histological alterations induced by exposure to PE-MP feeding were restored by dietary feeding on Chlorella, citric acid, and lycopene. Accordingly, this study recommends using citric acid, lycopene, and Chlorella as a natural remedy against MP neurotoxicity particularly with Chlorella.Publikationsfonds ML

Management of equivocal (early) Fournier’s gangrene

Background: Fournier’s gangrene (FG) is an acute progressive necrotizing fasciitis of the genital area and perineum with possible extension to the abdominal wall. Surgical debridement is the gold standard management modality of established patients. Equivocal (early) FG represents a challenge in diagnosis. The objective of this study was to compare conservative management and early exploration in cases of equivocal (early) FG. Methods: This was an observational study where data of all patients diagnosed as early FG in our departments over 4 years (2011–2015) were enrolled. Patients were divided into two groups: group 1 with conservative treatment, and group 2 managed with urgent exploration with longitudinal hemiscrotal incision starting from external inguinal ring. All patients’ demographics, vital signs, laboratory finding and clinical findings were reported. Results: A total of 28 patients were enrolled in the study. Group 1 was managed with conservative treatment (17 patients) and group 2 underwent urgent exploration (11 patients). Overall, four patients (23.5%) out of 17 patients of group 1 showed a good response to conservative management without any surgical debridement. A total of 13 patients (76.5%) developed gangrenous discoloration and needed surgical debridement later. In group 2, four patients (36.4%) underwent scrotal exploration and release incision only without debridement and showed an excellent clinical outcome. A total of four patients (36.4%) underwent debridement with excision of doubtful deep subcutaneous and fascial tissues. The remaining three patients (27.2%) underwent debridement of necrotic fascia. The hospital stay was significantly shorter in group 2 patients than group 1 (7.5 ± 3.75 versus 13.4 ± 5.19 days p < 0.05). The mean number of debridement sessions was 3.74 ± 0.69 in group 1 versus 1.82 ± 0.34 in group 2. Conclusions: Early exploration and debridement in equivocal (early) FG has a better clinical outcome with reduced hospital stay and number of debridement sessions than conservative treatment with delayed debridement

Knowledge, attitudes, and practices of Egypt’s future physicians towards antimicrobial resistance (KAP-AMR study): a multicenter cross-sectional study

International audienceAntimicrobial resistance (AMR) is a growing threat that causes over 700,000 deaths per year worldwide. The goal of the current multicenter, cross-sectional study was to identify the knowledge and practice gaps in antimicrobial stewardship among Egypt’s undergraduate medical students. Nine-hundred and sixty-three participants (375 male) from 25 medical schools responded to our self-administered questionnaire. Overall, the majority of students (96%) exhibited fair/satisfactory knowledge and attitude scores towards AMR. However, the most common misconceptions were that skipping one or two antimicrobial doses does not contribute to AMR (43%) and that antimicrobials are the drug of choice for the treatment of sore throat (38.8%). About 36% of the students thought that bacteria cause common cold and influenza. In terms of practices, about 62% of the students reported taking antibiotics when they have cough or sore throat and saving the remaining antibiotic for the next time. About 48% of the students reported that when they start feeling better, they stop the antibiotic course, and 41% stated that they often/sometimes discard the remaining leftover or share the leftover antibiotics with their friends. Interestingly, males had more frequently poorer levels of knowledge than females (p = 0.02). Moreover, students in the clinical science years (p < 0.001), living in urban areas (p= 0.02) or Cairo (p < 0.01) reported better practices than their counterparts. Educational programs about antimicrobial stewardship and the role of healthcareprofessionals in preventing AMR should be introduced early in medical curricula. Further, active educational techniques as clinical scenarios that simulate clinical settings and interactive learning workshops would be more efficient teaching methods

Application of Water Quality Indices, Machine Learning Approaches, and GIS to Identify Groundwater Quality for Irrigation Purposes: A Case Study of Sahara Aquifer, Doucen Plain, Algeria

In order to evaluate and project the quality of groundwater utilized for irrigation in the Sahara aquifer in Algeria, this research employed irrigation water quality indices (IWQIs), artificial neural network (ANN) models, and Gradient Boosting Regression (GBR), alongside multivariate statistical analysis and a geographic information system (GIS), to assess and forecast the quality of groundwater used for irrigation in the Sahara aquifer in Algeria. Twenty-seven groundwater samples were examined using conventional analytical methods. The obtained physicochemical parameters for the collected groundwater samples showed that Ca2+ > Mg2+ > Na+ > K+, and Cl− > SO42− > HCO3− > NO3−, owing to the predominance of limestone, sandstone, and clay minerals under the effects of human activity, ion dissolution, rock weathering, and exchange processes, which indicate a Ca-Cl water type. For evaluating the quality of irrigation water, the IWQIs values such as irrigation water quality index (IWQI), sodium adsorption ratio (SAR), Kelly index (KI), sodium percentage (Na%), permeability index (PI), and magnesium hazard (MH) showed mean values of 47.17, 1.88, 0.25, 19.96, 41.18, and 27.87, respectively. For instance, the IWQI values revealed that 33% of samples were severely restricted for irrigation, while 67% of samples varied from moderate to high restriction for irrigation, indicating that crops that are moderately to highly hypersensitive to salt should be watered in soft soils without any compressed layers. Two-machine learning models were applied, i.e., the ANN and GBR for IWQI, and the ANN model, which surpassed the GBR model. The findings showed that ANN-2F had the highest correlation between IWQI and exceptional features, making it the most accurate prediction model. For example, this model has two qualities that are critical for the IWQI prediction. The outputs’ R2 values for the training and validation sets are 0.973 (RMSE = 2.492) and 0.958 (RMSE = 2.175), respectively. Finally, the application of physicochemical parameters and water quality indices supported by GIS methods, machine learning, and multivariate modeling is a useful and practical strategy for evaluating the quality and development of groundwater