Primary Fibrosarcoma of the Testicle with Puzzling Post-surgery Presentation: Mimicking Recurrence

Sarcomas of the testis are extremely rare tumors, their incidence being difficult to assess accurately. The authors report a case of a 21-year-old male, presented with painless scrotal swelling that increased in size insidiously within three months. The examination revealed a 10 cm right testicular swelling—hard, not tender and oval in shape. Testicular ultrasound revealed right heterogenous testicular mass. Tumor markers (Human chorionic gonadotrophin (HCG) and alpha fetoprotein) were normal. CT chest and abdomen were normal. Radical orchidectomy was done through an inguinal approach. Histopathology showed testicular fibrosarcoma with spindle cells. After one month, the patient noticed reappearance of a swelling in the right hemiscrotum. Right inguinal exploration with massive resection of the recurrent scrotal mass was done. Histopathology revealed inflammatory process dominated by stitch granuloma. In conclusion, the recurrence rate of testicular sarcomas is high following radical orchidectomy, but still there was a place of non-malignant massthat looks like recurrence; it might occur like nonspecific inflammatory mass and stich granuloma

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

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

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

Abstract 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

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

Green synthesis, characterization and antimicrobial activity of iron oxide nanoparticles with tigecycline against multidrug resistant bacterial strains

Objectives: The current study focused on the green synthesis of iron oxide nanoparticles (IONPs) using Salvia officinalis leaf extract, aiming to control nosocomial infections caused by drug-resistant bacterial pathogens. The nanoparticles were characterized and evaluated for antibacterial effectiveness. Methods: The disc diffusion assay was utilized to determine the synergistic antibacterial efficiency of the biogenic IONPs against three nosocomial bacterial pathogens namely, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Pseudomonas aeruginosa strains. Results and conclusion: The change of color of ferric nitrate solution from orange to black color after addition of the extract preliminary indicated the formation of biogenic IONPs. The phytosynthesized IONPs were characterized using UV–Vis spectroscopy indicating the formation of a broad band at 349 nm. Moreover, X-ray powder diffraction (XRD) analysis revealed the formation of diffraction peaks positioned at 2 theta degrees of 24.80°, 33.41°, 35.03°, 41.28°, 49.15°, 53.41°, 57.37°, 62.40° and 64.31°, corresponding to lattice planes of (012), (104), (110), (202), (024), (116), (214) and (300), respectively. The phytosynthesized nanoparticles revealed a high antibacterial activity against the concerned pathogens at the concentration of 200 µg/disc with relative inhibitory zones of 21.14 ± 0.16, 17.26 ± 0.26, and 20.56 ± 0.62 mm, respectively against E. coli, P. aeruginosa and MRSA strains. The biogenic IONPs revealed the highest synergistic activity with tigecycline antibiotic against E. coli followed by MRSA and P. aeruginosa strains with relative increase in fold of inhibition values (IFA) of 1.79, 1.29 and 0.93, respectively. In conclusion, the water extract of S. officinalis facilitated the green fabrication of IONPs with distinctive physicochemical properties and synergistic antibacterial activity against the tested nosocomial bacterial pathogens

In Vitro Evaluation of Biological Activities and Phytochemical Analysis of Different Solvent Extracts of <i>Punica granatum</i> L. (Pomegranate) Peels

Antimicrobial resistance is a public health concern resulting in high rates of morbidity and mortality worldwide. Furthermore, a high incidence of food poisoning diseases besides harmful implications of applying synthetic food additives in food preservation necessitates fabrication of safe food preservatives. Additionally, damaging effects of free radicals on human health has been reported to be involved in the incidence of serious diseases, including cancer, diabetes and cardiovascular diseases; hence, finding safe sources of antioxidants is vital. Therefore, the present study was carried out to assess the antibacterial, antiradical and carcinopreventive efficacy of different solvent extracts of pomegranate peels. Agar disk diffusion assay revealed that Staphylococcus aureus, MRSA, E. coli and S. typhimurium were highly susceptible to methanolic fraction of Punica granatum L. peels recording inhibition zones of 23.7, 21.8, 15.6 and 14.7 mm respectively. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the methanolic fraction of Punica granatum L. peels against S. aureus were 0.125 and 0.250 mg/mL, respectively. In addition, the pomegranate acetonic and methanolic fractions revealed an impressive antiradical efficiency against DPPH (2,2-diphenyl-1-picrylhydrazyl) radical recording radical scavenging activity percentages of 86.9 and 79.4%, respectively. In this regard, the acetonic fraction of pomegranate peels revealed the highest anti-proliferative efficiency after 48 h incubation against MCF7 cancer cells recording IC50 of 8.15 µg/mL, while the methanolic extract was highly selective against transformed cancer cells compared to normal cell line recording selectivity index of 5.93. GC–MS results demonstrated that 5-Hydroxymethylfurfural was the main active component of methanolic and acetonic extracts of pomegranate peels recording relative percentages of 37.55 and 28.84% respectively. The study recommends application of pomegranate peel extracts in the biofabrication of safe food preservatives, antioxidants and carcinopreventive agents

Green Synthesis of Zinc Oxide Nanocrystals Utilizing Origanum majorana Leaf Extract and Their Synergistic Patterns with Colistin against Multidrug-Resistant Bacterial Strains

There is a crucial necessity for the formulation of efficient antimicrobial agents owing to the increasing prevalence of hospital-acquired bacterial infections triggered by multidrug-resistant microbes that result in significant deaths and illnesses around the world. Hence, the current investigation examined the antibacterial proficiency of zinc oxide nanoparticles formulated utilizing the green route against bacterial strains that were resistant to multiple drugs. In addition, the synergistic antibacterial action of ZnO nanoparticles (ZnO NPs) combined with colistin was investigated against the tested microbial strains to determine the efficiency of the bioinspired ZnO nanoparticles in boosting the antibacterial proficiency of colistin antibiotic. Incidentally, the bioinspired ZnO nanoparticles were synthesized using water extract of Origanum majorana leaves and these nanomaterials were physicochemically characterized using different analytical techniques. The bioactivity of the synthesized nanomaterials against multidrug-resistant bacterial strains was appraised using the agar diffusion method. The biogenic ZnO NPs at a concentration of 100 &mu;g/disk revealed a compelling antimicrobial efficacy against the tested strains, expressing the maximum antimicrobial action against Escherichia coli strain with clear zone diameter of 38.16 &plusmn; 0.18 mm. The remarkable antibacterial proficiency might be accredited to the tiny particle size of the bioformulated ZnO NPs of 12.467 &plusmn; 1.36 nm. The net charge of ZnO nanomaterials was &minus;14.8 mV while XRD analysis confirmed their hexagonal wurtzite structure. Furthermore, the bioformulated ZnO NPs showed a promising synergistic potency with colistin demonstrating respective synergism proportions of 91.05, 79.07, 75.04, 75.25, 56.28 and 10.60% against E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, Salmonella typhimurium, Enterobacter cloacae, and Pseudomonas aeruginosa, respectively. In conclusion, the water extract of O. majorana leaves mediated green formulation of zinc oxide nanoparticles with unique physicochemical characteristics and effective antibacterial proficiency against the examined drug-resistant bacterial strains. These nanomaterials could be used in the synthesis of effective antibacterial coatings to control hospital acquired infections caused by multidrug-resistant bacterial pathogens

Green Synthesis of Zinc Oxide Nanocrystals Utilizing <i>Origanum majorana</i> Leaf Extract and Their Synergistic Patterns with Colistin against Multidrug-Resistant Bacterial Strains

There is a crucial necessity for the formulation of efficient antimicrobial agents owing to the increasing prevalence of hospital-acquired bacterial infections triggered by multidrug-resistant microbes that result in significant deaths and illnesses around the world. Hence, the current investigation examined the antibacterial proficiency of zinc oxide nanoparticles formulated utilizing the green route against bacterial strains that were resistant to multiple drugs. In addition, the synergistic antibacterial action of ZnO nanoparticles (ZnO NPs) combined with colistin was investigated against the tested microbial strains to determine the efficiency of the bioinspired ZnO nanoparticles in boosting the antibacterial proficiency of colistin antibiotic. Incidentally, the bioinspired ZnO nanoparticles were synthesized using water extract of Origanum majorana leaves and these nanomaterials were physicochemically characterized using different analytical techniques. The bioactivity of the synthesized nanomaterials against multidrug-resistant bacterial strains was appraised using the agar diffusion method. The biogenic ZnO NPs at a concentration of 100 μg/disk revealed a compelling antimicrobial efficacy against the tested strains, expressing the maximum antimicrobial action against Escherichia coli strain with clear zone diameter of 38.16 ± 0.18 mm. The remarkable antibacterial proficiency might be accredited to the tiny particle size of the bioformulated ZnO NPs of 12.467 ± 1.36 nm. The net charge of ZnO nanomaterials was −14.8 mV while XRD analysis confirmed their hexagonal wurtzite structure. Furthermore, the bioformulated ZnO NPs showed a promising synergistic potency with colistin demonstrating respective synergism proportions of 91.05, 79.07, 75.04, 75.25, 56.28 and 10.60% against E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, Salmonella typhimurium, Enterobacter cloacae, and Pseudomonas aeruginosa, respectively. In conclusion, the water extract of O. majorana leaves mediated green formulation of zinc oxide nanoparticles with unique physicochemical characteristics and effective antibacterial proficiency against the examined drug-resistant bacterial strains. These nanomaterials could be used in the synthesis of effective antibacterial coatings to control hospital acquired infections caused by multidrug-resistant bacterial pathogens