Last Guidelines Overview of Consecutive Esotropia Management: Review Article

Background: Consecutive esotropia (ET) is persistent esodeviation for 24 weeks afterward bilateral lateral rectus recession (BLRR) for correcting exotropia (XT) with or without diplopia. Some patients may have limited eye movement; amblyopia and loss of binocularity can result. Early postoperative overcorrection has been recommended in surgical treatment of intermittent XT due to tendency towards postoperative exotropic drift. ET with small angles (within 15 PD) vanishes naturally over time, whereas bigger angles are more likely to be present at the start. Patients who have ET that has persisted for at least 24 weeks after BLRR and has been present for more than 15 postoperative days should have surgery. Objective: Hallmark the updated lines of management of consecutive esotropia. Conclusion: For the purpose of maintaining one MR muscle for a future intervention, several research have shown that ET can be performed consecutively after BLR recession by advancement of LR muscle previously recessed and MR muscle recession in the more deviating eye. Studies in recent years have sought to determine the effectiveness of the use of lateral rectus advancement in the treatment of consecutive ET

Serum and Circulatory Omentin mRNA Gene Expression as Predictive Markers of Systemic Lupus Erythematosus Disease Activity and Lupus Nephritis

Background: Lupus nephritis (LN) affects 50% of systemic lupus erythematosus (SLE). LN often leads to renal failure. Thus, early diagnosis of LN is mandatory for the prevention of complications. Objective: We aimed to evaluate serum and relative omentin mRNA gene expression levels as a noninvasive diagnostic test of LN and to assess their correlations with disease activity, clinical and laboratory features of SLE.Patients and Methods: Case-control study included 104 subjects, 60 patients with SLE were stratified into two subgroups LN group (n=25) and the non-LN group (n=35). Disease activity was assessed by the SLE disease activity index (SLEDAI). Measurement of serum omentin was done by ELISA and investigation of omentin mRNA relative expression was done by real-time PCR.Results: Our results detected that serum omentin levels were significantly lower in the LN group and non-LN group compared to controls. Intriguingly, omentin mRNA relative expression levels were significantly lower in the LN group and non-LN group compared to controls. Among the LN group, there were significant negative correlations between serum and relative omentin mRNA expression with SLEDAI, clinical, and laboratory features of LN. Moreover, SLEDAI, proteinuria, and serum creatinine were independently correlated with them. The sensitivities and the specificities of serum omentin were 91% and 65.5% respectively. While the relative omentin mRNA expression diagnostic power showed sensitivities and specificities of 93% and 68.8% respectively.Conclusion: LN group had significantly lower values of serum and relative omentin mRNA expression compared to non-LN and control groups. Additionally, it was negatively correlated with SLEDAI, clinical and laboratory features of LN. Thus, they could be used as non-invasive predictive markers of LN

Diagnostic evaluation of blunt abdominal trauma scoring system (BATSS)

Background: Blunt force abdominal trauma is a typical emergency room presentation in both adults and children. Trauma is widely acknowledged as one of the primary causes of illness and mortality in poor nations, as well as the greatest cause of death in those under the age of 45.Objectives: This study aims to study the diagnostic evaluation of blunt abdominal trauma scoring system (BATSS) in patients with blunt abdominal trauma in Zagazig University Hospital.Patients and methods: This study was conducted on 48 patients suffering from blunt abdominal trauma in Emergency Department of Zagazig University Hospital from January 2021 to June 2021.Result: The mean age of patients in the study was 25.87±10.7 years (range 17–61 years). Of the forty eight patients in the study there were 13 females (27.1%) and thirty five males (72.9%).There was statistically significant difference between blunt abdominal trauma scoring system (BATSS) and types of injury p<0.001. There was no statistically significant difference between blunt abdominal trauma scoring system (BATSS) and each of patients' sex and causes of injury p>0.05. Conclusion: The BATSS score system can be used as an initial screening to predict blunt abdominal trauma outcome and can be the basis of management in patients who experience blunt abdominal trauma

Evaluation of in vitro and in vivo Cytotoxic Activities and Kinase Inhibition of Newly Synthesized Cyclo (Nα-Dinicotinoyl)-Bis-[(L-Valinyl)-L-Lysine Methyl Ester]

222-225Cancer is a major risk disease affecting human survival. The pharmaceutical companies are continuing searching for new drug candidates with promising anticancer activities, and reduced side effects. The current work aimed at synthesized a new tripeptide with potential pharmacological properties. L-Valine methyl ester was used to prepare cyclo (Nα-dinicotinoyl)-bis-[(L-valinyl)-L-lysine methyl ester. The new compound revealed promising in vitro cytotoxic activities against different neuroblastoma, cervical carcinoma, fibrosarcoma as well as hepatocellular carcinomas. Furthermore, we also found that the obtained IC50 of the compound decreased by about 50% during its in vivo anti-prostate cancer evaluation. Furthermore, the mechanism of action studies proposes that the new prepared derivative affects cancer cells trough the inhibition of VEGFR-2 kinase enzyme

Evaluation of in vitro and in vivo Cytotoxic Activities and Kinase Inhibition of Newly Synthesized Cyclo (Nα-Dinicotinoyl)-Bis-[(L-Valinyl)-L-Lysine Methyl Ester]

Cancer is a major risk disease affecting human survival. The pharmaceutical companies are continuing searching for new drug candidates with promising anticancer activities, and reduced side effects. The current work aimed at synthesized a new tripeptide with potential pharmacological properties. L-Valine methyl ester was used to prepare cyclo (Nα-dinicotinoyl)-bis-[(L-valinyl)-L-lysine methyl ester. The new compound revealed promising in vitro cytotoxic activities against different neuroblastoma, cervical carcinoma, fibrosarcoma as well as hepatocellular carcinomas. Furthermore, we also found that the obtained IC50 of the compound decreased by about 50% during its in vivo anti-prostate cancer evaluation. Furthermore, the mechanism of action studies proposes that the new prepared derivative affects cancer cells trough the inhibition of VEGFR-2 kinase enzyme

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

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Assessment of Phytochemical Properties of Nigella sativa Seeds Essential Oil and Its Potential Antimicrobial Activity against Staphylococcus aureus in the Context of Safety Profiles and Therapeutic Applications in Neurosurgical Interventions

This comprehensive study explored the phytochemical properties of Nigella sativa L (N. sativa L) seeds essential oil using gas chromatography-mass spectrometry (GC-MS) analysis, with a specific focus on its potential compound Thymoquinone (TQ) exhibiting antimicrobial activity against Staphylococcus aureus (S. aureus) in the context of neurosurgical interventions.The study employs a meticulous methodology, encompassing the preparation of N. sativa essential oil, qualitative phytochemical screening, quantitative GC-MS analysis, and the antimicrobial analysis, employing Disc Diffusion, Minimum Inhibitory Concentration (MIC), and Minimum Bactericidal Concentration (MBC) evaluations to demonstrate the substantial inhibitory and bactericidal effects against Staphylococcus aureus (S.aureus}. comprehensive assessment of antimicrobial activity.The qualitative analysis reveals the presence of alkaloids, flavonoids, phenols, tannins, cardiac glycosides, steroids, saponins, and terpenoids, underscoring the multifaceted pharmacological potential of the essential oil. The quantitative GC-MS analysis provides a detailed breakdown of the chemical composition under different extraction conditions, showcasing the complexity of N. sativa essential oil. The study thoroughly compares the antimicrobial efficacy of N. sativa essential oil with various antibiotics, employing Disc Diffusion, MIC, and MBC analyses. N. sativa demonstrates substantial inhibitory effects, with a 29 mm zone comparable to Gentamycin. The MIC and MBC values align with established antibiotics, indicating similar bacteriostatic and bactericidal properties. Despite slightly lower potency than Vancomycin and Methicillin, N. sativa exhibits considerable antimicrobial effectiveness. This study contributes valuable insights into the phytochemical composition of N. sativa seeds essential oil and its potential as an antimicrobial agent in the context of neurosurgical interventions paves the way for future research

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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population. © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd