Multiple renal arteries with an ascending upward renal vein of the right kidney: A case report

As it is known; the majority of the human subjects has two renal arteries arising from the abdominal aorta; each will supply one kidney but in 30% of individuals, certain variations can be found. Accessory renal arteries constitute the most common and clinically important of these variations. For our case report, we are presenting one of these different variations that can be found in the blood supply of the kidneys. During dissecting the abdomen of an approximately 65 years-old male cadaver, multiple variations were found. There were double right renal arteries with prehilar branching of the upper renal artery. We found also that the right renal vein ascended upwards obliquely before ending in the lateral aspect of the inferior vena cava. Variation in the renal vessels is relatively common, especially multiple renal arteries, and can go smoothly without any abnormalities with the function of the kidney, but in some situations like renal transplantations, vascular reconstructions, and various surgical and radiological diagnostic techniques, the study of the anatomy of these variations is of crucial importance to decrease the patient morbidity during surgical procedures

Expression of leptin and leptin receptors in colorectal cancer—an immunohistochemical study

Obesity is demonstrated to be a risk factor in the development of cancers of various organs, such as colon, prostate, pancreas and so on. Leptine (LEP) is the most renowned of the adipokines. As a hormone, it mediates its effect through leptin receptor (LEPR) which is widely expressed in various tissues including colon mucosa. In this study, we have investigated the degree of expression of LEP and LEPR in colorectal cancer (CRC). We collected 44 surgically resected colon cancer tissues along with normal adjacent colon tissue (NACT) from a sample of CRC patients from the Malaysian population and looked for leptin and leptin receptors using immunohistochemistry (IHC). All the samples showed low presence of both LEP and LEPR in NACT, while both LEP and LEPR were present at high intensity in the cancerous tissues with 100% and 97.7% prevalence, respectively. Both were sparsed in the cytoplasm and were concentrated beneath the cell membrane. However, we did not find any significant correlation between their expression and pathological parameters like grade, tumor size, and lymph node involvement. Our study further emphasizes the possible causal role of LEP andmLEPR with CRC, and also the prospect of using LEPR as a possible therapeutic target

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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

Usefulness of Alvarado Score for the diagnosis of acute appendicitis in hospitals of poor resources

Background: The delay in diagnosing appendicitis is associated with a significant increase in mortality and morbidity among patients due to complications such as perforation, peritonitis and septicaemia. Therefore, Alvarado score is one of the tools used to diagnose appendicitis and reduce the probability of delayed diagnosis based on clinical and laboratory indicators. Objective: This study aimed to evaluate the precision of Alvarado score in diagnosing appendicitis among suspected patients in al-Wihda teaching hospital, Thamar University, Yemen. Methods: a total od 106 participants suspected of having appendicitis due to the clinical presentation were included in the study. Alvarado score was determined in each of the participants upon tier arrival to the emergency department of the hospital. Based on the follow up, histological examination and the intra operative observation the diagnosis was confirmed or excluded. The accuracy of the score was evaluated by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Results: The cut point of Alvarado score 8 was used in diagnosing appendicitis with 87% and 93% sensitivity and specificity respectively. The positive the likelihood ratio was 12 and the negative likelihood ratio was 0.14. Conclusion: Alvarado score is a promising criterion-based tool that would vitally help in early detection of appendicitis among patients. More efforts are required to improve precision of test and minimize the number of cases mistakenly diagnosed with appendicitis in hospitals with limited resources

Duplication of inferior vena cava- case report of an anatomic variation

Introduction:The inferior vena cava (IVC) is the largest vein in human being draining the blood from the lower part of the body running along the right side of the abdominal aorta. Double IVC is a rare congenital anomaly with an incidence of 0.2%–3%. Materials and Methods:This case of double IVC was observed during dissection of the abdomen of an adult male cadaver in the dissection hall of Anatomy, Faculty of Medicine, International Islamic University Malaysia. We report the presence of normal IVC on the right side with a left sided one seen running parallel to it. This left sided IVC starts at the junction of the left internal and external iliac vein dorsal to the left common iliac artery at the level of fifth lumbar vertebra. It joins the right IVC ventrally to the abdominal aorta at the level of first lumbar vertebra by connecting venous anastomosis. The left suprarenal vein drains to this connecting part between the right and left IVC. Discussion and conclusion: Double IVC is relatively uncommon and can prolong smoothly without any adverse consequences abnormalities, but in some situations such as retroperitoneal surgery, vascular interventional procedures, placement of IVC filters and various surgical / radiological techniques, the study of the anatomy of these variations is of crucial importance

Duplication of inferior vena cava-a rare case report

The inferior vena cava (IVC) is the biggest vein in the human being that started as the result of the union of the right and left common iliac veins at the level of the fifth lumber vertebra. IVC develops as part of the embryonic venous system which is divided into vitelline, umbilical and cardinal system at the beginning of the 5th week. Double IVC incidence ranges between 0.2% -3%. The variation was detected through dissecting a cadaver inthe Faculty of Medicine, International Islamic University Malaysia. We report a left sided IVC accompanied side by side to the normal right one. They joined together by a connecting venous anastomosis at the level of first lumbar vertebra. Double IVC can prolong smoothly without any consequences and may be discovered incidentally by radio-graphical studies, but in some conditions like retroperitoneal surgery, vascular interventional procedures, the study of the anatomy of these variations is of crucial importance

Co-expression of Leptin and Leptin Receptor in Adenocarcinoma of the Colon in Malay Population

Objectives: To assess the role of leptin in human colonic adenocarcinoma and to establish its expression in Malay population patients by using immunohistochemistry study. Methodology: Immunohistochemical study (IHC) using antibodies against leptin and its receptor was applied to assess the expression of leptin and its receptor in 38 samples of adenocarcinoma of the colon among Malay population and compare this expression with that of the adjacent normal colon tissue. Results: All the 38 colon adenocarcinoma samples stained strongly (100%) for leptin and 36 out of 38 also stained strongly for leptin receptor (95%). The other 2 (5%) stained weak (1+). However, the whole specimens of the normal adjacent colon tissue stained weakly (1+) for both leptin and leptin receptor. The expression of both hormones in cancer and normal tissue is significantly different (p<0.01). There was significant co-expression of both hormones in colonic cancerous tissue. Conclusions: Leptin/leptin receptor system may have a tumorigenic effect on the colon tissue, most likely by an autocrine process. Inhibition of leptin/leptin receptor system might be helpful in the prevention and management of colon cancer. Keywords: Leptin, Leptin receptor, Expression, Adenocarcinoma, Colon, Mala

The Relationship between Total Quality Management and Organizational Performance

This research aims to study the relationship of total quality management at King Khaled University in Saudi Arabia as education industry toward better performance. The variables measurement and evaluation, quality system improvement, employee involvement, recognition and reward and education and training were examined as independent variables affecting the organization performance in the University. This quantitative study used the survey as a data collection method to be distributed among the university employees; 135 questionnaires were collected as valid to be analyzed. Two types of analysis: descriptive analysis via SPSS and AMOS, have been done in this study. This study found a significant relationship between all the survey variables on organization performance, which means there are accepted hypotheses in this study. A significant relationship between measurement and evaluation and organization performance, a significant relationship between quality system improvement and organization performance. A significant relationship between employee involvement and organization performance, a significant relationship between recognition and reward and organization understanding and a significant relationship between education and training with organization performance. They indicated the importance of implementation, the variables of the study in King Khaled University, which contributed to the knowledge body and the practical aspect in the institution