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<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<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

Clinical outcomes in stump-preserving versus stump-sacrificing anterior cruciate ligament reconstruction; a randomized controlled study

Abstract Background Anterior Cruciate ligament (ACL) reconstruction (ACLR) aims to restore the anatomy and function of the knee. Although stump preservation during ACLR could be technically challenging, it may improve the revascularization and proprioceptive function of the graft. In this study, we aimed to compare the functional outcome after ACLR with and without stump preservation. Methods One hundred and twenty patients with acutely torn ACL and with intact tibial stump were included in this study. Half of them (60 cases) underwent ACLR with stump preservation. The other half (60 cases) had ACLR after total resection of the tibial stump. One hundred and nine out of 120 cases completed their 2 year-follow-up period. All patients were assessed by Tegner activity, Lysholm, and objective International Knee Documentation Committee (IKDC) scores. The side-to-side difference regarding stability was assessed by KT-1000 instrumented Lachman and proprioceptive function was measured by Passive angle reproduction test. Results There was no statistically significant difference between both groups regarding Tegner activity, Lysholm, and IKDC scores. Knee stability measured by KT-1000 and complication rate also showed no significant difference. But there was a significant difference in proprioception favoring stump preservation. On the other hand, the operative time was significantly shorter with stump resection. There was no significant difference in the complications rate between both groups and there were no cases with stiffness in either group. Conclusion Stump preservation ACLR is a safe technique that yields equivalent functional outcomes to standard ACLR. However; it provides better proprioception. It is more technically challenging, but in experienced hands; it is easily reproducible. Trial registration Registration number: NCT05364398 . 06/05/2022

Study of Massive Floating Solar Panels over Lake Nasser

Recently, the technology of floating photovoltaic panels has demonstrated several advantages over land installations, including faster deployment, less maintenance cost, and higher efficiency. Lake Nasser is the second largest man-made freshwater lake in the world with a surface area of almost 5000 square km. Being in one of the hottest areas in the world, evaporation of water causes loss of very precious and scarce resources: freshwater. Fortunately, the lake is also located in a very rich area in solar energy. This paper presents a study to utilize Lake Nasser’s surface for massive production of solar energy, while significantly reducing the loss of water by evaporation from the lake surface. The project has the potential to be one of the largest producers of low-cost clean electric energy in the world for Europe and the Middle East and North Africa (MENA) region, especially with the ongoing efforts to connect the North African countries with the European super power grid. The study shows that the first phase of the project is expected to deliver about 16% of European need of electricity and save about 3 billion m3 of freshwater. The subsequent phases will provide low-cost green energy to replace the combustible fuels in Europe by 2045, while saving up to 10-12 billion m3 of freshwater lost by evaporation from Lake Nasser

Development of a Spatial Model for Soil Quality Assessment under Arid and Semi-Arid Conditions

Food security has become a global concern for humanity with rapid population growth, requiring a sustainable assessment of natural resources. Soil is one of the most important sources that can help to bridge the food demand gap to achieve food security if well assessed and managed. The aim of this study was to determine the soil quality index (SQI) for El Fayoum depression in the Western Egyptian Desert using spatial modeling for soil physical, chemical, and biological properties based on the MEDALUS methodology. For this purpose, a spatial model was developed to evaluate the soil quality of the El Fayoum depression in the Western Egyptian Desert. The integration between Digital Elevation Model (DEM) and Sentinel-2 satellite image was used to produce landforms and digital soil mapping for the study area. Results showed that the study area located under six classes of soil quality, e.g., very high-quality class represents an area of 387.12 km(2) (22.7%), high-quality class occupies 441.72 km(2) (25.87%), the moderate-quality class represents 208.57 km(2) (12.21%), slightly moderate-quality class represents 231.10 km(2) (13.5%), as well as, a low-quality class covering an area of 233 km(2) (13.60%), and very low-quality class occupies about 206 km(2) (12%). The Agricultural Land Evaluation System for arid and semi-arid regions (ALESarid) was used to estimate land capability. Land capability classes were non-agriculture class (C6), poor (C4), fair (C3), and good (C2) with an area 231.87 km(2) (13.50%), 291.94 km(2) (17%), 767.39 km(2) (44.94%), and 416.07 km(2) (24.4%), respectively. Land capability along with the normalized difference vegetation index (NDVI) used for validation of the proposed model of soil quality. The spatially-explicit soil quality index (SQI) shows a strong significant positive correlation with the land capability and a positive correlation with NDVI at R-2 0.86 (p < 0.001) and 0.18 (p < 0.05), respectively. In arid regions, the strategy outlined here can easily be re-applied in similar environments, allowing decision-makers and regional governments to use the quantitative results achieved to ensure sustainable development

ADVANCED STUDIES ON IMPROVING SHEEP FERTILITY BY USING ARTIFICIAL MEANS OF REPRODUCTION

Artificial insemination (AI) in livestock is used to optimize reproduction efficiency. Compared to other semenpreservation methods, cryopreservation is an established industry used worldwide for performing AI. Adequateprotocols for semen collection and freezing and then for the use in the AI are set up for all the animal species. Insheep, AI with frozen-thawed semen resulted low fertility rate, which limits the practical application of thistechnique. Progressive sperm motility, sperm viability, sperm plasma membrane integrity and NAR weresignificantly (P < 0.05) higher for BIOX, MILK, and TEY extenders. Progressive motility increased significantly (p< 0.01) using licorice extract 10, 50 and 100 g/ml. Diluter type had a significant effect (p < 0.01) on sperm motility.The percentage of progressive motility in all extenders media containing LDL was also higher compared with 20%EY (control) during dilution and equilibration stages. All extenders containing LDL reduced the percentages ofabnormalities after dilution as compared to control 20% egg yolk. The percentages of intact Acrosome in all otherextenders containing LDL were significantly higher than 20% egg yolk extender. The highest percentage of postthawprogressive motility was recorded in extender containing 20mm glutamine. After dilution and equilibration,supplementation of glutamine at concentration of 40 and 60mm caused a significant increase in plasma membraneintact compared with control and all other concentrations tested. No significant difference between the control andthe irradiated samples for viability However, the semen samples irradiated with 6.12 J/cm2 showed a slight increasein sperm progressive motility, viability, osmotic resistance, Acrosome and DNA integrity, respect to the semensamples irradiated at low energy doses and control semen samples. Cysteine effected on the ultra-structure of theram sperm cell within the freezing- thawing dynamics. The positive effect of Cysteine could be a result of itsinterraction with membranes phospholipids during the freezing, giving it a better Cryopreservation

Tag Sultan

PROJECT NAME: TAG SULTAN PRJECT SITE: West of the intersection of ring roda is located with cairo-suze road OWNER: Madinet nasr housing Consultant: MOHARM-PAKHOM CONTRACTOR: Misr engineering development PROJECT TOTAL AREA: 3337200 METER TOTAL COST: 91 MILLION L

Different Techniques for the Management of Meniscal Ramp Lesions Using Standard Anterior Portals

There is strong association between meniscal lesions and anterior cruciate ligament injuries. Recently, light was shown on a new entity: ramp lesions. The incidence of these lesions and their management is still unclear. Although some believe that some lesions, when stable, can be managed conservatively, most surgeons repair ramp tears. Accessibility of these tears is challenging; they are best accessed through posterior portals, which is time-consuming and poses potential risk to vital structures. Our technique allows access to and management of ramp lesions through safe standard anterior portals. Ramp lesions are searched for as a routine step during anterior cruciate ligament reconstruction by advancing the scope through the intercondylar notch just beside the medial femoral condyle. If a lesion is found, it is repaired; only very stable small tears are treated with needling to refresh the edges and induce a healing response. A simple suture, horizontal mattress suture, or a circumferential stitch is used

Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

Traumatic brain injury (TBI) accounts for around 30% of all trauma-related deaths. Over the past 40 years, TBI has remained a major cause of mortality after trauma. The primary injury caused by the injurious mechanical force leads to irreversible damage to brain tissue. The potentially preventable secondary injury can be accentuated by addressing systemic insults. Early recognition and prompt intervention are integral to achieve better outcomes. Consequently, surgeons still need to be aware of the basic yet integral emergency management strategies for severe TBI (sTBI). In this narrative review, we outlined some of the controversies in the early care of sTBI that have not been settled by the publication of the Brain Trauma Foundation’s 4th edition guidelines in 2017. The topics covered included the following: mode of prehospital transport, maintaining airway patency while securing the cervical spine, achieving adequate ventilation, and optimizing circulatory physiology. We discuss fluid resuscitation and blood product transfusion as components of improving circulatory mechanics and oxygen delivery to injured brain tissue. An outline of evidence-based antiplatelet and anticoagulant reversal strategies is discussed in the review. In addition, the current evidence as well as the evidence gaps for using tranexamic acid in sTBI are briefly reviewed. A brief note on the controversial emergency surgical interventions for sTBI is included. Clinicians should be aware of the latest evidence for sTBI. Periods between different editions of guidelines can have an abundance of new literature that can influence patient care. The recent advances included in this review should be considered both for formulating future guidelines for the management of sTBI and for designing future clinical studies in domains with clinical equipoise