Urethral advancement procedure in the treatment of primary distal hypospadias: a series of 20 cases

Introduction: Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates and the final cosmetic outcome.Patients and methods: Between October 2014 and June 2015, the urethral mobilization technique was used in 20 patients who presented at the Pediatric Surgery Unit, Tanta University Hospital, with primary distal hypospadias. A submeatal crescent-like incision was performed a few millimeters proximal to the meatus with two vertical incisions from the lateral ends of the submeatal incisions. The urethra within the corpus spongiosum was dissected from the skin of the ventral surface and from the glans and corpora cavernosa for a distance of ~ 4 : 1. The urethra was advanced till the urethral meatus reached its normal position without any tension. Spongioplsty can be performed, and covering Buck’s or Dartos’ layers can be used. The follow-up was conducted on a weekly basis in the outpatient clinic in the first month, and then every month for 6 months.Results: The age of the patient at the time of operation ranged from 6 to 24 months, with a mean age of 10.5 months. The operative time ranged from 60 to 90 min, with a mean time of 73.5 min. Intraoperative urethral injury occurred only in one patient. In all patients, the catheter was removed immediately postoperatively except for one patient who had operative urethral injury. Deep wound infection was noticed in only one patient, followed by partial glanular disruption. Only one patient had urethrocutaneous fistula and two patients had meatal retraction.Conclusion: Urethral advancement can be used safely in the mobilization of the distal urethra with wide glanular dissection and wide lateral mobilization of glanular wings. However, it should be stressed that in the presence of hypoplastic distal urethra and/or persistent ventral curvature, another technique should be adopted. The majority of our patients had very good cosmetic results and minimal complication. However, the technique requires further studies with a larger number of patients and longer follow-up periods to draw more precise and final conclusions.Keywords: distal hypospidaus, primary, urethral advancemen

HPLC ANALYSIS AND ANTI-INFLAMMATORY PROPERTIES STUDIES OF TRUNK BARKS OF ACACIA NILOTICA VAR ADANSONII (GUILL AND PERR) O KTZE (MIMOSACEAE)

Objective: The objective of this study was to evaluate the in vitro and in vivo anti-inflammatory properties of the aqueous extract and fractions of the trunk bark of Acacia nilotica. Methods: A maceration of the powder of the trunks barks of the plant was realized. Then the aqueous macerate obtained was fractionated with dichloromethane, butanol and ethyl acetate successively. The phenolic compounds of the aqueous extract, butanol and ethyl acetate fractions were identified by HPLC/DAD. Lipoxygenase and phospholipase inhibition tests with the aqueous extract and the butanol and ethyl acetate fractions were carried out. The anti-inflammatory potential of the aqueous extract was assessed in vivo by the anti-edema test with carrageenan and the analgesic test with acetic acid at different doses (200 mg/ml; 400 mg/ml; 600 mg/ml). Aspirin (200 mg/ml) and paracetamol (200 mg/ml) were used as a reference. Results: The HPLC/DAD analysis of the extracts revealed that gallic acid is the most abundant phenol acid in the extracts. The aqueous extract inhibited lipoxygenase (IC50 = 18.32±1.18 μg/ml), phospholipase (11.44±0.32% per 100 μg/ml) and cyclooxygenase (56.48±0.29% for 100 μg/ml) as well as its tested fractions. It also reduced edema and pain in the mice by more than 50% from the 400 mg/ml dose. Conclusion: Aqueous extract of Acacia nilotica has anti-inflammatory properties. Hence its use in traditional medicine in the treatment of inflammation

New Method to Implement and Analysis of Medical System in Real Time

The use of information technology and technological medical devices has contributed significantly to the transformation of healthcare. Despite that, many problems have arisen in diagnosing or predicting diseases, either as a result of human errors or lack of accuracy of measurements. Therefore, this paper aims to provide an integrated health monitoring system to measure vital parameters and diagnose or predict disease. Through this work, the percentage of various gases in the blood through breathing is determined, vital parameters are measured and their effect on feelings is analyzed. A supervised learning model is configured to predict and diagnose based on biometric measurements. All results were compared with the results of the Omron device as a reference device. The results proved that the proposed design overcame many problems as it contributed to expanding the database of vital parameters and providing analysis on the effect of emotions on vital indicators. The accuracy of the measurements also reached 98.8% and the accuracy of diagnosing COVID-19 was 64%. The work also presents a user interface model for clinicians as well as for smartphones using the Internet of things

LIDAR-INERTIAL LOCALIZATION WITH GROUND CONSTRAINT IN A POINT CLOUD MAP

Real-time localization is a crucial task in various applications, such as automatic vehicles (AV), robotics, and smart city. This study proposes a framework for map-aided LiDAR-inertial localization, with the objective of accurately estimating the trajectory in a point clouds map. The proposed framework addresses the localization problem through a factor graph optimization (FGO), enabling the fusion of homogenous measurements for sensor fusion and designed absolute and relative constraints. Specifically, the framework estimates the light detection and ranging (LiDAR) odometry by leveraging inertial measurement unit (IMU) and registering corresponding featured points. To eliminate the accumulative error, this paper employs a ground plane distance and a map matching error to constraint the positioning error along the trajectory. Finally, local odometry and constraints are integrated using a FGO, including LiDAR odometry, IMU pre-integration, and ground constraints, map matching constraints, and loop closure. Experimental results were evaluated on an open-source dataset, UrbanNav, with an overall localization accuracy of 2.29 m (root mean square error, RMSE)

Effect of Denture Base Reinforcement Using Light Cured E- Glass Fibers on the Level of Salivary Immunoglobulin A

BACKGROUND: A gap still exists between in vitro and clinical studies concerning the biocompatibility of the material in the oral environment and their potential to cause immunological undesirable side effects. The uses of glass fibres to improve the mechanical properties of acrylic resin denture base polymers are well documented in vitro. AIM: The present study aimed to evaluate the effect of denture base reinforcement using light-cured E- glass fibres mesh on the level of salivary immunoglobulin A (S-IgA) in patients wearing complete dentures. MATERIAL AND METHODS: Fourteen completely edentulous patients, in need of complete dentures, participated in the study. The patients were divided into two groups (n = 7) according to the treatment protocol. In the first group, patients received conventional heat-cured acrylic resin dentures. In the second group, the mandibular dentures were reinforced using light cured resin impregnated E glass fibres mesh. In both groups, salivary samples were collected using passive drool technique. The level IgA was assessed by enzyme-linked immunosorbent assay (ELISA) technique at different time intervals. Statistical analysis was carried out using one-way ANOVA followed by Tukey`s post-hoc test and independent t-test. The significant level was set at P ≤ 0.05. RESULTS: Acrylic resin dentures and reinforced ones demonstrated an increase in the mean values of IgA level at the end of the follow-up intervals. And this increase was statistically significant (P ≤ 0.05). Although, the reinforced dentures revealed higher mean values, there was no statistically significant difference between the two groups (P > 0.05) CONCLUSIONS: Within the limitations of the present study, the following could be concluded: (1) the insertion of complete dentures induced changes in the level of IgA; and (2) denture base reinforcement using light cured resin impregnated E-glass fibres mesh had a similar effect to that of heat cured acrylic resin on the level of IgA

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta