The effect of caffeine ingestion in prevention of post-operative ileus after caesarean section: a randomized controlled trial

Background: Caesarian section (CS) has become more prevalent than the vaginal delivery in Egypt. Many complications could occur after an abdominal surgery. One of the commonest but yet serious complications is the postoperative ileus that can possibly be prevented by caffeine ingestion. The aim of the study is to assess the value of caffeine ingestion in promoting intestinal motility and prevention of postoperative ileus after CS.Methods: This is a randomized controlled trial that was conducted on 560 cases who were recruited from emergency unit and inpatient wards in Ain Shams University maternity hospital. The patients were divided into two groups where the intervention group received caffeinated coffee while the other group received decaffeinated coffee.Results: There was statistically significant difference between the two groups regarding the bowel function after CS (p <0.05). The intervention group had improved intestinal functions after the CS. Patients from the intervention group had audible intestinal sound sooner than the control group. In addition, they passed flatus and were able to tolerate food in less time.Conclusions: Consuming caffeinated coffee after CS contributes significantly to faster restoration of intestinal function. Coffee is a popular drink and can be used to decrease the incidence of postoperative ileus-related complications

Thermal based remediation technologies for soil and groundwater: a review

Thermal remediation technologies are fast and effective tools for the remediation of contaminated soils and sediments. Nevertheless, the high energy consumption and the effect of high temperature on the soil properties may hinder the wide applications of thermal remediation methods. This review highlights the recent studies focused on thermal remediation. Eight types of thermal remediation processes are discussed, including incineration, thermal desorption, stream enhanced extraction, electrical resistance heating, microwave heating, smoldering, vitrification, and pyrol-ysis. In addition, the combination of thermal remediation with other remediation technologies is presented. Finally, thermal remediation sustainability is evaluated in terms of energy efficiency and their impact on soil properties. The developments of the past decade show that thermal-based technologies are quite effective in terms of contaminant removal but that these technologies are associated with high energy use and costs and can has an adverse impact on soil properties. Nonetheless, it is anticipated that continued research on thermally based technologies can increase their sustainability and expand their applications. Low temperature thermal desorption is a prom-ising remediation technology in terms of land use and energy cost as it has no adverse effect on soil function after treatment and low temperature is required. Overall, selecting the sustainable remediation technology depends on the contaminant properties, soil properties and predicted risk level. © 2022 Desalination Publications. All rights reserved

A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies

Background The aim of this study is to describe the major evolutionary historical events among Leishmania, sandflies, and the associated animal reservoirs in detail, in accordance with the geographical evolution of the Earth, which has not been previously discussed on a large scale. Methodology and Principal Findings Leishmania and sandfly classification has always been a controversial matter, and the increasing number of species currently described further complicates this issue. Despite several hypotheses on the origin, evolution, and distribution of Leishmania and sandflies in the Old and New World, no consistent agreement exists regarding dissemination of the actors that play roles in leishmaniasis. For this purpose, we present here three centuries of research on sandflies and Leishmania descriptions, as well as a complete description of Leishmania and sandfly fossils and the emergence date of each Leishmania and sandfly group during different geographical periods, from 550 million years ago until now. We discuss critically the different approaches that were used for Leishmana and sandfly classification and their synonymies, proposing an updated classification for each species of Leishmania and sandfly. We update information on the current distribution and dispersion of different species of Leishmania (53), sandflies (more than 800 at genus or subgenus level), and animal reservoirs in each of the following geographical ecozones: Palearctic, Nearctic, Neotropic, Afrotropical, Oriental, Malagasy, and Australian. We propose an updated list of the potential and proven sandfly vectors for each Leishmania species in the Old and New World. Finally, we address a classical question about digenetic Leishmania evolution: which was the first host, a vertebrate or an invertebrate? Conclusions and Significance We propose an updated view of events that have played important roles in the geographical dispersion of sandflies, in relation to both the Leishmania species they transmit and the animal reservoirs of the parasites

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Recent Advances of Nanoremediation Technologies for Soil and Groundwater Remediation: A Review

Nanotechnology has been widely used in many fields including in soil and groundwater remediation. Nanoremediation has emerged as an effective, rapid, and efficient technology for soil and groundwater contaminated with petroleum pollutants and heavy metals. This review provides an overview of the application of nanomaterials for environmental cleanup, such as soil and groundwater remediation. Four types of nanomaterials, namely nanoscale zero-valent iron (nZVI), carbon nanotubes (CNTs), and metallic and magnetic nanoparticles (MNPs), are presented and discussed. In addition, the potential environmental risks of the nanomaterial application in soil remediation are highlighted. Moreover, this review provides insight into the combination of nanoremediation with other remediation technologies. The study demonstrates that nZVI had been widely studied for high-efficiency environmental remediation due to its high reactivity and excellent contaminant immobilization capability. CNTs have received more attention for remediation of organic and inorganic contaminants because of their unique adsorption characteristics. Environmental remediations using metal and MNPs are also favorable due to their facile magnetic separation and unique metal-ion adsorption. The modified nZVI showed less toxicity towards soil bacteria than bare nZVI; thus, modifying or coating nZVI could reduce its ecotoxicity. The combination of nanoremediation with other remediation technology is shown to be a valuable soil remediation technique as the synergetic effects may increase the sustainability of the applied process towards green technology for soil remediation

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research