Post-female-circumcision clitoral epidermal inclusion cyst: a case report and a review of literature

Cysts involving the female external genitalia are rare. These cysts are either congenital or acquired. Iatrogenic epidermoid cysts have been reported after female genital mutilation, which is common in some parts of Africa and the Middle East. We report a case of acquired epidermoid inclusion cyst of the clitoris following female circumcision in a 5-year-old girl. The cyst was surgically excised and histopathologic evaluation revealed an epidermal-type inclusion cyst. Keywords: complication, epidermal inclusion cyst, female circumcisio

Ultra-differentiation of Sperm Tail of Lesser Egyptian Jerboa, Jaculus jaculus (Family: Dipodidae)

In the present study, events of sperm tail differentiation in Lesser Egyptian Jerboa, Jaculus jaculus were studied for the first time. Generally, stages of sperm tail differentiation are more or less similar to that described by other studies in other rodents. In the present species, special structures were observed. These structures include, first: the formation of a hollow large unit of microtubules that appears to surround the nuclear envelope at its equatorial plane. The manchette microtubules (MMs) are re-oriented toward the longitudinal direction and attached along hollow large unit of microtubules. Second, the formation of perinuclear space filled with an electron-translucent substance surrounds the posterior third of the developing nucleus. Third, the nuclear fossa and the connecting piece were inserted in the ventrodorsal region of the nucleus. Fourth, the fibrous sheath (FS) is formed of dextral spiral fibrous ribs. Finally, the sperm tail of the present species has a single outer FS, however, other rodents, having additional inner fibrous units, between the outer FS and the inner developing axoneme

Internet Privacy

The benefits of the Internet have come at some cost, one of which is a loss of privacy, which is often regarded as a moral right or a legal right. Internet privacy is primarily concerned with protecting user information. It is widely acknowledged as the top consideration in any online interaction. New threats to privacy and civil liberties are emerging daily and privacy practices are not one size fits all. This paper provides a brief introduction to online privacy

Management of ureteropelvic junction obstruction associated with congenital upper urinary tract anomalies in children: Single-center experience

Purpose We report our experience in the management of ureteropelvic junction  obstruction in children with congenital upper urinary tract anomalies.Materials and methods A retrospective review was performed for all children with primary ureteropelvic junction obstruction associated with upper urinary tract anomalies between 1999 and 2011 at our hospital. Medical records were reviewed for patient age, sex, type of urinary tract anomalies, affected side, indication of surgery, and operative details. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at final follow-up.Results There were 12 children (10 boys and two girls) with mean age of 5.3 years (range 1–13 years). Anomalies included ectopic pelvic kidney in six patients,  crossed fused ectopia in two, a horseshoe kidney in two, and duplex renal units in two. The left kidney was affected in seven and the right kidney in five children. All patients were managed by open dismembered pyeloplasty. No significant perioperative complications were encountered in the study group. The mean follow-up was 30 months (range 15–45 months). Overall success rate was 84%. Relief of obstruction was evident in 10 patients as documented by intravenous urography or diuretic renography. Secondary nephrectomy was necessitated in two patients; one had severely impaired ipsilateral renal function and the other had recurrent pyelonephritis without radiological improvement.Conclusion Despite the anomalous renal anatomy and the challenging surgical  exposure, dismembered pyeloplasty in children with upper urinary tract anomalies has a high success rate with excellent functional results.Keywords: crossed ectopic, horseshoe kidney, obstruction, pyeloplasty, urete

Recent Guidelines in Bronchial Asthma Management in Children: Review Article

Background: A common childhood and adolescent illness, asthma is a chronic inflammatory condition marked by episodes of wheezing, dyspnea, tightness in the chest, and coughing. A mix of genetic and environmental factors is likely to be responsible for its occurrence. A short-acting beta-2 agonist (such as salbutamol) breathed into the lungs is mainly used to treat acute symptoms. Inhaling corticosteroids and avoiding triggers like allergens and irritants can help prevent symptoms. Objective: to determine the recent treatment modalities in bronchial asthma management in children. Conclusion: many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services

Attitudes of Middle Eastern Societies towards Organ Donation: The Effect of Demographic Factors among Jordanian Adults

Background: Organ donation gives thousands of patients a renewed chance at living full and active lives. Unfortunately, the need for organs does not match their availability. This study aims to analyze the effect of demographic factors on the knowledge and awareness of the Jordanian society towards organ donation. Methods: This cross-sectional study was conducted using a self-administered online questionnaire. We included 1041 adult Jordanians from all the governorates of the Hashemite Kingdom of Jordan. Results: Of the 1041 participants, only 124 (11.9%) had previously singed organ donation card. Overall, 827 (79.4%) were fully accepting organ donation. Among 782 participants in the medical field, 639 (81.7%) fully accepted organ donation, compared to 188 out of 259 (72.6%) in the non-medical field (p= 0.002), with no significant effect of any demographic factor on the willingness to sign organ donation card. There was significant difference in the acceptance of donation from brain dead donors (p< 0.001), with participants from medical field and male participants having higher acceptance rates when compared with non-medical and female participants, respectively. The main barrier for organ donation was found to be the desire to be buried as a whole (58.2%), followed by traditional beliefs (47.4%), and family refusal (42.2%). Conclusions: In conclusion, an educational strategy can improve organ donation awareness from an early age by spreading actionable information through social media and conducting nationwide public campaigns

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Ultra-differentiation of Sperm Head in Lesser Egyptian Jerboa, Jaculus jaculus (Family: Dipodidae)

In the present study, events of sperm head differentiation in Lesser Egyptian Jerboa, Jaculus jaculus were studied for the first time. Adult males of J. jaculus were collected during their period of sexual activity from sandy regions of Marsa-Matrouh at northwest of Egypt. Tissues of their testes were prepared for ultrathin sections, which examined under a Joel "JEM-1200EXII" operating at 60-70kv. Early and late spermatids were photographed to describe the successive stages of sperm head differentiation. Early spermatids have rounded or oval nuclei with fine chromatin granules and their cytoplasm showed numerous mitochondria, one or more chromatoid bodies and segments of rough endoplasmic reticulum. The first stage of spermatid development usually starts when the Golgi body produces secretory vesicles. These vesicles usually differentiate into an oval dense acrosomal granule, the rest forming a thin layer of acrosomal cap which extends to cover the anterior half of the nucleus and stop on at the nuclear shelf in the equatorial nuclear region. This cap is separated from the nuclear envelope by a narrowed subacrosomal space. Novel and complex structures are observed in the developing acrosome, which is, the crown, anterior, and posterior acrosomal segments, anterior and posterior acrosomal caps, as well as a long dorsal and a short ventral acrosomal caps; posterior subacrosomal spaces and subacrosomal cone at the tip of the elongated nucleus. Cytoskeletal elements are responsible for re-shaping of the nucleus. A light comprehensive strength of cytoskeletal elements usually induces nuclear prolongation and formation of implantation fossa that appears in the ventrodorsal region at the posterior side of the nucleus. Manchette microtubules, solitary microtubules, and microfilaments may generate gentle compressive strength to accelerate nuclear prolongation. Manchette microtubules, which disposed of parallel to one another and to the long axis of the nucleus, could exert the force, required to produce the spermatid nucleus elongation forward and perhaps backward and to protect DNA during nuclear condensation. A translucent space appears to surround the posterior half of the nucleus in order to mitigate the pressure on the nucleus and regulate the elongation with the protection of genetic material during nuclear condensation. Worth mentioning, that the translucent perinuclear space is a unique structure was not described or discussed before