Cut-edge mucoperiosteal flap for anterior fixation of palatal flap in palatoplasty

Introduction: This study was done at Mansoura University Children Hospital, Egypt from the period of June 2013 to June 2015 on 80 patients with incomplete intramaxillary cleft palate.Patients and methods: After oral layer closure of the cleft palate, anterior fixation of the flap is obtained by raising the anterior cut-edge of mucoperiosteal flap for about 0.5 cm then suturing the flap to the elevated cut-edge with two stitches. We divided the patients into two groups and evaluated the time needed for fixation the palatal flap anddifficulty of fixation and evaluated the incidence of anterior palatal fistula between the two groups.Results: The time used for elevation of the flap and taking the two stitches in group A ranged from 2.5 to 6 min. However, the time used for taking the two stitches without elevation of the flap in group B ranged from 2.8 to 9 min.Conclusion: We found that cut-edge mucoperiosteal flap for anterior fixation of two-flap palatoplasty is a simple step at the end of cleft palate repair procedure which allows easy fixation of the palatal flap with short time and good opposition of the tissue edges, allowing better healing.Keywords: anterior fixation palatal flap, cut-edge, palatoplast

Upper lip myomucosal flap for the repair of anterior oronasal fistula

Anterior oronasal fistula after cleft palatal repair is difficult to correct and it is consider challenging to many surgeons. Many techniques were used to repair this type of fistula without guarantee for success. Upper lip myomucosal flap is an alternative technique for the repair of this type of fistula. This is a retrospective descriptive case series study which included 10 patients diagnosed with anterior oronasal fistula after cleft palatal repair. They presented to Pediatric Surgery Department at the Faculty of Medicine, Mansoura University Children Hospital from the period between November 2013 and August 2014. In this technique, we do harvesting of the flap with measurement of its length and width, then baring the edge of the fistula with trying of its closure with local flaps. After that we suture the flap to the edge of the fistula and then evaluate the success rate. This study included 10 patients with age ranging from 15 to 72 months. The size of the fistula was less than 1 cm in six patients and more than 1 cm in four patients. The flap was used as an additional layer repair in seven patients and as the only layer for the repair in three patients. This technique was found to be successful in 70% of the patients with good healing without any recurrent fistula. We concluded that the use of this technique is feasible; however, its efficacy should be tested in larger number of patients to be considered as an option for the treatment of anterior oronasal fistula.Keywords: oronasal fistula, upper lip myomucosal flap, lip fla

Microbiome diversity in African American, European American, and Egyptian colorectal cancer patients

Purpose: Although there is an established role for microbiome dysbiosis in the pathobiology of colorectal cancer (CRC), CRC patients of various race/ethnicities demonstrate distinct clinical behaviors. Thus, we investigated microbiome dysbiosis in Egyptian, African American (AA), and European American (EA) CRC patients. Patients and methods: CRCs and their corresponding normal tissues from Egyptian (n = 17) patients of the Alexandria University Hospital, Egypt, and tissues from AA (n = 18) and EA (n = 19) patients at the University of Alabama at Birmingham were collected. DNA was isolated from frozen tissues, and the microbiome composition was analyzed by 16S rRNA sequencing. Differential microbial abundance, diversity, and metabolic pathways were identified using linear discriminant analysis (LDA) effect size analyses. Additionally, we compared these profiles with our previously published microbiome data derived from Kenyan CRC patients. Results:Differential microbiome analysis of CRCs across all racial/ethnic groups showed dysbiosis. There were high abundances of Herbaspirillum and Staphylococcus in CRCs of Egyptians, Leptotrichia in CRCs of AAs, Flexspiria and Streptococcus in CRCs of EAs, and Akkermansia muciniphila and Prevotella nigrescens in CRCs of Kenyans (LDA score \u3e4, adj. p-value Conclusions: Our findings showed altered mucosa-associated microbiome profiles of CRCs and their metabolic pathways across racial/ethnic groups. These findings provide a basis for future studies to link racial/ethnic microbiome differences with distinct clinical behaviors in CRC

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Microbiome diversity in African American, European American, and Egyptian colorectal cancer patients

Purpose: Although there is an established role for microbiome dysbiosis in the pathobiology of colorectal cancer (CRC), CRC patients of various race/ethnicities demonstrate distinct clinical behaviors. Thus, we investigated microbiome dysbiosis in Egyptian, African American (AA), and European American (EA) CRC patients. Patients and methods: CRCs and their corresponding normal tissues from Egyptian (n = 17) patients of the Alexandria University Hospital, Egypt, and tissues from AA (n = 18) and EA (n = 19) patients at the University of Alabama at Birmingham were collected. DNA was isolated from frozen tissues, and the microbiome composition was analyzed by 16S rRNA sequencing. Differential microbial abundance, diversity, and metabolic pathways were identified using linear discriminant analysis (LDA) effect size analyses. Additionally, we compared these profiles with our previously published microbiome data derived from Kenyan CRC patients. Results: Differential microbiome analysis of CRCs across all racial/ethnic groups showed dysbiosis. There were high abundances of Herbaspirillum and Staphylococcus in CRCs of Egyptians, Leptotrichia in CRCs of AAs, Flexspiria and Streptococcus in CRCs of EAs, and Akkermansia muciniphila and Prevotella nigrescens in CRCs of Kenyans (LDA score >4, adj. p-value <0.05). Functional analyses showed distinct microbial metabolic pathways in CRCs compared to normal tissues within the racial/ethnic groups. Egyptian CRCs, compared to normal tissues, showed lower l-methionine biosynthesis and higher galactose degradation pathways. Conclusions: Our findings showed altered mucosa-associated microbiome profiles of CRCs and their metabolic pathways across racial/ethnic groups. These findings provide a basis for future studies to link racial/ethnic microbiome differences with distinct clinical behaviors in CRC