Management of Gastroschisis

Gastroschisis (GS) is one of the congenital abdominal wall defects, in which the bowel has prolapsed without a covering through a defect adjacent to (and nearly always to the right of) an otherwise normal umbilicus. Proper management of such cases gives them the opportunity to survive and thrive. In this chapter, simplified flowcharts for the initial management of GS, surgical intra-operative decisions and post-operative active follow-up of such cases will be presented and discussed. The first flowchart will discuss how to deal with a GS case from birth till the operative theatre, while the second flowchart will take the lead to guide the surgeon with the available surgical options and how to choose the suitable one for the case. Finally, the post-operative active follow-up fluid management and possible complications are discussed

Experience with impacted upper ureteral Stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast?

<p>Abstract</p> <p>Introduction</p> <p>The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for the proximal ureteral stones is around 81% when treated by either SWL or ureteroscopy (URS).</p> <p>Complication rates, most notably ureteral perforation and long-term complications of URS such as stricture formation rates, have been reduced to < 5%. Moreover, impacted ureteral calculi are more difficult to fragment with SWL because of the lack of natural expansion space for stones, this result in a situation that is better managed by ureteroscopy. The aim of this study is to assess the efficacy, safety, and complications of impacted upper ureteral stone disintegration using semirigid ureteroscopes and pneumatic lithotripsy.</p> <p>Methods</p> <p>We retrospectively analyzed the records of 267 consecutive patients with impacted upper ureteral stones (9–20 mm) who were treated by semirigid ureteroscopes and pneumatic disintegration. The efficacy of treatment was estimated using the stone-free rate and all treatment related complications were analyzed.</p> <p>Results</p> <p>Except for 24 cases where the stone migrated to the kidney, the stone was successfully treated ureteroscopically, with a low rate of minimal complications such as mild hematuria (18.4%), short term low grade fever (13.5%). Only 3 patients (1.1%) had high grade fever and none had post operative stricture.</p> <p>Conclusion</p> <p>The use of semirigid URS and pneumatic lithotripsy in impacted upper ureteral stones in experienced hands has very satisfactory results with minimal complications. When Holmium laser and flexible URS are not available, semirigid URS and pneumatic lithotripsy is a good alternative that shouldn't, yet, be abandoned.</p

Assessment of Knowledge, Attitude and Practice of Molar-Incisor Hypomineralisation among a Group of Egyptian Dentists (Observational Cross-Sectional Study)

Abstract: Introduction: Molar Incisor Hypomineralisation (MIH) is one of qualitative DED. MIH is increasing dramatically in the new generations, which is considered to be challenging for the majority of dentists. MIH was found to be prevalent in 14.2% of the world\u27s population, with the high incidence 18% in South America and the least (10.9%) in Africa. This study was carried out to assess the knowledge, attitude, and practice of graduated Egyptian dentists\u27 group regarding MIH condition and compare the outcome information among different dental specialists. Material and methods: A google based questionnaire based on previously validated published papers distributed electronically through different social media by direct message or public social media link. Eligibility criteria including Graduated Egyptian licensed dentists excluding students, interns and other medical specialties. Model answer prepared by researchers in 3 rounds based on most recent published papers. Results: 416 participants enrolled in this study with response rate reach to 16.7% for direct message and 1.4% for public share link. 79.1% of PDs, 45.8% of GPs and 45.0% of other specialties are familiar with both MIH condition and terminology. A prevalence of 10-20 % was notice by participants during their practice (21.9% PDs, 22.0% GPs and 22.2 other specialties). Most of participants believe that there is a lack of information regarding MIH between Egyptian dentists. The majority of the participant used Full coverage for posterior teeth and composite resin for anterior teeth as treatment choice. 53.1% of PDs are encountered MIH in monthly bases. Conclusion: MIH is a clinical problem that Egyptian dentists well recognize and frequently encounter in clinical practice. There is a need to include MIH in academic curriculum to increase the awareness regarding the condition and clinical management

Single puncture percutaneous nephrolithomy for management of complex renal stones

<p>Abstract</p> <p>Background</p> <p>The purpose of this report is to assess the safety and efficacy of single lower pole access for multiple and branched renal calculi. A prospective non randomized clinical study included 26 patients with complex renal stones (9 patients had branched renal stones and the other 17 had multiple renal stones) in the period from May 2003 to May 2004. Mean patient age was 42 years ± 13.2 (range 18 to 67 years). All patients underwent percutaneous nephrolithotomy (PCNL) via a single lower calyceal puncture. Small stones were intactly extracted by a range of stone graspers while large stones (smallest diameter more than 1 cm) were disintegrated using either the pneumatic EMS Swiss lithoclast or Holmium YAG laser. Flexible nephroscope was used for stones inaccessible by the rigid instruments.</p> <p>Findings</p> <p>Overall stone-free rate was 74.8%. Patients with residual stones were managed by one session of shock wave lithotripsy (SWL). Mean operative time was (80 minutes ± 27.4) for branched stones and (49.1 minutes ± 15.9) for multiple stones. No significant blood loss reported. Perforation of pelvicalyceal system occurred in 2 patients (11.5%) with no serious sequelae. Only 1 patient developed secondary hemorrhage which necessitated blood transfusion and selective angio-embolization.</p> <p>Conclusion</p> <p>In our hands, the efficacy and safety of single lower calyceal puncture PCNL in management of complex renal stones are comparable to those of the general procedure stated in literature.</p

Selenium and Nano-Selenium Biofortification for Human Health

Selenium is an essential micronutrient required for the health of humans and lower plants, but its importance for higher plants is still being investigated. The biological functions of Se related to human health revolve around its presence in 25 known selenoproteins (e.g., selenocysteine or the 21st amino acid). Humans may receive their required Se through plant uptake of soil Se, foods enriched in Se, or Se dietary supplements. Selenium nanoparticles (Se-NPs) have been applied to biofortified foods and feeds. Due to low toxicity and high e ciency, Se-NPs are used in applications such as cancer therapy and nano-medicines. Selenium and nano-selenium may be able to support and enhance the productivity of cultivated plants and animals under stressful conditions because they are antimicrobial and anti-carcinogenic agents, with antioxidant capacity and immune-modulatory efficacy. Thus, nano-selenium could be inserted in the feeds of fish and livestock to improvise stress resilience and productivity. This review offers new insights in Se and Se-NPs biofortification for edible plants and farm animals under stressful environments. Further, extensive research on Se-NPs is required to identify possible adverse effects on humans and their cytotoxicity.Peer Reviewe