The prevalence of accessory heads of the flexor pollicis longus and the flexor digitorum profundus muscles in Egyptians and their relations to median and anterior interosseous nerves

Entrapment neuropathy in the forearm is not uncommon. Surgical interference for nerve decompression should be preceded by accurate diagnosis of the exact cause and site of the nerve entrapment. The aim of the present study was to investigate the prevalence of accessory heads of the flexor pollicis longus and flexor digitorum profundus muscles (FPLah) and (FDPah) in Egyptians and their topographical relationship with both the median nerve and its anterior interosseous branch. A total of 42 upper limbs of embalmed cadavers, 36 from males and 6 from females, were examined to elucidate the prevalence of both the FPLah and the FDPah muscles, their origin, insertion, nerve supply and morphology. The distribution of these two muscles in the right and left male and female upper limbs and their relationship to the anterior interosseous and median nerves were recorded. The total lengths of both accessory muscles and the lengths of their fleshy bellies and tendons were also measured. The FPLah was found to be present more frequently (61.9%) than it was absent, whereas the FDPah was observed in only 14.24% of the specimens examined. The combination of the accessory muscles in the same forearm was noticed in 9.52% of cases. As regards side, the FPLah appeared in 77.7% of the right forearms and in 50% of the left, while the FDPah was found in only 25% of the left forearms. The accessory muscles showed no single morphology, as the FPLah appeared fusiform in 53.8%, slender in 30.8% and voluminous fusiform in 15.4%, while the FDPah was slender in 66.6% and triangular in 33.3% of specimens. The FPLah arose mainly from the under surface of flexor digitorum superficialis, while the FDPah took its origin from the under surface of flexor digitorum superficialis or from the medial epicondyle. The insertion of the FPLah was mainly into the upper third of the FPL tendon, while the FDPah tendon joined the tendons of the flexor digitorum profundus muscle to the index or middle and ring fingers. The FPLah was found between the median nerve anteriorly and the anterior interosseous nerve posteriorly. Both FPLah and FDPah took their nerve supply mainly from the anterior interosseous nerve and, less frequently, from the median nerve. The mean values of the total lengths of FPLah and FDPah were 74.66 mm and 208.33 mm, respectively. Cadaveric dissection in this study confirmed the prevalence of the FPLah and FDPah in Egyptians and demonstrated the relationship of the FPLah to the median nerve and its anterior interosseous branch. These findings may provide the surgeon with information for the differential diagnosis of the causes and sites of anterior interosseous nerve syndrome and entrapment neuropathy of the median nerve in the forearm (Folia Morphol 2008; 67: 63-71)

Pedo-Chemical Studies on Saline Playas in the Arabian Shelf

This research was undertaken to study the pedo-chemical characteristics of selected playas (sabkhahs) in the Arabian Shelf. Results indicated that most of the sabkhahs are flat to almost flat having salt crusts with variable thickness. Profiles representing the sabkhah surface are extremely saline compared with that of the surrounding landscapes. The dominant soluble salts are Cl- and SO4(2-) of Na+ followed by Ca2 + or Mg2+. The compositions of the coastal sabkhahs profile layers are closely related to the Gulf water composition while the inland playas are more associated with local conditions. This was continued from the similarity in salt levels, ion molar ratios and relatively high correlation coefficients between the electrical conductivity of soluble salts (EC) and either soluble B3+ (r2 =0.80) or soluble Mg2 (r2=0.60) in coastal compared with that of the inland sabkhahs (r2=0.17) and (r2 =O.37), respectively. The main pedological process affecting the formation of coastal sabkhahs is the upward movement of the water table which is rich in sales originating from the Gulf waters either directly or through wind action. Leaching, accumulation of sediments and evaporative concentrations of the solutes are the processes prevailing in the inland sabkhahs. Salt crusts are dominated by Cl-and SO4(2-) of Na+ , Mg2+ and Ca2+ salts while K+ salts are relatively low. X-ray diffraction patterns confirm the presence of halite, gypsum and carbonate minerals. Epsomite and bloedtte minerals were identified in both coastal and inland sabkhahs. Specific minerals and relative abundance was quite variable between the salt cmsts due to the characteristic conditions of each sabkhah. The major differences between the inland and coastal sablthahs are related to the source, composition and depth of the water table and consequently the composition and mineralogy of the surface salt crusts

Pedo-Chemical Studies on Saline Playas in the Arabian Shelf

This research was undertaken to study the pedo-chemical characteristics of selected playas (sabkhahs) in the Arabian Shelf. Results indicated that most of the sabkhahs are flat to almost flat having salt crusts with variable thickness. Profiles representing the sabkhah surface are extremely saline compared with that of the surrounding landscapes. The dominant soluble salts are Cl- and SO4(2-) of Na+ followed by Ca2 + or Mg2+. The compositions of the coastal sabkhahs profile layers are closely related to the Gulf water composition while the inland playas are more associated with local conditions. This was continued from the similarity in salt levels, ion molar ratios and relatively high correlation coefficients between the electrical conductivity of soluble salts (EC) and either soluble B3+ (r2 =0.80) or soluble Mg2 (r2=0.60) in coastal compared with that of the inland sabkhahs (r2=0.17) and (r2 =O.37), respectively. The main pedological process affecting the formation of coastal sabkhahs is the upward movement of the water table which is rich in sales originating from the Gulf waters either directly or through wind action. Leaching, accumulation of sediments and evaporative concentrations of the solutes are the processes prevailing in the inland sabkhahs. Salt crusts are dominated by Cl-and SO4(2-) of Na+ , Mg2+ and Ca2+ salts while K+ salts are relatively low. X-ray diffraction patterns confirm the presence of halite, gypsum and carbonate minerals. Epsomite and bloedtte minerals were identified in both coastal and inland sabkhahs. Specific minerals and relative abundance was quite variable between the salt cmsts due to the characteristic conditions of each sabkhah. The major differences between the inland and coastal sablthahs are related to the source, composition and depth of the water table and consequently the composition and mineralogy of the surface salt crusts

Lingering SARS-CoV-2 in Gastric and Gallbladder Tissues of Patients with Previous COVID-19 Infection Undergoing Bariatric Surgery

Background Lingering severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gut tissue might be a source of infection during bariatric surgery. This study aimed to confirm the presence of SARS-CoV-2 nucleocapsid in gastric and gallbladder tissues removed during bariatric surgery in individuals previously infected with coronavirus disease 2019 (COVID-19) who had negative polymerase chain reaction results prior to the surgery.Methods Gastric and gallbladder specimens from 80 patients who underwent bariatric surgery between November 2021 and May 2022 and had a history of COVID-19 infection with gastrointestinal symptoms were examined for the presence of lingering SARS-CoV-2 nucleocapsid proteins using immunohistochemistry.Results Gastric specimens from 26 (32.5%) patients and 4 (100%) cholecystectomy specimens showed positive cytoplasmic staining for the anti-SARS-CoV-2 nucleocapsid protein in surface mucosal epithelial cells. The mean age was 37.8 +/- 10.3 years. The average body mass index was 44.2 +/- 7.0 kg/m(2); most of the patients were females (71.3%). The positive staining group was significantly younger than the negative staining group (p = 0.007). The full-dose vaccination rate was 58.8%, with a median of 91 days after the last vaccine dose. A positive serological anti-spike IgG response was observed in 99% of the patients. The median time between initial COVID-19 infection and surgery was 274 and 380 days in the positive and negative staining groups, respectively (p = 0.371).Conclusion Gastric and gallbladder tissues can retain SARS-CoV-2 particles for a long time after COVID-19 infection, handling stomach specimens from patients during an operation must be done with care, as we usually do, but now with the knowledge that in 1/3 of patients they can be present. Performing LSG on post-COVID patients did not seem to increase perioperative morbidity.Anesthesiolog

Gastroprotective potential of red onion (Allium cepa L.) peel in ethanol-induced gastric injury in rats : involvement of Nrf2/HO-1 and HMGB-1/NF-κB trajectories

Ethnopharmacological relevance: The utilization of plants with therapeutic properties in traditional medicine has a longstanding practice. Among them, the well-known Allium cepa L. commonly known as onion has been valued for its anti-inflammatory and antioxidant potential in the treatment of various ailments, including gastric ulcers. Aim of the study: This study investigated the gastroprotective potential of red onion peel extract and its fractions in a rat model of ethanol-induced gastric ulcer. Moreover, their phytochemical profiles were compared to identify the active metabolites. Materials and methods: Mass spectrometry-based metabolomics and chemometrics were performed for phytochemical analysis. Ethanol-induced gastric ulcer model was used to assess the gastroprotective activity. Nine groups of rats were allocated as follows: Group 1 was the normal control; Group 2 rats were used as a positive control/model and received 1 mL of absolute ethanol; and Group 3 rats were treated with famotidine at a dose of 20 mg/kg orally. Group 4 and 5 rats were treated with total acidified ethanolic extract (T1, T2). Group 6 and 7 rats were treated with anthocyanins-rich fractions (P1, P2). Groups 8 and 9 were the flavonoids-rich fraction (S1, S2) treatment. Prior to scarification, the ulcer index in mm was obtained from gastric tissues photographed beside a ruler with further analysis using ImageJ software. Results: Seventy key major and discriminatory metabolites were identified including flavonoids, anthocyanins, phenolic acids, and miscellaneous compounds. The examined extract and its fractions significantly reduced the ulcer index and inflammatory cytokines via downregulating HMGB-1/NF-κB. Also, they augmented the expression of Nrf2/HO-1 and reduced NOX1/4 mRNA expression. Moreover, there was a significant reduction in the oxidative stress and apoptotic biomarkers as well as a noticeable enhancement in histopathological changes of the stomach tissues. Conclusion: Red onion peels have a promising dose dependent gastroprotective potential in alcohol-induced ulcers via modulating Nrf2/HO-1 and HMGB-1/NF-κB trajectories. This highlights the potential of red onion peels in treating gastric ulcers

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this