Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis

Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Background: The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy–trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. Methods: This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Results: Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. Conclusions: CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings

Aflibercept or ranibizumab for diabetic macular edema

Background: Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME.   Methods: This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography.   Results: Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20–74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group.   Conclusions: Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naive DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.&nbsp

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 years; 78.2% included were male with a median age of 37 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

Occurrence, phenotypic and genotypic characterization of multidrug resistant zoonotic bacteria isolated from poultry slaughterhouses

A total of 125 swab samples were collected from tables, knives, rinsing water, carcasses' surfaces and workers' hands (25, each) in five poultry slaughter houses at Sharkia Province, Egypt. These samples were examined for the presence of E. coli and Salmonella spp. and the resistance patterns of the isolates were determined using disc diffusion method. The isolates were serologically, molecularly identified and screened for the presence of antibiotic resistance genes using PCR. The overall prevalence of E.coli was 58.4% compared to 4.8% for Salmonella spp. E. coli isolates were serologically identified into 10 different serotypes with the predominance of serotype O125:K70 (7 isolates). Moreover, Salmonella isolates were serotyped into S. Enteritidis (3 isolates), S. Typhimurium, S. Emek and S. Agona (one isolate, each). E.coli and Salmonella isolates showed marked variations in their antibiotic resistance patterns. QRDRs of the gyrA, sul1 and tetA genes were identified in 60, 62 and 68 % of E. coli isolates, respectively. On the other hand, the respective prevalence of the former genes in Salmonella isolates was 50, 50 and 66.7%. The higher incidence of multidrug resistant E.coli and Salmonella harboring resistance genes in this study constituting a devastating problem for poultry industry and poultry consumers

Genetic Mapping Reveals Novel Exotic and Elite QTL Alleles for Salinity Tolerance in Barley

Soil salinity is one of the constraints of crop production in Egypt. The aims of this study were to identify genomic regions associated with grain weight and its related traits along with their salinity tolerance indices and to identify the most salinity tolerant and high-yielding genotypes. Therefore, we evaluated an advanced backcross mapping population of barley in newly reclaimed soil under two salinity levels of groundwater aquifers in South of Sinai, Egypt. We detected significant QTL associated with grain weight related attributes and the salinity tolerance index (STI) distributed throughout the whole genome of barley, which can be used to enhance salinity tolerance. Moreover, the markers bPb-3739 (4H, 96.3 cM), AF043094A (5H, 156 cM), bPb-8161 (7H, 2.22 cM), and bPb-5260 (7H, 115.6 cM), were the most important identified genomic regions corresponding to vernalization, dwarfing and dehydrin genes, which are correlated with salinity tolerance. Additionally, the doubled haploid lines SI001, SI043, SI044, SI028, SI242, SI035, and SI005 had the highest STI values based on yield average. The present study demonstrated that wild and elite barley do harbor novel valuable alleles, which can enrich the genetic basis of cultivated barley and improve quantitative agronomic traits under salinity conditions

Anterior lamellar recession versus bilamellar tarsal rotation in upper lid cicatricial trichiasis

PURPOSE: In recent years, there has been a significant shift from this destructive procedure to a reconstructive procedure such as anterior lamellar recession (ALR) and bilamellar tarsal rotation (BLTR). The aim is to report the outcomes and success rates of ALR compared to BLTR in patients with upper lid cicatricial trichiasis. MATERIALS AND METHODS: Our study is a prospective, interventional, comparative study that was conducted at the Ophthalmology Department of Al-Azhar University Hospital, New Damietta, Egypt. Our study was conducted on 62 eyes of 45 consecutive patients suffering from upper lid cicatricial trichiasis that required surgical intervention (17 patients were bilateral and 28 were unilateral). Thirty-three of them were treated by ALR (group 1), and 29 of them by BLTR (group 2). All statistical analysis was performed using the SPSS version 26. RESULTS: As regards the immediate postoperative correction, we found that adequate correction was significantly higher in the ALR group at all follow-up periods (P < 0.05). However, the overcorrection and undercorrection were significantly higher in the BLTR group (P < 0.05). Compared to the ALR group, the BLTR group saw a greater undercorrection at 1, 3, and 6 months (9.3%% vs. 0%; P = 0.048, 18.6% vs. 1.8%%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, 18.6%% vs. 1.8%; P = 0.009, respectively). CONCLUSION: ALR is better than BLTR in the treatment of upper lid cicatricial trichiasis

Prevalence of Multidrug-resistant Enterotoxigenic Staphylococcus aureus in Pagrus and Saurus Fish Intended for Human Consumption

Staphylococcus aureus (S. aureus) is considered the most important cause of food borne intoxication, which occurs due to ingesting of food contaminated with enterotoxin of S. aureus. In this study, S. aureus from saurus, and pagrus fish species were isolated, then identified by morphological and biochemical examination. S. aureus coagulase, and D-Nase +ve were detected in 16 from 25 (64%), and 17 from 25(68%) of the examined samples of saurus, and pagrus, respectively. Total S. aureus counts were 5.14±0.06 in saurus, and 5.02±0.03 log 10 cfu/g in pagrus fish, respectively. Detection and typing of enterotoxin by Reverse Passive Latex Agglutination technique "RPLA" revealed the detection of staphylococcal enterotoxins (SEs) SEA, SEC, and SED at 18%, 6%, 0% in saurus and 5%, 0%, and 11%, at pagrus, respectively. S. aureus was tested for antimicrobial susceptibility. The recovered S. aureus coagulase, and D-Nase +ve in the current study showed resistance to kanamycin, clindamycin, nalidixic acid, and sulphamethoxazole at 100%, 87.9%, 84.8%, and 81.8%, respectively. The isolates showed sensitivity to amikacin, imipenem, meropenem, oxacillin at 90.9%, 87.9%, 84.8%, and 81.8% respectively. It could be concluded that multidrug resistant enterotoxigenic strains of S. aureus could be isolated from saurus and pagrus spp. Therefore, it is highly recommended to adopt strict hygienic measures and efficient cooking during before consumption of such fish species

Hygienic Status of the Carcass Surfaces of Cattle, Buffalo, Sheep, and Camel Carcasses and their Contact Surfaces

A main task for the food safety and animal hygiene sectors is to ensure safety and adoption of strict hygienic measures during the entire chain of the meat industry. To fulfill this task, continuous monitoring of the hygienic status of meat of different animal species and their contact surfaces is mandatory. In this study, the hygiene indicators including total bacterial counts (TBC), most probable number (MPN) of coliforms, total Staphylococcus aureus (TSC), and total mold and yeast counts (TMYC) of the surfaces of cattle, buffaloes, camel, and sheep retailed in Sharkia governorate Egypt were tested. Besides, such parameters were also investigated for the carcass contact surfaces including, the batcher hands, knives, cutting boards, and walls of the butcher shops. The obtained results indicated microbial contamination of the meat of different animals and their contact surfaces at variable rates. In general, cattle carcasses followed by that of the buffaloes had the highest microbial contamination. While, walls and cutting boards showed the highest microbial contamination among the examined contact surfaces. In conclusion, adoption of strict hygienic measure during handling of the animal carcasses, sterilization of the carcass's contact surfaces is highly suggested to produce meat of high keeping quality