Non-operative management of blunt abdominal solid organ trauma in adult patients

Introduction: Despite agreement in the literature that"stable"blunt trauma patients may be managed con-servatively, in Egypt many such patients receive operative management. This paper presents the results of apragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP)management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to TantaUniversity Emergency Hospital (TUH) in Egypt.Methods:A prospective observational study enrolled adult blunt abdominal trauma patients with solid organinjury at TUH over a 3-year period (June 2014­June 2017). Inclusion criteria were age≥18 yr, mean arterialpressure > 65 mm Hg, heart rate < 110 bpm, hematocrit≥7 mg/dl, and abdominal organ injury diagnosed byultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-tients were assigned to non-operative or operative management based on clinician preference. Outcomes ofinterest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics andχ2wereused to compare outcomes. Results:During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominaltrauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10­NOP vs. 28 ± 11­OP,p= 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP]vs.1155.17 ± 380.4 ml [OP] (p< 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs.6.45 ± 1.97 days [OP] (p= 0.012)). There was no difference in mortality between groups (p= 0.091). Conclusion:Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma wassafe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longerlength of stay for non-operative patients might reflect treating physician caution in their management

Incidence of human cytomegalovirus in breast carcinoma tissues is associated with a higher expression of growth factor receptor-bound protein 2

Background: female mammary carcinoma is the second most common cancer incidence among women and the fifth most common leading cause of cancer death worldwide. Premenopausal young women are more frequently targeted by inflammatory breast cancer (IBC), which is the most lethal form of breast cancer. The human cytomegalovirus (HCMV) has been identified as one of the viral infection with a higher frequency in carcinoma tissues of IBC than in non-IBC. The adaptor protein growth factor receptor-bound protein 2 (Grb2), was found to be upregulated in HCMV-infected cells and play as crucial role in cancer progression. Objective: this study aimed to assess the expression level of Grb2 in carcinoma tissues of IBC and non-IBC with HCMV infection. Patients and Methods: overall, 135 female diagnosed with breast carcinoma were enrolled in this study. Using conventional and real time polymerase chain reaction (PCR), we determined the incidence of HCMV and assessed the expression level of Grb2 mRNA in the breast cancer tissue samples. Results: Grb2 mRNA was significantly upregulated in HCMV+ IBC higher than in HCMV+ non-IBC. According to the molecular subtype, Grb2 mRNA was significantly higher upregulated in breast carcinoma tissues of HCMV+ hormonal positive (HP) than in triple negative (TN) counterparts. Conclusion: HCMV infection is associated with a high expression of Grb2 mRNA in IBC and that HP HCMV+ mammary carcinoma tissues confer upregulated Grb2 mRNA, suggesting a potential role of HCMV infection in enhancing of Grb2 mRNA expression in breast cancer with HP