How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis

Background/Aims@#Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database. @*Methods@#Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications. @*Results@#During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic. @*Conclusions@#During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.

Clinicopathologic profile of patients with maxillofacial tumors in a tertiary level government institution

RATIONALE@#Bone tumors of the head and neck region are rare. Their occurrence, biologic behavior, and management can cause significant personal, social, behavioral and economic ramifications. The aim of this study was to describe the clinicopathologic profile of patients with maxillofacial tumors in a tertiary level government hospital. @*METHODS@#This was a retrospective, descriptive study over a five-year period (January 2013 to December 2018).@*RESULTS@#A total of 256 patients was included in the study, with females accounting for 53.5% and males for 46.5%. The mean age of presentation was 37.4 years with a range of 18-80 years. The mean age of patients with benign tumors was 36.1 years, while those with malignant tumors was higher at 61.8 years. Majority of the tumors involved the mandible. Ameloblastoma and dentigerous cysts were the most prevalent benign odontogenic tumors while squamous cell cancer was the most common malignancy. Radical surgery with composite reconstruction was done in malignant cases to ensure adequate pathologic margins, while a more conservative tissue-sparing approach was done for benign cases.@*CONCLUSION@#Management of maxillofacial tumors remains a challenge because of its relative anatomic location and locally-advanced state upon detection. Identifying these tumors at an early stage ensures adequate resection with minimal functional and aesthetic loss. The low morbidity and mortality rates reported in this study emphasizes the role of the multidisciplinary team approach, surgical experience and comprehensive perioperative care in the management of bone tumors in the head and neck.

Synthesis, characterization and RHFlab initio simulations of 2-amino-1,3,4-thiadiazole and its annulated ring junction pyrimidine derivatives

Michael addition reaction of the 2-amino-1,3,4-thiadiazole to chalcone as biselectrophile - afforded 5,7-diphenyl-6-[1,3-diphenylpropan-1-on-3-yl][l,3,4]thiadiazolo[3,2-[a]pyrimidine [3] instead of 5,7-diphenyl-5H-[l,3,4]thiadiazolo[3,2-a]pyrimidine [5] via further Michael addition at C[5] in pyrimidine moiety. The structure 3 was established through the aspect of ab initio calculations, elemental analysis and spectral data

Awareness of World Health Organization methicillin-resistant Staphylococcus aureus guidelines at Alexandria university hospitals

This cross-sectional study aimed to assess knowledge of routes of transmission, awareness of MRSA control guidelines and reasons for non-adherence to guidelines among medical staff at Alexandria University hospitals. A random sample of 158 physicians and 47 nurses answered a self-administered questionnaire. Overall awareness of MRSA control guidelines was 67.3%, and nurses were significantly more aware than physicians [91.5% versus 60.1%]. The lowest awareness level was among anaesthesiologists; only 54.4% knew the correct transmission routes. Among medical staff overall, 70.0% accepted the necessity of screening measures for high-risk patients and 35.8% of doctors accepted the use of the same pair of gloves when caring for different body sites on an individual patient. Lack of resources was the most common justification for suboptimum adherence. The study showed low awareness levels of MRSA-related guidelines

Attitudes of cairo university medical students toward smoking: the need for tobacco control programs in medical education

Tobacco smoking rates are increasing in developing countries and so are tobacco-related chronic diseases. Reported figures from the WHO show rates of smoking in Egypt as high as 20% but limited information is available about smoking specifically among physicians and medical students. Final-year medical students of Cairo University were surveyed regarding their tobacco behavior and attitudes using a modified Global Health Professions Student Survey. We approached 220 students by randomly selecting clinical units into which they were assigned and requested completion of the survey. Ever users of some form of tobacco comprised 46.7% of students sampled, current users of cigarettes comprised 17.4%, and current users of water pipe 'sheesha' comprised 17.6%. The vast majority [87.7%] of students believed that smoking is a public health problem in Cairo and supported restriction of tobacco. Yet, only 58.5% stated that they were taught it is important for physicians to provide tobacco education materials to patients. Among ever users of cigarettes, 54.4% believed health professionals do not serve as health role models for patients, and only a small percentage of all students [34.2%] stated that they had received some form of training on smoking cessation in their medical curriculum to be able to instruct patients. A high rate of smoking was revealed among medical students in Cairo. Overall, approximately 23.4% of students were currently smoking cigarettes and/or sheesha, and 46.7% were ever users of some form of tobacc o. A formal antitobacco program for medical students should be incorporated into their medical curriculum to change the attitudes of medical students and overcome the anticipated increase in chronic diseases in Egypt

controlled study of nitazoxanide [NTZ] 3 years after treatment of hepatitis C genotype

This study is an extension of an earlier, randomized; placebo-controlled that showed the efficacy of nitazoxanide [NTZ] 500 mg tablets twice daily for 6 months in treating HCV genotype 4. Access was available to 13/32 patients of the original study with chronic HCV during more than 3 years after the study was finished. One patient [with portal hypertension and oesophageal varices [O.V]] was among 3 with SVR out of 9 of the NTZ treated patients suggesting that NTZ could successfully be used even in patients with O.V. SVR remain so up to the end of the follow-up period compared to none of the other 4 patients who received placebo. A fourth patient of NTZ group achieved virological response at the end of follow-up although she firstly showed RVR and then viral breakthrough. Most of the remaining patients of the NTZ group who did not achieve SVR showed variable partial response. No serious adverse events were reported in both groups during treatment and thereafter

Chromosomal study in newborn infants with congenital anomalies in Assiut University hospital: cross-sectional study

In 40-60% of congenital malformations, the cause is unknown. Genetic factors account for approximately 15%; environmental factors produce approximately 10%; a combination of genetic and environmental influences produces 20-25%. The study aims to document prevalence and patterns of congenital malformations detected at birth in Assiut University hospital and clarify underlying chromosomal abnormalities of such malformations. Also possible predisposing factors will be studied. Newborns with apparent congenital anomalies were selected from 5000 newborn infants delivered consecutively at the department of Obstetrics and Gynecology within 7 months. Full maternal history, family history, perinatal history, pedigree construction as well as clinical examinations and investigations including karyotype were done. Congenital anomalies were found in 103 cases with a prevalence of 2.06% with male to female ratio of 1.7:1. Skeletal system anomalies had the highest frequency [37.9%], followed in descending order by chromosomal abnormalities [27.2%], circulatory system anomalies [22.3%], central nervous system [CNS] anomalies [19.4%], genital organs anomalies [16.5%], gastrointestinal tract [GIT] anomalies [14.6%], eye and ear anomalies [8.7%], and lastly urinary system and others anomalies in 3.9% each. Breech presentation, perinatal asphyxia, incubator admission and the need for resuscitation were significantly associated with the presence of congenital anomalies. Higher prevalence of congenital anomalies was observed in neonates of grand multiparous women, diabetic mothers delivery by CS, cases with oligohydramnios and with positive consanguinity. Chromosomal abnormalities were found in 28 cases [27.18% of malformed cases] [5.6/1000]. Numerical abnormalities were found in 22 cases [21.35%] [4.4/1000], Down syndrome in 16 cases, Edward syndrome in two cases, Patau syndrome in one case and Turner syndrome [monosomy] in three cases. Structural abnormalities were present in six cases [5.83%] [1.2/1000], Down syndrome in two cases, Turner syndrome in two cases, balanced translocation [[12;13][q15;q34]] with dysmorphic features and undescended testis in one case and deletion 9[q11;q31] with disorder of sex development in one case. To conclude karyotype should not be done routinely for all malformed cases as many of them are due to genetic syndromes. So, it is more useful to consult expert dysmorphologists for proper syndrome identification and for the decision to use more recent molecular techniques for diagnosis

In vivo acute effects of orally administered hydro-ethanol extract of catha edulis on blood glucose levels in normal, glucose-fed hyperglycemic, and alloxan-induced diabetic rats

To investigate the blood glucose lowering effect of khat [Catha edulis] extract in normal, glucose-loaded, and alloxan diabetic rats. Three experimental protocols were used in this study. In each of the first 2 protocols, 3 groups of rats [6 rats per group] were used as control group [NS], Catha edulis [CE] treated, and glibenclamide treated groups. This study was carried out at the Physiological Laboratory of the Medical School of King Khalid University, Abha, Saudi Arabia between October and November, 2009. Normal rats were used in the first protocol while alloxan diabetic rats were used in the second protocol. Blood glucose levels were measured in all 3 groups after single dose injections of saline, CE or glibenclamide. In the third protocol, another 6 groups of rats [6 rats per group] were prepared as in the first 2 protocols and oral glucose tolerance test [OGTT] was performed on each rat after oral administration of glucose [1.5g/kg]. Oral administration of a hydro-ethanol extract of CE caused no statistically significant change in blood glucose levels in normal rats with or without glucose loading. There were slight, non significant increases in blood glucose levels of extract-treated diabetic rats, with and without glucose loading, as compared to the corresponding untreated rats. Oral administration of CE extract does not exert a hypoglycemic effect in normal, glucose-loaded, and diabetic rats

Differences in molecular pathologic characteristics of pancreatic adenocarcinoma between Egyptian and Moroccan patients

Pancreatic cancer has not been well studied, especially in developing countries. We studied the variations in genetic mutations in pancreatic adenocarcinoma between Moroccan and Egyptian populations. The molecular pathology of 30 tumors from a large hospital in Casablanca, Morocco were examined and compared with the findings of 44 tumors from the Gharbiah Governate in Egypt. K-ras mutations in codons 12 and 13 in addition to p53 mutations in exons 5-8 were evaluated. Overall, differences in the rates of K-ras mutations were not statistically significant [48.00 and 34.09%, respectively]; however differences in rates of p53 mutations were statistically significant with p53 mutations more common in Moroccan tumors than in Egyptian tumors [46.67 and 16.28%, respectively]. G ->T mutations of the K-ras gene were most commonly seen Egyptian tumors, whereas G -> A mutations were the most common type of mutations in Moroccan tumors. Logistic regression analysis showed that a p53 mutation in any exon as well as a p53 mutation in exon 5 predicted the country of residence and those mutations occurred more frequently in Moroccan patients. Our study shows that differences exist within the Arab population in the molecular pathology of both the K-ras and p53 genes. Further studies are necessary to clarify the differences in molecular pathways of pancreatic cancer in the Middle East and to investigate the role of environmental and/or genetic factors related to those pathways

Initial prodrome description in recent onset schizophrenia

Initial prodromal phase is gaining increasing significance for early detection, management and prognosis of recent onset psychosis. The present work aimed to assess and describe the prodromal phase in subjects with recent onset schizophrenia. 43 cases of recent onset schizophrenia were collected on outpatient basis and diagnosed according to ICD-10 DRC [WHO, 1993]. A prodrome questionnaire to subject and informant was used to assess prodromal phase retrospectively. Results showed that 30 cases [69.9%] had prodrome reported either by subject only [3 cases 7%], informant only [13 cases 30.2%] or by both subject and informant [14 cases, 32.6%]. The duration of the prodrome reported by subjects ranged from 30- 1825 days [5 years] [mean = 475.6 days, SD = +/- 495.1]. The duration of the prodrome reported by informants ranged from 30- 1095 days [3 years] [mean =361.1 days, SD = +/- 356.7]. Prodromal symptoms, most commonly reported by subjects, were: Suspiciousness and Social withdrawal, followed by Ideas of references and Insomnia. Prodromal symptoms, most commonly reported by informants, were: Social withdrawal, Impaired functioning, followed by Somatic symptoms, Anxiety and Decreased appetite. Recent onset schizophrenic patients experienced an initial prodromal phase that may vary from weeks to many years in duration. Prodrome can present with negative prodromal signs, positive symptoms and/or non-specific symptoms. The more prolonged prodromes are associated with more insidious onset and more impairment of functioning

Neuropsychological assessment of global and specific cognitive functions in children with epilepsy

Impairment of cognitive functions is an important problem in epileptic children that can burden their learning abilities and academic achievement. The present study aims at assessment of cognitive functions in epileptic children and to explore the relation of various neuropsychological functions to other variables such as seizure type, frequency, duration of epilepsy, EEG changes and antiepileptic drugs. The study included 58 epileptic children, 6-12 years old [39 males and 19 females]. All children were subjected to detailed history, full neurological and psychiatric examination, EEG and a battery of psychometric tests. Results confirmed that epileptic children have significant impairment in cognitive functions and this impairment is most evident in females, generalized seizures, higher frequency of seizures, right sided focus in EEG, poor seizure control and poly therapy

Results of flexible intra-medullary nailing in paediatric femoral fractures

Treatment of fracture femur in children between 6-14 years is still controversial. The aim of this study is to evaluate the results of treatment of fracture femur in children between 6 and 14 years old using elastic stable intramedullary nailing [ESIN]. ESIN was used to treat 20 patients between the age of six and fourteen years old with fracture shaft femur. The main mechanism of trauma was road traffic accidents. One fracture was an open grade II fracture. The most encountered level of the fractures was in the middle third. The mean time lapse before surgery was 6.65 +/- 5.4 days. The final results obtained were excellent in eighteen patients [90%] and good in two patients [10%]. The mean time to clinical union was 5.65 +/- 0.81 weeks, while the mean time to radiological union was 7.55 +/- 1.39 weeks. Final score had no statistically significant relations to age, sex, side affected, time lapse before the operation, minimum canal diameter, nail diameter used, intra-operative image intensifier time, mechanism of trauma, type/level/shape of fractures, the presence of associated injuries, and technique of reduction. Four patients had pain at insertion site, two had 10 external rotation, two had 20 valgus, one had 10 varus deformity and one had 10 anterior angulation. We concluded that flexible intramedullary nailing is an accepted treatment option with the advantage of shorter hospital stay and early recovery

Hyperinsulinemia and its potential role in preeclampsia

Pre-eclampsia remains one of the leading causes of maternal and fetal morbidity and mortality. Despite extensive researches, our knowledge of the etiology and pathphysiology of preeclampsia is still limited. Recently, insulin resistance is implicated in the pathogenesis of preeclampsia. We conducted a nested case-control study to test the hypothesis that insulin resistance is associated with preeclampsia. Blood glucose and insulin serum concentrations, both fasting and postprandial, were evaluated in sixty preeclamptic patients [thirty with mild preeclampsia and thirty with severe preeclampsia] and thirty normotensive control during the third trimester of gestation. Compared with control group, women who have preeclampsia had significantly higher serum insulin levels both fasting and postprandial, also it was found that the preeclamptic group patients with severe preeclampsia had significantly higher insulin serum levels compared to women with mild preeclampsia, No significant difference was observed between the three groups as regard to both fasting and postprandial blood glucose level

Antioxidant activity for a novel phenolic glycoside from koelreuteria elegans

Reactive oxygen species [ROS] have been implicated in the pathophysiology of many diseases such as atherosclerosis, Alzheimer's and Parkinson's diseases. Additional evidence also suggests ROS may play a role in the decline in neuronal function during normal aging. Phytochemical investigation of koelreuteria elegans resulted in isolation of a new benzoic acid monoglycoside, its structure was established as: benzoic acid 4-0-alpha-L-arabinopyranoside [compound 1] which exhibited strong radical scavenging properties on lipid peroxidation, hydroxyl radical and superoxide anion generation. Three other known flavonol glycosides; quercetin-3-O-alpha-L-arabinopyranside [compound 2], kaempferol-3-O-alpha-L-arabinopyranoside [compound 3] and ombuin 3-O-alpha-L-rharnnopyranosyl-6-D-glucopyranosyl [compound 4], in addition to a triterpene saponin 3-O-beta-D-glucopyranosyl[1-2][alpha-L-rhamnopyranosyl[1-3]] beta-D-glucuronopyranosyl 28-0-angeloyl-camelliagenin A [comped 5] were also isolated

Assessment of knowledge and attitude towards tuberculosis among samples Egyptian population

Tuberculosis continues to rank among the world's most serious problems despite unparalleled biomedical achievements of effective chemotherapy. Several factors are responsible for high incidence and prevalence of tuberculosis is underdeveloped and developed countries as cultural-determined beliefs about the knowledge of tuberculosis, failure to adhere to treatment, delay in diagnosis, patients' gender and low level of patient information. Beliefs about tuberculosis and its causes are major influences of people's behavior, understanding such attitudes and beliefs can aid health providers and policy makers in rectification through provision of properly designed educational strategies. Distorted tuberculosis knowledge and beliefs could participate in the patients delay, non-compliance and unfavorable outcome

Objectives: To assess the possible effect of anti tuberculosis health education campaign, and to explore areas of deficiency of tuberculosis knowledge among a sample of Egyptian community

Subjects and Methods: a multistage sampling technique was followed to select a sample of 3800 interviewees in 20 Egyptian Governorates. A questionnaire was designed and field pre-tested before being used in the pre and post assessment. Data collectors were trained on interviewee's selection as well as on the questionnaire

Results: The study demonstrated a possible positive some aspects of knowledge concerning the nature of tuberculosis as an infectious disease which is treatable and curable. About 30% of the included subjects considered TB as malignant tumors, God's punishment or will, related to extra marital sexual activities, and drug addition. Positive changes have been found regarding the ways of how TB is transmitted but still as substantial knowledge deficit on how to prevent infection, early symptoms of the disease and care seeking behavior in case of chest problems. Tuberculosis accompanying stigma is deeply settled and needs multiple educational interventions to ameliorate its effects. The study pointed out the potential role of the private sector, school and institutional curricula in addition to the role of the media in improving the TB knowledge among the population

Conclusions: Proper messages, collaboration between different health sectors and partners with implementation of effective culturally-sensitive educational strategies should be employed to increase TB knowledge regarding the nature of the disease, the early presentation, early diagnosis, and how to ameliorate the accompanying stigma

Trajectories with velocity corrections in the impulsive transfer orbits

The main goal of this paper is to acquire the precise final elliptic orbit stemming from an initial orbit via an optimal transfer orbit, by applying small tangential impulses at peri-apse and apoapse. We consider two systems; the generalized Hohmann and the generalized bi-elliptic transfer orbits. For the first system, we obtain the four relationships connecting the increments in major axes and eccentricities with the correctional increments in velocities delta vA and delta vB at points A, B. For the second system, we derive the three relationships, connecting slight changes in major axes with small increments in velocities at points A, B and C due to motor thrusts. Forminimum fuel consumption, we consider the initial impulse applied at periapse of initial orbit

Solution for the lambert's problem

In this work, we have formulated and solved the well known Lambert problem, one of the most important topics in celestial mechanics. As Lambert stated, the transfer time depends only on the unknown parameter a [semi major axis], the two radii and the chord length are already known from the definition of the problem. It should be possible to write the transfer time as a function of the semi major axis only [t[2] -t[1]=delta t =f[a]]. Also the transfer time can be written as a function of some other parameter such as AE, this allows for a well-behaved iteration, and is the chosen method for the universal variable formulation. We solve Lambert problem by using this method, for two cases, elliptic orbits and hyperbolic orbits. Parabolic orbits are of no practical importance. We consider the Earth - Mars trajectory case, as a numerical example

Hyperbolic Lambert-euler problem

We have derived Euler-Lambert equation for the hyperbolic orbital motion. It is a new derivation and a first time publication for this problem which is relevant to interplanetary rendezvous trajectories encountered in dynamics of space science. Some new additions to elliptic and parabolic trajectories are cited