Risk factors and outcomes of occurrence of anastomotic leakage and reoperations for its management after colorectal surgery

Background: Anastomotic leakage (AL) is still the most annoying postsurgery complication after colorectal resection due to its serious complications up to death. Limited data were available regarding differences in AL incidence, management, and consequences for different types of colorectal resection. The aim of the present work was to evaluate differences in incidence of AL, incidence of postoperative complications, and length of hospital stay in a large number of patients who underwent elective colorectal resection for management of colorectal lesions. In addition to detect when and what type of reoperation for management of AL occur after colorectal resection. Patients: All 250 included patients underwent elective surgeries for colorectal resection with performance of primary anastomosis for management of colorectal neoplastic and non-neoplastic diseases in the period between May 2016 and July 31, 2021. We followed the patients for 90 days; we registered the follow-up findings. Results: the rates of AL occurrence were variable after the different procedures. The lowest rate of AL occurrence was found in patients who underwent right hemicolectomy, then in patients who underwent sigmoidectomy, left hemicolectomy, transversectomy and anterior resection (p= 0.004). A stoma was frequently performed during reoperation (79.5%) which was significantly different between different procedures: 65.5% in right hemicolectomy, 75.0% in transversectomy, 85.7% in left hemicolectomy, and 93.0% in sigmoid resection (p< 0.001). Conclusion Rates, types, time of occurrence and severity of AL vary according to the type of colectomy performed and selective construction of stoma during AL reoperation is currently safely applied with comparable mortality rates for patients who did and who did not have a stoma after reoperation. (AU)

Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

Immunochemical studies of Toxocara canis proteases

@#Proteases of nematodes play a crucial role in larval molting and, in addition to their active role in egg hatching, proteases are also considered a crucial factor in tissue invasion and connective tissue remodeling. In Toxocara canis, proteases play important roles throughout the complex life cycle. They can degrade components of a model of extracellular matrix, basement membranes and different physiological substrates. In the present study, measurements of the proteolytic activity of the perivitelline fluid (PF) surrounding Toxocara canis embryos at different stages of development, the hatching fluid (HF) surrounding the infective larvae, as well as the excretory secretory (ES) products of the larvae in the culture media were performed. Measurements were made using casein as substrate following the Sigma non-specific protease activity assay. The results showed that enzyme activity increased as the embryo matured. The infective larvae were found to continuously produce proteases in the surrounding HF and ES products after in vitro cultivation indicating that Toxocara canis proteases might be important for the worm in the egg and the host. Optimal enzymatic activity was found at pH 8. Incubation of the antiserum from infected mice with the HF and ES products decreased their proteolytic activities, suggesting that there may be a link between the proteases present in these fluids and the immune response.

Treatment of adult Burkitt lymphoma with the CALGB 1002 protocol: a single center experience in Jordan

Background@#The treatment of adult Burkitt lymphoma with pediatric-based chemotherapy protocols usually results in high cure rates, although with significant toxicity. We report our experience with the Cancer and Leukemia Group B1002 (CALGB 1002) protocol. @*Methods@#The files of adult patients diagnosed with Burkitt lymphoma and treated with the CALGB 1002 protocol at King Hussein Cancer Center between 2008 and 2017 were reviewed.Baseline demographics, clinical laboratory features, treatment details, and responses were collected. The correlations between clinical and laboratory variables with event-free survival (EFS) and overall survival (OS) were determined by univariate and multivariate analyses using backward stepwise Cox regression models. EFS and OS were plotted using Kaplan‒Meier curves. @*Results@#This study included 19 patients with a median age of 33 years (range, 19‒65). Eleven (58%) and two (10.5%) patients had advanced-stage and central nervous system disease, respectively. Among 106 administered cycles, the median interval between cycles was 23 days (range, 19‒84 days). Sixteen patients (84%) achieved a complete response. After a median follow-up of 40.8 months, the 3-year EFS and OS rates were 78.95%. Patients with a low-risk International Prognostic Index (IPI) had better survival than those with intermediate-or high-risk IPI. Grade III‒IV hematological toxicities occurred in 88% of patients, while 73% had grade III‒IV mucositis. @*Conclusion@#In adult Burkitt lymphoma, the CALGB 1002 protocol provides high cure rates and can be administered promptly, but is associated with significant toxicity. Risk-adapted approaches and other, less toxic, chemotherapeutic regimens should be considered.

A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes

Actividad de las enzimas pancreáticas exocrinas en ratas hembras diabéticas / Activity of exocrine pancreatic enzymes in diabetic female rats

The study designed to evaluated the activity of pancreatic exocrine enzymes in diabetic male rats induced by alloxan. The hyperglycaemia was induced in forty-five rats after fasting of the animals for 24 hours by single intraperitoneal (i.p) injection of Alloxan100mg/kg B.W., three days after injection fasting blood glucose was measured when the concentration higher than 150mg/dL, were considered as hyperglycemic/ diabetes. A total of sixty adult male rats (45 diabetes and 15 non- diabetes) divided in to two groups as follows. The first group serves as control groups (15 animals) will be single i.p injection with distilled water. the second group diabetic groups (45 animals from first experiment) were subdivided into three subgroups as following (15 for each). Group (G1), Group (G2) and Group (G3) serves as 20, 40- and 60-days diabetic animals respectively. The blood samples collection were take through cardiac puncture technique from each rat for each period days for measurement the following parameters: (Serum glucose, total protein, insulin, cholesterol, albumin, triglyceride, LDL-C, HDL-C and VLDL-C) concentration, the rats pancreatic tissue were be taken for measured tissue pancreatic lipase, amylase, and trypsin concentration. The results demonstrate a significant increase in serum glucose concentration and a decrease in serum insulin and total protein in the diabetic group as compared with the control rats' group in all experimental days. The results showed a significant rise in serum total cholesterol concentration within the diabetic group when compared with the control group at day 20 and 60. Meanwhile, a significant increase in serum triglyceride and LDL concentration and a significant decrease in serum HDL concentration within the diabetic group when compared with the control rats group at day 20, 40 and 60. But the serum VLDL concentration depicted a significant increase in the group of diabetic when compared with the control rats group at day 40 and 60. The value of pancreatic tissue protease activity clarified there was a significant decrease of protease action in the group of diabetic rats when compared with the control rats group on both day 20 and day 60. And a significant decrease in amylase activity in the diabetic groups when compared with the group of control rats in both day 20, 40 and day 60. While the results of pancreatic tissue lipase show there were non-significant changes within the diabetics group when compared with the control group. In conclusion, the exocrine pancreatic function is very frequently and severely altered in diabetes mellitus male rats and the metabolic disorder effect of diabetes mellitus was manifested by hyperlipidemic and hypoprotenimic .

Prophylactic Impact of Beta vulgaris L in Ameliorating Cyclosporine A-Induced Hepatotoxicity in Rats

Background: Hepatotoxicity induced by Cyclosporine A (CsA) remains one of the major side effects. The aim of this studywas to determine the protective effects of beet root (Beta Vulgaris L) extract and silymarin against hepatotoxicity induced byCyclosporine A in rats. Methods: Sixty male albino rats, were divided into 6 groups (n=10). Group I control group. GroupII CsA-treated and received (50mg/kg weight, orally). Group III received (500mg/kg b.wt) beet root extract orally. Group IVreceived beet root extract and CsA as in group II and III. Group V was received (100 mg/kg b.wt) silymarin orally. Group VIreceived CsA and silymarin as in group II and V. Serum levels of (ALT, AST, ALP) and bilirubin (Total and Direct) weremeasured. Oxidative stress biomarkers, antioxidant status, damage to DNA, apoptosis and inflammatory mediators weremeasured in the tissues of the liver. Result: CsA administration significantly increased serum levels of the liver enzymesALT, AST, ALP and bilirubin. In addition, significant increase in MDA, Nitrite, 8-OHdG, caspase3, NF-κB, TNF-α andsignificant decrease of GST in liver tissues was noticed. Furthermore, histopathological changes occurred in CsA treatedrats exhibited disruption of normal liver architecture, congested central vein, vacuolated cytoplasm and inflammatory cellsinfiltration. Co-administration of beet root extract or silymarin +CsA ameliorated all these parameters. Conclusion: Thepresent study suggests that beet root extract and silymarin have beneficial effect in reducing hepatotoxicity induced by CsAvia decreasing oxidative stress, inflammation, DNA damage, apoptosis and repairing the histopathological changes.

Assessment of The Potential Role of Parsley (Petroselinum Crispum) Leaves Extract in Ameliorating Cyclosporin A- Induced Nephrotoxicity in Rats

In this study, a potentiometric titration method by Calvin-Bjerrum and Irwing-Rosotti was used to investigate binarycomplexes of ibandronate sodium, a nitrogen-containing bisphosphonate, with Ca(II), Mg(II) and Sr(II). Dissociationconstants (pKa) of ibandronate sodium were measured and the stability constants of the complexes formed in aqueoussolutions at 22 oC (I = 0.11 M NaClO4) were determined. The stoichiometry of ibandronate sodium/metal complexes wasfound as 1/1 for each metal ion.

Prophylactic Impact of Beta vulgaris L in Ameliorating Cyclosporine AInduced Hepatotoxicity in Rats

Background: Hepatotoxicity induced by Cyclosporine A (CsA) remains one of the major side effects. The aim of this studywas to determine the protective effects of beet root (Beta Vulgaris L) extract and silymarin against hepatotoxicity induced byCyclosporine A in rats. Methods: Sixty male albino rats, were divided into 6 groups (n=10). Group I control group. GroupII CsA-treated and received (50mg/kg weight, orally). Group III received (500mg/kg b.wt) beet root extract orally. Group IVreceived beet root extract and CsA as in group II and III. Group V was received (100 mg/kg b.wt) silymarin orally. Group VIreceived CsA and silymarin as in group II and V. Serum levels of (ALT, AST, ALP) and bilirubin (Total and Direct) weremeasured. Oxidative stress biomarkers, antioxidant status, damage to DNA, apoptosis and inflammatory mediators weremeasured in the tissues of the liver. Result: CsA administration significantly increased serum levels of the liver enzymesALT, AST, ALP and bilirubin. In addition, significant increase in MDA, Nitrite, 8-OHdG, caspase3, NF-κB, TNF-α andsignificant decrease of GST in liver tissues was noticed. Furthermore, histopathological changes occurred in CsA treatedrats exhibited disruption of normal liver architecture, congested central vein, vacuolated cytoplasm and inflammatory cellsinfiltration. Co-administration of beet root extract or silymarin +CsA ameliorated all these parameters. Conclusion: Thepresent study suggests that beet root extract and silymarin have beneficial effect in reducing hepatotoxicity induced by CsAvia decreasing oxidative stress, inflammation, DNA damage, apoptosis and repairing the histopathological changes

Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?

BACKGROUND/AIMS: Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. METHODS: Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. RESULTS: Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. CONCLUSIONS: Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care.

Characterization of the type of response to different hcv antigens and quantification of viral load in newly diagnosed hepatocellular carcinoma patients

Background: Hepatitis C virus (HCV) is a blood born virus that is considered a major cause of chronic liver disease and hepatocellular carcinoma (HCC) worldwide. HCV is thought to induce HCC either indirectly or directly by the effect of its viral proteins on different host cell proteins and signaling pathways.Objective: The aim of the study was to characterize the type of response to different HCV antigens, quantify HCV viral load, transforming growth factor- beta and miRNA 122 in patients with newly diagnosed Hepatocellular Carcinoma.Patients and methods: This study was done on three groups: the first group consisted of 40 newly discovered hepatocellular carcinoma patients with HCV infection. The second group consisted of twenty HCV infected patients with other types of cancer (other than HCC). The third group consisted of 20 healthy individuals served as a control group. Serum was separated for detection of the four parameters. Results: TGF-ß showed a very weak negative correlation with the miRNA 122 serum levels that is statistically non-significant. Results also showed that miRNA 122 may not be useful in differentiating between liver cirrhosis from HCC patients and it is associated with the severity of the disease rather than the viremia count. Conclusion: Study showed no correlation between the four investigated parameters (HCV antigens, HCV viral load, TGF-ß- serum levels of miRNA 122) in an attempt for early diagnosis of HCV induced HCC

Evaluation of serum interleukin-34, as a marker of disease activity in systemic lupus erythematosus and rheumatoid arthritis patients

Aim of the work: To evaluate the role of IL-34 in the pathogenesis of SLE and RA and to assess its role as a biomarker of disease activity. Subjects and methods: This study was carried out on 29 patients with SLE, 29 patients with RA, and 29 healthy control subjects. SLE disease activity was measured by systemic lupus erythematosus disease activity index (SLEDAI). RA disease activity was measured by 28-joint disease activity score (DAS-28). Serum IL-34 was measured by enzyme-linked immunosorbent assay (ELISA) . Results: There was highly significant elevation in IL-34 level in SLE and RA when compared to control group (p<0.001). IL34 level did not differ significantly between SLE and RA groups (p˃ 0.05). There was a significant positive correlation between IL-34 level and SLEDAI in SLE patients as well DAS 28 score in RA patients. The highest level was detected in patients with high disease activity. There was statistically significant correlation between IL-34 levels and ESR, CRP, and anti-ds DNA antibodies but inversely correlated with C3 in SLE patients. There was also statistically significant correlation between IL-34 levels and ESR, CRP RF, and anti CCP antibodies in RA patients. Conclusion: IL-34 could be useful marker for disease activity in SLE and RA

Challenges of Percutaneous Closure of PDA in Adolescents and Adults: Single Center Experience

Aim: To evaluate the challenges, feasibility, and efficacy of device closure of PDA in adolescents and adults by different types of occluder devices in Sohag University Hospital. Methods: Between 03/2012 to 06/2017, 33 adolescents and adults were chosen from 174 patients with PDA underwent transcatheter closure in our institute. The diameter of the device was chosen 4 mm larger than the narrowest pulmonary end. A balloon-sizing assisted PDA strategy was used in two patients in whom size of PDA could not accurately delineate. A retrospective review of the procedure, results and adverse events was performed. Results: Successful device placement was achieved in all patients (100%). The median minimum PDA diameter was 5.5 (2.5-9 mm), median weight 45 (35-80 kg), and median age 16 (13-35 years). Median of mean pulmonary pressure was 29 (9-55) mmHg. Median of fluoroscopy time was 11 min. Most of PDAs were closed by ADO I (79%). Four different devices were deployed; muscular VSD, Amplatzer Plug II, ADO II AS and Occlutech® PDA .30 patients had type A PDA. Nineteen out of 33 (81.5%) patients had completed 12-month follow-up.No adverse events encountered in all patients. Conclusions: Transcatheter closure of PDA is considered safe and efficacious in adolescents and adults. A balloon-sizing assisted PDA and oversizing of occluder strategies should be used to increase safety and feasibility of procedure in the poor delineation of sized of large PDA in this age group.

study of the prophylactic and curative effect of melatonin on postoperative delirium after coronary artery bypass grafting surgery in elderly patients

Background: delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. Postoperative delirium is associated with an increased length of stay in the intensive care unit, long hospital stay and high hospital charges

Aim of the Work: to investigate the effectiveness of melatonin as a preoperative sedative as well as the preventive and the curative effect of melatonin supplementation in elderly patients undergoing coronary artery bypass surgery on postoperative delirium

Patients and Methods: this prospective, randomized, controlled, double blind study was conducted on a total of 50 patients allocated into 2 equal groups. It was conducted in Ain Shams University hospitals, in the cardiothoracic surgery unit

Results: melatonin has superior sedative effect at 30 min preoperatively compared with placebo [P=0.022]. Melatonin succeeded to treat about 56% of delirious patients. The incidence of delirium was 8% in the melatonin group vs. 28% in the control group [P= 0.046]. In univariate analysis, predictors of delirium in both groups were age [P= 0.049 in melatonin group, P=0.021 in control group], higher fentanyl dose [P= 0.021 in melatonin group, P=0.047 in control group], lower ejection fraction [P= 0.018 in melatonin group, P=0.008 in control group], longer cardiopulmonary bypass [CPB] times [P= 0.026 in melatonin group, P=0.04 in control group] and longer aortic cross clamping [ACC] times [P= 0.04 in melatonin group, P=0.019 in control group]

Conclusion: administration of melatonin significantly decreased the incidence of postoperative delirium [POD] after coronary artery bypass grafting in elderly patients and significantly increased preoperative sedation. Advanced age, higher total intraoperative fentanyl dose, lower ejection fraction and longer CPB and ACC times were independent predictors of POD with or without melatonin supplementation.

Effect of different lung ventilatory patterns during and after cardiopulmonary bypass on oxygenation parameters after cardiac surgery in adults: a comparative study

Background: pulmonary complications after cardiac surgery recorded incidence of 25% of all cardiac surgeries. Ventilation strategies before and after CPB also cause problems. Alveolar over-distention and reduced lung recruitment are involved in lung injury during general anesthesia in cardiac surgeries. Protective lung ventilation is a common practice during general anesthesia and includes positive end expiratory pressure [PEEP], recruitment maneuvers and the use of FiO2 levels not greater than 80%

Aim of the Work: the aim of the study was to compare the effect of application of continuous positive airway pressure [C-PAP] ventilation during cardiopulmonary bypass and application of positive end expiratory pressure [PEEP] after cardiopulmonary bypass [CPB] per se or followed by lung recruitment [RM] in the intensive care unit [ICU] on arterial oxygenation after cardiopulmonary bypass

Patients and Methods: after obtaining approval from the medical ethical committee, this study was conducted at Cardiothoracic Academy of Ain Shams University and Ain Shams University specialized hospitals. The study included 66 patients divided into three equal groups

Conclusion: the application of alveolar recruitment strategy showed short term improvement in the arterial oxygenation and ventilation perfusion mismatch in patients undergoing CABG using CPB. Further studies are needed to determine if this beneficial effect of recruitment maneuvers could be further prolonged and produce more lasting clinical effects

Public knowledge, attitude, practice, antibiotics, riyadh,ksa

Background: Antibiotics are important drugs used against bacterial infections. Unfortunately, overusing them resulted in the development of resistant bacteria. There are limited data concerning antibiotic use so we worked on this study to provide more updated data

Objective: The aim of this study was to assess public knowledge, attitude and practice regarding antibiotics use and related factors in Riyadh - KSA

Method: It was a cross-sectional online and manual survey involving 474 respondents and was conducted in Riyadh, KSA in February 2016. The collected data were analyzed using SPSS version 20

Results: Most of the respondents [86.5%] had used antibiotics for others [friends and family]. Only 7% of respondents had good knowledge and about 50% of them had negative attitudes. Respondents' educational level was a predictor of negative attitude as those with a low level of education [below secondary] 66.7% were more likely to show negative attitude compared to those with high educational level [university and above; 40%]. Poor level of knowledge was a predictor of negative attitude; as 65% of respondents with poor knowledge showed negative attitude compared to only 24.2%;those with a good level of knowledge

Conclusion: This study concluded that females and married participants showed better practice toward antibiotics use. Higher education level was strongly associated with better knowledge, attitude and practice and was not associated with the increased risk of self-medication. Respondents with high income and those with better knowledge exhibited better practice

Description of some nematode parasites infecting american cockroach, periplaneta americana in sharkia governorate, egypt

In present study, three known species insect parasitic nematodes were recovered from Periplaneta americana collected from uptown Zagazig City. These nematodes were 1- Hammerschmidtiella dieingi, 2- Leidynema meerutensis, and 3- Thelastoma bulhoesi collected from the hindgut of the host P. americana. These parasites were studied by using light microscope, SEM and TEM