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)

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)

Clinical significance of LncRNA-MIAT as a non-invasive diagnostic marker of nonHodgkin's lymphoma associated with occult hepatitis C virus infection

Aims: the current research aimed to investigate LncRNA-MIAT in patients with nonHodgkin lymphoma (NHL) and to assess its correlation with clinicopathological features and treatment protocols of NHLs among Egyptian patients with Occult hepatitis C virus (HCV) infection (OCI). Patients & Methods: This study was conducted on 20 patients with NHL and 30 healthy subjects as the control group. All subjects were screened for HCV-RNA in both plasma and PBMCs. RT-PCR determined lncRNA-MIAT. Results: lncRNA-MIAT relative expression level was upregulated in NHL groups (2.73±0.86) compared to controls (1.06±0.07), P ˂0.001*. Among NHL, patients with OCI (3.2±0.63) had significantly higher levels of lncRNA-MIAT compared to HCV (2.6±1.08) and non-HCV (2.4±0.4), P ˂0.001*. Additionally, the relative expression levels of lncRNA-MIAT were significantly positively correlated with laboratory and clinicopathological features of NHL. Interestingly, concerning the treatment of DLBCLNHL, there were significantly higher levels of lncRNA-MIAT in no treatment subgroup (n=10, 3.31±0.95) compared to successfully treated subgroups [CHOP (n=7, 1.58±0.34) and R-CHOP (n=3, 11.16±0.21), P ˂0.001* Conclusions: lncRNA-MIAT level was upregulated in NHL patients, particularly patients with OCI. Thus, circulatory lncRNA-MIAT may serve as a promising non-invasive diagnostic marker for NHL associated with OCI

A comparison between different management surgical approaches in the treatment of splenic flexure colon cancer

Background: There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective: In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results: We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion: We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure. (AU)

Serum and ascitic fluid high sensitive C reactive protein as prognostic marker in patients with spontaneous bacterial peritonitis

Background: Spontaneous Bacterial Peritonitis (SBP) is the most frequent bacterial infection in cirrhotic patients with ascites. The mortality rate in those patients ranges from 40-70%.Aim: to assess level of serum and ascetic fluid polymorph nuclear leucocytes (PMN), high sensitive C reactive protein (hs-CRP) in patients with SBP before and after treatment. Methods: A cohort study was done on 114 patients SBP admitted in the Internal Medicine, Faculty of Medicine, Zagazig University during the period from December 2017 to September 2018. All patients were subjected to full history taking, thorough clinical examination, routine laboratory investigation, ultrasonography and ascitic fluid sampling. They was followed up for 5 days from starting treatment by parenteral third generation cephalosporin and peripheral blood (PMN), serum (hs-CRP), ascitic fluid PMN and hs-CRP were measured again.Results: the largest percentage of the patients were male, had posthepatitic C cirrhosis and child C score. There was statistically non-significant difference between antibiotic responders and non-responders regarding peripheral blood PMN before or five days after antibiotic use. There was statistically non-significant difference in ascitic fluid PMN, serum and ascitic fluid hs-CRP before treatment while the difference is significant between both groups regarding them five days after treatment. Percent change in serum hs-CRP was equal to that of ascitic fluid PMN. Percent change in ascitic fluid hs-CRP was comparable to that of ascitic fluid PMN. Conclusion: Serum and ascitic fluid hs-CRP level can be considered as alternative prognostic markers in cirrhotic patients with SBP

Mobilizing slit lamp to the field: A new affordable solution.

We are describing a simple and affordable design to pack and carry the slit lamp to the field. Orbis staff working on the Flying Eye Hospital (FEH) developed this design to facilitate mobilization of the slit lamp to the field during various FEH programs. The solution involves using a big toolbox, a central plywood apparatus, and foam. These supplies were cut to measure and used to support the slit lamp after being fitted snuggly in the box. This design allows easy and safe mobilization of the slit lamp to remote places. It was developed with the efficient use of space in mind and it can be easily reproduced in developing countries using same or similar supplies. Mobilizing slit lamp will be of great help for staff and institutes doing regular outreach clinical work.

Daily living activities of physically disabled children in ismailia city

The present study is descriptive study that aiming to assess daily living activities of physically disabled children. The study was conducted at the available established settings in Ismailia city including Handicapped Comprehensive Rehabilitation Center, Rheumatology and Rehabilitation Unit in Suez Canal University Hospitals and Physiotherapy Unit in Health Insurance Hospitals. The sample included 76 physically disabled children and their accompanying mothers. Data were obtained through an interview with the studied children and their accompanying mothers using three tools, structured interview questionnaire, physical assessment sheet to assess the physically disabled children's daily living activities and rating scale to assess the psychological aspects of the studied children. The results of the study revealed that the studied children were partially dependent in relation to eating and drinking, personal hygiene, toileting and studying their lessons, while they were independent in relation to their motor activities and using both telephone and money. Physical disability has negative physical, financial, social and psychological impact on the studied children's families as found in 65.8%, 59.2%, 46.1% and 75% respectively. Slightly more than three quarters of the studied mothers had unsatisfactory knowledge regarding the physical disability of their children [76.3%]. The study recommends applying an educational program to enable the physically disabled children to achieve their daily living activities independently. Further researches should be done aiming to increase the knowledge of mothers of the physically disabled children through experimental programs and assigning pamphlets on different types of disabilities

Compare the effectiveness of E-Learning versustraditional teaching methods on students' performance regarding critical care nursing

Twenty first century is the era of high technology, is the information age. E-Learning is becoming one of most important educational mean. This study aims at comparing the effectiveness of an e-Learning and traditional teaching methods in critical care nursing and assessing the effect of an e-Learning teaching unit on students' performance. The research hypothesis focuses on that; students exposed to e-Learning teaching unit will have positive effect on their performance regarding critical care nursing. A quasi-experimental design was applied. The study was conducted at Mubarak Kohl Technical Institute of Nursing Faculty of Medicine, Cairo University. A total of [60[second year nursing students divided into two groups, the control group [30] and the study group [30]. Data were collected using a self administered questionnaire, student's performance observational checklist, and a developed e-Learning module. The study results revealed that the two groups had similar characteristics. There were no statistically significant differences among the control group as compared with the study one regarding knowledge, highly statistically significant differences between control and study group regarding performance. The study recommended that it is preferable to use "blended learning", that the integration between e-Learning and traditional teaching methods to provide most efficient and effective teaching, and further studies will be planned to assess factors which affect applying of e-Learning program in Egypt

Factors affecting quality of life for patient with leukemia

Leukemia is a chronic and life-threatening illness. The symptoms and side effects from leukemia and its treatment, such as chemotherapy, affect every aspect of quality of life of patients with leukemia. The present study aims to identify factors affecting quality of life for patient with leukemia. The research question is; what are the factors affecting quality of life for patient with leukemia? The study subjects consisted of 37 patients diagnosed with leukemia, at the Hematology Unit, in Ain Shams University Hospital. The tools of data collection were;l] Patient assessment sheet; to assess patient's socio-demographic characteristics, disease characteristics and family history as well as smoking habits and level of knowledge regarding to leukemia.2] Activities of daily living scale; to assess patient's ability to perform activities of daily living. 3] Quality of life scale, to determine the effect of leukemia on physical, social, psychological and spiritual conditions of patients under study. The results of the study revealed that more than three quarters of patients had satisfactory level of knowledge regarding to their condition, most of them were independent, and the majority had moderate quality of life, while the majority of patients who had high level of quality of life were nonsmoker, had leukemia for less than 6 months and on chemotherapy. The study concluded that, factors affecting quality of life for patients with leukemia are age, marital status, educational level, socio-economic level, residency, smoking habits, duration of illness and being on chemotherapy treatment. The study recommended that, tailored counseling program is a must and essential to help patient with leukemia to cope with his physical, social, and psychological conditions

Factors affecting self-care for patient with leukemia

Leukemia is a serious chronic illness in which patients experience a decline in their performance of activities of daily living. The present study aimed to identity factors affecting self-care for patient with leukemia. The research question is; what are the factors affecting self-care for patient with leukemia? The study subjects consisted of 37 patients diagnosed with leukemia, at the Hematology Unit, in Ain Shams University Hospital. The tools of data collection were; 1] Patient assessment sheet; to assess patient's socio-demographic, disease characteristics and family history as well as smoking habits and level of knowledge regarding to leukemia. 2] Activities of daily living scale; to assess patient's ability to perform activities of daily living. 3] Self-care questionnaire; to measure self-care for patients under study. The results of the study revealed that more than three quarters of patients had satisfactory level of knowledge regarding to their condition, most of them were independent. More than half were having satisfactory self-care and near three quarters of patients who had unsatisfactory self-care had leukemia for less than 6 months, while three quarters of them who had satisfactory self-care were on chemotherapy. To conclude factors affecting self-care for patients with leukemia are educational level, socio-economic level, residency, adequacy of knowledge, duration of illness and being on chemotherapy. The study recommended that, tailored counseling program should be available, in the form of an illustrated booklet, in Hematology Unit as a reference for leukemic patients, where the nurses' act as an advocate to ensure that information needed is provided