Evaluation of the Cutting Seton Technique in Treating High Anal Fistula.

Objectives Fistula-in-ano is a common condition that negatively affects the quality of life of its sufferers. A high anal fistula poses a significant challenge for surgeons due to its proximity to the anorectal ring and the potential risk of incontinence rather than recurrence. Many modalities have been used in a justified search for a satisfactory cure for the condition, but the seton remains a mainstay of surgical treatment. Therefore, the rationale of this study is to assess the outcome of treating a high anal fistula using the cutting seton technique in a hospital in Al Madinah, Saudi Arabia. The evaluation is intended through a retrospective analysis of patients' outcomes, comparing its effectiveness to similar articles. Methods This is a retrospective study that includes 50 patients with high anal fistulas who were treated with a cutting seton at the National Guard Hospital over a four-year period (2019-2022). Information obtained from medical records included clinical and demographic data. The data collected during the study was compiled and statistically analyzed using the SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). A p-value of <0.05 was considered statistically significant. Results A total of 50 patients with high anal fistula treated with a cutting seton were included: 82% were males and 18% were females, with 66% below 45 years of age. Approximately 92% had inter-sphincteric fistulas, and only 28% had a recurrent fistula. Almost all patients (98%) had an MRI done before surgery. Around 70% of patients were completely cured, 26% had minor complications, 8% of the operated patients experienced mild incontinence, and only one recurrence (2%). Conclusion The cutting seton is still a valid modality in treating patients with a high anal fistula, as it is considerably safe, effective, and yields good outcomes. Standard preoperative assessment and thorough surgical techniques are cornerstones for achieving a satisfactory outcome.

Bladder Sparing Extirpation of Pelvic Mass With Ureteral Reimplantation: A Case Report on Pelvic Lipomatosis Treatment.

Pelvic lipomatosis is a proliferative disease characterised by excessive fat growth in retroperitoneal space leading to inadequate bladder drainage and ureteral compression. Cystitis glandularis, cystitis cystica, or cystitis follicularis can be found in the majority of patients with the disease. We report a case of a 63-year-old man diagnosed outside our hospital with pelvic lipomatosis after finding a pelvic mass behind the bladder causing severe bilateral hydronephrosis. A bladder-sparing excision of the pelvic lipomatosis mass with bilateral ureteric reimplantation was performed, thereby avoiding the need for urinary diversion. Our case supports the hypothesis that pelvic fat mass extirpation and ureteral reimplantation is an effective surgical treatment strategy for pelvic lipomatosis.

Evaluation of Patient Satisfaction With the New Web-Based Medical Appointment Systems "Mawid" at Primary Health Care Level in Southwest Saudi Arabia: A Cross-Sectional Study.

Background Patient satisfaction has become an influential corner in the health services process. Web-based appointment scheduling has been expanded for its benefits and has become a popular research topic. This study's objectives were to assess patients' satisfaction and perception with the new Web-Based Medical Appointment System "Mawid" program and determine the associated factors at the Primary Health Care Centers level in Jazan Southwest Saudi Arabia. Methods An observational cross-sectional survey was implemented among 424 adults aged 18 years and above, attending a randomly selected 12 primary health care centers in the Jizan region, Southwest Saudi Arabia. The study instrument included socio-demographic background information, perception, and level of satisfaction with the new appointment system. Responses were analyzed using the SPSS program by applying descriptive and inferential statistical techniques. Results The overall level of satisfaction was very high at 94.3% with 95% C.I. (91.7-96.1). A large proportion of study participants were highly satisfied with the new Web-Based Medical appointment System "Mawid" as nine satisfaction items scored a level of satisfaction of 90% and above. Regarding the perception, 89.1% of the participants agreed that the appointment booking system regulates the number of patients, while 87.7% of participants considered that the appointment system reduces clinic crowding. More than half of respondents (61.8%) agreed that the community culture might limit the scheduling system's use. Univariate and multivariate logistic regression analysis suggested that male patients were more likely to have a higher level of satisfaction as compared with female (COR= 2.95, 95% C.I.:1.15-7.60, p = 0.025) and (AOR= 3.12, 95% C.I:1.14-8.52, p = 0.026), respectively. Conclusions In conclusion, this study revealed a high level of satisfaction among study the participants with the new Web-Based Medical Appointment System "Mawid." The system effectively improved patients' satisfaction with registration and reduced waiting times. Patients' satisfaction can be assessed regularly and used systematically as a quality and benchmarking instrument in primary health care.

Transient Bilateral Sixth Nerve Palsy: A Rare Sequela of Head Trauma.

Sixth cranial nerve palsy is uncommon but a well-recognized consequence of head trauma. Although few cases documented traumatic persistent bilateral sixth nerve palsy, a transient episode is extremely rare and not reported before. We report an unusual case of transient bilateral abducens nerve palsy after minor head trauma, which was completely resolved without any intervention after 20 min. Diplopia may relate to anatomical lesion, and even transient diplopia can guide us to a serious anatomical lesion that may occur. CT scan of the head revealed a left nondisplaced occipital fracture, which extends to the left petrous bone. The patient was admitted for 24-h observation and discharged home on paracetamol. This case emphasizes the need to recognize the rare sequences of minor head trauma and manage them appropriately.

Thyroid Storm: Unusual Presentation and Complication.

Thyroid storm is a rare and a life-threatening condition, and serious complications could happen if not diagnosed and managed early. The typical clinical manifestations of hyperthyroidism are exaggerated in thyroid storm, particularly marked pyrexia and tachycardia, and altered mental status as agitation, delirium, or coma. Many precipitating factors contribute to the presentation of thyroid storm, and new recent factors like Epstein-Barr virus (EBV) could play a significant role. Serious and rare complications from the thyroid storm can increase the risk of mortality and morbidity up to 30% as fulminant hepatic failure, which is reported only a handful of times in the literature. Also, congestive heart failure can be part of the multiorgan dysfunction from the presentation, if associated with the thyroid storm. In this report, we present a case of thyroid storm precipitated by EBV and causing fast atrial fibrillation complicated by congestive heart failure and fulminant hepatic failure for 46-year-old Bangladeshi male not known to have any medical illness. He presented to the emergency department with 10-day history of an on and off subjective fever, associated with generalized abdominal pain and vomiting. He developed palpitation at the day of presentation. He was managed, stabilized, intubated, and shifted to the ICU as the patient started to be apneic after the conscious sedation for the cardioversion. During the admission anti-EBV viral capsid antigen IgM antibody was positive. The patient was discharged after five days in ICU and 14 days of overall hospital stay. Although the complication of thyroid storm as fulminant hepatic failure and congestive heart failure are rare, they should be considered in cases with thyroid storm. The pre-existing of EBV as a precipitating factor should always be considered, and more studies in these regards need to be done.

Genetic profiling of CAH Egyptian children: rapid guide to clinical interpretation of common mutations.

OBJECTIVES: The prevalence of CAH in Egypt is reported to be ten times more than that of the worldwide prevalence. The study aimed at genetic screening of children diagnosed with 21-alpha hydroxylase deficiency congenital adrenal hyperplasia (21OHD-CAH). In addition, the study offers a rapid and easy guide for clinical reporting of common mutations for endocrinologists. METHODS: A cohort of 174 unrelated Egyptian children with 21OHD-CAH were screened for 11 common CYP21A2 gene mutations using a strip hybridization assay, and then, bioinformatics analysis was done to report the pathogenicity of the common mutations for clinical classification. RESULTS: The most common mutations were I2 splice and p.Q318X. Deletions/conversions comprised 45.9% of the cohort, whereas 7.4% of the cases were negative for all mutations. The least positively detected point mutations were p.P453S, cluster E6, p.R483P, and p.L307FS, which were detected in fewer than 5% of cases. CONCLUSION: Strip hybridization assay is a rapid screening tool for the diagnosis of CAH. The authors hypothesized an easy and rapid scheme for clinical interpretation of the strip results to gain the highest value of the strip in diagnosis.

The millennial generation plastic surgery trainees in sub-Saharan Africa and social media: A review of the application of blogs, podcasts, and twitter as web-based learning tools.

The delivery of education and training in plastic surgery in Sub-Saharan Africa face increasing challenges. These include endemic shortages of plastic surgeons within postgraduate medical school faculties, the erosion of financial and clinical resources for teaching, and more recently, the millennial generation paradigm shift. It is generally accepted that the millennial generation will be more discerning and comfortable in their requirements for web-based learning content to support their education and training in plastic surgery. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google Scholar, and hand searching of bibliographies of published articles using the keywords: social media, Blogs, Twitter, plastic surgery, and millennial generation. This article defines and explores Blogs, Podcasts, and Twitter, as web-based learning tools, and discusses how to leverage social media to maximize their educational value and effectiveness.s.

Résumé L'offre d'éducation et de formation en chirurgie plastique en Afrique subsaharienne est confrontée à des défis croissants. Il s'agit notamment de la pénurie endémique de chirurgiens plasticiens au sein des facultés de médecine de troisième cycle, de l'érosion des ressources financières et cliniques pour l'enseignement et, plus récemment, du changement de paradigme de la génération du millénaire. Il est généralement admis que la génération du millénaire sera plus exigeante et plus à l'aise dans ses exigences en matière de contenu d'apprentissage en ligne pour soutenir son éducation et sa formation en chirurgie plastique. Nous avons examiné la littérature actuelle, y compris les articles originaux et critiques obtenus grâce à une recherche dans la base de données PubMed, Medline, Google Scholar, et une recherche manuelle dans les bibliographies des articles publiés à l'aide des mots clés: médias sociaux, blogs, Twitter, chirurgie plastique et génération du millénaire. Cet article définit et explore les blogs, les podcasts et Twitter, en tant qu'outils d'apprentissage basés sur le Web, et explique comment tirer parti des médias sociaux pour maximiser leur valeur éducative et leur efficacité.

Intermittent Superior Vena Cava Syndrome Secondary to Malignant Pericardial Mesothelioma.

Malignant pericardial sarcomatoid mesothelioma is a massively rare tumor accounting for 0.8% of all cases of mesothelioma. Superior vena cava syndrome (SVCS) occurs due to a partial obstruction or compression to the superior vena cava, which hinders the blood outflow to the upper body. It can be caused by an intrinsic factor such as thrombosis, or by an extrinsic factor such as tumors. Clinical presentation includes edema of the face and upper limbs, plethora, dyspnea, dysphagia, stridor and cough. we are reporting a case of a 56-year-old female, who is a known case of hypertension on angiotensin-converting enzyme inhibitors (ACEIs). Presented to the emergency department with intermittent facial swelling and dyspnea. Imaging and pathology reports confirmed the diagnosis of intermittent SVCS secondary to pericardial sarcomatoid mesothelioma with pericardial effusion. What makes our case unique is that both the etiology and the presenting complaint are rare entities, as most SVCS cases are continuously symptomatic throughout the disease course, and are usually caused by a lung cancer or lymphoma.

Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh.

BACKGROUND: Falls among the elderly are one of the major causes of morbidity and mortality worldwide. They constitute the second leading cause of unintentional deaths after road-traffic accidents. The aim of the study was to estimate the prevalence of falls among the elderly and to investigate the factors that contribute to this phenomenon. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in the elderly, over the age of 60, in Riyadh. The sample under scrutiny was estimated to be 357 in total. A pilot study was conducted among 15 subjects. Two questionnaires were used for the interviews which were translated into Arabic using the "Morse Fall Scale." The questionnaires assessed: the participants' previous history of falls, whether a secondary diagnosis had been obtained, whether any ambulatory aids had been used or whether an IV connection had been fitted during convalescence. They also inquired if any gait/transferring device had been used to assist the patient at any time. RESULTS: Out of 357 participants, 206 (57.7%) had a history of falls. Study found an association between the number of falls recorded, the age of the participants, and whether the participant was female. Furthermore, there were statistically significant associations between the history of falls and a condition of impaired health. The results also showed that environmental hazards play a significant role in the occurrence of falls with P ≤ 0.001, in which 103 (81.7%) of the individuals who were exposed to environmental hazards revealed a history of falls. CONCLUSION: Falls among the elderly are common. Significantly, if the health of the individuals is impaired, and there are contiguous environmental risk factors, these elements combine to play a part in the occurrence of such falls. There is, therefore, a need to design and develop a health awareness program to prevent such problems in the elderly.

Effects of solid-liquid interface on the interfacial tension measured by micropipet technique.

Measurement of interfacial tension (IFT) using the micropipet technique involves the solid-liquid interface. At equilibrium, oil-water interfacial tension is determined from the interface curvature and the critical pressure, according to the Young-Laplace equation. This paper aims to examine the possible contribution of the solid-liquid interface on IFT measurement. Three different experimental configurations are used to examine the sought effect. The three configurations are straight, concentric, and tapered pipets with diameters ranging from 2.5 to 30 microm. For all three configurations, the critical pressure is found to depend only on the pipet diameter. However, when the Young-Laplace equation is applied to determine the IFT, a significant error was noticed at small pipet diameters. The IFT error was described by an exponential function whose asymptote approached the independently determined IFT value with a sufficiently large pipet diameter. The IFT error is anticipated to arise from the layerlike effect of an "ultrastructured" liquid near the solid surface. The solid-induced error in oil-water IFT is noted to fade away at lowered IFT by the addition of surfactant.

Controlled pseudopod extension of human neutrophils stimulated with different chemoattractants.

The formation of pseudopods and lamellae after ligation of chemoattractant sensitive G-protein coupled receptors (GPCRs) is essential for chemotaxis. Here, pseudopod extension was stimulated with chemoattractant delivered from a micropipet. The chemoattractant diffusion and convection mass transport were considered, and it is shown that when the delivery of chemoattractant was limited by diffusion there was a strong chemoattractant gradient along the cell surface. The diffusion-limited delivery of chemoattractant from a micropipet allowed for maintaining an almost constant chemoattractant concentration at the leading edge of single pseudopods during their growth. In these conditions, the rate of pseudopod extension was dependent on the concentration of chemoattractant in the pipet delivering chemoattractant. The pseudopod extension induced using micropipets was oscillatory even in the presence of a constant delivery of chemoattractant. This oscillatory pseudopod extension was controlled by activated RhoA and its downstream effector kinase ROCK and was abolished after the inhibition of RhoA activation with Clostridium botulinium C3 exoenzyme (C3) or the blocking of ROCK activation with Y-27632. The ability of the micropipet assay to establish a well-defined chemoattractant distribution around the activated cell over a wide range of molecular weights of the used chemoattractants allowed for comparison of the effect of chemoattractant stimulation on the dynamics of pseudopod growth. Pseudopod growth was stimulated using N-formylated peptide (N-formyl-methionyl-leucyl-phenylalanine (fMLP)), platelet activating factor (PAF), leukotriene B4 (LTB(4)), C5a anaphylotoxin (C5a), and interleukin-8 (IL-8), which represent the typical ligands for G-protein coupled chemotactic receptors. The dependence of the rate of pseudopod extension on the concentration of these chemoattractants and their equimolar mixture was measured and shown to be similar for all chemoattractants. The inhibition of the activity of phosphoinositide-3 kinase (PI3K) with wortmannin showed that 72%-80% of the rate of pseudopod extension induced with N-formyl-methionyl-leucyl-phenylalanine, platelet activating factor, and leukotriene B4 was phosphoinositide-3 kinase-dependent, in contrast to 55% of the rate of pseudopod extension induced with interleukin-8. The dependence of the rate of pseudopod extension on the concentration of individual chemoattractants and their equimolar mixture suggests that there is a common rate-limiting mechanism for the polymerization of cytoskeletal F-actin in the pseudopod region induced by G-protein coupled chemoattractant receptors.

Experimental evidence for the limiting role of enzymatic reactions in chemoattractant-induced pseudopod extension in human neutrophils.

Chemoattractant-stimulated pseudopod growth in human neutrophils was used as a model system to study the rate-limiting mechanism of cytoskeleton rearrangement induced by activated G-protein-coupled receptors. Cells were activated with N-formyl-Met-Leu-Phe, and the temperature dependence of the rate of pseudopod extension was measured in the presence of pharmacological inhibitors with known mechanisms of action. Three groups of inhibitors were used: (i) inhibitors sequestering substrates involved in F-actin polymerization (latrunculin A for G-actin and cytochalasin D for actin filament-free barbed ends) or sequestering secondary messengers (PIP-binding peptide for phosphoinositide lipids); (ii) competitively binding inhibitors (Akt-inhibitor for Akt/protein kinase B); and (iii) inhibitors that reduce enzyme activity (wortmannin for phosphoinositide 3-kinase and chelerythrine for protein kinase C). The experimental data are consistent with a model in which the relative involvement of a given pathway of F-actin polymerization to the measured rate of pseudopod extension is limited by a slowest (bottleneck) reaction in the cascade of reactions involved in the overall signaling pathway. The approach we developed was used to demonstrate that chemoattractant-induced pseudopod growth and mechanically stimulated cytoskeleton rearrangement are controlled by distinct pathways of F-actin polymerization.

Interfacial effects in the spreading kinetics of liquid droplets on solid substrates.

Several theories deal with the spreading kinetics of liquids on solid substrate, most of which relate the rate of spreading to the surface tension and the viscosity of the liquid. Measurements of the spreading of a number of liquids exhibiting a wide range of surface tension and viscosity on dry soda-lime glass have been carried out to validate the proposed models. The measurements used a small droplet of constant volume to minimize gravitational effects. The contact radius was acquired as a function of time by an image analysis system. It was noted that power law theories describe the spreading rate for silicone oil on glass. However, significant departures were noted in the case of other liquids. Mechanistic considerations of our data suggest that equal volume droplets of similar surface tension and of diverse viscosity spread to the same area but at different rates. On the other hand, the spreading rate of glycerine, which exhibits incomplete spreading on glass, and that of silicone oil, with comparable viscosity behave similarly. These observations seemingly support the view that surface tension acts to retain the spherical shape of the droplet, whereas the difference between the solid-liquid and solid-vapor interfacial energies acts to enlarge the contact area. In the meantime, viscous dissipation acts to retard the spreading rate, past a constant rate regime.

Nigella sativa: effect on human lymphocytes and polymorphonuclear leukocyte phagocytic activity.

The effects of Nigella sativa (N. sativa) seeds and their soluble fractions were studied in vitro on lymphocyte response to different mitogens and on polymorphonuclear leukocyte phagocytic activity. No stimulatory effect of N. sativa was detected on lymphocyte response to phytohemagglutinin, concanavalin-A or pokeweed mitogen. A stimulatory effect of N. sativa was noticed on the lymphocyte response to pooled allogeneic cells. This effect was more pronounced when the low molecular weight (< 10 kDa) fraction was used and varied from one normal individual to another (25% to 825%). N. sativa enhanced the production of interleukin-3 by human lymphocytes when cultured with pooled allogeneic cells or without any added stimulator. N. sativa did not, however, enhance or suppress interleukin-2 secretion by mitogen activated peripheral blood mononuclear cells. Interestingly, N. sativa increased interleukin-1 beta, suggesting therefore, that it has an effect on macrophages. It also suppressed the leukocyte chemiluminescence activity using phorbol myristate acetate and Zymosan as stimulants. No effect of N. sativa or its fractions was, however, noticed on bacterial phagocytosis or killing when Staphylococcus aureus was used, indicating that the decrease in chemiluminescence activity in the presence of N. sativa is not relevant to the bactericidal activity.

Immunosuppression by human seminal plasma fractionated by DEAE Sephadex A-50 ion exchange chromatography.

We fractionated the whole human seminal plasma on DEAE Sephadex A-50 ion exchange columns. Complete separation was achieved in seven peaks using different salt concentrations in phosphate buffer pH 6. The seminal plasma proteins were separated by sodium dodecyl-sulphate polyacrylamide gel electrophoresis. Human seminal plasma (SP) and its fractions were used in mixed lymphocyte reaction in vitro. Fractions 3, 4, and 7 were found to suppress the proliferation of human peripheral blood mononuclear cells to phytohemagglutinin and pokweed mitogen at a concentration of 10 micrograms ml-1 while stimulatory effect was observed at lower concentrations (1 microgram and 2.5 micrograms ml-1). Whole human SP and other fractions failed to suppress the proliferation of lymphocytes in vitro. Furthermore, the effect of human SP and its fractions was also investigated on phagocytic function of polymorphonuclear leukocytes (PMNs) using luminol dependent chemiluminescence assay stimulated with phorbol myristate acetate and opsonized yeast. Fractionated SP was found to have a suppressive effect on the luminol-dependent chemiluminescence of PMNs in the whole blood.

[Study of Siphonaptera in Somalia]. / Contributo allo studio dei sifonatteri della Somalia.

In the period 1982-1984 samples of fleas were collected from wild animals of the Middle Scebeli, Low Scebeli and Bay Regions of Somalia. In total 1,335 specimens (486 males and 849 females) were obtained from 17 species of mammalian hosts out of the 19 examined. The following species of fleas were identified: Echidnophaga gallinacea, E. larina, E. murina, Ctenocephalides felis strongylus, Synosternus burtoni, S. somalicus, S. burtoni, S. somalicus, C. felis strongylus and E. larina are known to be widespread in Somalia; on the contrary, the presence of E. gallinacea in this country has not been reported in the literature, though the flea collection of the Institute of Parasitology of the University of Rome owns five females of this species which were collected by Zavattari in South Somalia during the year 1933. Moreover, as far as it is known, E. murina has not been reported in Somalia until now. The spermatheca of the females identified as S. burtoni is described in detail as it shows characteristics which have not been apparently reported before.

The optimal priming dose for atracurium.

To determine the optimal priming dose for administration in divided doses, atracurium was given to 77 patients either in a single dose of 0.5 mg X kg-1 or in an initial dose of 0.04, 0.05, 0.06, 0.07, 0.08 or 0.09 mg X kg-1, followed three minutes later by the remainder of the 0.5 mg X kg-1 dose. Patients were anaesthetized throughout the study. When atracurium was given as a single bolus of 0.5 mg X kg-1, the mean time to complete neuromuscular block was 141.5 seconds. Administration in divided doses accelerated the onset time (p less than 0.01), that is the time from the intubating dose to the complete suppression of train-of-four (TOF) response. The TOF ratio decreased slightly but statistically significantly following the priming doses. When the priming dose was 0.05 mg X kg-1, the mean onset time was 70.9 seconds and priming with larger doses did not add any further advantage. It is concluded that 0.05 mg X kg-1 appears to be the optimal priming dose for the administration of atracurium in divided doses. When 0.05 mg X kg-1 is given three minutes before the intubating dose, tracheal intubation can be accomplished in less than 90 seconds.