Incidence of secondary bacterial infections and risk factors for in-hospital mortality among coronavirus disease 2019 subjects admitted to secondary care hospital: A single-center cross-sectional retrospective study.

Background: This study aims to determine the prevalence of secondary bacterial infections (SBIs) in hospitalized coronavirus disease 2019 (COVID-19) subjects and evaluate their antibiotic susceptibility. The study also sought to identify risk factors for the outcome of SBIs in COVID-19 subjects. Methods: This single-center cross-sectional retrospective study was carried out at Sohar Hospital in Oman. The study examined hospitalized COVID-19 subjects diagnosed with SBIs during March 2020-December 2022. The relevant subjects' data were extracted from hospital electronic health records and analyzed using STATA version 14. The Chi-square test or Fisher's exact test was employed for analyzing categorical variables, and P < 0.05 was deemed statistically significant. Results: The research encompassed a total of 817 bacteria recovered from various clinical samples of 421 subjects. The older individuals (39.4%) and men (65.6%) experienced bacterial infections more frequently, with bloodstream and respiratory infections being the most common. Gram-negative bacilli (GNB) were responsible for a higher proportion (85.6%) of infections, with Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most common pathogens. Subjects who underwent mechanical ventilation, received corticosteroid therapy, and who had underlying comorbidities, such as diabetes and chronic renal disease, were found to have higher mortality rates. Neutrophilia, elevated C-reactive protein, lymphocytopenia, decreased serum albumin level, sepsis, and pneumonia were found to be independent contributors to mortality. Conclusions: SBI is common among COVID-19-hospitalized subjects. GNB were primarily linked to SBI. The severity and the likelihood of SBI increased in subjects undergoing medical interventions and immunosuppressive therapy.

Nimbolide: promising agent for prevention and treatment of chronic diseases (recent update).

Background: Nimbolide, a bioactive compound derived from the neem tree, has garnered attention as a potential breakthrough in the prevention and treatment of chronic diseases. Recent updates in research highlight its multifaceted pharmacological properties, demonstrating anti-inflammatory, antioxidant, and anticancer effects. With a rich history in traditional medicine, nimbolide efficacy in addressing the molecular complexities of conditions such as cardiovascular diseases, diabetes, and cancer positions it as a promising candidate for further exploration. As studies progress, the recent update underscores the growing optimism surrounding nimbolide as a valuable tool in the ongoing pursuit of innovative therapeutic strategies for chronic diseases. Methods: The comprehensive search of the literature was done until September 2020 on the MEDLINE, Embase, Scopus and Web of Knowledge databases. Results: Most studies have shown the Nimbolide is one of the most potent limonoids derived from the flowers and leaves of neem (Azadirachta indica), which is widely used to treat a variety of human diseases. In chronic diseases, nimbolide reported to modulate the key signaling pathways, such as Mitogen-activated protein kinases (MAPKs), Wingless-related integration site-ß (Wnt-ß)/catenin, NF-κB, PI3K/AKT, and signaling molecules, such as transforming growth factor (TGF-ß), Matrix metalloproteinases (MMPs), Vascular Endothelial Growth Factor (VEGF), inflammatory cytokines, and epithelial-mesenchymal transition (EMT) proteins. Nimbolide has anti-inflammatory, anti-microbial, and anti-cancer properties, which make it an intriguing compound for research. Nimbolide demonstrated therapeutic potential for osteoarthritis, rheumatoid arthritis, cardiovascular, inflammation and cancer. Conclusion: The current review mainly focused on understanding the molecular mechanisms underlying the therapecutic effects of nimbolide in chronic diseases.

A Canal of Nuck Cyst Presented as a Femoral Hernia: A Rare Case Report With Diagnostic Dilemma.

A cyst of the canal of Nuck is an uncommon disorder in females. It results from the failure of obliteration of the peritoneal fold that runs along the round ligament. This case report details a unique and rare presentation of a 38-year-old female who presented with a right groin swelling. Although her preoperative images showed only the right canal of the Nuck cyst, the intraoperative diagnosis was established as a femoral hernia containing a canal of the Nuck cyst. She underwent an elective cyst excision with repair of the femoral hernia. She had an uneventful post-operative recovery. A femoral hernia that contains a cyst of the canal of Nuck is a rare manifestation of this uncommon condition. The most effective treatment options are surgical cyst excision and repair of the femoral hernia.

Comparison of Omental Patch Closure Versus Simple Closure for Laparoscopic Repair of Perforated Peptic Ulcer: A Systematic Review and Meta-Analysis.

AIMS: To evaluate comparative outcomes of laparoscopic repair of perforated peptic ulcer with omental patch versus without omental patch. METHODS: A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic repair of perforated peptic ulcer (PPU) with and without omental patch were included. Operative time, postoperative complications, re-operation and mortality were the evaluated outcome parameters for the meta-analysis. Revman 5.3 was used for data analysis. RESULTS: Four observational studies reporting a total number of 438 patients who underwent laparoscopic repair of PPU with (n = 268) or without (n = 170) omental patch were included. Operative time was significantly shorter in no-omental patch group (NOP) when compared to omental patch group (P = .02). There was no significant difference in the risk of postoperative ileus (Odd ratio (OR) .76, P = .61), leakage (OR 1.17, P = .80), wound infection (OR 1.89, P = .34), intra-abdominal abscess (OR 1.17, P = .87), re-operation (OR .00, P = .94) and mortality (OR .55, P = .48). Moreover, length of hospital stay was comparable between the two groups (P = .81). CONCLUSION: Laparoscopic repair of PPU with or without omental patch have comparable postoperative complications and mortality rate. However, considering the shorter operative time, no-omental patch approach is an attractive and more favourable choice. Well-designed randomized controlled trials are needed to investigate this comparison.

QTRAP LC/MS/MS of Garlic Nanoparticles and Improving Sunflower Oil Stabilization during Accelerated Shelf Life Storage.

The purpose of this research was to assess and utilize the bioactive compounds of garlic nanoparticles (Ga-NPs) as a natural antioxidant in sunflower oil (SFO) stored at 65 ± 1 °C for 24 days. The garlic nanoparticles (Ga-NPs) from the Balady cultivar were prepared, characterized, and added to SFO at three concentrations: 200, 600, and 1000 ppm (w/v), and they were compared with 600 ppm garlic lyophilized powder extract (Ga-LPE), 200 ppm BHT, 200 ppm α-tocopherol, and SFO without Ga-NPs (control). The QTRAP LC/MS/MS profile of Ga-NPs revealed the presence of four organosulfur compounds. Ga-NPs exhibited the highest capacity for phenolic, flavonoid, and antioxidant compounds. In Ga-NP SFO samples, the values of peroxide, p-anisidine, totox, conjugated dienes, and conjugated trienes were significantly lower than the control. The antioxidant indices of SFO samples containing Ga-NPs were higher than the control. The Ga-NPs enhanced the sensory acceptability of SFO treatments up to day 24 of storage. The shelf life of SFO treated with Ga-NPs was substantially increased (presuming a Q10 amount). The results show that Ga-NPs are a powerful antioxidant that improves SFO stability and extends the shelf life (~384 days at 25 °C).

Alleviation of Herbicide Toxicity in Solanum lycopersicum L.-An Antioxidant Stimulation Approach.

Application of the herbicide glyphosate in crops is a common practice among farmers around the world. Tomato is one of the crops that are treated with glyphosate to fight weed growth and loss of crop. However, tomato plants often show phytotoxic effects from glyphosate. In this study, the ability of pongamia oil derived from Pongamia pinnata (known also as Millettia pinnata) tree to alleviate the herbicide glyphosate toxicity effects in tomato (S.lycopersicum L. cv. Micro-tom) plants was tested. Tomato plants were treated with a mixture of a dose of (GLY) glyphosate (10 mg kg−1) and different doses of pongamia oil (PO) foliar spray (5, 10, 50, and 100 mM) and compared with the herbicide or oil control (glyphosate 10 mg kg−1 or pongamia oil PO 50 mM). Some morphological features, non-enzymatic and enzymatic antioxidants, and gene expression were observed. Glyphosate-treated plants sprayed with PO 50 mM (GLY + PO 50) showed increased root biomass (0.28 g-p ≤ 0.001), shoot biomass (1.2 g-p ≤ 0.01), H2O2 (68 nmol/g), and the activities of superoxide dismutase (SOD; 40 mg-p ≤ 0.001), catalase (CAT; 81.21 mg-p ≤ 0.05), ascorbate peroxidase (APX; 80 mg-p ≤ 0.01) and glutathione reductase (GR; 53 min/mg-F4,20 = 15.88, p ≤ 0.05). In contrast, these plants showed reduced contents of Malondialdehyde (MDA; 30 nmol/g-F4,20 = 18.55, p ≤ 0.01), O2 (0.6 Abs/g), Prolne (Pro; 345 µg/g), Glutathine (GSH; 341 nmol/mg-p ≤ 0.001), ascorbate (AsA; 1.8 µmol/gm), ascorbic acid (AA; 1.62 mg-p ≤ 0.05) and dehydroascorbate (DHAR; 0.32 mg p ≤ 0.05). The gene expression analysis was conducted for seven oxidative stress related genes besides the house-keeping gene Actin as a reference. The gene CYP1A1450 showed the highest mRNA expression level (6.8 fold ± 0.4) in GLY-treated tomato plants, whereas GLY-treated plants + PO 50 showed 2.9 fold. The study concluded that foliar spray of 50 mM pongamia oil alleviated the toxic effects of glyphosate on tomato plants in the form of increased root and shoot biomass, SOD, CAT, APX, and GR activity, while reduced MDA, O2, Pro, GSH, AsA, AA, DHAR, and gene CYP1A1450 expression.

Comparison between Endoloop ligature and Hem-o-lok clip (Polymer ligation) for appendiceal stump closure during laparoscopic appendicectomy.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing laparoscopic appendicectomy is Hem-o-lok clip safer than Endoloop ligature for closure of appendiceal stump? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the safety and cost effectiveness of Hem-o-lok clip (Polymer ligation) versus Endoloop ligature for appendiceal stump closure during laparoscopic appendicectomy. We concluded that Hem-o-lok clip is a safe and feasible tool for appendiceal stump closure. It's also a cost-effective way and could be a cheaper option compared to other measures.

Use of a standardized reporting template: can we improve report quality in pancreatic and peri-ampullary malignancy?

BACKGROUND: Accurate pancreatic and periampullary cancer staging with resectability assessment is vital to optimize surgical management and improve patient outcomes. The aim of this study is to assess the usefulness of a standardized reporting template. METHODS: Retrospective review of all surgically managed patients with pancreatic or periampullary malignancy between January 2018 and June 2019. Pre-operative CT imaging report was anonymised and audited against a modified NCCN reporting template. The same imaging studies were re-reported by two experienced GI radiologists using the same template. RESULTS: Fifty-nine patients (37 male) with median age of 68 years (36-83) underwent surgery for suspected pancreatic/peri-ampullary malignancy. The median time between pre-operative CT scan and surgery was 56.5 days (14-225). The use of reporting template resulted in significant increase in number of reported key features (p < 0.005), interobserver agreed features (p < 0.005) and overall k-value assessed interobserver agreement (p < 0.005). Template reports correlated closely with key intraoperative findings whilst primary free text reports did not (k-value 0.85-0.96 versus 0.20-0.46, p < 0.05). CONCLUSION: The use of a reporting template resulted in a more complete and accurate pancreatic/peri-ampullary tumour evaluation, improved inter-observer relatability and correlation with intraoperative findings.

Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes.

BACKGROUND: There is no universal consensus on the optimal timing of cholecystectomy following endoscopic retrograde cholangio-pancreatography (ERCP). This study aims to evaluate the effect of time delay and post-ERCP complications on cholecystectomy outcomes. MATERIALS AND METHODS: All patients who underwent pre-op ERCP for concurrent cholelithiasis and choledocholithiasis between January 2009 and August 2019 at University Hospitals Plymouth, UK, were included. Patients who underwent single-stage cholecystectomy and common bile duct exploration were excluded from the study. Based on the delay to cholecystectomy, the patients were divided into early (within 2 weeks), intermediate (2-6 weeks) and late (> 6 weeks) groups. The operative outcomes between the three groups were compared. RESULTS: We included 444 patients in the study, with 62 (14%), 90 (20%) and 292 (66%) patients in the early, intermediate and late groups, respectively. The median duration from ERCP to cholecystectomy was 75 days. There was no statistically significant difference in the conversion-to-open rate, bile leak rate or retained stones between the three groups. The median post-operative hospital stay (PHS) was 2, 2 and 1 day (P = 0.005) in the early, intermediate and late groups, respectively. The readmission rate was significantly more in the delayed group (3.2%, 11.1% and 13.7%; P = 0.05). Patients who suffered post-ERCP complications had a significantly longer PHS (4 vs 1 day, P = 0.001) and had higher conversion-to-open rate (16 vs 4.5%, P = 0.04). CONCLUSION: Delayed cholecystectomy following ERCP is not associated with worse peri-operative outcomes and can facilitate more day-case surgery. However, early cholecystectomy can significantly reduce readmissions with gallstone-related symptoms and its associated hospital stay. Post-ERCP complications lead to a difficult cholecystectomy.

The survival rate among endovascular and open surgical repair of abdominal aortic aneurysms.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has higher Survival rates? The outcomes assessed were the overall survival rates in both techniques. The best evidence showed that there is no statistically significant difference between EVAR and OSR in survival rates.

Incidence of secondary rupture after abdominal aortic aneurysms (endovascular vs. open surgical repair).

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has lower secondary rupture rates? The outcomes assessed were the secondary rupture rate in both techniques. The best evidence showed that The OSR has statistically significant lower secondary rupture rates than the EVAR.

Re-intervention rate in endovascular vs open surgical repair for abdominal aortic aneurysms.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with Infrarenal abdominal aortic aneurysm (AAA), Does endovascular abdominal aortic repair (EVAR), AS compared to open surgical repair (OSR), has lower re-intervention rates? The outcomes assessed were the re-interventional rates in both techniques. The best evidence showed that the OSR has lower statistically significant difference rates in re-intervention rates than the EVAR.

Incidence of anal incontinence among patients with anal fissure treated with Botox injection versus lateral sphincterotomy.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with anal fissure, which technique has a lower of incidence anal incontinence: Botox injection or lateral sphincterotomy? The best evidence showed that Botox injection has lower incidence of incontinence.

Clipless laparoscopic cholecystectomy is a better technique in reducing intraoperative bleeding.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy associated with lower rates of intraoperative bleeding compared to conventional cholecystectomy? The search has been devised and 5 studies were deemed to be suitable to answer the question. The outcome assessed was the rate intraoperative blood loss in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors recommend adopting clipless laparoscopic cholecystectomy especially in patients with high risk of intraoperative bleeding.

Is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Using the reported search, 8083 papers were found. 8 studies were deemed to be suitable to answer the question. The outcomes assessed were post-operative pain differ in single or standard laparoscopic cholecystectomy, all study used VAS (visual analogue scale). The evidence showed no difference in post-operative pain for patients went for single laparoscopic in compared with standard laparoscopic cholecystectomy.

Is the rate of bile leak higher in clipless laparoscopic cholecystectomy compared to conventional cholecystectomy?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy is associated with higher risk of bile leak compared to conventional cholecystectomy? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the rate of bile leak in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors found that the rates of bile leak in clipless laparoscopic cholecystectomy is comparable to conventional technique. Clipless cholecystectomy is feasible and safe.

Is the surgical site infection rate higher in sublay or onlay mesh repair of incisional hernia?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In mesh repair of incisional hernia, which technique has a lower rate of surgical site infection (SSI), Sublay or Onlay? The best evidence showed that there is no statistically significant difference in the rate of SSI among the two techniques.

The role of postoperative antibiotics in preventing surgical site infections in uncomplicated appendicitis.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients who underwent appendicectomy for uncomplicated appendicitis is the use of postoperative antibiotics associated with lower rates of surgical site infections? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the efficiency of postoperative antibiotic therapy in decreasing the rate of surgical site infections in uncomplicated appendicitis. Authors recommend against the use of postoperative antibiotics based on the supported evidence. Hence, its usage was not associated with lower rates of surgical site infections. On the contrary, it might increase the cost, postoperative morbidity and length of stay.

Locally advanced breast cancer treated with neoadjuvant chemotherapy: Is breast-conserving surgery feasible?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is breast-conserving surgery feasible after neoadjuvant chemotherapy for locally advanced breast cancer? Using the reported search, 19 articles were found, out of these 6 studies were deemed to be suitable to answer the question. The outcomes assessed were local recurrence rate. The best evidence showed that breast conserving surgery is safe in terms of local recurrence.

Best evidence topic: Should patients with asymptomatic choledocholithiasis be treated differently from those with symptomatic or complicated disease?

Choledocholithiasis is a common finding in clinical practice, with presentation varying from asymptomatic to life-threatening complications. In symptomatic patients, there is no doubt that treatment to clear the bile duct is indicated, but there is still a debate regarding the treatment of patients with silent common bile duct stones (CBDS). The question addressed by this best evidence topic is whether patients with asymptomatic CBDS should be managed in the same way as patients with symptoms or complications. The search strategy yielded 609 articles, from which 8 articles found to be relevant to this topic. We also summarised the most notable societal guidelines recommendations, regarding this topic. We tabulated the article title, author, year, country, study type, outcomes, results, and comments. We concluded that patients with asymptomatic CBD stones should be offered endoscopic treatment If they are fit, after discussion of the potential risks and benefits of both options of conservative and interventional treatment with the patients.