Use of a vessel-sealing device compared with Jaboulay's technique for adult hydrocelectomy surgery: a retrospective cohort study.

Hydrocele is a common benign scrotal condition affecting adult men. The gold standard of treatment includes hydrocelectomy, with the use of Winkelman's/Jaboulay's technique or Lord's procedure. The vessel-sealing device (VSD) is a blood vessel-sealing system, known to enhance patient's postoperative outcomes in multiple different surgeries. The aim of this study was to compare the procedural and postoperative outcomes of a novel hydrocelectomy method using a VSD to the conventional hydrocelectomy using the Jaboulay's technique. We performed A retrospective review for all adult cases who underwent surgical hydrocelectomy at Hillel Yaffe Medical Center between 2011 and 2022. Study cases were grouped into one of two groups, patients undergoing conventional hydrocelectomy, or patients undergoing hydrocelectomy with the use of a VSD. Patients operated using other techniques were excluded. Data collected included demographic data and operative and postoperative parameters. Among 102 patients, 47 underwent Jaboulay's technique and 55 underwent hydrocelectomy using a VSD. We observed significantly shorter duration of hospitalization (1.18 vs 1.53, P = 0.038) and shorter surgery time (31.87 vs 37.4, P = 0.003) when using the VSD during a hydrocelectomy compared to conventional surgical hydrocelectomy. Both techniques indicated low complication rates and no recurrent hydrocele was observed in either group. We report our experience with a novel surgical technique that includes hydrocelectomy with the use of VSD. Our findings demonstrated shorter surgery time and length of hospitalizations, which may indicate improved patient's postoperative outcomes with the use of the VSD for hydrocelectomy.

Spatio-temporal patterns and trends of the air pollution integrating MERRA-2 and in situ air quality data over Egypt (2013-2021).

For best-informed decision-making to improve climate change adaptation and reduce present and future air pollution health hazards, it is essential to identify major trends in spatiotemporal air quality patterns of common air contaminants. This study examined the patterns and trends of SO2, NO2, CO, O3, and particulate matter (PM) air pollutants over 91 monitoring stations in Egypt during 93 months in the August (2013)-April (2021) period. In situ data with their monthly, seasonal, and yearly spatial trends are defined and used to validate the counterpart satellite reanalysis MERRA-2 data. The Mann-Kendall test characterized the seasonal monotonic trends and their Sen's slope, and annual change rate for both data series. Regression analysis of MERRA-2 against in situ concentrations of SO2 and PM10 revealed underestimation with RMSE values of 13.38 g m-3 and 69.46 g m-3, respectively. Local plumes with variable magnitudes characterized distinct industrial places clarified by patterns of in situ pollutants. As a result of the COVID-19 lockdown, the in situ air pollutants showed a considerable regional decline in the yearly average in 2020 compared to the years before. The in situ air pollutants showed annual trends far more significant than those seen in the MERRA-2 data. The shortcomings of the few and spatiotemporal discontinuities of the in situ contaminants are addressed by MERRA-2 air quality products. The in situ data made trends and magnitudes clear that were hidden in their MERRA-2 counterparts. The results clarified air pollution patterns, trends, and spatial variability over Egypt that are essential for climate risk management and for reducing environmental/health concerns. Supplementary Information: The online version contains supplementary material available at 10.1007/s11869-023-01357-6.

Phytoplankton dynamics and renewable energy potential induced by the environmental conditions of Lake Burullus, Egypt.

The research evaluates the spatio-temporal phytoplankton community structure and abundance along with the pollution sources and the lake bioenergy potential, primarily in order to better understand the interplay of the environmental factors affecting them in inland coastal waters. Burullus Lake, located in the north of the Nile Delta of Egypt, is selected as a case study area. Field investigations along with sampling of lake water from 55 sites in the period 20-25 September 2020 are performed. The physicochemical analysis is carried out for the lake water bathymetry, temperature (T°C), pH, salinities (total dissolved solids (TDS) and electric conductivity), and nutrient contents (nitrate, nitrite, ammonia, and phosphate). Phytoplankton identification and biological analysis are used to document the taxa and abundance along with their contents of chlorophyll-a, protein, carbohydrates, and lipids. Then, the trophic index (TRIX), along with the total phytoplankton biomass and the energy potentials, is estimated. Statistical analyses were appraised for the univariate summary statistics, correlation analysis, regression analysis, multivariate statistical analysis including principal component analysis (PCA), and clustering techniques (both geographic position and the k-means clustering) which were conducted using the PAST 4.03 package. The geostatistical modeling of the ordinary kriging implemented in the ArcGIS 9.3 package was appraised for mapping the studied parameters. Results clarified ranges with wide variations for the water depth of 0.90-2 m (av. 130.5 cm), T°C of 26.6-30.20°C (av. 28.3 °C), alkaline pH of 7.78-8.92 (av. 8.6), and TDS of 0.3-17.09 (av. 4.33) gm/l. Ranges of nutrients (mg/l) are also widely varied with nitrates of 0.44-8.36 (av. 3.5), nitrites of 0.004-7.45 (av. 0.4), ammonia range of 0.03-8.54 (av. 1.4), and phosphate of 0.1-4.9 (av. 0.9). A much-diversified phytoplankton community showed maximum counts of 1005 × 103 units.l-1 to a minimum of 340 × 103 units.l-1 for a total of 145 taxa from 61 genera and six classes typically of freshwater forms. The largest biomass (3.06 × 10-3 kg/m3) and energy potential (19.87 × 10-3 kWh/kg) marked the downstream area of the Brimbal Canal, followed by the area located in front of the eastern Burullus and El-Gharbiya drains, which exhibited 2.76 × 10-3 kg/m3 and 17.96 × 10-3 kWh/kg, for the biomass and the energy potential, respectively. Geographic position and k-means clustering techniques distinguished three homogenous classes of marked intra-class variations. PCA analysis distinguished three principal components summed for about 95% of the variations. Intense environmental pollution at the drain downstream areas is indicated by many fish mortality occurrences that were related to the blooms of the toxic Microcystis aeruginosa among the cyanophyte species, and also due to the dominance of the Euglena spp. and Phacus spp. of the Euglenophyceae, which assimilate lots of organic matters in these areas. Lake water movement in the form of turbulent flows and mixing regimes is affected by wind direction and the amount of flows from the sea drains. The estuarine Nile canal has a great effect on the water's physicochemical properties, particularly the nutrient loads, inducing the phytoplankton composition and abundance, total biomass, and the biological contents hence the energy potential. Nutrient load from discharged water from drains was a major contributor to raising the total algae counts and their corresponding contents of the carbohydrates, lipids, proteins, and the chlorophyll-a, which arranged in decreasing order of influence. Phytoplankton dynamics are mostly linked to climatic, hydrologic fluctuation of the drain water flows, and hence, the associated nutrient load discharged from land use changes to fish farms and the related agricultural practices south of the lake. The adopted integrated analyses proved promising, which confirmed the combined effects of environmental factors on lake pollution and the bioenergy potentials.

Numerical and experimental analyses of the use of double vertical barrier walls for groundwater protection.

The groundwater contamination and its impacts on the hydrologic systems and society are critical environmental concerns in the world. This research presents insights from the numerical (SEEP/W and CTRAN/W) and the experimental (sandbox model) analyses of the use of double vertical barrier walls for groundwater protection. The main objective was to evaluate contaminant transport under the effect of several variables. The arrival time increases with increasing the distance between the pollutant source and the first wall, first wall depth of penetration, the distance between the two walls and also increases at smaller hydraulic head differences, and lower conductivities. Furthermore, using double barrier walls would significantly reduce contaminant concentration at the downstream area. This control is most significant when the depth of first wall penetration is larger than that of the second wall. Results proved consistent with several similar studies and advantageous over many of them by the integrated use of both techniques with more variable parameters evaluated. PRACTITIONER POINTS: The research will introduce insights from the effect of using double barrier walls on the hydraulic control of contaminant transport. The effect of several variables on the contaminant arrival time and concentration is investigated. Using double barrier walls has a significant impact on contamination transport through the soil. This control is most significant when the penetration depth of the first wall is larger than that of the second.

[THE IMPACT OF ADMISSION TO THE MEDICAL WARD ON HEMOGLOBIN A1C LEVELS AMONG PATIENTS WITH TYPE-2 DIABETES].

INTRODUCTION: Blood glucose monitoring is a routine medical practice in the medical ward regardless of the cause of hospitalization of patients with diabetes. In this study we prospectively evaluated the impact of hospitalization on hemoglobin A1c (HbA1c) among patients with type-2 diabetes admitted to the medical ward, for reasons unrelated directly to their diabetes. METHODS: Patients with type-2 diabetes who were admitted to the medical ward for reasons not directly related to diabetes were asked to participate in our study. After consent , demographic, clinical and laboratory parameters were documented on admission, including age, sex, social status, years of study, duration of diabetes, type of anti-diabetic treatment, background medical problems and treatment, diagnosis on admission, temperature, blood glucose levels on admission to the medical ward, complete blood count and serum creatinine. In addition, HbA1c levels on admission, first 24-hour blood glucose levels at the medical ward, change of therapeutic treatment of their diabetes, diagnosis at discharge and recommended medication at discharge, were also documented. Three months following admission, the HbA1c study was repeated again. Paired t-test and Wilcoxon's rank sign test were used to compare between HbA1c levels at baseline and 3 months later among all the patients and among the subgroups. Multivariate regression analysis was used also to predict change in HbA1c levels among these patients. Physicians taking care of the patients on the medical ward were not aware of the study. RESULTS: Forty-four patients were recruited and 40 patients completed the study. There were 24 men (60%), with a mean age of 69.625±11.53 years for all the patients. The most common diagnosis on admission was infection followed by congestive heart failure. Mean 24-hour blood glucose level following admission was 209 mg% ±95. Among 12 patients there was an augmentation in diabetes treatment and in 3 there was dis-augmentation/discontinuation. Mean hemoglobin A1c levels on admission and 3 months later was 7.29% and 6.80% respectively (p=0.095). However, sub-analysis of patients with HbA1c levels >7.5% on admission, showed a significant decrease in the repeated HbA1c levels (p=0.003). CONCLUSIONS: Medical ward admission was associated with reduced HbA1C levels, yet not significant, among patients with type-2 diabetes who were admitted for reasons not directly related to diabetes.

Spatiotemporal evaluation of the groundwater quality in Gharbiya Governorate, Egypt.

Groundwater quality indicators were monitored over 6 years (2007-2012) from 55 drinking water supply wells in Gharbiya Governorate (Egypt). The prime objective was to characterize, for the first time, the governorate-wide significant and sustained trends in the concentrations of the groundwater pollutants. Quality indicators included turbidity, pH, total dissolved solid (TDS), electric conductivity (EC), Cl-, SO42-, Na+, total alkalinity, hardness (total, Mg, and Ca), Fe2+, Mn2+, Cu2+, Zn2+, F-, NH4+, NO2-, NO3-, PO43-, dissolved oxygen (DO), and SiO2 contents. Detection and estimation of trends and magnitude were carried out applying the non-parametric Mann-Kendall and Thiel-Sen trend statistical tests, respectively. Factor analysis was applied to identify significant sources of quality variation and their loads. Violation of groundwater quality standards clarified emergence of Mn2+ (46%), Fe2+ (35%), and NH4+ (33%). Out of the 55 wells, notable upward trends (deterioration) were significant (>95% level) for TDS (89%), NO3- (85), PO43- (75%), NH4+ (65%), total alkalinity (62%), Fe2+ (58%), NO2- (47%), Mg hardness (36%), turbidity (25%), and Mn2+ (24%). Ranges of attenuation rates (mg/l/year) varied for TDS (24.3, -0.7), Mg hardness (3.8, -0.85), total alkalinity (1.4, -1.2), NO3- (0.52, -0.066), PO43- (0.069, -0.064), NH4+ (0.038, -0.019), Mn2+ (0.015, -0.044), Fe2+ (0.006, -0.014), and NO2- (0.006, -0.00003). Highest rates marked Tanta (total alkalinity and Fe2+), Al-Mehala Al-Kubra (TDS, Mg hardness, and NO3-), Kafr Al-Zayat (NH4+), Zifta (Mn2+), Bassyun (NO2-), and Qutur (PO43-). Precision of the trend estimate varied in goodness of fit, for TDS (86%), Mg hardness (76%), total alkalinity (73%), PO43- (67.4%), NH4+ (66.8%), Mn2+ (55%), and Fe2+ (49.6%), arranged in decreasing order. Two main varimax-rotated factors counted for more than 55% of the quality variance and, in particular, significant loads of salinity (TDS, EC, Cl-, Na+, and SO42-), followed by the alkalinity, hardness, redox potentials (Mn2+ and Fe2+), and NH4+, in decreasing order were identified. The spatial-temporal variation in pollutants originated from organic matter degradation, either naturally from the aquifer peaty sediments or anthropogenic due to improper well head protection in the urban centers or from the agricultural drains in low relief areas. Considering the latest contents of indicators and their rate of increase, the time that the permissible limits would be reached can be accurately estimated and alleviative actions could be effectively set.