No drains versus drains after perforated peptic ulcer repair: A randomized controlled trail.

PURPOSE: The study aimed to evaluate safety of omitting the intraabdominal drains after perforated peptic ulcer repairs. MATERIALS AND METHODS: We conducted a prospective, randomized, controlled trial from January 2022 to January 2024 at the Emergency surgery department. Patients with perforated peptic ulcers were evaluated for eligibility. They were randomly assigned into two groups. In group A: two intraabdominal drains (pelvic and hepatorenal). in group B: no intraabdominal drains. The primary outcome was hospital length of stay (LOS), and the secondary outcomes included parameters of recovery and 30-day morbidities. The data were analyzed using SPSS 16 ®. RESULTS: Thirty five patients were in the no drain group, while 36 patients were in the drain group. Patients in the no drains group had significantly earlier bowel motion (21.6 vs 28.69 hours; p = 0.004), fluid diet (73.54 vs 86.78 hours; p 0.001), and solid intake (84.4 vs. 98 hours; p 0.001), less pain severity (p = 0.0001) and shorter hospital stay (4.74 vs 5.75 days; p 0.001). A significant less morbidity, including surgical site infection (p = 0.01), and respiratory complications (p 0.0001), were in the no drain group. There was no difference of fever duration nor wound dehiscence. CONCLUSIONS: Omitting the intraabdominal drains is safe after peptic ulcer perforation repair. It can improve outcomes. The study was registered at ClinicalTrials.gov Identifier: NCT06084741.

Intermediate Uveitis Complicated by Peripapillary Choroidal Neovascularization.

Choroidal neovascularization (CNV) is a very rare complication of intermediate uveitis with an incidence rate of around 2.0%. This case report examines the pathogenesis and prognosis of peripapillary CNV in a 52-year-old female patient with intermediate uveitis. The patient was initially diagnosed with intermediate uveitis and had two-month-old floaters, 20/25 vision, and snowballs in both eyes. After five years, she underwent a normal ocular checkup, which revealed peripapillary subretinal hemorrhage. The presence of a choroidal neovascular membrane was detected using fluorescein angiography and optical coherence tomography. The patient received monthly intravitreal injections of 1.25 mg of bevacizumab for four months, which improved and stabilized her eyesight, resolved the subretinal hemorrhage, and caused the CNV to recede without recurring.

Measuring the impact of water scarcity on agricultural economic development in Saudi Arabia.

This research measures the impact of water scarcity on agricultural economic development and economic development indicators in the Kingdom of Saudi Arabia during 1995-2018. By examining the current status of available water resources and their uses, and estimating a model to study the impact of water scarcity on agricultural economic development. The study relied on descriptive and standard economic analysis to estimate the proposed regression model. It found that a 10% change in the amount of water resources available leads to a 5.1% change in the same direction of the crop area. A 10% change in the estimated crop area results in a 1.5% change in the same direction of the total agricultural output value. A 10% change in employment and agricultural loans leads to a change in the same direction of the aggregate agricultural output value of 5.1% and 7.2%, respectively. A 10% change in the total value of the estimated agricultural output leads to a 2.9% change in the same direction of GDP. Thus, a lack of water resources will decrease the crop area and have a negative impact on the value of agricultural output, thereby impacting GDP. We therefore include policy recommendations for the conservation of water resources: The government should stop the export of virtual water, particularly for water-depleting products; an economic accounting framework for water should be introduced to monitor the amount of water in excess of the water codification for various crops prevailing in the crop composition.

Mutations in NMNAT1 cause Leber congenital amaurosis and identify a new disease pathway for retinal degeneration.

Leber congenital amaurosis (LCA) is a blinding retinal disease that presents within the first year after birth. Using exome sequencing, we identified mutations in the nicotinamide adenine dinucleotide (NAD) synthase gene NMNAT1 encoding nicotinamide mononucleotide adenylyltransferase 1 in eight families with LCA, including the family in which LCA was originally linked to the LCA9 locus. Notably, all individuals with NMNAT1 mutations also have macular colobomas, which are severe degenerative entities of the central retina (fovea) devoid of tissue and photoreceptors. Functional assays of the proteins encoded by the mutant alleles identified in our study showed that the mutations reduce the enzymatic activity of NMNAT1 in NAD biosynthesis and affect protein folding. Of note, recent characterization of the slow Wallerian degeneration (Wld(s)) mouse model, in which prolonged axonal survival after injury is observed, identified NMNAT1 as a neuroprotective protein when ectopically expressed. Our findings identify a new disease mechanism underlying LCA and provide the first link between endogenous NMNAT1 dysfunction and a human nervous system disorder.