Using ESN-Smartphone Application to Maximize AIS Reperfusion Therapy in Alexandria Stroke Network: A Stroke Chain of Survival Organizational Model.

Background: In developing countries like Egypt, the clinical workflow of stroke management is poorly established due to the lack of awareness of the stroke patients concerning their need of therapeutic intervention and the poor identification of facilities equipped to treat stroke. Hence, establishing a stroke system of care in developing countries that can efficiently and rapidly triage patients to the appropriate reperfusion therapy center is imperative to improving stroke management and outcomes. Aims: To evaluate a pilot experience in stroke hospital identification and expediting decision-making in AIS treatment through the Alexandria stroke network and Egyptian Stroke Network (ESN)-app. Methods: Between 2017 and 2019, seven hospitals registered themselves on the AS-Network as pilot hospitals. The ESN-application was used to detect stroke type, tele-connect stroke teams and hospitals, track triage of patients to equipped facility in real time, and streamline stroke workflow. The quality of and time required for stroke management were compared between 84 patients with acute ischemic stroke (AIS) whose treatment involved the ESN-app and 276 patients whose treatment did not. Results: During this pilot study, 360 AIS cases received reperfusion therapy, 84 of which were indicated by the ESN-app. The use of the application was associated with the significant drop in time metrics for the reperfusion AIS-patients (door-in-door-out time; 56 ± 34 min vs. 96 ± 45 min, door-to-groin puncture time; 50 ± 7 min vs. 120 ± 25 min, door-to-needle time; 55 ± 12 min vs. 78 ± 16 min with p < 0.0001). Its use was also associated with higher rates of excellent outcomes at the 90-day follow-up (without ESN-app vs. with ESN-app, 67.9 vs. 47.1%, p = 0.001) but no difference in 90-day mortality or symptomatic intracerebral hemorrhage (without ESN-app vs. with ESN-app, 9.5 vs. 11.2% and 4.8 vs. 5.1%, p > 0.05). Conclusion: Our pilot experience demonstrated that the use of the ESN-app expedited the stroke treatment workflow and facilitated tele-connection between registered stroke facilities. Additionally, its use might be associated with achieving higher rates of excellent outcomes at 90 days, where a larger scale study is needed for more confirmation.

Outcome of Laparoscopic Assisted Percutaneous Microwave Ablation for Exophytic Versus Non-exophytic Hepatocellular Carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third cause of cancer-related death worldwide. Surgery is the optimal treatment for early HCC; however, the majority of cases are not suitable for curative resection at the time of diagnosis. Surgical resection difficulties may be related to size, site, number of tumors, extrahepatic involvement, and patient general condition. Exophytic tumors were considered as relative contraindication for thermal ablation because of the risk of incomplete ablation or major complications as hemorrhage and seeding. AIM OF THIS STUDY: to evaluate the safety and efficacy of microwave ablation (MWA) of exophytic HCC in comparison with non-exophytic HCC. METHODS: Prospective comparative study carried on 30 patients having 30 exophytic (six of those patients had another non-exophytic lesion) and 32 patients having 44 non-exophytic HCC lesions (22 had single lesion, 8 patients had 2 lesions, and 2 patients had 3 lesions) within Milan criteria. All patients were child A or B, they were subjected to full clinical assessment, laboratory investigations, and radiological investigations. Laparoscopic assisted percutaneous MWA was the procedure of choice in our study for all patients either having exophytic or non-exophytic lesions using no-touch wedge technique for exophytic lesions and direct puncture for non-exophytic lesions. RESULTS: Technical success was 100% in both groups, all lesions were completely ablated as confirmed by LIOUS. There were no major complications or perioperative mortality and low incidence of local tumor progression in both exophytic and non-exophytic groups. CONCLUSION: Laparoscopic assisted MWA of exophytic HCC is safe and effective with comparable results to non-exophytic HCC. Exophytic HCC is not contraindication for MWA with proper technique selection.

Knowledge, attitudes, and practices of Egypt's future physicians towards antimicrobial resistance (KAP-AMR study): a multicenter cross-sectional study.

Antimicrobial resistance (AMR) is a growing threat that causes over 700,000 deaths per year worldwide. The goal of the current multicenter, cross-sectional study was to identify the knowledge and practice gaps in antimicrobial stewardship among Egypt's undergraduate medical students. Nine-hundred and sixty-three participants (375 male) from 25 medical schools responded to our self-administered questionnaire. Overall, the majority of students (96%) exhibited fair/satisfactory knowledge and attitude scores towards AMR. However, the most common misconceptions were that skipping one or two antimicrobial doses does not contribute to AMR (43%) and that antimicrobials are the drug of choice for the treatment of sore throat (38.8%). About 36% of the students thought that bacteria cause common cold and influenza. In terms of practices, about 62% of the students reported taking antibiotics when they have cough or sore throat and saving the remaining antibiotic for the next time. About 48% of the students reported that when they start feeling better, they stop the antibiotic course, and 41% stated that they often/sometimes discard the remaining leftover or share the leftover antibiotics with their friends. Interestingly, males had more frequently poorer levels of knowledge than females (p = 0.02). Moreover, students in the clinical science years (p < 0.001), living in urban areas (p = 0.02) or Cairo (p < 0.01) reported better practices than their counterparts. Educational programs about antimicrobial stewardship and the role of healthcare professionals in preventing AMR should be introduced early in medical curricula. Further, active educational techniques as clinical scenarios that simulate clinical settings and interactive learning workshops would be more efficient teaching methods.

EVALUATION OF PACKING THE RESIDUAL CAVITY AFTER TOTAL OR PARTIAL CYST RESECTION IN MANAGEMENT OF HEPATIC HYDATID CYSTIC DISEASE.

Hydatid disease is a worldwide zoonosis caused by the larval stage of the echinococcus tapeworm, that is endemic in many parts 6f the world (in Europe, Middle East, Mediterranean, South American and African countries). Hydatid disease is a relevant health problem in underdeveloped areas where veterinary control does not exist. The most frequent location of hydatid cystic lesions is the liver (up to 80% of cases), followed by the lung (about 20% of cases), and with a lower reported incidence in any other organ or tissue in the body. Currently, surgical operation remains the treatment of choice in hydatidosis. Many surgical options can be done for management of the cyst, ranging from unroofing of the cyst, pericystectomy, up to liver resection for the affected liver parenchyma site. The cyst cavity can be managed by different techniques, capitonnage, external drainage, introflexion or omentoplasty. The Omentoplasty (OP) filling technique was the method of choice for filling of the Residual -Cavity (RC). The omentoplasty filling was, done by two procedures Pedicle Omental Pack (POP), and Isolated Omental Pack (IOP); both techniques were applied for the filling of the residual cavity compared to non-filling of the re-sidual cavity after surgery, in our retrospective ,comparative multicenter study. Seventy six patients operated for hydatid cyst between January 2010 and February 2014 were analysed retrospectively. Either with or without filling of the cavity, and either the filling was with pedicle or isolated omentoplasty were used to treat the re-sidual cyst cavity. Patients were categorised into three groups to evaluate complications: without filling of the RC (GA), ouientoplasty filling with Pedicle Omental Pack (GB), and omentoplasty filling with Isolated Omental Pack (GC). The overall mortality rates were 0%. Overall morbidity rates were 57.1% for GA, and 10.3% for GB, and 7.7% for GC respectively. Mean hospital stay was 11.8 days for GA, and 8.1 days for GB, and 8.7 days for GC. The isolated omentoplasty filling technique is a safe management in the filling of the residual cavity after surgery with less operative time and same result as pedicle omentoplasty technique. Because of omentum has a high absorptive capacity and capable to fill the residual cavity, and omentoplasty was recommended (whether with pedicle or isolated omental flap) to manage patients with hydatid cyst of the liver.