Reconstructive surgery for mycetoma: Preliminary algorithm and a systematic review.

Background: Surgical treatments of mycetoma are a cornerstone in management. However, while doing a wide surgical excision of mycetoma lesion, surgeons think about how to close the skin defect, which can be closed primarily, left to heal by secondary intension, by skin grafts or local flaps. In this review, we demonstrate the various applications and changes of mycetoma reconstruction after surgical excision. Methods: This is a systematic literature search and review conducted to determine articles presenting mycetoma reconstruction options. Articles were identified, and the time of publication, type of study, time of study, and country of study were checked. Additionally, all patients in those articles were included. Patients' names, sex, clinical presentation, and management were identified. Results: A total number of 9 articles fulfilled our inclusion criteria; 8 of them are case reports, and 1 is a case series. The first mycetoma reconstruction case was published in 1959. The country of publication varies from tropical and non-tropical countries. The total number of patients found in those articles is 34 patients, most of whom are male. The causative organism is mainly eumycetoma. The site of mycetoma lesions is varied with variable sizes. The reconstruction options used were skin graft and local or regional flaps, where only 1 case underwent a free flap for reconstruction. Conclusion: Reconstruction of mycetoma should be considered following mycetoma surgery in small or large size defects if skin closure is not feasible and there is no indication for amputation.

Surgical management of eumycetoma: experience from Gezira Mycetoma Center, Sudan.

BACKGROUND: In this study, we share our experience of different operative techniques undertaken on 584 eumycetoma patients in the Gezira Mycetoma Center. METHODS: This is a retrospective, descriptive, hospital-based study, conducted to review the surgical treatment of eumycetoma patients. We included all patients diagnosed with eumycetoma who underwent a surgical operation in the center during January 2013-December 2016. RESULTS: A total number of 1654 patients were seen during the study period, and their records were revised, while 584 (35.3%) of them underwent an operation and included in the study. There was a male predominance 446 (76.4%). Surgical excision of mycetoma was the commonest operation performed among 513 (87.8%) patients in comparison with amputation 71 (12.2%). Below-knee amputation and toe amputation are the commonest types of amputation in 36 (6.1%) and 14 (2.3%) patients, respectively. Clinical features determining the type of operation performed included the size of the lesion, whether or not a bone was involved, and the feasibility of primary closure. A wide surgical excision (WSE) is performed mainly when the bone is not involved and when moderate or primary closure is possible or reconstruction is feasible. Amputations will typically follow identifying bone involvement, secondary infection, and an already disabled patient. CONCLUSION: The commonest procedure in our series was WSE and primary skin closure undertaken when the lesion was small (< 5 cm); there was no bone involvement, and the skin closure was achievable. Larger lesions (> 10 cm) without bone involvement were treated with excision and flap/graft. Bone involvement and large primary lesions were more likely to be managed by amputation. Recurrent and relapse of mycetoma were observed in patients with bone involvements or presented with recurrent mycetoma for the second time.

Axillary Lymph Node Dissection for Breast Cancer: Efficacy and Complication in Developing Countries.

PURPOSE: Axillary lymph node dissection (ALND) frequently is performed as part of the surgical management of breast cancer as a therapeutic and prognostic index, but increasingly has been perceived as associated with significant complications. Data on efficacy and complications of ALND in Sudan are lacking. The aim of this study was to assess the efficacy and complications of ALND in patients with breast cancer treated with mastectomy and breast-conserving surgery. METHODS: We performed a prospective, hospital-based study in women with invasive breast cancer who underwent modified radical mastectomy or breast-conserving surgery with ALND between September 2014 and August 2015. The efficacy of ALND was defined as retrieval of ≥ 10 lymph nodes. Complications of ALND were assessed objectively and subjectively and defined as either present or absent. RESULTS: Of 96 patients with breast cancer included in the study, 40 (42%) developed postaxillary clearance complications. The median follow-up time was 18 months (range, 12 to 24 months). Numbness was reported by 21.9% of patients. Seroma was noted in 15.6% and lymphedema in 9.4%. Approximately 9% reported episodes of infection or inflammation at the surgical site. None of the studied factors were found to affect the incidence of complications significantly. Ten or more lymph nodes were retrieved in 81.3% of patients, and nodal metastasis was found in 62.5%. CONCLUSION: This study shows that the prevalence of undesirable adverse effects after ALND is 42%, with paresthesia and seroma being the most prevalent. The lymphedema prevalence was low in relation to other evaluated symptoms.

Fecal microbiota profile in atopic asthmatic adult patients.

Summary: Background. Studies proposed a link between gut microbiota and airway tract. Objective. Study the diversity and density of gut microbiota in healthy and asthmatic patients. Method. Semi-quantitative stool cultures were performed from fecal samples collected from 80 adult asthmatic patients and 40 healthy individuals. Data on gender, age, dietetic history, clinical examination and investigations as skin prick test and pulmonary function testing were also collected. Results.Lactobacilli were found to be higher among patient group than control group. E. coli density was statistically higher in patient than control group. No significant difference was detected between male and female patients or controls. Lactobacilli were statistically more prevalent in stool culture of male cases than that of male controls. No difference was found between female cases and controls. There was no relationship between type of microbial growth and disease related parameters including age, duration of illness, number of allergens and pulmonary function test in cases. Conclusion. Atopic asthma is significantly associated with gut microbiota Lactobacilli and E. coli. It is important to determine the organism involved, to focus on microbiome-driven disease and therapies.

Effect of dietary counseling on preventing excessive weight gain during pregnancy.

OBJECTIVES: Excessive gestational weight gain (EGWG) is associated with short- and long-term health problems among mothers and their offspring. The aim of this study was to assess the effect of dietary counseling on EGWG. STUDY DESIGN: Randomized controlled intervention trial. METHODS: The study was conducted at the antenatal care (ANC) clinic, Center for Social and Preventive Medicine, Pediatrics Hospital, Cairo University, during the period from July 2015 to April 2016. A total of 200 primigravidae aged between 20 and 30 years were included and randomized into intervention and control groups. Based on data analysis from phase 1, nutritional practices of the studied participants were identified and tailored nutrition counseling sessions designed. Follow-up of the studied participants throughout ANC visits was done to enforce the healthy dietary intake and encourage weight gain according to the recommendations to avoid EGWG. RESULTS: The intervention resulted in a significantly higher proportion of women in the intervention group who gained gestational weight within the Institute of Medicine recommendations compared to women in the control group (42.7% vs 13.9%, respectively) (P-value <0.001); this was detected between the 25th and 35th weeks of gestation. Dietary counseling had significantly improved the frequency of consumption of different food items and knowledge, attitude, and practice mean scores of the intervention group in comparison with the control group (P-value <0.001). CONCLUSIONS: The results of the present study demonstrated that dietary counseling given to pregnant women reduced the proportion of EGWG and improved dietary practices. There is a strong need for effective intervention strategies targeting EGWG to prevent adverse pregnancy outcomes.

Estrogenic Activity Including Bone Enhancement and Effect on Lipid Profile of Luteolin-7-O-glucoside Isolated from Trifolium alexandrinum L. in Ovariectomized Rats.

Luteolin-7-O-glycoside (LG), an abundant component in many edible plants, was found to be one of the major constituents of the aqueous methanol extract of Trifolium alexandrinum L. family Fabaceae, a fodder plant widely cultivated in Egypt. The estrogenic activity of LG concerning the effect on uterotrophy, lipid profile, weight gain and bone enhancement activity was determined in ovariectomized rat model at a dose of 5 mg/kg. Luteolin-7-O-glycoside showed significant estrogenic effect through the preservation of normal uterine weight and plasma estradiol level. It also significantly inhibited the bone turnover markers plasma bone-specific alkaline phosphatase, plasma osteocalsin, type I procollagen N-terminal, and C-telopeptide of type II collagen levels. It induced a significant improvement in plasma lipid profile. The effect of LG was comparable with estradiol with lower effect on uterine weight. Liver and kidney functions revealed a wide safety of LG at this dose level. The present study revealed that LG may be a promising hormone replacement therapy after being examined thoroughly on human. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of indirect exposure of mice pups to endosulfan via their dams during gestation and lactation periods and the ameliorative effect of vitamin E.

During gestation and lactation, the experimental mice dams received one of the following treatments: (a) diet free of pesticide; (b) diet enriched with endosulfan (END); 30.0 µg kg(-1); (c) diet free of pesticide + oral vitamin E (α-tocopherol; 200 mg kg(-1) per mouse); and (d) diet enriched with END (30.0 µg kg(-1)) + oral vitamin E (200 mg kg(-1) per mouse). At weaning, pups and dams were killed, and selected organs as well as blood samples were collected for analyses. Compared with the control results, END induced alteration in a number of biochemical and histopathological parameters either in the dams or their offspring. The ameliorative effect of vitamin E to superoxide dismutase based on the "ameliorative index (AI)" for mothers and pups was 0.84 and 0.72, respectively. The AI for malondialdehyde reached a maximum value of nearly equal to 1.0 for dams or pups. For butyryl cholinesterase, the AI was 0.90 and 0.94 for dams and pups, respectively. In conclusion, a dietary exposure during gestation and lactation to low dose of END caused significant changes in the mother but also in the weaned animals that had not been directly exposed to this pesticide. These biological and histological alterations could be reversed to a great extent by oral supplementation of vitamin E.