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Abstract Background Anastomotic leaks (AL) are among the most serious complications due to the substantial impact on the quality of life and mortality. Inspite of the advance in diagnostic tools such as laboratory tests and radiological adjuncts, only moderate improvement has been recorded in the rate of detected leaks. The purpose of the research was to assess the perioperative risk factors for AL. Methods This study was achieved at MUH and MIH/Egypt within the period between January 2016 and January 2019 for the candidates who underwent bowel anastomosis for small intestinal (except duodenal one) and colorectal pathology. The collected data were analyzed using SPSS of V-26. Results This study included 315 cases, among them, 27 cases (8.57%) developed AL. The percentage of covering stoma was significantly higher in the non-leakage group vs leakage one (24.3% vs 11.1% respectively). lower albumin, operative timing, perforation, and covering stoma were shown as significant risk factors for leakage, but with multivariate analysis for these factors, the emergency operation, and serum albumin level was the only independent risk factors that revealed the significance consequently (p = 0.043, p = 0.015). The analysis of different predictors of AL on the third day showed that the cut-off point in RR was 29 with 83% sensitivity and 92% specificity in prediction of leakage, the cut-off point in RR was 118 with 74% sensitivity and 87% specificity in prediction of leakage and the cut-off point in CRP was 184.7 with 82% sensitivity and 88% specificity in prediction of AL and all had statistically significant value. Conclusions The preoperative serum albumin level and the emergency operations are independent risk factors for anastomotic leakage. Moreover, leakage should be highly suspected in cases with rising respiratory rate, heart rate, and CRP levels.

Abstract Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Abstract Mobile wireless sensor network (MWSN), as a backbone of most communication and embedded systems, is characterized by low data delivery as a result of the energy constraint and in‐deterministic movement of the nodes. To select optimal route path for a reliable data routing, protocols need to select neighbouring nodes with low mobility and residual energy parameters along the route. However, obtaining these parameters from the targeted nodes may encourage mischievous nodes to manipulate their energy and mobility parameters in their favor, leading to the selection of non‐optimal route path and/or exposing the network to other attacks. Rather than depending on the targeted nodes for these parameters, they can be accurately and securely obtained by sink node or base station using effective predictive models. However, most of the existing predictive models engaged by MWSN routing protocols either provide only the energy level or mobility factor of the nodes for optimal route path selection. This, therefore, reduces the reliability of the obtained optimal route paths in terms of data delivery. In this article, we propose predictive models for an accurate prediction of mobility and residual energy parameters of nodes in MWSN for efficient route management. The models are simulated on an existing MWSN protocol to determine their performance. The simulation results show that the adoption of these models in the development of routing protocol will not only lead to optimal route paths' selection but also enhance data delivery rate in MWSN.

Abstract Background Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016–September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

Abstract Background Bile acids are vital regulators of liver metabolism, and their dysregulation is closely linked with the progression of nonalcoholic fatty liver disease (NAFLD). Profiling these bile acids may provide valuable diagnostic and prognostic markers for these conditions. This study aimed to evaluate bile acid profiles in NAFLD patients and assess their potential as biomarkers for diagnosing and predicting disease progression. Serum levels of 14 bile acids were measured in 25 normal healthy controls (NHC), 35patients with metabolic dysfunction–associated steatotic liver disease (MASLD), and 40 patients with NASH, categorized by the NAFLD Activity Score (NAS). Quantification was performed using high-performance liquid chromatography-tandem mass spectrometry (HPLC–MS/MS). Results Primary unconjugated bile acids, CA and CDCA, along with conjugated acids GCA, GCDCA, TCA, and TCDCA, were significantly elevated in both MASLD and NASH compared to NHC (all p

Abstract Background Hepatic energy metabolism is intricately linked with the metabolic changes associated with HCV infection and hepatocellular carcinoma (HCC). This study investigated the potential of carnitine and acylcarnitines as markers for monitoring the development and progression of HCC in the context of HCV-induced liver cirrhosis. Blood samples from patients with chronic liver cirrhosis due to HCV (n = 55) and from those with HCC (n = 90) were analyzed, alongside samples from healthy control subjects (n = 25), utilizing liquid chromatography coupled with mass spectrometry. Results Principal component analysis revealed distinct metabolic clustering patterns, segregating HCC and HCV patients into separate groups. Pairwise comparisons showed significantly elevated acylcarnitine levels in both HCV and HCC patients when compared to the control group (p = 0.001). Importantly, there was no significant difference between HCV and HCC groups, although linear trend analysis indicated an increasing linear trend that reached its peak in the HCC group, signifying a notable relationship with disease severity (p = 0.001). Conclusion The observed carnitine and acylcarnitine levels in HCV and HCC patients offer crucial clinical insights, suggesting their potential as valuable diagnostic and prognostic markers.

Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive and often fatal malignancy. Most patients present with advanced disease, and the median overall survival is approximately one year. Objective: To review the cases of malignant mesothelioma admitted to Imbaba Chest Hospital in the period between 2013 and 2016. Subjects and Methods: The current study spotted the light over the malignant mesothelioma from epidemiological view, as a retrospective cohort study, conducted on all cases of malignant mesothelioma that were diagnosed at Embaba Chest Hospital in the period between 2013 until 2016 to explore the incidence of that disease and its characteristic features. The medical records of patients had been revised for the demographic criteria of patients, which included; age, sex, smoking status, residence and occupation, clinical presentation of cases, radiological findings, cytological examination of pleural fluid, pleural biopsy either thoracoscopic or open, and finally, histopathological diagnosis. Results: The prevalence of mesothelioma across years of the study was 1.5% (60 out of 4000cases) with increasing annual incidence; 1.7, 2 and 2.3% respectively. The mean age of mesothelioma patients was 57.96 years, most of them above 40 years (91.67%) and more than half of them were males (55%). In spite of decreasing percentage of male with mesothelioma within the study time (2014-2016), which was accompanied with increasing the percentage of female patients, it did not reach statistical significance. Conclusion: The overall incidence of malignant mesothelioma was 1.5% with increasing annual incidence from 1.7% up to 2.3%. The male gender was the more presentable one with gradual growing of female percent. The urban area was more affected than the rural one, specially the area near industries. Non-exposed persons (unemployed industrial workers) showed higher frequency of MM. Right-sided MM was more common than Left one, beside that the epithelial form of MM was the dominant histological pattern. [ABSTRACT FROM AUTHOR]

Background and aim Ascites in liver cirrhosis is associated with a poor prognosis and impairment of the quality of life and may be complicated by hepatorenal syndrome. Renal functions and haemodynamic changes after large-volume paracentesis (LVP) in cirrhotic patients with tense ascites were evaluated. Patients and methods A total of 50 cirrhotic patients with tense ascites were divided into two groups: group I 25 patients without renal impairment and group II 25 patients with renal impairment (type II hepatorenal syndrome). Results In groups I and II, the serum creatinine decreased significantly 24 h after LVP (P < 0.05 and 0.01, respectively). The glomerular filtration rate and the urine output increased significantly 24 h after LVP (P < 0.05, P < 0.01 and P < 0.01, P < 0.05, respectively, in groups I and II). The renal artery resistive index (RI) was significantly higher in group II compared with group I (P < 0.01). LVP caused a significant increase in the cardiac output, the stroke volume and the cardiac index (P < 0.01) and a significant decrease in the RI in both groups (P < 0.01). There was significant correlation between serum and ascetic fluid electrolyte levels in all patients. Conclusion LVP causes a significant reduction of heart rate and mean arterial pressure, serum creatinine, blood urea nitrogen and RI with a significant glomerular filtration rate increase, but had no effect on the plasma renin activity.

Background: degenerative lumbar disorders affect millions of people causing low back pain, which can restrict mobility and daily activities. Lumbar fusion operations are used as a treatment of degenerative lumbar disorders. However, the better choice among fusion techniques is still controversial. Objective: to compare the clinical and radiological outcome of Transforaminal Lumbar Interbody Fusion (TLIF) and Posterolateral fusion (PLF) in the treatment of degenerative lumbar spine stenosis and degenerative spondylolisthesis. Patients and Methods: a prospective study was conducted on 40 patients with degenerative lumbar spondylolisthesis and degenerative lumbar spine stenosis. Twenty patients underwent transforaminal lumbar interbody fusion and 20 patients underwent posterolateral fusion. Patients were followed up using the visual analogue scale (VAS) for back and leg pain and Oswestry Disability Index (ODI). Final fusion assessment was done according to Bridwell criteria. Results: ODI and VAS of leg and back pain improved in the two groups with no significant differences between the two groups whether after six or twelve months of follow up. TLIF group shows a high grade of fusion according to Bridwell grading criteria for spinal fusion and significantly better than the PLF group of patients either in six-month follow up (p=0.045) or twelve-month follow up (p=0.04). Conclusion: both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion. There is no significant clinical or functional outcome to support the use of TLIF over PLF in the treatment of degenerative lumbar disorders. [ABSTRACT FROM AUTHOR]

Aim: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients., Methods: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients' preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings., Results: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one or more) were found in 805 (25%) patients (19% group A vs 6% group B, P = 0.001). Seven patients had critical events during conscious sedation due to severe hypoxemia (< 60%). Rate of stricture in our study was 2.6%. Success rate of endoscopic dilation was 100%. One point nine percent patients with gastric leak were identified with 75% success rate of endoscopic therapy. Three point seven percent patients developed acute upper bleeding. Seventy-eight point two percent patients were treated by conservative therapy and EGD was performed in 21.8% with 100% success and 0% complications., Conclusion: Our results support the performance of EGD only in patients with upper gastrointestinal symptoms. Endoscopy also offers safe effective tool for anastomotic complications after bariatric surgery.