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Summary Objective The aim of this study is to explore the accuracy of two different approaches: transoral versus transnasal office-based laryngeal biopsy. Design Cohort-selection cross-sectional study. Setting Outpatient clinic of Phoniatrics in El Demerdash Hospital, faculty of medicine, Ain Sham University, Cairo, Egypt). Participants The study included all patients aged 18 years or more with suspicious lesions of the larynx or the oropharynx who are eligible for biopsy who came to the outpatient clinic due to different reasons during the period of March 2017 and March 2020. Main outcome measures Patients with suspicious lesions were referred for office-based-based biopsy—either transnasal biopsy or transoral biopsy. All patients were referred for subsequent direct laryngoscopy for definitive diagnosis. Results The overall sample was 60 cases with 30 in each group. The majority of both groups were smokers. The most frequent cause of referral for biopsy was suspicious laryngeal mass. The number of biopsies obtained was significantly higher in the transoral group. Both approaches were tolerated by all patients with few limited aspiration or epistaxis. The sensitivity of the transoral approach was compared with that of direct laryngoscopy and was 95.8% with a specificity of 83.3%. The sensitivity of the transnasal approach was compared with that of direct laryngoscopy and was 26.3%; the specificity was 90.9%. Conclusion The transoral approach to obtaining a biopsy from the upper aero-digestive tract has better diagnostic accuracy than the transnasal approach when combined with transnasal visualization and transcricothyroid anesthesia.

Background Penetrating abdominal trauma (PAT) poses a significant challenge to trauma surgeons. Laparotomy is still the most popular procedure for managing PAT but has high morbidity and mortality rates. Presently, laparoscopy aims to provide equal or superior visualization compared to open approaches but with less morbidity, postoperative discomfort, and recovery time. The aim of this research is to assess the impact of laparoscopy on the management of PAT. Methods This was a retrospective observational study carried out at the Emergency Hospital of Mansoura University/Egypt and at King Faisal Medical Complex, Taif/KSA from September 2014 to September 2018. All hemodynamically stable patients with PAT who were managed by laparoscopy were included in this study. Data extracted for analysis included demographic information, criteria of abdominal stabs, type of management, and perioperative outcome. Results Forty patients were recruited in this research and the male-to-female ratio was 5.6:1. The mean age of the patients was 31.4 ± 12.318 years. During the laparoscopic procedure, no peritoneal penetration was observed in 4 patients (negative laparoscopy), while peritoneal penetration was observed in the remaining 36 patients. No visceral injuries were noted in 2 patients of the 36 patients with peritoneal penetration, while the remaining 34 patients had intra-abdominal injuries. Conclusion Laparoscopy performed on hemodynamically stable trauma patients was found to be safe and technically feasible. It also reduced negative and non-therapeutic laparotomies and offered paramount therapeutic and diagnostic advantages for traumatic diaphragmatic injuries.

Introduction It is now evident that the loss of smell and/or taste may be consistent accompanying symptoms of the SARS-CoV-2 infection. Objective To estimate the social behavior of recent anosmic non-hospitalized patients in the COVID-19 pandemic and to try to obtain the natural pattern in society in a cross-sectional study. Methods A cross-sectional study conducted on 4,860 patients with anosmia complaints during the COVID-19 pandemic. Patients who needed a consultation for an anosmia complaint confirmed that they had completed the survey regarding age, gender, history of general diseases, history of nasal disease, associated COVID-19 symptoms, smoking, blood group, and risk factors. Results A total of 4,860 patients with a mean age of 34.26 ± 11.91 years completed the study. There was a predominance of female patients: 3,150 (58.9%). Most patients (4,083 patients; 83%) developed sudden anosmia. In 85% (4131 patients) of the patients, a previous history of contact with anosmic patients was present. The most prevalent blood group was O (39%). In total, 67.4% of the patients underwent medical treatment. A history of unusual influenza attacks in December 2020 was reported by by 27% (1312 patients) of the patients. Conclusion Despite large diversity of behaviors among anosmic patients in the COVID-19 pandemic, we can observe a great similarity in the pattern of anosmia in non-hospitalized patients, especially in the way it spreads, the predisposing factors, and the individual recovery.

Two millimetere needlescopic instruments induce minimal trauma to the abdominal wall and have excellent cosmetic results. However, these instruments are fragile and expensive with short weak jaws. The aim of this study was to present a novel needlescopic approach for inguinal hernia (IH) repair in girls using 1.6-mm suture grasper device (SGD), modified polypectomy snare (MPS) and a home-made snare (HMS). We refer to this technique as needlescopic inversion and snaring of hernial sac in girls. Over a period of 1 year from March 2018 to March 2019, a prospective study was conducted on girls that presented with IH. Preoperative inguinal ultrasound was performed in all patients to measure the internal inguinal ring (IIR) diameter. All hernias were repaired by our novel technique using two SGDs, MPS or HMS. Follow-up period was at least 12 months. Fifty-three girls with 74 hernias were included in this study, with a mean age of 38 ± 8 months. IIR diameter ranged between 8 and 15 mm with a mean of 11 ± 2 mm. Mean operative time was 15 ± 3 min in bilateral and 11 ± 2 min in unilateral presentations. All procedures were completed successfully with no conversion and without major complications. Follow-up ranged from 12 to 24 (median 16.5) months. Non-visible scars were obtained in all cases and there was no reported recurrence. Needlescopic inversion and snaring of inguinal hernial sac in girls using 1.6-mm instruments, MPS or a HMS is a safe, rapid and feasible method for IH repair. It has the advantage of invisible scars and no recurrence in the short-term outcomes.

Aim: To evaluate effectiveness of multiple rotary file systems on removal of the filling materials during retreatment of oval-shaped root canals. Methods: 40 oval root canals were instrumented with ProTaper Next to size X4. The canals were allocated into two equal groups according to the final rinse, Group I: with Biopure MTAD, and Group II: with 17% EDTA. All the canals were obturated with bioceramic based root canal sealer and gutta-percha using lateral compaction technique. According to the used retreatment rotary system, each group were further subdivided into two equal subgroups including subgroups Ia & IIa using D-Race (DR1) + XP-endo Shaper (XPS) + XP-endo Finisher R (XPFR), and subgroups Ib & IIb using R-Endo retreatment files up to R3 + Revo-S rotary files up to (40/.06). CBCT scans were used to calculate the remaining amount of root filling materials at the pre scan (after obturation), and that of air at the post scan (after retreatment). The dentin volumes were also recorded at both scans to analyze the amount of remaining filling materials. Results: No significant differences were recorded regarding the amount of residual filling material with the tested systems (p > 0.05). Intra subgroups assessments showed more filling material removed when using a larger sized final instrument (p < 0.001). Conclusions: Tested file systems were evenly efficient in removing filling materials from oval-shaped root canals of extracted molars. Types of chelators used and bioceramic based sealer had no significant validity on effectiveness of removal of root canal filling material.

Background: This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine the effectiveness of various palatal surgical techniques in treating OSAS and the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods: The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA). The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross-sectional studies as well as NIH tool for quality assessment for case series studies. Results: Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI (Apnea/Hypopnea Index) was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD = −0.848, 95% CI (−1.209 - −0.487), p-value < 0.001) and (SMD = −0.864, 95% CI (−1.234 - −0.494), p-value < 0.001), respectively]. The technique responsible for the best improvement in Epworth Sleepiness Score (ESS) was the Relocation Pharyngoplasty, with a significant mean reduction of [SMD = −0.998, 95% CI (−1.253 - −0.743), p-value < 0.001]. Minimal O2 saturation level improved most with the Expansion Sphincter Pharyngoplasty, with a significant mean reduction of [SMD = 1.011, 95% CI (0.581 - 1.440), p-value < 0.001]. The surgical procedure that results in the best post-operative Visual Analogue Scale (VAS) was Z-Palatoplasty, with a significant mean reduction of [SMD = −1.551, 95% CI (−2.049 - −1.052), p-value < 0.001]. Soft palate length changes with a significant mean reduction of [SMD = −2.219, 95% CI (−2.730 - −1.708), p-value < 0.001]. Finally, meta-analyses of relevant studies showed that expansion sphincter pharyngoplasty achieved the overall highest success rate [event rate = 77%, 95% CI (65.4% - 85.5%), p-value < 0.001]. Conclusion: The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Objective: This case-control study aimed to detect the presence of fungal biofilms in cases of fungal sinusitis, trying to find its role in recurrence of fungal sinus infection and resistance to medical treatment. Patients and Methods: This study was conducted at Ain-Shams University from June-2017 to June-2018 upon 20 patients as the fungal cases are not much in Egypt. All patients were subjected to functional endoscopic sinus surgery and taking specimens. Examination of specimens by scanning electron microscope was made. Results: The prevalence of fungal biofilms was 7 (70%) in cases and 0 (0%) in controls (p-value = 0.001). There is higher risk of fungal biofilms in cases of fungal sinusitis, the odds of biofilms is higher in the study group 2.33 than in the control group 0. The lower is the invasiveness, the higher is the fungal biofilms (OR = 0.94, 95% CI 0.46 - 4.05). Also, the analysis showed that the lower is the recurrence the lower is the fungal biofilms (OR = 2.25, 95% CI 0.15 - 7.93). Conclusion: This study showed the presence of fungal biofilms in different cases of fungal sinusitis whether primary or recurrent, also whether invasive or non-invasive. Studies with large sample size are recommended to get a strong evidence.

Background The growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations. Methods This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol. Discussion This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD. Systematic review registration PROSPERO CRD42020175016.

Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up.To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care.We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations.Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital.Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD).We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence).There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.

Background Sometimes it becomes a dilemma to repair a failed circumcised distal penile hypospadias with partial or complete wound dehiscence. In many of these cases, redo operations need a graft or a flap. The aim of this study is to evaluate the double-folded meatal-based flap in redo circumcised hypospadias with shallow urethral plate and a small glans penis. Results From September 2015 to August 2018, we prospectively studied the double-folded meatal-based flap in 56 failed circumcised distal hypospadias without penile curvature with shallow urethral plate and a small glans penis. Distally folded Mathieu flap was done. Forty-seven cases only had completed the study. We had 19 patients with distal penile hypospadias, 19 with sub-coronal hypospadias, and 9 with coronal hypospadias. Median operative time was 50 (range 40–80 min). The median length of the double-folded flap was 14 (range 10–18 mm). The median follow-up was 12 (range 1–33 months). The success of the operation means that there is an absence of any complications. Our success rate was 73%. We had 8 patients with meatal retraction, one fistula, and one patient with wound disruption. Only 3 patients (6.4%) needed re-operation: one case with meatal retraction, another with fistula, and a third with complete wound disruption. Conclusion Distally folded meatal-based flap is an additional option in redo circumcised hypospadias with shallow urethral plate, small glans penis, and pliable anterior penile skin with a considerable high percent of meatal recession.

Objective To report the outcomes of surgical correction of post-circumcision webbed penis using two previously described techniques: the Heineke-Mikulicz (HM) scrotoplasty and the multiple Z-plasty. Patients and methods A prospective study of children with post-circumcision webbed penis was conducted. The patients were classified into two groups according to the degree of web and the remaining ventral penile skin as to whether adequate or short after circumcision. Group I was repaired by HM scrotoplasty and in Group II the multiple Z-plasty technique was used. Results This study included 86 patients of whom 71 maintained follow-up; 44 (62%) in Group I and 27 (38%) in Group II. The median (range) operative time was 45 (30–55) min in Group I and 75 (60–90) min in Group II. Wound infection occurred in two (4.5%) patients in Group I. In Group II postoperative mild self-limited penile oedema was present in three patients (11.1%). A self-limited scrotal haematoma developed in two (7.4%) patients. Conclusion Correction of post-circumcision webbed penis in children can be done by one of two techniques: HM scrotoplasty in Grade 1 and multiple Z-plasty in Grade 2 and Grade 3, with favourable outcomes. Abbreviations HM: Heineke-Mikulicz; IQR: interquartile range

Background The first description of a patient with obstructive sleep apnea was in ‘The Posthumous Papers of the Pickwick Club’ published by English writer Charles Dickens in 18361. The first introduction of the terms ‘sleep apnea syndrome’ and ‘obstructive sleep apnea syndrome’ was by Guilleminault et al in 1967. Subsequently, Guilleminault coined the term ‘upper airway resistance syndrome’ in 19932. Objectives This paper aims to examine published articles between January 2008 and January 2019 on the different palatal surgeries performed on OSA patients and the treatment outcomes, which in turn will be used to determine two things. The first being the effectiveness of various palatal surgical techniques in treating OSAS and the second (if applicable) the most effective of the palatal surgical techniques in treating OSAS. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA)5. The detailed steps of methods were described elsewhere as well as PRISMA checklist. The quality of relevant studies was assessed using NIH quality assessment tool for observational cohort and cross -sectional studies as well as NIH tool for quality assessment for case series studies. Results Meta-analyses of relevant studies showed that the surgical technique that achieved the best reduction on AHI was the lateral pharyngoplasty followed by the Anterior Palatoplasty, with a significant mean reduction of [(SMD= -0.848, 95% CI (-1.209 – -0.487), p-value Conclusion The best procedure for treating OSA varies from patient to patient and there is no universal cure-all. Careful patient selection and pre-operative evaluation are mandatory.

Background: Alar rim collapse is an agonizing problem that has both cosmetic and functional sequalae. It has been usually addressed with batten grafts. In this study, we are describing a simple technique for insertion of alar rim grafts to fix external nasal valve collapse.Patients and Methods: Between January 2018 and October 2020, eighteen patients with alar rim collapse or deformities were addressed using alar rim septal cartilage grafting.Results: All patients who underwent alar rim grafting for external nasal valve collapse were evaluated functionally and aesthetically with post-operative follow up ranging from 12 to 24 month. During which, they showed marked improvement in their nasal airway patency with complete satisfaction for the aesthetic outcome. No complications were encountered.Conclusion: Alar rim grafting is a simple and effective approach to provide support for the external nasal valve and alar contour. In cases of malpositioned lower lateral cartilage, alar flaring, nasal tip deformities, mild retraction, or contour asymmetries, these cartilage grafts showed good outcomes in primary or revision cases.

Objective To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes. Design Systematic review and network meta-analysis (NMA). Methods Data sources—Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction—All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis—We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach. Results A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD –0.92, 95% confidence interval −1.55, −0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes. Conclusion and implications Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.

Introduction Achieving a hermetic apical seal is mandatory to prevent ingress of any microorganisms or periapical fluids into the root canal system. Therefore it is essential to develop new materials having favorable physical, chemical and biological properties. Aim the purpose of this study was to use scanning electron microscopy to compare the marginal adaptation of new formulation of MTA (Harvard MTA), MTA flow and glass ionomer as root end filling materials using ultrasonic root-end preparation. Methodology Thirty-nine extracted single rooted human teeth were prepared using Protaper Next file system (Dentsply/Sirona) and filled with gutta-percha and MTA fillapex sealer (MTA Fillapex; Angelus, Londrina, Brazil) and obturated using cold lateral compaction technique. The apical 3 mm of the roots were sectioned perpendicular to the long axis of the roots. A 3-mm depth root-end cavity was prepared with ultrasonic tips powered by an Enac ultrasonic device. The teeth were randomly allocated into three groups of 13 teeth each according to filling materials tested. Group I the samples were filled with Harvard MTA (Universal, Handmix, Germany, Harvard), Group II filled with MTA Flow (Ultradent Products Inc., South Jordan,UT, USA), group III filled with glass ionomer (Fuji II, GC gold label 2, GC International, Japan). Using SEM the distance between the tested materials and the surrounding dentin was measured at different points.Results According to the results of Kruskal-Wallis, there was significant difference between the three experimental groups at P value 0.01. The Man Whitney test was used for two-by-two comparison of the groups which revealed no statistical significant difference between MTA flow and MTA Harvard group however; there was statistically significant difference in Glass Ionomer group. Conclusion SEM results showed the presence of gaps in the root-end filling materials in all groups. MTA flow has the best marginal adaptation followed by MTA Harvard while the Glass Ionomer showed the least marginal adaptation.

The aim of this study is to evaluate the bond strength of AH Plus sealer after irrigation of the root canals using of Nano-Silver and Sodium hypochlorite. Sixty, freshly extracted, sound maxillary anterior teeth with completely formed apices and straight roots were used in this study. Each tooth was decoronated to provide approximately 16 mm± 1 of root, root canals with initial apical file size #20 were selected to approximately standardize the canal diameter. The samples were divided into two groups 30 root each according to the irrigation protocol used through instrumentation: Group A: root canal preparation was performed using the Protaper Next system during instrumentation the root canals were irrigated using Nano-Silver irrigant 0.02mol/L = 2000ppm. Group B: root canal preparation was also performed using the Protaper Next system but during instrumentation the root canals were irrigated using Sodium Hypochlorite (NaOCl) irrigant 5.25%. Root canals of each group were then obturated using master cones of #40/06 and AH Plus sealer in lateral condensation technique. 2mm thick slices of apical, middle and coronal root portion for all samples were prepared for assessment of push out bond strength for the two groups.Results showed that AH plus sealer had a lower value of push out bond strength ( 1.223± 0.533) in the group irrigated using nano silver than the second group irrigated with sodium hypochlorite (2.321 ± 0.650) at the coronal third with statistically significant difference( P= 0.004), also at the middle third it showed a lower value (1.732 ± 0.899) than the sodium hypochlorite but with no statistically significant difference, and finally at the apical third it also a lower value of push out bond strength (2.103 ± 1.319) than the other group irrigated with NaOCl (5.045 ± 1.397) with statistically significant difference (0.001)

This study aimed to compare the antimicrobial effect of Nano-Silver Irrigant, Sodium Hypochlorite and Chlorohexidine against Enterococcus Faecalis bifilm. 60 Sixty, recently extracted, sound maxillary anterior teeth with completely formed apices and straight roots were selected in this study. Canals were instrumented using the Protaper Next system (Dentsply Sirona) 1 mm shorter from the apical foramen up to size X5 ( size# 50/06). Sterility of the teeth after complete root canal cleaning and shaping were achieved by autoclaving for 15 min at 121oC with the teeth immersed in distilled water. Enterococcus Faecalis Biofilm was prepared by mixing 5 mL of the bacterial inoculum with sterilized BHI, then inoculated in teeth samples for 60 days. Teeth were then divided after the incubation period into three groups; 20 teeth each, and were treated by delivering the each of the tested irrigating solution using sterile plastic syringes. The first group was treated with Nano-Silver 0.02mol/L (2000ppm) while the second was treated using with Sodium Hypochlorite (NaOCl) 5.25% and the third was treated usinwith Chlorohexidine (CHX) 2.0%. Serial rinses ensured 5 minutes contact period between the aseptic solution and the bacteria. Sterile paper points size 50 were introduced into the canals and maintained for 3 min for sample collection, after which the paper points were placed in test tubes containing 2ml of sterile saline and several dilutions were prepared. 100 µL of each dilution was applied to the blood agar culture plates and incubated at 37oC for 24 hours. A classical bacterial counting technique was used for each group after the treatment application for the recovery of viable E. faecalis on agar plates The results showed that the NaOCl had the highest antibacterial activity with high statistically significant difference with the other groups followed by the chlorhexidine group which also show statistically significant difference than the other two groups, then came the nano silver irrigant group which showed the lowest antibacterial activity among all the groups with statistically significant difference with them.

Les outils cliniques employes dans les etablissements de soins peuvent fournir des informations pronostiques importantes aux professionnels de la sante. Dans cette etude observationnelle prospective d'un an, nous avons examine l'association entre les scores au Short Performance Physical Battery (SPPB), d'une part, et les consultations a l'urgence et les hospitalisations au cours de l'etude, d'autre part. Au total, 191 patients ayant ete nouvellement referes a une clinique geriatrique externe de Hamilton (Ontario) ont ete contactes, et parmi eux, 120 pris part a l'etude. Le SPPB et d'autres evaluations ont ete realises dans le cadre de consultations de routine. Les dossiers medicaux electroniques ont ete examines pour determiner le nombre de consultations a l'urgence et d'hospitalisations dans l'annee qui a suivi l'evaluation de base. Des analyses de regression logistique ont ete utilisees pour identifier des predicteurs des consultations a l'urgence et des hospitalisations. Le score moyen au SPPB dans la cohorte etudiee (moyenne d'âge = 80,6 ans, ecart-type = 6,3 ans ; 53 % de femmes) etait de 6,3 (ecart-type = 3,2). Au cours de cette periode d'un an, le score au SPPB etait associe au nombre de consultations a l'urgence [RR = 0,90 (0,78-1,03)] et d'hospitalisations [RR = 0,84 (0,72-0,97)], apres ajustement pour l'âge, le sexe et les comorbidites. Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78–1.03]) and hospitalization (OR = 0.84 [0.72–0.97]) after adjusting for age, sex, and co-morbidities.

Background: In mitral valve prolapse is associated with severe mitral regurgitation, mitral valve repairor surgical replacement may be necessary. In Mitral valve replacement, some surgeon use continuoussuture, others use interrupted suture technique.Aim of the work: to compare efficacy of semi-continuous technique & interrupted suture of prosthesticvalve replacement in mitral valve replacement.Patients and Methods: it was a prospective randomized comparative study done at the CardiothoracicSurgery Department, Qena University Hospitals, South Valley University, Egypt between April 2016 toApril 2018. It included 31 patients with rheumatic mitral valve disease whatever the cause. They weredivided into group1: patients underwent semi-continuous technique for MVR (18 cases) and group2:patients underwent interrupted technique (13 cases).All of patients were subjected to preoperative data:complete history, general examination including general condition of the patient and vital signs,investigations including routine laboratory investigations, especially complete blood count, chest X ray(CXR), 12 lead Electrocardiography (ECG), echocardiography and coronary angiography if patientmore than 40 years old, operative data including total bypass time, aortic CCT, number of sutures, andpostoperative outcome including ICU stage and inotrope use, postoperative complications, pulmonaryhypertension and echo findings as immediate postoperative and echo after 1 and 3 monthspostoperative.Results: We found that the mean total bypass time was significantly higher among interrupted group compared to semicontinuous one.Conclusion: Semicontinuous sutures showed significantly better results than interrupted ones,especially regarding the total bypass time

Aim: This study compared the efficacy of gutta percha and sealer removal during retreatment using Protaper universal retreatment rotary files, D-Race rotary files and hand files with Gates Glidden. Methods: Thirty six extracted single rooted teeth were selected for the current study. The canals were prepared using a modified crown-down technique then filled using the lateral compaction technique. Specimens were randomly divided into 3 equal groups each consisted of twelve specimens. Group one used manual files, group 2 used D-Race system while group 3 used Protaper retreatment system. Samples were split longitudinally and examined under the stereomicroscope. Results: No significant differences among the Protaper and the D-RaCe groups in the mean values of root canal filling remnants, whereas the hand files and Gates Glidden group differed significantly. Conclusion: D-Race and Protaper retreatment files removed gutta percha and sealer more efficiently than hand files and Gates Glidden. Keywords: D-race, Protaper, Gutta percha, Steriomicroscope, Hand files

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.

Background There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Patients and methods Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. Results A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. Conclusions Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

BackgroundThe increase rate seen in Total Hip Arthroplasty (THA) for younger patients has implications for future rehabilitation demands for primary and revision THA surgery. This study aims to determine the impact of a 6-week post-operative rehabilitation program designed for THA patients ≤ 60 years on physical activity (PA) and function compared to age- and a sex-matched control group received usual postoperative care at 12-week post-THA. MethodsIn this quasi-experimental study, a cohort of THA candidates was recruited during their 6-week postoperative visit to their surgeons. The out-patient rehabilitation program consisted of 12 structured exercise classes (2 hrs/class) over 6 weeks. Physical activity was assessed using Sense Wear Pro ArmbandTM [SWA]. Participants completed the Hip Osteoarthritis Outcome Score (HOOS), and THA satisfaction questionnaire before and immediately after the intervention. ResultsThe intervention group took significantly more steps/day at the follow-up compared to baseline. The intervention group had a higher mean change in the number of weekly PA bouts than the control group. Within the intervention groups, all HOOS subscales were significantly higher at the follow-up compared to baseline. ConclusionThe augmented rehabilitation program may have immediate effects on pain relief and symptom reduction for patients (≤60 years) following THA.

Financial inclusion is currently a very important event that had drawn many international organizations to talk about and try to spread all over the world. It had shown its importance for individuals and organizations. Financial stability is now so important in the economy of any country in which it refer to the capability of the economy and financial institution to resist internal and external economic shocks to achieve its primary functions. In this research we tried to find the relationship and the effect of the financial inclusion on the financial stability in the SME’s as the SME’s is the drivers for the country growth. The research will be applied on the Egyptian economy and our expectation that there is a positive relationship between the two variables. In this study, the focus was on analyzing the different stakeholders (CBE, FRA, and the Ministry of Finance) in promoting financial inclusion for different targeted beneficiaries mainly SMEs. The study tested the relationship between the Financial Inclusion & the financial stability. The importance of the study comes from the claim that financial inclusion can have over Egypt’s economic growth on different potential beneficiaries. The thesis general framework tried to find the link between FI & FS in Egypt SME’s through an exploratory study to identify the relationship and the recent progress achieved towards increasing the inclusive financial system for Egypt. Data was collected through questionnaire in which a questionnaire was distributed among a different participants that reached almost 200 participants and respondents reached 103 respondents and results were collected and analyzed through SPSS.

Objective: The aim of this study is to show another possible cause of oropharyngeal fibrosis causing breathing difficulty and dysphagia, and to demonstrate the possible effects of Khat chewing on the pharynx and larynx. Methods: This cross-sectional study included all patients using Khat referred to Phoniatric Unit, Oto-Rhino-Laryngology department[removed for blind peer review] due to different reasons during the period of March-2017 and September-2019. A nine-question self-administered structured questionnaire was developed to covers all the socio-demographic factors in addition to Khat chewing habits. Full endoscopic evaluation was made and biopsies were obtained whenever possible. Patients were grouped into two groups; one using hot Khat (insecticide-irrigated) and the other using cold Khat (not insecticide-irrigated). Results: The overall sample was 120 cases; 22 are using hot Khat and 98 cold Khat. Both groups are comparable with regard age, gender, smoking, duration of using Khat as well as its frequency. Reasons for referral for clinic were different between groups (p

Background :laparoscopic groin hernia repair has gained wide popularity in surgical practice in the last two decades. Trans abdominal pre peritoneal (TAPP) and totally extra peritoneal (TEP) repair are standing head to head as the most common laparoscopic techniques for groin hernia. Methods: This prospective randomized study was conducted between December 2013 and December 2015. Sixty male patients suffering from non complicated inguinal hernia were included. Patients were randomized into group A (TAPP) and group B (TEP). Intra operative variables and postoperative pain and complications were recorded in a pre structured form Results: In TEP group patient had lees post operative pain, were able to resume their normal daily activities and spent less operative time than TAPP group. No significant difference in terms of Intra operative and post operative complications between both groups. Conclusion: . TEP has a significant advantages over TAPP in reduction of operative time and postoperative pain, which resulted in earlier recovery and return to normal activity. Although both techniques seem to effective, TEP has a step over TAPP.

Background: Type 2 Diabetes Mellitus (T2DM) is an important health problem worldwide with about 23% of patients with morbid obesity have type 2 DM. Bariatric surgery originally developed solely as a weight-reduction therapy, but has been found to improve T2DM and to reduce rates of chronic vascular disease and death. The International Diabetes Federation have recommended consideration of bariatric surgery for control of T2DM.Methods: A total number of 45 patients were randomized into two groups, the first group with 26 patients (n=26) were submitted for Biliopancreatic Diversion (BPD) and the second group with 19 patients (n=19) were planned for Roux-en-Y Gastric Bypass (RYGBP). The main objective was to compare the efficacy of bariatric surgery in inducing clinical remission of T2DM mellitus in patients with body mass index less than 35 in both groups.Results: The operations were performed laparoscopically in all patients. There were no conversions, operative compli-cations or mortality. Data were collected during a two-year follow-up period and were analyzed at the following periods; pre-operatively and post-operatively at 1 months, 4 months, at 8 months, at 1 year and 2 years. The analyzed parameters included the levels of BMI, FBG, HbA1c, Triglycerides and cholesterol. There were no statistical significant difference between the two groups regarding the BMI, mean glucose levels, and HbA1c levels. However the levels of triglycerides were higher in the BPD group, while the levels of cholesterol were higher in the RYGBP group during most of the follow-up periods.Regarding the diabetes outcome, there was significant reduction of patients who showed diabetes remission at one year and those who remains remittent at 2 year, while the number of patients who showed diabetes failure tripled at 2 years follow-up.Conclusions: Although, BPD is known to have a better effect on type 2 DM in the higher BMI group. There was no difference regarding glycemic control between BPD and RYGBP. And both operations failed to maintain glycemic control at long term follow-up periods.

Aim: The present study aimed to compare between apical bacterial leakage of obturating systems such as EndoRez, ActiV GP and AH Plus sealers using gutta-percha, with two different irrigating materials Biopure MTAD (mixture of doxycycline, acetic acid and detergent) and 2.25% sodium hypochlorite (NaOCl). Methods: Seventy extracted human mandibular premolars with single canal were divided into two equal groups of 30 samples each according to the irrigating solution used either Biopure MTAD or 2.25% NaOCL. The other 10 teeth (5 roots positive group and 5 roots negative group) were used as control. The main groups were subdivided into 3 subgroups according to the obturation system used, EndoRez, ActiV GP or AH Plus with gutta percha. Sealing ability was assessed using Enterococcus faecalis (E. faecalis) in a double chamber leakage model. Samples were monitored weekly for periods of 1, 4 and 8 weeks to assess the turbidity of the medium in contact with the lower coronal portion of the root segment. Results: Showed statistically significant increase in the mean apical leakage with specimens irrigated with 2.25% NaOCL than Biopure MTAD in all periods, while roots obturated with EndoRez showed less statistically significant leakage than the rest of the experimental materials at 1 and 4 weeks periods while, at 8 weeks period all the experimental materials showed leakage with no statistically significance difference. Conclusion: EndoRez when used after Biopure MTAD irrigation provides better sealing with root canal dentin.

Proper assessment of risk factors contributes to the principle management of differentiated thyroid carcinoma post operatively. Aim of the study: to investigate the effect of Thyroglobulin (Tg) levels on prognosis together with other risk factors for Differentiated Thyroid Cancer (DTC). Patients and methods: Medical records of all patients with DTC presented to Clinical Oncology and Nuclear Medicine Department referred from Diabetes & Endocrine unit (Internal Medicine Hospital) and Surgery Department Mansoura University from 2011-2016 were retrospectively reviewed. Patients with distant metastasis or who lost follow-up were excluded. So data of 220 patients were analyzed. Data collected included pre-surgical assessment, also surgical interference either total or near total thyroidectomy with or without lymph node neck dissection were reviewed. Different prognostic factors that affect progression free survival (PFS) include age, umorsize, ymph node status, ex, multifocality, capsular infiltration, vascular invasion and Tg level were evaluated through multivariate analysis. Results: Most of the patients included were

Summary Background Webbed penis is a cause of concealed penis. It reflects abnormal attachment of the scrotal skin to different ventral penile shaft levels, possibly due to abnormal scrotal dartos insertion. Different techniques are available for correction of congenital webbed penis. However, there is no single one versatile for correction of different grades. Objective To evaluate the surgical outcome of penile degloving, excision of abnormal dartos fascia with penoscrotal fixation sutures to correct different grades of congenital webbed penis. Study design This prospective study was conducted on boys with congenital webbed penis. Thorough clinical examination to determine the degree of webbed penis and associated anomalies were done. A technical modification of previously described technique by Frenkl et al. 2004 (22) was used. The principles include; complete penile degloving with excision of all abnormal scrotal dartos attached to the penile shaft, creation of a well-defined penoscrotal angle by penoscrotal fixation sutures and the short ventral skin was compensated from the prepuce with circumcision. Assessments of surgical outcomes and parents' satisfaction were done during follow up visits. Results This study included 107 boys. The median age was 9 (range, 6–40) months, and the median operative time was 55 (range, 50–65) min. Five patients (4.7%) developed self-limited postoperative penile edema, two (1.9%) developed wound infections, and two (1.9%) had a self-limited scrotal hematoma. The median follow-up period was 19 months. At the 6 months follow-up, we had two patients with persistent mild grade I webs, with a success rate of 98.13%. Parental satisfaction was obtained for all patients. Discussion Currently, there is no current single technique suitable for the correction of all grades of webbed penis. In this study, we presented a technical modification of previously described technique by Frenkl et al. 2004 (9), this modified technique is versatile for correction of different grades of congenital webbed penis without leaving a scar at the penoscrotal angle. But, absence of a comparative group is considered a limitation; however, the versatility of this technique overcomes this limitation. Conclusions This described technique is simple and feasible. It could correct all types of congenital webbed penis. Short term outcome showed good cosmetic and functional results with parental satisfaction. Download : Download high-res image (2MB) Download : Download full-size image Summary Figure. . The principles of the technique.

Introduction: The objective of this cross-sectional study is to describe the prevalence and severity of self-reported musculoskeletal disorders (MSDs) in firefighters and how these vary by demographics and length of service (LOS). Methods: A cohort of 294 active-duty firefighters completed a body diagram to indicate the location and pain intensity of their MSK complaints. Where painful sites were indicated, they completed the relevant region-specific self-report disability measure – Neck Disability Index (NDI), Roland Morris Disability Questionnaire (RMDQ), Lower Extremity Functional Scale (LEFS), or the Short Form of Disabilities of the Arm, Shoulder and Hand (QuickDASH) – to quantify severity. Prevalence was determined from the body diagrams and severity from the site-specific self-report questionnaires. Differences in MSK severity based on demographics or LOS were determined using ANOVA. Results: The 294 active-duty firefighters had a mean age of 42.6 (SD 9.7) years and mean duration of service of 15.1 (SD 10.1) years. The prevalence of neck, back, upper-limb, and lower-limb complaints was 20%, 33%, 44%, and 45% respectively. Firefighters 42 years or older reported significantly more severe lower-extremity disability (median (IQR) LEFS: 71 (65, 77) vs. 75 (69.5, 78.5), p=0.03) and more severe back disability (median (IQR) RMDQ: 2 (1, 3) vs. 1 (0, 2), p=0.04). Firefighters with 15 years or more of firefighting service reported significantly more severe lower extremity disability (median (IQR) LEFS: 71 (64, 77) vs. 76 (70, 79), p=0.0005). Firefighters reporting >1 MSDs were significantly older than firefighters reporting no MSD ( F(5,285)=3.3, p=0.002). Discussion: The rate of MSDs is high in firefighters, and their severity is elevated with greater age and LOS, suggesting cumulative exposures/injuries and highlighting the need for ongoing assessment of the musculoskeletal system and interventions to reduce injury throughout firefighters' careers.

This is a prospective randomized study aimed to evaluate the round window membrane (RWM) surface tension in facilitating slim electrodes insertion during cochlear implantation. A total number of (118) children were included in this study (118 implantations). Mean age was 36.72 months (range from 18 to 60 months). This study was conducted from January 2015 to September 2016 at a cochlear implant centre in a tertiary referral hospital. Slit incision in the anterosuperior quadrant of the RWM was done in 70 cases, While RWM cruciate incision was done in 48 cases. Of the 48 patients who underwent RWM cruciate incision, 13 cases had no problem, while in 35 cases, we faced difficult insertion. When slit incision of the RWM was done (70 cases), 68 cases showed smooth insertion, meanwhile, we faced increased operative time due to flopping of the electrode in 2 cases only. Moreover, residual low-frequency hearing preservation was more achieved when slit incision of the RWM was done. Tensile strength of the round window membrane after slit incision of the RWM offers support to slim electrodes during introduction, decreasing incidence of kinking and floppiness, hence shortening the maneuver time and minimizing the number of trials. This facilitates easy smooth slim electrodes introduction, decreasing intracochlear trauma. Moreover, slit incision of the RWM may offer better residual hearing preservations than cruciate incision of the RWM during slim electrodes introduction.

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n=24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n=8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement+10% calcium hydroxide+20% bismuth oxide (Port Cal) and subgroup 3: Portland cement+bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively.

ObjectiveThe task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.MethodsThese recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care.Recommendations for Screening and AssessmentThe task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation).Recommendations for ManagementA comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing current practice and recommendations.We included publications from January 2007 to June 2017. We searched Embase, MEDLINE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews for clinical studies and surveys of surgeons; WorldCat for textbooks; and web sites for guidelines and institutional protocols.We identified 223 eligible publications that reported 100 clinical practice patterns and 276 recommendations with regard to systemic antibiotic administration, and 3 recommendations regarding local antibiotic administration alone. Most publications of clinical practice patterns used regimens with both gram-positive and gram-negative coverage and continued the administration for 2 to 3 days. Most publications recommended prophylactic systemic antibiotics. Most recommendations suggested gram-positive coverage for less severe injuries and administration duration of 3 days or less. For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Most publications reported intravenous administration of antibiotics immediately.Current practice and recommendations strongly support early systemic antibiotic prophylaxis for patients with open fractures of the extremities. Differences in antibiotic regimens, doses, and durations of administration remain in both practice and recommendations. Consensus with regard to optimal practice will likely require well-designed randomized controlled trials.The current survey of literature systematically provides surgeons' practice and the available expert recommendations from 2007 to 2017 on the use of prophylactic antibiotics in the management of open fractures of extremities.

The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.

Background/aim Vestibular and perineal fistulae are the most common anorectal malformations in female infants. The progress in surgical correction has been aimed at achievement of both good continence and cosmetic outcome. This study aimed to present two-center experiences in one-stage sphincter-saving modification of anterior sagittal anorectoplasty for vestibular and perineal fistulae in female infants. Patients and methods This prospective study was conducted on 38 patients. They were divided into vestibular and perineal groups. The position of anus was marked by Pena stimulator, and traction suture were placed around the fistula. With longitudinal midline perineal incision, separation of the rectum from posterior vaginal wall. The center of anal sphincter muscle complex was identified and the rectum was passed through it, finally anoplasty with reconstruction of perineal body. Continence was evaluated by Krickenbeck and Holschneider scores in patients older than 3 years. Results The mean age was 60.26 days. The mean operative time was 109.61 min. The rectum was passed through the intact sphincter in all cases. A total of three (7.89%) cases developed superficial wound dehiscence that was treated conservatively, one (2.63%) case needed colostomy and anal dilatation was done for 3 months, one (2.6%) case developed anal stenosis corrected by anoplasty, and five (13.15%) cases developed minor mucosal prolapse, with spontaneous improvement. Constipation occurred in six (15.78%) patients and was controlled by diet modification and laxatives. Good continence was obtained. Conclusion One-stage sphincter-saving anterior sagittal anorectoplasty is safe and feasible technique in vestibular and perineal fistulae in female infants. The short-term outcome show good cosmetic and functional results regarding continence.

Falls are the leading cause of injury and injury-related hospitalizations for seniors in Canada with annual healthcare costs exceeding $2 billion. Despite limited evidence of effectiveness, the withdrawal (discontinuation or dose reduction) of “fall-risk increasing drugs” (FRIDs) is typically part of falls prevention strategies and hospital accreditation initiatives. The study objectives were to determine the preventative efficacy of FRID withdrawal on falls and fall-related complications. An electronic search was conducted in MEDLINE, EMBASE, CENTRAL and CINAHL. A grey literature search included trial registries and conference abstracts. All randomized controlled trials in adults age ≥ 65 evaluating FRID withdrawal compared to usual care on falls rate or incidence, fall-related injuries, fractures or hospitalizations and/or adverse effects related to the intervention were included. Two reviewers independently screened eligible studies, abstracted data and assessed risk of bias. The GRADE criteria were used to rate overall confidence in effect estimates for outcomes. Five trials involving 1309 participants met eligibility criteria for inclusion. A FRID withdrawal strategy did not significantly change the rate of falls (RaR 0.98, 95% CI 0.63 to 1.51), number of fallers (RR 1.06, 95% CI 0.84 to 1.34) or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to 1.39) over a 6 to 12 month follow-up period. There is insufficient evidence that a FRID withdrawal strategy is effective for preventing falls. Based on very low quality evidence, it is uncertain whether FRID withdrawal leads to any appreciable clinically important benefit. Data evaluating the potential harms of FRID withdrawal is lacking.

Background Frailty is a common syndrome affecting 5–17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-analyses provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives. This systematic review and network meta-analysis of RCTs aims to determine the comparative effect of interventions targeting the prevention or treatment of frailty. Method We will identify relevant RCTs, in any language and publication date, by a systematic search of databases including MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Central Registry of Controlled Trials (CENTRAL), HealthSTAR, DARE, PsychINFO, PEDro, SCOPUS, and Scielo. Duplicate title and abstract and full-text screening will be performed. Authors will extract data and assess risk of bias (using the Cochrane Risk of Bias tool) of eligible studies. The review interventions will include (1) physical activity only, (2) physical activity with protein supplementation or other nutritional supplementation, (3) psychosocial intervention, (4) medication management, (5) pharmacotherapy, and (6) multi-faceted intervention (defined as an intervention that combine physical activity and/or nutrition with any of the following: (1) psychosocial intervention, (2) medication management, and (3) pharmacotherapy). Our primary outcome is difference in change of physical frailty from baseline measured by a reliable and valid frailty measure. Secondary outcomes and the assessments are (1) cognition, (2) short physical performance battery, (3) any other physical performance measure, (4) treatment cost, (5) quality of life, and (6) any adverse outcome. We will conduct a network meta-analysis using a Bayesian hierarchical model. We will also estimate the ranking probabilities for all treatments at each possible rank for each intervention and will assess the certainty of the estimates of effect using GRADE approach. Discussion To the best of our knowledge, this will be the first systematic review and network meta-analysis considering the direct and indirect effect of interventions targeting frailty prevention or treatment. Given the established high prevalence and socio-economic burden of frailty, there is an urgent need for a high-quality systematic review to inform evidence-based management of frailty. Systematic review registration PROSPERO 2016 CRD42016037465. Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0522-7) contains supplementary material, which is available to authorized users.

Background To compare the results obtained with T3 versus T4 sympathectomy in treatment of primary palmar hyperhidrosis (PH). Methods By retrospective review of medical records of patients with PH who underwent thoracoscopic sympathectomy from February, 2009 to September, 2012. The patients were categorized into two groups: T3 group underwent T3 sympathectomy and T4 group underwent T4 sympathectomy. Patients were evaluated according to the results of sweating, compensatory hyperhidrosis (CH), degree of satisfaction, complications and recurrence. Mean follow up was 19 ± 7 months. Results A total of 274 consecutive patients with PH were included in this study. There were 169 females and 105 males, with mean age of 29 ± 11 years. 129 patients underwent T3 sympathectomy (T3 group). The T4 group included 145 patients who underwent T4 sympathectomy. 71.7% patients of T4 group did not complain of CH in comparison to 25.6% patients in group T3 ( P = 0.001) and the incidence of mild to moderate CH was higher in the T3 group than T4 (64.4% vs. 26.9%; p = 0.001). T4 group showed a great significance in the (very satisfied category) in comparison to T3 group ( P = 0.001). The incidence of over-dry hands was significantly lower in group T4 (0.7%, 1 out of 145) than in group T3 (8.5%, 11 out of 129). The recurrence rate was similar in the two groups (0.8% vs. 1.4%; P = 0.19). Conclusion Video-assisted T3 or T4 sympathectomy is a safe and effective procedure for treatment of palmar hyperhidrosis. T4 sympathectomy appears associated with less severe dryness and CH than T3 sympathectomy at long-term follow-up.

Introduction Several techniques have been reported for mid-penile hypospadias repair, including Snodgrass tubularized incised plate (TIP) and onlay island flap (OIF) procedures, which are two popular procedures. Aim of the work To compare the outcomes and complication rates for both TIP and OIF techniques. Patients and methods A prospective randomized study was conducted on 140 boys (age range, 1–6 years) with primary mid-penile hypospadias who underwent repair from June 2011 to December 2016 at our university hospitals. The patients were prospectively randomly divided into two equal groups: group A (n=70), underwent Snodgrass TIP urethroplasty, and group B (n=70), underwent OIF. Inclusion criteria only males with fresh mid penile hypospadias without ventral chordee from 1 to 6years old. Exclusion criteria were recurrent cases, presence of ventral chordee, parental refusal or children more than 6years of age. Outcomes were assessed in terms of success rates, operative time complication rates, and cosmetic appearance during follow-up. All children were subjected to full history taking, thorough clinical examination, and routine laboratory investigations (CBC, BT, CT, FBS, urinalysis, liver and renal profile), results were compiled and compared statistically. Results There were statistically significant differences between the two techniques regarding success rate, operative time incidence of complications and cosmetic results. Conclusion Both techniques are reliable and feasible for treatment of mid-penile hypospadias, but there was a statistically significant difference regarding operative time, complications, and cosmetic outcome with TIP procedure. So, the authors preferred it if suitable urethral plate is present.

Background Acute calculous cholecystitis is a common disease presentation in critically ill patients. It is associated with increased mortality and morbidity rates in case of insufficient treatment. However, the best approach to management is still debatable. Patients and methods This is a retrospective analysis of prospectively designed study for the evaluation of different management planes in critically ill patients presented with acute cholecystitis in a single university hospital from 2013-2017. The study included all patients with acute cholecystitis as the main reason for patient deterioration and hospital admission and also those patients already admitted in hospital ICU and consulted other departments for symptoms of acute cholecystitis. Preoperative data and operative outcomes were analyzed. Results A total of 225 patients (median age68 years; range=57–91 years) were included. Overall, 28.9% (65 patients) underwent percutaneous cholecystostomy drainage (PCD), 34.2% (77 patients) underwent open cholecystectomy (OC), and 36.9% (83 patients) underwent laparoscopic cholecystectomy. The patients’ demographics were comparable in all groups, except for age and BMI. Laparoscopic cholecystectomy was successful in 85.5% of patients. Nine patients in PCD group needed completion OC (13.8%). Preoperative comorbidities were similar in the studied groups. The postoperative infection was high in OC group (P=0.013). The overall mortality was 4%, with the highest value in the PCD group, and no significant difference was observed among all groups (0.197). Hospital and ICU stays were increased in the OC group (P=0.001). Conclusion Open and laparoscopic approaches are safe in critically ill patients and have comparable results to PCD. The advantage of disease eradication cannot be overlooked. The laparoscopic approach is better in the view of short hospital stay and infection rate.

Background Prosthetic mesh reduces the risk of hernia recurrence. The use of mesh in patients with strangulated hernias requiring bowel resection is controversial. Patients and methods Patients with acutely incarcerated hernias (with small intestine contents) who underwent polypropylene mesh hernioplasty were included in this prospective study from June 2005 to Jan. 2011. Results 163 patients were included; 48 required intestinal resection and anastomosis (Group I) and 115 did not (Group II). Operative times and hospital stay were longer in Group I ( P = 0.001). No significant difference was noted between both groups in terms of postoperative morbidities (16.6% vs 13% P = 0.5), wound infection (6% vs 4% P = 0.6), and recurrence rate (2% vs 2.8% P = 0.8), All cases of wound infection were successfully managed with drainage and local wound care and no mesh had to be removed. One patient in Group I and five patients in Group II died of concomitant diseases in the follow-up period ( P = 0.5). Conclusion Mesh hernioplasty is crucial to prevent recurrence, and it is safe to utilize it in repair of acutely incarcerated hernias even if associated with intestinal resection.