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Short procedures constitute a large proportion of hand surgeries. Most of them are done as 1-day surgery. Regional anesthesia is considered the best option for these operations. Compared with general anesthesia, regional anesthesia improves early outcome after wrist and hand surgery. Distal nerve blocks have the benefits of lying away from critical structures and the preservation of proximal muscle function of the upper limb. Thus, this type of nerve block is ideal for short procedures where patients can tolerate a tourniquet.

AIM: The aim of the study was to evaluate and compare the effect of different access cavity designs, using cone-beam computed tomography (CBCT), on root canal transportation, and centralization performed on two rooted maxillary premolars. METHODS: Twenty maxillary premolars were randomly divided into two groups. In Group 1, traditional endodontic cavities (TECs) were prepared. In Group 2, contracted endodontic cavities (CECs) were prepared. Mechanical preparation was done by HyFlex electrical discharge machining (EDM) single file in both groups. CBCT imaging was performed pre- and post-root canal preparation for calculations of root canal transportation and centering ability. RESULTS: Data were analyzed using Mann–Whitney U test and Kruskal–Wallis test. For transportation, teeth with CECs showed the statistically significantly highest median amount of transportation, while as for centering ability, results showed no significant difference between both groups. CONCLUSION: Under the conditions of this study, HyFlex EDM prepared canals with different access cavity designs without significant shaping errors. TEC showed less transportation than CEC, while both TEC and CEC had no effect on the file centering ability.

Due to the higher potential for enhancing nutrient use efficiency, nanofertilizer (NF) is crucial in sustainable crop production. Thus, foliar-applied mixed nanofertilizer (MNFf) and commercial fertilizer (CF) into the soil (CFs) were claimed together ([MNFf + CFs]) and comparative nutrient use efficiency (NUE), productivity, and nutritional properties of tomato fruits were investigated. The mixed nanofertilizer (MNF) was prepared in our laboratory and characterized using scanning electron microscopy, X-ray diffraction, and Fourier transform infrared. To avoid the interference of other factors, all the treatments were divided into three groups: (i) blank treatment (no fertilizer), (ii) CF treatment, and (iii) combined [MNFf + CFs] treatment. The vegetative growth and qualitative and quantitative attributes of tomatoes were recorded, and the NUE, total production, and benefit–cost ratio (BCR) were also calculated. In addition, comparative nutritional properties for all treatments were analyzed. The plant’s height, stem diameter, root length, photosynthetic pigments, leaf minerals, and qualitative traits of tomato fruits were significantly (p < 0.05) increased by [MNFf + CFs] treatment compared to CFs. The protein, fiber, Fe, Zn, and K contents were significantly (p < 0.05) increased by 23.80, 38.10, 44.23, 60.01, and 2.39%, respectively, with the [MNFf + CFs] treatment as compared to CFs, while the ash and protein contents were both lower than the untreated tomato. Moreover, [MNFf + CFs] treatment has significantly (p < 0.05) increased the antioxidant properties. The NUE, total production, and BCR were also increased by 26.08, 26.04, and 25.38%, respectively, with the same treatment. Thus, [MNFf + CFs] treatment could be a potential alternative for reducing the excess use of CF.

Hair dye poisoning is an emerging big problem in Upper Egypt. The main component of hair dye causing toxicity is para-phenylenediamine (PPD). Ingestion of PPD could be accidental or suicidal. After oral intake it is metabolized in the liver into N-mono- (MAPPD) and N,N′- diacetylated (DAPPD) metabolites. Tissue damage after PPD ingestions occurs due to increased levels of free radical and oxidative stress that deplete tissue glutathione. Cardiac toxicity is a complication of PPD poisoning. It could be manifested by hypotension, different patterns of arrhythmia; in addition, myocarditis and elevated cardiac biomarkers were also found. Serum and urinary levels of PPD, N-acetyl-p-phenylenediamine (MAPPD) and N--diacetyl-p-phenylenediamine (DAPPD) were measured by HPLC. A prospective cohort study was planned to determine relation between the serum and urinary PPD, N-acetyl-p-phenylenediamine (MAPPD) and N,on -diacetyl-p-phenylenediamine (DAPPD) levels with cardiac manifestations of poisoned patient. Forty patients completed the diagnosis to have acute poisoning following hair dye ingestion. PPD and its metabolite concentrations did not show any significant correlation with the prevalence of cardiac toxicity and could not predict its occurrence among studied patient (p-value< .05)

The aim of this study is to study the incidence of occult nodal micrometastases (ONM) in the contralateral neck and compare it to the laterality of the primary tumor. Retrospective analysis of the medical records of patients with locally advanced supraglottic squamous cell carcinoma and Clinically negative contralateral neck (cN0-CLN) - who had concurrent total laryngectomy and bilateral neck dissection as their primary treatment at the Otolaryngology Department, Al Kas Al Ainy School of Medicine-Cairo University between 2015 and 2020 - was conducted. Patients were divided into 3 groups according to the extent of the primary tumor. 28 patients met the inclusion criteria. Patients with well-lateralized tumors were 14 (Group A), tumors abutting the midline were 4 (Group B) and tumors significantly involving the contralateral side were 14 (Group C). There was no statistically significant difference in age of patients among the three groups. Eleven patients had cervical lymphadenopathy in the final pathology reports. Seven patients had ONM, all of whom were among group C patients (7/14; 50%). The degree of tumor differentiation was not associated with the presence of ONM. Treatment of the cN0-CLN is justified in locally advance supraglottic carcinoma significantly crossing the midline. The total number of patients with ONM in the cN0-CLN exceeds the threshold for observation, however the authors could not recommend or refute the practice of routine prophylactic treatment of the cN0-CLN as none of the patients-in this study-with well-lateralized tumors or tumors just abutting the midline showed ONM.

Adequate knowledge and accurate characterization of root and canal anatomy is an essential prerequisite for successful root canal treatment and endodontic surgery. Over the years, an ever‐increasing body of knowledge related to root and canal anatomy of the human dentition has accumulated. To correct deficiencies in existing systems, a new coding system for classifying root and canal morphology, accessory canals and anomalies has been introduced. In recent years, micro‐computed tomography (micro‐CT) and cone beam computed tomography (CBCT) have been used extensively to study the details of root and canal anatomy in extracted teeth and within clinical settings. This review aims to discuss the application of the new coding system in studies using micro‐CT and CBCT, provide a detailed guide for appropriate characterization of root and canal anatomy and to discuss several controversial issues that may appear as potential limitations for proper characterization of roots and canals.

Background: In recent years, there has seen great progress in cataract surgery, both in the surgical technique as well as with modern phacoemulsifiers. Optical Coherence Tomography (OCT) is a noninvasive and noncontact diagnostic tool with high resolution to assess macular changes. Purpose: To assess the impact of uncomplicated phacoemulsification on the changes of central macular thickness (CMT) values in diabetic and non-diabetic patients. Methods: Thirty eyes of 30 subjects who underwent uneventful phacoemulsification were divided into 3 equal groups: Group I: Non diabetic patients, Group II: Diabetic patients without retinal changes and Group III: Diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR). Each patient was subjected to routine examination, best corrected visual acuity and CMT was assessed by OCT one day before operation, one week, one month and six months after the operation. Results: According to CMT, significant difference was reported after one month and six months between all groups. This study showed statistically significant differences between groups one week, one month and six months postoperatively according to BCVA. Also there were statistically significant differences over the periods through BCVA in the each group, negative significant correlations between CME and BCVA after 1 month and 6 months. The mean BCVA improved progressively in the postoperative period, and it was non-significant correlated with duration of DM one week postoperatively. However, the correlations were significant after one month and six months. The CMT increased progressively in the postoperative periods and it significantly correlated with the duration of DM after one month and six months. Conclusion: Diabetes influenced the central macular thickness in diabetic patients, who were more liable to changes in central macular thickness after cataract surgery even with uncomplicated cataract surgery.

Background: Diabetic retinopathy (DR) is a common complication of diabetes mellitus and is a leading cause of blindness worldwide. Diabetic macular ischemia is recognized as an important cause of visual disability. DMI is characterized by enlargement of the physiological capillary-free zone (FAZ). Objective: To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Patients and methods: Our study included 60 patients with diabetic retinopathy, divided into 2 groups: Group I: 80 eyes of diabetic patients with diabetic retinopathy and DMI and Group II: 40 eyes of diabetic patients with. Diabetic retinopathy and no DMI (diagnosed clinically and FA). All of them underwent full history taking, complete ophthalmological examination including FFA & OCTA during the period from October 2017 to December 2018. Results: Regarding the comparison of OCTA with FA in diagnosis of DMI according to ETDRS DMI grading. The present study found that moderate agreement between both devices (Kappa agreement k = 0.560 FAZ area was measured in DMI group and non DMI group. Group I Mean FAZ area ± SD was (0.57 ± 0.29 mm2) in OCTA6x6, (0.61 ± 0.28mm2) in FFA. Statistically, the difference in FAZ area between the OCTA and FFA was insignificant. The horizontal and vertical diameter was (650 ± 0.32Mm & 490 ±0.26) in OCTA6x6, (690 ± 0.25Mm & 530 ± 0.31Mm) in FFA. Statistically, the difference in horizontal and vertical diameter between the OCTA and FFA was insignificant. Conclusion: OCT angiography was a valid, reliable and easy-to-use method to detect and quantify DMI changes without use of dye .with a moderate degree of agreement between FFA and OCTA in evaluating DMI.

Background and Aim Colorectal cancer (CRC) accounts for over 8% of all deaths each year, with 1.2 million new cases diagnosed annually worldwide. It represents the seventh most common cancer in Egypt. Early detection of peritoneal metastasis is a major challenge in such cases. It helps with the decision of the immediate application of intraperitoneal chemotherapy after resection. Meta‐analysis studies reported contrast evidence for a possible prognostic role of intraperitoneal free cancer cells (IPCCs) in peritoneal recurrence and survival after curative resection. In this work, we aim to evaluate the prevalence and impact of detecting free malignant cells in peritoneal fluid on survival and local recurrence and to estimate the incidence of peritoneal carcinomatosis (PC) during follow up. Methods Design: This was a prospective cohort study. Settings: From June 2016 to December 2018, samples were collected from 104 patients who underwent abdominal surgery for colorectal cancer in the Egyptian National Cancer Institute. A total of 96 Egyptian CRC patients who underwent curative resection were enrolled. Intraoperative peritoneal lavage was performed to detect IPCC by conventional cytology. Patients with no residual tumor after surgery and no evidence of PC were followed up for a median 14 months. The cumulative 12‐month overall survival rate for patients with IPCC was 100% versus 86% for patients with negative cytology. Results Our results demonstrated that the prevalence of IPCC in the peritoneal lavage was 11.5%. Peritoneal and local recurrence occurred at a higher rate in patients with cytology positive lavage (9.1% vs 6.3% and 9.1% vs 3.8%, respectively), although this was statistically insignificant. Distant metastasis occurred significantly in patients with positive cytology (45.5% vs 8.9%) with P‐value, The presence of IPCC using conventional cytology was not an independent prognostic factor for the development of PC or survival.

Background: Obesity is established worldwide health problem. One of the methods to manage it is bariatric surgery. Our study aim is to determine the complications of bariatric surgery at Medina, KFH from surgical overview and compare the results with other studies. Objectives: To identify the most common health needs indicating bariatric surgery and the health impact of these procedures on them. And to determine the types of intra and postoperative complications can occur due to bariatric surgery. Methodology: This is an analytical retrospective study of the patients who underwent bariatric surgery in KFH, Medina, K.S.A, from 2010-2017. Data was gained from the hospital medical records between 8th – 16th April 2018. It had been typed into an excel 2010 program, and statistical analysis done by statistical package for the social sciences (SPSS v.21) for windows. Results: 154 patients underwent bariatric surgery in KFH, 78.6% of them are female and 21.4% are male. The mean BMI is 49.69 ± 9.386. 29.9% of them are previously diagnosed with chronic illnesses HTN 38.7%, DM 30.1%, IHD 2,2%, and others 29.0%. Regarding the type of operation gastric sleeve done approximately 96.1%, adjustable gastric banding approximately 3.3%, Roux en Y gastric bypass approximately 0.7%. With 0.0% intraoperative complication and 3.8% postoperative complications. Conclusion:In KFH Medina, bariatric surgery had a good effect on gynecological conditions. No mortalities or intraoperative complications. We recommend more studies to study the effect of bariatric surgery on DM and HTN in Medina in a longer period.

Objectives: To evaluate outcome of spreader flaps versus the spreader grafts in reconstruction of the nasal dorsum after large hump resection. This includes both functional and aesthetic aspects.Patients and Methods: Thirty patients seeking rhinoplasty for dorsal nasal hump. All surgeries were done through the closed approach. Patients were randomly divided into two groups and accordingly to the modality of nasal dorsal reconstruction after hump resection. Group (A) patients were scheduled for reconstruction using spreader grafts while in Group (B) spreader flaps were used. Evaluation included functional and aesthetic considerations. Functional subjective evaluation was done by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by active anterior rhinomanometry (AAR). Aesthetic evaluation included patients’ assessment of their problem according to Visual Analogue scale (VAS) while objective evaluation was done based on a suggested scoring system designed by the authors using pre and post-operative photography. The evaluating surgeons were blinded regarding the vault reconstructive modality.Results: In both groups significant improvement in both functional and aesthetic outcome - after a minimum of three months follow up- when comparing the pre and postoperative data that was obtained. There was no statistically significant difference in outcome between both groups.Conclusion: The spreader flap is a good alternative to the spreader graft in nasal dorsal reconstruction after large hump resection giving similar positive results both functionally and aesthetically however, the authors find the autospreader flap more superior to spreader graft technique as it does not require cartilage harvest.

This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20 cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients’ satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5 cm to 4.5 × 10.5 cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients’ factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients’ satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.

The X-ray repair cross-complementing 1 (XRCC1) enzyme plays an important role in the DNA repair pathway. XRCC1 polymorphism increased the risk of human oral squamous cell carcinoma. Loading of thymoquinone on gold nanoparticles as a drug carrier, had revealed a superior anti-cancer effect as a chemotherapeutic agent in DMBA-induced OSCC. This study aimed to evaluate the expression of DNA repair enzyme X-ray repair cross-complementing 1 (XRCC1) following treatment of induced oral cancer in hamster buccal pouch with thymoquinone (TQ) only and loaded on gold nanoparticles (AuNps). Sixty male Syrian golden hamsters were divided into 4 groups: Group A: (negative control). The left pouches of the rest of animals were painted with the carcinogen DMBA (3times / week/ 12 weeks), then: Group B: (positive control), Group C: painted and injected intraperitoneally (i.p) with TQ only (3 times/week for 6 and 12 weeks). Group D: painted with TQ loaded on AuNps (3 times/week for 6 and 12 weeks). After euthanization, all pouches were surgically excised, fixed and processed for H&E and XRCC1 immunohistochemical stains. Groups B, C1, C2, and D1 showed well-differentiated squamous cell carcinoma with low intensity of immune staining. Groups D2 showed remarkable regression of tumors both clinically and histologically with high intensity of IHC staining. Loading of TQ at low concentration (0.001 mg/kg) on AuNps /12 weeks was a promising chemotherapeutic combination, through enhancing XRCC1 expression to regress the carcinogenesis process. This effect could be due to the anti-oxidant, free-radicle scavenging effect and enhancing apoptosis by TQ.

Different types of DNA damages occur during the induced oral carcinogenesis, which can be eliminated through several DNA repair pathways. XRCC1 and ERCC1 are the main repair enzymes involved in repair of oral squamous cell carcinoma. A combination of thymoquinone with gold nanoparticles as a novel chemotherapeutic modality is the aim of the present work against chemically induced SCC in the classic model of HBP/DMBA carcinogenesis. One hundred male Syrian golden hamsters were divided into: Group A: Ten animals (negative control), group B: Ten animals (positive control) painted with DMBA only 3times / week/ 12weeks. The rest of animals were painted with DMBA (3times / week/ 12weeks) then painted and injected intraperitoneal with TQ only, 0.01mg/kg TQ-GNps, 0.001mg/kg TQ-GNps or GNps only for 6- and 12- weeks, intervals. By end of the experiment, both pouches from all groups were surgically excised, fresh samples from each pouch were processed for RT-PCR technique. The rest of the pouches were fixed and processed for H&E evaluation. Loading of thymoquinone on gold nanoparticles was promising chemotherapeutic combination, through regression of well-differentiated SCC (positive control) to dysplasia and enhanced expression of the studied DNA repair enzymes compared to either thymoquinone or gold nanoparticles groups.

This study aimed to assess regenerative treatment protocols for maturogenesis of immature teeth with apical periodontitis in dogs. Apical periodontitis was induced in immature premolars of 8 mongrel dogs teeth that were divided into 5 groups; regeneration via blood clotting (REG group); chitosan loaded with demineralised bone matrix (REG-CD group); chitosan loaded with dexamethazone corticosteroid (REG-CC group); and positive and negative control groups. All groups showed comparable apical hard tissue formation and significantly different from the control group. Results also showed decrease in inflammatory tissue reaction, bone resorption and periodontal ligament thickness. Tissue reaction and inflammatory infiltrates were significantly less in REG-CC group compared to others. Other parameters showed no significant difference. In conclusion, regenerative endodontic techniques using chitosan-based formulations have the potential to be used as an alternative for root maturation in teeth with apical periodontitis.

Background: Cystoid macular edema (CME) is addressed as one of the most important complication responsible for suboptimal visual acuity outcome after cataract surgery. Objective: Comparison between topical steroids versus NSAIDs regarding ability to reduce CME after uneventful cataract surgery of foldable intraocular lens (IOL) implantation in diabetic patients. Patients and methods: In this study, 30 patients underwent phacoemulsification surgery with posterior chamber foldable intraocular lens implantation in Ophthalmology Department, Al-AzharUniversityHospital between December 2017 and November 2018. Patients were randomly categorized into 2 groups. Group 1: Nepafenac eye drops (0.1%) 3 times daily for one month, Group 2: Prednisolone eye drops (1%) 5 times daily for one month. Results: At the end of the follow up, foveal thickness changes in optical coherence tomography (OCT) were found to be slightly less in the no steroidal anti-inflammatory eye drops (NSAIDs) group than in the steroidal group with no significant change in the final visual outcome between the two groups. Conclusion: There was no significant statistical difference between NSAIDs drops and steroids drops in prevention of development of pseudophakic macular edema post cataract surgery.

Nickel is an essential metal, and its compounds are widely used in industry and commerce. The development of industrialization has led to increased emission of nickel into environment causing teratogenesis in the developing embryos. This study aimed to investigate the toxic and teratogenic effects of nickel on Balb/C albino mice embryos during organogenetic period. This study was carried out on forty pregnant female albino mice; they were randomly divided into four equal groups: group I (control group) received distilled water; groups II, III, and IV (experimental groups): each group contains ten mice received 46.125 mg, 92.25 mg, and 184 mg Ni/kg body weight, per day, respectively, by orogastric tube for successive 8 days started from the 6th gestational day. The extracted lived fetuses were examined externally then double-stained and prepared for skeletal examination by dissecting microscope. The numbers of live-birth pups decreased significantly (p value for comparing between control and each other group, statistically significant at p ≤ 0.05). But there was significant increase in resorption sites in all nickel-treated groups compared to control group. Total number of resorption sites in all nickel-treated groups is 28: 15 resorption sites are present at left horn and 13 in the right horn. At the same time, there was significant increase in stillbirth fetuses in group IV. Double-stained fetal skeleton showed incomplete ossification of skull bones, unossified interparietal bone, open arch of atlas, incomplete ossification of vertebrae, supernumerary lumbar rib, incomplete ossification of ribs and sternebrae, incomplete ossification of bones of forelimb, incomplete ossification of bones of hindlimb, unossified carpals, metacarpals, tarsals, metatarsals, and phalanges in nickel-treated groups, compared to control group. Nickel results in number of skeletal congenital abnormalities indicating its teratogenic effect.

Background: Childhood developmental disorders and related problems such as learning disabilities and attention deficit hyperactivity disorder (ADHD) account for a growing burden on communities. Problems of child behavioral development could be caused by BisphenolA (BPA) in addition, westernization have the potential toinfluence its exposure.Exposure to BPA remains poorly characterizedin the developing countries so, in this pilot study, weevaluate BPA exposure and assess somesources of exposure among Egyptian children. Method: We measured total urinary BPA concentrations in spot samples in ADHD (N = 24) and healthy (N = 24) Egyptian children. We also collected questionnaire data regarding food storage behaviors to assess potential sources of exposure.Results: ADHD Egyptian children exhibited higher urinary BPA concentrations; with median value of 24.5 µg/L. Reported consumption of canned food wasa significant predictor of increasing concentrations of urinary BPA.Conclusions: The relatively high urinary BPA concentrations within Egyptian children with ADHD and the significantassociation between the canned foodconsumption and the increased urinary BPA concentration highlights the need to modify food and consumer product patterns to prevent potential adverse health outcomes in the future. Keywords: ADHD, Egyptian, children, Bisphenol A, canned food

Background Laparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer. However, the application of laparoscopic D2 lymphadenectomy remains controversial. This study aimed to evaluate the feasibility and outcomes of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer. Results Between May 2016 and May 2018, twenty-five consecutive patients with gastric cancer underwent laparoscopic D2 gastrectomy: eighteen patients (72%) underwent distal gastrectomy, four patients (16%) underwent total gastrectomy, and three patients (12%) underwent proximal gastrectomy. The median number of lymph nodes retrieved was 18 (5–35). A positive proximal margin was detected in 2 patients (8%). The median operative time and amount of blood loss were 240 min (200–330) and 250 ml (200–450), respectively. Conversion to an open procedure was performed in seven patients (28%). The median hospital stay period was 8 days (6–30), and the median time to start oral fluids was 4 days (3–30). Postoperative complications were detected in 4 patients (16%). There were two cases of mortality (8%) in the postoperative period, and two patients required reoperation (8%). Conclusions Laparoscopic gastrectomy with D2 lymphadenectomy can be carried out safely and in accordance with oncologic principles.

Anesthesiologists in Egypt as a representative of developing countries with large populations and shortage of trained personnel and extended working hours that may reach 30 continuous hours are sus...

Venous malformations represent a major sector of vascular anomalies. Most cases are asymptomatic or subclinical; however, large extensive lesions can cause severe disability and sometimes mortality. In this report, we present a successful case of sirolimus treatment in managing an extensive venous malformation in the pelvis of a 21-month-old boy who presented with life-threatening complications. With a history dating since the day 2 of life, the patient suffered from chronic bleeding due to scrotal skin ulcerations, in addition to recurrent attacks of severe bleeding per rectum necessitating hospital admission and blood transfusion (three attacks since the age of 7 months). Pelvic magnetic resonance image showed the typical findings of extensive venous malformation involving the pelvis, perineum, scrotum, and extending to the gluteal region. The lesion was seen totally encasing the anorectum with marked thickening of their walls almost occluding their lumen.Oral sirolimus (2 mg/m2) was started with a target blood trough level of 5 to 10 ng/mL. Over a follow-up period of 5 months, there was obvious clinical improvement that included healing of skin lesions (scrotal ulcer) with complete re-epithelialization, absence of bleeding per rectum with improvement of constipation, and rise of hemoglobin level from 7.5 to 11.5 g/dL.

Background: National data demonstrate a trend toward outpatient same-day mastectomy. The possible drivers of this change include the costs related to hospital admission and effective management of postoperative pain. We retrospectively analyzed our single-institution experience with outpatient same-day mastectomy that incorporates a multimodal pain management regimen. Methods: We retrospectively reviewed the medical records of patients who underwent same-day mastectomy at a single academic hospital. All patients received a multimodal, perioperative pain management regimen consisting of the intraoperative administration of 1,000 mg of intravenous (IV) acetaminophen and 30 mg of IV ketorolac, combined with the operating surgeon performing a 4- to 5-level, midaxillary, intercostal nerve block using liposomal bupivacaine. All patients were discharged with a prescription for acetaminophen with codeine, along with options for nonnarcotic alternatives as needed for pain. Results: We reviewed the data on 72 patients who underwent mastectomies: 11 (15.3%) bilateral and 61 (84.7%) unilateral. The average age was 57 years, and average body mass index was 30 kg/m2. The average length of stay of 4 to 6 hours was a marked reduction compared to a 23-hour observational period or an inpatient hospital stay. The average follow-up was 20.1 weeks. Five patients presented to the emergency department (ED) within the 30-day postoperative period, with 2 patients (2.8%) requiring readmission to the hospital for non–pain-related issues. The other 3 patients (4.2%) were evaluated for specific pain-related issues but did not require admission and were discharged home from the ED. Conclusion: Our data support outpatient same-day mastectomy incorporating a multimodal, perioperative pain management regimen as a safe and feasible treatment option. Potential additional benefits may include decreased oral opioid use and cost savings for the hospital.

Aim Measurable and controlled stretching of the fascia for 30 minutes during surgery to achieve primary tension-free abdominal wall closure in LOD hernias. This prospective observational study aimed to clarify the extent to which this traction method can function as an alternative to component separation methods. Material and Methods We have already applied this technique in > 50 procedures of LOD hernias. We published the data of first 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. The average patient age was 58 years with a gender ratio of 2.5 males: 1 female. ASA scores were III in 66.7% and II in 33.3%. The body mass index (BMI) averaged 32.5 kg/m2. Thirteen patients were treated with BTA 4 weeks before surgery. Results Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusions This method allows primary closure of complex LOD hernias and is potentially less prone to complications than component separation methods.

International audience; ObjectivesTo assess related studies and discuss the clinical implications of endodontic access cavity (AC) designs.Materials and methodsA systematic review of studies comparing the fracture resistance and/or endodontic outcomes between different AC designs was conducted in two electronic search databases (PubMed and Web of Science) following the PRISMA guidelines. Study selection, data extraction, and quality assessment were performed. Meta-analyses were undertaken for fracture resistance and root canal detection, with the level of significance set at 0.05 (P = 0.05).ResultsA total of 33 articles were included in this systematic review. The global evaluation of the risk of bias in the included studies was assessed as moderate, and the level of evidence was rated as low. Four types of AC designs were categorized: traditional (TradAC), conservative (ConsAC), ultraconservative (UltraAC), and truss (TrussAC). Their impact on fracture resistance, cleaning/disinfection, procedural errors, root canal detection, treatment time, apical debris extrusion, and root canal filling was discussed. Meta-analysis showed that compared to TradAC, (i) there is a significant higher fracture resistance of teeth with ConsAC, TrussAC, or ConsAC/TrussAC when all marginal ridges are preserved (P 0.05), and (iii) there is a significantly higher risk of undetected canals with ConsAC if not assisted by dental operating microscope and ultrasonic troughing (P

Adequate understanding and accurate characterization of normal and unusual root and canal morphology \udare essential requirements for successful root canal treatment. A new coding system for classifying root and \udcanal morphology, accessory canals and anomalies has been introduced. In addition to technological advances related to experimental studies involving micro-computed tomography, the continuing clinical advances in magnification, illumination, imaging and intra-operative root canal treatment procedures have \udallowed clinicians to identify an increasingly wide range of anatomical variations in roots and canals in an \udattempt to achieve more predictable clinical outcomes. This review aims to provide a step-by-step explanation for the clinical application of the new coding system in dental practice, and to describe the anatomical \udvariations in roots and canals for teeth scheduled for root canal treatment

Aims Due to the pandemic, surgical FY1s in our trust were re-deployed to cover medical patients. In addition to cancellation of surgery-specific teaching, there was less time spent by FY1s with senior surgical colleagues during the normal working day. Our FY1s appeared less confident in managing unwell surgical patients, and there was dissatisfaction for both FY1s and seniors. This project aimed to identify the particular areas of concern and deliver a tailored teaching session. Methods Surgical FY1s and SpRs were surveyed. We received 10 (83%) FY1 responses and 5 (42%) SpR responses. Management of common surgical presentations, routine administrative and clerical tasks were identified as areas of need. A teaching session was delivered via online conferencing software and uploaded to a video sharing website where it could be viewed at a later date. Seven of 12 (58%) surgical FY1s attended live and completed a post-teaching session feedback survey. Results Seven (100%) FY1s rated the session ‘very useful’, and a majority found the ‘common surgical presentations’ section of most value. All respondents felt more confident with both clerking surgical patients and administrative tasks following the refresher session. Conclusions This project demonstrated the need for additional training sessions to compensate for loss of opportunities due to re-deployment. Utilising remote teaching proved an acceptable alternative to previous in-person options. The tailored refresher session successfully improved confidence in target areas and should be delivered routinely.

Introduction It has been predicted that the COVID-19 pandemic would disrupt the delivery of UK cancer treatment pathways. This study aims to assess the mode of presentation and type of management offered to oesophagogastric (OG) and hepatopancreaticobiliary (HPB) cancer patients at a busy district general hospital during the pandemic. Methods Confirmed OG and HPB cancer patients were identified in the local MDT database. Patients were identified between 01/03/2020 - 30/09/2020 (pandemic), and 01/03/2019 - 30/09/2019 (pre-pandemic). Mode of presentation and management was identified and compared. Results In 2019, 42 and 15 patients were diagnosed with OG and HPB cancers, compared to 25 and 19 patients in 2020, respectively. 26 (46%) patients were referred via 2ww pathway in 2019, compared to 29 (66%) in 2020. The number of cancers referred routinely or emergently were 28 (49%) and 2 (4%) in 2019, compared to 2 (5%) and 9 (20%) in 2020, respectively (p Conclusion 2ww referrals were similar to 2019, while routine referrals reduced significantly. A marked, but not significant, reduction in patients suitable for curative intent is noted, perhaps due to delay in presentation despite the continuation of cancer surgical services. Further work on creating “COVID-free” pathways and increasing awareness of service availability would improve detectability of curable disease.

Background Working in hospitals entails several risks to nurses. A better nursing workplace can help in improving physical activity and reducing adverse occupational health outcomes among nurses. Aim This study aimed to investigate the relationships of the nursing workplace with occupational health outcomes and physical activity. Methods A cross-sectional correlation study was conducted with 623 nurses. Data were collected through report self-administered questionnaires that included employment and occupational conditions, hospital workplace environment, and adverse occupational health outcomes as well as physical activity pattern. Results The current study showed that the nursing workplace environment and conditions had a negative effect on occupational health outcomes and physical activity among nurses in the study units. Nurses in this study reported a high prevalence of low back pain (82.7%), burnout (78.3%), and occupational injuries (70.5%). They also reported insufficient physical activities (90.6%). High prevalence of burnout and low back pain were associated with low levels of physical activities among nurses. Conclusion A fair working environment and conditions have been implicated as a causative factor of negative occupational health outcomes and limitations of physical activity among nurses. Adverse occupational health outcomes also affect the nurses engaging in physical activity.

Summary Control of mRNA stability and degradation is essential for appropriate gene expression, and its dysregulation causes various disorders, including cancer, neurodegenerative diseases, diabetes, and obesity. The 5′–3′ exoribonuclease XRN1 executes the last step of RNA decay, but its physiological impact is not well understood. To address this, forebrain-specific Xrn1 conditional knockout mice (Xrn1-cKO) were generated, as Xrn1 null mice were embryonic lethal. Xrn1-cKO mice exhibited obesity with leptin resistance, hyperglycemia, hyperphagia, and decreased energy expenditure. Obesity resulted from dysregulated communication between the central nervous system and peripheral tissues. Moreover, expression of mRNAs encoding proteins that regulate appetite and energy expenditure was dysregulated in the hypothalamus of Xrn1-cKO mice. Therefore, we propose that XRN1 function in the hypothalamus is critical for maintenance of metabolic homeostasis., Graphical abstract, Highlights • Forebrain specific Xrn1-cKO mice exhibit obesity with hyperphagia • Xrn1-cKO mice exhibit leptin resistance, insulin resistance, and impaired glucose tolerance • Xrn1-cKO mice cannot utilize fat as an energy source and mainly use carbohydrate • AgRP expression is upregulated in the Xrn1-cKO hypothalamus, Physiology; Molecular biology

During pandemics, the ethicists, public health professionals, and human rights advocates raise a red flag about different public health actions that should, at best, be addressed through integrated, global policies. How to rationalize the healthcare resources and prioritize the cases is not a recent challenge but the serious concern about that is how to achieve this while not increasing the vulnerability of the disadvantaged population. Healthcare professionals use different scoring systems as a part of their decision-making so the medical teams and triage committees can allocate resources for predictable health outcomes and prognosis as well as to appropriately triage the patients accordingly. However, the value of the existing scoring systems to manage COVID-19 cases is not well-established yet. Part of this problem includes managing non-COVID patients with chronic medical conditions like non-communicable diseases and addressing their medical needs during the pandemic complex context in a way to avoid worsening their conditions and, on the other hand, avoid hindering the establishment of comprehensive standards for dealing with COVID-19. In this article, we discuss this dilemma as well as how preexisting ethical standards were challenged by COVID-19. We also discuss how monitoring the consistent application of ethical standards during the medical trials of new medications, vaccines, or unproven medical interventions is also a critical issue.

Purpose: was to assess the results of vitrectomy with and without internal limiting membrane (ILM) peeling on retinal function and anatomy in patients with diabetic macular edema (DME). Methods: Pars plana vitrectomy (PPV) was done in 40 eyes of 40 patients with DME (15 male, 25 female). Patients were enrolled randomly into two different groups. Group A- comprised (20) eyes who underwent vitrectomy without ILM peeling. Group B- comprised (20) eyes who underwent vitrectomy with ILM peeling. For each patient, visual acuity (VA) examination (in decimal charts), assessment of central macular thickness (CMT) with optical coherence tomography (OCT) and multifocal eletroretinogram (MF-ERG) were done before and 3 months post vitrectomy. Results: Postoperative mean VA increased significantly (from 0.17 to 0.27 in group A and from 0.21 to 0.38 in group B). Mean CMT decreased significantly after surgery (from 493 μm to 315 μm in group A and from 502 μm to 299 μm in group B). Mean P1 wave amplitude (nV/ deg2) in the macular area increased after surgery (from 32.15 to 41.10 in group A and from 35.5 to 40.8 in group B). Mean P1 wave latency (millisecond) in the macular area decreased after surgery (from 50.30 to 36.40 in group A and from 49.5 to 39.2 in group B).Conclusion: Vitrectomy with and without ILM peeling improve VA and macular edema in diabetic patients moreover an increase of amplitude and reduction of the latency of the macular mf-ERGs indicated an improvement of the macular visual function.

Background: Around one in three adults aged 65 years and over will have a fall at home within a one-year period. Falls are estimated to cost the NHS more than £2.3 billion per year. The National Institute for Health & Care Excellence (NICE) guidelines recommend older people who present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment which includes a cardiovascular examination and review of medications. Orthostatic hypotension (OH) is a common cardiovascular disorder, independently associated with an increased risk of falls in the elderly. Aims & Objectives: This study was carried out to assess improvement in lying and standing blood pressure (LSBP) measurement using clinical audit and staff education. Method: An initial audit of patients over the age of 60, admitted with a hip fracture between the 14th of April and the 25th of May 2020 to assess measurement and accurate recording of LSBP. This cycle was followed by brainstorming, root cause analysis, teaching sessions for staff, and use of aide-memoires. A second audit cycle of patients was admitted with a hip fracture secondary to a fall between the 10th of August and the 21st of September 2020. Result: Our initial audit results showed 68% of patients who met the criteria in the NICE guidelines on measurement of LSBP were not being assessed for OH. Following interventions, the second audit cycle showed significant improvement in compliance, confirming audits to be a powerful tool in quality improvement programs.

Early and frequent evaluation of thyroid profile in COVID‐19 infected patients is crucial as it will influence thyroid disease sequelae and management in those patients; moreover, it will facilitate setting an appropriate management plan.

The purpose was to evaluate the angle of the anterior chamber (ACA) and intraocular pressure (IOP) changes following eventless phacoemulsification surgery done for non-glaucomatous Egyptian patients. A prospective, interventional study involved 126 cataractous patients undergoing phacoemulsification with intraocular lens implantation. Patients were investigated for ACA and IOP preoperatively and postoperatively at 1 month and 6 months. Anterior chamber angles were evaluated by Scheimpflug camera, and IOP was measured by Goldmann applanation tonometer. A total of 144 eyes from 126 patients were enrolled: 65 males and 79 females; mean age was 59.72 years. At 6 months after phacoemulsification, there was highly significant decrease in IOP (P = 0) and anterior chamber angle (P = 0). The change in IOP did not correlate statistically with patient age, preoperative IOP, preoperative ACA or ACA widening. Phacoemulsification reduced significantly IOP which was maintained for 6 months and widened significantly the anterior chamber angle. None of the studied parameters in our study has proved to be a reliable predictive factor to the amount of IOP drop after phacoemulsification.

Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes inflammatory as well as degenerative changes in the central nervous system Objective: Studying the correlation between clinical disability of the disease and advanced volumetric MRI parameter in a sample of Egyptian MS patients Patients and methods: Sixty MS patients and 63 age and sex matched healthy controls were recruited for the study. Clinical measures including expanded disability status scale (EDSS), 9-hole peg test (9HPT), 25-Feet walk test (25FWT), and paced auditory serial addition test (PASAT) were used. 3D T1 MRI brain was acquired for measurement global as well as regional brain atrophy using FSL software, FLAIR sequence used for brain lesion load estimation; short tau inversion recovery (STIR) sequence was used for cervical spinal cord. Results: Brain volume was significantly lower in MS patients compared to healthy controls, progressive phenotypes showed lowest values compared to clinically isolated syndromes and relapsing remitting MS. Brain Lesion load correlated with EDSS was high in early-MS subgroup, and no correlation to EDSS found at later-MS subgroup. High cervical lesion count was found in the study group and cervical lesions showed significant correlation with clinical disability. Thalamic atrophy was present in early-MS group compared to healthy controls, and thalamic volume correlated with clinical disability in this subgroup. Conclusion: Egyptian patients showed relatively similar disease characteristics to western MS patients regarding clinical as well as radiological parameters. Heavier cord lesion burden, and strong correlation between lesion load and clinical disability early in the disease may account for the relatively more aggressive disease course in Egyptian population. Thalamic atrophy occurred early in MS, and may serve as a potential parameter in differentiating MS from other conditions.

Knowledge of root and canal morphology is essential for the effective practice of root canal treatment. Paediatric endodontics aims to preserve fully functional primary teeth in the dental arch; however, pulpectomy procedures in bizarre and tortuous canals encased in roots programmed for physiologic resorption are unique challenges. A new coding system for classifying the roots and main canals (https://doi.org/10.1111/iej.12685), accessory canals (https://doi.org/10.1111/iej.12800) and developmental anomalies (https://doi.org/10.1111/iej.12867) has been introduced recently. This paper discusses challenges for describing root and canal morphology in primary teeth and describes the potential application of the new classification system for root canals in the primary dentition.

INTRODUCTION: Post-operative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimise such complications, surgeons can utilise different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left-sided colonic resection, comparing use of intra-operative flexible endoscopy against conventional tests used to assess anastomotic integrity. METHODS: PubMed/MEDLINE and EMBASE online databases were searched for non-randomised and randomised case-control studies that investigated post-operative AL and/or AB rates in left-sided colonic resections, comparing intra-operative flexible endoscopy against conventional tests. Data from eligible studies were pooled, and a meta-analysis using Review Manager 5.3 software was performed to assess for difference in AL and AB rates. RESULTS: Data from six studies were analysed to assess the impact of flexible endoscopy on post-operative AL and AB rates (1084 and 751 patients respectively). Use of flexible endoscopy was associated with reduced post-operative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. OR favoured intra-operative flexible endoscopy; 0.37 (95% CI 0.21-0.68, p=0.001) for AL and 0.35 (95% CI: 0.15-0.82, p=0.02) for AB. CONCLUSION: This meta-analysis showed that the use of intra-operative flexible endoscopy is associated with a reduced rate of post-operative anastomotic leakage and bleeding, compared to conventional anastomotic testing methods. This article is protected by copyright. All rights reserved.

Background: Diabetic eye disease is an end-organ response to the effects of the condition on the human system. The cornea is a transparent structure protecting the anterior one-sixth of the eye. Chronic hyperglycemia can affect the corneal layers shape and functions that responsible for corneal transparency. Objectives: Comparison of the changes in corneal endothelium namely, cell density (CD), percentage polymegathism, cell volume (CV) and pleomorphism (6A) along with central corneal thickness (CCT) in patients of type 2 diabetes mellitus with normal age and sex- matched subjects. Patients and methods: A case-control study in Sayed Galal University Hospital. 20 eyes of type 2 diabetic patients and 20 eyes of age and sex matched controls were included in the study. Age, gender, other demographic data, and relevant diabetic history were obtained. Full evaluation of both cases and controls including both anterior and posterior segment complete evaluation was done. Non- contact specular microscopy was used to study the corneal endothelial cells. Results: The mean endothelial cell density (ECD) was non-significantly lower in type 2 diabetics compared to controls (p value = 0.751.). There was a highly significant reduction in hexagonally in the cases compared to controls and highly significant increase in coefficient of variation in the cases compared to controls Conclusion: This study acknowledged that type 2 diabetes causes a significant decrease of hexagonality and increase CV (polymegathism). However, non-significant reduction of ECD was documented

Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.