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Many diagnostic tools are essential for Mycobacterium bovis (M. bovis) eradication program. This study aimed to apply γ-IFN assay to detect bovine tuberculosis and multiplex PCR (m-PCR) for rapid identification of Mycobacterial isolates. A total no. of 150 cattle in 10 small farms at different Governorates in Egypt, were previously gave suspected results with comparative cervical tuberculin test (SICCT), they retested after 60 days later again with SICCT and bovine gamma-interferon (γ-IFN) immunoassay. Eighty-seven (58%) out of total 150 animals were +ve reactors by SICCT test while 80 (53.3%) animals gave +ve γ-IFN assay. The isolated M. bovis by conventional culturing and identification tests were +ve 55 (63.2%) out 87. The γ-IFN assay sensitivity and specificity gave 82.9% and 93.8% respectively. For rapid identification of different mycobacterial isolates using m-PCR two set of primers were used. The first set gave 123bp DNA PCR product expressing IS6110 insertion element for Mycobacterium tuberculosis (MTBC). The other one gave 500bp from RvD1Rv2031c genomic sequence definite to M. bovis. M-PCR findings were in a concordance with results of conventional culturing and identification tests with high sensitivity and specificity (100%). From this study, it is concluded that diagnosis of bovine tuberculosis (BTB) used tuberculin test and γ-IFN assay with m-PCR for rapid identification M. bovis isolates in living herds.

Aim: Orbital trauma is considered one of the most commonmaxillofacial traumas with functional and cosmetic impactto eye globe. The main objective is to establish a roadmap for the management of orbital floor fractures.Patients and Methods: One hundred and seventy-threepatients were selected from the database of Mansoura UniversityHospitals with orbital floor fractures who were treatedat the Department of Plastic & Reconstructive Surgery Departmentover past 4 years. Cases were retrospectively reviewedby preoperative clinical findings, management, surgical approaches,and sequelae. Authors evaluated timing and indicationof surgical intervention, surgical outcomes, complications,and materials used for orbital reconstruction.Results: In total, there were (173) cases of orbital fractureswith average age of (23.14) years. The leading cause of thesefractures was motor traffic accident (64.7%). Pure blow-outfractures represent 25% of cases while fractures of inferiororbital rim alone were 45% of cases. Inferior orbital rimassociated with orbital fractures were 30%. 57.2% of patientswere managed surgically while 42.8% patients were managedconservatively. Conchal graft was used in 19 cases for floorreconstruction while 15 cases were managed by titaniummesh. In the follow-up, 10 patients still complain of enophthalmos,while 7 patients still complain of diplopia.Conclusions: Better postoperative results were presentedin cases managed immediately or within two weeks surgically,A guideline for choice of effective protocol for managementwas developed.

Background and Objective: Mobile Wireless Sensor Network (MWSN) is a specialized wireless network made up of large number of mobile sensors, where each sensor is capable of changing its location, relaying data to either the base station or neighbouring nodes. MWSN has emerged as a useful integral part of modern communication systems; however, its major performance challenges are lack of data delivery assurance due to mobility of its sensors, low computational power of its nodes, and some security related issues. Methods: Most of the existing WSN routing protocols are for non-mobile sensors and require considerably high computational power. Thus, not suitable for energy-constraint WSN with mobile sensors. Therefore, there is need for a secure protocol for MWSN with mechanisms that take into account the limited resources of the nodes and dynamism of its nodes’ locations. Results: In this paper, an efficient routing protocol for MWSN is proposed, not to only improve data delivery but to ensure reliability. This protocol is capable of selecting optimal multi-hop route among available routes for the source node and securely hops the data to the destination nodes through intermediary nodes. Formal and informal security analysis of the routing protocol is done to ascertain the required security level of the protocol. In addition, computational cost analysis is done to evaluate the computational cost of the protocol. Conclusion: The analysis results showed that the proposed protocol was secure and required low computational cost.

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

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

Magnetic Levitation System is one of practical examples which faces some nonlinearities behavior. Such systems require special types of controller parameters consideration for accurate results. In this paper, the process of tuning is to determine the system poles and getting them away from the instability region using state feedback (SF) controller methodology. The resulted controllable system parameters are estimated using LQR controller. Since the desired goal is to minimize vital parameters in the system behavior like the steady state error, settling time, raising time of the system and system overshoot, optimization techniques have been used to minimize cost function of the parameters which need to be optimized and reach for more reliable ones for better performance. Particle swarm optimization (PSO) has been used for tuning process. System operation points should be 0.61 A for electric current and 6 mm distance between coil surface and balanced metal ball, results show that using LQR controller will cause about 33% error percentage as steady state error and about 20% overshoot. Using PSO optimization technique for controller parameters will produce less steady state error of 6.5% with 4% overshoot percentage.

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

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.

Introduction Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation. Methods We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient’s right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum. Results Since 2013, we have used this new technique in 570 patients (first group) and Palmer’s point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases. Conclusion This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer’s point in patients who are not candidates for classic midline entry.

Continuum robotic arm becomes the new area of scientific research nowadays. Its technology has grown and touched several vital applications included industry and agriculture thanks to many advantages made it a better choice than the conventional serial robotic manipulator. This paper represents a new designed model of continuum arm robot, which relates the motor shaft angle as the input parameter and transfers the motor torque to combined system of compression springs and results in six outputs: x,y and z 3D coordinates for the center point of the end effector and $\theta,~\psi$ and $\gamma$ to represent the angles of rotation around the three axis. As a black box, the system needs to be identified using different techniques from the common ones with the traditional instruments system we deal with in our daily life, so artificial neural network techniques are the solution for that dilemma. The system is trained many times to reach for high certainty results while the stage of validation and testing. Then the model is qualitatively tested while drawing its workspace which is expected to be like shell of semi sphere. After the stage of system identification, there is one about the control process of the system using fuzzy logic control, which depends of assigning fuzzification rules and using fuzzy sets to get the output. The main reasons for using that kind of controller that It deals most of time with the nonlinear systems which have multi-inputs and multi-outputs

This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy. In this retrospective study, we reviewed medical charts of all morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Patients who developed gastric obstruction symptoms and were diagnosed with twisted sleeve gastrectomy were identified and included in this study. From October 2005 to December 2015, there are 3634 morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Eighty-six (2.3%) patients developed symptoms of gastric obstruction. Forty-five (1.23%) patients were included in this study. The mean time of presentation was 59.8 days after surgery. Upper GI contrast study was done routinely, and it was positive for axial twist in 37 (82%) patients. Abdominal CT with oral and IV contrast was done in eight (18%) when swallow study was equivocal. Endoscopic treatment was successful in 43 patients (95.5%). Sixteen patients were successfully managed by endoscopic stenting, and 29 patients had balloon dilation. The average numbers of dilation sessions were 1.7. Out of these 29 patients, 18 responded well to a single session of dilatation and did not require any further dilatation sessions. Two patients who failed to respond to three subsequent sessions of balloon dilation underwent laparoscopic adhesiolysis and gastropexy. Endoscopic stenting is an effective tool in management of axial rotation of sleeved stomach. Balloon dilation can also be effective in selected cases. Few cases might require laparoscopic adhesiolysis and gastropexy.

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

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.

Background To evaluate early, mid and long term efficacy of laparoscopic sleeve gastrectomy as a definitive management of morbid obesity and to study factors that may predict its success. Materials and methods A retrospective study was conducted by reviewing the database of patients who underwent LSG as a definitive bariatric procedure, from April 2005 to March 2013. Univariate and multivariate analysis were performed. Results 1395 patients were included in this study. Mean age was 33 years and women:men ratio was 74:26. The mean preoperative BMI was 46 kg/m 2 . Operative time was 113 ± 29 min. Reinforcement of staple line was done only in 447 (32%) cases. 11 (0.79%) cases developed postoperative leak, with total number of complications 72 (5.1%) and 0% mortality. Percentage of excess weight loss (%EWL) was 42%, 53%, 61%, 73%, 67%, 61%, 59% and 57% at 6 months, 1–7 years. Remission of diabetes (DM), hypertension (HTN) and hyperlipidaemia (HLP) occurred 69%, 54% and 43% respectively. 56 (4%) patients underwent revision surgery, for insufficient weight loss ( n = 37) and severe reflux symptoms ( n = 19). Mean follow up was 76 ± 19 (range: 6–103) months. Smaller bougie size and leaving smaller antrum were associated with significant %EWL. Bougie ≤36F remained significant in multivariate analysis. Conclusion This study supports safety, effectiveness and durability of LSG as a sole definitive bariatric procedure. Smaller bougie size and shorter distance from pylorus were associated with significant %EWL.

Key Clinical Message Subarachnoid hemorrhage as a presentation of cerebral venous sinus thrombosis (CVST) is a rare but recognized phenomenon. A high index of suspicion among clinicians and an awareness of subtle CT features can avoid delayed diagnosis of underlying CVST [Eur J Neurol., 17, 2010, 1249]. Prompt but careful anticoagulation can prevent significant associated morbidity and mortality.

Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation.We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient's right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum.Since 2013, we have used this new technique in 570 patients (first group) and Palmer's point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases.This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer's point in patients who are not candidates for classic midline entry.

Vibrio parahaemolyticus is widely recognized pathogenic Vibrio species due to numerous outbreaks and its’ wide occurrence in the marine environment. A total of 50 Vibrio parahaemolyticus isolates were isolated from seawater and sediments in Malaysia were tested for sensitivity to 19 antibiotics using disc diffusion method. It was found that all isolates were resistant towards ampicillin (10 μg), penicillin (10 μg), methicillin (5 μg), and novobiocin (5 μg); but exhibit sensitivity to chloramphenicol (30 μg) and gentamicin (100 μg). The low percentage of sensitivity towards antibiotics was observed with the following antibiotics; amoxicillin 10μg (98%), fluconazole 25μg (98%), erythromycin 15 μg (92%), vancomycin 30 μg (92%), bacitracin 10 μg (84%), carbenicillin 100 μg (84%), cephalothin 30 μg (52%), nitrofurantion 200 μg (52%), ciprofloxacin 5 μg (40%), tetracycline 30 μg (20%), kanamycin 30 μg (10%), nalidixic acid 30 μg (10%) and streptomycin 20 μg (6%). Multiple antibiotic resistance (MAR) index was f...

Laparoscopic hernia repair accounts for 10% of all hernia surgery. Potential benefits include reduction in postoperative pain, rapid recovery, lower recurrence rate, and fewer complications. The outcomes of health-related quality of life and patient perspective after hernia repair are our aim. Consecutive patients treated for unilateral uncomplicated groin hernia were enrolled after evaluation for inclusion. Participants were randomly distributed to receive either laparoscopic transabdominal preperitoneal repair (TAPP) (group I) or Lichtenstein repair (group II). Operative and postoperative complications, operative time, hospital stay, and late complications were assessed early postoperatively, at 4 weeks, and every 6 months thereafter. Quality of life was assessed using Short Form-36 questionnaire in the first visit (after 4 weeks). One hundred and eighty-five patients of unilateral uncomplicated groin hernia were included; 88 patients (group I) were treated by TAPP, and 97 patients were treated by Lichtenstein repair (group II) with median follow-up of 17.9 months. Mean hospital stay, mean operative time, operative and postoperative complications were similar in the two groups. Quality of life showed better and significant outcomes in group I for physical function (p ≤ 0.001), role physical (p ≤ 0.011), bodily pain (p ≤ 0.017), general health (p ≤ 0.047), and total physical health (p ≤ 0.008). However, mental health showed no statistical significance in its four scales, but with better outcomes in group I. Total quality outcomes showed significantly better outcomes in group I (p ≤ 0.031). TAPP hernia repair technique is a safe technique with low complication rate, less postoperative body pain, and better quality-of-life outcomes compared with open technique, being well accepted from the patient’s perspective for quality of life.

Objectives : to evaluate the effica­cy of gastrografin in resolution of the episode of obstruction in patients ad­mitted with adhesive small bowel ob­struction, and to determine the inde­pendent predictors of failed non-operative management. Patients and Methods : This study was conducted on all admitted pa­tients with adhesive small bowel ob­struction at the Departments of Sur­gery, Mansoura Emergency Hospital and Mansoura University Hospital, Mansoura, Egypt, from May 2005 to July 2008. Patients were blindly ran­domized into two groups: Group 1 (control group), and Group 2 (gas- trografin group) 50 patients each. 100 ml of gasrografin was administered to group 2 patients. The progress of the contrast to the colon was assessed by serial abdominal radiographs. When the contrast reached the colon, oral fluids started. If the contrast failed to reach the colon after 24h, laparotomy was performed. Results : In Group 2, there were increased rate of resolution of the ob­struction, decreased rate of failure of conservative management, and over­all shorter hospital stay when com­pared to Group 1 (86% versus 68% & 14% versus 32% & 2.28 versus 4.06 days respectively).

To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients.This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI)40, or35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients' preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings.Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one or more) were found in 805 (25%) patients (19% group A vs 6% group B, P = 0.001). Seven patients had critical events during conscious sedation due to severe hypoxemia (60%). Rate of stricture in our study was 2.6%. Success rate of endoscopic dilation was 100%. One point nine percent patients with gastric leak were identified with 75% success rate of endoscopic therapy. Three point seven percent patients developed acute upper bleeding. Seventy-eight point two percent patients were treated by conservative therapy and EGD was performed in 21.8% with 100% success and 0% complications.Our results support the performance of EGD only in patients with upper gastrointestinal symptoms. Endoscopy also offers safe effective tool for anastomotic complications after bariatric surgery.

Timing of surgical intervention is critical for outcomes of patients diagnosed with surgical emergencies. Facing the challenge of multiple patients requiring emergency surgery, or of limited resource availability, the acute care surgeon must triage patients according to their disease process and physiological state. Emergency operations from all surgical disciplines should be scheduled by an agreed time frame that is based on accumulated data of outcomes related to time elapsed from diagnosis to surgery. Although literature exists regarding the optimal timing of various surgical interventions, implementation of protocols for triage of surgical emergencies is lacking. For institutions of a repetitive triage mechanism, further discussion on optimal timing of surgery in diverse surgical emergencies should be encouraged. Standardizing timing of interventions in surgical emergencies will promote clinical investigation as well as a commitment by administrative authorities to proper operating theater provision for acute care surgery.

The high increase of mobile technology is leading to mobilized learning environment, thus making traditional learning to diminish slowly and become inactive and unproductive. Learners worldwide are being attracted to mobile environment more so that it promotes anytime, anywhere learning. Biology as a secondary school subject will be applicable for mobile learning for such a time and generation as this. This paper is therefore an attempt to mobile based biology edutainment system for the students who normally range from the ages of thirteen to sixteen.