Till Research Articles

Evaluation of wound healing after angiosome-directed infrapopliteal endovascular angioplasty in critical limb ischemia

Background Because of delayed healing duration of variable foot wounds, techniques for identifying methods to expedite wound healing process were needed. Angiosome concept divides the foot into three-dimensional zones of tissue supplied by specific arterial source. Patients and methods This study included 40 patients (40 limbs) who presented with Rutherford class (5 and 6) foot wounds, with infrapopliteal arterial disease, without significant proximal arterial disease with good run-in and run-off tibial segments and patent foot arch and underwent successful primary tibial angioplasty. Patients were recruited from January 2018 till June 2018 and were followed up till 2 years from July 2018 till July 2020 for the effect of angiosome-directed angioplasty on wound healing and limb salvage rates. Results Direct angiosomal arterial flow to the wound zone was accomplished in 27 (67.5%) patients, with better and faster wound healing rate at 1.4 months (SD: 0.41) and high limb salvage rate, compared with indirect nonangiosomal arterial flow, which was accomplished in 13 (32.5%) patients with delayed wound healing rate at 7.8 months (SD: 1.7) and low limb salvage rate. Age, sex, and different comorbitities were statistically insignificant in wound healing rates. Conclusion The study established that direct angiosomal tibial angioplasty had a considerable role in improving foot wound healing rate, with higher limb salvage rate than the indirect nonangiosomal tibial angioplasty. Obtaining direct arterial supply based on the angiosome technique of perfusion to different foot ulcers or post minor toes amputation ulcer (gangrenous toes) seemed to be significant for wound healing rates in patients with critical limb ischemia.

Single-incision mid-urethral mini slings versus standard transobturator slings in management of women with stress urinary incontinence: a randomized controlled trial

Purpose To evaluate the single-incision suburethral mini-sling (SIMS) versus the transobturator tapes (TOT) procedure in the management of stress urinary incontinence (SUI) regarding safety, efficacy, postoperative pain, and the time to return to daily activity. Patients and methods A total of 40 female patients with SUI were included in our study and were divided into two equal groups: group A was managed by TOT, whereas group B was managed by SIMS. Patients were evaluated from day 1 till 6 months after surgery for postoperative pain, early return to daily activity, dyspareunia, and continence after surgery. Moreover, also any perioperative complications were recorded. Results Patients’ demographics data were similar in both groups. We reported a success rate of 85% for patients of group A versus 80% success rate for patients in group B, with no statistically significant difference. A lower pain score in favor of group B was reported; these results were significant starting from day 1 till 1 month postoperatively, whereas at 3 and 6 months, the results were not statistically significant. Moreover, there was an earlier return to daily activity with group B compared with group A. We reported three cases of dyspareunia in group A compared with two cases in group B. No cases of vaginal erosions, as well as bladder, vascular, or vaginal injuries were encountered in our study. Conclusion The use of SIMS in the treatment of SUI is as effective and safe as TOT, with significantly lower postoperative pain and analgesic requirement and earlier return to daily activity.

Evaluation of a new scoring system for early diagnosis and management of acute appendicitis in pediatric patients

Background Acute appendicitis is a common surgical emergency among infants and children. The diagnosis of acute appendicitis in young children remains a big challenge, as most of such patients present late, with complications. However, unnecessary surgery should be avoided. Over years, many scoring systems have been introduced for helping the diagnosis of acute appendicitis such as Alvarado score, the Pediatric Appendicitis Score (PAS), and Appendicitis Inflammatory Response score. Patients and methods In the period between 3/2018 and 9/2019, 130 infants and children till the age of 16 years, with acute right iliac pain, were included in this study. These patients were evaluated using three diagnostic scores: Acute Pediatric Appendicitis Score (APAS), PAS, and Alvarado scores. Results Logistic regression analysis yielded a model comprising nine variables, all being statistically significant (P Conclusion APAS score is a significant diagnostic tool for diagnosis of acute appendicitis in pediatrics. The study also provides a solid comparison among APAS, PAS, and Alvarado scores. APAS score is the first score in well-known literature to introduce ultrasound examination as a routine investigation among the suspected children with acute appendicitis with an accuracy of ∼95.38%.

Efficacy of far-near-near-far (Hughes) technique in closure of midline exploratory wound for reducing the incidence of incisional hernia in comparison with conventional mass closure

Background Incisional hernia is the commonest complexity for closure of midline incision after the abdominal surgery, causing morbidity, impaired life quality, and higher costs of health care. Hughes technique merges a standard mass closure with a chain of horizontal and two vertical mattress sutures within a single suture. Theoretically, this will spread the loading over the length of the incision in addition to across it. So, this technique is more effective for preventing the formation of incisional hernia after a closure of the midline incision. Aim The purpose of this investigation was to clarify the performance of Hughes technique in closure of midline exploratory wounds for reducing the incidence of postoperative dehiscence, either burst abdomen or incisional hernia, in comparison with conventional mass closure. Patients and methods Between June 2017 and November 2019, this prospective study was carried out on 100 patients. Patients were categorized randomly into two groups: group A included 50 patients who were closed by simple conventional mass closure, and group B included 50 patients who were closed by simple conventional mass closure along with far-near-near-far (Hughes) technique using vicryl 1 sutures. Results There was no significant difference between groups regarding basic demographic and clinical data. The operation duration and hospital stay were longer in Hughes, but with no significant difference. Furthermore, there was no significant difference regarding infection, but dehiscence was significantly associated more with mass technique. Moreover, Hughes group had significantly higher scores regarding visual analog scal (VAS) at 2 and 4 h, and thereafter the two groups were nearly matched till 24 h. Hughes technique was preferable in reduction of postoperative dehiscence, either burst abdomen or incisional hernia. Furthermore, better surgeon and patient satisfaction was gained. Conclusion The authors can conclude that the Hughes technique is more effective and preferable as a mesh repair for the handling and preventing the formation of incisional hernia after the closure of a midline wound in comparison with conventional mass closure.

Omentopexy in sleeve gastrectomy and its effect on postoperative complications

Background Sleeve gastrectomy is an effective and relatively safe procedure for morbid obesity. Diagnosis of leakage is mainly based on clinical suspicion rather than laboratory and radiological evidence. Aim To evaluate the benefit of omental reattachment with full-thickness stomach stitches during laparoscopic sleeve gastrectomy (LSG) in decreasing postoperative hemorrhage and/or leakage. Patients and methods A retrospective analysis was conducted on the collected data from 100 cases that were divided into two groups: group I included 50 cases that underwent LSG procedures with no omental reattachment, and group II included 50 cases that underwent LSG procedures with omental reattachment with full-thickness staple line of sleeved stomach stitches till the level of angle of His above and to the antrum below from April 2019 to April 2020 at Bariatric Surgery Unit of the General Surgery Department of Ain Shams University Hospitals. Results There was a statistically significant difference between the two groups regarding the operation time and drain content and amount. There was a decrease of postoperative bleeding between the two groups from 12% in group I to 0% in group II, with P value of 0.4, indicating slight significant difference. It also showed no difference in the percentage of postoperative leakage, as it was 1% in both groups. Conclusion A decrease in incidence of bleeding postoperatively can be achieved by omental fixation to the sleeved stomach by full gastric thickness stitches; it will decrease patient’s morbidity and mortality, as it decreases hospital stay and possibility of blood transfusion.

How to manage a dilated cystic duct during laparoscopic cholecystectomy

Back ground Closure of the cystic duct (CD) is a must during laparoscopic cholecystectomy (LC). Metal clips were the standard technique used before. Now there are different methods used to occlude the CD (endoloop, suturing with absorbable materials, and endo-GIA stapling devices). Aim To assess different methods used in closure of dilated CD during laparoscopic cholecystectomy. Patients and methods This was a retrospective study done on 169 patients with difficult cholecystectomies of 3645 patients who had laparoscopic cholecystectomy in the General Surgery Department, Zagazig University Hospitals, in the period from January 2011 till March 2020. Results A total of 169 patients were included, comprising 98 females and 71 males, with an average age of 45±17.2 years. All patients had dilated CD during laparoscopic cholecystectomy that was occluded by different methods: large metal clips in 39 patients, ligature in 43 patients, endoloop in 33 patients, suturing to close the CD orifice in 30 patients, and endo-GIA devices in 24 patients. Conclusion We should keep in mind different methods when facing dilated CD during laparoscopic cholecystectomy according to its diameter and the availability of equipment.

Emerging Pharmacotherapy for COVID-19 Treatment: An Integrative Review

Background: COVID-19 has become the global pandemic incapacitating the health systems and demanding investigation of possible pharmacotherapeutic options against SARS CoV-2. Although social distancing, hand sanitizing and supportive care remain as the preventive and management measures of COVID-19, clinical efficacy of various therapeutic agents is being tried out simultaneously to reduce the mortality associated with the disease. Objective: To ascertain the potential drugs/treatment for COVID 19 from the published literature across the world from its origin until June 2020. Methods: A literature search was done in CINAHL, Pub Med, Google Scholar, Science Direct, Springer, Wiley, EEEE, and Medline computerized repositories for complete texts from December 2019 until June 2020. The search terms used were COVID-19, treatment, antimalarial, antibiotics, antiretroviral, antiviral, plasma, immunoglobulin, heparin and immunosuppressant. The inclusion criteria adopted in the study were original research articles with current treatment process and potential drugs used in COVID 19 patients, primary data, published in English and full article available for free download. Results: There is no absolute single pharmacotherapeutic measure identified till date to cure this disease. The studies reviewed reported that the clinical improvement of the disease could be due to the result of other supportive measures and the results are inconclusive as the disease is impacted by various coexisting medical conditions. More clinical trials at large scales are needed to tackle this crisis at the earliest. Conclusion: Inventing a new vaccine or drug against coronavirus may take years to fully develop. However, clinicians are trying to treat this disease with already prescribed drugs for other diseases like H1N1, malaria, HIV, and SARS. It is important to note that there may be emergence of new clinical characteristics, treatment trials and outcome of COVID-19 as the disease evolves.

Years Till Now

Years Till Now

Is Covid-19 Sibling of SARS AND MERS? A Review on: Novel Covid-19

Pandemic times: Contemporary public health catastrophe terrifying the world over with the rapidly spreading of 2019-nCoV or SARS-CoV-2 Coronaviruses have pass over the species barriers to cause fatal disease in human since the 2002 and 2012;Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome respectively It was suggested that SARS-CoV and SARS-CoV-2 are firmly related to each and hypothesized it originated in animal (bats) and was transmitted to humans Though Novel Covid-19’s intermediary animal is not clear As a matter of fact, transmission of Covid-19 is direct contact with infected people or inhalation of droplets thus;escalate its spread World Health Organization stated the novel SARS-CoV-2 is one of the epidemic disease on January 30, 2020 and on March 11, 2020 declared a pandemic the rapidly spreading SARS-CoV-2-a globe first for corona virus Additionally, the incubation phase is from 2 to 14 days Usually the sign and symptoms are high temperature, dry cough, tiredness, sore throat, difficulty breathing (severe cases) AND malaise among others The diagnosis can be done with Real Time Polymerase Chain Reaction test to suspected SARS-CoV-2 infection along with chest X-ray Till time, no medicine or vaccines are prepared that can approved against SARS-CoV-2 or any human-infecting corona viruses But some researchers have confirmed to curtail its effects by administrating antiviral drugs such as Oseltamivir, Ribavirin, Ganciclovir, Lopinavir AND Ritonavir

Editors Note on Applied and Computational Mathematics

The journal has been started in the year 2012 and it released its first volume in the same year. Till now, the journal has released 8 volumes by the end of 2019 and is successfully running its 9th Volume. The Journal is an open access publication that features scientific works of considerable significance and impact in all branches of mathematics that concerns with mathematical methods that are typically used in science, engineering, business, and industry. Computational mathematics involves mathematical research in areas of science where computing plays a central and essential role in emphasizing algorithms, numerical methods and symbolic methods with the concept of ubiquitous computing. The journal provides an Open Access platform to analyse new computational and applied techniques for solving the scientific or engineering problems.

The Nature of the Il17 Cytokine Response In Rabbits PrimeBoosted With Eschrchia Coli-Pseudomonas Aeruginosa Prototype Bacterin Combinations

The prototype E .coli - P. aeruginosa heat killed bacterin balanced and unbalanced bacterin combinations,as well as monotypic E. coli and single P. aeruginosa bacterins were developed. They were prime-boosted rabbits by homologous prime-boost protocols. At the end of the specific immune-priming protocols ,rabbits were bleed, sera saved in 0.5 ml aliquots at -18C till testing due time.IL17 Eliza assay was done on the test and control sera. Single strength balanced combined bacterin combination induced increase in the mean IL17 concentration means as compared to monotypic, double balanced ,un-balanced bcterin combinations and control. The other combinations were showing inhibition in IL17 concentration means than control .The immune interference matched To as: one bacterin enhance the other, and one damp the other. Enhancement of IL17 response single strength combination might be a promise for efficacy of such combination in regulation and protection against natural or experimental infectious challenges .

Current coronavirus (SARS-CoV-2) epidemiological, diagnostic and therapeutic approaches: An updated review until June 2020.

Coronaviruses are a group of enveloped viruses with non-segmented, single-stranded, and positive-sense RNA genomes. In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Wuhan City, China. The World Health Organization (WHO) declared the coronavirus outbreak as a global pandemic in March 2020. Fever, dry cough and fatigue are found in the vast majority of all COVID-19 cases. Early diagnosis, treatment and future prevention are keys to COVID-19 management. Currently, the unmet need to develop cost-effective point-of-contact test kits and efficient laboratory techniques for confirmation of COVID-19 infection has powered a new frontier of diagnostic innovation. No proven effective therapies or vaccines for SARS-CoV-2 currently exist. The rapidly increasing research regarding COVID-19 virology provides a significant number of potential drug targets. Remdesivir may be the most promising therapy up till now. On May 1, 2020, Gilead Sciences, announced that the U.S. Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for the investigational Remdesivir as a potential antiviral for COVID-19 treatment. On May 7, 2020, Gilead Sciences, announced that the Japanese Ministry of Health, Labour and Welfare (MHLW) has granted regulatory approval of Veklury® (Remdesivir) as a treatment for SARS-CoV-2 infection, the virus that causes COVID-19 acute respiratory syndrome, under an exceptional approval pathway. Also, Corticosteroids are recommended for severe cases only to suppress the immune response and reduce symptoms, but not for mild and moderate patients where they are associated with a high-risk side effect. Based on the currently published evidence, we tried to highlight different diagnostic approaches, side effects and therapeutic agents that could help physicians in the frontlines.

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap

Background: Pilonidal sinus disease is a common condition usually affecting young individuals and has been conventionally treated by open excision technique. Rhomboid Limberg is a transposition flap that has been pleaded for treatment of this condition. Aim: To study the outcome of Rhomboid excision with Limberg flap closure for the treatment of Sacrococcygeal Pilonidal sinus. Material and Methods: The study was conducted prospectively in the department of surgery Skims Medical College Srinagar from March 2014 to February 2019 and total of 55 patients with primary or recurrent pilonidal sinus disease were studied. Results: The average operative time was 60 minutes (range 50-80 minutes) Postoperative stay of patients in the hospital was 3-4 days.The complications were seen in total of four patients which included Seroma and mild gaping of the wound in one patient each and dehiscence in two patients. None of the patients had recurrence till date.Conclusions: Rhomboid excision with Limberg flap transposition is an effective surgical technique for management of pilonidal sinus. Keywords: Pilonidal sinus, Limberg flap, rhomboid transposition flap, fasciocutaneous flap,

Total cyst excision with Roux-en-Y hepaticojejunostomy for choledochal cyst management: a single-center experience

Background Choledochal cystis considered as a cystic dilatation of the biliary tract, which is a rare disease. It is more common in children, but its incidence and diagnosis are increasing in adults, representing 20% of the cases. Aim To evaluate morbidity and mortality rates following hepaticojejunostomy done for patients, either child or adult, with choledochal cyst. Patients and methods A total of 30 patients were evaluated, comprising 13 children and 17 adults. The study was done in the period from January 2013 till January 2020, in the Advanced Hepato-Pancreatico-Biliary Center, Zagazig University Hospital, Egypt. Results Abdominal pain was the commonest complaint in all patients. Jaundice was present in 80%. Total cyst resection with reconstruction of the biliary tract with a standard 60–60 cm Roux-en-Y hepaticojejunostomy was done in 28 (93.33%) patients. Left hepatectomy was done in two patients with Caroli’s disease. There was no recurrence in our follow-up period. Conclusion Total cyst excision with Roux-en-Y hepaticojejunostomy is the standard treatment of choledochal cyst. It was associated with low incidence of recurrence and also decreased long-term postoperative complications and malignancy.

Effect of oral isotretinoin on anxiety and depression in patients with acne

Objective: To study the side effect profile of systemic isotretinoin (ITT) and its association with anxiety and depression in the Indian population. Materials and Methods: In this prospective observational study, 300 patients of either gender, aged >12 years, taking oral ITT were evaluated for severity of acne by the visual analog scale (VAS) and psychiatric side effects with the Hamilton anxiety rating scale (HAM-A) and Montgomery Asberg Depression Rating scale (MADRS) at baseline up till the fourth visit. Software R version 3.6.0. was employed to analyze the data. Results: A significant improvement in VAS score was observed at baseline to final visit (P = 0.001). Significant increase in MADRS score was observed at baseline to final visit (P

Trodden Lanes or New Paths: Ballisto- and Seismocardiography Till Now.

Ballisto- and seismocardiography (BCG/SCG) are methods of studying blood circulation and cardiac function by using the vibration measurements at the body surface, e.g. via accelerometers. The aim of this work is to show the current relevance of BCG/SCG for the target medical diagnostics. To reach this goal and to examine the relevance, an overall search for all BCG and SCG articles in the databases PubMed and IEEEXplore was first carried out ("ballistocardiography OR seismocardiography") for the years till 2019. The results of this literature study show, overall 425 papers for the years from 2003 till 2019, with BCG (317) as significantly stronger represented than SCG (120). The distribution of the included subjects shows that a smaller group (n<=10) of mostly healthy people is more common. Last but not least, we examined which sensors have been included in the articles since 2003, with the result that accelerometers, whether as self-developed prototypes or installed in smartphones, were used in slightly less than 50% of the articles found. The differences in the numbers of publications between BCG and SCG may also be due to the distinction's complexity between BCG, which is more intuitive, and SCG. Looking at the number and distribution of included subjects, it is noticeable that this is rather low and primarily healthy subjects are used. However, the publication increase indicates that we are at a threshold in this topic and actual benefit to medicine.

KNOWLEDGE AND ATTITUDE TOWARDS COVID-19 AMONG STUDENTS OF KING ABDULAZIZ UNIVERSITY

Since its discovery in Wuhan, China, in December 2019, Coronavirus (COVID-19) diseaseis considered one of the fastest spreading viral infections The virus spreads between humans by droplets or by direct contact with an incubation period reaching up to 14 days, and isolation is the best way to prevent its spread The symptoms of COVID-19 infection include dry cough, fever, and shortness of breath No vaccine or treatment is available at the moment Precautionary measures have been taken by the government of Saudi Arabia to control the spread This study aimed to assess the knowledge of Male King Abdulaziz University students in Rabigh branch about the new emerging coronavirus COVID-19 by distributing a questionnaire among them This survey was conducted between March 1 till March 5, 2020, before the suspension of all the educational activities at King Abdulaziz University Three hundred seventy-five students filled the questionnaire 51 % believed that COVID-19 is the deadliest virus in the world Around 47% knew about hand washing and COVID-19 symptoms In conclusion, at the time of the study, our students had average knowledge of the virus with many misconceptions and moderate attitude

SARS-CoV-2: Brief History and Molecular Biology

The COVID-19 pandemic started in early December 2019 It appeared first time in People Republic of China and spread worldwide infecting more than 50 million people till today The disease caused more than one million deaths worldwide and still the threat is present The acute pneumonia resulting in severe respiratory syndromes are typical symptoms of novel coronavirus End of the COVID-19 pandemic is unpredictable In this project, development of vaccine and early diagnosis of the disease is proposed Currently, there is no proper vaccine for this disease However, preventive measures are the only solutions for this typical disease The origin of COVID-19 can be traced back to bat coronavirus, where it is almost to 97% identical to existing strains However, due to unique furin cleavage site the novel human coronavirus is spreading at alarming rate This article is discusses the history, classification, characterization and epidemics of viruses especially the coronaviruses © 2020 Textile Bioengineering and Informatics Society

Assessment of agricultural practices on water quality of the Tono Dam in the Upper East Region of Ghana

Population growth has resulted in drastic increase in demand for agricultural products for consumption and also as raw materials for agro-based industries. Associated with this increased demand is the application of agrochemicals to increase yields. This study assessed the impact of agricultural practices employed by farmers in the Tono catchment in the Upper East Region of Ghana on water quality. The study involved a combination of surveys and laboratory analyses. Structured questionnaires were administered to farmers to determine the various agricultural practices employed towards increasing crop yields as well as their knowledge on the environmental effects of these practices among others. Laboratory analysis was performed to determine the levels of physicochemical parameters of the reservoir water so as to ascertain its pollution level. The study showed that farmers in the catchment used mechanized ploughs to till their lands and applied fertilizer and other agrochemicals to increase yield. These practices potentially can pose serious threats on water quality of the reservoir. Although the levels of all the parameters analyzed were within the WHO guideline values, it is recommended that farmers within the area should be educated on proper application of agrochemicals and farming practices in order to ensure that the quality of the water is maintained. In particular, farming around the intake areas of the dam should be prohibited as this constitutes a major source of sediment into the reservoir. Key words: Agricultural practices, agrochemical usage, surface water quality.

Reducing Hyperglycemia without Over-Stimulation of β-cells: Prevention rather than Cure Type 2 Diabetes

LONGDOM Journal of Diabetes & Metabolism has been started in the year 2010 and it released its first volume in the same year. Till now, the journal has released 10 volumes by the end of 2019 and is successfully running its 11th Volume.