Lymphatic Chyle Duct Injury and Identification During Laparoscopic Sleeve Gastrectomy Preventing Postoperative Chylous Ascites

We present a case of intraoperative detection of an iatrogenic chyle duct injury during laparoscopic sleeve gastrectomy. The chyle duct injury was identified and managed by ligature, preventing postoperative chylous ascites.

Can Incidental Gastric GISTs During Bariatric Surgeries Change the Primary Plan of Surgery? A Single Team Experience and a Systematic Review of Literature

As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy.

Serological and molecular surveys of Anaplasma spp. in Egyptian cattle reveal high A. marginale infection prevalence

BACKGROUND

Bovine anaplasmosis is an infectious disease with worldwide distribution. It spreads by various routes mainly through tick bites.

AIMS

This study aimed to investigate bovine related Anaplasma spp. in cattle from three northern governorates of Egypt by serological and molecular assays, to evaluate the associated risk factors and to analyze the phylogeny of revealed A. marginale isolates.

METHODS

During 2020, a total of 650 blood samples were collected from asymptomatic cattle in the governorates of Kafr El-Sheikh (n=240), Menofia (n=230), and Al-Gharbia (n=180). Sera samples were examined using the Anaplasma antibody test kit, cELISA v2. Blood genomic DNA of seropositive cattle was then examined by PCRs specific to A. marginale, A. centrale, and A. bovis. Selected positive samples were subjected to nucleotide sequencing. Risk factors (i.e. geographical area, breed, type of production, sex, age, herd size, season, husbandry system, tick infestation, and application of acaricides) were evaluated by logistic regression approach.

RESULTS

In total, 130 cattle (20%, 95% CI: 17.1-23.3) were recorded seropositive for Anaplasma species. Major risk factors associated with seropositivity were being crossbred, dairy cattle, aged more than 5 years, summer season, herd size of below 300, pasture grazing, tick infestation, and not being subjected to regular treatment with acaricides. By using species-specific PCR, only A. marginale was detected. Nucleotide sequencing showed the occurrence of two different msp4 genotypes.

CONCLUSION

This study shows the high prevalence of A. marginale in cattle of Kafr El-Sheikh, Al-Gharbia, and Menofia. However, the connection between Anaplasma species and their tick vectors remains unknown in Egypt and merits further investigations. Since these infections primarily spread through ixodid tick bites, effective ectoparasite control strategies, regular examination of cattle and successful chemoprophylaxis are recommended.

Impact of perioperative right ventricular assist device on ventricular arrhythmias in patients with continuous flow left ventricular assist device

Background

Patients with continuous flow left ventricular assist device (LVAD) may develop right ventricular failure in perioperative period of LVAD implantation. Some of these patients require temporary support with right ventricular assist device (RVAD). There is paucity of data regarding the impact of RVAD support on incidence of ventricular arrhythmias (VA) in LVAD patients.

Purpose

To assess the impact of perioperative RVAD support on the incidence of VA in the first 6 months after LVAD implant.

Methods

This is a retrospective study including 316 patients undergoing LVAD implantation at the University of Nebraska Medical Center, USA since 2012. Patients were divided into 2 groups- those who required perioperative RVAD support (BiVAD group) and those who did not require it (LVAD only group). VA was defined as any sustained ventricular tachyarrhythmia lasting more than 30 seconds or requiring therapy from implantable cardioverter-defibrillator. Incidence of VA in the first 6 months post-LVAD implantation was analyzed and compared between the groups using Cox proportional hazards regression analysis.

Results

Out of 316 total patients, 52 (16%) patients required RVAD support. The difference in age, gender, race and medications between the two groups was not statistically significant. The patients in BiVAD group had a higher incidence of post-LVAD VA (35%) as compared to LVAD only group (21%). On Cox proportional hazards regression analysis, the difference was found to be statistically significant even after adjusting for history of pre-LVAD VAs (HR: 2.27; p=0.02) (Figure 1).

Conclusion

In this large single center cohort of LVAD patients, we noticed a statistically higher incidence of VA in subgroup of patients requiring perioperative RVAD support.

Figure 1

Funding Acknowledgement

Type of funding source: None

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Antibacterial activity of silver nanoparticles against field and reference strains of Mycobacterium tuberculosis, Mycobacterium bovis and multiple-drug-resistant tuberculosis strains

Tuberculosis (TB) is an endemic disease in animals and humans in Egypt. This study aims to investigate the antimycobacterial activity of silver nanoparticles(AgNPs) by determining the minimal inhibitory concentration (MIC) of AgNPs, using the microplate Alamar blue assay. The AgNPs were chemically synthesised and their form and size were characterised by ultraviolet-visible absorption spectrophotometry, transmission electron microscopy and X-ray diffraction.The reference strains of Mycobacterium bovis and Mycobacterium tuberculosisH37Rv, and one multiple-drug-resistant (MDR) strain of M. tuberculosis were tested, as well as clinical isolates of M. bovis and M. tuberculosis. The AgNPs were tetrahydral with a few spherical particles and an average particle size of 50 nm. The mycobacterial strains were varied with MICs of AgNPs. Both reference strains of M. tuberculosis and M. bovis, in addition to the MDR strain of M. tuberculosis, were successfully inhibited by AgNPs at MICs of 1 ?g/ml, 4 ?g/ml and 16 ?g/ml, respectively, whereas clinical isolates of M. bovis and M. tuberculosis were inhibited at MIC values of 4-32 ?g/ml and 1-16 ?g/ml, respectively. The AgNPs showed an in vitro chemotherapeutic effect against Mycobacterium spp.Thus, they can be used to treat TB not only in humans but also in animals, and maybe useful in TB prevention and control strategies worldwide.

Characterization of Coxiella burnetii strains from ruminants in a Galleria mellonella host-based model

Coxiella burnetii is a small Gram-negative intracellular bacterium and is the causative agent of Q fever, which is a zoonotic disease with a worldwide distribution. Domesticated ruminants are the main reservoir of the disease, but the bacterium is able to infect a wide range of hosts, including humans, arthropods and invertebrates. Virulence studies of Coxiella strains usually require a suitable animal model. However, mammalian models are costly and are associated with many ethical constraints. An alternative infection model using Galleria mellonella has been used to study the virulence of several bacterial as well as fungal pathogens. Moreover, the G. mellonella larvae model has been used to identify virulence genes using phase II C. burnetii strain Nine Mile mutants. In our study we describe its use for the characterization of C. burnetii strains isolated from ruminants.

Pathogenicity of the Egyptian A/H5N1 avian influenza viruses in chickens

Long-term circulation of highly pathogenic avian influenza H5N1 viruses of clade 2.2.1 in Egyptian poultry since February 2006 resulted in the evolution of two distinct clades: 2.2.1.1 represents antigenic-drift variants isolated from vaccinated poultry and 2.2.1.2 that caused the newest upsurge in birds and humans in 2014/2015. In the present study, nine isolates were collected from chickens, ducks and turkeys representing the commercial and backyard sectors during the period 2009-2015. The subtyping was confirmed by hemagglutination inhibition (HI) test, RT-qPCR and sequence analysis. The Mean Death Time (MDT) and Intravenous Pathogenicity Index (IVPI) for all isolates were determined. Sequence analysis of the HA gene sequences of these viruses revealed that two viruses belonged to clade 2.2.1.1 and the rest were clade 2.2.1.2. Antigenic characterisation of the viruses supported the results of the phylogenetic analysis. The MDT of the isolates ranged from 18 to 72 h and the IVPI values ranged from 2.3 to 2.9; viruses of the 2.2.1.1 clade were less virulent than those of the 2.2.1.2 clade. In addition, clade-specific polymorphism in the HA cleavage site was observed. These findings indicate the high and variable pathogenicity of H5N1 viruses of different clades and host-origin in Egypt. The upsurge of outbreaks in poultry in 2014/2015 was probably not due to a shift in virulence from earlier viruses.

Evolution of highly pathogenic avian influenza H5N1 viruses in Egypt indicating progressive adaptation

Highly pathogenic avian influenza (HPAI) virus of the H5N1 subtype was first diagnosed in poultry in Egypt in 2006, and since then the disease became enzootic in poultry throughout the country, affecting the poultry industry and village poultry as well as infecting humans. Vaccination has been used as a part of the control strategy to help to control the disease. Epidemiological data with sequence analysis of H5N1 viruses is important to link the mechanism of virus evolution in Egypt. This study describes the evolutionary pattern of Egyptian H5N1 viruses based on molecular characterization for the isolates collected from commercial poultry farms and village poultry from 2006 to 2011. Genetic analysis of the hemagglutinin (HA) gene was done by sequencing of the full-length H5 gene. The epidemiological pattern of disease outbreaks in Egyptian poultry farms seems to be seasonal with no specific geographic distribution across the country. The molecular epidemiological data revealed that there are two major groups of viruses: the classic group of subclade 2.2.1 and a variant group of 2.2.1.1. The classic group is prevailing mainly in village poultry and had fewer mutations compared to the originally introduced virus in 2006. Since 2009, this group has started to be transmitted back to commercial sectors. The variant group emerged by late 2007, was prevalent mainly in vaccinated commercial poultry, mutated continuously at a higher rate until 2010, and started to decline in 2011. Genetic analysis of the neuraminidase (NA) gene and the other six internal genes indicates a grouping of the Egyptian viruses similar to that obtained using the HA gene, with no obvious reassortments. The results of this study indicate that HPAI-H5N1 viruses are progressively evolving and adapting in Egypt and continue to acquire new mutations every season.

Avian influenza H5N1 virus infections in vaccinated commercial and backyard poultry in Egypt

In this paper, we describe results from a high-pathogenic H5N1 avian influenza virus (AIV) surveillance program in previously H5-vaccinated commercial and family-backyard poultry flocks that was conducted from 2007 to 2008 by the Egyptian National Laboratory for Veterinary Quality Control on Poultry Production. The real-time reverse transcription PCR assay was used to detect the influenza A virus matrix gene and detection of the H5 and N1 subtypes was accomplished using a commercially available kit real-time reverse transcription PCR assay. The virus was detected in 35/3,610 (0.97%) and 27/8,682 (0.31%) of examined commercial poultry farms and 246/816 (30%) and 89/1,723 (5.2%) of backyard flocks in 2007 and 2008, respectively. Positive flocks were identified throughout the year, with the highest frequencies occurring during the winter months. Anti-H5 serum antibody titers in selected commercial poultry ranged from <2 (negative) to 9.6 log(2) when determined in the hemagglutination inhibition test using a H5 AIV antigen. In conclusion, despite the nationwide vaccination strategy of poultry in Egypt to combat H5N1 AIV, continuous circulation of the virus in vaccinated commercial and backyard poultry was reported and the efficacy of the vaccination using a challenge model with the current circulating field virus should be revised.

The Egyptian National Breast Screening Program: Priorities, challenges, and results of the pilot phase

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Background: According to the World Health Organization,the number of breast cancercases in developing countries will increase dramatically by the year 2050. Egypt is likely to see an increase in this disease burden unless effective programs for early detection and control are implemented. Many women, especially those who are medically underserved, still do not understand the importance of regular mammograms, or how and where to get one. Methods: Four mobile mammography vans were launched in October 2007, to screen women over 45 years old in the underserved areas of Cairo. Each van was equipped with a full field digital mammography (FFDM) machine, dedicated computer system linked to the National Breast Screening Center via video SAT & ADSL, sphygmomanometer, blood glucose measuring kit, and spring scale and meter to measure weight and height. Based on positive findings, patients were directed to Cairo University Hospital to receive appropriate treatment. Mobile units continued to operate through October, 2008. Results: From October 2007 through October 2008, 11,414 women were screened for breast cancer, hypertension, diabetes, and obesity. Two hundred forty four (2.13%) women were radiologically positive for cancer; of these, only 112 (45.9%) women agreed to be recalled for assessment; of these, 49.1% were confirmed to be true positive with BI-RADS 4,5 (61% cases were mass, with 27.9 % 1–2 cm in size; 16.4% cases were microcalcifications alone; multicentricity in 6.6 %; bilaterality in 2.5% of cases). 36.6% were false positive, and 14.2% are under further investigation. Conclusions: Although Cairo is the most developed city in Egypt, there is lack of breast cancer awareness, especially in the underserved areas. Breast cancer is now a priority for the Ministry of Health, with four more vans and 10 fixed FFDM units to be implemented during the next year. A 5-year plan has been established to cover all 29 Egyptian Governorates.

No significant financial relationships to disclose.

A Telephone-Linked Computer System for COPD Care

The current revolution in communications technology provides an opportunity for novel approaches to management of medical illness. As economic imperatives lead to a progressive reduction in the time that health-care providers spend with their patients, computerized, telephone-linked communication systems offer an inexpensive, widely available alternative with which patients and providers can maintain contact. Such systems may be particularly useful for providing ongoing monitoring and education of patients with chronic illnesses such as COPD. In this article, we describe the general application of telephone-linked communication systems in the health-care setting. We then present in detail one such system, which provides telephone-linked care for COPD (TLC-COPD). The operation of the system is described, as are its theoretical underpinnings in social learning theory. A randomized clinical trial currently is being performed to study the effects of the TLC-COPD system. The rationale for expected improvements in disease control and quality of life, and for a reduction in acute health-care utilization, is discussed.

A telecommunications system to manage patients with chronic disease

The care of patients with chronic disease is a large and growing problem in the United States and other industrialized countries.' it is expensive, and the quality of care received by patients is often sub-optimal, resulting in poor health outcomes. We developed a totally automated computer-controlled telecommunications system, called TLC, that provides--frequent, close monitoring of patients with chronic disease and reports the results to the patients' physicians on a timely basis, so that they can intervene appropriately. TLC also monitors the patients' important self care activities, such as medication-taking, and provides education and counseling to improve the patients' performance of these activities. The system operates through regularly scheduled telephone conversations with patients' in their homes. An evaluation of a TLC chronic disease application for patients with hypertension demonstrated that use of the system was associated with significant improvement of the patients' adherence to their medication regimens and significantly improved blood pressure control. These results show that it is possible to design an information science-based health care delivery system that performs functions usually performed only by health care professionals, and suggests that information science will become an important means of delivering health care services in the next millennium.

Microscopic localization of calcifications in and around breast carcinoma: a cautionary note for needle core biopsies

OBJECTIVE

To detail the microanatomic localization of microcalcifications (Ca++) occurring in association with breast carcinoma and thereby to determine their reliability as a marker of breast carcinoma in small tissue core biopsies.

SUMMARY BACKGROUND DATA

Identification of the pathology associated with Ca++ in mammograms has acquired increasing importance in the early detection of breast carcinoma. With recent advances enabling computer-guided stereoscopic needle biopsy of calcified foci, histopathologic diagnosis is rendered on increasingly small tissue samples, raising the risk of misdiagnosis. Knowledge of the microanatomic distribution of Ca++ in relation to diagnostic epithelial elements is essential for assessing their significance in small tissue biopsies.

METHODS

All 32 carcinomas with Ca++ within 1 cm of carcinoma diagnosed by open biopsy at the New England Deaconess Hospital from January 1994 to January 1995 were studied. Ca++ were classified as being within ductal or lobular carcinoma in situ, invasive carcinoma, carcinoma-associated stroma, benign stroma >1 mm from carcinoma, or benign ducts or terminal duct-lobular units. If Ca++ were peritumoral, their distance from the tumor was measured.

RESULTS

Ca++ were present only in malignant components in 31%, only in benign components in 34%, and in both in 34% of cases. The most common locations of Ca++ were benign peritumoral ducts (62%) and ductal carcinoma in situ (54%). The microanatomic distribution of benign peritumoral Ca++ in relation to the mass is detailed.

CONCLUSIONS

In carcinomas with Ca++ in the area of tumor, Ca++ may not be localized to malignant tissue. Caution should be used when interpreting the finding of Ca++ in benign components of small tissue samples of breast masses.

Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study

BACKGROUND

The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. To date, there has been no systematic measurement of health status in the VA. The Veterans Health Study has developed methods to assess patient-based health status in ambulatory populations.

OBJECTIVES

To describe the health status of veterans and examine the relationships between their health-related quality of life, age, comorbidity, and socioeconomic and service-connected disability status.

METHODS

Participants in the Veterans Health Study, a 2-year longitudinal study, were recruited from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Study patients received questionnaires of health status, including the Medical Outcomes Study Short Form 36-Item Health Survey; and a health examination, clinical assessments, and medical history taking. Sixteen hundred sixty-seven patients for whom we conducted baseline assessments are described.

RESULTS

The VA outpatients had poor health status scores across all measures of the Medical Outcomes Study Short Form 36-Item Health Survey compared with scores in non-VA populations (at least 50% of 1 SD worse). Striking differences also were found with the sample stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), scores were considerably lower among the younger patients; for the eighth scale (physical function), scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (>65 years). The mental health scores of young veterans were substantially worse than all other age groups (P<.001) and scores of screening measures for depression were significantly higher in the youngest age group (51%) compared with the oldest age groups (33% and 16%) (P<.001).

CONCLUSIONS

The VA outpatients have substantially worse health status than non-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; the young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health-related quality of life in young veterans. As health care systems continue to undergo a radical transformation, the Department of Veterans Affairs should focus on the provision of mental health services for its younger veteran.

Attentional performance of children with traumatic brain injury: a quantitative and qualitative analysis of digit span

Previous studies have indicated that digit span performance is not particularly sensitive to the effects of traumatic brain injury (Baddeley & Warrington, 1970; Brooks, 1975; Sterne, 1969). However, clinical lore posits poorer backward vs. forward performance compared to normals due to the greater attentional demands of the backward task. This study examined qualitative aspects of Digit Span performance including forward/backward span discrepancies and error patterns in children with traumatic brain injury (n = 20) and normals (n = 19). The hypothesis of greater forward/backward discrepancy with traumatic brain injury was not supported. Children with traumatic brain injury make a significantly greater number of preceiling errors than normals, consistent with other findings of increased performance variability. Preceiling errors are errors that occur in trials prior to the two failed trials, resulting in discontinuation of the task. In addition, cognitive correlates of error types, such as WISC-R factor scores, were significantly different between groups. The results of this study suggest that a more detailed analysis of performance on attentional tasks previously described as resilient to brain injury may shed further light on the nature of acquired attentional deficits.

Detection of herpes simplex virus DNA in cerebrospinal fluid of Saudi pediatric patients with encephalitis by the polymerase chain reaction

Twelve samples of cerebrospinal fluid (CSF) from Saudi pediatric patients with suspected encephalitis were found negative for herpes simplex virus by cell culture and by nucleic acid hybridization using(32)P-labeled specific probes. After amplification of DNA extracted from 100 microl of each sample using primers for the glycoprotein D gene of HSV, seven specimens were found positive for HSV DNA. Subsequent hybridization with the labeled DNA probe ensured the positivity of the seven samples and further detected one more positive sample, for a total of eight HSV DNA positive cases. This technique improved the detection of HSV in CSF samples and may assist in an early diagnosis for HSV ecephalitis.

A simple procedure for the isolation of schistosomules for biochemical studies or culture

Incubation of cercariae of Schistosoma mansoni in a 1:1 mixture of Eagle's Minimal Essential Medium and rat serum at 42 degrees C for only 5 minutes, plus subsequent vortexing, resulted in at least 98% conversion of cercariae to schistosomules. Subsequent centrifugation before or after settling for 30 minutes in an ice bath, resulted in schistosomule preparations with about 20% or 10% contamination with tail segments, respectively.

The potential role of various species of intermediate hosts of Schistosoma haematobium in Saudi Arabia

The potential role of 3 species of Bulinus in the transmission of Schistosoma haematobium in Saudi Arabia was assessed on the basis of their susceptibility to experimental infection, their geographical distribution and numbers, and the type of habitats in which they were found. B. truncatus, distributed mainly in the mid- and south-western regions, showed extremely low susceptibility to strains of S. haematobium from Yemen, Egypt and Sudan. The same species from one area in the north-west was refractory to a strain of the parasite from Yemen. In contrast, B. wrighti was very susceptible to infection but is found only in a few habitats far from human settlements, thus probably playing little part in the transmission of the disease. As B. beccarii is highly susceptible to the infection and is distributed widely, this snail is probably the main intermediate host of schistosomiasis in Saudi Arabia.

Keratoconus, magnesium deficiency, type A behavior, and allergy

The etiology of keratoconus is still unknown. This project was designed to study, in a group of keratoconic patients and a control group, the following: clinical, endocrinological, immunological, psychological, and ophthalmological factors. We found mean serum magnesium deficiency and type A behavior to be significantly more common in keratoconic patients than in a control group of patients. In addition changes in gluco-mineral corticoids, changes in glucose metabolism, edema of allergic origin, and genetic factors may collaborate in the development of keratoconus. All these factors could affect the osmotic mechanism of the cornea: Na-K and/or Ca ATPase, the collagen structure by alteration of the adenylate cyclase activity, and other mechanisms. This study suggests an association between keratoconus, magnesium depletion, and type A behavior, which together constitute a new clinical syndrome and confirm an association between keratoconus and atopy.

Laboratory and field evaluation of a direct filtration technique for recovery of schistosome cercariae

The use of cercariometry in epidemiological studies has been limited by turbidity, difficulty of recovering cercariae at low concentrations in natural waters, and by complex apparatus that requires a power source. The technique of differential filtration developed by Theron has been modified and tested in the laboratory and in the field in Upper Egypt for detection of Schistosoma haematobium cercariae. A recovery filter with a pore size of 30 micrometer was found to give the best results. The recovery rate in the laboratory was 51% on filtration of 5-liter samples of formalin-treated water, and 19-30% with 10- and 20-liter samples. This moderate efficiency is offset by simplicity of the technique, rapid filtration, and ease of reading the recovery filter, permitting sampling of large volumes of water in the field by persons with little training. Average densities of 0.024 cercariae per liter of water were found at the Nile and 0.029 cercariae per liter in the irrigation canals. Most cercariae were recovered between 0.700 and 0900 hours.