Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study.

PURPOSE: Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. METHODS: This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. RESULTS: Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. CONCLUSION: Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

Gene transcription and antioxidants production in Arthrospira (Spirulina) platensis grown under temperature variation.

AIM: To investigate the transcription of selected antioxidants and relevant genes under varying temperature conditions, and to identify the optimum temperature for antioxidants production by Arthrospira platensis. METHODS AND RESULTS: The dry weight (DW), pigment production, antioxidants production and gene transcription were examined in A. platensis growing under three temperatures of 23, 30 and 37°C. The cyanobacterial DW was highest in the high temperatures (30 and 37°C), while the pigments, such as Chl a, carotenoids, C-phycocyanin and total phycobiliprotein contents, showed their maximum value at 30°C. The total soluble protein and carbohydrate contents were highest at 30°C. Lipid peroxidation, as a marker for thermal stress, was high at 23°C, while higher temperatures remarkably reduced lipid peroxidation levels. Antioxidants activity was increased by 1·5-fold at 30°C and temperature fluctuations induced the antioxidant enzyme activities. The transcriptional abundance of heat shock protein (HSP90), glutamate synthase (GOGAT), delta-9 desaturase (desC), iron-superoxide dismutase (FeSOD) and the large subunit of Rubisco (rbcL) genes was measured under the same temperatures. CONCLUSION: The optimal temperature for growth, biochemical constituents and antioxidants of A. platensis is 30°C while some antioxidant enzyme activity increased at lower and higher temperatures. SIGNIFICANCE AND IMPACT OF THE STUDY: The study showed the significance of temperature for growth, enzymatic and non-enzymatic antioxidants and gene expression in A. platensis. This contributes to the knowledge of culturing A. platensis to harvest specific antioxidants or as an antioxidant-rich food source.

Non-invasive index of liver fibrosis induced by alcohol, thioacetamide and Schistosomal infection in mice.

BACKGROUND: Non invasive approaches will likely be increasing utilized to assess liver fibrosis. This work provides a new non invasive index to predict liver fibrosis induced in mice. METHODS: Fibrosis was generated by thioacetamide (TAA), chronic intake of ethanol, or infection with S. mansoni in 240 mice. Both progression and regression of fibrosis (after treatment with silymarin and/or praziquantel) were monitored. The following methods were employed: (i) The METAVIR system was utilized to grade and stage liver inflammation and fibosis; (ii) Determination of hepatic hydroxyproline and collagen; and (iii) Derivation of a new hepatic fibrosis index from the induced changes, and its prospective validation in a group of 70 mice. RESULTS: The index is composed of 4 serum variable including total proteins, gamma-GT, bilirubin and reduced glutathione (GSH), measured in diseased, treated and normal mice. These parameters were highly correlated with both the histological stage and the grade. They were combined in a logarithmic formula, which non-invasively scores the severity of liver fibrosis through a range (0 to 2), starting with healthy liver (corresponding to stage 0) to advanced fibrosis (corresponding stage 3).Receiver operating characteristic curves (ROC) for the accuracy of the index to predict the histological stages demonstrated that the areas under the curve (AUC) were 0.954, 0.979 and 0.99 for index values corresponding to histological stages 1, 2 and 3, respectively. Also, the index was correlated with stage and grade, (0.947 and 0.859, respectively). The cut off values that cover the range between stages 0-1, 1-2 and 2-3 are 0.4, 1.12 and 1.79, respectively. The results in the validation group confirmed the accuracy of the test. The AUROC was 0.869 and there was good correlation with the stage of fibrosis and grade of inflammation. CONCLUSION: The index fulfils the basic criteria of non-invasive marker of liver fibrosis since it is liver-specific, easy to implement, reliable, and inexpensive. It proved to be accurate in discriminating precirrhotic stages.

Modified lingual split technique versus conventional buccal technique in odontectomy of impacted mandibular third molars.

This study was conducted to compare two different techniques used in odontectomy of impacted mandibular third molar; the modified lingual split technique and the conventional buccal technique as regarding the duration of surgery as well as the incidence of postoperative sequelae such as pain, edema, and trismus. This study was carried out on thirty adult male patients having class II, position B mesioangular impacted mandibular third molar scheduled for removal, the cases were divided into two equal groups. Group one using the conventional buccal technique and group two using the modified lingual split technique. Pain was categorized into a three grade scale according to the dose of the analgesic taken by the patients postoperatively. The degree of trismus was calculated by measuring the interincisal distance when the mouth was opened at a maximum using a graduated caliper both preoperatively and postoperatively. Edema was measured linearly using a tape between different predetermined facial anatomical landmarks in different planes. All measurements were carried out immediately before surgery and after one, two and seven days postoperatively. The collected data were tabulated and were statistically analyzed. There was a significant difference between the two techniques as regarding the duration of surgery in favour of the modified lingual split technique, with a mean of 36.3 minutes, in group two against a mean of 54.3 minutes in group I. As regarding pain there was no significant difference in the first and the second postoperative days, while there was a significant difference in favour of the modified lingual split bone technique in the seventh postoperative day. Trismus and edema were comparable in both groups.