Tracheal resection and reconstruction: A 3-year case series of 14 patients.

INTRODUCTION: Tracheal resection and reconstruction is one of the most challenging procedures and is seldom performed due to its complexity. Despite being a life-saving procedure, only a handful of centres are performing this procedure in Malaysia. We report our 3 years' experience in Hospital Kuala Lumpur performing tracheal resection and reconstruction in 14 patients. MATERIALS AND METHODS: Retrospective review of medical records of tracheal resection and reconstruction was performed from September 2018 till August 2021. Data that were extracted include demographic information, indication for surgery, intraoperative airway management, surgical approach, perioperative parameters, complications, and 1- year outcome. RESULTS: Fourteen patients with the mean age of 49.1 years underwent tracheal resection and reconstruction, consisting of 9 benign and 5 malignant diseases. Non-intubated airway approach was used in three patients. Transcervical surgical access was used in 10 patients whereas thoracotomy, videoassisted thoracoscopic surgery, and combination of thoracotomy, transcervical incision with manubrial split were used in 3 patients respectively. The mean length of trachea resected was 2.3cm, with the longest length of 4.5cm. All patients were extubated post-operatively except for one due to traumatic brain trauma. No anastomosis dehiscence was seen. We also did not see any postoperative stenosis and all the patients are alive. CONCLUSION: Tracheal resection and anastomosis can be performed safely in complex stenosis and malignant tumours. Pre-operative planning with a multidisciplinary approach is vital to ensure a good outcome.

Nano-TiO2 modified carbon paste sensor for electrochemical nicotine detection using anionic surfactant.

A newly competitive electrochemical sensor for nicotine (NIC) detection was successfully achieved. Nano-TiO2 with a carbon paste electrode (CPE) were used for the sensor construction, where Nano-TiO2 was considered as one of the richest and highly variable class of materials. The sensor showed electrocatalytic activity in both aqueous and micellar media toward the oxidation of NIC at Britton-Robinson (B-R) buffer solution (4×10(-2)M) of pH range (2.0-8.0) containing (1.0mM) sodium dodecylsulfate (SDS) using cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) techniques. Scanning electron microscope (SEM) and Energy Dispersive X-Ray Analysis (EDX) techniques were also used. The linear range of detection for NIC using the new Nano-TiO2 Modified Carbon Paste sensor (NTMCP) was detected using diffrential pulse voltammetry (DPV) technique and it was found between 2×10(-6)M and 5.4×10(-4)M with a detection limit of 1.34×10(-8)M. The obtained results clarified the simplicity, high sensitivity and selectivity of the new NTMCPE for nicotine determination in real cigarettes and urine samples.

Corrosion resistance of Ti modified by chitosan-gold nanoparticles for orthopedic implantation.

Highly uniform bionanocomposite film composed of chitosan (CS) and gold nanoparticles (AuNPs) was synthesized successfully by electrodeposition method. The influence of AuNPs/CS bionanocomposite film on corrosion resistance of Ti was investigated. Surface morphology and compositional properties of the bionanocomposite were analyzed by scanning electron microscope (SEM), energy dispersive X-ray analysis (EDX), and X-ray photoelectron spectroscopy (XPS). Moreover, cyclic voltammetry (CV), open-circuit potential measurements (OCP), electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (Rp) were used to examine the corrosion behavior in Hanks' solution. In comparison with Ti, Nyquist and Bode plots displayed higher impedance values and phase angles for AuNPs/CS biocomposite denoting a more protective passive film on Ti with inhibition efficiency (IE%) of 98%. An electric equivalent circuit with three time constants was modeled for the bionanocomposite. In addition, the antibacterial effect revealed the high efficiencies of the bionanocomposite film for inhibiting bacterial growth. The combination of the high biocompatibility of chitosan and strong adsorption ability of AuNPs make AuNPs/CS bionanocomposite promising candidate for modifying biomaterial surfaces for medical implantation applications.

Utility of serum preoperative carcinoemberyonic antigen in colorectal cancer patients.

BACKGROUND/AIMS: The usefulness of preoperative CEA in CRC remains controversial as regards its biological function, and its use in the diagnosis, prognosis, and management and follow up of CRC patients. the aim of this study was to provide a critical and updated study for the value of CEA in CRC. METHODOLOGY: From January 2000 to June 2005, a prospective randomized study involving 200 CRC patients for whom curative resection was performed, another 100 healthy persons as a control group was included. Basal CEA using chemilumescence technique and routine follow up were done. RESULTS: (1) The mean basal CEA in CRC patients (17.3 ng% +/- 1.67) was significantly higher than control (3.41 ng% +/- 1.1). (2) A significant linear association between basal CEA and Dukes' classes was evident with the mean basal CEA for Dukes' A, B, C were 7.8, 12.7, 25.8 respectively (expressed as ng%). (3) The validity of basal CEA in primary CRC diagnosis was highly positive (sensitivity 80%--PPV 86.95%--accuracy 73.66%), with hig her efficacy in advanced disease detection (sensitivity 93%--NPV 7%--accuracy 84.5%--odds ratio 30.3) and negative exclusion power for DFS prediction (specificity 13.84%). (4) The basal CEA was a discriminate factor in colorectal prognosis - B value (3.74). (5) Patients with CEA < or =5 ng% had better DFS (15%) and DFT (23.6 months) than those with CEA > 5 ng% as they had DFS (33.75%) and DFT (18.48 months). (6) Basal CEA above 15 ng% had a significant shift in the cumulative hazard of recurrence. CONCLUSION: The CEA is a metastasis potentiator. The high serum CEA in CRC screening programs should be considered a marker of malignancy especially in patients with appropriate symptoms. The preop CEA in CRC patients identifies subsets with favorable, indolent and uneven biological behavior (< or =5 ng%, < or =15 ng%, > 15 ng% respectively). Moreover, the addition of preop CEA level to conventional staging forms a strong prognostic tool and supplies adopted practice guideline initiative for follow up and therapy in CRC.

Evaluation of the IgG4 in Egyptian bancroftian filariasis.

The IgG4 response against antigen extracts from Wuchereria bancrofti microfilariae and Dirofilaria immitis adult worms was determined by ELISA in 65 Egyptian adult male patients suffering from different clinical manifestations of W. bancrofti infection. They were divided into microfilaremic (n-35) and amicrofilaremic (n = 30) and these divisions were subdivided into early asymptomatic, hydrocele and late chronic elephantiasis subgroups. The IgG4 responses were significantly higher in early asymptomatic patients whether microfilaremic or amicrofilaremic than in hydrocele or in chronic elephantiasis (P < 0.05) & (P < 0.001) respectively. The IgG4 response was slightly higher in microfilaremic than in amicrofilaremic subjects. The mean OD value of IgG4 among the microfilaremics against the microfilaria antigen in early asymptomatic patients (0.840 nm) was lower than the IgG4 response against the adult antigen in the same group (0.960 nm), while among the early asymptomatic amicrofilaremics it was the same (0.690 nm) in both microfilaria and adult antigens.

Different cytokines profiles in spleen cells and liver granuloma of Schistosoma mansoni experimentally infected mice during disease development.

To determine the importance of Th1 and Th2 cells in modulating granuloma formation, mRNA transcripts for Th1 (IL-2 and IFN-gamma) and Th2 (IL-4 and IL-5) cytokines were assessed by the molecular technique of in situ hybridization in the liver granuloma. The molecular studies showed few number of cells expressing mRNA transcripts for INF-gamma whereas, considerable number of IL-2 cells were present in the liver granuloma at 6 weeks post-infection (p.i.). Complete disappearance of IFN-gamma expressing cells were found when the disease progressed to 13 weeks p.i. Conversely, very high number of cells expressing mRNA transcripts for IL-4 and fair number of IL-5 cells were present at 7 weeks p.i. with a peak level of IL-4 cells at 13 weeks p.i. These in situ molecular studies of the liver tissues, demonstrated that Th1 cells were present at the very early granuloma development. Moreover, Th2 cells were required for its full development. The main interesting finding was the number of cells expressing mRNA for IL-4, as they were very huge and it might exceed the total number of lymphocytes per se in the granuloma. Lymphocytes from experimentally infected mice-spleen cells were also cultured in vitro with S. mansoni soluble egg antigen (SEA) and the same cytokines of lymphocyte supernatant were measured by ELISA assay. The levels of IFN-gamma and IL-2 were high to 6 wk. p.i. with a slight decline of IFN-gamma, and increasing amount of IL-2 at 10-13 wk p.i. Spleen lymphocytes of fully formed granuloma secreted high levels of IL-4 and IL-5. The results suggest that the development of schistosome egg-induced liver granuloma is a complex process and both Th1 and Th2 cell subsets sharing with other inflammatory cells (non lymphocytes), may play an important role in regulating and modulating the immuno-pathology of granuloma formation and the subsequent hepatic fibrosis.

Evaluation of FAST-ELISA for the diagnosis of experimental trichniosis.

In order to compare between FAST-ELISA and ELISA for the diagnosis of experimental trichinosis and study the kinetics of antibody and eosinophilic responses, six New Zeland rabbits were infected orally by Trichinella spiralis larvae. Blood was collected every other day for the first 2 weeks, then weekly for eleven weeks post infection. T. spiralis crude larval antigen was prepared for coating of ELISA plates and FAST-ELISA beads. Blood was examined for eosinophilic count and for serum antibody level by ELISA and FAST-ELISA techniques. The burden of infection was assessed by counting encysted larvae in muscle samples of the infected rabbits. By FAST-ELISA antibodies were detected seven days post infection (P.I.), while with ELISA technique antibodies were detected after 10 days. Both tests detected maximum antibody levels on the 4th week. The eosinophilic count reached its peak by the 2nd week. There was a significant inverse correlation between the mean eosinophilic count and the mean larval count. FAST-ELISA proved to be more sensitive than ELISA in early detection of infection, besides being a simple, fast and sensitive assay for antibody detection against T. spiralis.

Mites infesting two migratory birds, Coturnix c. coturnix (quail or Simmaan) and Sturnus v. vulgaris (starling or zarzuur) with reference to avian zoonosis.

Birds are a marvelous group of creatures. Their beautiful coloration, singing, dancing and their attractive ways of life offer great pleasure to birdwatcher. Egypt is one of the most important countries of migratory birds. Not less than 300 species of birds visit Egypt annually from allover the world. The mite fauna of two migratory birds was studied in North Sinai Governorate and Suez Canal Zone. Thirty-one species of mites were recovered from quail and 39 from starling. Both types of birds serve hosts for 26 species of mites. Besides, five species were only recovered from quail and 13 species from starling. These totaled 44 species belonging to 30 families of three suborders (Mesostigmata, Trombidiformes and Sarcoptidiformes). The mite index on quail ranged between 1.0 to 5.0 in North Sinai G. and 1.0 to 17.0 in Suez Canal Z. The mite index on starling ranged between 1.0 to 4.75 in North Sinai G. and 1.0 to 4.5 in Suez Canal Z. Sixteen of the recovered species of mites were not recorded before on the Egyptian resident birds (house sparrow and laughing dove). The medical and veterinary importance of avian zoonosis was discussed. It is hoped to stimulate the awareness to migratory birds as reservoir hosts for microorganisms and parasites from allover the world. Besides, there is an urgent need to protect the resident and the visiting birds.

Oestrus ovis (sheep nasal fly) infesting the eyes and the nose of a camel keeper family.

Myiasis is a medical and veterinary health problem in many animal rearing countries. It is not a new problem in Egypt. A family of five persons were infested in the eyes (5) and nose (2) with the larvae of Oestrus ovis. It is concluded that the physicians in the MOH rural health units should keep in mind opthalmomyiasis when dealing with non specific catarrhal conjunctivitis particularly those people who are concerned with rearing of farm animals.

The ability of bovine mammary tissue to synthesize lipids for 96 h when cocultured with liver and adipose tissue.

Explants of bovine mammary, liver, and adipose tissues were cocultured in the same well for 24, 48, 72 or 96 h and their ability to synthesize lipids was measured by the incorporation of [14C]acetate into triglycerides, free fatty acids, and phospholipids. The model was developed to study the effect of bovine somatotropin on lipid synthesis in mammary tissue, because somatotropin will not affect mammary tissue unless liver tissue is present. Somatotropin reduced incorporation by mammary tissue relative to the control. However, the rate of incorporation remained constant through 96 h with somatotropin, but steadily decreased in control mammary tissue. Phospholipid release into the media increased dramatically from 2% of that synthesized during the first 24 h to 218% of that synthesized from 72 to 96 h. The high release of phospholipids after 24 h suggests that cellular breakdown was occurring. A 24-h incubation is recommended to study lipid synthesis with this system.

Study of C-reactive protein in bilharziasis and malignancy as causes of ascites.

C-reactive protein titre was estimated in serum and ascitic fluid in 23 patients, 12 with cancer stomach accompanied by liver metastatases and 11 with bilharzial liver fibrosis. The results showed no statistically significant differences between the titre in serum and ascitic fluid in the group of cancer with mean of serum/ascitic level ratio 1.3, while in bilharzial group there was significant difference with ratio mean 6.3.

Effect of bovine growth hormone on incorporation of [14C]acetate into lipids by co-cultures of bovine mammary, liver, and adipose tissue explants.

Incorporation of [14C]acetate into lipids was measured in 24 hr co-cultures of mammary, liver and adipose tissue from Holstein cows at 53, 210 and 318 d of lactation in the presence or absence of bovine growth hormone. Little (less than 1%) of the labeled lipids appeared in the media relative to that incorporated into the tissue. In mammary tissue, incorporation of [14C]acetate was highest into triglycerides (16,298 cpm/mg mammary tissue), followed by phospholipids (1,887 cpm), free fatty acids (1,252 cpm), diglycerides (708 cpm), free cholesterol (360 cpm) and monoglycerides (93 cpm). Bovine growth hormone did not increase incorporation of [14C]acetate when mammary or adipose tissue were incubated separately. However, in the presence of liver and adipose tissue, bovine growth hormone significantly increased the incorporation of [14C]acetate into triglycerides, diglycerides, free fatty acids and free cholesterol by mammary tissue. These results suggest that bovine growth hormone acts on mammary tissue indirectly through liver and adipose tissue to increase lipid synthesis. This mechanism may play a role in the action of bovine growth hormone in vivo to increase milk and milk fat production.