Prevalence of The Arterial Hand Dominance Using the Modified Allen Test and Pulse Oximetry among Plastic Surgery Patients.

Background: The ulnar and radial arteries are the major source of blood supply in the hand, as they form the superficial and deep palmar arches. Arterial hand circulation is one of the most complicated arterial trees and connections in the body, with tremendous variations in its structure. This study aimed to evaluate whether the ulnar artery or radial artery is the dominant artery in hand circulation among plastic surgery patients at King Khalid University Hospital and to correlate the arterial hand dominance with handedness and gender. Methods: This is an analytical cross-sectional study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, on plastic surgery patients. The sampling method is purposive sampling. The calculated sample size is 28; however, 100 participants have been enlisted in the study. The data have been collected using the modified Allen test with a pulse oximeter. Results: The collective prevalence of dual arterial dominance in our study was 69% compared with 56% and 30% for Little et al (P = 0.013) and Fuhrman et al (P < 0.001), respectively. With regard to gender, women were more likely to have a dual arterial blood supply than men, with the frequency values of 85% and 58.3% for women and men, respectively (P = 0.017). Conclusions: Our study found that dual arterial supply is predominant among our participants, with 69% of our participants possessing a dual arterial supply, while 18% and 13% constitute the prevalence of radial and ulnar dominance, respectively. This contrasts with what has been reported previously in the literature.

Co-Aggregative Effect of Probiotics Bacteria against Diarrheal Causative Bacteria.

Probiotics have been used for over a century to prevent and treat diseases. They can reduce the effects of gastroenteritis and are now used to treat acute diarrhea. This study aimed to evaluate the co-aggregative effects of probiotics bacteria against diarrheal causative bacteria. For this purpose, 11 isolates of probiotic bacteria were used in the current study, including three Lactobacillus plantarum, one Lactobacillus gasseri, two Lactobacillus fermentum, three Lactobacillus acidophilus, and two Lactococcus garvieae isolates. All isolates were tested for antibiotic susceptibility, autoaggregation ability, adhesion ability, antibacterial activity, acid tolerance, and bile salts tolerance. The results showed that most of them had the ability to autoaggregate after 4 h, with the highest percentage of 57.14% for L. fermentum. For the antibiotic susceptibility test, all the isolates showed resistance against trimethoprim/sulfamethoxazole, except one isolate. Moreover, all the isolates, except one, were susceptible to both vancomycin and tetracycline. All tested isolates had adhesion ability with different survival rates, which reached 34.57% for L. plantarum in acidic conditions. Besides, the highest survival rate was 85.17%, which belonged to L. garvieae, for bile salt tolerance. Probiotic isolates had an antibacterial effect against diarrhea-causative bacteria with an inhibition diameter of 17-49 mm for different Lactobacillus spp. and Lactococcus spp. isolates. Furthermore, the co-aggregation ability of probiotic isolates against diarrhea-causative bacteria was studied, and results showed that probiotic isolates had a co-aggregative effect against diarrhea-causative bacteria, Escherichia coli, Shigella sonnei, and Providencia alcalifaciens, after 24 h of incubation. The highest co-aggregative effect of probiotics isolates belonged to L. fermentum and L. acidophilus against P. alcalifaciens with a co-aggregation percentage of 100%, while the lowest co-aggregation rate was 14.29% against E. coli. The findings revealed the probiotic properties and co-aggregative effects of probiotic bacteria against diarrhea-causative bacteria.

UBC Reticulum: a province-wide network promoting surgical excellence and continuous improvement of general surgery in British Columbia.

The University of British Columbia's (UBC) Division of General Surgery is a diverse group, including both academic and community surgeons. Since its launch in 2019, the UBC Reticulum website has been a transformative tool in engaging general surgeons, fellows, residents, students and researchers through its many features and user-created content, such as its messaging board, Netter, and Connect feature, which connects members based on their specialty, location, procedures and interests. Reticulum also serves as a valuable repository of educational resources and is instrumental in the division's goal of improving continuing medical education; the Reticulum mentorship grant program provides financial support for practising surgeons pursuing peer-mentorship projects. UBC Reticulum serves as a model for how to coordinate surgical education, research and quality improvement within diverse provincial divisions.

The Relevance of Food Constituents to the Irritable Bowel Syndrome: A Rome IV-Based Prevalence Study Among Medical Students.

BACKGROUND/AIMS: Irritable bowel syndrome is prevalent in the general population. This study investigates the association between dietary intake and irritable bowel syndrome in medical college students at King Saud University besides its prevalence. MATERIALS AND METHODS: This is an analytical cross-sectional study of 426 students (271 males and 155 females, age 21.21 ± 1.58 years) from 5 academic levels of King Saud University Medical College. A self-reported questionnaire for Rome IV criteria was completed by each participant. They also filled out a food frequency questionnaire to assess their nutritional intake. RESULTS: The overall prevalence of irritable bowel syndrome was 17.8% without correlation to age and academic year in Medical School. However, the prevalence was higher in females than in males (40/115 vs. 36/235, P = .001). The irritable bowel syndrome group consumed significantly more energy, carbohydrates, and saturated fatty acids, while the non-irritable bowel syndrome group consumed significantly more fibers and niacin (P < .001 and P = .005, respectively). CONCLUSION: About 17.8% of medical students had irritable bowel syndrome with a greater prevalence in females. The irritable bowel syndrome group consumed significantly more energy, carbohydrates, and saturated fatty acids, while the non-irritable bowel syndrome group consumed significantly more fibers and niacin. Our results did not show any significant association between irritable bowel syndrome and fermentable oligosaccharide, disaccharide, monosaccharide, and polyol intake. Overall, both groups were not adhering to the Saudi dietary recommended intake.

Bone pathology mimicking non-accidental injury in a child - Bewildered by bones, case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Physical abuse of children is criminal conduct in the purview of medico-legal sciences and the confirmative diagnosis of 'child abuse' is imperative for further legal proceedings. Clinicians play a pivotal role in the protection of children by recognizing and reporting such cases and treating the victims of abuse. PRESENTATION OF CASE: To the best of our knowledge, we present the first case report in literature where osteofibrous dysplasia resulted in a pathological fracture in a 10-month-old South-Asian child which resembled the picture of child abuse. CLINICAL DISCUSSION: The challenges faced by clinicians in the process of analysis of presumed child abuse are numerous and careful formulation and elimination of medical conditions which may mimic non-accidental injury (NAI) is a must, prior to making an incontrovertible diagnosis. CONCLUSION: The telltale signs of NAI such as soft tissue injuries and fractures in a victimized child should always be evaluated cautiously with the intent of excluding pathologies that may mimic them and the evidence in this regard is seldom in literature.

The unrestricted global effort to complete the COOL trial.

BACKGROUND: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. METHODS: The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. DISCUSSION: OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. TRIAL REGISTRATION: National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).

Science fiction or clinical reality: a review of the applications of artificial intelligence along the continuum of trauma care.

Artificial intelligence (AI) and machine learning describe a broad range of algorithm types that can be trained based on datasets to make predictions. The increasing sophistication of AI has created new opportunities to apply these algorithms within within trauma care. Our paper overviews the current uses of AI along the continuum of trauma care, including injury prediction, triage, emergency department volume, assessment, and outcomes. Starting at the point of injury, algorithms are being used to predict severity of motor vehicle crashes, which can help inform emergency responses. Once on the scene, AI can be used to help emergency services triage patients remotely in order to inform transfer location and urgency. For the receiving hospital, these tools can be used to predict trauma volumes in the emergency department to help allocate appropriate staffing. After patient arrival to hospital, these algorithms not only can help to predict injury severity, which can inform decision-making, but also predict patient outcomes to help trauma teams anticipate patient trajectory. Overall, these tools have the capability to transform trauma care. AI is still nascent within the trauma surgery sphere, but this body of the literature shows that this technology has vast potential. AI-based predictive tools in trauma need to be explored further through prospective trials and clinical validation of algorithms.

Factors associated with recurrent appendicitis after nonoperative management.

BACKGROUND: The objective of this study is to identify predictors for recurrent appendicitis in patients with appendicitis previously treated nonoperatively. METHODS: This is a prospective cohort study of all adult patients with appendicitis treated at a tertiary care hospital. Patient demographics, radiographic information, management, and clinical outcomes were recorded. The primary outcome was recurrent appendicitis within 6 months after discharge from the index admission. Given the competing risk of interval appendectomy, a time-to-event competing-risk analysis was performed. RESULTS: Of the 699 patients presenting with appendicitis, 74 were treated nonoperatively (35 [47%] were women; median [IQR] age, 48 [33,64] years), and 21 patients (29%) had recurrent appendicitis. On univariate and multivariate analysis, presence of an appendicolith on imaging was the only factor associated with a higher risk of recurrent appendicitis (p = 0.02). CONCLUSIONS: The presence of appendicolith was associated with an increased risk of developing recurrent appendicitis within 6 months.

Penetrating cardiac trauma.

This chapter summarizes approaches to hemorrhage control in penetrating cardiac trauma, an injury that is a true test of trauma systems integration, trauma center readiness, teamwork, decision-making, technical excellence, and multidisciplinary trauma care.

Technical considerations in the management of penetrating cardiac injury.

Penetrating cardiac injuries require rapid diagnosis, efficient exposure and nuanced technical approaches, within a framework of highly coordinated and integrated multidisciplinary care. Acute care surgeons, with both strategic and technical expertise, are ideally positioned to address the potentially devastating consequences of these injuries. The aim of this narrative review is to offer a technical approach to the rapid evaluation, exposure, operative repair and postoperative care of penetrating cardiac injuries. A comprehensive review of the cardiac trauma literature, dating back to 1970, has provided a detailed toolbox of approaches to subxiphoid pericardial windows, resuscitative thoracotomy, median sternotomy, pericardiotomy, aortic clamping, cardiac hemorrhage control, cardiac repair, coronary artery injuries, pericardial closure, drain placement, chest wall closures, damage control thoracic procedures and immediate postoperative cardiac care, all based on fundamental physiological principles and anatomical considerations.

Uniaxial Strain Control of Bulk Ferromagnetism in Rare-Earth Titanates.

The perovskite rare-earth titanates are model Mott insulators with magnetic ground states that are very sensitive to structural distortions. These distortions couple strongly to the orbital degrees of freedom and, in principle, it should be possible to tune the superexchange and the magnetic transition with strain. We investigate the representative system (Y,La,Ca)TiO_{3}, which exhibits low crystallographic symmetry and no structural instabilities. From magnetic susceptibility measurements of the Curie temperature, we demonstrate direct, reversible, and continuous control of ferromagnetism by influencing the TiO_{6} octahedral tilts and rotations with uniaxial strain. The relative change in T_{C} as a function of strain is well described by ab initio calculations, which provides detailed understanding of the complex interactions among structural, orbital, and magnetic properties in rare-earth titanates. The demonstrated manipulation of octahedral distortions opens up far-reaching possibilities for investigations of electron-lattice coupling, competing ground states, and magnetic quantum phase transitions in a wide range of quantum materials.

Access to health care for people with stroke in South Africa: a qualitative study of community perspectives.

BACKGROUND: Incidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures. METHODS: In-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective. RESULTS: PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS. CONCLUSIONS: Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services.

A framework for role allocation in education, research and leadership services in Canadian academic divisions of general surgery: a modified Delphi consensus.

BACKGROUND: Moving toward a funding standard similar to that for clinical services for roles essential to the functioning of education, research and leadership services within divisions of general surgery is necessary to strengthen divisional resilience. We aimed to identify roles and underlying tasks in these services central to sustainable functioning of Canadian academic divisions of general surgery. METHODS: Between June 2018 and October 2020, we used a 4-step modified Delphi method (online survey, face-to-face nominal group technique [n = 12], semistructured telephone interview [n = 8] and nominal group technique [n = 12]) to achieve national consensus from an expert panel of all 17 heads of academic divisions of general surgery in Canada on the roles and accompanying tasks essential to education, research and leadership services within an academic division of general surgery. We used 70% agreement to determine consensus. RESULTS: The expert panel agreed that a framework for role allocation in education, research and leadership services was relevant and necessary. Consensus was reached for 7 roles within the educational service, 3 roles within the research service and 5 roles within the leadership service. CONCLUSION: Our framework represents a national consensus that defines role standards for education, research and leadership services in Canadian academic divisions of general surgery. The framework can help divisions build resiliency, and enable sustained and deliberate advances in these services.

Enhanced superconductivity and ferroelectric quantum criticality in plastically deformed strontium titanate.

The properties of quantum materials are commonly tuned using experimental variables such as pressure, magnetic field and doping. Here we explore a different approach using irreversible, plastic deformation of single crystals. We show that compressive plastic deformation induces low-dimensional superconductivity well above the superconducting transition temperature (Tc) of undeformed SrTiO3, with evidence of possible superconducting correlations at temperatures two orders of magnitude above the bulk Tc. The enhanced superconductivity is correlated with the appearance of self-organized dislocation structures, as revealed by diffuse neutron and X-ray scattering. We also observe deformation-induced signatures of quantum-critical ferroelectric fluctuations and inhomogeneous ferroelectric order using Raman scattering. Our results suggest that strain surrounding the self-organized dislocation structures induces local ferroelectricity and quantum-critical dynamics that strongly influence Tc, consistent with a theory of superconductivity enhanced by soft polar fluctuations. Our results demonstrate the potential of plastic deformation and dislocation engineering for the manipulation of electronic properties of quantum materials.

Effect of Serum Level of Human Epididymis Protein 4 and Interleukin-6 as Biomarkers in Patients with Adnexal Mass.

Ovarian carcinoma is one of the most common types of neoplasms in women and the fifth leading cause of cancer death among women worldwide. Adnexal masses are classified as simple or complicated and can be benign or malignant. No single biomarker has demonstrated high sensitivity and specificity for detecting early ovarian cancer. Therefore, the current study was designed to investigate the influence of using two biomarkers as a tool for diagnosis in patients with an adnexal mass. This prospective case-control study was carried out on female patients diagnosed by ultrasound and magnetic resonance imaging with adnexal masses and scheduled for surgery and healthy women as a control group (n=50 each). The patients were in the age range of 16-80 years old and had attended the surgical rooms of Basrah hospitals, Basrah, Iraq, from January to July 2021. The levels of serum biomarkers were quantitatively assessed using the enzyme-linked immunosorbent assay. The serum concentration of the human epididymis protein 4 (HE4) biomarker exhibited significant differences between females with adnexal mass and healthy women. There was no significant association between neither the patient's age nor the menopausal state and the serum level of HE4. The serum level of HE4 had a sensitivity of 92% and a specificity of 66% as a serum marker for the presence of adnexal mass with a positive predictive value of 73% and a negative predictive value of 89%. In this study, serum interleukin-6 (IL-6) had a sensitivity of 30% and specificity of 64% in determining patients with adnexal mass pathology. It was found that the level of IL-6 was similar in all patients, compared to that in the control group. The median levels of serum HE4 showed high value in patients in the age groups of 21-40, 41-50, and >50 than in the control group; however, it was not statistically different (P=0.413). Human epididymis protein 4 was the top biomarker representing a higher concentration in adnexal mass; moreover, it demonstrated the highest performance in all samples with Adnexal mass. The results of our study showed that combining more than one marker measurement increased both the sensitivity and specificity of distinguishing patients with adnexal mass pathology.

Detection of Salmonella spp. by Traditional and PCR Assays in Raw Milk, Maysan, Iraq.

Salmonella spp are characterized as rod- shaped, motile, gram- negative bacteria which has the ability to infect animals and human. Salmonella spp occasionally causes sickness while in most cases not lead to severe symptoms. Analyzing milk for Salmonella spp. is not routine but traditional culture methods are used to evaluate the health condition of the dairy products. However, the antibody-based and nucleic-acid- based methods are practical for identifying Salmonella spp. Therefore, this research was designed to evaluate the use of traditional culture methods and PCR in detection of the presence of Salmonella spp. in raw milk samples in, Maysan Iraq. A total number of 130 raw milk samples collected from Maysan Iraq. All the samples were analyzed for the presence of Salmonella spp. using traditional culture method and polymerase chain reaction (PCR). The culture method used in this experiment were done by using pre-enrichment, enrichment, selective plating and biochemical tests. The results of this traditional technique were compared with the results obtained from PCR method. The PCR was performed using a 284bp sequence of the invA gene. The results showed that 8 (7.07%) of samples were identified as salmonella positive using traditional culture technique but 14 (12.3%) samples were detected as salmonella positive by PCR method. The results of the current research revealed that the traditional culture based methods are generally time costuming and labor intensive but the development of new rapid methods including DNA based methods such as PCR are more sensitive and have dramatically decreased the time necessary for the detection of bacteria.