Endoscopic management of acute sigmoid volvulus in high risk surgical elderly patients: a randomized controlled trial.

BACKGROUND: Most patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction. METHODS: This prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 ( http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to "Endoscopic Group (EG)" or "Surgical Group (SG)" via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention. RESULTS: Sample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation. CONCLUSION: Endoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).

FOS-Like Antigen 1 Expression Was Associated With Survival of Hepatocellular Carcinoma Patients.

Background: Early diagnosis and proper management of hepatocellular carcinoma (HCC) improve patient prognosis. Several studies attempted to discover new genes to understand the pathogenesis and identify the prognostic and predictive factors in HCC patients, to improve patient's overall survival (OS) and maintain their physical and social activity. The transcription factor FOS-like antigen 1 (FOSL1) acts as one of the important prognostic factors in different tumors, and its overexpression correlates with tumors' progression and worse patient survival. However, its expression and molecular mechanisms underlying its dysregulation in human HCC remain poorly understood. Our study was conducted to evaluate the expression of FOSL1 in HCC tissues and its relationship with various clinicopathological parameters besides OS. Methods: This study is a retrospective cohort study conducted among 113 patients with a proven diagnosis of HCC, who underwent tumor resection and received treatment at South Egypt Cancer Institute. Immunohistochemistry for FOSL1 expression and survival curves were conducted followed by statistical analysis. Results: HCC occurred at older age group and affected males more than females. There was a statistically significant correlation between combined cytoplasmic and nuclear expression of FOSL1 and worse prognosis in HCC patients. There was a statistically significant correlation of FOSL1 expression with histological grade, lymphovascular embolization, and tumor budding where high expression indicated potential deterioration of HCC patients. There was statistically significant correlation between tumor size, tumor grade and FOSL1 expression with the cumulative OS. Conclusions: Combined cytoplasmic and nuclear FOSL1 expression has significant prognostic association with HCC and diagnostic importance, as it can identify cirrhosis and premalignant lesions that can progress to HCC. Furthermore, Kaplan-Meier survival analysis found that overexpressed FOSL1 was correlated with poor OS.

Endoscopic management of low output recurrent colonic fistula or leak after anterior resection for rectal cancer: a randomized controlled trial.

BACKGROUND: Colonic anastomotic leak and fistula following anterior resection surgery for rectal cancer are associated with high mortality rates. The incidence of occurrence varies from 2 to 25% and it is difficult to accurately calculate the incidence of fistula and leak post anterior resection, as most of them are asymptomatic. Endoscopic management of fistula and leak has become the first line of management after conservative management in many gastrointestinal surgical centers with the advantages of being less invasive, shorter length of post-operative hospital stay, effective and rapid recovery in comparison to revision surgery. Effective endoscopic management for colonic fistula or leak depends on the clinical status of the patient and fistula characters (time-to-occur and size and site of defect), and device availability. METHODS: This prospective randomized controlled clinical trial included all patients who developed the manifestations of low output recurrent colonic fistula or leak after colonic anterior resection for rectal cancer at Zagazig University Hospital between (December 2020 and August 2022). Sample size was 78 patients divided into two equal groups. Endoscopic group (EG): included 39 patients who underwent endoscopic management. Surgical group (SG): included 39 patients who underwent surgical management. RESULTS: The investigators randomized eligible 78 patients into two groups: 39 patients in SG and 39 patients in EG. The median size of the fistula or leak was nine (range: 7-14) mm in EG, versus ten (range: 7-12) mm in SG. Clipping and Endo-stitch device were used in 24 patients versus 15 patients, respectively, in EG while primary repair with ileostomy, and resection & anastomosis were used in 15 patients versus 24 patients, respectively, in SG. Recurrence, abdominal collection, and mortality were the post procedure's complications with incidence of occurrence of 10.3, 7.7 and 0%, respectively, in EG versus 20.5, 20.5 and 2.6%, respectively, in SG. Excellent, good, and poor were the parameters for quality of life with incidence of occurrence of 43.6, 54.6 and 0%, respectively, in EG versus 28.2, 33.3 and 38.5%, respectively, in SG. Median hospital stay was one (range: 1-2) day in endoscopic group, and seven (range: 6-8) days in SG. CONCLUSION: Endoscopic intervention may offer a successful modality in managing low output recurrent colonic fistula or leak after anterior resection for rectal cancer that did not respond to conservative measures in stable patients. CLINICALTRIALS: gov ID: NCT05659446.

Endoscopic management of refractory leak and gastro-cutaneous fistula after laparoscopic sleeve gastrectomy: a randomized controlled trial.

BACKGROUND: Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1-2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically. METHODS: This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I-II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively. RESULTS: Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4-7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1st week was significantly higher in SG than EG (p < 0.001). No mortality reported in EG, while 2 patients died in SG (p = 0.48). CONCLUSION: Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients.

Monitoring of level of mean concentration and toxicity equivalence (TEQ) of polychlorinated biphenyls (PCBs) in selected vegetables, beans and grains in khanewal and multan, Pakistan.

Contamination of food chain by Polychlorinated biphenyls through use of pesticides, electric and industrial waste poses human health risk. In previous studies, PCB species were stated as endocrine disrupting pollutants and showed toxic health effects like cancerous and noncancerous in animals. The aim of this study was to investigate the levels of PCBs and its toxicity equivalence in food item from plant source to evaluate the health risk in Khanewal and Multan, Pakistan. Samples were collected and processed for further analysis of PCB species through GC/MS after extraction and clean up. The mean concentrations of PCBs ranged as 2.71-151.67 ng/g in beans and grains and 2.30-97.00 ng/g dry weight in vegetables and were lower than 200-3000 ng/g PCBs recommended by FDA tolerance level for all foods. The mean concentrations of two NDL-PCB species detected in all vegetables, beans and grains except S.indicum and T.aestivum were lower than maximum allowable concentration of non-dioxin like PCBs i.e. 40ngg-1 reported by European Commission. Mean TEQ of sum of 14 PCB species ranged as 1.52-5.91 ng-WHO-TEQg-1 in vegetables and 1.46-10.04 ng-WHO-TEQg-1 in beans and grains. The present study concluded that the mean concentrations and mean TEQs of PCB species in most of the vegetables, beans and grains were found safe but due to higher consumption rate of some vegetables and grains, posed the moderate level of risk for human health. This study emphasizes on an implement of the strict rules regarding the use of restricted chemicals to diminish the effluence in food chains. Current research will be useful in up gradation of effective measures to reduce the poisonous contribution of PCB sources and the sustainability of terrestrial ecosystem in the country.

Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial.

BACKGROUND: Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage. METHODS: This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management. RESULTS: One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively). CONCLUSION: Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

Potential health risks assessment cognate with selected heavy metals contents in some vegetables grown with four different irrigation sources near Lahore, Pakistan.

Carcinogenic and health hazard causing heavy metals have been increasing in our dietary stuffs due to large amount of industrial effluents being dumped in water bodies that are ultimately used for irrigation purposes. The study was aimed to assess and compare the mean concentrations of heavy metals (Cd, As and Pb) in soil and vegetables irrigated with four different sources (Ground water, river water, domestic sewage water and industrial untreated effluents and domestic waste water receiving drains) for the estimation of carcinogenic and non-carcinogenic health risk associated with them. Prepared samples were analyzed by through ICP-OES. Statistical analysis revealed that domestic sewage water and drains water usage for irrigation purposes leads to high values of Estimated Daily Intake (EDI) of metals through vegetation. To assess the carcinogenic effects values daily intakes, Total hazard quotients (THQs) and Health indexes (HI), while for carcinogenic effects, Total cancer risks (TCR) were determined. The results of present study revealed that the daily intakes of these metals are far less than that of permissible levels but their bio-accumulating behavior produce high risks to human health. The HI values revealed that waste water usage is producing the vegetables of high health risks. In adults, the HI of Phaseolus vulgaris, Spinacia oleracea, Brassica compestris, Raphnus sativus, Daucus carota and Solanum tuberosum assessed as 0.81, 1.52, 1.26, 0.12, 0.22, and 0.15 (ground water irrigation), 0.046, 0.75, 0.51, 0.68, 0.90 0.064 (River Ravi water irrigation), 1.23, 3.34, 4.81, 4.23, 1.41 and 3.43 (domestic sewage irrigation) and 3.04, 5.50, 6.08, 2.50, 5.34 and 5.13 (Drain waste water irrigation), respectively. It was observed that cancer risks of As exceeded the threshold (1 × 10-4) in all i.e. ground river, domestic sewage and drain water grown vegetables, while, Cd and Pb were in permissible range.

The short-term outcome of distal mesogastric fixation after laparoscopic sleeve gastrectomy: a randomized controlled trial.

PURPOSE: The proposed etiology of leakage after laparoscopic sleeve gastrectomy may be the axial rotation of the stomach owing to the loss of abdominal ligament fixation along the greater curvature of the stomach. The mechanism of increased intra-gastric pressure due to axial gastric rotation may place a great deal of stress on the staple lines, leading to an increased incidence of leakage. Other complications may occur, including vomiting, food intolerance or persistent reflux. METHODS: This study was registered in ClinicalTrials.gov (ID: NCT04834323). This study included patients who were admitted to our center to undergo laparoscopic sleeve gastrectomy. Cases were collected in the period from December 2019 to December 2020. The study population included 83 patients, who were divided into the following two groups: Group 1 included 42 patients who received distal mesogastric fixation after laparoscopic sleeve gastrectomy; Group 2 included 41 patients who received laparoscopic sleeve gastrectomy alone without distal mesogastric fixation. RESULTS: No leakage or axial rotation occurs after laparoscopic sleeve gastrectomy with distal fixation, while in patients without distal fixation, leakage and axial rotation occurred with no statistically significant differences between the two groups. Leakage and axial rotation occurred two times more frequently among patients who received laparoscopic sleeve gastrectomy without distal fixations. CONCLUSION: Distal mesogastric fixation after laparoscopic sleeve gastrectomy decreased the axial gastric rotation and subsequently decreased gastric leakage.

Identification of Heat Tolerant Cotton Lines Showing Genetic Variation in Cell Membrane Thermostability, Stomata, and Trichome Size and Its Effect on Yield and Fiber Quality Traits.

Heat stress in cotton reduces its productivity. The development of heat-tolerant cotton varieties having resilience against changing climate is feasible. The purpose of this study was to probe the genetic variability in upland cotton for heat tolerance, the association of cell membrane thermostability (CMT), stomata, and trichome size with cotton adaptation to high temperature and effective breeding strategy to advance the valued traits. Relative cell injury percentage (RCI%) in studied genotypes ranged from 39 to 86%. Seventeen genotypes were found heat tolerant on the basis of low RCI%, heat susceptibility index (HSI<1), higher number of boll/plant, and seed cotton yield (SCY). Scanning electron microscopy (SEM) of heat-tolerant genotypes revealed the presence of different size of stomata (21.57 to 105.04 µm2) and trichomes (177 to 782.6 µm) on leaves of selected genotypes. The regression analysis showed a strong and negative association of RCI% and stomata size with SCY. However, no association was observed between the trichome size, yield, and fiber traits. On the overall location basis, a significant genotype × environment interaction was observed. All selected genotypes produced a higher SCY as compared with check varieties. But the stability analysis showed that the high yielding genotypes NIA-M-30, NIA-80, NIA-83, and CRIS-342 were also wide adaptive with unit regression (bi∼1) and non-significant deviation from the regression line (S2d∼0). The ability for the combination of some heat-tolerant genotypes was estimated by using the line × tester method among nine hybrids along with their 3 testers (i.e., male) and 3 lines (i.e., females). Genotypes, CRIS-342 and NIA-Perkh, were observed as best general combiners for SCY with a negative general combining ability effects for RCI%. Five hybrids showed a positive specific combining ability and heterotic effects for studied traits and also found lowest for HSI. RCI% and SCY/plant displayed higher estimates of heritability and genetic advance, indicating the heritability due to additive gene effects and chances of effective selection. The identified heat-tolerant and wide adaptive germplasm can be further advanced and utilized in cotton breeding programs for developing heat-tolerant cultivars. Selection criteria involving CMT and stomata size concluded to be an effective strategy for the screening of heat-tolerant cotton.

Antihyperglycemic effect of methanol extract of Tamarix aphylla L. Karst (Saltcedar) in streptozocin–nicotinamide induced diabetic rats

Objective To evaluate the antihyperglycemic potential of Tamarix aphylla (T. aphylla) leaves in STZ–NIC induced diabetes in Wister Albino rats. Methods Acute toxicity study was done to check the toxicity of T. aphylla (L. Karst) methanol extract. T. aphylla leaves extract was administered intraperitoneally (100 mg, 250 mg and 400 mg/kg body weight per day) to diabetic Wister rats for 21 days. The various parameters were studied including fasting blood glucose levels, haemoglobin and glycosylated haemoglobin. Results The treatment groups with the extract at three dose levels expressively abridged the intensities of blood glucose and Glycosylated Haemoglobin. The earlier detected reduced level of plasma haemoglobin of the diabetic rats was raised to near normalcy with treatment of extract. Conclusions The results of the current study confirm that the leaves extract of T. aphylla are nontoxic and have antidiabetic nature.

Effect of doxorubicin and daunorubicin on the activity of acetylcholinesterase in acute lymphoblastic leukamia.

BACKGROUND: Our study was based on the alteration in the Michaelis Mentin parameters Apparent Michaelis Constant (aKm) and Apparent Maximum Velocity (aVm), which reflects activity of actylcholinesterase (AChE). This activity decreases in Acute Lymphoblastic Leukaemia (ALL). This decrease in aKm and aVm values shows bad prognosis. Similarly the anticancer drugs like Daunorubicin and Doxorubicin further decreases the aKm and aVm values which worsen the prognosis. The objective of this study was to determine and compare the extent of inhibition of Acetylecholine Esterase by Daunorubicin and Doxorubicin in ALL. METHODS: Study of 100 patients including both male and female children who's age ranged from 4 to 8 years and were advised doxorubicin and daunorubicin separately were tested by Ellman's method using acetylcholine iodide as substrate and 5,5-dithiobis 2-nitrobenzine as a colour reagent regardless of dose regimen i.e. (once in 3 week, small dose per week or a continuous infusion for 72 to 96 hours. RESULTS: In this study the Michaelis Mentin parameters Apparent Michaelis Constant (aKm) and Apparent Maximum Velocity (aVm) of the enzyme were estimated both in normal individuals and in the patients and also during treatment with daunorubicin and doxorubicin. The value of Michaelis Mentin parameters, aKm, aVm and percentage activity of the enzyme in normal individual are 23, 70, and 100 respectively. The values of aKm, aVm and percentage activity of the enzyme were also estimated in the patients before and after treatment. The values of aKm and aVm in patients of acute lymphoblastic leukaemia and percentage activity of enzyme is decreased. After the treatment with daunorubicin and doxorubicin the values and activity is further decreased. CONCLUSION: We conclude that the drugs under study both decrease the enzyme activity but daunorubicin inhibits the enzyme more than doxorubicin.