Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion.

Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patient age, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3 years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testis was 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.

Clinical characteristics, complications, and predictors of outcome of hospitalized adult Sudanese patients with COVID-19 and malaria coinfection in Sudan: A multicenter retrospective cross-sectional study.

Malaria and coronavirus disease 2019 (COVID-19) share several characteristics that could lead to cross-infection, particularly in malaria-endemic areas. Early COVID-19 symptoms might be misdiagnosed for malaria in clinical settings. Also, both diseases can cause fatal complications. So, laboratory testing for both diseases was recommended by the World Health Organization. To study the clinical characteristics and outcomes of Adult Sudanese patients with COVID-19 and malaria coinfection. This retrospective cross-sectional study was conducted from January 2021 to October 2021 in Wad Medani. Total coverage of all Sudanese patients above 18 years old with a confirmed diagnosis of coinfection with COVID-19 and malaria was included, and data were collected using a data collection sheet. Data were analyzed using R software version 4.0.2. Data were described and presented as mean, standard deviation, and number (percentage). To find associated factors with in-hospital outcome, χ2 test, fisher exact test, and independent t test or Wilcoxon rank-sum test were used. In this study, 156 participants were diagnosed with COVID-19 and malaria coinfection. Most of them were between 60 and 70 years (30.8%), the majority were males (59%). Shortness of breath (76.3%) and acute respiratory distress syndrome (35.3%) were the most common symptom and complications among coinfected patients, respectively. Ground glass opacity (n = 47/49, 95.9%) is the most common result for computed tomography scan. Atrial fibrillation was the most common abnormal electrocardiogram finding (n = 6/62, 9.7%). Overall mortality among all participants was (63/156, 40.4%). High mortality rate was found among the coinfected patients. More attention is needed towards fighting COVID-19 and malaria coinfection. There may be a link between malaria and COVID-19.

Anakinra in hospitalized patients with severe COVID-19 pneumonia requiring oxygen therapy: Results of a prospective, open-label, interventional study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. METHODS: A prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. RESULTS: A total of 69 patients were included: 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. CONCLUSION: In patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. TRIAL REGISTRATION NUMBER: ISRCTN74727214.

ß-lactamases (bla TEM, bla SHV, bla CTXM-1, bla VEB, bla OXA-1 ) and class C ß-lactamases gene frequency in Pseudomonas aeruginosa isolated from various clinical specimens in Khartoum State, Sudan: a cross sectional study.

Background:Pseudomonas aeruginosa is a pathogenic bacterium, causing nosocomial infections with  intrinsic and acquired resistance mechanisms to a large group of antibiotics, including ß-lactams. This study aimed to determine the susceptibility pattern to selected antibiotics and to index the first reported ß-lactamases genes frequency in Ps. aeruginosa in Khartoum State, Sudan. Methods: 121 Ps. aeruginosa clinical isolates from various clinical specimens were used in this cross sectional study conducted in Khartoum State. Eighty isolates were confirmed as Ps.aeruginosa through conventional identification methods and species specific primers. The susceptibility pattern of the confirmed isolates to selected antibiotics was done following the Kirby Bauer disk diffusion method. Multiplex PCR was used for detection of seven ß-lactamase genes ( blaTEM, blaSHV, blaCTXM-1, blaVEB, blaOXA-1, blaAmpC and blaDHA). Results: Of the 80 confirmed Ps. aeruginosa isolates, 8 (10%) were resistant to Imipenem while all isolates were resistant to Amoxicillin and Amoxyclav (100%). A total of 43 (54%) Ps. aeruginosa isolates were positive for blaTEM, blaSHV, blaCTXM-1, blaVEB and blaOXA-1 genes, while 27 (34%) were positive for class C ß- Lactamases, and 20 (25%) were positive for both classes. Frequency of beta-lactamases genes was as follows: blaTEM, 19 (44.2%); blaSHV, 16 (37.2%); bla CTX-M1, 10 (23.3%); blaVEB, 14 (32.6%); blaOXA-1, 7 (16.3%). blaAmpC 22 (81.5%) and bla DHA 8 (29.6%).  In total, 3 (11.1%) isolates were positive for both bla AmpC and blaDHA genes. Conclusion:Ps. aeruginosa isolates showed a high rate of ß- lactamases production, with co-resistance to other antibiotic classes. The lowest resistance rate of Ps. aeruginosa was to Imipenem followed by Gentamicin and Ciprofloxacin. No statistically significant relationship between production of ß-lactamases in Ps. aeruginosa and resistance to third generation cephalosporins was found.

The first record of Centrocestus formosanus (Nishigori, 1924) (Digenea: Heterophyidae) in Egypt.

The life cycle of Centrocestus formosanus (Digenea: Heterophyidae) was to be successfully completed in the laboratory in the present study. Hundreds of the thiarid snail, Melanoides tuberculata, were collected from the main water course Mansouriya Canal, Giza Governorate, Egypt. The snails were individually exposed to artificial light to determine possible infection with trematode larvae. Fifteen snails were found infected with opthalmopleurolophocercous cercariae (infection index of 1.97). These opthalmopleurolophocercous cercariae shedded from snails were collected and placed in an aquarium with fish intermediate host, Gambusia affinis, to obtain metacercariae encysted in the gills. The gills with metacercariae were fed to albino rats, Rattus norvegicus, to obtain the adult worms. Adult worms were recovered in the small intestine of rats at 7 days after infection and they were identified as Centrocestus formosanus based on the morphological characteristics and the comparison with the previous descriptions in the literature. They were small, 518 × 324 µm in average size and had characteristic 32 circumoral spines around the oral sucker. The morphological characteristics of the developmental stages, from cercariae to adults, of this heterophyid fluke were given here. Therefore, the presence of this fluke is to be confirmed for the first time in Egypt by the present study.

Extensive study of shape and surface structure formation in the mercury beating heart system.

A phenomenological study of the mercury beating heart system in a three electrode electrochemical cell configuration forced with a harmonic perturbation is presented. The system is controlled via a potentiostat, where the mercury drop is electrically connected to a platinum wire and acts as the working electrode. This configuration exhibits geometrical shapes and complex surface structures when a harmonic signal is superimposed to the working electrode potential. This study involves a wide range of frequencies and amplitudes of the forcing signal. Differents levels of structure complexity are observed as a function of the parameters of the applied perturbation. At certain amplitudes and frequencies, rotational behavior is also observed.

Retention of forearm plates: risks and benefits in a paediatric population.

Most surgeons favour removing forearm plates in children. There is, however, no long-term data regarding the complications of retaining a plate. We present a prospective case series of 82 paediatric patients who underwent plating of their forearm fracture over an eight-year period with a minimum follow-up of two years. The study institution does not routinely remove forearm plates. A total of 116 plates were used: 79 one-third tubular plates and 37 dynamic compression plates (DCP). There were 12 complications: six plates (7.3%) were removed for pain or stiffness and there were six (7.3%) implant-related fractures. Overall, survival of the plates was 85% at 10 years. Cox regression analysis identified radial plates (odds ratio (OR) 4.4, p = 0.03) and DCP fixation (OR 3.2, p = 0.02) to be independent risk factors of an implant-related fracture. In contrast ulnar plates were more likely to cause pain or irritation necessitating removal (OR 5.6, p = 0.04). The complications associated with retaining a plate are different, but do not occur more frequently than the complications following removal of a plate in children.

Electron-impact ionization of CCl4 and CCl2F2.

Absolute partial and total cross sections for electron-impact ionization of CCl4 and CCl2F2 are reported for electron energies from threshold to 1000 eV. The product ions are mass analyzed using a time-of-flight mass spectrometer and detected with a position-sensitive detector whose output demonstrates that all product ion species are collected with equal efficiency irrespective of their initial kinetic energies. Data are presented for production of CCl3(+), CCl2(+), CCl+, C+, Cl2(+), and CCl3(2+) from CCl4; and for production of CCl(2)F+, CClF2(+), CClF(+), (CCl+ + CF2(+)), Cl+, CF+, F+, and C+ from CCl2F2. Data are also reported for formation of (CCl2(+),Cl+) and (CCl+, Cl+) ion pairs from CCl4. The total cross section for each target is obtained as the sum of the partial cross sections. The overall uncertainty in the absolute cross sections for most of the singly charged ions is +/- 5-7 %. The present partial cross sections for lighter fragment ions are found to be considerably greater than had been previously reported but the most recent total cross section measurements agree well with those reported here. Neither the binary-encounter-Bethe theory nor the Deutsch-Mark theory reproduces the experimental cross sections correctly for both targets.

Negative ion formation and motion in a mixture of CCl4 and Ar.

This paper deals with the measurement of the mobility of negative ions in the mixtures of CCl4 with Ar with the CCl4 ratio up to 33.3%. The pulsed Townsend technique was employed to produce an integrated ionic avalanche over a range of the density-reduced electric field E/N for which ionization is either negligible or absent, and attachment processes are dominant, leading to the formation of mostly CCl-4. The E/N range of measurement was 1-50 Td (1 Td=10(-17) V cm(2)). Our measurements strongly suggest that attachment is the dominant process and only negative ions are formed.

Negative ion motion in the mixtures of SF6 with CF4 and CH4-Ar.

This paper deals with the measurement of the mobility of negative ions in the mixtures of SF6 with CF4 and the CH4-Ar (50:50) binary mixture with SF6 contents up to 50%. The pulsed Townsend technique was used to observe the integrated ionic avalanches over a range of the density-reduced electric field E/N for which ionization is either negligible or absent, and attachment processes are significant, leading to the formation of mostly SF-6. The E/N range of measurement was from 1 to 70 Td (1 Td=10(-17) V cm(2)), over which the measured mobilities were found to be almost constant. The mobility of the negative ions was also measured for trace amounts of SF6 in CH4 and Ar and 1% CF4, thereby providing a good value of the mobility of SF-6 in these pure gases, in order to test the measured mobilities with Blanc's law. We have found good agreement, within quoted experimental uncertainties, between calculated and measured values.

Schistosomiasis in newly reclaimed areas in Egypt. 2--Patterns of transmission.

The distribution, abundance and seasonality of infected Biomphalaria alexandrina and Bulinus truncatus were studied for 2 years (1992-1994) in two newly reclaimed areas, namely El Manayef and El-Morra areas located on both sides of Suez Canal near Ismailia City. The results confirm the occurrence of transmission of both Schistosoma mansoni and S. haematobium since infected snails of both species were recovered in these areas. This consequently proves that reclamation of parts of the desert utilizing Nile water had led to spread of schistosomiasis to these areas. Analysis of the data shows that the infected snails, especially B. alexandrina, were found clustered in a relatively few numbers of transmission sites and furthermore the greater majority of these sites were found located within a less number of transmission foci. This pattern of focality is clearly demonstrated by Geographical Information System (GIS) produced maps. Infected B. alexandrina snails fluctuated seasonally showing 2 peaks, a minor peak in August and a higher one in November. Only one peak of infected B. truncatus was recognized in July.

Effect of six non-target snails on Schistosoma mansoni miracidial host finding and infection of Biomphalaria alexandrina under laboratory conditions.

Six snail species naturally associated with Biomphalaria alexandrina, the snail host of Schistosoma mansoni in Egypt, were tested under standard laboratory conditions, for impact on miracidial host findings and infection of the snail host. These snails are the prosobranchs Melanoides tuberculata, Cleopatra bulimoides, Bellamys unicolor and Lanistes carinatus, the pulmonates Planorbis planorbis and Physa acuta. The tested snail ssp. reduced considerably the infection rate of Biomphalaria with S. mansoni especially at a ratio of 10 decoy snails to one Biomphalaria snail. The prosobranchs Melanoides, Cleopatra and Lanistes exhibited more reducing effect on Biomphalaria infection than Bellamya and the pulmonates Physa and Planorbis being 65.2%, 78.8%, 62.9%, 33.3%, 30.3% and 46.9%, respectively.

Invasion of the Nile Valley in Egypt by a hybrid of Biomphalaria glabrata and Biomphalaria alexandrina, snail vectors of Schistosoma mansoni.

Two years (1996-1997) of systematic survey showed that a hybrid of Biomphalaria glabrata and Biomphalaria alexandrina has invaded the irrigation and drainage systems in the Nile Delta and the Valley nor the of El-Menya. However, the infestation of water courses by and the population density of this snail were variable in various localities. The infestation rate ranged between 7.1% in El-Fayoum Governorate and 52.6% in El-Dakahliya Governorate and the snail density from 2 snails/site to 69.7 snails/site in the same governorates, respectively. Comparing the survey results of the two study years in the sampling sites indicated that the hybrid snail has relatively increased in population density than B. alexandrina. The hybrid snail of B. glabrata and B. alexandrina was found alone in some sites, but was mostly associated with B. alexandrina. The results showed also that both Biomphalaria have almost the same major physicochemical requirements. However, the hybrid snails and B. alexandrina were found differently associated with aquatic snails and plants. The hybrid snail was found naturally infected with S. mansoni thus giving indication that it is presently participating in schistosomiasis mansoni transmission in Egypt.

Compatibility of Biomphalaria alexandrina, Biomphalaria glabrata and a hybrid of both to seven strains of Schistosoma mansoni from Egypt.

The susceptibility of Biomphalaria alexandrina, Biomphalaria glabrata and a hybrid snail of both, all obtained from natural habitats in Egypt, to infection with six human local strains of Schistosoma mansoni and a laboratory strain of human origin was determined. The infection rate, prepatent period, periodic cercarial production and duration of cercarial shedding were compared in all cases. The results showed that each of the three studied Biomphalaria snails had different rates of infection and different values of total periodic cercarial production with various strains of S. mansoni. However, the mean infection rate of all local S. mansoni strains was significantly much higher in B. alexandrina than each of B. glabrata and the hybrid snail, being 66%, 7.2% and 8.5%, respectively. Considering the mean of results of all local S. mansoni strains used, the longevity of cercariae-shedding B. glabrata and the hybrid snails was much longer than that of B. alexandrina, with high significant difference between them (P < 0.01), being 94.5, 103.3 & 69.1 days, respectively. The mean prepatent period of various S. mansoni strains showed no significant difference in the three Biomphalaria snails studied. The hybrid snail produced periodically (1 h stimulant twice weekly) more schistosome cercariae/snail (4,784.2) than B. glabrata (2,913.4 cercariae/snail) and the least production was in the case of B. alexandrina (1,397.2 cercariae/snail) (P < 0.05). The diurnal pattern of S. mansoni cercarial shedding was found to be similar for B. glabrata, B. alexandrina and the hybrid snail showing a peak of cercariae at the same time (9-10 a.m.).

Schistosomiasis in newly reclaimed areas in Egypt. 1-distribution and population seasonal fluctuation of intermediate host snails.

Two newly reclaimed areas located west & east of Suez Canal, namely El Manayef area and El Morra area, were studied for patterns of distribution and population seasonal fluctuation of Biomphalaria alexandrina and Bulinus truncatus, the intermediate host snails of Schistosoma mansoni and S. haematobium, respectively. In this study Geographic Information System (GIS) techniques were utilized for producing maps and analyzing the results. Habitats of the two vector snail species were categorized into suitability levels depending on the frequency with which snails were collected over a 12 months period. Data obtained from the most suitable habitats were only used for studying the seasonal fluctuation of snail population. The results showed that both study areas were almost similar in major physico-chemical parameters. However, oxygen content in canals was higher than in drains and conductivity was higher in drains than in canals. As regards snail distribution and density, most snails of both considered species were clustering in much fewer numbers of sites, more pronouncedly in the case of Biomphalaria than Bulinus. Population density of snails was significantly higher in El-Manayef area than in El-Morra area and in canals than in drains. Both species exhibited 2 population peaks/year, the peaks of Biomphalaria were in March-April & August in both study areas, while for Bulinus these peaks occurred in March-May and August in El-Manayef area and in May and March, respectively, in El-Morra area.

Cercariometry in the study of Schistosoma mansoni transmission in Egypt.

The recovery of Schistosoma mansoni cercariae was studied in experimental ditches and natural irrigation canals using a continuous operating centrifuge and a water suction sampling technique. Recovery of cercariae from static water in the ditches where caged infected Biomphalaria alexandrina snails were placed showed that cercariae recovered were more with increase of infected snails and decrease of water volume and were most abundant in the proximity of the snails which produced them. Shade or heavy vegetation cover reduced the recovery of cercariae. Results suggest also strong seasonal differences in diurnal patterns of cercarial recovery. An early morning peak with large number of cercariae occurred during hot weather while in cooler seasons cercariae appear in fewer numbers but persist for most of the day. Obtained information, beside contributing to knowledge of cercarial behaviour, should help to optimize taking water sample and consequently to increase efficiency of cercariometry techniques. In the natural irrigation system, cercariometry was significantly more sensitive in detecting transmission foci than snail sampling by a dip net.

Biomphalaria glabrata: a new threat for schistosomiasis transmission in Egypt.

This is the first report on the infestation of irrigation and drainage systems at Giza, Qalyoubiya and Kafr El Shiekh Governorates, with Biomphalaria glabrata (the snail host of Schistosoma mansoni in the new world). Identification of this snail species was based on morphometry of the shell, shape of the radular lateral teeth and presence of the characteristic renal ridge. B. glabrata snails collected from natural water courses in Egypt proved to be susceptible to a local strain of S. mansoni. These snails were infected by 52% versus 75% for Biomphalaria alexandrina (the only local host) under the same laboratory conditions. Meanwhile the periodic total cercarial production was higher in B. glabrata than in B. alexandrina (252 +/- 110 cercariae/snail versus 203 +/- 86 cercariae/snail, respectively). Differences in infection rate, length of schistosome incubation period, duration of cercarial shedding and cercarial production in various sizes of the two snail species are reported and discussed.

Filtration, centrifugation and mouse exposure for the detection of schistosome cercariae in water.

Three methods for detection of schistosome cercariae in water were studied under laboratory and simulated field conditions in Egypt. Water samples tested by filtration and centrifugation quantitatively reflected the density of cercariae in moderately turbid canal water (30 Nephelometry Turbidity Unites, NTU). When tested in waters of increasing turbidity, the centrifuge gave more consistent results than the filtration system. The centrifugation technique was more efficient in processing the water samples and took almost half the time of filtration. Mouse exposure was useful in detecting cercariae, but was not quantitative. However, there was a significant improvement in worm recovery when mice were more close together in the floatation device. Mouse exposure was also expensive and cumbersome to use. It appears from the present results that the technique of choice for further cercariometric work under Egyptian conditions may be centrifugation.

Population dynamics and schistosomal infection of Biomphalaria alexandrina in four irrigation canals in Egypt.

The natural growth, reproductivity, mortality and schistosomal infection of Biomphalaria alexandrina, the snail vector of Schistosoma mansoni in Egypt, were studied for one year in four irrigation canals, namely El-Khassa and Radwan (Giza Governorate) and Sendebis and Sanafeer (Qalyoubiya Governorate). Radwan canal contains a considerably dense Biomphalaria population and three generations of snails (parents generation and autumn and spring generations) were recognized. Two phases of growth were distinguished in both autumn and spring generations, a faster phase followed by a slower one. The faster phase extends from January to May and from March to August in the autumn and spring generations, respectively. The daily mortality rate of snails was highest in the hot season (June--September) and lowest in the cold months (December--April). Continuous reproductivity of Biomphalaria snails was observed allover the year with highest values of reproduction index from November to March. Biomphalaria snails collected from El Khassa and Radwan canals were free of S. mansoni infection, while snails of Sanafeer canal carried patent infection in September and October. Prepatent infection was also found in Sanafeer canal in July and September and in Sendebis canal in September.