Foundations of a life support equipment exchange platform.

Background: The Extracorporeal Life Support Organization Supplies Platform (https://Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product shortage prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables from other Centers when alternative avenues are exhausted. Methods: Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing Platform. The pandemic created by COVID-19 became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Conclusions: Records kept on the Platform website are helpful to the industry by providing insights into where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, of how critical situations can stretch resources and challenge our resolve for the best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply shortages.

Exploring the interplay of environmental conservation within spirituality and multicultural perspective: insights from a cross-sectional study.

The need to protect and sustain environmental resources for future generation remains sacrosanct in global sustainability agenda. This study was aimed at exploring the interplay between environmental conservation and spirituality from a multicultural perspective. While studies on "spirituality" have monumentally gained global attention, a growing number of evidence underscore the critical role of spiritual resources available for ensuring environmental stewardship. In this present study, attempt was made to respond to some critical questions: Is there any significant association between spirituality and environmental responsibility? What is the impact of spiritual leadership on environmental conservation? What key messages do spiritual leaders need to prioritize to encourage environmental conservation? And what are some of the spirituality-related predictors of willingness to engage in global environmental conservation efforts among the respondents? To determine this nexus between spirituality and environmentalism, a cross-sectional study design was adopted. Primary data were collected by means of a validated and adapted instrument from various literature searches. Data collected from a sample of 1,438 respondents were entered on Excel spreadsheet and eventually exported on SPSS version 21 for further analysis. Every segment of the instrument used yielded a Cronbach's alpha reliability test result of no less than 0.70. Descriptive statistics and ordinal logistics regression analysis were employed. The findings revealed that majority of respondents expressed a high level of spirituality (p value < 0.05). Majority (70%) of the respondents believe that everyone has a duty of care toward nature. More than two-third (> 60.0%) would be more inclined to observing environmental conservative measures if their spiritual leaders would continue to give exemplary teachings on environmental conservation. While a few indicators of spirituality yielded direct correlation with the willingness to engage in global environmental conservation efforts, most of the selected indicators reflect willingness. Some of these (predictors) include how often respondents pray, meditate, and fast; caring about people, animals, and the planet; being just happy to be alive; etc. In conclusion, this study reasoned that spirituality could indeed serve as a foundation for environmental conservation campaigns and could reinforce pro-environmental behaviors.

Effect of reduced needle versus standard needle on pain experience during oocyte retrieval procedure: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this study was to compare reduced needle versus standard needle regarding pain experience among women undergoing oocyte retrieval procedures. METHODS: A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during April 2021. We selected randomized clinical trials (RCTs) compared reduced needle versus standard needle among women undergoing ultrasound-guided oocyte retrieval procedures. Revman software was utilized for performing our meta-analysis. Our primary outcomes were pain scores evaluated by the Visual Analog Scale (VAS) during the procedure, directly post-procedure, and 30 min post-procedure. Our secondary outcomes were the request for more analgesia, clinical pregnancy rate, and rate of vaginal bleeding less than expected. RESULTS: Six RCTs met our inclusion criteria with a total number of 1063 patients. We found reduced needle was linked to a significant reduction in VAS pain score during and directly after the procedure, respectively (MD= -1.54, 95% CI [-2.38, -0.70], p = .003 and MD= -1.14, 95% CI [-1.38, -0.91], p < .001). After removal of the reported heterogeneity, the reduced needle had significantly reduced the pain score 30 min post-procedure and request for more analgesia in comparison with standard needle (p < .001). No significant difference was found between both groups regarding clinical pregnancy rate (p = .17). More patients in reduced needle group were reported to vaginally bleed less than expected compared to standard needle group (RR = 1.91, 95% CI [1.35, 2.70], p = .003). CONCLUSIONS: Patient perceived pain, analgesic requirement, and vaginal bleeding are decreased with reduced needle administration versus standard needle without affecting the clinical pregnancy rate in oocyte retrieval procedure.

Posterior component separation with transversus abdominis muscle release versus mesh-only repair in the treatment of complex ventral-wall hernia: a randomized controlled trial.

BACKGROUND: Complex ventral hernias (VHs) represent a real challenge to both general and plastic surgeons. This study aims to compare Sublay Mesh-Only Repair to Posterior Component Separation "PCS" with Transversus Abdominis Release "TAR" in the treatment of complex ventral-wall hernias (VHs). METHODS: This a randomized, controlled, intervention, including two parallel groups: A; Sublay Mesh-Only Repair and Group B; "TAR". Consecutive patients of both genders aged between 18 and 65 years old with complex VHs presented at Mansoura University Hospitals including large-sized abdominal-wall hernia ≥ 10 cm in width, loss of domain ≥ 20%, multiple hernial defects, or recurrent hernias. Immuno-compromised patients, patients with liver impairment, or severe heart failure were considered an exclusion criterion. The primary outcome is the recurrence rate after 12-months following the procedure. RESULTS: Fifty-six patients were recruited in this study. There was no significant difference between both groups regarding recurrence. However, there was significant differences between both groups regarding seroma favoring mesh-only repair. CONCLUSIONS: Although TAR may be associated with longer operative times and more blood losses, these were not found to be statistically significant. Postoperative complication, except for seroma, and recurrence rates were comparable in both groups. Trail registration The study was registered on clicaltrials.gov "NCT04516031".

Predictors of COVID-19 vaccine hesitancy among Egyptian healthcare workers: a cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination has raised concerns about vaccine hesitancy in general and COVID-19 vaccine hesitancy in particular. Understanding the factors driving the uncertainty regarding vaccination against COVID-19 is crucial. METHODS: This cross-sectional study was designed to identify the perceptions and attitudes of healthcare workers (HCWs) towards COVID-19 vaccines and determine the predictive factors that affect their willingness to receive the COVID-19 vaccine. An online survey was distributed among HCWs to collect data assessing demographic and general characteristics of the participants and vaccine-related characteristics, including source of information about the vaccine. In addition to items assessing the perception of COVID-19, there were items on COVID-19 vaccines and attitude towards vaccination in general and towards COVID-19 vaccines in particular. RESULTS: The participants were classified according to their willingness to take the COVID-19 vaccine as follows: hesitant (41.9%), refusing (32.1%), and willing (26%). Statistically significant differences were observed among the three groups for the perception of COVID-19 vaccines, attitude towards vaccination in general, and COVID-19 vaccines in particular (p < 0.01). CONCLUSIONS: Although the participants adequately perceived COVID-19 severity, prevention, and COVID-19 vaccine safety, they were widely hesitant or refused to be vaccinated. A multidimensional approach is required to increase the vaccine acceptability rate. Higher income and increased years of work experience are positive predictors of willingness to receive a vaccine. Thus, further studies addressing the scope of COVID-19 vaccine hesitancy are warranted as an initial step to build trust in COVID-19 vaccination efforts with continuous monitoring of attitudes and practices of HCWs towards COVID-19 vaccines in the future.

Influence of Carbon Nanotubes on Phase Composition, Thermal and Post-Heating Behavior of Cementitious Composites.

This paper experimentally investigates the influence of carbon nanotubes (CNTs) on phase composition, microstructure deterioration, thermal behavior, and residual mechanical strengths of cementitious composites exposed to elevated temperatures. Cement mortars with small dosages of CNTs, 0.05% and 0.2% by weight of cement, were prepared and then heated at 25 °C, 150 °C, 200 °C, 450 °C, and 600 °C for two hours before being tested. The results show positive impact of the CNTs on the hydration process of cement mortar at room temperature and at higher temperatures up to 200 °C. Decomposition of the hydration products is obvious at 450 °C, whereas sever deterioration in the microstructure occurs at 600 °C. The nano reinforcement and bridging effect of the CNTs are obvious up to 450 °C. Thermal behavior characterization shows that CNTs incorporation enhances the thermal conductivity of the unheated and heat-treated mortar specimens. The decomposition of the hydration products needs more heat in the presence of CNTs. Finally, presence of CNTs significantly enhances the residual compressive and flexural strengths of heated mortar specimens for all studied temperatures.

Changes on physicochemical and rheological properties of biscuits substituted with the peel and alcohol-insoluble solids (AIS) from cactus pear (Opuntia ficus-indica).

Cactus pear fruit consists of the peel, seeds and pulp. The peel is a major waste in cactus pear pulp based products accounting about 37.72% of the fruit weight. The aim of this study was to utilized and characterized the physicochemical and rheological properties of biscuits substituted with extracted cactus pear peel (CPP) and alcohol-insoluble solids (AIS) from cactus pear (Opuntia ficus-indica). To prepare AIS, peels were shredded and dropped in ethanol (70%) for 15 min. The mixture was boiled at 70 °C for 30 min, filtered and washed with ethanol 70% and the washing repeated until no sugars. The residue was washed and dried at room temperature. Changes in physiochemical and rheological properties of extracted CPP and AIS from cactus pear to qualify determine their use in the production of them to produce a fiber-rich food product. The water-holding capacity was 3.7 ml/g for the peel and 1.5 ml/g for the AIS, and the oil-holding capacity was approximately the same for both the CPP and AIS. The protein content was 3.5% for the CPP and 3.72% for the AIS. The CPP and AIS contained little fat (1.22% and 1.44%, respectively). Potassium and calcium in the AIS had the highest concentration, at 21.49 g/kg and 44.04 g/kg, respectively, and these minerals were found at 22.07 g/kg and 16.66 g/kg, respectively, in the CPP. The dominant phenolic compounds found in the CPP were pyrogallol, catechol, catechin, and alpha-coumaric acid. The results showed that the AIS contained pyrogallol (61.67 ppm), benzoic acid (10.68 ppm), vanillic acid (7.66 ppm), catechin (4.65 ppm) and salicylic acid (4.51 ppm). The CPP was rich in glucose (25.95%) and fructose (21.36%) compared to the AIS. The sensory evaluation indicated that 7.5% dried cactus pear peel or 7.5% AIS can be successfully used in substitution of wheat flour biscuits. It could be conducted cactus pear as major by-product can be important for the industrial utilization.

Assessment of Eco-friendly Gases for Electrical Insulation to Replace the Most Potent Industrial Greenhouse Gas SF6.

Gases for electrical insulation are essential for the operation of electric power equipment. This Review gives a brief history of gaseous insulation that involved the emergence of the most potent industrial greenhouse gas known today, namely sulfur hexafluoride. SF6 paved the way to space-saving equipment for the transmission and distribution of electrical energy. Its ever-rising usage in the electrical grid also played a decisive role in the continuous increase of atmospheric SF6 abundance over the last decades. This Review broadly covers the environmental concerns related to SF6 emissions and assesses the latest generation of eco-friendly replacement gases. They offer great potential for reducing greenhouse gas emissions from electrical equipment but at the same time involve technical trade-offs. The rumors of one or the other being superior seem premature, in particular because of the lack of dielectric, environmental, and chemical information for these relatively novel compounds and their dissociation products during operation.

A wandering folded liver displaced by the distended bowel: a new case report with review of the literature.

INTRODUCTION: The wandering liver is an extremely rare condition in which the liver moves significantly or 'wander' with changes in patient's lie. This is believed to be an acquired condition perhaps precipitated by persistent congenital ventral mesogastrium which acts as an axis or a mesentery for the liver to rotate. The vast majority of reported cases were associated with other chronic abnormalities of the gastrointestinal tract, especially sigmoid volvulus. PATIENTS AND METHODS: We present a case report of an acquired isolated transposition of the liver with a review of the English-language literature of wandering liver in adults and paediatric age group. RESULTS AND CONCLUSIONS: The clinical presentation of wandering liver is variable. Most of the reported cases were asymptomatic and are usually diagnosed while having investigation or surgery for other reasons, especially the commonly associated bowel problems. However, some patients may present with intermittent jaundice and abdominal pain secondary to the abnormal liver configuration. Due to the scarcity of the condition, the diagnosis can be challenging and improper concerns of permanent liver failure is possible. Hepatopexy is usually required for symptomatic patients with good results.

Changes on biogenic, volatile amines and microbial quality of the blue swimmer crab (Portunus pelagicus) muscle during storage.

Biogenic amines (BAs) are a group of substances with low molecular weight organic compounds such as aliphatic, aromatic or heterocyclic structures that are naturally present in animal tissues. The aim of this study was to investigate the changes on the formation of biogenic amine, bacterial load and biochemical characteristics in blue swimmer crab (Portunus pelagicus) at different storage temperatures (4 and 20 °C) up to 96 h. From seven BAs only four biogenic amines (tryptamine, putrescine, histamine, and tyramine) were detected while, the cadaverine, spermidine and spermine were absent in all investigated samples. Histamine was the major biogenic amine formed during the storage times and reached the highest concentration of 7.55 ± 0.46 mg/100 g and 17.68 ± 1.30 mg/100 g after 96 h at 4 and 20 °C, respectively. This level of histamine exceeded the maximum tolerance level of 5 mg/100 g. However, the proper icing procedure retarded the histamine effects, resulting only 7.55 mg/100 g after 96 h of ice storage. Spoilage indicator putrescine was only detected after 24-96 h of storage at 4 and 20 °C, respectively. The total volatile base nitrogen and the trimethylamine-nitrogen concentrations were considered to be reliable indicators of freshness index in blue swimmer crab. An aerobic mesophilic plate count of 6.68 and 7.31 log CFU/g were noted for crab stored in ice and ambient temperature after 96 h storage, respectively. It could be concluded that the biogenic amine forming bacteria and other susceptible perishing factors responsible for the biogenic amine formation could be prevented by continuous storage of P. pelagicus at low temperature.

Groundbreaking Dual-Graft Living Donor Liver Transplant Utilizing Full Right and Left Lateral Lobe Grafts: A Landmark Debut in the Kingdom of Saudi Arabia.

We introduce and documentthe first case of dual-graft living donor liver transplant, at the King Fahad Specialist Hospital in Dammam, Kingdom of Saudi Arabia, in which both a full right lobe and a left lateral segment graft were used. Our patient, a 63-year-old male, was diagnosed with nonalcoholic steatohepatitis cirrhosis and hepatocellular carcinoma involving segment 7 and selected for living donor liver transplant. Donor selection, graft volume assessment, surgical planning, procurement, and implantation of the dual grafts were meticulously executed. The first donor had an estimated right lobe volume of 639 mL, yielding an estimated graft-to-recipient weight ratio of 0.68. A liver biopsy revealed 3% macrosteatosis.The second donor's contribution comprised a left lateral segment volume of 280 mL.The decision was made for dual-graft liver transplant. With both grafts, the volume totaled 919 mL, representing graft-torecipient weight ratio of 0.98. Surgical techniques involved anastomoses of hepatic veins, portal veins, arteries, and biliary reconstruction. Both donors and the recipient were closely monitored posttransplant. After the procedure, both donors recovered swiftly and were discharged 4 days postoperation. The recipient experienced a smooth postoperative course, spending 4 days in the intensive care unit and discharged on day 26 posttransplant. This pioneering dual-graft living donor liver transplant showed successful outcomes and highlighted the potential of this approach to expand the limited donor pool, particularly in regions relying predominantly on living donors, like Saudi Arabia. This innovative surgical technique offers a promising solution to address the growing demand for liver transplants while ensuring safety for individual donors and maintaining acceptable recipient outcomes. Further exploration and adoption of dual-graft liver transplant could significantly affectthe field of livertransplant globally.

Effect of irradiation and storage on biogenic amine contents in ripened Egyptian smoked cooked sausage.

The effects of γ-irradiation upon the biogenic amine inventory in Egyptian smoked cooked sausages were investigated for the first time during storage for up to 90 days at 4 °C. Typical contents of biogenic amines in non-irradiated sausages ranged between 125.50 and 596.18 mg/kgDW; irradiation with 4 and 6 kGy decreased said total contents to 105.20-94.82 and 104.98-26.44 mg/kgDW respectively, by the end of storage. Putrescine and cadaverine were the major amines in non-irradiated samples-where it accounted for 33% and 29% respectively, of the total by 90 days; however, tyramine dominated in irradiated samples with 2, 4 and 6 kGy, where it accounted for 44, 52 and 42%. On the other hand, the histamine content in non-irradiated sausage by 90 days of storage (i.e. 109.12 mg/kgDW) clearly exceeded the maximum allowable of 50 mg/kg, unlike happened in their irradiated counterparts. Therefore, the dramatic reduction observed in the histamine levels suggests use of this preservation technique for that traditional meat food.

Resource utilization in management of spontaneous intracerebral hemorrhage without systemic risk factors. Does early surgical decompression matter?

BACKGROUND: Even though different subtypes of spontaneous ICH are frequently linked to a poor prognosis, their causes, pathological features, and prognoses vary. Atypical intracerebral hemorrhage is the subtype of spontaneous ICH that usually occurs due to an underlying localized vascular lesion. It is unrelated to systemic vascular risk factors, mostly affects children and young adults and is associated with a relatively good outcome. This fact should be considered when planning the evaluation and treatment. Investigating the cause of this subtype is fundamental to providing optimal management. However, if resources do not allow completing the investigations, the cause will be more difficult to discover. Treatment decisions will be made under stress to save the patient's life, especially with rapidly deteriorating patients. METHODS: We described three cases of spontaneous ICH without systemic risk factors where the bleeding source could not be determined before surgery due to a lack of resources, preventing preoperative vascular investigation. Knowing that the atypical ICH has a distinct identity, regarding etiology and prognosis, encouraged the surgeons to resort to early surgical decompression as an alternative plan. We reviewed the literature searching for supporting evidence. RESULTS: The results of treatment of the presented cases were satisfactory. The lack of reported similar cases was brought to light by a literature analysis that sought to provide backing for the proposed management strategy. In the end, we supplied two graphic organizers to help readers remember the different types and treatment of hemorrhagic stroke. CONCLUSION: There isn't enough evidence to show that there are other ways to treat atypical intracerebral haemorrhage when resources are limited. The presented cases highlight the importance of decisionmaking in resource-constrained situations when patient outcomes can be improved.

The management of asymptomatic radiological anastomotic leakage following anterior resection.

BACKGROUND: The evidence to guide the management of asymptomatic radiologically-detected anastomotic leakages (ARAL) following anterior resection (AR) with diverting ileostomy is deficient. This study describes the outcomes of managing ARAL one of the UK teaching hospitals. METHOD: The study included all patients diagnosed with ARAL following AR during 8 years period (2012-2020). The following data were retrospectively collected: patient demographics, surgical indication, anastomotic technique, tumour staging, neoadjuvant therapy, how ARAL was managed, the outcomes and duration to heal and ileostomy reversal. RESULTS: A total of 35 patients (M = 24) who developed ARAL during the study period were included. In 32 patients, AR was performed for rectal cancer. All patients with ARAL were treated conservatively and in 31 (89%) patients, there was complete resolution of the leakage within a median duration of 6 months. Covering loop ileostomies were reversed in 26 (74%) patients with a median interval to reversal of 10 months. CONCLUSION: Most asymptomatic radiologically-detected anastomotic leakages after anterior resection heal with conservative treatment in the presence of a covering loop ileostomy with an expected average delay of 6 months for the leakage to heal before covering ileostomies can be reversed.

The impact of Oncotype DX testing on adjuvant chemotherapy decision making in 1-3 node positive breast cancer.

BACKGROUND: Oncotype DX testing has reduced the use of adjuvant chemotherapy in node-negative early breast cancer but less is known about its impact in node positive patients. AIM: This study aimed to investigate the impact of Oncotype DX gene assay testing on the decision to offer adjuvant chemotherapy in oestrogen positive, human epidermal growth factor receptor 2 negative, 1-3 lymph node positive patients. METHODS: Retrospective review of all node positive patients who underwent Oncotype DX testing at a single centre. Clinicopathological data, as well as estimated survival benefit data (from the PREDICT tool), was evaluated by a multidisciplinary group of surgeons and oncologists. Treatment decisions based on clinicopathological data were compared to recurrence scores (RS). A cut off RS > 30 was used to offer adjuvant chemotherapy. RESULTS: The 69 patients were identified, of which 9 (13%) had an RS > 30 and assigned a high-genomic risk of recurrence. The 32 patients (46.4%) were offered adjuvant chemotherapy. Overall based on the use of the RS, the decision to offer adjuvant chemotherapy changed in 36% of patients, and ultimately 24 patients (34.7%) would have been spared chemotherapy. CONCLUSION: Using clinicopathological data alone to make decisions regarding adjuvant chemotherapy in node positive breast cancer leads to overtreatment. Additional information on tumour biology as assessed by the Oncotype DX RS helps to select those patients who will benefit from adjuvant chemotherapy and spare patients from unnecessary chemotherapy.

Oncocytoid Variant of High-Grade Salivary Duct Carcinoma: A Potential Diagnostic Pitfall. A Report on Two Patients.

Salivary duct carcinoma (SDC) is an uncommon and aggressive salivary malignancy. The oncocytoid variant of salivary duct carcinoma (OSDC) has only been reported in the English literature once before. Here we detail two new patients. A 71-year-old female presented with a painless enlarging left parotid mass. Imaging and fine-needle aspiration were nondiagnostic. The second patient, a 79-year-old male, presented with painless swelling in the right cheek. Imaging was nondiagnostic. Both patients underwent surgical resection. Histopathology revealed bland yet infiltrative OSDC in both cases. These tumors were AR+ (androgen receptor) by immunohistochemistry. Potential difficulty exists in distinguishing the oncocytoid variant of SDC, a rare and relatively bland tumor, from oncocytoma, a more commonly encountered entity. AR expression can aid in the correct diagnosis.

Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair.

BACKGROUND: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. METHODS: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. RESULTS: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. CONCLUSIONS: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

Management of anastomotic leaks after elective colorectal resections: The East of England experience. A retrospective cohort.

INTRODUCTION: Colorectal anastomotic leaks (AL) are associated with high morbidity and mortality. Management of AL and its intra-operative decision making is often difficult. The aim of this multi-centre study is to explore different management strategies, including different surgical options, and analyse rates and patterns of failure of initial management. METHODS: All consecutive patients who had a confirmed AL after elective colorectal resections from 1st January 2014 to 31st December 2019 were included at seven hospitals across the East of England Region. Morbidity (length of stay, and failures) and mortality were compared across the different management strategies, and survival analyses were performed (Clinicaltrials.gov ID: NCT05000580). RESULTS: Across all seven hospitals, a total of 3391 elective resection were done during the study period. 201 (5.9%) consecutive patients with confirmed AL were included. The initial treatment was conservative in 102(50.7%). 19 patients (9.5%) had a radiological procedure, 80 (39.8%) of patients required surgery as an initial treatment post AL. Of those who initially did not have a surgical intervention (n = 121), 10% (n = 12/121) eventually required laparotomy, 2 additional patients required transanal drainage. Ultimately 45.8% (n = 92/201) of the whole population eventually required a laparotomy. Patients managed conservatively had a shorter LOS when compared to either radiological drainage or surgical patients. Patients with a defunctioning stoma are more likely to have a successful conservative management and shorter LOS. 90-day mortality across the entire population was 8.1%. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities or whether the leak was right or left sided. CONCLUSION: Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy and over a quarter of patients will have an end stoma.

Isolation and Identification of Pathogenic Acanthamoeba Species from Air Conditioning Systems, Egypt.

Acanthamoeba are free-living amoebae that cause granulomatous amoebic encephalitis and keratitis. In this study, we aimed to isolate and identify Acanthamoeba from air conditioning systems using in vitro cell culture and polymerase chain reaction assays. We also estimated the pathogenicity of the isolates by measuring their thermotolerance and studying mice models inoculated with these isolates. Of the 80 dust samples acquired, 41 (51.25%) were found to be positive for Acanthamoeba spp. using in vitro cell culture and the results were validated using PCR. Out of these 41 samples, 27 (65.9%) were thermotolerant and 16 (39%) samples could infect mice and cause histopathological effects. Highly pathogenic Acanthamoeba isolates were characterized by their thermotolerance and the ability to disseminate in all organs after infection, causing early death of infected animals. Our study thus validated the presence of pathogenic isolates of Acanthamoeba in air conditioners that may be potentially infectious to humans.

The Role of Polypropylene Microfibers in Thermal Properties and Post-Heating Behavior of Cementitious Composites.

This paper experimentally studied the effect of polypropylene (PP) microfibers on thermal and post-heating mechanical behaviors of cementitious composites. Cement mortars with small dosage of polypropylene fibers were prepared, heated at various temperatures (150 °C, 200 °C, 450 °C, and 600 °C), and then tested. The investigated parameters include residual compressive and flexural strengths, elastic modulus, fracture energy, stress intensity factors, failure modes, microstructure (scanning electron microscopy (SEM) imaging), thermal conductivity, heat flow (differential scanning calorimetry (DSC) test), mass loss (thermogravimetric analysis (TGA) test), and chemical composition (XRD analysis). The results showed the efficiency of PP fibers to enhance the post-heating behavior and the residual mechanical properties of cement mortar after heating. The presence of PP fibers did not affect the heat flow and the mass loss of cement mortar at room temperature. However, heating cement mortar at temperature beyond the melting point of the fibers negatively affected its thermal behavior. The presence of PP fibers played a major role in bridging the cracks and mitigating their propagation. Once the melting point of the polypropylene fibers is exceeded, the fibers melted and created extra voids in the microstructure of concrete.