Search

Congenital infantile fibrosarcoma is a rare malignant soft tissue tumor, accounting for less than 1%-2% of childhood cancers. Although it can arise from any body part, an abdominal wall origin is exceptionally rare. This case report presents a case of congenital infantile fibrosarcoma originating from the abdominal wall. To the best of our knowledge, this is only the second reported case of abdominal wall congenital infantile fibrosarcoma. Unlike adult fibrosarcoma, infantile fibrosarcoma has a good prognosis with less metastasis. Early diagnosis and management are critical for improving outcomes in such rare cases.

Introduction Acute respiratory failure is a life-threatening condition frequently found in the emergency department. High-flow nasal oxygen (HFNO) is increasingly used in emergency departments for patients with hypoxaemic acute respiratory failure. However, despite the increasing number of studies, its potential advantages regarding the need for therapeutic escalation and mortality have not been precisely evaluated. Our objective is to compare conventional oxygen therapy to HFNO when they are initiated during the first hour following the patient’s arrival at the emergency department, with the hypothesis that HFNO would reduce the need for ventilatory therapy escalation.Methods and analysis This is a multicentric, prospective, open and randomised superiority study. 500 inpatients will be randomised (1:1) to receive conventional oxygen therapy or HNFO. The primary outcome is a failure in the oxygen therapy defined as the need for a therapeutic escalation within 4 hours after therapy initiation.Ethics and dissemination The study has been submitted and approved by the Comité de Protection des Personnes Nord Ouest IV (20 October 2020). As required, a notification was sent to the Agence nationale de sécurité du médicament et des produits de santé (22 October 2020). The research results will be published in peer-reviewed publications and presented at international conferences.Trial registration number NCT04607967.

AIM: To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty (t-DSEK) and tectonic Bowman layer transplant (t-BLT) as an alternative to tectonic penetrating keratoplasty (t-PKP). METHODS: Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included. The technique for DSEK was modified depending on individual requirements. The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture. Success was measured by the ability of this procedure to close a corneal perforation. RESULTS: All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period. Reinterventions were relatively common: 2 cases required amniotic membrane transplant for persistent epithelial defects. One case required DSEK rebubbling. One case developed angle closure glaucoma requiring surgical peripheral iridectomy. CONCLUSION: Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

PurposeDifferent biological characteristics, therapeutic responses, and disease-specific outcomes are associated with different molecular subtypes of breast cancer (BC). Although there have been different studies on BC in the Ethiopian capital city of Addis Ababa, there have been few studies in other parts of the nation, and none have evaluated biological characteristics in other locations in the context of the extensive ethnic and genetic diversity found in Ethiopia. This study was carried out to evaluate the distribution of immunohistochemistry (IHC) subtypes of BCs throughout four Ethiopian regions.MethodsA total of 227 formalin-fixed paraffin-embedded (FFPE) tissue blocks were collected from tertiary hospitals in four Ethiopian regions between 2015 and 2021. The IHC staining was performed for subtyping, ER, PR, HER2, and Ki-67 proliferation markers.ResultsThe mean age at diagnosis was 43.9 years. The percentage of ER and PR-negative tumors were 48.3% and 53.2%, respectively. The IHC subtypes showed the following distribution: 33.1% triple-negative breast cancer (TNBC), 27.6% luminal B, 25.2% luminal A, and 14.1% HER2 enriched. In multiple logistic regression analysis, grade III and HER2 positivity were associated with larger tumor size, and also originating from Jimma compared to Mekele.ConclusionPatients with ER-negative, PR-negative, and TNBC were found in 48.3%, 53.2%, and 33.1% of cases, respectively, showing that half the patients could potentially benefit from endocrine treatment. A considerably high prevalence of TNBC was reported in our study, demanding additional research that includes genetic predisposition factors. Additionally, aggressive tumors were found in a high percentage of younger age groups, which must be considered when planning personalized treatment strategies.

Background Hepatitis B virus (HBV) is one of the major threats to global health, affecting millions of people each year and causing morbidity and mortality. The risk of acquiring chronic HVV infection varies with age, with 90% of infections acquired during the perinatal period. Despite many studies, there is little evidence of this virus in the Borena Zone. Objectives This study was done to assess seroprevalence HBVinfection and associated factors among pregnant women attending antenatal care at selected Borena Zone public hospitals from June 1 to September 30, 2022. Methods A cross-institutional study was conducted on 368 randomly selected pregnant women who received antenatal care at Yabelo General Hospital and Moyale Primary Hospital. Data on sociodemographic and HBV-related factors were collected using a structured questionnaire. A 5 mL blood sample is then taken and tested using a diagnostic method, the enzyme-linked immunosorbent assay. Finally, data were entered using Epidata version 3.1 and exported to SPSS version 25 and Stata version 14 for analysis. Independent predictors were identified using logistic regression analysis and P

The evolution of tourism has been characterized in recent years worldwide by a trend of growth as a result of the favorable influence of economic, social, demographic and political factors. This upward trend in international tourism, even in periods of social, economic and political unfavourable, has led to tourism being considered one of the most dynamic economic sectors. The effects of the COVID-19 pandemic on the travel and tourist business were substantially underestimated from the onset of the COVID-19 problem in China. In spite of the massive impact, the tourism industry is trying to put together resources and finding ways to stay financially stable during this period. The present study attempts to explore the trend of several statistical indicators of international tourism and to present the current situation in Lebanon, a country that faced both the effects of COVID-19 restrictions, but also economic issues generated by the political instability and the Beirut Port explosion in 2020. The findings show a dramatical decrease in all indicators analysed in 2020 compared to 2019 at international level and in Lebanon.

Tourism is fundamental to economic development generating a continuous flow of people and investments, contributing to regional development, producing national and international wealth and stimulating the transfer of resources between countries. The benefits of tourism must contribute to the economic and social development of regions and citizens in all respects. Beyond the ultimate refinement, luxury is a way of life. Due to the quality of the services offered by luxury hotels, the prices charged by them are higher, because both the quality of the products and the service are at a higher quality level. Lately, luxury tourism has placed a great deal of emphasis on personalized services, which give guests an added comfort as well as confidence. The aim of this article is to review the recent research on current issues of luxury tourism market generated by the Covid-19 imposed restrictions. The main findings show that the sector changes as a result of government anti-Covid initiatives will almost certainly have an impact on the overall demand and supply of tourism products. Increased wealth disparity may lead to further fragmentation of the tourism market, with a corresponding rise in prices for both affordable and luxury locations.

The dynamically developing tourism sector can be the driving force of the region. Tourism at the regional level not only affects the local economy, but also local communities. In regional terms, tourism, depending on the tourist attractiveness of a given region, may be a polarizing, stimulating or neutral factor for the development of the region. Clustering has become a prerequisite for the survival of organisations, taking into account the economic, political, security and social situation currently observed at international level. The aim of the current paper is to present some of the current issues regarding the significance of tourism clusters in regional development performing an in-depth literature review on the research carried out in the field of tourism clustering and regional growth. The importance of cluster development is based on the need for partnerships between service providers as a source of increasing competitiveness. The findings present a broader perspective of the impact of tourism clusters in regional development. The development of the tourism cluster at regional level strengthens local society and social cohesion. All these determine the increase of the quality, the reduction of the costs, the better commercialization of the tourist products, therefore, the increase of the competitiveness of the destination.

The Covid-19 pandemic has hit tourism industry, affecting the livelihoods of people and the whole economy. Tourism managers seek for recovery plans to attain more sustainable tourism destinations. Hence, investing in protected areas is considered a vital tool for rural development and for building greener and safer tourism destination. Lebanon has significant unexploited potentials of natural assets presenting a dynamic background for ecotourism investments. Boosting protected areas in Lebanon may contribute to the development of sustainable tourism and strengthen the tourism industry. Shouf Biosphere reserve presents a worthy background for improved eco-tourism management to lessen the impact of reduced tourists’ influx to the region on locals living around. New niches in ecotourism have been blossomed in the biosphere but still confronted with several challenges that require a sustainable strategy for eco-tourism to be implemented in the country. In this context, the present paper aims to observe the ecotourism development in this biosphere region before and after the awake of Covid-19 and investigate the attitudes of tourists towards the evolvement of new niches of tourism in the region. Moreover, it suggests recommendations that may help to recover the losses of tourism industry and may contribute in further development of eco- tourism in protected areas in Lebanon..

Background: Breast cancer (BC) is the most common type of cancer in Ethiopia. The incidence of BC is also rising, but the exact figure is still poorly known. Therefore, this study was conducted to address the gap in epidemiological data on BC in southern and southwestern Ethiopia. Materials and Methods: This is a five-year (2015–2019) retrospective study. The demographic and clinicopathological data were collected from biopsy reports of different kinds of breast carcinomas in the pathology department of Jimma University Specialized Hospital and Hawassa University Specialized Referral Hospital. Histopathological grades and stages were conducted using Nottingham grading and TNM staging system, respectively. Collected data were entered and analyzed using SPSS Version-20 software. Results: The mean age of patients at diagnosis was 42.27 (SD = 13.57) years. The pathological stage of most BC patients was stage III, and most of them had tumor sizes greater than 5 cm. Most patients had moderately differentiated tumor grade, and mastectomy was the most common type of surgery at the time of diagnosis. Invasive ductal carcinoma was the most common histological type of BC, followed by invasive lobular carcinoma. Lymph node involvement was seen in 60.5% of cases. Lymph node involvement was associated with tumor size (χ2 = 8.55, p = 0.033) and type of surgery (χ2 = 39.69, p < 0.001). Conclusions: This study showed that BC patients in southern and southwestern Ethiopia displayed advanced pathological stages, relatively young age at diagnosis, and predominant invasive ductal carcinoma histological patterns.

Abstract Background Noise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC). Methods We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A). Results In the presence of the visual noise indicator, the LAeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P

"AIM: To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty (TM-DSEK). METHODS: Donor material was soaked in balanced salt solution (BSS) for 30min, before being mounted on an artificial anterior chamber (AAC). Rather than BSS, the AAC was filled with filtered air, resulting in a visible reflection at the corneal endothelium-air interface. This reflection served as a landmark for the depth of the dissection, facilitating the creation of a thin lenticule with low risk of perforation. Dissection was commenced at a standardized depth of 500 microns, with no initial pachymetry necessary. Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon. Dissection time, central graft thickness at 2mo and complications were analysed. RESULTS: Results were similar to other endothelial keratoplasty techniques, despite the cases being performed by a novice DSEK surgeon. Mean dissection time was 7min (range 6-10). One graft perforation occurred (3.45%), but the air tamponaded the break and enabled dissection to be restarted and completed from a different location. Mean central graft thickness after at least two months follow-up was 106 microns (range 25-170). CONCLUSION: A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule, or creating a thick graft due to fear of perforating. This modified air-guided technique addresses this problem, and is recommended for surgeons either embarking on the learning curve, or who wish to achieve more consistently thin grafts while reducing perforation rates."

This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.

In any nation across the world, effective governance involves improving the lives of all, providing value for new generations, consistent allocation of duties and functions, accountable decisions, providing quality of information, transparency and responsibility, good performance, a strong legal system, and above all developing sustainability on all levels. Governance is rooted and established based on the collaboration and coordination among nations governments, organizations, and people. The sluggishness in setting such governance goals as well as the incapability of many governments, like the Lebanese one, to develop and execute adequate legislative and institutional initiatives coupled with the absence of corporate governance knowledge, given that organizations remain connected to their elderly conventional method to manage their businesses that are based on nepotism, corruption legislation, and sectarian distribution, represent a crucial challenge for any reform and good governance endeavor. This paper aims to approach the need for Lebanon to reconsider new governance strategy and organizational and institutional reforms, especially, in conjunction with the severe economic crisis facing the country, the explosion of the port of Beirut on August 4, 2020, and the awaiting implementation of CEDRE project. The analysis revealed that moving to a new perspective in a complicated social and political environment, like Lebanon, involves multiple aspects. As a result, an in-depth implementation of a New Lebanese Public Governance in Lebanon along with political stabilization must lead to a progressive structural administrative reform and change which will also contribute to boosting confidence with the international community and speed up the international financial donation and support that will help Lebanon to heal its wounds and rise again. The defiance is to figure out if this could be another lost opportunity.

Abstract Background Studies have shown that providing adequate ventilation during CPR is essential. While hypoventilation is often feared by most caregivers on the scene, the most critical problem remains hyperventilation. We developed a Ventilation Feedback Device (VFD) for manual ventilation which monitors ventilatory parameters and provides direct feedback about ventilation quality to the rescuer. This study aims to compare the quality of conventional manual ventilation to ventilation with VFD on a simulated respiratory arrest patient. Methods Forty healthcare providers were enrolled and instructed to ventilate a manikin simulating respiratory arrest. Participants were instructed to ventilate the manikin for 5 min with and without the VFD in random order. They were divided in two groups of 20 people, one group ventilating through a mask and the other through an endotracheal tube. Results Ventilation with the VFD improved from 15 to 90% (p

Penile calciphylaxis, a rare manifestation of calcific uremic arteriolopathy, is infrequently reported in the literature. Surgical management has demonstrated similar outcomes as conservative management in terms of mean survival time. Therefore, the benefits of surgical intervention for this disease remain controversial. In this report, we present a case of penile calciphylaxis in a hemodialysis-dependent patient with end stage renal disease (ESRD). The interest of this case lies in the severity of illness on initial presentation, which precluded the possibility of conservative management and necessitated penectomy as a means of halting disease progression and improving patient quality of life.

Introduction and objective: The lethal necrotizing fasciitis, Fournier's Gangrene, is initially managed with resuscitation, broad-spectrum antibiotics, and aggressive surgical debridement. While the initial management steps are widely described, the subsequent management of skin loss is sparse. Our objective was to focus on the reconstruction of the penile shaft skin loss after wide surgical debridement. Methods: A single case was documented from presentation, to treatment, and to recovery. The primary focus was the reconstruction of the penile shaft skin. The combined planning and efforts of genitourinary and plastic surgery were used to reconstruct the penile shaft skin using a split thickness skin graft. Results: The penis was tunneled into a viable skin flap of the suprapubic fat pad in response to the wide surgical debridement from the treatment of Fournier's Gangrene. The penis maintained its anatomic function during the healing process. A 12/1000-in. split thickness skin graft from the lateral thigh was chosen to replace the skin deficient. 13 months later, we were able to excise around the preputial collar, un-tunnel the penis and place the skin graft around the penile shaft. A vacuum dressing and foley catheter remained in place for 7 days during an uneventful post-operative course. Ultimately, we found split thickness skin graft successful in this penile reconstruction after Fournier's Gangrene. Conclusion: Complete penile shaft skin loss can be managed acutely with tunneling in the suprapubic fat pad, and can be reconstructed with a split thickness skin graft from the lateral thigh.

AIM: To analyze the relationship between the score obtained in the Risk Score System (RSS) proposed by Hicks et al with penetrating keratoplasty (PKP) graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. METHODS: The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases), incomplete medical notes (5 cases) and follow-up less than 1y (3 cases). We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. RESULTS: Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure (P0.05) between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant (P