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Abstract H. pylori infects approximately 50% of the world’s population that causes chronic gastritis, and may lead to peptic ulcer disease (PUD). H. pylori-induced chronic infections are associated with gastric adenocarcinoma and low-grade gastric lymphoma. In Egypt, H. pylori strains are widespread and became resistant to antimicrobial agents, thus advanced typing methods are needed to differentiate infectious strains that are resistant to antibiotics, and therefore earlier prognosis and infection control. The main objectives were (i) to determine susceptibility of infectious H. pylori strains to some antimicrobial agents that are currently used in eradication therapy in Egypt; (ii) to identify diverse strains commonly detected in the gastrointestinal (GIT) endoscopy units in Egypt through phenotypic and genotypic analyses. In this observational study we isolated 167 isolates from 232 gastric biopsies (antrum and corpus) of patients who were admitted to the upper GIT endoscopy units in five governmental Egyptian hospitals. Antimicrobial susceptibility patterns were investigated using Kirby Bauer disc diffusion and agar dilution Minimum Inhibitory Concentrations (MICs) methods. Phenotypic characterization was based on biotyping and antibiogram typing techniques. Genotypic characterization was carried out using PCR-based Restriction Fragment Length Polymorphism (RFLP) and Enterobacterial Repetitive Intergenic Consensus (ERIC)-PCR analyses. H. pylori isolates were highly resistant to diverse antimicrobial agents including Metronidazole, Fluoroquinolones, Macrolides, Amoxycillin, Tetracycline and Gentamicin. Two factors contributed to the increased resistance of H. pylori to the conventional therapy seen in Egypt: (i) Metronidazole and Amoxycillin are inexpensive and available drugs being abused by patients; (ii) the regional prescribing practice of Macrolids commonly used to treat upper respiratory and urinary tract infections. Five different biotypes were identified depending on the ability of the isolates to synthesize different enzymes. Nine antibiogram types were identified. PCR-RFLP analysis revealed fifteen different fingerprints while ERIC-PCR revealed 22 fingerprints. Biotyping alone or in combination with antibiogram typing are highly useful molecular tools in the prognosis of strain relatedness. PCR-RFLP and ERIC-PCR acquired good discriminatory power for identifying H. pylori infectious sub-types.

Abstract Background Modern undergraduate nursing students face unique challenges as digital natives balancing internet activities with the substantial academic demands of nursing studies. Given the detrimental effects of internet addiction on students’ academic performance and well-being, having time management skills is crucial. Aims To assess the prevalence and levels of internet addiction and time management and their association among undergraduate nursing students. Design A cross-sectional, survey-based research design was used. Setting The Faculty of Nursing at Alexandria University in Egypt. Subjects A stratified random sample consisting of 825 undergraduate nursing students. Tools The internet addiction test and time management questionnaire were utilized to collect data. Findings Internet addiction was prevalent among 98.8% of students, with 56.0% exhibiting mild levels, 40.0% showing moderate levels, and 2.8% having severe levels. A statistically significant negative correlation was found between students’ internet addiction and overall time management (r= − 0.387, p

Abstract Background Progressive familial intrahepatic cholestasis is an autosomal recessive genetic disorder that manifests primarily with jaundice and pruritus and can progresses from persistent cholestasis to cirrhosis and late childhood liver failure. Classically, progressive familial intrahepatic cholestasis is classified into three subtypes: 1, 2, and 3 and results from a defect in a biliary protein responsible for bile formation and circulation in the liver. In the last decade and with the increased use of genetic testing, more types have been known. Case presentation A 6-month-old Afrocentric boy presented with progressive jaundice and pruritus that started since the age of 2 months. He was thoroughly investigated to be finally diagnosed as progressive familial intrahepatic cholestasis type 4. A low-fat diet, ursodeoxycholic acid, fat-soluble vitamins, and cholestyramine were started. He showed initial improvement then had refractory pruritus and impaired quality of life. He underwent surgical biliary diversion at the age of 1 year with marked improvement of manifestations. Conclusion Owing to the increased technology of genetic testing, more clinical subtypes of progressive familial intrahepatic cholestasis were diagnosed other than the classical three types. Surgical management using biliary diversion could be beneficial and delays or may even obviate the need for liver transplantation.

Abstract Seismocardiographic (SCG) signals are chest wall vibrations induced by cardiac activity and are potentially useful for cardiac monitoring and diagnosis. SCG waveform is observed to vary with respiration, but the mechanism of these changes is poorly understood as alterations in autonomic tone, lung volume, heart location and intrathoracic pressure are all varying during the respiratory cycle. Understanding SCG variability and its sources may help reduce variability and increase SCG clinical utility. This study investigated SCG variability during breath holding (BH) at two different lung volumes (i.e., end inspiration and end expiration) and five airway pressures (i.e., 0, ± 2–4, and ± 15–20 cm H2O). Variability during normal breathing was also studied with and without grouping SCG beats into two clusters of similar waveform morphologies (performed using the K-medoid algorithm in an unsupervised machine learning fashion). The study included 15 healthy subjects (11 Females and 4 males, Age: 21 ± 2 y) where SCG, ECG, and spirometry were simultaneously acquired. SCG waveform variability was calculated at each experimental state (i.e., lung volume and airway pressure). Results showed that breath holding was more effective in reducing the intra-state variability of SCG than clustering normal breathing data. For the BH states, the intra-state variability increased as the airway pressure deviated from zero. The subaudible-to-audible energy ratio of the BH states increased as the airway pressure decreased below zero which may be related to the effect of the intrathoracic pressure on cardiac afterload and blood ejection. When combining the BH waveforms at end inspiration and end expiration states (at the same airway pressures) into one group, the intra-state variability increased, which suggests that the lung volume and associated change in heart location were a significant source of variability. The linear trend between airway pressure and waveform changes was found to be statistically significant for BH at end expiration. To confirm these findings, more studies are needed with a larger number of airway pressure levels and larger number of subjects.

Understanding how individual students cognitively engage while participating in small group activities in a General Chemistry class can provide insight into what factors may be influencing their level of engagement. The Interactive-Constructive-Active-Passive (ICAP) framework was used to identify individual students' level of engagement on items in multiple activities during a General Chemistry course. The effects of timing, group size, and question type on engagement were investigated. Results indicate students' engagement varied more in the first half of the term, and students demonstrated higher levels of engagement when working in smaller groups or subsets of larger groups when these groups contained students with similar levels of knowledge. Finally, the relation between question type (algorithmic "versus" explanation) and engagement depended on the activity topic. In an activity on Solutions and Dilutions, there was a significant relation where algorithmic items had higher occurrences of Interactive engagement. The implications of this work regarding teaching and research are discussed.

The Learning Assistant (LA) model trains undergraduate student leaders to enhance student learning and engagement by supporting the classroom with research-based instructional strategies. Many disciplines in the life sciences that implemented the LA model reported increased learning gains and decreased performance gaps. However, the model is rarely implemented in engineering disciplines whose students would benefit immensely from having LA guidance in hands-on engineering courses. We illustrate Biomedical Engineering (BME), an engineering discipline whose students struggle to find cohesion between the courses and develop the learning habits they need for a successful career. The two main innovations of our work are (1) the implementation of a discipline-specific LA program for BME students and (2) the development of a neuroscience-inspired pedagogy course to introduce and push students to consider the neural underpinnings of their learning process. We report the implementation mechanics of the program and present preliminary data as success indicators. First, we qualitatively captured the pedagogy course's impact on the trained LAs using the classroom activities they developed and a self-reflection assignment. Second, we conducted a pilot pre-post-thematic analysis, which revealed increased self-awareness, motivation to learn, and a shift from self to students and team-based learning. Third, we also measured the program's initial impact on the students who attended LA-supported classes through surveys. The student surveys showed an overall improvement (p < 0.05, n = 217) in the socio-emotional measures contributing to career preparedness, like the sense of belonging, self-efficacy, and STEM identity. All program participants reported a transformative experience in their learning practices, study habits, and classroom dynamics.

Abstract Background Ganglioneuromatosis is a rare type of benign neurogenic tumor that usually affects the sites of the major sympathetic ganglia in the retroperitoneum and the posterior mediastinum. Affection of the gastrointestinal tract is rare, and involvement of the esophagus is exceptional. To the best of our knowledge, only 4 cases of esophageal ganglioneuromatosis in adults were reported in the literature. No cases have been reported in the pediatric age group. Case presentation An 11-year-old boy presented with dysphagia due to severe esophageal stenosis caused by esophageal ganglioneuromatosis. Conclusions Despite its rarity, the present case implies that ganglioneuromatosis should be considered in children with idiopathic esophageal stenosis.

Doaa Abdelrahaman,1 Ola A Habotta,2 Ahmed Ateya,3 Ahmed A Aldarmahi,4,5 Reham A El-Shafei,6 Mohamed M Badawy,7,8 Ahmed A El-Mansy,9,10 Thoraya M A-Elgadir,11 Aml M Nada,12 Mona G Elhadidy,13,14 Eman Hamza,15,16 Khairiah M Alwutayed,17 Mohamed El-Sherbiny,18 Liana Fericean,19 Florin Imbrea,20 Ahmed Abdeen21 1Department of Internal Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt; 3Department of Animal Husbandry and Wealth Development, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt; 4Department of Basic Science, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 5National Guard- Health Affairs, King Abdullah International Medical Research Centre, Jeddah, 21582, Saudi Arabia; 6Department of Pharmacology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt; 7Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 8Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Delta University for Science and Technology, Gamasa, Egypt; 9Department of Basic Medical and Dental Sciences, Faculty of Dentistry, Zarqa University, Zarqa, Jordan; 10Department of Medical Histology and Cell Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 11Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia; 12Department of Internal Medicine and Endocrinology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 13Department of Medical Physiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 14Department of Medical Physiology, Faculty of Medicine, Al-Baha University, Al Aqiq, Saudi Arabia; 15Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 16Department of Medical Biochemistry and Molecular Biology, Horus University, Damietta, Egypt; 17Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 18Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, 11597, Saudi Arabia; 19Department of Biology and Plant Protection, Faculty of Agriculture, University of Life Sciences “king Michael I” from Timișoara, Calea Aradului, Romania; 20Department of Crop Science, Faculty of Agriculture, University of Life Sciences “King Mihai I” from Timisoara, Calea Aradului, Romania; 21Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Benha University, Toukh, EgyptCorrespondence: Florin Imbrea, University of Life Sciences “King Mihai I” from Timisoara, 119, Calea Aradului, Timisoara, 300645, Romania, Email florin_imbrea@usab-tm.ro Ahmed Abdeen, Benha University, Toukh, 13736, Egypt, Email ahmed.abdeen@fvtm.bu.edu.egBackground: Nootkatone (NK), a bioactive sesquiterpene ketone, is a major ingredient in grapefruit that has distinguished biological activities. Melamine (MM), a food adulterant, was reported to induce toxic effects including renal disorders. Hence, this protocol was devoted to evaluate the renoprotective impact of NK toward MM-evoked renal damage.Methods: Rats were either exposed to MM (700 mg/kg) or a combination of MM and two doses of NK (5 and 10 mg/kg).Results: The results showed that NK therapy notably decreased the kidney functional parameters, along with KIM-1 and NGAL expressions of MM group. Furthermore, a decrease in MDA and NO levels as well as an elevation in SOD, CAT, GSH, and SOD and NRF2 mRNA expression in the NK group demonstrated NK’s ability to enhance the renal antioxidant defense of the MM group. Significant suppression in renal inflammatory markers was achieved by NK via lessening of IL-1β and TNF-α, besides downregulation of NF-κB and IL-1β expressions. NK also downregulated vimentin, nestin, and desmin in the MM group. Additionally, in response to the MM exposure, NK hindered renal apoptosis by decreasing caspase-3 expression and restoring renal histopathological features.Conclusion: These outcomes suggest that NK can be considered as a prospective candidate to guard against MM exposure-mediated renal toxic effects.Keywords: apoptosis, inflammation, intermediate proteins, melamine nephrotoxicity, nootkatone, oxidative stress

The objective of this study was to evaluate heterosis, general combining ability (GCA), maternal ability (GM), and sex-linked effects (SL) for growth performance from weaning (at 4 weeks) up to marketing age (at 12 weeks) using a complete 3×3 diallel crossing experiment in three different breeds of rabbit: one native Egyptian (Baladi Red, RR) and two exotic (Bauscat, BB, and Californian, CC). Offspring (2617 rabbits) body weight data (BW; 4–12 weeks of age) were analyzed, mainly to evaluate the effects of mating groups (MGs), sex, year season, and parity. MGs were further analyzed for crossbreeding parameters. All crossbreds showed positive, highly significant values (P≤0.001). Heterosis (HI; overall or specific) for body weight at all evaluated ages was highly significant (P≤0.001). Purebred differences were affected significantly (P≤0.01 or P≤0.001). No significant effects were detected due to general combining ability, maternal abilities, or reciprocal effect (sex-linked). Results suggest that to some extent and because of the highly purebred significant differences (P≤0.01 or P≤0.001), those three breeds are expected to be too genetically far apart to make crosses showing significant heterosis. Since other crossbreeding effects are non-significant, heterosis is the only reliable effect that can produce the Egyptian broiler rabbits when using those three breeds. However, the insignificance of the reciprocal impact (sex-linked as a whole or, by definition, the additive effects of genes carried on the sex chromosomes) of the two acclimatized standard breeds (CC and BB) seemed to be of magnitude at least to the 10th week of age.

Q fever has become one of the most common causes of abortion in sheep herds, resulting in signifi-cant financial losses for Egyptian farmers. The goal of this study was to establish Coxiella burnetii seroprevalence and molecular detection in three sheep farms in Egypt. A total of 184 sheep of various ages and sexes had their serum samples and vaginal swabs taken. All serum samples were checked for the presence of C. burnetii antibodies by using an ELISA, while 50 vaginal swabs were randomly chosen for molecular detection of the C. burnetii IS1111 gene. The overall seroprevalence of Q fever in sheep was 37.5%, and it was more common in females (39.5%) than in males (8.3%). Antibodies to C. burnetii were found in more than half of pregnant ewes (47.7%). Antibodies to C. burnetii were found in 47.7% of pregnant ewes, compared to 31.4% in non-pregnant and abortive ewes (43.8%). Seroprevalence was observed to be significantly higher in sheep older than 3 years (71.2%). The presence of the C. burnetii IS1111 gene was found in 20% of the molecularly analysed vaginal swabs. Based on the abortion history and pregnancy state of the studied sheep, no statistical significance was identified, since the C. burnetii gene was present in equal percentages in both aborted and non-aborted ewes. A comparison of ELISA and PCR results for vaginal swab samples revealed a statistically non-significant link between the two procedures’ results. These findings revealed sheep as an important reservoir for C. burnetii infection, implying that the role of C. burnetii in sheep should be studied further.

Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.Infographic and video abstract available for this article.

Abstract Background Nursing education presents unique challenges, including high levels of academic stress and varied learning approaches among students. Understanding the relationship between academic stress and learning approaches is crucial for enhancing nursing education effectiveness and student well-being. Aim This study aimed to investigate the prevalence of academic stress and its correlation with learning approaches among nursing students. Design and Method A cross-sectional descriptive correlation research design was employed. A convenient sample of 1010 nursing students participated, completing socio-demographic data, the Perceived Stress Scale (PSS), and the Revised Study Process Questionnaire (R-SPQ-2 F). Results Most nursing students experienced moderate academic stress (56.3%) and exhibited moderate levels of deep learning approaches (55.0%). Stress from a lack of professional knowledge and skills negatively correlates with deep learning approaches (r = -0.392) and positively correlates with surface learning approaches (r = 0.365). Female students showed higher deep learning approach scores, while male students exhibited higher surface learning approach scores. Age, gender, educational level, and academic stress significantly influenced learning approaches. Conclusion Academic stress significantly impacts learning approaches among nursing students. Strategies addressing stressors and promoting healthy learning approaches are essential for enhancing nursing education and student well-being. Nursing implication Understanding academic stress’s impact on nursing students’ learning approaches enables tailored interventions. Recognizing stressors informs strategies for promoting adaptive coping, fostering deep learning, and creating supportive environments. Integrating stress management, mentorship, and counseling enhances student well-being and nursing education quality.

Background and Study Aim. This study compares the effects of high-intensity interval training (HIIT) on unstable and stable surfaces on explosive strength, balance, agility, and Tsukahara vault performance in gymnastics. Material and Methods. A nonrandomized trial study was conducted on twenty-seven well-trained male vault players who were assigned into 3 equal groups, a HIIT unstable group (UG), a HIIT stable group (SG), and the control group (CG). The training period for the subjects lasted eight weeks, with 3 sessions each week. All of the aforementioned variables were assessed both before and after the training period. Results. The main findings indicate that both UG and SG showed greater improvement than the CG on explosive strength, balance, agility, and Tsukahara vault performance in gymnastics (ES= 0.52 to 0.68, P 0.05). Conclusions. Accordingly, HIIT with unstable surfaces can be used as an alternative method to improve explosive strength and balance. Also, it can be used alongside stable surface exercises when developing agility.

Objective In 2012, the Commission on Human Medicines mandated lowering the acetaminophen toxicity nomogram treatment threshold in the UK to 100 µg/ml at 4 h post-ingestion. The present study aim was to evaluate biochemical and liver toxicity patterns in patients who presented with acetaminophen overdose and had low serum acetaminophen concentrations (150 µg/ml or an unknown ingestion time were excluded. Data were extracted from electronic medical records and are presented as mean ± SD or median (interquartile range). Results A total of 103 patients were included (median age, 17 [4–21] years) and 80 (78%) were female. The median ingested acetaminophen dose was 5000 (2850–7650) mg. At baseline, the median serum acetaminophen concentration was 42 (4.5–64.8) µg/ml, and median alanine aminotransferase and aspartate aminotransferase levels were 22 (17–28) and 27 (16–45) IU/L, respectively. Twenty patients were treated with acetylcysteine, with none developing adverse reactions. No patient developed hepatotoxicity, including patients with initial multiple product ingestion or other risk factors. Conclusions Patients presenting with an acute acetaminophen overdose with acetaminophen level

Introduction: Self-medication during pregnancy remains a prevalent global phenomenon, with pregnant women often relying on their own judgment to manage symptoms. Objective: This study aimed to assess community pharmacist practice regarding self-medication requests for acne treatment in pregnant women within Saudi Arabia. Methods: A descriptive, observational cross-sectional study was conducted in Riyadh, Saudi Arabia. Community pharmacists completed a questionnaire after interacting with a simulated customer (SC) seeking doxycycline for a pregnant woman. Data were analyzed using SPSS software. Results: One hundred community pharmacists participated in the study. The majority were between 25 and 35 years old (56 %) and worked in chain pharmacies (81 %). Notably, 71 % requested a prescription before dispensing any medication. While 66 % advised the SC to consult a physician or dermatologist, only 15 % inquired about the pregnancy and related information of the SC's sister. Conclusion: This study suggests a positive trend in community pharmacy practice regarding self-medication requests during pregnancy. However, further improvement is needed, particularly in terms of in-depth inquiry about pregnancy status and potential risks associated with specific medications. Collaborative efforts between the Ministry of Health (MOH), Saudi Food and Drug Administration (SFDA), and pharmacy education programs are crucial to minimize inappropriate dispensing practices and ensure optimal patient safety.

PURPOSEEarly-onset colorectal cancer (EOCRC) is a rising health problem. The incidence of EOCRC has increased over the past 2 decades all over the world. Reports from Egypt since the 1990s have reported a higher incidence among young populations with no identifiable risk factors. The aim of this study was to assess EOCRC in Egypt regarding incidence, characteristics, treatment pattern, and survival compared with average age onset and elderly patients.MATERIALS AND METHODSThis was a retrospective, record-based, cohort study combining data from four different cancer centers in Egypt. We grouped patients according to age into three categories: the EOCRC group for patients age ≤45 years and the average age onset and elderly cancer group (for patients age ≥65 years).RESULTSThe study included 1,310 patients with histopathologically proven colorectal cancer, representing four different geographical areas in Egypt. Patients with EOCRC represented 42.4% of the study population. Female patients were 50.6% among the EOCRC group and 52.5% among the average age group. Rectal tumors were significantly higher in EOCRC (54.7% v 40.6%; P < .001). There was no significant difference between both groups regarding the tumor stage at presentation, obstruction, or presence of metastases at presentation. Patients with EOCRC had a significantly higher rate of peritoneum/adnexa metastases than the average age ones (12.3% in EOCRC v 6.9% in the average age group; P < .001). No statistically significant differences between EOCRC and average age groups in both disease-free survival and overall survival were reported.CONCLUSIONA comprehensive framework for the study of EOCRC is required in Egypt as well as a genomic analysis to identify possible underlying genetic alterations responsible for the high incidence of EOCRC.

Background: Ureteral atresia is a rare disease that is usually associated with a non-functioning dysplastic kidney. The condition may be unilateral or bilateral, short, or long, and may involve any part of the ureter. Case description: A 4-year-old boy presented with a gradually developing right-sided abdominal distension. Abdominal examination revealed a right lumbar mas of approximately 20 × 15 cm. Abdominal ultrasound showed a large cystic mass that extended from the hilum of the right kidney and crossed the midline to reach the left side of the abdomen. The left kidney was absent. Voiding cystourethrogram (VCUG) was unremarkable. Magnetic resonance urography (MRU) confirmed the presence of a thin-walled cystic lesion extending from the right renal hilum, crossing midline, reaching the left lumbar region, and the absence of the left kidney. Renal nuclear scan showed a functioning right kidney and an absent left kidney. Exploratory laparotomy via a Pfannenstiel incision revealed a normal right kidney and a large extraperitoneal abdominal cyst. This cyst contained about 200 cc of brownish fluid. The cystic mass was in fact a crossed fused left kidney with a proximal ureteral atresia. Excision of the cyst along with the left ureter was done. The postoperative course was uneventful. Conclusion: Ureteral atresia is a rare condition. It can result in a dysplastic kidney in the form of a large retroperitoneal abdominal cystic mass.

Background: Double appendix, also known as vermiform appendix duplex, is a rare congenital anomaly. It is estimated to occur in 1 in 25,000 people with fewer than hundred cases reported worldwide. Case description: A 10-year-old boy presented to our clinic with fecal incontinence. He had a history of an anorectal malformation (recto = bladder neck fistula), for which he had undergone a neonatal anorectoplasty with an abdominal approach. The patient was not on any bowel management program. A plan of daily enemas, toilet training, and dietary measures including a high fiber and low carbohydrate diet was started. Despite following this program, his fecal incontinence persisted. The patient subsequently underwent a laparoscopic-assisted Malone appendicostomy without complications. During the operation, two cecal appendices were found. One appendix was removed, while the other one was used for the Malone appendicostomy. His postoperative course was uneventful. The patient currently does antegrade enema twice daily and his incontinence has completely resolved. Conclusion: Double appendix, although very uncommon, can be found in patients with anorectal malformations.

Infections caused by drug-resistant bacteria, particularly Gram-negative organisms, are increasingly difficult to treat using antibiotics. A potential alternative is "phage therapy", in which phages infect and lyse the bacterial host. However, phage therapy poses serious drawbacks and safety concerns, such as the risk of genetic transduction of antibiotic resistance genes, inconsistent pharmacokinetics, and unknown evolutionary potential. In contrast, metallic nanoparticles possess precise, tunable properties, including efficient conversion of electronic excitation into heat. In this work, we demonstrate that engineered phage-nanomaterial conjugates that target the Gram-negative pathogen Pseudomonas aeruginosa are highly effective as a treatment of infected wounds in mice. Photothermal heating, performed as a single treatment (15 min) or as two treatments on consecutive days, rapidly reduced the bacterial load and released Zn2+ to promote wound healing. The phage-nanomaterial treatment was significantly more effective than systemic standard-of-care antibiotics, with a >10× greater reduction in bacterial load and ∼3× faster healing as measured by wound size reduction when compared to fluoroquinolone treatment. Notably, the phage-nanomaterial was also effective against a P. aeruginosa strain resistant to polymyxins, a last-line antibiotic therapy. Unlike these antibiotics, the phage-nanomaterial showed no detectable toxicity or systemic effects in mice, consistent with the short duration and localized nature of phage-nanomaterial treatment. Our results demonstrate that phage therapy controlled by inorganic nanomaterials can be a safe and effective antimicrobial strategy in vivo.