Abstract This paper explores the introduction of a quality improvement initiative in Kiribati’s primary health care (PHC) system.

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups.Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups.Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups.Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Background: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. Methods: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. Results: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). Conclusion Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

Aims: This study aimed to i) identify Pseudomonas savastanoi pv. savastanoi (Pss) as a causal agent of the olive knot on the basis of biochemical, pathogenicity and PCR technique ii) investigate in vitro bacterial resistance toward copper-based compounds and efficiency of some antibiotics on pathogen suppression. Methodology and results: Biochemical, pathogenicity and molecular identification based on alkaline method for the DNA extraction were performed to identify possible causal agent of the olive knot. Copper resistance for Pss strains was evaluated by inoculation of bacterial suspensions into YPG medium, containing the cupric sulfate at 0, 100, 250 and 500 ppm. The efficiency of eight antibiotics on Pss strain was evaluated at different concentrations. Fifty-nine isolates caused typical knots at the site of inoculation with bacterial suspensions. All isolates have been identified as Pss using specific primers. No resistance to copper was detected with concentration of 500 ppm. In contrast, copper resistance was found during 48 h with lower concentration (100 or 250 ppm). The maximal inhibition of Pss 2102-4M was observed with the highest concentration (20 μg/mL) of the Aureomycin, Streptomycin and Novobiocin with inhibition diameters of 30, 24 and 10 mm, respectively. Whereas, Colchicine, Bacitracin, Cephalex, Ampicillin and Cycloserine have no inhibitory effect on the Pss 2102-4M strain. Conclusion, significance and impact of study The alkaline method for the DNA extraction from pure culture was reliable and rapid and can be recommended for molecular detection the causal agent of the olive knot. This is the first report determined copper resistance levels of Moroccan strains of Pss and in vitro evaluated for the susceptibility towards the antibiotics.

Aims: Milk is rich of nutrients that are necessary for the growth of various microorganisms. The aim of the present study was to evaluate the microbial quantity and quality of the raw cow’s milk sold through street trading in Meknes, Morocco, and to study the variation and seasonal relationship of microbial diversity during the four seasons of the year. Methodology and results: Raw cow’s milk samples were collected randomly between May 2015 and April 2016 from 3 street trading sale points, two popular neighborhoods (station 1 and station 2) and one popular market, and they were analyzed microbiologically. The results showed that the contamination rates of Total Plate Count (TPC), total coliforms, fecal coliforms, lactobacilli, lactococci and yeasts and molds were 8.8×108 CFU/mL, 8.9×105 CFU/mL, 2×103 CFU/mL, 4.6×108 CFU/mL, 7.5×108 CFU/mL and 4.1×103 CFU/mL, respectively. Moreover, Escherichia coli, Staphylococcus aureus, Clostridium perfringens and Listeria monocytogenes were detected in 66.67% (24/36), 75% (27/36), 36.1% (13/36) and 19.44% (7/36), respectively, while Salmonella was not detected in this study. Conclusion, significance and impact of study The highest microbiological count in raw milk samples was found in summer, while the lowest was detected in winter (p˂0.005). Therefore, the quality of milk marketed in Meknes region of Morocco is deteriorated due to the lack of good hygienic conditions of raw cow’s milk sold through street trading.

BACKGROUND: Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. PURPOSE: We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care. METHODS: Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients. RESULTS: Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery. CONCLUSION: The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.
Carbon Dioxide ; Child ; Critical Care ; Critical Illness ; Diet ; Diet, High-Fat ; Energy Intake ; Enteral Nutrition ; Food Habits ; Humans ; Hypertriglyceridemia ; Intensive Care Units ; Lung Diseases ; Malnutrition ; Mortality ; Nutrition Assessment ; Nutritional Status ; Ventilation ; Ventilators, Mechanical

Objective: To investigate the diuretic and renal effects of Silybum marianum L. and Cistus ladaniferus L. in normal rats. Methods: Four groups of rats were used in each experiment. The first group received water, the second group received Cistus ladaniferus L. extract (100 mg/kg b.wt), the third group received Silybum marianum L. extract (100 mg/kg b.wt), and the fourth group received furosemide (10 mg/kg b.wt). Variables including urine volume, plasma and urine sodium, potassium and creatinine, and creatinine clearance were measured. Two experiments were conducted. A single dose of each intervention was used and the variables were measured during 24 h, and the interventions were given daily for a total of 8 d and the variables were measured during various intervals. Results: The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium (P<0.05). On the day 8 after daily administration, the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes (P<0.05), while furosemide caused hypokalemia. Both plant extracts significantly increased creatinine clearance (P<0.05). Conclusions: Silybum marianum L. and Cistus ladaniferus L. increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes. Silybum marianum L. is more potent than furosemide or Cistus ladaniferus L. http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=6;spage=393;epage=398;aulast=El;type=2.