Although there are different techniques to detect peritoneal violation in penetrating anterior abdominal wall injuries like local wound exploration (LWE), serial abdominal examination (SAE), computed tomography (CT) and diagnostic laparoscopy (DL) , none has been considered standard (1).

Even in the most recent guideline algorithm by Western Trauma Association (WTA), AASW management diverges into three equivalent options, namely CT evaluation, LWE and SAE (2). SAE is reliable in detecting significant injuries. However, it requires to be performed by experienced clinicians and preferably by the same team. Also, it risks the morbidity of delaying a therapeutic intervention.

Recently, CT was introduced in the management of penetrating abdominal trauma. It should be noted that two distinct types of CT are now being used; CT with oral and IV contrast and CT tractography—which is a CT of the abdominal stab wound tract performed using water-soluble contrast agent. (3) However, there is much debate in the literature regarding the utility of CT in anterior abdominal wall injuries.(5)

Preoperative chemotherapy (NAC) has been recognized as the   standard of care for patients with locally advanced breast cancer and recently some patients with stage 2 and chemoresponsive subtypes ( HER2 , TNBC). Lymph node status is the most important prognostic factor in patients who receive neoadjuvant therapy.Patients who have a positive lymph node by fine-needle aspiration (or core needle biopsy) before neoadjuvant therapy usually undergo completion axillary dissection at the time of primary tumor resection.ALND has been the standard treatment of the axilla after NAC for many years.SLNB as an alternative can reduce the extent of axillary surgery without compromising the prognostic and predictive value of axillary staging.

From January 2014 to January 2016, Eighty patients of haemorrhoids from grade II to IV were randomly assigned to undergo either the transanal suture rectopexy (n= 40) or the stapled haemorrhoidopexy (n=40). Outcome assessment was performed at 12 hours,24 hours, 2 days, 1 month and at 6 months. Variables included operative time, post-operative complications, resolution of symptoms, and recurrence. Both the groups were comparable in terms of demographic data. No statistically significant difference was found between two groups in terms of operative time, post-op discomfort, urinary retention and VAS score at 24 and 48 hours. However the mean requirement of doses of analgesic diclofenac sodium (0.85 and 1.5 for the TR and SH group) differed significantly. Four patients in SH group developed prolapse at one month of post-op period, while in TR group this count was zero (P = 0.040). At six months of follow up seven patients of SH group had per rectal bleeding while only one patient from TR group has developed bleeding (P = 0.025). Four patients of the SH group had prolapse while no patient of TR group still had developed prolapsed at six month (P = 0.40). Patients rated TR as a better procedure than SH. Though transanal suture rectopexy has similar operative time, and resolution of symptoms when compared to stapled haemorrhoidopexy; it certainly offers lower incidence of post-op pain and long term recurrence than stapled haemorrhoidopexy.

Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle‑third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta‑analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle‑Ottawa Scale was used to assess the quality of included studies and a meta‑analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta‑analysis. For patients who underwent DG, a lower rate of overall post‑operative complications, anastomosis leakage and intro‑abdominal infection was determined. No significant difference was observed between DG and TG in the 5‑year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5‑year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.

Background Laparoscopic appendectomy (LA) is an effective and a safe procedure for treatment of acute appendicitis. Various methods are used for securing mesoappendix during LA like LigaSure, harmonic scalpel, monopolar diathermy, and endoloops and endoclips, the use of which affects the duration of operation and the overall cost. Aim The aim of this study was to compare between the use of monopolar electrocoagulation versus LigaSure (Covidien) in securing of mesoappendix during LA regarding operative and postoperative findings as well as the overall cost. Patients and methods In total, 80 patients, diagnosed as acute appendicitis and scheduled for LA, were randomly grouped into two groups according to the instrument used for securing the mesoappendix: group A: monopolar diathermy was used and group B: LigaSure was used. Results Both methods were comparable regarding operative and postoperative findings; however, using LigaSure markedly decreased the operative time compared with using monopolar diathermy (mean 60.45 vs. 51.9 min, P<0.001) and using monopolar diathermy markedly decreased the cost of operation compared with LigaSure (868.75 vs. 1962.5 Egyptian pounds, P<0.001). Conclusion Within the limitations of this study, we conclude that the use of monopolar diathermy in securing the mesoappendix during LA is as safe as and is more cost-effective than using LigaSure.

Background: Diabetes mellitus (DM) is one of the strongest predictors of peripheral arterial occlusive disease, and a significant risk factor for the progression of an asymptomatic disease or claudication into critical limb ischemia (CLI). (CLI) is the most advanced stage of peripheral arterial occlusive disease. The prognosis is poor, with amputation rates up to be 30%.
Objective: To assess the calcium burden of infragenicular native vessels in diabetic patients, to clarify its impact on primary and secondary patency rate (1ry and 2ry) and efficacy of endovascular management.
Patients and Method: Between 2018 and 2020, data from 30 consecutive diabetic patients with tibial arteries calcifications, at Al-Zahra’a University Hospital. All patients underwent lower extremity computed tomographic angiography (CTA) before the intervention. Based on CTA, tibial artery calcification (TAC) severity was categorized into three groups: minimal calcification (12 patients), intermediate calcification (10 patients), or extensive calcification (8 patients), with a total number of 42 limbs (12 patients were affected bilaterally). Immediate and late outcomes of the interventions were compared.
Results: There was a high correlation between calcification of tibial arteries and both DM and smoking. Claudication, rest pain, and major tissue loss presentation between all groups were higher in patients with extensive calcifications. Technical success rate was 88.1%, and primary patency rate was 83.3%. The 2-year patency rate for minimal calcification was 100%, 92.9% in the intermediate group, and 71.4% in the extensive group.
Conclusion: The outcomes of endovascular treatment (EVT) for patients with TAC were acceptable, with better technical success in minimal and intermediate calcification than extensive calcified lesions.

DNA ARCHITECTURE THEORY

Zygote contains a dna as a architecture and form cells of ectoderm ,mesoderm and endoderm
DNA contains  a gene and act as a architecture for cell
It act as a digital clock for the cell division
1 DNA base pair supplies energy to the cell for division as when the cell divides before cytoplasmic division chromosome divides and during chromosome division a huge amount of energy is released
2 this energy is supplied for division of organelle and accurate amount of energy is released by DNA for cell to divide it is during S phase
3 During  meiotic when chromosome pair up then energy is released .
DNA as a digital clock
1 for cell division DNA act as a digital clock
2 During zygote formation or during cell division . DNA stores information for  when to cell to divide
3 During normal condition due to absence of  T loop normal human cell divides within 24 hours.