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The clinical manifestations of mucormycosis vary depending on the location of the infection. In general, sepsis begins within the oral cavity or nose and then spreads to the central nervous system through the eyes. It is typically seen in immunocompromised patients, including those who have been exposed to high doses of cortisone, such as corona virus disease 2019 patients. The infection can lead to severe destruction of the bones of the palate, nose, and maxillary and sinusoid areas. Treatment may require both medical and surgical intervention. In the secondary stage of recovery from mucormycosis, various methods of reconstructive surgery for the external nasal structure can be used. To my knowledge, this is the first case that compares to secondary nasal restoration. A former patient with mucormycosis was treated using an autologous bone graft from the ilium, and after 2 years, the restoration was done using a silicone implant due to the absorption of the bone graft. The restoration using the silicone implant led to satisfactory results for the patient and the surgeon from an aesthetic standpoint, and we did not notice any inflammatory or infectious symptoms during the 11-month follow-up period.

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Background: Patient-specific implants (PSIs) have been presented as an effective solution for diseases that require reconstruction. PSIs are designed to precisely fit anatomical defects or deformities in terms of shape and size. In addition to the possibility of predicting the results of surgery regarding soft tissue changes. Methods: A research sample consisting of 10 patients with facial deformities underwent maxillofacial reconstructive surgery between 2020 and 2021 in the Tishreen University Hospital, Syria. All patients underwent computed tomography scans; then, the design of the required facial implant was carried out, and the three-dimensional soft tissues were reconstructed using the ExoCad 3.0 program based on the computed tomography. The final form of the facial implant was printed from polyether ether ketone, and then surgical work was performed. The patients were followed up after 6 months. Then, a comparison was made between the virtual design and the real result. Results: The absolute difference between the expected soft tissue changes result and the actual result did not exceed three-tenths for all patients, and only two of 10 patients had measurements higher than 20%. Conclusions: This technique can be relied upon with the placement of implants to predict the outcome of the surgical procedure in terms of morphological changes in the facial soft tissues covering PSI polyether ether ketone. Therefore, it is possible to make a virtual design based on the cosmetic requirements of the patient.

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The Western Delta Deep Marine Concession (WDDM) in the Eastern Mediterranean Sea is one of northern Africa's most recent petroleum-potential regions for gas and condensate exploration. The present study aims to determine the characteristics of the 15 natural gases and 5 associated condensate samples, using molecular compositions and isotopes from the Miocene reservoir rocks in the various wells located in the WDDM. The results of this study are also used to determine the gas-condensate correlation for their probable source rocks as well as the methane-generating mechanisms (i.e., thermogenic or microbiological). Results highlighted in this research reveal that most of the natural gases in WDDM are mainly thermogenic methane gases, with small contributions of biogenic methane gases that were generated from mainly mixed sources, with a high sapropelic organic matter input for biogenic gases. The thermogenic methane gases were formed from secondary oil and oil/gas cracking at the high maturity stage of the gas window. The biogenic gases are also contributed to the Miocene reservoirs, which are formed from the primary cracking of kerogen at low maturity stage by the action of CO2 bacterial reduction. In addition, the saturated and aromatic biomarker results show that the condensate samples were generated from clay-rich source rocks. This source unit of the Miocene condensates were deposited in a fluvial deltaic environmental setting, containing mixed kerogen type II/III and accumulated during the Jurassic-Cretaceous, as evidenced by the age dating indicators. The properties of the natural gases and associated condensates in the Miocene reservoir rocks suggest that most of the thermogenic methane gases, together with the condensate, are derived primarily from mature Jurassic-Cretaceous source rocks and formed by secondary oil and oil/gas cracking at the gas generation window, as demonstrated by the 1-D basin modelling results highlighted in the prior works. Therefore, most of the natural gases in WDDM are non-indigenous and migrated from more mature Jurassic-Cretaceous source rocks in the nearby Northern Sinai provinces or the deeper sequences in the offshore Nile Delta provinces.

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Background: it is generally the case in any traumatic accident where a loss in hard tissue occurs to preform restorative plastic surgery, as there are many materials and approaches used to restore the loss, this research sheds the light on the use of one such material and approach being 3D printed facial implants manufactured from PolyEther Ether Ketone (PEEK) and to evaluate the level of patients' satisfaction following the use of said method in repairing maxillofacial deformities. Materials and methods: a research sample consisting of 10 patients with facial deformities underwent maxillofacial reconstructive surgery between 2020 and 2021 in the Department of Oral and Maxillofacial Surgery in the Tishreen University Hospital - Latakia - Syria. All patients underwent Computed Tomography (CT) scans, then the design of the required facial implant was carried out, the final form of the facial implant was printed from PolyEther Ether Ketone (PEEK), and then surgical work was performed, a check-up after 3 months of the surgical procedure was carried out to evaluate the level of satisfaction on a scale of 1-5. Results: The results from the 10 patients showed a good level of satisfaction except in one case where the facial implant had to be removed due to recurrent infection where the patient showed no signs of response to medicinal treatment following the surgery. Conclusions: this research suggests that the use of 3D printed PEEK facial implants to be very agreeable in terms of functionality and aesthetics in treating various facial deformities.

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Iron deficiency and iron deficiency anemia are common conditions in children, especially in developing countries. It is often difficult for the pediatrician to know which indices should be used in the diagnosis of these conditions in children. Reticulocyte hemoglobin (Hb) content (CHr) has been shown to be an accurate indicator of anemia, however whether its use suits the situation in developing countries or not is unclear. The aim of this study was to evaluate the value and effectiveness of using CHr as a method to diagnose iron deficiency and iron deficiency anemia in Saudi children. The samples for the study were collected from 305 children suspected to have anemia. Complete blood count, transferrin saturation (Tfsat), ferritin, circulating transferrin receptor (TfR) and CHr were measured. Three groups were defined, iron deficiency (Tfsat <20%, Hb >11 g/dL; n=120), iron deficiency anemia (Tfsat <20%, Hb <11 g/dL; (n=73) and controls (Tfsat >20%; n=112). The anemic group had significantly lower macrocytic anemia (MCV), mean corpuscular hemoglobin (MCH) and CHr. All of the variables in the anemia group were significantly lower than those of the control group except for the ferritin level. Compared to the control group, the iron deficiency group also showed significantly lower values except for transferrin receptor and the ferritin levels. CHr levels of <26 pg correlated well with anemic states. CHr together with a complete blood count may provide an alternative to the traditional hematologic or biochemical panel for the diagnosis of iron deficiency and iron deficiency anemia in young children and is cost-effective in developing countries. A CHr cut-off level of 26 pg is considered to be a reasonable indicator of anemic states.

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BACKGROUND: The aim of this cohort, prospective study was to compare the diagnostic value of intrapartum fetal pulse oximetry (FPO) with that of fetal scalp blood gas (FSBG) for an abnormal neonatal outcome in cases with abnormal fetal heart rate (FHR) tracings. METHODS: Fetal oxygen saturation was continuously monitored with Nellcor N-400 FPO during labor. Simultaneous FSBG determinations were obtained. The results were analyzed in relation to umbilical arterial cord blood pH and neonatal outcome. Studied FPO cutoff levels were 30 and 40% hemoglobin saturation and that of FSBG pH was 7.2. RESULTS: During the study, there were 9825 deliveries; 415 had abnormal FHR. Only 150 fulfilled the whole screening panel. When the outcome variable was umbilical arterial pH, the positive predictive values of the three methods (FPO30, FPO40, FSBG) were 57, 61 and 65% and the negative predictive values were 43, 39 and 35% respectively. The sensitivity of FPO30 was highest (75%). Considering abnormal neonatal outcome, again the sensitivity was also highest for FPO30 (89%). The sensitivity of FSBG was 82%. The specificity of the three methods were 53, 49 and 38% respectively. CONCLUSION: The diagnostic value of intrapartum FPO compares favorably with FSBG. FPO seems to be a reliable and less invasive tool and may decrease unnecessary interventions and unnecessary fetal scalp blood sampling in cases of suspected fetal distress. The FPO cutoff of 30% saturation defined by previous studies appears to be appropriate.

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OBJECTIVE: To study the concentration of oxygen flowing passively from the front and the rear parts of different brands of self-inflating bag valve mask ventilation devices at different oxygen flows and that flowing actively from the front part at different ventilation rates. METHODS: Two devices were tested, the Ambu device in which the added oxygen enters at a right angle to the axis of the bag and the VBM in which the oxygen enters parallel to the axis of the bag and faces either a hole or a ridge in the intake valve. An oxygen analyzer was used to measure the oxygen concentration at different oxygen flow rates (2, 4, 6, 8 and 10 L/min) supplied by a 100% oxygen source. This was measured in both devices from the front and rear parts as step one. With active ventilation compressing the bag, oxygen concentration was measured from the front part. This was done at ventilation rates of 30 and 60 min(-1). RESULTS: Passive flow oxygenation. With the Ambu device, the oxygen concentration measured at the front part of the bag was 21% and that measured from the rear part was 100%, at all oxygen flow rates. With the VBM brand, in the first position with the oxygen source facing a hole (VBM-hole), the oxygen concentration was high at low flow rates and decreased with increased flow. Similar findings happened when measuring oxygen concentration from its rear part. With the oxygen source facing a ridge (VBM-ridge), the oxygen concentration measured from the front was directly proportional to the oxygen flow rate i.e. it increased with increasing flow. From the rear part, the oxygen concentration was near 100% at all flow rates. Active ventilation. Using the Ambu device, the oxygen concentration increased with increasing flow rate and reached 100% at 10 L/min flow. With VBM-hole, the oxygen concentration increased gradually with increasing flow but never reached 100%. With VBM-ridge, the performance was comparable to the Ambu. In all the situations, the oxygen concentration was higher when the ventilation was done at 30 min(-1) than at 60 min(-1). CONCLUSION: The Ambu device can provide 100% oxygen from its rear part even at low flow rates and 100% oxygen during active ventilation provided at least 10 L/min oxygen is used. The VBM is at a disadvantage when the oxygen source faces a hole; as the jet flowing in the bag causes a Venturi effect; which sucks air in from outside and dilutes the oxygen concentration provided. The ridge type does not have this problem. Ventilation at a rate of 30 min(-1) produced a higher oxygen concentration. The operator should be aware of the limitations of the device used.

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Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine metabolite leads to a fall in glomerular filtration rate (GFR) and filtration fraction. This might be inhibited by the nonspecific adenosine receptor antagonist, theophylline. This study was designed to determine whether theophylline could prevent and/or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomized 40 severely asphyxiated term infants to receive intravenously a single dose of either theophylline (5 mg/kg; study group: n=20) or placebo (control group: n=20) during the first hour of life. Fluid intake, urine output, serum creatinine, creatinine clearance, GFR, urinary beta2 microglobulin (beta2 M) and sodium excretion were recorded during the first 5 days of life. The two groups were comparable. No significant difference was reported regarding mechanical ventilatory support, respiratory complications and seizures. Severe renal dysfunction was significantly higher in the control group. Serum creatinine values were less, and creatinine clearance and GFR were significantly higher in the theophylline group from the second day onwards. beta2 M excretion was significantly less in the theophylline group, while sodium excretion and hematuria showed no significant difference. Prophylactic theophylline treatment, given early after birth, has beneficial effects in reducing the renal involvement in asphyxiated full-term infants, with no significant changes in central nervous system involvement.

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Nosocomial sepsis is very common in newborn units in developing countries. Routes of infection are multiple but the personal factor stays important. The hypothesis of this study was that intravenous lines may be important routes of infection and that contamination of cannula hub may preceded sepsis episodes. Infants in the neonatal intensive care unit level III were enrolled in the study. Culture samples were obtained from the intravenous line hubs every day until removed. At times of suspected sepsis, all patients had blood obtained for culture from a peripheral vein and from the i.v. line hubs at the same time. Sepsis was considered i.v. line-related if the micro-organism isolated from the peripheral blood culture was identical to the organism recovered from the cannula hub or tip or from purulent material at the site of skin entry of the cannula. Two hundred and sixty lines were placed in 83 patients. Forty-five episodes of sepsis were diagnosed clinically and by blood culturing. Klebsiella species was the predominant organism. Among the Klebsiella cases, the organism was isolated from the i.v. line hub in more than 50 per cent of the cases before the onset of clinical and laboratory sepsis, and in 14 per cent of the cases it was also isolated from the i.v. line hub at the time of sepsis. This study supports the hypothesis that the cannula hub is a major portal of entry for causing sepsis in newborn units.

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