European Journal of Cardiovascular Medicine

Covid-19 with more than 2 crore cases and 7.5 lakh deaths brought world to standstill. India had about a century old Epidemic act with IPC and Cr PC as legal weapons to deal with such an aggressive pandemic which are far than minimal to deal with a situation like this in present time. So, looking at the gravity of current pandemic; Govt. of India passed a much clear and needed law as an Epidemic Disease ordinance 2020 on 22nd April 2020 for better containment and control of Covid-19 pandemic. Amendment has covered the fields which were either unclear or not at all covered or defined in the earlier Act.

Background: Urethrocutanous fistula after hypospadias surgery repair is the most common complication and remains a frustrating problem for the surgeon and the patient. The problem is exacerbated because the urethrocutanous fistula may recur which adds more demands surgery. Aim: To evaluate the use of buccal mucosal patch graft for treatment of recurrent post hypospadias repair urethrocutanous fistula. Patients and methods: Between January 2018 and August 2019 at Al- Shaheed Ghazi Al- Hariri Hospital in Medical City Complex in Baghdad. 10 boys with recurrent urethrocutanous fistula were included in this study. Their age ranged between 5-12 years. All were repair using a buccal mucosal graft with dartos fascia as an interposed reinforcing layer. Results: Nine out of 10 patients who involve in this study showed complete healing of their fistula, with no recurrence of the fistula during 6 months follow up period postoperatively and also no donor site complication. Conclusion: The Oral mucosal patch graft is simple and easy procedure that can be used for treatment of recurrent urethrocutanous fistula, it provided extragenital tissue for an area that had being fibrous from previous surgery. It shows to reduce the chance of recurrence of the urethrocutanous fistula with minimal or no donor site morbidity.

Background: The conventional surgical model is recently questioned via the statement that there is continuity in the mesentery. The concept stating the mesentery regress seems to be accurate with the latest literature stating continuity of mesentery to rectum from the duodenojejunal junction in radiological as well as surgical findings. Aims: The present trial on cadavers was done to evaluate and access the efficacy of this newly developed technique in preserving the continuity of the mesentery and ex-vivo mesentery characterization. Materials and Methods: In 16 cadavers, a newly developed dissection technique by Kumar A et al was adopted for judging and assessing the continuity of the mesentery. The whole mesentery is separated from the abdominal cavity. These observations were recorded photographically and clinically, and the results are formulated. Results: The continuity of the mesentery was continuous and this finding was uniform in all the 16 cadavers examined in the study. As this continuity continued from mesoduodenom to mesorectum, this showed and pointed towards the intestine location at the intestinal margin of the mesentery. With this continuity, the study also depicted that anatomical boundaries that divide the various regions were not prominent on examination. Conclusion: The mesoduodenum presence not abide by the area, gender, or race. Also, the recent dissection protocol adopted in the present study allows the complete dissection of the entire continuous mesentery along with its adjoining part.

Rhabdomyolysis is the breakdown of striated muscle cells resulting in leakage of cell matter into the extra-cellular space. It can present with myalgia, muscle weakness and swelling. Episodes of passing of dark tea-coloured urine have also been reported. Raised Creatinine Kinase (CK) is diagnostic of rhabdomyolysis. Raised serum myoglobin levels and presence of myoglobin in the urine (myoglobinuria) help to support the diagnosis. The aetiology for rhabdomyolysis can be both traumatic and non-traumatic. In the case of trauma, individuals with crush injuries trapped in cars or under collapsed buildings¬¬, struggling against restraints, immobilized and in the same position for hours due to injuries, comatosed states or positioning during prolonged surgeries and those with high voltage electrical injuries are at increased risk of rhabdomyolysis. Non-traumatic causes of rhabdomyolysis include hyperthermia, metabolic myopathies, drugs and toxins ingestions, electrolyte abnormalities and infections. The mechanism of rhabdomyolysis is often multifactorial. In the case of trauma, direct injury to cell membranes as well as hypoxia from direct compression leading to ATP (Adenosine Triphosphate) depletion leads to breakdown of striated muscle cells. The lysed cells release myoglobin, creatine kinase, urate and phosphate into the interstitium. Direct heme protein-induced toxicity on nephrons can result in Acute Kidney Injury (AKI). We report a case of traumatic rhabdomyolysis and share the latest in the literature on the understanding of the subject as well as that of myoglobinuria, with which it is often associated with.