The addition of date syrup (Dibis) as a substitution of sugar in the ice cream manufacturing was replaced by 20, 40, 60 and 100%. The effect of these replacements on the titratable acidity, pH, total solids, specific gravity, weight per gallon, viscosity in the ice cream mixes and the specific gravity, weight per gallon, overrun and melting rate as well as the sensory evaluation of the resultant ice cream were evaluated. The titratable acidity of ice mixes increased significantly with the increase of date syrup while the specific gravity of plain ice cream was higher significantly than the mixes prepared with the addition of dibis. The replacement of sugar in ice cream mixes resulted in an increase significantly in viscosity and the increase was proportional to the replacement ratio of dibis. The specific gravity as well as weight per gallon of resultant ice cream increased significantly with the increasing of sugar replacement by dibis. The overrun of the resultant ice cream decreased significantly as a result of replacing sugar by dibis. Regarding to the melting rate of resultant ice cream there was a significantly decrease of all treatment than the plain ice cream. The average of total bacterial, psychrotrophic bacteria and moulds & yeasts counts of mixes before pasteurization were higher than that after pasteurization in all treatments. On the other hand, the total bacterial, psychrotrophic bacteria and yeast & mould counts of resultant ice cream were increased in all treatments. It is recommended that the dibis can be used as replacement of sugar up to 60% to give good quality ice cream with enhancing the nutritive value of the products.

Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

Introduction Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management. Methods Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years. Results A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003). Conclusions In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.

Anti- phospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by persistently elevated antiphospholipid antibodies, resulting in recurrent arterial and venous thromboembolic events. The deep veins of the lower limbs and the cerebral arterial circulation are the most common sites of venous and arterial thrombosis, respectively [1] The other major clinical manifestations of the antiphospholipid syndrome are obstetrical. They include the unexplained death of one or more morphologically normal fetuses at or beyond the 10th week of gestation, the premature birth of one or more morphologically normal neonates before the 34th week of gestation because of either eclampsia or severe preeclampsia, and three or more unexplained, consecutive spontaneous abortions before the 10th week of gestation [2] Thrombotic events post COVID 19 infection has been described since the beginning of pandemic in 2019[3]. Autopsy reports have shown that most thromboses are located in the lung, although they have also been observed in other organs such as the skin and kidneys. SARS-CoV2 infection induces a generalized prothrombotic state, which is attributed to a combination of factors such as hypoxia, excess cellular apoptosis, and mainly to overactivation of the immune system [4]. Considering the high rate of mortality due to coagulation abnormalities and thrombosis among coronavirus disease 2019 patients, it is important to pay attention to the differential diagnoses of coronavirus disease 2019 and other diseases following thrombotic events [5].

Ovarian vein thrombosis (OVT) is a rare condition occurring in 1/600 to 1/2000 pregnancies mainly in the postpartum setting[1,2]. However,it is a potentially life-threatening condition andcan occur in other circumstances, such as inflammatory diseases of the pelvis, gynecological tumors, after pelvic surgery, during sepsis, hypercoagulable state, or even sometimes without an underlying cause [2]. It is usually manifested by nonspecific abdominal pain, with or without fever, and must be recognized because of its potentially serious complications (pulmonary embolism) [2,5]. Currently, the diagnosis is done earlier thanks to imaging techniques making the prognosis better[3,4].