Search

We evaluated a protocolized endoscopic necrosectomy approach with a lumen-apposing metal stent (LAMS) in patients with large symptomatic walled-off pancreatic necrosis (WON) comprising significant necrotic content, with or without infection.Randomized trials have shown similar efficacy of endoscopic treatment compared to surgery for infected WON.We conducted a regulatory, prospective, multicenter single-arm clinical trial examining the efficacy and safety of endoscopic ultrasound (EUS)-guided LAMS with protocolized necrosectomy to treat symptomatic WON ≥ 6 cm in diameter with 30% solid necrosis. After LAMS placement, protocolized WON assessment was conducted and endoscopic necrosectomy was performed for insufficient WON size reduction and persistent symptoms. Patients with radiographic WON resolution to ≤ 3 cm and/or 60-day LAMS indwell had LAMS removal, then 6-month follow-up. Primary endpoints were probability of radiographic resolution by 60 days and procedure-related serious adverse events (SAEs).Forty consecutive patients were enrolled September 2018 - March 2020, of whom 27 (67.5%) were inpatients and 19 (47.5%) had clinical evidence of infection at their index procedure. Mean WON size was 15.0 ± 5.6 cm with mean 53.2% ± 16.7% solid necrosis. Radiographic WON resolution was seen in 97.5% (95% CI, 86.8%, 99.9%) by 60 days, without recurrence in 34 patients with 6-month follow-up data. Mean time to radiographic WON resolution was 34.1 ± 16.8 days. SAEs occurred in 3 patients (7.5%), including sepsis, vancomycin-resistant enterococcal bacteremia and shock, and upper gastrointestinal bleeding. There were no procedure-related deaths.EUS-guided drainage with protocolized endoscopic necrosectomy to treat large symptomatic or infected walled-off necrotic pancreatic collections was highly effective and safe. Clinicaltrials.gov no: NCT03525808.

Although most jurisdictions allow stereoscopically deficient and monocular individuals to drive, studies regarding these visual components' effects on driving have to date yielded contradicting results. Interviews, record reviews, and experiments have been used to unmask these effects. In interviews, participants with amblyopia reported several difficulties operating automobiles. Record reviews yielded mixed results, with studies revealing an increased crash rate and/or severity in a group of stereoscopically deficient commercial drivers, whereas studies of non-commercial drivers failed to make that association. Furthermore, experimental studies showed that individuals with reduced stereopsis braked earlier and were less likely to crash. With regard to monocularity, real-life experiments failed to demonstrate a poorer driving performance and simulation studies showed that drivers with sudden monocularity were more likely to crash and drive off the road. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):6–12.]

Endoscopic ultrasound has evolved over the last decade from a purely diagnostic procedure into one with a rapidly growing list of therapeutic applications. One such evolution is the emergence of EUS-guided liver biopsy, which is currently considered a very safe and effective alternative to the traditional percutaneous and transjugular liver sampling techniques. EUS-guided liver biopsies allow for acquisition of liver tissue for a wide variety of indications and could have a dramatic impact on the management of patients with acute and chronic liver disorders. EUS-guided liver biopsy offers several advantages over the current standard of care techniques and appears to be associated with fewer contraindications and adverse events. There is a growing body of literature endorsing its efficacy by demonstrating comparable diagnostic yield to the percutaneous and transjugular methods. Improving diagnostic yield of EUS-guided liver biopsies remains a priority and hence, over the last decade, several needle types with enhanced tip designs have been introduced, and various tissue acquisition methods have been explored and modified to enhance the integrity of the liver specimen. This review covers the body of data on the efficacy and safety of EUS-guided liver biopsies. We closely examine the existing data on the diagnostic yield of the various needle types, tip designs and tissue acquisition techniques, and discuss proposals to enhance the adoption of EUS-guided liver biopsy across healthcare institutions.

BACKGROUND Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a lethal congenital disorder characterized by a large, non-obstructed bladder, microcolon, and lack of proper peristalsis. MATERIALS AND METHODS Five cases of MMIHS were identified, confirmed histologically and were predominantly female (F:M, 4:1). DNA sequencing was also performed. RESULTS Four cases showed mutations in the α3 and β4 nicotinic acetylcholine receptor (ηAChR) subunits (CHRNA3 and CHRNB4, respectively) on chromosome 15q24. The 5th case had a delayed clinical presentation of intussusception at 11 months and showed a novel missense mutation in ATP2B4 on Chromosome 1q32. CONCLUSION The first four patients showed a previously identified mutation. The 5th patient shows a novel mutation in ATP2B4. This novel gene was associated with a less severe presentation and increases success of multiorgan transplant than the other four patients. This highlights how identifying various mutations may impact prognosis and clinical treatment plans for MMIHS patients.

Disorders of fluid balance and electrolyte homeostasis are commonly observed in critically ill patients and in those who require emergency anaesthesia. Consequently, anaesthetists and intensive care physicians must understand the physiological principles that govern fluid balance. This article discusses the compartmentalization of total body water and describes methods by which the volume of the fluid compartments may be measured. The novel concept of the endothelial glycocalyx is discussed in addition to the conventional and contemporary models of capillary filtration dynamics. The core elements of fluid balance and cardiovascular homeostasis are also explored.

Overexpression and activation of matrix metalloproteinase-13 (MMP-13) within atheroma increases susceptibility to plaque rupture, a major cause of severe cardiovascular complications. In comparison to pan-MMP targeting [18F]BR-351, we evaluated the potential for [18F]FMBP, a selective PET radiotracer for MMP-13, to detect extracellular matrix (ECM) remodeling in vascular plaques possessing markers of inflammation. [18F]FMBP and [18F]BR-351 were initially assessed in vitro by incubation with en face aortae from 8 month-old atherogenic ApoE−/− mice. Ex vivo biodistributions, plasma metabolite analyses, and ex vivo autoradiography were analogously performed 30 min after intravenous radiotracer administration in age-matched C57Bl/6 and ApoE−/− mice under baseline or homologous blocking conditions. En face aortae were subsequently stained with Oil Red O (ORO), sectioned, and subject to immunofluorescence staining for Mac-2 and MMP-13. High-resolution autoradiographic image analysis demonstrated target specificity and regional concordance to lipid-rich lesions. Biodistribution studies revealed hepatobiliary excretion, low accumulation of radioactivity in non-excretory organs, and few differences between strains and conditions in non-target organs. Plasma metabolite analyses uncovered that [18F]FMBP exhibited excellent in vivo stability (≥74% intact) while [18F]BR-351 was extensively metabolized (≤37% intact). Ex vivo autoradiography and histology of en face aortae revealed that [18F]FMBP, relative to [18F]BR-351, exhibited 2.9-fold greater lesion uptake, substantial specific binding (68%), and improved sensitivity to atherosclerotic tissue (2.9-fold vs 2.1-fold). Immunofluorescent staining of aortic en face cross sections demonstrated elevated Mac-2 and MMP-13-positive areas within atherosclerotic lesions identified by [18F]FMBP ex vivo autoradiography. While both radiotracers successfully identified atherosclerotic plaques, [18F]FMBP showed superior specificity and sensitivity for lesions possessing features of destructive plaque remodeling. The detection of ECM remodeling by selective targeting of MMP-13 may enable characterization of high-risk atherosclerosis featuring elevated collagenase activity.

Objectives Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality. Methods In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia. Results Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628–0.807, p < 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≥ 7 versus vldCTs < 7: (98 [85.2%] vs 49 [51.6%]; p < 0.001 and 36 [37.9%] vs 12 [12.4%]; p < 0.001, respectively. The 30-day mortality increased if vldCTs ≥ 7 (HR, 3.16 (1.50–6.43); p = 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission. Conclusions By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30-day mortality independent of conventional risk factors of the disease. Key Points • In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission. • This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07938-2.

Background Subsequent epidemic waves have already emerged in many countries and in the absence of highly effective preventive and curative options, the role of patient characteristics on the development of outcomes needs to be thoroughly examined, especially in middle-east countries where such epidemiological studies are lacking. There is a huge pressure on the hospital services and in particular, on the Intensive Care Units (ICU). Describing the need for critical care as well as the chance of being discharged from hospital according to patient characteristics, is essential for a more efficient hospital management. The objective of this study is to describe the probabilities of admission to the ICU and the probabilities of hospital discharge among positive COVID-19 patients according to demographics and comorbidities recorded at hospital admission. Methods A prospective cohort study of all patients with COVID-19 found in the Electronic Medical Records of Jaber Al-Ahmad Al-Sabah Hospital in Kuwait was conducted. The study included 3995 individuals (symptomatic and asymptomatic) of all ages who tested positive from February 24th to May 27th, 2020, out of which 315 were treated in the ICU and 3619 were discharged including those who were transferred to a different healthcare unit without having previously entered the ICU. A competing risk analysis considering two events, namely, ICU admission and hospital discharge using flexible hazard models was performed to describe the association between event-specific probabilities and patient characteristics. Results Results showed that being male, increasing age and comorbidities such as chronic kidney disease (CKD), asthma or chronic obstructive pulmonary disease and weakened immune system increased the risk of ICU admission within 10 days of entering the hospital. CKD and weakened immune system decreased the probabilities of discharge in both females and males however, the age-related pattern differed by gender. Diabetes, which was the most prevalent comorbid condition, had only a moderate impact on both probabilities (18% overall) in contrast to CKD which had the largest effect, but presented only in 7% of those admitted to ICU and in 1% of those who got discharged. For instance, within 5 days a 50-year-old male had 19% (95% C.I.: [15,23]) probability of entering the ICU if he had none of these comorbidities, yet this risk jumped to 31% (95% C.I.: [20,46]) if he had also CKD, and to 27% in the presence of asthma/COPD (95% C.I.: [19,36]) or of weakened immune system (95% C.I.: [16,42]). Conclusions This study provides useful insight in describing the probabilities of ICU admission and hospital discharge according to age, gender, and comorbidities among confirmed COVID-19 cases in Kuwait. A web-tool is also provided to allow the user to estimate these probabilities for any combination of these covariates. These probabilities enable deeper understanding of the hospital demand according to patient characteristics which is essential to hospital management and useful for developing a vaccination strategy.

Background: Loss of mismatch repair (MMR) occurs frequently in endometrial carcinoma (EC) and is an important prognostic marker. However, the frequency of MMR deficiency (D-MMR) in EC remains inconclusive. This systematic review and meta-analysis addressed this inconsistency and evaluated related clinicopathology. Materials and Methods: Electronic databases were searched for articles: PubMed, Science Direct, Web of Science, EMBASE, and the Wiley Online Library. Data were extracted from 25 EC studies of D-MMR to generate a clinical dataset of 7,459 patients. A random-effects model produced pooled estimates of D-MMR EC frequency with 95% confidence interval (CI) for meta-analysis. Results: The overall pooled proportion of D-MMR was 24.477% (95% CI, 21.022 to 28.106) in EC. The Lynch syndrome subgroup had 22.907% pooled D-MMR (95% CI, 14.852 to 32.116). D-MMR was highest in type I EC (25.810) (95% CI, 22.503 to 29.261) compared to type II (13.736) (95% CI, 8.392 to 20.144). Pooled D-MMR was highest at EC stage and grades I-II (79.430% and 65.718%, respectively) and lowest in stages III-IV and grade III (20.168% and 21.529%). The pooled odd ratios comparing D-MMR to proficient MMR favored low-stage EC disease (1.565; 0.894 to 2.740), lymphovascular invasion (1.765; 1.293 to 2.409), and myometrial invasion >50% (1.271; 0.871 to 1.853). Conclusion: Almost one-quarter of EC patients present with D-MMR tumors. The majority has less aggressive endometrioid histology. D-MMR presents at lower tumor stages compared to MMR-proficient cases in EC. However other metastatic parameters are comparatively higher in the D-MMR disease setting.

Background ABO blood groups have been linked to susceptibility to infection with certain microorganisms, including coronaviruses. We examined the relationship between blood group and clinical outcomes in individuals infected with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and compared their blood group distribution with the general population. Methods At the inception of the pandemic, all individuals testing positive for SARS‐CoV‐2 in Kuwait were admitted to one designated coronavirus disease 2019 (COVID‐19) hospital and enrolled in a prospective registry. Patients admitted from February 24 to May 27, 2020, were stratified according to blood group. As a control, blood groups of 3,730,027 anonymized individuals representing almost Kuwait's entire population were obtained from a national database. Results Of 3305 SARS‐CoV‐2–positive patients, 37.1%, 25.5%, 28.9%, and 8.5% were groups O, A, B, and AB, respectively. Univariate analysis revealed no significant differences in severe clinical outcomes or death among the blood groups. However, multivariable analysis demonstrated that group A individuals had higher odds of developing pneumonia compared with non–group A (adjusted odds ratio 1.32, 95% confidence interval 1.02–1.72, p

This review aims to explore the burden of hypertension among refugees in the Middle East by reporting its prevalence, risk factors and access to care. A comprehensive literature search was performed using Web of Science, Ovid MEDLINE, PubMed, SCOPUS, CINHAL+, WHO Regional Office for the Eastern Mediterranean (EMRO) and United Nations High Commissioner for Refugees (UNHCR) on articles spanning from 1948 until 2020. Most studies were cross-sectional in design. After applying eligibility criteria 17 articles and 4 reports were included. Findings showed that hypertension represents a major burden among refugees. Hypertension risk factors present among the refugee population included increased salt intake, physical inactivity, and smoking. The majority of hypertensive refugees sought care for their condition at the public health care services. Barriers to seeking care included high cost of healthcare, accessibility to provided services, and lack of knowledge for the need to seek care. Non-adherence to medication among refugees was primarily linked to cost and lack of symptoms. This review highlights the need for further studies to shed light on the importance of targeting hypertension among refugees, to lower morbidity and mortality, in addition to providing adequate healthcare services to this population.

Purpose This study aims to investigate the influencers’ credibility dimensions (i.e. attractiveness, trustworthiness, expertise) on purchase intention (PI) through the mediating role of cognitive and affective online engagement among the aesthetic dermatology consumers in Jordan. Design/methodology/approach The population of this study entails all followers of aesthetic dermatology clinics on their Instagram accounts. However, only three influencers from the aesthetic dermatology industry were selected and approved the request of sharing the survey instrument on their official platforms. Overall, 600 surveys were distributed, but only 384 were completed fully, constituting a 64% response rate. Findings The data analysis revealed an excellent fit for the data and indicated an impact of attractiveness and expertise on online engagement and PI. Moreover, a mediating influence was also found for online engagement on the path between influencer credibility and PI. Research limitations/implications This study has a limitation of collecting the data from only three influencers; consequently, collecting data from the followers of more than four influencers would get more generalizable results. Second, considering further, examining the mediating role of other variables such as electronic word-of-mouth (EWOM) and loyalty programs could also provide further insights onto the nature of the factors affecting the PI. In addition, future studies should examine the differences of using more than one social media platform. Practical implications The main findings of this study have a number of managerial implications for marketing management that hint at liking the influencers who are highly trusted owing to their extensive expertise in the area they are marketing rather than only depending on their physical attractiveness. The Jordanian culture does not focus only on the image shared by the social media as the reviews can either support or decline the influence of even the celebrity. Significantly, a set of managerial implications come from the current research. Social implications Two major areas are the most important; these are the trustworthy issue and the EWOM. The marketers should encourage their customers to openly talk about their experiences as they have an imperative role in liking influencers in a way that improves their PI. The second implication is related to social media platforms management that marketing managers should resolve any negative EWOM caused and to enhance followers’ satisfaction levels of the services. The increase in satisfaction positively affects PI, and the service makes the influencer role become more effective. Originality/value This study was able to add a value to the current understanding of the main antecedents of customer engagement by looking at these dimensions of perceived credibility. Another contribution was captured in this study by successfully validating the meditating impact of customer engagement between influencers’ credibility dimensions and PI, especially in the absence of the studies that have addressed such relationship.

Introduction: Diabetes mellitus (DM) is a common metabolic disorder and a leading cause of mortality and morbidity worldwide. Dentists are increasingly encountered with patients affected by this chronic condition. Aim: To a review on updates in DM, dental management and emergencies. Methods: Database search was carried out in PubMed and Google scholar limited to articles of English language from 1998 to 2021 and pertaining to the keywords diabetes, orofacial manifestations , dental management diabetic emergency. A narrative review of this search is presented in this article. Results and Discussion: This article gives a concise update on DM and discuss the management of diabetic patients in a dental setting. Conclusion: Discussion of the possible orofacial manifestations of DM and management of diabetic emergencies is emphasized for efficicient dental practice.

Introduction Laparoscopic Sleeve Gastrectomy (LSG) is one of the most prevalent approaches to tackle obesity and its co-morbidities. The main complication following the LSG is Gastro-esophageal reflux disease (GERD), with most patients developing worsening symptoms of GERD, and a small number progressing to Barrett's esophagus. This retrospective analysis aims to assess the rate of GERD pre- and post- LSG as well as the rate of progression to Barrett's. Methods Data was collected from 1639 patients. 92 patients fit our inclusion criteria. Data was then analyzed and summarized against similar literature. Results Of 64 (69.6%) patients who had normal EGD findings pre-LSG, only 28 patients (30.4%) had the same results 5 years post-LSG (p=, Highlights • The main complication post-LSG is Gastro-esophageal reflux disease (GERD), with some progressing to Barrett’s esophagus. • We assessed Esophagogastroduodenoscopy (EGD) results pre-LSG and 5 yrs post-op to determine the development of Barrett’s. • This paper and the included literature demonstrate that LSG does lead to the development of Barrett’s Esophagus. • Performing an EGD pre- and post-LSG is an important protocol that aids in the diagnosis and management of LSG related GERD.

Aims and objectives This study aimed at describing the characteristics and outcomes of pediatric glaucoma patients in a university hospital in Lebanon and comparing them between primary congenital glaucoma (PCG) and secondary glaucoma. Materials and methods Sixty-four eyes of 40 pediatric glaucoma patients with a follow-up of 1 year or more were reviewed. Parameters were studied for both PCG and secondary glaucoma groups. Three major outcomes were considered: intraocular pressure (IOP) control, final best-corrected visual acuity (BCVA), and the proportion of failed angle surgeries. Results Sixty-four eyes were included divided into 29 PCG and 35 secondary glaucoma eyes, followed up for a mean of 6.6 ± 4.7 years. Eyes with PCG presented earlier, with a higher initial IOP and underwent earlier surgery than their secondary glaucoma counterparts. Although 85.9% of all eyes achieved good IOP control, 44.4% of them had a BCVA ≥20/50 with PCG having a better visual prognosis. Secondary glaucoma eyes needed more medications at the end of their follow-up. In this group, it was shown that a later age at first surgery, unilateral disease, and multiple surgeries were associated with a BCVA < 20/50. Conclusion Patients with PCG presented earlier and with a higher IOP than secondary glaucoma; they were also operated on earlier. Both groups demonstrated good IOP control at the end of the follow-up period with PCG eyes having a superior visual outcome. Secondary glaucoma eyes required a higher number of medications at their final visit. In this population, multiple surgeries, unilateral disease, and a delayed first surgery conferred a poorer visual prognosis. Clinical significance Data regarding the characteristics of pediatric glaucoma, especially in the Middle East, are scarce. Our study sheds the light on the presentation of different types of pediatric glaucoma and their outcomes namely IOP control and visual acuity. How to cite this article Dakroub M, Khair D, Noureddine B, et al. Pediatric Glaucoma in a University Hospital. J Curr Glaucoma Pract 2021;15(1):8–13.

Clinical presentation of coronavirus disease‐2019 (COVID‐19) ranges from asymptomatic to severe and life‐threatening. National‐level registries found that children, generally, have less severe disease when compared with adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID‐19 patients in Kuwait, and to estimate the potential duration of viral shedding. A retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from February 29 to April 30, 2020. During the study period and as part of the public health measures, all severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients from 1 month to 18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed. We found that 67.9% (95% CI, 59.4%–75.3%) of 134 SARS‐CoV‐2‐infected children were asymptomatic. Median PCR positivity was 15 days and did not vary with symptoms. Among patients who had laboratory investigations and chest imaging, symptomatic infection was associated with elevated C‐reactive protein and procalcitonin, and radiographic pneumonia. Asymptomatic SARS‐CoV‐2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, regardless of symptoms.

Diabetes mellitus (DM) is one of the challenging health problems worldwide. Primary care centers manage and treat most of DM cases. Diabetes requires ongoing, and evidence-based health care which should be provided by highly qualified physicians.This study aims at evaluating the Family Medicine training efficacy on the quality of care for diabetic patients.This is a cross-sectional study conducted among patients with DM at the AlJafer training center situated in AlAhssa, Saudi Arabia. The data of diabetic patients who were followed up initially with general practitioners (GPs) and later with family physicians (FPs) collected from the patients' electronic files. Clinical parameters including HbA1c, blood pressure, total cholesterol, LDL, and statin, aspirin initiation measured during initial visits and follow-ups to compare the quality of diabetic care between the two groups (FPs vs. GPs). All statistical analyses carried using SPSS version 21.Eighty-three patients were included in the study. Regarding the measurement process, FPs more likely to measure HbA1c twice a year than GPs (P:0.001). The number of patients with HbA1c level8% decreased significantly during the period of follow-up with FPs (P:0.001). Furthermore, a significant number of patients meet the BP target ≤130/85 during the follow-up period with FPs. The statin initiation is substantially achieved more by FPs (P 0.001).Family medicine training has a significant influence on the clinical outcomes of patients with DM. This study's findings suggest that FPs ensure a better quality of care in terms of clinical and process measures.

Background Endometrial carcinoma (EC) is classified into four distinct molecular subgroups including ultramutated DNA polymerase epsilon (POLE). POLE-mutated tumors have the best prognosis and are a promising target for immunotherapy. This meta-analysis consolidated the reported variation of POLE-mutant frequency and assessed prognostic value in EC. Methods Internet searches explored scientific data bases: EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials databases. Data was extracted from eligible studies including: sample size, number of positive POLE-mutant cases, sequencing information, clinicopathologic data, and survival data. Meta-analysis and a random-effects model produced pooled estimates of POLE frequency and prognostic parameters using 95% confidence intervals (CI), hazard ratios (HR), and odd ratios (OR). Results Six thousand three hundred and forty-six EC patient cases were pooled from 25 studies. The pooled proportion of POLE gene mutation in EC was 8.59% (95% CI, 7.01 to 10.32), of which 8.22% (95% CI, 6.27 to 10.42) were type I and 0.93% (95% CI, 0.34 to 1.81) type 2. Clinicopathologic data showed that POLE-mutated tumors are mostly endometrioid. They present at higher levels in earlier stages (I-II) of EC (89.51%; 95% CI, 81.11 to 95.66) at the highest grade III (51.53%; 95% CI, 36.08 to 66.84) with reduced myometrial invasion (OR, 1.48, 95% CI, 0.99 to 2.20). Survival analysis indicated favorable overall survival (HR, 0.90), disease-specific survival (HR, 0.41), and progression-free survival (HR, 0.23) for POLE mutant EC. Conclusions Almost one-tenth of EC patients have POLE-mutated tumors. Given their improved prognostic potential, identifying the POLE mutation status is key for the management of EC patients.

Background Pancreatic mass sampling has historically been performed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, its sensitivity has been reported to be within a wide range, which limits its reliability. Fine needle biopsy (FNB) has been shown to have superior diagnostic performance and is increasingly replacing fine needle aspiration. In FNA, 25 gauge (G) needles appear to outperform 22G. Data comparing these sizes in FNB platforms is limited. We aimed to prospectively compare the performance of 22G and 25G Franseen-tip core biopsy needles in the sampling of solid pancreatic lesions. Patients and methods Patients who underwent EUS-FNB of pancreatic lesions at the Indiana University Hospital using 2 needle sizes: 25G (Study group) and 22G (Control group) using the Acquire needle (Boston Scientific Co., Natick, MA, USA) were enrolled. Needle choice was left to the discretion of the endosonographer. Tissue specimens were evaluated onsite, and underwent touch and smear and cellblock preparation. Specimens were independently evaluated by 2 expert cytopathologists blinded to diagnosis. Cytopathologists assessed cytological yield (on smears) and histological yield (on cellblock) using a validated scoring system reached by a consensus among our cytopathologists as we have previously published. Results A total of 75 patients (42 males, median=65 years) underwent EUS-FNB during the study period (2017-2018): 50 using 25G and 25 using 22G needle. Diagnostic yield was numerically higher in 25G (98% vs. 88%, p=0.105). Number of passes for smears were similar, however the 25G group required additional passes for cell-block (1.6 vs. 0.4, p=0.001). 25G was used more frequently for pancreatic head and uncinate process sampling (70% vs. 52%, p=0.126). Four patients had self-limited adverse events in the 22G group, but none in the 25G group. Conclusion We report no difference in the diagnostic yield between 25G FNB vs. 22G sampling device with Franseen style tip, however, the 25G needle use was associated with the need of additional passes to collect a sufficient cell block.

Background Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. Methods This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. Results 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. Conclusions The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.

Background Secretin-induced duodenal aspiration (SIDA) of pancreatic duct fluid has been proposed for pancreatic neoplasm screening in very high-risk patients. We sought to determine the clinical yield and safety of commercially-analyzed SIDA samples in patients at moderately elevated risk. Patients and methods A prospectively maintained institutional database of pancreatic fluid DNA profiles was retrospectively reviewed. Results Fifty-seven patients underwent SIDA testing, most commonly for intraductal papillary mucinous neoplasms (n=43) and not otherwise specified solitary cysts (n=9). SIDA mutation yield was low compared to 37 concomitant endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of pancreatic fluid: KRAS (2.5% vs. 40.0%), GNAS (2.6% vs. 11.1%) and allelic loss of heterozygosity (3.1% vs. 0%). Patients undergoing SIDA alone experienced no complications while 3 patients with concomitant EUS-FNA had post-procedural pancreatitis. Conclusion The genetic yield of commercially-analyzed SIDA samples was relatively low in a moderately elevated risk cohort. SIDA testing may have a better safety profile than EUS-FNA.

Objectives The yield of genetic testing of main pancreatic duct (MPD) fluid collected during endoscopic retrograde cholangiopancreatography (ERCP) versus endoscopic ultrasound-guided fine-needle aspiration is unclear. Methods Consecutive MPD fluid samples obtained by endoscopic ultrasound/ERCP with DNA profiling were reviewed, excluding specimens designated "no amplification." Invasive disease included invasive cancer or malignant cytology. Results One hundred ten samples from 109 patients who underwent ERCP (n = 32) or endoscopic ultrasound-guided fine-needle aspiration (n = 78) were analyzed (2007-2018). Leading indications were dilated MPD and suspected intraductal papillary mucinous neoplasm. Elevated DNA quantity, KRAS, loss of heterozygosity (LOH), and GNAS mutations occurred in 61.5%, 25.5%, 16.4%, and 8.7% of samples, respectively. Elevated DNA quantity occurred more frequently in ERCP samples (84.4% vs 51.9%, P = 0.002); other mutation yields were similar (P > 0.05). Invasive pathology (P = 0.032) was associated with LOH in the subset of patients who underwent surgery (n = 44). Adverse events occurred more frequently after ERCP (28.1% vs 9.0%, P = 0.016). Conclusions Endoscopic MPD fluid sampling may yield genetic data to improve diagnosis and risk stratification. In our surgical cohort, LOH was the sole predictor of invasive pathology. Endoscopic ultrasound-guided fine-needle aspiration of MPD fluid, when possible, is preferred because of superior safety profile.

Cranial fasciitis is an uncommon benign fibroblastic tumor, generally histologically identical to nodular fasciitis. It develops almost exclusively in children. Cranial fasciitis manifests clinically as a painless rapidly growing solitary nodule in the head and neck area, frequently eroding the underlying bone. Thus, this entity is often confused with aggressive lesions such as sarcomas, both clinically and radiologically. Histopathologic examination is essential to differentiate between cranial fasciitis and fibrohistiocytic or even sarcomatous lesions observed in children. In this article, we present a case of cranial fasciitis with intracranial extension in a 2-year-old boy. Although USP6 rearrangement has recently been recognized as a recurring alteration in nodular fasciitis, we present a novel COL1A1-CAMTA1 fusion in this lesion.

Data on comparative efficacy of various available endoscopic ultrasound-guided liver biopsy (EUS-LB) needles are limited. We sought to compare the performance of a novel Franseen-tip 22G fine-needle biopsy (FNB) device to that of 19G needle platforms for liver parenchyma. Consecutive patients referred for EUS and suspected to have hepatic parenchymal disease underwent EUS-LB using different EUS needles and were included in this retrospective study. Two blinded expert liver pathologists independently reviewed and reported on: total number of tissue fragments, length of longest fragment, number of complete and incomplete portal tracts (CPT and IPT), and specimen adequacy. A 22G Franseen-tip needle (A) was used in 30 patients; 19G Tru-Cut needle (B) in 50 patients; 19G reverse beveled non-Tru-Cut needle (C) in 27 patients; and a 19G flexible non-Tru-Cut needle (D) in 28 patients. In the order of needles, A, B, C and D, > 10 tissue fragments were obtained in 100%, 6%, 82%, and 96% samples, the mean number of CPTs was 6.9; 3.0; 7.3; and 16.9, length of longest fragment was 3.8, 4. 7, 3.9, and 8.4 mm, and specimen adequacy was 66.7%, 46%, 82.1%, and 81.5%, respectively. A positive correlation was obtained between number of CPTs and length of longest fragment in samples accrued by 19G needles. EUS-LB specimens using 22G Franseen-tip needle appear highly fragmented, leading to inferior specimen adequacy compared to 19G non-Tru-Cut needles. We also report on using length of longest fragment as an additional criterion for specimen adequacy as it positively correlates with number of CPTs standard.

Owing to increased detection rates, the diagnosis and management of incidental pancreatic cysts has become a common predicament. Up to 13% of patients undergoing cross-sectional imaging studies for other indications are found to have pancreatic cystic lesions. Although most cystic lesions are benign, the malignant potential of several types of pancreatic cysts makes accurate classification vital to directing therapy. To this end, advances in the last decade led to better characterization of pancreatic cyst morphology and hence enhanced the ability to predict underlying histopathology, and biological behavior. Although accurate classification remains a challenge, the utilization of complementary diagnostic tools is the optimal approach to dictate management. The following review includes a description of pancreatic cysts, a critical review of current and emerging diagnostic techniques and a review of recent guidelines in the management of incidental pancreatic cysts.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic weight loss procedure used to treat obesity. The long-term goal of this project is to develop a Virtual Bariatric Endoscopy (ViBE) simulator for training and assessment of the ESG procedure. The objectives of this current work are to: (a) perform a task analysis of ESG and (b) create metrics to be validated in the created simulator. METHODS: We performed a hierarchical task analysis (HTA) by identifying the significant tasks of the ESG procedure. We created the HTA to show the breakdown and connection of the tasks of the procedure. Utilizing the HTA and input from ESG experts, performance metrics were derived for objective measurement of the ESG procedure. Three blinded video raters analyzed seven recorded ESG procedures according to the proposed performance metrics. RESULTS: Based on the seven videos, there was a positive correlation between total task times and total performance scores (R = 0.886, P = 0.008). Endoscopists expert were found to be more skilled in reducing the area of the stomach compared to endoscopists novice (34.6% reduction versus 9.4% reduction, P = 0.01). The mean novice performance score was significantly lower than the mean expert performance score (34.7 vs. 23.8, P = 0.047). The inter-rater reliability test showed a perfect agreement among three raters for all tasks except for the suturing task. The suturing task had a significant agreement (Inter-rater Correlation = 0.84, Cronbach’s alpha = 0.88). Suturing was determined to be a critical task that is positively correlated with the total score (R = 0.962, P = 0.0005). CONCLUSION: The task analysis and metrics development are critical for the development of the ViBE simulator. This preliminary assessment demonstrates that the performance metrics provide an accurate assessment of the endoscopist’s performance. Further validation testing and refinement of the performance metrics are anticipated.

Background and study aims The aim of this study was to evaluate whether timed barium esophagram within 24 hours post-per-oral endoscopic myotomy (POEM) (TBE-PP) could predict clinical outcomes. Patients and methods This was a single-center retrospective study of prospectively collected data on consecutive patients with ≥ 6-month follow-up who underwent POEM followed by TBE-PP. Esophageal contrast retention 2 minutes after TBE-PP was assessed as Grade 1 ( 90 %). Eckardt score, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM) and function lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) were obtained at baseline. These tests along with pH testing of antisecretory therapy were repeated 6 and 24 months after POEM. Clinical response by Eckardt score ≤ 3, EGJ-distensibility index (EGJ-DI) > 2.8 mm2/mm Hg, and integrated relaxation pressure (IRP) Results Of 181 patients (58 % male, mean 53 ± 17 yr), TBE-PP was classified as Grade 1 in 122 (67.4 %), Grade 2 in 41 (22.7 %), Grade 3 in 14 (7.7 %) and Grade 4 in 4 (2.2 %). At 6 months, overall clinical response by ES (91.7 %), IRP (86.6 %), EGJ-DI (95.7 %) and the diagnosis of GERD (68.6 %) was similar between Grade 1 and Grade 2–4 TBE-PP. At 24 months, Grade 1 had a higher frequency of a normal IRP compared to Grades 2–4 (95.7 % vs. 60 %, P = 0.021) but overall response by ES (91.2 %), EGJ-DI (92.3 %) and the diagnosis of GERD (74.3 %) were similar. Conclusions Contrast emptying rate by esophagram after POEM has limited utility to predict clinical response or risk of post-procedure GERD.

The authors describe a method to improve teaching the most critical step in strabismus surgery, the scleral pass. The attending surgeon fashions a “scleral tunnel” by performing the scleral pass and retracting the needle so the resident can pass it through the same tunnel. This ultimately helps decrease complications during surgical training. [ J Pediatr Ophthalmol Strabismus . 2021;58(5):e34–e35.]

Objectives Select patients with anatomically favorable walled off pancreatic necrosis may be treated by endoscopic (Endo-TGD) or operative (OR-TGD) transgastric debridement. We compared our experience with these two approaches. Summary background data Select necrotizing pancreatitis (NP) patients are suitable for transgastric debridement which may be accomplished endoscopically or surgically. Limited experience exists contrasting these techniques exists. Methods Patients undergoing Endo-TGD and OR-TGD at a single, high-volume pancreatic center between 2008-2019 were identified from a prospective database. Patient characteristics, procedural details, and outcomes of these two groups were compared. Results Among 498 NP patients undergoing necrosis intervention, 160 (32%) had TGD: 59 Endo-TGD and 101 OR-TGD. The groups were statistically similar in age, comorbidity, pancreatitis etiology, necrosis anatomy, pancreatitis severity, and timing of TGD from pancreatitis insult. OR-TGD required 1.1 ± 0.5 and Endo-TGD 3.0 ± 2.0 debridements/patient. Fewer hospital readmissions and repeat necrosis interventions, and shorter total inpatient length of stay were observed in OR-TGD patients. New onset organ failure [Endo-TGD (13%); OR-TGD (13%); P = 1.0] was similar between groups. Hospital length of stay after TGD was significantly longer in patients undergoing Endo-TGD (13.8 ± 20.8 days) compared to OR-TGD (9.4 ± 6.1 days; P = 0.047). Mortality was 7% in Endo-TGD and 1% in OR-TGD (P = 0.04). Conclusions Operative and endoscopic transgastric debridement achieve necrosis resolution with different temporal and procedural profiles. Clear multidisciplinary communication is essential to determine appropriate approach to individual necrotizing pancreatitis patients.

Laparoscopic sleeve gastrectomy (LSG) has become the most performed bariatric procedure as of 2015. However, inadequate weight loss may present the need for revisional procedures. The objective of this study was to analyze the efficacy of single-anastomosis gastric bypass (SAGB) in attaining successful weight loss following an initial LSG. A retrospective analysis was performed on all patients who underwent LSG at Amiri Hospital, Kuwait from 2008 to 2017. A list was obtained of those who underwent revisional SAGB surgery after initial LSG, and their demographics were analyzed. A total of 31 patients underwent revisional SAGB bariatric surgery after initial LSG, of which 87.1% were female. Prior to LSG, the mean weight of the patients was 127.5 kg and the mean BMI was 49.0 kg/m2. The mean weight loss after initial LSG was 43.8 kg, while the average duration until patients underwent revisional SAGB was 5.1 years. The cause for revision was weight regain (86.2%), inadequate weight loss (10.3%), or the development of a complication (reflux) (6.5%). Prior to undergoing revisional SAGB, the weight and BMI of the patients were 110.9 kg and 42.6 kg/m2, respectively. This demonstrated a %excess weight loss of 14.5, 31.9, 48.0, and 58.9% 2 weeks, 3 months, 6 months, and 1-year post-SAGB, respectively. Three (10.3%) morbidities were reported and thereafter successfully resolved. Revisional SAGB bariatric surgery is a safe and effective method in the short-term basis for the management of inadequate primary LSG.

Introduction The Orbera365 is a new balloon that can stay in the stomach for up to 12 months. The aim of this study is to investigate the safety and effect of Orbera365. Method Prospective study on our initial experience with a consecutive group of patients who underwent the insertion of Orbera365 in the period between September 2019 and August 2020. The patients were followed up to assess, pain, nausea, and vomiting after procedure, weight loss, and the complication rate. Results A total of 97 patients underwent Orbera365 placement. Mean weight and BMI before the procedure were 93.8 ± 15.2 kg and 35.2 ± 4.4 kg/m2, respectively, which dropped to 80.6 ± 13.1 kg and 29.8 ± 4.0 kg/m2 by 8.2 months and were 82.4 ± 16.1 and 30.4 ± 4.6 at the last day of follow-up of 12.9 months. Fourteen patients did not tolerate the balloon, and had to have it removed, six of them in the first week, and eight within the first 8 months of insertion. Other than intolerance, two patients had balloon rupture, three patients had leakage at time of insertion requiring balloon replacement, two patient had pancreatitis, one patient had spontaneous balloon hyperinflation, and one patient had balloon deflation and vomited the balloon. At day of last follow-up, total body weight loss % (TBWL%) was 16.2 ± 10.1 and %EWL was 54.6 ± 38.3. Conclusion Orbera365 is safe and effective for weight loss. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05729-8.

Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections. This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis. Subjects and Methods: Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire. Results: A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5 %, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively). Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age. Peer Review History: Received: 3 May 2021; Revised: 23 June; Accepted: 30 June, Available online: 15 July 2021 Academic Editor: Dr. Ali Abdullah Al-yahawi, Al-Razi university, Department of Pharmacy, Yemen, alyahawipharm@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Dr. Michael Otakhor Erhunmwunse, St. Philomena Catholic Hospital, Nigeria,dedoctor4life@yahoo.com Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, edress2020@gmail.com Similar Articles: VULVOVAGINAL CANDIDIASIS PREVALENCE AMONG PREGNANT WOMEN IN DIFFERENT HOSPITALS IN IBB, YEMEN PREVALENCE AND RISK FACTORS ASSOCIATED WITH VULVOVAGINAL CANDIDIASIS DURING PREGNANCY IN SANA'A, YEMEN

Purpose The aim of our study was to determine the prevalence of amblyopia risk factors in children visiting the American University of Beirut Medical Center (AUBMC) using automated vision screening. Methods This was a hospital-based screening of 1102 children aged between 2 and 6 years. Vision screening was performed using PlusoptiX S12 over 2 years (2018–2020). The need for referral to a pediatric ophthalmologist was based on the amblyopia risk factors set forth by the American Association for Pediatric Ophthalmology and Strabismus. Referred patients underwent a comprehensive eye examination. Results A total of 1102 children were screened, 63 were referred for amblyopia risk factors (5.7%); 37/63 (59%) underwent comprehensive eye examination and 73% were prescribed glasses. Of the non-referred group of children, 6.35% had astigmatism, 6.25% were hyperopic and 3.27% were myopic. The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. Refractive amblyopia risk factors were associated with the presence of systemic disorders. Bland-Altman plots showed most of the differences to be within limits of agreement. Conclusion Using an automated vision screener in a hospital-based cohort of children aged 2 to 6 years, the rate of refractive amblyopia risk factors was 5.7%. Hyperopia was the most commonly encountered refractive error and children with systemic disorders were at higher risk.

It was highlighted that in the original article [1] the Additional file 1 was missing. This Correction article includes the Additional file 1. The original article has been updated.

To evaluate the medical literature on the use of β-blockers, through different routes, for the treatment of periorbital infantile hemangiomas and to summarize the recommendations available on dosage and monitoring.β-blockers for the treatment of infantile hemangioma are now considered to be first-line treatment. Growing literature on the role of oral propranolol confirmed its efficacy but also presented its multiple side-effects including hypotension, bradycardia, hypoglycemia, and bronchospasm. No universal guidelines exist concerning pretreatment evaluation, dosage, monitoring, and duration of treatment but different protocols have been created.In the aim of minimizing side-effects, other routes of administration and more selective β-blockers have emerged. Many studies showed promising results for topical timolol especially in the treatment of superficial hemangiomas. Few studies evaluated intralesional propranolol. Limited data exist on the use of more selective β-blockers promising similar results to propranolol with fewer side-effects.Oral β-blockers are now the mainstay of treatment for periorbital hemangiomas but still with no consensus on their administration and monitoring. The topical form or more selective β-blockers may be the solution to minimize side-effects.

Background For pancreatic cysts with negative cytology, Integrated Molecular Pathology (IMP) is a malignancy risk score integrating clinical criteria with pancreatic cyst fluid DNA profiling. Aside from main pancreatic duct (MPD) diameter, integrated clinical criteria are not International Consensus Guidelines High-Risk Stigmata. We predicted exclusion of clinical criteria except MPD diameter could simplify the IMP and better distinguish invasive/malignant disease. Methods Records of >1100 patients with IPMN were reviewed retrospectively. Sensitivity, specificity, and accuracy of conventional IMP for invasive / malignant disease was compared to DNA profile including only MPD ≥10mm (IMP-10.) Invasive outcomes were invasive-IPMN/adenocarcinoma on surgical pathology, pathologic or radiographic evidence of invasive/metastatic disease during surveillance. Malignant outcomes included high grade dysplastic IPMN (HGD-IPMN). Results 225 patients who met study criteria underwent 283 IMP evaluations: 98 followed by surgery, 185 followed by ≥ 23 months surveillance. IMP-10 had greater specificity (90.1% vs. 73.7%) and accuracy (89.8% vs. 74.2%) for invasive disease compared to IMP in surgery + surveillance patients, but lower sensitivity (77.8% vs. 88.9%). Trends were similar in surgery patients alone and malignant outcome analyses. Conclusion IMP-10 excludes less-reliable clinical factors resulting in greater accuracy in predicting invasive / malignant disease and fewer patients with benign disease being recommended for surgery.

BACKGROUND: Pilonidal disease (PNS) is a common inflammatory disease that can significantly impact the quality of life of the patient. Previous open techniques for the management of this condition have been unsatisfactory, with high recurrence rates reported. OBJECTIVE: Investigate a new endoscopic procedure for the management of PNS disease. DESIGN: Case series. SETTING: Single hospital in Kuwait. PATIENTS: From April 2014 to October 2017, patients with symptomatic chronic or recurrent PNS were consecutively enrolled to undergo the endoscopic pilonidal sinus treatment (EPSiT) procedure. MAIN OUTCOME MEASURES: Control of pain, wound complications, recurrence rate over a 6-month follow up. SAMPLE SIZE: 35 patients. RESULTS: The mean age of the patients was 22 years, with 33 (94%) males. Fourteen (40%) presented with recurrent disease and were recommended to undergo an EPSiT procedure. A single tract was used in 32 (91%) of the cases, with an average operative time of 51 mins. On follow-up 5 patients reported minimal pain judging by the need of only mild analgesics for the control of pain. No patient experienced early wound complications necessitating hospitalization. There were 2 (6%) recurrences encountered by the time of the 6-month follow-up period. CONCLUSION: In these early results, the EPSiT procedure provided effective healing with acceptable recurrence rates and aesthetics. In addition, the procedure allows the surgeon to see the PNS, fistula tracts or any abscess cavities. LIMITATIONS: Short follow-up period with a small number of patients CONFLICTS OF INTEREST: None.

Purposes: Iliac crest avulsion fracture is an unusual pathology. Final functional outcomes are generally excellent, though recurrent symptoms may delay the return to play. There is a lack of publis...

A dilated main pancreatic duct in the distal remnant after proximal pancreatectomy for intraductal papillary mucinous neoplasms (IPMN) poses a diagnostic dilemma. We sought to determine parameters predictive of remnant main-duct IPMN and malignancy during surveillance. Three hundred seventeen patients underwent proximal pancreatectomy for IPMN (Indiana University, 1991–2016). Main-duct dilation included those ≥ 5 mm or “dilated” on radiographic reports. Statistics compared groups using Student’s T/Mann-Whitney U tests for continuous variables or chi-square/Fisher’s exact test for categorical variables with P

Critical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standardized approaches which implement an effective ‘chain of response’ are now utilized worldwide. They focus on attempting to reduce the incidence of serious adverse events (SAEs) such as in-hospital cardiac arrest and unplanned intensive care unit (ICU) admission using preventative measures. These systems should include: accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, rapid bedside patient assessment by trained teams and appropriate interventions. Early warning systems (EWS) are an important part of this and can help identify patients at risk of deterioration and SAEs. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized approach between professionals. Lastly, timely support and input from members of the critical care team are vital to ensure optimal outcomes for critically ill patients.

Background: Trachoma is a communicable infection of the eye by certain strains of the Chlamydia trachomatis. It is the principal cause of loss of sight globally. Mass drug administration (MDA) with azithromycin is a foundation stone of World Health Organization (WHO)’s global struggle to eradicate trachoma by 2020. Aims: The main objectives of the campaign's third monitoring are to check improvement of interventions and improvement of quality across times and activities implemented in seven selected districts of Ibb and Al-Hodeida governorates, Yemen. Methods: A community based cross-sectional coverage survey was performed. 68 divisions were selected per selected districts of the two governorates. A disconnect Results Entry Form for each district surveyed was finished, saved and uploaded directly into the online Coverage Survey Analysis Tool to check improvement of interventions and improvement of quality across times and activities implemented. Results: The national campaign for MDA covers 966 villages in 6 districts of Ibb and Al-Hodeidah governorates by 1932 healthcare workers. A total number of beneficiaries who were monitored from 476 homes reached 3,077, of whom 2,755 (90%, coverage rate) took the dose. The availability rates of trachoma medicines were ranged from 82% to 91% . The improper arrangement of treatment sessions rate was 17%, the incorrect position of the dose pole was 6%, while the correct records of drugs scored the rate of 99%, and the proper storage of drugs rate was 70%. The community collaboration during the treatment campaign the acceptable rate was 92%, while 3% exhibited unacceptable behaviors towards the treatment campaign. Conclusion: In this survey, the national campaign for MDA in the 966 villages reach the target threshold (i.e. 90%) for effective coverage; with proper rates for the availability of trachoma medicines, good people reactions towards taking treatment, and the community collaboration; while bad rates for the improper arrangement of treatment sessions , the incorrect position of the dose pole and the preparation dosages by MDA team. Hence, programmatic enhancement should be made for the future campaign to achieve the estimated thresholds. Peer Review History: Received 8 March 2021; Revised 29 March; Accepted 25 April, Available online 15 May 2021 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, drmmziqbal@gmail.com Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Similar Articles: BACTERIAL CAUSES AND ANTIMICROBIAL SENSITIVITY PATTERN OF EXTERNAL OCULAR INFECTIONS IN SELECTED OPHTHALMOLOGY CLINICS IN SANA’A CITY BACTERIAL CONJUNCTIVITIS OF ADULTS: CAUSES AND OPHTHALMIC ANTIBIOTIC RESISTANCE PATTERNS FOR THE COMMON BACTERIAL ISOLATES

Background Postoperative gastrointestinal symptoms are common in patients undergoing sleeve gastrectomy. This study is aimed to assess the effectiveness of omentopexy during laparoscopic sleeve gastrectomy in reducing gastrointestinal symptoms. Methods A retrospective analysis of patients who underwent laparoscopic sleeve gastrectomy with and without omentopexy in the period between January 2016 to September 2017. All procedures were performed by three surgeons utilizing the same surgical technique. Data extracted included patient socio-demographics’, preoperative body mass index (BMI), hospitalization period, treatments and post-operative gastrointestinal symptoms. It contained the GERD-Health Related Quality of Life Questionnaire (GERD-HRQL) measuring symptom severity in gastro esophageal reflux disease (GERD). Data were analyzed at 6, 12 and 18 months with reference to weight loss. Results A total of 140 patients were included in this study, 70 in each group arm. Age, preoperative BMI, pre-operative co-morbid conditions like hypertension, diabetes, and asthma were considered as confounding variables among the two groups. None of the previous factors were statistically significantly different among both groups. The outcomes of both groups were compared in terms of postoperative nausea, vomiting, regurgitation, intra-hospital stay, medication use, early return to work, and EWL%. None of the previous outcomes except for days of hospital stay and ondansetron use was found to be significantly different between both groups. Conclusion Omentopexy does not change the outcome for laparoscopic sleeve gastrectomy in terms of gastrointestinal symptoms or weight loss results., Highlights • Patients undergoing sleeve gastrectomy experience a significant amount of gastrointestinal symptoms postoperatively. • There are hypothesis that omentopexy reduces post-operative gastrointestinal symptoms. • Our study indicate that omentopexy during laparoscopic sleeve gastrectomy has no effect in terms of gastrointestinal symptoms or weight loss.

Medical students are an at-risk population to develop mental health disorders, especially students in Lebanon who are facing constant additional stress due to the volatile situation in the country. The present study used the APA’s DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult to screen for psychiatric symptoms in 12 different domains. Out of the sample of 364 students from all universities in Lebanon, only 5.2% had already a psychiatric diagnosis. Of the non-diagnosed subpopulation, a massive percentage of 92.75% screened positive and subsequently, were in need of further mental health evaluation. Roughly half of the participants described the existence of barriers for them to seek mental health services, finances and stigma being major reasons. Predictors of a more severe screen were being from a private university and previously being bullied. The situation in medical schools in Lebanon is profoundly alarming. Shouldn’t the health of future healthcare providers be a priority?

Objective: The purposes of this research were to establish cephalometric standards for Yemeni adults and to compare them with those of the Caucasians. Material and Methods: 100 Yemeni students (fifty males, mean age of 23.6 ± 2.1 years, and fifty female, mean age of 21.5 ± 3.1 years) with normal occlusions and wellbalanced faces were involved in the study. Inclusion criteria were a class I malocclusion with minor or no crowding, the whole teeth is present except third molars and no previous orthodontic, orthopedic or maxillofacial surgery treatment. Five angular and eighteen linear measurements were used for the skeletal, dental and soft tissue analysis. All participant’s lateral cephalometric radiographs were evaluated. The average values and standard deviations for all the angles and linear measurements were determined. The differences for each measurement between the Yemeni and Caucasian participants were calculated using unpaired t–tests. Results: Yemeni subjects had a more retrognathic mandibular positions (P< 0.05), protrusive mandibular incisors (P< 0.01), more protruded lip positions (P < 0.01), deeper mentolabial sulci (P< 0.01) and a steeper mandibular planes (P< 0.001) compared to the Caucasians. Yemeni females had a larger lower face height than Caucasian females (P< 0.001). Conclusions: The study provides specific standards for Yemeni adults and shows that the Yemenis had different skeletal and dentoalveolar cephalometric standards in comparison with Caucasians. Keywords Cephalometric comparison; Skeletal and dental features; Yemeni norms.

Background: Periodontitis is an inflammation caused by plaque in the surrounding dental structures. It is a major factor in adult tooth loss. There is lack of information on associated clinical features, risk factors and microbial etiology of periodontitis in Sana’a, Yemen. Aim: The study focused on associated clinical features, risk factors and the separation and classification of bacteria in periodontitis and associated risk factors amongst patients attending dental clinics is Sana’a city. Methods: First, 296 patients were admitted to the dental clinic at the Republican University Hospital and private dental clinics in Sana'a during a period of nearly one year, which began in December 2019 AD and ended in November 2020 AD, when they were diagnosed with dental diseases, then 49 of them were selected who are suffering from periodontitis, of whom 22 are males and 27 are females. Sterile paper points were used for the sample collection. Standard culture and biochemical techniques were used for the isolation and identification. Structured questionnaires were used to record clinical features, demographic variables and other risk factors of periodontitis. Results: A total of 130 microorganisms were isolated from 49 patients with periodontitis. Male patients accounted for 14.4% and females 18.9% of the all 296 patients who attended our clinics. There was no important association between sex and periodontitis occurrence while there was significant association the younger age groups (45.4% in

IntroductionA follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim to assess the feasibility, acceptability and early outcomes of a discharge and follow-up programme, called Hospital to Home (H2H), in a neonatal unit in central Uganda.Methods and analysisWe will use a mixed-methods study design comparing a historical cohort and an intervention cohort of newborns and their caregivers admitted to a neonatal unit in Uganda. The study design includes two main components. The first component includes qualitative interviews (n=60 or until reaching saturation) with caregivers, community health workers called Village Health Team (VHT) members and neonatal unit staff. The second component assesses and compares outcomes between a prospective intervention cohort (n=100, born between July 2019 and September 2019) and a historical cohort (n=100, born between July 2018 and September 2018) of infants. The historical cohort will receive standard care while the intervention cohort will receive standard care plus the H2H intervention. The H2H intervention comprises training for healthcare workers on lactation, breast feeding and neurodevelopmentally supportive care, including cue-based feeding, and training to caregivers on recognition of danger signs and care of their high-risk infants. Infants and their families receive home visits until 6 months of age, or longer if necessary, by specially trained VHTs. Quantitative data will be analysed using descriptive statistics and regression analysis. All results will be stratified by cohort group. Qualitative data will be analysed guided by Braun and Clarke’s thematic analysis technique.Ethics and disseminationThis study protocol was approved by the relevant Ugandan ethics committees. All participants will provide written informed consent. We will disseminate through peer-reviewed publications and key stakeholders and public engagement.Trial registration numberISRCTN51636372; Pre-result.

Background The development of barotrauma has been suggested to complicate the management of mechanically ventilated COVID-19 patients admitted to the intensive care unit (ICU). This study aims to identify potential risk factors associated with the development of barotrauma related complications in COVID-19 patients receiving mechanical ventilation. Methods A retrospective cohort study was carried out in a single COVID-19 designated center in Kuwait. Three hundred and forty-three confirmed COVID-19 patients transferred and/or admitted to our institution between February 26, 2020 and June 20, 2020 were included in the study. All patients were admitted into the ICU with the majority being mechanically ventilated (81.3%). Results Fifty-four (15.4%) patients developed barotrauma, of which 49 (90.7%) presented with pneumothorax, and 14.8% and 3.7% due to pneumomediastinum and pneumopericardium respectively. Of those that developed barotrauma, 52 (96.3%) patients were in acute respiratory distress syndrome (ARDS). Biochemically, the white blood cells (p = 0.001), neutrophil percentage (p = 0.012), lymphocyte percentage (p = 0.014), neutrophil: lymphocyte ratio (NLR) (p=

Endoscopic stenting is the standard of care for full thickness esophageal wall defects. The aim of this study is to evaluate outcomes of endoscopic closure of esophageal defects using stenting, with or without endoscopic suturing.This is a single-center retrospective study of patients with esophageal wall defects who underwent endoscopic interventions. Outcomes of stenting with or without endoscopic suturing of the defect were assessed. Univariate and multivariate logistic regression models were used to examine factors associated with successful defect closure.One hundred and fourteen patients with esophageal wall defects underwent 254 endoscopies with an overall complete closure rate of 75.8%. Twenty-three (20.2%) patients underwent primary closure using endoscopic suturing and subsequent esophageal stenting, while 91 (79.8%) underwent esophageal stenting only. The dual modality group (versus the stent-only group) had similar defect closure rates (84.2 vs. 73.8%, p = 0.55) and time to stent migration (37 vs. 12.5 days, p = 0.07), but was associated with longer procedure times (60 vs. 36 min, p 0.01) and fewer additional endoscopic procedures (13.6 vs. 43.2%, p = 0.01). Stent suturing significantly decreased migration (35.5 vs. 58.5%, p = 0.04), was associated with fewer additional endoscopies (15.4 vs. 50%, p 0.01) and reduced need for additional stents (7.7 vs. 34.3%, p 0.01). On multivariate analysis, chronic defects ( four weeks old) were 81% less likely to close compared to acute (≤ 4 weeks) defects (OR 0.19, CI 0.04-0.77, p = 0.02), and large diameter stents (23 mm) were associated with higher odds of defect closure (OR 3.36, CI 1.02-11.4, p = 0.04).Endoscopic treatment of esophageal wall defects is safe, effective, and more likely to be successful in acute defects using larger caliber stents. Stent suturing reduces migration, need for additional endoscopic procedures, and stent exchanges. Further comparative studies with larger cohorts are needed to validate our results.