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Background A stool color card has improved the prognosis of biliary atresia patients since it was first developed in Japan. This study investigated how Sudanese pediatric residents currently utilize stool color cards.Methods In January and February of 2022, 254 pediatric residents participated in this facility-based, cross-sectional study. The researchers developed a structured questionnaire, which was completed in Google form with a 100% response rate after it was pretested and validated. All the statistical analyses were performed with SPSS 25.0 (SPSS, Inc. Chicago, IL). The ethical committee of the Sudan Medical Specialization Board approved the study. All participants provided written informed consent.Results A total of 254 residents, ranging in age from 25 to 40 years, were enrolled in the study; 215 of whom were female (84.6%), and 39 were male (15.4%). Approximately 54.7% of the residents did not know about SCC. Of those who knew of SCC, 73% were proficient users. 71% of the participants properly identified the first three normal photographs of stool color out of the six photos in the SSC example. Nevertheless, only 13% of the participants correctly identified the final three abnormal images. The majority of residents (84.6%) were aware of when to send patients to gastroenterologists. At least one prereferral investigation was ordered by 83.8% of the residents.Conclusion The residents’ knowledge was unrelated to their practices. Educational interventions as well as practice protocols and guidelines are needed. More in-depth research with suitable designs and methodologies may offer additional clarity in the future.

Abstract The current study assessed the minimum inhibitory concentration (MIC) of Cowpea-legumin (CPL) against antibiotic-resistant foodborne pathogens (FBP), the consequences on Longissimus thoracis et lumborum (LTL) quality and shelf-life, and the growth curves of inoculated FBPs. Fresh LTL-steaks were enriched with either 0.5 mg/g (CPL0.5) or 1 mg/g (CPL1) and evaluated over 15 chilling-days at 4 °C. Antibiotic-resistant Salmonella enterica and Escherichia coli were inhibited by 25 and 3.125 mg/mL, respectively, while antibiotic-susceptible FBPs and antibiotic-resistant Staphylococcus aureus were suppressed by 0.1 mg/mL CPL. CPL1-fortification produced fully tender LTL that was initially yellower/less red than the control, then turned brighter red with storage. CPL demonstrated promising dose-dependent antioxidant, and antibacterial activities against native spoilage and antibiotic-resistant/susceptible FBPs. CPL’s proteinaceous composition, besides sample size, might impact stability. Conclusively, CPL demonstrated promising preservative stability in fresh meat for a maximum of fifteen-days and represents a viable antimicrobial alternative in battle against antibiotic-resistance.

Clinical research on the efficacy of nutraceutical compounds recommended for the relief of osteoarthritis (OA) symptoms has been largely disputed. In addition, no link has been established between its safety and efficacy in Kurdish population. The aim of this study is to determine the efficacy of New Zealand green-lipped mussel extract + Ginkgo biloba (GLME+) in patients with OA, and analyze the effect of GLME+ on inflammation. Methods: In an open-label, single-group allocation study, 40 patients diagnosed with knee OA were administrated 1000 mg/day of New Zealand green-lipped mussel extract and 100 mg/day of Ginkgo biloba for eight weeks. The outcome measure was scored using Western Ontario and McMaster Universities arthritis index (WOMAC). The serum concentration of inflammatory chemokine (CCL3) and myeloperoxidase (MPO) were measured. An intention-to-treat analysis was employed and subject data at T0 and T8 weeks. Results: Results showed a significant improvement in WOMAC score in post-treated OA patients with GLME+ (P 0.05). Conclusions: GLME+ improved knee joint pain, stiffness, and mobility in OA patients. Two of GLME+'s chondroprotective properties were the reduction of oxidative damage and the inhibition of inflammation, both of which have been linked to the etiology of OA cartilage destruction. The findings indicated that GLME+ may be useful in the treatment of OA patients.

Abstract Background Diabetes is a major public health problem in Qatar and is associated with an increased risk of depression. However, no study has been conducted in Qatar on the relationship between dietary patterns and depression symptoms in adults. The aim of this study was to assess the association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar. Methods A total of 1000 participants from the Qatar Biobank (QBB) were included in this cross-sectional study. Food intake was assessed using a computer-administered food frequency questionnaire (FFQ), and dietary patterns were identified using factor analysis. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Results Depression symptoms were present in 13.5% of the sample. Two dietary patterns were identified: “unhealthy” (high consumption of fast food, biryani, mixed dish (chicken/meat/fish), croissant) and “prudent” (high consumption of fresh fruit, salads/raw vegetables, canned/dried fruit, and dates). After adjusting for sociodemographic, lifestyle factors (smoking and physical activity), diabetes and medication use for diabetes and hypertension, a high intake of “unhealthy” pattern was associated with an increased prevalence of depressive symptoms in individuals with diabetes (prevalence ratio, PR = 1.41; 95% CI = 1.28, 1.56; p-value

Echinococcosis, alternatively referred to as hydatid disease, is caused by the larvae of the tapeworm Echinococcus. The primary agents of human infections are Echinococcus granulosus and Echinococcus multilocularis. The present case report pertains to an individual who relocated from an endemic region to the United Arab Emirates and subsequently manifested symptoms of hydropneumothorax. The 44-year-old male patient presented with a 4-day fever and right-sided chest pain, accompanied by cough and breathlessness for 2 weeks. Computed tomography (CT) of the chest revealed right hydropneumothorax and a ruptured hydatid cyst with consolidation. The patient was diagnosed with a ruptured pulmonary hydatid cyst based on a strongly positive hydatid serology and the presence of hydatid tissue on histopathological examination. The patient underwent surgical decortication with cyst removal and received medical treatment with ceftriaxone and albendazole. He was discharged in good condition after a 10-day hospitalisation period. Echinococcosis is a parasitic disease that most often affects the liver and lungs. Although more than half of the patients do not show any symptoms, the main symptoms observed during presentation include dry cough, haemoptysis, and chest pain. Plain radiographs or chest CT scans are used for diagnosis. Surgery is considered the primary treatment for pulmonary hydatid cysts and medical treatment with benzimidazoles (albendazole and mebendazole) is recommended. Complicated pulmonary hydatid disease can manifest in various ways, including hydropneumothorax, as observed in the present case. Early diagnosis, surgical intervention combined with medical treatment, and multidisciplinary teamwork can significantly improve patient outcomes.

Objective: The aim of this research was to evaluate the surgical complications and neurosensory deficits after coronectomy and the complete removal of mandibular third molars. Methods: The study sample included patients requiring surgical removal of mandibular third molars. A coronectomy was conducted on 220 teeth showing signs of close proximity to the inferior alveolar canal. A complete extraction was performed on 218 teeth with no risk signs. The patients were evaluated at 1 week and 1, 3, 6, 12, and 24 months after surgery for pain, swelling, neurologic deficit, dry socket, postoperative bleeding, infection, root migration, and eruption. Results: No significant difference was noted in pain and swelling; however, bleeding and dry socket were significantly higher in the odontectomy group (P = .017). The inferior alveolar nerve deficit was higher in the odontectomy group (3.7%) than the coronectomy group (0.5%) (P = .017). The percentage and distance of root migration of coronectomised teeth at 3, 6, and 12 months were 60% (2.37 ± 0.96 mm), 66% (3.35 ± 0.86 mm), and 74% (3.85 ± 0.93 mm), respectively. Conclusions: Coronectomy is a safe procedure and should be performed when the roots are closely associated with the mandibular canal. Although root migration is common, the likelihood of root exposure is low and roots rarely need removal.

This study was conducted to develop an approach for reducing severe damage to grains caused by various insect pests using the biological control agent Cypovirus1 and silver nanoparticles, both alone and in combination. Four types of beetles that infest stored products, including drugstore beetle (Stegobium paniceum), saw-toothed grain beetle (Oryzaephilus surinamensis), warehouse beetle (Trogoderma variabile), and Cowpea weevil (Callosobruchus maculates), were collected from seven different areas in the Kingdom of Saudi Arabia, specifically Mecca regions. We determined the morphological characteristics of the pests in various grains. Corn borer pupae and larvae of corn plants infected with Cypovirus1 were collected from the stems of live and dead maize plants in fields in Mecca regions to isolate Cypovirus1. Infected samples were examined using triple antibody sandwich-enzyme-linked immunosorbent assay (TAS-ELIZA) and reverse transcription-polymerase chain reaction (RT-PCR). Transmission electron microscopy (TEM) analysis revealed virus-containing occlusion bodies inside infected cells of corn borer larvae with irregular shapes and dimensions of 2.2–4.9 µm. The effects of different concentrations of the virus activated by synthetic spherical silver nanoparticles with an average diameter of 36.32 nm on the larva of grain pests taken were evaluated, and all treatments led to an increased mortality percentage after 72 h compared to at 48 h. The treatment mixture consisting of 10/100 viral and 400 µg/kg AgNPs led to the highest average death rates of the four insect larvae at 72 h after treatment. Protein bands that were present in the virus-infected larvae of the four pests were absent from healthy larvae, indicating viral infection.

Abstract Aim The aim of this study was to evaluate the effect of local betamethasone injection into the pterygomandibular space on postoperative neurosensory deficits. Materials and methods A prospective controlled clinical study was conducted on 16 patients (6 male, 10 female; mean age, 24.95 ± 9.22 years) who underwent bilateral sagittal ramus osteotomy for mandibular discrepancies. One side of each patient’s mandible was randomly selected as the control side, and the opposite side as the experimental side. On the experimental side, a solution of betamethasone (6 mg/1 ml) was injected into the pterygomandibular space after the completion of wound closure. Neurosensory tests, including light touch, two-point discrimination, direction of movement, thermal sensitivity, and pin-prick discrimination, were performed. The follow-up period ranged between 6 and 12 months, according to the particular sensory test. The Fisher exact test was used to analyse the data. Results The light touch sensation was abnormal in 75% of the control side and 31% of the study side, with the difference being significant (p = 0.03). However, at 6 months, all the study cases regained touch sensation, compared to 69% of the control side. No significant difference in direction movement discrimination was seen; however, at 3 months, the study side showed significantly less direction sensation (19%) compared to the control side (56%) (p = 0.02). There was no significant difference in the two-point discrimination; however, at 3 months, the study side had a significantly less abnormal two-point sensation (13%) than the control side (56%) (p = 0.02). In addition, no significant difference was noted in thermal sensitivity or pin-prick sensation. Conclusion Betamethasone injection into the pterygomandibular space reduces neurosensory disturbances after bilateral sagittal split ramus osteotomies nd leads to faster recovery of sensations.

The widespread destruction and the devastating humanitarian toll caused by the ongoing war on Gaza have transformed this besieged Strip into a place of death and despair. This review will explore the implications of this war for food security, focusing on Sustainable Development Goal (SDG) 2, which seeks to fight malnutrition and food insecurity and achieve zero hunger by 2030. This work is based on a review of grey literature, such as reports from government and non-governmental agencies, as well as recent scientific journal publications. Our results show that the ongoing war on Gaza has exacerbated the already acute food insecurity that Gazans have been struggling with since the blockade was imposed in 2007. Restless bombardment and ground operations have damaged or even razed agricultural land and all food production infrastructure (such as bakeries, mills, and food processing facilities), destroying Gaza’s food system. Facing catastrophic levels of hunger, some families, especially in northern Gaza have recently been resorting to eating animal feed and weeds to survive. With the starvation of civilians being used as a method of warfare, many experts and human rights organizations argue that Gaza is now the world’s worst hunger crisis and its population is on the verge of famine, if not already there. Moreover, this unprecedented humanitarian crisis in Gaza could have significant consequences on global food security in its six pillars, jeopardizing the implementation of SDG 2. While international organizations are making efforts to mitigate the catastrophic food shortage and famine, more comprehensive and sustainable solutions are needed to address the root causes of food insecurity in Gaza and ensure that all residents have access to an adequate and nutritious diet.

Abstract Aim The purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies. Patients and methods The sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern. Results In the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p

Background: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. Methods: STROBE-compliant protocol ascertained CWPF outcomes between March 2011–March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. Results: Across 15 centres, 507 patients with median age (54 years, IQR; 48–62), body mass index (25.4 kg/m2, IQR; 22.5–29), tumour size (26 mm, IQR; 18–35), and specimen weight (62 g, IQR; 40–92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11–39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). Conclusions: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.

Objectives: Tobacco-free campus policies are needed to create environments conducive to prevention or quitting in the Eastern Mediterranean Region (EMR), where the use of various tobacco products is on the rise among university students. The objectives of this study were to assess overall support for a 100% tobacco-free campus policy and its predictors among different stakeholder groups at the largest national university in Qatar and to understand attitudes towards specific policy components. Study design: A cross-sectional online survey of faculty and students. Methods: We measured sociodemographic variables, tobacco use, and support for components of a 100% tobacco-free campus policy. A total score for support was calculated, and associations with selected predictors were assessed using multivariable linear regression. Results: 413 respondents participated in the survey. A majority of faculty/staff and students (76.6% and 75.5%, respectively) supported the implementation of a 100% tobacco-free campus policy, with a majority supporting extension of the policy beyond cigarettes. Support for other components of the policy varied. Among students, overall support was lower among males and tobacco users and higher among the married. Among faculty and staff, support was lower among Qatari nationals and tobacco users. Conclusion: In the context of a growing tobacco crisis in the EMR, implementing and understanding the impact of tobacco-free campus policies is essential. This paper underscores the importance of addressing diverse stakeholder attitudes and providing empirical evidence to guide policy implementation and evaluation.

The study investigates the views of social studies teachers (SSTs) about the advantages and challenges of interactive whiteboard application in social studies lessons. Data was gathered using a questionnaire consisting of 58 items. The sample comprised 483 male and female SSTs from different governorates of Oman who were provided with three training programs about using Interactive Whiteboard (IWB). Data were analyzed by using: Means, T-test and One Way ANOVA. The results indicated that they considered its effect to be significant in supporting students' learning process by enhancing the quality of learning environment, excitement of use and importance of use in social studies lessons. It also showed that they used it widely in their lessons but they experienced moderate challenges, including related to technical support and the availability of IWB in all classes. The results also indicated that teachers' gender and experience influenced their views. The study recommends the provision of more technical support to teachers.

This study investigated how enzymatically modified lysozyme added to yogurt can improve its antioxidant activity and quality properties during cold storage. For this purpose, hen egg white native lysozyme (LZ) was hydrolyzed with trypsin, creating a functional tryptic lysozyme hydrolysate peptide (LZT). The obtained hydrolysate exhibited the highest antioxidant activity compared to native Lysozyme. The LZ and LZT were added in 0.4% concentration to yogurt made (YLZ and YLZT, respectively). The treated yogurt and control groups were stored at 4 °C for 28 days, and their antioxidant activity, sensory, physicochemical, and microbiological properties were analyzed. The result showed that the antioxidant, sensory properties, physicochemical, and microbiology of the yogurt with LZT were improved compared to yogurt treated with LZ and the control sample after 28 days of storage. In conclusion, the findings of this study suggested that yogurts enhanced with LZT may serve as functional food products with significant health benefits.

Background and Aim: The majority of animal-derived food safety studies have focused on foodborne zoonotic agents; however, members of the opportunistic Enterobacteriaceae (Ops) family are increasingly implicated in foodborne and public health crises due to their robust evolution of acquiring antimicrobial resistance and biofilms, consequently require thorough characterization, particularly in the Egyptian food sector. Therefore, this study aimed to determine the distribution and prevalence of Enterobacteriaceae family members in animal-derived foods, as well as their resistance to important antimicrobials and biofilm-forming potential. Materials and Methods: A total of 274 beef, rabbit meat, chicken meat, egg, butter, and milk samples were investigated for the presence of Enterobacteriaceae. All isolated strains were first recognized using traditional microbiological techniques. Following that, matrix-assisted laser desorption ionization-time of flight mass spectrometry was used to validate the Enterobacteriaceae's identity. The isolated enterobacteria strains were tested on disk diffusion and crystal violet quantitative microtiter plates to determine their antibiotic resistance and capacity to form biofilms. Results: There have been thirty isolates of Enterobacteriaceae from seven different species and four genera. Out of the three food types, Pseudomonas aeruginosa had the highest prevalence rate (4.1%). With three species, Enterobacter genera had the second-highest prevalence (3.28%) across five different food categories. In four different food types, the Klebsiella genera had the second-highest distribution and third-highest incidence (2.55%). Almost all isolates, except three Proteus mirabilis, showed prominent levels of resistance, particularly to beta-lactam antibiotics. Except for two Enterobacter cloacae and three P. mirabilis isolates, all isolates were classified as multidrug-resistant (MDR) or extensively multidrug-resistant (XDR). The multiple antibiotic resistance index (MARI) of the majority of isolates dropped between 0.273 and 0.727. The highest MARI was conferred by Klebsiella pneumoniae, at 0.727. Overall, 83.33% of the isolates had strong biofilm capacity, while only 16.67% exhibited moderate capacity. Conclusion: The MDR, XDR, and strong biofilm indicators confirmed in 83.33% of the currently tested Enterobacteriaceae from animal-derived foods suggest that, if not addressed, there may be rising risks to Egypt's economy and public health.

ObjectiveSports mass gatherings of people pose particular concerns and place an additional burden on the host countries and the countries of origin of the travelers. It is imperative to identify how countries dealt with various communicable diseases in the context of previous world cups and identify possible advice for protection from outbreaks.MethodsA scoping review was employed in this study and a PRISMA extension for scoping reviews was employed to guide the reporting of this study. A systematic search was performed using PubMed, Embase, Web of Science, SCOPUS, SportDiscus, and Google scholar. The search strategy included two main strings viz “communicable disease” AND “sport” AND “setting” as keywords for each string. A total of 34 studies were included in this review.ResultsInformation on risk factors for infectious diseases during FIFA, and recommendations for disease prevention in various stages of the event: pre-event, during, and post-event were charted. These strategies can be achieved with the empowerment of the public by enhancing their social responsibility and the coordination between the healthcare system, the ministry of public health, and other stakeholders.ConclusionThe findings will support planning for protection strategies to prevent any outbreak while having the FIFA World Cup or any other sports gatherings. A model was constructed to present the findings and recommendations from this review.

Dr.Mahmood Ahmad Ghazi (1950-2010) was a great scholar of the modern era. His scholarly work has been published in various Islamic fields. His special area of interest was Islamic Jurisprudence, Objectives of Shariah and Islamic International Law, but his contribution in Seerah studies was also recognized in academic circles for his multidimensional and critical approaches and work, scattered in various books,lectures,papers,review notes and prefaces of literary books.Most of his important work was produced by his well-known lectures”Muhazarat-i-seerat”. His research includes Prophetic Hijrah, Seerah evolution and Seerah writers, Orientalists contributions and its criticism, Muslim Response to orientalisam, Fiqh Us Seerah, Seerah writings in Sub- Continent and contemporey trends in Seerah.This article eloborates his Seerah Contribution by analyzing his work and highlighting its nevelity.

Article accepted. The article will be published here soon. Pending final quality checks.

(1) Background: The aim of this research was to investigate the antibacterial activity of dissolved silver from silver-coated titanium implants against Streptococcus mutans. (2) Methodology: Silver-coated titanium implant discs were immersed in 1.8 mL of brain heart infusion broth (BHIB) and incubated for 24 h in order to release the silver ions into the broth. The coating quality was confirmed via EDS, and the dissolved silver was measured via inductively coupled plasma mass spectrometry (ICP-MS). The experimental design used unconditioned broth (control) and broth conditioned with silver released from silver-coated titanium implants (n = 6). Regarding the antibacterial activity, isolated Streptococcus mutans was used. A turbidity test and lactate production test were performed to determine the effect of dissolved silver on bacterial growth in a suspension and biofilm formation. (3) Result: The results showed that the coating was successfully applied on the substrate. There was around 0.3 mg/L of silver released into the BHIB, and the turbidity of the control group was significantly higher than the treatment, with measured absorbance values of 1.4 and 0.8, respectively, indicating that the dissolved silver ions from the silver-coated titanium discs exhibited some degree of antibacterial activity by preventing the growth of Streptococcus mutans. However, the results of the antibiofilm activity test did not show any significant difference between the groups. (4) Conclusion: The dissolved silver from silver-coated titanium implants has an antibacterial activity but not a significant antimicrobial activity, indicating that the dissolved silver from silver-coated titanium abutments can significantly reduce the incidence of peri-implant mucositis.

The study aims to investigate the views of Omani post-basic education students (Grades 10-12) about religious and cultural tolerance. The sample consisted of 1390 male and female students in grades 10, 11 and 12, from four of Oman's seven regions. A questionnaire was used to gather data, which consisted of 27 items divided into five domains. The results showed that students place a strong emphasis on the importance of religious and cultural tolerance, both within Oman society and worldwide. They are also not in favour of any type of aggression, religious and cultural symbols or the fuelling of disagreements between religions or cultures. The results also indicated that female students are more strongly concerned with tolerance than males, grade 12 students more concerned than those in grades 10 and 11, and students from Muscat more concerned than those in other less urban areas.

aimani, Sulaimani, Kurdistan Region, Iraq; 3Biology Education Department, Tishk International University, Erbil, Iraq; 4Department of Biology, College of Science, Salahaddin University, Erbil, Kurdistan Region, Iraq; 5Department of Medical Microbiology, College of Science, Cihan University-Erbil, Kurdistan Region, Iraq Correspondence: Shukur Wasman Smail, Department of Biology, College of Science, Salahaddin University, Erbil, Kurdistan Region, Iraq, Tel +9647504491092, Email [email protected] Purpose: Systemic Sclerosis (SSc) is a rare connective tissue disorder characterized by autoimmunity, fibrosis, and vasculopathy that affects the skin and internal organs, including the gastrointestinal tract, particularly the esophagus. This article highlights the characteristics and clinical symptoms of esophageal involvement in patients with SSc. Patients and Methods: This study was conducted between November 2022 to August 2023, including 26 already diagnosed cases of SSc in the Department of Rheumatology and Rehabilitation and Kurdistan Center for Gastroenterology and Hepatology-Sulaymaniyah, Iraq. Esophageal involvement was investigated using esophageal manometry, esophagogastroduodenoscopy (EGD), and 24-hour impedance-pH monitoring. Results: Females were significantly predominant (P = 0.019) regarding the symptoms; 76.9% of the patients had heart burn, 76.9% dysphagia, 73.1% water brush, and 69.2% regurgitation. In total, 69.2% of the patients showed erosive gastrointestinal reflux disease (GERD) on EGD, 76.9% had decreased lower esophageal sphincter pressure (DLESP) and decreased distal esophageal peristaltic contractions (DDEPC) on esophageal manometry, and 84.6% had reflux on pH monitoring. Raynaud's phenomenon is the most common and typically the earliest clinical manifestation of SSc. The presence of erosive GERD was found to significantly increase the risk of developing dysphagia (B = 4.725, P = 0.014, OR = 3.482) and regurgitation (B = 3.521, P = 0.006, OR = 4.030). Conclusion: It is crucial to take gender-specific considerations into account when diagnosing and managing esophageal complications in patients with systemic sclerosis (SSc). Additionally, employing various diagnostic assessments to detect esophageal involvement during SSc is essential. Erosive GERD has been identified as a risk factor that contributes to the development of dysphagia and regurgitation in individuals with SSc. [ABSTRACT FROM AUTHOR]

Background Data: In double- and triple-segment lumbar disc herniation, a facet hypertrophy is more encountered specially in the same side of disc herniation with subsequent ipsilateral concave curve scoliosis. Lumbar fixation with interbody fusion surgery is a scientific and feasible option. Some authors believe that unilateral pedicle screw fixation can provide similar biomechanical support to the traditional bilateral pedicle screw fixation. Purpose: To assess the strategy of use of unilateral pedicle screw fixation with lumbar interbody fusion in surgical treatment of multilevel (2-3) symptomatic lumbar disc herniation syndromes. Study Design: Retrospective observational analytic study. Patients and Methods: Retrospective evaluation of 216 patients' files who underwent unilateral pedicular screws fixation for management of degenerative lumbar disc pathology, from July 2007 to June 2017. Only 24 patient’s files were selected with multilevel symptomatic lumbar disc prolapse who were managed by unilateral pedicular screw fixation with interbody fusion. All patients were presented with symptoms of nerve root compression. Patients' data included age, gender, levels of disc prolapse, preoperative and postoperative Visual Analogue Scale (VAS) for back and leg and Oswestry Disability Index (ODI) for functional outcome, presence of complications, and finally patients’ satisfaction according to Odom’s criteria. VAS and ODI were retrieved preoperatively, immediately postoperatively, and 6 months postoperatively. Results: They were 18 males (75%) and 6 females (25%) with a male-to-female ratio of 3:1 and age ranging 35–63 years with a mean age of 49±9.8 years. Double-level disc prolapse was recorded in 20 (83.3%) patients, while it was triple in 4 cases (16.7%). At the last follow-up, back pain VAS improved from 7.5±1.47 to 1.12±1.03, leg pain VAS from 8.7±1.04 to 0.33±0.63, and ODI from 78±8.3 to 11.08±4.6. Excellent and good Odom’s outcomes were reported in 95% of our patients. Conclusion: Our study suggests that unilateral pedicular screw fixation with interbody fusion for the management of multiple level ipsilateral lumbar disc disease could be considered as an effective and less invasive method with satisfying clinical outcomes. (2019ESJ191)

Background: Cancer is the second leading cause of death globally. Up to 86% of advanced cancer patients experience significant pain, while 10-20% live in chronic pain. Besides, increasing prescription of opioids resulted in 33,000 deaths in the US in 2015. Both reduce patients’ functional status and quality of life. While cancer survival rates are increasing, therapeutic options for chronic opioid refractory pain are still limited. Esketamine is the s-enantiomer of ketamine, with superior analgesic effect and less psychotomimetic side effects. Intranasal esketamine was approved by the FDA for treatment-resistant depression. However, its use in chronic cancer pain has never been tested. Therefore, we propose a phase II, randomized, placebo-controlled trial to evaluate the efficacy and safety of intranasal esketamine in chronic opioid refractory cancer pain. Methods and analysis: We will recruit 120 subjects with chronic opioid refractory pain, defined as pain lasting more than 3 months despite optimal therapy with high dose opioids (>60 mg morphine equivalent dose/day) and optimal adjuvant therapy. Subjects will be randomized into two groups: intranasal esketamine (56mg) and placebo. Treatment will be administered twice a week for four consecutive weeks. The primary outcome is defined as reduction in the Numeric Pain Rating Scale (NPRS) after first application. Secondary outcomes include NPRS reduction after four weeks, the number of daily morphine rescue doses, functional status and satisfaction, and depression. Conclusion: This study may extend therapeutic options in patients with chronic pain, thus improving their quality of life and reducing opioid use. Trial registration: Clinical Trials.gov, NCT04666623. Registered on 14 December 2020