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Pancreatic divisum (PD) is the most common congenital abnormality of the pancreatic duct. It can be associated with complications such as pancreatitis or pancreatitis-like pain. This article provides cumulative data of 57 case reports of PD and highlights the statistical findings of the most common presentations, diagnostic methods, treatment options, and associated complications. The goal of the article was to provide a comprehensive picture of clinical and epidemiological methods of diagnosis and treatment of PD. Objectives: Pancreatic divisum (PD) is the second most common congenital abnormality of the pancreatic duct, which affects 2% to 3% of the population. Most of the population remains asymptomatic, but in people who present with symptoms, it can be a cause of anguish and should be recognized. The main goal of this article was to provide a comprehensive picture of clinical and epidemiological methods of diagnosis and treatment of PD. Methods: A total of 57 PD case reports were considered in this descriptive analysis with 51 case reports and case series published within the last 25 years. The search strategies include systemic searches using scholarly search engines such as Medscape, Scopus, Cochrane, and PubMed. Results: The 57 cases we studied have an average age of presentation of 42 years, with female sex (58%) predominance. Common presenting symptoms were abdominal pain (87.72%) and radiation to the back (21.6%). Eighty-one percent of the case studies reported pancreatitis, and 63.2% had recurrent pancreatitis. At presentation, laboratory values demonstrated increased amylase, lipase, and liver enzymes. PD was diagnosed using magnetic resonance cholangiopancreatography (28.1%), endoscopic retrograde cholangiopancreatography (57.9%), endoscopic ultrasound (7%), or computed tomography (5.3%) scan of the abdomen. Of significance, biliary duct dilation was found in 70.6% of patients diagnosed as having PD. Incidental masses were found in 66.7% of the patients. The most successful treatment was sphincterotomy with or without stents (47.6%), followed by pancreatoduodenectomy (19%) and pancreaticojejunostomy (10%). Conclusions: Physicians managing pancreatitis should add PD to their differential diagnoses because it will help improve patient outcomes and avoid unfavorable consequences. [ABSTRACT FROM AUTHOR]

La neumoconiosis es una enfermedad profesional que afecta a trabajadores con exposición ambiental a polvo orgánico e inorgánico, como en la minería, el granallado, la alfarería, la cantería y la agricultura. La respuesta inflamatoria del pulmón al polvo respirable provoca la formación de máculas, nódulos y fibrosis, y un contenido mayor de sílice en el polvo inhalado se asocia con un aumento en la fibrosis. La neumoconiosis mixta por polvo (MDP) se caracteriza por la exposición a polvos que contienen 10–20% de sílice, con imágenes pulmonares que muestran opacidades irregulares. La histopatología desempeña un papel vital en el diagnóstico de la MDP. Aunque tiene un pronóstico favorable, la enfermedad evoluciona lentamente, a lo largo de muchos años de exposición constante, y se caracteriza por un agravamiento de la disnea y la tos, que progresa gradualmente hasta convertirse en cor pulmonale. El único tratamiento eficaz es eliminar la fuente de exposición, por lo que es esencial reconocer la enfermedad de forma temprana para lograr un resultado favorable. Presentamos un caso de neumoconiosis mixta por polvo en un agricultor de Sudamérica que padecía asma. El paciente se presentó con agravamiento de la disnea y múltiples nódulos en ambos pulmones en el diagnóstico por imagen, y cor pulmonale. Tras un amplio estudio, se descartó cualquier neoplasia maligna y tuberculosis. El análisis de las muestras de biopsia de cirugía toracoscópica asistida por video (VATS) confirmó el diagnóstico de neumoconiosis mixta por polvo. El paciente presentaba una confluencia de nódulos irregulares en los lóbulos superiores de los pulmones, y el mayor medía 2.1 cm. Esto coincide con la definición de la Organización Internacional del Trabajo (OIT) de fibrosis masiva progresiva. Este hallazgo, junto con el cor pulmonale, indica un mal pronóstico, incluso luego de eliminar la exposición al polvo. Se administraron corticoides, que produjeron una mejoría sintomática, y se dio de alta al paciente para seguimiento con el neumólogo. [ABSTRACT FROM AUTHOR]

Objective: Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in India.Design: Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' and derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).Results: From 45 712 abstracts screened, sixty-four cross-sectional, seven cohort, one qualitative and one case-control studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF practices were found in all studies. In twenty-nine of fifty-nine studies, CF was introduced between 6 and 9 months, with eight studies finding minimum dietary diversity was achieved in 6-33 %, and ten of seventeen studies noting minimum meal frequency in only 25-50 % of the study populations. Influencing factors included cultural influences, poor knowledge on appropriate CF practices and parental educational status.Conclusions: This is the first systematic review to evaluate CF practices in SA in India. Campaigns to change health and nutrition behaviour and revision of nationwide child health nutrition programmes are needed to meet the substantial unmet needs of these children. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is a common cardiac arrhythmia associated with debilitating complications, one of which is stroke. Anticoagulants (warfarin and the non-vitamin K antagonist oral anticoagulants) are recommended for stroke prophylaxis, their utilisation however requires stroke risk reduction to be balanced against hemorrhage risk. Current review of the literature suggests that despite the presence of risk stratification tools such as the CHADS2 and the newer CHA2DS2-VASc, clinicians often find it challenging to anticipate the risk-benefit ratio of anticoagulation. This results in both the underuse and overuse of anticoagulation in patients as well as uncertainty over whether to use anticoagulation in paroxysmal AF. This review looks at optimising anticoagulation by improving the assessment of bleeding risk and by improving the assessment of stroke risk. The percutaneous occlusion of the left atrial appendage is an emerging alternative to oral anticoagulation therapy. [ABSTRACT FROM AUTHOR]

Purpose To determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression. Methods A prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation. Results No significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02–5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption. Conclusions Despite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression. [ABSTRACT FROM AUTHOR]

We investigated whether sexual activity was associated with reproductive function in the BioCycle Study, a prospective cohort study that followed 259 regularly menstruating women aged 18 to 44 years for one (n = 9) or two (n = 250) menstrual cycles in 2005-2007. Women were not attempting pregnancy nor using hormonal contraceptives. History of ever having been sexually active was assessed at baseline and frequency of sexual activity, defined as vaginal-penile intercourse, was self-reported daily throughout the study. Serum concentrations of estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone, and testosterone were measured up to 8 times/cycle. Sporadic anovulation was identified using peak progesterone concentration. Linear mixed models were used to estimate associations between sexual activity and reproductive hormone concentrations and generalized linear models were used to estimate associations with sporadic anovulation. Models were adjusted for age, race, body mass index, perceived stress, and alcohol consumption and accounted for repeated measures within women. Elevated concentrations of estrogen (+ 14.6%, P < .01), luteal progesterone (+ 41.0%, P < .01) and mid-cycle LH (+ 23.4%, P < .01), but not FSH (P = .33) or testosterone (P = .37), were observed in sexually active women compared with sexually inactive women (no prior and no study-period sexual activity); sexually active women had lower odds of sporadic anovulation (adjusted odds ratio = 0.34, 95% confidence interval: 0.16-0.73). Among sexually active women, frequency of sexual activity was not associated with hormones or sporadic anovulation (all P > .23). Findings from our study suggest that ever having been sexually active is associated with improved reproductive function, even after controlling for factors such as age. [ABSTRACT FROM AUTHOR]

Objective: Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in Pakistan.Design: Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).Results: From 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs.Conclusions: This is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children. [ABSTRACT FROM AUTHOR]

Serious neurological complications of SARS-CoV-2 are increasingly being recognized. We report a novel case of HHV6 myelitis with parainfectious MOG-IgG in the setting of COVID-19-induced lymphopenia and hypogammaglobulinemia. The patient experienced complete neurological recovery with gancyclovir, high dose corticosteroids, and plasma exchange. To our knowledge, this is the first case of HHV6 reactivation in the central nervous system in the setting of COVID19 infection and the first case of MOG-IgG myelitis in the setting of SARS-CoV-2 and HHV6 coinfection. Patients with neurological manifestations in the setting of COVID19-related immunodeficiency should be tested for opportunistic infections including HHV6. Viral infection is a known trigger for MOG-IgG and therefore this antibody should be checked in patients with SARS-CoV-2 associated demyelination. [Display omitted] [ABSTRACT FROM AUTHOR]