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Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. The aim of our study is to evaluate the complication rate of ERCP in the treatment of choledocholithiasis and to assess the factors related to their occurrence. Methods: This is a retrospective descriptive and analytical study including 1048 patients who underwent ERCP for choledocholithiasis between January 2007 and August 2021. The factors associated with the occurrence of post-ERCP complications were studied by logistic regression analysis. Results: Among the patients studied, 60.5% had a simple lithiasis, 27.6% had multiple choledochal stones and 11.9% had large stones (> 15mm). Clinically, 18.7% of the patients presented with cholangitis and 9.4% with acute pancreatitis. A periampullary diverticulum was found in 9.4% of cases. A common bile duct stenosis was present in 6.5% of cases. The primary vacuity rate was 77.3%. However, additional manoeuvres were used in 20.5% of cases. Complications were reported in 5.8% of cases, including hemorrhage in 4.5%, pancreatitis in 0.8%, cholangitis in 0.2%, perforation in 0.1% and dormia impaction in 0.2%. No death was reported due to our procedures. In a multivariate analysis following adjustment of confounding factors, only the presence of a large stone (OR= 5.9, CI (1.460- 23.875), p=0.013) and female gender (OR= 1.867, CI (1.012-3.444), p=0.046) increased the risk of complications during ERCP. Conclusion: Our study suggests that female gender and the presence of à large gallstone are associated with a high risk of post-ERCP complications.

Background and study aims: During the COVID-19 pandemic, endoscopic procedures were associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to early endoscopy. The aim of this study was to assess the impact of the pandemic and the lockdown on the performance of digestive endoscopy for UGIB. Patients and methods: This is a retrospective observational cohort of 350 patients, conducted between January 2019 and December 2020, in the emergency endoscopy department of our institution. We have divided our patients into two groups, according to the period in which they were admitted (respectively pre-pandemic and pandemic periods corresponding to the year 2019 and 2020), and we have split the pandemic period into 3 subgroups according to the lockdown, each of these 3 phases was compared to its counterpart of the pre-pandemic period by adapting the same dates. Results: There was no difference in the number of admissions for UGIB before and after the COVID-19 pandemic. However, patients admitted during the pandemic period were significantly older. Peptic ulcer remained the main cause of UGIB in both study periods, with a significant decrease in the pandemic period. The subgroups analysis of the pandemic and pre-pandemic period showed that patients admitted during the lockdown phase were significantly older, with a significant decrease in the ulcerative origin of UGIB and an increase in the need for endoscopic haemostasis procedures, whereas during the post-lockdown period, there was furthermore an increase in the number of patients with UGIB of neoplastic origin. Conclusion: Despite the current epidemiological context, digestive endoscopy must be performed within the usual timeframe while adopting adequate precaution measures. Our study suggest that the reorganisation of our endoscopy department during the pandemic was effective in coping with routine endoscopic emergencies during this ........

Background and study aims: Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. Indeed, they can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. The current study reports that major gastrointestinal manifestations as initial symptoms of COVID-19 may suggest the diagnosis in patients who have been exposed, even in the absence of respiratory symptomatology. Patients and methods This prospective, descriptive, cross-sectional, and monocentric study of 713 cases was conducted in a field hospital in Morocco over a 5-week period from June 21 to July 25, 2020. Results The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastrointestinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286–1.698; p < 0.001) and treatment side effects (OR = 1.069, CI: 1.020–1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. Conclusion Gastrointestinal manifestations are common during COVID-19 and appear to be linked to a longer duration of the disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal–oral transmission. Therefore, hygiene is extremely important, especially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.

Background: Klatskin's tumour is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications. The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure. Methods: This is a retrospective and analytical study of 75 patients, conducted between July 2009 and August 2021, including all patients admitted with Klatskin's tumour and for whom endoscopic drainage was indicated. Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis. Results: The average age of our patients was 62.67 years with a male predominance of 68%. Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases. Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases, by a metal prosthesis in 45.2% and by nasobiliary drain in 4.1% . Forty-seven percent of patients had dilatation of the stenosis prior to prosthesis placement. Causes of stenting failure were primarily related to failure of papilla catheterisation, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumour. In multivariate analysis and by adjusting the studied parameters, namely the age, gender, bismuth tumour type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and the bismuth tumour classification affect the success rate. Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p

Introduction: Le drainage biliaire endoscopique connait des progres incessants et prend une large place dans le traitement palliatif des stenoses malignes des voies biliaires. Notre objectif est dexposer les resultats de cette technique dans notre formation, ainsi que les differents facteurs associes a son echec ou son succes. Methodes:Il sagit dune etude retrospective entre Janvier 2008 et novembre 2020, a propos de 204 patientsayant beneficie dun drainage endoscopique pour stenose biliaire dorigine neoplasique, et qui sont repartis en 3 groupes: les patients atteints dun cholongiocarcinome dans le groupe A , dun cancer du pancreas dans groupe B , et dun calculocancer dans le groupe C . Lanalyse statistique a ete realisee par le logiciel SPSS20.0. Resultats:Lage moyen etait de 63,5±11,4 ans avec un sex ratio a 1,4. Le succes global etait de 82,4% et letude comparative des resultats dans les 3 groupes a montre un taux de succes a 86,6% du groupe B, suivi du groupe C a 80,8% et du groupe A a 76,4%. En analyse multivariee et en ajustant les parametres etudies, a savoir le sexe, lage, limagerie, la presence de metastases et la dilatation endoscopique de la stenose, seule la presence de metastases et la dilatation endoscopique de la stenose modifient le taux de succes. La dilatation endoscopique de la stenose avant la mise en place de prothese multiplie par 8 le taux de succes [OR=9,177p

Background: Calcaneal fractures have considerable debate of the appropriate methods of management and how to lessen potential complications. Objective: Evaluation of intra-articular calcaneal fractures that treated by minimally invasive methods. Patients and Methods: A prospective study has been conducted on twenty patients having intra-articular calcaneal fractures and were managed by minimally invasive methods of fixation at Al Azhar university hospitals, Cairo, Egypt, after that they have been followed up for 6 months. Results: According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Score. There was: excellent (5 feet (25%), good (11 feet (55%), fair (2 feet (10%) and poor (2 feet (10%). The average score was 83 with a range of 68 to 95. No patient in this series experienced any failure of hard-ware, or developed deep infections. Complications included: superficial pin tract infection, varus heel deformity, flexion deformity of the big toe, reflex sympathetic dystrophy, subtalar arthritis and painful heel. Conclusion: Management of calcaneal, intra-articular, fractures by minimally invasive techniques is a viable surgical alternate as it provides shorter time of surgery, nominal invasiveness, less serious wound problems, and no residual hardware (in case of pinning). Their drawbacks include technical issues and inadequate reduction fracture fragment.

Aim: This study evaluates the clinical and microbiological effect of miswak and chlorhexidine gel on subgingival microbiota. Subjects and Methods: A full mouth randomized controlled clinical trial that carried out on 45 patients of both sex with mild to moderate chronic periodontitis. Selected patients were classified randomly into three equal group. After receiving the basic periodontal therapy group I used miswak 5 time a day (in accordance with the religious tradition), group II used CHX gel with tooth brush twice time daily, group III used tooth brush alone twice time daily. They evaluated clinicaly by Gingival Index, Plaque Index, Propping Depth and Attachment level at base line, after scalling and root blanning, one week, one month and finally after three month of using of each method, and microbiologically for detection and assessment of P.gingivalis at base line , after scalling and root blanning, one week, one month and finally after three month. Resultes: The present study exhibit that miswak more effective than tooth brush, as antimicrobial aginist p. gingivalis. There was no significant difference in the efficacy of miswak and CHX. Conclusion: Miswak more effective than tooth brush, as antimicrobial agonist.

Aim: This study aims to evaluate the effect of Platelet Rich Fibrin combined with Nano crystalline Hydroxy appatite bone graft on grade II mandibular furcation involvement. Subjects and methods: Thirty patients having grade II mandibular furcation defects, with vertical probing depth (VPD) ≥5mm and horizontal clinical attachment level (HCAL) ≥3mm. Following phase I therapy were classified into two groups, group1 received NcHA bone graft and group 2 received NcHA+PRF. Clinical and radiographic parameters were recorded at baseline, 6 and 12 months postoperatively. Results: Both treatment groups showed a significant probing pocket depth (PPD) reduction, clinical attachment gain, increase bone density 12‑months after surgery compared with baseline. However, there was a highly significant PPD reduction and clinical attachment gain when PRF was added to NcHA. Conclusion: The NcHA bone graft in combination with PRF demonstrated clinical advantages beyond that achieved by the NcHA alone.

Aim: This study aims to evaluate the effect of and compare between the piezosurgical ridge splitting and osseodensification in implant primary stability. Subjects and Methods: 28 implants were divided into two groups. Group I: 14 implants in sites received piezosurgery technique. Group II: 14 implants in sites received osseodensification technique. Then, all implants were evaluated clinically for primary stability after implant insertion by Osstell mentor magnetic resonance device and radiographically for peri-implant bone density. Results: unpaired t-test between the two groups showed moderate statistical significant difference in group II when compared with group I in both primary stability and bone density Conclusion: The primary stability in both piezosurgical ridge splitting and osseodensification techniques is within normal range but in favor of osseodensification technique suggesting that osseodensification enhance the bone density thereby improve the implant primary stability.

Aim: It is to determine the relationship between gingival thickness and (buccal bone thickness, crown length, crown width, papillary height and papillary width) at upper central incisors teeth by means of a noninvasive and relatively accurate digital registration method. Subjects and Methods: In 100 periodontally healthy subjects, cone-beam computed tomographic images were obtained. Measurements of buccal bone thickness and gingival thickness at the central incisors was performed at points 1 mm from the alveolar crest. Correlation coefficient was calculated to assess the correlation between gingival thickness and buccal bone thickness. Results: The mean and standard deviation values were calculated for each group. Pearson correlation was used to find the correlation between Gingival thickness and each of Bone thickness, Crown length, Crown width, Papillary height and Papillary width. Independent sample t-test was used to compare between females and males’ results in each variable. The significance level was set at p ≤ 0.05A statistically significant difference was found between females and males in all variables Gingival thickness, Bone thickness, Crown length, Crown width, Papillary height and Papillary width where (p

Background: pathological fractures in children occur from many aetiology. The physician has to develop an individual strategy for management and rehabilitation, considering the biology of bone and the biomechanics at the fracture site to detect pathology of lesion and to reach perfect bone healing. Time-efficient protection and reconstruction of the child’s musculoskeletal system is the aim of the orthopaedic surgeon’s intervention. The whole strategy must be individualized to every situation. Objective: The goals of managing a child’s pathological fracture are all based on establishing a diagnosis. Fracture management is then based on five points:(a) relief the pain; (b) achieve local control of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture healing; and (e) restoration of function. Patients and Methods: Our study was done over 20 cases of pathological fracture of lower limb in children in Al-Azhar University Hospitals (Al-Hossin and Saeid Galal hospitals) from January 2016 to December 2018. Imaging and radiology reports were used to determine fracture types. Complete fractures were classified to four major types: transverse, spiral, oblique and comminuted. In our study we use the Musculoskeletal Tumor Society (MSTS) scoring system to assess functional outcome for each patient. For lower extremity function, the MSTS used a 0-5 scale for the following variables: motion, pain, stability, deformity, strength, functional activity and emotional acceptance. Results: According to our study no patients with fractures underwent amputation, affection of neurovascular structures, or tumour progression on therapy. Pathologic fracture was not an indication for any of the amputation procedures, only the tumour pathology in an indication. Two patients refused surgery. Only one patient had a local recurrence after limb salvage surgery, and underwent no further surgical intervention.

Background: The clavicle is one of the bones that are most commonly fractured in the body. In adults, clavicle fractures represent 5–10 % of all fractures and 35 % of shoulder girdle fractures. Although most clavicular fractures may be treated nonoperatively, there is still a debate about the best therapy option for displaced mid-shaft clavicle fracture. Aim of the Study: To investigate the results of surgical fixation of displaced middle-third fracture clavicle by the anatomical pre-contoured locked plate in young adults. Materials and methods: This research involved 20 adult patients with a recent middle-third clavicle fracture. Results were assessed after 1 year according to the Disabilities of the Arm, Shoulder, Hand score (DASH). Results: The average age of the patients was 37 years old (25 - 52 years), all of them were males, All the fractures achieved union at 9 weeks (8-14 weeks ) postoperatively with no cases of implant failure, The average DASH score became15.3, 18 patients had no disabilities (90%), 1 patient had a mild disability (5%), 1 patient had a moderate disability (5%). 18 patients (90%) returned to their work within 3 months postoperatively, with no cases of deep infection with 1 case of superficial infection. Conclusion: Surgical treatment of displaced middle-third clavicle fracture in young adults by pre-contoured locked plates is an optimum procedure resulting in excellent functional outcomes, with a quicker return to the normal activities.

Background: Lumbar fusion is a common surgical procedure for treatment of back pain caused by degeneration of lumbar disc. The aim of fusion is to prevent motion in the destabilized segments to decrease the back pain . All types of interbody fusion approaches work with posterior pedicle screw fixation to increase stabilization and fusion rates. It has some disadvantages including paraspinal muscle dissection, screw malposition, neurologic risk , increased the time of operation with blood loss and risk of infection. A modified interspinous device can provide stabilization similar to pedicular screw fixation avoiding its complication when used for interbody fusion as a minimally invasive procedur. Patient and Methods: The study involved 20 patients with moderate segmental instability in lumbar spine . Transforaminal interbody fusion using the polyethere- therketone( PEEK )cage and rigid interspinous device fixation was performed. Patients were followed up and treatment outcomes were assessed within approximately 24 months after surgery. Results: according to pain intensity level on the visual analogue scale, the need for painkillers and the quality of life according to the Oswestry Disability Index scale during the early postoperative period demonstrated significantly better outcomes due to a less severe operative trauma to the paravertebral soft tissues. The formation of interbody bone formation was observed after 20—36 months in 94% of patients . Postoperative complications occurred in 2.2% of patient. Conclusion: The use of transforaminal interbody fusion and rigid interspinous stabilization provides better clinical outcomes and fewer postoperative complications in patients with moderate lumbar segmental instability.

Partially or completely invaginated appendix mistaken for a polyp during colonoscopy and leading to intussusception is a rare situation. This paper describes our experience with two cases of appendiceal intussusception. In the first case, there was no underlying ileocecal abnormality, and, in the second case, histologic examination of the resected appendix and cecum revealed widespread foci of angiodysplasia, and this was thought to be the basis for the intussusception. The authors present reviews of the literature concerning clinical features and associated conditions and emphasize that failure to recognize this condition may result in unexpected complications such as consequent peritonitis in case of endoscopic removal.

Ophthalmologic complications with interferon therapy are rare and usually reversible. The anterior ischemic optic neuropathy is an uncommon complication of interferon treatment. A case of irreversible anterior ischemic optic neuropathy complicating interferon therapy for chronic hepatitis C is reported. We suggest that periodic ophthalmological examinations, including visual acuity and fundus examinations, should be performed to patients with high risk of ocular complications after starting and during treatment. We also suggest that an ophthalmologist would be able to detect these complications. Antiviral treatment should be stopped immediately if severe ophthalmologic complications occur.