Ophthalmic complications of injectable facial fillers

The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery.One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit,causing unexpected effects at a site distant from that of the initial injection,including ophthalmoplegia,ptosis and even visual compromise.Acute vision loss following filler injection is a devastating complication,occurring in up to 0.0008%of cases.The greatest risk of this complication occurs with nasal augmentation,followed by glabellar wrinkle treatment.While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery,hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally.Treatment interventions include thrombolysis,hyperbaric oxygen therapy,oral aspirin,cobamamide and acetazolamide and administration of corticosteroids.However,most studies show a poor prognosis in the form of partial or no recovery of vision.Hence,prevention is of paramount importance.A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Esophageal ulceration complicating doxycycline therapy

AIM;TO report present state of iatrogenic drug-induced esophageal injury(DIEI)induced by medications in a private clinic. METHODS:Iatrogenic drug-induced esophageal injury (DIEI)induced by medications has been more frequently reported.In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population(median age 29 years). RESULTS:The most frequent presenting symptoms were odynophagia,retrosternal burning pain and dysphagia(94 %, 75 % and 56 %,respectively).The diagnosis was according to medical history and confirmed by endoscopy in all patients. Beside withdrawal of doxycycline,when feasible,all patients were treated with a proton-pump inhibitor(PPI)and a prokinetic.Thirty patients who reported to the clinic after treatment were improved within 1-7(median 1.7)days. CONCLUSION:Esophageal ulceration has to be suspected in younger patients with odynophagia,retrosternal burning pain and/or dysphagia during the treatment with doxycycline.

Colon mucosal injury caused by water jet malfunction during a screening colonoscopy:A case report

BACKGROUND Screening colonoscopies are routinely performed and have low occurrences of adverse events such as perforation,bleeding,infection,and post-polypectomy syndrome.True device related adverse events are rarely reported in the literature.CASE SUMMARY We report a case of a 51-year-old patient without past medical history who presented for her first screening colonoscopy.The patient was thought to have friable mucosa in the cecum and oozed upon water irrigation during screening colonoscopy.It was later identified that the colonoscope used during the index procedure had malfunctioned and produced a pin-point water jet which damaged the colon mucosa of cecum.The maintenance service identified a piece of rubber fragment lodged in the instrument component at the tip of the scope,resulting in high pressure water jet.Repeat colonoscopy with a functioning colonoscope confirmed normal colon mucosa without friability.CONCLUSION This is the first report of mucosa injury from a colonoscope water jet malfunction.Endoscopists should recognize the potential for endoscopic malfunction.

The Evolving Nature of Hepatic Abscess:A Review

Hepatic abscess (HA) remains a serious and often difficult to diagnose problem.HAs can be divided into three main categories based on the underlying conditions:infectious,malignant,and iatrogenic.Infectious abscesses include those secondary to direct extension from local infection,systemic bacteremia,and intra-abdominal infections that seed the portal system.However,over the years,the etiologies and risks factors for HA have continued to evolve.Prompt recognition is important for instituting effective management and obtaining good outcomes.