Laparoscopic retrieval of two intragastric spoons at least seven years after ingestion

Foreign body ingestion is a commonly encountered presentation.The majority of foreign bodies pass in stool spontaneously within one week or are managed endoscopically within the first 24e48 hours.No guidelines are available for management of chronically retained foreign bodies at present.A unique case is presented of two chronically retained teaspoons in the stomach that failed endoscopic retrieval and required laparoscopic surgery.Post operatively,the patient did well with no complications.A large foreign body that is not amenable to endoscopic intervention will benefit from surgery.If expertise is available,laparoscopic intervention is a safe and feasible option to remove large foreign bodies from the stomach that is not amenable to endoscopic retrieval.

Evaluation of the Antimicrobial Effect of <i>Nepeta cataria</i>and <i>Basella alba</i>against Clinically Resistant <i>Acinetobacter baumannii</i>in Nairobi, Kenya

Acinetobacter baumannii is among the common nosocomial infections microorganisms in the Intensive Care Unit (ICU). Antimicrobial resistance (AMR) is one of the major significant concerns in developing nations due to either over-use or inadequate use of antimicrobial agents. The purpose of this study was to emphasize the potential antimicrobial activity of Nepeta cataria and Basella alba against nosocomial diseases caused by Acinetobacter baumannii. Nepeta cataria and Basella alba leaves were collected from Oldonyo Sabuk National Park and Botanical garden JKUAT respectively. The leaves were dried under shade at room temperature for thirty days. After methanolic and aqueous plant extraction, the percentage yield was determined, and the extracts were subjected to toxicity testing using brine shrimp eggs and preliminary phytochemical screening. The results recorded from this study demonstrated that 70% methanolic extract of Nepeta cataria and Basella alba had greater antimicrobial effect against Acinetobacter baumannii than aqueous extracts. Nepeta cataria extracts showed greater antimicrobial effect than Basella alba extracts. The methanolic plant extracts had MIC values 60 mg/ml when tested against Acinetobacter baumannii. The phytochemical screening showed the presence of various phytochemical constituents from the methanolic and aqueous extraction of Nepeta cataria and Basella alba. The methanolic plant extracts revealed more phytochemicals as compared to aqueous extracts. More phytochemicals were detected from Nepeta cataria than Basella alba plant extracts.

Driving pressure in mechanical ventilation:A review

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

Metabolic dysfunction-associated fatty liver disease and low muscle strength: A comment

The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes,gender,basal metabolic index,and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases.As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD,as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.

Road to recompensation:BavenoⅦcriteria and transjugular intrahepatic portosystemic shunt in liver cirrhosis

Liver cirrhosis has long been considered a point of no return,with limited hope for recovery.However,recent advancements,particularly the Baveno VII criteria and the utilization of transjugular intrahepatic portosystemic shunt(TIPS),have illuminated the concept of hepatic recompensation.In this editorial we comment on the article by Gao et al published in the recent issue.This editorial provides a comprehensive overview of the evolution of understanding cirrhosis,the criteria for recompensation,and the efficacy of TIPS in achieving recompensation.We discuss key findings from recent studies,including the promising outcomes observed in patients who achieved recompensation post-TIPS insertion.While further research is needed to validate these findings and elucidate the mechanisms underlying recompensation,the insights presented here offer renewed hope for patients with decompensated cirrhosis and highlight the potential of TIPS as a therapeutic option in their management.

Foregut tuberculosis:Too close but miles apart

The worldwide burden of tuberculosis(TB)has increased and it can involve virtually any organ of the body.Intestinal TB accounts for about 2%of the cases of TB worldwide.The ileocecal region is the most commonly affected site,and the foregut is rarely involved.The reported incidence is approximately 0.5%.Esophageal TB presents with dysphagia,weight loss,and hematemesis in rare cases.Gastroduodenal TB usually manifests with symptoms such as nausea,vomiting,weight loss,and sometimes with gastric outlet obstruction.Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected,therefore histopathology plays pivotal role.On computed tomography,duodenal TB typically manifests as duodenal strictures predominantly,accompanied by extrinsic compression,and occasionally as intraluminal mass.But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing,TB polymerase chain reaction investigation and histopathological analysis.Despite being in close proximity to the lungs,the esophagus and stomach are rare sites of TB.The reasons could be low gastric pH and acidity which does not let mycobacterium grow.But there are various case reports of TB involving the foregut.We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy,histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.

Recurrent acute pancreatitis as an initial presentation of primary hyperparathyroidism:A case report

BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.

Low-Level Antibiotic Resistance among Staphylococcus aureus and Gram-Negative Pathogens from Infected Skin and Soft Tissues in Rural Kenya

Introduction: Bacterial skin and soft tissue infections (SSTIs) are a cause of frequent inpatient and outpatient care visits whose causative agents are associated with a high antimicrobial resistance burden. For insights on antimicrobial susceptibilities in a rural setting, we examined specimens from suspected SSTIs from two public health facilities in Kenya. We additionally assessed antibiotic use, appropriateness of empiric therapy and risk factors for SSTI. Methodology: Between 2021 and 2023, 265 patients at Kisii and Nyamira County Referral hospitals were enrolled. Wound swabs/aspirates were collected and processed following standard microbiological procedures. Identification and antimicrobial susceptibility were performed using the VITEK 2 Compact platform. Demographic, clinical, and microbiological data were analyzed with R Statistical software. Results: S. aureus was isolated in 16.2% (43/265) of patients with a methicillin resistance (MRSA) proportion of 14% (6/43). While 13/15 drugs elicited susceptibilities ranging from 84% - 100%, penicillin (16%) and trimethoprim-sulfamethoxazole [TMP-SXT] (23%) yielded the lowest susceptibilities. Escherichia coli (n = 33), Klebsiella pneumoniae (n = 8), Pseudomonas aeruginosa (n = 8), and Citrobacter species (n = 4) were the most commonly isolated gram-negative species. Gram-negative strains showed high susceptibilities to most of the tested drugs (71% - 100%) with the exception of ampicillin (18%), TMP-SXT (33%), and first and second generation cephalosporins. Conclusions: The low MRSA prevalence and generally high antibiotic susceptibilities for S. aureus and gram-negative bacteria present opportunities for antibiotic stewardship in the study setting. Diminished susceptibilities against penicillin/ampicillin and TMP-SXT accord with prevailing local data and add a layer of evidence for their cautious empiric use.

Climate change and the emergence and exacerbation of infectious diseases:A review

Experts expressed severe concerns over the possibility of increasing burden of infectious diseases as the planet’s climate began to change years ago.There have been increased rates of climate-related catastrophes and as global temperatures rise,emergence of certain viruses has become a serious concern.Vectors are susceptible to changing temperatures as they exhibit innate responses to thermal stress to increase survivability.Climate change impacts virus reservoirs,increasing transmission rates of vectors.Vector-borne diseases have already witnessed increasing numbers compared to before.Certain non-endemic areas are encountering their first-ever infectious disease cases due to increasing temperatures.Tick-borne diseases are undergoing transformations provoking a heightened prevalence.Food-borne illnesses are expected to increase owing to warmer temperatures.It is important to recognize that climate change has a multivariable impact on the transmission of viruses.With climate change comes the potential of increasing interspecies interactions promoting jumps.These factors must be considered,and an informed strategy must be formulated.Adaptation and mitigation strategies are required to curb these diseases from spreading.Despite significant evidence that climate change affects infectious diseases,gaps in research exist.We conducted this review to identify the potential role climate change plays in the emergence of new viruses.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Expansion of human umbilical cord derived mesenchymal stem cells in regenerative medicine

BACKGROUND Stem cells are undifferentiated cells that possess the potential for self-renewal with the capacity to differentiate into multiple lineages.In humans,their limited numbers pose a challenge in fulfilling the necessary demands for the regeneration and repair of damaged tissues or organs.Studies suggested that mesenchymal stem cells(MSCs),necessary for repair and regeneration via transplantation,require doses ranging from 10 to 400 million cells.Furthermore,the limited expansion of MSCs restricts their therapeutic application.AIM To optimize a novel protocol to achieve qualitative and quantitative expansion of MSCs to reach the targeted number of cells for cellular transplantation and minimize the limitations in stem cell therapy protocols.METHODS Human umbilical cord(hUC)tissue derived MSCs were obtained and re-cultured.These cultured cells were subjected to the following evaluation pro-cedures:Immunophenotyping,immunocytochemical staining,trilineage differentiation,population doubling time and number,gene expression markers for proliferation,cell cycle progression,senescence-associatedβ-galactosidase assay,human telomerase reverse transcriptase(hTERT)expression,mycoplasma,cytomegalovirus and endotoxin detection.RESULTS Analysis of pluripotent gene markers Oct4,Sox2,and Nanog in recultured hUC-MSC revealed no significant differences.The immunophenotypic markers CD90,CD73,CD105,CD44,vimentin,CD29,Stro-1,and Lin28 were positively expressed by these recultured expanded MSCs,and were found negative for CD34,CD11b,CD19,CD45,and HLA-DR.The recultured hUC-MSC population continued to expand through passage 15.Proliferative gene expression of Pax6,BMP2,and TGFb1 showed no significant variation between recultured hUC-MSC groups.Nevertheless,a significant increase(P<0.001)in the mitotic phase of the cell cycle was observed in recultured hUC-MSCs.Cellular senescence markers(hTERT expression andβ-galactosidase activity)did not show any negative effect on recultured hUC-MSCs.Additionally,quality control assessments consistently confirmed the absence of mycoplasma,cytomegalovirus,and endotoxin contamination.CONCLUSION This study proposes the development of a novel protocol for efficiently expanding stem cell population.This would address the growing demand for larger stem cell doses needed for cellular transplantation and will significantly improve the feasibility of stem cell based therapies.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Dosage and utilization of dexamethasone in the management of COVID-19: A critical review

BACKGROUND The severe respiratory manifestations observed in severe coronavirus disease 2019(COVID-19)cases are often associated with an excessive inflammatory response.Dexamethasone,a synthetic glucocorticoid,exerts its anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes and suppressing the activity of various immune cells.This mechanism has implications for mitigating the cytokine storm observed in severe COVID-19 cases.Early on in the pandemic,the Recovery Collaborative working group showed a mortality benefit of using dexamethasone in decreasing mortality in patients with COVID-19 requiring respiratory support.However,the optimal dosage of corticosteroids remains debatable.Several studies that compare different doses of dexamethasone in COVID-19 exist,but the results are conflicting.AIM To review the latest evidence regarding dosage,safety,and efficacy of dexamethasone in severe COVID-19.METHODS We followed preferred reporting items for systematic reviews and meta-analysis guidelines.A detailed literature search was conducted across PubMed,Google Scholar,and Medline to include publications up to March 2024.Our keywords included“COVID-19”“SARS-CoV-2”“dexamethasone”“corticosteroid”“steroid”and“glucocorticoid”-along with their combinations.We employed the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale to evaluate the integrity and potential of bias in the included studies.A meta-analysis was conducted using a random-effects model,assessing pooled odds ratios and mean differences,with heterogeneity gauged by the I2 statistic and theχ^(2) tests.RESULTS No statistical differences were found in 28-day all-cause mortality[pooled odds ratio(OR)=1.109,95%CI:0.918-1.340],60-day all-cause mortality(OR=0.873,95%CI:0.744-1.024;I2=47.29%),mean length of hospital stay(mean difference=-0.08 days,95%CI:-0.001 to 0.161)and adverse events(OR=0.877,95%CI:0.707-1.087).CONCLUSION Differing doses of corticosteroids have no clinical implications on mortality,mean length of hospital stay,and adverse events in COVID-19 patients.Additional research is required in patients requiring invasive or noninvasive ventilation.

Risk of hepatitis B virus reactivation in cancer patients undergoing treatment with tyrosine kinase-inhibitors

This editorial commented on an article in the World Journal of Gastroenterology titled“Risks of Reactivation of Hepatitis B Virus in Oncological Patients Using Tyrosine Kinase-Inhibitors:Case Report and Literature Analysis”by Colapietro et al.In this editorial,we focused on providing a more comprehensive exploration of hepatitis B virus reactivation(HBVr)associated with the usage of tyrosine kinase inhibitors(TKIs).It includes insights into the mechanisms underlying HBV reactivation,the temporal relationship between TKIs and HBV reactivation,and preventive measures.The aim is to understand the need for nucleos(t)ide analogs(NAT)and serial blood tests for early recognition of reactivation and acute liver injury,along with management strategies.TKIs are considered to be an intermediate(1%-10%)of HBVr.Current guidelines stipulate that patients receiving therapy with high or moderate risks of reactivation or recent cancer diagnosis must have at least tested hepatitis B surface antigen,anti-hepatitis B core antigen(HBc),and anti-hepatitis B surface antibody.Anti-HBc screening in highly endemic areas means people with negative tests should be vaccinated against HBV.Nucleoside or nucleotide analogs(NAs)like entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide(TAF)form the basis of HBV reactivation prophylaxis and treatment during immunosuppression.Conversely,lamivudine,telbivudine,and adefovir are generally discouraged due to their reduced antiviral efficacy and higher risk of fostering drug-resistant viral strains.However,these less effective NAs may still be utilized in cases where ETV,TDF,and TAF are not feasible treatment options.

Maternal Burnout: Prevalence and Associated Factors in Northern Benin (2023)

Introduction: Also known as maternal burnout syndrome, maternal burnout is a state of physical, emotional and mental exhaustion generated by prolonged stress in the family environment. It is experienced by women in their role as mothers. Those affected can develop psychological disorders, sleep disturbances, etc., all of which impair their day-to-day lives, and thus their maternal role. The repercussions affect both the child and other family members. Objective: The aim of the present study was to investigate maternal burnout among female users of public and private health facilities in the commune of Parakou in 2023. Methods: Descriptive cross-sectional study was conducted from December 2022 to July 2023 among all mothers using public and private health facilities in the commune of Parakou. All healthy mothers with at least one biological or adoptive child fully dependent on them and living at home, who came for a consultation in one of the health facilities or for an appointment at the Expanded Program on Immunization (EPI) and gave their free and informed consent. Sampling was done for non-exhaustive convenience were included in the study. Burnout was assessed using the Parental Burnout Assessment (PBA) scale. Results: A total of 888 mothers meeting the inclusion criteria were surveyed. The prevalence of burnout calculated using the Parental Burnout Assessment (PBA) scale was 6.19%. The risk factors for maternal burnout were poor relationships with family and friends (OR = 8.90;p = 0.045), moderate (OR = 11.71;p = 0.020) and severe depression (OR = 40.85;p = 0.001), followed by the presence of repeated nocturnal awakening (OR = 5.14;p = 0.014). Conclusion: This is a subject that is almost never discussed in African society, but whose reality is revealed by the present study, which provided statistical data on maternal burnout. From now on, the risk of burnout will no longer be discussed solely in the family context. It will also need to be explored within the family unit to prevent its deleterious consequences for children and adults alike.

Eating Disorders among Students in Northern Benin (2023)

Introduction: From their earliest hours, human beings are able to identify a source of food and to feed themselves. Feeding is therefore one of the most instinctive human functions. It is regulated by several factors (physiological, psycho-affective and environmental) whose disruption can lead to eating disorders. Objective: The aim of this study was to investigate eating disorders among students in the town of Parakou in 2023. Method: Descriptive cross-sectional study conducted from January to July 2023 in various universities in the city of Parakou, Benin. The study population consisted of all students in grades 1 to 7 at these universities. A two-stage non-proportional stratified sampling technique combined with a simple random draw was adopted. The Eating Attitude Test-26, Bulimia Inventory Test Edinburgh and a set of questions focusing on the diagnostic criteria for pica were used to screen for pica and other disorders such as anorexia, bulimia nervosa and binge eating disorder. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 25. Results: A total of 607 students were surveyed, 323 of whom had eating disorders. A prevalence of 53.21% of students at risk of eating disorders was found. In relation to the total population, the prevalences of anorexia, bulimia nervosa, binge eating disorder and pica were 45.96%, 0.82%, 15.48% and 12.68% respectively. In multivariate analysis, seven factors explained the risk to develop at least one eating disorder among the students surveyed. These were: urban area of residence (OR (95% CI) = 5.059 (1.75 - 14.65);p = 0.003);year of study (OR (95% CI) = 0.47 (0.28 - 0.79);p = 0.035);type of university attended (private university: OR (95% CI) = 1.63 (1.08 - 2.44);p = 0.019);parents’ marital status (couple or not) (OR (95% CI) = 1.50 (1.01 - 2.24);p = 0.046);father’s level of education: secondary (OR (CI 95%) = 3.85 (1.96 - 7.54);p 0.001)/higher (OR (CI 95%) = 2.83 (1.36 - 5.86);p = 0.005);mother’s one: secondary (OR (CI 95%) = 0.30 (0.18 - 0.51);p 0.001)/superior (OR (CI 95%) = 0.31 (0.16 - 0.61);p = 0.001);the presence of doubtful (OR (CI95% = 1.69 (1.11 - 2.58);p = 0.009) or certain anxiety symptomatology (OR (CI 95%) = 1.69 (1.11 - 2.58);p = 0.009). Conclusion: More than half the students in Parakou had at least one eating disorder. Diagnostic studies are needed, even if preventive actions are already necessary.

Exploring Novel Therapeutic Breakthroughs for Cancers:Potential Roles of miRNAs

MicroRNAs(miRNAs)are small non-coding RNAs,19-25 nucleotides in length,that regulate gene expression.miRNAs are involved in various cellular,biological,and pathological activities,including the development and progression of malignant tumors.Numerous studies have highlighted the significant roles of miRNA deregulation in various cancer types,involving critical pathways such as gene deletions and amplifications,abnormal epigenetic changes,and dysfunctional miRNA regulatory systems.miRNAs can function both as oncogenes and tumor suppressor genes in different contexts.Several cancer hallmarks are associated with deregulated miRNAs,including resistance to cell death,metastasis,sustained proliferative signaling,promotion of angiogenesis,and the suppression of growth factors.Recent research has demonstrated that miRNAs contribute to drug resistance in tumor cells by targeting genes linked to drug resistance or by influencing genes that regulate the cell cycle,apoptosis,and proliferation.A single miRNA often has tissue-specific regulatory functions and can affect multiple genes.Various miRNA types have been identified as potential biomarkers for tumor diagnosis and critical targets for novel therapeutic approaches.This review aims to explore the role of miRNAs in cancer progression,metastasis,and potential therapeutic interventions.

Craniocerebral injuries in war against terrorism-a contemporary series from Pakistan

Objective： Terrorism-relatedbomb at- tacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to impro- vised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan Uni- versity Hospital, Pakistan （AKUH）. Further, a few pertinent management guidelines have also been discussed. Methods： The hospital database and clinical coding during a 5-year period were examined for head injuries se- condary to terrorism-associated blasts. In addition to pa- tient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, manage- ment （conservative or operative） to associated complications, and discharge neurological status. Results： A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients （mean follow-up： 7.8 months）, with most patients having no active complaints. Conclusion： The results of this series show that civi- lian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.

Does sevoflurane sedation in pediatric patients lead to“pseudo”leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?

BACKGROUND Prominent leptomeningeal contrast enhancement(LMCE)in the brain is observed in some pediatric patients during sedation for imaging.However,based on clinical history and cerebrospinal fluid analysis,the patients are not acutely ill and do not exhibit meningeal signs.Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of‘pseudo’LMCE(pLMCE)on 3 Tesla magnetic resonance imaging(MRI).AIM To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.METHODS A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted.The patients underwent enhanced brain MRI under inhaled sevoflurane.The LMCE grade was determined by two radiologists,and interobserver variability of the grade was calculated using Cohen’s kappa.The LMCE grade was correlated with duration of sedation,age and weight using the Spearman rho rank correlation.RESULTS A total of 63 patients were included.Fourteen(22.2%)cases showed mild LMCE,48(76.1%)cases showed moderate LMCE,and 1 case(1.6%)showed severe LMCE.We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging(kappa value=0.61;P<0.001).Additionally,we found statistically significant inverse and moderate correlations between patient weight and age.There was no correlation between duration of sedation and pLMCE.CONCLUSION pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature.It should not be misinterpreted for meningeal pathology.Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.

Emerging evidence of neuronal cells-targeting SARS-CoV-2 causing anosmia associated with COVID-19

The anosmia and hypogeusia that accompany the syndromic manifestations of coronavirus disease2019(COVID-19)have become an increasing area of research during the current pandemic.These deficits are experienced as a major concern and are found to compromise the lifestyle of patients during and after acute phase of COVID-19.The key issue is the prevalence of smell and taste disorders that have been reported in some patients after partial recovery from COVID-19.