Therapeutic pediatric upper endoscopy: a retrospective report from a low-volume center

Background:Pediatric endoscopy has become an essential diagnostic and therapeutic tool for a range of gastrointestinal conditions in children,according to published guidelines.This study aimed to assess the indications,outcomes,and complications of therapeutic endoscopy in children at King Abdullah University Hospital(KAUH)in Jordan.Methods:This study conducted a retrospective chart review of therapeutic endoscopic procedures,including esophageal dilation,variceal and non-variceal hemostasis,foreign body retrieval,and percutaneous endoscopic gastrostomy(PEG)Tube insertion,performed between January 2014 and December 2020 at the Gastrointestinal Endoscopy Unit(a mixed adult and pediatric unit)at KAUH.Demographic data,indications for intervention,comorbidities,procedural outcomes,postprocedural treatment,complications,readmission,and patient follow-up data were extracted from the patient's medical records.Results:During the study period,185 patients underwent 260 therapeutic endoscopic procedures.110(60%)of the patients were boys.The average age of the patients was 81.8±51.46(standard deviation)months.Foreign body retrieval was the most common procedure,with accidental ingestion being the primary cause and coins being the most commonly impacted foreign body.Followed by esophageal dilatation and PEG tube insertion.Complications were mild and rare.Conclusion:The success rates and post-procedural complications of pediatric endoscopy procedures are similar between low-and high-volume hospitals worldwide,and procedural volume is not the only factor contributing to procedural outcomes and complication rates.

Ultrasound-guided transrectal extended prostate biopsy:a prospective study

Aim:To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer.Methods:One hundred and fifty-two patients with suspected prostate cancer were included in the study.Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4 ng/mL) and/or had undergone an abnormal digital rectal examination (DRE).In addition to sextant prostate biopsy cores,four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound.Sextant,lateral peripheral zone and suspicious area biopsy cores were submitted separately to the patho- logical department.Results:Cancer detection rates were 27.6 % (42/152) and 19.7 % (30/152) for the 10-core and sextant core biopsy protocols,respectively.Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6 % (12/42) increase in the cancer detection rate in patients with positive prostate cancer (P<0.01). The cancer detection rate in patients who presented with elevated PSA was 29.3 % (34/116).When serum PSA was 4-10 ng/mL TRUS-guided biopsy detected cancer in 20.6 %,while the detection rate was 32.4 % and 47.0 % when serum PSA was 10-20 ng/mL and above 20 ng/mL,respectively.Conclusion:The 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6 % when compared with the sextant biopsy technique alone,without increase in the morbidity.We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.

Constipation-predominant irritable bowel syndrome: A review of current and emerging drug therapies

Irritable bowel syndrome(IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS(IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

Celiac disease in patients with presumed irritable bowel syndrome:A case-finding study

AIM:To estimate the prevalence of celiac disease(CD) in adult patients with presumed irritable bowel syndrome(IBS) .METHODS:Between March 2005 and December 2008,742 consecutive patients(293 male,median age 43 years,range 18-69 years) fulfilling the Rome Ⅱ criteria for IBS were prospectively enrolled in the study.IBS was diagnosed via self-completed Rome Ⅱ modular questionnaires.Anti-tissue transglutaminase(anti-tTG) serology was checked to initially recognize possible CD cases.Patients with a positive test were offered endoscopic duodenal biopsy to confirm the diagnosis of CD.RESULTS:Thirty two patients(15 male,median age 41 years,range 19-59 years) were found to have organic diseases other than CD.Twenty four patients tested positive for anti-tTG antibodies,and duodenal biopsies confirmed the diagnosis in all of them.Thus,in this patient population with presumed IBS,3.23% actually had CD.CONCLUSION:CD is common in patients with presumed IBS.Routine screening for CD in patients with symptoms of IBS is recommended.

Protozoan parasites in irritable bowel syndrome:A case-control study

AIM To investigate the putative role of protozoan parasites in the development of irritable bowel syndrome(IBS).METHODS The study included 109 IBS consecutive adult patients fulfilling the Rome Ⅲ criteria and 100 healthy control subjects. All study subjects filled a structured questionnaire, which covered demographic information and clinical data. Fresh stool samples were collected from patients and control subjects and processed within less than 2 h of collection. Iodine wet mounts and Trichrome stained smears prepared from fresh stool and sediment concentrate were microscopically examined for parasites. Blastocystis DNA was detected by polymerase chain reaction, and Cryptosporidium antigens were detected by ELISA.RESULTS A total of 109 IBS patients(31 males, 78 females) with a mean age ± SD of 27.25 ± 11.58 years(range: 16-60 years) were enrolled in the study. The main IBS subtype based on the symptoms of these patients was constipation-predominant(88.7% of patients). A hundred healthy subjects(30 males, 70 females) with a mean ± SD age of 25.0 ± 9.13 years(range 18-66 years) were recruited as controls. In the IBS patients, Blastocystis DNA was detected in 25.7%, Cryptosporidium oocysts were observed in 9.2%, and Giardia cysts were observed in 11%. In the control subjects, Blastocystis, Cryptosporidium and Giardia were detected in 9%, 0%, and 1%, respectively. The difference in the presence of Blastocystis(P = 0.0034), Cryptosporidium(P = 0.0003), and Giardia(P = 0.0029) between IBS patients and controls was statistically significant by all methods used in this study.CONCLUSION Prevalence of Blastocystis, Cryptosporidium and Giardia is higher in IBS patients than in controls. These parasites are likely to have a role in the pathogenesis of IBS.

Artificial Neural Networks for Prediction of COVID-19 in Saudi Arabia

In this study,we have proposed an artificial neural network(ANN)model to estimate and forecast the number of confirmed and recovered cases of COVID-19 in the upcoming days until September 17,2020.The proposed model is based on the existing data(training data)published in the Saudi Arabia Coronavirus disease(COVID-19)situation—Demographics.The Prey-Predator algorithm is employed for the training.Multilayer perceptron neural network(MLPNN)is used in this study.To improve the performance of MLPNN,we determined the parameters of MLPNN using the prey-predator algorithm(PPA).The proposed model is called the MLPNN–PPA.The performance of the proposed model has been analyzed by the root mean squared error(RMSE)function,and correlation coefficient(R).Furthermore,we tested the proposed model using other existing data recorded in Saudi Arabia(testing data).It is demonstrated that the MLPNN-PPA model has the highest performance in predicting the number of infected and recovering in Saudi Arabia.The results reveal that the number of infected persons will increase in the coming days and become a minimum of 9789.The number of recoveries will be 2000 to 4000 per day.

Severe phimosis-like epiretinal membrane proliferation following internal limiting membrane peeling for macular hole

Dear Editor,I nternal limiting membrane(ILM)peeling with gas tamponade has been the preferred surgical technique for the macular hole treatment[1-2].Eckardt et al[1]achieved a complete closure of 92%of the macular holes.Generally,the procedure involves peeling of ILM from the macula using a microvitreoretinal blade with an intraocular forceps 500 mm superior to the hole,removal of membranes and releasing the traction around the macular hole.If a macular epiretinal membrane(ERM)is present,it should be peeled during the surgery[1-2].

Intramural cardiac hydatid cyst—Incidental finding

Hydatid cyst was commonly found in the liver followed by lungs and brain. Cardiac hydatid cysts are less common compared to hepatic ones. We report a case of intramural hydatid cyst that is incidentally found during the work-up of a hepatic hydated cyst.

Community-acquired serious bacterial infections in the first 90 days of life:a revisit in the era of multi-drug-resistant organisms

Background Infants in the first 90 days of life are more prone to develop serious bacterial infections(SBIs).Multi-drug-resistant organisms(MDROs)are emerging as important pathogens causing SBIs.We reviewed the epidemiology of SBIs in infants 0-90 days old and compared the clinical features,laboratory values and final outcome for SBIs due to MDROs vs.non-MDROs.Methods Episodes of culture-proven SBIs(bacteremia,urinary tract infections,or meningitis)with age at onset of 0-90 days during a 7-year period were retrospectively reviewed.Health care-associated infections were excluded.We collected demo-graphics,clinical features,and laboratory and microbiology data.We compared clinical characteristics,laboratory data,microbiologic results and final outcome for SBIs due to MDROs vs.non-MDROs.Results Ninety-four episodes(88 patients)including bacteremia(42.6%),urinary tract infections(54.3%)and meningi-tis(3.1%)were caused by Gram-negative bacteria(67%),and Gram-positive bacteria(33%).Escherichia coli,Klebsiella pneumoniae and GBS were the most common causes.MDROs caused SBIs in 39 patients(44.3%).SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs(74.4%vs.0%,P≤0.001,but no difference in case-fatality rate(12.8%vs.12.2%,P=1.0).Clinical features or basic laboratory values were not statistically different between the two groups.Conclusions The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs,which causes more delay in providing targeted antimicrobial therapy.Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner.

乳糜泻相关的Budd-Chiari综合征:病例报告及文献复习

We report a case of Budd-Chiari syndrome occurring in a patient with coeliac disease,who presented with symptoms of increased abdominal girth,right upper quadrant pain and shortness of breath for three weeks prior to admission.Initial assessment revealed the presence of moderate ascites,hepatosplenomegaly and right-sided pleural effusion.Further diagnostic work-up established a diagnosis of chronic Budd-Chiari syndrome.Interestingly,complete screening for pro-thrombotic factors was negative.A review of the literature on this association disclosed only 28 similar cases,with the majority of them describing individuals of North African origin.Interestingly,in the majority of cases no specific thrombotic factor could be identified,suggesting that coeliac disease may play a role in this thrombotic disorder.