Clinical utility of degradomics as predictors of complications and clinical outcome in aneurysmal subarachnoid hemorrhage.

Most of the debilitating conditions following aneurysmal subarachnoid hemorrhage result from symptomatic cerebral vasospasm and delayed cerebral ischemia. Several scales are being used, but they still lack objectivity and fail to quantify complications considered essential for prognostication routine use of biomarkers to predict complications and outcomes after aneurysmal rupture is still experimental. Degradomics were studied extensively in traumatic brain injury, but there is no discussion of these biomarkers related to aneurysmal subarachnoid hemorrhage. Degradomics involve the activation of proteases that target specific substrates and generate specific protein fragments called degradomes. While the proteolytic activities constitute the pillar of development, growth, and regeneration of tissues, dysregulated proteolysis resulting from pathological conditions like aneurysmal subarachnoid hemorrhage ends up in apoptotic processes and necrosis. To our knowledge, this is the first overview that lists a panel of degradomics with cut-off values in serum and cerebrospinal fluid, where specificity and sensitivity are only found in Kallikrein 6, Ubiquitin C Terminal Hydrolase 1 and Alpha-II-Spectrin.

COVID-19 and COVID-19 Vaccine-Related Skin Ulcerations in the Lower Extremities: A Case Report and Literature Review.

CASE: A 53-year-old male patient presented to the dermatology clinics with a three-week history of painful necrotic patches coalescent of the lateral malleolus of the right and left ankles. History goes back to when the patient reported developing pruritic papules two weeks after receiving his second shot of the Pfizer BioNTech COVID-19 vaccine (BNT162b2). Punch biopsy was consistent with leukocytoclastic vasculitis. He was prescribed a four-week course of systemic corticosteroids and antibiotics as per cultures. Vascular assessment confirmed normal peripheral arterial and venous system. Two months later, the patient re-presented with fever and worsening of his lower extremity ulcers. He underwent debridement of his wounds. Intra-operative cultures revealed multidrug resistant bacteria. He required an additional debridement session a few days later and a 14-day course of Piperacillin-Tazobactam. The patient was subsequently discharged on corticosteroids and Azathioprine and followed up in the vascular surgery and rheumatology clinics. At four months follow-up, the patient's wounds were almost completely healed. CONCLUSION: This article highlights a case of severe new-onset COVID-19 vaccine-associated leukocytoclastic vasculitis complicated with infected ulcers that required debridement twice in addition to a prolonged course of antibiotics and immunosuppression therapy. To our knowledge, none of the cases reported in the literature were this severe in nature. In this post-pandemic era, it must remain high on the differential list, and healthcare specialists should maintain a high index of suspicion when evaluating sudden new-onset skin lesions that do not have an immediately apparent etiology.

Performance and oncologic safety of sentinel lymph node biopsy after neoadjuvant chemotherapy: Results from a tertiary care center in Lebanon.

BACKGROUND: The feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) in initially node-positive patients is still controversial. We aim to evaluate the oncologic outcomes of SLNB after NACT and further compare the results between those who were initially node-negative and node-positive. METHODS: This is a retrospective cohort that included patients diagnosed with invasive breast cancer and had surgical management between January 2010 and December 2016. Survival and recurrence data after 3-5 years were collected from patients' records. We divided patients into Group A who were initially node-negative and had SLNB ± axillary lymph node dissection (ALND) and Group B who were node-positive and had SLNB ± ALND. RESULTS: Among initially node-negative patients, 43 out of 63 patients did SLNB (Group A). However, among initially node-positive patients only 28 out of 123 patients did SLNB (Group B). Out of the 71 patients who did SLNB after NACT, 26 patients had positive SLNs with only 14 patients who further underwent ALND. The identification rate of SLNB was 100% in Group A and 96.4% in Group B. The survival curves by nodal status showed no significant difference between overall survival and recurrence-free survival at 5 years between patients in Group A versus Group. CONCLUSION: The results suggest that in properly selected patients, SLNB can be feasible after NACT. Our results resemble the reported literature on accuracy of SLNB after NACT and adds to the growing pool of data on this topic.

Single Incision Versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review.

Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery and has been associated with excellent outcomes and a significant reduction in obesity-related morbidity and mortality. Traditionally, this surgery is performed using five to seven trocars. However, LSG performed through a single trocar is emerging as a less invasive method of performing this surgery. This systematic review and meta-analysis compare the outcomes and complication rates of single-port versus multi-port LSG. We searched PubMed, Medline, Scopus, and the Cochrane Library for articles published from 2008 to 2023, in accordance with the PRISMA 2020 guidelines. Data on variables such as operative time, excess weight loss, intraoperative bleeding, postoperative leak, and incisional hernia rates were collected and analyzed using a random-effects model. Fourteen articles met the inclusion criteria and were included in the meta-analysis. No significant differences were found between the single-port LSG (SILSG) and conventional LSG (CLSG) groups in terms of operative time, rate, intraoperative complications, length of hospital stay, postoperative complications, and excess weight loss (EWL). Furthermore, single incision sleeve gastrectomy showed better satisfaction with the cosmetic score. SILSG is a viable alternative procedure, showing comparable outcomes to multiport conventional sleeve gastrectomy, in addition, to a better cosmetic satisfaction score.

Robot-Assisted Heller Myotomy Versus Laparoscopic Heller Myotomy: A Systematic Review and Meta-Analysis.

Robot-assisted Heller myotomy (RAHM) is an increasingly popular alternative to the traditional laparoscopic Heller myotomy (LHM) in the surgical management of achalasia, with similar outcomes and potentially lower complication rates. We aimed to systematically review the literature by comparing the technical success, outcomes, and complications of RAHM and LHM. We searched PubMed, Medline, and Cochrane Central Register for articles published between 2001 and 2023. Data on technical success, clinical outcomes, length of hospital stay, esophageal perforation rate, and overall mortality were extracted. A total of 11 articles were included in the study, comparing a total of 3,543 RAHM and 15,434 LHM cases. The mean operative time was significantly higher in the RAHM procedure with a total mean difference of 23.95 (95% confidence interval (Cl) 17.09, 30.81; p < 0.00001; I2 = 99%). However, the RAHM was associated with a significantly shorter hospital stay, with a total mean difference of -0.24 (95% Cl = -0.40, -0.08; p < 0.00001; I2 = 81%). The volume of blood loss was significantly smaller in RAHM with a total mean difference of -61.11 (95% CI = -150.31, 28.09; p < 0.00001; I2 = 99%). Esophageal mucosal perforation was significantly lower in RAHM with an odds ratio of 0.36 (95% CI = 0.16, 0.82; p = 0.02; I2 = 22%). Both procedures were associated with similar rates of symptom relief. Although no mortality was recorded in patients who underwent RAHM as opposed to 16 cases in patients who underwent LHM, no statistically significant difference could be reached. Our results demonstrate that while both procedures yield comparable clinical outcomes, RAHM is associated with a lower overall complication rate, particularly a lower rate of esophageal mucosal perforation, shorter hospital stay, and possibly a lower mortality rate. This confirms that RAHM is a viable and justifiable alternative to the conventional LHM in the surgical management of achalasia.

Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

Purpose: This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy. Materials and Methods: This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted. Results: The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I2=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I2=0%). Conclusion: OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB. Trial Registration: PROSPERO Identifier: CRD42023474966.

Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis.

Purpose: Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. Materials and Methods: A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates. Results: SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50-149.46, I2=99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I2=44%), dyslipidemia in 55% (95% CI 40-69%, I2=30%), and diabetes in 63% (95% CI 53-72%, I2=30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I2=75%). In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61, I2=95%) at six months, 59.39% (95% CI 51.18-67.61, I2=95%) at twelve months, and 23.84% (95% CI 5.76-41.92, I2=100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I2=80%) of cases. Conclusion: SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis.

Purpose: In recent years, the need for revisional bariatric surgery (RBS) procedures has experienced a noteworthy surge to confront complexities and weight recidivism. Despite being a subject of controversy for many, the utilization of the Da Vinci robotic platform (Intuitive Surgical, Inc.) may present benefits in RBS. This study aimed to evaluate the outcomes of robotic RBS in comparison to Laparoscopic RBS. Methods: A meticulous and thorough analysis was ensured through a comprehensive exploration of the literature, which included PubMed, Medline, Scopus, and Cochrane. This exploration was conducted in adherence to the directives outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale was used for quality assessment. Results: A total of 11 studies were included in this meta-analysis, comprising 55,889 in the laparoscopic group and 5,809 in the robotic group. No significant differences were observed in the leak, bleeding, operative time, or length of stay across both groups. However, the robotic group showed higher rates of conversion to open surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53-0.79; p < 0.0001; I2 = 0%), reoperation (OR, 0.70; 95% CI, 0.57-0.87; p = 0.0009; I2 = 6%), and readmission (higher rate of readmission in the robotic group; OR, 0.76; 95% CI, 0.62-0.92; p = 0.005; I2 = 30%). Conclusion: Robotic-assisted bariatric surgery has no significant advantage over conventional laparoscopic surgery. Further research is warranted to explore and evaluate surgeons' methodology and proficiency differences.

Primary squamous cell carcinoma of the colon: A rare case report.

INTRODUCTION AND IMPORTANCE: Squamous cell carcinoma (SCC) of the colon is an extremely rare pathologic entity, accounting for less than 1 % of all colorectal cancer cases. They tend to be very aggressive with poor outcomes and treatment strategies are still controversial due to the paucity of data available to guide management. CASE PRESENTATION: A case of a cecal mass with metastatic liver lesions. Initially diagnosed as an adenocarcinoma, the patient underwent resection with metastasectomy. Despite achieving negative surgical margins and undergoing adjuvant chemotherapy, the patient relapsed and presented with a new mass in the descending colon. The patient underwent resection with subsequent follow-up revealing distant metastasis. The patient passed away soon after. CLINICAL DISCUSSION: Primary colorectal SCC has similar presentation to adenocarcinoma of the colon. Unfortunately, it usually presents at a late stage. Diagnosis of colorectal SCC requires histologic confirmation of SCC plus exclusion of possible causes. Management is predominantly definitive radical resection followed by adjuvant chemotherapy and radiotherapy. Surgical margins should be at least 5 cm, preferably 10 cm. Lymph node yield greater than 20 was associated with improved survival. Studies assessing the prognosis of primary colorectal SCC following chemo-radiotherapy have not been done. CONCLUSION: Surgery remains the most vital important step in the management of colonic SCC. The role of chemotherapy and/or radiation remains questionable. Depending on the aggressiveness of this disease the need for further frequent.

Indirect ballistic injury to the liver resulting in retained bullet complicated with hepatic abscess: a case report.

Indirect and extraperitoneal penetrating liver injury is an extremely uncommon phenomenon. In this report, we highlight the case of an 18-year-old male patient that sustained a gunshot wound with an entry site through the right buttock and landed in the liver. He presented to us in sepsis due to developing a hepatic abscess at the site of the dislodged bullet that was confirmed with computed tomography. Interestingly, the ballistic missile did not cause any visceral injury due to its indirect and extraperitoneal trajectory. The patient underwent diagnostic laparoscopy, where the hepatic abscess was unroofed and evacuated. A free-floating bullet was found and extracted, and a small bile duct leak was repaired. The patient had an uneventful post-operative course and was duly discharged on an empiric course of antibiotics.

Geographic Variation in Strabismus Pattern Among Pediatric Age Group in Lebanon: A Single-Centre Five-Year Observational Study.

BACKGROUND: Strabismus means ocular misalignment. It is also one of the most prevalent types of amblyopia and the leading cause of pediatric visual impairment. OBJECTIVE: This study aims to determine the frequency of different types of strabismus and the associated refractive errors and amblyopia in patients younger than 16 years of age. This study also aims to compare the age at presentation and gender between the geographic locations and between different strabismus types. MATERIALS AND METHODS: A cross-sectional retrospective study was done using the archives of Beirut Eye and ENT specialist hospital between January 2014 and December 2018. Lebanese pediatric patients aged <16 years having strabismus were included in this study. RESULTS: There was a total of 787 pediatric patients with strabismus, 62.6% of cases had esotropia (ET) and 30.2% exotropia (XT), with ET/XT: 2.07/1. Mt Lebanon had the highest number of cases, whereas Nabatieh was the only governorate with reversed ET/XT ratio. Most patients were diagnosed at the age of 1-5 years, with ET being the most common diagnosis, while XT was mostly found in patients aged 11-15. Hyperopia was the most common (55.4%) refractive error detected in our cohort of strabismus patients, followed by myopia and simple astigmatism. Amblyopia was found in 18.9% of cases, where Nabatieh had the highest count. CONCLUSION: Strabismus pattern was investigated for the first time across Lebanon to shed the light on the crucial role of early ophthalmologic examination, to detect early refractive error and strabismus, and to prevent amblyopia.

A Bibliometric Analysis of Neurosurgery Research Productivity in Arab Countries Between 2005 and 2019.

BACKGROUND: The Arab world is lagging behind in the world of publications and research, especially in the biomedical-related field. This is a bibliometric analysis that aims to assess the neurosurgical research productivity across different Arab countries. METHODS: PubMed was used to quantify the number of neurosurgery-related articles published by each Arab country, by several journals, investigating specific topics between 2005 and 2019. Numbers were normalized with respect to each country's average population and average gross domestic product (GDP). RESULTS: Arab countries contributed 0.53% of total neurosurgery publications. Egypt had the highest number of neurosurgery-related publications (362), ahead of Saudi Arabia (238) and Lebanon (133). In terms of publications per million persons, Lebanon was first with 21.6 publications per million persons. In terms of GDP, Egypt ranked first with 18.85 publications per million $. There was an insignificant correlation between the number of publications on one hand and the average GDP (P = 0.09) on the other hand, whereas the average population explains around 50% of the neurosurgery-related publications (R squared = 0.49, P < 0.01). Neoplasms were the dominating area of research, and the WORLD NEUROSURGERY journal had the highest number of publications. CONCLUSIONS: The results reached by this study reflect an undoubtable need for more research on neurosurgery by Arab countries. This goes back to the different obstacles facing Arab countries every day, affecting the economic, educational, and health care systems.

Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence.

BACKGROUND: Stent-assisted coil embolization of ruptured wide-necked aneurysms is a controversial treatment modality due to concerns on the peri-procedural safety of anti-platelet therapy in the setting of acute subarachnoid hemorrhage. Our aim was to systematically review the literature on stent-assisted coil embolization of acutely ruptured wide-neck aneurysms to calculate the pooled prevalence of clinical outcome, thromboembolic and hemorrhagic complication rates and overall mortality. METHODS: We searched PubMed and Google Scholar for articles published between 2009 and 2019 and stratified selected articles based on risk of publication bias. Data on thromboembolic and hemorrhagic complications, clinical outcomes and mortality rates were analyzed using quality-effects model and double arcsine transformation. RESULTS: 24 articles were included featuring a total of 1582 patients. Thromboembolic and hemorrhagic complication rates were witnessed in 9.1% [95% CI: 6.0% - 12.7%; I2 = 72.8%] and 8.7% [95% CI: 5.4 - 12.6%; I2 = 77.2%] of patients, respectively. 245 patients received external ventricular drains, of which 33 (13.5%) had EVD-related hemorrhages. Total complication rate was 20.8% [95% CI: 14.2 - 28.1%; I2 = 87.0%]. 57% of aneurysms were completely occluded and a favorable clinical outcome was reported in 74.7% [95% CI: 66.4 - 82.2%; I2 = 86.0] of patients. Overall mortality rate came at 7.8% [95% CI: 4.8 - 11.6%; I2 = 76.9%]. CONCLUSION: Stent-assisted coiling of ruptured intracranial aneurysm is a technically feasible procedure with controlled thromboembolic complication rate but may be associated with higher hemorrhagic and total complication rates compared to coiling alone. While stent-assisted coiling of ruptured wide-necked aneurysm seems to yield a lower rate of favorable clinical outcome, overall mortality is comparable to that of endovascular coiling alone.