Vesicoureteral reflux postoperative radical nephroureterectomy for upper urinary tract urothelial carcinoma: A case report.

Introduction: Primary Upper tract urothelial carcinoma (UTUC) is a rare subtype of urothelial carcinoma and has an unknown incidence and prevalence in Yemen. Radical nephroureterectomy (RNU) with bladder cuff removal is the standard treatment for UTUC. Case presentation: We present a 67-year-old male patient who developed grade II vesicoureteral reflux (VUR) on the left side of the urinary tract after undergoing right-sided RNU for non-invasive UTUC. Follow-up examinations at one-, three-, and six-month post-surgery revealed no evidence of kidney diseases. The patient's recovery has been satisfactory, and ongoing regular follow-ups are being maintained. Conclusion: Vigilant monitoring of VUR presence and effective management following RNU is crucial to minimize complications and preserve renal function. The underlying mechanisms linking VUR development and RNU remain unclear, necessitating further research.

Fatty infiltration of the pancreas: a systematic concept analysis.

Fatty infiltration of the pancreas (FIP) has been recognized for nearly a century, yet many aspects of this condition remain unclear. Regular literature reviews on the diagnosis, consequences, and management of FIP are crucial. This review article highlights the various disorders for which FIP has been established as a risk factor, including type 2 diabetes mellitus (T2DM), pancreatitis, pancreatic fistula (PF), metabolic syndrome (MS), polycystic ovary syndrome (PCOS), and pancreatic duct adenocarcinoma (PDAC), as well as the new investigation tools. Given the interdisciplinary nature of FIP research, a broad range of healthcare specialists are involved. This review article covers key aspects of FIP, including nomenclature and definition of pancreatic fat infiltration, history and epidemiology, etiology and pathophysiology, clinical presentation and diagnosis, clinical consequences, and treatment. This review is presented in a detailed narrative format for accessibility to clinicians and medical students.

Adverse physiological effects of smoking cessation on the gastrointestinal tract: A review.

Smoking cessation is known to have numerous health benefits, but it can also induce adverse physiological effects, including those affecting the gastrointestinal tract (GIT). Understanding the adverse physiological effects of smoking cessation on the GIT is critical for healthcare professionals and smokers attempting to quit, as it enables them to anticipate and manage potential challenges during the smoking cessation process. Although the detrimental effects of smoking on the GIT have been well established, there is a gap in the literature regarding the specific physiological reactions that may occur upon smoking cessation. This mini-review summarizes the current literature on the predisposing factors, pathophysiology, clinical presentation, and treatment options for adverse physiological effects of smoking cessation on the GIT. We aimed to raise awareness among busy clinical professionals about these adverse effects, empowering them to effectively support individuals striving to quit smoking and maintain their cessation. By consolidating the existing knowledge in this field, this review offers practical implications for smokers, healthcare providers, and policymakers to optimize smoking cessation interventions and support strategies to improve health outcomes.

A Challenging Case of Jejunal Dieulafoy's Lesion: A Rare Cause of Refractory Lower-Gastrointestinal Bleeding.

BACKGROUND Dieulafoy's lesion is a rare cause of severe gastrointestinal (GI) bleeding, accounting for approximately 1-2% of all cases of GI hemorrhage. Nevertheless, it can be life-threatening without prompt intervention. Dieulafoy's lesion of jejunal origin can be particularly challenging to identify due to the inability of conventional endoscopic techniques to visualize the jejunum. This case report emphasizes the difficulties in diagnosing and managing jejunal Dieulafoy's lesions and highlights the methods by which to approach refractory bleeding. CASE REPORT This is a case of a 41-year-old man with a history of uncontrolled hypertension who presented with an episode of syncope and melena associated with low hemoglobin levels requiring multiple packed red blood cell transfusions. This warranted searching for a source of bleeding within the gastrointestinal tract via 2 upper-GI endoscopies, a colonoscopy, and an abdominal computed tomography angiogram, all of which failed to localize the site of bleeding. A push enteroscopy was required to identify the lesion in the jejunum, but the bleeding was not controlled despite the application of hemoclips and epinephrine. Consequently, laparotomy and resection of the jejunal segment containing the Dieulafoy's lesion was performed and the diagnosis was established histopathologically. The patient recovered well and was discharged 4 days after the procedure. CONCLUSIONS Suspicion of a jejunal Dieulafoy's lesion should be raised if both upper- and lower-GI endoscopies yield unremarkable findings. Ideally, a push enteroscopy should be utilized diagnostically and to conservatively manage the bleeding. However, laparotomy should be considered in refractory lesions or in the presence of hemodynamic instability.

Sildenafil citrate as an adjuvant to clomiphene citrate for ovulation induction in polycystic ovary syndrome: crossover randomized controlled trial.

Introduction: To evaluate sildenafil citrate as an adjuvant to clomiphene citrate (CC) for ovulation induction (OI) in women with polycystic ovary syndrome (PCOS). Material and methods: A total of 595 infertile PCOS women were randomly assigned into either clomiphene/sildenafil (C/S) group or CC group. Transvaginal (TVS)-Doppler studies were done for participants when the dominant follicle reach 16 mm, to measure the resistance index, pulsatility index, and maximum velocity of sub-endometrial, uterine, and ovarian vessels. Participants were examined using TVS on the 21st day of the cycle to detect ovulation or, after a positive pregnancy test, for documentation of pregnancy. Participants with negative pregnancy tests were given 2 months' rest without OI, followed by crossover of OI medication between the 2 studied groups. The crossover results were assessed by TVS, TVS-Doppler, and pregnancy test. Results: The endometrial thickness was significantly higher among the C/S than the CC group during the first 3 months (9.6 ±1.2 vs. 8.7 ±1.0 mm, respectively, p = 0.003) and after crossover of OI (9.1 ±1.3 vs. 8.2 ±1.0 mm, respectively, p = 0.007).The chemical and clinical pregnancy rates were significantly higher among the C/S compared to the CC group (39.8% and 36.6% vs. 25% and 18.98%, respectively) (p = 0.01 and 0.001, respectively) during the first 3 months and after crossover of OI (36.6% and 33.1% vs. 23.8% and 20.6%, respectively) (p = 0.02 and 0.01, respectively). Conclusions: SC as an adjuvant to CC for OI in PCOS women increases the chemical and clinical pregnancy rates. It also improves the endometrial thickness and ovulation rate through improved endometrial and ovarian Doppler indices.

Results from the first Kuwait National Bariatric Surgery Report.

BACKGROUND: Currently, more than 30% of the population in the gulf demonstrate a body mass index (BMI) exceeding 30. This burden of obesity has proven to take a toll on the population; therefore, we created the first Kuwait National Bariatric Surgery Database to report on bariatric surgeries performed in Kuwait. METHODS: Data was collected from the six public hospitals in Kuwait. This data was then submitted to a merged National Registry. Data web portal were used to upload, merge, and analyze the data. RESULTS: The average age for participants was 32.6 years. The average preoperative BMI was 45.9 kg/m2 for males and 43.3 kg/m2 for females. 16.4% of males and 12.3% of females presented with type 2 diabetes, while the most prevalent obesity related disease was a poor functional status in both males and females (90.8% and 90.5%, respectively). Most procedures performed in Kuwait are sleeve gastrectomy. The most encountered in-hospital complication after primary bariatric surgery was bleeding (1.5%), with Roux-en-Y gastric bypass (RYGB) having the highest recorded rate of post-operative complications (3.6% bleeding). The overall rate of operative complications was 2.6%, which was most prevalent post-RYGB (10.3%) and lowest post-sleeve gastrectomy (2.5%). CONCLUSION: The importance of tracking and documenting the journey and change in the rates of obesity and effectiveness of bariatric procedures in individual countries with significantly high obesity rates is imperative to be able to create a plan of action to tackle this worldwide epidemic. This report will be able to provide the population with an accurate accounting that demonstrates further the safety of bariatric/metabolic surgery.

Behavior and Practices of Type 2 Diabetic Patients Regarding Obesity: A Cross-Sectional Study.

Background Obesity is a major public health concern and is associated with incident cardiovascular diseases. A very few studies around the globe have assessed how type 2 diabetic (T2D) patients comprehend obesity. Our study aims to evaluate the concerns and behaviors of T2D patients regarding obesity in a developing country like Pakistan. Methods A cross-sectional study was conducted in Karachi during the period of December to February 2020 in which T2D patients were assessed for their comprehension of how obesity affects their disease and concerns, as well as their practices such as weight loss activities and dietary habits. Data analysis was performed using Statistical Package for the Social Sciences Version 24 (IBM Corp., Armonk, NY, USA). Results Of 417 T2D patients inducted in our study, 265 (63.5%) knew their ideal body weight, whereas only 221 (52.9%) knew how to measure it. Among those who were willing to lose weight, this was mostly due to a wish to avoid further complications of obesity (N=155 [73.1%]) and also peer/family pressures (N=124 [58.5%]) among other reasons. More obese (N=68 [43.6%]) than non-obese participants (N=87 [33.3%]) were willing to consult a doctor to help them reduce weight. Participants had adopted various strategies to reduce weight, of which increasing exercise (N=242 [85.8%]) and healthy eating (N=162 [57.4%]) were most popular. Conclusions There is a need to address barriers to weight loss among T2D patients in Pakistan and to provide patients with pragmatic guidelines on how to make sustainable lifestyle changes to help reduce and maintain their body weight.

Electro-encephalogram as predictor of eclampsia.

OBJECTIVE: To assess the efficacy of using electroencephalographic changes for predicting eclampsia. METHODS: The observational case-control study was conducted in the Obstetrics Department of Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from April 1, 2016, to April 1, 2018, and comprised women with singleton pregnancy who had 24-40 weeks of gestation. They were divided into two groups as preeclamptic cases and normotensive controls. The groups were compared regarding electroencephalographic changes and the development of eclampsia in those with abnormal changes. Data was analysed using EVEIWS 9. RESULTS: Of the 100 subjects, 50(50%) were in each of the two groups. There was no significant difference between the groups in terms of demographic and clinical data (p>0.05) except blood pressure (p<0.05). Among the patients, 31(62%) had electroencephalographic abnormalities, while among the controls 3(6%) showed abnormal waves (p<0.001)..Focal sharp and intermittent slow waves were the commonest abnormal waves detected but the percentages of these waves between the groups were statistically not significant (p>0.05). CONCLUSIONS: Women with preeclampsia were found to have electroencephalographic abnormalities which might predict an eclamptic fit.

After crisis: health, politics and reflections on the European refugee crisis.

The years 2014 and 2015 saw a dramatic rise in the number of migrants entering Europe via the Mediterranean. This rise was mostly accounted for by refugees fleeing the civil war in the Syrian Arab Republic. Since that time Europe has been gripped in a political and humanitarian crisis as the incoming numbers overwhelmed individual state and collective European Union ability to respond effectively. In this article, I explore the European Migrant Crisis in geographical, political and humanitarian perspectives, describing and explaining the key events of the crisis. I then go on to a study of the major health issues arising from the crisis in terms of communicable and non-communicable disease, mental health, gender-related health and access to healthcare. Finally, I discuss the global dimensions of the refugee crisis and enter into a discussion of the roles and effectiveness of the UNHCR and the European Union's response as a whole.

The disabling consequences of Mycetoma.

Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. The disease is characterised by the triad of painless subcutaneous mass, multiple sinuses and discharge that contain grains. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications. In this descriptive cross-sectional study, we characterise the disabling consequences of mycetoma. The study included 300 patients; 228 (76%) male and 72 (24%) female with confirmed mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan in the period May 2016 and January 2017. The study design was based upon the International Classification of Functioning, Disability and Health, examining the impact of mycetoma on eight life domains. Our major finding is that mycetoma is a significantly disabling disease. Over 60% of the study population (181 patients) had moderate impairment or difficulty in at least one domain variable. The important disability was mobility impairment and walking difficulty that was reported in 119 patients (39.7%). There was significant pain associated with mycetoma lesions in 103 patients (34%), challenging the traditional view of mycetoma as a painless disease. The economic burden was also found to be substantial, with 126 patients (46.7%) reporting barriers to their ability to sustain themselves. This is the first study evaluating the disabling consequences of mycetoma and shows clear areas for intervention and further research. Options for mitigating social and economic impacts include routine integration of analgesia and physiotherapy into treatment protocols, and adapting educational provision and working practices based on disability assessment. Our data show that mycetoma is a public health issue with direct implications on quality of life.

Improving the view during flexible sigmoidoscopy: a systematic review of published randomized, controlled trials comparing the use of oral bowel preparation versus enema bowel preparation.

To systematically analyse the published randomized, controlled trials (RCTs) comparing the use of oral bowel preparation (OBP) versus enema bowel preparation (EBP) for diagnostic or screening flexible sigmoidoscopy. Published RCTs, comparing the use of OBP versus EBP, were analysed using RevMan(®), and the combined outcomes were expressed as odds ratios (OR). Eight RCTs evaluating 2457 patients were retrieved from the standard electronic databases. There was significant heterogeneity among included trials. The compliance of the patients (p = 0.32) and the acceptability of both bowel preparation regimens (OR, 1.42; 95% CI, 0.67, 2.99; z = 0.92; p = 0.36) were similar in both groups. In addition, the incidence of adverse reactions (OR, 0.87; 95% CI, 0.54, 1.41; z = 0.57; p = 0.57), the risk of incomplete procedure due to poor bowel preparation (p = 0.18) and the incidence of poor bowel preparation (OR, 1.21; 95% CI, 0.63, 2.33; z = 0.59; p = 0.56) were also similar in both groups. EBP and OBP were equally effective for bowel preparation in patients undergoing flexible sigmoidoscopy. Although this study failed to demonstrate the superiority of EBP, at least equivalent efficacy for bowel cleansing may be extrapolated.

Weight misperception amongst youth of a developing country: Pakistan -a cross-sectional study.

BACKGROUND: Weight misperception is the discordance between an individual's actual weight status and the perception of his/her weight. It is a common problem in the youth population as enumerated by many international studies. However data from Pakistan in this area is deficient. METHODS: A multi-center cross-sectional survey was carried out in undergraduate university students of Karachi between the ages of 15-24. Participants were questioned regarding their perception of being thin, normal or fat and it was compared with their Body Mass Index (BMI). Measurements of height and weight were taken for this purpose and BMI was categorized using Asian cut offs. Weight misperception was identified when the self-perceived weight (average, fat, thin) did not match the calculated BMI distribution. Chi square tests and logistic regression tests were applied to show associations of misperception and types of misperception (overestimation, underestimation) with independent variables like age, gender, type of university and faculties. P-value of <0.05 was taken as statistically significant. RESULTS: 42.4% of the total participants i.e. 43.3% males and 41% females misperceived their weight. Amongst those who misperceived 38.2% had overestimated and 61.8% had underestimated their weight. Greatest misperception of was observed in the overweight category (91%), specifically amongst overweight males (95%). Females of the underweight category overestimated their weight and males of the overweight category underestimated their weight. Amongst the total participants, females overestimated 8 times more than males (OR 8.054, 95% CI 5.34-12.13). Misperception increased with the age of the participants (OR 1.114, 95% CI 1.041-1.191). Odds of misperception were greater in students of private sector universities as compared to public (OR 1.861, 95% CI: 1.29-2.67). Odds of misperception were less in students of medical sciences (OR 0.693, 95% CI 0.491-0.977), engineering (OR 0.586, 95% CI 0.364-0.941) and business administration (OR 0.439, 95% CI 0.290-0.662) as compared to general faculty universities. CONCLUSION: There was marked discrepancy between the calculated BMI and the self-perceived weight in the youth of Karachi. Better awareness campaigns need to be implemented to reverse these trends.

Bicipital tuberosity osteochondroma causing painful clicking around the wrist: case report and literature review.

Osteochondromatas of bicipital tuberosity are rare, most commonly occurring as metaphyseal benign tumours of the long bones. The usual presenting symptoms are pain and reduced rotation of the elbow. A painful clunk in the wrist as a presenting symptom has not been described before. We present a young lady with a two-year history of a painful clunk in her wrist. Her case presented a diagnostic challenge, as the pain and the click originated from her elbow and radiated down her forearm to the wrist. She underwent several radiological studies, and examination under anaesthesia confirmed the diagnosis. Excision was performed resulting in complete resolution of her symptoms. Along with painful clunk in the wrist originating from the elbow, an enlarged radial tuberosity should raise a high index of suspicion, and MRI scans and examination under image intensification can aid in the diagnosis of radial tuberosity osteochondroma.

Perforated caecal diverticulitis mimicking an acute appendicitis: a case report.

Right iliac fossa pain, nausea and vomiting in young adults are common symptoms that require careful surgical assessment with acute appendicitis being a common cause. Uncommonly, other conditions can mimic this presentation such as caecal diverticulitis. This condition is often misdiagnosed due to lack of characteristic features and the commonest method of detection is an intraoperative one. Hereby, we describe a rare case of right iliac fossa pain in a 34-year-old female which mimicked an acute appendicitis. The ability to recognize such condition is vital as its management is different and worse outcome can be prevented by earlier detection and proper management.