Assessment of the knowledge, attitude, and perception of the world's population towards monkeypox and its vaccines: A systematic review and descriptive analysis of cross-sectional studies.

Background: Prevention and treatment of the monkeypox virus (Mpox) remain challenging in areas where it is endemic. This systematic review and meta-analysis aimed to collect this information from various studies in one study to give a comprehensive view of people's opinions, fears, and behaviors about this virus. Methods: We searched PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for descriptive cross-sectional study designs conducted in 2022 and 2023 addressing knowledge, attitude, perception, preparedness, willingness to get vaccinated, and practices against Mpox infection. Results: Among the included studies, 16 studies assessed the level of knowledge of study participants regarding Mpox with a total of 9066 participants. Among them, 4222 (46.6 %) were reported to have good knowledge, and 4844 (53.4%) were reported to have poor knowledge about Mpox. Regarding willingness to get vaccinated against Mpox, 14 studies with a total of 10,696 participants were included. Among them, 7006 (65 %) were willing to get vaccinated while 3690 (35 %) weren't willing to be vaccinated. Conclusion: Knowledge about Mpox should be increased and awareness should be spread regarding the importance of preventive measures such as vaccination to protect the population from another COVID-19-like pandemic.

Dumping Syndrome after Bariatric Surgery.

Dumping syndrome (DS) is a collection of gastrointestinal (GI) and vasomotor symptoms arising postprandially because of prompt gastric emptying. This can develop due to any changes in gastric anatomy or innervation during esophageal, gastric, or bariatric surgery. Due to the increase in the number of bariatric operations and innovative surgeries performed internationally, bariatric surgery has emerged as the most common cause of this disease entity. 25-50% of all gastric surgery patients experience dumping symptoms after their procedures. Patients who have had Roux-en-Y gastric bypass (RYGB) are at an extremely high risk (up to 40%) of developing dumping syndrome postoperatively. The goal of this review is to provide an insightful evaluation of the most recent literature on the overlooked scientific and clinical elements of dumping syndrome, such as diagnostic aspects, pathogenesis, terminology, and management. More research is needed to establish guidelines and terms used to properly document and manage dumping syndrome.

Incarcerated incisional hernia on an old orthopedics incision, a rare case report and a review of the literature.

A previous surgical incision can lead to an abdominal wall defect known as an incisional hernia. The protrusion of abdominal viscera, particularly bowel loops, through this defect can result in various complications and affect organ function. Bowel loops are frequently involved and can lead to incarceration, obstruction or even strangulation. A 38-year-old male with a history of open reduction internal fixation for the left iliac wing presented with abdominal pain, vomiting and obstipation. Abdominal examination revealed a tender, distended abdominal area with swelling on the left hip. Radiological examination revealed bowel obstruction at the previous surgery site. During surgery, an incisional hernia was confirmed, and the bowel was found viable. Incisional hernias can occur even many years after primary surgery and may remain asymptomatic until complications arise. Elective hernial repair is recommended in some cases, such as the one presented here, as complications can be fatal.

Effectiveness of Gabapentin as a Benzodiazepine-Sparing Agent in Alcohol Withdrawal Syndrome.

Background and Objectives: Gabapentin has shown promise as a potential agent for the treatment of alcohol withdrawal syndrome. We aimed to evaluate the effectiveness of gabapentin as a benzodiazepine-sparing agent in patients undergoing alcohol withdrawal treatment in all the hospitals of a large tertiary healthcare system. Materials and Methods: Medical records of patients admitted to the hospital for alcohol withdrawal management between 1 January 2020 and 31 August 2022 were reviewed. Patients were divided into two cohorts: benzodiazepine-only treatment who received benzodiazepines as the primary pharmacotherapy and gabapentin adjunctive treatment who received gabapentin in addition to benzodiazepines. The outcomes assessed included the total benzodiazepine dosage administered during the treatment and the length of hospital stay. The statistical models were calibrated to account for various factors. Results: A total of 4364 patients were included in the final analysis. Among these, 79 patients (1.8%) received gabapentin in addition to benzodiazepines, and 4285 patients (98.2%) received benzodiazepines only. Patients administered gabapentin required significantly lower average cumulative benzodiazepine dosages, approximately 17.9% less, compared to those not receiving gabapentin (median 2 mg vs. 4 mg of lorazepam equivalent dose (p < 0.01)). However, there were no significant differences in outcomes between the two groups. Conclusions: Our findings demonstrate that using gabapentin with benzodiazepine was associated with a reduction in the cumulative benzodiazepine dosage for alcohol withdrawal. Considering gabapentin as an adjunctive therapy holds promise for patients with comorbidities who could benefit from reducing benzodiazepine dose. This strategy warrants further investigation.

Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis.

BACKGROUND: Surgery is the primary treatment for chronic subdural hematoma, and anesthesia significantly impacts the surgery's outcomes. A previous systematic review compared general anesthesia to local anesthesia in 319 patients. Our study builds upon this research, analyzing 4,367 cases to provide updated and rigorous evidence. METHODS: We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and Web of Science, to identify eligible comparative studies. All studies published until September 2023 were included in our analysis. We compared six primary outcomes between the two groups using Review Manager Software. RESULTS: Eighteen studies involving a total of 4,367 participants were included in the meta-analysis. The analysis revealed no significant difference between the two techniques in terms of 'recurrence rate' (OR = 0.95, 95% CI [0.78 to 1.15], P = 0.59), 'mortality rate' (OR = 1.02, 95% CI [0.55 to 1.88], P = 0.96), and 'reoperation rate' (OR = 0.95, 95% CI [0.5 to 1.79], P = 0.87). Local anesthesia demonstrated superiority with a lower 'complications rate' than general anesthesia, as the latter had almost 2.4 times higher odds of experiencing complications (OR = 2.4, 95% CI [1.81 to 3.17], P < 0.00001). Additionally, local anesthesia was associated with a shorter 'length of hospital stay' (SMD = 1.19, 95% CI [1.06 to 1.32], P < 0.00001) and a reduced 'duration of surgery' (SMD = 0.94, 95% CI [0.67 to 1.2], P < 0.00001). CONCLUSION: Surgery for chronic subdural hematoma under local anesthesia results in fewer complications, a shorter length of hospital stay, and a shorter duration of the operation.

The Role of Clinical Audits in Advancing Quality and Safety in Healthcare Services: A Multiproject Analysis From a Jordanian Hospital.

Introduction Clinical audits have become essential instruments for evaluating and improving the standard of patient care in healthcare services. While individual clinical audits focus on particular aspects of care, multiple clinical audits across various domains, specialties, or departments provide a more comprehensive understanding of clinical practice and encourage systemic improvements. Methodology This study employed a mixed-methods approach to review and assess various clinical audits and quality improvement initiatives conducted at Al-Karak Governmental Hospital in southern Jordan. The study aimed to identify obstacles and possibilities of conducting clinical audits and provide suggestions for enhancing audit procedures and results. Data were collected from both retrospective and prospective sources and analyzed using descriptive and inferential statistics. Results The study comprised 11 audits conducted in three medical departments, namely surgery, obstetrics and gynecology (OB/GYN), and pediatrics, with a total of 618 participants. The improvements in adherence to guidelines after the second loop of all the audits were significant and showed significant improvements in adherence to guidelines, demonstrating the efficacy of clinical audits in improving clinical practice and outcomes. Conclusions Clinical audits are essential for maintaining and improving quality and safety in healthcare services, particularly in developing nations where emergency obstetric care is lacking. Multiple clinical audits provide a comprehensive understanding of clinical practice and encourage systemic improvements. The findings of our study suggest that clinical audits can lead to significant improvements in adherence to guidelines and better clinical outcomes. Future research should focus on identifying best practices for conducting clinical audits and evaluating their long-term viability and expandability.

Neuro-oncological research output in Africa: a scoping review of primary brain tumors.

BACKGROUND: There is evidence that individuals of African ancestry, particularly those residing in Africa, suffer from an unfortunate amount of under-representation in cancer research worldwide. AIM: We aimed to analyze current research output and potentially predict future trends in neuro-oncological research in Africa. Investigating deficits in the field will assist in identifying top-performing countries, which ones face challenges, and how to solve them. Therefore, targeted interventions can be applied to overcome these challenges. METHODS: We conducted a systematic computer-based search on the following databases (PubMed, Scopus, Web of Science, and Embase) for research articles related to the neuro-oncological field in Africa. We aimed to retrieve any article published in the period between 1 January 2000 and 10 January 2023. RESULTS: We included 200 eligible articles in our study. The output of neuro-oncological research has been increasing over the past two decades, peaking in 2019. Among the included articles, clinical practice issues constituted the majority (80%), while public health-related topics accounted for 20% of the publications. Regarding the type of neurological tumor, neuroblastoma was the most common, with 26 articles (13%), meningioma with 21 (10.5%), and glioma with 16 articles (8%). CONCLUSION: The interest in African neuro-oncological research is increasing. Hence, there is a need for ongoing efforts to address issues with clinical practice and public health related to neurological tumors in the continent. Future studies should concentrate on filling in knowledge gaps and investigating novel methods for neuro-oncological conditions that affect African populations in terms of prevention, diagnosis, treatment, and management strategies.

Prune Belly Syndrome in a Female Newborn following In Vitro Fertilization-Induced Pregnancy: A Case Report and Literature Review.

Prune belly syndrome (PBS) is a rare congenital anomaly characterized by a triad of abdominal flaccidity, varying degrees of urinary system involvement, and cryptorchidism. The exact cause of PBS is unknown. Clinical symptoms can range from stillbirth to significant renal and respiratory abnormalities to almost normal children. Treatment typically involves surgical repair of the abdominal wall defect and urinary tract abnormalities, early orchiopexy, and supportive management of related problems. We report the first case of a female newborn with PBS following in vitro fertilization-induced pregnancy with a comprehensive systematic review of all relevant cases.

Insights into head and neck cancer research in Egypt: A scoping review.

BACKGROUND: Head and neck cancer (HNC) encompasses malignant tumors in areas like the oral cavity, pharynx, and larynx. This analysis identifies strengths and deficiencies in HNC research, aiming to improve published papers' quality, quantity, and diversity. It also encourages more participation from oncologists, particularly in Egypt, to bridge the gap with Western healthcare standards. METHODS: A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and Embase. The goal was to gather research articles on HNC in Egypt published from January 1, 2000, to December 31, 2022. RESULTS: From 2150 articles, 1329 were screened by title and abstract, leading to 193 for full-text review. Finally, 174 articles were included in the final analysis. 2020 saw the highest number of publications. The majority were primary research articles, with randomized controlled trials being prevalent. Most studies were clinical, focusing on radiotherapy, and involved adult patients, emphasizing service delivery. Publications were predominantly in non-Egyptian journals, with the Egyptian Journal of Radiology and Nuclear Medicine being the most frequent. Research was mainly conducted by Egyptian authors and at Cairo University. CONCLUSION: The growing prevalence of HNC in Egypt underscores the need for more comprehensive research on its various aspects, including etiology, risk factors, and prevention. There's a call for increased research outputs at different Egyptian universities, multicenter studies, and international collaborations. This approach can improve the understanding and management of HNC, contributing to global discussions and advancing treatment and prevention strategies in Egypt.

Cervical Spine Osteophyte: A Case Report of an Unusual Presentation.

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that causes abnormal bone growth at the sites of ligament insertion, mainly in the spine. It is of unknown etiology and usually affects older males. It is often asymptomatic, but it can sometimes cause dysphagia if it affects the anterior cervical spine. We report the case of a 50-year-old male patient with DISH who presented with chronic dysphagia and was diagnosed with a large cervical osteophyte compressing the esophagus. The patient had a history of several comorbidities, including diabetes, hypertension, stroke, and gout. He underwent surgical removal of the osteophyte and recovered well. We discuss the clinical features, diagnosis, and treatment options for this rare complication of DISH.

An Intestinal Type Gastric Neuroendocrine Tumor: A Case Report.

Neuroendocrine tumors (NETs) represent a diverse set of malignancies, originating from the neuroendocrine cells dispersed throughout the body. Their symptoms are associated with the secretion of bioactive peptides by tumor cells. Five-year survival rates depend on the disease stage: 93% for local, 74% for regional, and 19% for metastatic disease. This report describes a case involving a 64-year-old male patient, who was enduring high blood pressure and anemia. His symptomatology included frequent fainting and bloody vomiting without prior bleeding, coupled with persistent abdominal pain and weight loss. A complete blood count revealed microcytic anemia. His condition improved postoperatively after the transfusion of two units of packed red blood cells, normalizing all parameters. Further biochemistry and serology tests did not provide significant insights. However, an upper endoscopy unveiled a deep ulcer below the gastroesophageal junction with ulcer desquamation. A combination of clinical, laboratory, and radiographic data initially indicated a gastric carcinoma of the intestinal type, characterized by extensive extracellular mucin secretion. The surgical intervention led to the extraction of multiple tumors from lymph nodes, culminating in a postoperative diagnosis of a gastrointestinal (GI) mesenchymal tumor. NETs predominantly manifest in the GI tract, initiating primarily in the small intestine but can also originate in the stomach, appendix, colon, and other parts of the GI tract. Their development from neuroendocrine cells enables them to produce high concentrations of hormone-like substances such as neuropeptides and amines.

Aggressive Fibromatosis of the Left Mesocolon Mimicking a Gastrointestinal Stromal Tumor: A Case Report.

Mesenteric fibromatosis (MF) is a proliferative fibroblastic lesion of the intestinal mesentery. It constitutes 8% of all desmoid tumors, representing 0.03% of all neoplasms. It is benign histologically, although it could infiltrate locally and recur following excision; however, it is free from the potential to metastasize. It is spontaneous or associated with familial adenomatous polyposis (FAP]) mutation as a part of Gardner's syndrome. This case report discusses the radiological, intraoperative, and histopathological findings from a 45-year-old male patient who presented with abdominal pain and a palpable mass in the left hemiabdomen. The pain was dull and aching, extending to the back and unrelated to any other gastrointestinal symptoms. There was no history of severe weight reduction. Furthermore, he is not a smoker. There were no comorbidities, severe medical diseases, or prior surgical procedures. Computerized tomography revealed a well-defined, lobulated, heterogeneously enhancing altered signal intensity mass at the mesocolon. Ultrasonography of the abdomen showed an intra-abdominal mass. Macroscopic mass characteristics include a well-defined mass measuring 22 × 14 × 11 cm connected to a small intestine segment measuring 21 × 2 × 2 cm. Histopathological and immunohistochemical examinations of the resected tumor, including positive nuclear immunostaining for beta-catenin, confirmed a postoperative diagnosis of desmoid-type fibromatosis. Based on its clinical presentation and computed tomography results, this case demonstrated how desmoid-type fibromatosis of the colon might mimic gastrointestinal stromal tumors (GISTs). Due to the varied therapies and follow-up methods used for these lesions, the differential diagnosis between desmoid-type fibromatosis and GIST is clinically significant.

Dumping Syndrome in Children: A Narrative Review.

Dumping syndrome (DS) is a typical side effect of stomach surgery, which includes cancer, non-cancer esophageal and gastric surgery, and bariatric surgery. It is marked by the fast evacuation of undigested food from the stomach into the small intestine, which causes a variety of symptoms. Early dumping symptoms include gastrointestinal symptoms such as stomach discomfort, diarrhea, and nausea, as well as vasomotor symptoms such as drowsiness and face flushing, and occur within the first hour following a meal. Late dumping symptoms appear one to three hours after a meal and are related to reactive hypoglycemia, resulting in hypoglycemia, sweating, palpitations, and confusion. Early dumping pathophysiology involves abnormalities in stomach structure and function, which result in rapid transit of stomach contents to the duodenum, insufficient digestion, and fluid transfers from the vascular compartment to the intestine. Late dumping occurs as a result of hyperinsulinemia caused by the fast passage of undigested foods to the gut. Symptom-based questionnaires and diagnostic testing such as plasma glucose measurement and stomach emptying studies can be used to confirm a diagnosis of DS. The primary approach to managing DS is dietary modifications, including eating smaller, more frequent meals and avoiding high glycemic index carbohydrates. Dietary supplements and medications may be used to slow down gastric emptying or control blood glucose levels. Pharmacological options include alpha-glycosidase inhibitors, somatostatin analogs, glucagon-like peptide-1 analogs, and sodium-glucose cotransporter inhibitors. In severe cases, refractory to conservative measures, surgical interventions may be considered. DS can arise in children following gastric surgery for obesity or corrective surgery for congenital abnormalities. It is frequently misdiagnosed and can have serious implications, such as hypoglycemia-related cognition deficits. Screening and early identification using glucose tolerance testing and continuous glucose monitoring (CGM) are critical in at-risk youngsters. Children's treatment techniques are similar to those used in adults, with dietary changes and medication therapies serving as the cornerstone of care. Overall, DS is a complex condition that requires a multidisciplinary approach to diagnosis and management. Further research is needed to improve understanding of its pathophysiology and optimize treatment strategies, particularly in children. This review aims to provide a well-rounded informative summary of the most recent literature on the under-recognized clinical and scientific aspects of DS among the children age group. It incorporates the quality of life, pathophysiology, diagnosis, prevalence, and treatment.

Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis and a Double Superior Vena Cava.

BACKGROUND Situs inversus totalis (SIT) is an uncommon condition characterized as a congenital disorder in which the visceral organs are inverted relative to their typical anatomical position. SIT with double superior vena cava (SVC) is an even rarer presentation. Due to the underlying anatomical difference, the diagnosis and treatment of gallbladder stones in patients with SIT are challenging. CASE REPORT We report the case of a 24-year-old male patient who presented with an intermittent history of epigastric pain for 2 weeks. Clinical assessment and radiological investigations confirmed gall bladder stones with evidence of SIT and double superior vena cava (SVC). The patient underwent elective laparoscopic cholecystectomy (LC) with an inverted laparoscopic approach. The recovery from the operation went smoothly, the patient was discharged from the hospital the following day, and the drain was removed on the third postoperative day. CONCLUSIONS Because anatomical variations in the SIT can affect localization of symptoms in patients with complicated gallbladder stones, the diagnosis of patients who have abdominal pain and SIT necessitates both a high index of suspicion and a thorough assessment. Although LC is considered to be a technically challenging surgery and calls for modification of the standard protocol, it is nevertheless feasible to perform the procedure effectively. To the best of our knowledge, this is the first time that LC has been documented in a patient who has SIT and double SVC.

Unexpected diagnosis of both adenocarcinoma of the colon and metastatic lobular carcinoma of the breast in the gastrointestinal tract.

Breast cancer rarely metastasises to the gastrointestinal tract. Lobular carcinoma more commonly metastasises to the uterus and appendages, peritoneum, and gastrointestinal tract than other types of breast cancer, while ductal carcinoma has a propensity to metastasise to the lungs, liver, and brain. We describe the case of a patient with no known history of breast cancer, whose primary presentation of lobular breast cancer was with malignant small intestinal and colonic strictures, with coexisting previously undiagnosed adenocarcinoma of the colon.

Metastatic renal cell carcinoma in an ovarian benign mixed mucinous cystadenoma and brenner tumour: a case report.

This is a case of a 71-year-old woman, who presented with a large abdominal mass. Microscopic examination revealed metastatic renal cell carcinoma in an otherwise massively enlarged benign ovarian tumour of mixed mucinous cystadenoma and Brenner tumour. Clinicopathological and radiological assessment together with a thorough evaluation of gross and histological features, including the use of immunohistochemical stains, is essential to confirm the diagnosis and rule out the possibility of primary clear cell carcinoma of ovary, as this has important prognostic and therapeutic implications.

Borderline serous papillary tumour of the testis: a case report and review of the literature.

Borderline serous tumour of the testis and paratestis is an uncommon entity. We report a case of borderline serous tumour of a 59-year-old male, who presented with a right testicular swelling which was clinically suspicious of carcinoma. Radical orchidectomy was performed and a cystic lesion was identified in the testis. Macroscopically the tumour was composed of a unilocular cyst with excrescences in the inner surface. The histological features were identical to the ovarian counterpart of borderline serous papillary tumour. The excrescences were formed by stratified columnar epithelium, which exhibited mild nuclear pleomorphism and mitotic activity, with a fibrovascular core and scattered psammoma bodies. There was no lymphovascular or stromal invasion. The lesion was surrounded by a dense fibrous wall. On immunohistochemistry, the lining epithelial cells expressed cytokeratin AE1/AE3 but not carcinoembryonic antigen or calretinin. Following the removal of the tumour, the patient was followed up and no recurrence or metastasis has occurred to date. This case highlights the need for clinicians and pathologists to be aware of this rare entity and to develop the best approach for patient management.

Metastatic breast cancer mimicking cholecystitis. A rare clinical presentation.

We report a case of a 61-year-old lady who presented with central chest and epigastric pain. A clinical diagnosis of cholecystitis was established, and a cholecystectomy was carried out. Microscopic examination of the gallbladder showed chronic cholecystitis and metastatic carcinoma of probable breast lobular carcinoma origin. The report was followed by further clinical and mammographic examination, which showed a focal area of thickening in the left breast. Core biopsy of this lesion confirmed the diagnosis of lobular carcinoma of the breast. Her tumor was treated with surgery followed by chemo/hormone therapy. The patient died 5 years after the cholecystectomy from disseminated breast malignancy.

Spontaneous regression of Merkel cell carcinoma of the nose.

BACKGROUND: Merkel Cell Carcinoma (MCC) is a rare neurendocrine tumor of cutaneous origin. METHODS AND RESULTS: A 79-year-old woman was seen with a neck lump and a lesion in the left nasal vestibule. Biopsy of the lesion revealed a primary neurendocrine MCC of the skin of the nasal vestibule with metastases to the cervical lymph nodes. The patient decided against any further active treatment. Follow-up of patient for 30 months showed spontaneous regression of the lesions without any active treatment. CONCLUSIONS: Although spontaneous resolution of MCC has been described for other head neck sites, there has not been any published case of nasal MCC regression. We present this rare case of nasal MCC with neck metastases and its regression.