Performance of Low-Dose Immunotherapy and Standard-Dose Immunotherapy in Microsatellite Instability-High Metastatic Colorectal Cancer: Real-World Data (CLouD-High Study).

PURPOSE: Standard-dose immune checkpoint inhibitors (SD-ICIs) are the standard of care as initial therapy in microsatellite instable-high (MSI-H) advanced/metastatic colorectal adenocarcinomas (mCRC), but there are preclinical data to suggest that low-dose ICIs (LD-ICI) might also have similar efficacy. MATERIALS AND METHODS: A retrospective study of patients with MSI-H mCRC receiving ICIs between June 2017 and January 2023 was conducted. The primary end point of the study was 12-month progression-free survival (PFS), which was computed using the Kaplan-Meier method. RESULTS: A total of 65 patients were available for analysis during the study period. Sixty patients (92%) received nivolumab, whereas the remaining received pembrolizumab. First-line ICIs were received by 18 patients (28%), whereas 47 patients (72%) received ICIs during later lines. Thirty patients (47%) received LD-ICIs (all received nivolumab), with the remaining receiving SD-ICIs (53%). At a median follow-up of 16.5 (95% CI, 11.8 to 21.2) months, median PFS was not reached in the entire cohort. The 12-month PFS rate in the LD-ICI cohort was 90%, whereas it was 75.8% in the SD-ICI cohort. There were no statistical differences in patients receiving ICIs as first-line therapy (12 months PFS-94.4%) or during later lines of therapy (12-month PFS-77.9%; P = .56). CONCLUSION: ICIs in the current study show survivals which are similar to those seen in seminal trials in patients with MSI-H mCRC. Low-dose ICIs appear to work in MSI-H mCRC and should be explored prospectively in clinical trials. Patients with MSI-H status should be exposed to ICIs, whether initially or later during treatment, whenever feasible.

A comprehensive overview of substance abuse amongst Syrian individuals in an addiction rehabilitation center.

Objectives: This study aims to provide a comprehensive overview of substance abuse amongst Syrian individuals in an addiction rehabilitation center. Methods: This is a descriptive cross-sectional survey-based study, from patients receiving treatment in an addiction rehabilitation center in Damascus. Syria. The study was conducted over a period of nine months. Results: A total of 82 participants were recruited, the majority of them were males (n = 78.95.1%). More than half of those investigated reported multi-level failure (n = 46, 56.1%) during their education. Most of the participants (n = 44, 53.7%) started to use drugs at a friend's home. The family was shown to play a positive role in stopping the initial drug taking trials at early stages (33/56, 58.9%). Again, friends' effect was the main reason for the return of abusing drugs (20/56, 35.7%). Sources of drugs were mainly from drug promoters for most of the participants (n = 58, 70.7%) followed by friends (n = 28, 34.1%). Participants revealed that taking drugs were mostly accompanied by additional habits such as cigarette smoking before using their drugs (n = 65, 79.3%), or drinking alcohol (57.3%). Surprisingly, participants believed that drug abuse does not lead to addiction (n = 52, 63.4%). The most common experienced feeling was depressed, desperate, or sad (n = 47, 57.3%), followed by anxiety and the desire to escape reality and resort to imaginations (n = 44, 53.7%). Conclusions: The findings of this study indicate the need of policymakers to give more attention, in developing preventive strategies, to friends, as a main cause of addiction, in addition to the family influences on individual's drug abuse, addiction behaviors, and mindsets. Understanding the influencing factors could spot the light on the key to solve the addiction problem. A realist rehabilitation programs must be well designed and implemented as the level of individuals, institutions and communities to face this problematic addiction disaster.

Colonoscopy Colorectal Cancer Screening Programme in Southern Iraq: Challenges, Knowledge Gaps and Future Potential.

Data on current colorectal cancer screening practices in Iraq are limited. This study aimed to better understand the current colorectal cancer screening practice and perceived barriers. The project also aimed to use UK expertise to introduce Bowel Cancer Screening Programme (BCSP) in Basra, Iraq. The study consisted of two parts: A pre-visit online survey of clinicians to test the project's feasibility. A public survey was conducted to understand and gauge the general knowledge and perceived barriers to having colorectal cancer screening. The second phase included a short visit to Basra and the delivery of a multidisciplinary meeting for bowel screening colonoscopists. Fifty healthcare providers completed the survey. Basra has no established bowel cancer screening programme, let alone the country. Opportunistic colonoscopy surveillance is done on an ad hoc base. A total of 350 individuals completed the public survey. The survey showed that more than 50% of participants were not familiar with the concept of a BCSP and less than 25% were aware of "red flag" symptoms of bowel cancer. The short visit to Basra included a roundtable discussion and delivered a training workshop for screening colonoscopists using UK training materials in conjunction with the Iraqi Medical Association. Feedback from the course was extremely positive. Several potential barriers were identified to participate in BCSP. The study highlighted potential barriers, including a lack of public awareness and insufficient training resources to be addressed in future screening programmes. The study has identified several potential areas for future collaboration to support the development of a BCSP centre in Basra.

Prevalence of Chronic Postsurgical Pain among Cancer Patients: A Cross-Sectional Study.

Background: Cancer patients accept surgeries as part of their treatment. They may not be aware of the possibility of surgical pain persisting long after the surgery. Understanding chronic postsurgical pain is essential for effective pain management. Aims: We aimed to assess the prevalence of chronic postsurgical pain in cancer patients and the associated symptom burden. Settings and Design: This study was carried out at a tertiary cancer center. It was a cross-sectional study. Materials and Methods: Participants who underwent surgeries were asked to provide feedback on the MD Anderson Symptom Inventory at 3 months. Statistical Analysis Used: Descriptive statistics were used. Statistical tests included Kruskal-Wallis test, Chi-square test, Fisher's exact test, and Spearman's correlation. Logistic regression was used to assess the influence of variables on the presence or absence of chronic postsurgical pain. Results: Nine hundred and eighteen participants completed the study. Ninety-two percent (n = 840) were asymptomatic. Eight percent (n = 78) had postsurgical pain. Chronic postsurgical pain was influenced by the type of surgery (P = 0.01), specifically orthopedic and thoracic surgeries. Patients who receive epidurals are three times less likely to continue to have pain at 3 months. Conclusions: The prevalence of chronic postsurgical pain at 3 months in this study is lower than the rates in the literature. It is still associated with symptom burden that interferes with daily life. The risk of developing chronic postsurgical pain increases with thoracic and orthopedic surgeries. The risk may be lowered with epidural analgesia.

Characteristics of thyrotoxicosis among thyroid patients and their quality of life in a teaching hospital in Jordan: A cross-sectional study.

Aim: This study aimed to describe the general characteristics of thyrotoxicosis patients, evaluate their quality of life and adherence to medications as an outpatient at endocrine clinic in Jordan. Method: This was a descriptive cross-sectional study. The eligible participants, who were patients from endocrine outpatient clinics at JUH were recruited. The inclusion criteria limited the study to patients aged 18 years and older who were newly diagnosed with or had a past diagnosis of hyperthyroidism disease for any cause. Data were analyzed using Statistical Package for Social Sciences version 24.0 (SPSS® Inc., Chicago, IL, USA). Result: Most participants were females (81.3%) and married (87.9%). The majority were educated and had a bachelor's degree or higher (41.8%). The average reading for T3 was 6.80±8.26 pmol/l, T4 16.87±7.98 pmol/l, TSH 3.49±11.51 Mu/L, Anti thyroglobulin 2.37±1.73, and Anti thyroglobulin peroxidase 4.80±1.13. There were no significant findings in assessing the effect of treatment types on lab tests (p-value >0.05). The majority of thyrotoxicosis cases were caused by Graves' disease (64.7%), followed by 17.60% from benign multinodular goiter, 11.80% thyroiditis and 5.90% toxic adenoma. There was no significant correlation (p>0.05) between the type of treatments and the following health related quality of life (HRQOL) sub-domains: generally unwell, social problem, muscular skeletal problems, eye problem, classical symptoms of hyperthyroidism(CSH) hand tremor, CSH palpitation, decreased appetite and constipation. Conclusion: Thyrotoxicosis is understudied in the Middle East, particularly Jordan. The main findings revealed that thyrotoxicosis is more prominent in females, mainly in their 4th decade. Future work should focus on the main possible methods to improve the HRQOL. In addition, awareness programs are required to encourage patients to obey the advice of their physician and increase their self-care towards improving the quality of their life.

Prevalence of fetal alcohol spectrum disorder in Greater Manchester, UK: An active case ascertainment study.

BACKGROUND: Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school. METHODS: A 2-phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8-9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen-positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties. RESULTS: Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis. CONCLUSIONS: FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD.

The Era of E-Cigarettes: A Cross-Sectional Study of Vaping Preferences, Reasons for Use and Withdrawal Symptoms Among Current E-Cigarette Users in the United Arab Emirates.

Electronic cigarette (E-cig) use has increased substantially among the young population, who adopt using E-cig for various reasons. Our present study aimed to explore vaping preferences and reasons for using E-cig among current users in the United Arab Emirates (UAE) and to assess physical and psychological symptoms experienced while using E-cig during intermittent fasting. A cross-sectional study was conducted from April 23 to May 22, 2020, to solicit responses from current E-cig users in the UAE. Data were collected about sociodemographic profile, tobacco cigarette smoking, vaping preferences, reasons for use, and withdrawal symptoms during fasting in Ramadan. A convenience sample of 591 adult E-cig users were initially recruited, of whom 392 participants with complete responses were included in our analysis. The majority of participants were males (n = 275, 70.2%) and around 28.6% (n = 112) were dual users. Vape tank/Box-mod was the most used type of E-cig (50.3%). Most of the participants (n = 317; 80.9%) believed that E-cigs are less harmful than tobacco cigarettes. During fasting time, around 46.2% (n = 181) of E-cig users have experienced various physical symptoms, while 51.0% (n = 200) of users have experienced various psychological symptoms. E-cig use is gaining popularity within the UAE after the recent legalization as these devices are commonly advertised and claimed by manufacturers to aid smoking cessation. The effectiveness of E-cig in aiding smoking cessation should be investigated with a higher level of evidence, especially in a new context of usage as the UAE, considering various types of devices, hundreds of E-liquid brands, and the influence of concurrent poly-tobacco use.

Electronic cigarettes' withdrawal severity symptoms among users during intermittent fasting: a cross-sectional study.

BACKGROUND: Recently, electronic cigarette (e-cig) usage has increased significantly, making it a potentially effective smoking cessation tool. In Muslim countries, most people who use e-cigarettes fast the month of Ramadan, which results in intermittent fasting. This study aims to reveal the severity of e-cig withdrawal symptoms among users during this intermittent fasting period. METHODS: A self-administered survey was developed and validated to solicit anonymous responses from e-cig users living in Jordan, through a cross-sectional study design. Participants were recruited through social media resources. Severity scores of physical (out of 11) and psychological (out of 8) withdrawal symptoms for each participant were assessed and calculated for each participant, depending on the symptoms reported. RESULTS: A convenience sample (n = 523) of e-cig adult users were recruited. The majority of the participants were males (96.4%) aged between 18 and 40 years (86.4%). Many participants replaced tobacco smoking with e-cig (53.5%) in order to help them stop smoking. More than half of the participants experienced relatively weak physical (0.82 ± 1.78) and psychological (1.24 ± 1.89) withdrawal symptoms during the month of fasting. Most of the participants (63.2%) preferred to engage themselves with a busy schedule to tolerate the related withdrawal symptoms they experienced. CONCLUSION: E-cigs could play a vital role in smoking cessation among tobacco smokers during intermittent fasting. Ramadan offers a good opportunity for smokers to quit, as the reported physical and psychological e-cig withdrawal symptoms were found to be relatively weak. Awareness and behavioral interventions would help clarify the effect of e-cigs and help determine alternative ways to cease smoking.

Perception of adults toward electronic cigarettes: a cross-sectional study from Jordan.

INTRODUCTION: The rate of Jordanian tobacco smokers has been reported to be one of the highest rates in the world. The electronic cigarette (E-cig) has become an option, or an alternative, to tobacco cigarette smoking. This study was aimed to measure the perception of Jordanian adults toward E-cig use. METHODS: A cross-sectional study design was used. A self-administered survey was developed and validated to solicit anonymous responses from the study participants. A convenience sample (n = 984) was recruited electronically through social media platforms. Descriptive statistics and correlation analyses were completed using the Statistical Package for the Social Sciences (SPSS). RESULTS: More than half of the participants (53%) were females, and almost all participants had heard about E-cig (99.2%), mainly from their friends (40%) and social media (34.5%). About half of the participants were nonsmokers and around one-third of them (33.1%) were current E-cig users. The majority of the participating E-cig users had replaced tobacco with E-cig (56.4%)/All the E-cig users reported positive beliefs toward the E-cig as a safer alternative for tobacco smoking. About 45% of participants believed that the E-cig is helpful in tobacco smoking cessation, but should be highly regulated. CONCLUSION: This study illustrated a significant prevalence of E-cig usage among Jordanian adults. E-cig users perceived E-cig as a safer and cheaper alternative to tobacco smoking and that it helps in tobacco smoking cessation. However, health awareness campaigns are needed for the entire Jordanian community about E-cig use, related emerging health findings, and how to promote tobacco smoking cessation.

Biomechanical properties of a novel locking compression plate to stabilize oblique tibial osteotomies in buffaloes.

OBJECTIVE: Quantitation of mechanical properties of a novel locking compression plate (LCP) for bovine tibia. STUDY DESIGN: Prospective in vitro study. SAMPLE POPULATION: Adult Murrah buffalo (250-350 kg) tibiae. METHODS: Forty tibiae were randomly assigned to five treatment groups (n = 8/group): intact bone and bone constructs with a standard nonlocking plate, single LCP, double LCP, and novel LCP. During implant application, a mid-diaphyseal, oblique osteotomy was performed in all constructs, which were subsequently tested in axial compression (n = 4 each) or three-point craniocaudal bending (n = 4 each). Novel LCP alone (n = 4) was tested only in bending. Stiffness, yield load, ultimate failure load, and bending moment were determined from the load deformation curves and compared among different treatment groups (P < .05). RESULTS: Under compression, yield load of the novel LCP (24.07 ± 3.45 kN) was greater than that of the nonlocking plate (11.10 ± 2.46 kN) and the single LCP (18.01 ± 2.07 kN) but less than that of the double LCP (30.61 ± 1.95 kN), and ultimate failure load of the novel LCP (25.85 ± 4.32 kN) was greater than that of the nonlocking plate (13.18 ± 2.91 kN) but similar to that of the single LCP (21.17 ± 2.33 kN) and the double LCP (32.40 ± 1.46 kN). Bending moment, yield load, and ultimate failure load of the novel LCP were 565.37 ± 79.30 Nm, 7.90 ± 1.14 kN, 9.83 ± 1.38 kN, respectively, which were greater than those of the nonlocking plate and the single LCP but comparable to those of the double LCP. CONCLUSION: The novel LCP developed for bovine tibia was mechanically superior to the standard nonlocking plate or the single LCP and comparable to the double LCP. CLINICAL SIGNIFICANCE: The novel LCP may provide rigid fixation of tibial diaphyseal fractures in buffaloes and cattle weighing 250 to 350 kg.

Personal Protective Equipment for Endoscopy in Low-Resource Settings During the COVID-19 Pandemic: Guidance From the World Gastroenterology Organisation.

Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations. We determined that there is limited flexibility with regard to the utilization of PPE between ideal and low-resource settings. Some compromises are possible, especially with regard to PPE use, during endoscopic procedures. We have, therefore, also stressed the need to prevent transmission of COVID-19 by measures other than PPE and to conserve PPE by reduction of patient volume, limiting procedures to urgent or emergent, and reducing the number of staff and trainees involved in procedures. This guidance aims to optimize utilization of PPE and protection of health care providers.

A rare case of duplicated appendix presenting as perforated appendicitis.

Anomalies of the appendix have been reported mostly in adults as an incidental finding during surgery. The incidence of duplication of the vermiform appendix is reported to be 0.004% and <10 cases of appendicitis have been reported in duplicated appendix. This is a case report of an 18-year-old male who was diagnosed to have perforated appendicitis by imaging, and on open surgical exploration was found to have appendiceal duplication. Histopathological examination of both specimens revealed a perforated necrotic first appendix and an acutely inflamed second appendix. Surgeons must always bear in mind a high degree of suspicion regarding the possibility of duplicated appendices in all cases that are clinically and radiologically suspected to have acute appendicitis or perforated appendicitis. A thorough intraoperative examination of caecum is mandatory to avoid missing the duplication; thus, preventing post-operative complications and medicolegal issues.

Assessing the effectiveness of a pharmaceutical care service on the quality of life of women with polycystic ovarian syndrome living in war and non-war countries.

RATIONALE, AIMS, AND OBJECTIVES: Polycystic ovarian syndrome (PCOS) is a serious health problem that affects women of all ages worldwide, including their quality of life (QOL). Interventions on lifestyle modification can be a suitable therapy. This study aimed to evaluate the effect of a PCOS pharmaceutical care service on QOL for women diagnosed with PCOS living in Syria (a country affected by war) and Jordan (non-war-zone country). METHODS: PCOS women from both Syria and Jordan with age above 16 years were recruited in the study. Women randomly allocated into active group received an educational intervention by the pharmacist (via oral and written educational module) with special focus on diet and exercise. Women allocated to the control group did not receive the educational intervention. Both groups were followed for 4 months. Women in both groups completed the QOL questionnaire at both baseline and end of study. Multiple-regression analysis was performed to identify factors associated with change in QOL scores across the study. RESULTS: PCOS women (n = 118) from both Syria (n = 60) and Jordan (n = 58) were recruited. Unlike control group patients, QOL was significantly improved in the active group at the end of the study for Syrian (102.75 vs 118.50, P < 0.001) and Jordanian women (95.31 vs 112.67, P < 0.001). Study group (active versus control) and difference in anxiety scores across the study were the only independent variables that showed association with the dependent variable, difference in QOL mean scores across the study period. CONCLUSION: A pharmacist led intervention on lifestyle modification delivered to PCOS women led to positive effects on QOL scores. The intervention was successful in Syria and Jordan. This highlights the significant role that pharmacists can play in improving the life of women with PCOS whether living in war or non-war-zone countries.

Rare Mandibular Ramus Fracture.

Mandibular fractures represent approximately two-thirds of all maxillofacial fractures (nearly 70%), out of which fractures of mandibular ramus represent 3.09% which is considered to be a rare fracture site. They occur alone or in combination with other facial bone fractures resulting in loss of function and disfigurement. The pattern of mandibular fractures varies with geographic location, physical activity, social, cultural, and environmental factors. The main causes of mandibular fracture are road traffic accidents, interpersonal violence, falls, sports injuries, industrial trauma, and pathological fractures. In this clinical case, the authors describe a vertical ramal fracture extending from subsigmoid region to inferior border of angle of the mandible combined with symphysis fracture which was surgically operated through open reduction and internal fixation by extraoral approach.

Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years.

Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.

Posterior Tibial Nerve Lymphoma Presenting as Tarsal Tunnel Syndrome: A Case Report.

We report a case of isolated posterior tibial B-cell lymphoma of the posterior tibial nerve presenting as tarsal tunnel syndrome. This diagnosis was considered because of the clinical presentation and electrophysiologic abnormalities. It was further confirmed by the magnetic resonance imaging findings of the ankle and tissue pathologic findings. Whole body positron emission tomography confirmed this to be a localized lymphoma involving the peripheral nerve. The patient underwent chemotherapy with complete tumor resolution. She had had no relapse after 8 months of follow-up. Isolated peripheral nerve lymphomas are very rare, and involvement of the posterior tibial nerve has not been previously reported. Furthermore, the present case report highlights the importance of the clinical examination in the diagnosis of tarsal tunnel syndrome before performing surgical decompression.

Preliminary studies of PVA/PVP blends incorporated with HAp and ß-TCP bone ceramic as template for hard tissue engineering.

Polyvinylalcohol (PVA) and Polyvinylpyrrolidone (PVP) blend incorporated with hydroxyapatite (HAp) and ß-tricalcium phosphate (ß-TCP) is electrospun as nanofibrous composite scaffolds to act as suitable template for bone tissue engineering. Microscopic and spectroscopic characterizations confirm uniform integration of the crystalline calcium phosphate ceramics in the scaffolds. PVA-PVP blends are usually amorphous in nature and addition of phosphate ceramic particles specifically HAp elevates its crystalline behavior which is substantiated by XRD details. Further incorporation of ceramics is confirmed using FT-IR as characteristic PO43- groups for HAp and ß-TCP were observed in the distinguished composites. Single glass transition temperature is observed for pure and composite blends indicating the formation of highly miscible blends. Also, addition of these ceramics augments the thermal stability of the blend scaffolds. Biocompatibility of the prepared (PVA: PVP)-HAp and (PVA: PVP)-TCP scaffolds is assessed using MG-63 Osteoblast cell lines in the time interval of 1st, 4th and 7th day. The cell viability percentage for (PVA: PVP)-HAp is high compared to ß-TCP added blend composites, reinforcing the fact that scaffolds with good mechanical strength and enhanced porosity supports better cell adhesion.

A review of complementary therapies for chemotherapy induced gastrointestinal mucositis.

Administration of chemotherapy often leads to gastrointestinal mucositis (GIM). GIM manifests as nausea, abdominal pain and diarrhoea in recipients of chemotherapy. GIM is a major complication occurring in approximately 80% of patients receiving 5-flurouracil treatment. These side-effects may become so severe that significant dose reductions are required, ultimately affecting treatment efficacy and patient survival. Complementary and alternative medicine (CAM) is a growing area of public interest. This review will provide an overview of current knowledge of complementary medicinal therapies for chemotherapy induced GIM. An understanding of this evolving literature is useful in discussing these therapies with patients who are considering using them.

Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment.

BACKGROUND: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD). METHODS: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively. RESULTS: A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%). CONCLUSIONS: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

"Evaluation of safety margin" in ameloblastoma of the mandible by surgical, radiological, and histopathological methods: An evidence-based study.

OBJECTIVE: The purpose of this study is to elicit the amount of safety margin necessary around the ameloblastic lesion in view of preventing further recurrence. MATERIALS AND METHODS: The study consisted of 25 cases of mandibular ameloblastoma. Diagnosis was based on clinical and radiological analysis and confirmed by histopathological report. An incisional biopsy was done preoperatively to confirm the diagnosis. Segmental resection was planned for all the cases. After the resection, postoperative panoramic radiograph of the specimen was taken followed by histopathological examination of its margin to detect tumor cell infiltration. RESULTS AND CONCLUSION: In all our cases, the ameloblastoma was infiltrating in nature. A follow-up period of 10 years showed neither recurrence nor implant failure. In our study, we conclude our safe margin for infiltrating variant of ameloblastoma based on histopathological report of the resected specimen.