Migrated toothpick causing a hepatic abscess with portal vein thrombosis: A case report and review of literature.

Key Clinical Message: Accidental foreign body ingestion is the most common hidden cause of abdominal pain. A high index of suspicion should be implemented in patients with unresolved abdominal pain. Here we reported a 54-year-old patient with vague abdominal pain who had a successful laparoscopic removal of a toothpick. Abstract: Toothpicks and fish bones are considered one of the most common accidentally ingested foreign bodies. Fortunately, most patients are asymptomatic. About 80%-90% of ingested foreign bodies pass through the gut spontaneously within a week. We present a case of a 54-year-old female with chronic epigastric pain and fever found to have a foreign body (toothpick) that penetrated the stomach and migrated to the liver causing liver abscess with portal vein thrombosis. The patient was managed with laparoscopic removal of the foreign body with an uneventful postoperative course.

Prevalence of Internet Addiction and Its Associated Risk Factors Among Medical Students in Sudan: A Cross-Sectional Study.

Background Internet addiction has been studied extensively worldwide and shown to have adverse social, psychological, and functional consequences. It has become a global health issue, particularly among young adults. Unfortunately, few studies have been conducted among medical students in Sudan. This study aimed to measure the prevalence of internet addiction and determine its associated risk factors among medical students in Sudan. Methods This cross-sectional study was conducted among medical students using a systematic sampling technique. An online structured questionnaire was used, which included sociodemographic data and the Internet Addiction Test (IAT) to assess the presence and severity of internet addiction, as well as the Kessler Questionnaire to assess psychological distress. Results Among the 307 medical students who participated in this study, 63.8% (n=196) were female. The majority 78.5% (n=242) were aged 18-22 years, and the prevalence of internet addiction was 75.5% (n=232). The addiction levels were as follows: mild, 39.7% (n=122); moderate, 33.2% (n=102); and severe, 2.6% (n=8). Multivariate regression analysis revealed that being a female medical student was associated with a 1.9 times higher risk of internet addiction (adjusted odds ratio (AOR) = 1.87, p = 0.033). Psychological distress was associated with a 6.368-fold higher risk of internet addiction compared to non-distressed students (AOR = 6.368, p < 0.001). Additionally, students in the clinical years had a lower risk of internet addiction, specifically in the fourth and fifth years (AOR = 0.325, p = 0.010; AOR = 0.398, p = 0.043, respectively). Conclusions This study found a high prevalence of internet addiction among medical students at the National University, Khartoum, Sudan, which was strongly associated with mental distress. Effective awareness programs, potentially initiated by educational authorities, are required to educate students on limiting excessive internet usage and addressing associated risk factors. Future research should include longitudinal and multi-university studies to obtain more generalizable results and to investigate the relationship between internet addiction and mental distress more robustly.

Knowledge and Attitudes Toward Pressure Ulcer Prevention Evidence-based Guidelines among Nursing Students at Jazan University, Saudi Arabia.

BACKGROUND: Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. AIMS: This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. SETTING AND DESIGN: This descriptive, cross-sectional study was conducted among nursing students at Jazan University. MATERIALS AND METHODS: Data were collected using an electronic questionnaire. STATISTICAL ANALYSIS USED: Data were entered, coded, and analyzed using the SPSS version 23. RESULTS: A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0-16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). CONCLUSIONS: The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs.

Résumé Contexte:Les ulcères de pression (UP) sont un problème mondial courant. Ils affectent les coûts de santé et la santé des patients en raison de l'augmentation des taux de morbidité et de mortalité. Les patients gravement malades sont plus susceptibles de développer des UP que d'autres patients. Comme la prévalence des UP est élevée en Arabie saoudite, une attention accrue est nécessaire pour la prévention des UP. Les connaissances et attitudes des infirmiers en matière de prévention des UP sont cruciales.Objectifs:Cette étude visait à évaluer les connaissances et attitudes des étudiants en soins infirmiers concernant les directives de prévention des UP basées sur des preuves. Cadre et conception : Cette étude descriptive et transversale a été menée auprès des étudiants en soins infirmiers de l'Université de Jazan.Matériels et méthodes:Les données ont été collectées à l'aide d'un questionnaire électronique. Analyse statistique utilisée: Les données ont été saisies, codées et analysées à l'aide de la version 23 du logiciel SPSS.Résultats:Au total, 378 participants ont été inclus. L'âge moyen était de 22,4 ± 3,4 ans et le score moyen de connaissance était de 7,6 ± 2,64 (plage = 0-16). Parmi les participants, 365 (96,6 %) avaient une connaissance médiocre et 13 (3,4 %) une bonne connaissance des UP. Seuls 72 (19 %) ont correctement identifié un manque d'oxygène comme étant la cause des UP; les autres participants ont répondu la malnutrition et l'humidité. En revanche, 200 (52,9 %) participants ont indiqué qu'une perte de poids récente en dessous du poids idéal des patients augmente le risque de UP. En ce qui concerne les connaissances sur les mesures préventives, 64 (16,9 %) participants ont répondu correctement qu'une position assise inclinée vers l'arrière, avec les deux jambes reposant sur un repose-pieds, peut réduire la pression. Pendant ce temps, 169 (44,7 %) participants ont correctement sélectionné un coussin d'air épais comme moyen de réduire l'ampleur de la pression lorsque les patients glissent sur une chaise. Certains participants ont répondu que les UP peuvent être réduits si les patients sont mobilisés. Soixante-douze (19 %) participants ont indiqué que les patients allongés sur un matelas en mousse viscoélastique devraient être repositionnés toutes les 2 heures pour réduire la durée de la pression. L'âge, l'année d'éducation, l'expérience de formation et le département n'étaient pas significativement associés aux connaissances sur les UP (P = 0,333, P = 0,370, P = 0,700 et P = 0,810, respectivement).Conclusions:Les connaissances générales et les attitudes à l'égard des UP des étudiants en soins infirmiers de l'Université de Jazan étaient médiocres. Néanmoins, ils avaient un niveau de connaissance moyen concernant la prévention des UP. L'âge et l'expérience de formation n'étaient pas significativement associés aux connaissances sur les UP.

Symptoms and management of cow's milk allergy: perception and evidence.

Introduction: The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. Our aim was to compare the opinions of expert groups from the Middle East (n = 14) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n = 13). Methods: These Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared. Results: Overall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g., malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow's milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence. Discussion: Differences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area.

Updates in the pathophysiology of COVID-19 infection in male reproductive and sexual health: a literature review.

This extensive comprehensive review explores the impact of the Coronavirus disease 2019 (COVID-19) pandemic on men's sexual and reproductive health. We conducted a literature review focusing on the possible pathophysiology by which severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) affects men's sexual and reproductive systems. We reviewed most of the studies that reported the impact of SARS-CoV-2 infection on the Testicular, Epididymal, Prostatic, and Penile tissue. Also, we focused on evaluating the SARS-CoV-2 infection on semen parameters and male reproductive hormones. Finally, we reviewed the COVID-19 vaccine's effect on male reproductive and sexual health. Findings revealed the adverse consequences of SARS-CoV-2 at cellular and organ levels on the male genital tract. However, the reported data are still controversial. The initial data regarding COVID-19 vaccination was promising promoted safety for men's reproductive and sexual health. We conclude this paper by offering recommendations to address these adverse consequences and potentially improve sexual and reproductive health among men in the post-COVID-19 pandemic era.

Efficacy of Biomarkers in Predicting Anastomotic Leakage After Gastrointestinal Resection: A Systematic Review and Meta-Analysis.

Our systematic review and meta-analysis were designed to evaluate the published literature from 2016 to 2019 on which the role of biomarkers in predicting the anastomotic leakage (AL) in gastroesophageal cancer surgery was investigated. This extensive literature search was conducted on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica dataBASE (EMBASE) were used to gather the relevant information. No restrictions were made on the type of biomarkers. Wald or likelihood ratio (LRT) fixed effect tests were used to estimate the pooled prevalence to generate the proportions with 95% confidence intervals (CI) and model-fitted weights. For analyzing heterogeneity, the Cochran Q test and I square test were used. The Egger regression asymmetry test and funnel plot were used for publication. In this meta-analysis, a total of 15 studies were recruited with 1892 patients undergoing the resection. The pooled elevated C-reactive protein (CRP) was observed as 13.9% ranging from 11.6% to 16.1%. The pooled prevalence of other biomarkers with AL was observed as 4.4%. Significant heterogeneity was observed between studies that reported CRP and other biomarkers (92% each with chi-squared values of 78.80 and 122.78, respectively). However, no significant publication was observed between studies (p=0.61 and p=0.11, respectively). We concluded our study on this note that different biomarkers are involved in the diagnosis of AL. However, all these biomarkers are poor predictors with insufficient predictive value and sensitivity.