Feasibility and Importance of Enteroscopy after Gastric Bypass.

BACKGROUND: Bariatric surgery has increased in popularity, with Roux-en-Y Gastric Bypass (RYGB) being one of the most frequently performed. This leads to many cases in which the stomach is removed from routine gastroscopy access, sometimes being a major source of concern. Performing enteroscopy in these patients is technically difficult. We present our experience with 24 cases in which the aim was to access the detached stomach. METHODS: Retrospective analysis on RYGB enteroscopy procedures aimed to access the detached stomach. Data recorded: demographic parameters, indication, gas insufflation, time to bypass stomach, total procedure and recovery times, and endoscopic and pathological findings. RESULTS: This study included 24 patients who underwent RYGB in the previous 3-36 months. Indications were chronic abdominal pain, refractory anemia, or unexplainable weight loss. Detached stomach was accessed in 79% of patients. Access time ranged from 25 to 55 min. Recovery time for all procedures was 86.66 min on average and shorter with CO2 insufflation (42.5 min). All detached stomachs showed macroscopic gastritis; four of them were Helicobacter pylori positive. Significant findings included three patients with jejunojejunostomy stenosis and one patient with a marginal gastrojejunal ulcer, which was later diagnosed with Signet ring cell carcinoma of the proximal anastomosis. CONCLUSIONS: We present the feasibility and importance of enteroscopy of the detached stomach and believe that this procedure should be performed more frequently. A high index of suspicion is needed for postoperative symptoms in order to exclude significant pathologies and reassure symptomatic patients that there is no abnormality in the bypassed stomach.

Mapping family planning policy and programme best practices in the WHO Eastern Mediterranean Region: a step towards coordinated scale-up.

Family planning is recognized as among the 4 core components of safe motherhood. This survey aimed to map evidence-based best policy and programme practices in family planning in the Member States of the WHO Eastern Mediterranean Region. A self-administered, structured questionnaire was developed to survey different components of 7 essential elements of successful family planning programmes. Responses were received from the ministry of health in 18 out of 22 Member States. A total of 17 out of 18 responding countries (94%) (including 7 priority countries for Millennium Development Goals 4 and 5) confirmed the availability of at least 5 out of the 7 surveyed essential elements of successful family planning programmes. Documented available best practices in family planning suggest a need for close coordination and collaboration among stakeholders in scaling up these best practices, especially in priority countries, to improve maternal and child health in the Region.

Mapping family planning policy and programme best practices in the WHO Eastern Mediterranean Region: a step towards coordinated scale-up

Family planning is recognized as among the 4 core components of safe motherhood. This survey aimed to map evidence-based best policy and programme practices in family planning in the Member States of the WHO Eastern Mediterranean Region. A self-administered, structured questionnaire was developed to survey different components of 7 essential elements of successful family planning programmes. Responses were received from the ministry of health in 18 out of 22 Member States. A total of 17 out of 18 responding countries [94%] [including 7 priority countries for Millennium Development Goals 4 and 5] confirmed the availability of at least 5 out of the 7 surveyed essential elements of successful family planning programmes. Documented available best practices in family planning suggest a need for close coordination and collaboration among stakeholders in scaling up these best practices, especially in priority countries, to improve maternal and child health in the Region

Anaemia among pregnant Palestinian women in the Occupied Palestinian Territory.

OBJECTIVE: To assess anaemia prevalence and correlated social and biological determinants among pregnant women in the Occupied Palestinian Territory (oPt). DESIGN: A cross-sectional survey conducted among pregnant women attending/accessing UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East) health centres in the Gaza Strip and the West Bank in September and October 2006. SETTING: Fifty-five UNRWA health centres in the oPt (eighteen in the Gaza Strip and thirty-seven in the West Bank). SUBJECTS: A random sample of 1740 pregnant women. RESULTS: Overall anaemia prevalence was 38.6 % (95 % CI 36.3, 40.9 %). A substantial difference in anaemia prevalence was observed between the Gaza Strip and the West Bank (44.9 % v. 31.1 %, respectively), as well as a significant increase in anaemia prevalence in the Gaza Strip compared with an Agency-wide survey conducted in 2004 (44.9 % v. 35.7 %, respectively). Anaemia prevalence was found to increase with age, parity and trimester of gestation. CONCLUSIONS: Anaemia still appears to be a public health problem among pregnant women in spite of UNRWA interventions. The West Bank shows prevalence rates similar to those observed in neighbouring countries, while the Gaza Strip has higher rates. Prevalence rates of anaemia among pregnant Palestinian women are more than two times higher than those observed in Europe.

Domestic violence against women during pregnancy: the case of Palestinian refugees attending an antenatal clinic in Lebanon.

OBJECTIVES: To determine the factors associated with domestic violence against pregnant Palestinian refugee women residing in Lebanon and currently using the United Nation Relief and Work Agency's (UNRWA) primary healthcare services. METHODS: This was a cross-sectional study conducted at a polyclinic of primary healthcare of the UNRWA in South Lebanon during the years 2005-2006. The sample was 351 pregnant women who were 15-42 years of age and not accompanied by their husbands or relatives. All women were invited by the midwife to participate in the study during their visit to the clinic for their first checkup or during a follow-up visit. The Abuse Assessment Screen instrument was used to screen for past and recent history of physical and emotional abuse among the participants. RESULTS: Domestic violence was significantly associated with education, gestational age, fear of husband or someone else in the house, and unintended pregnancy. The odds of abuse for women with an elementary or lower education were 6.86 (95% CI 1.2-38.1) and for women with an intermediate or secondary education 6.84 (95% CI 1.4-33.3) compared with women with a university education. The odds of abuse during pregnancy for women whose husbands did not desire their pregnancy were 3.80 (95% CI 1.5-9.7) compared with other women. CONCLUSIONS: Domestic violence against women in Lebanon was associated with educational level, gestational age, fear of husband or someone else in the house, and unintended pregnancy.

The effect of bactibilia on the course and outcome of laparoscopic cholecystectomy.

Although bactibilia is an important condition of acute cholecystitis, its effect on the course and outcome of the infectious gallbladder disease has rarely been studied, particularly in relation to the laparoscopic procedure. The current study attempts to learn more about the inter-relationship between bactibilia and laparoscopic cholecystectomy during acute cholecystitis. Demographic, preoperative, operative, and postoperative data were prospectively collected in every patient with acute cholecystitis treated in the department of surgery at the Bnai Zion Medical Center, Israel. Intraoperative biliary samples were collected under aseptic conditions at the time of operation for bacteriologic examination and were routinely cultured in aerobic and anaerobic media for 3 days. The study population was divided into culture-positive and culture-negative groups, and the collected parameters were compared between the groups. Age over 60 years, a palpable gallbladder, temperature over 37.5 degrees C, a white blood cell (WBC) count of more than 12,000/cc(3), and serum alkaline phosphatase higher than 100 U/dL were all found to be factors capable of predicting bactibilia. Bactibilia was a significant factor associated with total, as well as infectious, operative complications. Bactibilia is considered to indicate an advanced stage of acute cholecystitis. In cases of laparoscopic cholecystectomy for infectious gallbladder disease, bactibilia is strongly associated with total, as well as local, infectious complications. Preoperative conditions such as older age, elevated temperature, a palpable gallbladder, elevated WBC count, and elevated serum levels of alkaline phosphatase can serve as predictors of bactibilia and its consequent complications. Although the sensitivity and specificity of the predictive factors for bactibilia are limited to 63% and 67%, respectively, in their presence during acute cholecystitis, conservative wide-spectrum antibiotics as the first-line therapy is appropriate, and, upon regimen failure, laparoscopic surgery by an experienced surgeon is indicated as the adjusted therapy.

Infant and child mortality rates among Palestinian refugee populations.

We estimated infant and early child mortality rates among Palestinian refugees using maternal and child services in Jordan, Gaza, Lebanon, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates were 32 in Jordan, 33 in Gaza, 35 in Lebanon, and 29 in Syria.

PIP: Since 1950, the UN Relief and Works Agency for Palestine Refugees in the Near East has provided education, health, and relief and social services to registered Palestinian refugees in Jordan, Gaza, the West Bank, Lebanon, and Syria. This study estimated infant and early child mortality rates among Palestinian refugees who attended the agency's primary health care facilities. Using a modified version of the Preceding Birth Technique to estimate early childhood and infant mortality rates, it was noted that infant mortality rate was highest in Lebanon, followed by Gaza, Jordan, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates registered in Jordan were 32, 33 in Gaza, 35 in Lebanon, and 29 in Syria.