Design of Experimental Approach for Development of Rapid High Performance Liquid Chromatographic Process for Simultaneous Estimation of Metoprolol, Telmisartan, and Amlodipine from Formulation: Greenness and Whiteness Evaluation.

The design of an experimental approach, the Box-Behnken design, was implemented to optimize the chromatographic condition to develop a rapid HPLC procedure for quantification of a ternary mixture of metoprolol (MET), telmisartan (TEL), and amlodipine (AML) from the formulation. The perturbation plots, contour, and 3D response surface pictures were developed to study the impact of each variable on the analytes' retention time and the probable interaction between the parameters with fewer chromatographic runs. The optimized HPLC method separated the three analytes within 5 min with excellent selectivity and peak shape on a Zorbax C18 HPLC column using acetonitrile and phosphate buffer (20 mM, pH 5.8) with isocratic elution at a 1.1 mL/min flowrate. A wavelength 230 nm was utilized to monitor the elute. The validation of proposed method demonstrated a wide linearity range of 10-200 µg/mL for MET and TEL and 5-50 µg/mL for AML along with an excellent correlation coefficient. The correctness of the HPLC approach was further confirmed by excellent recovery of the added amount of analytes utilizing the standard addition technique. The recommended HPLC approach was employed safely for quality assurance of the formulation, because the evaluation of the method's greenness and whiteness confirmed the environmentally friendly nature of the approach.

An Extremely Rare and Aggressive Case of Undifferentiated Carcinoma With Osteoclast-Like Giant Cells of the Pancreas Presenting as a Paraneoplastic Syndrome: A Case Report and Literature Review.

Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is a rare tumor type of pancreatic cancer. Paraneoplastic syndromes, an idiopathic inflammatory myositis characterized by various skin manifestations (such as dermatomyositis (DM)), cannot be attributed to the primary tumor itself. Here, we report an unusual case of UC-OGC presenting as a paraneoplastic syndrome, the first reported from Saudi Arabia and the Arabian Gulf states. A 49-year-old Eritrean woman with known DM was referred to our hospital with a left-sided pleural effusion. Computed tomography of the abdomen revealed a large necrotic splenic mass (~17 × 12.9 × 18.2 cm). The patient underwent exploratory laparotomy with en bloc resection of the mass (splenectomy, distal pancreatectomy, and partial excision of the left hemidiaphragm). Following a histopathological examination of the mass, UG-OGC of the pancreas, presenting as a paraneoplastic syndrome, was diagnosed. To our knowledge, this case is the first to present a paraneoplastic syndrome associated with UC-OGC. The identification of an exceedingly rare tumor presenting atypically as a paraneoplastic syndrome shows the importance of conducting comprehensive examinations of patients with malignancies, emphasizing the need for more reports of similar cases.

An Overview of Developmental Dysplasia of the Hip and Its Management Timing and Approaches.

Developmental dysplasia of the hip (DDH), if uncorrected, can result in several chronic abnormalities, including chronic hip pain, degenerative arthritis, and gait abnormalities. The outcome of DDH generally depends on the age of presentation; a worse prognosis is linked to a higher age of presentation. Although treatment continues to be a challenge, recent advancements in the field have improved our understanding of the disease, which has resulted in advancements in DDH surveillance during infancy and the reduction of complications with early intervention. The databases used for this overview include Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, MEDLINE, and EMBASE. These databases were used to search for ongoing trials related to the management and diagnosis of DDH.

Clinicohistological Characteristics of Patients with Oral Lichenoid Mucositis: A Retrospective Study for Dental Hospital Records.

Oral lichenoid mucositis (OLM) of the oral mucosa is a histological diagnosis mainly characterised by a band of inflammatory infiltrate in lamina propria and basal cell degeneration. These features describe oral lichen planus or oral lichenoid reaction. However, it could be seen in oral dysplasia. The study aimed to assess the demographics and clinicohistological characteristics of patients with OLM and their relevance to dysplastic changes in the oral mucosa. This was a cross-sectional and retrospective study of archived and electronic records of individuals with histological confirmation of OLM at King Saud University Medical City, Saudi Arabia. The descriptive and correlation assessments were used to describe the demographics and clinicohistological characteristics and their associations, respectively [p < 0.05]. The analysis included 140 records of patients with histological confirmation of OLM with a mean age of 47 (±13), and 57% (n = 81) were females. Notably, 40% of patients had at least one medical condition, mainly diabetes mellitus, 74% were asymptomatic, and 52% had lesions in the buccal mucosa. Dysplasia was seen in 18 (12%) of the 140 reviewed records. Regarding the associations between study variables, dysplastic changes were associated with the male gender [p = 0.024] and were of no significance with increased age [p = 0.594]. Moreover, having oral symptoms was associated with older age [p < 0.001], medical history of diabetes [p = 0.0132] and hypertension [p < 0.001]. The present study findings could help indicate the individuals with histologically confirmed OLM who suffer the most from the clinical disease and have an increased risk of dysplastic changes. Therefore, symptomatic management and long-term follow-up can be planned accordingly.

Nanoscale plasmonic logic gates design by using an elliptical resonator.

This study implemented AND, NAND, OR, XOR, NOR, XNOR, and NOT plasmonic logic gates using the finite element method. The all-optical nanoscale logic gates were designed using a single structure based on the technology of insulator-metal-insulator nanoscale plasmonic waveguides. The phase of optical waves and the position of the control and input ports are the most important factors for attaining the optimal transmission value based on interference between the input and control ports. The transmission threshold is 35%, and 850 nm is the operating wavelength. This design creates nanoscale logic gates with a structure dimension of 250nm×250nm. The transmission threshold, modulation depth, contrast ratio, and insertion loss criteria were proposed to evaluate the efficacy of the all-optical gates.

Nanoscale plasmonic combinational logic circuits based on an elliptical resonator.

The half-adder (HA) and half-subtractor (HS) plasmonic combinational logic circuits are explained using a finite element method with a COMSOL software package. The combinational circuits are created using insulator-metal-insulator technology with nanoscale plasmonic structures. In order to achieve an excellent transmission value, the phase angle of optical waves and the position of the control and input ports are the more crucial elements. In this design, the nanoscale combinational circuits are realized at a 35% transmission threshold to distinguish between the logic "0" and logic "1" stand on the interference between the input and control ports with 540n m×250n m dimensions and an 850 nm resonant wavelength. The modulation depth, contrast ratio, and insertion loss have 97.38%, and 11.84 and 3.3 dB for the HA, and they have 92.38%, and 7.12 and -1.41d B for the HS, respectively.

Assessing the risk of a clinically significant infection from a Microneedle Array Patch (MAP) product.

Microneedle Array Patches (MAPs) are an emerging dosage form that creates transient micron-sized disruptions in the outermost physical skin barrier, the stratum corneum, to facilitate delivery of active pharmaceutical ingredients to the underlying tissue. Numerous MAP products are proposed and there is significant clinical potential in priority areas such as vaccination. However, since their inception scientists have hypothesized about the risk of a clinically significant MAP-induced infection. Safety data from two major Phase 3 clinical trials involving hundreds of participants, who in total received tens of thousands of MAP applications, does not identify any clinically significant infections. However, the incumbent data set is not extensive enough to make definitive generalizable conclusions. A comprehensive assessment of the infection risk is therefore advised for MAP products, and this should be informed by clinical and pre-clinical data, theoretical analysis and informed opinions. In this article, a group of key stakeholders identify some of the key product- and patient-specific factors that may contribute to the risk of infection from a MAP product and provide expert opinions in the context of guidance from regulatory authorities. Considerations that are particularly pertinent to the MAP dosage form include the specifications of the finished product (e.g. microbial specification), it's design features, the setting for administration, the skill of the administrator, the anatomical application site, the target population and the clinical context. These factors, and others discussed in this article, provide a platform for the development of MAP risk assessments and a stimulus for early and open dialogue between developers, regulatory authorities and other key stakeholders, to expedite and promote development of safe and effective MAP products.

Intraoral angiosarcoma with unusual clinical presentation: A case report.

Introduction: Angiosarcoma is a rare and highly aggressive soft tissue malignancy originating from vascular and lymphatic endothelial cells. Epithelioid angiosarcoma is the rarest subtype of angiosarcoma, characterized by the proliferation of large polygonal cells with an epithelioid feature. The occurrence of these tumors in the oral cavity is highly uncommon, and immunohistochemistry staining is essential to differentiate epithelioid angiosarcoma from mimicking lesions. Aim: To present a case of intraoral angiosarcoma with an unusual clinical presentation and behavior and to report, to the best of our knowledge, a first primary appendix epithelioid angiosarcoma with metastasis foci in the oral cavity. Objectives: To discuss the clinical, histological, and immunochemical features of an unusual case of intraoral angiosarcoma. Case report: A 53-year-old Saudi female with an uncommon clinical presentation of intraoral angiosarcoma. The patient reported the lesion being painless, slowly growing, and of a six-month duration. The microscopic examination and immunohistochemical evaluation showed epithelioid angiosarcoma. The tumor cells were positive to ERG, FLI 1, and CD31 (focal) and negative to CK HMW, CD45, S100, HMB 45, D2-4, and CD 34. Discussion: Due to the extremely rare occurrence and non-characteristic presentation of angiosarcoma in the oral cavity, many lesions maybe included in the differential diagnosis. Thus, making the diagnosis of intraoral angiosarcoma difficult.

Unusual Acute, Massive Lower Gastrointestinal Bleeding Secondary to a Proximal Jejunal Gastrointestinal Stromal Tumor: A Case Report.

The most common primary non-epithelial neoplasms of the gastrointestinal (GI) tract are gastrointestinal stromal tumors (GISTs). Ten percent (10%) of GISTs arise from the jejunum. Usually, patients complain of abdominal discomfort, but they may present with complications such as intestinal obstruction or bleeding. This report describes a 35-year-old male who presented with unusually massive, acute lower GI bleeding. After resuscitation and investigations (including a contrast-enhanced computed tomography of the abdomen and lower GI endoscopy), the patient underwent diagnostic laparoscopy and bowel resection of the affected section with anastomosis, and he had an eventful postoperative course. Studies suggest that GI bleeding in GIST occurs due to the ulceration and necrosis of the overlying mucosa caused by the pressure effect of the mass. Small-bowel GISTs are categorized based on their size. Many guidelines have advocated conservative management for small GISTs (<2 cm) that are in the jejunum. This patient has a rare case of a small jejunal GIST with a rare presentation of massive lower GI bleeding. A multidisciplinary approach is useful in managing such cases, and our case showed that laparoscopic intervention is a feasible option in a stable patient with massive lower GI bleeding.

Is Appendiceal Diverticulitis Mimicking Acute Appendicitis?

Appendicular diverticulitis (AD) is a rare entity characterized by the inflammation of the arising diverticulum of the appendix. It has been reported to carry a high risk of perioperative complications, such as bleeding and perforation. Furthermore, multiple articles have highlighted the importance of diagnosing AD early due to its strong association with malignancies. Limited published cases concerning AD in our country and globally are available in the literature. Hence, we present in this article a case series of five exciting cases of incidental findings of AD that were initially diagnosed as acute appendicitis based on clinical evaluation and imaging findings. In our series, we performed a retrograde evaluation of the computed tomography scans of all five cases that showed diverticula. In conclusion, histopathological evaluation remains the method of choice to reach the definitive diagnosis; however, it is essential to highlight the relevance of imaging in diagnosing AD preoperatively in the early stages to reduce morbidity and mortality.

Foreign Body Ingestion: A Common Presentation Among Pediatric Age Group in the City of AlAhsa Eastern Province, Saudi Arabia.

Background Foreign body ingestion is a prevalent issue among children and presents considerable morbidity and mortality rates. Due to children's increased accessibility to electronic toys and equipment, foreign body ingestion has become a common reason for presenting to pediatric emergency departments worldwide. In this context, this research aims to determine the prevalence of foreign body ingestion among children in AlAhsa, Saudi Arabia. Methodology This observational retrospective descriptive study was conducted at Maternity and Children Hospital, AlAhsa, Saudi Arabia, from 2017 to 2021. The study included children (less than 14 years old) who presented to the emergency department with a history of foreign body ingestion. The biographical data, clinical presentation, type of foreign body, and X-ray findings were documented. Results A total of 91 cases of foreign body ingestion or aspiration in children under 14 years of age were included. Approximately half of the patients were under the age of three, and 62.2% of them were male, while 37.8% were female. The clinical presentation revealed that only 24% were symptomatic. Coins were the most commonly ingested foreign bodies (28.9%), followed by metallic objects (20%), and batteries were the least frequently ingested foreign bodies, recorded in eight cases. Conclusion Early detection and treatment of foreign body ingestion is crucial to prevent consequences. In this study, the most frequent foreign bodies detected were coins among children up to three years old. Raising parents' awareness about the prevention of foreign body ingestion is an important step toward reducing its incidence.

A Rare Case and Presentation of Traumatic Penetrating Aortic Arch Injury: A Case Report and Literature Review.

A penetrating injury to the thoracic aorta is an extremely rare, life-threatening condition, with a high overall mortality rate. The incidence of a penetrating injury to the aortic arch is unknown because the majority of patients die before receiving adequate treatment due to excessive bleeding. Through a literature review, 23 cases of favorable outcomes were found. We report the first case from the Arab Gulf states. We present the extremely rare case of a 23-year-old male who presented to the emergency department with stable hemodynamics after being stabbed in the left supraclavicular region. The investigation revealed that he suffered from aortic arch transection and contrast extravasation. The patient was rushed to the operating room, where a primary repair was performed through a median sternotomy approach. The patient was discharged on the 14th postoperative day without complications. Penetrating chest trauma (aortic arch injury) is uncommon, and it is typically fatal at the scene or time of injury, even in patients who arrive at the emergency department alive or while undergoing surgery. CT aortography should be performed on patients with normal vital signs but abnormal clinical findings suggestive of a vascular injury. For injuries of types II to IV without concomitant injuries, immediate surgical repair is recommended. Aortic arch penetrating injuries continue to be extremely lethal. Emergency surgical repair remains the standard of care and is associated with high morbidity and mortality rates. However, managing such uncommon injuries remains a formidable challenge. We encourage additional studies.

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience.

Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment. A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.

Enabling Intelligent IoTs for Histopathology Image Analysis Using Convolutional Neural Networks.

Medical imaging is an essential data source that has been leveraged worldwide in healthcare systems. In pathology, histopathology images are used for cancer diagnosis, whereas these images are very complex and their analyses by pathologists require large amounts of time and effort. On the other hand, although convolutional neural networks (CNNs) have produced near-human results in image processing tasks, their processing time is becoming longer and they need higher computational power. In this paper, we implement a quantized ResNet model on two histopathology image datasets to optimize the inference power consumption. We analyze classification accuracy, energy estimation, and hardware utilization metrics to evaluate our method. First, the original RGB-colored images are utilized for the training phase, and then compression methods such as channel reduction and sparsity are applied. Our results show an accuracy increase of 6% from RGB on 32-bit (baseline) to the optimized representation of sparsity on RGB with a lower bit-width, i.e., <8:8>. For energy estimation on the used CNN model, we found that the energy used in RGB color mode with 32-bit is considerably higher than the other lower bit-width and compressed color modes. Moreover, we show that lower bit-width implementations yield higher resource utilization and a lower memory bottleneck ratio. This work is suitable for inference on energy-limited devices, which are increasingly being used in the Internet of Things (IoT) systems that facilitate healthcare systems.

A Constitutional Mismatch Repair Deficiency Syndrome Presented With an Advanced Rectal Cancer in a Juvenile Female: A Case Report and Literature Review.

The constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and challenging condition with a poor prognosis. It results from biallelic mismatch repair gene mutations and leads to multiorgan cancers. Therefore, we report the first case of advanced juvenile rectal cancer related to CMMRD syndrome in the Gulf region. She is a 13-year-old female, born to non-consanguineous parents with a positive family history of malignancy, presented with an eight-month history of a retractable bulging anal mass associated with diarrhea mixed with blood and constitutional symptoms. She was cachectic with café au lait spots all over her body. Upon investigation, she was found to have invasive rectal adenocarcinoma. The case was started on neoadjuvant chemoradiotherapy in addition to genetic testing which showed a homozygous pathogenic variant in PMS2, indicating CMMRD syndrome. The patient underwent pre-operative post-neoadjuvant reassessment followed by laparoscopic total proctocolectomy with ileal J-pouch creation and ileoanal anastomosis with temporary diverting loop ileostomy which later on was reversed with no complications or recurrence. The family declined to continue the adjuvant therapy but accepted the surveillance programs and genetic testing. Unusual or late presentation secondary to a very rare syndrome like CMMRD is a major challenge to clinicians, hence a high index of suspicion and proper utilization of genetics programs might be the best available solutions.

A Rare Case of Pancreatic Adenocarcinoma With Incidental Synchronous Hepatic and Sigmoid Colonic Metastasis: A Case Report and Literature Review.

Metastasis of pancreatic adenocarcinoma to the colon is a very rare condition that might be underdiagnosed and underreported in the literature. We report a very rare case of incidental findings of sigmoid metastasis secondary to pancreatic adenocarcinoma in a 60-year-old Saudi male, who is a non-smoker with a normal medical and surgical history. The patient presented to a primary care clinic with abdominal bloating and vague on/off abdominal pain for almost 1 year as well as unintentional weight loss without lower gastrointestinal (GI) symptoms. After the case was discussed in the multidisciplinary tumor board, the patient was started on systematic palliative chemotherapy. However, after receiving the first cycle, he started to deteriorate rapidly and succumbed to secondary cardiopulmonary arrest. Cases of synchronous metastasis of pancreatic adenocarcinoma to the colon might not be well known or common. However, a high index of suspicion and individualizing the workup tools may need to be used.

Complete bilateral blindness associated with ruptured anterior communicating artery aneurysm: A literature review and illustrative case.

Background: Anterior communicating artery (AcomA) aneurysms are considered one of the most common intracranial aneurysms, contributing to approximately 40% of the subarachnoid hemorrhages related to aneurysmal rupture. Aneurysms of the anterior circulation are commonly present with visual defects varying in their nature according to the aneurysmal site. However, complete bilateral vision loss associated with AcomA aneurysms is a significantly rare finding. We are reporting a case of complete bilateral blindness in a patient with a ruptured AcomA aneurysm with a literature review. Methods: We conducted a PubMed Medline database search by the following combined formula of subjects' headings: (((Intracranial Aneurysm [MeSH Terms]) AND (AcomA Aneurysm [Title/Abstract])) AND [(Vision loss OR Blindness [Text Word])) AND (case reports [Filter]). Additional articles were searched through the reference lists of the included articles. Results: Our review yielded a total of five cases. All the present cases revealed unilateral blindness only, and their outcomes after treatment vary from recovery of vision to unchanged complete vision loss - none of the cases found in the literature presented with bilateral blindness. Conclusion: AcomA aneurysms can be associated with visual loss in some cases. However, usually, the defect is unilateral. Studies of the visual defects, including potential bilateral complete blindness associated with rupture inferiorly, directed AcomA aneurysm, should be highlighted.

Large Asymptomatic Retroperitoneal Ganglioneuroma Displacing Major Abdominal Organs and Vessels in an Adult.

BACKGROUND Ganglioneuromas (GNs) are benign neuroblastic tumors. These extra-cranial solid tumors are common in childhood but unusual in adults. Patients with GNs typically do not have any symptoms and the tumors usually are incidental findings. However, if a GN is large enough to compress adjacent organs, complications can occur. Furthermore, even in patients who have incomplete resection of a GN, long-term survival rates are high. After a GN is seen on imaging, the diagnosis usually is made with a biopsy and treatment is with surgery alone. CASE REPORT A 29-year-old woman was referred to General Surgery from the Gynecology Clinic for an incidental finding of an abdominal mass on routine ultrasound for secondary infertility and admitted for an investigation. Abdominal and pelvic computed tomography (CT) and magnetic resonance imaging showed a retroperitoneal mass that measured 6.318×22 cm arising from the paravertebral region with intraspinal extension. The mass was displacing the patient's thoracic aorta, abdominal inferior vena cava, and ureters. A CT-guided biopsy revealed a GN. Debulking surgery was performed and a small amount of residual tumor was left in the paravertebral nerve roots. The patient recovered well with no complications. The diagnosis of GN was confirmed with pathology, which was reviewed by the Tumor Board; the Board agreed that only follow-up in the Surgery Clinic was needed. During the patient's last visit, 10 months after surgery, a follow-up CT scan showed that the residual tumor was stable. CONCLUSIONS GNs are benign abdominal and retroperitoneal tumors that are typically asymptomatic and detected incidentally. Surgical resection is the treatment of choice and even when it is incomplete, the prognosis for patients is excellent.

Maize Tassel Detection From UAV Imagery Using Deep Learning.

The timing of flowering plays a critical role in determining the productivity of agricultural crops. If the crops flower too early, the crop would mature before the end of the growing season, losing the opportunity to capture and use large amounts of light energy. If the crops flower too late, the crop may be killed by the change of seasons before it is ready to harvest. Maize flowering is one of the most important periods where even small amounts of stress can significantly alter yield. In this work, we developed and compared two methods for automatic tassel detection based on the imagery collected from an unmanned aerial vehicle, using deep learning models. The first approach was a customized framework for tassel detection based on convolutional neural network (TD-CNN). The other method was a state-of-the-art object detection technique of the faster region-based CNN (Faster R-CNN), serving as baseline detection accuracy. The evaluation criteria for tassel detection were customized to correctly reflect the needs of tassel detection in an agricultural setting. Although detecting thin tassels in the aerial imagery is challenging, our results showed promising accuracy: the TD-CNN had an F1 score of 95.9% and the Faster R-CNN had 97.9% F1 score. More CNN-based model structures can be investigated in the future for improved accuracy, speed, and generalizability on aerial-based tassel detection.

Trends in bariatric surgery and incidentalomas at a single institution in Saudi Arabia: a retrospective study and literature review.

BACKGROUND: Data are lacking on trends in bariatric surgery and the frequency of incidental findings in Saudi Arabia. OBJECTIVE: Report on trends in bariatric surgery as well as our experience in incidental findings along with a literature review (mainly on gastrointestinal stromal tumor). DESIGN: Retrospective chart and literature review. SETTINGS: Academic tertiary care center. PATIENTS AND METHODS: We conducted a retrospective study at King Khalid University Hospital and analyzed the data collected from 2009 to 2019. We collected data on age, body mass index (BMI), H pylori infection, type of bariatric surgery performed, and type and location of incidental findings. MAIN OUTCOME MEASURES: Incidental findings during or after bariatric surgery (in pathology specimen). SAMPLE SIZE: 3052 bariatric surgeries, 46 patients with incidentalomas. RESULTS: The mean and standard deviation for the age of the 46 patients with incidentalomas was 42.1 (13.9) years and the mean (SD) preoperative BMI was 43.4 (6.4) kg/m2. Of 3052 bariatric surgeries performed, the most common type was sleeve gastrectomy (93.9%), followed by gastric bypass surgery (4.58%) and gastric banding (1.47%). The total frequency of incidentalomas was 1.5%; 10.8% of patients had gastrointestinal stromal tumors (GIST), with the stomach being the commonest site for incidental findings. Eighty percent of the patients with GIST were positive for H pylori (P=.01 vs negative patients). CONCLUSION: The number of incidentalomas and other findings were consistent with other reports. All these findings suggest that bariatric surgeons should take special care before, during, and after a laparoscopic operation in obese patients. LIMITATIONS: Since this is a single-center, retrospective study, we did not collect data on important variables such as gender, socioeconomic status of the patient, and family history of obesity, and we did not perform a preoperative esophagogastroduodenoscopy. CONFLICT OF INTEREST: None.