The Effects of Post-Surgical Pregnancy on Weight Loss Trajectories after Bariatric Surgery: Are Initial Weight and Age Prognostic Factors?

Introduction: A substantial percentage of patients undergoing bariatric surgery are of childbearing age. Pregnancy outcomes after bariatric surgery are known. However, there are limited data on the impact of pregnancy on weight loss after surgery. Objectives: This study aims to evaluate the effects of pregnancy on post-bariatric surgery weight loss trajectories (WLTs) and to determine the association with age and initial weight. Methods: All who had primary bariatric surgeries (Roux-en-Y gastric bypass or sleeve) between September 2015 and July 2020 were classified into two groups: post-surgery gravid (GG) and post-surgery non-gravid (NG). WLTs were examined using a random intercept mixed-effects model with repeated measures nested within patients. The post-surgery/pre-gravid time phase (PoPG) was modelled using a third-degree polynomial. For GG, two third-degree spline functions modelled the post-surgery while gravid (PoWG) and post-partum (PoPP) time phases. Age and initial weight were used to control for pre-existing differences during PoPG. Weight differences at 6 months PoPP were examined by applying general linear hypothesis testing to the mixed-model results. Results: A total of 508 patients were included, 20 in GG and 488 in NG. The mean age at surgery was 33 years in GG and 37 years in NG. The mean initial BMI was 47 kg/m2 and 43 kg/m2, respectively. During PoPG, adjusted average weight in both groups follows the path across time. For GG, weight decreases and then increases during PoWG. For GG during PoPP, weight immediately decreases after delivery and then increases over time to levels similar to NG. Weight differences at 6 months PoPP for GG and NG were not statistically different. Older age was associated with reduced weight loss during PoPG by Baseline Age, while higher initial weight was associated with increased weight loss during PoPG by Baseline Weight. In both instances, these effects attenuate over time. Conclusions: This model indicates that pregnancy following bariatric surgery affects WLT during PoWG and PoPP, and no difference in weight is expected after 6 months post-gravid. Age and initial weight could be considered prognostic factors during PoPG. Patients wishing to conceive should undergo preconception counselling and be advised to avoid pregnancy during the period of rapid weight loss. They also should be informed that WLT may vary during pregnancy and early post-partum.

One-time definitive attachment connection versus healing abutment placement for an implant-retained mandibular overdenture: Peri-implant metabolic activity.

STATEMENT OF PROBLEM: Unscrewing the healing abutment can affect the soft tissue integration and apical migration of the biological width, which may compromise the integrity of peri-implant soft tissue. PURPOSE: The purpose of this clinical study was to determine the level of glycosaminoglycan (GAG) detected in the peri-implant crevicular fluid (PICF) between the test group (1-time abutment) and control group (healing abutment) for implant-retained mandibular overdentures. MATERIAL AND METHODS: Two dental implants were installed in the canine regions of the mandibular ridge of 18 healthy completely edentulous participants using 2-stage surgery and a delayed loading protocol. At the second stage surgery, the implant on the right side was exposed, and a healing abutment was screwed onto the implant (control group), while on the left side the definitive ball abutment was screwed onto the implant (test group). After 10 days, the healing abutment in the control group was unscrewed and replaced with the definitive ball abutment. For both groups, the ball attachment was directly picked up to incorporate the attachment house to the mandibular denture. PICF samples were collected from the participants at 7 days, 3 months, and 6 months after overdenture use. Statistical analysis was done with an independent samples t test (α=.05). RESULTS: A significant difference was found in the volume of PICF and the level of GAG between the test and control groups at the 7-day evaluation period (P=.008, P=.002, respectively), while the volumes of PICF and the levels of GAG were not significantly different (P>.05) at the other evaluation periods. CONCLUSIONS: The 1-time abutment protocol offers biochemical and economic advantages compared with the conventional method of using the healing abutment before placement of the definitive attachment for an implant-retained overdenture with single attachments.

Cardiovascular disease risk scores in patients with optimal vs suboptimal weight loss after bariatric surgery: Translating improvements into clinical practice.

INTRODUCTION: The aim of this study was to evaluate cardiovascular disease (CVD) risk modification in patients with optimal weight loss (OWL) versus suboptimal weight loss SWL following MBS. METHODS: This was a retrospective analysis. The 10-year risk CVD was estimated before and after one year of surgery using the "Framingham Score". RESULTS: 191 patients were included in our study. Mean baseline Framingham score was 7.2 â€‹± â€‹6.9%. According to the score, 54% of patients were classified as low risk (n â€‹= â€‹104), 23% as moderate (n â€‹= â€‹43), 20% moderately high (n â€‹= â€‹39) and 3% as high risk (n â€‹= â€‹5). One year after surgery, 91% of the patients showed reduction of their Framingham score. Mean CVD risk score decreased significantly to 4.1 â€‹± â€‹3.7% when compared to baseline (p-value is â€‹< â€‹0.001); 80% of patients classified as low risk (n â€‹= â€‹153), 13% as moderate (n â€‹= â€‹25), 7% moderately high (n â€‹= â€‹13) and 0% as high risk (n â€‹= â€‹0). CONCLUSION: Weight loss after bariatric surgery reduces CVD risk scores and the magnitude of effect correlates with the degree of weight loss.

Innovative approach for predicting daily reference evapotranspiration using improved shallow and deep learning models in a coastal region: A comparative study.

Accurate and reliable estimation of Reference Evapotranspiration (ETo) is crucial for water resources management, hydrological processes, and agricultural production. The FAO-56 Penman-Monteith (FAO-56PM) approach is recommended as the standard model for ETo estimation; nevertheless, the absence of comprehensive meteorological variables at many global locations frequently restricts its implementation. This study compares shallow learning (SL) and deep learning (DL) models for estimating daily ETo against the FAO-56PM approach based on various statistic metrics and graphic tool over a coastal Red Sea region, Sudan. A novel approach of the SL model, the Catboost Regressor (CBR) and three DL models: 1D-Convolutional Neural Networks (1D-CNN), Long Short-Term Memory (LSTM), and Gated Recurrent Unit (GRU) were adopted and coupled with a semi-supervised pseudo-labeling (PL) technique. Six scenarios were developed regarding different input combinations of meteorological variables such as air temperature (Tmin, Tmax, and Tmean), wind speed (U2), relative humidity (RH), sunshine hours duration (SSH), net radiation (Rn), and saturation vapor pressure deficit (es-ea). The results showed that the PL technique reduced the systematic error of SL and DL models during training for all the scenarios. The input combination of Tmin, Tmax, Tmean, and RH reflected higher performance than other combinations for all employed models. The CBR-PL model demonstrated good generalization abilities to predict daily ETo and was the overall superior model in the testing phase according to prediction accuracy, stability analysis, and less computation cost compared to DL models. Thus, the relatively simple CBR-PL model is highly recommended as a promising tool for predicting daily ETo in coastal regions worldwide which have limited climate data.

An innovative approach for predicting groundwater TDS using optimized ensemble machine learning algorithms at two levels of modeling strategy.

Groundwater salinization in coastal aquifers is a major socioeconomic challenge in Oman and many other regions worldwide due to several anthropogenic activities and natural drivers. Therefore, assessing the salinization of groundwater resources is crucial to ensure the protection of water resources and sustainable management. The aim of this study is to apply a novel approach using predictive optimized ensemble trees-based (ETB) machine learning models, namely Catboost regression (CBR), Extra trees regression (ETR), and Bagging regression (BA), at two levels of modeling strategy for predicting groundwater TDS as an indicator for seawater intrusion in a coastal aquifer, Oman. At level 1, ETR and CBR models were used as base models or inputs for BA in level 2. The results show that the models at level 1 (i.e., ETR and CBR) yielded satisfactory results using a limited number of inputs (Cl, K, and Sr) from a few sets of 40 groundwater wells. The BA model at level 2 improved the overall performance of the modeling by extracting more information from ETR and CBR models at level 1 models. At level 2, the BA model achieved a significant improvement in accuracy (MSE = 0.0002, RSR = 0.062, R2 = 0.995 and NSE = 0.996) compared to each individual model of ETR (MSE = 0.0007, RSR = 0.245, R2 = 0.98 and NSE = 0.94), and CBR (MSE = 0.0035, RSR = 0.258, R2 = 0.933 and NSE = 0.934) at level 1 models in the testing dataset. BA model at level 2 outperformed all models regarding predictive accuracy, best generalization of new data, and matching the locations of the polluted and unpolluted wells. Our approach predicts groundwater TDS with high accuracy and thus provides early warnings of water quality deterioration along coastal aquifers which will improve water resources sustainability.

Solusomes (novel soluplus® enriched nano-vesicular carriers) for improving the oral bioavailability of Candesartan cilexetil.

Candesartan cilexetil (CAN) is administered for treating hypertension and heart failure. CAN suffers poor oral bioavailability, owing to limited aqueous solubility, and first-pass metabolism. Solusomes (novel Soluplus® enriched nano-vesicular carriers) combine the merits of Soluplus®, and the traditional liposomes. They were explored to increase CAN solubility, allow a high drug release rate, and improve the oral drug bioavailability. Solusomes were developed via thin film hydration technique utilizing lipid (phosphatidylcholine; PC) and polymeric solubilizer (Soluplus®; Solu). S6 system comprising PC (0.1% w/v), CAN and Soluplus® (at 1:5 ratio; w/w), following a 5 min sonication period, was the optimum one with respect to drug entrapment efficiency (83.5 ± 2.6%), drug loading (11.9 ± 0.3%), particle size and shape (377.2 ± 12.1 nm, spherical), zeta-potential (-19.6 ± 2.1 mV), saturated drug solubility (32.09 ± 0.71 µg/mL), drug released % after 1 h (68 ± 0.9%), and stability. Significantly higher Cmax (969.12 ± 46.3 ng/mL), shorter median Tmax (1h), and improved relative bioavailability (≈ 6.8 folds) in rabbits could evidence the potential of S6 system in enhancing oral CAN bioavailability. S6 solusomes act as dual platform to improve the oral drug bioavailability and maintain effective drug concentration for a prolonged period.

Maxillary "All-on-six" treatment using zygomatic implants. Bone loss evaluation by cone beam computed tomography; Three years' follow-up.

PURPOSE: To evaluate radiographic changes around six implants (Two posterior zygomatic and four conventional implants) used with fixed detachable restorations in patients with severe maxillary posterior resorption with either Polyether ether ketone (PEEK) or titanium frameworks. MATERIALS AND METHODS: Twelve maxillary edentulous patients were rehabilitated with six implants, including two posterior zygomatic and 4 conventionally placed implants for each patient following all-on-six distribution, and opposing mandibular all-on-four implant retained fixed detachable prostheses. A two-stage surgical unloaded healing protocol was performed. According to framework and teeth materials, there were two groups; Group I: CAD-CAM milled framework from modified BioHPP PEEK, bonded to polymethylmethacrylate crowns. Group II: screw-retained CAD-CAM milled framework from titanium, bonded to zirconium crowns. Bone loss evaluation for six implants was performed using cone beam computed tomography at the time of insertion (T0), after one year (T1), and after three years (T2). RESULTS: There was a statistically significant difference in bone loss between PEEK and titanium groups. Less bone loss in PEEK groups around anterior conventional implants at buccal surfaces (P =0.01), at mesial surfaces (P <0.001), at distal surfaces (P <0.001), and zygomatic implants at buccal surfaces (P =0.004), and at palatal surfaces (P =0.003). CONCLUSIONS: Within the limitations of the study, the full-arch PEEK and titanium frameworks of fixed-detachable prostheses used with an All-on-Six distribution using zygomatic implants for rehabilitation of maxillary edentulous atrophied posterior arches was a promising treatment approach. Less bone loss was observed with the PEEK framework restorations combined with the PMMA crowns group.

Downregulation of MGMT expression by targeted editing of DNA methylation enhances temozolomide sensitivity in glioblastoma.

Glioblastoma is the most common and aggressive primary tumor of the central nervous system with poor outcome. Current gold standard treatment is surgical resection followed by a combination of radio- and chemotherapy. Efficacy of temozolomide (TMZ), the primary chemotherapeutic agent, depends on the DNA methylation status of the O6-methylguanine DNA methyltransferase (MGMT), which has been identified as a prognostic biomarker in glioblastoma patients. Clinical studies revealed that glioblastoma patients with hypermethylated MGMT promoter have a better response to TMZ treatment and a significantly improved overall survival. In this study, we thus used the CRISPRoff genome editing tool to mediate targeted DNA methylation within the MGMT promoter region. The system carrying a CRISPR-deactivated Cas9 (dCas9) fused with a methyltransferase (Dnmt3A/3L) domain downregulated MGMT expression in TMZ-resistant human glioblastoma cell lines through targeted DNA methylation. The reduction of MGMT expression levels reversed TMZ resistance in TMZ-resistant glioblastoma cell lines resulting in TMZ induced dose-dependent cell death rates. In conclusion, we demonstrate targeted RNA-guided methylation of the MGMT promoter as a promising tool to overcome chemoresistance and improve the cytotoxic effect of TMZ in glioblastoma.

Endovascular retrieval of left atrial appendage closure device embolized to the aorta.

Patients with atrial fibrillation with contraindications to anticoagulation can undergo left atrial appendage closure with a device. Hours after a 73-year-old man had undergone left atrial appendage closure, he lost perfusion to his lower extremities. Imaging studies showed that the device had migrated to the infrarenal aorta. After right common femoral artery cutdown and sheath placement, the device was retrieved with a balloon embolectomy catheter, and a balloon was simultaneously deployed in the proximal left common femoral artery to prevent device embolization. To the best of our knowledge, this report represents the first documented device retrieval from the aorta using balloon embolectomy and contralateral lower extremity embolic protection.

Lost in translation: the pitfalls of Ensembl gene annotations between human genome assemblies and their impact on diagnostics.

BACKGROUND: Gene models based on GRCh37 human genome assembly are preferred by many international projects over other updated assemblies (GRCh38 and T2T). Discrepant genes (DGs), those recognized as protein coding in the new but not the old assembly, are ignored by several genomic resources and discarded by variant prioritization tools relying on information based on GRCh37. METHODS: We curated a set of Ensembl genes with discrepant annotations between GRCh37 and GRCh38, additionally matching their RefSeq transcripts. Furthermore, we examined their clinical and phenotypic relevance. RESULTS: A total of 337 genes were reclassified as 'protein-coding' in GRCh38 but not in GRCh37, with 194 having a discrepant HGNC gene symbol. Many remain missing from the current known RefSeq gene models (N = 73). We found many clinically relevant genes in this group of neglected genes, and we anticipate that many more will be found relevant in the future. Important additional annotations such as evolutionary constraint metrics are also not calculated for these genes, further relegating them into oblivion. CONCLUSION: For discrepant genes, the inaccurate label of 'non-protein-coding' has relevant ramifications on clinical genetics. Accurate collation of these genes allows for manual curation in clinically relevant scenarios.

Knowledge, attitude and practice of medical students towards COVID19 in Sudan: A cross sectional study among 19 universities.

Background: Since December 2019, an outbreak of severe respiratory infection (COVID-19) emerged in the city of Wuhan in China. The knowledge, awareness and practice of medical students toward COVID-19 pandemic is of most importance as it demonstrates their preparedness to deal with this pandemic. The objective of this study is to assess the knowledge, awareness and practice of medical students in Sudan universities about COVID 19. Methodogy: This is a cross-sectional study conducted on 19 universities that have medical schools in Sudan. Data from at least 100 medical students from each university were included in the study. Data were collected using an online questionnaire in April 2020. Statistical analysis was conducted using the Statistical Package for Social Science software, version 25. Results: About 2603 medical students from 19 universities were included. Overall good knowledge and practice were demonstrated by the medical students (88.9%) and (78.6%), respectively. Respondents who answered that the most common clinical symptoms of COVID-19 were the main combination of dry cough, fatigue and fever were (27.7%), and the first initial symptom was headache were (48.3%.). (60.2%) Wear medical masks, (95%) said that avoiding crowded places protects against the spread of COVID-19, and (50.7%) have confidence that Sudan can win the battle against the COVID-19. Finally, (68.8%) agreed that COVID-19 will finally be successfully controlled. Conclusion: This study has found that medical students in Sudan demonstrated good knowledge and good practice toward Covid19.

Third wave of COVID-19 pandemic in Africa: Challenges and recommendations.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has evolved in different waves and is currently in its third wave for the majority of countries around the world. Each wave emanated with its own set of challenges. Lower- and middle-income countries such as most African countries have faced additional challenges compared to high-income countries. This paper highlights the challenges faced by Africa during the third wave of COVID-19 and proposes recommendations and strategies to contain the spread. We conducted a mini-review for the newly released articles and researches about the challenges faced by Africa during COVID-19. Fragmented healthcare sectors, limited healthcare resources and emergence of co-infections in COVID-19 patients, inadequate vaccination rollout and political conflicts are the major challenges faced by the African countries. Our recommendations to defeat this outbreak and subsequent pandemics is to raise the public's awareness about vaccines through campaigns and social media in order to lessen vaccine hesitancy. Governments as well should focus on under-served and vulnerable populations, patients with comorbidities, and communities living in endemic-striking settings as these people are more prone to the severe form of the disease. Moreover, by adopting socio-ecological perspectives, one can implement multi-level integrated interventions to help control COVID-19 more effectively.

Cubosomal Betamethasone-Salicylic Acid Nano Drug Delivery System for Enhanced Management of Scalp Psoriasis.

Introduction: Betamethasone dipropionate (BD), a potent corticosteroid, and salicylic acid (SA), a keratolytic agent, have been used in combination to treat scalp psoriasis; however, undesirable side effects associated with their prolonged topical use are inevitable. In this study, BD and SA were loaded into cubosomes, a nanoparticulate system with outstanding biocompatibility, bio-adhesivity and penetration power. Methods: Design of experiments (DOE) was utilized to prepare thirteen different cubosomal dispersions by emulsification technique using glycerol monoolein (GMO) as a lipid phase and Poloxamer 407 (P407) as a surfactant, sodium carboxymethyl cellulose (SCMC) was added to enhance the dispersions' rheological properties. The thirteen dispersions were in-vitro characterized for their particle size, polydispersity index (PDI), zeta potential, BD and SA content and rheological behaviour. The desirability of an optimized formula (OF) was set to the smallest particle size, lowest zeta-potential and highest viscosity. The OF was in-vitro characterized for the same parameters in addition to transmission electron microscope imaging and in-vitro drug release. The OF's anti-psoriatic activity was evaluated in-vivo using an imiquimod-induced psoriasis model. Results: The OF achieved a particle size of 197.4 ± 9.47 nm, a PDI of 0.443 ± 0.025, a zeta potential of -44.4 ± 0.141mv, BD content of 105.85 ± 2.290%, SA content of 88.855 ± 2.920% with shear-thinning rheological behaviour and completed in-vitro drug release within 2-3 hours. The in-vivo studies confirmed the cubosomes' higher anti-psoriatic efficacy over the commercial product with lower changes in ear thickness, spleen to body weight ratio, psoriasis area severity index score and improved histopathological findings. Conclusion: The developed BD SA-loaded cubosomes exhibit promising anti-psoriatic activity attributed to its nano-size and unique lipid content, with enhanced skin penetration and modified rheological properties; increasing the formulation's in-contact duration with the scalp resulting in lower application frequency and thus reduced BD and SA associated side effects.

Personalized Health Care Technology in Managing Postoperative Gastrointestinal Surgery Complications: Proof of Concept Study.

Background: Advances in three-dimensional (3D) printing technology have allowed the development of customized medical devices. Endoscopic internal drainage (EID) is a novel method to facilitate drainage of an abscess cavity into the lumen of the gastrointestinal tract by placing a double pigtail biliary stent through the fistula opening, originally designed for biliary drainage. They are available in manufacture-determined sizes and shapes. The aim of this study is to explore the feasibility of 3D printing personalized internal drainage stents for the treatment of leaks following gastrointestinal surgery over a sequential period. Methods: We retrospectively identified patients who underwent gastrointestinal anastomotic surgery complicated by postoperative leaks and underwent serial EID for treatment. Computerized Tomography scans were reviewed over a period of time, abscess cavity dimensions and characterizations were evaluated, and 3D reconstructions were obtained. The stents were designed, their shape and size were customized to the unique dimensions of the abscess and lumen of the patient. Stereolithography (SLA) 3D printing technique was used to produce the stents. Results: A total of 8 stents were produced, representing 3 patients. These stents corresponded to 2 or 3 stents per patients. Each patient underwent several endoscopic treatments, before resolution of leak. Conclusions: Customized stents may improve drainage of intra-abdominal abscesses after gastrointestinal surgery, if based on unique anatomy. This proof-of-concept study is a real-world application of personalized health care, which introduces the novel description of customizable 3D printed stents to manage complications following gastrointestinal surgery and may advance therapy for this complex clinical condition. Research Ethics Committees (REC) number is A-2021-012.

The egyptian clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease.

The landscape of chronic liver disease in Egypt has drastically changed over the past few decades. The prevalence of metabolic-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the magnitude of the problem, no regional guidelines have been developed to tackle this disease. This document provides the clinical practice guidelines of the key Egyptian opinion leaders on MAFLD screening, diagnosis, and management, and covers various aspects in the management of MAFLD. The document considers our local situations and the burden of clinical management for the healthcare sector and is proposed for daily clinical practical use. Particular reference to special groups was done whenever necessary.

Human papillomavirus, gene mutation and estrogen and progesterone receptors in breast cancer: a cross-sectional study.

INTRODUCTION: recent studies show a good relationship between breast cancer (BC) and human papillomaviruses (HPV) wich is responsible for about 18% of BC cases. This study aimed to assess the relationship between different genotypes of HPV and the expression of P53 and retinoblastoma (RB) genes and estrogen and progesterone receptors in BC among Sudanese women. METHODS: one hundred and fifty tissue blocks were obtained from females diagnosed with BC. Positive samples were used to determine genotypes with an applied biosystem (ABI 3730XL) genetic analyzer for sequencing and immunohistochemistry. RESULTS: 13/150 samples showed HPV DNA. High-risk HPV-16 was detected in 5 cases, high-risk-HPV-58 was found in four cases, and HPV-18 was detected in three cases. Low-risk-HPV-11 was detected in a single invasive lobular carcinoma (ILC) case. P53 and RB gene mutations were detected in 35 and 30 BC cases, respectively. P53 gene mutation was frequently identified in grade (III) BC while RB gene mutation was positive in grade (II). Grade (II) BC had a higher incidence of HPV-16 and 58. On the other hand, HPV-18 had a higher incidence in grade (III). Estrogen and progesterone receptors were expressed in 94 and 79 HPV cases among the study group, respectively. CONCLUSION: this study elucidates the associations between HPV genotypes and BC. A statistically significant association was observed among p53 and RB gene mutations and different BC histological types. On the other hand, there was a statistically insignificant association between HPV genotyping and different BC gradings, BC histological types, P53 and RB genes mutations, and estrogen and progesterone receptor expression. Also, there was a statistically insignificant association among estrogen and progesterone receptors expression and BC grading. RB gene mutation was significantly associated with different BC grades. On the other hand, there was a statistically insignificant association between progesterone receptor expression and BC.

A Novel Primer Probe Set for Detection of SARS-CoV-2 by Sensitive Droplet Digital PCR

BackgroundThe current increase in the spread of (SARS-CoV-2) critically needs a multitarget diagnostic assays to promote analytical sensitivity to facilitate the public health actions. ObjectiveThe aim of this study was to develop a new primer-probe set targeting N gene of SARS-CoV-2 to improve the sensitivity for detection of COVID-19(Corona Virus Disease 2019)in multiplex rRT-PCR (Reversetranscript Realtime PCR) and ddPCR (Droplet Digital PCR). ResultsWe designed primers/probes set N(LZU3) targeting the N gene of 2019-nCov and proved its sensitivity in both rRT-PCR and ddPCR. When the quantity of template was 105 copies/reaction, the mean Ct value of N(LZU3) was 32.563, the detection rate was 91.7%. If the quantity of template was 52.5 copies/reaction, the mean Ct value of N(LZU3) was 33.835, and the detection rate was 83.3%, which were similar with that of N(CDC) and N(USA). The calculated lower limit of detection (LOD) of the new primer-probe set N(LZU3) used in rRT-PCR was 118 copies/reaction. We also did one-step ddPCR for detection the same serial dilution of RNA template. It shows good linearity for primer/probe sets N(LZU3). The calculated lower limit of detection (LOD) of N(LZU3) was 22.4 copies/reaction, which was 1.12 copies/ul. ConclusionThe novel primer-probe set(LZU3) targeting N gene of SARS-CoV-2 could be both used in rRT-PCR and ddPCR with better sensitivity, furthermore, ddPCR method had higer sensitivity than rRT-PCR, hence it could significantly improve SARS-CoV-2 detection efficiency in low virus load and asymptomatic infection.

The Effect of Fasting during Ramadan on Outcomes after Bariatric Surgery at an Academic Medical Center in the Middle East.

INTRODUCTION: Ramadan is characterized by a month of fasting between dawn and sunset. Cleveland Clinic Abu Dhabi is located in the United Arab Emirates, where the majority of our patients observe Ramadan. In many practices, bariatric surgery has been delayed until after Ramadan in order to avoid postoperative complications. However, there are no studies that evaluate this theory. OBJECTIVES: Our study aimed to evaluate perioperative outcomes between bariatric surgeries performed before/during Ramadan and at times distant to Ramadan. METHODS: All patients who underwent primary bariatric surgery at Cleveland Clinic Abu Dhabi between September 2015 and July 2019 were retrospectively reviewed. The Pre-Ramadan (PR) cohort included patients that underwent surgery during the month of Ramadan and up to 3 months before Ramadan. The Non-Ramadan (NR) cohort included patients from the remainder 8 months. RESULTS: Our study included 542 patients: 185 patients in the PR cohort and 357 patients in the NR cohort. Baseline characteristics were similar. There were no statistically significant differences in perioperative outcomes, including emergency department (ED) visits (23.2% PR vs. 24.4% NR, p = .77), readmission rates (2.2% PR vs. 4.5% NR, p = .17), reoperation (1.1% PR vs. 3.6% NR, p = .09), and complications within 30 days (3.8% PR vs. 7.0% NR, p = .13). CONCLUSIONS: There is no difference among patients who undergo surgery before/during Ramadan and at times distant to Ramadan. Based on this data, there does not appear to be an increased risk of performing bariatric surgery prior to or during Ramadan in a comprehensive, multi-disciplinary program.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group.

BACKGROUND: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database. RESULTS: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey. CONCLUSIONS: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.

Comparative study between fractional carbon dioxide laser vs intralesional steroid injection in treatment of alopecia areata.

Few studies have reported Fractional Carbon Dioxide (FCO2) laser use in treating alopecia areata (AA), yet, effectiveness of this therapy has not been comparatively analyzed. To assess efficacy and safety of FCO2 laser in comparison to traditional intralesional corticosteroids injection (ILCs) in treatment of AA. This study included 20 patients with at least two patches of AA. Patients were subjected to history taking, general, dermatological and folliscopic examination. One patch was treated by FCO2 laser every 2 weeks for 3 to 6 sessions, while the other treated with intradermal injection of Triamcinolone Acetonide monthly for three sessions maximally. Evaluation of treatment response was done by physician clinical assessment using Mean Improvement Score (MISP), patient satisfaction and folliscopic examination measuring hair density (hair/cm2 ) before each session, 1 month and 3 months after end of sessions. The obtained data were tabulated and statistically analyzed. There was a highly significant improvement with FCO2 laser rather than ILCs 3 months after last session according to MISP, patient satisfaction and hair density without serious side effects or relapse. FCO2 laser could be a better therapeutic alternative for treating AA in comparison to traditional ILCs.