Trends of gastric malignancies: Case study of Ibn Sina Hospital 2010-2011

Back ground: Gastric malignancies carry poor prognosis, because they commonly present at an advanced stage.Objective: to find out mode of presentation and its impact on the outcome and management of gastric cancer and to find if there are changes in trends of gastric malignancies over the last decade.Patients and methods: A review of 53 patients with gastric malignancies, treated at Ibn Sina Hospital from August 2010 through August 2011. Their demographic data, pattern of clinical presentation, histopathology grading and staging, type of management and hospital mortality were studied.Statistical analysis: Data was fed to Statistical Package for Social Sciences. Means and correlations were computed where appropriate. One sample t-test was performed. Statistical significance was taken at P = 0.05.Results: Out of 53 patients males comprise 30(56.6%) males. The peak frequency was at the age group 55-70 years. Patients from the Northern Region of Sudan constituted 34%. Adenocarcinoma comprised 43(81.3%), GIST 8(15%), lymphoma 1(1.9%) and carcinoid 1(1.9%). Epigastric painwas the commonest symptom in 47(88.7%) patients. Smoking and snuff (Tombak) and high salt diet were found in 7.5% and 5.7% and 3.8% patients respectively. Blood group A and O was found in 22.6% and 60.4% respectively. Family cancer syndrome was found in 11.3% patients.Malignancies of the antrum constitute 27(65.85%), cardia 4(9.8%), body 7(17.1%), and whole stomach 3(7.3%) patients. There were only 6.25% clinically early cases. Potentially curative resection was attempted in 31.7%. The mean hospital stay was 12 days.Conclusion: Patients presented at stage III and IV comprise 30 (93.75%) out of 32 carcinoma patients. The hospital morbidity was 13(24.6%) patients and mortality 4(7.5%) patients. When compared with results from same hospital there is improvement in outcome over a decade.Keywords: Adenocarcinoma, lymphoma, carcinoid, dysphagia

Prevalence and Factors Associated with Rapid Eye Movement-Related Obstructive Sleep Apnea in Patients with Narcolepsy

Hamza O Dhafar,1 Ali A Awadh,2 Salih A Aleissi,1 Galal Eldin Abbas Eltayeb,3 Samar Z Nashwan,1 Ahmed S BaHammam1,4 1The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Seha Virtual Hospital, Ministry of Health, Riyadh, Saudi Arabia; 3Department of Management Information Systems, College of Business and Economics, Qassim University, Buraydah, Saudi Arabia; 4The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi ArabiaCorrespondence: Ahmed S BaHammam, University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia, Email [email protected]: Data on the prevalence and correlates of rapid eye movement (REM)–related obstructive sleep apnea (REM-OSA) in narcolepsy remains limited. This study aimed to assess the prevalence and independent associated factors with OSA and REM-OSA in patients with narcolepsy, and to compare the distribution of REM-OSA between patients with narcolepsy and matched controls without narcolepsy.Patients and Methods: This retrospective study of a prospectively collected cohort included 190 adult patients with narcolepsy (narcolepsy type 1 [NT1] = 119, narcolepsy type 2 [NT2] = 71) who underwent polysomnography and multiple sleep latency test at the University Sleep Disorders Center, King Saud University Medical City, between January 2007 and February 2022. REM-OSA was defined as an apnea–hypopnea index (AHI) ≥ 5, AHI-REM/AHI–non–rapid eye movement (NREM) ≥ 2, AHI-NREM < 8, and REM sleep duration > 10.5 minutes. A total of 106 patients with narcolepsy were diagnosed with OSA. A control group of 122 patients with OSA but without narcolepsy, matched by age, sex, AHI, and BMI, was used for comparison. Logistic regression identified independent associated factors with OSA and REM-OSA.Results: OSA was diagnosed in 106 patients with narcolepsy (55.8%). REM-OSA was present in 26.4% of these cases, with a slightly higher prevalence in NT2 (30%) than in NT1 (24%). REM-OSA showed a trend toward higher prevalence in the narcolepsy group compared to controls (26.4% vs 17.2%, OR: 1.73, 95% CI: 0.91– 3.27, p = 0.09). Male sex, BMI, and arousal index were independent correlates of OSA among patients with narcolepsy. REM-OSA was independently associated with arousal index and REM sleep duration.Conclusion: OSA and REM-OSA are common in patients with narcolepsy. REM-OSA was more prevalent in the narcolepsy group than in matched controls, suggesting a potential association between narcolepsy and REM-OSA that warrants investigation in larger cohorts.Plain Language Summary: People with narcolepsy often struggle with excessive daytime sleepiness and disrupted nighttime sleep. When another sleep disorder, such as obstructive sleep apnea (OSA), occurs alongside narcolepsy, it can make symptoms worse. A specific form of OSA, known as REM-OSA (which primarily occurs during rapid eye movement sleep), has been associated with an increased risk of heart and metabolic conditions. However, studies examining REM-OSA in people with narcolepsy remain limited.In this study, we evaluated 190 adults with narcolepsy and found that more than half had OSA. Among those with OSA, over one in four also had REM-OSA. We compared these patients to a group of individuals who had OSA but not narcolepsy. The two groups were matched by age, sex, apnea severity, and body mass index (BMI). We found that REM-OSA was more common in people with narcolepsy than in the matched controls. Although the difference was not statistically significant, the trend suggests a possible link worth further investigation.Understanding the relationship between narcolepsy and REM-OSA is important for improving diagnosis and treatment. A better understanding of this overlap may help improve patient outcomes. More research in larger groups is needed to confirm this connection.Keywords: sleep-disordered breathing, REM sleep, arousal index, sleep fragmentation, polysomnography, multiple sleep latency tes

The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review

Item does not contain fulltextPURPOSE: The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis. METHODS: PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5. RESULTS: Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5]. CONCLUSION: Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure

Ascorbate Biosynthesis during Early Fruit Development Is the Main Reason for Its Accumulation in Kiwi

Background: Ascorbic acid (AsA) is a unique antioxidant as well as an enzyme cofactor. Although it has multiple roles in plants, it is unclear how its accumulation is controlled at the expression level, especially in sink tissues. Kiwifruit (Actinidia) is well-known for its high ascorbate content. Our objective was to determine whether AsA accumulates in the fruits primarily through biosynthesis or because it is imported from the foliage. Methodology/Principal Findings: We systematically investigated AsA levels, biosynthetic capacity, and mRNA expression of genes involved in AsA biosynthesis in kiwi (A. deliciosa cv. Qinmei). Recycling and AsA localization were also monitored during fruit development and among different tissue types. Over time, the amount of AsA, with its capacity for higher biosynthesis and lower recycling, peaked at 30 days after anthesis (DAA), and then decreased markedly up to 60 DAA before declining more slowly. Expression of key genes showed similar patterns of change, except for L-galactono-1,4-lactone dehydrogenase and L-galactose-1-phosphate phosphatase (GPP). However, GPP had good correlation with the rate of AsA accumulation. The expression of these genes could be detected in phloem of stem as well as petiole of leaf and fruit. Additionally, fruit petioles had greater ascorbate amounts, although that was the site of lowest expression by most genes. Fruit microtubule tissues also had higher AsA. However, exogenous applications of AsA to those petioles did not lead to its transport into fruits, and distribution of ascorbate was cell-specific in the fruits, with more accumulation occurring in large

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

INTRODUCTION: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.METHODS: This multi-centre cohort study involved patients aged 18years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables.RESULTS: Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54-5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27-9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.CONCLUSIONS: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age

Host Determinants of Reinfection with Schistosomes in Humans: A Systematic Review and Meta-analysis

Background: Schistosomiasis is still a major public health burden in the tropics and subtropics. Although there is an effective chemotherapy (Praziquantel) for this disease, reinfection occurs rapidly after mass drug administration (MDA). Because the entire population do not get reinfected at the same rate, it is possible that host factors may play a dominant role in determining resistance or susceptibility to reinfection with schistosomes. Here, we systematically reviewed and meta-analyzed studies that reported associations between reinfection with the principal human-infecting species (S. mansoni, S. japonicum and S. haematobium) and host socio-demographic, epidemiological, immunological and genetic factors.Methodology/Principal Findings: PubMed, Scopus, Google Scholar, Cochrane Review Library and African Journals Online public databases were searched in October 2013 to retrieve studies assessing association of host factors with reinfection with schistosomes. Meta-analysis was performed to generate pooled odds ratios and standardized mean differences as overall effect estimates for dichotomous and continuous variables, respectively. Quality assessment of included studies, heterogeneity between studies and publication bias were also assessed. Out of the initial 2739 records, 109 studies were included in the analyses, of which only 32 studies with 37 data sets were eligible for quantitative data synthesis. Among several host factors identified, strong positive association was found with age and pre-treatment intensity, and only slightly for gender. These factors are major determinants of exposure and disease transmission. Significant positive association was found with anti-SWA IgG4 level, and a negative overall effect for association with IgE levels. This reconfirmed the concept that IgE/IgG4 balance is a major determinant of protective immunity against schistosomiasis. Other identified determinants were reported by a small number of studies to enable interpretation.Conclusions: Our data contribute to the understanding of host-parasite interaction as it affects reinfection, and is a potential tool to guide planning and tailoring of community interventions to target high-risk groups

Single high scrotal incision orchidopexy for unilateral palpable testis: A randomised controlled study

Background: Bianchi and Squire introduced single high trans-scrotal incision for mobilisation of palpable undescended testes to decrease the potential morbidity of the traditional inguinal approach. This incision has not gained widespread acceptance and there is still a considerable debate about its efficacy. This study evaluated the outcome of high single scrotal incision in comparison to the classic inguinal exploration for unilateral palpable testes regardless to its pre-operative location to assure its validity and safety.Patients and Methods: This was a randomised controlled study conducted on seventy males with palpable unilateral undescended testicles from  November 2009 to October 2013. They were divided into two equal groups; group I had high single scrotal incision and group II had the classic inguinal approach. The comparative parameters between both groups were the operative time, intra-and post-operative complications, postoperativepain and scar.Results: There was statistical significant difference between both groups regarding the operative time (P < 0.001). The high scrotal approach (Group I) was not completed in three cases and were converted to the classic inguinal approach. No statistical significant difference between both groups regarding the post-operative complications. Conclusions: Single high scrotal incision orchidopexy for palpable  undescended testis is safe, has shorter operative time but may not besuitable for proximally lying testis.Key words: Scrotal orchidopexy, palpable undescended testes, single scrotal incisio