Insights into the Epidemiology and Determinants of Helicobacter Pylori Negative Gastritis: A Retrospective Study

Introduction: The prevalence of Helicobacter pylori (HP)-negative gastritis is rising in the United States, yet its origins and risk factors remain largely unexplored. This study aims to assess the prevalence of HP-negative gastritis and explore the demographic, clinical, and risk factor profiles that differentiate HP-negative from HP-positive subjects with histological evidence of gastritis. Methods: We conducted a retrospective analysis of 241 patients who underwent Esophagogastroduodenoscopy (EGD) for upper gastrointestinal symptoms at a tertiary care center between July 2020 and July 2021. Symptoms prompting referral included dysphagia, abdominal pain, nausea, and others. Gastric biopsies were collected from the antrum and body, and clinical, demographic, and laboratory data were analyzed to compare HP-negative and HP-positive gastritis cases. Results: Of the patients biopsied, 38.2% (n=92) showed histological evidence of gastritis, with 78% of these being HP-negative and 22% HP-positive. HP-negative cases were predominantly chronic chemical gastritis (61.5%), while all HP-positive cases were active chronic gastritis. Significant ethnic disparities were noted; 61.5% of HP-negative patients were Caucasian, and 72.7% of HP-positive patients were African American. Medical comorbidities, particularly gastroesophageal reflux disease (GERD), were more associated with HP-negative gastritis. The antrum was more frequently affected in HP-negative cases compared to HP-positive cases. Conclusion: HP-negative gastritis is significantly linked with Caucasian ethnicity and existing medical comorbidities but shows no strong associations with the analyzed lifestyle or medication factors. These findings highlight the need for further large-scale prospective studies to better understand the etiology, risk factors, and clinical implications of HP-negative gastritis

Challenges and Infectious Complications in Living Donor Liver Transplantation in Egypt: A Comprehensive Review

Background: Living donor liver transplantation (LDLT) is a crucial therapeutic option for patients with end-stage liver disease in Egypt, where deceased donor grafts are scarce. This study aims to investigate the challenges and infectious complications associated with LDLT in Egypt. Methods: A comprehensive review of relevant literature was conducted, focusing on factors affecting donor selection, the prevalence of infections in recipients, and the impact of healthcare providers\u27 knowledge on organ donation. The study included data on complications affecting donors and recipients in the context of LDLT. Results: The high prevalence of the hepatitis C virus and poverty in Egypt negatively impact the live donor pool. Lack of knowledge about liver donation, inadequate media coverage, and family pressure contribute to the low number of liver donors. Infectious complications play a significant role in the outcomes of LDLT, with bacterial infections being the most common. Donors also experience complications, with intraabdominal collections and pneumonia being the most frequent. Healthcare providers\u27 knowledge and attitudes toward organ donation need improvement, and educational efforts should be tailored to the cultural and religious context. Conclusion: Addressing the challenges in donor selection, raising public awareness about organ donation, and improving healthcare providers\u27 knowledge are essential steps toward optimizing LDLT outcomes in Egypt. Moreover, it is crucial to monitor and manage infectious complications in both donors and recipients to ensure the success of the transplantation process

Benign Pheochromocytoma Coming Back with Bony Metastasis: A Case Report and Literature Review

Pheochromocytoma is an uncommon adrenal medulla tumor that secretes catecholamines. It is usually a benign condition and is generally treated with adrenalectomy; in a small proportion of cases, however, it might return or spread. Pheochromocytoma is uncommon to recur or metastasize, meaning every reported case is clinically relevant.  A 46-year-old Caucasian woman initially presented with conventional catecholamine excess symptoms—refractory hypertension, palpitations, diaphoresis, and headaches. Imaging showed a sizable right adrenal mass; biochemical testing indicated very high plasma metanephrines. A medical decision was made to perform a right adrenalectomy; pathology confirmed a benign pheochromocytoma. After surgery, her symptoms went away, but she was missed for follow-up. Four years later, she came back with comparable symptoms; biochemical screening found increased metanephrines once more, and a computed tomography (CT) scan revealed local recurrence in the right adrenal bed. Notably, the CT also disclosed a lytic lesion in a lumbar vertebra and evidence of bone metastases from the pheochromocytoma. This instance highlights a rare situation in which a pheochromocytoma, initially thought to be innocuous, reoccurred with distant skeletal involvement. In conclusion, a very rare, recurrent pheochromocytoma with bone metastases underscores the importance of continuous monitoring even after complete tumor removal. Early recognition of metastasis or relapse can significantly impact therapy and outcomes. This case highlights the necessity of ongoing follow-up in patients with pheochromocytoma and alerts individuals to potential late metastatic symptoms

TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research

Introduction: The increasing utilization of real-world data platforms in medical research necessitates a comprehensive understanding of their methodological strengths and limitations. TriNetX has emerged as a significant platform for exploring large healthcare datasets. This review aims to critically evaluate the methodological framework and limitations of TriNetX, assess the impact of electronic health record coding accuracy on data reliability, and analyze the platform\u27s capacity for generating generalizable real-world evidence in clinical research. Methods: We conducted a comprehensive review examining TriNetX\u27s data architecture, quality metrics, and research applications, focusing on data integrity, platform architecture, and the external validity of research findings. Results: The analysis reveals significant methodological considerations. TriNetX\u27s reliance on retrospective data introduces biases such as selection bias and confounding variables. The coding accuracy of electronic health records, which have not been independently validated, is a critical determinant of data reliability. The demographic representation is limited, affecting the generalizability of results. Discussion: Despite its extensive use, TriNetX\u27s effective utilization requires careful consideration of its inherent limitations. The platform\u27s data, predominantly from insured populations in academic and acute care settings, may not fully represent broader demographic groups. Addressing these methodological constraints is crucial for enhancing the reliability and applicability of research findings derived from TriNetX. Conclusions: TriNetX is a valuable resource for healthcare research. However, its limitations must be acknowledged, and future research should focus on standardizing data collection and enhancing data validation processes to mitigate platform-specific biases and improve the quality and applicability of the findings

Investigating the Impact of Primary Education on Birth Control Practices in Bangladesh: A Primary Study

Introduction: Bangladesh faces significant challenges due to overpopulation, impacting essential resources such as healthcare, employment, and education. This study investigates the role of primary education in influencing contraceptive adoption and examines the socio-economic and educational factors affecting birth control practices in Bangladesh. Methods: A cross-sectional study was conducted in four districts (Sylhet, Habiganj, Sunamganj, and Moulvibazar). These areas were selected to provide a diverse representation of both urban and rural populations. A stratified random sampling technique was used to select 160 service recipients. A validated questionnaire was administered face-to-face by trained data collectors. Statistical methods included Chi-square tests, logistic regression modeling, and sensitivity analysis to control for confounding variables. Results: Higher education levels were significantly associated with increased contraceptive use (OR = 2.31, 95% CI: 1.58-3.47, p < 0.01). Multivariate analysis confirmed that income, religion, and geographic location were significant predictors of contraceptive adoption. Specifically, 41% of service recipients had secondary education, and 56% earned between 4000-5000 Taka per month. Discussion: This study underscores the importance of primary education in contraceptive adoption and identifies key socio-economic determinants affecting family planning choices. Despite methodological limitations, such as sample size constraints, the findings suggest a need for targeted interventions to enhance educational access and contraceptive awareness, particularly among lower-income groups. Conclusion: Expanding primary education is a critical strategy for population control in Bangladesh. This study provides valuable insights for policymakers and public health professionals, emphasizing the necessity of data-driven interventions and expanded educational programs to enhance birth control awareness and adoption

A Systematic Review and Meta-Analysis of Liver Transplant Outcomes in Lean Versus Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease Patients

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent hepatic disease with metabolic dysfunction-associated steatohepatitis (MASH) as its severe necro-inflammatory subtype. At present, it is the second leading cause of liver transplant. A systematic literature review (SLR) was conducted to assess the effect of lean vs non-lean BMI on clinical outcomes after transplant in MASLD patients. Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar databases was executed. Review Manager 5.4.1 was used for statistical analyses. A random-effect model was used with the results reported as Odds Ratio (OR) and 95% confidence interval (CI). A narrative approach was used where it was not feasible to conduct a meta-analysis. Results: Eleven observational studies were included in the SLR. Pooled results from three studies showed no significant difference in mortality between lean and non-lean patients at 1 year (OR= 0.78, p= 0.76), 2 years (OR= 0.83, p= 0.24), and 5 years (OR= 1.07, p= 0.51) post-transplant. There was also no significant relation of lean and non-lean BMI in graft survival, observed over 30 days (OR= 1.34, p= 0.27), 1 year (OR= 0.75, p= 0.25), 2 years (OR= 1.20, p= 0.45), and 5 years (OR= 1.07, p= 0.60) post-transplant. Qualitative analysis suggested morbid obesity is linked with higher waitlist dropout in MASH patients. Conclusion: The qualitative analysis of eight studies indicates a trend towards poorer outcomes in the non-lean group. There is a need for further investigations to comprehensively examine the factors influencing the relationship between BMI and post-transplant outcomes

Efficacy and Safety of Tofacitinib in Pediatric Ulcerative Colitis Patients: A Systematic Review

Introduction: Ulcerative colitis (UC), an inflammatory Bowel Disease (IBD), is a chronic illness of unknown mechanism affecting the colonic mucosa, mainly causing diarrhea and bleeding. It can potentially disrupt the quality of life. Tofacitinib, a Janus Kinase inhibitor, showed a promising effect in inducing remission in IBD patients. In this study, we aim to assess the efficacy and safety of Tofacitinib in treating children with ulcerative colitis. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), we searched four electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies reported up to July 2024. We reported outcomes as frequencies and proportions in our study. Results: We identified five studies encompassing 83 children diagnosed with IBD, of which 57 children had ulcerative colitis. The proportion of patients achieving a clinical response across one included study was 66.67%. The proportion of patients achieving clinical remission was 38.46%. Also, the proportion of patients achieving steroid-free remission across the three studies was 48.57%. The rate for serious adverse events was 25.53% across the three included studies. Conclusion: Tofacitinib could be useful in achieving clinical remission in children with UC and reducing colectomy rates. Also, a low infection rate and the incidence of serious adverse events were observed. Future randomized controlled trials with larger samples and longer follow-up periods are needed to support these findings

An Unusual Case of Disseminated Hydatid Disease: A Laparoscopic Wonder

Human echinococcosis, caused by Echinococcus tapeworms, is a zoonotic disease in which ingested eggs of the tapeworm form cysts in the organs known as Hydatid cysts. These cysts are commonly found in the Liver and lungs, but in rare cases, they can also be found in the spleen, ovaries, round ligament, and peritoneal cavity. Treatment typically involves surgery. This is a case of a 32-year-old female who presented with chief complaints of pain in the abdomen for 2 months, which was associated with nausea, vomiting, reduced appetite, and increased size of mass per abdomen. Further investigations revealed the presence of multiple disseminated hydatid cysts in the upper abdomen and the peritoneal cavity. This was a rare & unusual entity that was meticulously managed by minimally invasive laparoscopic surgery. Echinococcosis can occur anywhere in the body, with concurrent localizations in the liver, spleen, round ligament, ovaries, and peritoneal cavity, which are rare and pose a diagnostic as well as a surgical management challenge. The inconvenience of multiple localization and the risk of contamination usually lead to open surgery in these cases. The presented case is unique due to the laparoscopic approach to the multiple localizations of hydatid disease, advocating for a minimally invasive first-line approach even in these particular localizations

Epiploic Appendagitis Following Blunt Abdominal Trauma: A Case Report with Literature Review

Epiploic appendagitis (EA) is a rare and self-limiting cause of acute abdominal pain resulting from ischemia due to torsion or venous thrombosis of epiploic appendages. It often mimics more common conditions, such as diverticulitis or appendicitis, leading to misdiagnosis and unnecessary interventions. While EA is typically idiopathic, we present a unique case of trauma-induced EA in a 58-year-old man who developed sharp left lower quadrant pain after prolonged abdominal pressure while repairing a boat engine managed conservatively, which, to our knowledge, has not been previously reported. With the increasing availability of computed tomography (CT), EA is being diagnosed more frequently, yet clear management guidelines remain lacking

Epidemiological Assessment of Risk Factors for Inguinal Hernia Among Male Patients in Iraq: A Case-Control Study

Introduction: Inguinal hernia is one of the most common surgical conditions, particularly among males. Despite its prevalence, limited regional data exist on the associated risk factors in Iraq. This study aimed to identify socio-demographic, lifestyle, and clinical risk factors contributing to inguinal hernia among male patients. Methods: A case-control study was conducted on 250 male patients diagnosed with inguinal hernia at multiple public hospitals and surgical clinics across three major cities in Iraq: Wasit, Baghdad, and Basra. Compared with a 250-member control group. Data were collected using structured questionnaires covering socio-demographic details, occupational exposure, lifestyle habits, medical history, and family history. Univariate and logistic regression analyses were performed to identify significant risk factors. Results: Most patients (57.5%) were between 41 and 60 years old. Heavy lifting (63.6%), smoking(62.0%), chronic cough (38.6%), and constipation (32.4%) were frequently reported. A positive family history was noted in 22.4% of cases. Univariate analysis revealed significant associations between inguinal hernia and heavy lifting (p < 0.001), smoking (p < 0.001), chronic cough (p = 0.002), constipation (p = 0.020), and a family history of inguinal hernia (p = 0.001). Logistic regression confirmed heavy lifting (OR=2.78),  family history (OR=2.46), smoking (OR=1.69), and chronic cough (OR=1.54) as independent risk factors. Conclusion: Heavy lifting, smoking, chronic cough, and family history were significantly associated with increased risk of inguinal hernia among Iraqi males. Public health strategies that focus on prevention, early identification, and lifestyle modification are essential for reducing the incidence and recurrence of this condition