Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Acute Cholangitis Secondary to a Clogged Biliary Stent: A Review on the Cause of Clogging and the Appropriate Time of Replacement

Choledocholithiasis is preferably treated by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone removal, to reduce the risk for acute cholangitis. Frequently, patients who are ill, surgically unfit, or unable to undergo stone extraction during the index procedure underwent antibacterial treatment and temporary biliary stenting via ERCP to prevent biliary sepsis and septic shock. After a period of convalescence, a repeat ERCP is scheduled to clear the bile duct and remove the stent, followed by laparoscopic cholecystectomy to complete the treatment circuit. Cholangitis may often recur in patients with an indwelling biliary stent while waiting for definitive treatment. Here, we present a case of a 42-year-old female with choledocholithiasis who developed moderate acute cholangitis 5 months after ERCP and insertion of a biliary plastic stent. She was provisionally diagnosed with obstructive jaundice with concurrent acute cholecystitis. Through intravenous antibacterial therapy, stent exchange, and an interval open cholecystectomy, she had fully recovered. We also discuss the underlying mechanism of stent blockage and the optimal interval for stent exchange after temporary placement for benign cases. Understanding the pathophysiology of stent clogging and recognizing the optimal interval for stent replacement may help reduce the risk of stent clogging and potentially fatal acute cholangitis. </jats:p

Kitab Aqidah Al-Najin dari segi pemaknaan, Tahqiq dan Takhrij: satu kajian awal

Artikel penyelidikan ini membahaskan tentang kitab ‘Aqidah al-Najin dari segi pemaknaan, tahqiq dan takhrij. Aqidah al-Najin merupakan salah sebuah kitab akidah yang digunakan secara meluas oleh masyarakat Nusantara sama ada sebagai kitab pengajian atau sumber rujukan dalam persoalan yang berkaitan dengan akidah. Kitab ini dikarang oleh Syeikh Zainul Abidin bin Muhammad al-Fatani atau juga dikenali dengan julukan Tuan Minal. Kitab ini berdasarkan versi cetakan Maktabah wa Matba’ah Ben Halabi, Patani, mengandungi 140 halaman merupakan antara kitab akidah yang paling tebal dihasilkan setelah kitab Wardu al-Zawahir yang dikarang oleh Syeikh Daud alFatani. Pemaknaan merupakan satu usaha penterjemahan yang dilakukan untuk memberi maksud kepada sesuatu perkataan atau lainlain. Tahqiq dan takhrij merupakan dua istilah yang dipakai dalam kaedah para ulama mengenalpasti ketepatan maklumat sesebuah manuskrip atau kitab serta pencerahan terhadap beberapa perkara yang menjadi kesamaran dan perlu diperjelaskan. Pada dasarnya takhrij dan tahqiq lebih ditumpukan kepada kitab-kitab yang memuatkan riwayatriwayat hadith yang perlu dikesan sumber dan status periwayatannya. Matlamat di sebalik mentahqiq sesebuah kitab ialah bagi mendapat teks yang tepat sejajar dengan yang dikehendaki oleh pengarang asal kitab terbabit setelah dilakukan pengesahan penisbahan kitab itu kepada pengarang, tajuk yang dibahaskan serta menjelaskan maksud yang terkandung dalam kitab terbabit. Di sana terdapat perbezaan antara tugas yang dilakukan oleh seorang pentahqiq dan pentakhrij bagi kitab-kitab hadith atau kitab-kitab turath yang lain. Kitab yang ditahqiq ialah kitab yang telah disahkan benar judulnya, nama penulisnya, penisbahan kitab itu kepada penulis, dan teks kitab yang ditahqiq itu adalah paling menyamai dengan teks asal yang ditinggalkan oleh penulis asalnya. Atas sebab itu, usaha-usaha yang perlu dilakukan bagi semua bentuk manuskrip ialah melakukan pengkajian dari aspek-aspek mentahqiq judul kitab, mentahqiq nama pengarangnya, mentahqiq penisbahan kitab itu kepada pengarangnya dan mentahqiq teks kitab sehingga jelas yang ia adalah hampir menyamai teks asal pengarangnya. Takhrij pula membawa pengertian. Namun dalam kalangan ulama Mutaakhirin, takhrij ialah menunjukkan tempat sesuatu hadith dari sumber asalnya yang dikeluarkan dengan sanadnya kemudian menerangkan martabat hadith itu jika ada keperluan untuk berbuat demikian. Manakala nas-nas hadith itu hendaklah dicari dalam sumber-sumber hadith dengan mengambil kira ketepatan teks hadith yang disebutkan oleh pengarang berserta kepelbagaian riwayatnya. Tujuannya ialah bagi memastikan bahawa apa yang dinyatakan oleh pengarang adalah berdasarkan pengambilan yang tepat daripada sumber-sumbernya. Artikel ini menceritakan tentang proses dan strategi kajian yang dijalankan terhadap ‘Aqidah al-Najin dari segi pemaknaan, tahqiq dan takhrij yang menggunakan kaedah pengkajian tekstual (textual studies). Setiap teks dalam kitab tersebut diteliti dan dikaji hingga mustahil dikatakan bahawa ada yang terlepas daripada kajian berkenaan

Survival analysis of cholangiocarcinoma: A 10-year experience in Malaysia

AIM: To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Abstract The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract </jats:p

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS (R) v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 +/- 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 +/- 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 +/- 4.9 and 7.8 +/- 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 +/- 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI