Staple Line Polyposis and Cytomegalovirus Infection after Stapled Haemorrhoidectomy

Early bleeding after stapled haemorrhoidectomy (SH) is not uncommon. Late and persistent bleeding occurring weeks or months after SH, however, is rare; it has only been described in more than 10% of cases. It is attributed to the development of inflammatory polyps at the staple line. Occurrence of rectal bleeding in the presence of palpable polypoid lesions at the stapled anastomotic line can cause diagnostic confusions, and it is not uncommon that such lesions are initially confused with rectal carcinoma. We report a case of a 38-year-old male who presented with persistent rectal bleeding some 6 months after SH performed in another hospital. Rectal and colonoscopic examinations revealed polypoid lesions at the anastomotic line. The biopsy failed to confirm malignancy, but identified cytomegalovirus (CMV) infection. The development of multiple inflammatory polypoid lesions in conjunction with CMV infection at the stapled anastomotic line has caused a diagnostic confusion, but – after exclusion of cancer – this complication was efficiently treated by CMV infection eradication combined with surgical excision of the remaining polyps due to persistence of bleeding. This case is reported to highlight late bleeding due to inflammatory polyps after SH and to increase the awareness of surgeons and gastroenterologists of this benign but somewhat common complication

Readability Analysis of Text in English Textbooks of Federal Board of Intermediate and Secondary Education for Higher Secondary Level

This study mainly focuses on the readability of the text of the HSSC-II textbook. Considering the importance of textbook evaluation, the study evaluated the English textbook of HSSC-II, which is taught at all the colleges affiliated with the Federal Board of Intermediate and Secondary Education (FBISE). Selected texts from the book have been analyzed so as to determine their readability. The texts were analyzed through an online text evaluation tool, the Text Readability Consensus Calculator (TRCC), which determines the grade level, text readability level, and age of the reader as well as the appropriation of the text. The readability scores of the text yielded by the TRCC were compared with the students\u27 results of the comprehension test. This comparison reveals that the original text is "fairly difficult to read" for 13–15-year-old native readers among 8th and 9th grade students, while the evaluator rates the simplified text as "fairly easy to read" for native readers among 12–14-year-old 7th and 8th grade students. While the results of the comprehension test for non-native readers show that the text is extremely difficult, non-native 12th graders with an average age of 17 could only get 39% in the original text and 47.6% in the simplified text. The research concludes with some suggestions for the text designer to consider various features for making text readability compatible with the grade level of the students

Petrophysical Study of Limestone Rocks for Al-Nfayil Formation –Bahr Al-Najaf Depression and Suitability for Industrial Purposes

مقدمة: ينتشر الحجر الجيري في الطبيعة على نطاق واسع ويشكل حوالي (20-25٪) من إجمالي الصخور الرسوبية [1]. وتحتل المرتبة الثالثة عالمياً من حيث المصادر المعدنية والصخور المستخرجة [2]. يمثل الحجر الجيري نسبة كبيرة من العمود الطبقي في العراق [3]. طرق العمل: تقييم صخور الحجر الجيري كمواد بناء لتكوين النفايل في منخفض بحر النجف بواقع 15 محطة موزعة على منطقة الدراسة. اشتمل البحث على الجوانب الحقلية والمختبرية. الاستنتاجات: من خلال الفحوصات اللازمة، تم تحديد صلاحية الحجر الجيري لأغراض البناء. وكانت مناسبة للبناء لأنها نجحت في تلبية متطلبات معيار البناء (ASTM، C568، 2004) ولم تفِ بمتطلبات معيار صخور التحكم في السكك الحديدية (O.R.B.D، 1999، Raymond، 1979). لذا توصي الدراسة بتقدير وحساب كمية احتياطيات الصخور الجيرية المتوفرة في منطقة الدراسة لغرض حساب الجدوى الاقتصادية.Abstract Background:        Limestone is widely spread in nature and constitutes about (20-25%) of the total sedimentary rocks [1]. It is ranked third globally from mineral sources and extracted rocks [2]. Limestone represents the large ratio of the stratified column of Iraq [3].   Materials and Methods: This study involves the evaluation of limestone rocks as construction materials of Al- Nfayil formation in Bahr Al-Najaf Depression by 15 stations distributed over a region. The research includes field and laboratory aspects. Results: Through the tests, the viability of limestone for construction purposes was determined. As it is suitable for construction because it succeeded the requirements of the building standard (ASTM, C568, 2004), and did not succeed in the requirements of the standard for railway control aggregates (O.R.B.D, 1999, Raymond, 1979). The study recommends estimating and calculating the amount of reserves of limestone rocks available in the study area for the purpose of calculating economic feasibilit

Strongyloides stercoralis hyperinfection in a post-renal transplant patient

Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist asymptomatic for many years through autoinfection. It causes life-threatening hyperinfection in immunocompromised hosts. This report describes a rare case of strongyloidiasis in a 40-year-old male following renal transplant, which was diagnosed by colonoscopic biopsy. The literature on the subject is also reviewed

Schooling and Students’ Linguistic and Cultural Identity in Baltistan: Silencing the Local Music

This paper investigates the role of the schooling process in shaping the linguistic and cultural identity of secondary school students in Baltistan, a region in Northern Pakistan known for its unique culture and the Sino-Tibetan language \u27Balti\u27. Specifically, the study examines the impact of excluding local music from school activities on students\u27 linguistic and cultural identity. Previous literature highlights the significant value of local music in Baltistan, which serves as an integral part of cultural life, rituals, and ceremonies, contributing to a strong sense of identity among students. However, over time, music has been discouraged for various reasons. Surprisingly, the data reveals that neither private nor public schools offer music lessons, reflecting a growing conservative attitude towards music and its negative implications for students\u27 linguistic and cultural affiliation. Consequently, students are alienated and distanced from their local musical traditions, which poses policy challenges in fostering an inclusive learning environment that supports the positive development of linguistic and cultural identity. &nbsp

Thromboembolism in inflammatory bowel diseases: a report from Saudi Arabia

Thromboembolism (TE) is a serious but under-recognized complication of inflammatory bowel disease (IBD). This is specially so in developing countries where the incidence of IBD is low. In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing. Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare. This report describes six IBD patients with TE. This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Epigenetic therapy in urologic cancers: an update on clinical trials

Epigenetic dysregulation is one of many factors that contribute to cancer development and progression. Numerous epigenetic alterations have been identified in urologic cancers including histone modifications, DNA methylation changes, and microRNA expression. Since these changes are reversible, efforts are being made to develop epigenetic drugs that restore the normal epigenetic patterns of cells, and many clinical trials are already underway to test their clinical potential. In this review we analyze multiple clinical trials (n=51) that test the efficacy of these drugs in patients with urologic cancers. The most frequently used epigenetic drugs were histone deacetylase inhibitors followed by antisense oligonucleotides, DNA methyltransferase inhibitors and histone demethylase inhibitors, the last of which are only being tested in prostate cancer. In more than 50% of the clinical trials considered, epigenetic drugs were used as part of combination therapy, which achieved the best results. The epigenetic regulation of some cancers is still matter of research but will undoubtedly open a window to new therapeutic approaches in the era of personalized medicine. The future of therapy for urological malignancies is likely to include multidrug regimens in which epigenetic modifying drugs will play an important role

Neutralising antibodies after COVID-19 vaccination in UK haemodialysis patients

Vaccination against COVID-19 induces highly protective immune responses in most people. As some countries switch from suppression to acceptance of transmission of SARS-CoV-2 within a largely vaccinated adult population, vulnerable patient groups that have not mounted adequate immune responses to vaccination might experience significant morbidity and mortality. There is an urgent need to identify such patient groups and to optimise medical advice and vaccination strategies for them

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics