Evaluation of Imaging-Guided Peritoneal Biopsy in Diagnosis of Ascites of Undetermined Origin

Abstract Background Regarding ascites of unknown origin, diagnostic laparoscopy is an invasive procedure, there are certain complications reported with this procedure i.e. haemorrhage, infection and air embolism. Ultrasound-guided percutaneous biopsies are easy to perform in an outpatient clinic. This procedure is safe, has a low incidence of injury and does not cause serious complications. Computed tomography (CT)-guided percutaneous biopsy is not a real-time operation, and it involves quite a few complicated procedures. Aim To evaluate the role of imaging guided peritoneal biopsy in diagnosis of ascites of undetermined origin (ascites of local cause). 2ry aim was to present the role of imaging-guided biopsy of the omentum or other extravisceral masses as a minimally invasive procedure compared to laparoscopy in the diagnosis of these difficult-to-diagnose group of patients. Patients and methods Patients with clinically suspected and radiologically confirmed ascites of unknown etiology represented the population of our study. These patients were referred to the ascites study group (ASG) and admitted to Tropical Medicine Department, Ain Shams University Hospitals in the period from June 2017 to November 2019. The study was conducted on 63 patients with ascites of unknown etiology fulfilling the inclusion criteria. They underwent ultrasound-guided cytology/biopsy of peritoneum, omentum or extravisceral masses. CT guided percutaneous peritoneal biopsy was done in cases of failure of ultrasound guided technique. Laparoscopy was needed when the imaging-guided biopsy was not diagnostic. Results 54 patients (85.7%) underwent US guided biopsies, 48 patients of them (76.2%) were successfully diagnosed, while the other six patients (9.5%) were sent for laparoscopy after nonconclusive histopathological examination of the biopsies taken US guided. The patients underwent laparoscopy were successfully diagnosed except for one patient who died intraoperatively. The other nine patients (14.3%) underwent CT guided biopsies (not accessible by US guided modality) and all of them were successfully diagnosed. Imaging guided biopsies had perfect sensitivity (100%) and NPV (100%) in differentiating neoplastic lesions. We found that imaging-guided procedures had a high diagnostic accuracy of 88.8% &amp; 100% done US &amp; CT guided respectively with a sensitivity of 100%, specificity of 83.3% and NPV of 100%, which could distinguish malignant from benign ascites. Complications were most frequent in laparocopy, followed by CT guided biopsies and least in US guided biopsies with P-value &amp;lt;0.001. Conclusion Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures e.g laparoscopy. It can help in directing the management, shortening the patient’s hospital stay and reducing the costs and complications. </jats:sec

Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023

Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1-77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6-20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6-17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill &amp; Melinda Gates Foundation and Gavi, the Vaccine Alliance