Endoscopic retrograde cholangiopancreatography versus conservative treatment for patients with symptomatic small common bile duct stones: A randomized controlled trial

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended treatment for common bile duct stones (CBDS). However, CBDS, tiny ones, can spontaneously pass through the ampulla of Vater, reducing unnecessary ERCP and its related significant complications. Objectives: This study compared endoscopic stone extraction versus conservative treatment for managing symptomatic small CBDS. Patients and methods: This randomized controlled trial included 168 patients with symptomatic CBDS (≤ 7 mm) and gallbladder stones. Of these, 85 patients underwent endoscopic stone extraction, and 83 patients underwent conservative treatment for the CBDS, followed by laparoscopic cholecystectomy and intraoperative cholangiography between June 2019 and March 2023. The primary outcome was the overall success rate, while useless procedures, morbidity, mortality, length of hospital stay, total cost, and recurrent biliary symptoms were considered secondary outcomes. Results: Our study showed that the ERCP group had a significantly higher overall success rate (96.5% vs. 22.9%, P < 0.001), fewer useless procedures (14.1% vs. 77.1%, P < 0.001), a shorter median hospital stay (5 vs. 8 days, P < 0.001), and reduced total costs (1810 vs. 2250 US$, P < 0.001). Both groups had no significant difference in morbidity or recurrent biliary symptoms (2.4% vs. 7.2%, P = 0.14). There was no mortality rate in both groups. Conclusion: Symptomatic small CBDS should be managed surgically as early as possible. Endoscopic stone extraction has a significantly high success rate, a shorter hospital stay, and a lower total cost. The conservative treatment for symptomatic small CBDS is useless and should not be practiced

Diagnostic Value of Upper and Lower Endoscopy in Assessment of Patients with Microcytic Hypochromic Anaemia without Site-specific Gastrointestinal Manifestations

Background: Iron deficiency anemia (IDA), is often caused by digestive disorder and should always be assessed, as its causes could be severe illness such as cancer. Objectives: To study the diagnostic value of both upper and lower endoscopic examinations among patients with microcytic hypochromic anaemia without site -specific gastrointestinal (GIT) manifestations. Patients and methods: A total of 50 Egyptian patients with IDA were included. Patients were clinically evaluated and investigated for: Complete blood picture, serum ferritin, serum iron and total iron binding capacity (TIBC). Patients were screened with Esophagogastroduodenoscopy (EGD) and colonoscopy. Results: The mean ±SD age of the patients was 36.4 ± 16.7, 19 males (38%) and 31 females (62%). The most common finding of EGD was Gastritis, it was present in 20 patients (40%) followed by Peptic ulcer in 9 patients (18%). There were 2 patients (4%) with celiac disease, 1 patient (2%) with crohn’s disease, 2 patients (4%) with Gastric cancer, and 1 patient (2%) with angiodysplasia while there were 14 patients (28%) with normal EGD. Both procedures showed negative findings in 10 patients (20%), both procedures showed positive findings in 8 patients (16%) while 1 procedure only showed positive finding in 32 patients (64%). Conclusion: Bidirectional endoscopies are valuable to detect the cause of IDA in patients without site –specific (GIT) manifestations. The most common GIT lesions were gastritis followed by peptic ulcer

An unusual presentation of adult T-cell leukemia/lymphoma

Adult T-cell Leukemia/Lymphoma (ATL) is a rare disease, related to human T-lymphotropic virus-1 (HTLV-1) and presented mainly in adulthood by generalised lymphadenopathy, hepatosplenomegaly, skin lesions and hypercalcaemia, with rare gastrointestinal and/or oral manifestations. We reported this case to raise awareness and demonstrate the therapeutic challenges of this rare disease. A 49-year-old Japanese female presented with skin papules on both forearms, painful mouth ulcers and multiple neck swellings since early February 2017. Initial clinical examination and laboratory investigations were misleading and her condition was diagnosed as candidiasis. Because of un-improvement of the case, a screening upper endoscopy was requested 2 months later and revealed characteristic oropharyngeal ulcers which were biopsied, and its pathologic examination confirmed smouldering type ATL. This case report should raise awareness of doctors and endoscopists about this disease especially in HTLV-1 endemic areas to avoid late diagnosis and help achieve earlier therapeutic decisions

Body Mass Index as a Major Prognostic Contributing Factor in COVID-19: A Multicentral Egyptian Study

Hossam Abd El-Moez Mohammed,1 Mohammed H Hassan,2 Hytham Abdalla,3 Marwa Ahmed Mahmoud,4 Amira Maher,5 Mohamed Malak,6 Mohammed Tag-Adeen,7 Mohamed Ramadan Izzaldin,8 Sara Adel,8 Wael Esmat Ali,8 Alyaa Abo-Rahma,9 Mona Gouda Maghrabi Abd Elnabi,10 Ibrahim Ahmed Mosa Abdalla,11 Mohamed Fakhry Mohamed Morsy,12 Mohamed Abdel Fattah Mohamed Sayed,13 Usama Mohamed Abdelaal6 1Department of Chest Diseases, Faculty of Medicine, Luxor University, Luxor, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 3Department of Chest Diseases, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 4Department of Medical Physiology, Faculty of Medicine, Sohag University, Sohag, Egypt; 5Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt; 6Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt; 7Department of Internal Medicine, Division of Gastroenterology and Hepatology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 8Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 9Department of Public Health and Community Medicine, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 10Department of Diagnostic Radiology, Faculty of Medicine, Luxor University, Luxor, Egypt; 11Anasthesia and Critical Care Department, Faculty of Medicine, Luxor University, Luxor, Egypt; 12Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 13Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan, EgyptCorrespondence: Mohammed H Hassan, Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt, Tel +20 1009097968, Email [email protected]; [email protected]: Extreme body mass index (BMI) is an influential pathophysiological risk factor for serious illnesses following lower respiratory tract infection. The purpose of the current study was to examine how the BMI of Coronavirus disease-19 (COVID-19) patients affects their prognosis.Methods: Two hundred patients with COVID-19 admitted to Al-Azhar, Qena, Aswan, and Sohag University hospitals in Egypt were included and categorized into four groups according to their BMI. The diagnosis was made according to a real-time reverse transcription-polymerase chain reaction (rRT-PCR) positive result for the SARS-CoV-2 nucleic acid in swabs from upper respiratory tract. A detailed history, clinical examination, and outcomes (disease severity and complications, hospital stay, ICU admission, mortality) were recorded for all patients. SPSS version 24 software was used for data analysis.Results: Average age of participants (19– 90 years old), 92 (46%) males and 108 females (54%). ICU admission was significantly higher among underweight patients (75%) and obese patients (78.6%). The majority of underweight (62.5%) and obese (57.1%) patients had critical disease. Invasive mechanical ventilation (MV) is frequently used in underweight (50%) and obese patients (42.9%) patients. Adult respiratory distress syndrome (ARDS), cardiac, neurological, and hematological complications, and incidence of myalgia and bed sores were most frequent among obese and overweight patients. Acute kidney injury was significantly higher among underweight patients (37.5%) and obese patients (28.6%) than among other classes (p=0.004). Frequency of endocrine complications was significantly higher in underweight patients than that in other classes (p=0.01). The majority of underweight (75%) and obese patients (50%) deteriorated and died, whereas the majority of normal-weight patients (90.3%) and overweight patients (75.8%) improved and were discharged (p< 0.001).Conclusion: Body mass index is a major contributing factor to the outcome of patients with COVID-19, and patients with extreme of body mass index were associated with the worst prognosis.Keywords: body mass index, COVID-19, obese, underweight, intensive care uni

Healthcare Providers' Perspective about the Use of Telemedicine in Egypt: A National Survey.

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption

Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions. To determine the characteristic EUS features of SPN and define its role in preoperative assessment. This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics. One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed. SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis