Outcomes of Endoscopic Stapedectomy: Systematic Review

Abstract Introduction Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. Objective To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. Data Synthesis A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. Endoscopic stapes surgery or stapedotomy were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies.

Factors associated with chemsex in Portugal during the COVID-19 pandemic / Fatores associados à prática de chemsex em Portugal durante a pandemia da COVID-19 / Factores asociados a la práctica de chemsex en Portugal durante la pandemia de COVID-19

Objective: to investigate the factors associated with the practice of sex under the influence of drugs (chemsex) among Portuguese men who have sex with men during the period of social distancing to prevent the COVID-19. Method: online survey applied in May 2020 to a sample of 1,301 participants living in Portugal, recruited according to Respondent Driven Sampling and via social media Facebook®. Descriptive and bivariate analyses were performed along with logistic regression to calculate adjusted Odds Ratio (ORa). Results: the prevalence of chemsex was 20.2%. The likelihood of practicing chemsex increased with group sex (ORa: 28.4, 95%CI 16.93-47.49); unprotected sex (ORa: 7.1 95%CI 4.57-10.99); the use of pre-exposure prophylaxis (PrEP) to prevent COVID-19 (ORa: 4.2, 95%CI 2.71-6.39) and COVID-19 testing (ORa: 1.9, 95%CI 1.15-3.10). Conclusion: the practice of chemsex among men who have sex with men during the COVID-19 pandemic in Portugal was very frequent and may support greater understanding of the role and impact of sexual behavior on the COVID-19 transmission rates and the current pandemic situation in Portugal.

Objetivo: investigar os fatores associados à prática do sexo sob o efeito de drogas (chemsex) entre homens que fazem sexo com homens (HSH) portugueses durante o período de distanciamento social pela COVID-19. Método: inquérito on-line aplicado em maio de 2020 a uma amostra de 1301 participantes residentes em Portugal recrutados pelo método Respondent Driven Sampling na rede social Facebook®. Realizaram-se as análises descritiva e bivariada e a regressão logística para o cálculo dos Odds ratio ajustado (ORa). Resultados: a prevalência de chemsex foi de 20,2%. A chance de praticar chemsex aumentou com: o sexo grupal (ORa: 28.4, IC95% 16.93 - 47.49); o não uso de preservativo (ORa: 7,1 IC95% 4,57 - 10,99); fazer uso da profilaxia pré-exposição (PrEP) como medida protetiva para a COVID-19 (ORa: 4,2, IC95% 2,71 - 6,39) e realizar teste para a COVID-19 (ORa: 1,9, IC95% 1,15 - 3,10). Conclusão: a prática de chemsex entre homens que fazem sexo com homens, no período da pandemia da COVID-19 em Portugal, foi elevada e pode fornecer subsídios para entender o papel e o impacto que as relações sexuais possuem nas taxas de transmissão e na atual situação pandêmica no país.

Objetivo: investigar los factores asociados a la práctica de sexo bajo el efecto de drogas (chemsex), entre hombres que tienen sexo con hombres portugueses, durante período de distanciamiento social por COVID-19. Método: encuesta online aplicada en mayo de 2020 a una muestra de 1.301 participantes, residentes en Portugal, reclutados por el método Respondent Driven Sampling en la red social Facebook®. Se realizó análisis descriptivo, bivariado y regresión logística para cálculo de los Odds Ratio ajustado (ORa). Resultados: la prevalencia de chemsex fue de 20,2%. La chance de practicar chemsex aumentó con: el sexo grupal (ORa: 28.4, IC95% 16.93 - 47.49); no usar preservativo (ORa: 7,1 IC95% 4,57 - 10,99); hacer uso de la profilaxis antes de la exposición (PrEP) como medida protectora para la COVID-19 (ORa: 4,2, IC95% 2,71 - 6,39) y realizar el test para COVID-19 (ORa: 1,9, IC95% 1,15 - 3,10). Conclusión: la práctica de chemsex entre hombres que tienen sexo con hombres, en el período de la pandemia de la COVID-19, en Portugal, fue elevada y puede suministrar informaciones para entender el papel e impacto que relaciones sexuales poseen en las tasas de transmisión y actual situación de la pandemia en el país.

[Reclassification of gastrointestinal mesenchymal tumors]

Background: Gastrointestinal stromal tumors - commonly called GISTs - are rare; yet, they represent an important type of mensenchymal tumors arising within the gastrointestinal tract. The acronym GIST was introduced in 1998 to define a well established pathological entity which bears a highly specific marker called KIT [CD117]. Scientific interest for these tumors in recent years is mainly due to the progress in identification by immunohistochemistry and the advent of targeted molecular therapy

Aim: To reclassify mesenchymal tumors of the digestive tract using advanced immunophenotyping

Methods: We examined the digestive tissue tumors operated at the Principal Military Hospital of Instruction of Tunis over a 19-year period from 1992 to 2011

Results: We collected 22 cases of benign mesenchymal tumors of the digestive tract. Tumors were initially diagnosed as leiomyomas [4 cases], schwannomas [2 cases], gastrointestinal stromal tumors [14 cases], a leiomyoblastoma and a mesenchymal tumor with fusiform cells. The immunohistochemical study has allowed to correct some diagnoses and, in one case, the block has been exhausted. In total, we selected 18 cases of gastrointestinal stromal tumor, a schwannoma and two leiomyosarcomas among 21 mesenchymal tumors. The final diagnosis of GIST was confirmed by the positivity of C-kit or DOG1

Conclusions: The combined use of C-kit and DOG1 ensures accurate diagnosis of GIST. The DOG1 has allowed us to detect the 3 stromal tumors negative for C-kit. This antibody has achieved a diagnostic gain of 15%. The rate of GIST tumors labeled increased from 71% to 86% among mesenchymal tumors

Accessory pancreatic lobe with gastric duplication cyst- A rare case of recurrent acute pancreatitis

Introduction: Hereditary anomalies of the pancreas and the pancreatic duct is not uncommon and can pose a diagnostic challenge. Accessory pancreatic lobe [APL] is a very rare and curable congenital anomaly of the pancreas which can present as recurrent acute pancreatitis [RAP] and association of APL with a gastric duplication cyst is even rarer. To the best of our knowledge, there are only 18 cases reported so far in the world literature and therefore the aim of this article is to highlight the significance of recognising these conditions in clinical practice for avoiding misdiagnosis

Case Discussion We present an interesting case of 28-year old lady who presented with severe abdominal pain with similar episodes in the past but never evaluated before. A possibility of recurrent acute pancreatitis [RAP] was considered, further confirmed on serum amylase, lipase and imaging. CT pancreatography [CTP] followed by MRCP showed an accessory lobe in the head region of pancreas with a separate pancreatic duct associated with a gastric duplication cyst .She was managed as recurrent acute pancreatitis with conservative measures and she improved

Conclusion Prompt identification and understanding of the congenital anomalies related to pancreas and pancreatic duct is imperative as these represent correctable causes of RAP.Moreover, as in our case, the pancreas can have lobulated contours, simulating a pancreatic tumor/tumor deposit or lymphadenopathy. Therefore it is prudent to be aware of this condition to avoid misdiagnosis and to offer appropriate treatment

Rapid diagnosis of spontaneous bacterial peritonitis by use of leukocyte esterase reagent strips

Spontaneous bacterial peritonitis [SBP] is a serious complication in cirrhotic ascitic patients. That is why, its early diagnosis and treatment is important for prevention of further complications as hepatorenal syndrome or encephalopathy. Leukocyte Esterase reagent strips have been used successfully for many years for diagnosing urinary tract infections, being accurate, safe, rapid, available and cheap. The aim of our study was to assess the diagnostic accuracy of these leukocyte esterase reagent strips for diagnosing spontaneous peritonitis. One hundred ascitic cirrhotic patients were tested by leukocyte esterase strips and also by bedside culture of ascitic fluid using blood culture bottles. The study showed high sensitivity [98.4 %] and specificity [87.2 %] of the leukocyte esterase [LE] strips in diagnosis of spontaneous bacterial peritonitis

Short term prognostec value of interleukin-10

A role for inflammation has become well established over the past decade or more in theories describing the atherosclerotic disease process. From a pathological viewpoint, all stages, of the atherosclerotic plaque might be considered to be an inflammatory response to injury. Indeed patients with acute coronary syndromes demonstrate elevated levels of systemic markers of inflammation. Yet little is known about the role of anti-inflammatory cytokines in this setting. The aim of this work was to study the serum level of interleukin-10, which is produced by various inflammatory cells and identified as a cytokine synthesis inhibitory factor, in patients of unstable angins using stable angina patients as a control group and its prognostic value during in hospital stay. This study included 60 patients who were admitted for the assessment of angina chest pain. They were classified into 2 groups. Of the 60 patients, 30 had unstable angina [Group I] and 30 had chronic stable angina [Group II]. Samples from those patients were taken under aspirin cover at the time of admission and another ones were collected in the first 48 hours after admission to assess serum interleukin-10 level. According to the serum level of IL- 10, patients of group I [Unstable angina] was arranged into two equal subgroups. Each subgroup includes 15 patients. Group [IA] included patients with low serum IL-b and Group [IB] included patients with high serum IL- 10. We have compared the two subgroups regarding cardiovascular events during in hospital stay and regarding baseline characteristics. Also coronary angiography was carried out and analyzed. We found that, no significant differences between the two groups regarding baseline characteristics. Interleukin-10 was significantly lower in patients of group I compared with patients with group II [t = 8.6, p < 0.05]. Also, Interleukin- 10 was significantly negatively correlated with different types of lesions [P = 0.0004]. IL- 10 was not significantly correlated with the morphology of the lesions in group I [P = 0.065]. Angiographic findings were similar in the two groups except for the number of vessels affected which was significantly higher in the unstable group [P = 0.01]. IL-b was not significantly correlated with type or morphology of the lesions in patients of group II. During hospital stay, there was more poor prognosis among patients of group IA compared to those in group IB

influence of breech delivery on the anal sphincter and faecal incontinence

One hundred and twenty five pregnant women were included. They were divided into three groups: Group I included patients with cephalic presentation, group II included patients with breech presentation and a plan for elective cesarean section and group III included patients with breech presentation and a plan for vaginal delivery. Antenatal anal ultrasonography was done, and those with anal sphincter injury were excluded. Also, patients who underwent emergency cesarean section were excluded. Post-natal, anal ultrasonography and a clinical interview were performed to find out those with anal sphincter injury and/or anal incontinence. Sixty patients were included in the final analysis, 20 in each group. There were two cases of anal sphincter injury in the cephalic group, none in the cesarean section group and nine in the breech vaginal delivery group. There was one case of fecal incontinence in the cephalic group, none in the cesarean section group, and nine in the breech vaginal delivery group. All those differences were statistically significant. Vaginal breech delivery is associated with a significantly higher incidence of anal sphincter injury and fecal incontinence in comparison with both vaginal cephalic delivery and cesarean section for breech presentation

Blood lead level in full-term and pre-term delivering women and their neonates

Lead toxicity causes hematological, gastrointestinal and neurological dysfunction in children and adults. This work aimed to determine whole blood lead level in full- and pre-term mothers and their neonates, to find the relation between maternal and neonatal blood lead level and to correlate it with some biochemical and hematological parameters. One hundred delivering women and their neonates were subjected to this study, fifty women were full-term and fifty were pre-term. In addition to whole blood lead level and complete blood picture which provides measurement of RBCs, Hb, Ht and MCV, determination of serum iron, total iron binding capacity [TIBC], ferritin and calcium was done for the mothers and their neonates. The blood lead level was> or= 200 micro g/L in 59% of mothers and 47% of neonates. The level was significantly higher in full-term mothers [273.5 +/- 112 micro g/L] and their neonates [215.5 +/- 90.2 micro g/L] than in pre-term ones [218 +/- 109.2 and 191.4 +/- 96.6 micro g/L]. There was non-significant differences between full- and pre-term mothers or their neonates regarding serum iron, TIBC, calcium, Hb, Ht and MCV [p > 0.05]. A significant statistical difference in serum iron, TIBC, Ferritin, Hb, Ht and MCV was found between mothers and their neonates in full- and pre-term groups [p < 0.05] whereas no significant differences were found as regards serum calcium and RBCs. There was significant correlation between blood lead level and each of serum iron, RBCs, Hb and MCV whereas no significant correlation was found between blood lead level and each of serum TIBC, ferritin, calcium and Ht in full-term mothers and their neonates. There was significant correlation between blood lead level and each of serum iron, TIBC, RBCs, Hb and MCV and non-significant correlation with serum ferritin, calcium and Ht in pre-term neonateSoThe blood lead level was higher in frequent Kohl users [338 micro g/L] than in infrequent users [209 micro g/L] and non-users [142 micro g/L]. The blood lead level was statistically higher in mothers having smoking husbands and their neonates [259 and 210 micro g/L respectively] than in those with non- smoking husbands [181 and 154 micro g/L respectively]. In conclusion, this study found high blood lead levels in delivering women and their neonates suggesting that lead exposure would be a major health problem which deserves special attention if possible future healthy pregnancy outcomes are to be considered