Children with type one diabetes who are migrants and refugees suffer from poor metabolic control and frequent acute complications, a study from Jordan, a limited resource country with high migrant/refugee population.

BACKGROUND: Data from developed countries show that pediatric patients with type one diabetes (T1D) who are migrants/refugees suffer from poor metabolic control and frequent complications. Their status in developing countries is underreported. AIM: To compare Jordanian and migrant/refugee children with T1D in terms of socio-demographic and metabolic characteristics. METHODS: This is a questionnaire-based, cross-sectional study. It was completed using Microsoft forms and patients/caregivers were asked to consent if they agreed to answer. RESULTS: A total of 146 children with T1D were enrolled in the study (42, 28.8% migrants/refugees). Jordanian and migrant/refugee children with T1D had poor metabolic control: average HbA1c was 8.9 ± 1.99% (74 ± 22 mmol/mol) and 9.0 ± 1.93% (75 ± 21 mmol/mol), respectively P = 0.81. Migrant children with T1D suffered from recurrent hypoglycemia more than the Jordanian group 33 (78.6%) and 56 (53.8%) respectively, p = 0.006. Although not statistically significant, recurrent attacks of DKA was reported more in the migrant/refugee group 13 (31.0%) and 18 (17.3%) respectively, p = 0.068. CONCLUSION: Both Jordanian children with T1D and those who are refugees/migrants had poor metabolic control. However, those who are of migrant/refugee background were more likely to develop acute complications related to diabetes.

Cutaneous Myiasis Around Gastrostomy (PEG) Tube Insertion Site: The Second Case Report.

BACKGROUND: Myiasis refers to the infestation of live human with 2-winged larvae (maggots). Cutaneous myiasis is the most commonly encountered clinical form. It is divided into 3 main forms: furuncular, creeping (migratory), and wound (traumatic) myiasis. CASE REPORT: In this article, we report an extremely rare case of myiasis around percutaneous endoscopic gastrostomy (PEG) tube in a 71-year-old female patient. She had the tube placed for feeding purposes, 8 months prior to her presentation. Family noticed alive worms emerging from skin at the gastrostomy tube insertion site. Patient was treated conservatively with daily dressing with no debridement or use of systemic agents. CONCLUSIONS: PEG tube cutaneous myiasis is an extremely rare disease. Conservative management with petroleum-based and sterilizing agents is shown to be efficient to clear the disease in a short period of time.

Portomesenteric Venous Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Do Energy Systems Pose as Instigating Factor to This Infrequent Complication?

BACKGROUND: Portomesenteric venous thrombosis (PMVT), a rare complication after laparoscopic sleeve gastrectomy (LSG). Severe consequences are owed to a high risk of bowel ischemia. Our aim is to present a series of patients who developed PMVT after LSG, highlighting the potential role of the vessel sealer and divider as a risk factor. METHODS: Medical records of seven patients who underwent LSG and developed PMVT from April 2010 to January 2019, at King Abdullah University Hospital and Jordan University Hospital, Jordan were reviewed. Our findings were studied, audited, and compared with published data. RESULTS: A sum of 4900 patients underwent LSG, 7 (0.14%) developed PMVT. The mean age and body mass index (BMI) were 36.8 years and 45 kg/m2, respectively. Four were women. Epigastric pain radiating to the back was the presenting symptom at a median time of 9 days after surgery. Computed tomography (CT) of the abdomen confirmed the diagnosis. Five patients presented with a total portal vein thrombosis (PVT), one with splenic vein thrombosis and one with dual portal and mesenteric vein thrombosis. CONCLUSION: Portomesenteric venous thrombosis is a relatively uncommon complication following LSG. Early recognition is required to avoid catastrophic outcomes. The role of energy systems in the development of PMVT remains unknown and requires further elaboration.