One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) Versus a 200-cm BPL, a Systematic Review and Meta-analysis

This is a systematic review and meta-analysis that assessed the impact of performing OAGB with a 150-cm BPL versus a 200-cm BPL concerning weight loss, comorbidities remission, and adverse nutritional effects. The analysis included studies that compared patients who underwent OAGB with a 150-cm BPL and 200-cm BPL. Eight studies were eligible for this review after searching in the EMBASE, PubMed central database, and Google scholar. The pooled analysis revealed favoring the 200-cm BPL limb length for weight loss, with a highly significant difference in the TWL% (p=0.009). Both groups showed comparable comorbidities remission. Significantly higher ferritin and folate deficiency rates were found in the 200-cm BPL group. Considering a 200-cm BPL when performing OAGB delivers a better weight loss outcome than a 150-cm BPL, which is at the expense of a more severe nutritional deficiency. No significant differences were found regarding the comorbidities' remission.

Can botulinum toxin help in managing children with functional constipation and obstructed defecation?

BACKGROUND

Functional constipation (FC) is a common pediatric healthcare problem worldwide. Obstructed defection syndrome (ODS) is frequently presented with an inability to coordinate the bowel movement with pelvic floor muscles. Botulinum toxin (BT) intraanal sphincteric injection can improve the obstructed defecation by relaxing the anal sphincter and reducing the required force to propel the stools.

PURPOSE

This study aimed to compare the changes in Rintala scores (as a mean of assessing defecatory function), in children with FC and ODS, managed by BT injection, bowel management program (BMP), and senna based laxatives (SBL), versus a control group managed by BMP and SBL only.

METHODS

Prospective randomized controlled study, started at December 2017 on 40 pediatric patients, divided into 2 equal groups (group A: managed by BMP and SBL, group B: like group A with once intraanal sphincteric BT injection) suffering from FC, ODS, with contrast enema showing persistence of ≤90 rectoanal angle (RAA) even with trials of defecation. Patients were excluded if they have neuromuscular abnormalities, hypothyroidism, previous colorectal or anal surgery. Rintala score was assessed before treatment, at 2 months, and 6 months after management.

RESULTS

The study included 18 females (45%) and 22 males (55%). Group A had equal gender distribution and mean age of 6.9 years, while group B had 12 males with mean age of 7.35 years. The mean follow up period was 11.35 months in group A and 11.6 months in group B. Mean Rintala scores of both groups at initial presentation, 2 months and 6 months follow up were: group A: 9.10, 9.40, 10.90; group B: 9.30, 10.70, 11.05 respectively, and showed no statistically significant difference (p value: 0.884, 0.294, 0.923 respectively). No complications were detected from BT injection like allergic reactions, neuromuscular urinary or lower limbs disturbances.

CONCLUSION

Intraanal sphincteric injection of botulinum toxin by the mentioned technique and dose, did not result in additional defecatory functional improvement (when assessed by Rintala score) over the routine protocol (using bowel management program and laxatives) of managing functional constipation with obstructed defecation. ANNOUNCEMENT: a preliminary report of this work was presented in the 34th Egyptian pediatric surgery association (EPSA) meeting in Cairo in November 2019.

TYPE OF STUDY

Treatment/prospective study.

LEVEL OF EVIDENCE

Level I.

Compliance with haemodialysis practice guidelines in Egypt

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% (SD 11.2%) overall. Within the 5 separate domains, compliance was: 58.8% (SD 12.4%) for personnel, 68.5% (SD 16.0%) for patient care practices, 61.3% (SD 15.4%) for infection prevention and control, 51.5% (SD 18.2%) for the facility and 56.5% (SD 7.1%) for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities.

Are patients and healthcare providers satisfied with health sector reform implemented in family health centres?

BACKGROUND

Patients' and healthcare providers' satisfactions are important outcomes for any healthcare programmes. In Egypt, the Health Sector Reform Program (HSRP) has been implemented since 1999 in primary healthcare (PHC) centres adopting the family health approach.

OBJECTIVES

To assess the clients' satisfaction towards the overall health services provided by health centres affiliated to HSRP and to evaluate the satisfaction of healthcare providers, physicians, nurses and social workers.

METHODOLOGY

Four reformed PHC units were compared with four non-reformed units in the Alexandria governorate regarding patients' and providers' satisfactions. Assessment of the satisfaction was done using survey questionnaire and focus group discussion. The provider survey questionnaire was carried out on all providers working in the selected units. Focus group discussion was done in one reformed health unit and another non-reformed unit.

RESULTS

The current study showed that providers in the reformed PHCs were more satisfied than providers in non-reformed PHCs regarding availability of equipments, job satisfaction and income satisfaction. No significant differences were noticed between both groups regarding social relations with either colleagues or directors. The patient satisfaction was higher in accredited family health units compared to non-accredited units in all aspects: cleanness, doctors and nurses, waiting area and waiting time. During the focus group discussion, patients in the accredited PHCs expressed their satisfaction regarding the cleanness, privacy, attitude of doctors and nurses as well the waiting area and waiting time.

CONCLUSION

Implemented HSRP in PHC units has had positive implications regarding patients' and providers' satisfactions in most areas studied.

Infant mortality rate at a selected urban, semi-urban and rural areas of Egypt, 1992: a retrospective study

A study of infant mortality rate (IMR) in Egypt in 1992 was conducted at three randomly selected areas representing different social classes. IMR per 1000 live births was ranged between 27.1 to 33.5. The differences between male and female IMR were markedly observed with no consensus amongst study areas. Neonatal mortality rate ranged between 4.7 to 11.1 while the post neonatal mortality rate ranged between 18.4 to 23.0. Diarrheal diseases were the most common cause of death amongst infants at all study areas, followed by respiratory illnesses. Inaccurate and under registration were noticed clearly in this work as observed from absence of neonatal deaths in rural areas. Also, in rural areas, prematurity was not recorded as a cause of death. Similarly, neonatal tetanus was not recorded as a cause of death at all study areas.

Age-related rate of seropositivity of antibody to Giardia lamblia in different age groups in Cairo

Two hundred and twenty normal individuals were subjected to Giardia lamblia antibody IgG analysis. All subjects were of low socioeconomic standard using Indirect Immunofluorescent Antibody Test (IFAT). According to age the study persons were divided into 4 groups : group I with age in between 6 to 35 months, group II with age in between 3 years and less than 6 years, group III with age group ranged between 6 years and 16 years old and group IV with age above 16 years. The Seropositivity to Giardia infection was (37%) in all age groups, while it was 23%, 52%, 32% and 40% in each of the four age groups respectively. It is a noteworthy that infants after 12 months of age showed seropositivity to Giardia infection which meant that they caught actual infection in this early period of life while infants younger than 12 months were all seronegative to Giardia antibody. Different patterns of age associated acquisition of antibody levels were noted in the study groups. Infants and children showed a progressive acquisition of antibody titre which arrived to the highest level at the adult age group greater than 16 years that was significantly higher than other age groups.

The epidemiology of human visceral leishmaniasis in El Agamy (Alexandria Governorate), Egypt: serosurvey and case/control study

In Alexandria Governorate, Egypt, 27 cases of visceral leishmaniasis (VL) were detected from 1982-1985 through active and passive case detection. Twenty-two were located in El Agamy, a resort town of 50,000 residents located 15 km west of the City of Alexandria. To describe the disease focus, eight areas of 100-200 households in El Agamy were mapped and censused. All individuals were examined clinically, and blood was obtained by finger stick to measure leishmanial antibodies by radioimmune assay. Two case/control studies were carried out in the mapped areas. In one study, case households were more often found near open garbage containers than were control households. In a second case/control study, houses with cases of VL or seropositive individuals were found more likely to face open areas. These results demonstrate that characteristics of houses which could increase exposure to reservoir hosts can be associated with VL or leishmanial seropositivity. This suggests that control programmes should improve garbage disposal and should focus on houses located in peripheral areas of the community.

Comparative study of different types of treatments in chronic active hepatitis

Ninety-six patients with pathologically-proven, chronic, active hepatitis were studied to evaluate different lines of treatment. Patients were divided into the following groups: control (followed without specific active treatment), corticosteroid group, azathioprine group, corticosteroid and azathioprine group, chlorambucil group, 5-fluorouracil group, colchicine group and isoprinosine group. Patients were followed clinically, biochemically, and histopathologically. Results showed that patients put on any therapeutic regimen did either the same or worse than the control group left without active therapy. There was no difference in response to treatment between HBsAg +ve or -ve patients; both groups showed no improvement. Some patients given active treatment developed the side effects and complications from the drug used.