Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis

Objectives Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal etiologies, including a viral infection-induced autoimmune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis aimed to estimate to what extent CMV infection is detected in patients with BA. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE, Embase, Scopus, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. The risk of bias was assessed using the Newcastle–Ottawa scale. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using Comprehensive Meta-Analysis Software version 3.3. Results A total of 19 studies that fulfilled the eligibility criteria were included in the meta-analysis. The total number of infants with BA was 630 patients, and the pooled overall prevalence of CMV infection among them was 25.4% (95% CI: 15.9%–38.0%). There was high heterogeneity among studies (I2 = 85.1%, p < .001), and subgroup analyses showed significant regional differences (X2 = 48.9, p <.001). Data on the prognosis of CMV-associated BA were scarce and obtainable from few studies that suggested an association between detection of CMV infection and poor prognosis of BA. Conclusions The limited available data demonstrates that the rate of detection of CMV infection is high in infants with BA. There is still a need for large studies with appropriate controls for obtaining more reliable results about the various aspects of the association between CMV infection and BA.

The Curious Case of a Missing Gallbladder: An Unusual Presentation of a Cholecystoduodenal Fistula

Large gallstones could erode through gallbladder wall to nearby structures, causing fistulas, gastric outlet obstruction and gallstone ileus. They typically occur in elderly patients with comorbidities carrying therapeutic challenges. We present a case of a middle-aged woman who was thought to have symptomatic cholelithiasis. Extensive adhesions precluded safe cholecystectomy. While hepatobiliary iminodiacetic acid scan and magnetic resonance imaging with cholangiopancreatography (MRI-MRCP) failed to visualize the gallbladder, computed tomography (CT) was consistent with cholecystoduodenal fistula. A very large gallstone was seen endoscopically in the duodenum, which was broken down into pieces using a large stiff snare.

Practice Patterns for the Acceptance of Medically Complex Living Kidney Donors with Hematuria, Sickle Cell Trait, Smoking, Illegal Drug Use, or Urological Issues: A Multinational Survey

Background To review the practice patterns for the acceptance of medically complex living kidney donors (MCLKD) among the transplant providers of the international transplant community. Methods We distributed a survey globally, through major international transplantation societies, among nephrologists and transplant surgeons (TS). The survey contained questions regarding potential donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, smoking, or illegal drug use. Results There were 239 respondents from 29 countries, including nephrologists (42%) and TS (58%). Although most respondents would investigate microscopic hematuria, one-third of them indicated they would decline these potential donors without investigation. Interestingly, most respondents accepted heavy smokers, intermittent illegal drug users (with advice to quit), and those with incidentally identified kidney stones, remote history of renal colic or simple renal cysts. We found multiple areas of consensus in practice with some interesting differences between nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, heavy smoking, or illegal drug use.

Large Bowel Obstruction Caused by Metastatic Prostate Cancer: A Case Report

Bowel obstruction is a frequently encountered condition worldwide that causes numerous admissions to hospitals. Metastatic carcinoma has been identified as one of the infrequently encountered causes of bowel obstruction. Prostate cancer typically metastasizes to lymph nodes, bone, lungs, liver, and brain. In this article, we reported the case of a 75-year-old man who presented with bowel obstruction due to narrowing and stricture of the rectum. Primary rectal mass was initially diagnosed, but upon further investigation, it was found that the mass resembled prostate tissue. The bowel obstruction was managed surgically with a colostomy. The patient was later referred to oncology for chemotherapy and hormonal therapy.

Fetal Complications in COVID-19 Infected Pregnant Woman: A Systematic Review and Meta-Analysis

Background Pregnancy is an immunocompromised state and, for this reason, a pregnant woman is at a higher risk of getting infected as compared with a healthy individual. There is limited data available regarding the impact of COVD-19 on pregnancy; however, the case of miscarriage due to placental infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in second trimester has already been reported. Methods We searched for all published articles in PubMed, Science Direct, Cochrane, Scopus, and Embase. The literature search produced 167 relevant publications; 67 manuscripts were further excluded because they did not satisfy our inclusion criteria. Out of the remaining 100 articles, 78 were excluded after full text screening. Therefore, a total of 22 articles were eligible for review in our study. Results Overall, these 22 studies included a total of 7,034 participants: 2,689 (38.23%) SARS-CoV-2 positive pregnant women, of which 2,578 (95.87%) were laboratory confirmed and 111 (4.13%) were clinically diagnosed. Among the positive patients, there were 174 (6.47%) cases of abortion, of them 168 (96.55%) were spontaneous abortions and 6 (3.45%) were missed. Most patients either reported mild symptoms of fever, cough, fatigue, and anosmia or they presented asymptomatic. Conclusion Additional investigation and rigorous research are warranted to confirm placental pathology mechanisms concerning COVID-19 to protect maternal and fetal health.

Assessment of Growth in Pediatric Syrian Refugee Populations in Jordan

Background Externally displaced pediatric Syrian refugees are at risk of adverse developmental health outcomes in the setting of food insecurity. To evaluate the impact of displacement on nutritional status of Syrian children, this study describes the prevalence of malnutrition of Syrian children residing in Jordan. Methods A retrospective cross-sectional analysis of data from patient records < 18 years of age from the Syrian American Medical Society's (SAMS) January 2019 mission trip to Jordan was performed. Prevalence of stunting, severe wasting, wasting, overweight, and underweight were calculated using the World Health Organization (WHO) definitions. Results Overall, 392 Syrian children were included. In the 0 to 59 months group (n = 191), prevalence of stunting was 13.9% (n = 165), severe wasting 4.2% (n = 165), wasting 6% (n = 165), overweight 16.4% (n = 165), and underweight 5.3% (n = 190). In the > 59 months group (n = 201), prevalence of stunting was 7.2% (n = 194), severe wasting 3.6% (n = 194), wasting 5.2% (n = 194), overweight 6.7% (n = 194), and underweight 4.6% (n = 153). Age group was significantly associated with stunting (odds ratio [OR] = 2.08,9 5% CI 1.03 to 4.19) and overweight (OR = 2.72; 95% CI 1.36 to 5.47) with increased odds of each in the 0–59 months group. Conclusion The findings suggest evidence of higher prevalence of malnutrition in Syrian children compared with prior assessments and greater impact on the younger cohort. In 0 to 59 months' old Syrian children, stunting and wasting were of medium severity and overweight was of high severity. This may reflect food insecurity in the setting of ongoing conflict, strain on resources, and evolving refugee policies, acknowledging study limitations. Syrian refugee children living in Jordan experience wasting and stunting. Comprehensive assessment of current nutritional status of Syrian children is needed. Access to adequate and nutritious food is paramount.

Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy

Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs). Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology. Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS).Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.

Job Satisfaction and Evidence of Burnout Comparing Arab and Non-Arab Urologists with a Migration Background Working in German Hospitals

Background In German hospitals, severe shortage of physicians can currently be partially compensated by hiring foreign physicians. Results on job satisfaction (JS) and physician burnout (PBO) in this important occupational group are currently not available. Methods The cross-sectional “Assessment of their urological work environment by foreign clinicians in Germany (EUTAKD)” study was conducted in 2020 using a 101-item questionnaire among physicians working in German urological departments who were born in a country outside Germany and having non-German citizenship. This study compared JS and the occurrence of PBO between Arab (group A, n = 57) and non-Arab (group B, n = 39) participants. Results Significant group differences with advantages for group B were analyzed in overall JS and also in other JS items. High scores in the PBO dimensions, that is, “emotional exhaustion” and “depersonalization,” were shown by 27.9 and 51.5% of the study participants, respectively, although there were no group differences found (p = 0.972 and 0.237, respectively). Conclusion Prospective longitudinal studies of appropriate intervention measures aimed at increasing JS and decreasing PBO are needed.

COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending?

Mucormycosis (also known as black fungus) is caused by fungi of the Zygomycetes class and is the third most common invasive mycosis after candidiasis and aspergillosis. They colonize a large number of patients without invading them. Systemic glucocorticoids are currently used to treat severe Coronavirus disease 19 (COVID-19). In such patients, opportunistic fungal infections are a problem. Although COVID-19-related pulmonary aspergillosis is becoming more common, mucormycosis is still uncommon. Mucormycosis normally appears 10 to 14 days after being admitted to the hospital. Mucormycosis is a rare but dangerous infection that can make extreme COVID-19 worse.Mucormycosis is more likely to occur in people who have diabetes mellitus and other risk factors. Mucormycosis is most likely exacerbated by concurrent glucocorticoid treatment. To improve outcomes, a high index of suspicion and aggressive management is required. Excessive usage of steroids, monoclonal antibodies, and broad-spectrum antibiotics might cause the formation or worsen of a fungal infection.A high index of suspicion and aggressive management are needed. In patients with COVID-19 infection, physicians should be vigilant of the likelihood of subsequent invasive fungal infections. To enhance results in pulmonary mucormycosis, early diagnosis and treatment are critical. Confirmation of the clinical form necessitates a combination of symptoms that are consistent with tissue invasion histologically. Combining various clinical data and the isolation of the fungus from clinical samples in culture is needed for the probable diagnosis of mucormycosis. The organism that causes mucormycosis is identified using macroscopic and microscopic morphological criteria, carbohydrate assimilation, and the maximum temperature at which they can expand. Mucormycosis must be treated with antifungal medication prescribed by a doctor. It may necessitate surgery in some circumstances, and it can result in the loss of the upper jaw and, in some situations, an eye.

An Arab Adolescent with Multisystem Inflammatory Syndrome Associated with COVID-19: A Report from Syria

Multisystem inflammatory syndrome in children (MIS-C) is a rare and critical condition that affects children following exposure to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, leading to multiorgan dysfunction and shock. MIS-C has been reported from different parts of the world but rarely from Arab countries. In this report, we describe a 15-year-old Arab boy who was admitted to the ICU during the surge of Coronavirus transmission in Syria with a clinical picture consistent with MIS-C, including high-grade fever, gastrointestinal symptoms, rash, multiorgan dysfunction, and shock. Laboratory profile showed significant elevation of inflammatory markers, negative SARS-CoV-2 RT-PCR testing but positive serologic testing for SARS-CoV-2. The patient received intravenous immunoglobulins (IVIG) and glucocorticoids with remarkable cardiac improvement and significant alleviation in inflammatory markers. To our knowledge, this is the first reported case of MIS-C from Syria, which adds to the epidemiological data about this new syndrome.