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   2022| January-March  | Volume 6 | Issue 1  
    Online since August 11, 2022

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Pathology pick up rate in routine preoperative endoscopy and its impact on patients undergoing gastric bypass surgery
Abdulmajid Ali, Peter Ishak, Chinaka Ugochukwu, Andisheh Bakhshi, Rifat Mohamed, Jean Rankin
January-March 2022, 6(1):7-13
Background and Aims: Patients with obesity are known for higher chances of having upper gastrointestinal (UGI) pathology and diseases. Esophagogastroduodenoscopy (OGD) is considered the investigation of choice to detect and confirm UGI pathology in patient with obesity. The routine OGD as a preoperative workup remained controversial before gastric bypass surgery. The need for preoperative OGD on patients undergoing bariatric surgery has been a subject of debate among bariatric surgeons. The study's aim is to evaluate the impact of routine preoperative endoscopy on patients underwent gastric bypass surgery laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients and Materials: Retrospective review of prospectively kept patients' records who underwent LRYGB in our unit from February 2009 to March 2020. Patients were divided into two groups according to the absence or presence of symptoms before their preoperative OGD: Group A (asymptomatic patients) and Group B (symptomatic patients). Further data on OGD reports, campylobacter-like organism test and histology results and changes in the management plan were collected and analyzed. Calculation of post hoc power and Fisher's exact test was to investigate the correlation between OGD indication and its findings. All analyses were conducted at a 5% critical level. Results: A total of 114 patients included in the analysis, 85 (74.56%) were in Group A and 29 in Group B. OGD detected pathology in 34 patients in Group A and 21 in Group B (P = 0.004). Those included hiatus hernia (HH) (17.65% Group A, 44.83% Group B, P = 0.006); stomach ulcer (7.06% Group A, 3.45% Group B, P = 0.676), Helicobacter pylori (H. pylori) infection (12.86% Group A, 29.41% Group B). This led to change of management in 22 patients in Group A and 12 in Group B (P = 0.157). Those changes included H. pylori eradication (10.59% Group A, 17.24% Group B, P = 0.153), HH repair (3.53% Group A, 24.14% Group B, P = 0.002). Conclusions: Preoperative OGD has some significant impact on symptomatic patients. However, this is debatable among asymptomatic patients; hence, cheaper noninvasive alternatives could replace preoperative OGD.
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Hepatitis B virus-related nephropathy: Review and update
Elmukhtar Habas, Fahim Khan, Khalifa Farfar, Aml Habas, Aisha Al Aldab, Mehdi Errayes, Eshrak Habas, Ijaz Kamal, Amnna Rayani, Abdel-Naser Elzouki
January-March 2022, 6(1):1-6
Viral-associated nephropathy indicates the direct pathogenic relationship between viral status and the development of nephropathy. Hepatitis B virus (HBV) infection (especially chronic) causes different glomerular, tubular, and interstitium damages. Membranous and membranoproliferative are the common HBV-associated nephropathy. The pathogenesis of HBV-associated nephropathy is primarily immune complex mediated; however, direct tubular damage may occur. The virus load and activity are essential risk factors in HBV-associated nephropathy development. Decreasing virus load and early treatment reduce the risk of HBV-associated nephropathy and may prevent the disease progression. Prevention of HBV infection by a worldwide vaccination program governed by the World Health Organization is the prime target to prevent hepatic and extrahepatic HBV-related complications. The authors searched the EMBASE, Google Scholar, Scopus, and Google search engines for articles about HBV-associated nephropathy using phrases, texts, and keywords such as chronic HBV infection and kidney, HBV-associated glomerulonephritis, nephritis in HBV infection, viral nephropathy, and HBV vaccination. Following multiple meetings and discussions, each author was given a section on the topic to search and summarize. Then, this narrative review manuscript has been written and revised to update HBV-associated nephropathy pathogenesis and treatment.
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Mineral bone disorders in hemodialysis patients in the West of Libya
Khairi Ayad, Badreddin Shaibani, Zaynab Rahouma, Yousef AL-Adawi, Fatma Malool, Amina Smaida, Samiha Shamli, Reema Gattusa
January-March 2022, 6(1):19-22
Background and Objectives: Chronic kidney disease (CKD) is affecting 5%–10% of the world population. As kidney function declines, there is progressive deterioration in minerals homeostasis manifesting as disruption of serum and tissue concentrations of phosphorus, calcium (Ca), and parathyroid hormone (PTH). CKD-mineral bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism manifested by any or a combination of the following: abnormalities of Ca, phosphorus, PTH, Vitamin D metabolism, abnormalities of bone turnover, and vascular or soft-tissue calcification, associated with fractures, cardiovascular disease, and mortality in CKD patients. The study aims to identify the prevalence and pattern of CKD-MBD among hemodialysis patients in the west of Libya. Patients and Methods: A cross-sectional study was carried out on 186 regular hemodialysis patients from five hemodialysis centers in the west of Tripoli-Libya District. All patients were investigated for complete blood count, blood sugar, serum albumin, blood urea, serum creatinine, total Ca level, serum phosphate, serum alkaline phosphatase, and serum intact PTH (iPTH) level. Results: According to the Kidney Disease Outcomes Quality (KDOQ) iPTH level guideline, 88.10% of the studied patients had metabolic bone disorders, and 39.80% showed low bone turnover. About 48.40% were high bone turnover; only 11.80% of studied patients were within the target range according to the KDOQ Initiative guidelines. About 40.36% of studied patients had low calcium levels (below 8.5 mg%), and 35.48% had high phosphorus levels (more than 5.5 mg%). About 61.10% of high bone turnover patients complain of bone pain and 50.50% complain of muscle weakness. Among low bone turnover patients, 36.48% had no symptoms, and 28.38% were complaining of both muscle weakness and bone pain. Conclusions: The prevalence of MBDs among studied patients with abnormal PTH levels is 87.6%, distributed as 39.2% in abnormal low PTH (low bone turnover), and 48.4% in abnormal high PTH (high bone turnover).
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A comparative study of biological sample preparation methods conventional cryopreservation of human tissue
Anisa Ali Elhamili, Shaban Eljali Saad, Fathi Sadek Eladressi
January-March 2022, 6(1):14-18
Background/Aims: Data that compare the effectiveness of methodologies for cryopreservation of human tissue are very limited. Thus, two different biological sample preparation methods, the conventional cryopreservation of human ovarian tissue using either spontaneous or initiated (so-called “seeded”) ice formation, was carefully investigated and compared. Materials and Methods: Biopsies of ovarian tissue were obtained from women with indications for chemotherapy or radiotherapy, and small pieces of experimental tissue (0.5 mm × 1 mm × 1–3 mm) were randomly distributed into three different groups: group 1 immediately after biopsy, experimental pieces after cryopreservation (thawing) with spontaneous ice formation (Group 2) and cryopreservation with initiated ice formation (Group 3). The pieces of tissue were cultured in vitro for 16 days, after which follicle viability and hormonal activity were evaluated. The level of statistical significance was set at P < 0.05. Results: The obtained results indicated that culture supernatants for Groups 1, 2, and 3 showed estradiol 17-ß concentrations of 476, 465, and 459 pg/mL, respectively. Whereas pProgesterone concentrations were 9.68, 5.77, and 5.61 ng/mL, respectively. In addition, the mean primordial follicle density per mm3 for Group 1 was 12.1 ± 3.9, 3.1 ± 1.4 for Group 2 and 6.0 ± 2.3 for Group 3. Moreover, it was recognized that 91%, 16%, and 87% follicles for Groups 1, 2, and 3, respectively, were normal (P2-1, 3 < 0.05; P1-3 > 0.1). Conclusions: The obtained results revealed that for the best results using cryopreservation of human ovarian tissue, the protocol of conventional cryopreservation must include a step of initiated ice formation. Moreover, an advanced analytical detection technique of high sensitivity, mass spectrometry, can further be used in the future for an accurate determination of hormonal levels and other related compounds and for screening of possible biomarkers using the best-obtained sample preparation method.
  1,417 136 -
Classic hodgkin lymphoma involving spleen, stomach, and pancreas without peripheral lymphadenopathy: Report of a very rare case
Sharath K Krishnan, Bhavya P Mohan, Ravindran Chirukandath, M Feroze
January-March 2022, 6(1):23-26
Classic Hodgkin lymphoma (HL) is a lymphoid neoplasm most often affecting the lymph nodes of the cervical region (75%), followed by mediastinal, axillary, and para-aortic areas. Extranodal involvement is much less common in HL. We present an extremely rare case of classic HL (CHL) with involvement of the spleen, stomach, and pancreas and perigastric, mesenteric, and para-aortic lymph nodes without peripheral lymphadenopathy, in a 54-year-old male, which clinicoradiologically mimicked a carcinoma. An extensive English literature search did not reveal any case of CHL involving the spleen, stomach, and pancreas simultaneously.
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Transverse sinus aneurysm presented as fetal intracranial hemorrhage: A new case report
Faisal S Taleb, Seraj Ajaj, Abdussalam Abograra
January-March 2022, 6(1):30-33
A transverse sinus aneurysm is a very rare vascular pathology. Limited cases were reported in the literature. Here, we report a new case of a transverse sinus aneurysm presented as fetal intracranial hemorrhage of third-trimester pregnant women.
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Neuroendocrine tumor in a patient living with human immunodeficiency virus
Khalid Albsheer, Shahda Mohamed Alhassan Ahmed, Rayan M Sibira, Elmukhtar M. A B. Habas
January-March 2022, 6(1):27-29
Neuroendocrine tumors (NETs) are epithelial neoplasms with predominant neuroendocrine differentiation, potentially arising from anywhere along the alimentary tract. We report a case of NET in a patient living with human immunodeficiency virus (HIV) (PLWH). A 58-year-old gentleman presented to the emergency department with a 2-week history of dry cough, loose motions, and fatigue; he had unintended weight loss ongoing during the past 4 months. Examination is significant for hepatomegaly (20 cm). On evaluation, a diagnosis of both HIV/AIDS and metastatic NET of gastrointestinal origin was confirmed. The chronic antigenic stimulation, cytokine dysregulation, and inflammation observed in PLWH are believed to influence the development of variety of malignancy. Hence, a high index of suspicion for neoplasms in HIV/AIDS (PLWH) regardless of their viral load or immunosuppression status is necessity when presented with red flag malignancies, especially with the overlapping symptoms of AIDS and the constitutional symptoms of cancers.
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