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Endovascular arteriovenous fistula (endoAVF) creation offers a minimally invasive method for the formation of arteriovenous shunts utilized for hemodialysis. Currently, there exist two similar yet unique devices: WavelinQ and Ellipsys. This review analyzes the anatomy, pre- and postoperative considerations, fistula creation methods, and outcomes associated with endoAVF. Currently, data are limited with regard to clinical efficacy of endoAVFs when compared to surgical AVFs. However, early data suggest endoAVFs are a useful technique in the creation of AVFs.

Venous thromboembolism is a significant source of morbidity and mortality worldwide. Catheter-directed thrombolytics is the primary treatment used to relieve critical obstructions, though its efficacy varies based on the thrombus composition. Non-responsive portions of the specimen often remain in situ, which prohibits mechanistic investigation of lytic resistance or the development of diagnostic indicators for treatment outcomes. In this study, thrombus samples extracted from venous thromboembolism patients were analyzed ex vivo to determine their histological properties, susceptibility to lytic therapy, and imaging characteristics. A wide range of thrombus morphologies were observed, with a dependence on age and etymology of the specimen. Fibrinolytic inhibitors including PAI-1, alpha 2-antiplasmin, and TAFI were present in samples, which may contribute to the response venous thrombi to catheter-directed thrombolytics. Finally, a weak but significant correlation was observed between the response of the sample to lytic drug and its magnetic microstructure assessed with a quantitative MRI sequence. These findings highlight the myriad of changes in venous thrombi that may promote lytic resistance, and imaging metrics that correlate with treatment outcomes.

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

Background: Laparoscopic sleeve gastrecomy is the most popular bariatric procedure with good outcome and acceptable complications (bleeding, leakage, stenosis or twist). Aim of Study: To evaluate the role of omentopexy rein-forcement of staple line in reducing postoperative leakage, bleeding and gastric twist. Patients and Methods: This is a prospective cohort study conducted at Ain-Shams University Hospitals, in the period From May 2017 to November 2020. Four hundred morbid obese patients were recruited for this study. Ethical approval was obtained from the Ethical Committee of Ain Shams University Hospitals, and informed written consents were obtained from all patients. Results: Our study included 200 patients who underwent Laparoscopic sleeve gastrectomy, one hundred patients un-derwent LSG without omentopexty (group A) and the other one hundred patients underwent LSG with omentopexy (group B). As regards the age, group A (control group) mean age of 35.74±7.88 while group B (omentopexy group) mean age of 35.6±7.85. The mean BMI 40.95±5.25 in group A while 40.94±5.02 in group B. Three cases of group A (1.5%) while group B had no cases of postoperative leakage with p-value is 0.24. Two cases of group A had postoperative bleeding (1%) while it did not happen in group B with P value is 0.499. Gastric twist had happened in only 1 case of group A (0.5%) while did not happen in any cases of group B, P value is 1. The mean operative time in group A 46.08±10.95 minutes, while 67.49±9.19 minutes in group B with p-value 0.00. Conclusion: LSG with omentopexy reduce rate of post-operative complications (bleeding, leakage and gastric twist) but need longer time than conventional LSG.

Saudi Arabia is the largest of the Arabian Gulf countries with a total population of 33.41 million as of 2017. This report summarizes the experience from four leading tertiary care hematopoietic stem cell transplantation (HSCT) centers in Saudi Arabia representing more than 90% of all HSCTs performed in the country. Between 1984 and 2016, a total of 6,184 HSCTs were performed. Of these, 3,586 HSCTs were performed in adults and 2,598 HSCTs were performed in pediatric patients. Malignancy was the main indication for transplantation (47%). While most transplants were performed from an identical sibling donor, HSCTs from cord blood, unrelated and, more recently, haploidentical donors have also been performed. Relative shortage of HSCT bed capacity is perceived to be a limiting factor in Saudi Arabia. Lately, more HSCT centers are emerging with rapid growth, which may significantly improve the access to HSCT in the country in the near future.

To analyze the financial impact following implementation of a hybrid Angio–CT system at a tertiary care academic medical center. Aggregate case types and volumes were compared 24 months before and 12 months after a hybrid Angio–CT system replaced a traditional interventional C-arm angiography suite at an academic medical center. Procedure revenues from this 36-month study period were derived from five payors mixes (Medicare, Medicaid, commercial insurance, out-of-pocket and managed care program) and Medicare-rate adjusted to each individual payor types. Average case volume per month increased 12% in the hybrid Angio–CT suite when compared to the previous traditional angiography suite (P

To determine the efficacy and safety of inferior vena cava (IVC) filters in preventing pulmonary embolism (PE) in high-risk patients undergoing hip or knee arthroplasty.2857 hip or knee arthroplasty procedures between January 2013 and December 2018 were retrospectively reviewed. Patients with a preoperative history of venous thromboembolism (VTE), either PE or deep venous thrombosis (DVT), were categorized as high-risk patients. The incidence of overall VTE, PE, and DVT were compared between patients with filters and those without. The subgroup analysis was also performed by patient risk, and filter status and the incidence of VTE, PE, and DVT were compared. Variables such as filter placement, history of hypercoagulability etcetra were evaluated as risk factors for the development of postoperative VTE.In the high-risk group, the use of IVC filters was significantly associated with a lower incidence of pulmonary embolism (0.8% vs 5.5%, P = .028). When compared with the low-risk group, the high-risk group had significantly higher incidence of PE (3.8% vs 2.0%, P = .038), DVT (11.6% vs 5.3%, P.001), and overall VTE (15.0% vs 6.8%, P.001). The history of VTE was associated with postoperative VTE (P.001), PE (P = .042), and DVT (P.001). There was no significant correlation between filter placement and postoperative VTE, DVT, or PE in the low-risk group. Filter retrieval was successful in 100% (96/96) of attempted patients with no complications.The use of IVC filters is significantly associated with a lower incidence in pulmonary embolism in high-risk arthroplasty patients. High-risk patients demonstrated an incidence of postoperative VTE over two times greater than other patients. Prophylactic placement of IVC filters in hip/knee arthroplasty is safe.

Background To conduct a meta-analysis to assess the safety and efficacy of prophylactic transcatheter arterial embolization (PTAE) for the treatment of high-risk bleeding peptic ulcers after achieving endoscopic hemostasis. Methods PubMed and Cochrane Library were queried for full-text articles published up to December 2019. The following keywords were used: “prophylactic embolization”, “supplement embolization”, “gastrointestinal bleeding”, and “ulcer bleeding”. High-risk ulcers were defined based on endoscopic findings (i.e., large ulcers, Forrest class I-IIb) and/or clinical presentation (i.e., hypotension, decreased hemoglobin during endoscopy). Only comparative studies investigating PTAE versus conservative treatment after achieving endoscopic hemostasis were included. Baseline study characteristics, rebleeding rate, need for surgery, mortality, and PTAE-related complication rates were investigated. Quantitative analyses were performed with Stata 15.1. Results Among the five included original studies, a total of 265 patients received PTAE and 617 were managed conservatively after endoscopy. The rebleeding rate (6.8% vs 14.3%, p = 0.003) and mortality (4.5% vs 8.8%, p = 0.032) of patients from the PTAE group were lower than the control group. PTAE also reduced the cumulative need for future surgical intervention (3.0% vs 14.4%, p = 0.005). The PTAE-related major and minor events were 0.75% and 14.4%, respectively. Conclusion PTAE had therapeutic potentials in reducing rebleeding risk, need for surgical intervention, and morality in high-risk peptic ulcers after achieving endoscopic hemostasis. The embolization-associated adverse events were minimal. Future studies should aim to increase the sample size and resources for performing endovascular interventions.

OBJECTIVE. The purpose of this study was to report national utilization trends and outcomes after percutaneous cholecystostomy, cholecystectomy, or no intervention among patients admitted to hospitals with acute cholecystitis. MATERIALS AND METHODS. The Nationwide Inpatient Sample was queried from 2005 to 2014. Admissions were identified and stratified into treatment groups of percutaneous cholecystostomy, cholecystectomy, and no intervention on the basis of International Classification of Diseases, 9th revision, codes. Outcomes, including length of stay, inpatient mortality, and complications including hemorrhage and bile peritonitis, were identified. Multivariate analysis was performed to identify mortality risk by treatment type after adjustment for baseline comorbidities and risk of mortality. RESULTS. Among 2,550,013 patients (58.6% women, 41.4% men; mean age, 55.9 years) admitted for acute cholecystitis over the study duration, 73,841 (2.9%) patients underwent percutaneous cholecystostomy, 2,005,728 (78.7%) underwent cholecystectomy, and 459,585 (18.0%) did not undergo either procedure. Use of percutaneous cholecystostomy increased from 2985 procedures in 2005 to 12,650 in 2014. The percutaneous cholecystostomy cohort had a higher mean age (70.6 years) than the other two groups (cholecystectomy, 53.8 years; no intervention, 62.5 years), a higher mean comorbidity index (cholecystostomy, 3.74; cholecystectomy, 1.77; no intervention, 2.65), and a higher mean risk of mortality index (cholecystostomy, 2.88; cholecystectomy, 1.45; no intervention, 2.07) (p < .05). Unadjusted inpatient all-cause mortality was 10.1% in the percutaneous cholecystostomy, 0.8% in the cholecystectomy, and 5.2% in the no intervention cohorts. After adjustment for baseline mortality risk, percutaneous cholecystostomy (odds ratio, 0.78; 95% CI, 0.76-0.81) and cholecystectomy (odds ratio, 0.42; 95% CI, 0.41-0.43) were associated with reduced mortality compared with no intervention. CONCLUSION. Use of percutaneous cholecystostomy is increasing among patients admitted with acute cholecystitis. After adjustment for baseline comorbidities, percutaneous cholecystostomy is associated with improved odds of survival compared with no intervention.

Leptomeningeal cysts secondary to trauma represent an extremely rare complication of calvarial fractures experienced during childhood. The early diagnosis and surgical treatment of such cysts can serve to prevent neurological sequelae. A 23-year-old male from a remote region attended the neurosurgery department complaining of headache, insomnia, and slowly progressing swelling over the right frontal region. The patient reported experiencing trauma (cow horn) in the same region of the head some 15 years previously. Non-contrast cranial computed tomography showed a lytic calvarial lesion with a large cystic area in the right frontal bone. Further, brain magnetic resonance imaging (MRI) revealed hyperintensity on the T2-weighted MRI and no enhancement on the T1-weighted post-contrast images. Moreover, there was no restricted diffusion corresponding to the cystic lesion in the frontal region. The dura mater and the bone gap were repaired using titanium mesh. The patient, whose headache and insomnia symptoms had completely disappeared, was discharged five days after the operation. Özet Travmaya sekonder leptomeningeal kistler, çocukluk çağında yaşanan kalvarial kırıkların son derece nadir bir komplikasyonunu temsil eder. Bu tür kistlerin erken teşhisi ve cerrahi tedavisi nörolojik sekelleri önlemeyi sağlayabilir. Kent merkezine uzak bir bölgeden gelen 23 yaşındaki genç bir erkek baş ağrısı, uykusuzluk ve sağ frontal bölgede yavaş ilerleyen şişlik şikayetleri ile beyin cerrahisi bölümüne başvurdu. Hasta yaklaşık 15 yıl önce başın aynı bölgesinde bir travma (inek boynuzu) yaşadığını bildirdi. Kontrastsız bilgisayarlı tomografide sağ frontal kemikte geniş bir kistik alana sahip litik bir kalvariyal lezyon görüldü. Ayrıca, beyin manyetik rezonans görüntüleme (MRI), T2 ağırlıklı MRI'da hiperintensite ve T1 ağırlıklı kontrast sonrası görüntülerde herhangi bir artış olmadığını ortaya koydu. Ayrıca frontal bölgedeki kistik lezyona karşılık gelen sınırlı difüzyon yoktu. Dura mater ve kemik boşluğu titanyum ağ kullanılarak onarıldı. Baş ağrısı ve uykusuzluk semptomları tamamen kaybolan hasta operasyondan beş gün sonra taburcu edildi.

Aplastic anemia is a relatively rare but potentially fatal disorder, with a reported higher incidence in developing countries in comparison to the West. There are significant variations in epidemiological as well as etiological factors of bone marrow failure syndromes in the developing countries in comparison to the developed world. Furthermore, the management of bone marrow failure syndromes in resource constraint settings has significant challenges including delayed diagnosis and referral, limited accessibility to healthcare facilities, treatment modalities as well as limitations related to patients who require allogeneic stem cell transplantation. Here we will provide a review of the available evidence related to specific issues of aplastic anemia in the developing countries and we summarize suggested recommendations from the Eastern Mediterranean blood and bone marrow transplantation (EMBMT) group and the severe aplastic anemia working party of the European Society of blood and marrow transplantation (SAAWP of EBMT) related to the diagnosis and therapeutic options in countries with restricted resources.

Background: The coronavirus disease‐2019 (COVID‐19) caused by SARS Coronavirus 2 (SARS‐CoV‐2) is a potentially lethal infection. Cancer patients, and specifically hematopoietic cell transplant (HCT) recipients are severely immunocompromised and may be at a higher risk of a complicated course with this infection. We aimed to study the COVID-19 outcomes and severity in post HCT patients. Methods: We retrospectively reviewed post-HCT patients diagnosed with COVID-19 between March 15, 2020, and December 1, 2020 at 10 transplant centers across the Middle East. Results: We identified 91 patients with confirmed SARS-CoV-2 infection across 10 transplant centers. 52 patients were post allo-HCT while the remaining 39 patients were post auto-HCT. The median time from transplant was 14.9 months. Mortality rate was 4.4%. Hospital admission rate was 53%. ICU admission rate was 14%. Mechanical ventilation rate was 10%. Oxygen supplementation rate was 18%. Time from HCT to COVID-19 > 6 months was associated with lower admission rates and lower rates of the “severity” composite endpoint. Antibody responses was seen 67% of evaluable patients. Conclusion: In this series of HCT recipients, we report overall favorable clinical outcomes for patients with COVID-19 and provide preliminary insights into the clinical course of this disease in this specific population. Funding Statement: None Declaration of Interests: None. Ethics Approval Statement: The hospitals’ Institutional Review Board approved the study.

Background The prevalence of SLE and the spectrum of clinical manifestations vary widely in different races and geographical populations. Objective To investigate the possible role of ARID5B rs10821936 and rs10994982 polymorphism as a risk factor for the development of SLE in children (jSLE) and to evaluate their role in relation to clinical manifestations especially lupus nephritis (LN). Methods DNA extraction and Real-time PCR genotyping of ARID5B rs10821936 and rs10994982 were done for 104 jSLE and 282 healthy controls. Results The C allele and C containing genotypes (CC, CT and CC+CT) of ARID5B rs10821936 were higher in children with SLE (p = 0.009, OR = 1.56, 0.037, OR = 2.35, 0.016, OR = 1.81 and 0.008 OR = 1.88 respectively). ARID5B rs10994982 alleles, genotypes and haplotypes are not associated with jSLE (p > 0.05). The ARID5B rs10821936 and rs10994982 genotypes showed non-significant associations with LN, proliferative versus non proliferative and biopsy grades (p > 0.05). Conclusion ARID5B rs10821936 SNP may be a susceptibility risk factor for juvenile SLE in the studied cohort of Egyptian children.

COVID-19 brought the global tourism industry to a standstill. In response, various tourism stakeholders adopted innovative approaches such as virtual tours (VTs) to keep their attractions firmly in the minds of potential visitors. This study has integrated the Technology Acceptance Model (TAM) and Protective Action Decision Model (PADM) models to determine the factors that affect a person’s decision to adopt VTs as temporary alternatives during times of crises. Data were collected from a sample of 401 respondents after they had experienced at least one of the VTs simulating Egyptian heritage sites. The results show that the antecedents of the TAM and PADM models are effective in predicting users’ intention to adopt VTs and that adoption intention has a positive impact on the tendency to visit the actual site. In addition, practical implications are provided for site managers to consider when opting for VTs as a promotional tool or as an alternative product during times of crisis.

The Jacket platform needs gas and diesel to run its turbines, and in the end, they produce catastrophic emissions annually. The environmental concerns regarding these platforms have forced us to utilize an alternative source of energy that is sustainable and clean. In this study 51 locations, are of interest where oil and gas activities are in progress at present in the shape of a jacket platform or pipelines. The significant wave height and wave period scatter diagram data are collected from the platforms in the South China Sea. The linear wave theory is used to find the wave power. The given time period is converted into an equivalent time period first before wave energy is determined. The study shows that location no. 20 is the ideal location to deploy the wave energy converter Pelamis P2 with a potential mean wave power of 6.61 kW/m A single unit of Pelamis P2 can produce on an average electricity output of 91.37 kW/m including, the losses and machine efficiencies, whereas a wave farm can generate an average output of 62 GWh/yr. The electricity supply of 70.3 % of the minimum and 14.1 % of the maximum energy demand, while using only wave energy converter. If hybrid wind and wave energy system is used, then energy production will increase. The results show that the wave farm could also reduce the use of natural gas up to 17.6E06 m3/year, avoiding the emission of 12000 tonnes of CO and 54000 tonnes of NOx annually, and can save up to RM 20 billion annually with the reduction of natural gas emissions.

Purpose: Both external beam radiation therapy (EBRT) and selective-internal radiation therapy (SIRT) are implemented to treat unresectable intrahepatic cholangiocarcinoma (iCCA). The present study aimed to evaluate the efficacy of EBRT and SIRT in managing iCCA through a systematic review and meta-analysis. Methods: PubMed and Cochrane database were queried to search for studies published from January 2000 toJune 2020 without language restrictions. Median survival time, overall survival, and radiological response were extracted. Secondary outcomes such as complication rates, predictors of survival, and downstage to surgery were pooled. Patient-level survival data were obtained to generate Kaplan-Meier survival graph. Pooled outcomes were analyzed with a random-effect model. Results: Twenty-nine and 20 studies including 732 and 443 patients from the SIRT and EBRT groups were included in the present study. From initial radiation treatment, the median survival time for patients who underwent SIRT and EBRT were 12.0 (95% confidence interval [CI]: 10.8–14.6) and 13.6 (95% CI: 11.1–16.0) months, respectively. As first-line therapy, the median survival time was 36.1 (95% CI: 20.6–39.5) months for SIRT and 11.0 (95% CI: 9.3–13.6) months for EBRT. Both radiation modalities were effective in downstaging initially unresectable iCCA to surgery (SIRT: 30.5%; EBRT: 18.3%). Patients in the SIRT group encountered more post-embolization abdominal pain (6.9 vs. 2.2%), ulcer (1.0 vs. 0.5%), nausea (1.6 vs. 0.7%), anorexia (5.9 vs. 0%), thrombocytopenia (7.3 vs. 6.0%), hyperbilirubinemia (5.2 vs. 2.1%), and hypoalbuminemia (13.2 vs. 3.3%), whereas EBRT was associated with higher rates of anemia (0.6 vs. 7.5%) and neutropenia (6.5 vs. 11.0%). Conclusions: Both EBRT and SIRT were safe and effective in treating unresectable iCCA. However, available evidence was highly heterogeneous regarding patient population, limiting fair comparison between 2 radiation modalities. Future high-quality comparative studies are warranted.

The first meeting of the African Blood and Marrow Transplantation (AfBMT) was held in Casablanca from April 19, 2018 to April 21, 2018, with the aim of fostering hematopoietic stem cell transplantation (HSCT) activity in Africa. Out of the 54 African countries, HSCT is available only in six (Algeria, Egypt, Morocco, Nigeria, South Africa, and Tunisia). During this meeting, African teams and international experts from the Worldwide Network for Blood and Marrow Transplantation (WBMT) gathered to share their experience and discussed ways to help fill the gap. Nurses and patients held their meeting in parallel. International support and collaboration can help by providing expertise adapted to local resources and regional population needs. Local engagement including government and private participants are necessary to initiate and develop local HSCT capability.

Cell phones are the most common gadgets used in today’s world. Studies from different countries demonstrated that these electronic gadgets can carry different bacterial species, including potential pathogenic strains. These gadgets are in the hands of every health care professionals (HCPs) and can even be found in the operation theatres (OT). Moreover, healthcare workers tend to neglect the potential infectious threat that these gadgets carry. Hence, we investigated the microbial profile present on cell phones used by HCPs in United Arab Emirates (UAE). Standard microbiological procedures were used for collection and identification of bacterial species. Disk diffusion assay and crystal violet dye binding spectrophotometric assay were used for determining antibiogram and biofilm forming potential, respectively. Staphylococcus epidermidis was present in 64.1% of the samples, followed by Micrococci (22.3%), Streptococcus viridians (2.2%), Diphtheroids (2.9%), Bacillus spp. (5.2%), Enterobacter spp. (1.4%) and Pseudomonas spp. (1.4%). The tested strains exhibited varied degree of antibiotic resistance and biofilm producing potential. Our data highlights that mobile phones may just not be carriers for normal skin flora but also for antibiotic resistant, biofilm forming potential opportunistic pathogens and thus may serve as transmission vectors for bacteria. This is the first report from UAE analyzing carriage of bacteria in mobile gadgets used by HCPs. Furthermore, this would help to raise awareness among the HCPs about these electronic gadgets serving as a vehicle of transmission of bacterial pathogen.

Purpose To assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center. Materials and Methods The total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month). Results The percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19. Conclusions Operational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.

Skin cancer is measured as one of the fatal types of cancer diseases in humans, among numerous kinds of malignancy. Current diagnostic classifications are lacking in finding an effective treatment. The effective and early stage treatment of skin disease can increase the survival rate of patients. Substantial investigative work has been developed to improve computer aided diagnosis system to detect cancer at early stage. However, early detection of skin cancer still requires better accuracy through experiment on digital skin lesion images as a multiclass classification, rather than using biopsy methods. This paper presents an intelligent framework to detect and classify four types of skin cancer. Before classification, noise removal from skin lesion is performed by gaussian filter. Textural and colour features are extracted from skin lesion to detect and classify cancer into four types. Support vector Machine is trained to classify Melanoma, Nevus, Basal and Squamous skin cancer types. Extensive experiments are performed on standard benchmark skin cancer images dataset with an improvement in accuracy of 92.41% after comparison with the well-known methods.

Objectives To investigate the incidence and clinical significance of caval pseudoaneurysm and extravasation post-complex inferior vena cava filter retrieval. Methods A total of 83 patients (70% female, average age 56) underwent complex inferior vena cava filter retrieval between January 2015 and December 2019 utilizing either rigid endobronchial forceps ( n = 69, 83%) and/or excimer laser ( n = 20, 24%). Procedural variables were recorded. The incidence and size of caval pseudoaneurysms and extravasation along with treatment type and clinical outcomes were analyzed. Results Technical success in all cases was 96% (n = 80). Average fluoroscopy time was 23 min (median: 20.2, range: 0.9–129.5). Average filter dwell time was 85 months (range: 2–316 months). Caval pseudoaneurysm was detected on post-retrieval venography in 10 patients (12%) and frank extravasation occurred in 1 case (1%). Average pseudoaneurysm length and width was 20.4 mm (range: 5–45 mm) and 12.9 mm (range: 4–24 mm), respectively. Pseudoaneurysms occurred most frequently during the removal of Optease ( n = 5) and Celect ( n = 2) filters. The pseudoaneurysms completely resolved with prolonged (>5 min) balloon angioplasty in all but one instance where a small portion of the pseudoaneurysm persisted. This patient was admitted and observed overnight before being discharged without complication. The solitary case of significant extravasation was effectively managed with immediate stent placement and the patient remained hemodynamically stable. Conclusions Radiographically detectable caval pseudoaneurysm and extravasation is not uncommon in complex inferior vena cava filter retrieval and, despite being considered a major complication by Society of Interventional Radiology guidelines, can often be managed without stenting or other invasive treatment.

To conduct a systematic review and meta-analysis evaluating the safety and effectiveness of inferior vena cava filter (IVCF) placement in the setting of massive and submassive pulmonary embolism (PE), Pubmed and Cochrane Library were queried to identify all clinical studies evaluating IVCF placement in patients with massive and submassive PE from database establishment to December 2019. The rate of recurrent PE, PE-related mortality, adverse events, IVCF type, additional treatment intervention, DVT status, and follow-up length were retrieved. Recurrent PE, mortality, and complication rates were pooled. Meta-analysis was performed to compare mortality rates between groups with and without IVCF placement. Subgroup analysis was performed based on whether catheter-directed therapy was used for PE intervention. Fifteen observational studies with a total of 232 patients who received IVCF for submassive or massive PE were included. The pooled overall recurrent symptomatic PE and mortality rates were 1.4% and 5.5%, respectively. A lower mortality rate among patients with IVCF was observed than those without (6.8% vs 26.3%; odds ratio [OR] 0.275 [95% confidence interval] 0.090 to 0.839], I2 = 30.6%, p = 0.023). Patients who received concurrent catheter-directed therapy demonstrated a lower recurrent PE (0% vs 2.8%) and mortality rate (3.4% vs 7.8%) than those who did not. The cumulative IVCF-related complication rate was 0.63%. In conclusion, based on a limited amount of low-quality evidence, IVCF placement is associated with low recurrent PE and PE-related mortality rates among patients with massive and submassive PE, suggestive of a potential clinical benefit in this scenario. Prospectively designed studies are warranted to confirm these findings.

PurposeSoft total quality management (TQM) aspects are the facets of TQM that mainly concern with the management of human resource in a way to achieve the results of employees' job satisfaction. Based on this approach, the objective of this research is to examine the relationship between the most popular five soft TQM aspects and employees' job satisfaction in “ISO 9001” certified Sudanese oil companies.Design/methodology/approachData were collected through questionnaires from employees across a total of five Sudanese oil companies owned by the government, and adopting an ISO-9001 quality program. The total population of the study consists of 1,505 permanent employees, while the sample size was 253 employees, determined by adopting a stratified random sampling technique. The multiple regression model was adopted for data analysis.FindingsThe results showed that the construct of soft TQM aspects including “top management commitment”, “employee empowerment”, “teamwork”, “training and education” and “employee involvement” explain 74% in the variance of employees' job satisfaction. Results showed positive association between soft TQM aspects and employees' job satisfaction at the 5% significance level. It was also found that each individual variable of the five soft TQM aspects has a significant positive association with employees' job satisfaction. Meanwhile, the results indicated that the most important soft TQM aspect in explaining the variability of employees' job satisfaction was the “employee empowerment” with the highest correlation coefficient (β) of (0.189).Practical implicationsThe study recommends that in order to achieve their primary goal of employees' satisfaction, HR practitioners within organizations adopting total quality programs should align their practice in such a way to enhance soft aspects of TQM. Policy makers and top management in order to gain long-term infrastructural benefits obtained from employees' job satisfaction should show a visible support to TQM programs and allocate necessary resources to train their staff in the quality management system that enhance their empowerment and involvement. The study also recommends that since soft aspects of TQM raise their job satisfaction, employees should support and conform to quality management systems within their organizations.Originality/valueThe paper focuses on soft TQM aspects’ practical implementation. The findings make a significant contribution by using ISO-certified governmental Sudanese oil companies and tested the hypothesized model entails the impact of soft TQM implementation and employees' job satisfaction.

Aims: To assess the safety and efficacy of dialysis shunt thrombectomy utilizing a rotational thrombectomy device in patients with pseudoaneurysms refractory to declot by conventional treatments. Methods: Between July 2016 and August 2019, 34 dialysis shunt thrombectomies were retrospectively examined in 29 individual patients. All patients presented with pseudoaneurysms and clotted accesses that were refractory to angioplasty balloon sweeps (“push–pull”) to restore patency. The Cleaner® rotational thrombectomy device was used as a bail-out in an attempt to restore patency to the clotted shunt. Procedure success, complications, primary patency, primary-assisted patency, secondary patency, average number of shunt pseudoaneurysms, and average pseudoaneurysm size were documented and analyzed. Results: Thirty-three of the 34 (97%) thrombectomies were successful in restoring patency and facilitating same-day hemodialysis. An average of 1.5 pseudoaneurysms were present per patient (range 1–3 pseudoaneurysms, standard deviation [SD] 0.65 pseudoaneurysms), with an average size of 15.0 mm (range 9.4–31.1 mm, SD 4.87 mm). Postprocedural complications occurred in 14.7% of the cases, none of which were definitively device related. Primary patency to the time of data collection was achieved in 29% of the cases, and the average primary patency for these cases was 124.5 days (range 10–946 days, SD 186.9 days). The average primary-assisted patency was 126.8 days (range 1–564 days, SD 169.8 days). Dialysis accesses were eventually abandoned or surgically revised in ten instances, resulting in an average secondary patency of 157.5 days (range 6–712 days, SD 257 days). Conclusions: In patients with pseudoaneurysms, rotational thrombectomy with the Cleaner® device appeared to be a safe and effective option for restoring patency to thrombosed dialysis accesses refractory to standard push–pull techniques with angioplasty balloons.

The aim of this study was to evaluate trends in bone marrow biopsies performed in the United States by physician specialty and practice setting.The CMS Medicare Physician Supplier Procedure Summary database was queried from 2005 to 2016 for bone marrow biopsies and aspirations (BMBs). Data were categorized according to the largest subspecialty groups (medicine, surgery, radiology, pathology, and other) and encounter setting (office, inpatient hospital, and outpatient hospital). Trends in procedure volume by specialty and practice setting were evaluated.Between 2005 and 2016, an annual average of 11,417 BMBs were performed (range, 10,380-14,204), with no significant year-over-year change in volume. Medicine was the largest provider of BMBs by specialty, although their market share over this time period declined from 60.2% to 36.6%. Radiology saw the greatest growth in BMB market share from 4.1% to 16.2%. The compound annual growth rate (CAGR) of BMBs performed by medicine subspecialists demonstrated a decrease in year-over-year procedural volume at -5.16% (P.001). Both surgery and radiology demonstrated positive trends in the number of BMBs performed, with CAGRs of 6.20% (P.001) and 12.43% (P.001), respectively. Independent of physician specialty, there was a decrease in the number of biopsies performed in the office setting, decreasing by a CAGR of -5.59% (P.001).From 2005 to 2016, medicine has remained the primary provider of BMBs, although their market share has declined. Radiology has experienced the greatest rate of growth in this time period and now represents the third largest individual specialty providing this service.

Russia began making contact with Gulf States back in 1932, when the USSR became one of thefirst countries that formally recognized Saudi Arabia and established diplomatic relations with the state.Shortly after, due to the change in the Soviets’ party line (conversion to a new ideology and developmentof a moderate stance towards regional conflicts), the relations were suspended. The aggravation ofinternational relations in the region was also the result of the competition between the Great Powers, andtheir respective political ambition. In the light of “West—East” political-military confrontation, the SovietUnion took immediate interest in the latest regional developments.This article used descriptive approach to the specificity of the problem of the study, which aims tostudy relations and differences, where this method is concerned with the study of what is the object andinterpretation and determine the relationships between the facts.The results of the study reached that Russia is one of the largest oil and gas producers in the world,and the largest oil exporter outside OPEC, as it usually seeks to maintain high energy prices despite tensionsand conflicts in the Middle East, as it has caused huge losses to the economy of the Gulf countriesdue to lower oil prices. The volume of trade exchange between Russia and the countries of the CooperationCouncil is very low compared to the Gulf’s trade relations with China. This may be due to the factthat Russia is futile in trade, although the latter is working to correct this deficit, but the desired resultsmay take some time.In the changing world, Moscow’s allies are not necessarily Washington’s foes, and vice versa. Cooperationbetween Russia and Gulf States is based on their shared interests, in particular, fighting internationalterrorism.Key words: Russia, Arabian Gulf, GCC, Syria, Saudi Arabia, UAE, international relations, oil.

Energy performance in the construction industry is one of the significant features to be assessed in order to achieve sustainability in the built environment. There is a limited amount of literature on the analytical network process (ANP) in achieving sustainability towards reducing embodied energy. The aim of this study was to achieve buildings with less embodied energy through design, construction techniques and automation using ANP in order to promote sustainable construction. Data collection was primarily done by way of a well-structured questionnaire and an expert opinion survey. The responses retrieved from the questionnaire were analyzed using descriptive statistics and ranked accordingly. An ANP model was developed using multi-criteria decision-making based on the expert survey and used to prioritize and assign an important weighting for the identified criteria. The findings showed that multi-criteria decision-making with ANP when effectively employed will help in achieving sustainable buildings with low embodied energy. Reducing the amount of cement through design and building information modeling is the most significant factor towards achieving buildings with less embodied energy.

Idiopathic aplastic anemia is a rare and life-threatening disorder, and hematopoietic stem cell transplantation (HSCT) from a matched sibling donor (MSD) is the standard treatment strategy for young patients. Alternative donor transplantation (ADT) from a matched unrelated donor or an HLA haploidentical donor is not commonly used in the frontline setting. This systematic review/meta-analysis was conducted to compare ADT as an upfront, rather than delayed, treatment strategy in the absence of an MSD to immunosuppressive therapy (IST) in severe aplastic anemia (SAA). We searched PubMed/MEDLINE and Embase (1998 to 2019) for studies that compared the outcomes of ADT with IST as upfront therapy in patients with SAA. We included studies with 5 patients or more in each arm. Studies that included patients with inherited forms of bone marrow failure syndromes were excluded. The primary outcome was the 5-year overall survival (OS) rate. Five studies met the inclusion criteria and were included in this meta-analysis. The pooled 5-year odds ratio (OR) for OS was statistically significant at 0.44 (95% confidence interval [CI], 0.23 to 0.85) in favor of upfront ADT. In addition, survival was compared between upfront ADT versus salvage ADT in 6 studies. The pooled 5-year OR for OS was statistically significant at 0.31 (95% CI, 0.15 to 0.64) in favor of upfront ADT. Although this analysis has some limitations, including the retrospective nature of the included studies, the lack of ethnic diversity, the predominantly pediatric population, and the relatively suboptimal IST regimen used in some of the studies, it indicates that upfront ADT is a potential alternative treatment option in young and pediatric SAA patients who lack an HLA identical sibling donor, particularly when optimal IST is not available. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Background Viral suppression remains the most desired outcome in the management of patients with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and this can be achieved by an effective combined Antiretroviral Therapy (cART). However, some patients who achieve viral suppression may experience viral rebound with dire consequence. We evaluated viral suppression and rebound and their associated factors among adult patients on cART in Kumasi, Ghana. Methods This hospital-based retrospective study was conducted at the Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records of 720 HIV patients on cART. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism version 8.0. Pp<0.0001], having good adherence to ART [aOR=5.64, 95%CI (2.86-11.13), pp=0.0260] and increasing duration of treatment (pppppp=0.004) and Zidovudine/Lamivudine/Nevirapine (aOR=18.68, 95% CI: 1.58-220.90; p=0.02) were independently associated with higher odds of viral rebound. Conclusion Approximately 76% viral suppression rate among HIV patients on cART in Kumasi falls below the WHO 95% target by the year 2030. Choice of ART combination, drug adherence, WHO clinical staging and baseline viral load are factors associated with suppression or rebound. These clinical characteristics of HIV patients must be monitored concurrently with the viral load.

Background : (COVID-19) had a great impact on the world’s health systems since December 2019. A little is known about the clinical characteristics and risk factors associated with COVID-19 severity in Sudanese Patients; therefor it is necessary to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors associated with COVID-19 severity. Methods : A one-year retrospective cohort study (May 2020- May2021) was done at three isolation centers in Wad Medani. Sample contained all COVID-19 patients who are over 18 years old and were confirmed to be COVID-19 by nucleic acid testing or features Suggestive of Covid19 on Chest CT scan. Results : This study included 418 patients confirmed COVID-19 cases with a median age of 66.3±13years. 179 (64.2%) patients were men. Hypertension (n=195; 46.7%) and diabetes (n=187; 44.7%) were the most common comorbidities. The most common symptoms at COVID-19 onset were fever (n=303; 72.5%), cough (n=278; 66.5%) and dyspnea (n= 256; 61.2%). the overall mortality rate was 35.4% (n=148). The morality rate was 42.3% (n=118) among patients with severe disease. The Chi-square test and ANOVA analysis revealed that older age, anemia, neutrophilia and lymphcytopenia, higher glucose levels, HbA1c levels and creatinine levels were variables associated with severe COVID-19. In inflammatory markers, the levels of CRP and d-dimer were elevated in severe infection more than moderate and mild infections. Conclusion : Patients with these factors are more likely to deteriorate into severe infection and have higher mortality rate than those without these factors.

Background Treating adolescents and young adults (AYA) patients with acute lymphoblastic leukemia (ALL) using pediatric-inspired protocols have shown improvement in outcomes. Most data available in the literature of such protocols is derived from well-controlled clinical trials. This report aims to provide a real-world experience from using a pediatric-inspired protocol in ALL-AYA population in larger number of patients treated at a national tertiary care referral center. Methods Newly diagnosed Philadelphia negative ALL-AYA patients ages between 14 and 55 years of age were treated on an institutional protocol (AYA-15 protocol) adopted from a modified version of Children's Cancer Group (CCG) 1900 protocol. At the time of this publication, a total of 79 patients were treated using the AYA-15 protocol between 2015 and 2020). Event-free survival (FFS), disease-free survival (DFS), and overall survival (OS) were analyzed using cumulative incidence and Kaplan-Meier methods. Results The median age at diagnosis was 18 years (14–51 years) with 63% male patients. Complete remission (CR) at day 28 of induction was achieved in 88.6% of which 73.4% were minimal residual disease (MRD) negative. At a median follow up of 5 years, EFS, DFS and OS were 57.5%, 69.2% and 75.8% respectively. Toxicities were within the expected range with infections and transaminitis being the most common adverse events. Conclusion Our single-center experience real-world data in treating AYA-ALL patients with pediatric-inspired protocol demonstrates encouraging results of high survival rate and excellent tolerability for patients aged 18–55 years.

Pneumomediastinum is defined as the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema [1]. Pneumomediastinum can be categorized as spontaneous (SPM) or traumatic. Traumatic pneumomediastinum is caused by blunt or penetrating trauma to the chest, or iatrogenic injury, such as that produced by thoracic surgery. Mechanical ventilation is a common cause of barotrauma and pneumomediastinum. Pneumomediastinum caused by mechanical ventilation is often considered a type of traumatic pneumomediastinum, rather than SPM (UpToDate). We report a case of spontaneous pneumomediastinum, pneumothorax and surgical emphysema in a 20-year-old patient with COVID-19. He was managed conservatively.

Thoracic duct embolization (TDE) is a minimally invasive alternative to surgery for the treatment of postoperative chylous leaks that fail conventional medical management. TDE can be a technically challenging procedure that requires real-time image guidance to visualize the thoracic duct. This case report describes using hybrid angiography/computed tomography technology to perform TDE through direct access of the cisterna chyli, potentially eliminating the need for intranodal lymphangiography, and reducing procedure length.

Background: A high level of adherence to treatment is essential for cure and prevention of tuberculosis (TB) treatment resistance. Methods: A Systematic review of 53 studies addressing the patient characteristics associated with TB medication non-adherence was performed. The publications were identified by searching the PubMed, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) database, EmBase, Scopus database Arts, Humanities, Social Science database and Google scholar. Only English language publications were eligible. Potentially eligible studies were retrieved and the full articles were assessed. The potentially eligible studies were included if they concerned patients treated for tuberculosis, reported non adherence and reported on potential risk factors associated with non-adherence. Results: Factors that were most frequently consistently and statistically significantly related to non-adherence to tuberculosis treatment were: family income, patient movement and changing address or giving wrong address, tuberculosis relapse or multidrug-resistant TB (MDRTB), during intensive phase of treatment, history of default, treatment regimen (long course), response to treatment, homeless, stigma, seeking traditional healers, staff receptiveness, lack of directly observed therapy short course (DOTS), poor knowledge or lack of health education, side effects of drugs, feeling better, alcohol intake and lack of family and social support. Conclusions: Non-adherence to tuberculosis treatment was influenced by several factors.

Aims: To determine the safety and feasibility of continuous aspiration mechanical thrombectomy (CAT) for restoring patency to thrombosed hemodialysis reliable outflow (HeRO) arteriovenous grafts. Subjects and Methods: Between December 2016 and August 2017, eleven consecutive patients (average age 63, range 39–80 years) with thrombosed HeRO grafts underwent percutaneous thrombectomy procedures (n = 21) using the Penumbra Indigo® CAT 8 or CAT D (Alameda, CA, USA) thrombectomy catheter as the primary device to clear the venous outflow tract before removing the arterial plug with a compliant balloon. A total of 21 hemodialysis declot procedures using CAT were documented and analyzed. Average procedure length and fluoroscopy time, length of thrombus cleared, blood loss, complications, and time between thrombectomy procedures were recorded and compared to the same patient's previous three thrombectomy procedures. Results: All procedures were technically successful (100%) at restoring graft patency; however, reocclusion within 5 days occurred in four (19.0%) cases. Three (14.3%) interventions required additional balloon maceration or sweep to clear the venous outflow following thrombectomy. Average thrombus length treated by suction thrombectomy measured 23.15 cm (range 2.2–65 cm). Average blood loss was 162.6 mL (range 50–250 mL). No procedure-related complications were recorded. The average procedure length and fluoroscopy time using suction thrombectomy was 74.7 and 14.2 min, respectively, compared with 82.0 and 14.0 min, respectively, in the previous thrombectomy procedures using standard methods (P > 0.05). Seventeen (81%) HeRO grafts treated by CAT presented with rethrombosis at a mean of 42.47 days (range 1–208 days, median 22 days, standard deviation [SD] 28.2 days) since CAT procedure compared to patients treated by conventional methods who presented for rethrombosis at a mean of 55.33 days (range 1–321 days, median 34 days, SD 43.1 days) since standard thrombectomy – no statically significant difference (P > 0.05). Conclusion: CAT is a safe and feasible method for removing thrombus and restoring patency to thrombosed HeRO grafts. Further studies are required to elucidate the advantages of CAT over standard thrombectomy techniques.

Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

Background. Minimum meal frequency, a proxy indicator for a child’s energy requirements, examines the number of times children received foods other than breast milk. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and increased morbidity and mortality. In Ethiopia, only 45% of children had fed with an age-appropriate minimum meal frequency. Objective. The study was aimed to assess the minimal meal frequency practice, and its associated factors among children aged 6–23 months in Amibara district, North East Ethiopia. Methods. A community-based cross-sectional study was conducted from May 07–May 23, 2018. Systematic random sampling technique was applied to select 367 children aged 6–23 months. The univariable and multivariable binary logistic regression analyses model was used to identify potential predictors of meeting minimum meal frequency. All variables with P values P values Results. The study revealed a prevalence of minimum meal frequency 69.2% (95% CI: 0.64–0.74). Timely initiation of breastfeeding (AOR = 2.2, 95% CI (1.17, 4.18)), current breastfeeding status (AOR = 7.5, 95% CI (3.95, 14.4)), meeting minimum dietary diversity (AOR = 3.7, 95% CI (1.85, 7.44)), and household hunger scale (AOR = 5.3, 95% CI (1.5, 12.5)) were some of the significant predictors to achieve minimum meal frequency. Conclusion. The prevalence of minimum meal frequency practice is low in the study area. Current breastfeeding status, timely initiation of breastfeeding, no/little household hunger scale, and meeting minimum dietary diversity were found as significant predictors for minimum meal frequency practice. Mothers having children aged 6–23 months should be aware and practice appropriate infant and young child feeding practices including timely initiation of breastfeeding, breastfeeding till the child celebrate his/her second birthday, recommended meal frequency, and dietary diversity practice. In addition, households should be assessed and strengthened for food security.

The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. Although this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state-of-the-art treatments, including transplantation, by providing financial, technological, legal, ethical, and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population and potentially provide long-term cost savings by circumventing the need for their citizens to seek care abroad. The costs of establishing an HSCT program and the costs of the HSCT procedure itself can be substantial barriers in developing countries. In addition, socioeconomic factors intrinsic to specific countries can influence access to HSCT, patient eligibility for HSCT, and timely utilization of HSCT center capabilities. This report describes recommendations from the Worldwide Network for Blood and Marrow Transplantation for establishing HSCT programs, with a specific focus on developing countries, and identifies challenges and opportunities for providing this specialized procedure in resource-constrained settings.

Acute soft skull syndrome is an uncommon complication of patients with sickle cell anemia. Here, we report a case of an adult patient in Sudan with the acute soft syndrome, with our aim of providing more knowledge on this type of complication. The 20-year old patient, with a known history of sickle cell anemia, presented with a 1-day history of headache and joint pain. The complaint continued after admission, with increasing headache severity and development of rapid skull swelling, which indicated the rare sickle cell disease complication known as an acute soft head syndrome. Conservative management resulted in good response and rapid recovery of this case of acute soft skull syndrome with sickle cell anemia mainly related to skull infraction.

Hematopoietic cell transplantation (HCT) is a highly complex procedure that requires a dedicated multidisciplinary team to optimize safety. In addition, institutions may have different needs regarding indications based on regional disease prevalence or may have an interest in developing specialized services. Structured recommendations are not commonly available, however. The Transplant Center and Recipient Issues Standing Committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) organized a structured review of all pertinent elements for establishing a transplantation program. First, we solicited components from committee members and grouped them into domains (infrastructure, staff, cell processing laboratory, blood banking, laboratory, radiology, pharmacy, HLA testing, ancillary services, and quality). Subsequently, reviewers scored each element on a 7-point scale, ranging from an absolute requirement (score of 1) to not required (score of 7). An independent group of 5 experienced transplantation physicians reviewed the rankings. The minimum requirements for establishing any HCT program were identified among elements with mean score of ≤2.0, and specific elements for allogeneic and autologous HCT were identified. Mean scores of >2.0 to 4.0 were classified as preferred recommendation, and mean scores of >4.0 to ≤ 7.0 were considered ideal recommendations for advanced and complex types of transplantation. This structured set of recommendations guides the prioritization of minimum requirements to establish a transplantation program and set the stage for expansion and further development.

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.

Esophageal cancer (EC) generally consists of squamous cell carcinoma (which arise from squamous epithelium) and adenocarcinoma (which arise from columnar epithelium). Due to the increased recognition of risk factors associated with EC and the development of screening programs, there has been an increase in the diagnosis of early EC. Early EC is amenable to curative therapy by endoscopy, which can be performed by either endoscopic resection or endoscopic ablation. Endoscopic resection consists of either endoscopic mucosal resection (preferred in cases of adenocarcinoma) or endoscopic submucosal dissection (preferred in cases of squamous cell carcinoma). Endoscopic ablation can be performed by either radiofrequency ablation, cryotherapy, argon plasma coagulation or photodynamic therapy, amongst others. Endoscopy can also assist in the management of complications post-esophageal surgery, such as anastomotic leaks and perforations. Finally, there is a growing role for endoscopy to manage end-of-life palliative symptoms, especially dysphagia. The growing use of esophageal stents, debulking therapy and dilation can assist in improving a patient's quality of life. In this review, we examine the multiple roles of endoscopy in the management of patients with EC.

Background Treatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients using traditional adult chemotherapy protocols give low overall survival (OS) rates. Data are growing regarding the use of pediatric-inspired chemotherapy protocols in AYA patients with improvement in OS. Patients and Methods To assess efficacy and tolerability of using a pediatric-inspired protocol in AYA patients, we initiated our local prospective trial using a modified version of the Children’s Cancer Group 1900 protocol for newly diagnosed high-risk Philadelphia chromosome-negative ALL patients. Results A total of 40 patients were enrolled in the study (from 2015 to 2018). The median age was 18 years (range, 14-34 years). The complete remission rate after induction was 37 patients [93%] and after a median follow-up of 5 years, OS, disease-free survival (DFS), and event-free survival were 75%, 72%, and 60%, respectively. Use of this protocol was well tolerated with manageable toxicities. Pegylated asparaginase was given to all patients during the induction phase and was well tolerated. Conclusion The use of a pediatric-inspired protocol for high-risk AYA ALL patients was effective and well tolerated with improvement in OS and DFS compared with historical data using adult protocols in such populations.

Inferior vena cava filters are placed to prevent life-threatening pulmonary embolism in a selected group of patients. Significant complications are known to occur with prolonged dwell times, and rarely during initial placement. In this report, we describe two cases of inadvertent noncaval inferior vena cava filter placements, specifically in the azygous vein and right renal vein, and the complex methods used to retrieve them, which exemplify the critical importance of routine and careful placement techniques. Keywords: IVC filter, Venogram, Filter migration

Medical professional liability (MPL), also commonly referred to as medical malpractice, is a costly issue in health care today, accounting for roughly 2.4% of total health care expenditure in the United States. Almost all physicians currently in clinical practice will either be subject to a lawsuit themselves or work with someone who has. Given a lack of formal structured education about MPL in medicine for trainees, this review aims to define and discuss the relevant concepts in MPL as a reference for early career interventionalists to understand the current medicolegal environment and learn best practices to avoid litigation.

PURPOSE: We aimed to assess the association between complication rate and time to feeding in a cohort of patients undergoing radiologically guided placement of gastrostomy tubes. METHODS: A retrospective study was conducted of all patients receiving pull-type and push-type gastrostomy tubes placed by interventional radiologists between January 1(st), 2017 and December 31(st), 2018 at a single institution. Primary outcomes included procedural and tube-related complications per medical chart review with a follow-up interval of 30 days. Exclusion criteria were enteral nutrition delayed more than 48 hours, no feeding information, and tubes placed for venting (n=20). Overall, 303 gastrostomy tubes (pull-type, n=184; push-type, n=119) were included. The most common indications for placement included head and neck carcinoma for push-type tubes (n=76, 63.9%) and cerebral vascular accident for pull-type tubes (n=78, 42.4%). RESULTS: In a multiple regression analysis, there was no statistically significant association between complications and time to feeding (p = 0.096), age (p = 0.758), gender (p = 0.127), indication for tube placement (p = 0.206), or type of tube placed (p = 0.437). Average time to initiation of enteral nutrition was 12.3 hours for the pull-type and 21.7 hours for the push-type cohort (p < 0.001). Additional multiple regression analyses of pull-type tubes and push-type tubes separately also did not find any significant association between complications and the above factors (p > 0.05). CONCLUSION: There was no statistically significant correlation between time to feed and complications, suggesting that there is no clinical difference between early and late feeding following gastrostomy tube placement.