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Profitability is key in fish farming, just as it is to any other enterprise. For the farmers to actualize high-profit margins, it is imperative to have access to well-balanced nutritive and cost-effective feeds, backed by sound on-farm feed management practices. This paper audits Kenya's fish feed industry and the on-going on-farm feed management practices, and emerging opportunities for fish farmers. The development of fish feed quality standards has boosted the aquaculture sector in Kenya, providing them hope that farmers will access high quality fish feeds. Much of the fish feed currently being used in Kenya is produced on-farm or by small-scale fish feed manufacturers within the East African region, while a few are imported directly from overseas countries, notably Israel, Netherlands, Mauritius and Denmark. Fish feeds produced by small-scale manufacturers are not closely monitored by quality standard agencies and not surprising that a majority are of poor quality. The improvement in the quality of these feeds is likely to lead to increased productivity and profitability because they are cheaper and readily available to fish farmers, compared to imported fish feeds. Besides feed quality, feed management practices markedly impact both the growth and economic performance of fish production. Adopting appropriate feed management strategies, therefore, is instrumental in the maximization of fish production and economic returns. Research has demonstrated several strategies for best feed management practices, which have not hitherto, been adopted by fish farmers in Kenya. Farmers have mainly focused on the mode of delivery of feeds to the fish. Furthermore, promoting natural pond productivity and supplementary feeding is still a common practice in the East African region. Provision of species-specific feeds and targeting the nutritional requirements of the different life stages of fish is still a major issue, although some local companies like Unga Farm Care (EA) have come up with a size and species-specific feed for catfish such as Fugo catfish[R]. To improve access to such information, public-private partnerships should be developed and, programmes that utilize the local media platforms such as extension service outlets must also be encouraged. Feed quality checks can also be carried out amongst fish feed suppliers. Lastly, farmers should be trained in various fish feed aspects like formulation, transportation and storage to sustain a steady fish feed supply and save on associated feed costs. Key words: Feeds, management practices, quality, aquaculture enterprises, tilapia, catfish, INTRODUCTION The United Nations's Food and Agriculture Organization [1] estimates that to feed the world population by 2050, agricultural output emanating from fisheries and aquaculture must somehow grow by over [...]

Fish and fish products have high nutritional value and are important in supplementing human diet. Fish products have little or no cholesterol and saturated fat, but instead have omega 3 and low-fat content essential for human health. Despite the high nutritional value of fish products, their consumption is hindered significantly by setbacks such as spoilage and foodborne diseases that spread through contamination in the fish supply chain. The objective of this study was to evaluate fish vendors' attitudes, knowledge, and practices on food safety in selected markets in Kirinyaga County that included Sagana, Tebere, Mwea, Ndia, Kianyaga, and Kerugoya markets. A structured questionnaire was administered to 54 fish vendors to collect information on fish safety, spoilage, risk factors, personal hygiene, food contamination, type of hazards, foodborne diseases and attitudes towards training on food safety. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyse the data from the respondents. The relationship between fish vendors' demographic characteristics and risk factors was assessed using Spearman's rank correlation coefficient. The majority of the fish vendors had a positive attitude towards education in hygiene practices (56%). There was a positive correlation between education and fish vendors' awareness of fish foodborne diseases at p<0.05. The study revealed that fish foodborne diseases awareness was positively influenced by respondents' level of experience and age. Moreover, there was also a significant (p= 0.05) positive correlation on the awareness of fish foodborne diseases with hygiene and food safety. Majority of the fish handlers had average level of knowledge, attitude and hygiene practices for food safety. These findings presented a foundation for formulating policies to increase food safety and hygiene practices of fish handlers in the region, thereby preventing foodborne diseases and postharvest losess. The results of this study can also form a basis for an indepth research for students and researchers in verious disciplines scuh as public health, marketing, community development and more. [ABSTRACT FROM AUTHOR]

Abstract: A polyculture experiment with African carp (Labeo victorianus) and Nile tilapia (Oreochromis niloticus) was conducted for 24 weeks in 12 earthen ponds measuring 150 m2 to assess their compatibility. Monoculture treatments T1 and T4 for L. victorianus and O. niloticus, respectively, were the controls for the two species, while treatments T2 and T3 were a polyculture of L. victorianus and O. niloticus at a ratio of 1:2 and 2:1, respectively. All treatments were carried out in triplicate, with feedings performed twice daily at 09:00 hr and 16:00 hr at 10%, 5% and 3% body weight distributed evenly over the 24‐week growth period. Fish sampling was conducted monthly, while water quality was measured biweekly. Treatment T3 (1L: 2T) had a significantly (p < .05) higher survival (L = 49% and T = 87%), compared to T2 (L = 31% and T = 69%, 2L: 1T). O. niloticus monoculture treatment (T4) exhibited a significantly higher survival (p < .05) and higher growth (80%; 79 ± 20.04 g) than L. victorianus monoculture (T1) (50%; 13.12 ± 4.49 g). Dawn and afternoon temperatures ranged between 20.16–24.49°C and 23.76–31.07°C, respectively. The lowest temperatures were recorded in the months of June, July and August. The NH3 concentration was zero at 14:00 hr for all treatments throughout the growth period, but significantly higher (p < .05) in T1 at 06:00 hr. The pH and DO levels at 06:00 hr and 14:00 hr were significantly different in all the treatments (p < .05). The slow growth of L. victorianus can be associated with the low temperatures and DO levels. However, there is need to identify other factors that may have contributed to the poor growth of L. victorianus. Accordingly, this study recommends L. victorianus growth trials in other culture systems, coupled with different feed formulations, to identify optimal culture conditions. [ABSTRACT FROM AUTHOR]

Food insecurity remains one of the most visible dimensions of poverty. The increasing population amid competition for land and water resources means that the global demand for food will continue to increase. In Kenya, the food insecurity trend is worrying as the population is expected to hit 55 million by 2020 against an annually declining arable land per capita and consequent increase in food prices. The Kenyan agricultural sector has failed to either eliminate or reduce malnourishment for poor populations as the annual national production for both staple food and livestock products fall short of national consumption levels. The nutritional deficiency levels remain high among a significant segment of the Kenyan population. With increasing food production challenges such as dwindling capture fisheries and impacts of climate change becoming more eminent, solutions to food insecurity and malnutrition in Kenya must bring about quick results in food availability by stimulating more own-food production. Aquaculture has so far been recognized as an important opportunity to enhance household food security in developing countries. The existing literature reveals scattered but increasing evidence of the contribution of aquaculture to nutritional security through direct fish consumption and income stability among vulnerable groups through involvement in aquaculture value chain linkages. This paper reveals the status of food insecurity, poverty and malnutrition problems and discusses aquaculture initiatives as the remedial solutions. This paper also provides a framework for examining aquaculture's value chain linkages to food and nutritional security and national economic growth by elucidating key pathways concerning the role of aquaculture in household food and income systems. The authors advocate for clear and sustainable national policies for aquaculture development to address food insecurity and poverty questions more sharply. More empirical evidence should be collected on the varied aquaculture opportunities to improve the income, employment and food consumption levels within the poor households. [ABSTRACT FROM AUTHOR]

Integrated livestock-fish culture approach envisages the integration of fish farming with cattle, sheep, goats, poultry, pigs or rabbit husbandry in a design allowing wastes from one system to be used as inputs in another system. The aim is to conserve resources while increasing farm returns. This paper reviews integrated livestock-fish culture in Asia and some African countries towards stimulating growth in East Africa's livestock-fish integration practices. Livelihood challenges and current status of integrated livestock-fish culture in some segments of East Africa are discussed. Economic analyses of integrated livestock-fish farming in selected places are presented. Challenges facing integrated livestock-fish aquaculture in the region include: government neglect of aquaculture sector, weak aquaculture research and applications, political interferences as well as social and religious challenges. Poor publicity, poor infrastructure, lack of clear legislations and policies and high illiteracy among potential fish farmers have also been mentioned as bottlenecks to the growth of integrated fish farming in the region. So far, fish-poultry integration is the most popular across Africa and Asia while fish-cattle integration is unpopular in many countries. Livestock manure as source of organic fertilizer for fish ponds and biogas production can help reduce cost of investment in purchasing inorganic fertilizers. With the present high cost of pelleted fish feeds, integrated fish farming stands to reduce the cost of feeding fish while simultaneously increasing the yield, leading to high economic returns. This paper concludes that livestock-fish integration is one of the most practicable solutions to food insecurity and malnutrition in the East African community despite its current poor status. In fact, it could be the forgotten asset that can guarantee present and future aquaculture sustainability in the region. The paper recommends capacity building among stakeholders to recognise integrated aquaculture as a 'self feeding' biotechnology unit, which deserves special attention in East Africa. [ABSTRACT FROM AUTHOR]

Fish feed constitutes 40-60% of the total operational costs of a fish farm. Commercial feeds are often too expensive for rural fish farmers. Consequently, farmers use non-conventional and locally available fish feed ingredients including agro-industrial by-products. These feeds have not led to increased pond productivity due to poor processing, higher fibre content, and anti-nutritional factors that limit nutrient bio-availability. Farmers have not embraced processing of fish feeds because the cost-effectiveness of processing has not been clearly demonstrated. The African catfish (Clarias gariepinus) is an important farmed fish in sub-Saharan Africa hence the need for research on its nutrition and growth performance. The growth performance and cost-benefit of using pelleted diets formulated from locally available feed ingredients on C. gariepinus were evaluated in a rural African setting. The experiment included diets that differed in the ingredients and form used (pelleted and un-pelleted). Four isocaloric and isonitrogenous diets were formulated from freshwater shrimp (Caridina nilotica), rice bran (Oryza sativa) and wheat bran (Triticum aestivum). The diets were C. nilotica and wheat bran pelleted (CWBp), C. nilotica and wheat bran un-pelleted (CWBup), C. nilotica and rice bran pelleted (CRBp), and C. nilotica and rice bran un-pelleted (CRBup). The diets were fed to C. gariepinus fingerlings (mean initial weight 1.75±0.03g), in triplicates for 5 months. The pelleted diets showed significantly better performance (P<0.05) compared to the un-pelleted diets. Fish grew to a weight of 266.77±6.21g on CWBp, 224.9±3.91g on CRBp, 211.38±4.46g on CWBup and 190.87±4.47g on CRBup. Cost benefit analysis of the pelleted and un-pelleted diets indicated positive net returns of US$ 180.1 for CWBp, US$142.5 for CRBp, US$ 126.8 for CWBup and US$ 115.5 for CRBup. The CWBp had significantly higher net returns than the other diets. This paper demonstrates that although on-farm pelleting of diets adds extra cost of labour, pelleted diets are cost-effective and should be incorporated as an essential part of on-farm feed production. [ABSTRACT FROM AUTHOR]

Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting non- discogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20. 1%) cases division occurred in the pelvis, while in 131(79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the pinformis muscle in 131(79.9%) cases. In cases of pelvic division, the tibial nerve was always infnapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7. 9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67. 1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11. 6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgenj and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended. [ABSTRACT FROM AUTHOR]

Rationale: Rectus sheath hematoma (RSH) is an unusual cause of acute abdominal pain. It is more common in elderly patients on anticoagulation. The diagnosis is often challenging, as it mimics other more common causes of acute abdomen. No standard treatment guidelines exist, presenting therapeutic dilemmas. Herein, we describe a case of spontaneous RSH complicated by deep venous thrombosis (DVT)., Patient Concerns: The patient was a 58-year-old female on follow-up for end-stage renal failure, admitted for management of uremic gastritis, fluid overload state, and bronchopneumonia. On the third day of admission, she developed worsening abdominal pains, associated with dizziness, headaches, hypotension, tachycardia, and desaturation. Abdominal examination revealed tender swelling, with localized guarding., Diagnoses: An urgent abdominal computed tomography scan demonstrated a large complex collection of approximately 12 cm × 10 cm in the left rectus sheath with intraperitoneal extension, consistent with RSH., Interventions: She underwent laparotomy with evacuation of 1.5 L of hematoma. Her postoperative recovery was complicated by the development of DVT on the sixth postoperative day. Due risk of rebleed, the inferior vena cava filter was favored over therapeutic anticoagulation. Her postoperative hospital stay was thereafter unremarkable., Outcomes and Lessons: Although rare, RSH is a potential cause of acute abdomen, particularly among patients on anticoagulation, and can be life-threatening. A high index of suspicion is therefore important for early diagnosis. Clinicians should also appreciate the heightened risk of DVT in the immediate postoperative period despite mechanical anticoagulation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown., Methods: Sixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi., Results: Fifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally., Conclusion: The present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount., (© 2022 Brian N.B., et al.)

Purpose: Pyramidalis is a lower anterior abdominal wall muscle that is considered vestigial and shows variations in prevalence and size. It's been utilized as an anatomical landmark and harvested for use in various surgical procedures. Despite knowledge of its clinical importance, data on the prevalence of pyramidalis remain absent from the Kenyan population with few studies globally reporting on its pubo-umbilical index. We therefore aimed to determine the prevalence and relative lengths (pubo-umbilical index) of pyramidalis muscle in a sample Kenyan population., Materials and Methods: Fifty-two cadavers (41 males, 11 females) from the Department of Human Anatomy, University of Nairobi were used. Prevalence and length of the muscle (l) were established, and the distance between pubic symphysis and umbilicus (L) measured and used to calculate pubo-umbilical index (l/L ×100%). Independent and paired T tests were done, using SPSS® version 22. A p value of ≤ 0.05 was considered statistically significant at a 95% confidence interval., Results: Pyramidalis was present in 84% (44) of cadavers; 83% (43) bilaterally, 2% (1) unilaterally, and 85.4% (35) in males, 81.8% (9) in females. Mean length in males and females was 71.8 ± 35 mm and 63.5 ± 37.5 mm, respectively. Mean pubo-umbilical index was 38% ± 18 (39 % ± 18 males, 35% ± 19 females). No statistically significant difference was found., Conclusion: Pyramidalis is a highly prevalent muscle in the Kenyan population and, hence, could be exploited for its clinical and surgical utilities. The muscle terminates largely within the 2nd quarter (25-50%) of the infra-umbilical linea alba measured from pubic symphysis. Its pubo-umbilical index would be useful to surgeons making midline infra-umbilical incisions and performing procedures involving the muscle., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Aim: Surgical resection of splenic flexure cancers (SFCs) is technically demanding due to the complex regional anatomy, characterized by the presence of embryological adhesions, close proximity to the pancreas and spleen, and a highly heterogeneous arterial supply and lymphatic drainage. The accessory middle colic artery (AMCA) is increasingly being recognized as an important source of blood supply to the splenic flexure. The aim of this study is to determine the prevalence and anatomical features of the AMCA., Method: A systematic search of the scientific literature was conducted on PubMed and Embase from inception to November 2020 to identify potentially eligible studies. Data were extracted and prevalence was pooled into a meta-analysis using MetaXL and Meta-Analyst software., Results: A total of 16 studies (n = 2203 patients) were included. The pooled prevalence (PP) of the AMCA was 25.4% (95% CI 18.1-33.4). Its prevalence was higher in patients without a left colic artery (LCA) (PP = 83.2%; 95% CI 70.4-93.1). The commonest origin for the AMCA was the superior mesenteric artery (PP = 87.9%; 95% CI 86.4-90.7). The AMCA shared a common trunk/gave rise to pancreatic branches in 23.1% of cases (95% CI 15.3-31.9)., Conclusion: The AMCA contributes to the vascularization of the splenic flexure in approximately 25% of individuals, and may be an important feeder artery to SFCs, especially in the absence of a LCA. Preoperative identification of this artery is important to ensure optimal surgery for SFC and minimize complications., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)

Background: Coronavirus disease 2019 (COVID-19) is a rapidly escalating pandemic that has spread to many parts of the world. As such, there is urgent need to identify predictors of clinical severity in COVID-19 patients. This may be useful for early identification of patients who may require life-saving interventions. In this meta-analysis, we evaluated whether malignancies are associated with a significantly enhanced odds of COVID-19 severity and mortality., Method: A systematic search of literature was conducted between November 1, 2019, to May 26th, 2020 on PubMed and China National Knowledge Infrastructure (CNKI) to identify studies reporting data on cancers in patients with or without severe COVID-19 were included. The primary outcome of interest was the association between malignancies and COVID-19 severity, while the secondary outcome was the association between malignancies and COVID-19 mortality. Data were pooled into a meta-analysis to estimate pooled odds ratio (OR) with 95% confidence interval (95% CI) for either outcome., Results: A total of 20 studies (n = 4549 patients) were included. Overall, malignancies were found to be associated with significantly increased odds of COVID-19 severity (OR = 2.17; 95% CI 1.47-3.196; p < 0.001) and mortality (OR = 2.39; 95% CI 1.18-4.85; p = 0.016). No heterogeneity was observed for both outcomes (Cochran's Q = 6.558, p = 0.922, I 2  = 0% and Cochran's Q = 2.91, p = 0.71, I 2  = 0% respectively)., Conclusion: Malignancies were significantly associated with a 2-fold increase in the odds of developing severe COVID-19 disease, as well as mortality. Larger studies are needed to corroborate these findings. These patients should be closely monitored for any signs of unfavorable disease progression., Competing Interests: Declaration of Competing Interest None of the authors have any conflicts of interests with regard to this publication., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Rouvière's sulcus (RS) is increasingly being recognized as an important extra-biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random-effects meta-analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra-biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury., (© 2020 Wiley Periodicals, Inc.)

Background: Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and macro-vascular thrombotic angiopathy. Although venous thrombotic events in COVID-19 patients have been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients., Methods: A systematic search of literature was conducted between November 1, 2019, and June 9, 2020, on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies., Results: A total of 27 studies (5 cohort, 5 case series, and 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill intensive care unit-admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% confidence interval 2.8-6.4). Most of the patients were male, elderly, and had comorbidities. AT was symptomatic in >95% of these patients and involved multiple arteries in approximately 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid, and brachiocephalic trunk; 19%), coronary arteries (9%), and superior mesenteric artery (8%). The mortality rate in these patients is approximately 20%., Conclusions: AT occurs in approximately 4% of critically ill COVID-19 patients. It often presents symptomatically and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The association between acute kidney injury (AKI) and outcome of coronavirus disease 2019 (COVID-19) has not yet been conclusively established. Therefore, we conducted a meta-analysis of recent scientific literature to assess whether AKI may be associated with worse prognosis and increased mortality in COVID-19 patients., Methods: A systematic search of literature was conducted between 1st November 2019 and 15th May 2020 on Medline (PubMed interface) and China National Knowledge Infrastructure (CNKI) to identify potentially eligible studies. Cohort or case-control studies reporting data on AKI in patients with or without severe COVID-19 were included. Studies were divided into separate cohorts for analysis based on two endpoints (severity [severe vs non-severe] and mortality [non-survivors vs survivors]). Data were pooled into a meta-analysis to estimate pooled odds ratio (OR) with 95% confidence interval (95% CI) for either outcome., Results: A total of 15 studies (n= 5,832 patients) were included in the analysis. Overall, AKI was found to be associated with significantly increased odds of COVID-19 severity (OR= 18.5; 95% CI 8.99-38.08) and mortality (OR= 23.9; 95% CI 18.84-30.31). No heterogeneity was observed for both outcomes (Cochran's Q= 6.21, p=0.52, I2=0% and Cochran's Q= 4.56, p=0.47, I2=0% respectively). -Conclusion: According to current data, AKI seems to be associated with worse prognosis in COVID-19 -patients. -Further investigation of the underlying mechanism of renal disease in COVID-19 would be needed to clarify possible therapeutic targets. AKI could be used as a clinical characteristic in severity classification and risk -stratification.

Background: Our aim was to provide an evidence-based assessment of the relationship between pulmonary vein variants and atrial fibrillation (AF). Methods: A comprehensive systematic search was performed on the databases PubMed, EMBASE, Cochrane library and Science Direct. Following assessment of eligibility and methodologic quality, data on PV variants were extracted and pooled into a meta-analysis. Results: A total of 12 studies (1337 cases and 1250 controls) were included. Presence of a right middle pulmonary vein was significantly associated with AF (OR = 1.85, 95% CI 1.26-2.72, p  = .002). No significant association was however noted between presence of a common pulmonary vein ostia and AF. In the analysis of ostial diameters, the strongest association was observed between increased left common ostia diameter and AF (OR = 2.71, 95% CI 0.99-4.44, p  = .002), followed by right superior (OR = 2.39, 95% CI 1.76-3.02, p  < .00001), left superior (OR = 2.30, 95% CI 1.48-3.13, p  < .00001), right inferior (OR = 2.19, 95% CI 1.69-2.69, p  < .00001) and left inferior (OR = 1.79, 95% CI 1.25-2.34, p  < .00001) pulmonary veins. Conclusion: The findings of the current study support the hypothesis that pulmonary vein variations predispose to AF. Further studies into the role of structural abnormalities of the pulmonary veins variations in the genesis of AF are recommended.

Purpose: To provide a comprehensive evidence-based assessment of the anatomical characteristics of the external branch of the superior laryngeal nerve (EBSLN)., Materials and Methods: A thorough systematic search was performed on the major electronic databases PubMed, EMBASE, Cochrane library, and ScienceDirect to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the EBSLN identification rate (total number of EBSLN identified divided by the total number of dissected hemilarynges) and the prevalence of various EBSLN types., Results: A total of 56 studies (n = 13,444 hemilarynges) were included. The overall pooled EBSLN identification rate was 89.24% (95% CI 85.49-92.49). This rate was higher for cadaveric (95.00%; 95% CI 89.73-99.35) compared to that reported in intraoperative studies (86.99%; 95% CI 82.37-91.01). Significantly higher identification rates were reported for studies in which intraoperative nerve monitoring was used (95.90%; 95% CI 94.30-97.25) compared to those which only relied on direct visual identification of the EBSLN (76.56%; 95% CI 69.34-83.08). Overall, Cernea type IIa (nerves crossing the superior thyroid artery less than 1 cm above the upper edge of the superior thyroid pole) and Friedman type 1 (nerves running their entire course superficial to the inferior pharyngeal constrictor) were the most prevalent (41.84%; 95% CI 33.28-48.08 and 50%; 95% CI 29.90-65.62, respectively). The combined prevalence of Cernea IIa and IIb (nerves crossing the superior thyroid artery below the upper edge of the superior thyroid pole) was higher in intraoperative studies compared to that in cadaveric studies (64.3% vs 49.4%). The EBSLN coursed medial to the superior thyroid artery in 70.98% (95% CI 55.14-84.68) of all cases., Conclusion: The use of intraoperative nerve monitoring improves EBSLN identification rates. In light of the highly variable anatomical patterns displayed by the EBSLN, thorough pre-operative knowledge of its anatomy can be crucial in minimizing incidences of its iatrogenic injury.