Perioperative Outcomes of Pancreaticoduodenectomy: Nepalese Experience

Background  

Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital.     

Rare synchronous primary large B-cell gastric lymphoma and huge retroperitoneal liposarcoma with inguinal hernia in chronic hepatitis B patient

Multiple primary neoplasms with synchronous or metachronous presentation are rare, although the incidence has recently increased because of several factors. We present the case of a 53-year-old patient with chronic hepatitis B who presented with abdominal mass, mild abdominal pain, and inguinal hernia. Computed tomography imaging demonstrated diffuse thickening of the gastric antral wall, together with a huge heterogeneous abdominal mass with predominant fat attenuation with septa that showed mild enhancement on contrast-enhanced scans. Distal gastrectomy and wide resection of the retroperitoneal mass was performed. Pathology exam led to a diagnosis of diffuse large B-cell gastric lymphoma with retroperitoneal liposarcoma. This is a rare case of a primary gastric lymphoma with another primary (sarcomatous) malignancy occurring synchronously in same patient.     

Painful dysphagia in a case of mediastinal tuberculous lymphadenopathy.

A patient with mediastinal tuberculous lymphadenopathy is described. Presentation was with rapid onset of painful dysphagia following trauma to the neck. Early diagnosis was achieved by mediastinoscopy.     

Experimental Investigation of Additive Manufacturing of Continuous Carbon Fiber Composites with Multifunctional Electro-Tensile Properties

Manufacturing processes for monofunctional and multifunctional materials vary depending on the design optimization. Multifunctional continuous carbon fiber composites provide great potential in achieving coupled structural and electrical properties for their applications in aircraft, unmanned aircraft systems, and spacecraft. Proper optimization of tensile and electrical properties offers benefits early in the design and continuous operational safety phases to obtain coupled multifunctional properties. In this paper, fused filament fabrication additive manufacturing (AM) technique was used to fabricate continuous carbon fiber solid laminated composites test coupons. The proposed new method characterizes the electrical conductivity’s coupled effects on the tensile properties, including the failure loads and modes. This paper addresses a novel way of integrating electrical function into the composites that significantly reduce weight, potentially replacing the bulky electrical wires. Tensile and electrical conductivity tests were concurrently conducted on coupons, and the results were plotted and tabulated. The results showed the multifunctional properties of the maximum ultimate tensile strength of 392 MPa with the maximum tensile load of 8907 N, and resistance of 37.5 G·Ω. The average values for ultimate tensile strength and maximum load were 371 MPa and 8459 N, respectively.     

New-onset diabetes in COVID-19 and clinical outcomes: A systematic review and meta-analysis

BACKGROUNDDiabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with coronavirus disease 2019 (COVID-19). The relationship between diabetes and COVID-19 is known to be bidirectional.AIMTo analyze the rate of new-onset diabetes in COVID-19 patients and compare the clinical outcomes of new-onset diabetes, pre-existing diabetes, hyperglycemic, and non-diabetes among COVID-19 patients.METHODSWe used the Meta-analysis of Observational Studies in Epidemiology statement for the present meta-analysis. Online databases were searched for all peer-reviewed articles published until November 6, 2020. Articles were screened using Covidence and data extracted. Further analysis was done using comprehensive meta-analysis. Among the 128 studies detected after thorough database searching, seven were included in the quantitative analysis. The proportion was reported with 95% confidence interval (CI) and heterogeneity was assessed using I².RESULTSAnalysis showed that 19.70% (CI: 10.93-32.91) of COVID-19 patients had associated DM, and 25.23% (CI: 19.07-32.58) had associated hyperglycemia. The overall mortality rate was 15.36% (CI: 12.57-18.68) of all COVID-19 cases, irrespective of their DM status. The mortality rate was 9.26% among non-diabetic patients, 10.59% among patients with COVID-19 associated hyperglycemia, 16.03% among known DM patients, and 24.96% among COVID-19 associated DM patients. The overall occurrence of adverse events was 20.52% (CI: 14.21-28.70) among COVID-19 patients in the included studies, 15.29% among non-diabetic patients, 20.41% among patients with COVID-19 associated hyperglycemia, 20.69% among known DM patients, and 45.85% among new-onset DM. Meta-regression showed an increasing rate of mortality among new hyperglycemic patients, known diabetics, and new-onset DM patients in comparison to those without diabetes.CONCLUSIONA significantly higher rate of new onset DM and hyperglycemia was observed. Higher mortality rates and adverse events were seen in patients with new-onset DM and hyperglycemia than in the non-diabetic population.     

Diagnostic accuracy of glycogen phosphorylase BB for myocardial infarction: A systematic review and meta‐analysis

PurposeWe tried to investigate the diagnostic accuracy of glycogen phosphorylase BB as a cardiac marker for myocardial infarction.MethodsWe searched through different electronic databases (PubMed, Google‐scholar, Embase, and Cochrane Library) to locate relevant articles. Studies, with sufficient data to reconstruct a 2 × 2 contingency table, met our inclusion criteria were included. Three reviewers independently screened the articles. Discrepancies were resolved by other reviewers. Unpublished data were requested from the authors of the study via email. Subsequently, data extraction was done using a standardized form and quality assessment of studies using the QUADAS‐2 tool. Meta‐analysis was done using a bivariate model using R software.ResultsFourteen studies were selected for the final evaluation, which yielded the summary points: pooled sensitivity 87.77% (77.52%–93.72%, I² = 86%), pooled specificity 88.45% (75.59%–94.99%, I² = 88%), pooled DOR 49.37(14.53–167.72, I² = 89%), and AUC of SROC was 0.923. The lambda value of the HSROC curve was 3.670. The Fagan plot showed that GPBB increases the pretest probability of myocardial infarction from 46% to 81% when positive, and it lowers the same probability to 12% when negative.ConclusionWith these results, we can conclude that GPBB has modest accuracy in screening myocardial infarction, but the limitations of the study warrant further high‐quality studies to confirm its usefulness in predicting myocardial infarction (MI).