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Emergency laparotomy is a life-saving intervention for acute abdominal conditions, yet its impact on patients' long-term quality of life (QOL) remains poorly understood. This systematic review synthesizes evidence on QOL outcomes following emergency laparotomy, with a focus on emergency medicine perspectives, including recovery trajectories, influencing factors, and implications for clinical practice. A comprehensive search of PubMed/Medline, Embase, Web of Science, and Scopus was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In total, 11 studies were included, encompassing prospective and retrospective cohorts, cross-sectional surveys, and one randomized controlled trial. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Narrative synthesis was performed due to heterogeneity in QOL measures. Key findings revealed significant variability in QOL recovery. Survivors of peritonitis without malignancy reported acceptable QOL, while cancer and advanced age predicted worse outcomes. Chronic pain affected 19-45% of patients, particularly after small bowel obstruction surgery, and was linked to long-term functional impairment. Laparoscopy improved QOL in elderly patients compared to laparotomy. Frailty and prolonged hospitalization were associated with declines in physical and social functioning. Patient-reported outcome measures were feasible in emergency settings but highlighted unmet needs in psychological and social recovery. Emergency laparotomy significantly impacts QOL, with recovery shaped by surgical approach, comorbidities, and postoperative pain. Standardized QOL assessment, integrated multidisciplinary care, and targeted rehabilitation are needed to optimize long-term outcomes. Future research should prioritize prospective studies with uniform QOL metrics to guide patient-centered interventions.

Background and Objectives: Endoscopic biliary plastic stenting is a safe and effective temporary therapeutic modality used in various benign biliary disorders. Long-term indwelling stents for more than one year without retrieval are termed “forgotten biliary stents”. In clinical practice, the forgotten stents are underestimated and the majority of data were obtained from case reports. The aim of this study was to determine the forgotten-biliary-plastic-stent-related complications, their management, and the patients’ clinical outcomes. Materials and Methods: This retrospective study was performed at three hospitals during the period from January 2021 to December 2023. In total, 577 patients with biliary plastic stents—inserted for a variety of benign biliary conditions—were included. They were divided into two groups, as follows: group 1 included 527 patients who had biliary stents removed within 3 months, and group 2 included 50 patients with biliary stents retrieved after one year of their deployment. The stent-related complications (e.g., acute cholangitis, stent clogging, distal stent migration, new common bile duct (CBD) stone formation, and proximal stent migration) and the endoscopic management success rate were evaluated. Results: Irretrievable CBD stones were the main indication for biliary plastic stenting in both groups. The stent-related complications, number of endoscopic sessions, and hospital admissions were significantly higher in the patients with forgotten biliary stents than those with stent removal within 3 months. All the study patients were successfully managed endoscopically with uneventful outcomes. Conclusions: Based on this retrospective study, non-adherence to the endoscopists’ instructions is the main reason for retained biliary stents for more than one year. The patients with forgotten stents had significantly higher complication rates, a higher number of endoscopic sessions, and a higher number of hospital admissions than those with stents that were retrieved in the scheduled time. All patients were managed endoscopically with a technical success rate of 100%, and with no complication-related mortality.

Background The optimal timing for initiating oral anticoagulation (OAC) after acute ischemic stroke in patients with atrial fibrillation (AF) remains a critical clinical dilemma. Early anticoagulation may lower recurrent ischemic stroke risk but could raise hemorrhagic transformation risk, and current guidelines are conflicting. This meta-analysis examined the impact of early versus late initiation of anticoagulation on clinical outcomes—recurrent stroke, intracranial haemorrhage, Bleeding, mortality, transient ischemic attack (TIA), and thrombosis—in AF-related ischemic stroke. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of observational and experimental studies that compared early and late anticoagulation; seventeen studies met inclusion criteria. Results Early anticoagulation was associated with a significantly lower risk of recurrent ischemic stroke (OR = 0.72, 95% CI [0.55-0.96], P = .03). The incidence of intracranial hemorrhage did not differ significantly between groups (OR = 1.13, 95% CI [0.83-1.53], P = .44). No significant differences were observed for Bleeding (OR = 0.87, 95% CI [0.67-1.12], P = .27), mortality (OR = 0.94, 95% CI [0.72-1.24], P = .68), TIA (OR = 0.99, 95% CI [0.57-1.74], P = .98), or thrombosis (OR = 0.87, 95% CI [0.59-1.27], P = .47). Notable heterogeneity—likely due to differences in study design, anticoagulant type, and stroke severity—limits firm conclusions. Conclusion Early anticoagulation appears to reduce ischemic recurrence without significantly increasing major hemorrhagic events, but randomized trials are needed to define optimal OAC timing.

Background and Objectives: Functional gastric stenosis, a consequence of sleeve gastrectomy, is defined as a rotation of the gastric tube along its longitudinal axis. It is brought on by gastric twisting without the anatomical constriction of the gastric lumen. During endoscopic examination, the staple line is deviated with a clockwise rotation, and the stenosis requires additional endoscopic manipulations for its transposition. Upper gastrointestinal series show the gastric twist with an upstream dilatation of the gastric tube in some patients. Data on its management have remained scarce. The objective was to assess the efficacy and safety of endoscopic balloon dilatation in the management of functional post-sleeve gastrectomy stenosis. Patients and Methods: Twenty-two patients with functional post-primary-sleeve-gastrectomy stenosis who had an endoscopic balloon dilatation between 2017 and 2023 were included in this retrospective study. Patients with alternative treatment plans and those undergoing endoscopic dilatation for other forms of gastric stenosis were excluded. The clinical outcomes were used to evaluate the efficacy and safety of balloon dilatation in the management of functional gastric stenosis. Results: A total of 45 dilatations were performed with a 30 mm balloon in 22 patients (100%), a 35 mm balloon in 18 patients (81.82%), and a 40 mm balloon in 5 patients (22.73%). The patients’ clinical responses after the first balloon dilatation were a complete clinical response (4 patients, 18.18%), a partial clinical response (12 patients, 54.55%), and a non-response (6 patients, 27.27%). Nineteen patients (86.36%) had achieved clinical success at six months. Three patients (13.64%) who remained symptomatic even after achieving the maximal balloon dilation of 40 mm were considered failure of endoscopic dilatation, and they were referred for surgical intervention. No significant adverse events were found during or following the balloon dilatation. Conclusions: Endoscopic balloon dilatation is an effective and safe minimally invasive procedure in the management of functional post-sleeve-gastrectomy stenosis.

Successful endodontic therapy is mainly governed by the satisfactory sealing ability of the applied root canal sealer. Also, tolerability of root canal structure to accommodate the presence of a sealer participates in the efficiency of the treatment. Hence, this study was aimed to extrapolate our previous one that was concerned with the preparation and evaluation of novel nature-based root canal sealers. Our current work is focused on the evaluation of sealing ability and in vivo biocompatibility. Egyptian propolis was extracted (ProE) and encapsulated in polymeric nanoparticles (ProE-loaded NPs). Two root sealers, PE sealer and PE nanosealer, were fabricated by incorporating ProE and ProE-loaded NPs, respectively. The sealing ability of the developed sealers was tested by a dye extraction method. An in vivo biocompatibility study was conducted using a subcutaneous implantation method for two and four weeks. At the same time, a model sealer (AH Plus®) was subjected to the same procedures to enable accurate and equitable results. The teeth treated with PE sealer exhibited weak sealing ability which did not differ from that of unfilled teeth. PE nanosealer enhanced the sealing ability similarly to the model sealer with minimal apical microleakage. Studying in vivo biocompatibility indicated the capability of the three tested sealers to induce cell proliferation and tissue healing. However, PE nanosealer had superior biocompatibility, with higher potential for cell regeneration and tissue proliferation. PE nanosealer can be presented as an innovative root canal sealer, with enhanced sealing ability as well as in vivo biocompatibility. It can be applied as a substitute for the currently available sealers that demonstrate hazardous effects.

PurposeOne anastomosis gastric bypass (OAGB) is a promising bariatric procedure. We performed this study to evaluate the changes in a group of inflammatory cytokines 12 months after OAGB.MethodsA single-arm prospective study was conducted on obese patients who underwent OAGB. The serum levels of the following adipocytokines were monitored pre- and 12 months postoperatively: adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity C-reactive protein (hs-CRP), and monocyte chemotactic protein 1 (MCP-1).ResultsA total of 62 patients were included with a mean age of 43.9 ± 6.8 years old. The serum adiponectin increased significantly from 7.64 ± 0.29 to 8.76 ± 0.42 μg/mL 12 months after the operation (p < 0.001). hs-CRP and IL-6 decreased significantly 12 months after the OAGB from 3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL and 3.64 ± 6.9 pg/mL, respectively (p < 0.001). The MCP-1 showed significant increase in its level after OAGB as well (p = 0.014). In contrary, there were no significant changes in serum levels of IL-8 (p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The correlation analysis showed significant correlations between initial body mass index (BMI) with serum adiponectin, IL-8, and serum SAA.ConclusionOAGB can significantly impact the inflammatory cytokine profile in obese patients with possible subsequent protection from obesity-related comorbidities such as insulin resistance, cardiovascular diseases, and certain cancers.

Background Radiology plays a crucial role in diagnosing and managing numerous diseases, yet it remains underrepresented in many medical school curricula. This is the first multicenter study to evaluate the knowledge and attitudes of Arab medical students towards radiology, aiming to identify educational disparities and their potential causes. Methods This cross-sectional study was conducted across three Arab countries: Egypt, Libya, and Yemen. It targeted medical students in their 4th, 5th, or 6th year, as well as postgraduate internship year. Data was collected using an online questionnaire comprising 38 questions organized into seven sections. The questions were formatted using a multiple-choice Likert scale and yes/no responses. Statistical analysis was carried out using Jamovi software version 2.3. Results A total of 802 students (51.4% male, 48.6% female), ranging from 4th-year students to interns, completed the questionnaire. The overall level of radiology knowledge was modest (9.0 ± 2.4), with mean scores slightly above half of the maximum possible (17 points). Yemen exhibited the highest mean score (9.3 ± 2.4), followed by Egypt (8.9 ± 2.5) and Libya (8.6 ± 2.2). Students who received their radiology education through individual modules achieved significantly higher knowledge scores than those instructed through integrated modules ( p  = 0.0001). The participants also demonstrated a high level of knowledge about radiology screening tests. However, understanding radiation exposure levels for CT, MRI, and ultrasound was limited. Of the total, 491 students (61.2%) expressed interest in pursuing a career in radiology, while 311 (38.7%) cited lack of interest and concerns about radiation exposure as deterrents. Conclusions Our findings suggest that medical students in Egypt, Libya, and Yemen have awareness of some core radiology concepts; particularly those related to fetal safety and established screening practices. However, their overall knowledge of radiology is modest, with substantial gaps in areas such as radiation exposure levels and contraindications. It highlights the need for enhanced radiology education early on in clinical years to address these gaps in the field.