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Background There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. Methods This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020–July 2022) to those who did not (March 2011–March 2020). The primary outcome was postoperative bleeding (Hb < 9 g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1 g intravenous was administered immediately after a methylene blue leak test, prior to extubation. Results TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8 years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p  = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group ( p  = ns). There was no VTE or death. Conclusions This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial. Graphical Abstract

Background Roux-en-Y gastric bypass (RYGB) is widely regarded as a cornerstone intervention for individuals afflicted with metabolic syndromes and severe obesity. However, one anastomosis gastric bypass (OAGB) emerged after RYGB as a more straightforward and less technically demanding operation. This systematic review and meta-analysis aims to compare both procedures and update the currently existing evidence. Methods We systematically searched PubMed, Scopus, and the Cochrane Central Register for randomized controlled trials (RCTs) that compared OAGB with RYGB as primary operations. Results Twelve studies were included in this meta-analysis, with a total of 904 patients. Total weight loss percentage (TWL%) was statistically higher in the OAGB group at 6 months (95% CI 0.80 to 2.94; P  = 0.006) with no differences in 12, 24, and 36 months compared to RYGB. On the other hand, OAGB exhibited a significantly higher excess weight loss percentage (EWL%) compared to RYGB at 12 months (95% CI 3.08 to 9.73; P  = 0.0002). EWL% was comparable in both procedures at 6, 24, and 60 months of follow-up. There were no statistically significant differences in terms of the resolution of comorbidities related to obesity. De novo gastro-esophageal reflux disease (GERD) (RR 2.58; 95% CI 1.55 to 4.3; P  = 0.0003) and marginal ulcers (RR 2.7; 95% CI 1.07 to 6.84; P  = 0.04) were significantly higher in patients who underwent OAGB in comparison to RYGB. Conclusions In conclusion, OAGB is comparable to RYGB in terms of weight loss parameters and comorbidity resolution. However, OAGB can lead to a higher risk of development of marginal ulcers and de novo GERD.

Background It has been observed that 5–8% of primary bariatric procedures result in inadequate treatment response, necessitating the need for revisional surgery. In this systematic review and meta-analysis, we aim to compare the effectiveness of single anastomosis duodeno-ileal bypass (SADI) and one anastomosis gastric bypass (OAGB) in addressing weight recurrence following sleeve gastrectomy. Methods We systematically searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. Studies were considered eligible if they compared SADI with OAGB as revisional surgeries following sleeve gastrectomy. Results Our search strategy yielded four articles with a total of 309 patients. Regarding weight loss at 1 year of follow-up, SADI was favorable based on excess weight loss percentage (EWL%) and total weight loss percentage (TWL%). At 2 years of follow-up, EWL% did not show a statistically significant difference between the two operations although TWL% was higher in SADI group. Regarding postoperative bile reflux, the OAGB group had a significantly higher incidence of biliary reflux (OR 0.15; 95% CI 0.04 to 0.53; P  = 0.003). Patients enrolled in SADI did not develop anastomotic ulcers according to the four studies included in the analysis. In contrast, seven patients in the OAGB group did develop anastomotic ulcers, but the difference was not statistically significant (OR 0.23; 95% CI 0.05 to 1.10; P  = 0.07). Conclusion ADI is a feasible procedure with a favorable outcome compared to OAGB as a revisional surgery following sleeve gastrectomy regarding weight loss at 1 year with a lower incidence of postoperative biliary reflux.

Abstract Background and aims Stroke is the second cause of mortality and the third cause of disability worldwide. Main controllable risks include hypertension, diabetes, smoking, obesity, and physical inactivity. Nonetheless, the evidence of stroke risk among healthcare professionals in Egypt remains limited. This study assesses the five-year stroke risk and potential risk factors among healthcare providers in Misr University for Science and Technology hospitals. Methods A cross-sectional study was conducted from November 2024 to May 2025 among 368 healthcare professionals at Saud Kafafi University Hospital, Giza, Egypt. Stroke risk was measured with the validated Stroke Riskometer app through a structured questionnaire that gathered demographic, lifestyle, clinical, and work-related data. Data were analyzed using SPSS version 25, with statistical significance set at p ≤ 0.05. Results Of 379 hospital workers screened, only 368 met the inclusion criteria (151 females, 217 males). Participants aged 20-65 years and had no history of stroke or transient ischemic attack. Stroke risk showed a significant association with age, diabetes, cardiac diseases (cardiomyopathy, arrhythmia, and IHD), low socioeconomic status, and traumatic brain injury (p < 0.001) Similarly, patients on antihypertensive medications reported significantly higher risk of stroke (p = 0.001). Notably,administrative staff showed the highest projected five-year risk. Conclusions Stroke risk among hospital staff is significantly associated with several demographic and lifestyle factors; hence, targeted prevention strategies are needed to address these controllable variables within this population. Conflict of interest nothing to disclose

BackgroundGlobally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched.MethodsThe process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of ‘High’ or above were added to an operational watchlist and assistance was deployed as needed.ResultsSince June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%–67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available.ConclusionsThe system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators.

Background Otosclerosis is one of the most frequent causes of conductive hearing loss in adults. Surgical treatment is considered to be the gold standard for this disease. Endoscopic stapedectomy is a new approach for the treatment of otosclerosis that requires a bloodless field. Aim of the Study To determine whether the routine use of β blockers as a premedication can improve the operative field in endoscopic stapedectomy or not. Patients and Methods Sixty patients aged from 18 to 50 years, undergoing endoscopic stapedectomy, were included in this prospective, randomized, double blinded, placebo-controlled study. Patients were randomly assigned to receive either metoprolol 100 mg ( group 1) or a placebo, vitamin tablet, (group 2) 60 min before surgery. Results The age, gender, body weight and ASA physical status were comparable between the two groups. The average blood loss in the placebo group was significantly greater than in the metoprolol group, but the time of operation in the metoprolol group was not significantly shorter. The surgical field was assessed using the Fromme-Boezaart scale, and those who received metoprolol had considerably cleaner (p0.001) surgical fields. The mean arterial pressure (MAP) didn’t differ statistically significant at basal measurement up to 30 min after anesthesia induction while it was significantly lower in the metoprolol group after 30 min of induction up to end of surgery ( p  < 0.001). The heart rate was also significantly lower ( p  < 0.001) in patients who received metoprolol from prior to anesthesia induction up to end of surgery. Conclusion metoprolol significantly improves visual clarity and hemodynamics during endoscopic stapedectomy.