Objectives To assess the diagnostic performance of Pap smear screening with or without human papillomavirus (HPV) testing and colposcopy in detecting preinvasive lesions of the cervix among women with reference to histopathological findings. Materials and methods We performed a retrospective study in a tertiary care center of the clinical and pathological records of women with evocative symptomatology. The diagnostic performance of Pap smear screening and colposcopy was analyzed. The sensitivity and specificity of Pap smear screening and colposcopy in detecting preinvasive lesions of the cervix were calculated in 388 patients. Results The mean age was 45.12 years, and the most frequent gynecological symptoms included abnormal bleeding (17.2%) and postcoital bleeding (10.9%). Histopathology showed abnormal results in 26.5% of the 388 patients, including cervical intraepithelial neoplasia 1 (CIN 1; 20.4%), CIN 2 (2.8%), CIN 3 (1.3%), and SCC (1.3%). Both Pap smear screening and colposcopy were highly sensitive in detecting CIN 1+ (94.2%vs.93.2%, respectively) and CIN 2+ (100.0% vs.95.8%, respectively) intraepithelial lesions; however, Pap smears had very low specificity in detecting both CIN 1+ (8.1% vs.73.7%, respectively) and CIN 2+ (8.0% vs. 59.3%, respectively) compared with colposcopy. When combined with HPV status, the specificity of Pap smear increased considerably. Conclusion It has become a high priority to improve the efficiency of cervical cancer (CC) screening programs by optimizing the practice of Pap smear screening, increasing the test specificity, and implementing systematic cytology-HPV co-testing.
Background: Postoperative complications are a major concern after colorectal surgery, and can lead to an increased burden on patients and the healthcare system. Complications include postoperative ileus (POI) and prolonged postoperative ileus (PPOI). There are well-established risk factors and potential modifiable risk factors that affect the incidence of POI and PPOI, including invasive techniques, operative difficulty, perioperative blood loss, and delayed mobilization. We compared the incidence of POI, PPOI, and other postoperative complications between laparoscopic colectomy and open colectomy. Methods: This retrospective review investigates 120 patients who underwent either laparoscopic or open colectomy in King AbdulAziz University Hospital in Jeddah, Saudi Arabia, between January 2016 and June 2019. Data were collected from patients’ electronic medical records. Patients were classified into laparoscopic and open colectomy groups. The main outcomes of interest were POI, PPOI and the overall complication rate. These outcomes were calculated and compared between the two groups. Results: The overall incidence of POI and PPOI was 4.2% and 15%, respectively. There was a higher incidence of POI in the laparoscopic approach group (7.2% vs. 1.5%, P=0.03); however, the incidence of PPOI was higher in the open approach group (20% vs. 9.1%, P=0.03). The open surgery group showed a higher rate of overall complications (P=0.001). The mean estimated blood loss was lower in the laparoscopy group (139.09±145.83 vs. 343.85±307.78 mL; P<0.001). Significant earlier mobilization was observed in the laparoscopic group (3.12±1.77 vs. 5.39±3.48 days; P<0.001). Conclusion: The incidence of PPOI was significantly different depending on the surgical approach; however, the laparoscopy group tolerated regular diet earlier and had better outcomes regarding postoperative complications. The laparoscopic approach was associated with earlier ambulation and was more cost-effective based on the length of the hospital stay. Further randomized studies are required to confirm superiority of the laparoscopic approach in terms of postoperative recovery.
CASE REPORTFifty six years old male, heavy smoker, alcoholic with a history of ischemic heart disease, presented to emergency department with a complaint of severe epigastric abdominal pain for two days. The pain was stabbing in nature, associated with heavy meals, nausea and vomiting, and responding well to pain killers. No history of diarrhea, constipation, upper nor lower GI bleeding, gallstones, regular medication, blood transfusion nor fever were noted. ABSTRACTEmphysematous gastritis (EG) is a rare disease entity related to infection of the gastric wall. It is caused by gasforming pathogens including Enterobacter species, Clostridium perfringens and others. EG patients clinically present with symptoms similar to acute abdomen and can have a mortality that can reach up to 80%. Alcoholism was identified as a risk factor for such a disease. Different diseases like diabetes mellitus, ulcerative colitis and use of nonsteroidal anti-inflammatory agents were found to be associated with EG. To date, no clear guidelines regarding EG management, however, early detection and management is crucial to prevent related deaths. In the acute setting, the role of surgery is limited. Surgical interventions might be needed if obstruction of gastric outlet or perforation ensues. Fifty six years old male, heavy smoker, alcoholic with a history of ischemic heart disease, presented to Emergency Department with a complaint of severe epigastric abdominal pain for two days. The patient was vitally stable, conscious, oriented, however, looks in severe pain. His lab investigations were within normal ranges. Computed tomography (CT) of the abdomen was consistent with emphysematous gastritis. To our knowledge, this is the first case of emphysematous gastritis reported in Saudi Arabia using only radiological modality.
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