Introduction: Malignant pleural mesothelioma (MPM) remains a serious health problem due to the poor outcome of different therapies. In Egypt, it is mainly attributed to an environmental origin with a high incidence in women and young adults. Aim of work: To identify risk factors of malignant pleural mesothelioma and to carry out survival analysis for malignant pleural mesothelioma patients attending outpatient clinic of Clinical Oncology department at Ain Shams University hospital. Materials and methods: Ninety cases with pathologically confirmed MPM attending the outpatient clinic of clinical oncology department at Ain Shams University hospital were interviewed. Patients in critical conditions who needed hospitalization or palliative treatment were excluded. Included patients were then followed up for two years starting from the date of diagnosis. Results: Logistic regression analysis revealed that living in industrial areas, household exposure to asbestos and history of smoking were significant risk factors of MPM. The mean survival duration of all cases was 24.49 months. Cox regression analysis revealed that factors predicting survival were age and gender. The difference in survival between patients treated with different treatment modalities was not statistically significant. Conclusion: Environmental and household exposure to asbestos as well as smoking play an important role in occurrence of MPM. Age and gender were significant predictors of survival of patients. Strict measures to reduce pollution and thus rates of MPM should be adopted in addition to community awareness of the possible risk factors and preventive measures. Moreover, development of a national record system is required to determine the true size and scope of this environmental problem in Egypt.
IntroductionAcute perforations are one of the recognised complications of both diagnostic and therapeutic gastrointestinal endoscopy. For decades, surgical treatment has been the standard of care, but endoscopic closure has become a more popular approach, due to feasibility and the reduction of the burden of surgery, combined with the availability of various endoscopic closure devices.We aimed to assess the technical and clinical success and safety of endoscopic closure, in total, and for each endoscopic device used in closing acute perforations in animal models.MethodMedical literature (Cochrane library, EMBASE, MEDLINE) from 1966 till September 2016 was searched. A systematic review and meta-analysis were performed on studies reporting technical and clinical success of endoscopic closure of acute perforations, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.Results46 studies on animal models were identified. 15 studies,including 4 randomised controlled trials, met our inclusion criteria (acute, less than 24 hours, iatrogenic, no fistulas or leaks, clear documentation of the method of closure, and technical and clinical success and 5 cases or more of endoscopic closure per study), were analysed. A total of 214 endoscopic closures were attempted in these studies. The overall technical success rate was 94.8% (n=201/214, 95% CI: 92%>97.6%), clinical success was 92.3% (n=189/214, 95% CI: 88.8%>95.8%), and complication rate was 4.2% (n=6/214, 95% CI: 1.6%>6.8%).Technical success for endoclip closure was 84.9% (95% CI: 71.4%>93.6%), and clinical success was 83.2% (95% CI: 69.5%>92.5%), and complication rate was 2.7% (95% CI: 90.12%>99.88%).For OTSC (Over the scope clip device), technical success was 97% (95% CI: 88%>99.7%), clinical success was 97% (95% CI: 88%>99.7%), and complication rate was 1.87% (95% CI: 91.2%>98.8%).The technical success for endosuturing (endoscopic suturing device) was 92.7% (95% CI: 82% to 98%), clinical success was 87% (95% CI: 74.9%–94.8%), complication rate was 1.9% (95% CI: 91.1%>98.9%).ConclusionOur study suggests that endoscopic closure is a suitable treatment option for acute iatrogenic gastrointestinal perforations with a reasonable technical and clinical success, and low complication rate. Further confirmation from prospective studies in human is needed.Disclosure of InterestNone DeclaredAbstract PTH-009 Figure 1
acting opioids with benzodiazepines, long-acting opioids with benzodiazepines, and short-acting opioids with propofol. The primary outcome was the frequency of cardiorespiratory events, defined as intra-procedural episodes of hypotension or hypoxemia. We conducted a random-effects Bayesian network meta-analysis using Markov Chain Monte Carlo simulation methods to generate risk ratios and 95% credible intervals for each sedative comparison. We plotted cumulative ranking probabilities based on the direct and indirect estimates generated by the network. Results: We identified 20 studies, including 2,277 patients, directly comparing the cardiorespiratory events between sedatives of interest. Cardiorespiratory events were rare across all sedatives and sedative combinations. Long-acting opioids used with benzodiazepines were associated with a greater risk of cardiorespiratory events than short-acting opioids used alone (RR 3.73; 95% CrI: 1.14-15.15). We did not find any other significant differences in the risk of cardiorespiratory events between the various sedative combinations evaluated; however, there was a trend towards greater events when long-acting opioids with benzodiazepines were compared to all other sedative combinations and fewer events when short-acting opioids were compared to all sedative combinations (Table ). Ranking probabilities demonstrated short-acting opioids used alone to have the highest probability of being the safest sedative and long-acting opioids used with benzodiazepines to have the highest probability of being the least safe sedative combination. Conclusions: The frequency of adverse cardiorespiratory events among the sedatives commonly used in colonoscopy is low. Propofol and non-propofol sedative combinations demonstrate similar cardiorespiratory risk profiles, suggesting equivalent safety when used in this setting.
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