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Background: Femoral nerve block is a widely accepted nerve block method with evident reduction in consumption of opioid painkiller and minimization of the duration of hospital stay but may cause weakness of quadriceps muscle strength. Adductor canal block is another nerve block technique that attracts the attention of scientific community nowadays because of its possible superiority over Femoral nerve block regarding mobility and muscle strength. Methods: This is a systematic review and meta-analysis of 33 studies, aiming to compare femoral nerve block with adductor canal block following total knee arthroplasty regarding pain control and mobilization. Results: Adductor canal block showed better preservation of quadriceps muscle strength (MD = 0.28, 95% CI [0.11, 0.46], P = .002), and better mobilization up to 2 days postoperatively. However, no significant difference was found between the 2 interventions regarding pain control (MD = 0.06, 95% CI [−0.06, 0.17], P = .33) or opioid consumption (SMD = 0.08, 95% CI [−0.06, 0.22], P = .28) up to 2 days postoperatively. The better mobilization results of adductor canal block did not translate into a significant difference in the risk of falls or patients’ satisfaction; however, adductor canal block patients had less mean length of hospital stay than the patients with femoral nerve block. Conclusion: Both femoral nerve block and adductor canal block provide similar results regarding pain control and opioid consumption, however adductor canal block provides better preservation of quadriceps strength and mobilization, giving it more advantage over femoral nerve block.

Background and Aims Fecal microbiota transfer (FMT) is a potential treatment for irritable bowel syndrome (IBS). Several randomized trials have tested FMT effects using different routes of administration, doses, and sample sizes. We aim to assess the overall efficacy of FMT for IBS patients and the safety of the intervention. Methods We systematically searched four databases for randomized control trials that studied the efficacy and safety of FMT in IBS patients. Results We included 8 randomized trials (472 patients) that compared FMT with placebo in IBS patients. Pooled results showed no statistically significant difference between FMT and control groups in the overall change in IBS symptom severity (IBS‐SSS) at 1 month ( p = 0.94), 3/4 months ( p = 0.82), and at the end of trials ( p = 0.67). No significant difference in the total number of respondents between the FMT and control groups (risk ratios = 1.84, [95% confidence interval (CI) = 0.82–2.65], p = 0.19). Although the oral route of administration showed a significant difference in the number of respondents ( p = 0.004), there was no statistically significant difference in the IBS‐SSS when subgrouping the oral route of administration (mean difference = 47.57, [95% CI = −8.74–103.87], p = 0.10). Conclusion FMT is not an effective treatment to relieve all the symptoms of IBS. Even in the groups that showed relatively significant improvement after FMT, the effect was proven to wear off over time and the re‐administration carries a low success rate. Future research should consider different bacterial‐based interventions such as probiotics or specific antibiotics.

Background Depression is a prominent cause of mental disability globally, having a severe impact on mental and physical health. Depression rehabilitation and treatment, whether through psychiatric management or counseling therapy, is hampered by stigmatizing attitudes regarding psychiatric illness patients impacted by societal and cultural factors. However, little is known about the stigma toward people with depression among the students in Syria. Methodology A total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. A total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. The survey looked at attitudes toward depression, the desire to keep a safe distance from depressed people, stigma attitudes toward people with depression among college students, perceived beliefs about depressive people, gender (male and female), and the major section (medical and medical and non-medical) differences. Results Four questionnaires have refused to finish the survey, out of 1259 issued. Around 47.80% of respondents, most of whom were females, felt that sad people might snap out of it. 14.60 percent believe depression isn’t even an actual medical condition. Surprisingly, 2% of respondents with a medical background thought the same thing. Regarding more extreme stigmatization, 16.80% of respondents thought depressed persons were harmful. People with depression will be avoided by 19.50 percent of respondents, and people with medical backgrounds will be avoided by 5.20 percent of respondents. Nearly one-fifth of those polled said they would not tell anyone if they were depressed. Only a tiny percentage of respondents (6.90 percent) said they would not hire or vote for a politician who suffers from depression (8.40 percent). Conclusion According to the study, Syrian college students had a significant level of stigma and social distance toward mentally ill patients. Female students and non-medical students had a higher stigma in most subscale items for people with depression.

Extrapulmonary manifestations of COVID-19 infection include a wide spectrum of cutaneous, endocrine, and cardiovascular complications. We report three cases of new-onset Henoch–Schonlein purpura (HSP) in COVID-19 infected children that were diagnosed and treated in Abha Maternity and Children Hospital, Saudi Arabia, between 28th July 2020 and 10th August 2020. All three cases were males younger than 5 years of age that presented with Henoch–Schonlein purpura characteristic rash and arthralgia without a recent history of any infection, especially respiratory infections. They all tested positive for COVID-19. At the time of the admission, pediatric COVID-19 cases were managed conservatively and we ruled out any other diagnosis before establishing the diagnosis of Henoch–Schonlein purpura according to the clinical picture. The three boys responded significantly to prednisolone and achieved a rapid recovery. We present the clinical scenario and laboratory tests of these children along with pictures of the lesions detected in each case.

IntroductionDespite the growing popularity of laparoscopic sleeve gastrectomy (SG) for managing severe obesity in children, adolescents, and adults, there is a paucity of studies reporting the effects of SG on metabolic and hormonal outcomes in pediatric populations.MethodologyIn this single-centre, retrospective study, we assessed nutritional biomarkers (hemoglobin, ferritin, iron profile, Vitamin B12, Vitamin D, and calcium), glucose homeostasis indicators (C-peptide, HbA1C, and random blood glucose), blood lipids (triglycerides and cholesterol components), hormones involved in the hypothalamic-pituitary-adrenal axis (cortisol and adrenocorticotropic hormone), and thyroid hormones (T3, T4, thyroid-stimulating hormone, and parathyroid hormone) preoperatively and 12-month after SG in children aged 5–15 years.ResultsThis study included 64 adolescents (mean age = 11.2 ± 2.3 years) who underwent laparoscopic SG. Significant reduction in circulatory C-peptide (−62.1%; p = 0.005), HbA1C (−10.9%; p = 0.001), random blood glucose (−15.4%; p = 0.036), and triglycerides (−39.4%; p = 0.003) were observed postoperatively at 12 months compared to baseline. Although we did not observe any changes in cortisol levels, adrenocorticotropic hormone levels declined significantly by −40.9% postoperatively (p = 0.033). However, cholesterol components, thyroid hormones, and nutritional biomarkers remained unchanged from baseline.ConclusionsConsistent with prior literature, our study demonstrates improvement or resolution of diabetes and hypertriglyceridemia in the year following SG. However, given that blood cholesterol components, nutritional biomarkers, and thyroid profiles remained unchanged warrants long-term monitoring of nutritional, metabolic, and endocrine factors in adolescents undergoing laparoscopic SG. To the best of our knowledge, this is the first study reporting the effects of SG on thyroid and hypothalamic-pituitary-adrenal axis hormones in pediatric populations.

Background After the COVID-19 pandemic, anxiety and depression have reached high levels, especially after the last wave, Omicron. Healthcare workers in contact with COVID-19 patients or those who come in contact with them may exhibit high levels of anxiety and depression. Therefore, we aimed to assess anxiety and depression symptoms among ICU companions of COVID-19 patients. Methods From 30 November 2021 to 1 March 2022, sixth-year medical students at Aleppo University Hospital conducted interviews with the companions of COVID-19 patients who they brought their patient to the ICU centre as part of a cross-sectional quantitative study using the PHQ-9 and GAD-7 tools to gauge their level of anxiety and depression among companions of COVID-19 patients. The data were analyzed using the SPSS program. In addition, logistic regression models were used to study possible factors of anxiety and depression symptoms during COVID-19. Results The total number was 997 participants in contact with COVID-19 patients. The mean score of the depression assessment tool (PHQ-9) in our questionnaire was 9.5 with a range of 0 to 27. At the same time, the anxiety assessment tool (GAD-7) had a mean score of 9.1, ranging from 0 to 21. A binary logistic regression was used to predict the relationship between depression and anxiety and various factors. We found that the companions with medical specialties were substantially less likely to develop anxiety than other companions [AOR = 0.459; 95%CI (0.23–0.9)], in addition females were substantially higher likely to develop depression than males [AOR = 1.322; 95%CI (0.992–1.762)]. 45.4% of companions had moderate to severe anxiety, in additon 50.8% of companions had moderate to severe depression. Conclusion Our research reveals that moderate to severe anxiety and sadness are present in roughly half of the COVID19 patients’ companions. Females, people with children, and hard workers were more inclined to feel anxious than others, and those who are not in the medical field were more likely to suffer from depression than others, thus it is critical to assist these groups during the present outbreaks (Omicron and Monkeybox).

Placenta accreta spectrum (PAS) can cause complications like hysterectomy or death due to massive pelvic bleeding. We aim to evaluate the efficacy of two different arterial ligation techniques in controlling postpartum haemorrhage and minimizing bleeding complications. We searched six databases. 11 studies were finally included into our review and analysis. We graded their quality using the Cochrane tool for randomized trials and the NIH tool for retrospective studies. Our analysis showed that internal iliac artery ligation has no significant effect on bleeding control (MD = −248.60 [−1045.55, 548.35] P = 0.54), while uterine artery ligation significantly reduced the amount of blood loss and preserved the uterus (MD = −260.75, 95% CI [−333.64, −187.86], P < 0.00001). Uterine artery ligation also minimized the need for blood transfusion. Bleeding was best controlled by combining both uterine artery ligation with uterine tamponade (MD = 1694.06 [1675.34, 1712.78], P < 0.00001). This combination also showed a significant decrease in hysterectomy compared to the uterine artery ligation technique alone. Bilateral uterine artery ligation in women with placenta accreta spectrum can effectively reduce the amount of bleeding and the risk of complications. The best bleeding control tested is a combination of both, uterine artery ligation and cervical tamponade. These techniques may offer an easy and applicable way to preserve fertility in PAS patients. Larger randomized trials are needed to define the best technique.