No abstract

Management of pilonidal sinus using thrombin gelatin matrix, despite being expensive, is an effective, simple treatment that is easy to perform and associated with low recurrence rate, minimal morbidity, and rapid recovery.

Purpose Diabetes mellitus (DM) increases the risk of morbidity and mortality after liver resection. Albuminuria is associated with a higher risk for all-cause and cardiovascular mortality. This study evaluated albuminuria as a predictor of the outcome of living donor liver transplantation (LDLT) in patients with pre-existing DM. Methods This retrospective study involved 103 type II diabetic patients with end-stage liver disease who received LDLT. Preoperative spot urine albumin: creatinine ratio was used to determine the degree of albuminuria. The primary outcome measure was the impact of urinary albumin excretion on the 3-year mortality rate after LDLT in this diabetic cohort. Results Hepatitis C virus infection was the main cause of cirrhosis. Albuminuria was detected in 41 patients (39.8%); 15 had macroalbuminuria, while 26 had microalbuminuria. Patients with microalbuminuria were significantly older than those with macroalbuminuria and normal albumin in urine. After 3 years, twenty-four patients (23.3%) died within 3 years after LT. Myocardial infarction was the leading cause of death (25%). Albuminuria was an independent factor affecting 3-year mortality with an odds ratio of 5.17 (95% CI: 1.86–14.35). Conclusion Preoperative albuminuria is an independent factor affecting mortality within 3 years after LDLT in type II diabetic patients. Myocardial infarction was the leading cause of death in 25% of cases, followed by hepatocellular carcinoma recurrence, sepsis, and graft failure. KEY MESSAGES Diabetes mellitus (DM) increases the risk of morbidity and mortality after liver resection. Albuminuria is associated with a higher risk for all-cause and cardiovascular mortality. Preoperative albuminuria is a significant predictor of mortality within 3 years after LDLT in diabetic patients.

Pregnant patients with systemic lupus erythematosus (SLE) represent a high-risk group. The aim of this study is to describe the pregnancy outcomes among SLE patients who were followed prospectively at a conjoint high-risk pregnancy/rheumatology clinic from 2007 to 2021 and to identify predictors of adverse maternal and fetal outcomes. This study included 201 singleton pregnancies of 123 women with SLE. Their mean age was 27.16 ± 4.80 years, and their mean disease duration was 7.35 ± 5.46 years. Secondary antiphospholipid syndrome (APS) was diagnosed in 77 (38.3%) pregnancies. The pregnancy was planned in 104 (51.7%) pregnancies. Flares occurred in 83 (41.3%) and pre-eclampsia in 15 (7.5%) pregnancies. Full-term pregnancy occurred in 93 (46.3%), fetal loss (miscarriage and intra-uterine fetal death) in 41 (20.4%), and prematurity in 67 (33.3%) of the pregnancies, respectively. Seven neonates died from complications of prematurity, and another one died from cardiac congenital anomalies. In the multivariate analyses, unplanned pregnancy was associated with eight times higher risk of disease flare OR = 7.92 ( p < 0.001), lupus nephritis flare during pregnancy increased the odds of pre-eclampsia occurrence four times OR = 3.98 ( p = 0.02), while disease flares during pregnancy predicted prematurity OR = 2.49, p = 0.049. Patients with secondary APS had three times increased risk of fetal loss OR = 2.97, p = 0.049. To conclude, unplanned pregnancy, disease flares, and APS have been identified as predictors for adverse maternal and/or fetal outcomes. Pregnancy planning is necessary to reduce maternal and fetal complications.

ObjectiveThe aim of this study was to compare the effects of the squatting position versus the supine position during the second stage of labor in terms of forceps application, extension of episiotomy, the occurrence of perineal tears, shoulder dystocia, the complications of the third stage of labor, and the Apgar score. Patients and methodsThis prospective cohort study was carried out at A total of 200 full-term ( Z37 weeks) pregnant women presenting in active labor with cephalic presentation were included. ResultsA total of 200 pregnant women were included in this prospective cohort study. There was no evidence of a statistically significant difference between both groups in terms of maternal age, gestational age, BMI, and infant birth weight. There was an evidence of a statistically significant use of forceps delivery in group II (supine position) than group I (squatting position) (P = 0.003); episiotomy extension, and second-degree and third-degree perineal tears (Po0.05). However, there was no evidence of a statistically significant difference in the incidence of shoulder dystocia, retained placenta, or postpartum hemorrhage between both groups (P40.05). Fetal outcomes, in terms of the Apgar score, neither the 1-min mean Apgar score nor the 5-min mean Apgar score, were statistically significantly different from one group to the other. ConclusionThe use of the squatting position in managing the second stage of labor results in less instrumental delivery, extension of episiotomy, perineal tear, and shoulder dystocia compared with the supine position. Both methods showed no statistically significant difference in terms of fetal well-being or the need for fetal resuscitation.