Monkeypox virus (MPOX) is a zoonotic disease in humans. It is similar genetically to its virus family member, smallpox. This virus has been studied since the 1970s. The virus remains endemic to the Congo and West African regions, but non-endemic spreads have been cited. The most recent non-endemic outbreak in the spring of 2022 amidst the current COVID-19 pandemic is of interest due to its impact on global medical, economic, and societal climates. This literature review aims to highlight the virology, clinical signs and symptoms, diagnosis, prevention, and treatment of MPOX and discuss the social implications of the recent 2022 outbreak.We hope this review can pinpoint important clinical pearls of the MPOX virus and its societal impacts to further promote important discussion of this virus and its disease.

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INTRODUCTION: Surgical gastroenterostomy has been the traditional approach to manage malignant gastric outlet obstruction (GOO). With advances in Endoscopic Ultrasound (EUS) technology and availability of dedicated devices and stents for EUS scopes, EUS guided gastroenterostomy (GE) is emerging as an alternative to surgical gastroenterostomy. Recently studies have been published comparing the outcomes between these two approaches. We performed a systematic review and meta-analysis of studies that compare the outcomes between the two approaches (EUS-GE vs Surgical GE). METHODS: We performed a systematic search of multiple databases through May 2019 to identify studies that compared outcomes of EUS-GE vs surgical GE in management of malignant gastric outlet obstruction. Pooled odds ratios (OR) of technical success, clinical success and adverse events between EUS-GE and surgical GE groups were calculated. RESULTS: Three comparative studies with a total of 171 patients; were included in the analysis. The pooled OR for technical success of EUS-GE in comparison to surgical GE was 0.16 (95% CI: 0.03-0.86; P = 0.033; I2 = 2%). The pooled OR for clinical success (EUS-GE vs surgical GE) was 0.98 (95% CI: 0.13-7.48; P = 0.984; I2 = 25%) The pooled OR for overall adverse events (EUS-GE vs surgical GE) was 0.35 (95% CI: 0.15-0.81; P = 0.014, I2 = 0%). There was minimal heterogeneity in the analysis. CONCLUSION: While EUS-GE is associated with similar rates of clinical success compared to surgical GE, the rate of overall adverse events is statistically lower. Hence in centers with expertise in EUS, EUS-GE could be considered as an effective alternate option.

Both ischemic and hemorrhagic strokes in children can be a complication of sickle cell disease, which also affects adults. The occurrence is high without any screening or preventative care. This review article found that although transcranial Doppler (TCD) has reduced the prevalence of stroke in pediatric patients, there is still a need for an epidemiological survey to define such screening for adults, the ideal dose of hydroxyurea to reduce the incidence of stroke, and to identify silent cerebral stroke to prevent its complications. Increased hydroxyurea prescription and specific antibiotic and vaccination regimes lowered the occurrence of this condition. In pediatric cases with a time-averaged mean of the maximal velocity greater than 200cm/s, transcranial Doppler screening and preventive chronic transfusion for at least the first year have lowered the occurrence of stroke by up to 10 times. The ideal dose of hydroxyurea is still debatable, but it seems to reduce the risk of the first stroke to a comparable level in the average population. Adult ischemic and hemorrhagic stroke prevention has not yet received the same attention. Though there are fewer studies, sickle cell disease is also more common than age-matched controls in terms of silent cerebral infarction on magnetic resonance imaging (MRI), as well as other neurological problems such as cognitive impairment, seizures, and headaches. Currently, there is no evidence-supported way to prevent ischemic stroke in adults at any age. Also, there is no defined ideal dose of hydroxyurea that can be helpful in preventing strokes. Data also lack a way to identify a silent cerebral infarction, so its complications can be prevented. An additional epidemiological survey may help in the prevention of the condition. The primary aim of this article was to emphasize the importance of information on clinical, neuropsychological, and quantitative MRI assessment of sickle cell patients to understand the epidemiology and etiology of stroke in sickle cell patients to prevent stroke and its related morbidity.