Objectives: We aimed to analyze the laboratory data of coronavirus disease 2019 (COVID-19) patients for clinical help, to overcome the vulnerabilities of reverse transcription–polymerase chain reaction testing for diagnosing COVID-19, and to reduce the number of negative results when diagnosing, particularly in global regions which are recognized to have limited resources. Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors performed a systematic literature review, using three databases to assess laboratory data of COVID-19-confirmed cases, and the articles that described significant laboratory irregularities were ultimately chosen. Crosschecking was performed on the references of these articles in order to identify further studies. The statistical software R version 3.6.1 was used for meta-analysis of COVID-19 studies. Results: A total of 13 relevant articles were included. They yielded a total of 2662 individuals who tested positive for COVID-19. The analysis results demonstrated that male patients comprised a more substantial proportion, accounting for 57.9% of the total. The principal laboratory findings of the COVID-19 patients indicated that they commonly had lymphocytopenia 0.943 (confidence interval [CI]: 0.857–1.03), high D-dimer 0.459 (CI: 0.237–0.6808), high procalcitonin 0.089 (CI: 0.066–0.111), high C-reactive protein 17.203 (CI: 6.520–27.886), and high lactate dehydrogenase 278.265 (CI: 238.995–317.535). Conclusions: Infection with COVID-19 is associated with significant laboratory irregularities. The increased focus must be applied to laboratory parameters to quickly identify a large number of infected patients and asymptomatic carriers, prevent virus transmission, and assure timely treatment of patients, particularly in regions characterized by limited resources.

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Background: We aimed to characterize the clinical presentation of primary and secondary Sjögren's syndrome (SS) among patients in Benghazi, Libya. Patients and Methods: Sixty consecutive patients (55 females and 5 males) diagnosed with SS according to 2016 European–American consensus criteria were studied. Patients with chronic hepatitis C virus, human immunodeficiency virus infection, and previous lymphoproliferative processes were excluded. Results: The mean age at the time of diagnosis was 41.9 ± 9.9 years (25–56 years). Seventeen patients (28.3%) had primary SS (pSS). At diagnosis, commonly reported symptoms included dry mouth (52; 86.7%), dry eyes (55; 91.7%), dental caries (25; 41.7%), and oral candidiasis (20; 33.3%). Schirmer's test was positive in seven patients (11.7%). The most common extraglandular manifestations were arthralgia and arthritis (49; 81.7%), Raynaud's phenomenon (23; 38.3%), and interstitial lung disease (9; 15%). Both pSS and secondary SS (sSS) were associated with lymphocytosis. Abnormal thyroid disease was reported in 14 (23.3%). sSS was mostly associated with rheumatoid arthritis 28 (46.7%), followed by systemic lupus erythematosus 11 (18.3%). Fifty-three patients (88.3%) had positive rheumatoid factor (RF) and 18 patients (30%) had positive antinuclear antibodies (ANAs). RF was strongly associated with sSS and Sicca symptoms with P = 0.004 and 0.001, respectively, while ANA positivity was strongly associated with pSS and extraglandular manifestations (P = 0.001 and P = 0.003, respectively). Conclusions: This is the first series of SS from Libya. It should help understanding the characteristics and associations that should help understand the global picture.

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Kidney transplant (KT) surgery can increase survival probability more than any other transplant. In this context, neurological complications could occur in an important percentage of individuals because this surgery is considered one of the most common organ transplantations. One rare type of neurological complication, which can occur after KT surgery, is the femoral motor neuropathy. We aimed to evaluate the clinical epidemiological profile and pathological mechanisms of femoral motor neuropathy after KT surgery. Relevant reports in six databases were identified and reviewed by two reviewers without language restriction. Seventeen reports of 183 cases from ten countries, more one unpublished case from our institution were assessed. The mean age was 39 years (range 5–69) with male sex (62.5%) and Asiatic origin predominance. The central primary kidney disease leading to renal failure was essential hypertension. The mean time from KT surgery to the onset of femoral neuropathy was 1.78 days, and the time from the occurrence of neuropathy to recovery was 6 months. The incidence of femoral neuropathy after KT surgery was 1.85%. The current review provides four possible mechanisms related to this complication, but maybe these explanations lead to a misunderstanding of the main risk factors for the development of femoral neuropathy. Furthermore, studies with current surgical techniques should be investigated because most of the data come from the old literature. Therefore, prospective studies and reports assessing the graft-recipient ratio and management options should be done.

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Gastric cancer is a heterogeneous, multifactorial, aggressive disease that has been and remains one of the most common causes of cancer-related deaths and a significant public health issue worldwide. Currently, gastric cancer shows decreasing trends in its incidence and mortality in some geographic areas; however, the disease still shows a poor prognosis and remains difficult to cure. The prognosis for gastric cancer patients depends on the stage at which the gastric cancer is detected, and complete excision of the cancer is the only proven curative option. Gastric cancer prevention remains a priority. Patients at higher risk should be screened for early detection and chemoprophylaxis. Surgical resection enhanced by standardized lymphadenectomy remains the gold standard in the treatment of gastric cancer. Systemic therapy improves long-term disease-free survival compared to surgical treatment alone. Palliative chemotherapy in patients with inoperable gastric cancer prolongs survival and improves the quality of life. Demographic, ecological, environmental, cultural, and genetic variables all contribute to the heterogeneity of gastric cancer; however, environmental risk factors play an important role throughout all the stages of the disease progression, management, and surveillance. In this review, we address the role of important environmental risk factors in the onset of gastric cancer and highlight the current treatment modalities and prevention measures.

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Introduction: Acute respiratory infections (ARIs) are the most frequent infections of childhood. They continue to be the most common leading cause of acute illnesses and account for many hospital admissions worldwide. Objectives: We determined the ARIs among children admitted to the Pediatric Department at Tripoli University Hospital over a period of 3 months. Patients and Methods: In this cross-sectional study on risk factors of ARIs among children <5 years old, diagnosis was based on clinical features according to WHO guideline criteria. A pro forma was used to collect information from the child's mother, including sociodemographic factors, clinical profile, perinatal history, family history of atopy or other associated medical problems, nutritional factors, environmental factors, and type of respiratory tract infection. Results: A total of 200 children with different respiratory illnesses admitted to the Pediatric Department were included. In this study, severe pneumonia was the most common illness; the age of the admitted cases ranged from 21 days to 4.5 years; 56.5% were boys and urban residents account for 76% from the total. Nearly 53% of the cases were from families with low income, and 3.5% of the participated children in this study had missed doses of the immunization schedule. In 88% of the cases, cough was the main presenting symptom followed by shortness of breath in 83.5%. Almost 58.5% of the children had a positive family history of atopy, and only 8% of cases were exclusively breastfed for their first 6 months of age. Conclusions: Lower respiratory infections are more prevalent among children under the age of 5. Younger age, male gender, urban residence, positive family history of atopy, lack of breastfeeding, and indoor air smoke were the common risk factors for ARIs.

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Drug-induced immune hemolytic anemia (DIIHA) is a rare adverse reaction that causes secondary autoimmune hemolytic anemia in susceptible patients. Drug-induced antibodies and nonimmunological protein absorption are the known mechanisms associated with DIIHA. The two most common reported antibiotics to cause drug dependent antibodies are cephalosporin and penicillin. The author reports two rare cases of DIIHA. The first case is a middle-aged woman clinically diagnosed with community-acquired pneumonia, which develops hemolytic anemia secondary to ceftriaxone. The second case is an elderly gentleman who developed DIIHA secondary to piperacillin–tazobactam that started managing gastrostomy site infection. Both patients had hypoxemia and shortness of breath secondary to drop in hemoglobin, but the outcome was uneventful. Antibiotic-induced hemolytic anemia can develop as early as 2 days after starting the antibiotic. Therefore, early diagnosis and discontinuation of the offending agent can prevent poor prognosis.

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Objective: The objective of this study was to assess the effect of Ramadan fasting on blood pressure, fasting glucose, lipid profile, and serum proteins between non-Muslim and fasting Muslim students. Methodology: The study was conducted on undergraduate medical students of a medical university of Karachi. Participants were invited for data collection: in the last 10 days of Shaban, Ramadan, and Shawwal. Along with blood pressure, height, and weight were measured and a sample of 10 cc blood was also drawn in each visit. Blood samples were analyzed for glucose, lipid profile, and serum protein. Two samples, “t”-test and repeated measure design analysis of variance were utilized for statistical analysis. Results: Sixty Muslims and 15 non-Muslim students completed all the three visits. Seventy-five percent were females. Mean systolic blood pressure reduced significantly in Ramadan. Mean diastolic blood pressure reduced noticeably in Ramadan and Shawwal for non-Muslim students and minor changes occurred in Muslim students. Even though the fasting blood sugar increased insignificantly from Shaban to Ramadan in the total sample, but the increment among Muslim students showed a significant increase. The mean cholesterol value of Muslim students significantly increased in Ramadan but decreased in Ramadan for non-Muslim students. The mean value of low-density lipoprotein increased significantly in Ramadan for Muslim students but decreased in Ramadan for non-Muslim. The mean values of triglyceride showed a significant reduction from Shaban to Ramadan and then increased in Shawwal. Conclusion: The study revealed that the environment of Ramadan was helpful to the non-Muslim students more than the Muslim students, with respect to the biochemical parameters.

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Background: Guidelines on indications for adrenaline auto-injector (AAI) exist. There is no consensus on the prescription criteria of AAI. However, the European Academy of Allergy and Clinical Immunology (EAACI) and the United Kingdom (UK) resuscitation council provide guidances on prescription practices. Objectives: This study aims to investigate prescription practices of AAIs prescribed by members of four regional pediatric allergy groups (PAGs) in the UK. Materials and Methods: An online questionnaire was e-mailed to the PAGs members. Scenarios of absolute and relative indications for AAI prescriptions (as per the EAACI guidelines) were presented to clinicians to establish whether they would prescribe an AAI. Results: One hundred and seventeen responses from members of PAGs working in four different regions were received. Practices were similar in scenarios of absolute indications for AAI. Intraregional (variations within the regions) as well as interregional (variations between the regions) variations were observed. There were statistically significant interregional differences in scenarios of relative indications for AAIs. For mild reaction to peanut (PN)/tree nut (TN), AAI would be prescribed more often by doctors from Wessex clinicians (67%) than those from Midlands (31%), London (24%), and Northern (20%) (P < 0.05). Whereas for a previous mild reaction to trace of PN/TN, Northern clinicians (47%) would prescribe AAI less often than those from the Midlands (78%), Wessex (82%) and London (79%) (P < 0.05). Intraregional differences were also observed. Conclusions: There is a consensus with absolute indications for AAI prescriptions across and within regions. There are intraregional and interregional differences in prescribing practices in scenarios where there is a relative indications for an AAI. Better intra- and interregional work could improve consistency or practice across the country are explain differences in practice.

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A large number of presentations on clinical, basic science, and genetics were discussed at the first virtual American Diabetes Association conference held in June 2020. Studies of relevance to practicing clinicians included the results of the VERTIS-CV study that confirmed the SGLT2 inhibitor ertugliflozin was similar to other drugs in the group in terms of cardiovascular safety, heart failure, and renal benefits. A symposium on heart failure also highlighted the benefits of this group of drugs for treating heart failure both in patients with and without diabetes. The new Food and Drug Administration guidance for new diabetes drugs was presented and created a lively discussion about the pros and cons of these new rules. Another lively debate on whether there is a place for sulfonylureas in the era of the modern diabetes medications reached the conclusion that there is probably still a place for these old and established drugs. On the lipid front, the safety of statins was emphasized in face of negative publicity in the social media, while the recently published REDUCE-IT study showed that tackling low-density lipoprotein cholesterol only may not be enough in the battle against increased cardiovascular risk in diabetes. Looking to the future, a weekly basal insulin may be in sight in a few years' time.

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Periauricular sinuses are common and are often associated with other congenital anomalies. The most common type is the preauricular sinus followed by the postauricular variant. Intrapinna sinus is extremely rare with very few cases reported in literature. We present a 15-year-old male presented with recurrent perichondritis of his left pinna. Examination revealed a sinus opening in the pinna. The sinus along with its cul de sac was excised completely. We conclude that although intra-auricular sinuses are extremely rare, they should be kept in the differential diagnosis of a patient presenting with recurrent pinna perichondritis. The treatment includes complete excision of the sinus tract along with its sac.

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Objectives: The aim of this study is to compare the low-risk patients with the high- and very high-risk patients who choose to fast during Ramadan regarding the rates of breakfasting, hypoglycemia, hyperglycemia, hospitalization, and death. Patients and Methods: This is an observational, analytic, 1-month prospective, cohort study that involved patients with diabetes mellitus who choose to fast during the month of Ramadan in the Muslim year 1437. The patients were divided into two cohorts: Cohort 1 (high-risk) consisted of 83 patients who were categorized as high/very high-risk according to the International Diabetes Federation–Diabetes and Ramadan International Alliance guidelines on diabetes and Ramadan and Cohort 2 (low-risk) consisted of 65 patients categorized as moderate/low risk. Results: The overall of whole month fasting rate was 88% (100% in the low-risk group and 79% in the high-risk group, P = 0.000), and the rate of hypoglycemia was 12% (20.9% in the high-risk group vs. 0% in the low-risk group, P = 0.002). The rate of severe hyperglycemia was 7.7% (13.5% in the high-risk group vs. 0% in the low-risk group, P = 0.14). Conclusions: Patients in the high-risk category were significantly more likely to breakfasting during Ramadan than those in the low-risk category. Hypoglycemia was significantly higher in the high-risk group. The rates of severe hyperglycemia, hospitalization, and presumed mortality were not significantly higher in the high-risk group.

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The use of an ileal segment has been previously described in the treatment of long-segment ureteral strictures. The aim of this study was to describe the use of a skin and muscle flap tube as an alternative procedure to perform ureterocutaneostomy in patients who are not eligible for the use of bowel segments in the urinary diversion or when the patients are at high risk of morbidity and mortality. We describe the case of a 74-year-old male patient. The technique was performed without complications and complete recovery of the patient. No anastomotic leaks and stenosis were reported at a follow-up of 36 months. The use of a skin and muscle flap tube can be a feasible and safe procedure in case of huge loss of tissue (long-segment ureteral strictures), in patients whose underwent radical cystectomy with UCS, in particular when the patients are not eligible for the use of bowel segments in the urinary diversion or when the patients are at high risk of morbidity and mortality.

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