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Meta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP)

Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA

Surg Laparosc Endosc Percutan Tech, 2015 Jun;25(3):185-203.
PMID: 25799261 DOI: 10.1097/SLE.0000000000000142

The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.
Fulltext Anterior dor or posterior toupet with Heller myotomy for achalasia cardia: a systematic review and meta-analysis

Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA

World J Surg, 2019 06;43(6):1563-1570.
PMID: 30756164 DOI: 10.1007/s00268-019-04945-9

BACKGROUND AND AIMS: Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

MATERIAL AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

RESULTS: Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI 0.47 to 0.99; P
Suture Cruroplasty Versus Mesh Hiatal Herniorrhaphy for Large Hiatal Hernias (HHs): An Updated Meta-Analysis and Systematic Review of Randomized Controlled Trials

Memon MA, Siddaiah-Subramanya M, Yunus RM, Memon B, Khan S

Surg Laparosc Endosc Percutan Tech, 2019 Aug;29(4):221-232.
PMID: 30855402 DOI: 10.1097/SLE.0000000000000655

BACKGROUND: To explore the clinical outcomes, safety and effectiveness of suture cruroplasty versus mesh repair for large hiatal hernias (HHs) by an updated meta-analysis.
MATERIAL AND METHODS: Randomized controlled trials evaluating the effects of these 2 treatment modalities were searched from PubMed and other electronic databases between January 1991 and July 2018. The outcome variables analyzed included operating time, complications, recurrence of HH or wrap migration, reoperation, hospital stay and quality of life.
RESULTS: Five randomized controlled trials totaling 478 patients (suture=222, mesh=256) were analyzed. For reoperation variable, the odds ratio was significantly 3.26 times higher for the suture group. For recurrence of HH, the odds ratio for the suture group was nonsignificantly 1.65 times higher compared with the mesh group. Comparable effects were noted for all other variables.
CONCLUSIONS: Mesh repair seems to be superior to suture cruroplasty for large HH repair. Therefore, the routine use of mesh may be advantageous in selected cases.
Systematic Reviews: Understanding the Best Evidence For Clinical Decision-making in Health Care: Pros and Cons

Memon MA, Khan S, Alam K, Rahman MM, Yunus RM

Surg Laparosc Endosc Percutan Tech, 2020 Dec 04;31(2):234-240.
PMID: 33284258 DOI: 10.1097/SLE.0000000000000889

In the era of evidence-based decision-making, systematic reviews (SRs) are being widely used in many health care policies, government programs, and academic disciplines. SRs are detailed and comprehensive literature review of a specific research topic with a view to identifying, appraising, and synthesizing the research findings from various relevant primary studies. A SR therefore extracts the relevant summary information from the selected studies without bias by strictly adhering to the review procedures and protocols. This paper presents all underlying concepts, stages, steps, and procedures in conducting and publishing SRs. Unlike the findings of narrative reviews, the synthesized results of any SRs are reproducible, not subjective and bias free. However, there are a number of issues related to SRs that directly impact on the quality of the end results. If the selected studies are of high quality, the criteria of the SRs are fully satisfied, and the results constitute the highest level of evidence. It is therefore essential that the end users of SRs are aware of the weaknesses and strengths of the underlying processes and techniques so that they could assess the results in the correct perspective within the context of the research question.
The relationship between age of smoking initiation and current smoking: an analysis of school surveys in three European countries

Reidpath DD, Ling ML, Wellington E, Al-Sadat N, Yasin S

Nicotine Tob Res, 2013 Mar;15(3):729-33.
PMID: 22990215 DOI: 10.1093/ntr/nts177

INTRODUCTION: It is held that younger smoking initiates are more likely to become regular smokers. The definitions of smoking initiation (a puff, part of a cigarette, a whole cigarette) are inconsistent and raise questions about the robustness of the view. We sought to re-examine the relationship using adolescent smoking data from 3 European countries.
METHODS: A stratified secondary, logistic regression analysis of Global Youth Tobacco Survey data was conducted using a design-based analysis. Subgroup analyses were conducted of 13- to 15-year olds from Latvia (high smoking prevalence), Slovenia (moderate prevalence), and Montenegro (low prevalence) who had initiated smoking. The outcome was current smoking--smoking everyday for the past 30 days, or smoking 10 or more days in the past 30 days. Smoking initiation was operationalized as a single puff of a cigarette, and age of smoking initiation was a derived continuous measure.
RESULTS: In Latvia, there was a significant association between age of smoking initiation and current smoking for males (p < .05) and females (p < .001) when smoking was operationalized as smoking every day. It was only significant in female adolescents (p < .001) for smoking 10 or more days. In Slovenia and Montenegro, there was no significant relationship between age of smoking initiation and current smoking for either males or females.
CONCLUSIONS: The evidence about the relationship between age of smoking initiation and current smoking is not clear. Explanations for the findings may relate to a lack of power, the specificity of the measure, or problems with the theory.
Gastroesophageal reflux disease following laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass: meta-analysis and systematic review of 5-year data

Memon MA, Osland E, Yunus RM, Alam K, Hoque Z, Khan S

Dis Esophagus, 2024 Feb 29;37(3).
PMID: 37935430 DOI: 10.1093/dote/doad063

To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I2 = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I2 = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I2 = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.
Fulltext The effect of laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass on gastroesophageal reflux disease: An updated meta-analysis and systematic review of 5-year post-operative data from randomized controlled trials

Memon MA, Osland E, Yunus RM, Hoque Z, Alam K, Khan S

Surg Endosc, 2024 Nov;38(11):6254-6269.
PMID: 39384655 DOI: 10.1007/s00464-024-11303-x

BACKGROUND: To evaluate 5-year effect of laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) solely based on randomized controlled trials (RCTs).
METHODS: A systematic review and meta-analysis of 5-year postoperative GERD data comparing LVSG and LRYGB in adults were undertaken. Electronic databases were searched from January 2015 to March 2024 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was applied to estimate pooled odds ratio where meta-analysis was possible. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool 2 and GRADE.
RESULTS: Five RCTs were analysed (LVSG n = 554, LRYGB n = 539). LVSG was associated with increased adverse GERD outcomes compared to LRYGB at 5 years. The odds for revisional surgery to treat GERD in LVSG patients were 11 times higher compared to LRYGB (OR 11.47, 95% CI 1.83 to 71.69; p = 0.02; I2 = 0% High level of certainty). Similarly pharmacological management for increasing GERD was significantly more frequent in LVSG patients compared to LRYGB (OR 3.89, 95% CI 2.31 to 6.55; p ≤ 0.01; I2 = 0% Moderate level of certainty). Overall, LVSG was associated with significantly more interventions (both medical and surgical) for either worsening GERD and/or development of de novo GERD compared to LRYGB (OR 5.98, 95% CI 3.48 to 10.29; p ≤ 0.01; I2 = 0%) Moderate level of certainty).
CONCLUSIONS: The development and worsening of GERD symptoms are frequently associated with LVSG compared to LRYGB at 5 years postoperatively requiring either initiation or increase of pharmacotherapy or failing that revisional bariatric surgery. Appropriate patient/surgical selection is crucial to reduce these postoperative risks of GERD.
Effect of Fish Meal Substitution with Black Soldier Fly (Hermetia illucens) on Growth Performance, Feed Stability, Blood Biochemistry, and Liver and Gut Morphology of Siamese Fighting Fish (Betta splendens)

Kari ZA, Téllez-Isaías G, Hamid NKA, Rusli ND, Mat K, Sukri SAM, et al.

Aquac Nutr, 2023;2023:6676953.
PMID: 39553242 DOI: 10.1155/2023/6676953

Insects such as black soldier fly larvae (BSFL) are gaining interest among researchers and the aquafeed industry due to the fluctuating price and supply of fish meal (FM). This study evaluated the growth performance, feed stability, blood biochemistry, and liver and gut morphology of Betta splendens using BSFL as an alternative to FM. Five formulated diets were prepared: 0% BSFL, 6.5% BSFL, 13% BSFL, 19.5% BSFL, and 24.5% BSFL. The expansion rate, pellet durability index, floatability, bulk density, and water stability of the prepared feed have been assessed. Except for the diameter of the feed, all the parameters studied differed significantly (p < 0.05) across the experimental diets. After 60 days, the fish fed with 13% BSFL had the highest final length, final weight, net weight gain, specific growth rate, weight gain, and gastrointestinal weight, with mean and standard deviation values of 3.97 ± 0.43 cm, 3.95 ± 0.1 g, 2.78 ± 0.1 g, 4.63 ± 0.17, 4.65 ± 0.13, 237.26 ± 7.9%, and 0.04 ± 0.01 mg, respectively. Similar blood haematology and biochemical properties, including corpuscular volume, lymphocytes, white blood cells, red blood cells, haematocrit, albumin, and alkaline phosphatase, were the highest (p < 0.05) in the 13% BSFL diet group compared to the other treatment groups. In addition, BSFL had a significant impact (p < 0.05) on villus length, width, and crypt depth for the anterior and posterior guts of B. splendens. The 13% BSFL diet group had an intact epithelial barrier in the goblet cell arrangement and a well-organized villus structure and tunica muscularis, compared to the other treatment groups. Furthermore, the liver cell was altered with different BSFL inclusions; the 13% FM group demonstrated better nuclei and cytoplasm structure than the other treatment groups. In conclusion, replacing 13% FM with BSFL could improve the growth performance, blood parameters, and liver and intestine morphology of B. splendens, thus providing a promising alternative diet for ornamental freshwater fish.
Fulltext Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic

Bahar Moni AS, Abdullah S, Bin Abdullah MFIL, Kabir MS, Alif SM, Sultana F, et al.

PLoS One, 2021;16(9):e0257304.
PMID: 34506576 DOI: 10.1371/journal.pone.0257304

INTRODUCTION: The COVID-19 pandemic has enormously affected the psychological well-being, social and working life of millions of people across the world. This study aimed to investigate the psychological distress, fear and coping strategies as a result of the COVID-19 pandemic and its associated factors among Malaysian residents.
METHODS: Participants were invited to an online cross-sectional survey from Aug-Sep 2020. The study assessed psychological distress using the Kessler Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, and coping strategies using the Brief Resilient Coping Scale. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders.
RESULTS: The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) years, and most of them were females (67.1%). Half of the participants had an income source, while 216 (30%) identified themselves as frontline health or essential service workers. People whose financial situation was impacted due to COVID-19 (AOR 2.16, 95% CIs 1.54-3.03), people who drank alcohol in the last four weeks (3.43, 1.45-8.10), people who were a patient (2.02, 1.39-2.93), and had higher levels of fear of COVID-19 (2.55, 1.70-3.80) were more likely to have higher levels of psychological distress. Participants who self-isolated due to exposure to COVID-19 (3.12, 1.04-9.32) and who had moderate to very high levels of psychological distress (2.56, 1.71-3.83) had higher levels of fear. Participants who provided care to a family member/patient with a suspected case of COVID-19 were more likely to be moderately to highly resilient compared to those who did not.
CONCLUSION: Vulnerable groups of individuals such as patients and those impacted financially during COVID-19 should be supported for their mental wellbeing. Behavioural interventions should be targeted to reduce the impact of alcohol drinking during such crisis period.