As the prevalence of gastro-oesophageal reflux disease (GORD) continues to rise, diagnostic modalities are crucial to differentiate GORD from related and overlapping conditions such as Barrett's oesophagus (BO), eosinophilic oesophagitis (EO) and jackhammer oesophagus (JO). Patient medical history and symptom assessment are critical in the diagnosis of GORD, and endoscopy should be utilized when patients present with alarming symptoms or are unresponsive to proton pump inhibitors. Ambulatory pH monitoring is the modality with the highest sensitivity and specificity; it is particularly helpful in unclear cases and during preoperative testing. BO is a consequence of GORD and a well-known preneoplastic condition; endoscopic evaluation is required. EO and JO are important overlapping conditions that should be differentiated when diagnosing GORD; JO is typically diagnosed using high-resolution manometry whereas EO is typically diagnosed by measuring rates of infiltrating eosinophils.

One of the most innovative fields in modern medicine is surgical therapy for gastro-oesophageal reflux disease (GORD). As Western lifestyle and modern working conditions have led to a burdensome increase in people experiencing symptoms of GORD, academic surgeons have needed to develop strategies for patient-adapted treatment. Several new techniques are challenging the standard surgical approach of laparoscopic fundoplication. First and foremost is magnetic sphincter augmentation, a powerful new tool that uses magnetic force to strengthen the lower oesophageal sphincter; inclusion criteria for this treatment are relatively extensive and outcomes are promising. Alternatively, electrical sphincter stimulation is a minimally invasive implantation process associated with a reduction in oesophageal acid exposure time and improved quality of life. Both of these therapies are available to patients at our centre as part of our individualized treatment for GORD. Endoscopic fundoplication is yet another technique enriching the pool of newly developed antireflux therapies; promising initial results, including a notable reduction in gastro-oesophageal reflux, will have to prove durable.

Serum interleukin 8 (IL-8) levels have been shown to increase in post-relapse survivors of breast cancer, and its levels are linked with a poor prognosis and progression of breast tumours. This study aims to assess serum IL-8 levels and the components of metabolic syndrome in breast cancer survivors, taking into consideration their menopausal status. This observational study was carried in Nanakali Hospital in Erbil, Kurdistan. A total of 120 women with a history of breast cancer were enrolled and divided into premenopausal (group I, n = 30) and postmenopausal (group II, n = 90) groups. Cardiometabolic determinants including body mass index, blood pressure, fasting serum lipids and lipoproteins were measured. Markers that related to breast cancer, including high-sensitivity C-reactive protein (hs-CRP) and IL-8, were determined. Group II patients had significantly higher levels of atherogenic lipids than group I patients. The mean levels of hs-CRP and IL-8 were significantly higher in group II {3.040 mg/l [standard deviation (SD) ± 0.762] and 424.7 pg/ml (SD ±87.3 pg/ml), respectively} than in group I [2.435 mg/l (SD ±0.891) and 354.6 pg/ml (SD ±109.4), respectively] patients. We conclude that postmenopausal women with breast cancer are at a significant risk of dyslipidaemia and have higher levels of inflammatory and pro-tumorigenic factors than premenopausal women.

Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone titanium cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone titanium mesh cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06° [standard deviation (SD) 10.92°], which improved to –5.51° (SD 77°) (P < 0.05). When comparing the visual analogue scores, there was also a statistically significant difference in pain improvement. All patients underwent single-stage radical debridement, decompression and instrumentation. Anterior column reconstruction was performed in all patients using a stand-alone titanium cage. The use of titanium cages effectively corrects sagittal deformity in the TB-affected spine with no donor site morbidity.

Glycaemic control is fundamental in the management of diabetes. The primary objective of this study was to evaluate the effectiveness of insulin glargine administered in combination with oral antidiabetic drugs (OADs) in patients with type 2 diabetes mellitus (T2DM) uncontrolled on pre-mixed insulin-based therapy in the United Arab Emirates, Oman and Kuwait. The secondary objectives were to observe the proportion of patients achieving the targeted glycated haemoglobin (HbA_1c) level of < 7% and to describe the safety profile. In this 16-week non-interventional, prospective, multicentre, non-comparative, post-authorization study, we included adults with T2DM who failed to achieve HbA_1c < 7% after 3–12 months on pre-mixed insulin-based therapy and whose physician had decided (at his or her discretion) to switch the patient's treatment to basal insulin plus OADs with insulin glargine (one injection), or a basal insulin plus insulin glargine (one injection) and one injection of short-acting insulin regimen. Change in HbA_1c and fasting blood glucose (FBG) at 16 weeks, and the proportion of patients achieving HbA_1c < 7% at 16 weeks were evaluated. Safety was assessed by occurrence of adverse events, primarily hypoglycaemia. Out of 397 patients enrolled, 375 were analysed and 361 were included in the study population. In the study population, the mean reduction in HbA_1c and FBG from baseline to the end point was 1.60% [standard deviation (SD) ± 1.07%] (P < 0.001) and 76.26 (SD ± 57.00) mg/dl] (P < 0.001), respectively, corresponding to a 23% and 34% relative reduction, respectively. The percentage of patients achieving HbA_1c level < 7% was significantly higher at 16 weeks than at 4 weeks (42.7% vs. 7.6%). A total of 24 patients (6.04%) reported hypoglycaemia at the 16-week visit. A significant mean reduction in HbA_1c and FBG levels (P < 0.001) was observed among the treatment subgroups (insulin glargine alone and insulin glargine + short-acting insulin). In this observational study, initiation of insulin glargine plus OADs in patients with T2DM who failed to achieve glycaemic control on pre-mixed insulin led to significant overall improvements in HbA_1c and FBG levels.

The historical publication by Stone and Fabian (Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg 1979; 190:430–6) has modernized the management of colonic injuries, ending the once ongoing debate following publication by Ogilvie (Ogilvie WH. Surgical lessons of war applied to civil practice. Br Med J 1945; 1:619–23). However, the recent introduction and popularity of damage control laparotomy has revived the debate on the safety of delayed primary repair for colonic injuries. As a tertiary referral trauma centre, Rashid Hospital, Dubai, frequently receives polytrauma patients with associated abdominal trauma requiring damage control laparotomies. The aim of this article is to review our experience of colonic injuries to find out if delayed primary repair has a place in practice and issues regarding its safety.

Aarskog–Scott syndrome (AAS), which is also known as faciogenital dysplasia, is a rare developmental disorder inherited mainly as an X-linked recessive trait. Broad hands with brachydactyly, facial clefts, a small nose and an increased upper-to-lower-segment ratio represent the features amenable to prenatal diagnosis. We report an ultrasound diagnosis at 13 gestational weeks in a family with a history of the disease. Genetic testing in the neonate confirmed the familial mutation in the FGD1 gene, which has not been described so far in AAS (c.53del–p.Pro18Argfs*106). This report demonstrates that couples with a history of AAS can be reassured that the fetus is likely to be disease free if the first trimester ultrasound shows no features of the syndrome.

Laparoscopic sleeve gastrectomy is a safe and accepted procedure for morbid obesity to reduce weight with an overall low rate of complications; the incidence of major blood vessel injury reported in the literature is 0.1%. In our patient, sudden bradycardia and a fall in blood pressure and oxygen saturation were immediately identified. A camera was inserted and revealed bleeding under the first trocar, necessitating conversion of the laparoscopic procedure to laparotomy. Management included repair of injuries to the aorta and the inferior vena cava by the vascular surgeon, initial supportive therapy with crystalloids, and initiation of inotropic agents and vasopressor drugs. A predefined massive transfusion protocol of red blood cells, fresh-frozen plasma/cryoprecipitate and platelet units (random donor platelets) in each pack in a 1 : 1 : 1 ratio was followed.

Malaria can be diagnosed and treated in 48 hours; however, complications such as splenic rupture, although rare, can still occur. Infections caused by Plasmodium vivax are usually benign and complications are uncommon. A 29-year-old Pakistani male driver with no past medical history of malaria presented to Rashid Hospital, United Arab Emirates, having suffered epigastric pain, vomiting, diarrhoea and fever for 1 day. After serial investigations he was diagnosed as having P. vivax malaria, which was complicated by a ruptured spleen. Later he developed shock as a result of the splenic rupture and hypovolaemia. Urgent laparotomy was performed and splenectomy undertaken to secure haemostasis. The patient was discharged after 28 days following treatment of his initial symptoms and when his condition had stabilized.

Tarlov cysts, also known as perineural or sacral nerve root cysts, are cerebrospinal fluid-filled dilatations of the nerve root sheath most commonly found at the sacral spine, near the dorsal root ganglion. The cysts are relatively rare and usually asymptomatic, but some can exert pressure on the nerve root, causing perineal pain/discomfort or lower back pain or sphincter/sexual dysfunction. Tarlov (perineural) cysts of the nerve roots were first described in 1938.