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Article: A Case of Gastrointestinal Stromal Tumour (GIST) in the Duodenum in a Young Adult.

Shanker, Dinesh Abhijeeth / Kumar, Sampath / Al-Mukhtar, Ahmed / Dube, Asha / Samuel, Nehemiah

2024 Volume 16, Issue 1, Page(s) e53331

Abstract: Gastrointestinal stromal tumours (GISTs) are rare gastrointestinal (GI) malignancies, but the most prevalent mesenchymal tumours of the GI tract arise from the interstitial cells of Cajal. They account for 1-3% of all GI malignancies, and only 3-5% of ... ...

Abstract	Gastrointestinal stromal tumours (GISTs) are rare gastrointestinal (GI) malignancies, but the most prevalent mesenchymal tumours of the GI tract arise from the interstitial cells of Cajal. They account for 1-3% of all GI malignancies, and only 3-5% of all cases of GIST are located at the duodenal. We present a case of a young adult who presented to the ED with symptoms of GI bleeding.
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.53331
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Calcifying fibrous tumour-a rare cause of anaemia.

Abd Kahar, Nurul Nadhirah / Al-Mukhtar, Ahmed

Journal of surgical case reports

2021 Volume 2021, Issue 1, Page(s) rjaa573

Abstract: Calcifying fibrous tumour (CFT) is a rare benign tumour with non-specific anatomical distribution. We describe a case of a patient who presented with chronic generalised fatigue secondary to anaemia. Her symptoms did not improve while being on oral iron ... ...

Abstract	Calcifying fibrous tumour (CFT) is a rare benign tumour with non-specific anatomical distribution. We describe a case of a patient who presented with chronic generalised fatigue secondary to anaemia. Her symptoms did not improve while being on oral iron replacement therapy. Further endoscopic investigations were unremarkable. She had a computed tomography scan showing masses in the right pleural base and in the spleen. She then underwent splenic biopsy that only showed inflammatory changes. As her symptoms persisted, she was worked up for elective laparoscopic splenectomy during which she was found to have multiple peritoneal deposits. Biopsies were taken and the splenectomy was abandoned. The biopsies eventually showed changes consistent with CFT. This was conclusive for diagnosis of multifocal CFT.
Language	English
Publishing date	2021-01-18
Publishing country	England
Document type	Case Reports
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rjaa573
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Article ; Online: Using Mixed Reality Simulation to Improve Junior Medical Trainees' Preparedness to Manage High-Acuity Trauma.

Clarke, Kirsty / Al-Mukhtar, Aws / Alim, Lina / Nimer, Amr / Hatfield, Emma / Sabharwal, Sanjeeve / Syed, Sadie

BMJ open quality

2024 Volume 13, Issue 2

Abstract: High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality ... ...

Abstract	High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.The Plan-Do-Study-Act quality improvement method was used to refine six emergency trauma vignettes compatible with an MR teaching platform. Each vignette was curated by a multidisciplinary team of orthopaedic surgeons, clinical fellows and experts in simulation-based medical education. As a baseline assessment, a 2-hour emergency trauma course was delivered using traditional didactic methods to a cohort of pre-registration medical students with no clinical exposure to high-acuity trauma (n=16). Next, we delivered the MR simulation to an equivalent cohort (n=32). Clinical knowledge scores derived from written test papers were recorded for each group during and 2 weeks after each course. Each attendee's end-of-rotation clinical supervisor appraisal grade was recorded, as determined by a consultant surgeon who supervised participants during a 2-week placement on a major trauma ward. Balancing measures included participant feedback and validated cognitive load questionnaires (National Aeronautics and Space Administration-Task Load Index).Overall, attendees of the MR simulation course achieved and sustained higher clinical knowledge scores and were more likely to receive a positive consultant supervisor appraisal. This project serves as a proof of concept that MR wearable technologies can be used to improve clinical knowledge recall and enhance the preparedness to practice of novice learners with otherwise limited clinical exposure to high-acuity trauma.
MeSH term(s)	United States ; Humans ; Augmented Reality ; Computer Simulation ; Education, Medical/methods ; Students, Medical
Language	English
Publishing date	2024-04-08
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2023-002575
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Article: Yield of testing for micronutrient deficiencies associated with pancreatic exocrine insufficiency in a clinical setting: An observational study.

Jalal, Mustafa / Campbell, Jennifer Anne / Tesfaye, Solomon / Al-Mukhtar, Ahmed / Hopper, Andrew Derek

World journal of clinical cases

2022 Volume 9, Issue 36, Page(s) 11320–11329

Abstract: Background: Pancreatic exocrine insufficiency (PEI) can be difficult to diagnose and causes maldigestion symptoms and malabsorption. There has been a number of studies that have identified PEI associated micronutrient deficiencies (PEI-MD), however ... ...

Abstract	Background: Pancreatic exocrine insufficiency (PEI) can be difficult to diagnose and causes maldigestion symptoms and malabsorption. There has been a number of studies that have identified PEI associated micronutrient deficiencies (PEI-MD), however there is variation in both the frequency and type of PEI-MD reported, with the majority of studies including patients with PEI due to chronic pancreatitis (CP) or CP without PEI. There is a paucity of information regarding the prevalence of PEI-MD in patients with PEI without CP and the yield of testing for PEI-MD in a clinical setting in patients with suspected benign pancreatic diseases. Aim: To prospectively assess the yield and type of PEI-MD in patients with and without PEI secondary to benign pancreatic disease. Methods: Patients investigated for maldigestion symptoms with Faecal Elastase-1 (FEL-1) and suspected or proven benign pancreatic disease were prospectively identified. At the time of FEL-1 testing, serum samples were taken for micronutrients identified by previous studies as PEI-MD: prealbumin, retinol binding protein, copper, zinc, selenium, magnesium and later in the study lipid adjusted vitamin E. FEL-1 was recorded, with a result < 200 µg/g considered diagnostic of PEI. Patients underwent computed tomography (CT) imaging when there was a clinical suspicion of CP, a new diagnosis of PEI recurrent, pancreatic type pain (epigastric abdominal pain radiating to back with or without previous acute pancreatitis attacks) or weight loss. Results: After exclusions, 112 patients were recruited that underwent testing for FEL-1 and PEI-MD. PEI was identified in 41/112 (36.6%) patients and a pancreatic CT was performed in 82 patients. Overall a PEI-MD was identified in 21/112 (18.8%) patients. The yield of PEI-MD was 17/41 (41.5%) if PEI was present which was significantly higher than those without 4/71 (5.6%) ( Conclusion: Testing for PEI-MD in patients with suspected pancreatic disease has a high yield, specifically when PEI and CP are found together. PEI-MD testing should include selenium, magnesium and prealbumin.
Language	English
Publishing date	2022-01-05
Publishing country	United States
Document type	Journal Article
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v9.i36.11320
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Article ; Online: The epidemiology of and management of pediatric patients with head trauma: a hospital-based study from Southern Sweden.

Al Mukhtar, Ali / Bergenfeldt, Henrik / Edelhamre, Marcus / Vedin, Tomas / Larsson, Per-Anders / Öberg, Stefan

Scandinavian journal of trauma, resuscitation and emergency medicine

2022 Volume 30, Issue 1, Page(s) 67

Abstract: Background: Traumatic brain injury (TBI) is a common cause of morbidity and mortality in children worldwide. In Scandinavia, the epidemiology of pediatric head trauma is poorly documented. This study aimed to investigate and compare the epidemiology and ...

Abstract	Background: Traumatic brain injury (TBI) is a common cause of morbidity and mortality in children worldwide. In Scandinavia, the epidemiology of pediatric head trauma is poorly documented. This study aimed to investigate and compare the epidemiology and management of pediatric patients with isolated head trauma (IHT) and head trauma in connection with multitrauma (MHT). Methods: We conducted a retrospective review of medical records of patients < 18 years of age who attended any of the five emergency departments (ED) in Scania County in Sweden in 2016 due to head trauma. Clinical data of patients with IHT were analyzed and compared with those of patients with MHT. Results: We identified 5046 pediatric patients with head trauma, 4874 with IHT and 186 with MHT, yielding an incidence of ED visits due to head trauma of 1815/100,000 children/year. There was male predominance, and the median age was four years. Falls were the dominating trauma mechanism in IHT patients, while motor vehicle accidents dominated in MHT patients. The frequencies of CT head-scans, ward admissions and intracranial injuries (ICI) were 5.4%, 11.1% and 0.7%, respectively. Four patients (0.08%) required neurosurgical intervention. The relative risks for CT-scans and admissions to a hospital ward and ICI were 10, 4.5 and 19 times higher for MHT compared with IHT patients. Conclusion: Head trauma is a common cause of ED visits in our study. Head-CTs and ICIs were less frequent than in previous studies. MHT patients had higher rates of CT-scans, admissions, and ICIs than IHT patients, suggesting that they are separate entities that should ideally be managed using different guidelines to optimize the use of CT-scans of the head.
Language	English
Publishing date	2022-12-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-022-01055-9
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Article ; Online: Identification of "Digital Sarcopenia" Can Aid the Detection of Pancreatic Exocrine Insufficiency and Malnutrition Assessment in Patients with Suspected Pancreatic Pathology.

Jalal, Mustafa / Rosendahl, Jonas / Campbell, Jennifer A / Vinayagam, Ragu / Al-Mukhtar, Ahmed / Hopper, Andrew D

Digestive diseases (Basel, Switzerland)

2021 Volume 40, Issue 3, Page(s) 335–344

Abstract: Background: Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly ... ...

Abstract	Background: Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly recognised as a tool to diagnose sarcopenia. Objective: The aim of the study was to assess the prevalence of sarcopenia in patients with PEI secondary to benign disease using novel skeletal muscle recognition software. Methods: Prospective recruitment of patients referred for endoscopic ultrasound (EUS) with suspected pancreatic pathology. Patients with suspected pancreatic cancer on initial computed tomography (CT) were excluded. The diagnosis of chronic pancreatitis (CP) was based on CT and EUS findings. PEI was assessed with faecal elastase-1. Digital measurement of skeletal muscle mass identified sarcopenia, with demographic and comorbidity data also collected. Results: PEI was identified in 45.1% (46/102) of patients recruited, and 29.4% (30/102) had changes of CP. Sarcopenia was significantly more prevalent in PEI 67.4% (31/46) than no-PEI 37.5% (21/56) (37.5%), regardless of CP changes (p < 0.003). The prevalence of sarcopenia (67% vs. 35%; p = 0.02) and sarcopenic obesity (68.4% vs. 25%; p = 0.003) was significantly higher when PEI was present without a radiological diagnosis of CP. Multivariate analysis identified sarcopenia and diabetes to be independently associated with PEI (odds ratio 4.8 and 13.8, respectively, p < 0.05). Conclusion: Sarcopenia was strongly associated with PEI in patients undergoing assessment for suspected benign pancreatic pathology. Digital skeletal muscle assessment can be used as a tool to aid identification of sarcopenia in patients undergoing CT scan for pancreatic symptoms.
MeSH term(s)	Exocrine Pancreatic Insufficiency/diagnostic imaging ; Exocrine Pancreatic Insufficiency/epidemiology ; Humans ; Malnutrition/complications ; Malnutrition/diagnosis ; Malnutrition/epidemiology ; Pancreas/pathology ; Pancreatitis, Chronic/diagnosis ; Pancreatitis, Chronic/diagnostic imaging ; Prospective Studies ; Sarcopenia/diagnostic imaging ; Sarcopenia/epidemiology
Language	English
Publishing date	2021-06-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000517554
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Article ; Online: Autoimmune pancreatitis with concomitant autoimmune haemolytic anaemia.

Passby, Lauren / Harris, Matthew / Al-Mukhtar, Ahmed

BMJ case reports

2018 Volume 2018

Abstract: Autoimmune pancreatitis (AIP) is an infrequent cause of acute pancreatitis, being more commonly associated with chronic pancreatitis. AIP can be associated with other autoimmune manifestations, including Sjögren's, inflammatory bowel disease, primary ... ...

Abstract	Autoimmune pancreatitis (AIP) is an infrequent cause of acute pancreatitis, being more commonly associated with chronic pancreatitis. AIP can be associated with other autoimmune manifestations, including Sjögren's, inflammatory bowel disease, primary biliary cirrhosis, rheumatoid arthritis, hypothyroidism and sarcoidosis. Rarely, concurrent autoimmune haemolytic anaemia (AIHA) is observed, as seen in our case report of a 33-year-old postpartum woman.
MeSH term(s)	Adult ; Anemia, Hemolytic, Autoimmune/diagnosis ; Anemia, Hemolytic, Autoimmune/drug therapy ; Autoimmune Diseases/diagnosis ; Autoimmune Diseases/drug therapy ; Comorbidity ; Diagnosis, Differential ; Female ; Humans ; Pancreatitis, Chronic/diagnosis ; Pancreatitis, Chronic/drug therapy ; Postpartum Period ; Prednisolone/therapeutic use ; Treatment Outcome
Chemical Substances	Prednisolone (9PHQ9Y1OLM)
Language	English
Publishing date	2018-03-23
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2018-224280
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Article ; Online: Pancreatic enzyme replacement therapy following surgery for pancreatic cancer: An exploration of patient self-management.

Dunleavy, Lisa / Al-Mukhtar, Ahmed / Halliday, Vanessa

Clinical nutrition ESPEN

2018 Volume 26, Page(s) 97–103

Abstract: Background: For those diagnosed with pancreatic cancer, ill-addressed pancreatic exocrine insufficiency (PEI) following surgery can result in malnutrition related complications that may impact on predict mortality and morbidity. The use of pancreatic ... ...

Abstract	Background: For those diagnosed with pancreatic cancer, ill-addressed pancreatic exocrine insufficiency (PEI) following surgery can result in malnutrition related complications that may impact on predict mortality and morbidity. The use of pancreatic enzyme replacement therapy (PERT) is recommended and often demands a degree of patient self-management. Understanding more about how this treatment is managed is fundamental to optimising care. Objective: This study aimed to explore patient self-management of PERT following surgery for pancreatic cancer. Methods: Semi-structured interviews were conducted with nine participants. Eligible participants included adult patients who had undergone surgery for a malignancy in the pancreatic region and were prescribed PERT post-operatively. Inductive thematic analysis was used to analyse our findings. Results: Data analysis revealed three overarching themes; the role of professional support, factors influencing decisions to use PERT in symptom management and the challenges of socializing. The difficulties negotiated by participants were considerable as they struggled with the complexities of PERT. Symptom management and subsequently reported physical repercussions and undesirable social implications were problematic. Professional support was largely inconsistent and relinquished prematurely following discharge. Consequently, this impacted on how PERT was self-managed. Conclusion: Enabling patients to appropriately self-manage PERT may lessen the post-treatment burden. Our findings suggest that support should continue throughout the recovery phase and should address the patient's 'self-management journey'. Intervention by healthcare professionals, such as a specialist dietitian is likely to be beneficial. Furthermore there are focal issues, primarily explicit education and appropriately timed information that require consideration by those developing and delivering services.
MeSH term(s)	Adaptation, Psychological ; Adult ; Aged ; Enzyme Replacement Therapy/adverse effects ; Enzyme Replacement Therapy/methods ; Exocrine Pancreatic Insufficiency/diagnosis ; Exocrine Pancreatic Insufficiency/drug therapy ; Exocrine Pancreatic Insufficiency/etiology ; Exocrine Pancreatic Insufficiency/physiopathology ; Female ; Health Communication ; Health Knowledge, Attitudes, Practice ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Pancreatectomy/adverse effects ; Pancreatic Neoplasms/surgery ; Patient Education as Topic ; Physician-Patient Relations ; Qualitative Research ; Self Care/adverse effects ; Self Care/methods ; Socialization ; Treatment Outcome
Language	English
Publishing date	2018-05-04
Publishing country	England
Document type	Journal Article
ISSN	2405-4577
ISSN (online)	2405-4577
DOI	10.1016/j.clnesp.2018.04.007
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Article: Caseous mitral valve calcification and concurrent hypertrophic obstructive cardiomyopathy: A rare cause of stroke.

Ullah, Waqas / Haas, Donald / Almas, Talal / Al-Mukhtar, Aws- / Inayat, Asad

International journal of cardiology. Heart & vasculature

2020 Volume 30, Page(s) 100647

Keywords	covid19
Language	English
Publishing date	2020-09-29
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2020.100647
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Article ; Online: Atypical presentation of a spontaneous coeliac artery dissection resulting in jejunal ischaemia.

George, Jayan / Nathani, Harsh / Hu, Andrew / Al-Mukhtar, Ahmed

BMJ case reports

2017 Volume 2017

Abstract: We describe a case of a 59-year-old man with no significant medical history apart from a hiatus hernia and depression who presented with periumbilical pain which woke him at night. Before this he had 6 weeks of generalised abdominal pain. Blood tests ... ...

Abstract	We describe a case of a 59-year-old man with no significant medical history apart from a hiatus hernia and depression who presented with periumbilical pain which woke him at night. Before this he had 6 weeks of generalised abdominal pain. Blood tests were relatively normal and CT revealed some ill-defined stranding around the coeliac artery. He was diagnosed with a spontaneous coeliac artery dissection. Given the complexity of the case, a multidisciplinary team approach was adopted. He was managed conservatively and improved significantly over the next few days. Further investigations confirmed ischaemic changes to the distal duodenum and proximal jejunum. He has since been followed-up with CT scans and has had no further episodes 12 months from his initial admission.
MeSH term(s)	Aneurysm, Dissecting/complications ; Aneurysm, Dissecting/diagnostic imaging ; Celiac Artery/diagnostic imaging ; Duodenum/blood supply ; Duodenum/diagnostic imaging ; Endoscopy, Gastrointestinal ; Humans ; Ischemia/diagnostic imaging ; Ischemia/etiology ; Jejunum/blood supply ; Jejunum/diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed
Language	English
Publishing date	2017-02-20
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-218182
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