Ahmed Mohamed

Background While current surgical approaches for obstructed defecation syndrome (ODS) primarily target rectocele and rectal intussusception, excessive perineal descent (PD) may contribute to persistent symptoms and suboptimal surgical outcomes. This study aimed to evaluate early outcomes of transverse perineal support (TPS), a procedure designed to reinforce the perineum, in patients with ODS and pathological PD. Patients and method All consecutive patients with ODS and pathological PD were assessed for eligibility. After at least one year of conservative management (dietary fiber, biofeedback, laxatives) that failed to relieve symptoms, twenty-nine patients were evaluated preoperatively using the Cleveland Clinic Constipation Score (CCCS), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), perineometry, anorectal manometry, and MRI defecography. All patients underwent TPS procedure and were followed up for a minimum of 6 months. The primary outcome was the change in CCCS at 6 months. Results Significant postoperative improvements were observed. The CCCS decreased significantly, with a mean difference (Post - Pre) of -5.31 (95% CI: -6.13 to -4.48 ; p < 0.001). Postoperative PISQ-12 scores were significantly higher than preoperative scores, with median (IQR) values of 35 (34–36) and 25 (24–27), respectively (p = 0.003). Intrarectal pressure during push increased from 34.34 ± 6.03 mmHg preoperatively to 41.17 ± 5.85 mmHg postoperatively with a mean difference (Post - Pre) of 6.83 (95% CI: 5.41 to 8.24; p < 0.001). Perineal descent measured by perineometry decreased from 2.29 ± 0.55 cm preoperatively to 1.74 ± 0.51 cm postoperatively with a mean difference of -0.64 cm (95% CI: -0.75 to -0.52; p < 0.001). No mesh-related complications (erosion, chronic pain) were observed. Nine patients (31.03%) reported persistent symptoms. All had rectal intussusception. Compared with patients who improved, these patients were older, had smaller perineal bodies, and greater preoperative perineal descent. Conclusions Transverse perineal support procedure may be an effective option for selected patients with ODS and pathological PD. Outcomes were less favorable in patients with rectal intussusception, older age (observed as an association only, not causation) or smaller perineal body dimensions, underscoring the importance of careful patient selection and individualized surgical planning. Given the small sample size and the absence of a control group, these findings should be interpreted with caution as associational rather than causal.

Angioscopy is an emerging technology in neurointervention.[1–4][1] The Vena MicroAngioscope (MA) is a sterile, single-use, full-color, forward-viewing angioscope delivered through a guiding or distal access catheter, with or without flow arrest, and saline irrigation. The device is 160 cm in length, with a 3 Fr distal radiopaque tip, and connects to the Vena Camera Control Unit for illumination and real-time image capture (see [video 1][2]). We present a video demonstrating the second-generation MA used with the SmartGUIDE deflectable tip guidewire in treating a carotid–cochlear dehiscence causing pulsatile tinnitus.[5][3] A 45-year-old man underwent balloon occlusion testing confirming symptom origin, followed by BeGraft covered stent placement. The MA demonstrated intraluminal vascular indentation consistent with the underlying bony defect. Post-deployment angioscopy confirmed complete defect coverage, optimal wall apposition, and absence of thrombus, while detecting subtle iatrogenic endothelial injury that was undetectable by angiography, underscoring its value for intraprocedural vessel wall assessment.­Video 1  [1]: #ref-1 [2]: #F1 [3]: #ref-5

Purpose This study aimed to synthesise diagnostic evidence comparing a novel myocardial perfusion radiotracer [¹⁸F]flurpiridaz PET with SPECT myocardial perfusion imaging (MPI) in detecting coronary artery disease (CAD). Methods A systematic search to Feb 2026 was conducted in Web of Science, Scopus, PubMed, and the Cochrane Library. Studies comparing [¹⁸F]flurpiridaz PET with SPECT/MPI were screened. Primary outcomes were sensitivity and specificity using invasive coronary angiography as the reference standard. Secondary outcomes included image quality and radiation dose. Results Out of 558 studies, 28 publications were fully screened, and three trials comparing [¹⁸F]flurpiridaz PET with [⁹⁹ᵐTc]Tc-sestamibi/tetrofosmin SPECT were identified (1476 patients). For ≥ 50% stenosis, pooled sensitivity/specificity were 76% (95% CI 71–81%)/71% (63–78%) for flurpiridaz PET and 61% (53–69%)/76% (60–86%) for SPECT; for ≥ 70% stenosis, values were 87% (77–94%)/63% (52–73%) versus 73% (62–81%)/72% (50–87%), respectively. In patients with BMI ≥30kg/m², sensitivity/specificity were 74% (68–78%)/73% (64–80%) for flurpiridaz PET and 61% (49–72%)/75% (56–88%) for SPECT. In women, sensitivity/specificity were 73% (57–84%)/76% (70–81%) for flurpiridaz PET versus 50% (29–70%)/78% (60–90%) for SPECT. Rest and stress image quality favoured flurpiridaz PET (RR1.29[1.19–1.41] and 1.14[1.11–1.17], both p<0.00001) with superior image quality and lower radiation dose. Conclusion This first meta-analysis suggests higher sensitivity of [¹⁸F]flurpiridaz PET vs SPECT MPI with significantly lower radiation dose and improved image quality. [¹⁸F]flurpiridaz is especially useful for assessing women and patients with high BMI, given its superior sensitivity and comparable subgroup specificity. However, findings should be interpreted cautiously due to the limited number of studies. Graphical Abstract

NOUAKCHOTT, Mauritania (AP) — The United Nations refugee agency said Tuesday it is “extremely saddened” after well over 100 people died or went missing from boats off Mauritania last week while trying to make their way to Europe.

The United Nations refugee agency says it is “extremely saddened” after nearly 150 people died or went missing off Mauritania last week. It said 144 people were dead or missing

Excessive screen time and insufficient physical activity are increasingly common among adolescents and have been linked to adverse physical and psychological health outcomes. This school-based cross-sectional study examined associations between sedentary screen time, physical activity frequency, and motor control performance in adolescents, and explored acute psychophysiological responses to a single bout of high-intensity interval training (HIIT). A total of 366 adolescents (mean age = 14.52 ± 1.21 years) were categorized into low-, moderate-, or high-screen-time groups and classified as physically active or inactive based on self-reported behavior. Participants completed standardized assessments of balance, coordination, neuromuscular speed, and reaction time. All participants then undertook an 8-minute HIIT session, with pre- and post-exercise measures of heart rate recovery, perceived exertion, and self-reported mood and cognitive states. Higher daily screen time was significantly associated with poorer motor control performance across multiple domains (p < 0.001), whereas greater frequency of physical activity was independently associated with better motor control performance (B = 1.45, 95% CI 0.88–2.02, p < 0.001). Physically active adolescents demonstrated superior heart rate recovery, lower perceived exertion, and more favorable post-exercise profiles of fatigue and alertness compared with inactive peers. The HIIT session elicited significant acute improvements in energy, alertness, motivation, and cognitive focus, alongside reductions in fatigue and tension (all p < 0.001). These findings indicate that greater sedentary screen time is associated with poorer motor control performance in adolescents and suggest that brief, school-feasible physical activity strategies warrant further investigation as potential approaches to support physical and psychological health. Given the cross-sectional design, these associations should not be interpreted as evidence of causality.

Peter C. Britton Send email to [email protected] ∙ Ahmed Mohamed ∙ Tracy Stecker ∙ Wilfred R. Pigeon

NOUAKCHOTT, Mauritania (AP) — Mauritania said Thursday it intercepted a boat off its coast carrying 161 migrants trying to make their way to Europe.

Introduction: Dynamic hip screw (DHS) and proximal femoral nail (PFN) are both used to fix extracapsular proximal femoral fractures, with implant selection in routine practice typically guided by fracture morphology. This study describes perioperative outcomes and the pattern of implant selection in older adults treated at a single UK trauma centre.

Abstract Background Chemical pleurodesis is a standard palliative intervention for recurrent malignant pleural effusion (MPE). Historically, patient