Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.

Background  This study explored the association of residence, caste, social determinants of health (SDH) of parents, and daily junk food intake with the nutritional status of school children living in different residential areas of a district in Nepal. Methods  A survey was conducted from December 2017 to March 2019, including 331 school children aged 6 to 12 years as well as their parents, in the primary village for Japan International Cooperation Agency (JICA) support and the surrounding area in the Machapuchare Administrative Region of Kaski District, Gandagi Province, Nepal. In this study, the body mass index for age z-score (BMIZ), a criterion used by the WHO for assessing malnutrition, was used for determining underweight; BMIZ <−2 SD was defined as underweight.  The children’s anthropometric data were measured to assess their nutritional status, and a survey on children’s daily junk food intake and parents' SDH was conducted among parents. The responses were analyzed by logistic regression analysis.Results  Of the children who participated in the survey, 31 (9.4%) were underweight.   An association between parents’ SDH and children’s underweight was found after adjusting for mothers’ age at marriage, number of siblings, and daily junk food intake, and the results showed that lower caste (OR＝0.241, p＝0.001), lower education of mothers (OR＝3.879, p＝0.011) and non-literacy of fathers (OR＝2.790, p＝0.023) had statistically significant effects on BMIZ.Conclusions  In this study, BMIZ, indicating underweight in Nepalese school children, was associated with higher caste and a mother’s level of educational attainment and father’s of non-literacy. To understand the factors influencing children’s health, it is necessary to evaluate sociodemographic parameters of parents as childcare providers, including culture, education, employment, living conditions, and diet, and to conduct surveys that capture data on the SDH of parents from various perspectives.

Early detection of third-generation cephalosporin-resistant bacteria in blood culture tests influences the choice of antimicrobial agents. We report on our hospital’s system for early reporting of third-generation cephalosporin-resistant bacteria and its utility. The hospital operates a 24-h simple cefpodoxime (CPDX) testing system, where the content of a sample container with a positive blood culture result is smeared on a CA Sheep Blood Agar/VCM Chocolate EX II fractionation medium, and an antibiotic susceptibility test (AST) disk (Sensi-Disk CPDX) is placed at the center of the medium and incubated. The presence or absence of third-generation cephalosporin-resistant bacteria is estimated from the diameter of the growth inhibition zone. The physician in charge of AST makes comments on the chart based on the simple CPDX test results. The sensitivity of the simple CPDX test for detecting third-generation cephalosporin-resistant bacteria, based on AST results, was 95.5%. Among patients with failed antimicrobial therapy, the rate of switching antimicrobials before the AST results were known was 57.9% in cases where there were comments made by the physicians in charge of AST, compared with 42.9% in cases without comments. These results suggest that the simple CPDX test enables early and accurate detection of third-generation cephalosporin-resistant bacteria, facilitating early switching of antimicrobial agents through collaboration with physicians in charge of AST.