Background: Pneumatic dilation (PD) is often presented today as a “short term” treatment for achalasia but, in truth, it can last for years. our study aims to determine the short and long-term efficacy of pneumatic dilatation on clinical remission in a treatment-naïve achalasia patient. Materials and Methods: A single center retrospective, descriptive and analytical study conducted between January 2007 and September 2022. Treatment naïve patients with manometric diagnosis of primary achalasia (subtype I and II) were included. We evaluated the clinical outcomes; single vs multiple PD, complications, and estimated duration of effect. Results: 121 patients were included, (mean age 42,2±14,5; 53,8% male), 88,4% (n=104) underwent 2 PD and 11,6% (n=17) underwent 3 PD, 23,1% (n=28) needed repeated PD at one year, The PD procedure was completed without major complications in all patients. Patients with subtype II had a better response to PD than subtype I(p=0,003). In the long-term follow up (median time: 50 months), the mean Eckardt score was 2.2. A subsequent 35 mm dilatation was associated with long-term clinical remission than an initial dilatation with 35 mm.(p=0.003). On univariate analysis, the non-responders more often was male gender, had age< 40 years (p=0.0006), and had high baseline LESP (lower esophageal sphincter pressure>50 mmHg), p=0.004). On multivariate analysis only age<or= 40 years (p=0.02) was associated with poor outcome. Conclusion: PD is an effective, durable and safe treatment for achalasia. A graded-protocol PD starting with a 30 mm dilation applied in the appropriate achalasia subtypes was shown to be a highly effective approach, in both the short- and long-term. Age<40 years, male patients and hight LESP have poorer outcomes following PD.

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract and mesentery. They are usually found in the stomach or small intestine but can occur anywhere along the GIT and rarely have extra GI involvement. They are associated with high rates of malignant transformation. Most GISTs present asymptomatically but also present with bleeding, abdominal pain, and rarely gastric outlet obstruction. There have been many risk stratification classifications systems which are calculated based on tumour size, mitotic rate, location, and perforation. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. The approaches to treating GISTs are to resect primary low-risk tumours, high-risk tumours and further treated with imatinib therapy and unresectable tumours treated with neoadjuvant imatinib 400 mg daily followed by surgical resection and regular follow up by abdominal CT scan.

Among gastric malignancies, lymphomas rank as the second most common type, following gastric adenocarcinoma. The majority of gastric lymphomas are either mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt lymphoma, is a subtype of non-Hodgkin's lymphoma, represents an exceptionally rare and aggressive malignancy, with only a limited number of reported cases globally. We present the case of a male patient with primary gastric Burkitt lymphoma revealed by digestive hemorrhage. The diagnosis was confirmed by endoscopy and gastric biopsies. The gastric localization of Burkitt's lymphoma is unusual. Our work is a review of the literature on Burkitt's lymphoma in its gastric localization.

Background: The species of Pseudomonas aeruginosa is a nosocomial bacterium that increases the risk of multidrug-resistant infections, especially in vulnerable patients. The plant Piper cubeba, commonly referred to as cubeb or tailed pepper, it is specifically cultivated for its fruit and essential oil. The plant belongs to the genus Piper. The study aims at assessing the effectiveness of Piper cubeba extract against different P. aeruginosa strains that could produce biofilm and carry blaIMP gene. Method: Isolates from 85 samples (17 sputum, 40 urine and 28 diarrhea samples). Collected from Al Nasiriyah Teaching Hospital during the period of December 2021 to March 2022. Samples were cultivated using routine cultivation methods, catalase test, oxidase reaction, and the Api20E system were performed to identify P. aeruginosa. Results: Out of a total of 17 isolated samples of Pseudomonas aeruginosa, 3 (17.64%) were from sputum, 6(35.29%) from urine, and 8 (47.05%) diarrhea samples. Out of 17 isolates 6 were sensitive in stool isolates 4 isolates were moderate sensitive and 7 isolates were resistance. Conclusion at concentrations of 25, 50, 75, and 100 mg/mL for Piper cubeba, respectively, the greatest MBC of plant extracts was noted. Also, all the isolates were capable of producing a biofilm by using presterilized 96-well polystyrene microtiter plates. Out of 17 isolates, 9 had a potent biofilm ability and the remaining 7 were moderate biofilm producers. Additionally, 7 of the isolates (41.17%) carried the blaIMP gene. Conclusion: Piper cubeba extract has potential as an antimicrobial agent against both sensitive and moderately resistant strains of Pseudomonas aeruginosa. This antimicrobial effect becomes more pronounced with an increase in the concentration of the extract. Additionally, Pseudomonas aeruginosa that produce biofilms tend to consistently produce more Metallo-beta-lactamase (MBL), which can further contribute to antibiotic resistance.

Alimentary Tract Duplications (ATD) are congenital anomalies that can arise at any level from the mouth to the anus [3]. They are rare and often found early in life. A minority of cases may remain undiscovered until adulthood when they may give rise to different symptoms, depending on the location. Diagnosis is difficult due to the rarity of this entity. Surgical correction is the treatment of choice.

Cupriavidus pauculus is an environmental gram-negative bacilli of low virulence, being increasingly reported to be associated with invasive infections in immunocompromised patients and device related infections. Often undetected or misidentified in most microbiology laboratories, identification of this organism requires increased suspicion and automated identification or molecular methods. We hereby describe a curious case of post-operative acute sinusitis caused by this rare yet emerging human pathogen.