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ABSTRACT Introduction: We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before. Methods: This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63). Results: Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation. Conclusion: TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.
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Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.
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Background: Celiac disease is a chronic immune-mediated enteropathy that affects the small intestine of genetically predisposed individuals and is precipitated by the ingestion of food containing gluten. Treatment consists of a glutenfree diet to control the signs and classic symptoms of the disease and prevent complications. Objective: To determine the awareness of the public about celiac disease in children in Saudi Arabia. Methods: A cross-sectional communitybased study conducted during the period from 1st May to 31st July 2019. A systematic random sampling technique was used. The study included 1619 participants. Data collected using a pre-designed online questionnaire distributed among parents of children and adolescents. The questionnaire includes about 18 items that guide us to the awareness of the public about celiac disease in children. Results: Half of participants (50.1%) think that Celiac diseases are a form of allergy to wheat products. Less than half (46.7%) of cases think that there is a correlation between the presence of celiac and disease and other immunological diseases and 33.7% don’t know. The majority of participants 59.9% think that family history has a role in the occurrence of celiac diseases and 62.4% think that it affects humans at any age. Only 28.8% of participants think that celiac disease is more prevalent in the Middle East than in any other region and the majority 49.8% don’t know. The majority (35.2%) of participants don’t know if there was a relation between cough and asthma with celiac disease. About third (31.6%) of the participants agreed that CD is linked to diabetes and 26.3% think that the CD associated with genetic diabetes than acquired diabetes. More than half of participants 51.5% think that psychological disorders are among the causes of celiac disease but, 39% of them don’t think that pregnancy and childbirth are among the causes of CD and 40.6% don’t know if surgical operations are among the causes or not. The majority of participants 59% think that CD is treatable disease, and 49.7% think that a patient with CD should have food that is completely free of wheat and its products. More than half (52.3%) participants think that colon cancer is one of the consequences of CD. Conclusion: The general population of Saudi Arabia, has reasonable knowledge about celiac diseases in children. We recommend health education sittings to raise the awareness of the public about the disease.