The Role of Endoscopic Ultrasound in Hepatology

Endoscopic ultrasound (EUS) has been an indispensable and widely used diagnostic tool in several medical fields, including gastroenterology, cardiology, and urology, due to its diverse therapeutic and diagnostic applications. Many studies show that it is effective and safe in patients with liver conditions where conventional endoscopy or cross-sectional imaging are inefficient or when surgical interventions pose high risks. In this article, we present a review of the current literature for the different diagnostic and therapeutic applications of EUS in liver diseases and their complications and discuss the potential future application of artificial intelligence analysis of EUS.

Effect of Methanolic Extract of Securigera securidaca as Antioxidant and Antibacterial Activities

In the present work, the phytochemical screening, polyphenolic content, antibacterial activity and antioxidant activity of Securigera securidacaseeds in methanol were carried out. Phytochemical analysis of seeds showed the presence of alkaloids, flavonoids, saponins, terpenoids, steroids and glycosides. Total phenolic content was estimated by Folin Ciocalteau method and the result showed the highest phenolic content of 62.28 mg/g. Methanolic extract was screened for antibacterial activity by disc diffusion method and it found to be potent. The MIC of methanol extract identified by broth dilution method showed a MIC value of 0.25 mg/ml for both E. coliand Kl. Oxytoca, and also 0.5 mg/ml for both S. aureusand S. epidermis.The antioxidant effect of the seeds was tested by DPPH scavenging activity as in vitro assay. The extract had potent inhibitory activity (IC50) value of 0.057mg/ml. The finding experimental results showed that methanolic extract of Securigera securidacais important as a source of antibacterial activity and polyphenolic antioxidants.

Comparative molecular studies of halophilic bacteria from saline water and soil in the Saudi environment / Estudos moleculares comparativos de bactérias halofílicas de água salina e solo no meio ambiente saudita

Halophilic bacteria are microorganisms that grow optimally in the presence of the very high concentration of sodium chloride. Halophiles are vital sources of various enzymes including hydrolases, which are very stable and catalytically highly efficient at high salt concentration and other extreme conditions such as high temperature, pH and presence of organic solvents. Several hydrolases such as amylases, proteases, and lipases have been obtained from halophilic bacteria and are commonly used for various industrial applications. We initiated a screening to isolate and characterize the halophilic bacteria from the Red Sea, which is one of the saltiest bodies of water in the world. Water and soil samples, collected from the Red Sea coast, Jeddah, Saudi Arabia, were screened for isolation of halophilic bacteria. Ten bacterial isolates were obtained, which were characterized by biochemical tests and 16S rRNA gene sequencing. Hydrolase producing bacteria among the isolates were screened by plate assay on starch and gelatin agar plates for amylase and protease, respectively. Two bacterial isolates i.e. Bacillus glycinifermentans S3 and Enterobacter cloacae W1were found to possess significant amylase and protease activity.

Bactérias halofílicas são microrganismos que crescem de maneira ideal na presença de uma concentração muito alta de cloreto de sódio. Halófilos são fontes vitais de várias enzimas, incluindo hidrolases, que são muito estáveis e cataliticamente altamente eficientes em alta concentração de sal e outras condições extremas, como alta temperatura, pH e presença de solventes orgânicos. Várias hidrolases como amilases, proteases e lipases foram obtidas a partir de bactérias halofílicas e são comumente usadas para várias aplicações industriais. Iniciamos uma triagem para isolar e caracterizar as bactérias halofílicas do Mar Vermelho, que é um dos corpos de água mais salgados do mundo. Amostras de água e solo, coletadas na costa do Mar Vermelho, Jeddah, na Arábia Saudita, foram examinadas quanto ao isolamento de bactérias halofílicas. Foram obtidos dez isolados bacterianos, caracterizados por testes bioquímicos e seqüenciamento do gene 16S rRNA. As bactérias produtoras de hidrolase entre os isolados foram triadas por ensaio em placa em placas de amido e ágar de gelatina para amilase e protease, respectivamente. Verificou-se que dois isolados bacterianos, isto é, Bacillus glycinifermentans S3 e Enterobacter cloacae W1, possuíam significativa atividade de amilase e protease.

Literature Review on Prevalence, Risk Factors and, Evaluation of Acute Lower Back Pain

Background: Acute back pain is any pain located at the back that lasts for less than 4 weeks duration. Theprevalence is fair with as many as 84% of the adult population around the globe experience back pain at somepoint in life and is often self-limiting. However, in few selected patients it may serve as indicator of a seriousunderlying disease making it crucial to properly evaluate, characterize and address this concern. Objectives: Inthis review we intend to explore the prevalence, risk factors and highlight the available methods using diagnosticimaging modalities to evaluate and address this condition. Materials and Methods: A review of relevant articlespublished from 1987 onwards in English language was done using the electronic databases of PubMed Pico and,Google Scholar with preset keywords. Conclusion: Acute back pain prevalence range between 22 to 48 percentand risk factors are non-modifiable such as advanced age and female gender while modifiable risk factors areobesity, smoking, low education, sedentary lifestyle, etc. Employment related factors such as physically strenuouswork also increase the risk of developing back pain. Notably, under-appreciated risk factors includingpsychological risk factors such as anxiety should be screened for while evaluating patients. Evaluation of backpain mostly relies on comprehensive history and physical examination, as most cases are self-limited. Diagnosticimaging is only recommended in cases presenting with red flag symptoms.

Dientamoeba fragilis Infection in Patients with Digestive and Non-Digestive Symptoms: A Case-Control Study

In most developing countries, Dientamoeba fragilis infection is an obscure protozoan infection. We aimed to determine a frequency and clinical importance of D. fragilis infection in Taif, Saudi Arabia. A 1-year case control study included patients with gastrointestinal (cases, n=114) or non-gastrointestinal symptoms (controls, n=90). The fecal samples were examined with the classical parasitological methods for intestinal protozoa, and by real time PCR for D. fragilis. The infection by D. fragilis was detected in 5.8% by PCR and in 4.4% patients by microscopy. The infection was identified more in control group (n=9) than in cases (n=3); a sole infection in 11 patients and mixed with Giardia in 1 patient. The other enteric parasites detected were Blastocystis sp. (8.3%), Giardia sp. (5.3%), Cryptosporidium sp. (2.9%), Entamoeba histolytica (1.4%), Entamoeba coli (0.9%) and Hymenolepis nana (0.4%). Our results tend to reinforce the need to increase awareness of D. fragilis infection in Saudi Arabia.

Date Supplement and Iron Salts Plus Physical Activity on Efficiency of Iron Absorption

The aim of this study was to investigate the effect of date supplement and iron plus physical activity on anemic femalestudents. This study includes 40 anemic female students, from the new valley university; they were divided into four equalgroups ten in each group; 1st group ingested “date” plus exercise, 2nd group ingested date without exercise, 3rd groupsupplemented with iron salts with exercise, 4th group supplemented with iron salts without exercise, pre/post-test VO2max,pulse rate, Hb, iron, ferritin and O2 were determined. 5 ml venous blood was drawn from all participants for the pre/postvariables. Dose of date sheet was (10 gm) twice daily, and dose of iron salts was one capsule (5mg) daily. Results: Resultsindicated that date supplement, and iron together with exercise affect positively the anemic female students. Conclusion:black dates and iron with or without hulls, are effective, safe and cheap supplements for improving hemoglobin andrestoring iron stores to correct iron deficiency.

Phenolic-antioxidant capacity of mango seed kernels: therapeutic effect against viper venoms

Abstract In this study, mango seed kernels extract contained a considerable amount of phenolics and flavonoids (17,400 and 3325 mg/100 g seed, respectively). The HPLC profiling revealed that hesperidin was the major phenolic compound of the mango seed kernels extract. This is the first report find hesperidin in mango extracts. The phenolic compounds of mango seed kernels extract were effective in scavenging free radicals of DPPH and ABTS with IC50 values of 47.3 and 7.9 µg/ml, respectively. The total antioxidant activity of mango seed kernels extract based on the reduction of molybdenum was also measured. The phenolic compounds of mango seed kernels extract potentially inhibited the protease, fibrinogenase, phospholipase A2, l-amino acid oxidase, hyaluronidase, and hemolytic activities of the most dangerous Cerastes cerastes and Echis coloratus viper venoms. The phenolic compounds of mango seed kernels extract could completely neutralize the hemorrhage and lethality of both venoms in experimental animals. It could be concluded that the mango seed kernels extract phenolic compounds with potential antioxidant activity are considered as a new avenue in the viper bite treatment.

Immobilization of horseradish peroxidase on Fe3O4 magnetic nanoparticles

Background: Iron magnetic nanoparticles have attracted much attention. They have been used in enzyme immobilization because of their properties such as product is easily separated from the medium by magnetic separation. The present work was designed to immobilize horseradish peroxidase on Fe3O4 magnetic nanopraticles without modification. Results: In the present study, horseradish peroxidase (HRP) was immobilized on non-modified Fe3O4 magnetic nanoparticles. The immobilized HRP was characterized by FT-IR spectroscopy, scanning electron microscopy, and energy dispersive X-ray. In addition, it retained 55% of its initial activity after 10 reuses. The optimal pH shifted from 7.0 for soluble HRP to 7.5 for the immobilized HRP, and the optimal temperature shifted from 40°C to 50°C. The immobilized HRP is more thermostable than soluble HRP. Various substrates were oxidized by the immobilized HRP with higher efficiencies than by soluble HRP. Km values of the soluble and immobilized HRP were 31 and 45 mM for guaiacol and 5.0 and 7.0 mM for H2O2, respectively. The effect of metals on soluble and immobilized HRP was studied. Moreover, the immobilized HRP was more stable against high concentrations of urea, Triton X-100, and isopropanol. Conclusions: Physical immobilization of HRP on iron magnetic nanoparticles improved the stability toward the denaturation induced by pH, heat, metal ions, urea, detergent, and water-miscible organic solvent.

Gonadosomatic index and some hematological parameters in African catfish Clarias gariepinus (Burchell, 1822) as affected by feed type and temperature level

ABSTRACT The purpose of the current study was to examine the effects of different feeds/nutrients and temperature on the gonadal development of Clarias gariepinus. The gonadosomatic index (GSI) and blood parameters including red blood cell count (RBCs), white blood cell count (WBCs), hemoglobin (Hgb) level, hematocrit (HCT), platelets (PLT) and mean corpuscular volume (MCV) were investigated. Four types of fish feed of 36% protein content [D1(fish meal), D2 (soybean meal), D3 (peameal) and D4 (commercial tilapia feed)] and 3 different levels of temperature (T1(24℃), T2(28℃) and T3(32℃) were tried in this study for a duration of 4 months. The mean values were as follows: female GSI (14.68 ± 4.86), male GSI (0.70 ± 0.32), RBCs x 106(2.45± 0.64), WBCs x 103(9.28 ± 2.34), Hgb (12.42± 2.21g/dl), HCT (29.06 ± 3.54%), PLT (90.75 ± 9.18/mm3), and MCV (118.08 ± 10.3 g/l). Fish meal diet revealed the most significant (p<0.05) increase in weight gain, female GSI, and also exerted significant increases on most of the blood parameters. This study revealed that animal-based protein diet and temperature around 28℃ were the critical requirements for the physiological performance and relative gonadal weight of C. gariepinus. GSI and blood parameters were useful indicators of stress exerted by nutrition and temperature on fish, and their study is critical for fish health and mass production of viable seeds for aquaculture enterprise.

Pattern of new-onset pancytopenia among Yemeni children aged 2 months to 15 years

Backgrotutd: pancytopenia refers to a reduction in all the three cellular elements of blood. The aim of this study was to identiy various causes of pancytopenia in Yemeni children and its clinical correlation with peripheral smear and bone marrow examination

Patients and Methods: this was a prospective cross sectional study which conducted at Hadhramout university hospital for pediatric and gynecology and obstetrics and enrolled 103 pancytopenic children aged 2 month to 15 years evaluated with criteria of recent pancytopenia on peripheral blood smear during the sttady period from January 2013 to Jmuary 2015. Demographic profile and clinical findings were taken,laboratory investigations performed at the time of admission for all cases included a complete hernogram, reticulocyte counts, and peripheral blood film. Bone marrow biopsy was performed wherever aspiration was inconclusive. Other investigations that were performed in selected cases

Results: a total of 103 patients of both sexes with pancytopenia were enrolled in the study. The mean [SD] age was 6.75 +/- 4.09 years and their ages rangedpom 2 months to 15 years. Among them 63 [61%] were males and 40 [39%] females with a male to female ratio of 1.58:1. Maximum number of patients 44[43%] were in the two month-5 years age group, 77ze most common clinicaEfiatures of pancytopenia at presentation, was pallor in 101 [98%], Prolonged fever or recurrent fever in 89[86%].The most common three causes were visceral leishmaniasis [kala zar] in 39 [37.9%], followed by acute lymphoblastic leukemia[ALL] in 21[20.5%], and then megaloblastic anemia 9 [8.7%].Nan- malignant pancytopenia which was found in 70 [68%] of patients, and malignant pancytopenia that was found in 33 [32%]

Conclusions: the three most common causes of pancytopenia in our study was visceral leishmaniasis [kala zar] followed with ALL and then megaloblastic anemia. Bone marrow examination is a useful technique for diagnosing the causes of pancytopenia There are varying trends in clinical pattern, peripheral hematological features depending on the prevalence of causes ofpancytopenia in the dgerent geographical locations

Interesting cases of aspirated foreign bodies: review articles

Five cases of rare and interesting foreign bodies are reported. Their presentation, difficulties in diagnosis, management and possible complications are discussed. These cases were seen in Al-Ain Hospital, ENT Department, UAE. All were diagnosed and managed by the author of this paper at variable dates. The aim of this publication is to report on rare inhaled foreign bodies, which is not seen often and to report on the difficulty in diagnoses of certain foreign bodies. It is advisable that rigid bronchoscopy be performed under general anaesthesia for all cases of highly suspicious for aspirated foreign bodies, for cases with chronic long lasting cough and in children with wheezy chest of unclear causes who do not response to medical therapy

Assessment of Hospital Physicians' Knowledge, Awareness, Attitude and Practice of Reporting Adverse Drug Reactions in Jeddah, Saudi Arabia.

Background: Adverse drug reactions (ADRs) are an important cause of morbidity and mortality around the world. Spontaneous reporting of ADRs is considered an essential component of successful pharmacovigilance (PV). Physicians’ unfamiliarity with ADRs and reporting procedures are major factors that lead to sub-optimal reporting of ADRs. Objective: This study explored knowledge, awareness, attitude and practice (KAAP) of physicians towards ADRs and their reporting. Methods: This study was conducted at three general hospitals in Jeddah City. A 7-item, self-administered questionnaire was developed to explore physicians’ KAAP. Results: Majority of physicians had post-graduate qualification (n=243, 72%), were from medical departments (n=146, 43.3%), had long clinical experience (n=258, 77%) and consulted more than 10 patients daily (n=258, 77%). About 72% of physicians were never exposed to ADR training program. More than 60% of physicians were not fully aware of ADR reporting perspectives. Majority of them (75%) knew the correct definition of ADR and adequate knowledge of reportable ADRs (>90%). Majority of physicians depended on textbooks on drugs and therapies (31.2%) and drug package inserts (22.3%) as sources of ADR information. The majority of respondents (>90%) showed positive attitude towards ADRs and ADRs reporting and monitoring system. About 57.6% of physicians had come across ADRs in practice but only 21.7% reported these reactions. Most of physicians agreed to improve KAP towards ADRs reporting. Conclusion: The preliminary findings of this study suggest that though majority of physicians had good awareness and positive attitude towards ADR and ADR reporting, but needed correct knowledge in some areas of ADRs and their reporting system. Majority of physicians were not exposed to ADR training courses. Physicians certainly need ADR training programs in order to further enhance their KAAP towards ADRs and ADR reporting.

[Effects of a resistance-training program on cross sectional areas of vastus medialis and vastus lateralis muscles in women with patellofemoral pain syndrome]

An increased cross-sectional area of the distal portion of the vastus medialis muscle without any increase in the cross-sectional area of the vastus lateralis is associated with an increased risk of patella cartilage injuries, and an increase in patella bone volume. The aim of the present study was to evaluate the effects of 8 weeks of specific vastus medialis training on cross sectional areas of vastus medialis and vastus lateralis in women with patellofemoral pain. 24 women with patellofemoral pain participated in this experimental study. Subjects were randomly divided into training [age: 24.1 +/- 2.6 years] and control [age: 24.0 +/- 2.1 years] groups. Each training program consisted of three sessions per week for 8 weeks. Supervision of the workouts was maintained at all times. Targeted training included the leg press exercise to the last 45? of knee extension/flexion with vigorous hip adduction in the training group. The cross-sectional areas of the distal vastus medialis and lateralis were measured 37.5 mm above the insertion site of quadriceps tendon at the proximal pole of the patella by using ultrasonography before and after exercise in both groups. Paired t- test and independent t-test were used for statistical analysis [p<0.05]. The cross-sectional areas of both distal vastus medialis [P=0.03] and lateralis [P=0.01] increased after training significantly in the training group, while vastus medialis showed more increase in cross-sectional area in comparison to vastus lateralis but this differences was not statistically significant [P=0.128]. In addition, the control group did not show any significant difference [P>0.05]. Cross-sectional area of distal vastus medialis increased more than that of vastus lateralis which showed no significant difference. This training method could be helpful in women with patellofemoral pain syndrome

Incidence, efficacy and safety of YAG laser goniopuncture following nonpenetrating deep sclerectomy at a university hospital in Riyadh, Saudi Arabia

Assessing the frequency and evaluating the efficacy and safety of Neodymium:Yttrium Aluminum Garnet [Nd:YAG] Laser goniopuncture [LGP] following nonpenetrating deep sclerectomy [NPDS]. Retrospective cohort study. We retrospectively reviewed the outcome of 197 eyes of 153 patients with open angle glaucoma who underwent either NPDS or NPDS combined with cataract extraction between January 2005 and September 2010 at King Abdulaziz University Hospital [KAUH]. Both demographic and clinical data were retrieved and analysed. Goniopuncture [GP] was needed in 48 [24.4%] of the eyes which had NPDS or NPDS with cataract extraction after a mean post operative interval of 9.78 [ +/- 11.16] months. The mean IOP had significantly decreased from 23.3 [ +/- 5.9] mmHg prior to Nd:YAG LGP procedure to 14.6 [ +/- 4.4] mmHg at the last post-procedure assessment. At the last follow-up; Nd:YAG LGP was successful in controlling IOP in 27 eyes [56.3%]. Mean Nd:YAG LGP failure time was 6.04 [ +/- 5.80] months. Young age [<50 years] [p = 0.001]; type of glaucoma [secondary versus primary open angle, p = 0.0258] and the use of drainage implant [p = 0.038] were the identified predicting factors for the need of Nd:YAG LGP. Complications following Nd:YAG LGP occurred in 5 eyes [iris touch to TDM [4.2%], Hyphema [2.1%], hypotony maculopathy [2.1%] and choroidal detachment [2.1%]. LGP is an efficient IOP lowering procedure after NPDS, when it is indicated. It is a simple and noninvasive procedure. However, certain precautions should be taken to avoid complications

Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment?

To examine whether pregnancy rate [PR] of intrauterine insemination [IUI] is related to certain demographic factors, such as age and body mass index [BMI], along with number of IUI cycles performed, a set of infertile Saudi women. During this prospective study [a 24-month period], 301 Saudi women with infertility underwent IUI in our infertility clinic. We investigated whether PR is correlated with patient age and BMI, and the number of IUI trials, in order to determine if they could be used as prognosticators of pregnancy success. The highest PR was 14.89% for ages 19-25 and the lowest PR was 4.16% for ages 41-45, indicating no statistically significant difference among PR in all age groups [p value of 0.225]. Also, in terms of BMI, the highest PR was 13.04% for BMI >/= 35 and the lowest was 7.84% for BMI of <25 to 18.5, indicating no significant difference among different BMI groups [p value of 0.788]. One-cycle treatment, as expected, was more successful [PR=12.84%] than 2-cycle treatment [PR=5.75%], however, 3-5-cycles treatment still showed encouraging results [PR=17.24%]; but the difference did not reach statistical significance [p value=0.167]. PR after IUI treatment remained approximately 10% from 19 to 40 years of age and declined after 40. Although no significant difference was observed among different age groups, earlier treatment is still recommended. There was a positive but not statistically significant correlation between PR and patient's BMI indicating that BMI is not a determining factor. There was also no correlation between PR and number of IUI trials. Patients can thus try as many times as they want before moving on to in vitro fertilization [IVF] treatment

Early versus delayed laparoscopic cholecystectomy for management of acute calculus cholecystitis: our experience at King Hussein medical center

To compare early laparoscopic cholecystectomy during index admission with delayed [interval] laparoscopic cholecystectomy in the management of acute cholecystitis at King Hussein Medical Center. Over the study period of 48 months [June 2005 to May 2009], a total of 317 patients with clinical and radiographic diagnosis of acute cholecystitis were studied. One hundred-thirty one patients underwent laparoscopic cholecystectomy during the index admission [group A] while 186 patients [Group B] underwent cholecystectomy at least six weeks after the attack. Data analyzed included patients' age, gender, duration of symptoms, white blood cell count, operative time, hospital stay, overall surgical outcomes and postoperative morbidity and mortality. Both groups were demographically and clinically comparable. Surgical outcomes were comparable in group A and B with conversion rates of 8.3% and 7.4% [p = 0.6645], and complication rates of 12.25% and 12.6% [p = 0.9352] respectively. Although delayed surgery shortens operative time significantly [60 versus 100 min, p<0.0001], the overall hospital stay is significantly reduced by early operation [5 versus 14.6 days, p<0.0001]. Although both the early and delayed approaches in management of acute calculus cholecystitis are comparable in terms of complication and conversion rates, the early approach has the advantage of offering patients a definitive treatment while reducing the overall total hospital stay and avoiding the problems of failure of delayed therapy

Update on diabetes diagnosis: a historical review of the dilemma of the diagnostic utility of glycohemoglobin A1c and a proposal for a combined glucose-A1c diagnostic method

The role of glycohemoglobin A1c [A1c] for the diagnosis of diabetes has been debated for over three decades. Recently, the American Diabetes Association [ADA] has recommended adding A1c as an additional criterion for diabetes diagnosis. In view of the continued debate about the diagnostic utility of A1c, and in view of the unabated burden of undiagnosed diabetes, the search for alternative diagnostic methods is discussed. A historical literature review is provided, in view of the new ADA diagnostic guidelines, and a proposal is provided for combining A1c and a glucose measurement as a diagnostic alternative/adjunct to the use of a single criterion. This proposal is based on the non-overlapping of the advantages and disadvantages of these individual tests. The cost-effectiveness of this method remains to be tested

Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery

This study was designed to evaluate the effect of intravenous dexmedetomidine infusion in patients undergoing major abdominal surgery on stress response markers as plasma interleukin-6, cortisol and blood glucose level. It also assessed its effect on recovery profile and postoperative pain. Thirty adult ASA I-III patients admitted to the surgery department of the Alexandria Main University Hospital scheduled for elective major abdominal surgery under general anaesthesia were included. They were randomly classified into two equal groups of 15 patients each, dexmedetomidine group [Group D] received intravenous dexmedetomidine infusion and placebo group [Group P] received intravenous infusion of normal saline. Haemodynamic parameters were recorded intra- and postoperatively. Interleukin-6, cortisol and blood glucose levels were measured. Recovery profile, postoperative pain score and analgesic requirement postoperatively were assessed. Heart rate and mean arterial pressure were significantly lower in group D relative to group P during most of the intra- and postoperative periods. Postoperatively, the levels of interleukin-6, cortisol and blood glucose were significantly lower in group D relative to group P. Recovery time was longer in group D than group P but with no significant difference. Postoperative pain score was significantly less in group D relative to group P during the early postoperative period with smaller amount of analgesic requirements in group D. Dexmedetomidine is safe and effective in blunting the postoperative rise of the proinflammatory cytokine interleukin-6 and resulted in lower levels of markers of stress response to surgery as cortisol and blood glucose. Dexmedetomidine also reduces the postoperative pain score without delaying recovery from anaesthesia

Epidemiology of medico-legal litigations and related medical errors in central and northern Saudi Arabia. a retrospective prevalence study

To study medico-legal litigations and related medical errors in Central [Al-Qassim], and Northern [Hael] districts in the Kingdom of Saudi Arabia [KSA], and to identify types and causes of errors to reduce medical errors and patient harm. This retrospective prevalence study was carried out between May 2010 and December 2011 to analyze medico-legal litigations in Al-Qassim and Hael districts that were investigated by the Al-Qassim Medico-Legal Committee, Al-Qassim, KSA. Final verdicts issued between 1992 and 2009 included 293 cases. The patient's mean age was 29.5 years. Fiftyseven percent of the patients were females, and 92% were Saudis. The Obstetric and Gynecology department was involved in 29.7% of litigations followed by General Surgery, and Pediatrics [11.3% each]. Of the 635 defendants, 90% were physicians, and 7.6% were nurses. Investigations showed "no error" in 47.1% of cases, "error but no harm" in 11.9%, and "error resulted in harm" in 39.6%. Errors were negligence [45.8%], wrong diagnosis [14.2%], surgical error [10.3%], and administrative error [5.2%]. The average total duration of litigations was 13.9 months. "Type of harm" was the most significant predictor to determine a "guilty" decision [p<0.001]. Obstetric practice in Al-Qassim and Hael districts and provider negligence contribute to a large portion of medico-legal litigations, and therefore this has to be further studied to recognize the specific causes and possible interventions. A systematic review of the medico-legal committee is needed to shorten the long duration of litigation

Right upper quadrant pain with normal hepatobiliary ultrasound: can hepatobiliary scintigraphy define the cause?

The objective of this study was to assess the value of hepatobiliary scintigraphy [HS] for the diagnosis of right upper quadrant [RUQ] abdominal pain in patients with normal hepatobiliary ultrasound [HU]. This is an observational study with a retrospective analysis of data from March 2008 to August 2010. We reviewed the HS results of 30 patients, aged 29-69 years [average 45.8 years]; 12 male and 18 female patients. Patient selection to perform the HS was RUQ abdominal pain, suspected hepatobiliary disorder, and negative HU. All patients had gone through the standard procedure of HS. Based on predefined interpretation criteria, HS results were divided into 2 patterns: Normal [n=8, 25.8%] and abnormal [n=22, 73%]: 18 patients [81.8%] having early gallbladder [GB] and common bile duct visualization, and delayed transit to small bowel [SB], which can be seen only after a fatty meal with normal or abnormal GB ejection fraction [GBEF] pattern characteristic of Oddi's sphincter dyskinesia. The remaining 4 patients [8.18%] had acalculous cholycystitis pattern: Delayed GB visualization with activity appearing in SB before GB. HS with fatty meal stimulation and GBEF estimation seems to be a reliable test, which may reveal a biliary cause in more than 70% of patients with RUQ abdominal pain and normal HU. Normal results exclude functional biliary cause. The decision for invasive or noninvasive therapeutic approach may depend on the results of HS