Familial Clustering of Nonalcoholic Fatty Liver Disease in Family Members of Nonalcoholic Steatohepatitis Cirrhotic Patients

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disorder with combination of environmental, genetic and metabolic factors that play role in the progression of disease. This study is aimed to explore the familial clustering of NAFLD among the family members of NASH cirrhotic patients and the association of insulin resistance, metabolic syndrome and genetic polymorphism with the familial clustering. Methods: This cross-sectional observational study included 50 NASH cirrhosis patient and 81 1st degree relatives. Family members were screened for fatty liver by ultrasonogram. Insulin resistance, metabolic syndrome, PNPLA3 and staging of liver stiffness by fibroscan were done. Results: Among 81 family members 47 (58.02%) were found having fatty liver. Of these 14(17.28%) had significant fibrosis. PNPLA3 polymorphism was higher (80.85%) in fatty liver group than (55.9%) without fatty liver groups. Sons (57.89%) and daughters (51.6%) were affected by fatty liver equally. Multivariate logistic regression analysis revealed that a subject with TG>150 mg/dl had 6.159 times increase in odds having NAFLD. A subject with PNPLA3 polymorphism had 3.33 times increase in odds having NAFLD. A subject with HOMA-IR >1.6 had 4.375 times increase in odds having NAFLD. Conclusion: This study indicates that there is a strong familial clustering of NAFLD along with significant fibrosis among the family members of NASH cirrhosis patients. This findings warrants screening for NAFLD among the family members of NASH cirrhosis patients especially with PNPLA3 polymorphism.

Post-Tonsillectomy Bleeding: Assessing the Merit of Some Risk Factors in a Series of Saudi Patients

Background: Post-tonsillectomy bleeding is a commonly encountered problem due to several risk factors. This study aimed to assess the burden of post-tonsillectomy bleeding and its possible hematological risk factors in Saudi Arabia. Methodology: This is a retrospective study involved a series of 311 patients who attended with evidencebased indications of tonsillectomy and subsequently underwent surgical removal of the tonsils, with or without adenoidectomy (adeno/tonsillectomy). All of the patients underwent bipolar diathermy surgical techniques. Results: Out of the 311 patients, 67.5% underwent tonsillectomy and 32.5% underwent adenotonsillectomy. Post-tonsillectomy bleeding was experienced in 5.8% patients, 6.9% were males and 4% were females. The males’ risk (relative risk (RR)) of Post-tonsillectomy bleeding and the 95% confidence interval 95% CI): RR (95% CI)=1.7011 (0.6220 to 4.6521), p=0.3007. Conclusion: The prevalence of post-tonsillectomy bleeding is relatively higher in Saudi Arabia than the reported values in most studies. Factors such as post-operative infection, use of bipolar diathermy technique, and pain might be incriminated in the reported cases of postoperative bleeding in the current study.

Literature Review on Patient Demographics, Risk Factors and Causative Agents of Otomycosis

Background: Otomycosis can be defined as a fungal infection of the external auditory canal, frequentlyencountered in the general otolaryngology department. Otomycosis is more commonly reported in hot andhumid climates and various individual as well as environmental factors predispose to this infection. Otomycosisis not only a prevalent condition but also follows a set patterns in patient demographics, predisposing factorsand, causative pathogens, which we aim to explore in this review. Objectives: In this review, we intend to shedlight on the prevalence of otomycosis, along with the characteristics of patients that are most commonlypresented with this condition including age, gender, occupation, socioeconomic class, as well as complains. Wealso aim to elucidate the various predisposing risk factors that increase the likelihood of contracting otomycosisand explore the usually encountered pathogenic causes. Materials and Methods: A review of relevant articlespublished between the years of 1975 to 2019 in English language was done using the databases of PubMed Pico,Google Scholar and Google, using the predetermined keywords. Conclusion: Otomycosis is a prevalent fungalear infection mostly seen in young patients between the ages of 21-30 years. Otomycosis mostly involves oneear, and bilateral involvement is mostly observed in immunodeficient patients. The most frequently reported riskfactors include self-cleaning of ears with objects such as Q-tips, wooden sticks, metal pickers, instillation ofmustard oil in ears, undue use of antibiotic ear drops, and swimming. Otomycosis causative organism isespecially Aspergillus and Candida while concomitant bacterial infection can be seen in several cases ofotomycosis, the most common implicated bacteria being staphylococcus aureus. This literature reviewhighlights the need for education to eradicate the aforementioned predisposing risk factors to reduce theincidence of otomycosis.

Assessment of myocardial viability after acute ST- elevated myocardial infarction using stress speckle tracking echocardiography and cardiac MRI

Background: Speckle-tracking echocardiography has emerged as a unique technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking measured under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability. Objective: The aim of the current study was to evaluate stress speckle tracking to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients. Patients and methods: 74 patients were prospectively enrolled in 18-month's study. Dobutamine stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 3 months with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 3 months. Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. Meanwhile it provided 81.82% sensitivity and 82.6% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI. Moreover, it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission

Evaluation The Discomfort Level For Students Polytechnic Kuching Sarawak Sitting On Chairs

This study was conducted to evaluate the discomfort level of students from the Polytechnic Kuching Sarawak while they were sitting on chairs. Polytechnic Kuching students (n=500) completed a set of questionnaires utilizing a survey form which showed the body chart discomfort using Borg’s CR-10 Scale. The students was asked to identify body areas experiencing discomfort and to rate this discomfort using score rating groups (0 to 5) where score 0-1.99 = No discomfort (1), score 2.00-3.99 = Discomfort (2) and score 4.00-5.00 = Very uncomfortable (3). The evaluation of seating discomfort levels showed acceptable levels for the students and possible outstanding problems. Students were asked to rank over an order 10 statements about comfort and choose three responses which gave the most consistent equal interval scale. The results showed that the main response of discomfort indicated the students felt cramped, stiff, numb, sore and tender muscle, unbearable pain, barely comfortable and uncomfortable. This project was identified to evaluate the comfort level for classrooms chairs of polytechnic students. Overall, there was a significant discomfort level for the students whilst sitting on chairs and a possible solution put forward is to design a new type of classroom chair made of natural fibre reinforced composite.

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile Saudi patients

The study meant to define the prognostic factors that help in prescribing intrauterine insemination [IUI] for infertility treatment which remains an area of continuous improvements. The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates [PRs] were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months [January 2010 till August 2011], and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant. The highest PR, 18.87%, of the polycystic ovarian syndrome [PCOS]-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, [p=0.011, compared to all other groups combined]. The second highest PR, 14.0%, of the tubal factor [TF]-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR [0.0% to 2.70%]. Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR [8.33% to 11.11%]. There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances

Is surgical treatment of gingival and palatal cysts of the newborns necessary?

Purpose of this study was to investigate the conservative and or surgical treatment of gingival and palatal cysts of the newborns. A three years prospective study was conducted between 2009 and 2012 at Prince Hashem Ben Al-Hussein Military Hospital/Zarqa-North of Jordan and Prince Zaid Ben Al-Hussein Military Hospital, Atafela-South of Jordan. A total of 5000 newborns were examined. Those newborns who were diagnosed initially to have a single or multiple gingival and or palatal cysts were included in the study, but those with cleft palate and or cleft lip and all with congenital abnormalities were excluded. All infants diagnosed initially by neonatologist as having either gingival or palatal cyst were referred to periodontist for confirmation of the diagnosis. Further evaluations were conducted by neonatologist and periodontist after every two weeks. Over a period of three years, a total of 144 newborns with gingival and or palatal cysts were diagnosed during routine examination of the newborns at Prince Hashem Military Hospital and Prince Zaid Ben Al-Hussein Military Hospital. Patients were followed up for a period of 8 months. Sixty three percent of all cysts were broken by themselves after one week while 8% broke at the age of 3 months, 10% at 6 months of age, 6% at the age of 8 months and only 4% required surgical treatment. The study concluded that the majority of gingival and palatal cysts of the newborns resolved by the age of 8 months by themselves. This emphasizes the need for conservative and regular follow-ups and just reassuring the guardians of the newborns. The minority of them need surgical treatment

Impact of total parenteral nutrition on deciduous tooth eruption of very low birthweight premature infants

Purpose of this study was to investigate the effect of total parenteral nutrition on deciduous teeth eruption of very low birth weight premature infants. It was a prospective study done at Prince Hashim Ben Al-hussein Military Hospital of 85 healthy preterm infants who were born with birthweight of 800-1500grams, and at 27-32 weeks gestational age. They were divided into two main groups Group [40 preterm infants who did not receive total parenteral nutrition] and Group B [45 preterm infants who received total parenteral nutrition [TPN] during stay in the neonatal intensive care unit]. Group B was divided into two subgroups B1 [20 preterm infants who received only 3.5 grams/Kg/day Amino acids] and B2 [25 preterm infants who received amino acids and 3 grams /kg/day intralipids]. A first tooth eruption record was completed by the neonatologist and the parents of the enrolled infants during regular clinic appointments. Normal eruption was seen in subjects with birthweight [1001-1500 grams] than those with birth weight of 800-1000 grams and gestational age [30-32 weeks] than [27-29 weeks]. There were significant differences between groups for total parenteral nutrition, and they were highly significant when amino acids and intralipids were used together. As far as intubation is concerned the difference was not significant when the delayed group compared to the normal group. Neonatal sepsis were significantly increased when the oral intubation was more than 5 days. The study concluded that the introduction of total parenteral nutrition to very low birth weight premature infants resulted with early first tooth eruption. It is concluded that intralipids component of TPN is responsible for this observation, but further studies to evaluate the role of other TPN components are mandatory

Spontaneous rupture of hepatocellular carcinoma

From Sep. 1996 through Aug. 1998, 10 patients presented at the causality department in Ain Shams University Hospitals were diagnosed as having suffered from spontaneous rupture hepatocellular carcinoma [HCC]. Six patients were in Child's class A, 2 patients were in Child's class B and a further 2 patients were in Child's class C. All patients except one were men and the mean age was 55.75 years. For hemostasis, transcatheter arterial embolization [TAE] was performed for 2 patients. Only one of them benefited from such procedure. Emergency hepatic resection was feasible in 4 patients. There were 2 bisegmentectomies, one segmentectomy and another one sub-segmentectomy. The mean weight of the specimens, blood loss and tumor diameter were 732.5 gm., 2025 c.c. and 6.5 cm respectively. One patient who was in Child's class B died from liver failure, whereas another patient who was in Child's class C died from bleeding oesophageal varices. Five patients were managed by an alternative surgical measure, which was suture plication in 2 patients; one of them rebled, packing controlled such bleeding, packing was also applicable in another patient; hemostatic agent [gel foam] in one patient and hepatic artery ligation in the last patient. Two out of 5 died from liver failure after rebleding in one patient and after hepatic artery ligation in the last patient. In conclusion, emergency hepatic resection would be fruitful if the tumor was limited and peripherally located and the patient was in Child's class A