Refractory Cytomegalovirus Colitis in Common Variable Immunodeficiency Requiring Total Colectomy.

Cytomegalovirus (CMV) colitis is an uncommon infection in immunocompetent hosts, usually occurring in the presence of an underlying immunodeficiency condition that allows for the reactivation of latent CMV infection. CMV colitis typically presents with persistent diarrhea, sometimes accompanied by bloody stools and nonspecific abdominal pain. We present the case of a 76-year-old woman known to have chronic CMV colitis, which was diagnosed in the context of underlying common variable immunodeficiency (CVID). Despite multiple attempts at managing CMV colitis, her symptoms persisted over the years. Ultimately, the patient required a pan colectomy due to refractory CMV colitis.

Ectopic Cecal Varices as a Cause of Lower Gastrointestinal Bleeding.

Ectopic varices account for 1%-5% of all variceal bleeding episodes in patients with portal hypertension. They can be found at any part of gastrointestinal tract including the small intestines, colon, or rectum. We report a case of a 59-year-old man who presented with bleeding per rectum 2 days after a routine colonoscopy, in which 2 lesions were biopsied. Gastroscopy was negative for bleeding, and he was not stable enough to undergo colonoscopy. CT angiography showed a large portosystemic shunt with multiple collaterals in the right lower quadrant. These findings were clues for a diagnosis of ectopic cecal varices.

Nonalcoholic Fatty Liver Disease Increases Cardiovascular Risk in Inflammatory Bowel Diseases.

Background: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate-high cardiovascular risk in IBD. Methods: We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m-1 and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if <5%, borderline if 5%-7.4%, intermediate if 7.5%-19.9%, and high if ≥20% or if previous cardiovascular event. Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Results: Of 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56-5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22-1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35-3.98). Conclusions: Assessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.

Measurement of Parents' Knowledge toward Oral Health of their Children: An Observational Study from Hail, Saudi Arabia.

AIM: Parents' knowledge of oral health maintenance is of crucial importance. Children are dependent on their parents for the maintenance of their oral health. Hence, the present study is aimed to measure parents' knowledge toward the oral health of their children. MATERIALS AND METHODS: It was an observational study, having a cross-sectional design in which information from 223 participants were collected after obtaining written consent using a convenient sampling technique. Data obtained from the questionnaire were coded and analyzed using the Statistical Package for the Social Sciences (SPSS Version 20). Descriptive and inferential statistics were used. Data were displayed as number and percentage, and the Chi-square test was used to measure association. Ethical approval was obtained from the ethical approval committee of the University of Hail. RESULTS: The total numbers of parents included in the study were 223, out of which, 91 (40.8%) were males and 132 (59.1%) were females. Around 58.3% of the respondents believed that they would go for a dental visit when the child had dental pain. A majority of the participants (60%) believed that concerns with primary dentition would lead to permanent dentition in the future. Almost 97% of parents knew that sugar and sticky food had a bad effect on oral health. Nearly 50% of parents reported correctly that prolonged bottle-feeding had a negative effect on their children's oral health. CONCLUSION: Most parents had satisfactory knowledge about the maintenance of oral hygiene of their children for most of the questions. However, the overall result of this study indicates that parents' information and approach toward oral hygiene and dental care need to be improved. CLINICAL SIGNIFICANCE: Parents' knowledge and positive attitude are central to children's oral health. The present study measured and recommends the need for oral health education and promotion for the parents.