Hepatic subcapsular hematoma: A rare complication post-ERCP; a case report.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in gastroenterology wards for both diagnostic and therapeutic purposes. It doesn't however come free of complications. As a matter of fact, complications are reported in up to 10% of patients undergoing ERCP. PATIENT CONCERNS: In this article, we report the case of a patient who underwent ERCP and sphincterotomy for choledocholithiasis. Twenty-four hours after the procedure, the patient developed sudden sharp abdominal pain and dropped her hemoglobin levels. DIAGNOSIS: An emergent gastroscopy was done and it ruled out bleeding from the sphincterotomy. Computed tomography of the abdomen showed a large hepatic subcapsular hematoma. INTERVENTIONS: Blood was urgently transfused and the patient was transferred to the intensive care unit for monitoring. OUTCOMES: The patient's condition quickly deteriorated despite extensive resuscitative measures, and eventually passed away on day 4 post ERCP. LESSONS: Hepatic subcapsular hematoma is a very rare but fatal complication after ERCP and should be ruled out in patients who underwent the procedure and develop sudden abdominal pain with hemodynamic and laboratory instability.

Non-nutritive Sweeteners: Weight Loss or Weight Gain?

The consumption of non-nutritive sweeteners (NNS) is on the rise among different populations. In parallel, the debate about their potential health benefits and risks remains inconclusive. Numerous published studies elucidate the impact of NNS on general health, weight control, and the risk of certain diseases. However, no definitive conclusions regarding the effect of chronic NNS use on weight have been reached in humans. This review summarizes current evidence related to the biological role of NNS and their subsequent effects on weight. The mechanisms of action through which NNS impact weight are discussed, including their effect on sweet taste receptors, cognition, metabolic and endocrine functions, intestinal microbiota, and adiposity. Conflicting evidence is hindering the formulation of precise recommendations, but the evidence opposing the use of NNS remains weak, and the ultimate impact on weight largely relies on several other behavioral patterns.

Can Nutrition Help in the Treatment of Infertility?

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse or six months for women aged 35 years or older. The physical, emotional, psychological, and financial statuses of infertile couples are tremendously affected especially after undergoing diagnostic and/or curative treatments. Human fertility is influenced by multiple factors including female or male, and modifiable or non-modifiable factors. There is growing evidence that nutri-tion may play an important role in adjusting fertility-related outcomes in both men and women. The objective of our study was to summarize the latest data on nutritional factors (specific food groups, nutrients, and nutritional supplements) that have an impact on female or male sexual and reproductive function. PubMed and Google Scholar platforms were used to collect appropriate articles for the review using several combinations of keywords (infertility, diet, dietary supplements, antioxidants, and beverages). Adherence to a healthy dietary pattern favoring fish, poultry, whole grains, fruits, vegetables, and healthy fats, was related to better fertility in both genders. Despite the multifactorial etiology of sexual infertility, nutrition may affect the sexual/reproductive function in both women and men.

The Influence of the Gut Microbiome on Obesity in Adults and the Role of Probiotics, Prebiotics, and Synbiotics for Weight Loss.

The link between the gut microbiome and obesity is not well defined. Understanding of the role of the gut microbiome in weight and health management may lead to future revolutionary changes for treating obesity. This review examined the relationship between obesity and the gut microbiome, and the role of probiotics, prebiotics, and synbiotics for preventing and treating obesity. We used PubMed and Google Scholar to collect appropriate articles for the review. We showed that the gut microbiome has an impact on nutrient metabolism and energy expenditure. Moreover, different modalities of obesity treatment have been shown to change the diversity and composition of the gut microbiome; this raises questions about the role these changes may play in weight loss. In addition, studies have shown that supplementation with probiotics, prebiotics, and synbiotics may alter the secretion of hormones, neurotransmitters, and inflammatory factors, thus preventing food intake triggers that lead to weight gain. Further clinical studies are needed to better understand how different species of bacteria in the gut microbiome may affect weight gain, and to determine the most appropriate doses, compositions, and regimens of probiotics, prebiotics, and synbiotics supplementation for long-term weight control.

When and How to Diagnose and Treat Vitamin D Deficiency in Adults: A Practical and Clinical Update.

Vitamin D deficiency is considered a major public health concern. Inadequate sun exposure, limited oral intake, and impaired intestinal absorption are common risk factors for vitamin D deficiency. An increasing amount of research is aimed at answering questions regarding the most convenient test that can assess vitamin D status, the indications for screening, and finally the utility of treatments for vitamin D deficiency. Our review outlines practical strategies to diagnose and treat vitamin D deficiency in adults. This study was undertaken in the PubMed and the Google Scholar databases in April 2018 without limitation as to the publication period. Vitamin D status is determined by measuring the 25-hydroxyvitamin D serum concentration. However, this technique has several limitations. Determining the accurate thresholds for vitamin D deficiency is still a matter of debate. Only individuals at risk for vitamin D deficiency should be screened. The symptoms of vitamin D deficiency are unspecific and very common. Therefore, physicians may easily suspect vitamin D deficiency, measure 25-hydroxyvitamin D levels, and sometimes overprescribe supplementation. Hypovitaminosis D could rarely be treated by increasing consumption of foods naturally containing and fortified with vitamin D. Special attention should be given to vitamin D supplementation to prevent adverse effects. No safe and well-defined threshold of ultraviolet exposure allows adequate vitamin D synthesis without increasing the risk of skin cancer. Unanimous and decisive guidelines are urgently needed to improve knowledge and practices related to vitamin D deficiency.

Prevalence and correlates of a positive screen for eating disorders among Syrian refugees.

The objective of this cross-sectional study was to examine the prevalence and correlates of a positive screen for eating disorders (EDs) in a sample of Syrian refugees living in North Lebanon. The study was conducted on a convenience sample of 450 (84.67% women and 15.33% men) refugees, aged between 18 and 45 years. The prevalence of a positive screen for ED was 5.79%. Bivariate analyses revealed that female gender (p = 0.02), presence of medical conditions (p = 0.01), old occurrence of major stressful life event (p < 0.01), and positive primary care post-traumatic stress disorder screen (p < 0.01) were associated with the positive sick, control, one stone, fat, food tool. Multiple logistic regression analyses showed that subjects screened with post-traumatic stress disorder had a three times higher risk of having a positive screen for ED (odds ratio = 3.2; 95% confidence interval [1.32, 7.78]). Early detection of ED and related factors may help identify refugees who would benefit from interventions to improve mental health.

The Fluoride Debate: The Pros and Cons of Fluoridation.

Fluoride is one of the most abundant elements found in nature. Water is the major dietary source of fluoride. The only known association with low fluoride intake is the risk of dental caries. Initially, fluoride was considered beneficial when given systemically during tooth development, but later research has shown the importance and the advantages of its topical effects in the prevention or treatment of dental caries and tooth decay. Water fluoridation was once heralded as one of the best public health achievements in the twentieth century. Since this practice is not feasible or cost effective in many regions, especially rural areas, researchers and policy makers have explored other methods of introducing fluoride to the general population such as adding fluoride to milk and table salt. Lately, major concerns about excessive fluoride intake and related toxicity were raised worldwide, leading several countries to ban fluoridation. Health-care professionals and the public need guidance regarding the debate around fluoridation. This paper reviews the different aspects of fluoridation, their effectiveness in dental caries prevention and their risks. It was performed in the PubMed and the Google Scholar databases in January 2018 without limitation as to the publication period.

Are the Level of Knowledge and Practices of Pregnant Women Regarding Folic Acid Supplementation Still Inadequate? A Cross-Sectional Study in a Middle Eastern Urban Setting.

This observational cross-sectional study aimed to examine the knowledge and practices of pregnant women in North Lebanon regarding periconceptional folic acid (FA) supplementation. A convenience sample of pregnant women attending gynecology clinics in North Lebanon was recruited between May and September 2013. Data were collected from a face-to-face interview performed by a trained local dietician as well as from review of obstetric charts. A total of 465 women were included in the study. Only 37 (7.9%) were aware of the role of FA in preventing birth defects, while 129 (27.7%) were able to identify one food item rich in FA or folate. Only 125 (26.9%) were taking FA supplementation before pregnancy. While 440 (94.6%) participants were taking FA supplements during pregnancy, 158 (34%) were receiving an inadequate dose. Adequate preconceptional supplementation of FA was significantly associated with the women's level of education (p =.008), planned pregnancy (p <.0001), and gynecologic visit before pregnancy (p <.0001). Moreover, young age (p =.003) and small number of children (p =.019) were significant predictors of adequate supplementation during pregnancy. Our study revealed deficient knowledge and inadequate intake of FA supplements before and during pregnancy.

War stress may be another risk factor for eating disorders in civilians: a study in Lebanese university students.

OBJECTIVE: Traumatic life events are important risk factors for eating disorders (ED). War has been associated, in military populations, with an increased post-service incidence of ED and an increased mean body mass index. We hypothesize that a modification of eating behavior (EB) related to stress during wartime may increase the risk of developing an ED later on among civilians exposed to war stress during adulthood. METHODS: This descriptive cross-sectional study was performed in a group of 303 undergraduate young adult students of both sexes from Lebanon, 6 months after the July 2006 war. Modification of EB during wartime, sociodemographic and other potential risk factors were assessed retrospectively. Students were then screened for ED using the SCOFF questionnaire. RESULTS: SCOFF was positive in 31.4% of the students, with a mean value 41.6% higher among subjects who reported an altered EB during the war. Among subjects with a positive SCOFF screening, 71% had experienced a change of EB during wartime. Alteration of EB during war was related to an odds ratio for a positive SCOFF screening of 2.6 (95% CI 1.54-4.34) and 1.8 (95% CI 1.01-3.21) for non-adjusted and adjusted analysis, respectively. CONCLUSIONS: Modification of EB related to stress during wartime is associated with an increased risk of eating disorders. Early detection and treatment of eating disorders may be improved by routinely evaluation of EB modification in patients with a past history of war exposure.