Awareness of Non-alcoholic Fatty Liver Disease and Its Determinants in Jazan, Saudi Arabia: A Cross-Sectional Study.

Background Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis. It is the leading cause of liver-related mortality, end-stage liver disease, and the need for liver transplantation. This study aimed to assess the level of awareness regarding NAFLD among the adult population in Jazan, Saudi Arabia, and to explore the determinants of the awareness level. Method This descriptive cross-sectional study was conducted among the general population of Jazan, Saudi Arabia, under the supervision of Jazan University, excluding those with end-stage liver failure. An online self-administered questionnaire, adopted from the literature, was sent through different social media platforms. A total of 1,034 people participated in this study. The chi-square test and multiple linear regression were used to identify the predictors of NAFLD awareness. Results Fifty-three percent of the participants were aware of NAFLD. The mean score of the participants' awareness was 22.7 ± 4.9 out of 40 points. Employed (95% confidence interval (CI): -1.9, -0.03; p = 0.044) and private business individuals (95% CI: -3.5, -1.1; p < 0.001) had a lower awareness level than students. The higher income level was associated with greater awareness (95% CI: 0.36, 2.4; p = 0.008). Those who had never heard of NAFLD had nearly twice as much awareness (95% CI: -3.0, -0.67; p = 0.002). Conclusions Nearly half the study participants displayed good awareness of NAFLD. However, efforts must focus on awareness campaigns, encouraging health-seeking behaviors, and targeted screening for early detection and treatment, especially in at-risk populations, since many participants were unaware of NAFLD.

Transfusion-Associated Graft-Versus-Host Disease in Adults.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication of blood transfusion that usually develops two to 30 days following a blood transfusion giving rise to graft versus host disease (GVHD) clinical features that are consisting of fever, skin rash, jaundice, diarrhea, and pancytopenia. The disease is fulminant in most patients with a mortality rate of >90% of cases. The main aim of this review is to enhance awareness among medical practitioners about this fatal disease. Data were extracted manually from the main medical databases (Medline, Scopus, and Google Scholar) after the revision of selected articles and assessed for their contribution to the knowledge of TA-GVHD. TA-GVHD occurs when the viable donor T-cells in the blood or blood products attack the recipient's tissues which his/her immune system is incapable to destroy due to several reasons. The recipient's tissues that are usually involved in TA-GVHD include the liver, intestine, skin, lungs, and bone marrow. Any blood component either whole blood, packed red blood cells (RBCs), platelets, or fresh non-frozen plasma that contains viable T lymphocytes can cause TA-GVHD. Host immunodeficiency, transfusion of fresh blood, and partial human leukocyte antigen (HLA) matching between the donors and the recipients represent the major risk factors of TA-GVHD. Partial HLA matching includes immunocompetent recipients who receive blood from a first-degree relative also, seen in genetically homogenous populations because of high rates of consanguineous marriage. The diagnosis of TA-GVHD is mainly suspected based on clinical manifestations. However, a histopathological study of either skin or rectal biopsy is diagnostic. The treatment of TA-GVHD is generally not effective, unless the patient received emergency stem cell transplantation, while prevention via irradiation of blood or blood products represents the standard of care for this disease. In conclusion, medical practitioners should have a high index of suspicion for this disease. Moreover, future clinical trials targeting and comparing the outcomes of the different therapeutic options for TA-GVHD are required.

A Rare Presentation of Hepatocellular Carcinoma in a Young Adult: A Case Report.

Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in a young patient with no cirrhosis or fibrosis is a relatively rare condition. The present case report describes a young 24-years-old male patient who presented with a two-month history of fever, right upper quadrant abdominal pain, and weight loss with no evidence of pre-existing liver disease, initially treated as liver abscess; however, a computed tomography (CT) showed numerous hepatic hypodensities with ring enhancement. Serum alpha-fetoprotein level was high (>1000 ng/L) and histopathological study confirmed the presence of primary hepatocellular carcinoma. The present case findings suggest that multifocal hepatocellular carcinoma can occur in a young patient with no apparent risk factor, and that the clinical presentation of hepatocellular carcinoma can be similar to liver abscess.

Hyper-Reactive Malarial Splenomegaly Syndrome (HMSS).

Hyper-reactive malarial splenomegaly syndrome (HMSS) is a massive enlargement of the spleen due to an exaggerated immune response to repeated attacks of malaria.  Tropical splenomegaly syndrome (TSS) is the most frequent cause of massive tropical splenomegaly in malarious areas [1-2].  It is seen more commonly among residents of endemic areas of malaria.  It occurs mainly in tropical Africa, but also in parts of Vietnam, New Guinea, India, Srilanka, Thailand, Indonesia, South America, and the Middle East. TSS is characterized by massive splenomegaly, hepatomegaly, marked elevations in levels of serum IgM, and malaria antibody.

Celiac Disease Initially Misdiagnosed as Irritable Bowel Syndrome: Case Report.

BACKGROUND:  The increasing availability of serological testing & upper endoscopy has led to more frequent diagnosis of celiac disease & recognition that it may mimic Irritable bowel syndrome (IBS). OBJECTIVE:  The objective of the present case report is to describe the importance of screening those with vague abdominal symptoms (like patients with IBS) and iron deficiency anemia for celiac disease. METHODS:  We report the clinical course of a 30-year-old patient with vague abdominal symptoms initially misdiagnosed as having IBS; when the patient presented in our clinic, he was noted to have iron-deficiency anemia. On work-up for the cause of iron deficiency anemia, he was found to have celiac disease on basis of positive serological tests and small bowel biopsy result. After being placed on gluten-free diet, plus iron supplements, his abdominal symptoms and iron deficiency anemia totally improved. CONCLUSIONS:  Our case demonstrates that routine screening for celiac disease should highly be considered for patients with iron-deficiency anemia and IBS.