The Bouveret Syndrome: An Unusual Cause of Hematemesis

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery

Assessment of the challenges influencing the adoption of smart building technologies

Introduction: Over the past few decades, there has been an increasing focus on Smart Building Projects (SBP) and the technologies associated with them. Numerous studies have been conducted globally to define smart building technologies (SBT), identify challenges, and explore areas for improvement. This study aims to examine the concept and terminology of SBT and the expertise and experience of participants in SBP in the Arab Gulf countries, specifically Saudi Arabia. The study also investigates the challenges faced by SBT throughout its life cycle.Methods: To identify and assess the challenges affecting the adoption of smart building technologies. This approach included a literature review, pilot-testing, and a questionnaire survey. The survey targeted a sample of 90 architects/engineers, managers, and contractors.Results: A total of 55 challenges were identified and categorized into four groups, corresponding to the key phases of the project life cycle. These phases include the programming and feasibility analysis phase, design phase, installation and commissioning phase, and operation and maintenance phase. The findings of this research expand the body of knowledge by providing architects/engineers, managers, and contractors in the architecture, engineering, construction, and facility management (AEC/FM) industry with insights into the influential challenges related to the adoption of SBT. In conclusion, this study sheds light on the concept and terminology of smart building technologies and explores the challenges faced by SBT during its life cycle. By identifying and categorizing these challenges, the study provides valuable information to AEC/FM practitioners, enabling them to overcome obstacles and improve the adoption of SBT

High-fat diet-induced aggravation of cardiovascular impairment in permethrin-treated Wistar rats.

This study characterized the impact of post-weaning high-fat diet (HFD) and/or permethrin (PER) treatment on heart dysfunction and fibrosis, as well as atherogenic risk, in rats by investigating interactions between HFD and PER. Our results revealed that HFD and/or PER induced remarkable cardiotoxicity by promoting cardiac injury, biomarker leakage into the plasma and altering heart rate and electrocardiogram pattern, as well as plasma ion levels. HFD and/or PER increased plasma total cholesterol, triacylglycerols, and low-density lipoprotein (LDL) cholesterol levels but significantly reduced high-density lipoprotein (HDL) cholesterol. Cardiac content of peroxidation malonaldehyde, protein carbonyls, and reactive oxygen species were remarkably elevated, while glutathione levels and superoxide dismutase, catalase and glutathione peroxidase activities were inhibited in animals receiving a HFD and/or PER. Furthermore, cardiac DNA fragmentation and upregulation of Bax and caspase-3 gene expression supported the ability of HFD and/or PER to induce apoptosis and inflammation in rat hearts. High cardiac TGF-β1 expression explained the profibrotic effects of PER either with the standard diet or HFD. Masson's Trichrome staining clearly demonstrated that HFD and PER could cause cardiac fibrosis. Additionally, increased oxidized LDL and the presence of several lipid droplets in arterial tissues highlighted the atherogenic effects of HFD and/or PER in rats. Such PER-induced cardiac and vascular dysfunctions were aggravated by and associated with a HFD, implying that obese individuals may be more vulnerable to PER exposure. Collectively, post-weaning exposure to HFD and/or PER may promote heart failure and fibrosis, demonstrating the pleiotropic effects of exposure to environmental factors early in life

PERFORMANCE EVALUATION OF REPAIR MATERIALS

Reduction in the useful service-life of reinforced concrete construction, mainly due to reinforcement corrosion, is a major problem facing the construction industry worldwide, in general, and the Arabian Gulf in particular. Deteriorating structures need to be repaired not only to utilize them for their intended service-life but also to assure the safety and serviceability of the associated components. While several repair materials are used for repair and rehabilitation of the deteriorated concrete structures worldwide, their performance in the Arabian Gulf environment, dominated by the extreme temperatures and aridity, has not been thoroughly investigated. This paper reports the results of a study conducted to evaluate the performance of repair materials available in the local market. Based on the data developed in the study, criteria for the selection of repair materials are recommended

A comparative study of voluntarily reported medication errors among adult patients in intensive care (IC) and non- IC settings in Riyadh, Saudi Arabia

Purpose: To investigate the risk factors associated with medication errors and to compare the incidence and types of voluntarily reported medication errors among adult intensive care unit (ICU) and non-ICU patients at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: The design of this study was retrospective. All voluntarily reported medication errors involving adult patients (≥ 18 years) who were admitted into King Abdulaziz Medical City during the study period (January 2012 to June 2013) were included in the study. Reported medication errors were classified as ICU or non-ICU errors. Medication errors were also classified according to the node of medication use, harm category, and type of medication errors.Results: A total of 31,399 patients admitted into the hospital were included in the study, with 1,966 (6 %) admitted into the ICU and 29,433 (94 %) admitted into the non-ICU units. Overall, the incidence of medication errors was 1.2 % (390/31,399), 1. Over half of the errors were administration-related (51 %). The incidence of medication errors was 5.5 % (108/1,966) in ICU compared with 0.96 % (282/29,433) in non-ICU units (p < 0.001. In both settings, prescribing errors, delay in drug administration and dispensing extra dose were the most common medication errors. Higher risk for medication errors was significantly associated with admission into ICU vs. non-ICU units [OR = 5.24, 95 % CI: (4.12, 6.65); p < 0.001] and with patients’ age ≥ 60 vs. < 60 years [OR = 1.48, 95 % CI: (1.19, 1.83); p < 0.001].Conclusion: Medication errors are common in the health facility and occur during all stages of medication use from prescribing to administration. Higher risk for medication errors is associated with admission into the ICU and with patients’ age ≥ 60. Physician, pharmacists, and nurses need to be vigilant, up-to-date, and continuously trained to reduce the incidence of medication errors.Keywords: Medication errors, Voluntary reporting, Intensive care unit, Hospital settin

Overview on Epidemiology and Management of Myxedema Coma or Crisis

The most severe type of hypothyroidism is known as myxedema coma, which can quickly lead to death if not identified and treated aggressively. The condition known as hypothyroidism is easily detected and treated. But if ignored, it might eventually progress to myxedema coma, the most serious form of hypothyroidism. Since the majority of patients do not initially appear in a coma, the term "myxedema coma" is usually regarded as misleading. Lethargy usually progresses to stupor, which then becomes a coma with hypothermia and respiratory failure. only clinical criteria are used for diagnosis because thyroid hormone assays are unable to distinguish between simple hyperthyroidism and thyroid storm. Apart from essential medical interventions, the treatment focuses on preventing thyroid hormone production and secretion as antithyroid medications, and preventing the peripheral effects of thyroid hormone as β-blocker, glucocorticoids. The diagnosis of thyroid-stimulating hormone (TSH) in the blood is the same as that of simple hypothyroidism. As soon as a diagnosis is obtained, treatment should start right away. The majority of hospital and commercial laboratories can turnaround a TSH test in a matter of hours

Analysis of Blood Cultures in Major Burns in Tertiary Care Burn Unit in Oman

Objectives: In this study we review blood stream infections of major burns in a tertiary care burn unit to determine the most prevalent organisms in order to have a better empirical therapy protocol. Methods: This is a retrospective study where blood stream infection of major burns (>20% Total Body Surface Area) were analysed. Results:155 patients fulfilled the criteria. Median age was 33 years.  Median TBSA was 38%. 57.42% were males and 42.58% were females. Mortality was 25.16%. 50.9% of patients had positive blood culture. Expired patients had higher TBSA, Abbreviated Burns Severity Index score and earlier first positive blood culture. The most prevalent organisms grown from all blood cultures were Acinetobacter, staphylococci, Klebsiella, Enterococcus and pseudomonas. Candida is also commonly grown in blood cultures. All Acinetobacter species are always multidrug resistant. 8 of 14 patients had multidrug resistant Klebsiella.  There were only 4 patients who had Methicilin resistant Staphylococcus Aureus (MRSA) grown. The number of blood cultures samples taken ranged from 1 to 28 (median 6). First positive blood culture showed that Staphylococcus epidermidis   and Acinetobacter are the most common organisms. Conclusion: In conclusion multidrug resistant Acinetobcater has become the most predominant microorganism grown in blood cultures of major burns in our unit. Empirical therapy should include antibiotics that are effective against it to reduce the mortality. Keywords: Infection; Blood; Burn; Resistance; Antibiotics; Culture

Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availability in Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5% to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs. Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D. Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentre for many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to be taken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised.http://www.samj.org.zaam201

Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availabilityin Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency(25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5%to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs.Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D.Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentrefor many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to betaken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised