Endoscopic treatment of biliary leak following gunshot injury: A case report

This report describes the endoscopic treatment of a biliary leak, following a gunshot injury to the liver of a young Saudi female. She was admitted to the emergency unit having sustained an accidental gunshot on the upper part of her right shoulder when her spouse was maintaining his gun sitting on a higher level chair. She was intubated and immediately taken for exploratory laparotomy, which revealed right liver lobe laceration and significant hemoperitoneum. Bleeding was controlled surgically, and two peritoneal lavage catheters were inserted for drainage. However, about 300–400 ml of bile drainage was observed daily. Accordingly, endoscopic retrograde cholangiopancreatography (ERCP) was performed, which demonstrated a biliary leak. Sphincterotomy was performed and a stent was inserted, following which the biliary leak eventually subsided. A follow-up ERCP was performed 10 weeks later, and no further leak was observed. This is the first case report of a successful endoscopic treatment of traumatic biliary injuries due to a gun shot in Saudi Arabia. ERCP is a valuable method in the treatment of a traumatic bile leak. This report describes the endoscopic treatment of a biliary leak following a gunshot injury in a young Saudi female. She was admitted to the emergency unit having sustained an accidental gunshot on the upper part of her right shoulder when her spouse was maintaining his gun sitting on a higher level chair. She was intubated and immediately taken for exploratory laparotomy, which revealed right liver lobe laceration and significant hemoperitoneum. Bleeding was controlled surgically, and two peritoneal lavage catheters were inserted for drainage. However, about 300–400 ml of bile drainage was observed daily. Accordingly, endoscopic retrograde cholangiopancreatography (ERCP) was performed, which demonstrated a biliary leak. Sphincterotomy was performed and a stent was inserted, following which bile drainage gradually reduced, and stopped after 5 days. A follow-up ERCP was performed 10 weeks later, and no further leak was observed. This is the first case report of a successful endoscopic treatment of traumatic biliary injury due to a gunshot in Saudi Arabia. ERCP is a valuable method in the treatment of a traumatic bile leak

Hepatitis B and C viral infections in Tihamet Aseer, south-western Saudi Arabia: Are there gender differences?

Background: Hepatitis B virus (HBV) infection is endemic in Saudi Arabia. Many studies have shown varying results in gender differences in HBV and hepatitis C virus (HCV) infection. The objective of this study was to determine if gender differences exist in HBV and HCV infection and to elucidate any related risk factors in Tihamet Aseer, south-western Saudi Arabia. Materials and Methods: The study was a cross-sectional study of a representative sample of males and females in Tihamet Aseer, south-western Saudi Arabia. A comprehensive questionnaire was completed by all participants. Blood samples were taken and sera were tested for hepatitis B surface antigen and HCV antibodies by fourth-generation enzyme immunoassays. Results: The study included 1532 participants from the Tihamet Aseer area. An overall seroprevalence of 7.9% and 1.7% was found for HBV and HCV infections, respectively. In logistic regression analysis, no gender differences were found for HBV seroprevalence. Identified risk factors for HBV infection included a history of blood transfusion and lack of hepatitis B vaccination. On the other hand, females were more prone to become seropositive for HCV (adjusted odds ratio = 5.034, 95% confidence interval: 1.042–9.321). Other identified risk factors for HCV infection were illiteracy and a history of blood transfusion. Conclusion: The prevalence and HBV and HCV infection is high compared to the national figures. Gender differences were only observed in HCV infection. It is recommended to have an active educational and media campaign. A “catch-up” vaccination program against HBV should be introduced for adults as a strategy to achieve the herd immunity effect in the affected area

Pattern of helicobacter pylori sensitivity to various antimicrobial agents

To evaluate the pattern of Helicobacter pylori (<i> H. pylori</i> ) susceptibility to different antimicrobial agents, we prospectively studied 45 <i> H. pylori</i> isolates by disc diffusion method. These isolates were obtained from patients aged between 16-75 years, of both sexes who had no prior history of metronidazole ingestion. A total of 45 patients were included, of which 36 were males with a mean age of 42.9 years and nine females with a mean age of 36.4 years, 62&#x0025; of patients were Saudis. Almost all the <i>H. pylori</i> isolates were susceptible to clarithromycin, penicillin, erythromycin, ampicillin, tetracycline, clindamycin and cephradine. However, 64.4&#x0025; of the isolates were resistant to metronidazole. No significant difference was found either in susceptibility of isolates from Saudi, non-Saudi or male and female patients

Use of serum immunoglobulins G and A for detection of <i> Helicobacter pylori </i> infection in dyspeptic patients by enzyme immunosorbent assay

Since the discovery of Helicobacter pylori (H. pylori), several invasive and non invasive tests have become available. The aim of this study was to test the performance of immunoglobulins IgG and IgA by using an enzyme linked immunosorbent assay (ELISA) test (In vitro diagnostika GmbH, Germany) for the diagnosis of H. pylori among dyspeptic patients. Blood samples from 152 dyspeptic patients and 51 asymptomatic controls were analyzed in a case control study. IgG and IgA were positive in 33.5&#x0025; and 41.1&#x0025; respectively compared to 13.8&#x0025; for both IgG and IgA in controls (P=0.002). We support the future use of serology as a non invasive, and rapid test for the diagnosis of H. pylori infection among dyspeptic patients in areas with low prevalence. Endoscopy remains the method of choice for elderly dyspeptic patients and for those with possible gastric or duodenal pathology

Hepatitis C Virus Infection at Primary Healthcare Level in Abha City, Southwestern Saudi Arabia: Is Type 2 Diabetes Mellitus an Associated Factor?

Background: There is an increasing concern about the relation between hepatitis C virus infection (HCV) and type 2 diabetes mellitus (T2DM). The present study aims to determine the prevalence of HCV infection among T2DM patients and non-diabetic patients attending primary healthcare centers (PHCCs) in Abha city, southwestern Saudi Arabia, and to explore the possible association between T2DM and HCV infection. Methods: A cross-sectional study targeting a random sample of T2DM and non-diabetic patients attending PHCCs in Abha City was conducted. Patients were interviewed using a structured questionnaire and screened for HCV infection using fourth-generation ELISA kits. All positive cases were confirmed by qualitative RT-PCR immune assay. Results: The study revealed an overall seroprevalence of HCV infection of 5% (95% CI: 2.9&#8315;7.9%). Among T2DM and non-diabetics, a seroprevalence of 8.0% and 2.0% was found, respectively. Using multivariable regression analysis, the only significant associated factor for HCV infection was T2DM (aOR = 4.185, 95% CI: 1.074&#8315;16.305). Conclusions: There is strong positive association between T2DM and HCV infection. Yet, the direction of relationship is difficult to establish. Patients with T2DM have higher prevalence of HCV infection than non-diabetic group. It is highly recommended for primary health care providers to screen for HCV infection among T2DM patients and to increase the level of HCV awareness among them

Clinical and Biochemical Predictors of Nonalcoholic Fatty Liver Disease among Type 2 Diabetes Mellitus Patients at Primary Health Care Level in South Western Saudi Arabia

Objectives: To predict the role of different clinical and biochemical parameters in identifying nonalcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) in Abha city, southwestern Saudi Arabia. Methods: A stratified random sample was selected. A detailed clinical and biochemical examinations were performed. Using portable abdominal ultrasound examination, NAFLD was identified. The study used receiver operating characteristic (ROC) analysis. Results: The study covered 237 T2DM patients. NAFLD was detected among 174 patients. Area under the curve (AUC) calculations showed that the ability of age, duration of DM in years, and body mass index to predict NAFLD was poor (AUC &lt; 0.6). Similarly, biochemical factors like HbA1c%, AST, cholesterol, triglycerides, HDL, LDL, and VLDL were poor in discriminating between those with and without NAFLD among T2DM. On the other hand, the ability of ALT to predict NAFLD among T2DM was good (AUC = 0.701, 95% CI: 0.637&ndash;0.761). The analysis identified the optimal cutoff point of ALT to be &le;22.1 nmol/L. The corresponding sensitivity was 60.7% (95% CI: 53.0&ndash;68.0) and specificity was 62.5% (95% CI: 49.5&ndash;74.3). Conclusions: Early identification of NAFLD among T2DM is important. A threshold cutoff value of 22.1 nmol/L of ALT has been identified to predict NAFLD. They should be referred for ultrasound examination for NAFLD

Non-Alcoholic Fatty Liver Disease among Type-2 Diabetes Mellitus Patients in Abha City, South Western Saudi Arabia

The objective of this study was to determine the prevalence and the factors associated with non-alcoholic fatty liver disease (NAFLD) among type-2 diabetes mellitus (T2DM) patients in Abha City, Southwestern Saudi Arabia. Using a cross-sectional study design, a representative sample of 245 T2DM patients were recruited from all primary healthcare centers in Abha city. A detailed medical history as well as laboratory investigations were done. NAFLD was diagnosed using abdominal ultrasound examination. The overall prevalence of NAFLD was 72.8% (95% CI: 66.6%&#8315;78.1%). In a multivariable regression analysis, the risk of NAFLD was significantly higher among overweight T2DM patients (aOR = 6.112, 95% CI: 1.529&#8315;4.432), Obese (aOR = 10.455, 95% CI: 2.645&#8315;41.326), with high ALT of more than 12 IU/L (aOR = 2.335, 95% CI: 1.096&#8315;5.062), moderate diet-compliant patients (aOR = 2.413, 95% CI: 1.003&#8315;5.805) and poor diet-compliant patients (aOR = 6.562, 95% CI: 2.056&#8315;20.967). On the other hand, high HDL (high density cholesterol) (in mg/dL) was a protective factor for NAFLD (aOR = 0.044, 95% CI: 0.005&#8315;0.365). It was concluded that NAFLD is a common association of T2DM. Increasing BMI (Body mass index), lower HDL level, and poor dietary control are significant factors associated with NAFLD among T2DM patients. Health education to improve dietary control and avoid excessive weight gain, testing for NAFLD among diabetic patients, especially those with abnormal BMI and HDL, are recommended for early detection and to ensure optimal levels of HDL

Crataegus Aronia protects and reverses vascular inflammation in a high fat diet rat model by an antioxidant mechanism and modulating serum levels of oxidized low-density lipoprotein

Context: Crataegus aronia (Willd.) Bosc (Rosaceae) (syn. Azarolus L) is traditionally used to treat cardiovascular disorders. Objectives: To investigate C. aronia protection against a high-fat diet (HFD)-induced vascular inflammation in rats. Materials and methods: Wistar Male rats (180–220 g) were divided (n = 10/group) as control fed a standard diet (STD), STD + C. aronia (200 mg/kg, orally), HFD, HFD + C. aronia and HFD post-treated with C. aronia. Simvastatin (20 mg/kg) was co- or post-administered as a positive control drug. HFD was given for 8 weeks, and all other treatments were administered for 4 weeks. Results: Most significantly, co-administration of C. aronia to HFD-fed rats reduced the thickness of aorta tunica media (90 ± 5 vs. 160 ± 11.3 µm) and adventitia (54.3 ± 3.8 vs. 93.6 ± 9.4 µm). It also lowered protein levels of TNF-α (0.51 ± 0.15 and 0.15 ± 0.16 vs. 0.1 ± 0.09%) and IL-6 (0.52 ± 0.19 vs. 1.0 ± 0.2%) in their aorta or serum (5.9 ± 0.91 vs. 12.98 ± 1.3 ng/mL and 78.1 ± 6.7 vs. 439 ± 78 pg/mL, respectively). It also lowered all serum lipids and increased aorta levels of GSH levels (70.4 ± 4.0 vs. 40.7 µM) and activity of SOD (5.7 ± 0.7 vs. 2.9 ± 0.6 U/mg) and decreased serum levels of ox-LDL-c (566.7 ± 46 vs. 1817 ± 147 ng/mL). Such effects were more profound than all other treatments. Conclusions: C. aronia inhibits the HFD-induced vascular inflammation and its use in clinical trials is recommended

MiR-155 Dysregulation Is Associated with the Augmentation of ROS/p53 Axis of Fibrosis in Thioacetamide-Induced Hepatotoxicity and Is Protected by Resveratrol

Liver fibrosis is a hallmark of thioacetamide (TAA) intoxications. MicroRNAs (miRs), such as miR-155, have been implied in the pathogenesis of liver disease, and regulated by the antioxidant and anti-inflammatory compound resveratrol (RES). The link between reactive oxygen species (ROS), tumour suppressor p53 (p53), and liver fibrosis-during the pathogenesis of TAA-induced liver injury-associated with miR-155 dysregulation with and without RES incorporation has not been previously studied. Therefore, one group of rats received TAA injections of 200 mg/kg; twice a week at the beginning of week 3 for 8 weeks (TAA group; or model group), whereas the protective group was pretreated daily with RES suspension (20 mg/kg; orally) for the first two weeks and subsequently sustained on receiving both RES and TAA until being sacrificed at the 10th week. Liver injuries developed in the model group were confirmed by a significant (p &lt; 0.0001) elevation of hepatic tissue levels of miR-155, ROS, p53, and the profibrogenic biomarkers: tissue inhibitor of metalloproteinases-1 and &alpha;-smooth muscle actin, as well as collagen deposition (fibrosis). All these parameters were significantly (p &le; 0.0234) protected by resveratrol (RES + TAA). In addition, we observed a significant (p &lt; 0.0001) correlation between ROS/p53 axis mediated liver fibrosis and miR-155. Thus, TAA intoxication induced miR-155 imbalance and ROS/p53-mediated liver fibrosis, with resveratrol, conversely displaying beneficial hepatic pleiotropic effects for a period of 10 weeks