Risk factors for multimodal conservative approach failure before bariatric surgery.

BACKGROUND: A multimodal conservative approach (MCA) is internationally recommended prior to bariatric surgery for the majority of patients. This research aimed to identify risk factors for therapy failure within the MCA. METHODS: This study was conducted in a German bariatric obesity centre. Patients who underwent a 3- to 6-month preoperative MCA from November 2019 to October 2020 were prospectively recorded and analysed. MCA included dietary and movement therapy, psychological and endocrinological referral and connection to a patient support group. The change in BMI was considered the main parameter for therapeutic success. Explanatory factors were evaluated for this outcome of interest and included physical and mental well-being (SF-36), perceived stress (DASS-21), social and economic situation and educational background (SOEP). RESULTS: Out of 413 eligible patients, 209 were analysed. Overall, patients gained BMI (average gain 0.23 kg/m² (s.d. 1.44 kg/m²)) during the preoperative MCA. Diverse social, demographic and economic and health properties did not influence the course of the therapy. There was a significant positive correlation between successful loss of BMI and physical well-being (ß = 0.03, 95% c.i. 0.01 to 0.04, P < 0.0001) and a negative correlation between mental well-being (ß = -0.02, 95% c.i. -0.004 to -0.001, P = 0.001) as well as self-perceived stress (ß = -0.05, 95% c.i. -0.09 to -0.01, P = 0.019), although these effects were small and did not affect the overall trend of gaining BMI during MCA. CONCLUSION: The current therapeutic approach of preoperative conservative treatment within the multimodal concept of bariatric treatment fails to achieve its intended outcome. A different conservative weight loss programme from the pre-bariatric setting, which should focus on a surgical preparation, is therefore recommended.

[Epiploic appendagitis: an uncommon and nonsurgical cause of abdominal pain]. / Appendagitis epiploica: eine seltene und nichtchirurgische Ursache abdomineller Schmerzen.

BACKGROUND: Epiploic appendagitis (AE) is a rare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis or diverticulitis due to its low incidence and its nonspecific clinical picture. This study presents the clinical course of AE and typical radiological features for an early and correct diagnosis in order to emphasize the importance of an early and correct diagnosis of AE. METHODS: This is a retrospective review of 43 patients diagnosed with AE between June 2010 and September 2022 at the Charité - University Hospital Berlin, Campus Benjamin Franklin. The medical records were reviewed regarding clinical und radiological features, anatomical location of the AE und treatment methods. RESULTS: A total of 43 patients (29 male, 11 female) were diagnosed with AE and almost all patients presented with abdominal pain, except in 8 cases (18.6%). Specific findings in computer tomography (CT) with a typical picture of AE were found in 33 patients (76.7%). AE was mostly localized in the left colon: 12 were found in the sigmoid colon (27.9%), 16 in the descending colon (37.2%) and 5 at the junction of the descending colon and the sigmoid colon (11.6%). Of the patients 28 (65.1%) were admitted for conservative treatment and the rest of the patients were treated as outpatients. No patient underwent surgery, all were treated with analgesics (NSAID) and 17 patients received antibiotics in addition. CONCLUSION: AE is a self-limiting disease and a common mimic of other serious causes of abdominal pain. Due to the emergence of the widespread use of imaging modalities, an early diagnosis of AE and a conservative approach as first choice of treatment in patients with AE could be established.

Fatalities Involving Khat in Jazan, Saudi Arabia, 2018 to 2021.

Interpreting fatalities involving khat is challenging due to a lack of data on cathinone and cathine reference concentrations in postmortem tissues. This study investigated the autopsy findings and toxicological results of fatalities involving khat in Saudi Arabia's Jazan region from 1 January 2018 to 31 December 2021. All confirmed cathine and cathinone results in postmortem blood, urine, brain, liver, kidney, and stomach samples were recorded and analyzed. Autopsy findings and the manner and cause of death of the deceased were assessed. Saudi Arabia's Forensic Medicine Center investigated 651 fatality cases over four years. Thirty postmortem samples were positive for khat's active constituents, cathinone and cathine. The percentage of fatalities involving khat was 3% in 2018 and 2019 and increased from 4% in 2020 to 9% in 2021, when compared with all fatal cases. They were all males ranging in age from 23 to 45. Firearm injuries (10 cases), hanging (7 cases), road traffic accident (2 cases), head injury (2 cases), stab wounds (2 cases), poisoning (2 cases), unknown (2 cases), ischemic heart disease (1 case), brain tumor (1 case), and choking (1 case) were responsible for the deaths. In total, 57% of the postmortem samples tested positive for khat only, while 43% tested positive for khat with other drugs. Amphetamine is the drug most frequently involved. The average cathinone and cathine concentrations were 85 and 486 ng/mL in the blood, 69 and 682 ng/mL in the brain, 64 and 635 ng/mL in the liver, and 43 and 758 ng/mL in the kidneys, respectively. The 10th-90th percentiles of blood concentrations of cathinone and cathine were 18-218 ng/mL and 222-843 ng/mL, respectively. These findings show that 90% of fatalities involving khat had cathinone concentrations greater than 18 ng/mL and cathine concentrations greater than 222 ng/mL. According to the cause of death, homicide was the most common fatality involving khat alone (77%). More research is required, especially toxicological and autopsy findings, to determine the involvement of khat in crimes and fatalities. This study may help forensic scientists and toxicologists investigate fatalities involving khat.

COVID-19 vaccination side effects among the child age group: a large cross-sectional online based survey in Saudi Arabia.

BACKGROUND: Multiple vaccines have been tested in clinical trials for their efficacy and safety. In Saudi Arabia, Pfizer-BioNTech or Moderna were approved for children, however, previous studies to report their safety profile are limited. This research aims to understand the side effect of children's vaccination against SARS-CoV-2 infection in Saudi Arabia. METHODS: This was an observational retrospective cross-sectional study was conducted using an online survey in Saudi Arabia from March to May 2022. The inclusion criteria were parents aged 18 years and above who live in Saudi Arabia and have vaccinated their children. The self-reported questionnaire was adopted from published studies to investigate the study objectives Descriptive statistics were used to describe patients' demographic characteristics, continuous data were reported as mean ± S.D., categorical data were reported as percentages (frequencies), and logistic regression was used to identify predictors of persistent post-COVID-19 symptoms. RESULTS: This study had a total of 4,069 participants. Only 41.9% of the participants reported that their child(ren) had been infected with the coronavirus. 2.00 was the median number of children (IQR: 1.00-4.00). More than half of the study participants (64.2%) reported that a family member had been infected with the coronavirus. Both parents received COVID-19 vaccination, according to most participants (88.7%). Most participants (70.5%) stated that all children who met the vaccination criteria had received the vaccine. Most participants (83.5%) said their child or children had two doses of their vaccine, and about half (50.4%) of those who received the vaccine reported experiencing side effects. In addition, the majority (78.9%) reported that the side effects appeared within one day of receiving the vaccine, and nearly two-thirds (65.7%) reported that the side effects lasted between one and three. A total of 11,831 side effects cases were documented. Pain at the injection site, hyperthermia, and fatigue were the most reported side effects, accounting for 15.3%, 14.1%, and 13.2%, respectively. CONCLUSION: It appears that the side effects of the COVID-19 vaccine for children are minor, tolerable, and like those described previously in clinical trials. Our data should encourage the public about the safety of receiving the COVID-19 vaccine for children.

The Prevalence of Irritable Bowel Syndrome and Its Relation to Psychiatric Disorders Among Citizens of Makkah Region, Saudi Arabia.

BACKGROUND AND AIM: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. Many adults worldwide have symptoms associated with IBS and are responsible for most gastroenterology visits. The aim of this study is to illustrate and analyze the prevalence of IBS among the general population in Makkah Al-Mukarramah city using the Rome IV criteria in relation to psychiatric disorders. METHODOLOGY: This was a cross-sectional study conducted on Makkah citizens. The study excluded all residents in Makkah without Saudi nationality or below the age of 18. The survey was created using Google forms and shared randomly on social media. The sample size was calculated using the OpenEpi website v3.0. The online questionnaire is composed of three sections: sociodemographic data, Rome IV criteria with the Bristol Stool Scale, and lastly the Depression, Anxiety, and Stress Scale 21 (DASS-21) score for stress, anxiety, and depression. Data were analyzed using SPSS software for Windows V.23, and odds ratio (OR) with 95% confidence intervals (95% CI) was obtained for selected risk factors using logistic regression. RESULTS: Nine hundred and twenty-one individuals from Makkah city completed the survey. The overall IBS prevalence was 20.19%. The commonest subtypes of IBS were IBS-M followed by IBS-C (53.8% and 22%, respectively). In the multiple regression analysis, stress (P = <0.001, OR = 2.473) was statistically significantly associated with IBS. CONCLUSION: In this study, the prevalence of IBS among Makkah citizens is high. Stress was found to be a major risk factor for IBS.

Mullerianosis of the urinary bladder.

Endometriosis is the ectopic presence of endometrial tissue outside of the uterus. Bladder involvement of these lesions is not uncommon and has been reported and studied extensively. Mullerianosis is a term that describes the ectopic presence of tissues from the endocervix and endosalpinx in extrauterine sites. Only a few cases of Mullerianosis involving the urinary tract system have been reported in literature. We report a case of a 32-year-old lady with bladder mass and periodic hematuria and dysuria. She underwent TURBT 1and on histopathology was found to have bladder Mullerianosis. Patient was later treated with oral contraceptives with improvement.

Management of iatrogenic ureteral injury: Ureteral reimplantation with a bilateral Boari flap.

Reconstruction of the ureter is still regarded as a sophisticated approach demanding absolute dedication of the urologists. Similarly, iatrogenic ureteral injuries, as well as strictures, are quite common complexities of the pelvic and gynecological surgeries which if left untreated could lead to short as well as long-term issues. Presently, a case of a post-caesarian section along with hysterectomy of 40 years old woman has been presented that has resulted in distal left ureteral injury. A bilateral Boari flap was performed for the mobilization of the bladder.

Acute scrotum in elderly; is it torsion !

Testicular torsion occurs most frequently in a preadulthood age. In geriatric people, it is very rare and should not be an exclusion criterion for the diagnosis. Lack of awareness about testicular torsion in elderly people may end up with delayed or misdiagnosis. In this article, we report a case of testicular torsion in 62 years old Saudi man.

Perspectives of primary health care physicians on diagnosing and referring patients with apparent osteolytic lesions on plain X-ray films: a cross-sectional study.

BACKGROUND AND OBJECTIVES: The identification and diagnosis of musculoskeletal symptoms are major challenges for primary care physicians. A lack of clinical suspicion, limited exposure, and referral of patients to nonspecialized centers can delay the management of cases, which in turn can increase morbidity and mortality. SUBJECTS AND METHODS: Four different sets of X-ray films were shown to 91 primary health care physicians. The first two were normal, whereas the third and fourth showed bone lesions. Participants were asked to indicate the presence of an abnormality, the diagnosis, and the approach to referral if required. RESULTS: There was a variation in the results for the first two sets of normal X-ray films. Most participants (73.6%) were able to diagnose the first case correctly. However, 73.6% of participants were unable to diagnose the second case correctly. A high percentage of participants (90.1%) were able to detect abnormalities in Cases 3 and 4, with nearly all participants indicating that they would refer patients to centers other than bone oncology centers in the western region of Saudi Arabia if they suspected bone tumors. Only 25.8% of participants were aware of these bone oncology centers. CONCLUSION: Physicians in many primary health care centers need practice in reading normal X-ray films to avoid unnecessary referral of patients to specialized medical centers. We recommend the development of a new system for referring patients suspected to have bone tumors to avoid a delay in the management of cases and to decrease morbidity and mortality.

Irritable bowel syndrome in secondary school male students in AlJouf Province, north of Saudi Arabia.

OBJECTIVES: To investigate the frequency of irritable bowel syndrome (IBS), and symptoms compatible with this condition among male students studying in secondary schools for boys in AlJouf province of Saudi Arabia. METHODS: A cross sectional study was conducted in April 2009, AlJouf province of Saudi Arabia, involving a self administered questionnaire (translated in Arabic) based on Manning and Rome II criteria for diagnosis of IBS that was distributed to 2025 students at secondary school for boys, by convenience sampling. About 86.3% (1747) completed the questionnaire. Sample size was calculated using Epi. Info 6.4, seat calculator. RESULTS: The prevalence of IBS was 8.9% and 9.2% according to Manning and Rome II criteria for diagnosis of IBS respectively in the study subjects with mean age of 17.5 +/- 3 years and range of 15-23 years. The most common symptom compatible with IBS was abdominal pain or discomfort in 37.9% of our sample, followed by feeling of incomplete rectal evacuation after defecation in 32.2% of the same sample. Recurrent abdominal pain or discomfort caused increase in rates of absence from schools in 28.2% of affected students (p < 0.05). There is a statistically significant association between family size and clusters of symptoms compatible with IBS (p < 0.045). CONCLUSION: IBS is common health problem in apparently healthy males studying in secondary schools for boys in AIJouf province of Saudi Arabia. Symptoms suggestive of this condition leading to a negative impact on their quality of life measures, and school performance. Early diagnosis and health education of this condition are imperative.