The association between night eating syndrome and GERD symptoms among university students at An-Najah National University in Palestine: a cross-sectional study.

BACKGROUND: Night eating syndrome (NES) is a kind of eating disorder. NES association with gastroesophageal reflux disease (GERD) symptoms among university students is still not fully understood. We aimed to determine the relationship between NES and the presence of GERD symptoms among university students at An-Najah National University in Palestine. METHODS: This study involved undergraduate students from An-Najah National University. The data were collected through online surveys from November to December 2023. The sampling frame involved voluntary sampling, as the data were collected using a structured questionnaire to collect data on sociodemographic variables, medical history, lifestyle habits, nutritional status, GERD risk, and NES. The GERD questionnaire (GerdQ) was used to assess symptoms, while the Arabic version of the validated Night Eating Questionnaire (NEQ) was used to assess night eating. Physical activity was assessed using the short form of the International Physical Activity Questionnaire (SF-IPAQ), and adherence to a Mediterranean diet was assessed using the validated Arabic version of the MEDAS. Both univariate and multivariate analyses were also conducted to assess the study hypotheses. RESULTS: The study involved 554 participants, 59.9% female. A total of 33.4% reported GERD symptoms, with 10.3% having NES. A strong association was observed between GERD and NES and between GERD and physical activity. Night eating syndrome (AOR = 2.84, CI = 1.07-3.19), high physical activity (AOR = 0.473, CI = 1.05-3.19), and non-smoking (AOR = 0.586, CI = 1.27-7.89) were identified as independent predictors of GERD symptoms. CONCLUSION: This study revealed that 33.4% of undergraduate students were at risk of GERD, with night eaters having a greater risk. GERD risk was negatively associated with physical activity level and smoking status. No associations were found between GERD risk and weight status, Mediterranean diet adherence, sociodemographic factors, or sleep disturbances.

A rare delayed onset of esophageal varices and portal vein thrombosis in a ten-year-old patient following umbilical vein catheterization.

Introduction and significance: Portal vein thrombosis (PVT) is not commonly observed in patients, particularly those who have gone through neonatal intensive care unit (NICU) stays and had umbilical catheters. Although PVT can potentially cause hypertension and gastrointestinal bleeding it is highly unusual for this condition to manifest during childhood. Case presentation: The authors present a case of a 10-year-old child who developed portal hypertension, esophageal varices, and multiple thrombophilia associated mutations. This child was born prematurely. Had to stay in the NICU, where an umbilical venous catheter was used which likely triggered the development of PVT. At the age of 7 he started experiencing distension, anemia and low platelet count, which eventually led to splenectomy. On at the age of 10 he began experiencing episodes of bleeding. Was diagnosed with esophageal varices and portal gastropathy. Through procedures, like Histoacryl glue injection and band ligation bleeding was successfully controlled. Genetic analysis revealed mutations associated with thrombophilia. Clinical discussion: This case highlights how rare it is for older children to develop PVT and emphasizes the possibility of delayed onset symptoms following catheterization. The placement of catheters in NICUs can disrupt blood flow and increase the likelihood of clot formation. The presence of hypertension resulting from PVT can lead to complications such as varices. Effective control, over bleeding was achieved through interventions.Importantly, the presence of ACE I/D, FXIII Val34Leu, and Factor V Leiden mutations introduces an aspect to this scenario. It is worth noting that these mutations are not commonly linked to thrombophilia or clotting disorders. Conclusion: This case highlights pediatric PVT, emphasizing the need for a collaborative approach among gastroenterologists, hematologists, and geneticists. Further research is required to understand PVT mechanisms and long-term implications, aiding in diagnosis and management, especially when it appears in late childhood. Evaluation is crucial in deciphering thrombophilia-related complications in the context of hypertension.

Management of Enterocutaneous Fistula in Crohn's Disease by Embolization With Glue Injection and Coiling: A Case Report.

There is one reported case of a pancreatoduodenal fistula that was managed using combined coil embolization and fibrin glue after the failure of other methods. Herein, we document this case to highlight the value of coil embolization and fibrin glue as surgical alternatives for fistula treatment. We present a case of a 39-year-old female patient who has a known case of Crohn's disease (CD) and presented with an enterocutaneous fistula (ECF) after her most recent surgery. With the failure of conservative approaches and as she refused any surgical interventions, fibrin glue injection and coiling were used. As a conclusion, embolization may work well as a surgical management alternative due to its simplicity.

Splenic infarction secondary to polycythemia Vera: Case report and literature review.

Splenic infarction is a medical condition characterized by compromised blood flow to the spleen, resulting in partial or complete organ infarction. This condition is commonly observed in patients with an increased risk of thrombosis, such as those with Polycythemia Vera (PV). A 40-year-old female patient presented with fatigue, weakness, and an enlarged spleen, further tests revealed elevated levels of hemoglobin, white blood cells, and platelets. A bone marrow biopsy and positive Jack II mutations confirmed the diagnosis of PV. The patient later developed portal hypertension, varices, and splenic infarction. This case report aims to raise awareness about the potential complications of PV and emphasizes the importance of early intervention to prevent serious consequences such as splenic infarction. Additionally, it highlights the role of splenectomy in managing complications associated with PV.

An unusual case of chronic mesenteric ischemia: Case report.

Chronic mesenteric ischemia (CMI) is a rare cause of abdominal pain with risk factors as Diabetes, Hypertension, smoking and age above 65-year-old age. A 55 -year-old man, a heavy smoker, with no other risk factor for chronic mesenteric ischemia, presented with a recurrent episodes of abdominal pain. Many differential diagnoses were excluded, CT angiography was showed Inferior Mesenteric artery (IMA) and superior Mesenteric artery (SMA) stenosis, then the Intervention was done successful. Gastric ulcers that are resistant to treatment, H. pylori negative and with no history of non-steroidal anti-inflammatory drugs (NSAID) use should be investigated for a possible ischemic.

An arteriovenous malformation associated ischemic colitis in the setting of acute gastrointestinal clostridium difficile colitis and intestinal amebiasis: A case report.

BACKGROUND: There is one reported case of inferior mesenteric arteriovenous malformation presenting as ischemic colitis after an episode of gastrointestinal infection. We documented this case to emphasize the possible association between ischemic colitis and vascular malformations. In addition, this is the number 15th case in the literature about this association. CASE SUMMARY: A 40 years old male patient presented with abdominal pain and diarrhea of 10 days duration after he was diagnosed and managed as a case of Clostridium Difficile infection and amebiasis. Computed tomography angiography revealed a vascular malformation of the inferior mesenteric artery, repeated colonoscopy showed ulceration and sloughing of the mucosa, he underwent Hartmann's procedure due to colonic ischemia diagnosed by the previous measures. Later on he had a colostomy closure and end to end colorectal anastomosis. CONCLUSION: There is a possible association between acute gastrointestinal infection and ischemic colitis in the setting of arteriovenous malformation.

Assessment of health-related quality of life in patients with inflammatory bowel disease in occupied Palestinian territory: a correlation cross-sectional study.

BACKGROUND: Disease activity is suggested to be an important indicator for quality of life (QoL) in patients with inflammatory bowel disease (IBD). Few studies of the association between adherence to medication and QoL in patients with IBD are available, and their findings are conflicting. We examined associations between disease activity, medication adherence, and QoL in patients with IBD in occupied Palestinian territory. METHODS: This correlation cross-sectional study was done from July 1, 2017, to Feb 30, 2018. We used convenience sampling to recruit patients from three major hospitals in southern and northern regions of occupied Palestinian territory. The disease-specific inflammatory bowel disease questionnaire (IBDQ) was used to examine QoL. Medication adherence was measured with the modified Morisky adherence scale. Associations were assessed by regression analysis. Results were analysed with SPSS version 20. The study was approved by the Al-Quds University Research Ethics Committee. Informed verbal consent was obtained from the participants before the start of the study. INTERPRETATION: 132 patients were enrolled. The mean age was 34 years (SD 13) and 77 (58%) patients were men. Active disease in the previous 6 months was reported in 81 participants (61%). Low adherence to medication (score <6) was reported in 52 (39%) of participants. The average IBDQ score was low (150·72 [SD 30·08]), with the emotional and bowel domains being most affected. Active disease was the most significant factor associated with patients' QoL overall (p<0·001). No significant association was found between medication adherence and QoL. Regression analysis revealed significant independent associations between QoL and disease remission (p<0·001), high educational status (p=0·009), and using azathioprine (p=0·034). INTERPRETATION: Our results provides baseline data about Palestinian IBD patients' QoL and medication use and adherence, and might help health-care providers to identify patients with IBD at risk of low QoL, especially those with relapse and active symptoms. Attention should be given by health-care providers and strategists to increasing knowledge about IBD. The importance of treatment adherence should be explored further. Some limitations were encountered during the study period; it was conducted in only three hospitals and the results might not be generalisable. The cross-sectional type of this study might prevent the identification of any cause-and-effect relationships, especially between medication and post-treatment improvements in QoL. FUNDING: None.

Helicobacter pylori resistance to antibiotics at the An-Najah National University Hospital: a cross-sectional study.

BACKGROUND: Bacterial resistance to antibiotics is considered the most important determinant of treatment failure. Monitoring the evolution of antimicrobial resistance to common antibiotics is therefore of special importance for clinicians. The frequency of resistance to antibiotics in Helicobacter pylori isolates is increasing. The aim of this study was to determine the pattern of H pylori antibiotic resistance at the An-Najah National University Hospital. METHODS: In this cross-sectional study, we recruited patients older than 18 year who were admitted to the An-Najah National University Hospital. Participants underwent oesophageal gastroduodenoscopy and gastric biopsy in the hospital's laparoscopic department. Biopsies were taken from the gastric antrum and body during endoscope. The analysis of the biopsies included rapid urease test, histological examination to detect H pylori, and bacterial culture using selective media. After culturing the bacteria for 7 days, we tested oxidase, urease, and catalase activity. Cultures that were positive for H pylori were tested for their susceptibility to various antimicrobial agents. Ethical approval was obtained from the An-Najah National University before starting the data collection. All participants gave informed consent before the procedure. FINDINGS: Between July 1, 2016, and Jan 1, 2017, we enrolled 91 patients with dyspepsia (49 women and 42 men). 38 (42%) patients had an H pylori infection. H pylori was found in three (100%) of three patients with a duodenal ulcer, three (46%) of ten patients with a gastric ulcer, 20 (54%) of 37 patient with gastritis, and 12 (41%) of 29 patient with a normal endoscopic appearance. When isolates of H pylori isolates were subjected to sensitivity tests against six antibiotics, ciprofloxacin was the most effective drug against H pylori (0% resistance), followed by levofloxacin (0%), moxifloxacin (3%), and amoxicillin (18%). Metronidazole and clarithromycin were the least effective drugs, with resistance rates of 100% and 47%, respectively. INTERPRETATION: H pylori isolates from the Palestinian patients included in this study were highly resistant to the traditional first-line antibiotics clarithromycin and metronidazole. However, fluoroquinolones and amoxicillin are still effective antimicrobial choices. This could be the result of the unjustified wide use of antibiotics in the Palestinian community and the use of clarithromycin-based therapy as first-line treatment for H pylori, which in turn has led to increased rates of H pylori eradication failure. We recommend using quinolone-based regimens for H pylori and rationing the use of antibiotics in Palestinian patients. FUNDING: An-Najah National University.

Anticonvulsant hypersensitivity syndrome after phenytoin administration in an adolescent patient: a case report and review of literature.

BACKGROUND: Hypersensitivity is a rare adverse drug reaction (ADR) associated with anti-epileptic medications. Phenytoin is one of the commonly used drugs for treatment of epilepsy that encounters a hypersensitivity reaction. This reaction can be ranged from mild cutaneous rash to anticonvulsant hypersensitivity syndrome (AHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) that includes fever, rash, eosinophilia and involvement of multiple internal organs. CASE PRESENTATION: A 15 year old middle eastern female patient from Gaza strip with free past medical and allergic history. She presented to An-Najah National University Hospital (NNUH) in Nablus with intermittent high grade fever, jaundice, rash and skin peeling. On examination, she had axillary and inguinal lymphadenopathy, moderate splenomegaly and diffuse maculopapular rash. The patient was on phenytoin which started 1 month prior to her presentation as a seizure prophylaxis due to previous head injury. Eventually, the patient was diagnosed with AHS/DRESS. CONCLUSIONS: AHS is a diagnosis of exclusion and it is significantly underreported that requires a high index of suspicion. We liked to share this case and shed the light in more details on AHS/DRESS. Our goal was to help making AHS more reported in the literature in adolescent patients, as well as to make physicians more alert of this condition's seriousness when they prescribe antiepileptic medications in particular. In this report, we included the first case of AHS which was reported in an adolescent patient in Palestine. Moreover, we reviewed the available literature for a better understanding of the pathophysiology and management of AHS. We still believe that the full understanding of the pathogenesis of AHS is lacking, and also we are lacking a clinical tool or scoring system to determine the severity of AHS/DRESS.

Aggressive Recurrence of Primary Hepatic Epithelioid Haemangioendothelioma after Liver Transplantation.

HEHE is a rare neoplasm of vascular origin that occurs in the liver; UNOS reported a favorable outcome after liver transplantation in 110 patients with 1-year and 5-year survival of 80% and 64%. Case Report. A 40-year-old lady presented with a three-month history of right upper abdominal pain with nausea, vomiting, and significant loss of weight associated with scleral icterus and progressive abdominal distension. Examination revealed jaundice, hepatomegaly, and ascites. Serum bilirubin was 26.5 mg/dL and ALP was 552 CT. Abdomen and pelvis showed diffuse infiltrative neoplastic process of the liver with a mass effect and stretching of the hepatic and portal veins, in addition to bile duct dilatation. Viral hepatitis markers were negative and serum alpha fetoprotein was within reference range. Liver biopsy was consistent with HEHE, with positive endothelial markers (CD31, CD34, and factor VIII-related antigen). She underwent living related liver transplantation on June 2013 and was discharged after 20 days with normal liver enzymes. Four months later, she presented with diffuse disease recurrence. Liver biopsy confirmed disease recurrence; she received supportive treatment and unfortunately she died 2 weeks later. Conclusion. HEHE can have rapid and aggressive recurrence after liver transplantation.