The objective of the study was to find the determinants related to not breastfeeding (BF) and others related to the delay in the early initiation of BF in the Mecca region, Saudi Arabia. A cross-sectional study in the Maternity and Children Hospital and primary healthcare centers was performed. A questionnaire was filled by dietitians to 814 asymptomatic Saudi mothers. Determinants related to not BF and the delay in the early initiation of BF were determined by binary logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were determined. Significant factors associated with not BF were not rooming-in infants in the mother’s room (OR: 2.37; 95% CI: 1.66–3.41) and using a pacifier (OR: 1.62; 95% CI: 1.13–2.33). The most significant determinant of the early initiation of BF was the initiation of bottle feeding (OR: 18.16; 95% CI: 10.51–31.4), followed by not rooming-in infants in the mother’s room (OR: 2.2; 95% CI: 1.52–3.18), initiation of partial feeding (OR: 1.89; 95% CI: 1.3–2.74), uninformed mothers regarding the importance of BF (OR: 1.56; 95% CI: 1.04–2.35), and cesarean sections (OR:1.42; 95% CI: 1.02–1.98). Risk factors affecting BF and the early initiation of BF in Mecca City should be highlighted in national campaigns to increase mothers’ awareness and promote BF practice.

Coronavirus disease 2019 (COVID-19 pandemic has affected the psychological health of people, causing a higher level of stress. Stress can exaggerate the symptoms of irritable bowel syndrome (IBS). To assess the effect of the COVID-19 pandemic stress on patients with IBS in Saudi Arabia. A descriptive cross-sectional approach was used, which targeted accessible subjects with IBS from different regions of Saudi Arabia. Data were collected from participants using a structured electronic questionnaire, which captured the participants’ socio-demographic data, medical history, IBS clinical data, self-reported stress due to COVID-19, and its effect on IBS symptoms. A total of 1255 IBS patients completed the questionnaire. About 63.4% of them reported stress due to the pandemic. The most frequently reported causes of stress were fear of infection occurring in the family, followed by fear of self-infection (43.5%), and death due to COVID-19 infection (17.2%). Most of the stressed participants (56.6%) reported that stress usually exaggerated IBS symptoms. Almost 22% of them consulted a physician for stress aggravation of the symptoms, 18.1% used sedatives due to stress, 9.2% modified IBS medications due to the stress, and 75.5% of the participants reported impaired daily activities due to symptoms exacerbation. Coexisting chronic morbidities and inability to differentiate between COVID-19 gastrointestinal symptoms and IBS symptoms were significantly associated with COVID-19 related stress ( P = .039 and .001, respectively). Two-thirds of IBS patients were stressed during the first few months of COVID-19 pandemic. Patients unable to differentiate between COVID-19 gastrointestinal tract symptoms and IBS symptoms, and patients suffering from chronic morbidities were more vulnerable. Pandemic stress exacerbated patients’ symptoms and impacted their activities of daily life.

Angiodysplasia is a term used to describe distinct gastrointestinal mucosal ectasias that are not associated with cutaneous lesions, systemic vascular disease or a familial syndrome. Seventy-seven percent of angiodysplasia are located in the cecum and/or ascending colon. Fifteen percent are located in the jejunum and/or ileum and the remainder are distributed throughout the alimentary tract. Most commonly, the angiodysplastic lesions are typically seen in elderly patients of both genders, although gastric and duodenal lesions have been reported occasionally in subjects within the third decade of life. However, data on infants and children are scarce. We describe three cases (ages 7 days, 2 years, and 5 years) who presented to our unit with gastrointestinal bleeding. One of these patients developed moderate-to-severe symptoms and was blood-transfusion dependent. She was misdiagnosed as having inflammatory bowel disease and underwent a total colectomy and ileoanal anastomosis. The other two patients were managed conservatively for up to 5 years with no further bleeding.

Background: Trichohepatoenteric syndrome (THES) is a very rare disorder that is characterized by intractable congenital diarrhea, woolly hair, intrauterine growth restriction, facial dysmorphism, and short stature. Our knowledge of THES is limited due to the small number of reported cases. Methods: Thirty patients diagnosed with THES, all molecularly confirmed by whole exome sequencing (WES) to have biallelic variants in TTC37 or SKIV2L , were included in the study. Clinical, biochemical, and nutritional phenotypes and outcome data were collected from all participants. Results: The median age of THES patients was 3.7 years (0.9–23 years). Diarrhea and malnutrition were the most common clinical features (100%). Other common features included hair abnormalities (96%), skin hyperpigmentation (87%), facial dysmorphic abnormalities (73%), psychomotor retardation (57%), and hepatic abnormalities (30%). Twenty-five patients required parenteral nutrition (83%) with a mean duration of 13.34 months, and nearly half were eventually weaned off. Parenteral nutrition was associated with a poor prognosis. The vast majority of cases (89.6%) had biallelic variants in SKIV2L , with biallelic variants in TTC37 accounting for the remaining cases. A total of seven variants were identified in TTC37 ( n = 3) and SKIV2L ( n = 4). The underlying genotype influenced some phenotypic aspects, especially liver involvement, which was more common in TTC37 -related THES. Conclusion: Our data helps define the natural history of THES and provide clinical management guidelines.

No abstract

No abstract

Objective: To study the incidence, causes and maternal outcome in emergency peripartum hysterectomy. Materials and methods:Retrospective, descriptive study of emergency peripartum hysterectomy by analyzing the labor records of patients undergoing the procedure in the past 5 years.Results: There were 57 emergency hysterectomies among the 28940 deliveries, over the past 5 years. The incidence of EPH was 1.97 per 1000 deliveries. The mean age of the patients was 35.03  5.9 (range: 21-47) years. Mean parity was 4.8  2.8 (range: 0-13). Of 57 patients, 50 (87.7%) patients had previous history of cesarean section (CS). The main indications for hysterectomy were placental abnormalities 63.1% (OR = 1.54; 95% CI = 9.5-13.34, p-value <0.001) and uterine atony 24.5% (OR = 1.42; 95% CI = 7.43-15.43, p-value <0.001). Subtotal hysterectomy was performed in majority 50 (87.7%) of the cases. Bladder injury was the significant intraoperative complication in 17 (30%) cases (OR = 1.87; 95% CI = 9.45-18.97, p-value <0.001) with no residual damage. Infections were the commonest complication seen in 15 (26%) patients postoperatively. The maternal mortality occurred in 2 (3.5%) patients. Conclusion:Emergency peripartum hysterectomy, though uncommon, remains a challenging but life saving procedure in obstetrics. Its indications in modern obstetrics are changing and still emerging. Abnormal placentation, previous CS, multiparity are important risk factors. Antenatal diagnosis of low lying and adherent placenta, minimizing the CS rate, proper and timely management of third stage of labor and emergency preparedness are imperative to minimize the chances of emergency peripartum hysterectomy and improving the outcome.

Inflammatory bowel disease (IBD) patients have a higher risk of thrombosis. Most data about thrombosis in inflammatory bowel disease are related mainly to inpatients with disease activity, but in this article, we report one case of inflammatory bowel disease with two different sites of venous thrombosis which happened in a patient with nonactive IBD at an outpatient setting.