Appendicitis in pregnancy: a case report and a review of the current literature

Acute appendicitis is the most common surgical problem in pregnancy. Antibiotic treatment does not always improve the outcome and emergency intervention is required. We present a case of appendicitis complicated by a plastron formation occurring during pregnancy and the outcome.     

The Role of the Gut Microbiota on the Beneficial Effects of Ketogenic Diets

The ketogenic diet is a dietary regime focused on strongly reducing carbohydrate intake and increasing fat intake; leading to a state of ketosis. The ketogenic diet has gained much popularity over the years due to its effects on promoting weight loss, increasing insulin sensitivity and reducing dyslipidaemia. All these factors play a crucial role in the development of cardio-metabolic diseases; one of the greatest health challenges of the time. Moreover, the ketogenic diet has been known to reduce (epileptic) seizure activity. It is still poorly understood how following a ketogenic diet can lead to these beneficial metabolic effects. However, in recent years it has become clear that diet and the gut microbiota interact with one another and thus influence host health. The goal of this review is to summarize the current state of knowledge regarding the beneficial metabolic effects of the ketogenic diet and the role of gut microbiota in these effects.     

Physical inactivity and its predictors among adolescents in Saudi Arabia: A cross-sectional comparison between cities with and without a Healthy Cities Program

Objectives:To estimate the prevalence of insufficient physical activity and excessive screen time among adolescents living in cities participating in the Healthy Cities Program (HCP) and cities not running the program in the Qassim region of Saudi Arabia.Methods:We surveyed 1133 adolescents from the Qassim region using systematic random sampling between April and September 2017. Multivariable logistic regression analyses were conducted to investigate the predictors of insufficient levels of PA and excessive screen time.Results:The prevalence of <60 minutes of moderate- to vigorous-intensity physical activity/day was 82.4% and <3 days of vigorous intensity physical activity/week among adolescents was 59%. There was no significant association between living in healthy cities (HCPs) and insufficient levels of physical activity. The odds of excessive screen time were higher in HCPs than in cities not running the program (NHCPs) (OR: 1.49). The odds of insufficient daily PA (OR: 2.19) are higher among girls than boys. Increasing age is positively associated with insufficient weekly PA (OR: 1.19). The prevalence of excessive recreational screen time is 84.6% with higher odds in HCPs than in NHCPs (OR: 1.51).Conclusion:Our findings report a lack of evidence of any impact of the HCP on adolescents’ physical activity behaviors. This outcome warrants a further in-depth evaluation of the process and outcomes of the HCP in Saudi Arabia.     

Novel appearance of hyperglycemia/diabetes,associated with COVID-19

In a recent meta-analysis the prevalence of coronavirus disease 2019 (COVID-19)-associated hyperglycemia was 25%, and that of COVID-19-associated new-onset diabetes was 19%. An association between hyperglycemia or new-onset diabetes and COVID-19 has been suggested. In a recent relevant study of critically and non-critically ill patients with COVID-19, we found that indeed beta-cell function was compromised in critically ill patients with COVID-19 and that these patients showed a high glycemic gap. Nevertheless, one quarter of critically ill patients with no history of diabetes have stress hyperglycemia, a finding which could obscure the prevalence of hyperglycemia or new-onset diabetes that could be attributed to COVID-19 per se.     

High prevalence of decreased cortisol reserve in brain-dead potential organ donors

OBJECTIVE: To investigate the adrenocortical function in brain-dead patients, potential organ donors. DESIGN: Prospective study. SETTING: Intensive care units in two teaching hospitals. PATIENTS: A total of 37 patients (28 men, nine women) with severe brain injury, having a mean age of 42 +/- 18 yrs, were included in the study. Group A consisted of 20 brain-injured patients who did not deteriorate to brain death. Group B included 17 brain-injured patients who were brain dead; of these, ten patients developed brain death during ICU stay and seven patients were admitted to the ICU after clinical brain death. INTERVENTIONS: In all patients (group A and group B), a morning blood sample was obtained at admission to the ICU to determine baseline plasma cortisol. Subsequently, 1 microg of corticotropin (adrenocorticotropic hormone, Synacthen) was administered intravenously, and a blood sample was taken 30 mins after the injection. In group B patients who became brain dead while being treated in the ICU (n = 10), the same procedure was repeated the morning after the confirmation of brain death. Patients having a cortisol level of at least 18 microg/dL after the administration of adrenocorticotropic hormone were defined as responders. MEASUREMENTS AND MAIN RESULTS: After the occurrence of brain death, group B patients had significantly lower values for baseline (8.5 +/- 6.2 vs. 17.0 +/- 6.6 microg/dL, p <.001) and stimulated (16.9 +/- 6.3 vs. 23.9 +/- 5.7 microg/dL, p =.001) plasma cortisol compared with group A patients. Thirteen group B patients (76%) and two group A patients (10%) were nonresponders to adrenocorticotropic hormone (p <.001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r =.71, p =.001), whereas there was no correlation between baseline cortisol and the increment in cortisol (r = -.37, p =.15). Mean hormonal data of the ten brain-dead patients studied at admission in the ICU and after the occurrence of brain death were the following: baseline plasma cortisol (23.5 +/- 11.4 vs. 6.8 +/- 4.2 microg/dL, p =.003) and stimulated serum cortisol (28.8 +/- 9.9 vs. 16.3 +/- 4.3 microg/dL, p =.008). CONCLUSIONS: Adrenal cortisol secretion after dynamic stimulation is deficient in a substantial proportion of brain-dead potential organ donors.     

Non-alcoholic fatty liver disease and hepatocellular carcinoma: Clinical challenges of an intriguing link

Non-alcoholic fatty liver disease(NAFLD)has emerged as the most common liver disorder worldwide mainly attributed to the epidemic spread of obesity and type 2 diabetes mellitus.Although it is considered a benign disease,NAFLD can progress to non-alcoholic steatohepatitis,liver cirrhosis and hepatocellular carcinoma(HCC).Most data regarding the epidemiology of NAFLD-related HCC are derived from cohort and population studies and show that its incidence is increasing as well as it is likely to emerge as the leading indication for liver transplantation,especially in the Western World.Although cirrhosis constitutes the main risk factor for HCC development,in patients with NAFLD,HCC can arise in the absence of cirrhosis,indicating specific carcinogenic molecular pathways.Since NAFLD as an underlying liver disease for HCC is often underdiagnosed due to lack of sufficient surveillance in this population,NAFLDHCC patients are at advanced HCC stage at the time of diagnosis making the management of those patients clinically challenging and affecting their prognostic outcomes.In this current review,we summarize the latest literature on the epidemiology,other than liver cirrhosis-pathogenesis,risk factors and prognosis of NAFLD-HCC patients.Finally,we emphasize the prevention of the development of NAFLD-associated HCC and we provide some insight into the open questions and issues regarding the appropriate surveillance policies for those patients.     

Cervical ectopic pregnancy after endometrial ablation: a case report

Case report A 44-year-old woman, with prior endometrial ablation, complaining of heavy vaginal bleeding was diagnosed with cervical ectopic pregnancy. Two doses of intramuscular methotrexate were administered as conservative treatment of the cervical pregnancy. Close follow-up in a dedicated early pregnancy unit allowed successful management on an outpatient basis. Conclusion The urine pregnancy test maintains a crucial role in the investigation of abnormal vaginal bleeding in a sexually active patient. Conservative management of a cervical pregnancy can reduce the potential morbidity and mortality associated with the surgical treatment option.     

Pandemic and precocious puberty - a Google trends study

BACKGROUND Recent publications from several countries have reported that more young people(mainly girls) are experiencing precocious puberty(PP)/menarche during the coronavirus disease 2019 pandemic compared to the past. This variation is attributed to the stress of confinement, lack of exercise, obesity and disturbed sleep patterns. A common feature of the relevant papers, however, is the small number of reported cases of PP. Studies have shown that searches for diseases on the internet also re...