Background: Hepatic cysts (HCs) lesions are common in clinical practice. These lesions can be benign and have no clinical significance, or they can be malignant and potentially fatal.

Aim: The current manuscript aimed to assess HCs with varying image modalities and the prevalence of it among gender as well as link the HCs with age, in the two main governmental hospitals in Taif city.

Materials and methods: 100 confirmed diagnosed HCs were retrieved from period of 2020 to 2023, through picture archiving and communication system (PACs), they divided into groups according to gender and age, as well as dividing cysts according to their radiographic appearances Microsoft Excel was used to analyzed the data achieved.

Results: The older age more than 46 years and female are more exposed to HCs than male and younger age respectively. The HCs types, appearances, classification and characterization in each image modality are tabulated in specific tables. While simple cysts were benign, complicated cysts, appeared as echinococcosis, and cystic neoplasms that, require early and accurate diagnosis.

Conclusion: The findings of current study matched the findings of previous studies. More studies are required in the highlights of current findings.

Empathy has been recognized in recent years to play a central role for the successful practice of medicine. Hence, developing empathetic skills needs to be the underlying objective during the training of undergraduate medical students as well as in continuous education of health professionals. However, during the process of medical education, the quality of empathy that is naturally present within the student has been found to decline. The task is to achieve the process of learning medicine and at the same time preserve and foster the quality of empathy. Spontaneous learning based on one’s own interest, is a form of self-directed learning that taps the student’s sense of curiosity about the problem and concern for the patient. Knowledge is acquired in a case-centered manner. All evaluations to be done through case-based discussions. The textbooks in each subject are to be treated as knowledge repositories for choosing the topics that need to be learnt. The ‘self-directed spontaneous learning’ ensures creativity in approach to problems, optimum utilization of one’s time and avoids stress. The student’s connection with his or her own ‘inner self’ is crucial for a focused and creative mind; therefore, its cultivation through the process of meditation is important. Empathy-based medical education-EBME facilitates the training of doctors who are competent as well as empathetic. Keeping the subjective aspect of education as the base while acquiring the objective aspect, leads to balance between competence and empathy.

Introduction: Heart failure with moderately impaired ejection fraction (HFmEF) has garnered increasing attention in recent years. However, understanding this new phenotype, particularly concerning morbidity and mortality, remains limited.

Materials and Methods: A prospective, observational, and single-center study spanning 26 months was conducted on 204 patients with HFmEF selected from 447 patients with chronic heart failure (CHF) categorized based on their left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF) if LVEF ≤ 40% (n = 173) and HF with preserved ejection fraction (HFpEF) if LVEF ≥ 50% (n = 70). This study included a detailed evaluation of factors precipitating cardiovascular (CV) death and rehospitalizations in patients with HFmEF.

Results: After a mean follow-up of 431 days in the HFmEF patient group, our results indicated that CV mortality at six months was 2.5%, and at one year, it was 5.9%. Prognostic factors for survival included chronic kidney disease, blood glucose level > 1.4g/l, presence of moderate to severe secondary mitral insufficiency, sphericity index < 1.7, elevated pulmonary vascular resistance, and resistance to diuretic treatment. HF rehospitalization rates at 6 and 12 months were 2.5% and 8.3%, respectively. Predictive factors for HF rehospitalizations included diabetes, hemoglobin level < 13g/dl, left atrial volume > 34 ml/m^3-, mitral S-wave < 0.05cm/s, non-improvement of global longitudinal strain, and resistance to diuretic treatment.

Conclusion: This category of HF remains underrecognized and neglected by practitioners, and its prognosis is formidable, especially in the presence of adverse prognostic factors.

Background

Left ventricle dysfunction is the most recurrent consequence of ST-elevated myocardial infarction, and still, it is a powerful predictor of mortality. The percutaneous coronary intervention of the culprit artery disease in acute coronary syndrome is related to a significant improvement of left ventricle segmental function.

It is a retrospective case series study on a patient population with the diagnosis of ST-elevated myocardial infarction patients who presented to the hospital within 12 hours and underwent percutaneous coronary intervention at the French Medical Institute of Mother and Children Hospital. Data was collected retrospectively from the patient's medical record files and analyzed. We took the patients with Left ventricle dysfunction on echocardiography on the first presentation before percutaneous coronary intervention and saw the left ventricle function after three months of follow-up.

We reviewed the charts of 102 patients (78.4% male and 21.6% female) with a diagnosis of St-elevated myocardial infarction who presented within 12 hours of chest pain. Of 102 patients, 55.9% had hypertension, 21.6% diabetes, 22.5% dyslipidemia, and 19.6% history of smoking, and their mean age was 58.11 ± 11.993 years.  We noticed that percutaneous coronary intervention led to significant left ventricle dysfunction improvement in the patient population with ST-elevated myocardial infarction who presented within 12 hours of chest pain.

Rupture of descending aorta is a rare fatal complication after coronary angiography, we report a case of 65 years-old man who presented  acute coronary syndrome without ST segment elevation and underwent coronary angiography in a private hospital, he was admitted in cardiology departement  twelve days after coronary angiography for strong suspision of aortic dissection, Computed Tomography angiography of the chest performed immediately revealed  descending aorta dissection and its rupture in the left lung; surgically recused, the patient died few days later.

Atherosclerotic disease and its clinical manifestations, including acute myocardial infarction and ischemic stroke, are the leading cause of morbidity and mortality worldwide. Among the atherogenic risk factors, the most well-documented and the one that determines a causal relationship with atherosclerotic disease is low-density lipoprotein cholesterol (LDL-C) values. It is essential to identify LDL-C as a therapeutic target to reduce cardiovascular risk, especially after the emergence of new drugs that further reduce LDL-C levels, with additional risk reduction. Our objective is to demonstrate that LDL-C is an important atherogenic risk factor and that any mechanism of reduction of plasma LDL-C concentrations reduces the risk of events proportional to the absolute reduction of LDL-C and the cumulative time of exposure to it. Mendelian randomization studies: even though the association between LDL-C and cardiovascular risk is well demonstrated and reproducible in meta-analyses of prospective cohort studies, such studies are not randomized and therefore susceptible to biases such as reverse causality and confounders. Mendelian randomization is used especially when randomized controlled trials to examine causality are not feasible. This method will assess the causal relationship between a modifiable exposure, or risk factor, and a clinically relevant outcome. The confluence of the results of both Mendelian randomization and clinical trials leads to the same proposition: the lower the LDL-C, the better for the prevention of atherosclerotic lesions.

Background: Workplace fatigue is a major concern that demands proper management, as it can result in various health issues. Gas station attendants who remain stationary for prolonged periods are especially susceptible to this problem. Therefore, this study aims to examine the relationship between standing time and work fatigue among Simpang Jam gas station operators in Banda Aceh City.

Research method: In order to explain the relevance between standing period and work fatigue, this study uses descriptive analytics. All 30 officers participated in the study as the population. At the Simpang Jam Gas Station in Banda Aceh City, this study was carried out in June. Chi-Square test was conducted.

Results: 40.0% of respondents reported being at risk and frequently worn out when standing for extended periods. Additionally, 91.7% of respondents experienced discomfort and exhaustion while working in standing positions.

Conclusion: Standing time and work fatigue have a relationship with a P value of 0.017, and standing work position and work fatigue have a relationship with a P value of 0.005.

Suggestion: When operators begin to experience signs of work fatigue, provide chairs for them and pay closer attention to rest periods.

The purpose of this study was to evaluate the the connection between hemoglobin glycated (Hba1c) and testosterone levels in the patients of type 2 diabetes mellitus compare with healthy person, also determine the significant differences between this parameter among healthy and diabetic patients, after assumed whole blood and serum specimens from laboratory of Diabetes and Endocrinology Center in Marjan hospital and privately owned in Babylon City starting in October 2022 to February 2023.

The outcomes showed non-significant (P>0.05) variations between those with diabetes and control groups in age , which refer to all persons in the same age, also it revealed significant increase (P ˂ 0.05) in Hba1c level in diabetic group compare with healthy men, which may refer to disease effect on these patients and lead to elevation in Hba1c in diabetic group,   also it was revealed significant decrease (P ˂ 0.05) in diabetic group compare with control in Testosterone level, in addition to significant increase (P˂0.05) in body mass index in diabetic men compare to control group, and The results showed negative correlation between glycated hemoglobin and testosterone levels in both healthy and diabetic men.

The research was concluded that HbA1c value is associated with testosterone levels in diabetic patients.

Congenital pulmonary valve stenosis is a relatively common congenital defect, often related to abnormal development and fusion of pulmonary valves.

Critical pulmonary valve stenosis should be treated, early in life, before dilation of right chambers, and occurrence of arrhythmias.

We report one case of enormous enlargement of right atrium revealed by typical atrial flutter which occurred very late, in 48-year-old man, who underwent surgical dilation of pulmonary valve stenosis at eleven years old, but without repairing dilated tricuspid annulus.

Despite successfully ablation of atrial flutter in our cathlab, the patient developed atrial fibrillation, because of an enormous enlargement of right atrium and massive tricuspid regurgitation.

Objective: To assess the obstacles affecting compliance with established hand hygiene protocols among medical students at university teaching hospitals

Design and Methods: The study was conducted at Ndola Teaching Hospital, Kitwe Teaching Hospital, Copperbelt University Dental Clinic, and Arthur Davidson Children’s Hospital, serving as training sites for medical students at Copperbelt University School of Medicine in Zambia. The target population were Bachelor of Medicine and Bachelor of Surgery (MBChB) and Bachelor of Dental Surgery (BDS) students in their clinical years. The research employed a cross-sectional descriptive questionnaire-based study to evaluate the factors hindering compliance to hand hygiene protocols. A non-probability quota sampling technique was applied, stratifying participants by clinical year for a comprehensive representation.

Results: The sample was derived from a population of 497 students, using EpiInfo Build Number 1.4.3 at a confidence level of 95%, an expected value of 50% and a confidence limit of 5%. A required sample of 217 was needed and factoring in an assumed response rate of 70%, at least 300 questionnaires were distributed in which there was a response rate of 81% resulting in a sample size of 244. Lack of facilities was the major self-reported factor limiting compliance at 50.4%, lack of knowledge and facilities at 17.2%, lack of knowledge at 10.2% and a personal failure to adherence at 9.8% while 12.3% reported no factors.

Conclusion: A multi-faceted approach that combines improvements in facilities, educational initiatives, and addressing individual attitudes is essential for enhancing hand hygiene practices. By addressing the identified barriers comprehensively, healthcare settings and individuals can collectively contribute to effective infection prevention.

Objective: To examine the association between cholesterol ratio and viral load among HIV positive individuals receiving antiretroviral therapy (cART)

Design and Methods: A retrospective cohort study was conducted at the Ndola Teaching Hospital in Zambia, focusing on individuals with HIV who were receiving care at the outpatient department. Through an in-depth secondary analysis of an existing database, we explored the relationship between cholesterol ratio and viral load in HIV-positive individuals undergoing antiretroviral therapy.

Using a quantitative-methods approach, we selected and processed data from the database to address our research question. The study records included patient subjects initiating and on cART within 12 months and were stratified into 3 groups namely: group A optimal normal (cholesterol ratio between 1 and 3.5), group B high normal (cholesterol ratio between 3.5 and 5) and group C, high cholesterol ratio (cholesterol ration above 5). STATA was used for statistical analysis.

Results: A total of 174 participants were included in the study analysis, with 61% (107) being female and 39% (67) male. Lipid profiles fell within normal ranges for both genders. The median cholesterol ratio was [3.16 (2.93, 3.40)] and total cholesterol was [3.86 (3.02, 4.62)]. The median HDL-c concentration was higher in males [1.4 (1.21, 1.55)] than females [1.33(1.13, 1.51)].  The median viral load in females was [355; (20, 6770)] and in males, [254 (23, 2694)] with a p=0.84. The study identified an inverse relation between cholesterol ratio and viral load, but this association did not reach statistical significance.

Conclusion: The study population predominantly exhibited normal cholesterol ratios, and although a potential inverse relationship with viral load was indicated, statistical significance was not established.

Surgery for coronary insufficiency begins with surgery to eliminate the pain of angina pectoris by cutting the sensory nerve pathways to the heart. Subsequently, surgeons attempted to revascularise the myocardium indirectly, by causing adhesions between the heart and various tissues, altering the direction of coronary circulation or creating artificial shunts in the myocardium by implanting the internal mammary artery directly into the left ventricle. But all these techniques proved insufficient, and surgeons turned to direct revascularisation of the coronary arteries. It was in 1968 that the first direct coronary revascularisation by bypass with the long saphenous vein was performed. Under the impetus of the pioneers of cardiac surgery, this type of surgery took off, helped by the development of extracorporeal circulation. Coronary surgery evolved at every level, with the development of microsurgical techniques for anastomoses, the use of arterial grafts, which are more durable than veins, and complete revascularisation. Over time, this surgery will prove to be reliable and reproducible, with excellent results and very low post-operative mortality and infarction rates. Above all, it will improve quality of life and long-term survival. Coronary surgery is still today an indispensable therapeutic tool in the treatment of ischaemic coronary disease.

Left atrial myxoma is a rare tumor. The polymorphism of its clinical presentation is sometimes confusing for the clinician. Although its histologically benign nature is recognized by the majority of authors, its intracardiac location gives it a significant lethal evolutionary potential in the absence of surgical treatment. We report here the case of a 38-year-old patient who presented with a massive ischemic stroke.

Objectives: Redux valve surgery is increasingly common in Algeria, and the aim of this study was to identify the risk factors for hospital morbidity and mortality in this type of surgery.

Method :49 patients with a mean age of 51 years (20-67 years) and a sex ratio of 0.88 underwent redux valve surgery between January 2015 and december 2019. 79%), and in almost half of the cases (46%) the first operation was performed in our department; the most frequent reasons for repeat operations were mitral plasty dysfunction, expression of new valve damage and removal of mechanical prostheses due to infective endocarditis.

The Euroscore was used to predict operative risk.

Results: 80% of our patients were classified in the moderate risk group (score 3-5) with an expected mortality of between 2.90 and 2.94%. Our results show a mortality rate of 2.56% for these patients. The study of post-operative results revealed a number of cardiac complications (28.5% low output and 37% rhythm disorders), infectious complications (8% mediastinitis) and neurological complications (6%). The risk factors for operative mortality were multiple valve procedures (p=0.03), persistent atrial fibrillation or fibrillation that appeared postoperatively (p=0.05) and age over 70 (p=0.04).

Conclusion: Valvular redux surgery with a single-valve procedure has an operative morbi-mortality, actuarial survival and post-operative functional benefit that are entirely comparable to those of a primary intervention; whereas in redux surgery with a multi-valvular procedure, the operative morbi-mortality is significantly higher, but the actuarial survival and functional benefit are comparable to those of a primary intervention

Objective: Valve surgery after the age of 70 is increasingly common in Algeria. The aim of this study was to identify risk factors for in-hospital mortality in this population.

Methods: 56 patients with a mean age of 72 years (70-81) underwent valve surgery between 2016 and December 2019. 32 patients (57.4%) had aortic valve replacement, 17 patients (29.7%) had mitral surgery and 07 patients (12.9%) had aorto-mitral surgery. 04 procedures (8%) were urgent. The Euroscore was used to predict operative risk. The mean additive Euroscore was 9.05 and the mean logistic Euroscore was 14.2%.

Results: Operative mortality was 3.8%. Preoperative risk factors were: NYHA III class, repeat operations, critical status according to the Euroscore,STS score , PAH, mitral surgery and tricuspid surgery. Post-operative complications were: low flow (12%), supra-ventricular arrhythmia (32.7%), renal dysfunction (14.6%), pulmonary (11%), intestinal (3.5%), infection (4%) and surgical re-exploration (6.5%). Post-operative risk factors for mortality were low flow, renal dysfunction, gastrointestinal complications and surgical re-exploration.

Conclusion: Valve surgery after the age of 70 is a low-risk procedure. Our data are correlated with the Euroscore.

Objectives : To evaluate the results of surgical treatment of post-tuberculous constrictive pericarditis.

Materials and methods: This was a retrospective study of 08 cases of constrictive pericarditis of tuberculous origin observed between January 2015 and december 2019. These patients presented with right (3 cases) or bilateral (5 cases) adiastolism. All patients underwent subtotal pericardectomy by vertical median sternotomy.

Results : There were no early deaths. Non-fatal complications included 3 cases of haemorrhage from a wound in the right atrium. The mean length of stay in intensive care was 2 +/- 0.5 days and the mean length of hospitalisation was 10 +/- 2 days.

None of the 08 patients was lost to follow-up. After a mean follow-up of 28 +/- 6 months, 06 are currently at NYHA functional stage I (75%) and 02 at stage II (25%); the mean cardio thoracic ratio had become 0.58 +/- 0.2.

Conclusion : Pericardectomy remains the only life-saving procedure for any patient at the stage of constrictive pericarditis.