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Background: Brucellosis is an infectious disease transmitted by animals to humans and affects both genders and all age groups. In children, the most common symptoms are excessive sweating, chills, bone ache, and painful or swollen joints. Objective: The aim of this study was to assess the demographic data, clinical manifestations, main risk factors, management, and outcomes in children with brucellosis in Buraidah, AlQassim region, Saudi Arabia. Methods: The medical records of all children ( 1/360 in nine (56.3%) participants. The most reported clinical symptom was fever (62.5%), myalgia and arthralgia (50%). The most typical combination therapy was doxycycline with rifampicin. Age, gender, and area of residence were not found to be significantly associated with brucellosis. Conclusion: Brucellosis has a wide range of clinical presentation involving multiple organ systems. A family history of brucellosis and positive raw milk consumption are important risk factors in increasing risk of brucellosis.

Purpose The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. Methods Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed. Results The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. Conclusion TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.

Aneurysmal bone cyst is a benign highly vascular lesion that occurs in children. Traditionally ABCs were treated by surgical resection. However, lesions at difficult to access anatomical locations such as the pelvis have higher morbidity when treated surgically. Recently with the advances in endovascular treatment selective arterial embolization became a promising option for primary treatment of ABC. The authors present a case of a 14-year-old female with a pelvic ABC that was successfully treated by selective arterial embolization. Selective arterial embolization is a cost-efficient way of managing ABC especially in cases where surgical treatment carries high risk.

Aim: The aim of the study was to assess clinical outcomes following uterine artery embolization (UAE) in the treatment of dysmenorrhea and menorrhagia related to pure adenomyosis. Materials and Methods: This was a retrospective analysis of 14 patients with dysmenorrhea and menorrhagia related to pure adenomyosis treated with UAE using polyvinyl alcohol (PVA) between January 2017 and September 2019. The baseline and 3-month and 12-month postintervention outcomes were assessed using Uterine Fibroid Symptom-Health-Related Quality of Life Questionnaire (UFS-QOL), Symptom Severity Score (SSS), and magnetic resonance imaging findings. The median age of the patients was 47 years (28–55). The main clinical presentation was dysmenorrhea and menorrhagia, with a median duration of symptom of 24 (12–84) months. All patients received combined estrogen-progestin and nonsteroidal anti-inflammatory drugs prior to UAE without clinical improvement. Results: According to UFS-QOL and SSS results, the score for distress level was statistically significantly reduced from baseline 4.6 (3.6–5) to 2.25 (1–3.37) (P = 0. 018) after 3 months, and remained stable 12 months later. The score of symptom level was statistically significantly reduced from 4 (3.6–5) at baseline to 1.6 (1–3.58) (P = 0. 018) after 3 months with maintained clinical satisfaction after 12-month follow-up. The junctional zone was statistically significantly reduced from baseline with a median of 33.5 mm (19–79 mm) to 25 mm (8–77 mm) after 3 and 12 months (P = 0.046). The incidence of post-UAE permanent amenorrhea is 71% with a mean age of 49 years. No patient underwent hysterectomy during the follow-up period. Conclusion: UAE using PVA can improve the quality of life in patients with menorrhagia and dysmenorrhea related to adenomyosis. However, larger prospective studies are needed to establish the long-term outcomes and risk of amenorrhea.

Context: No study has investigated the awareness of uterine artery embolization (UAE) as a treatment option for uterine fibroids among Saudi women. Aims: The aim of this study was to investigate Saudi women's awareness of UAE as a therapeutic modality for uterine fibroids Settings and Design: This was a cross-sectional study conducted in Hail and Riyadh. Subjects and Methods: In 2019, an anonymous online questionnaire was sent via social media to women residing in Hail and Riyadh. The questionnaire contained 11 multiple-choice questions divided into two parts. The first part contained questions about demographic characteristics and one question about their history of fibroids. The second part contained items pertaining to awareness of treatment options for uterine fibroids and whether they were aware of UAE. Statistical Analysis Used: The Chi-square test was used for statistical analysis. Results: Eight hundred and forty-five responses have been received. Overall, 76.1% of the respondents had never heard of UAE. Awareness of treatment options for uterine fibroids was significantly associated with education level and participants' involvement in a medical field (P < 0.05; Chi-squared test). 9.2% were from respondents who reported a history of fibroids. Among them, 71.7% had never heard of UAE; 9% had heard about it from an obstetrician or gynecologist. Only 6.4% of the participants were aware of all the treatment options for uterine fibroids; 28.2% believed that hysterectomy was the only treatment for uterine fibroids. Conclusions: This study highlights the need for public awareness of the treatment options for uterine fibroids to appropriate candidates.

Aim: The aim of this study was to evaluate awareness and knowledge about radiation risks and safety principles among medical students at the College of Medicine, University of Hail, Hail, Saudi Arabia, in their clinical years. Materials and Methods: In this cross-sectional study, an anonymous electronic questionnaire was sent to 174 randomly selected students in clinical years 4–6. The questionnaire contained 38 questions. The respondents’ answers to these questions were used to classify them according to their demographic characteristics and to evaluate their knowledge about common imaging modalities, radiation risks, and safety measures. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 22. Results: Seventy-five (51.7%) of 145 respondents were female and 70 (48.3%) were male. Fifty-five respondents (37.9%) were in year 4, 38 (26.2%) were in year 5, and 52 (35.9%) were in year 6. The mean score for knowledge about common imaging modalities was 4.10 ± 2.030 of 10, that for knowledge about the risks of radiation was 3.17 ± 1.954 (range, 0–8) of 13, and that for knowledge about radiation protection measures was low at 0.79 ± 0.922 (range, 0–4) of 8. Overall, there was an improvement in knowledge about the imaging modalities and the risks of radiation as the number of clinical years increased (P = 0.000), but it was still unsatisfactory. Conclusion: The results of this study indicate that the medical students at the University of Hail have very limited knowledge about radiation risks and safety measures. These findings highlight the need for urgent action to improve students’ knowledge of these topics.

Plummer–Vinson syndrome is known as the association of dysphagia, upper esophageal web, weight loss, and iron-deficiency anemia. Esophageal dilation therapy is usually necessary to remove webs and to relieve dysphagia in order to encourage oral intake. We report two cases of Plummer–Vinson syndrome. Both patients presented with significant and longstanding dysphagia, sideropenia, and painful swallowing. Patients’ esophagograms revealed the presence of tight stenosis in the high cervical esophagus. Both patients were treated with fluoroscopically guided balloon dilation and iron supplementation. These patients were followed up after the initial treatment and showed improvement of dysphagia and iron-deficiency anemia.

Context: One of the most important challenges facing the evolution of modern interventional radiology is its lack of awareness among medical students. Aims: This study aimed to determine the knowledge, perception, and views of the University of Hail clinical year medical students and medical interns regarding various interventional radiology topics. Settings and Design: A cross-sectional study on 244 clinical years' medical students and 87 medical interns from the University of Hail. Materials and Methods: A validated anonymous electronic questionnaire regarding awareness of various interventional radiology topics was sent to all clinical years' students and medical interns, and the results were analyzed. Statistical Analysis Used: The sample size was calculated through the Raosoft sample size calculator website. Data analysis was performed using SPSS statistics. Results: We received 200 responses. Majority of the participants (45%) agreed that their knowledge and information regarding interventional radiology was poor. Few participants (17%) were interested in considering a career in diagnostic radiology or interventional radiology. The most common reported reason for not considering radiology as a career option was lack of adequate knowledge about the subject (27.5%). Majority of participants (72.5%) had not been exposed to interventional radiology. Only 36.5% of participants were interested in doing a 2-week interventional radiology elective during their internship year. Conclusions: This study demonstrated that the majority of undergraduates and interns lack basic knowledge of interventional radiology. About one-third of the respondents were interested in doing their elective term in interventional radiology, and more than half of the participants were not interested or were unsure.

To evaluate the efficacy and safety of transarterial chemoembolization (TACE) plus radiotherapy compared with TACE alone for patients with hepatocellular carcinoma (HCC) invading the hepatic vein (HV) or inferior vena cava (IVC).Data from 79 patients who underwent TACE plus radiotherapy as a first-line treatment for non-metastatic HCC invading the HV or IVC between 2006 and 2018 were retrospectively evaluated. These findings were compared with data from a historical control group, consisting of 80 patients who received TACE alone between 2000 and 2006.Baseline characteristics were similar in both groups. Median progression-free survival (PFS) (8.1 vs. 4.4 months, P = 0.003) and overall survival (OS) (18.3 vs. 9.5 months, P = 0.002) were longer in the TACE plus radiotherapy than in the TACE alone group. Multivariate analysis showed that PFS and OS were significantly associated with treatment type. Subgroup analyses found that TACE plus radiotherapy showed better OS than TACE alone in patients with Child-Pugh class A, maximal tumor size 9 cm, tumor number 4, serum alpha-fetoprotein level ≥ 400 ng/mL, infiltrative tumor, IVC tumor thrombus, and combined portal vein invasion. The major complication rates were similar between the TACE plus radiotherapy (16.5%) and the TACE alone (13.8%) group (P = 0.664) CONCLUSION: Both TACE plus radiotherapy and TACE alone showed similar safety in treating non-metastatic HCC invading the HV or IVC. TACE plus radiotherapy seems effective to prolong OS and PFS compared to TACE alone in this specific patient group.

Mesoiliac shunts in the absence of liver cirrhosis are rarely reported as a cause of hyperammonemia with encephalopathy. Here, we report the case of a 65-year-old female patient with no history of liver disease, who developed significant confusion. Workup showed hyperammonemia and encephalopathy due to spontaneous mesoiliac shunt with no imaging signs of portal hypertension. Liver biopsy showed no evidence of cirrhosis. The shunt was occluded using a vascular plug, resulting in complete resolution of symptoms with no recurrence at 8-year follow-up.

Purpose To evaluate the clinical implications of initial and best responses during repeated transarterial chemoembolization procedures for hepatocellular carcinoma (HCC). Materials and Methods This study included 726 patients who received a diagnosis of intermediate-stage HCC with Child-Pugh class A liver function between 2007 and 2016, and who were treated with transarterial chemoembolization as the first-line treatment. Evaluation of treatment response was based on the modified response evaluation criteria in solid tumors. Overall survival (OS) was compared between response categories after implementation of landmark analysis. Results Of the 726 patients, an objective response (complete response [CR] or partial response [PR]) was observed as the initial response in 78.1% of patients. Regarding the best response during the transarterial chemoembolization series, 87.2% of patients were overall responders. The median OS of initial responders (n = 483) was not significantly different from that of subsequent responders at the 1-year landmark (stable disease [SD] after first transarterial chemoembolization but CR or PR after repeated transarterial chemoembolization; n = 61; 46.2 vs 40.1 months, respectively; P = .145). Likewise, the median OS of initial CR patients (n = 326) was not significantly different from that of the subsequent CR group (n = 126) at the 1-year landmark (PR or SD after first transarterial chemoembolization but CR after repeated transarterial chemoembolization; 53.4 vs 46.3 months, respectively; P = .455). Multivariate Cox analyses showed that the objective responses, the initial responses (hazard ratio [HR], 0.638; P = .001), and the best responses (HR, 0.304; P Conclusions Both the initial and best responses during repeated transarterial chemoembolization were significantly associated with OS in patients with intermediate-stage HCC and preserved liver function.

A combination of transarterial chemoembolization (TACE) plus sorafenib or radiotherapy (RT) has demonstrated efficacy in patients with advanced hepatocellular carcinoma (HCC). Here, the two combined treatment approaches were compared in patients with HCC and portal vein tumor thrombus (PVTT). Data from 307 patients treated with TACE plus RT (n = 203) or TACE plus sorafenib (n = 104) as first-line treatment for HCC with PVTT were retrospectively evaluated. Using the propensity model to correct selection bias, 87 patients were included from each treatment group. During follow up (median, 12 months) in the entire study population, the median progression-free survival (PFS) and overall survival (OS) were significantly longer in the TACE plus RT group than in the TACE plus sorafenib group (6.5 vs. 4.3 months, respectively, p = 0.017 and 16.4 vs. 12 months, respectively, p = 0.007). Following propensity score matching, the median PFS and OS in the two groups showed no statistically significant difference. Multivariable analysis found no significant association between PFS or OS and the treatment type. In conclusion, this retrospective study of data from patients with advanced HCC with PVTT shows that PFS and OS did not differ significantly in patients treated with TACE plus RT and TACE plus sorafenib.

The histamine 4 receptor (H4R) is expressed primarily on cells involved in inflammation and immune responses. Despite much research into inflammatory diseases, no drugs with favourable safety profiles are yet available for their treatment. The aim of the present study was to determine the potential anti-inflammatory effect of 4-methylhistamine (4-MeH) or JNJ77777120 (JNJ) and to explore the role of H4R in a mouse model of carrageenan (Cg) -induced pleurisy. A single dose of 4-MeH or JNJ (30 mg/kg) was administered intraperitoneally 1 hr before Cg administration. The results illustrate that both the numbers of CD4(+) , CD25(+) , CD4(+) CD25(+) , GITR(+) , GITR(+) IL-17A(+) -expressing T cells and the levels of T helper type 1 (Th1)/Th17 cytokines were markedly increased in both the Cg-treated and 4-MeH-treated groups, whereas the cytokines produced by Th2 cells were significantly decreased in the same groups. However, JNJ treatment significantly decreased both the number of T-cell subsets and GITR(+) , GITR(+) IL-17A(+) -expressing T cells, and the production of Th1/Th17 cytokines. Further, JNJ up-regulated the expression of the Th2 cytokines. RT-PCR analysis revealed an increased expression of interleukin-1β, tumour necrosis factor-α, monocyte chemoattractant protein-1 and intercellular adhesion molecule-1 in the Cg-treated and 4-MeH-treated groups, which was reduced by treatment with JNJ in lung tissues. Moreover, histological examinations revealed anti-inflammatory effects of JNJ, whereas 4-MeH worsened Cg-induced inflammation. In conclusion, the results of the present work clearly indicate that JNJ possesses important anti-inflammatory properties that are increased in 4-MeH-treated mice, suggesting that H4R are involved in pleurisy and that JNJ has an anti-inflammatory effect in associated disease conditions.

Rheumatoid arthritis (RA) is one of the major autoimmune diseases with a global prevalence. Despite significant research into this disease, no drugs with acceptable safety profiles are yet available for its treatment. We investigated the possible anti-arthritic effects of the 4-methylhistamine (4-MeH) histamine 4 receptor (H4R) agonist and the JNJ77777120 (JNJ) H4R antagonist to explore the role of H4R in a mouse model of collagen antibody-induced arthritis (CAIA). Arthritis was induced via intravenous (tail vein) injection of Balb/c mice with a 5-clone cocktail of mAbs against collagen type II, followed by LPS, and the effects of treatment with 4-MeH or JNJ (30mg kg−1, i.p, twice daily) for 7 days (prophylactic or therapeutic regimens) were assessed. The results revealed increased paw edema, arthritic scores, joint histological inflammatory damage and matrix metalloproteinase-3 levels and high levels of Th1 pro-inflammatory cytokine mRNA and serum proteins in CAIA mice or following H4R activation via 4-MeH. Additionally, 4-MeH efficiently increased expression levels of NF-κB p65. JNJ-treated mice showed a substantial reduction in all the previously mentioned effects, with a similar trend being observed under prophylactic and therapeutic treatment regimens. The results of the present work indicate that JNJ exhibits significant anti-inflammatory and anti-arthritic activities, demonstrating the clear involvement of H4R antagonism in the pathogenesis and progression of RA.