Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in developed societies, which can lead to inflammation, fibrosis, and even cirrhosis. Recent studies have also suggested an association between NAFLD and an increased risk of cardiovascular diseases through inflammatory mechanisms and insulin resistance. This study aimed to investigate the relationship between carotid artery stenosis and liver fibrosis severity in patients with coronary artery disease (CAD). In this cross-sectional study, 200 patients referred for coronary angiography at Shahid Beheshti hospital, Qom, Iran, in 2019 were evaluated. Based on carotid Doppler ultrasonographic findings, patients were divided into two groups: with and without carotid stenosis. The severity of fatty liver was assessed using ultrasound, and fibrosis was evaluated using the fibrosis-4 (FIB-4) index. Demographic, laboratory, and imaging data were analyzed using SPSS software. Among 200 patients (mean age 58.04 years, 50.5% female), 50% had carotid stenosis. Patients with carotid stenosis had a grade II and III fatty liver (44% with grade 2-3 vs. 19% in the non-stenosis group, P=0.001) and a higher FIB-4 score (40% vs. 8%, P<0.001). Additionally, patients with high FIB-4 scores had more severe coronary artery involvement (62.5% with 2-3 vessel disease vs. 40.8%, P=0.003) and a higher prevalence of carotid stenosis (83.3% vs. 39.5%, P<0.001). This study demonstrated that liver fibrosis severity (based on the FIB-4 index) is significantly associated with carotid artery stenosis and coronary artery involvement. Therefore, assessing liver fibrosis may serve as a predictive marker for cardiovascular risk in patients with NAFLD. The use of non-invasive methods such as FIB-4 alongside ultrasonography is recommended for fibrosis evaluation.

Non-diarrheal celiac disease (NDCD) is increasingly recognized in Iraq, but many cases are often missed or underdiagnosed because of its non-classical presentation. This study aimed to determine the clinical features and relevant investigations for patients with NDCD in Iraq. This is a prospective study that includes 117 cases of NDCD collected from different centers across Iraq. The study evaluated presenting symptoms, associated features, serological markers, endoscopic findings, and histopathological features. Patients with classical diarrhea were excluded from the study. 90 patients (77%) were women, and 94 patients (80%) were younger than 40 years. More than half had a normal body mass index, while a quarter of patients were classified as overweight and obese. Only 22% of patients with NDCD received a diagnosis within one year of the onset of symptoms, and 99 patients (84.6%) were suspected of having celiac disease during gastroscopy. Common symptoms among patients with NDCD included epigastric pain and anemia reported by 78.6% and 86.3% of patients, respectively. Endoscopic features suggestive of celiac disease were present in 94% of cases, and Marsh grade 3 histopathological features were observed in 75% of patients. NDCD is more prevalent in young, normal-weight, and obese female patients. Due to non-classical presentations such as epigastric pain or anemia, there is often a delay of more than one year in receiving a diagnosis. A gastroscopy performed by an experienced doctor yields a high diagnostic success rate in identifying NDCD. Furthermore, most patients with NDCD exhibit advanced histopathological features of celiac disease in their duodenal biopsies.

Sharp foreign body ingestion may result in simple impaction to mucosal perforation along the gastrointestinal tract. We report a rare case of a 62-year-old woman with jujube ingestion, a fruit that contains sharp-edged seeds causing impaction in the esophagus. Contrast computed tomography (CT) confirmed the transverse lie of the seed at the esophageal wall with features of through-and-through perforation. Flexible endoscopy under local anaesthesia successfully retrieved the jujube seed, followed by application of endoscopic hemoclips for the esophageal perforation. The patient was discharged well within a few days with no fatal outcomes.

Background: Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disease in which the patients may be asymptomatic or complain of heartburn and regurgitation or pulmonary symptoms. Aim of the study: Examine the serum level of soluble HLA-G (sHLA-G) in patients with GERD, which can be used as a biomarker for early detection of GERD. Methods: The study was a case-control prospective study that enrolled 40 patients who consulted the Gastroenterology Unit-Al-Kindy Teaching Hospital and were diagnosed with GERD by their physician. They were compared with 40 control healthy individuals from January 2023 to May 2024. Serum samples were used for quantitative assessment of sHLA-G using a sandwich enzyme-linked immunosorbent assay. Results: A higher proportion of females were observed in the GERD group compared with the control group (72.5% vs. 42.6%). This difference was statistically significant (P=0.006). A statistically non-significant difference was observed in sHLA-G levels between patients with GERD and healthy controls (P=0.158). The median sHLA-G level was non-significantly higher in patients with GERD (0.529 ng/mL) compared with the controls (0.523 ng/mL). Conclusion: The present study provides early evidence for an association between elevated sHLA-G levels and GERD with limited diagnostic value. It revealed a significant negative correlation between sHLA-G levels and sex. Further studies are needed to elucidate the mechanisms underlying this relationship and explore the potential of sHLA-G as a diagnostic or therapeutic target for GERD.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that can affect various organs. This report describes a 65-year-old woman who presented with abdominal pain, weight loss, and elevated liver enzymes. After the diagnostic workup, a percutaneous biopsy of the liver lesions showed histological changes in EHE. What stands out in this case is that imaging studies revealed multiple cystic lesions with fluid-fluid levels, even though such manifestation is not typically seen in this disease. This case emphasizes the importance of considering EHE in the differential diagnosis of hepatic lesions, even in atypical presentations.

The quality of bowel preparation is one of the key determinants of a successful colonoscopy. Bowel preparation regimens have evolved greatly over the past few decades, with attempts to improve the efficiency and tolerability; still an ideal agent or regimen continues to be oblivious. To compare the efficacy, safety, and tolerance of three bowel preparation regimens for colonoscopy: split dose of oral sulfate solution (OSS), split dose of polyethylene glycol (PEG), and same-day single dose PEG. This study was a randomized, single-blind control design with three study groups. Group A received a split dose of OSS, group B received a split dose of PEG, and Group C received a single dose of PEG for bowel preparation. The quality of preparation was assessed using the Boston Bowel Preparation Scale (BBPS), and the adverse effects and tolerance were noted. The data were compared statistically for any significant difference between the regimens. Mean total BBPS scores were 8.08, 7.52, and 7.92 for groups A, B, and C, respectively (P=0.076). Segmental BBPS scores were statistically similar for the right and transverse colon but differed for the left colon (A: B: C=2.79: 2.54: 2.75; P<0.01). Gastrointestinal side effects and electrolyte disturbances were similar across the three groups. Split-dose preparations were associated with more significant sleep disturbances than single-dose PEG (P<0.001). Patients who received OSS reported more taste intolerance (P<0.01), while those who received single PEG reported more volume intolerance (P<0.001). Split-dose OSS, split-dose PEG, and single-dose PEG regimens provide adequate and comparable bowel preparation for colonoscopy with good patient tolerance and no significant adverse effects. Overnight PEG and OSS preparations were associated with more substantial sleep disturbances. OSS is associated with more taste intolerance, while single PEG is associated with more volume intolerance.

Background: Repeated polyserositis, another name for familial Mediterranean fever (FMF), is an autoimmune disorder with an autosomal recessive nature primarily characterized by short-lived repeated periods of peritonitis, pleuritis, and arthritis, generally accompanied by fever. Methods: Our participants were divided into two groups. Group I (patients): 100 individuals who were diagnosed as patients with FMF and were monitored. Group II (control): matched- healthy individuals (100 controls). They were compared and followed up as regards demographic, clinical, and laboratory data: routine investigations, neutrophil/lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and mean platelet volume (MPV), red cell distribution width (RDW), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Results: Group I: MPV mean was 12.03±2.89, whereas group II MPV mean was 7.74±0.57. MPV was significantly statistically greater in group I than in group II. RDW mean in group I was 17.07±1.39 and in group II was 12.92±0.63. RDW was also significantly statistically greater in group I compared with group II. Group I’s NLR mean was 3.05±0.71, whereas group II’s NLR mean was 1.75±0.2. PLR mean in group I was 164.8±122.8 and in group II was 111.26±29.16. Conclusion: A statistically significant association was shown between the diagnosis of adult FMF and NLR, PLR, MPV, and RDW.

Background: Among environmental factors, infectious agents, including Helicobacter pylori, can act as triggers for autoimmune thyroid diseases. Therefore, this study aimed to investigate the correlation between autoimmune Hashimoto’s thyroiditis with H. pylori infection.Methods: The participants in this case-control study were 74 individuals 17-62 years who were divided into two groups, including 38 diagnosed Hashimoto’s thyroiditis patients from an outpatient clinic of endocrinology and 36 apparently healthy individuals that were selected from family members of cases group age-matched and sex-matched. For individuals in two groups, a questionnaire was completed, including demographic information. Then, they were referred to the laboratory for thyroid stimulating hormone (TSH) and free T4 (FT4) in the control group and anti-thyroid peroxidase antibody (TPO-Ab) levels measurement in case and control groups. Stool samples were obtained from all individuals for H. pylori antigen detection using the ELIZA kit. Results: There was no significant difference in the mean age of case and control groups (P=0.96), and 81.1% of individuals were female. 58.6% of patients with Hashimoto’s thyroiditis and 41.4% of the control group had positive H. pylori, but there was no statistically significant difference between the two groups (P=0.34). Furthermore, there was a significant positive correlation between TPO-Ab levels and H. pylori infection (r=0.2, P=0.03). Conclusion: TPO-Ab levels were associated with H. pylori infection diagnosed by H. pylori antigen.

Fournier gangrene is a rare but severe complication of ulcerative colitis, characterized by necrotizing fasciitis affecting the genital and perineal regions. We present a case of a 53-year-old man with a history of ulcerative colitis and cytomegalovirus (CMV) colitis who developed Fournier gangrene, an exceptionally uncommon occurrence in this patient population. The patient initially presented with intense pain, swelling, and skin discoloration in the genital area, accompanied by systemic symptoms, including fever. Prompt recognition and intervention are critical due to the aggressive nature of Fournier gangrene, which often results in significant morbidity and mortality. This case underscores the importance of vigilance for unusual presentations of necrotizing infections in patients with inflammatory bowel disease (IBD), particularly those with complicating factors such as immunosuppression and concurrent infections.