OWR is a genetic disease, transmitted as an autosomal dominant disorder characterized by arteriovenous malformations predominantly involving the mucocutaneous epithelium. One of the significant complications is the development of arteriovenous fistulas in different organs like the liver and brain. One of the rarest complications of this arteriovenous conduit is a high-output heart failure. We would like to describe a 66 years old woman who was admitted with a high-output cardiac failure who deteriorated clinically and was treated successfully by conservative management.

A 59-year old man was admitted with severe pustular psoriasis all over his body that was triggered by a flu vaccine injection 8 days before admission. Until then, his psoriasis was under control and was noticed slightly only on extensor tendons of the hands and around the elbows. He was treated with steroids and the skin eruption disappeared slowly within 3 days. This is the first report of a patient with psoriasis who had a flare up of the autoimmune skin disease following vaccination.

BackgroundNonalcoholic fatty liver disease (NAFLD) is an emerging condition and is constituted as a vital public health epidemic globally. This study evaluated the process of identification and documentation of NAFLD and metabolic syndrome in correlation with those diagnosed with obesity.MethodsParticipants included 352 patients older than 18 years who were diagnosed with fatty liver disease. We performed a cross-sectional study between August 2016 and September 2017. Categorical variables were extracted and analyzed using SPSS. The body mass index (BMI) was determined by the study staff and compared with the data retrieved from the family physician’s database.ResultsPatients who presented documented BMI in their past medical history showed to be significantly higher than those without documentation of BMI (29+4.4 vs 25.7+4.6 kg/m2, P<0.01). For instance, 54% of patients with NAFLD were documented in the electronic medical record (EMR) by the family physician, with higher documentation rate among males than females. Moreover, 72% qualified for documentation of metabolic syndrome, but only 5% were documented in their EMR. Patients with significant obesity and obesity-related conditions were more likely to have documentation in their EMR.DiscussionFurther analyses supported the conclusion that family physicians inadequately identify BMI in the EMR for overweight, obesity, metabolic syndrome, and fatty liver disease. Additional efforts are necessary to improve knowledge of proper identification of NAFLD and metabolic syndrome.

No abstract