In this issueCLINICAL PRACTICE GUIDELINESORIGINAL ARTICLESCASE REPORT
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# CLINICAL PRACTICE GUIDELINES {#article-title-2}

**Position statement on the diagnosis and management of non-alcoholic fatty liver disease**

Alswat et al discuss non-alcoholic fatty liver disease as a major national and international health burden. It is also known as an important cause of cryptogenic cirrhosis and second leading cause for liver transplantation. In spite of promising performance of non-invasive tools, liver biopsy remains the gold standard test for non-alcoholic steatohepatitis (NASH) diagnosis. Patients with suspected NASH and advanced fibrosis who are undergoing elective surgery should be assessed preoperatively for the presence of cirrhosis and the risk of decompensation.

View this table:
[Table1](http://smj.org.sa/content/40/6/529/T1)

Noninvasive methods for non-alcoholic fatty liver disease diagnosis and assessment

*see page 531*

# ORIGINAL ARTICLES {#article-title-3}

**Determinants of bone mineral density through quantitative ultrasound screening of healthy children visiting ambulatory paediatric clinics**

Al-Agha et al investigate the determinants of bone mineral density (BMD) through screening healthy children using a non-invasive quantitative ultrasound measurement device. A significant association with BMD was found during first 2 years with height (*p*=0.015), vitamin D supplementation (*p*=0.03), and breastfeeding (*p*=0.025). A directly proportional relationship with BMD was found with pubertal status, physical activity, diet, sun exposure, and calcium supplement intake. The investigation of the dietary, lifestyle, and demographic determinants of bone mineral density in the healthy middle-eastern child otherwise unaffected by chronic medical or metabolic disease or exposed to long term medications that could have affected bone metabolism.

![Figure1](http://smj.org.sa/https://smj.org.sa/content/smj/40/6/529/F1.medium.gif)

[Figure1](http://smj.org.sa/content/40/6/529/F1)

Estimated marginal means of Z score plotted against height.

*see page 560*

**Evaluation of the Diagnostic Accuracy of Smartphone Electrocardiogram Recorder Compared to Standard 12 lead Electrocardiography in Hospital settings**

Tawhari et al conclude that electrocardiogram recorders rhythms produced by smartphone accessory have a good diagnostic accuracy in diagnosing arrhythmias. The utility of using S-ECG-R for out-patient is to be determined. Analysis revealed an overall similar diagnostic sensitivity and specificity of S-ECG-R to the standard 12 lead ECG recording, sensitivity (97.3% versus (vs) 98%) and specificity (99.6% vs. 99.6%). However, cardiologists were more confident during interpreting standard ECG recordings in 91% of the recordings while in 71% of S-ECG-R recordings.

![Figure2](http://smj.org.sa/https://smj.org.sa/content/smj/40/6/529/F2.medium.gif)

[Figure2](http://smj.org.sa/content/40/6/529/F2)

Standard ECG recording for a 64 years old women who was found to have atrial fibrillation with rapid ventricular response

*see page 575*

# CASE REPORT {#article-title-4}

**Acute pulmonary embolism in a child with ANCA-negative idiopathic pulmonary capillaritis**

Asseri et al present a fatal case of diffuse alveolar hemorrhage in an 11-year-old girl with worsening hypoxia and left-sided chest pain. Diffuse alveolar hemorrhage is an uncommon condition in children that is characterized by distinct histopathological etiologies. The patient had lung biopsy-proven idiopathic pulmonary capillaritis and was being treated with prednisolone every alternate day, azathioprine, and hydroxychloroquine. A contrast-computed tomography scan of the chest showed an acute left lower-lobe pulmonary embolism. Negative results were obtained on a test for thrombophilia.

![Figure3](http://smj.org.sa/https://smj.org.sa/content/smj/40/6/529/F3.medium.gif)

[Figure3](http://smj.org.sa/content/40/6/529/F3)

Left pulmonary artery embolism (black arrow)

*see page 610*

*   Copyright: © Saudi Medical Journal

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