Lung Transplantation Triggered "Jackhammer Esophagus": A Case Report and Review of Literature

A 19-years-old girl was referred for lung transplant due to end stage lung disease secondary to idiopathic bilateral bronchiectasis. Her routine pre lung transplant evaluation showed normal esophageal high-resolution manometry (HRM) and 24-hours impedance pH monitoring. Four weeks after the bilateral sequential lung transplantation (LTx), she developed dysphagia, chest pain and regurgitation, complicated by aspiration pneumonia. Repeated HRM showed Jackhammer esophagus, delayed gastric emptying and abnormal 24-hour pH impedance monitoring consistent with the diagnosis of gastroesophageal reflux disease. Twelve weeks after LTx, she was symptom free, HRM and 24-hour impedance pH monitoring returned to normal. To the best of our knowledge, this rare transient esophageal hypercontractility episode occurred after LTx and recovered without any specific treatment was never reported in literature. The etiopathogenesis of Jackhammer esophagus in general and LTx induced dysmotility in particular is discussed and reviewed.

Prevalence of pulmonary hypertension in sickle cell disease patients in eastern saudi arabia

To study the prevalence of pulmonary hypertension associated with the Asian haplotype of sickle cell disease in eastern region of Saudi Arabia. All consecutive adult patients [age = 12 years] presenting with sickle cell disease were recruited from January 2006 to December 2007. All patients were evaluated by the history, laboratory studies and transthoracic echocardiography. For the purpose of analysis we assessed the pulmonary hypertension by measuring right ventricular systolic pressure of at least 30 mm Hg. A total of 42 patients were enrolled in the study. Two of them were excluded, as they didn't complete their echocardiogram. Pulmonary hypertension was detected in 10 [25%] patients. The patients with pulmonary hypertension were of significantly higher age [39.9 +/- 27.5 vs. 25.1 +/- 10.5; p .01] and more commonly found in males [80% vs. 47%; p .06] than did those without pulmonary hypertension. The prevalence of pulmonary hypertension in our patients is higher compared to the previous reports of the benign nature of sickle cell disease in the Eastern province of Saudi Arabia

Extended spectrum Beta-lactamase producing Escherichia coli and Klebsiella pneumoniae bacteremia. Risk factors and outcome in the Eastern Region of Saudi Arabia

To study the risk factors for bacteremia caused by Escherichia coli [E.coli] or Klebsiella pneumoniae [K.pneumoniae] producing extended-spectrum beta-lactamase [ESBL] and their outcome. A case-control study was conducted in King Abdul-Aziz National Guard Hospital, Al-Ahsa, Kingdom of Saudi Arabia from January 2006 through December 2007. All adult patients for whom culture results were positive for E. coli or K. pneumoniae were eligible. Twenty-nine patients with ESBL producing bacteremia [cases] were compared with 80 patients with non-ESBL producing bacteremia controls. Hospital mortality was the primary end point. Univariable and multivariable logistic regression were performed to analyze risk factors for ESBL bacteremia and its 30-day mortality. A total of 109 patients with bacteremia were enrolled that included 29 cases and 80 controls. Forty-nine percent of the patients were male. The mean age was 60.2 +/- 21.1 years. Nosocomial infection was the only independent risk factor for bacteremia due to ESBL-producing pathogens [odds ratio [OR] 3.40, 95% confidence interval [CI] 1.14-8.44, p=0.02]. Overall 30-day mortality was 22%, and was similar in both groups. The nosocomial infection [OR 3.20, 95% CI 1.48-6.94, p=0.01], presentation with septic shock [OR 48.88, 95% CI 6.01-397.32, p=0.004], and intensive care unit care [OR 7.40, 95% CI 1.94 -28.34, p=0.001] were the independent risk factors for 30-day mortality. The ESBL rate is high in our study among the bacteremic patients. Nosocomial infection is identified both as a risk factor for ESBL bacteremia and mortality