Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis

SUMMARY Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.

RESUMO Comparação dos sistemas de escores radiológicos, escores clínicos razão neutrófilo/linfócito e níveis séricos de proteína C-reativa para determinação da gravidade e mortalidade em casos de pancreatite aguda OBJETIVO Comparar sistemas de escores radiológicos, escores clínicos, os níveis séricos de proteína C-reativa (PCR) e a razão neutrófilo/linfócitos (RNL) como métodos de previsão de gravidade e mortalidade em casos de pancreatite aguda (PA). MATERIAIS E MÉTODOS Dados demográficos, clínicos e radiográficos de 80 pacientes com PA foram avaliados retrospectivamente. Os valores de Harmless Acute Pancreatitis Score (HAPS), Síndrome da Resposta Inflamatória Sistêmica (SIRS), Índice de Gravidade na Pancreatite Aguda à Beira do Leito (BISAP), escore de Ranson, escore de Balthazar, Índice Modificado de Gravidade por Tomografia Computadorizada (CTSI), escore de Inflamação Extrapancreática em Tomografia Computadorizada (EPIC) e grau renal foram registrados. O desempenho prognóstico dos sistemas de escores clínicos e radiológicos e RNL no momento da internação e os níveis séricos de PCR após 48 horas foram comparados quanto à gravidade, de acordo com os critérios de Atlanta revisados e mortalidade. Os dados foram avaliados pelo cálculo das curvas ROC e da área sob a curva ROC (AUROC). RESULTADOS De 80 pacientes, 19 (23,8%) tinham PA grave e 9 (11,3%) morreram. A AUROC para o escore BISAP foi de 0,836 (95%CI: 0.735-0.937), com o valor mais alto de gravidade. Com um valor de corte de BISAP ≥ 2 , a sensibilidade e a especificidade foram de 68,4% e 78,7%, respectivamente. A AUROC para o a RNL foi de 0,915 (95%CI: 0.790-1), com o valor mais alto de mortalidade. Com um valor de corte de RNL > 11,91, a sensibilidade e a especificidade foram de 76,5% e 94,1%, respectivamente. Entre os sistemas de escore radiológico, o EPIC apresentou o maior valor de AUROC, 0,773 (95%CI: 0.645-0.900) para gravidade e 0,851 (95%CI: 0.718-0.983) para mortalidade com um valor de corte ≥6. CONCLUSÃO O escore BISAP e a RNL podem ser preferíveis como determinantes precoces de gravidade e mortalidade na PA. O escore EPIC pode ser sugerido entre os atuais sistemas de escores radiológicos.

Coprologic and molecular prevalence of Giardia duodenalis from children in Tabuk City, Saudi Arabia

Giardia infection in children has been recognized as a significant cause of diarrhea in school children around the world. The objective of the present study was to determine the prevalence and genotypes of Giardia duodenalis in school children in Tabuk City, Saudi Arabia. Fecal samples from 200 children with ages ranging from 9 to 12 years (106 boys and 94 girls) were examined for the presence of Giardia cysts using direct microscopy and ELISA. DNA was extracted from fecal samples and subjected to polymerase chain reaction (PCR) using primers which amplified the partial 18S rRNA locus. Direct microscopy revealed that 9 (4.5%) were positive for Giardia cysts. ELISA and PCR revealed 20 (10%) and 44 (22%) of the samples were positive respectively. Assemblage A was detected through genotyping of Giardia duodenalis isolates prevalent in Tabuk City through sequencing the fragment obtained as a result of amplifying partial 18S rRNA locus.

Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals

Idiopathic pulmonary fibrosis [IPF] is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia. This was a retrospective study that looked at all the patients diagnosed with IPF between 2007 and 2012 at two tertiary care hospitals in Saudi Arabia. We collected the demographical, clinical, laboratory and radiological data from the patients' medical records. Medications administered and 1 year survival was also assessed. Between 2007and 2012, 134 IPF patients were identified. Their baseline characteristics [Mean +/- SD] included: age 64 +/- 13 years, body mass index 29 +/- 8 kg/m 2, FEV 1 56 +/- 15 percent of predicted, FVC 53 +/- 13 percent of predicted, FEV 1 /FVC 0.81 +/- 0.09, total lung capacity 75 +/- 13 percent of predicted, diffusing capacity of the lung for carbon monoxide 57 +/- 15 percent of predicted, on home oxygen at presentation 71 [53%], mean ejection fraction 0.50 +/- 0.07, mean pulmonary artery systolic pressure [via echocardiogram] 40 + 22 mmHg, presentation mean S pO2 92 +/- 7%, presentation 6-min walk distance 338 +/- 64 m and lowest S pO2 during 6-min walk test 88 +/- 5%. Patients were predominantly female [56%], and 42% of patients had diabetes and were active smokers. The IPF patients' frequency of hospital admission [n = 99] was 2.4 +/- 1.7 per year and duration of hospital stay [n = 99] was 17.4 +/- 23.8 days. Overall 1 year survival in all IPF patients was good, 93% [124] patients remained alive after 1 year. In Saudi Arabia, IPF patients tended to be slightly older and the disease progression was somewhat slower than reported IPF cohorts in other populations. They had frequent hospital admissions and a long hospital length of stay. The influence of genetics and co-morbid diseases on the incidence and outcome of IPF should be explored further

Prevalence of chronic obstructive pulmonary disease in Saudi Arabia

To assess the prevalence of epidemiologically defined chronic obstructive pulmonary disease [COPD] in Saudi Arabia. This cross-sectional, observational, population-based survey of COPD was conducted between June 2010 and December 2011 across the country of Saudi Arabia. A total of 56,000 randomly selected telephone numbers were called, which identified 10,001 eligible subjects; of whom 9,779 agreed to participate. A screening questionnaire included 6 questions related to cigarette consumption and water-pipe use was administered to each participant. Subjects with positive screening results were invited to provide input for a detailed COPD questionnaire. The adjusted proportion of subjects who reported a current, or past smoking history was 27.9%. Gender specific smoking rates adjusted by age were 38.7% [95% confidence interval [CI]: 37.5-39.9%] in men, and 7.4% [95% CI: 6.5-8.3%] in women. The epidemiological definition of symptomatic COPD was met by a total of 249 subjects. The age and gender-adjusted prevalence of COPD was 2.4% [95% CI: 2.1-2.7%]. Overall, COPD was more frequently documented [p<0.0001] in men [3.5% [95% CI: 3-4%]] than in women [1% [95% CI: 0.7-1.3%]]. The prevalence of epidemiologically defined COPD in the general population of Saudi Arabia is 2.4%, which is lower than that reported in industrialized countries

Analytical study of treated patients with anal fissure at a private surgical clinic in Aden

The objectives of the study were to find out the frequency of anal fissures related to sex, age and to determine the treatment and complications. A retrospective study on patients from a private clinic suffering from anal fissure, during the years 2010 - 2011. Males to females difference was very small, 55.6% and 44.4% respectively. Most of them [54.8%] were in the fourth decade of life aged between 25-49 years, and [27.4%] aged 50 years or more while only [17.8%] patients were less than 25 years. The mean age was 39.6 +/- 11.8 years. Chronic constipation and vaginal delivery were the principle causes, [90.4%] and [9.6%] respectively. Anal pain [63%] and anal bleeding [37%] were the only symptoms at admission. The diagnosis was made by history and direct inspection, [75.6%] had acute anal fissure and [24.4%] had chronic anal fissure. Lateral internal sphincterotomy was the main surgical procedure used in the treatment [72.6%] of patients with acute anal fissure and [18.5%] of patients with chronic fissure. Anal dilation was done for 12 [8.9%] patients, 4 of them had acute fissure and 8 had chronic fissure. Anal dilatation was done manually [p < 0.05]. Four [3%] patients with acute anal fissures had complications of incontinence to flatus. We conclude that males were more commonly affected and the most common cause of anal fissure was chronic constipation. Majority of the patients had lateral internal sphincterotomy performed.

Quality of life of patients with chronic obstructive pulmonary disease in the gulf cooperation council countries

To assess the health-related quality of life [HRQL] of patients with chronic obstructive pulmonary disease [COPD] in 4 Gulf Council Cooperation countries. We conducted a cross-sectional survey between December 2011 and March 2012 in the following countries: Kingdom of Saudi Arabia [Riyadh, Dammam, and Jeddah], Kuwait, Bahrain, and the United Arab Emirates. The HRQL was measured using the COPD Assessment Test [CAT] and the Chronic Respiratory Disease Questionnaire-Self-Administered Standardized questionnaire [CRQ-SAS]. We recruited 120 patients from 6 centers in 4 countries. Their average forced expiratory volume [FEV][1] was 49.3% [+/- 13.4] of predicted, and the ratio of FEV[1] to forced vital capacity was 0.58 [+/- 0.11]. The average COPD Assessment Test [CAT] score was 20.4 +/- 7.6; CAT scores were highest for Riyadh [24.1 +/- 7.7]; and lowest for Kuwait [18.5 +/- 9.2], with no significant difference between the centers. For the CRQ-SAS, the dyspnea domain score was 4.6 +/- 1.6, the fatigue domain score was 4.3 +/- 1.3, the emotional domain was 4.6 +/- 1.2, and the mastery domain was 4.8 +/- 1.4. The correlation coefficients of the association between the CAT score and the 4 domains of the CRQ-SAS for all of the centers combined was statistically significant. The CAT and CRQ-SAS revealed that the patients with COPD experienced a moderate to severe impact from the disease, and a considerably compromised quality of life in the GCC countries

Lung cancer at the University Hospital in Saudi Arabia: a four-year prospective study of clinical, pathological, radiological, bronchoscopic, and biochemical parameters

Lung cancer accounts for 4% of all newly diagnosed cancers in Saudi Arabia. The pattern of presentation is unknown. The objectives of this study were to assess the clinical, radiological pathological, biochemical and cronchospcopic abnormalities in lung cancer patients and to compare our findings with those reported in the literature. A total of 114 patients with proven lung cancer were selected for the study. A questionnaire concerning patients' demographic data was obtained; the abnormalities and the cell types of lung cancer were recorded prospectively in each subject. A total of 114 patients with lung cancer were studied. Mean age +/- SD was [59.8 +/- 10.8] years, and [71.1%] were smokers and 95.1% of them were male, [90.1%] smoked > 20pack/yr [96.2%] for 20 years of more. Cough [76.3%] and clubbing [40.4%] were the most common symptom and physical abnormality respectively. The right lung [64.9%] was more commonly affected than the left [37.7%]. Metastases were present in [49.1%] at presentation. The right and left upper bronchi [24% vs. 16%] were the mostly affected. Hypercalcemia was more common in squamous cell, while hyponatremia was more common in adenocarcinoma, and small cell. Squamous cell carcinoma was the most common cell type [51.85] and significantly associated with smoking [P

VCT Uptake and Associated Factors among Teachers from Harari Administrative Region

Background: Although HIV/AIDS is affecting most productive segments of the population; the basic education sector which is vital to the creation of human capital is also equally affected. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of quality education in most African countries and thus; needs appropriate intervention measures that reverse the current trend. Objectives: To assess the prevalence and determining factors of VCT uptake among teachers of Harari Administrative Region. Methods: A cross sectional study design with analytic component was conducted among 566 teachers drawn from 20 randomly selected schools of Harari Administrative Region from March to April 2009. Self administered questionnaire; adapted from previous relevant studies was used to estimate the prevalence of VCT uptake and the various socio-demographic and psychological factors. Data were entered and analyzed using bi-variate and multivariate models. Results: A total number of 497 teachers responded to the questionnaire adequately making the response rate of 87.8. The mean age of the participants was 34.68 ranging from 18 - 61 years. There were more teachers from urban areas (72.0) and most of them were males (62.2). About half (54.1) were married and few (5.2) were divorced. The vast majority (98.6) heard about the confidential VCT service and their major sources of information were mass media (85.3) and health workers (56.2). The prevalence of VCT uptake was 46.3. The odds of utilizing VCT significantly increased with being younger age group; female and first and second cycle teachers' category.Conclusions: The major factors identified for increased uptake of VCT are gender; age and salary category. Actions targeting the males; non-youth age group and low grade teachers' are necessary to follow their peer groups to utilize the VCT service in order to achieve the goal of education set for 2015

Prevalence of epstein barr virus in malignant lymphomas in Iraq

Malignant lymphomas are among the common tumors that are associated with and may complicate Epstein Barr Virus [EBV] infection. Although the strongest association is with the endemic Burkitt lymphomas [BL], the trend of association with sporadic lymhpomas reveals a consistently increasing prevalence of the virus in Hodgkin's disease [HD] in recent years compared to the non-Hodgkin type [NHL] which may point to a possible role for the virus in the predisposition and etio-pathogenesis of the disease. evaluate the association of EBV with Hodgkin's and non-Hodgkin lymphomas in relation to age, sex and HD subtype retrospectively using archival tissue biopsy sections. EBV was detected by In Situ Hybridization [ISH] using EBERs RNA probes in paraffin-embedded tissue sections prepared from archival tissue biopsy blocks. [a] EBV was detected in 25 of 40 HD cases [62.5%], 9 of 30 [30%] NHL cases, 4 of 10 [40%] BL cases, and in 5 of 20 [25%] other [non-BL] NHL cases, [b] Among the EBV-positive HD cases, 19 [76%] were of the mixed cellularity [MC] subtype, 1 [4%] of the Nodular Sclerosis [NS] subtype, 1 [4%] of the Lymphocyte Predominance [LP] subtype and 4 [16%] cases were of the Lymphocyte Depletion [LD] subtype, [c] Age distribution of HD cases revealed a bi-modal pattern characterized by an early major peak [67.5% of cases] below 35 years and a minor peak [32.5% of cases] above the age of 40. On the contrary, NHL cases revealed a nearly even age distribution [43.3% versus 56.6%] below and above the age of 40, respectively, [d] No difference was observed in the incidence of HD between males and females where the ratio was close to 1:1. On the other hand, a slight male predominance was seen among NHL cases with a male to female ratio of 2:1. [a] the prevalence rate of EBV infection was high among HD cases and fell within the prevalence rates found in previous similar studies revealing a range of values from 20 to 90%. [b] the higher prevalence of EBV positivity in HD compared to NHL found in this study points to a more substantial role for the virus in the pathogenesis of former compared to the latter disease which also comes in agreement with the greater environmental element compared to the genetic element in the etiology of HD. [c] The unexpected high EBV positivity in the LD subtype of HD may be interpreted as result of the progression of some of the early less aggressive MC-HD cases to the advanced more aggressive LD-HD subtype, [d] the bi-modal age distribution of EBV-positive HD cases follows the same pattern of distribution of the disease in general and testifies for the influence of environmental factors in the incidence of the disease

Pitfalls of inhalation technique in chronic asthmatics: effect of education program and correlation with peak expiratory flow

To determine the pattern of pitfalls of inhalation technique in chronic asthmatics; to assess whether an educational program can reduce the pitfalls of inhalation technique; and to evaluate whether reduction of the pitfalls could have a positive correlation with peak expiratory flow [PEF] measurements. The pitfalls of inhalation technique in 106 chronic asthmatics using either metered dose inhaler [MDI] [65%] or turbuhaler [35%] were studied prospectively. The pitfalls of inhalation technique and PEF measurement were recorded before and after an educational program at first and second visit. It was performed in the outpatients asthma clinic of the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2001 until March 2002. Among the MDI group; failure to breath hold for 5-10 seconds [52.2%] and failure to breath in slowly and deeply after inhaler activation [46.4%] were the most common pitfalls that have been reduced after education [20.3%, 21.7%]. While in the turbuhaler group; failure to breath hold for 5-10 seconds [23.1%] and failure to twist the grip forward and backward before use [21.1%] were the most common pitfalls that have been reduced after education [0%, 0%]. In both groups, the education program has been significantly contributed in reducing the mean number of pitfalls among MDI and turbuhaler users with p<0.001 and p=0.002. Moreover, the mean PEF has been improved significantly from 312.4 +/- 109.9 l/minute to 331 +/- 105.8 l/minute [p=0.003]. An educational program used in the outpatients asthma clinic has been significantly reduced the pitfalls of inhalation technique. The reduction of the pitfalls correlated positively with an increase in the PEF measurement. Therefore, we recommend such an education to be used in patients using such inhalers

efficacy of a management protocol in reducing emergency visits and hospitalizations in chronic asthmatics

To assess whether a simple protocol used in the outpatient's asthma clinic was effective in reducing emergency room [ER] visits and hospitalizations in chronic asthmatics during a year of follow-up, and to evaluate which type of asthmatics, according to severity of asthma, may benefit more from the protocol. Prospective assessment of a simple protocol [consisted of combined medical and educational aspects in the form of corticosteroids inhalation as a monotherapy and correction of the pitfalls of inhalation technique] in reducing ER visits, and hospitalization in chronic asthmatics. It was performed in the outpatients asthma clinic at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. A total of 128 chronic asthmatics were evaluated and followed up for one year between January 1999 and March 2000. Between January 1999 and March 2000 the total number of ER visits, and hospitalizations in 128 chronic asthmatics in the year before the protocol were 269 and 85. This was reduced to 116 ER visits and 27 hospitalizations a year after the protocol, a 55.4%, and 68.2% reduction. While only 25% never attended ER before the protocol, almost 58.6% did not attend ER after the protocol. The proportion that visited ER more frequently [at least 3 times/year] decreased from 50.8-18%, a 65% reduction. Similarly, patients who did not require hospitalization increased from 62.5% up to 85.2%. Moreover, the proportion that was hospitalized more frequently [at least 3 times/year] decreased from 10.2% to as low as 0.8%. Mean paired differences for ER visits were -1.16 +/- 1.42 with 95% confidence interval extending from -1.412 to - 0.916 with a P value <0.001. Mean paired differences for hospitalization were -0.453 +/- 0.955 with 95% confidence interval extending from -0.620 to -0.286 with a P value <0.001. A simple protocol in outpatient's asthma clinic can significantly reduce ER visits and hospitalizations in chronic asthmatics. All asthmatics, irrespective of severity benefited significantly from the protocol

Bronchoscopy, indications, safety and complications

To review the safety, indications, complications of flexible fiberoptic bronchoscopies performed at university teaching hospital, and to correlate the bronchoscopic findings with radiology, histology, and history of smoking. A total of 124 consecutive flexible fiberoptic bronchoscopies were reviewed in the last 3 years. A special form that contains personal data, indications, premedications, route of insertion, bronchoscopic findings, and complications in subjects-undergone bronchoscopy was completed. A suspicion of pulmonary tuberculosis [31%], lung mass [19%] and hemoptysis [18%] were the most common indications. Hypoxemia [14%] during procedure and pneumothorax post procedure were the most common complications. Mortality rate was 0%. For 57% of subjects who had histology, lung cancer [44%], and tuberculosis [15.5%] were commonly found. Lung cancer [72%] and tuberculosis granuloma [18%] were mainly responsible for narrow segments during bronchoscopy. A radiological tumor like mass was found histopathologically to be as lung cancer in 86% and as tuberculous granuloma in 5%. About 84% of lung cancer patients were either smokers [57%] or ex-smokers [27%] as compared to only 35% in smokers and 13% in ex-smokers in patients without lung cancer, P-value<0.01. Flexible fiberoptic bronchoscopy can be performed safely whenever indicated. Complications occurred were minor and self limiting. Appropriate preparation, and close supervision and adherence to the protocol were essential for a successful and safe procedure

Isolated respiratory failure caused by myasthenia gravis

Isolated respiratory failure due to myasthenia gravis that selectively involved the respiratory muscles alone is extremely rare and difficult to diagnose. We reported herein, a 46 year old patient who presented with acute respiratory failure, 4 weeks after thymoma resection. The respiratory failure was due myasthenia gravis that selectively affected the respiratory muscles only without having any peripheral signs. The initial response to therapy with pyridostigmine was unexpectedly complicated with severe bradycardia that made insertion of permanent pacemaker essential, before further therapy

Isolated respiratory failure caused by myasthenia gravis

Isolated respiratory failure due to myasthenia gravis that selectively involved the respiratory muscles alone is extremely rare and difficult to diagnose. We reported herein, a 46 year old patient who presented with acute respiratory failure, 4 weeks after thymoma resection. The respiratory failure was due to myasthenia gravis that selectively affected the respiratory muscles only without having any peripheral signs. The initial response to therapy with pyridostigmine was unexpectedly complicated with severe bradycardia that made insertion of permanent pacemaker essential, before further therapy