ABSTRACT
Background and Objective: Neuromyelitis optica (NMO) shares certain features with multiple sclerosis (MS). Similar phenotypes, wide spectrum and the differential prevalence of NMO among ethnic backgrounds pose diagnostic challenges. NMO-IgG antibodies are specific biomarker for NMO and facilitate its differentiation from other demyelinating diseases. This study aimed to assess the frequency of NMO and NMO-IgG seropositivity in Saudi patients with demyelinating diseases of the central nervous system. Methods: One hundred and four patients from neurology database at King Abdulaziz Medical City, Riyadh underwent clinical and laboratory examination, neuroimaging and NMO-IgG antibodies screening. Results: The mean age at presentation was 32 (±9) years and there was an excess of females (female:male – 3:1). The mean duration of illness was 4.6 (±3.2) years. During the illness, 48.1% of patients had clinical evidence of spinal cord involvement, 29.8% had optic neuritis and 14.4% had both features. A large majority (75.8%) of brain lesions fulfilled MRI criteria for MS and 17% had lesions extending over ≥3 vertebral segments. NMO-IgG antibodies were present in only one patient – a frequency of 0.96% in our study cohort. Conclusion: Prevalence of NMO and NMO-IgG seropositivity is rare in Saudis with demyelinating diseases of the central nervous system. Hence, routine NMO-IgG testing is likely to have a low diagnostic yield
ABSTRACT
To examine and test the possible association between boarding time and stroke patients' outcome. This study is a retrospective review of stroke patients presenting to the Emergency Department [ED] of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time [BT] was defined as time of arrival to ward minus time of decision to admit. Primary outcome [PO] was defined as a composite of mortality, and/or any of post-stroke complications. We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO [odds ratio [OR] =0.9, p=0.3[, or any of the secondary outcomes, such as, death [OR=0.97, p=0.5], severe disability [OR=0.97, p=0.3], pneumonia [OR=1, p=0.9], urinary tract infection [OR=1,p=0.9], or neurological deterioration [OR=0.8,p=0.1]. Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure [HF], onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. Although [admit no bed] was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged
ABSTRACT
Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis