Post-tonsillectomy hemorrhage: an analysis of incidence and risk factors in Kuwait

Introduction: Post-Tonsillectomy Hemorrhage [PTH] remains one of the commonest complications associated with tonsillectomies. Its incidence and risk factors vary widely in literature

Objective: To examine our local experience and assess the incidence of PTH in comparison to that in the literature and to identify factors that contribute in increasing the risk of PTH in our setup. Design: Retrospective study. Setting: Al-Sabah and Zain Hospital, MoH, Kuwait

Methods: A retrospective chart review was conducted on 2,038 patients who underwent tonsillectomy with or without adenoidectomy during a 12-month period [January to December 2010] in Zain and Al Sabah hospitals. Details regarding the patients' age, gender, surgical technique, and level of the operating surgeon were recorded in order to assess any correlation. Intervention: Tonsillectomy. Main Outcome Measure: Incidence of PTH

Results: Out of the 2,038 patients included in this study, a total of 98 patients [4.8%] developed PTH. Thirty-one patients [31.6%] who developed PTH were above the age of 26 years. Out of the 98 patients [4.8%] who developed PTH, 63 patients [64.3%] were male. 'Hot' dissection technique was associated with higher incidence of PTH [71 patients; 72.4%] in comparison to the 'cold' dissection [27 patients; 27.5%]

Conclusion: The incidence of PTH in our institution is 4.8%, which is comparable with that reported in the literature, ranging between 1.5% and 6.68%. Male patients, increasing age and 'Hot' dissection technique were all identified as risk factors for PTH in our setup

Angiotensin-converting enzyme gene insertion/deletion polymorphism in Saudi patients with rheumatic heart disease

To investigate the association between angiotensin-converting enzyme [ACE] insertion/deletion [I/D] polymorphism and rheumatic heart disease [RHD] in Saudi patients. A case-control study was conducted in Saudi RHD patients. Genomic DNA was isolated from 99 RHD patients attending the Pediatric Cardiology Clinic at the Maternity and Children Hospital, Al-Madinah, Saudi Arabia from March 2013 to June 2014, and from 145 age- and gender-matched controls. Patient clinical records were reviewed to report major and minor modified Jones' criteria for diagnosis. The diagnosis was confirmed by echocardiography. The ACE I/D polymorphism was identified by polymerase chain reaction. A significant difference in ACE D allele carriage [DD+ID] distribution between RHD cases and controls was identified [p=0.02, odds ratio = 3.6, 95% confidence interval: 1.2-10.8]. The D allele carriage was significantly associated with development of mitral valve lesions alone [p=0.03]. The ACE I/D polymorphism is associated with an increased risk of RHD in the Saudi population. Further studies are needed to confirm our findings and to understand the molecular mechanisms underlying this association

Numerical simulation on wind flow over step-shaped cliff topography with rough surface

To enhance the understanding of the impact of obstacle buildings on pollution transportation and dispersion in the atmospheric boundary layer, it is necessary to know the atmospheric flow characteristics over terrains. Wind flow characteristics in a boundary layer over a step-shaped cliff topography model with rough and smooth surfaces were studied numerically using Computational Fluid Dynamics models [CFD]. The CFD models that were used for the simulation were based on the steady-state Reynolds-Average Navier- Stoke equations [RANS] with turbulence models; standard and RNG models. The rough surface was modeled using windbreak fence, which was set on the step-shaped cliff model surface. The results of the numerical model were validated against the wind tunnel results in order to optimize the turbulence model. Numerical predictions agreed reasonably with the wind tunnel results. The results indicated that rough surface has a great influence on the turbulent flow characteristics and vortex rotating. The wind velocity for rough surface near the ground level was observed to be lower than that for the smooth surface of the step-shaped cliff model. Large flow separations were formed by the windbreak fences. Distortion of the flow at the windward corner of the step created a steep gradient of velocity and large turbulent mixing

Vitamin A status in wheezing Saudi children

To examine the serum retinol levels of wheezing children, and to investigate the relation as an biochemical indicator of vitamin A status in wheezing children between serum levels of retinol and severity of wheezing. A prospective cohort study including 400 wheezing Saudi children aged 3-36 months, who were treated in the pediatrics ward of Ohoud Public Hospital in Al-Madinah, Kingdom of Saudi Arabia between January 2009 and August 2010. Patients were subdivided according to the course of wheeze into 93 patients with persistent wheeze, and 307 patients with acute wheeze. Severity of wheeze was graded mild, moderate, and severe. Among the persistent wheezing patients 9.7% had deficient, and 20.4% had marginal serum vitamin A concentration, while in the acute wheezing patients, 1.6% had deficient, and 8.1% had marginal serum vitamin A concentrations. Results revealed that the prevalence of deficient and marginal vitamin A concentration is higher in the persistent than in the acute wheezing group [p<0.05]. Serum vitamin A was related to wheezing severity. Deficient serum vitamin A was found only in severe wheezing groups. Wheezing Saudi infants had prevalent deficiency and marginal deficiency of vitamin A. Serum vitamin A concentrations were related to the wheezing severity and course

Kawasaki disease in western Saudi Arabia

To describe our experience on Kawasaki disease in the Madinah region, Kingdom of Saudi Arabia [KSA]. This is a retrospective hospital based study. The study was conducted in Maternity and Children Hospital, Madinah, Kingdom of Saudi Arabia during January 2007 to January 2010. The study included 51 patients' records as suspected cases of Kawasaki disease. The study was approved by the Ethical Committee. Twenty-four patients were proven to have Kawasaki disease in this study. The mean age of the patients at diagnosis was 3.1 +/- 2.4 years. Most patients were younger than 5 years [83.3%]. The male to female ratio was 1.7:1. Diagnosis was made 8.1 +/- 3.3 days after start of fever with a range from 4-15 days. All patients received intravenous immunoglobulin [IVIG] with 2 requiring another dose of IVIG. Echocardiography was performed 10.1 +/- 3.9 days from onset of fever with a range of 4-20 days. The duration of hospital stay was 7.9 +/- 5.8 days with a range from 3-25 days. Three patients had coronary artery abnormalities and still have coronary artery dilatation at last follow-up appointment. A high index of suspicion is mandatory for early diagnosis of Kawasaki disease as delayed diagnosis may lead to coronary lesions. A national awareness program on Kawasaki disease is recommended

Investigation of the biological significance of p53 tumor suppressor gene and Ki-67 in colorectal carcinoma resected from Saudi patients: An immunohistochemical analysis

p53 protein accumulation has been shown to be an unfavorable prognostic parameter in many human cancers, but findings in colorectal carcinoma [CRC] are equivocal. The objective of this study is to evaluate the value of p53 and Ki-67 as prognostic markers in patients with colorectal carcinoma. We conducted a retrospective analysis on 56 colorectal cancer specimens resected at King Abdulaziz university hospital, Jeddah, Saudi Arabia [40 cases of left colon and 16 from right colon]. Immunohistochemistry [IHC] was performed on formalin fixed paraffin embedded tissue using the avidin-biotin peroxidase complex method. Antibodies to p53 [DO7] and Ki-67 were used. This was correlated with the following clinicopathologic parameters: patient sex, age and survival; pathological stage, and grade of the tumors. Among the 56 cases of colorectal cancer [male/female=1.3; mean age 54.9 years, range 30-80 years], 85.7% [n=48] of tumors were positive for p13 IHC. Ki-67 was positive in 94% [n=53]. The p53 positivity in different stages was as follows [2/2 stage A, 23/28 stage B, 15/18 stage C and 8/8 stage D]. The positivity of p53 according to tumor differentiation was as follows: [well differentiated 6/6, moderately differentiated 38/45, poorly differentiated 4/5]. P53 was positive in 34/40 of left colon [including rectosigmoid] and in 14/16 of right colon carcinoma. Imunoreactivity for p53 was seen in adenomatous epithelium only in 8/22 cases. Although p53 and Ki-67 expression expresse4 strongly in cancer compared to normal tissue [p<0.05], there was no relation with survival, grade or Dukes' stage of the tumor. P53 cannot be considered as independent prognostic marker in colorectal carcinoma

use of endovascular stent-grafts for the treatment of common carotid-internal jugular fistula

We report a case of a fistula between the common carotid artery and the internal jugular vein due to a hemodialysis catheter insertion. We managed the fistula by the insertion of a covered-stent at the common carotid artery, and completely sealed the fistula without immediate complications. We present this case to highlight this new successful method of treatment

Antinociceptive activity of vigabatrin in mice

Vigabatrin [an inhibitor of GABA catabolism] was examined for its antinociceptive activity, changes in locomotor activity and body temperature in mice after acute treatment over a period of 24 hours. Vigabatrin [125 and 500 mg/kg i.p] resulted in rapid antinociception within 15 min. At the low dose of vigabatrin this effect returned to normal after-45 min but persisted more than 12 hours at the high dose. With the same dose regimen, the locomotor activity declined significant, with persistence up to 24 hour of the treatment. The effect of this treatment on body temperature was dose related being significantly reduced at 15 min. It returned to normal after 6 hours of treatment with vigabatrin 500 mg/kg. Treatment with bicuculline [a specific GABA A-receptor antagonist] was found to be minimally effective to avert locomotor or body] temperature changes induced by vigabatrin. Picrotoxin [a GABA Aand GABA gated-chloride ion channel blocker] was also ineffective on the hot-plate latency, locomotion or body temperature. However, picrotoxin slightly though significantly [p<0.05] reversed the changes in locomotion and rectal temperature only at first observation [15 min]. On the other hand, naloxone did not antagonize the effect of vigabatrin on body temperature but caused a significant decline in hot-plate latency at 45 min, perhaps because of hepotentiation of naloxone by vigabatrin in the induction of hyperalgesic response. These effects are thought to be a result of neuromediator interactions with the probable involvement of GABA receptor mediated processes and a possible direct effect of drug

Intensive behavioral therapy for primary enuresis

To assess the effect of intensive behavioral therapy on Saudi children with primary enuresis. Twenty-six children, aged 6-14-years, presented with complains of bed wetting during a 12-months period from January 2001 through to January 2002, ArAr Central Hospital, Kingdom of Saudi Arabia were studied in an interventional, non-randomized trial without control. After complete verbal autopsy, physical examination and laboratory investigation, they were offered intensive behavioral therapy. They were evaluated for response, regularity, esteem and recurrence of enuresis. Mean age of the study group was 9.6-years [SD = +/- 2.6] and boys were affected almost twice of girls [P<0.05]. Family history, social history and school performance did not show any significant [P>0.05] association with enuresis. Sixty point five% were regular and out of those 27.9% never missed any visits. 91.7% were completely dry out of regular patients. There was 75% success rate in those, who visited 4-8 times while 25% in those, who visited 1-3 times. Ninety-six% of the parents and 80.7% of the children were fully satisfied with this therapy. Socio-economic status seems to play a significant [P<0.05] role in regularity of follow up and response to behavioral therapy. This result shows an excellent response to intensive behavioral therapy in primary enuresis if the follow up is regular

Effects of smoking on semen quality in infertile men in Riyadh, Saudi Arabia

to compare the quality of semen between smokers and non-smokers in infertile men in Saudia Arabia. Materials and this is a prospective study performed in the Infertility Clinic of the Maternity and Children's Hospital in Riyadh Medical Complex in Riyadh. One hundred semen samples were collected from infertile Saudi Arabian males who were smokers and non-smokers. Semen analysis was done according to WHO recommendations. a higher percentage of primary infertility [57%] was observed in the smoker group. In the non-smoker group, there was more secondary infertility [55%]. The age range from 26-30 years predominated in both groups. Sperm count and total sperm count were significantly lower in the smokers compared to non-smokers, but semen volume and motility were not significantly reduced in the smoker group. Normal spermatozoa with abnormal semen parameters [18 percent] was the main cause of male infertility in the smoker group whereas in the non-smoker group it was asthenozoospermia [27%]. s significant difference in sperm concentration between the smoker and non-smoker groups observed, but there was no significant difference in other seminal parameters analyzed. This observation could be due to the effect of smoking

Influence of desferrioxamine on cytotoxic and biochemical changes induced by doxorubicin in noma cell bearing swiss albino mice

Normal and Ehrlich ascites carcinoma cell [EAC cell] bearing Swiss albino mice,6-8 weeks old were treated with desferrioxamine [DFO] at doses of 125 and 250 mg/kg / day body weight. Some of the mice in each group were injected with doxorubicin [DOXO] [15 mg/kg] and killed 30 h after the last DFO treatment. The total proteins and nucleic acids were analyzed in the liver and testes of normal mice and EAC cells in the ascetic mice. DFO treatment was found to be devoid of any significant effect on protein and nucleic acids in hepatic and testicular cells of normal mice and the EAC cells of ascetic mice. Pre treatment with DFO at a single dose failed to protect the biochemical changes induced by DOXO, whereas DFO treatment for 7 days was found to provide significant protection against the DOXO induced changes in nucleic acids in normal mice, but it does not interfere with the antineoplastic effect of doxorubicin. The protective effect of DFO may be advantagous in cancer therapy involving drugs which binds to DNA and cause neoplastic changes

Effect of ACE inhibitors on cisplatin-induced nephrotoxicity in rats

The effects of captopril and enalapril on cisplatin-induced nephrotoxicity in rats were evaluated. Aqueous solution of either captopril or enalapril was administered orally for 7 days. Cisplatin [15 mg/kg,i.p.] was injected in non-treated rats or with last dose of either captopril or enalapril30 hrs before animal sacrificing. Captopril failed to alter serum urea and creatinine, renal non-protein thiol and malondialdehyde contents. However, enalapril in a high dose [20mg/kg] increased serum creatinine, non-protein thiol. Cisplatin increased serum urea and creatinine levels, renal non-protein thiol and malondialdehyde content. Pretreatment with captopril decrease the effects of cisplatin on serum urea, renal RNA and DNA and. non-protein thiol. In contrast, enalapril potentiated the effects of cisplatin. It is concluded that the protective effect of captopril is a function of sulfhydryl group. Further studies are suggested in determining the role of thiol compounds as a basis for cisplatin-induced nephrotoxicity and its prevention

Cytological effects desferrioxamine in somatic cells of Swiss albino mice

Desferroxamine an iron chelator, has been shown to be ineffective in increasing the frequency of micronuclei in bone marrow cells of mice on acute and sub - acute treatment. However, a significant mitodepressive effect is produced at the higher dose on sub - acute treatment. The mito - depressive potentials of DFO may be either due to the disproptionate ratio of Fe2+/Fe3+ which is known to stimulate lipid peroxidation or due to total chelation of iron resulting in bone narrow depression and anemic condition