case of near fatal asthma: the role of ECMO as rescue therapy

We report a case of an adolescent with near fatal asthma [NFA]. He presented with severe hypoxemia and lifethreatening acidemia, who failed to respond to conventional therapy. His hospital course was complicated by barotrauma and hemodynamic instability. Early introduction of extracorporeal membrane oxygenation [ECMO] led to dramatic improvement in gas exchange and lung mechanics. This case illustrates the important role of ECMO as salvage therapy in NFA

Liver metastases in Egyptian patients with colorectal cancer: incidence and clinico-pathological predictors

Carcinoma of the large bowel is the fourth commonest cancer worldwide. The most frequent site for metastasis is the liver. Overall 30% of patients develop liver metastasis during the course of their illness; of these, 23% to 47% are synchronous lesions. These data are based on western studies. No data are published on patients with colorectal cancer from Egypt. We aimed to assess the incidence of colorectal liver metastasis in Egyptian patients and to evaluate the differences in the clinico-pathological features and tumor behavior in patients with and without liver metastasis. One hundred forty eight patients were prospectively enrolled in the study. Patients were classified into metastatic group [n=78] and non metastatic group [n=70]. In the two groups macroscopic features compared including: tumor size [2 cm, 2-5 cm, and >5 cm], site of primary tumor, side of liver involved, clinical symptoms and liver profile. Carcinoembryonic antigen [CEA] and cancer antigen [CA19.9] levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. No difference was found in the distribution of the primary site and size of the tumor. Jaundice, hepatomegaly and ascites were significantly higher in patients with liver metastases. Patients with liver metastasis had higher levels of CEA, CA19.9, higher frequency of vascular invasion and nodal involvement

Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting

To examine the validity of central venous oxygen saturation [ScvO 2] as a numerical substitution of mixed venous oxygen saturation [SvO 2] in adult patients undergoing normothermic on pump beating coronary artery bypass grafting [CABG]. Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter [PAC] as a part of our routine intraoperative monitoring. SvO 2 and ScvO 2 were simultaneously measured 15 minutes [T1] and 30 minutes [T2] after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass [T3 and T4], and 15 and 30 minutes after admission to intensive care unit [T5 and T6]. ScvO 2 showed higher reading than SvO 2 all through our study. Our results showed perfect positive statistically significant correlation between SvO 2 and ScvO 2 at all data points. Individual mean of difference [MOD] between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. In on pump beating CABG patients; ScvO 2 and SvO 2 are not interchangeable numerically. ScvO 2 is useful in the meaning of trend; our data suggest that ScvO 2 is equivalent to SvO 2, only in the course of clinical decisions as long as absolute values are not required

prevalence of HCV antibodies in skin disease patients in Saudi Arabia

Hepatitis C virus [HCV] infection is a worldwide health issue with about 3% of the world's population having HCV. In Saudi Arabia, prevalence ranges from 1.0% to 5.87%. Cutaneous diseases can indicate the presence of HCV infection. The research project aims to identify prospectively the prevalence of HCV infection in 200 patients with various types of skin disorders and 50 healthy blood donors, and to quantify this association through clinical and laboratory investigations. Two hundred patients with cutaneous manifestations who presented at the Dermatology outpatient clinics of King Khalid University Hospital [KKUH] and King Abdulaziz University Hospital [KAUH], Riyadh, and 50 healthy blood donors were prospectively studied. Patients were examined by a team of dermatologists and clinical data were collected through a standard questionnaire. Ten milliliters of venous blood were collected from fully consented, 8-1 Oh fasting patients and serum was analyzed for AST, ALT, double infection with HBsAg, anti-HCV antibodies, and screened for HCV-RNA-PCR. Patients from the study [n = 200] consisted of 25 [12.5%] males and 175 [87.5%] females, with a mean age of 42.9 +/- 15.06 years. Clinical examinations revealed that [35%] had urticaria, followed by pruritus [28%], lichen planus [25.5%], prurigo [10%], and palpable purpura [1.5%]. The main serum levels of ALT and AST were within the normal reference ranges. Twenty-four patients [12%] tested positive for anti-HCV antibodies, with 15 [62.5%] being positive for the presence of HCV-RNA by PCR and 9 [37.5%] resulting negative for the viral RNA. Of the 24 anti-HCV positive patients, pruritus 12 [50%], urticaria 5 [20.8%], lichen planus 5[20.8%], and palpable purpura 2[8.3%]. Five [2.5%] patients were positive for HBsAg, with 3 [60%] having pruritus and 2 [40%] presenting with urticaria. Of the 50 healthy blood donors, only one [2%] tested positive for the presence of anti-HCV antibodies, and all the donors tested negative for HBsAg. Results clearly indicate the prevalence of anti-HCV antibodies in 24 out of 200 patients [12%] with skin manifestations seen at the dermatology outpatient clinics and documented with HCV-RNA-PCR positivity of 15/24 [62.5%]. A p-value of <0.05 was considered significant, therefore, it is suggested that patients presenting with urticaria, pruritus and LP be investigated to exclude the possibility of HCV infection

Pattern of varicella and associated complications in children in United Arab Emirates: 5-year descriptive study

The objective of this study was to characterize the epidemiology of varicella and varicella associated complications in Al-Ain, United Arab Emirates [UAE] during 2000-04. The annual number of reported cases varied from 373 to 790 per 100 000 population. Most [89%] occurred in children < 15 years old. Of 187 children requiring hospital admission, 50.3% had febrile illness due to secondary bacterial infection and 17.6% had neurological complications. The overall mortality rate among hospitalized children was 1.1%, all due to invasive group A Streptococcus. Varicella and associated complications in previously healthy children is becoming an important clinical and public health problem in the UAE

[Evaluation of zinc status in patients with metabolic syndrome]

This preliminary study is an attempt to controls and to assess zinc status in a sample of metabolic syndrome patients in comparison with those of apparently healthy controls and to ascertain the relationship between zinc and metabolic syndrome features. Collection of data was carried out during the period April 2006 till January 2007, at the Medical Consultation Department, Baghdad Teaching Hospital in the Medical City, Baghdad, Iraq. In the first part of the study [a case-control study], the metabolic syndrome group, 100 metabolic syndrome patients who were chosen from patients with cardiovascular disease attending the medical examination during the period of the study. The control group includes 90 subjects who were selected from the workers of the same hospital. In the second part of the study [single blind with intervention study], metabolic syndrome patients [24 patients] divided into two groups, the first group included 12 patients supplemented with oral zinc [30 mg/day] for 50 days, and second group included 12 patients given placebo and designed as a control group. General information for each subject was obtained by questionnaire designed for the study. Waist circumference, blood pressure estimation, fasting serum glucose, triglycerides, high density lipoprotein cholesterol, zinc and urinary zinc/g creatinine were estimated for each subject. The first part of the study shows that the mean value for serum zinc level was significantly lower in metabolic syndrome patients than healthy controls [83.1 +/- 18.3 micro g/dl Vs 87.7 +/- 11.1 micro g/dl, p<0.05]. The mean urinary zinc levels, corrected for creatinine, were higher in metabolic syndrome patients than in controls [p<0.01] and increased linearly with the increasing number of metabolic syndrome components [r=0.252, p<0.05]. The prevalence of marginal zinc deficiency was significantly higher in metabolic syndrome group than in controls [24.0% Vs 14.4%, p<0.05]. The prevalence of raised fasting serum glucose, triglycerides and reduced high density lipoprotein cholesterol was higher in the metabolic syndrome group with low serum zinc [Zn< 70.0 micro g/dl] compared to zinc sufficient group [Zn> 70.0 micro g/dl] by 5.7%, 2 0.6% and 10.3% respectively. The second part of the study showed that the mean value of triglycerides of the zinc-supplemented group decreased at the end of 50 days by 6.2%, whereas the mean value of high density lipoprotein cholesterol increased by 13.6%. Marginal zinc deficiencies have been observed in the subjects study with a higher prevalence in metabolic syndrome group. The measured zinc status is associated with the features of metabolic syndrome

Coronary artery bypass grafting on beating heart. does it provide superior myocardial preservation than conventional technique?

To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting [CABG]. A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients [15 patients in each of 3 sub-groups] who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a] conventional technique, b] off-pump technique, and c] on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band [CKMB] levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. This study indicates that the off-pump technique provides better myocardial preservation than other methods

Treatment of mild to moderate unilateral congenital ptosis using single suture levator resection

To assess the effectiveness single large suture levator resection in the repair of mild to moderate unilateral congenital ptosis. All patients included in the study were younger than 7 years. They all had unilateral congenital ptosis with fair to good levator function. They all underwent levator resection by a single large suture in the ptotic eyelid. At the end of our study, 80% of patients showed sufficient elevation of the ptotic eyelid with a MRD of >/=4mm. 75% of the patients showed symmetry between the two eyelids with eyelid margins within 1mm of each other. The results of our study suggest that the single large suture levator resection procedure is effective in the treatment of mild to moderate unilateral congenital ptosis

Comparison of neurological outcomes in patients undergoing conventional coronary artery bypass grafting, on-pump beating heart coronary bypass, and off-pump coronary bypass

To study the differences in the prevalence of neurological complications following coronary artery bypass [CAB] carried out by conventional, on-pump beating and off-pump techniques. A retrospective analysis of all isolated coronary bypass operations [n=127] performed in King Fahad Cardiac Center, Riyadh over a period of one year starting from January 2005. Out of 127 patients, 73 underwent conventional CAB graft [CABG], 33 patents on-pump beating heart coronary bypass, and 21 had off pump coronary bypass grafting [OPCAB]. All patients had preoperative carotid scans and those who developed neurological complications underwent CT-brain and expert neuro-psychiatric assessment. Preoperative characteristics of patients in all 3 groups were similar. The bypass times in the conventional CABG group were significantly longer than the on-pump beating group. The maximum number of grafts was in the on-pump beating group, followed by the conventional CABG, and the least in the OPCAB group. Seven out of 73 cases in the conventional bypass group developed neurological events of various severities. Only one out of 33 patients developed acute confusional state in the on-pump beating group and no neurological events were noticed in 21 patients operated by the OPCAB technique. Low ejection fraction, preoperative congestive cardiac failure, non-elective surgery and preoperative catastrophic state were found to be significant risk factors independent of the bypass technique. This study shows no significant difference in the prevalence of neurological complications among different types of bypass surgery in our institution. There was a trend towards less neurological outcomes in the OPCAB and on-pump beating groups

Application of optical coherence tomography to predict visual outcome in diabetic macular oedema after intravitreal triamcinolone

To study the predictive role of optical coherence tomography [OCT] in patients with diabetic macular oedema treated with a single dose intravitreal triamcinolone injection as regards the visual outcome. This study included 15 eyes of 15 patients of different ages and sex. Preoperative OCT's were carried out, then after intravitreal single dose injection of triamcinolone postoperative OCT's were performed and both results compared over a period of 1-3 months. Visual improvement was better after intravitreal triamcinolone injection in patients showing thickened inner retinal layers on preinjection OCT [high reflectivity of the inner layers] than in cases with thinned inner retinal layers [low optical reflectivity] although macular thickness decreased significantly after the injection in both groups. It may be that a lower optical reflectivity and hence thinning of the inner retinal layers on preinjection OCT's is attributed to atrophy of these layers thus resulting in failure of visual acuity recovery in these patients. OCT pattern has a considerable role in the predicition of visual outcome in patients with diabetic macular oedema after intravitreal triamcinolone injection

Evaluation of changes in peripapillary nerve fibre layer thickness in glaucoma patients using optical coherence tomography after lowering the intraoccular pressure

To assess, using optical coherence tomography [OCT] changes in the thickness of the peripapillary retinal nerve fibre layer in glaucoma patients after surgical lowering of the intraocular pressure. 10 eyes of 8 glaucoma patients were included in this study planned subscleral trabeculectomy was done in all cases. OCT measurement of the peripapillary nerve fibre layer thickness was carried out before and after IOP reduction by the surgery. 8 eyes out of the 10 had and intraocular pressure reduction of more than 30% [from a mean 30mmHg +/- 2.8 SD to a mean 18 mmHg +/- 3.0 SD]. OCT scans were performed 2-3 weeks before surgical intervention and 3-4 months post-operative to measure the thickness of the peripapillary retinal nerve fibre layer. The study showed significant increase in mean peripapillary nerve fibre layer thickness

Correlation between intraocular lens design, material and posterior capsular opacification rate

To evaluate and to compare the rate of occurrence and degree of posterior capsular opacification [PCO] after small-incision cataract surgery and implantation of two different Intraocular lens [IOL] materials and designs over 6 months follow-up. Magrabi Eye and Ear Hospital, Jedda, KSA, New Dar Al-Shifa Hospital [NDASH], State of Kuwait, International Eye Hospital, Cairo, Egypt. 80 eyes were included in our study. All eyes underwent st and ardized phacoemulsification technique and were divided into 2 groups; Group [A]: 40 eyes implanted with silicone IOL [PhacoFlex, round edged design, Allergan] and Group [B]: 40 eyes implanted with acrylic IOL [Acrysof, sharp edged design, Alcon]. A st and ardized morphological mapping for evaluation of PCO was done 1, 3, and 6 months postoperatively. Nd:YAG capsulotomy rate was also reported. Acrysof group had lower PCO incidence than silicone group, [20% and 30% respectively]. The Nd: YAG capsulotomy rate was 12.5% in Acrysof group and 22.5% in silicone group. Eyes implanted with acrylic lOLs had lesser PCO incidence and subsequently lesser Nd: YAG capsulotomy incidence than those with silicone IOL

Intraoperative evaluation of graft patency in off-pump coronary artery bypass grafting

The accuracy of the anastomosis in off-pump coronary artery bypass [OPCAB] is sometimes questionable due to incomplete stability of the anastomotic site and wet field. Transit time flowmetry is a new technology used to evaluate the immediate graft patency intraoperatively. This is a prospective study to evaluate the benefit of this new technology in detecting silent technical errors leading to early graft stenosis or occlusion. In a period of 22 months, a prospective study of 112 patients underwent OPCAB with total number of 308 anastomoses. All grafts were tested by transit time flowmetry. The pulsatility index [PI] and the flow pattern wave were used to evaluate the patency of the grafts. These parameters were acceptable in all but 4 grafts [1.2%]. The cause was a technical error in all 4 grafts which were revised. None of these cases required revision on the pump. ECG and hemodynamics were normal in all 4 cases. We concluded that transit time flowmetry is an effective and reliable method in detecting early anastomotic problems in the operating room. Surgeons should be encouraged to use it routinely in the operating room in off- and on- pump technique

Haemophilus influenzae type b diseases in children: a pre-vaccination study

Haemophilus influenzae type b [Hib] can now be prevented by vaccination. We present the clinical and laboratory characteristics of acute invasive H. influenzae diseases in children admitted over a 4-year period to a tertiary paediatric ward of the Al-Ain medical district hospital, before vaccination became available in the United Arab Emirates. In all, 38 children had bacteriologically proven H. influenzae invasive diseases and all the isolates were serotype b. Meningitis was diagnosed in 60.5% of the children and 66% of the studied children were under 12 months. There were no deaths but substantial morbidity occurred in 12 children

effect of Ramadan fast on the diurnal change of total calcium, parathyroid hormone and calcitonin

Calcium, parathyroid hormone, and calcitonin levels were measured at 9 a.m., 4 p.m., 9 p.m., and 4 a.m. in 9 healthy subjects observing the dawn to sunset fast of the Muslims Holy Month Ramadhan. Similar measurements were undertaken in an ordinary non- fasting day for comparison. Significant diurnal fluctuations was seen in calcium only. During fasting and non-fasting calcium peaks at 9 a.m. It also seems to be significantly lower during fasting. On the other hand, PTH is significantly higher at 9 a.m. During Ramadhan fast. No significant differences were seen in calcitonin levels between fasting and non-fasting

Association between blood groups and body weight

The association between blood groups and diseases is an old one. A number of studies demonstrated an increased incidence of certain diseases in particular blood group. This study concluded that group AB seems to run higher with body weight than other groups in the ABO, Rh system

Prevalence of antibody to cytomegalovirus [CMV] in a Saudi Arabian population

Sera from 830 apparently healthy Saudis from various age groups were tested for antibody to cytomegalovirus [CMV] by an enzyme immunoassay test [EIA]. The high prevalence of positive tests in children under 5 years of age [80%] indicated that infection with this virus is widespread in this country and infection as in many other developing countries is acquired early in life. Comparative testing of the same sera by two other techniques: complement fixation [CFT] and an immunofluorescent test [IFT] showed the EIA test to be more sensitive and it is recommended that this test should be used routinely as a screening test

Prevalence of antibodies to Herpes Viruses in central Saudi Arabia

Sera from a total of 770 individuals [488 adults, 282 children] living mainly in the central area of Saudi Arabia were serologically investigated for antibodies to the herpesvirus family, which is known to cause medical important disease. The hepesviruses include: cytomegalovirus [CMV], Epstein-Barr virus [EBV], varicella zoster virus [VZY] and herpes simplex viruses [HSV-1 and HSV-2]. Using the indirect immunofluorescent test, the overall prevalence of antibodies in children was 75.5% for CMV, 61% for EBV, 66.6% for VZY, 55.3% for HSV-1, and 0% for HSV-2. For adults, the overall prevalence of antibodies was 88.5% for CMV, 85.2% for EBV, 88.9% for VZV, 89.5% for HSV-1 and 3% for HSV-2. This indicates a high incidence of infection for all herpesviruses apart from HSV-2, as well as early acquisition of infection in childhood. Males and females appeared to be almost equally susceptible to infection by the entire family of herpesviruses