Acute cutaneous zygomycosis of the scalp: a case report and literature review

Cutaneous zygomycosis is the third most common form of zygomycosis. However, scalp involvement is rare for this disease. In this study, we present a case of acute zygomycosis in a diabetic patient who was effectively treated with local debridement, amphotericin B lipid complex and posaconazole

Factors associated with poor asthma control in the outpatient clinic setting

The goal of the study was to assess asthma control using asthma control test [ACT] and to explore the factors that effects asthma control among participants with bronchial asthma in the outpatient clinic setting. This cross-sectional descriptive study was conducted in the outpatient primary care clinic at King Abdulaziz Medical City in Riyadh. Adult patients who were diagnosed with bronchial asthma by their primary treating physician were recruited over a 6-month period. Patients completed the ACT and questionnaires, which identified factors that affect asthma control. Four hundred asthmatic patients [n = 400] were enrolled, and 70% of these patients were women. Fifty-four percent of patients inappropriately used the inhaler device. The estimated prevalence of uncontrolled asthma at the time of the study was 39.8%. Inappropriate device use by the patient was more frequently associated with uncontrolled asthma [P - value = 0.001]. Active smoking [P - value = 0.007], passive smoking [P - value = 0.019], unsealed mattress [P - value = 0.030], and workplace triggers [P - value = 0.036] were also associated with uncontrolled asthma. However, the extent of asthma control did not appear to be related to the existence of regular follow-ups, bedroom carpets, outpatient clinic visits, age, body mass index [BMI], or duration of asthma. The present study identified a high prevalence of uncontrolled asthma in the primary outpatient clinic setting and common risk factors that may contribute to poor asthma control

Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome

Sepsis syndrome is a major worldwide cause of morbidity and mortality. While community-acquired severe sepsis and septic shock constitutes a major cause of admission to the intensive care unit, hospital-acquired severe sepsis and septic shock remain major preventable causes of ICU admission. This study evaluates the rate, etiology, complication and outcome of community- and hospital-acquired sepsis in a tertiary care hospital in Saudi Arabia. This is a retrospective evaluation of all admissions with severe sepsis and septic shock to a general intensive care unit over a period of six months. A total number of 96 patients were included, which represented 15% of the total number of admissions during the study period. The mean age was 57.4 [SD 21]. Sixty percent of cases were due to hospital-acquired infections, and 40% were community-acquired. The majority of the infections acquired in the hospital occurred in medical wards and intensive care units [27% and 21%, respectively]. At least one co-morbid condition was present in 94% of the sample patients, with cardiovascular disease and diabetes being the most frequently encountered disorders [58%]. Both community and hospital-acquired severe sepsis and septic shock carry very high mortality [58%]. The ICU length of stay was significantly longer for hospital and ICU acquired infections. Both community and hospital-acquired infections carry high mortality. Hospital-acquired severe sepsis is frequent in medical wards and ICUs, and measures to further evaluate risk factors are prudent

Validation of the arabic version of the epworth sleepiness scale

The Epworth Sleepiness Scale [ESS] is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population [ArESS], to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 [normal sleep] and 24 [very sleepy]. An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire [Cronbach's alpha = 0.86 in the initial test, and 0.89 in the retest]. The test-retest intra-class correlation coefficient [ICC] shows that the test-retest reliability was substantially high: ICC = 0.86 [95% confidence interval: 0.789-0.909, p-value < 0.001]. The difference in ArESS scores between the initial test and retest was not significantly different from zero [average difference = -0.19, t = -0.51, df = 89, p-value = 0.611]. In this study, the averages of the ESS scores [6.3 +/- 4.7, range 0-20 in the initial test and 6.5 +/- 5.3, range 0-20 in the retest] are considered high in Western cultures. The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures

Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube [QFT-G] test for the diagnosis of latent tuberculosis infection in dialysis patients

Dialysis patients are more likely than the general population to develop active tuberculosis [TB]. In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube [QFT-G] test was compared with the tuberculin skin test [TST] for the diagnosis of latent tuberculosis infection [LTBI] among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 [13%] were TST positive, and 65 [32.5%] were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% [k = 0.34] being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 [66.7%] were positive by the QTF-G test, resulting in an overall agreement of 33.3% [k = 0]. A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve [AUC] obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis

Home intravenous antibiotics in a tertiary care hospital in Saudi Arabia

Home intravenous [IV] antibiotic programs are becoming increasingly popular worldwide because of their efficacy and safety. However, in Saudi Arabia these programs have not yet become an integrated part of the health care system. We present our experience with a home IV antibiotic program, as one of the major health care providers in Saudi Arabia. Retrospective chart review of patients enrolled in the King Abdulaziz Medical City Home Health Care IV Antibiotic Program from 1 May 2005 [the start of the program] until 30 December 2007. In addition to demographic characteristics, we collected data on the site of infection, the clinical diagnosis, the isolated microorganisms, and the type of antibiotics given. Outcome measures evaluated included the relapse rate, failure rate, the safety of the program, and readmission rates. Of the 1 55 patients enrolled, 1 52 patients completed the program. Those who completed the program had a mean [SD] age of 52.8 [23.9] years. The mean [SD] duration of the IV antibiotic treatment was 20.6 [17] days. Three patients refused to complete the intended duration of therapy. Peripherally inserted central catheter [PICC] lines were utilized in 130 patients [86%]. One-hundred and thirty-one patients completed the intended duration of therapy, although the therapy was changed from the initial plan for 21 [13.8%] patients. Readmission to the hospital during therapy was required for 13 patients [8.5%]. Osteomyelitis was the most frequently encountered diagnosis [65 patients, 42.8%], followed by urinary tract infection [36 patients, 23.7%]. The home health care-based IV antibiotic program was an effective and safe alternative for in-patient management of patients with non-life-threatening infections, and was associated with a very low complication rate. Home IV antibiotic programs should be used more frequently as part of the health care system in Saudi Arabia

Saudi Guidelines for testing and treatment of latent tuberculosis infection. Joint statement of the Saudi thoracic society, the Saudi society of medical microbiology and infectious diseases, the Saudi association of public health, and the society of family and community medicine

Pulmonary tuberculosis is a common disease in Saudi Arabia. As most cases of tuberculosis are due to reactivation of latent infection, identification of individuals with latent tuberculosis infection [LTBI] who are at increased risk of progression to active disease, is a key element of tuberculosis control programs. Whereas general screening of individuals for LTBI is not cost-effective, targeted testing of individuals at high risk of disease progression is the right approach. Treatment of those patients with LTBI can diminish the risk of progression to active tuberculosis disease in the majority of treated patients. This statement is the first Saudi guideline for testing and treatment of LTBI and is a result of the cooperative efforts of four local Saudi scientific societies. This Guideline is intended to provide physicians and allied health workers in Saudi Arabia with the standard of care for testing and treatment of LTBI

Tuberculosis of the breast

Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction [PCR] may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required