Cerebellar ataxia after a single day of metronidazole use: Case report

Cerebellar ataxic syndromes, although uncommon, have been reported previously in patients taking metronidazole. However, almost all cases describe instances where patients were taking prolonged or high doses of the drug. We report a 65-year-old man who consumed 400 mg of metronidazole 3 times over 1 day and presented with slurring of speech, imbalance while walking and diplopia. The symptoms developed the day after consumption of metronidazole. Examination showed slurring of speech, gaze-evoked nystagmus, and dysmetria in all limbs. MRI brain revealed symmetric hyperintense lesions in the dentate nucleus and pons on T2-weighted imaging and FLAIR, which have a well-established association with metronidazole-induced central nervous system (CNS) toxicity. On discontinuation of the drug, symptoms improved, and complete recovery was noted at follow-up 2 weeks later. This case indicates that CNS side effects of metronidazole may not necessarily occur only at high doses or after prolonged courses of metronidazole, but may occur as an idiosyncratic reaction to the drug. Reasons for variable susceptibility require further investigation.

Phylogeny and Detection of blaTEM, blaSHV, blaCTX-M Genes in Escherichia coli Isolates from Patients with Urinary Tract Infections in Taif Hospitals, Saudi Arabia

Background: Urinary tract infections (UTIs) represent one of the most common diseases that are encountered in clinical practice and are caused mainly by Escherichia coli (E. coli). Aims: The objectives of this study were to identify and compare the blaTEM, blaSHV and blaCTX-M as marker of beta-lactamase genes in E. coli strains isolated from patients with UTIs collecting from King Abdul-Aziz hospital in Taif region, Saudi Arabia. Study Design: In vitro experimental and molecular study. Place and Duration of Study: Genetic engineering and biotechnology unit, Taif University, from September, 2016 to November, 2017. Methodology: Beta-lactame antibiotics are prescribed in most infectious disease including UTIs. Twenty one isolates identified as E. coli using microbial identification and confirmed by 16S rDNA. Results: These isolates were susceptible to Imipenem (100%), Ampicillin (90%) and Cefoxitin, but resistant to Cefepime (38%). Existance of selected bla-genes (blaTEM, blaSHV and blaCTX-M) were detected in the 21 isolates by PCR. Moreover, phylogeny tree was drawn based on 16S rDNA sequence. The results of this study show significant differences in susceptibility to different beta-lactam antibiotics among the bla-genes in E. coli isolates. Conclusion: Therefore, our findings instead of our data provide some new epidemiological information about the clonal nature of E. coli isolated from patients with UTIs in Taif region, KSA.

Screening of SHOX gene sequence variants in Saudi Arabian children with idiopathic short stature / 소아과

PURPOSE: Short stature affects approximately 2%–3% of children, representing one of the most frequent disorders for which clinical attention is sought during childhood. Despite assumed genetic heterogeneity, mutations or deletions in the short stature homeobox-containing gene (SHOX) are frequently detected in subjects with short stature. Idiopathic short stature (ISS) refers to patients with short stature for various unknown reasons. The goal of this study was to screen all the exons of SHOX to identify related mutations. METHODS: We screened all the exons of SHOX for mutations analysis in 105 ISS children patients (57 girls and 48 boys) living in Taif governorate, KSA using a direct DNA sequencing method. Height, arm span, and sitting height were recorded, and subischial leg length was calculated. RESULTS: A total of 30 of 105 ISS patients (28%) contained six polymorphic variants in exons 1, 2, 4, and 6. One mutation was found in the DNA domain binding region of exon 4. Three of these polymorphic variants were novel, while the others were reported previously. There were no significant differences in anthropometric measures in ISS patients with and without identifiable polymorphic variants in SHOX. CONCLUSION: In Saudi Arabia ISS patients, rather than SHOX, it is possible that new genes are involved in longitudinal growth. Additional molecular analysis is required to diagnose and understand the etiology of this disease.

Physicians' job satisfaction and its correlates in a tertiary medical care center, Riyadh, Saudi Arabia

Objectives: to measure the degree of job satisfaction among physicians working in a Tertiary Care Hospital and to identify background and work environment characteristics that affect overall and differential job satisfaction

Subjects and Methods: this is a cross-sectional study of 340 physicians selected from a Tertiary Care Center using a stratified random sample with proportional allocation using a self-administered questionnaire with the 5-point Likert scale. From the 340 physicians requested to participate in the study, 217 [63.8%] completed the questionnaire. Descriptive statistics were used appropriately, including mean +/- standard deviation for the quantitative variables, while frequency and percentages were used for the qualitative variables. ANOVA, t-test, and Chi-square were used as necessary to determine if there are any significant relationships between satisfaction scores and the predictor variables

Results: a total of 217 physicians [males 75.6% females 24.4%] completed the questionnaire. Of this total, 52.5% were non-Saudis. The overall perceived satisfaction as measured by one question was 3.42 points out of 5 [68.4%] significantly lower than the overall satisfaction which took in consideration all variables 3.67 points [73.4%]. Mean satisfaction scores were significantly negatively related to the number of children [P < 0.001] the physicians had, but positively correlated to stipend, duration of vacation leave, sick leave policy, health coverage for the employee and family, overall benefits package, involvement in academic work, and involvement in research work [P < 0.001]

Conclusion: the working environment and policies of an organization play important roles in the satisfaction of its physicians. Boosting physician satisfaction is important for both the success of a Tertiary Care Center and for the high quality services offered to patients

Screening for urine abnormalities among preschool children in western Saudi Arabia

To estimate the frequency of urinary problems among preschool children. In this cross-sectional study, 1000 preschool asymptomatic children attending the outpatient clinics of the Children's Hospital, Taif, Kingdom of Saudi Arabia between August 2013 and December 2013 were subjected to dipstick urine analysis. Microscopic examination was performed for the abnormal dipstick samples, and children with hematuria were investigated for kidney function. Dipstick urine analysis revealed abnormal findings in 25.1% of the screened children. The most common dipstick abnormalities were positive nitrite test in 18.1%, hematuria in 16.9%, and positive leukocyte esterase test in 14.3% of the cases. The most common abnormality in microscopic urine examination was crystals in 13% of the cases. Pyuria were evident in 5% of cases and hematuria in 2.5%. The most common bacteria in positive urine culture samples was Escherichia coli in 62.6%.In view of these important findings, dipstick screening should be implemented in preschool children.

The tryptophan utilization concept in pregnancy

The decrease in maternal plasma total (free + albumin-bound) tryptophan (Trp) during the third pregnancy trimester is attributed to induction of indoleamine 2,3-dioxygenase (IDO). When measured, free [Trp] is increased because of albumin depletion and non-esterified fatty acid elevation. The Trp depletion concept in pregnancy is therefore not supported because of incorrect interpretation of changes in Trp disposition and also for not addressing mouse strain differences in Trp-related responses and potential inhibition of Trp transport by the IDO inhibitor 1-methyl tryptophan. Application of the Trp utilization concept in pregnancy offers several physiological advantages favoring fetal development and successful outcome, namely provision of Trp for fetal protein synthesis and growth, serotonin for signaling pathways, kynurenic acid for neuroprotection, quinolinic acid for NAD+ synthesis, and other kynurenines for suppression of T cell responses. An excessive increase in Trp availability could compromise pregnancy by undermining T cell suppression, e.g., in pre-eclampsia.

Prevalence of vitamin D deficiency in Saudi adults

To determine the prevalence of vitamin D deficiency in healthy Saudi adults. A cross-sectional study carried out as part of the screening and early evaluation of kidney disease project. Vitamin D was measured in subjects recruited at 2 screening camps in Riyadh, Saudi Arabia, between March to May 2008. Subjects from the 2 large commercial centers in Riyadh aged >/= 18 years and Saudi nationals were invited. The study sample comprised of 488 subjects. The mean age of the subjects was 37.43 [11.32] years, of which 50.2% [n=245] were males. Twenty-nine percent of subjects were in the vitamin D deficiency group, 22.7% were in the relative insufficiency group, and 47.5% had normal levels of 25-hydroxy vitamin D. We observed that female gender was an independent predictor of vitamin D deficiency or insufficiency [odds ratio [OR]: 2.992; 95% confidence intervals [CI] 2.069-4.327]. Anemia was also a predictor for vitamin D deficiency or insufficiency [OR: 3.16; 95% CI 2.02-4.92]. Age was positively correlated with vitamin D levels [Pearson correlation=0.183, p<0.000]. Vitamin D deficiency is common in healthy Saudi adults. This is more pronounced in females and in the younger age groups. Wearing of traditional clothes, deliberate avoidance of the sun, and inadequate dietary intake are likely to be the principal causes of low vitamin D levels

Association between apolipoprotein E-polymorphism and ischemic heart disease patients with or without type 2 diabetes mellitus: a preliminary study in Kuwait

We investigated the association between apolipoprotein E polymorphism and ischemic heart disease with or without type 2 diabetes in Kuwait and examined the impact of apolipoprotein E polymorphism in diabetic patients. The present study was conducted from January 2005 to June 2006 in the Diabetic Clinic of AI-Amiri and Al-Sabah Hospitals in Kuwait City. Apolipoprotein E polymorphism was assessed in 250 subjects of which 83 were ischemic heart disease patients [41 diabetic and 42 non-diabetic] and 105 were diabetic patients without ischemic heart disease. Results were compared with 62 healthy controls. Apolipoprotein E polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism. Apolipoprotein E3 allele was the most commonly occurring form. The frequency of apolipoprotein E4 was higher in ischemic heart disease patients with type 2 diabetes [39%] and the non-diabetic [31%] group, but lower in the diabetic [20%] and control groups [16%]. Apolipoprotein E4 allele may be related to the development of ischemic heart disease in patients with or without type 2 diabetes in Kuwait. However, future studies with larger population sizes are needed to establish such relationship

Inpatients' care experience and satisfaction study

Measures to promote patient satisfaction are important components of the assessment of outcome and strategies for the delivery of health care. In this article, we assess satisfaction among inpatients and the impact of demographics on satisfaction levels. This cross-sectional survey adapted from previously used survey tools and validated in our patient group included questions on demographics, communication skills, hospital environment, and the patients' overall evaluation of the hospital. Inpatients from acute wards of five different specialties who stayed for at least 2 days were enrolled. There were 988 respondents with a mean age of 39.1 years [25.9%] and the mean length of stay [LOS] of 10.0 days [24.1%]. Illiteracy rate was 42.4%, and 43.1% were male. The overall satisfaction scores-out of five-were 4.3 [0.6%] for communication with nurses, 4.4 [0.4%] for communication with doctors, and 4.1 [0.3%] for hospital environment; 98.9% of the patients would recommend the hospital to their family and friends. The lowest score was for the "room environment" [3.99, 0.8%] and the highest for "overall services of the hospital" [4.7, 0.5%]. Satisfaction levels drop significantly with LOS of more than 4 days [P < 0.006]. The satisfaction was higher in females than males across all the three domains of care assessed [P < 0.005]. The highest satisfaction seen in the obstetrics service could be explained by the nature of the condition normally seen in this department and the normally good outcome. There was higher satisfaction in the medical than surgical services but this reached a significant level for the overall center score domain only [4.1, 0.3% versus 4.0, 0.3%; P < 0.0001]. The factors with positive impact on satisfaction were the female gender and shorter LOS. There was higher satisfaction in the medical than surgical services for all three domains reaching significant levels for center score only

End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene

There have been a marked rise in the prevalence and incidence of end stage chronic kidney disease [CKD] in Saudi Arabia over the last 3 decades. This rise exceeds those reported from many countries. The enormous and rapid changes in lifestyle, high population growth, and fast increase in life expectancy, and massive urbanization that has occurred over the last 3 decades combined to make the current CKD status different to what it was. The 2 major factors that influence the CKD status are the very high rate of diabetic nephropathy and shift in age demographics

Trends in infant nutrition in Saudi Arabia: compliance with WHO recommendations

The WHO recommends exclusive breastfeeding in the first 6 months of life. Our objective was to evaluate trends in infant nutrition in Saudi Arabia and the degree of compliance with WHO recommendations. A nationwide nutritional survey of a sample of Saudi households was selected by the multistage probability sampling procedure. A validated questionnaire was administered to mothers of childdren less than 3 years of age. Of 5339 children in the sample, 4889 received breast milk at birth indicating a prevalence of initiattion of 91.6%. Initiation of breastfeeding was delayed beyond 6 hours after birth in 28.1% of the infants. Bottle feeding was introduced by 1 month of age to 2174/4260 [51.4%] and to 3831/4260 [90%] by 6 months of age. The majority of infants 3870/4787 [80.8%] were introduced to 'solid foods' between 4 to 6 months of age and whole milk feedings were given to 40% of children younger than 12 months of age. The current practice of feeding of Saudi infants is very far from compliance with even the most conservative WHO recommendations of exclusive breastfeeding for 4 to 6 months. The high prevalence of breastfeeding initiation at birth indicates the willingness of Saudi mothers to breastfeed. However, early introdduction of complementary feedings reduced the period of exclusive breastfeeding. Research in infant nutrition should be a public health priority to improve the rate of breastfeeding and to minimize other inappropriate practices

Our Experience with posturography in hemiparetic patients after stroke in Kuwait

To study the Berg Balance Scale [BBS] as balance functional impairment of hemiparetic stroke patients after onset of stroke; to quantitatively assess control of balance by computerized dynamic posturography [CDP]; to correlate composite equilibrium score [ES] with sex, side of lesion and stroke type; and to correlate ES with static and dynamic posturography in hemiparetic stroke patients. A retrospective case control study. Outpatient clinic in Physical Medicine and Rehabilitation Hospital, Kuwait. A total of 21 hemiplegic ambulatory stroke patients and 19 age-matched healthy individuals as control group. BBS and CDP. ES and sensory organization test [SOT] 1-6. BBS scores of stroke patients were below the lower limit of the normal control group [p < 0.001]. Significant reduction was observed for composite ES of stroke patients compared to control group. Although no significant difference of static balance function was observed between patients and controls, significant reduction of dynamic balance function [SOT 4, SOT 5, SOT 6] was observed in stroke patients, compared to control group [p < 0.05]. In linear regression correlation [r-] of stroke patients, no significant correlation was observed of ES with static balance function [SOT 1, SOT 2, SOT 3] in hemiparetic stroke patients [p > 0.05]. However, there was a direct significant correlation of ES with dynamic balance function including SOT 4, SOT 5 and SOT 6 [r = -0.71; p < 01], [r = 0.761, p < 0.01] and [r = -0.761, p < 0.05] respectively in hemiparetic stroke patients. Impaired dynamic equilibrium in stroke patients is likely to reflect reduction of muscle strength of the paretic side along with the possible impairment of sensory organization

Immediate and six-month clinical outcome of percutaneous coronary intervention in a tertiary hospital in the Sultanate of Oman

To evaluate the clinical characteristics, angiographic profile, in-hospital and six-month clinical outcome of patients who underwent percutaneous coronary intervention in a tertiary hospital in the Sultanate of Oman. Two hundred and five consecutive patients with both acute coronary syndrome and stable coronary artery disease, who underwent percutaneous coronary intervention between January 2007 and June 2007, were retrospectively analyzed. Follow-up information was obtained from outpatient visits of these patients at six-months. The primary end point in this study was the occurrence of major adverse cardiovascular events [MACE], defined as cardiac death, any myocardial infarction [MI], cerebrovascular accident [CVA] and target vessel revascularization [TVR] with either repeat percutaneous coronary intervention [PCI] or coronary artery bypass surgery [CABG]. Secondary end points included angiographic success rate, procedural success rate, angina status, and the rate of clinical and angiographic restenosis. The angiographic and procedural success rate was 98% and 95% respectively. Fifty-one percent of patients surveyed had single vessel disease, 34% had double vessel disease and triple vessel disease was seen in 15% of patients. Type A lesion was found in 16%, Type B in 55% and Type C in 29% of patients. The majority of patients had single vessel stenting [83%]. The mean +/- SD number of stents per patient was 1.6 +/- 0.9. There were four in-hospital deaths [2%] and six patients [2.9%] had non-ST elevation myocardial infarction before hospital discharge. Out of 205 patients, 53 patients were lost to follow-up. Among the 148 patients followed up, 105 patients [71%] were asymptomatic at follow-up, 36 [24%] patients had stable angina and 7 [5%] had a late myocardial infarction including three patients with stent thrombosis [2%]. Among the 43 patients with angina or late infarction, 28 patients underwent coronary angiogram. Angiographic in-stent restenosis was seen in 14 patients. Of them, 8 patients underwent CABG and 6 patients repeat PCI. Fourteen patients had patent stents. The remaining fifteen patients were on optimal medications including two patients with stent thrombosis as they refused coronary angiogram. Overall, 132 of 148 patients [105 asymptomatic/14 patents tents/13 with angina] [89%] were free from major adverse cardiac events. Considering anginal status and repeat angiograms, composite clinical [15 patients] and angiographic [14 patients] six-month restenosis rate in percutaneous coronary intervention patients [29/148] was 19.5%. Results of percutaneous coronary intervention in our setup is excellent with good immediate results, low complication rate, good six-month clinical outcome and is comparable to international standards

Antibiotic resistance pattern and empirical therapy for urinary tract infections in children

To study the type of bacterial pathogen causing urinary tract infection in children at Aseer Central Hospital, southwestern Saudi Arabia, and their antimicrobial resistance patterns. A retrospective study of all the urine cultures carried out on children in the period from January 2003 to December 2006, for a total of 4 years were reviewed at the bacteriology laboratory, Aseer Central Hospital, southwestern region of Saudi Arabia. Their antimicrobial resistances as well as sensitivities were also analyzed. A total of 464 urine cultures were identified. Escherichia coli constitutes the most common pathogen isolated 37.3%, followed by Klebsiella 16.4% and Pseudomonas species 15.7%. In general, there was a significant increase in the resistance rates of different bacterial pathogens to different antibiotics. In spite of an increase in the resistance rates of bacterial pathogens causing UTI, ceftriaxone, imipenem, and to some extent Azactam are appropriate for initial empirical intravenous therapy in UTI. In patients with uncomplicated UTI not requiring hospitalization, Nalidixic acid, and Nitrofurantoin can be used as oral treatment

Antenatal diagnosis and management of fetal mid-gut volvulus

Fetal volvulus is an uncommon cause of bowel obstruction, which is rarely detected by an antenatal ultrasound scan. We report a case which presented with fetal stomach and small bowels dilatation at 33 weeks of gestation detected by ultrasonography. She was referred to our unit for safe delivery at 34th week of gestation following a spontaneous rupture of membranes and signs of fetal distress. Delivery was accomplished by Cesarean section. Postnatally, the infant was surgically explored with resection of ileum and end to end anastomosis because of bowel gangrene and volvulus. Ultrasound diagnosis during pregnancy with fetal bowels dilatation is an important tool and may lead to early diagnosis and optimal management of intestinal obstruction

Level of health awareness of Saudi patients on renal replacement therapy

To assess health awareness in patients on renal replacement therapy [RRT] in Saudi Arabia. This is a cross-sectional survey using a 22-item questionnaire in 143 randomly selected adult RRT patients [40 on hemodialysis [HD], 61 on peritoneal dialysis [PD] and 42 with renal transplant [TX]]. The study was carried out at King Abdul-Aziz Medical City, Riyadh in April 2006. The questionnaire was designed to evaluate patients' knowledge in 5 areas: 1. causes of renal failure, 2. biology of the kidneys, 3. symptoms of kidney disease, 4. therapeutic options available, 5. national kidney patients support facilities. The association between the level of awareness [the percentage of correct answers] to different demographic factors was assessed. Three fifths of the patients had less than secondary education. The average mark for correct responses of all patients was 45.9% with a highest [58%] for the category on biology of the kidney and lowest [36.8%] for national kidney patients support facilities. The PD group had the highest score [54.4%] followed by HD [44.3%] and finally TX [35.1%]. The level of our patients' health awareness is lower than satisfactory. Level of education seems to be a contributory factor

Noninvasive treatment of benign prostatic hyperplasia. Where do we stand in 2005

Noninvasive treatment of lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH] includes self-management and medical treatment. Self-management should be encouraged as an initial step for all men with uncomplicated LUTS/BPH. It consists of 3 elements, namely: education and reassurance, lifestyle modification of fluid intake and concurrent medical therapy and finally behavioral interventions including management of post-void dribbling and bladder retraining. If self-management fails, medical or surgical interventions are required. Further, research is required to define and test the effectiveness of self-management either as a primary intervention or to augment existing medical therapies. Benign prostatic hyperplasia patients in need of rapid onset of symptom relief and those with small prostates benefit from the use of alpha-blockers. Although 5-alpha-reductase inhibitors [5 ARIs] provide symptomatic benefits, the onsets of these are slower than those observed with the alpha-blockers. Amongst available therapies, only 5 ARIs have been shown to reduce the risk of acute urine retention [AUR] and BPH-related surgery compared to placebo. The Medical Therapy of Prostatic Symptoms [MTOPS] Study provides rational basis for combined alpha-blockers plus 5 ARIs in patients with a high index of disease progression [prostate volume >30 g and prostate-specific antigen >1.6 ng/ml]. Preliminary studies suggest that anticholinergics could be safe in LUTS/BPH and can help to alleviate irritative bladder symptoms due to overactive bladders commonly associated with BPH

Human papillomavirus infection among women attending health facilities in the Kingdom of Bahrain

To investigate the occurrence of human papillomavirus [HPV] infection and the associated risk factors in Bahrain's female population. This study was carried out between March to December 2004, which includes cervical scrapings for Pap smear and HPV-DNA testing using polymerase chain reaction[PCR] and restriction fragment length polymorphism [RFLP] analysis, obtained from 100 women attending the Gynecology Clinic at Salmaniya Medical Center and Sheikh Sabah Health Center in the Kingdom of Bahrain. We distributed questionnaires that include the sociodemographic data as well as information on risk factors such as smoking, parity, and the contraceptive used. Eleven women [11%] with normal cytology were HPV-positive. The RFLP analysis detected HPV-types 16, 18, 45, 62 and 53. Positive women were significantly older [43.3 +/- 10.1 years] than negatives [36.5 +/- 9.9 years; P=0.04], however, there was no difference in age of first sexual contact [positive: 18.1 +/- 5.7 years versus negative: 20.6 +/- 4.4 years]. Polygamy, smoking and hormonal contraception was not identified as risk factors, but positive women showed higher parity. In this study on HPV infection in Bahrain, the 11% positivity with high risk HPV types, in the presence of normal cytology suggests that in addition to the cervical cancer screening program, offer of HPV testing deserves consideration

Proliferative glomerulonephritis and primary antiphospholipid syndrome

Little is known regarding the association of primary antiphospholipid syndrome APLS and proliferative glomerulonephritis GN. We describe a biopsy-documented case with primary APLS and proliferative GN with no evidence of thrombotic microangiopathy TMA, and in the absence of other manifestations of systemic lupus erythematosus SLE. She presented initially with left popliteal deep venous thrombosis and nephrotic syndrome. Her first pregnancy at the age of 26 years resulted in intra-uterine fetal death at term. Two subsequent pregnancies ended up with miscarriages at 3 and 4 months of gestation. Urinalysis revealed glomerular red blood cells of 1.0000.000/ml and granular cast; proteinuria of 13.4 grams/24 hours, which was non-selective; hemoglobin 12 gm/dl, normal white blood cell and platelets; serum albumin 2.6 gm/dl; anti-nuclear antibody ANA and anti DNA were negative and complement levels normal. Lupus anticoagulant was positive leading to a diagnosis of primary APLS. The biopsy findings were consistent with membranoproliferative GN. She continued to have steroid-resistant proteinuria, but stable renal function after a 12-year follow up period. She had 2 pregnancies during this period and was delivered at term using caesarian section. She received heparin during the pregnancies. Later she developed hypertension easily controlled by atenolol. This case provides evidence that primary APLS can be associated with proliferative GN due to immune deposits and not only TMA as previously reported, and in the complete absence of SLE. Performing more renal biopsies in this group of patients may disclose a greater prevalence of proliferative GN and may help in devising a rationale for treatment