Migrated guide wire during femoral vein catheterization

Central venous line catheterization is the main route for therapeutic intervention in critically ill patients. Despite the relatively common complications, the femoral vein is a standard route for catheterization. This is a case report of a rare preventable complication of migration of the guide wire and catheter from the femoral vein through the systemic circulation in a 75-year-old critically ill man in a university hospital in Saudi Arabia

Characteristics of pulmonary tuberculosis and extrapulmonary tuberculosis in immunocompetent adults

Objective: While tuberculosis is primarily considered a pulmonary disease, it has the potential to infect almost every organ via lymphohematogenous dissemination during the initial pulmonary infection. The aim of this study was to explore the importance of demographics, clinical characteristics and the various patterns of extrapulmonary tuberculosis among Saudi and non Saudi patients presenting to King Fahd Hospital of the University, Alkhobar, in the Eastern Province of Saudi Arabia. <br>Methods: Prospective study of all adult patients (13 years of age and above) with tuberculosis over a period of 9 years between 1997 and 2005. <br>Results: A total of 390 cases of tuberculosis were diagnosed during the 9-year period. There were 221 Saudis (57%), and 169 non-Saudis (43%). Pulmonary tuberculosis (PTB) was diagnosed in 132 cases (33 %), extrapulmonary tuberculosis (EPTB) in 244 cases (63%), and both pulmonary and extrapulmonary in 14 cases (4%). The proportion of EPTB was similar among Saudi and non Saudi patients. Constitutional symptoms were more common among PTB than EPTB patients. Lymphadenopathy was the most frequent site of involvement. Of the 244 EPTB patients, 113 (45%) had lymphadenopathy and more than half were located in the cervical region. Osteoarticular tuberculosis noted in 41 patients (17%) was the second most frequent involvement. Pleural, peritoneal, miliary, genitourinary, and central nervous system tuberculosis, each accounted for 2%10% of the total number of cases of EPTB. Co-morbidities were found in 56 patients, 12% from EPTB, and 16% from PTB. Human immunodeficiency virus test results were available for 234 patients; all were found to be seronegative. <br>Conclusion: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. Dealing with EPTB has been hampered by the absence of a quick and accurate diagnostic tool. Because the clinical presentation of EPTB is extremely variable, a high level of suspicion is required to diagnose and treat EPTB in a timely and health-preserving manner.

Assessment of ambient noise levels in the intensive care unit of a university hospital

Noise is recognized as a source of hazard to the patient's environment. Studies have also shown that it has a direct impact on mortality and morbidity as a result of sleep deprivation which affects the immunity of critically ill patients. The aim of this study was to measure levels of environmental noise in a six- bed, open-plan general medical intensive care unit [MICU]. Levels of exposure to environmental noise were assessed in the intensive care unit of King Fahad Hospital of the University [KFHU] where measurements of environmental noise were taken using calibrated sound level meter during shifts of working days and weekends. Statistical analysis revealed that there were no significant differences between noise levels in the morning, evening and night shifts of working days and weekends in the ICU of KFHU [p value =0.155, 0.53 and 0.711] respectively. There was no significant difference between overall level of exposure to noise in the working days and weekends as well [p-value= 0.71]. However, the assessed levels of exposures to noise were still higher than stipulated international standards. Some sources of environmental noise, such as the use of oxygen, suction equipment or respirators are unavoidable. Nevertheless, hospital ICUs should have measures to minimize the level of exposure to noise in the ICU. Further research in this area might focus on the noise level and other modifiable environmental stress factors in the ICU that affect patients as well as the staff

Acute renal failure in an intensive care unit

To determine the clincal course and outcome of acute renal failure in an intensive care unit set-up. All patients admitted to the intensive care until who developed acute renal failure were prospectively studied over a 3-year period from 1996 to 1999, at King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia. They were investigated for the causes of their acute renal failure, given appropriate treatment and their course carefully documented until discharge from the intensive care unit. Forty-seven patients [29 male and 18 female] were studied. The majority were Saudis [81%]. The age range was 28-81 years with a mean of 53 +/- 14 years. Renal causes, 31 cases [66%], were the most frequent causes of acute renal failure. Pre-renal causes occurred in 12 cases [25.5%] and post-renal causes in 4 cases [8.5%]. Three quarters of the causes were medical and one quarter surgical. Septicemia [22 cases], dehydration with hypovolemia [8 cases] and myo/hemoglobinuria [5 cases] were the leading medical causes. Fifteen patients [32%] died in the intensive care unit while 32 were discharged [68%]. Multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus were the major factors that adversely affected mortality. There was a statistically significant difference in the length of intensive care unit stay of the survivors [5.7 +/- 2.6 days] compared to the deceased [11 +/- 5.8 days] [P<0.005]. Renal replacement therapy was performed in 15 patients [10 continuous veno-venous hemodialysis and 5 conventional hemodialysis]. Almost 3 quarters [73%] of the deceased required renal replacement therapy. The development of acute renal failure in the setting of an intensive care unit carried a poor prognosis. Renal causes are responsible for 2 in 3 cases. Septicemia, dehydration/hypovolemia, myo/hemoglobinuria are the leading medical causes while multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus increase mortality. The poor prognosis of patients developing acute renal failure in the intensive care unit can be improved if attention is paid to prevention of septicemia, dehydration, prompt and aggressive treatment of multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus