Evaluation of Clinical Preventive Management Provided by Primary Healthcare Physicians Against Brucellosis in Saudi Arabia.

BACKGROUND:  Brucellosis is among the most common zoonotic bacterial infections, leading to major public health consequences in endemic areas such as Saudi Arabia. Primary healthcare is crucial in controlling brucellosis, as it serves as the frontline for disease prevention, early detection, and appropriate management. However, enhancing the contribution of primary healthcare to the entire brucellosis notification process is necessary to minimize the underreporting and inadequate data collection, which hinders the implementation of effective control measures. OBJECTIVE: The objective of the study is to assess primary care physicians' knowledge and practice of clinical preventive management in Saudi Arabia regarding brucellosis using an adapted assessment tool featuring a semi-structured questionnaire. SUBJECTS AND METHODS: The current study's design is a cross-sectional study based on a questionnaire. Three hundred and seventy-three primary healthcare physicians in Saudi Arabia were chosen for self-administered online standardized questionnaires. RESULTS:  One-third of the participants answered all the knowledge assessment questions correctly. Most participants had more than 10 years of professional experience and were 40 or older. In response to the practice assessment questions, 210 physicians stated that they had encountered at least one case of brucellosis, and two-thirds had no compliance with the notification process of their cases. CONCLUSION: The limited knowledge and improper practice of primary care physicians regarding human brucellosis are possible underlying reasons for the underdiagnosis and underreporting of brucellosis patients at primary health care clinics in Saudi Arabia. Most research indicates that implementing specific educational programs to improve knowledge is necessary for primary healthcare workers. Furthermore, enhancing the community interaction between healthcare centers and the community facilitates effective control measures against brucellosis.

Retraction: A Giant Porencephaly: A Rare Etiology of Pediatric Seizures.

[This retracts the article DOI: 10.7759/cureus.19623.].

Postnatal Calyceal-to-Parenchymal Ratio: A Promising Predictor for Surgical Correction of Ureteropelvic Junction Obstruction in Newborns.

OBJECTIVE: This study aims to explore a new parameter, the calyceal-to-parenchymal ratio (CPR) of postnatal renal ultrasonography (RUS) as a predictor of surgery in newborns with possible ureteropelvic junction obstruction (UPJO). Although UPJO remains the main surgical category of antenatally detected hydronephrosis, there is a lack of a gold-standard test that predicts the need for pyeloplasty. SUBJECTS AND METHODS: We retrospectively reviewed infants with a positive antenatal history of hydronephrosis who were confirmed to have grade 3 or 4 hydronephrosis on postnatal RUS between 2010 and 2020. We compared postnatal CPR between surgical and control groups and tested the correlation between postnatal CPR and diuretic renogram. RESULTS: A total of 79 and 136 kidneys were included in the surgical and control groups, respectively. Kidneys that were managed with pyeloplasty between January 2010 and July 2020 were included in the surgical group, while kidneys from patients with comparable traits who were managed conservatively comprised the control group. At a mean age of 18.9 weeks at presentation and a mean follow-up period of 48.99 months, the median postnatal CPR was significantly greater in the surgical group (3.62 vs. 0.98, p<0.001). A postnatal CPR of 1.68 had a sensitivity and specificity of 96.2% and 84.8%, respectively, in predicting the need for future pyeloplasty (area under the curve (AUC)=0.966). There was a positive and significant correlation between postnatal CPR and the half-life of the renogram (p=0.018) but not significant with the differential function (p=0.090). CONCLUSION: Diuretic renography has little capability for predicting future pyeloplasty. Current RUS grading systems do not offer an objective measure of renal parenchyma. Numerous other RUS parameters are less frequently utilized in clinical practice, and many are challenging to assess and require sophisticated software or equipment. Postnatal CPR is a promising tool for predicting the need for pyeloplasty in newborns with UPJO. Further prospective studies are needed to standardize and assess the reproducibility of this parameter.

Optimization of a near-zero-emission energy system for the production of desalinated water and cooling using waste energy of fuel cells.

In the present study, a biomass-based multi-purpose energy system that can generate power, desalinated water, hydrogen, and ammonia is presented. The gasification cycle, gas turbine, Rankine cycle, PEM electrolyzer, ammonia production cycle using the Haber-Bosch process, and MSF water desalination cycle are the primary subsystems of this power plant. On the suggested system, a thorough thermodynamic and thermoeconomic evaluation has been conducted. For the analysis, the system is first modeled and investigated from an energy point of view, after which it is similarly studied from an exergy point of view before the system is subjected to economic analysis (exergoeconomic analysis). The system is evaluated and modeled using artificial intelligence to aid in the system optimization process after energy, exergy, and economic modeling and analysis. The resulting model is then optimized using a genetic algorithm to maximize system efficiency and reduce system expenses. EES software does the first analysis. After that, it sends the data to MATLAB program for optimization and to see how operational factors affect thermodynamic performance and overall cost rate. To find the best solution with the maximum energy efficiency and lowest total cost, multi-objective optimization is used. In order to shorten computation time and speed up optimization, the artificial neural network acts as a middleman in the process. In order to identify the energy system's optimal point, the link between the objective function and the choice factors has been examined. The results show that increasing the flow of biomass enhances efficiency, output, and cost while raising the temperature of the gas turbine's input decreases cost while simultaneously boosting efficiency. Additionally, according to the system's optimization results, the power plant's cost and energy efficiency are 37% and 0.3950$/s, respectively, at the ideal point. The cycle's output is estimated at 18900 kW at this stage.

Relationship Between Vesicoureteric Reflux and Nephrocalcinosis in Children: A Case-Control Study at a Tertiary Medical Center in Saudi Arabia.

BACKGROUND:  Vesicoureteral reflux (VUR), one of the most common pediatric congenital urogenital abnormalities, refers to the abnormal backflow of urine from the urinary bladder back into the ureter or to the kidney. This causes urinary tract infections. Nephrocalcinosis (NC) refers to abnormal deposits of calcium within the renal parenchyma and/or in the renal cortex. Patients with NC are mostly asymptomatic and severe disease may progress to renal failure. Early diagnosis through examinations such as radiography, computed tomography, and ultrasonography, is crucial for therapeutic treatment. Ultrasonography is the preferred method for scanning and grading nephrocalcinosis in children, primarily because it emits no radiation. This study aimed to increase the body of knowledge regarding VUR and nephrocalcinosis by determining its prevalence and assessing the relationship between VUR and nephrocalcinosis in children presenting at our institution. ​​​​Methods:A case-control study was conducted using data from the medical records of 632 children younger than 14 years in a tertiary medical center in Riyadh, Saudi Arabia. Eligible participants were assigned to two groups: Group 1 consisted of 316 patients with VUR, while Group 2 consisted of 316 sex- and age-matched patients without VUR. The difference in the prevalence of nephrocalcinosis between the two groups was assessed. Frequency and percentage were used to present the categorical variables; Pearson product-moment correlation was utilized to establish the association between VUR and nephrocalcinosis. Statistical significance was established at p<0.05. ​​​​​Result: Only two cases in Group 1 were positive for nephrocalcinosis (0.63%, one male and one female), while four cases in Group 2 were positive for the condition (1.26%, two males and two females). There was no significant difference in the incidence of nephrocalcinosis between the two groups (p=0.873), indicating no relationship between VUR and nephrocalcinosis in children. CONCLUSION: There is no relationship between VUR and nephrocalcinosis in children under the age of 14 years.

A Giant Porencephaly: A Rare Etiology of Pediatric Seizures.

Pediatric convulsive seizure is common and represents a source of major concern and anxiety for the parents. Seizures can have a broad spectrum of etiologies in children, including metabolic, traumatic, developmental, and infectious causes. Depending on the clinical presentation, laboratory testing and neuroimaging may be indicated in the workup of the first unprovoked afebrile seizure. We present a case of a six-year-old boy who was brought to the emergency department by his mother after an episode of convulsion. She reported that he had jerky repetitive movements of all extremities that lasted around two minutes with spontaneous termination. The child did not have a febrile illness. The mother reported no history of similar episodes. Upon examination, the child appeared alert and conscious. No dysmorphic features were evident. Initial laboratory investigations were within the normal limits. The child underwent magnetic resonance imaging for the brain, which demonstrated a large well-defined extra-axial cystic lesion occupying most of the left hemisphere that is connected to the ventricular system. The lesion had no grey-matter lining and it strictly followed the cerebrospinal fluid in all sequences. Such finding represented the diagnosis of a giant left porencephalic cyst. Porencephaly is an extremely rare neurological anomaly that may present with pediatric seizures. Magnetic resonance imaging is the gold standard modality for the diagnosis of porencephaly. The case demonstrated that porencephaly can have a massive size in a patient with normal psychoneurological development.

Prevalence and morphological variations of maxillary sinus septa in different age groups: a CBCT analysis.

BACKGROUND: There are limited data from Saudi Arabia on the prevalence and characteristics of maxillary sinus septa. OBJECTIVE: Determine the prevalence and morphological characteristics of septa in the maxillary sinus and their relationship to gender and age using cone beam computed tomography (CBCT). DESIGN: Cross-sectional SETTING: CBCT images acquired from the maxillofacial radiology department in a dental school. PATIENT AND METHODS: CBCT scans of 1010 maxillary sinuses from 505 patients were analyzed to determine the prevalence, location, type, and orientation of maxillary sinus septa. Descriptive statistics, chi-square tests and t tests were used to analyze the data. MAIN OUTCOME MEASURES: The prevalence, location, type, and orientation of maxillary sinus septa. SAMPLE SIZE: 1010 sinuses from 505 patients. RESULT: Approximately 46% of the studied patients had maxillary septa, which were present in 370 (37%) sinuses. About 64% of the septa were present on the right side and 85.7% of all septa were mediolater-ally oriented. The mean height of the septa was 6.06 mm (0.84) in the right sinuses and 5.70 mm (0.93) in the left sinuses. Multiple septa were found in 101 patients (20%). Among males, 58.5% had septa compared to 34% of females (P<.001.) A significant positive association was found between age and the presence and number of septa, P<.001. CONCLUSIONS: Maxillary sinus septa were highly prevalent with various heights and directions among the studied sample. Careful assessment of different anatomic variation must be conducted prior to any maxillary sinus augmentation, particularly in older patients. LIMITATIONS: Cross-sectional evaluation of CBCT images from one dental school patient population; thus, the findings cannot be generalized to other populations. CONFLICT OF INTEREST: None.

Translation and validation of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) version 4 quality of life instrument into Arabic language.

BACKGROUND: Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) has been translated from English into several languages. Currently, there is no validated translation of FACT-BMT in Arabic. Here, we are reporting the first Arabic translation and validation of the FACT-BMT. METHODS: The study was approved by the Institutional Research Advisory Council. The Arabic translation followed the standard Functional Assessment of Chronic Illness Therapy (FACIT.org) translation methodology (with permission). Arabic FACT-BMT (50- items) was statistically validated. Cronbach's alpha for internal consistency, Spearman's rank correlation coefficients method for Inter-scale correlations and Principal Component Analysis for factorial construct validity was used. RESULTS: One hundred and eight consecutive relapsed /refractory lymphoma patients who underwent high dose chemotherapy and autologous stem cell transplant were enrolled. There were 68 males (63%) and 40 females (37%) with a median age of 29 years (range 14-62). After Arabic questionnaire pre-testing (Cronbach's alpha 0.744), the study included 108 patients. Cronbach's alpha for the entire FACT-BMT indicated an excellent internal consistency (0.90); range (0.67 to 0.91). Cronbach's alpha for sub-groups of social (0.78), emotional (0.67) and functional wellbeing was (0.88). Cronbach's alpha for bone marrow transplant (0.81), FACT-General (0.89), and FACT- Trial Outcome Index (TOI); (0.91) also revealed excellent internal consistency. Patients had high scores in all domains of quality of life, indicating that most patients were leading a normal life. This translation of FACT-BMT in Arabic was reviewed and approved for submission by the FACIT.org. CONCLUSIONS: Our data reports the first translated, validated and approved Arabic version of FACT-BMT. This will help large numbers of Arabic speaking patients undergoing stem cell/bone marrow transplantation, across the globe.

Paraganglioma of Urinary Bladder Managed by Laparoscopic Partial Cystectomy in Conjunction with Flexible Cystoscopy: A Case Report.

Background: Paraganglioma of the urinary bladder (PUB) is exceedingly rare, accounting for <0.1% of all urinary bladder tumors. Various challenging treatment options are available. Case Presentation: A 67-year-old female presented with malignant hypertension on four medications for which investigation was done. An observation of having functioning PUB was noted. She was admitted and laparoscopic partial cystectomy was done with the guidance of flexible cystoscopy. She had a smooth postoperative course and was discharged home, then catheter was removed after cystogram. Histopathology confirmed the diagnosis of a bladder paraganglioma. Finally, during the last follow-up, the patient was asymptomatic with controlled blood pressure and normalized catecholamine levels with no evidence of recurrence. Conclusion: PUB is an exceedingly rare tumor that can be managed with minimally invasive techniques such as laparoscopic partial cystectomy with cystoscopy guidance.

Four successful pregnancies in a patient with Fontan palliation and congenital heart disease: a case report.

BACKGROUND: Fontan is a palliative procedure in patients with single ventricle. Single ventricle supports systemic cardiac output and pulmonary blood flow is passively directed to the right pulmonary artery. Women with Fontan palliation are reported to have increased maternal risk during pregnancy. There are few reports of successful pregnancies in such cases. However data on these pregnancies is lacking, we consider this to be the first reported from kingdom of Saudi Arabia. CASE PRESENTATION: We present a 35-year-old woman from the Kingdom of Saudi Arabia who had Fontan surgery and who had four successful pregnancies and multiple miscarriages. She delivered live, low birth weight neonates. CONCLUSION: This report provides an anecdotal evidence that pregnancy can be tolerated in an adequate Fontan patient with successful outcomes.

The CRASH report: emergency management dilemmas facing acute physicians in patients with pulmonary arterial hypertension.

Treatment of acute emergencies in patients with pulmonary arterial hypertension (PAH) can be challenging. In the UK and Ireland, management of adult patients with PAH is centred in eight nationally designated pulmonary hypertension (PH) centres. However, many patients live far from these centres and physicians in local hospitals are often required to manage PAH emergencies. A committee of physicians from nationally designated PH centres identified the 'most common' emergency clinical scenarios encountered in patients with PAH. Thereafter, a review of the literature was performed centred on these specified topics and a management approach was developed based on best available evidence and expert consensus. Management protocols were developed on the following PAH emergencies: chest pain (including myocardial ischaemia), right ventricular failure, arrhythmias, sepsis, haemoptysis ('CRASH'), as well as considerations relevant to surgery, anaesthesia and pregnancy. Emergencies are not uncommon in PAH. While expertise in PAH management is essential, all physicians involved in acute care should be aware of the principles of acute management of PAH emergencies. A multidisciplinary approach is necessary, with physicians from tertiary PH centres supporting care locally and planning safe transfer of patients to PH centres when appropriate.

Glioblastoma treatment in the elderly in the temozolomide therapy era.

BACKGROUND: optimal treatment of glioblastoma (gBM) in the elderly remains unclear. the impact of age on treatment planning, toxicity, and efficacy at a Canadian Cancer Centre was retrospectively reviewed. METHODS: glioblastoma patients treated consecutively between 2004 and 2008 were reviewed. utilizing 70 years as the threshold for definition of an elderly patient, treatments and outcome were compared in younger and elderly populations. RESULTS: four hundred and twenty one patients were included in this analysis and median overall survival (oS) for the entire cohort was 9.8 months. 290 patients were aged <70 (median age 57, range 17- 69) and 131 were aged ≥ 70 (median age 76, range 70-93). patients ≥ 70 were more likely to receive best supportive care (BSC) and all patients >70 who were treated with radiotherapy received <60 gy (P<0.001), except one. patients aged >70 demonstrated inferior survival (one year oS 16% versus 54% for those <70, hr 3.46, P<0.001). in patients treated with BSC only, age had no impact on survival (median survival two months in both groups, hr 0.89, P=0.75). for those treated with higher doses of radiotherapy (>30 gy to <60 gy), one year survival was 19% versus 24% in patients aged >70 versus <70 (hr 1.47, P=0.02) respectively. CONCLUSION: in this retrospective single institution series, elderly patients were more likely to be treated with BSC or palliative doses of radiotherapy. randomized phase iii study results are required for guidance in treatment of this population of patients.

Glioblastoma management in the temozolomide era: have we improved outcome?

Temozolomide (TMZ) during and after radiotherapy (RT) is recommended for patients with newly diagnosed glioblastoma (GBM). We analyzed the adoption of this new standard of care for GBM in an academic cancer centre in Canada and assessed its impact on survival. GBM patients registered with Cancer Care Ontario between 2004 and 2008 were identified. Those ≥ 16 years age, newly diagnosed, treated at our institution, had confirmed pathology and complete records were included. Demographics, treatments, toxicity and outcome were captured. For survival analysis patients were stratified by age, ECOG, and treatment modalities including total cycles of TMZ. Descriptive statistics were used for early progressors and long term survivors. Kaplan-Meier curves, log-rank test and Cox proportional hazards model were used for survival analyses. At a median follow-up of 28 months, we compared our outcome to updated EORTC-NCIC CE 3 results. Of 517 patients 433 were included for analysis. Majority were male (63 %), ECOG 0-1 (66 %), and ≤ 65 years (55 %). 44 % received CRT followed by TMZ, 13 % had CRT only, 30 % had RT only and 13 % had best supportive care. 10 % were early progressors and 9 % survived beyond 2 years. Comparison of our results to NCIC CTG CE.3 study data showed median survival was 15.8 versus 14.6 months, 2 year survival rate for CRT plus TMZ was 35 versus 26 %, and for RT alone 0 versus 10 %, respectively. <50 % of GBM patients complete CRT with TMZ in the real-world setting. Prognosis for most patients with GBM remains dismal particularly if they are not suitable for RT and CRT.

A novel technique of stenting for laparoscopic pyeloplasty in children.

PURPOSE: We introduce the novel technique of a percutaneous pyelo-ureterostomy stent for laparoscopic pyeloplasty in children, which overcomes the limitations of previously described stenting techniques. MATERIALS AND METHODS: A Chiba needle is passed percutaneously across the anterior wall of the renal pelvis after completion of the anterior pyelo-ureteric anastamotic line. A guide wire is inserted through the trocar followed by an angiocatheter over the wire. The stent is passed through the angiocatheter, over the wire and across the wall of the renal pelvis. The wire is withdrawn and the stent distal tip is advanced to the mid-ureter. The posterior anastamotic line is then completed and the renal pelvis closed. The stent is capped on postoperative day 1 and removed in the office on postoperative day 10. RESULTS: Since 2007 we have used this approach for 14 laparoscopic pyeloplasties (5 right, 9 left) in children with a mean age of 8.8 years (range 5-17). Mean time of insertion was 9:55 min with no difficulties or perioperative complications noted. CONCLUSION: The antegrade pyelo-ureteral stent is easily and quickly inserted percutaneously as well as removed in the office, thus obviating the need for a second anesthetic.

Peripheral dentinogenic ghost cell tumor: report of a case and literature review.

Peripheral dentinogenic ghost cell tumor is a rare tumor with only 24 cases previously described in the English literature. The majority of cases have been reported to occur in the anterior part of the jaws. A case occurring in posterior (molar region) of the mandible in a 75-year-old edentulous woman is reported. The patient presented with a nodular swelling in the left mandible that showed erosion (saucerization) of the underlying bone radiographically. On microscopy, the tumor showed mainly solid epithelial islands resembling ameloblastoma in fibrous connective tissue. The islands were associated with ghost cells and dysplastic dentin. This report includes the clinical, radiographic, and microscopic features of the patient, in addition to the review of the English literature on the tumor.

Post-augmentation bladder perforation during urodynamic investigation.

AIMS: To report for the first time bladder rupture during filling cystometry many years after bladder augmentation. METHODS: A 17-year-old girl with T10 meningomyelocele had received an ileocystoplasty, continent catheterizable stoma, and bladder neck sling for neurogenic bladder dysfunction and intractable incontinence 8 years previously. She was continent with clean intermittent self-catheterization four times per day. Yearly urodynamics showed a bladder capacity of up to 700 ml with good compliance and low bladder pressures. In March 2006, filling cystometry was performed. RESULTS: Bladder pressure was normal until 400 ml, after which it increased due to lower compliance. At 620 ml filling, the detrusor pressure was 52 cm H2O, and the patient complained suddenly of abdominal discomfort and bilateral shoulder pain, and the infusion was stopped. A catheter was placed and cystography showed intraperitoneal leakage along the left lateral bladder aspect and at the Mitrofanoff insertion site on the bladder dome. The perforations were closed via a midline incision and a ventriculoperitoneal shunt had to be exteriorized. There were no post-operative complications and a control cystogram revealed no leakage. CONCLUSIONS: Augmentation ileocystoplasty has been used extensively in order to increase bladder capacity and decrease intravesical pressure. Although spontaneous or traumatic perforation of the augmented bladder has been described previously, it was never reported in correlation with urodynamic investigation. Extreme caution is warranted in the face of decreased compliance during filling cystometry in these patients, even though urodynamics showed good bladder compliance and low bladder pressures many years after ileocystoplasty.

Bartholin's gland abscess in a neonate: a case report.

Bartholin's gland abscesses are extremely rare in prepubertal girls. A literature search revealed that only 3 cases have been reported in infancy and that 1 case has been reported in a neonate. We report the second case of a Bartholin's gland abscess in a female neonate.

Multiple spinal ring-enhancing schwannomas.

We present a case of intradural multiple ring-enhancing lesions in a 20-year-old male with symptoms and signs of progressive spastic paraparesis. An MRI of the thoracolumbar area showed 2 peculiar ring-enhancing lesions, at the level of T12 and L1. The differential diagnosis includes inflammatory or infectious lesions in addition to rare cystic tumors. The patient underwent surgical resection of the 2 lesions with an uneventful perioperative course. Histologically, the diagnosis was consistent with cystic schwannomas.