Adolescents' Usage and Attitude Toward Contact Lenses: A Descriptive Study In Saudi Arabia.

AIMS: The aim of this study was to explore adolescents' (11-20 years) usage of, beliefs in, attitudes toward, and barriers to contact lens use in Riyadh, Saudi Arabia. METHOD: The study recruited 1252 healthy participants from 20 highly populated schools. The schools were selected at random from middle and high schools in Riyadh. A self-administered contact lens questionnaire was used directed towards glasses usage and contact lens knowledge, usage, attitudes, and barriers. RESULT: A total of 726 of the 1252 participants had refractive errors, and 47% of those wore glasses. The proportion of non-compliance was 24%. One of the main reasons of non-compliance was cosmetic appearance (26%). Fewer than 10% were offered contact lenses for refractive error correction. One hundred and fifty-nine participants used contact lenses, and most obtained them without proper professional consultation. About 90% of contact lens-wearing participants did not sleep with the lenses and about 50% had no complications wearing them. CONCLUSION: The percentage of contact lens users was relatively low. A substantial number of older adolescents and females were found to wear contact lenses, although without proper professional consultation. Knowledge of and attitudes toward contact lenses among adolescents were in acceptable levels. These results gave indications that contact lens usage in adolescents can be achievable and valuable for refractive error correction, especially for those who are non-compliant with glasses.

The Saudi Clinical Practice Guideline for the treatment of venous thromboembolism: outpatient versus inpatient management

Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Prospective study of rabbit antithymocyte globulin and cyclosporine for aplastic anemia from the EBMT Severe Aplastic Anaemia Working Party.

Rabbit antithymocyte globulin (rATG; thymoglobulin, Genzyme) in combination with cyclosporine, as first-line immunosuppressive therapy, was evaluated prospectively in a multicenter, European, phase 2 pilot study, in 35 patients with aplastic anemia. Results were compared with 105 age- and disease severity-matched patients from the European Blood and Marrow Transplant registry, treated with horse ATG (hATG; lymphoglobulin) and cyclosporine. The primary end point was response at 6 months. At 3 months, no patients had achieved a complete response to rATG. Partial response occurred in 11 (34%). At 6 months, complete response rate was 3% and partial response rate 37%. There were 10 deaths after rATG (28.5%) and 1 after subsequent HSCT. Infections were the main cause of death in 9 of 10 patients. The best response rate was 60% for rATG and 67% for hATG. For rATG, overall survival at 2 years was 68%, compared with 86% for hATG (P = .009). Transplant-free survival was 52% for rATG and 76% for hATG (P = .002). On multivariate analysis, rATG (hazard ratio = 3.9, P = .003) and age more than 37 years (hazard ratio = 4.7, P = .0008) were independent adverse risk factors for survival. This study was registered at www.clinicaltrials.gov as NCT00471848.

The distribution of peripheral arterial disease in a defined population of elderly high-risk Saudi patients.

OBJECTIVES: To find out the prevalence rate of peripheral arterial disease (PAD) in a defined population of high risk Saudi patients aged 50-80 years, using simple measuring techniques. DESIGN: A hospital-based cross-sectional study using a simple protocol. MATERIALS AND METHODS: Four groups of patients were studied: three high risk groups (214 cases of diabetes (DS), 60 of chronic renal failure (CRF), 78 of ischaemic heart disease (IHD) and 50 controls. PAD was only diagnosed if the ankle-brachial index (ABI) was < or =0.9. The contribution of a history of intermittent claudication (IC) and palpation of pulses to the diagnosis was assessed. RESULTS: A total of 402 patients was studied. Their mean age was 59.31+/-8.1 (range 50-80). There were 257 males (63.9%) and 145 females (36.1%). 171 cases of PAD were detected (42.5%) and distributed among the various groups: 105 (61.4%) in the DM, 23 (13.4%) in the CRF, 36 (21.4%) in the IHD and 7 (4.1%) in the control groups. The prevalence rate was highly significant in each of the 3 high risk groups compared to the control group; however, there was no statistically significant difference in the incidence of PAD between the high risk groups. Questionnaires for IC and palpation of peripheral pulses were of very limited validity in diagnosing PAD. Overall, DM headed the list of significant risk factors followed by smoking and greater age. CONCLUSIONS: In contrast to the general impression that PAD is an uncommon disease, we found a significant prevalence rate of PAD in elderly high risk patients. Screening for PAD in aged diabetics, IHD and CRF patients is a simple and cost-effective approach.

Screening for abdominal aortic aneurysm in the Jeddah area, western Saudi Arabia.

Atherosclerosis and its complications are associated with high morbidity and mortality in the elderly. One of these complications is abdominal aortic aneurysm which may be prevented from rupturing if diagnosed early. Screening for aortic aneurysm was carried out in Jeddah, which is in the western region of Saudi Arabia, to identify the magnitude of this problem. Three groups were studied: patients with hypertension (n = 101), patients with peripheral vascular disease (n = 71) and a third group of a controls (n = 220). The mean (range) age of the whole sample was 66.0 (60-80) years. Evidence of aortic aneurysm was found in seven participants: five in the peripheral vascular disease group (7.0%), one in the hypertensive group (1.0%) and one in the controls (0.5%). In view of the expected increase in the elderly population of Saudi Arabia, as a result of improvements in health care which have recently been achieved, it is expected that a similar increase in the incidence of abdominal aortic aneurysm may occur. Routine screening for abdominal aortic aneurysm in the elderly, especially in those with peripheral vascular disease, may be worthwhile.

Bird's nest inferior vena caval filter migration into the duodenum: a rare cause of upper gastrointestinal bleeding.

PURPOSE: To report the first case of a potentially catastrophic complication of vena caval interruption with a bird's nest filter. METHODS AND RESULTS: A 55-year-old Saudi patient presented with hypovolemic shock from massive upper gastrointestinal hemorrhage. Endoscopy identified a metallic object penetrating the duodenum. Five years earlier, the patient had a bird's nest vena caval filter inserted for recurrent pulmonary embolism. During emergent laparotomy, a broken filter wire was found projecting into the duodenum, where it had induced three profusely bleeding ulcers. The wire was transected and the ulcers oversewn. A hook projecting from the inferior vena cava (IVC) was also cut flush with the vessel wall, but the IVC was not opened nor the filter replaced. The patient's postoperative course was complicated by deep venous thrombosis, but he recovered and is asymptomatic on warfarin anticoagulation after 1 year. Computed tomography (CT) at 1-year follow-up confirmed no further migration of the filter. CONCLUSION: This event reinforces the need to monitor patients with IVC filters over the long term, preferably using CT scanning, and to consider filter migration as a possible cause of upper gastrointestinal bleeding.

Popliteal vein aneurysm.

The successful management of a popliteal vein aneurysm in a 25-year-old Saudi man is described. An extensive review of the English literature revealed another 11 similar cases.

Iatrogenic vascular injuries in western Saudi Arabia.

A group of 30 consecutive patients with iatrogenic vascular injury were studied to determine the aetiology of the condition and to investigate its possible prevention. Of the patients, 18 were males and 12 females; mean age was 37.0 years (range 2 weeks to 70 years). Most injuries (n = 25) involved the arterial system; eight cases (27%) were recognized during the operative procedure. The most common presentations were bleeding and chronic ischaemia. Cannulation of vessels was the cause of injury in 14 cases (47%); two-thirds of these were iatrogenic in nature. A conservative policy was adopted in nine patients; surgery was planned but not performed in two. A total of 19 patients were operated on (17 reconstructions, one ligation, one fasciotomy); two died from causes related to their original condition. In order to reduce the incidence of iatrogenic injury, medical personnel should be informed of possible vessel damage, especially during cannulation. All surgical and radiological procedures should be carefully audited.

Arteritis: experience in Jeddah, Saudi Arabia.

Inflammation of the arteries is a difficult condition to diagnose and treat. Eighteen consecutive patients (16 men, two women) with arteritis treated in the vascular surgery department of King Fahad Hospital, Jeddah, Saudi Arabia, over a period of 3 years were reviewed to define the local pattern of the disease. The mean age of the group was 29.2 (range 18-50) years. Buerger's disease was diagnosed in 11 patients and considered to be the most common type of arteritis. Other types of arteritis identified were: non-specific (four patients), infective (one), irradiation (one) and vasculitis secondary to scleroderma (one). The most common finding was severe lower-limb ischaemia from infrapopliteal occlusion. Arteriography carried out in 16 patients showed either occlusion or stenosis of the affected artery. In one patient an associated renal aneurysm was detected. All patients were advised to stop smoking and unilateral or bilateral lumbar sympathectomy undertaken in those with Buerger's disease. By adopting this policy limb salvage was achieved in nine of the 11 patients with Buerger's disease. In addition to these measures, corticosteroids were prescribed for selected cases of arteritis.

False aneurysm of the abdominal aorta after blunt trauma.

Injuries of the abdominal aorta due to blunt trauma are rare. So far, 33 cases have been reported in the English literature and false aneurysm formation after such injuries is even rarer. In this article, a case of false aneurysm of the abdominal aorta after blunt trauma in an acrobat which was successfully managed is reported, and the English literature for similar cases reviewed.