Comparative efficacy of digital panoramic radiograph and cone beam computed tomography in locating mandibular foramen.

OBJECTIVE: The aim of this study was to compare the accuracy of panoramic radiographs (PAN) with cone-beam computed tomography (CBCT) in locating the position of the mandibular foramen (MF). PATIENTS AND METHODS: A total of 100 patients who underwent CBCT and panoramic imaging were included in the study. The location of the MF was evaluated anterior-posteriorly and superior-inferiorly on both CBCT and panoramic radiographs. Measurements were taken by two examiners, reviewed by a radiologist, and intra-examiner variability was assessed. A comparison of statistical analysis was performed using the Mann-Whitney U test, independent and paired t-test. A p-value ≤0.05 was deemed significant. RESULTS: The mean age of the patients was 35.03 years, with 51% females and 49% males. CBCT and panoramic radiographs showed comparable accuracy in locating the left (p=0.937) and right (p=0.371) MF anterior-posteriorly. In the superior-inferior dimension, the accuracy of CBCT and panoramic radiographs were comparable in locating the right (p=0.292) and left (p=0.640) MF. The gender-based accuracy of PAN and CBCT radiographs in locating the right (p=0.353) and left (p=0.985) MF was comparable. CONCLUSIONS: The study concludes that panoramic radiographs showed comparable accuracy in effectively locating MF in comparison to CBCT. The influence of gender and anatomic location (right and left sides of MF) on MF identification with panoramic radiographs was insignificant. Digital panoramic radiographs are an effective tool in accurately identifying MF location in clinical practice.

Streptococcus anginosus group infections: Management and outcome at a tertiary care hospital.

BACKGROUND: Data on patients with invasive Streptococcus anginosus group (SAG) infections is limited, as it's been considered commensal bacteria in the human microbiota. We conducted an analysis of SAG infections to assist clinicians in understanding their burden and clinical outcomes. METHODS: A retrospective study of medical records, identifying invasive SAG bacteria of sterile-site isolates that were managed from May 2015 to April 2017, at a tertiary care hospital in Riyadh, Saudi Arabia. Demographic data, clinical presentation, site of infection, antibiotic use, and outcome were recorded and analyzed to identify factors associated with poor outcome and/or polymicrobial growth. RESULTS: We identified 105 cases of SAG infections in adults, with 52% of the patients being male and the mean age of 52.4 years with comorbidities occurring in more than half of the cases such as diabetes (38%) and malignancy (15%). Overall mortality was 6%, and it was statistically associated with age older than 65 years, polymicrobial growth and a history of malignancy. The infection frequencies were skin and soft tissue infections (SSTI; 55%), intra-abdominal infections (24%), bacteremia (14%), genitourinary infections (8.5%), and pleuropulmonary infections (5%). Abscesses accounted for 68% of cases. Polymicrobial infection (46%) with Enterobacteriaceae and Gram-negative anaerobes coincided with SAG infection. Polymicrobial growth was significantly associated with abscess formation, intra-abdominal source of infections, and poor outcome. In addition, death in patients with SAG was statistically associated with patients older than 65 years of age and those with history of cancer or transplant. CONCLUSION: SSTIs and intra-abdominal infections are the most common clinical presentations in our cohort. Bacteremia was uncommon; however, the prognosis is less favorable. Overall susceptibility to penicillin was 91%, therefore ß-lactam antibiotics are the drug of choice and additional coverage for anaerobic and gram-negative bacteria should be considered for intra-abdominal collection and solid or organ abscesses.

Prevalence of hepatitis C antibodies among hemodialysis patients in the Western province of saudi arabia.

We studied 408 patients on maintenance hemodialysis at four different centers in the Western province of Saudi Arabia to assess the prevalence of antibody against Hepatitis C Virus (HCV) and the possible risk factors. There were 212 males and 196 females with a mean age of 42.9 +/- 13.9 years (range 12 to 75 years). They were on dialysis for a period between 3 to 140 months with a mean of 52.2 + 38 months. Assay for anti-HCV was made by second generation ELISA. A total of 295 patients (72.3%) tested positive. The prevalence rates varied considerably among the four centers studied and were as follows: the center at Jeddah, 62.7%; two centers at Makkah, 87% and 79.7% respectively and one center at Taif, 80.9%. A total of 311 patients had received varying number of blood transfusions. Of these, 230 (74%) were anti-HCV positive as against 97 patients who were never transfused of whom 65 (67%) were positive. This difference did not reach statistical significance (P = 0.22). Similarly, we found no significant correlation between the anti-HCV prevalence rates and serum alanine transaminase levels (P = 0.93). Our study further confirms that there are routes other than blood transfusion involved in the transmission of the HCV and there is a need to determine these routes in order to prevent the spread of this virus.

High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies.

Non-A, non-B is a major form of hepatitis in haemodialysis (HD) patients. Hepatitis C virus (HCV) has been recently identified as the leading cause of non-A, non-B hepatitis in HD. A variable prevalence of hepatitis in HD has appeared in the literature, ranging between 1% and 29% in the Western world, and between 30% and 54% in Saudi Arabia, but all these reports used first-generation ELISA. Using second-generation enzyme immunoassay, we conducted a multi-centre study involving 22 HD centres all over Saudi Arabia in order to establish the prevalence and risk factors for HCV in HD patients in Saudi Arabia. A total of 1147 patients were studied, with a mean age of 43.4 +/- 15.3 years. Five hundred and eighty were males and 567 were females. The overall prevalence rate of positive anti-HCV was 68%, with a range from as low as 14.5%, to 94.7%. To our knowledge, this is the highest value reported among dialysis patients world-wide. A positive correlation was found between anti-HCV positivity and male sex (P = 0.005), longer duration on dialysis (P = 0.002) and blood transfusion (P = 0.003). However, interestingly 62.6% of the patients who had not had blood transfusion had anti-HCV antibodies. HCV antibodies were also found more frequently in Egyptians, Pakistanis and Yemenis than in Saudis. A comparison between those centres with low prevalence of positive HCV and those with high prevalence regarding risk factors was carried out, and it was found that the major difference between them was the adherence of the staff to universal infection precautions.(ABSTRACT TRUNCATED AT 250 WORDS)