Gastrointestinal basidiobolomycosis: a rare manifestation of Basidiobolus ranarum in a non-endemic region.

Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by the Basidiobolus ranarum, and it possesses a significant challenge to diagnose it as it presents with non-specific symptoms that often mimic cancer. Herein, we report a case of GIB in a 51-year-old male from the central region of Saudi Arabia, a non-endemic region of GIB, which was initially misdiagnosed as colon cancer. A 51-year-old man presented with abdominal pain for two-months, non-bloody diarrhea, loss of appetite, and weight loss. Abdominal examination revealed a large mass measuring ~10x15cm. Radiological findings prompted the diagnosis of a colon mass, and the patient was surgically treated under that impression. Hemicolectomy and end colostomy with mucous fistula from distal sigmoid stump were done. Histopathology was consistent with GIB. The diagnosis of GIB presents a serious challenge and requires a high index of clinical suspicion.

Fungemia Due to Saprochaete capitata in a Non-Neutropenic Critically Ill Patient.

Saprochaete capitata is an uncommon yeast species; its impact on non-neutropenic patients appears to be on the rise. We describe a case of S. capitata fungemia in a critically ill end-stage kidney disease (ESKD) patient on peritoneal dialysis. The patient presented with mesenteric ischemia and underwent several laparotomies during hospitalization. His hospital stay was complicated as fungemia developed and spread to multiple sites, which resulted in severe complications and ultimately led to fatal outcomes. S. capitata's diagnostic delay is a concern, but matrix-assisted laser desorption/Ionization time-of-flight (MALDI-TOF) mass spectrometry may help provide accurate identification. Our case highlights the need for prompt diagnosis and tailored antifungal therapy, especially when managing this challenging infection in immunocompromised patients.

A 20-Year-Old Man with IgA Vasculitis following COVID-19 Vaccination.

IgA vasculitis is a common type of vasculitis that is generally triggered by infectious causes. Vaccines have been reported as a trigger as well. Herein, we report a case of a young man who is previously healthy and who developed IgA vasculitis after the first dose of the COVID-19 mRNA vaccine Pfizer-BioNTech. The patient's symptoms were mainly skin and joint without renal or other system involvement. The patient had an excellent outcome with complete resolution after treatment with steroid tapering and azathioprine as a steroid-sparing agent over 6 months.

Satisfactory outcomes of post-operative subtalar extra-articular arthroereisis in juvenile flexible flat foot.

OBJECTIVES: To analyze the surgical outcomes of subtalar extra-articular arthroereisis and the patient/parent satisfaction regarding the foot's shape, foot pain, ability to walk, ability to jump, and shoe wear. METHODS: Our retrospective cross-sectional study was carried out through an online-based questionnaire to assess patient satisfaction postoperatively at 3 hospitals (King Khalid University Hospital, Sultan bin Abdulaziz Humanitarian City, and Dallah Hospital, Riyadh, Saudi Arabia) between the years 2014-2021. RESULTS: A total of 65 patients participated in our study. Approximately 86.1% of them had the operation bilaterally. The most important aspects where patients noticed the most improvement were the foot's shape (90.8%), pain (81.5%), and ability to walk (76.9%). CONCLUSION: Several studies have been carried out highlighting the surgical technique and complications of the procedure. However, a limited number of studies have been carried out to assess patient satisfaction with the procedure, especially in Saudi Arabia, as the procedure is considered relatively new in the region with insufficient data regarding it. Therefore, this study is considered one of the few articles regarding subtalar extra-articular arthroereisis in the region.

Targeted Minimally Invasive Percutaneous Posteromedial Release of Residual Clubfoot in Myelomeningocele Patients: A Report of Two Cases.

Congenital talipes equinovarus (CTEV) is commonly associated with myelomeningocele (MMC). It is thought to be a mixture of intrauterine development and a result of an imbalance in muscular innervation. Conservative management has been explored for those cases, but most resulted in recurrence. In this study, we report two cases where targeted minimally invasive percutaneous posteromedial release of residual clubfoot was done using an 18-gauge needle and a small incision for the cuboid osteotomy. In both cases, we achieved plantigrade shoeable/braceable feet. Both cases are still followed in our clinic. They require further follow-up to assess their long-term outcomes.

Assessment of Micafungin Dosage Regimens in Patients with Cancer Using Pharmacokinetic/Pharmacodynamic Modeling and Monte Carlo Simulation.

Micafungin is widely used for invasive candidiasis, especially in critically ill patients and those with cancer, and for empirical antifungal therapy in patients with neutropenic fever. This is the first study to investigate the pharmacokinetics and disposition parameters of micafungin in patients with cancer. In this observational pharmacokinetic study, blood samples were collected and analyzed using high-performance liquid chromatography. Pharmacokinetic parameters were estimated using Monolix 4.4 software. The plasma micafungin concentrations were measured in a total of 133 samples from 19 patients. In the final two-compartment model with linear elimination, the estimated micafungin clearance (CL) was significantly higher in patients with cancer than in those without cancer (1.2 vs. 0.6 L/h, p = 0.012), whereas other parameters did not significantly differ between the two groups. Aspartate and alanine transaminases and body weight significantly influenced micafungin CL in patients, with and without cancer. Overall, the probability of target attainment increased with increasing doses and decreased with higher MICs in both groups. In simulations, the patients without cancer achieved higher pharmacokinetic/pharmacodynamic targets with a 90% probability for all simulated doses, compared to the patients with cancer. Micafungin demonstrated dose-proportional linear pharmacokinetics in both the patients with and those without cancer. The estimated micafungin CL was significantly higher in patients with cancer, suggesting a need for increased dosage, especially for Candida spp. with high MICs, in these patients. Further studies should assess the efficacy and optimum dosage of micafungin for the treatment and prevention of febrile neutropenia (FN) in patients with cancer.

Ecthyma gangrenosum secondary to MRSA in a young patient with chronic kidney disease.

Ecthyma gangrenosum (EG) is a well-recognized dermatological condition classically associated with Pseudomonas aeruginosa infection, however, the association with other bacteria, especially gram positive, is rare. There are only a few reported cases of EG caused by staphylococcal infection. Here, we report a case in a young patient with chronic kidney disease (CKD) presenting with EG secondary to Methicillin Resistant Staphylococcus aureus.

Stroke during sleep and obstructive sleep apnea: there is a link.

OBJECTIVES: The onset of ischemic stroke symptoms has been established to have a diurnal variation, with a sizeable proportion (8-28%) occurring during sleep. Obstructive sleep apnea (OSA) has been established as an important risk factor for ischemic stroke. However, data on the relationship between OSA and wake-up stroke (WUS) has been scarce. The aim of our study is to determine the relationship between OSA and WUS. METHODS: This is a case-control study conducted on acute stroke patients who presented to one of two major medical centers in Riyadh of Saudi Arabia. Those who woke up with the symptoms were labeled as WUS, and those whose stroke occurred while awake were labeled as non wake-up stroke (NWUS). The Berlin Questionnaire, which was submitted to either the patient or his/her partner, was used to determine the frequency of OSA in the two groups. RESULTS: One hundred seven patients (60% males) with acute stroke were admitted between March 2016 and March 2017. Of the 40 patients with WUS, 29 (72.5%) had underlying OSA based on the Berlin Questionnaire, whereas only 30 (45%) of the 67 patients with NWUS have underlying OSA. Logistic regression analysis showed OSA is highly prevalent in the patients with WUS (OR = 3.25; 95% CI = 1.397-8.38; p = 0.0053). CONCLUSION: OSA is an important risk factor for ischemic stroke during sleep. Health care providers must be vigilant in inquiring about symptoms suggestive of OSA in every ischemic stroke patient, especially the patient whose stroke occurred during sleep.

To what extent are Arab pilgrims to Makkah aware of the middle east respiratory syndrome coronavirus and the precautions against it?

BACKGROUND: Approximately, 80% of the many cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) confirmed worldwide were diagnosed in the Kingdom of Saudi Arabia (KSA). The risk of the disease spreading internationally is especially worrying given the role of KSA as the home of the most important Islamic pilgrimage sites. This means the need to assess Arab pilgrims' awareness of MERS-CoV is of paramount importance. MATERIALS AND METHODS: A cross-sectional study was carried out during Ramadan 2015 in the Holy Mosque in Makkah, Saudi Arabia. Self-administered questionnaires were distributed to 417 Arab participants at King Fahad Extension, King Abdullah Prayer Extension and, King Abdullah Piazza Extension after Taraweeh and Fajr prayers. RESULTS: The mean MERS-CoV knowledge score was 52.56. Majority of the respondents (91.3%) were familiar with MERS-CoV. Saudis had significantly higher knowledge of MERS-CoV than non-Saudis (56.92 ± 18.55 vs. 44.91 ± 25.46, p = 0.001). Females had significantly more knowledge about consanguineous MERS-CoV than males (55.82 ± 19.35 vs. 49.93 ± 23.66, p = 0.006). The average knowledge was significantly higher in respondents who had received health advice on MERS-CoV (56.08 ± 20.86 vs. 50.65 ± 22.51, p = 0.024). With respect to stepwise linear regression, knowledge of MERS-CoV tended to increase by 14.23 (B = 14.23%, p = 0.001) in participants who were familiar with MERS-CoV, and by 8.50 (B = 8.50, p = 0.001) in those who perceived MERS-CoV as a very serious disease. CONCLUSION: There is a great need for educational programs to increase awareness about MERS-CoV.

Socioeconomic factors affecting patients' utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia.

BACKGROUND: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. OBJECTIVES: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. RESULTS: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). CONCLUSION: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services.

Determinants of asthma control among children in Saudi Arabia.

OBJECTIVE: Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children. METHODS: A cross-sectional study was conducted among children with asthma aged 4-11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables. RESULTS: Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10-0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04-0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81-0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02-5.21) and 3.33 (95% CI = 1.33-8.35), respectively. CONCLUSIONS: In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.