Severe Acute Kidney Injury Secondary to Rhabdomyolysis in Diabetic Ketoacidosis (DKA): A Case Report.

Delayed diagnosis and treatment of rhabdomyolysis in diabetic emergencies may lead to irreversible kidney damage and progress to chronic kidney disease. Therefore, early detection and correction of electrolyte disturbances, resulting from diabetes and risk factors for rhabdomyolysis, is essential to avoid complications and renal function improvement. In this case report, a patient with two weeks history of polyuria, polydipsia, and nocturia showed up at ED with epigastric abdominal pain, nausea, and non-bloody vomiting. The patient was in a diabetic ketoacidosis episode in which rhabdomyolysis developed and complicated into acute renal failure. Few case reports in the literature have mentioned the association of hypophosphatemia, severe acidosis, and high osmolarity as contributors to rhabdomyolysis leading to acute kidney injury (AKI) in patients with hyperglycemic emergency cases. To our knowledge, this is the first case reported in Saudi Arabia. Therefore, our unique case sheds some light on an overlooked complication in diabetic ketoacidosis (DKA), rhabdomyolysis, in which electrolyte abnormalities are the most probable trigger.

Rasagiline-induced severe recurrent hypoglycemia in a young woman without diabetes: a case report.

BACKGROUND: We report a case of a patient with recurrent severe hypoglycemia after initiating the drug rasagiline (Azilect) for Parkinson disease. CASE PRESENTATION: A 25-year-old Emirati woman who had been diagnosed with Parkinson disease due to a genetic mutation since the age of 18 years presented to our hospital. She had been treated with a rotigotine patch 2 mg per day along with carbidopa + levodopa + entacapone 25 mg/100 mg/200 mg (Stalevo) over these years. Recently, her Stalevo had been changed to rasagiline (a monoamine oxidase B inhibitor). Soon after this change, she started experiencing recurrent documented severe hypoglycemia requiring hospitalization. Her hypoglycemic symptoms completely disappeared after 5-7 days of drug withdrawal. Despite detailed evaluation, no other causal relationship was documented except for rasagiline. CONCLUSIONS: To the best of our knowledge, this case report documents an unknown association between rasagiline and hypoglycemia.

Kawasaki disease among Egyptian children: A case series.

Kawasaki disease is an acute vasculitis of early childhood. Its incidence varies among different ethnic groups with higher rates among Asians. In this case series, we presented four cases of Kawasaki disease with incomplete or atypical presentations in Egyptian children. Two cases presented with meningitis, which is not a criteria for the diagnosis of Kawasaki disease. The other two cases presented with pharyngitis and fever, which did not respond to antibiotics. The clinical criteria for diagnosis of Kawasaki disease were either incomplete or appeared sequentially. Coronary artery aneurysms were detected in one case, while the others had normal coronary by echocardiography. All cases were followed in our clinic, according to international guidelines. Early diagnosis and management of Kawasaki disease are important to ensure a good outcome and a high index of suspicion in febrile children is required irrespective of the clinical presentation.

In vitro activity of quinolones against S. pneumoniae, H. influenzae and M. catarrhalis in Saudi Arabia

Susceptibility of 88 clinical Streptococcus pneumoniae isolates, 116 Haemophilus influenzae isolates and 80 Moraxella catarrhalis isolates to 6 fluoroquinolones--ciprofloxacin, ofloxacin, levofloxacin, trovafloxacin, grepafloxacin and gemifloxacin--were determined. Isolates were from patients with invasive disease at 4 hospitals in Saudi Arabia between 1996 and 1998. S. pneumoniae isolates were fully susceptible to trovafloxacin, grepafloxacin and gemifloxacin; susceptibility to ofloxacin and levofloxacin was 97.7% and 98.9% respectively. H. influenzae isolates were susceptible to all agents, except for trovafloxacin [99.1%]. M. catarrhalis strains were fully sensitive to all agents except ofloxacin [97.5%]. No isolates were resistant to gemifloxacin or grepafloxacin

Observations on the recent epizootic of bovine ephemeral fever in Saudi Arabia.

Observations of the epizootic of bovine ephemeral fever which occurred in Saudi Arabia during 1996 are presented. The investigations included the collection of epidemiological data from affected farms and the testing of sera for antibodies to the virus. The authors report a mean morbidity rate of 50% and a mean case fatality rate of 0.3%. Of the infected cattle, 4% were affected by recumbency, the majority of these recovered (89%). The clinical signs observed in affected cattle were uniform throughout the region concerned. The features of the outbreak, obtained through field investigations, were considered in relation to the ecological and meteorological conditions which were prevalent at the time. The outbreak occurred during the summer months (May to October) in the central and eastern regions of Saudi Arabia, with the initial infection reported at the Al-Ahsa oasis. Farms which were subsequently affected were all reported to possess areas of stagnant water suitable for the reproduction of the vectors of the disease (Culicoides spp. and mosquitoes). To conclude, the authors discuss precautions to prevent future outbreaks of bovine ephemeral fever in Saudi Arabia.

Splenic abscess and sickle cell disease.

This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease (SCD). All presented with fever and abdominal pain and were found to have a tender enlarged spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation. Although both ultrasound and CT-scan of the abdomen were of diagnostic value, we found CT-scan more accurate and reliable in the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be used routinely in the evaluation of SCD patients who present with fever and abdominal pain, especially if they have a tender enlarged spleen. Diagnostic aspiration under CT-scan or ultrasound guidance should be used in doubtful cases to differentiate between splenic abscess and a large splenic infarct. All our patients were managed by peri operative antibiotics and splenectomy with no mortality. Salmonella was the commonest causative organism. Although CT-guided aspiration of splenic abscess is being advocated recently, we feel splenectomy should be the treatment of choice in patients with SCD as there is no point in preserving a non-functioning spleen that is present in the majority of patients. CT-guided aspiration may be employed as a temporary measure for those patients who are at high surgical risk with unilocular abscess.

Solitary thyroid nodule in Khartoum.

Ninety four patients with solitary and significantly dominant thyroid nodules were studied. Inadequate sampling was reported in 5 patients (5.9%). In the remaining 89 patients, 64 had simple goitre (72%), 12 follicular adenoma (13.5%), 12 were malignant nodules (6 follicular, 5 papillary and one anaplastic) (13.5%) and one patient had Hashimoto's thyroiditis. The incidence of malignancy in the clinically solitary nodules was 14% (10/70) compared to 10% (2/19) for the dominant nodules which increased to 16% (8/49) versus 10% (4/40) respectively after ultrasonography and histopathological confirmation of the nature of the gland. There is a low positive predictive value for follicular neoplasm with fine needle aspiration cytology (FNAC) (44%). This is due to the fact that reports of suspicious follicular pattern is agreed not to imply definite malignancy, however total lobectomy was done for those patients whereas terms like "not suspicious" and "highly suspicious" are considered to mean, benign and malignant respectively and in those latter groups the prediction was 100%. The study stresses the importance of FNAC techniques in reducing the surgical load with minimal false negative results, increasing the yield of carcinoma and projecting the importance of a significantly dominant nodule in endemic areas.

The patterns of oropharyngeal microflora in patients with homozygous sickle cell disease.

A controlled prospective study was carried out between 16 July 1991 and 31 January 1992 to evaluate the oropharyngeal flora in homozygous sickle cell disease (SS). Throat swabs for cultures were taken from 163 asymptomatic SS patients attending sickle cell clinics (90 children and 73 adults). Throat swabs were also taken from 84 asymptomatic healthy individuals as a control group (44 children and 40 adults). Group A beta hemolytic Streptococci were isolated from 16.6% of children with SS compared to 4.5% of children without SS (P<0.05). Staphylococcus aureus was isolated from 16.4% of adults with SS compared to 0% of adults without SS (P<0.0001). Group G beta hemolytic Streptococci and nongroupable Streptococci were also isolated from 11% and 13.7% of adults with SS compared to 0% and 2.5% of adults without SS respectively. Several other organisms were isolated only from SS patients. We conclude that the oropharyngeal flora of patients with SS is disturbed. This disturbance may contribute to morbidity of these patients.

Bacteriuria, incidence, causative microorganism, and susceptibility pattern at Qatif Central Hospital.

From August 1988 to January 1990, a total of 13,193 urine specimens were collected from inpatients and outpatients of Qatif Central Hospital, located in the Eastern Province of Saudi Arabia, to determine the incidence of significant bacteriuria, causative microorganisms, and antimicrobial susceptibility. Among these, 1004 specimens (7.6%) showed significant bacteriuria. In community-acquired cases of bacteriuria, the prevalence was greater in female than in male patients. The most common organisms isolated were Escherichia coli and Klebsiella-Enterobacter species. Antimicrobial susceptibility showed high resistance to ampicillin, and therefore we suggest that norfloxacin be considered in empherical therapy, particularly in suspected cases of Pseudomonas urinary tract infections. For patients with an indwelling catheter, it is important to differentiate between colonization and infection before initiating antimicrobial therapy. The difficulties in treating urinary tract infections in patients with an indwelling catheter emphasize the importance of preventive measures.

Incidence of major infection in sickle cell pediatric patients at Qatif Central Hospital.

During the two-year period, 20 Jumada I 1408 (January 9, 1989) to 20 Jumada I 1410 (December 18, 1989), a total of 450 pediatric patients with sickle-cell anemia were admitted to the pediatric ward of Qatif Central Hospital. Thirty-nine patients had a major infection (septicemia, meningitis, or osteomyelitis), with an incidence of 8.6%. During the same period, 3700 non-sickle pediatric patients were admitted and 38 of them had a major infection, with an incidence of 1% (P<0.001). Three patients died in the sickle cell groups, for a case fatality rate of 7.6%, while only one patient in the control group died, for a case fatality rate of 2.6% (P<0.002). Salmonella species were responsible for 12 cases of septicemia and three episodes of osteomyelitis, and Streptococcus pneumoniae was the source in eight cases of septicemia and one case of meningitis in sicklers. Meningitis was caused by different organisms, such as Streptococcus pneumoniae, Salmonella, and Meningococcus. Antibiotics that cover both Salmonella and Streptococcus pneumoniae must be considered in all children with sickle cell anemia who have a febrile illness.