Peritoneal Dialysis-Associated Peritonitis Caused by Achromobacter xylosoxidans: A Case Report and Literature Review.

Achromobacter xylosoxidans is a gram-negative bacterium that is responsible for rare peritonitis associated with peritoneal dialysis (PD). We present a case of a 64-year-old woman with a medical history of end-stage renal disease undergoing PD who was admitted to the emergency department with abdominal pain and nausea. Physical examination and laboratory studies revealed peritoneal signs and laboratory abnormalities consistent with peritonitis. Intraperitoneal catheter dysfunction was identified and subsequently resolved via laparoscopy. Following a peritoneal fluid culture, A xylosoxidans was identified, leading to the initiation of intraperitoneal meropenem treatment. After an initial improvement, the patient developed an ileus and recurrent abdominal symptoms, and further peritoneal cultures remained positive for A xylosoxidans. Subsequent treatment included intravenous meropenem and vancomycin for Clostridium difficile colitis. Owing to the high likelihood of biofilm formation on the PD catheter by A xylosoxidans, the catheter was removed, and the patient transitioned to hemodialysis. Intravenous meropenem was continued for 2 weeks post-catheter removal. This case highlights the challenges in managing recurrent peritonitis in PD patients caused by multidrug-resistant A xylosoxidans. A high index of suspicion, appropriate microbiological identification, and targeted intraperitoneal and systemic antibiotic treatment, along with catheter management, are crucial in achieving a favorable outcome in such cases.

Knowledge and Awareness of Leukemia Among the Population of Eastern Province, Saudi Arabia.

INTRODUCTION: Cancer is characterized by the rapid proliferation of abnormal cells that exceed their normal boundaries, infiltrating other body parts and leading to metastasis, a distinctive feature setting it apart from other diseases. Metastasis is the primary cause of cancer-related deaths, with nearly 10 million global fatalities, making it the leading cause of mortality. Leukemia, a type of cancer originating in the bone marrow or blood cells, presents significant complications and is associated with various risk factors, including a positive family history, smoking, and obesity. This study aims to evaluate the general knowledge of leukemia and its associated risks among the inhabitants of the Eastern Province, Saudi Arabia. METHODS: A cross-sectional survey was conducted targeting all residents of the Eastern Province, Saudi Arabia, who were Saudi nationals, spanning both genders and aged 15 to 59 years. The questionnaire was distributed electronically through social networking applications, and responses were collected via Google Forms (Google, Mountain View, CA). RESULTS: The study findings indicated that the most frequently identified risk factors for leukemia included blood disorders, genetic disorders, and extensive exposure to radiation and chemicals. The most prevalent leukemia symptoms were bruising and bleeding, followed by vomiting, nausea, and headache. The most commonly reported side effects of leukemia treatment were dizziness, followed by anorexia and exhaustion. CONCLUSION: The study revealed a lack of awareness about leukemia and its associated risks among participants. This underscores the need for continued educational initiatives and awareness campaigns to improve leukemia knowledge and early detection rates, potentially leading to better outcomes for affected individuals. Future research should aim to overcome study limitations and provide a broader perspective on leukemia awareness throughout Saudi Arabia.

Autonomy and paternalism in shared decision-making in a Saudi Arabian tertiary hospital: A cross-sectional study.

Medical paternalism has long been a common medical practice. However, patient autonomy in healthcare has been recently adopted by doctors and patients alike. This study explored whether doctors and patients in a tertiary care hospital in Saudi Arabia preferred autonomy or paternalism in shared decision-making. A total of 118 participants (51 patients requiring total knee replacement, owing to stages 3-4 of osteoarthritis, and 67 doctors) from the Eastern province, Saudi Arabia. responded to a 17-question category-based questionnaire involving four scales of autonomy. Descriptive statistics and chi-square test results revealed that in this hospital, patients preferred a paternalistic approach toward their medical care along with a full disclosure of the risks related to surgical procedures. We recommend health education regarding the specific autonomy subscales (doctor knows best, patient should decide, right to non-participation, and obligatory risk information), and the implementation of protocols that protect patients' rights and enhance personal autonomy.

Patients' Awareness of Their Rights and Responsibilities: A Cross-Sectional Study From Al-Ahsa.

Introduction Patient rights are an essential part of healthcare practice. In fact, patients are one of the most vulnerable members of society. As a result, improving the rights of patients is considered a priority in medical services. Aim The purpose of this study is to measure the level of patients' awareness of their rights. Subjects and methods This is a cross-sectional study conducted among patients living in Al-Ahsa, Saudi Arabia. A self-administered questionnaire was distributed among Al-Ahsa patients using an online survey. The questionnaire was composed of socio-demographic variables (i.e., age, gender, education, etc.), sources of patient information regarding patients, means of increasing awareness toward patients' rights, and a 15-item questionnaire to measure the awareness about patient rights and responsibilities. Results Among the 295 patients, 59.7% were males and 39% were aged between 31 and 40 years old. The overall mean awareness score was 54.6 (SD 7.44). 53.2% of the patients were categorized as having moderate awareness levels, 44.1% were good and only 2.7% were categorized as having poor levels of awareness. Factors associated with increased awareness were being older, hospital admission, hospital visitation for the last three months, and healthcare providers as the sources of the patient's right information. Conclusion There was sufficient awareness of patient rights and responsibilities in our region. Increasing age, frequent hospital visitation, and education given by healthcare providers could effectively improve awareness of patient rights and responsibilities. A multicenter study is required to shed more light on the awareness of patients regarding their rights and responsibilities.

SARS CoV-2 infection in a patient with sickle cell disease - Atypical presentation.

Severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection causes the disease known as coronavirus disease that started in Wuhan (China) in December 2019, leading to the current COVID-19 pandemic. The common presenting symptoms include fever, dry cough, shortness-of-breath, while sore throat, diarrhea, and abdominal and chest pain are the least. The atypical presentation of SARS CoV-2 infection poses a challenge for family physicians to screen and manage such patients for COVID-19 and specifically those at high risk with underlying disease such a sickle cell disease. Herein, we report a case of SARS CoV-2 infection in a known patient of sickle cell disease (SCD) with an atypical presentation, in whom the course of the disease was mild to moderate, uncomplicated, and the patient had an uneventful recovery. Primary care physicians should be vigilant to screen and manage such patients with established protocols, especially in the ongoing COVID-19 pandemic.

Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years.

PURPOSE: We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). METHODS: A total of 5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor-matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months. RESULTS: A total of 165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3 ± 5.6 mmHg, and the baseline number of glaucoma medications was 2.7 ± 1.1 in both groups. At 24 months, IOP was reduced to 15.8 ± 5.2 mmHg in AIT and 12.4 ± 4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p < 0.01) and lower in TRAB than AIT (p < 0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p < 0.01) and more infrequently in TRAB than in AIT (p > 0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT. CONCLUSION: Both AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions.

Antimicrobial and anticancer activities of Scenedesmus obliquus metabolites.

This study was conducted to evaluate the antimicrobial activities and cytotoxicity of both crude extracts of Scenedesmus obliquus and their fractions. In vitro cytotoxicity assay against human hepatocellular carcinoma (HepG2), colon cancer (HCT116) and breast cancer (MCF7) cell line was monitored. The highest inhibition was observed using diethyl ether crude extract (DEE) recording between 12.5 and 19.5 mm inhibition zone against all tested bacteria and between 8.7 and 18.3 mm against tested fungi. The highest anticancer effect of DEE was observed at IC50 against HCT116 and HepG2 cell lines using just 24.6 and 42.8 µg ml-1, respectively. While, high concentration, 93.8 µg ml-1, was required to exhibit its effect against MCF7. Column chromatography technique was used to separate DEE crude extract to its main components using 7 different mobile phases. Fractions F1 and F7 were the highest fractions that had antimicrobial activity against tested bacteria and fungi. High IC50 > 80 µg ml-1 were required to exhibit anticancer activity at IC50 against the tested cancer cell lines. The main compounds responsible for the bioactivity were identified using GC-MS, nonadecane and butylated hydroxytoluene in F1 and 9-octadecadienoic acid and quercetin 7,3',4'-trimethoxy in F7 were identified. The current study highlights the potential use of S. Obliquus extract and their fractions as a source of antimicrobial and anticancer compounds.

Bio-evaluation of crustacean and fungal nano-chitosan for applying as food ingredient.

Chitosan, bio-polyaminosacharide, is derived from chitin. Two sources (shrimp wastes and fungus biomass) were used to produce chitosan. And then the chitosan was produced in the nano-form followed by characterization by transmission electron microscopy. The images obtained clearly showed that the size of nano-chitosan ranged between 7 and 13 and 3-6 nm with spherical shape for shrimp and fungal sources, respectively. The antimicrobial activities of the tested concentrations of chitosan and nano-chitosan were examined and found to have high activity against the tested pathogens. The evaluation of the toxicity of the tested concentrations of the produced chitosan and its nano-size were performed using brine shrimp and rat bioassay. Toxicity examination of chitosan and their nano derivatives is an essential procedure to assess the possibility of using these concentrations as food ingredient. Nine groups of rats were treated with either chitosan or nano-chitosan of both sources at 100 and 200 mg kg-1 bw. Adding chitosan in the diet of all groups showed no significant changes in both the blood biochemical and oxidative stress parameters when compared with control group. The histopathology of liver, kidney and stomach confirmed the results of the previous parameters. No signs of inflammation, fibrosis or cirrhosis were found in examined organs. It is concluded that chitosan and nano-chitosan of shrimp and Rhizopus stolonifer had high antimicrobial activity and are not toxic in the same time and it can be used as food ingredients.

Disc battery ingestion; a single event with different outcomes.

Foreign body (FB) ingestion is a common problem especially in children below the age of 5 years. This is fueled by their curiosity to explore their surroundings. The ingested foreign body finds its way out of the gastrointestinal tract without any serious consequences most of the time. On the other hand, disc battery ingestion has been reported to cause serious harm when ingested including death. We report two patients who had ingested disc batteries and their respective outcomes.

Cardioprotective role of tadalafil against cisplatin-induced cardiovascular damage in rats.

The present study investigated the possible cardioprotective effect of tadalafil (Tad) on cisplatin (CDDP)-induced cardiac and vascular damages in rats. A total number of seventy two healthy male albino rats initially weighting between 200 and 220 g were used and randomly divided into four groups,18 rats in each. The control group received no treatment; CDDP group received a single dose of CDDP (4 mg/kg) intraperitoneal (i.p.) per week for 4 weeks the duration of the experiment; Tad group received 0.4 mg/kg BW Tad i.p. daily and Tad +CDDP group received 0.4 mg/kg BW Tad i.p. +4 mg/kg BW CDDP i.p. The results showed that Tad was able to decrease blood pressure, heart rate, levels of serum cardiac troponin (cTn-I), malondialdehyde (MDA) and increased levels of reduced glutathione (GSH) and nitric oxide (NO) in the heart homogenate sample from CDDP treated rats. Semi-quantitative analysis showed that Tad was able to decrease the histopathological scores of cardiac muscular hyalinzation and fibrosis in three sacrifices in CDDP treated rats. CDDP treated rats showed significantly increased thickening in wall of aorta with an irregular luminal layer of endothelial cell linings in three sacrifices when it was compared to other groups. Moreover, immunohistochemical labeling of α- smooth muscle actin (α-SMA) in aorta revealed significant lower scores in Tad +CDDP group when they were compared to CDDP group. In conclusion, Tad alone did not induce any harmful effects on blood pressure, selective antioxidant, peroxidation markers or cardiac histology, in addition, Tad has a cardio-protective role against CDDP.

Choroidal metastases as the sole initial presentation of metastatic lung cancer: case report and review of literature.

BACKGROUND: Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. Herein, we present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. CASE REPORT: A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adenocarcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. CONCLUSION: Metastatic lung cancer can manifest with choroidal metastasis as an initial presentation.

Choroidal metastasis as the sole initial presentation of metastatic lung cancer.

Choroidal metastasis as an initial presenting feature of metastatic lung cancer is exceedingly rare. External beam radiotherapy (EBRT) is an effective and widely accepted therapeutic modality. However, data addressing the effectiveness of other treatment strategies is limited. We present a patient with choroidal metastases secondary to lung cancer and review the relevant literature. A 25-year-old male presented with deterioration of vision. His evaluation revealed bilateral choroidal metastasis secondary to adeno- carcinoma of the lung. Unfortunately, his vision continued to deteriorate despite treatment with EBRT and chemotherapy. Choroidal metastasis as an initial presentation of metastatic lung cancer is exceedingly rare, as only 30 cases have been reported. EBRT and systemic chemotherapy are effective therapeutic modalities. This case report could prove helpful to clinicians faced with a similar exceedingly rare scenario.

Comparison of the photochemical behaviors of α-tocopherol and its acetate in organic and aqueous micellar solutions.

Photoionization is known to take place when α-tocopherol (TOH) is excited to the S(1) state in a polar medium. It has been previously suggested that TO(•) is formed only as a result of proton release by TOH(•+), a process that is expected to occur, in a protic solvent, on the subnanosecond time scale. Recent redeterminations of the molar absorption coefficients of e(aq)(­) (Hare J. Phys. Chem. A 2010, 114, 1766) and of TOH(•+) and TO(•) (Naqvi J. Phys. Chem. A 2010, 114, 10795) have paved the way for testing the above suggestion, even if subnanosecond time resolution is not available, since it implies the equality of [e(aq)(­)](0) and [TO(•)](0), where [···](0) denotes the concentration of the enclosed species immediately after a nanosecond laser pulse. Nanosecond pump-probe spectroscopy of TOH in aqueous micellar solution (AMS) and two organic solvents with similar polarities (acetonitrile and methanol) has revealed that prompt formation of TO(•) through dissociation (TOH + hν → TO(•) + H(•)) is not negligible even in AMS. In acetonitrile, TOH(•+) and TO(•) are formed with comparable yields, and the former converts quantitatively into TO(•) within 15 µs. In methanol, TO(•) was observed, but no evidence was found for electron ejection from TOH. Only one photoproduct, namely TO(•), could be detected when α-tocopherol acetate (TOAc) was excited to the S(1) state in several polar and nonpolar solvents; TOAc has been found to be a more efficient energy degrader than TOH.

Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses.

BACKGROUND AND OBJECTIVES: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder that affects millions of people worldwide, and is a major health problem in Jordan. We studied factors that may predict severe hemolysis in children with G6PD deficiency. METHODS: We reviewed the records of patients with low G6PD activity admitted to a teaching hospital be- tween 1996 to 2007. We collected demographic data, details of sign and symptoms, history and type of fava bean ingestion, blood and Rh group, history of neonatal jaundice, history and type of drug use, abdominal pain at admission and the results of tests for hemoglobin, white blood cells (WBC), and hepatic function. We classified patients into mild and severe groups based on hemoglobin levels at admission. RESULTS: Of 428 children with G6PD deficiency, 79 (18%) were severe cases and 349 (82%) patients with mild disease. There were no statistically significant differences in most factors between the two groups. Factors that achieved statistical significance for severe hemolysis included younger age (P<.05), male gender (P<.05), higher alkaline phosphatase (ALP) (P<.05), presence of fever at admission (P<.01), presence of vomiting during the at- tack (P=.006), and a negative family history for G6PD deficiency (P=.005). CONCLUSIONS: Severe hemolysis can be predicted during hemolytic episodes in children with low G6PD by young age, male gender, a negative family history of G6PD deficiency, the presence of fever and vomiting and a high ALP.

Long-term effects of a ketogenic diet in obese patients.

BACKGROUND: Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-term effects on various physical and biochemical parameters are not known. OBJECTIVE: To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1 g/kg body weight protein, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients. PATIENTS AND METHODS: In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m(2), and high glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment. RESULTS: The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant. CONCLUSIONS: The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

Investigating inflammatory bowel disease--white cell scanning, radiology, and colonoscopy.

OBJECTIVE: To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease. DESIGN: Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken. SETTING: Great Ormond Street Hospital for Children, London. SUBJECTS: 39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years). MAIN OUTCOME MEASURES: There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%). CONCLUSION: The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.

Dates and date pits as ingredients in broiler starting and coturnix quail breeder diets.

Two broiler growth and two quail breeder studies were conducted to evaluate the dietary potential of dates, date meat, and date pits. The test ingredients were incorporated in broiler starting diets at levels ranging from 8 to 43% dates, 16 to 43% date meat, and 5 to 27% date pits. The quail breeder diet had ingredient ranges of 10 to 30% dates, 8 to 24% date meat, and 5 to 15% date pits. The date ingredient diets supported broiler weights and feed conversions comparable to or better than the control diet. Quail breeder feed consumption decreased at the 30% date level; however in the second trial 24% dates supported normal intake. Egg production and egg weight on all date and date part diets were equal to those of the control.