Risk factors of primary and secondary restless legs syndrome among a middle-aged population in Saudi Arabia: A community-based study.

INTRODUCTION: Restless legs syndrome (RLS) is etiologically divided into primary and secondary syndromes. However, a comparative description of both types is lacking in the literature. We compared primary and secondary RLS with respect to demographic determinants, associated risk factors, and comorbidities. METHODS: Following a cross-sectional survey on the prevalence of RLS in a Saudi population, RLS cases were identified using the International RLS Study Group (IRLSSG) criteria. Cases were assessed with an interview-based questionnaire regarding baseline characteristics, risk factors, and comorbidities and with lower limb examinations and laboratory measurements. RLS severity was assessed using the IRLSSG Severity Rating Scale. RESULTS: In total, 78 patients with RLS, including 50 (64.1%) primary and 28 (35.9%) secondary cases, were examined. Of the primary cases, 35 (70%) were male; of the secondary cases, 25 (89.3%) were female (P < 0.001). Multivariate regression confirmed the association of male gender with primary RLS (odds ratio = 14.53, 95% confidence interval [2.9-75], P = 0.001). There were more dark- and black-skinned participants in the primary RLS group (38, 72%) than in the secondary group (15, 28%) (P = 0.042). Iron deficiency was observed in most (26, 92%) of the secondary cases. More severe symptoms were reported in secondary than in primary RLS cases (P < 0.05). CONCLUSIONS: Primary RLS is more common but less severe than secondary RLS. Male gender and ethnicity play significant roles in primary RLS, whereas female gender and iron deficiency may be the main risk factors associated with secondary RLS.

Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial.

BACKGROUND: Intravenous magnesium sulfate, a rescue therapy added to bronchodilator and systemic steroid therapy for moderate and severe asthma, is uncommonly administered. We hypothesized that nebulized magnesium would confer benefit without undue risk. DESIGN AND METHODS: Patients aged 2 to 14 y with moderate and severe asthma (PRAM severity score ≥ 4) admitted to infirmary/observation unit care were randomized double-blind on admission to receive 800 mg nebulized magnesium or normal saline placebo after all received intensive therapy with combined nebulized albuterol-ipratropium and intravenous methylprednisolone. Time to medical readiness for discharge was the primary outcome; sample size was chosen to detect a 15% absolute improvement. Improvement over time in PRAM severity score and other secondary outcomes were compared for the overall group and severe asthma subset. RESULTS: One hundred and ninety-one magnesium sulfates and 174 placebo patients met criteria for analysis. The groups were similar with mean baseline PRAM scores >7. Blinded active therapy significantly increased blood magnesium level 2 hr post-treatment completion compared to placebo, 0.85 vs 0.82 mmol/L, P = 0.001. There were no important adverse effects. Accelerated failure time analysis showed a non-significantly shortened time to medical readiness for discharge of 14% favoring the magnesium sulfate group, OR = 1.14, 95% CI 0.93 to 1.40, P = 0.20. Mean times until readiness for discharge were 14.7 hr [SD 9.7] versus 15.6 hr [SD 11.3] for the investigational and placebo groups, respectively, P = 0.41. CONCLUSIONS: Adding nebulized magnesium to combined nebulized bronchodilator and systemic steroid therapy failed to significantly shorten time to discharge of pediatric patients with moderate or severe asthma.

Oral dexamethasone for bronchiolitis: a randomized trial.

OBJECTIVE: Determine whether dexamethasone treatment added to salbutamol reduces time to readiness for discharge in patients with bronchiolitis and possible asthma. METHODS: We compared efficacy and safety of dexamethasone, 1 mg/kg, then 0.6 mg/kg for 4 more days, with placebo for acute bronchiolitis in patients with asthma risk, as determined by eczema or a family history of asthma in a first-degree relative. All patients received inhaled salbutamol. Time to readiness for discharge was the primary efficacy outcome. RESULTS: Two hundred previously healthy infants diagnosed with bronchiolitis, median age 3.5 months, were enrolled. Five placebo recipients needed admission to intensive care unit during infirmary treatment (P = .02). Among 100 dexamethasone recipients, geometric mean time to readiness for discharge was 18.6 hours (95% confidence interval [CI], 14.9 to 23.1 hours); among 90 control patients, 27.1 hours (95% CI, 21.8 to 33.8 hours). The ratio, 0.69 (95% CI, 0.51 to 0.93), revealed a mean 31% shortening of duration to readiness for discharge favoring dexamethasone (P = .015). Twenty-two dexamethasone and 19 control patients were readmitted to the short stay infirmary in the week after discharge (P = .9). No hospitalizations or side effects were reported during 7 days of surveillance. CONCLUSIONS: Dexamethasone with salbutamol shortened time to readiness for infirmary discharge during bronchiolitis episodes in patients with eczema or a family history of asthma in a first-degree relative. Infirmary and clinic visits in the subsequent week occurred similarly for the 2 groups.