Changes in the patterns and microbiology of spontaneous bacterial peritonitis : analysis of 200 cirrhotic patients.

BACKGROUND AND AIMS: The microbiological characteristics of spontaneous bacterial peritonitis (SBP) are changing worldwide with a shift in patterns of SBP and increasing prevalence of antibiotic-resistant bacteria. We, therefore, conducted this retrospective study aiming to characterise the current patterns and microbiology of SBP in our region. METHODS: We performed a retrospective chart review of patients presenting with their first episodes of SBP. The demographical, clinical and laboratory parameters of all patients at first paracentesis were recorded. RESULTS: The study included 200 cirrhotic patients with SBP. Mean age was 60.4±13.5 years and 116 (58%) patients were males. Liver cirrhosis was predominantly viral in 138 (69%) patients. Ascitic fluid cultures were positive in 103 (51.5%) patients and negative in 97 (48.5%). Ninety-eight (95.1%) patients had monomicrobial bacterial growth. The most common variants of spontaneous ascitic fluid infection were culture negative neutrocytic ascites (CNNA) in 97(48.5%) patients and SBP in 65 (32.5%) patients. E.Coli was most frequently isolated microorganism in 41 (39.8%) patients followed by staphylococcus species in 19 (18.4%) patients, Klebsiella pneumonae in 14(13.6%) patients and streptococcus species in 13 (10.7%) patients. The prevalence of extended spectrum beta-lactamases (ESBL) resistant E.Coli was 29.3%. Antibiotic resistance rate for meropenem, piperacillin\ tazobactam, ceftriaxone and ciprofloxacin was 0%, 22.0%, 29.0%, and 28.6% respectively. CONCLUSIONS: Changes in the patterns and microbiology of SBP are evident in our region with increasing prevalence of culture negative SBP, extended spectrum beta-lactamases resistant E.Coli, and increased resistance rate to first line antibiotics. Our data argue for relying on periodic hospital based antibiotic susceptibility data whenever SBP is treated.

Assessment of natural radioactivity and (137)Cs in some coastal areas of the Saudi Arabian gulf.

The levels of natural radioactivity have been investigated in some Saudi Arabian Gulf coastal areas. Sampling sites were chosen according to the presence of nearby non-nuclear industrial activities such as, the two main water desalination plants in Al Khobar and Al Jubail, and Maaden phosphate complex in Ras Al Khair, to ensure that effluents discharges into the Arabian Gulf didn't enhance radioactivity in seawater and shore sediments. Seawater samples were analyzed for radium isotopes (Ra-226 & Ra-228) and measured by gamma spectrometry using high purity germanium detector, after radiochemical separation of the isotopes by co-precipitation with MnO2. Shore sediment samples were analyzed for (226)Ra, (228)Ra ((232)Th), (4)°K and (137)Cs using gamma sepectrometry. A small variation was observed in the activity concentrations of the investigated radioisotopes, and the activity levels were comparable to those reported in literature. Quality assurance and methods validation were established through the efficiency calibration of the detectors, the estimation of uncertainties, the use of blanks, the analysis of standard reference materials and the intercomparison and proficiency tests. Radiological hazards were assessed, and the annual effective dose had an average value of 0.02 mSv. On the basis of the current results, we may conclude that any radiological hazards to the public visiting these shores are not expected.

Standard formula for liver volume in Middle Eastern Arabic adults.

OBJECTIVES: To determine a formula for estimating the standard liver volume (SLV) in Middle Eastern Arabic adults and to compare it with the 12 standard liver volume (SLV) formulas reported for eastern and western populations. METHODS: Liver volume measured using computed tomography (CTLV) was determined in 351 Saudi Arabian adults older than 16 years without liver or body build abnormality. This measurement was correlated with body indices including age, sex, height, weight, body mass index, and body surface area to derive a new formula using multiple-step linear regression analysis. The CTLV was compared with the 12 SLV formulas using the t test, with error % as (SLV - CTLV)/CTLV × 100. RESULTS: Body weight was the only significant factor that correlated with CTLV, that is, 12.26 × body weight (kg) + 555.65 (R(2) = .37; P = .000). Only the Vauthey formula (1267.28 × body surface area (m(2)) - 794.41) yielded an estimation of SLV that did not differ significantly from CTLV (P = .26), and had the least mean % error of +1% (underestimation by 15.7 mL) and the closest agreement, that is, 62.4% demonstrated less than ±16% error). Other formulas also yielded acceptable agreement with mean % error less than 12%, although the differences from actual measurements were statistically significant. The Chengdu and Chouker formulas were the exceptions, with more than 16% underestimation or overestimation. CONCLUSIONS: Either the formulas derived in the present study and the Vauthey formula could be used to estimate SLV in Middle East Arabic adults. However, the moderate coefficient of determination (R(2) = .37) suggested wide interindividual variation. Caution must be exercised when using these formulas in preoperative planning.

Attention deficit-hyperactivity symptoms among Palestinian children.

We aimed to establish the prevalence and distribution of attention deficit-hyperactivity disorder (ADHD) symptoms and other associated comorbid mental health problems in Palestinian schoolchildren. Thus 349 children aged 6-15 years were randomly selected from 23 schools in Gaza and the West Bank and were rated by their parents and teachers using both the ADHD DSM-IV Checklist and the Strengths and the Difficulties Questionnaire, which also measures conduct and emotional problems. There was a significant agreement between parents and teachers, with 4.3% of the children rated above the established cut-off scores on both the parent and teacher DSM-IV Checklist. Male gender, family size and living in an area of socioeconomic deprivation were independently associated with ADHD symptoms.

Attention deficit-hyperactivity symptoms among Palestinian children

We aimed to establish the prevalence and distribution of attention deficit-hyperactivity disorder [ADHD] symptoms and other associated comorbid mental health problems in Palestinian schoolchildren Thus 349 children aged 6-15 years were randomly selected from 23 schools in Gaza and the West Bank and were rated by their parents and teachers using both the ADHD DSM-IV Checklist and the Strengths and the Difficulties Questionnaire, which also measures conduct and emotional problems. There was a significant agreement between parents and teachers, with 4.3% of the children rated above the established cut-off scores on both the parent and teacher DSM-IV Checklist. Male gender, family size and living in an area of socioeconomic deprivation were independently associated with ADHD symptoms

A proposed objective way to assess results of randomized prospective clinical trials with acute graft-versus-host disease as an outcome of interest.

The assessment of graft-versus-host disease (GVHD) as an end-point in clinical trials requires subjective judgement to distinguish morbidity caused by GVHD from morbidity caused by other complications. We developed a method based on ordinal regression for longitudinal assessment of morbidity involving the skin, liver and gut, regardless of cause as an objective end-point in randomized prospective phase III treatment or prevention trials for which GVHD is an outcome of interest. This method was validated for treatment studies by showing that morbidity was more severe among patients with grade II-IV GVHD than among those who did not have GVHD. We found no differences in morbidity involving the skin, liver and gut after the diagnosis of GVHD in a group of 30 patients who received peripheral blood stem cells and a group of 37 who received marrow in a randomized phase III clinical trial. These preliminary results suggest that objective end-points could be used in randomized clinical trials for treatment of GVHD. Further studies will be needed to determine if similar methods could be used in randomized clinical trials for prevention of GVHD.

Primary T-cell lymphoma of the brain in children: a case report and literature review.

Described here are the clinical features and results of treatment in a 10-year-old Saudi Arabian girl with primary T-cell lymphoma of the central nervous system. At presentation the patient had nystagmus and ataxia. The diagnosis was established by tissue biopsy obtained from the cerebellum. Therapy included cranio-spinal irradiation and combination chemotherapy of a systemic high dose of methotrexate, cytosine, arabinoside, and L-asparaginase. Remission was obtained easily but was interrupted by a local intracranial relapse 57 months after diagnosis (37 months after cessation of therapy; at present the patient is still alive and receiving palliative treatment). This report is warranted because of the rarity of this condition in children.