Rhodococcus equi bacteremia with necrotizing pneumonia and brain abscess in a newly diagnosed HIV patient in Saudi Arabia: A case report and review of literature.

Rhodococcus equi is a Gram-positive coccobacillus that falls within the category of aerobic actinomycetes. The Rhodococcus genus belongs to the nocardioform bacteria group. This microorganism has been found in various settings, including natural environments, animals, and particularly in individuals with compromised immune systems, such as those living with HIV. Notably, there is an increasing number of reports concerning R. equi infections in transplant recipients and even individuals with a normally functioning immune system. Traditionally, R. equi has been primarily associated with pulmonary infections, but there is a growing body of evidence documenting its involvement in extrapulmonary infections. In this report, we present a case involving a newly diagnosed HIV patient who experienced R. equi -induced necrotizing pneumonia, bacteremia, and a brain abscess in newly diagnosed HIV patient. It is important to note that a direct Gram stain may potentially lead to misclassification of such microorganisms as contaminants. Microbiologists should therefore prioritize the careful examination of colony morphology, biochemical reactions, and consider the limitations of automated machine databases. Furthermore, they should correlate their identification findings with clinical data to ensure optimal patient care and management, especially in the context of an immunocompromised state.

Influence of High Expectations and Selfie Photographs on the Satisfaction Level of Facial Plastic Surgery in the Eastern Region of Saudi Arabia.

Introduction Selfies are most commonly posted on social media, where their popularity has led to intensified awareness by the subjects of their appearance. This, led to higher demand for cosmetic procedures, intending to enhance how the subject appears in future selfies. Aim This study aims to evaluate the influence of high expectations and selfie photographs on satisfaction level results of facial plastic surgery in Eastern Province, Saudi Arabia. Subject and methods This cross-sectional study was conducted among Eastern Province residents of Saudi Arabia. A self-administered questionnaire was sent to the residents using an online survey. The questionnaire included demographic characteristics (i.e., age, gender, nationality, etc.) and specific questions regarding the influence of selfie photographs and high expectations on the satisfaction rates among patients who had facial plastic surgery. Results Of the 192 participants, 79.2% were females, and 44.8% were aged between 18 to 30 years old. The most commonly sought cosmetic surgery was rhinoplasty (38.5%). 71.4% were taking selfies, while 39.1% perceived better expectations with plastic surgery. High expectations with plastic surgery were more prevalent in older and married participants. It is important to note that an increased satisfaction rate after cosmetic procedures was more associated with high expectations of plastic surgery. Conclusion High expectations directly influence satisfaction with appearance after the cosmetic procedure, but taking selfies does not. Respondents of older age and who were married demonstrated better expectations of plastic surgery compared to the rest of the groups. More investigations are required to confirm the relationship between expectation and taking selfies in terms of satisfaction with self-appearance after cosmetic surgery.

Perception of Heart Attack Risk Factors and Their Complications Among the Adult Population in the Eastern Region of Saudi Arabia.

Background Among the young population, many have risk factors that are nonmodifiable, modifiable, or both, increasing their chances of developing cardiovascular diseases (CVDs) and/or experiencing a heart attack later in life. Knowledge of both risk factors has a major role in preventing CVD by encouraging screening and applying the necessary lifestyle modifications. This study aims to assess the knowledge of risk factors and complications associated with heart attacks among individuals in the early adulthood age group. Methodology This descriptive cross-sectional study encompassed residents of the Eastern Region who met the specified inclusion criteria. Data were collected and recorded on a structured questionnaire regarding their demographic information, current risk factors, and knowledge of cardiovascular risk factors and complications. The questionnaire was distributed in hard copy among schools, colleges, and primary healthcare centers. The statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY). The results were presented in tables as percentages and frequencies for all variables, and the scores were presented as mean and standard deviation.  Results Among the 334 participants, the average overall score was 15.47 out of 28. The participants exhibited varying levels of knowledge across different aspects of the risk factors. The correct response rate ranged from as high as 84.4% (282) to as low as 41.6% (139) in the assessment of risk factors items. The majority of the participants showed a good understanding of the preventive measures, such as exercise and weight reduction. However, 43.4% (145) of participants reported not participating in physical activity and 29.1% (97) had a body mass index of 25 and above. Conclusions The outcome of this study suggests that there's a need for structured educational programs in schools and public health campaigns. The general public must have a reliable source of information rather than the mass media and false information read from social media.

Reversible Cerebral Vasoconstriction Syndrome in a Background of Eclampsia Responding to Milrinone Infusion.

BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological disorder with a complex physiopathology that is not fully understood. Suggested underlying mechanisms include failure of autoregulation, endothelial dysfunction, and oxidative stress. It is characterized by reversible multifocal constriction of the cerebral arteries, and can be triggered by many conditions, including, vasoactive medications (eg, triptans), cerebrovascular events, primary headache disorders, and metabolic causes (eg, hypercalcemia). RCVS can also be associated with pregnancy-related conditions, such as thrombotic thrombocytopenic purpura, eclampsia, and pre-eclampsia. Thunderclap headache is the most common clinical manifestation; however, other symptoms can result from complications of the disease, such as stroke, brain edema, and seizures. Several case reports have been published of an association between RCVS and eclampsia, but to the best of our knowledge, only 3 cases were successfully treated with intravenous milrinone and this is the only patient reported in Saudi Arabia. CASE REPORT We report a case of 25-year-old primigravida woman who presented with acute-onset headache, nausea, elevated blood pressure, and generalized tonic clonic seizure. She was diagnosed as having RCVS secondary to eclampsia based on clinical and radiological features. She was initially started on nimodipine, which is usually the first-line management of RCVS, as well as magnesium sulfate and levetiracetam; however, she only achieved full recovery after starting intravenous milrinone. CONCLUSIONS Milrinone is one of the emerging drugs for treatment of RCVS, and this case report delineates the potential of using the drug, especially in cases refractory to standard therapy.

Hypertensive Intracerebral Hemorrhage in Young Patients From a Tertiary Care Center in Saudi Arabia: An Observational Study.

Objective: Young patients with intracerebral hemorrhage (ICH) make up a small but important subgroup of patients with ICH. This study investigated the clinical characteristics and outcomes of hypertensive ICH in very young (18-45 years) and young (46-55 years) patients.Methods: This was a retrospective study of patients aged 18-55 years with hypertensive ICH admitted to a hospital from April 2014 to April 2019. Clinical and radiologic features as well as long-term clinical outcomes were compared between 2 age groups: group 1 (18-45 years) and group 2 (46-55 years). Factors affecting the clinical outcome were investigated as well.Results: Of 63 patients with hypertensive ICH, 24 (38.1%) were in group 1 (mean ± SD age of 38 ± 4.6 years), and 39 (61.9%) were in group 2 (50 ± 2.5 years). The risk factor profile was similar except for diabetes, which was more prevalent in group 1 (odds ratio [OR] = 4.65; 95% CI, 1.4-15.2). Patients in group 1 had higher mean ± SD NIH Stroke Scale scores (15.7 ± 4.6, P = .044), had lower Glasgow Coma Scale (GCS) scores (OR = 3.33; 95% CI, 1.0-10.8), were at higher risk of intubation (OR = 2.79; 95% CI, 1.1-9.9), and had higher ICH volume (21 ± 18, P = .034). Worse clinical outcome was higher in group 1 (OR = 5.14; 95% CI, 1.0-26.1). Low GCS score, mean hematoma volume, and intraventricular extension were independently associated with worse outcome.Conclusions: Relatively young patients with hypertensive ICH have higher prevalence of diabetes and worse clinical outcome in comparison to older patients with hypertensive ICH. Such patients should be monitored and treated more aggressively.

Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a common cause of death worldwide (Neumar et al., Circulation 122:S729-S767, 2010), affecting about 300,000 persons in the USA on an annual basis; 92% of them die (Roger et al., Circulation 123:e18-e209, 2011). The existing evidence about the use of sodium bicarbonate (SB) for the treatment of cardiac arrest is controversial. We performed this study to summarize the evidence about the use of SB in patients with out-of-hospital cardiac arrest (OHCA). METHODS: We searched PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library, until June 2019, for randomized controlled trials (RCTs) and observational studies that used SB in patients with OHCA. Outcomes of interest were the rate of survival to discharge, return of spontaneous circulation (ROSC), sustained ROSC, and good neurological outcomes at discharge. Odds ratio (OR) with their 95% confidence interval (CI) were pooled in a random or fixed meta-analysis model. RESULTS: A total of 14 studies (four RCTs and 10 observational studies) enrolling 28,412 patients were included; of them, eight studies were included in the meta-analysis. The overall pooled estimate did not favor SB or control in terms of survival rate at discharge (OR= 0.66, 95% CI [0.18, 2.44], p=0.53) and ROSC rate (OR= 1.54, 95% CI [0.38, 6.27], p=0.54), while the pooled estimate of two studies showed that SB was associated with less sustained ROSC (OR= 0.27, 95% CI [0.07, 0.98], p=0.045) and good neurological outcomes at discharge (OR= 0.12, 95% CI [0.09, 0.15], p<0.01). CONCLUSION: The current evidence demonstrated that SB was not superior to the control group in terms of survival to discharge and return of spontaneous circulation. Further, SB was associated with lower rates of sustained ROSC and good neurological outcomes.

Attitude Toward Using the Triple Combination Bleaching Formula and Related Outcomes: A Cross-Sectional Study.

Introduction Kligman's formula is a topical triple combination consisting of hydroquinone, tretinoin, and topical corticosteroid. It has recently become widely popular among the general population for different purposes. Its improper use can lead to unsatisfactory results and unpleasant side effects. Aim This study aimed to assess the attitude, satisfaction, and complications related to topical usage of Kligman's formula among the general population in Saudi Arabia. Materials and methods A cross-sectional study was conducted among the general population of Saudi Arabia. A self-administered questionnaire was distributed among the targeted population using an online survey. The questionnaire includes socio-demographic characteristics, assessment of attitude, and satisfaction in using Kligman's formula. Data were tabulated and cleaned, and all statistical analyses were performed. Results A total of 292 participants met the inclusion criteria (26 males vs. 266 females) with a mean age of 26.9 (SD 7.71) years. Nearly 40% of participants showed a positive attitude in using Kligman's formula, while 46.9% were satisfied with using it. The most common reason for using Kligman's formula was to lighten the skin (55.8%), while skin redness was the most commonly reported adverse effect. Factors associated with increased attitude and satisfaction were using Kligman's formula based on a doctor's prescription and regular follow-up with a dermatologist. Conclusion The general population showed an improper attitude toward using Kligman's formula. However, a better attitude and satisfaction rate can be seen among those using Kligman's formula with prescription and those who regularly visit a dermatologist.