RESUMO
Deficiency in interleukin-12 (IL-12) can result in susceptibility to opportunistic infection, with IL-12 deficiency being a rare genetic cause. Nocardia farcinica is a gram-positive aerobic actinomycete that can cause disseminated and potentially lethal nocardiosis in immunocompromised patients. This report describes a 16-year-old male adolescent with IL-12 deficiency presenting with generalized lymphadenopathy due to disseminated Nocardia farcinica. The subject of our study is a male adolescent who exhibited clinical manifestations consistent with cholestasis. He underwent extensive workup for malignancy, suspecting cholangiocarcinoma initially. The workup turned out unremarkable, and later during his hospital stay, he deteriorated and required intensive care unit (ICU) admission, as he developed superior vena cava (SVC) syndrome from massive enlargement of mediastinal and cervical lymph nodes. During the patient's admission, it was found that he had a deficiency of interleukin-12 (IL-12). Later on, a blood culture revealed the presence of Nocardia farcinica species. Subsequently, the patient was initiated and improved drastically on an empirical antibiotic regimen consisting of amikacin, co-trimoxazole, meropenem, and moxifloxacin. Following that, the susceptibility results came out, and he was switched to oral co-trimoxazole and oral moxifloxacin as he no longer required inpatient care. This report highlights the importance of accurate diagnosis of causes of immunosuppression and early investigation, diagnosis, and management of potentially fatal opportunistic infections such as disseminated Nocardia farcinica.
RESUMO
BACKGROUND: Pre-conception care is well known as part of opportunistic, proactive, preventive care for men and women throughout their reproductive years; to lower behavioural, environmental and health-related factors that could lead to poor maternal and foetal outcomes. Many studies have been conducted on the delivery of pre-conception care worldwide. However, no studies were conducted in Saudi Arabia on this topic. OBJECTIVE: To explore knowledge, attitudes and practice of pre-conception care among primary health care physicians in Riyadh's Ministry of Health primary care centres and identify barriers they may face. METHODS: A phenomenological qualitative approach using in-depth interviews was conducted on participants recruited, between January 2019 and January 2020. Data collection and thematic analysis continued concurrently until maximum variation and theme saturation was achieved by the 10th interview. RESULTS: Three themes emerged from the data: interpretation of pre-conception care; pre-conception care initiative; and collaboration and education. Participants believed in the benefits of pre-conception care despite their expressed hesitancy in providing it. They expressed dissatisfaction with a few barriers to pre-conception care provision including time constraints in the clinical setting and cultural factors. However, they remained optimistic and motivated to implement changes to attain a higher quality of care. CONCLUSIONS: The gained insight from the in-depth exploration of physicians' perspectives on pre-conception care helps direct future resources and efforts to both team-based, multi-disciplinary preventative approaches, and population education on the importance of preparing for a pregnancy.
