Pseudohypoaldosteronism Type 1b in a Saudi Female Infant Due to Homozygous Variant Gene Mutation in SCNN1A: A Case Report.

Pseudohypoaldosteronism type 1 (PHA1) is a rare, heterogeneous group of disorders characterized by resistance to aldosterone action. We report the case of a 17-day-old Saudi female infant who presented on the third day of life with persistent hyperkalemia, hyponatremia, and metabolic acidosis. Initial evaluation for congenital adrenal hyperplasia was unremarkable. Genetic testing confirmed a novel homozygous variant (c.1522C>T p.(Arg508) chr 12:6458147 in SCNN1 A) in the SCNN1A gene, consistent with the diagnosis of PHA1B, a genetically confirmed subtype of PHA1. Prompt recognition and management of electrolyte disturbances are crucial in these neonates to prevent life-threatening complications.

Risk Prediction of Severe Bronchopulmonary Dysplasia (BPD) Using the Respiratory Severity Score (RSS) in Extremely Preterm Infants: A Retrospective Study From Saudi Arabia.

Background Bronchopulmonary dysplasia (BPD) is a significant complication in extremely preterm infants. Therefore, early diagnosis of BPD is important for planning treatment strategies. In this study, we aimed to assess the predictive efficacy of the Respiratory Severity Score (RSS) in determining severe BPD or death outcomes in very preterm infants. Methodology This retrospective study included preterm infants born with a gestational age of ≤30 weeks. The inclusion criteria comprised individuals who were mechanically ventilated (<1 week) during the first four weeks of life. Any patients who died during the first seven days of life were excluded. RSS values were recorded on days 3, 14, 21, and 28 of life. Multivariate logistic regression was used to identify a correlation between RSS and patient outcomes. Results A total of 154 infants were included in the analysis, of whom 82 (53.24%) developed severe BPD and 38 (24.67%) died. RSS was higher in patients who either died or developed severe BPD compared to those who survived. The multivariate logistic regression analysis revealed that RSSs at postnatal day 14 (odds ratio (OR) = 3.970; 95% confidence interval (CI) = 1.114-14.147; p < 0.05), day 21 (OR = 6.201; 95% CI = 1.937-19.851; p < 0.05), and day 28 (OR = 8.925; 95% CI = 3.331-28.383; p < 0.05) was significantly associated with a higher risk of death or severe BPD. Conclusions The findings of the present study revealed that RSS can help predict the risk of severe BPD in very preterm infants.

Antibiotics efficacy in clinical and microbiological cure of uncomplicated urinary tract infection: a systematic review and network meta-analysis.

PURPOSE: Fosfomycin has been used more frequently in managing uncomplicated urinary tract infections (UTIs) due to decreased compliance and increased multidrug-resistant bacteria. The aim of this network meta-analysis was to assess the efficacy of Fosfomycin compared to Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), and Ciprofloxacin in terms of clinical and microbiological cure alongside with other measurements. MATERIALS AND METHODS: We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). We included randomized control trials (RCTs) with uncomplicated UTI patients who received Fosfomycin, Nitrofurantoin, TMP-SMX, or Ciprofloxacin and reported the clinical or microbiological cure. We used Cochrane Risk of Bias Assessment Tool to assess the included studies' quality. R-software was used for all statistical analysis. We ranked all antibiotics using the netrank function which yielded P scores. Frequentist network meta-analysis was used to assess the efficacy of all outcomes. RESULTS: We included 13 RCTs with a total number of 3856 patients that showed Fosfomycin ranked the highest among the other antibiotics with respect to clinical cure (P-score = 0.99) and microbiological cure (P-score = 0.99) while Ciprofloxacin ranked the lowest (P-score = 0.11 and 0.02, respectively). Moreover, Ciprofloxacin yielded the highest relapse rate (P-score = 1), whereas TMP-SMX had the lowest relapse rate (P-score = 0.07). As for the adverse events, Ciprofloxacin demonstrated the highest adverse events as opposed to Fosfomycin (P-score = 0.98 and 0.05, respectively). CONCLUSION: The network meta-analysis demonstrated that Fosfomycin is the most effective antibiotic in treating uncomplicated UTIs with respect to clinical cure, microbiological cure, and adverse events profile.

A Rare Case of Neonatal Hypomagnesemia with Secondary Hypocalcemia Caused by a Novel Homozygous TRPM6 Gene Variant.

BACKGROUND Familial hypomagnesemia with secondary hypocalcemia (HSH) is a rare autosomal recessive disorder (OMIM# 602014) caused by mutations in the gene encoding transient receptor potential melastatin 6 (TRPM6)) on chromosome 9q22, a channel involved in epithelial magnesium resorption. While a plethora of studies have delineated various clinical manifestations pertinent to this mutation, the literature is devoid of connections between TRPM6 mutations and bleeding diathesis, or sudden infant death syndrome (SIDS). This report presents a case of familial HSH associated with the novel homozygous TRPM6 gene variant c.5281C>G p. (Arg1761Gly) chr9: 77354845. CASE REPORT This report details a 26-day-old neonate, born full term with optimal Apgar scores, who experienced an abrupt emergence of apnea, cyanosis, bilateral nasal bleeding, and diminished alertness. Despite the neonate's initially unremarkable clinical birth indicators, a meticulous assessment unveiled a pronounced family history of SIDS, including a sibling previously diagnosed with hypomagnesemia. Laboratory examination of the infant demonstrated severe hypomagnesemia and hypocalcemia, conditions which were promptly ameliorated following intravenous administration of magnesium and calcium. Whole-exome sequencing identified a homozygous TRPM6 gene mutation c.5281C>G p. (Arg1761Gly) at chr9: 77354845. This gene is crucial for magnesium regulation. The mutation involves a cytosine-to-guanine shift, resulting in an arginine to glycine amino acid substitution at position 1761 of the TRPM6 protein. CONCLUSIONS This report has highlighted that infantile hypomagnesemia may be associated with symptoms and signs that can mimic infection, or it can present with seizures. Although familial HSH is a rare genetic disorder that can be identified by genetic testing, correction of hypomagnesemia is the most important and immediate clinical management strategy.

Retraction: Giant Unruptured Internal Carotid Artery Aneurysm.

[This retracts the article DOI: 10.7759/cureus.20423.].

Parents' Awareness and Knowledge of G6PD Deficiency in the Eastern Province Saudi Arabia: A Cross-Sectional Study.

Background Glucose-6-phosphate dehydrogenase deficiency, known as G6PD deficiency, is a common hematological disease in the Eastern Province. The presence of Glucose-6-phosphate dehydrogenase enzyme in the erythrocyte is crucial, as it aids in the protection of RBCs by preventing cellular damage. It was found that more than 400 million people in the world lack this enzyme, making it the most common enzyme deficiency worldwide. Because of the high prevalence of the disease in the world and the paucity of research in Saudi Arabia about G6PD deficiency, the idea of examining and assessing the awareness and knowledge of parents who have children affected with G6PD emerged. Objective This study aimed to evaluate parental knowledge regarding G6PD deficiency, identify the common and spread misconceptions regarding the disease, provide general insight for physicians about parental knowledge, and propose strategies to educate parents about G6PD deficiency. Methods This cross-sectional study was conducted from September 2022 to May 2023 on 459 individuals from the Eastern Province, Saudi Arabia. Using a questionnaire, parents with variable education levels and incomes participated. The questionnaire was available in both Arabic and English. The study aimed to gather comprehensive data regarding parental awareness and knowledge of G6PD deficiency, it focused on evaluating levels of awareness, knowledge, and misinformation of the participants. Data were analyzed by using Statistical Package for the Social Sciences, ver 22 (IBM Corp., Armonk, NY). The chi-square test was applied to check any association between demographics and level of knowledge (Good and Poor). Multiple logistic regression analysis was performed on significant demographic variables and an odds ratio with a 95% confidence interval was calculated. P < 0.05 was considered statistically significant. Results The study included a total of 459 participants, 309 (67.3%) were females and 150 (32.7%) were males. Regarding the demographics, the majority of the participants were <40 years old (61.9%), Saudi (99.3%), married (98.5%), having bachelor's/diploma level or above (Master/PhD) (76.9%), having inherited disorder (44.2%), and having a family history of chronic diseases (82.6%). Furthermore, regarding the knowledge of the disease, the majority of the participants who recognized the disease (82.1%) were familiar with the term fava bean anemia rather than it being called G6PD deficiency anemia. On the other hand, 73.2% of the participants were unable to recognize the disease and had never heard of G6PD deficiency anemia. In addition, the majority of participants had deficient information regarding medication triggers (61.4%), whether the gender of a person is linked to G6PD (77.5%), and whether both parents must be carriers to have a child with G6PD deficiency anemia (50.9%). Female respondents proved to be more knowledgeable regarding this topic as 57.9% of them showed good knowledge as compared to (44.7%) of the male subjects. Conclusion There are discrepancies in the level of awareness among research participants. Our result indicates the need for educational interventions regarding the nomenclature, medication triggers, inheritance mode and its relation to gender, and the symptoms of the disease and its severity. Therefore, it is advised to spread awareness in the eastern province through brochures, medical campaigns, and by healthcare professionals in different medical organizations.

Congenital Factor X-Riyadh (Stuart-Prower) Deficiency With Isolated Prothrombin Time Prolongation: A Case Report.

Factor X (FX) deficiency is an extremely rare autosomal recessive inherited coagulation defect. We report a case of congenital Factor X-Riyadh deficiency discovered during a routine workup before a dental procedure. During routine work-up for dental surgery, prothrombin time (PT) and the international normalized ratio (INR) were prolonged. The prothrombin time (PT) was found to be 78.4 (normal 11-14 seconds) with an international normalized ratio (INR) of 7.83; the activated partial thromboplastin time (APTT) was 30.7 (normal 25-42 seconds). Specific coagulation factor assays confirmed an FX deficiency (<10 % of normal activity) and a mild factor VII deficiency 37% (normal 48%-124%). Molecular genetic analysis of the whole exome sequence (WES) confirmed the diagnosis of FX deficiency (homozygous pathogenic variant c. 271G>A p {Glu91Lys} chr13:113793685). The patient is currently on regular follow-up and is advised to take oral antifibrinolytic medications for any superficial or mucosal bleeding.

Public awareness about arthritic diseases in Saudi Arabia: a systematic review and meta-analysis.

PURPOSE: Raising public knowledge and perception would have a discernible impact on providing optimal care and reducing the burden of arthritis in the community. This systematic review aimed to identify the public knowledge about the common arthritic conditions in Saudi Arabia. METHODS: We searched MEDLINE, Embase, and CENTRAL for relevant literature. We included questionnaire-based cross-sectional studies performed in Saudi Arabia assessing the public perception of general knowledge, causes/risk factors, signs/symptoms, and relieving/management measures of the common arthritic conditions including osteoarthritis (OA), rheumatoid arthritis (RA), and gout. The meta-analysis was performed on outcomes reported in ≥ two studies utilizing a random-effects model RESULTS: Ten studies representing 6703 participants were deemed eligible for inclusion in this review. A total of 35 questions were feasible to be included in the meta-analysis. The meta-analysis estimated that 83.51%, 54.51%, and 80.42% have ever hearsd or read about OA, RA, and gout. Joint pain and swelling were perceived to be the main signs/symptoms of OA, RA, and gout. 7.5% think OA is predisposed by genetics while only 33.6% think the same of RA. RA knowledge in general is suboptimum. Only 27.04% think medications can help in the management of gout. CONCLUSION: The Saudi public perception of the general knowledge and causes/risk factors of the most common arthritic conditions was acceptable. The level of knowledge about other aspects of the common arthritic conditions is still limited and needs to be addressed by future educational interventions. TRIAL REGISTRATION: PROSPERO registration number: CRD42022345274.

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. INTRODUCTION: The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). PURPOSE OF THE STUDY: To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. METHODS: We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. RESULTS: Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = -0.48, 95% CI -0.73 to -0.22, P < .001; SMD = -0.69, 95% CI -0.97 to -0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. CONCLUSION: This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses.

Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS: We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS: A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION: This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.

Botulinum toxin type A for lower limb lengthening and deformity correction: A systematic review and meta-analysis.

BACKGROUND: Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. METHODS: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03). CONCLUSIONS: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events. PROSPERO REGISTRATION NUMBER: CRD42021271580.

The role of soluble B cell maturation antigen as a biomarker in multiple myeloma.

Currently used stratification models in myeloma precursor disease as well as staging systems and response criteria in myeloma have limitations including failure to identify functionally high-risk myeloma patients. B-cell maturation antigen, a transmembrane glycoprotein required for long-lived plasma cells, is specific and expressed by myeloma cells. When it sheds from the surface of myeloma cells it can be measured in the blood as serum (sBCMA) and correlated with clinical outcomes in myeloma precursor disease as well as in active myeloma. We performed a literature review using PubMed and found 825 articles since 1992 of which any articles related to sBCMA were reviewed. These studies show the potential of sBCMA to become an important biomarker in myeloma. Here, we describe the potential advantages of sBCMA in the biology, diagnosis, prognosis, and surveillance of myeloma, while also reviewing the challenges that lie ahead before it can be implemented as a clinical tool.

LAD-III, a Mild Phenotype Resulting From a Novel Variant of FERMT3 Gene: A Case Report.

Leukocyte adhesion deficiency-III (LAD-III) is a rare recessive autosomal disorder characterized by bleeding syndrome of Glanzmann-type and life-threatening infections. The main etiology of this condition is variations in the FERMT3 gene, which encodes kindlin-3, an integrin-binding protein. This protein is responsible for the activation of fibrinogen receptors and integrin-mediated hematopoietic cell adhesion. So far, only limited cases of LAD-III have been reported. This case report discusses a two-year-old male infant from the Asir region, Saudi Arabia, who was referred to the pediatric hematology service due to recurrent ecchymosis and epistaxis. He was born at full term with a history of transient tachypnea of the newborn and recurrent bronchiolitis. The patient exhibited normal platelet count and coagulation profiles alongside a familial history of bleeding disorders, including a cousin with a similar condition. The patient also presented with hypospadias and café-au-lait spots. Laboratory findings revealed anemia, microcytosis, and hypochromia indicative of iron deficiency anemia. Whole exome sequencing (WES) identified a homozygous variant of uncertain significance in the FERMT3 gene, associated with autosomal recessive LAD-III. The patient was subsequently referred to an immunology subspecialty for further investigation and bone marrow transplant preparation. This case underscores the importance of comprehensive clinical and genetic evaluations in pediatric patients with unexplained bleeding tendencies.

Improvement of the aerodynamic behaviour of the passenger car by using a combine of ditch and base bleed.

The current study investigates different methods to minimize the drag coefficient (CD) without ignoring the safety factor related to the stability of a vehicle, i.e., the lift coefficient (CL). The study was carried out by employing an SUV car analyzed numerically using one of the CFD software, Ansys. Four different models such as realizable k-ε, standard k-ω, shear stress transport k-ω, and Reynolds stress model (RSM). The considered models have been validated with experimental data and found in good agreement. The considered inlet velocity varies from 28 to 40 m/s, the results showed that the drag coefficient and the stability are both improved by applying a modification on the roof of the considered car.

Determination of Anti-phage Antibodies in Calf Sera Following Application of Escherichia Coli and Mannheimia Haemolytica-specific Bacteriophages.

Introduction: The widespread occurrence of drug-resistant bacteria has increased interest in alternatives to antibiotics for combatting bacterial infections, among which bacteriophages play an important role. The ability of phage proteins to induce an anti-phage immune response can significantly limit the effectiveness of treatment, which was the basis for the study described in this article. The aim of the study was to assess the effects of bacteriophages on the induction of an anti-phage humoral response in calves. Material and Methods: The study was conducted using phage components of experimental preparations and sera from calves treated and not treated with phages. Levels of G, M and A immunoglobulins were analysed by ELISA. The assay plates were coated with whole Escherichia coli and Mannheimia haemolytica phages and selected phage proteins obtained in sodium dodecyl sulphate-polyacrylamide gel electrophoresis and two-dimensional electrophoresis. Neutralisation of phages by immunoglobulins was assessed by determining phage titres using double-layer plates. Results: The results confirmed an increased anti-phage response affecting all immunoglobulin classes in the calf sera. The highest significant (P ≤ 0.05) level of antibodies was observed for IgG in the sera of calves receiving phages. The phage neutralisation test showed a significant differences (P ≤ 0.05) in the reduction of phage titres in comparison to untreated calves. Conclusion: Despite the induction of an anti-phage response, no significant negative effect on the antibacterial activity of phages was observed in vitro.

Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background: Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. Methods: We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. Results: A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Conclusions: Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00718-0.

Primary Ciliary Dyskinesia: Phenotype Resulting From a Novel Variant of LRRC56 Gene.

Primary ciliary dyskinesia (PCD) involves cilia impairment, with resultant symptoms of repeated respiratory infections, sinusitis, and infertility. We report a seven-year-old boy of Arab ethnicity, with consanguineous parents, who was identified to have situs inversus totalis in neonatal life. There was a significant family history of ciliopathy as situs inversus totalis, infertility, and recurrent respiratory infections were noted in his two paternal uncles. From five months of age, the child started to have recurrent hospital visits due to respiratory infections. Infancy was marked by failure to thrive along with delay in achieving developmental milestones. Next-generation sequencing of known or potential ciliopathy genes revealed him homozygous for a novel mutation c.494T>C of the LRRC56 gene, thus defining PCD as a potential cause of his features.

Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis.

BACKGROUND: Trigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications. METHODS: This was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications. RESULTS: Five articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2. CONCLUSION: RFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.

Organophosphate Poisoning in a Paediatric Intensive Care Unit: A Retrospective Analysis Based on Ten Years of Experience.

Background: Organophosphate (OP) poisoning is one of the most common etiologies of poisoning in the pediatric age group. Objective: This study aimed to evaluate the demographic characteristics, clinical features, clinical course, and outcomes of children with toxicity from organophosphates admitted to the pediatric intensive care unit. Methods: A retrospective review of hospital medical records of all children aged 14 years and younger who were admitted to the PICU with a provisional diagnosis of organophosphate poisoning at King Fahad Hospital of the University (KFHU), Alkhobar, Saudi Arabia, between January 1, 2008, and December 31, 2018, was conducted. Patients with incomplete medical record information or with suspicion or evidence of one or more agents other than organophosphate were excluded from the study. Results: Thirty-one patients were enrolled in the study. The median age of the study population was 2 years, and 19 (61%) were males. The majority of patients (68%) had more than one route of organophosphate exposure. Skin exposure was reported in 26 patients (84%). Only three patients (10%) had suicidal organophosphate exposure from organophosphates, while the majority (28 patients; 90%) had accidental poisoning. Bronchorrhea was the most prevalent presenting feature, reported in 28 patients (90%). 17 patients (55%) were treated with intravenous atropine and (45%) were used a combination of pralidoxime with atropine for treatment. Five patients (16%) developed acute respiratory distress syndrome. Twelve patients (39%) needed endotracheal intubation and mechanical ventilation secondary to respiratory failure. Conclusion: The presenting features of organophosphate poisoning differ widely in children. Risk factors for mortality for PICU patients with organophosphate poisoning include delayed hospital arrival by more than 1 hour, inhalational route of exposure, need for mechanical ventilation, and high lactate levels in the first 24 hours post-exposure.

Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: A systematic review and meta-analysis.

OBJECTIVES: Overactive bladder (OAB) is identified as a urinary urgency accompanied by frequency and nocturia with or without urgency urinary incontinence in the nonexistence of a urinary tract infection or other evident pathologies. This systematic review and meta-analysis aimed to evaluate the efficacy of the transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) or anticholinergic drugs in reducing symptoms and improving the quality of life for OAB patients. METHODS: We performed a systematic search in Medline, Embase, and CENTRAL, in which we included randomized controlled trials that compared TTNS with anticholinergic drugs or PTNS in treating idiopathic OAB. We evaluated the following outcomes: 3-day voiding diary (voiding frequency/day, daytime micturition frequency/day, nighttime micturition frequency/day, number of urgency episodes/day, number of incontinence episodes/day, and mean voiding volume), symptom bother, health related quality of life (HRQoL), and adverse events. We used 95% as a confidence interval (CI) and p < 0.05. Standardized mean difference (SMD) was used for continuous outcomes, and the risk ratio (RR) was used for dichotomous outcomes. RESULTS: There was no significant difference comparing TTNS with anticholinergic drugs or PTNS regarding voiding frequency/day (SMD = -0.01, 95% CI -0.33 to 0.32), nighttime micturition frequency/day (SMD = -0.28, 95% CI -0.94 to 0.37), number of urgency episodes/day (SMD = -0.05, 95% CI -0.36 to 0.26), number of incontinence episodes/day (SMD = -0.04, 95% CI -0.32 to 0.25), symptom bother (SMD = -0.19, 95% CI -0.55 to 0.16), HRQoL (SMD = 0.27, 95% CI -0.32 to 0.85), and adverse events (RR = 0.07, 95% CI 0.01 to 0.54). CONCLUSION: The current meta-analysis reveals that there is no statistically significant difference between TTNS versus PTNS or anticholinergic drugs for the nonsurgical management of OAB patients.