Pediatric community acquired urinary tract infections due to extended-spectrum beta-lactamase versus non-extended-spectrum beta-lactamase producing bacteria.

BACKGROUND: This study aimed to evaluate the demographics, clinical characteristics, risk factors, and antibiotic resistance of pediatric community-acquired urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing uropathogens. METHODS: This retrospective study was conducted at a tertiary care hospital in Saudi Arabia, among children aged between 0 and 14 years, with a culture-proven diagnosis of community-acquired UTI between February 2019 and September 2021. Patients were divided into two groups based on whether or not their UTI was caused by ESBL-producing bacteria. RESULTS: A total of 383 patients with community-acquired UTI were evaluated. Escherichia coli was detected in 72.6% of cultures. Extended-spectrum beta-lactamase-producing organisms were responsible for 35.7% of UTI episodes. Of these 69% and 31% were caused by E. coli and Klebsiella pneumoniae, respectively. There were no significant differences between the two groups with regard to clinical presentation or urine analysis. The resistance rates in the ESBL-producing group were 39.4% for amoxicillin/clavulanic acid, 65.7% for ciprofloxacin, 72.3% for co-trimoxazole, 32.8% for nitrofurantoin, 21.2% for gentamicin, and 0.7% for amikacin and carbapenems. In the non-ESBL-producing group, it was 22.4% for amoxicillin/clavulanic acid, 22.4% for ciprofloxacin, 38.2% for co-trimoxazole, 23.6% for nitrofurantoin, 6.1% for gentamicin, and zero for amikacin and carbapenems. The presence of renal abnormalities (p = 0.014) and male gender (p = 0.026) were determined to be independent risk factors for ESBL UTIs. CONCLUSIONS: Recognizing risk factors and antibiotic resistance for ESBL-producing bacteria may aid in tailoring an antibiotic regimen for pediatric patients at high risk of ESBL-UTIs.

Clinical description and evaluation of 30 pediatric patients with ultra-rare diseases: A multicenter study with real-world data from Saudi Arabia.

BACKGROUND: With the advancement of next-generation sequencing, clinicians are now able to detect ultra-rare mutations that are barely encountered by the majority of physicians. Ultra-rare and rare diseases cumulatively acquire a prevalence equivalent to type 2 diabetes with 80% being genetic in origin and more prevalent among high consanguinity communities including Saudi Arabia. The challenge of these diseases is the ability to predict their prevalence and define clear phenotypic features. METHODS: This is a non-interventional retrospective multicenter study. We included pediatric patients with a pathogenic variant designated as ultra-rare according to the National Institute for Clinical Excellence's criteria. Demographic, clinical, laboratory, and radiological data of all patients were collected and analyzed using multinomial regression models. RESULTS: We included 30 patients. Their mean age of diagnosis was 16.77 months (range 3-96 months) and their current age was 8.83 years (range = 2-15 years). Eleven patients were females and 19 were males. The majority were of Arab ethnicity (96.77%). Twelve patients were West-Saudis and 8 patients were South-Saudis. SCN1A mutation was reported among 19 patients. Other mutations included SZT2, ROGDI, PRF1, ATP1A3, and SHANK3. The heterozygous mutation was reported among 67.86%. Twenty-nine patients experienced seizures with GTC being the most frequently reported semiology. The mean response to ASMs was 45.50% (range 0-100%). CONCLUSION: The results suggest that ultra-rare diseases must be viewed as a distinct category from rare diseases with potential demographic and clinical hallmarks. Additional objective and descriptive criteria to detect such cases are needed.

Short-term effectiveness and side effects of ketogenic diet for drug-resistant epilepsy in children with genetic epilepsy syndromes.

Background: Drug-resistant epilepsy (DRE) impacts a significant portion, one-third, of individuals diagnosed with epilepsy. In such cases, exploring non-pharmacological interventions are crucial, with the ketogenic diet (KD) standing out as a valuable option. KD, a high-fat and low-carb dietary approach with roots dating back to the 1920s for managing DRE, triggers the formation of ketone bodies and modifies biochemistry to aid in seizure control. Recent studies have increasingly supported the efficacy of KD in addressing DRE, showcasing positive outcomes. Furthermore, while more research is needed, limited data suggests that KD May also be beneficial for specific genetic epilepsy syndromes (GESs). Objective: This study aimed to assess the short-term efficacy of KD among pediatric patients diagnosed with GESs. Materials and methods: This is a multi-center retrospective analysis of pediatric patients with GESs diagnosed using next-generation sequencing. The enrolled patients followed the keto-clinic protocol, and the KD efficacy was evaluated at 3, 6, and 12-month intervals based on seizure control and compliance. The collection instrument included demographic, baseline, and prognostic data. The collected data was coded and analyzed promptly. Results: We enrolled a cohort of 77 patients with a mean current age of 7.94 ± 3.83 years. The mean age of seizure onset was 15.5 months. Notably, patients experienced seizures at a younger age tended to have less positive response to diet. Overall, 55 patients responded favorably to the diet (71.4%) while 22 patients (28.6%) showed no improvement. Patients with genetic etiology showed a significantly more favorable responses to the dietary intervention. Patients with Lennox-Gastaut syndrome showed the most significant improvement (14/15) followed by patients with Dravet syndrome (6/8), and West syndrome (3/4). The number of used anti-seizure medications also played a significant role in determining their response to the diet. While some patients experienced mild adverse events, the most common being constipation, these occurrences were not serious enough to necessitate discontinuation of the diet. Conclusion: The study revealed a high improvement rate in seizure control, especially among younger patients and those with later seizure onset. The success of dietary treatment hinges greatly on early intervention and the patient's age. Certain genetic mutations responded favorably to the KD, while efficacy varied among various genetic profiles.

Demographics and Clinical Presentations of Patients Visiting the Emergency Department During the Holy Month of Ramadan: A Three-Year Retrospective Study in a Muslim-Majority Country.

Background and objective Ramadan is the Muslim's holiest month; it is a time when believers engage in special practices that include fasting from dawn till dusk and making cultural and dietary modifications in their everyday lives. The impact of Ramadan on human activity, sleeping patterns, and circadian rhythms of hormones have been addressed in the literature. Fasting, which constitutes the main pillar of practices during Ramadan and lasts from sunrise to sunset, can significantly affect common health conditions, leading many to seek medical care in the Emergency Department (ED). Hence, it is important to understand the pattern of ED visits and understand the impact caused by fasting during this holy month in a Muslim-majority country. In light of this, this study aimed to gather new insights into the pattern of ED visits during Ramadan at a busy tertiary care center in the period from 2019 to 2021. Methods This study was conducted by reviewing the hospital health information system to gather relevant information in May 2022. Data of patients who visited the ED during Ramadan were collected, as well as during a month prior to and after Ramadan for the purpose of comparison. Sociodemographic characteristics and clinical profiles were collected for analysis.  Results The total number of ED visits in the three months of Ramadan during the study period (three years) was 33,142, all of which were included in our analysis. Sociodemographic data were analyzed for patients who visited the ED during the month of Ramadan and the two lunar months that precede and succeed Ramadan (Shaban and Shawal). Fever was the most common complaint (16.5%), followed by abdominal pain (14%). When analyzing the findings based on patient age groups, fever was found to be the most prevalent complaint in both adults (15.6%) and pediatric patients (34.4%). Of the total ED patient visits, 7,527 patients were admitted for further care, and 197 patients deceased. Conclusion Our study findings illustrate the change in ED visit patterns during the month of Ramadan in a Muslim-majority country. Also, the type of complaints was affected significantly due to the ongoing coronavirus disease 2019 (COVID-19) pandemic during the study period. The outcomes in patients reflected substantial progress and outcomes in the ED. These findings highlight that analyzing ED data can help provide accurate information that can be used to help modify/adjust the quality of services provided in the ED. However, these modifications may affect all hospital facilities, not just the ED.

Antibiotic resistance patterns of pediatric community-acquired urinary tract infections in a tertiary care center in Jeddah, Saudi Arabia.

INTRODUCTION: Urinary tract infections (UTIs) are common in children. UTIs can lead to serious and permanent damage to the urinary tract if treatment is delayed or insufficient, particularly in repeated infections. Knowledge of antibiotic resistance trends aids in the selection of appropriate empiric antibiotics. There is limited data regarding this in Saudi Arabia. This study aimed to investigate uropathogens and their antibiotic resistance patterns in the pediatric community in a tertiary care center. METHODOLOGY: The study population included children aged 0 to 14 years old who had culture-proven UTIs evaluated in the Department of Pediatrics, King Abdulaziz University Hospital in Jeddah, Saudi Arabia from February 2019 to September 2021. RESULTS: Out of 510 UTI episodes, Escherichia coli (54.5%) was the predominant causative pathogen. Of the total episodes, 137 (26.8%) were caused by extended spectrum beta-lactamase (ESBL) producers. In general, the highest resistance was observed against ampicillin (73.2%), cefazolin (54.6%), co-trimoxazole (46%), and cefuroxime (40.6%), whereas amikacin (0.4%), imipenem (0.8%), and meropenem (0.8%) showed the lowest rates of resistance. CONCLUSIONS: Antibiotic resistance is a major concern worldwide due to misuse of antibiotics and subsequent rise of multidrug resistant organisms. Our findings highlight the rise in antibiotic resistance, particularly in E. coli strains. Furthermore, ESBL-producing bacteria were responsible for approximately one-third of UTIs. Our study emphasizes the importance of local antibiograms for pediatric community-acquired infections, as it guides clinicians in every center in the choice of appropriate empiric antibiotic treatment.

Adverse Childhood Experiences and Their Effect on Irritable Bowel Syndrome Among Saudi Arabian Adults.

Background Adverse childhood experiences (ACEs) are traumatic events that occur before 18 years of age. ACEs have been associated with many negative health problems, including the development of chronic diseases, such as irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by abdominal pain. We investigated the prevalence of ACEs among patients with IBS, identified the types of ACEs commonly related to patients with IBS, and further assessed the impact of ACEs on IBS severity. Methodology A cross-sectional study was performed. The study targeted patients with IBS aged ≥ 18 years who were recruited from gastroenterology outpatient clinics at King Abdulaziz University Hospital. Adults were contacted and invited to take part in the study by completing a survey. Data were collected using two validated questionnaires, the ACE questionnaire for adults and the IBS symptom severity scoring system. Results The study included 109 patients with IBS (59.6% females). The prevalence of ACEs (patients with IBS exposed to at least one ACE) was 63.3%. The most prevalent type was emotional abuse (34.9%), followed by both physical abuse and emotional neglect (28.4%). Females reported significantly more ACEs (p = 0.035) than males. The overall IBS symptoms (r = 0.195, p = 0.043) and abdominal pain (r = 0.240, p = 0.012) severity were significantly correlated with total ACEs score. Conclusions Our findings point to a probable association between ACEs exposure and IBS, demonstrating their long-term impacts on symptoms severity. Further studies are needed to acquire a better understanding of the potential impact of ACEs on IBS.