Emergency physicians' preferences in bronchodilator delivery for asthma exacerbations: a cross-sectional study.

OBJECTIVE: Asthma is a chronic respiratory disorder characterized by airway inflammation and narrowing often leading to acute exacerbations that necessitate a visit to the emergency department (ED). While life threatening cases usually require bronchodilator delivery by nebulizers, mild to moderate acute asthma exacerbations can be treated by bronchodilators delivered either by metered dose inhalers (MDI). Numerous studies have attempted to compare between the two modalities and have drawn similar conclusions in that both are comparable in efficacy with minimal differences. What is evident, however, is that physicians remain inclined to favor nebulizers in the majority of acute asthma exacerbations. METHODS: In this questionnaire-based study, a survey was distributed to physicians who treat asthma exacerbations to examine demographics, knowledge, beliefs, and current practice in regard to bronchodilator therapy. RESULTS: The majority (90.8%) of physicians prefer short-acting beta agonists via nebulizer, with 9.2% favoring MDI + spacer. Participants include consultants, residents, and specialists across various emergency disciplines. While 90.1% find MDI + spacer equally effective as nebulizers, advantages cited include cost-effectiveness (49.6%), shorter ED stays (63.4%), quicker administration (67.9%), and ease of use (58.8%). Challenges include availability (66.4%) and ineffectiveness in younger patients (45%). Despite this, 65.6% are willing to switch to MDI for initial asthma management in the ED, while 34.4% are resistant. CONCLUSION: Concerns about availability and effectiveness in younger patients remain barriers. However, a significant number are willing to adopt MDIs with spacers, indicating potential for broader use with better availability and training.

Using tissue mitral valves in younger patients: A word of caution.

BACKGROUND: The debate about the optimal mitral valve prosthesis continues. We aimed to compare the early and late outcomes, including stroke, bleeding, survival, and reoperation after isolated mitral valve replacement (MVR) using tissue versus mechanical valves. METHODS: This retrospective cohort study included 291 patients who had isolated MVR from 2005 to 2015. Patients were grouped into the tissue valve group (n = 140) and the mechanical valve group (n = 151). RESULTS: There were no differences in duration of mechanical ventilation, hospital stay, and hospital mortality between groups. Fifteen patients required cardiac rehospitalization, nine in the tissue valve group, and six in the mechanical valve group (p = .44). Stroke occurred in nine patients, five with tissue valves, and four with mechanical valves (p = .66). Bleeding occurred in 22 patients, seven patients with tissue valves, and 15 patients with mechanical valves (p = .09). Freedom from reoperation was 95%, 93%, 84%, 67% at 3, 5, 7, and 10 years for tissue valve and 97%, 96%, 96%, and 93% for mechanical valves, respectively (p˂ .001). The median follow-up was 84 months (Q1: Q3: 38-139). Survival at 3, 5, 7, and 10 years was 94%, 91%, 89%, 86% in tissue valves and 96%, 93%, 91%, 91% in mechanical valves, respectively (p = .49). CONCLUSIONS: Tissue valve degeneration is still an issue even in the new generations of mitral tissue valves. The significant risk of reoperation in patients with mitral tissue valves should be considered when using those valves in younger patients. Mechanical valves remain a valid option for all age groups.

Naphthalene Toxicity in a Three-Year-Old Child Complicated by Severe Hemolytic Anemia and Mild Methemoglobinemia: A Case Report.

BACKGROUND: Exposure to naphthalene, which is widely used in mothballs, does not usually produce adverse effects. However, naphthalene can be toxic, especially in individuals with underlying conditions such as glucose-6-phosphate-dehydrogenase (G6PD) deficiency. CASE REPORT: A 3-year-old boy was brought to our Emergency Department after accidentally ingesting naphthalene mothballs 3 days prior to presentation. Laboratory investigations revealed that he had severe hemolytic anemia and mild methemoglobinemia (6%), which were treated with ascorbic acid and N-acetylcysteine. The patient tested positive for G6PD deficiency after stabilization and completion of his treatment. All provided treatments were administered empirically; test results were available only after the patient was discharged. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Naphthalene exposure is a common pediatric presentation with various complications that can occur in certain high-risk individuals, such as those with G6PD deficiency. Emergency physicians should be aware of this to anticipate and be able to treat worsening toxicity.

Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review.

MATERIALS AND METHODS: The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines. RESULTS: Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth. CONCLUSIONS: This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

Risk of Neuropsychiatric Adverse Effects of Lipid-Lowering Drugs: A Mendelian Randomization Study.

Background: Recent studies have highlighted the possible risk of neuropsychiatric adverse effects during treatment with lipid-lowering medications. However, there are still controversies that require a novel genetic-based approach to verify whether the impact of lipid-lowering drug treatment results in neuropsychiatric troubles including insomnia, depression, and neuroticism. Thus, we applied Mendelian randomization to assess any potential neuropsychiatric adverse effects of conventional lipid-lowering drugs such as statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and ezetimibe. Methods: A 2-sample Mendelian randomization study was conducted based on summary statistics from genome-wide association studies for lipids, insomnia, depression, and neuroticism. Single-nucleotide polymorphisms located in or near drug target genes of HMGCR, PCSK9, and NPC1L1 were used as proxies for statins, PCSK9 inhibitors, and ezetimibe therapy, respectively. To assess the validity of the genetic risk score, their associations with coronary artery disease were used as a positive control. Results: The Mendelian randomization analysis showed a statistically significant (P <.004) increased risk of depression after correcting for multiple testing with both statins (odds ratio=1.15, 95% CI: 1.04-1.19) and PCSK9 inhibitor treatment (odds ratio =1.19, 95%CI: 1.1-1.29). The risk of neuroticism was slightly reduced with statin therapy (odds ratio=0.9, 95%CI: 0.83-0.97). No significant adverse effects were associated with ezetimibe treatment. As expected, the 3 medications significantly reduced the risk of coronary artery disease. Conclusion: Using a genetic-based approach, this study showed an increased risk of depression during statin and PCSK9 inhibitor therapy while their association with insomnia risk was not significant.

Management of heart failure in the elderly.

PURPOSE OF REVIEW: Heart failure is a major chronic illness with no definitive cure. With improving healthcare and with an aging population in many countries, heart failure has become a common disease of the elderly. Pharmacological management of heart failure in the elderly remains a challenge. The syndrome of heart failure cannot be isolated from other comorbidities, which are very common in this population. The purpose of this review is to assist practicing clinicians to more effectively make decisions about management of heart failure in the elderly. RECENT FINDINGS: In this review, we will try to integrate recent research studies, recent guidelines, and new treatment modalities, and discuss some controversies. SUMMARY: In general, the elderly patient with heart failure should be treated according to current heart failure guidelines; however, untailored heart failure management may cause untoward effects in this age group and may worsen clinical outcome.

Stent-assisted coiling of intracranial aneurysms located on small vessels: midterm results with the LVIS Junior stent in 40 patients with 43 aneurysms.

INTRODUCTION: The Low-profile Visualized Intraluminal Support (LVIS) Junior stent is dedicated for endovascular treatment of wide-neck intracranial aneurysms located on small-diameter vessels (2-3.5 mm). This study reports midterm clinical and anatomical results of this device. METHODS: This study was approved by authors' ethical committees. A retrospective review of our prospectively maintained database identified all patients treated by this stent in three institutions. Technical issues and immediate and mid-term anatomical and clinical outcomes were evaluated. RESULTS: Forty patients (30 women/10 men, mean age of 55 years) with 43 aneurysms were identified. Mean aneurysm diameter was 5.6 mm (range, 2-13 mm). In all patients, treatment was successful and the stent could be precisely placed. There were three procedure-related complications, one stent thrombosis and two aneurysm ruptures, leading to immediate morbidity in one patient. Delayed ischemic events occurred in three patients including two transient attacks and one permanent deficit. The overall permanent morbidity rate was thus 5 %. No mortality occurred. Immediate aneurysm occlusion consisted of 36 complete occlusions (83.7 %), five neck remnants (11.6 %), and two incomplete occlusions (4.7 %). Twenty-seven patients (29 aneurysms) and 11 patients (11 aneurysms) had a 12- and 6-month angiographic follow-up, respectively. Final anatomical results included 36 complete occlusions (90 %) and four neck remnants (10 %). Two minor recanalizations were seen but did not require retreatment. Non-significant intrastent stenosis occurred in 7/40 followed-up cases (17.5 %). CONCLUSION: The LVIS Junior stent appears safe and effective for endovascular treatment of wide-neck intracranial aneurysms located on small vessels. Midterm results show high rates of adequate and stable occlusion.

Chyle and Bile Leak Following Open Cholecystectomy: A Rare Complication.

Gallstone disease is extremely common and frequently and safely treated by cholecystectomy. Chyle leak is a rare but significant side effect of many abdominal surgeries with rarely reported post-cholecystectomy. In this case, we report a 78-year-old lady with multiple comorbidities and symptomatic gallstones who underwent open cholecystectomy complicated by bile and chyle leak, which was successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting for bile leak and conservative management for the chyle leak, which included drainage, low-fat diet, and octreotide.

Video Game Addiction and its Relationship with Sleep Quality among Medical Students.

BACKGROUND: Although many health problems, including sleep disorders, have been associated with video gaming, further studies are required to establish the validity of these connections. This study aimed to determine the prevalence of gaming addiction among medical students and its association with poor sleep quality, which may be reflected in academic performance. METHOD: A cross-sectional survey was conducted between January and June 2023 among medical students at the institution under study. An online survey was conducted and was divided into three sections. The first section included the demographic data, the second section included the 7-item Gaming Addiction Scale (GAS), and the third section included the Pittsburgh Sleep Quality Index. Using the GAS, and based on the total score, gamers were classified as addicted, problematic, engaged, or normal. Hence, abnormal gamers include engaged, problematic, and addicted gamers. RESULT: There were 356 participants with a mean age of 22.5 -/+ 1.8 years, and 75.3% were males. The data showed that 38.8% of the study population were abnormal gamers: 40 (11.2%) engaged gamers, 81 (22.8%) problematic gamers, and 17 (4.8%) addicted gamers. Furthermore, abnormal gaming was linked to poor sleep quality when comparing abnormal gamers with normal gamers (92% vs. 80.3%, p = 0.002). Further comparison between the types of abnormal gamers revealed that addicted gamers were found to rely on sleep medication to help them sleep at night and took longer time to fall asleep (p = 0.050 and p = 0.045, respectively). CONCLUSION: Abnormal gamers are common among medical students and strongly associated with poor sleep quality compared to normal gamers.

Comparing short-axis versus long-axis ultrasound-guided techniques for internal jugular vein cannulation: A meta-analysis of clinical outcomes and safety.

Introduction: Central venous access plays a crucial role in various clinical settings, and ultrasound guidance has become increasingly popular for improving its safety and success rates. The aim of this meta-analysis was to compare the short-axis (SAX) and long-axis (LAX) ultrasound-guided techniques for internal jugular vein (IJV) cannulation in terms of first needle pass success rate, number of cannulation attempts, access time, guidewire insertion time, posterior IJV wall puncture, arterial puncture, haematoma and catheter-related bloodstream infection. Methods: A comprehensive literature search was conducted, and randomised controlled trials (RCTs) comparing SAX and LAX techniques for IJV cannulation on adults were included. Results: A total of 11 RCTs involving 1183 patients were included in the meta-analysis. The SAX technique demonstrated a significantly greater first needle pass success rate and faster IJV access time compared to the LAX technique. However, more posterior IJV wall puncture was significantly associated with the SAX technique. There was no significant difference between the two techniques in terms of number of cannulation attempts, guidewire insertion time, arterial puncture, haematoma and catheter-related bloodstream infection. Conclusion: This meta-analysis suggests that the SAX technique may have advantages over the LAX technique in terms of first needle pass success rate and potentially reducing cannulation attempts and access time. However, the occurrence of posterior IJV wall puncture raises concerns. The decision on the choice of technique should be based on individual patient factors and operator proficiency.

Effects of Thermocycling with Two Different Curing Techniques on Enamel Micro-Cracks Formation, Debonding, and Failure Modes of Ceramic Brackets: An In Vitro Study.

Despite the rise in popularity of ceramic braces for adults, the risk of enamel microcracks (EMCs) upon removal remains a significant drawback for both dental professionals and patients. Our study aimed to assess the effects of thermocycling, pre-curing, and co-curing techniques with different bonding agents on the enamel surface of teeth after the removal of ceramic brackets. We also examined the incidence, quantity, length, and direction of EMCs on tooth surfaces. Additionally, the adhesive remnant index (ARI) scores and orthodontic bracket bond failure modes were evaluated and compared. The study divided 40 extracted upper canine teeth into ten groups for further analysis. Two groups had intact enamel as the negative control, while the remaining groups had orthodontic ceramic brackets bonded using different bonding agents and curing techniques. Thermocycling was performed in five groups, and ARI was assessed after debonding. The study findings were statistically significant (p < 0.05) in demonstrating the impact of curing techniques on EMCs and debonding outcomes. Seventh-generation bonding agents resulted in complete adhesive removal (ARI = 0). The microcracks' incidence, number, and length showed insignificant results. Differences in ARI between thermocycler and non-thermocycler samples were insignificant. Both co-curing and pre-curing techniques yielded comparable ARI results. This study highlights the importance of using advanced bonding agents to minimize enamel damage during ceramic bracket debonding.

Prevalence of depression among subjects practicing aerobic vs. anaerobic exercise: a cross-sectional study.

BACKGROUND: As already proven in the literature, exercise positively affects mental health. However, the question regarding which type of exercise and what limit and time are sufficient to gain the maximum benefit still exists. The current study attempts to answer this question by comparing aerobic and anaerobic exercise in terms of the prevalence of depressive symptoms and their relationship with two different exercise categories. METHODS: Walking, running, and cycling represent forms of aerobic exercise, while resistance training represents anaerobic sport. A total of 680 participants, 428 males and 252 females, met the inclusion criteria. Of those, 368 stated that walking and running was their main form of exercise, while 174 preferred cycling and 138 took part in resistance training. RESULTS: The P value between the aerobic and anaerobic exercise groups in terms of the prevalence of depressive symptoms was 0.8, which is insignificant. This study also found that compliance, number of sessions, and time per session directly affected the prevalence of depressive symptoms. CONCLUSIONS: The results show that all exercise may lead to individuals becoming less prone to depression; there is no advantage to undertaking aerobic exercise over anaerobic exercise. As long as there is good adherence and the appropriate number of sessions and amount of time, individuals should be encouraged to choose their type of exercise according to their needs and preferences.

Paramedics' Success and Complications in Prehospital Pediatric Intubation: A Meta-Analysis.

BACKGROUND: Prehospital pediatric intubation is a potentially life-saving procedure in which paramedics are relied upon. However, due to the anatomical nature of pediatrics and associated adverse events, it is more challenging compared to adult intubation. In this study, the knowledge and attitude of paramedics was assessed by measuring their overall success rate and associated complications. METHODS: An online search using PubMed, Scopus, Web of Science, and Cochrane CENTRAL was conducted using relevant keywords to include studies that assess success rates and associated complications. Studies for eligibility were screened. Data were extracted from eligible studies and pooled as risk ratio (RR) with a 95% confidence interval (CI). RESULTS: Thirty-eight studies involving 14,207 pediatrics undergoing intubation by paramedics were included in this study. The prevalence of success rate was 82.5% (95% CI, 0.745-0.832) for overall trials and 77.2% (95% CI, 0.713-0.832) success rate after the first attempt. By subgrouping the patients according to using muscle relaxants during intubation, the group that used muscle relaxants showed a high overall successful rate of 92.5% (95% CI, 0.877-0.973) and 79.9% (95% CI, 0.715-0.994) success rate after the first attempt, more than the group without muscle relaxant which represent 78.9% (95% CI, 0.745-0.832) overall success rate and 73.3% (95% CI, 0.616-0.950) success rate after first attempt. CONCLUSION: Paramedics have a good overall successful rate of pediatric intubation with a lower complication rate, especially when using muscle relaxants.

Cupping Therapy as a Potential Complimentary Treatment for Meniere's Disease: A Case Report.

Meniere's disease is defined by the presence of three essential symptoms: episodic vertigo, tinnitus, and sensorineural hearing loss. The mainstay of its management constitutes lifestyle modification and medical and surgical therapies. Cupping therapy is an ancient treatment that is still widely used especially in the Middle East, Africa, and the United Kingdom. This study portraits the case of a 54-year-old patient suffering from long-standing Meniere's disease. The patient was treated with the routine treatment that was to no avail. It was decided that the patient undergoes cupping therapy. Over two years of monthly cupping therapy sessions, the patient reported a decrease in intensity and frequency of symptoms until its disappearance. Cupping therapy has shown a positive outcome on the patient. According to our search, there is a previous case report published in 2020 that shares multiple similarities with our case. Further studies on cupping therapy and its efficacy, mechanism of action, and complications on a larger scale are advised.

Should routine pulmonary function tests be performed in patients with left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery?

BACKGROUND: It is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes. METHODS: This is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test. The patients were divided into two groups: Group 1 who had a normal or mild reduction in pulmonary function tests and group 2 who had moderate to severe reduction in pulmonary function tests. The postoperative outcomes, including pulmonary complications, were compared between the two groups. RESULTS: Pulmonary function tests were normal or mildly reduced in 190 patients (group 1) and moderately to severely reduced in 176 patients (group 2). Propensity matching identified 111 matched pairs in each group with balanced preoperative and operative characteristics. Compared to group 1, Group 2 had longer duration of mechanical ventilation [12 (7.5-16) vs. 9 (6.5-13) hours, p < 0.001], higher postoperative Creatinine [111 (90-142) vs. 105 (81-128) µmol/dl, p = 0.02] and higher hospital mortality (6.31% vs. 0%, p = 0.02). CONCLUSION: Routine Pulmonary Function Testing should be performed in patients with Left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery since moderate to severe reduction in those patients was associated with longer duration of mechanical ventilation and higher hospital mortality.

The Prevalence of Musculoskeletal Injuries Among Pilgrims During the 2023 Hajj Season: A Cross-Sectional Study.

Background Hajj, the annual Islamic pilgrimage, brings together over two million pilgrims in the city of Makkah to participate in a series of rituals. Given the physically demanding nature of the Hajj, pilgrims are susceptible to musculoskeletal (MSK) injuries and exhaustion. MSK pain and injuries are frequent occurrences among pilgrims, necessitating an assessment of the scope of this issue. Therefore, the primary objective of this study was to determine the prevalence of MSK injuries among pilgrims during the 2023 Hajj season. Methods This is a cross-sectional questionnaire-based study that was conducted in the city of Makkah, Saudi Arabia, during the 2023 Hajj season. Results A total of 463 pilgrims were included in the analysis. The most frequently reported types of injuries were muscular injuries (169, 45.4%), primarily characterized by pain (99, 58.6%), muscle spasms (55, 32.5%), and muscle tears (eight, 4.7%). The second most commonly reported MSK injury was bony injuries (97, 26.1%), which included fractures, followed by 79 cases (21.2%) of joint injuries, predominantly featuring pain (69, 87.3%) and joint prolapse (10, 12.7%). Notably, 27 pilgrims (7.3%) suffered from ligament injuries, including tears. Regarding the mechanisms or causes of these MSK injuries, the most frequently reported factors were fatigue (206, 55.4%), falls (76, 20.4%), crowding (34, 9.1%), accidents (30, 8.1%), and the use of wheelchairs (14, 3.8%). Additionally, it is noteworthy that muscular injuries were more prevalent among all age groups, particularly among young-aged pilgrims, while joint injuries were more common among elderly pilgrims. Conclusion MSK injuries are prevalent among pilgrims, with muscular injuries being the most frequently encountered. This underscores a noteworthy public health concern that necessitates attention from the Ministry of Health of Saudi Arabia.

Risk Factor Predictors for Developing Epilepsy in Cerebral Palsy Patients in a Tertiary Hospital in Saudi Arabia: A Retrospective Study.

Background Cerebral palsy (CP) is a major cause of childhood motor impairment worldwide. The prevalence of CP related to preterm births has increased consistently. Perinatal hypoxic-ischemic encephalopathy, intra- or periventricular haemorrhage, cerebral dysgenesis and intracranial infections are among the factors contributing to CP onset. Several studies have explored epilepsy-related morbidity among children with CP, finding notable correlations between the two conditions. Worldwide, there are multiple studies highlighting the high prevalence of epilepsy among children with CP and its association with specific CP subtypes and neurologic insults. However, research on the risk factors for epilepsy in CP children is limited, particularly in the Middle East and Saudi Arabia. Aim This study aims to address this gap by analysing potential prenatal, antenatal, and postnatal risk factors associated with epilepsy development in children with CP. Methods A retrospective cohort analysis of 152 children aged 1-14 years diagnosed with CP at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, was conducted. Results The study showed a significant prevalence of epilepsy (68.4%), with generalised seizures being the most common type. Quadriplegia was notably common among CP children with epilepsy, indicating a potential correlation between motor impairment severity and epilepsy risk. Furthermore, CP children with epilepsy exhibited a higher prevalence of co-morbidities, emphasising the multifaceted nature of this condition. Perinatal and neonatal factors, such as hypoxic events, mechanical ventilation, perinatal asphyxia, neonatal convulsions, and microcephaly, were identified as significant risk factors for epilepsy in children with CP. While speech and hearing disorders were present in CP children with and without epilepsy, a slightly higher prevalence of impaired speech was observed in those with epilepsy. However, the difference between the two groups was not significant. Conclusion This study provides valuable insights into the epidemiology, clinical characteristics and potential risk factors associated with epilepsy among children diagnosed with CP in Saudi Arabia. The findings underscore the complexity of managing epilepsy in this population and highlight the need for further research to elucidate the underlying mechanisms and support the development of targeted interventions to improve patient outcomes.

Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Neonates Undergoing Open-heart Surgeries: Single Center Experience.

Background: Incidence and outcomes of acute kidney injury (AKI) among neonates who underwent open-heart surgery are not well highlighted in the literature. We aim to assess the incidence, risk factors, and outcome of AKI among neonates undergoing open-heart surgery. Methods: This is a retrospective cohort study between 2016 and 2021 for all neonates requiring open heart surgery. The cases were divided into 2 groups: the AKI (index) group and the non-AKI (control) group. The two groups were statistically compared for risk factors, needs for dialysis, and outcomes. Results: 100 patients fulfilled the inclusion criteria. Among them, 74 (74%) developed AKI, including 41 (55%), 15 (21%), and 18 (24%) patients in KDIGO stages 1, 2, and 3, respectively. Multivariate analysis comparing both groups demonstrated that low pre-operative creatinine (p = 0.01), prolonged bypass time (p = 0.0004) and high vasoactive inotropic score (VIS), (p = 0.0008) were risk factors for developing AKI post-operatively. Furthermore, in the AKI group, 17 (23%) neonates required renal replacement therapy in the form of peritoneal dialysis. The length of stay was higher in the AKI index group (p = 0.015). Patients who had AKI recovered their kidney function at discharge. There was no difference in mortality between both groups. Conclusion: The AKI occurred in 74% of neonates undergoing open-heart surgery, with 23% of them needing peritoneal dialysis. Low pre-operative creatinine, high VIS score, and prolonged bypass time are potential risk factors for AKI development after neonatal open-heart surgery. AKI may lead to prolonged hospitalization, though most affected patients recovered their normal kidney function at discharge.

Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises.

Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1-14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.

Evaluation of Serial Procalcitonin Levels for the Optimization of Antibiotic Use in Non-Critically Ill COVID-19 Patients.

BACKGROUND: Procalcitonin (PCT) has been used as a biomarker to guide antibiotic therapy in various patient populations. However, its role in optimizing antibiotic use in COVID-19 patients has not been well studied to date. Thus, we aimed to evaluate the use of serial PCT monitoring as an antimicrobial stewardship tool for COVID-19 patients. METHODS: This retrospective study included 240 COVID-19 patients who were admitted to a tertiary medical institution in Saudi Arabia between January 2020 and February 2022. Patients who received empiric antibiotic therapy for community-acquired pneumonia (CAP) and had serial procalcitonin levels were included. The patients were divided into two groups: the normal procalcitonin arm (PCT level < 0.5 ng/mL) and the elevated PCT arm (PCT level > 0.5 ng/mL). The primary and secondary outcomes were the effect of PCT monitoring on the duration of antibiotic exposure and the length of hospital stay, respectively. To measure the accuracy of PCT, the receiver-operating characteristic area under the curve (ROC-AUC) was determined. RESULTS: Among the included patients, 142 were in the normal procalcitonin arm (median PCT, 0.12 ng/mL), and 78 were in the elevated PCT arm (median PCT, 4.04 ng/mL). The baseline characteristics were similar between the two arms, except for the higher prevalence of kidney disease in the elevated PCT arm. There was no statistically significant difference in the duration of antibiotic exposure between the normal and elevated PCT arms (median duration: 7 days in both arms). However, the length of hospital stay was significantly shorter in the normal PCT arm (median stay, 9 days) than in the elevated PCT arm (median stay, 13 days; p = 0.028). The ROC-AUC value was 0.54 (95% CI: 0.503-0.595). CONCLUSIONS: Serial PCT monitoring did not lead to a reduction in the duration of antibiotic exposure in COVID-19 patients. However, it was associated with a shorter hospital stay. These findings suggest that PCT monitoring may be useful for optimizing antibiotic use and improving outcomes in COVID-19 patients. While PCT-guided algorithms have the potential to enable antibiotic stewardship, their role in the context of COVID-19 treatment requires further investigation.