Eosinophilic pneumonia: experience at two tertiary care referral hospitals in Saudi Arabia

Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary opacities associated with tissue or peripheral eosinophilia. A retrospective study conducted at two tertiary care hospitals from January 1999 to December 2009. All cases with the diagnosis of pulmonary eosinophilia were reviewed over a period of 10 years. Data on demographic, clinical, and radiologic characteristics were collected. Thirty-five patients with a mean age of 33.9 [16.2] years, of which 20 [57.1%] were male and meeting the criteria of eosinophilic lung disease were identified. Cough and dyspnea were the most frequent symptoms at presentation in 29 [82.9%] and 27 [77.1%] patients, respectively. Reticulonodular and airspace patterns were the most common radiographic findings in 17 [48.6%] and 15 [42.9%] patients, respectively. Peripheral eosinophilia was present in 33 [94.3%] patients. Twenty-four patients [68.6%] were labeled as having idiopathic pulmonary infiltrate with eosinophilia. Complete remission was achieved in 13 [54.2%] of 24 patients, while 10 [41.7%] patients relapsed within a few months of discontinuation of therapy. Specific therapy for a specific disease was administered in 8 patients: 2 patients for pulmonary tuberculosis, 2 for Churg-Strauss syndrome, 1 for lymphoma, 1 for schistosomiasis, 1 for acute eosinophilic pneumonia, and 1 for Wegener granuloma; 3 patients were treated as allergic bronchopulmonary aspergillosis. Pulmonary eosinophilia remains rare but challenging, and it can have the same diverse clinical and radiographic presentations seen with other common pulmonary conditions. Clinicians should be alert to these syndromes and must think of them in any lung disease differential diagnoses

-hospital mortality among a cohort of cirrhotic patients admitted to a Tertiary hospital

To determine the mortality rate in a cohort of hospitalized patients with cirrhosis and examine their resuscitation status at admission. A retrospective chart review was conducted of patients with cirrhosis who were admitted to a tertiary care hospital in Riyadh, Saudi Arabia, from January 1, 2009, to December 31, 2009. We reviewed 226 cirrhotic patients during the study period. The hospital mortality rate was 35%. A univariate analysis revealed that worse outcomes were seen in patients with advanced age or who had worse child-turcotte-pugh [CPT] scores, worse model for end-stage liver disease [MELD] scores, low albumin and high serum creatinine. Using a multivariate analysis, we found that advanced age [P=0.004] and high MELD [P=0.001] scores were independent risk factors for the mortality of cirrhotic patients. The end-of-life decision were made in 34% of cirrhotic patients, and the majority of deceased patients were "no resuscitation" status [90% vs. 4%, P<0.001]. The relatively high mortality in cirrhotic patients admitted for care in a tertiary hospital, Saudi Arabia was comparable to that reported in the literature. Furthermore, end-of-life discussions should be addressed early in the hospitalization of cirrhotic patients

Septic arthritis of the knee joint secondary to prevotella bivia

Prevotella bivia is an obligatory anaerobic, gram-negative rod, which often produces a detectable beta-lactamase. To date, there has been only 3 descriptions of septic arthritis secondary to this microorganism in a patients pre-existing sever joint disease like rheumatoid arthritis and osteoarthritis or after joint prosthesis. We are reporting the first case of septic arthritis due to Prevotella bivia in a patient with no pre-existing joint symptoms