Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy.

OBJECTIVES: To determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24-32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence. STUDY DESIGN: Retrospective chart review of preterm infants with a gestational age (GA) of 24-326 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors. RESULTS: Among 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24-27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007). CONCLUSION: Cesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period.

Evaluation of pollen germination of some palm males and pollination impact on bunch weight and fruit quality in Kadary date palm cultivar (Phoenix dactylifera L.).

The present study was carried out during two successive seasons (2013-2014) at the Research and Agriculture Experiment Station, Dirab, College of Food and Agricultural Sciences, King Saud University, Riyadh. Pollen grains, used in this trial, were collected from eleven male, namely Succary, Menify, Sallag, Dikhiny, Nabout Zamel, Serry, Khalas, Shagra, Safry, Maktumi and Kadary in order to pollinate female Kadary date palm cultivar. Results indicated that pollens of Safry male followed by Succary, Menify and Serry males increased the physical and biochemical characteristics of fruits during both seasons. Also, all the studied characters were significantly affected with different pollen males used in this trial. Pollens of Safry male gave highest fruit retention and bunch weight and best fruit quality like fruit and flesh weight, fruit size and fruit length and fruit biochemical properties as compared with other male. In vitro pollen germination of eleven males was studied using various concentration of sucrose (4, 6, 8 and 10%). The results showed that best germination was achieved with 8% sucrose concentration; however, 10% sucrose resulted in reduced percentage of pollen germination. In addition, pollen tube growth of five males (Succary, Sallag, Nabout-Zamel, Khalas and Safry) at 8% sucrose was alsostudied at 2, 4, 6 and 24 hr time interval. Elongation rate of pollen tube increased significantly after 24 hrs and it was found that pollens of Safry male gave highest pollen tube growth after 24 hrs than pollens of other male.

Macular corneal dystrophy in Saudi Arabia: a study of 56 cases and recognition of a new immunophenotype.

PURPOSE: To determine the immunophenotype or immunophenotypes of macular corneal dystrophy in Saudi Arabia. METHODS: We studied 56 cases of macular corneal dystrophy. Tissue from 60 corneal transplant buttons was stained by the avidin-biotin complex method using an anti-keratan sulfate monoclonal antibody. The serum antigenic keratan sulfate was measured in 23 of the 56 patients, four unaffected relatives, and 13 individuals with chronic actinic keratopathy. Serum and corneal tissue were studied in 17 of the 50 affected individuals with corneal transplant material. RESULTS: Thirty-five corneas (58.3%) of 29 of 50 patients did not react with anti-keratan sulfate monoclonal antibody. The stroma and abnormal intracellular and extracellular corneal accumulations reacted with anti-keratan sulfate monoclonal antibody in seven corneas (11.7%). The stroma in the other 18 corneas (30.0%) from 15 patients did not react with the anti-keratan sulfate monoclonal antibody, but corneal fibroblasts did. Twenty-one of the 23 patients with macular corneal dystrophy had no detectable serum antigenic keratan sulfate (< 9 ng/ml); two had values of 12 and 51 ng/ml, respectively, and their corneal stroma and abnormal accumulations reacted with anti-keratan sulfate monoclonal antibody. CONCLUSIONS: We detected macular corneal dystrophy type IA, a new immunophenotype characterized by the lack of detectable antigenic keratan sulfate in the serum (< 9 ng/ml), and a corneal stroma that did not react with the keratan sulfate monoclonal antibody but in which corneal fibroblasts did react with keratan sulfate monoclonal antibody (in 15 of 50 patients).

Bacterial keratitis following phototherapeutic keratectomy.

BACKGROUND: Phototherapeutic keratectomy (PTK) is effective in the treatment of many superficial corneal disorders. The incidence of bacterial keratitis following PTK has not been assessed in a large, prospective clinical trial. METHODS: We report three cases of bacterial keratitis that occurred in a prospective study of 258 consecutive PTK procedures at King Khaled Eye Specialist Hospital. RESULTS: Three (1.2%) of 258 eyes developed bacterial keratitis during a period of follow up ranging from 1 to 24 months. All three cases were in 183 eyes (1.6%) with a diagnosis of climatic droplet keratopathy, while no cases were observed in 75 eyes with other anterior corneal disorders. Gram-positive species (Streptococcus pneumonia in two, coagulase-negative Staphylococcus in one) were the predominant species isolated from all three cases. Two of the cases were polybacterial. The final visual outcomes ranged from 20/125 to 20/400. CONCLUSIONS: The risk of bacterial keratitis following treatment of superficial corneal disorders with PTK is low but its occurrence may adversely affect the final visual outcome.

Tuberculosis simulating malignancy.

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Juvenile mammary hypertrophy: is reduction mammaplasty always feasible?

Juvenile mammary hypertrophy is a rare disorder, and till date only 21 cases have been reported in the literature. The management of this condition includes screening for hormonal imbalance and reduction mammaplasty. However, we believe that the following case is worth reporting not only because of the rarity of the condition but also because it is the only case in which a bilateral subcutaneous mastectomy was performed instead of a reduction mammaplasty procedure because of massive intraoperative bleeding.

Vascular injuries associated with limb fractures.

The records of 46 patients with vascular injuries of the lower and upper limbs associated with bone fractures and managed in the authors' vascular and orthopaedics divisions were reviewed. All were young men, 26 with blunt and 20 with penetrating vascular injuries; 20 were treated by end to end anastomosis, 12 by vein interposition grafting, six by prosthetic graft, six by vein patches and lateral sutures and two by ligations. The limb salvage rate was 93 per cent. Three patients died (6.5 per cent) of severe associated injuries. Amputations were needed in three patients (6.5 per cent) with popliteal, tibial arteries and vein injuries. An aggressive approach to limb salvage is needed in these extensive injuries.

Morphological identification of scorpion species from Jazan and Al-Medina Al-Munawara regions, Saudi Arabia

The present work is a complementary contribution to the comprehensive study of the scorpion sting syndrome in Saudi Arabia. It deals with the identification and determination of medically important scorpions and the other ones, which were collected from two regions (Jazan and Al-Medina Al-Munawara), based on their morphology (the molecular phylogeny and venom characteristics will appear in subsequent publications). The specimens collected from those two regions were brought to the Research Center laboratories in several batches. Morphological identification of the collected specimens was done employing identification keys. There were 646 specimens collected from Jazan Region. A single species, Nebo hierichonticus (Family Diplocentridae), and five genera with four identified species, Parabuthus liosoma, Hottentotta jayakari (salei?), Compsobuthus werneri, Leiurus quinquestriatus (Vachoniolus globimanus?), Vachoniolus spp. (other species) and Orthochirus innesi (Family Buthidae), were classified as extant scorpions in the region. Three hundred and ninety-six specimens from Al-Medina Al-Munawara Region were categorized into eight groups; four of them were identified. Three buthids, Leiurus quinquestriatus, Androctonus crassicauda, Orthochirus innesi and one scorpion specimen, Scorpio maurus, were identified and classified as extant scorpions in this region. The other four species are still not completely identified. They are Vachoniolus (Buthacus minipectinibus?) globimanus? (Unidentified-1), Compsobuthus spp (arabicus?) (Unidentified-2), Compsobuthus spp (werneri?) (Unidentified-3) and a single specimen of Androctonus spp (australis?) (Unidentified-4), all of which belong to the family Buthidae.(AU)

Morphological identification of scorpion species from Jazan and Al-Medina Al-Munawara regions, Saudi Arabia

The present work is a complementary contribution to the comprehensive study of the scorpion sting syndrome in Saudi Arabia. It deals with the identification and determination of medically important scorpions and the other ones, which were collected from two regions (Jazan and Al-Medina Al-Munawara), based on their morphology (the molecular phylogeny and venom characteristics will appear in subsequent publications). The specimens collected from those two regions were brought to the Research Center laboratories in several batches. Morphological identification of the collected specimens was done employing identification keys. There were 646 specimens collected from Jazan Region. A single species, Nebo hierichonticus (Family Diplocentridae), and five genera with four identified species, Parabuthus liosoma, Hottentotta jayakari (salei?), Compsobuthus werneri, Leiurus quinquestriatus (Vachoniolus globimanus?), Vachoniolus spp. (other species) and Orthochirus innesi (Family Buthidae), were classified as extant scorpions in the region. Three hundred and ninety-six specimens from Al-Medina Al-Munawara Region were categorized into eight groups; four of them were identified. Three buthids, Leiurus quinquestriatus, Androctonus crassicauda, Orthochirus innesi and one scorpion specimen, Scorpio maurus, were identified and classified as extant scorpions in this region. The other four species are still not completely identified. They are Vachoniolus (Buthacus minipectinibus?) globimanus? (Unidentified-1), Compsobuthus spp (arabicus?) (Unidentified-2), Compsobuthus spp (werneri?) (Unidentified-3) and a single specimen of Androctonus spp (australis?) (Unidentified-4), all of which belong to the family Buthidae.