Efficacy of newer modalities in the management of indirect hyperbilirubinaemia at a secondary care hospital: A prospective study from 2015-2018.

OBJECTIVE: To evaluate the efficacy of current practices and new modalities for the management of neonatal indirect hyperbilirubinaemia. METHODS: The prospective study was conducted at King Khalid Hospital, Al Majmaah, Saudi Arabia, from September 2015 to September 2018, and copmprised neonates with hyperbilirubinaemia who were managed using the National Institute for Health and Clinical Excellence 2010 guidelines. The outcomes were measured in terms of decrease in total serum bilirubin and clinical improvement. Data was analysed using SPSS 25. RESULTS: Of the 233 subjects, there were 119(51%) girls and 114(49%) boys. Phototherapy was used in 162(69.5%) cases, intensive phototherapy in 36(15.5%) and intravenous immunoglobulin in 35(15%). Exchange transfusion was done in 2(0.85%) patients. All the 233(100%) patients improved with the management and total serum bilirubin significantly reduced (p<0.05). CONCLUSIONS: Newer techniques were found to have a vital role in the management of neonatal hyperbilirubinaemia.

Sensitivity Profile of Fosfomycin, Nitrofurantoin, and Co-trimoxazole Against Uropathogens Isolated From UTI Cases in a Secondary Care Center, KSA.

Background Fosfomycin, nitrofurantoin, and co-trimoxazole are cheap and effective first-line oral antimicrobials in cases of uncomplicated cystitis in males and non-pregnant females. Fosfomycin and nitrofurantoin are called urinary antiseptics because these two drugs are primarily excreted in the kidney and concentrated in the urine without systemic effect. The present study was designed to evaluate the in vitro activities of fosfomycin, nitrofurantoin, and co-trimoxazole against uropathogens isolated at King Khalid Hospital Al-Majmaah, KSA. Methods The study was conducted at the King Khalid Hospital Al Majmaah, KSA, from September 1, 2021, until February 28, 2022. The patients' urine samples were inoculated on the Cystein Lactose Electrolytes Deficient (CLED) medium, and uropathogens were isolated. The organisms' identification and sensitivity testing against cotrimoxazole, fosfomycin, and nitrofurantoin was conducted using a Microscan automated analyzer, the MicroScan WalkAway Beckman Coulter, Sacramento, CA, USA. Results The study comprised non-repeat 137 patients who were either admitted to the hospital or treated as outpatients, yielding a total of 147 isolates. Nitrofurantoin showed a lower resistance rate, around 20% (n = 29), followed by fosfomycin at 23% (n = 34). The resistance rate of cotrimoxazole was 43% (n = 63). Overall, nitrofurantoin and fosfomycin showed relatively lower resistance against all isolates. Conclusions Being cheap and effective, we propose that fosfomycin and nitrofurantoin be used as first-line treatments in patients presenting with uncomplicated UTIs.

Epidemiological Analysis And Successful Management Of A Candida Auris Outbreak In A Secondary Care Hospital Setting In Saudi Arabia; An Outbreak Report.

Candida auris has emerged as a major diagnostic and therapeutic challenge in the hospital environment. C. auris is resistant to many antifungals, making it a newer example of one of the world's most problematic and feared health threats. We recently confronted a cluster of C. auris cases at our hospital during the spring of 2020.This outbreak investigation took place at the ICU of King Khalid hospital Al Majmaah Saudi Arabia. Considering its potential to cause an outbreak with serious consequences, strict control measures were implemented thus effectively controlling the outbreak.

Recurrent Urinary Tract Infection in a Renal Transplant Patient by Pan-resistant Myroides Spp.

The myroides bacteria species are multidrug-resistant gram-negative aerobic bacilli. The genus myroides comprises two species, i.e., M. odoratimimus and M. odoratus, and is usually associated with infections in immunocompromised patients; though infections in immunocompetent individuals have also been reported. They are a rare cause of infection worldwide. So far, only 53 cases have been reported in the literature. Here, we report a case of recurrent urinary tract infection by myroides species. This is the first documented case in Saudi Arabia to the best of our knowledge. Key Words: Myroides, Recurrent UTI, Renal transplant recipient, Immunosuppression.

Use of online resources by undergraduate medical students at College of Medicine, Majmaah University, Kingdom of Saudi Arabia.

The current pandemic has revolutionized medical education with a rapid shift to online teaching and learning strategies. The students have coped by turning to the online resources to keep pace with the change. To determine the type and practice of online resources used by undergraduate medical students and compare the use of online resources with gender and GPA. This was a cross-sectional study in which an online self-administered questionnaire was used to evaluate the type and practices of the online resources used by the medical students during the Covid-19 pandemic. Complete enumeration sampling method was used to collect the data from 180 medical students studying at College of Medicine, Majmaah University, Saudi Arabia. One hundred and thirty students (72.2%) were unaware of the free online resources offered by the University. Most students (58.3%, n = 105) consulted peers for online references. Male students preferred PowerPoint presentations and consulting online resources for studying as compared to the females, whereas females preferred to study textbooks predominantly as compared to males (p = 0.005). Male students significantly shifted to the online resources during the COVID-19 pandemic as compared to females (p = 0.028). Students with the highest GPA scores shifted to online educational resources during pandemic. A significant proportion of the undergraduate medical students at College of Medicine, Majmaah University used online educational resources for learning. We recommend that the college administration for deliberation with the medical educationalists for necessary curricular amendments and taking necessary steps to make the college Academic supervision and mentorship program more proactive to meet the challenges of students' use of online educational resources.

Brucella melitensis presenting as erythema nodosum-like lesions.

Brucellosis is a chronic granulomatous zoonosis with protean manifestations. Cutaneous involvement in Brucellosis is a relatively rare phenomenon. We describe a case of Brucella melitensis infection presenting with erythema nodosum like skin lesions involving palms and soles in a 70 years old lady.

An update on the diagnosis of tuberculosis.

Tuberculosis (TB) continues to be the bane of mankind. Early diagnosis is the cornerstone of tuberculosis control strategies. Recent years have seen major advances in the fields of biotechnology and molecular biology with introduction of several new diagnostic techniques for tuberculosis and improvement in the existing ones. The new automated culture techniques have appreciably reduced the time required for detection and antimicrobial susceptibility testing. The molecular amplification techniques like the Polymerase Chain Reaction (PCR) have made the same-day diagnosis a reality. Improvements in serology and introduction of novel new techniques like the bacteriophage assays have also shown a lot of promise. However, most of these new techniques are too expensive and sophisticated to be of any practical benefit to the vast majority of TB patients living in underdeveloped countries like Pakistan for whom an early and inexpensive diagnosis remains as elusive as ever. In this article various existing modalities as well as the new advances in TB diagnostics are reviewed.

Correlation of HBV DNA PCR and HBeAg in hepatitis B carriers.

OBJECTIVE: To correlate hepatitis B HBV DNA polymerase chain reaction (PCR) results with HBeAg and serum alanine transferase (ALT) in carriers. DESIGN: Non-interventional descriptive study. PLACE AND DURATION OF STUDY: The study was carried out at Virology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from January 2001 to September 2002. MATERIALS AND METHODS: Fifty hepatitis B carriers, with known HBsAg positive serostatus, raised serum ALT and detectable HBV DNA, were selected out of the patients reporting at AFIP for their blood test for HBV DNA. HBV DNA testing in these cases was carried out using PCR kit of Accugen-USA. After confirmation of their carrier status and raised serum ALT levels, the sera were tested for HBeAg and results of HBeAg testing were correlated with those of HBV DNA testing. RESULTS: Out of the total 50 HBV DNA PCR positive hepatitis B carriers, 48 samples were positive for HBeAg. All the 50 HBV DNA positive cases had raised serum ALT levels. CONCLUSION: In case of non-availability of facility for HBV PCR, detectable HBeAg should be taken as a surrogate marker for HBV DNA in hepatitis B carriers with raised serum ALT.

End of treatment response in chronic hepatitis C patients treated with interferon alpha and ribavirin.

We conducted a study at Combined Military Hospital (CMH), Sialkot, from August 2010 to February 2011 with the objective to determine the frequency of early and end of treatment virological response in patients with chronic hepatitis C infection treated with IFN-a / ribavirin therapy. HCV RNA PCR positive adult patients of either gender were included in the study. A total of 123 patients (56 males and 67 females) were given alpha-interferon ribavirin for 24 weeks. At 12 weeks posttreatment, 82 patients out of 123 (EVR 66.6%) had negative HCV RNA PCR while 85 patients out of 123 were HCV PCR negative at 24 weeks (ETR 69.1%). Conventional alpha-interferon ribavirin therapy should be discontinued in patients who are non responders at 12 weeks of treatment and be offered pegylated interferon to save time, money and minimize the side effects.