Dupilumab: An emerging therapy in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Viridans Group Streptococcus Meningitis in an Immunocompetent Child: A Case Report.

BACKGROUND Viridans group streptococci (VGS) are commensal organisms in humans that are considered contaminants when isolated from culture specimens. However, VGS can be pathogenic when recovered multiple times from blood cultures or when in immunocompromised hosts. VGS are the leading cause of dental abscesses and infective endocarditis in children with underlying congenital heart diseases. They are not commonly involved in meningeal infections, but meningitis due to VGS can be fatal if not treated. The onset is usually preceded by an upper respiratory tract infection or in association with neurological surgical procedures. CASE REPORT Our patient was a 14-month-old girl with no significant past medical history who presented with fevers and irritability for 2 weeks. A full sepsis workup, including blood, urine, and cerebrospinal fluid (CSF) cultures, was obtained. Culture results were notable for the abundant growth of VGS in the CSF. However, brain imaging and echocardiogram were normal, with no evidence of brain abscesses or cardiac vegetations, respectively. The patient had shown marked clinical improvement after receiving 2 weeks of intravenous ceftriaxone, which was selected based on the VGS susceptibility profile. CONCLUSIONS Bacterial meningitis is one of the most burdensome infectious diseases worldwide, despite improvements in diagnostic methods, management, and national immunization programs. Clinicians should consider VGS in the differential diagnosis of potential infections that can cause meningitis.

Fine particles exposure and cardiopulmonary morbidity in Jeddah: A time-series analysis.

Health effects linked to PM2.5, have been extensively studied in developed countries of Europe and N. America. However, little has been done in Saudi Arabia and the Middle East. This study evaluated the morbidity risk for cardiovascular (CVD) and respiratory (RD) diseases, associated with PM2.5 exposure in Jeddah, Saudi Arabia. 24-h PM2.5 sampling was conducted at 3 sites for 6 weeks quarterly from Apr 8th, 2013-Feb 18th, 2014 with simultaneous hospital data collection. The relative risks (RRs) for cardiopulmonary morbidity at different moving averages (MAs) of lagged exposures were estimated using a generalized linear time-series model. Elevated risks for RD were associated with recent PM2.5 exposures (0-2 days). RD prevalence was highest in children 0-14 years. Overall, RD morbidity risk ranged from 1.081 (CI: 1.005-1.162) to 1.096 (CI: 1.023-1.173) at MAs_2-4; male, 1.081 (CI: 1.019-1.146) to 1.087 (CI: 1.020-1.159) at MAs_2-3, and female, 1.086 (CI: 1.007-1.172) to 1.093 (CI: 1.017-1.175) at MAs_2-4. Generally, females 0-14 years were the most at risk for RDs with RR = 1.097 (CI: 1.025-1.174) to 1.148 (CI: 1.049-1.257). CVD morbidity risk was highest in ER visits with overall RR = 1.057 (CI: 1.005-1.111) to 1.137 (CI: 1.065-1.213) across all MAs; male, 1.060 (CI: 1.007-1.204) to 1.131 (CI: 1.060-1.208); female, 1.065 (CI: 1.008-1.125) to 1.116 (CI: 1.045-1.192). PM2.5 exposure showed significantly increased cardiopulmonary morbidity risk, accentuating the severe health effects associated with elevated PM2.5 in Jeddah. Overall, females (0-14 years) were more at risk for RD morbidity than males. CVD morbidity risk was relatively higher in males than females, with highest risk observed in age-groups above 40 years.

Ambient air quality in the holy city of Makkah: A source apportionment with elemental enrichment factors (EFs) and factor analysis (PMF).

Air pollution remains a major global public health and environmental issue. We assessed the levels of PM2.5 and delineated the major sources in Makkah, Saudi Arabia. Fine particulate matter (PM2.5) sampling was performed from February 26, 2014-January 27, 2015 in four cycles/seasons. Samples were analyzed for black carbon (BC) and trace elements (TEs). PM2.5 source apportionment was performed by computing enrichment factors (EFs) and positive matrix factorization (PMF). Backward-in time trajectories were used to assess the long-range transport. Significant seasonal variations in PM2.5 were observed, Spring: 113 ±â€¯67.1, Summer: 88.3 ±â€¯36.4, Fall: 67.8 ±â€¯24, and Winter: 67.6 ±â€¯36.9 µg m-3. The 24-h PM2.5 exceeded the WHO (25 µg m-3) and Saudi Arabia's (35 µg m-3) guidelines, with an air quality index (AQI) of "unhealthy to hazardous" to human health. Most delta-C computations were below zero, indicating minor contributions from bio-mass burning. TEs were primarily Si, Ca, Fe, Al, S, K and Mg, suggesting major contributions from soil (Si, Ca, Fe, Al, Mg), and industrial and vehicular emissions (S, Ca, Al, Fe, K). EF defined two broad categories of TEs as: anthropogenic (Cu, Zn, Eu, Cl, Pb, S, Br and Lu), and earth-crust derived (Al, Si, Na, Mg, Rb, K, Zr, Ti, Fe, Mn, Sr, Y, Cr, Ga, Ca, Ni and Ce). Notably, all the anthropogenic TEs can be linked to industrial and vehicular emissions. PMF analysis defined four major sources as: vehicular emissions, 30.1%; industrial-mixed dust, 28.9%; soil/earth-crust, 24.7%; and fossil-fuels/oil combustion, 16.3%. Plots of wind trajectories indicated wind direction and regional transport as major influences on air pollution levels in Makkah. In collusion, anthropogenic emissions contributed >75% of the observed air pollution in Makkah. Developing strategies for reducing anthropogenic emissions are paramount to controlling particulate air pollution in this region.

Eosinophilic esophagitis in children from Western saudi arabia: relative frequency, clinical, pathological, endoscopic, and immunological study.

Background and Purpose. Eosinophilic esophagitis (EE) is an evolving allergic disease with an accelerated incidence. The purpose of this study was to delineate the relative frequency and clinicopathological characteristics of EE in children from western Saudi Arabia. Methods. Children with EE were studied retrospectively between October 2002 and December 2011 at King Abdulaziz University Hospital and International Medical Center. Results. The relative frequency of EE was 0.85% of 2127 upper gastrointestinal endoscopies performed during the study period. Eighteen patients were identified with EE. The median age was 8.6 years (range, 1.5-18 years). Thirteen (72.2%) were males. Dysphagia and vomiting were the most common symptoms. Ten (55.6%) children had history of atopy. Testing for food allergy by skin prick test was positive in 11 (61.1%). The most common endoscopic abnormalities were mucosal longitudinal furrow and loss of vascular pattern followed by patchy specks and strictures. The histopathological findings included increased intraepithelial eosinophils, eosinophilic degranulation, lamina propria fibrosis, and eosinophilic microabscesses. Treatment was initiated by swallowed topical corticosteroids in 12 (66.7%) and oral prednisolone in 6 (33%) patients, followed by low dose of topical corticosteroids and dietary elimination. Conclusions. Eosinophilic esophagitis is an uncommon but evolving problem. A high index of suspicion is required for early identifications and intervention to avoid possible complications.