Impact of preoperative steroid or immunosuppressant use on short-term outcomes following colectomy in Crohn's disease patients.

BACKGROUND: Evaluating the impact of steroid or immunosuppressants (SI) therapy prior to colectomy in Crohn's disease (CD) patients on postoperative septic and colectomy-specific outcomes using the American College of Surgeons (ACS)-National Surgical Quality Improvement Program (NSQIP)-targeted colectomy database. METHODS: All CD patients undergoing colectomy were retrieved from the 2012-2013 NSQIP-targeted database. Thirty-day postoperative outcomes were compared for patients who were on steroids or immunosuppressants (SI) within the 30 days prior to colectomy to the others using univariable and multivariable analyses. RESULTS: Of 2208 CD patients, 1387 (63%) were on SI. Patients in the SI group were younger, and a greater proportion underwent laparoscopic surgery (p < 0.05). SI use was associated with a higher rate of sepsis (7.6 vs. 5.2%), anastomotic leak (5.6 vs. 3.5%), and return to operating room (6.8 vs. 3.3%). On multivariable analysis, SI was associated with sepsis, septic shock, and anastomotic leak [odds ratio = 1.58, 95% confidence interval 1.09-2.27]. CONCLUSIONS: These results suggest that SI use within 30 days of colectomy is associated with a higher rate of sepsis and septic shock and anastomotic leak in CD patients. Withholding SI prior to surgery, or the selective use of an ostomy to mitigate the consequences of a leak and hence sepsis need due consideration prior to surgery.

Group A streptococcal bacteraemia: experience at a university hospital in Riyadh.

A recent increase in the frequency and severity of group A beta-haemolytic streptococcal (GABHS) infections has been reported from several parts of the world. A retrospective analysis of bacteraemic GABHS infections encountered at a major teaching hospital in Riyadh, Saudi Arabia between 1982 and 1993 was performed. The epidemiologic, clinical and laboratory aspects of 29 episodes of GABHS bacteraemia were reviewed, and the differences between frequency and severity of these episodes were compared between the initial (1982-1989) and the late (1990-1993) periods of the study. The overall frequency of GABHS bacteraemia was 0.14 episodes per 1000 admissions with no difference between the initial and the late periods. Seventeen patients were adults and 12 were paediatrics. Adults were mostly females (82%) and paediatrics were predominantly males (75%). Seven episodes (24%) were nosocomial. Most patients (72%) had a predisposing factor for GABHS infections. Primary bacteraemia occurred in 13 patients (45%); and the skin and throat were the major sources of the bacteraemia in the rest of the patients. Shock complicated five episodes (17%) and acute renal failure developed in six (21%) patients. The overall case fatality rate was 21%. All five episodes complicated by shock were in the late period, and the rate of acute renal failure as well as the case fatality rate have doubled in the late vs. the early periods. Although no recent increase in frequency of GABHS bacteraemia was found, invasive GABH infections may have become more severe.

Mucormycosis of the upper limb.

A rare case of mucormycosis of the upper limb in a patient with AIDS is described. The pathophysiology and natural history of the disease are described along with a classification of its clinical stages.

Prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia.

The prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia, was determined through a randomized multistage sampling of 8000 preschool children. Duplicate specimens from each child were examined using a simple sedimentation technique. The overall prevalence of intestinal parasites among children screened was 18.4%. The most common parasite isolated was Giardia lamblia (14.5%). This was followed by Entamoeba histolytica (2.7%), Enterobius vermicularis (1.4%), Ascaris lumbricoides (1.0%) and others. Out of the 1462 children positive for parasites, 183 (12.5%) had mixed parasitic infections. Prevalence among preschool children was highly associateed with older age, rural residence, non-municipal water supply, inadequate latrine type, low level of parental education, abdominal pain, and diarrhea.

Streptococcal toxic shock-like syndrome: case report and review of the literature.

Streptococcal toxic shock-like syndrome is a newly recognized complication of infections by group A beta-haemolytic streptococci (GABHS). Previous reports of this syndrome have originated from developed countries, predominantly North American and Europe. This report describes a 5-year-old Saudi child who developed this syndrome in association with streptococcal pharyngitis. It indicates that the recent resurgence of severe GABHS diseases is a global phenomenon.

Comparison of adverse reactions to whole-virion and split-virion influenza vaccines in hospital personnel.

OBJECTIVE: To compare the adverse effects, particularly generalized aching, of a trivalent, inactivated whole-virion vaccine (WVV) and split-virion vaccine (SVV) for influenza in hospital personnel. DESIGN: Recipient-blinded study; first-time vaccinees were randomly assigned to receive either of the vaccines from one manufacturer in the 1989-90 influenza season. Subjects were asked to complete a symptom questionnaire during the 48 hours after immunization. SETTING: Annual influenza program for staff of a tertiary care children's hospital. PARTICIPANTS: Volunteers were sought among approximately 2200 members of the hospital staff. Of the 358 vaccinated for the first time, 333 (93%) returned the questionnaire. RESULTS: During the 48 hours after vaccination 13% of the SVV recipients reported generalized aching, as compared with 26% of the WVV recipients (p less than 0.01). Also, the SVV group reported fewer visible local reactions and more transient arm soreness, but the actual differences between the two groups were small. The occurrence of mild symptoms was equally common in the two groups (local reactions in at least 70% of cases, systemic reactions in at least 33%). In each group 1% of the subjects reported missing work because of the vaccination. CONCLUSIONS: The use of SVV reduces the rate of the most objectionable of the common adverse effects of influenza vaccination. Therefore, as with children, it might be more acceptable to health care workers than the current use of WVV.

The haematological manifestations of visceral leishmaniasis in infancy and childhood.

The haematological manifestations were reviewed in 94 patients (55 males and 39 females) with visceral leishmaniasis. Their ages ranged from 4 months to 12 years (mean per cent 1.8 years). All patients had splenomegaly and were anaemic, while (73 per cent) were neutropenic and (56 per cent) thrombocytopenic. Coagulation abnormalities were encountered in 10 (11 per cent) patients; in four patients this was associated with disseminated intravascular coagulopathy. Bone marrow was hypercellular in (90 per cent), normocellular in (5 per cent), and hypocelluar in (4 per cent). Also variable degrees of erythrophagocytosis and leukophagocytosis were noted with preponderance of histiocytes (46 per cent) and granulomatous formation (25 per cent). Low haemosiderin content in the bone marrow was noted, which together with the finding of high serum ferritin is consistent with anaemia of chronic inflammation. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow, chronic inflammation, and dietary factors appear to be the most important factors in the causation of the haematological changes in visceral leishmaniasis.

Spectrum of Haemophilus influenzae type b disease in children at a university hospital in Riyadh, Saudi Arabia.

During a period of 5 years, 42 cases of invasive Haemophilus influenzae type b (Hib) disease were studied. An outstanding finding in our patients was occult bacteraemia, which was detected in 13 (31 per cent) patients. Other clinical conditions encountered were nine (21 per cent) patients with pneumonia, nine (21 per cent) with meningitis, six (14 per cent) with cellulitis, three (7 per cent) with arthritis, one (2 per cent) with epiglottitis, and one (2 per cent) with urinary tract infection. The mean age of children was 21 months (range 1-156 months); the majority (62 per cent) belonged to the age group 7-18 months. There were 24 females and 18 males. Eighty-one per cent of these patients were Saudi nationals. Five isolates (12 per cent) of Hib were resistant to ampicillin and similar numbers were resistant to chlorampenicol. Twenty-five children (60 per cent) were treated with ampicillin, nine (21 per cent) with chlorampenicol and eight (19 per cent) with ceftriaxone. All patients made complete recovery.

CAPD in saudi arabian children: ten years experience from a single center.

In this paper we describe our experience with chronic ambulatory peritoneal dialysis (CAPD) in children. Between 1984 and 1993, a total of 51 patients were treated by CAPD at King Khalid University Hospital. Eight patients were excluded from the study because of incomplete data. There were 25 boys and 18 girls aged three months to 16 years; 12 patients (27.9%) were below two years, 15 patients (34.9%) were between 2-6 years, and 16 patients (37.2%) were above six years of age. Reflux nephropathy secondary to obstructive uropathy was the main cause of ESRD in the study patients (27.9%). The total period of CAPD was 579 patient-months (48.25 years). The overall incidence of peritonitis was high, one episode per 4.7 patient months; one episode per 3.2 patient months in the first five years of the study and one episode per 6.2 patient-months in the 2nd five years of the study period. The cause of peritonitis was gram positive organisms in 38.7% and gram negative organisms in 24.9%. Seventeen (39.5%) of catheters were changed because of infection or mechanical obstruction. In 90.7% of patients, the mother was the person who was performing dialysis. At the end of the study, seven patients (16.2%) were still on CAPD, 10 patients (23.3%) shifted to heraodialysls, 16 patients (37.2%) were transplanted, six patients (14.0%) died and four patients (9.3%) recovered. We conclude that CAPD may be a suitable renal replacement therapy for children in a country with a wide geographical area and low population density as Saudi Arabia.