Urinary tract infections are very prevalent among women. The majority of urinary tract infections are uncomplicated and can be managed empirically with no further investigations. However, imaging studies may be indicated in patients with severe or persistent symptoms. Complicated urinary tract infections typically develop in the setting of diabetes mellitus. We report a case of a 52-year-old woman who presented to the emergency department with severe lower abdominal pain for two days that was associated with nausea, vomiting, and fever. There was no history of change in urine or bowel habits. Besides the history of well-controlled asthma, the patient was not known to have any comorbid medical condition. Upon examination, the patient had tachycardia, low-grade fever, and a localized suprapubic tenderness with guarding. Laboratory investigation revealed leukocytosis, elevated erythrocyte sedimentation rate and Creactive protein, and deranged renal functions. Further, urinalysis revealed numerous white blood cells, red blood cells, positive nitrite, and leukocyte esterase. A computed tomography scan demonstrated the presence of small locules of gas within the lumen and the wall of the bladder representing emphysematous cystitis. The patient was admitted to the intensive care unit. She received aggressive hydration therapy and a short course of opioid therapy for pain control. Broad-spectrum antibiotic therapy in the form of piperacillin-tazobactam was initiated. Over the following few days, the patient exhibited significant improvement in his symptoms and resolution of the laboratory parameters. Emphysematous cystitis is a rare infection of the lower urinary tract with gas formation. The case highlighted that such a condition may develop in the absence of diabetes mellitus or other risk factors. Prompt treatment is crucial as emphysematous cystitis can be life-threatening if the diagnosis is missed or delayed.
Background: By December 2021, the COVID-19 pandemic had caused more than 266 million cases and 5 million deaths, especially among geriatric patients. Objective: To identify determinants of COVID-19-related death in geriatric patients. Methods: This is a comparative retrospective study involving 145 COVID-19 hospitalized patients who are more than 60 years old, conducted at King Faisal Medical Complex in Taif, Saudi Arabia, from June 2020 to August 2020. The main outcome studied was COVID-19-related death. Results: Out of 145 elderly COVID-19 patients, 11% have died. There was a significant difference between those who died and the surviving group regarding hospital stay duration, with a higher duration median among those who died (22 days vs 12 day respectively, p=0.002). Transfer to ICU, mechanical ventilation, low oxygen saturation, shortness of breath, respiratory support, x-ray trend, and prolonged QT interval showed significant statistical differences between them (p<0.001, <0.001, 0.017, 0.045, <0.001, <0.001, 0.004, respectively). After doing logistic regression of predictors for progression to death, putting patients on oxygen only vs mechanical ventilation was statistically significant, with an adjusted odds ratio (AOR) of 0.038 (p=0.012). Worse x-rays vs constant also were statistically significant and had AOR of 23.459 (p=0.001). There was a significant moderate positive correlation between duration of hospital stay and duration from admission to medication start (SP=0.336 and p<0.001). Conclusion:We recommend accurately monitoring patients using x-rays to determine which patients have worse x-rays. However, the cost-benefit of using radiation must be well assessed and needs further research to determine if its benefit outweighs its risks, especially in high-risk patients. Furthermore, mechanically ventilated patients must be carefully monitored. Finally, the duration of hospital stay was highly correlated with the duration from admission to medication start. Therefore, proper treatment must be started as early as possible.
Tumors of the salivary gland constitute a heterogeneous group of variable histological and biological behaviors. Patients with salivary gland tumors typically present with painless swelling. However, several neoplastic and non-neoplastic pathologies can result in salivary gland enlargement. We report the case of a 35-year-old woman complaining of a left neck swelling for 3 months duration. She had no relevant past medical or surgical history. On examination, there was a left submandibular swelling that was firm in consistency, non-tender, non-pulsatile, relatively mobile, and was not tethered to the underlying structures. Otherwise, examination of the head and neck was unremarkable. A CT scan of the neck revealed a welldefined hypodense lesion in the left submandibular region with foci of calcification along with multiple enlarged lymph nodes. After surgical exploration, the submandibular gland region, a mass lesion was found arising from the submandibular gland. Histopathological examination revealed the diagnosis of schwannoma. Salivary gland schwannoma is a very rare form of neurogenic tumor. Surgical resection is the treatment of choice; however, neural deficits are important and common postoperative complications.
Background and Objectives Epilepsy is a chronic brain disease, with inherent and noninherent factors. Although over 20 anti-seizure medications (ASMs) are commercially available, nearly one-third of patients develop drug-resistant epilepsy. We evaluated the association between the clinical features and the methyl tetrahydrofolate (MTHFR) rs1801133 polymorphism and ASMs response among pediatric patients with epilepsy. Materials and Methods This was a multicenter, retrospective, case–control study of 101 children with epilepsy and 59 healthy children in Jeddah. The MTHFR rs1801133 polymorphism was genotyped using the real-time polymerase chain reaction TaqMan Genotyping Assay. Results Among the patients with epilepsy, 56 and 45 showed good and poor responses to ASMs, respectively. No significant genetic association was noted between the single-nucleotide polymorphism (SNP) rs1801133 within the MTHFR gene and the response to ASMs. However, a significant association was noted between reports of drug-induced toxicity and an increase in allele A frequencies. The MTHFR rs1801133 genotype was significantly associated with the development of electrolyte disturbance among good and poor responders to ASMs. Conclusion This is the first pharmacogenetic study of MTHFR in patients with epilepsy in Saudi Arabia that found no significant association between the MTHFR SNP rs1801133 and gene susceptibility and drug responsiveness. A larger sample size is needed for testing gene polymorphisms in the future.
Many children were suffering from neurological problems. One of these neurological problems is epilepsy, which causes seizures. Children with seizures were managed with different drugs. A drug like phenobarbital is used mainly for epilepsy. This study aimed to assess the awareness of parents about the side effects of phenobarbital and the management of epileptic children, describe the clinical presentation of children with epilepsy and assess the knowledge of parents about the management of epileptic children. A descriptive cross-sectional study was conducted among parents of children diagnosed with epilepsy. Online questionnaire survey distributed to parents of children with epilepsy. A total of 200 parents were included. The age group is 31-40 years old, 72(36%). Parents' knowledge about epilepsy was 98(49%). There were 104(52%) parents who reported seizures caused by low doses of Phenobarbital led to a loss of consciousness. Non-compliance with the required dose occurred majorly due to forgetting the dose 102(51%). The number of children with epilepsy was significantly associated with the awareness level of parents (P=0.0001). In addition, the awareness of parents was significant at the time of epilepsy diagnosis of children (P=0.01). An inadequate awareness among parents regarding the side effects of Phenobarbital, and there were gaps in their knowledge regarding other aspects of the condition and its management.
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Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. Drug administration errors were the second most frequent type of medication error, after prescribing errors, but the latter were often intercepted; hence, administration errors were more probably to reach the patients. Therefore, this study was conducted to determine the frequency and types of drug administration errors in a Taif hospital ward. Prospective study based on a disguised observation technique in nine wards in a general hospital in Taif, Saudi Arabia (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. The main outcomes were the number, type and clinical importance of errors and associated risk factors. The drug administration error rate was calculated. Relationships between the drug dose frequency, dosage form and types of medication administration error were measured. A total of 7105 medications administered by 250 nursing staff members to 700 patients were observed. Observers intervened in seven administrations. There are 1769 medication administration errors confirmed. The most common medication administration errors were drug preparation error (40.56%, n =727) then, improper dose error (18.58%, n=333); the most common drug class error was Antibiotic (38.9%, n =399) then Analgesic and anti-inflammatory drugs (17%, n =176). The most drug dose frequency had Drug preparation error was seen in a drug used three times a day by 484. MAEs were more likely to occur in the evening shift compared to the morning and afternoon shifts. The study indicates that the frequency of drug administration errors in developing countries such as Malaysia is similar to that in developed countries.
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