Treatment of Disseminated Mycobacterial Infection with High-Dose IFN-γ in a Patient with IL-12Rβ1 Deficiency

IFN-γ has been used in the treatment of IL-12Rβ1 deficiency patients with disseminated BCG infection (BCGosis), but the optimal dose to reach efficacy is not clear. We used IFN-γ in the treatment of a 2.7-year-old patient with IL-12Rβ1 deficiency and refractory BCG-osis. IFNγ was started at a dose of 50 μg/m2 3 times per week. The dose was upgraded to 100 mcg/m2 after 3 months, then to 200 mcg/m2 6 months afterwards. Serum mycobactericidal activity and lymphocytes number and function were evaluated throughout the study. There was no clinical response to IFN-γ with 50 or 100 μg/m2 doses. However, there was some response to the 200 μg/m2 dose with no additional adverse effects. The serum mycobactericidal activity was not significantly different during the whole treatment period. Lymphocytes proliferation in response to PHA was significantly higher after 3 months of using the highest dose as compared to the lowest dose. The tuberculin skin test reaction remained persistently negative. We conclude that in a patient with IL-12Rβ1 deficiency, IFN-γ at a dose of 200 μg/m2, but not at lower dosages, was found to have a noticeable clinical effect with no additional adverse effects

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

DOES ACADEMIC PERFORMANCE IN THE PREMEDICAL YEAR PREDICT THE PERFORMANCE OF THE MEDICAL STUDENT IN SUBSEQUENT YEARS?

Background: Student admission into the College of Medicine at King Saud University (KSU) is dependent on the achievement of a grade point average (GPA) of ≥ 3.5 /5 by the end of the premedical year. This study was undertaken to ascertain whether pre-selected medical students who achieve a relatively low GPA (≤3.75/5) in the premedical year are at risk of having academic difficulties in subsequent years. Method: A cross-sectional study of all students admitted to the College of Medicine at KSU during 5 academic years (1994 to 1998) was conducted in 2004. The likelihood of completing the program by 2004 and the dropout frequency were compared in the two groups based on their GPA in the premedical year: High GPA (>3.75) and Low GPA (≤3.75). Results: During the study period, 739 students were admitted to the college. Of these, 619 (84%) were in High GPA group, and 120 (16%) in the Low GPA group. Of the students with High GPA, 545 (88%) out of 619 graduated compared with 79 (66%) of 120 in the Low GPA group (OR 3.822 [95% CI: 2.44, 5.99]: P<0.0001). Overall, 28 students (3.8%) dropped out, but there was a significantly greater frequency of dropping out in the Low GPA group (10/120; 8.3%) compared with the High GPA group (18/619; 2.9%: OR 3.035 [95% CI: 1.37, 6.75], P=0.01). Conclusion: Our results support the prerequisite of a minimum GPA in the premedical year before proceeding to the higher levels. The GPA of premedical year is a useful predictor of students who need close monitoring and academic support. The use of GPA in the premedical year for admission into medical colleges should help optimize the use of resources and reduce student wastage

The epidemiology of pneumococcal, meningococcal, and Haemophilus disease in the Middle East and North Africa (MENA) Region—Current status and needs

Information about the burden and epidemiological characteristics of meningitis and other invasive disease caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis is of great value to healthcare decision makers to prioritize public health interventions. A group of regional experts in the Eastern Mediterranean and North African regions formed the MENA Vaccine-Preventable Diseases Regional Advisory Group to collate and discuss such information on an annual basis. This paper provides an up-to-date summary of the available epidemiological data regarding these pathogens in these regions. In doing so, it highlights the need for additional surveillance studies to better measure the burden of these diseases, as well as the potential impact of introduction of new vaccines against these pathogens

Penicillin resistance in serogroups/serotypes of Streptococcus pneumoniae causing invasive infections in Central Saudi Arabia

Objective: To determine the minimum inhibitory concentrations (MICs) of penicillin, ceftriaxone and vancomycin of serogroups/serotypes of Streptococcus pneumoniae (S. pneumoniae) from invasive diseases in all age groups from major hospitals in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: All isolates of S. pneumoniae from patients with invasive pneumococcal infections between February 2000 and November 2001 were prospectively collected from 8 major hospitals in Riyadh, KSA. The isolates were confirmed as S. pneumoniae at the King Khalid University Hospitals, Riyadh, KSA and then serogrouped/serotyped using the agglutination method. The MICs for penicillin, ceftriaxone and vancomycin were carried out using the E-test. Results: Forty-three percent of the isolates were resistant to penicillin mostly of the intermediate type (97%). The resistant strains were mainly confined to serogroups/ serotypes 6, 23, 19 and 15 and the 7-valent conjugate vaccine covers 76% of the penicillin-resistant strains. Only one isolate was resistant to ceftriaxone. Conclusion: In view of the rather insignificant level of highly resistant-penicillin strains and the virtual absence of resistance to ceftriaxone we would like to suggest using ceftriaxone for treating invasive pneumococcal infections outside the central nervous system. We recommend that the conjugate vaccine would be a useful adjunct to penicillin prophylaxis in patients at risk in our community.Corresponding Author: Dr. Kingsley Twum-Danso, Associate Professor & Consultant of Microbiologist, College of Medicine (32), King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Email: [email protected]

Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia

Introduction: Few studies have estimated screen time among Arab adolescents, and no studies, to date, have published data on addiction to video games or Internet games among Arab adolescents. This study aimed to assess the prevalence of addiction to video games and its correlation with mental health in a sample of expatriate high school students from the Al-Qassim region of Saudi Arabia. Methods: The survey was conducted in 2016 among 276 students enrolled in ninth through twelfth grades in the International Schools in Buraidah, Al-Qassim. Students who returned signed consent forms from their parents filled out a self-administered questionnaire that included validated scales on addiction to video games, general health, and lifestyle. Results: The proportion between the sexes and the schools were roughly equal. Around 32% were overweight or obese, 75% had screen timeâ¥2h/day, and 20% slept<5h/night. Sixteen per cent (16%) were addicted to video games and 54% had psychological distress. Addiction to video games was strongly associated with psychological distress (OR=4.1, 95% CI=1.80, 9.47). Other significant correlates were female gender, higher screen time, and shorter sleep hours. Conclusions: The proportion of students with psychological distress was high. Future studies should investigate other potential correlates of distress such personal traits, family relations, and academic performance. Keywords: Video games, Addiction, Adolescent, Psychological distress, Screen time, Saudi Arabi

Health benefits of Quran memorization for older men

Objective: To examine the association between Quran memorization and health among older men. Methods: This cross-sectional study included older Saudi men (age ≥ 55 years) from Buraidah, Al-Qassim. The neighborhoods were selected randomly (20 out of 96); eligible men from the mosques were recruited. Demographics, lifestyle, and depression were assessed with standardized questionnaires; height, weight, blood pressure, and random blood glucose (glucometer) were measured with standard protocol. Results: The mean and standard deviation for age, body mass index, and Quran memorization were 63 years (7.5), 28.9 kg/m 2 (4.8), and 4.3 sections (6.9). Prevalence of hypertension, diabetes, and depression were 71%, 29%, and 22%, respectively. Those who memorized at least 10 sections of Quran were 64%, 71%, and 81% less likely to have hypertension, diabetes, and depression compared to those who memorized less than 0.5 sections, after controlling for covariates. Conclusion: There was a strong linear association between Quran memorization and hypertension, diabetes, and depression indicating that those who had memorized a larger portion of the Quran were less likely to have one of these chronic diseases. Future studies should explore the potential health benefits of Quran memorization and the underlying mechanisms