Obstetric Outcomes in Advanced Maternal Age among Women at King Abdulaziz University Hospital

Background: Advanced maternal age, over 35 years, is a well-known risk factor for poor pregnancy outcomes. It is commonly associated with various pregnancy complications, such as spontaneous miscarriage, preeclampsia/ toxemia, gestational diabetes mellitus, preterm labor, stillbirth, chromosomal abnormalities, and cesarean delivery. Objectives: This study assessed obstetric and neonatal complications associated with advanced maternal age. Methods: We reviewed the medical records of 199 pregnant women over 35 years old at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January to June 2022. We gathered data on age, nationality, number of antenatal visits, results of ultrasound scans for dating and viability, nuchal translucency and anatomy surveys, medications and multivitamins taken during pregnancy, smoking status, pregnancy, and fetal complications, and mode of delivery. Results: The prevalence of obstetric complications was 71.4% (preeclampsia/toxemia, 4.5%;antepartum hemorrhage, 4%;postpartum hemorrhage, 1%;and gestational diabetes, 23.1%). The most frequent complication was preterm labor between 34 and 36 weeks (48%), and only 12.6% of all deliveries were associated with fetal and neonatal complications such as congenital anomalies and neonatal jaundice. The prevalence of anemia during pregnancy was 10.1%, 21.1%, and 28.6% in the first, second, and third trimesters, respectively, and pregnancies complicated with antepartum or postpartum hemorrhage were associated with higher rates of anemia in the second trimester. A significant relationship was found between mean maternal age (38.84 ± 2.75 years) and the development of maternal complications (p < 0.05). Newborns with neonatal complications were much more likely to be born to mothers with a history of antepartum hemorrhage and anemia in the second trimester. Conclusion: Our findings confirm that pregnancy at an advanced maternal age is associated with increased overall maternal complications. The most frequent complication was preterm labor (48%). Other complications, such as preeclampsia/toxemia, antepartum hemorrhage, postpartum hemorrhage, gestational diabetes, and anemia, were less frequent in the sample we reviewed.

Knowledge and Attitudes of Nurses Working at King Abdulaziz University Hospital toward Cancer Pain Management

Objective: This survey aims to identify the levels of knowledge and attitudes among nurses regarding cancer pain management. Methods: This cross-sectional survey was undertaken at King Abdulaziz University Hospital, Jeddah, between September 4 and September 27, 2015. The survey instrument was a pre-set questionnaire comprising 39 closed-ended format questions. Participants were asked questions to assess their knowledge and attitudes about cancer pain management and adherence to frequent misconceptions regarding opioid therapy. The chi-square test was used to compare differences between variables. Results: One hundred twenty-eight questionnaires were completed and analyzed. A mean sample score of 41.3% was achieved on pain-related knowledge questions. The average score on all 39 questions was 16.1 ± 4.6 (range, 0 - 24). Nurses on the male medical ward were most knowledgeable compared with those on other wards (p p p p p = 0.002). Conclusion: Optimization of inpatient supportive procedures should be a specific task at King Abdulaziz University Hospital until an oncology unit with nurses specialized in cancer care is established.

Pattern of Thyroid Cancer at King Abdulaziz University Hospital, Jeddah: A 10-Year Retrospective Study

Background and objective: Thyroid cancer is the most common endocrine malignancy. This report aims to describe the pattern of thyroid cancer presentations at King Abdulaziz University Hospital, Jeddah. Methods: This was a retrospect chart review of all thyroid cancer cases diagnosed between 2001 and 2010 at King Abdulaziz University Hospital, Jeddah. We documented patients’ demographic and clinical data, including age at diagnosis, tumor type and size, extrathyroidal extension, and metastasis. Results: A total of 114 thyroid cancer cases were diagnosed from 2001 through 2010. Females comprise the majority of cases (female to male ratio of 4:1). The mean ages of patients diagnosed with different thyroid cancers were: papillary thyroid cancer, 39.6 years;follicular thyroid cancer, 43.2 years;medullary thyroid cancer, 55.8 years;and anaplastic thyroid cancer, 46.0 years. Papillary thyroid cancer was diagnosed in 88 cases (77%), follicular thyroid cancer in 19 cases (17%), medullary thyroid cancer in 5 cases (4%), and anaplastic thyroid cancer in 2 cases (2%). Conclusion: Thyroid cancers are more common among females. The disease is diagnosed at a relatively young age among our patients (40 years). Papillary thyroid cancer is the most common type of thyroid cancer.

Knowledge, Attitudes and Practice about Obstetric Ultrasonography among Women Attending a University Hospital: A Cross-Sectional Study

Background: Obstetric sonography is one of the prenatal tests offered to most pregnant women and an essential tool that helps health care providers to establish fetal condition and growth. The Objective: to assess the knowledge, attitudes, and practice about obstetric sonography among women at KAUH in Jeddah, Saudi Arabia. Method: A cross-sectional study was conducted during 2018-2019 among 367 women. It included all women that attend the OB/GYN outpatient clinic at KAUH in Jeddah. The data was collected through interviewing questionnaire. The questionnaire consisted of 5 items to assess their knowledge, attitude, practice, and sociodemographic characteristics. Data were entered into a Microsoft Excel 2014 sheet, and statistical analysis was performed using IBM SPSS Statistics. Result: The mean knowledge score about obstetric sonography was 13.9 ± 1.7, where 343 (93.0%) had good knowledge, and only 26 (7.0%) had poor knowledge. The result revealed that the third-fourths of the women 291 (78.9%) believed that obstetric sonography is safe, and 309 (83.8%) believed that obstetric sonography doesn’t lead to a congenital anomaly. There was a difference in the knowledge score regarding education level, occupation, monthly income, and those with higher education, those who worked, and those with higher monthly payment had a higher knowledge score. Also, there was a positive correlation between knowledge score and both gravidity and parity. Conclusion: Women’s knowledge, attitude, and practice about the purpose of the obstetric sonography were good. So, the primary health care providers should be advised to focusing more on providing health education on obstetric sonography to all pregnant women during their ANC visits.

A Single-Center Experience of Systemic Onset Juvenile Idiopathic Arthritis at a Tertiary Hospital in Jeddah, Saudi Arabia

Background and Objective: Systemic-onset juvenile idiopathic arthritis (JIA) is a major and prevalent subset of arthritis among children and it has a broad spectrum of clinical presentation, course and prognosis. This study described the clinical presentation of systemic-onset JIA in a Saudi-based cohort. Methods: A retrospective chart review was performed of the medical records of children with systemic-onset JIA who were followed up at King Abdul Aziz University Hospital, Jeddah, between January 1997 and December 2013. Patients’ files were reviewed for demographic, clinical, and paraclinical data, which were analyzed using the statistical Package for the Social Sciences. Results: We included 20 patients of both genders (8 boys and 12 girls). The mean age of disease onset was 7 (4.5) years. The most common presenting symptoms were fever (100%), arthritis (100%), and rash (55%). Hepatomegaly (5%), abdominal (5%) and pulmonary manifestations (3%) were less frequent manifestations. Most patients had high white blood cell counts (50%), elevated erythrocyte sedimentation rates (80%) and C-reactive protein levels (90%). The interval between onset of symptoms and diagnosis was 9.4 (12.5) weeks. Patients were treated with non-steroidal anti-inflammatory drugs, methotrexate, steroids, anti-tumor necrosis agents, and disease-modifying anti-rheumatic drugs. Bone marrow biopsy was conducted to exclude malignancy in 20% of the patients. Conclusion: Saudi children with systemic-onset JIA present with prolonged fever and arthritis (mainly oligoarticular rather than polyarticular). Physicians should be aware of the presentation of systemic-onset JIA in our setting in order to make prompt diagnosis and treatment decisions as early as possible. Carful follow-up of febrile patients is paramount to reaching the diagnosis early and initiating treatment.

Evaluation of Charcot Neuroarthropathy in Diabetic Foot Disease Patients at Tertiary Hospital

Purpose: To evaluate Charcot neuroarthropathy in diabetic foot patients at tertiary hospital. Methods and Material: It is a retrospective study from 2005 to 2015 of Charcot foot patients in diabetic patients admitted in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Sixty-four patients were admitted as diabetic foot disease and were studied by reviewing patients records of demography, pain, discharge, duration of disease, duration and types of diabetes IDDM [Insulin Dependant Diabetes Mellitus] NIDDM [Non Insulin Dependent Diabetes Mellitus], history of trauma, peripheral vascular disease, obesity, hypertension, co-morbid conditions, previous surgery, involvement of fore foot/midfoot/hindfoot, deformity, ulcer and treatment like casts, offloading devices, pharmacological like biphosphonates, debridement, osteotomy, arthrodesis, exostectomy, and amputation. Results: Majority of patients were males (81.2%). Mean age was 61.75 years. Pain was reported in 25% of patients, numbness in 12.5%, foot deformity in 23.4%, pus discharge in 73.4%, difficulty in walking in 12.5%, and 10.9% had history of trauma. Majority of patients were NIDDM 68.8%, IDDM 31.3%, (62.5% had DM more than 10 years and 36.9% had DM less than 10 years), controlled DM in 21.9% and uncontrolled DM in 73.4%, nephropathy in 46.3%, neuropathy in 59.4%, retinopathy in 40.6%, cardiomyopathy in 48.4% and vasculopathy in 56.3%. Charcot arthropathy was in 28.1% of cases and forefoot was involved in 65.5%, midfoot in 4.7% and hindfoot/ankle in 21.9%. It was forefoot which was mainly involved in Charcot joint disease. It was demonstrated by X-rays which showed subluxation in 40.6%, dislocation in 54.7%, disorganized foot joints in 42.2%, bone resorption in 23.4%, osteomyelitis in 14.1%, fractures in 50%, joint collapse in 39.1% and destruction of articular surfaces in 37.5%. Debridement was done in 25% of cases while 75% of patients underwent some sort of amputation. 14.1% of patients underwent above knee amputation, 10.9% below knee amputation, 10.9% transmetatarsal and 39.1% toe amputation. Debridement and amputation were the main treatment offered. Conclusions: Diabetic patients with Charcot joint disease pose great challenge in management. Emphasis should be given for early detection, investigations and prompt treatment. Treatment should be tailored according to stage of disease and patient occupation.

Functional MRI and MR Spectroscopy Utilization in Jeddah Hospitals

Functional magnetic resonance imaging “fMRI” and magnetic resonance spectroscopy “MRS” are two crucial milestones that were introduced apart from one another into brain imaging and their implementation in major local cities is eventual step. Thus, the purpose of this study was to compare those techniques in terms of their clinical utilization in patient care delivery among the major governmental and private hospitals within Jeddah city. The study initially included eighteen hospitals to identify whether they were utilizing fMRI and MRS in their clinical practice. Out of the 18 hospitals under study only one hospital (5.6%) had both fMRI and MRS software;7 (38.9%) had MRS but not fMRI;4 (22.2%) did not have fMRI or MRS;and 6 (33.3%) hospitals had no MRI machine at all. Out of the eight hospitals applying MRS with one being excluded, the starting date of application was 2002 in 4 (57.1%) hospitals, 2004 in 1 (14.3%) hospital, and 2006 in 2 (28.6%) hospitals. The frequency of doing MRS was once a week in 2 (28.6%) hospitals, 2-3 cases/week in 3 (42.9%) hospitals, 5-10 cases/week in 1 (14.3%) hospital, and once every 6 months in 1 (14.3%) hospital. On the other hand, fMRI was applied only by one hospital starting in 2000 and was soon dismissed due to its time consumption and the inability of patients to accurately follow given instructions. It was concluded that MRS was more widely utilized compared to fMRI. Later on, a follow-up survey in the year of 2014 demonstrated that MRS has started to become a standard service in most hospitals whereas fMRI was still being unrecognized.

Ocular manifestations of children with atopic dermatitis in Saudi Arabia

AIM:To examine the incidence of ocular abnormalities in children with atopic dermatitis(AD)in Saudi Arabia and its association with the severity of AD.METHODS:This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age.The severity of AD was evaluated using the SCORing Atopic Dermatitis(SCORAD)index.All the children underwent slit lamp exams,visual acuity assessment,intraocular pressure measurement,and corneal topography.The children were considered to have an ophthalmic abnormality if one or more of the following signs were present:glaucoma,keratoconus suspicion,in addition to lid,conjunctival,corneal,lenticular,or retinal abnormalities.RESULTS:Based on the SCORAD severity index,14%of children had mild AD(7/50),38%had moderate AD(19/50),and nearly half had severe AD.More than half the children exhibited facial involvement,and half had peri-orbital signs.The mean SCORAD index was 35.75.The mean age was 10.48±3.6y,and the cohort showed a slight male predominance(54%males).Both eyes of the 50 children in the cohort were studied.Based on the ocular examinations,92%of the patients showed ocular abnormalities:lid abnormalities(27/50)followed by keratitis(22/50).Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus.However,SCORAD severity index was not associated with age,sex,or the number or presence of ophthalmic abnormalities.CONCLUSION:This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD.The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities.Based on these findings,larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.

Saudi Consensus on the Usage of Sodium-Glucose Cotransporter-2 Inhibitors on the Management of Chronic Kidney Diseases

According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3rd June 2023. A drafted report was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval (i.e. above 75%). The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on 21st June 2023. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

The correlation between keratoconus and eye rubbing: a review

Keratoconus is a non-inflammatory disorder which is gradual in development;corneal thinning and ectatic protrusion characterizes it. Keratoconus prevalence varies between different regions depending on several factors that affecting its prevalence. There are risk factors for developing keratoconus such as demographic and environmental factors. It was suggested that eye rubbing was associated with the development of keratoconus. The main aim of this review was to summarize the literature data about keratoconus and to identify the role of eyerubbing in the aetiology of the disease. A number of 24 articles was reviewed through the Pub Med, Google Scholar and Research Gates. There are many keywords used such as keratoconus, aetiology of keratoconus, eye rubbing, keratoconus prevalence, keratoconus and eye rubbing correlation. We concluded that eye rubbing causes the thinning of keratocyte, and the degree of effect of eye rubbing depends on the period and force of performing eye rubbing. It is recommended to avoid eye rubbing to prevent keratoconus, this can be achieved by avoiding itching and treating dryness of the eye and avoiding wearing eye lenses.

Rituximab for troublesome cases of childhood nephrotic syndrome

Nephrotic syndrome(NS) is the most common glomerular disease of childhood. Steroid-dependent and steroid-resistant nephrotic syndrome present challenges in their pharmaceutical management; patients may need several immunosuppressive medication for optimum control, each of which medication has its own safety profile. Rituximab(RTX) is a monoclonal antibody that targets B cells and has been used successfully for management of lymphoma and rheumatoid arthritis. Recent clinical studies showed that rituximab may be an efficacious and safe alternative for the treatment of complicated nephrotic syndrome. In this review article, we aim to review the efficacy and safety of RTX therapy in nephrotic syndrome. We reviewed the literature pertaining to this topic by searching for relevant studies on Pub Med and Medline using specific keywords. The initial search yielded 452 articles. These articles were then examined to ensure their relevance to the topic of research. We focused on multicenter randomized controlled trials with relatively large numbers of patients. A total of 29 articles were finally identified and will be summarized in this review. The majority of clinical studies of RTX in complicated pediatric NS showed that rituximab is effective in approximately 80% of patients with steroid-dependent NS, as it decreases the number of relapses and steroid dosage. However, RTX is less effective at achieving remission in steroid-resistant NS. RTX use was generally safe, and most side effects were transient and infusion-related. More randomized, double-blinded clinical studies are needed to assess the role of RTX in children with nephrotic syndrome.

Transposable elements in <i>Escherichia coli</i>antimicrobial resistance

Transposable elements are capable of switching their positions on the genome thereby causing gene arrangements and contributing to genome evolution. The aim of this review is to specifically discuss the role of transposable elements in transferring antimicrobial resistance genes in E. coli, thus contributing to increase in virulence and conferring the possibility of multidrug resistance. Different types of transposable elements such as transposons and integrons and their profound influence on E. coli antimicrobial resistance are the focus of this review.

Spectrum of Henoch-Schonlein Purpura in Children: A Single-Center Experience from Western Provence of Saudi Arabia

The aim of this study was to describe the common presentation, frequency, and complications of Henoch-Schonlein purpura (HSP) in patients <18 years who were followed up at King Abdulaziz University Hospital, Jeddah over the last 12 years. We performed a retrospective chart review of the medical records of all patients diagnosed as HSP. During this period, only 29 cases were reported (15 males, 14 females), with the mean age at the diagnosis 7.5 years. 82% percent of the patients had joint involvement in the form of arthritis or arthralgia;17.2% had no joint involvement. Abdominal manifestations were reported in 72.4% of the patients, while renal involvement was documented in 24.1% of the cases;two patients had scrotal involvement. Four patients (13.7%) had a recurrence within four months of HSP diagnosis. However, all patients had full recovery within a month. More research is warranted to study the prevalence, clinical manifestations, preceding factors, and complications of HSP in a Saudi-based cohort.

Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience

Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.

Growth Pattern in Children with Juvenile Idiopathic Arthritis: A Retrospective Study

Aim of this study is to assess growth pattern in children with juvenile idiopathic arthritis (JIA) and factors associated with growth retardation. Methods: A retrospective chart review of all cases of JIA following up at Pediatric Department of King Abdulaziz University Hospital, between July 2000 to July 2016. Demographic, clinical and biological data were collected and analyzed as risk factor for growth retardation. These included age, gender, age at diagnosis, disease duration, type of JIA, the presence of uveitis, rheumatoid factor (RF) positivity, antinuclear antibody (ANA) titer and treatment. Growth pattern was assessed as the percentile for height-for-age, weight-for-age and weight-for-height in reference to the Growth Chart for Saudi Children and Adolescents. Change in percentile rank was divided into 3 categories: regression (a drop of ≥1 percentile);stable (uphold of the same percentile);and progression (change for a superior percentile). Results: A total 78 children were eligible, 52.6% females, mean ± SD age = 9.94 ± 4.92 years, and age at diagnosis = 7.44 ± 4.52 years, mean ± SD [range] disease duration = 2.93 ± 2.70 [6 months;15 years]. The most frequent types of JIA were systemic (33.3%), oligoarticular (30.8%) and polyarticular negative RF (26.9%). Other parameters included positive ANA in 41.0%, positive RF in 7.7% and uveitis in 9.0%. The most frequent treatment was methotrexate (59.0%), followed by biological therapy (47.4%), non-steroid anti-inflammatory drugs (43.6%) and prednisolone (33.3%). Growth data were available for 67 (85.9%) children, and assessments showed 36% cases of break of the growth curve in both height-for-age and weight-for-age percentiles and 31% in weight-for-height percentiles. In all three parameters, there were shifts towards lower percentiles from time of diagnosis to last follow-up, in both males and females. Correlation and regression analysis showed low age at diagnosis and disease duration to be significant predictors for growth retardation severity. Conclusion: One in three children with JIA has growth retardation, the severity of which is predicted by low age at disease onset and long disease duration.

Simple approach for the histomolecular diagnosis of central nervous system gliomas based on 2021 World Health Organization Classification

The classification of central nervous system(CNS)glioma went through a sequence of developments,between 2006 and 2021,started with only histological approach then has been aided with a major emphasis on molecular signatures in the 4^(th) and 5^(th) editions of the World Health Organization(WHO).The recent reformation in the 5th edition of the WHO classification has focused more on the molecularly defined entities with better characterized natural histories as well as new tumor types and subtypes in the adult and pediatric populations.These new subclassified entities have been incorporated in the 5^(th) edition after the continuous exploration of new genomic,epigenomic and transcriptomic discovery.Indeed,the current guidelines of 2021 WHO classification of CNS tumors and European Association of Neuro-Oncology(EANO)exploited the molecular signatures in the diagnostic approach of CNS gliomas.Our current review presents a practical diagnostic approach for diffuse CNS gliomas and circumscribed astrocytomas using histomolecular criteria adopted by the recent WHO classification.We also describe the treatment strategies for these tumors based on EANO guidelines.

CT Optimization for Diagnosis of Some Acute Abdomen Cases

The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim of this study was to demonstrate optimum CT aspects and emphasize on the important features of CT for those patients presenting with an acute abdominal pain at the Emergency Department both in general and in a number of selected conditions (appendicitis, small-bowel obstruction, acute pancreatitis, and diverticulitis). The reported data by this study are based on the author working experience, which forms a continuous protocol adjustment process. The present study provides evidence that CT would result in definite diagnosis of patients with abdominal pain in terms of the detection of some urgent conditions.

Is There a Role for Chest Computed Tomography in Patients with Primary Spontaneous Pneumothorax?

Background: Primary spontaneous pneumothorax is a relatively common condition in young adults. Although blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they are very rarely the actual cause of the pneumothorax. Objective: To assess our experience with chest computed tomography evaluation in patients with recurrent spontaneous pneumothorax as compared to their histopathology findings. Study Design: A prospective study analysis. Materials and Methods: From January 2013 to December 2016, 38 consecutive patients with unilateral recurrent spontaneous pneumothorax underwent video-assisted thoracic surgery. Their chest computed tomography scans were reviewed and compared with their histopathology findings. Results: Thirty-six adult patients with unilateral recurrent spontaneous pneumothorax were included;their mean age was 33.9 years, and they all received video-assisted thoracic surgery and mechanical pleurodesis. Blebs or bullae were present in the chest computed tomography scans of fourteen patients (39%);of those fourteen patients, five (35.7%) had emphysematous changes in histopathology. Seventeen out of the thirty-six (47%) had no blebs or bullae in their chest computed tomography scans;of those seventeen patients, ten (59%) had emphysema like changes and seven (41%) had blebs in their histopathology studies. The remaining five patients (14%) had normal chest computed tomography scans. Conclusions: We conclude that preoperative chest computed tomography is not beneficial in every patient with recurrence of primary spontaneous pneumothorax.

A 10-Year Saudi Experience of Using Adalimumab in Treating Juvenile Idiopathic Arthritis

Background: Traditionally, management of Juvenile Idiopathic Arthritis (JIA) involves use of non-steroidal anti-inflammatory drugs (NSAIDS) or disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate (MTX) or sulfasalazine;or steroids. However, in several cases, a low therapeutic response or important side effects is encountered. This study reports our experience in using adalimumab in JIA patients by assessing the efficacy and safety of this treatment in this category of patients. Methods: A retrospective study was conducted among 38 patients with JIA at the Pediatric Department, King Abdulaziz Univesrity Hospital, Jeddah, Saudi Arabia, in the period January 2005-March 2016. Patients’ records were reviewed and relevant demographic and clinical data were collected. Data were analyzed using SPSS version 21 and represented using tables. Results: The 38 patients were distributed as 11 (28.9%) males and 27 (71.1%) females;mean ± SD age was 11.91 ± 4.54 (range = 3 - 19) years. Mean ± SD (range) disease duration was 3.26 ± 2.52 (0 - 12) years and most frequent diagnoses included polyarticular rheumatoid factor (RF) negative form 12 (31.6%), followed by systemic and oligoarticular JIA with 9 (23.7%) cases each. Before adalimumab, fever was present in 13 (34.2%) cases, followed by rash in 8 (21.0%) cases;while 21 (55.3%) were asymptomatic. Thirty-one (81.6%) were in failure of MTX, 19 (50%) of steroids, 7 (18.4%) of NSAIDS and 3 (7.9%) had had intraarticular injections. Biologically, ANA, RF and anti-CCP were positive in 22 (57.9%), 8 (21.1%) and 4 (10.5%) of the cases, respectively. Uveitis was present in 11 (28.9%) of the patients. Analysis of adalimumab efficacy showed 10 (52.6%) cases of complete remission, 9 (23.7%) of partial remission and 9 (23.7%) other where treatment was discontinued. Major adverse effects included local pain (4 [10.5%]), new onset uveitis (1 [2.6%]) and rash (1 [2.6%]), responsible of 1case of treatment discontinuation. Predictors for complete remission on adalimumab were oligoarticular form (β = 3.450, p = 0.009) and negative RF (β = 2.381, p = 0.036);while predictors for nonresponse, whether complete or partial, were polyarticular form (β = ?3.784, p = 0.005) and positive anti-CCP (β = ?3.178, p = 0.021). Conclusion: Adalimumab is an efficient and relatively safe alternative in the treatment of JIA with relatively high remission rates and lower rates of adverse effects. Further multicentre experiences are warranted to prove its efficacy and safety in the Saudi patients.

Robotic Mediastinal Parathyroidectomy in a Patient with Maxillary Giant Cell Tumor

A 50-year-old woman with a maxillary giant cell tumor had primary hyperparathyroidism from a mediastinal parathyroid adenoma. Computed tomography showed a mildly enhanced, oval soft tissue nodule (2.5 × 1.5 × 1.7 cm) at the anterosuperior mediastinum. Mediastinal parathyroidectomy was performed with a 3-arm surgical robot. After surgery, the plasma parathyroid hormone level decreased markedly (before surgery, 70.5 pg/ml;after surgery, 5.5 pg/ml;normal reference range, 1.6 to 6.9 pg/ml). The 3-dimensional visualization, high-dexterity, and full range of motion of the robotic system provided an efficient and safe surgical procedure for the mediastinal tumor. The purpose of this case study is to show the feasibility and effectiveness of robot assisted dissection for mediastinal parathyroid gland and to demonstrate the giant cell tumor of the bone can regress after resection of parathyroid adenoma.