Prevalence of bleeding symptoms among young adults in Saudi Arabia,a national survey

Prevalence of bleeding disorders vary due to several factors including geographical location. Mild bleeding disorders can lead to iron deficiency, morbidity, and in severe cases mortality. Quantification of haemorrhagic symptoms is a key component in management of bleeding disorders and a challenging task for clinicians.An abridged version of MCMDM-1vWD questionnaire with validated Arabic translation was used to quantify bleeding disorders in adult students (n = 1138) in 4 different regions of Kingdom of Saudi Arabia. Statistical analysis was performed to indicate gender disparity and prevalence.74.5% of respondents answered at least 1 question with affirmation, with 32.3% affected in Riyadh showing the highest prevalence and 14.03% affected in Dammam showing the least prevalence (P-value < .001). Gender-wise, higher prevalence of bleeding disorders in females 54.9% than in males 45.1% was observed (P-value .01). Epistaxis prevalence was significantly higher in males 30.7% vs 23.2% in females (P-value .0004), while cutaneous symptoms were reported significantly more by female participants 29.7% vs 12.3% in males (P-value < .001). Menorrhagia was reported by 28% of females, with heavy bleeding experienced by 57.6% female participants for <7 days while in 42.4% of females for >7 days.The current study signifies the ethnic distribution and gender disparity of mild bleeding disorders, and highlights the need for national surveillance system in order to improve management of patients with bleeding disorders.     

Vesicovaginal fistula due to an unreported foreign body in an adolescent

BACKGROUND: In the United States, vesico-vaginal fistula formation is most commonly associated with prior gynecologic surgery, and only rarely with severe pressure necrosis. CASE: A 16-year-old girl presented with continuous urinary leakage and malodorous discharge. Examination revealed an incarcerated plastic cup in the vagina with a 5 cm vesico-vaginal fistula at the bladder neck. After trans-vaginal repair, the patient underwent full recovery with an intact continence mechanism. CONCLUSION: Evaluation of unusual urinary symptoms in an adolescent should include pelvic examination and/or imaging. An undisclosed vaginal foreign body is a rare, but well described entity, contributing to vesico-vaginal fistula formation.     

Detection of circulating tumour cells in colorectal cancer: Emerging techniques and clinical implications

Despite several advances in oncological management of colorectal cancer, morbidity and mortality are still high and devastating. The diagnostic evaluation by endoscopy is cumbersome, which is uncomfortable to many. Because of the intra- and inter-tumour heterogeneity and changing tumour dynamics, which is continuous in nature, the diagnostic biopsy and assessment of the pathological sample are difficult and also not adequate. Late manifestation of the disease and delayed diagnosis may lead to relapse or metastases. One of the keys to improving the outcome is early detection of cancer, ease of technology to detect with uniformity, and its therapeutic implications, which are yet to come. "Liquid biopsy" is currently the most recent area of interest in oncology, which may provide important tools regarding the characterization of the primary tumour and its metastasis as cancer cells shed into the bloodstream even at the early stages of the disease. By using this approach, clinicians may be able to find out information about the tumour at a given time. Any of the following three types of sampling of biological material can be used in the "liquid biopsy". These are circulating tumour cells (CTCs), circulating tumour DNA, and exosomes. The most commonly studied amongst the three is CTCs. CTCs with their different applications and prognostic value has been found useful in colorectal cancer detection and therapeutics. In this review, we will discuss various markers for CTCs, the core tools/techniques for detection, and also important findings of clinical studies in colorectal cancer and its clinical implications.     

Five‐year survival without major disability of extremely preterm infants born at 22–27 weeks’ gestation admitted to a NICU

Aim: To compare the 5‐year survival without major disability in infants born at the threshold of viability at 22–25 weeks who were actively treated in the delivery room and admitted to a NICU to that of those born at 26–27 weeks of gestation. Methods: All infants between 22⁺⁰ and 27⁺⁶ weeks of gestation admitted to a regional intensive care unit during 1999–2003 were enroled prospectively. The survival and major disability at 5 years of age were analysed by gestational age. Results: Of 242 treated infants, 202 survived (83.5%). Although the overall survival rate was significantly higher in the 25–27 weeks’ gestation infants than the 22–24 weeks’ gestation infants (p < 0.001), the survival rate among infants 22–24 weeks (63.6%, 63.6%, and 70%) did not significantly differ, likewise infants 25–27 weeks (88.7%, 90.6%, and 92%) had similar results. Overall, 28 children (14.4% of assessed) had major disability. Both survival and survival without major disability were positively influenced by increasing gestational age, increasing birth weight, being born at 25–27 weeks and being female child. Conclusion: With an active approach in treatment, the outcome of infants born at 25 weeks is comparable to those born at 26–27 weeks. Thus, the ‘grey zone’ in which the risk of adverse outcome is high narrows to 22–24 weeks.     

Helicobacter pylori infection in children: population‐based age‐specific prevalence and risk factors in a developing country

Aim: We estimated the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) seroprevalence in children aged 1–15 years. Methods: Exposure was assessed using ELISA. Parents responded to a questionnaire regarding number of individuals sharing house, rooms, water source, latrines, housing and assessment of socioeconomic status (SES) by Hollingshead Index. Results: Serum of 1976 children was tested. Helicobacter pylori seropositivity in children aged 11–15 years was 53.5% (OR: 2.0, 95% CI: 1.58–2.5). It increased with moderate crowding index (CRI) of 2–4 to 45.9% (OR: 1.23, 95% CI: 0.92–1.63) and to 51.2% with CRI >4 (OR: 1.52, 95% CI: 1.12–2.06). In middle SES, seropositivity was 50.5% (331/655) (OR: 1.7, 95% CI: 1.29–2.35), whereas in lower SES, it was 47.1% (500/1062) (OR: 1.5, 95% CI: 1.1–2.0). Multivariate analysis showed that Helicobacter pylori seroprevalence was high in children aged 6–10 and 11–15 years (OR: 1.5, 95% CI: 1.2–1.9 and OR: 1.9, 95% CI: 1.56–2.47 respectively), in lower‐middle SES (OR: 1.6, 95% CI: 1.2–2.1 and OR: 1.5, 95% CI: 1.10–2.0 respectively) and in uneducated fathers (OR: 1.58, 95% CI: 1.27–1.95). Conclusion: Helicobacter pylori seropositivity increases with age, in low‐middle SES and is related to father’s educational status. Reducing H. pylori seroprevalence will require improvement in sanitary conditions and educational status of the population.