Neonatal encephalopathy: a prospective comparison of head US and MRI

Background  

Head US, the cornerstone neuroimaging modality in neonates, is believed to be less sensitive than MRI for detecting hypoxic ischemic injury (HII). Most reports comparing these modalities are retrospective and have a long interval between the exams.     

Concurrent validity of the Arabic version of General Medication Adherence Scale using two validated indirect adherences measures in Saudi patients with non-communicable diseases

PurposeThis study aimed to evaluate the concurrent validity of the Arabic version of the General Medication Adherence Scale (GMAS) using two validated scales namely Adherence to Refills and Medications Scale (ARMS) and Medication Adherence Rating Scale (MARS) in Saudi patients with non-communicable diseases.MethodsA cross sectional study was conducted for 2 months in out-patient departments at a tertiary care hospital in Khobar, Saudi Arabia. The study collected data from patients with chronic illnesses through convenience sampling. Pearson correlation (ρ) was conducted to report concurrent validity of GMAS. A correlation coefficient value ≥ 0.5 with p-value < 0.01 was considered threshold for establishing concurrent validity. The study was approved by an ethics committee (IRB-2019–05-002).ResultsA total of 406 patients responded to the study. The average age was 42.4 ± 5.94 years, and most patients were females (53.7%), married (70%), graduates (65.3%), employed (39.9%) and, had a monthly family income > SAR 10,000, i.e., USD 2666.2 (56.4%). The mean adherence scores obtained from MARS, ARMS and GMAS were 7.09, 19.9, and 27.4. The correlation (ρ) between GMAS and MARS scores was 0.65, and between GMAS and ARMS scores was −0.79, p < 0.01 for both comparisons.ConclusionThe concurrent validity of GMAS-AR was established in this study that would further substantiate psychometric properties of the scale in this population.     

The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly

In many centres, a test dose (TD) of octreotide is administered before commencing somatostatin analogue therapy (SAT), although the merits of this procedure are uncertain. We have analysed the value of the GH response to a TD in predicting the efficacy of subsequent SAT in 47 patients with acromegaly (25 male, median age 51 years, range 20-82). The primary goal of SAT was a mean GH of < 5 mU/l. Median baseline GH was 19.3 mU/l (2.2-233 mU/l) and with the TD fell by 78% (35-98%) to a nadir of 4.2 mU/l (< 0.3-85 mU/l). Optimal predictive power was observed when GH fell to < 5 mU/l after the TD. With this criterion, the TD had a positive predictive value (PPV) of achieving the primary goal on SAT of 82% and a negative predictive value (NPV) of 50%. However, baseline GH was also highly predictive of the likelihood of successful SAT (GH < 5 mU/l). The GH response to the TD had PPV of 83% and NPV of 61% of normalising IGF-I on SAT. In summary, baseline GH and nadir after a TD are highly predictive of a good response to SAT; however, a poor response to a TD does not exclude an optimal response to SAT. Furthermore, failure to achieve biochemical control does not equate to no benefit, as biochemical improvement was seen in every patient; therefore, no patient should be deprived of octreotide therapy because of the result of a TD. In conclusion, our data indicate that the octreotide TD has no place in selecting patients for SAT.     

Management strategies and results for severely encrusted retained ureteral stents

PURPOSE: To review the management approach to and results of severely encrusted retained ureteral stents and analyze predictive risk factors. PATIENTS AND METHODS: Medical records from January 1996 to March 2006 were reviewed for Double-J stent complications and their final outcome. A total of 876 stents were inserted in 784 patients for treatment of renal calculi with extracorporeal shockwave lithotripsy, ureteral calculi, after percutaneous nephrolithotomy, pyeloplasty, or injury to the ureter and kidney. Of these stents, 95 (10.84%) were found to be encrusted, and 26 (2.96%) were not only encrusted but retained as well. These patients, 21 men and 5 women with a mean age of 34 years (range 18-69 years), underwent one or more of the following procedures: cystolitholapaxy, retrograde ureteroscopic manipulation, intracorporeal or extracorporeal lithotripsy, percutaneous nephrolithotomy, and open surgical removal to make them stent free. RESULTS: The average duration of stent placement was 14 months (range 5 months-9 years). The encrustation was confined to the upper coil in 4 and the upper coil and body in 5. The lower coil and body in 8 and 9, respectively, were totally encrusted, of which 2 were fragmented as well. A total of 62 sessions of auxiliary procedures were required to render patients stent free. Four patients required percutaneous nephrolithotomy and one open removal. CONCLUSION: Encrustation and retention of a ureteral stent is a serious complication. Successful management of encrusted retained stents requires multimodality procedures along with proper record keeping of stent insertion and removal and patient counseling.