Overweight and Obesity in Saudi Arabian Adult Population, Role of Sociodemographic Variables

The objectives of this Community-based National Epidemiological Household Survey, conducted between 1990–1993, were to estimate the prevalence of overweight and obesity in Saudi Arabia and to examine its association with the socio-demographic characteristics of the adult population. A sample of Saudis 20 years and over was selected using a multistage stratified cluster sampling technique with probability proportionate to size. The selected subjects were requested to visit primary health care centers in their localities. Physicians in these clinics took measurements of heights and weights and collected other relevant data. Obesity was measured by the Body Mass Index, using the Quetelet Index. The results showed the sample of 10,651 subjects of which 50.8% were males, had a mean age of 35.8 years (SD = 14.27 years). The prevalence of overweight was 31.2% (95% confidence interval: 30.3%, 32.1%); 33.1% for males and 29.4% for females. For obesity, the overall prevalence was 22.1%; males 17.8% and females 26.6%. The study design suggested that these estimates could be closer to the true values. The multiple logistic regression analysis showed that age, residential area, region, income, gender, and education are statistically significant predictors of obesity. The prevalence of obesity was higher in females than males, lower in subjects living in rural areas with traditional lifestyles than those in more urbanized environments, and increased with increasing age. The observed prevalence and pattern of overweight and obesity with age and gender is similar to those observed in the Arab community and some Western nations. There is a need for increased physical activity and better nutrition education programs to reduce the extent of obesity and to pre-vent the serious health consequences, especially, in the middle age group.     

Booster effect of two-step tuberculin skin testing among hospital employees from areas with a high prevalence of tuberculosis.

During a baseline survey of TST, 236 nurses underwent a two-step TST. Overall, 29 (12%) showed boosting. All age groups showed boosting; the rate was 9.7% in those younger than 35 years. Subjects older than 45 years were more likely to have a booster effect than younger individuals (29% vs 10.1%).     

Pott's puffy tumor. A condition still to be considered

In the era of antibiotics, Pott-Puffy Tumor PPT is a rarely recognized entity. An 11-year-old girl presented with headache, fever for one week, and frontal swelling for 3 days. On examination, she was febrile, congested nasal mucosa with yellowish nasal discharge and frontal swelling; tender not fluctuating with normal eye mobility. Computed tomography CT scan of brain and paranasal sinus revealed opacity of maxillary, left ethmoid, frontal sinus opacity and epidural collection in the right frontal region with post contrast enhancement. An extracranial superficial swelling with fluid collection at the same level of epidural collection. The patient underwent bilateral antral washout and left frontal sinus trephination, which had resulted into a complete resolving of symptoms and an avoidance of further invasive surgical intervention.     

How does esophagus look on barium esophagram in pediatric eosinophilic esophagitis?

Purpose

The clinical, endoscopic, and histologic findings of eosinophilic esophagitis (EoE) are well characterized; however, there have been very limited data regarding the radiologic findings of pediatric EoE. We report on the radiologic findings of pediatric EoE observed on barium esophagram and correlate them with the endoscopic findings.

Methods and materials

We identified children diagnosed with EoE in our center from 2004 to 2015. Two pediatric radiologists met after their independent evaluations of each fluoroscopic study to reach a consensus on each case. Clinical and endoscopic data were collected by retrospective chart review.

Results

Twenty-six pediatric EoE cases (age range 2–13 years; median 7.5 years) had barium esophagram done as part of the diagnostic approach for dysphagia. Thirteen children had abnormal radiologic findings of esophagus (50%): rings formation (n = 4), diffuse irregularity of mucosa (n = 8), fixed stricture formation (n = 3), and narrow-caliber esophagus (n = 10). Barium esophagram failed to show one of 10 cases of narrow-caliber esophagus and 10 of 14 cases of rings formation visualized endoscopically. The mean duration of symptoms prior to diagnosis of EoE was longer (3.7 vs. 1.7 year; p value 0.019), and the presentation with intermittent food impaction was commoner in the group with abnormal barium esophagram as compared to the group with normal barium esophagram (69% vs. 8%; p value 0.04).

Conclusion

Barium swallow study is frequently normal in pediatric EoE. With the exception of narrow-caliber esophagus, our data show poor correlation between radiologic and endoscopic findings.

     

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure,technical details and review of the literature

Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.     

Length of MRI signal may predict outcome in advanced cervical spondylotic myelopathy

Objective:

To study clinical and radiological factors that may correlate with independent walking (IW) following advanced cervical spondylotic myelopathy (CSM) surgery.

Methods:

A retrospective case series including all advanced CSM patients (Nurick 4 and 5) who underwent surgery from 2003-2010 in the Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia. Only patients with 6 months or more follow-up were included. A neuroradiologist who was blinded to the clinical data reviewed all MRI studies.

Results:

Forty-three patients were included (83% males, mean follow-up 29 months). A better preoperative neurological status was a positive predictor of IW after surgery (85.7% Nurick 4 versus 36.4% Nurick 5, p=0.001). Independent walking was less likely in patients with the following MRI features: longer T2-weighted image (T2WI) signal changes (p=0.001), well-circumscribed T2WI signal changes (p=0.028), T1WI hypointensity (p=0.001), and narrow spinal canal diameter (p=0.048). Multivariate regression revealed that both an increased T2WI signal change length and T1WI hypointensity were independent predictors. The risk of dependent walking increased by 1.35 times as the T2WI signal intensity length increased by one mm, and by 14-times with T1WI hypointensity.

Conclusions:

Regaining IW after surgery in patients with advanced CSM was less likely for cases showing MRI features of longer T2WI signal changes and T1WI hypointensity. Better baseline walking, less defined T2WI signal change, and a wider spinal canal were good prognostic factors.Cervical spondylotic myelopathy (CSM) may lead to significant disability.1-3 Progressive compression of the spinal cord causes chronic ischemia, local inflammatory response, and endothelial cell loss that may result in permanent spinal cord damage.4 In addition, there is an enhanced permeability in the blood-spinal cord barrier, leading to contact between the peripheral immune system and the spinal cord. Subsequently, there is an increased inflammatory reaction, resulting in more adverse effects on the spinal cord.5 Eventually, the spinal cord develops cystic cavitation, gliosis, degeneration of the central grey and medial white matter, Wallerian degeneration of the posterior columns and posterolateral tracts, and a loss of anterior horn cells. These changes are reflected on the clinical presentation and MRI features of the patients. The ability to detect changes related to spinal cord compression plays an important role in predicting clinical and functional outcomes. Several clinical and radiological factors have been studied as potential predictors for functional outcome. Relevant clinical predictors include the patient’s age at diagnosis, the duration of symptoms prior to surgery, medical comorbidities, the preoperative neurological status, and the surgical procedure performed.6,7The MRI predictors of unfavorable outcome include hypointensity on T1-weighted images (T1WI), the type of signal intensity on T2-weighted images (T2WI), and a reduction of the spinal canal diameter.6,8-12 The correlation between the length of signal change on T2WI MRI sequences and clinical outcome after surgery has not been established. Changes in the internal structure of the spinal cord could appear as alterations in the signal intensity on T1- and T2-weighted MRI sequences.8,13 Hyperintensity on T2WI corresponds to focal gliosis, myelomalacia, vascular ischemia, and edema. Therefore, it is possible that patients with longer MRI signals experience less favorable clinical recoveries after surgery, particularly if the changes correspond to hypointensity on T1WI. In the current study, our objective was to assess the correlation between clinical and MRI features and independent walking (IW) after surgery in an attempt to predict functional recovery. Only patients with advanced myelopathy were included to avoid any bias that may result from involvement of patients with different disease severity.