The impact of the coronavirus (COVID-19) pandemic on the development of obsessive-compulsive symptoms in Saudi Arabia

Objectives:To explore the impact of the COVID-19 pandemic on the development of obsessive-compulsive disorder (OCD) symptoms and its correlation with the level of perceived stress among the Saudi population.Methods:In July 2020, a cross-sectional survey of 2909 participants in Saudi Arabia during the outbreak was conducted to collect data related to sociodemographic characteristics and scores on the Brief Obsessive-Compulsive Scale (BOCS) and Perceived Stress Scale (PSS).Results:Most participants were female (73.9%) with a university level of education or higher (81%). The prevalence of new-onset obsessions was 57.8%, compulsions 45.9%, and moderate/high perceived stress 72.4%. New-onset dirt, germs, and virus obsessions were significantly higher among 40-49 age group, employees, housewives, students, quarantine discipliners, and those who spent 20 or more days in quarantine. New-onset hand-washing compulsions were significantly higher among the 30-49 age group. A significantly higher level of perceived stress was reported among those in the 18-29 age group, females, singles, participants with no children, students, non-smokers, those who were unemployed, living with families, diagnosed with a psychiatric disorder, living in the northern region, quarantine discipliners, and those who spent 60 or more days in quarantine.Conclusion:This study revealed a significantly higher prevalence of high perceived stress in respondents with new-onset OCD contamination symptoms during the COVID-19 pandemic. This implies that a biodisaster is associated with high psychological morbidity.     

Device-related infections in a pediatric intensive care unit: The Jordan University of Science and Technology experience

To estimate the prevalence of the most frequent infections related to device utilization and their antimicrobial sensitivity panel, and to investigate the overall incidence of device associated infection rates per 1000 device days, at the pediatric intensive care unit of the Jordan University of Science and Technology.This is a retrospective study from a single pediatric intensive care unit. Data were collected in relation to bloodstream infections associated with central venous catheters, pneumonia associated with ventilator endotracheal tubes, and urinary tract infections associated with Foley catheters, between January 2013 and December 2018, according to the center of disease control and prevention protocols.During the 5-year study, 3195 patients were admitted to the pediatric intensive care unit for a total of 16,487 days. Forty-six patients (1.4%) developed 55 infections, with a median incidence rate of 7.4, 3.7, and 0.7 per 1000 days for central line associated infections, ventilator associated pneumonia, and catheter associated infections, respectively. The commonest isolated microorganisms were gram-negative bacteria in 89.1% of cases, and fungi in 10.9% of cases. Among the resistant bacterial isolates, 59.2% were multidrug resistant, and 32.6% were extended spectrum beta lactamase producers Klebsiella pneumoniae and Eschericia coli. High infection rates were related to Acinetobacter baumannii and K pneumoniae, associated with high resistance to cephalosporins. Susceptibility was highest to tigecycline and imipenem at 42.9% and 32.7% respectively.Microbial isolates are commonly associated with healthcare device insertions in pediatric intensive care unit, invasive bacterial infections associated with critical morbidity and mortality. Further studies on device associated infections are recommended for regional profiling purposes.     

Plasma level and tissue expression of angiogenic factors in patients with hereditary hemorrhagic telangiectasia

The value of angiogenic factors interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) was determined in patients with hereditary hemorrhagic telangiectasia (HHT) to evaluate their role in HHT pathogenesis. IL-8 and VEGF were measured in plasma of 41 HHT patients and healthy controls by ELISA technique. In both groups, the IL-8 and VEGF tissue expression in cryostat sections of the nasal mucosa were then compared. VEGF plasma levels were significantly increased in HHT patients compared to healthy controls. In contrast, the IL-8 plasma levels in both groups did not show any significant difference. Compared to healthy controls, HHT tissue samples showed a weak IL-8 staining, whereas the VEGF staining was very strong. The plasma levels of VEGF and IL-8 could not be correlated to the patients' clinicopathological findings. Additionally to the angiogenic pro-inflammatory cytokine IL-8, the angiogenic factor VEGF seems to play a major role in HHT pathogenesis.     

Effect of vascular endothelial growth factor on fibroblasts from external auditory canal cholesteatoma

BACKGROUND: EACC is a disease of the external auditory canal resulting in destruction of adjacent tissue. However, the role of the surrounding mesenchymal fibroblasts of the perimatrix still remains unclear. In this study we treat isolated fibroblasts of EACC with VEGF and determine FGF-2 levels. We also treat the fibroblast cultures with FGF-2 and measured VEGF levels. METHODS: All EACC cell cultures were obtained from five patients undergoing surgery and used at passage 3. After 1-4 days incubation with 50 ng/mL FGF-2, and 1-8 days incubation with 50 pg/mL VEGF incubation, the expression of the FGF-2 and VEGF protein in the supernatants of the HGF/SF-treated and -untreated culture cell lines was analyzed, respectively. RESULTS: After 8 days of incubation with 50 ng/mL VEGF, the levels of FGF-2 decreased. However, after 4 days of incubation with FGF-2 the VEGF levels increased significantly in treated tissue culture (p <0.05) in comparison to untreated EACC fibroblasts. The total protein concentration showed no significant difference in both cultures (p >0.05). CONCLUSIONS: In summary, exogenous FGF-2 increased fibroblast expression of VEGF, which is a major autocrine mediator of FGF-2-induced angiogenesis and proliferation. However, incubation with VEGF resulted in decrease of FGF-2 levels. Regarding the slow growth of the fibroblasts, they may not be as likely to exhibit a reactive or invasive phenotype as seen in middle ear cholesteatoma fibroblasts.     

Segmental early relaxation phenomenon: incidence, clinical characteristics, and significance in stress echocardiography

STUDY OBJECTIVES: To evaluate the incidence, patient characteristics, and clinical significance of segmental early relaxation phenomenon (SERP) in stress echocardiography. DESIGN: Retrospective interpretation of digitized rest/stress echocardiographic images of 244 consecutive patients undergoing exercise or dobutamine echocardiography with subsequent patient follow-up for outcomes. SETTING: Tertiary care referral center. PATIENTS: Two hundred forty-four consecutive patients referred for stress echocardiography (exercise or dobutamine) for various clinical indications. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: SERP was diagnosed as a sudden outward motion of a portion of the left ventricle during early diastole (using frame-by-frame analysis) after peak systole prior to mitral valve opening at rest and after stress. Stress-associated SERP was observed in 71 patients (29.1%), with 25 patients having SERP in more than one segment. Five patients had resting SERP, with two persisting during stress. Ninety-six of 3,658 analyzed segments were positive for SERP. The apical septum and midseptum were most commonly involved in 49% and 18%, respectively. Only 5 of 96 patients (5.2%) had new hypokinesis and SERP in the same segment. No significant differences existed in demographic, clinical, or echocardiographic variables in patients with and without SERP. Follow-up revealed no significant differences in event rates in those with and without SERP. CONCLUSIONS: This is the first stress echocardiographic study demonstrating that SERP is a distinct and relatively common stress echocardiographic phenomenon occurring in early diastole regardless of type of stress. SERP occurs predominantly in apical and midseptum in the distribution of the left anterior descending coronary artery. It should not be mistaken for atypical septal motion, ischemia, or dyskinesia, and does not seem related solely to the presence of underlying coronary disease or stress-induced ischemia. No adverse long-term outcomes are seen in patients with SERP and no inducible ischemia.     

A case of fatal invasive aspergillosis in a patient with neurosarcoidosis treated with infliximab

Introduction: CNS involvement in sarcoidosis is seen in 5–10% of cases. Long term treatment involves steroids and other immunomodulatory agents, including infliximab. Chronic immunosuppression can result in increased patient susceptibility to opportunistic infections. We present a case of fatal aspergillosis in a patient with neurosarcoidosis treated with infliximab. Case report: A 55-year-old woman with neurosarcoidosis on infliximab (started 4?months prior) and dexamethasone, presented with progressive cognitive decline. Exam revealed impaired attention and disorientation with preserved language. Brain MRI showed multiple, bilateral cortical and subcortical ring-enhancing lesions. We held immunosuppression due to suspicion of infection; empiric Amphotericin B was given early in the hospital course. The patient rapidly deteriorated from a neurological and respiratory standpoint, requiring intubation. CSF analysis showed elevated protein of 511 and normal glucose of 104 (67% serum), with lymphocytic pleocytosis (25 cells, 96% lymphocytes). Systemic and CNS microbiological studies were negative. On hospital day 13, bronchial fluid grew Aspergillus fumigatus, prompting a switch to voriconazole. Despite early empiric antifungal treatment, she died from respiratory failure; autopsy revealed systemic and CNS aspergillosis with multiple brain abscesses. Discussion: This case represents an example of a fatal complication of infliximab therapy, which was recently shown to be effective in neurosarcoidosis in one study. It also serves to highlight the challenges faced in diagnosing ring-enhancing lesions, especially in patients with pre-existing brain disorders. Finally, it highlights the difficulty in treating invasive aspergillosis. Further studies are needed to identify risks associated with infliximab therapy and potential early interventions to improve outcomes.     

Treatment of chronic osteomyelitis secondary to hydatid disease of bone using gentamycin beads

Hydatid disease of bone is rare. It remains asymptomatic over a long period. It is usually detected after a pathological fracture or secondary infection or following the onset of compressive myelopathy in cases of vertebral lesions. Secondary infection of hydatid disease of bone could be difficult to treat. The authors present a case of chronic osteomyelitis of the proximal aspect of the left femur in a 37-year-old male patient secondary to hydatid disease of bone. It was treated by aggressive debridement, gentamycin beads, and bone graft to fill the defect. No recurrence of the hydatid lesion or infection was detected after 2 years. This case showed that in addition to aggressive debridement, gentamycin beads may be valuable in eradicating the infection in such a case.     

The significance of Wilms Tumor Gene (WT1) and p53 expression in curettage specimens of patients with endometrial carcinomas

In this retrospective experimental study, we assessed the immunohistochemical expression of Wilms Tumor Gene (WT1) and p53 in endometrial biopsies of patients with endometrial cancer, and correlated their expression with the final pathological findings.