Utility of cardiac magnetic resonance in recurrent myocarditis

We report a 26-year-old man who presented to the emergency department four times within a 4-year period with recurrent myocarditis. His presentations were characterized by chest pain, elevated troponin I, and normal coronary angiography. Endomyocardial biopsy showed nonspecific inflammatory process. Laboratory workup including viral screening and autoimmune markers were negative. Cardiac magnetic resonance imaging showed evidence of recurrent myocarditis with progressive appearance of new areas of myocardial delayed enhancement seen in each admission.     

The Extent of Commitment of Saudis During Holy Ramadan to Social Distancing Measures Required for the Prevention of Transmission of COVID-19

Journal of Community Health - Coronavirus disease (hereafter COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. People were admitted to hospitals complaining of...     

Prevalence and risk factors of myasthenia gravis recurrence post-thymectomy

Objectives:To evaluate the prevalence and the factors associated with recurrence of myasthenia gravis following thymectomy.Methods:Six electronic databases which reported on recurrence of myasthenia gravis following thymectomy and/or its risk factors from 1985 to 2018 were searched. Summary prevalence and risk values obtained based on the random effect models were reported.Results:Seventy (70) papers containing 7,287 individuals with myasthenia gravis who received thymectomy as part of their management were retrieved. The patients had a mean follow-up of 4.65 years post-thymectomy. The prevalence of myasthenia gravis recurrence post-thymectomy was 18.0% (95% CI 14.7–22.0%; 1865/7287). Evident heterogeneity was observed (I²=93.6%; p<0.001). Recurrence rate was insignificantly higher in male compared with female patients (31.3 vs. 23.8%; p=0.104). Pooled recurrence rates for thymomatous (33.3%) was higher than the rate among non-thymomatous (20.8%) myasthenia gravis patients (Q=4.19, p=0.041). Risk factors for recurrence include older age, male sex, disease severity, having thymomatous myasthenia gravis, longer duration of the myasthenia gravis before surgery, and having an ectopic thymic tissue.Conclusion:A fifth of individuals with myasthenia gravis experience recurrence after thymectomy. Closer monitoring should be given to at-risk patients and further studies are needed to understand interventions to address these risks.

Myasthenia gravis (MG) a rare clinical condition characterized by autoimmune abnormalities is also the commonest neuromuscular junction (NMJ) disorder.1 Its pathophysiology involves the production of abnormal antibodies which binds to nicotinic acetylcholine receptors at the NMJ of skeletal muscles leading to alteration and damage of the NMJ.1-2 The disease is common in young women, however, another peak in incidence may occur at the 6th or 7th decade of life mainly in men in some population; and it may exhibits no sex preference in others.2 Clinically, patients with MG develop varying levels of skeletal muscle weakness affecting the ocular, bulbar, oculo-bulbar system, respiratory system, and the extremities.1 The pattern and course of MG is complex, varying from early remission to acute exacerbation and even death.3Previous research has revealed a strong relation between MG and disorders affecting the thymus. About 40 to 70% of individuals with MG have thymic follicular hyperplasia, and 10 to 21% of them have thymoma.4-6 Also, 20-47% of individuals having a thymoma have already developed or will develop MG.6-7 Findings from the literature indicate that 40 to 90% of individuals with MG attained remission following thymectomy compared with 10 to 20% among individuals with MG treated with medications without any surgery.6,8 Also, a recent randomised controlled trial demonstrated that thymectomy for individuals with nonthymomatous MG demonstrated better treatment outcomes during a three-year period compared with pharmacological therapy alone.9 Thus, guidelines now recommend thymectomy as a key treatment approach for MG.10A number of systematic reviews and/or meta-analyses among individuals with MG have been carried out. Some of these reviews explored the differences in outcomes between thymectomy and conservative management of MG,11,12 others compared surgical approaches of thymectomy,13-15 or potential prognostic factors for remission among individuals with MG irrespective of histological type following thymectomy.3,16 None assessed recurrence of MG following thymectomy or its risk factors. The identification of patient factors which are associated with recurrence of MG following thymectomy is crucial for the development of targeted interventions to address challenges associated with the care of individuals with MG. This systematic review and meta-analysis aimed to estimate the post-thymectomy recurrence rates and to investigate the factors associated with recurrence of MG following thymectomy in individuals with MG.     

Chickenpox complications in Saudi Arabia: Is it time for routine varicella vaccination?

INTRODUCTION: Varicella zoster (chickenpox) infection is a common and benign disease of childhood. The predominance of uncomplicated cases in children tends to overshadow the morbidity associated with severe cases and the resultant hospitalization. OBJECTIVE: The objective was to establish the complication rate of chickenpox in the Saudi National Guard population over a 2(1/2)-year period. METHODS: All reported cases of chickenpox at the King Abdulaziz Medical City, Riyadh were prospectively followed for development of complications during the period between 1 June 2001 and 30 December 2003. RESULTS: A total of 3802 cases of chickenpox were reported and followed during the acute illness phase. The majority of cases, 2984 (78%), occurred in children less than 15 years of age. Among all chickenpox cases, 78 (2%) required hospitalization, and 50 patients developed 58 (1.5%) complications. Skin and soft tissue infections were the most common complications, 20 (34%), followed by pneumonia in 16 (28%), bacteremia in six (10%), encephalitis in four (7%) and necrotizing fasciitis in four (7%). Complications were less common in children (36/2984, 1.2%) as compared to adults (14/818, 1.7%) (p = 0.26). However, pneumonia (p = 0.03) and hospitalization (p = 0.004) were more common in adults as compared to children. The overall fatality rate was 0.05%; two patients died, one aged two months the other 28 years. CONCLUSION: These data provide a baseline for morbidity and mortality from chickenpox, and further support the inclusion of varicella vaccine in the routine childhood immunization program in Saudi Arabia.     

Facile preparation of cesium salt of tungstophosphoric acid for catalytic synthesis of one-pot two-component 1,3,4-oxadiazole derivatives in water: A doubly green approach

Solid acid catalysts facilitate many organic reactions, Cesium salt of tungstophosphoric acid (CsPW) exhibits excellent catalytic activity due to its safety, efficiency, strong acidity, cost-effectiveness and being water tolerant. CsPW has provided promising results under aqueous conditions with the high catalytic efficiency for the synthesis of target 1,3,4-oxadiazoles. The prepared catalyst was fully characterized by FT-IR, X-ray diffraction (XRD), Brunauer–Emmett–Teller (BET), scanning electron microscopy (SEM), Energy-dispersive X-ray spectroscopy (EDAX) and X-ray photoelectron spectroscopy (XPS). 1,3,4-oxadiazoles synthesis is an environmentally friendly, clean and safe synthetic process in short reaction time, simple workup, excellent yield and catalytic recovery. The best yield results (94%) were obtained using cesium tungstophosphoric acid catalyst by model compound in just 40 min. In addition, thermodynamic and kinetic model reaction analysis was also conducted at a temperature range of 298–323 K under the influence of the catalyst. The reaction under kinetic analysis was found to be more regulated than thermodynamic, which may be attributed to the influence of the optimum amount of catalyst being used.