Brain abscess in Saudi Arabia

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982–1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period.Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15–39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.     

Use of complement monoclonal antibody eculizumab in Shiga toxin producing Escherichia coli associated hemolytic uremic syndrome: A review of current evidence

Complement activation plays an important role in the pathogenesis of atypical hemolytic uremic syndrome. Eculizumab is a monoclonal antibody that blocks complement activity and has been approved for use in the treatment of atypical hemolytic uremic syndrome (HUS). Less well appreciated is the role of complement in Shiga toxin‐induced HUS (Shiga toxin producing Escherichia coli [STEC]‐HUS). To a limited extent, eculizumab has been used off label in patients with severe STEC‐HUS with neurological involvement. Through a systematic search of available databases, we identified 16 reports describing the use of eculizumab in STEC‐HUS (eight case reports/series, seven retrospective studies, and one prospective cohort study). All studies described its use in severe STEC‐HUS with neurological or multiorgan dysfunction; none were randomized or blinded. Four studies used the control groups. Although the overall quality of evidence is low, some published studies showed positive clinical improvement after treatment with eculizumab in severe STEC‐HUS with progressive neurological involvement.     

Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: a 30-day follow-up study.

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost-effective, small-molecule GP IIb/IIIa blocker with a shorter half-life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 microg/kg 10 min apart and a 24-hr infusion of 2 microg/kg/min). Clinical outcomes were evaluated at 30 days after the procedure. The angiographic patency of the vessel with TIMI flow rates, TIMI myocardial perfusion (TMP) grade, and corrected TIMI frame counts were assessed at the end of procedure and before hospital discharge. At 30 days, the primary endpoint, a composite of death, myocardial infarction, and urgent target vessel revascularization (TVR) was seen in 12.7% of patients. The TIMI 3 and TMP grade 3 flow, which was seen in 93% and 86% of patient, respectively, at the end of the procedure, declined to 86% and 78%, respectively (P < 0.05) before hospital discharge. Corrected TIMI frame counts also decreased from 25.7 +/- 7.2 to 22.9 +/- 6.8 (P < 0.05). There were five (9.1%) instances of subacute thrombosis (SAT) presenting as AMI, needing urgent TVR in all, within 3-5 days of the primary procedure. No excessive bleeding complication, directly attributable to the use of eptifibatide, was observed. The study was terminated prematurely because of an unacceptable SAT rate. Administration of eptifibatide along with primary stenting for AMI is associated with a high TIMI 3 and TMP grade 3 flow acutely. However, these flows decline significantly before hospital discharge and lead to a high rate of SAT. The dosage and duration of infusion of eptifibatide in this setting needs further evaluation.     

Lower Frequency and Diversity of Antibiotic-Producing Fluorescent Pseudomonads in Rhizosphere of Indian Rapeseed–Mustard (<Emphasis Type="Italic">Brassica juncea</Emphasis> L. Czern.)

Fluorescent pseudomonads are one of the most important microbial communities which play a key role in rhizosphere to enhance plant growth-promotion and protection. The diverse groups of antibiotics viz. 2,4-diacetylphloroglucinol (DAPG), phenazine-1-carboxylic acid (PCA) and pyoluteorin (PLT) are produced by fluorescent pseudomonads inhibiting growth of fungal pathogens which results in health upliftment of plants. The present study, discusses about frequency and diversity of 138 antibiotic-producing fluorescent pseudomonads isolated from eight genotypes of rapeseed mustard rhizosphere (Brassica juncea L. Czern.). The plant growth promoting traits and antibiotics (DAPG, PCA and PLT) production of isolates were examined by using polymerase chain reaction (PCR), thin layer chromatography (TLC) and dot blot-hybridization. Among 138 isolates, 47, 25 and 9 % of isolates were positive in indole production, phosphate solubilization and antagonism potential against Sclerotinia sclerotiorum (causal agent of white mold disease in rapeseed mustard), respectively. PCR amplifications showed that none of the isolates had phlD (DAPG) and phzC (PCA) genes, but four isolates (UKA-2, UKA-8, UKA-11, UKA-66) had pltB (PLT) gene, which was further confirmed by TLC and DNA dot-blot hybridization. BOX profiles of pltB positive isolates were distinct, showing unique genetic diversity in the small population. The four pltB positive fluorescent pseudomonad isolates could be used as promising bio-control and plant growth-promoting inoculants for Indian rapeseed mustard.     

The NUGGET study: NIR ultra gold-gilded equivalency trial.

This study should clarify whether the gold-coated NIROYAL stent is equivalent to the stainless steel NIR stent. Patients were randomized to either NIR stent (n = 298) or a NIROYAL stent (n = 305). The primary endpoint was the minimum lumen diameter of the target lesion at 6 months postprocedure. Secondary endpoints focused on clinical events. At 30 days, adverse events were similar in both groups. At 6 months, the minimal lumen diameter was 1.83/1.64 mm (P < 0.001; 95% CI = 0.08-0.30) and the angiographic restenosis rate was 20.6%/37.7% (P < 0.001; 95% CI = -24.7 to -9.3) for NIR/NIROYAL. The 6-month MACE rates were NIR 7.4% and NIROYAL 10.5% (95% CI = -7.7 to 1.4). Compared to stainless steel stent, the NIROYAL stent demonstrated a smaller minimal lumen diameter, a higher late loss (i.e., higher neointimal hyperplasia in spite of a significantly better initial gain), with higher restenosis and similar MACE rates at 6 months.     

Mitomycin‐C: ‘a ray of hope’ in refractory corrosive esophageal strictures

Increasingly frequent dilation may become a self‐defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin‐C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin‐C was applied for 2–3 minutes at the strictured esophageal segment after dilation with wire‐guided Savary‐Gilliard dilator. Patient was kept nil by mouth for 2–3 hours. After 4–6 sessions of mitomycin‐C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin‐C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.