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Mahmoud A.A.H.,Neurosciences Center | Rizk T.,Neurosciences Center | El-Bakri N.K.,Research and Scientific Publication Center | Riaz M.,Research and Scientific Publication Center | And 2 more authors.
Epilepsia | Year: 2011

Purpose: We ran this study to assess the incidence of nephrolithiasis in a group of children on topiramate (TPM) therapy for at least 1 year. Methods: In this retrospective observational surveillance study, we reviewed the medical charts of children on TPM for at least 1 year seen at the pediatric neurology department during the period from 2005 to 2010 at King Fahad Medical City. Children with a normal baseline ultrasound report were included. Follow-up ultrasound reports after at least 1 year were collected. However, patients with any evidence of chronic illness or medications that may affect the kidney functions in addition to those who are not compliant with the prescribed dose were excluded. Family history of renal stones, symptoms suggestive of urologic disorders, and comorbidities were recorded. Key Findings: Medical charts of 96 children on TPM with a mean age of 6.9 (±3.8) years were reviewed; 52 (54.2%) of the children were male. The follow-up ultrasound showed that five children (5.2%) had developed kidney stones. The occurrence of kidney stones was found in four female patients (80%) versus one male (20%) (p > 0.05). Significance: Long-term use of TPM may result in increased incidence of asymptomatic kidney stones in the pediatric population. Hence, routine baseline and follow-up ultrasound of the urinary system should be recommended during the use of TPM in children. © 2011 International League Against Epilepsy.


Tleyjeh I.M.,King Fahad Medical City | Tleyjeh I.M.,Research and Scientific Publication Center | Tleyjeh I.M.,Mayo Medical School | Alasmari F.A.,King Fahad Medical City | And 8 more authors.
Infection Control and Hospital Epidemiology | Year: 2012

Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections.We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery.We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64-1.01]; P=.06; I2=75%). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted. © 2012 by The Society for Healthcare Epidemiology of America.


Alangari A.A.,King Saud University | Malhis N.,King Fahad Medical City | Mubasher M.,Research and Scientific Publication Center | Al-Ghamedi N.,Pharmacy Services Administration | And 6 more authors.
Chest | Year: 2014

Background: Inhaled corticosteroids, known to be effective as a maintenance medication in chronic asthma, have also been suggested as a therapy for acute asthma when given at high doses. Methods: A double-blind, randomized, placebo-controlled trial was conducted in children aged 2 to 12 years with moderate or severe acute asthma, as determined based on a clinical score of 5 to 15 points, where 15 is the most severe. We compared the addition of budesonide 1,500 μ g vs placebo to standard acute asthma treatment, which included salbutamol, ipratropium bromide, and a single dose of prednisolone 2 mg/kg given at the beginning of therapy. The primary outcome was hospital admission rate within 4 h. Results: A total of 906 ED visits by children with moderate or severe acute asthma were evaluated. Seventy-five cases out of 458 (16.4%) in the budesonide group vs 82 of 448 (18.3%) in the placebo group were admitted (OR, 0.84; 95% CI, 0.58-1.23; P = .38). However, among cases with high baseline clinical score ( ≥ 13), significantly fewer children were admitted in the budesonide group (27 of 76 [35.5%]) than in the placebo group (39 of 73 [53.4%]; OR, 0.42; 95% CI, 0.19-0.94; P = .03). Conclusions: The addition of budesonide nebulization did not decrease the admission rate of children with acute asthma overall. However, it may decrease the admission rate of children with severe acute asthma. © 2014 American College of Chest Physicians.


Shah U.H.,Pediatrics at the Canberra Hospital | Shah U.H.,Jawaharlal Nehru Medical College Hospital | Abu-Shaheen A.K.,Research and Scientific Publication Center | Malik M.A.,Jawaharlal Nehru Medical College Hospital | And 3 more authors.
Clinical Nutrition | Year: 2013

Background & aim: Acute lower respiratory infections are the most frequent illnesses globally in children less than 5 years old. The aim of this randomized double blind controlled trial is to assess the effectiveness of zinc gluconate supplementation for 2 months period compared to placebo in reducing respiratory morbidity in acute lower respiratory infected children up to 5 years of age living in zinc poor population. Methods: Children were randomly assigned to receive either 10 mg zinc gluconate or placebo for 60 days. Demographic and clinical data were collected at baseline and every two weeks for 180 days. Results: The final analysis included 96 children allocated equally to the two groups. The number of episodes of acute lower respiratory infections and severe acute lower respiratory infections were significantly lower in zinc group compared to placebo group (20.8% vs. 45.8% (P = 0.009) and 21.7% vs. 58.3% (P < 0.001), respectively). The acute lower respiratory infections free days were higher in the zinc supplemented group (P < 0.001). The median recovery time of morbidity was significantly shorter in zinc group (P < 0.001). Conclusions: Zinc supplement may result in significant reduction in respiratory morbidity among children with acute lower respiratory infections in zinc poor population. This study was registered under ClinicalTrials.gov Identifier no. NCT00536133. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Dbaibo G.,American University of Beirut | Rajab M.,Makassed General Hospital | Inati A.,Lebanese American University | Inati A.,Nini Hospital | And 7 more authors.
Trials in Vaccinology | Year: 2013

Background Rotavirus (RV) is a major cause of gastroenteritis (GE) in infants and young children globally, with rotavirus gastroenteritis (RVGE) causing dehydration due to diarrhea and frequently leading to hospitalization. Epidemiological data on RVGE in Lebanon are lacking, therefore this study aims to collect such baseline data. Methods We conducted multicenter, hospital-based surveillance across Lebanon to estimate the proportion of diarrheal hospitalizations attributable to RV in children under 5 years of age. Medical history, GE symptoms, treatment prior to hospitalization and demographics were obtained from medical records and parent/guardian interviews. The severity of GE episodes was determined using the 20-point Vesikari scale (score ≥11 was considered severe). Stool samples were analyzed for RV using an enzyme immunoassay and for strain prevalence using reverse transcriptase polymerase chain reaction. Results Between April 2007 and September 2008, a total of 534 subjects were enrolled, of whom 491 were included in the final analysis. GE attributable to RV was 27.7% and nearly 75% of the RVGE cases occurred in children under 2 years of age. No differences were observed between the severity of signs and symptoms in RV positive and negative subjects. Hospitalization occurred mainly between December-March and lasted for a median of 3 days. Treatment primarily consisted of intravenous rehydration and almost all subjects (96.1%) had recovered by the time of discharge. Prevalent circulating G and P types were G4 (36.9%), G1WT (29.2%), P[8]WT (77.7%) and P[4] (17.7%); the most common circulating RV strain was G4P[8]WT (36.9%). Conclusion RVGE hospitalizations are prevalent in children under 5 years of age in Lebanon. This baseline data might be useful for decision makers when initiating measures, such as vaccination, to prevent the disease. © 2013 The Authors.


Khan A.R.,University of Toledo | Riaz M.,Research and Scientific Publication Center | Abdulhak A.A.B.,University of Missouri - Kansas City | Al-Tannir M.A.,Research and Scientific Publication Center | And 6 more authors.
PLoS ONE | Year: 2013

Background: Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications. Purpose: Performed a systematic review to address the role of statins in the prevention or treatment of CAP. Data Source: Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies. Study Selection: Two authors independently reviewed studies that examined the role of statins in CAP. Data Extraction: Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted. Data Synthesis: Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I2 = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I2 = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder. Conclusions: Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias. © 2013 Khan et al.


Bin Abdulhak A.A.,King Fahd University of Petroleum and Minerals | Altannir M.A.,Research and Scientific Publication Center | Almansor M.A.,King Fahd University of Petroleum and Minerals | Almohaya M.S.,King Fahd University of Petroleum and Minerals | And 9 more authors.
BMC Public Health | Year: 2011

Background: Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios. Methods. A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women). Results: A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/ clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases. Conclusions: We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted. © 2011 Bin Abdulhak et al; licensee BioMed Central Ltd.


Tleyjeh I.M.,King Fahad Medical City | Tleyjeh I.M.,Mayo Medical School | Abdulhak A.A.B.,University of Missouri - Kansas City | Riaz M.,Research and Scientific Publication Center | And 8 more authors.
PLoS ONE | Year: 2013

Background: Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose: We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source: We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection: Two authors independently reviewed the studies for eligibility. Data extraction: Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis: Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion: In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics. © 2013 Tleyjeh et al.


Bin Abdulhak A.A.,King Fahad Medical City | Ba-Mougadam F.A.,National Neuroscience Institute | Al-Nakshabandi N.A.,King Saud University | Al-Tannir M.A.,Research and Scientific Publication Center
Oman Medical Journal | Year: 2011

Transient osteoporosis of the hip (TOH) is a rare condition mainly affecting pregnant women in their third trimester and middle aged men. We report a case of TOH/Bone marrow edema syndrome in pregnancy with involvement of the surrounding soft tissues on magnetic resonance image, which has not been previously reported. The presence of such edema in the soft tissues may help to differentiate this condition from early avascular necrosis of the hip, and may also provide an insight into the pathogenesis of the condition. The reported patient was treated conservatively and fully recovered. © OMSB, 2011.


Tleyjeh I.M.,King Fahad Medical City | Tleyjeh I.M.,Alfaisal University | Tleyjeh I.M.,Mayo Medical School | Bin Abdulhak A.A.,University of Missouri - Kansas City | And 11 more authors.
PLoS ONE | Year: 2012

Introduction: Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods: Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results: We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26-1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions: In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship. © 2012 Tleyjeh et al.

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