Background: Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in termi‑ nating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. Methods: In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. Results: Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intrave‑ nous SVT termination medication without any significant increase in adverse events or time spent in the emergency department. Conclusion Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

Background: Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in termi‑ nating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. Methods: In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. Results: Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intrave‑ nous SVT termination medication without any significant increase in adverse events or time spent in the emergency department. Conclusion Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes. Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications. Results:The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections. Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients. Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle. Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Postprocedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months. Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

No abstract available.
Echocardiography ; Lymphoma, B-Cell*

BACKGROUND: Diabetes mellitus (DM) is associated with high mortality, morbidity, poor general health, and loss of health-related quality of life (HRQOL). The objective of the study was to assess the factors associated with HRQOL among patients with type 2 diabetes mellitus (T2DM). METHODS: This was a cross sectional study conducted among 283 T2DM patients during June 2011 and September 2012 at a major tertiary hospital in Riyadh, Saudi Arabia. The respondents were purposively and conveniently selected according to their availability during their routine visit to the outpatient clinics and they were interviewed using the Arabic version of the Short-Form 36-item survey (SF-36) to assess the HRQOL. RESULTS: The mean age of the participants was 56.4+/-13.2 years. Around 63% (178) were males and 37% (105) were females. Glycosylated hemoglobin level was found to be significantly higher among female and HRQOL was higher among male. Respondents who were more than 50 years old had poor HRQOL than less than 50 years age group. Poor economic status, reported diabetic complications and longer duration of diabetes were significantly associated with poor HRQOL. The respondents treated with combination of therapies (oral medication plus insulin) indicated better HRQOL than patients with insulin therapy alone. Multivariate analysis indicated that gender, economic status (except subscale energy), and complications of DM (except subscale energy) as independent risk factor for HRQOL. CONCLUSION: Gender, economic status, and complication of DM were independent risk factors for majority of the subscales of HRQOL.
Ambulatory Care Facilities ; Anxiety ; Arabs ; Cross-Sectional Studies* ; Surveys and Questionnaires ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Female ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Male ; Mortality ; Multivariate Analysis ; Quality of Life* ; Risk Factors ; Saudi Arabia ; Tertiary Care Centers

No abstract available.
Echocardiography ; Tetralogy of Fallot*

BACKGROUND: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. MATERIALS AND METHODS: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed. RESULTS: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. CONCLUSIONS: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.
Diagnosis ; Humans ; Life Change Events* ; Microscopy ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Saudi Arabia* ; Tuberculosis* ; Tuberculosis, Pulmonary