Shorman M.,King Fahad Specialist Hospital |
Al-Tawfiq J.A.,Specialty Internal Medicine Unit
Interdisciplinary Perspectives on Infectious Diseases | Year: 2013
Background. Vancomycin-resistant enterococci (VRE) are significant nosocomial pathogens worldwide. There is one report about the epidemiology of VRE in Saudi Arabia. Objective. To determine the risk factors associated with VRE infection or colonization in intensive care unit (ICU) settings. Design. This is a descriptive, epidemiologic hospital-based case-control study of patients with VRE from February 2006 to March 2010 in ICU in a tertiary hospital in Saudi Arabia. Methods. Data were collected from hospital records of patients with VRE. The main outcome measure was the adjusted odds ratio estimates of potential risk factors for VRE. Results. Factors associated with VRE included ICU admission for multiorgan failure, chronic renal failure, prior use of antimicrobial agents in the past three months and before ICU admission, gastrointestinal oral contrast procedure, and hemodialysis. Being located in a high risk room (roommate of patients colonized or infected with VRE) was found to be protective. Conclusions. Factors associated with VRE acquisition are often complex and may be confounded by local variables. © 2013 Mahmoud Shorman and Jaffar A. Al-Tawfiq.
Issa H.,King Fahad Specialist Hospital
World Journal of Hepatology | Year: 2010
Aim: To evaluate the safety and efficacy of combined pegylated interferon and ribavirin for the treatment of chronic hepatitis C (HCV) in patients with sickle cell anemia (SCA). Methods: Fifty-two patients with SCA and HCV were treated over a period of 7 years from June 2002 to July 2009. Their medical records were reviewed for: age at treatment, sex, body mass index, Hb level at the start of therapy and on follow-up, hemoglobin electrophoresis, liver function tests, G6PD level, LDH, bilirubin, HCV-RNA viral load, HCV genotype, liver biopsy, duration of treatment, and side effects. All were treated with pegylated interferon and a standard dose of ribavirin. The treatment was continued for 24 wk for those with genotype 2 and 3 and for 48 wk for those with genotype 1 and 4. Results: Fifty-two patients (30 females and 22 males) were treated. Their mean age was 29.5 years (range 15-54 years). HCV genotype was determined in 48 and 15 had liver biopsy. Their mean pre-treatment HCV-RNA viral load was 986330 IU/mL (range 12762-3329282 IU/mL). The liver biopsy showed grade I in 6 and grade II in 9 and stage I in 13 and stage II in 2. Only 8 were receiving hydroxyurea at the time of treatment. All tolerated the treatment well and none experienced a decrease in their Hb which required blood transfusion pre, during or after therapy. There were no hematological side effects attributable to ribavirin at the usual recommended dose. Thirty-seven (71.2%) achieved SVR at 6 mo after the end of treatment. The remaining 15 were non-responders. Two of them showed an ETR but had a relapse. The remaining 13 had a relatively significant HCV-RNA viral load with a mean HCV-RNA viral load of 1829741.2 IU/mL (900000-3329282 IU/mL) and eight of them had HCV genotype 1, four had HCV genotype 4, and one had HCV genotype 5. Conclusion: Patients with SCA and HCV can be treated with pegylated interferon and ribavirin at the usual recommended dose. This is even so in those who are not receiving hydroxyurea. The treatment is safe and effective and the response rate is comparable to those without SCA. © 2010 Baishideng.
Alajmi D.,King Saud University |
Almansour S.,King Fahad Specialist Hospital |
Househ M.S.,King Saud University
Studies in Health Technology and Informatics | Year: 2013
Telemedicine is a tool used to deliver health care from a distance. Developing countries can benefit from telemedicine because these countries face such issues as a lack of specialists and medical infrastructure. Telemedicine in the developing world can offer solutions to healthcare access for people in rural areas, reduce healthcare costs, and possibly improve healthcare quality. A major benefit for patients is that they will be more involved in maintaining their health without the constant need to visit healthcare centers. The purpose of this paper is to provide solutions and recommendations for the implementation of telemedicine in the developing world. A comprehensive search of both academic and gray literature was conducted in September 2012. The results show that there are potential benefits of and challenges in the implementation of telemedicine in developing countries. How to overcome the key challenges related to financial issues, acceptance, health infrastructure, and legal and privacy issues is discussed. © 2013 The authors and IOS Press. All rights reserved.
Khan I.A.,King Fahad Specialist Hospital
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2014
The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (<16 year) were performed of a total of 246 kidney transplants (14.2%). The mean age was 8.1 years, with a mean weight of 23.3 kg, and there were 21 (60%) boys in the study. Kidney dysplasia/hypoplasia was the most common etiology (51.4%). Preemptive kidney transplantation was performed in six (17%) patients. Peritoneal dialysis was the most common mode of dialysis [24 (69%) children]. Living donation was the source of kidney allografts in 13 (37%) cases. During a mean follow-up of 1.5 years, one patient died and one graft was lost due to kidney vein thrombosis. The one year patient and graft survival rates were 97% and 94%, respectively. Efforts should now be focused on achieving optimal long-term results. There is also a need to encourage preemptive transplantation and living donation in this population.
Al-Goblan A.S.,King Fahad Specialist Hospital |
Al-Alfi M.A.,King Fahad Specialist Hospital |
Khan M.Z.,Sulaiman AlRajhi Colleges
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | Year: 2014
Body mass index has a strong relationship to diabetes and insulin resistance. In obese individuals, the amount of nonesterifed fatty acids, glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance, is increased. The pathogenesis in the development of diabetes is based on the fact that the β-islet cells of the pancreas are impaired, causing a lack of control of blood glucose. The development of diabetes becomes more inevitable if the failure of β-islet cells of the pancreas is accompanied by insulin resistance. Weight gain and body mass are central to the formation and rising incidence of type 1 and type 2 diabetes. This literature review will demonstrate the facts that link obesity with insulin resistance and pancreatic β-cell dysfunction. In conclusion, new approaches in managing and preventing diabetes in obese individuals must be studied and investigated based on the facts. © 2014 Al-Goblan et al.
Chaudhry I.U.,King Fahad Specialist Hospital
BMJ case reports | Year: 2014
Solitary pulmonary nodule due to various pathologies has been reported in the medical literature. We report a case of solitary pulmonary nodule in an asymptomatic 60-year-old male smoker, who had a positive family history of pulmonary tuberculosis. His routine screening chest X-ray revealed a 2 × 1.5 cm nodule in the right lung upper zone. A CT scan of the thorax confirmed the finding. Bronchoscopy, lavage, biopsy and screening for tuberculosis were negative. Owing to its technical difficulty, a CT-guided biopsy was deferred by the radiologist, hence we decided to perform segmentectomy that showed granuloma harbouring an adult Schistosoma worm. This is the first case of asymptomatic solitary pulmonary nodule due to adult Schistosoma worm 26 years after the exposure.
AlBugami M.,King Fahad Specialist Hospital |
Kiberd B.,Dalhousie University
Transplantation Reviews | Year: 2014
The overall incidence of cancer is increased 2-3 fold in solid organ transplant recipients compared to the general population. The increase in risk is not uniform for all malignancies, in all ages or in all regions of the world. Several cancers are greatly increased, many are increased 2-4 fold and others do not appear to be increased at all. The pattern of increase is similar to patients with acquired immunodeficiency syndrome and those cancers most increased are associated with viral infections. These observations support the concept that much of the increased risk is from immunosuppression. Nonetheless there are differences between specific organ groups that deserve further examination. Those with advanced organ failure are also at increased risk for certain malignancies, which suggest either organ damage per se may pre-dispose to cancers or there are exposures to carcinogens in common. The purpose of this review to examine cancer incidence and mortality in solid organ transplantation and the role of pre transplant screening and post-transplant surveillance to reduce the burden of disease and improve patient outcomes. This review will focus on cancers that are common, associated with significant case fatality rates and have potential screening strategies to reduce burden of disease. © 2014 Elsevier Inc.
Meshikhes A.-W.N.,King Fahad Specialist Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2010
Background: Diagnostic laparoscopy currently is emerging as an important tool in the diagnostic armamentarium for abdominal tuberculosis (TB). However, the laparoscopic view may be deceiving even to the most experienced eyes, and it is not uncommon for TB to be diagnosed erroneously before the final histologic confirmation is received. Methods A retrospective review of 20 diagnostic laparoscopies was conducted. The cases erroneously diagnosed at laparoscopy were collected and analyzed. Results Five cases (20%) were identified. For two patients, the laparoscopic findings were thought to be those of carcinomatosis, but histology showed TB. For the other three patients, TB was suspected laparoscopically, but the final diagnoses were carcinomatosis, spontaneous bacterial peritonitis, and panniculitis. Two patients died: one due to delayed diagnosis and treatment of abdominal TB and the other due to carcinomatosis. Conclusion For a percentage of patients, the laparoscopic features of abdominal TB at diagnostic laparoscopy may be mistaken for other pathologies. Caution should be exercised before disclosure of the provisional diagnosis to the patient based on laparoscopy alone without histologic confirmation.
Chaudhary M.W.,King Fahad Specialist Hospital |
Al-Baradie R.S.,King Fahad Specialist Hospital
Application of Clinical Genetics | Year: 2014
Ataxia-telangiectasia (A-T) is an autosomal recessive multi-system disorder caused by mutation in the ataxia-telangiectasia mutated gene (ATM). ATM is a large serine/threonine protein kinase, a member of the phosphoinositide 3-kinase-related protein kinase (PIKK) family whose best-studied function is as master controller of signal transduction for the DNA damage response (DDR) in the event of double strand breaks (DSBs). The DDR rapidly recognizes DNA lesions and initiates the appropriate cellular programs to maintain genome integrity. This includes the coordination of cell-cycle checkpoints, transcription, translation, DNA repair, metabolism, and cell fate decisions, such as apoptosis or senescence. DSBs can be generated by exposure to ionizing radiation (IR) or various chemical compounds, such as topoisomerase inhibitors, or can be part of programmed generation and repair of DSBs via cellular enzymes needed for the generation of the antibody repertoire as well as the maturation of germ cells. AT patients have immunodeficiency, and are sterile with gonadal dysgenesis as a result of defect in meiotic recombination. In the cells of nervous system ATM has additional role in vesicle dynamics as well as in the maintenance of the epigenetic code of histone modifications. Moderate levels of ATM are associated with prolonged lifespan through resistance to oxidative stress. ATM inhibitors are being viewed as potential radiosensitizers as part of cancer radiotherapy. Though there is no cure for the disease at present, glucocorticoids have been shown to induce alternate splicing site in the gene for ATM partly restoring its activity, but their most effective timing in the disease natural history is not yet known. Gene therapy is promising but large size of the gene makes it technically difficult to be delivered across the blood–brain barrier at present. As of now, apart from glucocorticoids, use of histone deacetylase inhibitors/EZH2 to minimize effect of the absence of ATM, looks more promising. © 2014 Chaudhary and Al-Baradie.
Bunyan R.F.,King Fahad Specialist Hospital |
Pittock S.J.,Mayo Medical School
Multiple Sclerosis Journal | Year: 2012
As physicians how do we counsel our patients with clinically isolated syndrome (CIS) when they ask, 'what is the benefit of injecting disease-modifying agents (DMAs) over many years? What disability will they prevent in my future?' In this debate, we will provide three core points supporting the concept that a watchful waiting approach (annual neurological evaluation and magnetic resonance imaging of the head (with gadolinium) at least for the first few years after diagnosis) for most patients with CIS represents appropriate medical care. © The Author(s) 2012.