King Khalid National Guard Hospital

Jeddah, Saudi Arabia

King Khalid National Guard Hospital

Jeddah, Saudi Arabia
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Borai A.,King Khalid National Guard Hospital | Borai A.,King Abdullah International Medical Research Center Jeddah | Livingstone C.,University of Surrey | Livingstone C.,Royal Surrey County Hospital | And 2 more authors.
BMC Medical Research Methodology | Year: 2011

Insulin resistance is one of the major aggravating factors for metabolic syndrome. There are many methods available for estimation of insulin resistance which range from complex techniques down to simple indices. For all methods of assessing insulin resistance it is essential that their validity and reliability is established before using them as investigations. The reference techniques of hyperinsulinaemic euglycaemic clamp and its alternative the frequently sampled intravenous glucose tolerance test are the most reliable methods available for estimating insulin resistance. However, many simple methods, from which indices can be derived, have been assessed and validated e.g. homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI). Given the increasing number of simple indices of IR it may be difficult for clinicians and researchers to select the most appropriate index for their studies. This review therefore provides guidelines and advices which must be considered before proceeding with a study. © 2011Borai et al; licensee BioMed Central Ltd.

Rosa F.,Casa de Saude S. Rafael | Schreiner A.,Janssen Cilag GmbH | Thomas P.,Lille University Hospital Center | Sherif T.,King Khalid National Guard Hospital
Clinical Drug Investigation | Year: 2012

Background: Patients with schizophrenia or related disorders often switch antipsychotic therapy, most commonly due to lack of efficacy and side effects. The differences in anticipated efficacy and tolerability among atypical antipsychotics may drive switching behaviours. Switching to long-acting antipsychotics may improve adherence. Improving adherence is essential as relatively short medication gaps significantly increase the risk of schizophrenia hospitalizations. Long-term treatment with risperidone long-acting injectable (RLAI), the first available long-acting atypical antipsychotic, versus oral atypical antipsychotics showed better adherence with RLAI. Stable patients with schizophrenia or related disorders treated with a stable dose of antipsychotic showed improved efficacy when switched to flexible doses of RLAI. The most common reason for patients to switch from olanzapine to another antipsychotic is excessive weight gain. Metabolic dysfunction also occurs more commonly with olanzapine than with risperidone. Patients switching from olanzapine to risperidone experienced significant decreases in body weight, body mass index and triglyceride levels, whereas patients switching from risperidone to olanzapine experienced significant increases in body weight and triglyceride levels. The efficacy, tolerability and safety of RLAI in non-acute patients with schizophrenia or schizoaffective disorder previously treated with oral olanzapine needs to be explored. Objective: The objective of this study was to evaluate the efficacy, tolerability and safety of switching from oral olanzapine to RLAI. Methods: This was a six-month, prospective, multicentre, non-randomized, single-arm, open-label trial. The trial evaluated non-acute adult patients with psychotic disorders treated with a stable olanzapine dose who required a treatment change. Three weeks after RLAI initiation, olanzapine was tapered off over 1 week or 3 weeks. Efficacy and safety measures included the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S), Global Assessment of Functioning (GAF) and treatment-emergent adverse events (TEAEs). Results: Among 96 patients analysed, significant endpoint efficacy changes versus baseline were observed for PANSS, CGI-S and GAF (all p < 0.0001). PANSS total score improvement was ≥20% for 65.6% of patients and ≥50% for 31.3%. TEAEs were similar in the 1- and 3-week taper groups (40.0% and 46.5%, respectively). TEAEs were generally mild (34.5%) or moderate (49.0%) in intensity. Conclusion: Switching non-acute patients with schizophrenia or schizoaffective disorder requiring a treatment change from a stable dose of oral olanzapine to RLAI improved psychiatric symptom control, functioning andpatient treatment satisfaction. RLAI was generally well tolerated. Clinical Trial Registration: identifier: NCT00216632. © 2012 Adis Data Information BV. All rights reserved.

Halawa M.R.,Ain Shams University | Halawa M.R.,Dr Erfan and Bagedo General Hospital | Karawagh A.,King Khalid National Guard Hospital | Zeidan A.,Alexandria University | And 3 more authors.
Current Medical Research and Opinion | Year: 2010

Objective: To determine the prevalence of painful diabetic peripheral neuropathy in adult patients with diabetes mellitus (type 1 and 2) attending outpatient clinics in Saudi Arabia and to determine the demographic profile and pharmaceutical management of these patients. Research design and methods: Eligible patients from 100 outpatient clinics treating patients with diabetes mellitus across Saudi Arabia completed an epidemiologic questionnaire to obtain demographic information and medication history. Following this, the validated DN4 pain questionnaire was used to identify the presence of painful diabetic peripheral neuropathy (score of ≥4). Results: A total of 1039 patients were enrolled. Following the DN4 pain questionnaire, an overall prevalence of painful diabetic peripheral neuropathy of 65.3 (n=678) was found. The age of patients, their sex, and the duration of underlying diabetes were found to be statistically significant factors in the development of painful diabetic peripheral neuropathy. No statistically significant difference was found between smoking history, body mass index, or racial origin and presence of painful diabetic peripheral neuropathy. On initial evaluation, 42.3 (n=440) stated they were receiving treatment for pain. Following evaluation using the DN4 pain questionnaire, the number prescribed therapeutic pain management increased to more than two thirds (68.7, n=714) of which 62.3 (n=579) were prescribed pregabalin. Conclusions: In patients with reduced pain intensity DN4 has not been directly compared with other tools to measure neuropathic pain; however, using the DN4 in this study 65.3 of adult outpatients with type 1 and 2 diabetes in Saudi Arabia were found to have painful diabetic peripheral neuropathy; far higher than anticipated. © 2010 Informa UK Ltd All rights reserved.

Mehta S.,Royal Free Hospital | Livingstone C.,Royal Free Hospital | Livingstone C.,Royal Surrey County Hospital | Borai A.,King Khalid National Guard Hospital | Ferns G.,Keele University
British Journal of Diabetes and Vascular Disease | Year: 2012

Insulin-like growth factors (IGFs) are peptide hormones that have significant structural homology with insulin. IGF binding proteins (IGFBPs), in particular IGFBP-1, are important determinants of IGF activity such as enhancing peripheral glucose uptake, decreasing hepatic glucose output and modifying lipid metabolism. Herein factors which alter IGFBP-1 and the utility of measuring IGFBP-1 are considered as the role of IGFBP-1 is explored within the context of insulin resistance and the development of cardiovascular disease. © SAGE Publications 2012.

Obeid T.,King Khalid National Guard Hospital | Abulaban A.,King Khalid National Guard Hospital | Al-Ghatani F.,King Khalid National Guard Hospital | Al-Malki A.R.,King Khalid National Guard Hospital | Al-Ghamdi A.,King Khalid National Guard Hospital
Seizure | Year: 2012

Purpose: Epilepsy has been linked to divine, demonic and supernatural powers throughout its long history. This study was conducted to explore if misconceptions such as possession by demons (Jinns) are still believed to be a cause of epilepsy among educated Saudis today. Method: This study was conducted among university-educated school teachers and undergraduate students. The findings are based on a structured questionnaire enquiring about familiarity with epilepsy, sources of knowledge, and depth of knowledge about specific aspects of epilepsy. Results: Responses from 398 participants were included in the analysis of the results. Most participants had witnessed epileptic seizures. 2/3 of the participants reported that they had learned about epilepsy from friends and relatives. 172 (43.1%) members believed that epilepsy is a psychiatric disease. 62 (40.3%) of the school teachers and 123 (50.4%) of the students in the study considered possession as a cause of epilepsy. The majority of the cohort believed medical treatment for the condition exists despite the fact that a significant number believed that faith healers and traditional medicine can be of help in the treatment of epilepsy. Conclusion: Jinn possession is still believed to be a cause of epilepsy in Saudi society, even among fairly well-educated people. This finding emphasizes the urgent need for public education campaigns at all levels of education. © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Jamjoom A.A.B.,Western General Hospital | Jamjoom A.B.,King Khalid National Guard Hospital
Journal of Neurotrauma | Year: 2013

Patients with traumatic brain injury (TBI) are at an increased risk of developing venous thromboembolic events (VTE). Pharmacological thromboprophylaxis (PTP) is routinely delayed because of concerns of exacerbating intracranial hemorrhage (ICH). The aim of this review is to examine the literature and assimilate suitable data to assess the safety and efficacy of PTP administered within 72 h in TBI patients. We systematically searched the literature for randomized controlled trials or cohort studies reporting on the timing of PTP in TBI. We dichotomized the timing of PTP to early and late at 72 h post-injury. The rates of VTE and ICH progression were our primary endpoints and were pooled using a fixed-effects model. A total of five retrospective cohort studies were included within the review including a total of 1624 patients, of which 713 received early PTP and 911 received late PTP. Within the early and late group there was a total of 43 and 106 VTE respectively, with a risk ratio of 0.52 (0.37, 0.73). Assessing safety, the relative risk of ICH progression in the early compared with the late PTP group was 0.64 (0.35, 1.14). Based on the available literature, we can tentatively conclude that early PTP (<72 h) reduces the risk of VTE without affecting progression of ICH. However, much work is yet to be done to better clarify ICH subtypes at risk of progression and the implementation of evidence-based guidelines backed up with randomized control trial level evidence. © 2013, Mary Ann Liebert, Inc.

Basakran N.S.,King Khalid National Guard Hospital
Saudi Medical Journal | Year: 2015

CD44 is a cellular protein that has been intensively studied in relation to carcinogenesis over the last decade. It is altered during inflammatory responses and cellular malfunctioning during tumor progression. Tumors of epithelial origin express CD44 in multiple isoforms called variants; some isoforms are related to specific cancer cells. An increase of CD44 specific isoforms is detected in certain leukemic proliferations. Most published data indicates a partial involvement of CD44 in cancer cells, either in invasiveness or self-renewability. However, there is still uncertainty regarding the exact mechanism by which CD44 participates in growth of cancer or the inflammatory response. This review focuses on CD44 prevalence in cancer cell. It considers tumorigenic behavior of cells that highly express CD44 as an early marker for neoplastic stem cell proliferation. We will discuss multiple examples of tumor in this paper, with an emphasis of 2 solid tumors; namely, breast and colon cancer. © 2015, Saudi Arabian Armed Forces Hospital. All rights reserved.

Al-Harbi T.,King Khalid National Guard Hospital | Al-Shaikh A.,King Abdul Aziz Medical City KAMC Jeddah
Journal of Pediatric Endocrinology and Metabolism | Year: 2012

The syndrome of apparent mineralocorticoid excess (AME) is an autosomal recessive disorder characterized by hypertension, hypokalemia, low renin, and hypoaldosteronism. It is caused by deficiency of 11 β -hydroxysteroid dehydrogenase, which results in a defect of the peripheral metabolism of cortisol to cortisone. As a consequence, the serum cortisol half-life (T 1/2 ) is prolonged, ACTH is suppressed, and serum cortisol concentration is normal. The hormonal diagnosis of the disorder is made by the increased ratio of urine-free cortisol to cortisone. In patients with AME, this ratio is 5 - 18, while in normal individuals it is < 0.5. These studies suggest that an abnormality in cortisol action or metabolism results in cortisol behaving as a potent mineralocorticoid and causing the syndrome of AME. We report three siblings - two female and one male - with the syndrome of apparent mineralocorticoid excess who presented with hypertension, hypokalemia, low renin, and low aldosterone levels. The finding of abnormally high ratios of 24-h urine-free cortisol to cortisone in our three patients (case 1, 8.4; case 2, 25; and case 3, 7.5) confirmed the diagnosis of apparent mineralocorticoid excess syndrome in these children. They were treated with oral potassium supplements. The addition of spironolactone resulted in a decrease in blood pressure, rise in serum potassium and a gradual increase in plasma renin activity in all three. In this study, the genetic testing of those three siblings with the typical clinical features of AME has detected missense mutation c.662C > T (p.Arg208Cys) in exon 3 of the HSD11B2 gene in the homozygous state.

PubMed | King Khalid National Guard Hospital, King Fahad National Guard Hospital and King Saud University
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016

During the past decade there have been major changes in the susceptibility of bacteria that cause various infections. Resistance to anti-infective agents, including antibiotics, is worldwide, both in developed and developing countries. Almost all bacterial species can develop resistance to anti-infective agents and resistance can readily be transferred among bacteria by transmissible elements (plasmids). Measures to prevent the emergence of resistance must be implemented urgently. A multiplicity of factors drive antibiotic resistance and solutions require the collaboration of governmental agencies, pharmaceutical companies, healthcare providers and consumers. Knowledge of resistance patterns and of the ways by which resistance is overcome is vital to the future of antimicrobial chemotherapy.

PubMed | King Khalid National Guard Hospital and King Fahad National Guard Hospital
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016

The diagnostic value of Brucella ELISA IgG and IgM has been evaluated in patients with brucellosis. Serum samples and blood cultures were collected from 83 patients with brucellosis. The sera were tested by Brucella ELISA for Brucella IgM and IgG antibodies. All 44 controls were negative for IgG and IgM. Brucella melitensis was isolated from blood cultures of 30/83 (36.1%) patients. Among the 30 bacteremic patients, 24 (80%) had an increased IgM titer of 200. Of the 53 non-bacteremic patients, 41 had IgM titer 200, while 22 had IgG titer of 1,600. The ELISA IgM and IgG tests achieved a specificity and sensitivity of 100% and 96% respectively, while the positive and negative predictive values were 100% and 94% respectively. The Brucella ELISA is a reliable and sensitive test in the diagnosis of brucellosis. The test is rapid, easy to perform and can be automated.

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