Prince Sultan Military Medical City

Riyadh, Saudi Arabia

Prince Sultan Military Medical City

Riyadh, Saudi Arabia
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Al Rayes H.,Prince Sultan Military Medical City | Touma Z.,University of Toronto
Drug Design, Development and Therapy | Year: 2014

Management of systemic lupus erythematosus (SLE) represents a fascinating, emerging field. Research has recently provided us with a better understanding of the immuno-logic alterations of SLE, leading to the creation of immunomodulatory agents designed to disrupt specific cell targets and pro-inflammatory pathways. Despite the improvement in the prognosis of SLE in the last 50 years with the use of immunosuppressive therapy such as cyclophosphamide and mycophenolate mofetil, cytotoxicity remains a major complication of these medications and the need for more specific targeted immunotherapy is increasing. Early recognition and treatment of SLE with targeted immunotherapy has the potential to improve quality of life and reduce the risk of disease fare-ups and complications. In this review, we will explore the role of B-cells in the pathogenesis of SLE highlighting current insights into SLE development and management. In addition, we will discuss epratuzumab’s role in the treatment of SLE. Epratuzumab is a humanized anti-CD22 monoclonal antibody that targets CD22 on B-cell and its role in B-cell modulation, migration, function, and inhibition of B-cell receptor signaling. Epratuzumab is currently in a Phase III study evaluating its effcacy in the management of moderate to severe SLE. All published trials on epratuzumab have shown great promise with safe profiles. © 2014 Al Rayes and Touma.

Alzaid A.,Prince Sultan Military Medical City
Diabetes Technology and Therapeutics | Year: 2017

It is no secret that the diabetes community has been yearning for good news for quite some time. One outstanding issue undermining effective diabetes management has been the lack of demonstrable effects of glycemic interventions on cardiovascular (CV) outcome in people with type 2 diabetes. This, however, seems to have changed recently after the publication of the Empa-Reg Outcome Trial. The study reported an impressive reduction in CV deaths that was observed within weeks of treatment with the diabetes agent, Empagliflozin. The results exceeded all expectations and was quickly embraced by a wide and receptive diabetes audience. Fans and admirers of the study have since set out to accommodate the new findings to reshape our diabetes practice guidelines. However, before everything becomes cast in stone, I believe there's another side to the story of the Empa-Reg Outcome trial that the diabetes community needs to hear. Here, I debate the merits of the study and present the case as to why I think we might be led down the garden path by accepting this study at mere face value. © 2017, Mary Ann Liebert, Inc.

Al-Saleem A.I.,Prince Sultan Military Medical City | Al-Jobair A.M.,King Saud University
Drug Design, Development and Therapy | Year: 2016

Congenital malformations might occur because of environmental or genetic factors, and sometimes occur because of unknown causes. Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension, glaucoma, and epilepsy. The use of acetazolamide has not been recommended for pregnant women because of reported teratogenic risks. Congenital malformations, such as ectrodactyly, syndactyly, cleft lip/palate, and retarded incisor teeth development, have been reported in experimental animals. However, tooth agenesis due to the use of acetazolamide has not been reported yet. Oligodontia is a severe type of tooth agenesis involving six or more congenitally missing teeth. The causes of oligodontia are attributed to environmental factors, such as irradiation, drugs, trauma, tumors, infection, genetic factors, or a combination. There is no credible evidence of undesirable effects of acetazolamide use in human pregnancy. However, we report a case of a 12-year-old Saudi boy who was exposed to maternal acetazolamide (1,000 mg/day) for treatment of idiopathic intracranial hypertension before pregnancy, during the first trimester, and throughout the pregnancy. This treatment might have resulted in some congenital malformations, such as ectrodactyly, syndactyly, and oligodontia. © 2016 Al-Saleem and Al-Jobair.

Elyamany G.,Theodor Bilharz Research Institute | Alzahrani A.M.,Prince Sultan Military Medical City | Bukhary E.,Prince Sultan Military Medical City
Clinical Medicine Insights: Oncology | Year: 2014

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. In addition to VTE, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, and is possibly related to genetic predisposition. Several risk factors for developing venous thrombosis usually coexist in cancer patients including surgery, hospital admissions and immobilization, the presence of an indwelling central catheter, chemotherapy, use of erythropoiesis-stimulating agents (ESAs) and new molecular-targeted therapies such as antiangiogenic agents. Efective prophylaxis and treatment of VTE reduced morbidity and mortality, and improved quality of life. Low-molecular-weight heparin (LMWH) is preferred as an efective and safe means for prophylaxis and treatment of VTE. It has largely replaced unfractionated heparin (UFH) and vitamin K antagonists (VKAs). Recently, the development of novel oral anticoagulants (NOACs) that directly inhibit factor Xa or thrombin is a milestone achievement in the prevention and treatment of VTE. Tis review will focus on the epidemiology and pathophysiology of cancer-associated thrombosis, risk factors, and new predictive biomarkers for VTE as well as discuss novel prevention and management regimens of VTE in cancer according to published guidelines. © the authors, publisher and licensee libertas academica limited.

Omrani A.S.,Prince Sultan Military Medical City | Saad M.M.,Prince Sultan Military Medical City | Baig K.,Prince Sultan Military Medical City | Bahloul A.,Prince Sultan Military Medical City | And 6 more authors.
The Lancet Infectious Diseases | Year: 2014

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) infection is associated with high mortality and has no approved antiviral therapy. We aimed to compare ribavirin and interferon alfa-2a treatment for patients with severe MERS-CoV infection with a supportive therapy only. Methods: In this retrospective cohort study, we included adults (aged ≥16 years) with laboratory-confirmed MERS-CoV infection and pneumonia needing ventilation support, diagnosed between Oct 23, 2012, and May 1, 2014, at the Prince Sultan Military Medical City (Riyadh, Saudi Arabia). All patients received appropriate supportive care and regular clinical and laboratory monitoring, but patients diagnosed after Sept 16, 2013, were also given oral ribavirin (dose based on calculated creatinine clearance, for 8-10 days) and subcutaneous pegylated interferon alfa-2a (180 μg per week for 2 weeks). The primary endpoint was 14-day and 28-day survival from the date of MERS-CoV infection diagnosis. We used χ2 and Fischer's exact test to analyse categorical variables and the t test to analyse continuous variables. Findings: We analysed 20 patients who received ribavirin and interferon (treatment group; initiated a median of 3 days [range 0-8] after diagnosis) and 24 who did not (comparator group). Baseline clinical and laboratory characteristics were similar between groups, apart from baseline absolute neutrophil count, which was significantly lower in the comparator group (5·88 × 109/L [SD 3·95] vs 9·88 × 109/L [6·63]; p=0·023). 14 (70%) of 20 patients in the treatment group had survived after 14 days, compared with seven (29%) of 24 in the comparator group (p=0·004). After 28 days, six (30%) of 20 and four (17%) of 24, respectively, had survived (p=0·54). Adverse effects were similar between groups, apart from reduction in haemoglobin, which was significantly greater in the treatment group than in the comparator group (4·32 g/L [SD 2·47] vs 2·14 g/L [1·90]; p=0·002). Interpretation: In patients with severe MERS-CoV infection, ribavirin and interferon alfa-2a therapy is associated with significantly improved survival at 14 days, but not at 28 days. Further assessment in appropriately designed randomised trials is recommended. © 2014 Elsevier Ltd.

Elzein F.E.,Prince Sultan Military Medical City | Mursi M.,Prince Sultan Military Medical City
American Journal of Tropical Medicine and Hygiene | Year: 2014

Neurobrucellosis is relatively uncommon. In a prospective study of 530 patients with brucellosis, neurologic involvement was reported in only 1.7% of the patients. Unlike Campylobacter jejuni, the commonest infection implicated in Guillain-Barré syndrome, there are very few reports in the literature of Guillain-Barré syndrome in association with brucellosis. Out of 1,028 cases of brucellosis, polyneuritis was reported in only 2 out of 58 patients with neurological involvement. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.

The objectives of this work were to estimate the amount of fluorine-18 fluorodeoxyglucose (F-FDG) excreted (AFE) in the patient urine during the uptake phase as percentage of the injected activity and to examine the effect of blood glucose levels (BGL) on the excreted amount and whether it varies among men and women using statistical analysis methods. Radiation dose rates were measured at 1 m from 50 patients, 24 men and 26 women, before and after the first void using a calibrated ionization chamber. The F-FDG was injected in the patients using a calibrated automatic dose injection system. Statistical analysis using hypothesis testing was carried out. Patients with BGL above 5 mmol/l had a higher AFE of 12.3% in comparison with 8.3% of the patients with BGL below 5 mmol/l. A statistically nonsignificant correlation (r=0.183, P<0.249) between AFE and BGL was found; a nonsignificant difference was found in the AFE measured among the male and female patients. The AFE measured was 12±6%, with a range of (2–30%). There was a wide variation in the first void time of 39±8 min, with a range of (17–68) min. A simple noninvasive measurement method is presented that enabled the estimation of the amount of F-FDG excreted from the patient during voiding. Statistical analysis concluded that the amount of F-FDG excreted does not depend on sex, but is perhaps influenced by BGL. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Al-Jadid M.S.,Prince Sultan Military Medical City
Saudi Medical Journal | Year: 2013

Objectives: To determine the causes, age and gender differences, hospital length of stay (HLoS), and prevalence of traumatic spinal cord injury (TSCI) in a Saudi referral trauma center. Methods: We retrospectively reviewed hospital records of all patients who completed the TSCI rehabilitation program in the Rehabilitation Medicine Division, Department of Neurosciences at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia from August 1982 and November 2010. The age and gender of the patient, type and mechanism of trauma, type and severity of neurologic deficits, frequency, and HLoS of patient's were collected for analysis. Results: The mean age of the patients was 29.7 ± 0.73 years. Out of 466 TSCI patients, 398 were males (85.4%) and 68 were females (14.6%). The higher frequency of TSCI was found in the 16-30 age group, and a lower frequency was found in the 0-15 and >45 age groups. Out of the 466 TSCI patients 377 (80.1%) sustained their injuries as a result from motor vehicle accidents. Cervical cord was the most common site of injury accounting for 34% (n=137) of cases in male population, and in females, the higher frequency was the upper thoracic (n=31 [45.6%]) There were 250 TSCI patients that stayed in the hospital for 1-70 days, and only 12 patients stayed in the hospital for >280 days. Conclusion: Compared to females, the frequency of TSCI was higher in males, and 16-30 age group sustained more TSCI. Road traffic accident is the most common cause of injury, and more than 50% of the TSCI patients stayed in the hospital for <70 days.

Al-Jadid M.S.,Prince Sultan Military Medical City
Saudi Medical Journal | Year: 2013

Disability is a complex, influential, dynamic, multidimensional challenge, and it can substantially limit major life activities of human beings and their ability to integrate/reintegrate into society. According to the World Health Organization reports almost 15% of the world's population lives with certain types of disability, of whom 2-4% experience substantial difficulties in functioning. In Saudi Arabia, very limited research has been conducted on the prevalence and incidence of disability, and most of this is on disabled children. There are several difficulties associated with conducting research on disability related issues in Saudi Arabia. Here, we review the current situation of disability, disability research, and rehabilitation in Saudi Arabia from the published literature.

Al-Jadid M.S.,Prince Sultan Military Medical City
American Journal of Physical Medicine and Rehabilitation | Year: 2014

Abstract: Disability is a major challenge for the Saudi healthcare sector. Data about the incidence and prevalence of impairment and disability and sociodemographic characteristics of people with disabilities are scarce and incomplete and probably underestimate the actual burden of disability. Policies and legislation have supported the equal rights of persons with disabilities, but ineffective implementation of these laws has created a gap between the intended aims and the actual provision of services. Clearly, more research is needed to plan for appropriate management programs, effective implementation of primary prevention strategies, and proper allocation of health resources in this area. Copyright © 2013 by Lippincott Williams & Wilkins.

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