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Al Harthi F.,Prince Sultan Military Medical City
Disease markers | Year: 2014

BACKGROUND/AIM: Apolipoprotein E (APOE) gene variants have been reported to influence psoriasis risk. However, data is limited to a few ethnicities and no similar study has been performed in middle eastern populations. We investigated this association in Saudi psoriasis patients.METHODS: Saudi subjects (294) were genotyped for APOE gene using APOE StripAssay kit.RESULTS: The frequencies of alleles ε2, ε4, and genotypes ε3/ε4 and ε3/ε2 were significantly higher in psoriasis patients compared with those in controls. The frequency of ε3 allele and ε3/ε3 genotype was significantly lower in patients. Other genotypes, ε2/ε4, ε2/ε2, and ε4/ε4, were absent in both groups. The serum cholesterol, triglycerides, and LDL levels were significantly higher in psoriasis patients contrary to HDL level. Patients with APOE ε 4 had significantly higher levels of total cholesterol and LDL cholesterol, whereas those with the ε2 had higher HDL cholesterol, and triglycerides.CONCLUSION: APOE alleles ε2, ε4, and genotypes ε2/ε3 and ε4/ε3 are associated with psoriasis and can be a risk factor while allele ε3 and genotype ε3/ε3 may be protective for psoriasis in Saudis. Results of lipid profile support that psoriasis is one of the independent risk factors for hyperlipidemia and emphasize the need of screening cardiovascular diseases in psoriatic patients.


Assiri A.,Global Center for Mass Gatherings Medicine | Assiri A.,Public Health Directorate | Al-Tawfiq J.A.,Aramco Services Company | Al-Rabeeah A.A.,Global Center for Mass Gatherings Medicine | And 14 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities. Methods: We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR. Findings: 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]). Interpretation: Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition. © 2013 Elsevier Ltd.


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.


Elyamany G.,Prince Sultan Military Medical City | Elyamany G.,Theodor Bilharz Research Institute | Al Mussaed E.,Princess Nora Bint Abdulrahman University | Alzahrani A.M.,Prince Sultan Military Medical City
Advances in Hematology | Year: 2015

Plasmablastic lymphoma (PBL) is an aggressive subtype of non-Hodgkin's lymphoma (NHL), which frequently arises in the oral cavity of human immunodeficiency virus (HIV) infected patients. PBL shows diffuse proliferation of large neoplastic cells resembling B-immunoblasts/plasmablasts, or with plasmacytic features and an immunophenotype of plasma cells. PBL remains a diagnostic challenge due to its peculiar morphology and an immunohistochemical profile similar to plasma cell myeloma (PCM). PBL is also a therapeutic challenge with a clinical course characterized by a high rate of relapse and death. There is no standard chemotherapy protocol for treatment of PBL. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens have been the backbone while more intensive regimens such as cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, high-dose cytarabine (CODOX-M/IVAC), or dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) are possible options. Recently, a few studies have reported the potential value of the proteasome inhibitor bortezomib and thalidomide in PBL patients. The introduction of genes encoding artificial receptors called chimeric antigen receptors (CARs) and CAR-modified T cells targeted to the B cell-specific CD19 antigen have demonstrated promising results in multiple early clinical trials. The aim of this paper is to review the recent advances in epidemiology; pathophysiology; clinical, pathologic, and molecular characteristics; therapy; and outcome in patients with PBL. © 2015 Ghaleb Elyamany et al.


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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