Identification of IgE- binding pollen protein from Cannabis sativa in pollen-hypersensitive patients from north Pakistan

Cannabis sativa [C.sativa] is well-known for its medicinal, industrial and recreational use. However, allergies in relation to Cannabis sativa [C.sativa] are rarely reported. C. sativa is one of the common weeds found in Pakistan and its pollen grains are common in spring and fall season. Although categorized as an aeroallergen, there are limited number of reports regarding allergenic potential in C. sativa. Therefore, the current study is aimed at exploring the IgE- binding potential among the C.sativa pollen in local pollen allergic patients. Initial screening of C. sativa sensitized individuals was carried out by dot blot from the sera of pollen allergic patients. Proteins from the pollen grains were extracted and resolved on 10% gel. Eight bands were visible on gel however only one protein fragment i.e. of 14KDa size was found to bind to IgE as analyzed through protein gel blot analysis. Strong IgE affinity of a 14 kDa protein fragment from C. sativa pollen extract suggests its allergenic potential. Further study is required to find the exact nature of this protein fragment

Acute back pain: a survey of primary health care physicians' awareness and knowledge of "red flag" signs

Background: the failure to detect "red flag" signs in patients presenting with acute low back pain can adversely affect the outcome of management. This can seriously affect the quality of life and productivity of the patient

Objective: the present questionnaire-based study was performed to assess the knowledge and awareness of red flag signs among primary health care physicians managing patients with acute back pain in Riyadh, Saudi Arabia

Materials and Methods: the study sample size was comprised of 80 subjects. The level of knowledge was assessed by means of a new structured self-administered questionnaire. The design of this questionnaire was based on the Agency for Health Care Research and Policy [AHCRP] guidelines for detection of red flag signs. Physicians were asked about red flag signs that indicate the presence of tumor, infection, spinal fracture, or cauda equina syndrome

Results: sixty-eight [85% of total] physicians were aware of red flag signs. Of the 68 physicians who were aware of the red flag signs, 58 [72%] were aware of neurological deficit, 36 [45% of total] were aware of extremes of age [<10 years and >50 years], and 33 [41% of total] were aware of and routinely inquired about the history of spinal trauma, whereas only 24 [30% of total] were aware of and inquired about constitutional symptoms in their patients with acute back pain

Conclusion: although low back pain is extremely common, knowledge and awareness of red flag signs of primary health care physicians managing patients with acute back pain in Riyadh appear to be inadequate. This indicates a lack of adherence to the international guidelines. Specific educational programs should target these deficiencies and increase awareness

Immunological evaluation of beta-thalassemia major patients receiving oral iron chelator deferasirox

To determine the immune abnormalities and occurrence of infections in transfusion-dependent beta-thalassemia major patients receiving oral iron chelator deferasirox [DFX]. An observational study. Hematology Clinics, King Khalid University Hospital, Riyadh, Saudi Arabia, from July to December 2010. Seventeen patients with beta-thalassemia major [12 females, median age 26 years] receiving deferasirox [DFX] for a median duration of 27 months were observed for any infections and had their immune status determined. Immune parameters studied included serum immunoglobulins and IgG subclasses, serum complement [C3 and C4] and anti-nuclear antibody [ANA] level, total B and T-lymphocytes, CD4+ and CD8+ counts, CD4+/CD8+ ratio, and natural killer [NK] cells. Immunological parameters of the patients were compared with age, gender, serum ferritin level and splenectomy status. Lymphocyte subsets were also compared with age and gender matched normal controls. A considerable reduction in serum ferritin was achieved by DFX from a median level of 2528 to 1875 micromol/l. Serum IgG levels were increased in 7 patients. Low C4 levels were found in 9 patients. Total B and T-lymphocytes were increased in 14 patients each, while CD4+, CD8+ and NK cells were increased in 13, 12 and 11 patients respectively. Absolute counts for all lymphocyte subsets were significantly higher compared to the normal controls [p

Pattern of patch test reactivity among patients with clinical diagnosis of contact dermatitis: a hospital-based study

Contact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population. Retrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010. Of the 196 patients referred to the allergy clinic over the 2-year period, 91 [46.4%] patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 [91.1%] of Saudi nationality and 9 [8.9%] patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes. Of the 91 cases who reacted positively to one or more allergens, 67 [73.6%] were females with a mean age of 37 [8.3 years] and 24 [26.4%] were males with a mean age of 34 [11.6 years]. Thirty-three [36.2%] patients reacted to nickel sulfate, 14 [15.3%] to p-phenylenediamine, 13 [14.2%] to p-tert-butylphenol-formaldehyde resin, 13 [14.2%] to thimerosal, and 9 [9.8%] to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate [84.8% vs 15.2% in males; P=.0001], p-tert-butylphenol-formaldehyde resin [92.3% vs 7.7%; P=.0001], and thimerosal [76.9% vs 23.1%; P=.03]. Patch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure

Antenatal screening for syphilis at a tertiary care hospital in Riyadh

Routine serologic screening for syphilis is recommended for all pregnant women in Saudi Arabia. This study examined the results of routine antenatal syphilis screening at a tertiary care hospital in Riyadh. Patients and The results of rapid plasma reagin [RPR] tests were compiled for in 3270 pregnant women tested between October 2002 and March 2003 at King Khalid University Hospital. Any RPR reactivity observed in neat or diluted serum was considered positive and confirmed by a Treponema pallidum hemagglutination [TPHA] test.Syphilis screening constituted 87% of RPR tests requested for all reasons during the study period. The majority of women [73%] were screened between 15 to 22 weeks of gestation. Of the 3270 women tested only one was found to have syphilis, a prevalence rate of 0.03%. The prevalence of syphilis is extremely low in the antenatal care population at King Khalid University Hospital in Riyadh. This calls for a nation-wide survey to assess the need for continuation of antenatal syphilis screening with regards to its potential benefits and cost effectiveness in the Kingdom of Saudi Arabia

Serial evaluation of percentage of activated T-lymphocytes in peripheral blood of human immunodeficiency virus infected individuals as a prognostic marker

Immune activation often associated with human immunodeficiency virus [HIV] infection is characterized by increasing number of peripheral blood T-lymphocytes expressing HLA-DR molecule. This study was performed to investigate the changes in the percentage of activated lymphocytes in the peripheral blood of HIV infected patients on antiretroviral therapy. Routine flow cytometry data for peripheral blood lymphocyte subsets were analyzed in 11 HIV infected hemophilia patients [mean age 27 +/- 7] at approximately 6 monthly intervals from 1996 to 2002 in the Division of Immunology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The number of data sets for each individual was variable, ranging between 5-13. Percentages of each lymphocyte subset were extracted and correlations were sort by using linear regression analysis. Proportion of activated T-lymphocytes in the peripheral blood was initially high. Over a period of 2-5 years the percentage of T-lymphocytes, expressing HLA-DR molecule was found to have decreased significantly [P < / =0.0001] in all the patients most probably as a result of antiretroviral therapy. There was no statistically significant change in the proportion of any other lymphocyte subtype studied. The reduction in the percentage of HLA-DR+ T-lymphocyte population inversely correlated with CD4/CD8 ratios in 8 and for the CD4+ lymphocyte proportions with 5 out of 11 patients, whereas positive correlation for CD8+ lymphocyte proportions was noted in 4 patients. These findings confirm immune activation in HIV infection with the increasing percentage of HLA-DR+ T-lymphocytes in the peripheral blood. Declining activated T-lymphocyte proportion in the peripheral blood and its inverse correlation with CD4/CD8 ratio may be more sensitive in detection of changes in CD4+ and CD8+ lymphocyte populations in HIV infection serving as a prognostic marker

effects of low dose intravenous immunoglobulin on the outcome of Guillian Barre syndrome

Twenty-two patients with Guillian Barre Syndrome admitted to the Department of Neurology, Pakistan Institute of Medical Sciences [PIMS] between November 1993 and March 1995 were given five grams of intravenous immunologlobulin daily for five days. Fourteen patients were male and 8 female. The duration of symptoms before the start of treatment was one to ten days. Fifty per cent of patients had no history of antecedent illness, while seven [31.82%] had diarrhoea and 3 [13.64%] had upper respiratory infection up to 2 weeks prior to the onset of GBS. Improvement was assessed on days 7 and 14, and 4 weeks after start of treatment. Fifteen patients [68.18%] had grade 0-1 power at the start of the treatment. After one month of follow-up all patients had grade 2 power or more. Fifteen [68.18%] had grade 4 and 5 power. Two patients died. This preliminary trial of low dose immunoglobulin indicates its effectiveness in GBS

Hypertension is a major risk factor for stroke in men and women of all ages

All patients admitted with stroke to the Neurology Department of Pakistan Institute of Medical Sciences in the first six months of 1993 were included in this study. All information about risk factors including hypertension, previous stroke, history of diabetes and smoking was obtained and tabulated. Hypertension was found to be the single most important risk factor in the patients under study