Complications of Sub-microscopic Plasmodium vivax Malaria among Orang Asli in Pos Lenjang, Kuala Lipis

@#In recent years, increasing cases of Plasmodium vivax complications had been reported all over the world. This former benign Plasmodium species is now recognized to be one of the human malaria parasites that can produce severe disease. In this article, we report two cases of sub-microscopic P. vivax malaria confirmed by PCR. Both patients were asymptomatic before treatment. They showed unusual presentations few days after initiation of antimalarial treatment. Both patients had subsequently completed antimalarial treatment and recovered completely.

Shear bond strength of resin composite to rotary and Er:YAG laser-prepared enamel

The aim of this study was to compare enamel shear bond strength to resin composite following preparation with a carbide bur, fine diamond bur, or erbium doped, yttrium-aluminium-garnet [Er:YAG] laser. Forty-eight human anterior teeth, randomly assigned to each preparation group, were studied. Each tooth was mounted in self-curing acrylic resin with the desirable flat facial surface exposed and was randomly assigned to 3 groups according to surface preparation: Er:YAG laser irradiation, carbide bur, or fine-grit diamond bur. A polypropylene cylinder was fixed to the prepared surface, which was demarcated for the area to be bonded with the single bonding system. Restorative composite was then incrementallyinserted into the tubing lumens. The teeth were shear tested to failure at a crosshead speed of 1.0mm/minute. One-way ANOVA and the Tukey test were used for analysis. The mean bond strength values were as follows: fine diamond bur, 23.88MPa; carbide bur, 13.28 MPa; and Er:YAG laser, 12.61 MPa. Different enamel preparation methods affect the shear bond strength between enamel and resin composite

Pancreatic cancer in Saudi patients treated at tertiary institution. Ten years retrospective study

To describe presentation, management, and outcome, and determine prognostic factors for pancreatic cancer patients. A retrospective review of patients diagnosed with pancreatic cancer at King Abdulaziz Medical City, Riyadh, Saudi Arabia during the period from January 2000 to December 2010. Descriptive statistics were conducted on the collected data and survival was estimated using the Kaplan Meier estimate. Univariate and multiple regression analyses were carried out. The medical records of 179 patients were reviewed. The patients' median age was 63 years ranging from 15-96 years, and 116 [64.8%] of them were male. The one-year survival rate was 39% and the 5-year survival was 10%. The median overall survival [OS] was 6.9 months. Age at diagnosis, grade, T stage, N stage, M stage, TNM stage group, and the combined stage group [stage III/IV versus others], site of distant metastasis, carcinoembryonic antigen [CEA], carbohydrate antigen 19-9, surgery and chemotherapy were significant predictors for OS on an univariate Cox proportional hazards regression analysis. A multiple regression model including all the significant predictors was conducted. Age at the time of diagnosis and M stage were significant variables. Our patients present at a younger age and have better 5-year survival compared with the United States Surveillance Epidemiology and End Results data, which deserves further evaluation. Age and disease stage were identified as independent prognostic factors for survival in this patient population

Libman-sacks endocarditis with an unusual presentation

Systemic lupus erythematosus is relatively common medical disorder with female predominance. This disorder can affect any organ system. Cardiac involvement is variable which can include pericardium, myocardium and endocardium. The endocardial involvement commonly affects mitral and aortic valves. This report discusses lupus endocarditis in young man with atypical presentation

first national public breast cancer screening program in Saudi Arabia

Despite its relatively low incidence in Saudi Arabia, breast cancer has been the most common cancer among Saudi females for the past 12 consecutive years. The objective of this study was to report the results of the first national public breast cancer screening program in Saudi Arabia. Women 40 years of age or older underwent breast cancer screening. Mammograms were scored using the Breast Imaging-Reporting and Data System [BI-RADS]. Correlations between imaging findings, risk factors and pathological findings were analyzed. Between September 2007 and April 2008, 1215 women were enrolled. The median age was 45 years, and median body mass index was 31.6 kg/m[2]. Sixteen cases of cancer were diagnosed. No cancer was diagnosed in 942 women with R1/R2 scores, and only 1 case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions. No correlation was found between known risk factors and imaging score or cancer diagnosis. Public acceptance of the breast cancer screening program was encouraging. Longitudinal follow-up will help in better determining the risk factors relevant to our patient population

Zinc and magnesium levels in toxoplasmosis patients with and without liver cirrhosis versus cirrhosis

The influence of Zinc and Magnesium serum levels on selected chronic toxoplasmosis with and without liver cirrhosis versus pure liver cirrhosis was studied. Zn and Mg serum levels were measured in 199 male and female subjects [age range 19-62 years]. These were divided into 4 groups. GT: 100 patients with toxoplasmosis, G2: 25 toxoplasmosis patients with liver cirrhosis, G3: 25 patients with liver cirrhosis without toxoplasmosis and G4: 49 cross-matched liver parasites healthy control. A statistically significant reduction in the serum level of both Zn and Mg was recorded in G2 compared with G4. Also, a statistically significant reduction in serum level of both Zn and Mg in G2 compared to G3 in whom Zn and Mg were already depleted. However, patients with chronic toxoplasmosis and without cirrhosis [Gl] compared G4, showed a statistically significant reduction in serum Mg level, but reduction in Zn level was not significant

Gamma-tocotrienol Alters Protein Expression of HepG2 Cell Line

Gamma-tocotrienol (GTT) has been shown to exhibit significant antitumor activity in a variety of tumor cells. Previous findings have demonstrated that GTT had antiprolifera-tive effects on a liver cancer cell line (HepG2) with an IC50 value of 170μM. In this study, two dimensional gel electrophoresis (2DE) was used to determine changes in protein expression in HepG2 cell line following treatment with GTT. The ultimate aim is to identify the possible molecular mechanisms involved in GTT antitumor activity. This study is focused on obtaining a 2DE protein profile for HepG2 cell line with and without GTT treatment. In the preliminary analysis of the resulting 2DE profiles, 18 protein spots were found to be differentially expressed in cells treated with GTT. This observation is confirmed by extending the analysis to a larger sample size. By studying the effects of GTT treatment on differential protein expression in HepG2 cells the underly-ing mechanisms involved in the antitumor activity of GTT may be elucidated.

Sporadic creutzfeldt Jacob disease

We report a 65-year-old lady who presented with rapidly progressive dementia and was found to have Creutzfeldt-Jacob disease [CJD]. On reviewing the literature, there have been only 3 case reports of CJD from Saudi Arabia. Our aim is to report this rare disease and to include it in the differential diagnosis of rapidly progressive dementia in our practice

Histological and laboratory features of patients undergoing liver biopsy at a University Hospital in Central Saudi Arabia

To identify the most common liver pathologies seen in our center, to find the prevalence of advanced fibrosis and cirrhosis in patients with chronic hepatitis B and C, and to correlate the histological and laboratory features of the most common diseases and compare between them. Liver biopsy procedures performed in our Gastroenterology Unit at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were traced from records between the years 1997-2003. Clinical, histopathological, and laboratory features were recorded. We identified 574 liver biopsies during the study period. Of the 502 included patients, males were 58.6%. The mean age of the patients was 43.5 years. Approximately half of the biopsies [49%] were performed for patients with hepatitis C, followed by hepatitis B, for which 17% of the biopsies were performed. Patients with hepatitis B were approximately 10 years younger than patients with hepatitis C [p=0.01]. They were 10% more likely to be males. In terms of fibrosis, only approximately 17% of patients with hepatitis B and 27% of patients with hepatitis C had advanced fibrosis. Most liver biopsies performed in our center are performed for patients with hepatitis C. Rates of advanced fibrosis in our series are significantly lower than what was previously reported in other studies

Nucleic acid amplification technology Screening for hepatitis C virus and human immunodeficiency virus for blood donations

To investigate the performance of the commercial Roche COBAS AmpliScreen assay, and demonstrate whether the COBAS AmpliScreen human immunodeficiency virus-1 [HIV-1] test, v1.5, and COBAS AmpliScreen hepatitis C virus [HCV] v 2.0 for screening for HIV-1 and HCV RNA in the donated blood units from which plasma mini pools were collected, by nucleic acid amplification technology [NAT], could detect the positive pools and reduce the risk of transmission of infections for those routinely tested by serological assays. The study was performed on 3288 plasma samples collected from blood donors in a period of 13 months, from August 2004 to August 2005, at Al-Hada Armed Forces Hospital, Molecular Pathology Laboratory, Taif, Kingdom of Saudi Arabia. The samples were tested by the reverse transcriptase polymerase chain reaction [RT-PCR] after RNA extraction [this represents the major method in NAT assays], in parallel with the routine serological testing to detect qualitatively for HIV-1 and HCV. The NAT assays that include an automated COBAS AmpliPrep system for RNA extraction and COBAS Amplicor Analyzer using AmpliScreen kits for RT-PCR assays, and the routine serological screening assays for the detection of the HIV-1 and HCV RNA in the plasma samples from the blood donors have shown to be a reliable combination that would meet our requirements. The collected data further confirms the results from the serological assays and enables us to decrease the residual risk of transmission to a minimum with the finding of no seronegative window period donation. The results demonstrate that out of 3288 samples, the percentages of RT-PCR [NAT] negative blood donations that were also confirmed as seronegative were 99% for HCV, and 99.1% for HIV-1. The modified combined systems [automated COBAS AmpliPrep system for RNA extraction and COBAS Amplicor Analyzer using AmpliScreen kits for RT-PCR assays] for NAT screening assays has allowed the release of all blood donations supplied in the specified period of the study with no seronegative window period donations. This facilitates keeping the residual risk of transmission of HIV-1 and HCV to its minimum through blood transfusion

House dust mites and allergic manifestations among some children in Dammam, Saudi Arabia

The house dust mites is [= HDM] still one of the many causes of allergy, particularly atopic dermatitis. In the houses of children who were suffering allergic manifestations as atopic dermatitis, respiratory allergy, bronchitis, skin rash and fever. Double manifestations with fever were reported in four children. In the present study, two types of mites were recovered, Dermatophagoides farinae and Ornithonyssus bacoti. The immunoglobulins [G., M., A. and E] as well as complements [C3 and C4] were measured in the patients and cross-matched controls. The complements did not show any significant difference among patients and controls. Elevation was detected in IgG and 1gM, but not in IgA. However, high significant elevation was in IgE. The results were discussed on the light of regional work

Examination of urine for bacteria and parasites among elder persons in the rural area, in Dammam district

The asymptomatic bacteria and parasites in urines were studied in elder persons living in the rural areas of Dammam District. Complete history taking, clinical examination, urine analysis and culture, blood glucose level and haemoglobins in gm were performed for 43 elders of both sexes. The bacteria detected in urine in a descending order were Klebsiella sp. Staphyloccocus sp., Escherichia coli and Pseudomonas sp. The parasites detected were only Trichomonas vaginalis in three diabetic females. No doubt, regular urine examination is a must for the elders in rural areas

Impact of gestational diabetes on lipid profiling and indices of oxidative stress in maternal and cord plasma

To study the effect of gestational diabetes mellitus [GDM] on indices of oxidative stress and lipid profiles in maternal and cord blood samples. Blood samples were collected from 40 normal pregnant women and 46 women with GDM during the period 1998 through to 1999 at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. The GDM patients were subdivided into 2 groups: patients receiving insulin treatment [GDM-I, N=19] and patients under control diet [GDM-D, N=27]. Plasma a- and y-tocopherols were estimated by high-performance liquid chromatography, whereas malondialdehyde [MDA] was analyzed by fluorometry. Serum lipids [low density lipoprotein, high density lipoprotein, total cholesterol, triglycerides, and total lipids] were determined by enzymatic colorimetry using automated clinical analyzer. The results of lipid profiles in maternal serum showed no significant difference between GDM patients and controls; however, all the lipid constituents except total cholesterol were significantly reduced in the cord blood of GDM patients as compared to control subjects. a-tocopherol levels in the maternal plasma were not significantly different among the 3 groups, whereas, cord plasma a-tocopherol was significantly decreased in both GDM-D and GDM-I. Maternal y-tocopherol was found to be significantly increased in GDM-D and only insignificantly increased in GDM-I, but the cord y-tocopherol showed no appreciable changes. The level of MDA was 3-fold higher in maternal plasma as compared to cord plasma. However, neither the maternal plasma nor cord plasma showed significant differences in MDA levels between GDM patients and normal pregnant women. A significant depletion of a-tocopherol in the cord blood of GDM patients is indicative of a possible oxidative stress in their fetuses. Further studies are warranted to examine a wider range of biochemical parameters to evaluate the potential risks of oxidative damage

Wandering spleen.

Congenital malformations of the spleen are rare. We report 3 cases of wandering spleen presented as abdominal or pelvi-abdominal mass. Two patients were suffering from chronic lower abdominal pain with thrombosed splenic pedicle and the third patient had an acute abdomen. All patients underwent splenectomies. Abdominal ultrasound, computerized tomography, Doppler ultrasound, and radioisotope studies were used to confirm the diagnosis. The clinical, diagnostic and treatment modalities are discussed

Structural study on cultured isolated fetal rat pancreatic islets

To perform a morphometric and structural study of the cultured isolated fetal rat pancreatic islets. Islets of the fetal rat pancreas, aged 22 days were isolated by the standard procedure of collagenase digestion and culture technique. The islets were cultured for 1, 2, 3, 4 and 5 days. The islets were counted under a dissecting microscope and islet diameter and purity were measured under a phase contrast microscope fitted with a calibrated grid. The islet specimens were fixed in buffered neutral formalin, dehydrated in alcohol and embedded in parablast. Sections were stained with hematoxylin and eosin. This study was conducted in King Fahd Medical Research Center, Faculty of Medicine, King Abdul-Aziz University, Kingdom of Saudi Arabia, during 2003 and 2004. The purity of the cultured islets gradually increased with time and was significantly different between the cultured groups. The number of the cultured islets gradually decreased with time. The islet diameter gradually increased with culture period. The islet purity and diameter were significantly different between the cultured groups. Parablast sections stained with hematoxylin and eosin showed that the shape and histological structure of the cultured islets were intact. The results of the present work represent an extensive morphometric structural study of isolated cultured fetal islets. The culture islet diameter and purity showed gradual increase with culture period, while the islet number showed gradual decrease

Pencillin resistance in serogroups/serotypes of streptococcus pneumoniae causing invasive infections in central Saudi Arabia

To determine the minimum inhibitory concentrations [MICs] of penicillin, ceftriaxone and vancomycin of serogroups/serotypes of Streptococcus pneumoniae [S. pneumoniae] from invasive diseases in all age groups from major hospitals in Riyadh, Kingdom of Saudi Arabia [KSA]. All isolates of S. pneumoniae from patients with invasive pneumococcal infections between February 2000 and November 2001 were prospectively collected from 8 major hospitals in Riyadh, KSA. The isolates were confirmed as S. pneumoniae at the King Khalid University Hospitals, Riyadh, KSA and then serogrouped/serotyped using the agglutination method. The MICs for penicillin, ceftriaxone and vancomycin were carried out using the E-test. Forty-three% of the isolates were resistant to penicillin mostly of the intermediate type [97%]. The resistant strains were mainly confined to serogroups/serotypes 6, 23, 19 and 15 and the 7-valent conjugate vaccine covers 76% of the penicillin-resistant strains. Only one isolate was resistant to ceftriaxone. In view of the rather insignificant level of highly resistant-penicillin strains and the virtual absence of resistance to ceftriaxone we would like to suggest using ceftriaxone for treating invasive pneumococcal infections outside the central nervous system. We recommend that the conjugate vaccine would be a useful adjunct to penicillin prophylaxis in patients at risk in our community

Sero-prevalence of toxoplasmosis in pregnant mothers and new-born infants in eastern province, Saudi Arabia

Toxoplasma gondii is an obligate intracellular protozoa of worldwide distribution. In immunocompetent adults, it is usually the cause of asymptomatic infection. However, infection during pregnancy poses a special risk because of the teratogenic effect of toxoplasma. Determine the sero-prevalence of toxoplasmosis in pregnant women and newborn infants in King Fahd Hospital of the University, Al-Khobar, Eastern Province. In this hospital-based study. sera from 175 pregnant females were screened for toxoplasma IgG and 1gM. Results and A very low number [N = I/175, 0.57%] of pregnant mothers seroconverted during pregnancy, although many [N = 69/175, 39.4%] were recorded with inactive toxoplasmosis during pregnancy Delivery was normal in all cases except for a small number [N = I/175. 0.57%] of newborns [as recorded from cord blood] who were positive for toxoplasmosis

Continuing medical education on infectious diseases: a Saudi University Hospital experience

Continuing medical education [CME] is an important and useful activity for updating knowledge in order to improve for outcome of health care. A CME update symposium on Infectious Diseases was therefore organized at the King Fahd Hospital of the University [KFHU] Al-Khobar, Saudi Arabia. Participants included clinicians, laboratory personnel and nursing staff from different hospitals and universities in Saudi Arabia. To report the proceedings of the first CME on Infectious Diseases in the region and to evaluate it using a questionnaire-based feedback. Methodology: This CME was evaluated on specific feedback obtained on standardized evaluation forms provided during the symposium. The responses of 194 participants were statistically analyzed for the various components of the symposium. Results and Salient important issues covered during the program are presented The CME included five sessions on: hospital acquired infections, immunology, mycotic diseases, malaria, lesihmaniasis and virology. Some lacunae were also identified. The evaluation of the scientific sessions showed a satisfaction level of 3.98 +/- 0.59, on a scale of five. As this CME activity proved successful on many counts, it was concluded that it was worthwhile to conduct updates on infectious diseases on a regular basis