Effect of intravenous cyclophosphamide pulse therapy on renal functions and histopathology in patients with severe lupus nephritis.

Despite the wide use of intravenous cyclophosphamide (IC) in lupus nephritis (LN), there are few published studies showing the effect of this treatment on renal histology. In this prospective study, we report the effect of IC on the evolution of histopathologic features in successive renal biopsies in patients with LN. Thirty patients with class IV or V LN were started on IC (10-15 mg/kg) administered once every month for six months followed by three monthly for another six doses making a total of two years of therapy. The clinical course of the disease, serum creatinine and 24 hours urinary protein and creatinine clearance were tested at entry and subsequently during each follow-up visit. Repeat renal biopsy was performed after completion of two years of therapy. The mean serum creatinine of the study patients was 166.3 + 42 tmol/L at entry which decreased to 104 + 46.4 tmol/L at two years (P + 2.4 g at entry to 1.39 + 1.54 g at two years (P + 31 ml/min at the start of treatment to 64 + 32 ml/min at two years of therapy (P 200 tmol/L, of whom six progressed to variable degrees of chronic renal failure. Repeat renal biopsy was performed in 21 patients. The original biopsy of these patients showed class IV in 17 and class V in four patients. On repeat biopsy, five of class IV disease had progressed to advanced sclerosis, four to class V, and five remained unchanged. The remaining three patients with class IV LN changed to one each of class I, II and III. Of the four patients with class V, one progressed to advanced sclerosis, one changed to class III and two remained the same. There was a significant decrease (P < 0.05) in the activity index although there was a significant increase in the chronicity index (P < 0.001). Multivariat analysis for possible risk factors for progression to chronic renal failure showed initial high serum creatinine to be a powerful predictor of renal failure. In conclusion, IC pulse therapy is effective in improving or stabilizing renal function in patients with class IV or V LN. The only poor prognostic determinant observed was higher initial serum creatinine value.

The prevalence of rheumatoid arthritis in the Qassim region of Saudi Arabia.

BACKGROUND: Although rheumatoid arthritis (RA) of varying degrees of severity has been seen in our clinics, there is no statistical evidence of the magnitude of the problem in Saudi nationals. We conducted this study to determine the prevalence of RA in the Al Qassim Region of Saudi Arabia. PATIENTS AND METHODS: Five thousand eight hundred and ninety-one Saudi adults, aged 16 years and over, were studied in a house-to-house survey in the Al Qassim Region. RESULTS: Of the 5891 adults studied, 13 cases of RA were identified, using the criteria set for the diagnosis of RA by the American College of Rheumatology. Thirty-five percent of our patients showed positive rheumatoid factor. CONCLUSION: The prevalence of RA in Al Qassim was estimated at 2.2 per thousand people. It was also noted that the prevalence of the disease increased with age, and that it was more common in females.

Juvenile rheumatoid arthritis: The Saudi Experience.

We retrospectively studied the charts of 115 Arab children with juvenile rheumatoid arthritis (JRA), all of whom satisfied the American College of Rheumatology (ACR) criteria for JRA. They were followed between 1978 and 1993 at King Faisal Specialist Hospital and Research Centre and King Khalid University Hospital in Riyadh, Saudi Arabia. All patients were followed up for at least 18 months. The female to male ratio was 1.2:1, and the mean age of onset of the disease was six years. Ninety of the patients were Saudis and the remainder were Middle Eastern Arabs. The mode of onset was systemic in 44%, polyarticular in 30%, and periarticular in 26%. Chronic uveitis was found in only two of the children (1.7%). Antinuclear antibody (ANA) was determined in 96 patients and was positive in 29 (30%). Amyloidosis was not detected in this study population. The clinical and laboratory manifestations of this disease are presented. This review shows that the spectrum of clinical presentation differs in Arab children from those in the West. Systemic and polyarticular onset subtypes were more common, and the incidence of uveitis and amyloidosis was lower. Whether this reflects a genuine difference in the pattern of the disease, or is due to bias in referral pattern, remains to be detected. The answer is currently being sought through an ongoing prospective study.

Nongonococcal septic arthritis at a major teaching hospital in Riyadh, Saudi Arabia.

Twenty five (25) consecutive cases of nongonococcal septic arthritis admitted to King Khalid University Hospital were retrospectively reviewed. The patients were mostly adults (64%) and Staphylococcus aureus was the most common bacterial species isolated (69%). Predisposing factors were identified in 52% of patients, including diabetes mellitus in seven patients, pre-existing joint disease in two patients and the infection followed intra-articular steroid injections in two patients. All patients were treated with appropriate antibiotics; however, 11 (44%) patients were left with permanent joint damage.

High level resistance to aminoglycosides in enterococci from Riyadh.

Enterococci with high level of aminoglycosides resistance are being reported from different parts of the world with increasing frequency. Treatment of infections caused by such isolates is associated with a high incidence of failure or relapse. This is attributed to the loss of the synergetic effect of aminoglycosides and cell wall active agents against isolates exhibiting this type of resistance. To determine the prevalence of enterococci with high level resistance to aminoglycosides in Riyadh, Saudi Arabia, 241 distinct clinical isolates were examined by disk diffusion method using high content aminoglycosides disks. Seventy-four isolates (30%) were resistant to one or more of the aminoglycosides tested. The most common pattern of resistance was that to streptomycin and kanamycin. Of the 241 isolates tested, 29 (12%) were resistant to high levels of gentamicin, 35 (15%) to tobramycin, 65 (27%) to kanamycin and 53 (22%) to streptomycin. The highest rate of resistance to a high level of gentamicin was found among enterococcal blood isolates (30%). Eighteen of the isolates were identified as Enterococcus faecium, 13 (72%) of these showed high level resistance to two or more of the aminoglycosides tested.

Seasonal variation of culture positive brucellosis at a major teaching hospital.

Brucellosis is one of the main zoonoses in the world. In Saudi Arabia, it was recognized as a major health problem in 1983G and since then many measures have been implemented to control the disease. We conducted a study to determine the yearly incidence and seasonal variation of blood culture positive brucellosis (Brucella cases) diagnosed at King Khalid University Hospital (KKUH) in Riyadh between 1985G and 1991G. The results showed that there was a fivefold decline in the incidence of Brucella cases over the seven years of the study from 8.6 cases/1000 admissions in 1985G to 1.4 cases/1000 admissions in 1991G. The disease showed a prevalence that extended throughout year with the majority of cases occurring during spring, summer and early fall. The possible reasons for the seasonal variation and decreasing incidence of brucellosis noted in this study are discussed.

Meningococcaemia: a life threatening complication of upper gastrointestinal endoscopy.

Minor and major complications of diagnostic and therapeutic upper gastrointestinal endoscopy, especially after injection sclerotherapy, are well recognised. We report a case of septicaemia with Neisseria meningitidis serogroup A in a 4-year-old girl after diagnostic endoscopy.

Pattern of adult onset of polymyositis and dermatomyositis and association with malignancy.

A retrospective study of 22 adult patients with dermatomyositis (DM) or polymyositis (PM) was performed. Male to female ratio was 1:2.7. Mean age of onset was 37.3 +/- (16.3) and symptoms were present for a mean of 11.2 +/- 14.6 months before diagnosis. Primary polymyositis was diagnosed in 11 (50%), primary dermatomyositis in three (13.6%). PM/DM was associated with connective tissue disease in three (13.6%) and malignancy in five patients (22.7%). Muscle disease followed the diagnosis of malignancy by a mean of 12.2 months (one to 36 months). All were female. Diffuse erythema was observed in all three patients with DM and malignancy. Arthritis was seen more frequency in our patients (55%). Sixty-eight percent of patients showed substantial improvement of muscle disease with steroids alone or in combination with other immunosuppressive agents, 18% did not improve or their disease progressed in spite of the treatment. Three patients died (14%), two from respiratory failure and one from underlying malignancy.

Enteric fever due to multi-resistant Salmonella typhi.

Five cases of enteric fever due to multi-resistant Salmonella typhi are reported. Four of these patients most probably contracted the disease in India and the fifth in Egypt. All of them were successfully treated either with ceftriaxone or ciprofloxacin.

Prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia.

The prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia, was determined through a randomized multistage sampling of 8000 preschool children. Duplicate specimens from each child were examined using a simple sedimentation technique. The overall prevalence of intestinal parasites among children screened was 18.4%. The most common parasite isolated was Giardia lamblia (14.5%). This was followed by Entamoeba histolytica (2.7%), Enterobius vermicularis (1.4%), Ascaris lumbricoides (1.0%) and others. Out of the 1462 children positive for parasites, 183 (12.5%) had mixed parasitic infections. Prevalence among preschool children was highly associateed with older age, rural residence, non-municipal water supply, inadequate latrine type, low level of parental education, abdominal pain, and diarrhea.

Association of anti-cardiolipin antibodies with vascular thrombosis and neurological manifestation of Behçets disease.

We have studied 44 patients with Behçet's Disease (BD) to look for any correlation of arterial and venous thrombosis or central nervous system (CNS) manifestations with anti-cardiolipin antibodies (ACLA). Twenty patients were positive for ACLA by MELISA method. Ten patients had IgG antibody, four had IgM and six had both IgG and IgM. Of these patients, 11 had a history of vascular thrombosis and thrombophlebitis and nine had CNS manifestations. The association of ACLA with vascular thrombosis or CNS manifestation of Behçet's disease was statistically not significant.

Antibacterial activity of citreamicin-alpha (LL-E 19085 alpha) against gram-positive cocci.

In vitro antibacterial activity of 429 clinical isolates of gram-positive cocci was tested against citreamicin-alpha (LL-E 19085-alpha) by the agar dilution method. The microorganisms consisted of 313 isolates of staphylococci and 116 strains of streptococci. In vitro activity of citreamicin-alpha was compared with ampicillin, augmentin, cephalothin, erythromycin and vancomycin. MICs of citreamicin-alpha for staphylococci ranged between 0.12-4.0 micrograms/ml and 0.03-0.12 micrograms/ml for Streptococcus pyogenes. Enterococci, however, were relatively more resistant, requiring 2.0 micrograms/ml of this drug to inhibit 64% of the 62 isolates tested. In vitro activity of this antibacterial agent was far superior to that of ampicillin, augmentin, cephalothin and erythromycin, but equal to or slightly inferior to that of vancomycin.

Transferrin C subtypes in patients with rheumatoid arthritis.

Transferrin (Tf) subtypes were investigated in 128 patients with rheumatoid arthritis (RA) and the frequencies of TfC subtypes were compared with the results in normal individuals. The frequencies of the Tf genes: C1, C2, C3, D1, and D2 were 0.4765, 0.3867, 0.0742, 0.0390 and 0.0234, respectively. The frequency of TfC2 gene was significantly higher in these patients (0.3867) compared to the value in the control group (C2 = 0.247). The relative risk of RA in association with TfC1C2 type was 2.0, while it was 0.18 in association with TfC1C1 type and the results were statistically significant. This paper confirms the significant association between TfC2 and RA. Furthermore, it appears from our results that TfC1 homozygous phenotype is protective for the development of RA. The results are discussed in the light of earlier suggestions that the TfC2 subtype confers an increased risk of cellular damage by enhancing hydroxyl radical formation, although it is possible that there exists a genetic linkage of Tf variant to some other locus which is influencing susceptibility to RA.