Outcome of patients with systemic lupus erythematosus in intensive care unit.

The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.

The expression of rheumatoid arthritis in Saudi Arabia.

This retrospective study describes the characteristics of rheumatoid arthritis patients seen at the King Khalid University Hospital, Riyadh over a period of 5 years. One hundred and ninety-five patients with rheumatoid arthritis seen during this period were reviewed. There were 155 females and 40 males (F:M ratio 4:1). Females had a younger age at onset than males (38.6 +/- 13.4 vs 42.9 +/- 13.3 year for male - p = 0.037). The majority of patients (76.4%) described an insidious onset. 45.1% used one or more forms of local medicine. Constitutional symptoms were reported in 78 (40%). Rheumatoid factor was positive in 79.5%. The most frequently involved joints were the proximal interphalangeal (PIP) joints, knees and metacarpophalangeal (MCP) joints. Rheumatoid nodules were observed in 15.9% and keratoconjunctivitis sicca in 14.4%. Most patients used second line drugs. The majority of patients (57.4%) were in functional class 1 and 2. The disease pattern and joint distribution resemble more the pattern reported in developed countries.

Epidemiology of human brucellosis in southern Saudi Arabia.

There have been indications that human brucellosis is widely distributed in Saudi Arabia. In order to assess the situation in the south, and as a part of a nationwide prevalence survey, a sample of 4900 subjects was randomly selected for a house-to-house survey. Investigations included an interview, clinical examination and blood sampling for antibody titre determinations. Blood samples were first screened for Brucella antibodies by a microplate agglutination test to measure the exposed rate. Reactive sera were further analysed by the standard tube agglutination and 2-mercaptoethanol tests. A total of 4794 completed the study. Results of laboratory tests indicated that a significant proportion of the population in the southern region (19.2%) had serological evidence of exposure to Brucella antigen, and 2.3% had active disease. Direct contact with domestic animals and consumption of raw products of animal origin were identified as the main risk factors.

Systemic lupus erythematosus in Saudi patients.

Eighty-seven patients with systemic lupus erythematosus (SLE) were retrospectively studied in King Khalid University Hospital, Riyadh. There were 78 females and 9 males (F:M ratio of 9:1). The mean age (+/- SD) at onset and at diagnosis were 25.3 +/- 10.5 and 28.5 +/- 10.9 years, respectively, with peak incidence in the 20-30 year age group. Musculoskeletal (91%), constitutional (76%), cutaneous (72%) and renal (63%) manifestations occurred most frequently, while neuropsychiatric manifestations (26%), photosensitivity (26%) and oral ulcers (16%) were relatively less frequent. The most common laboratory abnormalities included ANA (98%), anti-DNA (93%), LE cells (66%) and lymphopenia (70%). There were seven deaths during the study period and most of them were related to renal failure and complications from infections. Overall, the pattern of SLE observed in the series was comparable to that observed in other series among Caucasians.

Effect of short-term use of different non-steroidal anti-inflammatory drugs on renal function during fasting in ramadan.

This study was conducted to determine the combined effect of Ramadan fasting and short-term use of different non-steroidal anti-inflammatory drugs (NSAIDs) on renal function in healthy volunteers. The study subjects were assigned to six different groups, five of whom took different NSAIDs (namely nabumetone, indomethacin, diclofenac, sulindac, tenoxicam) and the sixth was a control group. Data were collected on serum sodium, chloride, potassium, urea, creatinine, bicarbonate and uric acid as well as urinary osmolarity, sodium, potassium, chloride and urea. These measurements were taken before fasting, 10 days into fasting while using NSAIDs, and five days after stopping the use of NSAIDs. The results showed slight changes in serum and urine measurements during fasting while using NSAIDs. These changes, although were significant in some cases, were within the normal range and were noted in all the study groups including the control group. We conclude that short-term use of NSAIDs in healthy subjects during fasting is not associated with any major adverse effects on the renal function.

Causes of morbidity among a sample of elderly hospital patients in Riyadh, Saudi Arabia.

The causes of admission to hospital over a 5-year period of 3539 persons aged 60 years and above in Riyadh, Saudi Arabia have been analysed; 54.2% were males and 45.8% females and 68.5% were aged 65 years and above. The causes of morbidity were chronic degenerative disorders of which cardiovascular diseases were the most frequent followed by acute respiratory problems, diabetes, and digestive and neoplastic diseases. The pattern of disease was very similar to that in the industrialized countries. The median stay in hospital was 10.7 days. Respiratory diseases and diabetes mellitus were significantly higher in females than males (P < 0.02), while cardiovascular diseases, particularly ischaemic heart disease and heart failure, as well as malignant neoplastic diseases mainly of the digestive system, were more prevalent in males.

Pharmacokinetics of ketoprofen enantiomers in young and elderly arthritic patients following single and multiple doses.

Ketoprofen (KT), a chiral nonsteroidal anti-inflammatory drug (NSAID), is marketed and used as a racemic mixture. In healthy volunteers, negligible differences have been reported between the plasma time courses of KT enantiomers. Using a stereospecific high-performance liquid chromatographic (HPLC) assay measuring (R)- and (S)-KT in plasma and urine, pharmacokinetics of the enantiomers following single (50 mg) and then multiple (50 mg every 6 h for 3 d) doses were delineated in nine young and nine elderly arthritic patients. There were no significant differences between pharmacokinetic indices calculated after single and multiple doses, or between the two groups. In plasma, there were no significant differences between intact enantiomers in either patient group. However, significantly more conjugated (S)-KT was found in elderly patient plasma. Similar to findings in healthy volunteers, elimination of conjugated KT in both patient groups was more extensive for the (S)-, as compared with the (R)-isomer. It is suggested that age-dependent impaired elimination of conjugated (S)-KT, along with preferential biliary excretion of conjugated (R)-KT, is responsible for these observations.

Pharmacokinetics of ketoprofen enantiomers in healthy subjects following single and multiple doses.

Ketoprofen (KT; m-benzoylhydratropic acid), a 2-arylpropionic acid (2-APA) nonsteroidal anti-inflammatory drug (NSAID), is marketed and used as a racemic mixture. Although generally the activity of 2-APAs is suggested to be mainly due to the S-enantiomer, information on KT pharmacokinetics is based on measurement of total concentrations of S- and R-enantiomers. In this work, using a crossover fashion, the pharmacokinetics of KT enantiomers following single (50 mg, po) and then multiple (50 mg, q6h for 3 d) doses were delineated in eight healthy subjects. A sensitive stereospecific HPLC assay was used to measure KT enantiomers in plasma and urine, and conjugated KT enantiomers in urine. There were no significant differences between the pharmacokinetic indices calculated after single and multiple administration of KT. In plasma, small but significant differences were found between concentrations of the enantiomers (mean S:R ratios of 0.81 +/- 0.19 after single and 0.87 +/- 0.11 after repeated doses). Negligible amounts of unchanged KT enantiomers were found in urine. More than 80% of the given doses was found in urine as conjugated S- and R-KT, the predominant enantiomer being S-KT (mean S:R ratios of 1.19 +/- 0.05 after single and 1.17 +/- 0.05 after repeated doses). No significant difference between the elimination t1/2 of the enantiomers was observed. It is suggested that stereoselective conjugation followed by preferential biliary excretion of the conjugated R-KT enantiomer is responsible for the observed stereoselectivity in the pharmacokinetics of the drug.

A case of drug induced lupus due to carbamazepine.

We report a case of drug induced lupus related to carbamazepine. Both clinical and serological data are described. This represents the first documented case of carbamazepine induced lupus erythematosus in the literature with serological confirmation.