Monitoring the effect of TNF-alpha inhibitors on laboratory parameters and adverse effects in different diseases: a retrospective, single-center study.

BACKGROUND: The introduction of biological treatments has revolutionized the management of moderate-to-severe psoriasis. Multiple clinical trials have established the efficacy of biological agents in the treatment of moderate-to-severe psoriasis. Nevertheless, there are no clear indications for optimal monitoring intervals during treatment. OBJECTIVES: Collect and analyze laboratory evaluation data from patients receiving biological therapy to provide a better understanding of the need for laboratory investigations before and during treatment with biological agents, and to analyze adverse events and other factors. DESIGN: Retrospective cohort SETTINGS: Tertiary care center in Riyadh, Saudi Arabia. PATIENTS AND METHODS: Data were collected from the electronic medical records of patients attending the dermatology, rheumatology, and gastroenterology clinics from June 2014 to June 2019. The laboratory parameters of patients who have received one of the TNF-alpha inhibitors (adalimumab, etanercept, or infliximab) were collected starting at baseline and up to at least one year from treatment initiation. MAIN OUTCOME MEASURES: The time points at which patients developed significantly abnormal laboratory results during treatment with one of the TNF-alpha inhibitors. SAMPLE SIZE: 250 patients RESULTS: Most patients were treated with adalimumab (38.4%); a similar proportion (38%) with infliximab, whereas only 23.6% were treated with etanercept. The majority of the significant abnormal laboratory results occurred at baseline, 3-6 and 9-12 months. Most abnormalities were among patients using infliximab, followed by etanercept, and then adalimumab. The median number of laboratory abnormalities for dermatology patients was significantly lower than that for gastroenterology patients (P<.001), and for rheumatology patients (P=.002). CONCLUSIONS: Because dermatology patients showed a lower median number of laboratory abnormalities than patients treated by other specialties in our study, we believe that dermatology patients require less frequent laboratory monitoring. Therefore, we recommend laboratory evaluation at baseline, after 3-6 months, 1 year from the beginning of treatment, and annually thereafter for patients using TNF-alpha inhibitor agents. However, more frequent testing might be warranted according to patient comorbidities, concomitant medications, and physician judgment. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

Tofacitinib Treatment in Patients With Active COVID-19 Infection.

Alopecia areata is a chronic autoimmune disorder attacking the hair follicle epithelium; hence, causing non-scarring hair loss. It has been found that Janus kinase 3 (JAK3) hyperactivity plays a key role in the pathogenesis of the disease. Tofacitinib is an effective JAK1 and JAK3 inhibitor that can block several cytokines such as IL-2, IL-7, and IL-6. Several studies have demonstrated the efficacy of oral tofacitinib in hair regrowth in alopecia areata patients. With the recent COVID-19 pandemic, it has been advised to withhold JAK inhibitors during the period of active infection due to possible immunosuppression. We herein report two cases of patients with alopecia universalis who continued to use tofacitinib during their active COVID-19 infection and showed no deterioration in their course of illness.

Dapsone in the Management of Pemphigus and Pemphigoid: Rediscovery of its Long-Lost Efficacy.

Introduction Autoimmune mucocutaneous blistering dermatoses (AMCBD) are a group of disorders characterized by the production of autoantibodies that target specific adhesion molecules of the skin and/or mucous membranes. As a result, there is blister formation on the skin with or without mucous membrane involvement. Systemic corticosteroids have been used as the mainstay of treatment in AMCBD. However, due to the debilitating side effects associated with their use, there is significant morbidity and mortality, especially on the fragile elderly patients. Although the efficacy of dapsone in the treatment of AMCBD was identified decades ago, few recent studies shed light on that. Hence, further studies are needed to evaluate the efficacy of dapsone as a single agent in maintaining disease remission in patients with AMCBD. Materials and methods An observational retrospective study was performed. Patients with a known diagnosis of bullous pemphigoid (BP) or pemphigus vulgaris (PV) who are treated with dapsone with or without low-dose systemic corticosteroids were included in the study, and their medical files were reviewed.  Results A total of seven patients were included (three males and four females). All patients showed a satisfactory response to dapsone, achieving disease remission in a short period of time with no serious side effects necessitating treatment cessation. Conclusions Our findings support that dapsone may have a corticosteroid-sparing effect in the management of AMCBD. Further studies are warranted to confirm our findings.

Sources of Health Information and Their Impacts on Medical Knowledge Perception Among the Saudi Arabian Population: Cross-Sectional Study.

BACKGROUND: Having a reliable source for health information is vital to build a strong foundation of knowledge, especially with the current revolution of the internet and social media, which raises many concerns regarding harmful effects on the health of the public. However, there are no studies on how the Saudi Arabian population seeks health information. Details about the most used and trusted sources of health information among the public will help health authorities and public awareness accounts on social media to effectively disseminate health information. OBJECTIVE: To investigate the types of sources accessed by the Saudi Arabian population while seeking health information, as well as their level of trust in the sources and to assess the impact of these sources on their perception of medical knowledge and health decision-making. METHODS: A cross-sectional study was conducted to meet the objectives. The study population included both men and women who were aged 16 years or more and visited primary care clinics at King Khalid University Hospital. Four hundred and thirteen participants were sampled using the simple random method, and a self-administered questionnaire was used to collect data. The data were analyzed using SPSS software (IBM Corp, Armonk, New York, USA). RESULTS: A total of 413 participants were included in this study, and of these, 99 (24.0%) were males and 206 (49.9%) had a bachelor's degree. Doctors were chosen as the first source of information by 87.6% (283/323) of the participants, and they were completely trusted by most of the population (326/411, 79.3%). The second most commonly used source was pharmacists (112/194, 57.7%), and they were partially trusted by 41.4% (159/384) of the participants. Internet searches, social media, and traditional medicine were not prioritized by most of the participants as the first or second source of health information. The majority of the participants did not trust information obtained from social media, and WhatsApp was the most untrusted source. Almost half of the respondents (197/413, 47.7%) acknowledged that various sources of information can often help them understand their health problems. However, the majority disagreed on substituting a doctor's prescription with information obtained from the internet or a friend or relative. CONCLUSIONS: Although physicians were preferred and highly trusted, internet sources appeared to impact the medical knowledge of the population. The population still preferred to use internet search to obtain health information prior to a doctor's visit.

Clinical spectrum of neurofibromatosis type 1 among children in a tertiary care center.

OBJECTIVE: To identify the clinical and neuroradiological features of neurofibromatosis type 1 and the risk of malignancy in a pediatric age group. METHODS: This observational retrospective cohort study was conducted at King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia, for the patients with neurofibromatosis type 1 who were seen and had follow up from January 2000 to January 2019. RESULTS: A total of 50 children were included. Approximately 90% of patients presented with cafe-au-lait macules, and 34% had skin-fold freckling. Moreover, 42% of the participants had a first-degree relative with neurofibromatosis type 1, and about a quarter presented with associated epilepsy. About 90% of the neuroradiological features were consistent with those of neurofibromatosis type 1. About 52% of the patients had one or multiple types of tumors, and 34% presented with optic pathway glioma. CONCLUSION: This study described clinical spectrum of neurofibromatosis type 1 among children. It showed also a higher percentage of tumors than previous studies.

Linear dermatomyofibroma over the nape of neck: a report of an unusual case and literature review.

Dermatomyofibroma is a rare cutaneous mesenchymal tumor of benign fibroblastic and myofibroblastic derivations. It predominantly affects young women, and it usually presents as a reddish-brown plaque or nodule, which is commonly located over the upper trunk. We report the case of a 41-year-old female patient who presented with progressive linear dermatomyofibroma over the nape of her neck. This case report expands the knowledge about the clinical and histopathological features of this rare, benign and cutaneous tumor.