Immunomodulators, sFas and Fas-L as potential noninvasive predictors of IFN treatment in patients with HCV genotype-4.

Recent studies have indicated that cytokines can be used as markers for disease progression in hepatitis C virus (HCV)-infected patients, therefore this study was conducted to determine the influence of pegylated IFN vs standard IFN on interleukin-2 receptor (IL-2R), IL-6R, IL-8, TNFR-I, TNFR-II, sFas, and sFas-L in Egyptian patients with chronic hepatitis C genotype 4, as no previous studies have been performed on this genotype. We also aim at establishing a possible relationship between these cytokines and the response to INF to determine whether they can be used as noninvasive markers for the response to INF therapy and as monitors for the outcome of treatment. Thirty-eight patients with chronic HCV hepatitis were investigated for the serum levels of the previously mentioned cytokines in a randomized opened controlled trial (22 patients treated with pegylated IFN and 16 patients treated with standard IFN). Cytokine levels were measured by ELISA at 0, 1 and 12 months of IFN therapy. There was marked increase in the serum levels of IL-2R and IL-6R in nonresponders to pegylated interferon, IL-8, TNFR-I and II were significantly higher in nonresponders to standard interferon but were also high in responders of pegylated interferon. sFas and sFas-L showed high levels among responders to pegylated interferon but the standard interferon was again less effective in this regard. Serum levels of TNFR-II, sFas and sFas-L have the potential to be used as serological markers for response to pegylated IFN therapy, and IL-8 is a predictor for nonresponse. Moreover, TNFR-I and II have the potential to be used as markers of response to standard IFN treatment. The persistent correlation between sFas and TNFR-II may elaborate the possible role of pegylated IFN in the induction of apoptosis as a possible new mechanism of viral clearance during treatment with pegylated interferon treatment.

Epstein-Barr viral infection in extranodal lymphoma of the head and neck: correlation with prognosis and response to treatment.

AIMS: To determine the prevalence of Epstein-Barr virus (EBV) infection in primary extranodal lymphoma of the head and neck (PELHN) in immunocompetent patients. PELHN represents 16.18% of all lymphoma diagnosed at the National Cancer Institute, Cairo. Although EBV infection is highly associated with lymphoma in immunocompromised patients, the situation in immunocompetent patients is still unclear. MATERIAL AND METHODS: The study included 50 PELHN (11 cases in the nose and paranasal sinuses, 11 in the nasopharynx, 13 in the tonsils, seven in the oropharynx and eight in the oral cavity), five reactive lymph nodes, 15 normal nasopharyngeal tissue and 25 throat washes of healthy subjects from Egypt. Cases and controls were assessed for the presence of EBV by polymerase chain reaction (PCR) and in situ hybridization techniques, the presence of 30 base pair deletion of the LMP-1 (del-LMP1) gene and for the expression of p53, Ki67, bcl-2 and Bax by immunohistochemistry. This was also correlated with the clinical outcome of patients. RESULTS: EBV was detected in 90% and 70% of the cases using EBER in situ hybridization and PCR, respectively. All cases of nasal type lymphoma were positive for EBV. del-LMP1 gene was detected in 24/35 of EBV+ cases (68.6%), whereas 11 cases had wild-type variant either alone or mixed with del-LMP1. There was a significant difference in the frequency of del-LMP1 between lymphoma and normal tissues. Overexpression of Ki67, p53 and bcl-2 was detected in 78.1%, 62.5% and 20% of cases, whereas loss of Bax was detected in 18% of the cases. Multivariate analysis showed that only p53 overexpression, del-LMP1 variant and advanced disease stage are independent prognostic factors. CONCLUSION: EBV infection is frequent in PELHN in Egypt. Possible pathogenic mechanisms involve deregulation of p53 and enhanced proliferation (as detected by high Ki67 index). The presence of del-LMP1 variants, p53 overexpression and advanced disease stage are poor prognostic factors associated with reduced survival and poor response to therapy.

Haematological, lipid profile and other biochemical parameters in normal and hypertensive subjects among the population of the eastern province of Saudi Arabia.

OBJECTIVE: To determine the lipid profile complete blood count and other biochemical parameters in normotensive and hypertensive individuals. DESIGN: Cross-sectional population-based epidemiological household survey. SETTING: Population sample of the Eastern Province of Saudi Arabia. RESULTS: Hypertensive individuals had significantly higher mean levels of glucose, Tc, LDL-c, HDL-c, triglycerides and HBAIc, compared to normotensive individuals while there were no significant difference in the mean levels of Apo AI and Apo B. Within the same group there were variations in the levels of certain parameters between male and female. While the mean levels of haemoglobin, WBC and platelets were significantly higher in the hypertensive group compared to normotensive, there were no significant differences between these two groups in the levels of RBC, MCV, HCT, MCH and MCHC. However, the mean levels haemoglobin, RBC count and HCT were significantly higher in male compared to female within the same group with no significant difference in levels of WBC, MCV, MCH and MCHC. Furthermore, the mean concentration of platelets was significantly higher in females compared to male within the same group. Hypertensive individuals had significantly higher serum sodium, chloride and calcium levels but a significantly lower potassium level when compared to normotensive with no siginificant differences between male and female within the same group. CONCLUSION: The lipid and electrolyte profile of hypertensive individuals differ from that of normotensive individuals in this population. This study has contributed towards establishing the normal values for a number of parameters involved in the aetiology of cardiovascular diseases in the population of Eastern province.

Physicians' knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia.

We aimed to test the knowledge, attitude and practice (KAP) of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected standard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by andrologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for > or = 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed.

Changes in intraocular pressure after laser in situ keratomileusis.

PURPOSE: To evaluate changes in intraocular pressure (IOP) measurements by Goldmann applanation tonometry after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism, and to assess the accuracy of Goldmann applanation tonometry measurements after LASIK in these eyes. METHODS: LASIK was performed on 166 eyes of 93 patients for correction of myopia and myopic astigmatism. Intraocular pressure was measured by Goldmann applanation tonometry at the central and temporal parts of the cornea before and at 1, 3, 6, and 12 months after LASIK. The amount of change in IOP was computed and its relation to different variables was evaluated by regression analysis. RESULTS: Intraocular pressure measured at the center of the cornea was reduced by a mean of 3.69 +/- 1.63 mmHg after LASIK. Multiple regression analysis showed that the decrease in IOP was related to the preoperative IOP and the change in central corneal thickness after LASIK. Measurements of IOP at the temporal part of the cornea were also reduced by a mean of 2.39 +/- 1.71 mmHg. There was wide variability in the amount of difference between the temporal and central measurements after LASIK (temporal measurements were higher than central by 0 to +4 mmHg). CONCLUSION: LASIK for myopia produced underestimation of IOP measured by Goldmann applanation tonometry at the central part of the cornea by a mean of 3.69 +/- 1.63 mmHg. The decrease of IOP was related to preoperative IOP and the change in central corneal thickness after LASIK. Temporal Goldmann applanation tonometry measurements, although decreased after LASIK, were less reliable.

Epidemiological profile of malaria in a university hospital in the eastern region of Saudi Arabia.

OBJECTIVE: To study the epidemiological, clinical and hematological profile of laboratory-diagnosed malaria cases at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, during the period from January 1990 to December 1999, and to provide suitable recommendations accordingly. METHODS: This was a clinical case series study of confirmed cases presenting to King Fahd Hospital of the University during the period from January 1990 to December 1999. A specially designed form was used for data collection and 602, laboratory-confirmed cases of malaria were retrospectively analyzed. RESULTS: There were 602 cases with a mean age of 25.8 + 14.3 and a male to female ratio of 2.9:1. Less than half the cases were Saudis (42%), most of whom (93%) reported a history of travel to the Southwestern part of the Kingdom. The highest frequency of cases was observed in the years 1992, 1994 and 1998 and 40% of the cases were diagnosed during the months of February, March and September. Plasmodium falciparum was the most common species among Saudi (83%), Sudanese (72%) and Yemeni (64%) patients, while Plasmodium vivax was predominant among others. Most of these cases (75%) had a history of travel to their home countries (endemic areas). The most common clinical presentation was fever (97%), while the most common clinical signs were splenomegaly (9%) and jaundice (8%). Anemia (60%) and thrombocytopenia (53%) were the most common hematological findings. CONCLUSION: Although it appears that the Eastern Province is still free of indigenous malaria transmission, this could not be confirmed by the data. Imported cases, however represent a continuous threat due to the existence of such vectors as Anopheles stephensi, Anopheles fluviatilis, Anopheles sergentii and Anopheles superpictus and a large number of non-immune persons. It is recommended that malaria be always considered in the differential diagnosis of all acute fevers, especially among those with a history of travel to an endemic area. Prompt diagnosis and treatment is necessary. Chemoprophylaxis, when traveling to endemic areas is mandatory, as well as the use of other primary preventive measures to protect against mosquito bites.

Hepatitis C virus genotyping versus serotyping in Egyptian patients.

BACKGROUND: The RNA genome of hepatitis C virus (HCV) displays extensive sequence variation. In this study, serotyping and genotyping techniques were applied to assess this variability by comparing the performance of the serotyping assay with a panel of well-characterized HCV strains isolated from chronic active hepatitis (CAH) patients. PATIENTS AND METHODS: 60 serum samples from CAH patients were analyzed. All isolates were genotyped by a line probe assay and the results of genotyping and serotyping were evaluated. RESULTS: The overall sensitivity of the serotyping and genotyping techniques was 81.16% with a concordance of 73.3%. Type 4 was detected in 73.3% of cases and it was highly heterogeneous. CONCLUSION: Type 4 HCV is the most prevalent type in Egyptian CAH patients and there is a high concordance between the results of serotyping and genotyping techniques.

Increased rate of cholecystectomy after introduction of laparoscopic cholecystectomy in Saudi Arabia.

A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45-64 years followed by the age group 25-44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.

Predictive factors and incidence of complications in apparently healthy full term infants of diabetic mothers.

AIM: To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early. METHODS: A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours. RESULTS: One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively. CONCLUSION: Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

Knowledge, attitude and smoking patterns among nursing and laboratory technology students, dammam, saudi arabia.

OBJECTIVE: To study the reported practices of knowledge about and attitude towards smoking among nursing and medical laboratory technology (MLT) students, College of Medicine, King Faisal University at Dammam and Al-Khobar. SETTING: College of Medicine, Dammam and King Fahd Hospital of the University, Al-Khobar, Saudi Arabia METHODS: A cross-sectional approach involving a sample of 266 students and interns (152 nursing and 114 MLT), which included all enrolled students in the academic year (1998/1999). A self-administered questionnaire was used to collect data covering knowledge, practice and attitude to smoking. SPSS was used for statistical analysis. RESULTS: The overall smoking prevalence was low (5.6%), slightly higher among nursing (6.6%) versus MLT (4.4%) students. Knowledge of and attitude towards smoking was generally satisfactory in both groups, although deficient in some key areas, such as the addictive nature of smoking, some of its consequences on health, and difficulty of quitting. CONCLUSION AND RECOMMENDATIONS: The prevalence of smoking among nursing and MLT students is generally low but their knowledge and attitude need improvement. Health education on facts, dangers and consequences of smoking should start as early as the primary school, and should continue throughout the education of future health professionals (role models for the community).

Audit of diabetic care in a saudi primary care setting.

OBJECTIVE: To audit the care offered to diabetic patients attending the Family and Community Medicine Clinic (FAMCO), King Faisal University, Kingdom of Saudi Arabia (KSA). DESIGN: A cross-sectional study of medical records of 45 diabetic patients who regularly visited the clinic during a one-year period from June 1997 to May 1998. SUBJECTS: Patients who presented at the clinic because of non-insulin-dependent diabetes mellitus (type II). RESULTS AND CONCLUSIONS: The level of care for diabetic patients was relatively inappropriate, and some important parameters were under-recorded. Specific measures to improve and promote diabetic care in FAMCO clinics need to be undertaken. These include formulating and using protocols for diabetes management and better training of health-care providers.

Pediatric inguinal hernia: Outcome of repair.

Full text is available as a scanned copy of the original print version.

The prevalence of cardiovascular risk factors among students in jeddah, saudi arabia.

OBJECTIVES: To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students. RESULTS: Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9(th) to 12(th) grades, 6.9% of males and 0.5% of females were current cigarette smokers. CONCLUSIONS: Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.

Endourethrotomy of posterior urethral obliterations and severe strictures: improved outcome with urethral self-dilatation.

Eighteen male patients underwent endoscopic management of urethral obliterations and severe strictures of the subprostatic urethra. Thirteen patients who performed clean urethral self-dilatation after endoscopic repair had a lower incidence of recurrent strictures (P = 0.03) and required fewer visual internal urethrotomies than the initial five patients, who did not self-dilate (P = 0.01). All patients had minimal morbidity and required short hospitalization to achieve adequate urine flow and a stable urethral neolumen during the follow-up period.

Aminoglycoside prescription, therapeutic monitoring and nephrotoxicity at a university hospital in Saudi Arabia.

We studied the use of aminoglycosides at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, including prescriptions, dosage, serum levels, toxic factors and treatment outcome. Two hundred and fifty-six patients on aminoglycosides were involved in the study period November-December 1994: 24 (9.4%) patients were on amikacin and 232 (90.6%) patients were on gentamicin. The serum concentration was below the therapeutic range in 75% of the patients on amikacin and 50% on gentamicin. Serum concentrations within the therapeutic range (> 20 micrograms/ml; < 35 micrograms/ml for amikacin, and > 6 micrograms/ml and < 10 micrograms/ml for gentamicin) were achieved in 4% and 44% of patients respectively. The dosage was adjusted during therapy for 57% of the patients because of low levels, and for 43% of the patients because of toxic levels. More than 30% of the patients had their serum monitored for the first time 3 days after starting aminoglycoside therapy. Aminoglycosides were discontinued before the end of the course in 157 (62%) patients because 24% of them had developed toxic levels and 24% had not responded to the treatment. Successful outcome was achieved in 170 (66%) of the patients, however, 50% of them had inappropriate serum levels. The risk factors that are significantly associated with aminoglycoside nephrotoxicity were duration of therapy (P = 0.008), renal, liver diseases and ampicillin given concurrently with the aminoglycosides (P = < 0.05).

Bacteriuria and colonization of double-pigtail ureteral stents: long-term experience with 237 patients.

We prospectively studied 266 patients with indwelling double-pigtail ureteral stents to determine the incidence of stent colonization and associated bacteriuria. A urine culture was obtained just prior to stent insertion and was repeated at the time of its removal. The stent itself was also cultured. Of the 237 evaluable patients, 71 (29.9%) developed bacteriuria. Of the 237 stents, 161 (67.9%) became colonized with microorganisms. Pseudomonas aeruginosa was the most common pathogen isolated from the urine and the stents. Stents in female patients had a higher rate of colonization than those used in males (74.4% v 66.5%). The longer the duration of stenting, the higher was the rate of colonization (58.6% for stents left for < 1 month v 75.1% for those left for > 3 months). The rate of colonization according to catheter type was as follows: C-flex 55.5%, silicone 62.6%, urethane 100%, and Urosoft 56%. Long-term ureteric stenting is associated with a high rate of bacteriuria and stent colonization. The duration of stenting and the type of stent influence the results. We recommend that patients with double-J ureteral stents who could be at risk from bacteremia be covered by appropriate antibiotics, and the stents should be kept indwelling for the shortest possible time. If a patient with a stent develops symptomatic infection, an antibiotic should be started that covers the Pseudomonas species.

Maternal knowledge, attitudes, and practices as predictors of diarrboeal disease in Saudi children < 3 years of age.

Diarrhoeal disease continues to be a leading cause of morbidity and mortality in many developing countries. This study demonstrates the importance of behavioral risk factors as determinants of diarrhoeal disease. The study design used is incidence-base, case-control design. The cases were obtained from Primary Health Care Centers (PHCC) in Makkah area, Saudi Arabia, during October 1994 to January 1995. The studied sample consisted of 319 cases and 312 controls < 3 years of age. The results showed that mothers of cases were significant inferior knowledge about aetiology and transmission of diarrhoeal disease than did mothers of controls. Poor hygiene was significantly high in households of cases for two items; disposal of faeces in latrine and presence of toilet papers (p < 0.05). Assuming causal association between the risk factors and diarrhoeal disease, up to 60% of diarrhoeal disease in the study population may be attributable to the studied behavioral factors.

Serum immunoglobulin concentrations in diabetic patients.

The relationship between glycated haemoglobin (an index of long-term diabetic control), fructosamine (an index of intermediate-term diabetic control), and serum IgA, IgG, and IgM was studied in 110 diabetic patients (41 Type 1 and 69 Type 2) and compared with 111 healthy non-diabetic subjects. Significant increases in serum IgA (by 82.7%, p < 0.001) and IgG (by 35.2%, p < 0.001) concentrations were observed whereas the concentration of IgM was significantly decreased (by 46.7%, p < 0.001) in diabetic patients compared with non-diabetic subjects. Using Spearman's rank correlations, IgA correlated with fructosamine (r = 0.77, p < 0.001), HbA1 (r = 0.76, p < 0.001), and albumin (r = -0.58, p < 0.001) for the entire population sample but only fructosamine (r = 0.19, p < 0.05) and HbA1 (r = 0.28, p < 0.001) correlated with IgA in diabetic patients, respectively. It is concluded that abnormal levels of IgA, IgG, and IgM are very common in diabetic patients in whom serum IgA concentrations are influenced by the degree of glycaemic control. Whether changes in IgA and other immunoglobulins are implicated in the pathogenesis of diabetic complications (such as susceptibility to infection) deserve further study.

Fructosamine in obese normal subjects and type 2 diabetes.

The effect of various grades of obesity on serum fructosamine concentrations was studied in Type 2 diabetic (n = 105) and non-diabetic (n = 128) subjects. In obese diabetic and non-diabetic subjects (body mass index > or = 30 kg m-2), the concentration of fructosamine was markedly lower than that obtained for lean diabetic and non-diabetic subjects with similar glycaemic control. Stepwise multiple-regression analysis showed that fructosamine was associated with glycaemic control (as indicated by fasting plasma glucose and glycated haemoglobin), fasting triglycerides, and body mass index in both diabetic and non-diabetic subjects. In vitro studies showed marked decreases in both the extent of [14C]-glucose incorporation into plasma proteins and fructosamine production by incubated sera of obese patients whether diabetic or non-diabetic, with obese subjects with body mass index > 40 kg m-2 exhibiting the greatest decrease. In conclusion, serum fructosamine concentrations are shown to decrease in obese diabetic and non-diabetic subjects with body mass index > or = 30 kg m-2 giving rise to the underestimation of glycaemic control as indicated by fructosamine measurement. A change in the glycation reaction itself may be partly responsible for such decrease.

Epidemiological study of patients with acute asthma attending accident and emergency department.

A study of episodes of asthma was conducted in patients attending the Accident and Emergency (A&E) Department of King Abdulaziz University Hospital (KAUH) from August 1989 to July 1990. The total number of cases reporting to the A&E Department during this period was 89,178; of which 5,101 presented with episodes of asthma. The estimated prevalence of asthma was calculated to be 5.72% in relation to all other diseases reported to the A&E Department during this period; asthma was found more frequently among boys. A majority of patients with acute asthma attended the A&E Department during late afternoon and a night. Repeated episodes of asthma increased proportionately with age, and were more severe in males compared to females. A significant seasonal trend was noted, with two peaks noted during December and May. Hospital admissions for patients experiencing acute asthma was approximately 1.5% of all reported asthma episodes. No deaths were reported during the study period.