Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is ra... more Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is rare (2-5% of cases), but is a devastating complication with a poor survival rate. The administration of high-dose methotrexate (HDMTX) for CNS prophylaxis in patients with DLBCL is controversial and variable in the literature. The present study aimed to evaluate the clinical outcomes of HDMTX CNS prophylaxis in patients with intermediate and high CNS-International Prognostic Index (IPI) DLBCL using real-world data. An observational retrospective cohort study was conducted of all patients with intermediate and high CNS-IPI DLBCL treated at Princess Noorah Oncology Center (King Abdulaziz Medical City, Jeddah, Saudi Arabia) between January 2010 and December 2020. Patients were treated with HDMTX either intravenously or intrathecally, according to the physician's evaluation of the patient. Data on patient clinical characteristics, CNS relapses, risk factors and survival rates were obtained from hospital records. Data were analyzed using Student's unpaired t-test and the χ 2 test to compare the two subgroups, the Kaplan-Meier survival method with log-rank test to calculate and compare the survival rates, and regression analysis to determine the risk factors for CNS relapse and death. The study included 358 patients (n=32 with HDMTX CNS prophylaxis and n=326 without CNS prophylaxis). Patients in the CNS prophylaxis group had a significantly higher CNS relapse rate than those in the non-CNS prophylaxis group (12.5% vs. 1.8%; P=0.008). Patients who received CNS prophylaxis were younger and had an advanced stage of disease, with extranodal involvement and a high serum lactate dehydrogenase level at presentation. CNS prophylaxis was significantly associated with CNS relapse, while relapsed disease was associated with the risk of death (all P<0.05). In conclusion, the present study found that patients with intermediate and high CNS-IPI who received HDMTX CNS prophylaxis did not have fewer CNS relapses; however, those without CNS relapse had higher survival rates. In addition to CNS prophylaxis, Stage of DLBCL and IPI were significantly associated with CNS relapse. Future randomized control trials are needed to evaluate the efficacy of HDMTX CNS prophylaxis in patients with DLBCL.
Introduction: Alcohol use disorder (AUD) is anticipated to affect about eighteen percent of the p... more Introduction: Alcohol use disorder (AUD) is anticipated to affect about eighteen percent of the population and five percent yearly. Furthermore, it has been suggested that about twenty percent of adults in the emergency department have AUD and that the incidence of alcohol withdrawal syndrome (AWS) in patients admitted to surgical Intensive Care Unit (ICU) varies from eight to forty percent, and most likely to be linked to infectious complications and have a higher mortality rate. It is estimated that up to fifty percent of AUD patients will experience withdrawal symptoms, a minority of whom needs management. AWS represents a clinical condition recognized by symptoms of autonomic hyperactivity like agitation, tremors, irritability, anxiety, hyperreflexia, confusion, hypertension, tachycardia, fever and diaphoresis. AWS often presents in alcoholdependent patients within six to twenty four hours after the sudden stop or reduction of alcohol intake. It is highly life-threatening condition. The severity can range from mild/moderate forms characterized by tremors, nausea, anxiety, and depression, to severe forms recognized by hallucinations, seizures, delirium tremens and coma. The mild-moderate form of AWS is usually self-managed by patients or symptoms improves within two to seven days from the last drink, whereas the more severe AWS needs medical treatment. The recognition and further management of AWS is of great clinical value, as AWS is one of the causes of morbidity and mortality. Aim of work: In this review, we will discuss Alcohol withdrawal syndrome, manifestation and management Methodology: We did a systematic search for alcohol withdrawal syndrome, manifestation and management using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles. Conclusions: AWS exemplifies a possibly life-threatening medical illness usually affecting AUD patients suddenly reducing or stopping alcohol intake. AWS should be considered in the differential diagnosis of any patients presenting with symptoms of autonomic hyperactivity. The use of a clinician-administered scale (CIWA-Ar or Alcohol Withdrawal Scale) is of great value to diagnose AWS and start adequate treatment. BZDs represent the gold standard treatment as a result both for their high rate of efficacy and being the only medications with proven ability to prevent the complicated forms of AWS (seizures, DTs). The management of AWS may be difficult. The primary phase is recognized by patient agitation and non-collaboration. This phase should be managed aggressively, to decrease the risk of medical complications (seizures, DTs, death), decrease patient suffering and improve quality of life. The direct effect of these measures will be, in most of cases, a strong physician-patient relationship. The latter is essential to enhance patient's disposition toward medical management and to start a long-term, multidisciplinary treatment of alcohol dependence. While BZD's addictive characteristics limit their long-term use, the possibility of using other medications able to be effective both for the management of AWS and the further long-term program for alcohol relapse prevention represents an advantage, i.e. carbamazepine, SMO, baclofen, gabapentin and topiramate. The initial administration of a non-BZD agent together with gold-standard treatments represents a useful choice to reduce the need for extra-dose BZD prescription (BZD-sparing drugs) and to start a medication with anti-craving characteristics. But it is highly essential to keep in mind that at present, BZDs are the most effective and manageable medications for the management of AWS.
World Journal of Advanced Research and Reviews, 2020
King Fahad University Hospital, a leading public healthcare institution in the Eastern region of ... more King Fahad University Hospital, a leading public healthcare institution in the Eastern region of KSA, implemented a disruptive innovation of Telepharmacy in pursuit of compliance with the National COVID-19 Response Framework. It emerged and proved to be an essential and critical pillar in suppression and mitigation strategies. Telepharmacy innovation resulted in Pharmacy staffing protection and provided uninterrupted access and care continuum to the pharmaceutical services, both for COVID-19 and Collateral care. This reform-oriented initiative culminated in adopting engineering and administrative controls to design the workflows, practices, and interactions between healthcare providers, patients, and pharmaceutical frontline staff. Pharmaceutical services enhanced its surge capacity (14,618 OPD requests & 10,030 Inpatient orders) and improved capability (41,242 counseling sessions) to address the daunting challenge of complying with the inpatient needs and robust outpatient pharmaceutical consumer services. Pharmacy services established a harmonious momentum between spatial and temporal consumers amidst the peak of the pandemic, where footfalls, air gaps, physical proximity and use of crisis standard of care was an institutional priority and national obligation. This powerful tool of Telepharmacy significantly had an impact on the technical efficiency and healthcare system's effectiveness on resource utilization in this newly adopted institutional pandemic response model. Core determinants of safe, integrated medication management use were protected by using e-tools and vehicles such as WhatsApp, webpage portals, and applications along with express shipping couriers.
is the most common hematological malignancy in Kosovo. These are a variety of subtypes of the dis... more is the most common hematological malignancy in Kosovo. These are a variety of subtypes of the disease present, with Diffuse large B-cell lymphoma being the most common. The diagnosis of this disease has increased in the last few years and the treatment with chemotherapy and other supportive care has many challenges. With this study I want to better understand the disease so we can improve the quality of care for the patients. Design: Cross sectional retrospective epidemiological study. The data was collected during the 5 year period of 2014-2018. Setting: The data was collected from the chemotherapy treatment protocol books in the Hematology clinic of the University clinical center of Kosovo. Patients: Adults, age 18 and older, both genders, diagnosed the treated with Non-Hodgkin lymphoma in the Hematology clinic of Kosovo. The diagnosis was made based on histo-pathological and immunohistochemical analysis of lymphoid tissue. Main Outcomes Measures: No main outcome, because it is an epidemiological study. Results: During the period of 2014-2018, 251 of patients were diagnosed and treated with Non-Hodgkin lymphoma, the most common was DLBCL with 114 (45.41%) then Follicular lymphoma with 23 (9.16%), Mantle cell lymphoma with 19 (7.56%), Marginal zone lymphoma with 14 (5.57%), Splenic B-cell lymphoma with 10 (3.98%) and the rest of the Non-Hodgkin lymphomas with 71 (29.32%). The mean age at diagnosis was 57 years old with the most common age group being 60-69 years old. From the patients diagnosed with Non-Hodgkin lymphoma during this period, 198 were treated with the R-CHOP protocol as first line chemotherapy, 19 with R-CVP, 26 with CHOP (T-cell lymphoma), 1 with only Rituximab (monthly), 1 with CHOEP, 1 with mini R-CHOP, 1 with EPOCH, 2 with mini CHOP, one refused chemotherapy, three died. Conclusions: The majority of patients were treated with the R-CHOP chemotherapy protocol as first line therapy. The patients with T-cell lymphomas received the CHOP protocol. The results of the treatments were successful in achieving remissions in the majority of patients. A small number of patients that did not achieve remission, received a second treatment protocol with mixed results.
The presence of vaginal fluid as a bio-stain in the crime scene of sexual assaults provides pivot... more The presence of vaginal fluid as a bio-stain in the crime scene of sexual assaults provides pivotal evidence. The vaginal secretions are known to be rich in Lactobacillus; hence the current work aims to identify vaginal secretions via detection and quantification of Lactobacillus DNA in pre and postmenopausal females and to test its stability over storage time using Critical Threshold method applied by Polymerase chain reaction approach. Comparative study is done by Critical Threshold and Relative Expression methods aiming to evaluate the two methods. Results showed that (ΔCT) <9 powerfully indicates the presence of vaginal fluids. Values of ΔCT in all vaginal samples are stable and not affected by storage. Two novel cutoff values are obtained in order to differentiate between premenopausal and postmenopausal vaginal fluid samples which are (8.42) using the Critical Threshold method and (0.24) using the Relative Expression method. One novel cutoff value is obtained to differentiate between fresh and stored vaginal samples by the Relative Expression method which is (0.39). It is concluded that Lactobacillus DNA quantification via PCR is a good positive identifier for vaginal secretions which is remarkably stable over storage time.
Atypical hemolytic-uremic syndrome (aHUS) is a rare disease of complement dysregulation leading t... more Atypical hemolytic-uremic syndrome (aHUS) is a rare disease of complement dysregulation leading to thrombotic microangiopathy (TMA). Renal involvement and progression to end-stage renal disease are common in untreated patients. We report a 52-year-old female patient who presented with severe acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. She was managed with steroid, plasma exchange, and dialysis. Kidney biopsy shows TMA and renal cortical necrosis. Genetic analysis reveals heterozygous complement factor I (CFI) mutation. Eculizumab was initiated after 3 mo of presentation, continued for 9 mo, and stopped because of sustained hematologic remission, steady renal function, and cost issues. Despite this, the patient continued to be in hematologic remission and showed signs of renal recovery, and peritoneal dialysis was stopped 32 mo after initiation. We report a case of aHUS due to CFI mutation, which, to the best of our knowledge, has not been reported b...
Background: Hodgkin lymphoma (HL) exhibits considerable clinicopathological variations in differe... more Background: Hodgkin lymphoma (HL) exhibits considerable clinicopathological variations in different parts of the world. This study was prompted by the limited availability of HL data in developing countries (particularly long-term outcomes). Methods: We performed a retrospective review of eligible adult HL patients treated at 3 tertiary centers in Saudi Arabia between January 1997 and December 2012. Results: The review included 340 patients with a median age of 26 years (range 15-82 years); 53% were male, 74% had an advanced stage, 22% had bulky disease, and 70% had low-to-intermediate risk according to the International Prognostic Score. Nodular sclerosis was the most common histological subtype (59%). Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) was offered to 92% and radiotherapy to 43%. Initial therapy outcomes were complete response, partial response, and progressive disease in 91%, 5%, and 2% of patients, respectively. At a median follow-up of 39 months, the actu...
No study has been published yet in the Arab world regarding response and outcome of imatinib in p... more No study has been published yet in the Arab world regarding response and outcome of imatinib in patients with chronic myeloid leukemia (CML). This study evaluated a total of 122 patients with CML treated with imatinib between 2001 and 2012. Survival, hematologic, cytogenetic and molecular responses and adverse events were assessed. The 5-year overall survival (OS), event free survival (EFS) and progression-free survival (PFS) rates were: 95.4 ± 2.3%, 81.4 ± 4.6% and 90.8 ± 3.2%, respectively. Significant differences in OS (p = 0.001), EFS (p = 0.001) and PFS (p = 0.001) were noted when patients were stratified by cytogenetic response. Survival by Sokal risk groups was not significant (p = 0.293). Complete hematologic response was achieved in 94 patients (93.1%), cytogenetic response in 84 (83.2%), major molecular response in 62 (61.4%) and complete molecular response in 34 (33.7%). This article presents the first evidence on the effectiveness of imatinib in patients with CML from Saudi Arabia and highlights similarities and differences in response patterns in published studies.
All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, T... more All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, Turkish, and North African populations; with no studies arising from the Arabic Gulf Region. This study aimed to define nasal anthropometric measurements in Saudi Arabia (the largest Arabic Gulf country) and compare them with different races. A total of 104 Saudi men and 105 Saudi women with a mean age of 22 years (range, 18-27 years) were included in the study. A total of 25 nasal anthropometric variables were measured. Comparison with other races was done using the t-test (P &amp;amp;lt; 0.05 is considered significant). The intercanthal distance of Saudi men is significantly smaller than that in women (the reverse is true for other races). Hence, Saudi women (and not men) have significantly wider intercanthal distance than do whites. The nasal widths of Saudi men and women lie between the whites and the Chinese. A unique feature of the Saudi nose is the significantly larger nasofrontal angle of Saudi men and women compared with all other races. Within the Saudi race, the nasofacial angle of men is so much larger than that of women (41.4 vs 33.3 degrees). In other races, the difference between men and women is usually slight (0- to 1-mm difference only). In Saudi men, the nasofacial angle is significantly larger than that in whites, but the value for Saudi women is significantly smaller than that for whites. Finally, in both Saudi sexes, the nasal tip angle/nasal tip protrusion is significantly smaller than all other races. It was concluded that the Saudi nose has several unique features when compared with other races including other Middle Eastern populations.
Results: The study findings indicate that bacterial infection prevalence differed significantly a... more Results: The study findings indicate that bacterial infection prevalence differed significantly across the different disease status pre-salvage as patients with the relapsed disease were more likely to have bacterial Original Article infections. The median of engraftment days differed significantly between those who had a bacterial infection and those who did not. Interestingly, previous pneumonia infection had a positive relationship with the number of hospital stays. Conclusion: Bacterial infections are the dominant type of infection among the autologous patient population. The research reflects authentic practice and reports unique characteristics of autologous transplant patients in terms of the prevalence and types of infection these patients experience.
Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is ra... more Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is rare (2-5% of cases), but is a devastating complication with a poor survival rate. The administration of high-dose methotrexate (HDMTX) for CNS prophylaxis in patients with DLBCL is controversial and variable in the literature. The present study aimed to evaluate the clinical outcomes of HDMTX CNS prophylaxis in patients with intermediate and high CNS-International Prognostic Index (IPI) DLBCL using real-world data. An observational retrospective cohort study was conducted of all patients with intermediate and high CNS-IPI DLBCL treated at Princess Noorah Oncology Center (King Abdulaziz Medical City, Jeddah, Saudi Arabia) between January 2010 and December 2020. Patients were treated with HDMTX either intravenously or intrathecally, according to the physician's evaluation of the patient. Data on patient clinical characteristics, CNS relapses, risk factors and survival rates were obtained from hospital records. Data were analyzed using Student's unpaired t-test and the χ 2 test to compare the two subgroups, the Kaplan-Meier survival method with log-rank test to calculate and compare the survival rates, and regression analysis to determine the risk factors for CNS relapse and death. The study included 358 patients (n=32 with HDMTX CNS prophylaxis and n=326 without CNS prophylaxis). Patients in the CNS prophylaxis group had a significantly higher CNS relapse rate than those in the non-CNS prophylaxis group (12.5% vs. 1.8%; P=0.008). Patients who received CNS prophylaxis were younger and had an advanced stage of disease, with extranodal involvement and a high serum lactate dehydrogenase level at presentation. CNS prophylaxis was significantly associated with CNS relapse, while relapsed disease was associated with the risk of death (all P<0.05). In conclusion, the present study found that patients with intermediate and high CNS-IPI who received HDMTX CNS prophylaxis did not have fewer CNS relapses; however, those without CNS relapse had higher survival rates. In addition to CNS prophylaxis, Stage of DLBCL and IPI were significantly associated with CNS relapse. Future randomized control trials are needed to evaluate the efficacy of HDMTX CNS prophylaxis in patients with DLBCL.
Introduction: Alcohol use disorder (AUD) is anticipated to affect about eighteen percent of the p... more Introduction: Alcohol use disorder (AUD) is anticipated to affect about eighteen percent of the population and five percent yearly. Furthermore, it has been suggested that about twenty percent of adults in the emergency department have AUD and that the incidence of alcohol withdrawal syndrome (AWS) in patients admitted to surgical Intensive Care Unit (ICU) varies from eight to forty percent, and most likely to be linked to infectious complications and have a higher mortality rate. It is estimated that up to fifty percent of AUD patients will experience withdrawal symptoms, a minority of whom needs management. AWS represents a clinical condition recognized by symptoms of autonomic hyperactivity like agitation, tremors, irritability, anxiety, hyperreflexia, confusion, hypertension, tachycardia, fever and diaphoresis. AWS often presents in alcoholdependent patients within six to twenty four hours after the sudden stop or reduction of alcohol intake. It is highly life-threatening condition. The severity can range from mild/moderate forms characterized by tremors, nausea, anxiety, and depression, to severe forms recognized by hallucinations, seizures, delirium tremens and coma. The mild-moderate form of AWS is usually self-managed by patients or symptoms improves within two to seven days from the last drink, whereas the more severe AWS needs medical treatment. The recognition and further management of AWS is of great clinical value, as AWS is one of the causes of morbidity and mortality. Aim of work: In this review, we will discuss Alcohol withdrawal syndrome, manifestation and management Methodology: We did a systematic search for alcohol withdrawal syndrome, manifestation and management using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles. Conclusions: AWS exemplifies a possibly life-threatening medical illness usually affecting AUD patients suddenly reducing or stopping alcohol intake. AWS should be considered in the differential diagnosis of any patients presenting with symptoms of autonomic hyperactivity. The use of a clinician-administered scale (CIWA-Ar or Alcohol Withdrawal Scale) is of great value to diagnose AWS and start adequate treatment. BZDs represent the gold standard treatment as a result both for their high rate of efficacy and being the only medications with proven ability to prevent the complicated forms of AWS (seizures, DTs). The management of AWS may be difficult. The primary phase is recognized by patient agitation and non-collaboration. This phase should be managed aggressively, to decrease the risk of medical complications (seizures, DTs, death), decrease patient suffering and improve quality of life. The direct effect of these measures will be, in most of cases, a strong physician-patient relationship. The latter is essential to enhance patient's disposition toward medical management and to start a long-term, multidisciplinary treatment of alcohol dependence. While BZD's addictive characteristics limit their long-term use, the possibility of using other medications able to be effective both for the management of AWS and the further long-term program for alcohol relapse prevention represents an advantage, i.e. carbamazepine, SMO, baclofen, gabapentin and topiramate. The initial administration of a non-BZD agent together with gold-standard treatments represents a useful choice to reduce the need for extra-dose BZD prescription (BZD-sparing drugs) and to start a medication with anti-craving characteristics. But it is highly essential to keep in mind that at present, BZDs are the most effective and manageable medications for the management of AWS.
World Journal of Advanced Research and Reviews, 2020
King Fahad University Hospital, a leading public healthcare institution in the Eastern region of ... more King Fahad University Hospital, a leading public healthcare institution in the Eastern region of KSA, implemented a disruptive innovation of Telepharmacy in pursuit of compliance with the National COVID-19 Response Framework. It emerged and proved to be an essential and critical pillar in suppression and mitigation strategies. Telepharmacy innovation resulted in Pharmacy staffing protection and provided uninterrupted access and care continuum to the pharmaceutical services, both for COVID-19 and Collateral care. This reform-oriented initiative culminated in adopting engineering and administrative controls to design the workflows, practices, and interactions between healthcare providers, patients, and pharmaceutical frontline staff. Pharmaceutical services enhanced its surge capacity (14,618 OPD requests & 10,030 Inpatient orders) and improved capability (41,242 counseling sessions) to address the daunting challenge of complying with the inpatient needs and robust outpatient pharmaceutical consumer services. Pharmacy services established a harmonious momentum between spatial and temporal consumers amidst the peak of the pandemic, where footfalls, air gaps, physical proximity and use of crisis standard of care was an institutional priority and national obligation. This powerful tool of Telepharmacy significantly had an impact on the technical efficiency and healthcare system's effectiveness on resource utilization in this newly adopted institutional pandemic response model. Core determinants of safe, integrated medication management use were protected by using e-tools and vehicles such as WhatsApp, webpage portals, and applications along with express shipping couriers.
is the most common hematological malignancy in Kosovo. These are a variety of subtypes of the dis... more is the most common hematological malignancy in Kosovo. These are a variety of subtypes of the disease present, with Diffuse large B-cell lymphoma being the most common. The diagnosis of this disease has increased in the last few years and the treatment with chemotherapy and other supportive care has many challenges. With this study I want to better understand the disease so we can improve the quality of care for the patients. Design: Cross sectional retrospective epidemiological study. The data was collected during the 5 year period of 2014-2018. Setting: The data was collected from the chemotherapy treatment protocol books in the Hematology clinic of the University clinical center of Kosovo. Patients: Adults, age 18 and older, both genders, diagnosed the treated with Non-Hodgkin lymphoma in the Hematology clinic of Kosovo. The diagnosis was made based on histo-pathological and immunohistochemical analysis of lymphoid tissue. Main Outcomes Measures: No main outcome, because it is an epidemiological study. Results: During the period of 2014-2018, 251 of patients were diagnosed and treated with Non-Hodgkin lymphoma, the most common was DLBCL with 114 (45.41%) then Follicular lymphoma with 23 (9.16%), Mantle cell lymphoma with 19 (7.56%), Marginal zone lymphoma with 14 (5.57%), Splenic B-cell lymphoma with 10 (3.98%) and the rest of the Non-Hodgkin lymphomas with 71 (29.32%). The mean age at diagnosis was 57 years old with the most common age group being 60-69 years old. From the patients diagnosed with Non-Hodgkin lymphoma during this period, 198 were treated with the R-CHOP protocol as first line chemotherapy, 19 with R-CVP, 26 with CHOP (T-cell lymphoma), 1 with only Rituximab (monthly), 1 with CHOEP, 1 with mini R-CHOP, 1 with EPOCH, 2 with mini CHOP, one refused chemotherapy, three died. Conclusions: The majority of patients were treated with the R-CHOP chemotherapy protocol as first line therapy. The patients with T-cell lymphomas received the CHOP protocol. The results of the treatments were successful in achieving remissions in the majority of patients. A small number of patients that did not achieve remission, received a second treatment protocol with mixed results.
The presence of vaginal fluid as a bio-stain in the crime scene of sexual assaults provides pivot... more The presence of vaginal fluid as a bio-stain in the crime scene of sexual assaults provides pivotal evidence. The vaginal secretions are known to be rich in Lactobacillus; hence the current work aims to identify vaginal secretions via detection and quantification of Lactobacillus DNA in pre and postmenopausal females and to test its stability over storage time using Critical Threshold method applied by Polymerase chain reaction approach. Comparative study is done by Critical Threshold and Relative Expression methods aiming to evaluate the two methods. Results showed that (ΔCT) <9 powerfully indicates the presence of vaginal fluids. Values of ΔCT in all vaginal samples are stable and not affected by storage. Two novel cutoff values are obtained in order to differentiate between premenopausal and postmenopausal vaginal fluid samples which are (8.42) using the Critical Threshold method and (0.24) using the Relative Expression method. One novel cutoff value is obtained to differentiate between fresh and stored vaginal samples by the Relative Expression method which is (0.39). It is concluded that Lactobacillus DNA quantification via PCR is a good positive identifier for vaginal secretions which is remarkably stable over storage time.
Atypical hemolytic-uremic syndrome (aHUS) is a rare disease of complement dysregulation leading t... more Atypical hemolytic-uremic syndrome (aHUS) is a rare disease of complement dysregulation leading to thrombotic microangiopathy (TMA). Renal involvement and progression to end-stage renal disease are common in untreated patients. We report a 52-year-old female patient who presented with severe acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. She was managed with steroid, plasma exchange, and dialysis. Kidney biopsy shows TMA and renal cortical necrosis. Genetic analysis reveals heterozygous complement factor I (CFI) mutation. Eculizumab was initiated after 3 mo of presentation, continued for 9 mo, and stopped because of sustained hematologic remission, steady renal function, and cost issues. Despite this, the patient continued to be in hematologic remission and showed signs of renal recovery, and peritoneal dialysis was stopped 32 mo after initiation. We report a case of aHUS due to CFI mutation, which, to the best of our knowledge, has not been reported b...
Background: Hodgkin lymphoma (HL) exhibits considerable clinicopathological variations in differe... more Background: Hodgkin lymphoma (HL) exhibits considerable clinicopathological variations in different parts of the world. This study was prompted by the limited availability of HL data in developing countries (particularly long-term outcomes). Methods: We performed a retrospective review of eligible adult HL patients treated at 3 tertiary centers in Saudi Arabia between January 1997 and December 2012. Results: The review included 340 patients with a median age of 26 years (range 15-82 years); 53% were male, 74% had an advanced stage, 22% had bulky disease, and 70% had low-to-intermediate risk according to the International Prognostic Score. Nodular sclerosis was the most common histological subtype (59%). Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) was offered to 92% and radiotherapy to 43%. Initial therapy outcomes were complete response, partial response, and progressive disease in 91%, 5%, and 2% of patients, respectively. At a median follow-up of 39 months, the actu...
No study has been published yet in the Arab world regarding response and outcome of imatinib in p... more No study has been published yet in the Arab world regarding response and outcome of imatinib in patients with chronic myeloid leukemia (CML). This study evaluated a total of 122 patients with CML treated with imatinib between 2001 and 2012. Survival, hematologic, cytogenetic and molecular responses and adverse events were assessed. The 5-year overall survival (OS), event free survival (EFS) and progression-free survival (PFS) rates were: 95.4 ± 2.3%, 81.4 ± 4.6% and 90.8 ± 3.2%, respectively. Significant differences in OS (p = 0.001), EFS (p = 0.001) and PFS (p = 0.001) were noted when patients were stratified by cytogenetic response. Survival by Sokal risk groups was not significant (p = 0.293). Complete hematologic response was achieved in 94 patients (93.1%), cytogenetic response in 84 (83.2%), major molecular response in 62 (61.4%) and complete molecular response in 34 (33.7%). This article presents the first evidence on the effectiveness of imatinib in patients with CML from Saudi Arabia and highlights similarities and differences in response patterns in published studies.
All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, T... more All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, Turkish, and North African populations; with no studies arising from the Arabic Gulf Region. This study aimed to define nasal anthropometric measurements in Saudi Arabia (the largest Arabic Gulf country) and compare them with different races. A total of 104 Saudi men and 105 Saudi women with a mean age of 22 years (range, 18-27 years) were included in the study. A total of 25 nasal anthropometric variables were measured. Comparison with other races was done using the t-test (P &amp;amp;lt; 0.05 is considered significant). The intercanthal distance of Saudi men is significantly smaller than that in women (the reverse is true for other races). Hence, Saudi women (and not men) have significantly wider intercanthal distance than do whites. The nasal widths of Saudi men and women lie between the whites and the Chinese. A unique feature of the Saudi nose is the significantly larger nasofrontal angle of Saudi men and women compared with all other races. Within the Saudi race, the nasofacial angle of men is so much larger than that of women (41.4 vs 33.3 degrees). In other races, the difference between men and women is usually slight (0- to 1-mm difference only). In Saudi men, the nasofacial angle is significantly larger than that in whites, but the value for Saudi women is significantly smaller than that for whites. Finally, in both Saudi sexes, the nasal tip angle/nasal tip protrusion is significantly smaller than all other races. It was concluded that the Saudi nose has several unique features when compared with other races including other Middle Eastern populations.
Results: The study findings indicate that bacterial infection prevalence differed significantly a... more Results: The study findings indicate that bacterial infection prevalence differed significantly across the different disease status pre-salvage as patients with the relapsed disease were more likely to have bacterial Original Article infections. The median of engraftment days differed significantly between those who had a bacterial infection and those who did not. Interestingly, previous pneumonia infection had a positive relationship with the number of hospital stays. Conclusion: Bacterial infections are the dominant type of infection among the autologous patient population. The research reflects authentic practice and reports unique characteristics of autologous transplant patients in terms of the prevalence and types of infection these patients experience.
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Papers by Ahmed Alsaeed