Internal Medicine

Activated monocytes may contribute to the pathogenesis of ischemic stroke. We tested the hypothesis that release products and procoagulant activity of monocytes are increased in acute ischemic stroke. In patients on days 1, 3 and 7 after ischemic stroke and in age-Ž . Ž and sex-matched healthy control subjects, we assessed plasma levels of interleukin 8 IL-8 and neopterin enzyme linked immunosorbent . Ž . Ž . assay, ELISA and investigated superoxidanion release ferricytochrome C reduction , procoagulant activity one-stage clotting assay and Ž . Ž . tissue factor TF gene transcription reverse transcriptase polymerase chain reaction by monocytes.

Introduction: Brucellosis is a zoonotic disease that can affect the central and peripheral nervous system and it has variable neurological manifestation. However, brucellosis infection that presents with acute peripheral neuropathy mimicking Guillain-Barre syndrome (GBS) is rarely reported in the literature. Objective and method: We report a 56-year-old man who was initially diagnosed with GBS, and then he was confirmed to have acute Brucella infection. We also did a systematic literature review to study the natural history and management of previously reported cases of brucellosis that presented with manifestations consistent with GBS. Results: We found 19 (including our patient) cases of brucellosis that presented with GBS-like manifestations. The age range was 9–62 years. Eight (42.1%) patients had a history of fever. Seven (36.8%) patients had no constitutional symptoms. Five (26.3%) patients had splenomegaly. Brucella serological tests were positive in all patients, while blood...

Objectives: To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA. Methods: Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018. Results: Thrombolysis was performed in 148 patients)mean age: 58.2±14.5 years(, 94)63.5%(of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke

Reduced septal uptake of thallium-201 during exercise is frequently observed in patients with left bundle branch block (LBBB) and normal coronary arteries. This may reflect normal coronary autoregulation in response to lower septal oxygen demand; thus, dipyridamole, which uniformly exploits flow reserve, would be more accurate for diagnosis of coronary artery disease (CAD). Sixteen patients with LBBB underwent exercise and dipyridamole thallium-201 single-photon emission computed tomography and coronary angiography within 3 months. Sensitivity for detection of left anterior descending CAD (greater than 50% stenosis) was 0.83 for exercise and 1.00 for dipyridamole. Specificity was 0.30 (visual) or 0.20 (quantitative analysis) for exercise and 0.80 (visual) or 0.90 (quantitative) for dipyridamole (p less than 0.05). Dipyridamole combined with quantitative analysis also improved specificity of CAD detection overall (p less than 0.01). These data demonstrate that pharmacologic vasodilation is more accurate than exercise when diagnosing CAD by myocardial perfusion scintigraphy in patients with LBBB.

... No abstract is available. To read the body of this article, please view the Full Text online. KingFahad Medical City, Interventional Cardiologist, Riyadh, Saudi Arabia. PII: S1016-7315(11)00081-9. doi:10.1016/j.jsha.2011.02.069. © 2011 Published by Elsevier Inc. View previous. ...

Left ventricular pseudoaneurysms occur as a consequence of left ventricular free wall rupture contained by pericardium. This clinical situation is an uncommon but lethal complication of acute myocardial infarction. Surgery usually is the preferred therapeutic option but is associated with significant perioperative risk. We present a case of successful percutaneous closure of left ventricular ruptured pseudoaneurysm post myocardial infarction in a patient who failed two previous surgical repairs

Cardiovascular disease is the leading cause of mortality in patients with diabetes mellitus (DM). We sought to establish for the first time in Saudi Arabia an intravascular ultrasound (IVUS) profile of DM patients with acute coronary syndrome (ACS). Patients and methods: We retrospectively analyzed 210 IVUS studies in 181 patients hospitalized in King Salman Heart Centre for ACS. IVUS was performed to guide percutaneous coronary interventions (PCI) of borderline moderate lesions. Results: Mean age was 58 ± 10 years, 78% (n = 163) of IVUS studies were performed in men. There were 71% (n = 128) patients with DM. ST elevation myocardial infarction (STEMI) was the most common clinical presentation (47%, n = 88 patients). As compared to non-DM, the intermediate lesions of DM patients had a significantly larger IVUS plaque volume (267 ± 174 mm 3 versus 193 ± 111 mm 3 , p < 0.01), vessel volume (496 ± 314 mm 3 versus 358 ± 182 mm 3 , p < 0.01), lumen volume (231 ± 156 mm 3 versus 164 ± 88 mm 3 , p < 0.01) and longer lesions (37 ± 12 mm versus 30 ± 8 mm, p < 0.01). A positive remodelling index was observed for patients with and without DM, without significant difference (1.4 versus 1.3 respectively, p = 0.7). Percent plaque volume and obstruction were not different. Conclusion: IVUS demonstrates longer lesions to be treated in DM patients with ACS in Saudi Arabia, however no difference in average plaque burden or remodelling index. These findings are likely to impact our understanding of optimal PCI strategies in DM patients.

This study analyzes the safety and efficacy of LCZ696 (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure and preserved ejection fraction (HFpEF). Patients and Methods: An observational pilot study was conducted using a prospective design. A sample of 50 HFpEF patients (27 females and 23 males) was included on LCZ696 (50 mg orally, twice daily), which was then titrated up to a maximum tolerated dose, and followed up in the outpatient clinic. Thirty-seven patients received LCZ696 during hospitalization for decompensated heart failure or before their discharge while same titration was followed for the remaining patients. Results: Patients were classified as New York Heart Association (NYHA) class III (64%), NYHA class IV (22%), and NYHA class II (14%). Diabetes mellitus was found in 74% of patients, while hypertension in 94%. Rapid clinical improvement was found with significant reduction in NYHA class down to NYHA class II (p=0.018). Patients had cleared off the fine basal crackles (specific for the interstitial pulmonary disease) secondary to heart failure (p<0.001) and improvement or disappearance of edema of the lower limbs (p<0.001). Heart rate response and jugular venous pressure and NT-pro-BNP were reduced significantly (p-value <0.001, 0.005, respectively). Echocardiographic criteria for diastolic LV dysfunction (primarily E/A ratio) improved (p=0.001). Serum sodium (NA) levels improved significantly (p=0.015), without worsening renal function or limiting hyperkalemia. Conclusion: LCZ696 (sacubitril/valsartan; ARNI) led to significant clinical improvements in patients with HFpEF. Further, a randomized study is needed to test whether it leads to positive outcomes for a larger sample.

As periodontitis continues to have a high prevalence within the population and the fact that CVD remains as the major cause of human death in developed countries, in light of these associations we can legitimately, based on evidence, state that oral health has an influence on systemic health in general and in CVD in particular.

Background: Coronary Artery Disease in Saudis is reaching epidemic levels. The extent of Coronary Athero-Thrombosis (CAT) is yet to be studied. We present the design and preliminary results of IVUS project intended for centres with IVUS capabilities in Saudi Arabia. We aim at gathering clinical and quantitative IVUS data. Methods: 60 pts. IVUS studies at Prince Salman Heart Center (PSHC), King Fahad Medical City reviewed. 40 of 105 runs analysed for Borderline Lesions 35 pts. Pre-Runs (PR), 67 runs 25 pts. post stenting (PS). Initial analysis done at