Publications by authors named "H Al Riyami"

4 Publications

  • Page 1 of 1

Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route.

J Saudi Heart Assoc 2020 17;32(1):52-56. Epub 2020 Apr 17.

Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman.

Aim: Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction.

Methods: All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale.

Results: A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 ( = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 ( = 90; 201 ± 43 min vs. 274 ± 54 min; < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 ( = 0.01).

Conclusion: A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.
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April 2020

Practice Variation in Establishing the Adequacy of Beta-Blockers as an Antiarrhythmic Agent in School-Aged Children and Adolescents.

CJC Open 2020 Jul 27;2(4):244-248. Epub 2020 Mar 27.

Division of Cardiology, Department of Pediatrics, Dalhousie University/Izaak-Walton-Killam, Health Centre, Halifax, Nova Scotia, Canada.

Background: Beta-blockers (BBs) are commonly prescribed to manage arrhythmias in children and adolescents without any standardised approach to establish BB adequacy. We invited all Canadian pediatric cardiologists to participate in an anonymous survey to understand practice variation in the assessment of BB adequacy in school-aged children and adolescents with arrhythmia or the potential for arrhythmia.

Methods: An electronic survey approved by the Institutional Ethics Board was distributed by e-mail to 96 Canadian pediatric cardiologists who had been active in practice for at least 1 year. Incomplete surveys were excluded.

Results: Forty-one cardiologists (43%) responded to all questions in the survey. Thirteen cardiologists (32%) reported always assessing BB adequacy, 17 (41%) did so only for specific arrhythmias, and 11 (27%) reported never performing such an assessment. A total of 19 cardiologists (46%) and 18 cardiologists (44%) reported using Holter monitoring and exercise testing, respectively, to assess beta receptor blockade adequacy. Thirteen cardiologists (32%) considered BB therapy adequate if Holter demonstrated a 20% decrease in heart rate (HR) from baseline, and 10 respondents (24%) defined adequate BB therapy using exercise testing as a 20% decrease in maximal HR or blood pressure from baseline.

Conclusion: Despite wide variation in practice, Holter monitoring and exercise testing are commonly used methods to measure the adequacy of BB therapy. There are no standard criteria, but the majority (56%) reported using a 20% decrease in HR or blood pressure from the pretreatment state as a criterion for adequate BB therapy in children and adolescents with arrhythmia or the potential for arrhythmia.
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July 2020

Histocompatibility antigens in Omanis: Comparison with other Gulf populations and implications for disease association.

Ann Saudi Med 1999 May-Jun;19(3):193-6

Transplant Immunology Laboratory, Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Sultanate of Oman.

Background: This is the first comprehensive report of HLA antigens in Omanis, and the first application of HLA sequence-specific primer (SSP) DNA typing in a Gulf population. The objective was to compare the findings with other Gulf populations and assess their implications for disease association.

Patients And Methods: HLA typing was carried out on 321 healthy Omanis. One hundred and twenty-six of these were typed for Class II antigens by low-resolution SSP DNA typing. The results were compared with other HLA antigen frequencies recorded from Kuwait and Saudi Arabia.

Results: The Omani population was characterized by a very high incidence of HLA-DR2 (66%), with associated HLA-DQ1 (76%) and a reduced incidence of DR4, DR7 and DR53. The incidence of DR2 is the highest recorded worldwide. HLA-A11, A32, B17, B35 and B40 were significantly higher than in Kuwait and Saudi Arabia, and A9, B21(B50) significantly lower (Pc<0.05). HLA-B27 is very low in the Omani population (0.3%). The high incidence of HLA-DR2 in Oman and disparities in the frequency of other antigens would indicate that there has not been any significant migration from northern Arabia. Class II DNA typing revealed that DR16 was the predominant split of DR2 (63%), with DR15 being 18% and both DR15 and 16 being found in 6%, giving a total of 87% for A centAADR2A centAA-associated antigens (serology of the same individuals gave a DR2 incidence of 74%). The major disparity between serology and DNA typing was in the definition of DR4 (serology 8%, DNA 14%) and DR51 (53% vs. 70%).

Conclusion: The frequency of many HLA antigens in Omanis differs significantly from frequencies found in the populations of Kuwait and Saudi Arabia, possibly reflecting different migration patterns. The high incidence of HLA-DR2 in Oman may have important implications for disease association.
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October 2012

HLA antigens in Omanis with blinding trachoma: markers for disease susceptibility and resistance.

Br J Ophthalmol 1997 Jun;81(6):431-4

Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Sultanate of Oman.

Aim: To determine the presence of HLA antigens in people with blinding trachoma.

Methods: Fifty Omanis with blinding trachoma were serologically typed for HLA A, B, C, DR, and DQ antigens and DNA typed for class II DR beta and DQ beta alleles and compared with a population of 100 healthy controls.

Results: chi 2 analysis of serological reactions did not reveal any significant differences in HLA antigen frequencies after correction of probability, although DR4, DR7, and DR53 were completely absent in the patients and all of the patients were HLA DQ1 positive. In the case of DQ1 the relative risk was 22.6 (95% confidence interval of 20.7-24.7). Class II DNA low resolution DR beta typing showed a significant increase in HLA DR16 (pc = 0.036, relative risk = 3.8) and a significant decrease in HLA DR53 (pc = 0.018, relative risk = 0.05).

Conclusion: The finding that HLA DR16 (a DR2 subtype) is associated with susceptibility to blinding trachoma, a disease that is caused by an intracellular micro-organism, is consistent with reports of an HLA DR2 association with leprosy and tuberculosis, diseases also caused by an intracellular micro-organism. Similarly, resistance to leprosy is associated with HLA DR53 as is the case with blinding trachoma described here. It is postulated that HLA DR2 or subtypes in association with HLA DQ 1 may enable an intracellular micro-organism to enter the cell or are involved in presentation of peptides derived from intracellular micro-organisms to T lymphocytes initiating a delayed hypersensitivity or autoimmune reaction. These findings are the first report that genetic factors are of major importance in the development and protection against blinding trachoma.
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June 1997