Publications by authors named "Saad Alghamdi"

35 Publications

Thiazolidine Derivatives Attenuate Carrageenan-Induced Inflammatory Pain in Mice.

Drug Des Devel Ther 2021 4;15:369-384. Epub 2021 Feb 4.

State Key Laboratory of Oncogenomics, School of Chemical Biology and Biotechnology, Shenzhen Graduate School, Peking University, Shenzhen, People's Republic of China.

Background: Peripheral inflammation leads to the development of persistent thermal hyperalgesia and mechanical allodynia associated with increased expression of interleukin-1β (IL-1β) in the spinal cord. The aim of the present study was to investigate the effects of thiazolidine derivatives, 1b ([2-(2-hydroxyphenyl)-1,3-thiazolidin-4-yl](morpholin-4-yl)methanone) and 1d (2-hydroxy-4-{[2-(2-hydroxyphenyl)-1,3-thiazolidine-4-carbonyl]amino}benzoic acid), on thermal hyperalgesia, mechanical allodynia and on IL-1β expression during carrageenan-induced inflammation in the spinal cord in mice. Inflammatory pain was induced by injecting 1% carrageenan into the right hind paw of the mice.

Methods: The animals were administered thiazolidine derivatives, 1b and 1d (1 mg/kg, 3 mg/kg, or 10 mg/kg), intraperitoneally 30 minutes before carrageenan administration. The animals' behavior was evaluated by measuring thermal hyperalgesia, mechanical allodynia, and motor coordination. The IL-1β expression was measured by enzyme-linked immunosorbent assay. Acute and sub-acute toxicity studies were conducted to evaluate the toxicity profile of compounds.

Results: Treatment with the thiazolidine derivative, 1b and 1d, attenuated carrageenan-induced thermal hyperalgesia and mechanical allodynia at doses of 1 mg/kg, 3 mg/kg, and 10 mg/kg. No motor coordination deficits were observed in animals. The compounds also reduced IL-1β expression in the spinal cord of mice. Acute and sub-acute toxicity studies revealed that both compounds were safe.

Conclusion: The compounds exhibit promising activity against inflammatory pain due to their ability to produce anti-hyperalgesic and anti-allodynic effects and to inhibit IL-1β expression in the spinal cord.
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http://dx.doi.org/10.2147/DDDT.S281559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871178PMC
February 2021

Emerging paradigms in treating cerebral infarction with nanotheranostics: opportunities and clinical challenges.

Drug Discov Today 2020 Dec 28. Epub 2020 Dec 28.

Senior Research Scientist, Inn Research Sdn. Bhd., Subang Jaya, Selangor, Malaysia.

Interest is increasing in the use of nanotheranostics as diagnosis, imaging and therapeutic tools for stroke management, but movement to the clinic remains challenging.
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http://dx.doi.org/10.1016/j.drudis.2020.12.018DOI Listing
December 2020

Promising Lead Compounds in the Development of Potential Clinical Drug Candidate for Drug-Resistant Tuberculosis.

Molecules 2020 Dec 2;25(23). Epub 2020 Dec 2.

Department of Pharmacy, Abasyn University Peshawar, Khyber Pakhtunkhwa 25000, Pakistan.

According to WHO report, globally about 10 million active tuberculosis cases, resulting in about 1.6 million deaths, further aggravated by drug-resistant tuberculosis and/or comorbidities with HIV and diabetes are present. Incomplete therapeutic regimen, meager dosing, and the capability of the latent and/or active state tubercular bacilli to abide and do survive against contemporary first-line and second line antitubercular drugs escalate the prevalence of drug-resistant tuberculosis. As a better understanding of tuberculosis, microanatomy has discovered an extended range of new promising antitubercular targets and diagnostic biomarkers. However, there are still no new approved antitubercular drugs of routine therapy for several decades, except for bedaquiline, delamanid, and pretomanid approved tentatively. Despite this, innovative methods are also urgently needed to find potential new antitubercular drug candidates, which potentially decimate both latent state and active state . To explore and identify the most potential antitubercular drug candidate among various reported compounds, we focused to highlight the promising lead derivatives of isoniazid, coumarin, griselimycin, and the antimicrobial peptides. The aim of the present review is to fascinate significant lead compounds in the development of potential clinical drug candidates that might be more precise and effective against drug-resistant tuberculosis, the world research looking for a long time.
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http://dx.doi.org/10.3390/molecules25235685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729780PMC
December 2020

Nanocarriers-loaded with natural actives as newer therapeutic interventions for treatment of hepatocellular carcinoma.

Expert Opin Drug Deliv 2021 Jan 20:1-25. Epub 2021 Jan 20.

Department of Pharmaceutics, School of Pharmaceutical Education and Research, Nanomedicine Research Lab, Jamia Hamdard , New Delhi, India.

: Cancer has always been a menace for the society. Hepatocellular carcinoma (HCC) is one of the most lethal and 3rdlargest causes of deaths around the world. : The emergence of natural actives is considered as the greatest boon for fighting cancer. The natural actives take precedence over the traditional chemotherapeutic drugs in terms of their multi-target, multi-level and coordinated effects in the treatment of HCC. Literature reports have indicated the tremendous potential of bioactive natural products in inhibiting the HCC via molecular drug targeting, augmented bioavailability, and the ability for both passive or active targeting and stimulus-responsive drug release characteristics. This review provides a newer treatment approaches involved in the mechanism of action of different natural actives used for the HCC treatment via different molecular pathways. Besides, the promising advantage of natural bioactive-loaded nanocarriers in HCC treatment has also been also presented in this review. : The remarkable outcomes have been observed with therapeutic efficacy of the nanocarriers of natural actives in the treatment of HCC.Furthermore, it requires a thorough assessment of the safety and efficacy evaluation of the nanocarriers for the delivery of targeted natural active ingredients in HCC.].
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http://dx.doi.org/10.1080/17425247.2021.1854223DOI Listing
January 2021

Superbranched polyglycerol nanostructures as drug delivery and theranostics tools for cancer treatment.

Drug Discov Today 2020 Nov 17. Epub 2020 Nov 17.

Department of Pharmaceutics, School of Pharmaceutical Education and Research, Nanomedicine Research Lab, Jamia Hamdard, New Delhi, India. Electronic address:

Hyperbranched polymers (HBPs), such as hyperbranched polyglycerols (HPGs) with a dendritic configuration, have been recognized for their excellent biocompatibility and multifunctionalization. HPGs have been studied for use in the delivery diagnostic, imaging and therapeutic molecules in the area of nanobiomedicine. They show superior characteristics to linear polymers and dendrimers, such as compact structure, a simple manufacturing process with easy functionalization ability, low viscosity, and high stability. Owing to these advantages, HPGs are now considered promising carriers for drug delivery, diagnostics, imaging, and theranostics applications for cancer treatment. In this review, we also discuss safety aspects of HPG-based nanoformulations in various animal models and the clinical translation status of such polymers for real-time applications.
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http://dx.doi.org/10.1016/j.drudis.2020.11.007DOI Listing
November 2020

Systematic development of a bioanalytical UPLC-MS/MS method for estimation of risperidone and its active metabolite in long-acting microsphere formulation in rat plasma.

J Chromatogr B Analyt Technol Biomed Life Sci 2020 Dec 29;1160:122433. Epub 2020 Oct 29.

Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India. Electronic address:

A systematic approach to develop a UPLC-MS/MS method was applied for quantifying of risperidone (RISP), its active metabolite, 9-hydroxy risperidone (9-OH-RISP) and internal standard (propranolol) in rat plasma. Liquid-liquid extraction was performed using methyl tert-butyl ether for quantification of drug and its active metabolite by MS detection in the positive ion mode. Acquity UPLC system with BEH C18 (2.1 mm × 100 mm, particle size 1.7 μm) column was used along with acetonitrile (0.1% formic acid)-2 mM (milli mole) ammonium acetate in isocratic condition was used as the mobile phase. Detection was performed by multiple reactions monitoring with precursor-to-product ion transitions with m/z 411.2 → 191.0 for RISP, m/z 427.2 → 207.0 for 9-OH-RISP and m/z 260.1 → 116.0 for IS. The method was validated as per the FDA guidance on bioanalytical method validation. Linearity (r = 0.999) was observed in the drug concentration ranging between 0.1 and 50 ng mL, while all other parameters were found to be within the acceptable ranges. Method robustness was optimized by Box-Behnken design to monitor the influential variables to achieve maximal recovery of the analytes in the rat plasma. Pharmacokinetic evaluation of the analytes from long-acting microparticles in rat plasma showed two peaks indicating an initial burst effect within 24 h of administration followed by controlled drug release pattern upto 45 days, while marketed formulation (Risperdal Consta®) showed no plasma concentration during the lag-time of 21 days followed by maximal drug absorption between 28 and 40 days.
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http://dx.doi.org/10.1016/j.jchromb.2020.122433DOI Listing
December 2020

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia.

Saudi Pharm J 2020 Oct 14;28(10):1166-1171. Epub 2020 Aug 14.

Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti of Sains Malaysia, Penang, Malaysia.

Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. The general administration of pharmaceutical care in the Saudi ministry of health (MOH) is putting outstanding efforts in implementing antimicrobial stewardship in Saudi health care settings. Several surveys have been conducted globally and reported many types of antimicrobial stewardship strategies in health institutions and their effectiveness. This study aims to identify ASPs in Makkah region hospitals and their perceived level of success. We administered a regional survey to explore current progress and issues related to the implementation of ASPs in Makkah region hospitals at the pharmacy level (n = 25). Among responding hospitals, 19 (76%) hospitals, the most commonly reported ASP were as following: formulary restrictions (90%) for broad-spectrum antimicrobials and use of prospective feedback on antimicrobial prescribing (68%), use of clinical guidelines and pathways (100%), and use of automatic stop orders (68%) to limit inappropriate antimicrobial therapy. The study outcomes will also be of pivotal importance to devise policies and strategies for antimicrobial stewardship implementation in other non-MOH settings in the Makkah region. Based on our results, all reported institutions have at least one antimicrobial stewardship program in a process with a high success rate. A multidisciplinary ASP approach, active involvement of drug & therapeutic committee, formulary restrictions, and availability of education & training of pharmacists and physicians on ASP are the primary elements for perceived successful antimicrobial stewardship programs in the Makkah region hospitals.
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http://dx.doi.org/10.1016/j.jsps.2020.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584782PMC
October 2020

The effect of age on recollection is not moderated by differential estimation methods.

Memory 2020 09 1;28(8):1067-1077. Epub 2020 Sep 1.

Center for Vital Longevity, University of Texas at Dallas, Dallas, TX, USA.

Episodic memory performance declines with increasing age. It has sometimes been reported that this decline is more marked when episodic recollection is estimated by "objective" measures such as source memory performance than when it is estimated by "subjective" measures such as the "Remember/Know" procedure. Here, our main goal was to directly contrast recollection estimates derived from these procedures in the same samples of young and older participants (24 adults per age group, within-subjects manipulation of test procedure). Following identical study phases in which words were paired with either faces or scenes, participants' memories were assessed in separate test blocks using either Remember/Know or source memory procedures. Contrary to several prior reports, the deleterious effects of age on recollection estimates did not differ according to test type. Thus, we found no evidence that age differentially impacts subjective and objective recollection estimates. Additionally, and consistent with prior findings, effects of age on estimates of familiarity-driven recognition were small and non-significant.
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http://dx.doi.org/10.1080/09658211.2020.1813781DOI Listing
September 2020

Lipid-based nano delivery of Tat-peptide conjugated drug or vaccine-promising therapeutic strategy for SARS-CoV-2 treatment.

Expert Opin Drug Deliv 2020 12 31;17(12):1671-1674. Epub 2020 Aug 31.

Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University , Makkah, Saudi Arabia.

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http://dx.doi.org/10.1080/17425247.2020.1813712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484566PMC
December 2020

Primary Intracranial Angiomatoid Fibrous Histiocytoma: Two Case Reports and Literature Review.

World Neurosurg 2020 Nov 7;143:398-404. Epub 2020 Aug 7.

Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.

Background: Angiomatoid fibrous histiocytoma (AFH) is a rare, fibrohistiocytic, soft-tissue neoplasm. Intracranial AFH is extremely rare. Here we present 2 pediatric cases of intracranial AFH and perform a literature review on this disease entity.

Case Description: We present 2 cases. The first case is a 10-year-old boy who presented with seizures and hemiparesis. The second case is an 11-year-old girl who presented with 2-year history of seizures. Radiologic images demonstrated right frontal lesions in both patients. Complete surgical resection was achieved. Histopathological findings established the diagnosis of intracranial AFH confirmed with fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction testing that demonstrated EWSR1 gene rearrangement in both cases.

Conclusions: Twenty-two cases of intracranial AFH have been previously documented, with the majority of lesions located in the frontal lobe. Most cases occurred in adolescents and young adults, with a slight female predilection. Headaches and seizures constituted the most common clinical presentation. Complete surgical resection remains the standard of care in the management of this pathology.
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http://dx.doi.org/10.1016/j.wneu.2020.07.225DOI Listing
November 2020

Bioactive Compounds, Pharmacological Actions, and Pharmacokinetics of Wormwood ().

Antibiotics (Basel) 2020 Jun 23;9(6). Epub 2020 Jun 23.

Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Rancho Universitario Av. Universidad km 1, EX-Hda de Aquetzalpa, 43600 Tulancingo, Hgo, Mexico.

Plants have been used since ancient times to cure certain infectious diseases, and some of them are now standard treatments for several diseases. Due to the side effects and resistance of pathogenic microorganisms to antibiotics and most drugs on the market, a great deal of attention has been paid to extracts and biologically active compounds isolated from plant species used in herbal medicine. is an important perennial shrubby plant that has been widely used for the treatment of several ailments. Traditionally, has always been of pharmaceutical and botanical importance and used to manage several disorders including hepatocyte enlargement, hepatitis, gastritis, jaundice, wound healing, splenomegaly, dyspepsia, indigestion, flatulence, gastric pain, anemia, and anorexia. It has also been documented to possess antioxidant, antifungal, antimicrobial, anthelmintic, anti-ulcer, anticarcinogenic, hepatoprotective, neuroprotective, antidepressant, analgesic, immunomodulatory, and cytotoxic activity. Long-term use of A. absinthium essential oil may cause toxic and mental disorders in humans with clinical manifestations including convulsions, sleeplessness, and hallucinations. Combination chemotherapies of artemisia extract or its isolated active constituents with the currently available antibabesial or anti-malarial drugs are now documented to relieve malaria and piroplasmosis infections. The current review examines the phytoconstituents, toxic and biological activities of
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http://dx.doi.org/10.3390/antibiotics9060353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345338PMC
June 2020

The Resurgence of Measles Infection and its Associated Complications in Early Childhood at a Tertiary Care Hospital in Peshawar, Pakistan.

Pol J Microbiol 2020 ;69:1-8

Department of Pharmacy, Abasyn University , Peshawar KP , Pakistan.

Measles infection is of substantial interest to immunologists due to its paradoxical interaction with the immune system. After the acquisition of the measles infection, secondary infection plays a pivotal role in measles-related deaths. A cross-sectional study conducted between December 2018 and July 2019 is presented here. A total of one hundred children of both genders presented with measles complications were included following WHO criteria. Measles confirmation was done by quantitative determination of anti-measles antibodies (IgM) in patients' sera while patient-related demographic data, vaccination status, and other clinical information were obtained on a separate form. The number of female patients (52%) slightly exceeded the number of males (48%). 43% of patients' parents were illiterate, and half of the patients (50%) were from a poor background. The majority of children (76%) who presented with the complications did not receive a measles vaccine. 56% of children were breastfed while 58% received vitamin A supplements but developed complications. The elevated levels of anti-measles IgM were observed in 77% of cases. In both genders, the major complications were pneumonia, lower respiratory tract infection (LRTI), acute diarrhea, diarrhea and LRTI, pneumonia and diarrhea, otitis media and pneumonia, myocarditis and LRTI, and pneumothorax. The majority of the infected children (n = 48) under 12 months of age had associated complications. It has been observed that the measles virus strikes early age children in the northwestern region of Pakistan, which is an alarming situation and is associated with the aforementioned complications, especially in unvaccinated children. Anti-measles IgM is an important serological parameter for early diagnosis of measles infection.

Measles infection is of substantial interest to immunologists due to its paradoxical interaction with the immune system. After the acquisition of the measles infection, secondary infection plays a pivotal role in measles-related deaths. A cross-sectional study conducted between December 2018 and July 2019 is presented here. A total of one hundred children of both genders presented with measles complications were included following WHO criteria. Measles confirmation was done by quantitative determination of anti-measles antibodies (IgM) in patients’ sera while patient-related demographic data, vaccination status, and other clinical information were obtained on a separate form. The number of female patients (52%) slightly exceeded the number of males (48%). 43% of patients’ parents were illiterate, and half of the patients (50%) were from a poor background. The majority of children (76%) who presented with the complications did not receive a measles vaccine. 56% of children were breastfed while 58% received vitamin A supplements but developed complications. The elevated levels of anti-measles IgM were observed in 77% of cases. In both genders, the major complications were pneumonia, lower respiratory tract infection (LRTI), acute diarrhea, diarrhea and LRTI, pneumonia and diarrhea, otitis media and pneumonia, myocarditis and LRTI, and pneumothorax. The majority of the infected children (n = 48) under 12 months of age had associated complications. It has been observed that the measles virus strikes early age children in the northwestern region of Pakistan, which is an alarming situation and is associated with the aforementioned complications, especially in unvaccinated children. Anti-measles IgM is an important serological parameter for early diagnosis of measles infection.
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http://dx.doi.org/10.33073/pjm-2020-020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324859PMC
January 2021

Antinociceptive Effect of the Citrus Flavonoid Eriocitrinon Postoperative Pain Conditions.

Authors:
Saad Alghamdi

J Pain Res 2020 22;13:805-815. Epub 2020 Apr 22.

Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia.

Background: Postoperative pain remains a major clinical problem as there are limited analgesic strategies that have been proven to be effective in preventing and relieving this type of pain. Natural products, including flavonoids, have distinct pharmacological properties and play an important role in the discovery of analgesic drugs.

Materials And Methods: In this study, the flavonoid eriocitrin (eriodictyol 7--rutinoside), which is the main flavonoid in lemon fruit (), was mechanistically investigated for its prospective antinociceptive effect in a mouse model of postoperative pain. The antinociceptive property was evaluated by utilizing both tonic (acetic acid-induced writhing behavior) and phasic (hot-plate) nociception modalities. The hindpaw incisional surgery was performed and hyperalgesia was assessed using von Frey filaments.

Results: The tested doses of eriocitrin significantly attenuated (<0.01, <0.001) the chemically-induced tonic visceral nociception (5, 10, 15, and 30 mg/kg) and acute phasic thermal nociception (10, 15, and 30 mg/kg). A significant dose-dependent reduction in the incisional nociceptive hyperalgesia was exhibited by eriocitrin, with a marked antinociception observed at doses of 15 mg/kg (<0.05 during 30-60 minutes) and 30 mg/kg (<0.05, <0.01 during 30-120 minutes).

Conclusion: The antinociceptive effect of eriocitrin (30 mg/kg) was strongly blocked by the antagonists of the opioid receptor, naltrexone, and GABA receptor, bicuculline, thereby suggesting the involvement of opioidergic and GABAergic mechanisms in the nociception, reducing proclivity of eriocitrin during transmission of incisional nociception. These results concluded that eriocitrin has a potent antinociceptive effect in postoperative pain conditions, probably mediated through opioid and GABA receptors.
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http://dx.doi.org/10.2147/JPR.S250391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183786PMC
April 2020

Antimicrobial, Cytotoxic, and Antioxidant Potential of a Novel Flavone "6,7,4'-Trimethyl Flavone" Isolated from .

Evid Based Complement Alternat Med 2020 8;2020:3903682. Epub 2020 Mar 8.

Islam College of Pharmacy, Sialkot, Punjab, Pakistan.

belongs to the Scrophulariaceae family and various plants of this family are known for their biological activities. The present study was focused on the isolation of bioactive compounds including a novel flavone 6,7,4'-trimethyl flavone (TMF) along with three known flavonoids such as quercetin, rutin, and a steroid -sitosterol which were isolated from the ethanolic extract of (Himalayan Wulfenia) through column chromatography and purified by using HPLC. Their structures were identified and elucidated through electron ionization mass spectroscopy (EIMS), 1DNMR (H-NMR and C-NMR), and 2DNMR (COSY, HMQC, and HMBC) spectroscopy. The antimicrobial activities of this novel compound were evaluated through agar well diffusion method, while antioxidant and cytotoxic activities were assessed through 2,2-diphenyl-1-picrylhydrazyl (DPPH) free-radical scavenging assay and brine shrimp lethality assay, respectively. The NMR data revealed that TMF is a novel compound. TMF showed potential antibacterial and antifungal activities against (MIC = 128 g/ml) and (MIC = 128 g/ml). The cytotoxic potential of TMF was determined from brine shrimp lethality assay with LD of 127.01 g/ml. The free-radical scavenging potential of TMF at various concentrations implicated its strong antioxidant activity in vitro. The results revealed that TMF demonstrated substantial antimicrobial activity against and , strong antioxidant activity, and moderately cytotoxic activity.
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http://dx.doi.org/10.1155/2020/3903682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063882PMC
March 2020

Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial.

Gastrointest Endosc 2020 04 9;91(4):882-893.e4. Epub 2019 Nov 9.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

Background And Aims: Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy.

Methods: In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills.

Results: In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (-.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P = .03) but not in overall technical skills (intervention, -.26 [SD, 1.4]; control, 1.76 [SD, .7]; P = .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, -.7 [SD, 1.3]; control, .7 [SD, 1.3]; P = .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, -.1 [SD, 1.5]; P = .77).

Conclusions: Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.).
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http://dx.doi.org/10.1016/j.gie.2019.10.032DOI Listing
April 2020

Detection and determination of stability of the antibiotic residues in cow's milk.

PLoS One 2019 10;14(10):e0223475. Epub 2019 Oct 10.

Laboratory of Plant Healthcare and Diagnostics, Department of Studies in Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India.

In the present study, antibiotic residues were detected in milk samples collected from the dairy herds located in Karnataka, India, by microbiological assay. Subsequently, the detected antibiotics were identified as azithromycin and tetracycline, by high-performance liquid chromatography, further both the antibiotics detected in the cow milk samples were found to be at high concentration (9708.7 and 5460 μg kg-1, respectively). We then investigated the effects of temperature and pH on the stabilities of azithromycin and tetracycline to determine the degradation rate constant k using first-order kinetic equation. Results indicated that significant reduction in stability and antibacterial activity of azithromycin solution when subjected to 70 and 100°C for 24 h. While stability of tetracycline was significantly reduced when subjected to 70 and 100°C for 24 h. However no significant reduction in antibacterial activity of tetracycline was observed at respective temperatures when compared with that of control. In addition, the stabilities of azithromycin and tetracycline were found to be decreased in acidic pH 4-5. The results of the present study revealed the high risk of contamination of milk sample with veterinary antibiotics and also demonstrated the effect of temperature and pH on stability of antibiotics. Therefore the study suggest that the qualitative and quantitative screening of milk for the presence of antibiotics need to be strictly performed to ensure safe drinking milk for consumers.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223475PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786530PMC
March 2020

Liver Disease in Pregnancy and Transplant.

Curr Gastroenterol Rep 2019 Jul 25;21(9):43. Epub 2019 Jul 25.

Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.

Purpose Of Review: The purpose of this review is to discuss current and new knowledge regarding liver disease in pregnancy and pregnancy post-liver transplantation.

Recent Findings: Severe liver disease associated with pregnancy is rare. Liver biopsy is rarely needed for diagnosis but is safe in selected cases. Intrahepatic cholestasis of pregnancy (ICP) with serum bile acids level > 40 μmol/L is associated with adverse fetal outcomes. Ursodeoxycholic acid should be initiated at diagnosis. Portal hypertension can worsen during pregnancy and screening endoscopy should be performed in the 2nd trimester. Maternal hepatitis B antiviral therapy can be considered in the 3rd trimester if HVB DNA > 200,000 IU/ml. Tacrolimus is the optimal immunosuppressive therapy during pregnancy post-transplantation. Preconception renal function predicts pregnancy outcome. Overall, the outcome of pregnancy post-transplantation is good but there is an increased risk of preterm delivery, low birth weight, hypertension, and pre-eclampsia. Liver disease of pregnancy can be divided into diseases unique to pregnancy, exacerbated by pregnancy or coexisting with pregnancy. Overall, the outcome of pregnancy post-liver transplantation is good.
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http://dx.doi.org/10.1007/s11894-019-0711-8DOI Listing
July 2019

A Prospective Multicenter Study Evaluating Endoscopy Competence Among Gastroenterology Trainees in the Era of the Next Accreditation System.

Acad Med 2020 Feb;95(2):283-292

S. Han is a fellow, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. J.C. Obuch is faculty, Division of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania. A.M. Duloy is advanced endoscopy fellow, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. R.N. Keswani is associate professor, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, Illinois. M. Hall is principal biostatistician, Children's Hospital Association, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. V. Simon is professional research assistant, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. E. Ezekwe is professional research assistant, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. P. Menard-Katcher is associate fellowship program director and assistant professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. S.G. Patel is assistant professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado. E. Aagard is senior associate dean for education and professor of medical education, Washington University School of Medicine in St. Louis, St. Louis, Missouri. B. Brimhall is advanced endoscopy fellow, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina. A. Ahmad is fellowship program director and professor, Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Alghamdi is advanced hepatology fellow, Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri. M.D. Brown is fellowship program director and professor, Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, Illinois. C. Broy is fellow, Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois. L. Carlin is senior professional research assistant, Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado. P. Chugh is assistant professor, Icahn School of Medicine at Mount Sinai, New York, New York. S.E. Connolly is chief of general gastroenterology and fellowship program director, Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana. D.M. Cooley is gastroenterologist, Community Hospitals and Wellness Center, Archbold, Ohio. K. Cowley is fellow, Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana. J.A. Di Palma is division director, fellowship program director, director, Section of Inflammatory Bowel Diseases, and professor, Division of Gastroenterology, University of South Alabama, Mobile, Alabama. D.S. Early is director of endoscopy, advanced interventional fellowship program director, and professor, Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri. S. Ellert is research informaticist, Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado. E.A. Gaumnitz is fellowship program director and professor, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin. K.A. Ghassemi is director of clinical programs, Center for Esophageal Disorders, Division of Gastroenterology, University of California, Los Angeles, Los Angeles, California. E. Lebovics is director of gastroenterology and hepatobiliary diseases, fellowship program director, and professor, Division of Gastroenterology, New York Medical College, Valhalla, New York R.H. Lee is director of gastrointestinal motility, Division of Gastroenterology, University of California, Irvine, Irvine, California. T. Lunsford is associate professor and consultant, Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona. J. Massaad is fellowship program director and assistant professor, Division of Gastroenterology, Emory University School of Medicine, Atlanta, Georgia. M. Mittal is gastroenterologist, Southern California Permanente Medical Group, Woodland Hills, California. K. Morigeau is gastroenterologist, Idaho Gastroenterology Associates, Meridian, Idaho. S. Pietrak is fellow, Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania. M. Piper is fellowship program director, Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan. A.S. Shah is assistant professor, Icahn School of Medicine at Mount Sinai, New York, New York. A. Shapiro is fellowship program director, Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois. W. Sonnier is fellow, Division of Gastroenterology, University of South Alabama, Mobile, Alabama. C. Sorrell is gastroenterologist, Lubbock Digestive Disease Associates, Lubbock, Texas. S. Vignesh is chief, fellowship program director, and associate professor, Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, New York. S. Woolard is gastroenterologist, Division of Gastroenterology, Emory University School of Medicine, Atlanta, Georgia. S. Wani is medical director, Esophageal and Gastric Center, and associate professor, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado.

Purpose: The Next Accreditation System requires training programs to demonstrate competence among trainees. Within gastroenterology (GI), there are limited data describing learning curves and structured assessment of competence in esophagogastroduodenoscopy (EGD) and colonoscopy. In this study, the authors aimed to demonstrate the feasibility of a centralized feedback system to assess endoscopy learning curves among GI trainees in EGD and colonoscopy.

Method: During academic year 2016-2017, the authors performed a prospective multicenter cohort study, inviting participants from multiple GI training programs. Trainee technical and cognitive skills were assessed using a validated competence assessment tool. An integrated, comprehensive data collection and reporting system was created to apply cumulative sum analysis to generate learning curves that were shared with program directors and trainees on a quarterly basis.

Results: Out of 183 fellowships invited, 129 trainees from 12 GI fellowships participated, with an overall trainee participation rate of 72.1% (93/129); the highest participation level was among first-year trainees (90.9%; 80/88), and the lowest was among third-year trainees (51.2%; 27/53). In all, 1,385 EGDs and 1,293 colonoscopies were assessed. On aggregate learning curve analysis, third-year trainees achieved competence in overall technical and cognitive skills, while first- and second-year trainees demonstrated the need for ongoing supervision and training in the majority of technical and cognitive skills.

Conclusions: This study demonstrated the feasibility of using a centralized feedback system for the evaluation and documentation of trainee performance in EGD and colonoscopy. Furthermore, third-year trainees achieved competence in both endoscopic procedures, validating the effectiveness of current training programs.
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http://dx.doi.org/10.1097/ACM.0000000000002885DOI Listing
February 2020

Novel Green Biomimetic Approach for Synthesis of ZnO-Ag Nanocomposite; Antimicrobial Activity against Food-borne Pathogen, Biocompatibility and Solar Photocatalysis.

Sci Rep 2019 06 5;9(1):8303. Epub 2019 Jun 5.

School of Mechanical Engineering, Beijing Institute of Technology, 100081, Beijing, China.

A simple, eco-friendly, and biomimetic approach using Thymus vulgaris (T. vulgaris) leaf extract was developed for the formation of ZnO-Ag nanocomposites (NCs) without employing any stabilizer and a chemical surfactant. T. vulgaris leaf extract was used for the first time, in a novel approach, for green fabrication of ZnO-Ag NCs as a size based reducing agent via the hydrothermal method in a single step. Presence of phenols in T. vulgaris leaf extract has served as both reducing and capping agents that play a critical role in the production of ZnO-Ag NCs. The effect of silver nitrate concentration in the formation of ZnO-Ag NCs was studied. The in-vitro Antimicrobial activity of NCs displayed high antimicrobial potency on selective gram negative and positive foodborne pathogens. Antioxidant activity of ZnO-Ag NCs was evaluated via (2,2-diphenyl-1-picrylhydrazyl) DPPH method. Photocatalytic performance of ZnO-Ag NCs was appraised by degradation of phenol under natural sunlight, which exhibited efficient photocatalytic activity on phenol. Cytotoxicity of the NCs was evaluated using the haemolysis assay. Results of this study reveal that T. vulgaris leaf extract, containing phytochemicals, possess reducing property for ZnO-Ag NCs fabrication and the obtained ZnO-Ag NCs could be employed effectively for biological applications in food science. Therefore, the present study offers a promising way to achieve high-efficiency photocatalysis based on the hybrid structure of semiconductor/metal.
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http://dx.doi.org/10.1038/s41598-019-44309-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549174PMC
June 2019

Pro: Moderate alcohol use is beneficial in nonalcoholic steatohepatitis.

Clin Liver Dis (Hoboken) 2018 Feb 28;11(2):35-38. Epub 2018 Feb 28.

Division of Gastroenterology Washington University School of Medicine in Saint Louis St. Louis MO.

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http://dx.doi.org/10.1002/cld.698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314284PMC
February 2018

Genome-wide analysis of multi- and extensively drug-resistant Mycobacterium tuberculosis.

Nat Genet 2018 02 22;50(2):307-316. Epub 2018 Jan 22.

Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

To characterize the genetic determinants of resistance to antituberculosis drugs, we performed a genome-wide association study (GWAS) of 6,465 Mycobacterium tuberculosis clinical isolates from more than 30 countries. A GWAS approach within a mixed-regression framework was followed by a phylogenetics-based test for independent mutations. In addition to mutations in established and recently described resistance-associated genes, novel mutations were discovered for resistance to cycloserine, ethionamide and para-aminosalicylic acid. The capacity to detect mutations associated with resistance to ethionamide, pyrazinamide, capreomycin, cycloserine and para-aminosalicylic acid was enhanced by inclusion of insertions and deletions. Odds ratios for mutations within candidate genes were found to reflect levels of resistance. New epistatic relationships between candidate drug-resistance-associated genes were identified. Findings also suggest the involvement of efflux pumps (drrA and Rv2688c) in the emergence of resistance. This study will inform the design of new diagnostic tests and expedite the investigation of resistance and compensatory epistatic mechanisms.
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http://dx.doi.org/10.1038/s41588-017-0029-0DOI Listing
February 2018

Seroprevalence of Asymptomatic Dengue Virus Infection and Its Antibodies Among Healthy/Eligible Saudi Blood Donors: Findings From Holy Makkah City.

Virology (Auckl) 2017 24;8:1-5. Epub 2017 Feb 24.

Department of Human Genetics, College of Medicine, Umm Al-Qura University, Holy Makkah, Saudi Arabia.

Background: Threat to blood transfusion-transmitted dengue virus (DENV) and its antibodies has recently emerged worldwide. Dengue fever is an endemic disease in Saudi Arabia, particularly in its Western region. The aim of this study was to estimate the seroprevalence of asymptomatic DENV infection and its antibodies among eligible Saudi blood donors.

Methods: Serum samples from 910 healthy/eligible adult male Saudi blood donors, who reside in Holy Makkah City of Saudi Arabia, were collected between March 2015 and August 2016 and screened for the detection of DENV nonstructural protein 1 (NS1) antigen and anti-DENV IgM and IgG antibodies using commercial enzyme-linked immunosorbent assay kits (Panbio, Brisbane, QLD, Australia).

Results: Among the tested donors, 48 (5.3%) were seropositive for DENV-NS1 antigen, whereas 50 (5.5%) and 354 (38.9%) were seropositive for anti-DENV IgM and IgG antibodies, respectively. Seropositivity for DENV-NS1 antigen and/or anti-DENV IgM antibody among the tested donors reflects their ongoing asymptomatic viremic infectious stage with DENV during their donation time, whereas high prevalence of anti-DENV IgG seropositivity reflects the high endemicity of dengue disease in this region of Saudi Arabia.

Conclusions: These results show high prevalence of asymptomatic DENV infection and its antibodies among Saudi blood donors, raising the importance of establishing blood screening for dengue disease at different blood donation services and units in Saudi Arabia to improve the guarantee of blood transfusions and to control DENV dissemination.
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http://dx.doi.org/10.1177/1178122X17691261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348084PMC
February 2017

Predominance and association risk of subtype I in colorectal cancer: a case control study.

Infect Agent Cancer 2017 12;12:21. Epub 2017 Apr 12.

Medical Parasitology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.

Background: a genetically diverse intestinal parasite with controversial pathogenic potential, has increasingly been incriminated for diarrheal illness in immunocompromised individuals including colorectal cancer (CRC) patients. The aim of the current study was to assess the possible association between infection and CRC condition in Makkah, Saudi Arabia (KSA).

Methods: Stool samples were collected from 80 non-cancer (NC) and 138 cancer subjects including 74 CRC patients and 64 patients with other cancers outside gastrointestinal tract (COGT). Molecularly confirmed isolates were genetically grouped and subtyped using multiplex polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) and sequence-tagged site primers-based PCR (PCR-STS), respectively.

Results: were confirmed in 29.7, 25 and 15% among CRC, COGT and NC patients, respectively. Obtained isolates were initially categorized into 2 groups (A and C), which were subsequently subtyped into 3 different subtypes; subtype-I (38%), subtype-II (44%) and subtype-V (22%). Interestingly, subtype-I was the most predominantly detected subtype (54.5%) among CRC patients with a significant association risk (COR 7.548; 95% CI: 1.629-34.987;  = 0.004).

Conclusion: To the best of our knowledge, the current study is the first to provide genetic insights on the prevalence of among CRC patients in Makkah, KSA. Moreover, the study suggests for a possible association between subtype-I of and CRC, which could indicate a potential influence of Blastocystis on CRC condition. Further studies are required to confirm this association risk and to investigate the possible underlying mechanism of postulated carcinogenic influence of subtype-I.
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http://dx.doi.org/10.1186/s13027-017-0131-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389010PMC
April 2017

Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service.

Dig Dis Sci 2017 06 8;62(6):1448-1454. Epub 2017 Apr 8.

Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.

Background: Inpatient care is a fundamental part of gastroenterology training and involves the recommendation, performance, and interpretation of diagnostic tests. However, test results are not always communicated to patients or treating providers. We determined the process of communication of test results and recommendations in our inpatient gastroenterology (GI) consult service.

Methods: Test recommendations on 304 consecutive new GI consults (age 60.2 ± 1.0 year) over a 2-month period were recorded. Demographic factors (age, race, gender, zip code, insurance status) were extracted from the electronic medical record (EMR). Charts were independently reviewed 6 months later to determine results of recommended tests, follow-up of actionable test results, 30-day readmission rates, and predictors of suboptimal communication.

Results: Of 490 recommended tests, 437 (89.2%) were performed, and 199 (45.5%) had actionable findings. Of these, 48 (24.1%) did not have documented follow-up. Failure of follow-up was higher for upper endoscopy (31.9%) compared to colonoscopy (18.0%, p = 0.07). Women (p = 0.07), patients on Medicare (p = 0.05), and procedures supervised by advanced GI fellows (p = 0.06) were less likely to receive follow-up. Median income and identification of a primary provider did not influence follow-up rates; 30-day readmission rates were not impacted. Female gender, insurance (Medicare) status, and attending type remained independent predictors of failure of follow-up on multivariate regression (p ≤ 0.03).

Conclusions: Failure to follow up test results on inpatient services at a large academic center was unacceptably high. Maximizing personnel participation together with diligence and technology (EMR) will be required to improve communication.
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http://dx.doi.org/10.1007/s10620-017-4563-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890923PMC
June 2017

Elevated alanine aminotransferase levels in HIV-infected persons without hepatitis B or C virus coinfection.

Ann Saudi Med 2016 Jul-Aug;36(4):288-91

Dr. Saad Alghamdi, Department of Medicine,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, ORCID: http://orcid.org/0000-0001-7693-7201.

Background: Mortality related to human immunodeficiency (HIV) has improved with the use of antiretroviral therapy; however, liver disease-related mortality remains a major concern for the HIV population. Elevation of alanine aminotransferase (ALT) has been noted in HIV-infected persons even without viral hepatitis infection.

Objective: The objective of this study was to determine the incidence and prevalence of chronic alanine ALT elevation among patients infected with HIV who are negative for hepatitis B or C infection.

Design: Retrospective chart review.

Settings: We reviewed the medical records of all patients infected with HIV who had been treated from November 2002 to December 2010.

Patients And Methods: Patients with an unknown or positive HBV or HCV infection status were excluded. We identified patient demographics, route of transmission, peak viral load, and nadir CD4 count.

Results: We followed 440 patients for up to 2265 person-years. A total of 123 patients developed chronically elevated ALT levels, with an incidence of 5.8 cases per 100 person-years. Chronically elevated ALT levels were associated with high HIV viral load, mean body mass index, and diabetes mellitus. We found exposure to lamivudine in 58% of the patients, efavirenz in 41%, and zidovudine in 38%. Abdominal ultrasounds revealed fatty liver in 20 of 39 (51%) of the patients.

Conclusion: Among patients without viral hepatitis coinfection, the prevalence and incidence of chronic elevated ALT levels were high and accompanied by high HIV RNA levels and increased BMI.

Limitations: The limitations of this report are its retrospective nature and lack of a control group.
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http://dx.doi.org/10.5144/0256-4947.2016.288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074405PMC
February 2017

Tenofovir in the treatment of naïve and refractory chronic Hepatitis B: A single center experience in Saudi Arabia.

Saudi J Gastroenterol 2015 Sep-Oct;21(5):295-9

Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Background/aims: Tenofovir disoproxil fumarate (TDF) is a nucleotide analog used in the treatment of chronic hepatitis B (CHB) infection. This study evaluated the efficacy of TDF in achieving undetectable HBV DNA after 48 weeks of treatment in a Saudi cohort of CHB patients.

Patients And Methods: This retrospective study included patients treated at a tertiary care center in Saudi Arabia from January 2009 to December 2012. Of the 68 eligible patients, 51 were treatment naïve and 17 were treatment-refractory. Twenty-three patients tested positive for HBeAg. The remaining 45 patients were HBeAg-negative.

Results: The mean HBV DNA viral load decreased from 95 million IU/mL at baseline to 263 IU/mL after 48 weeks of treatment (P < 0.001). Overall, 62% of patients achieved a complete virological response (CVR) and 37% a partial virological response (PVR). Respective CVR and PVR rates according to subgroup were: HBeAg-positive (21.7% and 78.3%) and HBeAg-negative (84.4% and 15.6%). At 48 weeks, HBV DNA was undetectable in 66.7% of treatment-naÏve and 53% of treatment-refractory patients (P = 0.3). Seroconversion occurred in 13 (57%) of HBeAg-positive patients. Two (3%) of the HBeAg-negative patients lost HBsAg at follow up. Mean alanine aminotransferase decreased significantly from 134 U/L before treatment to 37 U/L at 48 weeks (P < 0.001). Significant adverse events were not encountered during the study period.

Conclusion: Forty-eight weeks of treatment with TDF reduced HBV DNA to undetectable levels in more than half of our patients regardless of whether they were treatment-naïve or refractory. HBeAg-negative (vs positive) patients experienced a better response rate.
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http://dx.doi.org/10.4103/1319-3767.164189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632254PMC
August 2016

Evaluation of the usefulness of a D dimer test in combination with clinical pretest probability score in the prediction and exclusion of Venous Thromboembolism by medical residents.

Thromb J 2014 28;12(1):28. Epub 2014 Nov 28.

Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Introduction: Venous thromboembolism (VTE) requires urgent diagnosis and treatment to avoid related complications. Clinical presentations of VTE are nonspecific and require definitive confirmation by imaging techniques. A clinical pretest probability (PTP) score system helps predict VTE and reduces the need for costly imaging studies. d-dimer (DD) assay has been used to screen patients for VTE and has shown to be specific for VTE. The combined use of PTP and DD assay may improve exclusion of VTE and safely avoid imaging studies.

Materials And Methods: We prospectively used the Wells PTP score and a DD test to evaluate 230 consecutive patients who presented with VTE symptoms. The receiver operating characteristic curve was used to identify a new DD cutoff value, which was applied to VTE diagnosis and compared with the upper limit of locally established reference range for prediction of thrombosis alone and in combination with the clinical PTP score.

Results: We evaluated 118 patients with VTE symptoms fulfilling the inclusion criteria, 64 (54.2%) with clinically suspected deep vein thrombosis (DVT) and 54 (45.8%) with symptoms of pulmonary embolism (PE). The PTP was low in 28 (43.8%) and moderate/high in 36 (56.25%) of the suspected DVT patients, and low in 29 (53.7%) and moderate/high in 25 (46.3%) of the suspected PE patients. Eighteen cases were confirmed by imaging studies: 9 DVT and 9 PE. The agreement between confirmed cases and PTP was significant with PE but not DVT. The negative predictive value for both DVT and PE with current DD cutoff value of <250 μg/L DDU was 100%, whereas with the calculated cutoff the NPV was 88%.

Conclusions: We confirm that PTP score is valuable tool for medical residents to improve the detection accuracy of VTE, especially for PE. The DD cutoff value of 250 μg/L FEU is ideal for excluding most cases of low PTP; however, the calculated cutoff was less specific for the exclusion of VTE.
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http://dx.doi.org/10.1186/s12959-014-0028-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272774PMC
December 2014

Viral hepatitis B and C in HIV-infected patients in Saudi Arabia.

Ann Saudi Med 2014 May-Jun;34(3):207-10

Dr. Abdulrahman A. Alrajhi, MBC 46 Department of Medicine,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, Riyadh 11211, Saudi Arabia, T: +966 11 442 7494, F: +966 11 442 7499,

Background And Objectives: Hepatitis B and C are among the leading causes of death in human immunodeficiency virus (HIV)-infected patients. Prevalence data on viral hepatitis B and C in HIV-infected people in the region of Middle East and North Africa are scarce. We report the prevalence of viral hepatitis B and C in HIV-infected patients in Saudi Arabia.

Design And Settings: Data on all HIV patients who attended HIV Program at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, were kept longitudinally. For the purpose of this report, patients enrolled in the program between January 1985 and December 2010 were included.

Methods: Data on all HIV patients who received HIV care at age 18 and older between January 1985 and December 2010 were collected. Data were collected from patients' charts at our medical records department and electronically from the electronic health records and HIV database. We excluded patients who were de.ceased prior to completing work-up, lost follow-up, or acquired HIV perinatally.

Results: Among 341 HIV-infected patients, hepatitis C infection was found in 41 (12%) patients. The commonest risk factor for hepatitis C virus and HIV acquisition was blood/blood product transfusion in 24 (60%) patients, of these 21 (88%) were hemophiliacs, followed by heterosexual transmission in 9 (22%) patients. The commonest genotype was genotype 1 observed in 18 patients (44%) followed by genotype 4 in 6 (15%) patients. Hepatitis B surface antigen was found in 11 (3%) patients. The commonest risk factor for hepatitis B virus and HIV acquisition was heterosexual transmission in 8 (73%) patients, followed by blood/blood product transfusion in 2 (18%) patients.

Conclusion: The prevalence of hepatitis C virus and hepatitis B virus infections are, respectively,10 and 20 times higher among HIV-infected patients than in the general population.
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http://dx.doi.org/10.5144/0256-4947.2014.207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074600PMC
June 2015

Demographic distribution and transmission potential of influenza A and 2009 pandemic influenza A H1N1 in pilgrims.

J Infect Dev Ctries 2014 Sep 12;8(9):1169-75. Epub 2014 Sep 12.

Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia.

Introduction: The World Health Organization's persistent reporting of global outbreaks of influenza A viruses, including the 2009 pandemic swine A H1N1 strain (H1N1pdm09), justified the targeted surveillance of pilgrims during their annual congregation that pools more than two million people from around 165 nations in a confined area of Makkah city in the Kingdom of Saudi Arabia (KSA).

Methodology: A total of 1,600 pilgrims were included in the targeted surveillance of influenza A and the 2009 pandemic swine H1N1 strain in the Hajj (pilgrimage) season of 2010. Each pilgrim responded to a demographic and health questionnaire. Collected oropharyngeal swabs were analyzed by real-time PCR for influenza A viruses, and positive samples were further analyzed for the presence of H1N1pdm09. Fisher's exact test was applied in the analysis of the significance of the distribution of influenza-positive pilgrims according to demographic characters.

Results: A total of 120 pilgrims (7.5%) tested positive for influenza A viruses by real-time PCR. Nine out of the 120 influenza-A-positive pilgrims (7.5%) were positive for H1N1pdm09. Demographics played a significant role in those pilgrims who tested positive for influenza A.

Conclusions: The detection of H1N1pdm09 in pilgrims at their port of entry to the KSA was alarming, due to the high potential of trans-boundary transmission. This situation necessitates the implementation of specific prevention and control programs to limit infection by influenza A viruses.
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http://dx.doi.org/10.3855/jidc.4204DOI Listing
September 2014