Publications by authors named "Zahid Shakoor"

38 Publications

The effect of low versus high tidal volume ventilation on inflammatory markers in animal model undergoing lung ventilation: A prospective study.

Saudi J Anaesth 2021 Jan-Mar;15(1):1-6. Epub 2021 Jan 5.

Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Background And Aims: Mechanical ventilation (MV) with high tidal volume (Vt.) may induce or aggravate lung injury in critically ill patients. It might also cause an overwhelming systemic inflammation leading to acute lung injury (ALI), diffuse alveolar damage (DAD) and multiple organ failure (MOF) with subsequent high mortality. The objective of this study was to compare the effects of different Vt. on the inflammatory markers of the broncho-alveolar lavage (BAL) fluid and lung biopsy in a group of animal model (Beagle dogs).

Methods: A two-phased prospective study involving 30 Beagle dogs (15 dogs/phase), each phase divided into three groups (each 5 dogs/group). In the first phase each group received MV with Vt. of 8 (low), 10 (normal, control group), and 12 (high) ml/kg body weight (b.w.) respectively. BAL fluid was obtained at the time of induction of anesthesia immediately following tracheal intubation and one hour later following MV to count the macrophages, neutrophils and lymphocytes. In the second phase of the experiment, in addition to obtaining (BAL) fluid similar to the phase one, mini thoracotomy and lung biopsy obtained from the upper lobe of the right lung at same timings for histopathological examination study. Mann-Whitney-Wilcoxon test was used for statistical analysis of the data obtained.

Results: BAL fluid analysis showed increase in the counts of macrophages and lymphocytes with Vt. of 12 ml/kg b.w. compared to the control group (10 ml/kg b.w.) ( < 0.05). in the second phase, similar findings obtained. The histopathological study of the lung tissue obtained in the second phase of the study from the group that received a high Vt. of 12 ml/kg b.w. showed significant inflammatory changes with presence of neutrophil infiltration and edema in the bronchial wall compared to the control group (10 ml/kg b.w.) ( < 0.05).

Conclusions: The use of high Vt. in ventilated animal lung model may increase the risk of inflammation and subsequent damage in healthy lungs, these findings may help physicians to avoid using high Vt. in short-term mechanically ventilated patients in the operating room setting.
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http://dx.doi.org/10.4103/sja.SJA_650_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016054PMC
January 2021

Assessment of Th1/Th2 cytokines among patients with Middle East respiratory syndrome coronavirus infection.

Int Immunol 2020 11;32(12):799-804

Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a member of the beta-coronavirus genus of zoonotic origin that emerged in the Arabian Peninsula and is associated with significant morbidity and mortality. This study was conducted to assess the plasma levels of cytokines to evaluate the Th1/Th2 status among 46 MERS-CoV-infected patients (19 asymptomatic and 27 symptomatic) and 52 normal healthy controls using a customized luminex kit. Comparative analysis of data between MERS-CoV-infected patients and normal healthy controls revealed that although no difference was observed between asymptomatic MERS-CoV patients and controls, the mean plasma levels of interleukin (IL)-10 (44.69 ± 40.04 pg ml-1 versus 14.84 ± 6.96 pg ml-1; P < 0.0001), IL-4 (22.46 ± 8.02 pg ml-1 versus 16.01 ± 9.97 pg ml-1; P < 0.0001), IL-5 (10.78 ± 2.86 pg ml-1 versus 8.06 ± 1.41 pg ml-1; P < 0.0001) and IL-13 (14.51 ± 3.97 pg ml-1 versus 11.53 ± 4.16 pg ml-1; P < 0.003) in MERS-CoV symptomatic patients were significantly higher than the normal controls. The mean plasma levels of interferon (IFN)-γ and IL-12 were no different among the study groups. The cytokine profile among symptomatic MERS-CoV-infected patients was skewed to a Th2 type immune response.
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http://dx.doi.org/10.1093/intimm/dxaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454581PMC
November 2020

Pattern of antinuclear antibody and antiextractable nuclear antigen antibody test requisitions in Riyadh.

J Family Med Prim Care 2019 Nov 15;8(11):3559-3564. Epub 2019 Nov 15.

Department of Pathology, King Khalid Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Background: International guidelines for screening of systemic autoimmune rheumatic diseases (SARD) recommend antinuclear antibody (ANA) test as the first level test and antiextractable antigen (anti-ENA) along with anti-double-stranded DNA (anti-dsDNA) as second line tests following a reactive ANA test. This study was performed to assess adherence to international guidelines for investigation of SARD and to compare the requesting pattern of ANA and second level tests between rheumatology and nonrheumatology physicians in Riyadh.

Methodology: This retrospective cross-sectional study comprising of 300 first time requests for investigation of SARD was performed in the immunology unit at King Khalid University Hospital (KKUH). Data were collected between April and May 2018. Information regarding the requesting physicians' specialty and the first time requested tests (ANA, anti-dsDNA, and anti-ENA) were extracted from the electronic medical records. Reasons for requisition of tests were also recorded.

Results: Of the total requests, 159 (53%) requests included ANA as a single first level test, whereas the rest of the requests ( = 141, 47%) included ANA test in conjunction with second level tests for the investigation of SARD. From the department of rheumatology, 14 (29.8%) initial requests were for ANA test as the only first line investigation that was significantly lower than 145 (57.3%) similar requests from the rest of the departments ( < 0.001).

Conclusion: ANA and second level tests requests by physicians particularly among rheumatologists lacked compliance to international guidelines. The current study strongly suggests the need for strict compliance to international guidelines for screening of systemic autoimmune disorders among physicians.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_758_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881934PMC
November 2019

Nickel challenge up regulates CD69 expression on T lymphocyte sub-sets from patients with nickel induced contact dermatitis.

Afr Health Sci 2019 Mar;19(1):1460-1466

Alrebat University, Republic of Sudan.

Background: Persistent antigenic stimulation due to repeated exposure to nickel may lead to chronic inflammation resulting in allergic contact dermatitis (ACD).

Objectives: This study was performed to assess nickel induced immune activation among patients sensitized against nickel.

Patients And Methods: A total of 35 patients (29 females and 6 males; mean age 36±9 years) with nickel contact dermatitis and 20 patch test negative healthy individuals (14 females and 6 males; mean age 29±7 years) were included in this study. Peripheral blood of patients and controls was incubated with nickel sulfate for 24 hours. Immune activation was assessed by CD69 up-regulation on T lymphocyte sub-sets by flow cytometry.

Results: Base line expression of CD69 on CD8 lymphocytes was higher among patients compared to controls (4.1±1.3%vs2.8±1.1%;p<0.009). There was no difference in proportions of CD±CD69 cells between patients and controls (3.2±0.9%vs2.3±0.8%). Exposure to nickel induced expression of CD69 on a significantly higher proportion of CD4 lymphocytes (22.1±6.2%) of the ACD patients compared to controls (2.8±2.5%;p<0.0001). Similarly nickel induced CD69 expression on a higher proportion of CD8 lymphocytes (18.2±5.3%) from ACD patients compared to the controls (1.9±1.8%;p<0.0006).

Conclusion: CD69 molecule appears to be an important regulator of immune response in nickel contact dermatitis.
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http://dx.doi.org/10.4314/ahs.v19i1.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531931PMC
March 2019

Suboptimal Immune Reconstitution among HIV-Infected Saudi Patients following Successful Antiretroviral Treatment.

Can J Infect Dis Med Microbiol 2019 10;2019:1842106. Epub 2019 Jan 10.

Infectious Diseases Division, Department of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.

Background And Objectives: Variations in immune reconstitution following antiretroviral treatment (ART) among HIV patients have previously been observed. This study aims at assessing immune reconstitution after successful ART among HIV-infected Saudi patients.

Methods: This retrospective study of 240 HIV-infected patients was performed between May 2010 and June 2015 in the HIV center at King Saud Hospital, Riyadh. Data were extracted for CD4, CD8 cell, and CD3/HLA-DR counts along with the viral load from patient records before and after four years of successful ART. The inclusion criterion was patients with CD4 reconstitution of either equal to or more than 400 cells/mm with an undetectable HIV viral load following ART. Based on their presentation, the HIV patients were grouped into early treatment (ET) and delayed treatment (DT) groups with CD4 counts of 200-350 cells/mm and less than 200 cells/mm, respectively.

Findings: The pretreatment CD8+ counts of median 865 cells/mm (interquartile range (IQR) 774-1072) in the DT group declined to median 753 cells/mm (IQR 574-987; < 0.0001). Moreover, there was a decline in CD8 counts from 703 cells/mm (IQR 655-747) to 620 cells/mm (IQR 563-645; < 0.04) in the ET group after four years of successful ART. Pretreatment activation marker (CD3/HLA-DR+) expression of median 29% in the DT group declined to 22% and in the ET group from a median of 23% to 19% after treatment. The CD4/CD8 ratio in the DT group increased from 0.14 (IQR 0.09-0.88) to 0.71 (IQR 0.54-0.9) and from 0.42 (IQR 0.35-0.55) to 0.87 (IQR 0.71-0.98) in the ET group.

Conclusion: Immune reconstitution after successful ART among HIV-infected Saudi patients was associated with a CD8 T-cell population expansion with a suboptimal CD4/CD8 ratio and persistent immune activation. Early initiation of ART appears to favorably influence the CD4/CD8 ratio.
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http://dx.doi.org/10.1155/2019/1842106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348910PMC
January 2019

Screening for Q fever. A tertiary care hospital-based experience in central Saudi Arabia.

Saudi Med J 2018 Dec;39(12):1195-1199

Department of Pathology, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To evaluate the presence of Coxiella burnetii  (C. brunetii) infection among patients presenting with fever of unknown origin (FUO).

Methods: A cross-sectional study of 100 patients (54 men and 46 women; mean age: 34.3 ± 19.2 years) with FUO was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia between March 2015 and June 2016. Phase 1 and phase 2 C. burnetii-specific antibodies in serum samples were detected by enzyme-linked immunosorbent assay.

Results: Coxiella burnetii phase 1 and phase 2 antibodies were detected in 16% of the patients. Phase 2 IgM was present in 2% of the patients, whereas phase 2 IgG antibodies were detected in 11%  of the patients. Coxiella burnetii-specific phase 1 IgG was found in 2% of the patients, and 8% of the patients harbored phase 1 IgA antibodies in their serum.

Conclusion: The presence of C. burnetii-specific antibodies in many patients suffering from FUO highlights the importance of Q fever screening among patients presenting with febrile illness.
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http://dx.doi.org/10.15537/smj.2018.12.23695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344652PMC
December 2018

A TRAF6 genetic variant is associated with low bone mineral density in rheumatoid arthritis.

Clin Rheumatol 2019 Apr 1;38(4):1067-1074. Epub 2018 Dec 1.

Laboratory of Immunology, Research Unit UR 807, Faculty of Medicine of Sousse, Ibn Al Jazzar street, 4000, Sousse, Tunisia.

Objectives: This study was aimed to investigate the association of the single nucleotide polymorphism of tumor necrosis factor receptor associated factor 6 (TRAF6), rs540386, with low bone mineral density (BMD) among patients with rheumatoid arthritis (RA).

Methods: TRAF6 rs540386 genotyping was performed by mutagenically separated PCR in a cohort of 188 (23 men, 165 women, median age, 56.2 years) adult RA patients and 224 age and gender-matched controls. BMD was measured using dual-energy X-ray absorptiometry (DXA) (Lunar Prodigy advance scans, GE Healthcare, USA).

Results: Among the RA patients, 64 (55 women, 9 men) had low BMD comprising of 57 patients with osteoporosis and 7 with osteopenia. Whereas TRAF6 rs540386 was not associated with RA susceptibility, it was however found to be a risk factor for reduced lumbar spine Z-score in the recessive model (OR = 3.34, 95% CI = (1.01-11.00), p = 0.038). This association was confirmed further in the multivariate logistic regression analysis taking into account several potential confounding factors (OR = 3.34 (1.01-11.00), p = 0.048). In addition, mean total femur Z-score was found to be reduced in TT patients when compared to CC + CT patients (- 1.30 ± 1.32 versus - 0.60 ± 1.05, p = 0.034). No association between TRAF6 rs540386 and local bone damage was observed.

Conclusions: This study for the first time ever demonstrated an association between a genetic variant of TRAF6 and low BMD among patients with RA. Further investigations are needed to elucidate the exact role of this variant.
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http://dx.doi.org/10.1007/s10067-018-4362-1DOI Listing
April 2019

HLA-DQB1*06:02 allele frequency and clinic-polysomnographic features in Saudi Arabian patients with narcolepsy.

Sleep Breath 2019 Mar 5;23(1):303-309. Epub 2018 Sep 5.

University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Narcolepsy is an uncommon neurological disorder characterised by irresistible spells of sleep associated with abnormal rapid eye movement (REM) sleep. The association between narcolepsy and human leukocyte antigen HLA- DQB1*06:02 has been established elsewhere but remains to be investigated among Saudi Arabian patients with narcolepsy.

Methods: A total of 29 Saudi patients with type I or type 2 narcolepsy comprising of 23 (79%) males and 6 (21%) females with a mean age of 17.2 ± 9.6 years were included in this study. Type 1 or type 2 narcolepsy was diagnosed by full polysomnography followed by a multiple sleep latency test in accordance with International Classifications of Sleep Disorders-3 criteria. HLA typing for DQB1 alleles was performed by polymerase chain reaction and hybridization with sequence-specific oligonucleotide probes. Differences in clinical and sleep parameters were compared by univariable analyses. HLA-DQB1*06:02 frequency was systematically compared with the published literature.

Results: Type 1 narcolepsy was diagnosed in 19/29 (65.5%) patients, whereas 10/29 (34.5%) patients had type 2 narcolepsy. DQB1*06:02 was present in 25/29 (86.2%) patients; 15/19 (78.9%) narcolepsy type 1 patients and 10/10 (100%) narcolepsy type 2 patients harboured the DQB1*06:02 allele. REM latency was significantly lower in DQB1*06:02-positive patients compared to DQB1*06:02-negative patients (17.6 ± 32.3 min vs. 106.0 ± 86.0 min; p = 0.025). Epworth Sleepiness Scale scores were significantly higher among type 1 than type 2 narcolepsy patients (19.7 ± 3.2 vs 15.3 ± 3.6; p = 0.02).

Conclusions: DQB1*06:02 allele frequencies among Saudi patients with narcolepsy were consistent with previously published data.
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http://dx.doi.org/10.1007/s11325-018-1717-4DOI Listing
March 2019

Association of IL-13 rs20541 and rs1295686 variants with symptomatic asthma in a Saudi Arabian population.

J Asthma 2018 11 6;55(11):1157-1165. Epub 2017 Dec 6.

a Immunology Research Laboratory and Asthma Research Chair, College of Medicine , King Saud University , Riyadh , Saudi Arabia.

Objective: Interleukin 13 (IL-13) plays a critical pro-inflammatory role in asthma. Several single nucleotide polymorphisms (SNPs) are associated with asthma susceptibility in specific populations; however, further replicative studies in other ethnic groups are mandatory.

Methods: The association between IL-13 SNPs rs762534, rs20541, rs1295686, and rs1800925 (risk alleles A, A, T, and A, respectively) and asthma predisposition in a Saudi Arabian cohort was examined via a case-control cross-sectional study.

Results: The frequencies of alleles between asthmatics and control populations were significantly different for rs20541 and rs1295686 SNPs (p < 0.001), whereas the frequencies of genotypes between asthmatics and controls were significantly different only for rs20541. The association of the risk (minor) alleles with asthma was examined using the dominant genetic model. Individuals with at least one copy of the risk alleles A (for rs20541) and T (for rs1295686) had significantly greater odds of being asthmatic (OR = 2.13, 95% CI = 1.39-3.26, p < 0.0001; OR = 1.69, 95% CI = 1.12-2.54, p = 0.008) relative to their most common homozygous genotypes. On the other hand, the minor A alleles for rs762534 and rs1800925 were not significantly associated with asthma risk. Regarding haplotype association analysis, individuals with at least one copy of the minor "risk" allele for both rs20541 and rs1295686 (CATG and CATA, respectively) had greater odds of being asthmatic relative to CGCG haplotype; however, this trend was not statistically significant (p > 0.3).

Conclusions: IL-13 minor T and A alleles for rs1295686 and rs20541, respectively, were associated with significantly higher risk of asthma in the Saudi Arabian population.
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http://dx.doi.org/10.1080/02770903.2017.1400047DOI Listing
November 2018

IRAK2 is associated with susceptibility to rheumatoid arthritis.

Clin Rheumatol 2018 Apr 11;37(4):927-933. Epub 2017 Nov 11.

Laboratory of Immunology, Research Unit UR 807, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.

This study was performed to investigate the association of the single nucleotide polymorphisms of interleukin-1 receptor-associated kinase 2 (IRAK2) rs3844283 and rs708035 with rheumatoid arthritis (RA). IRAK2 rs3844283 and rs708035genotyping was determined by mutagenically separated PCR with specifically designed primers in a cohort of 222 (30 men, 192 women, mean age 49 years) adult RA patients and 224 matched controls. IRAK2 rs3844283 C allele was detected in 66% of RA patients and 74% of controls. The CC genotype was the most frequent genotype in both RA patients (45.5%) and the controls (56.3%). The G allele was found to be associated with RA susceptibility (OR = 1.47, 95% CI = 1.10-1.96, p = 0.008). The GG genotype was found to be associated with RA in the co-dominant and the dominant models (OR = 2.03, 95% CI = 1.08-3.81, p = 0.042 and OR = 1.54, 95% CI = 1.06-2.23, p = 0.023, respectively). IRAK2 rs708035 was found not to be in the Hardy-Weinberg equilibrium. The hyperfunctional IRAK2 rs708035 A allele was more frequent in RA patients than in controls (69.9 versus 62.2%, respectively, p = 0.015). Moreover, IRAK2 rs708035 and IRAK2 rs3844283 were in linkage disequilibrium and the GA haplotype was significantly more frequent in RA patients than in controls (p = 0.034). This study for the first time ever reports the association of IRAK2 rs3844283, IRAK2 rs708035, and the corresponding haplotypes with RA. Functional studies are recommended to elucidate the risk posed by the GA haplotype for the development of RA.
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http://dx.doi.org/10.1007/s10067-017-3906-0DOI Listing
April 2018

Screening for skin-sensitizing allergens among patients with clinically suspected allergic contact dermatitis.

Saudi Med J 2017 09;38(9):922-927

Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To detect common skin-sensitizing agents among patients experiencing allergic contact dermatitis (ACD). Methods: This was a retrospective study of 152 patients with clinically suspected ACD who underwent patch testing in an allergy clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2012 and February 2015. Of these patients, only 74 (48%) patients reacted to one or more contact allergens. This group of patients included 58 (78.4%) women and 16 (21.6%) men (mean age: 37.8±13.8 years). Patch testing was performed using the thin-layer rapid-use epicutaneous patch test panels. Results: Nickel sulfate was the most common sensitizing agent, with 26 (35.1%) patients yielding a positive result; followed by p-phenylenediamine in 17 (22.9%), butyl-tetra-phenol formaldehyde in 12 (16.2%), gold sodium thiosulfate in 10 (13.5%), and thimerosal in 6 (8.1%) patients. Nickel reactivity was significantly higher among women (41.4%) than among men (12.5%) (p less than 0.0001). Similarly, gold reactivity among women (15.5%) was also higher than among men (6.2%) (p≤0.02).  Conclusion: The high level of skin sensitization due to nickel, PPD, and gold in patients with ACD emphasizes the need for measures to decrease exposure to these sensitizing agents.
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http://dx.doi.org/10.15537/smj.2017.9.19864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654026PMC
September 2017

Assessing the Detection of Middle East Respiratory Syndrome Coronavirus IgG in Suspected and Proven Cases of Middle East Respiratory Syndrome Coronavirus Infection.

Viral Immunol 2017 11 5;30(9):649-653. Epub 2017 Sep 5.

4 King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia .

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory disease with significant mortality. Two testing methods are currently used for MERS-CoV diagnostics: nucleic acid detection (the gold standard) and serological analysis. In this study, we evaluated the detection of MERS-CoV-IgG in suspected and proven cases of MERS-CoV infection. We enrolled 174 patients: 113 had respiratory symptoms/suspected MERS-CoV infection, 31 had confirmed influenza A or B infection, 23 had a recent confirmed MERS-CoV infection, and 7 had confirmed MERS-CoV infection 1 year before. All underwent MERS-CoV RNA and MERS-CoV-IgG testing. Thirty patients were found to be MERS-CoV RNA positive; however, during serological analysis, only 6 (3.4%) patients were positive for MERS-CoV-IgG, 1 (0.6%) patient was equivocal, and 167 (96%) patients were negative. Among the serological positives, four were recently MERS-CoV RNA positive and two were MERS-CoV RNA negative. No cross-reactivity to influenza A or B was detected. Based on the lack of correlation between nucleic acid and serological analysis, we conclude that MERS-CoV-IgG testing may not be suitable for diagnosing acute infection or estimating its prevalence during an outbreak. In addition, our findings show that MERS-CoV-IgG may not have significant value in determining disease severity or prognosis.
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http://dx.doi.org/10.1089/vim.2017.0091DOI Listing
November 2017

Identification of IgE- binding pollen protein from Cannabis sativa in pollen-hypersensitive patients from north Pakistan.

Pak J Pharm Sci 2017 Jan;30(1):37-42

Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan.

Cannabis sativa (C.sativa) is well-known for its medicinal, industrial and recreational use. However, allergies in relation to Cannabis sativa (C.sativa) are rarely reported. C. sativa is one of the common weeds found in Pakistan and its pollen grains are common in spring and fall season. Although categorized as an aeroallergen, there are limited number of reports regarding allergenic potential in C. sativa. Therefore, the current study is aimed at exploring the IgE- binding potential among the C. sativa pollen in local pollen allergic patients. Initial screening of C. sativa sensitized individuals was carried out by dot blot from the sera of pollen allergic patients. Proteins from the pollen grains were extracted and resolved on 10% gel. Eight bands were visible on gel however only one protein fragment i.e. of 14KDa size was found to bind to IgE as analyzed through protein gel blot analysis. Strong IgE affinity of a 14 kDa protein fragment from C. sativa pollen extract suggests its allergenic potential. Further study is required to find the exact nature of this protein fragment.
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January 2017

Increased Spontaneous Programmed Cell Death Is Associated with Impaired Cytokine Secretion in Peripheral Blood Mononuclear Cells from Hepatitis C Virus-Positive Patients.

Viral Immunol 2017 05 17;30(4):283-287. Epub 2017 Mar 17.

4 Department of Zoology, College of Sciences, King Saud University , Riyadh, Saudi Arabia .

Peripheral blood mononuclear cells (PBMCs) play a critical role in clearing hepatitis C virus (HCV). PBMC defects have been linked with HCV infection; however, the underlying mechanisms remain obscure. We hypothesized that PBMCs of HCV-infected patients are more susceptible to programmed cell death (PCD), and are therefore unable to clear HCV. We compared spontaneous PBMC PCD and cytokine [interleukin (IL)-1, -6, -8, -10, and -12] secretion between untreated (naive) HCV and treated [sustained responder (SR)] patients with HCV, and HCV healthy controls. Spontaneous PBMC PCD was assessed by annexin-V fluorescein isothiocyanate/propidium iodide staining, and cytokine levels were measured by cytometric bead array. Differences between groups were analyzed through paired and nonpaired t tests and Mann-Whitney U test. The rate of spontaneous PCD was higher in PBMCs of naive HCV patients (p < 0.0001) and SR-HCV patients (p < 0.002) than in HCV controls. Significantly low levels of IL-8, -6, and -10 were detected in the supernatant of cell cultures of PBMCs from naive HCV (p < 0.05) and SR-HCV (p < 0.05) patients relative to HCV controls. There was no difference between the naive HCV and SR-HCV groups in terms of PBMC PCD rate or cytokine levels. The present findings indicate that HCV infection is associated with increased PBMC susceptibility to PCD and decreased production of IL-8, -6, and -10.
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http://dx.doi.org/10.1089/vim.2016.0166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421508PMC
May 2017

Neonatal brucellosis: A case report.

J Infect Dev Ctries 2017 Feb 28;11(2):199-202. Epub 2017 Feb 28.

College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia.

Although brucellosis is not uncommon in Saudi Arabia, neonatal brucellosis has been infrequently reported. In this case of neonatal brucellosis, Brucella abortus was isolated by blood culture from both the mother and the neonate. Serology was positive only in the mother.
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http://dx.doi.org/10.3855/jidc.8938DOI Listing
February 2017

Micro RNA-146a But Not IRAK1 is Associated with Rheumatoid Arthritis in the Tunisian Population.

Genet Test Mol Biomarkers 2017 Feb;21(2):92-96

1 Laboratory of Immunology , Research Unit UR 807, Faculty of Medicine of Sousse, Sousse, Tunisia .

Background: Rheumatoid arthritis (RA) is characterized by the production of an array of proinflammatory cytokines through the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway. Interleukin-1 receptor (IL-1R) and Toll-like receptors contain a common cytoplasmic motif the Toll/IL-1R (TIR) homology domain. This motif is required for NF-κB activation. IL-1R-associated kinase 1 (IRAK1) is a key adapter molecule recruited during the signaling cascade of the TIR. Its gene expression is regulated by the micro-RNA (miR)-146a.

Objective: We investigated the role of IRAK1 single-nucleotide polymorphism (SNP) rs3027898 (IRAK1 rs3027898) and miR-146a SNP rs2910164 (miR-146a rs2910164) in Tunisian patients with RA and their association with C reactive protein (CRP), rheumatoid factor (RF), anticyclic citrullinated peptide (anti-CCP) antibodies, and erosion.

Patients And Methods: In a cohort of 172 adult RA patients and 224 matched controls, IRAK1 rs3027898 genotyping was determined by mutagenically separated polymerase chain reaction (MS-PCR) with newly designed primers, and miR-146a rs2910164 genotyping was determined by fragment length polymorphism PCR-restriction (RFLP-PCR).

Results: The IRAK1 rs3027898 A allele was detected in 67% of RA patients and 70% of controls indicating that it is not associated with RA in codominant, dominant, or recessive models even after stratification by age and gender. The miR-146a rs2910164 G allele was detected in 76% of RA patients and 68% of controls, thus the C allele confers some protection based on a dominant model [CC+GC (odds ratio (95% confidence interval) = 0.6 (0.3-0.9), p = 0.03)]. No association with CRP, RF, anti-CCP, or erosion was found for either SNPs.

Conclusion: The IRAK1 rs3027898 was not associated with RA, whereas C allele of miR-146a rs2910164 was found to be protective. Functional studies are required to investigate the exact role of miR-146a rs2910164 during RA.
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http://dx.doi.org/10.1089/gtmb.2016.0270DOI Listing
February 2017

Prevalence of IgG-mediated food intolerance among patients with allergic symptoms.

Ann Saudi Med 2016 Nov-Dec;36(6):386-390

Background: Food intolerance mediated by food specific IgG antibodies has been implicated in a variety of disorders.

Objectives: To assess the prevalence of food specific IgG antibodies among patients clinically presenting with allergic symptoms lacking laboratory evidence of allergy.

Design: Descriptive retrospective cross-sectional study.

Setting: King Khalid University Hospital, Riyadh between 2010-2015.

Patients And Methods: Patients were screened for food specific IgG antibodies. All symptomatic patients lacking laboratory evidence of allergy who underwent food specific IgG testing during the study duration were included.

Main Outcome Measure(s): Levels of IgG antibodies in patients with unidentified allergic symptoms.

Results: We selected 71 patients with allergic symptoms lacking laboratory evidence of allergy. There were 49 female and 22 male patients mean age 38.8 (16.0) years. The majority (85.7%) had urticaria. The most frequently occurring food specific IgG antibodies were against cola nut in 80.3% of patients followed by yeast in 78.9%, wheat in 77.5%, red kidney bean in 71.8%, pea in 63.4%, corn in 62% and egg white in 62% of the patients. Compared with male patients, females harbored significantly higher food specific IgG antibodies for frequently occurring food materials, particularly against wheat (74% vs 25.5%; P < .0001), corn (77.3% vs 22.7%; P < .0001) and cola nut (71.9% vs 28.1%; P < .001). Patients aged less than 40 years had higher levels of food specific IgG against gliadin (P < .003), egg white (P < .03) and barley (P < .05) compared with older patients.

Conclusion: The detection of a variety of food specific IgG antibodies among patients with allergic symptoms indicates a possible link to food intolerance allergy. Females are prone to develop food intolerance more than males.

Limitations: Difficulty of comparison of results with previous studies because of lack of data. Follow-up studies could not be performed to assess the effects of elimination from the diet due to limited time allocated for this study.
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http://dx.doi.org/10.5144/0256-4947.2016.386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074204PMC
March 2017

Evaluation of GeneXpert MTB/RIF for detection of Mycobacterium tuberculosis complex and rpo B gene in respiratory and non-respiratory clinical specimens at a tertiary care teaching hospital in Saudi Arabia.

Saudi Med J 2016 Dec;37(12):1404-1407

Department of Pathology/Microbiology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To assess the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), against smear microscopy and culture method for diagnosis of MTB infection. Methods: This is a retrospective analysis of 103 respiratory and 137 non-respiratory patient specimens suspected of tuberculosis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia performed between April 2014 and March 2015. Each sample underwent smear microscopy, mycobacterial culture, and GeneXpert MTB/RIF test. Results: Fifteen out of 103 respiratory samples were smear and culture positive, whereas 9 out of 137 non-respiratory samples were smear positive. Out of 9 smear positive specimens, 8 were also culture positive. All 15 culture positive respiratory samples were detected by Xpert MTB/RIF (sensitivity  and positive predictive value [PPV]=100%). Similarly, all 8 culture positive non-respiratory specimens were identified by Xpert MTB/RIF (sensitivity 100%; PPV 88.8%). The Xpert MTB/RIF detected only one false positive result in 88 smear negative respiratory specimens (specificity 98.9%; negative predictive value [NPV]= 100%). All 125 smear negative non-respiratory specimens tested negative by culture and Xpert MTB/RIF (sensitivity, specificity, PPV, NPV= 100%). Conclusion: The performance of Xpert MTB/RIF was comparable to the gold standard culture method for identification of MTB in both respiratory and non-respiratory clinical specimens.
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http://dx.doi.org/10.15537/smj.2016.12.15506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303782PMC
December 2016

Performance of the BD ProbeTec ET direct detection assay for the analysis of in respiratory and non-respiratory clinical specimens.

J Taibah Univ Med Sci 2017 Aug 12;12(4):364-368. Epub 2016 Nov 12.

Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, KSA.

Objectives: Early detection of Mycobacterial tuberculosis infection (MTB) is pivotal for the treatment of tuberculosis (TB).

Background: This study was performed to evaluate the performance of BD ProbeTec ET direct detection assay (DTB) against the gold standard culture technique for confirmation of MTB infection.

Methods: A total of 266 consecutive and non-duplicate clinical specimens for detection of MTB were included in this study. There were 118 respiratory and 148 non-respiratory samples. All samples were tested by microscopy for acid-fast bacillus (AFB), MTB culture and biochemical identification with simultaneous testing by DTB.

Results: A total of 88 samples (33%) were culture-positive for MTB including 39/118 respiratory, 29/99 fluid and 20/49 tissue samples. DTB sensitivity for respiratory samples was 97% and specificity was 96% with a positive predictive value (PPV) of 93% and negative predictive value (NPV) of 99%. Sensitivity of DTB in fluid samples was 80%, specificity 88%, PPV 69% and NPV 93% whereas sensitivity of DTB for tissue samples was 25%, specificity 90%, PPV 63% and NPV 63%. Of the 50 (56.8%) smear-positive samples, DTB sensitivity was 100% for respiratory, 85% for fluid and 100% for tissue samples.

Conclusion: DTB performed within acceptable limits for the rapid detection of MTB in respiratory samples compared to fluid and tissue specimens.
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http://dx.doi.org/10.1016/j.jtumed.2016.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694877PMC
August 2017

Assessment of pro-inflammatory cytokines in sera of patients with hepatitis C virus infection before and after anti-viral therapy.

J Infect Dev Ctries 2016 Oct 31;10(10):1093-1098. Epub 2016 Oct 31.

King Khalid University Hospital, Riyadh, Saudi Arabia.

Introduction: A number of cytokines have been implicated in hepatitis C virus (HCV)-related liver disease. This study aimed to assess the serum levels of pro-inflammatory cytokines in patients with HCV infection before (naïve) and after successful treatment (sustained responders) with Pegylated interferon and ribavirin.

Methodology: The present study included 19 naïve HCV patients and 8 sustained responders. Additionally, 20 healthy individuals were included as a control group. The serum levels of the pro-inflammatory cytokines interleukin-8 (IL-8), IL-6, IL-10, IL-1β, and IL-12p70 were measured using flow cytometry.

Results: The serum IL-8 levels were significantly higher in the naïve group (21.5±10.7 pg/mL; p=0.02) than in the control group (14.1±1.7 pg/mL) and the sustained responder group (10.4±6.2 pg/mL; p=0.002). The serum IL-6 levels were significantly higher in the naïve group (7.3±2.06 pg/mL; p=0.02) than in the control group (5.9±1.01 pg/mL) whereas IL-6 in sustained responder group (6.4±1.5 pg/mL) was no different than naïve HCV patients or the controls. The serum IL-10 levels were significantly higher in the naïve group (4.42±0.64 pg/mL) than in the control group (3.6±0.34 pg/mL; p=0.0002) and not the sustained responder group (4.1±0.86 pg/mL). Moreover, the serum IL-12p70 levels were higher in the sustained responder group (3.43±0.84 pg/mL; p=0.05) than in the control group (2.76±0.83 pg/mL). There were no differences in the serum IL-1β levels among the groups.

Conclusion: Successful anti-viral therapy against HCV was associated with significant reductions in the serum IL-8 levels and skewing of the pretreatment Th2 dominant immune response to the Th1 response.
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http://dx.doi.org/10.3855/jidc.7595DOI Listing
October 2016

Assessment of antigen presenting cell infiltration in lung tissues of patients with bronchiectasis.

Indian J Pathol Microbiol 2016 Oct-Dec;59(4):469-473

Department of Pathology and Immunology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Background: Bronchiectasis is a chronic disease characterized by permanent dilatation of the conducting airways accompanied by sustained inflammation.

Aims: To assess whether chronic inflammation of lungs in bronchiectasis is associated with alterations in the numbers of infiltrating antigen presenting cell (APC).

Setting And Design: Lobectomy specimens from 12 nonsmoker, nonasthmatic patients with acquired (noncongenital) bronchiectasis and six control patients were included in the study. Histopathology slides were reviewed, and immunohistochemical markers for dendritic cells (DCs) macrophages and Langerhans cells have been applied and analyzed.

Materials And Methods: Tissue specimens were stained by immunohistochemistry using markers for DCs (CD83 and CD23), macrophages (CD68 and CD163), and Langerhans cells (CD1A and S-100 protein). The mean cell counts of stained cells in five high power microscopic fields were recorded.

Statistical Analysis Used: Descriptive statistics, mean, standard deviation, median, and interquartile range were used. A nonparametric Mann-Whitney U-test was used to compare cell counts between bronchiectasis and control patients. P <0.05 was considered significant.

Results: The mean age of patients with bronchiectasis and controls was 36.7 ± 16.6 and 31.8 ± 22.6 years, respectively. The predominant cell type among the patients was macrophage (median 50.5) followed by DCs (median 44.85), histiocytes (median 32), and Langerhans cells (median 5%). Compared to the controls a significantly higher number of macrophages (P = 0.01), DCs (P = 0.001), and Langerhans cells (P = 0.014) were present.

Conclusion: Chronic inflammatory response in acquired (noncongenital) bronchiectasis is most probably mediated by increased infiltration of APCs in lung tissues.
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http://dx.doi.org/10.4103/0377-4929.191779DOI Listing
March 2017

Acute Back Pain: A Survey of Primary Health Care Physicians' Awareness and Knowledge of "Red Flag" Signs.

Saudi J Med Med Sci 2016 Jan-Apr;4(1):15-18. Epub 2015 Dec 2.

Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: The failure to detect "red flag" signs in patients presenting with acute low back pain can adversely affect the outcome of management. This can seriously affect the quality of life and productivity of the patient.

Objective: The present questionnaire-based study was performed to assess the knowledge and awareness of red flag signs among primary health care physicians managing patients with acute back pain in Riyadh, Saudi Arabia.

Materials And Methods: The study sample size was comprised of 80 subjects. The level of knowledge was assessed by means of a new structured self-administered questionnaire. The design of this questionnaire was based on the Agency for Health Care Research and Policy (AHCRP) guidelines for detection of red flag signs. Physicians were asked about red flag signs that indicate the presence of tumor, infection, spinal fracture, or cauda equina syndrome.

Results: Sixty-eight (85% of total) physicians were aware of red flag signs. Of the 68 physicians who were aware of the red flag signs, 58 (72%) were aware of neurological deficit, 36 (45% of total) were aware of extremes of age (<10 years and >50 years), and 33 (41% of total) were aware of and routinely inquired about the history of spinal trauma, whereas only 24 (30% of total) were aware of and inquired about constitutional symptoms in their patients with acute back pain.

Conclusion: Although low back pain is extremely common, knowledge and awareness of red flag signs of primary health care physicians managing patients with acute back pain in Riyadh appear to be inadequate. This indicates a lack of adherence to the international guidelines. Specific educational programs should target these deficiencies and increase awareness.
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http://dx.doi.org/10.4103/1658-631X.170882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298267PMC
December 2015

Rapid detection of circulating fibrocytes by flowcytometry in idiopathic pulmonary fibrosis.

Ann Thorac Med 2015 Oct-Dec;10(4):279-83

Firestone Institute for Respiratory Health, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Background: Current protocols for detection of circulating fibrocytes (CFs) in peripheral blood described in various pulmonary and nonpulmonary disorders involve complex and time consuming, non standardized techniques.

Objective: Testing a method to rapidly detect and quantify CFs using whole blood lysis flow cytometry-based assay in patients with idiopathic pulmonary fibrosis (IPF) and healthy controls.

Methods: One milliliter of venous blood sample in ethylenediaminetetraacetic acid (EDTA) from 33 IPF patients and 35 healthy control subjects was collected. Using whole blood lysis method peripheral blood leukocytes were labeled with monoclonal antibodies for cell surface (CD34 and CD45) and intracellular markers (collagen-1) for flow cytometric analysis. CFs were defined as CD45(+) cells coexpressing collagen-I and CD34 molecules.

Results: In 29 (87.8%) IPF patients and 10 (28.5%) control subjects, a well-defined highly granular CD45(+) cell population was detected in dot plots generated by side scatter properties of CD45(+) cells. These CD45(+) cells were identified as CFs on the basis of coexpression of collagen-I and CD34; none of the other cell types in the peripheral blood were labeled with these monoclonal antibodies. In IPF patients the percentage of CFs was significantly higher compared to healthy controls (median (range): 1.37% (0.52-5.65) and 1.04% (0.1-1.84), respectively; P = 0.03).

Conclusions: Whole blood lysis method combined with fluorescence-activated cell sorting (FACS) allows detecting a well-defined homogeneous population of CFs. This method is simple, reproducible, and provides an accurate and rapid estimation of CFs.
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http://dx.doi.org/10.4103/1817-1737.157294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652295PMC
December 2015

Combined effect of a mixture of tetracycline, acid, and detergent, and nisin against Enterococcus faecalis and Actinomyces viscosus biofilms.

Saudi Med J 2015 Feb;36(2):211-5

Department of Restorative Dental Science, College of Dentistry, King Saud University, PO Box 62645, Riyadh 11595, Kingdom of Saudi Arabia. E-mail.

Objectives: To evaluate the combined effect of a mixture of tetracycline, acid, and detergent (MTAD) and Nisin against Enterococcus faecalis (E. faecalis) and Actinomyces viscosus (A. viscosus) biofilms.

Methods: This study was conducted between June and December 2013 in collaboration with Dental Caries Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Single-species biofilms (n=9/species/observation period) were generated on membrane filter discs and subjected to 5, 10, or 15 minute incubation with MTADN (MTAD with 3% Nisin), 5.25% sodium hypochlorite (NaOCl), or normal saline. The colony forming units were counted using the Dark field colony counter.

Results: A 100% bactericidal effect of 5.25% NaOCl was noted during the 3 observation periods; a significant reduction (p=0.000) in mean survival rates of E. faecalis (77.3+13.6) and A. viscosus (39.6+12.6) was noted after 5 minutes exposure to MTADN compared with normal saline (78000000+5291503) declining to almost no growth after 10 and 15 minutes. The survival rates of the E. faecalis and A. viscosus biofilm were no different after treatment with MTADN and 5.25% NaOCl at the 3 observation periods (p=1.000).

Conclusion: A combination of MTAD and Nisin was as effective as NaOCl against E. faecalis and A. viscosus biofilms.
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http://dx.doi.org/10.15537/smj.2015.2.9947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375700PMC
February 2015

Screening for hen's egg and chicken meat specific IgE antibodies in Saudi patients with allergic disorders.

Afr Health Sci 2014 Sep;14(3):634-40

Department of Pathology, College of Medicine and University Hospitals, King Saud University.

Background: Allergy to hen's egg and meat contributes significantly to the manifestations of food allergy all over the world.

Objectives: This study was performed to assess the presence of hen's egg and meat specific IgE antibodies among patients investigated for various allergic disorders.

Methods: This is a retrospective study performed at King Khalid University Hosptial, Riyadh. Data from 421 patients with allergic disorders screened for food specific IgE antibodies between January 2009 and March 2011 were analyzed. Sixty (14.25%) patients including 42 males and 18 females with the mean age (sd) of 7.5 (7.4) years were found to have specific IgE antibodies against hen's egg and chicken meat. There were 56 (93.3%) children and 4 (6.7%) adult patients. Specific IgE antibodies were measured by radioallergosorbent test (RAST) using Pharmacia ImmunoCAP 250 analyzer.

Results: Atopic dermatitis was the most common (55%) clinical condition. Out of the total 60 patients harboring hen's egg and chicken meat specific IgE antibodies high levels of egg white, yolk and chicken meat specific IgEs were detected in 58 (96.6%), 37 (61.6%) and 6 (10%) patients respectively. Both the egg white and yolk antibodies coexisted in 35 (58.3%) patients.

Conclusion: Sensitization against hen's egg was higher compared to the chicken meat. Egg white sensitization higher than the egg yolk particularly in Saudi children with food related allergic disorders.
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http://dx.doi.org/10.4314/ahs.v14i3.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209629PMC
September 2014

ESBL-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care hospital in Saudi Arabia.

J Infect Dev Ctries 2014 Sep 12;8(9):1129-36. Epub 2014 Sep 12.

King Saud University Hospital, Riyadh, Saudi Arabia.

Introduction: The increasing frequency and antibiotic resistance among extended-spectrum β-lactamases (ESBLs)-producing bacteria are posing a serious threat. This study sought to investigate the frequency and antibiotic susceptibility of ESBL-producing E. coli and K. pneumoniae at a tertiary care hospital.

Methodology: Data were collected from samples sent to the microbiology laboratory between 2006 and 2010 at King Khalid University Hospital, Riyadh. ESBLs were confirmed using Etest strips of cefotaxime/cefotaxime + clavulanic acid, ceftazidime/ceftazidime + clavulanic acid, and cefepime/cefepime + clavulanate.

Results: Out of 17,105 samples, 1,076 (6.3%) ESBL-producing isolates of E. coli (808) and K. pneumoniae (268) were confirmed. Among these, 680 (63.2%) isolates were found in urine samples, followed by 287 (26.7%) in superficial swabs, deep wounds swabs, tissues and sterile body fluids, 71 (6.6%) in respiratory, and 38 (3.5%) in blood samples. The overall frequency rates of ESBL E. coli and K. pneumoniae were 6.6% and 5.5%, respectively. The frequency of ESBL-producing E. coli and K. pneumoniae increased significantly during the study period. E. coli resistance against cotrimoxazole was 71.1%, followed by ciprofloxacin (68.2%) and gentamicin (47%). Similarly, 62.7% of K. pneumoniae isolates were resistant to gentamicin, 59.5% to cotrimoxazole, and 49.8% to ciprofloxacin. There was no statistically significant change in antimicrobial resistance over the study period.

Conclusions: Although the frequency rates of ESBL-producing E. coli and K. pneumoniae increased, no change in the anti-microbial susceptibility was observed over the study period.
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http://dx.doi.org/10.3855/jidc.4292DOI Listing
September 2014

Cytotoxic effect of Salvadora persica extracts on human gingival fibroblast cells.

Saudi Med J 2014 Aug;35(8):810-5

Department of Restorative Dental Science, Division of Endodontics, College of Dentistry, King Saud University, PO Box 62645, Riyadh 11545, Kingdom of Saudi Arabia. Tel. +966 (11) 4677420. E-mail.

Objectives: To assess the cytotoxic potential of Salvadora persica (S. persica) extracts on human gingival fibroblast (HGF) cells.

Methods: This study was conducted between January and May 2012 in collaboration with Dental Caries Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Extracts of S. persica using hexane, ethylacetate, and ethanol as solvents at concentrations of 0.5 mg/ml and 1 mg/ml were evaluated for their cytotoxic activity against HGFs using the 3 cytotoxic assays: (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, a tetrazole) (MTS), lactic dehydrogenase (LDH), and crystal violet (CV). International standards for the evaluation of medical materials recommended cut-off value of cell survival >70% was used for interpretation of the results.

Results: Ethanol extract of S. persica at 0.5 mg/ml and 1 mg/ml and hexane extract of S. persica at 0.5 mg/ml were completely devoid of cytotoxic activity, hexane extract at 1 mg/ml in comparison with controls  demonstrated some cytotoxicity with cell survival of 88% (p=0.045) in MTS, 86% (p=0.01) in LDH, and 88% (p=0.002) in CV assays. Similarly, ethyl acetate extract of S. persica at 0.5 mg/ml maintained cell viability of 91% in MTS, 81% in LDH, and 80% in CV assays. Maximum cytotoxicity against HGFs was observed with ethyl acetate extract of S. persica at 1 mg/ml with cell survival of 60% in MTS, 40% in LDH, and 66% CV assays (p=0.0001).  

Conclusion: The acceptable level of cytotoxicity associated with S. persica ethanol and hexane extracts requires further evaluation to be used as irrigation solutions in endodontic treatment. 
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August 2014

Immunological evaluation of β-thalassemia major patients receiving oral iron chelator deferasirox.

J Coll Physicians Surg Pak 2014 Jul;24(7):467-71

Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

Objective: To determine the immune abnormalities and occurrence of infections in transfusion-dependent β-thalassemia major patients receiving oral iron chelator deferasirox (DFX).

Study Design: An observational study.

Place And Duration Of Study: Hematology Clinics, King Khalid University Hospital, Riyadh, Saudi Arabia, from July to December 2010.

Methodology: Seventeen patients with β-thalassemia major (12 females, median age 26 years) receiving deferasirox (DFX) for a median duration of 27 months were observed for any infections and had their immune status determined. Immune parameters studied included serum immunoglobulins and IgG subclasses, serum complement (C3 and C4) and anti-nuclear antibody (ANA) level, total B and T-lymphocytes, CD4+ and CD8+ counts, CD4+/CD8+ ratio, and natural killer (NK) cells. Immunological parameters of the patients were compared with age, gender, serum ferritin level and splenectomy status. Lymphocyte subsets were also compared with age and gender matched normal controls.

Results: A considerable reduction in serum ferritin was achieved by DFX from a median level of 2528 to 1875 μmol/l. Serum IgG levels were increased in 7 patients. Low C4 levels were found in 9 patients. Total B and T-lymphocytes were increased in 14 patients each, while CD4+, CD8+ and NK cells were increased in 13, 12 and 11 patients respectively. Absolute counts for all lymphocyte subsets were significantly higher compared to the normal controls (p ² 0.05 for all parameters). Raised levels of IgG were associated with older age, female gender, splenectomized status and higher serum ferritin levels but this did not reach statistical significance except for the higher ferritin levels (p=0.044). Increased tendency to infections was not observed.

Conclusion: Patients with β-thalassemia major receiving DFX exhibited significant immune abnormalities. Changes observed have been described previously, but could be related to DFX. The immune abnormalities were not associated with increased tendency to infections.
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http://dx.doi.org/07.2014/JCPSP.467471DOI Listing
July 2014

Autoantibody detection: prevailing practices at a tertiary care hospital in Riyadh.

Clin Lab 2014 ;60(4):671-5

Background: Anti-nuclear antibody (ANA) test as the first level investigation for detection of auto-immune rheumatic disease has been recommended in a number of international guidelines. This study was performed to evaluate the local practice and trends of auto-antibody laboratory requests.

Methods: Data were collected from 249 initial laboratory requests for first level auto-antibody detection between April 2012 and April 2013 in the Immunology Unit at King Khalid University Hospital, Riyadh. This group of patients included 151 females and 98 males (mean age 40.1 +/- 21; range 4-85 years).

Results: Of the total requests, ANA as a single first level investigation was requested by only 32 (13%) clinicians whereas the rest of the investigations included simultaneous testing of ANA and second level extractable nuclear antigen (ENA) auto-antibody tests. Anti-double stranded DNA (anti-dsDNA) antibody was simultaneously tested with ANA in 158 patients as first level test where both the tests were positive in 44 (27.8%) patients and in 24 (15.1%) patients a negative ANA test was associated with a positive anti-dsDNA antibody test. Rheumatoid factor (RF) tested positive in 04/53 (7.5%), anti-neutrophil cytoplasmic antibody (ANCA) in 01/48 (2%) and SS-A and SS-B in 03/37 (8.1%) requests as first level tests with ANA.

Conclusions: Using second level auto-antibody tests in conjunction with ANA as the first line investigation does not appear to be a cost effective approach, highlighting the importance of adherence to the guidelines. ANA negative and anti-dsDNA positive group of patients requires further assessment in a large scale study.
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http://dx.doi.org/10.7754/clin.lab.2013.130632DOI Listing
May 2014

Q fever: a neglected zoonosis in Saudi Arabia.

Ann Saudi Med 2013 Sep-Oct;33(5):464-8

Dr. Adel Almogren, Pathology, Immunology Unit,, College of Medicine, King Saud University,, PO Box 2925 Riyadh 11461,, Saudi Arabia, T:966-11-467-1843, F:966-11-467-1925,

Background And Objectives: Infection due to Coxiella burnetii (C burnetii), the causative agent of Q fever is rarely sought for in clinical practice. This study was performed to detect C burnetii infection in patients with pyrexia of undetermined cause (PUC).

Design And Settings: This is a prospective study conducted at King Khalid University Hospital, Riyadh be.tween March 2011 and January 2013.

Patients And Methods: A total of 3 mL venous blood was collected from 51 patients with PUC at King Khalid University Hospital, Riyadh. This group of patients included 30 males and 21 females (mean age 33.9 [21.3] years) with the history of febrile illness ranging between 4 and 8 weeks. A control group of 50 healthy individuals comprising 39 males and 11 females (mean age 27 [9] years) was also included in the study. Detection of phase II C burnetii-specific IgG antibodies was performed by immunofluorescence assay, and a titer of > 1:64 was considered positive.

Results: Phase II C burnetii-specific IgG antibodies were detected in 18 (35.2%) patients out of the total 51 tested. Two (4%) individuals out of 50 in the control group tested positive for anti-C burnetii IgG antibodies. The proportion of positive results among the patients was significantly higher than the controls (P < .0002, 95% CI, 15.09-46.25). The antibody titer range was between 1:128 and 1:1024 where 6 patients had titers of 1:256, 5 had 1:512, 4 had 1024, and 3 had 1:128.

Conclusion: The evidence of C burnetii infection in a sizable number of patients emphasizes the need for inclusion of serologic investigations for Q fever in patients with PUC.
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http://dx.doi.org/10.5144/0256-4947.2013.464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074889PMC
August 2014