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   Table of Contents - Current issue
July-September 2020
Volume 3 | Issue 3
Page Nos. 143-229

Online since Thursday, July 2, 2020

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Non-COVID-19 research and publications must never be at the mercy of COVID-19 research p. 143
Ahmed S BaHammam, Haitham Jahrami, Moez Al-Islam Faris
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Hemoglobinopathy correction with CRISPR or not; gene therapy is the solution p. 146
Bader Al Alwan, Arwa A Alsubait, Bahauddeen M Alrfaei
Hemoglobin (Hb) disorders or hemoglobinopathies are groups of blood conditions involving inherited genetic diseases – mostly as single-gene autosomal recessive – that lead to the formation of abnormal Hb structure or inadequate to no production of globin chains in Hbs. Disorders of Hb are a global concern since these diseases can cause severe morbidity and early mortality of the affected populations. Treatments vary between chemicals and molecular approaches. The most promising approach is Hb correction. However, the stability of the correction faces a big challenge along with safety concerns. It is worth noting that most of the inherited hemoglobinopathies share common clinical presentations and laboratory findings, although some have distinct features. Hemoglobinopathies with emphasis on recent advances in gene therapy targeting sickle cell disease and thalassemia are discussed in this review.
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Coronavirus disease-2019 pandemic in the Kingdom of Saudi Arabia: Mitigation measures and hospital preparedness Highly accessed article p. 155
Mazin Barry, Leen Ghonem, Aynaa Alsharidi, Awadh Alanazi, Naif H Alotaibi, Fatimah S Al-Shahrani, Fahad Al Majid, Ahmed S BaHammam
Coronavirus disease-2019 is currently causing a world pandemic. The Kingdom of Saudi Arabia (KSA) reported its first case on March 2, 2020. Due to its potential rapid dissemination within the public and a large probability of a countrywide outbreak, along with the country's experience in battling another similar coronavirus (the Middle East respiratory syndrome–coronavirus), the KSA was among the leading bodies in the world for its swift community action and hospital preparedness.
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Evaluating the long-term patient satisfaction, esthetic harmony, and creeping attachment levels in patients treated with gingival augmentation surgery: A retrospective study p. 159
Mustafa Ozay Uslu
Objective: Free gingival grafts (FGGs) are commonly used for increasing the keratinized tissue and root coverage in gingival recessions (GRs). The aim of this retrospective study was to evaluate the long-term patient satisfaction ratings, esthetic adaptation of graft, and creeping attachment (CA) levels after FGG surgery. Methods: Thirty-five surgical areas from thirty patients with Miller Class I, II, and III GRs were included in the study. GRs were treated with FGGs, and palatal donor area was covered with the same surgical pack in all patients. Gingival index (GI), bleeding on probing (BoP), probing depth, plaque index (PI), vertical and horizontal GRs (VGR and HGR, respectively), keratinized gingiva width (KGW), keratinized gingiva thickness (KGT), CA, evaluating the esthetic harmony with modified Manchester Scar Scale (mMSS), and patient satisfactory ratings were collected at the 1st month, 6th month, and 5th year control. Descriptive statistical methods as well as distribution of the data were evaluated by the Shapiro–Wilk test, the Friedman test was used in comparison of three and more dependent groups, and the Wilcoxon test was used in comparison of two dependent groups. Results: The mean follow-up period was 76.91 ± 7.60 months. The last control measurements of clinical parameters such as GI, PI, BoP, VGR, HGR, and mMSS measurements were statistically significantly lower than the baseline and 1st-month measurements (P < 0.01). The 1st-month, 6th-month, and last control measurements of KGW and KGT were statistically significantly higher than the initial measurements (P < 0.01). The last control CA measurements were statistically significantly higher than the 6th-month measurements (P < 0.01). Patient satisfaction ratings were between 2 and 3 at the last control and demonstrated a high satisfaction result. Conclusion: Within the limitations of this study, it can be stated that FGGs provide successful results in terms of esthetics and maintenance of the periodontal health and also patient satisfaction was at the highest level in the long term.
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Nusinersen in spinal muscular atrophy: Respiratory outcomes at tertiary care centers p. 165
Fahad Alsohime, Mohamad-Hani Temsah, Muneera Al-Jelaify, Hind Ali Bafaqih, Kamal El Masri, Ahmed Abusibah, Ayman Al-Eyadhy, Gamal Hasan, Ali Alhaboob, Majed Alabdulhafid, Mohammed Abdulrahman Almazyad, Abdulaziz Alghamdi, Fahad A Bashiri
Objectives: The objective of the study wasto describe the effect of nusinersen therapy and its 1st-year associated outcomes, weaning of ventilator support, and length of stay in pediatric intensive care among ventilator-dependent spinal muscular atrophy (SMA) patients. Methods: This is a multicenter, retrospective case series study that was conducted in four tertiary care centers in Saudi Arabia. We report all the genetically diagnosed SMA ventilator-dependent patients who were admitted to the pediatric intensive care unit (PICU) and received a course of nusinersen therapy from (January 2017 to March 2018). The study endpoints were success to wean or extubate the patient and discharge from the PICU. Results: Five patients from four tertiary PICUs were included in this report. All five patients received a minimum of four doses of nusinersen intrathecally as per the manufacturer. At 12 months postinitiation of therapy, only one patient showed clinical improvement, while the other four patients did not experience improvement in their respiratory status following the administration of nusinersen. These four patients are still admitted in the PICU due to the inability to wean them from respiratory support. The remaining patient was discharged to home successfully and neither require any home ventilatory support nor oxygen therapy. Conclusion: In conclusion, our clinical experience and data suggest that the response to nusinersen therapy is very likely but mostly dependent on the time of initiation of nusinersen therapy and the cumulative number of doses among other variables related to disease severity. However, further studies targeting a larger group of patients with better standardized respiratory care are needed to investigate the effect of nusinersen on particularly the long-term outcomes.
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Human papillomavirus associated with head and neck cancer in the Middle East and North Africa: A systematic review and meta-analysis p. 170
Shahad Saad Asiri, Dalia Abdullah Obeid, Fatimah Saeed Alhamlan
Background: Head and neck cancer (HNC) is associated with tobacco or heavy alcohol use and chronic human papillomavirus (HPV) infection. Aims and Objectives: In this systematic review and meta-analysis, we determined the HPV-associated HNC prevalence rates and potential factors affecting prevalence rates in the Middle East and North Africa (MENA) region. Materials and Methods: Between July and August 2019, we searched and collected 38 articles from PubMed and Medline databases related to head and neck squamous cell carcinoma and HPV in the MENA region. Of those articles, 25 met the inclusion criteria. Results: The overall pooled HPV prevalence rate of all HNC cases reported in the MENA region was 16% (confidence interval 95%, 12%–21%). HPV was found primarily in the salivary glands (20%) and tonsils (16%). The characteristics of patients associated with HPV-driven HNC were being male, having a benign tumor, and using tobacco. The genotypes most strongly associated with HNC in the MENA region were HPV-16 followed by HPV-18. The highest reported prevalence rates of HPV-associated HNC were in Turkey (48%) and Palestine-Israel (31%), whereas the lowest were in Yemen (2%) and Saudi Arabia (4%). HNC-associated HPV prevalence decreased over time in the MENA region, from 19% during 1998–2010 to 15% during 2011–2014 to 12% during 2015–2019. Conclusion: Although the current prevalence of HPV-associated HNC in this region is low relative to rates observed elsewhere, HNC is typically fatal, and a global rise in HPV-driven HNC indicates that additional studies should be conducted in the MENA region to address this risk and to develop HPV awareness, screening, and vaccination programs.
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Studying the effect of silver nanoparticles synthesized by ulva fasciata aqueous extract against liver toxicity induced by CCl4in rats p. 182
Fawzia A Alshubaily, Ebtihaj J Jambi, Sohair M Khojah, Maha J Balgoon, Maryam H Al-Zahrani, Nuha A Alkhattabi
Background: Researchers in recent years have been increasingly concerned with the production of synthesizing nanoparticles (NPs) applying plant extracts, as these NPs have low environmental risk and low human toxicity. The present study aimed to use Ulva fasciata (UF) as a reducing agent for the green synthesis of silver NPs (AgNPs) and to investigate the hepatoprotective effect of these NPs against CCl4. Methods: In this study, aqueous extract of UF was used for the reduction of silver nitrate. Results: The results revealed a spherical shape of the AgNPs that are well distributed in solution with a size ranging 9–37 nm and an optical absorption at 430 nm. A total of 28 rats used in this study were randomly divided into four groups each of seven animals; control group, UF AgNPs group (150 mg/kg body weight/20 days), CCl4group (2 ml/kg/20 days of 1:1 v/v mixture of CCl4and olive oil), and CCl4and UF-AgNPs group. The results showed that CCl4injection increases in liver function enzymes, level of urea and creatinine, hepatic oxidative stress (a significant increase in lipid peroxidation with a significant decrease in glutathione and antioxidant enzyme activities), and histopathological disorders of liver tissues as compared to control group. Rats received CCl4with UF- AgNPs showed significantly less severe damage and a remarkable improvement in the measured parameters when compared to CCl4rats. Conclusion: It is concluded that the aqueous extract UF can be used as an effective and eco-friendly reducing agent for the biosynthesis of AgNPs. Furthermore, AgNPs capped with UF can be used as a potent antioxidant and a hepatoprotective agent against the biochemical and histopathological alterations induced by CCl4toxicity in the liver tissues.
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Awareness of human papillomavirus and its vaccine among patients attending primary care clinics at King Saud University Medical City p. 189
Maha F Alrajeh, Sulaiman Abdullah Alshammari
Objectives: We aimed to assess the awareness, attitudes, and practice regarding human papillomavirus (HPV) and its vaccine among women attending primary care clinics in Riyadh. Methods: This cross-sectional study included 326 women aged 18–60 years who attended primary care clinics between June 2014 and June 2015. The participants completed a validated, self-administered questionnaire. Data collected included sociodemographic information (e.g., age, marital status, education, and employment), knowledge of HPV and its vaccine, and attitudes regarding HPV vaccine acceptance. Results: Among the respondents, 59.4% were married, and 43.6% had received a university education. The study population had a marked lack of information regarding HPV infection and vaccination. Only 32.8% of the women knew that HPV is transmitted sexually, while 21% knew that it could cause cervical cancer. A quarter of the participants were aware of the protective vaccine against HPV. There were no statistically significant differences in participants' knowledge levels, according to age, marital status, educational level, and occupational status. The doctors, the media, and the friends were the primary sources of information to 5.6%, 7.7%, and 24.5% of the participants, respectively. Conclusion: Overall awareness of HPV and its vaccine and cervical cancer screening is low among Saudi women. There is a need for formulating preventive strategies and effective awareness programs for better HPV-related education, vaccine availability, and the importance of cervical cancer screening.
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Lack of association between interleukin 13, interleukin 4 receptor alpha, andMS4A2 gene polymorphisms and asthma in adult Saudis p. 196
Eman A Al Abdulsalam, Mohamed S Al-Hajjaj, Mohammad S Alanazi, Arjumand S Warsy
Objectives: Several genes, including interleukin-13 (IL13), MS4A2, and IL 4 receptor alpha (IL4Rα), have been shown to associate with the inflammatory process in asthma. We investigated the possible association between asthma and five single-nucleotide polymorphisms (SNPs) in the IL13, IL4Rα, and MS4A2 gene in comparison with the level of the IL-13 protein in the Saudi asthmatics and controls. Subjects and Methods: The study group included 50 adult asthmatic patients and 50 normal healthy controls. Blood was extracted, and DNA was prepared. Genotyping was performed on DNA using direct sequencing for four SNPs (rs20541, rs1800925, rs1801275, and rs569108), and real-time polymerase chain reaction allelic discrimination to study rs1805010 polymorphism. Levels of IL-13 were measured in plasma using (enzyme-linked immunosorbent. Genotype and allele frequencies were calculated for each SNP. Results: The results showed that GG genotype of rs1801275 in the IL4Rα gene was more common in the asthmatic patients compared to the control group, though the results did not show any statistical significance (P < 0.08). Conclusions: No significant association was observed for any of the other SNPs examined. Of all the SNPs analyzed, only rs1801275, an A > G transition nonsynonymous mutation, resulting in the substitution of glutamine by arginine showed an association, but it was statistically not significant. Interestingly, presence of the mutant allele of both SNPs of IL-13 gene significantly elevated IL-13 level. Comparison of the Saudi results with those of other populations, showed several significant differences. We conclude that further more detailed studies are necessary in Saudis to identify the contribution of SNPs in cytokine genes in asthma development.
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A protocol advocating delayed surgical management of pediatric treadmill friction burn of the hand p. 204
Adnan Ghazi Gelidan
Introduction: Treadmills are common exercise machine used in households. The high-speed running pad can result in serious injuries to children's hands in the form of friction burns. These friction burns can be severe enough to require surgical intervention and prolonged wound care, frequently resulting in hypertrophic scarring and functional contracture. Materials and Methods: Retrospective data were collected for all pediatric patients who underwent surgical procedure for digit contracture secondary to treadmill friction burn between January 2017 and October 2019. Collected data included age, sex, percentage of burn, number of digits involved, duration of nonsurgical conservative treatment, course of surgical treatment, joints involved, degrees of joint flexion, and skin graft donor sites. Results: A total of 13 patients with a mean age of 4.77 years underwent delayed surgical correction of digit flexion contracture secondary to hypertrophic scar that involved the metacarpophalangeal joint, proximal interphalangeal joint, or distal interphalangeal joints that involved release of contracture full thickness skin graft (FTSG), and Kirschner (K-wire) fixation. Middle and ring fingers were the most commonly affected, with the left hand more involved than the right (9:4). Conclusion: Pediatric friction treadmill burn injury is a rising public health issue. The victims are mainly children younger than 10 years of age. The volar hands and digits are most frequently affected. Resulting flexion contracture will significantly affect hand function. In our series, delayed release of contracture, FTSG, and K-wire fixation was a treatment protocol which resulted in excellent preservation of hand function and minimal complication.
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Baseline characteristics of patients with type 2 diabetes mellitus initiating dapagliflozin in Saudi Arabia: Results from postauthorization safety study p. 210
Abdullah M Alguwaihes
Context: There are limited reports in the literature regarding treatment with dapagliflozin in actual clinical settings in Saudi Arabia. Aims: The primary objective is to examine the safety profile of dapagliflozin in uncontrolled patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia. In this brief report, we describe the baseline characteristics of patients initiating dapagliflozin in Saudi Arabia. Settings and Design: Prospective regulatory postmarketing study that was conducted in governmental and private hospitals in Riyadh and Jeddah, Saudi Arabia. Subjects and Methods: Five hundred T2DM patients initiating dapagliflozin at the decision of the treating physician as indicated by the Saudi Food and drug authority. Statistical Analysis Used: Data were statistically described in terms of frequencies and percentages for categorical variables. Mean, standard deviations (SD), minimum and maximum were used to describe the numerical variables. Results: At baseline, a total of 503 patients (female 38.8%, male 61.2%, and mean [SD] age 50.9 [10.1] years) were eligible for the analysis. Their mean body mass index was 32.8 (6.5) kg/m2. The mean duration of diabetes was 8.9 (8.3) years. Comorbidities were reported in 62% of our eligible population: 50.5% with hyperlipidemia and 39.6% with hypertension. Mean HbA1c at baseline was 8.6 (1.6) %, mean fasting blood glucose was 183.2 (70.1) mg/dL, and mean postprandial blood glucose was 237.8 (94.1) mg/dL. Conclusion: Recruited patients were matching our eligibility criteria and were representing average diabetic patients in the local community.
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Utilizing a risk assessment and mitigation measure checklist to reduce the threat of coronavirus disease-2019 outbreak in social gatherings p. 214
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The impact of the Corona Virus Disease-2019 (COVID-19) pandemic extends beyond the health dimension alone and has also simultaneously affected the socioeconomic domains. It is noteworthy that in some of the nations, outbreaks of the disease have been linked with religious gatherings, which acts as a ground for rapid transmission of the disease, if appropriate prevention and control measures are not taken. Under ideal scenario, as long as the threat of the pandemic looms over the world, it is best to avoid any social or religious gatherings and encourage virtual meetings with the help of the religious leaders. However, if the gathering is a must and cannot be avoided, it should be planned after conducting the risk assessment and checking for mitigation measures. In conclusion, it is extremely important that a systematic approach of risk assessment and assessment of mitigation measures is done before any social gathering is planned, as there is a potential risk of onset of new chain of transmission of COVID-19 infection, which in turn can have serious after effects.
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Topiramate: Is it friend or hostile to the patients? p. 216
Akram Askar
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Biological activities of bisdesmethoxycurcumin p. 219
Roopesh Jain
Bisdesmethoxycurcumin (about 3%) is one of the three principal forms of Curcuminoids and reported to be more stable than the other two curcuminoids. Considering its pharmacological effects, the objective of this study was to assess antioxidant and anti-inflammatory potential of bisdesmethoxycurcumin. The study revealed that bisdesmethoxycurcumin downregulates tumor necrosis factor alpha-induced nuclear factor-kappa B expression and has highest antioxidant activity among curcuminoids.
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COVID-19: Containment strategies and management options p. 221
Falah Hasan Obayes AL-Khikani
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The role of blood group in COVID-19 Infection: More information is needed Highly accessed article p. 225
Falah Hasan Obayes AL-Khikani
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Erratum: Arabic validation of problematic use of mobile phone scale among university students in Saudi Arabia p. 227
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Erratum: Community awareness of noise-induced hearing loss from portable listening devices and possible preventive measures p. 228
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Erratum: Diagnostic accuracy of fine-needle aspiration cytology with histopathology of thyroid swellings in King Abdulaziz Medical City p. 229
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