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   Table of Contents - Current issue
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January-March 2020
Volume 3 | Issue 1
Page Nos. 1-77

Online since Monday, January 6, 2020

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EDITORIAL  

Hookah and cigarette smoking: Two sides of the same coin p. 1
Ahmed Salem BaHammam
DOI:10.4103/JNSM.JNSM_71_19  
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REVIEW ARTICLES Top

Laboratory diagnosis of encephalitis: New insights into areas of uncertainty p. 3
Deema A Alokaili, Mustafa A Salih, Ali Mohammed Somily
DOI:10.4103/JNSM.JNSM_4_19  
Encephalitis is a serious clinical syndrome, which presents with a wide range of severity. Some cases might be missed due to non specific symptoms, especially in old debilitated patients and immunocompromised host. In this review, we cover the various clinical presentations of this syndrome and provide an overview of laboratory testing that can be performed in routine clinical microbiology laboratories and reference laboratories. Recently, the advance in medical care and advancing age of our patient population, as well as increased number of immunocompromised conditions either due to post chemotherapy, human immunodeficiency virus, transplant and autoimmune diseases complicated both clinical and laboratory diagnosis of encephalitis. Other noninfectious differential diagnoses of encephalitis should be ruled out with appropriate tests. There has been tremendous development in advanced laboratory testing including multiplex polymerase chain reaction, and next-generation sequencing requiring tedious validation and cost-effectiveness study to justify wise clinical utilization for these tests in the management of patients with encephalitis. Understanding of the interpretation of these new tests by treating physicians though better communication with medical microbiologists is required. Whole-genome sequencing is a new molecular test that enables us to detect a rare pathogen or even a new pathogen with a high degree of sensitivity and specificity if the standard recommendations are followed. The use of these tests should be available for specific clinical indications in an accredited reference laboratory for better utilization. Preanalytical parameters such as type of sample collected, tests requested, transportation, and storing of sample, could all affect the result of the test performed.
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Review of the efficacy of ultraviolet C for surface decontamination p. 8
Abba Amsami Elgujja, Haifa Humaidan Altalhi, Salah Ezreqat
DOI:10.4103/JNSM.JNSM_21_19  
Evidence has shown that the state of the patient care environment has a direct impact on heightening the risks of hospital-acquired infections among patients admitted in hospitals. Moreover in view of the suboptimal standard of cleanings by housekeeping staff, there has been the quest for a better approach to reliably disinfect environmental surfaces in health-care facilities. The ultraviolet light has been known for its antimicrobial property and has been used in water treatment, food processing, and in-duct cleaning of ventilations. A recent introduction of its use for surface decontamination has raised interest among health-care facilities. However, studies have shown that, in spite of its relative success in other applications, there is doubt in its efficacy in decontaminating shadowed areas of the room, and therefore, may not be seen as justifying its capital intensiveness.
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Virulence markers, phylogenetic evolution, and molecular techniques of uropathogenic Escherichia coli p. 13
Etefia U Etefia, Solomon A Ben
DOI:10.4103/JNSM.JNSM_31_19  
Urinary tract infections are very significant public health concerns globally with most of them being caused by uropathogenic Escherichia coli (UPEC). The wide range of genetic makeup of UPEC due to the acquisition of specialized virulence genes located on mobile genetic elements called pathogenicity islands is the rationale behind colonization of the urinary tracts of humans as against diarrheagenic E. coli pathotype. Indebt understanding of the virulence mechanisms and pathogenesis of UPEC lies in the knowledge of the molecular techniques of UPEC which have advanced tremendously. This review has carefully summarized the unique virulence markers, the phylogenetic evolution, and molecular techniques used in the studies of pathogenesis and virulence of UPEC.
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Source of blood and its consumption at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia p. 23
AM Abdel Gader, Abeer K Al Ghumlas
DOI:10.4103/JNSM.JNSM_25_19  
The King Khalid University Hospital (KKUH) blood bank undertakes all the functions of blood transfusion service, from the recruitment of donors to the issue of blood products to patients. Currently, the blood bank depends on a mixture of replacement and voluntary donations. The blood bank had a previous experience of organizing a successful centralized King Saud University student donor drive which in the years 1885 to 1990 collected over 4000 blood units that almost covered KKUH blood needs. However, due to administrative difficulties, this drive did not continue. The main blood products consumed at the KKUH are packed red blood cell (PRBC), fresh frozen plasma (FFP), and platelet concentrate (PC). Long-term audits of their consumption showed that their consumption initially increased slowly with the total hospital admissions up to the year 1995 and then fell sharply to its lowest level in the year 2000: FFP dropped by 30.9%, PRBC by 27.8%, and PC by 48.6%. From 1995 onward, the total hospital patient admissions remained stable around 32,000 patients. The drop in consumption was taken to represent the magnitude of the inappropriate use of these products. This drop in consumption coincided with and was attributed to the widespread “HIV scare” that blood transfusion can transmit the infection, which made both patients and physicians reluctant to resort to blood therapy. There is a need to make sure that guidelines for the use of blood products are followed by all involved in the blood transfusion from blood collection to infusion into patients. These guidelines need to be supported by educational efforts targeting all those involved in hemotherapy, particularly physicians and nurses.
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ORIGINAL ARTICLES Top

Consanguinity in unexplained recurrent pregnancy loss and preterm delivery among Saudi females p. 33
Arjumand S Warsy, Afrah Alkhuriji, Bashaier Abdullah A. Al-Marry, Atikah Abdullah Alraqibah, Amal Awad Alharbi, Zainb Babay, Mohammed Addar, Maha Daghestani
DOI:10.4103/JNSM.JNSM_5_19  
Objectives: Consanguinity is considered as a factor which influences reproductive health. This study aimed to investigate the role of cousin marriages on the occurrence of recurrent pregnancy loss (RPL) and preterm delivery (PTD) in Saudi females. Methods: The study included 300 Saudi women (RPL = 100; PTD = 50; control = 150). Demographic and clinical data were entered on forms specially designed for the study, and the women were interviewed about the relationship with their husbands. The degree of consanguinity as the first and second cousins was recorded, and the prevalence of PTD and RPL was calculated in consanguineous and nonconsanguineous marriages. Results: The results revealed that consanguinity occurs at a higher frequency in RPL and PTD (RPL = 55%; PTD = 52%) compared to the control group (36%) and the difference compared to the controls were statistically significant for both PTD and RPL (P < 0.05). Conclusion: The results of this study show that the frequency of consanguinity is significantly higher in the females giving preterm birth (PTB) and those with RPL. Since consanguinity increase homozygosity of autosomal recessive conditions, our result implicates the involvement of some autosomal recessive genes, in the pathogenesis of PTD and RPL. Further studies are required to identify gene mutations or polymorphisms which are involved in early fetal loss and PTD, conduct genetic screening for such genetic mutations and polymorphisms, and conduct genetic counseling to decrease the frequency of both conditions. Furthermore, there is a greater need to increase awareness about complications that may occur among consanguineous families, in an attempt to decrease the frequency of consanguinity.
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The effect of monetary incentives on promoting weight loss in individuals with obesity p. 39
Assim A Alfadda, Norah A Alsaber, Amr S Moustafa, Shaffi A Shaik
DOI:10.4103/JNSM.JNSM_8_19  
Objectives: This study evaluated the effect of a cash reward program on promoting weight loss and whether this effect will last after 1 year of follow-up. Materials and Methods: This is a retrospective analysis of a 4-month program that provides cash reward for losing weight. The study individuals were weight loss program participants, aged 18–65 years, reached after 1 year (n = 162). Participants were categorized according to their main reason for joining the program as follows: those for whom incentive was the primary reason to enroll (incentive-motivated) and those who participated mainly to lose weight regardless of the incentive (self-motivated). Results: There was a significant weight loss in all participants at the end of the 4-month program compared with that at baseline (89.49 ± 18.86 vs. 96.09 ± 20.38 kg,P < 0.001). Approximately 58% of all participants lost ≥5% of their initial body weight, and almost 55% remained above this threshold at 1 year. The incentive-motivated group lost more weight than the self-motivated group at the end of the program but did not lose any further weight, whereas the self-motivated group continued to lose weight. After 1 year, both groups had achieved the same weight loss. Conclusions: The cash reward program was effective in inducing short-term weight loss. The optimal duration for financial incentive-based programs in inducing a sustainable weight loss and their cost-effectiveness are important questions for further investigation.
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Sensitivity and specificity of a Middle East respiratory syndrome screening tool used in the emergency department p. 44
Sami Alsolamy, Anas Khan, Sami Yousef, Faisal Alghusen, Ahmad Alsalman, Abdulaziz Alnaim, Majid Alsalamah, Najla Alassim, Thamer Alenazi, Nawfal Aljerian, Yasser Alaska
DOI:10.4103/JNSM.JNSM_15_19  
Background: Middle East respiratory syndrome coronavirus (MERS-CoV) infection becomes a global health issue because of its ability to spread rapidly, especially in healthcare settings. Improper triage of MERS-CoV-infected patients in the emergency department (ED) increases the risk of infection in healthcare providers and other patients. Having a good triage screening tool would improve early detection and isolation of suspected infected patients, thus preventing future outbreaks. Materials and Methods: This is a retrospective cohort study performed in a large urban, academic ED in a tertiary care center in Riyadh, Saudi Arabia. The aim of the study was to assess the accuracy of the triage screening tool used in the ED. A convenience sample of 734 patients visiting the ED during the 2015 MERS-CoV outbreak was included. Patients deemed positive were isolated and underwent MERS-CoV polymerase chain reaction (PCR) testing. Patients deemed negative were followed up via phone after two weeks of their ED visit. They were checked for the development of symptoms and whether the patients sought medical advice in another hospital or underwent MERS-CoV PCR testing. Results: The sensitivity of the screening tool for detecting PCR-positive MERS-CoV infection was 100% (95% confidence interval [CI]: 15.8–100), and the specificity was 78.2% (95% CI: 75.1–81.2). Conclusions: The ED triage screening tool used during the 2015 MERS-CoV outbreak is highly sensitive. It is effective for early detection of infection in the ED, thus allowing timely isolation of suspected patients.
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Does hookah smoking carry less cardiovascular risks than cigarette smoking in patients presenting with myocardial infarction? p. 48
Turki B Albacker, Rakan Barghouthi, Ibrahim Al Fawaz, Yazeed Al Saadan, Mahmood Tokhta, Abdulaziz Alkorbi, Sayed Abou Almakarem, Moustafa Refaie, Khalid Eskandar
DOI:10.4103/JNSM.JNSM_26_19  
Introduction: Smoking is an important risk factor for cardiovascular diseases. There is an increase in the prevalence of hookah smoking in both genders and among all age groups in Saudi Arabia with the misconception that hookah smoking carries less risk than cigarette smoking.Objective: Our aim in this study was to compare the outcomes of hookah versus cigarette smoking in patients presenting with myocardial infarction (MI). Methodology: In this retrospective study, we included 246 patients who presented with MI between May 2014 and October 2016. The prevalence of smoking was 56.5% in this group. The smokers were divided into two groups: hookah smokers and cigarette smokers. Propensity matching was performed to control for differences in patients' characteristics. The outcomes of in-hospital mortality, number of diseased vessels, type of intervention, and recurrence of ischemia were compared between the two groups. Results: Among the 139 smokers, 35 were hookah smokers (25%) and 104 were cigarette smokers (75%). The median number of cigarettes or cigarette equivalent per day was similar between the two groups (20). Both groups had similar outcomes in the number of diseased vessels, type of intervention, recurrence of symptoms, and mortality (hookah = 4.9% and cigarettes = 2.9%, P = 1). Conclusion: These findings support the fact that hookah smoking carries the same harmful effect as cigarette smoking on patients with MI and that the risk might be related to the number of cigarettes smoked per day rather than the type of smoking.
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Quality of life of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia p. 53
Sultan Mohammed Alshehri, Abdulrhman Faeq Alzamil, Rayan Ibrahim Alturki, Humoud Auoad Alhoraim, Riyadh Ali Alghamdi, Mohammed Salman Almutairi, Emad Mohammad Masuadi, Abdullah Mohammed Algarni
DOI:10.4103/JNSM.JNSM_28_19  
Introduction: Measurement of quality of life (QoL) can be an important tool for the comprehensive care of the patients. This study was designed to assess the QoL of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia, and examined its association with sociodemographic variables and also identified the worst type of cancer. Materials and Methods: This cross-sectional study involved 178 participants who met the selection criteria: adult Saudi patients (≥18 years) who had been diagnosed with cancer, were documented in the health care system, and were cognitively able to answer the questionnaire. Those who underwent any surgical, hormonal, radiation, or chemotherapy within 2 weeks were excluded from the study. Patients are recruited by nonprobability convenience sampling between December 20, 2017, and January 1, 2018. Data were obtained using an Arabic version of the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ)-C30 developed, translated, and validated by the EORTC. QLQ-C30 measures three domains: functional, symptoms, and global QoL. Results: The younger (≤29 years) the patients, the better their global QoL. Women had a trend to score worse in all domains but only statistically significant in dyspnea (P < 0.05). Furthermore, patients with high school education and higher exhibited better physical function (PF) than illiterate patients. Multivariate analysis revealed gastric cancer as the most distressing cancer in terms of global QoL (P < 0.01), whereas patients with hematologic and genitourinary cancers trended high scores but insignificant. Moreover, patients with Stage I–II disease had better scores for PF, role function, social function, and anorexia compared with Stage III–IV disease. Conclusion: The QoL of cancer patients is a useful barometer of their overall health. It can also indicate the impact of different types of cancer on QoL. Sociodemographic variables, such as age, gender, level of education, diagnosis, and stage, can affect the QoL of cancer patients.
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Knowledge, attitude, and practice of influenza vaccineamong health-care employees in Sultan Bin Abdulaziz Humanitarian City p. 59
Mariam H Alghamdi, Sulaiman Abdullah Alshammari
DOI:10.4103/JNSM.JNSM_27_19  
Objectives: This study aimed to investigate the knowledge, attitudes, and practices (KAP) of health-care employees (HCEs) in Sultan Bin Abdulaziz Humanitarian City (SBAHC) toward influenza vaccine. Methodology: We conducted this cross-sectional study between November and December 2018. The study population included all HCEs. We recruited eligible participants through stratified random sampling. Data collection was done using a validated questionnaire, comprising 19 questions and designed to explore the KAP of influenza vaccine among HCEs. Results: A total of 391 HCEs completed the electronic questionnaire. Overall, 66% of them had received the influenza vaccine and 44.8% of them had received the vaccine from SBAHC. The number of participants who reported direct involvement with patient care was 292 (74.7%). The primary reasons attributable for not receiving the influenza vaccine at all over the past years ranged from a belief that it was not effective, to the unavailability of the vaccine during the night shift. The primary reasons for not receiving it annually, among those who had been vaccinated at least once in the same period, ranged from lack of time to being away during the vaccination campaigns. Participants who were planning to get the vaccine in the present year accounted for 30.7% of the sample. Conclusion: The low number of participants intending to get the vaccine in the present year can be attributed to inadequate knowledge, false beliefs, and fears regarding the vaccine efficacy and safeness. An extensive campaign aimed at promoting vaccination is recommended. Although physicians are quite clear about the importance of vaccine, aggressive educational campaign to increase vaccination rate is still needed for nurses, allied health professionals, and support staff.
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Safety of rituximab on testicles, a double-blindedcontrolled trial in mice p. 66
Sultan Mogren Al-Mogairen
DOI:10.4103/JNSM.JNSM_38_19  
Objectives: Rituximab (RTX) is a biologic agent used for rheumatic and autoimmune disorders. RTX is a drug indicated for the treatment of patients with refractory rheumatoid arthritis patients who have not responded to nonbiological therapy and one or more anti-tumor necrosis factor-α drugs. The purpose of this trial was to investigate the RTX effects on testes in BALB/c mice by histology. Materials and Methods: A total of 20 mice were divided into two groups. Ten mice were subjected to weekly subcutaneous (SC) injection of RTX (0.31 mg/25 g body weight, in a final volume of 0.03 ml normal saline [NS] solution) for only the first 4 weeks. For the control group, ten mice were subjected to weekly SC injection of 0.03 ml NS solution. At the 10th week after first SC injection, mice were sacrificed, and histological analysis of tests was performed. Results: One out of ten mice died in the RTX-tested group; meanwhile, the remaining mice and the NS-tested group mice showed no abnormal histological findings. Conclusion: This is the first experimental animal trial which demonstrated that RTX treatment may not elicit testicular toxicity.
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CLINICO-PATHOLOGICAL PEARLS Top

A puzzling case of brain disease following cutaneous lesions in childhood: A spectrum of disease or induced by therapy? p. 71
Khaldoon Aljerian, Latifa Alanazi, Waleed Al Rajban, Mohammed Mubarak, Mohammed Khalifah, Abdulrahman Alsultan
DOI:10.4103/JNSM.JNSM_7_19  
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Green discoloration of the serum and influence on analytical variation p. 74
Khalid Sumaily
DOI:10.4103/JNSM.JNSM_18_19  
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