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Alsaeed A, Alhaddad MJ, Alkhalifah RH, Abu Shaigah FA, Alshehab MM, Alali ZH, Ebrahim SH, Abdulla HM, Al Ibraheem GA, Al Bensaad GA, Alaliw WA, Alsheef HJ, Altriki MY, Alkhalaf AA. Prevalence of Chronic Kidney Disease in People Living With HIV Following in Dammam Medical Complex, Saudi Arabia. Cureus 2024; 16:e51947. [PMID: 38333467 PMCID: PMC10852097 DOI: 10.7759/cureus.51947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Backgrounds People living with human immunodeficiency virus (HIV) are at a greater risk of chronic kidney disease (CKD) compared to people not having HIV. Evaluating the prevalence of CKD in people living with HIV in Dammam, Saudi Arabia was the main objective of this study. Methods This cross-sectional study included adult HIV patients who were followed at Dammam Medical Complex. The patients' demographic data, comorbid conditions, and HIV history were reviewed from their electronic medical records. Results A total of 729 patients were counted. The glomerular filtration rate (GFR) of 235 patients could not be estimated. The data for the remaining 494 patients were analyzed. The cohort consisted of 406 male patients (82.19%) and 88 female patients (17.81%). The mean ± standard deviation for the patients' age and HIV duration were 39.08±10.93 years and 4.37±3.15 years, respectively. Ten patients (2.02%) had a GFR of <60 mL/min/1.73 m2. Among 136 patients who had an estimated GFR of ≥60 mL/min/1.73 m2 and were tested by a urine examination, 27 patients (19.85%) had albuminuria. Combining the two figures resulted in an estimated prevalence of CKD in HIV patients of 21.47%. Only one patient (0.02%) was receiving dialysis. Conclusions The prevalence of CKD in people living with HIV in Dammam, Saudi Arabia was higher than the general population. The findings highlight the elevated risk of CKD among people living with HIV and emphasize the importance of regular monitoring and early detection of kidney dysfunction in this population.
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Affiliation(s)
- Ali Alsaeed
- Infectious Disease, Dammam Medical Complex, Dammam, SAU
| | | | | | | | | | - Zahra H Alali
- College of Medicine, Mansoura University, Mansoura, EGY
| | | | | | | | | | - Welaa A Alaliw
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Alsaeed A, AlKhalaf A, Alhudaifi A, Alwesaibi AA, Al Muhaif A, Alzaher W, Alsolami S. Castleman's Disease With Tongue Lesions in an HIV-Positive Patient From Saudi Arabia. Cureus 2023; 15:e50177. [PMID: 38186418 PMCID: PMC10771808 DOI: 10.7759/cureus.50177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder that presents with heterogeneous clinical manifestations. We present a case report of a 34-year-old male patient co-infected with CD and HIV, who exhibited tongue lesions along with systemic symptoms. Prompt diagnosis and appropriate management, including antiretroviral therapy (ART) and targeted treatment for CD, resulted in significant clinical improvement. This case highlights the challenges faced in managing CD with tongue involvement in the setting of HIV infection and emphasizes the importance of comprehensive management strategies.
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Affiliation(s)
- Ali Alsaeed
- Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | | | | | | | - Ali Al Muhaif
- Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Waad Alzaher
- Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Sana Alsolami
- Anatomical Pathology, Dammam Medical Complex, Dammam, SAU
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Alotaibi FF, Alshahrani A, Mohamed G, AlShamrani MA, Bin Amir H, Alsaeed A, Heji A, Alghanmi S, Alqurishi M, Alanazi A, Aldraye H, Asiri M, Alqahtani M, Alreshaid AA, AlKawi A, AlHazzani A, AlZawahmah M, Alokaili RN, Shuaib A, Al-Ajlan FS. Diagnostic accuracy of large and medium vessel occlusions in acute stroke imaging by neurology residents and stroke fellows: A comparison of CT angiography alone and CT angiography with CT perfusion. Eur Stroke J 2023:23969873231214218. [PMID: 37990504 DOI: 10.1177/23969873231214218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Neurology senior residents and stroke fellows are first to clinically assess and interpret imaging studies of patients presenting to the emergency department with acute stroke. The aim of this study was to compare the diagnostic accuracy of brain CT angiography (CTA) with and without CT perfusion (CTP) between neurology senior residents and stroke fellows. METHODS In this neuroimaging study, nine practitioners (four senior neurology residents (SNRs) and five stroke fellows (SFs)) clinically assessed and interpreted the imaging data of 50 cases (15 normal images, 21 large vessel occlusions (LVOs) and 14 medium vessel occlusions (MeVOs) in two sessions, 1 week apart in comparison to final diagnosis of experienced neuroradiologist and experienced stroke neurologist consensus. Interrater agreement of CTA alone and CTA with CTP was quantified using kappa statistics, sensitivity, specificity and overall accuracy. RESULTS Overall, arterial occlusions were correctly identified in 221/315 (70.1%) with CTA alone and in 266/315 (84.4%) with CTA and CTP (p < 0.001). The sensitivity of overall arterial occlusions detection with CTA alone was 94.2% (95% CI: 90.8%-96.6%) while with addition of CTP was 98% (95% CI: 95.6%-99.3%), The specificity of CTA alone was 74.7% (95% CI: 67.2%-81.3%) which increased with CTP to 84.4% (95% CI: 77.7%-89.8%). The likelihood of correct identification with CTA alone was 156/189 (82.54%) for LVOs and 65/126 (51.59%) for MeVOs. This increased to 169/189 (89.42%; p = 0.054) for LVOs and 97/126 (76.98%; p < 0.001) for MeVOs when the CTA images with CTP were viewed. There was good overall interrater agreement between readers when using CTA alone (k 0.71, 95% CI, 0.62-0.80) and almost perfect (k 0.85, 95% CI, 0.76-0.94) when CTP was added to the image for interpretation. CTA and CTP had a significantly lower median interquartile range (IQR) interpretation time than CTA alone (114 [IQR, 103-120] s vs 156 [IQR, 133-160] s, p < 0.001). DISCUSSION In cerebral arterial occlusions, the rate of LVO and MeVOs detections increases when adding CTP to CTA. The accuracy and time for diagnosing arterial occlusion can be significantly improved if CTP is added to CTA. As MeVOs are commonly missed by front-line neurology senior residents or stroke fellows, cases with significant deficits and no apparent arterial occlusions need to be reviewed with neuroradiological expertise.
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Affiliation(s)
- Fawaz F Alotaibi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Asma Alshahrani
- Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gamal Mohamed
- Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed A AlShamrani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hussain Bin Amir
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alsaeed
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alaa Heji
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suwaidi Alghanmi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alqurishi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Azhar Alanazi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hamad Aldraye
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muhannad Asiri
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alqahtani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman A Alreshaid
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Ammar AlKawi
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Adel AlHazzani
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed AlZawahmah
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyadh N Alokaili
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Fahad S Al-Ajlan
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
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Alsaeed A, Alkhadrawi Z, Alsadah B, Almudhry Z, AlBayat H, Alhadad F, Dahlawi A, Abu Ali B, Al Muhainy B, Alhaddad TA, Alhaddad MJ. Prevalence of the HLA-B*5701 Allele and Abacavir Hypersensitivity in Saudi HIV Patients: A Multicenter Study. Cureus 2023; 15:e48229. [PMID: 38050529 PMCID: PMC10693910 DOI: 10.7759/cureus.48229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Human immunodeficiency virus (HIV) incidence and prevalence are increasing in Saudi Arabia, with a total prevalence of 12,000 in 2020. Treatment of HIV patients includes multiple regimens that may involve abacavir (ABC), which is a potent drug for treating HIV and can be used as a single or combined pill. Unfortunately, its use was limited by the known associated hypersensitivity reaction (HSR). A worldwide literature review over the past decades reported that the incidence of ABC-related HSR is 5-8%. Methods The study was a cross-sectional multicentric study involving five governmental hospitals in Saudi Arabia and included all HIV patients who were following in these centers. Results Out of 3082 patients, 1293 were tested for HLA-B*5701. The prevalence for ABC-HSR is 1.59%, with variability among the five hospitals, with the highest in King Fahad Hospital in Hafuf (KFH-H) at 4.00% and the lowest in Dammam Medical Complex (DMC) at 0.49%. In previous studies, HLA-B*5701 associated with ABC-HSR varied among different ethnic groups. Our study showed that two patients developed ABC-HSR clinically while they were both negative for HLA-B*5701. Conclusion The fact that patients with negative genetic testing are still at risk of developing ABC-HSR makes continuing screening for HLA-B*5701 status essential, as the consequences of missing such a life-threatening HSR could be detrimental.
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Affiliation(s)
- Ali Alsaeed
- Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | | | | | | | - Hawra AlBayat
- Infectious Diseases, King Saud Medical City, Riyadh, SAU
| | - Fadel Alhadad
- Internal Medicine, Qatif Central Hospital, Qatif, SAU
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Alsaeed A, AlKhalaf A, Al Matar F, AlRamadan S, Al Muhaif A, Marzooq Z, Alaali Z. Unveiling Monkeypox: A Rare Case of Sexual Transmission in Saudi Arabia. Cureus 2023; 15:e47785. [PMID: 38022203 PMCID: PMC10676519 DOI: 10.7759/cureus.47785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
This case report describes the presentation, management, and clinical course of monkeypox in a 30-year-old female with multiple sexual partners admitted to Dammam Medical Complex, a major hospital in eastern Saudi Arabia. The patient presented with a rash on her inner thighs and vagina, accompanied by subjective fever and itching. A biopsy confirmed the diagnosis of monkeypox. Despite the absence of complications, the patient was isolated and received conservative therapy under the care of the infectious disease team. This case report highlights the effectiveness of conservative therapy in managing monkeypox, testing another possibility of sexually transmitted disease, and emphasizes the role of the infectious disease team in providing comprehensive care to patients with infectious diseases.
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Affiliation(s)
- Ali Alsaeed
- Infectious Disease Division, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Abdullah AlKhalaf
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Fatimah Al Matar
- Internal Medicine Residency Program, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Saleh AlRamadan
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Ali Al Muhaif
- Internal Medicine Residency Program, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Zahra Marzooq
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Zainab Alaali
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
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Alsaeed A, Alhaddad MJ, AlKhalaf AA, Alkhudair A, Alqannas N. Successful Treatment of Infective Endocarditis With Oral Antibiotics: A Case Report. Cureus 2023; 15:e43514. [PMID: 37719561 PMCID: PMC10500962 DOI: 10.7759/cureus.43514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Infective endocarditis (IE) is a serious and potentially life-threatening infection of the heart valves. It is commonly treated with prolonged courses of intravenous antibiotics, and in some cases, surgical intervention may also be necessary. While the use of oral antibiotics in the treatment of IE is generally limited, there are select cases where they may be considered as an alternative treatment option. Here, we report a case of staphylococcal right-sided IE successfully treated with oral antibiotics (linezolid and rifampicin). Our case highlights the potential for oral antibiotics to be used as step-down therapy for select patients with IE.
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Affiliation(s)
- Ali Alsaeed
- Infectious Disease, Dammam Medical Complex, Dammam, SAU
| | | | | | - Ashraf Alkhudair
- Saud Albabtain Cardiac Center, Dammam Medical Complex, Dammam, SAU
| | - Naif Alqannas
- Saud Albabtain Cardiac Center, Dammam Medical Complex, Dammam, SAU
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Alsaeed A, Alkhalaf A, Alomran A, Alsfyani W, Alhaddad F, Alhaddad MJ. Paxlovid for Treating COVID-19 Patients: A Case-Control Study From Two Hospitals in the Eastern Province of Saudi Arabia. Cureus 2023; 15:e39234. [PMID: 37337482 PMCID: PMC10277155 DOI: 10.7759/cureus.39234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an infectious disease that shortly progressed into an unprecedented pandemic spreading all over the world and causing millions of deaths. Many new COVID-19-specific therapies were suggested for the treatment of the patients at increased risk of progression to severe disease, especially those who were unvaccinated and those with a likely inadequate vaccine response. One of the preferred therapies in this setting is Paxlovid, a combination of the oral protease inhibitors nirmatrelvir and ritonavir. Paxlovid was authorized by the Saudi Ministry of Health for the treatment of mild to moderate COVID-19. This study aimed to report the effects of Paxlovid on the mortality of the COVID-19 patients at Dammam Medical Complex (DMC) and Qatif Complex Hospital (QCH), two hospitals in the Eastern Provence of Saudi Arabia, and compare the results with the international data. Methods The study was a retrospective study that included all the COVID-19 patients who were treated with Paxlovid at DMC and QCH between January and December 2022. Those patients were compared with control COVID-19 patients who did not receive Paxlovid. The patients were included irrespective of their COVID-19 vaccination status. All the patients were managed according to the Saudi Ministry of Health guidelines. They were followed up through the infectious disease virtual clinics and were monitored for ICU admissions and death of any cause for three months following their COVID-19 infections. Results A total of 92 COVID-19 patients were included. The patients consisted of 47 male and 45 female patients (51.09% and 48.91%, respectively). The mean ± standard deviation for the patients' age was 55.58±19.25 years. Twenty-eight patients were given Paxlovid (30.43%). Eighteen patients (19.57%) died. The use of Paxlovid was associated with lower ICU admissions (0.0% vs. 18.75%, P value <0.05) and with lower deaths (3.57% vs 26.56%, P value <0.05) but the Paxlovid group included less immunocompromised patients (7.14% vs. 60.94%, P value <0.001), cancer patients (0.0% vs. 42.19%, P value <0.001), and chronic kidney disease patients (7.14% vs. 29.69%, P value <0.05) than the control group. Conclusion This study suggests that Paxlovid is highly effective in reducing the risk of severe COVID-19 or mortality. However, larger studies with better qualities are needed for a full assessment of the role of Paxlovid in COVID-19 management in Saudi Arabia.
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Affiliation(s)
- Ali Alsaeed
- Infectious Disease Division, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Abdullah Alkhalaf
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Ali Alomran
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Walaa Alsfyani
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Fadhel Alhaddad
- Infectious Disease Division, Department of Internal Medicine, Qatif Cental Hospital, Qatif, SAU
| | - Mousa J Alhaddad
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
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Alhaddad MJ, Alsaeed A, Alkhalifah RH, Alkhalaf MA, Altriki MY, Almousa AA, Alqassim MJ, Alibrahim F. A Surge in Malaria Cases in the Eastern Health Region of Saudi Arabia During the COVID-19 Pandemic. Cureus 2023; 15:e37740. [PMID: 37213951 PMCID: PMC10192777 DOI: 10.7759/cureus.37740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/23/2023] Open
Abstract
Background Malaria transmission was stopped on most of the vast area of the Kingdom of Saudi Arabia. However, the pandemic of coronavirus disease (COVID-19) has negatively affected the efforts to control malaria. For instance, COVID-19 was reported to induce a relapse of malaria that is caused by Plasmodium vivax. Furthermore, physicians' attention toward COVID-19 can only result in neglect and delayed diagnosis of complicated malaria cases. These factors, among others, might have contributed to an increase of malaria cases in Dammam, Saudi Arabia. Thus, this study was conducted to examine the effects of COVID-19 on malarial cases. Methods The medical records of all patients who were treated at Dammam Medical Complex for malaria between July 1, 2018, and June 30, 2022, were reviewed. Malaria cases were compared between the pre-COVID-19 period (between July 1, 2018, and June 30, 2020) and the COVID-19 period (between July 1, 2020, and June 30, 2022). Results A total of 92 malaria cases occurred in the total study period. There were 60 cases of malaria in the COVID-19 period as opposed to only 32 cases in the pre-COVID-19 period. All the cases were imported from the endemic Saudi southern areas or from outside the country. Eighty-two patients (89.1%) were males. Most of them were Sundaneses (39 patients, 42.4%), Saudis (21 patients, 22.8%), and tribal peoples (14 patients, 15.2%). Fifty-four patients (58.7%) were infected with Plasmodium falciparum. Seventeen patients (18.5%) were infected with Plasmodium vivax. Another 17 patients (18.5%) had a mixed infection with both Plasmodium falciparum and Plasmodium vivax. A trend toward more infected stateless tribal patients was observed in the COVID-19 period compared to the pre-COVID-19 period (21.7% vs 3.1%). A similar trend was noticed for mixed malarial infections with both Plasmodium falciparum and Plasmodium vivax (29.8% vs 0%) with a P value of less than 0.01. Conclusion Malaria cases were almost doubled during the COVID-19 pandemic as compared to the pre-pandemic era signifying the negative effects of the pandemic on malaria epidemiology. The cases increased for a variety of causes that include alternation of health-seeking behaviors, changes in healthcare structures and regulations, and the interruption of malaria preventive services. Future research is needed to study the long-term effects of the changes imposed by the COVID-19 pandemic and to mitigate the effects of any future pandemic on malaria control. As two patients from our cohort were diagnosed with malaria based on blood smears, although they had negative rapid detection tests (RDTs), we recommend testing all the patients who are suspected to have malaria with both RDTs and peripheral blood smears.
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Affiliation(s)
- Mousa J Alhaddad
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Ali Alsaeed
- Department of Internal Medicine, Infectious Disease Division, Dammam Medical Complex, Dammam, SAU
| | | | - Makarem A Alkhalaf
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Arif A Almousa
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | | | - Fatimah Alibrahim
- Department of Internal Medicine, Infectious Disease Division, Dammam Medical Complex, Dammam, SAU
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9
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Alrashed A, Cahusac P, Mohzari YA, Bamogaddam RF, Alfaifi M, Mathew M, Alrumayyan BF, Alqahtani BF, Alshammari A, AlNekhilan K, Binrokan A, Alamri K, Alshahrani A, Alshahrani S, Alanazi AS, Alhassan BM, Alsaeed A, Almutairi W, Albujaidy A, AlJuaid L, Almalki ZS, Ahmed N, Alajami HN, Aljishi HM, Alsheef M, Alajlan SA, Almutairi F, Alsirhani A, Alotaibi M, Aljaber MA, Bahammam HA, Aldandan H, Almulhim AS, Abraham I, Alamer A. A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data. Front Cardiovasc Med 2022; 9:978420. [PMID: 36051287 PMCID: PMC9424612 DOI: 10.3389/fcvm.2022.978420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients. Methodology This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24–48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. Results A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94–2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88–1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88–2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83–2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23–2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79–5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26–6.80) and aHR = 3.9 (95% CI, 1.73–8.76), respectively. Conclusion Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.
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Affiliation(s)
- Ahmed Alrashed
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Peter Cahusac
- Pharmacology and Biostatistics/Comparative Medicine, Alfaisal University College of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yahya A. Mohzari
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Reem F. Bamogaddam
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mashael Alfaifi
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Maya Mathew
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bashayer F. Alrumayyan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Basmah F. Alqahtani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amjad Alshammari
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kholud AlNekhilan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aljawharah Binrokan
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalil Alamri
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alshahrani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Safar Alshahrani
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad S. Alanazi
- Administration of Pharmaceutical Services, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Batool M. Alhassan
- Department of Clinical Pharmacy, Almoosa Specialist Hospital, Al-Ahasa, Saudi Arabia
| | - Ali Alsaeed
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Asma Albujaidy
- Department of Clinical Pharmacy Service, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Lama AlJuaid
- Pharmacy College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Nehad Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hamdan N. Alajami
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hala M. Aljishi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alsheef
- Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh A. Alajlan
- Department of Pediatric Dentistry, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Atheer Alsirhani
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Manayer Alotaibi
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Melaf A. Aljaber
- Department of Pharmacy Service, Prince Mutib Bin Abdulaziz Hospital, Sakaka, Saudi Arabia
| | - Hammam A. Bahammam
- Department of Pediatric Dentistry, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hussain Aldandan
- Department of Pharmacy, Alahsa Hospital, Al-Ahsa, Saudi Arabia
- *Correspondence: Hussain Aldandan
| | - Abdulaziz S. Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ivo Abraham
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tuscon, AZ, United States
| | - Ahmad Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tuscon, AZ, United States
- Ahmad Alamer
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Alamer A, Alrashed AA, Alfaifi M, Alosaimi B, AlHassar F, Almutairi M, Howaidi J, Almutairi W, Mohzari Y, Sulaiman T, Al-jedai A, Alajami HN, Alkharji F, Alsaeed A, Alali AH, Baredhwan AA, Abraham I, Almulhim AS. Effectiveness and safety of favipiravir compared to supportive care in moderately to critically ill COVID-19 patients: a retrospective study with propensity score matching sensitivity analysis. Curr Med Res Opin 2021; 37:1085-1097. [PMID: 33890544 PMCID: PMC8146299 DOI: 10.1080/03007995.2021.1920900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Favipiravir is a repurposed drug to treat coronavirus 2019 (COVID-19). Due to a lack of available real-world data, we assessed its effectiveness and safety in moderately to critically ill COVID-19 patients. METHODS This retrospective study was conducted in two public/specialty hospitals in Saudi Arabia. We included patients ≥18 years) admitted April-August 2020 with confirmed SARS-CoV-2 diagnosed by real-time polymerase chain reaction (RT-PCR) from nasopharyngeal swab. Patients received either favipiravir (1800 mg or 1600 mg twice daily loading dose, followed by 800 mg or 600 mg twice daily) or supportive-care treatment. Patients were excluded if they were outside the study period, classified as having a mild form of the disease per WHO criteria, or had an incomplete patient file. Kaplan-Meier (KM) models were used to estimate median time to discharge. Discharge ratios, progression to mechanical ventilation, and mortality outcomes were estimated across the severity spectrum using Cox proportional-hazards models. As a sensitivity analysis, we performed propensity score-matching (PSM) analysis. RESULTS Overall, median time to discharge was 10 days (95%CI = 9-10) in the favipiravir arm versus 15 days (95%CI = 14-16) in the supportive-care arm. The accelerated discharge benefit was seen across the COVID-19 spectrum of severity. The adjusted discharge ratio was 1.96 (95%CI = 1.56-2.46). Progression to mechanical ventilation was slower with favipiravir (HRadj = 0.10, 95%CI = 0.04-0.29). There was no significant effect on mortality (HRadj = 1.56, 95%CI = 0.73-3.36). There was a statistically non-significant trend toward worse outcomes in the critical category (HRadj = 2.80, 95%CI = 0.99-7.89). Age was an independent risk factor for mortality in mechanically ventilated patients. PSM analyses confirmed these findings. CONCLUSION Favipiravir was associated with clinical benefits, including accelerated discharge rate and less progression to mechanical ventilation; however, no overall mortality benefits were seen across the severity spectrum.
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Affiliation(s)
- Ahmad Alamer
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmed A. Alrashed
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mashael Alfaifi
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bandar Alosaimi
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatimah AlHassar
- Department of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia
| | - Jude Howaidi
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wedad Almutairi
- Department of Clinical Pharmacy, Shaqra University, Riyadh, Saudi Arabia
| | - Yahya Mohzari
- Clinical Pharmacy Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Tarek Sulaiman
- Department of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al-jedai
- Ministry of Health, Deputyship of Therapeutic Affairs, Riyadh, Saudi Arabia
- Alfaisal University, Colleges of Pharmacy and Medicine, Riyadh, Saudi Arabia
| | - Hamdan N. Alajami
- Pharmaceutical Services Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fatima Alkharji
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Alsaeed
- Neurology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alaa H. Alali
- Department of Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Abdulaziz S. Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
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Kajtazi NI, Bafaquh M, Ghamdi JA, AlEissa Z, Shmeikh AA, Alsaeed A, Sulaiman T, Vizcaino MA, Al Hameed M, Raghunathan A. An Unusual Case of EBV-Negative Primary CNS Lymphoma of Natural Killer/T-Cell Lineage. Clin Med Insights Pathol 2021; 14:2632010X211065692. [PMID: 34927072 PMCID: PMC8671822 DOI: 10.1177/2632010x211065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Extranodal NK/T-cell lymphoma (ENKTL) is a well-defined cytotoxic lymphoma strongly associated with Epstein–Barr virus (EBV) infection, commonly affecting the nasopharynx and upper aerodigestive tract. Primary central nervous system (CNS) involvement is rare, and only 17 cases were previously reported in the literature. Here, we report the case of a 44-year-old male admitted with a 3-month history of personality changes and progressive right leg weakness. Brain magnetic resonance imaging studies (MRIs) revealed multiple rim-enhancing brain lesions bilaterally. An extensive clinical and laboratory workup was unrevealing, and 2 brain biopsies were initially considered inconclusive. Pertinently, no systemic lymphoproliferative disorder was identified. The patient initially experienced remarkable clinical improvement with dexamethasone, pulse methylprednisolone, and rituximab therapy. However, he eventually had rapid clinical deterioration, was found to have increased brain lesions, and died nearly 6 months after the initial presentation. During this time, the second brain biopsy was found to show involvement by T-cell lymphoma of NK-cell lineage, which was EBV negative. No post-mortem examination was done to identify any systemic lymphoma. This case serves to expand the spectrum of lymphomas involving the CNS.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Juman Al Ghamdi
- Medical Imaging Administration, Neurointervention Radiology, King Fahad Medical City, Riyadh, KSA
| | - Zahra AlEissa
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Arwa Al Shmeikh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Ali Alsaeed
- Internal Medicine Department, Infectious Diseases, King Fahad Medical City, Riyadh, KSA
| | - Tarek Sulaiman
- Internal Medicine Department, Infectious Diseases, King Fahad Medical City, Riyadh, KSA
| | - M Adelita Vizcaino
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Majed Al Hameed
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, KSA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Alsaeed A, Thallaj A, Alzahrani T, Khalil N, Aljazaeri A. Short beveled sharp cutting needle is superior to facet tip needle for ultrasound-guided rectus sheath block in children with umbilical hernia: a case series. Middle East J Anaesthesiol 2014; 22:559-566. [PMID: 25668999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The most common peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and regional block (caudal block). Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this study is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery, and to evaluate the easiness of soft tissue puncture and ultrasonic appearance of two different needle types. METHODS Twenty two (22) pediatric patients (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz linear probe. An ultrasound-guided rectus sheath block in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). A 22 gauge short beveled sharp cutting needle 1.1 x 30 mm needle A (BD Insyte--W, Vialon material. Spain) was used in one side, and a Stimuplex A insulated Needle 22G 50mm (needle B) was used on the other side. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia were evaluated. RESULTS Ultrasonograghic visualization of the posterior sheath was possible in all patients. Needle A scored 72.7% of excellent needle tip and shaft view (16 out of 22) compared to 63.63% for needle B (14 out of 22). None of the needles scored poor view. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one child who postoperatively requested morphine 0.1 mg/kg intravenously in recovery room. There were no complications. CONCLUSIONS Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia in the lateral edge of the rectus muscle. Use of the sharp short beveled needle of 22 gauge intravenous (IV) cannula stylet provides easy, less traumatic skin and rectus muscle penetration and better needle visualization by the ultrasound.
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Reddy YP, Tiwari SK, Shaik AP, Alsaeed A, Sultana A, Reddy PK. Effect of sodium fluoride on neuroimmunological parameters, oxidative stress and antioxidative defenses. Toxicol Mech Methods 2013; 24:31-6. [DOI: 10.3109/15376516.2013.843224] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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