http://www.saudiannals.net/currentissue.asp Table of Contents:Ann Saudi Med 2010 - 30(2) Al-Attas Safia A, Amro Soliman O Original Article Annals of Saudi Medicine 2010 30(2):101-1080256-4947 Al-Attas Safia A, Amro Soliman O

Annals of Saudi Medicine 2010 30(2):101-108

Background and Objectives : Candidal colonization in diabetics is a matter of debate. The aim of this study is to investigate oral candidal colonization, strain diversity, antifungal susceptibility, and the influence of local and systemic host factors on candidal colonization in adult diabetics. Methods : We conducted a case-control study that compared 150 diabetics (49 type 1, 101 type 2) with 50 healthy controls. Two salivary samples were collected, using the oral rinse sampling method: one for salivary flow rate and pH determination, and the other for candidal colonization assessment. The candidal isolates were identified and tested in vitro for antifungal susceptibility using the commercial kit, Candifast. The relationship between specific host factors and candidal colonization was also investigated. Results : Diabetics had a higher candidal carriage rate compared to controls, but not density. Candida albicans was the most frequently isolated species, but diabetics had a variety of other candidal species present. None of the control samples were resistant to any tested antifungal, while the diabetic samples had differing resistances to azole antifungals. Although there was a significant positive correlation between glycemic control and candidal colonization in type 2 diabetics, there was a negative correlation between salivary pH and candidal carriage in the controls versus density in type 2 diabetics. Conclusions : Diabetic patients not only had a higher candidal carriage rate, but also a variety of candidal species that were resistant to azole antifungals. Oral candidal colonization was significantly associated with glycemic control, type of diabetes, and salivary pH.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=101;epage=108;aulast=Al-Attas Al-Qahtani Ahmed A, Kessie George, Cruz Damian Dela, Al-Faleh Faleh Z, Al-Ahdal Mohammed N Original Article Annals of Saudi Medicine 2010 30(2):109-1140256-4947 Al-Qahtani Ahmed A, Kessie George, Cruz Damian Dela, Al-Faleh Faleh Z, Al-Ahdal Mohammed N

Annals of Saudi Medicine 2010 30(2):109-114

Background and Objectives : Many patients with hepatitis C virus (HCV) infection do not respond to antiviral treatment, possibly due to viral quasispecies. We aimed to investigate whether the quasispeices population could be used as a predictor of response to therapy in our patients. Methods : The quasispecies of HCV genotype 4 (HCV-4) were studied in 25 na&amp;#239;ve Saudi patients at zero, three, and six months following interferon alfa and ribavirin combination therapy. Hypervariable region 1 within the E2/NS1 gene of the virus was analyzed by the single-strand conformation polymorphism (SSCP) technique after amplification. Results : Pretreatment DNA bands by SSCP (2-7 bands) were detected in all patients. In those who achieved a complete virological response within six months (viral load <0.2 Meq/mL; n=7), bands ranged from 2-6 (mean = 3.71&amp;#177;1.25). In six of these seven patients, the number of SSCP bands remained either the same or decreased sequentially. In those patients who did not respond (viral load &gt;0.2 Meq/mL; n=18), the bands also ranged from 2-7; mean 3.77&amp;#177;1.73. In six of these non-responding patients, the SSCP bands remained the same or decreased sequentially. There was no significant difference between pretreatment quasispecies composition and response (P=.53). Two of the four patients with pretreatment high viral load and the same or decreased composition of quasispecies bands responded to the therapy. Conclusion : Quasispecies in our studied patients cannot be used to predict responsiveness to treatment, but may offer an explanation for failure of most HCV-4 patients to respond to interferon alfa and ribavirin therapy.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=109;epage=114;aulast=Al-Qahtani Al-Abdulhadi Saleh A, Al-Rabia Mohammed W.O Original Article Annals of Saudi Medicine 2010 30(2):115-1220256-4947 Al-Abdulhadi Saleh A, Al-Rabia Mohammed W.O

Annals of Saudi Medicine 2010 30(2):115-122

Background and Objectives : Genomic scan analyses have suggested that the chemokine receptor cluster (CCR2, CCR3, CCR5 <300 kb span) on the short arm of chromosome 3 may contribute to susceptibility to HIV-1 infection and to the expression of a number of inflammatory diseases. Two single nucleotide polymorphisms (SNP) and a deletion in these chemokine receptors have also been found in case-control studies to be associated with susceptibility for asthma and related phenotypes. We extended these case-control studies by establishing whether these polymorphisms were in linkage and linkage disequilibrium with asthma and related phenotypes using linkage and haplotype analyses. Methods : We genotyped 154 nuclear families identified through two child probands with physician-diagnosed asthma (453 unrelated individuals) including 303 unrelated parents and 150 unrelated children. Atopy was defined as a positive skin prick test (SPT 3 mm) to a panel of common inhaled allergens. Results : From a panel of ten known SNPs, only three polymorphisms: -G190A in CCR2, -T51C in CCR3, and a 32 bp deletion in CCR5 were found to occur at clinically relevant frequencies. All 154 families were used for haplotype analysis but only 12 nuclear families were eligible for linkage analysis. Both analyses confirmed that the mutations were in linkage with asthma, but not with atopy. Conclusion : The chemokine receptor genes on 3p21.3 are significantly plausible candidate genes that can influence the expression of asthma. The previous association of the CCR5&amp;#8710;32 deletion with protection from childhood asthma appears to be explained by linkage disequilibrium with the -G190A mutation in the CCR2 receptor gene.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=115;epage=122;aulast=Al-Abdulhadi Guan Bing, Zhang Xinhua, Ma Henhui, Zhou Hangbo, Zhou Xiaojun Original Article Annals of Saudi Medicine 2010 30(2):123-1280256-4947 Guan Bing, Zhang Xinhua, Ma Henhui, Zhou Hangbo, Zhou Xiaojun

Annals of Saudi Medicine 2010 30(2):123-128

Background and Objectives: Plasmablastic lymphoma is a recently described B-cell derived lymphoma. The prognosis of plasmablastic lymphoma patients is usually poor. We performed a systematic review of the literature on the use of highly active anti-retroviral therapy (HAART) and the prognosis of plasmablastic lymphoma. Methods : A comprehensive search of relevant databases, including Medline, Embase, the Cochrane Controlled Trials Register, the Cochrane Library, and the Science Citation Index yielded ten randomized controlled trials. Trials were divided into two groups according to therapy. The rates of plasmablastic lymphoma were analyzed using a fixed-effects model. Sensitivity analyses (on publication type, statistical model) were performed to further detect and evaluate clinically significant heterogeneity. Tests of survival for plasmablastic lymphoma were also performed by using Kaplan-Meier method. Results : Meta-analysis result showed that the prognosis of plasmablastic lymphoma patients was statistically different in the patients receiving HAART in addition to chemotherapy and/or radiotherapy than in the patients receiving the chemotherapy and/or radiotherapy alone (pooled relative risk=3.04; P=.03). Survival analyses also displayed a statistically significant difference (&amp;#967;² =6.22, P=.013). Conclusion : HAART in addition to chemotherapy and/or radiotherapy is effective in improving the prognosis of plasmablastic lymphoma. However, the small sample sizes increase the likelihood of bias in the studies in this meta-analysis, and therefore, the results should be taken cautiously.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=123;epage=128;aulast=Guan Al-Khawari Hanaa, Athyal Reji P, Al-Saeed Osama, Sada Prio N, Al-Muthairi Sana, Al-Awadhi Adel Original Article Annals of Saudi Medicine 2010 30(2):129-1330256-4947 Al-Khawari Hanaa, Athyal Reji P, Al-Saeed Osama, Sada Prio N, Al-Muthairi Sana, Al-Awadhi Adel

Annals of Saudi Medicine 2010 30(2):129-133

Background and Objectives : Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography (HRCT). Methods : HRCT images of 65 patients known to have systemic lupus erythematosus (with clinical pulmonary involvement) were retrospectively reviewed by four nonthoracic radiologists (two with expertise in magnetic resonance [MR] and two general radiologists). Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic. Results : There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist (kappa=0.482); the other three radiologists had kappa values that were good to excellent (0.716, 0.691, and 0.829). There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers (kappa range: 0.362-0.519) and moderate to good between the other three radiologists (0.508-0.730). Conclusion : The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=129;epage=133;aulast=Al-Khawari Al-Bayyari Nahla Subhi, Abu-Heija Adel Taha Original Article Annals of Saudi Medicine 2010 30(2):134-1400256-4947 Al-Bayyari Nahla Subhi, Abu-Heija Adel Taha

Annals of Saudi Medicine 2010 30(2):134-140

Background and Objectives : Estimated intrauterine fetal weight (EIUFW) is important for reducing prenatal mortality and morbidity through early detection of faltering growth. Our objectives were to develop patterns of ultrasonically determined EIUFW by gestational age, for normal singleton pregnancies, and to assess the effect of a number of variables on EIUFW. Methods : Ultrasonically, EIUFW was obtained from 600 pregnant women who were at 20 to 42 weeks of gestation (WG). EIUFW was categorized into low weight and normal weight using the tenth and twentieth percentile as the cut-off points. Logistic regression was used to calculate the odds ratio and their 95% confidence limits for a number of risk factors hypothesized to be associated with low fetal weight. EIUFW percentiles (twenty-fifth, fiftieth, and seventy-fifth), by gestational age and sex, were calculated for singleton pregnancies. Results : Up to 32 WG there was no statistically significant difference between male and female fetuses in EIUFW. Between 32 and 39 WG males had significantly (P<.05) higher fetal weight than females. Charts of ultrasonically determined EIUFW by gestational age and sex for singleton pregnancies were created. A number of variables were significantly associated with EIUFW such as pregnancy weight gain, maternal hemoglobin level, frequency of antenatal visits, smoking status, and fetal sex. Conclusion : Weight gain during pregnancy should be encouraged for pregnant mothers who gain less than one kilogram per month in the second and third trimester. A prospective study on a national representative sample in Jordan is needed to generate our own standards for fetal growth.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=134;epage=140;aulast=Al-Bayyari Aljubran Ali H Review Annals of Saudi Medicine 2010 30(2):141-1440256-4947 Aljubran Ali H

Annals of Saudi Medicine 2010 30(2):141-144

Disclosing the diagnosis or prognosis to cancer patients in Saudi Arabia can be a serious challenge to the physician in his daily clinic practice. The public attitude towards full disclosure is still conservative, and in order to appropriately deal with such an attitude, physicians need to deeply understand its sociocultural background. This article attempts to look into what governs the public attitude towards disclosure in Saudi Arabia as an example of what may affect attitudes in developing countries. It also brings some data from local surveys among physicians and patients as well as from public surveys to describe the changing trend in attitude over the years with a comparative analysis of the Western literature.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=141;epage=144;aulast=Aljubran Ghnnam Wagih, Malek Jawid, Shebl Emad, Elbeshry Turky, Ibrahim Ahmad Brief Report Annals of Saudi Medicine 2010 30(2):145-1480256-4947 Ghnnam Wagih, Malek Jawid, Shebl Emad, Elbeshry Turky, Ibrahim Ahmad

Annals of Saudi Medicine 2010 30(2):145-148

Background and Objectives : Problems during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. We retrospectively evaluated the causes for conversion and the rate of conversion from laparoscopic to open cholecystectomy and assessed the postoperative complications. Methods : Of 340 patients who presented with symptomatic gall bladder disease over a 2-year period, 290 (85%) patients were evaluated on an elective basis and scheduled for surgery, while the remaining 50 (14.7%) patients were admitted emergently with a diagnosis of acute cholecystitis. Results : The mean age of the patients was 41.9 (12.6) years. Conversion to laparotomy occurred in 17 patients (5%). The incidence of complications was 3.2%. The most common complication was postoperative transient pyrexia, which was seen in four patients (1.2%) followed by postoperative wound infection in three patients (0.9%), postoperative fluid collection and bile duct injury in two patients each (0.6%). Conclusion : Laparoscopic cholecystectomy remains the 'gold standard' by which all other treatment modalities are judged. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertise.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=145;epage=148;aulast=Ghnnam Al-Swiahb Jamil N, Al Dousary Surayie H Brief Report Annals of Saudi Medicine 2010 30(2):149-1520256-4947 Al-Swiahb Jamil N, Al Dousary Surayie H

Annals of Saudi Medicine 2010 30(2):149-152

Background and Objectives : Endoscopic sinus surgery (ESS), markedly improved with the introduction of new preoperative imaging techniques, intraoperative visualization tools, and the use of surgical navigation systems. In this retrospective study we evaluated the usefulness of CT-guided endscopic sinus surgery and studied its advantages over conventional endscopic sinus surgery. Methods : We retrospectively reviewed the records of 60 randomly chosen patients with chronic rhinosinusitis (CRS) and moderate-to-severe sinonasal polyposis, undergoing endoscopic sinus surgery with surgical navigation (n=30) and without navigation (n=30). Data on the operative note, time of surgery, complications, and recurrence rate were collected and analyzed. Results : Of the 60 patients, 40 (66.7%) were diagnosed with CRS and 20 (33.3%) had allergic fungal sinusitis. Primary surgery was performed in 37 (61.7%) and revision surgery was performed in 23 (38.3%) cases. The computer-aided surgery (CAS) group included 28 (93.3%) patients with extensive disease and 12 (40%) with bone erosions, with intraorbital or extradural extension, while the non-CAS group included 24 (80%) patients with extensive disease and seven (23.3%) with bone erosions, with intraorbital or extradural extension. The average operative time was approximately 13 minutes greater in the navigation group, with significant improvement in the recurrence rate (n=11, 36.7% in the non-CAS group; n=5, 16.7% in the CAS group), and intraoperative complications were fewer in the CAS group (two exposures of orbital fat in the non-CAS group; no complications in the CAS group). Conclusion : Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=149;epage=152;aulast=Al-Swiahb Al-Allawi Nasir A.S, Shamdeen Maida Y, Rasheed Najeeb S Case Report Annals of Saudi Medicine 2010 30(2):153-1550256-4947 Al-Allawi Nasir A.S, Shamdeen Maida Y, Rasheed Najeeb S

Annals of Saudi Medicine 2010 30(2):153-155

Hemoglobin Barts hydrops fetalis syndrome is the most severe and generally fatal clinical phenotype of &amp;#945;-thalassemia. We diagnosed a fetus at 23-weeks gestation with having hydrops fetalis, by ultrasound. At 32 weeks, intrauterine death was detected. Molecular studies revealed that the fetus had the hemoglobin Barts hydrops fetalis syndrome due to homozygosity for the Mediterranean &amp;#945;-thalassemia deletion. This clinical phenotype is generally rare in the Eastern Mediterranean, and this is the first report of this syndrome from Iraq. Techniques for molecular characterization became available only very recently in this country, in a diagnostic setting. Thus, the detection of further cases might be expected in future.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=153;epage=155;aulast=Al-Allawi Yildiz Baris, Sokmensuer Cenk, Kaynaroglu Volkan Case Report Annals of Saudi Medicine 2010 30(2):156-1580256-4947 Yildiz Baris, Sokmensuer Cenk, Kaynaroglu Volkan

Annals of Saudi Medicine 2010 30(2):156-158

Antral gastric vascular ectasia is a rare cause of chronic anemia. When encountered, the diagnosis is usually delayed. Endoscopic findings are well established, although radiologic findings are not. Patients respond well to surgery. Our case was of a 62-year-old female with chronic anemia who required multiple blood transfusions and iron replacement therapy, without significant response. Computed tomography revealed a focal thickening of the gastric antrum. Endoscopy showed vascular ectasia between the antrum and corpus. The patient underwent gastrectomy. We reviewed the literature on gastric angiodysplasia and have presented our unique tomography findings in this first report on a novel association between ectopic pancreas and gastric angiodysplasia.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=156;epage=158;aulast=Yildiz Cengiz Zeynep Tas, Yilmaz Hasan, Dulger Ahmet Cumhur, Cicek Mutalip Case Report Annals of Saudi Medicine 2010 30(2):159-1610256-4947 Cengiz Zeynep Tas, Yilmaz Hasan, Dulger Ahmet Cumhur, Cicek Mutalip

Annals of Saudi Medicine 2010 30(2):159-161

Human dicrocoeliosis is reported sporadically in various parts of the world. We report a case in a 21-year-old male, who had right upper abdominal pain, weight loss, and chronic relapsing watery diarrhea three to four times daily for four weeks. The patient had abdominal tenderness to palpation in the right upper quadrant. Alkaline phosphatase, alanine aminotransferase, and serum immunoglobulin E levels were slightly elevated; all other biochemical and hematological findings were in their normal ranges. The duodenal biopsy samples were normal and an abdominal ultrasonography showed no biliary or hepatic abnormality. Stool microscopy revealed numerous eggs of Dicrocoelium dendriticum. As pseudoparasitosis can result from eating raw, infected animal liver, the patient was given a liver-free diet for three days, to rule out that possibility. Subsequent stool examinations showed eggs in each of the samples indicating that the infection was genuine. The patient was treated with triclabendazole 10 mg/kg in a single dose. Four weeks later, no parasite eggs were detected in the microscopic examination of the stool samples. The patient got better gradually and the symptoms disappeared. Physicians should keep in mind parasitic diseases such as the rarely encountered dicrocoeliosis.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=159;epage=161;aulast=Cengiz Al-Mahdi Maria, Al Mutair Angham, Al Balwi Mohammed, Hussain Khalid Case Report Annals of Saudi Medicine 2010 30(2):162-1640256-4947 Al-Mahdi Maria, Al Mutair Angham, Al Balwi Mohammed, Hussain Khalid

Annals of Saudi Medicine 2010 30(2):162-164

Neonatal diabetes mellitus is considered a rare disease that is diagnosed in the first six months of life, and can be either transient or permanent. Recent advances in molecular genetics have shown that activating mutations in KCNJ11 (the gene that encodes for the Kir6.2 subunit of the K _ATP potassium channel of the pancreatic &amp;#946;-cell) is a common cause of permanent neonatal diabetes mellitus. Patients with mutations in this gene may respond to oral sulfonyureas. We describe a 3-year-old girl with permanent neonatal diabetes mellitus with a mutation in the KCNJ11 gene (R201H), who was successfully transferred from subcutaneous insulin to oral glibenclamide, with a marked improvement in glycemic control. This is the first successful switch from insulin to oral sulfonylurea in a patient with R201H mutation, in the Arabian Gulf.]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=162;epage=164;aulast=Al-Mahdi Altraif Ibrahim, Dafalla Mutasim Letter Annals of Saudi Medicine 2010 30(2):165-1670256-4947 Altraif Ibrahim, Dafalla Mutasim

Annals of Saudi Medicine 2010 30(2):165-167

]]> http://www.saudiannals.net/article.asp?issn=0256-4947;year=2010;volume=30;issue=2;spage=165;epage=167;aulast=Altraif Mauskar Anupama, Shanbag Preeti, Ahirrao Varsha, Nagotkar Leena Letter Annals of Saudi Medicine 2010 30(2):167-1690256-4947 Mauskar Anupama, Shanbag Preeti, Ahirrao Varsha, Nagotkar Leena

Annals of Saudi Medicine 2010 30(2):167-169

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Annals of Saudi Medicine 2010 30(2):169-170

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Annals of Saudi Medicine 2010 30(2):171-172

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