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Background Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are more prevalent in hemodialysis patients compared to the general population. The objective of this study was to evaluate the prevalence of HBV, HCV, and HIV infections in hemodialysis patients dialyzing regularly at Kano Kidney Center (KKC) in the Eastern Health Cluster of Saudi Arabia in 2022. Methods This retrospective study included all hemodialysis patients who were dialyzed regularly at KKC during 2022. Their electronic medical records were reviewed for the results of HBV, HCV, and HIV along with the patient's demographics, comorbid conditions, and dialysis history. The study was approved and monitored by the Institutional Review Board of Dammam Medical Complex. Results A total of 239 regular hemodialysis patients were included, consisting of 142 males and 97 females (59.41% and 40.59%, respectively), with a mean age of 52.71±15.83 years. Most of the patients were Saudis (156 patients, 65.27%) with the non-Saudi patients being composed mostly of Arabian patients. Nine patients (3.77%) tested positive for hepatitis B surface antigen (HBsAg), the serologic hallmark of HBV infection. Two patients (0.84%) had resolved HBV infections as evidenced by positive hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs). However, the majority (226 patients, 94.56%) were never tested for anti-HBc. Anti-HBs, which can imply long-term immunity against HBV from prior immunizations or infections, were positive in 165 patients (69.04%). A protective anti-HBs level of ≥ 10 IU/L was detected in 158 patients (66.11%) including 104 patients (43.51%) having ≥ 100 IU/L. Eighteen patients (7.53%) had reactive HCV antibodies. Four patients (1.67%) had chronic HCV infection as they had detectable HCV RNA. The remaining 14 patients (5.86%) cleared HCV either spontaneously (seven patients, 2.93%) or by medications (seven patients, 2.93%). HIV screening tests were negative in all 239 patients (100%). HBsAg-positive patients did not have any statistically significant differences from HBsAg-negative patients. On the other hand, the patients who were positive for HCV antibodies were older than the patients who were negative for HCV antibodies (60.66 vs 52.05 years on average, p-value <0.05). They also contained a statistically larger proportion of non-Saudi patients than the patients with no evidence of prior infections (61.11% vs 32.13%, p-value <0.05). Conclusions The study found that the prevalence of HBV and HCV infections among hemodialysis patients in KKC at 3.77% and 1.67%, respectively, is higher than that reported in the general population in Saudi Arabia, with non-Saudis having a higher prevalence rate of HCV infection than Saudis. However, the current prevalence rate is lower compared to the previous studies that were conducted in Saudi Arabia in the first decade of the 21st century, and there were no cases of HIV infections. Nevertheless, a significant proportion of patients had unprotective or negative anti-HBs antibody titers, indicating the need for strict vaccination protocols and monitoring of antibody titers to ensure optimal protection.
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Libman-Sacks endocarditis (LSE) is a rare disease found incidentally in postmortem autopsies, characterized by microscopic to large verrucous vegetation on the cardiac valves, the most affected site is the mitral valve followed by the aortic valve. Females of reproductive age were observed as the most affected individuals as found in studies. Most individuals with LSE are asymptomatic and generally discovered lately when they presented with thromboembolic disorders such as stroke, cognitive disabilities, and death. Malignancy and autoimmune diseases involving systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are considered the primary etiology of LSE. As recognized, the majority of LSE cases are asymptomatic, it tends to be challenging to spot the condition at the early pathway of the disease. In this paper, we describe a young female who is known to have SLE on medications, she presented to the emergency department (ED) due to chest pain and exertional dyspnea for a few days, laboratory investigations showed anemia, raised inflammatory marker, and anti-DsDNA. Imaging studies showed bilateral pleural effusion on the chest X-ray and a large vegetation on the posterior mitral valve with moderate regurgitation and normal wall motion in transesophageal echocardiography. The patient was managed by pulse steroid therapy, anticoagulation therapy, and a low dose of diuretic, the patient improved dramatically and discharged home with close follow-up in the clinic. The primary treatment of LSE is anticoagulant therapy, however, surgical intervention should be considered in case of large vegetation recurrent thromboembolism despite anticoagulant therapy. As the prognosis in LSE is considered very poor and there is no definitive laboratory investigation exists to confirm the diagnosis, we highlight the importance of considering LSE as a serious and crucial differential diagnosis when dealing with SLE patients who presented with dyspnea and pleural effusion secondary to valvular dysfunction, mainly the mitral valve.
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Background Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by heartburn and acid regurgitation. A higher incidence is found in Arab countries. Untreated GERD has a negative impact on individuals that interfere with daily activities and impaired quality of life. This study aims to estimate the prevalence of GERD and associated risk factors in the Eastern region, Saudi Arabia. Material & Methodology A descriptive cross-sectional study was carried out among 1517 healthy participants from the Eastern province of Saudi Arabia from May to August 2021. The sample was randomly collected through a structured self-administered questionnaire. The questionnaire was composed of questions related to sociodemographic and lifestyle characteristics as risk factors for GERD. The existence of GERD was assessed by using GERD Questionnaire (GerdQ) for diagnosing GERD, when the score is 8 or more. Results A total of 1517 participants were included in the study: 58.8% male, 41.2% female; 9% of whom were pregnant. The age of participants ranged from 18 to 58 with a mean age of 27.5 ± 11.4 years old. The existence of GERD was 20.6% among the total participants, in which their GerdQ scores were 3-7 (68.9%), 8-10 (22.1%), and 8-11 (8.5%). The higher risk groups of having GERD were pregnant women, smoker, being male, regular usage of analgesia, soft drinks, and having a family history of GERD. Conclusion This study showed the prevalence of GERD among the general population of the Eastern region, Saudi Arabia was 20.6%. Several sociodemographic and lifestyle characteristics were associated with the disease. Further studies are needed to explore the role of psychological factors in developing GERD.
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Moyamoya disease (MMD) is a rare cerebrovascular occlusion condition characterized by progressive stenosis in the terminal portion of the internal carotid arteries on both sides. The measured incidence of MMD is 0.086 per 100,000 people. MMD has variable neurological manifestations, however, seizure is a significant manifestation of MMD with few reported studies. The combination of sickle cell disease (SCD) and MMD confers a much higher risk of ischemic stroke. In this paper, we describe a 32-year-old female with a known case of SCD taking tramadol for a vaso-occlusive crisis, who was presented to the emergency department by a family member due to a low level of consciousness. Despite ongoing management, the patient developed multiple seizure attacks and intubation was performed. A computed tomography (CT) brain angiogram was performed, and the diagnosis of MMD was made. The patient was shifted to the intensive care unit (ICU) and in spite of the ongoing management in the ICU, the patient died. In this case, we highlight the importance of considering MMD as a differential diagnosis when dealing with an SCD patient who developed refractory status epilepticus. .