A Saudi Gastroenterology Association Position Statement on the Use of Tumor Necrosis Factor-alfa Antagonists for the Treatment of Inflammatory Bowel Disease

The objective of this position statement from the Saudi Gastroenterology Association is to guide gastroenterologists on the use of tumor necrosis factor-alfa (TNF-α) antagonists for the treatment of the idiopathic inflammatory bowel diseases, Crohn''s disease, and ulcerative colitis. In this article, we summarize the relevant literature regarding the safety and efficacy of TNF-α antagonists, highlight relevant safety concerns specific to the environment in Saudi Arabia, and provide specific recommendations for the use of these agents.     

Molecular Characterisation of α‐ and β‐Thalassaemia among Indigenous Senoi Orang Asli Communities in Peninsular Malaysia

Thalassaemia is a public health problem in Malaysia, with each ethnic group having their own common mutations. However, there is a lack on data on the prevalence and common mutations among the indigenous people. This cross‐sectional study was performed to determine the common mutations of α‐ and β‐thalassaemia among the subethnic groups of Senoi, the largest Orang Asli group in Peninsular Malaysia. Blood samples collected from six Senoi subethnic groups were analysed for full blood count and haemoglobin analysis (HbAn). Samples with abnormal findings were then screened for α‐ and β‐globin gene mutations. Out of the 752 samples collected, 255 showed abnormal HbAn results, and 122 cases showing abnormal red cell indices with normal HbAn findings were subjected to molecular screening. DNA analysis revealed a mixture of α‐ and β‐globin gene mutations with 25 concomitant cases. The types of gene abnormalities detected for α‐thalassaemia were termination codon (T>C) Hb CS (α^CSα), Cd59 (G>A) haemoglobin Adana (Hb Adana) (α^Cd59α), initiation codon (ATG>A‐G) (α^IniCdα), two‐gene deletion (–^SEA), and single‐gene 3.7‐kb deletion (‐α^3.7). For β‐thalassaemia, there were Cd26 (G>A) Hb E (β^E), Cd19 (A>G) Haemoglobin Malay (Hb Malay) (β^Cd19), and IVS 1–5 (G>C) (β^{IVS 1–5}).     

Platelets rich plasma for treatment of chronic plantar fasciitis

Background

Plantar fasciitis is a common cause of heel pain in adults. Many treatment options exist. Platelets rich plasma (PRP) is derived from autologous blood and contains high concentration of growth factors necessary for tissue healing. The use of PRP in the treatment of plantar fasciitis is a fairly recent and evolving concept. The purpose of our work was to study the effectiveness of PRP treatment for chronic plantar fasciitis.

Materials and methods

Between February 2010 and June 2011, 25 patients with chronic plantar fasciitis with a mean age of 44?years were treated by PRP injection and included in this prospective study. All patients were assessed for the pain on Visual Analogue Scale (VAS) pre-injection and post-injection. Using ultrasound, the thickness of the plantar fascia was measured prior to the injection of PRP and at each visit of follow-up after injection. The mean follow-up was 10.3?months.

Results

Using a visual analog pain scale, the average pre-injection pain in patients of was 9.1 (range 8–10). Prior to injection, 72?% of patients had severe limitation of activities, and 28?% of patients had moderate limitation of activities. Average post-injection pain decreased to 1.6. Twenty-two patients (88?%) were completely satisfied, two patients (8?%) were satisfied with reservations, and one patient (4?%) was unsatisfied with using the visual analog scale. Fifteen patients (60?%) had no functional limitations post-injection and eight patients (32?%) had minimal functional limitations. Two patients (8?%) had moderate functional limitations post-injection. Twenty PRP injections. Ultrasonography, we noted significant changes not only in thickness but also in the signal intensity of the plantar fascia after PRP injection. None of our patients experienced any complications from PRP injection at the end of follow-up period.

Conclusion

Injection of PRP is safe and doesn’t affect the biomechanical function of the foot. Our successful early findings with injection of PRP indicate that this may become a very commonly used modality in treating this difficult condition.     

Allogeneic hematopoietic stem cell transplantation in Tunisia

In 1998, the Tunisian team of the 'Centre National de Greffe de Moelle Osseuse' initiated allogeneic hematopoietic SCT (AHSCT) in Tunisia. As of June 2007, information was collected about 299 patients with a first AHSCT and 12 additional retransplants. The median age was 19 years (range 2-49 years). The main indications were aplastic anemia (n=106, 36%), leukemia and nonmalignant disorders (n=153, 51%), Fanconi anemia (n=26, 9%) and other nonmalignant disorders (n=14, 4%). Preparative regimens depended on indication. All donors were HLA geno-identical. The stem cell sources were BM (87%) and PBSCs (13%). At the time of analysis, 200 patients (67%) were alive after a median follow-up of 42 months (range 3-112 months). The overall TRM rate was 17%. Outcome depended on indication. According to our results, allogeneic HSCT is potentially curative for hematological diseases, but it is a toxic approach for malignant disorders.     

Transforming growth factor-beta 1 in diabetic nephropathy

In diabetic nephropathy the extent of matrix accumulation in both glomeruli and the interstitium correlates strongly with the degree of renal insufficiency and proteinuria. Factors responsible for the deposition and accumulation of extra cellular matrix material within the kidney are therefore of considerable interest. Such factors include the potent fibrotic cytokine TGF-beta. We measured serum TGF-beta1 in patients with various stages of diabetic nephropathy, and correlated its level with different biochemical parameters. The study was conducted on: Group I: 30 patients with diabetic nephropathy (Subgroup IA: 20 patients with microalbuminuria; Subgroup IB: 10 patients with overt nephropathy), Group II: 19 diabetic patients without nephropathy (positive control), Group III: 20 healthy volunteers (negative control). Serum creatinine, Fasting and postprandial blood glucose, Fasting serum cholesterol, Glycated haemoglobin (HbA1c), Microalbumin estimation in urine, Serum TGF-beta1 estimation were done for all the studied groups. Our results showed a statistically significantly higher serum TGF-beta1 level in patients with diabetic nephropathy versus diabetic patients without nephropathy (mean +/- SD, 47.66 +/- 21.92 and 27.07 +/- 15.46 respectively) (P<0.001). Also in patients with diabetic nephropathy versus healthy controls (mean +/- SD, 47.66 +/- 21.29 and 27.05 +/- 8.95 respectively) (P<0.001). While serum TGF-beta1 concentrations were almost similar in diabetic patients without nephropathy and in healthy controls. Serum TGF-beta1 was statistically significantly higher in patients with overt nephropathy versus patients with microalbuminuria (mean+/-SD, 73.5 +/- 2.41 and 34.9 +/- 12.41) (P<0.001). Serum TGF-beta1 was significantly positively correlated with albumin excretion rate, fasting and postprandial blood glucose levels, serum cholesterol and HbA1c, these correlations were only found in diabetic patients with nephropathy but not in those without nephropathy or the control group. (r=0.86, P<0.001, r=0.444, P<0.05, r=0.375, P<0.05, r=0.532, P <0.01, r=0.696, P<0.001 respectively. HbA1c was found to be predictor of 68% of changes of serum TGF-beta1 (P<0.001) and serum cholesterol was predictor of 73% of changes of serum TGF-beta1 concentration (P<0.01). In conclusion, our results suggest that TGF-beta1 may play a key role in the development and progression of diabetic nephropathy. Accordingly, it may be also directly implicated in the functional deterioration of the kidney functions seen in patients with diabetic nephropathy, therefore beside proper glycemic control, strategies aiming at antagonizing TGF- beta1 for example by the use of specific antibodies or a specific inhibitor of TGF-beta1 may help to prevent the development or attenuate the progression of nephropathy in diabetic patients.     

Rejection of the second allogeneic graft in a child with Fanconi anemia reversed by antilymphocyte globulin and donor lymphocyte infusion

Rejection after allogeneic bone marrow transplantation for Fanconi anemia (FA) is a complication with a high risk of mortality. We describe a patient who, following a second episode of rejection after a second allogeneic stem cell transplantation, was successfully treated with antilymphocyte globulin, followed by donor lymphocyte infusion. At three and a half years after donor lymphocyte infusion, she is alive with a Karnofsky score of 90%. Her molecular chimerism is of donor origin. Thus, donor lymphocyte infusion can be considered as a therapy option for rejection after allogeneic bone marrow transplantation for FA.     

Promoting Arab and Israeli cooperation: peacebuilding through health initiatives

This article describes a positive experience in building Arab and Israeli cooperation through health initiatives. Over the past 10 years Israeli, Jordanian, and Palestinian health professionals have worked together through the Canada International Scientific Exchange Program (CISEPO). In the initial project, nearly 17,000 Arab and Israeli newborn babies were tested for early detection of hearing loss, an important health issue for the region. The network has grown to address additional needs, including mother-child health, nutrition, infectious diseases, and youth health. Our guiding model emphasises two goals: project-specific outcomes in health improvement, and broader effects on cross-border cooperation. Lessons learned from this experience and the model provide direction for ways that health professionals can contribute to peacebuilding.