ASSOCIATION OF MHC CLASS I WITH SPONDYLOARTHROPATHIES IN KUWAIT

This study is the first to assess the prevalence of HLA B27 in Kuwaiti patients with ankylosing spondylitis (AS) or related spondyloarthropathies compared to healthy controls. Positive HLA B27 was found in nine (25.7%) of 35 patients, but only in 22 (4%) of 544 controls (P = 0.000). A significant difference in Cw2 and Cw6 between patients and controls was also found (P < 0.01 and 0.000, respectively), suggesting a linkage disequilibrium between B27 and Cw2 (P < 0.000) in the Kuwaiti population. These findings suggest that B27-positive Kuwaitis are at high risk of developing AS and spondyloarthropathies, especially if they carry Cw2 and Cw6. The importance of HLA Cw loci is becoming increasingly apparent in disease association studies.     

Ethyl glucuronide and ethyl sulfate: a review of their roles in forensic toxicology analysis of alcohol postmortem

Forensic Toxicology - This review presents the current methods used for determining ethyl glucuronide (EtG) and ethyl sulfate (EtS) concentrations in postmortem specimens, including sample...     

HLA class II DQA and DQB epitopes: Recognition of the likely binding sites of HLA-DQ alloantibodies eluted from recombinant HLA-DQ single antigen cell lines

Donor-specific antibodies (DSA) in sera of sensitized transplant patients are often produced against the specific epitopes on mismatched HLA antigens. In this study, we selected sera from 30 kidney transplant patients with DSA and AMR to define DQ epitopes. Using adsorption and elution assays, we identified 18 antibody reaction patterns to define 6 new epitopes and to confirm 12 previously defined epitopes. In one patient case, one mismatched antigen produced 3 different antibodies and, in another, antibodies were produced against the alpha and beta chains of the same antigen. For some sera, a single epitope can explain reactions for 27 of the 29 DQ beads in the single antigen panel.     

Neuroimaging manifestations and genetic heterogeneity of Walker-Warburg syndrome in Saudi patients

BackgroundWalker-Warburg syndrome (WWS), an autosomal recessive disease, is the most severe phenotype of congenital muscular dystrophies. Its diagnosis remains primarily clinical and radiological. Identification of its causative variants will assist genetic counseling. We aim to describe genetic and neuroimaging findings of WWS and investigate the correlation between them.MethodsWe retrospectively reviewed the clinical, genetic and neuroimaging findings of eleven Saudi neonates diagnosed with WWS between April 2012 and December 2018 in a single tertiary care center. Correlation between neuroimaging and genetic findings was investigated.ResultsAll patients had macrocephaly except one who had intrauterine growth restriction. Dysmorphic features were identified in nearly half of the patients. Creatine kinase levels were available in nine patients and were always elevated. Homozygous pathogenic variants were identified in all patients spanning POMT1 (n = 5), TMEM5 (n = 3), ISPD (n = 2) and POMT2 (n = 1) including one patient who had a dual molecular diagnosis of ISPD and PGAP2. On neuroimaging, all patients showed cobblestone cortex, classical infratentorial findings, and hydrocephalus. Other cerebral cortical malformations included subependymal heterotopia, polymicrogyria and open-lip schizencephaly in four, two and one patients, respectively. Buphthalmos and microphthalmia were the most prevalent orbital findings and found in all patients either unilaterally or bilaterally.ConclusionWWS is a genetically heterogeneous disorder among Saudis. The case with an additional PGAP2-related phenotype exemplifies the increased risk of dual autosomal recessive disorders in consanguineous populations. MRI is excellent in demonstrating spectrum of WWS brain and orbital malformations; however, no definite correlation could be found between the MRI findings and the genetic variant.     

Prevalence of post-traumatic stress disorder during the COVID-19 pandemic in Saudi Arabia

BackgroundThe coronavirus diseases of 2019 (COVID-19) pandemic was classified as one of the worst pandemics in the 21st century. Its rapid transmission, unpredicted mortality rate, and the uncertainty surrounding its transmission method have evoked additional fear and anxiety. Nonetheless, to the best of our knowledge, no prior study has explored PTSD prevalence three months after the start of the quarantine procedures in Saudi Arabia nor has examined PTSD prevalence by three different methods.ObjectiveThis observational cross-sectional study aimed to identify the prevalence, severity, and influencing factors of PTSD in different regions of Saudi Arabia three months after the onset of the quarantine procedures related to the COVID-19 pandemic.MethodsThrough the month of June 2020, 1374 people (49.05% men and 50.95% women) completed a 35-item, 10-minute online. The prevalence of PTSD was measured using PCL-S (specific for COVID-19) that assesses the 17 symptoms of PTSD. Resilience was measured using 2-items Arabic version of the Connor-Davidson Resilience Scale 2 (CD-RISC 2).ResultsWe calculated the prevalence by three methods, namely, PTSD cut-off score, criteria, and combined, and the prevalence was 22.63%, 24.8%, and 19.6%, respectively. Female participants showed higher prevalence than male. As well, participants who were either tested positive or suspected of having been infected with COVID-19 showed higher PTSD prevalence. Higher resilience was associated with lower PTSD prevalence.ConclusionsThis was the first study to report PTSD prevalence by three differential methods three months after the onset of the quarantine procedures related to the COVID-19 pandemic in Saudi Arabia. We observed a significant impact of the COVID-19 pandemic in the Saudi population; therefore, great attention should be performed in implementing new procedures that deal with the highlighted risk factors, especially in vulnerable groups, to overcome the psychological impact of the COVID-19 pandemic.     

Evaluation of knowledge and behavior of workers in Prince Mohammed International Airport in Western Saudi Arabia regarding public health emergency measures applied during Hajj season 2014

Objectives:

To evaluate the knowledge and behavior of workers at a Saudi airport regarding public health emergency measures applied during Hajj season.

Methods:

This study is a cross-sectional study conducted at the Prince Mohammed International Airport in Al-Madinah Al-Munawwarah, Saudi Arabia between August and September 2014. Data were collected by semi-structured questionnaires during personal interviews. Non-random purposive sampling was conducted to target workers at higher risk of acquiring infection from travellers.

Results:

One hundred and eighty-six participants were recruited of whom 92.5% were males. The study participants were workers in 8 different sectors. Twenty-six percent of the participants were health workers. Non-health workers were more likely to be concerned on acquiring infection while working at the airport compared with health workers (p=0.023). The most commonly feared disease was Ebola viral disease (EBV) among 30% of health workers, and 47% of non-health workers. Approximately 47% of non-health workers reported no knowledge of the procedures implemented during public health emergencies. The proportion of participants who received public health related training among non-health workers was significantly lower compared with health workers (p<0.00001).

Conclusion:

More emphasis should be given to educating airport workers on the potential health threats at the airport. Specific guidelines for public health emergencies at the airport should be established and communicated with airport sectors.Airports are frontier gates where proper public health measures are likely to reduce the possibility of allowing the entrance of communicable disease to a country. According to the World Health Organization (WHO) International Health Regulations mandate WHO member states to ensure that every designated point of entry is equipped with staff and instruments enabling smooth movements of the travellers while maintaining appropriate public health measures.1 Maintaining such regulations is likely to enhance proper travellers’ movement during public health emergencies by reducing possible interference between application of preventive public health measures, and the ability of travellers to access the designated points of entry. Additionally, ensuring the application of public health measures might aid in preventing the occurrence of any public health emergencies. A public health emergency is defined as any situation with health consequences that are likely to overwhelm the community’s routine capability of addressing them. A health situation can be considered as an emergency if there is a risk due to timing, such as facing emerging diseases threats during Hajj season, scale, as with an overwhelming number of causalities, or due to the unpredictability of the situation. Defining the nature of potential public health emergencies is crucial to allow competent development of preparedness plans.2 Having a large number of passengers arriving at a particular point of entry during a limited time is a burden on the available health services. A meticulous state of readiness is required to respond to any risk of spreading a communicable disease. The state of readiness is maintained by several steps including preparation of staff, equipment, and buildings.3,4 The burden of not maintaining effective public health event response measures is aggravated if an epidemic is announced in a particular region of the globe where travellers form these areas are scheduled to arrive in the country. During the Hajj season of 2014, the Ebola Virus Disease (EVD), which is a viral hemorrhagic disease, was announced as an epidemic disease in Guinea, Liberia, and Sierra Leone in West Africa. Additionally, a localized spread of the virus was announced in certain areas of Nigeria.5 The Saudi Arabian government, as a preventive measure, decided to prevent citizens of EVD-affected countries from entering the country. However, nationals of Nigeria were exempt as no extended transmission of EVD was announced.6,7 Nonetheless, several procedures were applied to prevent the transmission of Ebola virus among thousands of Nigerian pilgrims arriving in the country. These measures were mainly related to exit screening of travellers in Nigeria,8 and entry screening at points of entry in Saudi Arabia. Additionally, the Ministry of Health in Saudi Arabia produced response plans for infectious diseases (Middle East Respiratory Syndrome [MERS] and EVD) to be implemented during Hajj.9 There are many potential sources of infectious disease transmission from a single infected individual. The presence of infected travellers, such as an EVD infection, on an aircraft increases the risk of transmitting infection to neighboring passengers and flight crew. Airport workers, such as ground workers handling cleaning of aircrafts and lavatories, are at risk of the infection, especially with the presence of spilled infectious materials. Airport workers handling the flow of passengers during busy times are at risk of acquiring infection such as immigration, customs, security, and healthcare workers. Therefore, all of these individuals have to be aware of the potential health threats at the airport, should be aware of preventive methods, how to use preventive methods, and know what to do when facing a public health emergency event in the airport. Prince Mohammed Airport (Al-Madinah, Saudi Arabia) workers’ level of knowledge of the potential health threat at the airport is currently not known. Additionally, the attitude and practice of the staff when a public health emergency is announced in the airport is not measured. The significance of this study stems from the ability to investigate the degree to which airport workers, at the time of dealing with travellers during Hajj season, were able to deal with potential urgent infectious cases, and to adhere to the relevant protective guidelines.     

Ultra-fast,low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure

Background

Coronary computed tomography angiography (CCTA) is increasingly being used for the evaluation of coronary artery disease; however, radiation exposure remains a major limitation of its use.