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Objectives: The study aimed to assess the national attitudes toward individuals with mental health illnesses in Saudi Arabia, exploring the relationship between these attitudes and various sociodemographic factors. Methods: A cross-sectional design with computer-assisted telephone interviews was employed, covering all 13 administrative regions in Saudi Arabia. A total of 4,533 adults agreed to participate, and their attitudes toward people with mental illnesses (PWMI) were measured using an 11-item scale. The translation of the original English version of the PWMI to Arabic was validated and published previously. The scale used level of agreement on a 5-point Likert scale. The score varies from 11 to 55, where a higher score signifies higher stigma. The associations between total PWMI scores and sociodemographic variables were analyzed using linear regression. Results: The mean age of participants was 35.92 ± 12.84, with equal distribution across regions. The linear regression model showed significant associations between total PWMI scores and gender, education level, marital status, living with, or being friends with someone diagnosed with a mental illness, and working in healthcare. No significant associations were found with age, income level, and previous mental health diagnosis. The study suggests that negative stereotypes about mental illness may be more prevalent in Saudi Arabia, while Saudi participants had a more optimistic view regarding the recovery and outcomes of mental illnesses. Conclusions: The study highlights the importance of assessing mental health stigma and its associations with sociodemographic factors in Saudi Arabia. The significant associations found point to the need for targeted interventions and public health campaigns to address misconceptions and stereotypes surrounding mental health, ultimately improving the societal acceptance and well-being of individuals with mental health illnesses. [ABSTRACT FROM AUTHOR]

Antimicrobial dispensing without a prescription has been identified as a significant contributor to the burgeoning crisis of antimicrobial resistance. To combat this, the Saudi Ministry of Health introduced a stringent antimicrobial restriction policy in mid-2018, mandating prescriptions for all antimicrobial drug dispensations at pharmacies. Therefore, this study aimed to assess the immediate impact of this policy on retail antimicrobial sales. To do so, we analyzed annual sales data from 2017 to 2019 sourced from the IQVIA-MIDAS® database, which included a range of antimicrobials, such as antibiotics, antifungals, and other related agents. The analysis revealed a notable reduction in overall antimicrobial sales by 23.2%, decreasing from 818.9 million SAR in 2017 to 648.4 million SAR in 2019. While the Wilcoxon signed-rank test indicated a statistically significant median reduction in total antimicrobial sales post-policy implementation (p = 0.0397), it is important to acknowledge that the long-term effects and adherence to the policy require further investigation. Notably, sales of amoxicillin dropped by 70% in 2019 compared to 2017, contributing largely to the decline. Conversely, a continuous increase in sales of some antimicrobial drugs following the restriction policy was observed, led by amoxicillin/clavulanic acid. Our data support the implementation of antimicrobial restriction measures as an effective means of controlling excessive antimicrobial sales and dispensing without prescriptions. [ABSTRACT FROM AUTHOR]

Background: Understanding antibiotic consumption patterns over time is essential to optimize prescribing practices and minimizing antimicrobial resistance. This study aimed to determine whether the antibiotics restriction policy launched by the Saudi Ministry of Health in April 2018 has impacted antibiotic use by assessing changes and seasonal variations following policy enforcement. Methods: Quarterly sales data of J01 antibacterial for systemic use in standard units were obtained from the IQVIA-MIDAS database, spanning from the first quarter of 2016 to the last quarter of 2020. Antibiotics consumption was measured in defined daily doses per 1,000 inhabitant per day- in a quarter (DDDdq). A comparative analysis of antibiotic consumption pre- and post-policy periods introduction was conducted by computing the average consumption values for each period. Statistical comparison of the mean differences between the two periods were then made using independent samples t-test, Mann-Whitney U Test where needed. Time series analysis was employed to estimate the projected antibiotic consumption in the post-policy period if the restriction policy had not been implemented, which was then compared to actual consumption values to evaluate the effectiveness of the restriction policy. Results: During the pre-policy, there were seasonal trends of the total and oral antibiotic consumption through quarters, with higher consumption observed in the first and fourth quarters. In contrast, parenteral antibiotic consumption did not appear to follow a clear seasonal pattern. Following the restriction policy, there was a significant reduction in total and oral antibiotic use, with mean reductions of -96.9 DDDdq (p-value = 0.002) and -98 DDDdq (p-value = 0.002), respectively. Conversely, a significant increase in parenteral antibiotic consumption was observed with a mean increase of +1.4 DDDdq (p-value < 0.0001). The comparison between the forecasted and actual models showed that the actual antibiotics consumption for total, oral, and parenteral were lower than the corresponding forecasted values by 30%, 31%, and 34%, respectively. Conclusion: Overall, our analysis of antibiotics consumption from 2016 to 2020 displays great success for the policy implemented by the Saudi Ministry of Health in significantly reducing the total and oral use of antibiotics. However, future studies are needed to explore the increased consumption of the parenteral antibiotics as well as the persistent high consumption patterns during the fall and winter months even after the implementation of the restriction policy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to validate the Arabic Version of the Mental Health Literacy Scale (Arabic-MHLS) among the Saudi Arabian general population, assessing its internal consistency, test-retest reliability, and structural validity. Methods: A total of 700 Arabic-speaking Saudi adults were randomly selected to complete the electronic questionnaire in May 2023, which generated 544 participants. Data were coded and stored in the ZdataCloud research data collection system database. Test-retest reliability was assessed using a subsample of 48 participants who completed the questionnaire twice, with a one-week interval. Structural validity was examined using confirmatory factor analysis (CFA) and Exploratory Factor Analysis (EFA). Results: The Arabic-MHLS demonstrated good internal consistency (Cronbach's alpha = 0.87) and test-retest reliability (intraclass correlation coefficient = 0.89). EFA revealed a four-factor model closely resembling the model identified in the Slovenian validation of MHLS, with factor loadings ranging from 0.40 to 0.85. The four factors included knowledge of mental health disorders, knowledge of help-seeking, knowledge of self-help strategies, and knowledge of professional help also showed good internal consistency. Conclusion: The Arabic-MHLS is a valid and reliable tool for assessing mental health literacy in the Saudi Arabian general population. However, further research is needed to refine the measurement tool and understand the complex relationships between mental health literacy and other mental health-related concepts. This will contribute to the development of targeted interventions and policies aimed at improving mental health literacy and promoting mental well-being in the Saudi Arabian population and beyond. [ABSTRACT FROM AUTHOR]

In this study, we investigated both meat-derived and methicillin-resistant Staphylococcus aureus (MRSA), exploring their genetic relatedness to patient-derived MRSA isolates in Saudi Arabia. We collected 250 meat samples and identified 53 S. aureus isolates, with 79% being methicillin-sensitive Staphylococcus aureus (MSSA) and 21% being MRSA. Moreover, we included 80 clinically confirmed patient-derived MRSA isolates. We identified the most common S. aureus clone in both patients and retail meat. In meat, ST6 and ST97 were the most common clones in 55% of the MRSA isolates, and ST1153 and ST672 were the most common in 21% and 17% of the MSSA isolates. In patients, ST5 and ST6 were the predominant clones in 46% of the S. aureus isolates. CC5/ST5-SCCmecVc-t311 and CC361/ST672-SCCmecV-t3841 were common MRSA clones in both meat and patients. CC97 and CC361 clones were the second most prevalent S. aureus clones in meat and were relatively common in patients. Furthermore, we sequenced and characterized novel S. aureus strains ST8109, ST8110, and ST8111. The genomic similarities between meat- and patient-derived S. aureus isolates suggest that retail meat might be a reservoir for S.aureus and MRSA transmission. Therefore, a structured One Health approach is recommended for S. aureus dissemination, genetic characterization, antibiotic resistance, and impact on human health. [ABSTRACT FROM AUTHOR]

Escherichia coli O157:H7 is a foodborne pathogen, which causes various health conditions in humans, including fatigue, nausea, bloody diarrhoea and in some cases, even death. In 2017, 15.71% of the total imported food products in Saudi Arabia (SA) were meat-based. India and Brazil are two of the top five countries from where SA imports meat. According to the Saudi Food and Drug Authority, in 2017, at least 562, 280, and 50 samples of imported beef, chicken and sheep meat, respectively, were tested for the presence of E. coli O157:H7. Amongst these, E. coli O157:H7 was detected in respectively 6.80% and 2.20% of the tested beef meat samples imported from India and Brazil as well as in respectively 6.96% and 3.57% of the tested chicken samples imported from Brazil and Ukraine. Moreover, the pathogen was detected in 2.13% of the tested sheep meat samples imported from India. The present report provides evidence that imported meat can serve as the carrier of E. coli O157:H7, which may lead to epidemics within the Kingdom of Saudi Arabia. [ABSTRACT FROM AUTHOR]

The incidence of hospital- and community-acquired infections has been dramatically increased worldwide. Accordingly, hands hygiene and the use of disinfectants have been increased leading to the expansion in hand sanitizers production to meet public demand. This study was conducted to assess the efficiency of common disinfectants in the market of Riyadh, Saudi Arabia in inhibiting the microbial growth during the time of Coronavirus disease 2019 (COVID-19) pandemic. Five bacterial strains of commonly hospital-acquired infections (Pseudomonas aeruginosa, Escherichia coli, Salmonella enteritidis, Staphylococcus aureus, and Enterococcus faecalis) (ATCC reference strains and clinical isolates) were examined for their susceptibility against 18 disinfectants collected from the Saudi market. The tested 18 disinfectants were broadly clustered into different groups based on their active chemical composition as following: 12 products contained alcohol, 2 products had chlorhexidine, 3 products contained mixed concentration of alcohol/chlorhexidine and 1 product had a mixture of chlorhexidine/Hexamidine/Chlorocresol. By measuring the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), our results revealed that all the 18 disinfectants have reduced the microbial growth of all the tested strains. Generally, the MICs and the MBCs for the clinical strains are higher than those of the reference strains. Taken together, our findings showed that all tested products have high disinfectants' killing rate against microbes of different origins, which suggest the high quality of these disinfectants and the good surveillance practice by the local authorities in Saudi Arabia. [ABSTRACT FROM AUTHOR]

The present study was carried out to investigate food habits and associated risk factors of depressed patients with cardiovascular disease in Riyadh city, Saudi Arabia. Depressed and healthy females (n = 30 each) and males (n = 30 each) aged 18–65 years were involved in this study. Sociodemographic, anthropometric proxies, and nutritional status were evaluated. Cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels of respondents' blood were determined. The respondents were varied according to demographic factors and anthropometric proxies. The majority of depressed males had higher values than healthy ones. The student t-test analysis showed that the average daily intake of fat especially saturated fat, by depressed respondents was higher than that of the healthy ones as well as the dietary requirement intake (DRI). The analysis of respondents' blood showed that the number of depressed females had higher abnormal HDL-c than males, who were observed to have an abnormal level of cholesterol and triglycerides. The correlation of daily nutrient intake and depression duration, depression severity, and age showed that the nutrients responsible for the extension and severity of depression were intake of food rich in dietary fat. Factors including demographics daily nutrient intake appeared to be associated with depression. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of comparing the effect of the traditional Hijamah and the Asian wet cupping techniques in the management of patients with chronic low back pain (CLBP), a randomized clinical trial comparing traditional and Asian wet cupping techniques for CLBP was conducted in two secondary care hospitals in Saudi Arabia. Seventy eligible participants with CLBP were randomized to receive one session of wet cupping using either Asian technique (34 patients) or traditional Hijamah technique (36 patients). Cupping was performed at four sites of the bilateral bladder meridian (BL23, BL24, and BL25). The numeric rating scale, Present Pain Intensity, and Oswestry Disability Questionnaire scores were measured immediately after intervention, at seven days, and 14 days after intervention. In both groups, there was a significant decrease in the numeric rating scale, Present Pain Intensity, and Oswestry Disability Questionnaire scores, immediately after intervention, at seven days, and 14 days after intervention. However, there was no significant difference between the two groups across all the outcome measures up to 14 days after intervention. The study did not show a superiority of one technique compared with the other. Longer follow-up periods and more than one cupping session may be needed to evaluate the difference, if any, between both the techniques. NCT02012205. [ABSTRACT FROM AUTHOR]

The presence of organic compounds in drinking water is well recognized in many developing countries; however, the occurrence of organic contaminants in the groundwater of Saudi Arabia, which is the main source of drinking water in the country, is not well documented. A national comprehensive study was carried out to assess the occurrence of organic compounds in groundwater wells used for drinking water purpose, in different regions of Saudi Arabia. A total of 993 well water samples were collected from all 13 administrative regions of the kingdom. Samples were analyzed for a total of 131 organic compounds using the standard methods. The results indicated that total organic carbon values were in the range of 0.01 to 84.13 mg/L with an average weighted value of 12.61 mg/L. Organic compounds were detected in only 9 regions, with 19.84% of the samples containing organic compounds. Only 96 wells (9.67%) showed contents of organic compounds above the safe limits. Pesticides were not detected in any of the well water samples. Overall, organic compounds were found in only 197 out of 993 wells (19.84%) in the whole country. Most of the wells containing organic compounds were located in residential, industrial, and agriculture areas. Riyadh region and Eastern Province were found to have the most affected wells as compared to other regions. Several regions did not show any organic compounds in the well waters. It can be said that the problem of groundwater contamination with organic compounds in Saudi Arabia is not acute and is manageable at present. It is, however, recommended that a regular monitoring of drinking water wells of all regions should be carried out by the competent authorities for organic compounds to know any contamination if and when it happens. Preventing such contaminants from reaching drinking water sources and protecting drinking water well heads from such contaminants remains a priority. [ABSTRACT FROM AUTHOR]

Purpose: To report the incidence of endophthalmitis, the clinical and microbiological aspects, after intravitreal (IVT) injection of anti‑vascular endothelial growth factor. Methods: A chart review was performed of patients diagnosed with endophthalmitis after receiving IVT injections of bevacizumab (Avastin) and ranibizumab (Lucentis) presenting to King Khaled Eye Specialist Hospital (KKESH) from May 2006 to December 2012. Endophthalmitis was diagnosed clinically as an intraocular infection with vitreous involvement that required treatment with IVT antibiotics or had undergone pars plana vitrectomy (PPV) to remove the suspected microorganism. Main outcome measures were the incidence of endophthalmitis and the clinical and microbiological features. Results: Seven cases of endophthalmitis were identified, there was 1 (0.004%) case of endophthalmitis of 22674 IVT injections performed at KKESH. All cases were after IVT bevacizumab. Three (42.85%) cases were culture‑positive and caused by Staphylococcus epidermidis. The initial management was vitreous tap and IVT injection of antibiotics followed by PPV in 6 (85.7%) cases. One (14.3%) case underwent evisceration. Visual acuity improved at last visit in only 2 (28.6%) cases. The rate of endophthalmitis was 0.0004% for bevacizumab. Conclusions: The rate of endophthalmitis after IVT bevacizumab and ranibizumab was very low. We recommend following a standardized injection protocol, adherence to sterile techniques, and proper patient follow‑up are determinant factors for low incidence rates. In addition, endophthalmitis after IVT bevacizumab and ranibizumab have poor visual outcomes despite prompt treatment. [ABSTRACT FROM AUTHOR]

Background and Objective Gingival overgrowth is a prominent side effect of cyclosporine (CsA) therapy in renal transplant patients. Although the exact mechanism by which this drug induces gingival overgrowth is uncertain, marked variations in individual susceptibility to this drug suggest a genetic predisposition. Studies have shown that genetic variation (polymorphism) in the trinucleotide cytosine-adenine- guanine (CAG) sequence in exon 1 of the androgen receptor ( AR) gene is related to altered activity of the AR as a transcription factor. However, the relationship between the length of the CAG repeat and gingival overgrowth has not yet been studied. The present study was carried out to determine whether there is an association between CsA-induced gingival overgrowth and the length of the CAG repeats in the AR gene. Material and Methods Genomic DNA samples were prepared from the blood of 50 renal transplant patients with CsA-induced gingival overgrowth and from the blood of 100 renal transplant patients on CsA with no gingival overgrowth. Results The difference in allele distribution among the subjects with gingival overgrowth and control samples was statistically significant ( p = 0.001). Conclusion The findings suggest a link between CsA7induced gingival overgrowth and a smaller size of CAG repeat in the AR gene. [ABSTRACT FROM AUTHOR]

Nine domestic and three imported bottled water brands were analyzed in Saudi Arabia for various physicochemical water quality parameters. The results of the analysis were compared with the drinking water standards set by different regulatory agencies. The levels of different physicochemical parameters like pH, total dissolved solids (TDS), Ca, Mg, Na, K, NO3, Cl, and SO4 of all local and imported bottled water brands met the standards set by different regulatory agencies. Fifteen (15) trace metals viz. Al, As, Ba, Be, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Sr, Pb, and Zn were also analyzed in all the samples. Comparison of analyzed results with the reported label values showed considerable variation for different parameters. Variation was also recorded for the analyzed parameters for 3 bottles of the same bottled water brand, both for local and imported bottled waters. Zamzam water was also collected from Makkah Al Mukarrama from different locations and analyzed for various physical and chemical parameters. Bottled waters were also compared with the city municipal water supply and Zamzam water. [ABSTRACT FROM PUBLISHER]

To study the demographic, clinical, laboratory features, treatment and outcome of childhood systemic lupus erythematosus (SLE) in western province of Saudi Arabia. Children with SLE who were diagnosed at King Abdulaziz University Hospital, Jeddah, between March 1998 and October 2008 were included. Charts of all patients were reviewed retrospectively for clinical and laboratory features, treatment and outcome. There were 28 girls and 2 boys, with a mean age of 10.5 years (range 5-18). The female:male ratio was 14:1. Constitutional symptoms represent significant symptoms. Hematological manifestations were the most frequent finding (86.7%) at the time of diagnosis followed by arthritis and nephritis (73.3%). The malar rash represents the most common skin manifestation (46.7%). Discoid lupus was very rare. Neurological symptoms were seen in 30%, while cardiac and pulmonary involvement was uncommon. All patients had positive ANA and 90% of them had high anti-ds DNA. All patients were treated with steroids and hydroxychloroquine and 26 patients received immunosuppressive therapy. Three patients died due to severe infection; massive brain infraction and severe lung disease (one in each). Twenty-seven patients are alive in stable condition. Clinical manifestations and laboratory abnormalities were similar to previously reported series. This report confirms that SLE has comparable findings among children from different ethnicities. [ABSTRACT FROM AUTHOR]

The objective of our study was to determine the influence of gender and age of onset on the outcome in Saudi children with systemic lupus erythematosus (SLE). Medical records of children with SLE treated at King Faisal Specialist Hospital and Research Center were reviewed. Outcome measures included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SLICC/ACR), renal disease requiring dialysis, or transplant and death related to SLE. Patients were classified based on age at disease onset into early onset (<5 years) and late onset (>5 years). Data were analyzed, and comparison was made according to the gender and age groups. Eighty-nine patients (76 female and 13 male) were included. The median disease duration was 5 years. Twelve patients had early-onset disease. There was no difference in the mean age, age at diagnosis, disease duration, and follow-up between the different groups. Logistic regression analysis showed significant association of high SLICC/ACR score with early-onset disease and male gender, while renal disease requiring dialysis and renal transplant was associated significantly with male gender independently of age of disease onset. In contrast, death related to SLE was influenced by early-onset disease. Male children and early onset disease of this cohort had poorer outcome. This finding indicates that gender and early-onset disease influence the long-term outcome of SLE in children. [ABSTRACT FROM AUTHOR]

Background and Aim: Query fever (Q fever) is an endemic zoonotic disease and ruminants are considered to be the primary source of infection in humans. It is caused by Coxiella burnetii which is an obligate intracellular bacterial pathogen with a worldwide distribution. This study estimated the prevalence of Q fever in livestock with a history of abortion in Makkah Province, Saudi Arabia. Material and Methods: Sera from 341 camels, 326 sheep, and 121 goats of either sex from various locations (Makkah, Jeddah, AL-Taif, AL-Qunfudah, AL-Laith, and AL-Kamil) were examined using a Q fever indirect enzyme-linked immunosorbent assay. Results: Among the 788 serum samples, 356 animals had anti-Coxiella burnetii immunoglobulin G antibodies with an overall seroprevalence of 45.4%. Significant differences were observed in seroprevalence between species and locations. Camels had the highest percentage of Q fever-positive sera, with a prevalence of 50.4%, followed by goats (44.6%) and sheep (36.8%), with a high significant difference between animals (p = 0.000). The prevalence was significantly higher in Makkah (65.4%) than in Jeddah (28.8%). Conclusion: C. burnetii infection is prevalent in agricultural animals, especially camels maintained at livestock farms in Makkah province. Therefore, these animals considered as the main source of Q fever infections in Saudi Arabia, which is also a reason for the abortion in these animals. Therefore, there is an urgent need for further studies on Q fever infection with interventional approaches for prevention and control. [ABSTRACT FROM AUTHOR]

Capsicum is a common spice used in food flavouring. However, they are prone to mycotoxin contamination. Mycotoxins are natural toxins produced by filamentous fungi and can pose serious risks to human health. Fungal contamination was assessed in 130 randomly collected samples following ISO 21527–2:2008 standards. Results revealed that 84.6% of the samples exceeded the acceptable fungal count limit (102 CFU/g) according to Gulf Cooperation Council (GCC) standards (GSO1016:2015). The predominant fungal isolates were Aspergillus (51.1%), notably Aspergillus flavus (38.8%) and Aspergillus niger (37.7%). Molecular characterization focused on crucial genes associated with aflatoxin (AF) and ochratoxin (OT) biosynthesis, 14.4% of the isolates exhibited all targeted AF genes. The mycotoxin analysis, conducted on 34.6% of samples via liquid chromatography-mass spectrometry (LC-MS), detected AFB1 in 28.8% (0.2–13.8 μg/kg) and OTA in 35.5% (6.87–59.00 μg/kg) of the tested samples. This study demonstrates the need of implementing rules governing the methods of storing, shipping, and packing spices in Saudi Arabia, which may help to minimizes the prevalence of toxigenic fungus and mycotoxins. This was the first study in KSA that focused on Aspergillus in Capsicum products. • Fungus contaminations were revealed in 84.6 % of the tested powder capsicum samples. • Aspergillus spp. is the most prevalent genus in the tested samples. • Mycotoxin biosynthesis genes were detected in several Aspergillus isolates. • Sample packaging has no effect on fungal contamination in this study. • AFB1 and OTA were found in 28.8 and 35.5% of the samples analyzed, respectively. [ABSTRACT FROM AUTHOR]

Renal involvement of systemic lupus erythematosus needs aggressive treatment. Despite the development of multiple international guidelines, differences in practices exist. This study aimed to explore the current practices of pediatric rheumatologists and nephrologists for the diagnosis, management, and monitoring of lupus nephritis (LN) in Saudi Arabia through a survey. Among the 61 respondents, 54.1% were pediatric nephrologists and 49.9% were pediatric rheumatologists. Predominantly, the participating physicians received training either nationally (57%) or in North America (45%). Most of the respondents (77%) did not have a combined rheumatology-nephrology clinic, primarily because of space or time limitations (75%), or a lack of the other specialty (13%). In terms of the decision to request a renal biopsy, the most common factors were nephrotic-range proteinuria (85%) and a lower level of proteinuria associated with hypocomplementemia or elevated anti-double-stranded (ds) DNA (73%). There was marginal agreement over monitoring the disease's activity and treatment response; Complements 3 and 4, anti-dsDNA, protein-creatinine ratio, and estimated glomerular filtration rate were the most popular parameters. The main reason for repeating a renal biopsy was a new renal manifestation that was inconsistent with the previous biopsy. There was considerable variability in the induction therapies used to initiate and taper corticosteroids and conventional immunosuppressive drugs. Most respondents (91%) used angiotensin-converting enzyme agents to control proteinuria. Considerable agreement exists among Saudi physicians managing children with LN but significant variations exist regarding the therapeutic strategies. Additional endeavors are needed to establish a unified national clinical approach for managing LN in children., (Copyright © 2023 Copyright: © 2023 Saudi Journal of Kidney Diseases and Transplantation.)

Semantic Textual Similarity (STS) is the task of identifying the semantic correlation between two sentences of the same or different languages. STS is an important task in natural language processing because it has many applications in different domains such as information retrieval, machine translation, plagiarism detection, document categorization, semantic search, and conversational systems. The availability of STS training and evaluation data resources for some languages such as English has led to good performance systems that achieve above 80% correlation with human judgment. Unfortunately, such required STS data resources are not available for many languages like Arabic. To overcome this challenge, this paper proposes three different approaches to generate effective STS Arabic models. The first one is based on evaluating the use of automatic machine translation for English STS data to Arabic to be used in fine-tuning. The second approach is based on the interleaving of Arabic models with English data resources. The third approach is based on fine-tuning the knowledge distillation-based models to boost their performance in Arabic using a proposed translated dataset. With very limited resources consisting of just a few hundred Arabic STS sentence pairs, we managed to achieve a score of 81% correlation, evaluated using the standard STS 2017 Arabic evaluation set. Also, we managed to extend the Arabic models to process two local dialects, Egyptian (EG) and Saudi Arabian (SA), with a correlation score of 77.5% for EG dialect and 76% for the SA dialect evaluated using dialectal conversion from the same standard STS 2017 Arabic set., Competing Interests: The authors have declared that no competing interests exist.

The gut microbiota is often affected by the dietary and lifestyle habits of the host, resulting in a better efficacy that favors energy harvesting from the consumed food. Our objective was to characterize the composition of gut microbiota in adult Saudis and investigate possible association with lifestyle and dietary practices. Feces from 104 Saudi volunteers (48% males) were tested for microbiota by sequencing the V3-V4 region of bacterial 16S ribosomal RNA (rRNA). For all participants, data were collected related to their lifestyle habits and dietary practices. The relative abundance (RA) of Fusobacteria was significantly higher in normal weight Saudis (P = 0.005, false discovery rate-FDR = 0.014). Individuals who consumed more coffee presented marginally significant more RA of Fusobacteria (P = 0.02, FDR = 0.20) in their gut microbiota compared to those reporting low or no coffee intake, but the RA of Fusobacteria was significantly higher in smokers compared to non-smokers (P = 0.009, FDR = 0.027). The RA of Fusobacteria was also significantly higher in those reporting daily consumption of bread (P = 0.005, FDR = 0.015). At the species level, the gut microbiota of people who consumed coffee was dominated by Bacteroides thetaiotaomicron followed by Phascolarctobacterium faecium and Eubacterium rectale. Similarly, the gut microbiota of smokers was also enriched by B. thetaiotaomicron and Lactobacillus amylovorus. Smoking cessation, bread and coffee consumption induce changes in the intestinal microbial composition of Saudis. This indicates the significance of diet and lifestyle practices in the determination of the composition of the gut microbiota, which could possibly lead later to changes in metabolic profile and weight., Competing Interests: The authors declared that they have no competing interests.

The MIRACLE trial (MERS-CoV Infection tReated with A Combination of Lopinavir/ritonavir and intErferon-β1b) investigates the efficacy of a combination therapy of lopinavir/ritonavir and recombinant interferon-β1b provided with standard supportive care, compared to placebo provided with standard supportive care, in hospitalized patients with laboratory-confirmed MERS. The MIRACLE trial is designed as a recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The aim of this article is to describe the statistical analysis plan for the MIRACLE trial. The primary outcome is 90-day mortality. The primary analysis will follow the intention-to-treat principle. The MIRACLE trial is the first randomized controlled trial for MERS treatment. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02845843. Registered on 27 July 2016.

To define the spectrum and phenotypic characteristics of systemic autoinflammatory diseases (SAIDs) other than familial Mediterranean fever (FMF) in Arab children and to delineate diagnostic evaluation. Data retrospectively collected on patients with clinical and/or genetically proven SAIDs other than FMF at 10 tertiary Arab pediatric rheumatology clinics from 1990 to 2018. The collected data comprised the clinical findings and diagnostic evaluation including genetic testing, the provided treatment and the accrual damage related to SAIDs. A total of 144 patients (93 female) with a median age at onset of 2.5 (range 0.1-12) years were enrolled. The initial diagnosis was inaccurate in 49.3%. Consanguinity rate among parents was 74.6%. The median time-to-diagnosis for all SAIDs was 2.5 (range 0.1-10) years. There were 104 patients (72.2%) with a confirmed diagnosis and 40 patients with suspected SAIDs. Seventy-two had monogenic and 66 patients with multifactorial SAIDs while six patients had undifferentiated SAIDs. The most frequent monogenic SAIDs were LACC1 mediated monogenic disorders (n = 23) followed by CAPS (12), TRAPS (12), HIDS (12), and Majeed's syndrome (6). The most frequent multifactorial SAIDs was CRMO (34), followed by PFAPA (18), and early onset sarcoidosis (EOS) (14). Genetic analysis was performed in 69 patients; 50 patients had genetically confirmed disease. Corticosteroid used for 93 patients while biologic agents for 96 patients. Overall, growth failure was the most frequent accrual damage (36%), followed by cognitive impairment (13%). There were three deaths because of infection. This study shows a heterogenous spectrum of SAIDs with a high number of genetically confirmed monogenic diseases; notably, LACC1 associated diseases. Hopefully, this work will be the first step for a prospective registry for SAIDs in Arab countries.

Therapeutic plasma exchanges (TPE) is considered as one of the treatment modalities that is used in systemic autoimmune diseases. This study aimed to describe the early and late effect of TPE in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) presented with acute kidney injury (AKI). Retrospective study comprised patients with SLE and AAV with AKI seen between January 2000 and June 2014 at King Faisal Specialist Hospital and Research Center in Riyadh. All patients underwent TPE. Retrospectively, all patients were assessed for early and late renal outcome at 12- month and 24-month intervals. Renal outcome was assessed according to serum creatinine level, glomerular filtration rate, active urine sediment, and proteinuria. P <0.05 was considered significant. A total of 68 patients were included, 58 patients (51 females) had SLE and 10 patients (7 females) had AAV completed TPE. All patients had active disease and had AKI. At the first 12 months, 18 patients (17 SLE and 1 AAV) showed complete response and 14 patients had partial response while 22 patients did not show therapeutic benefit. The nonresponders (22 patients) entered the late assessment interval (24 months) without any therapeutic response. Statistically, there was no significant difference between the patient's response to TPE at the first and second assessment intervals and the baseline serum creatinine level. TPE might be an alternative rescue treatment in lupus nephritis with AKI.

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Arabic language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic and clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 100 JIA patients (27.0% systemic JIA, 23.0% oligoarticular, 25.0% RF negative polyarthritis, and 25.0% other categories) and 100 healthy children, were enrolled in one paediatric rheumatology centre. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed satisfactory psychometric performances. In conclusion, the Arabic version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and in clinical research.

In a continuation of our efforts to identify bioactive compounds from Red Sea Verongid sponges, the organic extract of the sponge Suberea species afforded seven compounds including two new dibrominated alkaloids, subereamollines C and D (1 and 2), together with the known compounds aerothionin (3), homoaerothionin (4), aeroplysinin-1 (5), aeroplysinin-2 (6) and a revised subereaphenol C (7) as ethyl 2-(2,4-dibromo-3,6-dihydroxyphenyl)acetate. The structures of the isolated compounds were assigned by different spectral data including optical rotations, 1D (1H and 13C) and 2D (COSY, multiplicity-edited HSQC, and HMBC) NMR and high-resolution mass spectroscopy. Aerothionin (3) and subereaphenol C (7) displayed potent cytotoxic activity against HeLa cell line with IC50 values of 29 and 13.3 µM, respectively. In addition, aeroplysinin-2 (6) showed potent antimigratory activity against the human breast cancer cell line MDA-MB-231 with IC50 of 18 µM. Subereamollines C and D are new congeners of the previously reported compounds subereamollines A and B with methyl ester functionalities on the side chain. These findings provide further insight into the biosynthetic capabilities of members of the genus Suberea and the chemical diversity as well as the biological activity of these compounds.

Objectives: We aimed to describe the social, educational, employment and long-term clinical outcomes of adults with childhood-onset systemic lupus erythematosus (SLE) in a Saudi cohort., Methods: All adult patients with childhood-onset SLE who were treated and had regular follow-up between 1990 and 2013 at King Faisal Specialist Hospital and Research Centre (KFSH-RC), Riyadh were included. The long-term outcome measures comprised SLE Disease Activity and Damage Indices at the last follow-up visit and death related to SLE. Social, educational and employment history were obtained via personal or phone interviews., Results: Forty-eight patients (45 female) were included, whose mean age was 23.6±4 years and mean disease duration 15±4 years. At the last follow-up visit, 24 (50%) patients were found to have active disease with mean of accrual damage index of 2 (0-7). Forty patients (83%) had renal involvement, 7 (15%) of them progressed to end stage renal disease, 5 patients underwent renal transplant, 2 failed the transplant and are currently on haemodialysis. Sixteen patients had central nervous system involvement in the form of seizure disorder (6 patients), chorea (3 patients) and cerebrovascular accident (3 patients). Forty-three patients completed high school and 21 joined a college. Six patients were in employment. Eight patients got married and 5 of them had children. There were 3 deaths related to SLE (6.25%), mainly due to infection., Conclusions: Our cohort indicates that the outcome of adult Saudi patients with childhood-onset SLE was satisfactory and comparable to earlier reports.

To report the safety and efficacy of combined cyclophosphamide and rituximab treatment in Saudi children with systemic lupus erythematosus (SLE). Medical records of all children with SLE treated with cyclophosphamide and rituximab between June 2007 and June 2012 at King Faisal Specialist Hospital and Research Center, Riyadh, were reviewed for demographic characteristics, age at diagnosis, concomitant treatments, indication of using rituximab and adverse events during the treatment period. Clinical and serologic response parameters included SLE Disease Activity Index (SLEDAI), complement, anti-ds DNA antibody and ANA levels, and mean daily corticosteroid dose assessed 3 months before combined cyclophosphamide and rituximab infusion course and at 6-month interval afterward. Sixteen patients (13 girls) with refractory SLE treated with cyclophosphamide and rituximab were included. The mean age at onset of SLE was 7.8 + 3.3 years, while the mean age at diagnosis was 8.1 + 3.4 years; the mean disease duration was 4.7 + 3.2 years. All patients were treated with corticosteroid and immunosuppressive drugs. Nephritis (8 patients) was the most frequent indication; other indications included refractory arthritis, thrombocytopenia, severe mucocutaneous lesions and central nervous system involvement. All patients received 2 doses, but 4 required 4-8 extra doses. All patients showed improvement in response parameters. There was significant reduction in SLEDAI (P < 0.0002) and corticosteroid dose (P < 0.005). A total of 4 adverse events were notified; 2 developed infusion-related reactions. One patient had severe soft tissue fungal infection, and other patient had pancreatitis. Our data showed beneficial therapeutic and steroid-sparing effects of rituximab as adjunctive treatment for children with refractory SLE including both renal and extrarenal manifestations. Although rituximab was well tolerated by the majority of patients, it may associated with various adverse events.

Purpose: To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser., Design: Consecutive case series., Participants: Fourteen eyes of 14 patients., Methods: Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography., Main Outcome Measures: Analysis of the types of maculopathy and vitreoretinal pathologic features., Results: All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300)., Conclusions: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Glomerular diseases continue to be the leading cause of end-stage renal disease (ESRD) globally. Hence, it is important to recognize the pattern of glomerular diseases in different geographical areas in order to understand the patho-biology, incidence and progression of the disorder. Published studies from different centers in Saudi Arabia have reported contradicting results. In this retrospective study, we report our experience at the Armed Forces Hospital, Riyadh, Saudi Arabia. A total of 348 native renal biopsies performed at our center on patients with proteinuria >1 g, hematuria and/or renal impairment during a period of 5 years (between January 2005 and December 2009) were studied by a histopathologist using light microscopy, immunofluorescence and electron microscopy, and were categorized. Results showed that primary glomerular disease accounted for 55.1% of all renal biopsies. The most common histological lesion was focal and segmental glomerulosclerosis (FSGS) (27.6%), followed by minimal change disease (MCD) (17.7%) and membrano-proliferative glomerulonephritis (MPGN) (13.0%). Secondary glomerular disease accounted for 37.9% of the glomerular diseases, with lupus nephritis (LN) being the most common lesion (54.5%), followed by hypertensive nephrosclerosis (22%), post-infectious glomerulonephritis (7.5%), diabetic nephropathy (DN) (6.8%) and vasculitides (4.5%). Four percent of all biopsies turned out to be ESRD while biopsy was inadequate in 2.8% of the cases. In conclusion, our study showed that FSGS was the most common primary GN encountered, while LN was the most common secondary GN. We encountered 14 cases of crescentic glomerulonephritis. Also, the prevalence of MPGN, MCD, IgA nephropathy and membranous GN was many folds higher in males when compared with the Western data. We believe that it is mandatory to maintain a Saudi Arabian Renal Biopsy Registry to understand better the pattern of glomerular disease in the Saudi population and to follow any change in trend.

Background: Camptodactyly-arthropathy-coxavara-pericarditis (CACP) syndrome is a rare autosomal recessive disorder caused by mutations in the gene proteoglycan 4 (PRG4), affecting lubricin production, which is an essential protein for joint function. Manifestations vary between affected individuals with camptodactyly, early-onsetnon-inflammatory arthropathy, coxa vara deformity and non-inflammatory pericarditis., Objective: To describe the clinical, laboratory, radiological and genetic findings of CACP syndrome in children from Saudi Arabia., Methods: Medical records of all the children with CACP syndrome seen between June 1990 and June 2012 at King Faisal Specialist Hospital and Research Center, Riyadh were reviewed. The data include gender,age of first disease manifestations,referral diagnosis, clinical and radiological features, and molecular genetic studies as well as functional status at the last follow-upvisit., Results: Twenty-two patients (15 boys), (clinical and genetic data of 15 patients were previously published) with mean age at diagnosis 3.7 (1-14) years, were included in this cohort study. The referral diagnosis was inaccurate in all patients; juvenile idiopathic arthritis (JIA) was the referral diagnosis in majority of the patients. Six families had more than one affected child. Camptodactyly and large joints arthropathy were present in all the cases. Camptodactyly was observed in the neonatal period in all the patients, while other joint involvement was observed through the 1st year of life. All patients had a normal cardiac evaluation but two children had evidence of pericarditis. All patients had normal inflammatory markers and the result for rheumatoid factor test was negative. Radiological findings included coxa vara with a short femoral neck and flat, irregular femoral heads and intra-osseous cysts, increased joint space, and abnormal modeling of the acetabulum with small iliac wings. Other joints (knees, ankle, elbow and wrist) showed soft-tissue swelling consistent with thick cartilage and abnormal modeling with evidence of intra-articular fluid in majority of the patients. Synovial biopsy from three patients revealed proliferating synovial epithelium with moderate fibro-collagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils were identified. Previously, a locus responsible for causing CACP syndrome has been reported in eight patients of our cohort; it has been assigned to 1q25-q31. Furthermore, in seven newly diagnosed patients from four unrelated families, five novel mutations were found. All patients were referred to us while they were on NSAIDs, 10 patients used antirheumatic drugs (prednisone and methotrexate) and two patients were treated with etanercept. In all patients, treatment was ineffective apart from mild pain relief., Conclusion: CACP syndrome is an autosomal recessive disorder occurring due to mutations in the gene PRG4 encoding lubricin; it is not an uncommon disorder in Saudi Arabia. Pericarditis is rarely seen in our patients. Our data suggest that CACP syndrome may be easily confused with JIA, causing a delay in diagnosis and probably unnecessary treatment with antirheumatic drugs including biologic agents., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To report the long-term outcome of Saudi children with systemic lupus erythematosus (SLE)., Methods: Charts of all children with SLE treated between 1990 and 2010 at King Faisal Specialist Hospital and Research Center Riyadh, were reviewed. The long-term outcome measured by pediatric adaptation of the Systemic Lupus International Collaborating Clinics American College of Rheumatology Damage Index (pSDI) and death related to SLE were determined. The data included: gender, age at disease onset, clinical features and treatment at last follow-up visit., Results: One hundred and fifty-two patients (129 girls and 23 boys) were included. The mean age at onset of SLE was 8.8 ± 2.6 years, while the mean age at diagnosis was 9.5 ± 2.6 years and the mean disease duration was 7.5 ± 4.6 years. All patients were treated with corticosteroid and immunosuppressive drugs. Eighty (52.6%) patients had damage with a mean SDI score of 1.3 ± 1.7. Damage accrual was mostly in the growth (26.8%), renal (17.1%) and neuropsychiatric (15.8%) domains. Due to progressive renal disease, 14 patients required dialysis; five of them underwent renal transplant. There were nine deaths related to SLE, eight of them due to infection. Based on logistic regression, patient disease damage was significantly associated with young age at disease onset and long disease duration. Similarly, death related to SLE was influenced by early-onset disease. In contrast, gender, disease duration and therapy did not affect the suggested outcome measures., Conclusion: Our results are comparable to reports from other tertiary centers. Early-onset disease probably influences the long-term outcome of SLE in children. Infection remains an important cause of death in children with SLE., (© 2012 The Author International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Background and Objectives: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, systemic, aseptic, inflammatory disorder that involves different sites. Pathogenesis of chronic recurrent multifocal osteomyelitis is currently unknown. To our knowledge, there are no reports of CRMO from Saudi Arabia. We describe the clinical and laboratory features and treatment of a cohort of children with CRMO., Design and Setting: Retrospective, patients referred to pediatric rheumatology clinic at a tertiary care center in Riyadh, Saudi Arabia., Patients and Methods: The diagnosis of CRMO was based on evidence of recurrent osteomyelitis with radiographic evidence of chronic osteomyelitis involving at least two sites in the absence of infectious cause in a child less than 14 years old., Results: Ten patients (9 female, 1 male) with CRMO; 2 patients presented in infancy. The referral diagnosis was inaccurate in all patients. All of them presented with pain and 8 of them had associated swelling and were found to have multifocal lesions. Imaging studies showed findings consistent with chronic osteomyelitis. Histopathological and microbiological examination confirmed the diagnosis in 9 patients. Cyclic pamidronate infusions induced good improvement in 6 patients., Conclusion: This report indicates that CRMO may be overlooked in our community. Early diagnosis and treatment are required to avoid potential complications.

Background and Objective: Published data from Saudi Arabia regarding autoinflammatory diseases are scarce. In this study, we describe the clinical and laboratory features of autoinflammatory diseases in Saudi children., Design and Setting: Restrospective, hospital-based study conducted from January 2010 until June 2010., Patients and Methods: Patients with autoinflammatory disease treated at the Pediatric Rheumatology Clinic at King Faisal Specialist Hospital and Research Center, Riyadh, over the past 10 years were included. Autoinflammatory diseases included the following: familial Mediterranean fever (FMF); chronic recurrent multifocal osteomyelitis (CRMO); early-onset sarcoidosis (EOS); periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA); chronic infantile neurologic cutaneous and articular syndrome (CINCA); and Muckle-Wells syndrome (MWS). Demographic characteristics, diagnosis, age at onset, disease duration, follow-up duration, clinical and laboratory variables, and outcome data were compiled. Gathered laboratory data were part of patients' usual medical care., Results: Thirty-four patients (females, 53%) with autoinflammatory diseases were included (mean age, 151 months). Mean disease duration was 118 months; mean age at onset was 32 months; consanguinity was present in 40%. Patients were diagnosed as follows: FMF, 50%; CRMO, 23.5%; CINCA, 8.8%; EOS, 8.8%; MWS, 6%; and PFAPA, 2.9%. The referral diagnosis was inaccurate in all patients except for FMF patients. Gene study was informative in 9 of 14 FMF patients who had molecular analyses. None of our cohort had amyloidosis. All CRMO patients had a favorable response to treatment except 1 patient, who had refractory, progressive disease. All patients with EOS had multiorgan involvement, including uveitis. All CINCA patients had a favorable response to anakinra., Conclusion: Our report shows that autoinflammatory diseases other than FMF may be overlooked. Increased awareness among pediatricians about these conditions will help to provide better health care to patients in the form of early diagnosis and management.

Objective: To delineate the clinical and laboratory features of systemic lupus erythematosus (SLE) in C1q-deficient Saudi children and to compare them with sporadic SLE patients with respect to their clinical and laboratory features and disease outcome., Methods: The C1q-deficient SLE patient group comprised 14 patients, while the comparative group comprised 11 patients selected by systemic sampling from our pediatric lupus clinic database. The two groups were compared with respect to: demographic, clinical and laboratory variables and outcome., Results: The C1q-deficient SLE patients had an earlier age of onset of disease (P = 0.003); 43% had familial SLE and none of the comparative group had family histories of SLE. The two groups were comparable with respect to gender, disease duration and follow-up. Scarring alopecia, discoid rash and nail changes were more frequent in the C1q-deficient SLE patient group. However, there were no significant differences. The mean white blood cell count was lower (P = 0.04) and the level of anti-Sm and anti-phospholipid antibodies were higher (P = 0.04) in the C1q-deficient SLE patients. Other variables did not show significant differences. Two patients from the C1q-deficient SLE patient group died due to infection. All patients from the control group are alive. Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index mean was higher in the C1q-deficient SLE patients group but was not statistically significant., Conclusion: C1q-deficient SLE patients tend to be younger and more likely to have familial disease with severe cutaneous manifestations. The mortality among them is more frequent, which may reflect disease severity., (© 2010 The Authors. International Journal of Rheumatic Diseases © 2010 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.)

Background: Familial arthropathy comprises a heterogeneous group of arthropathies. It can be either an inflammatory or a noninflammatory condition. The worldwide frequency of these disorders is unknown., Objective: To study the demographic, clinical and biochemical features, and survival of a large series of children with familial arthropathies., Methods: The medical records of children who had an arthropathy and a family history of a similar condition at the Pediatric Rheumatology Clinic at King Faisal Specialist Hospital-Riyadh between 1990 and 2005 were reviewed. These included children with familial juvenile idiopathic arthritis (FJIA), infantile systemic hyalinosis (ISH), the nodulosis-arthropathy-osteolysis (NAO) syndrome, and the camptodactyly-arthropathy-coxa vara (CAC) syndrome. Familial rheumatic diseases including spondyloarthropathies or known syndromes associated with articular manifestations were excluded. In each case age, gender, presenting symptoms, laboratory data, diagnostic procedures, and provisional and final diagnoses as well as treatment and outcome were reviewed., Results: Sixty-two children with various familial arthropathies were reviewed. Twelve children (9 female/3 male) with FJIA presented with polyarthritis. These children belonged to 4 unrelated families, all of whom were from the same geographical area, with 2 families belonging to the same tribe. The mean age at onset was 2.4 years, and mean age at diagnosis was 3.5 years. All children had high inflammatory markers. Nineteen children (11 male/8 female) with ISH presented in the neonatal period with painful joint contractures and typical mucocutaneous features. The referral diagnosis was inaccurate in 14 patients. Thirteen patients were the product of first-degree cousin marriages, and 5 families had more than 1 affected child. Radiological findings included periosteal reaction and osteolytic lesions. Tissue biopsy was performed in 8 patients and the findings were consistent with the diagnosis in all 8 patients. Despite aggressive management, 16 patients died. The mean age of the remaining 3 surviving children was 20 months. There were 15 children (9 female/6 male) with the NAO syndrome with a mean age at onset of 3.4 years. They were from 7 unrelated families; 5 families had more than 1 affected child. The referral diagnosis was juvenile idiopathic arthritis (JIA). Most children presented with painful deformed hands. Eleven children (70%) had advanced osteolytic changes. All children had normal inflammatory markers. There were 16 children (11 male/5 female) with the CAC syndrome who were diagnosed at a mean age of 3.7 years. Camptodactyly presented at birth or in first months of life, while other features developed in early childhood. JIA was the referral diagnosis. Fourteen children had bilateral coxa vara. Two children exhibited symptoms or signs of pericarditis. Inflammatory markers were normal in all children., Conclusions: Familial arthropathies are not uncommon conditions which may be easily confused with JIA, causing a delay in diagnosis and management. Careful evaluation of a child presenting with an arthropathy, particularly in a population where consanguinity is common, is required for timely and accurate diagnosis. Overall, the prognosis of these conditions remains guarded despite treatment.

Objective: To compare patients with familial versus sporadic juvenile idiopathic arthritis (JIA) with respect to clinical and laboratory variables., Methods: The familial JIA group comprised 11 affected siblings belonging to 4 families, while the comparative group comprised 22 patients selected by systematic sampling from JIA patients presenting to our pediatric rheumatology clinic; the first patient was chosen randomly and the subsequent patients chosen at intervals of 3. The 2 groups were compared with respect to demographic information, age at onset of disease, disease activity, disease damage, and laboratory variables., Results: The 2 groups were comparable with respect to age, sex, and onset type of disease. All patients from the familial group were from a southern province of Saudi Arabia (p = 0.001). The familial group had an earlier age at onset of disease (p = 0.039), the mean number of actively inflamed joints was higher (p = 0.009), and functional capacity as measured by Childhood HAQ was worse (p = 0.048), compared with the sporadic group. Other variables showed no significant differences., Conclusion: The comparison of patients with familial versus sporadic JIA revealed a significant difference in origin of patients and age at onset of disease. These differences may be helpful in identifying the predisposing genes in familial patients with JIA.

The camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is an autosomal recessive disorder caused by mutations in the PRG4 (Proteoglycan 4) gene. Manifestations vary across families as well as between affected individuals from the same family, with camptodactyly and arthropathy of the knees the most ubiquitous, while pericarditis is evident in only one-fifth of all reported cases. Thus far only eight pathogenic mutations have been described in this gene. We examined seven newly diagnosed childhood patients of this syndrome, hailing from four unrelated families of Saudi origin. Five novel mutations were uncovered, including four frameshift deletions and one nonsense mutation (c.923&#95;924delAA, c.3125&#95;3128delGAGT, c.3139&#95;3140delAA, c.3276&#95;3277delAA, c.4078A>T). No genotype/phenotype association was observed. Because all mutations reported in CACP patients thus far predict premature truncation, we hypothesize that missense mutations are either not physiologically relevant, or that they trigger a clinical phenotype that is distinct from classical CACP. This is only the second published communication on PRG4 mutations, and increases the number of reported mutations for all ethnicities from 8 to 13, and for the Arab population specifically from one to six., (2006 Wiley-Liss, Inc.)

Objective: To determine the feasibility, reliability and validity of the childhood health assessment questionnaire--modified for Arab children (CHAQ--MAC)., Methods: One hundred and eighteen modified questionnaires were completed by 75 juvenile rheumatoid arthritis (JRA) patients and their parents attending the Pediatric Rheumatology Clinic at the King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia over an 18 month period (January 1996 to May 1997)., Results: The modified questionnaire was self-administered by 82% of the parents. The median time to complete the questionnaire was 10 minutes. The main difficulty in comprehension was discomfort dimension (visual analogue scale [VAS] and morning stiffness). Test retest reliability was good (r=0.79). Validity of the CHAQ-MAC was confirmed by the strong correlation between disability index and VAS score (r=0.58). Functional activities that caused the most difficulties were cross sitting, assuming the prayer position, and using the Arabic style toilet., Conclusion: The modified CHAQ is a suitable assessment tool for Arab children suffering from JRA.

There are currently 5706 patients receiving hemodialysis therapy in the Kingdom of Saudi Arabia - a 15 fold increase when compared to 1983. The annual increase in the number of patients on dialysis for 1999 is 696 (10 fold increase when compared to 1983). Besides the massive increase in the number of patients in the last 20 years, we have noticed a marked increase in the mean age of patients (51.3 years in 1999 as compared to 37.9 years in the early 80s). Diabetes mellitus which was an insignificant contributory etiology (4%) in the early 80s is now a major cause (16-25%). Similarly mortality has increased from 4% annually to 11-14% annually. This is largely due to increasing age and prevalence of diabetes mellitus. Within the expired cohort the mean age was 62.3 years compared to 51.3 years of the total dialysis population, and diabetes mellitus was present in 60.5% in those who expired. Moreover, ischemic heart disease was diagnosed in 50% before death. Tuberculosis and Hepatitis C virus incidences, however, have not improved over the years but the degree of rehabilitation has, largely due to better hemoglobin level and due to the technological advances in dialysis delivery. This article describes these changes, their causes and implications.

Background: To assess the aerobic and anaerobic characteristics of Saudi elite soccer players, and to examine the interrelationship between measures of aerobic and anaerobic power in the elite soccer players. METHODS., Participant: Twenty-three outfield elite soccer players representing the Saudi national team participated. Their means (+/- SD) for age, body mass, height and estimated fat % were: 25.2 +/- 2.3 years; 73.1 +/- 6.8 kg; 177.2 +/- 5.9 cm; and 12.3 +/- 2.7%, respectively., Measures: Cardiorespiratory parameters, including maximal oxygen uptake (V O2 max), were assessed by open-circuit spirometry during graded treadmill running. Anaerobic power measures were obtained using Wingate anaerobic test, and included peak power (PP), and average power for 5 sec (AP 5), 10 sec (AP 10), 20 sec (AP 20) and 30 sec (AP 30)., Results: Mean (+/-SD) values for V O2max in absolute and relative to body mass were 4.16 +/- 0.34 l x min-1 and 56.8 +/- 4.8 ml x kg-1 x min-1, respectively. Such V O2max value was 118% and 80% of those reported for Saudi college males and distance runners, respectively. The ventilatory anaerobic thereshold (Tvent) averaged 43.6 ml x kg-1 x min-1. There were no significant differences in V O2max and Tvent between players based on positions, although the midfielders and the centre-backs had the highest and the lowest individual values for both measures, respectively. Values (+/- SD) of PP and AP 30 were 873.6 +/- 141.8 W (11.88 +/- 1.3 W x kg-1), and 587.7 +/-55.4 W (8.02 +/- 0.53 W x kg-1), respectively. Only in absolute PP & AP 30 were the centre-backs significantly superior to the other players. In addition, V O2max was inversely related to PP (r = - 0.54; p < 0.05) and positively related to AP 30 (r = 0.45; p < 0.05)., Conclusions: The aerobic power, expressed relative to body mass, of Saudi elite soccer players was in the lower range of values normally reported in the literatures for elite soccer players. Both PP and AP 30 were somewhat lower than values previously reported for elite soccer players from other countries.

Objectives: We conducted this study to evaluate the prevalence, and risk factors of hypercholesterolemia (HC) in renal transplant population., Methods: We reviewed the records of the active renal transplant patients at two large transplant centers in Riyadh and Jeddah in Saudi Arabia transplanted between 1979 and November 1998. The patients were grouped according to the measurement of serum cholesterol level; group I (normal): below or equal 5.2 mmol/L, group II (mild HC): from 5.3-6.0 mmol/L, group III (moderate HC): from 6.1-8.0 mmol/L group IV (severe HC): above 8.0 mmol/L., Results: There were 1096 patients' records included in the study. According to the level of measured serum cholesterol, there were 421 (38.4%) patients is group I, 256 (23.3%) patients in group II, 363 (33.1%) patients in group III and 57 (5.2%) patients group IV. We found no significant difference between the study groups in terms of gender (60% males, 40% females), mean duration of transplantation (66.9 months), between those transplanted before 1990 and those transplanted after 1990, donor type, prevalence of hypertension (85%), history of hypertension on dialysis, original kidney disease, frequency of rejections in the first year (28%), mean serum creatinine (220 mumol/L), cyclosporine mean dose (3.2 mg/kg/day) mean prednisone dose (0.15 mg/kg/day), number of patients on azathioprine (65%), the mean proteinuria (0.6 G/L) or number of antihypertensives. In comparison with the group with normal serum cholesterol level, the group with severe hypercholesterolemia had significantly higher mean age (40.6 versus 37.4 years), higher mean weight (72 versus 65.8 kg), rate of retransplantation (8.8% versus 3.1%), higher frequency of diabetics (35% versus 20%) and higher frequency of abnormal electrocardiogram (18.2% versus 5.2%)., Conclusion: That hypercholesterolemia is a significant problem in the renal transplant population in Saudi Arabia. Risk factors for the development of hypercholesterolemia are mainly related to weight, age, diabetes and retransplantation.

The main aims of this study were, first, to estimate the need for periodontal care among adult residents of Saudi Arabia using the community periodontal index of treatment need (CPITN) and, second, to quantify the relationship between the frequency of using the 'Miswak' and the need for periodontal care. The Miswak is a stick made from the roots of the Arak tree (Salvadora persica) and is used for oral hygiene purposes by many cultures. A total sample of 480 adults aged 35 to 44 years and 65 years and older from the cities of Mecca and Jeddah was included in the study. The findings indicate that the level of need for periodontal care in the sample chosen is low when compared with the findings of similar studies undertaken in other countries. The frequent use of the 'Miswak' was associated with a lower need for treatment.