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Ezeldine K Abdalhabib,1 Denise E Jackson,2 Badr Alzahrani,1 Elyasa Elfaki,1 Alneil Hamza,1 Abdelbaset Mohamed Elasbali,1 Fehaid Alanazi,1 Abdulrahman Algarni,3 Ibrahim Khider Ibrahim,4 Muhammad Saboor5,6 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, AlQurayyat, Jouf University, Sakaka, Saudi Arabia; 2Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Victoria, Australia; 3Department of Medical Laboratory Technology, College of Applied Medical Sciences, Northern Borders University, Arar, Saudi Arabia; 4Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan; 5Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6Medical Research Center (MRC), Jazan University, Jazan, Saudi ArabiaCorrespondence: Muhammad SaboorDepartment of Medical Laboratory Technology, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi ArabiaTel +966 54 495 9029Email msaboor@jazanu.edu.saEzeldine K AbdalhabibDepartment of Clinical Laboratory Sciences, College of Applied Medical Sciences-AlQurayyat, Jouf University, Saudi ArabiaTel +966 538949566Email ezeldine@ju.edu.saPurpose: DNA damage to hematopoietic progenitor cells is an essential factor for leukemia development as a failure of the host DNA repair system to fix errors in DNA. This study aimed to assess the association of XRCC1 gene polymorphisms including Arg194Trp, Arg399Gln, and Arg280His with the risk of development of CML in Sudanese population.Patients and Methods: The present study was conducted on 186 newly diagnosed patients with CML, aged 19– 70 years (118 males and 68 females; mean age of 46.15± 13.91 years) and 186 normal healthy controls (123 males and 63 females; mean age of 44.94± 8.97 years). Polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) assay was utilized to analyze the XRCC1 (Arg194Trp, Arg399Gln, and Arg280His) gene polymorphisms.Results: The genotypic frequencies of Arg399Gln polymorphism in cases were 131 (70.4%) homozygous Arg/Arg, 46 (24.7%) homozygous Gln/Gln, and 9 (4.8%) heterozygous Arg/Gln as compared to the controls ie, 153 (82.3%), 73 (14.5%), and 6 (3.2%), respectively. The Arg399Gln variant genotypic frequencies significantly differed between the cases and controls (χ2 = 7.249, P = 0.027). By comparison, no statistically significant difference was observed in the variant genotype frequencies between the cases and controls in terms of Arg194Trp and Arg280His polymorphisms.Conclusion: XRCC1 Arg399Gln gene polymorphism might have an important role in increasing the risk of chronic myeloid leukemia among Sudanese patients. Furthermore, all tested three polymorphisms showed no association of risk of the development of CML with age and gender.Keywords: XCCR1, chronic myeloid leukemia, polymorphism

Samia Alhassan,1 Abdelgadir Elmugadam,1 Ghada A Elfadil,1 Nuha Abubaker,1 Elyasa M Elfaki,2 Alneil Hamza,2 Ezeldine K Abdalhabib,2 Tarig Karar3,4 1Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan; 2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia; 3Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4King Abdullah International Medical Research Centre, Riyadh, Saudi ArabiaCorrespondence: Elyasa M Elfaki, Department of Clinical Laboratory Sciences, College of Applied Medical Science, Jouf University, Omer bin Alkhattab Street, Al-Qurayyat, 77452, Saudi Arabia, Tel +966500769479, Email eelfaki@ju.edu.saBackground: Polycystic ovary syndrome (PCOS) is one of the most important contributing factors to infertility. The diagnosis of PCOS is not an easy procedure, as the signs and symptoms are heterogeneous and of undefined etiology. There are only a few published studies that address the diagnostic performance of anti-Müllerian hormone in diagnosis of PCOS in sub-Saharan Africa including Sudan.Objective: This study aims to assess anti-Müllerian hormone (AMH), luteinizing to follicle-stimulating hormone ratio (LH: FSH), total testosterone (TT), and prolactin (PRL) levels among PCOS. In addition, we determine if AMH can be used as a predictor of PCOS among Sudanese women.Methods: There were 600 women enrolled in this observational cross-sectional study, 300 of whom had PCOS, and 300 of whom healthy women; PCOS was diagnosed using the Rotterdam criteria. On days 2– 4 of the menstrual cycle, serum LH, FSH, AMH, TT, and PRL levels were measured for all participants. Diagnostic performance of these parameters for PCOS was determined by receiver operating characteristic (ROC) curve.Results: Significantly higher means among PCOS regarding their BMI, AMH; LH: FSH ratio; TT; PRL, whereas significantly inverse in FSH compared with normal ovulatory women. On ROC analysis, AMH had the largest operating characteristic curve at cut-off > 3.95 ng/mL; AUC = 0.999 with Youden’s index 0.99%, followed by LH: FSH ratio at cut-off 0.749; AUC=0.932; Youden’s index 0.813%, TT cut-off 0.82 mIU/L, AUC=0.852 with Youden’s index 0.58, while PRL showed the lowest AUC=0.627 with cut-off 15.3 ng/mL, Youden’s index was 0.18%, P. value< 0.001.Conclusions: Sudanese women with PCOS had higher serum AMH level, LH:FSH ratio, and TT level. Moreover, AMH level has better discriminative power and good diagnostic potency for the diagnosis of PCOS among Sudanese.Keywords: PCOS women, AMH, LH:FSH ratio, TT, PRL, Sudan

Ezeldine K Abdalhabib,1 Badr Alzahrani,1 Muhammad Saboor,2– 4 Alneil Hamza,1 Elyasa M Elfaki,1 Fehaid Alanazi,1 Fawaz O Alenazy,1 Abdulrahman Algarni,5 Ibrahim Khider Ibrahim,6 Hozifa A Mohamed,7 Ayman Hussein Alfeel,8 Nahla Ali Alshaikh3,4 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia; 2Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 3Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 4Medical Research Center (MRC), Jazan University, Jazan, Saudi Arabia; 5Department of Medical Laboratory Technology, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia; 6Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan; 7Department of Molecular Biology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan; 8Department of Medical Laboratory Sciences, College of Health Sciences, Gulf Medical University, Ajman, United Arab EmiratesCorrespondence: Ayman Hussein Alfeel, Department of Medical Laboratory Sciences, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates, Email aymanalfeel@gmail.com Muhammad Saboor, Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, Tel +971 56 443 2008, Email msaboor@jazanu.edu.saPurpose: Single-nucleotide polymorphism (SNP) in the promoter region of the IL-10 gene can increase susceptibility to tumor development. The current study aimed to explore the genotypic frequency of interleukin-10 (IL-10) rs1800896 polymorphism in newly diagnosed adult patients with acute lymphoblastic leukemia (ALL) and validate whether this SNP is a risk factor for adult ALL.Patients and Methods: This case–control study was based on a subset of newly diagnosed 154 adult patients with ALL recruited from the Radiation and Isotope Center in Khartoum (RICK) and 154 healthy controls from the same geographical area. Genomic DNA was used for the genotyping of rs1800896 polymorphism through allele-specific polymerase chain reaction (PCR) assays.Results: The genotypic frequencies of rs1800896 showed a statistically significant association of AG and AA genotypes with adult ALL (p< 0.001). Combined genotypes AG+GG vs AA also showed a positive association of rs1800896 with adult ALL (OR=4.89). The allelic frequencies of G and A did not show any significant difference in adult patients with ALL compared with the control group. AG rs1800896 genotype showed an increased risk of B and T ALL (OR=2.51 and 4.70, respectively). Age at diagnosis, gender, and immunophenotype (B vs T ALL) did not exhibit any association of rs1800896 with ALL in this patient group.Conclusion: rs1800896 polymorphism is associated with an increased risk of ALL in adult patients irrespective of the age at diagnosis, gender, and immunophenotype of ALL.Keywords: acute lymphoblastic leukemia, polymorphism, IL-10, – 1082 (A>G), rs1800896

Ezeldine K Abdalhabib,1 Denise E Jackson,2 Badr Alzahrani,1 Elyasa M Elfaki,1 Alneil Hamza,1 Fehaid Alanazi,1 Elryah I Ali,3 Abdulrahman Algarni,3 Ibrahim Khider Ibrahim,4 Muhammad Saboor5,6 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences-Al Qurayyat, Jouf University, Sakaka, Saudi Arabia; 2Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Victoria, Australia; 3Department of Medical Laboratory Technology, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia; 4Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan; 5Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6Medical Research Center (MRC), Jazan University, Jazan, Saudi ArabiaCorrespondence: Muhammad SaboorDepartment of Medical Laboratory Technology, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi ArabiaTel +966 54 495 9029Email msaboor@jazanu.edu.saPurpose: Glutathione S-transferases (GSTT1 and GSTM1) are instrumental in detoxification process of activated carcinogens. Nucleotide excision repair is carried out by DNA helicase encoded by xeroderma pigmentosum group D (XPD) genes and aberrations in the XPD gene predisposes to increased risk of cancer. The present study aimed to investigate GSTT1, GSTM1 and XPD polymorphisms in newly diagnosed chronic myeloid leukemia (CML) patients and to examine the association of these polymorphisms with the risk of developing CML.Patients and Methods: This case–control study was carried out from June 2019 to August 2021 involving 150 newly diagnosed patients with CML and an equal number of randomly selected age- and sex-matched healthy individuals. A multiplex-PCR assay was used to genotype GSTT1 null and GSTM1 null polymorphisms. XPD gene polymorphism was detected by PCR-RFLP using predesigned gene-specific primers.Results: GSTT1 and GSTM1 null polymorphisms were detected in 42.7% and 61.3% of cases, respectively, compared to 18% and 35.3% for controls. The combination of both GST null polymorphisms revealed a significant association with CML. Frequencies of XPD Lys751Gln genotypes in cases were 62.7% heterozygous Lys/Gln, 24% homozygous Lys/Lys and 13.3% homozygous Gln/Gln, while in the controls were 74.7%, 20%, and 5.3%, respectively. Significant differences were also noted regarding the combination of GSTT1/GSTM1 null with XPD Lys/Lys, and GSTM1 null with XPD Lys/Lys.Conclusion: In conclusion, GSTT1 null, GSTM1 null and XPD polymorphisms showed positive association with the risk of development of CML. Furthermore, age and gender did not exhibit any association with the studied polymorphisms, while CML phases were associated with GSTT1 null polymorphism.Keywords: GSTT1 null polymorphism, GSTM1, XPD, chronic myeloid leukemia

Withania somnifera (L.) Dunal (Solanaceae) (also known as Ashwagandha) is a botanical drug that has been used for centuries to treat many chronic diseases like high blood pressure, arthritis, diabetes, Alzheimer's disease, and depression. As many botanical drugs, w. Somnifera possesses anti-inflammatory, antioxidant, anticarinogenic, anti-diabetic, and anti-asthmatic properties. W. somnifera is often compared to the ginseng plant due to its ability to reduce stress, improve cognitive functions (e.g., memory), and promote a healthy immune system. It promotes immunomodulatory effects whose function is to balance the humoral and cellular responses of the adaptive immune system. The therapeutic effect of w. Somnifera is attributed to active ingredients like alkaloids, steroidal lactones (such as withanolides, withaferins), and steroidal saponins. Although w. Somnifera is safe and highly recommended for treating various diseases, the current knowledge and understanding of its operational mechanisms are limited. One of the proposed mechanisms states that w. Somnifera promotes cellular-mediated immunity or initiates chemical interactions that contribute to therapeutic effects. Withania somnifera has been shown to play a significant role in immunological diseases by modulating several cytokines, increasing T-cell proliferation and enhancing macrophages functions. In this review, we will discuss the latest therapeutic effects of w. Somnifera on a number of diseases through modulating immunological markers and which specific components of w. Somnifera induce these therapeutic activities. We will also focus on the chemical properties in w. Somnifera components and their immunomodulatory role in type 2 allergic diseases where type 2 inflammation is highly imbalanced., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alanazi and Elfaki.)

Around 257 to 291 million people worldwide are infected with the hepatitis B virus (HBV). Immunization is one of the most effective ways to combat HBV infection. Saudi Arabia implemented a mandatory hepatitis B immunization program in 1989. This project investigated the levels of hepatitis B surface antibodies (anti-HBs) among medical students in the college of applied medical science at Najran University in December 2020. Students (n=82) were tested for anti-HBs levels using a chemiluminescent microparticle immunoassay (CMIA). Anti-HBs levels were the main outcome measures. Results showed that about 81.7% of participants had an insufficient amount of Anti-HBs levels (<10 IU/ L) compared to 18.3 % of participants who had protective levels of anti-HBs (≥10 IU/ L). However, 78.5% of the reactive group was at risk of losing immunity with a level between 12 and 42 IU/ L. Our study also showed an association between the age and the level of anti-HBs. Moreover, male students were at more risk than female students. Our results showed a strong relationship between Blood Groups and Anti-HBs antibody levels. The O+ (with 38.8%) and A+ (with 25.4%) blood groups showed the highest percentage amongst participants who had inadequate protection of anti-HBs (<10 IU/ L). Thus, data helps in our understanding and observations on anti-HBV immunity in individuals twenty years after being vaccinated as a child. According to the findings of our study, a large majority of students had a non-protective anti-HBs titer., Competing Interests: There is no conflict of interests., (© 2022 Biomedical Informatics.)

Deep vein thrombosis (DVT) is a critical condition and a potential cause of mortality and morbidity in Africa and worldwide with a high recurrence rate. The study was designed to assess the roles of natural anticoagulants and fibrinolytic regulatory factors in the development of DVT in Sudanese patients. A case-control study was conducted in Omdurman Teaching Hospital, Khartoum State over a period of 1 year. The study enrolled 200 patients diagnosed with DVT and 200 age-matched and gender-matched controls. Demographic data and data on acquired risk factors were collected using a semi-structured questionnaire. Protein C (PC), protein S (PS), antithrombin III (AT-III), thrombin-activable fibrinolysis inhibitor (TAFI), and plasminogen activator inhibitor-1 (PAI-1) were measured in patients and controls. Among the patients with DVT, 5.5% had PC deficiency, 8.5% had PS deficiency, and 3% had AT-III deficiency. Elevated TAFI and PAI-1 levels were demonstrated in 1.5 and 0.5% of patients, respectively. Risk factors for DVT (overweight, surgical history, and family history of DVT) were remarkably higher in patients than in controls. Among the female participants, pregnancy and usage of oral contraceptive pills were the highest associated risk factors for DVT. The findings concluded that the early assessment of risk factors, including the measurements of natural inhibitors, can predict the occurrence of DVT before it is actually detected in patients., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: Non-accidental suicidal insulin overdose is a rare presentation among non-diabetic patients. It seems to be more common among working medical professionals., Objectives: To present the case of a young patient, who despite injecting a large dose of rapid-acting insulin presented with only mild symptoms, and to familiarize the medical professionals involved in managing this condition with the recognition, pathophysiology and appropriate therapeutic interventions., Materials and Methods: We report the case of a previously healthy non-diabetic young medical professional who presented with a rapid-acting insulin overdose. On initial assessment the patient was alert and oriented, and glucose measurement was 1.4 mmol/L. The oral glucose gel and intramuscular glucagon failed to raise the glucose. Hypokalaemia, hypomagnesaemia, hypophosphataemia, lactic acidosis and ECG changes completed the presentation., Outcomes: The treatment consisted of dextrose infusion and appropriate electrolytes replacement. An uneventful recovery was made, so 36 hours later the patient was discharged with psychiatric follow-up., Conclusions: Insulin overdose should be considered as a differential diagnosis in hypoglycaemic patients when blood glucose fails to correct as expected. Improper management carries a significant risk of hypoglycaemic encephalopathy, which can cause lifelong cerebral changes.