Vascular endothelial growth factor A polymorphism and risk of Kaposi's sarcoma herpesvirus viremia in kidney allograft recipients.

BACKGROUND: Kaposi's sarcoma herpesvirus (KSHV) causes Kaposi's sarcoma (KS), primary effusion lymphoma, and multicentric Castleman's disease in immunocompromised patients including allograft recipients. Detection of KSHV DNA in blood, as well as host genetic polymorphisms has been found to be associated with an increased risk for KS. We investigated an association between single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor A (VEGFA) gene region and KSHV viremia in kidney transplant recipients (KTR) in Saudi Arabia. METHODS: In total, 152 KTR who have survived kidney transplantation for at least 6 months were included in the study. KSHV viremia was determined by real-time polymerase chain reaction (PCR). Genotyping of SNPs in the VEGFA region was performed by PCR and direct sequencing, as well as by restriction fragment length polymorphism. RESULTS: KSHV DNA was detected in 28.9% (n = 44) of the study population. The A-allele at position C172A VEGFA gene promoter region was found to be associated with KSHV viremia (odd ratio [OR] = 4.8, P = 0.005). In addition, the G-allele at position C+405G in the 5'-untranslated region was associated with KSHV viremia in women, but not in men (OR = 3.98, P = 0.004). CONCLUSIONS: Our results suggest an association of VEGFA polymorphisms with KSHV viremia among KTR in this study population. A limitation of our study is that the results can only be predicated for patients 6 months after kidney transplantation and should be validated in another cohort with larger sample size.

[Transient cerebral ischemia and the risk factors]. / Ischemia cerebrale transitoria e fattori di rischio.

A retrospective study was carried out in a general medicine ward of 100 male patients suffering from their first transient ischemic attack (TIA) in order to evaluate the incidence of different cerebrovascular risk factors. The results were then compared with those from another group of 100 patients suffering from initial cerebral ischemic softening (CIS) in order to identify a cerebrovascular risk population taking into account clinical similarities and common and divergent features. The study revealed that age is the prime risk factor in the genesis of TIA, followed by arterial hypertension and hypercholesterolemia. From a comparison with the group of patients affected by initial CIS it was clear that TIA is typical of senility and is more closer correlated to age than other risk factors; therefore, che TIA population is an expression of those who have "survived" cerebrovascular death due to the lesser exposure to risk factors.

Public awareness survey about organ donation and transplantation.

BACKGROUND: This survey was conducted to assess the public perception on organ donation and transplantation. METHODS: A random sample of the population attending the outpatient clinics in Dhahran Military Hospital, Saudi Arabia, from December 1, 2011, to January 31, 2012, answered a questionnaire related to the above aim. RESULTS: From 582 subjects who answered the questionnaire, 85 were excluded for incoherent answers. From the remaining 497, 77.7% were males and 22.3% females with the age ranging from 18 to 65 years, and the majority was at a secondary or university level of education. More than 90% were aware organ transplantation and donation. From a religious point of view, 68.6% considered it legal to donate organs versus 26.2%. Those who disagreed with the concept of donation believed that one kidney is not enough to survive (50%), and that the remaining kidney may be affected (25.8%), whereas 15.2% expressed fear of the operation. Kidney transplantation was the preferred treatment for 73.2% of respondents and 12.75% were in favor of dialysis. Regarding financial incentive, 14.5% asked for reward from the government, 3.4% believed that the reward should come from the donor, and the majority (82.1%) stated that organ donation should be for the sake of God. Finally, there was a 61.2% willingness of respondents to donate relatives' organs after brain death. CONCLUSION: The level of awareness about donation and transplantation in our population was found to be satisfactory. Religion was not a bar for organ donation; moreover, financial incentive was not found to be a positive stimulus toward donation because the majority was willing to donate for the sake of God.

Donor and recipient gender distribution in a Saudi kidney transplant center.

Worldwide reports from national renal registries show a donor gender imbalance in living renal transplantation. In these studies women represent on the one hand about 65% of living donors and on the other hand, receive fewer kidneys than men. Because of scarcity of reports on this matter from the Eastern world, we undertook this study to assess the gender demographics of recipients and living donors in our transplant center in the eastern region of Saudi Arabia. We retrospectively reviewed our living related transplantations performed from 1992 to 2008 (n=135). Ninety-one males (67.4%) versus 44 females (32.6%) donated a kidney (P=.0000.) The male predominance (n=80; 59.3%) was also noticed among recipients with 80 versus 55 females (40.7%; P=.001). When splitting the results into two periods, 1992 to 1999 versus 2000 to 2008, we noticed a trend to an improved donation rate from females, rising from 29% to 38.7% (P=NS). Further analysis showed that brothers were giving more frequently to brothers than to sisters (38 vs 11; P<.001) and that sisters donated equally to brothers and sisters (12 vs 11; P=NS). Interspousal donation showed no significant difference between husband to wife and vice versa (4 vs 5). Unlike the international experience, our study showed men to be donating more kidneys than women. Sociocultural reasons may have a role in such findings.

Idiopathic membranous nephropathy in identical twins.

Familial idiopathic membranous nephropathy is rarely reported, despite the striking immunogenetic association of the disease with certain HLA antigens. This report describes a pair of identical male twins who contemporaneously developed idiopathic membranous nephropathy. HLA typing was carried out in the twins and in almost all members of their family. Interestingly, HLA antigens that have been reported to be associated with idiopathic membranous nephropathy, especially DR3, were found not only in the twins, but in the other family members as well. Due to similarities between Heymann nephritis and human membranous nephropathy, we performed a search for anti-brush border and antipodocyte antibodies. The inability to detect these antibodies suggests that they were probably not involved in the pathogenesis of these cases.

Resistance to activated protein C in healthy women taking oral contraceptives.

Resistance to activated protein C (APC) is at present considered the most frequent laboratory abnormality in patients with deep-vein thrombosis. An increased risk for venous thrombosis is associated to the use of oral contraceptives (OC). We studied APC sensitivity in 50 healthy women taking OC and in 50 healthy controls, matched for age, smoking habit, educational and social levels, and the main biochemical routinary parameters. Subjects with a personal or familial history of thrombosis and also with chronic or acute diseases were excluded. Protein C, protein S, antithrombin III and lupus anticoagulant activity (LAC) were also evaluated. Increased fibrinogen and protein C levels, decreased protein S. and shortened PT and APTT were also observed in women taking OC. APC sensitivity ratio (APC-SR) was significantly lower in the OC group than in a control group (2.6 +/- 0.38 v 2.81 +/- 0.35, P < 0.01). Seven of eight women with APC ratio < or = 2 (APC resistant) were OC users: the difference of prevalence was statistically significant (chi-squared test, P < 0.05). Only two out of eight women were found heterozygous for the Leiden factor V mutation. Two APC-resistant women without the Leiden mutation subsequently discontinued OC and both then normalized their APC-SR. We conclude that acquired factors, i.e. oral contraceptives, may play an important role in determining plasma APC resistance.

PIP: During April-June 1994, at Borgo Roma Polyclinic in Verona, Italy, clinical researchers compared data on 50 healthy women 18-41 who used low-dose combined oral contraceptives (OCs) with data on 50 healthy women matched for age, smoking, education, social class, and biochemical routinary parameters. Almost all the subjects were medical students or medical staff working in the hospital where the study occurred. The researchers aimed to examine the prevalence of resistance to activated protein C (APC) in both groups. They also evaluated protein C, protein S, antithrombin III, and lupus anticoagulant activity. The APC-sensitivity ratio (APC-SR) was much lower in OC users than nonusers (2.6 vs. 2.81; p 0.01). Seven of the eight women with an APC-SR of no greater than 2 (i.e., demonstration of APC resistance) used OCs (p 0.05). Prevalence of APC resistance was higher among OC users than nonusers (14% vs. 2%; p 0.05). Among the eight women with APC resistance, two were heterozygous for the Leiden factor V mutation. One of these women used OCs and the other did not. Two APC resistant women who did not have the Leiden factor V stopped using OCs and their APC-SR subsequently normalized. OC users had higher fibrinogen and protein C levels, a lower protein S level, and shorter prothrombin and activated partial thromboplastin times than nonusers. These findings suggest that OCs may contribute to plasma APC resistance, which in turn increases the risk of venous thrombosis.

Experience with renal transplantation in the eastern province of saudi arabia.

We evaluated our experience with renal transplantation to determine its safety and efficacy. Of the 47 renal transplants performed at our institution from June 1992 to December 1995, 29 were performed from living related donors and 18 from cadaveric donors. The age of the patients ranged from 17 to 65 years with a mean age of 32.2 years. Patient survival, allograft survival and the incidence of complications were used as determinants of successful outcome. Patient survival was 100% for both groups. The allograft survival was 100% for living related donor recipients, with 90% of the cases having normal graft function and 96% for cadaveric recipients with 78% of the cases having normal graft function after a mean follow-up of 24 months (range 3 to 42 months). The incidence of complications encountered was similar to that reported from European and North American renal transplant centers. Our study shows the safety and efficacy of the renal transplantation program in the Eastern Province of Saudi Arabia.