Allergic reaction to abciximab with atypical manifestations.

Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had been approved for treatment of acute coronary syndrome undergoing coronary interventions. It is a chimeric monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor with a potential for the development of an immune response to variable portions within the antigen binding site following its administration. We describe a 58-year-old man who developed sudden headache, short of breath, choking and restlessness after receiving Abciximab for coronary intervention. Discontinuation of abciximab and administration of intravenous fluids, steroid and antihistamines led to improvement of his symptoms gradually.

Tissue factor pathway inhibitor, natural coagulation inhibitors and hemostatic activation markers in patients with acute coronary syndromes.

OBJECTIVE: This study aims at characterizing the hemostatic changes, in a large cohort of Saudi Arab patients with acute coronary syndromes. METHODS: We consecutively enrolled 389 patients (unstable angina [UA]: n=181; myocardial infarction [MI]: n=208) in this study at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the period from April 2000 to November 2001. We collected blood samples before coronary angiography. Controls (n=101) were healthy males and females. All hemostatic assays were undertaken using enzyme linked immunosorbent assay based techniques and commercial kits. RESULTS: The mean plasma levels of both bound and free tissue factor pathway inhibitors (TFPI) were significantly higher and to comparable levels, in patients with MI and UA, than in healthy control levels. Markers of thrombin generation: the mean levels of prothrombin fraction 1+2, thrombin antithrombin complexes, and D-Dimer were very significantly elevated in the 2 patients groups than in controls. Proteins C and antithrombin III showed statistically significant reduction especially in patients with MI. Plasminogen activator inhibitor levels were significantly elevated in the 2 patient groups, but were higher in MI patients. The mean levels of fibrinogen and D-Dimer as well thrombin antithrombin complex were higher and the levels of free tissue factor pathway inhibitor were lower in patients with 3-vessel coronary artery disease than those with single and double vessel disease. CONCLUSION: The results of this study confirm the existence, and to a similar extent, of a hypercoagulable state in Saudi patients with MI than UA and in those with 3-vessel coronary artery disease than those with one or 2-vessel disease.

Obesity in Saudi Arabia.

OBJECTIVE: Obesity and overweight are well known risk factors for coronary artery disease (CAD), and are expected to be increasing in the Kingdom of Saudi Arabia (KSA) particularly among females. Therefore, we designed this study with the objective to determine the prevalence of obesity and overweight among Saudis of both gender, between the ages of 30-70 years in rural as well as in urban communities. This work is part of a major national project called Coronary Artery Disease in Saudis Study (CADISS) that is designed to look at CAD and its risk factors in Saudi population. METHODS: This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70 years of selected households over a 5-year period between 1995 and 2000 in KSA. Data were obtained from body mass index (BMI) and were analyzed to classify individuals with overweight (BMI = 25-29.9 kg/m2), obesity (BMI >/=30 kg/m2) and severe (gross) obesity (BMI >/=40 kg/m2) to provide the prevalence of overweight and obesity in KSA. RESULTS: Data were obtained by examining 17,232 Saudi subjects from selected households who participated in the study. The prevalence of overweight was 36.9%. Overweight is significantly more prevalent in males (42.4%) compared to 31.8% of females (p<0.0001). The age-adjusted prevalence of obesity was 35.5% in KSA with an overall prevalence of 35.6% [95% CI: 34.9-36.3], while severe (gross) obesity was 3.2%. Females are significantly more obese with a prevalence of 44% than males 26.4% (p<0.0001). CONCLUSION: Obesity and overweight are increasing in KSA with an overall obesity prevalence of 35.5%. Reduction in overweight and obesity are of considerable importance to public health. Therefore, we recommend a national obesity prevention program at community level to be implemented sooner to promote leaner and consequently healthier community.

Coronary artery disease in Saudi Arabia.

OBJECTIVE: Coronary artery disease (CAD) is a major public health problem worldwide. To our knowledge, there is no national data available from community based studies on prevalence of CAD in the Kingdom of Saudi Arabia (KSA). Therefore, we designed this study with the objective to determine the prevalence of CAD among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. Further, to determine the prevalence and clinical pattern of the major modifiable risk factors for CAD among the same population. This work is part of a major national study on CAD in Saudis Study (CADISS). METHODS: This is a community based study conducted by examining subjects in the age group of 30-70-years of selected households during 5-year period between 1995 and 2000 in KSA. Data were obtained from history using a validated questionnaire, and electrocardiography. The data were analyzed to provide prevalence of CAD and risk assessment model. RESULTS: Nine hundred and forty-four subjects, out of 17232 were diagnosed to have CAD. Thus, the overall prevalence of CAD obtained from this study is 5.5% in KSA. The prevalence in males and females were 6.6% and 4.4% (P<0.0001). Urban Saudis have a higher prevalence of 6.2% compared to rural Saudis of 4% (P<0.0001). The following variables are found to be statistically significant risk factors in KSA: age, male gender, body mass index (BMI), hypertension, current smoking, fasting blood glucose, fasting cholesterol and triglycerides. CONCLUSION: The overall prevalence of CAD in KSA is 5.5%. A national prevention program at community level as well as high risk groups should be implemented sooner to prevent the expected epidemic of CAD that we are seeing, beginning. Measures are needed to change lifestyle and to address the management of the metabolic syndrome, to reduce modifiable risk factors for CAD. A longitudinal study is needed to demonstrate the importance of reducing modifiable risk factors for CAD in KSA.