Real-world retrospective study of effectiveness and safety of FINgOlimod in relapsing remitting multiple sclerosis in the Middle East and North Africa (FINOMENA).

OBJECTIVES: Evidence on the effectiveness and safety of fingolimod in real-world clinical practice in the Middle East and North African (MENA) region is limited. This study aimed to evaluate the effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) in real-world setting in the MENA region. PATIENTS AND METHODS: RRMS patients who had been treated with fingolimod for at least 12 months were retrospectively identified from the databases of 34 centers across the MENA region. Study outcomes included the annualized relapse rate (ARR), relapse-free rate (RFR), time to first and second relapses, mean change in Expanded Disability Status Scale (EDSS), proportion of patients with Magnetic Resonance Imaging (MRI) activity and no evidence of disease activity (NEDA)-3, retention of patients on treatment, as well as all safety measures. RESULTS: A total of 806 patients were included: 66.34 % female; mean age 32.97 ± 9.62 years; mean disease duration 4.92 ± 4.66 years; mean fingolimod use 37.2 ± 16.7 months. Most patients had received previous disease-modifying therapy (79.65 %). Compared to the year preceding fingolimod initiation, RFR improved (33.00%-86.35%; p < 0.001), ARR decreased (0.84 ± 0.73 to 0.16 ± 0.45; p = 0.005), EDSS decreased (2.69 ± 1.74-2.01 ± 1.66; p < 0.001), and the proportion of patients with Gadolinium-enhancing T1 lesions decreased (57.84 % to 12.93 %; p < 0.001), after 12 months of fingolimod treatment. NEDA-3 was achieved in 41.3 % of patients. Median time to first and second relapses was not reached since 86.35 % and 98.39 % of patients had not experienced relapses for the first time and second time, respectively. Eight-hundred one (99.38 %) patients continued fingolimod treatment beyond 12 months. One-hundred thirty patients (16.13 %) experienced adverse events, mainly lymphopenia (5.46 %) and leukopenia (2.11 %), while 13 patients (1.61 %) experienced serious adverse events. CONCLUSION: This study confirms the effectiveness and safety profile of fingolimod in real-world setting in the Middle East and North African (MENA) region.

The Prevalence of Fabry Disease Among Young Cryptogenic Stroke Patients.

Introduction Fabry disease is a metabolic storage disorder that causes disorders in multiple organs including the brain. Data regarding the prevalence of the disease among the Saudi stroke population is scarce. Hence, tests for the same are not conducted on a regular basis when investigating stroke of uncertain cause. Our study aimed to provide insight into whether testing for Fabry disease is justifiable in cryptogenic stroke patients who have no other features of the disease. Method This was a prospective study conducted at a single stroke center. We included young patients between the ages of 18 and 55 years who had confirmed and unexplained ischemic or hemorrhagic insults. Alpha-galactosidase enzyme testing was conducted in all suspected cases. Further genetic testing was performed in patients with abnormal enzyme results. Result A total of 51 patients met the inclusion criteria. The mean age was 42 years. All the included patients completed a workup of ischemia or hemorrhage. All cases had no clear etiology of their vascular events. All included patients lacked classic systemic manifestations of Fabry disease. We identified one case of borderline low α-galactosidase A (GLA) enzyme level. However, GLA genetic testing did not reveal any Fabry disease-related mutation. The study did not identify any subject with confirmed Fabry disease. Conclusion In this single-center study, we found that Fabry disease had a low prevalence among Saudi cryptogenic stroke patients who lack other systemic manifestations. Hence, Fabry testing is not generally considered in routine workup related to cryptogenic stroke.

Role of Prophylactic Dexamethasone Before Thyroidectomy in Reducing Postoperative Pain, Nausea and Vomiting.

Introduction Post-operative nausea, vomiting (PONV) and pain are the most frequently encountered complains after thyroid surgery. Steroids effectively reduce pain, nausea, and inflammation, therefore prophylactic administration of steroids improve these outcomes. The aim of our study was to compare the prophylactic administration of dexamethasone with placebo in terms of PONV and pain. Patients and methods We conducted a double-blinded randomized controlled trial including 100 patients who underwent thyroid surgery from January 2017 to December 2017 in Surgical Unit-I of the Holy Family hospital, Pakistan. The outcome in terms of post-operative pain, nausea and vomiting were measured. Results The mean age of the patients was 39.62 ± 12.73 years in group A, while in group B it was 39.06 ± 13.25 years. Out of the 100 patients included in our trial, 52 (52%) patients were males and 48 (48%) patients were females. The mean value of pain in group A patients was 1.60 ± 1.26, while in group B it was 3.60 ± 1.94. A statistically significant difference was found between the study groups with regard to the pain score of the patients i.e. p-value = 0.001. The PONV was found in 28 patients from group A and 19 patients from group B and no significant improvement was seen (p-value = 0.071). Conclusion A single dose of prophylactic dexamethasone significantly reduces the mean pain score in patients undergoing thyroidectomy; however, insignificant relation was noted in terms of PONV condition.

Isolation and antimicrobial susceptibility testing of Helicobacter pylori strains from gastric biopsies from Pakistani patients.

Helicobacter pylori is the etiological agent of gastritis and peptic ulcer. This importance had proposed antibiotics as a principle treatment of gastrointestinal pathologies. The focus of this research was to investigate the occurrence of H. pylori in patients having gastritis or gastric ulcer and also draw the susceptibility profile of isolates to several antibiotics. Blood and biopsy specimen from 96 acid peptic disease patients from both sexes were collected. Each sample was used for culture, gram staining, catalase, oxidase, urease and nitrate reduction test by conventional method. Serology using anti Helicobacter pylori IgG was done. The susceptibility profile to six common antibiotics was checked by E- test method. H. pylori was obtained from 40 patients (41.67%) with greater frequency in male (25%) than females (16.67%). With regards to age, H. pylori was recovered highest from the patients between 51-55 (75.86%) years of age. Tetracycline and rifampin were the most effective antibiotics in vitro, while metronidazole was less effective. Nine (22.5%) strains displayed resistance to at least one antimicrobial drug. Whereas, resistance to amoxicillin, ciprofloxacin, clarithromycin, metronidazole and combination of antibiotics like ciprofloxacin, clarithromycin and metronidazole, and ciprofloxin and metronidazole were 11.11, 55.56, 22.22, 33.33, 11.11 and 44.44% respectively. Lower susceptibility profile of H. pylori to antibiotics is because of frequent use of antibiotics to treat other infections.

Prevalence and attitude of university students towards mobile phone use while driving in Jeddah, Saudi Arabia.

This study aimed to investigate the prevalence and attitude of university students towards mobile phone use while driving. The present study was conducted at King Abdulaziz University, Jeddah, Saudi Arabia. Five hundred and ninety-three participants were recruited for this study. Attitude, consequences and their involvement in various reckless behaviours pertaining to the use of mobile phone while driving were checked by a questionnaire. Overall, the majority of the respondents (90%) use a mobile phone while driving. About half of the participants had experienced consequences regarding texting while driving and had engaged in reckless behaviour. The majority of the students of Faculty of Medicine, Engineering Sciences, Earth Sciences, Administration and Economics and Orientation Classes were more frequently texting while driving (p < .001). The unmarried students were more often texting while driving as compared to married (p < .001). Overall, the majority of the respondents use the mobile phone while driving.

An Uncommon Cause of Posterior Reversible Encephalopathy Syndrome Related to Antibiotic Ingestion.

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state manifested with a unique computed tomography (CT) or magnetic resonance imaging (MRI) appearance. PRES is associated with different conditions, such as eclampsia, sepsis, organ transplantation, and drugs, especially immunosuppressive medications. Besides pharmacologic side effects, antibiotics can cause PRES as well. Here, we report a 37-year-old female from Saudi Arabia, presenting to the emergency department (ED) with a two-day history of fluctuations in consciousness level, headache, and blurring of vision. A generalized vesicular skin rash preceded the condition for one month; this was diagnosed as chicken pox and the patient received co-amoxiclav for a possible superadded bacterial infection. Besides clinical manifestations, the patient had radiological abnormalities, which were resolved following the withdrawal of causative antibiotics. Ascertaining the exact etiological cause of PRES is essential for diagnosing this reversible condition as these patients undergo a complete neurological recovery if the underlying cause is identified early.