Identification of the novel HLA-C allele, HLA-C*12:351Q, using next-generation sequencing.

The novel allele HLA-C*12:351Q differs from HLA-C*12:02:02:01 by a single nucleotide deletion in exon 5.

Challenges and insights: Methamphetamine analysis in post-mortem putrefied human tissues in a hot climate.

Background: The production and distribution of methamphetamine (meth) is often associated with illegal and clandestine laboratories, posing significant challenges for law enforcement and public health efforts. Global concern is growing over meth-related fatalities, as its high potential for abuse and detrimental impact on health make it an important issue in the realm of substance abuse and addiction. This concern has notably increased in Saudi Arabia, where the hot climate adds complexity to the analysis due to challenges posed by putrefaction. There is still an urgent need to enhance the screening capabilities of many toxicology laboratories to determine the cause of death, whether it be due to drug use or natural causes. Aim: This research aimed to investigate meth concentrations in post-mortem putrefied human solid tissues in a hot climate and comparing meth metabolite concentrations in cases where signs of putrefaction were observed versus those with no signs of putrefaction. The objective is to assist criminal investigations by analyzing meth and its metabolite concentrations. Methods: This retrospective cohort study involved postmortem samples from human subjects during autopsies conducted between 2016 and 2022. It focused on analyzing meth and its metabolite concentrations using LC-MS/MS analysis. Data on demographics, medical history, age, location, putrefaction, and other drug use were retrieved from medical records. Results: Out of the 27 reported samples of meth and its metabolite amphetamine in both putrefied and non-putrefied biological fluids and tissues, only 8 (30%) exhibited signs of putrefaction between 2016 and 2022. Despite decomposition, detectable concentrations of meth and amphetamine were sufficient to determine the cause of death and the source of amphetamines. Conclusion: This study found no significant difference in concentrations between putrefied and non-putrefied cases, underscoring the importance of multiple sample testing during autopsy for accurate interpretation. Each case is unique and must be considered individually.

Did the COVID-19 Pandemic Influence the Awareness About Vitamin D Among the General Population in Jeddah, Saudi Arabia?

Background Vitamin D deficiency has been a major health concern over the last decade. With the coronavirus disease 2019 (COVID-19) pandemic, health officials and social media have stressed the importance of vitamin D and its role in immune systems. This research focused on the level of vitamin D awareness in Jeddah after the pandemic in 2022. Methodology A cross-sectional study was conducted among the adult general population in Jeddah, Saudi Arabia. Data were obtained through an electronically distributed questionnaire designed to collect information on self-reported knowledge questions about vitamin D, which was previously validated and used in a similar study on the same population before the pandemic. The validated questionnaire included sociodemographic characteristics and questions assessing the knowledge about vitamin D. Ethical approvals were obtained from the Biomedical Research Ethics Committee, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Results Of the 385 total participants, 198 (51.4%) were aged 18-28 years, 331 (86%) were of Arab ethnicity, 289 (75.1%) had a university degree, 86 (22.3%) had completed high school, 186 (48.3%) were married, and 197 (51.2%) had no children. The overall mean knowledge score was 67.12%, and the mean knowledge score for vitamin D benefits was 73.51%. The mean knowledge score for vitamin D sources was 51.53%, and the mean knowledge score for toxicity was 86.49%. When comparing knowledge scores based on demographic variables, only a few variables were significant. Regarding vitamin D awareness following the COVID-19 pandemic, most participants (54.55%) believed the pandemic had affected or increased their vitamin D awareness. Approximately 52.85% had used vitamin D supplements before the pandemic, and 53.25% were currently using vitamin D supplements. Conclusions In general, compared to pre-COVID-19 studies conducted in Saudi Arabia, this study revealed a greater understanding of vitamin D. Participants who had completed high school or more displayed a higher level of knowledge than other groups. It is still recommended that primary care physicians educate their patients and families about the benefits of vitamin D, the effects of its deficiency, and its toxicity.

11-Nor-9-Carboxy Tetrahydrocannabinol Distribution in Fluid from the Chest Cavity in Cannabis-Related Post-Mortem Cases.

In this study, the presence of 11-nor-Δ9-carboxy tetrahydrocannabinol (THC-COOH) in postmortem fluid obtained from the chest cavity (FCC) of postmortem cases collected from drug-related fatalities or criminal-related deaths in Jeddah, Saudi Arabia, was investigated to evaluate its suitability for use as a complementary specimen to blood and biological specimens in cases where no bodily fluids are available or suitable for analysis. The relationships between THC-COOH concentrations in the FCC samples and age, body mass index (BMI), polydrug intoxication, manner, and cause of death were investigated. METHODS: Fifteen postmortem cases of FCC were analyzed using fully validated liquid chromatography-positive-electrospray ionization tandem mass spectrometry (LC-MS/MS). RESULTS: FCC samples were collected from 15 postmortem cases; only THC-COOH tested positive, with a median concentration of 480 ng/mL (range = 80-3010 ng/mL). THC-COOH in FCC were higher than THC-COOH in all tested specimens with exception to bile, the median ratio FCC/blood with sodium fluoride, FCC/urine, FCC/gastric content, FCC/bile, FCC/liver, FCC/kidney, FCC/brain, FCC/stomach wall, FCC/lung, and FCC/intestine tissue were 48, 2, 0.2, 6, 4, 6, 102, 11, 5 and 10-fold, respectively. CONCLUSION: This is the first postmortem report of THC-COOH in the FCC using cannabinoid-related analysis. The FCC samples were liquid, easy to manipulate, and extracted using the same procedure as the blood samples. The source of THC-COOH detected in FCC could be derived from the surrounding organs due to postmortem redistribution or contamination due to postmortem changes after death. THC-COOH, which is stored in adipose tissues, could be a major source of THC-COOH found in the FCC.

Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018.

To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21-30 age group. In addition, 61% of cases were classified as "rapid deaths," while 24% were classified as "delayed deaths." The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.

A Cross-Sectional Study on the Awareness and Practice of the Use of Supplemental Vitamin C, Arginine, and Zinc in Managing Wounds Among Healthcare Workers in Saudi Arabia.

Introduction The intricate connection between nutrition and compromised wound healing exposes patients to heightened risks of pressure ulcers, infections, and delayed recovery from wounds or traumatic injuries. In-depth scientific investigations have shed light on the potential of specialized nutritional supplements, combined with regular wound care, to significantly boost the management of pressure ulcers and the wound healing process. The study focuses on supplemental Vitamin C, Arginine, and Zinc due to their established roles in wound healing, aiming to assess the awareness and practice of healthcare workers in Saudi Arabia regarding these essential nutrients for effective wound management. This cross-sectional study aimed to assess awareness and practice among healthcare workers in Saudi Arabia regarding the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds. Methods This study adopts a cross-sectional research design to explore the dynamics to assess the awareness and practice among healthcare workers about the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds in Saudi Arabia. The research methodology encompasses developing and validating a questionnaire, data collection, and subsequent analysis. Thorough statistical analyses, encompassing descriptive statistics, validated assessment scales, and inferential statistics, were conducted using SPSS and Microsoft Excel to explore intricacy prevalence and severity relationships with various factors, maintaining a statistical power of 80% at a cutoff value of 0.05. Result In a cross-sectional survey of 510 healthcare professionals, the socio-demographic analysis revealed a predominant hospital workplace (61.56%), with pharmacists representing 10.19%, and comprehensive tabulation of response rates and p-values, while the knowledge and awareness assessment demonstrated varied understanding and perceptions of wound care supplements, including frequent encounters with pressure ulcers or wounds (36.5%), diverse awareness levels for Vitamin C, Arginine, and Zinc, with the collaboration and communication dynamics among healthcare workers, detailed in tabulated response rates and p-values. Conclusion The findings reveal a diverse understanding landscape, with varying levels of awareness, perceived effectiveness, and confidence in applying these supplements.

Knowledge, Attitudes, and Practices of COVID-19 Safety Measures Among Type 1 Diabetes Mellitus Patients at King Abdulaziz University Hospital: A Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19), an infectious disease caused by an enveloped RNA beta coronavirus, has become a pandemic, with a mortality rate ranging from 0.7% to 10.8%. Although older adults with comorbidity are more likely to suffer severe disease and eventual mortality, diabetes mellitus (DM) is one of the most frequently reported noncommunicable diseases shown to predict poor prognosis in COVID-19 patients. AIM:  To determine the knowledge, attitudes, and practices (KAP) of COVID-19 safety measures and factors associated with poor knowledge and practice among type 1 diabetes mellitus (T1DM) patients at King Abdulaziz University Hospital (KAUH), Jeddah. METHODOLOGY:  This cross-sectional study included 267 patients with T1DM aged 18-65, admitted to the hospital from January to June 2020. Data were collected via phone interviews during September 2020. The questionnaire consisted of 15 questions for knowledge, five for attitude, and eight concerning practices, and some questions were based on diabetes and COVID-19 specifically. RESULTS:  Overall, 64 participants with a median age of 53 years were studied. The median COVID-19 knowledge score showed poor (11.50%), average (43.75%), and good knowledge (6.25%). Most of the participants practiced precautionary measures outside their homes. CONCLUSION:  In conclusion, half of the population had poor COVID-19 knowledge, 60.9% of the participants felt anxious, and most of them performed precautionary measures, including wearing a facemask, maintaining a 1-m distance, and washing their hands regularly.

Post-Mortem Analysis of Heroin Biomarkers, Morphine and Codeine in Stomach Wall Tissue in Heroin-Related Deaths.

Toxicological analysis of some cases can be complicated by poor sample quality caused by decomposition. Although heroin-related deaths have been researched extensively, the interpretation of toxicology findings in these cases is challenging, especially in instances where blood samples are unavailable. Thus, it is important to develop analytical methods for different sample types. In this study. a method for the quantification of 6-monoacetylmorphine, 6-acetylcodeine, morphine, and codeine in postmortem stomach wall tissue using liquid chromatography coupled with tandem mass spectrometry was developed and validated. All calibration curves prepared with the stomach wall tissue were linear and ranged from 0.5−1000 ng/g with determination coefficients of >0.99 and a lower limit of quantification of 1.0 ng/g. The coefficients of variation for within-run precision and between-run precision were <9%. Matrix effects of stomach wall tissues and their extraction recoveries were investigated and ranged from −19% to +17% and 76% to 80%, respectively. Among the 16 analyzed heroin-related death cases, 6-monoacetylmorphine, 6-acetylcodeine, morphine, and codeine were detected in 75%, 31%, 100%, and 94% of all stomach wall tissues with median concentrations of 90 ng/g, 20 ng/g, 140 ng/g, and 30 ng/g, respectively. This study provides new data on the distribution of 6-monoacetylmorphine, 6-Acetylcodeine, morphine, and codeine in postmortem stomach wall tissue and suggests the usefulness of alternative matrices for investigating heroin-related fatalities when blood samples are unavailable. In addition, the prevalence of 6-monoacetylmorphine in the stomach wall tissue was higher than that in the liver and kidney tissues.

Graft-versus-host disease after pediatric liver transplantation: A diagnostic challenge.

BACKGROUND: Graft-versus-host disease (GVHD) is a rare but serious complication after pediatric liver transplantation (LTx). Early diagnosis is difficult due to nonspecific presenting symptoms and non-pathognomonic skin histopathological features. The aim of this article was to describe a case of pediatric GVHD after LTx and to review available data on pediatric GVHD highlighting the diagnostic difficulty. We also propose a diagnostic algorithm to improve the diagnostic capability and increase clinical awareness about this potentially fatal condition. METHODS: We did a comprehensive literatures review on studies on GvHD following pediatric LTx between 1990 and February 2021, chimerism study by short tandem repeat (STR), HLA typing by sequence-specific oligonucleotide (SSO) method, and flowcytometry crossmatch. RESULTS: Our search yielded 23 case reports. The most common clinical manifestations were fever and rash (91%) followed by diarrhea. Mortality rate was 36.8% mainly due to sepsis and organ failure. Diagnosis was challenging and chimerism study to confirm donor engraftment was performed on only half of the cases. Prevalence of "donor dominant HLA one-way matching" typically occurs in homozygous parents-to-child transplantation was 75% in cases with HLA testing. CONCLUSION: So far, there are no available standard diagnostic criteria for GVHD following pediatric LTx. Recognition of multiple risk factors through proper laboratory assessment can predict the occurrence, and early chimerism study can confirm suggestive clinical manifestation. The strong likelihood of developing GVHD in "donor one-way HLA match" and the severe problems imposed by this complication may justify avoidance of HLA homozygous parent's donation.

Outcomes After Transcatheter Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Diastolic Dysfunction.

OBJECTIVES: Left ventricular diastolic dysfunction (LVDD) in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with poor outcomes; however, the effect of its severity is controversial. We sought to assess the impact of diastolic dysfunction on hospital outcomes and survival after TAVR and identify prognostic factors. METHODS: We included patients who underwent TAVR for severe aortic stenosis with preexisting LVDD from 2009 to 2018 (n = 325). Patients with prior mitral valve surgery (n = 4), atrial fibrillation (n = 39), missing or poor baseline diastolic dysfunction assessment (n = 36) were excluded. The primary endpoint was all-cause mortality. 246 patients were included in the study. RESULTS: The median age was 80 years (25th and 75th percentiles:75-86.7), 154 (62.6%) were males and the median EuroSCORE II was 4.3 (2.2-8). Patients with severe LVDD had significantly higher EuroSCORE, and lower ejection fraction (p < 0.001). There was no difference in post-TAVR new atrial fibrillation (p = 0.912), pacemaker insertion (p = 0.528), stroke (p = 0.76), or hospital mortality (p = 0.95). Patients with severe LVDD had longer hospital stay (p = 0.036). The grade of LVDD did not affect survival (log-rank = 0.145) nor major adverse cardiovascular events (log-rank = 0.97). Predictors of mortality were; low BMI (HR: 0.95 (0.91-0.99); p = 0.019), low sodium (0.93 (0.82-2.5); p = 0.021), previous PCI (HR: 1.6 (1.022-2.66); p = 0.04), E-peak (HR: 1.01 (1.002-1.019); p = 0.014) and implantation of more than one device (HR: 3.55 (1.22-10.31); p = 0.02). CONCLUSION: Transcatheter aortic valve replacement is feasible in patients with diastolic dysfunction, and the degree of diastolic dysfunction did not negatively affect the outcome. Long-term outcomes in those patients were affected by the preoperative clinical state and procedure-related factors.

Biochemical and histological effects of five weeks ingestion of Zamzam water on the liver and kidneys of Wistar rats.

Zamzam water is a natural alkaline water which has become alkaline as a result of the natural environment. It comes from what is considered as one of the oldest springs in the world. The water contains high concentrations of alkaline minerals as well as trace and heavy metals. The aim of the current study is to evaluate the effects of five weeks ingestion of Zamzam water on the liver and kidney functions of rats. Adult female Wistar rats weighing 150-200 g were divided into two groups, with 15 rats in each. The control group was supplied daily by bottled water and the Zamzam water group was supplied daily by 500 ml of Zamzam water for five weeks. The rats were weighed weekly and, at the end of the experiment, blood samples were collected from all rats for the biochemical determination of serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), urea, creatinine, albumin, and uric acid, using calorimetric methods. Liver and kidney tissues were fixed in 10% neutral buffered-formalin solution and further embedded in wax blocks for routine hematoxylin and eosin (H&E) staining and were examined for histopathological changes using a light microscope. The results of the current study showed that there was a significant increase (P < 0.05) in the weight of the Zamzam group when compared to the control group after five weeks of ingestion. Liver and kidney function tests did not show any significant difference when compared with the controls (P > 0.05). In addition, histological examination of the liver and kidney tissues did not show any toxicological changes. In conclusion, the results showed that the ingestion of Zamzam water did not alter serum levels of kidney function tests and liver enzymes; and did not result in a noticeable change in the liver and kidney histology. Thus, the high concentrations of elements in Zamzam water do not induce hepatotoxicity or nephrotoxicity and the water is considered safe for long-term consumption.

Incidence, risk factors, clinical presentation, and outcomes of hemorrhagic transformation in patients with ischemic stroke admitted to a tertiary hospital in Kingdom of Saudi Arabia.

OBJECTIVE: To describe the incidence rate, clinical presentation, relevant risk factors, and outcome of hemorrhagic transformation (HT) among ischemic stroke patients. METHODS: This retrospective study analyzed HT in patients with ischemic stroke admitted to King Abdullah Medical City from August 2011 to April 2019. Data were analyzed using SPSS. Patients characteristics, procedures, treatments, and outcomes were reported. RESULTS: There were 504 ischemic stroke patients. The HT was detected in 38 patients (8%). The median age was 66.5 (54.3 -77.5) years, and 24 (63%) were males. HT was classified as hemorrhagic infarction (HI) in 22 patients (58%) while 16 patients (42%) were parenchymal hematoma (PH). The most common risk factors noted were: hypertension (74%), diabetes mellitus (DM) (66%), hyperlipidemia (63%) and ischemic heart disease (IHD) (61%). Nine patients (23.6%) developed HT after receiving thrombolytic therapy. Only one patient (3%) died of HT patients. CONCLUSION: HT accounted for (8%) of all ischemic stroke patients. Old age, DM, hypertension, and hyperlipidemia are frequently encountered with stroke patients who developed HT. Follow up CT brain could be of value and could identify HT early to get better outcomes.

Use of Geophysical and Remote Sensing Data for Assessment of Aquifer Depletion and Related Land Deformation.

An integrated approach [field, Interferometric Synthetic Aperture Radar (InSAR), hydrogeology, geodesy, and spatial analysis] was adopted to identify the nature, intensity, and spatial distribution of deformational features (sinkholes, fissures, differential settling) reported over fossil aquifers in arid lands, their controlling factors, and possible remedies. The Lower Mega Aquifer System (area 2 × 106 km2) in central and northern Arabia was used as a test site. Findings suggest that excessive groundwater extraction from the fossil aquifer is the main cause of deformation: (1) deformational features correlated spatially and/or temporally with increased agricultural development and groundwater extraction, and with a decline in water levels and groundwater storage (- 3.7 ± 0.6 km3/year); (2) earthquake events (years 1985-2016; magnitude 1-5) are largely (65% of reported earthquakes) shallow (1-5 km) and increased from 1 event/year in the early 1980s (extraction 1 km3/year), up to 13 events/year in the 1990s (average annual extraction > 6.4 km3). Results indicate that faults played a role in localizing deformation given that deformational sites and InSAR-based high subsidence rates (- 4 to - 15 mm/year) were largely found within, but not outside of, NW-SE-trending grabens bound by the Kahf fault system. Findings from the analysis of Gravity Recovery and Climate Experiment solutions indicate that sustainable extraction could be attained if groundwater extraction was reduced by 3.5-4 km3/year. This study provides replicable and cost-effective methodologies for optimum utilization of fossil aquifers and for minimizing deformation associated with their use.