Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia.

OBJECTIVES: This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD: Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS: The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION: Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.

Identifying the Anti-MERS-CoV and Anti-HcoV-229E Potential Drugs from the Ginkgo biloba Leaves Extract and Its Eco-Friendly Synthesis of Silver Nanoparticles.

The present study aimed to estimate the antiviral activities of Ginkgo biloba (GB) leaves extract and eco-friendly free silver nanoparticles (Ag NPs) against the MERS-CoV (Middle East respiratory syndrome-coronavirus) and HCoV-229E (human coronavirus 229E), as well as isolation and identification of phytochemicals from GB. Different solvents and high-performance liquid chromatography (HPLC) were used to extract and identify flavonoids and phenolic compounds from GB leaves. The green, silver nanoparticle synthesis was synthesized from GB leaves aqueous extract and investigated for their possible effects as anti-coronaviruses MERS-CoV and HCoV-229E using MTT assay protocol. To verify the synthesis of Ag NPs, several techniques were employed, including X-ray diffraction (XRD), scan, transmission electron microscopy, FT-IR, and UV-visible spectroscopy. The highest contents of flavonoids and phenolic compounds were recorded for acetone, methanol, and ethanol as mixtures with water, in addition to pure water. HPLC flavonoids were detected as apegenin, luteolin, myricetin, and catechin, while HPLC phenolic compounds were pyrogallol, caffeic acid, gallic acid, and ellagic acid. In addition, our results revealed that Ag NPs were produced through the shift from yellow to dark brown. TEM examination of Ag NPs revealed spherical nanoparticles with mean sizes ranging from 5.46 to 19.40 nm and an average particle diameter of 11.81 nm. A UV-visible spectrophotometric investigation revealed an absorption peak at λ max of 441.56 nm. MTT protocol signified the use of GB leaves extract as an anti-coronavirus to be best from Ag NPs because GB extract had moderate anti-MERS-CoV with SI = 8.94, while had promising anti-HCov-229E, with an SI of 21.71. On the other hand, Ag NPs had a mild anti-MERS-CoV with SI = 4.23, and a moderate anti-HCoV-229E, with an SI of 7.51.

Intercalary frozen autograft for reconstruction of malignant bone and soft tissue tumours.

PURPOSE: In 1999, we developed a technique using frozen autografts-tumour-containing bone treated with liquid nitrogen-for the reconstruction of malignant bone tumours. The purpose of this study was to evaluate the functional and oncological outcomes of frozen autografts for intercalary reconstruction of malignant bones and soft tissue tumours. METHODS: This retrospective study was designed to assess 34 patients of mean age 35 (range, 6-79) years. The mean follow-up period was 62 (24-214) months. The median length of the frozen autografts was 138.4 ± 60.39 (50-290) mm. RESULTS: Postsurgically, 20 patients remained disease-free, seven patients survived with no evidence of disease, five patients were alive with disease, and two patients died of disease. The five- and ten-year survival rates of the frozen autografts were 91.2% and the mean International Society of Limb Salvage score was 90%. Complete bony union was achieved in 97% of the patients. There were five cases of nonunion, six cases of fracture, two cases of deep infection and four cases of local recurrence. CONCLUSION: Utilizing intercalary frozen autografts for patients with a nonosteolytic primary or secondary bone tumour without involvement of the subchondral bone is a good alternative treatment, because it is a straightforward biological technique and can provide excellent limb function.

Two stage reconstruction versus bone transport in management of resistant infected tibial diaphyseal nonunion with a gap.

INTRODUCTION: Infected nonunion of the tibial diaphysis poses one of the most challenging scenarios. There is no clear cut guidelines for cases of infected diaphyseal nonunion with bony defects of ≤6 cm. MATERIALS AND METHODS: A retrospective comparative study was conducted on 30 patients who sustained resistant infected tibial diaphyseal nonunion with bony defect of ≤6 cm. The 30 patients were the sum of two groups; group I (16 patients, mean age 33.6 years) which included all patients, who underwent two stage reconstructions, and Group II patients (14 patients, mean age 29.5 years) who were managed by application of Ilizarov ring external fixator in a single stage surgery. Union was judged both clinically and radiologically. A scoring system comprising dual functional and bony grading was employed to evaluate the final results of both groups. RESULTS: The results of both groups regarding the size of the resultant bony defect, the time to union, and the postoperative limb length discrepancy showed no statistically significant differences. Group II patients needed postoperative plastic reconstruction procedures significantly more than group I patients (p = 0.019). Similarly, group II patients exhibited more complications than group I patients (p = 0.003). Regarding both clinical and bony grading, the results of group I showed superiority to group II results with the only significant difference being the preservation of the preoperative range of motion of both ankle and subtalar joints (p = 0.072). CONCLUSIONS: The use of two stage reconstruction in cases of resistant infected tibial diaphyseal nonunion gives comparable results to the Ilizarov ring external fixator in cases associated with bony defects within the confines of 6 cm with superiority in preservation of ankle and subtalar joints range of motion.

Early Versus Delayed Fourth Ray Amputation With Fifth Ray Transposition for Management of Mutilating Ring Finger Injuries.

PURPOSE: To compare hand function after early versus delayed fourth ray amputation and transposition of the fifth ray in mutilating ring finger injuries. METHODS: We prospectively compared 2 groups of patients who sustained either isolated mutilating ring finger or complex hand injuries between January 2008 and December 2013. The first group (12 patients; 10 male and 2 female) was managed by early (within 14 d) fourth ray amputation with fifth ray transposition, and the second group (13 patients; 9 male and 4 female) was managed similarly but on a delayed basis (after 20 d). The postoperative fifth metacarpophalangeal joint active range of motion was recorded and compared with the preoperative value. Function was evaluated by measuring grip and key pinch strengths, supination and pronation strengths, and hand breadth. All parameters were evaluated by comparing the injured and the noninjured hands. RESULTS: Group 1 patients exhibited superior results to group 2 patients regarding the postoperative grip and key pinch strength and pronation and supination strength in addition to the mean postoperative active range of motion of the transposed ray metacarpophalangeal joint. However, the results were statistically significant regarding only grip and pronation strengths. Postoperative active range of motion of the transposed ray metacarpophalangeal joint was significantly reduced in the cases having preoperative compromise of the transposed digit in group 1. The final subjective cosmetic satisfaction was better in group 1. CONCLUSIONS: Our results support early fourth ray amputation with fifth ray transposition for mutilating ring finger injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Functional and electrophysiological outcome after autogenous vein wrapping of primary repaired ulnar nerves.

PURPOSE: This study aimed at assessing the functional and electrophysiological recovery after vein wrapping of primary repaired ulnar nerves METHODS: From January 2010 till December 2012, 23 patients (diagnosed with distal ulnar nerve injury) were prospectively studied where they were divided into two groups; group one (11 patients) and group two (12 patients). The injury was sharp in all cases but for one. The first group was managed by primary epineurorraphy. The second group was managed by primary epineurorraphy and autogenous vein wrapping. Final outcome was based on sensory recovery, motor recovery, and the presence or absence of electrophysiological response RESULTS: Clinically, only one case in each group exhibited negative Tinel's sign. The second group achieved statistically significant superiority regarding motor recovery (P = 0.018), sensory recovery (P = 0.042) and electrophysiological recovery (P = 0.044). Group one showed two good, two satisfactory, six moderate, and one bad results while the second group showed five good, six satisfactory, one bad and no moderate results (P = 0.026). The first time to show clinical response in group one was the third month while in the second group it was at 1.5 month (P < 0.001). In addition, the first time to show electromyographic response in group one was at the sixth month while in group two it was at the third month CONCLUSIONS: Vein wrapping is a simple technique that could be used reliably to augment primary neurorrhaphy particularly in cases with associated vascular or tendon injuries to prevent scarring and enhance functional and electrophysiological recovery.

Effectiveness of some plant extracts in biocontrol of induced onion basal rot disease in greenhouse conditions.

One of Egypt's most notable and historically significant vegetable crops is the Liliaceae plant, Allium cepa L. In this study, the effectiveness of methanolic extracts of Artemisia absinthium leaves, Calotropis procera latex, Moringa oleifera seeds, and Syzygium aromaticum clove was investigated in vitro and, in a greenhouse, setting against Fusarium oxysporum, the pathogen that causes onion basal rot in Assiut Governorate, Egypt. The S. aromaticum extract exhibited the inhibition peak (63.3%), whereas the A. absinthium extract had the lowest inhibition impact against F. oxysporum growth (41.1%). The gas chromatography-mass spectroscopy (GC-MS) analysis revealed that 82 important compounds, with abundances ranging from low to high, were present in the tested S. aromaticum's methanolic extract. The primary components were acetaldehyde, hydroxy- and 2-propanone, 1,1,3,3-tetrachloro-(42.71%), 1,2-ethanediol, and methyl alcohol (34.01%). In comparison to the infected control, the disease severity was significantly reduced by 20% with the use of a plant extracts mixture and Dovex 50% and increased by 62.22% with the use of an extract from A. absinthium. When compared to the infected control, onion plant fresh weight and dry weight were considerably higher under the clove extract therapy. The plant extracts used in this study's testing contain a number of active ingredients, including amino acids, vitamins, minerals, antioxidants, and enzymes, which is probably why they have such positive impacts. The application of a combination of plant extracts was suggested as a feasible strategy for improving the growth and productivity of onion plants by the study's findings. More research is needed to comprehend the mechanisms by which plant extracts promote plant development and to optimize the concentration and timing of administration.

Bioactive Compounds from Vicia sativa L. and Vicia monantha Retz. with Unveiling Antiviral Potentials in Newly Green Synthesized CdO Nanoparticles.

BACKGROUND: in the current study, a comparative phytochemical analysis was carried out to explore the phenolic and flavonoid contents in the aerial parts of Vicia sativa L and Vicia monantha Retz growing in cultivated, reclaimed, and desert habitats. METHODS: High-performance liquid chromatography (HPLC) was used to detect Vicia methanolic extracts' individual phenolic and flavonoid constituents. The first-time synthesis of cadmium oxide nanoparticles (CdO NPs) using the aqueous extract of V. monantha has been developed using a green approach. Also, the cytotoxicity of V. monantha extract and CdO NPs was examined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay for unveiling them as anti-HAV and anti-AdV. RESULTS: Our results indicated that in the case of desert habitat, the contents of total phenolics (76.37 mg/g) and total flavonoids (65.23 mg/g) of V. monantha were higher than those of V. sativa (67.35 mg/g and 47.34 mg/g, respectively) and the contents of these secondary metabolites were even increased in V. monantha collected from reclaimed land (phenolics: 119.77 mg/g, flavonoids: 88.61 mg/g). Also, V. monantha surpassed V. sativa in the contents of some individual HPLC constituents, and hence, V. monantha was used to synthesize the green CdO NPs and subsequent antiviral tests. The average size of CdO NPs was determined to be 24.28 nm, and the transmission electron microscopy (TEM) images of CdO NPs clearly showed their spherical form and varying particle sizes, with different diameters in the range of 19-29 nm. MTT assay was positive to the exposure of CdO NPs in the normal cell line, proposing that CdO NPs can reduce cell viability. V. monantha extract showed promising antiviral activity against Hepatitis A virus (HAV) and Adenovirus (AdV) with SI of 16.40 and 10.54. On the other hand, CdONPs had poor antiviral activity against HAV with an SI of 4.74 and moderate antiviral activity against AdV with an SI of 10.54. CONCLUSION: V. monantha is now considered a new, valuable natural resource for phenolics and flavonoids, especially when grown in reclaimed soil. The green CdO NPs based on V. monantha extract showed a promising antiviral effect against HAV and AdV.

Mouse ovarian follicle cryopreservation using vitrification or slow programmed cooling: assessment of in vitro development, maturation, ultra-structure and meiotic spindle organization.

AIM: To compare different outcomes of vitrification and slow freezing of isolated pre-antral follicles and to evaluate different cryo-devices for vitrification of isolated follicles. METHODS: Pre-antral follicles were isolated from mouse ovaries and cryopreserved using vitrification and slow freezing. A preliminary experiment was carried out to select the optimal cryo-device for vitrification of isolated follicles. A total of 414 follicles were randomly distributed among four groups: control (CT) fresh (n=100), nylon mesh (n=96), electron microscopy grid (n=102), and micro-capillary tips (n=116). Subsequently, a total of 979 follicles were randomly assigned to three different groups: CT fresh (n=256), vitrification (n=399) and slow freezing (n=324). CT and cryopreserved/thawed follicles were cultured in vitro and examined daily for development. Final maturation was triggered with human chorionic gonadotrophin and rates of oocyte maturation were calculated. The ultra-structure of cryopreserved/thawed follicles was studied using electron microscopy. Meiotic spindle presence and organization in mature oocytes were examined using the Oosight imaging system. RESULTS: Micro-capillary tips resulted in poor immediate post-warming survival but no differences were observed in the subsequent in vitro development characteristics between different cryo-devices. Nylon mesh proved to be the easiest carrier, particularly when large numbers of follicles were to be vitrified. Compared to vitrification, slow freezing resulted in a significantly lower number of intact follicles at the end of the culture period (P<0.0001). However all other outcome measures were comparable between both techniques. CONCLUSIONS: Isolated follicles were more vulnerable to cryodamage after slow freezing as compared to vitrification.

Codelivery of DOX and siRNA by folate-biotin-quaternized starch nanoparticles for promoting synergistic suppression of human lung cancer cells.

In this paper, the self-assembled folate-biotin-quaternized starch nanoparticles (FBqS NPs) were used as carrier system of doxorubicin (DOX) and siRNAIGF1R for the codelivery of both into human lung adenocarcinoma cell lines (A549 cells) in vitro. The cytotoxicity, targeted ligand competition, cell proliferation inhibition, cellular uptake, endocytosis mechanism and target protein suppression of drug-loaded FBqS NPs were evaluated in detail. Compared with several other drug formulations under same condition, siRNAIGF1R/DOX/FBqS NPs exhibited the greatest cytotoxicity to A549 cells and the cytotoxicity was competitively inhibited by free folate in dose-dependent manner. The A549 cells treated by siRNAIGF1R/DOX/FBqS NPs showed the lowest cell proliferation capacity. The energy-dependent clathrin- and caveolae-mediated endocytosis might be the primary cellular uptake mechanism of drug-loaded FBqS NPs. The expression of IGF1R protein in A549 cells treated by siRNAIGF1R/FBqS NPs declined dramatically. So the FBqS NPs were expected as the co-carrier system of chemotherapeutants and siRNAs for future clinical application.

Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant.

PURPOSE: The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. PATIENTS AND METHODS: This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. RESULTS: Fifteen males and five females were followed up for a mean of 63.35 (26-144) months with average age at the time of presentation was 20.8 (range: 12-32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75-250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. CONCLUSION: The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.

Oral insulin delivery by carboxymethyl-ß-cyclodextrin-grafted chitosan nanoparticles for improving diabetic treatment.

In this paper, a new oral insulin formulation, insulin-loaded carboxymethyl-ß-cyclodextrin-grafted chitosan nanoparticles (insulin/CMCD-g-CS NPs), was fabricated by ionic crosslinking technique. The therapeutic efficacy of new formulation was investigated in detail. Firstly, the CMCD-g-CS was synthesized by EDC-mediated esterification reaction. The prepared CMCD-g-CS exhibited favourable loading capacity and encapsulation efficiency of drug. The release experiment in vitro showed that the nanocarrier could efficiently protect encapsulated insulin at simulated gastric environment and release drug in the simulated colonic fluid. The insulin/CMCD-g-CS NPs effectively promoted drug internalization into Caco-2 cells and could reversibly open the tight junction between cells. The oral administration of insulin/CMCD-g-CS NPs could lastingly decrease blood sugar level in diabetic mice. The liver function study verified that the insulin/CMCD-g-CS NPs had not obvious toxicity to experimental mice. Therefore, the CMCD-g-CS could be an effective and safe oral insulin delivery carrier for future clinical application. A new biocompatible polysaccharide nanoparticle was fabricated as oral insulin delivery carrier for improving diabetic treatment.

Treatment of the benign lytic lesions of the proximal femur with synthetic bone graft.

BACKGROUND: Benign bone tumors and tumor-like conditions are commonly located in the proximal femur. The main indications for surgical treatment are lesions with impending or actual pathological fractures, or with aggressive or recurrent lesions. However, patients complaining of persistent pain, limping, or abnormal gait patterns are also considered for surgical treatment. In this study, we describe the outcomes of the surgical treatment of benign lytic lesions of the proximal femur by curettage followed by implantation of synthetic bone graft. METHODS: This retrospective study included 27 patients (22 females and 5 males) with benign lytic lesions of the proximal femur. The average age was 25.5 years (6-65 years), and the mean follow-up period was 54.5 months (9-145 months). The histopathological diagnoses were fibrous dysplasia (8 patients), simple bone cyst (8 patients), chondroblastoma (7 patients), giant cell tumor (3 patients), and eosinophilic granuloma (1 patient). These lesions were managed with curettage followed by implantation of the bone defects with alpha tricalcium phosphate in 14 patients, beta tricalcium phosphate granules in 11 patients, hydroxyapatite granules in 1 patient, and combined beta tricalcium phosphate and hydroxyapatite granules in 1 patient. Internal fixation was performed in three patients. RESULTS: The mean operative time was 143 min (80-245 min). Patients had regained normal unrestricted activity without pain at the operation site. Patients treated with beta tricalcium phosphate achieved radiographic consolidation of the bone defects within 1 year after the surgery, and those treated with alpha tricalcium phosphate or hydroxyapatite experienced no progression nor recurrence of the lesions. Local tumor recurrence was observed in one patient with giant cell tumor 5 years after the surgery. Post-operative pathological fracture was occurred in one patient with a simple bone cyst of the subtrochanteric region 1 month after surgery. No post-operative infection was observed. CONCLUSION: We concluded that the treatment of benign lytic lesions of the proximal femur, either primary or recurrent, using synthetic bone graft is a safe and satisfactory method and the addition of internal fixation should be carefully planned.

Improved survival in HIV-associated diffuse large B-cell lymphoma with the addition of rituximab to chemotherapy in patients receiving highly active antiretroviral therapy.

PURPOSE: Recent trials suggest serious toxicity in HIV-associated non-Hodgkin's lymphoma (NHL) with rituximab (R) and chemotherapy (CT), offsetting the benefit of rituximab. METHOD: We retrospectively reviewed experience with CHOP-R vs. CT in 40 patients with HIV-associated diffuse large B-cell lymphoma (DLBCL) diagnosed between December 1992 and February 2006, all of whom were treated with curative intent. RESULTS: In a univariate analysis, International Prognostic Index (IPI) score, prior AIDS, HAART, and rituximab were significant for overall survival (OS). In a multivariate analysis, IPI 0-1 (p < .02), no prior AIDS (p < .0002), and receiving CHOP-R (p < .01) were significant for improved OS, and HAART use (p < .09) retained a trend for improved OS. The hazard ratio (HR) for patients with high IPI receiving CHOP-R was 0.3 (95% CI 0.1-0.8). Patients without prior AIDS receiving CHOP-R had an HR of 0.5 (95% CI 0.1-1.7). The OS at 30 months in patients not receiving HAART was 0%. With HAART, OS was 33% for CT and 86% for CHOP-R; HR for CHOP-R was 0.4 (95% CI 0.1-1.2). Toxic deaths were 3 (33%) for CHOP-R and 6 (25%) for CT (p = ns); all toxic deaths with CHOP-R were in patients not receiving HAART. Rituximab-treated patients had a lower death rate from lymphoma (CHOP-R, 2 [16%] vs. CT, 15 [63%]; p < .04), and overall mortality (CHOP-R, 5 [42%] vs. CT, 21 [88%]; p < .01). CONCLUSION: These retrospective data suggest that fatal toxicity of rituximab in HIV-NHL is not increased provided HAART is used, that the addition of rituximab to CT improved outcome, and that further prospective trials investigating this issue are warranted.

Autogenous Vein Wrapping versus In Situ Decompression for Management of Secondary Cubital Tunnel Syndrome after Surgical Fixation of Elbow Fractures: Short-Term Functional and Neurophysiological Outcome.

PURPOSE: The aim of this study was to compare the functional and neurophysiological outcome of in situ decompression versus in situ decompression augmented with autogenous vein wrapping in management of secondary cubital tunnel syndrome at the elbow following fixation of elbow fractures. METHODS: A prospective comparative randomized study was performed on 29 patients who were divided into two groups: group I (in situ decompression) and group II (in situ decompression augmented with autogenous vein wrapping). We measured the patients' demographics, subjective reports of symptoms, and objective evaluation of the functional and neurophysiological outcomes of both groups. RESULTS: Group II patients achieved statistically better results in both neurophysiological scoring and clinical sensory rating but not in all other parameters. CONCLUSION: Autogenous vein wrapping for secondary cubital tunnel syndrome after elbow fracture fixation only provides a better sensory outcome. LEVEL OF EVIDENCE: Level II, therapeutic prospective comparative study.

Functional and MRI follow-up after reconstruction of chronic ruptures of the Achilles tendon Myerson type III using the triple-loop plantaris tendon wrapped with central turndown flap: a case series.

BACKGROUND: Reconstruction of chronic ruptures of the Achilles tendon poses a great challenge for the orthopaedic surgeon both technically and functionally. The aim of this study was to assess the results of a new technique for reconstruction of chronic Achilles tendon ruptures with defects longer than 5 cm using the triple-loop plantaris tendon autograft wrapped in a central turndown flap from the proximal portion of the Achilles tendon. PATIENTS AND METHODS: Eighteen patients (14 female and 4 male; mean age, 40.7 years), having chronic ruptures of the Achilles tendon Myerson type III, were enrolled in this study. The mean follow-up period of our patients was 21.8 months. All patients were assessed via the following parameters: lag of interference since the first complaint, length of the defect, length of the turndown flap and length of the harvested plantaris tendon, surgery time, complications, active range of motion at the ankle and the final score. Average values were presented as means. Independent sample t test, Mann Whitney test, paired sample t test and Pearson's correlation coefficient were used to evaluate the clinical and functional results. The results were considered statistically significant if a P value was <0.05. To analyse the time course of the gap following surgery, the data from the first MRI session were compared with those from the second and third sessions using the Wilcoxon's signed rank test. In addition, the paired data of the tendon gap disappearance rate between T1-weighted and T2-weighted images were also compared using the McNemar test. RESULTS: The mean preoperative American Orthopaedic Foot and Ankle Society score was 62.2 points while at the patients' last follow-up, the mean postoperative score was 94.9 points. The results of this study confirmed that both the Achilles tendon healing and tendon gap disappearance have been perceived with higher sensitivity in T2-weighted images than in T1-weighted images. CONCLUSIONS: We believe that this new technique is biologic, synchronous and reliable in cases of chronic Achilles tendon ruptures with defects longer than 5 cm.

Prevalence of antibodies to hepatitis C virus in Saudi and expatriate women in Riyadh, Saudi Arabia.

Six of 511 (1.17%) parturient Saudi females were positive for antibodies to hepatitis C virus (HCV), while one of 171 (0.58%) expatriate female nurses tested positive for the antibody. The prevalence of 1.17% in Saudis compares with 1.2% among pregnant women in Spain, while none of the 40 pregnant women screened in England tested positive for anti-HCV. Antibodies to hepatitis B core antigen in the same sample from Saudi women were positive in 24.6%. Judging by the low prevalence of its antibody, HCV is not as highly endemic as hepatitis B virus (HBV) in this population.

Prevalence of antibodies to hepatitis C virus in Saudi patients with chronic liver disease.

The prevalence of antibodies to hepatitis C virus (anti-HCV) has been measured in 113 Saudi patients with chronic liver diseases. Twenty-five percent of 20 patients with hepatocellular carcinoma (HCC) were positive for anti-HCV and 29.7% of 38 patients with cirrhosis and 27.3% of 33 patients with liver fibrosis, respectively, also tested positive. The positivity rate for a miscellany of liver diseases (22) was 13.6%. The differences between these prevalence rates were not statistically significant. By comparison, 45% of HCC tested positive for hepatitis B surface antigen (HBsAg) while 52.7% of cirrhosis cases were positive. There rates were statistically significant when compared with HBsAg positivity rates of 9.1% and 18.2% in the liver fibrosis and miscellaneous groups. The role of hepatitis C virus (HCV) may be secondary or additive in the causation of chronic liver disease and hepatocellular carcinoma in this environment in which hepatitis B virus (HBV) is highly endemic.

Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh.

Prevalence of antibodies to hepatitis C virus (anti-HCV) was determined in 190 adults (mean age 40.4 years; range 15 to 75) with end-stage renal disease (ESRD) who are on regular hemodialysis in the Nephrology Unit, Riyadh Central Hospital. The overall prevalence rate was 53.7% (48.7% and 61.0% in Saudi's and expatriates, respectively). These figures are considerably higher than figures of 34.8% reported from hemodialysis units in Riyadh, 20% in Spain, 5.5% in Germany, and 1% in the United Kingdom. The possible reasons for the high prevalence of this marker of HCV in our hemodialysis unit are considered and suggestions made for its control.

Prevalence of antibodies to hepatitis C virus in blood donors in Riyadh.

Prevalence of antibodies to hepatitis C virus (anti-HCV) was determined in 580 voluntary blood donors in Riyadh. Among 403 Saudis screened, the prevalence was 1.24%, while among 177 expatriates screened the prevalence was 4.52%. The difference was statistically significant (P<0.02; x(2)test). The overall prevalence of 2.24% is lower than that reported in Spain (7.3%) but higher than reports from the United Kingdom (0.5 to 1%0, Italy (0.87%), or Germany (0.24 to 0.79%0. In view of reports that blood positive for anti-HCV can transmit non-A, non-B hepatitis, it is advisable to routinely screen donor blood for anti-HCV.