Tamer Saber

Background and Objectives: polycystic ovarian syndrome (PCOS) prevails in females in the 18–40-year-old age group and varies from 5–20% depending on the demographic and diagnostic standards. It is unknown how long passes between the onset of a specific symptom and the appearance of the disease. The three most significant characteristics of PCOS include irregular menstruation, a polycystic ovarian shape found by pelvic ultrasound, and hyperandrogenism, which could possibly delay menarche. This study’s objective was to assess insulin resistance and bone bio-markers’ metabolism-involved characteristics of females with PCOS. Materials and Methods: We present a cross-sectional study carried out on 100 female patients suffering from PCOS and 100 healthy female subjects as a control living in Saudi Arabia in the Al-Madinah Al-Munawara Region between May 2021 and March 2022. The age of the studied groups ranges from 20–40 years, and patients were categorized into three groups; group I (cont...

Hepatitis C virus (HCV) chronic infection is a major causative factor for several chronic liver diseases, including liver cirrhosis, liver cell failure, and hepatocellular carcinoma. The HCV has seven major genotypes. Genotype 4 is the most prevalent genotype in the Middle East, including Saudi Arabia, followed by genotype 1. The HCV genotype affects the response to different HCV treatments and the progression of liver disease. Currently, combinations of direct-acting antiviral drugs (DAAs) approved for the treatment of HCV achieve high cure rates with minimal adverse effects. Because real-world data from Saudi Arabia about the efficacy of DAAs are still limited, this study was conducted to assess the effectiveness of DAAs in treating patients with chronic hepatitis C and to identify the variables related to a sustained virologic response (SVR) in a real-world setting in Saudi Arabia. This prospective cohort study included 200 Saudi patients with chronic HCV who were 18 years of age...

PURPOSE Clostridium difficile (C. difficile) is an important causative agent of nosocomial diarrhoea and has become a major worldwide public health concern. The current study was conducted to determine the prevalence of C. difficile infection (CDI) amongst patients with nosocomial diarrhoea in a large tertiary care hospital in Taif, Saudi Arabia, and to define molecular characteristics and antimicrobial sensitivity profiles of C. difficile strains isolated from those patients. MATERIALS AND METHODS Stool specimens were collected from 456 patients and were cultured for C. difficile isolation. The isolates were subjected to multiplex polymerase chain reaction (PCR) for detecting genes encoding the toxins (toxin A, toxin B and binary toxin [CDT]), genotyping by PCR ribotyping method and antimicrobial sensitivity testing using E test strips. RESULTS Seventy-four C. difficile strains were recovered, of which 44 (59.5%) were A+B+CDT-, 14 (18.9%) were A-B+CDT-, 4 (5.4%) were A+B+CDT+ and 12 (16.2%) were A-B-CDT-. Toxigenic strains, and hence CDI, were detected in 13.6% of the patients (62/456). Fourteen different ribotypes were distinguished amongst bacterial isolates, of which ribotypes 002, 001, 017, 014 and 020 were the most prevalent (20.3%, 18.9%, 18.9%, 9.5% and 8.1%, respectively). Four isolates (5.4%) belonged to ribotype 027. All bacterial isolates showed sensitivity to metronidazole, vancomycin and piperacillin-tazobactam. The isolates exhibited resistance to linezolid (2.7%), chloramphenicol (5.4%), rifampicin (13.5%), tetracycline (21.6%), moxifloxacin (48.6%), clindamycin (54%) and imipenem (83.8%). Multiple drug resistance was observed in 56.8% of the isolates. CONCLUSION Further larger studies are required for an accurate understanding of CDI epidemiology in Saudi Arabia.

Background: Bone is a vital, dynamic connective tissue that throughout life is continuously remodeled by balanced bone formation and resorption. It has been reported that diabetes and its metabolic disturbances and medications lead to important alterations in bone metabolism. The objective of this study is to determine the effect of metformin on markers of bone metabolism [N-terminal cross-linked telopeptide of type-1 collagen (NTx) and osteocalcin] in male patients with type 2 diabetes mellitus. Methods: a case-controlled study was conducted on 100 male type 2 diabetic patients. Their ages ranged from (35–50years) living in Saudi Arabia at Al-Madinah Al- Monawara Province. They were on oral antidiabetic drugs, divided into two groups according to treatment with metformin. Routine laboratory measurements included serum levels of fasting glucose, HbA1c, total calcium, inorganic phosphorus, total alkaline phosphatase and intact parathyroid hormone, osteocalcin was measured as a bone f...

Hepatitis C virus (HCV) is a major cause of acute and chronic hepatitis in the United States and abroad. HCV antibody prevalences ranging from 10 to 90% have been reported in intravenous drug abusers, hemodialysis patients, and persons suffering from other liver diseases, whereas HCV seropositivity rates for volunteer-blood donor populations are generally under 1%. However no information has been available concerning the prevalence of HCV in general hospital populations in the United States. We examined the rate of HCV seropositivity in 530 patients admitted to the Atlanta VA Medical Center between November 1993 and November 1994. The test population consisted of 400 random hospital admissions, 100 successive admissions to the surgical service, and 30 random admissions to the gastrointestinal service. Serum samples were assayed for HCV antibodies by a second generation EIA, and all repeat reactives were re-examined using a supplemental research assay to confirm the presence of HCV antibodies. Complete chart reviews were carried out on all HCV seropositive patients and on 100 HCV seronegative patients. Sixty-two of the 530 patients tested (11.7%) were repeatedly positive for HCV antibodies. Of these 62 repeat reactives, 56 (90.3%) were positive and 3 others (4.8%) indeterminate by the supplemental assay. The HCV seropositivity rate after supplemental testing was 11.8% for random admissions, 5.0% for surgical admissions, and 13.3% for patients admitted to the gastroenterology service. HCV-associated risk factors in HCV seropositive patients included a history of intravenous drug abuse, current or previous alcohol abuse, previous or concurrent liver disease, previous blood transfusions, hemodialysis, and multiple sex partners or unsafe sex. HCV infection may be more prevalent among hospitalized VA patients (and among other US hospital populations) than previously expected.

We aimed to assess the predictive value of admission HbA1c level in nondiabetic patients presented by acute STEMI, on outcome of PCI and short term outcome of adverse cardiac events.Methods. 60 nondiabetic patients were admitted to Cardiology Department, Zagazig University Hospital, with acute STMI: 27 patients with HbA1c levels of 4.5% to 6.4% (group 1), 17 patients with HbA1c levels of 6.5% to 8.5% (group 2), and 16 patients with HbA1c levels higher than 8.5% (group 3). Either invasive intervention was done at admission by (pPCI) or coronary angiography was done within month (3–28 days) from taking thrombolytic. Participants were followed up for 6 months.Results. There was significant difference among different groups of HbA1c as regards the number of diseased vessels, severity of CAD lesions (pvalue < 0.01), and TIMI flow grades (pvalue < 0.05). There was significant difference among different groups as regards the adverse cardiac events on short term follow-up period (pval...

Background: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children. Compliance to medication in patients with CH is known to improve the neurodevelopmental outcomes of CH. Compliance to therapy can be affected by multiple factors. Aim of the work: The aim of this study is to explore compliance of the patients and/or their target families to therapy of CH, and to explore factors affecting compliance to medication in patients with CH. Subjects and Methods: This was descriptive crosssectional study, which was conducted in Endocrinology and Pediatric Outpatient Clinics in Sharkia Governorate health insurance center, Egypt. The study participants were 120 newborn and infant with CH and their mothers. Data were collected using multi-structured questionnaires for determining socioeconomic state, clinical picture of congenital hypothyroidism, personal, family history and Morisky Medication Adherence Scale 8 (MMAS 8) to assess patient co...

Background: Asymptomatic bacteriuria (ASB) is a common condition where bacteria are present in a significant count in urine without symptoms. Pathogen persistence for a long period of time can cause urinary tract infection (UTI) that may lead to a serious complication. This study was carried out to assess the prevalence of ASB among female student and staff in College of Applied Medical Sciences, Taif university. Methods: This was a cross sectional study where a clean-catch midstream urine specimens were collected from 50 participant; 29 staff (group A) and 21 students (group B). The urine specimens were cultured quantitatively onto CLED agar plates and incubated at 35-37 ºC for 24-48 hours. Bacterial growth equal to or more than 10 5 CFU/ml was considered significant. Bacteria that grew in significant count were identified by Gram stain, catalase test, and coagulase test and novobiocin sensitivity. Results: Out of the 50 urine specimens screened for ASB, two specimens (4 %) showed significant bacterial growth; where one specimen (3.4 %) in group A and one specimen (4.8 %) in group B showed significant bacterial growth. The rest of urine specimens showed either no or non-significant bacterial growth. Staphylococcus saprophyticus and Staphylococcus epidermidis were the isolated organisms. Conclusion: Low prevalence of asymptomatic bacteriuria was noted in this study. This may be due to the relatively small number of the students and staff investigated. Another likely explanation is that our target group has high educational status as socioeconomic marker.

Keywords: Inappropriate Antibiotics; Ambulatory; Acute Viral Respiratory Tract Infections; Cairo University Hospital Conclusion: Inappropriate AB prescription was reported in 46% of the patients confirmed viral respiratory tract infection. The most frequently used AB were penicillins/cephalosporins/macrolides. Results: Eligible patients who fulfilled the inclusion criteria were 3207. 1075 (33.5%) were found to be positive for viral and atypi-cal bacteria, 912 (84.4%) women. The mean age among cases was 5.74 ± 13.87 years. Children less than 5 years represented 83% of the cases. Data about how frequent AB before admission was only available for 784 cases over 1075 positive cases. Almost 46% (360/784) of viral confirmed cases were received AB before admission. The most frequently used ABs were penicillin/cephalospo-rin/macrolides. Methods: The current study was conducted at Cairo University Hospitals. It was conducted on hospitalized both adults as well as pediatric patients (age < 18 years old), over the period of 4 years from 2010 to 2014. All the patients who fulfilled the WHO case definition of sever acute respiratory tract infection (SARI) were enrolled. Demographic data, Clinical manifestations, co-morbid conditions and data about AB usage during the last week before admission to Hospital were collected. Nasopharyngeal (NP) and/or oropharyngeal (OP) swabs were collected and analyzed for the viral panel and atypical bacteria through PCR technique. Rationale: Antibiotic (AB) that prescribed inappropriately could accelerate the AB resistance. AB resistance represents a major health issue and will be of a great economic burden if not properly addressed. Data about the inappropriate antibiotic use of AB in Egypt is limited so the aim for this study to detect how frequent AB inappropriately prescribed for acute viral respiratory tract infections .

Rationale: Many studies have studied the role of antiviral therapy in reducing the severity and reducing the both morbidity and mortality, also emphasized its role in reducing the length of stay. In Egypt Data is very limited about the role of different antiviral drugs and its role and impact on the treatment of influenza , so the significance of this study is to explain what are the most frequently prescribed antiviral medications and try to address its impact on outcome of the laboratory confirmed influenza cases. Methods: The current study was conducted at Cairo University Hospitals over 2 years from 2010-2012. It was conducted on hospitalized patients both adult and pediatric age group. All the patients who fulfilled the WHO case definition of severe acute respiratory infection (SARI) were enrolled and admitted. Criteria used were; fever of ≥ 38°C or history of fever plus cough within the last 10 days. Demographic data, co-morbid conditions, outcome and data about antiviral treatment received were collected. Nasopharyngeal and oropharyngeal swabs were collected and analyzed for the pandemic influenza 2009 A (H1N1), seasonal A H1N1, seasonal A H3N2 with influenza B and C by using PCR. Results: Influenza virus has been detected in 81 cases distributed as follows; 48 cases of influenza A (28 cases of pandemic 2009 H1N1, 20 cases H3N2) while 30 cases were influenza B subtype while 3 cases were non A non B subtype. only one case was combined A and B subtype. Mean age for these patients was 19.2 years and 50% were below age of 5 years (41/81), while only 5% were above age of 65 years. Female was accounted for 43% of the cases and two were pregnant in 2 nd trimester. None the current study patients received flu vaccine during the preceding year prior to this episode of infection. Only 2.5% (2/81) cases had received the oseltamivir treatment. One patient was male patient 55 years old with seasonal influenza H3N2, he was asthmatic with no other risk factors, he has no consolidation on CXR received 75 mg twice daily orally for 5 days from within the 48 hours from onset of the symptoms, he has been discharged from the hospital without need for either ICU admission nor need for mechanical ventilation (MV). The other patient who received oseltamivir was 9-month boy with pandemic 2009 H1N1, he had consolidation on CXR, he received oseltamivir according to his weight for 5 days, also this patient discharged without need for ICU nor need for MV. None of them have been complicated during hospital stay. both of these cases have been discharged after of average 4 days from admission.no side effects from oseltamivir treatment had been reported from both conditions. Neither zanamivir nor peramivir or adamantanes have been tested during this study. Conclusion: Only 2.5% cases who had laboratory confirmed influenza infection had been received antiviral therapy in the first 48 hours. Oseltamivir was the only available and the only prescribed antiviral therapy. Neither zanamivir nor peramivir or adamantanes was prescribed. Oseltamivir prescribed into usual standard dose. Further randomized studies are needed to properly assess the role of different antiviral therapies on influenza outcomes.

Background: Bone is a vital, dynamic connective tissue that throughout life is continuously remodeled by balanced bone formation and resorption. It has been reported that diabetes and its metabolic disturbances and medications lead to important alterations in bone metabolism. The objective of this study is to determine the effect of metformin on markers of bone metabolism [N-terminal cross-linked telopeptide of type-1 collagen (NTx) and osteocalcin] in male patients with type 2 diabetes mellitus. Methods: a case-controlled study was conducted on 100 male type 2 diabetic patients. Their ages ranged from (35–50years) living in Saudi Arabia at Al-Madinah Al- Monawara Province. They were on oral antidiabetic drugs, divided into two groups according to treatment with metformin. Routine laboratory measurements included serum levels of fasting glucose, HbA1c, total calcium, inorganic phosphorus, total alkaline phosphatase and intact parathyroid hormone, osteocalcin was measured as a bone formation marker. Second-morning void urine was collected from patients to measure urinary NTx as a resorptive marker. Results: there was no significant difference between the two groups as regard the clinical, biochemical and diabetic control parameters(age, BMI, duration of diabetes, FBS, HbA1c, calcium, Phosphorus, total alkaline phosphatase, and iPTH). No statistical differences in osteocalcin (ng/ml) between the two groups (13.3±1.43 vs 13.0±1.4, P-value =0.348). The mean of NTx (nM BCE/mM creatinine) of metformin group 1 was (29.6±7.8) lower than that of non-metformin group 2 (44.6±6.1) with highly significant differences between the two groups (P=0.000).Conclusion: metformin may have a favorable effect on bone metabolism in type 2 diabetic males through a decrease of bone resorption marker, but more researches are required to know the overall impact of this medication on bone health on the long term

Background. We tested the prevalence and impact of HCV seropositivity among Egyptian patients referred for coronary angiog-raphy. Subjects and Methods. This cross-sectional study was conducted in Zagazig University hospitals including 509 patients scheduled for elective coronary angiography between June 2013 and June 2014. By taking full history on admission, laboratory workup including HCV Ab, echocardiography study, and coronary angiography, we calculated the mean number of coronary artery lesions and the mean number of affected coronary artery vessels for all patients. The severity of the coronary lesions was estimated using the Gensini score. Results. HCV seropositive patients referred for coronary angiography were about 30.3% (which is greater than the prevalence of HCV seropositivity among general population in Egypt), patients proved to have CAD who are HCV antibody positive had more severe coronary lesions than in seronegative one (í µí± < 0.05), and patients proved to have CAD who are HCV antibody positive had comparable prevalence of cardiovascular risk factors as seronegative patients except for diabetes and hypertension which are more prevalent in seronegative patients (í µí± < 0.05). Conclusion. Prevalence of HCV antibody positive patients referred for coronary angiography was about 30.3%, and CAD patients who are HCV antibody positive had more severe coronary lesions and less prevalence of diabetes and hypertension than HCV antibody negative.

Abstract Background: Thyroid dysfunction or non-thyroidal illness syndrome (NTIS) is frequently
detected in chronic, systemic diseases. The systemic manifestations of chronic obstructive
pulmonary disease (COPD) include a number of endocrine disorders. The severity of hypoxia
and airway obstruction in COPD patients might cause alterations in thyroid function.
The aim of this study is to assess serum levels of thyroid hormones and the inflammatory biomarkers;
IL-6, TNF-a in COPD patients during stability and acute exacerbation of the disease,
and also to assess the relation between severity of COPD and levels of thyroid hormones.
Subjects and methods: Forty stable COPD patients and twenty COPD patients with acute exacerbation
were included in this study as patient groups and twenty healthy age-matched non smoker
subjects with normal pulmonary function as a control group. The diagnosis of COPD and acute
exacerbation of COPD were established according to GOLD (2011) criteria. Stable COPD patients
were further subdivided into Mild-to-moderate COPD patient group (FEV1 P 50% of predicted
value, which included 14 patients) and Severe COPD patient group (FEV1 <50% of predicted
value, which included 26 patients). All enrolled patients were subjected to measurements of pulmonary
function tests (FEV1%, FVC% and FEV1/FVC ratio), arterial blood gases (ABGs) (PaO2,
PaCO2, pH), serum levels of thyroid hormones (TSH, total T3, total T4, free T3 and free T4)
and the inflammatory biomarkers IL-6 and TNF-a on the first day of admission to RICU or first
visit to the outpatient clinics

Background: The metabolic syndrome (MS) has emerged as a clinical and public health crisis. The incidence of the MS has reached epidemic proportions, with more than 1 in 4 adults affected by this disorder worldwide. Cardiovascular mortality in the MS is increased 2-fold compared to those without MS. Aim: The aim of this work was to study the role of cortisol and its circadian rhythm in the MS, the correlation of cortisol to insulin resistance using HOMA model and the correlation of cortisol to various components of the MS. Patients and methods: 50 Subjects were included in this study, they were divided into 3 groups: Group I: Included 10 apparently healthy subjects as a control group. Group II: Included 20 obese non diabetic normotensive subjects. Group III: included 20 MS patients (obese, hypertensive and type 2 diabetic). All subjects of the study were subjected to through history and physical examination including anthropometric measures, routine investigations and measurement of plasma fasting and evening cortisol, fasting insulin, estimation of insulin resistance by HOMA index, estimation of B cell function and C-reactive protein. Results: There was a significant increase in the fasting glucose, fasting insulin, and HOMA index in MS group compared to control group and obese group: HOMA-IR was 1.36±0.175 in control group, 3.3±0.6 in obese group and 11.4±4.5 in MS group. Obese group also showed significant increase in the fasting insulin, HOMA index compared to control group. The results also showed significant increase in total cholesterol, LDL cholesterol, triglycerides and CRP and significant decrease in HDL cholesterol in both obese group and MS group compared to control group. The results showed significant increase in fasting cortisol in both obese group and MS group compared to control group: fasting cortisol in ng/ml was 128±46.2 in control group, 210±79.1 in obese group and 235.1±76.8 in MS group, while no significant difference was found in the evening cortisol in the different groups: evening cortisol in ng/ml was 54.2±22.4 in control group, 59.2±30.6 in obese group and 83.6±35.7 in MS group. Fasting cortisol level was positively correlated with waist circumference, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol, triglycerides and negatively correlated with HDL cholesterol in MS group. While, in obese group fasting cortisol level was found to be positively correlated with waist circumference, total cholesterol, LDL cholesterol, triglycerides and negatively correlated with HDL cholesterol. Conclusion: Fasting cortisol is increased in central obesity and in MS. Evening cortisol in not increased in central obesity or MS. Fasting cortisol level can be used as a marker for central obesity which isconsidered the main factor in the MS, but can't be used as a marker for MS itself. Fasting cortisol is correlated with many features of the MS denoting its role in the pathophysiology of the MS. Further work is still needed to justify the role of cortisol in MS regarding its role in diagnosis, prognosis and therapy.

Background: Vitamin D deficiency has been linked to increased susceptibility to the development of rheumatoid arthritis (RA) and may be associated with disease activity in patients with RA. Vitamin D deficiency is common in healthy Saudi Arabian women. The objective of this study was to evaluate vitamin D status in patients with RA and to assess the relationship between vitamin D levels and disease activity in adult Saudi Arabian women. Subjects and method: This study was conducted at King Saud Hospital, AL-Qassem area, Saudi Arabia between January 2012 and May 2013 and had been carried out on 40 patients diagnosed as having RA and 40 healthy adult females matched for age as a control group. All participants were subjected to full history taking, clinical examination, laboratory investigations including assessment of serum calcium, serum phosphorus, and 25-hydroxy vitamin D3 (25(OH)D3). Disease activity of RA was assessed using Disease Activity Score Index of a 28 joint count (DAS28), CRP and ESR.
Results: There was a highly significant difference between RA patients and healthy controls as regarding the mean 25(OH)D3 (10.8±4.8 vs 19±7.96 ng/ml; p< 0.001) and both were below the reference range . We found that 25(OH)D3 was not correlated with DAS28, the correlation coefficient being -0.14, and was also not correlated with CRP or ESR in RA patients.
Conclusion: Vitamin D deficiency is prevalent in healthy Saudi women and highly prevalent in Saudi women with RA, but vitamin D deficiency is not linked to disease activity in RA. These results may raise our important rationale for vitamin D supplementation to decrease the risk of development of rheumatoid arthritis, but more definitive evidence is also required to demonstrate the clinical benefit of vitamin D supplementation in the treatment of RA.