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Biomedical subjects

S al-Mohaya

Publications and source records attributed to S al-Mohaya.

10 recordsLinked to original sources

Intraventricular and brachial artery thrombosis in nephrotic syndrome.

A 23-year-old Saudi female presented with nephrotic syndrome. On renal biopsy she had primary focal and segmental glomerulosclerosis which was resistant to steroids. Two years later she presented with absent left arm pulses and on investigation a diagnosis of left ventricular thrombosis and thromboembolism of left brachial artery was made. Low antithrombin III, high fibrinogen levels and diuretic therapy were the possible causative factors for hypercoagulable state. On anticoagulation therapy initiated with heparin and continued with warfarin for 8 weeks there was complete dissolution of intraventricular and improvement of left brachial artery thrombosis. An early diagnosis and treatment of this potentially serious complication of nephrotic syndrome are stressed.

Adult↗

Serum ionic fluoride levels in haemodialysis and continuous ambulatory peritoneal dialysis patients.

High serum fluoride (F-) in patients with chronic renal failure (CRF) and end-stage renal disease (ESRD) is associated with risk of renal osteodystrophy and other bone changes. This study was done to determine F- in normal healthy controls and patients with ESRD on haemodialysis (HD) or peritoneal dialysis (PD). Seventeen healthy controls (12 males, 5 females) and 39 ESRD patients on dialysis (17 males, 22 females) were recruited in the study in a community with 47.4 +/- 3.28 microM/l (range 44-51 microM/l) of F- content in drinking water. Control subjects showed a mean serum F- concentration of 1.08 +/- 0.350 microM/l. Males in control group showed slightly higher F- levels (1.15 +/- 0.334, range 0.55-1.9 microM/l) than females (0.92 +/- 0.370, range 0.6-1.5 microM/l). Mean serum F- concentration did not correlate significantly with age and sex among control subjects, whereas such correlation was observed in patients with ESRD on dialysis. Mean serum F- concentration was significantly higher in patients on dialysis (2.67 +/- 1.09, range 0.8-5.2 microM/l) than normal controls. When grouped according to sex, the mean serum F- concentration in males (3.05 +/- 1.04, range 1.8-5.2 microM/l) was significantly higher than females (2.38 +/- 1.08, range 0.8-5.2 microM/l). When patients were grouped according to age, it was observed that F- concentration was significantly higher in patients with age groups 21-70 (2.86 +/- 1.05) than those with age group 13-20 years (1.42 +/- 0.531). Thus F- concentration correlated with age and sex, being higher in males and above 20 years. Despite appreciable clearance of F- (39-90%) across the peritoneum, patients on CAPD showed higher serum F- concentration than those on HD (3.1 +/- 1.97 vs 2.5 +/- 1.137 microM/l). Of the total 39 patients on dialysis 39% had their serum F- concentration above 3.0 microM/l, posing the risk of renal osteodystrophy.

Adult↗

Bartter's syndrome in two successive generations of a Saudi family.

Bartter's syndrome (BS) is characterized by primary renal tubular hypokalemic metabolic alkalosis, hyperreninemia, hyperaldosteronism and normal blood pressure. The parents and siblings of a BS patient were evaluated for renal tubular function. The father and all 9 siblings of the patient had biochemical features of BS. His mother, a first cousin of his father, had hypokalemia and hyperkaluria but no other features of BS and could have been a 'carrier'. The mother and all 9 siblings were asymptomatic. Including the patient, hypomagnesemia was present in 8 of 12 family members. Therapy with a combination of potassium chloride and magnesium increased the serum potassium and magnesium levels to within normal limits. The familial occurrence in BS is well known, and reports of the disorder in siblings and the first generation of children of consanguineous marriages and normal parents have been taken to suggest an autosomal recessive inheritance. One affected parent and involvement of all siblings of the patient raise the possibility of an autosomal dominant inheritance in the present family.

Adolescent↗

Liver disease in dialysis patients with antibodies to hepatitis C virus.

Eighty-three patients with chronic end-stage renal failure, including 65 on haemodialysis and 18 on intermittent peritoneal dialysis, were evaluated for hepatitis B virus profile and antibodies to hepatitis C virus (HCV). All those positive for HBsAg were excluded from the study. Nineteen patients were found to be positive for antibodies to HCV by the ELISA II test. Eight cases were already positive for HCV antibody when they started dialysis in our unit, the other 11 became positive during dialysis in our unit. Only one of the patients on peritoneal dialysis was positive for HCV. A liver biopsy was obtained from 17 patients, who consented to the procedure. All the cases were evaluated for the number of blood transfusions received, HIV infection and the approximate time of contracting the HCV infection. Liver enzymes were determined every month. Only three patients had abnormally raised serum aminotransferase at the time of biopsy. The various histopathological lesions detected were chronic active hepatitis (n = 3, including one with changes consistent with cirrhosis), chronic persistent hepatitis (n = 4), non-specific hepatitis (n = 3) and haemosiderosis (n = 3); four biopsy samples were normal. There was no correlation between the biochemical and histopathological changes. Moreover, patients with normal serum aminotransferase levels had abnormal histopathological changes. All were negative for HIV and none of the patients had received a renal graft. Twelve patients had received blood transfusions varying from 2 to 12 units, four had not received any blood, and in one the history of blood transfusion could not be confirmed. The four patients with anti-HCV antibodies who had not received blood transfusion had relatively mild disease--non-specific hepatitis (n = 2) or normal biopsy (n = 2). One patient with cirrhosis died 30 months after liver biopsy from hepatic insufficiency and three received renal transplants. Others are continuing on dialysis and their biochemical tests are within normal limits 12-45 (30 +/- 14) months after biopsy. In conclusion, biochemical tests are poor indicators of liver disease, and liver biopsy is a definitive way of evaluating the patients of dialysis with positive HCV antibodies for prognosis.

Adolescent↗

Hepatitis C in chronic renal failure patients.

The occurrence of hepatitis C virus (HCV) infection amongst chronic renal failure (CRF) patients in our Nephrology Unit was investigated over a period of 1 year. A total of 71 patients was studied comprising 26 chronic haemodialysis (CHD) patients, 6 acute haemodialysis patients, 4 peritoneal dialysis patients and 35 CRF patients not on dialysis. Patients were screened before and after haemodialysis, and their baseline and postdialysis values of liver enzymes were determined. Eleven (15.5%) of the total 71 patients were HCV antibody positive. Analysis of the individual patient groups showed that 8 (30.7%) of the 26 CHD patients were positive for HCV. Our data showed a statistically significant relationship between seroconversion and duration of dialysis (p < 0.05). A high statistically significant (p < 0.0001) correlation was observed between the HCV antibodies and CRF. The relative risk of hepatitis C was about 22 times greater for those with CRF compared with the normal controls, which makes CRF an important risk factor. A high proportion of the HCV seroconverters had elevated liver enzyme (serum glutamic pyruvic transaminase). The data presented show a positive correlation between HCV seroconversion, CRF, duration on dialysis and elevated serum liver enzymes.

Hemofiltration↗

Primary hyperparathyroidism: presentation and management.

164 hypercalcemic patients were examined to determine the co-relation, frequency and mode of presentation of primary hyperparathyroidism. Primary hyperparathyroidism was diagnosed in 11 patients (6.7%). All of them presented late with renal and bony complications. The incidence of primary hyperparathyroidism appears to be lower than that of the western countries, and the introduction of routine serum calcium estimates can be expected to yield more cases of primary hyperparathyroidism especially asymptomatic cases.

Adult↗

Arteriovenous fistula for hemodialysis. A report of 112 consecutive cases.

Arterio-venous fistula of Brescia was created in 112 consecutive patients during a five year period from May 1983 at King Fahd University Hospital of King Faisal University, Al-Khobar, Saudi Arabia. These fistulae were created for hemodialysis in patients with chronic renal failure. There were 67 males and 45 females. The youngest patient was 13 years and the oldest 75 years. Complications were negligible (0.85%), even-though 31% were diabetics and 24% had sickle cell hemoglobinopathy. The arteriovenous fistula failed in 6 patients and the patency rate was 94.6%. The minimum follow up was three months and the maximum fifty-two months. The end-to-side anastomosis gave better results. For long term dialysis arterio-venous fistula of Brescia should remain as the first choice.

Adolescent↗

Hansen's disease: a cause of lymphadenopathy in endemic areas.

In this paper we report two unusual cases of leprosy, both presenting with lymphadenopathy as the initial manifestation of the disease. Lymphadenopathy was the dominant presenting complaint of the first patient in whom skin lesions were absent. A diagnosis of lepromatous leprosy was made only after a lymph node biopsy. Following this diagnosis neural involvement was evident. In the second patient the lymphadenopathy was associated with polyarthritis leading to a false clinical diagnosis of Still's disease. This unusual presentation in both cases led to a delay in the final diagnosis which was based on histopathological examination of lymph nodes. The clinical and histopathological features of both patients are discussed. Superficial nerves should be palpated in all patients presenting with lymphadenopathy in endemic areas.

Adolescent↗