Publications

Objective: The current systematic review was carried out to compare the safety and efficacy of thalidomide vs hydroxyurea in β-thalassemia patients. Methods: literature were extensively searched by using four databases: Web of Science, PubMed, Cochrane Library, and Scopus until January 22, 2024, for studies that did hit to hit comparison of thalidomide vs hydroxyurea based on safety and efficacy in β-thalassemia patients. Original research studies in English with observational and/or experimental designs, regardless of age and gender, used thalidomide for ≥3 months were included in this systematic review. Two independent reviewers extracted the data using a data extraction form. Results: Two studies collectively involving n=57 β-thalassemia patients fulfilled eligibility criteria. Thalidomide exhibited greater potential in improving Hb levels, HbF, and in reducing blood transfusion needs and serum ferritin levels compared to hydroxyurea in β-thalassemia patients. Mild adverse events (AEs) of non-serious nature were reported with both thalidomide and hydroxyurea. somnolence, and headache were the main AEs reported in patients treated with thalidomide, whereas abdominal pain, pruritis and gastritis were the main AEs reported in patients treated with hydroxyurea. Conclusion: This study demonstrates the higher potential of thalidomide in improving Hb levels and reducing transfusion requirements compared to hydroxyurea in β-thalassemia. However, these findings must be endorsed until well-designed clinical trials are conducted.

A series of chitosan-based β-ketosulfone derivatives (CsB-β-KS) were synthesized, characterized, and evaluated as anti-cancer agents against three types of cancer cell lines, including the colon carcinoma (HCT), liver hepatocellular carcinoma (HEPG2), and breast carcinoma (MCF-7) cell lines. Before product formation, the β-ketosulfone derivatives, 1-(4-halophenyl)-2-(phenylsulfonyl)ethanone, were synthesized by the reaction of phenacyl halide with sodium benzene sulfinate. The (CsB-β-KS)a-e derivatives were synthesized by chemical modification of chitosan (Cs) with freshly prepared p-halo-β-ketosulfone derivatives in a mildly acidic aqueous solution. Various loading percentages, 5%, 10%, 15%, and 20%, of the p-halo-β-ketosulfone derivative (by weight) with respect to the Cs weight were evaluated. The chemical structures were confirmed by variable elemental and spectral analyses, including FT-IR, 1H-NMR, 13C-NMR, and mass spectroscopes. The (CsB-β-KS)a-e derivatives were also characterized by various techniques, such as FT-IR, 1H-NMR, XRD, FE-SEM, and thermal analyses. FT-IR spectroscopy and XRD confirmed the formation of these products. Moreover, the XRD results proved the strong interactions between the organic substituent and the Cs host molecule. All (CsB-β-KS)a-e derivatives showed similar thermal stabilities in three degradation steps. Among these derivatives, (CsB-β-KS)a3 showed the highest thermal stability. The synthesized compounds showed significant biological screening against Gram-positive and Gram-negative bacteria and fungi. Among the tested products, (CsB-β-KS)a3 displayed high efficiencies toward the three types of cancer cell lines under investigation with low concentrations. The ranking of the anti-cancer activity was (CsB-β-KS)a3 > (CsB-β-KS)d3 > (CsB-β-KS)d2.

Despite the great efforts by health authorities in Kingdom of Saudi Arabia (KSA), Cutaneous leishmaniasis (CL) continues to be a major public health problem in the country. Many risk factors make KSA prone to outbreaks and epidemics; among these, rapid urbanization and the huge population movement are the most important. The disease is endemic in many parts of KSA, with the majority of cases concentrated in six regions, including Al-Qaseem, Riyadh, Al-Hassa, Aseer, Ha'il, and Al-Madinah. Leishmania major (L. major) and Leishmania tropica (L. tropica) are the main dermotropic species, and Phlebotomus papatasi (vector of L. major) and Phlebotomus sergenti (vector of L. tropica) are the proved vectors of the disease. Psammomys obesus and Meriones libycus have been defined as the principal reservoir hosts of zoonotic CL in Al-Hassa oasis, Al-Madinah, and Al-Qaseem provinces. Clinically, males are affected more than females, and there is no variation between the Saudis and expatriates in terms of number of reported cases, but the disease tends to run a more severe course among non-Saudis. Face is the most commonly affected site, and ulcerative pattern accounts for 90% of lesions. Despite local and international recommendations of using laboratory diagnostics to confirm CL cases, most cases in KSA are diagnosed and treated on clinical grounds and local epidemiology. However, systemic parenteral sodium stibogluconate (SSG) is the first line of therapy and used to treat all CL patients irrespective of their clinical presentation or the incriminated species. In brief, more efforts are needed to combat this disease. Several aspects of the disease require more evaluation through encouragement of national and regional studies. Development of evidence based national diagnostic and management guidelines, as well as algorithms, is urgently needed to improve the practice of diagnosing and treating CL in KSA.

Mohammed AlOmair,* Hanan AlMalki,* Nouf AlShamrani, Ghadah Habtar, Maram AlAsmari, Wejdan Mobasher, Hanan AlQahtani, Aydah Rahman, Alhussain Asiri Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia*These authors contributed equally to this workCorrespondence: Mohammed AlOmairDivision of Rheumatology, Department of Medicine, Aseer Central Hospital, P.O. Box 34, Abha, Saudi ArabiaTel +966 507735466Fax +966 172243595Email alomair.mohd@gmail.com; MAL-OMAIR@moh.gov.saPurpose: To study the pattern of response to different treatment strategies in seropositive rheumatoid arthritis (RA) patients and to describe our clinical practice in RA management.Patients and Methods: Over a period of two years from April 2018 to April 2020, we conducted a retrospective analysis of data for 288 consecutive seropositive RA patients attending rheumatology clinics and the daycare unit at Aseer Central Hospital. Data were collected on patient demographics, disease duration, extraarticular manifestations, comorbidities and treatment. Disease activity was assessed using the clinical disease activity index (CDAI).Results: Out of the total 288 patients, 42% (120) are on csDMRADs, while 54% (162) are on bDMRADs and 4% (6) are on tsDMARDs. Of the patients on csDMARDS, 51%, 43% and 7% of them were on remission, low and moderate disease activity, respectively. However, of the patients on non-csDMARDS, 36.3%, 49.4% and 14.3% of them were on remission, low and moderate disease activity, respectively. Failure of csDMARDs was affected by the presence of high disease activity at baseline, extraarticular lung manifestations and coexistent fibromyalgia, with a significant effect of the latter on remission rate. Among patients on non-csDMARDs, 42 (25%) showed one or more therapy changes. Tumor necrosis factor inhibitors were the predominant first-line agents in biologically naive patients (65%) followed by abatacept (18%). Abatacept was the most frequently prescribed second biologic in 52% of cases followed by tocilizumab in 19%.Conclusion: The current clinical practice in our hospital is consistent with the latest American College of Rheumatology (ACR)/The European League Against Rheumatism (EULAR) guidelines. Treat-to-target strategy was achieved in the vast majority of our patients, while remission was observed in almost half of the patients.Keywords: rheumatoid arthritis, DMARDs, biologics, remission, CDAI