Search

Ali AlSahow,1 Bassam Bulbanat,2 Bassam Alhelal,3 Khaldoun Alhumoud,4 Ahmad Alkharaza,5 Torki Alotaibi,6 Heba Alrajab,7 Anas Alyousef,8 Fatimah Hadi9 1Nephrology division, Jahra Hospital, Al Jahra, Kuwait; 2Cardiac Center, Amiri Hospital, Kuwait City, Kuwait; 3Nephrology Division, Adan Hospital, Hadiya, Kuwait; 4Al salam International Hospital, Kuwait City, Kuwait; 5Cardiology Division, Adan Hospital, Hadiya, Kuwait; 6Hamad AlEssa Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait; 7Nephrology Division, Farwaniya Hospital, Sabah Al Nasser, Kuwait; 8Nephrology Division, Amiri Hospital, Kuwait City, Kuwait; 9Cardiology Division, Chest Diseases Hospital, Kuwait City, KuwaitCorrespondence: Ali AlSahow, Nephrology Division, Department of Medicine, Jahra Hospital, Bishr Bin Awana, Jahra, 00004, Kuwait, Email alsahow@hotmail.comIntroduction: Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.Methods: A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.Results: The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.Conclusion: Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.Keywords: chronic kidney disease, heart failure, hemodialysis, hyperkalemia, potassium binders

Ahmed Fathi Elkeraie,1 Saeed Al-Ghamdi,2 Ali K Abu-Alfa,3 Torki Alotaibi,4 Ali Jasim AlSaedi,5 Abdulkareem AlSuwaida,6 Mustafa Arici,7 Tevfik Ecder,8 Mohammad Ghnaimat,9 Mohamed Hany Hafez,10 Mohamed H Hassan,11 Tarik Sqalli12 1Department of Internal Medicine and Nephrology, Alexandria University, Alexandria, Egypt; 2Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon; 4Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Sabah Health Region, Kuwait City, Kuwait; 5Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq; 6Department of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Department of Nephrology, Faculty of Medicine, Hacettepe University, Altındağ, Ankara, Turkey; 8Department of Medicine, Istinye University; Division of Nephrology, Topkapı, Istanbul, Turkey; 9Department of Nephrology, Specialty Hospital, Jaber Ibn Hayyan St. Shmeisani, Amman, Jordan; 10Department of Nephrology and Medicine, Cairo University, Cairo, Egypt; 11Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; 12Department of Nephrology, Moroccan Society of Nephrology, Casablanca, MoroccoCorrespondence: Ahmed Fathi Elkeraie, Department of Internal Medicine and Nephrology Alexandria University, Alexandria, Egypt, Email drahmed@hotmail.comAbstract: Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD.Keywords: chronic kidney disease, nephrology referral, screening, sodium-glucose cotransporter-2 inhibitors

Background and Objective: Sickle cell disease (SCD) complications, such as sickle cell nephropathy (SCN), may begin in childhood and progress insidiously to chronic kidney disease in adulthood. In Saudi Arabia (SA), there is a lack of studies evaluating kidney function in children with SCD. This study aims to assess microalbuminuria (MA) as an early marker of renal dysfunction in SCD children living in the Eastern region of SA, to potentially institute appropriate early treatment., Materials and Methods: A prospective cross-sectional study was conducted on 114 Saudi children with SCD under the age of 14 years who attended the pediatric hematology clinic for routine follow-up. Demographic and clinical information were collected from the patients and their parents, who provided informed consent. Morning urine samples were collected and tested for the presence of MA using the urinary albumin/creatinine ratio (ACR). Blood samples were also collected for basic laboratory investigations. The prevalence of MA and its correlation with various clinical and laboratory data were analyzed. Additionally, a comparison of clinical characteristics and MA was conducted between children originating from the Southwestern (SW) and Eastern regions of the country, all of whom lived in the Eastern Province., Results: A total of 114 children with SCD were included in the study. The mean age was 8.8 ± 3.2 years, with a male-to-female ratio of 1.3:1. Based on their region of origin, they were divided into two groups: Eastern (n = 26/114) and SW (n = 88/114). MA was detected in 28 patients (24.6%), with no significant difference in prevalence between the two groups. There was no significant statistical difference in clinical and laboratory data between the groups, except for hemoglobin F (HBF) levels and the use of hydroxyurea (HU). HBF levels were significantly higher in children from the Eastern region, while more SW patients used HU. No correlation was found between MA and any of the studied variables., Conclusion: MA is common in children with SCD in the Eastern region of SA, with no difference in its prevalence between children of the two different ancestries carrying the Arab-Indian (AI) and African haplotypes. It is not associated with any of the studied clinical variables in this report. Further studies are needed to confirm these findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Armed Forces Hospitals Eastern Province Institutional Review Board (IRB) issued approval AFHER-IRB-2021-018. Approval is granted with the understanding that the King Abdulaziz City for Science and Technology (KACST) Implementing Regulations of the Law of Ethics of Research will be strictly adhered to. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zayed et al.)

Objectives: To report the development and administration of the Saudi pediatric speech intelligibility (SPSI) test., Methods: This study was carried out at King Abdullah Ear Specialist Center, King Saud University, Riyadh, Saudi Arabia, between 2021 and 2023. A pilot study was carried out in 5 regions of Saudi Arabia including 100 normal hearing children aged 7-11 years old, with 20 children from each region. The final test materials were voice-recorded by a native Saudi radio announcer, and a software-based application for administering the SPSI was developed., Results: During the pilot study, minor adjustments were carried out to the test for more clarity. The developed SPSI software is an android-based application that includes features like automatic result calculation, data saving, and individual user accounts for examiners to review results. The SPSI test comprises 4-word cards and 2 sentence cards, each with 5 pictures, and operates in 3 modes: quiet, background noise, and competing sentences., Conclusion: The SPSI test has been developed in an android-based software using the Saudi local dialects. It can facilitate comprehensive and accurate assessment of speech intelligibility, particularly in children with hearing impairments., (Copyright: © Saudi Medical Journal.)

Background: Since its debut in 1949, lithium (Li) has been regarded as a gold standard therapy for mood stabilization. Neuroprotective effects of Li  have been replicated across many different paradigms ranging from tissue cultures to human studies. This has generated interest in potentially repurposing this drug. However, the optimal dosage required for neuroprotective effects remains unclear and may be different than the  doses needed for treatment of bipolar disorders. Recent studies on trace-Li levels in the water suggest that Li, could slow cognitive decline and prevent dementia with long-term use even at very low doses. The current review aims to synthesize the data on the topic and challenge the conventional high-dose paradigm., Results: We systematically reviewed five available studies, which reported associations between trace-Li in water and incidence or mortality from dementia. Association between trace-Li levels and a lower risk or mortality from dementia were observed at concentrations of Li in drinking water as low as 0.002 mg/L and 0.056 mg/L. Meanwhile, levels below 0.002 mg/L did not elicit this effect. Although three of the five studies found dementia protective properties of Li in both sexes, a single study including lower Li levels (0.002 mg/l) found such association only in women.  CONCLUSION: The reviewed evidence shows that trace-Li levels in the water are sufficient to lower the incidence or mortality from dementia. Considering the lack of options for the prevention or treatment of dementia, we should not ignore these findings. Future trials of Li should focus on long term use of low or even micro doses of Li in the prevention or treatment of dementia., (© 2024. The Author(s).)

(1) Background: Food allergy (FA) is an immune-mediated hypersensitivity to foods, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence, characteristics, and influencing factors of parent-reported FAs among children in Saudi Arabia. (2) Methods: This cross-sectional study utilized a validated parental questionnaire distributed across all regions of Saudi Arabia. Data from 2130 participants were collected and analyzed using SPSS v. 26 and Prism software v. 10.3.0. (3) Results: Parent-reported FA prevalence was 15.2%. Egg was the most common allergen (6.2%), followed by tree nuts (4.1%), peanuts (4.0%), milk (3.8%), and sesame (3.2%). Significant geographical variations were observed, with the western region having the highest burden ( p < 0.001). Older children had higher rates of shellfish and fish allergies. Parental allergies and co-existing asthma/drug allergies were positively associated with childhood FAs. (4) Conclusions: This study highlights a substantial burden of parent-reported FAs in Saudi Arabia, with regional variations in food allergen distribution. Parental allergies and co-existing allergic conditions may influence FA risk.

Background Hypertension (HTN) is a global health issue as it causes significant mortality and morbidity among the worldwide population. Various treatments are available, but many patients are unable to control the disease. There are various factors like medication non-adherence and lifestyle habits that contribute to this problem. There is a need for evidence-based interventions to address HTN effectively, especially in regions like Saudi Arabia, where there is limited data on uncontrolled HTN. This study aimed to assess the prevalence of uncontrolled HTN and contributing factors to poor blood pressure control among patients in Primary Health Centers (PHCs) in Riyadh, Saudi Arabia. Methodology An analytical cross-sectional study was conducted using an interviewer-administered questionnaire among all patients aged 18 years and above who have uncontrolled HTN and who visited the PHCs of Riyadh's first health cluster in Saudi Arabia. Data was cleaned in Microsoft Excel and analyzed using IBM SPSS 29. Results The study comprised 516 patients with HTN. The majority were males (53.1%, n=274) compared to females (46.9%, n=242), with an average age of 58 years (SD=10.5). Notably, most patients were obese (63.2%, n=326), and 62.4% (n=322) had uncontrolled HTN. Multivariate analysis identified sociodemographic factors like higher education (p-value = 0.013, adjusted odds ratio (AOR) = 0.795) as protective against uncontrolled HTN, while employment (p-value = 0.031, AOR = 1.786) increased the risk of uncontrolled HTN. Risk factors such as smoking (p-value = 0.001, AOR = 3.011) and salt restriction (p-value = 0.021, AOR = 0.643) significantly influenced HTN control. Management-related predictors like stopping medication after feeling better (p-value = 0.001, AOR = 3.196) were also found significant. Conclusion This study revealed a high prevalence of uncontrolled HTN, especially among males and obese individuals. Sociodemographic factors like higher education were protective, while employment increased the risk of the disease. Further, smoking, salt restriction, and medication adherence significantly impacted HTN control, highlighting the importance of tailored interventions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of King Saud Medical City issued approval H0RI-08-Feb24-04. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alshuhri et al.)

The orientational effect concept in a molecular-scale junction is established for asymmetric junctions, which requires the fulfillment of two conditions: (1) design of an asymmetric molecule with strong distinct terminal end groups and (2) construction of a doubly asymmetric junction by placing an asymmetric molecule in an asymmetric junction to form a multicomponent system such as Au/Zn-TPP+M/Au. Here, we demonstrate that molecular-scale junctions that satisfy the conditions of these effects can manifest Seebeck coefficients whose sign fluctuates depending on the orientation of the molecule within the asymmetric junction in a complete theoretical investigation. Three anthracene-based compounds are investigated in three different scenarios, one of which displays a bithermoelectric behavior due to the presence of strong anchor groups, including pyridyl and thioacetate . This bithermoelectricity demonstration implies that if molecules with alternating orientations can be placed between an asymmetric source and drain, they can be potentially utilized for increasing the thermovoltage in molecular-scale thermoelectric energy generators (TEGs)., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Introduction: The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis., Methods: A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic., Results: A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient's condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic., Conclusion: Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff., Competing Interests: Source of Support: None. Conflict of Interest: None.

Allopurinol is a commonly prescribed agent in the urologic population for the prevention of urinary stones. Although generally well-tolerated, several serious potential side effects can occur with its use. Allopurinol hypersensitivity syndrome (AHS), in particular, is a relatively rare but potentially life-threatening complication. With the observed increase in urinary stone disease, especially those of uric acid composition, it is likely that the use of allopurinol will increase. Urologists play an important role in the assessment and medical management of patients with urinary stones, thus a greater awareness of the potential adverse events associated with allopurinol use, especially AHS, is important, as well as strategies that can minimize such risks. Herein, we review the potential adverse effects of allopurinol. In addition, the results of a comprehensive review of the current literature on AHS will be presented, highlighting those patients at highest risk, reviewing the genetic susceptibility testing currently available, and providing guidance on best practices when allopurinol therapy is being considered.

This study aims to prepare new nanocomposites consisting of Cr 2 O 3 /CaCO 3 as a catalyst for improved hydrogen production from NaBH 4 methanolysis. The new nanocomposite possesses nanoparticles with the compositional formula Cr 2-x Ca x O 3 (x = 0, 0.3, and 0.6). These samples were prepared using the sol-gel method, which comprises gelatin fuel. The structure of the new composites was studied using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy, environmental scanning electron microscopy (ESEM), and X-ray spectroscopy (XPS). The XRD data showed the rhombohedral crystallinity of the studied samples, and the average crystal size was 25 nm. The FTIR measurements represented the absorption bands of Cr 2 O 3 and CaO. The ESEM micrographs of the Cr 2 O 3 showed the spherical shape of the Cr 2 O 3 nanoparticles. The XPS measurements proved the desired oxidation states of the Cr 2-x Ca x O 3 nanoparticles. The optical band gap of Cr 2 O 3 is 3.0 eV, and calcium doping causes a reduction to 2.5 and 1.3 eV at 15.0 and 30.0% doping ratios. The methanolysis of NaBH 4 involved accelerated H 2 production when using Cr 2-x Ca x O 3 as a catalyst. Furthermore, the Cr 1.7 Ca 0.3 O 3 catalyst had the highest hydrogen generation rate, with a value of 12,750 mL/g/min.

Objectives: The benefits of reduction in low-density lipoprotein cholesterol by evolocumab by nearly 60% has not been evaluated among kidney transplant recipients to our knowledge. We assessed the efficacy and safety of evolocumab, a proprotein convertase subtilisin/kexin-9 inhibitor, in reducing lipids and cardiovascular events among kidney transplant recipients in a randomized controlled study., Materials and Methods: Between June 2017 and June 2019, we enrolled 197 kidney transplant recipients with high cardiovascular risk score (>20). Patients who received evolocumab (140 mg/2 weeks) comprised group 1 (n = 98), and patients maintained on statin therapy comprised group 2 (n = 99). We followed patients clinically and with necessary laboratory investigations over 24 months., Results: The 2 groups had comparable demographic characteristics (P > .05). Before enrollment in the study, smokers were significantly more prevalent in group 1, whereas posttransplant diabetes mellitus was more prevalent in group 2 (P = .033). Moreover, baseline serum creatinine was higher in group 1, whereas immunosuppression was equivalent in both groups (P > .05). We found no significant differences between the 2 groups concerning cardiovascular events, and both graft and patient outcomes were comparable (P > .05). The higher baseline cholesterol in group 1 (5.5 vs 4.7 mmol/L; P < .001) decreased significantly after 3 months and thereafter (P = .031) compared with levels in group 2 and baseline values (P < .001). We reported 2 cases of acute myocardial infarction and 1 atrial fibrillation in group 2., Conclusions: Proprotein convertase subtilisin/kexin-9 inhibitors, as an added therapy to statins, are safe and effective in treating hypercholesterolemia after kidney transplant. Evolocumab can minimize cardiovascular events after kidney transplant in patients with high events at baseline. Longer-term trials with larger number of patients are needed to confirm its beneficial effects on cardiovascular complications and patient and graft survival.