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Background: Anemia is defined as a decrease in the hemoglobin concentration of blood, which accordingly decreases the oxygen-carrying capacity of red blood cells such that they are unable to meet the body’s physiological requirements. Numerous reports have specified that anemia customarily occurs in patients with diabetes with renal insufficiency whereas limited studies have described the occurrence of anemia in people with diabetes prior to indication of renal impairment. Other studies have similarly recognized anemia as a risk factor for the need for renal replacement treatment in diabetes. Understanding the pathogenesis of anemia allied with diabetes can lead to the development of interventions to optimize results in these patients. Purpose: The purpose of this study was consequently to determine the pervasiveness of anemia among patients with type 2 diabetes. Materials and Methods: A total of 50 (25 with type 2 diabetes and 25 controls) participants were enlisted for the current study. Participants’ blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The pervasiveness of anemia was then determined statistically. Results: A high incidence of anemia was perceived in the cases. Of the patients with diabetes, 85 % had a hemoglobin concentration that was significantly less (males 10.88±1.78 and females 10.32±1.52) compared to that of controls (males 14.16±1.82 and females 12.49±1.11). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (8.02±1.28, 5.21±2.01, 141.08±7.01, 4.84±0.49 and 1.51±0.28 respectively) as compared to the controls (4.57±0.52, 3.61±2.09, 134.86±6.75, 4.38±0.61 and 1.31±0.31 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases. Conclusions: The findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.

Purpose: To Compare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection and staging of BI-RADS 4–5 anomalies, as a function of breast composition, histology, size, and lesion location. Materials and methods: 25 patients underwent tomosynthesis, MRI, mammography, and ultrasound. The diagnostic accuracy of the different examinations was compared. Results: The sensitivities for detection were as follows: 92.7% for MRI, 80.5% for ultrasound, 75.6% for tomosynthesis, and 61% for mammography. Tomosynthesis improves the sensitivity of mammography (P = 0.0001), but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis Compared to mammography (P = 0.016), but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis (P = 0.00012), but not with microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size. Conclusion: In our series, tomosynthesis found more lesions than mammography in 10% of patients, resulting in an adaption of the surgical plan.

New ultrastructural observations are described in skin lesions of two brothers with Richner-Hanhart's syndrome (RHS). Physical examination of the two patients showed painful skin lesions of palms and soles combined with denderitic corneal ulceration and mental retardation. The diagnosis of RHS was confirmed biochemically with high tyrosine levels in both blood and urine. Examination by transmission electron microscopy revealed several abnormal ultrastructural changes in the epidermal cells. The horny cells contained heterogeneously, electron-dense cytoplasm with many lipid droplets. The granular cell cytoplasm contained abundant tonofibrils and keratohyaline granules. The spinous cell cytoplasm was vacuolated due to the presence of minute tyrosine crystals, which are known to have a lytic effect. The surrounding keratinocytes contained multilobed nuclei. The basal epidermal cells appeared normal except for Merkel cells, which were severely damaged by vacuolatio, also due to the presence of tyrosine crystals. This study showed that high tyrosine levels can induce several ultrastructural pathological changes in the epidermal cells, including the skin chemoreceptor Merkel cells.

Background Vitiligo is not uncommon in southern Saudi Arabia. The response of Saudi patients to PUVA therapy has not been previously assessed. The aim of this study was to evaluate this response. Methods This is a retrospective study for the period of 1990–2001 in which 32 patients were included: Data were collected from the patients’ records, including: age, sex, age at onset of disease, type of vitiligo, cumulative dose, maintenance dose, total number of sessions, number of sessions to induce pigmentation, treatment duration, and response rate. Results The overall response rate was 59.4%. The most sensitive sites were the face, trunk, arms, and legs, while the most resistant sites were the hands, feet, and perioroficial areas (perioral and periorbital). Acute complications occurred in 59.4%, while chronic complications occurred in 78.1%. Analysis of the factors that affect the response rate showed that age, sex, the disease duration, and the treatment duration did not affect the response rate, while the surface area and the number of sessions to induce pigmentation showed a positive relation. Conclusions PUVA is still considered as the most appropriate and effective treatment for vitiligo. Saudi patients showed good response to treatment in general. Some sites such as the face, trunk, arms, and legs showed sensitivity to therapy, while hands, feet, and periorificial areas showed resistance to therapy. Generalized type was the best type to respond, followed by the periorificial type. Acral and segmental types were very resistant to therapy.

Les interactions entre infiltrat inflammatoire et corps de Leishman (LBs) sont decrites en microscopie electronique dans les lesions cutanees de 16 malades atteints de leishmaniose cutanee aigue. Dans les premiers stades de l'inflammation, l'infiltrat cellulaire consiste a la fois en monocytes indifferencies et differencies (M), en macrophages (Mc), en cellules geantes multinuclees (MNGC), en plasmocytes (PC) en lymphocytes (Ly) et en fibroblastes (F). Dans les stades avances, l'infiltrat est sous forme de granulomes tuberculeux consistant en cellules epithelioides de type I secretoire et de type II vesiculaire (ECs), on plus de quelques cellules inflammatoires observees au cours des premiers stades. les deux types ECs n'ont ete trouves que chez six malades. Les M actives, les Mc et les MNGC sont souvent parasites par les LBs. Les parasites sont inclus dans les vacuoles digestives (DVs) de la cellule hote ou des phagolysosomes avec des melanosomes cutanes qui sont connus pour avoir une action lysosomiale. Dans les DVs, les LBs sont soit en survie, soit morts soit expulses du cytoplasme de la cellule hote. L'etude montre, pour la premiere fois, que les melanosomes semblent intervenir pour tuer les LBs, peut-etre en augmentant les effets lethaux des enzymes hydrolytiques des DVs. Les plasmocytes sont agglomeres avec de grands « corps de Russell », indiquant une grande activite des immunoglobulines cellulaires les grands lymphocytes granuleux sont en contact etroit avec les M actives, probablement pour declencher les signaux d'activation. Les ECs de type I secretrices contiennent des granules comparables a de la mucine avec des noyaux denses. Au cours des derniers stades de l'inflammation, les ECs de type II vesiculaires contiennent des granules lysosomaux, et coexistent avec les ECs de type I dans des granulomes tuberculeux eclates. Il etait admis precedemment que les ECs de type I secretoire produisaient un mediateur « granuloma factor » qui recrute des mononucleaires indifferencies afin de perpetuer le processus granulomateux ; les ECs type II vesiculaire sont interpretes comme n'apparaissant qu'a la fin du processus granulomateux, precedant la guerison par fibrose.

Background This is the first epidemiologic study of pemphigus in the southern region of Saudi Arabia. Methods Data were collected from patient records in the outpatient and inpatient departments of Asir Central Hospital during the period 1990-99. The diagnosis of pemphigus was based on the clinical, histopathologic, and direct immunofluorescence patterns which were consistent with pemphigus. Results The results showed that the mean incidence of the disease in the general population was 0.16/100 000; the mean incidence of the disease in the population above 20 years of age was 0.27/100 000. The prevalence of the disease at the end of the study period was 1.56/100 000 for the total population, and 2.7/100 000 for the population above 20 years of age. The male to female ratio was 2.2 : 1. The age of onset of the disease ranged from 23 to 67 years, except for one case at an age of 9 years, giving an average of 43.1 +/- 13.4 years and a median of 40 years. Pemphigus vulgaris was the most commonly encountered type, followed by pemphigus erythematosus (94.7% and 5.3%, respectively). Mucosal involvement occurred in 84.2% of cases. No association with neoplasia was found in the current study. Conclusions Pemphigus in the southern region of Saudi Arabia is as common as in other parts of the world, but with higher mucosal involvement.

Fewer than 100 cases of Richner-Hanhart syndrome have been reported. We describe two additional patients who have the classic clinical, biochemical, and microscopic features of this syndrome.

The association of granuloma annulare (GA) and autoimmune thyroiditis has been documented in the literature in 13 previous cases. However, the pathogenesis of GA remains obscure. Possible pathogenetic factors suggested include: humoral and delayed type hypersensitivity, vascular damage, metabolic disorder, or, primary collagen and/or elastin alteration mediated through an immunologic mechanism. We present herein the report of a 37-year old Saudi female who presented with autoimmune thyroiditis associated with GA. The patient was managed with clobetasol propionate, intra-lesional prednisolone and neomercasol. There was complete resolution of the GA lesions and the patient has remained euthyroid after a few weeks.This presentation is a further evidence that GA and autoimmune thyroiditis may be associated. Key Words: Granuloma annulare, Autoimmune thyroiditis. Résumé L'association d'un granulome annulaire (GA) et auto-immunité de la thyroidite a été documenté dans la litterature au cours des 13 cas précédents. Toutefois, la pathogénèse de GA reste obscure. Des facteurs pathogéniques possibles qu'on a suggéré comprend: humoral et type d'hypersensitivite retardée, degats vasculaire, troubles métabolique, ou bein, collagène primaire et/ou bien changement elastin provoqué par un mécanisme immunologique. Nous présentons dans ce travail, un rapport d'une femme saoudienne qui était atteinte d'une auto-immunite thyroidite associée au GA. On a soigné le patient avec propionate clobetasol, prednisolone intra-lesional et néomercasol. Il y avait un résolution complète des lesions GA et le patient était resté euthyroidie après quelques semaines. A travers cette présentation on peut dire qu' il y a une association entre le GA et l'auto-immunite thyroidite. West African Journal of Medicine Vol.23(3) 2004: 264-266

Background: There is a paucity of reports in the literature detailing the assessment of the beliefs,perception and psychological impact of acne patients . This is the first study from Saudi Arabia designed to address this issue. Materials and methods: A voluntary self-completed questionnaire was used to collect data from acne patients visiting a community-based hospital in Assir region of Saudi Arabia. Data collected, included: patients biodata, duration and severity of the disease before the presentation, source of knowledge, psychological impact, and medication preference. The findings were compared to those of developed countries. Results: 130 patients completed the questionnaires. Females were more affected than males (71.5%, 28.5% respectively). The M: F ratio was 1:2.5. Males tend to present with more severe form of the disease. Most patients had the disease for more than 1 year at presentation. Most patients sought medical advice as a self-made decision. Doctors were the most common source of information to patients. Most patients believe that hormonal imbalance and dirt were the major cause of acne while most of them believed that stress and diet were the major exacerbating factors. The most significant psychological impact in acne patients was on their self image which was severe in 49% of the patients, while the most bothering symptom was the spot of acne lesion. Most patients had used skin cleansers and creams before seeking medical advice (46.1%, 31.5% respectively). Retinoids and antibiotics were the most known prescribed medications to acne patients. Most acne patients expressed no preference of medication, but most of those who did so preferred topical medication. Conclusions: No major differences were found in the beliefs, perception and psychological impact of acne patients from a developing society compared to more developed societies. More community-based and developmental programmes are needed to upgrade the knowledge and common beliefs of acne patients. Key words: Acne vulgaris, Psychological impact, Beliefs. Resume Introduction: Il y a le manque de rapports sur une documentation detaillee basee sur l'evaluation des convictions, perceptions et l' impact psychologique des patients atteints d'acne. Voici la premiere etude d'Arabie saoudite preparee et mis au point pour aborder ce probleme. Materiels et Methode: Un questionnaire voluntairement rempli a ete utilise pour recueillir les donnees chez des patients atteints d'acne tout en rendant visit a l'hopital d'une communaute dans la region d'Assir d'Arabie saoudite. Des donneess recuiillies compris: bio-donnees des malades, la duree et la gravite de la maladie avant sa presentation, la source de la connaissance, l'impact psychologique et traitement prefere. Les resultats ont ete compares avec ceux des pays developpes. Resultats: 130 patients ont rempli les questionnaires. Les femmes etaient plus touches que les hommes, 71,5% et 28,5% respectivement. Le rapport H: F etait 1:2,5. II Parait que les cas des hommes sont plus grave. La pulpart des patients avaient eu la maladie pour plus d'une annee avant de venir a l'hopital. La pulpart des patients avaient essaye de se faire soigner par un medecin comme une decision personnelle. Des medecins etaient la source d'information la plus courante pour des maladies. La plupart des patients croient que le desequilibre hormonal et la salete etaient la cause principale de l'acene tandis que la plupart d'entre enx croyaient que le stress et l'alimentation etaient des facteurs les plus aggravantes. L'impact psychologique le plus sensible chez des patients atteints de l'acne etait surtout leur image de soi qui etait grave en 49% des patients, tandis que le symptome le plus inquietant etaient le siege de la lesion de l'acne. La plupart des patients avaient utilise le demaquillant et la creme de beaute avant daller aupres d'un medecin pour se faire soigner (46,1%, 31,5% respectivement). Les retinoides et les antibiotiques etaient les medicament les plus connus prescris pour des patients atteints de l'acne. La pulpart des malades atteints de l'acne n'expriment aucune preference pour un medicament mais la plupart d'entre eux qui s'exprimaient preferaient un medicament tropical. Conclusion: On n'a pas note aucume difference principale a l'egard des convictions, perceptions et l'impact psychologique des patients atteints de l'acne dans la societe en voie de developpement par rapport a la societe plus developpee. On a besoin des programmes developmentaux base sur la communaute afin d'ameliorer la connaissance et les convictions des patients atteints de l'acne. West African Journal of Medicine Vol.23(1) 2004: 85-87

Twenty-seven patients were randomly picked for an open pilot study using terbinafine with a dose range of 250-500 mg/day for 4 weeks. The inclusion criteria were as follows: (1) the patient had to be aged 5 years or older; (2) the patient could be of either sex; (3) any number or location of the lesions was allowed; (4) parasitologic confirmation was required; (5) the patient was allowed no previous treatment; (6) pregnant or lactating patients were excluded; (7) informed consent from the patient or his/her parents was required. The parasitologic diagnosis was carried out by a slit smear technique followed by a Giemsa stain for parasite identification. Terbinafine was given in two different doses to two groups sorted according to age. The groups were as follows: Group 1, 5-15 years, 125 mg orally twice daily for 4 weeks: Group 2, > 15 years, 250 mg orally twice daily for 4 weeks. Laboratory blood investigations including complete blood count, creatinine, urea, and liver function tests were carried out initially and at 2 weeks and 4 weeks. Clinical response was evaluated by assessing the per cent of improvement of erythema, induration, and ulceration at 2 weeks and at 4 weeks after admission. The final assessment was reported at 4 weeks: complete cure, 100% improvement with no relapse; partial cure, > or = 60% improvement; failure, < 60% improvement. Overall clinical response included patients with both complete and partial cure. Follow-up for patients with complete cure was carried out monthly for 6 months to assess the relapse rate. Patients with partial cure or failure were switched to sodium stibogluconate intralesionally.

Background. Various therapeutic modalities have been used for treating cutaneous leishmaniasis. Intralesional pentavalent antimonial injection is one of the effective therapeutic modalities. In this study, the efficacy of three different intralesional schedules with sodium stibogluconate have been investigated. Methods. Ninety-six patients with 129 lesions were entered into the study, all with confirmed diagnosis of cutaneous leishmaniasis. The lesions were treated with three different schedules, including daily, alternate day, and weekly interlesional injections of sodium stibogluconate. The clinical response was then compared to arrive at the most effective schedule. Results. The clinical responses (complete and partial cure) were 67%, 97%, and 91% for the daily, alternate-day, and weekly schedules, respectively. Lesions with either partial cure or failure of treatment were injected weekly with the same medication until complete cure had been achieved. The final overall success rate of complete cure was 99.2%. Conclusions. Alternate day or weekly intralesional treatment of cutaneous leishmaniasis with sodium stibogluconate are more effective than daily treatments.

Background. The clinical diagnosis of cutaneous leishmaniasis is confirmed by demonstrating the organism on a superficial smear or on a biopsy of the lesion. Misdiagnosis in a biopsy specimen may be due to scanty Leishmania organisms that may not be identified in histologic sections. Methods. Punch biopsies of skin lesions, suspected clinically to be cutaneous leishmaniasis, from 29 patients were taken. Touch smears on slides were air-dried, fixed with methyl alcohol, and stained with Giemsa stain. Results of routine histologic examination were then compared with those of touch preparation. Results. Twenty-one cases were positive for leishmaniasis. In 18 cases, the organisms were seen both in the biopsy and in the touch preparation. In three cases, the organisms were only identified on touch preparation. Conclusions. A touch preparation improves the sensitivity of the diagnosis of cutaneous leishmaniasis without incurring additional cost to the laboratory.

Background. Adolescence is characterized by a sensitivity to issues of attractiveness. With dermatologic conditions, this may adversely affect early detection and compliance. Methods. A cross-sectional study was carried out on a multistage stratified random sample of 647 adolescent schoolboys in Abha, Saudi Arabia, to determine the prevalence of skin diseases. The age of the boys ranged from 11 to 19 years with an average of 15.3 ± 1.9 years. Results. It was found that 19.8% of the children were affected by one form or another of transmissible skin diseases (TSD). The most common types were: pediculosis capitis (9.6%), verruca vulgaris (3.9%), and tinea pedis (1.9%). The prevalence of TSD increased significantly as the age decreased and as the crowding index increased. As for nontransmissible skin diseases, acne vulgaris was the most prevalent disease (56.3%). The prevalence and severity of acne increased significantly as the age increased. Conclusions. The findings indicate the need to develop regional intervention programs at the school level. Appropriate continuing medical education programs for school health workers in the region are mandatory to achieve this goal.