Nature and Medicine

The prevalence of allergic rhinitis and its complications: A survey from Al-Ahssa, Saudi Arabia Noor Nabil Albaloushi, Khalid Alyahya Journal of Nature and Science of Medicine 2019 2(2):57-60 Objectives: Allergic rhinitis (AR) is an inflammatory disorder induced by immunoglobulin E-mediated response after allergen exposure. It is the most common allergic disorder with a high burden on patients and society. The purpose of this study is to report the prevalence and severity of AR and its complications among the population of Al-Ahssa in the Eastern Province of Saudi Arabia. Materials and Methods: This study analyzed observational, descriptive, cross-sectional data. Our sample includes males and females from all age groups from Al-Ahssa, Saudi Arabia, in October 2017. Our sample size was 807 with a confidence level of 95% and a confidence interval of 3.45. Results: The study suggested that 48% of the samples were diagnosed with AR, 28% had symptoms suggestive of AR, and 24% did not have any symptoms. Results suggest a great association between AR, eczema, and asthma. About 53% of patients who live near a farm were diagnosed with AR and 28% of them had symptoms. This indicates an association between living near a farm and AR. In addition, there was a clear relationship between owning a pet and AR. In 44% of cases, recurrence occurred in winter. Eighty-one percent of patients either with AR or who have symptoms of AR are triggered when exposed to a certain stimulus. Sixty-four percent reported that symptoms are provoked by dust. The most common symptoms reported were nasal itching followed by sneezing. Fifty-seven percent of patients who have AR or symptoms of AR have severe disease. Seventy-five percent of them complain of sleep disturbance. Twenty-seven percent of patients reported 0 effect on life, 14% scored 5, and 14% scored 10 on the daily activity scale. Conclusion: We concluded that 76% of the samples were either diagnosed with AR or have symptoms suggestive of AR. These symptoms are mainly triggered by dust and are associated with living near farms.

Recent insight into the prevalence, etiology, and outcome of epistaxis in a university hospital in Saudi Arabia Sami E Alharethy Journal of Nature and Science of Medicine 2019 2(2):61-63 Objectives: The objective of the study is to study the prevalence, pattern, etiology, and outcome of epistaxis in a tertiary university hospital. Methods: A retrospective study conducted at King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia, from January 2014 to January 2017. Patients' demographics, causes of bleeding, and management techniques were recorded. This study was approved by the Institutional Review Board at King Saud University. Results: A total of 1126 patients had an epistaxis prevalence rate of 0.98% of all emergency visits. There were 462 males (41.0%) and 664 females (59.0%). The mean age was 39.1 years (from 6 to 74 years). The highest number of patients with epistaxis was 340 (30.2%) in age group of 41–50 years. The mean height was 144.6 cm and the mean weight was 56 kg. The most common cause of epistaxis was idiopathic in 353 (31.3%) patients. A total of 510 (45.3%) patients had an anterior bleeding site, while 152 (13.5%) had bilateral bleeding. The diagnosis was reached both endoscopic and clinical. The majority were treated with a nonsurgical method; anterior packing was successful in 840 (74.6%) patients and chemical and electric cautery in 80 (7.1%) patients. There was a history of recurrent epistaxis in 46 children (4.1%). No mortality occurred during the study period. Conclusion: Epistaxis is common in Saudi Arabia. The age group of 41–50 years is more prone to epistaxis with a prevalence of 30.2%. Exposure to dry, hot weather, idiopathic, and hypertension are the frequent causes. Packing and cauterization successfully treated epistaxis in most cases, and there were no cases with mortality.

Relationship between parasitic infection of Toxoplasma gondii, IL-2, TNF-α tryptophan and CD4+ count Mathew Folaranmi Olaniyan, Temitayo Afolabi, Nwachi Ogbona Idume Journal of Nature and Science of Medicine 2019 2(2):64-68 Study Background: Toxoplasma gondii a protozoan and zoonotic infection can stimulate innate and adaptive immune responses. Aims and Objectives: This work was designed to determine relationship between parasitic infection of T. gondii, interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α), and Tryptophan and CD4+ count. Materials and Methods: A total of 150 individuals aged 21–73 years (male: 100 and female: 50) were recruited from Saki-West, Saki-East, and ATISBO local governments of Nigeria. Plasma TNF-α, IL-2, Tryptophan, anti-hepatitis C virus (anti-HCV), hepatitis B surface antigen (HBsAg), anti-HIV, Plasmodium, and T. gondii infections were determined in each of the subjects. The results were used to group the subjects into: Control (n = 104; individuals not infected with T. gondii noninfected, Plasmodium spp., HIV or HCV); T. gondii mono-infected patients (n = 9) and patients with T. gondii co-infection with Plasmodium spp., HIV, HBV, or HCV. Plasma TNF-α, IL-2, anti-HCV, HBsAg, and anti-HIV were determined by enzyme-Linked Immunosorbent Assay. Plasmodium spp., was identified by thick blood film-Giemsa staining technique. Plasma tryptophan was determined by fluorometry. Results: Of 150 subjects recruited for the work, the results obtained showed a frequency of occurrence of 69.3% (104) T. gondii noninfected control not infected with Plasmodium spp., HIV, HBV, and HCV; 8.0% (9) T. gondii-infected patients not infected with Plasmodium spp., HIV and HCV; 22% (33) were infected with at least one of the Plasmodium spp., HIV, HBV, and HCV; 2.7% (4) T. gondii patients co-infected with at least one of the Plasmodium spp., HIV, HBV, and HCV. There was a significant decrease in plasma tryptophan in T. gondii mono- and co-infection including T. gondii noninfected individuals but infected with at least Plasmodium spp., HIV, HBV, and HCV compared with the control [P < 0.05]. There was a significant decrease in CD4 count in T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV and T. gondii co-infection compared with T. gondii mono-infection; controls and also in T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to T. gondii confection (P < 0.05). There was a significant increase in plasma TNF-α in T. gondii mono-infected patients compared with the controls; T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to controls; T. gondii confection compared to controls; T. gondii mono-infected patients compared to T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV; T. gondii mono-infected patients compared to T. gondii co-infection and T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to T. gondii confection (P < 0.05). Conclusion: T. gondii and its coinfection with HIV, HCV, and HBV caused a significant immunological alterations in the plasma values of IL-2, TNF-α, Tryptophan, and blood CD4+ count.

Clustered regularly interspaced short palindromic repeats-Cas9 gene therapy: The top 50 most-cited papers Jude Howaidi, Ali Howaidi, Faisal Howaidi Journal of Nature and Science of Medicine 2019 2(2):69-76 Background: Clustered regularly interspaced short palindromic repeats/Cas9 (CRISPR/Cas9) is a gene-editing technique that creates advancement in biomedical technology. It is a form of gene alteration method that was investigated and examined from Streptococcus pyogenes dependable on Cas9 nuclease enzyme through microbiological and genetic examination. This system consists of a nucleic acid, RNA, specifically guide RNA (gRNA), and a nuclease enzyme, Cas9. The potential implications of CRISPR/Cas9 include cancer, cystic fibrosis, familial hypercholesterolemia, and Duchenne's muscular dystrophy. Objective: The objective was to show the most impactful publications through a bibliometric analysis of the top 50 most-cited papers regarding the topic of CRISPR/Cas9 gene-editing tool. Methods: The most-cited research articles relative to CRISPR Cas9 were collected using Scopus. The order of the most-cited papers was conducted by categorizing the studies in an ordinal manner from the most-cited to the least-cited studies. The studies were stratified by selecting the top 50 most-cited papers with the title “CRISPR Cas9.” Results: A number of 2230 research papers regarding CRISPR Cas9 were retrieved. 42% of the papers from the top 50 most-cited papers were published in 2014. The total citation count for each of the top 50 studies ranged from 183 to 1824, and the mean number of citations was 420. The first five articles were cited more than 1000 times and the remaining articles were cited more than 100 times. The journal “Nature” has published the most studies relevant to CRISPR Cas9 with a total of 23 studies, Cell with 8 studies, followed by Science and Nucleic Acids with 4 studies published and Genetics with 2 and the remaining journals with one publication each. Conclusion: It is clear that the future of CRISPR Cas9 is promising as demonstrated by the highly impactful studies in the topic with high citation counts in a relatively short period of time after publication.

Pulmonary manifestations and radiographic findings in granulomatosis with polyangiitis patients in a university teaching hospital in Saudi Arabia Abdurhman Saud Al Arfaj, Najma Khalil, Sultan M Al Mogairen, Hussain Al Arfaj, Abdulaziz Al Khalaf, Mohammad Al Bedaiwi Journal of Nature and Science of Medicine 2019 2(2):77-80 Objectives: Granulomatosis with polyangiitis (GPA) affects respiratory system very often. In this report, we document the pulmonary manifestations and computed tomography (CT) findings in GPA patients. Subjects and Methods: We conducted retrospective study of GPA patients followed up at King Khalid University hospital, King Saud University, Riyadh, during the period 1990–2014. Various disease manifestations, X-ray and CT findings, therapy, and outcome in GPA patients with pulmonary involvement were retrieved. Results: Among 23 cases of GPA, 14 were males and 9 were females. Mean age at onset of disease was 42.1 ± 14.5 (range: 11–63) years. Respiratory tract was the most frequently involved system (82.6%); upper airways were affected in 56.5% and lungs in 65.2% patients. Among 19 patients with respiratory system involvement antineutrophil cytoplasmic antibody (ANCA) was positive in 18 (94.7%) patients; c-ANCA was positive in 15 (78.9%) and p-ANCA was positive in 3 (15.8%) patients. Chest CT findings in 15 patients showed that lung nodules were the most frequent pathologies, seen in 12 (80.0%) patients, and were cavitated in 8 (53.3%) patients. Airspace opacification was seen in 73.3%, air bronchogram in 20.0%, and ground-glass opacities in 33.3%. CT results at follow-up showed resolution of lung nodules in 9 (60.0%) patients. Lung biopsies showed chronic granulomatous inflammation with vasculitis and necrosis. Intravenous cyclophosphamide was received by 63.2% patients and 10.5% required rituximab therapy along with other drugs. Conclusion: Respiratory system involvement in our GPA patients was similar to previous reports but with variation in certain parameters. Disease outcome was good, and lung CT at follow-up showed resolution of nodules with treatment.

The association between smartphone addiction and dry eye disease: A cross-sectional study Ayman Mohammed Baabdullah, Abdulmalik Ghassan Abumohssin, Yara Aedh Alqahtani, Ismail Ahmed Nemri, Dania Abdulelah Sabbahi, Nizar Mohammed Alhibshi Journal of Nature and Science of Medicine 2019 2(2):81-85 Background: The use of smartphones has increased exponentially. Excessive usage of smartphones has been shown to have a negative impact on ocular health. This study aimed to evaluate the relationship between smartphone addiction and dry eye disease (DED) and determine the risk factors of DED in participants associated with smartphone addiction. Materials and Methods: This cross-sectional study was conducted in May 2017. Participants were selected from the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia. Stratified random sampling technique was used to recruit participants according to their academic year with an equal allocation of males and females. Only participants owning smartphones were included in the study. DED was assessed using the ocular surface disease index (OSDI) questionnaire and a short-version of the smartphone addiction scale (SAS-SV) was used to assess smartphone addiction among the participants. Data were analyzed using Pearson's Chi-squared test and binary logistic regression. Results: A total of 443 completed questionnaires were received, providing a response rate of 94%. Almost half of the participants were found to have DED (49.4%). There was no significant association between smartphone addiction and DED (P = 0.102). However, significant associations were observed between DED and contact lens use, eye drops, eye disease, and Vitamin A therapy (P < 0.05). Conclusion: Contrary to what was locally reported, DED had a lower prevalence. Despite no significant correlation with smartphone addiction, DED was found to be associated with the use of contact lenses, Vitamin A therapy, and eye drops. Several risk factors and clinical predictors of DED might exist, which highlight the importance of performing a complete clinical ophthalmological assessment.

Clinical profile of Saudi patients with multiple myeloma Alanoud Abdulaziz Alhuqayl, Zahid Shakoor, Adel Almogren, Rim Sghiri, Rana Hasanato, Rawan Abdulaziz Albadia Journal of Nature and Science of Medicine 2019 2(2):86-89 Background: Multiple myeloma (MM) is a neoplasm of plasma cells. Ethnic variations among the clinical features of MM have been reported. Objectives: This study was performed to assess the clinical features of Saudi MM patients. Patients and Methods: Data were collected retrospectively from the medical records of patients between November 2014 and September 2017 at King Khalid University Hospital, Riyadh, Saudi Arabia. During the study period, MM was diagnosed among 36 patients (mean age: 65.2 ± 11.2 years) comprising of 19 females and 17 males of Saudi nationality. Results: Out of the 19 female patients, 15 (78.9%) had κ chain restriction, whereas among the 17 male MM patients, 14 (82.3%) had λ light-chain restricted disease. All the patients (100%) had anemia (median 93 g/L; interquartile range [IQR] 22.5), 35/36 (97.2%) patients had increased red cell distribution width (RDW) (median 18.3%; IQR 4.5), 34/36 (94.4%) patients had increased monocyte percentage (median 13.7%; IQR 3.4), and 34/36 (94.4%) patients had diabetes mellitus. Conclusion: Gender preferences for κ and λ light chain among MM patients and the association of increased RDW with MM require validation in large-scale studies.

The overall survival rate for patients with hepatocellular carcinoma who underwent hepatic resection or radiofrequency ablation procedure for curative intent Aisha K Al-Raddadi, Mohammed A Jameel, Alaa A Al-Zulfi, Waleed K Al-Shammari, Weam S Hussein, Ester A Robles, Faisal Al-Saif, Faisal Al-Alem, Abdulsalam Al-Sharabi, Ahmad Madkhali, Mazen Hassanain Journal of Nature and Science of Medicine 2019 2(2):90-94 Background: Hepatocellular carcinoma (HCC) is currently one of the leading causes of cancer-related deaths worldwide. According to the data obtained from the last Saudi Cancer Registry 2014, liver cancer represents 4.3% of all cancers diagnosed in Saudi Arabia. This study aimed to measure the overall outcome and “disease-free” survival rates of HCC patients who underwent either a liver resection or radiofrequency ablation (RFA) rehabilitation procedures in Riyadh, Saudi Arabia. Methods: A retrospective study was conducted in Riyadh, Saudi Arabia, examining 41 patients with HCC who underwent either liver resection or RFA with curative intent from 2011 to May 2016. The study took place in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, and utilized prospectively collected data. Among the patients who were studied, 7 patients underwent surgical resection and 34 patients underwent RFA. Patients' characteristics, overall survival (OS), and recurrence-free survival were analyzed. Results: Out of the 34 participants who underwent RFA, 17 (50%) experienced recurrence compared to only 3 (42.9%) participants who underwent liver resection. Seven (20.6%) patients who underwent RFA died out of a total of 34. However, only one patient (14.3%) from a total of seven who underwent liver resection died. Conclusion: When comparing the two treatment modalities, it was deemed that there was no significant difference in both recurrence and the OS in both groups.

Stress among staff nurses: A hospital-based study Nandita Kshetrimayum, Darshana Bennadi, Sibyl Siluvai Journal of Nature and Science of Medicine 2019 2(2):95-100 Background: Stress can be described as a dynamic and reciprocal relationship between the person and the environment. Nursing is an occupation with a constellation of circumstances leading to stress. Work-related stress (occupational stress) can be damaging to a person's physical as well as mental status, which directly and indirectly affecting their quality and productivity of work. Hence, an attempt has been made with an aim to assess stress-perceived stress among staff nurses in Mysore city, India. Methodology: The descriptive cross-sectional study was conducted among 500 staff nurses selected from eight hospitals in Mysore City, India, using multistage sampling technique. Study duration was 5-month period and response rate was 100%. A structured questionnaire was administered to assess stress using Perceived Stress Scale (PSS) and Expanded Nursing Stress Scale (ENSS). Results: A cross-sectional study consisted of 500 staff nurses. Majority of the participants (467 [93.4%]) had diploma and 454 (90.8%) nurses worked on day shift. Nearly 277 (55.4%) had a moderate level of perceived stress and 249 (49.8%) had moderate occupational stress. Significant positive correlation (r = 0.144, P < 0.001) between ENSS and PSS. Conclusion: A positive correlation was found between perceived stress and occupational stress among staff nurses of Mysore City. This shows that those with general stress also have occupational stress.

Anaphylaxis secondary to ingestion of pumpkin seeds in a child: A case report Sarah F Alsukait, Abdullah A Alangari Journal of Nature and Science of Medicine 2019 2(2):101-102