Saudi Man Research Articles

A novel candidate hepatitis C virus genotype 4 subtype identified by next generation sequencing full-genome characterization in a patient from Saudi Arabia.

Hepatitis C virus (HCV) infection is a major global public health concern, being a leading cause of chronic liver diseases such as chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The virus is classified into 8 genotypes and 93 subtypes, each displaying distinct geographic distributions. Genotype 4 is the most predominant in the Middle East and Eastern Mediterranean and is associated with high rates of hepatitis C infection worldwide. This study used next-generation sequencing to fully characterize the HCV genome and identify a novel subtype within genotype 4 isolated from a 64-year-old Saudi man diagnosed with hepatitis C. We analyzed the complete genome of the 141-HCV isolate using whole-genome sequencing. Our phylogenetic reconstructions, based on the entire genome of HCV-4 strains, revealed that the 141-HCV isolate formed a distinct group within the genotype 4 classification, providing valuable new insights into the variability of HCV. This discovery of a previously unclassified HCV subtype within genotype 4 sheds light on the ongoing evolution and diversity of the virus. Such knowledge has significant implications for diagnostic and therapeutic approaches, as different subtypes may exhibit varying drug sensitivities and resistance profiles.

Unusual presentation and outcomes of bilateral brain abscess in adult: a case report

Background: Brain abscesses are rare but serious infections caused by bacteria or fungi in the brain tissue. They can cause serious problems if not treated quickly, so it is important to find the problem and treat it as soon as possible. Case Presentation: A 46-year-old Saudi male heavy smoker presented to the emergency department with a 3-day history of dry cough, sore throat, subjective fever, malaise, and generalized body pain. Three pneumonia hospitalizations and a bronchoscopy confused the patient upon admission. The patient had a Glasgow Coma Scale of 14/15 and a mild right pronator drift. Brain imaging showed bilateral frontal intra-axial space-occupying lesions. Escherichia coli and Staphylococcus aureus, sensitive to amoxicillin and clavulanic acid, grew together in culture. At 1-month follow-up, the patient had fully recovered. Peripheral enhancement reduced abscess cavity size on a repeat computed tomography-brain. The patient showed no neurological deficits at his 3- and 6-month clinic visits. Long-term antibiotics were recommended for 6 months. Conclusion: A 46-year-old Saudi man with bilateral brain abscesses shows the importance of early diagnosis and treatment. Imaging and culture results helped diagnose and treat. Aspirating the cystic lesions and the patient's recovery prove the treatment's efficacy.

CASE REPORT OF AN EPITHELIOID VARIANT OF KAPOSI SARCOMA: A RARE MIMIC OF ANGIOSARCOMA

Cutaneous Kaposi sarcoma (KS) is a vascular neoplasm with a broad spectrumclinicopathology. An epithelioid morphology, a rare recent variant of KS, with many variants of KS that may mimic other vascular neoplasms poses a diagnostic challenge. We report on a 75-year-old Saudi man HIV- negative who had been diagnosed with classical KS on the right foot 8 years before the present episode. Histopathological findings of the new lesion included areas showing epithelioid cells with moderate pleomorphism, growing in solid sheets. The epithelioid cells show nuclear enlargement and hyperchromasia mimicking angiosarcoma. Immunohistochemistry shows a strong diffuse nuclear staining pattern for HHV-8 latent nuclear antigen-1 (LNA-1) in the epithelioid as well as the classical spindle cells. A diagnosis of epithelioid Kaposi sarcoma is made, which should be included within the known histological variants of KS. Prior to this case, the epithelioid variant of Kaposi sarcoma has been reported only three times in the literature. Since this variant shares similar clinical and histological features with angiosarcoma, integration of clinical findings and context, histopathologic features and immunohistochemical results is critical in obtaining the correct diagnosis and treatment.

Painless Left Scrotal Mass: A Rare Case of Paratesticular Angiofibroma

Angiofibromas, also known as angiomyofibroblastoma-like tumors or AMF-like tumors, refer to a collection of rare, benign yet highly cellular tumors of the vulva, scrotum, perineum, or inguinal region. In this paper, we present a 34-year-old Saudi man who presented with findings of a testicular tumor on physical examination and imaging and tested negative for all the markers associated with testicular tumors.

Spotted fever rickettsioses should be considered in the differential diagnosis of “Fever with Purpuric Rash” in Saudi Arabia: A Case report

There is a paucity of literature about human spotted fever rickettsioses (SFR) from the Arab Gulf Region, including Saudi Arabia. Here, we present an elderly Saudi man who had fever, headache, purpuric maculopapular skin rash, and an eschar. Together, the clinical findings, the serologic positivity, the presence of a vector tick in addition to the histopathologic changes, and the dramatic clinical response to oral doxycycline confirmed the diagnosis of SFR. This may be the first case of SFR reported to the health-care authorities in Saudi Arabia. We recommend considering SFR in the differential diagnosis of “fever with purpuric rash” in Saudi Arabia. Ideally, treatment with a tetracycline antibiotic should be considered for patients with fever and headache even before a purpuric rash develops.

Acquired right-sided diaphragmatic hernia in a patient with retroperitoneal hydatidosis: a\xa0case report and review of the\xa0literature

BackgroundDiaphragmatic hernia is primarily congenital in origin and has potentially devastating pulmonary complications. Acquired diaphragmatic hernia as a complication of hydatid disease remains a rare clinical entity. Retroperitoneal hydatidosis, in particular is an exceptionally rare cause behind a similar presentation. This paper aims to present the first case of acquired diaphragmatic hernia likely caused by eroding retroperitoneal hydatid cysts and provide a succinct literature review regarding the causative association between hydatid disease and diaphragmatic defects.Case presentationA 71-year-old Saudi man, with a history of hydatid disease involving several areas including the retroperitoneum, presented with multiple episodes of shortness of breath and abdominal pain of 10 months’ duration. Computed tomography scans of the chest and abdomen demonstrated the presence of a large diaphragmatic defect, with herniation of bowel loops into the chest cavity. Initially, the patient underwent a diagnostic laparoscopy which was then converted to a posterolateral thoracotomy to repair the defect.ConclusionsThe ability of hydatid disease to involve several body organs makes diagnosis and management of resultant complications a challenge in some cases, like ours. Knowledge about a reported rare complication could enable early detection and management to avoid serious complications, including abdominal viscera incarceration and strangulation.

Allergic reaction with angioedema after exposure to e-cigarette liquid: a case report

Background: The use of electronic cigarettes (e-cigarettes) is increasing worldwide. Allergic reactions have been reported from the metal used, and a few cases have been reported of angioedema of the lip, but none were related to the e-cigarette liquid. Case Presentation: We report a case of allergic reaction with angioedema from e-cigarette liquid, most likely histamine-mediated angioedema, in a healthy 24-year-old Saudi man, who did not have a history of any allergy or atopy. The subject presented complaining of left lower lip swelling 1 hour after smoking an e-cigarette and spilling liquid into the mouth. The case reported no shortness of breath, skin rash, or tongue swelling. On examination, vital signs were normal. The patient had left lower lip swelling and gingival erythema. The patient reported having experienced a similar episode in the past with a different type of e-cigarette liquid on the right lower lip, but it was less severe. The patient was diagnosed with allergic reaction with angioedema from the e-cigarette liquid and was managed with hydrocortisone 200 mg Intravenous and chlorphenamine 10 mg Intramuscular, and was discharged after 3 hours with full recovery. Conclusion: E-cigarettes are still relatively new and could cause harm. Further studies and reports should be conducted concerning the health effects of e-cigarettes.

Unusual and incredible weight loss after intragastric balloon: A case report

ABSTRACT The intragastric balloon system is a minimally invasive weight loss measure for people with obesity. Intra Gastric balloons oblige the patient to eat less food, by occupying space in the stomach, creating a feeling of constant satiety. We report a rare case of a 19-year-old Saudi man who presented with morbid obesity. At the time of presentation, the patients weight was 143 kg and BMI 49.48 kg/m2 intragastric balloon insertion done using 6 months END BALL intragastric balloon system at Almana Tertiary Referral Hospital, Dammam, Saudi Arabia. surprisingly, and after 10 months duration of gastric balloon procedure, the patient incredibly lost about 77 kg and his weight become 66 kg and BMI 22.83 kg/m2 and this considered an unusual weight loss after intragastric balloon not previously reported worldwide as loss of about 7% to 15% of body weight is typical during the 6 months after intragastric balloon placement however, in our case the patient lost 53.84% of body weight.

Using cyproterone acetate to treat recurrent ischemic priapism in a\xa0patient with sickle cell anemia as a\xa0comorbidity: a case report

IntroductionThe management of recurrent ischemic priapism is unclear in contemporary practice. Yet, if left untreated, the condition may evolve into an acute ischemic priapism and in some cases result in erectile dysfunction. This report documents the results of successful management of recurrent ischemic priapism using cyproterone acetate in a 30-year-old Saudi man with sickle cell anemia as a comorbidity.Case presentationA 30-year-old Saudi man denoted visited the emergency room with a painful erection which had lasted for more than four hours. The patient has sickle cell anemia and a family history of sickle cell disease. He is married and has two children. His first priapism case occurred when he was 7 years old. At the age of 15, the condition recurred, and the patient’s doctor prescribed cyproterone acetate 50 mg twice daily for 5 days. The doctor had told him that whenever he was experiencing priapism, he should adhere to this regimen for 5 days. The doctor could not find any guidelines for the prescription of cyproterone acetate.ConclusionPriapism cases represent a significant challenge in therapeutic management because of the elevated risk of structural damage to the penis. The fact that there lacks a clinically approved standard approach to managing the condition make it difficult for physicians to effectively manage the condition. Management of the condition is further complicated by existence of comorbidities such as sickle cell anemia. This patient’s case demonstrates that cyproterone acetate prescription is a great preventative strategy that limits priapism recurrences.

Venetoclax in combination with carfilzomib and dexamethasone in relapsed/refractory multiple myeloma harboring t(11,14)(q13;q32): two case reports\xa0and a\xa0review of the literature

BackgroundMultiple myeloma has witnessed significant advances due to the approval of many novel agents. However, in spite of all these new developments, multiple myeloma remains an incurable disease with inevitable relapse in the majority of patients. Venetoclax is a selective antiapoptotic protein B-cell lymphoma 2 inhibitor that induces cell death in multiple myeloma cells, particularly in those harboring t(11,14)(q13;q32). We report two cases of patients with multiple myeloma with t(11,14)(q13;q32) who were treated with venetoclax/carfilzomib/dexamethasone with rapid initial response; however, the response was short-lived.Cases presentationPatient 1 was a 50-year-old Saudi man with International Staging System stage III kappa light chain multiple myeloma with normal karyotype diagnosed in May 2013. He received bortezomib/thalidomide/dexamethasone treatment and underwent autologous hematopoietic stem cell transplant. Three years later, he presented with disease progression and received multiple lines of chemotherapy, including carfilzomib/lenalidomide/dexamethasone. Venetoclax/carfilzomib/dexamethasone was started after acquiring t(11,14)(q13;q32) 5 years into his disease course. He achieved complete remission, with disease progression after cycle 6. Patient 2 was a 48-year-old Saudi man with International Staging System stage III immunoglobulin G kappa multiple myeloma with t(11,14)(q13;q32) diagnosed in May 2017. He received bortezomib/thalidomide/dexamethasone treatment and underwent autologous hematopoietic stem cell transplant. Eighteen months later, he had disease progression, and he received multiple lines of chemotherapy, including carfilzomib/dexamethasone. He was shifted to venetoclax/carfilzomib/dexamethasone in April 2019 and had an initial clinical response; two months later, he progressed to plasma cell leukemia with rapid deterioration to multiorgan failure.ConclusionsAcquired t(11;14)(q13;q32) is unreported in the multiple myeloma literature. In the era of targeted therapy, it is essential to repeat the cytogenetic and multiple myeloma fluorescence in situ hybridization panel with each disease progression. Multiple myeloma remains a challenging hematological malignancy despite advances in personalized/precision medicine.

The Role of Saudi Literature in Cultural Development Taking Ghazi Al Qusaibi as an Example

The research aims at studying the literary efforts of Al Qusaibi within the cultural development which he earnestly sought as he believed in the necessity of building man in the society to be a productive doer، to present a successful experience for students and the forthcoming generations to help them face reality. The importance of the research is indicated by shedding light on the literature of a Saudi man of letters who created a perception of cultural development and its impact on social building and changing its paths to the best. Through his multi intellectual participations، he attempted to awaken man’s conscience and urge the society to interact with culture with its social concept. From this research، we might have concluded some theoretical researches which were far from reality and society as we want to present a development view coated with a literary garment. Through the basic question of research: How did the literature of Al Qaisibi whether in the development process in general and in the cultural development in particular? We shall try to answer through studying examples of his poetry and prose taking his novel "Al Asfouria" as a model.

Coexistence of chronic myeloid leukemia and diffuse large B-cell lymphoma with antecedent chronic lymphocytic leukemia: a case report and review of the literature

BackgroundChronic lymphocytic leukemia and chronic myeloid leukemia are the most common types of adult leukemia. However, it is rare for the same patient to suffer from both. Richter’s transformation to diffuse large B-cell lymphoma is frequently observed in chronic lymphocytic leukemia. Purine analog therapy and the presence of trisomy 12, and CCND1 gene rearrangement have been linked to increased risk of Richter’s transformation. The coexistence of chronic myeloid leukemia and diffuse large B-cell lymphoma in the same patient is extremely rare, with only nine reported cases. Here, we describe the first reported case of concurrent chronic myeloid leukemia and diffuse large B-cell lymphoma in a background of chronic lymphocytic leukemia.Case presentationA 60-year-old Saudi man known to have diabetes, hypertension, and chronic active hepatitis B was diagnosed as having Rai stage II chronic lymphocytic leukemia, with trisomy 12 and rearrangement of the CCND1 gene in December 2012. He required no therapy until January 2016 when he developed significant anemia, thrombocytopenia, and constitutional symptoms. He received six cycles of fludarabine, cyclophosphamide, and rituximab, after which he achieved complete remission.One month later, he presented with progressive leukocytosis (mostly neutrophilia) and splenomegaly. Fluorescence in situ hybridization from bone marrow aspirate was positive for translocation (9;22) and reverse transcription polymerase chain reaction detected BCR-ABL fusion gene consistent with chronic myeloid leukemia. He had no morphologic or immunophenotypic evidence of chronic lymphocytic leukemia at the time. Imatinib, a first-line tyrosine kinase inhibitor, was started. Eight months later, a screening imaging revealed new liver lesions, which were confirmed to be diffuse large B-cell lymphoma.ConclusionsIn chronic lymphocytic leukemia, progressive leukocytosis and splenomegaly caused by emerging chronic myeloid leukemia can be easily overlooked. It is unlikely that chronic myeloid leukemia arose as a result of clonal evolution secondary to fludarabine treatment given the very short interval after receiving fludarabine. It is also unlikely that imatinib contributed to the development of diffuse large B-cell lymphoma; rather, diffuse large B-cell lymphoma arose as a result of Richter’s transformation. Fludarabine, trisomy 12, and CCND1 gene rearrangement might have increased the risk of Richter’s transformation in this patient.

Hepatotoxicity Associated with Carvedilol

Objective: The serum transaminases document is severe elevated in a patient who was receiving Carvedilol. Case Summary: A 65-year-old Saudi man admitted to hospital with acute heart failure (EF 15%), acute liver failure and acute kidney injury. He was admitted to CCU and started treatment. Within one week the kidney and the liver function improved. After that the doctor changed Bisoprolol to Carvedilol for one day only, the laboratory tests showed elevated serum transaminases. So, discontinued Carvedilol immediately and restart bisoprolol the liver function returned to the normal within four weeks. Conclusion: Carvedilol may cause liver enzymes elevated in liver impairment patient. This reaction resolves if the patient is switched to another beta- blocker. Carvedilol is contraindication in sever hepatic impairment.

Hepatotoxicity Associated with Carvedilol

Objective: The serum transaminases document is severe elevated in a patient who was receiving Carvedilol. Case Summary: A 65-year-old Saudi man admitted to hospital with acute heart failure (EF 15%), acute liver failure and acute kidney injury. He was admitted to CCU and started treatment. Within one week the kidney and the liver function improved. After that the doctor changed Bisoprolol to Carvedilol for one day only, the laboratory tests showed elevated serum transaminases. So, discontinued Carvedilol immediately and restart bisoprolol the liver function returned to the normal within four weeks. Conclusion: Carvedilol may cause liver enzymes elevated in liver impairment patient. This reaction resolves if the patient is switched to another beta- blocker. Carvedilol is contraindication in sever hepatic impairment.

Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy: a case report

BackgroundProliferative diabetic retinopathy is a major cause of visual impairment in working-age adults worldwide. Panretinal photocoagulation is a cornerstone in its management; however, it may include a range of side effects and complications, one of these being serous retinal detachment. To the best of our knowledge, this is the first report of the use of intravitreal injection of bevacizumab for serous retinal detachment after panretinal photocoagulation.Case presentationA 24-year-old Saudi man with poorly controlled type 1 diabetes presented with bilateral progressive proliferative retinopathy in spite of several sessions of panretinal photocoagulation. After one additional such session, he developed bilateral serous retinal detachment and vision loss, which was managed with a single bilateral intravitreal bevacizumab injection. The serous retinal detachment subsided with partial recovery of vision.ConclusionsSerous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy is a rare complication nowadays. In this case, it seems that excessive photocoagulation exceeded the energy-absorbing capacity of the retinal pigment epithelium, leading to a disruption of the blood–retinal barrier. A single injection of bilateral intravitreal bevacizumab was sufficient to control the serous retinal detachment. This effect may have been due to a reduction of vascular leakage resulting from the mechanism of action of this drug. No complications were noted from the injection. Caution should be exerted when attempting bilateral panretinal photocoagulation.

Tuberculosis presenting as broncho-oesophageal fistula in a young healthy man

A 21-year-old Saudi man presented with a history of dysphagia and choking. CT scan of the chest showed clear evidence of chronic recurrent aspiration pneumonia in the left lung. It...

Thyrotoxic periodic paralysis as an initial presentation of Graves’ disease in a Saudi patient

Thyrotoxic periodic paralysis (TPP) is a well-known complication of hyperthyroidism, characterised by recurrent flaccid paralysis with hypokalaemia. To date, only five cases of this rare disorder have been reported in...

Wegener’s Granulomatosis in A Saudi Patient Presenting As Refractory Chronic Rhinosinusitis Following Septoplasty and Fess – A Case Report

This is a case report of a 45 year old Saudi man who presented in Northwest Armed Forces Hospital, Tabuk, Saudi Arabia with unresolving rhinosinusitis and septal perforation following FESS and Septoplasty. He later on developed pulmonary and renal problems and was at last diagnosed as having Wegener’s granulomatosis. He was put on standard treatment that resulted in remission. The purpose of this article is to highlight the fact that Wegener’s granulomatosis should be suspected if we come across a patient with chronic sinusitis refractory to treatment especially if patient develops septal perforation. A brief review of literature is also presented.

A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System.

Introduction. Illness anxiety disorder (IAD) entails a preoccupation with having a serious, undiagnosed illness in which somatic symptoms are, if present, mild in intensity (American Psychiatric Association, 2013). Case Report. This is a case of seventy-three-year-old Saudi man who started visiting the primary health care center around twenty-five years ago. With concerns of having cancer, the patient continuously visited the hospital, costing over $170,000. Throughout this period, the patient has been exposed to extensive unnecessary imaging studies and laboratory tests that have effects on his life in all aspects with such concerns. Five years ago, a family doctor has put an end to that by directing the patient to the right path. The doctor made several actions; most importantly, he directed the patient to a cognitive behavioral therapy which significantly improved a range of hypochondriacal beliefs and attitudes. This patient's case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting the medical resources. Moreover, this case emphasizes the important role of the family physician who can be the first physician to encounter such patients. Thus, proper understanding of the nature of such disorder is a key element for better diagnosis and management.

Crossing the Red Line: Public Intimacy and National Reputation in Saudi Arabia

In July 2009, the Lebanese Broadcasting Corporation (LBC) aired via satellite an episode of the talkshow Bold Red Line titled “Sexual Pleasure,” in which a Saudi man bragged about his sexual exploits. A wave of protest broke out in Saudi Arabia clamoring for the punishment of the man who would heretofore be known as the “LBC sex braggart.” Saudi authorities brought suit against him and prosecuted two Saudi women who worked for LBC. Drawing on a rich corpus of primary, Arabic-language source—119 articles, most from Saudi newspapers—this article uses the Bold Red Line controversy and Lauren Berlant's work on the “intimate public sphere” to analyze the articulation of patriarchy and nationalism in Saudi public discourse. The controversy, we conclude, reflects how the redefinition of political-economic issues in moral terms depends on an intentional re-articulation of the private-public nexus.