Isolation of filter passing bacteria from a range of dental clinic surfaces

Filter passing bacteria have been isolated from a variety of natural environments, appearing as a mixture of Gram-positive and Gram-negative, as well as nano-forms and wall-free species. In this study, filter passing bacteria were isolated from surfaces located in various dental departments at the College of Dentistry, King Saud University Hospital. Surface samples were obtained by using Q-tip swabs, with ten different surfaces being sampled in each clinic during pre-patient and post-patient visits. Filterable bacteria (using 0.4 and 0.2 micron filters, but not 0.1 micron filter) were isolated, being mainly Gram-positive cocci. Isolation results of filterable bacteria were compared before and after patient treatment in the clinic. More frequently, filter passing bacteria were isolated on clinic surfaces after patient treatment. The results show that dental settings are contaminated with filterable bacteria which may act as a reservoir for the wider contamination of hospital environments

Systematic review of the role of rituximab in treatment of antineutrophil cytoplasmic autoantibody-associated vasculitis, hepatitis C virus-related cryoglobulinemic vasculitis, Henoch–Schönlein purpura, ankylosing spondylitis, and Raynaud's phenomenon

Rbab Taha,1 Hadeel El-Haddad,1 Abdulqader Almuallim,2 Fatma Alshaiki,3 Elaf Obaid,2 Hani Almoallim1,2,4 1Department of Medicine, Dr Soliman Fakeeh Hospital, Jeddah, 2Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Mecca, 3Department of Medicine, East Jeddah Hospital, Jeddah, 4Rheumatic Diseases, Umm Al-Qura University, Mecca, Saudi Arabia Abstract: Rituximab (RTX) is established for the treatment of rheumatoid arthritis. This systematic review of the literature since 2006 summarizes evidence for the use of RTX in the treatment of additional rheumatological diseases: antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV), hepatitis C virus-related cryoglobulinemic vasculitis, Henoch–Schönlein purpura, ankylosing spondylitis, and Raynaud’s phenomenon. Data from randomized controlled trials are available only for AAV, confirming efficacy for remission induction, including in disease resistant to conventional treatment, and maintenance of remission. Further studies are required to confirm optimal maintenance regimens in AAV, important questions needing to be addressed including protocol administration versus treatment in response to clinical relapse and the importance of maintaining B-cell depletion. Sufficient data are available in other diseases to suggest RTX to be useful and that randomized controlled trials should be conducted. Keywords: anti-CD20 monoclonal antibody, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, refractory ankylosing spondylitis, resistant cryoglobulinemic vasculitis, refractory rheumatological diseases&nbsp

Achieving comprehensive remission or low disease activity in rheumatoid patients and its impact on workability – Saudi Rheumatoid Arthritis Registry

Hani Almoallim,1–3 Nahid Janoudi,2 Fahdah Alokaily,4 Zeyad Alzahrani,5 Shereen Algohary,3 Hanan Alosaimi,3,6 Suzan Attar3,7 1Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia; 2Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 3Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia; 4Division of Rheumatology, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 5Department of Medicine, Faculty of King Saud bin Abdulaziz for Health Sciences, Jeddah, Saudi Arabia; 6Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 7Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Purpose: Ability to work is an important endpoint in rheumatoid arthritis (RA). It is not clear what outcome measures should be used to guide treatment in order to maximize workability. This study addressed the impact of RA on workability in a Saudi population and examined the correlation between objective measures of disease activity and reduced workability. This will allow better understanding of treatment targets that will translate into improved workability. Patients and methods: Data were collected through a digital patient record keeper: The Rheumatoid Arthritis Saudi Database. Male and female patients, ≥18 years of age, that met the American College for Rheumatology criteria for diagnosis of RA, were recruited, regardless of treatment. Demographic and disease-specific data were collected. Disease Activity Score-28 (DAS-28) was used to define patients as low (DAS-28 ≤3.2) vs high (DAS-28 >3.2) disease activity. Health assessment questionnaire (HAQ) score, visual analog scale (VAS) score, and musculoskeletal ultrasound 7 joint score were documented also. The work productivity and activity impairment (WPAI) score was used to measure absenteeism, presenteeism, overall work impairment, and activity impairment. DAS-28 score was correlated with WPAI score and linear regression used to identify the demographic and measures of treatment response that predict improvement in WPAI score. Results: Higher absenteeism and more activity impairment were seen for patients with persistent DAS-28 >3.2 (non-achievers). HAQ and VAS scores correlated with presenteeism, overall work impairment, and activity impairment. Conclusion: Disease activity, as defined by DAS-28 score, correlates with absenteeism and work impairment in a Saudi population. However, on linear regression analysis, HAQ and VAS scores were the only measures predictive of work impairment. These scores should be used to monitor response to treatment regimens that aim to maximize work potential for Saudi individuals. Keywords: rheumatoid arthritis, work impairment, WPAI score, disease activity, HAQ score, VAS scor

Adalimumab impact on fatigue measured by FACIT-F: a study of rheumatoid arthritis patients in Saudi Arabia

Nahed Janoudi,1 Narges Omran,2 Waleed Hussain,3 Hanan Al-osaimi,4 Matouqa Baamer,5 Muhammad Irfanullah Siddiqui,6 Omar Fathaldin,7 Hani Almoallim1,4,8 1Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, 2Department of Medicine, Alnoor General Hospital, 3Department of Medicine, Heraa General Hospital, 4Alzaidi Chair of Research in Rheumatic Diseases, Umm Al-Qura University, Makkah, 5Department of Medicine, King Abdulaziz Hospital & Oncology Center, Jeddah, 6Department of Community Medicine and Public Health, Faculty of Medicine, Umm Al-Qura University, Makkah, 7Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 8Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia Objective: The objective of the study was to assess the effectiveness of adalimumab as a treatment for fatigue in patients with rheumatoid arthritis (RA). Methods: Fatigue was monitored in patients with RA who were already on an adalimumab treatment regimen. Fatigue, general well-being, comorbidities, and disease activity were measured at baseline and ~8, 16, and 24 weeks, thereafter. Results: Significant reductions in fatigue scores and disease activity were observed from baseline to 6 months after. A predictive regression model of fatigue severity was proposed and was found to be significant, with RA disease activity as the most significant predictor of fatigue severity. Conclusion: This quasi-experimental study is a good starting point for research on the efficacy of adalimumab in treating fatigue in RA patients. The results here suggest that a randomized controlled trial assessing adalimumab as a treatment option for RA patients suffering from fatigue is warranted. Keywords: rheumatoid arthritis, fatigue, adalimumab, disease activity, Saudi Arabia, FACIT-F&nbsp

Clinical characteristics and outcomes of cancer patients with post-chemotherapy arthritis: a retrospective case series report

Hani Almoallim,1–3 Sultana Abdulaziz,4 Eilaf Fallatah,1 Haya Alhazmi,1 Nuha Meraiani,2 Tuqa Bazuhair,5 Mohammed Mansour,1 Anan Tayeb,1 Omar Fathaldin6 1Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, 2Department of Medicine, King Faisal Specialist Hospital, Jeddah, 3Alzaidi Chair of Research in Rheumatic Diseases, Umm Al-Qura University, Makkah, 4Rheumatology Unit, Department of Medicine, King Fahad Hospital, Jeddah, 5Department of Medicine, King Abdullah Medical City, Makkah, 6Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Objective: The objective of this report was to describe the demographics, clinical characteristics and outcomes of patients with cancer presenting with arthritis following chemotherapy in Jeddah, Saudi Arabia.Patients and methods: This is a retrospective case series report. We included any patient ≥18 years of age with an established diagnosis of cancer who had received standard therapeutic intervention and was subsequently diagnosed with arthritis after developing rheumatic symptoms either during or after treatment. Patients with clinical evidence of arthritis at the time of their cancer diagnosis were excluded.Results: Seven cases from different centers were identified. Breast cancer was the most common type of cancer reported. The diagnosis of arthritis was established by a rheumatologist. Bilateral involvement of the metacarpophalangeal and proximal interphalangeal joints was the most common presentation. The knee, back, shoulder and wrist joints were less affected. Following treatment, one patient experienced complete resolution of symptoms, four patients symptomatically improved and one patient had no improvement.Conclusion: Arthritis can develop both during and after treatment of a malignancy. Solid tumors seem to be more commonly associated with this phenomenon. In this case series, the prognosis was poor as the majority of patients developed persistent arthritis. Keywords: arthralgia, rheumatic diseases, rheumatoid arthritis, rheumatism, malignancies, breast cancer, autoimmunit

Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study

Hani Almoallim,1–3 Nahid Janoudi,2 Suzan M Attar,4 Mohammed Garout,5 Shereen Algohary,3 Muhammad Irfanullah Siddiqui,5 Hanan Alosaimi,3 Ashraf Ibrahim,3 Amira Badokhon,6 Zaki Algasemi7 1Department of Medicine, Medical College, Umm Alqura University, Makkah, 2Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, 3Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah, 4Department of Medicine, King Abdulaziz University, Jeddah, 5Department of Community Medicine and Public Health, Umm Alqura University, Makkah, 6Administration of Public Health, Ministry of Health, Jeddah, 7Joint Program of Family and Community Medicine, Ministry of Health, Jeddah, Kingdom of Saudi Arabia Objective: Early diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist. Patients and methods: We analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were ≥18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist. Results: A total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies. Conclusion: Nine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment. Keywords: inflammatory arthritis, rheumatoid, diagnosis, primary care, early referral criteri