The current covid-19 era is significant and unprecedented. There are significant challenges for re-organisation of care, re-distribution of resources and rationing of services for those with Covid-19. 1,2 However, the wide array of non-covid-19 diagnoses are still presenting, albeit at lesser rates.   We present the re-configuration of our Medical Ambulatory Care service (Same Day Emergency Care service) and hope that it can be applied to a certain extent across the United Kingdom (UK).

Objective: The study aimed to compare the differences in patients diagnosed with early versus late-onset systemic lupus erythematosus (SLE) in terms of clinical features, disease activity, laboratory findings, and the 5-year survival rate. Materials and Methods: All newly diagnosed SLE patients from 2000 to 2010 in two tertiary centers in Saudi Arabia were enrolled. Retrospectively, early-onset SLE (18–49 years at the age of diagnosis) was compared to late-onset SLE (≥50 years at the age of diagnosis) using chart review of their clinical features, serology, and organ damage and disease activity. Results: A 196 SLE patients were included, 156 were in the early-onset SLE group while 40 in the late-onset SLE group. Arthritis was a frequent symptom in both groups. Proteinuria and anemia were prevalent in the early-onset SLE group (46.4%, 82.1%). The majority of the early-onset SLE (78.2%) group were anti-dsDNA positive compared to 42.5% in the late-onset SLE group. Similarly, 78.4% of the early-onset SLE group had hypocomplementemia compared to 44.7% in the late-onset SLE group. Renal insufficiency and thromboembolic events were more prevalent in the early-onset SLE group (24.2%, 13.6%), while pulmonary hypertension and hepatitis more prevalent in the late-onset SLE group (15% and 20%, respectively). Estimated 5-year survival analysis was lower in the late-onset SLE group compared to the early-onset SLE group. Conclusion: Early-onset SLE had a higher frequency of American College of Rheumatology criteria than the late-onset SLE group. However, the late-onset SLE group exhibited a higher frequency of medical comorbidities with a lower 5-year survival rate.

Objectives: Autoimmune hypothyroidism (AHT) is a common endocrine disorder. Although the exact cause of AHT is not yet understood, genetic factors may play a major role. Uncoupling protein 2 (UCP2) is a member of mitochondrial protein family involved in the regulation of cellular metabolism. An important functional polymorphism in the UCP2 gene, 45-bp insertion/deletion (ins/del) polymorphism, has been linked to certain clinical conditions. However, an association between the 45-bp ins/del polymorphism and AHT has not yet been established. Methods: In this study, about 259 blood samples were collected from, patients with AHT and age-matched healthy control subjects. DNA was extracted for UCP2 45-bp ins/del polymorphisms genotyping, using a standard polymerase chain reaction technique. The distribution of different genotypes was determined in both groups and possible association with AHT was also assessed by logistic regression analysis using the Del/Del variant as a reference genotype. Results: The frequency of the UCP2 45-bp ins/del polymorphism in the total study population was 49.04%, 40.15%, and 10.81% for Del/Del, Ins/Del, and Ins/Ins genotypes, respectively. The logistic regression analysis showed crude odds ratios (ORs), respectively, with their 95% confidence intervals (CIs) and P-values in codominant (Del/Ins) (OR = 1.53, CI = 0.89–2.60, P = 0.17), codominant (Ins/Ins) (OR = 0.75, CI = 0.34–1.74, P = 0.53), dominant (OR = 1.30, CI = 0.79–2.16, P = 0.37), and recessive (OR = 0.62, CI = 0.29–1.36, P = 0.30) inheritance models tested, where none of which were statistically significant. Conclusion: Our data revealed the distribution of the UCP2 45-bp ins/del polymorphisms in Jazan area and confirmed the lack of association between these genetic variants and the development of AHT.

Objectives: Ewing’s sarcoma is an aggressive malignancy of bone and soft tissue in children and young adults. Despite advances in modern therapy, metastasis can occur and results in high mortality. The objective of this study was to identify whether the signaling transduction proteins, insulin growth factor receptor (IGF1R) and S6 kinase (S6K), can predict poor prognosis in Ewing’s sarcoma. Materials and Methods: After the Institutional Research Board approval, immunohistochemical experiments on tissue microarray slides containing 32 archived Ewing’s sarcoma tumor samples were performed with antibodies against IGF1Rβ and p-S6K. Immunohistochemical staining results were correlated with patients’ clinical data including clinical stage and overall survival (OS). Results: Patients had an age range of 12–72 years and 8 (25%) were ≤20 years. After a follow-up to 14 years, the OS ranged from 25 to 5065 days. High expression of IGF1Rβ and p-S6K, defined as staining stronger than positive control, was identified in 25% and 68.75% of cases, respectively. Statistical analysis revealed that IGF1Rβ high expression had a significant association with adverse outcome, shorter OS (P < 0.05), and near significant association with advanced stage tumors (P = 0.0534). Expression of S6K exhibited a trend toward shorter survival (P = 0.0934). Conclusion: High expression or strong staining of IGF1Rβ in Ewing’s sarcoma may be more important than overall positive staining in identifying poor prognosis and aggressive cases to be selected for IGF1R inhibitory therapy. More definitive studies are needed to confirm the role of S6K in the prognosis in Ewing’s sarcoma tumors.

Objective: Osteoporosis is the most common type of bone disorder characterized by low bone mineral density (BMD). It is a multifactorial disease and caused by the interaction of environmental and genetic factors. It has been reported that mutations in the vitamin D receptor (VDR) gene highly affect the metabolism of minerals, which reduces bone density. Therefore, this study aimed to determine the association of VDR gene polymorphisms TaqI (rs731236) and ApaI (rs7975232) with osteoporosis risk in the Saudi population. Methods: This case–control study involved 73 individuals with osteoporosis and 73 healthy controls in Jeddah, KSA. DNA extracted from peripheral blood was used to determine the genotypes and allele frequencies of VDR variants by polymerase chain reaction-restriction fragment length polymorphisms. Osteoporosis was confirmed by measuring BMD using dual-energy X-ray absorptiometry. The results were interpreted using the Hardy–Weinberg equilibrium assumption with P < 0.05 considered as significant. Results: A significant increase in the genotype frequencies of the ApaI (Aa) and (aa) was observed among osteoporotic patients compared to controls (P = 0.002 and P < 0.0001, respectively). Only the homozygous (tt) genotype of TaqI was significantly higher in those with osteoporosis than in the controls (P = 0.001). The minor “a” allele of ApaI and the “t” allele of TaqI were significantly more common in the patients as compared to controls (P < 0.0001 and P = 0.01, respectively). Conclusion: VDR polymorphisms ApaI and TaqI were found to be significantly determinant risk factors for osteoporosis progression in the Saudi population.

Objectives: Induction chemotherapy (ICT) is the standard of care for patients with locally advanced breast cancer. The major criticism about ICT is the delay of surgery, which may affect the local control. Survivin functions by the regulation of mitosis and inhibition of apoptosis. The miR-542-3p regulates survivin mRNA, upregulation of miR-542-3p leads to the downregulation of survivin and arrest of the cell cycle at G1 and G2/M phases resulting in tumor growth suppression. We studied whether we can use survivin mRNA and miRNA-542-3p as potential biomarkers to predict response to ICT. Methods: Fifty-one patients with locally advanced breast cancer were treated with ICT. miRNA-542-3p and survivin mRNA were determined in breast cancerous tissues and their nearby healthy breast tissues by a real-time quantitative polymerase chain reaction. Results: Our results revealed a negative correlation between miRNA and survivin. miRNA-542-3p levels were elevated in normal tissues and in patients with good prognostic features and response to ICT. On the contrary, survivin was upregulated in malignant tissues in patients with adverse prognostic features and patients with no response to neoadjuvant chemotherapy. Conclusions: ICT is a promising option for the treatment of patients with locally advanced carcinoma of the breast. The studied miRNA-542-3p and its target survivin correlate inversely with each other in both malignant and their nearby normal tissues. miRNA-542-3p and survivin can be used as possible molecular markers for the prediction of response to ICT in locally advanced carcinoma of the breast.

Objectives: Bleeding is the most serious complication of cardiac surgery among pediatric patients. Recombinant factor VII (rFVII) is a widely used coagulant, despite a lack of evidence on its effectiveness. The current study aimed to summarize the effectiveness and safety of using rFVII in pediatric cardiac surgery using data from existing double-arm studies. Methods: After a systematic search of existing databases and careful scrutiny by two independent researchers, seven double-arm studies were shortlisted. Of these seven studies, there was one randomized control trial, one cohort study, and five case–control studies, which together had 1117 pediatric patients of cardiac surgery. rFVII was administered in the intervention arm group, whereas either a placebo or blood products were given to the control group for bleeding. Pooled risk ratio was the summary measure of association for thrombotic complications, reexploration, and mortality among the two groups. The standard mean difference was calculated for comparing mean chest tube output before and after the administration of rFVII between the two groups using the random-effects model. The heterogeneity coefficient was calculated for each outcome measure. Results: No statistically significant difference was observed for mean chest tube output (before – [mean difference = 3.36, 95% confidence interval (CI) = −0.60, 7.31, P = 0.10] and after – [mean difference = −0.34, 95% CI = −0.26, 2.01, P = 0.78] administering rFVII), thrombotic complications (RR = 1.39, [95%] CI = 0.69–2.81) and mortality (relative risk [RR] = 1.19 [95%] CI = 0.82–1.74). However, the rate of reexploration was 1.86 times more in the intervention arm as compared to the control arm (RR = 1.86 (95%] CI = 1.16–2.98). There were insufficient data for length of stay in intensive care unit and hospital, and volumes of transfused blood for deriving summary measure. Conclusions: The administration of rFVII does not provide any added advantage for bleeding control among pediatric patients of cardiac surgery. However, it increased the rate of reexploration among the intervention arm. However, due to the small sample sizes of the included studies, the results need to be taken cautiously.

Melanoma is a rare tumor in Saudi population. Therefore, diagnosing melanoma among Saudi population in unexpected location is difficult without high-index of suspicion and the help of laboratory investigation methods including ancillary immunohistochemical studies. Here, we present the first reported case of anorectal melanoma in the central region of Saudi Arabia and the second reported case in the whole country. This is a report of 59-year-old Saudi female patient showed abdominal large rectal mass. Urgent colonoscopy examination revealed large fungating rectal mass with ulcerated surface. The microscopic examination of these biopsies showed colonic mucosa with a lamina propria infiltrated by pleomorphic atypical round/oval neoplastic cells arranged in sheets, clusters, and trabecular patterns. The immunohistochemical stains showed neoplastic cells are positive for S100 and Melan-A with negative for CKpan, CK7, CK20, CDX2, CD45, DOG1, chromogranin, & synaptophysin. Overall diagnosis revealed that this was a case of primary anorectal melanoma.