Yussuf Al-Gindan

Dissemination in Cutaneous Leishmaniasis I. Subcutaneous Nodules

ABSTRACT: In a study of cutaneous leishmaniasis (CL) caused by Leishmania major in Saudi Arabia, 10% of the patients were found to have subcutaneous nodules (5CN). The SCNs were usually inconspicuous, painless, and proximal to the primary skin lesions; when multiple, they showed a “sporotrichoid” configuration or appeared as “beaded cords.” Their number ranged from 1–16 (average 3.25 ± 2.50; mean ± 1 SD). In some patients, the SCNs seemed to be triggered by antileishmanial treatment. The clinical picture and pathologic findings suggest, that SCNs in patients with CL represent lymphatic dissemination, a phenomenon not widely recognized.

Dissemination in cutaneous leishmaniasis. II: Satellite papules and subcutaneous induration

ABSTRACT: In a field study of cutaneous leishmaniasis (CL) due to Leishmania major, zymodeme Lon‐4, in an endemic focus in Saudi Arabia, 80 patients in a group of 643 patients (12.44%) were found to have multiple, inflammatory, satellite papules (SP) around one or more CL lesions. The SP often appeared to erupt after commencement of antileishmanial treatment. They showed a range of morphology and pathology, and comparisons with corresponding CL lesions showed important differences. Amastigotes were seen in only one of seven biopsy specimens. Another morphologic feature, subcutaneous induration (SCI), was noted on routine palpation in 20 patients in the same patient group (3.11%). The SCI either was radiating all around the lesion and appeared as an “iceberg nodule” or was present as a “tonguelike” process proximal to the CL lesion. Amastigotes were seen in four of nine biopsy specimens of SCI. SP and SCI represent reactions to local dissemination of the parasite or its antigenic products, and as morphologic features aid in the clinical diagnosis of CL.

Peripheral nerve involvement in cutaneous leishmaniasis (Old World).

ABSTRACT: A review of 288 skin biopsy specimens from cutaneous leishmaniasis lesions caused by Leishmania major showed assorted nerve changes in 14 biopsy specimens (5%). Ten patients had perineural inflammatory cell infiltrate consisting of either lymphocytes or a mixture of lymphocytes, plasma cells, and macrophages. Four patients had inflammatory cell invasion of the nerves (neuritis), and in one of them the inflammation was granulomatous and associated with nerve destruction. Amastigotes were seen inside the nerves in two patients. Sensory testing of 50 consecutive patients with cutaneous leishmaniasis identified two patients with diminished sensations over the lesions.

Acute Myocardial Infarction in the Eastern Province of Saudi Arabia: Retrospective Analysis of 264 Patients

The medical records of all patients (N = 264) admitted to King Fahd Hospital with a confirmed diagnosis of acute myocardial infarction (AMI) between January 1982 and December 1987 were retrospectiv...

COMPARISON OF INTRAVENOUS FAMOTIDINE AND RANITIDINE IN SUPPRESSING GASTRIC ACID SECRETION IN CRITICALLY ILL PATIENTS

Abstract Histamine 2 (H 2 )-receptor antagonists are administered to raise gastric pH levels and have been found to reduce the risk of stress ulceration and gastrointestinal bleeding in patients admitted to intensive care units. This study compared the efficacy of famotidine to ranitidine in raising gastric pH above 4.00 in critically ill patients. Thirty-two patients were randomly assigned to receive intravenous bolus doses of either famotidine 20 mg every 12 hours (n = 16) or ranitidine 50 mg every 8 hours (n = 16) for a minimum of 3 days and a maximum of 7 days, depending on when the nasogastric tube was removed from the patient. Gastric fluid was aspirated before the start of treatment (baseline) and six times during each 24-hour period; pH was measured using a pH meter. Baseline pH (mean ± SD) was 1.87 ± 0.42 for the famotidine group and 1.71 ± 0.31 for the ranitidine group ( P > 0.05). Famotidine elevated gastric pH to higher levels than ranitidine, reaching statistical significance ( P

Evaluation of students' performance and examination procedures in final certifying examinations in internal medicine (1982-1988).

We conducted a retrospective analysis to evaluate the performance of 459 students on their final certifying examination in internal medicine. These examinations were taken during 1982 through 1988, and the failure rate was 17.6%. Two hundred and five students (44.6%) received grade D (60-69% of the total marks) and 139 (30.1%) grade C (70-79% of total marks). Only 7.7% of the students scored higher (80% or more). A temporal trend has been observed in that a higher percentage of lower grades and lower percentage of higher grades has been observed in recent (1986-1988) compared with earlier (1982-1984) years. Female students generally performed on a par with males, though males students performed better on multiple choice questions (MCQs). The analysis also showed lower mean scores for the essay, oral, and clinical components in recent (1986-1988) than in earlier (1982-1984) years. In studying the interrelationships between different examination components, the MCQs were found to have the highest correlation with other procedures. A lower correlation was observed for clinical examination. Factor analysis also showed that MCQs had the highest and clinical examinations the lowest factor loading. Low correlation and factor loading were also noted for the essay portion. While in the newly implemented curriculum the essay paper has been wisely eliminated, our data suggest that the traditional clinical examination should be replaced by a more objective and structural method. Our analysis may serve as a guide for formulation of final certifying examinations in medical schools throughout the Kingdom.