Aim: The dynamics of coronavirus disease 2019 (COVID-19) pandemic has become of special concern to the rheumatology community. Rheumatic patients are required to engage in effective health management but their behavior is often influenced by intrinsic and extrinsic factors. This cross-sectional study aims to examine patients' experiences during the current pandemic and its implication on their health perception and behavior. Method: A patient-centered electronic survey was used, randomly sampling rheumatic patients in Saudi Arabia during March and April 2020. Questions included patients' socio-demographics, diseases, medications, COVID-19 knowledge, source of information, fear level, disease activity perception, health care utilization, medication accessibility, and therapeutic compliance (measured using a modified version of Medication Adherence Reporting Scale). Correlation and regression coefficients were used to evaluate associations among the aforementioned variables. Results: A total of 637 respondents were included. The majority were rheumatoid arthritis patients (42.7%). Patients' knowledge about COVID-19 was correlated with social media use (P = .012). Fear of COVID-19 infection correlated with healthcare facility for follow-up visits (P = .024) and fear of disease deterioration if contracting the infection correlated with patients' levels of knowledge (P = .035). Both types of fear did not correlate with patients' perceptions of disease activity. However, patients' perceptions of worsened disease activity were correlated with unplanned healthcare visits (P < .001), medication non-adherence, and difficulty accessing medication (P = .010 and .006, respectively). Conclusion: The COVID-19 pandemic and surrounding public health measures could affect rheumatic patients' health management which might contribute to disease flare-up and subsequently taxing healthcare systems even further.

Systemic Lupus erythematosus (SLE) is a chronic multisystem, multifactorial inflammatory autoimmune disease. The SLE patients have 3 times increased risk of mortality based on international data with ethnicity playing an important impact on patients' morbidity and mortality. Descriptive studies from Saudi Arabia showed variation in clinical features from one region to another. Moreover, reliable inference from these studies is limited by study methodology and lack of translational data using biological samples to understand clinical phenotypes of Saudi SLE patients.The aim of this report is to describe the prospective study protocol of the National Systemic Lupus Erythematosus Cohort in Saudi Arabia. The purpose of this cohort study is multifold: first, to examine clinical characteristics and molecular phenotypes of Saudi SLE patients in relation to local environment and practices/lifestyles; second, to assess long-term outcomes of SLE in Saudi population and factors that influence favorable outcomes; third, to compare the effectiveness of various treatment regimens in Saudi SLE population.This study is a longitudinal prospective cohort study of adult, Saudi SLE patients using open cohort study design. Primary outcomes include disease-related outcomes (activity, improvement, and organ damage) and patient-reported outcomes (quality of life). Secondary outcomes include physiological and molecular modifications associated with changes in disease activity states. Results and analysis are in on-going study.This study provides a source of reliable data for clinical and translational research. This will allow us to have a holistic approach to SLE pathogenesis especially in Saudi population and may take us a step further toward much more personalized medicine.This protocol has been registered in NIH ClinicalTrial.gov (ClinicalTrial.gov identifier: NCT04604990) on October 27, 2020.Abbreviations: ACR = American College of Rheumatology, DMARD = disease-modifying anti-rheumatic drugs, IRB = institutional review board, KKUH

The aim of the present study, is to investigate the influence of obesity, with and without polycystic ovarian syndrome (PCOS), on the levels of kisspeptin, vitamin D (Vit D), and vascular endothelial growth factor (VEGF) and to explore the relationship between these parameters and endocrine and metabolic variables. The study group included 126 obese Saudi females. Of these 63 were suffering from PCOS while the rest were normo-ovulatory obese women (non-PCOS obese). In the obese PCOS, VEGF was almost four times as high as in the non-PCOS obese, while kisspeptin and Vit D did not differ. A highly significant elevation was recorded in the waist/hip (WHR), cholesterol, LDL-C, fasting glucose, LH, LH/FSH ratio, estradiol (E2), and testosterone, while hip circumference, leptin, progesterone, and sex hormone binding globulin (SHBG) were lower in the obese PCOS subjects. BMI, HDL-C, ghrelin, insulin, and FSH levels did not differ significantly between the two groups. The obese PCOS had the same level of insulin resistance as the non-PCOS group, as judged by QUICK Index. Correlation studies showed a significant negative correlation between kisspeptin and glucose and LH levels, and a positive correlation with LH/FSH ratio in obese PCOS while in the non-PCOS obese, the kisspeptin correlated positively with glucose, and there was no correlation with LH or LH/FSH. VEGF negatively correlated with FSH and positively with LH/FSH ratio in the non-PCOS obese but this was lost in the obese PCOS. PCOS had no effect on the correlation between Vit D and all studied parameters. Multiple regression analysis showed triglyceride as predictor variable for kisspeptin as a dependent variable, while, leptin is a predictor variable for VEGF as a dependent variable. ROC studies showed the highest sensitivity and specificity for VEGF (AOC=1.00), followed by LH/FSH ratio (AOC=0.979). In conclusion, our study shows that PCOS results in significant elevation of VEGF in obese females, while kisspeptin and Vit D levels are not affected. It also leads to elevation in several of the lipid and hormonal abnormalities in the obese females. In addition, PCOS influences relationship between Kisspeptin and VEGF and some parameters such as glucose, LH or FSH and LH/FSH ratio in obese females, but does not affect Vit D relationship with other parameter.

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Objectives: To determine the prevalence of selected single nucleotide polymorphisms )rs1080985, rs28624811, rs1065852, rs28371725, and rs1135840( in cytochrome P450 2D6 )CYP2D6( gene among Saudi systemic lupus erythematosus )SLE( patients and to investigate the association between the genetic variants and clinical features of SLE.

The role of inflammation in colon cancer is understood as a well-accepted factor that has the tendency to release multiple pro- and anti-tumorigenic inflammatory mediators. Inflammation-induced increased expression of anti-tumorigenic inflammatory mediators and decreased expression of pro-tumorigenic inflammatory mediators encourage beneficial inflammatory effects in terms of powerful anti-tumor immunity. The present study aims to screen the beneficial inflammatory effects of Walterinnesia aegyptia venom via determining its modulatory tendency on the expression of 40 pro- and anti-tumorigenic inflammatory mediators (cytokines/growth factors/chemokines) in LoVo human colon cancer cell line. LoVo-cells were treated with varying doses of crude venom of W. aegyptia. Cell viability was checked utilizing flow cytometry, and IC50 of venom was determined. Venom-induced inflammatory effects were evaluated on the expression of 40 different inflammatory mediators (12 anti-tumorigenic cytokines, 11 pro-tumorigenic cytokines, 7 pro-tumorigenic growth factors, 9 pro-tumorigenic chemokines and 1 anti-tumorigenic chemokine) in treated LoVo-cells [utilizing enzyme-linked immunosorbent assay (ELISA)] and compared with controls. Treatment of venom induced significant cytotoxic effects on inflamed LoVo-cells. IC50 treatment of venom caused significant modulations on the expression of 22 inflammatory mediators in treated LoVo-cells. The beneficial modulatory effects of venom were screened via its capability to significantly increase the expression of five powerful anti-tumorigenic mediators (IL-9, IL-12p40, IL-15, IL-1RA and Fractalkine) and decrease the expression of four major pro-tumorigenic mediators (IL-1β, VEGF, MCP-1 and MCP-3). Walterinnesia aegyptia venom-induced beneficial modulations on the expression of nine crucial pro/anti-tumorigenic inflammatory mediators can be effectively used to enhance powerful anti-tumor immunity against colon cancer.

BackgroundThe utilization of telemedicine has been rapidly growing among patients with rheumatic disease especially following COVID-19 pandemic. The ease and convenience seems to dominate the reasons of such growth. Yet the effect of this approach on patients with systemic lupus erythematosus (SLE) is yet to be revealed.ObjectivesIn this study, we aimed to examine the effect of telemedicine in SLE patients on the outcome of disease activity.MethodsThis is a case-cross over study nested within the national prospective cohort of SLE, Saudi Arabia. SLE patients who fulfils the SLICC classification criteria within the period between March 2020 to March 2021 and have been assessed at three-time point with three months’ time difference between assessments according to standardized protocol were included. Telemedicine was conducted at first point while in person assessment were used for second and third points. Primary outcome was difference in SLEDAI-2K score. Primary analysis was conducted using GEE model and adjusted for potential confounders including demographics, medications and changes in steroid doses. Several sensitivity analyses were conducted to mitigate selection and time varying confounders.ResultsA total of 92 participants were included. Majority of them were females (88%), with a mean (±SD) age of 36 (±13). mean (±SD) disease activity scores at baseline as follows: SLEDI 5 (±5); SRI 3.8 (±3.5); SDI 1 (±1). Mean difference of SLEDI score of -1.641 (95% CI -2.773 ─ -0.510), p=0.005* between telemedicine and follow up visits. Adjusted value and mean with mean diffrence in Figure 1. Results were consistent in all sensitivity analyses.ConclusionWe found that the Telemedicine assessment was associated with much higher disease activity score compared to in person in subsequent assessments which may suggest potentially overestimation of disease activity and later assessment accuracy. Cautious adoption is suggested in SLE patients with active disease.References[1]Anderson JT, Bouchacourt LM, Sussman KL, Bright LF, Wilcox GB. Telehealth adoption during the COVID-19 pandemic: A social media textual and network analysis. Digit Health. 2022 Mar 31;8:20552076221090041. doi: 10.1177/20552076221090041. PMID: 35392254; PMCID: PMC8979849.[2]Tang, W., Inzerillo, S., Weiner, J., Khalili, L., Barasch, J., Gartshteyn, Y., Dall’Era, M., Aranow, C., Mackay, M.C., & Askanase, A.D. (2022). The Impact of Telemedicine on Rheumatology Care. Frontiers in Medicine, 9.Figure 1Repeated measure analysis of difference in SLEDAI between the virtual visit and the physical visit taking factors affecting SLEDAI on univariate analysis into consideration (abnormal urine test, fibromyalgia, haemolytic anaemia and mycophenolate use).Acknowledgements:NIL.Disclosure of InterestsNone Declared.

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