) is a global pandemic that is caused by COVID-19 virus, which was initially identified in December 2019 in Wuhan, China. Vaccination is one of the most effective public health interventions, and soon after the Pfizer/BioNTech (BNT162b2) vaccine became available late in 2020, it began to be actively used to fight against COVID-19. Since then, cases of vaccine-associated immune-mediated diseases (IMDs) have been reported. There have been few cases of IMD flare-ups or onset after COVID-19 vaccine administration, and emerging IMDs may be identified over next few years after high use of this vaccine. To this day, few cases of newly diagnosed systemic lupus erythematosus (SLE) following COVID-19 vaccine exposure were reported. Herein, we present the case of a patient diagnosed with SLE, acute pancreatitis, and vasculitic skin rash on the extremities 1 week after the first dose of the Pfizer-BioNTech COVID-19 vaccine. Key Point• COVID-19 Vaccine induced Systemic Lupus Erythematosus.
Immunoglobulin G4-related disease (IgG4-RD) is rare disease entity and has recently been recognized as an inflammatory disorder with the tendency to affect multiple organs. Pachymeningitis of spine caused by IgG4-related disease is extremely rare. Neck pain and spinal cord compression symptoms consist of usual presentation of IgG4-related spinal pachymeningitis; however, polyarthritis is an unusual presentation of this disease, and it was reported in only one case that mimicked psoriatic arthritis. In this report, we describe a case of IgG4-related spinal pachymeningitis in a middle-age male who presented initially with neck pain and rheumatoid arthritis-like symptoms and later on developed both right upper and lower limb weakness. He was found to had pachymeningeal thickening on a cervical magnetic resonance image (MRI) and elevated serum IgG4 levels. He was treated with glucocorticoids and rituximab, which led to a significantly positive radiological response.
Background: The objective was to evaluate the level of awareness regarding systemic lupus erythematosus (SLE) among the general population in the Al-Qassim region, Kingdom of Saudi Arabia (KSA).Methods: This was a cross-sectional study carried out between March and April 2021 and conducted among the general population at Al-Qassim region, KSA. A valid pre-tested electronic questionnaire was distributed through social media among the targeted population that included socio-demographic characteristics and questionnaires measuring awareness, attitude and their belief about SLE. All statistical analyses were performed using SPSS version 26.Results: A total of 377 participants were enrolled. The most common age group was more than 40 years old (39%), with slightly females (52.5%) than males. The prevalence of participants who had heard about SLE was 52.5%. Of those who have heard about SLE, a poor level of awareness was detected among 69.2% of participants, while 30.8% were at a good level. Factors associated with an increased level of awareness were having diagnosed been with SLE and those who indicated their doctor as their sources of SLE information.Conclusions: The awareness of the general population in the Al-Qassim region regarding SLE was insufficient. Obtaining SLE information from their doctor and having been diagnosed with SLE are associated with better awareness. We propose that awareness campaigns should be promoted.
Background: The long QT syndrome is characterized by prolongation of QT interval, which may lead to life-threatening cardiac arrhythmias. Objectives were to assess prevalence, quantity and severity of QTc prolongation with combined drugs (azithromycin and hydroxychloroquine) in adults COVID-19 patients treated on these agents at KFSHRC. And to characterize cardiac complications of QTc prolongation with combined drugs.Methods: A retrospective cohort study at KFSH&RC, in Riyadh, Saudi Arabia. Baseline and daily ECG was done until completion of duration as per KFSH&RC guidelines for management of Covid-19, QTc prolongation>500 or increase of at least 60 ms compared with the pre-drug baseline value, or presence of cardiac conductive complications (torsades de pointes). The QTc prolongation was defined as>470 for male and >480 for female as per American Heart Association. A risk score that has been validated by Tisdale et al, for prediction of QT prolongation drug-related in admitted patients in cardiac care unit. The study duration was specified as one month after study approval by Research Ethics committee.Results: A total of 74 patients were included in the study. The patients were distributed according to their risk score for prediction of QT prolongation as the following: low (67/74), medium (6/74), high (1/74). Two patients with medium risk were started on both azithromycin and hydroxychloroquine. one of them his baseline QT was 490, Azithromycin was stopped as QT reached 502. The second patient has QT baseline 471, after starting treatment; QT range was 472-475, hydroxychloroquine was stopped on day 4. None of them had torsades de pointes. Only one patient with low risk, no baseline QT was recorded, but QT was 499 on day three, so hydroxychloroquine was stopped. Repeated ECG showed: QT decreased to 478, no torsades de pointes. Conclusions: In this single centered-retrospective cohort, we noticed that a small percentage of patients developed QT prolongation with the use of this combination. With the increasing the risk of developing QT prolongation the number of the patient who developed the condition increased. We used Tisdale score which is a scoring system Identifying hospitalized patients at risk for QT interval prolongation could lead to interventions to reduce the risk of torsades de pointes validated in May 2013.5 None of our population developed significant cardiac complications of QTc prolongation with combined drugs.
Background: Current guidelines recommend the early recognition and diagnosis of rheumatoid arthritis and treatment with disease-modifying antirheumatic drugs (DMARDs). Methotrexate is the first drug of choice for most patients with rheumatoid arthritis, but this medication has contraindications and side effects that need monitoring. This survey analysis aims to explore the level of knowledge of primary healthcare physicians towards the early detection of rheumatoid arthritis and monitoring treatment with methotrexate.Methods: A self-administered structured questionnaire was distributed to primary healthcare physicians in the region of Riyadh, Saudi Arabia. The survey consists of sections including the demographics of respondents, knowledge about rheumatoid arthritis, and methotrexate. Data were analyzed using SPSS version 22.Results: In total, 249 physicians responded to the survey. Physicians with more years of experience showed a significantly higher level of knowledge about rheumatoid arthritis and methotrexate monitoring (p-value <0.001). The responses of physicians regarding knowledge about the disease were better than their responses about the drug.Conclusions: The knowledge of primary healthcare physicians in Riyadh, Saudi Arabia, is considered satisfactory in regard to rheumatoid arthritis diagnosis, but the level of knowledge about methotrexate requires improvement.
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