To evaluate the use of rituximab in the treatment of severe glomerulonephritis (GN) in order to prevent progression of kidney disease toward the end stage, we designed a multicenter, retrospective study in Saudi Arabia about the efficacy and safety of the use of "off label" rituximab in a variety of severe refractory GN to conventional treatment and the progression of kidney disease for at least one year of follow-up. All the patients had kidney biopsies before treatment with rituximab, and proteinuria and glomerular filtration rate (GFR) were followed-up for the period of the study. The immediate side-effect at the time of administration of rituximab included itching in three patients, hypotension in one patient and anaphylaxis in one patient (dropped out from the study). After the administration of rituximab in 42 patients and during the first six months of therapy, 16 (38%) patients had complete remission (CR), 13 (31%) patients had partial remission (PR) and 13 (31%) patients had no remission. The mean follow-up period for the patients was 19.0 ± 6.97 months (median 18.0 months). The long-term follow-up during the study period disclosed a good hospitalization record for almost all of the patients. Membranous GN (MGN) was the largest group in the cohort (58% of the patients), and we observed CR and PR in 40% and 28% of them, respectively, which was comparable with the previous experience with rituximab in MGN patients with more CR than PR in our cohort. We conclude that our study suggests the safety and efficacy of the use of rituximab in patients with refractory GN and that larger and long-term prospective studies are required to define the role of rituximab in the different categories of these diseases.

Calcific uremic arteriopathy (CUA) is a rare but potentially life-threatening complication of end-stage renal disease (ESRD) and secondary hyperparathyroidism. It typically presents with ischemic necrosis involving areas of adiposity in the body mainly the trunk, buttocks, or proximal extremity. Patients can also present with digital ischemia and more rarely penile gangrene. The pathogenesis of CUA is not yet clear but several putative factors, mainly hyperparathyroidism and related metabolic abnormalities are implicated. A number of conditions can mimic CUA clinically and should be differentiated from it. We present in the current study, a patient who presented with progressive penile gangrene and skin necrosis due to CUA. We review the current understanding of the pathogenesis, diagnosis/differential diagnosis, and management of this rare but potentially life-threatening complication of ESRD.

We recently found that SspABCD, catalyzing single-stranded (ss) DNA phosphorothioate (PT) modification, coupled with SspE provides protection against phage infection. SspE performs both PT-simulated NTPase and DNA-nicking nuclease activities to damage phage DNA, rendering SspA-E a PT-sensing defense system.

Introduction: Health-related quality of life (HRQOL) is an individual's satisfaction or happiness with the dimensions of life mentioned above, in the context of being affected by or affecting the individual’s health. There have been multiple standardized questionnaires developed to evaluate the HRQOL of people, and the 36-item Short Form Health Survey (SF-36) is one of them. Objective: To assess the health-related quality of life of the general adult population of Peshawar city by use of the SF-36 survey form. Materials & methods: A cross-sectional study was conducted in Peshawar city from March to May 2019. The sample comprised of 263 respondents aged 18 and above. Data were collected by systematic random sampling of households using the SF-36 survey form and analyzed using SPSS version 22. Results: A total of 263 questionnaires were fully filled and valid. Of the 263, 66.9% were male (n=176) and 33.1 % were female (n=87). The age of the participants ranged from 18-70 years, with a mean age of 30.5 ± 11.3 years.   The domain value for SF at 67.78, followed closely by BP at 67.54, then MH at 62.69, PF at 61.27, GH at 60.50, VT at 62.69, RP at 57.03, and the lowest value was of RE at 56.52. Conclusion: The study revealed that the HRQOL of the population of Peshawar city was less as compared to other international studies. It showed males had a better HRQOL in all domains except one. The HRQOL also declined with increasing age. Keywords: Quality of Life; Adult; Mental Health; Health Surveys

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