The Association of Body Mass Index with COVID-19 Complications and Survival Rate at a Tertiary Hospital

A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases (p = 0.013); end-stage renal disease (p = 0.021); and cardiovascular disease (p = 0.003) but not diabetes mellitus (p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots (p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients (p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 (p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients.

Prevalence of urinary incontinence among women in Saudi Arabia: a cross-sectional study

OBJECTIVE

Urinary incontinence is defined as involuntary loss of urine, a common health condition that is more frequent in women. It disturbs the affected individuals and interferes with their daily activities. This study aimed to estimate the prevalence of urinary incontinence among Saudi women in the western area of the Kingdom of Saudi Arabia.

SUBJECTS AND METHODS

A descriptive cross-sectional design was used for this study. A survey was administered to Saudi women in the western area of the Kingdom of Saudi Arabia ranging in age from 18 to 70 years. The data were collected using the Arabic version of the Questionnaire for Urinary Incontinence Diagnosis. Descriptive statistics were generated by calculating numbers and percentages of information on the prevalence of incontinence in women. p-values < 0.05 were considered statistically significant.

RESULTS

The prevalence of urinary incontinence was 44.2%, with the urge type being the most reported. Stress urinary incontinence was reported by 155 women (15.4%), urgency urinary incontinence by 257 women (25.6%), and mixed urinary incontinence by 102 women (10.15%).

CONCLUSIONS

Urinary incontinence is prevalent in women in Western Saudi Arabia. Age, multiparty obesity, and vaginal surgery are significant risk factors influencing its occurrence.

Assessing incidence and risk factors of laparoscopic cholecystectomy complications in Jeddah: a retrospective study

Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, it is associated with several complications. No previous studies have investigated LC complications and their associated risk factors in the western region of Saudi Arabia.

Aims

We aimed to identify the risk factors for postoperative complications (POCs) of LC at a tertiary institute in Jeddah, Western Saudi Arabia.

Settings and design

This retrospective study was conducted between June 2021 and August 2021 among patients who underwent LC at a tertiary centre in Jeddah, Saudi Arabia.

Materials and methods

Records of 596 patients were reviewed, and 510 patients were included in the final analysis after applying the exclusion criteria. Data were collected from hospital medical records. χ ² tests and independent t tests were used to analyse categorical and continuous variables, respectively. The Mann-Whitney U test was used for nonparametric data. Multivariate regression analysis was used to adjust the P values to determine the most strongly and independently associated risk factors.

Results

Our data showed that the overall incidence of intraoperative complications (IOCs) was 10.8%. The most common complications were gallbladder perforation (n=28, 5.5%), bile leakage (n=25, 4.9%), and bleeding (n=15, 2.9%). POCs occurred in 11% of the patients; the majority complained of abdominal pain (n=36, 6.9%), had elevated liver function tests (n=14, 2.7%), and retained stones (n=11, 2.2%). Acute cholecystitis, overweight, diabetes, and male sex were significant predictors of IOC, POC, and conversion to open cholecystectomy (P<0.05).

Conclusions

LC complications have a multifactorial aetiology. Patient awareness of all possible IOCs is fundamental. The improved skill and experience of the surgical team can mitigate serious complications.

Abstract 2525: Analyzing the role of MDMX for regulating cell death in prostate cancer cells

Prostate cancer (PCa) is the most prominent cancer type and the second leading cause of cancer death among men in the USA. The five-year survival rate for localized PCa is 98% but drops to 31% when PCa spreads to different parts of the body. Various treatment strategies that can induce cell death through different mechanisms are used while treating cancers. In recent years, necroptosis has been established as one of the effective mechanisms of inducing cell death in cancers. Necroptosis can be identified as a regulated form of cell death that can occur independently of executioner caspases. Despite numerous studies on the effects of necroptosis in cancer, it’s role on PCa has not been fully elucidated. In this study, we have evaluated the role of MDMX, a proto-oncogene involved in the negative regulation of p53, in causing cell death through p53-independent mechanisms. We have observed that inhibition of MDMX decreased the cell viability of LNCaP cells in response to 20 µM of NSC (NSC-207895), a MDMX specific inhibitor treatment, in a concentration-dependent manner. MDMX inhibition appears to induce necroptosis in LNCaP prostate cancer cells by elevating the expression of receptor-interacting protein kinase 1 (RIP1), which is a key element of the necroptotic pathway. In general, the necroptosis pathway can trigger two opposing mechanisms in cancer where it can promote tumor migration and metastasis on one hand and can also act as a defensive mechanism on the other hand when apoptosis is disrupted. To further assess the effect of MDMX on cell migration, the LNCaP cells were treated with 20 µM of NSC, which effectively blocked the cancer cell migration for up to 48 h, which was confirmed using the scratch assay. Interestingly, NSC treatment also reduced the expression of Vascular Endothelial Growth Factor A (VEGFA), which is one of the main markers for angiogenesis. Our results show that the p53-independent mechanisms that are activated following MDMX inhibition can regulate both cancer cell migration and angiogenesis. MDMX also seemed to be involved in regulating PCa cell survival through necroptosis. The outcomes of our experiments provide additional knowledge and strategies for making an accurate prognosis and choosing the most suitable therapeutic strategies for offering effective treatments for MDMX-positive PCa. (This research was supported by the Royal Dames of Cancer Research Inc. Ft. Lauderdale, Florida)

Citation Format: Ahmed Alsarrani, Umamaheswari Natarajan, Samia Alsubhi, Amal Alzahrani, Appu Rathinavelu. Analyzing the role of MDMX for regulating cell death in prostate cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2525.

A time and motion study in pediatric ER of the Secondary Hospital in Al Jouf Region, Saudi Arabia

OBJECTIVE

In the hospital setting, long waiting times and the lengthy formal process have increased the inefficiency and mismanagement resulting in the missing chance of saving the patients' life. Our aim was to assess the time wastage of every patient coming from reception to the actual emergency unit, to analyze the factor associated with the time lapse that occurs during every visit, and to see the effect of training on the services provided in the Pediatric emergency room.

SUBJECTS AND METHODS

An intervention study was carried out in the following secondary care hospital in the Al Jouf region, Saudi Arabia: Esawiyah Hospital, Haditha Hospital, King Faisal Hospital, and Gurayat General Hospital among 400 study participants for 12 months. The study was carried out in 2 phases: pre-training, a period of training for hospital staff, and post-training data collection. Templates were generated on an MS Excel sheet and analysis of data was done using SPSS software. Percentages and proportions were calculated for descriptive statistics.

RESULTS

Male and female patients were in the ratio of nearly 1:1. Training has significantly reduced the time to doctor consultation (U = 188, p < 0.001), and the time difference pre- and post-training from triage to consultation in a pediatric emergency is not significant (U = 16,769, p = 0.01). There is a strongly significant association (p < 0.001) between Canadian Triage and Acuity Scale (CTAS) implementation in triage. The practice of giving intravenous (IV) antibiotics in the emergency room has reduced significantly (p < 0.001) post-training.

CONCLUSIONS

Training has a significant impact on the services provided in the pediatric emergency room.

Durable Surfaces from Film-Forming Silver Assemblies for Long-Term Zero Bacterial Adhesion without Toxicity

The long-term prevention of biofilm formation on the surface of indwelling medical devices remains a challenge. Silver has been reutilized in recent years for combating biofilm formation due to its indisputable bactericidal potency; however, the toxicity, low stability, and short-term activity of the current silver coatings have limited their use. Here, we report the development of silver-based film-forming antibacterial engineered (SAFE) assemblies for the generation of durable lubricous antibiofilm surface long-term activity without silver toxicity that was applicable to diverse materials via a highly scalable dip/spray/solution-skinning process. The SAFE coating was obtained through a large-scale screening, resulting in effective incorporation of silver nanoparticles (∼10 nm) into a stable nonsticky coating with high surface hierarchy and coverage, which guaranteed sustained silver release. The lead coating showed zero bacterial adhesion over a 1 month experiment in the presence of a high load of diverse bacteria, including difficult-to-kill and stone-forming strains. The SAFE coating showed high biocompatibility and excellent antibiofilm activity in vivo.

Rapid Assembly of Infection-Resistant Coatings: Screening and Identification of Antimicrobial Peptides Works in Cooperation with an Antifouling Background

Bacterial adhesion and the succeeding biofilm formation onto surfaces are responsible for implant- and device-associated infections. Bifunctional coatings integrating both nonfouling components and antimicrobial peptides (AMPs) are a promising approach to develop potent antibiofilm coatings. However, the current approaches and chemistry for such coatings are time-consuming and dependent on substrates and involve a multistep process. Also, the information is limited on the influence of the coating structure or its components on the antibiofilm activity of such AMP-based coatings. Here, we report a new strategy to rapidly assemble a stable, potent, and substrate-independent AMP-based antibiofilm coating in a nonfouling background. The coating structure allowed for the screening of AMPs in a relevant nonfouling background to identify optimal peptide combinations that work in cooperation to generate potent antibiofilm activity. The structure of the coating was changed by altering the organization of the hydrophilic polymer chains within the coatings. The coatings were thoroughly characterized using various surface analytical techniques and correlated with the efficiency to prevent biofilm formation against diverse bacteria. The coating method that allowed the conjugation of AMPs without altering the steric protection ability of hydrophilic polymer structure results in a bifunctional surface coating with excellent antibiofilm activity. In contrast, the conjugation of AMPs directly to the hydrophilic polymer chains resulted in a surface with poor antibiofilm activity and increased adhesion of bacteria. Using this coating approach, we further established a new screening method and identified a set of potent surface-tethered AMPs with high activity. The success of this new peptide screening and coating method is demonstrated using a clinically relevant mouse infection model to prevent catheter-associated urinary tract infection (CAUTI).

Self-Limiting Mussel Inspired Thin Antifouling Coating with Broad-Spectrum Resistance to Biofilm Formation to Prevent Catheter-Associated Infection in Mouse and Porcine Models

Catheter-associated urinary tract infections (CAUTIs) are one of the most commonly occurring hospital-acquired infections. Current coating strategies to prevent catheter-associated biofilm formation are limited by their poor long-term efficiency and limited applicability to diverse materials. Here, the authors report a highly effective non-fouling coating with long-term biofilm prevention activity and is applicable to diverse catheters. The thin coating is lubricous, stable, highly uniform, and shows broad spectrum prevention of biofilm formation of nine different bacterial strains and prevents the migration of bacteria on catheter surface. The coating method is adapted to human-sized catheters (both intraluminal and extraluminal) and demonstrates long-term biofilm prevention activity over 30 days in challenging conditions. The coated catheters are tested in a mouse CAUTI model and demonstrate high efficiency in preventing bacterial colonization of both Gram-positive and Gram-negative bacteria. Furthermore, the coated human-sized Foley catheters are evaluated in a porcine CAUTI model and show consistent efficiency in reducing biofilm formation by Escherichia coli (E. coli) over 95%. The simplicity of the coating method, the ability to apply this coating on diverse materials, and the high efficiency in preventing bacterial adhesion increase the potential of this method for the development of next generation infection resistant medical devices.

Relationship of asthma control test scores with pulmonary function tests, quality of life and adiposity in asthmatic children

OBJECTIVE

This study aimed at assessing asthma control test (ACT score), quality of life (QOL), and pulmonary functions in asthmatic children, and to see the correlations between ACT score, QOL, and pulmonary functions.

PATIENTS AND METHODS

This cross-sectional study was conducted at the departments of pediatrics and physiology, College of Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. A total of 109 (53 asthmatics and 56 controls) children (aged 6 to 13 years) of both genders were studied. All subjects underwent clinical evaluation, 36-Item Short Form Survey (SF-36) for QOL, Spirometry, and cognitive assessment through mini mental state examination (MMSE).

RESULTS

QOL showed significantly lower scores in asthmatic compared to non-asthmatic children. The higher social functioning [SF] (p=0.0012) and less role limitation due to physical health [RLPH] (non-asthmatic patients had had higher physical functioning [PF] (p=0.0001), less energy/fatigue [EF] (p=0.0008=0.0068). On the opposite side, no significant difference was found regarding role limitations due to emotional problems [RLEP] (p=0.0644) and Emotional well-being [EW] (p=0.0758) between the two groups. A significant positive correlation was seen between QOL items and ACT score in PF (r=.535, p<0.01), less RLPH (r=.593, p<0.01), less FE (r=.379, p<0.01), higher EW (r=.310, p<0.05), and higher SF (r=.495, p<0.01). No significant correlation was found between body mass index (BMI) and lung functions in children with asthma. Interestingly, a positive correlation was found in asthmatic children between BMI and MMSE scores (r=.298, p=0.030).

CONCLUSIONS

Our study concluded that QOL in asthmatic patients was significantly lower than healthy subjects in terms of patient's physical functioning and social life. However, the emotional aspects of QOL were not significantly affected in asthmatic children.

Acute Kidney Injury in Pediatric Patients Treated with Vancomycin and Piperacillin-Tazobactam Versus Vancomycin and Cefotaxime: A Single-center Study

Background

Previous literature showed a higher incidence of acute kidney injury (AKI) in pediatric patients using vancomycin + piperacillin-tazobactam compared to cefepime + vancomycin. Our aim was to compare the incidence of developing AKI during the use of vancomycin + cefotaxime with that during the use of vancomycin + piperacillin-tazobactam in pediatric patients.

Methods

This was a retrospective, matched cohort study that used electronic records from May 1, 2015 through April 30, 2018 for all patients aged less than 16 years who received intravenous (IV) vancomycin + piperacillin-tazobactam or cefotaxime + vancomycin for at least 72 hours. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Each patient from the vancomycin + piperacillin-tazobactam group was matched 1:1 with those in the vancomycin + cefotaxime group according to their age, chronic disease, gender, and the number of concomitant nephrotoxic agents. A total of 64 cases were included. Statistical analysis was performed using descriptive statistics and binary logistic regression.

Results

AKI developed in 10 of 32 patients (31.25%) who were using vancomycin + piperacillin-tazobactam. On the other hand, 13 of 32 patients (40.62%) were using cefotaxime + vancomycin (p = 0.047). Of the 10 patients who were on vancomycin + piperacillin-tazobactam regimen, 80% developed AKI Stage I. Of the 13 patients who were using cefotaxime + vancomycin, 46% developed AKI Stage II, although no statistical significance was noted in all stages. 

Conclusion

Our study showed that patients treated with cefotaxime and vancomycin showed a higher incidence of AKI than patients treated with vancomycin and piperacillin-tazobactam, although the study showed no statistical significance.

Social Media Use By People With Diabetes In Saudi Arabia: A Survey About Purposes, Benefits And Risks

PURPOSE

The aim of this study was to analyze the use of social media by people with diabetes in Saudi Arabia and to know the purposes, benefits and risks of its use.

METHODS

In this study a cross-sectional survey was carried out with a random sample of 158 people with all type of diabetes living in Saudi Arabia. The survey was distributed using WhatsApp and Twitter accounts of diabetic associations in Saudi Arabia. Descriptive statistics was used to analyze the data.

RESULTS

The majority of the respondents were females (69%), and most of them had type 1 diabetes (70%). Almost half (47%) of the sampled population stated that they used social media for obtaining information related to diabetes; 34% employed these platforms to get information not linked to diabetes; and the rest, 19%, were not users of social media. Also, the participants used these tools for different purposes; and the most used social media for obtaining diabetes related information were WhatsApp (67%), Twitter (54%) and Snapchat (39%). The principal benefits involved in the utilization of social media were raising awareness about diabetes (78%), improving education among patients (78%), and facilitation of communication between patients and doctors (44%). The respondents pondered that breaching of patient privacy (5%) and dissemination of inaccurate information (30%) were dangers implicated in the use of social media.

CONCLUSION

The outcomes indicated that WhatsApp was the social media most used by the participants to communicate and obtain information about diabetes. According to the participants, social media platforms were useful to improve education, awareness and communication among people with diabetes, family and doctors. However, due to the risks involved in the use of social media, health and educational organizations must work to ensure that the published information is accurate and does not affect the privacy of patients and healthcare providers.

Is end-organ surveillance necessary in patients with well-functioning metal-on-metal hip resurfacings?

Aims

Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied.

Patients and Methods

In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements.

Results

None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m2 vs 67 ml/m2, p = 0.045; right ventricular: 80 ml/m2 vs 71 ml/m2, p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time.

Conclusion

Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. Cite this article: Bone Joint J 2019;101-B:540–546.

Increased β2-adrenoceptor phosphorylation in airway smooth muscle in severe asthma: possible role of mast cell-derived growth factors

The purpose of this study was to investigate whether growth factors produced by activated human lung mast cells (HLMCs) impair β₂ -adrenoceptor (β₂ -AR) function in human airway smooth muscle (ASM) cells. Protein array analysis confirmed the presence of various growth factors, including transforming growth factor (TGF)-β1, in the supernatants of high-affinity IgE receptor (FcεRI)-activated HLMCs which, when applied to ASM cells, impaired albuterol-induced cyclic adenosine monophosphate (cAMP) production, an effect that was prevented following neutralization of TGF-β1. This blunted β₂ -AR response was reproduced by treating ASM cells with TGF-β1 or fibroblast growth factor (FGF)-2, which induced β₂ -AR phosphorylation at tyrosine residues Tyr¹⁴¹ and Tyr³⁵⁰ , and significantly reduced the maximal bronchorelaxant responses to isoproterenol in human precision cut lung slices (PCLS). Finally, ASM cells isolated from severe asthmatics displayed constitutive elevated β₂ -AR phosphorylation at both Tyr¹⁴¹ and Tyr³⁵⁰ and a reduced relaxant response to albuterol. This study shows for the first time that abnormal β₂ -AR phosphorylation/function in ASM cells that is induced rapidly by HLMC-derived growth factors, is present constitutively in cells from severe asthmatics.

Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015

OBJECTIVES

As of 1 November 2015, the Saudi Ministry of Health had reported 1273 cases of Middle East respiratory syndrome (MERS); among these cases, which included 9 outbreaks at several hospitals, 717 (56%) patients recovered, 14 (1%) remain hospitalised and 543 (43%) died. This study aimed to determine the epidemiological, demographic and clinical characteristics that distinguished cases of MERS contracted during outbreaks from those contracted sporadically (ie, non-outbreak) between 2012 and 2015 in Saudi Arabia.

DESIGN

Data from the Saudi Ministry of Health of confirmed outbreak and non-outbreak cases of MERS coronavirus (CoV) infections from September 2012 through October 2015 were abstracted and analysed. Univariate and descriptive statistical analyses were conducted, and the time between disease onset and confirmation, onset and notification and onset and death were examined.

RESULTS

A total of 1250 patients (aged 0-109 years; mean, 50.825 years) were reported infected with MERS-CoV. Approximately two-thirds of all MERS cases were diagnosed in men for outbreak and non-outbreak cases. Healthcare workers comprised 22% of all MERS cases for outbreak and non-outbreak cases. Nosocomial infections comprised one-third of all Saudi MERS cases; however, nosocomial infections occurred more frequently in outbreak than non-outbreak cases (p<0.001). Patients contracting MERS during an outbreak were significantly more likely to die of MERS (p<0.001).

CONCLUSIONS

To date, nosocomial infections have fuelled MERS outbreaks. Given that the Kingdom of Saudi Arabia is a worldwide religious travel destination, localised outbreaks may have massive global implications and effective outbreak preventive measures are needed.

Protein phosphatase 5 mediates corticosteroid insensitivity in airway smooth muscle in patients with severe asthma

BACKGROUND

The mechanisms driving glucocorticoid (GC) insensitivity in patients with severe asthma are still unknown. Recent evidence suggests the existence of GC-insensitive pathways in airway smooth muscle (ASM) caused by a defect in GC receptor (GRα) function. We examined whether other mechanisms could potentially explain the reduced sensitivity of ASM cells to GC in severe asthmatics.

METHODS

Airway smooth muscle cells from healthy and severe asthmatic subjects were treated with TNF-α and responses to corticosteroids in both cohorts were compared by ELISA, immunoblot, immunohistochemistry and real-time PCR. Immunohistochemistry and flow cytometry assays were used to assess the expression of the protein phosphatase PP5 in endobronchial biopsies and ASM cells.

RESULTS

The production of CCL11 and CCL5 by TNF-α was insensitive to both fluticasone and dexamethasone in ASM cells from severe asthmatic compared to that in healthy subjects. Fluticasone-induced GRα nuclear translocation, phosphorylation at serine 211 and expression of GC-induced leucine zipper (GILZ) were significantly reduced in ASM cells from severe asthmatics compared to responses in healthy subjects. Levels of PP5 were increased in ASM cells from severe asthmatics and PP5 knockdown using siRNA restored fluticasone repressive action on chemokine production and its ability to induce GRα nuclear translocation and GRE-dependent GILZ expression. In vivo PP5 expression was also increased in the ASM bundles in endobronchial biopsies in severe asthmatics.

CONCLUSIONS

PP5-dependent impairment of GRα function represents a novel mechanism driving GC insensitivity in ASM in severe asthma.

Comprehensive analysis of the clinical and urodynamic outcomes of primary tethered spinal cord before and after spinal cord untethering

INTRODUCTION

Primary tethered spinal cord (TSC) refers to a group of abnormalities associated with a posterior bony spinal defect that develops beneath an intact dermis and epidermis. There is relative agreement that patients with symptomatic TSC will require surgical intervention. However, it is still debatable as to how to approach asymptomatic patients with primary TSC.

OBJECTIVE

To study the clinical and urodynamic (UDS) outcomes of patients with primary TSC after spinal cord untethering (SCU).

STUDY DESIGN

Charts of patients with primary TSC between 1998 and 2010 were retrospectively reviewed. Patients that underwent before and after SCU clinical and UDS evaluation with minimum of 5-years follow-up were included. Continence status was assessed in children ≥5 years. Patients with dry intervals of ≥4 h were considered continent. Urologic and neuro-orthopedic manifestations, as well as UDS parameters, were compared before and after SCU. Categorical data were compared using Fisher-Exact test and continuous variables were compared using Wilcoxon-Signed-Rank test. A P-value <0.05 was considered significant.

RESULTS

Twenty-two patients met the inclusion criteria. The median age at time of SCU was 11.5 months (range 3-211). The median age at time of follow-up UDS after SCU was 22 months (range 9-218). The median age at time of last follow-up was 153.5 months (range 65-228). The median follow-up time was 71 months (range 60-192). A total of 14/22 patients had clinical manifestation before SCU, while 8/22 were asymptomatic and diagnosed based on magnetic resonance imaging/UDS findings. Of the symptomatic patients, 86% had symptom improvement after SCU. The UDS parameters showed statistically significant improvement in the median percentage of change of actual bladder capacity (P = 0.01), median intravesical pressure for patients with pre-operative pressure ≥40 cm/H2O at total cystometric bladder capacity (P = 0.012), and median bladder compliance at 75% bladder capacity (P = 0.01) (Table).

DISCUSSION

Tethered spinal cord syndrome (TSCS) is a clinical entity that presents with neurological, urological, and/or orthopedic symptoms caused by primary or secondary tethering of the spinal cord, which may result in ischemic damage of the neural tissue and symptom development. While some authors believe that surgical management should be reserved for symptomatic patients, others prefer prophylactic surgery to avoid possible irreversible neurological damage. The present study provides detailed discussion of the clinical and UDS outcomes for patients with primary TSC that underwent SCU.

CONCLUSION

For patients with primary TSC, spinal cord untethering is beneficial in terms of clinical and UDS outcomes. A prospective long-term study with large numbers could further highlight outcomes for this particular group of patients.

Correlation of Preoperative Ki67 and Serum CA15.3 Levels with Outcome in Early Breast Cancers a Multi Institutional Study

BACKGROUND

To investigate the association between preoperative pathological Ki67 labeling index and serum tumor marker cancer antigen 153 (CA 153) with clinicpathological parameters and treatment outcomes in early breast cancer.

MATERIALS AND METHODS

A retrospective study at 4 cancer centers in Saudi Arabia and Egypt was performed. Data were collected for female patients diagnosed with unilateral early breast cancer between March 2010 and October 2013. Cases treated with neoadjuvant chemotherapy (NACT) followed by surgery and radiotherapy were included. NACT included 68 cycles of anthracycline and taxane based regimens. Trastuzumab and hormonal treatments were added according to HER2 and hormone receptor status. Baseline serum CA15.3 and pathological Ki67 levels were evaluated and correlated with disease free survival (DFS) and overall survival (OS).

RESULTS

A total of 280 pts was included. The median age was 49 years (3866 y) and median overall survival was 35 (2038) months (mo). Estrogen receptors (ER), progesterone receptors (PR) and HER 2 receptors were positive in 233 (83.2%), 198 (70%) and 65 cases (23.2%), respectively. High preoperative Ki67 and CA15.3 were noted in 177 (63.2%) and 131 (46.8%). A total of 45 (16%) patients had distal or local recurrence and 24 (8.6%) died of their disease. Most of the relapsed cases had high preoperative Ki67 (n=41, 91%) and CA15.3 (n=28, 62%) values. All of the patients who died had a high Ki67 but CA15.3 was high in 9 (37%) only. Mean DFS/OS in patients with high preoperative Ki67 was 32 months /32 months as compared to 37 months/35 months in those with normal Ki67 (p<0.001). Correlation of preoperative CA15.3 and survival was statistically not significant.

CONCLUSIONS

Preoperative Ki67 can be a predictive and prognostic marker. Higher levels are associated with poor DFS and OS in patients with early BC.

Predictive Value of the Pattern of β-Catenin Expression for Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients

PURPOSE

This study aimed to explore the association of β-catenin expression pattern with pathological response after neoadjuvant chemotherapy in breast cancer (BC) patients.

MATERIALS AND METHODS

In this retrospective exploratory study, data for 50 BC patients who received neoadjuvant chemotherapy were recorded. β-catenin expression in tumours was assessed using immunohistochemistry and classified as either membranous or cytoplasmic according to the pattern of staining. Distributions of different clinico-pathological parameters according to β-catenin expression were assessed using the Chi-square test. Logistic regression analysis was used to assess any relation of the pattern of β-catenin expression with the pathological response.

RESULTS

Cytoplasmic β-catenin expression was detected in 34% of BCs. Among our cases, 52% were hormonal receptor (HR)-positive, 24% were HER2-positive, 74% were clinical stage III and 74% received both anthracycline and taxane-based chemotherapy. Patients with cytoplasmic expression were more commonly younger than 40 years at diagnosis (cytoplasmic, 41.2% vs. no cytoplasmic expression, 12.1%, p=0.03). By doing t-test, cytoplasmic β-catenin expression was linked with a higher body mass index compared to membranous-only expression (mean± SD 33.0 ± 4.47 vs. 29.6 ±6.01, respectively, p=0.046). No significant associations were found between β-catenin expression and other parameters such as HR and HER2 status, or clinical stage. Complete pathological response (pCR) rate was twice as great in patients with membranous expression but without statistical signi cance (membranous- only, 33.3% vs. cytoplasmic, 17.6%, OR=2.3, 95% CI= 0.55-9.87, p=0.24).

CONCLUSIONS

This study suggests that cytoplasmic β-catenin expression may be linked with lower probability of achieving pCR after neoadjuvant chemotherapy. These data need to be validated in a larger cohort of patients.

Mammographic breast density: Predictive value for pathological response to neoadjuvant chemotherapy in breast cancer patients

BACKGROUND

This study aims to evaluate the relation between mammographic breast density (BD) and pathological response to neoadjuvant chemotherapy.

METHODS

In this retrospective study, 241 breast cancer patients who received neoadjuvant chemotherapy were included. BD was assessed in mammograms already performed at diagnosis. Pathological complete response (pCR) and pathological stage were correlated with BD, tumour phenotype and other clinico-pathological factors.

RESULTS

Patients with low BD had better pCR compared to those with high density (30.5% vs 19.5% respectively, OR = 1.8, 95% CI = 0.98-3.3, p = 0.056) which was more pronounced after adjustment with body mass index (BMI) (OR = 2.4, 95% CI = 1.2-4.8, p = 0.011). HER2-positive disease (32.5% vs. 18.4%, OR = 2.2, 95% = 1.2-4.0, p = 0.01), lower BMI (OR = 1.1, 95% CI = 1.03-1.15, p = 0.004) and lower clinical stage (p = 0.002) were significant predictors of pCR in univariate analysis. In multivariate analysis, low BD (OR = 2.7, 95% CI = 1.3-5.5, p = 0.006) and lower BMI (OR = 1.1, 95% CI = 1.03-1.17, p = 0.003) were independent predictors of better pCR, while early clinical stage (I, II) was of borderline significance (OR = 2.6, 95% CI = 0.99-6.7, p = 0.052). High BD (OR = 1.8, 95% CI = 1.1-3.2, p = 0.03), advanced clinical stage (III) (OR = 1.5, 95% CI = 1.03-2.1, p = 0.03) and higher BMI (OR = 1.06, 95% CI = 1.02-1.11, p = 0.006) were significant predictors of advanced pathological stage.

CONCLUSION

Low mammographic BD, low BMI and early clinical stage were associated with improved pCR rate and lower pathological stage after neoadjuvant chemotherapy. BD had more pronounced association with response to chemotherapy after adjustment with BMI.

Genome-wide expression analysis of Middle Eastern papillary thyroid cancer reveals c-MET as a novel target for cancer therapy

In an attempt to find genes that may be of importance in malignant progression of papillary thyroid carcinoma (PTC) in the Middle East, which therefore can be targeted in cancer therapy, we screened and validated the global gene expression in PTC using cDNA expression arrays and immunohistochemistry (IHC) on tumour tissue microarrays. Twenty-nine PTC tissue specimens were compared with seven non-cancerous thyroid specimens by use of cDNA microarray. Results for selected genes were confirmed by quantitative real-time PCR. Protein expression of selected genes was further studied using a tissue microarray consisting of 536 PTCs and compared with histologically non-cancerous tissue samples. One hundred and ninety-six genes were overexpressed in PTC tissues relative to non-cancerous thyroid tissues. The genes that were up-regulated in PTC were involved in cell cycle regulation, cell signaling, and oncogenesis. Among these genes, c-MET was identified by immunohistochemical methods as a protein that is overexpressed in 37% of PTCs and was significantly associated with more aggressive behaviour, eg higher stage, nodal involvement, and tall cell variant (p value = 0.01, 0.01 and 0.04, respectively). In this study, 55% of the PTC cases expressed activated AKT (P-AKT), which suggests that activated AKT may play an important role in PTC tumourigenesis. The fact that most of the PTC cases that had activated AKT showed overexpression of c-MET (p = 0.027) leads us to hypothesize that c-MET may be an alternative mechanism of AKT activation in Middle Eastern PTCs. Finally, our data suggest that c-MET dysregulation is associated with aggressive behaviour and may serve as a molecular biomarker and potential therapeutic target in this disease.

Surgical approach after failed enteryx injection for GERD

OBJECTIVE

We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection.

METHODS

Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication.

RESULTS

Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia.

CONCLUSION

Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively.