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Alanteet A, Attia H, Alfayez M, Mahmood A, Alsaleh K, Alsanea S. Liraglutide attenuates obese-associated breast cancer cell proliferation via inhibiting PI3K/Akt/mTOR signaling pathway. Saudi Pharm J 2024; 32:101923. [PMID: 38223522 PMCID: PMC10784703 DOI: 10.1016/j.jsps.2023.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
This study aims to explore the anti-proliferative, pro-apoptotic, and anti-migration activities of liraglutide (LGT) in MCF-7 breast cancer (BC) cells in subjects with obesity, particularly its effects on the PI3K/Akt/mTOR/AMPK pathway. The role of AMPK/SIRT-1, an essential regulator of adipokine production, in the effect of LGT on the production of adipose-derived adipokine was also assessed. MCF-7 cells were incubated in conditioned medium (CM) generated from adipose-derived stem cells (ADSCs) of obese subjects. MCF-7 cells were then treated with LGT for 72 h. Anti-proliferative, pro-apoptotic, and anti-migration activities were investigated using alamarBlue, annexin V stain, and scratch assay, respectively. Protein levels of phosphorylated PI3K, p-Akt, p-mTOR, and p-AMPK were investigated using immunoblotting. Levels of adipokines in ADSCs were determined using RT-PCR before and after transfection of ADSCs using the specific small interference RNA sequences for AMPK and SIRT-1. LGT evoked anti-proliferative, apoptotic, and potential anti-migratory properties on MCF-7 cells incubated in CM from obese ADSCs and significantly mitigated the activity of the PI3K/Akt/mTOR survival pathway-but not AMPK-in MCF-7 cells. Furthermore, the anti-proliferative effects afforded by LGT were similar to those mediated by LY294002 (PI3K inhibitor) and rapamycin (mTOR inhibitor). Our results reveal that transfection of AMPK/SIRT-1 genes did not affect the beneficial role of LGT in the expression of adipokines in ADSCs. In conclusion, LGT elicits anti-proliferative, apoptotic, and anti-migratory effects on BC cells in obese conditions by suppressing the activity of survival pathways; however, this effect is independent of the AMPK/SIRT1 pathway in ADSCs or AMPK in BC cells.
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Affiliation(s)
- Alaa Alanteet
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hala Attia
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Musaed Alfayez
- Anatomy Department, Stem Cell Unit, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Amer Mahmood
- Anatomy Department, Stem Cell Unit, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Khalid Alsaleh
- College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sary Alsanea
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Alsaleh K, Al Zahwahry H, Bounedjar A, Oukkal M, Saadeddine A, Mahfouf H, Bouzid K, Bensalem A, Filali T, Abdel-Razeq H, Larbaoui B, Kandil A, Abulkhair O, Al Foheidi M, Ghosn M, Rasool H, Boussen H, Mezlini A, Haddaoui A, Ayari J, Al Ghamdi M, Errihani H, Abdel-Aziz N, Arafah M, Dabouz F, Bahadoor M, Kullab S, Nabholtz JM. Neoadjuvant endocrine therapy with or without palbociclib in low-risk patients: a phase III randomized double-blind SAFIA trial. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04588-3. [PMID: 36680581 PMCID: PMC9864499 DOI: 10.1007/s00432-023-04588-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The most prevalent subtype of breast cancer (BC) is luminal hormonal-positive breast cancer. The neoadjuvant chemotherapy regimens have side effects, emphasizing the need to identify new startegies. OBJECTIVE Analyze the complete pathologic response (pCR) rate and overall response in a low-risk hormone-positive subset of patients receiving neoadjuvant hormone treatment (NAHT) with or without Palbociclib (a CDK4/CDK6 inhibitor) to boost NAHT effectiveness. MATERIALS AND METHODS Based on the upfront 21-gene Oncotype DX or low-risk Breast Recurrence Score assay (RS™), the SAFIA trial is designed as a prospective multicenter international, double-blind neoadjuvant phase-III trial that selects operable with luminal BC patients that are HER2-negative for the induction hormonal therapy with Fulvestrant 500 mg ± Goserelin (F/G) followed by randomization of responding patients to palbociclib versus placebo. The pCR rate served as the study's main outcome, while the secondary endpoint was a clinical benefit. RESULTS Of the 354 patients enrolled, 253 initially responded and were randomized to either F/G fulvestrant with palbociclib or placebo. Two hundred twenty-nine were eligible for the evaluation of the pathologic response. No statistically significant changes were observed in the pCR rates for the patients treated with the F/G therapy with placebo or palbociclib (7% versus 2%, respectively) per the Chevallier classification (Class1 + Class2) (p = 0.1464) and 3% versus 10% assessed per Sataloff Classification (TA, NA/NB) (p = 0.3108). Palbociclib did not increase the rate of complete pathological response. CONCLUSION Neoadjuvant hormonal therapy is feasible in a selected population with a low RS score of < 31 CLINICAL TRIAL: NCT03447132.
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Affiliation(s)
- K. Alsaleh
- grid.56302.320000 0004 1773 5396College of Medicine, King Saud University, King Saud University Medical City (KSUMC), Oncology Center, Riyadh, 12372 Saudi Arabia
| | - H. Al Zahwahry
- grid.7776.10000 0004 0639 9286National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | | | - M. Oukkal
- Medical Oncology Department/Beni-Messous University Hospital, Algiers, Algeria
| | - A. Saadeddine
- grid.415254.30000 0004 1790 7311Oncology Center, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | | | - K. Bouzid
- Oncology Center of Pierre Et Marie Curie, Algiers, Algeria
| | - A. Bensalem
- Dr. Benbadis University Hospital, Constantine, Algeria
| | - T. Filali
- Constantine University Hospital, Constantine, Algeria
| | - H. Abdel-Razeq
- grid.419782.10000 0001 1847 1773King Hussein Cancer Center (KHCC), Amman, Jordan
| | - B. Larbaoui
- Oncology Center of Emir Abdelkader, Oran, Algeria
| | - A. Kandil
- grid.7155.60000 0001 2260 6941Alexandria University, Alexandria, Egypt
| | - O. Abulkhair
- Specialized Medical Center (SMC), Riyadh, Saudi Arabia
| | - M. Al Foheidi
- grid.415254.30000 0004 1790 7311Oncology Center of Princess Noorah, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - M. Ghosn
- grid.413559.f0000 0004 0571 2680Hematology-Oncology Department/Hotel Dieu de France/University Saint Joseph, Beirut, Lebanon
| | - H. Rasool
- grid.415310.20000 0001 2191 4301King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia
| | - H. Boussen
- grid.12574.350000000122959819Faculty of Medicine, University Tunis El Manar, Abderrahmen Mami Hospital, Tunis, Ariana Tunisia
| | - A. Mezlini
- Medical Oncology Department, Tunis, Tunisia
| | | | - J. Ayari
- Faculty of Medicine Tunis, Oncology Department, University Tunis El Manar, Military Hospital of Tunis, Tunis, Tunisia
| | - M. Al Ghamdi
- grid.56302.320000 0004 1773 5396Oncology center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, 12372 Saudi Arabia
| | - H. Errihani
- Medical Oncology, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - N. Abdel-Aziz
- grid.56302.320000 0004 1773 5396Oncology Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - M. Arafah
- grid.56302.320000 0004 1773 5396Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - F. Dabouz
- International Cancer Research Group (ICRG), Sharjah, UAE
| | - M. Bahadoor
- International Cancer Research Group (ICRG), Sharjah, UAE
| | - S. Kullab
- grid.56302.320000 0004 1773 5396Oncology center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, 12372 Saudi Arabia
| | - J. M. Nabholtz
- grid.56302.320000 0004 1773 5396Oncology center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, 12372 Saudi Arabia
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Cicin İ, Oukkal M, Mahfouf H, Mezlini A, Larbaoui B, Ahmed SB, Errihani H, Alsaleh K, Belbaraka R, Yumuk PF, Goktas B, Özgüroğlu M. An Open-Label, Multinational, Multicenter, Phase IIIb Study with Subcutaneous Administration of Trastuzumab in Patients with HER2-Positive Early Breast Cancer to Evaluate Patient Satisfaction. Eur J Breast Health 2022; 18:63-73. [DOI: 10.4274/ejbh.galenos.2021.2021-9-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022]
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Alyamani MJ, AlSalloum H, Elgohary G, Alsaleh K, Abd El Warith A, Abd El-Aziz N. Granulocyte Colony-Stimulating Factor Utilization and Prescribing Patterns in Cancer Patients: A Single Institution Experience of a Saudi Cancer Center. Cureus 2022; 14:e27017. [PMID: 35989759 PMCID: PMC9387745 DOI: 10.7759/cureus.27017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Febrile neutropenia (FN), owing to its negative association with immune function and infectious complications, acts as a treatment-limiting factor in myelotoxic cancer chemotherapy. This study aimed to analyze the incidence of FN, utilization of granulocyte colony-stimulating factor (G-CSF) in patients who experienced FN, and its association with age and comorbidities. Methodology This retrospective study was conducted in a major tertiary hospital in Riyadh, Kingdom of Saudi Arabia. Inclusion criteria entailed all neutropenic adults aged >18 years with a proven cancer diagnosis, including solid and hematological malignancies. Patients who were treated with chemotherapy and G-CSF were included in the study. Data regarding FN, administration of G-CSF, and patient and physician-related factors were collected. Results We collected data on 53 cancer patients with a mean age of 41.9 ± 17.1 years (range = 16-75). FN was present in 16 (30.2%) patients and absent in 37 (69.8%) patients. The mean neutrophil count post-filgrastim did not significantly differ from pre-chemotherapy neutrophil count (Student’s t-test, p = 0.067), while there was a significant difference from post-chemotherapy neutrophil count (Student’s t-test, p = 0.044). In our cohort, 24 (45.3%) patients achieved remission, 12 (22.6%) died, and 17 (32.1%) were not cured. We did not find any significant association between gender, specialty, comorbidities, and age with FN. Conclusions G-CSF administration significantly decreases the incidence of FN post-chemotherapy in cancer patients.
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AlHejazi A, AlBeihany A, AlHashmi H, Alzahrani H, Motabi I, El-Hemaidi I, Alsaleh K, El Tayeb K, Rabea M, Khallaf M, Qari M. Approaches to acquired thrombotic thrombocytopenic purpura management in Saudi Arabia. J Appl Hematol 2022. [DOI: 10.4103/joah.joah_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kepesidis KV, Bozic-Iven M, Huber M, Abdel-Aziz N, Kullab S, Abdelwarith A, Al Diab A, Al Ghamdi M, Hilal MA, Bahadoor MRK, Sharma A, Dabouz F, Arafah M, Azzeer AM, Krausz F, Alsaleh K, Zigman M, Nabholtz JM. Breast-cancer detection using blood-based infrared molecular fingerprints. BMC Cancer 2021; 21:1287. [PMID: 34856945 PMCID: PMC8638519 DOI: 10.1186/s12885-021-09017-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer screening is currently predominantly based on mammography, tainted with the occurrence of both false positivity and false negativity, urging for innovative strategies, as effective detection of early-stage breast cancer bears the potential to reduce mortality. Here we report the results of a prospective pilot study on breast cancer detection using blood plasma analyzed by Fourier-transform infrared (FTIR) spectroscopy - a rapid, cost-effective technique with minimal sample volume requirements and potential to aid biomedical diagnostics. FTIR has the capacity to probe health phenotypes via the investigation of the full repertoire of molecular species within a sample at once, within a single measurement in a high-throughput manner. In this study, we take advantage of cross-molecular fingerprinting to probe for breast cancer detection. METHODS We compare two groups: 26 patients diagnosed with breast cancer to a same-sized group of age-matched healthy, asymptomatic female participants. Training with support-vector machines (SVM), we derive classification models that we test in a repeated 10-fold cross-validation over 10 times. In addition, we investigate spectral information responsible for BC identification using statistical significance testing. RESULTS Our models to detect breast cancer achieve an average overall performance of 0.79 in terms of area under the curve (AUC) of the receiver operating characteristic (ROC). In addition, we uncover a relationship between the effect size of the measured infrared fingerprints and the tumor progression. CONCLUSION This pilot study provides the foundation for further extending and evaluating blood-based infrared probing approach as a possible cross-molecular fingerprinting modality to tackle breast cancer detection and thus possibly contribute to the future of cancer screening.
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Affiliation(s)
- Kosmas V Kepesidis
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany.
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany.
| | - Masa Bozic-Iven
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
| | - Marinus Huber
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Nashwa Abdel-Aziz
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Sharif Kullab
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Ahmed Abdelwarith
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | | | - Mohammed Al Ghamdi
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Muath Abu Hilal
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Mohun R K Bahadoor
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Abhishake Sharma
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Farida Dabouz
- Clinical Operations, International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Maria Arafah
- Pathology Department, King Saud University, Riyadh, Saudi Arabia
| | - Abdallah M Azzeer
- Physics and Astronomy Department, Attosecond Science Laboratory, King Saud University, Riyadh, Saudi Arabia
| | - Ferenc Krausz
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Khalid Alsaleh
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
| | - Mihaela Zigman
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Laboratory for Attosecond Physics, Max Planck Institute of Quantum Optics (MPQ), Garching, Germany
| | - Jean-Marc Nabholtz
- Department of Laser Physics, Ludwig Maximilian University of Munich (LMU), Garching, Germany
- Oncology Centre, King Saud University (Medical City), Riyadh, Saudi Arabia
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Owaidah T, Saleh M, Aguilos AM, Amri AA, Maghrabi K, Owaidah M, Siddiqui K, Alsaleh K, Alnounou R. Incidence of lupus anticoagulant in hospitalized covid-19 patients. Am J Blood Res 2021; 11:317-324. [PMID: 34322296 PMCID: PMC8303017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Procoagulant profile of 2019-nCoV/SARS-CoV-2 has been well documented over the last year. Perturbance in coagulating factors has also been reported in Covid-19 patients, including increased d-dimers and reports of lupus anticoagulant (LA). METHODS The current study aimed to identify the incidence of positivity of lupus anticoagulant in Covid-19 patients and analyze the association between LA and D-dimer in predicting thrombosis and mortality in one-hundred and five hospitalized adult (age >14 years) patients and forty-three hospitalized pediatric (age <14 years) patients with a confirmed diagnosis of Covid-19 between June 2020 and September 2020. RESULTS Twenty-one (20%) adult patients were tested positive for PTT LA, of which nine (8.6%) turned out to be confirmed positive for LA through StaClot and DRVVT Ratio tests. Six (14%) pediatric patients were positive for PTT LA, and only one (2.3%) had positive StaClot. Median D-dimer at admission was positively correlated with age and CRP among adult patients and was significantly higher in expired cases (P=0.001). No association between any of the coagulation tests and thrombosis or mortality was observed in the pediatric cohort. CONCLUSION We report an increased incidence of LA in Covid-19 patients, yet we didn't find any association between thrombotic events or mortality, probably due to the small sample size.
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Affiliation(s)
- Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
- Alfaisal UniversityRiyadh 11533, KSA
| | - Mahasen Saleh
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
| | - Amelita M Aguilos
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
| | - Abdulllah Al Amri
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
| | - Khalid Maghrabi
- Department of Critical Care, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
| | | | - Khawar Siddiqui
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
| | - Khalid Alsaleh
- Department of Medicine, College of Medicine, King Saud UniversityRiyadh 12372, KSA
| | - Randa Alnounou
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research CentreRiyadh 11211, KSA
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Alsaleh K, Essbaiheen F, Aldosari K, Alsubei B, Alabdulkareeem M. Morphometric Analysis of Subaxial Cervical Spine Pedicles in a Middle Eastern Population. Int J Spine Surg 2021; 15:413-417. [PMID: 33963031 DOI: 10.14444/8061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pedicle screw instrumentation of the posterior cervical spine is the most secure form of fixation available to surgeons. It has not achieved widespread use yet in the Middle East, mostly due to concerns regarding its feasibility in the target population. A detailed morphometric analysis of the lower cervical spine pedicles using computerized tomography (CT) was proposed to address this issue. METHODS Two hundred and seventy patients were enrolled in the study. CT scans were reviewed by two experienced assessors, and measurements of pedicle width (PW), height (PH), and transverse angle (TA) were recorded for all patients. Interobserver and intraobserver reliability were calculated using the kappa statistic. Sex differences were also recorded and analyzed. The t test was used to assess for any significant differences in measurements due to sex (P < .05). RESULTS The mean PW varied from 4.4 mm in C3 to 6.1 mm in C7. The mean PH was 6.4 mm in C3 and 6.8 mm in C7. Pedicle TA varied from 42 to 51 degrees between the different levels. Sex differences were observed and were statistically significant for PW and PH. Interobserver reliability was high for PW and PH, but was low for TA. Intraobserver reliability was 0.99 for both assessors. CONCLUSION This study provides reliable PW and PH measurements and demonstrates that cervical pedicle screw instrumentation is feasible in our local population. Significant variability exists, however, and each patient must be addressed individually for best results. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE This study shows that the morphology of the subaxial cervical pedicle permits instrumentation in a majority of cases of our target population.
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Affiliation(s)
- Khalid Alsaleh
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Essbaiheen
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Bandar Alsubei
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alfadda A, Albilali A, Alqurtas E, Alharbi A, Ekhzaimy A, Muayqil T, Bedaiwi M, Barry M, Azzam N, Aljebreen A, Isnani A, Bahammam A, Nasser A, Nouh T, Alzahrani M, Alsaleh K, Alfaadhel T, Alotaibi N, Alayed K, Alkhowaiter M. COVID-19 pandemic preparedness and mitigation plan: Department of internal medicine experience from a clinical perspective. J Nat Sci Med 2021. [DOI: 10.4103/jnsm.jnsm_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shaheen M, Almohareb F, Aljohani N, Ayas M, Chaudhri N, Abosoudah I, Alotaibi S, Alshahrani M, Alsharif F, Akhtar S, Alhumaidan H, Rasheed W, Alfraih F, Al-Anazi K, Alhashmi H, Al-Daama S, Hanbali A, Alsaleh K, Alzahrani H, Ibrahim K, Alawwami M, Albeirouti B, Albeihany A, Alabdulwahab A, Motabi I, Zaidi SZA, Ahmed SO, Aljefri A, Hussain F, Alahmari A, Hashmi S, Elsolh H, Alseraihy A, Aljurf M. Hematopoietic stem cell transplantation in Saudi Arabia between 1984 and 2016: Experience from four leading tertiary care hematopoietic stem cell transplantation centers. Hematol Oncol Stem Cell Ther 2020; 14:169-178. [PMID: 32888899 DOI: 10.1016/j.hemonc.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
Saudi Arabia is the largest of the Arabian Gulf countries with a total population of 33.41 million as of 2017. This report summarizes the experience from four leading tertiary care hematopoietic stem cell transplantation (HSCT) centers in Saudi Arabia representing more than 90% of all HSCTs performed in the country. Between 1984 and 2016, a total of 6,184 HSCTs were performed. Of these, 3,586 HSCTs were performed in adults and 2,598 HSCTs were performed in pediatric patients. Malignancy was the main indication for transplantation (47%). While most transplants were performed from an identical sibling donor, HSCTs from cord blood, unrelated and, more recently, haploidentical donors have also been performed. Relative shortage of HSCT bed capacity is perceived to be a limiting factor in Saudi Arabia. Lately, more HSCT centers are emerging with rapid growth, which may significantly improve the access to HSCT in the country in the near future.
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Affiliation(s)
- Marwan Shaheen
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia.
| | - Fahad Almohareb
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Naif Aljohani
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Ibraheem Abosoudah
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | | | | | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Saad Akhtar
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Hind Alhumaidan
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | | | - Hani Alhashmi
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Saad Al-Daama
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- King Khalid University Hospital, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Khalid Ibrahim
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Moheeb Alawwami
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Bassim Albeirouti
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Jeddah, Saudi Arabia
| | | | | | | | | | - Syed O Ahmed
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Abdullah Aljefri
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Fazal Hussain
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Shahrukh Hashmi
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Hassan Elsolh
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Amal Alseraihy
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Hematopoietic Stem Cell Transplantation, Riyadh, Saudi Arabia
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Abstract
STUDY DESIGN Bibliographic analysis. OBJECTIVE The aim of this study is to identify the most cited studies on lumbar spondylolisthesis and report their impact in spine field. METHODS Thomson Reuters Web of Science-Science Citation Index Expanded was searched using title-specific search "spondylolisthesis." All studies published in English language between 1900 and 2019 were included with no restrictions. The top 100 cited articles were identified using "Times cited" arranging articles from high to low according to citation count. Further analysis was made to obtain the following items: article title, author's name and specialty, country of origin, institution, journal of publication, year of publication, citations number, study design. RESULTS The citation count of the top 100 articles ranged from 68 to 589. All published between 1932 and 2016. Among 20 journals, Spine had the highest number of articles (49), with citation number of 6155 out of 13 618. Second ranked was Journal of Bone and Joint Surgery with 15 articles and total citations of 3023. With regard to the primary author's specialty, orthopedic surgeons contributed to the majority of top 100 list with 82 articles, and neurosurgery was the second specialty with 11 articles. The United States had produced more than half of the list with 59 articles. England was the second country with 7 articles. Surgical management of degenerative lumbar spondylolisthesis was the most common discussed topic. CONCLUSION This article identifies the top 100 influential articles on lumbar spondylolisthesis and recognizes an important aspect of knowledge evolution served by leading researchers as they guided today's clinical decision making in spondylolisthesis.
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Affiliation(s)
- Khalifah Aldawsari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Khalifah Aldawsari, College of Medicine, King Saud
University, Riyadh 11451, Saudi Arabia.
| | | | - Khalid Alsaleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,College of Medicine, King Khalid University Hospital, Riyadh, Saudi
Arabia
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12
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Balkhi B, Alqahtani S, Altayyar W, Ghawaa Y, Alqahtani Z, Alsaleh K, Asiri Y. Drug utilization and expenditure of anticancer drugs for breast cancer. Saudi Pharm J 2020; 28:669-674. [PMID: 32550797 PMCID: PMC7292878 DOI: 10.1016/j.jsps.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/17/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Drug utilization studies have proven to be an effective tool in the evaluation of rational drug use in different health care systems, including oncology. The drug utilization studies were used in many institutes to ensure the safe, effective and appropriate use of drugs being prescribed. The main aim of this study was to assess the utilization pattern of anticancer drugs in breast cancer patients. Method A retrospective cross-sectional observational study was carried out at King Saud University Medical City (KSUMC) for 1 year from January 2016 to December 2016. All female patients diagnosed with breast cancer during this year were included in the study. Results A total of 101 patients were included in this study. Most patients received an average of three anticancer drugs. The most commonly prescribed medication was fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen, which was used in 81% of patients. Combinations of FEC + docetaxel and FEC + docetaxel + trastuzumab were received by43% and 23% of patients, respectively. Docetaxel was the most commonly used drug in neoadjuvant setting, whereas letrozole and trastuzumab were prescribed more frequently in hormonal and targeted therapies, respectively. The total drug expenditure on anticancer therapy was approximately 3.8 million Saudi Riyals (S.R), with adjuvant therapy constituting over half of the total spending. In neoadjuvant settings, the spending cost for hormonal therapy was the highest. The condition of most breast cancer patients was improved during the study period, whereas only 29% of the included patients progressed. Conclusion FEC was the most common regimen used in this study, consistent with the National Comprehensive Cancer Network (NCCN) guideline recommendation. Our results indicated that adherence to a clinical guideline and recommended medication regimens improved patient outcomes. Our finding indicate how analyzing drug utilization pattern could benefit institutions in managing inventory and efficiently using health care resources.
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Affiliation(s)
- Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Saeed Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Clinical Pharmacokinetics and Pharmacodynamics Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Waad Altayyar
- Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yazeed Ghawaa
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Zuhair Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Oncology Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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13
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Jazieh AR, Ibrahim N, Abdulkareem H, Maraiki F, Alsaleh K, Thill M. Expert-Based Strategies to Improve Access to Cancer Therapeutics at the Hospital Level. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/jqsh.jqsh_4_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Background: Challenges related to access to cancer medications is an increasing global problem that has far-reaching impact on patients and healthcare systems. In this article, we are enlisting suggested solutions at the hospital or practice level to maximize the access to these important treatment modalities. Methods: An expert panel of practicing oncologists, clinical pharmacists, and health economists convened using a framework approach. The panelists identified individuals and entities that impact the use of cancer therapeutics and how they can improve the utilization and access to them. They enlisted the potential actions that hospital management and staff can take to enhance access to cancer therapeutics, then they grouped them into specific categories. Results: List of potential strategies and related action items were compiled into different categories including hospital leadership, drug evaluation entities, pharmacy, physicians, patients and families, and other parties. Recommendations included various actions to be considered by each group to achieve set goals. Conclusion: Our expert panel recommend multiple strategies and approaches to reduce the cost of cancer medications and improve patients' access to them. These recommendations can be adapted by the decision-makers and staff of the hospitals to their own settings and the current circumstances.
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Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
| | - Nagwa Ibrahim
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Pharmacy, Prince Sultan Military Medical City,
| | - Hana Abdulkareem
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs,
| | - Fatma Maraiki
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Pharmacy, King Faisal Specialist Hospital and Research Center,
| | - Khalid Alsaleh
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of Oncology, King Khalid University Hospital, Riyadh, Saudi Arabia,
| | - Marc Thill
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Ministry of National Guard Health Affairs,
- Department of OB and GYN, Certified Breast Cancer Center, Certified Cancer Center, Certified Endometriosis Center, Certified Dysplastic Unit, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
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14
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Azzam N, AlRuthia Y, Alharbi O, Aljebreen A, Almadi M, Alarfaj M, Alsaleh K, Almasoud A, Alsharidah M, Alseneidi S, Alali F, Alalwan M. Predictors of Survival Among Colorectal Cancer Patients in a Low Incidence Area. Cancer Manag Res 2020; 12:451-459. [PMID: 32021457 PMCID: PMC6982433 DOI: 10.2147/cmar.s233215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Colorectal cancer is the third most common malignancy in Saudi Arabia. The best therapeutic regimen for colorectal cancer is a matter of ongoing debate and data on its treatment in Saudi Arabia are limited. Purpose The objective of this study was to explore the predictors of survival and to compare the risk of mortality among colorectal cancer patients treated with different therapeutic modalities. Patients and Methods The study utilized data from the electronic colorectal cancer registry of a university-affiliated tertiary care hospital. The Kaplan-Meier survival analysis was used to estimate the survival rates over 36 months of follow-up across rectal and colon cancer patients as well as different sociodemographic and medical characteristics. Bivariate and multiple Cox proportional-hazards regressions were conducted to estimate the risk of mortality among rectal and colon cancer patients undergoing different treatments. Results The number of patients in the registry who were followed up for 36 months was 143 patients. The majority of patients had colon cancer (74.13%). Rectal cancer patients had generally better survival estimates compared to their colon cancer counterparts. Colon cancer patients treated with chemotherapy had a significantly lower risk of mortality controlling for the use of surgery, radiotherapy, and other variables including age, gender, stage of cancer, and family history of colorectal cancer (HR=0.33; P=0.03). Additionally, colon cancer patients with a family history of colorectal cancer had significantly higher risk of mortality (HR=3.40; P=0.02). Conclusion The findings of this study highlight the value of chemotherapy in managing colon cancer patients.
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Affiliation(s)
- Nahla Azzam
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Othman Alharbi
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Aljebreen
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majid Almadi
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Maryam Alarfaj
- Department of Pharmaceutical Care, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Hematology/Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Almasoud
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhannad Alsharidah
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sarah Alseneidi
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah Alali
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Malak Alalwan
- Gastroenterology Division, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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15
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Alsaleh K, Alduhaish A. A limited unilateral transpedicular approach for anterior decompression of the thoracolumbar spinal cord in elderly and high-risk patients. J Craniovertebr Junction Spine 2019; 10:88-93. [PMID: 31404136 PMCID: PMC6652254 DOI: 10.4103/jcvjs.jcvjs_20_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Surgical treatment for elderly patients with thoracolumbar (TL) kyphosis and spinal cord (SC) compression presents significant challenges due to compression location, the amount of deformity, and patient's medical status might not permit full correction of the deformity. In this series, we present a surgical approach that provides adequate decompression without the risks associated with a pedicle subtraction osteotomy/posterior vertebral column resection or an anterior corpectomy. Methods: Three patients presented with TL kyphosis and progressive neurologic symptoms. All had acute weakness; none were ambulatory. SC was compressed over the apex of kyphosis, and for some, there was spinal stenosis at the proximal junction of the TL spine. The surgical technique involved unilateral resection of the pars, pedicles, the posterior one-third of the lateral wall of the vertebral body, decancellation of the impinging kyphus, and finally resection of the posterior vertebral body wall compressing the SC followed by instrumentation and fusion two levels above and below the fused segments. Results: All patients survived the procedure and left the hospital after 10–22 days. Estimated blood loss was 653 ml. No deep infections occurred. One patient developed acute tubular necrosis but recovered fully. The other two showed improvement of one Frankel grade and were independent in the final follow-up. One patient developed acute tubular necrosis but recovered fully yet his neurologic status was unchaged. The other two showed improvement of one Frankel grade and were independent in the final follow-up. Conclusion: The procedure described presents a compromise that fits the more elderly patient that might not be able to tolerate major deformity correction and at the same time provides similar results in the short and medium term to more extensive procedures.
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Affiliation(s)
- Khalid Alsaleh
- Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amjad Alduhaish
- Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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16
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Alosaimi FD, Abdel-Aziz N, Alsaleh K, AlSheikh R, AlSheikh R, Abdel-Warith A. Validity and feasibility of the Arabic version of distress thermometer for Saudi cancer patients. PLoS One 2018; 13:e0207364. [PMID: 30427918 PMCID: PMC6241127 DOI: 10.1371/journal.pone.0207364] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables. METHODS The original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS). RESULTS Receiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients. CONCLUSIONS We found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population.
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Affiliation(s)
| | - Nashwa Abdel-Aziz
- Hematology Oncology center, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Khalid Alsaleh
- Hematology Oncology center, King Saud University, Riyadh, Saudi Arabia
| | - Rawan AlSheikh
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Rana AlSheikh
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
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17
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Fadhil I, Alkuwari M, Al Tahan F, Alsaleh K, Alsaadoon D. Early Detection of Breast Cancer in Gulf Cooperation Council Countries: Case Studies. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.64800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Breast cancer is the most frequently diagnosed cancer among women in Gulf countries. Although breast cancer incidence rates in the Gulf are substantially lower than rates in developed countries, yet an increasing trend is evident. Most breast cancers are diagnosed at an advanced stage, only 23.3% of patients presented with localized tumors and less than 2% with in situ, making improvements to early detection of breast cancer a priority. There has been good progress and investment in early detection of breast cancer program in Gulf countries based on augmenting breast cancer awareness through public education, investing in mammographic based screening and improving infrastructure. Nevertheless, development of breast cancer early detection programs in most of the Gulf countries has been based on sporadic investments and actions rather than on a planned, approved and resource-linked national control plan. In many instances the scientific evidence-base for such investments has not been obtained and the evaluation of implemented programs is lacking. Aim: To review breast cancer screening, early detection practices in Gulf region, outlines enablers and identifies priorities for scaling up early detection programs in Gulf countries. Methods: The study relies heavily on review of published literature and data gathered through interview and discussion with key informants from government and nongovernment institutions at the studied countries. Results: Four case studies will be discussed from Bahrain, UAE, Kuwait and Saudi Arabia. Conclusion: Breast cancer is a major and increasing problem in Gulf countries, but it is still largely diagnosed at an advanced stage. While mammography based screening programs have been initiated in Gulf countries, however they generally have limited uptake, with very little evidence to support their effectiveness, largely because their attempts at education on the curability of breast cancer, and their endeavors to dispel the prevalent myths on breast cancer, have not been sufficiently successful. Thus, it is essential that the highest priority in each country should be improving awareness, early diagnosis of breast cancer, by public and professional education. This will require considerable investment in training primary care professionals, organizing referral mechanisms and setting up multidisciplinary breast cancer diagnosis and treatment facilities across the countries. While population-level screening for breast cancer is feasible in Gulf countries, yet careful consideration for available resources is critical for success. Moreover, it is important to pilot any screening programs prior to national roll-out.
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Affiliation(s)
- I. Fadhil
- Ministry of Health, Dubai, United Arab Emirates
| | - M. Alkuwari
- Ministry of Health, Dubai, United Arab Emirates
| | - F. Al Tahan
- Ministry of Health, Dubai, United Arab Emirates
| | - K. Alsaleh
- Ministry of Health, Dubai, United Arab Emirates
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18
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Abstract
AIM To assess the in-hospital mortality rate in adult patients suffering acute traumatic complete quadriplegia and determine the possible predictors of mortality in these patients. MATERIAL AND METHODS A review of all complete quadriplegics treated from January 1996 through March 2004 in a regional spine injuries unit measuring in-hospital mortality and other factors that might contribute to increased mortality. Multivariate logistic regression analysis was performed to explore these possible predictors of mortality. RESULTS We identified 126 cases of cervical spinal cord injury treated at our hospital from January 1996 to March 2004 and identified only 62 cases of complete quadriplegia. Of 62 patients, 11 (17.7%) died in the hospital. Age, gender, injury mechanism and medical co-morbidity showed only trends towards a higher mortality. Age and pre-injury medical co-morbidity were found to be significant independent predicting factors for mortality. Gender, mechanism of injury, neurological level and injury severity score were not the predictors of mortality in these patients. CONCLUSION Despite the limitations of the current evidence, advanced age and pre-existing medical co-morbidity are likely predictors of hospital mortality in the traumatic quadriplegia population.
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Affiliation(s)
- Khalid Alsaleh
- King Saud University, Department of Orthopaedic Surgery, Riyadh, Saudi Arabia
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19
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Sayyed AH, Aleem A, Al-Katari MS, Algahtani F, Aljerian K, Aleem TA, Alsaleh K. Acute Lymphoblastic Leukemia Presenting with Liver Infiltration and Severe Lactic Acidosis. Am J Case Rep 2018; 19:453-457. [PMID: 29662049 PMCID: PMC5923601 DOI: 10.12659/ajcr.907383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Type-B lactic acidosis is a rare complication of solid tumors and hematological malignancies. It occurs secondary to Warburg effect, when glucose metabolism in cancer cells switches from the oxidative pathway to the glycolytic pathway. Malignant lactic acidosis is a life-threatening condition if not promptly diagnosed and treated urgently. CASE REPORT We report the case of a 58-year-old male patient who presented with severe chest pain, dyspnea, systemic symptoms, leukopenia, normocytic anemia, and severe lactic acidosis. He was admitted with a possible diagnosis of acute pericarditis and lactic acidosis. Sodium bicarbonate replacement did not improve the lactic acidosis. Liver biopsy was performed because of persistently elevated alkaline phosphatase and gamma-glutamyl transferase; the biopsy showed atypical lymphoblasts and bone marrow biopsy confirmed the diagnosis of precursor B acute lymphoblastic leukemia. Lactic acidosis normalized after initiation of chemotherapy. CONCLUSIONS Cancer, particularly hematological malignancy, should be considered as an etiology and differential diagnosis of type-B lactic acidosis. Prompt recognition and urgent initiation of specific therapy to control the underlying malignancy are critical to manage this serious metabolic complication.
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Affiliation(s)
- Ayman Hassan Sayyed
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Sami Al-Katari
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Fatma Algahtani
- Division of Hematopathology, Department of Pathology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khaldoon Aljerian
- Division of Histopathology and Forensic Medicine, Department of Pathology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Talha A Aleem
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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20
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Alsaleh K, Aleem A, Almomen A, Anjum F, S Alotaibi G. Impact of Day 14 Bone Marrow Biopsy on Re-Induction
Decisions and Prediction of a Complete Response in Acute
Myeloid Leukemia Cases. Asian Pac J Cancer Prev 2018; 19:421-425. [PMID: 29479992 PMCID: PMC5980929 DOI: 10.22034/apjcp.2018.19.2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: With acute myeloid leukemia (AML), there are limited data about the accuracy of day 14 bone
marrow (BM) biopsies for predicting complete remission as compared to day 28 BM biopsy results. We here aimed
to estimate the correlation between, and the diagnostic accuracy of, both approaches. Materials and Methods: We
reviewed 84 patients with AML treated with standard induction chemotherapy to evaluate the remission rate and
treatment decisions based on day 14 BM biopsy from 2000-2012. Results: Sixty five patients (77%) demonstrated
remission (CR) with less than 5% blasts on their day 14 BM. Thirteen patients (16%) had residual disease (RD), and
6 (7%) were classified as indeterminate response (IR) i.e., blasts 5-20%. Two patients with RD on day 14 underwent
re-induction. Out of the 17 remaining cases with RD+IR, 14 (all 6 with IR and 8 out of 11 with residual disease with
no re-induction) demonstrated a morphologic complete remission (CR) on day 28 BM. The percentages for complete
remissions on days 28 and 14 were significantly different [94% versus 79.3%, respectively; p=0.004, (OR= 0.143, 95%
CI: 0.032-0.63)]. Day 14 BM had 82% sensitivity in predicting CR on Day 28; however, it had insufficient specificity
(60%) in predicting failure of CR. Conclusions: Induction treatment response assessment based on day 14 BM does
not accurately predict the response rate on day 28 and the use of day 14 BM as a sole marker of response to therapy
might expose patients to unnecessary interventions.
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21
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Aleem A, Akhtar S, Alsaleh K. Multiple Lung Cavities in Hodgkin's Lymphoma. J Coll Physicians Surg Pak 2018; 28:82-83. [PMID: 29290204 DOI: 10.29271/jcpsp.2018.01.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Aamer Aleem
- Department of Medicine (Hematology/Oncology), College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Saad Akhtar
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine (Hematology/Oncology), College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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22
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Ali AM, Ansari JAK, El-Aziz NMA, Abozeed WN, Warith AMA, Alsaleh K, Nabholtz JM. Triple Negative Breast Cancer: A Tale of Two Decades. Anticancer Agents Med Chem 2017; 17:491-499. [PMID: 27456662 DOI: 10.2174/1871520616666160725112335] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/10/2016] [Accepted: 07/25/2016] [Indexed: 11/22/2022]
Abstract
Triple negative breast cancer (TNBC) is a heterogeneous disease entity constituting about 15% of breast cancer cases worldwide. TNBC is associated with poor prognosis and lack of sustained response to conventional chemotherapeutic agents. Tumoral heterogeneity and the presence of several subtypes of TNBC such as Basal like (BL)-1, BL-2, immune-modulatory, luminal androgen receptor, mesenchymal, and mesenchymal/stem like subtype and claudin low subtype, may explain some of the difficulties faced in managing this challenging disease subgroups. Although no approved targeted therapy is available for TNBCs, molecular-profiling efforts have revealed promising molecular targets such as the vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), polyadenosine ribose polymerase inhibitors (PARPi) and DNA repair pathway, androgen pathway, and NOTCH pathway. TNBC is subject to intense research activities aiming at dissecting potential pathways, identifying potential molecular signatures and biomarkers in order to properly develop new targeted biologic modifiers. Despite this, there is a lack of approved predictive and prognostic biomarkers, and keeping in view the complexity of TNBC biology, research should be targeted towards identifying multi-factorial signatures rather than single markers. This review aims to summarize the current evidence, ongoing research and discuss future strategies for the treatment of patients with TNBC. In addition we have reviewed the recent advances in detecting predictive and prognostic biomarkers and identifying surrogate markers for early identification of potential responders to the new therapies.
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Affiliation(s)
- Arwa M Ali
- Oncology Center, King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Jawaher A K Ansari
- Oncology Center, King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Nashwa M Abd El-Aziz
- Department of Medical Oncology, South Egypt Cancer Institute, Asyut University, Asyut, Egypt
| | - Waleed N Abozeed
- Department of Clinical Oncology, Faculty of Medicine, Mansura University, Mansura, Egypt
| | - Ahmed M Abdel Warith
- Oncology Center, King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Khalid Alsaleh
- Oncology Center, King Khalid University Hospital, King Saud University, Saudi Arabia
| | - Jean-Marc Nabholtz
- Oncology Center, King Khalid University Hospital, King Saud University, Saudi Arabia
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Alqahtani M, Edwards C, Buzzacott N, Carpenter K, Alsaleh K, Alsheikh A, Abozeed W, Mashhour M, Almousa A, Housawi Y, Al Hawwaj S, Iacopetta B. Screening for Lynch syndrome in young Saudi colorectal cancer patients using microsatellite instability testing and next generation sequencing. Fam Cancer 2017. [PMID: 28643016 DOI: 10.1007/s10689-017-0015-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with Lynch syndrome (LS) have germline variants in DNA mismatch repair (MMR) genes that confer a greatly increased risk of colorectal cancer (CRC), often at a young age. Identification of these individuals has been shown to increase their survival through improved surveillance. We previously identified 33 high risk cases for LS in the Saudi population by screening for microsatellite instability (MSI) in the tumor DNA of 284 young CRC patients. The aim of the present study was to identify MMR gene variants in this cohort of patients. Peripheral blood DNA was obtained from 13 individuals who were at high risk of LS due to positive MSI status and young age (<60 years at diagnosis). Next generation sequencing, Sanger sequencing and Multiplex Ligation-dependent Probe Amplification were used to screen for germline variants in the MLH1, MSH2, MSH6 and PMS2 MMR genes. These were cross-referenced against several variant databases, including the International Society for Gastrointestinal Hereditary Tumors Incorporated database. Variants with pathogenic or likely pathogenic significance were identified in 8 of the 13 high risk cases (62%), comprising 4 in MLH1 and 4 in MSH2. All carriers had a positive family history for CRC or endometrial cancer. Next generation sequencing is an effective strategy for identifying young CRC patients who are at high risk of LS because of positive MSI status. We estimate that 7% of CRC patients aged <60 years in Saudi Arabia are due to LS, potentially involving around 50 new cases per year.
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Affiliation(s)
- Masood Alqahtani
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Caitlin Edwards
- Department of Diagnostic Genomics, PathWest, Nedlands, Australia
| | | | - Karen Carpenter
- Department of Diagnostic Genomics, PathWest, Nedlands, Australia
| | - Khalid Alsaleh
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik Alsheikh
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Abozeed
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Clinical Oncology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Miral Mashhour
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Afnan Almousa
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Yousef Housawi
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Shareefa Al Hawwaj
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Barry Iacopetta
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.
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Alshamsan A, Khan S, Imran A, Aljuffali IA, Alsaleh K. Prediction of Chlamydia pneumoniae protein localization in host mitochondria and cytoplasm and possible involvements in lung cancer etiology: a computational approach. Saudi Pharm J 2017; 25:1151-1157. [PMID: 30166903 PMCID: PMC6111117 DOI: 10.1016/j.jsps.2017.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/30/2017] [Indexed: 01/22/2023] Open
Abstract
Collecting evidence suggests that the intercellular infection of Chlamydia pneumoniae in lungs contributes to the etiology of lung cancer. Many proteins of Chlamydia pneumoniae outmanoeuvre the various system of the host. The infection may regulate various factors, which can influence the growth of lung cancer in affected persons. In this in-silico study, we predict potential targeting of Chlamydia pneumoniae proteins in mitochondrial and cytoplasmic comportments of host cell and their possible involvement in growth and development of lung cancer. Various cellular activities are controlled in mitochondria and cytoplasm, where the localization of Chlamydia pneumoniae proteins may alter the normal functioning of host cells. The rationale of this study is to find out and explain the connection between Chlamydia pneumoniae infection and lung cancer. A sum of 183 and 513 proteins were predicted to target in mitochondria and cytoplasm of host cell out of total 1112 proteins of Chlamydia pneumoniae. In particular, many targeted proteins may interfere with normal growth behaviour of host cells, thereby altering the decision of program cell death. Present article provides a potential connection of Chlamydia pneumoniae protein targeting and proposed that various targeted proteins may play crucial role in lung cancer etiology through diverse mechanisms.
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Affiliation(s)
- Aws Alshamsan
- Nanomedicine Research Unit, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,King Abdullah Institute for Nanotechnology, King Saud University, Riyadh, Saudi Arabia
| | - Shahanavaj Khan
- Nanomedicine Research Unit, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahamad Imran
- King Abdullah Institute for Nanotechnology, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim A Aljuffali
- Nanomedicine Research Unit, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Oncology Center, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
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Almutairi KM, Alonazi WB, Alodhayani AA, Vinluan JM, Moussa M, Al-Ajlan AS, Alsaleh K, Alruwaimi D, Alotaibi NE. Barriers to Cancer Clinical Trial Participation Among Saudi Nationals: A Cross-Sectional Study. J Relig Health 2017; 56:623-634. [PMID: 27631996 DOI: 10.1007/s10943-016-0306-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aims to determine the factors that act as barriers to Saudi cancer patients in participating in a clinical trial (CT). A total of 244 patients from two different tertiary level hospitals (King Khalid University Hospital and King Fahad Medical City Hospital) in Riyadh, Saudi Arabia, participated in this cross-sectional study. The participants were interviewed by a trained researcher between September and November 2015. All respondents answered a three-part questionnaire which includes demographics, clinical information, and questions related to awareness of CTs, willingness to participate, and factors affecting participation in CTs. The mean age of the participants was 50.83, and 57 % of the participants were females. Most of the participants (63.5 %) were currently being treated for cancer, and 28 % were diagnosed with breast cancer followed by colorectal cancer. Health status or quality of life was self-reported as acceptable by 27.9 % of the participants, and 25 % of the participants at stage II of cancer. The factors that act as barriers to Saudi cancer patients in participating in a CT can be categorized into patient- and physician-related factors. Patient factors include lack of awareness, misconception and fear in participating in CTs; physician-related factors comprise of lack of encouragement from physician to patients in participating in a CT. The study identified few major barriers to participation in CTs. Increased patient awareness and recruitment strategies are required to increase accrual of patients including training for physicians and disseminating easy-to-read tools to the public.
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Affiliation(s)
- Khalid M Almutairi
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia.
| | - Wadi B Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jason M Vinluan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Mahaman Moussa
- Medical Surgical Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman S Al-Ajlan
- Clinical Laboratories Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Duna Alruwaimi
- Clinical Laboratories Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nader E Alotaibi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
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Awwad W, Bourget-Murray J, Zeiadin N, Mejia JP, Steffen T, Algarni AD, Alsaleh K, Ouellet J, Weber M, Jarzem PF. Analysis of the spinal nerve roots in relation to the adjacent vertebral bodies with respect to a posterolateral vertebral body replacement procedure. J Craniovertebr Junction Spine 2017; 8:50-57. [PMID: 28250637 PMCID: PMC5324361 DOI: 10.4103/0974-8237.199869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. SUMMARY OF BACKGROUND DATA The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. METHODS This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1-L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). RESULTS (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. CONCLUSIONS The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level.
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Affiliation(s)
- Waleed Awwad
- Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jonathan Bourget-Murray
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada
| | - Nadil Zeiadin
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Juan P Mejia
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Steffen
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | | | - Khalid Alsaleh
- Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jean Ouellet
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Michael Weber
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
| | - Peter F Jarzem
- Division of Orthopedic Surgery, Department of Surgery, Orthopedic Research Laboratory, McGill University Health Center, McGill University, Montreal, Canada; Department of Surgery, McGill University, Montreal, Canada
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Aldiab A, Al Khayal KA, Al Obaid OA, Alsheikh A, Alsaleh K, Shahid M, Alkharji H. Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia. Oncology 2016; 92:75-86. [DOI: 10.1159/000450857] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/01/2016] [Indexed: 11/19/2022]
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Abdelwarith A, Alsaleh K, Abdelaziz N, Ali A, Elsamany S, Rasmy A, Elfarargy O, Husain S, Rikabi A. A multicenter study of the impact of body mass index (BMI) on the incidence of pathologic complete response (pCR) among Saudi patients with locally advanced breast cancer (LABC) post neoadjuvant chemotherapy (NCth). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Alsaleh K, Ho D, Rosas-Arellano MP, Stewart TC, Gurr KR, Bailey CS. Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT? Eur Spine J 2016; 26:362-367. [PMID: 27663702 DOI: 10.1007/s00586-016-4724-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the reliability and dependability of magnetic resonance imaging (MRI) and computerized tomography (CT) in the assessment of lumbar spinal stenosis and correlate the qualitative assessment to both a quantitative assessment and functional outcome measures. Multiple studies have addressed the issue of CT and MRI imaging in lumbar spinal stenosis. None showed superiority of one modality. METHODS We performed a standardized qualitative and quantitative review of CT and MRI scans of 54 patients. Intra-observer and inter-observer reliability was determined between three reviewer using Kappa coefficient. Agreement between the two modalities was analyzed. ODI and SF-36 outcomes were correlated with the imaging assessments. RESULTS Almost perfect intra-observer reliability for MRI was achieved by the two expert reviewers (κ = 0.91 for surgeon and κ = 0.92 for neuro-radiologist). For CT, substantial intra-observer agreement was found for the surgeon (κ = 0.77) while the neuro-radiologist was higher (κ = 0.96). For both CT and MRI the standardized qualitative assessment used by the two expert reviewers had a better inter-observer reliability than that between the expert reviewers and the general reporting radiologist, who did not utilize a standardized assessment system. When the qualitative assessment was compared directly, CT overestimated the degree of stenosis 20-35 % of the time (p < 0.05) while MRI overestimated the degree of stenosis 2-11 % of the time (p < 0.05). No correlation was found between qualitative and quantitative analysis with functional status. CONCLUSIONS This study directly demonstrates that MRI is a more reliable tool than CT, but neither correlates with functional status. Both experience of the reader and the standardization of a qualitative assessment are influential to the reliability.
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Affiliation(s)
- Khalid Alsaleh
- Division of Orthopaedics, Department of Surgery, University of Western Ontario, London, Canada.
- Orthopaedic Spine Program, Victoria Hospital, London Health Science Centre, London, Canada.
- Department of Orthopedics (49), College of Medicine, King Saud University, P. O. Box 7805, Riyadh, 11472, Saudi Arabia.
| | - Derek Ho
- Department of Radiology, University of Western Ontario, London, Canada
| | | | - Tanya Charyk Stewart
- Orthopaedic Spine Program, Victoria Hospital, London Health Science Centre, London, Canada
| | - Kevin Roger Gurr
- Division of Orthopaedics, Department of Surgery, University of Western Ontario, London, Canada
- Orthopaedic Spine Program, Victoria Hospital, London Health Science Centre, London, Canada
| | - Christopher Stewart Bailey
- Division of Orthopaedics, Department of Surgery, University of Western Ontario, London, Canada
- Orthopaedic Spine Program, Victoria Hospital, London Health Science Centre, London, Canada
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Aleem A, Aziz S, Hussain S, Algahtani F, Alsaleh K. Isolated Uterine Myeloid Sarcoma Preceding the Diagnosis of Acute Myeloid Leukemia. J Coll Physicians Surg Pak 2016; 26:S52-S55. [PMID: 27376223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/29/2015] [Indexed: 06/06/2023]
Abstract
Myeloid sarcoma (MS) is an extramedullary solid tumor composed of leukemic myeloid cells. MS is an uncommon tumor complicating acute myeloid leukemia (AML), or less often myelodysplestic syndrome (MDS) and myeloproliferative disorders. Rarely, MS may precede the systemic onset of AML, which usually follows within months. We report a 36 year-old lady who presented with a cervical-uterine mass, which proved to be MS. Initially, she had no systemic AMLand was treated with hysterectomy and systemic chemotherapy. She developed bilateral-flank pain and renal impairment after 9 months. Imaging revealed a soft-tissue mass in the para-aortic and peri-sacral region with bilateral hydronephrosis. Biopsy from the mass confirmed recurrence of MS. Bone marrow (BM) biopsy revealed 20% blasts consistent with AML. She was treated with aggressive chemotherapy and local radiotherapy. Despite these measures, she died of progressive disease. MS should be considered and treated as systemic AML, rather than an isolated mass; and we discuss management issues in such patients.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shahid Aziz
- Department of Division Hematology - Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sajjad Hussain
- Department of Emergency Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Fatmah Algahtani
- Department of Radiology and Pathology, Division of Hematopathology,College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Aleem A, Alsaleh K, Aljabry M, Aziz S, Iqbal Z, Almomen A. A comparison of two techniques of preparing bone marrow aspirate slides. J PAK MED ASSOC 2016; 66:528-7. [PMID: 27183929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare direct smear technique with ethylenediaminetetraacetic acid (EDTA) preserved smear technique in terms of preparing bone marrow aspirate slides. METHODS This prospective study was carried out between September 2009 and July 2012 at the Haematology/Oncology Department, King Khalid University Hospital, Riyadh, Saudi Arabia. With a standard gauge disposable bone marrow aspirate needle, 0.5 to 1.0 ml bone marrow was aspirated with a 10ml syringe. Half of the marrow was immediately transferred to an EDTA tube with gentle mixing, while slides were prepared directly from the rest of the sample in the syringe. The tube sample was used to prepare slides at the end of the procedure. A score of 1-4 was assigned to each slide depending on the quality and number of particles. RESULTS A total of 245 bone marrow aspirate samples were evaluated related to 216 patients. Of the total, 238 (97%) samples were included in the study. The mean score for the direct smear group was 3.40±0.79 and for the EDTA smear group it was 3.34±0.75 (p=0.27), which was not statistically significant. An informal comparison of the morphological analysis of the samples did not reveal any differences. CONCLUSIONS Bone marrow aspirate slides prepared at the end of the procedure from EDTA preserved samples were not inferior to slides prepared directly from the aspirated sample.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Haematology/Oncology, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Division of Haematology/Oncology, Riyadh, Saudi Arabia
| | - Mansour Aljabry
- Department of Pathology, Division of Haematopathology, Riyadh, Saudi Arabia
| | - Shahid Aziz
- Department of Emergency Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Zafar Iqbal
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkareem Almomen
- Department of Medicine, Division of Haematology/Oncology, Riyadh, Saudi Arabia
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Rasmy A, Abozeed W, Elsamany S, Baiomy ME, Nashwa A, Amrallah A, Hasaan E, Alzahrani A, Faris M, Alsaleh K, AlFaraj A. Correlation of Preoperative Ki67 and Serum CA15.3 Levels with Outcome in Early Breast Cancers a Multi Institutional Study. Asian Pac J Cancer Prev 2016; 17:3595-3600. [PMID: 27510014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
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.
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Affiliation(s)
- A Rasmy
- Medical Oncology Department, Zagazig University, Zagazig, Egypt Email :
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Elsamany S, Alzahrani A, Abozeed WN, Rasmy A, Farooq MU, Elbiomy MA, Rawah E, Alsaleh K, Abdel-Aziz NM. Mammographic breast density: Predictive value for pathological response to neoadjuvant chemotherapy in breast cancer patients. Breast 2015; 24:576-81. [PMID: 26071795 DOI: 10.1016/j.breast.2015.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 05/08/2015] [Accepted: 05/20/2015] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- S Elsamany
- Oncology, King Abdullah Medical City, Makkah, Saudi Arabia; Oncology, Oncology centre, Mansoura University, Mansoura, Egypt.
| | - A Alzahrani
- Oncology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - W N Abozeed
- Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Clinical Oncology, Mansoura University Hospital, Mansoura, Egypt
| | - A Rasmy
- Oncology, King Fahd Specialist Hospital, Dammam, Saudi Arabia; Oncology, Zagazig University Hospital, Zagazig, Egypt
| | - M U Farooq
- Research, King Abdullah Medical City, Makkah, Saudi Arabia
| | - M A Elbiomy
- Oncology, Oncology centre, Mansoura University, Mansoura, Egypt
| | - E Rawah
- Radiology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - K Alsaleh
- Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia
| | - N M Abdel-Aziz
- Medical Oncology, King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Medical Oncology, South Egypt Cancer Institute, Assuit University, Assuit, Egypt
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Wu C, Alotaibi GS, Alsaleh K, Linkins LA, Sean McMurtry M. Case-fatality of recurrent venous thromboembolism and major bleeding associated with aspirin, warfarin, and direct oral anticoagulants for secondary prevention. Thromb Res 2015; 135:243-8. [DOI: 10.1016/j.thromres.2014.10.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/31/2014] [Indexed: 11/27/2022]
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Wu C, Alotaibi GS, Alsaleh K, Sean McMurtry M. Case fatality of bleeding and recurrent venous thromboembolism during, initial therapy with direct oral anticoagulants: A systematic review. Thromb Res 2014; 134:627-32. [DOI: 10.1016/j.thromres.2014.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/20/2022]
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Al-Anazi KA, Al-Jasser AM, Alsaleh K. Infections Caused by Mycobacterium tuberculosis in Recipients of Hematopoietic Stem Cell Transplantation. Front Oncol 2014; 4:231. [PMID: 25207262 PMCID: PMC4144006 DOI: 10.3389/fonc.2014.00231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022] Open
Abstract
Mycobacterium tuberculosis (M. tuberculosis) infections are uncommon in recipients of hematopoietic stem cell transplantation. These infections are 10-40 times commoner in recipients of stem cell transplantation than in the general population but they are 10 times less in stem cell transplantation recipients compared to solid organ transplant recipients. The incidence of M. tuberculosis infections in recipients of allogeneic stem cell transplantation ranges between <1 and 16% and varies considerably according to the type of transplant and the geographical location. Approximately 80% of M. tuberculosis infections in stem cell transplant recipients have been reported in patients receiving allografts. Several risk factors predispose to M. tuberculosis infections in recipients of hematopoietic stem cell transplantation and these are related to the underlying medical condition and its treatment, the pre-transplant conditioning therapies in addition to the transplant procedure and its own complications. These infections can develop as early as day 11 and as late as day 3337 post-transplant. The course may become rapidly progressive and the patient may develop life-threatening complications. The diagnosis of M. tuberculosis infections in stem cell transplant recipients is usually made on clinical grounds, cultures obtained from clinical specimens, tissues biopsies in addition to serology and molecular tests. Unfortunately, a definitive diagnosis of M. tuberculosis infections in these patients may occasionally be difficult to be established. However, M. tuberculosis infections in transplant recipients usually respond well to treatment with anti-tuberculosis agents provided the diagnosis is made early. A high index of suspicion should be maintained in recipients of stem cell transplantation living in endemic areas and presenting with compatible clinical and radiological manifestations. High mortality rates are associated with infections caused by multidrug-resistant strains, miliary or disseminated infections, and delayed initiation of therapy. In recipients of hematopoietic stem cell transplantation, isoniazid prophylaxis has specific indications and bacillus Calmette-Guerin vaccination is contraindicated as it may lead to disseminated infection. The finding that M. tuberculosis may maintain long-term intracellular viability in human bone marrow-derived mesenchymal stem cells complicates the development of effective vaccines and strategies to eliminate tuberculosis. However, the introduction of linezolid, cellular immunotherapy, and immunomodulation in addition to autologous mesenchymal stem cell transplantation will ultimately have a positive impact on the overall management of infections caused by M. tuberculosis.
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Affiliation(s)
- Khalid Ahmed Al-Anazi
- Section of Adult Hematology and Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | - Khalid Alsaleh
- Section of Adult Hematology and Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Alotaibi G, Alsaleh K, Wu C, Mcmurtry MS. Dabigatran, rivaroxaban and apixaban for extended venous thromboembolism treatment: network meta-analysis. INT ANGIOL 2014; 33:301-308. [PMID: 25056161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Many new oral anticoagulants (NOACs; dabigatran, rivaroxaban, and apixaban) are currently available to treat thromboembolic disease. There are no head-to-head trials comparing these agents. To assess the efficacy and safety of NOACs for prevention of recurrent venous thromboembolism (VTE), we performed a network meta-analysis. METHODS Medline, Embase, and the Cochrane-controlled trial register were searched, without language restriction, to identify trials. Studies were evaluated according to a priori inclusion criteria and appraised using established internal validity criteria. Adjusted indirect comparisons between agents were performed using well-established methods. RESULTS Three trials meeting inclusion criteria were identified. Direct comparison between apixaban 2.5 mg twice daily (BID) versus apixaban 5 mg BID showed no difference for any outcome. Clinically relevant non-major bleeding occurred less with both apixaban 2.5 mg BID (OR 0.23, 95% CI 0.08-0.62, P=0.004) and apixaban 5 mg BID [OR 0.31, 95% CI 0.11-0.82, P=0.019] compared to rivaroxaban 20 mg daily. Apixaban 2.5 mg BID showed less clinically relevant non-major bleeding than dabigatran 150 mg BID [OR 0.4, 95% CI 0.16-0.9, P=0.04], but not apixaban 5 mg BID. There were no differences between rivaroxaban 20 mg daily and dabigatran 150 mg BID. No differences in risk for recurrent VTE, major bleeding, or mortality were observed for any comparison between any pair of NOACs. CONCLUSION There were no significant differences in risk for recurrent VTE, major bleeding, or all-cause mortality between the NOACs. However, apixaban 2.5 mg BID was associated with less clinically significant non-major bleeding than either rivaroxaban 20 mg daily or dabigatran 150 mg BID.
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Affiliation(s)
- G Alotaibi
- Department of Medicine, University of Alberta, Edmonton, Canada -
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Aleem A, Shakoor Z, Alsaleh K, Algahtani F, Iqbal Z, Al-Momen A. Immunological evaluation of β-thalassemia major patients receiving oral iron chelator deferasirox. J Coll Physicians Surg Pak 2014; 24:467-71. [PMID: 25052967 DOI: 07.2014/jcpsp.467471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/23/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the immune abnormalities and occurrence of infections in transfusion-dependent β-thalassemia major patients receiving oral iron chelator deferasirox (DFX). STUDY DESIGN An observational study. PLACE AND DURATION OF STUDY Hematology Clinics, King Khalid University Hospital, Riyadh, Saudi Arabia, from July to December 2010. METHODOLOGY Seventeen patients with β-thalassemia major (12 females, median age 26 years) receiving deferasirox (DFX) for a median duration of 27 months were observed for any infections and had their immune status determined. Immune parameters studied included serum immunoglobulins and IgG subclasses, serum complement (C3 and C4) and anti-nuclear antibody (ANA) level, total B and T-lymphocytes, CD4+ and CD8+ counts, CD4+/CD8+ ratio, and natural killer (NK) cells. Immunological parameters of the patients were compared with age, gender, serum ferritin level and splenectomy status. Lymphocyte subsets were also compared with age and gender matched normal controls. RESULTS A considerable reduction in serum ferritin was achieved by DFX from a median level of 2528 to 1875 μmol/l. Serum IgG levels were increased in 7 patients. Low C4 levels were found in 9 patients. Total B and T-lymphocytes were increased in 14 patients each, while CD4+, CD8+ and NK cells were increased in 13, 12 and 11 patients respectively. Absolute counts for all lymphocyte subsets were significantly higher compared to the normal controls (p ² 0.05 for all parameters). Raised levels of IgG were associated with older age, female gender, splenectomized status and higher serum ferritin levels but this did not reach statistical significance except for the higher ferritin levels (p=0.044). Increased tendency to infections was not observed. CONCLUSION Patients with β-thalassemia major receiving DFX exhibited significant immune abnormalities. Changes observed have been described previously, but could be related to DFX. The immune abnormalities were not associated with increased tendency to infections.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Zahid Shakoor
- Department of Pathology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Farjah Algahtani
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Zafar Iqbal
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkareem Al-Momen
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Aleem A, Anjum F, Algahtani F, Iqbal Z, Alsaleh K, Almomen A. Clofarabine in the treatment of elderly patients with acute myeloid leukemia. Asian Pac J Cancer Prev 2014; 14:1089-92. [PMID: 23621192 DOI: 10.7314/apjcp.2013.14.2.1089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients with acute myeloid leukemia (AML) have a poor outcome because of co- morbidities, poor tolerance to intensive chemotherapy and inherently more resistant disease. Clofarabine is a second generation nucleoside analogue which has shown promising activity in elderly patients with AML. This study was conducted to review the outcome of treatment with clofarabine in a group of such patients. METHODS The records of 5 elderly patients who were diagnosed to have AML and treated with clofarabine over a 12 month period were reviewed retrospectively. RESULTS There were 2 female and 3 male patients with a median age of 68 years (range 65-82). At the time of treatment, 2 patients had newly diagnosed AML not considered suitable for intensive therapy, while 3 patients had partial or no response to conventional chemotherapy. The overall response rate was 100%, all patients achieving a complete remission. Induction and consolidation were well tolerated. All patients developed neutropenia with a median duration of 20 days (range 17-42). One patient developed hand and foot syndrome and a generalized rash but recovered. There was no mortality and all patients remained in remission after a median follow-up of 5.2 months (Range 3-10). CONCLUSION Clofarabine (alone or in combination) is active in elderly AML patients with an acceptable safety profile and should be considered a potential option in this group.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology /Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Alotaibi GS, Alsaleh K, Bolster L, Sean McMurtry M, Wu C. Preoperative transfusion in patients with sickle cell disease to prevent perioperative complications: A systematic review and meta-analysis. Hematology 2014; 19:463-71. [DOI: 10.1179/1607845414y.0000000158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Khalid Alsaleh
- Department of MedicineKing Saud University, Riyadh, Saudi Arabia
| | - Lauren Bolster
- Department of MedicineUniversity of Alberta, Edmonton, AB, Canada
| | - M. Sean McMurtry
- Department of MedicineUniversity of Alberta, Edmonton, AB, Canada
| | - Cynthia Wu
- Department of MedicineUniversity of Alberta, Edmonton, AB, Canada
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Alsaleh K. Sweet′s syndrome with multiple myeloma. J Appl Hematol 2014. [DOI: 10.4103/1658-5127.137158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alsaleh K. Routine administration of standardized questionnaires that assess aspects of patients’ quality of life in medical oncology clinics: A systematic review. J Egypt Natl Canc Inst 2013; 25:63-70. [DOI: 10.1016/j.jnci.2013.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/22/2013] [Accepted: 03/12/2013] [Indexed: 01/21/2023] Open
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Aleem A, Al Diab AR, Alsaleh K, Algahtani F, Alsaeed E, Iqbal Z, El-Sherkawy MS. Frequency, clinical pattern and outcome of thrombosis in cancer patients in Saudi Arabia. Asian Pac J Cancer Prev 2013; 13:1311-5. [PMID: 22799324 DOI: 10.7314/apjcp.2012.13.4.1311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Thrombotic risk is increased in patients with cancer and there are important implications for those who suffer a venous thromboembolism (VTE). We undertook this study to determine the frequency, clinical patterns, and outcome of VTE in Saudi patients with cancer. METHODS Cancer (solid tumors and lymphoma) patients who developed VTE from January 2004 to January 2009 were studied retrospectively. Demographics and clinical characteristics related to thrombosis and cancer were evaluated. RESULTS A total of 701 patients with cancer were seen during the study period. VTE was diagnosed in 47 (6.7%) patients (median age 52, range 18-80 years). Lower limb DVT was the most common type, seen in 47% patients, followed by PE in 19%, and 19% patients had both DVT and PE. Thrombosis was symptomatic in 72% patients while it was an incidental finding on routine workup in 28% . Cancer and VTE were diagnosed at the same time in 38% of patients, and 47% patients developed VTE during the course of disease after the cancer diagnosis. The majority of VTE post cancer diagnoses occurred during the first year (median 4 months, range 1-14). Additional risk factors for VTE were present in 22 (47%) patients and 14 (30%) of these patients were receiving chemotherapy at the time of thrombosis. Only 5 (10.6%) patients were receiving thrombo-prophylaxis at the time of VTE diagnosis. Most common types of tumors associated with thrombosis were breast cancer, non-Hodgkin's lymphoma and lung cancer. The majority of the affected patients (79%) had advanced stage of cancer. After a median follow-up of 13 (range 0.5-60) months, 38 (81%) patients had died. There was no difference in the mortality of patients with symptomatic or asymptomatic thrombosis (82% vs 78.6%). CONCLUSIONS Thrombotic complications can develop in a significant number of patients with cancer, and almost half of the patients have additional risk factors for VTE. Thrombosis is usually associated with advanced disease and can be asymptomatic in more than a quarter of cases. Thromboprophylaxis in cancer patients is under-utilized. Community based studies are needed to accurately define the extent of this problem and to develop effective prophylactic strategies.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology, King Saud University, Riyadh, Saudi Arabia.
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Aleem A, Al-Katari M, Alsaleh K, AlSwat K, Al-Sheikh A. Vanishing bile duct syndrome in a Hodgkin's lymphoma patient with fatal outcome despite lymphoma remission. Saudi J Gastroenterol 2013; 19:286-9. [PMID: 24195983 PMCID: PMC3958977 DOI: 10.4103/1319-3767.121037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) is a condition resulting from severe bile duct injury, progressive destruction, and disappearance of intrahepatic bile ducts (ductopenia) leading to cholestasis, biliary cirrhosis, and liver failure. VBDS can be associated with a variety of disorders, including Hodgkin's lymphoma (HL). We describe a 33-year-old male patient who presented with lymphadenopathy and jaundice, and was diagnosed to have HL. Serum bilirubin worsened progressively despite chemotherapy, with a cholestatic pattern of liver enzymes. Diagnosis of VBDS was established on liver biopsy. Although remission from HL was achieved, the patient died of liver failure. Presence of jaundice in HL patients should raise the possibility of VBDS. This report discusses the difficulties of delivering chemotherapy in patients with liver dysfunction. HL-associated VBDS carries a high mortality but lymphoma remission can be achieved in some patients. Therefore, liver transplantation should be considered early in these patients.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Aamer Aleem, Consultant Hematologist, Department of Medicine (38), King Khalid University Hospital, Riyadh 11472, Saudi Arabia. E-mail:
| | - Mohammad Al-Katari
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid AlSwat
- Department of Gastroenterology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik Al-Sheikh
- Department of Pathology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Al-Ahaideb A, Khoshhal K, Alsiddiky A, Heissam K, Alzakari A, Alsaleh K. Patterns and Obstacles of Provision of Minor Orthopedic Procedures among Primary Care Physicians in Saudi Arabia. Int J Health Sci (Qassim) 2012; 6:13-21. [PMID: 23267300 DOI: 10.12816/0005969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Musculoskeletal disorders are common reasons for consultation with the primary care provider (PCP). For many of these disorders, treatment with minor procedures can bring about rapid and effective response with a very low complication rate. In reality, not many of these procedures are carried out in the primary care facilities in Saudi Arabia and in many other countries around. MATERIALS AND METHODS A cross sectional study design was chosen. The questionnaire aimed to quantify the number and different types of injections performed by PCPs; to evaluate the level of training and to identify barriers to PCPs performing joint and soft tissue injections in the primary care facilities. This questionnaire was distributed on 298 physicians working in primary care setting in Riyadh. The absolute frequency and percentages were calculated, and Chi square and ANOVA analyses were calculated and correlation test was done to procedures obstacles and their patterns. RESULTS One hundred and thirty physicians (43.6%) of the respondents have taken orthopedic training during their residency program. Among the respondents who have taken a training period during their residency 115 (88.5%) had orthopedic training for 4 weeks. Only 69 (53.1%) of them -who had training- had performed joint and soft tissue injections during their family medicine residency program. The top reasons cited for not performing the procedures were "Lack of up to date skills" and "limited consultation time" because of work overload. CONCLUSION Many physicians working in primary care settings in Saudi Arabia refer patients requiring minor office procedures for specialist consultation. Treating patients at the primary care level can be more time and cost effective. These results uncover that there is a big need for improvement in orthopedic and rheumatology training during undergraduate medical vocational training and family medicine residency program.
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Alhajri K, Alzerwi N, Alsaleh K, Yousef HB, Alzaben M. Disseminated (miliary) abdominal tuberculosis after laparoscopic gastric bypass surgery. BMJ Case Rep 2011; 2011:bcr.12.2010.3591. [PMID: 22696746 DOI: 10.1136/bcr.12.2010.3591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The development of disseminated (miliary) abdominal tuberculosis (TB) in patients following operations which affect their immunity, such as laparoscopic gastric bypass, is rare. The authors report the case of middle aged woman, who a few months after undergoing laparoscopic gastric bypass surgery for morbid obesity (body mass index 49), presented with generalised fatigability and abnormal liver function. A CT scan of the abdomen was suggestive of miliary TB. The patient developed acute abdomen pain. Intraoperative findings included perforated stomal ulcers at the gastrojejunostomy, diffuse micronodular involvement of the liver and spleen and thickened omentum. The perforation was closed and liver and omental biopsies were taken. Histology results from the liver and omentum revealed necrotising granulomatous inflammation suggestive of TB. Abdominal TB is a relatively rare manifestation of extrapulmonary TB. However, this diagnosis should be considered in patients immunocompromised due to immunosuppressive medication or operations affecting their nutrition. Early diagnosis and effective treatment of abdominal TB may decrease morbidity and mortality in such patients.
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Affiliation(s)
- Khalid Alhajri
- Department of Surgery, Riyadh Military Hospital, Riyadh, Saudi Arabia.
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Abstract
Metastatic disease of the acetabulum is a common and challenging surgical problem. We asked whether acetabular reconstruction for metastatic bone disease improves functional outcome with an acceptable risk of surgical morbidity. We also asked if primary tumor type and the presence of visceral metastases predicted patient survival. We analyzed prospectively accumulated records of 62 consecutive patients who underwent 63 hip arthroplasties with acetabular reconstruction. Operative technique was guided by the extent of dome and column involvement. Demographics, functional status in the form of the Eastern Cooperative Oncology Group (ECOG) score, and survival data were analyzed. Functional scores improved from an average of 2.6 preoperatively to 1.1 postoperatively. Four patients had postoperative complications for which we performed further surgery. Mean survival for the patients with breast cancer was longer at 21 months compared to 9 months for the patients with other primary malignancies. Patients who did not present with visceral metastases had longer survival than those with visceral metastases. Despite the moderate risk of operative complications, an anatomically based approach to reconstruction of acetabular defects from metastatic disease improves functional outcome. Breast cancer as the primary malignancy and the absence of visceral metastases predicted longer survival.
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Affiliation(s)
- Michelle Ghert
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
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