Nonpain Symptoms of New and Follow-up Cancer Patients Attending a Palliative Care Outpatient Clinic in Saudi Arabia

Background:

Epidemiology of cancer-related nonpain symptoms receives less attention in literature as compared with cancer pain.

Objective:

This paper aims at exploring the prevalence and severity of nonpain symptoms in cancer patients attending a palliative care (PC) outpatient clinic.

Materials and Methods:

Over a 5 months period, consecutive adult cancer patients attending PC outpatient clinic at a tertiary hospital were evaluated for the presence and severity of 10 nonpain symptoms. Patients were grouped to new or follow-up cases and were also grouped according to performance status and cancer type. Prevalence and severity of symptoms were compared between groups using t test or analysis of variance as appropriate.

Results:

Fifty-one males and 73 females were interviewed. The most common cancer is female breast (27.4%) followed by head and neck (15.3%). Majority of patients (67%) were new to PC clinic. Patients had 5.1 nonpain symptoms on average, with most common symptoms being tiredness (79.8%), loss of appetite (71.8%), dry mouth (69.4%), anxiety (60.5%), and depression (50.8%). The least common symptoms were confusion and nausea (22.6% each). The median scores of severity were highest for tiredness, loss of appetite, dry mouth, and insomnia (5 points each). Symptoms were fewer among patients with good performance status (P = 0.002), whereas age, gender, cancer type, and encounter type were not associated with difference in symptom prevalence. Younger patients, females and those with poor performance status have shown a tendency toward higher severity scores for several symptoms.

Conclusion:

The significant prevalence and severity of nonpain symptoms among new and follow-up cancer patients seen in a PC outpatient clinic emphasizes the need for comprehensive assessment and routinely audited symptom management plans.     

Ethnic differences in dentofacial relationships of Turkish and Saudi young adults with normal occlusions and well-balanced faces

Objectives

The aims of the present study were (1) to determine ethnic differences in craniofacial dimensions between Turkish and Saudi populations and (2) to identify possible gender differences between males and females, based on a sample of untreated young adult subjects with normal occlusions and well-balanced faces.

Methods

In total, 163 cephalometric radiographs were traced and evaluated to compare untreated adults of Turkish and Saudi ethnicity. The Turkish group comprised 86 subjects; 45 females and 41 males. The Saudi group comprised 77 subjects; 39 females and 38 males. For statistical evaluation, an independent-samples t-test was performed.

Results

The Turkish sample had a more retrognathic maxilla and mandible (p < 0.001 for SNA and SNB) and a more vertical direction of facial development (p < 0.001), with Turkish males having more retrusive lips (p < 0.001). Distinctive ethnic differences were found in craniofacial structures between Turkish and Saudi young adults.

Conclusions

It is appropriate to consider these aesthetic differences when a Turkish or a Saudi patient is being evaluated during routine diagnosis and treatment planning.     

Canine location in different maxillomandibular relationships in Egyptians and Saudis

The standards or proportions commonly used as guides for the selection of maxillary anterior teeth for a removable prosthesis have been developed mainly on Caucasian populations with normal ridge relationships.

Purpose

This study was conducted to determine the canine position in relation to commissures in different maxillomandibular relationships among Egyptian and Saudi populations.

Material and methods

Two hundred subjects participated in this study, 100 from each population. The location of the corners of the mouth for each subject was marked on the buccal surface of a screen previously constructed on the maxillary cast and transferred to the casts. The distances between the corners of the mouth and the canines’ distal aspect were measured on the casts. The measurements were subdivided according to their relation to the commissures: at commissures, medial to commissures, or distal to commissures. The data were then statistically analyzed.

Results

Coincidence between the canine distal aspects and commissures was recorded only within 8% of both Egyptian and Saudi populations. Additionally, within the Egyptian population, coincidence was recorded only at Class-I ridge relationship.

Conclusion

Commissures are not a reliable landmark for determination of the distal aspect of the canine distal aspects of both Egyptian and Saudi populations.     

PAX6 Analysis of Two Unrelated Families from the Arabian Peninsula with Classic Hereditary Aniridia

Introduction: Reports from around the world confirm that heterozygous PAX6 mutation is the major cause of hereditary aniridia (with a classic phenotype of iris hypoplasia, keratopathy, lens opacity, and foveal hypoplasia). However, genotype/phenotype reports are lacking from the Arabian Peninsula, a historically isolated region with a relatively high incidence of recessive disease and thus a potential for phenocopy and pseudodominance. The purpose of this study to assess for PAX6 mutation in two unrelated families with classic hereditary aniridia from the Arabian Peninsula. Methods: Interventional cases series of two unrelated affected Saudi Arabian families. Available family members underwent ophthalmic examination and venous blood sampling for PAX6 sequencing. Results: The pedigrees of both families suggested dominant (or pseudodominant) inheritance of the classic aniridia phenotype. Affected individuals in Family #1 were heterozygous for a novel frameshift PAX6 mutation (c.delA1294). Affected individuals in Family #2 had heterozygosity for a commonly-reported PAX6 nonsense mutation (p.Arg240X). Conclusions: PAX6 haploinsufficiency, the major cause of classic hereditary aniridia worldwide, is also associated with the phenotype in two different families from the Arabian Peninsula. Homozygosity by descent is not expected to affect genotype/phenotype correlation for the classic phenotype.     

Hepatitis B genotypes： Relation to clinical outcome in patients with chronic hepatitis B in Saudi Arabia

INTRODUCTION Hepatitis B virus (HBV) infection is a global health problem with over 350 million chronic carriers of the virus with the risk of developing chronic hepatitis, cirrhosis or hepatocellular carcinoma (HCC). HBV is a circular, partially double-s…     

Smoking in Saudi Arabia and its relation to coronary artery disease

Objectives

The health hazards related to smoking are well known. Smoking is a recognized risk factor for coronary artery disease (CAD). Despite rejection of smoking by the Saudi community, we are still seeing smokers in our population. This study is designed to determine the prevalence of smoking in the Kingdom of Saudi Arabia (KSA), and to find out its relation to CAD. This study is part of the Coronary Artery Disease In Saudis (CADIS) study.

Methods

This health survey was conducted by collecting data regarding smoking status among adult Saudis aged between 30 and 70 years of both sexes in KSA over a five year period from 1995 up to 2000. The study sample was of normal distribution and representative of all regions of KSA. The data were analyzed to provide the prevalence of smoking and its relation with CAD.

Results

The total number of subjects was 17,350, and current smokers were 2217; accordingly the overall prevalence of smoking among Saudis was 12.8%. Males (1555) were significantly smoking more than females (662) with a prevalence of 18.7% and 7.3%, respectively (P < 0.0001). Smoking is more prevalent among Saudis living in urban, northern, western, and eastern regions compared to other regions of KSA. Smokers are more likely to develop CAD compared to non-smokers (P < 0.0001).

Conclusions

Smoking is a prevalent health problem among Saudis that requires intervention for eradication. We found clear association between cigarettes smoking and CAD particularly among males. Persistent education of the health hazards related to smoking is recommended particularly at early age in-order to prevent initiation of smoking.     

The Saudi Project for Assessment of Coronary Events (SPACE) registry: Design and results of a phase I pilot study

OBJECTIVE:

The delay between the availability of clinical evidence and its application to the care of patients with acute coronary syndrome (ACS) in the Kingdom of Saudi Arabia remains undefined. The Saudi Project for Assessment of Coronary Events (SPACE) registry provides a comprehensive view of the current diagnostic and treatment strategies for patients with ACS; thus, the registry may be used to identify opportunities to improve the care of these patients.

METHODS:

Eight hospitals in different regions of Saudi Arabia were involved in the pilot phase of the registry, from December 2005 to July 2006. The study patients included individuals with ST segment elevation myocardial infarction (STEMI), non-STEMI and unstable angina.

RESULTS:

A total of 435 patients (77% men and 80% Saudis) with a mean age of 57.1 years were enrolled. Medical history included previously diagnosed ischemic heart disease (32%), percutaneous coronary intervention (12%), diabetes mellitus (53%), hypertension (48%), current smoking (39%), hyperlipidemia (31%) and family history of premature coronary artery disease (11%). The median door-to-needle time for fibrinolytic therapy received by patients with STEMIs was 90 min. Inhospital medications included acetylsalicylic acid (98%), clopidogrel (73%), angiotensin-converting enzyme inhibitors (74%), beta-blockers (73%), statins (88%), unfractionated heparin (80%), low-molecular weight heparin (22%) and glycoprotein IIb/IIIa inhibitors (9%). The inhospital mortality rate was 5%.

CONCLUSION:

The first nationwide registry of patients with ACS in the Kingdom of Saudi Arabia is presented. In contrast to registries from developed countries, our cohort is characterized by a younger age at presentation and a much higher prevalence of diabetes mellitus. Most patients with STEMIs did not receive fibrinolytic therapy within the time recommended in the American College of Cardiology/American Heart Association guidelines. The results of the present pilot study show potential targets for improvement in care.     

Putting the evidence into practice: the King Faisal Specialist Hospital and Research Centre experience

For more than a decade, evidence-based practice has become the desired aim behind organized health care. Although a plethora of reasons exist as to why clinicians are reluctant to adopt research-based findings, the fundamentals relate to management of change and the nature of the individuals involved. Large organizations, with their daily routines and operations, are inherently difficult to change. Hence, one has to use the very structures that drive the organization to effect 'sustained' change. In large tertiary care facilities, such as the King Faisal Specialist Hospital and Research Centre, these structures are policies and procedures. This paper provides details of the process developed by the Nursing Affairs Practice Committee of the King Faisal Specialist Hospital and Research Centre to achieve the committee mandate of: 'Establish and implement an evidence-based process for the systematic review and revision of nursing clinical standards, policies, procedures and protocols'.     

Comparative study between the protective effects of Saudi and Egyptian antivenoms, alone or in combination with ion channel modulators, against deleterious actions of Leiurus quinquestriatus scorpion venom

This study compared efficacy of two polyvalent antivenoms (Saudi Arabian and Egyptian), against lethality and pathophysiological changes of Leiurus quinquestriatus quinquestriatus (LQQ) scorpion venom in mice. Additionally, the study examined whether treatment with selected ion channel modulators, lidocaine, nimodipine or amiodarone would be effective, alone or combined with the antivenoms.The protein concentration of the Saudi antivenom was 1/3 of Egyptian, indicating lesser immunogenicity, while both preservative contents were within limits. In immunodiffusion experiments, both exhibited prominent precipitin bands indicating high concentrations of specific antibodies. Neutralizing capacities (60-70 LD₅₀) stated on labels were confirmed. Both antivenoms significantly (P < 0.001) prolonged survival time (from 26.9 ± 1.18 min, 100% dead with venom to 224-300 min, 0-30% dead) of envenomed mice, whether injected iv before or 5 min after venom. Injection of either antivenom plus ion channel modulators, gave comparable results to that observed in mice treated with antivenoms alone. The Na⁺ channel blocker lidocaine and the Ca²⁺ channel blocker nimodipine on their own significantly protected the animals (P < 0.05), but to a lesser extent.The two antivenoms, significantly ameliorated the venom-evoked changes in serum LDH (P < 0.001) and CKMB (P < 0.01) plus cardiac TNFα and nitrate/nitrite levels (P < 0.001). When combined with lidocaine or nimodipine, the effects were not greater than antivenom alone. Moreover, the antivenoms ameliorated characteristic venom-evoked changes in the isolated perfused Langendorff hearts. Lidocaine and amiodarone were more effective than nimodipine.In Conclusion both Saudi and Egyptian antivenoms protected mice from the pathological and lethal effects of LQQ scorpion. Sodium and calcium channel blockers, lidocaine and nimodipine, may be useful when antivenoms are not available.