USE OF COMPLEMENTARY/ALTERNATIVE MEDICINE (CAM) BY CANCER PATIENTS AT A UNIVERSITY HOSPITAL

Background and purpose: Complementary and alternative medicine (CAM) therapies are commonly used by cancer patients around the world. The aim of this cross-sectional study was to explore the extent of CAM therapies use by cancer patients, discover patients’ motives, sources, and beliefs regarding the benefits of CAM therapies, and determine patient awareness of possible adverse effects. Materials and methods: A comprehensive, validated questionnaire in Arabic was explained and given to patients who provided their consent to participate. All patients attended King Saud University-Medical City Oncology Center. Results: Among the patients, 136 responded to the questionnaire and 97 (71.3%) reported using some form of CAM therapies. The most frequently used CAM therapies were Zamzam water (Holy water from Makkah), honey, olive oil, black seeds, dates, and camel milk (with/without camel urine). Many patients were unaware of any adverse effects of CAM therapies. Statistical analyses showed that there were no significant differences between users and non-users in terms of gender, age, nationality, marital status, or educational level (p<.05). Conclusion: Many cancer patients use various forms of CAM therapies because they believe that CAM therapies may be beneficial and are harmless. Key Words: Complementary and alternative medicine, cancer, neoplasm, Saudi Arabia

Innovation Output and the Cost of Funds

Do firms with higher levels of innovation output, measured by patent counts and citations, enjoy lower costs of funds? The process to develop and apply for patents involves valuable resources. Thus, applying for a patent is a credible signal that the underlying invention is valuable. This value is validated to some degree when the patent is granted. In addition, patents contain detailed information about the firm's inventions and provide collateral value as they can be sold and licensed. The number of citations a firm receives act as a proxy for high-quality inventions, active networking, and pioneering. These attributes are expected to attract investors and reduce the cost of funds. Univariate and cross-sectional regression analyses of a sample consisting of 404,595 firm-years, involving firms from twenty-eight countries spanning from 1976 to 2012, demonstrate a significant negative association between innovation output and the cost of funds. The evidence suggests that the marginal benefit of innovation diminishes as innovation output increases. The results are robust to different measures of the cost of equity and the cost of debt. The negative association between the cost of equity and innovation output is economically larger for younger and smaller firms. The long-term level of innovation seems to be more important to shareholders than short-term changes of innovation. In addition, shareholders demonstrate an ability to discern between low and high-quality innovations, as they require lower rates of returns when initial patents exhibit a high quality. Shareholders place more value on innovation output when firms operate in countries with legal systems that are more effective in controlling self-dealing practices, in countries that have higher economic freedom, and in countries that have more developed financial markets. The correlation between the cost of debt and innovation output is predominantly derived by larger, more mature, and more leveraged firms. Innovation output and the cost of debt are not correlated for low levels of innovation; however, medium and high levels of innovation output relative to peer firms are associated with lower costs of bonds. The findings suggest that the effect of innovation on the cost of debt is stronger in countries with more developed financial markets and in countries characterized by higher levels of economic freedom. Practices that control for self-dealing do not affect the association between innovation output and the cost of debt

Response to Lisinopril in Patients with Sickle Cell Anemia and Proteinuria

Proteinuria is a manifestation of sickle cell anemia (SCA)-related renal disease and is a risk factor of renal impairment. Angiotensin-converting enzyme (ACE) inhibitors have benefits, but their role in SCA remains undefined. This study aimed to assess the role of lisinopril, an ACE inhibitor, in reducing proteinuria in SCA patients. Thirty-five patients older than 15 years with known SCA (HbSS or HbS-β0) and a 24-h urinary protein level of 150 mg or more participated in this study. Urine was collected over 24 h to quantify proteinuria. The patients had a mean age of 28.5 ± 6.98 years. The median 24-h urinary protein before treatment was 0.3006 g and that after treatment was 0.150 g (P = 0.01). After a median follow-up of 38 months, 24-h urinary protein decreased in 27 (77%) patients and normalized in 18 (52%) patients. Urinary protein increased in 2 (6%) patients and remained stable (no change) in 6 (17%) patients. There was no significant difference in blood pressure (BP) before and after treatment. The average dose of lisinopril was 5 mg. Twenty patients were still on lisinopril at last follow-up. The reasons for stopping lisinopril included normalization of protein, noncompliance, adverse effects, and pregnancy. Lisinopril effectively reduced proteinuria in SCA patients, without significantly reducing BP. Only a few patients developed adverse effects, including coughing, dizziness, and diarrhea. It is unclear how long lisinopril should be continued and whether it can be stopped in patients with normalized urinary protein

Health-related quality of life in adult patients with hemophilia, Riyadh, Saudi Arabia

Background: Despite a reduction in mortality rates, hemophilia patients continue to suffer the consequences of repeated bleeding episodes. Assessment of health-related quality of life (HRQoL) attempts to determine how different life aspects are affected and helps guide future decision-making. AIMS: The aim of the study was to assess HRQoL in adult patients with hemophilia managed at King Khalid University Hospital (KKUH), Riyadh and to identify factors affecting HRQoL. Settings and Design: An observational cross-sectional study was conducted at KKUH in Riyadh from September 2014 to April 2015. Subjects and Methods: Sixty-one patients followed up and treated at KKUH from 2000 to 2015 were enrolled in the study. Patients were asked to complete the Arabic version of the Hemophilia-Specific QoL (HAEMO-QoL-A) Questionnaire. Results: Forty-Nine hemophilic patients completed the HAEMO-QoL-A questionnaire. Of these, 81.6% had hemophilia A, with a mean age of 29.84 years. The most common target joint was the knee (89.7%). The majority used on-demand treatment (55.1%). The HAEMO-QoL-A mean total score was 99.89. “Treatment concerns” were the most impaired dimension, whereas the “work/school, family, and social life” dimension was least affected. Patients receiving on-demand treatment had the lowest average bleeding events (8.22, P = 0.007). Conclusion: Frequent bleeding events, prophylactic treatment, and presence of clotting factor inhibitors negatively impact the HRQoL of patients with hemophilia

Management of Glanzmann's Thrombasthenia – Guidelines based on an expert panel consensus from gulf cooperation council countries

Glanzmann thrombasthenia is a rare disorder, due to quantitative and/or qualitative abnormalities of the platelet integrin αIIbβ3 and/or αIIbβ3. Although it is considered a rare disorder with a global incidence of 1/1,000,000 population, the case is different at the Gulf Cooperation Council countries, where prevalence rate as high as 1/40,000 in Madinah, Saudi Arabia. This makes it necessary to develop patient's management guidelines. Due to limited resources in the literature, experts' consensus was important to develop such guidelines. Experts panel elected to use recombinant activated factor VII (rFVIIa) as the first line of treatment of acute bleeds and reserve platelets transfusion for nonresponding patients or severe bleeds, rFVIIa at high dose (270 μg/kg body weight) may tried upfront. rFVIIa may be tried as prophylactic treatment in patients with frequents bleeds. Experts panel elected to allow girls with Glanzmann thrombasthenia to have menstruation and to adapt a special protocol for this purpose (Madinah protocol). Pregnancy should be managed carefully, where normal delivery encouraged under coverage of rFVIIa. Risk of bleeding should be expected in neonates. Minor surgeries and dental workup can be managed under coverage of rFVIIa. Glanzmann thrombasthenia patients with severe disease should be encouraged for hematopoietic stem cell transplant

Saudi expert consensus on acquired hemophilia A diagnosis and management

الملخص: أهداف البحث: يصاب حوالي شخص واحد من كل مليون شخص بالهيموفيليا المكتسبة. يعد التشخيص في الوقت المناسب أمرا بالغ الأهمية لإدارة المرض بطريقة مناسبة والوقاية من المضاعفات التي تهدد الحياة. قد يلجأ هؤلاء المرضى في البداية إلى أطباء غير متخصصين وقد يبقون غير مشخصين لسنوات عدة. يهدف هذا الإجماع إلى توفير إرشادات لجميع الممارسين في المملكة العربية السعودية لتشخيص وإدارة الهيموفيليا المكتسبة. طرق البحث: تعكس هذه البيانات الإجماعية الآراء التي تم صياغتها بواسطة مجموعة من أخصائيي أمراض الدم باستخدام عملية منهجية صريحة لتحديد مجالات الاتفاق والاختلاف. النتائج: يمكن استخدام هذا البيان الإجماعي كدليل لجميع الممارسين في المملكة العربية السعودية فيما يتعلق بتشخيص المظاهر السريرية، والعلاقة، وخصائص أعراض النزيف، وإدارة هذه الحالات، مع توجيه خاص للأخصائيين غير المتخصصين. سوف يناقش الإجماع جميع جوانب الإدارة، من التشخيص إلى أساليب العلاج. الاستنتاجات: قد يلجأ مرضى الهيموفيليا المكتسبة في البداية إلى أطباء يفتقرون إلى الخبرة المناسبة في تشخيص وإدارة هؤلاء المرضى. يوفر هذا البيان الإجماعي وثيقة مفصلة لتشخيص وإدارة الهيموفيليا المكتسبة، بتوجيه من أفضل الخبراء في المرض في المملكة العربية السعودية. Abstract: Objectives: Acquired hemophilia affects approximately one in 1 million people. Timely diagnosis is key to appropriate disease management and the prevention of life-threatening complications. Patients with this condition may initially be seen by inexperienced physicians and remain underdiagnosed for several years. This consensus statement is aimed at providing guidelines for all practitioners in the Kingdom of Saudi Arabia (KSA) to diagnose and manage acquired hemophilia A. Methods: This consensus statement reflects the opinions drafted by a group of hematology specialists, who used an explicit systematic process to identify areas of agreement and disagreement. Results: This consensus statement provides a guide for all practitioners in the KSA regarding the diagnosis of clinical presentation, relevance, characteristics of bleeding symptoms, and case management; it additionally provides guidance for non-specialists. All management aspects, including diagnosis and treatment modalities, are discussed. Conclusions: Patients with acquired hemophilia may initially be seen by physicians who lack appropriate expertise in diagnosing and managing this condition. This consensus statement from the premier experts on the disease in the KSA provides details for diagnosing and managing acquired hemophilia

Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey

Iron deficiency is the most prevalent nutritional deficiency worldwide. According to an estimate by the World Health Organization, up to 27% of the world’s population experience iron deficiency anemia (IDA). Studies conducted in the Middle East, including Saudi Arabia, have suggested that IDA is the most common cause of anemia, especially among females. This study aimed to determine the prevalence of IDA and iron deficiency (ID) among apparently healthy young university students from four regions in Saudi Arabia. Students were asked to complete a simple survey questionnaire; blood samples were then collected and analyzed after obtaining informed consent. A total of 981 students completed the survey, with 11% of the participants reporting symptoms of anemia; 34% of participants were diagnosed with IDA and 6% reported a diagnosis of hemoglobinopathy. Blood analysis confirmed the prevalence of ID and IDA in 28.6% and 10.7% of the participants, respectively; those with ID and IDA were mostly females (88.5% and 94%, resp.). Thalassemia trait and sickle cell trait were detected in 1.3% and 7% of participants, respectively. Our findings from a national survey among young university in Saudi Arabia indicate a high prevalence of ID and IDA

Efficacy and safety of a new human fibrinogen concentrate in patients with congenital fibrinogen deficiency: an interim analysis of a Phase III trial

WOS: 000424395000021PubMed ID: 29194665BACKGROUNDFibrinogen concentrate is the preferred choice for fibrinogen replacement in congenital fibrinogen deficiency. This study investigated hemostatic efficacy of a new plasma-derived, double virus-inactivated (using two dedicated virus inactivation/elimination steps) human fibrinogen concentrate for on-demand treatment of bleeding episodes (BEs) and surgical prophylaxis. STUDY DESIGN AND METHODSIn this planned interim analysis of a prospective, multinational Phase III study (NCT02267226), 13 patients with afibrinogenemia (12 years) received fibrinogen concentrate (FIBRYGA, Octapharma AG). Hemostatic efficacy was assessed by investigators and an independent data monitoring and endpoint adjudication committee (IDMEAC) using objective four-point criteria and by thromboelastometry maximum clot firmness (MCF). RESULTSFibrinogen concentrate was used on-demand to treat 23 BEs in 11 patients, with 21 (91.3%) requiring a single infusion only. Treatment success was 95.7% (90% confidence interval [CI], 0.81-1.00; assessment missing for one BE) by investigators and 100% (90% CI, 0.88-1.00) by IDMEAC. Mean MCF increased significantly from 0.0 to 6.5 mm (95% CI, 5.65-7.40; p<0.0001) at 1 hour postinfusion of a median (range) dose of 58.8 (33.9-101.7) mg/kg per BE. Four patients received fibrinogen concentrate as surgical prophylaxis, with intraoperative and postoperative treatment success rated 100% (90% CI, 0.50-1.00) by investigators and IDMEAC (median [range] dose per surgery 93.5 [34.1-225.4] mg/kg). No additional hemostatic interventions were required. No deaths, thromboses, or seroconversions were reported. CONCLUSIONThese data showed that the new fibrinogen concentrate was efficacious for on-demand treatment of acute bleeding and surgical prophylaxis in congenital afibrinogenemia patients