Knowledge of breast cancer and its risk and protective factors among women in Riyadh

Background: We conducted this study to assess knowledge of breast cancer and sources of information about breast cancer among women in Riyadh. We also analyzed whether associations existed between de-mographic variables, knowledge of breast cancer, and the practice of breast self-examination and use of mammography screening. Methods: Women interested in participating in this community-based descriptive study provided data by completing a pre-tested structured questionnaire. Results: Of 864 participating women, 84% were Saudi, 45% were mar-ried and 67.8% had a university level education. Eighty percent were be-tween the ages of 20 to 50 years. Knowledge of breast self examination (BSE) was high; 82% (95% confidence intervals [CI], 79.2%-84.4%) knew about BSE, while 61% (95% CI: 57.9%-64.5%) knew about mammogra-phy, but only 41.2% (95% CI, 37.9%-44.5%) had performed BSE and 18.2% (95%CI, 15.5%-20.8%) had had mammography screening. Knowledge of breast cancer, risk factors and protective factors for breast cancer was moderate. There was a statistically significant association between the demographic characteristics (marital status, educational status and family history of breast cancer) and knowledge and practice of BSE and mammography. Conclusion: Though it has limitations, this study revealed an imbal-ance between the knowledge and practice of BSE among women. It also showed that there is only moderate knowledge of risk and protective factors for breast cancer and that knowledge and practice of BSE and mammograms vary according to marital and educational status. Hence, frequent community-based awareness programs are needed so that all women can know and practice BSE, which in turn helps to prevent breast cancer

Intermittent Oral Versus Intravenous Alfacalcidol in Dialysis Patients

Patients with end-stage renal failure (ESRF) on maintenance dialysis, commonly develop secondary hyperparathyroidism and renal osteodystrophy (ROD). Alfacalcidol, taken orally or administered intravenously, is known to reverse these complications. In this study, 19 ESRF patients, who were on dialysis (13 on hemodialysis and six on peritoneal dialysis) for longer than six months and having serum parathormone levels at least four times normal and serum calcium less than 2.1 mmol/L, were randomly allocated to treatment with oral or intravenous (i.v.) alfacalcidol for a period of 12 months. There were six patients on hemodialysis (HD) and three on peritoneal dialysis (PD) in the oral treatment group while in the i.v. group there were seven patients on HD and three on PD. Clinical and serial biochemical assessments showed no statistically significant difference between the orally- and i.v.-treated patients in terms of suppressing secondary hyperparathyroidism and osteodystrophy. However, patients with features of mild ROD on bone histology, had more satisfactory changes in biochemistry when compared to others. Our results further support the use of intermittent oral alfacalcidol in ESRF patients because of its cost effectiveness, ease of administration and convenience, especially for peritoneal dialysis patients

Concomitant macro and microvascular complications in diabetic nephropathy

To determine the prevalence of concomitant microvascular and macrovascular complica-tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Dete-rioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing com-plications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggre-ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD

Evaluation of best quality okra parental lines based on morpho-physiological and nutritional attributes

The study was conducted to investigate the best quality parental line selection of okra (Abelmoschus esculentus) varieties based on morpho-physiological and nutritional attributes. Significant variations were observed for the measured morpho-physiological and nutritional attributes among those varieties. Among the major traits; highest fresh and dry weight of fruit was recorded in variety 3 (Ok1-MKB1) and 7 (Ok7-GGS). Days to 50% flowering and days to mature fruit harvest showed that varieties 2 (Ok2-0366) and 4 (Ok4-LG) were the earliest. Variety 4 possessed the highest level of P while variety 6 (Ok6-ABM) of okra fruits contained the highest concentration of K. Zinc content was the highest in variety 4 and the lowest was in variety 1. Next, Variety 7 had the highest concentration of Mg and the lowest was in variety 6. Variety 5 (Ok5-SS103) contained the highest concentration of Fe while variety 3 had the lowest. Lastly, variety 3 possessed the highest content of Ca while the lowest was in variety 1, respectively. Pearson’s correlation analysis revealed the strongest correlation (P ≤ 0.001) in between days to 50% flowering and days to harvest, while fruit fresh weight and fruit dry weight as well. Cluster analysis grouped those 7 okra varieties into five different clusters; where V2, V3 and V6 were solely different from others, indicating the highest diversity compared to other accessions. So, for varietal improvement program, the most judicious crossing combination can be made with V2, V3 and V6 with V1 or V5 and V4 or V7, which would bring about the greater genetic diversity

Hepatitis G virus (HGV) infection in Saudi dialysis patients and healthy controls

Background: Viral hepatitis is a global health problem with a high mortality rate. End stage renal disease (ESRD) patients have a high prevalence of Hepatitis B and C virus infection. Present study was done to identify the prevalence and course of a new isolate Hepatitis G virus (HGV) infection in Saudi dialysis patients. Methods: The pattern of viral hepatitis infection (HBV. HCV and HGV) was investigated in 109 Saudi patients with ESRD and 100 healthy Saudi blood donors. Donated blood was tested for markers of Hepatitis B, C and G viruses. Liver functions were measured and blood picture and liver biopsies were also performed at regular intervals. Results: Out of the 109 ESRD patients 68 (62.4%) were positive for at least one viral marker: 59 (54.1%) were positive for HCV, six (5.5%) were positive for HGV and three (2.8%) were positive for HBsAg. Four of the six HGV positive patients were also co-infected with HCV. Eight (8%) of the blood donors were positive for at least one viral marker. Elevated ALT levels (>4 times normal) were recorded in four out of the six HGV-positive patients including three co-infected with HCV. Conclusions: Our results are in agreement with similar studies from different countries and also raise the question about the causal relationship between HGV and liver disease among dialysis patients

Living Unrelated Renal Transplant: Outcome and Issues

Living unrelated transplantation (LURT) is emerging as a practical option in renal transplantation due to shortage of living related and cadaver donors. We report a six-years (December 1991 to December 1996) follow-up of 60 LURT patients. The majority of these patients (95%) were transplanted outside the Kingdom of Saudi Arabia; 37 in India, 14 in Egypt, five in the USA and one in Pakistan. Only three patients (emotionally related) were transplanted in Saudi Arabia. Before transplantation, 50 (83.4%) patients were on chronic hemodialysis, three (5%) on peritoneal dialysis and three (5%) were transplanted pre-emptively. Post-operatively, the majority of the study patients were on three drug immunosuppressive therapy. One and five year graft survival was 93.0% and 59.6%, while patient survival at one and three years was 93.7% and 81%, respectively. Surgical complications included lymphocele in 10% of the study patients, urinary leak in 8.3%, and bleeding from the vascular anastomosis in 6.6%. There were eight episodes of acute rejection in eight (13.3%) patients and all episodes were successfully treated; two patients required monoclonal anti-lymphocyte antibodies (OKT3). Eleven (18.3%) patients developed chronic rejection, which resulted in the loss of ten (90%) allografts. Infection was the commonest cause for hospital admission; urinary tract infection (UTI) being responsible for 40% of admissions. Three patients had Cytomegalovirus pneumonia, one had Pneumocystis Carinii pneumonia and one had candida pneumonia. Two (3%) patients developed Kaposi′s sarcoma. We conclude that LURT can help in overcoming the shortage of organs for transplant, however, commercial transplantion in developing countries is associated with high morbidity and mortality

Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors)

Medical providers are often asked by their kidney recipients and donors about what to do or to avoid. Common questions include medications, diet, isolation, return to work or school, pregnancy, fasting Ramadan, or hajj and Omrah. However, there is only scant information about these in English language and none in Arabic. Here, we present evidence-based education materials for medical providers (in English language) and for patients and donors (in Arabic language). These educational materials are prepared to be easy to print or adopt by patients, providers, and centers

Effect of Intravenous Cyclophosphamide Pulse Therapy on Renal Functions and Histopathology in Patients with Severe Lupus Nephritis

Despite the wide use of intravenous cyclophosphamide (IC) in lupus nephritis (LN), there are few published studies showing the effect of this treatment on renal histology. In this prospective study, we report the effect of IC on the evolution of histopathologic features in successive renal biopsies in patients with LN. Thirty patients with class IV or V LN were started on IC (10-15 mg/kg) administered once every month for six months followed by three monthly for another six doses making a total of two years of therapy. The clinical course of the disease, serum creatinine and 24 hours urinary protein and creatinine clearance were tested at entry and subsequently during each follow-up visit. Repeat renal biopsy was performed after completion of two years of therapy. The mean serum creatinine of the study patients was 166.3 <u> &#x002B;</u> 42 tmol/L at entry which decreased to 104 &#x002B; 46.4 tmol/L at two years (P &lt; 0.01). The mean 24 hours proteinuria decreased from 2.81 <u> &#x002B;</u> 2.4 g at entry to 1.39 <u> &#x002B;</u> 1.54 g at two years (P &lt; 0.003) and the mean creatinine clearance increased from 58 <u> &#x002B;</u> 31 ml/min at the start of treatment to 64 <u> &#x002B;</u> 32 ml/min at two years of therapy (P &lt; 0.05). Nine patients had serum creatinine of &gt; 200 tmol/L, of whom six progressed to variable degrees of chronic renal failure. Repeat renal biopsy was performed in 21 patients. The original biopsy of these patients showed class IV in 17 and class V in four patients. On repeat biopsy, five of class IV disease had progressed to advanced sclerosis, four to class V, and five remained unchanged. The remaining three patients with class IV LN changed to one each of class I, II and III. Of the four patients with class V, one progressed to advanced sclerosis, one changed to class III and two remained the same. There was a significant decrease (P &lt; 0.05) in the activity index although there was a significant increase in the chronicity index (P &lt; 0.001). Multivariat analysis for possible risk factors for progression to chronic renal failure showed initial high serum creatinine to be a powerful predictor of renal failure. In conclusion, IC pulse therapy is effective in improving or stabilizing renal function in patients with class IV or V LN. The only poor prognostic determinant observed was higher initial serum creatinine value

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution

Background and Objectives: Because there is no recent update on the state of diabetes and its concomi--tant complications in Saudi Arabia , we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. Methods: We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital , Riyadh , Saudi Arabia , between January 1989 and January 2004. Results: Of 1952 patients , 943 (48.3&#x0025;) were males. For the whole study population the mean age at enrollment was 58.4&#x00B1;14.2 years , the mean age at onset of diabetes was 48.1&#x00B1;12.8 years , the mean duration of diabetes was 10.4&#x00B1;7.5 years , and the mean duration of follow-up was 7.9&#x00B1;4.6 years. Nephropathy was the most prevalent complication , occurring in 626 patients (32.1&#x0025;). Acute coronary syndrome occurred in 451 (23 .1 &#x0025;), cataracts in 447 (22.9&#x0025;) , retinopathy in 326 (16.7&#x0025;) , and myocardial infarction in 279 (14.3&#x0025;) , Doubling of serum creatinine was seen in 250 (12.8&#x0025;) and 79 (4.0&#x0025;) went into dialysis. Hypertension was present in 1524 (78.1&#x0025;) and dyslipidemia in 764 (39.1&#x0025;). Overall mortality was 8.2&#x0025;. Multiple complications were frequent. Males had higher prevalence of complications than females (P&#60; .05). Mortality was significantly higher in males 92 (9.8&#x0025;) than females 69 (6.8&#x0025;) (P=.024). The prevalence of complications significantly increased with dura--tion of diabetes and age (P&#60; .05). Conclusion: Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovas--cular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities

Comparison of high and low dose of cyclophosphamide in lupus nephritis patients: A long-term randomized controlled trial

To evaluate the outcome of low doses of cyclophosphamide (Cyclo) therapy in lupus nephritis (LN) patients, we studied 117 biopsy-proven, de novo LN WHO class IV patients double-blinded and randomized in December 1997 to receive Cyclo in different doses; Group I (n=73) received Cyclo 10 mg/kg monthly for six months then every two months for 12 months. Group II (n=44) received Cyclo 5 mg/kg monthly for six months then every two months for 36 months. The patients were followed-up till January 2007. Six months post-induction values for creatinine clearance were significantly higher in Group I (67.7 ± 28.6 mL/min) compared with Group II (55.1 ± 30.1 mL/min), P = 0.026. Serum C4 and ANA were not significantly different between the groups (P > 0.05). At the mean follow-up of 6.77 ± 3.3 years, the mean creatinine clearance was 44.74 ± 31.7 mL/min in Group I vs. 49.3 ± 38.8 in Group II. Urinary protein was 1.65 ± 1.8 g/dL in Group I vs. 1.02 ± 1.01 in Group II (P = 0.03). The survival curve showed that kidney survival overtime was comparable in both groups (P = 0.2). Complete remission was observed in 25 (34.2%) patients in Group I vs. 11 (25%) in Group II (P = 0.288), while partial remission was similar in both groups; 43 (58.9%) patients in Group I vs. 26 (59%) patients in Group II. End-stage renal disease was observed in 10 (13.7%) patients in Group I vs. 9 (20.4%) patients in Group II (P = 0.359). Side-effects were more frequent in Group I patients than in Group II patients; gonadal toxicity and malignancy were lower in Group II patients (P = 0.0000). Moreover, different infections occurred in 23 (31.3%) patients vs. six (13.6%), digital infarcts occurred in 1.35% vs. 0%, diabetes in 4.1% vs. 2.27%, and vasculitis in 4.1% vs. 2.27% in Group I vs. Group II, respectively. Sustained amenorrhea without pregnancy was observed in both groups; however, significantly more in Group I patients, P ≤ 0.05. We conclude that low-dose Cyclo therapy is sufficiently effective for WHO class IV LN patients with lower side-effects compared with standard dose