Retinoblastoma: Update on Current Management

Retinoblastoma (Rb) is the most common primary intraocular malignancy in children with an incidence from 1:15,000 to 1:20,000 live births. It can present as a unilateral or bilateral involvement of the eyes. It is generally induced by biallelic mutation of the RB1 tumor suppressor gene that leads to malignant transformation of primitive retinal cells. The most common presentation is leukocoria, followed by strabismus. The initial assessment and future treatment of such tumor should be based on the laterality, the stage of the tumor, and the presenting age of the child. In general, the primary target of therapy is to preserve the child’s life. However, preserving the globe and preserving vision should be achieved whenever it’s possible. Retinoblastoma treatment has evolved from enucleating the affected globe to also involving external beam radiation therapy, cryotherapy, laser photocoagulation, thermotherapy, brachytherapy, and chemotherapy (intravitreal, intra-arterial, and systematic). This chapter is intended to discuss briefly the clinical presentation of Rb, as well as a comprehensive review about the evolution and current treatment modalities with a focus on cases with low-risk features

Adherence of Primary Health Care Physicians to Hypertension Management Guidelines in Aljouf Region of Saudi Arabia

Abstract Introduction: Hypertension affects more than one-third of the world population and is a common public health problem. Primary health care physician's (PHCP's) adherence to the hypertension management guidelines constitutes an essential step for controlling hypertension

The Effect of Socio-economic status on the Oral Hygiene of Elementary School Children in the City of Dammam, Saudi Arabia

ABSTRAC

A decision aid for considering indomethacin prophylaxis vs. symptomatic treatment of PDA for extreme low birth weight infants

Abstract Background Decision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants. Methods We developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale. Results The DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008). Conclusion We have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice.</p

Pulse pressure in acute heart failure: Insights from the hearts registry

Introduction: Low Pulse Pressure (PP) predicts mortality in chronic symptomatic Heart Failure (HF). Data in Acute HF (AHF) are lacking. Our aim was to examine the prognostic value of PP in AHF for short- and long-term outcomes. Methodology: Data from the Heart Function Assessment Registry Trial (HEARTS) were analyzed. AHF patients were prospectively enrolled from October 2009 to December 2010, with a mortality follow-up until January 2013. Comparisons were done according to PP median value (50 mmHg). Primary outcomes were hospital adverse events and short and long-term mortality rates. Results: 2609 patients were included. In crude comparisons, patients with low PP had higher rates of recurrence of HF (35.4% vs. 26.5%; P < 0.001), and greater risk of hospital and 30-day mortality (7.8% vs. 5.1%; P 0.006 and 9.5% vs. 6.6%; P = 0.006, respectively). There were no differences observed in long-term mortality rates. Multiple regression analyses showed no independent role for PP on all studied outcomes. However, a subgroup analysis revealed that hospital mortality was greater in HF with reduced Ejection Fraction (HFrEF). Conclusion: Low PP was not predictive of mortality in the overall AHF population. However, it still remains an important prognostic marker in the HFrEF phenotype

Predictors and impact of in-hospital recurrent myocardial infarction in acute coronary syndrome patients: Findings from Gulf RACE-2

IntroductionLittle in the literature is known about the predictors and the adverse impact of recurrent ischemia and infarction in patients with acute coronary syndrome (ACS). Accordingly; our objectives were to determine the risk factors, and long term outcome of patients with recurrent ischemia.MethodsWe evaluated ACS patients who were enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).ResultsOut of 7930 ACS patients, 172 (2.2%) developed recurrent myocardial infarction (Re-MI) during their hospitalization. Patients with Re-MI were more likely to be older (mean age 59.12±13.5 vs. 56.8±12.4; P=0.016), had higher rates of hyperlipidemia (41.3% vs. 32.6%; P=0.027) and previous angina (47.7% vs. 37.9%; P=0.006), presented more with STEMI (72.1% vs. 43.9%; P<0.001), and had more Killip class 4 upon admission (8.1% vs. 3.2%; P<0.001) than patients without Re-MI. Management-wise, Re-MI patients received less aspirin (94.8% vs. 98.5%; P=0.002), beta-blockers (59.3% vs. 74.7%; P<0.001), and statin (87.2% vs. 94.9%; P<0.001), and were less frequently assessed by coronary angiogram (30.8% vs. 32.5%; P=0.036). These patients had more in-hospital complications including congestive heart failure (44.2% vs. 12.4%) and cardiogenic shock (25.6% vs. 5.3%) as well as higher mortality rates; both during hospitalization (23.8% vs. 4.1%) and after a discharge period of 30days (27.3% vs. 6.87%) and 1year (29.1% vs. 9.3%). P<0.001 for all comparisons.ConclusionPatients with recurrent infarction have a bad prognosis in terms of in-hospital complications and high mortality rates. High risk patients need to be monitored and managed differently to prevent secondary attacks

Impact of in-hospital recurrent ischemia event: findings from GULF RACE-2

BackgroundLittle in the literature is known about the long term outcome of patients with acute coronary syndrome (ACS) and in-hospital recurrent ischemic event. Accordingly; our objectives were to determine the baseline characteristics of patients, the predictors, and the long term outcome of patients with recurrent ischemia.MethodsThe population compromised 7930 enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).ResultsOut of the 7930 ACS patients, 172 (2.2%) had Re-MI during their hospital stay. Patients with Re-MI were more likely to be older (mean age 59.12±13.5 vs. 56.8±12.4, P=0.016), had significantly higher rate of prior history of angina (48% vs. 38.2%, P=0.006), and hyperlipidemia (45.2% vs. 37.3%, P=0.027) than patients without Re-MI. On admission patients with Re-MI had significantly higher HR, lower systolic BP, Killip class 4 and high GRACE risk score than those without Re-MI (27.3% vs. 17.6%), (11% vs. 4.8%), (8.1% vs. 3.2%), and (31.8% vs. 21.5%, P<0.05 for all comparisons), respectively. Patients with Re-MI had a higher rate of STEMI on admission than patients without Re-MI (72.1% vs. 43.9%; P<0.001). Re-MI patients were less likely to receive Aspirin (94.8% vs. 98.5%, P=0.002), beta blockers (95.3% vs. 74.7%, P<0.001), and Statin (87.2% vs. 94.9%, P<0.001) than patients without Re-MI. Coronary angiogram was less frequently performed on patients with Re-MI than patients without Re-MI (30.8% vs. 32.5%, P=0.036). In hospital adverse events including HF, cardiogenic shock, VT/VF were more frequent in the Re-MI group than patients without Re-MI (44.2% vs. 12.4%), (25.6% vs. 5.3%), (7.6% vs. 2.7%; P<0.001 for all comparisons) respectively. In ACS patients with Re-MI in-hospital, 30days and 1year were significantly higher that patients without Re-MI (23.8% vs. 4.1%), (28.1% vs. 7.7%), and (31.6% vs. 12.1%; P<0.001 for all comparisons), respectively.ConclusionRecognizing patients at high risk of Re-MI is important as modifying the risk factors, and managing the patient aggressively may reduce the incidence of such events and the associated morbidity and mortality