Cervical cancer in Saudi Arabia: trends in survival by stage at diagnosis and geographic region

Background: Regional differences in cervical cancer survival have been reported in several countries. They may result from disparities in access to early diagnostic services, timely referral or appropriate treatment. Estimates of survival by stage at diagnosis could help to distinguish whether lower-than-expected survival is due to late-stage diagnosis or sub-optimal management, and to inform health-policy makers for resource allocation. In this retrospective cohort study, we aim to provide a detailed and up-to-date analysis of cervical cancer survival in Saudi Arabia by stage and region, and to explore whether any differences in survival between regions are due to differences in stage at diagnosis. Methods: Data on all women diagnosed with invasive cervical cancer during 2005–2016 were obtained from the Saudi Cancer Registry (SCR). Vital status and date of death if dead were ascertained by linking the registry records to vital registration data in the National Information Centre (NIC) of the Ministry of Interior. Women for whom no death record existed on the day of record linkage were considered to be alive. We estimated age-standardised five-year net survival using the Pohar-Perme estimator for women diagnosed during 2005–2010 and 2011–2016. Survival was also estimated by region and stage at diagnosis, and by region stratified by stage. Results: Age-standardised 5-year net survival did not change in Saudi Arabia between 2005–2010 [59.2%; 95% confidence interval (CI) 52.7–65.7%] and 2011–2016 (59.7%; 54.7–64.6%), or in any of the regions, except Makkah, where there was a 19% increase in survival for women diagnosed during 2011–2016 compared to 2005–2010. Survival for women diagnosed at a distant stage was substantially lower in the Eastern Region than in other regions. Conclusions: Cervical cancer survival has remained largely unchanged. Higher survival could be achieved by improving early diagnosis and access to high-quality treatment

The Role of Family Physicians in Mental Health Care: Screening, Diagnosis, and Treatment Options

amily physicians play a pivotal role in the early detection, diagnosis, and management of mental health disorders within the community. This review article delves into the multifaceted responsibilities of family physicians in the realm of mental health care. Emphasizing the importance of primary care settings as the first point of contact for many patients, the article underscores the need for effective screening tools and methodologies tailored for these environments. The diagnostic precision of family physicians, often challenged by the broad spectrum of mental health symptoms, is explored alongside the potential implications of misdiagnoses. Furthermore, the article evaluates various treatment options, from pharmacological interventions to psychotherapy, and their applicability in primary care settings. The integration of technological advancements, such as electronic health records and telemedicine, is also discussed in the context of enhancing patient care. The review concludes by highlighting the importance of educating primary care physicians to not only pay close attention to the mental health of their patients, but also to be able to accurately screen and diagnose mental health issues using various diagnostic tools. Moreover, it is critical to develop more useful tools that can be used in the context of primary care settings

How does Linkage to the National Death Index Affect Population-Based Net Survival Estimates for Women with Cervical Cancer in Saudi Arabia?

BACKGROUND: Population-based cancer survival is a key metric for the assessment of cancer control strategies. Accurate estimation of cancer survival requires complete follow-up data for all patients. AIM: To explore the impact of linking national cancer registry data to the national death index on net survival estimates for women diagnosed with cervical cancer in Saudi Arabia during 2005-2016. METHODS: We acquired data on 1,250 Saudi women diagnosed with invasive cervical cancer during the 12- year period 2005-2016 from the Saudi Cancer Registry. These included the woman's last known vital status and the date of last known vital status, but this was restricted to information from clinical records and death certificates that mention cancer as a cause of death ("registry follow-up"). We submitted available national ID numbers to the National Information Center (NIC) of the Ministry of Interior, to ascertain the date of death, from any cause of death, for women who had died up until 31 December 2018 ("NIC follow-up"). We estimated age-standardised 5-year net survival using the Pohar-Perme estimator under five different scenarios using the two sources of follow-up, and censoring at the date of last contact with the registry versus extending survival until the closing date if no information on death was obtained. RESULTS: 1,219 women were eligible for survival analysis. Five-year net survival was lowest when using NIC followup only (56.8%; 95%CI 53.5 - 60.1%), and highest when registry follow-up only was used and survival time was extended until closure date for those with no information on death (81.8%; 95%CI 79.6 - 84%). CONCLUSION: Reliance solely on information from deaths certified as due to cancer and clinical records leads to a high proportion of missing deaths in the national cancer registry. This is probably due to low quality of certification of the cause of death in Saudi Arabia. Linkage of the national cancer registry to the national death index at the NIC identifies virtually all deaths, providing more reliable survival estimates, and it eliminates the ambiguity in determining the underlying cause of death. Therefore, this should become the standard approach to estimating cancer survival in Saudi Arabia

Swirled Jet Flame Simulation and Flow Visualization Inside Rotary Kiln—CFD with PDF Approach

CFD (computational fluid dynamics) simulation using a commercial package (Fluent-ANSYS) on industrial rotary kilns using annulus-type burners and methane gas was carried out to examine the characteristics of the flame length and flow visualization. New influencing design and operating parameters—primary air swirl number, primary air inlet annulus diameter, and secondary air temperature—were investigated and discussed. The influence of these parameters on axial temperature distribution, axial mean mixture fractions, velocity vectors, mixture fractions, and temperature contours were investigated. The current numerical findings were compared with existing experimental results to validate the simulation approach. The results showed that the primary air swirl number had a remarkable influence on the flame length at a lower primary air inlet annulus diameter ratio of 2.3. Moreover, the flame length increased by 20% and 6% with increasing the swirl number from zero to one for primary air inlet annulus diameter ratios of 2.3 and 5, respectively, and it also increased by 19% with increasing primary air inlet annulus diameter ratio from 2.3 to 5

Treatment of acidic palm oil for fatty acid methyl esters production

Acidic crude palm oil (ACPO) produced from palm oil mills with an acid value of 18 mg g−1 was considered to be a possible feedstock for biodiesel production. Due to its high acidity, conventional transesterification cannot be applied directly for biodiesel production. Methane sulphonic acid (MSA, CH3SO3H) is used to reduce the acidity prior to the alkaline transesterification reaction. The laboratory-scale experiments involved an MSA to ACPO dosage of 0.25–3.5 %, a molar ratio (methanol to ACPO) from 4: 1 to 20: 1, reaction temperature of 40–80°C, reaction time of 3–150 min, and stirrer speed of 100–500 min−1. The optimum esterification reaction conditions were 1 % of catalyst to ACPO, with a molar ratio of methanol to ACPO of 8: 1, a stirring speed of 300 min−1, for 30 min and at 60°C. Under these conditions, the FFA content was reduced from 18 mg g−1 to less than 1 mg g−1 and with a yield of 96 %. The biodiesel produced met the EN14214 standard specifications. MSA was recycled for three times without losing its activity. The biodiesel produced in a two-stage process has a low acid value (0.14 mg g−1)

Whole-exome sequencing reveals a recurrent mutation in the cathepsin C gene that causes Papillon–Lefevre syndrome in a Saudi family

Papillon–Lefevre syndrome (PALS) is a rare, autosomal recessive disorder characterized by periodontitis and hyperkeratosis over the palms and soles. Mutations in the cathepsin C gene (CTSC) have been recognized as the cause of PALS since the late 1990s. More than 75 mutations in CTSC have been identified, and phenotypic variability between different mutations has been described. Next generation sequencing is widely used for efficient molecular diagnostics in various clinical practices. Here we investigated a large consanguineous Saudi family with four affected and four unaffected individuals. All of the affected individuals suffered from hyperkeratosis over the palms and soles and had anomalies of both primary and secondary dentition. For molecular diagnostics, we combined whole-exome sequencing and genome-wide homozygosity mapping procedures, and identified a recurrent homozygous missense mutation (c.899G>A; p.Gly300Asp) in exon 7 of CTSC. Validation of all eight family members by Sanger sequencing confirmed co-segregation of the pathogenic variant (c.899G>A) with the disease phenotype. This is the first report of whole-exome sequencing performed for molecular diagnosis of PALS in Saudi Arabia. Our findings provide further insights into the genotype–phenotype correlation of CTSC pathogenicity in PALS