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Jeddah, Saudi Arabia

Ramjaun A.,Princess Margaret Cancer Center | Alduhaiby E.,Princess Noorah Oncology Center | Ahmed S.,Princess Margaret Cancer Center | Wang L.,Princess Margaret Cancer Center | And 4 more authors.
Pediatric Blood and Cancer | Year: 2015

Background: Childhood cancer survivors treated with anthracycline chemotherapy are at an increased risk of long-term cardiac toxicity, and guidelines recommend that exposed survivors undergo echocardiography every 1-5 years. However, it is unclear whether survivors should undergo echocardiographic screening indefinitely, or if a period of echocardiographic stability indicates that screening is no longer necessary. The objective of this study was to evaluate the outcomes of echocardiographic screening to aid in the refinement of existing guidelines. Methods: We retrospectively analyzed the results of echocardiographic screening in a cohort of adult survivors of childhood cancer treated with anthracyclines and/or cardiac radiation therapy. Interval regression analysis was performed to identify predictors of single-episode or sustained abnormal echocardiograms. Results: The cohort constituted 333 survivors, with median follow-up time of 15.8 years post-treatment (range: 5.0-47.9), and median age at treatment of 8 years (range: 1.5-18). Forty-nine survivors had an abnormal echocardiogram (14.7%), and 29 (8.7%) had reproducible abnormal findings. An ongoing continual increase in the incidence of sustained echocardiographic abnormality was seen among patients treated with >250mg/m2 doxorubicin at age <5 years, reaching 43% by 20 years of therapy. In contrast, no sustained abnormal echocardiographic findings arose after 10 years of therapy in survivors treated with <250mg/m2 at age ≥5 years. Conclusions: Single-episode echocardiographic abnormalities are often not reproduced in subsequent evaluations. The duration of echocardiographic screening for childhood cancer survivors should be reassessed for patients who received lower doses of anthracycline after age 5. © 2015 Wiley Periodicals, Inc. Source

Alqahtani N.,Armed Forces Hospital Southern Region | Khan W.A.G.,Armed Forces Hospital Southern Region | Alhumaidi M.H.,King Khalid University | Ahmed Y.A.A.R.,Princess Noorah Oncology Center
International Journal of Preventive Medicine | Year: 2013

Background: A highly standardized screening test for newly diagnosis diabetes and pre-diabetes is necessary. the study goal was to clarify the power and efficacy of glycated hemoglobin (HbA1c) in the diagnosis of diabetes and pre-diabetes by comparing against the other American Diabetes Association (ADA) diagnostic criteria of fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). Methods: This is a retrospective study. A total of 27,001 individuals attended to the internal medicine outpatient clinic between 2006 and 2010 years were screened. All diabetic patients and those using drugs associated with the development of diabetes were excluded. The results of FPG, OGTT and HbA1c for 1814 individual were analyzed and all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients and non-diabetic patients according to new ADA criteria for the diagnosis of diabetes. Results: The prevalence of newly diagnosed diabetes was 69.6% and 54% by using HbA1c alone, 64.2% and 28.2% with 2-h OGTT alone and 43.2% and 60.3%, respectively with FPG alone. Differences between FPG versus 2-h OGTT, FPG versus A1c and OGTT versus A1c were statistically significant (P < 0.0001, P < 0.0001 and P = 0.02, respectively). Diagnostic sensitivity of all diabetic criteria was 69.6% for A1c; Nearly, 64.2% for OGTT and only 43.1% for FPG respectively. In terms of diagnostic ratio of glucose intolerance; difference between HbA1C and OGTT was statistically significant (P < 0.0001). Conclusions: As a screening tool for newly diagnosed diabetes and pre-diabetes, the HbA1C level performed better than FPG and 2-h OGTT in this general Saudi population. High diagnostic power of A1C may contribute to the decrease in the number of undiagnosed patients. Source

Rahiem Ahmed Y.A.A.,Princess Noorah Oncology Center | Hasan Y.,King Abdulaziz Medical City
Journal of Cancer Science and Therapy | Year: 2013

Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a range of childhood and adult cancers. Unlike other chemotherapeutic agents, MTX is used in a wide variety of doses. For example, MTX can be given in low doses (eg, 20 mg/m2) in maintenance chemotherapy and in the treatment of benign conditions such as psoriasis and rheumatoid arthritis, but it can also be given in much higher doses (eg, 1,000 mg/m2 to 33,000 mg/m2) over prolonged intravenous (IV) infusion for the treatment of certain cancers. The latter dose range is referred to as high-dose MTX (HDMTX) and requires aggressive supportive care to prevent unacceptable toxicity. Although HDMTX can be safely given to most patients with supportive-care measures, approximately 2% to 12% will develop HDMTX-associated renal dysfunction. Without timely recognition and treatment, the accumulation of toxic MTX levels can lead to significant morbidity and mortality in these patients. Fortunately, aggressive monitoring and prompt intervention can promote MTX excretion, prevent most toxicity, and allow patients to receive subsequent HDMTX treatment if needed. © 2013 Rahiem Ahmed YAA, et al. Source

Al-Foheidi M.,Princess Noorah Oncology Center
BMC Cancer | Year: 2012

Background : Women treated for Hodgkin's lymphoma (HL) have an elevated risk of developing second breast cancer (SBC) compared with the general population. We planned this meta-analysis to quantify the long-term risk of SBC and analyze the contributing risk factors among HL survivors.Methods: According to predefined selection criteria, literature search identified 34 studies that were included in the analyses.Results: After eliminating overlapping or duplicate data, 957 incidences of SBC were encountered in 24,505 females with HL over a median follow-up of 14.9 years. The medians: age at the diagnosis of HL, age at diagnosis of SBC, and latency since HL treatment to the development of SBC were 23.7, 35.0, and 17.7 years, respectively. The pooled relative risk (RR) of SBC was 8.23 (95% CI, 5.43-12.47, I2 = 96%), with a median absolute excess rate of 22.9 per 10,000 person-years. The RR was found inversely related to age at diagnosis of HL with the highest rate (68.7; [95%CI, 28.08-168.11], I2 = 79%), occurred in young patients (≤ 15 years old), where the RR in older women (≥ 40 years old) was not significant (0.55; [95% CI, 0.09-3.52]). Analysis of RR by 5-year increments since the treatment of HL showed that the risk was highest after 15-19 years of latency (13.87; [95% CI, 7.91-24.30], I2 = 89%). Analysis of the effect of treatment modalities showed that the RR rates were (4.70; [95% CI, 3.28-6.75], I2 = 74%), (5.65; [95%CI, 2.94-10.88], I2 = 91%), and (1.19; [95% CI, 0.50-2.82], I2 = 65%), for radiotherapy (RT) only, combined RT and chemotherapy (CT), and CT only, respectively. To investigate the demonstrated heterogeneity, meta-regression analysis was performed when feasible. In most such analyses, the natural logarithm of RR was inversely associated with age at HL diagnosis.Conclusions: We conclude that, the current meta-analysis provided the most recent comprehensive estimate of the risk of SBC in a broad-range of HL survivors. Younger age at diagnosis proved to be a dominant risk factor. The obtained results would serve providing breast cancer screening recommendations for HL survivors. © 2012 Ibrahim et al.; licensee BioMed Central Ltd. Source

Jastaniah W.,University of Umm Al - Qura | Jastaniah W.,Princess Noorah Oncology Center
Annals of Saudi Medicine | Year: 2011

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by production of abnormal hemoglobin S and is associated with high morbidity and mortality. Information about the prevalence of SCD in Saudi Arabia is patchy and probably underestimated, but studies have reported that SCD is a relatively common genetic disorder in this part of the world. The prevalence of SCD in Saudi Arabia varies significantly in different parts of the country, with the highest prevalence is in the Eastern province, followed by the southwestern provinces. The reported prevalence for sickle-cell trait ranges from 2% to 27%, and up to 2.6% will have SCD in some areas. Clinical and hematological variability exists in SCD in Saudi Arabia with two major phenotypes: a mild phenotype and a severe phenotype. Further studies on the prevalence, molecular and clinical epidemiology of SCD may help predict disease severity and risk stratification of patients to determine whether to receive early intensive care or continued symptomatic care. Source

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