Flourescein Angiogram and Funduscopic Features of Radiation Induced Retinopathy: A Descriptive Value of Retinopathy Severity in Patients with Nasopharyngeal Carcinoma

Radiation retinopathy (RR) is a known complication after radiotherapy for Nasopharyngeal Carcinoma (NPC). This study aims to relate the relationship of RR and radiation dose in patients with NPC through assessment with clinical funduscopy and fundus fluorescein angiogram (FFA). A cross sectional study was conducted on patients with NPC who had completed radiotherapy treatment in the Oncology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Eighty two eyes of 42 patients were examined and the prevalence of RR was found to be 35.4%. The severity of RR is strongly associated with the dose of radiation to the retina (Spearman correlation value=0.48; p<0.001). The common features of RR assessed by FFA were telangiectatic vessels (26.2%) and capillary non-perfusion (14.3%). Retinal neovasularization occurred in 10.7% of eyes. The level of visual deterioration correlated with the severity of RR with 26% of eyes experiencing a visual acuity of 6/18 or worse. More than one third of patients developed RR, with radiation maculopathy being the commonest cause for significant visual loss. FFA is a useful tool in detecting early signs of radiation retinopathy and maculopathy. Keywords:

C-erbB-2 onco-protein expression in breast cancer: relationship to tumour characteristics and short-term survival in Universiti Kebansaan Malaysia Medical Centre.

Breast cancer is the commonest cancer affecting females in Malaysia, contributing 31% of all newly diagnosed cases amongst Malaysian women. The present retrospective cohort study evaluated the relationship between cerbB- 2 onco-protein overexpression with various tumour characteristics and survival rate of breast cancer patients treated at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1996-2000. CerbB- 2 oncoprotein overexpression was determined by immunohistochemistry (IHC) and tumors showing 2+ positivity were verified by Fluorescence In Situ Hybridization (FISH). One hundred and seventy two patients were eligible for the study with a short-term follow-up (median) of 5.1 years. C-erbB-2 oncoprotein overexpression correlated with lymph node positivity, oestrogen receptor (ER) and progesterone receptor (PR) negativity. Univariate analyses showed shorter disease free survival (DFS) and overall survival (OS) in patients with cerbB- 2 oncoprotein overexpression, Malay ethnicity, higher tumour grade, lymph node positivity, ER and PR negativity. In a subgroup of patients with c-erbB-2 oncoprotein overexpression, a shorter OS was observed in those with lymph node positivity, ER and PR negativity. In multivariate prognostic analysis, lymph node status, ER status and tumour grading were the strongest independent prognostic factors for both OS and DFS. However, c-erbB-2 status was not a significantly independent prognostic factor, even in subsets with lymph node positive or negative group. C-erbB-2 oncoprotein overexpression correlated well with lymph node status, ER and PR. Shorter OS and DFS were significantly observed in patients with c-erbB-2 oncoprotein overexpression. Lymph node status, ER status and tumour grading were the only three independent prognostic factors for OS and DFS in this study. Although c-erbB-2 expression is obviously important from a biological standpoint, multivariate analysis showed that it is not an independent prognostic indicator in breast carcinoma in the local population.

Mortality in the pediatric intensive care units, experience from Saudi Arabia

This study was conducted to deternine the pediatric intensive care mortality in the Southwestern region of Saudi Arabia. The mortality rate was found to be 9.3% of all admitted cases. The mean age was 36.9 months. Children below 2 years of age constituted 64.3% of the total. The study showed multi system involvement accounted for 31.0% of the cases as the immediate cause leading to mortality. In this category sepsis was the commonest leading individual cause accounting for 26.2% of the cases. The underlying primary condition showed CNS involvement in 23.8% of the cases, followed by CVS and GIT [11.9% each.] In conclusion: children dying in the PICD are likely to have multi system failure as the immediate cause of death, while their primary underlying disease is likely to be in the CNS, GIT or CVS

Congenital heart diseases and other major anomalies in patients with Down syndrome

To determine the frequency and types of congenital heart diseases [CHDs] and other congenital anomalies among Down syndrome [DS] patients, and the short-term survival rate. This is a retrospective review of 98 DS patients seen in Aseer Central Hospital from July 1994 to June 2005. The clinicians notes, echocardiography reports and operative notes were examined. The mean follow up period was 30 +/- 40.1 months. Ninety-three patients had echocardiography; CHDs were found in 57 patients [61.3%]. Ventricular septal defect [VSD] was the most common [33.3%] followed by atrioventricular septal defect [22.8%], atrial septal defect [21.1%], patent ductus arteriosus [14%] and tetralogy of Fallot [5.3%]. Three patients [5.3%] developed inoperable obstructive pulmonary vascular disease [OPVD] and 3 were deemed inoperable for other reasons. The CHD was clinically suspected in 96%. The most common noncardiac anomalies were gastrointestinal, affecting 22 patients [22.4%]: duodenal atresia 8 patients, imperforate anus 7 patients and Hirschsprung disease 4 patients. Sixteen patients [16.3%] died at a mean age of 19 months, 15 of them [93.8%] had anomalies. The most common CHD in DS is VSD and the most common noncardiac anomaly is gastrointestinal. Down syndrome patients should be screened by echocardiography early in life to avoid OPVD. The mortality in DS is highest among those with congenital anomalies, and therefore, early intervention is crucial

Fever in young patients with sickle cell disease in southwest region of Saudi Arabia

The aim of the study was to determine the magnitude of the problem of infection in patients with sickle cell disease. A total of 269 admissions of 94 patients with sickle cell disease, aged 3 months to 20 years, were reviewed. Frequency of fever in the absence of obvious infection, and profile of infection with temperature over 38.5C were noted. Patients with sickle cell / thalassaemia or other combinations and those given pneumococcal vaccinations or prophylactic antibiotics were excluded. Two hundred and seven admissions were due to crises and 62 admissions were due to fever. Of the crises, 111[53.6%] were associated with fever, 79 of whom had no focus of infection [38.2%]. Of the 173 admissions with fever, the temperature was over 38.5°C in 96 and the profile of infections was as follows: upper respiratory infection 18.8%, pneumonia 10.4% septicemia 6.3%, osteomyelitis 5.2%, urinary infection 4.2%, gastroenteritis 3.1%, malaria 1%, septic arthritis 1%, lymphadenitis 1%, no focus 49%. Septicemia was caused by Salmonella on three occasions [one death], Streptococcus pneumoniae [death], Staphylococcus aureus and Streptococcus viridans in the remaining three. Infection with Streptococus pneumoniae was not common in our patients

Preliminary study on acute rheumatic fever at high and low altitudes of Assir region

The objective was to study the profile of acute rheumatic fever [ARF] at high and low altitudes [hot and temperate areas respectively] with particular attention to the influence of these differences on the frequency or severity of carditis. Methodology: Thirty eight children with initial attack of ARF, diagnosed between November 1987 and July 1995, were studied. Result: Twenty seven were living at altitude, temperate climate [group-1] while 11 were living at low altitudes of Tihama, hot climate [group-2]. Twenty two were males and 16 were females. The mean age was 9.7 years. Arthritis was the commonest feature [86.8%] and carditis [68.4%] came second. Mitral regurgitation occurred in 96.2% of those with carditis, aortic regurgitation occurred in 19.2% and tricuspid regurgitation in 7.7%. Mitral stenosis and aortic stenosis were not encountered. A comparison between group-1 and group-2 showed the frequency of carditis to be 66.7% and 72.7% respectively and the frequency of severe carditis in those affected to be 27.8% and 25% respectively. Chorea, erythema marginatum and subcutaneous nodules were uncommon. The study indicates that altitude and climate may not affect the frequency nor severity of carditis

Effectiveness of conservative management in neonatal congestive heart failure due to isolated absence of pulmonary valve

Absent pulmonary valve with intact ventricular septum is a rare disease. This report discusses the case of a 20-month-old boy who presented immediately after birth with severe pulmonary regurgitation and severe congestive heart failure. The patient improved on conservative medical therapy, avoiding surgical intervention with its high mortality in that young age