Risk of osteoporosis and osteopenia in patients with prolonged use of proton pump inhibitors

Background and aim of the work: Several studies suggest that proton pump inhibitors [PPIs] use may be involved in development and acceleration of osteoporosis. The aim of this study is to investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux disease [GERD] and to reveal their possible role in development of osteopenia or osteoporosis with evaluation of different diagnostic tools which help in follow up of those patients

Patient and methods: This prospective controlled study which was conducted at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016. We compared the prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy control subjects .In both groups we measured the bone mineral density using the dual energy X-ray absorptiometry [DEXA], calcium [Ca], inorganic phosphorus [P], serum alkaline phosphatase, and deoxypyridinoline [DPD] in urine

Results: there were no significant differences between the 2 groups as regards, age, gender, and their clinical history [P > 0.05], however, the history of fragility fracture was significantly higher in PPIs group of patients [P< 0.05]. The means of antroposterior spine and left femur BMD-T scores were lower than normal in both groups; however, it was significantly lower in PPIs group than in control group [P< 0.05]. Serum calcium was slightly lower than the reference range with normal phosphorus level without significant difference between both groups [P> 0.05]. The serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but, significantly higher in patients receiving PPIs [P< 0.05]. The number of osteopenic/osteoporotic patients was significantly higher in PPIs group than in control group [P< 0.05]. Osteopenia and osteoporosis were significantly correlated in PPIs group with male gender, younger age group of patients [P< 0.05], and the correlation was highly significant with the duration of use of the drug [P<0.001]. In control group the decrease in bone density was significantly correlated with the female gender and to older group of patients [P< 0.05]

Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected, taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical options as alternative therapy

Prognostic roles of endostatin, matrix metalloproteinase-2 and 9 and tissue inhibitors of metalloproteinase-1 in advanced non-small cell lung cancer

Background and aim of the work: Previous studies verified that Endostatin, matrix metalloproteinase [MMP] -2 and -9, in addition to tissue inhibitors of metalloproteinase [TIMP] -1 may play a crucial role in prognosis of non-small cell lung cancer [NSCLC]. In this study we will investigate the changes in the pretreatment serum levels of these factors and to evaluate their clinical implication in patients with advanced non-small cell lung cancer [NSCLC]

Patients and methods: Pretreatment serum samples were collected from 25 patients and 10 control healthy individuals. The levels of Endostatin, MMP-2, MMP-9, and TIMP-1 were measured using a sandwich enzyme immunoassay kit

Results: The pretreatment serum levels of Endostatin and TIMP1 were significantly elevated and correlated with their stages and survival [P< 0.05], where, the serum level of Endostatin in healthy subjects was 81.20 +/- 23.99 ng/ml and in patients with NSCLC was 354.40 +/- 164.01 ng/ml. The serum level of TIMP1 in healthy subjects was 1.49 +/- 0.29 ng/ml and in patients with NSCLC was 2.96 +/- 0.58 ng/ml. The serum level of MMP2 and 9 were non-significantly decreased in serum of NSCLC patients [P > 0.05], where the serum activity of MMP2 in healthy subjects was 0.14 +/- 0.03 ng/ml and in patients with NSCLC was 0.09 +/- 0.03% and the serum activity of MMP9 in healthy subjects was 0.13 +/- 0.019 ng/ml and in patients with NSCLC was 0.10 +/- 0.03%

Conclusions: Our results indicated that the circulating levels of Endostatin, and TIMP-1 in patients with NSCLC may be valuable future tools for treatment planning and monitoring of treatment, however, these blood tests need to be standardized and validated in large-scale prospective clinical trials

Uniportal therapeutic video-assisted thoracoscopic surgery: a single hospital experience, Taif Saudi Arabia

Background and aim of the work: Therapeutic uniportal video-assisted thoracic surgery [VATS] has less postoperative pain, shorter hospital stay, and less operative time. In this study we will present our experience in therapeutic VATS at King Abdul Aziz Specialist Hospital, Taif Saudi Arabia

Patients and methods: This retrospective study was conducted in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, from July 2012 to January 2016 and included 162 patients who were admitted to the hospital in this period and therapeutic uniportal VATS was conducted for them

Results: The 162 patients were 102 males [63%] and 60 females with mean age of 45.1 +/- 6.8years. Bilateral sympathectomy was performed for palmar hyperhidrosis in 36% of cases, VATS stapled blebectomy with apical pleurectomy were performed for primary spontaneous pneumothorax in 32% of cases, wedge resections in 23.5%, adhesiolysis was performed in 5%, and in 3.7% anatomical segment resections was done. Mean operative time was 25.5 +/- 5.5 minutes. The mean hospital stay was 5.3 +/- 1.2 days. No operative or early postoperative mortality was recorded

Conclusion: Uniportal VATS was proved to be safe and effective and can replace the multiportal approach in the management of various disorders which require thoracic surgery

Effect of altitude on Vascular Endothelial growth factor levels with validation of its prognostic significance in patients with non-small cell Lung Carcinoma

Background and aim of the work: Recent studies revealed that hypobaric hypoxia stimulates release of vascular endothelial growth factor [VEGF] and other studies found that high levels of this angiogenic factor are correlated with poor prognosis in patients with non-small cell lung cancer [NSCLC]. In this study we will measure the serum levels of VEGF in both healthy individuals and in patients with operable non small cell lung carcinoma living in hypobaric oxygen environment [Taif] and validate the prognostic significance of its pretreatment level in those patients

Patients and methods: Thirty one patients with operable [stage I, II and III A] non-small cell lung cancer [the patient group] and 15 healthy volunteers with matched gender and age [control group] were enrolled in this study from January 2010 to March 2015. The pretreatment level of VEGF was measured in patients in addition of its level in controls. All patients had the same diagnostic and therapeutic protocols. Mean follow up of patients was 30.4 +/- 7.8months

Results: The mean level of VEGF was high in control group, however, it was significantly lower than that in patient group [P value 0.041]. The median survival of stage I patients was 13 months, stage II was 9 months, and of stage III A was 6 months. Univariate analysis showed asignificant correlation between survival and pretreatment level of VEGF in patients with small lung cancer

Conclusions: Our results revealed that hypobaric hypoxia significantly increases the circulating levels of VEGF in healthy individuals without remarkable effect on its level in patients with NSCLC. Our study verified also that the pretreatment mean serum level of VEGF showed a highly significant increase in NSCLC patients than that in control group and it was significantly correlated with patient survival in levels above 618 pg/ml

Endoscopic thoracic sympathectomy: a comparative study of resection and electro-diathermy ablation in the treatment of primary palmar hyperhidrosis, Taif experience

Palmar Hyperhidrosis is an excessive and unpleasant sweating and it is under control of the thoracic sympathetic chain. At present, endoscopic upper thoracic Sympathectomy [ETS] offers a safe and durable solution of the condition. The operation includes excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia T2 and T3. The present study was done to compare the results achieved by excision and electro-diathermy ablation. This prospective randomized study was conducted in King Abdul Aziz Specialist Hospital and Al-Hada Armed Forces Hospital, Taif- Saudi Arabia, from January 2007 to August 2010 and included sixteen patients with primary palmar hyperhidrosis. They were randomized into 2 groups; each of 8 patients. In one group; the sympathetic chains with T2 and T3 ganglia were excised on both sides and in the other group, the sympathetic chains and ganglia were ablated bilaterally using electro-coagulation diathermy hook. There were 10 women and six men. The mean age of the ablation group was 23.6 +/- 7.6 years and in the resection group it was 22.5 +/- 8.4years. The mean operating time for bilateral Sympathectomy in the resection group was 74 +/- 18.6minutes; whilst in the thermal ablation group it was 32 +/- 7.8 minutes. The mean postoperative hospital stay in the excision group was 48 +/- 12 hours and in the ablation group, it was 24 +/- 6 hours. No deaths occurred and all patients are discharged with dry hands. The mean follow up was 24 +/- 18 months. Intraoperative intercostal venous bleeding occurred in 18.75% of sympathectomies in the excision group but not in the ablation group. Neuralgic pain of the chest wall developed in 31.25% of sympathectomies of the excision group and 6.25% of the sympathectomies of the ablation group. Horner's syndrome developed in 6.25% per cent of the sympathectomies in both groups. Compensatory hyperhidrosis of trunk and thighs occurred in 37.5% of both groups. Recurrence developed in 6.25% of ablation group but no recurrence in the excision group. The rate of recurrence after endoscopic thoracic sympathectomy for treatment of primary palmar hyperhydrosis, if ablation is used, may be higher than resection, however; it is practically accepted as the procedure is easier, has shorter operating time with less liability to develop neuralgic pain and intercostal venous bleeding