Therapeutic implications of Nigella sativa against cancer metastasis

Nigella sativa [N. sativa], remedial usage against different diseases associated with skeleton, cardiovascular, digestive and urinary systems has a long-standing history. At present, efforts are underway to study its effects against various cancers at both the cellular and molecular levels. In this review, the role of active constituents like thymoquinone [TQ] on different types of cancer has been explored. TQ putative involvement in metastasis has been assessed by elucidating its effects on cell proliferation, adhesion, invasion and angiogenesis. Up regulation of caspase 3, Smac and down regulation of p-AKT, p65, XIAP, Bcl-2, COX-2 is also influenced by N. sativa. These findings prove a significant positive correlation between TQ concentrations and induction of apoptosis, decrease in motility and a reduction in invasion and angiogenesis in cancerous cells. However, there are still quite a few unaddressed domains, which need to be understood. One of these may include target specificity of N. sativa against cancerous tissues, mode of administration, dosage and downstream regulators in mediating these effects. In reference to earlier findings and low cost availability, N. sativa may, also, be suggested as either a suitable sole remedy for cancer or as a complementary to ongoing conventional therapy based extensive and rigorous in vivo optimization and validation

Treatment adherence and quality of life outcomes in patients with sickle cell disease

To assess the health-related quality of life [HRQL] of patients with sickle cell disease [SCD] and to measure the impact of treatment adherence on disease complication, severity, crisis, and outcome. This was a cross-sectional study on patients with SCD who attended the Hematology Clinic at King Abdulaziz University Hospital from January 2009 to December 2011. We measured the primary outcome of health-related quality of life [HRQL] using the World Health Organization quality of life assessment instrument [WHOQOL-BREF]. Data were collected and analyzed using the Statistical Package for Social Sciences. Analysis of HRQL was carried out along the scoring of WHOQOL-BREF. One hundred fifteen patients completed the questionnaire. Eighty-seven patients [75.7%] had severe SCD, while 28 [24.3%] had mild disease. Patients with severe disease had a low HRQL [p=0.002]. Pain episodes were the main cause of hospitalization [n=59; 51.3%]. Thirty-six of patients [31.3%] who had pain episodes were on regular narcotics and had low HRQL scores [p=0.0001]. The HRQL scores significantly decreased as pain levels increased. Patients with delayed treatment or those who were not adherent to treatment showed worse HRQL scores [p=0.001]. Treatment adherence and early intervention in SCD improved HRQL outcomes

Randomized clinical trial to evaluate the safety of avoiding pre-operative transfusion in sickle cell anemia

Patients with sickle cell anemia have an increased chance of undergoing surgical procedures with higher morbidity. The practice of pre-operative blood transfusion for such patients is still controversial. The aim of the study was to evaluate and assess the safety of avoiding pre-operative transfusions in patients with sickle cell anemia. Prospective randomized clinical trial. Surgical departments, King Abdulaziz University Hospital and King Fahed Armed Forces Hospital in Jeddah. A randomized clinical trial of 369 sickle cell anemic patients with a median age of 16 years old [range: 1-35 years old], underwent surgical procedures between November 1996 and November 2001. Surgical procedures included adenoidectomy, tonsillectomy, total hip arthroplasty, cholecystectomy, splenectomy, and Obstetric and Gynecological surgeries. Patients with stable clinical and hematological state were randomized into two groups: Group I [n=181], received no pre-operative transfusion and Group II [n=188] received simple or partial exchange transfusion pre-operatively. All patients were carefully hydrated and good oxygenation was maintained. None of the patients developed major intra or postoperative complications in both groups. Fourteen percent of the pre-operative transfusion group developed postoperative complications versus 7% in non-transfused group with a significant P value [0.002]. Avoidance of pre-operative transfusion is a safe practice in properly selected steady state sicklers. On the contrary, it is believed that the risks associated with transfusion were avoided

Primary thrombophilia in Saudi Arabia

Venous thromboembolism [VTE] is a common disorder associated with significant mortality and morbidity. Considerable progress has been made in the understanding of the risk factors. Significant portion of patients develop VTE without obvious risk factors. The clinical applications of molecular techniques allowed identification of many important inherited, yet not uncommon risk factors. The aim of our study was to determine whether the activated protein C resistance [APCR]/Factor V Leiden [FVL], and prothrombin mutation as being the most common inherited risk factor for venous thrombosis among Saudi patients attending an anticoagulant clinic. One hundred and seventy-nine consecutive patients [74 males, 105 females] accrued in a prospective study with a median age of 42 years [range 17-60 years] have been screened between October 1997 and January 2002 at the King Abdul-Aziz University Hospital [KAUH] and King Fahd Armed Forces Hospital [KFAFH], Jeddah, Kingdom of Saudi Arabia. All patients were Saudis with at least one of the following features: history of recurrent VTE, first episode of unprovoked VTE, thrombosis in unusual site or thrombosis at young age with or without positive family history. Thrombotic workup included protein C, protein S, antithrombin [AT], APCR, prothrombin mutation, lupus anticoagulant [LA], and anticardiolipin [ACL]. Functional assays were carried out in 179 patients. Molecular analysis of both FVL, prothrombin G29210A mutation was performed in 67 patients. All tests were carried out in reference laboratories [Mayo Clinic, United States of America and Bioscientia, Germany]. Protein S deficiency was the most common, identified in 26/179 [14.5%] followed by protein C in 15/179 [8.4%], while AT was not deficient in all 179 tested patients. Activated protein C resistance was present in only 4 patients [2.2%]. Two patients were tested positive for prothrombin mutation; one of them was heterozygous for FVL too. Eight% of the patients had LA, while 4% had ACL antibodies. Our study shows a different distribution pattern of the underlying thrombophilic state than reported in the western literature. If this holds true in larger trials, this may result in changing our local screening and diagnostic workup in patients with suspected hypercoagulable state