Validation of new D-Dimer cutoff values to increase its diagnostic utility as biochemical marker in acute venous Thromboembolic Disease

Background: Diagnosis of venous thromboembolic disease [deep venous thrombosis and pulmonary embolism] is often inaccurate because signs and symptoms are nonspecific. Numerous clinical management trials using D-dimer which is one of the coagulation markers have shown that it has a sufficient specificity to assist in the diagnosis of venous thromboembolic disease

Aim of the work: This study was done to validate the utility of D-dimer as a diagnostic biomarker for DVT using a higher cutoff values which may improve the test specificity

Material and method: In this retrospective chart review study, we reviewed the hospital records of all patients for whom D-dimer assay was done in King Abdul Aziz Specialist Hospital, Al Taif - Saudi Arabia from January 2011 to October 2013. The study involved 141 individuals; 25 who were proved to be normal were chosen to serve as control group [Group I], 61 patients who were positive for DVT by duplex scanning [Group II] and 55 patients who had symptoms of DVT but showed negative results on duplex ultrasound[group III]

Results: The demographic data revealed statistically insignificant difference between all studied groups. No significant differences were detected between the studied groups, except for hemoglobin level which was significantly lower in patients of groups II and III than in control group. However, highly significant differences were detected between different studied groups as regards D-dimer. Analysis of the receiver operator characteristic [ROC] curve to establish the cutoff level of the studied marker in the diagnosis of DVT, verified that D-dimer value of 0.92 mg/L can accurately differentiate patients who were positive for DVT on duplex scanning from control group. Level of 2.81 mg/L for D-dimer was considered as a cutoff point that can differentiate patients who were duplex negative and free from thrombosis from those who eventually developed thrombosis

Conclusion: This study suggests the importance of the use of modified D-dimer cut-off values that can safely differentiate patients who are free from venous thromboembolic disease from others who are positive for the disease sparing patients the unnecessary risks of anticoagulation. In addition it can detect the patients who will eventually develop thrombosis regardless their primary duplex ultrasound scanning results, so, they could receive anticoagulation treatment

Synchronous Colorectal Neoplasias: a single hospital study

Background and the aim of the study: The presence of more than one primary tumor in the colon at time of presentation is diagnosed as colorectal synchronous neoplasias [SN] and the largest one is considered the index tumor. The aim of this study is to identify the magnitude of synchronous colorectal neoplasias and its relation to different variables as pattern of presentation, age, gender and histopathology in addition to evaluation of different methods of diagnosis in patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia

Patients and methods: This is a retrospective chart review study. The hospital records and the files of all patients diagnosed to have colonic neoplasms were reviewed from January 2008 to August 2014

Results: The study involved 87 patients, 53 males and 34 females. Ten of the 87 patients [6 males and 4 females] had synchronous colonic neoplasms [11.5%]. Intestinal obstruction was the presenting symptom in 4/10 patients [40%, Vs 35.6% in patient with single lesion], rectal bleeding in 4/10 patients [40%] and in 20% mass in right lower quadrant was the presenting symptom. In obstructed patients, SN was diagnosed after examination of the operative specimen, however; intra-operative palpation detected multiple colonic polypi in one patient and intra-operative colonoscopy detected SN in another 2 patients. In the non obstructed patients preoperative colonoscopy and biopsy diagnosed multiple lesions in 5/6 of the patients [83.3%]. Pre and intra- operative colonoscopy helped to guide accurately the extent of resection in 83.3% of non obstructed patients and in 75% of obstructed patients respectively. Mean period of follow up was 3. 4 +/- 0.8 years

Conclusion: The incidence of SN is significantly higher in this study than that recorded in English literature, so a larger study involving all regions of Saudi Arabia is strongly recommended as the presence of SN worsens the prognosis entailing modification of the treatment options. Thorough pathological examination is mandatory of any doubtful colonic lesions, and the study verified the effectiveness of preoperative colonoscopy in patients with non obstructed colorectal cancer and intra- operative colonoscopy in obstructed patients for visualization and biopsy of these lesions

Assessment of a classroom based medical and paramedical undergraduates' infection control awareness program

To evaluate the level of knowledge of medical and paramedical female students regarding the fundamentals of infection control and to assess the impact of a short- term infection control educational program on creating awareness about the standard infection control precautions and the utmost importance of their implementation. This study was a quasi-experimental extracurricular activity that was applied on students of faculties of Medicine and Applied Medical Sciences. An awareness program was conducted along 2months duration: Dhulhija 1433 for designing and preparation and Muharram 1434 for implementation. Enrolled students were surveyed on their scores of basic information they have about the infection control principals. Students' assessment was in the form of a pre- and post testing, using a structural questionnaire of 30 different statements concerning the fundamentals of infection control, with a classroom based awareness program in between over a period of four weeks. Infection control manual, as an integral part of the awareness program, was planed and prepared. Results revealed that the used intervention program was effective in improving knowledge of students. Comparison between mean score of medical students before and after intervention showed high significance [39.6 +/- 7.5 vr 53.9 +/- 4.4 respectively, P= 0.000]. The same finding was noticed among paramedical students [37.3 +/- 9.3 vr 49.2 +/- 9.9 respectively, P=0.000]. The used classroom based infection control awareness program was effective for both medical and paramedical female students. Continuing awareness would prepare the future healthcare workers to practice safely. It is recommended to study this program effectiveness on male students

Gastrointestinal stromal tumor of the stomach and retroperitoneal paraganglioma in Saudi woman, "a case report"

Gastrointestinal stromal tumor [GIST] and paraganglioma are uncommon tumors; mostly occur in a sporadic and isolated form. They are occasionally components of 3 clinical syndromes, familial paraganglioma and gastric GIST, neurofibromatosis type 1 and Carney triad. The latter does not show genetic mutations and affects young women predominantly. This article reports the occurrence of GIST and retroperitoneal paraganglioma in young Saudi woman aged 22 years. The initial clinical presentation was acute severe gastric bleeding. Gastric mass with retroperitoneal mass was discovered during surgical exploration. Histological and immunohistochemical study of both masses showed features of GIST and paraganglioma. The combination of GIST and retroperitoneal paraganglioma in the reported case may be incomplete expression of Carney triad or be coincidental occurrence