Quality of Life and Psychological Wellbeing of Breast Cancer Survivors in the Kingdom of Saudi Arabia.

INTRODUCTION: Breast cancer is the most common cancer among Saudi population. Breast cancer patients suffer from several negative consequences after treatment and these include pain, fatigue, sexual problems, appearance and body image concerns, with psychological dysfunction. This could affect the patient quality of life and psychological well-being. METHODS: a multicenter cross-sectional study to assess quality of life and psychological wellbeing and their predictors for female breast cancers survivors diagnosed between 1 January 2015 and May 2017 with the assessment conducted at 12 to 36 months after initial diagnosis. Assessment was performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Breast Module (QLQ-BR23) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: 246 Breast cancer patients participated in the study with a mean age of 49.5±10.9. The mean global health status has a mean of 72.7±23.5. The worst domain of the functioning scales was physical functioning (mean score of 62.14±26.03, while the best scores were for social functioning of 80.06±29.18. For the symptom scales, the worst scores were reported for fatigue and pain. Results of HADS scale showed that 57% had moderate to severe depression, while 44% had moderate to severe anxiety. Only 6.8% of the participants reported receiving psychosocial support. DISCUSSION: Breast cancer survivors in the KSA have overall good quality of life scores when compared with patients from Western countries. However, their psychological wellbeing is more impaired. There is an urgent need for psychosocial support programs and psychological screening and consultation for breast cancer patients at cancer care centers in the KSA.

Features and incidence of thromboembolic disease: A comparative study between high and low altitude dwellers in Saudi Arabia.

To estimate and compare the incidence of thromboembolic disease among patients who are clinically suspected for VTE among high and low altitude dwellers in Saudi Arabia. A prospective study conducted over two years (2011-2013) conducted in two different geographical areas in Saudi Arabia; Abha City and Riyadh City. Patients clinically suspected with deep vein thrombosis and pulmonary embolism was recruited to the study. A detailed social, medical and laboratory investigations were taken from all patients including lifestyle, occupation and smoking. A total of 234 patients participated in the study. There were 146 (62.4%) females and 88 (37.6%) males. Mean age was 51.7 years. A 56.8% incidence of DVT was seen among high altitude dwellers compared to 13.0% among low altitude dwellers. Also, a 12.6% incidence of PE was documented among high altitude dwellers, compared to 4.1% of the low altitude dwellers. VTE was significantly more among high altitude dwellers (81.9%) compared to low altitude dwellers (21.9%). Mean WBC count was significantly higher among the high altitude dwellers (10.8 ± 9.7 vs. 8.2 ± 3.4, p = 0.043). Mean platelet count was significantly higher among the high altitude dwellers compared to the low altitude dwellers (327.4 ± 162.4 vs. 212.0 ± 158.9, p = 0.005). The likelihood of developing VTE is greater among people who resided at moderate to high altitude for prolonged periods of time. The changes in the factors for coagulation including platelet counts may not reflect the true status of hypercoagulability especially if patients have stayed longer in high altitudes because of physiological adaptation to the environment.

Stroke and renal artery stenosis from Takayasu's arteritis diagnosed in a 57-year-old male patient.

Takayasu arteritis (TA) is a rare chronic granulomatous inflammatory arterial disease of unknown etiology that affects the aorta, its main branches and pulmonary artery. The clinical presentation is nonspecific, with signs and symptoms that vary according to the affected arterial segment. The most commonly affected vessel is the subclavian artery, while renal artery stenosis is relatively uncommon. We report a case of a 57-year-old male patient with late diagnosis of TA and various related complications including stroke in the left middle cerebral artery territory, predominant left renal artery stenosis, and hypertension with discrepancy of blood pressure between two arms due to predominant left subclavian artery stenosis. Thus, physicians should keep in their mind this late presentation after the age of 40 years. The aim is to increase the awareness of this condition because of early diagnosis and the timely introduction of treatment can lead to improved outcomes in this poorly understood clinical enigma.

Assessment of cylindrospermopsin toxin in an arid Saudi lake containing dense cyanobacterial bloom.

This study reports the presence of the cyanobacterial toxin cylindrospermopisn (CYN) and its producer Cylindrospermopsis raciborskii for the first time in Saudi freshwater sources. C. raciborskii was found in Gazan Dam Lake water with two morphotypes (coiled and straight). The appearance and cell density of this species was significantly positively related to high temperature and high ammonium concentrations, and negatively with nitrate and phosphate concentrations in the lake. Intracellular concentrations of CYN (4-173 µg L(-1)) were associated with C. raciborskii rather than other cyanobacteria with a maximal value obtained in June 2011, coinciding with the highest bloom of this species (19 × 10(7) trichome L(-1)). CYN cell quotas (0.6-14.6 pg cell(-1)) varied significantly along the study period and correlated with most environmental factors. The results of ELISA and liquid chromatography-mass spectrometry proved that the CYN production by strains of this species was isolated from this lake during the present study, with an amount reaching 568 µg g(-1). Extracellular CYN was also detected in cell-free lake water at concentrations 0.03-23.3 µg L(-1), exceeding the drinking water guideline value of 1 µg L(-1) during the Apr-Jul period. As this lake is an important source for drinking and irrigation waters, CYN monitoring should be included in the environmental and health risk assessment plans of these water bodies.

Bonding quality of contemporary dental cements to sandblasted esthetic crown copings.

AIM: To evaluate the shear bond strength of current luting cements to sandblasted crown-coping substrates. METHODS: Specimens of nickel-chromium, pressable glass ceramic, and zirconia crown-coping substrates were sandblasted in three groups (n = 30 each) with 50 (group 1), 110 (group 2), and 250 µm (group 3) alumina particles at a pressure of 250 kPa. Cylinders of glass ionomer, universal resin, and self-adhesive resin cements were then built up on the sandblasted substrate surfaces of each group (n = 10). All bonded specimens were stressed to evaluate the cement-substrate shear bond strength. Both the mode and incidence of bond failure were also considered. RESULTS: No difference was noticed between all test groups in terms of cement-substrate bond strength. In comparison to self-adhesive type, the universal resin cement provided lower bond strengths to both metal and glass-ceramic substrates in group 1. The self-adhesive resin cement provided the highest bond strengths to the zirconia substrates in groups 2 and 3. The adhesive type of bond failure was common in the metal and zirconia substrates in all groups. CONCLUSIONS: Cement-substrate bonding quality is not affected by the size of sandblasting particles. Resin cements bond better to different coping substrates. Self-adhesive resin cement is the best choice to bond zirconia-based substrates.

Microcystin production in epiphytic cyanobacteria on submerged macrophytes.

Cyanotoxins have been largely studied in planktonic and benthic cyanobacteria, but microcystin (MCYST) production in epiphytic cyanobacteria has not been reported yet. The present study reports for the first time the MCYST production in epiphytic cyanobacteria on submerged macrophytes. During this study, four common submerged macrophytes in eutrophic pond in Saudi Arabia were surveyed for the presence of toxic epiphytic cyanobacteria. The results showed that chlorophyll-a and total biovolume of epiphytic cyanobacteria differed significantly among submerged plants with highest values obtained in Stratiotes aloides and lowest in Elodea canadensis. Epiphytic materials collected from Ceratophyllum demersum and S. aloides had higher species diversities than materials collected from E. canadensis and Myriophyllum verticillatum. The cyanobacteria, Merismopedia tenuissima and Leptolyngbya boryana were recorded with a high abundance in epiphytic materials collected from all submerged macrohpytes. Based on Enzyme-linked immunosorbent assay (ELISA), these two species were found to produce MCYSTs (MCYSTs) with concentrations of 1438 and 630 microg g(-1) dry weight, respectively. HPLC analysis of the methanolic extracts of the two species showed that M. tenuissima extract contained MCYST-RR and -LR/demethyl LR plus 3 minor unidentified MCYSTs, while L. boryana extract contained MCYST-YR, -LR/demethyl LR, and 2 minor unidentified MCYSTs. This study suggests that epiphytic species should be considered during monitoring of toxic cyanobacteria in water sources.

Microcystins in groundwater wells and their accumulation in vegetable plants irrigated with contaminated waters in Saudi Arabia.

The present study describes the presence of toxic cyanobacteria and microcystin (MCYST) concentrations in groundwater wells and tissues of vegetable plants irrigated with well waters in Asir region, southwest of Saudi Arabia. The results revealed the presence of cyanobacteria in all groundwater wells with a dominance of Oscillatoria limentica. This species was found to produce MCYSTs at a concentration of 336 microg g(-1) as determined by enzyme-linked immunosorbent assay (ELISA). HPLC chromatogram for the methanolic extract of this species showed one main peak corresponding to MCYST-YR. MCYSTs were also detected in well waters at concentrations (0.3-1.8 microg L(-1)), exceeding the WHO guideline level (1 microg L(-1)) in some wells. All vegetable plants collected during the present study were found to accumulate MCYSTs in their leaves and roots at concentrations ranged from 0.07 to 1.2 microg g(-1) fresh weight. The study suggests that ground waters and vegetable plants should be continuously monitored for the presence of MCYSTs to protect the public against the exposure to such potent hepatotoxins.

Microcystin-producing blooms of Anabaenopsis arnoldi in a potable mountain lake in Saudi Arabia.

This study reports for the first time the presence of Anabaenopsis arnoldi blooms in Saudi freshwaters. This species has been investigated with high cell densities (3.8 x 10(3)-264 x 10(3) cells mL(-1)) during June-November 2007 in Tendaha Lake, one of the major freshwater sources in Saudi Arabia. High temperature and conductivity, and a high concentration of phosphate, and low nitrate concentrations may have contributed to the formation of these blooms. The blooms were found to produce microcystins (MCYSTs) at concentrations up to 364 microg g(-1) dry weight as detected by an enzyme-linked immunosorbent assay. MCYSTs were also detected in the raw and treated water of the lake at concentrations (1.6-8.3 and 0.33-1.6 microg L(-1), respectively) exceeding the World Health Organization guideline level of 1 microg L(-1) for these toxins. HPLC analysis revealed that the extracts of A. arnoldi blooms contained MCYST-RR, -YR and two unidentified MCYSTs, but a pure culture of A. arnoldi isolated from Tendaha Lake during the present study produced MCYST-RR and -YR only. This is the first study to report MCYST production by A. arnoldi. Therefore, this cyanobacterium should be taken into consideration during monitoring of toxic cyanobacterial blooms in drinking and recreational water sources in the world, particularly arid and semi-arid countries including Saudi Arabia.

Cyanobacteria and their toxins in treated-water storage reservoirs in Abha city, Saudi Arabia.

Occurrence of toxic cyanobacteria in drinking and recreational waters poses human health at risk as they can release potent toxins into the water. In the present study, open and covered treated-water storage reservoirs as well as their relevant tap waters in Abha city, Saudi Arabia, were surveyed for the presence of cyanobacteria and their toxins. The results revealed the contamination of most open reservoir and tap waters by algae and cyanobacteria, with an abundance of toxigenic species of cyanobacteria. Depending on the results of the Limulus amebocyte lysate (LAL) assay and enzyme linked immunosorbent assay (ELISA), endotoxins and microcystins (MCYSTs) were found in most open reservoir and tap waters at concentrations up to 32 EU ml(-1) and 0.3 microg ml(-1), respectively. The extracts of axenic cultures of most cyanobacterial species isolated from these reservoirs showed activity to LAL assay, with large endotoxin amounts obtained in Calothrix parietina (490 EU g(-1)) and Phormidium tenue (210 EU g(-1)). Based on ELISA and HPLC analysis for these extracts, only C. parietina can produce MCYSTs (202 microg g(-1)) with a profile consisting of MCYST-RR and -LR. This study suggests that open treated-water storage reservoirs should be covered to prevent the presence of cyanobacteria and their toxins in such drinking and recreational waters.