Emerging Perspectives on the Impact of Diabetes Mellitus and Anti-Diabetic Drugs on Premenstrual Syndrome. A Narrative Review.

Diabetes mellitus (DM) and premenstrual syndrome (PMS) are global health challenges. Both disorders are often linked to a range of physical and psychological symptoms that significantly impact the quality of life of many women. Yet, the exact relation between DM and PMS is not clear, and the management of both conditions poses a considerable challenge. In this review, we aimed to investigate the interplay between DM, anti-diabetic drugs, and the different theories and symptoms of PMS. Female sex hormones are implicated in the pathophysiology of PMS and can also impair blood glucose control. In addition, patients with diabetes face a higher susceptibility to anxiety and depression disorders, with a significant number of patients experiencing symptoms such as fatigue and difficulty concentrating, which are reported in patients with PMS as well. Complications related to diabetic medications, such as hypoglycemia (with sulfonylurea) and fluid retention (with thiazolidinediones) may also mediate PMS-like symptoms. DM can, in addition, disturb the normal gut microbiota (GM), with a consequent loss of beneficial GM metabolites that guard against PMS, particularly the short-chain fatty acids and serotonin. Among the several available anti-diabetic drugs, those (1) with an anti-inflammatory potential, (2) that can preserve the beneficial GM, and (3) possessing a lower risk for hypoglycemia, might have a favorable outcome in PMS women. Yet, well-designed clinical trials are needed to investigate the anti-diabetic drug(s) of choice for patients with diabetes and PMS.

Assessment of the Level of Knowledge and Awareness of the Risk of Chronic Use of Steroids in Causing Cataracts Among the General Population in the Western Region of the Kingdom of Saudi Arabia (KSA): A Cross-Sectional Study.

BACKGROUND/AIM: Cataracts consequence blindness to burden and impose health and economic burdens on communities. Steroid-induced cataracts have scarcely been highlighted in previous literature, creating a demand for reinvestigating this issue among the general population of western Saudi Arabia. METHODS: A cross-sectional study was conducted in 2022 using an online survey distributed among the target participants via social media platforms. The data were gathered and statistically analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. software. RESULTS: Overall, 866 respondents (males = 42.5%, females = 57.5%) were enrolled in this survey (mean age = 28.08, SD = 13). The participants' correct responses to questions about steroid-induced cataracts showed inadequate representation (below 50%). Additionally, most of the participants (94.23%) had a poor understanding of steroid-induced cataracts. CONCLUSION: The participants' level of understanding of the risk factors associated with chronic steroid usage and its impact on cataracts was inadequate.

A Systematic Review of Novel Therapies of Pulmonary Arterial Hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive, cureless disease, characterized by increased pulmonary vascular resistance and remodeling, with subsequent ventricular dilatation and failure. New therapeutic targets are being investigated for their potential roles in improving PAH patients' symptoms and reversing pulmonary vascular pathology. METHOD: We aimed to address the available knowledge from the published randomized controlled trials (RCTs) regarding the role of Rho-kinase (ROCK) inhibitors, bone morphogenetic protein 2 (BMP2) inhibitors, estrogen inhibitors, and AMP-activated protein kinase (AMPK) activators on the PAH evaluation parameters. This systematic review (SR) was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42022340658) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Overall, 5092 records were screened from different database and registries; 8 RCTs that met our inclusion criteria were included. The marked difference in the study designs and the variability of the selected outcome measurement tools among the studies made performing a meta-analysis impossible. However, the main findings of this SR relate to the powerful potential of the AMPK activator and the imminent antidiabetic drug metformin, and the BMP2 inhibitor sotatercept as promising PAH-modifying therapies. There is a need for long-term studies to evaluate the effect of the ROCK inhibitor fasudil and the estrogen aromatase inhibitor anastrozole in PAH patients. The role of tacrolimus in PAH is questionable. The discrepancy in the hemodynamic and clinical parameters necessitates defining cut values to predict improvement. The differences in the PAH etiologies render the judgment of the therapeutic potential of the tested drugs challenging. CONCLUSION: Metformin and sotatercept appear as promising therapeutic drugs for PAH. CLINICAL TRIALS REGISTRATION: This work was registered in PROSPERO (CDR42022340658).

Burnout among ICU Healthcare Workers at Two Tertiary Care Hospitals in Makkah during the Hajj Season.

Background: The Hajj season results in increased workload and longer shift hours for healthcare workers at the intensive care units (ICUs), which may result in burnout. Objective: To determine the point prevalence of professional burnout and its predictors among healthcare workers at the ICUs of two tertiary care hospitals in Makkah during the Hajj season. Methods: This cross-sectional descriptive study included all healthcare professionals working at the ICU departments of two of the largest tertiary care hospitals in the Makkah region during the 1439/2018 Hajj season. The original Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout. Logistic regression models were fitted to estimate the effect size of the associated risk factors. Results: A total of 354 participants completed the questionnaire. Moderate to severe burnout was found in each of the three subscales: emotional exhaustion, 56%; depersonalization, 82%, and impaired personal achievement, 72%. Nurses were significantly more likely to experience burnout compared with physicians (P = 0.017). Independent predictors of moderate or severe burnout were being aged ≤40 years (odds ratio [OR]: 2.1, 95% CI: 0.395-4.002; P = 0.045), female gender (OR: 2.2, 95% CI: 0.242-4.346; P = 0.037); work having a negative impact on family (OR: 3, 95% CI: 0.164-5.504; P = 0.019); unsatisfaction with salary (OR: 2.8, 95% CI: 0.28-5.056; P = 0.025); and working at the cardiac critical care unit (OR: 2.6, 95% CI: 0.440-4.467; P = 0.035). Conclusion: This study revealed that the point prevalence of burnout is common among ICU healthcare workers during the Hajj season. These findings can be used by policymakers to devise strategies to mitigate the risks of burnout during the Hajj season.

Knowledge and attitude of young population toward CPR training, results from largest training session in an official attempt to enter Guinness Book of Records: A cross-sectional study from Saudi Arabia.

Objective: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives and it is important to rise the willingness of the general population to help cardiac arrest victims. The primary objective of the present study is to assess the levels of the knowledge and attitude toward CPR among the young population who underwent the largest CPR training session in an official attempt to enter the Guinness Book of Records. Methods: Through a cross-sectional design, the study had 2,528 subjects, who met the inclusion and exclusion criteria during the largest CPR training session at the King Abdul-Aziz Sports City Stadium, Makkah city, Saudi Arabia. Results: Descriptive statistics showed that two-thirds (72%) of the subjects were in the age category of less than 20 years. At least 50% of the subjects had a Bachelor's degree. Overall, the findings of this study suggested a good level of knowledge and attitude against CPR and this is might be attributed to certain factors which are mainly the high level of education, age, and gender factors (P value < 0.05). Conclusion: Our findings support the need for proper and high-quality training for each member in the community about CPR as well as using social media and online training to highlight the importance of CPR among the young population.

Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study.

OBJECTIVES: To quantify the extent and variation of depression, anxiety and stress among medical and non-medical Saudi Arabian students. METHODS: In this cross-sectional study, students from Umm Al-Qura University, Makkah, Saudi Arabia, were recruited. The Faculty of Education was randomly selected to represent the non-medical colleges. The depression, anxiety and stress scale-21 items (DASS-21) was used to estimate the study outcomes. RESULTS: Of the 465 undergraduates recruited in this study, 49.68% (n=231) were medical students and 50.32% (n=234) were non-medical students. Approximately 54%, 53%, and 38% of the participants were found to be suffering from depression, anxiety, and stress, respectively. The analyses showed that the two groups did not differ significantly with respect to stress and depression (p=0.934 and 0.423, respectively). However, the non-medical students exhibited a significantly higher anxiety score compared to the medical students (p=0.002). Family conflicts was a common risk factor for the studied psychological disturbances. Female gender and travel time from home to university were significant predictors of depression and anxiety, whereas a positive history of a psychological condition increased the likelihood of depression and stress. CONCLUSION: There was a high prevalence of anxiety, stress, and depression among the students, with a significantly higher anxiety levels among the non-medical students.

Hypothesis: The potential therapeutic role of nicorandil in COVID-19.

At present, there is yet no specific antiviral treatment or immunization against the newly identified human severe acute respiratory syndrome virus (SARS-CoV2) that results in a rapidly progressive pandemic coronavirus disease 2019 (COVID-19). We believe in a crucial need for a clinical strategy to counteract this viral pandemic based on the known pathogenesis throughout the disease course. Evidence suggests that exaggerated patient's inflammatory response and oxidative stress are likely to aggravate the disease pathology. The resulting endothelial dysfunction further induces fibrosis and coagulopathy. These disturbances can generate severe acute respiratory distress syndrome (ARDS) that can progress into respiratory and circulatory failure. Nicorandil is an anti-anginal vasodilator drug acts by increasing nitric oxide bioavailability and opening of the KATP channel. Recently, nicorandil has been recognized to possess multiple protective effects against tissue injury. Here, we address a possible modulatory role of nicorandil against COVID-19 pathogenesis. We hypothesise nicorandil would be an effective form of adjuvant therapy against COVID-19.

Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Scarce data exists about analgesic requirements in super morbidly obese (SMO) patients who underwent sleeve gastrectomy. We attempted to investigate analgesic requirements for SMO, when compared with morbidly obese (MO) individuals who underwent sleeve gastrectomy and its impact on postoperative outcome. METHODS: We studied 279 consecutive patients (183 MO, 96 SMO) who underwent bariatric surgery. Data analysis included perioperative anaesthetic management, analgesic consumptions, opioids side effects, and ICU admission. RESULTS: The SMO group showed higher patients with asthma, epilepsy, obstructive sleep apnoea (OSA), and ASA III percentages (P = 0.014, P = 0.016, P Ë‚ 0.001, and P Ë‚ 0.001, respectively). There were no significant differences in the total morphine consumption intraoperatively, or after 24 h. However, reduced consumption of intraoperative fentanyl and morphine in SMO when calculated per total body weight (TBW) (P = 0.004 and P = 0.001, respectively). At PACU, tramadol consumption per TBW and lean body mass (LBM) were significantly reduced in SMO (P = 0.001 and P = 0.025, respectively). Paracetamol consumption was significantly reduced in the SMO group (P = 0.04). They showed higher comorbidities (P Ë‚ 0.001), longer anaesthesia time (P = 0.033), and greater ICU admissions (P Ë‚ 0.001). Vomiting was higher in the MO group (P = 0.004). Both groups showed comparable pain scores (P = 0.558) and PACU stay time (P = 0.060). CONCLUSIONS: Super morbidly obese patients required fewer opioids and analgesics perioperatively. They exhibited higher comorbidities with greater anaesthesia time and ICU admissions. PACU stay time and pain scores were comparable.

Patterns of emergency department visits during Hajj period: Towards healthcare optimization in view of Saudi Arabia's vision 2030.

OBJECTIVE: This study aimed to examine the pattern of emergency department (ED) visits by Hajj patients and determine the urgency of emergency visits at an advanced healthcare center. METHODS: A retrospective review of medical records of Hajj patients visiting the ED at King Abdullah Medical City Makkah from September 1 to October 5, 2015 was conducted. RESULTS: We considered 233 visits by 199 Hajj patients. Most diseases were cardiovascular related. Approximately half of the ED visits led to hospital admission, which were largely during the evening and nighttime. Potentially avoidable visits were significantly encountered during the daytime. Average bed occupation time in the ED was similar for both cases: those admitted to inpatient care and discharged from ED. Results from the Canadian Triage and Acuity Scale revealed that most patients were triaged with a score of III (48.4%) followed by a clinically better score of IV (32%); however, scores did not change significantly throughout the Hajj day. CONCLUSIONS: During Hajj, a significant proportion of patients who visited the ED at the ultimate healthcare facility were discharged within 24 hours, with a higher rate in the morning-afternoon period. Both admitted and discharged cases required equal levels of care. Therefore, an extension in working days at primary care centers and optimization of advanced healthcare facilities during Hajj is currently warranted.

Dexmedetomidine and propofol sedation requirements in an autistic rat model.

BACKGROUND: Autism is a challenging neurodevelopmental disorder. Previous clinical observations have suggested altered sedation requirements for children with autism. Our study aimed to test this observation experimentally in an animal model and to explore its possible mechanisms. METHODS: Eight adult pregnant female Sprague-Dawley rats were randomly divided into two groups. Four were injected with intraperitoneal sodium valproate on gestational day 12 and four were injected with normal saline. On postnatal day 28, the newborn male rats were subjected to the open-field test to confirm autistic features. Each rat was injected intraperitoneally with a single dose of propofol (50 mg/kg) or dexmedetomidine (0.2 mg/kg). The times to loss of righting reflex (LORR) and to return of righting reflex (RORR) were recorded. On the following day, all rats were re-sedated and underwent electroencephalography (EEG). Thereafter, the rats were euthanized and their hippocampal gamma-aminobutyric acid type A (GABAA) and glutamate N-methyl-D-aspartate (NMDA) receptor gene expressions were assessed. RESULTS: Autistic rats showed significantly longer LORR times and shorter RORR times than did the controls (median LORR times: 12.0 versus 5.0 min for dexmedetomidine and 22.0 versus 8.0 min for propofol; P < 0.05). EEG showed a low-frequency, high-amplitude wave pattern 2 min after LORR in the control rats. Autistic rats showed a high-frequency, low-amplitude awake pattern. Hippocampal GABAA receptor gene expression was significantly lower and NMDA gene expression was greater in autistic rats. CONCLUSIONS: This study supports the clinical observations of increased anesthetic sedative requirements in children with autism and our biochemical analyses using GABAA and glutamate receptor gene expression highlight possible underlying mechanisms.

The impact of stone composition on renal function.

BACKGROUND: Nephrolithiasis is a common condition that has various classifications according to stone composition. Stone formation can affect renal function; it can be a strong risk factor for chronic kidney disease (CKD). The main objective of this study is to explore the association between creatinine clearance and different stone compositions. METHODS: This is a retrospective cohort study conducted in a tertiary center in Jeddah, Saudi Arabia, between 2005 and 2014. Renal function was assessed by the estimating glomerular filtration rate (eGFR) by the Cockcroft-Gault equation. Stone composition was determined by urinary calculi analysis with infrared spectrometry. RESULTS: Stones of 365 patients, with a mean age of 48.2 ± 13.6 years and a male to female ratio of 3.2:1, were analyzed. Stage 2 CKD has been documented. It involved oxalate, struvite, cystine, and uric acid stones. The worst eGFR was reported for stones containing uric acid. The eGFR was least affected with apatite stones followed by brushite stones. CONCLUSION: Stone disease can affect renal function. Different stone compositions show factor for renal impairment, and this should be considered in patient management. A special precaution should be considered for higher risk groups. Multidisciplinary patient care and immediate referral to a nephrologist are strongly advised.

Knowledge regarding noncytotoxic medication extravasation among registered nurses working in western Saudi Arabia.

Extravasation and infiltration are among the most common intravenous therapy complications. For noncytotoxic agents, the incidence of extravasation remains unknown. There has been little research into extravasation due to ethical considerations limiting controlled research; most evidences are based on small, uncontrolled trials or case reports. The purpose of this study was to assess the knowledge level regarding noncytotoxic medications extravasation and its associated factors among staff nurses.A descriptive correlational design using self-administered questionnaire was employed. A convenience sample of 387 nurses completed a questionnaire about noncytotoxic medication extravasation. Statistical Package for Social Sciences version 21 was used to analyze data by applying the chi-square test, t test, and the Mann-Whitney test to assess the knowledge difference between open and closed units' nurses.The results indicate that only 19.6% of nurses have a good knowledge about noncytotoxic medications extravasation. There was consistently poor staff knowledge regarding noncytotoxic medications extravasation. Although the closed units' nurses reported relatively higher level of knowledge than open units' nurses, their level of knowledge still inadequate. Health care organizations must consider developing specific policies regarding extravasation. Closed and open units' nurses should be enrolled in special education programs to improve their level of knowledge regarding noncytotoxic medication extravasation.

Prevalence and intensity of smoking among healthcare workers and their attitude and behavior towards smoking cessation in the western region of Saudi Arabia: A Cross-sectional study.

INTRODUCTION: This study aimed to estimate the magnitude of tobacco smoking among healthcare workers (HCWs) and to assess the need to establish a smoking cessation program. METHODS: This is an institute survey that targeted HCWs from the following specialties: physicians, allied healthcare professionals and administrative workers who are affiliated to a tertiary healthcare institution in the western region of the Kingdom of Saudi Arabia (KSA). An electronic self-administrated questionnaire was distributed among the study subjects during the day shift from June to September, 2015. The analysis was descriptive, and comparison of the characters of smokers and nonsmokers was done. RESULTS: The total number of participating HCWs was 697 with about 62.3% response rate. Males (62.3%), allied health professionals (45.2%), and age group 19-30 years old (44.5%) dominated the sample. The crude prevalence of the current smoking was 18.4%, while 9.8% were past smokers, and 71.9% never smokers. Administrative workers, males and Saudis demonstrated significantly higher prevalence of current smoking (p>0.001). Approximately half of the current smokers had a mild smoking intensity and the subgroups did not show any significant differences for nicotine dependence (p>0.05). The results of the attitude towards smoking cessation showed that 80.3% of the currently smoking HCWs had positive attitudes and there were no statistically significant differences based on the characteristics of the participants (p>0.05). CONCLUSIONS: The smoking prevalence among HCWs included in the study parallels nationally reported values. The results showed a need for the establishment of smoking cessation programs targeting HCWs, which eventually should make Mecca (Makkah) city truly free from smoking.

Diagnosis and Control of Hypertension as Indicators of the Level of Awareness Among Relatives of Medical Students in Saudi Arabia.

INTRODUCTION: Patients' awareness plays an important role in the early diagnosis and control of many diseases including hypertension. AIM: To estimate the level of awareness among relatives of medical students by assessing the prevalence of undiagnosed and uncontrolled hypertension. METHODS: A predefined group of medical students were recruited and properly instructed in order to conduct this cross-sectional study among their respective first-degree adult relatives whom their sociodemographic and medical history were obtained along with their blood pressure readings. According to the absence or presence of hypertension in their history, relatives with high blood pressure were considered as undiagnosed or uncontrolled hypertension, respectively; while those who had normal blood pressure were considered as normal or controlled hypertension, respectively. Comparative analysis of different parameters was carried out between these subgroups. RESULTS: We included 770 relatives of 82 (57.7 %) total students' participations. The prevalence of undiagnosed hypertension among the total study population was 14.4 % (111 cases). Among participants with previously diagnosed hypertension, 61.9 % were uncontrolled at the time of the study. Predictors for undiagnosed hypertension were age below 40 years, working at the present time in either governmental or private sectors, current smoking, absence of diabetes and cardiac diseases. None of the investigated factors showed to be a significant predictor for uncontrolled hypertension. CONCLUSIONS: There is insufficient level of awareness among family members of clinically oriented medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The most frequent profile associated with the lowest awareness level is that of the young smoking employee with no history of diabetes or cardiac disease.

Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study.

BACKGROUND: Low Back Pain (LBP) is the commonest musculoskeletal disorder and an important occupational hazard among healthcare workers (HCWs) that peaks among Operating Room (OR) staff. This cross-sectional study aimed to assess the prevalence, characteristics, and risk factors of low back pain among operating room (OR) staff in a tertiary healthcare center in Makkah, Saudi Arabia. METHODS: A 39-item self-administered questionnaire was distributed to all available OR staff. Data about personal, sociodemographic, general risk factors OR specific risky activities, and LBP characteristics were obtained. Descriptive, crosstabs, and univariate and multivariate logistic regression tests were employed. RESULTS: Out of the 143 distributed questionnaires, 84 % were received. LBP prevalence was 74.2 %. No statistically significant associations were detected between LBP and any of the general risk factors (p >0.05). However, most of the OR risky activities were significantly associated with the occurrence of LBP (p <0.05) e.g. lifting objects above the waist, rotating torso while bearing weight, transferring patients onto bed or chair, pulling a patient up the bed, and repositioning a patient in bed. These significant associations were preserved after adjustment for gender, perceived stress at work, educational level, and receiving education about LBP. Rest and analgesics were reported to be the most common relievers. CONCLUSIONS: LBP is a common health issue among KAMC OR staff. OR risky activities were found to contribute to this problem. We suggest designing educational interventional programs to teach OR staff the best way to prevent this problem.

Predictive Value of IHC4 Score for Pathological Response to Neoadjuvant Chemotherapy in Hormone Receptor-Positive Breast Cancer.

PURPOSE: This study aimed to explore the value of IHC4 in predicting pathological response after neoadjuvant chemotherapy in patients with hormonal receptor (HR)-positive breast cancer (BC). MATERIALS AND METHODS: In this retrospective exploratory study, data for 68 HR-positive BC patients who received neoadjuvant chemotherapy were recorded. IHC4 scores were calculated based on estrogen receptors/progesterone receptors, Ki-67 and HER2 status. Logistic and ordinal regression analyses in addition to likelihood ratio test were used to explore associations of IHC4 scores and other clinico-pathological parameters with pathological complete response (pCR) and pathological stage. RESULTS: Taking the 25th percentile as the cut-off, a lower IHC4 score was associated with an increased probability of pCR (low; 52.9% vs. High; 21.6%, OR=4.1, 95% CI= 1.28-13.16, p=0.018) and a lower pathological stage (OR =3.9, 95% CI=1.34-11.33, p=0.012). When the IHC4 score was treated as a continuous variable, a lower score was again associated with an increased probability of pCR (OR=1.010, 95% CI=1.001-1.018, p=0.025) and lower pathological stage (OR=1.009, 95% CI= 1.002-1.017, P=0.008). Lower clinical stage was associated with a better pCR rate that was of borderline significance (P=0.056). When clinical stage and IHC4 score were incorporated together in a logistic model, the likelihood ratio test gave a P-value of 0.004 after removal of the IHC4 score and 0.011 after removal of the stage, indicating a more significant predictive value of the IHC4 score for pCR. CONCLUSIONS: This study suggests that the IHC4 score can predict pathological response to neoadjuvant chemotherapy in HR-positive BC patients. This finding now needs to be validated in a larger cohort of patients.

INTESTINAL PARASITES DETECTED DURING PRE-EMPLOYMENT STOOL EXAMINATION AT TERTIARY HEALTH CARE CENTER IN MAKKAH, KINGDOM OF SAUDI ARABIA.

This retrospective study determined the intestinal parasites discovered in 2490 new employees in a tertiary health care center in Makah as regards nationalities, age groups and sex over the period from January 2010 to January 2014 to decrease introduction of communicable diseases. All the data were provided through the electronic hospital information system. The overall positive cases were 16%, significantly higher in females 57.4% than males 42.6%. Differences in distribution of positive records among different geographical areas were highly significant being highest in East Asia 59.8 %. Blastocystis hominis was the most common parasite. It occurred in 78,9% of positive cases followed by Entamoeba coli 9.3%, Giardia lamblia 5.8% and Entamoeba histolytica/dispar 5.3%. These findings should motivate any other country importing expatriate employees to have effective screening programs for intestinal parasites.

Effect of simvastatin and atorvastatin on serum vitamin d and bone mineral density in hypercholesterolemic patients: a cross-sectional study.

Background. Besides lipid-lowering effect of statins, they have been shown to have nonlipid lowering effects, such as improving bone health. An improvement in bone mineral density (BMD) has been indicated in some studies after the use of statins, in addition to an increase in 25-hydroxyvitamin D (25OHD) level. The aim of this study is to explore the association between statins and bone health taking into consideration 25OHD level and BMD. Methods. This is a randomized, cross-sectional comparative study. Subjects were divided into two groups, hypercholesterolemic participants taking simvastatin or atorvastatin as the study group and a matched control group not taking statins. All participants were assessed for serum 25OHD and BMD at lumbar spine and femoral neck. Results. A total of 114 participants were included in the study, 57 participants in each group. Results of serum 25OHD showed no significant difference between study and control groups (P = 0.47), while BMD results of lumbar spine and femoral neck showed significant difference (P = 0.05 and 0.03, resp.). Conclusion. Simvastatin and atorvastatin, at any dose for duration of more than one year, have no additive effect on 25OHD level but have a positive effect on the BMD.

Clinico-pathological patterns and survival outcome of colorectal cancer in young patients: western Saudi Arabia experience.

BACKGROUND: The prognosis of young colorectal cancer (CRC) patients has been addressed by several studies but with contradictory results. The aim of the present study was to evaluate the clinico-pathological features of young Saudi patients with CRC in addition to displaying their survival outcome. MATERIALS AND METHODS: In this retrospective study, young CRC patients (≤ 40 years) diagnosed between 2007 and 2011 from 4 centres in western Saudi Arabia, were included. Clinico-pathological features, tumor markers, dates of disease relapse and death were collected. Survival parameters were compared with those of older Saudi patients, reported in previous studies. RESULTS: One hundred and sixteen young patients with CRC were identified (32.2% rectal, 67.8% colon). Some 44% were metastatic while 32.7% had stage III at diagnosis. Patients with grade 3 tumors made up 29.4% of the total while 49.5% had positive lymphovascular invasion (LVI), 56% had a lymph node (LN) ratio ≥ 0.2 and 40.2% were K-ras mutant. Median disease-free survival (DFS) and overall survival (OS) in non-metastatic cases were 22.8 and 49.6 months respectively with better median DFS in K-ras wild compared to mutant patients (28.5 vs 20.9 months, p=0.005). In metastatic cases, median OS was 19.5 months. These survival outcomes are inferior compared to those of older Saudi patients reported in prior studies. CONCLUSIONS: Young CRC patients present more commonly with advanced stage and a high incidence of adverse prognostic factors such as LVI and high LN ratio. Young CRC patients seem to have worse survival compared to older Saudi patients.