The Saudi Clinical Practice Guideline for the treatment of venous thromboembolism: outpatient versus inpatient management

Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Primary clear cell carcinoma of minor salivary gland of the soft palate: a case report.

Clear cells can be found in numerous salivary and non-salivary tumors in the head and neck region, including metastatic lesions. They are rare low-grade tumors accounting for less than 1% of all salivary gland tumors and occur almost exclusively in the intra-oral minor salivary glands. Hyalinizing clear cell carcinoma (HCCC) is an extremely rare and recently described neoplasm predominantly affecting the oral cavity. Histologically, it is characterized by nests of glycogen-rich monomorphic clear cells within a hyaline stroma. HCCC often follows an indolent course with a limited metastatic potential. It is therefore important to differentiate this entity from other more aggressive clear cell tumors including metastatic tumors such as renal cell carcinoma. We hereby report a case of HCCC localized in minor salivary glands specifically in soft palate for its rarity, as well as to discuss the role of immunohistochemical stains, essential for its definitive diagnosis.

Synthesis and anti-proliferative activity of substituted-anilinoquinazolines and its relation to EGFR inhibition.

4-Anilinoquinazoline is a privileged scaffold in developing small molecule inhibitors of tyrosine kinases (TK) especially epidermal growth factor receptor (EGFR). 2 series belonging to 3'-substituted-4-anilinoquinazoline scaffold were synthesized and screened in vitro on isolated and a breast cancer cell line. The research aims at exploring the activity of compounds having diverse substituents at 3' position of the aniline moiety. Generally, the meta-substituted-anilinoquinazolines exhibited significant inhibitory activity against isolated enzyme as well as MCF-7 cancer cell line. For instance, compound 10b inhibited >99% of EGFR activities at 10 µM concentration. 6 of the tested compounds exhibited range of anti-proliferative activity below 10 µM potency. In particular, compounds 6e and 10b displayed the highest activity among the tested compounds with IC50 values equal to 8.6 and 4.84 µM, respectively. Structure-based tools were utilized to rationalize EGFR-TK binding of compound 10b since it is the most active compound in the enzyme inhibition test.

Nasal NK/T cell lymphoma mimicking an latrogenic lateral nasal wall infection: a diagnostic dilemma.

Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The prevalence of nasal lymphoma is estimated at 0.17-1.5% for all non -Hodgkin's lymphomas (NHL), of which 45% originate from the NK/T cell. It is more commonly encountered in Asian countries. The main clinical features are nasal congestion and epistaxis due to local aggressive destruction. It has a distinct immunophenotypic profile of CD2+, CD56+ and CD3-. The tumor often shows polymorphic lymphoreticular infiltrates and necrosis. We present a case of a 50-year-old male who presented with lateral nasal wall infection following endoscopic sinonasal surgery and later proven to be extranodal NK/T cell 'nasal type' lymphoma with immunophenotypic features.

Clinical trials in vaccination with leukemia associated antigens in acute myelogenous leukemia.

Vaccination with purified leukemia associated antigens (LAA) was performed in sixty adult patients with acute myelogenous leukemia (AML) who were admitted to Medical City, Yermok Hospital, Alshaab Hospital, Altefelalarabie Hospital, Basrah Hospital, Mosul Hospital, Althawra Hospital and Samaon Hospital. LAA were prepared from leukemic cells, using hypotonic lysis and low frequency sonication, followed by discontinuous polyacrylamide gel electrophoresis or column chromatography. Five doses were given intradermally, after discontinuation of the maintenance therapy. Clinical and immunological studies were done prevaccination and used to evaluate the effect of this vaccine. The patients were randomized into two groups: one group included 32 patients who received LAA alone and the other group included 28 patients who received LAA with BCG-cell wall skeleton as an adjuvant. Control groups of patients were also randomized into two subgroups: one subgroup included 30 patients who did not receive any kind of immunotherapy, the other subgroup included 30 patients who received BCG-cell wall skeleton only. All the LAA vaccinated groups showed increased blastogenic response to LAA most pronounced on day 22 and afterwards. There was increased response to non-specific mitogens after vaccination, especially after the 63rd day. All the vaccinated groups showed increased skin reactivity to LAA after vaccination. Fifty-seven of these patients had an initial weak reaction but it became more marked after vaccination. There was a correlation between the blastogenic responses and skin test reactivity to the clinical course. All the nonvaccinated group and those who were given BCG-cell wall skeleton alone died within 9 weeks (range 7--11 weeks) after discontinued chemotherapy making the survival range from 23--40 weeks (median of 29 weeks), in contrast all the vaccinated groups who received LAA alone or in combination with three BCG-cell wall skeleton doses are in complete unmaintained remission ranging in survival from 58 weeks to 74 weeks (median value is 63 weeks).