The prevalence of masked hypertension in a group of young healthy soldiers.

BACKGROUND: To assess the prevalence of masked hypertension (MH) in young Saudi National Guard soldiers based on 24h ambulatory blood pressure monitoring (ABPM). METHODS: A prospective study of 196 soldiers, aged between 21-50 years, without a history of hypertension or antihypertensive medication use. Each participant was fitted with a 24h-ABPM. Patients were considered to have MH if the office blood pressure (OBP) was <140/90 mm Hg and the 24h-ABPM average was ≥130/80 mmHg. RESULTS: The mean age of the MH group was 34.5 years compared to 32.4 years of the normotensive group. By pairing the average OBP with the 24h-ABPM, the prevalence of MH was estimated to be 29/196 (14.8%), with the SBP (systolic blood pressure) and DPB MH (diastolic BP) prevalence 12.8% and 7.7%, respectively. For the systolic BP, the OBP compared with the 24h-ABPM was 120.0±8.1 vs. 134.7±4.5 (P<0.001) and for the diastolic BP, 70.7±7.0 vs. 79.9±4.2 (P<0.001). CONCLUSIONS: The prevalence of MH among this sample of healthy military soldiers was 14.8%. It is important not to rely solely on the OBP and to consider MH when screening for hypertension in apparently healthy individuals.

The prognostic significance of hypertension at diagnosis in children with wilms tumor.

OBJECTIVES: To determine the prognostic effect of hypertension at diagnosis on outcomes of children with Wilms tumor (WT).   Methods: A single center retrospective analysis was conducted on 85 consecutive children with WT diagnosed between January 2000 and August 2013. Patients were classified as hypertensive or normotensive at diagnosis. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression was used to determine the predictive significance of hypertension and other clinical factors.  Results: Seventy-one patients had complete data. Of this, 25 (35.2%) were hypertensive and 46 (64.8%) normotensive with corresponding remission rates of 56.0% versus 82.6%, p=0.032; and death as first event of 7% versus 0%, p=0.004. The 5-year OS in the hypertensive versus normotensive patients were (67.1±10.3% versus 89.6±4.9%, p=0.009) and the corresponding 5-year PFS were (53.4±10.4% versus 79.1±6.2%, p=0.007). With univariate analysis, hypertension and local stage were predictors of OS (p=0.012 and p=0.029) and PFS (p=0.030 and p=0.008). In the multivariate analysis, hypertension, local stage, and histopathology were identified as independent prognostic factors of OS (p=0.004, p=0.034, and p=0.038); and hypertension  and local stage as prognostic for PFS (p=0.010 and p=0.012).  Conclusion: Hypertension at diagnosis is a prognostic predictor of poor outcome in WT and may signify tumor resistance.

Does the early intensification of intrathecal therapy improve outcomes in pediatric acute lymphoblastic leukemia patients with CNS2/TLP+ status at diagnosis?

OBJECTIVES: We aimed to determine whether the addition of two extra intrathecal methotrexate (ITM) doses during induction in acute lymphoblastic leukemia (ALL) patients eliminate the prognostic significance of CNS2/TLP+ status. METHODS: We retrospectively analyzed 224 patients according to the central nervous system (CNS) involvement at diagnosis: CNS1, CNS2, or CNS3. Patients with CNS2/TLP+ received two additional ITM doses during induction. Patients were treated according to the Children's Cancer Group (CCG)-1991/1961 protocols between January 2001 and December 2007. RESULTS: The 5-year relapse-free survival (RFS) rates for the ALL patients in the CNS1, CNS2, and CNS3 groups were 80.4 ± 3.0, 100, and 73.5 ± 11.3%, respectively; a non-significant difference was observed between the groups (P = 0.063). However, the patients with CNS2 had significantly better survival compared with the CNS3 patients (P = 0.03). The 5-year cumulative incidence of relapse (CIR) rates for the three groups were 17 (95% confidence interval (CI): 11.9-22.9), 0, and 18.8% (95% CI: 4.3-41.1), respectively; (P = 0.214) and those of isolated or combined CNS relapse were 9.6 (95% CI: 5.8-14.5), 0 and 6.3% (95% CI: 0.3-25.8), respectively (P = 0.424). CONCLUSIONS: This study shows that the intensification of ITM therapy during induction improves outcomes in patients with CNS2/TLP+ status and eliminates its prognostic significance. This suggests that early intensification using CNS-directed therapy is beneficial in controlling minimal CNS disease.

Chemotherapy-induced febrile neutropenia in patients with breast cancer. A multivariate risk assessment model for first cycle chemotherapy.

OBJECTIVE: To identify factors that increase the risk of developing febrile neutropenia (FN) during the first cycle of chemotherapy in breast cancer patients. METHODS: In this retrospective study, we reviewed the records of 211 patients with confirmed breast cancer treated with chemotherapy at the Princess Norah Oncology Center, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia between January 2010 and May 2012. Statistical analysis was conducted using descriptive analysis, univariate, and multivariate logistic regressions. A multivariate regression of FN occurrence in the first cycle was developed. RESULTS: The median age of patients was 48 years. Febrile neutropenia was documented in 43 (20.3%) of 211 patients. Twenty-one (49%) of the 43 patients had FN during the first cycle of chemotherapy. A multivariate logistic regression revealed that age (odds ratio [OR] 1.059, 95% confidence interval [CI]: 1.007-1.114), non-anthracycline and/or taxane-based chemotherapy regimens (OR of 39.488; 95% CI: 4.995-312.187), and neo-adjuvant chemotherapy (OR of 8.282; 95% CI: 1.667-41.152) were the most important independent risk factors of FN. CONCLUSION: Identifying risk factors of FN may help to target high-risk patients with granulocyte colony-stimulating factor prophylaxis and reduce FN incidences, with subsequent morbidities and mortalities.