Publications by authors named "Mohammed Essa"

34 Publications

Incidence and Mortality trends of Atrial Fibrillation/Atrial Flutter in the United States 1990 to 2017.

Am J Cardiol 2021 Feb 25. Epub 2021 Feb 25.

Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Cardiology, Mount Auburn Hospital, Cambridge, Massachusetts 02138. Electronic address:

Atrial fibrillation (AF) and flutter (AFL) are the most common clinically significant arrhythmias in older adults with an increasing disease burden due to an aging population. However, up-to-date trends in disease burden and regional variation remain unknown. In an observational study utilizing the Global Burden of Disease (GBD) database, age-standardized mortality and incidence rates for AF overall and for each state in the United States (US) from 1990-2017 were determined. All analyses were stratified by sex. The relative change in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) over the observation period were determined. Trends were analyzed using Joinpoint regression analysis. The mean ASIR per 100,000 population for men was 92 (+/-8) and for women was 62 (+/-5) in the US in 2017. The mean ASDR per 100,000 population for men was 5.8 (+/-0.3) and for women was 4.4 (+/-0.4). There were progressive increases in ASIR and ASDR in all but one state. The states with the greatest percentage change in incidence were New Hampshire (+13.5%) and Idaho (+16.0%) for men and women, respectively. The greatest change regarding mortality was seen in Mississippi (+26.3%) for men and Oregon (+53.8%) for women. In conclusion these findings provide updated evidence of increasing AF/AFL incidence and mortality on a national and regional level in the Unites States, with women experiencing greater increases in incidence and mortality rates. This study demonstrates that the public health burden related to AF in the United States is progressively worsening but disproportionately across states and among women.
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http://dx.doi.org/10.1016/j.amjcard.2021.02.014DOI Listing
February 2021

Total Body Irradiation or Chemotherapy Conditioning in Childhood ALL: A Multinational, Randomized, Noninferiority Phase III Study.

J Clin Oncol 2021 Feb 17;39(4):295-307. Epub 2020 Dec 17.

Goethe University, University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Frankfurt am Main, Germany.

Purpose: Total body irradiation (TBI) before allogeneic hematopoietic stem cell transplantation (HSCT) in pediatric patients with acute lymphoblastic leukemia (ALL) is efficacious, but long-term side effects are concerning. We investigated whether preparative combination chemotherapy could replace TBI in such patients.

Patients And Methods: FORUM is a randomized, controlled, open-label, international, multicenter, phase III, noninferiority study. Patients ≤ 18 years at diagnosis, 4-21 years at HSCT, in complete remission pre-HSCT, and with an HLA-compatible related or unrelated donor were randomly assigned to myeloablative conditioning with fractionated 12 Gy TBI and etoposide versus fludarabine, thiotepa, and either busulfan or treosulfan. The noninferiority margin was 8%. With 1,000 patients randomly assigned in 5 years, 2-year minimum follow-up, and one-sided alpha of 5%, 80% power was calculated. A futility stopping rule would halt random assignment if chemoconditioning was significantly inferior to TBI (EudraCT: 2012-003032-22; ClinicalTrials.gov: NCT01949129).

Results: Between April 2013 and December 2018, 543 patients were screened, 417 were randomly assigned, 212 received TBI, and 201 received chemoconditioning. The stopping rule was applied on March 31, 2019. The median follow-up was 2.1 years. In the intention-to-treat population, 2-year overall survival (OS) was significantly higher following TBI (0.91; 95% CI, 0.86 to 0.95; < .0001) versus chemoconditioning (0.75; 95% CI, 0.67 to 0.81). Two-year cumulative incidence of relapse and treatment-related mortality were 0.12 (95% CI, 0.08 to 0.17; < .0001) and 0.02 (95% CI, < 0.01 to 0.05; = .0269) following TBI and 0.33 (95% CI, 0.25 to 0.40) and 0.09 (95% CI, 0.05 to 0.14) following chemoconditioning, respectively.

Conclusion: Improved OS and lower relapse risk were observed following TBI plus etoposide compared with chemoconditioning. We therefore recommend TBI plus etoposide for patients > 4 years old with high-risk ALL undergoing allogeneic HSCT.
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http://dx.doi.org/10.1200/JCO.20.02529DOI Listing
February 2021

Aortic Distensibility Can Predict Events in Patients With Premature Coronary Artery Disease: A Cardiac Magnetic Resonance Study.

Angiology 2021 04 15;72(4):332-338. Epub 2020 Nov 15.

Department of Cardiology, 68796Assiut University, Asyut, Egypt.

Noninvasive assessment of aortic distensibility (AD) is feasible with cardiac magnetic resonance (CMR). We investigated the relationship between AD (assessed by CMR) and coronary artery disease (CAD) severity (assessed by the SYNTAX score) in patients with premature CAD. We recruited 125 patients with CAD confirmed by coronary angiography (males were <55 years old and females <65 years old). We excluded patients with significant aortic disease or contraindications to CMR. We also recruited 25 age- and sex-matched healthy patients as controls. One-year follow-up was also carried out. Aortic distensibility at the aortic root (AR) and descending aorta (DA) was significantly ( < .001 for both) lower in the patient group. There was a significant negative correlation between SYNTAX score and AD at the AR (r = -0.56; < .001) and DA (r = -0.34; < .001), but insignificant correlation with distensibility at the ascending aorta (AA; r = -0.03; = .81). AR, AA, and DA distensibility, as well as left ventricular ejection fraction were predictors of adverse events. The severity of CAD in young patients is associated with decreased AD, especially at the level of the AR. Aortic distensibility can predict adverse events in these patients.
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http://dx.doi.org/10.1177/0003319720968391DOI Listing
April 2021

COVID-19 in Pediatric Cancer Patients: How Concerned We Should Be? Lessons Learned From a Single Center in Middle East.

J Pediatr Hematol Oncol 2020 Nov 11. Epub 2020 Nov 11.

Department of Pediatric Hematology & Oncology, King Abdullah Specialized Children's Hospital.

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http://dx.doi.org/10.1097/MPH.0000000000002013DOI Listing
November 2020

Orbital extramedullary leukemia relapse in a pediatric patient post-CART cell therapy-Case report.

Pediatr Transplant 2020 Sep 30:e13852. Epub 2020 Sep 30.

Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

CART therapy is an approved therapy in advanced ALL. The mechanism of relapse post-CART therapy is under vigorous research. We report a 9-year-old boy who received CD19-CART therapy after BM ALL relapse post-HSCT. He presented with unilateral eye swelling which was initially managed as orbital cellulitis. Later on, it was proven to be an isolated ALL orbital relapse without peripheral blood B-cell detection or BM involvement. Despite radiotherapy, he subsequently developed refractory CD19 positive ALL BM relapse. This case highlights the possibility of unusual relapse sites after CART-therapy and that regular peripheral B-cell monitoring is not enough to assure remission status. Better monitoring tools are needed to detect early disease relapse. Further understanding of the pathophysiology of isolated extramedullary relapse post-CART therapy is warranted to improve the management of such challenging presentations.
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http://dx.doi.org/10.1111/petr.13852DOI Listing
September 2020

Lack of transmission of SARS-CoV-2 by platelet transfusion from a COVID-19-positive donor in a hematopoietic stem cell transplantation patient.

Pediatr Blood Cancer 2021 02 19;68(2):e28658. Epub 2020 Aug 19.

College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.1002/pbc.28658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460955PMC
February 2021

Spectrum of medulloblastoma subtypes and frequency of MYC amplification; Experience from a tertiary care center in Saudi Arabia.

Neurosciences (Riyadh) 2020 Jul;25(3):218-221

Department of Pathology & Lab Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail:

Objective: To clarify the spectrum of morphological and molecular subtypes of medulloblastoma (MBL), in addition to MYC and MYCN amplification statuses in a cohort of Saudi patients. The latter was correlated with patient outcome.

Methods: We conducted a retrospective cohort study of 57 patients with MBL, diagnosed at the central laboratory of King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2006 and 2019. Molecular analysis for MYC and MYCN amplification was performed for the 19 most recently diagnosed patients.

Results: Classic MBL was the most prevalent histologic subtype and MBL with extensive nodularity was the rarest. The non-WNT/non-SHH molecular subgroup was the most common while the WNT-activated was the least common. Among 19 patients analyzed, MYC and MYCN amplifications were discovered in 2 (10.5%) and 1 (5.3%) cases, respectively, using interphase fluorescence in-situ hybridization. The 2 MYC amplified cases belonged to the large cell/anaplastic subtype and had the worst outcomes.

Conclusion: The MYC amplification corresponded with poor prognosis, the large cell/anaplastic variant of MBL, and the non-WNT/non-SHH molecular subtype.
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http://dx.doi.org/10.17712/nsj.2020.3.20190124DOI Listing
July 2020

Impact of Covid19 on a tertiary care pediatric oncology and stem cell transplant unit in Riyadh, Saudi Arabia.

Pediatr Blood Cancer 2020 09 12;67(9):e28560. Epub 2020 Jul 12.

Department of Pediatric Hematology & Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.1002/pbc.28560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404607PMC
September 2020

Incidence trends of childhood acute lymphoblastic leukemia in Saudi Arabia: Increasing incidence or competing risks?

Cancer Epidemiol 2020 08 16;67:101764. Epub 2020 Jun 16.

Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Introduction: The incidence of childhood acute lymphoblastic leukemia (cALL) varies between countries likely as a result of competing risks including infections, access-to-care, socioeconomic influences, and/or ethnicity. However, little is known about disease burden in high-income Arab countries offering free-of-charge healthcare. The hypothesis was that, due to population characteristics (young age, high fertility and parental consanguinity rate), the incidence of cALL in Saudi Arabia is equal or higher than that observed in high-income Western countries.

Methods: Saudi databases were used to calculate the incidence of cALL from 2001 to 2014. Incidence trends over time of children with ALL, 14-years of age or younger, were analyzed and compared with those reported in USA.

Results: The age-adjusted incidence over the years was lower in Saudi Arabia compared to USA. However, the incidence trend of cALL in Saudi Arabia was increasing at a rate higher than that observed in USA (p < 0.001). The overall incidence of cALL in Saudi Arabia increased from 1.58/100,000 in 2001 to 2.35/100,000 population in 2014. The median annual increase was 4.58 %. The incidence in males increased from 1.88 to 2.71/100,000, and from 1.21 to 1.86/100,000 population in females.

Conclusions: The reported incidence of cALL in Saudi Arabia is rapidly increasing. The increasing trend may reflect evolving socioeconomic structure, improved access-to-cancer care, and improved diagnosis/ reporting capacity. This highlights the need for better understanding of cALL causes and the need for the formation of separate national pediatric cancer registries in different countries to monitor childhood cancer incidence trends.
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http://dx.doi.org/10.1016/j.canep.2020.101764DOI Listing
August 2020

Frequency of Management of Cardiogenic Shock With Mechanical Circulatory Support Devices According to Race.

Am J Cardiol 2020 06 6;125(12):1782-1787. Epub 2020 Apr 6.

Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.

Mechanical circulatory support (MCS) has influenced the management of cardiogenic shock (CS), but the association between race and MCS utilization is unknown. We sought to evaluate the effect of race on MCS utilization in CS and whether there are racial differences in in-hospital outcomes. Our study was a population-based retrospective cohort study that enrolled patients with CS, defined by International classification of disease, ninth Revision, clinical modification (ICD-9-CM) codes, between 2013 and 2015 from the National Inpatient Sample. Race was adjudicated by National Inpatient Sample and included White, Black, Hispanic, Asian, and Native American. The primary outcomes were the utilization of MCS devices in CS with and without acute myocardial infarction (AMI), and in-hospital mortality by race. The statistical adjustment was performed for clinical co-morbidities as well as in-hospital events using multivariate logistic regressions. Among 332,885 patients with CS, there were 71% white and 14% black patients, and AMI was present in 42% and MCS was utilized in 23% of patients. There was less utilization of MCS only in Black patients with CS, and with AMI after adjustment (odds ratio [OR] 0.84, 95% confidence interval [CI][0.79 to 0.89] and OR 0.85, 95% CI 0.78 to 0.92, respectively). In addition, only Black patients had greater in-hospital mortality in AMI after adjustment (OR 1.16, 95% CI [1.06 to 1.27]) whereas there was no statistically significant increase in in-hospital mortality in any other race. In conclusion, these results suggest that there is less utilization of MCS devices and, in parallel, increased odds of in-hospital mortality in Black patients in comparison to other races. Further steps may be needed to address possible implicit bias in acute clinical scenarios as new devices emerge, which carries new opportunities to improve clinical outcomes but there is a lack of clear guidelines.
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http://dx.doi.org/10.1016/j.amjcard.2020.03.025DOI Listing
June 2020

injection corticosterone method for physiological and behavioral studies in chickens.

MethodsX 2020 11;7:100908. Epub 2020 May 11.

Department of One Health, Medical and Cancer Research Institute, Nyala, South Darfur State, Sudan.

The phenotype of organisms is not only influenced by genetic factors, but also by environmental factors that play a critical role in shaping their morphology, physiology, behavior and reproductive capacity. In avian species, maternal influences have aroused much attention after the discovery that avian eggs contain a variety of maternal derived steroid hormones. Precocial birds offer a useful animal model so as to solve the mother-offspring interference problem. By removing the maternal effect, scientists can evaluate the effect of glucocorticoid exposure during the embryonic development and its effects on later of phenotypic traits. However, the study of bird's aggressive behaviors using in ovo injection of hormone has not been reported. We used in ovo injection of corticosterone to study aggressive and fearfulness behaviors in chicken in their life later.•Fertilized chicken egg consider as pregnant mother•In ovo injection of corticosterone by pass mother-offspring interference problem•The method allow scientist to evaluate the influences of stress hormone on embryonic development and its later life consequences.
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http://dx.doi.org/10.1016/j.mex.2020.100908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243187PMC
May 2020

Frequency of pathogenic/likely pathogenic germline variants in cancer-related genes among children with acute leukemia in Saudi Arabia.

Pediatr Blood Cancer 2020 07 2;67(7):e28340. Epub 2020 May 2.

Department of Oncology, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Background: The frequency of pathogenic/likely pathogenic (P/LP) germline mutations in cancer-related genes among children with cancer in highly consanguineous populations is not well studied.

Methods: Whole-exome sequencing of germline DNA was performed in 60 children with acute leukemia. We used the St. Jude Pediatric Cancer Variant Pathogenicity Information Exchange (PeCanPIE) data portal for the classification of germline variants by the St. Jude Medal Ceremony pipeline.

Results: Fifty-seven patients had acute lymphoblastic leukemia (ALL) and three patients had acute myeloid leukemia. Parental consanguinity was present in 27 (45%) patients. All patients were of Arab ancestry. Three patients (5%) had a history of cancer in their siblings. Five patients (8.3%) had P/LP germline mutations in cancer-related genes. Three patients with B-ALL had heterozygous pathogenic mutations in TP53, BRCA1, and BRCA2; one patient with B-ALL had homozygous pathogenic mutation in PMS2; and one patient with T-ALL had LP homozygous mutation in AK2 that was associated with reticular dysgenesis. Among patients who had history of parental consanguinity, three (11%) had P/LP germline mutations compared with two (8%) in the absence of parental consanguinity. Fourteen (23%) patients had gold medal variants in cancer-related genes, 13 were heterozygous, and one was homozygous. Silver medal variants were present in 35 (58%) patients; all were heterozygous except one homozygous.

Conclusions: Children with acute leukemia in Saudi Arabia had low frequency of P/LP mutations in cancer-related genes despite the high rate of consanguinity. Larger studies using whole-genome sequencing are needed to further explore the heritability of childhood leukemia.
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http://dx.doi.org/10.1002/pbc.28340DOI Listing
July 2020

Population pharmacokinetics of busulfan in Saudi pediatric patients undergoing hematopoietic stem cell transplantation.

Int J Clin Pharm 2020 Apr 5;42(2):703-712. Epub 2020 Mar 5.

Pharmaceutical Analysis Section, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

Background Busulfan is an antineoplastic drug that is used widely as part of a conditioning regimen in pediatric patients undergoing hematopoietic stem cell transplantation. It has a narrow therapeutic index and highly variable pharmacokinetics; therefore therapeutic drug monitoring is recommended to optimize busulfan dosing. Objective To study the population pharmacokinetics of busulfan in Saudi pediatric patients to optimize its dosing. Settings King Abdullah Specialist Children's Hospital in Riyadh, Saudi Arabia. Methods This pharmacokinetic observational study was conducted between January 2016 and December 2018. All pediatric patients receiving IV busulfan and undergoing routine therapeutic drug monitoring were included. Population pharmacokinetics modeling was conducted using Monolix2019R1. Pharmacokinetic data of busulfan in children. Results The study included 59 patients and 513 samples. The mean ± SD age was 6.10 ± 3.17 years, and the dose administered was 0.994 ± 0.15 mg/kg. The mean ± SD Cmax and area under the curve (AUC) were 900.60 ± 402.8 ng/mL and 1031.14 ± 300.75 µM min, respectively. Based on our simulations, the European Medicines Agency recommended dose were adequate for most patient's groups to achieve the conventional target of an AUC of 900-1350 µM min. For patients in the lower weight group < 9 kg, higher doses were need at 1.2 mg/kg. With regards to the newly proposed target of AUC 78-101 mg h/mL, all of the doses we tested had low probability of achieving it. Conclusions Most of our patients had less than a proportional increase in busulfan concentration suggesting autoinduction. The high interindividual variability and autoinduction make dose adjustments challenging and AUC at steady state difficult to predict from the first dose. One approach to improve dose predictions is to use Bayesian dosing software. Based on our simulations, the European Medicines Agency recommended doses were adequate for most patient groups, except those in the lower (< 9 kg) and higher weight groups (> 34 kg).
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http://dx.doi.org/10.1007/s11096-020-00989-3DOI Listing
April 2020

Sewage Sludge ZnCl-Activated Carbon Intercalated MgFe-LDH Nanocomposites: Insight of the Sorption Mechanism of Improved Removal of Phenol from Water.

Int J Mol Sci 2020 Feb 25;21(5). Epub 2020 Feb 25.

Department of Civil Environmental Engineering, King Fahd University of Petroleum & Minerals, Dhahran 31261, Saudi Arabia.

: sludge-activated carbon; MgFe layered double hydroxide; nanocomposite materials; phenol aqueous uptake; mechanistic studies; reusability performance.
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http://dx.doi.org/10.3390/ijms21051563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084656PMC
February 2020

Successful hematopoietic stem cell transplant in leukocyte adhesion deficiency type III presenting primarily as malignant infantile osteopetrosis.

Clin Immunol 2020 04 21;213:108365. Epub 2020 Feb 21.

Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Leukocyte adhesion deficiency type III (LAD-III) is caused by mutations in FERMT3 that encodes Kindlin-3 which regulates integrins activation. LAD-III predisposes to infections and bleeding. Osteopetrosis was reported in some cases. We report three patients who presented as malignant infantile osteopetrosis. One had recurrent infections and none had bleeding. Exome sequencing revealed a novel homozygous mutation in FERMT3 c.1555C > T (p.Gln519Ter). Two patients underwent successful hematopoietic stem cell transplant (HSCT) from matched siblings with resolution of osteopetrosis. The third patient died secondary to sepsis prior to HSCT. Our results support early HSCT in LAD-III prior to the occurrence of life-threatening complications.
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http://dx.doi.org/10.1016/j.clim.2020.108365DOI Listing
April 2020

The feasibility of contrast echocardiography in the assessment of right ventricular size and function.

Echocardiography 2019 11 21;36(11):1979-1988. Epub 2019 Oct 21.

Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.

Background: Right ventricle (RV) evaluation requires dedicated imaging to achieve a comprehensive functional and anatomical assessment. Right ventricular imaging could be technically difficult which results in suboptimal visibility and inconsistent assessment between observers. The aim of this study was to assess feasibility and the additive value of contrast enhancement for right ventricular evaluation.

Methods: Eighty patients referred for clinically indicated echocardiography studies were included. Patients with irregular rhythms were excluded. Dedicated RV-focused view was attained; RV dimensions measured, and RV segment visualization and wall motion were assessed with and without contrast enhancement. Paired sample t test was used to compare continuous variables, Wilcoxon signed-rank test to compare segments visualization on enhanced versus (vs) nonenhanced images, and Cohen kappa coefficient to assess the agreement of wall motion between two observers. Reproducibility was measured by the absolute mean difference method.

Results: A total of 240 total segments of 80 patients were analyzed, and 178 (74%) were visible on unenhanced while 221 (92%) on enhanced images, P < .05. Further, RV measurements on enhanced images were consistently larger on RV focused, SAX, and RVOT. Inter- and intra-observer reproducibility showed a higher reproducibility with a lower bias on enhanced images. Absolute agreement on RV segmental wall motion between two independent observers was higher on enhanced images. Percent agreement was 78% on UE vs 89% on CE.

Conclusion: Contrast RV imaging is feasible and improves RV segment visualization and inter-observer agreement. Compared with unenhanced images, RV measurements on contrast images are larger and more reproducible with lower bias.
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http://dx.doi.org/10.1111/echo.14504DOI Listing
November 2019

Potential of epigenetic events in human thyroid cancer.

Cancer Genet 2019 11 23;239:13-21. Epub 2019 Aug 23.

Department of Cancer Research and Awareness, Medical and Cancer Research Institute, Nyala, Sudan.

Thyroid cancer remains the highest prevailing endocrine malignancy, and its incidence rate has progressively increased in the previous years. Above 95% of thyroid tumor are follicular cells types of carcinoma in which are considered invasive type of tumor. The pathogenesis and molecular mechanism of thyroid tumors are yet remains elucidated, in spite of activating RET, RAS and BRAF carcinogenesis have been well introduced. Nemours molecular alterations have been defined and have revealed promise for their diagnostic, prognostic and therapeutic capacity but still need further confirmation. Among different types of mechanisms, the current article reviews the importance of epigenetic modifications in thyroid cancer. Increasing data from previous reports demonstrate that acquired epigenetic abnormalities together with genetic changes plays an important role in alteration of gene expression patterns. Aberrant DNA methylation has been well known in the CpG regions and profile of microRNAs (mi-RNAs) expression also involved in cancer development. In addition, the gene expression through epigenetic control contribution to thyroid cancer is analyzed and it is semi considered in the clinic. However the epigenetic of the thyroid cancer is yet remains in its early stages, and it carries encouraging potential thyroid cancer detections in its early stages, assessment of prognosis and targeted cancer treatment.
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http://dx.doi.org/10.1016/j.cancergen.2019.08.006DOI Listing
November 2019

Practices, awareness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia.

Saudi Pharm J 2019 Feb 10;27(2):235-239. Epub 2018 Nov 10.

College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. BOX 3660, Riyadh 11426, Saudi Arabia.

Background: Self-medication is a common practice among health sciences students in Saudi Arabia. It is known that inappropriate selfmedication may harm individuals due to increasing the risk of drug misuse or delaying a hospital visit by masking some symptoms. Thus, the aim of our study is to investigate and assess practices, awareness and attitudes toward analgesics self-medication among health science students in Riyadh, Saudi Arabia.

Methods: This is a cross-sectional study in a form of electronic survey that was conducted among health sciences students from different universities in Riyadh, Saudi Arabia in 2016. Two hundred and seventy-two students responded to the questionnaire. The electronic questionnaire survey covered demographics, self-medication practice and the analgesics consumption, attitude and awareness about the safety of self-medication practice of analgesics.

Results: Factors associated with high prevalence of self-medication were not significant except for age (P = 0.04). Health sciences students had adequate knowledge about the safety of analgesics consumption itself and simultaneous use of analgesics with other drugs, significantly different by college; 80% for Pharmacy, 71% for Medicine, 61% for Nursing and Dentistry, and 25% for Applied Medical Sciences and pre-professional students (p = 0.037).

Conclusion: The occurrence of self-medication practices is distressingly high among health sciences students. It is necessary to educate the students about the side effects and drawbacks of irresponsible selfmedication.
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http://dx.doi.org/10.1016/j.jsps.2018.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362167PMC
February 2019

Pregnant women's use and attitude toward herbal, vitamin, and mineral supplements in an academic tertiary care center, Riyadh, Saudi Arabia.

Saudi Pharm J 2019 Jan 11;27(1):138-144. Epub 2018 Sep 11.

College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. BOX 3660, Riyadh 11426, Saudi Arabia.

Background: Herbal medicine has been widely utilized by pregnant women despite the limited available evidence regarding the safety and efficacy of that practice. The current available studies, from different countries, estimated that the use of herbal medicine during pregnancy range from 7% up to 96%. The aim of this study is to determine the prevalence, attitude, source of information, and reasoning behind the use of herbal medicine among pregnant women in Saudia Arabia.

Methods: A cross-sectional study conducted using a convenience sample including pregnant women who visited the obstetric clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A survey was administered in order to evaluate the prevalence and perception toward herbal medicine use among pregnant women in Saudi Arabia.

Results: A total of 297 pregnant women completed the survey. The results showed that 56% of the respondents have used some type of herbal medicine during their pregnancy. Olive oil was utilized in 26% of the respondents followed by cumin 20% and garlic 15%. In addition, 37% of the respondents used herbal medicine by their own initiative, while 33% and 12% used herbal medicine based on recommendations from their families and friends, respectively. Furthermore, 19% of the respondents reported a positive attitude toward herbal medicine use during pregnancy. In addition, the percentage of women with positive attitude was marginally higher among respondents with lower educational level.

Conclusion: The prevalence of using herbal medicine is considerably high among pregnant women in Saudi Arabia. Unfortunately, the majority of the users relied on informal sources to use herbal medicine during pregnancy.
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http://dx.doi.org/10.1016/j.jsps.2018.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323193PMC
January 2019

Veno-occlusive disease after high-dose busulfan-melphalan in neuroblastoma.

Bone Marrow Transplant 2020 03 4;55(3):531-537. Epub 2018 Sep 4.

Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA.

Survival for high-risk neuroblastoma patients is still suboptimal. Although stem cell transplantation (SCT) is used, there is no consensus as to which conditioning regimen has the greatest efficacy and fewest toxicities. We assessed the incidence of and risk for hepatic veno-occlusive disease (VOD) for neuroblastoma patients who underwent autologous SCT with busulfan and melphalan (BuMel) at eight centers following Children's Oncology Group (COG)-based induction chemotherapy. Data regarding the patients, SCT characteristics, busulfan steady-state concentrations, incidence of VOD, and survival were evaluated. VOD was defined using the modified Seattle criteria. Possible factors associated with VOD (age, busulfan-pharmacokinetic parameters, history of hepatic dysfunction, and day of neutrophil engraftment) were evaluated. Seventy five patients were included and 23 children (31%) developed VOD at a median of 19 days after SCT (range 14-27 days). VOD was the cause of death in 4 patients (5%). In a multivariable analysis, young age (OR 1.7 (95% CI: 1.16-2.56; p = 0.012)) and early day of neutrophil engraftment (OR 1.4 (95% CI: 1.08-2.14; p = 0.041) were associated with the development of VOD. Initial or cumulative busulfan steady-state concentration were not associated with VOD. We found that despite the use of intravenous busulfan with adjusted serum levels, the incidence of VOD remains high in pediatric neuroblastoma patients.
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http://dx.doi.org/10.1038/s41409-018-0298-yDOI Listing
March 2020

Drug resistant tuberculosis in Saudi Arabia: an analysis of surveillance data 2014-2015.

Antimicrob Resist Infect Control 2018 22;7:12. Epub 2018 Jan 22.

4College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Background: There is limited data that investigates the national rates of drug-resistant tuberculosis (TB) in Saudi Arabia.This study aimed to estimate the rates of multi-drug-resistant tuberculosis (MDR-TB), rifampicin-resistant tuberculosis (RR-TB), and monoresistance (MR) in Saudi Arabia.

Methods: A retrospective cohort study was conducted on all TB cases reported to the National TB Control and Prevention Program (NTCPP) registry at the Saudi Ministry of Health between January 1, 2014 and December 31, 2015. A total of 2098 TB patients with positive TB cultures were included in the study. Subgroup analyses and multivariate binary logistic regression models were performed with IBM SPSS 23.0.

Results: Of the total TB cases, 4.4% (95% CI: 3.59%-5.40%) were found to have MDR-TB. The rates of MR were 3.8% (95% CI: 2.99%-4.67%) for ethambutol, 5.4% (95% CI: 4.50%-6.49%) for pyrazinamide, 10.2% (95% CI: 5.89%-11.52%) for isoniazid, 11% (95% CI: 9.70%-12.43%) for streptomycin, and 5.9% (95% CI: 4.90%-6.96%) for rifampicin. The high rates of MDR and RR-TB were found among the younger age group, female gender, and those who had a previous history of TB. We also discovered that renal failure tends to increase the risk of rifampicin resistance.

Conclusions: National TB data in Saudi Arabia shows that the rate of MDR-TB was similar to the global rate reported by the World Health Organization (WHO). It is a relatively high rate as compared to Western countries. The proportion of MDR/RR-TB patients tends to be higher in the younger age group, female gender, and in patients with a previous history of TB treatment. Effective strategies for prevention of all multi-drug-resistant TB cases are warranted.
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http://dx.doi.org/10.1186/s13756-018-0306-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778613PMC
June 2019

Augmenting granular activated carbon with natural clay for multicomponent sorption of heavy metals from aqueous solutions.

Water Sci Technol 2017 Oct;76(7-8):2213-2221

Civil Engineering Department, University of Hafr Al-Batin, Hafr Al-Batin 31991, Saudi Arabia.

Multicomponent adsorption of Cd, Cr, Cu, Pb and Zn onto date palm pits based granular activated carbon (GAC) augmented with highly active natural clay at different proportion was investigated. The effects of the initial pH and the adsorbents mixed ratio on the removal selectivity sequence of the metals evaluated. Batch adsorption experiments were undertaken at initial pH 2, 6 and 12. At initial pH 2, both the percent removal and the metals adsorptive capacity decreased with increasing GAC to clay ratio (from 0 to 1) with the percentage removal of Cd, Zn and Cr ions dropping from 68, 81, 100% to 43, 57 and 70%, respectively. At both pH 6 and 12, the percentage removals and adsorption capacities of all the heavy metal ions are higher than at pH 2. Selectivity sequences for pH 2, 6 and 12 followed the order Pb > Cr > Cu > Zn > Cd; Pb > Cr > Cu > Cd > Zn and Cd > Cr > Cu > Pb > Zn, respectively. The adsorption trends were analyzed in relation to point of zero charge and ξ-potential and the metals ions speciation at different pH. These results will help better understand the feasibility of augmenting GAC with natural clay minerals during fixed bed column test which is more beneficial for practical industrial applications.
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http://dx.doi.org/10.2166/wst.2017.395DOI Listing
October 2017

A novel LC-MS/MS method for the quantitative measurement of the acetate content in pharmaceutical peptides.

J Pharm Biomed Anal 2017 Nov 6;146:354-360. Epub 2017 Sep 6.

Department of Pharmaceutical Sciences, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdulaziz Medical City, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia.

Most pharmaceutical peptides are supplied as acetate salts and the relative amount of acetate to peptide in the final product is one quality criterion required by regulatory agencies to approve the product for clinical use. The objective of the present study was to develop a validated LC-MS/MS method that allows the quantitative determination of the acetate content in pharmaceutical peptide preparations and simultaneous monitoring and collection of qualitative and quantitative information on the peptide during manufacture and in the final product. The method uses reversed phase C-chromatography to elute the acetate ions under acidic conditions, pH 3, followed by post-column infusion of ammonium hydroxide 0.6M, methanolic solution (30:70) at a rate of 0.5mL/hr. The acetate ions were monitored in negative polarity mass spectrometry by pseudo multiple reaction monitoring (pseudo MRM) against 1, 2- C labelled acetate, the internal standard used in the method. The method was linear for acetate concentrations between 0.4 and 25μg/mL with a coefficient of determination (r) equal to 0.9999. The minimum level of detection and minimum level of quantification were at 0.06μg/mL and 0.18μg/mL respectively. Accuracy of the method was judged by determining the acetate content in a commercial product of the peptide pharmaceutical tetracosactide (TCS) and parallel comparison to the amounts determined by a reversed phase HPLC method with detection at a wavelength of 210nm. The amounts determined by the two methods were in agreement with a RSD that was less than 2%. Additional confirmation of method accuracy was determined by spiking the pharmaceutical peptide with varying amounts of acetate. The recoveries ranged on average between 101 and 102% for the spiked amounts. Accuracy was also determined by calculating the percentage relative error of the predicted to actual acetate concentration in quality controls and was determined to be less than 5%. The LC-MS/MS method was precise with an intra- and inter-day RSD of less than 5%. The standard solutions were stable for at least one month when kept frozen at -80°C with no loss in response and an inter-day RSD of less than 5%. The method was applied to quantify the acetate content in the clinically available product of TCS and to simultaneously evaluate the average peptide molecular weight and detect known impurities by switching from negative polarity MRM analysis to positive polarity MS analysis following the elution of the acetate peak. The method reported herein should corroborate quantitative determinations of the acetate content in pharmaceuticals by the traditional compendial HPLC method.
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http://dx.doi.org/10.1016/j.jpba.2017.08.043DOI Listing
November 2017

Clinical characteristics and genetic subtypes of Fanconi anemia in Saudi patients.

Cancer Genet 2016 Apr 15;209(4):171-6. Epub 2016 Feb 15.

Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia; Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address:

We reviewed our institutional experience from 2011 to 2015 on new cases of Fanconi anemia (FA). Ten unrelated cases were diagnosed during this period. Four patients with severe aplastic anemia (SAA) had c.2392C > T (p.Arg798*) BRIP1/FANCJ mutation. Another child with SAA had novel c.1475T > C (p.Leu492Pro) FANCC mutation. One individual with SAA and acute myeloid leukemia had c.637_643del (p.Tyr213Lysfs*6) FANCG mutation. Three patients presented with early onset of cancer, two had BRCA2 mutation c.7007G > A (p.Arg2336His) and one had a novel c.3425del (p.Leu1142Tyrfs*21) PALB2 mutation. Another infant with c.3425del PALB2 mutation had clonal aberration with partial trisomy of the long arm of chromosome 17. Mutations in FA downstream pathway genes are more frequent in our series than expected. Our preliminary observation will be confirmed in a large multi-institutional study.
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http://dx.doi.org/10.1016/j.cancergen.2016.02.003DOI Listing
April 2016

Management of Adolescent Low-Risk Classical Hodgkin Lymphoma: Which Chemotherapy Backbone Gives the Best Chance of Omitting Radiotherapy Safely.

J Adolesc Young Adult Oncol 2016 Mar 9;5(1):2-7. Epub 2015 Oct 9.

3 Department of Pediatric Hematology/Oncology, King Saud bin Abdulaziz University for Health Sciences , King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia .

Even though more than 90% of adolescents with low-risk classical Hodgkin lymphoma (LRcHL) will be cured with first-line therapy, many will suffer serious late toxic effects from radiotherapy (RT). The goals for care have shifted toward minimizing late toxic effects without compromising the outstanding cure rates by adapting a risk and response-based therapy. Recent published and ongoing randomized clinical trials, using functional imaging, may allow for better identification of those patients for whom RT may be safely omitted while maintaining excellent cure rates. To evaluate the best chemotherapy regimens with a reasonable toxicity profile and that are expected to have a high chance of omitting RT based on a response-directed therapy while maintaining high cure rates, a mini review was conducted of the recent clinical trials in pediatric and adult LRcHL. The UK RAPID trial chemotherapy backbone (3 × ABVD) followed by a response-based positron emission tomography scan offers up to a 75% chance of safely omitting RT without compromising the cure rate, which remained well above 90%.
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http://dx.doi.org/10.1089/jayao.2015.0038DOI Listing
March 2016

Microwave-assisted digestion followed by parallel electromembrane extraction for trace level perchlorate detection in biological samples.

J Chromatogr B Analyt Technol Biomed Life Sci 2016 Feb 12;1012-1013:1-7. Epub 2016 Jan 12.

Center for Environment & Water, King Fahd University of Petroleum and Minerals, Saudi Arabia.

A simple and parallel electromembrane extraction (pEME) method was developed and used to investigate trace perchlorate ion contamination in seafood. In this method, three different EME units were arranged simultaneously and connected parallel to a single DC power supply. In each unit, the ClO4(-) ions were electro-kinetically extracted from the microwave digested seafood homogenates into 100mM NaOH via a supported liquid membrane (1-Hexanol). Influential extraction parameters were carefully investigated. Under optimized conditions, good linearity with a coefficient of determination (R(2)) of 0.9949 over a concentration range of 1-125μg/g was obtained. The limit of detection (LOD) was 0.04μgg(-1). The methods intraday and inter day precision varied between 4.3-5.6% respectively. Mean recoveries were up to 107% (n=6, RSD=0.7-6.8%). This method was applied to different seafood samples to assess its feasibility for real applications and it exhibited an enhanced sample throughput compatible with both microwave and ion chromatography.
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http://dx.doi.org/10.1016/j.jchromb.2016.01.014DOI Listing
February 2016

Significant Transplantation-Related Mortality from Respiratory Virus Infections within the First One Hundred Days in Children after Hematopoietic Stem Cell Transplantation.

Biol Blood Marrow Transplant 2015 Oct 25;21(10):1802-7. Epub 2015 Jun 25.

Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.

Respiratory viral infections (RVI) are important in hematopoietic stem cell transplantations (HSCT) and knowledge regarding incidence, morbidity, mortality, and long-term pulmonary complications is limited. We report a study to evaluate incidence and outcomes, both short and long-term, of RVI in children receiving HSCT. Between January 2000 and December 2012, 844 patients underwent hematopoietic stem cell transplantation (HSCT) at the Hospital for Sick Children: 491 were allogeneic and 353 were autologous. When screening for causes of death in the first year after HSCT in the 844 patients, we found that RVI as a cause of death was only evident in the first 100 days after HSCT. Fifty-four (6.5%) patients were found to have an RVI within the first 100 days after HSCT (allogeneic = 32, autologous = 22). Upper and lower respiratory tract infections were documented in 31 (57%) and 23 (43%) patients, respectively. Viruses were parainfluenza (35%), respiratory syncytial virus (28%), influenza (22%), adenovirus (7%), human metapneumovirus (4%), coronavirus (2%), and rhinovirus (2%). Three patients relapsed with their primary disease before day 100 and were excluded. The overall mortality for the remaining 51 patients was 10% (allogeneic = 4, autologous = 1). All 5 deaths were directly attributable to RVI and all 5 deaths occurred in patients with a lower respiratory tract infection. The remaining patients were followed for a median of 4.3 years (range, 1.4 to 11.8) and no chronic pulmonary complications were observed. A clear seasonal pattern for contracting RVI was evident with 65% of total RVI occurring between October and March (35 of 427 versus 19 of 417, P = .03). Given the significant mortality from RVI and the challenges in preventing them, choosing the time to start HSCT, whenever possible, may help prevent RVI and improve outcomes.
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http://dx.doi.org/10.1016/j.bbmt.2015.06.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110880PMC
October 2015

Geochemical modeling of trivalent chromium migration in saline-sodic soil during Lasagna process: impact on soil physicochemical properties.

ScientificWorldJournal 2014 24;2014:272794. Epub 2014 Jul 24.

Department of Environmental Engineering, University of Dammam, Dammam, Saudi Arabia.

Trivalent Cr is one of the heavy metals that are difficult to be removed from soil using electrokinetic study because of its geochemical properties. High buffering capacity soil is expected to reduce the mobility of the trivalent Cr and subsequently reduce the remedial efficiency thereby complicating the remediation process. In this study, geochemical modeling and migration of trivalent Cr in saline-sodic soil (high buffering capacity and alkaline) during integrated electrokinetics-adsorption remediation, called the Lasagna process, were investigated. The remedial efficiency of trivalent Cr in addition to the impacts of the Lasagna process on the physicochemical properties of the soil was studied. Box-Behnken design was used to study the interaction effects of voltage gradient, initial contaminant concentration, and polarity reversal rate on the soil pH, electroosmotic volume, soil electrical conductivity, current, and remedial efficiency of trivalent Cr in saline-sodic soil that was artificially spiked with Cr, Cu, Cd, Pb, Hg, phenol, and kerosene. Overall desirability of 0.715 was attained at the following optimal conditions: voltage gradient 0.36 V/cm; polarity reversal rate 17.63 hr; soil pH 10.0. Under these conditions, the expected trivalent Cr remedial efficiency is 64.75%.
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http://dx.doi.org/10.1155/2014/272794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131513PMC
March 2015

Integrated electrokinetics-adsorption remediation of saline-sodic soils: effects of voltage gradient and contaminant concentration on soil electrical conductivity.

ScientificWorldJournal 2013 29;2013:618495. Epub 2013 Dec 29.

Department of Civil and Environmental Engineering, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia.

In this study, an integrated in situ remediation technique which couples electrokinetics with adsorption, using locally produced granular activated carbon from date palm pits in the treatment zones that are installed directly to bracket the contaminated soils at bench-scale, is investigated. Natural saline-sodic clay soil, spiked with contaminant mixture (kerosene, phenol, Cr, Cd, Cu, Zn, Pb, and Hg), was used in this study to investigate the effects of voltage gradient, initial contaminant concentration, and polarity reversal rate on the soil electrical conductivity. Box-Behnken Design (BBD) was used for the experimental design and response surface methodology (RSM) was employed to model, optimize, and interpret the results obtained using Design-Expert version 8 platform. The total number of experiments conducted was 15 with voltage gradient, polarity reversal rate, and initial contaminant concentration as variables. The main target response discussed in this paper is the soil electrical conductivity due to its importance in electrokinetic remediation process. Responses obtained were fitted to quadratic models whose R (2) ranges from 84.66% to 99.19% with insignificant lack of fit in each case. Among the investigated factors, voltage gradient and initial contaminant concentration were found to be the most significant influential factors.
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http://dx.doi.org/10.1155/2013/618495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891438PMC
June 2014