Effects of nomophobia on anxiety, stress and depression among Saudi medical students in Jeddah, Saudi Arabia.

OBJECTIVE: To assess the prevalence of depression, anxiety and stress in medical students, and to analyse effects of demographics and nomophobia on depression, anxiety and stress. METHOD: The descriptive cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, from April 1 to May 23, 2019, and comprised male and female medical students aged 19-25 years. Data was collected using a demographic information form, the 21-item depression, anxiety and stress scale and the 20-item nomophobia questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 230 students, 108(47%) were boys and 122 (53%) were girls. The overall mean age was 21.93±1.80 years. Anxiety, depression and stress was reported in 168 (74.6%), 158 (70.2%) and 127 (55.9%) of the students. Extremely severe anxiety, depression and stress were self-reported by 92 (40.9%), 38 (16.8%) and 16 (7.04%) students. There was a significant difference in the distribution of subjects within different levels of anxiety across gender (p<0.05). Higher anxiety and stress scores were observed in 78 (33.9%) students with severe nomophobia. Differences in the levels of anxiety and stress with regards to type of residence and nomophobia levels were significant (p<0.05). CONCLUSIONS: There was high prevalence of depression, anxiety and stress associated with gender, nomophobia levels and residence type.

Experiences of expatriate university teachers in a health science university in Saudi Arabia-A Qualitative study.

BACKGROUND AND OBJECTIVE: A large number of university teachers in Saudi Arabia comprise of expatriates. Their experiences are unique in context of the challenges and benefits of academic expatriation. The purpose of this study was to describe the experiences of expatriate university teachers in Saudi Arabia. METHODS: A qualitative descriptive design was used based on in-depth interviews with academic expatriates, recruited through snowball sampling in a Health Science University in Saudi Arabia. The study was conducted from 12 September 2019 to 20 October 2019 after IRB approval. Graneheimian inductive approach was used for content analysis of the data. Standard principles of trustworthiness were applied. RESULTS: Three major themes emerged as 'conscious venture', 'spirit at work' and 'coping strategies'. Each theme had 2-3 subthemes, populated by 14-23 statements. CONCLUSION: Expatriate faculty members described antecedents for their motivations at work. They shared their experiences regarding job adjustments, work environment and professional commitment.

Hepatoprotective effects of ethanolic extract of Boerhaavia diffusa against oxaliplatin induced hepatotoxicity in albino rats.

The hepatoprotective effects of Boerhaavia diffusa was studied against the hepatotoxicity induced by oxaliplatin. Male Wistar rats were divided in three groups.Group N* control group (0.9% normal saline), Group NP0 oxaliplatin treated group and Group NP2 were prophylactically treated with Boerhaavia diffusa and then with oxaliplatin in order to assess the protective effects of Boerhaavia diffusa against the toxicity of oxaliplatin. The levels of liver enzymes ALT, AST and γ-GT were significantly reduced in the group prophylactically treated with Boerhaavia diffusa (NP2) compared with the group treated with oxaliplatin (NP0). Boerhaavia diffusa was effective in reducing risk of hypercholestremia associated with oxaliplatin. Histopathological examination of rat liver revealed that prophylactically treated group with Boerhaavia diffusa was effective in reducing oxidative stress induced steatohepatitis by oxaliplatin.

Histopathological and biochemical assessment of liver damage in albino Wistar rats treated with cytotoxic platinum compounds in combination with 5-fluorouracil.

INTRODUCTION: Chemotherapy-induced hepatotoxicity in cancer patients often results in cessation of therapy and prevents completion of the treatment plan. The entire pathological description and comparison of hepatic damage induced by oxaliplatin or cisplatin in combination with 5-fluorouracil (5-FU) is not adequately reported. This study reports histopathological assessment of hepatotoxicity of a non-tumor bearing organ in rats treated with 5-FU, oxaliplatin and cisplatin (CDDP). MATERIAL AND METHODS: Changes in hepatic biochemical profile of 36 albino Wistar rats equally divided into different treatment groups with cisplatin, oxaliplatin, 5-FU, cisplatin plus 5-FU and oxaliplatin plus 5-FU were compared with a group of rats treated with normal saline (control group). At the end of treatments, hepatic tissues were taken for blinded histopathological assessment by light microscopy. RESULTS: Serum glutamate pyruvate transaminase and serum glutamic-oxaloacetic transaminase levels were disrupted in rats treated with 5-FU alone and in combination with cisplatin or oxaliplatin. Hepatocellular injuries, e.g. sinusoidal dilatation, venular fibrosis and centrilobular vein injury induced by oxaliplatin were intensified in treatment groups also receiving 5-FU, manifested as massive architectural distortion, periportal fibrosis, hepatic cord degeneration and cystic lesions with demarcated margins. Hepatocellular degenerative sequence and abnormally dilated central hepatic vein was shown in the cisplatin plus 5-FU treatment group with hemorrhage and blood filled sinusoids. CONCLUSIONS: Oxaliplatin-associated cystic lesions were intensified in rats treated with a combination of 5-FU and oxaliplatin.

Effect of diabetes on neurological adverse effects and chemotherapy induced peripheral neuropathy in advanced colorectal cancer patients treated with different FOLFOX regimens.

This retrospective study reports impact of diabetes on incidence rate of dose limiting symptoms of neurological toxicity and chemotherapy induced peripheral neuropathy (CIPN). Post-surgical colorectal cancer (CRC) patients with metastatic disease, treated with four different schedules of FOLFOX were included in this study. Neurological adverse effects were assessed by CTC v2.0. The incidence rate of adverse neurological symptoms in CRC patients, clinically diagnosed with diabetes (n=6) were compared with non-diabetic CRC patients (n=32). The results show that the difference in the incidence rate of paresthesia is significant (p=0.043) between diabetic and non-diabetic patients. The difference in the incidence rates of hypoesthesia (p=0.445), peripheral neuropathy (p=0.889), dizziness (p=0.445), insomnia (p=0.690), taste disturbances (p=0.258), and headache (p=0.498) in diabetic and non-diabetic CRC patients was not significant. The findings indicate that risk of frequent, distal and transient paresthesia within the first few minutes of Oxaliplatin infusion is higher in diabetic CRC patients.

Histopathological and biochemical assessment of kidney damage in albino wistar rats treated with cytotoxic platinum compounds in combination with 5-FU.

Kidney cells damage and subsequent renal adverse effects with oxaliplatin are less reported phenomena, whereas cisplatin (CDDP, first generation platinum compound) has therapeutic limitations due to renal toxicity. This experimental study reports oxaliplatin (third generation platinum compound) induced direct damage in rat kidney tissues and alterations in renal biochemical profile. Oxaliplatin was administered in albino wistar rats with 5-FU (5 Fluorouracil) to mimic as model of FOLFOX, the mainstay chemotherapeutic regimen in colorectal cancer (CRC). This study reports changes in renal biochemical profile (serum creatinine and urea) in rats treated in different treatment groups with cisplatin, oxaliplatin, 5-FU, cisplatin+5-FU and oxaliplatin+5-FU which are compared with group of rats treated with normal saline (control group). Subjective renal toxicity in tissues was compared among rats treated with oxaliplatin alone and cisplatin, with and without 5-FU by light microscopy. Cast formation, medial hypertrophy of the vessel wall, vacuolization and necrosis was seen in kidney tissues of oxaliplatin treated rat. Changes in serum creatinine well-above diagnostic risk levels were noted. Apparent tubular degenerative sequence associated with vacuolization and cast formation was observed in 5-FU treated rats. Kidney damage ensued after treatment with 5-FU and oxaliplatin are slightly comparable to massive tubular damages, hemorrhage, casts and vacuolization along with multiple foci of alterations induced by cisplatin.

Clinical Features of Oxaliplatin Induced Hypersensitivity Reactions and Therapeutic Approaches.

Oxaliplatin, a third generation novel platinum compound is the most effective first line chemotherapeutic agent for colorectal cancer (CRC) in combination with 5FU and leucovorin. It is indicated for pancreatic, gastric and testicular cancers combined with bevacuzimab, capecitabine, irinotecan and other cytotoxic agents. However, moderate to severe hypersensitivity reactions (HSR) during or after oxaliplatin infusion usually require cessation of chemotherapy or substitution of the key therapeutic drug which largely interferes with improved patient prognosis. This mini- review showcases recent and accepted opinions/approaches in oxaliplatin induced HSR management. Physicians and oncologists have varying attitudes regarding the decision to rechallenge the patient after an HSR experience, efficacy of desensitization protocols, effectiveness and selection of drugs for premedication and possibilities of cross sensitivity to other platinum agents (e.g. carboplatin). A brief insight into underlying molecular mechanisms and clinical manifestations of oxaliplatin induced HSR is offered. We have also discussed the management of oxaliplatin induced HSR and risk stratification for a successful and complete chemotherapeutic plan.

Report: Sensitivity pattern of ceftriaxone against different clinical isolates.

Emerging resistance against broad-spectrum antibiotics for standard empiric therapy is a global concern. Ceftriaxone (broad spectrum, third generation cephalosporin) is widely used in tertiary care settings to treat severe bacterial infections usually non-responsive to other antibiotics. The aim of the study is to evaluate the current sensitivity pattern of ceftriaxone (30µg/disk) among different clinical isolates. For this purpose, three hundred clinical isolates including Escherichia coli (25%), Staphylococcus aureus (30%), Salmonella typhi (17%) and Klebsiella pneumoniae(20%) were collected from different pathological laboratories of Karachi, Pakistan. The in-vitro sensitivity of different Gram positive and Gram-negative bacteria was determined by disk-diffusion technique using 0.5 McFarland standard. Results showed that ceftriaxone was highly sensitive against Escherichia coli (90%) and least sensitive against Klebsiella pneumoniae (65%). It is concluded that the sensitivity of ceftriaxone is progressively decreasing in comparison with past studies creating an alarming situation. Therefore, continuous surveillance is required to determine the current resistance status of clinical pathogens and for effective anti-microbial therapy.

ADVERSE DRUG REACTIONS: FACTORS AND ROLE OF PHARMACIST IN THEIR PREVENTION.

Adverse drug reactions (ADRs) are the undesirable effects of drugs even when administered in daily normal doses. It has been seen that ADRs may arise even after single administration of drug(s), however, long term therapies are more prone to ADRs. Currently it has become a burning issue all around the world and connected with financial expansion owing to hospitalization. Pharmacists are the custodians of drugs especially clinical pharmacists play a vital role in preventing the risks of ADRs. This review deals with the factors leading to possible ADRs, its prevention and the role of pharmacist in management of ADRs.

Gastrointestinal adverse effects in advanced colorectal carcinoma patients treated with different schedules of FOLFOX.

BACKGROUND: To assess the frequency and severity of gastrointestinal adverse effects in advanced colorectal carcinoma patients treated with four different schedules of FOLFOX. MATERIALS AND METHODS: Patients (median age 61 years) who underwent surgery were included in the study. All had measureable disease at CT scan, ultrasonography or clinical examination. Toxicity was graded on a scale of 1-5 according to the general grade definition of CTC v2.0. The severity of adverse effects (Grade 3 and 4) assessed in each treatment arm was compared. RESULTS: Differences between the incidence rates of 3 and 4 toxicity and all grades of toxicity for all parameters in GI toxicity were very highly significant (p<0.001). Severe gastrointestinal symptoms of toxicity were noted with FOLFOX7 (oxaliplatin 130 mg/m2). Grade 3 diarrhea was reported in 25% patients and grade 4 diarrhea in 4% in the FOLFOX7 treatment arm. Grade 2 vomiting was very frequently reported in the FOLFOX4 treatment arm (oxaliplatin 85mg/m2). Grade 2 stomatitis was reported in 42% patients treated with mFOLFOX6 (oxaliplatin 100mg/m2). Differences in the incidence rate of nausea, diarrhea and stomatitis among all treatment arms of FOLFOX were significant (p<0.05) . CONCLUSIONS: Severe diarrhea is associated with FOLFOX7 treatment. No grade 3 or 4 GI toxicity was reported in patients of the mFOLFOX6 arm.

Adverse effects on cardiovascular status and lipid levels of albino Wistar rats treated with cisplatin and oxaliplatin in combination with 5 Fluorouracil.

The study was designed to comparatively assess direct damages on cardiac tissues and aorta associated with abnormalities in lipid profile and cardiac biomarkers induced by two platinum cytotoxic compounds with and without 5FU (5Fluorouracil) in rats. Albino Wistar rats were treated with 5FU (15mg/kg), cisplatin (0.8mg/kg) and oxaliplatin (0.8mg/kg) in different dosing schedules. The changes in the lipid levels, CPK and Tropinin I levels, following treatment with single and combination schedules of CDDP, 5FU and Oxaliplatin were compared with the control group maintained on normal saline. Changes in LDL and cholesterol levels were highly significant in cisplatin and oxaliplatin treated rats. Myofibrillar loss and vascular wall thickening was seen in cisplatin treatment groups in the acute model of toxicity. The damages were mild but progressive. Tropinin I levels were raised well above diagnostic risk levels in the delayed model of toxicity in the rats treated with oxaliplatin in combination of 5FU, indicative of definite cardiotoxic potential of oxaliplatin in combination of 5FU mimicking the FOLFOX regimen.

Neurological Adverse Effects in Patients of Advanced Colorectal Carcinoma Treated with Different Schedules of FOLFOX.

The study is designed to assess the frequency and severity of few dose limiting neurological adverse effects of four different schedules of FOLFOX. Patients with histologically confirmed advanced colorectal carcinoma (CRC) were included in the study. Toxicity was graded according to CTC v 2.0. The frequency of grade 3 and 4 adverse effects was comparatively assessed in each treatment arm. The difference in the pattern of toxicity between the treatment schedule was evaluated. The most frequent adverse symptom of neurological adverse effect was grade 1 paresthesia in the patients treated with FOLFOX4 schedule. Grade 4 peripheral neuropathy was reported in few patients of FOLFOX7 treatment arm. Frequency and onset of neurological adverse effects like paresthesia, dizziness, and hypoesthesia were significantly different (P < 0.05), whereas frequency and onset of peripheral neuropathy were highly significant (P < 0.01) in each treatment arm of FOLFOX. Peripheral neuropathy was associated with electrolyte imbalance and diabetes in few patients. Frequency of symptoms, for example, paresthesia, is associated with increased number of recurrent exposure to oxaliplatin (increased number of cycles) even at low doses (85 mg/m(2)), whereas severity of symptoms, for example, peripheral neuropathy, is associated with higher dose (130 mg/m(2)) after few treatment cycles.

Comparative cardiac toxicity in two treatment schedules of 5-FU/LV for colorectal carcinoma.

The purpose of the study is evaluation and assessment of parameters of cardiac toxicity in patients subjected to 5-FU based chemotherapy. Cardiac morbidity is a reported outcome in different 5FU/LV regimens; however none of them are definite or proximate. The bimonthly regimen of high dose leucovorin is reported to be less toxic and more effective as compared to the monthly regimen of low dose leucovorin. We report the detailed assessment of few cardiac parameter of toxicity in patients of advanced colorectal carcinoma subjected to two Schedules of high and low dose Folinic Acid, 5-Fluorouracil, bolus and continuous infusion. The correlation of elevated cardiac biomarkers, angina and hypertension is comparatively assessed in patients with normal general status, hyperglycemia and known cardiac disorders subjected to two different 5FU based chemotherapeutic regimen.

Comparative assessment of skin and subcutaneous toxicity in patients of advanced colorectal carcinoma treated with different schedules of FOLFOX.

OBJECTIVE: The study was designed to assess the skin and subcutaneous toxicity in patients with advanced colorectal carcinoma treated with four different schedules of FOLFOX. METHODS: The patients with histologically confirmed advanced colorectal carcinoma (CRC) were included in the study as per specified inclusion criteria. Toxicity was graded according to CTC v2.0. The frequency of grade 3 and 4 adverse effects were comparatively assessed in each treatment arm. RESULTS: Very severe toxicity was attributed to the FOLFOX7 schedule. The difference between the incidence rate of grade 4 toxicity with all other grades for all parameters of skin and subcutaneous toxicity was highly significant (p=0.00<0.001). Grade 4 hand and foot syndrome was reported only in the FOLFOX7 treatment arm. The most frequent adverse symptom of skin and subcutaneous toxicity reported in the patients treated with modified schedule of FOLFOX was pruritus (grade 1). Frequency and onset of skin and subcutaneous toxic symptoms like alopecia (p=0.000), nail discoloration (p=0.021) and pruritis (p=0.000) was significantly different in each FOLFOX treatment arm. A few cases of oncholysis were also reported in the FOLFOX7 treatment arm. Hand and foot syndrome was fast progressing in patients with grade 1 toxicity. CONCLUSION: Higher frequency and severity of hand and foot syndrome and pruritus wasa found in the FOLFOX7 treatment arm. Skin and subcutaneous toxicity was comparatively low in the FOLFOX6 treatment arm.

High and low dose folinic acid, 5-fluorouracil bolus and continuous infusion for poor-prognosis patients with advanced colorectal carcinoma.

OBJECTIVE: Evaluation and assessment of response rate, duration and toxicity in patients subjected to 5-FU based chemotherapy. BACKGROUND: The therapeutic ratio shifts with different 5FU/LV regimens and none yet serve as the internationally accepted Gold Standard. A bimonthly regimen of high dose leucovorin is reported to be less toxic and more effective than monthly low dose regimens. We here compare therapeutic responses and survival benefit of the two regimens in poor prognosis patients with advanced colorectal carcinoma. PATIENTS AND METHODS: A total of 35 patients with histologically confirmed colorectal carcinoma were subjected to de Gramont and Mayo Clinic regimen. Nineteen patients were treated with high dose folinic acid (200 mg/m2), glucose 5%, 5-FU (400 mg/m2) and 22 hr. CIV (600 mg/m2) for two consecutive days every two weeks. These patients had failed responses to previous chemotherapy and were above sixty years of age with poor general status. Sixteen patients (six below 60 years) with progressive disease were subjected to low dose folinic acid (20 mg/m2)for five days, 5FU(425 mg/m2) injection bolus for 5 days, every five weeks. An initial evaluation was made in sixty days and responders were reevaluated at sixty days interval or earlier in case of clinical impairment. Based on positive prognosis, the therapy was continued. Evaluation of treatment response was made on the basis of WHO criteria. RESULTS: The response rate was 44% in thirty four evaluable patients, with 4 complete responses (11.8%) and 11 (32.4%) partial responses. The two schedules were well tolerated, whereas, mild toxicity without WHO Grade ≥ 2 events was assessed. The response duration was extended (12 months) in a few patients with age above sixty years treated by high dose bimonthly regimen of 5FU/LV. CONCLUSION: The regimens are safe and effective in advanced colorectal carcinoma patients with poor general status.