Wean early leave early: Apt strategy for weaning from non-invasive ventilation.

BACKGROUND: Weaning protocols from Non-invasive ventilation (NIV) are scant. We set out to study a protocol that was different from the British Thoracic Society protocol and lay down a weaning protocol from NIV in patients with Acute acidotic hypercapnic respiratory failure (AAHRF). MATERIALS AND METHODS: Patients admitted with AAHRF and treated with NIV (baseline pH<7.35, PaCO2 >45 mmHg, and not requiring intubation) at a tertiary care teaching hospital, after taking into consideration the inclusion and the exclusion criteria were randomised in to one of the two group of weaning form NIV and serial ABGs were monitored. RESULTS: The primary outcome of the study shows that there was no significant differences in the success rates of weaning from NIV in both the arms. The secondary outcome shows a few factors such as age, gender, SAPS2 score having an effect on the determination of weaning failure. CONCLUSION: Our study showed that both weaning by duration reduction and pressure reduction had equal success rates but a point on noting the SAPS II score on admission and the age of a particular patient will help decide on weaning initiation.CTRI/2019/12/022560 [Registered on: 30/12/2019].

Association of Serum Pentraxin 3 and High-Sensitivity C-Reactive Protein with Severity of Coronary Stenosis.

Background: Atherosclerosis being the keystone in the pathology of coronary artery disease (CAD) is a chronic inflammation of arterial intima mediated by various inflammatory markers. Pentraxin 3 (PTX3) and high-sensitivity C-reactive protein (hs-CRP) are the two important biomarkers of chronic inflammation that causes atherosclerosis. Aims: This study aims to investigate the association of serum PTX3 and hs-CRP with the severity of coronary stenosis in patients undergoing coronary angiogram. Subjects and Methods: A total of 80 patients who underwent elective coronary angiogram were included. Their blood sample was collected for PTX3 and hs-CRP estimation prior to angiogram. Based on the angiogram, the participants were divided into four groups based on the number of arteries affected. PTX3 was estimated using enzyme-linked immunosorbent assay and hs-CRP was assayed using latex-enhanced immunosorbent assay. Statistical Analysis Used: Kruskal-Wallis test was used to find the association of PTX3 and hs-CRP in each group and Pearson's correlation was used to correlate PTX3 and hs-CRP with the extent of stenosis. Results: The mean PTX3 and hs-CRP levels in patients with some lesions in the coronary artery were 231.5 ± 129.9 pg/mL and 2.4 ± 0.4 mg/mL, respectively. The PTX3 levels elevate gradually with the severity of stenosis with P = 0.000 which is highly significant. A strong positive correlation was observed (R = 0.7929, P < 0.00001) with PTX3 and severity of stenosis. Whereas, for hs-CRP, the correlation was weaker (R = 0.3011, P = 0.006). Conclusions: PTX3 and hs-CRP can not only predict the number of arteries affected but also can differentiate between normal coronaries and CAD which can minimize the use of angiography.

Predictors of Unsatisfactory Conventional Pap Smears.

OBJECTIVE: The objective of this study is to determine the clinical predictors of unsatisfactory Pap smears. METHODOLOGY: This was a case-control study done in a tertiary care institute. All unsatisfactory conventional pap (CP) smears between January 2015 and June 2017 were retrieved, and the slides were viewed. Clinical details were recorded from request forms and case files. Simple and multiple logistic regression analyses were used to identify the predictors of unsatisfactory CP smears. RESULTS: In this study, we have included 314 unsatisfactory Pap smears and 541 controls with satisfactory Pap smears. Clinical parameters such as older age and cervical erosion proved to be important predictors of unsatisfactory pap smears. The most common reason for unsatisfactory pap smears was due to a paucity of epithelial elements (66.6%), followed by obscuration of smear details by blood/inflammatory cells/mucus (9.9%) and air drying artifacts (4.4%). There were multiple reasons in 19.1% of cases with unsatisfactory pap smears. CONCLUSION: Our study shows that older age groups and cervical erosion are predictors of unsatisfactory pap smears. Incidence of unsatisfactory pap smears can be reduced by education and retraining of health-care workers and doctors.

Cutaneous scar visibility after external dacryocystorhinostomy: A comparison of curvilinear and W shaped incision.

PURPOSE: The major drawback of an external dacryocystorhinostomy (ExDCR) is visible skin scar leading to poor patient satisfaction. In this study we have analyzed the skin scarring objectively after Curvilinear incision (CLI) and W shaped incision (WSI). METHODS: This is prospective trial done at Department of Ophthalmology at tertiary level hospital. All the patients with primary acquired nasolacrimal duct obstruction were included in the study. Patients were assigned to group A(CLI) or Group B (WSI). Cosmetic outcome was assessed by scar visibility at 1st, 3rd and 6th month postoperatively by two ophthalmologists separately, who were unaware of incision type. RESULTS: We studied 64 patients with median age 59.0 years (IQR [Interquartile range]: 50.0-66.8 years). Scar visibility was significantly (p = 0.001) more in WSI group at all follow-ups. None of the patients of CLI group showed visible scar at six months whereas ten patients (31.3%) of WSI group still had minimal scar (p < 0.001). Older patients had significantly less scar than younger patients. The time taken to perform ExDCR was significantly more with WSI (41.0 min, IQR: 40.0-44.0 min) than for CLI (33.0 min., IQR: 31.3-35.0 min); p < 0.05. Overall complication rates were similar in both the groups (p > 0.05) but extension of skin incision was more common in WSI group. CONCLUSIONS: We found that CLI is more aesthetic, simpler, requiring less operative time and less incision related complications when compared with WSI.

Comparison of Effect of Airway Nebulization with Lignocaine 2% versus Ropivacaine 0.25% on Intubation and Extubation Response in Patients Undergoing Surgery under General Anesthesia: A Randomized Double-Blind Clinical Trial.

CONTEXT: Both intubation and extubation are associated with pressor response. AIMS: We aimed to evaluate if ropivacaine 0.25% nebulization would prevent hemodynamic and cough responses to intubation and extubation and compared it with lignocaine 2% and saline group. SETTINGS AND DESIGN: This was a randomized double-blind clinical trial. MATERIALS AND METHODS: A total of 75 patients classified as the American Society of Anaesthesiologists physical status Classes I and II belonging to 18-60 years were included in the randomized double-blind trial and divided into three groups; Group 1: received 5 ml of normal saline, Group 2: received 5 ml of 0.25% ropivacaine, Group 3: received 5 ml of 2% lignocaine through nebulization before the induction. Patients were then administered general anesthesia. Mean arterial pressure (MAP), heart rate (HR), and saturation were recorded at baseline (T1), at intubation (T2), upon anesthetic withdrawal (T3), upon eye opening (T4), upon extubation (T5), and 2 min after extubation (T6). Cough response was recorded at emergence and extubation. STATISTICAL ANALYSIS USED: Repeated measures analysis of variance were used to compare hemodynamic variables and Chi-square test to compare the grades of cough between the two groups. RESULTS: The drug ropivacaine was found to be effective in reducing the hemodynamic responses to both intubation and extubation when compared to saline (P < 0.05). At extubation, though the mean values of HR and MAP were lower in ropivacaine compared to lignocaine group, the difference did not achieve statistical significance (P = 0.103 and 0.153 respectively). Only 40% of patients who received ropivacaine had cough at extubation (P < 0.001). CONCLUSION: Ropivacaine when used through nebulization preinduction effectively reduced both intubation and extubation responses when compared to saline. However, there was no significant difference between the ropivacaine and lignocaine on extubation response.

Lipid Accumulation Product Index as Visceral Obesity Indicator in Psoriasis: A Case-control Study.

BACKGROUND: Psoriasis has well-known associations with individual components of metabolic syndrome such as hypertension, dyslipidemia, insulin resistance, and obesity. Traditional anthropometric measurements of obesity such as waist circumference (WC) and body mass index (BMI) do not differentiate between subcutaneous fat and visceral fat, the latter being associated with cardiovascular risk factors. Lipid accumulation product (LAP) index is a measure of visceral fat and has been found to be a better predictor of cardiovascular risk. However, LAP index has not been well-studied in psoriasis patients. AIMS AND OBJECTIVES: Our objective was to find out if LAP index differs significantly between psoriasis patients and controls and whether LAP index shows a correlation with duration and severity of psoriasis. MATERIALS AND METHODS: A case-control study was undertaken with 40 chronic plaque psoriasis patients and 42 controls. BMI and LAP index were calculated for all the patients and controls. Psoriasis area severity index (PASI) was calculated for all the psoriasis patients. Mann-Whitney U-test was done for comparing the age, BMI, WC, serum triglyceride, and LAP index between the cases and controls and to compare the LAP index between mild psoriasis and moderate-to-severe psoriasis groups. Spearman's correlation coefficient was used to assess the correlation of LAP index with duration of psoriasis and with PASI. Logistic regression models were done to assess the risk factors in psoriasis. RESULTS: A statistically significant difference was observed between the LAP index of controls (23.79 ± 13.02) and that of psoriasis patients (46.42 ± 27.2). LAP index was significantly higher in the moderate-to-severe psoriasis group as compared to the mild psoriasis group. LAP index was a significant risk factor associated with psoriasis (OR = 1.07; 95% CI: 1.03 - 1.11). CONCLUSION: Calculation of LAP index in psoriasis patients helps in identification of more individuals at high risk of cardiovascular morbidity than traditional anthropometric measurements of obesity.

Comparison of Lipid Accumulation Product Index with Body Mass Index and Waist Circumference as a Predictor of Metabolic Syndrome in Indian Population.

BACKGROUND: Metabolic syndrome (MetS), which confers a high risk for cardiovascular diseases, needs early diagnosis and treatment to reduce morbidity and mortality. Lipid accumulation product index has been reported to be an inexpensive marker of visceral fat and metabolic syndrome. This study aimed to evaluate lipid accumulation product index as a marker for metabolic syndrome in the Indian population where the prevalence of the condition is steadily increasing. METHODS: A hospital-based, case-control study was conducted with 72 diagnosed cases of metabolic syndrome and 79 control subjects. In all the participants, body mass index (BMI) and lipid accumulation product index were calculated. The difference between cases and controls in BMI, waist circumference (WC), and lipid accumulation product index was assessed by Mann-Whitney U test/unpaired t-test. Associations of BMI, WC, and lipid accumulation product index with metabolic syndrome were compared by multiple logistic regression analysis and receiver operating characteristic analysis. RESULTS: BMI, WC, and lipid accumulation product index were significantly higher in metabolic syndrome (P < 0.05). Although all were independently associated with metabolic syndrome, lipid accumulation product index had the highest prediction accuracy. The parameter also had a high area under curve of 0.901 (95% confidence interval 0.85-0.95) and a high sensitivity (76.4%), specificity (91.1%), positive predictive value (88.7%), and negative predictive value (80.9%) for detection of metabolic syndrome. CONCLUSION: In the Indian population, lipid accumulation product index is a better predictor of metabolic syndrome compared to BMI and WC and should be incorporated in laboratory reports as early, accurate, and inexpensive indicator of metabolic syndrome.

Multidrug-resistant Enterobacteriaceae colonising the gut of adult rural population in South India.

BACKGROUND: Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics. AIM: Detection of multidrug resistance genes of extended spectrum ß-lactamase (ESBL-CTX-M), AmpC ß-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo ß-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community. METHODOLOGY: Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blaCTX-M,blaCIT,blaKPC-1 and blaNDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively. RESULTS: Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively. CONCLUSIONS: Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.

Serum Uric Acid in Chronic Obstructive Pulmonary Disease: A Hospital Based Case Control Study.

INTRODUCTION: Airway inflammation and imbalance between oxidant/anti-oxidant mechanisms are postulated to play a major role in the pathogenesis and exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies on the role of serum Uric Acid (UA) in COPD subjects have been both confounding and inconclusive. AIM: To measure the serum UA levels among COPD subjects and to correlate with different stages of the disease. MATERIALS AND METHODS: The study included 39 stable COPD subjects (21 males, 18 females; 13 smokers, 26 nonsmokers; age group; 40 to 60 years) and compared with 46 control subjects from the general population. Serum UA levels were measured by enzymatic colorimetric assay in fully automated analyser (Cobas Integra 400+, Roche, Germany) using commercially available kits from Roche. This was further correlated with duration and severity of COPD {determined as per Global Initiative for Obstructive Lung Disease (GOLD) criteria}. RESULTS: The mean age of COPD and control subjects was 62.97±11.30 and 48.76±12.71 years, respectively (p<0.001). COPD cases had significantly higher level of UA compared to control subjects (4.85±1.67 vs. 2.32±0.93 mg/dl, respectively, p<0.001). Female subjects with COPD had higher levels of UA compared to their male counterparts (5.15±1.89 vs. 4.59±1.45 mg/dl, respectively, p=0.3). Similar insignificant (p=0.56) trend was also observed among control subjects. Hyperuricaemia correlated significantly (p< 0.05) with advance duration (≥ 10 years) of COPD; whereas, statistically insignificant trend was observed for GOLD stage 3/4 versus stage 1/2 disease. Nonsmokers were having higher uric acid level than smokers. Alcohol intake did not affect the level of uric acid in COPD cases (p=0.79). CONCLUSION: Serum uric acid is a simple, cost effective biochemical test which may be useful in risk stratification of subjects with newly diagnosed chronic obstructive pulmonary disease. Hyperuricaemia is associated with advance duration and stage of COPD.

Evaluation of Leptin as a Marker of Insulin Resistance in Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a leading cause of mortality and morbidity worldwide, whose incidence is rapidly increasing in India. T2DM is caused by varying degrees of insulin resistance (IR) and relative insulin deficiency. Leptin, an adipokine with the primary function of regulating energy balance, is found to mediate insulin secretion and sensitivity in peripheral tissues. Hence, we aimed to determine the role of leptin in the development of IR in newly diagnosed T2DM patients. AIM: This study aims to compare the leptin levels and homeostatic model assessment-IR (HOMA-IR) levels in the study population. MATERIAL AND METHODS: The study included a total of sixty patients newly diagnosed with T2DM. Their fasting blood samples were collected to estimate the glucose, insulin, and leptin levels. IR was calculated using HOMA-IR formula. Statistical analysis was done by Pearson's correlation, Spearman's correlation, and One-sample Wilcoxon Signed Rank test. RESULTS: Leptin and HOMA-IR levels were significantly high in T2DM patients (P < 0.001) when compared with reference values. Body mass index showed a significant positive correlations with insulin (r = 0.40, P < 0.01), HOMA-IR (r = 0.37, P < 0.01), and leptin levels (r = 0.90, P < 0.01). Leptin levels showed significant positive correlations with plasma insulin (r = 0.35, P < 0.01) and HOMA-IR levels (r = 0.31, P < 0.05). The correlation between leptin and HOMA-IR levels was more pronounced and significant among the obese T2DM subjects (r = 0.82, P = 0.01). CONCLUSION: Hyperleptinemia reflecting leptin resistance plays an important role in the development of IR in obeseT2DM patients, making leptin a possible biomarker for the same.

High atherogenic index of plasma in subclinical hypothyroidism: Implications in assessment of cardiovascular disease risk.

BACKGROUND: A controversy exists regarding the association between subclinical hypothyroidism (SH) and dyslipidemia. Moreover, studies on lipid ratios and atherogenic index of plasma (AIP) in SH are rare, particularly in the Indian scenario. AIM: This study aimed to investigate abnormalities in conventional lipid profile, lipid ratios, and AIP in SH and attempted to correlate thyroid stimulating hormone (TSH) and AIP in SH. MATERIALS AND METHODS: In this retrospective analysis of patient records of SH subjects and euthyroid subjects, age, free triiodothyronine, free thyroxine, TSH, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol, lipid ratios, and AIP were compared between the two groups. The correlation of TSH and AIP in SH was studied. Spearman's correlation, Mann-Whitney U-test and logistic regression analysis were performed. RESULTS: Triglyceride, triglyceride/HDL-C, and AIP were significantly higher in SH as compared to euthyroid group, but there was no correlation between TSH and AIP in SH. AIP emerged as the significant single factor associated with SH in multiple logistic regressions. CONCLUSION: The positive association of dyslipidemia and SH indicates a need for regular screening of these patients to enable early diagnosis and treatment of dyslipidemia. Even in patients who have a normal conventional lipid profile, lipid ratios, and AIP have to be calculated for better assessment of atherogenic risk.

Cutaneous Hyperpigmentation in Megaloblastic Anemia: a Five Year Retrospective Review.

BACKGROUND: Cutaneous hyperpigmentation is an often overlooked clinical sign in megaloblastic anemia (MA) which has been sporadically reported in the literature. METHODS: We describe the bone marrow (BM) changes and clinicolaboratory characteristics of 25 of 198 adult cases (>16 years) with cutaneous hyperpigmentation who underwent BM evaluation for cytopenia (s). RESULTS: Twenty-one of 25 cases (84%) had MA, while MA without hyperpigmentation occurred only in 12 of remainder 173 cases (P<0.001). Knuckle pad hyperpigmentation (KP) was noted in 16 (64%) cases; whereas 9 (36%) had diffuse brownish black discoloration (DP) of the palms and/or soles. Eighteen of 25 (72%) cases had pancytopenia (13 with KP) and 7 of 25 (28%) had bicytopenia (3 with KP). In addition, five cases (20%) presented with pyrexia. Of the 17 cases where data available, eleven were B12 deficient [<190 pg/ml; eight had severe deficiency (<100 pg/ml); ref.; 190-800pg/ml], while 4 had pure folate deficiency (< 4.0 ng/ml; ref.; 4-20ng/ml); and remainder 2 had combined B12 and folate deficiency. Compared to those with diffuse pigmentation; KP group had lower Hb (69.6 ± 24.2 vs. 86.3 ± 33.9 g/L), higher MCV (106.1 ±12.6 vs. 99.2 ± 7.6 fL), lower platelet count (50.9 ± 29.3 vs. 69.6 ± 36.5 × 10(9)/L), and lower median B12 [100.0 (30.0 - 822.0) vs. 316.0 (142.0 - 1617.3) pg/ml] (P>0.05). In six cases where follow-up data were available, there was a significant reversal of hyperpigmentation at 12 weeks following parenteral cobalamin therapy. In all five cases with pyrexia, fever subsided after 24 to 72 hours following administration of parenteral cobalamin therapy. CONCLUSION: Cutaneous hyperpigmentation and cytopenia (s) are strongly associated with megaloblastic anemia. Knuckle pad hyperpigmentation is much more frequent than diffuse pigmentation of the palms and/or soles in such patents. A nonsignificant trend towards a greater degree of MA was found in cases with pigmentation of the knuckles.

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated Mycobacterium tuberculosis (MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable. MATERIALS AND METHODS: Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975-March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (n = 44/63) was 5963 ng/mL (range 500-38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (n = 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03-7.56, P = 0.03], presence of comorbidities (HR 4.59, CI: 1.08-19.52, P = 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16-6.05, P = 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51-7.87, P = 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (P > 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66-3.22, P = 0.35) did not alter the outcome in these patients. CONCLUSION: HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.

A study of blood utilization in a tertiary care hospital in South India.

BACKGROUND: Monitoring blood utilization helps in effective management of blood stock to meet present and future demands in a hospital. Hence, we analyzed the age, gender and frequency distribution of each blood product used in different diseases conditions. MATERIALS AND METHODS: We included all blood products utilized from January 2008 to December 2012 in our tertiary care hospital in South India. The primary and secondary discharge diagnoses (International Classification of Diseases [ICD-10]) were matched with clinical information provided in the request forms. The most relevant indication requiring blood transfusion was selected for each recipient and grouped into broad diagnostic categories according to the headings of ICD-10. The utilization of stored whole blood, packed red blood cells (RBCs), fresh frozen plasma (FFP) and platelets was stratified according to age, gender and diagnosis. RESULTS: Our results indicated decline in usage of whole blood and an increase in use of FFP and platelets over the years. While packed RBCs were frequently used for treating injury and poisoning conditions, platelets and FFP were preferred for infectious and parasitic diseases. Various blood products were used less frequently in patients aged over 60 years and the overall usage of blood products was higher in males. CONCLUSION: The patterns of blood products utilization is in contrast to the Western nations, which may be due to difference in age structure among Indian population and higher prevalence of infectious diseases such as Dengue in our region. Nevertheless, this study highlights the importance of understanding the epidemiology of blood transfusion locally to improve usage of blood and blood products.

Consanguinity and occurrence of cleft lip/palate: a hospital-based registry study in Riyadh.

This paper focuses on the influence of consanguinity on the occurrence of orofacial clefts. All patients with orofacial clefts registered at King Faisal Specialist Hospital and Research Center, Riyadh since June 1999 until December 2009 were included in this study. Patients were classified in two distinct groups: cleft lip with or without cleft palate (CL ± P) and isolated cleft palate (CP). Chi-squared test was used to test independence of variables. Intracluster correlation coefficient was estimated to assess the degree of concordance between siblings. Among 1,171 total patients, CL ± P was found to be more common (64.0%). Males were more likely to be affected with CL ± P (M:F = 1.5:1) and females were more likely to be affected with CP (M:F = 0.9:1; P < 0.0001). About a third of patients had a family history of clefts; family history was more likely to be positive for patients with CL ± P than for patients with CP (33.6% vs. 22.0%; P < 0.0001). Consanguineous relationships were seen in 56.8% of our patients' parents. Family history was more likely to be positive for patients whose parents were consanguineous than those who were non-consanguineous (34.2% vs. 25.8%; P = 0.003), both for the CL ± P and CP groups. Recurrence among siblings did not differ between those born to consanguineous versus non-consanguineous parents. Recurrence of clefts in offspring was higher among parents affected by cleft compared to those who were not affected (51.4% vs. 11.4%; P < 0.0001), both for CL ± P and CP groups. Education about anticipated genetic consequences of consanguinity is important for populations with a high degree of consanguinity.

Knowledge, attitude, and behavior among Saudis toward cancer preventive practice.

OBJECTIVE: To examine self-reported knowledge, attitude, and preventive practices on cancer among Saudis. MATERIALS AND METHODS: Data was collected from Saudis aged 15 years or more, who attended one of the randomly selected 20 Primary Health Centers (PHC) or the four major private hospitals located in the Riyadh region, either as patients or their escorts. The association between the variables was evaluated by the Chi square test. RESULTS: The study population consisted of 618 males and 719 females. Among the female respondents 23.1% reported that they practiced breast self-examination (BSE); 14.2 and 8.1%, respectively, had clinical breast examination (CBE) and mammography. However, 10.0 and 16.1% of the females, aged 40 years and older, reported having had mammograms and CBE, respectively. The BSE performers were more educated, knew someone with cancer, and had heard of the cancer warning signal. Both educational level and 'heard of cancer warning signal' were significantly related to CBE. Cancer information was received from television / radio by 65.1% and from the physician by 29.4%. Even though 69.4% believed that cancer could be detected early, a vast majority (95.8%) felt early detection of cancer was extremely desirable and 55.1% said their participation was definite in any screening program. A majority of the respondents (92.6%) insisted on the need for physician recommendation to participate and 78.1% expected that any such program should be conducted in the existing hospitals / clinics. CONCLUSION: Culturally sensitive health education messages should be tailored to fulfill the knowledge gap among all population strata. Saudis will benefit from partnerships between public health educators and media to speed up the dissemination of cancer information.

Public knowledge on cancer and its determinants among Saudis in the Riyadh Region of Saudi Arabia.

BACKGROUND: Earlier studies on cancer knowledge/awareness from Saudi Arabia have been few and mostly limited to knowledge of and attitude towards breast cancer. The objectives of the present cross sectional study were to determine the levels of knowledge concerning cancer and to identify associated factors. METHODS: This study was carried out among 1,407 Saudis who were either patients or their escorts, attending selected hospitals in Riyadh region and aged 15 years or more. Required information was obtained by interview using a piloted Arabic questionnaire. Associations between different variables and respondents knowledge were evaluated by Chi square test. Multiple logistic regression analyses were performed to examine the potential impact of the variables. RESULTS: This study population consisted of 688 males and 719 females. Approximately two thirds of participants (67.6%) had never heard of any cancer warning signals, but 80.7% believed some cancers can be cured if detected early, 27.1% believed cancer means end of life and 74.2% believed cancer will appear overnight. The majority of the respondents (65.1%) received information about cancer from television/radio. Although 1,159 had high level knowledge (scored 50.0% and more), only 233 individuals scored 75.0% and more. Significant differences in the knowledge level across age groups, educational levels and marital status were observed. Females had higher level knowledge than males. Odds of having high level knowledge about cancer was 5.27 times higher among those who had undergone any of the tests (breast self examination, mammography, occult blood, Papanicolau smear) compared to those who had none of those tests (95% CI: 1.87-14.8). Those who had heard about any cancer warning signal were more knowledgeable (OR=1.55; 95% CI: 1.10-2.19) than those who hadn't. The other most important determinants of knowledge level included age, and attending a primary health care centre. CONCLUSIONS: Our results suggest that the knowledge of cancer is poor among the public and greater attempts should be made to increase public awareness.

Pattern of cleft lip and palate in hospital-based population in Saudi Arabia: retrospective study.

OBJECTIVE: To report the patterns of cleft lip and/or cleft palate in Saudi Arabia from data collected at a tertiary care hospital. DESIGN AND SETTING: King Faisal Specialist Hospital and Research Center, Riyadh. PATIENTS: All the cleft lip and/or cleft palate patients registered in the Cleft Lip/Palate and Craniofacial Anomalies Registry from June 1999 to December 2005. RESULTS: Retrospectively, 807 cases of cleft lip and/or palate were registered. There were 451 boys and 356 girls. Cleft lip and palate was more common (387) than isolated cleft palate (294) and isolated cleft lip (122). Boys predominated in cleft lip and palate and cleft lip; whereas, girls predominated in isolated cleft palate, with boy to girl ratios of 1.6:1, 1.2:1, and 0.9:1 for cleft lip and/or palate, isolated cleft lip, and isolated cleft palate, respectively. The Riyadh region had more cases (32.0%) than the Asir (15.6%) and Eastern (14.6%) regions. Parents of 439 individuals had consanguineous marriages. A positive family history of cleft was seen in 224 cases. Of 238 cases with associated anomalies, 91 had congenital heart disease. Of the children with isolated cleft palate, 40.5% had associated anomalies, whereas only 23.0% of the children with isolated cleft lip or cleft lip and palate had associated malformations. CONCLUSION: The pattern of cleft observed in this study does not differ significantly from those reported in the literature for Arab populations.

The incidence of lung cancer in the Gulf Cooperation Council countries.

BACKGROUND: Lung cancer is the most common cancer in the world, with an estimated number of 1.3 million new cases as of 2002. This is the first report from the countries that comprise the Gulf Cooperation Council (GCC). PATIENTS AND METHODS: All the primary lung cancer cases registered in the Gulf Center for Cancer Registration during 1998 to 2001 were used to calculate the age-standardized incidence rate (ASR) per 100,000 person-years by the direct standardization method. RESULTS: Overall, there were 1607 (1261 males, 346 females) primary lung cancer cases registered during this period with the male to female ratio of 3.6:1. The highest ASR was in Bahrain (34.3 for males, 12.1 for females) followed by Qatar (18.5 for males, 5.5 for females) and Kuwait (13.8 for males, 4.0 for females); the lowest rate was in Saudi Arabia (4.8 for males, 1.3 for females). The mean age at diagnosis for males ranged from 68.7 years in Bahrain to 59.2 years in Oman. For females it ranged from 68.2 years in Bahrain to 58.0 years in Oman. Squamous cell carcinoma in males (except in Qatar) and adenocarcinoma in females were the predominant histological type. CONCLUSIONS: Cancer of the lung is one of the common cancers among males in all the GCC countries and ranks second among Bahraini females. Adenocarcinomas were more common in women than men.