Circulating Long Non-Coding RNA GAS5: A Non-Invasive Molecular Marker for Prognosis, Response to Treatment and Survival in Non-Small Cell Lung Cancer.

Circulating long non-coding RNAs (lncRNA) are dysregulated in several diseases, especially cancers, e.g. non-small-cell lung cancer (NSCLC). Of specific notice in this regard is growth arrest-specific 5 gene (lncRNA GAS5), which is principally recognised as a tumor suppressor gene in numerous cancers. Functionally, GAS5 is involved in arresting cellular growth and induction of apoptosis. We analysed plasma GAS5 expression by qRT-PCR in 100 patients with NSCLC before and after tumour resection surgery. We reported a downregulation of GAS5 expression in NSCLC tissue and plasma, which showed elevation after surgery. Downregulation of GAS5 was associated with poor prognosis of NSCLC patients.

Locally Advanced Oral Cavity Cancers: What Is The Optimal Care?

Patients with oral cavity cancers often present late to seek medical care. Surgery is usually the preferred upfront treatment. However, surgical resection cannot be achieved in many cases with advanced disease without major impact on patient's quality of life. On the other hand, radiotherapy (RT) and chemotherapy (CT) have not been employed routinely to replace surgery as curative treatment or to facilitate surgery as neoadjuvant therapy. The optimal care of these patients is challenging when surgical treatment is not feasible. In this review, we aimed to summarize the best available evidence-based treatment approaches for patients with locally advanced oral cavity cancer. Surgery followed by RT with or without CT is the standard of care for locally advanced oral cavity squamous cell carcinoma. In the case of unresectable disease, induction CT prior to surgery or chemoradiotherapy (CRT) can be attempted with curative intent. For inoperable patients or when surgery is expected to result in poor functional outcome, patients may be candidates for possibly curative CRT or palliative RT with a focus on quality of life.

Transoral Endoscopic Coblation Tongue Base Surgery in Obstructive Sleep Apnea: Resection versus Ablation.

BACKGROUND: A new transoral tongue base surgical procedure for the treatment of snoring and obstructive sleep apnea (OSA) is described. It is named "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but it is performed by means of coblation technology in order to resect the tongue base in countries where TORS is not an available option for such benign conditions. METHODS: In this prospective, randomized, controlled trial, the new Robo-Cob technique was carried out in 25 adult OSA patients with confirmed tongue base hypertrophy at preoperative drug-induced sedation endoscopy. The results of this procedure were compared with the coblation endoscopic lingual lightening (CELL) technique used to ablate (or minimally resect) the central part of the tongue base, in another 25 adult OSA patients with similar characteristics (age, sex, preoperative body mass index and Apnea-Hypopnea Index, AHI). The base of tongue surgery was part of multilevel surgery including also septoturbinoplasty and barbed reposition pharyngoplasty (with/without tonsillectomy). RESULTS: In this study, the Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgical settings. No/minimal intraoperative or postoperative complications were observed. Postoperative pain as measured by visual analog scale ranged from 3 to 7. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by a level 3 polygraphy performed 6 months after surgery. There was significant difference in operative time at the level of the tongue base between Robo-Cob and CELL techniques, with shorter times observed within the Robo-Cob group. Moreover, the Robo-Cob technique provided tongue base tissue specimens that allowed measurement of the volume that ranged from 5 to 17 cm3 (mean 11.64 ± 3.49 cm3). It was found that resection of at least 10 cm3 of tongue base tissue was associated with better outcomes in terms of postoperative AHI reduction. CONCLUSION: In this study, the added values of using coblation for resection and not ablation appear to be the short surgical time, the low postoperative tissue edema, and the possibility of providing tissue specimens to measure resected volumes.

Referred otalgia in patients with thyroid cancer: Case series from Saudi Arabia.

INTRODUCTION AND IMPORTANCE: Referred Otalgia is very unlikely to be the first presentation of thyroid carcinoma, however, it is important to examine thyroid in cases of otalgia lacking any evidence of primary origin. CASE PRESENTATION: We report five cases of thyroid carcinoma, variant types, presented by secondary otalgia in Al-Baha region, KSA followed by proper surgery and patient relief during the last eight years. Patients' ages ranged from 25 to 65 years old. CLINICAL DISCUSSION: Thyroid inflammation, including acute and subacute thyroiditis, was reported as a possible cause of the pain referred to the ear and the angle of the mandible, however otalgia caused by thyroid cancer is an extremely rare presentation. CONCLUSION: Otolaryngologists should be aware that thyroid cancer may be associated with otalgia in any age group, however extremely rare. With very limited sources for this clinical entity, we recommend further studies on the different varieties of thyroid cancer presentations and the possibilities of the unexplained otalgia.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology (FNAC) in Thyroid Nodule Excision Cases.

INTRODUCTION: Fine needle aspiration cytology (FNAC) for thyroid nodules has a high diagnostic accuracy, according to several studies worldwide. Patients who experienced preoperative FNAC had more optimal surgical treatment than others who did not perform FNAC. Therefore, achieving an accurate FNAC procedure appears to be an important tool for the proper management of thyroid nodules. We aimed to study the accuracy and challenges of the thyroid FNAC diagnostic tool in the Al-Baha region, Kingdom of Saudi Arabia. METHODS: The study involves 52 patients with thyroid nodules who underwent preoperative FNAC and postoperative histopathology with the same surgery and pathology team at Al-Baha region in 2022-2023. RESULTS AND CONCLUSION: The mean age of the included patients was 47.7 years, with a female predominance. The diagnostic accuracy was 90%, and the main cause of inaccurate diagnosis was processing challenges, where the majority of cases were taken on the palpation-only technique, a few cases were ultrasound-guided, and the only technique used in the laboratory was conventional smears. The applied interrater reliability Cohen kappa coefficient (κ) for the clinical-histopathological agreement was "moderate agreement". We recommend using and evaluating more cytological techniques in addition to the currently used conventional smears in pathology laboratories to enhance the efficacy of the FNAC diagnosis of thyroid lesions.

Knowledge, Awareness, and Attitude Regarding Obstructive Sleep Apnea Among Primary Healthcare Physicians in the Al-Baha Region of Saudi Arabia.

INTRODUCTION: Obstructive sleep apnea (OSA) is a clinically significant disorder that requires attention from healthcare professionals. This study aimed to assess the knowledge, awareness, and attitude of primary healthcare physicians regarding OSA in Saudi Arabia. METHODOLOGY: A cross-sectional observational study design was employed from January 18, 2023, to August 18, 2023, focusing on primary healthcare physicians practicing in the Al-Baha region of Saudi Arabia. The survey included questions related to knowledge, awareness, and attitudes toward OSA, using the Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire for OSA, and demographic information. Descriptive statistics and chi-square tests were used to analyze the data. RESULTS: A total sample size of 174 primary health care physicians was collected, where the majority of participants were male (101, 58.0%), and the mean age of the participants was 32.73 years (SD = 9.14). The item with the most correct answers was "The majority of patients with obstructive sleep apnea snore" (150, 86.2%). On the other hand, the item with the lowest number of correct answers was "Laser-assisted uvulopalatoplasty is an appropriate treatment for severe obstructive sleep apnea" (17, 9.8%). The majority of participants agreed that it is essential for physicians to know about OSA as a clinical disorder (161, 92.5%). However, when it came to screening all patients for possible OSA, there was a higher proportion of participants who disagreed or strongly disagreed (111, 63.8%). In general, the majority of participants had a low level of knowledge (109, 62.6%). Gender was significantly associated with both knowledge (p = 0.021) and awareness (p = 0.039), as well as nationality (knowledge (p = 0.012) and awareness (p = 0.039)), and specialty training, which was significantly associated with both knowledge (p = 0.000) and awareness (p = 0.002). CONCLUSION: Although all participants acknowledged that OSA is a clinical disease, their perspectives on screening and levels of confidence in utilizing screening techniques varied. While the participants exhibited commendable understanding in the majority of domains, there were some facets of OSA in which they lacked expertise.

A Rare Case of Recurrent Carcinoma Ex Basal Cell Adenoma of the Parotid Gland.

Basal cell adenoma is encountered in the salivary glands, particularly the parotid gland; however, malignant transformation is rare, and recurrence is much rarer. We report the case of a 60-year-old man who had experienced a slow-growing mass in the parotid gland, which was suspected to be pleomorphic adenoma. Radiological and cytological examination suggested an atypical lesion in the left parotid. The final diagnosis reached on the excised specimen was that of a basal cell adenocarcinoma ex adenoma with close margins. The patient presented with a recurrence after two years. Routine histopathological examination with careful examination by the pathologist is essential for proper management of such rare malignant lesions, and recurrence is a possibility. A complete excision of the tumor with tumor-free margins from the beginning is suggested.

Assessment of the Current Knowledge and Practice of General Practitioners Towards Laryngopharyngeal Reflux in Saudi Arabia.

Background General practitioners (GPs) have a significant role in the diagnosis of patients with laryngopharyngeal reflux (LPR). Some published data revealed a lack of knowledge among GPs about the disease, consequently, this lack of knowledge impacted their performance. This survey aims to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia. Methodology This survey study was conducted to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia using an online questionnaire. The questionnaire was distributed and collected from the five regions in Saudi Arabia, which are The Central Region (Riyadh, Qassim), Eastern Region (Dammam, Al-Kharj, Al-Ahasa), Western Region (Makkah, Madinah, Jeddah), Southern Region (Asir, Najran, Jizan), and Northern Region (Tabuk, Jouf, Hail). Results In the current study, we collected data from 387 general practitioners, 61.8% of whom were aged between 21-30 years old, and 57.4% of the participants were males. Moreover, 40.6% of the participants thought that both LPR and gastroesophageal reflux disease (GERD) share pathophysiology, however, they are two different diseases considering their clinical presentation. Moreover, it was found that heartburn was the most known symptom of LPR among the participants (Mean score 2.14 (SD=1.31), where a lower score indicated more relation). Considering the treatment of LPR, 40.6% and 40.3% of the participants reported using proton pump inhibitors once or twice daily respectively. In contrast, antihistamine/H2 blockers, alginate, and magaldrate were used to a lesser extent as reported by 27.1%, 21.7%, and 12.1%. Conclusion The current study showed limited knowledge among general practitioners considering LPR with a higher rate of referring patients to other departments depending on symptoms which may increase the pressure on other departments of mild cases.

Self-Medication Practices Among the General Population in Al-Baha City, Saudi Arabia: A Cross-Sectional Study.

Background The practice of self-medication (SM) is the use of self-consuming medication without consulting healthcare which carries its own risks. SM patterns differ across populations and are influenced by several factors. This study aimed to assess the prevalence of SM practices in Al-Baha, Saudi Arabia, to identify the factors contributing to this practice and develop effective strategies to decrease its occurrence and associated risks. Methodology This cross-sectional study was conducted in Al Baha Province, Saudi Arabia, over two weeks in July 2023, with a sample of 580 participants. Eligible participants were males and females, both Saudi and non-Saudi, aged 18-65. The data were collected using a self-administered online questionnaire. Results Of all participants, 48.7% admitted taking medications without a healthcare practitioner's prescription in the last three months. Analgesics were the most common SM (29.1%), followed by vitamins and minerals (16.2%), and antipyretics (14.1%). The side effects experienced from SM included nausea (24.5%), headache (20.5%), and shortness of breath (8.7%). Regarding the source of medication, the majority (61.9%) obtained medications from a pharmacy and 14.6% used existing stock. Age was significantly associated with higher rates in the 18-29 and 40-49 age groups. Educational status was significantly associated with higher SM among graduates. Regarding reading medical instructions, 39.2% always read, 47.7% sometimes read, and 13.1% never read. Regarding antibiotic SM, 61 participants reported using over-the-counter (OTC) antibiotics. Common reasons for use included sore throat (27.8%) and common cold (19.6%). The most common reason for SM was to save time (25.9%), followed by avoiding crowds and long waits (17.1%). Conclusions A significant prevalence of SM practice concerning antibiotic misuse and sex differences with female dominance was detected. We recommend further public awareness activities from related organizations and more regulations for OTC prescription practices to ensure safe SM practices. In addition, further research is needed to explore SM patterns.

Perception of Pathology of Otolaryngology-Related Subjects: Students' Perspective in an Innovative Multidisciplinary Classroom.

AIM: Multidisciplinary, as a term, is used to define people from different scientific backgrounds working together, each drawing on their field of expertise. Some related terms are frequently used interchangeably, such as interdisciplinary and transdisciplinary, but they are confusing and ambiguous. Introduction of a multidisciplinary teaching method in the early phases of medical curricula is insufficient for effective learning. Here, we aim to implement a multidisciplinary approach in the early phase of medical education and identify outcomes. METHODS: Two groups were evaluated in this study, each representing phases II and III of the Albaha medical curriculum, and including 90 and 86 students, respectively. "Hearing tests and their clinical applications" was selected as a subject to evaluate the understanding of special senses as studied by the phase II group, while "pathology of otolaryngology-related tumors and clinical correlations" was selected as a subject to evaluate the understanding of otolaryngology as studied by the phase III group. These subjects were selected by faculty members from otolaryngology, pathology and physiology departments and taught in successive stations. Teaching sessions were followed by a formative test that included 10 multiple-choice questions and a mini-clinical evaluation exercise (mini-CEX). A questionnaire to evaluate student satisfaction was completed after the exam. RESULTS: Students' satisfaction for the "hearing tests and their clinical applications" and "pathology of otolaryngology-related tumors and clinical correlations" subjects were 80% and 90.5%, respectively. The formative assessment revealed good student performance at 63.28%, and 60.46% of all students in both phases attained scores above 80%. CONCLUSION: Introduction of a multidisciplinary approach early in the medical curriculum improves knowledge and skill acquisition. This is reflected in student performance, especially if evaluated using the mini-CEX format, thus providing rapid feedback to students concerning their performance.

Cancerous Inhibitor of Protein Phosphatase 2A as a Molecular Marker for Aggressiveness and Survival in Oral Squamous Cell Carcinoma.

Cancerous inhibitor of protein phosphatase 2A (CIP2A) has been identified as one of the most commonly altered proteins in human cancers. It blocks the tumor-suppressive action of protein phosphatase 2A (PP2A) complex and enhances malignancy. Thirty-five patients with squamous cell carcinoma of the oral cavity underwent surgical resection of the tumor. CIP2A was assessed by quantitative real-time PCR in the resected tumor tissues and in their adjacent normal tissues. CIP2A was found to be overexpressed in all oral squamous cell carcinoma (OSCC) specimens in comparison to their surrounding normal tissue. CIP2A overexpression was statistically correlated with poor prognostic feature of the tumor. Thus, a high expression level of CIP2A was associated with shorter survival. In conclusion, CIP2A is upregulated in OSCC, and its overexpression is correlated with aggressiveness of the tumor and poor outcome and survival. It may serve as a prognostic marker of OSCC.

Oncology research in Saudi Arabia over a 10-year period. A synopsis.

OBJECTIVES: To assess the quality and quantity of Saudi publications in oncology over a 10-year period. METHODS: A systematic PubMed search was conducted between January 2008 and December 2017 to retrieve all Saudi oncology publications. Data about the articles was collected. The level of evidence (LOE) was independently assessed by 2 authors. Two 5-year periods (2008-2012 and 2013-2017) were compared using the relevant parameters. Clinicaltrials.gov was also searched for all oncology trials registered in Saudi Arabia. RESULTS: A total of 839 publications met our inclusion criteria. The most common type of research was case series, totaling 32% of all publications. Clinical trials formed less than 2% of the total. The LOE was I, II, III, and IV in 0.3%, 2.1%, 58.4%, and 39.3% of the included publications, respectively. The LOE was the same in the 2 periods. There were more publications in international journals (p=0.004), more international collaborations (p=0.001), and higher journal impact factors (p=0.037) in 2013-2017 than in 2008-2012. Only 76 registered clinical trials were found in the Clinicaltrials.gov registry. CONCLUSION: Despite an increase in the number of Saudi publications in the field of oncology over time, the LOE did not change. There were, however, some improvements in the international collaboration and journal impact factor, as well as an increase in the number of studies published in international journals. These observations call for a national strategy to improve oncology research in Saudi Arabia.

Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy.

BACKGROUND: The rules of quantitative measures such as parathyroid hormone (PTH) levels in the first hours following total thyroidectomy have since been validated repeatedly. Such measures play an integral rule in identifying patients at significant risk for hypocalcaemia and have allowed for earlier supplementation of these patients with calcium with or without vitamin D. METHODS: A retrospective analysis was conducted of 40 consecutive patients with well differentiated thyroid cancer (WDTC) who underwent total thyroidectomy without central neck dissection (CND) as an initial surgery and no comorbidity at King Abdulaziz Medical City (National Guard hospital), between July 2011 and July 2012. A blood testing protocol was applied for all patients that measured serum calcium PTH at 6 hours postoperatively. RESULTS: Following total thyroidectomy, women were found to experience transient hypocalcaemia in 12.5% of cases (4/32), whereas no men cases encountered this postoperative complication (0/8). However, most probably due to small sample size, this difference was not statistically significant. PTH level was significantly associated with post thyroidectomy hypocalcaemia (43.7±39.3 versus 13.40±24.9 ng/L), P=0.014. Only negligible differences in the length of hospital stay were observed with and without post-thyroidectomy hypocalcaemia. CONCLUSIONS: Using post-thyroidectomy PTH levels to predict hypocalcaemia has been confirmed in the current study. So, the use of PTH levels allows for early risk stratification of our patients and we feel this has resulted in better patient satisfaction.

Thyroid Langerhans cell histiocytosis and papillary thyroid carcinoma.

A 27-year-old female, married with two children, presented to our clinic with a 1-year history of thyroid swelling and pressure symptoms on lying backward and bilateral cervical lymphadenopathy. The patient was a known case of panhypopituitarism for 5 years. Comprehensive patient evaluation including FNAC with papillary thyroid cancer result then she underwent total thyroidectomy and bilateral neck dissection and final histologic examination confirmed papillary thyroid carcinoma in the background of lymphocytic thyroiditis, associated with Langerhans cell histiocytosis (LCH). The draining cervical lymph nodes were also involved by LCH and metastatic papillary thyroid carcinoma. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very uncommon.