Clinicopathological Features and Predictive Factors for Colorectal Cancer Outcome in the Kingdom of Saudi Arabia.

BACKGROUND/AIMS: Colorectal cancer (CRC) is the most frequent cancer and a leading cause of cancer death in the Kingdom of Saudi Arabia (KSA). To date, no nationwide screening programs have been adopted. This prospective, longitudinal study investigated factors influencing the outcome of CRC in Saudi patients. METHODS: Patients completed a CRC awareness questionnaire. Colonoscopy, CT/MRI, histopathology of tumor biopsies, and KRAS and BRAF testing were performed. Patients were treated according to their stage. All patients were followed until the end of the study and 3- and 5-year survival was assessed. RESULTS: Sixty percent of study patients with sporadic CRC presented with significantly advanced disease (stages III and IV) with or without metastases at entry. Patients showed low levels of awareness of the risk factors and signs of CRC. Patients presented at a median age of 50 years. Family history of CRC and ulcerative colitis were positive in 11 and 6% of patients, respectively. Stage III/IV tumors with distant metastases at enrollment, right-sided tumors, mucinous tumors, lymphovascular invasion, and KRAS (51%) or BRAF (28%) mutations predicted poor prognosis and survival. CONCLUSION: CRC in KSA is usually diagnosed at advanced stages with metastases and KRAS/BRAF, and is associated with poor prognosis and short survival. Nationwide awareness campaigns and screening programs for CRC are critical for prevention, early detection and adequate management of CRC.

Bowel function and its associated variables in Saudi adults. A population based study.

OBJECTIVE: To study bowel patterns (function/habits) and its associated variables in an adult Saudi population. METHODS: In a cross sectional study, a 21-item questionnaire on bowel function (habits and frequency) was distributed to 10,000 high school students from all 5 regions of Riyadh City, Saudi Arabia, between February and April 2011. The randomly selected students, and 2 of their household or family members completed the questionnaire. Socio-demographic characteristics, eating habits, chronic diseases, and medications used were studied. RESULTS: Sixty-one percent (N=4918) were above the age of 16 years, of which 51.5% were males, and 88.1% were Saudis. It was observed that 18.1% of respondents perceived their bowel movements as being irregular and abnormal. There was no association between gender and abnormal/irregular bowel movement (OR: 0.89; p=0.13). Individuals over 60 years suffered from bowel pattern abnormalities (OR=1.8; p=0.01). Educational status (secondary), occupation (teacher and unemployed), diet habits, and chronic diseases of study subjects were also statistically significantly associated with their bowel movements. Respondents consuming more vegetables, fruits, meats, dairy products, and rice had significantly more normal bowel movements. Females tended to defecate less frequently as compared with males (p<0.0001). Approximately 40% of both genders have bowel movements at least once a day. CONCLUSION: Our results may serve as a baseline for appropriate intervention strategies, and also for future studies to substantiate, negate, or add more observations/conclusions.

Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis.

Acute appendicitis is the most common acute surgical condition of the abdomen. Computed tomography (CT) and Ultrasonography (US) can reduce the rate of complications and unnecessary appendectomies, in addition, they can establish an alternative diagnosis. We carried out a systematic review to evaluate the evidence relating radiological imaging (US and CT scan) and early detection of acute appendicitis in patients presenting with equivocal findings, and to provide recommendations to use radiological imaging (US and CT scan) in diagnosing acute appendicitis as part of the initial clinical assessment of the patients presenting with equivocal findings to reduce complications and unnecessary appendectomies. We used the MEDLINE to search for articles published from 1966 to December 2005 that related to radiological imaging of acute appendicitis; additional articles were identified from the bibliographies of review articles. Selection criteria were used to limit the analysis to prospective studies with more than 100 patients involved in each study as a study group. Forty-five studies fulfilling our inclusion and exclusion criteria were extracted, and 13,046 patients were included. Although the CT scan was more sensitive than US in diagnosing patients with equivocal appendicitis (93.4% [95% CI 92.1-94.6] versus 83.7% [95% CI 82.3-85.0]), either diagnostic study should be used as part of the initial assessment of the patients presenting with equivocal findings.