Are Saudi Arabian Patients Willing to Be Deprescribed Their Medications? An Exploratory Study.

Purpose: Deprescribing is a complex process that requires active patient involvement, so the patient's attitude to deprescribing is crucial to its success. This study aimed to assess predictors of Saudi Arabian patients' willingness to deprescribe. Patients and Methods: In this cross-sectional study, adult patients from two hospitals in Riyadh completed a self-administered questionnaire gathering data on demographic information and the Arabic revised Patients' Attitudes Towards Deprescribing (rPATD) questions. Descriptive analysis and binary logistic regression were used to analyze the data. Results: A total of 242 patients were included (mean age 59.8 (SD 11.05) years, range 25-87 years; 40% 60-69 years; 54.1% female). The majority (90%) of participants were willing to have medications deprescribed. Willingness to deprescribe was significantly associated with the rPATD involvement factor (OR=1.866, 95% CI 1.177-2.958, p=0.008) and the patient's perception of their health status (OR=2.08, CI=1.058-4.119, p=0.034). Conclusion: The majority of patients were willing to have one or more medications deprescribed if recommended by their doctors. Patient perceptions about their own health and their involvement in deprescribing were important predictive factors that could shape counseling and education strategies to encourage deprescribing.

Demographic and clinical characteristics associated with advanced stage colorectal cancer: a registry-based cohort study in Saudi Arabia.

BACKGROUND: In Saudi Arabia, approximately one-third of colorectal cancer (CRC) patients are diagnosed at an advanced stage. Late diagnosis is often associated with a worse prognosis. Understanding the risk factors for late-stage presentation of CRC is crucial for developing targeted interventions enabling earlier detection and improved patient outcomes. METHODS: We conducted a retrospective cohort study on 17,541 CRC patients from the Saudi Cancer Registry (1997-2017). We defined distant CRCs as late-stage and localized and regional CRCs as early-stage. To assess risk factors for late-stage CRC, we first used multivariable logistic regression, then developed a decision tree to segment regions by late-stage CRC risk, and finally used stratified logistic regression models to examine geographical and sex variations in risk factors. RESULTS: Of all cases, 29% had a late-stage diagnosis, and 71% had early-stage CRC. Young (< 50 years) and unmarried women had an increased risk of late-stage CRC, overall and in some regions. Regional risk variations by sex were observed. Sex-related differences in late-stage rectosigmoid cancer risk were observed in specific regions but not in the overall population. Patients diagnosed after 2001 had increased risks of late-stage presentation. CONCLUSION: Our study identified risk factors for late-stage CRC that can guide targeted early detection efforts. Further research is warranted to fully understand these relationships and develop and evaluate effective prevention strategies.

Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: are sink drains to blame?

BACKGROUND: Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU). AIM: To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission. METHODS: This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen. FINDINGS: Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. CONCLUSION: Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.

Synchronous Tumour: A Rare Case Report.

The occurrence of synchronous tumors is rare and there have been only a few reported cases. In this particular report, a 30-year-old female presented with abnormal heaviness and anorexia for one month. The case involved the presence of two simultaneous tumors: an immature teratoma in the ovary and a carcinoid tumor in the appendix. This case was complex and presented challenges for diagnosis and treatment. Although synchronous tumors are uncommon, they should be considered as a possibility in the differential diagnosis. Physicians may encounter difficulties in both clinical and histopathological diagnosis when dealing with such cases.

A theory-informed systematic review to understand physical activity among women in Gulf Cooperation Council countries.

BACKGROUND: This systematic review was conducted to identify health beliefs and modifying factors influencing physical (in) activity among adult women in Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). METHODS: A comprehensive search of the Medline (Ovid), EMBASE, Cochrane Central, Web of Science, and Google Scholar databases was conducted to identify relevant articles published between 2009 and 2019. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data collection and analysis based on the health belief model were performed to systematically examine the relationships of health beliefs and modifying factors to physical activity. RESULTS: The sample comprised 15 studies (Saudi Arabia, n = 6; Oman, n = 5; Qatar, n = 2; Kuwait, n = 2). Reported physical activity prevalences were low (nearly 0% to 50%) and depended on the location, subpopulation, and measurement instrument. Evidence for relationships of modifying factors and health beliefs to physical activity was scarce and sometimes inconclusive. Among modifying factors, middle age and employment were associated positively with physical activity; marital status, educational level, income, and body mass index were not associated. Regarding health beliefs, the only conclusive evidence reported was that a lack of time was not associated significantly with physical activity in a population of men and women. Women reported a lack of social support and lack of skills significantly more frequently than men; these factors may explain the gender difference in physical activity prevalence. Differences in the reporting of fear of injury and lack of willpower were not significant. CONCLUSIONS: Robust qualitative and quantitative research on the contributions of health beliefs and modifying factors to the low prevalence of physical activity among women in GCC countries is urgently needed. Current evidence indicates that unemployed women, women aged < 25 years, and elderly women are less likely to be physically active. Women in this population are more likely than men to believe that a lack social support and skills affects their physical activity. Many known factors and health beliefs appear to be unrelated to physical activity among adult women in GCC countries.

Statistical methods for measuring trends in colorectal cancer incidence in registries: A systematic review.

Background: Monitoring cancer trends in a population is essential for tracking the disease's burden, allocating resources, and informing public health policies. This review describes variations in commonly employed methods to estimate colorectal cancer (CRC) incidence trends. Methods: We performed a systematic literature search in four databases to identify population-based studies reporting CRC incidence trends, published between January 2010 and May 2020. We extracted and described data on methods to estimate trends and assess model validity, and the software used. Results: This review included 145 articles based on studies conducted in five continents. The majority (93%) presented visual summaries of trends combined with absolute, relative, or annual change estimates. Fourteen (10%) articles exclusively calculated the relative change in incidence over a given time interval, presented as the percentage of change in rates. Joinpoint regression analysis was the most commonly used method for assessing incidence trends (n= 65, 45%), providing estimates of the annual percentage change (APC) in rates. Nineteen (13%) studies performed Poisson regression and 18 (12%) linear regression analysis. Age-period-cohort modeling- a type of generalized linear models- was conducted in 18 (12%) studies. Thirty-nine (37%) of the studies modeling incidence trends (n=104, 72%) indicated the method used to evaluate model fitness. The joinpoint program (52%) was the statistical software most commonly used. Conclusion: This review identified variation in the calculation of CRC incidence trends and inadequate reporting of model fit statistics. Our findings highlight the need for increasing clarity and transparency in reporting methods to facilitate interpretation, reproduction, and comparison with findings from previous studies.

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children.

Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.

Demographic Characteristics, Comorbidities, and Length of Stay of COVID-19 Patients Admitted Into Intensive Care Units in Saudi Arabia: A Nationwide Retrospective Study.

Background: This study aimed to describe the demographic characteristics and determine the risk factors associated with disease severity and length of hospital and intensive care unit (ICU) stay in a cohort of COVID-19 patients admitted into ICU in Saudi Arabia. Methods: This was a national, multi-center, retrospective cross-sectional study of all COVID-19 cases admitted into different ICUs in Saudi Arabia between March 2020 and September 202l. Demographic, clinical features, comorbidities, and length of stay (LOS) data were retrieved from the national Health Electronic Surveillance Network (HESN) and Taqassi databases at the Saudi Ministry of Health (MOH) for subsequent analyses. We used multiple linear regression models to determine risk factors associated with critical outcomes (including LOS in ICU) among COVID-19 cases. Results: A total of 12,436 COVID-19 patients were included in this study, with a mean age of 59.57 ± 18.30 years and 7,679 (62%) were <65 years old. COVID-19 was more common in males (N = 7,686, 61.9%) and Saudi nationals (N = 8,516, 68.5%). The clinical characteristic findings showed that 36.3% of patients required invasive ventilation whilst 65.4% received tracheostomies for ventilation, and 4% were on dialysis. Our analysis revealed that 2,978 (23.9%) patients had one comorbidity, 4,977 (47.4%) had two or more comorbidities, and diabetes (48.2%) was the most prevalent comorbidity, followed by hypertension (44.2%), and chronic cardiovascular disease (10.5%). Thirteen variables emerged as significant predictors of LOS in ICU using multiple linear regression analyses, with invasive ventilation as the strongest predictor of LOS in the ICU (beta = -0.68, p = 0.001) and hospital admission (beta = -0.65, p = 0.001). Conclusions: COVID-19 continues to affect millions of people around the world, with a mortality rate of about 2-3% of all infected patients. Our analysis revealed that comorbidities such as chronic kidney disease, cardiovascular disease, diabetes, and older age were significant risk factors associated with a poorer prognosis and longer duration of stay in hospitals and ICU.

A systematic review of methods to estimate colorectal cancer incidence using population-based cancer registries.

BACKGROUND: Epidemiological studies of incidence play an essential role in quantifying disease burden, resource planning, and informing public health policies. A variety of measures for estimating cancer incidence have been used. Appropriate reporting of incidence calculations is essential to enable clear interpretation. This review uses colorectal cancer (CRC) as an exemplar to summarize and describe variation in commonly employed incidence measures and evaluate the quality of reporting incidence methods. METHODS: We searched four databases for CRC incidence studies published between January 2010 and May 2020. Two independent reviewers screened all titles and abstracts. Eligible studies were population-based cancer registry studies evaluating CRC incidence. We extracted data on study characteristics and author-defined criteria for assessing the quality of reporting incidence. We used descriptive statistics to summarize the information. RESULTS: This review retrieved 165 relevant articles. The age-standardized incidence rate (ASR) (80%) was the most commonly reported incidence measure, and the 2000 U.S. standard population the most commonly used reference population (39%). Slightly more than half (54%) of the studies reported CRC incidence stratified by anatomical site. The quality of reporting incidence methods was suboptimal. Of all included studies: 45 (27%) failed to report the classification system used to define CRC; 63 (38%) did not report CRC codes; and only 20 (12%) documented excluding certain CRC cases from the numerator. Concerning the denominator estimation: 61% of studies failed to state the source of population data; 24 (15%) indicated census years; 10 (6%) reported the method used to estimate yearly population counts; and only 5 (3%) explicitly explained the population size estimation procedure to calculate the overall average incidence rate. Thirty-three (20%) studies reported the confidence interval for incidence, and only 7 (4%) documented methods for dealing with missing data. CONCLUSION: This review identified variations in incidence calculation and inadequate reporting of methods. We outlined recommendations to optimize incidence estimation and reporting practices. There is a need to establish clear guidelines for incidence reporting to facilitate assessment of the validity and interpretation of reported incidence.

Mental Health Outcomes of Healthcare Providers During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Study.

Objective: In this descriptive cross-sectional study we aimed, to assess the level of depression, anxiety, insomnia and distress symptoms experienced by healthcare providers during the COVID-19 pandemic in Saudi Arabia. Methods: All healthcare providers currently working in different hospitals were invited to participate in this study. Data gathering started in March 2020 to May 2020. The participants answered a five-part questionnaire which includes demographic data, a 9-item Patient Health Questionnaire, a 7-item Generalized Anxiety Disorder, a 7-item Insomnia Severity Index, and a 22-item Impact of Event Scale-Revised, which assess the level of depression, anxiety, insomnia, and distress. Results: Out of 200 healthcare providers, 40% were males. 52% were aged 31-40 years old, 61% were married. The majority of the participants were Saudi nationals (84%), 74% were nurses, 11% were physicians and 15% were other healthcare providers. More than half of the participants worked as front-liners (57%). Overall, 73, 69, 62, and 83% of all healthcare providers reported symptoms of depression, anxiety, insomnia, and distress, respectively. The analysis showed severe symptoms level of depression for physicians and nurses was 35% and 20% (p < 0.05), respectively. Only three of the independent variables made a unique contribution to the model (gender, profession, and working position) (p < 0.05). Conclusion: COVID-19 pandemic has a significant impact on the mental health of healthcare providers in Saudi Arabia. Female nurses and healthcare providers working in the frontline who were directly treating patients with COVID-19 are at increased risk of severe depression, anxiety and distress.

Awareness of Premarital Screening and Genetic Counseling among Saudis and its Association with Sociodemographic Factors: a National Study.

BACKGROUND: Premarital screening and genetic counseling (PMSGC) is compulsory in Saudi Arabia and aims to identify and decrease the prevalence of some genetic and sexually transmitted infectious diseases. However, there are little data on community awareness about PMSGC. This study assessed knowledge levels, attitudes, and behaviors associated with PMSGC in the general Saudi Arabian population and their associations with sociodemographic characteristics. METHODS: This was a cross-sectional, population-based study of 6263 participants randomly selected from all 20 health regions in Saudi Arabia, stratified according to age and fulfilling predefined selection criteria. Trained data collectors used a comprehensive pretested questionnaire to collect data. Data were collected in March and April 2019. Univariable and multivariable associations between sociodemographic characteristics and knowledge levels, attitudes, and behaviors were examined. RESULTS: While all 6263 study participants had heard about PMSGC, only 575 (9.2%) participants had satisfactory knowledge, while 3283 (52.4%) participants had fair knowledge. Predictors of high knowledge scores were university or higher education level (aOR=2.06; 95% CI: 1.80-2.36), positive medical history of PMSGC-screened disease (aOR=2.02; 95% CI: 1.51-2.69), family income ≥3000 SR/month (aOR=1.70; 95% CI: 1.50-1.93), being married/previously married (aOR=1.46; 95% CI: 1.25-1.70), female gender (aOR=1.25; 95% CI: 1.12-1.40), and age >18 years (aOR=1.25; 95% CI: 1.06-1.48). The majority of participants (5246, 83.8%) had positive attitudes towards the importance of PMSGC, the burden of screened genetic and infectious diseases on the family, and that marrying was inadvisable with incompatible results. Of the 3986 engaged or married participants, 2911 (73.0%) had undertaken premarital screening, of whom 360 (12.4%) had incompatible results; 98 (37.1%) married despite this information. CONCLUSION: Despite advances in public healthcare measures in Saudi Arabia, gaps remain in the knowledge, beliefs, and behaviors associated with PMSGC. Culturally specific community health education programs for PMSGC must be devised that emphasize the risks associated with consanguineous marriage.

Predictors of students' academic achievements in allied health professions at King Saud University: a retrospective cohort study.

BACKGROUND: The admissions criteria for colleges of medicine and allied health professions include several cognitive predictors. Little is known of the admissions criteria for the allied health professions and their correlation with students' academic performance. This study investigates predictors for students' academic achievements at allied health colleges at King Saud University. DESIGN: Retrospective cohort study. SETTINGS: College of Applied Medical Sciences, College of Nursing, and Prince Sultan bin Abdulaziz College for Emergency Medical Services, Saudi Arabia. PARTICIPANTS: The sample comprised 1634 students. METHOD: The high school grade average (HSGA), aptitude test (APT) score, achievement test (ACT) score, and current grade point average (GPA) were retrieved. The data were analysed using Pearson's correlation coefficient and regression analysis. RESULTS: HSGA, ACT, and APT were significantly positively associated with students' academic performance in colleges for all allied health professions. Multivariate regression analysis showed that the most predictive variable for all allied healthcare professions was HSGA (ß = 0.347), followed by ACT (ß = 0.270) and APT (ß = 0.053) scores. The regression model indicated that the HSGA, APT, and ACT together predicted 26.5% of the variation in students' cumulative GPAs at the time of graduation. CONCLUSION: The admissions criteria for the allied health colleges at King Saud University predicted only 26.5% of the students' cumulative GPA at the time of graduation. Other noncognitive admission criteria should be taken into consideration to improve the prediction of students' academic potential.

Reproductive interference between Aedes albopictus and Aedes flavopictus at a place of their origin.

Aedes (Stegomyia) albopictus and Aedes (Stegomyia) flavopictus are related species that have overlapping distributions from southern to central Japan. To understand how they interact, we studied reproductive interference between them, particularly focusing on the body size difference between the mating pair. Here, we examined the effects of conspecific, heterospecific and double mating (i.e. heterospecific mating followed by conspecific mating) on copulation duration, egg production and hatchability of eggs using mosquitoes that varied in body size. Females mated only with heterospecific males produced few viable eggs, indicating that post-mating isolation is almost complete. When mated with heterospecific males before conspecific mating, the production of viable eggs was lower than when mated only with conspecific males, revealing the occurrence of reproductive interference. The degree of reproductive interference was larger in Ae. flavopictus than in Ae. albopictus when the female size was small but did not differ between them when the female size was large. Aedes albopictus females appear to be able to distinguish Ae. flavopictus males from conspecific males and larger females are more successful in the rejection of heterospecific males. On the other hand, Ae. flavopictus were not able to discriminate between conspecific and heterospecific males.

Association between type 2 diabetes mellitus and Helicobacter pylori infection among Saudi patients attending National Guard Primary Health Care Centers in the Western Region, 2018.

BACKGROUND: Reports on Helicobacter pylori infection in diabetics are inconsistent and contradictory. This study attempted to identify the possible association between type 2 diabetes and H. pylori infection. MATERIALS AND METHODS: Following a cross-sectional design, participants were recruited from four National Guard Primary Health Care Centers in Jeddah City, Saudi Arabia. The study was conducted from December 2017 to November 2018. All participants underwent hemoglobin A1C (HbA1c) assessment and stool antigen test for H. pylori. RESULTS: A total of 212 type 2 diabetic patients aged 40 years or more, and 209 age-matched nondiabetic subjects were included in the study. About one-quarter of the diabetics and nondiabetics were positive for H. pylori (26.9% and 26.3%, respectively). There was no significant difference. The prevalence of H. pylori did not differ significantly in the type 2 diabetics, with regard to their age groups, gender, smoking status, body mass index, chronic diseases, their HbA1c level, duration of diabetes, or received type of therapy. The prevalence of H. pylori was significantly higher in overweight and obese nondiabetic subjects (P = 0.013). Obese participants in both groups had the highest prevalence of infection (57.9% and 54.5%, respectively, P = 0.038). CONCLUSION: About one-quarter of type 2 diabetics and nondiabetics in Jeddah City have H. pylori infection. There is no association between diabetes and H. pylori infection. H. pylori was significantly higher in patients with a high body mass index.

Comorbidities in Patients with Psoriasis.

Psoriasis, a chronic inflammatory disease is associated with a long list of comorbidities. In our practice we like to draw attention in comorbidities of psoriatic arthritis and we are adapted with cardiovascular comorbidities. A great deal remains unknown about psoriasis associated comorbidities. An understanding of these comorbidity patterns can help us to ensure better care of patients with psoriasis. Objective of the study was to find out the comorbid conditions in the patients of psoriasis. This observational case control study was conducted 150 diagnosed cases of psoriasis and 150 age matched healthy control. Purposively 150 patients of psoriasis were selected from the Dermatology OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2018 as case. After a complete physical examination, a pre-designed structured questionnaire was fulfilled with patients and controls. To detect unknown comorbidities the following tests was done in both groups and compared: Blood sugar, urine routine and microscopic examination, serum creatinine, serum AST, ALT, GGT, and ALP levels measured by an enzymatic method, X-ray chest view, USG of whole abdomen/KUB. The diagnosed comorbidity was listed and referred for treatment accordingly. Charlson-age comorbidity index chart was used to estimate risk of mortality in two groups. The mean age of incident psoriasis was 38.64 years. Diabetes mellitus (4.67%), hypertension (4%), ischemic heart disease (IHD) (3.33%) were the top three comorbidities in patients with psoriasis. among them 11(7.33%) patients of psoriasis was with single comorbidity and 5(3.33%) of them was with multiple comorbidity. In control group 3(2%) participants was detected with comorbidity and that difference was significant statistically. In current study Charlson-Age Comorbidity index (CACI) was used as a tool to estimate the risk of mortality in two groups. The mean CACI score was 2.5 and 1 in two groups respectively and the difference was significant (p<0.05). The estimated risk of death (ERRD) score was calculated form CACI chart and the score was 2.78 and 1.47 in two groups respectively. There was no significant difference in two groups (p>0.05). The rate of occurrence of comorbidity was more in psoriasis group than in control. The listed comorbidity was in mild severity range but the risk of mortality was same in psoriasis group and control.

A comparative assessment of bite marks in analyzing the overlay generation using styrofoam sheet and modeling wax with the dental casts as one of the adjuncts for archiving the forensic records: An in vivo study.

INTRODUCTION: Bite mark evidence is unique to an individual and plays an important role in the legal system. There has always been the need to develop newer materials for bite mark analysis that will have excellent reproducibility as well as reliability. AIM: The present study aimed to evaluate the efficacy of styrofoam sheets and modeling wax with time-dependent changes when compared to the routine dental cast models. MATERIALS AND METHODS: The present study included thirty volunteers and their bite marks were taken on the styrofoam and wax sheet materials that were traced on the transparent sheet and evaluation of the bite marks on the two materials were carried out at an interval of 1 day for 3 alternate days and grades were given, respectively. ANOVA test and t-test were used for statistical analysis. RESULTS: The comparison between the styrofoam sheet and wax sheet with the dental cast on day 1 proved to be excellent materials for reproducibility, but from day 3 onward, the styrofoam sheet showed changes in bite registered area; whereas wax sheet maintained its registered dimensions. CONCLUSION: The study concludes that bite mark registration on styrofoam and wax sheet had excellent reproducibility on day 1, which makes these two materials advantageous in bite mark registration and overlay generation on the same day, whereas on day 3 and day 5, the styrofoam sheet showed changes with respect to bite registration and overlay generation, which questions the reliability of the styrofoam sheet for long-term record keeping when compared with the modeling wax.

Serum sonic hedgehog (SHH) and interleukin-(IL-6) as dual prognostic biomarkers in progressive metastatic breast cancer.

Serum from one hundred and ten breast cancer patients and thirty healthy female volunteers, were prospectively collected and evaluated for serum levels of Shh and IL-6 using human Shh and IL-6 specific enzyme-linked immunoassays. All patients were regularly monitored for event free survival (EFS) and overall survival (OS). Overall outcome analysis was based on serum Shh and IL-6 levels. In patients with progressive metastatic BC, both serum Shh and IL-6 concentrations were elevated in 44% (29 of 65) and 63% (41 of 65) of patients, respectively, at a statistically significant level [Shh (p = 0.0001) and IL-6 (p = 0.0001)] compared to the low levels in healthy volunteers. Serum levels tended to increase with metastatic progression and lymph node positivity. High serum Shh and IL-6 levels were associated with poor EFS and OS opposite to the negative or lower levels in serum Shh and IL-6. The elevated levels of both serum Shh and IL-6 were mainly observed in BC patients who had a significantly higher risk of early recurrence and bone metastasis, and associated with a worse survival for patients with progressive metastatic BC. Further studies are warranted for validating these biomarkers as prognostic tools in a larger patient cohort and in a longer follow-up study.

Overexpression of sonic hedgehog in the triple negative breast cancer: clinicopathological characteristics of high burden breast cancer patients from Bangladesh.

Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.