Prognostic value of p53 expression in hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer patients receiving neoadjuvant chemotherapy.

PURPOSE: The aim of this study was to determine whether the outcome to neoadjuvant chemotherapy (NAC) can be predicted by analyzing p53 expression in hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients. METHODS: We retrospectively reviewed 594 patients diagnosed with stage I-III HR-positive, HER2-negative breast cancer, and treated with NAC at the Asan Medical Center between 2008 and 2014. Expression of p53 was assessed, and overall survival (OS) and breast cancer-specific survival (BCSS) were investigated and compared between groups. RESULTS: At a median follow-up period of 69.8 months, OS and BCSS were higher in the p53-negative (p53(-)) group than in the p53-positive (p53(+)) group. Five-year OS was 95.4% in the p53(-) and 92.1% in the p53(+) group (p = 0.005). BCSS was 96.2% in the p53(-) group and 93% in the p53(+) group (p = 0.008). CONCLUSION: High expression of immunohistochemically detected p53 was strongly and significantly associated with decreased OS and BCSS than low p53 expression, suggesting that p53 may be a powerful prognostic factor in HR-positive, HER2-negative breast cancer patients receiving NAC.

Women's Knowledge and Attitudes Regarding the Risk Factors and Warning Signs of Breast Cancer in the Eastern Province, Saudi Arabia: A Cross-Sectional Study.

Introduction Breast cancer is the leading type of cancer in women globally, contributing significantly to cancer-related deaths. In Saudi Arabia, it ranks as the second most common cancer among women. Studies have highlighted a lack of awareness about breast cancer, negatively impacting breast self-examination practices. The Eastern Province has particularly high incidence rates. Knowledge of risk and protective factors can aid in prevention and early detection. While some studies show good awareness, this research aims to assess women's knowledge and attitudes about breast cancer risk factors and warning signs in the Eastern Province. Methodology This is a cross-sectional study conducted in Saudi Arabia's Eastern Province from June to October 2023 to assess breast cancer awareness among adult females. Data were collected via an online survey. Data were cleaned in MS Excel (Microsoft Corporation, Redmond, Washington) and analyzed in IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York). Results Our study assessed breast cancer awareness in 697 participants in Saudi Arabia's Eastern Province. Most were aged 20-24 years (30.3%), married (49.2%), and Saudi nationals (97.6%), with higher education (59.4%). Significantly, 69.2% received education on breast cancer risk factors/signs. Some had personal breast cancer diagnoses (5.0%), and 31.7% had affected family members. Participants showed good awareness of various risk factors and warning signs. Significant associations were found between nationality, personal breast cancer diagnosis, and knowledge and attitudes about risk factors. Age, marital status, occupation, education on breast cancer, and personal breast cancer diagnosis influenced knowledge and attitudes about warning signs. Conclusion Our study findings indicate generally good awareness of breast cancer risk factors and warning signs among participants. Age, marital status, occupation, education on breast cancer, and personal breast cancer diagnosis influenced knowledge and attitudes about risk factors and warning signs. Educational efforts should target lesser-known risk factors to enhance prevention and early detection.

Factors That Influence Undergraduate Medical Students to Choose General Surgery as a Future Career in Saudi Arabia.

Objective The objective of this cross-sectional study conducted in Saudi Arabia was to determine the factors that influence Saudi medical students to choose general surgery as their future specialty and pursue it as a career. Study design The study was conducted over a six-month period from December 2022 to May 2023 and employed a cross-sectional design. Patients and methods Undergraduate medical students from various universities in Saudi Arabia were included as study participants. Only those who met the study's criteria completed a questionnaire, and the data collected was analyzed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Results Out of the 283 medical students included in the study, 53% were females, and 55.1% were junior students. The results revealed that the most common influential factors towards selecting a general surgical specialty were "Opportunity to be involved in patient care" (86.9%), "Opportunities for higher studies or further specialization" (85.9%), and "Compatible with personality" (84.8%). Conclusion This study concluded that several factors moderately influenced medical students considering general surgery as their future career. Notably, female students were found to be more likely to be influenced by research opportunities, less stressful working conditions, shorter working hours, and having family members in the same specialty.

Endovascular Interventions for Peripheral Arterial Disease in Saudi Patients: A Cross-Sectional Study Assessing Efficacy and Economic Impact.

Introduction Peripheral Arterial Disease (PAD) is characterized by arterial narrowing or blockage, causing pain and reduced quality of life. Endovascular interventions, like angioplasty and stenting, offer less invasive treatment options with potential benefits. This study, conducted in the Al-Ahsa region of Saudi Arabia from January to August 2023, aims to assess the impact of these interventions on PAD management in Saudi patients. Specifically, we aim to evaluate their effectiveness in improving clinical outcomes, such as symptom relief and quality of life, and their cost-effectiveness in the Saudi healthcare system. By addressing these objectives, our research provides evidence to support informed clinical decisions and healthcare policy in Saudi Arabia, ultimately enhancing patient care. Methods In this study, a cross-sectional design was used to assess the impact of endovascular interventions on PAD management in Saudi patients in the Al-Ahsa region. Data collection took place from January to August 2023. The study focused on a sample of 385 or more Saudi patients who had undergone endovascular interventions. Inclusion criteria involved diagnosed PAD patients who had received these interventions, while non-Saudi patients and those without PAD or interventions were excluded. Data was collected through an online questionnaire distributed in hospitals. The study considered demographic and clinical/economic variables to evaluate intervention effectiveness and cost-effectiveness. Results The findings of this study emphasize the significance of variables such as gender, education level, employment status, and geographic location in shaping perceptions concerning the effectiveness and cost-effectiveness of endovascular interventions for the management of PAD. Participants in the study reported substantial improvements in symptom relief, quality of life, and daily activities following endovascular interventions. Moreover, the study revealed divergent perceptions regarding the cost-effectiveness of these interventions among participants. Conclusion This study highlights a positive association between the use of endovascular interventions and improved clinical outcomes in Saudi patients diagnosed with PAD. The results of this research indicate that endovascular interventions are not only more cost-effective when compared to alternative treatment modalities for PAD management but also lead to significant enhancements in symptom relief, quality of life, and daily activities among patients. The implications of these findings for the Saudi healthcare system are substantial, underscoring the importance of evidence-based decisions in the adoption of endovascular interventions for PAD management.

Enhanced Recovery After Surgery (ERAS) in Saudi Arabian Surgical Practice: A Comprehensive Analysis of Surgical Outcomes, Patient Satisfaction, and Cost-Effectiveness.

Introduction Surgical procedures present substantial healthcare costs, patient discomfort, and potential adverse outcomes. In response, enhanced recovery after surgery (ERAS) protocols have emerged as comprehensive, evidence-based preoperative care pathways designed to optimize preoperative, intra-operative, and postoperative management. These protocols incorporate various interventions, such as preoperative education, nutritional optimization, minimally invasive techniques, multimodal pain management, early mobilization, and patient engagement. Despite their global success and growing popularity, the adoption and influence of ERAS protocols in Saudi Arabia have not been extensively explored. This study aims to assess the ERAS effects on surgical outcomes and evaluate its relationship with patient satisfaction, considering factors such as cost-effectiveness and compliance in the Saudi context. Methods This cross-sectional study encompassed data collection from 1,452 patients who underwent surgical procedures such as bariatric surgery and cholecystectomy, employing systematic random sampling across multiple healthcare facilities in Saudi Arabia. Data were gathered through structured questionnaires, medical records, and cost-effectiveness analysis within the period spanning from January to August 2023. The relationship between ERAS protocol implementation, surgical outcomes, patient satisfaction, and cost-effectiveness was analyzed using statistical tests, including correlation, regression analysis, and chi-square tests. A statistical significance threshold was set at p < 0.05, and Statistical Product and Service Solutions (SPSS, version 28.0) (IBM SPSS Statistics for Windows, Armonk, NY) was used for data analysis. Results Among the 1,452 respondents, 1,152 (79.3%) reported the implementation of ERAS protocols during their surgical procedures. Those receiving ERAS protocols exhibited significantly lower rates of surgical complications, readmissions, and reduced dependency on pain medication (p < 0.001). Additionally, participants subjected to ERAS protocols reported significantly higher satisfaction levels based on the mean satisfaction scale score, with a p-value of less than 0.001. Conclusion The results highlight substantial improvements associated with the implementation of ERAS protocols, particularly in terms of reduced surgical site infections, shortened hospitalization periods, and decreased pain management-related complications. Moreover, ERAS protocol implementation demonstrated enhanced surgical outcomes, increased postoperative satisfaction, and overall improved recovery experiences. These findings underscore the potential benefits of integrating ERAS protocols into the surgical practices of Saudi Arabia. This research contributes to a better understanding of the advantages offered by ERAS protocols and their potential for enhancing healthcare delivery in the region.

Assessing the Impact of Laparoscopic Cholecystectomy on Satisfaction, Quality of Life, and Cost-Effectiveness in Saudi Patients With Gallstone Disease: A Comprehensive Cross-Sectional Analysis.

INTRODUCTION: Cholelithiasis, or gallstone disease, is a prevalent medical condition with substantial global implications. Laparoscopic cholecystectomy (LC) has become the dominant surgical solution for treating various biliary conditions in affluent countries due to its numerous benefits, such as shorter hospital stays and reduced costs. An assessment of postoperative recovery, patient satisfaction, and quality of life (QoL) is crucial to judge the success of any medical procedure regarding long-term patient well-being. Given the scarcity of research on the satisfaction, QoL, and cost-effectiveness of LC among Saudi patients, this study seeks to fill this gap. METHODS: To achieve the study's objectives, a cross-sectional research study was conducted from January to December 2023, focusing on Saudi patients who had received LC for gallstone disease. We utilized an extensive questionnaire to determine patient satisfaction, QoL, and the perceived value of LC, which combined closed and open-ended questions to provide a holistic understanding. Additionally, an in-depth literature review was performed to compare our findings with existing research. RESULTS: Our survey received answers from 886 Saudi LC patients. Generally, participants showed satisfaction with LC, though complications were reported in a significant number of cases. However, a minority of participants were dissatisfied. Most respondents indicated a moderate enhancement in their QoL postsurgery. Notably, demographic factors like gender, age, and employment status had profound effects on satisfaction and QoL, with male participants more likely to report higher satisfaction and QoL than females. CONCLUSION: Our data firmly support the ongoing use of LC as the preferred surgical technique for treating biliary diseases in Saudi Arabia. They emphasize the benefits of personalizing care based on patient demographics to improve the overall experience. Proper communication, thorough preoperative planning, and attentive postoperative care are essential for achieving the best outcomes. Despite these findings, more research is needed, focusing on different patient demographics and comparing LC with other treatment methods to enhance our understanding of gallstone disease management in the Saudi context.

The appropriateness of thyroid lobectomy as an initial surgery for preoperatively detected unilateral multifocal papillary carcinoma.

BACKGROUND: Whether multifocal papillary thyroid carcinoma (PTC) is more associated with recurrence than unifocal PTC is controversial. This study investigates the appropriateness of lobectomy for patients with preoperatively detected unilateral multifocal PTC. METHODS: This study retrospectively analyzed 198 patients with unilateral multifocal PTC at the Asan Medical Center between 2000 and 2005. Clinicopathological features and locoregional recurrence rates were compared according to operation type (lobectomy, n = 62; total thyroidectomy (TT), n = 136). RESULTS: The lateral neck lymph node area was the most frequent recurrence site. Univariate analyses showed that gross extrathyroidal extension (ETE), bilateral multifocal malignancy diagnosed after operation (bilaterality), lymph node (LN) metastasis, lymphovascular invasion, tumor size (≥2 vs < 2 cm), and extranodal extension (ENE) were associated with locoregional recurrence (P < 0.05). Multivariate analyses showed that ENE (hazard ratio (HR), 5.7; p = 0.007; 95% confidence interval (CI) = 1.1-9.8), LN metastasis (HR, 8.6; p = 0.046; 95% CI = 1.1-70.7), and lymphovascular invasion (HR, 11.1; p = 0.001; 95% CI = 2.7-46.1) were significantly associated with locoregional recurrence. The occult contralateral malignancy (rate, 15.4% of TT patients) and gross ETE were not risk factors for locoregional recurrence in the multivariate analysis of this study. CONCLUSION: Lobectomy may be considered as an alternative treatment to TT for patients with preoperatively detected unilateral multifocal PTC with diameters less than 2 cm, even in the pres-ence of risk fac-tors, such as gross ETE, and the pos-si-bil-ity of oc-cult ma-lig-nancy of the con-tralat-eral lobe. Although recurrence in the contralateral lobe after lobectomy could be diagnosed in unilateral multifocal PTC, it would not increase the rates of locoregional recurrence and death.

Usefulness of 3-Dimensional-Printed Breast Surgical Guides for Undetectable Ductal Carcinoma In Situ on Ultrasonography: A Report of 2 Cases.

Tumor localization is challenging in the context of ductal carcinoma in situ (DCIS) treated with breast-conserving surgery. Conventional localization methods are generally performed under the guidance of ultrasonography or mammography and are rarely performed with magnetic resonance imaging (MRI), which is more sensitive than the aforementioned modalities in detecting DCIS. Here, we report the application of MRI-based individualized 3-dimensional (3D)-printed breast surgical guides (BSGs) for patients with breast cancer. We successfully resected indeterminate and suspicious lesions that were only detected using preoperative MRI, and the final histopathologic results confirmed DCIS with clear resection margins. MRI guidance combined with 3D-printed BSGs can be used for DCIS localization, especially for lesions easily detectable using MRI only.