The Saudi Clinical Practice Guideline for the treatment of venous thromboembolism: outpatient versus inpatient management

Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Seat belt utilisation and awareness in UAE.

Seat belts (SBs) are effective devices for reducing injury risk due to traffic accidents. Seat belt wearing was made compulsory in the United Arab Emirates (UAE) in January 1999 for drivers and front seat passengers (FSPs). No comprehensive study has ever assessed SB wearing rates across the country. Also, little is known on drivers' awareness of the importance of wearing seatbelts and how human factors affect wearing habits. This study aims to determine SB wearing rates for drivers and FSPs in UAE through an observational field study. It also aims to investigate perceptions and behaviour of drivers on this issue as well as human factors that affect wearing rate through a randomly distributed questionnaire. The results of the field study show that the overall SB wearing rate across the country was 61% for drivers and 43.4% for FSPs and that there were significant differences between the seven emirates that constitute the country. The questionnaire results show that age, education level, gender, marital status and nationality of drivers affect wearing habits and perceptions. Future implications in terms of improving traffic safety awareness are discussed.

Trichilemmal pilar tumor of the scalp: a case report.

Proliferating trichilemmal tumors (PTTs) are uncommon exuberant growths of cells derived from the external root sheath. They tend to occur in older women, with a predilection for the scalp. Wide local excision has been the standard treatment. Recent reports have described a rare malignant variant with an aggressive clinical course and a propensity for nodal and distant metastases which, therefore, merits aggressive treatment.

Role of pemetrexed in advanced non-small-cell lung cancer: meta-analysis of randomized controlled trials, with histology subgroup analysis.

PURPOSE: Platinum-based regimens represent the standard first-line treatment for non-small-cell lung cancer (nsclc). However, newer data have established a role for pemetrexed in the treatment of this disease. Such data suggest that histology represents a determining factor in the selection of treatment. METHODS: We undertook a systematic review of the literature for randomized controlled trials that compared the efficacy of pemetrexed with that of other treatments in advanced nsclc. Data and study quality were assessed according to published guidelines. RESULTS: We identified five trials that compared pemetrexed with other treatments or with placebo. Overall survival for patients treated with pemetrexed was superior to that with other treatments: hazard ratio (hr): 0.89; 95% confidence interval (ci): 0.80 to 0.99. The survival benefit was limited to patients with non-squamous histology: hr: 0.82; 95% ci: 0.73 to 0.91. Pemetrexed was inferior to other chemotherapy options in patients with squamous histology: hr: 1.19; 95% ci: 0.99 to 1.43. CONCLUSIONS: Compared with other chemotherapy agents, pemetrexed is more effective for the treatment of nsclc in patients with non-squamous histology.

Drivers' behaviour at roundabouts in Riyadh.

As is the case in many cities, roundabouts are used extensively in Riyadh. However, instead of improving safety, driving through roundabouts in Riyadh can be a dangerous experience as many drivers do not follow regulations. Unfortunately, no official statistics exist on accidents or violations at roundabouts and no studies have been done to assess this problem. A field study to collect data on drivers' behaviour at five roundabouts in Riyadh was done and a questionnaire was randomly distributed to drivers to explore this issue. Results showed that the percentage of drivers breaching at least one traffic regulation is approximately 90% of all drivers driving through these roundabouts, with leaving without flashing and entering the roundabout without giving way being the most frequent violation types. Questionnaire results from 384 respondents showed that there is a lack of information among most drivers on roundabout driving regulations and that driver training and licensing process does not include enough information related to this matter. Finally, practical suggestions as how to tackle this issue in terms of education, training and policing are given.

Hyperfractionated radiation therapy and concurrent chemotherapy for advanced head and neck cancer.

PURPOSE: To investigate the feasibility of combining hyperfractionated radiotherapy regimen with concomitant chemotherapy and to assess its toxicity in patients with advanced head and neck carcinoma (HNC). Progression free survival (PFS) and overall survival (OS) were set as secondary end points. PATIENTS AND METHODS: Between November 2003 and November 2007, 48 patients with stage III and IV HNC who met the eligibility criteria were enrolled in the study. Hyperfractionated Radiation consisted of 120 Gys twice daily, 6 hours apart, for a total of 69.6 Gys in 58 fractions over 6 weeks and boost of 6 Gys in 3 fractions in case of residual disease. Three cycles of concurrent chemotherapy in the form of Cisplatin 75 mg/ m² on day 1 and Fluorouracil 750 mg/m² 24 hour infusion on day 1-4 during weeks 1, 4 and 6 of irradiation. RESULTS: 48 patients have completed the treatment to date. The median radiation dose was 72 Gys including the boost to residual lymph node or primary site. The treatment was delivered in a median overall period of 54 days, with a recorded median delay of 7 days. Grade 4 skin toxicity was experienced by 4.1% of patients only. Therapy was well tolerated (grade 3 mucositis in 21%, grade 4 in 26%, grade 3 leukopenia in 10%). Weight loss of more than 10 kg was reported in 10 (16.7%) of the cases. The most common late toxicity was mild to moderate xerostomia which was encountered in 34 (70.8%) cases and improved thereafter. Hypothyroidism was encountered in 7 (14.6%) of the cases. Complete response (CR) was observed in 40 patients (83.3%). Partial response (PR) was achieved in the remaining 8 patients (16.7%). Disease relapse occurred in 9 patients (18.8%) after complete response and 2 patients developed progressive disease after partial response. 3 patients relapsed locally, 5 patients developed distant metastasis and 1 patient developed both local and distant metastasis. 2 patients (4.1%) died of treatment complications, 8 patients (16.7%) died with progressive locoregional, and metastatic disease. The 2- year disease free survival was 77% and the 2- year overall survival was 79%. CONCLUSION: Hyperfractionated radiotherapy and concurrent chemotherapy is tolerable. Results regarding LC and OS are encouraging as compared to conventional radiotherapy and concurrent chemotherapy.

Comparison of whole body scintigraphy with Tc-99m-methoxyisobutylisonitrile and iodine-131 NA in patients with differentiated thyroid cancer.

UNLABELLED: In this study we compared whole body scintigraphy with Tc-99m-methoxyisobutylisonitrile (MIBI) and Iodine-131 NA (131I) for detection of residual and/or metastatic disease in well differentiated thyroid carcinoma. METHODS: MIBI and I-131 scans were obtained in 60 patients. TSH measurements were done in all the patients prior to scintigraphy. RESULTS: Out of 60 patients, for whom both I-131 and MIBI scans were done, I-131 scans were positive in 59 (98.3%) patients, whereas MIBI scans were positive in only 17 (27%) patients. There was only one patient in which I-131 scan was negative and MIBI scan was positive. CONCLUSION: I-131 scintigraphy still remains the best way to successfully detect residual/metastatic disease in differentiated thyroid carcinoma.

An intraoral-extraoral combination appliance. A maxillofacial prosthetic device.

Reconstructing a cancer patient's head and neck region can be challenging for the restorative team because of the size of the defect and the tumorous condition of the remaining anatomical structures. This article presents a case that uses remaining healthy tissue, along with intraoral and extraoral devices, to deliver a sophisticated prosthetic device designed to restore physical function.

Cesarean section in Kuwait, 1983 through 1988.

Examination of the cesarean section (CS) rate at the Ministry of Public Health hospitals in Kuwait during 1983 through 1988 revealed a rate of 9.36% and showed no significant trend. The rates in the individual 4 hospitals differed significantly. A significant weak positive correlation between the CS rate and instrumental delivery rates was found. No significant correlation was found between the CS rate and perinatal mortality rate, but a weak positive correlation was found between the CS rate and neonatal mortality rates. Based on the existing health information system in Kuwait, it was not possible to determine whether variations in CS rates were secondary to differences in the risk status of the population subgroups, or were related to physicians' practice style which offers a potential for reduction of the higher rates. Deficiencies identified in the existing health information system included unavailability of information about parity, indications of CS, and whether the procedure was a primary or repeat one. Recommendations to rectify these deficiencies were suggested.