Outcomes of Breast Intraoperative Electron Beam Radiotherapy (IOeRT) : Case Series of Single Institute Experience in Saudi Arabia.

INTRODUCTION: 85-90% of local recurrences after breastconserving surgery occurs within the index quadrant. Intraoperative radiotherapy may be a good alternative for eligible patients avoiding long course of adjuvant radiation. PATIENTS AND METHODS: Eligible patients were early stage node negative at least 50 years at time of inclusion, unicentric less than 30mm in diameter any hormone receptor status. 21 Gy was delivered intraoperatively, biologically equivalent to 58 to 60 Gy in standard fractionation using electron beam to 90% isodose line. Cosmetic, Oncological and Patient Satisfaction Evaluation of treated Patients between March 2018 and August 2020 at the King Khalid university hospital, using the IOeRT (Mobetron® ). Evaluation done at a combined clinic between surgical and radiation oncology teams at the end of the follow up period before publication. RESULTS: 15 female patients were evaluable with mean follow up period 33.8 months (19-48 months). Mean Age 56.4 years (50-65 years). Mean tumor size 1.213 cm. Majority of patients were T1. 2 patients showed Sentinel lymph node positive.21 Gy was delivered intraoperatively.4 Patients (26.7%) received adjuvant postoperative external beam radiation therapy (EBRT). 2 patients due to being in Caution group due to positive extensive Ductal carcinoma in situ (DCIS). External beam radiation was 40 Gy/15 fractions/3 weeks using three dimensional radiation therapy (3DCRT). Cosmetically, Apart from one patient score 9 due to presence of keloid scar formation, most patients were in range of 0-3 according to physician evaluation and Modified Hollander's score otherwise, No more than score 3 in any of the patients was detected. Oncologically, Till the time of publication no local or distant relapses was detected. As a patient experience, 100 % of patients were satisfied. CONCLUSION: Breast IOERT is a convenient, safe and a valid treatment modality as an option for patients who are otherwise appropriate candidates for APBI. Proper patient selection should focus on clinicopathologic factors predictive of negative nodes and negative margins. Careful assessment of preoperative mammographic and other imaging studies for features, such as extent of calcifications, may be helpful.

Aqueous Extract of Origanum majorana at Low Temperature (0°C) Promotes Mitochondrial Fusion and Contributes to Induced Apoptosis in Human Breast Cancer Cells.

Marjoram plants have varied pharmacological properties because they contain antioxidants. In the present study, to evaluate the effect of Origanum majorana, gathered from Abha, Saudi Arabia, on the growth of human breast cancer cells using MCF7. Fresh aerial parts from Origanum majorana were extracted at a low temperature (0 ℃/6 hours). Human MCF7 breast cancer cells were then treated with 4 separate fluctuated concentrations of 0, 50, 150, 200 and 350 µg/mL for 24 and 48 hours. The findings showed that Origanum majorana aqueous extract contained absolute phenolic content (TPC) was 58.24 mg equivalent/g DW, and the complete flavonoid content (TFC) 35.31 mg GAE equivalent/g DW in the Origanum majorana aqueous extract. The endurance of MCF7 cells after incubation with aqueous extract diminished, indicating that Origanum majorana is tumour cell selective. Origanum majorana extract increased the mRNA Expression of Apoptotic Genes in MCF7. Majorana aqueous extract expanded the activity of Caspase-7 action specifically at higher concentrations, 150, 200, and 350 µg/ml. Our findings indicate that Origanum majorana could induce apoptosis of human breast cancer cells. This is the first study that provides a basis for the use of aqueous Origanum majorana extracted at low temperature (0 °C/6 hours) as more effective anticancer treatment.

Rare case of iatrogenic aortic valve leaflet tear following a diagnostic coronary angiogram.

We report a rare case of a 44-year-old male who underwent a diagnostic coronary angiogram following a non-ST elevation myocardial infarction complicated by an aortic valve leaflet tear requiring surgical intervention. Routine transthoracic echocardiogram demonstrated a mobile echogenic structure prolapsing into the left ventricular outflow tract. An intraoperative transesophageal echocardiogram confirmed that the structure originated from the ventricular side of left coronary cusp, causing malcoaptation between left and right coronary cusps, and subsequent moderate to severe aortic regurgitation.

Prevalence of Dental Caries and Periodontal Status among Down's Syndrome Population in Riyadh City.

AIM: Aim of the present study was to evaluate the prevalence of dental caries and periodontal status among Down's syndrome population in Riyadh City. MATERIALS AND METHODS: A total of 81 male Down's syndrome subjects were examined in this study. All subjects were recruited from the Saudi Center for Down Syndrome, Riyadh. Clinical examination was carried out by a single precalibrated examiner. Dental caries experience was counted according to the DMFT (decayed, missing, and filled teeth) indexes. Periodontal status was evaluated by using plaque and gingival indexes. Statistical analysis was performed using SPSS 19 version. Consequently, Pearson chi-square test and Fisher exact test was used to calculate p-value for parametric variables. RESULTS: In this study 11.1% of the subjects were not having any decayed teeth, 39.5% were not having any missing teeth, and 55.6% were not having any filled teeth. In plaque index, maximum number of subjects in all the age group were in the fair group, and there was a highly significant (P value <0.001) association between the age group and the plaque index groups. In gingival index, maximum number of subjects in all the age group was in the poor group. No significant (P value = 0.697) association between the age group and the gingival index groups was found. CONCLUSION: The present study concluded that the prevalence of dental caries was high and periodontal status of Down's syndrome subjects was poor.

Comparison of the application of treatment Panel III and American College of Cardiology/American heart Association guidelines for blood cholesterol treatment in Saudi Arabia.

BACKGROUND: One of the major risk factors for cardiovascular diseases is hyperlipidemia. The primary aim of this study was to estimate the proportion of individuals between 40-75 years old that would be eligible for statin therapy based on ACC/AHA guideline as compared to ATP-III guideline in a population of patients in Saudi Arabia. We also intended to extrapolate the results to the entire Saudi population, and estimate the cost implications of the ACC/AHA treatment guideline. METHODS: This study was a retrospective, observational study involving adult patients aged between 40-75 years old. The study was conducted at the primary health care clinics at King Abdul-Aziz Medical/Riyadh. The eligibility for statins use was assessed and compared for each patient based on both the recent 2013 ACC-AHA guideline and the 2002 ATP-III guideline. The cost implication of applying the ACC/AHA treatment guideline was estimated based on the average cost for 40 mg Atorvastatin in the Saudi Market. RESULTS: A total of 1005 patients were included in the study. Using the ATP-III guideline, there were 139 male (43.7%) and 279 female (40.6%) eligible to receive statin therapy. Based on the 2013 ACC/AHA guideline, treatment is recommended in 315 males (99.1%) and 564 females (82.1%). On the other hand, high-intensity statin was recommended in 302 male (95%) and 400 female (58.2%). Only 74 (10.5%) patients were prescribed high-intensity statin of the 702 eligible patients. Extrapolating the results to the entire Saudi population, 2.369 million additional patients would be eligible for statin therapy when applying the ACC/AHA guideline. Applying the new guideline would result in a cost increase of at least 4.318 billion SR per year. CONCLUSIONS: The eligibility for statin therapy was much higher when applying the ACC/AHA guideline as compared to ATP-III guideline. Applying the recent ACC/AHA dyslipidemia guideline increased the number of patients eligible for statin therapy to approximately two folds. This would be associated with a substantial increase in cost and possibly side effects. The concerns surrounding the ACC/AHA guideline should be addressed at the national level.