Impact of renin-angiotensin system blockade on clinical outcome in glioblastoma.

BACKGROUND AND PURPOSE: Despite surgery, radiotherapy (RT) and temozolomide (TMZ), the prognosis of glioblastoma (GBM) patients remains dismal. Normally prescribed with the aim to lower blood pressure, angiotensin-II (Ang-II) inhibitors were reported to reduce angiogenesis and tumour growth in several tumour models including one glioma. Thus whether treatment with Ang-II inhibitors could be associated with a better clinical outcome in GBM patients was investigated. METHODS: A series of 81 consecutive patients, homogeneously treated with RT and TMZ for a newly diagnosed, supratentorial GBM, were analysed. The objective of this retrospective study was to assess the impact of angiotensin-converting enzyme inhibitors (ACEIs) and Ang-II receptor 1 blockers (ARBs) on functional independence, progression-free survival (PFS) and overall survival (OS). RESULTS: Amongst the 81 GBM patients analysed, 26 were already treated for high blood pressure (seven with ACEIs and 19 with ARBs). The number of patients who remained functionally independent at 6 months after RT was higher in the group of patients treated with Ang-II inhibitors compared to the other patients (85% vs. 56%, P = 0.01). In patients treated with Ang-II inhibitors, PFS was 8.7 months (vs. 7.2 months in the other patients) and OS was 16.7 months (vs. 12.9 months). The use of Ang-II inhibitors was a significant prognostic factor for both PFS (P = 0.04) and OS (P = 0.04) in multivariate analysis. CONCLUSION: Treatment with Ang-II inhibitors in combination with RT and TMZ might improve clinical outcome in GBMs. Prospective trials are needed to test this hypothesis.

Knowledge, attitude, and practice toward COVID-19 among the public in three Gulf countries - a cross-sectional survey.

OBJECTIVE: This study investigated the knowledge, attitude, and practice toward COVID-19 among residents/citizens of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Kuwait. PATIENTS AND METHODS: A cross-sectional online survey on 3,920 citizens/residents from three Gulf-countries (KSA, UAE, and Kuwait) was conducted between June 15 and August 25, 2020. The survey instrument consisted of demographic characteristics, 13 items on knowledge, 4 items on attitudes, and 7 items on practice towards prevention and control of COVID-19. The Survey link was constructed to be available in Arabic and English. Descriptive statistics of frequency distribution and percentages were calculated, and non-parametric tests were applied to compare the mean knowledge, attitude, and practice scores among different countries. RESULTS: This study included participants from KSA (2,938, 74.9%), UAE (403, 10.3%), and Kuwait (579, 14.8%). The study subjects from KSA, UAE, and Kuwait showed significant differences in the mean knowledge (10.13, 10.52, and 9.19, p<0.001), attitude (2.84, 3.12, and 5.98, p<0.001), and practice (6.11, 5.98 and 5.38, p<0.001) scores towards COVID-19. In addition, Kuwaiti citizens and residents showed significantly lower knowledge, attitude, and practice scores toward COVID-19 than UAE and KSA participants. Participants from Kuwait showed significantly lower knowledge, attitude, and practice scores than the UAE and KSA. However, in general (38.2%), the study participants were optimistic about controlling Coronavirus. Nearly 48.6% started to take an immune-boosting diet to protect themselves from the Coronavirus. CONCLUSIONS: Study participants from KSA, UAE, and Kuwait demonstrated adequate knowledge, positive attitude, and acceptable practices towards COVID-19 control. Electronic and social media should be effectively utilized to spread awareness of COVID-19 among the public.

Urinothorax following blunt trauma to the kidney.

A case of urinothorax is reported in a 19-year-old girl with multiple injuries sustained in an auto accident. Thus blung injury to the right kidney was followed 8 days later by reduced urinary output and serous chest tube drainage. Intravenous dye injection showed dye in urine and in chest tube fluid, and the macerated right kidney was removed. The right pleural effusion then cleared with further drainage. The mechanism by which urine is transferred across the intact diaphragm is thought to be lymphatic drainage.