Assessing frequency and clinical outcomes of BRCA mutated ovarian cancer in Saudi women

Purpose BRCA gene mutations (BRCAm) have an impact on patients’ characteristics and clinical outcomes of ovarian cancer (OC). The frequency and patterns of BRCAm vary among countries and ethnicities. There are limited data from Saudi Arabia (SA); thus, this study aims to determine the frequency, pattern, and impact on patient characteristics and outcomes of BRCAm OC compared to wild-type BRCA (BRCAw) in Saudi women. Methods This retrospective study evaluated women diagnosed with non-mucinous OC, fallopian tube, or peritoneal carcinoma who had BRCA status tested in an accredited lab between January 2016 and December 2017. The associations between various parameters and BRCAm were estimated using logistic regression. Statistical analysis performed with SPSS (Version 27). Result Sixty-one women with a median age of 52 at diagnosis were analyzed. Germline BRCA mutations were found in 41% of cases (25/61). The most common deleterious germline BRCA1 mutation was c.1140dupG (39%). Most women (72%) had no family history of cancers and 82% had advanced stage. Regardless of BRCA mutations, an optimal overall response rate (ORR) to first-line treatment has been achieved although most cases relapsed (84%) and the majority were platinum-sensitive relapse (85%). Higher ORR to subsequent lines and better survival were obtained in women with BRCA-mutation. Conclusion The prevalence of BRCAm of OC was higher in Saudi women compared to regional and most of the international figures. The better clinical outcomes of BRCAm women agreed with the reported evidence. Further studies on BRCA mutations of OC and genetic counseling are highly recommended. Trial registration Trial approved by the Institutional Review Board of King Faisal Specialist Hospital and Research Center (RAC # 2171137) and conducted at King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11,211, Saudi Arabia.

Safety and Efficacy of Multi-chamber Bag Parenteral Nutrition

Background There is a significant degree of debate regarding the use of standardized parenteral solutions. Multi-chamber bag parenteral nutrition (MCB-PN) showed advantages over compounded PN in previous literature. Meanwhile, some literature has shown the limitations in use of MCB-PN. This study was conducted to evaluate the nutritional efficacy and safety of commercially available MCB-PN.Methods All adult hospitalized patients who have been on MCB-PN for at least seven consecutive days at King Faisal Specialist Hospital & Research Center in Riyadh from January 2015 until December 2019 were included. Laboratory parameters were evaluated before PN started, which was used as a baseline, and every seven days while on PN. Primary outcomes were the percentage of patients who achieved calculated target calories and protein and the percentage of patients who developed electrolyte abnormalities. The secondary outcome was a percentage of adverse drug reactions during the treatment period.Results Two hundred and thirty-one patients met the inclusion criteria. Among the included subjects, 101 (44%) achieved target calories; 29 (12.6%) were underweight; 40 (17.3%) were normal weight; 18 (7.8%) were overweight; and 14 (6.1%) were in obese subgroups, with p-value 0.145. Sixty-eight (29.6%) achieved the target protein dose; 26 (11.3%) were underweight; 33 (14.3%) were normal weight; five (2.2%) were overweight; and four (1.7%) were in obese subgroups, with p-value < 0.01. One hundred and ninety-one (83.4%) developed electrolyte imbalances; 39 (16.9%) were underweight; 87 (37.7%) were normal weight; 34 (14.7%) were overweight; and 34 (14.7%) were in obese subgroups, with p-value 0.085, during the treatment period. A small percentage of ADRs and metabolic abnormalities were reported during the treatment period.Conclusion Among patients receiving MCB-PN, only 44% achieved the caloric target, and 29.6% achieved the target protein dose with fewer percentages of ADRs.

A Multi-Objective Optimization Method for Hospital Admission Problem—A Case Study on Covid-19 Patients

The wide spread of Covid-19 has led to infecting a huge number of patients, simultaneously. This resulted in a massive number of requests for medical care, at the same time. During the first wave of Covid-19, many people were not able to get admitted to appropriate hospitals because of the immense number of patients. Admitting patients to suitable hospitals can decrease the in-bed time of patients, which can lead to saving many lives. Also, optimizing the admission process can minimize the waiting time for medical care, which can save the lives of severe cases. The admission process needs to consider two main criteria: the admission time and the readiness of the hospital that will accept the patients. These two objectives convert the admission problem into a Multi-Objective Problem (MOP). Pareto Optimization (PO) is a common multi-objective optimization method that has been applied to different MOPs and showed its ability to solve them. In this paper, a PO-based algorithm is proposed to deal with admitting Covid-19 patients to hospitals. The method uses PO to vary among hospitals to choose the most suitable hospital for the patient with the least admission time. The method also considers patients with severe cases by admitting them to hospitals with the least admission time regardless of their readiness. The method has been tested over a real-life dataset that consisted of 254 patients obtained from King Faisal specialist hospital in Saudi Arabia. The method was compared with the lexicographic multi-objective optimization method regarding admission time and accuracy. The proposed method showed its superiority over the lexicographic method regarding the two criteria, which makes it a good candidate for real-life admission systems.

Assessing Frequency and Clinical Outcomes of BRCA Mutated Ovarian Cancer in Saudi Women

Purpose: BRCA gene mutations (BRCAm) had an impact on patients' characteristics and clinical outcomes of ovarian cancer (OC). The frequency and patterns of BRCAm vary among countries and ethnicities. There are limited data from Saudi Arabia (SA); thus, this study aims to determine the frequency, pattern, and impact on patient characteristics and outcomes of BRCAm OC compared to wild-type BRCA (BRCAw) in Saudi women.Methods: This retrospective study evaluated women diagnosed with non-mucinous OC, fallopian tube, or peritoneal carcinoma who had BRCA status tested in an accredited lab between January 2016 and December 2017. The associations between various parameters and BRCAm were estimated using logistic regression. Statistical analysis performed with SPSS (Version 27). Result: Sixty-one women with a median age of 52 at diagnosis were analyzed. Germline BRCA mutations were found in 41% of cases (25/61). The most common deleterious germline BRCA1 mutation was c.1140dupG (39%). Most women (72%) had no family history of cancers and 82% had advanced stage. Regardless of BRCA mutations, an optimal overall response rate (ORR) to first-line treatment has been achieved although most cases relapsed (84%) and the majority were platinum-sensitive relapse (85%). Higher ORR to subsequent lines and better survival were obtained in women with BRCA-mutation.Conclusion: The prevalence of BRCAm of OC was higher in Saudi women compared to regional and most of the international figures. The better clinical outcomes of BRCAm women agreed with the reported evidence. Further studies on BRCA mutations of OC and genetic counseling are highly recommended.Trial registration number and The addresses of the institution at which the work was performed:Trial approved by the Institutional Review Board of King Faisal Specialist Hospital and Research Center (RAC # 2171137) and conducted at King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Saudi Arabia.

Tuberculosis Diagnostics and Susceptibility in Saudi Arabia’s Western Region

Introduction: Saudi Arabia has a moderate infection rate of tuberculosis (TB) in comparison to other countries in the region. The prevalence of TB varies among different parts of the Kingdom, with its western provinces reporting to have the leading rate of incidence. Method : In this retrospective study, Acid-fast bacilli smear (AFB), and nucleic acid amplification test (NAAT) were performed on all positive cultures from 254 identified TB cases from November 2006 to August 2016 in King Faisal Specialist Hospital and Research Center – Jeddah, Saudi Arabia. Results: From the positive cultures for Mycobacterium tuberculosis complex, 99.1% were found to be positive by using NAAT. From the NAAT positive samples, only 36.8% were positive for AFB. TB was predominant among the younger age group (59.4%) compared to the elderly population (35.8%) and pediatrics (4.7%), and it was also observed that males had a higher prevalence of 56.3 % in comparison to females. In regards to the site of infection, 53.1 % were pulmonary and 46.9% from an extrapulmonary. It was noted that resistance to first-line anti-TB drugs individually was found to be 11.0% to Streptomycin, 10.2% to isoniazid, 5.1% to pyrazinamide, 2.4% to Rifampicin, and 1.2% Ethambutol, yet multi-drug resistance (MDR) was found in 2.4% of observed cases. Conclusion: Young age predominance, low direct smear positivity, increased incidence of the extrapulmonary site of infection, and re-emergence of TB resistance all were observed in our study compared to previous national surveys.