Hassan Y. Al-Idrissi

Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy

A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone and high-dose metoclopramide in the treatment of chemotherapy-induced nausea and vomiting. All entered patients had no prior chemotherapy and all received inpatient emetogenic chemotherapy mainly without cisplatin. Of the 40 evaluable patients, 23 (58%) had no vomiting with dexamethasone compared with only 11 (28%) receiving metoclopramide (P less than 0.025). Dexamethasone was found to have less adverse effect than metoclopramide on patients appetite and activity (P less than 0.025 and P less than 0.01, respectively). Twenty-one patients (53%) developed mild to severe somnolence with metoclopramide compared to only seven (18%) who experienced this adverse effect with dexamethasone (P less than 0.01). Six patients (15%) developed extrapyramidal manifestations with metoclopramide, but none with dexamethasone. Furthermore, during dexamethasone therapy, patients developed less diaphoresis, insomnia, headache and dizziness. Upon questioning patients about their preference to future use of the antiemetic drug therapy, 28 patients (70%) preferred dexamethasone, two (5%) preferred metoclopramide and 10 (25%) found no difference. We conclude that high-dose dexamethasone has a greater antiemetic activity and is more safe than high-dose metoclopramide in patients receiving emetogenic chemotherapy mainly without cisplatin.

Non-Hodgkin's Lymphoma in Saudi Arabia: Prognostic Factors and an Analysis of the Outcome of Combination Chemotherapy Only, for Both Localized and Advanced Disease

Seventy-eight previously untreated patients with clinical stage (CS) I and II (42 patients) and CS III and IV (36 patients) and non-Hodgkins lymphoma (NHL) were treated with systemic chemotherapy only. All patients had intermediate or high grade lymphoma. Two different regimens were used: bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP); and a combination of methotrexate with folinic acid rescue, epirubicin, cyclophosphamide, vincristine, prednisone and bleomycin (MECOP-B), for 57 and 21 patients respectively. Objective clinical remission was achieved in 90% of the cases, of which 73% were complete. Complete remission (CR) was demonstrated in 90% and 53% of patients with CS I + II and III + IV respectively (P = 0.0008). Two variables, bone marrow and liver involvement, were negatively associated with CR rate in a multivariate analysis. The actuarial overall survival for the entire group was 65%. The median survival for complete responders has not been reached, but a projected 80% relapse-free survival at 3 years is estimated. The Cox proportional hazards model predicted that advanced stage (CS III and IV) and pretreatment lactic dehydrogenase serum level above 400 iu/l (N less than 200 iu/l) independently influenced survival adversely. The latter prognostic variables were used to identify several groups with different risk probabilities. Despite an apparent comparability between patients receiving the two regimens, no significant difference in response or survival rates was noted between the two protocols. We conclude that the results of systemic chemotherapy compared favorably with radiation therapy for early stage disease and is an acceptable strategy for developing countries with limited availability of radiotherapy facilities. Based on certain risk factors, therapy should be individualized so that more intense regimens, with or without radiation, should be offered only to those patients in the high risk group at highly specialized centers.

Combination chemotherapy only for stage II non-Hodgkin's lymphoma

Twenty-six previously untreated patients with clinical stage (CS) II B non-Hodgkins lymphoma (NHL) were treated with systemic chemotherapy only. Patients received bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP). All patients had intermediate- or high-grade lymphoma. Objective response was demonstrated in 25 patients (96%), with 21 patients (81%) achieving complete remission (CR). Two of CR patients developed unsalvageable relapse, the remaining 19 patients are still alive and disease-free. The median duration of CR has not been reached. Of four patients (15%) with documented partial remission (PR), three were salvaged using second-line therapy. Over a median follow-up of 12 months (range, 3-30), 22 patients (85%) are alive and disease-free, of whom 16 (62%) have survived more than 1 yr. Bulky disease or gastrointestinal tract (GIT) involvement did not influence the CR rate. Our results compared favorably with radiation therapy for stage II NHL; however, a larger controlled and randomized study is warranted.

­­­­­­­­­­­­­Gastric malignancy : Clinicopathologic spectrum and relationship to helicobacter pylori infection

BACKGROUND Upper gastrointestinal cancer particularly of stomach is a relatively frequent form of cancer. Gastric H pylori infection has been implicated in the pathogenesis of both gastric carcinoma and gastric lymphoma. Gastric carcinoma has been addressed by many articles in the Kingdom of Saudi Arabia (KSA) and the Middle East, while only a few addressed gastric lymphoma. AIM OF THE STUDY To investigate the relative frequency of gastric carcinoma and gastric lymphoma and their association with H pylori infection in endoscoped patients. PATIENTS AND METHODS A retrospective study of patients endoscoped at King Fahad Hospital of the University, Al-Khobar, KSA during the period 1983-1999 was performed. Endoscopy and pathology records were retrieved and reviewed. The histopathology slides were re-examined, applying immunohistochemical techniques on corresponding paraffin sections to classify the various tumors. H pylori were identified on routine histology and by utilizing Giemsa stain. RESULTS During the study period of 17 years (1983-1999), a total of 94 endoscopically-diagnosed, histologically-confirmed cases of gastric malignancy were identified. Of these, there were 55 gastric adenocarcinoma and 39 gastric lymphoma. H pylori was identified in the adjacent gastric mucosa in 18 of all cases of gastric adenocarcinoma and in 27 of the 39 cases of lymphoma. CONCLUSION The study demonstrates the comparatively high frequency of gastric lymphoma in this population and confirms the intimate association of H-pylori infection to both gastric adenocarcinoma and MALT-lymphoma. Gastric lymphoma should always be considered in the differential diagnosis of gastric malignancy and the use of immunohistochemistry is essential for the differential diagnosis of some of these tumors.

Prevalence of Primary Adult Lactose Malabsorption in the Eastern Province of Saudi Arabia

Although it has been reported that adult lactose malabsorption (ALM) is relatively common among Arabs, data on the prevalence of ALM in the Saudi and Yemeni populations are scant. We have determine...

Granulomatous oesophagitis: a case of tuberculosis limited to the oesophagus.

In this paper we report on a 31-year-old Saudi male with tuberculosis limited to the oesophagus, presenting with dysphagia. Radiological examination revealed oesophageal ulceration with diverticulum formation. The diagnosis of oesophageal tuberculosis was made only after endoscopy and histopathological examination. The patient gained weight and became symptomless after three months of chemotherapy with antituberculous drugs. The rarity of such a presentation prompted this case report.

Duodenal Ulcers in the Eastern Region of Saudi Arabia

Using a method that involves corrections for pyloric losses and duodenogastric reflux, we determined gastric acid secretion in 36 control subjects (25 males and 11 females) and 58 patients with duo...

Evaluation of students' performance and examination procedures in final certifying examinations in internal medicine (1982-1988).

We conducted a retrospective analysis to evaluate the performance of 459 students on their final certifying examination in internal medicine. These examinations were taken during 1982 through 1988, and the failure rate was 17.6%. Two hundred and five students (44.6%) received grade D (60-69% of the total marks) and 139 (30.1%) grade C (70-79% of total marks). Only 7.7% of the students scored higher (80% or more). A temporal trend has been observed in that a higher percentage of lower grades and lower percentage of higher grades has been observed in recent (1986-1988) compared with earlier (1982-1984) years. Female students generally performed on a par with males, though males students performed better on multiple choice questions (MCQs). The analysis also showed lower mean scores for the essay, oral, and clinical components in recent (1986-1988) than in earlier (1982-1984) years. In studying the interrelationships between different examination components, the MCQs were found to have the highest correlation with other procedures. A lower correlation was observed for clinical examination. Factor analysis also showed that MCQs had the highest and clinical examinations the lowest factor loading. Low correlation and factor loading were also noted for the essay portion. While in the newly implemented curriculum the essay paper has been wisely eliminated, our data suggest that the traditional clinical examination should be replaced by a more objective and structural method. Our analysis may serve as a guide for formulation of final certifying examinations in medical schools throughout the Kingdom.

Life events stress in Saudi peptic ulcer patients of the eastern province.

The frequency of stress, as measured by the occurrence of 34 life events in the year preceding evaluation, was compared between 51 Saudis with peptic ulcers, diagnosed endoscopically, and 52 Saudis without peptic ulcer. All subjects were examined at King Fahd Hospital, Al-Khobar, Eastern Saudi Arabia, and were seen between March 1985 and July 1987. The mean number of events, their frequency distribution, and their categorization into areas of activity such as bereavement and other problems relating to health, marital, financial, and undesirable circumstances were similar for both groups. With regard to individual events, the only significant differences between ulcer patients and controls were that more patients had had serious arguments with in-laws or relatives and more controls had had minor personal illness or moderate financial problems. Excessive stress, as measured by life events, does not appear to be evident in Saudi peptic ulcer patients of the Eastern Province. Anxiety and/or depression was significantly more frequent in the group of patients with ulcers.

Clinical Usefulness of Predicted Creatinine Clearance in Cancer Patients Receiving Cisplatin Therapy

ABSTRACT We assessed the practical usefulness of a formula known to predict creatinine clearance in 40 consecutive cancer patients admitted for cisplatin chemotherapy. Of 112 24-hour urine collecti...