Khalid Sait

Massive ascites as a presentation in a young woman with endometriosis: a case report.

OBJECTIVE To report a case of endometriosis associated with massive ascites and an elevated CA-125 level. DESIGN Case report. SETTING Tertiary care center. PATIENT(S) A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer. INTERVENTION(S) Ultrasonography, laparotomy, and bilateral ovarian cystectomy and reconstruction. Endometriosis was diagnosed postoperatively on the basis of histopathology. The patient received 6 months of treatment with a GnRH analogue. MAIN OUTCOME MEASURE(S) Ultrasound examination 6 months after surgery to evaluate for ascites or recurrent ovarian cysts. RESULT(S) Frozen sections obtained at laparotomy and ovarian cystectomy ruled out a malignancy. The final histologic report was compatible with a diagnosis of endometriosis. After 6 months of treatment with the GnRH analogue, the patient experienced a progressive reduction of the ascitic fluid and full remission after 2 years. CONCLUSION(S) Endometriosis associated with massive bloody ascites is an unusual occurrence. This report draws attention to this condition as a complication of endometriosis. For this reason, endometriosis should be included in the differential diagnosis of reproductive-age women presenting with an apparent ovarian malignancy.

Prevalence of human papillomavirus in women from Saudi Arabia.

BACKGROUND Human papillomavirus (HPV) infection is the main causes of cervical cancer in women worldwide. The goal of the present study was to determine the prevalence and distribution of HPV genotypes in women from Saudi Arabia. Recently, several HPV detection methods have been developed, each with different sensitivities and specificities. METHODS In this study, total forty cervical samples were subjected to polymerase chain reaction and hybridization to BioFilmChip microarray assessment. RESULTS Human papillomavirus (HPV) infections were found in 43% of the specimens. The most prevalent genotypes were HPV 16 (30%) HPV 18 (8.0%) followed by type HPV 45, occurring at 5.0%. CONCLUSION Our finding showed the HPV infection and prevalence is increasing at alarming rate in women of Saudi Arabia. There was no low risk infection detected in the tested samples. The BioFilmChip microarray detection system is highly accurate and suitable for detection of single and multiple infections, allowing rapid detection with less time-consumption and easier performance as compared with other methods.

Prevalence of high-risk human papillomavirus infections in healthy Saudi women attending gynecologic clinics in the western region of Saudi Arabia.

BACKGROUND AND OBJECTIVES Infection with human papillomavirus (HPV) is the major cause of cervical cancer. There is little published data on the prevalence of HPV infection among Saudi women. The aim of this study was to determine the prevalence of HPV in a group of women in the western region of Saudi Arabia. DESIGN AND SETTING A prospective study of Saudi women seeking gynecologic care at King Abdulaziz University Hospital from March 2010 to January 2011. PATIENTS AND METHODS Four hundred eighty-five Saudi women of different age groups attending gynecology clinic were tested for high-risk HPV DNA. HPV DNA was detected in cervical scrapes using Hybrid Capture 2 (HC2) high-risk HPV DNA test. The prevalence of HPV DNA positivity in different age groups was calculated. RESULTS Out of the 485 specimens, 27 (5.6%) were positive for the high-risk HPV. The highest percentage was among women aged 60 years and older. Patients in the age group 40–49 years were more likely to accept HPV testing with a total of 188 patients. CONCLUSION The prevalence of HPV in this group of Saudi women is similar to what was reported in some Arab countries and lower than that reported in developed countries. This information could be used to help in establishing a primary screening program using HPV DNA testing in Saudi Arabia.

Perception of patients with cancer towards support management services and use of complementary alternative medicine--a single institution hospital-based study in Saudi Arabia.

BACKGROUND To evaluate the perception of cancer patients toward treatment services and influencing factors and to inquire about the use of complementary alternative medicine (CAM). MATERIALS AND METHODS Information was obtained through pre-tested structured questionnaires completed by cancer patients during treatment at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS Of 242 patients, 137 (64.6%) accepted to enter this study. Most were Saudi (n=93, 68%), female (n= 80, 58%), educated at university (n=71, 52%), married (n=97, 72%) and with breast cancer (n=36, 26%). One-hundred (73%) patients were satisfied with the services provided; 61% were Saudi. Ninety-four (68%) respondents were satisfied with the explanation of their cancer. Twenty-eight (21.6%) patients received CAM, of them 54.0% received herbal followed by rakia (21.0%), nutritional supplements/vitamins (7.0%) and Zamam water (18.0%), with significant differences among them (p =0.004). Seven (5%) patients believed this therapy could be used alone; 34 (25%) patients believed it could be used with other treatments, regardless of whether they themselves used this therapy. Fifty-three (53%) satisfied patients felt they received enough support; 31 (58%) patients received support from family and friends; 22 (41.6%) patients received support from the health-care team. Patients who received information about their disease from their physicians and those who felt they had enough support were more satisfied. The patients who took alternative treatment were older age, mostly female and highly educated but values did not reach significance. CONCLUSIONS We stress enhancing the educational and supportive aspects of cancer-patient services to improve their treatment satisfaction and emphasize the need for increasing the educational and awareness programs offered to these patients.

Current Understanding of HSP90 as a Novel Therapeutic Target: An Emerging Approach for the Treatment of Cancer

Heat Shock Protein 90 (HSP90) is a ubiquitous molecular chaperone that is considered to be the most abundantly expressed protein in various human cancers such as breast, lung, colon, prostate, leukemia and skin. The master regulator, HSP90 plays a pivotal role in the conformational stabilization, maturation and activity of its various labile oncogenic client proteins such as p53, ErbB2, Bcr-Abl, Akt, Her-2, Cdk4, Cdk6, Raf-1 and v-Src in altered cells. Hence, making a guaranteed attempt to inhibit such a master regulator for cancer therapy appears to be a potential approach for combinatorial inhibition of numerous oncogenic signaling pathways simultaneously. Considerable efforts are being under way to develop novel molecular targets and its inhibitors that may block key signaling pathways involved in the process of tumorigenesis and metastasis. In this regards, HSP90 has acquired immense interest as a potent anticancer drug-target due to its key functional link with multiple signaling pathways involved in the process of cell proliferation and cell survival. Notably, geldanamycin and its derivatives (17-AAG, 17-DMAG) have shown quite encouraging results in inhibiting HSP90 function in several cancers and currently almost 17 drug candidates known to be target HSP90 are being under clinical trials either as single agents or combinatorial therapy. Hence, this review is an attempt to get new insight into novel drug target therapy by focusing on recent advances made in understanding HSP90 chaperone structure-function relationships, identification of new HSP90 client proteins and, more importantly, on the advancements of HSP90 targeted therapy based on various existing and emerging classical inhibitors.

Ovarian Teratoma Diagnosis and Management: Case Presentations

BACKGROUND Ovarian teratomas (OTs) may be of mature or immature morphologies. Mature cystic teratomas (MCTs), often referred to as dermoid cysts, are the most common germ cell tumours of the ovary in women of reproductive age. OTs are usually asymptomatic until they reach considerable size. Frequently, ultrasonography is diagnostic. Women requiring surgery for OTs should be appropriately counselled about the risks and benefits of laparoscopic and open approaches. CASE PRESENTATIONS Case I: An 18-year-old woman presented with hirsutism and irregular menses, both of which reversed after bilateral MCT removal by laparoscopy. Case II: A 47-year-old multigravid woman presented with a large unilateral OT, with a focus of malignancy. Case III: A 19-year-old woman presented with a large unilateral OT associated with gliomatosis peritonei. CONCLUSION Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of OT in selected cases. Women younger than 15 years of age or older than 45 years of age who have large, solid teratomas on ultrasound or positive markers for germ cell tumours are at risk for malignant variants, and for these women laparotomy is the preferred approach.

Molecular tests to detect human papillomavirus infection in patients with cervical dysplasia and invasive cervical cancer in Saudi Arabia

correspondence: Khalid h Sait Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia Tel +966 2 640 8111 Mob +966 50 569 3160 Fax +966 2 640 8111 email khalidsait@yahoo.com Purpose: The aim of this study was to determine the actual human papillomavirus (HPV) subtype that presents in cervical dysplasia and invasive carcinoma in the Saudi population, and the feasibility of using Hybrid Capture 2 technique (HC2) on biopsy specimens to detect certain HPV subtypes. Patients and methods: A prospective study was conducted from March 2007 to December 2008. The subjects studied were women with a mean age of 48.18 years, who attended the hospital for cervical biopsy due to the suspected diagnosis of cervical dysplasia or an invasive disease, based on previous suspicious Pap smear. HPV DNA hybridization by HC2 was performed on the cervical biopsies of these patients, to detect HPV infection. Results: During the period of this study, 45 patients had cervical biopsies taken for HPV testing. Seven patients had a negative HC2 result and were found to have no cervical dysplasia on the final pathology review. Seventeen cases with cervical dysplasia and 21 patients with invasive disease were presented; the mean age was 48 years. HC2 testing for HPV were found to be positive in patients with cervical dysplasia, invasive carcinoma, and all in 5 (29.4%), 13 (61.9%) and 18 (47.4%), respectively. The sensitivity of the test is 47% and specificity is 100%. Conclusion: The use of molecular detection of HPV DNA by HC2 in biopsy is feasible and effective. These results confirm the finding that HPV contributes to the etiology of cervical cancer in Muslim society.

Hysterectomy for benign conditions in a university hospital in Saudi Arabia.

BACKGROUND AND OBJECTIVE Hysterectomy is a common surgical procedure among women with a lifetime prevalence of 10%. The indications and complications of this procedure have not been previously reported from a teaching institution in Saudi Arabia. We examined the indications for hysterectomy and the surgical morbidity for women undergoing hysterectomy at a university hospital in Saudi Arabia. PATIENTS AND METHODS We reviewed the records of women who underwent hysterectomies for benign gynecological conditions between January 1990 and December 2002, at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, comparing patient characteristics, indications for hysterectomy and the rate of complications in women undergoing abdominal hysterectomy (AH) versus vaginal hysterectomy (VH). RESULTS Of 251 women, 199 (79%) underwent AH and 52 (21%) underwent VH. An estimated blood loss of ≥500 mL occurred in 104 patients (52.3%) in the AH group and in 20 patients (38.5%) in the VH group (difference not statistically significant). The most common indications for hysterectomy were uterine fibroids (n=107, 41.6%) and dysfunctional uterine bleeding (n=68, 27.1%). The most common indication for VH was uterine prolapse (n=45, 86.5%). The overall complication rates were 33.5%, 15.4% and 30.4% in women who underwent AH, VH and both, respectively. Intraoperative and postoperative complications occurred in 24 (9.7%) patients in the AH group and in 51 patients in the VH group (20.3%). Postoperative infection occurred in 42/199 (21.6%) in the AH group and 5/52 (9.6%) in the VH group (difference not statistically significant). CONCLUSIONS We describe a large series of hysterectomies, which provides information for surgeons on the expected rate of complications following hysterectomy for benign conditions. We found that the rate of complications was not significantly higher than other centers internationally.

Cervical Cancer Prevention in Saudi Arabia: It is Time to Call for Action

Background: Cervical cancer is the third most common cancer in the world, with 2.3 million prevalent cases and 510,000 incident cases documented each year. Annually, 288,000 women die of cervical cancer, and 80% of these deaths occur in developing countries. The population of Saudi Arabia is young and growing at an increasing rate. The es- timated number of new cases of cervical cancer in 2025 is 309. Lake of comprehensive information on cytological cervi- cal abnormalities and cervical Humen Papiloma virus (HPV) infection in Saudi Arabia. Objectives: One aim of this review is to understand the current status of cervical cancer in Saudi Arabia. Based on this in- formation, another aim is to formulate recommendations for cervical cancer prevention that can be applied in our local setting. Methods: An English literature search was conducted using the Pub Med data base between January 2000 till June 2011 , which aimed to review all the publication which was done regarding cancer cervix and cervical dysplasia in the kingdom of Saudi Arabia. Suggestions and Recommendations: Screening should be started at a later age and should include human papillomavirus (HPV) testing. The age of onset of screening should be determined based on data collected regarding the age of sexual de- but for women.

Clinical Practice Guidelines on the Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention in Saudi Arabia.

BACKGROUND Cervical cancer is the third most common gynecological malignancy in Saudi women with an estimated incidence rate of 1.9 cases per 100 000 women-years. More than 40% of cervical cancer cases are diagnosed at advanced stages due to lack of a routine screening program in Saudi Arabia. Thus, national guidelines for routine screening and treatment of precancerous cervical lesions are needed. METHODS The Saudi Centre for Evidence-Based Healthcare invited a panel of local experts and partnered them with a team from McMaster University in Canada for methodological support, to develop national clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer. After the panel identified key clinical questions, the McMaster University working group updated existing systematic reviews that had been used for the 2013 WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Recommendations were based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Those recommendations took into account the available evidence, patient values and preferences, and resource use in the Saudi context. The panel provided recommendations on two major issues: screening for precancerous lesions (cervical intraepithelial neoplasia 2 & 3) and treatment of those lesions to prevent cervical cancer in women who tested positive after screening. CONCLUSIONS The Saudi expert panel recommends using the HPV DNA test followed by colposcopy or cytology (Pap test) followed by colposcopy to screen for CIN2+ in women at risk of cervical cancer. The panel recommends cryotherapy or loop excision electrosurgery procedure (LEEP) over cold knife cone biopsy to treat women at risk of cervical cancer that tests positive for CIN2+. Universal screening for precancerous cervical dysplasia in women in Saudi Arabia is recommended using HPV testing and or cytology. Either cryotherapy or LEEP are preferred for treatment. LIMITATIONS National studies on cervical cancer screening modalities and treatment of precancerous cervical lesions, including HPV prevalence and its association with cervical cancer, are scarce.