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Acne is the most prevalent skin disorder affecting primarily adolescents and young adults. Side effects of acne, such as scarring, dyspigmentation, and low self-esteem, can cause severe morbidity. Isotretinoin is a medication that is used to treat severe acne. The medicine was licensed by the Food and Drug Administration in 1982 to treat severe nodular acne that had been resistant to other treatments, including systemic antibiotics. Other indications of isotretinoin include moderate acne, cutaneous T-cell lymphomas, neuroblastoma, and the prevention of squamous cell carcinoma in high-risk patients. Rosacea, folliculitis, and pyoderma faciale have all been treated with isotretinoin. Some side effects are also associated with the use of isotretinoin including teratogenicity the most severe one. The purpose of this research is to review the available information about indication, contraindication, complication and monitoring of Isotretinoin. Various dermatological conditions are also treated with isotretinoin apart from the common indication of acne. Complete blood count along with the lipid profile, and liver function test are monitored in patients on isotretinoin therapy. Dry lips and dry skin are among the common side effects of isotretinoin. Due to the severe complication of teratogenicity isotretinoin is contraindicated among pregnant women. Evidence from the literature suggests that isotretinoin is the effective medication in treatment of acne and low dose of isotretinoin does not cause any complication. Evidence-based guidelines and strategies for safety and efficacy of isotretinoin can be developed by further clinical research and trials.

Alpha-lipoic acid, a sulphur-containing fatty acid, also known as thioctic acid, occurs as a coenzyme and component of the pyruvate dehydrogenase complex in the mitochondria of almost all living things with a cell nucleus. As a natural substance, it is considered a safe, well tolerated chelating agent. Unlike the hydrophilic chelating agents DMSA, DMPS or EDTA, which are prescription items, not easily available in some countries, the lipophilic α-lipoic acid (ALA) is a natural substance and as such not regulated as strictly. It has the ability to pass the blood brain barrier (BBB) and can thus penetrate all areas of the nervous system. Consequently, current research investigates whether and to what extent oral administration influences the development of metal-based multiple sclerosis (MS) and M. Alzheimer. With our clinical research we could confirm ALAs metal-binding ability and the extend of urinary excretion for the metals Arsenic, Barium, Manganese, Mercury and Nickel following oral application. We established a treatment protocol, suitable for people of all ages and confirmed the safety of ALA, if given in moderate doses.

Chronic health conditions comprise illnesses as well as physical disabilities that last longer than 12 months and limit the patient’s usual activity. The prevalence of chronic illnesses and disabilities in children and adolescents has more than doubled in the last 60 to 70 years. Common chronic conditions encountered among children across the globe include bronchial asthma, cystic fibrosis, diabetes mellitus, epilepsy, and developmental disabilities like cerebral palsy, in addition to congenital and heredofamilial conditions including certain hemolytic anemias and genitourinary disorders endemic to Saudi Arabia and the Middle East. Factors implicated in the shift in child health epidemiology from acute to chronic illnesses include better availability of diagnostic tools, improved specialized care access for pediatric patients suffering from complex congenital disorders, neoplasms, and premature births, and especially in case of disadvantaged populations, environmental factors like unhealthy living conditions, food insecurity and poor perinatal health. The two most common chronic conditions of childhood and adolescence managed by primary care physicians around the world and in Saudi Arabia are asthma and diabetes. Common risk factors across various diseases are urbanization, poor lifestyle, and consanguinity. The research on childhood-onset diseases and their different phenotypes in Saudi Arabia is scarce and confined largely to a few highly prevalent conditions at present.

Previous clinical studies show that the condition is significantly associated with mortality and increased cardiovascular morbidities. Accordingly, it is essential to conduct adequate diagnosis and evaluation to assess these cases properly. Studies show that different etiologies have been associated with hypercalcemia development with variable prevalence rates among different populations. Reduced PTH levels among patients with hypercalcemia indicate the presence of a non-PTH-dependant etiology for hypercalcemia. We have discussed various causes of hypercalcemia, including dependant and non-dependant causes. We found that malignancy-induced hypercalcemia is the commonest non-PTH-dependant etiology of hypercalcemia. Many malignancies were reported in the literature to attribute to the development of hypercalcemia. Vitamin D-mediated hypercalcemia was also reported as another common etiology for the condition. It might occur secondary to overdosing, immobilization, endocrine disorders, and granulomatous diseases. Other familial and congenital causes were also reported in the literature and discussed.

Background and purpose: Complementary and alternative medicine (CAM) therapies are commonly used by cancer patients around the world. The aim of this cross-sectional study was to explore the extent of CAM therapies use by cancer patients, discover patients’ motives, sources, and beliefs regarding the benefits of CAM therapies, and determine patient awareness of possible adverse effects. Materials and methods: A comprehensive, validated questionnaire in Arabic was explained and given to patients who provided their consent to participate. All patients attended King Saud University-Medical City Oncology Center. Results: Among the patients, 136 responded to the questionnaire and 97 (71.3%) reported using some form of CAM therapies. The most frequently used CAM therapies were Zamzam water (Holy water from Makkah), honey, olive oil, black seeds, dates, and camel milk (with/without camel urine). Many patients were unaware of any adverse effects of CAM therapies. Statistical analyses showed that there were no significant differences between users and non-users in terms of gender, age, nationality, marital status, or educational level (p<.05). Conclusion: Many cancer patients use various forms of CAM therapies because they believe that CAM therapies may be beneficial and are harmless. Key Words: Complementary and alternative medicine, cancer, neoplasm, Saudi Arabia.

Background: With acute myeloid leukemia (AML), there are limited data about the accuracy of day 14 bone marrow (BM) biopsies for predicting complete remission as compared to day 28 BM biopsy results. We here aimed to estimate the correlation between, and the diagnostic accuracy of, both approaches. Materials and Methods: We reviewed 84 patients with AML treated with standard induction chemotherapy to evaluate the remission rate and treatment decisions based on day 14 BM biopsy from 2000-2012. Results: Sixty five patients (77%) demonstrated remission (CR) with less than 5% blasts on their day 14 BM. Thirteen patients (16%) had residual disease (RD), and 6 (7%) were classified as indeterminate response (IR) i.e., blasts 5-20%. Two patients with RD on day 14 underwent re-induction. Out of the 17 remaining cases with RD+IR, 14 (all 6 with IR and 8 out of 11 with residual disease with no re-induction) demonstrated a morphologic complete remission (CR) on day 28 BM. The percentages for complete remissions on days 28 and 14 were significantly different [94% versus 79.3%, respectively; p=0.004, (OR= 0.143, 95% CI: 0.032-0.63)]. Day 14 BM had 82% sensitivity in predicting CR on Day 28; however, it had insufficient specificity (60%) in predicting failure of CR. Conclusions: Induction treatment response assessment based on day 14 BM does not accurately predict the response rate on day 28 and the use of day 14 BM as a sole marker of response to therapy might expose patients to unnecessary interventions.

Fibrinogen concentrate is the preferred choice for fibrinogen replacement in congenital fibrinogen deficiency. This study investigated hemostatic efficacy of a new plasma-derived, double virus-inactivated (using two dedicated virus inactivation/elimination steps) human fibrinogen concentrate for on-demand treatment of bleeding episodes (BEs) and surgical prophylaxis.In this planned interim analysis of a prospective, multinational Phase III study (NCT02267226), 13 patients with afibrinogenemia (≥12 years) received fibrinogen concentrate (FIBRYGA, Octapharma AG). Hemostatic efficacy was assessed by investigators and an independent data monitoring and endpoint adjudication committee (IDMEAC) using objective four-point criteria and by thromboelastometry maximum clot firmness (MCF).Fibrinogen concentrate was used on-demand to treat 23 BEs in 11 patients, with 21 (91.3%) requiring a single infusion only. Treatment success was 95.7% (90% confidence interval [CI], 0.81-1.00; assessment missing for one BE) by investigators and 100% (90% CI, 0.88-1.00) by IDMEAC. Mean MCF increased significantly from 0.0 to 6.5 mm (95% CI, 5.65-7.40; p 0.0001) at 1 hour postinfusion of a median (range) dose of 58.8 (33.9-101.7) mg/kg per BE. Four patients received fibrinogen concentrate as surgical prophylaxis, with intraoperative and postoperative treatment success rated 100% (90% CI, 0.50-1.00) by investigators and IDMEAC (median [range] dose per surgery 93.5 [34.1-225.4] mg/kg). No additional hemostatic interventions were required. No deaths, thromboses, or seroconversions were reported.These data showed that the new fibrinogen concentrate was efficacious for on-demand treatment of acute bleeding and surgical prophylaxis in congenital afibrinogenemia patients.

To compare direct smear technique with ethylenediaminetetraacetic acid (EDTA) preserved smear technique in terms of preparing bone marrow aspirate slides.This prospective study was carried out between September 2009 and July 2012 at the Haematology/Oncology Department, King Khalid University Hospital, Riyadh, Saudi Arabia. With a standard gauge disposable bone marrow aspirate needle, 0.5 to 1.0 ml bone marrow was aspirated with a 10ml syringe. Half of the marrow was immediately transferred to an EDTA tube with gentle mixing, while slides were prepared directly from the rest of the sample in the syringe. The tube sample was used to prepare slides at the end of the procedure. A score of 1-4 was assigned to each slide depending on the quality and number of particles.A total of 245 bone marrow aspirate samples were evaluated related to 216 patients. Of the total, 238 (97%) samples were included in the study. The mean score for the direct smear group was 3.40±0.79 and for the EDTA smear group it was 3.34±0.75 (p=0.27), which was not statistically significant. An informal comparison of the morphological analysis of the samples did not reveal any differences.Bone marrow aspirate slides prepared at the end of the procedure from EDTA preserved samples were not inferior to slides prepared directly from the aspirated sample.