BACKGROUND Gram-positive bacterial infections are considered one of the major causes of mortality and morbidity in patients with cancer. Hence, the challenge lies in regulating the pervasive use of vancomycin in the management of infections facing such patients due to the anomalous vancomycin pharmacokinetics (PKs) and pharmacodynamics (PDs). Inappropriate vancomycin exposure is associated with toxicity, pathogen resistance, and therapeutic failure. OBJECTIVE The aim of this study was to estimate vancomycin PK in patients with cancer and without cancer. The standard dosage regimens of vancomycin were then evaluated using data from PK modeling. METHODS In this observational PK study, the data were extracted from a matched patient cohort of those with cancer and those without cancer. Pharmacokinetic analysis was performed using Monolix version 4.4, and the PK parameters were compared in both groups (cancer vs noncancer). The standard and suggested vancomycin dosing regimens were evaluated using PK/PD modeling and Monte Carlo Simulations. RESULTS In total, 448 blood samples were analyzed from 147 patients enrolled in this study, of which 73 patients had cancer and 74 patients were noncancer patients. In general, no significant differences were observed between the two groups (cancer vs noncancer) in all characteristics except for the vancomycin levels, which were significantly lower in patients with cancer (p = 0.00104). This analysis showed that patients with cancer showed a significantly higher vancomycin clearance than noncancer patients (p = 0.002), whereas the volume of distribution (V) was found to be similar in both groups (p = 0.83).This resulted in most of the patients failing to achieve the target area under the curve from zero to 24 hours (AUC 0-2) to the minimum inhibitory concentration. These data showed that a higher maintenance dose of vancomycin is required to achieve the PD target. CONCLUSIONS The findings of this study showed that the patients with cancer have lower levels of vancomycin due to higher clearance than noncancer patients. Thus, higher doses than the standard vancomycin doses may be needed to treat invasive Methicillin-resistant Staphylococcus aureus infections in patients with cancer.

BackgroundDue to limited data, our understanding of the trends and outcomes of adrenalectomy in the Saudi surgical practice is limited and insufficient. The aim of this study was to review the clinical data regarding the diagnosis and management of patients with adrenal masses and to assess the effect of surgeon specialty on the outcomes.

The aim of the study was to evaluate the knowledge, attitude, and practice toward prostate cancer and its screening methods among patients attending primary care facilities in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Materials and methodsA cross-sectional survey was conducted on a random sample of 385 men. The questionnaire was distributed using a non-random sampling method (convenience sampling) that included 13 questions that assess the knowledge, attitude, and practice of adult male patients toward prostate cancer and its screening methods. The questions were divided into three general questions that test the knowledge, four questions that analyze patients' opinions (attitude), and six questions on how patients are practicing screening methods with questions three and six being dependent on the answers to the questions that come before them. ResultsAround 64% of the participants had adequate knowledge about prostate cancer. Respondents with higher socioeconomic status demonstrated a higher level of knowledge about prostate cancer than the other groups. Regarding the attitude, more than 70% of the respondents believed that it is very important to screen for prostate cancer. About 23% of the participants had done some form of prostate screening test either prostate-specific antigen (PSA) or digital rectal exam (DRE); most of them were men older than 50 years. ConclusionsThe majority of the respondents to our survey demonstrated high general knowledge about prostate cancer. However, practice toward prostate screening methods was significantly low regardless of the positive attitude on the importance of screening. More data should be obtained to investigate the potential multifactorial reasons for such a low practice.

BACKGROUND: Our understanding of the risk factors, prevalence, incidence rate, and age distribution of bladder cancer (BC) in Saudi Arabia is insufficient due to limited data. OBJECTIVE: Describe the epidemiology and analyze factors associated with survival in patients with BC in Saudi Arabia. DESIGN: Retrospective medical record review. SETTINGS: Registry-based nationwide study. PATIENTS AND METHODS: The study included all records in the Saudi Cancer Registry of patients diagnosed with a primary BC from 1 January 2008 to 31 December 2017. Collected data included year of diagnosis, gender, age, marital status, region and nationality, tumor site of origin, tumor histological subtype, tumor behavior, tumor grade, tumor extent, tumor laterality, the basis of the diagnosis, and survival status. Factors predicting survival were tested by a Kaplan-Meier and Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: Mortality status on last contact. SAMPLE SIZE: 3750 patients. RESULTS: The overall incidence of BC was 1.4 per 100 000 persons. Significant differences in the distribution of survival were observed by age, gender, nationality, place of residency, tumor morphology, tumor grade and extension. The adjusted predictors of decreased survival were age, squamous cell carcinoma, Grade III and IV bladder tumors, regional direct extension, regional lymph node extension, combined regional lymph node and direct extension, and distant metastasis. Male gender and being widowed were predictors of improved survival in the unadjusted analysis. CONCLUSION: This study provides further understanding of BC in a region with a high prevalence of risk factorsuch as smoking. Highlighting these factors, specifically in Saudi Arabia, improves evidence-based practice in this region and may facilitate appropriate care to optimize outcomes. LIMITATIONS: Retrospective study and underreporting. CONFLICT OF INTEREST: None.