King Fahad University Hospital of Dammam (KFHU) is a major referral teaching Hospital in the Eastern province in Saudi Arabia. With permission, The Breast Division at KFHU accepts expatriate patients for treatment of breast cancer free of charge. Between Jan 2010 and June 2015 the unit has received 435 new and previously treated breast cancer patients, 35% of them were expatiates. We have noticed that most of these patients had an out of their hand delay in initiating either their investigations for a breast lump or start of active treatment; this has resulted in less than optimum prognosis in many cases. We reported that 75% of these patients had an average of 6-19 months delay before they presented for investigations of a breast mass, 25% had received previous irregular treatment and did not complete their management due to war unrest and travelling. More than 70% of patients who needed radiotherapy …

[en] Respiration induced heart movement during radiotherapy exposes the heart to the inevitable risks of radio-exposure, and hence radiation injury, in cases of Lt. sided breast cancer. The impact of such a risk is additionally aggravated by the use of radiotherapy in combination with cardiotoxic chemotherapeutic agents. Radio-oncologists pay special attention to the coronary arteries that might be included in this small part of the heart exposed to radiation. The aim of this study was to include the internal heart movement for improving respiration-gated radiotherapy of left sided breast cancer. For 70 patients, all females left sided breast cancer, two planning CT's in inspiration and expiration, and one free breathing scan are performed. The heart motion was analyzed with the clinic-developed software ORAT in the simulator sequence for acquiring information of the cranio-caudal amplitude of heart movements in free breathing (respiration-induced amplitude) and a 15 seconds breath-hold phase (inherent amplitude). The role of inherent heart movement varies from one patient to another which should be taken in consideration during defining the parameters of respiration-gated radiotherapy. The inherent amplitude of the heart motion is the physiological lower limit of the respiration-gating window.

Subclinical hypothyroidism (SH) is defined as serum thyroid-stimulating hormone (TSH) above the upper limit of the reference range in the presence of normal free T4 concentrations. Depending on the degree of TSH elevation, SH could be defined as mild (TSH, 4.5–10 mIU/L) or severe (TSH>10 mIU/L). While there is a general consensus to treat children with serum TSH levels above 10 mU/L, the management of the mild form is uncertain and should be individualized. In this mini-review, we present a brief review of SH in children based on extensive literature review and long-standing clinical experience. This review provides the prevalence, causes, clinical presentation, consequences, investigation, and up-to-date therapeutic approach of SH in children. Generally, the purpose of the review is to provide pediatricians with an update of this common and continuously evolving condition.

Evaluate ferritin levels in children and adolescents with type 1 diabetes mellitus and its
relation to diabetic microvascular complications, and metabolic control. Subjects and methods: This
study included 180 children and adolescents with type 1 diabetes mellitus (T1DM) with a mean age
of 14.9 ± 3.1 years and 180 apparently normal children matched for age and sex (control group). All
children were evaluated with full history taking, thorough clinical examination, laboratory assessment
of high-sensitivity C-reactive protein and hemoglobin A1c (HbA1c), and evaluation of the presence of
microvascular complications. Serum ferritin levels were measured using electrochemiluminescence
immunoassay. The patients were divided into two groups according to the presence or absence of
microvascular complications. Results: Serum ferritin levels were significantly higher in patients
with T1DM in both groups compared with healthy controls (p < 0.001). Additionally, patients with
microvascular complications had higher serum ferritin concentrations than those without microvascular
complications (p < 0.001). Patients with microalbuminuria showed higher ferritin levels compared with
patients without microalbuminuria (p < 0.05). Stepwise regression analysis revealed that levels of HbA1c
and urinary albumin excretion were independently related to ferritin levels (p < 0.001 for both). On
receiver operating characteristic (ROC) curve analysis, a ferritin cutoff value of 163.6 ng/mL differentiated
patients with microvascular complications from those without microvascular complications with a
sensitivity of 92.1% and specificity of 93.4%. Conclusion: Serum ferritin levels are elevated in T1DM,
particularly in patients with microvascular complications.

Background and aims: Patients with congenital adrenal hyperplasia (CAH) are at increased risk of cardiometabolic
abnormalities. We aimed to evaluate vascular endothelial dysfunction and its association with serum neopterin
(NP) levels in CAH patients.
Methods: The study included 40 patients, with a mean age of 14.8 ± 2.6 years; 28 (70%) subjects were females.
They were compared with 40 healthy controls matched in anthropometric evaluation and measurement of
fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance [HOMA-IR], and serum NP
levels (nmol/L). Vascular ultrasound was used to measure brachial artery flow-mediated dilation (FMD%) and
carotid intima-media thickness (CA-IMT). According to the degree of control on medical treatment, patients were
classified into poor (n = 12) and good (n = 28) control groups.
Results: Compared to controls, CAH patients had lower brachial FMD% (4.60 ± 2.13 versus 9.31 ± 2.29, p =
0.001), similar CA-IMT (0.44 ± 0.08 versus 0.44 ± 0.06, p = nonsignificant) and higher NP (42.6 ± 11.6 versus
9.2 ± 3.8, p = 0.001). However, differences between poor and good control CAH patients were significant
regarding FMD%, CA-IMT, and NP measurements. FMD% correlated significantly with NP (r = ? 0.54, p =
0.001), high-sensitivity CRP (r = ? 0.53, p = 0.001), HOMA-IR (r = ? 0.31, p = 0.01), CA-IMT (r = ? 0.22, p <
0.05), diastolic blood pressure (r = 0.32, p = 0.01) and systolic blood pressure (r = ? 0.022, p < 0.05). NP was the
most significant independent predictor of FMD%, as determined by linear regression analysis (p = 0.001).
Conclusions: Our study showed that CAH patients had endothelial dysfunction, which is an early process of
vascular affection. This was significantly associated with NP levels, suggesting a crucial role of inflammation in
the pathogenesis of vascular damage. Further studies are needed to confirm our findings and to investigate the
exact role of NP, as either protective or proatherothrombotic.