Annals Of Saudi Medicine[JOURNAL]
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200 papers
Epidemiology and risk factors of colorectal polyp detection: a regional, single-center retrospective study.
Tao J, Wang X, Wei S … +1 more , Zhao X
Ann Saudi Med · 2026 · PMID 42251520 · Full text
BACKGROUND: Colorectal polyps are the most important precursor lesions of colorectal cancer. Their epidemiological characteristics and risk factors exhibit substantial regional and population-based variations. Qinghai Pr...
BACKGROUND: Colorectal polyps are the most important precursor lesions of colorectal cancer. Their epidemiological characteristics and risk factors exhibit substantial regional and population-based variations. Qinghai Province, located on the Qinghai-Tibet Plateau in China, is characterized by a unique hypoxic environment and a multi-ethnic population. However, large-scale epidemiological data on colorectal polyps in this region is limited. OBJECTIVE: To characterize the detection rate, temporal trends, demographic distribution, and risk factors for colorectal polyps in Qinghai Province. DESIGN: Retrospective study. SETTING: A single tertiary medical center in Qinghai Province, China. PATIENTS AND METHODS: We enrolled 33059 patients who underwent colonoscopy at Qinghai University Affiliated Hospital (2021-2025). Data on demographics and endoscopic findings were collected. Temporal trends were analyzed using the linear-by-linear association LLA test, and independent risk factors were identified by binary logistic regression. MAIN OUTCOME MEASURES: Colorectal polyp detection rate and risk factors. SAMPLE SIZE: 33059 patients. RESULTS: The overall colorectal polyp detection rate was 31.82% (10519/33059), with a slight upward trend over the study period. Rates were significantly higher in males (39.01%) than females (24.04%) and increased sharply with age. Multivariable analysis identified male sex (OR=2.493, 95 %CI:2.106-2.950, <.001), age 41-64 years (OR=2.535, 95% CI:2.056-3.125, <.001), and age ≥65 years (OR=4.379, 95% CI:3.328-5.761, <.001) as independent risk factors. Tibetan and Hui ethnicities were associated with lower risk compared with Han (OR=0.611, 95% CI:0.448-0.833, =.002). CONCLUSIONS: Colorectal polyp detection is high and rising in Qinghai. Male sex and advanced age are major risk factors. Notably, Tibetan or Hui ethnicity appear as potential protective factors, offering new insights into genetic interactions that may inform region-specific screening strategies. LIMITATIONS: Single-center retrospective design, potential selection bias, lack of lifestyle and metabolic data.
Acute exacerbation of chronic rhinosinusitis: clinical and microbiological perspectives from a Saudi tertiary care center.
Alfallaj R, Almousa H, BinGhaith A … +4 more , AlMaglouth M, Alfirm R, Alrasheed AS, Alsaleh S
Ann Saudi Med · 2026 · PMID 42251519 · Full text
BACKGROUND: Acute exacerbations of chronic rhinosinusitis (AECRS) are increasingly recognized as a distinct clinical entity that significantly impacts quality of life. Despite its clinical relevance, data on its prevalen...
BACKGROUND: Acute exacerbations of chronic rhinosinusitis (AECRS) are increasingly recognized as a distinct clinical entity that significantly impacts quality of life. Despite its clinical relevance, data on its prevalence, clinical characteristics, and underlying bacteriology remain limited. OBJECTIVES: This study investigated the clinical features of AECRS and characterized the bacterial profile of middle meatus cultures during exacerbation episodes. Furthermore, characteristics of AECRS were compared across chronic rhinosinusitis (CRS) phenotypes. DESIGN: Retrospective cohort study. SETTING: Single tertiary care referral center, King Saud University Medical City (KSUMC). PATIENTS AND METHODS: Medical records from patients with established AECRS with positive middle meatus cultures from 2015 to 2025 were extracted. Data included demographics, CRS phenotype, comorbidities, prior treatments, microbiological findings, and clinical outcomes. MAIN OUTCOME MEASURES: Bacterial etiology and clinical characteristics of AECRS across phenotypes, including chronic rhinosinusitis with nasal polyposis, chronic rhinosinusitis without nasal polyposis, and allergic fungal rhinosinusitis. SAMPLE SIZE: 104. RESULTS: The study enrolled 104 patients (mean age 39.9 years); 49 (47.1%) had asthma and 21 (20.2%) had aspirin-exacerbated respiratory disease. Endoscopic pus was present in 71 (68.3%), and 77 (74%) had prior sinus surgery. The most common isolates were methicillin-sensitive 35 (33%), methicillin-resistant 26 (25%), and Pseudomonas species 24 (23.1%). Oral antibiotics were administered in 75 (72.1%) of AECRS episodes, while oral steroids were used in 27 (26%). Clinical improvement following antibiotic therapy was documented in 64 (85.3%) cases. High resistance was observed for ampicillin, penicillin, and oxacillin. CONCLUSION: AECRS presents considerable heterogeneity in both clinical presentation and microbiology. Therefore, culture-directed therapy is recommended due to variable antibiotic resistance patterns. Asthma was strongly associated with treatment failure. These findings emphasize the importance of individualized management strategies in AECRS. LIMITATIONS: Retrospective design, and single tertiary care center.
Age-related patterns in hysterectomy: indications and surgical route selection in a three-year tertiary-center cohort.
Bacak HB, Coșkun ES
Ann Saudi Med · 2026 · PMID 42251518 · Full text
BACKGROUND: Hysterectomy indications and surgical route selection may vary with age due to shifting case mix. OBJECTIVES: To describe age-stratified hysterectomy indications and routes and identify factors independently...
BACKGROUND: Hysterectomy indications and surgical route selection may vary with age due to shifting case mix. OBJECTIVES: To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection. DESIGN: Retrospective chart review. SETTINGS: Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology. METHODS: Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age [<50, 50-59, or ≥60 years]. Indications were assigned using PALM-COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal-Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery. MAIN OUTCOME MEASURES: age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery. SAMPLE SIZE: 769 hysterectomies. RESULTS: Primary indications differed significantly by age group (<.001; Cramer's V=0.38): treatment-resistant abnormal uterine bleeding predominated in patients <50 and 50-59 years, whereas pelvic organ prolapse predominated in patients ≥60 years. Surgical route also varied by age (<.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those ≥60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age ≥60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08-3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02-46.60). In binary regression, age ≥60 years (aOR 4.18, 95% CI 2.41-7.26) and parity (aOR 1.18 per birth, 95% CI 1.06-1.32) favored minimally invasive surgery. CONCLUSIONS: Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients. LIMITATIONS: Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.
Diagnostic utility and limitations of CT-guided transthoracic fine-needle aspiration biopsy in Lung-RADS 4 pulmonary nodules ≤2 cm.
Cengiz SK, Demirer E, Baysal T … +5 more , Dizman R, Fidan A, Geçmen GG, Demirhan R, Cömert SŞ
Ann Saudi Med · 2026 · PMID 42251517 · Full text
BACKGROUND: Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions ≤2 cm require further evaluation to optimize outcomes and reduce...
BACKGROUND: Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions ≤2 cm require further evaluation to optimize outcomes and reduce unnecessary surgeries. OBJECTIVES: This study aimed to evaluate the diagnostic accuracy, safety, and factors influencing the outcomes of CT-guided TTFNAB in Lung-RADS category 4 pulmonary nodules measuring ≤2 cm. DESIGN: Retrospective study. SETTING: Single-center, a tertiary referral center. MATERIALS AND METHODS: A retrospective analysis was performed on 95 patients who underwent CT-guided TTFNAB between January 2021 and April 2024. Data included demographics, lesion characteristics (size, location, density, and pleural proximity), histopathological findings, and procedural outcomes. MAIN OUTCOME MEASURES: The primary endpoints were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and factors influencing TTFNAB results, alongside procedural complications-specifically pneumothorax and chest tube requirement. SAMPLE SIZE: 95 patients. RESULTS: Of the 95 nodules, 26 (27%) were benign and 69 (73%) were malignant according to TTFNAB. Final pathology confirmed 18 (19%) benign and 77 (81%) malignant lesions. All biopsies yielded sufficient material. Sensitivity, specificity, and overall diagnostic accuracy were 83%, 94%, and 89%, respectively. The PPV was 98%, while the NPV was 65%. Pleural thickening was significantly more frequent in both the TTFNAB benign group (38% vs. 13%, =.006) and final benign diagnosis group (44% vs. 14%, =.008). Pneumothorax occurred in 30% of cases, with 24% of these requiring chest tube drainage. No significant associations were found between diagnostic accuracy or complications and variables such as age, emphysema, Lung-RADS category, or nodule size. CONCLUSION: CT-guided TTFNAB is an effective diagnostic method for confirming malignancy in pulmonary nodules ≤2 cm classified as Lung-RADS 4, providing an overall accuracy of 89% and a PPV of 98%. However, a benign TTFNAB result cannot be considered diagnostically safe: the NPV of 65% and false-negative rate of 35% indicate that a negative biopsy does not reliably exclude malignancy. Clinicians must not rely on a negative result alone; close radiological follow-up or surgical biopsy is essential for these high-risk lesions. LIMITATIONS: The retrospective single-center design, small sample size, and limited generalizability. IRB APPROVAL NUMBER: 2024/010.99/6/23 (Date: 26.07.2024).
Association between proton pump inhibitor use and vitamin B12 deficiency: a retrospective cohort study in primary care centers in Riyadh, Saudi Arabia.
Alanazi S, Bin Sulaiman N, Aldahoul SK … +4 more , Alsawadi WK, Alshail SE, Almansouf AS, Amber ST
Ann Saudi Med · 2026 · PMID 42251516 · Full text
BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed, yet their long-term effects on vitamin B12 status remain debated with inconsistent findings across studies. Data from Saudi Arabia and the Middle Eastern p...
BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed, yet their long-term effects on vitamin B12 status remain debated with inconsistent findings across studies. Data from Saudi Arabia and the Middle Eastern primary-care context are limited. OBJECTIVES: To evaluate changes in serum vitamin B12 levels following ≥6 months of PPI therapy and assess the association between PPI use and vitamin B12 deficiency. DESIGN: Retrospective chart-review cohort study with paired pre-post design. SETTINGS: Family Medicine clinics at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (2016-2022). PATIENTS AND METHODS: Adults (≥18 years) receiving PPI therapy for ≥6 months with paired vitamin B12 measurements were included. Patients with conditions or medications affecting B12 absorption (metformin, gastrointestinal surgery, atrophic gastritis, vegetarian diet) were excluded. Paired pre-post vitamin B12 levels were compared using Wilcoxon signed-rank and McNemar tests. Neurological symptoms were documented from clinical records. MAIN OUTCOME MEASURES: Change in serum vitamin B12 concentration, incidence of vitamin B12 deficiency (<200 pg/mL), and prevalence of neurological symptoms. SAMPLE SIZE: 376 adult PPI users. RESULTS: Most participants were aged ≥56 years (n=282, 75%), female (n=211, 56.1%), and overweight/obese (n=308, 81.9%). Median vitamin B12 declined significantly from 312 to 297 pg/mL (<.001), with vitamin B12 deficiency prevalence increasing from 8.2% (n=31) to 12.2% (n=46) (=.05). New-onset deficiency developed in 9.6% [Author: Please insert n for context, e.g., 9.6% (n)] of patients, with lower baseline B12 predicting greater decline. Neurological symptoms were nearly four times more common among those who developed deficiency (42.4% [95% confidence interval, CI 27.2-59.2] vs. 10.9% [95% CI 7.9-14.8], <.001). No significant associations were observed with age, sex, BMI, PPI type, or duration. The mean change in serum vitamin B12 was -41.3 pg/mL (95% CI -67.1 to -15.5) and the McNemar paired odds ratio for new-onset deficiency was 1.83 (95% CI 1.00 to 3.46). CONCLUSIONS: PPI use for six months or longer was associated with significant vitamin B12 decline, with neurological symptoms more frequent among deficient individuals. These findings support periodic vitamin B12 monitoring and structured deprescribing strategies, particularly for high-risk individuals. LIMITATIONS: Retrospective design, single-center setting, and inability to assess dietary B12 intake or PPI adherence.
Comparative overall survival in T4N0 and T2-3N1 non-metastatic colon cancer: a retrospective cohort study.
Akagunduz F, Güren AK, Kocaaslan E … +12 more , Paçacı B, Tunç MA, Demirel A, Ağyol Y, Erel P, Çelebi A, Işik S, Coban E, Sarı M, Bayoğlu IV, Köstek O, Demircan NC
Ann Saudi Med · 2026 · PMID 42251515 · Full text
BACKGROUND: The prognostic significance of pathological T stage relative to nodal involvement in colon cancer remains controversial. Emerging evidence suggests that patients with T4N0 disease may experience outcomes comp...
BACKGROUND: The prognostic significance of pathological T stage relative to nodal involvement in colon cancer remains controversial. Emerging evidence suggests that patients with T4N0 disease may experience outcomes comparable to or worse than those with node-positive disease. OBJECTIVES: This study aimed to compare long-term oncologic outcomes between patients with non-metastatic T4N0 colon cancer and those with T2-3N1 disease. DESIGN: Retrospective. SETTINGS: Single-center. PATIENTS AND METHODS: Retrospective analysis of patients with histologically confirmed, non-metastatic colon adenocarcinoma who underwent curative-intent surgery between 1999 and 2020. Patients were categorized into T4N0 and T2-3N1 groups. MAIN OUTCOME MEASURES: Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models. SAMPLE SIZE: A total of 273 patients were included, of whom 78 (28.6%) were staged as T4N0 and 195 (71.4%) as T2-3N1. RESULTS: After a median follow-up of 72 months, patients with T4N0 disease showed significantly worse OS than those with T2-3N1 disease (HR=1.72, 95% CI 1.06-2.75; =.02). Five-year OS rates were 66.6% and 79.8% in the T4N0 and T2-3N1 groups, respectively. On multivariate analysis, pathological T4N0 stage (HR=1.74, 95% CI 1.03-2.93; =.03), age ≥65 years, vascular invasion, and omission of oxaliplatin-based adjuvant chemotherapy independently predicted poorer OS. Stage T4N0 was also associated with higher locoregional and distant recurrence rates, with increased peritoneal involvement. CONCLUSIONS: Non-metastatic T4N0 colon cancer is associated with less favorable long-term survival and higher recurrence rates compared with T2-3N1 disease, supporting its classification as a biologically aggressive subgroup that may benefit from treatment strategies similar to selected stage III colon cancers. LIMITATIONS: The retrospective, single-center design may introduce selection bias, and limited molecular data precluded detailed sub-group analyses.
Establishment and validation of reference intervals for the neutrophil CD64 index in a healthy adult population from Guangxi, China.
Zhan X, Liu X, Ding Y … +7 more , Du L, Zhang K, Zeng J, Ren S, Yu H, Meng Y, Lu Y
Ann Saudi Med · 2026 · PMID 42251514 · Publisher ↗
BACKGROUND: The neutrophil CD64 (nCD64) index is a potent biomarker for infectious diseases; however, the lack of standardized reference intervals (RIs) limits its clinical utility. OBJECTIVES: This study aimed to establ...
BACKGROUND: The neutrophil CD64 (nCD64) index is a potent biomarker for infectious diseases; however, the lack of standardized reference intervals (RIs) limits its clinical utility. OBJECTIVES: This study aimed to establish and validate reference intervals (RIs) for the nCD64 index specifically for the Guangxi population using flow cytometry. DESIGN: Cross-sectional study. SETTINGS: Conducted in Guangxi, China. PATIENTS AND METHODS: A total of 494 healthy adults (aged 18-83 years) were enrolled. Peripheral blood nCD64 expression was measured via flow cytometry. Reference intervals were determined using the non-parametric 95th percentile method (2.5th-97.5th) per CLSI EP28-A3c guidelines. Validation was performed in an independent cohort (n=30). MAIN OUTCOME MEASURES: The primary outcome was the 95% reference interval for the nCD64 index. Secondary outcomes included correlations between nCD64 index and sex, age, BMI, and primary hematological parameters. SAMPLE SIZE: 494 healthy adults for establishment, plus 30 independent subjects for validation. RESULTS: No clinically significant differences in the nCD64 index were found between sexes or across age groups, and partitioning was not required. The nCD64 index exhibited a skewed distribution. Although sex showed a weak positive correlation with nCD64 expression (r=.115, =.011), the standard normal deviation test (z<z) indicated no requirement for sex-specific partitioning. No significant correlations were observed between nCD64 and age, BMI, or primary hematological parameters. The established 95% RI was .08-0.94, with the 90% confidence intervals (CI) for the lower and upper limits were .08-.09 and .92-1.04. Validation confirmed the RI's reliability, with 97% (29/30) of results falling within the range. CONCLUSIONS: We established a robust RI (.08-.94) for the nCD64 index in the Guangxi population, which remained consistent across age and sex groups. This provides a standardized baseline for the diagnosis of inflammatory and infectious conditions in Southern China. LIMITATIONS: The study was limited to a single regional population (Guangxi) and did not include pediatric or pregnant populations. Additionally, potential confounding from subclinical inflammation or undiagnosed chronic infections cannot be completely excluded despite strict enrollment criteria.
Endotracheal tube size selection in critically ill patients: a 4-year single-center experience in Saudi Arabia.
Alquorain S, Alzanadi RH, Almukhodher S
Ann Saudi Med · 2026 · PMID 42251513 · Full text
BACKGROUND: Intubation is a critical aspect of airway management and supportive care for intensive care unit (ICU) patients. Inappropriate size of endotracheal tubes (ETT) affects the patient's airway, it is crucial to c...
BACKGROUND: Intubation is a critical aspect of airway management and supportive care for intensive care unit (ICU) patients. Inappropriate size of endotracheal tubes (ETT) affects the patient's airway, it is crucial to choose an appropriate size for each patient. OBJECTIVES: This study aimed to assess current practices of ETT size. SELECTION: for adult ICU patients and to explore factors associated with it. DESIGN AND SETTINGS: Single-center, retrospective cohort study at King Fahad Hospital of the University, Saudi Arabia. PATIENTS AND METHODS: A retrospective review was conducted for adult patients admitted to ICU from January 2020 to January 2024 at King Fahad Hospital of the University. Inclusion criteria included patients aged 18 years or older, underwent intubation and was followed by tracheostomy. Those with missing data, had laryngeal or thyroid masses, had upper airway obstruction by any cause and upper airway surgery were excluded. MAIN OUTCOME AND MEASURES: The primary outcome was compliance of ETT size selection with established guidelines. Secondary outcomes included associations between ETT size (mm), patient demographics and intubation indications. RESULTS: A total of 228 ICU patients were analysed [mean (standard deviation) age of 61.8 (19.6) years]. The median internal diameter of the ETT size was 7.5 mm, with neurological causes being the most common indication for intubation. ETT size showed a significant positive correlation with height (rs=.341; <.001) and weight (rs=0.190; p=0.004), but not with body mass index (rs=.050; =.456). In multivariable analysis, larger ETT size was significantly associated with male sex (adjusted odds ratio, aOR 2.38, 95% confidence interval, CI 1.12-5.05), pulmonary indication for intubation (aOR 2.31, 95% CI 1.10-4.86), older age (aOR 1.20 per 10 years, 95% CI 1.02-1.42), and height (aOR 1.95 per 10 cm, 95% CI 1.20-3.16), whereas weight was not independently associated after adjustment (aOR 1.04 per 10 kg, 95% CI 0.85-1.26). Overall, 77% of ETT size selection did not comply with height-based guidelines. CONCLUSIONS: No standardized ETT size selection guidelines were followed for adult ICU patients. Male sex, height, older age, and pulmonary indication were independent predictors of larger ETT size, supporting the implementation of more structured, height-informed ETT sizing protocols.
Genetic analysis and clinical phenotype of pulmonary arterial hypertension in an Algerian population.
Berkane AW, Yahiaoui R, Methia N … +5 more , Djami-Temim N, Coulet F, Antigny F, Montani D, Hamouli-Said Z
Ann Saudi Med · 2026 · PMID 42001268 · Full text
BACKGROUND: Pulmonary arterial hypertension (PAH) involves progressive obstruction of small pulmonary vessels due to vascular remodeling. Although the genetic architecture of PAH is increasingly understood, it remains po...
BACKGROUND: Pulmonary arterial hypertension (PAH) involves progressive obstruction of small pulmonary vessels due to vascular remodeling. Although the genetic architecture of PAH is increasingly understood, it remains poorly characterized in Algeria due to limited studies and the absence of molecular diagnostic infrastructure. OBJECTIVES: To identify pathogenic variants in and other PAH-related genes in Algerian patients, enabling targeted screening of high-risk individuals, refined classification of variants of uncertain significance (VUS), and early, personalized clinical management. DESIGN: Cross-sectional study using targeted next-generation sequencing (NGS) of 15 PAH-associated genes. SETTING: Multicenter (3 university hospitals in Algiers). PATIENTS AND METHODS: Thirty adults with confirmed pre-capillary PAH (Group 1) of unknown etiology, diagnosed according to clinical guidelines, and 30 age- and sex-matched healthy controls were enrolled. Peripheral blood was collected for genetic analysis, and pathogenic variants were identified using targeted NGS. IL-6 plasma levels were quantified by immunoassay. MAIN OUTCOME MEASURES: Contribution to the genetic characterization of PAH and potential implications for personalized clinical management. SAMPLE SIZE: 30 patients and 30 controls. RESULTS: Pathogenic variants were identified in 6 out of 30 patients (20%) involving , and . Homozygosity for the variant led to a revised diagnosis of Pulmonary Veno-Occlusive Disease/Pulmonary Capillary Hemangiomatosis (PVOD/PCH). Carriers of pathogenic variants were younger at diagnosis (30 vs. 49 years, =.0115) and exhibited more severe hemodynamic profiles. Most patients (80%) were in New York Heart Association (NYHA) functional class III or IV. Mean pulmonary arterial pressure (mPAP) was 59 (45-64) vs. 46 (39.7-59) mmHg in patients without variants. IL-6 levels were significantly higher in patients than in controls (<.0001). CONCLUSION: This first genetic study in Algerian PAH patients highlights the relevance of genetic testing for diagnosis and management. The findings support the development of national genetic infrastructure and confirm the role of inflammation in PAH. LIMITATIONS: Modest sample size and the lack of family segregation data limited the assessment of Variant of Unknown Significance (VUS) and heritability.
Clinical features and disease severity across immune status in pediatric patients with COVID-19.
Al-Dajani NM, Bahasan MA, Alzubed MA … +3 more , AlSahafi RA, Alturkistani EL, AlZahrani NS
Ann Saudi Med · 2026 · PMID 42001267 · Full text
BACKGROUND: COVID-19 pandemic has caused a major global health disruption. Pediatric presentations vary widely, particularly among children with differing immune status. OBJECTIVES: To compare the clinical presentation,...
BACKGROUND: COVID-19 pandemic has caused a major global health disruption. Pediatric presentations vary widely, particularly among children with differing immune status. OBJECTIVES: To compare the clinical presentation, disease course, and outcomes of immunocompetent versus immunocompromised pediatric patients with COVID-19 in a tertiary referral hospital in Jeddah, Saudi Arabia. DESIGN: Retrospective chart review. SETTINGS: A tertiary center treating immunocompromised children including those with HIV, solid and hematologic malignancies, and solid organ or hematopoietic stem cell transplantation. PATIENTS AND METHODS: Records of 123 pediatric patients (<15 years) with confirmed COVID-19 from March 2020 to March 2021 were reviewed. Demographic, clinical, laboratory, radiologic, and treatment variables were extracted and compared between immunocompetent and immunocompromised patients. Chi-square testing was used with significance set at <.05. Immunocompromised status was defined as the presence of an underlying medical condition or treatment associated with clinically significant immune suppression. MAIN OUTCOME MEASURES: Differences in symptoms, severity, clinical progression, and outcomes between immunocompetent and immunocompromised children. SAMPLE SIZE: 123 children. RESULTS: Most patients were immunocompetent (93, 75.6%). Immunocompromised children primarily included post-transplant or oncology patients on chemotherapy. Fever was the most common presenting symptom (69, 56.1%), significantly more common in immunocompetent children (=.029). Immunocompromised children were more frequently admitted, mainly for non-COVID-related concerns (e.g., abnormal chest radiograph, febrile neutropenia, or hydration). Nearly all patients recovered without complications, and no significant difference in recovery rate was observed between groups (=.568). CONCLUSION: COVID-19 severity and recovery appeared similar between immunocompetent and immunocompromised pediatric patients in this cohort. However, the higher hospitalization rate observed among immunocompromised children likely reflects precautionary admission practices rather than increased disease severity. Findings should be interpreted cautiously given the small immunocompromised subgroup and heterogeneity of underlying conditions. Interpretation of these findings is limited by the retrospective design and relatively small sample size. Larger multicenter studies are required to confirm these observations.
Morbidity and mortality of pediatric drowning in Qatar: an epidemiological analysis of submersion encounters at a level I pediatric trauma center.
Abbas OK, Mahgoub S, Faqih N
Ann Saudi Med · 2026 · PMID 42001266 · Full text
BACKGROUND: Pediatric drowning is a preventable cause of mortality and morbidity worldwide, yet detailed outcome data from the Gulf region remain scarce. OBJECTIVES: To describe the epidemiology, clinical characteristics...
BACKGROUND: Pediatric drowning is a preventable cause of mortality and morbidity worldwide, yet detailed outcome data from the Gulf region remain scarce. OBJECTIVES: To describe the epidemiology, clinical characteristics, neurological outcomes, and predictors of poor prognosis in pediatric drowning cases in Qatar. DESIGN: Retrospective observational study. SETTING: Sidra Medicine, the only level I pediatric trauma and tertiary care center in Qatar. PATIENTS AND METHODS: Records of all pediatric drowning cases (0-18 years old) over a 6.5-year period from May 2018 to November 2024 were reviewed. Data included demographics, incident details, prehospital interventions, clinical presentation, laboratory findings, and outcomes using the Pediatric Cerebral Performance Category Scale (PCPCS). Predictors of mortality were analyzed. MAIN OUTCOME MEASURES: Neurological status at discharge (PCPCS), mortality, and associations between clinical variables and outcome. SAMPLE SIZE: 225 pediatric drowning cases. RESULTS: Median age was 3.0 years (IQR 2.0-6.0), and 65.3% were male. Incidents occurred in freshwater (76.4% [n=172]), predominantly residential pools (67.6% [n=152]). Mortality was 12.0% (n=27). Good neurological outcomes at discharge (PCPCS=1) occurred in 81.3% (n=183) of children, while 2.7% (n=6) survived with neurological disability (PCPCS 3-5). Prolonged submersion duration and lower initial arterial pH were independently associated with mortality. CPR duration and lactate were associated with mortality in univariate analysis but lost statistical significance after adjustment. CONCLUSION: Pediatric drowning in Qatar predominantly involves preschool-aged boys in residential pools. Mortality is strongly associated with prolonged submersion and severe acidosis at presentation. Prevention strategies should prioritize pool safety regulation, supervision, and early rescue to reduce hypoxic injury. LIMITATIONS: Retrospective single-center design with incomplete prehospital details and no long-term follow-up.
Molecular characterization of Carbapenem-resistant Gram-negative bacilli associated with nosocomial infections in Hail, Saudi Arabia.
Alkaik FA, Rakha EB, Alkhateeb AA … +1 more , Al-Zahrani IA
Ann Saudi Med · 2026 · PMID 42001265 · Full text
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are listed as critical priority antibiotic-resistant pathogens by the World Health Organization. OBJECTIVE: This study investigated the prevalence and the molecul...
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are listed as critical priority antibiotic-resistant pathogens by the World Health Organization. OBJECTIVE: This study investigated the prevalence and the molecular mechanisms underlying carbapenem resistance among four clinically relevant Gram-negative bacterial species associated with nosocomial infections. DESIGN: Single-centre cross-sectional study. SETTING: A tertiary hospital in Hail, Saudi Arabia. METHODS: A total of 207 nosocomial gram-negative bacilli isolates were collected from December 2022 to July 2023. The isolates' identification and antimicrobial susceptibility testing (AST) were done using BD Phoenix M50. Isolates that showed resistance to one or more Carbapenemes agents in the antibiotic susceptibility test (AST) profile were further tested by a molecular method using Polymerase Chain Reaction (PCR) (Xpert Carba-R assay) for the detection of five most common Carbapenemases [ carbapenemase (KPC), imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), the New Delhi metallo-β-lactamase (NDM) and oxacillinase (OXA-14)]. MAIN OUTCOME MEASURES: Identification of carbapenemase producers among Gram-negative bacteria associated with nosocomial infections. SAMPLE SIZE: 207 Gram-negative bacilli isolates. RESULTS: Of 207 GNB isolates, 162 were carbapenem-resistant, with being the most prevalent isolates (n=59), followed by (n=55), (n=34), and Proteus mirabilis (n=14). At least one carbapenemase gene was detected in 65 isolates, where has the highest rate with (n=43) followed by (n=9), (n=8), and (n=5). The most predominant carbapenemase gene was bla with 70.8% (n=46), followed by bla with 15.4% (n=10) and 13.8% (n=9) co-harboring bla and bla. CONCLUSION: Carbapenemase-producing Gram-negative bacilli were prevalent among hospitalized patients in Hail, with bla and blaNDM detected primarily in . Whole genome sequencing (WGS) is recommended to identify dominant nosocomial clones in the region. LIMITATIONS: The lack of sufficient funding has impeded the expansion of this study to perform WGS on all isolates.
Safety and heterogeneity of mRNA-based seasonal Influenza vaccines: A systematic review and meta-analysis of randomized controlled trials.
Albargy HA, Othman AA
Ann Saudi Med · 2026 · PMID 42001264 · Full text
BACKGROUND: Messenger RNA (mRNA)-based influenza vaccines represent a promising advancement in seasonal influenza prevention. However, comprehensive evaluation of their serious safety profile is essential as these vaccin...
BACKGROUND: Messenger RNA (mRNA)-based influenza vaccines represent a promising advancement in seasonal influenza prevention. However, comprehensive evaluation of their serious safety profile is essential as these vaccines progress toward widespread clinical use. While individual randomized controlled trials (RCTs) have reported low rates of serious adverse outcomes, pooled evidence is limited. OBJECTIVE: This systematic review and meta-analysis of RCTs aim to assess the risk of serious adverse events (SAEs) and adverse events of special interest (AESIs) associated with mRNA-based seasonal influenza vaccines in adults. DESIGN: Systematic review and meta-analysis. SETTING: All RCTs included in the meta-analysis were carried out in the USA. METHODS: A systematic literature search was done until December 2025. RCTs evaluating mRNA-based influenza vaccines in adults and reporting participant-level data for SAEs and/or AESIs were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. MAIN OUTCOME MEASURES: Risks of SAEs and AESIs associated with mRNA-based seasonal influenza vaccines in adults, expressed as pooled risk ratios with 95% CIs. SAMPLE SIZE: Seven RCTs (containing 12 datasets) were included in this meta-analysis. The total number of cases in the intervention and comparator groups were 23,754 and 22,806 respectively. RESULTS: The pooled analysis demonstrated no increased risk of SAEs (RR=0.90, 95% CI: 0.64-1.27, =.56) and AESI (RR=0.76, 95% CI: 0.41-1.36, =.35) among mRNA vaccine recipients compared with controls. RISK OF BIAS: Based on funnel plots, there is no evidence of systematic asymmetry or absence of smaller studies with null or adverse findings. Risk-of-bias assessment using the Cochrane traffic-light framework indicated low risk across all domains in all included RCTs. HETEROGENEITY: The heterogeneity was low-to-moderate (τ=0.08; I=27.79%; H=1.38) for SAEs and the Q-test indicated statistically significant heterogeneity (Q=14.46, =.21). For AESIs, heterogeneity was absent (τ=0.00; I=0.00%; H=1.00), with no evidence of between-study variability by the Q-test (Q=4.70, =.94). CONCLUSIONS: Pooled evidence shows that mRNA-based seasonal influenza vaccines are not associated with an increased risk of SAEs or AESIs compared with established influenza vaccines or placebo. LIMITATIONS: Low absolute number of AESIs limiting detection of extremely rare events, limited long-term follow-up beyond early and intermediate risk windows, and potential differences between trial populations and real-world vaccine recipients. REGISTRATION: CRD420251271174.
Complications of silicone airway stents in malignant and benign central airway stenosis: timing of complications and survival outcomes.
Akan EG, Aktaş Z, Öztürk AM … +1 more , Yılmaz A
Ann Saudi Med · 2026 · PMID 42001263 · Full text
BACKGROUND: Silicone airway stents restore airway patency in central airway stenosis but may be complicated by migration, mucostasis, granulation tissue, and tumor overgrowth. OBJECTIVE: To compare complication profiles,...
BACKGROUND: Silicone airway stents restore airway patency in central airway stenosis but may be complicated by migration, mucostasis, granulation tissue, and tumor overgrowth. OBJECTIVE: To compare complication profiles, timing of complications, and survival outcomes after silicone airway stent placement in malignant versus benign central airway stenosis. DESIGN: Retrospective comparative cohort study. SETTING: Single center, tertiary referral interventional bronchoscopy unit in Ankara, Türkiye. PATIENTS AND METHODS: Consecutive adults who underwent silicone airway stent placement by rigid bronchoscopy between September 2012 and July 2017 were reviewed and analyzed. MAIN OUTCOME MEASURES: Complication distribution by etiology, time to first complication, complication-free survival, and stent survival. SAMPLE SIZE: 80 patients (59 malignant, 21 benign). RESULTS: Complications occurred in 48% of benign and 30% of malignant cases, with significant differences in complication profiles between groups (=.003). Migration was the most frequent complication in benign stenosis, whereas stent-edge granulation predominated in malignant stenosis. In benign stenosis, median time to migration, mucostasis, and granulation was 17 days (interquartile range, 6-50), 135.5 days (63-140.5), and 206 days (103.8-354.5), respectively. In malignant stenosis, the corresponding times were 25.5 (21.3-29.8), 22 (21.3-22.0), and 89 days (57.5-181.5), while stent-margin tumor overgrowth was 105 days (78.5-174.5). Median complication-free survival was 500 days (95% CI, 353-857), with no significant difference between benign (701 days) and malignant (410 days) groups (=.5138). Median stent survival was 578 days (95% CI, 351-956), also comparable between groups (351 vs 578 days; =.9688). CONCLUSIONS: Silicone airway stenting is associated with distinct complication patterns and timing in benign and malignant central airway stenosis. These findings support structured post-stent bronchoscopic surveillance. LIMITATIONS: Retrospective single-center design, small benign subgroup, symptom-driven follow-up, and potential confounding and immortal-time bias in survival analyses.
Epidemiological patterns of acute respiratory illnesses in a tertiary center in Riyadh, Saudi Arabia.
Althomali MA, Bouafia N, Balhareth IA … +7 more , AlHarbi SS, Alshammari KH, Alwetishi R, Al Alanazi MS, Alateah SM, Al Odayani A, Kaabia N
Ann Saudi Med · 2026 · PMID 42001262 · Full text
BACKGROUND: Acute respiratory illnesses (ARIs) are a major public health concern and are ranked by the World Health Organization among the leading causes of death worldwide. OBJECTIVES: To determine the positivity propor...
BACKGROUND: Acute respiratory illnesses (ARIs) are a major public health concern and are ranked by the World Health Organization among the leading causes of death worldwide. OBJECTIVES: To determine the positivity proportion, clinical presentation, and risk factors associated with major respiratory viruses, including Influenza A, Influenza B, respiratory syncytial virus RSV, and SARS-CoV-2. DESIGN: Retrospective study conducted between October 2022 and March 2023. SETTINGS: Single center tertiary hospital in Riyadh, Saudi Arabia. PATIENTS AND METHODS: Nasopharyngeal swabs (NPS) were collected from patients with ARI and tested for Influenza A, RSV, and SARS-CoV-2 using a multiplex polymerase chain reaction (PCR) panel, a molecular technique used to amplify DNA for detection and analysis. Patients were categorized into three groups based on the type of viral infection, and comparisons between groups were performed using chi-square or Fisher's exact tests for categorical variables to assess associations among viral infections. MAIN OUTCOME MEASURES: Epidemiological and clinical characteristics of patients with positive PCR results. SAMPLE SIZE: 4526 patients with ARI underwent NPS for viral PCR screening. RESULTS: Among study population, 537 (11.9%) patients tested positive for at least one of the targeted respiratory viruses. RSV was the predominant pathogen among pediatric patients (n=195, 62.2%), particularly in infants younger than six months. In adults, SARS-CoV-2 was most common (n=98, 44.1%), followed by Influenza A and B. RSV infection was significantly associated with lower respiratory tract involvement (<.0001), whereas SARS-CoV-2 and Influenza were more frequently linked to upper respiratory tract symptoms. The overall recovery rate was 98.8% (n=531), with a mortality rate of 1.2% (n=6). CONCLUSION: RSV, Influenza, and SARS-CoV-2 remain significant causes of ARIs in Riyadh, Saudi Arabia, showing distinct age and seasonal patterns. The results underscore the importance of targeted vaccination and strengthened surveillance to protect high-risk groups. LIMITATIONS: The study was limited by its single-center design and short six-month duration.
Epidemiology of pediatric invasive group A streptococcus infection in a Saudi tertiary care center.
Ali A, Alhuthil R, Gashgarey D … +13 more , Altayeb M, Alsuhaibani M, Al-Shareef D, Al-Ansari R, Dahhan A, Adeeb S, Aljumaa R, AlGhalayini B, Alghamdi S, Aljumaah S, Alyabes O, Albanyan EA, Al-Hajjar S
Ann Saudi Med · 2026 · PMID 42001261 · Full text
BACKGROUND: Invasive group A Streptococcus (iGAS) infections in children can cause severe illness and lead to high rates of complications and death. While recent global reports show a rise in pediatric iGAS after the COV...
BACKGROUND: Invasive group A Streptococcus (iGAS) infections in children can cause severe illness and lead to high rates of complications and death. While recent global reports show a rise in pediatric iGAS after the COVID-19 pandemic, there is limited data from Saudi Arabia. OBJECTIVES: Assess the clinical features, outcomes, and patterns of pediatric iGAS at a major tertiary center in Riyadh. DESIGN: Retrospective case series study. SETTING: King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia. PATIENTS AND METHODS: Pediatric patients aged 14 years or younger who had symptoms of iGAS confirmed by a positive culture from January 2018 to May 2025. MAIN OUTCOMES MEASURES: Clinical features, outcomes, and patterns of pediatric iGAS. SAMPLE SIZE: 32 children. RESULTS: Out of the 585 total infections recorded, 32 cases were classified as iGAS and included in the study. Most infections happened in winter and spring, with (433/585) 74% occurring from November to April. The highest rates of iGAS were seen during the COVID-19 pandemic years. The average age of patients was 4.1 years, and 94% (n=30) had other health problems, mainly congenital heart disease (n=9, 28%) and hematology/oncology (n=8, 25%). Bacteremia was the most common presentation (n=17, 53%), followed by cellulitis/necrotizing fasciitis (n=9, 28%) and pneumonia (n=8, 25%). Eleven children (34%) needed intensive care, and the overall death rate was 9% (3/32), with all deaths in patients who had bacteremia. CONCLUSION: In our center, pediatric iGAS infections carry a substantial comorbidity and disease severity burden, frequently presenting with complex and aggressive clinical manifestations. These findings underscore the urgent need for heightened vigilance in high-risk children, improved diagnostic precision, and strengthened local surveillance systems to enhance prevention and optimize management of these serious infections. LIMITATIONS: Single-center, retrospective design and absence of rapid diagnostic testing.
Investigation of the susceptibility rates to ceftazidime-avibactam and colistin, clonal relationships, and clinical data of patients with carbapenem-resistant isolates detected in the ICUs of a hospital in İstanbul.
Akkaya Y, Aydın İ, Harmankaya S … +7 more , Karakuş M, Aydin M, Erdin BN, Yılmaz AM, Büyükavcı EH, Toraman ZA, Kılıç İH
Ann Saudi Med · 2026 · PMID 41562169 · Full text
BACKGROUND: The increase in carbapenem-resistant (CR-Kp) in intensive care units (ICUs) causes treatment difficulties and increases risk in mortality. OBJECTIVES: The aim of this study was to investigate the susceptibil...
BACKGROUND: The increase in carbapenem-resistant (CR-Kp) in intensive care units (ICUs) causes treatment difficulties and increases risk in mortality. OBJECTIVES: The aim of this study was to investigate the susceptibility rates of CR-Kp isolates obtained from ICUs to ceftazidime-avibactam (CAZ-AVI) and colistin, carbapenem resistance genes, clonal relationships and clinical characteristics of the patients. DESIGN: Retrospective cohort. SETTING: Single-center, University of Health Sciences, Ümraniye Training and Research Hospital. MATERIALS AND METHODS: This study was conducted between June 2023 and December 2024. Isolates were identified using VITEK MS v.3.2, and antibiotic susceptibility testing was performed using the VITEK 2 Compact system. CAZ-AVI susceptibility was determined using disk diffusion, and colistin susceptibility was determined using broth microdilution to determine minimum inhibitory concentration (MIC) values. Carbapenem resistance genes were determined using multiplex real-time polymerase chain reaction (RT-PCR) and clonal relationship arbitrarily primed-polymerase chain reaction (AP-PCR). MAIN OUTCOME MEASURES: Resistance genes of CR-Kp isolates, clonal relationships, CAZ-AVI and colistin resistance, and clinical characteristics of patients. SAMPLE SIZE: Ninety-seven isolates from 76 patients. RESULTS: Among patients with CR-Kp isolates, central venous catheter use was detected in 59 cases (78%), ventilator-associated pneumonia in 44 cases (58%), and bacteremia in 39 cases (51%), respectively. It was determined that 53 of the patients (70%) died. Using the AP-PCR method, 60 different genotypes were identified among 97 isolates, and clustering was determined in 42 of the isolates (46%). It was determined that 36 (37%) of the isolates were resistant to colistin and 42 (45%) were resistant to CAZ-AVI. NDM+OXA-48, OXA-48, KPC, KPC+NDM, and NDM genes were detected in 40 (43%), 32 (35%), 10 (11%), 2 (2%), and 3 (3%) isolates, respectively. It was determined that 30 (75%) of the isolates with NDM+OXA-48 and only 4 (12%) of the isolates with OXA-48 were resistant to CAZ-AVI. CONCLUSION: In addition to OXA-48, an increase in the frequency of CR-Kp isolates containing the NDM, NDM+OXA-48, KPC+NDM, and OXA-48+KPC genes were also detected. It was also determined that resistance to colistin and CAZ-AVI is increasing. The AP-PCR method can also be used to investigate infections. LIMITATIONS: Single center, Pulsed Field Gel Electrophoresis (PFGE) could not be performed together with AP-PCR.
Beyond the ports: outcomes in uni-port vs. multi-port video assisted thoracoscopic surgery (VATS) lung resections.
Kaaki S, Alzelfawi L, Almajed E … +5 more , Aldeligan SH, Alzaaidi B, Addas A, Nasser A, Maghrabi AA
Ann Saudi Med · 2026 · PMID 41562168 · Full text
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become the preferred minimally invasive approach for thoracic surgical procedures, with potential advantages over traditional thoracotomy. Perioperative and lon...
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become the preferred minimally invasive approach for thoracic surgical procedures, with potential advantages over traditional thoracotomy. Perioperative and long-term outcomes between uni-port (U-VATS) versus multi-port (M-VATS) techniques remains under investigation. OBJECTIVES: To compare U-VATS and M-VATS in terms of operative outcomes, complications, and oncological parameters. DESIGN: Retrospective cohort study. SETTING: Single tertiary referral center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. PATIENTS AND METHODS: Adult patients aged 18-75 years who underwent VATS lung resection between January 2015 and September 2024 were included. Pediatric patients and those undergoing open techniques were excluded. Collected data included sociodemographic, preoperative, intraoperative, and postoperative variables. Statistical analysis used t-test, Mann-Whitney U, Chi-square, and multivariate logistic regression. MAIN OUTCOME MEASURES: Operative time, blood loss, lymph node dissection, postoperative complications, hospital stay, mortality, and recurrence. SAMPLE SIZE: 194 patients (103 U-VATS, 91 M-VATS). RESULTS: Baseline characteristics were similar between groups. U-VATS was associated with longer operative time, [mean (SD) 210.0 (110.4) vs. 154.2 (69.9) min, <.001] and greater blood loss [416.7 (392.2) vs. 150.0 (76.4) ml, =.034]. Malignant lymph node involvement was higher in U-VATS (39.8% vs. 19.8%, =.021), with more lymph node stations sampled. Anatomical resections were more common in U-VATS (31.1% vs. 13.2%, =.005). Complication rates were low, with pneumonia (4.4%) as the most frequent in M-VATS and prolonged air leak (2.9%) in U-VATS. Thirty-day mortality was comparable (17.5% vs. 15.4%). Multivariate analysis showed M-VATS was associated with dissecting more lymph nodes (odds ratio, OR: 1.223; 95% confidence interval, CI: 1.019-1.468; =.030), while anatomical resections were more likely with U-VATS (OR: 0.40; 95% CI: 0.180-0.740; =.006). CONCLUSIONS: Both U-VATS and M-VATS are safe for lung resections. U-VATS is more commonly used for anatomical resections and allows broader lymph node station sampling, supporting its expanding role in thoracic surgery. LIMITATIONS: Single-center retrospective design, relatively small sample, and incomplete lymph node documentation.
Diagnostic yield of pre- versus post-biopsy bronchial washing in endobronchial cancer: Impact of procedural sequence.
Abdullayev G, Ilgazli A, Bayrak BY
Ann Saudi Med · 2026 · PMID 41562167 · Full text
BACKGROUND: Fiberoptic bronchoscopy is a crucial diagnostic tool in the evaluation of lung cancer, particularly in tumors with endobronchial involvement. While forceps biopsy, bronchial brushing, and bronchial washing ar...
BACKGROUND: Fiberoptic bronchoscopy is a crucial diagnostic tool in the evaluation of lung cancer, particularly in tumors with endobronchial involvement. While forceps biopsy, bronchial brushing, and bronchial washing are commonly used, the diagnostic value and optimal timing of bronchial washing remain debatable. OBJECTIVES: To evaluate the effect of pre- and post-biopsy bronchial washing on cytological diagnostic yield in patients with visible endobronchial lesions. DESIGN: Prospective diagnostic study. SETTINGS: Single tertiary university hospital. MATERIALS AND METHODS: Between April 2018 and April 2021, 55 patients with bronchoscopically visible endobronchial lesions underwent flexible bronchoscopy. Patients with invisible or submucosal tumors were excluded. Bronchial washings were obtained before and after 4-6 forceps biopsies. Cytological analyses were conducted blindly on all specimens. Statistical analysis included Chi-square and McNemar tests, with <.05 considered significant. MAIN OUTCOME MEASURES: Cytological diagnostic positivity rates in pre- and post-biopsy bronchial washings. SAMPLE SIZE: Fifty-five patients. RESULTS: Forceps biopsy alone achieved a diagnostic yield of 95%, which increased to 96% when combined with bronchial washing. Post-biopsy washing demonstrated a significantly higher cytological positivity rate (47%) than pre-biopsy washing (22%) (=.002). No complications were observed. CONCLUSIONS: Bronchial washing after forceps biopsy significantly improves cytological diagnostic yield in endobronchial lung lesions. Its simplicity, low cost, and additional diagnostic yield support its routine use in bronchoscopic evaluation. LIMITATIONS: Single-center design and relatively small sample size; other cytologic methods such as brushing orendobronchial ultrasound (EBUS) were not evaluated.
ANCA-associated vasculitis in the United Arab Emirates: a 17-year case series with review from Gulf literature.
Shahrour H, Luqman N, AlKindi F … +2 more , Khan M, Al Nokhatha SA
Ann Saudi Med · 2026 · PMID 41562166 · Full text
BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare and severe autoimmune disease characterized by pauci-immune necrotizing vasculitis. OBJECTIVES: The study aims to explore the...
BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare and severe autoimmune disease characterized by pauci-immune necrotizing vasculitis. OBJECTIVES: The study aims to explore the frequency, clinical characteristics, and management of AAV patients in two tertiary centers in the United Arab Emirates (UAE) over 17 years. DESIGN: A retrospective observational case series. SETTING: Two tertiary centers in the UAE. METHODS: Patients diagnosed with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA) from 2008 to 2024 were included. Demographic, clinical, laboratory, histopathological information, treatment, complications, relapses, and mortality were collected. ANCA testing for anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) antibodies was performed using enzyme-linked immunosorbent assays. Descriptive statistical analysis was performed to summarize the data. MAIN OUTCOME MEASURES: Subtype distribution, organ involvement, ANCA positivity, relapse, and mortality rates. SAMPLE SIZE: Twenty-six patients. RESULTS: We identified 26 AAV patients with a median age of 52.5 years. The majority were females (58%, n=15), and half were locals. The most common AAV subtype was microscopic polyangiitis (50%, n=13), followed by granulomatosis with polyangiitis (38%, n=10) and eosinophilic granulomatosis with polyangiitis (12%, n=3). ANCAs tested positive in nearly all of these cases. The most common clinical manifestations of AAV were constitutional symptoms with renal and pulmonary involvement. The induction therapy included corticosteroids, rituximab, cyclophosphamide, mycophenolate mofetil, and plasma exchange. The most prescribed maintenance medications were corticosteroids and azathioprine. The overall relapse rate was 31%, and the overall mortality rate was 19% (n=5). CONCLUSION: In our cohort, MPA was the most common subtype, being predominantly associated with P-ANCA/MPO-ANCA positivity. Notably, few studies from the Gulf region have addressed this topic. It's unclear whether this finding reflects low occurrence or potential underdiagnosis and, thus, points to unmet needs and a significant gap in the understanding of AAV. Multicenter studies are needed to validate these results and improve AAV management in Middle Eastern populations. LIMITATIONS: Retrospective design with small number of participants.
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