Annals Of Saudi Medicine[JOURNAL]
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200 papers
Epidemiological and clinical profiles of Saudi patients with hyperprolactinemia in a single tertiary care center.
Mahzari M, Alhamlan KS, Alhussaini NA … +4 more , Alkathiri TA, Al Khatir AN, Alqahtani AM, Masuadi EF
Ann Saudi Med · 2022 · PMID 36252148 · Full text
BACKGROUND: Prolactin is a hormone of the pituitary gland whose main function is the production of milk. Hyperprolactinemia is defined as an increase in prolactin levels above 25 μg/L in women and 20 μg/L in men. Causes...
BACKGROUND: Prolactin is a hormone of the pituitary gland whose main function is the production of milk. Hyperprolactinemia is defined as an increase in prolactin levels above 25 μg/L in women and 20 μg/L in men. Causes of hyperprolactinemia include pituitary tumors, especially prolactinomas. Hyperprolactinemia can manifest clinically with a variety of symptoms, including galactorrhea and menstrual irregularities in women and erectile dysfunction in men. There are limited data on the epidemiology of hyperprolactinemia in the Middle East region. OBJECTIVES: Description of the epidemiology and clinical features of hyperprolactinemia in a cohort from Saudi Arabia. DESIGN: Medical record review SETTING: Tertiary medical center in Riyadh PATIENTS AND METHODS: The study included adult patients with hyperprolactinemia in King Abdulaziz Medical City in Riyadh. The patients were treated in endocrinology clinics from 2015 to 2019. Patients of both sexes older than 14 years were enrolled in the study. Patients with insufficient follow-up were excluded. Data were collected on demographic characteristics, symptoms, prolactin level, cause of high prolactin level, and treatment. MAIN OUTCOME MEASURES: The frequency of different etiologies and symptoms in patients with hyperprolactinemia. SAMPLE SIZE: 295 patients RESULTS: The majority of patients with hyperprolactinemia were female 256 (86.8%). Hyperprolactinemia was diagnosed more frequently in patients in the age groups 21-30 years (42.6%) and 31-40 years (24.1%). The majority of the study population was obese or overweight: 136 (46.3%) and 74 (25.2%), respectively. Most of the cases were symptomatic (192, 65.1%). In women, the most common symptom was oligomenorrhea (35%). In men, infertility and erectile dysfunction were the most common clinical symptoms (50% and 44.7%, respectively). Idiopathic causes were the most common etiology (108, 36.6%), followed by pituitary adenomas (81, 27.5%). The majority of patients were treated (184,62.4%), with cabergoline being the most commonly used medication (173, 94.0%). CONCLUSION: The demographic and clinical presentations and causes of hyperprolactinemia in male and female Saudi patients were similar to that in studies in other populations. LIMITATIONS: Single-center retrospective chart review study. CONFLICT OF INTEREST: None.
Prevalence and classification of accessory navicular bone: a medical record review.
Alsager GA, Alzahrani K, Alshayhan F … +3 more , Alotaibi RA, Murrad K, Arafah O
Ann Saudi Med · 2022 · PMID 36252147 · Full text
BACKGROUND: The accessory navicular bone (ANB) is one of the most common accessory bones in the foot. Certain pathologies, such as posterior tibial tendon insufficiency are associated with ANB, and should be differentiat...
BACKGROUND: The accessory navicular bone (ANB) is one of the most common accessory bones in the foot. Certain pathologies, such as posterior tibial tendon insufficiency are associated with ANB, and should be differentiated from midfoot and hindfoot fractures such as navicular tuberosity avulsion fractures. There are few studies addressing the prevalence and types of ANB in Saudi Arabia. OBJECTIVES: Determine the prevalence and morphological variations of ANB and its relation with age and sex in patients visiting foot and ankle clinics. DESIGN: Medical record review SETTING: Orthopedic foot and ankle clinic at a university hospital. PATIENTS AND METHODS: The presence of ANB was retrospectively analyzed in radiographs from patients who presented to the orthopedic foot and ankle at our university hospital from February 2010 to December 2020. The patients were stratified according to sex, age, and diagnosis. For each ANB, recorded information included site, size, classification, subtypes, and symptomatology. Purposive sampling was used to select the patients for the study (non-probability sampling). MAIN OUTCOME MEASURES: Prevalence of ANB in patients attending a foot and ankle clinic. SAMPLE SIZE: 117 patients and 194 feet. RESULTS: ANB was analyzed in 1006 radiographs from 503 patients. ANB was detected in 117 (23.3%) patients and 194 (19.3%) feet Prevalence was significantly higher in females (67.5%) than in males (32.5%) (Z=5.359, <.001). The ages ranged from 19 to 86 years, with a mean age of 48.26 (14.5) years. The most common site was bilateral (77 patients, 65.8 %). Type I was the most common type, with a prevalence of 42.1%. There were no significant differences in types in relation to sex, but all types and subtypes differed significantly from each other. CONCLUSION: ANB was common among patients presenting to the foot and ankle clinic, with an overall prevalence of 23.3%. It should be considered among the differential diagnosis in chronic foot pain, and should be differentiated from midfoot and hindfoot fractures. Further studies with a larger, randomized sample are needed, for more accuracy and to confirm the reported results. LIMITATIONS: Retrospective chart review, non-probability sampling, and use of plain radiographs. CONFLICT OF INTEREST: None.
Diagnostic value of strain elastography and shear wave elastography in differentiating benign and malignant breast lesions.
Shahzad R, Fatima I, Anjum T … +1 more , Shahid A
Ann Saudi Med · 2022 · PMID 36252146 · Full text
BACKGROUND: Conventional B-mode breast ultrasonography, though the primary modality to determine benign or malignant nature of a solid breast lesion, sometimes encounters overlapping sonographic morphological features in...
BACKGROUND: Conventional B-mode breast ultrasonography, though the primary modality to determine benign or malignant nature of a solid breast lesion, sometimes encounters overlapping sonographic morphological features in a single lesion. Elastography leads to improvement by evaluating the structural aspects and characterization of the lesion as benign or malignant on the basis of multi-parametric assessment. OBJECTIVE: Determine the role of strain elastography (SE) and shear wave elastography (SWE) in differentiating benign and malignant breast lesions. DESIGN: Cross sectional SETTING: Radiology department of hospital PATIENTS AND METHODS: Patients meeting inclusion criteria referred to our hospital for ultrasonography followed by biopsy or surgical excisions were examined with B-mode ultrasonography and by both strain and shear wave elastography. MAIN OUTCOME MEASURES: Mean values of SE and SWE in benign and malignant breast lesions, determination of cutoff using AUC curves and sensitivity and specificity of both techniques. SAMPLE SIZE: One hundred breast lesions from 95 consecutive patients. RESULTS: The mean (SD) strain elastography ratio in the overall patient population was 4.1 (2.0). Cutoff for benign vs. malignant lesions was 2.86 on the ROC curve. The AUC was 0.911 (95%CI; 0.835-0.988: SE, 0.039) with a sensitivity of 95.8% and a specificity of 89.3%. For the SWE kPa values, the ROC curve showed the AUC was 0.929 (95% CI, 0.870-0.988; SE: 0.030, <.001). Assigning 45.3 as a cut off value provided a sensitivity of 95.8% with a specificity of 85.7%; the positive predictive value was 94.5% and the negative predictive value was 89.6%. The Breast Imaging Reporting and Data System (BI-RADS) category alone was able to differentiate between benign and malignant lesions with a sensitivity of 91.7% and a specificity 100% keeping the cut off value between 4a and 4b. The area under the ROC curve was 0.979. Combining the three (BI-RADS + SE + SWE) distinguished benign vs. malignant lesions with a sensitivity up to 100% and specificity up to 96.3%. CONCLUSION: Combining SE and SWE as a complementary tool with conventional B-mode ultrasonography has a significant potential for better characterization of solid breast lesions and decreasing unnecessary biopsies of BI-RADS IVa lesions. LIMITATIONS: Single institution study. CONFLICT OF INTEREST: None.
Monitoring the effect of TNF-alpha inhibitors on laboratory parameters and adverse effects in different diseases: a retrospective, single-center study.
Madani AN, Al-Saif FM, Alzamil LR … +7 more , Almazroua AM, Alfurayh NA, Aldokhayel SD, Almuhaideb QA, Alballa NS, Daham NA, Alkharashi AA
Ann Saudi Med · 2022 · PMID 36252145 · Full text
BACKGROUND: The introduction of biological treatments has revolutionized the management of moderate-to-severe psoriasis. Multiple clinical trials have established the efficacy of biological agents in the treatment of mod...
BACKGROUND: The introduction of biological treatments has revolutionized the management of moderate-to-severe psoriasis. Multiple clinical trials have established the efficacy of biological agents in the treatment of moderate-to-severe psoriasis. Nevertheless, there are no clear indications for optimal monitoring intervals during treatment. OBJECTIVES: Collect and analyze laboratory evaluation data from patients receiving biological therapy to provide a better understanding of the need for laboratory investigations before and during treatment with biological agents, and to analyze adverse events and other factors. DESIGN: Retrospective cohort SETTINGS: Tertiary care center in Riyadh, Saudi Arabia. PATIENTS AND METHODS: Data were collected from the electronic medical records of patients attending the dermatology, rheumatology, and gastroenterology clinics from June 2014 to June 2019. The laboratory parameters of patients who have received one of the TNF-alpha inhibitors (adalimumab, etanercept, or infliximab) were collected starting at baseline and up to at least one year from treatment initiation. MAIN OUTCOME MEASURES: The time points at which patients developed significantly abnormal laboratory results during treatment with one of the TNF-alpha inhibitors. SAMPLE SIZE: 250 patients RESULTS: Most patients were treated with adalimumab (38.4%); a similar proportion (38%) with infliximab, whereas only 23.6% were treated with etanercept. The majority of the significant abnormal laboratory results occurred at baseline, 3-6 and 9-12 months. Most abnormalities were among patients using infliximab, followed by etanercept, and then adalimumab. The median number of laboratory abnormalities for dermatology patients was significantly lower than that for gastroenterology patients (<.001), and for rheumatology patients (=.002). CONCLUSIONS: Because dermatology patients showed a lower median number of laboratory abnormalities than patients treated by other specialties in our study, we believe that dermatology patients require less frequent laboratory monitoring. Therefore, we recommend laboratory evaluation at baseline, after 3-6 months, 1 year from the beginning of treatment, and annually thereafter for patients using TNF-alpha inhibitor agents. However, more frequent testing might be warranted according to patient comorbidities, concomitant medications, and physician judgment. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.
Time in therapeutic range for virtual anticoagulation clinic versus in-person clinic during the COVID-19 pandemic: a crossover study.
Alanazi Z, Almutairi N, AlDukkan L … +2 more , Arafat AA, Albabtain MA
Ann Saudi Med · 2022 · PMID 36252144 · Full text
BACKGROUND: COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation manageme...
BACKGROUND: COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation management during the pandemic using the Whatsapp application. OBJECTIVES: Compare anticoagulation management quality in virtual versus in-person clinics. DESIGN: A retrospective crossover study SETTINGS: Specialized cardiac care center PATIENTS AND METHODS: The study included patients who presented to Prince Sultan Cardiac Center in Riyadh for anticoagulation management during the pandemic from March 2020 to January 2021. We compared time in therapeutic range (TTR) in the same patients during virtual and in-person clinics. All international normalized ratio (INR) measures during the virtual clinic visits and prior ten INR measures from the in-person clinic were recorded. Patients who had no prior follow-up in the in-person clinic were excluded. MAIN OUTCOME MEASURE: TTR calculated using the Rosendaal method. SAMPLE SIZE: 192 patients RESULTS: The mean age was 58.6 (16.6) years and 116 (60.4%) were males. Patients were diagnosed with atrial fibrillation (n=101, 52.6%), mechanical mitral valve (n=88, 45.8%), mechanical aortic valve (n=79, 41%), left ventricular thrombus (n=5, 2.6%) and venous thromboembolism (n=8, 4.2%). Riyadh residents represented 56.7% of the study population (n=93). The median (IQR) percent TTR was 54.6 (27.3) in the in-person clinic versus 50.0 (33.3) (=.07). CONCLUSION: Virtual clinic results were comparable to in-person clinics for anticoagulation management during the COVID-19 pandemic. LIMITATIONS: Number of INR measures during the virtual clinic visits, retrospective nature and single-center experience. CONFLICT OF INTEREST: None.
Evaluation of expelled droplets through traditional Islamic face coverings.
Alkhateeb N, Almubarak R, Aldurayb S … +4 more , Alanazi M, Alsuliman F, Aljabr R, Gardner MR
Ann Saudi Med · 2022 · PMID 36252143 · Full text
BACKGROUND: Expelled droplet count is an important factor when investigating the efficacy of face coverings since higher droplet counts indicate an increased possibility of disease transmission for airborne viruses such...
BACKGROUND: Expelled droplet count is an important factor when investigating the efficacy of face coverings since higher droplet counts indicate an increased possibility of disease transmission for airborne viruses such as COVID-19. While there is some published work relating facemask style to expelled droplet count during speech, there is no published data regarding the effectiveness of traditional Islamic face coverings such as the ghutra and niqab commonly worn by men and women in the Arabian Peninsula. OBJECTIVES: Measure the effectiveness of worn traditional Islamic face coverings in reducing expelled droplet count during speech. DESIGN: Experimental study SETTING: Biomedical engineering department at a university in Saudi Arabia. MATERIALS AND METHODS: Using a previously described low-cost method for quantifying expelled droplets, this study compares droplet counts through commonly worn traditional Islamic face coverings and conventional three-ply surgical masks worn during speech. The device records scattered light from droplets (>5 μm diameter) as they pass through a laser light sheet (520 nm), and then video processing yields droplet counts. MAIN OUTCOME MEASURES: Percent reduction in the number of expelled droplets passing through face coverings during speech compared to no face covering MAIN OUTCOME MEASURES: 9-15 recorded samples per face covering (n=3) plus no face covering control (n=1) in three females. RESULTS: The average percent reduction for each mask type compared to no mask trial was 76% for the cotton ghutra, 93% for the niqab, and 95% for the surgical mask. The niqab and ghutra had relatively high variability in droplet reduction. CONCLUSIONS: Traditional Islamic face coverings block some expelled droplets, but at lower rates than surgical masks. High standard deviations within facemask groups with high variability in fit (i.e., the cotton ghutra) further denote the importance of fit in face covering effectiveness. Some protection from airborne viruses is likely with traditional Islamic face coverings compared to no mask, but the amount of protection depends on the fit of the face covering. LIMITATIONS: Detectable droplets limited to particles greater than 5 μm diameter with forward expulsion direction. CONFLICT OF INTEREST: None.
Impact of diabetes mellitus on periprocedural and 18-month clinical outcomes in Korean patients requiring rotational atherectomy: results from the ROCK Registry.
Lee SN, Moon D, Her SH … +11 more , Jang WY, Moon KW, Yoo KD, Lee K, Lee JH, Lee JH, Lee SR, Lee SW, Yun KH, Lee HJ, Choi IJ
Ann Saudi Med · 2022 · PMID 36252142 · Full text
BACKGROUND: Diabetes mellitus (diabetes) increases the risk of severe coronary artery calcification, which increases the complexity of percutaneous coronary intervention requiring rotational atherectomy (RA) by interferi...
BACKGROUND: Diabetes mellitus (diabetes) increases the risk of severe coronary artery calcification, which increases the complexity of percutaneous coronary intervention requiring rotational atherectomy (RA) by interfering with lesion preparation, and limiting final stent expansion. OBJECTIVE: Investigate 30-day and 18-month clinical outcomes in patients with and without diabetes treated with percutaneous coronary intervention requiring RA. DESIGN: Medical record review SETTING: Multicenter registry in South Korea PATIENTS AND METHODS: The ROtational atherectomy in Calcified lesions in Korea (ROCK) registry was a large, retrospective, multicenter study to assess RA treatment of severe coronary artery calcification. MAIN OUTCOME MEASURES: The primary endpoint was target-vessel failure including cardiac death, target-vessel myocardial infarction, and target-vessel revascularization. SAMPLE SIZE: 540 patients followed for a median of 16.1 months. RESULTS: Of the 540 patients, 305 had diabetes (56.5%). The diabetes group had a significantly higher frequency of multivessel disease; comorbidities such as hypertension, dyslipidemia, and chronic kidney disease; and lower ejection fraction of the left ventricle compared to the non-diabetes group (n=235). There were no significant differences in procedure success and complications observed between the two groups. Target vessel failure at 30 days between the diabetes and non-diabetes groups was not statistically significant in a multivariate Cox regression analysis (1.6% vs. 2.6%, adjusted hazard ratio [HR] 0.595, 95% confidence interval [CI] 0.154-2.300, =.451). During an 18-month follow-up, the risk of target vessel failure was higher (12.5% vs. 8.9%) but the difference was not statistically significant (adjusted HR 1.393, 95% CI 0.782-2.482, =.260). CONCLUSIONS: Patients with diabetes have a risk of complications comparable to patients without diabetes, and 30-day and 18-month clinical outcomes are similar in severe coronary artery calcification requiring RA, despite having more comorbidities. LIMITATIONS: Retrospective design. Sample size not based on power calculation. CONFLICT OF INTEREST: None.
Prevalence of anti-SARS-CoV-2 antibody in hemodialysis facilities: a cross-sectional multicenter study from Madinah.
Housawi AA, Qazi SJS, Jan AA … +18 more , Osman RA, Alshamrani MM, AlFaadhel TA, AlHejaili FF, Al-Tawfiq JA, Wafa AA, Hamza AE, Hassan MA, Alharbi SA, Albasheer H, Almohmmdi MM, Alsisi SA, Mankowski M, Van de Klundert J, Alhelal AM, Sala FH, Kheyami A, Alhomayeed BA
Ann Saudi Med · 2022 · PMID 35933611 · Full text
BACKGROUND: Since the occurrence of coronavirus disease in 2019 (COVID-19), the global community has witnessed its exponential spread with devastating outcomes within the general population and specifically within hemodi...
BACKGROUND: Since the occurrence of coronavirus disease in 2019 (COVID-19), the global community has witnessed its exponential spread with devastating outcomes within the general population and specifically within hemodialysis patients. OBJECTIVES: Compare the state of immunity to SARS-CoV-2 among hemodialysis patients and staff. DESIGN: Cross-sectional study with a prospective follow-up period. SETTING: Hemodialysis centers in Madinah region. PATIENTS AND METHODS: We prospectively tested for SARS-CoV-2 antibodies in dialysis patients using dialysis centers staff as controls. The participants were tested on four occasions when feasible for the presence of anti-SARS-CoV-2 antibodies. We also analyzed factors that might be associated with seropositivity. MAIN OUTCOME MEASURES: SARS-CoV-2 positivity using immunoglobulin G (IgG) levels SAMPLE SIZE: 830 participants, 677 patients and 153 dialysis centers staff as controls. RESULTS: Of the total participants, 325 (257 patients and 68 staff) were positive for SARS-CoV-2 IgG antibodies, for a prevalence of 38.0% and 44.4% among patients and staff, respectively (=.1379). Participants with a history of COVID-19 or related symptoms were more likely to have positive IgG (<.0001). Surprisingly, positivity was also center-dependent. In a multivariable logistic regression, a history of infection and related symptoms contributed significantly to developing immunity. CONCLUSION: The high prevalence of SARS-CoV-2 antibody among hemodialysis patients and previously asymptomatic staff suggested past asymptomatic infection. Some centers showed more immunity effects than others. LIMITATIONS: Unable to collect four samples for each participant; limited to one urban center. CONFLICT OF INTEREST: None.
Trends in colorectal cancer in Iraq over two decades: incidence, mortality, topography and morphology.
Ibrahem S, Ahmed H, Zangana S
Ann Saudi Med · 2022 · PMID 35933610 · Full text
BACKGROUND: Colorectal cancer (CRC) is mainly a disease of the elderly in the Western world, but its characteristics are changing globally. Iraq does not have a well established CRC screening program. Understanding trend...
BACKGROUND: Colorectal cancer (CRC) is mainly a disease of the elderly in the Western world, but its characteristics are changing globally. Iraq does not have a well established CRC screening program. Understanding trends of CRC incidence, fatality and the clinical features of CRC patients is vital to the design of effective public health measures; public awareness, screening, diagnosis and treatment strategies to meet the future demands. OBJECTIVES: Determine trends in demography, incidence proportion, mortality, topography (primary tumor site) and morphology (histology) over two decades. DESIGN: Registry-based study SETTING: Iraqi National Cancer Registry (INCR) database PATIENTS AND METHODS: We collected and analyzed data from CRC patients obtained from the INCR to calculate incidence and mortality proportion per 100 000 population for the period from 2000 to 2019. In addition to estimation, data were examined by anatomic location and morphological type. MAIN OUTCOME MEASURES: Change in the incidence and mortality proportion, topography and morphology of CRC over 20 years. SAMPLE SIZE: 20 880 CRC patients ranging in age from 14-80 years. RESULTS: The overall (males and females) CRC incidence proportion (CIP) increased from 2.28 to 6.18 per 100 000 population in 2000 and 2019, respectively, with an annual percentage change (APC) of 5.11%. The incidence proportion (IP) of CRC in patients from 20 to <50 years rose from 1.46 in 2000 to 4.36 per 100 000 population in 2019, which is an APC of 5.6%. The IP in patients older than 50 years rose from 12.7 to 40.59 per 100 000 population in 2000 and 2019, respectively, with an APC of 5.98%. The percentage of all CRC cases to all total malignancies in Iraq grew from 3.69% in 2000 to 6.5% in 2019. The CRC mortality proportion increased from 1.25 to 1.77 per 100 000 populations in 2010 and 2019, respectively, reflecting an APC of 3.54%. Anatomically, colon (C18) tumor represented 59.2% and 65.7% in 2000 and 2019, respectively. Rectal (C20) tumors were 37.2% in 2000 down to 31.4% in 2019, while rectosigmoid junction tumor (C19) were 3.6% in 2000 dropping to 2% in 2019. CONCLUSIONS: CRC in Iraq is still a disease of the elderly and is rising in incidence and mortality in all age groups. This necessitates reconsidering health policy regarding CRC; public awareness, screening and management strategies to accommodate for these alarming changes. LIMITATIONS: Data about stages, grades and molecular characterisations are not available in the INCR. CONFLICT OF INTEREST: None.
Association between serum vitamin D levels and age in patients with epilepsy: a retrospective study from an epilepsy center in Saudi Arabia.
Alhaidari HM, Babtain F, Alqadi K … +3 more , Bouges A, Baeesa S, Al-Said YA
Ann Saudi Med · 2022 · PMID 35933609 · Full text
BACKGROUND: Vitamin D deficiency has been linked to various medical conditions such as bone loss, decreased mineralization, endocrine disorders, and central nervous system disorders, including epilepsy. Vitamin D deficie...
BACKGROUND: Vitamin D deficiency has been linked to various medical conditions such as bone loss, decreased mineralization, endocrine disorders, and central nervous system disorders, including epilepsy. Vitamin D deficiency is prevalent among patients with epilepsy (PWE). However, the specific association between vitamin D levels and age in PWE is unclear. OBJECTIVES: Identify the relation between vitamin D level and age in PWE and evaluate factors that may play a role in seizure control. DESIGN: Retrospective analytical medical record review SETTING: Outpatient epilepsy research clinic in Saudi Arabia PATIENTS AND METHODS: Between November 2016 and April 2020, we selected eligible PWE aged older than 14 years whose vita-min D levels were recorded at least once after reviewing 1550 patient electronic files. We analyzed data on serum vitamin D level by age and other factors, vitamin D supplement use, seizure classification, and conducted a multivariate logistic regression to assess associations with seizure control. MAIN OUTCOME MEASURES: Relationships between vitamin D levels and age and factors that might affect seizure control. SAMPLE SIZE: 524 patients RESULTS: The prevalence of low serum vitamin D levels was high (86.8%). The median vitamin D level in all patients was low (38 nmol/L), and was lower in young PWE than in adult PWE (<.01). Only 146 patients received vitamin D supplements. High vitamin D levels were associated with a 40% seizure reduction. CONCLUSION: Vitamin D deficiency is underestimated in PWE in Saudi Arabia, and is more prevalent among young adults and patients on polytherapy than in other PWE. Patients with high vitamin D levels had good seizure control compared with those with low levels. The effect of vitamin D supplements on seizure control should be further investigated in randomized control trials. LIMITATIONS: Retrospective study and no categorization by presence of supplementation. CONFLICT OF INTEREST: None.
COVID-19 and Acute Pancreatitis: A Systematic Review of Case Reports and Case Series.
Georgakopoulou VE, Gkoufa A, Garmpis N … +8 more , Makrodimitri S, Papageorgiou CV, Barlampa D, Garmpi A, Chiapoutakis S, Sklapani P, Trakas N, Damaskos C
Ann Saudi Med · 2022 · PMID 35933608 · Full text
BACKGROUND: Coronavirus disease 2019 (COVID-19) presents mainly with mild symptoms and involvement of the respiratory system. Acute pancreatitis has also been reported during the course of COVID-19. OBJECTIVE: Our aim is...
BACKGROUND: Coronavirus disease 2019 (COVID-19) presents mainly with mild symptoms and involvement of the respiratory system. Acute pancreatitis has also been reported during the course of COVID-19. OBJECTIVE: Our aim is to review and analyze all reported cases of COVID-19 associated acute pancreatitis, reporting the demographics, clinical characteristics, laboratory and imaging findings, comorbidities and outcomes. DATA SOURCES: We conducted a systematic search of Pubmed/MEDLINE, SciELO and Google Scholar to identify case reports and case series, reporting COVID-19 associated acute pancreatitis in adults. STUDY SELECTION: There were no ethnicity, gender or language restrictions. The following terms were searched in combination:"COVID-19" OR "SARS-CoV-2" OR "Coronavirus 19" AND "Pancreatic Inflammation" OR "Pancreatitis" OR "Pancreatic Injury" OR "Pancreatic Disease" OR "Pancreatic Damage". Case reports and case series describing COVID-19 associated acute pancreatitis in adults were included. COVID-19 infection was established with testing of nasal and throat swabs using reverse transcription polymerase chain reaction. The diagnosis of acute pancreatitis was confirmed in accordance to the revised criteria of Atlanta classification of the Acute Pancreatitis Classification Working Group. Exclusion of other causes of acute pancreatitis was also required for the selection of the cases. DATA EXTRACTION: The following data were extracted from each report: the first author, year of publication, age of the patient, gender, gastrointestinal symptoms due to acute pancreatitis, respiratory-general symptoms, COVID-19 severity, underlying diseases, laboratory findings, imaging features and outcome. DATA SYNTHESIS: Finally, we identified and analyzed 31 articles (30 case reports and 1 case series of 2 cases), which included 32 cases of COVID-19 induced acute pancreatitis. CONCLUSION: COVID-19 associated acute pancreatitis affected mostly females. The median age of the patients was 53.5 years. Concerning laboratory findings, lipase and amylase were greater than three times the ULN while WBC counts and CRP were elevated in the most of the cases. The most frequent gastrointestinal, respiratory and general symptom was abdominal pain, dyspnea and fever, respectively. The most common imaging feature was acute interstitial edematous pancreatitis and the most frequent comorbidity was arterial hypertension while several patients had no medical history. The outcome was favorable despite the fact that most of the patients experienced severe and critical illness. LIMITATIONS: Our results are limited by the quality and extent of the data in the reports. More specifically, case series and case reports are unchecked, and while they can recommend hypotheses they are not able to confirm robust associations. CONFLICT OF INTEREST: None.
Outcome after single dose of ChAdOx1 vaccine against SARS-CoV-2 infection at 16 weeks post-vaccination among healthy adults in Saudi Arabia.
Alghamdi A, Alsanea N, Alraey M … +7 more , Joseph M, Aboud M, Almangour T, Alharbi W, Alhumidan H, Alanizi A, Al-Jedai A
Ann Saudi Med · 2022 · PMID 35933607 · Full text
BACKGROUND: The rate of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection and immunogenicity of a single dose of ChAdOx1 vaccine at 16 weeks post-vaccination among young and healthy participants rema...
BACKGROUND: The rate of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection and immunogenicity of a single dose of ChAdOx1 vaccine at 16 weeks post-vaccination among young and healthy participants remains unclear in Saudi Arabia. OBJECTIVES: Assess the rate of subsequent infection and immunogenicity of a single dose of ChAdOx1 vaccine at 16 weeks post-vaccination in a sample of healthy and young participants. DESIGN: Cross-sectional study SETTING: Academic teaching hospital in Riyadh, Saudi Arabia SUBJECTS AND METHODS: Healthy participants 18-50 years of age, who received one dose of ChAdOx1 vaccine and had no history of SARS CoV-2 infection were recruited, and blood samples were obtained 16 weeks after vaccination to assess immunogenicity using a commercially available kit. MAIN OUTCOME MEASURES: The rate of SARS-CoV-2 infection within 16 weeks post-vaccination. SAMPLE SIZE: 385 participants with median (IQR) age of 34 (29-38) years. RESULTS: Eleven (2.8%) participants acquired polymerase chain reaction (PCR)-confirmed infection within 16 weeks after a single dose of ChAdOx1 vaccine (mean [SD] 42.5 [28] days post-vaccination). No hospital or intensive care unit admissions occurred among the subjects in this sample. Females were significantly over-represented in PCR-confirmed cases of SARS-CoV-2 infection, with 10 of 11 infections occurring in females (=.006). Antibody response against anti-spike IgG were detectable in 92.7% of subjects at 16 weeks' post-vaccination. The median anti-spike IgG level after vaccination was 273.1 (IQR 107-1052 AU/mL). However, the anti-nucleocapsid IgG antibody demonstrated a sensitivity of only 20%. CONCLUSION: A single dose of ChAdOx1 vaccine in healthy and young individuals was associated with a low, single-digit rate of PCR-confirmed infection, most of which were mild. LIMITATIONS: Small sample size and single-center. CONFLICT OF INTEREST: None.
Comment on "The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: a randomized controlled study".
Kashoo FZ, Ahmad M, Sidiq M … +1 more , Shahood H
Ann Saudi Med · 2022 · PMID 35933606 · Full text
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Comparison of nutritional risk status assessment tools in predicting 30-day survival in critically ill COVID-19 pneumonia patients.
Kasapoglu US, Gok A, Delen LA … +1 more , Ozer AB
Ann Saudi Med · 2022 · PMID 35933605 · Full text
BACKGROUND: Few clinical studies have addressed nutritional risk assessment in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU). OBJECTIVES: Assess the nutritional risk status of the critically...
BACKGROUND: Few clinical studies have addressed nutritional risk assessment in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU). OBJECTIVES: Assess the nutritional risk status of the critically ill COVID-19 pneumonia patients admitted to the ICU, and compare the nutritional risk screening tools. DESIGN: Medical record review SETTING: Tertiary critical care unit PATIENTS AND METHODS: We included adult (age >18 years) PCR-confirmed critically ill COVID-19 pneumonia cases admitted to the ICU between August 2020 and September 2021. Scoring systems were used to assess COVID-19 severity and nutritional status (mNUTRIC: modified Nutrition Risk in Critically Ill, NRS2002: Nutritional Risk Screening 2002). The 30-day mortality prediction performance of nutritional scores and survival comparisons between clinical and demographic factors were assessed. MAIN OUTCOME MEASURES: Compare the nutrition risk tools SAMPLE SIZE: 281 patients with a mean (SD) age of 64.3 (13.3) years; 143 (50.8%) were 65 years and older. RESULTS: The mean mNUTRIC score of the cases was 3.81 (1.66) and the mean NRS-2002 score was 3.21 (0.84.), and 101 (35.9%) were at high risk of malnutrition according to the mNUTRIC score and 229 (81.4%) according to the NRS 2002 score. In cases at high risk of malnutrition by the mNUTRIC score there was a greater need for invasive mechanical ventilation, vasopressors, and renal replacement therapy (<.001 for all comparisons). The mNUTRIC score was superior to the NRS-2002 score in estimating 30-day mortality. In patients who died within 30 days, the mNUTRIC score and NRS-2002 score on the day of hospitalization were significantly higher (<.001), and the proportion of patients with NRS-2002 score ≥3 and mNUTRIC score ≥5 was significantly higher in the non-surviving group (<.001). In addition, patients with a high risk of malnutrition had a shorter survival time. The mNUTRIC score was an independent and important prognostic factor for 30-day mortality, and patients with an mNUTRIC score ≥5 had a 6.26-fold risk for 30-day mortality in the multivariate Cox regression. CONCLUSION: One third of critical COVID-19 pneumonia cases hospitalized in the ICU due to acute respiratory failure have a high risk of malnutrition, and a high mNUTRIC score is associated with increased mortality. LIMITATIONS: Single center retrospective study. CONFLICT OF INTEREST: None.
Health outcomes after acute ischemic stroke:retrospective and survival analysis from Oman.
Al Alawi AM, Al Busaidi I, Al Shibli E … +5 more , Al-Senaidi AR, Al Manwari S, Al Busaidi I, Muhanna F, Al Qassabi A
Ann Saudi Med · 2022 · PMID 35933604 · Full text
BACKGROUND: Stroke mortality and related functional disability have been declining over the last two decades, but stroke continues to represent the second leading cause of cardiovascular death worldwide and the number on...
BACKGROUND: Stroke mortality and related functional disability have been declining over the last two decades, but stroke continues to represent the second leading cause of cardiovascular death worldwide and the number one cause for acquired long-term disability. OBJECTIVES: Assess short- and long-term health outcomes after acute ischemic stroke and analyze factors associated with poor survival and functional outcomes. DESIGN: Retrospective and survival analysis SETTING: Inpatient unit at a tertiary care referral hospital. PATIENTS AND METHODS: All patients admitted with acute ischemic stroke from 1 January 2017 to 31 August 2018 were included in the study. Functional status was assessed using the modified Rankin Scale (mRS). Other demographic and clinical variables were obtained from medical records. Data were analyzed by multivariable logistic regression, Cox proportional hazards, and the Kaplan-Meier method. Long-term follow-up data, including mortality and mRS was collected by follow-up phone call. MAIN OUTCOME MEASURES: Functional dependency and factors associated with mortality. SAMPLE SIZE AND CHARACTERISTICS: 110 with mean age of 67.0 (14.7) years; 59 patients (53.6%) were males. RESULTS: Hypertension (75.5%), diabetes mellitus (54.6%), and dyslipidemia (29.1%) were common. Sixty-five patients (59.1%) had mRS >2 upon discharge including 18 patients (16.4%) who died during the hospital stay. The cumulative mortality rate was 25.4% (28/110) at 12 months and 30.0% (33/110) at 24 months. Twenty-nine stroke survivors (29/70, 41.4%) remained physically dependent (mRS >2) at the end of follow-up. Old age, atrial fibrillation, history of prior stroke, chronic kidney disease, and peripheral arterial disease were associated with increased mortality and functional dependence. CONCLUSIONS: Patients in Oman with acute ischemic stroke tend to have a high comorbidity burden, and their functional dependency and mortality are higher compared to patients from developed countries. Therefore, evidence-based measures such as establishing stroke units are essential to improve the health outcomes of patients with acute ischemic stroke. LIMITATIONS: Retrospective at single center. CONFLICT OF INTEREST: None.
Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman.
Alhassan R, Al Busaidi N, Al Rawahi AH … +4 more , Al Musalhi H, Al Muqbali A, Shanmugam P, Ramadhan FA
Ann Saudi Med · 2022 · PMID 35933603 · Full text
BACKGROUND: Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling n...
BACKGROUND: Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling need to explore FNAC accuracy among Omanis. OBJECTIVE: Describe cytological features of FNAC and assess FNAC accuracy compared to the postsurgical histopathology report. DESIGN: Retrospective diagnostic accuracy study SETTING: Tertiary care center. PATIENTS AND METHODS: Our study included adult Omani adult patients with thyroid nodules who underwent FNAC from 2014 to 2017 and had final pathology results for patients who underwent thyroid surgery. The results were classified according to the UK Royal college of Pathologists 'Thy' categories. Accuracy of FNAC was calculated by determining false and true positive and negative results based on histopathology findings. MAIN OUTCOME MEASURES: FNAC accuracy (sensitivity and specificity) compared to the postsurgical histopathology. SAMPLE SIZE: 867 patients with 1359 ultrasound guided FNACs of thyroid nodule; 137 underwent surgery. RESULTS: The mean age of the 867 patients was 43.7 (13.3) years, with a median of 42 years, and 87.8% were females. Out of 1359 FNACs, 1001 (73.7%) were benign (Thy2), 119 (8.8%) were atypia of undetermined significance or follicular lesion of undetermined significance (Thy3a), 31 (2.3%) were follicular neoplasm or suspicious for a follicular neoplasm (Thy3f), 52 (3.8%) were suspicious for malignancy (Thy4), 55 (4%) were malignant (Thy5), 101 (7.4%) as Unsatisfactory (Thy1). Only 137 patients underwent thyroid surgery, and the FNAC reports were compared with their final histopathology reports. The sensitivity, specificity and total accuracy of FNAC were 80.2%, 98.9% and 89.9%, respectively. The positive and negative predictive values of FNAC were 98.6% and 84.3%, respectively. CONCLUSION: Our study findings confirmed that FNAC of the thyroid is a sensitive, specific, and accurate initial tool for the diagnosis of thyroid lesions. Most of the FNACs were benign with a very low malignancy rate. Due to the minimal chance of false negative results and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow-up. LIMITATIONS: Retrospective design and single-center study, and thyroid nodule size unavailable. CONFLICT OF INTEREST: None.
Prognosis of gastric adenocarcinoma associated with girdin, Akt, and cortactin.
Zhang Y, Liu C, Zhou L
Ann Saudi Med · 2022 · PMID 35770962 · Full text
BACKGROUND: The actin-binding protein girdin regulates tumor cell migration and invasion by maintaining actin structure. PI3K/Akt signaling is an important actin-remodeling pathway. The protein cortactin acts directly on...
BACKGROUND: The actin-binding protein girdin regulates tumor cell migration and invasion by maintaining actin structure. PI3K/Akt signaling is an important actin-remodeling pathway. The protein cortactin acts directly on microfilaments and promotes tumor invasion and metastasis by rearranging the cytoskeleton. However, there are few reports on the co-expression of girdin, Akt, and cortactin in gastric adenocarcinoma (GAC). OBJECTIVES: Evaluate girdin, Akt, and cortactin expression in GAC tissues and assess their relationship to the prognosis of GAC patients. DESIGN: Survival analysis SETTING: Medical college in China PATIENTS AND METHODS: We compared survival in 110 paraffin-preserved GAC with corresponding normal gastric mucosa tissues in relationship to girdin, Akt, and cortactin expression levels. MAIN OUTCOME MEASURE: Expression levels of the proteins. SAMPLE SIZE: 110 RESULTS: The expression of girdin, Akt, and cortactin were all upregulated in GAC tissues compared with corresponding normal tissues (66.4% vs 36.3%, 57.3% vs 28.2% and 69.1% vs 22.7%, respectively; <.05) and expression was mutually positive (all <.05). Overall survival in the girdin, Akt, and cortactin high expression groups was reduced. Multivariate analysis showed that girdin, Akt, cortactin, lymph node metastasis (LNM) and TNM stages were independent factors affecting GAC patients prognosis (<.05). CONCLUSIONS: Girdin and cortactin may promote GAC invasion and metastasis via the PI3-K/Akt signaling pathway. Girdin, Akt, and cortactin co-expression might serve as a novel molecular target for GAC therapy and improve the prognosis of patients with this disease. LIMITATIONS: A small sample size and lack of related research on molecular mechanisms. CONFLICT OF INTEREST: None.
Spinal anesthesia versus combined sciatic nerve/lumbar plexus nerve block in elderly patients undergoing total hip arthroplasty: a retrospective study.
Kaçmaz M, Turhan ZY
Ann Saudi Med · 2022 · PMID 35770961 · Full text
BACKGROUND: The most important cause of mortality due to long bone fractures in the elderly patients are femoral fractures that require total hip arthroplasty (THA). THA surgeries may cause severe postoperative pain, lon...
BACKGROUND: The most important cause of mortality due to long bone fractures in the elderly patients are femoral fractures that require total hip arthroplasty (THA). THA surgeries may cause severe postoperative pain, long hospital stays, a need for transfusion and mortality. OBJECTIVE: Compare outcomes of spinal anesthesia (SA) versus combined sciatic nerve/lumbar plexus block (CSLPB). DESIGN: Retrospective cohort trıal. SETTING: University hospital in Turkey. PATIENTS AND METHODS: We selected patients from the electronic medical records by date of surgery (most recent first) and compared demographic and pre- and postoperative clinical characteristics including the amount of opioid use within the first 48 postoperative hours, 30-day mortality rates, length of hospital stay, intraoperative oxygen saturation (SpO) and mean arterial pressure (MAP) values, duration of the surgery, and blood transfusion need. MAIN OUTCOME MEASURE: Opioid use within the first 48 postoperative hours. SAMPLE SIZE: 204, 102 patients in each group with overall median (IQR) age of 82 (10.2) years. RESULTS: There was no significant difference between the groups in terms of the amount of opioid use within the postoperative 48 hours, 30-day mortality rates, intensive care need, duration of the surgery, blood transfusion need, and length of hospital stay. While the intraoperative SpO value was lower in the CSLPB group (=.03), MAP values were lower in the SA group (=.046). Preoperative American Society of Anesthesiology score (ASA) scores (=.039) and the number of comorbidities were higher in the CSLPB group. CONCLUSION: We prefer CSLPB used with standardized sedation protocols for anesthesia in THA surgery in elderly patients. LIMITATIONS: Retrospective design and single-centered. CONFLICT OF INTEREST: None.
Hematologic reference intervals for healthy adult Saudis in Riyadh.
Bakr S, AlFattani A, Al-Nounou R … +8 more , Bakshi N, Khogeer H, Alharbi M, Almousa N, Alomaim W, Aguilos A, Almashary M, Owaidah T
Ann Saudi Med · 2022 · PMID 35658586 · Full text
BACKGROUND: Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools...
BACKGROUND: Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region. OBJECTIVES: Provide reference values of routine hematological parameters in Saudi adults according to age and gender. DESIGN: Cross-sectional SETTING: Central province of Saudi Arabia. PATIENTS AND METHODS: Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire. MAIN OUTCOME MEASURES: Hematological reference values based on the local population. SAMPLE SIZE AND CHARACTERISTICS: 637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years. RESULTS: The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks. CONCLUSION: The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population. LIMITATIONS: Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population. CONFLICT OF INTEREST: None.
Clinical outcomes of patients with COVID-19 and inflammatory rheumatic diseases receiving biological/targeted therapy.
Pehlivan Ö, Aydin T
Ann Saudi Med · 2022 · PMID 35658585 · Full text
BACKGROUND: Anti-cytokine treatments are used in the treatment of severe COVID-19. Other studies have shown statistical significance with TNF inhibitors but not with other biological/targeted synthetic disease-modifying...
BACKGROUND: Anti-cytokine treatments are used in the treatment of severe COVID-19. Other studies have shown statistical significance with TNF inhibitors but not with other biological/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD). OBJECTIVES: Compare the rate of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection and the course and incidence of COVID-19 infection in patients who received b/tsDMARD with control patients. DESIGN: Analytical cross-sectional SETTINGS: Tertiary care hospital PATIENTS AND METHODS: All patients who applied to the rheumatology outpatient clinic between June 2020-March 2021 and received b/tsDMARD were included in the study. All patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis who applied to the rheumatology outpatient clinic in the three months before March 2021 and did not receive b/tsDMARD were included as the control group. History of COVID-19 infection and treatments were recorded. Multivariate analysis was performed to assess factors associated with use of tumor necrosis factor (TNF) inhibitors and differences between specific biologic drugs. MAIN OUTCOME MEASURES: Rate of COVID-19 disease among patients using biological/targeted synthetic therapy and non-biological/targeted synthetic therapy. COVID-19 clinical outcomes (hospitalization, intensive care admission, mechanical ventilation and death). SAMPLE SIZE: 533 in total; 341 received b/tsDMARD, 212 in the control group that did not receive b/tsDMARD. RESULTS: One hundred patients (18%) had been infected with SARS-COV-2. The difference in SARS-COV-2 infection between b/tsDMARD and the control was statistically significant (13, 2% vs. 25, 9%, respectively) (<.001). The hospital stays were longer in the controls (<.001). Multinomial regression analysis revealed that COVID-19 negative patients were more likely to use tumor necrosis factor (TNF) inhibitors (OR: 2, 911; 95% CI: 1.727-4.908; <.001) compared to COVID-19 positive participants. Multinomial logistic regression analysis indicated that hospitalized patients were more likely to use TNF inhibitors (OR: 11, 006; 95% CI: 3.447-35.138; <.001) and there was no significant difference between b/tsDMARDs other than TNF inhibitors in frequency of hospitalization. CONCLUSIONS: Patients who were medicated with b/tsDMARD were less likely to be infected with COVID-19 and be hospitalized due to the infection. We have found that this effect was particularly dependent on the use of TNF inhibitors. LIMITATIONS: Conducted in a single center and unable to provide a homogeneous study population. CONFLICT OF INTEREST: None.
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