Annals Of Saudi Medicine[JOURNAL]
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200 papers
Impact of ileostomy creation on apixaban plasma concentrations: a retrospective case-series.
Hakeam HA, McGrath S, Alrebeh G … +1 more , Alrebdi AF
Ann Saudi Med · 2026 · PMID 41562165 · Full text
BACKGROUND: Apixaban is a direct-acting oral anticoagulant indicated for stroke and systemic embolism prevention in atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). It is absorbed throughou...
BACKGROUND: Apixaban is a direct-acting oral anticoagulant indicated for stroke and systemic embolism prevention in atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). It is absorbed throughout the small intestine, with possible contribution from the distal ileum and ascending colon. The effect of ileostomy creation, which excludes the colon from the gastrointestinal tract, on apixaban plasma concentrations remains unclear. OBJECTIVES: To evaluate the impact of ileostomy creation on apixaban plasma concentrations. DESIGN: Retrospective case series. SETTING: A single tertiary care center in Saudi Arabia. PATIENTS AND METHODS: Patients receiving apixaban who had peak apixaban plasma concentrations measured following ileostomy creation between January 2021 and June 2025 were included. Patients were followed for at least three months and up to 12 months, or until ileostomy closure, discontinuation of apixaban, or death, whichever occurred first. MAIN OUTCOME MEASURES: Peak apixaban plasma concentrations, proportion of patients within the expected 5th-95th percentile range reported in Phase II and Phase III trials, the distribution of apixaban plasma concentrations below or above the median of the expected range, and clinical bleeding or thrombotic events. SAMPLE SIZE: Ten patients. RESULTS: Apixaban was prescribed for VTE in six patients and AF in four. Eight patients (80%) had peak apixaban concentrations within the expected 5th-95th percentile range of apixaban concentrations; one patient was below the 5th percentile, and one was above the 95th percentile. Six patients had apixaban plasma peak concentrations below the median of the expected 5th-95th percentile range. Two patients experienced rectal bleeding, and no thrombotic events were observed. CONCLUSIONS: In patients with an ileostomy, apixaban peak concentrations generally fall within the expected 5th-95th percentile range, though frequently below the median. Ileostomy may slightly affect apixaban absorption, but does not appear to result in underexposure. Standard apixaban dosing seems appropriate. LIMITATIONS: Small sample size, lack of control, and retrospective design.
Medical malpractice in pediatric surgery: an analysis of Supreme Court decisions involving physicians.
Çördük N, İzci A, Dereli AK … +1 more , Acar K
Ann Saudi Med · 2026 · PMID 41562164 · Full text
BACKGROUND: In pediatric surgical practice, physicians may face malpractice claims leading to substantial compensations and even criminal liability. OBJECTIVES: To examine the legal processes and responsibilities of phys...
BACKGROUND: In pediatric surgical practice, physicians may face malpractice claims leading to substantial compensations and even criminal liability. OBJECTIVES: To examine the legal processes and responsibilities of physicians by reviewing Supreme Court decisions related to malpractice claims involving pediatric surgeons. DESIGN AND SETTINGS: A retrospective study based on the online archive of Supreme Court decisions. PATIENTS AND METHODS: A search was conducted using keywords from the Supreme Court decision search engine. Decisions were reached regarding malpractice claims involving pediatric surgery. MAIN OUTCOMES MEASURES: The medical procedure that was the subject of the malpractice claim, the resulting damage, the expertise of the physicians, and the reasons for the Supreme Court's reversal and approval were evaluated. SAMPLE SIZE: 82 Supreme Court decisions. RESULTS: Among 82 decisions, circumcision (46%; n=38) was the most common. Appendicitis and testicular torsion followed. Total/subtotal penile amputation was present in 40% (n=15) of circumcisions. Half of the appendicitis cases resulted in death, and all testicular torsion cases resulted in organ loss. General surgeons were the most frequent physicians involved in litigation, accounting for 16% of cases (n=13), followed by pediatric surgeons and general practitioners, each accounting for 15% of cases (n=12). Supreme Courts found physicians at fault in 35% of criminal cases and 38% of civil cases. Deficiencies in expert reports were the reason for reversals in 42% of the decisions. CONCLUSION: Supreme Courts conduct comprehensive evaluations in malpractice cases, considering factors such as indication, authority, fault status, complication management, and causal link. Physicians' understanding of these issues will significantly contribute to minimizing malpractice claims. LIMITATIONS: Retrospective study.
Effectiveness of intercostal tube drainage versus other invasive approaches in initial management of pneumothorax in adults: a systematic review and meta-analysis.
Alsaigh S, Abu Reida F, Almimoni MM … +6 more , Alnajm MF, Alhojailan RA, Alhamrani M, Alharbi A, Alwadai MMH, Alotaibi AJ
Ann Saudi Med · 2026 · PMID 41562163 · Full text
BACKGROUND: The comparative effectiveness of intercostal tube drainage (ITD) and less invasive methods in initial pneumothorax management remains uncertain. OBJECTIVES: To compare ITD with other invasive approaches in ad...
BACKGROUND: The comparative effectiveness of intercostal tube drainage (ITD) and less invasive methods in initial pneumothorax management remains uncertain. OBJECTIVES: To compare ITD with other invasive approaches in adults. DESIGN: A systematic review and meta-analysis based on PRISMA guidelines, covering twelve studies from nine countries (Iran, UK, Netherlands, USA, Belgium, Kuwait, Norway, Pakistan, Switzerland) published between 1994 and 2021. MATERIALS AND METHODS: A comprehensive search was conducted in PubMed, and Google Scholar. The study encompassed randomized controlled trials (RCTs), prospective and retrospective analyses with adults presenting pneumothorax. Quality assessment was conducted using the Cochrane risk-of-bias (RoB 2) tool for randomized trials and the MINORS tool for non-randomized studies. MAIN OUTCOME MEASURES: Immediate success rates, hospital stay durations, complication rates, and recurrence rates at 12 months. SAMPLE SIZE: A total of 1204 patients were included across 12 studies, ten RCTs (n=932), one prospective (n=60) and one retrospective study (n=212). RESULTS: Meta-analysis showed no statistically significant differences between the ITD and the less invasive techniques in the immediate success rate (OR: 0.88, 95% CI: 0.47-1.65, =.69). Also, no difference was noticed in the 1-week success rate (OR: 1.01, 95% CI: 0.6-1.5, =.96) and recurrence (OR: 1.20, 95% CI: 0.80-1.80, =.38). RISK OF BIAS: The RoB was low in 82% of studies assessed by RoB 2 and the study evaluated by MINORS demonstrated a moderate RoB. HETEROGENEITY: A high statistical heterogeneity was observed (I=77%). CONCLUSIONS: ITD and other invasive approaches demonstrated comparable effectiveness, with no significant differences in immediate success, 1-week success, or recurrence rates. LIMITATIONS: The studies varied widely in design, patient groups, and quality. There were also signs of publication bias and a limited number of high-quality RCTs. PROSPERO REGISTRATION NUMBER: CRD42024517888.
Liver measurements on computed tomography: a guide for day-to-day practice in the Saudi population.
Molla NW, Aleisa AA, Alhuqayl FS … +5 more , Aljohani DW, Alghamdi YA, Alghamdi KA, Almayouf OA, Alduraibi AA
Ann Saudi Med · 2026 · PMID 41562162 · Full text
BACKGROUND: Liver size can indicate the presence of liver diseases such as cirrhosis, hepatitis, and malignancy. Accurate assessment of liver span is essential for the early identification of liver pathologies. OBJECTIVE...
BACKGROUND: Liver size can indicate the presence of liver diseases such as cirrhosis, hepatitis, and malignancy. Accurate assessment of liver span is essential for the early identification of liver pathologies. OBJECTIVES: The objective of this study is to establish a reference value for the average liver size of the Saudi population using abdominal computed tomography (CT) scans. A secondary objective of the study is to explore the correlations of demographic factors and comorbidities with liver size. DESIGN: A retrospective cross-sectional study. SETTING: Tertiary healthcare center in Riyadh, Saudi Arabia. PATIENTS AND METHODS: A retrospective cross-sectional analysis of liver span, liver width, and spleen span was performed. The maximum oblique craniocaudal (MaxCC) length and transverse width of the liver and maximum length of the spleen were obtained in coronal view. The demographic characteristics and comorbidities of patients were collected. MAIN OUTCOME MEASURES: Liver span, width, and spleen span of the study population. In addition to demographic characteristics and comorbidities that were correlates of larger liver size. SAMPLE SIZE: 2500 adult patients who underwent CT scans for conditions unrelated to liver disease. RESULTS: The mean (SD) liver span of the study population was 17.6 cm (2.4), while mean liver width was 18.9 cm (2.8). Multivariate analysis showed that a larger liver span was significantly correlated with increased age, height, a diagnosis of diabetes, as well as fatty liver and a larger BMI score. CONCLUSIONS: Measurement of the liver span using the MaxCC length and liver width is a simple method for routine clinical screening. The values established are useful in screening for liver disease that causes hepatomegaly and should therefore be used more frequently in a clinical setting in CT imaging. LIMITATIONS: Retrospective single-center design and reliance on CT-based diagnosis of fatty liver, which may not detect subclinical steatohepatitis.
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Ann Saudi Med · 2025 · PMID 41275352 · Full text
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Frequencies and causes of pre-analytical errors in a tertiary care hospital laboratory in Saudi Arabia.
Alenezy NT, Arain SA, Omair A … +4 more , Afnan R, Nadheef A, Ahmed AF, Sindi HM
Ann Saudi Med · 2025 · PMID 41275351 · Full text
BACKGROUND: Errors in clinical laboratory tests can have a detrimental effect on healthcare delivery. The pre-analytical phase accounts for most laboratory errors, known as pre-analytical errors (PAEs). OBJECTIVE: This s...
BACKGROUND: Errors in clinical laboratory tests can have a detrimental effect on healthcare delivery. The pre-analytical phase accounts for most laboratory errors, known as pre-analytical errors (PAEs). OBJECTIVE: This study investigated the causes and frequencies of PAEs occurring within a laboratory of a tertiary care hospital. DESIGN: A single-center, retrospective, observational study. SETTING: King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia. MATERIALS AND METHODS: All laboratory test orders and repeated or rejected specimens in the Laboratory Information System (LIS) during 2021. The data consisted of the types of PAEs, their distribution across laboratory sections, the patient source among hospital departments, and the working shift during which PAEs were recorded. MAIN OUTCOME MEASURES: The causes and frequencies of PAEs across laboratory sections, hospital departments, and work shifts were analyzed. SAMPLE SIZE: 2104 PAEs from a total of 3 346 199 test orders. RESULTS: Of the 3 346 199 test orders, 3137 were recorded as either repeated or rejected. Of these, 2104 (67.1%) were attributed to PAEs, representing a rate of 0.063% (95% CI: 0.060-0.066%) of the total test orders. 'Clotted specimens' (32%) and 'insufficient quantity' (31%) were the most frequent PAEs. Significant differences were identified in the error rate and type of PAEs across laboratory sections, hospital departments, and working shifts (<.001 for each). The highest error rate was in the blood bank (0.4%). The hematology section accounted for the largest proportion of errors (48.4%). Most PAEs were test orders from the inpatient department (47.3%), with a majority occurring in the morning shift (58.2%). CONCLUSION: Our study revealed a low overall PAE rate of 0.063%. 'Clotted specimens' and 'insufficient quantity' were the most frequent errors. Importantly, we identified significant differences in the types of PAEs across laboratory sections, hospital departments, and working shifts, indicating their multifaceted and context-dependent nature. LIMITATIONS: A retrospective, single-center study.
Predictors of permanent hypoparathyroidism following total thyroidectomy: a retrospective analysis.
Samargandy S, Alotaibi AS, Alzahrani AA … +7 more , Alzahrani SA, Alghamdi AH, Alotaibi AM, Alsahafi HA, Alsolami AA, Marzouki HZ, Samargandy S
Ann Saudi Med · 2025 · PMID 41275350 · Full text
BACKGROUND: Hypoparathyroidism (HPT) is a significant potential complication following thyroidectomy. Identifying predictors can aid in risk stratification, management, and potentially prevention. OBJECTIVE: To determine...
BACKGROUND: Hypoparathyroidism (HPT) is a significant potential complication following thyroidectomy. Identifying predictors can aid in risk stratification, management, and potentially prevention. OBJECTIVE: To determine clinical and biochemical predictors of permanent HPT in post-thyroidectomy patients. DESIGN: Single-center, retrospective cohort study. SETTINGS: Tertiary care center in Saudi Arabia. PATIENTS AND METHODS: We conducted a retrospective analysis of 1085 patients who underwent total thyroidectomy from 2015 to 2022. Patients who developed postoperative HPT were categorized into transient and permanent HPT groups. Demographic, surgical, and biochemical variables were analyzed. Multivariable logistic regression was used to identify independent predictors of permanent HPT, using transient HPT as the reference. MAIN OUTCOME MEASURES: Identification of independent predictors associated with permanent HPT. SAMPLE SIZE: 1085 patients, 264 with postoperative HPT. RESULTS: We had 264 patients (24.3%) who developed postoperative HPT: 207 (19.1%) had transient and 57 (5.2%) had permanent HPT. Independent predictors of permanent HPT included thyroid cancer (Odds ratio, OR 2.08, 95% Confidence Interval, CI 1.03-4.17), autoimmune thyroid disease (OR 2.01, 95% CI 1.00-4.08), increased thyroid weight (OR 1.52 per 1 SD increase, 95% CI 1.08-2.14), and longer hospital stay (≥7 days) (OR 3.53, 95% CI 1.87-6.68). Preoperative vitamin D deficiency was identified as the only modifiable risk factor (OR 2.25, 95% CI 1.17-4.32). A postoperative parathyroid hormone (PTH) level ≤1.52 pmol/L within 24 hours was strongly associated with the risk of permanent HPT. CONCLUSION: Permanent HPT is significantly associated with preoperative vitamin D deficiency, thyroid malignancy, autoimmune thyroid disease, and greater thyroid weight. A postoperative PTH level ≤1.52 pmol/L is a reliable early biochemical predictor. Risk-based stratification may support individualized patient management and follow-up planning. LIMITATIONS: This was a single-center, retrospective study, limiting generalizability, in addition to the heterogeneity in surgeon experience and the time of PTH measurements post-operatively.
Age, not tumor size, modifies the association between extrathyroidal extension and long-term outcomes in patients with follicular cell-derived thyroid carcinoma.
Samargandy SA, Samargandy S, Faruqui HM … +3 more , Baharoon A, Merdad M, Alsuwat AKM
Ann Saudi Med · 2025 · PMID 41275349 · Full text
BACKGROUND: Follicular cell-derived thyroid carcinomas (FCTC) are common, with stable mortality rates but significant recurrence risks. Extrathyroidal extension (ETE) affects recurrence risk and staging. The 8th edition...
BACKGROUND: Follicular cell-derived thyroid carcinomas (FCTC) are common, with stable mortality rates but significant recurrence risks. Extrathyroidal extension (ETE) affects recurrence risk and staging. The 8th edition of the AJCC/TNM classification excludes microscopic ETE from upstaging but considers gross ETE a significant factor in older patients. OBJECTIVE: This study examines clinical outcomes and disease-free survival (DFS) in FCTC patients with and without ETE, evaluating the modifying effects of age and tumor size on incomplete response risk. DESIGN: A single-center retrospective chart review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. SETTING: King Abdulaziz University Hospital. PATIENTS AND METHODS: Patients aged ≥13 years diagnosed from January 2017 to December 2021 with long-term follow-up (≥18 months) were included. Medullary and anaplastic thyroid cancers were excluded. Data on demographics, tumor characteristics, risk stratification, and clinical outcomes were collected. Response to therapy was categorized per the 2015 ATA guidelines. Chi-square and Multivariable analysis assessed interactions between age, tumor size, and ETE in predicting incomplete response. Kaplan-Meier curves visualized survival differences. MAIN OUTCOME MEASURES: Identifying the interactions between age and tumor size with ETE to predict the risk of incomplete response to therapy among patients with FCTC. SAMPLE SIZE: 255 patients. The median follow-up duration was 4 years. RESULTS: Patients with ETE were present in (n=38) 15.7% (8% microscopic, 7% gross). Older patients (≥55 years) with ETE had 26.47-fold higher odds of incomplete response than younger patients. Tumor size independently predicted incomplete response, but its interaction with ETE was not significant. Patients with ETE had a significantly higher incomplete response rate (58% vs. 17%, =.0001). CONCLUSION: Older patients with ETE face a markedly higher risk of incomplete response. Tumor size is an independent risk factor in those patients. Management should be stratified by age, advocating more aggressive management for older patients with ETE. LIMITATIONS: Retrospective, and single-center design.
Does the use of perioperative corticosteroids reduce the incidence of seroma formation after breast cancer surgery? A systematic review and meta-analysis.
Alnajjar JS, Bakheet HA, Addas MAM … +5 more , Alghamdi RA, AlSharit MA, Farghal NN, Trabulsi NH, Farsi A
Ann Saudi Med · 2025 · PMID 41275348 · Full text
BACKGROUND: Seroma is a common complication of breast cancer surgery, affecting up to 85% of cases. OBJECTIVE: To assess the effectiveness of perioperative corticosteroids in reducing seroma formation. DESIGN: Systematic...
BACKGROUND: Seroma is a common complication of breast cancer surgery, affecting up to 85% of cases. OBJECTIVE: To assess the effectiveness of perioperative corticosteroids in reducing seroma formation. DESIGN: Systematic review and meta-analysis of published literature from PubMed, Ovid, Google Scholar, and Web of Science databases. METHODS: A systematic search identified randomized controlled trials (RCTs) on corticosteroids in breast cancer surgery. Data were pooled using a random-effects model. Subgroup analyses were performed by corticosteroid type, timing, and route. Risk of bias (RoB) was assessed using the Cochrane Collaboration's RoB Tool for RCTs. Articles were collected from inception to August 2024. Inclusion criteria: RCTs and observational studies evaluating perioperative corticosteroids in breast cancer surgery. Exclusion criteria: non-breast surgery populations and absence of seroma outcome data. MAIN OUTCOMES MEASURES: Incidence of postoperative seroma. SAMPLE SIZE: Seven RCTs involving 689 patients were included. RESULTS: Pooled analysis using random-effects model demonstrated that corticosteroids reduced seroma risk (OR: 0.31, 95% CI: 0.20-0.48). Hydrocortisone was more effective than methylprednisolone (OR: 0.14 vs. 0.41; =.0155). Heterogeneity was low (I²=17.3%). RISK OF BIAS: Publication bias assessment using Duval and Tweedie method identified three hypothetically missing studies; adjusted pooled estimate: OR 0.42 (95% CI: 0.28-0.63, <.001). CONCLUSION: Corticosteroids, especially hydrocortisone, appears to be effective in reducing seroma formation. LIMITATIONS: Small sample size, protocol variability, and moderate publication bias as evidenced by funnel plot asymmetry and heterogeneity in timing subgroups (I²=48.1%). REGISTRATION NO: CRD42024590767.
Influence of the coronavirus disease 2019 pandemic on gastric cancer: associations with diagnostic delays, clinicopathological features, and 3-year survival.
Yarıkkaya E, Cin M
Ann Saudi Med · 2025 · PMID 41275347 · Full text
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted cancer care, resulting in significant diagnostic delays. OBJECTIVES: While prior studies have examined shifts in clinical stage, limited data exist o...
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted cancer care, resulting in significant diagnostic delays. OBJECTIVES: While prior studies have examined shifts in clinical stage, limited data exist on the pandemic's effect on histopathological features and long-term survival in gastric cancer (GC). We aimed to address this gap through a comprehensive comparative analysis. DESIGN: Retrospective cohort study. SETTING: Tertiary-care center. PATIENTS AND METHODS: This single-center study included 317 participants newly diagnosed with GC, divided into pre-pandemic (March 2018-March 2020) and pandemic (March 2020-March 2022) groups. Demographic, clinical, and detailed histopathological characteristics and 1- and 3-year overall survival (OS) rates were compared between groups. MAIN OUTCOME MEASURES: Comparison of clinical stage, treatment modality, histopathological features, and 1- and 3-year overall survival between GC patients diagnosed before and during the COVID-19 pandemic. SAMPLE SIZE: 317 patients. RESULTS: The pandemic group exhibited a significantly higher rate of metastasis at diagnosis (38.0% vs. 26.9%; =.035), lower rate of surgical resection (54.0% vs. 65.3%; =.041), and higher rate of palliative therapy (44.0% vs. 31.1%; =.018). Histopathologically, this cohort had a greater proportion of high-grade (G3) tumors (=.014), lower median number of dissected lymph nodes (=.002), and poorer response to neoadjuvant therapy (=.025). Both 1- and 3-year OS were significantly lower in the pandemic group (=.009 and .045, respectively). CONCLUSIONS: The COVID-19 pandemic was associated with more advanced disease at diagnosis and significantly worse long-term survival for patients with GC. These outcomes appear to result from diagnostic and treatment delays rather than substantial changes in tumor biology. These findings underscore the need to establish resilient cancer care systems to reduce vulnerability during health crises. LIMITATIONS: Single-center retrospective design and selection bias due to histopathological analyses being limited to surgically treated patients.
Angiotensin converting enzyme inhibitors (ACEIs) for anthracycline-induced cardiotoxicity: a systematic review and meta-analysis of randomized controlled trials.
Safwan M, Bourgleh MS, AlShakaki H … +1 more , Haider KH
Ann Saudi Med · 2025 · PMID 41275346 · Full text
BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show...
BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage. OBJECTIVES AND DESIGN: This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy. METHODS: A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied. MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events. SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group). RESULTS: ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events. QUALITY OF EVIDENCE: Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger's regression test indicated a low risk of publication bias for LVEF. HETEROGENEITY: High (I²=97%) for LVEF at 6 months. CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits. LIMITATIONS: The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects. REGISTRATION: PROSPERO CRD42024555546.
Seroprevalence of Toxoplasmosis and rubella infection among women of childbearing age in Makkah Province, Saudi Arabia: a five-year, retrospective study.
Ramadhan MA, Hassanein RA, Bahasan MA … +5 more , Almakki AA, Basha TA, AlKaf AA, Bayumi DT, Al-Dajani NM
Ann Saudi Med · 2025 · PMID 41275345 · Full text
BACKGROUND: Toxoplasmosis, an opportunistic intracellular protozoan infection caused by (), and rubella, caused by the rubella virus (RV) are the two most common TORCH infections. OBJECTIVES: To evaluate seroprevalence...
BACKGROUND: Toxoplasmosis, an opportunistic intracellular protozoan infection caused by (), and rubella, caused by the rubella virus (RV) are the two most common TORCH infections. OBJECTIVES: To evaluate seroprevalence of and rubella infection among child bearing age women. DESIGN: Retrospective design. SETTINGS: Multi-center study. PATIENTS AND METHODS: The study included women of childbearing age living in the Western region of Saudi Arabia, who sought medical check-up in one of the governmental public hospitals. Electronic health records of eligible patients were reviewed during the period January 2017 to December 2021 from three major health care institutions. MAIN OUTCOME MEASURES: Seroprevalence of and rubella infection among women of childbearing age in the Western region of Saudi Arabia. SAMPLE SIZE: 13 895 women were screened and 2117 women of childbearing age were eligible. RESULTS: Among the 2117 women, seropositive-antibodies-results for were 148 (6.1%) for IgG antibodies anti-Toxo-IgG-antibodies, 16 (0.8%) for anti-Toxo-IgM-antibodies, and 14 (0.7%) for anti-Toxo-IgG and IgM-antibodies. Univariate analysis showed that the highest proportion of IgG+ women were recorded among 35-39 years of age followed by 25-29 years. The highest proportion of IgM+ was observed among 40-44 years old followed by 35-39 years. Among the women tested for rubella seroprevalence, 16 (0.8%) were IgM positive, 1346 (63.6%) were immune (IgG positive), and the remaining 755 (35.7%) were susceptible. Rubella immunity was moderately high (63.6%) but dropped significantly with increasing age. CONCLUSION: The seroprevalence of Toxoplasmosis in our study appears to be lower than the global average. Nevertheless, it highlights the need for targeted educational programs and public health initiatives with interventions to raise awareness in the community. Rubella immunity, while moderately high overall, showed a notable decline with increasing age, highlighting regular assessment of rubella vaccination programs in the country to ensure effective prevention and control of the disease. The study highlights the need for future research focusing on the epidemiologic trends of TORCH infections, given their broader implications on public health in Saudi Arabia. LIMITATIONS: The seroprevalence results were based on a small sample size living in the Western region of Saudi Arabia and may not reflect other regions in the country.
Incidence and risk factors of obstetric anal sphincter injuries: a retrospective study.
Althaher FF, Alghamdi DS, Bayoumi HE … +5 more , Alshanqity LF, Al Basri SF, Aldardeir NF, Shamrani HM, Allagany FM
Ann Saudi Med · 2025 · PMID 41275344 · Full text
BACKGROUND: Obstetric anal sphincter injuries (OASIS) are severe complications of vaginal deliveries with long-term physical and psychological sequelae. Data on the prevalence and risk factors of OASIS are limited in Sau...
BACKGROUND: Obstetric anal sphincter injuries (OASIS) are severe complications of vaginal deliveries with long-term physical and psychological sequelae. Data on the prevalence and risk factors of OASIS are limited in Saudi Arabia. This study aimed to assess the incidence of OASIS annually from 2017 to 2020, identify associated maternal and delivery factors, and investigate patients' characteristics related to OASIS Grades. OBJECTIVE: To evaluate the annual incidence of OASIS from 2017 to 2020, identify maternal and delivery-related risk factors, and assess characteristics associated with different OASIS grades. DESIGN: Single-center, retrospective observational study. SETTING: King Abdulaziz University Hospital, Jeddah, Saudi Arabia. METHODS: Medical records of all vaginal deliveries from 2017 to 2020 were reviewed. The study included 112 patients with singleton vaginal deliveries complicated by OASIS, out of a total of 12 081 deliveries. Exclusion criteria included preterm births and incomplete records. Data on maternal demographics, obstetric history, labor type, mode of delivery, episiotomy use, and neonatal outcomes were collected. The Royal College of Obstetricians and Gynaecologists (RCOG) classification was used to grade OASIS severity. Chi-square and t-tests were used for analysis. MAIN OUTCOME MEASURES: Annual incidence of OASIS, distribution of OASIS grades, and associations between clinical variables and injury severity. SAMPLE SIZE: 112 cases of OASIS among 12081 vaginal deliveries. RESULTS: The incidence of OASIS was 0.93%, showing a decreasing trend from 2017 to 2020. Most patients were Saudis (78.6%), primigravidae (58%), and nulliparous (67%). Spontaneous vaginal delivery occurred in 73.2% of cases, with episiotomies performed in 62%. Grade III tears were observed in 79.5% of cases, whereas 8.0% were classified as Grade IV. No significant differences were observed between Grades III and IV in terms of maternal and delivery characteristics, except for higher estimated blood loss in Grade IV cases. Incomplete documentation was noted in repair techniques and episiotomy details. CONCLUSION: Incidence of OASIS shows a decreasing trend in both the number of cases and the incidence rate over the four years between 2017 and 2020. Further research is necessary to address documentation gaps and refine regional prevention and management practices. LIMITATION: Retrospective design and missing values limited the ability to analyze some variables thoroughly.
Fine needle aspiration vs. surgical pathology specimen in salivary gland tumors: a study of diagnostic accuracy and predictive value.
Almulla LA, Alnujaidi AM, Alhezam YI … +5 more , Slais HA, Mosaqlab MA, Khuraidah HA, Awadalla A, Alsayyah A
Ann Saudi Med · 2025 · PMID 41047812 · Full text
BACKGROUND: While the present literature emphasizes that surgical biopsies are the gold standard in diagnosing salivary gland tumors, several studies highlight the role of fine needle aspiration (FNA) due to its high dia...
BACKGROUND: While the present literature emphasizes that surgical biopsies are the gold standard in diagnosing salivary gland tumors, several studies highlight the role of fine needle aspiration (FNA) due to its high diagnostic yield and minimally invasive nature. However, the role of FNA and its accuracy in diagnosing salivary gland tumors compared to surgical biopsies is poorly investigated in the Eastern region of Saudi Arabia. OBJECTIVE: Assess the diagnostic accuracy of FNA in salivary gland tumors as compared to histopathological findings from surgical specimens. Identify sources of diagnostic discrepancies between FNA and surgical biopsies. DESIGN: Retrospective diagnostic accuracy study. SETTINGS: King Fahd Hospital of the University in Eastern Province, Al Khobar, Saudi Arabia. PATIENTS AND METHODS: Patients with confirmed diagnosis of salivary gland tumor who underwent both FNA and surgical biopsy between 2014-2024. FNA was performed under ultrasound (US) guidance and examined by two consultant pathologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the diagnostic accuracy of FNA. MAIN OUTCOME MEASURES: FNA diagnostic accuracy compared to histopathological findings from surgical specimens. SAMPLE SIZE: 40 cases. RESULTS: A total of 267 cases were considered in this study, of which only 40 cases were included. FNA had a high specificity of 100% (95% CI: 85.8%-100%) but a low sensitivity of 23.08% (95% CI: 5.0%-53.8%). The PPV is 100% (95% CI: 29.2%-100%). The NPV is 70.6% (95% CI: 64.0%-76.4%). Finally, the overall accuracy is 73% (95% CI: 55.9%-86.2%). CONCLUSION: Our study supports the utility of FNA as a diagnostic modality for salivary gland tumors, demonstrating high specificity with variable sensitivity. The observed false negative rate emphasizes the need for cautious interpretation of negative results, necessitating confirmatory histopathological studies. The findings highlight the influence of sample size on cytology performance, with smaller studies reporting lower sensitivity compared to larger multi-center analyses. LIMITATIONS: Sample size, retrospective design, data extraction, incomplete data.
Epidemiology of pediatric bacteremia at a tertiary care center in Riyadh, Saudi Arabia.
Gashgarey D, Alhuthil R, Alsuhaibani M … +5 more , Alghamdi S, Al Jumaah S, Al Yabes O, Albanyan EA, Al-Hajjar S
Ann Saudi Med · 2025 · PMID 41047811 · Full text
BACKGROUND: Invasive infection in children is associated with significant morbidity and fatality. OBJECTIVES: Investigate the clinical characteristics, antimicrobial susceptibility, outcomes, and fatality-related risk f...
BACKGROUND: Invasive infection in children is associated with significant morbidity and fatality. OBJECTIVES: Investigate the clinical characteristics, antimicrobial susceptibility, outcomes, and fatality-related risk factors of bacteremia in children. DESIGN: A retrospective case series study. SETTING: King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia. PATIENTS AND METHODS: The study included children (aged 0-14 years) with a positive blood culture for species from January 2015 to December 2022. MAIN OUTCOMES MEASURES: Clinical characteristics, antimicrobial susceptibility, case fatality rate, and fatality-related risk factors. SAMPLE SIZE: 42 children. RESULTS: 17 girls (40%) and 25 boys (60%) with a median age of 10.5 months [interquartile range (IQR): 2-48]. The most common underlying conditions were hematologic/oncologic disease (n=15, 36%) and congenital heart disease (n=12, 29%). Thirty-three patients (79%) developed Acinetobacter bacteremia as a hospital-acquired infection. The predominant species were complex (n=34, 45%) and (n=15, 36%). Common exposures within 30 days prior to infection were previous hospitalization (n=32, 76%), antimicrobial therapy (n=26, 62%), central line insertion (n=19, 45%), mechanical ventilation (n=16, 38%), surgery (n=15, 36%), immunosuppressive therapy (n=9, 21%) and dialysis (n=9, 21%). Furthermore, 14 patients (33%) exhibited multidrug resistance, and one patient (2%) developed meningitis. Following treatment, 33 patients (79%) recovered with a median treatment duration of 15 days (IQR=12-21), two patients (5%) experienced relapse while on treatment, and two patients (5%) exhibited recurrent infection. The case fatality rate was 12% (5/42) and all died within 10 days post-infection. In the univariable analysis of fatality-related risk factors showed that younger age (median 2 months [IQR: 1-2]) (=.025), congenital heart disease (=.018), and dialysis within 30 days prior to infection were significantly associated with fatality (=.005). CONCLUSION: In this study, children with bacteremia often had a history of prior hospitalization, antimicrobial therapy, invasive procedures, and chronic underlying comorbidities, specifically congenital heart disease and hematologic/oncologic disorders. Additionally, younger age, congenital heart disease, and recent dialysis were associated with fatality in the univariable analysis. LIMITATIONS: Small sample size, lack of multivariable analysis, lack of molecular epidemiologic data.
Detection of by molecular methods and investigation of clinical symptoms of patients in a tertiary hospital in Istanbul.
Akkaya Y, Erdin BN, Aydın İ … +5 more , Özel AS, Yılmaz AM, Çılkız M, Kılıç İH, Toraman ZA
Ann Saudi Med · 2025 · PMID 41047810 · Full text
BACKGROUND: is resistant to many antifungals, spreads rapidly and causes deaths in patient groups with comorbid factors. OBJECTIVES: The aim of this study was to determine the virulence of , antifungal resistance genes...
BACKGROUND: is resistant to many antifungals, spreads rapidly and causes deaths in patient groups with comorbid factors. OBJECTIVES: The aim of this study was to determine the virulence of , antifungal resistance genes and clinical characteristics of the patients. DESIGN: Retrospective cohort. SETTING: Single-center. MATERIAL AND METHODS: This study was conducted between August 2022 and December 2023 at Ümraniye Training and Research Hospital. ITS1-5.8S-ITS2 and ITS1-ITS4 gene regions of the rDNA gene of isolates identified by VITEK MS v.3.2 were amplified by polymerase chain reaction (PCR) method. These regions were partially sequenced using the Sanger method. The presence of specific and gene regions were determined by PCR. Antifungal susceptibility testing of was performed with VITEK 2 Compact AST YS08 and SYO. MAIN OUTCOME MEASURES: Variations in isolates, antifungal resistance and clinical characteristics of patients. SAMPLE SIZE: Forty-four isolates from 31 patients. RESULTS: According to gene regions, nine different variations were identified in our hospital, with VAR-1 being the most common. Twenty-five (80.6%) of the patients died and isolation of the causative agent was between days 1-30 in 13 (41.9%) patients. Antibiotic use, ICU admission rate, and central venous catheter use in patients were 29 (93.6%), 28 (90.3%), and 21 (67.7%), respectively. Hypertension, diabetes mellitus (DM) and septic shock were found in 14 (45.2%), 13 (41.9%) and 10 (32.3%) patients, respectively. Antifungal resistance rates of the isolates were determined as 97.7% and 84.1% for amphotericin B and fluconazole, respectively. No resistance to micafungin and caspofungin was detected. The survival rate with echinocandin use was 22% (4 patients). CONCLUSION: Identification of gene regions is valuable in determining the pathogenicity of . Due to the presence of comorbidities in patients with , it is not possible to determine the exact proportion of deaths attributable to alone. LIMITATIONS: Single center setting; gene regions could not be expressed.
Incidence of recurrent laryngeal nerve injury and associated risk factors after thyroidectomy: a retrospective study.
Alkaf H, Abuduruk S, Bayounos S … +5 more , Abdelmonim SK, Alharbi J, Alessa MA, Alkaff H, Alherabid A
Ann Saudi Med · 2025 · PMID 41047809 · Full text
BACKGROUND: Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for impr...
BACKGROUND: Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for improving surgical outcomes. OBJECTIVES: To assess the incidence of permanent VCP after thyroidectomy and evaluate its possible associated risk factors. DESIGN: A retrospective cohort study. SETTING: A multicenter study conducted in Makkah, Saudi Arabia. METHODS: The study assessed incidence of permanent RLNI and its associated risk factors in 314 patients who underwent thyroidectomy at our centers in Makkah, Saudi Arabia, between December 2014 and December 2024. The data were gathered on general characteristics, clinical findings, and surgical details. Statistical analyses were performed to identify significant risk factors. MAIN OUTCOMES MEASURES: Incidence of permanent RLNI and the associated risk factors. SAMPLE SIZE: 314 patients. RESULTS: Overall incidence of permanent VCP was 9 (2.9%). The left vocal cord was affected in 3 (1%) of cases, while the right vocal cord was affected in 6 (1.9%). Significant risk factors included age over 45 years (=.043), male patients (=.04), prior thyroid surgery (=.006), and high cumulative doses of radioactive iodine (=.008). However, no significant associations with factors such as family history of thyroid disease, carcinoma, or incidental disease onset. CONCLUSION: Post-thyroidectomy VCP is influenced by several factors, including age, gender, previous thyroid surgery, and radioactive iodine dose. These findings highlight the importance of careful pre-operative risk assessment and the use of preventive measures, such as Intra-Operative Nerve monitoring, use of optical magnification and pre-operative predicting of thyroidectomy difficulty to reduce RLNI risk. LIMITATIONS: Possibility of selection bias due to the retrospective design. In addition to lack of use of certain analytical tests and detailed subgroup analysis due to the moderate sample size.
Humoral immune response to mRNA-based influenza vaccines in older adults: a systematic review and meta-analysis of randomized controlled trials.
Othman AA, Albargy H
Ann Saudi Med · 2025 · PMID 41047808 · Full text
BACKGROUND: Influenza causes substantial morbidity and mortality in older adults, and conventional inactivated vaccines often elicit suboptimal immune responses in this population. Recent phase II/III randomized controll...
BACKGROUND: Influenza causes substantial morbidity and mortality in older adults, and conventional inactivated vaccines often elicit suboptimal immune responses in this population. Recent phase II/III randomized controlled trials (RCTs) have evaluated mRNA-based influenza vaccines, but a quantitative synthesis of their immunogenicity in adults aged ≥65 years is lacking. OBJECTIVE: To determine whether mRNA influenza vaccines yield higher seroconversion rates (SCRs) at 29 days post-vaccination compared to licensed inactivated vaccines in adults aged ≥65 years. DESIGN: Systematic review and meta-analysis of RCTs. SETTINGS: Hospital, out-patient and community-based RCTs conducted in the USA. METHODS: We searched PubMed, Scopus, Web of Science, and Google Scholar from database inception to July 2025 for RCTs reporting SCR at 29 days post-mRNA influenza vaccination in adults aged ≥65 years. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. MAIN OUTCOME MEASURE: SCR at day 29 post-vaccination for each influenza strain (A/H1N1, A/H3N2, B/Victoria, B/Yamagata). SAMPLE SIZE: Seven RCTs out of 4 studies comprising 7,114 participants aged ≥65 years were included. RESULTS: Across the seven RCTs (100% RCTs), mRNA vaccines achieved significantly higher SCRs than controls: A/H1N1 (RR 3.41; 95% CI 2.8-4.2), A/H3N2 (RR 3.54; 95% CI 2.9-4.3), B/Victoria (RR 2.83; 95% CI 2.3-3.5), and B/Yamagata (RR 3.34; 95% CI 2.7-4.2). Heterogeneity was high for all strains (I>80%). Sensitivity analyses omitting one study at a time confirmed robustness of the pooled estimates. Funnel plots and Egger's test indicated possible small-study effects. Meta-regression found no significant association between vaccine dose and effect size. RISK OF BIAS: Visual inspection of Begg's funnel plots for the A/H1N1, A/H3N2, and B/Victoria strains revealed asymmetry, suggesting the possibility of publication bias. HETEROGENEITY: There was significant heterogeneity among studies for A/H1N1, A/H3N2, and B/Victoria strains but not B/Yamagata strain. CONCLUSION: In adults aged ≥65 years, mRNA influenza vaccines elicit substantially higher seroconversion rates across all four seasonal strains compared with licensed inactivated vaccines, suggesting a promising strategy to enhance immune protection in this high-risk population. Findings should be interpreted with caution given the small number of studies available. LIMITATIONS: Low number of studies included limits full assessment of heterogeneity and bias. REGISTRATION: PROSPERO CRD420251108768.
Retrospective analysis of carbon monoxide exposure cases in a secondary-level state hospital emergency department.
Yılmaz AM, Kalıntaş E
Ann Saudi Med · 2025 · PMID 40856993 · Full text
BACKGROUND: Carbon monoxide (CO) poisoning is one of the leading causes of mortality and morbidity among inhaled toxins worldwide. The use of chimneyless stoves, barbecues and water heaters in small areas with poor venti...
BACKGROUND: Carbon monoxide (CO) poisoning is one of the leading causes of mortality and morbidity among inhaled toxins worldwide. The use of chimneyless stoves, barbecues and water heaters in small areas with poor ventilation leads to CO poisoning and increases the number of emergency department admissions. OBJECTIVE: To evaluate the morbidity and mortality rates of CO poisoning cases admitted to the emergency department of our hospital. DESIGN: Retrospective, cross-sectional study. SETTING: Single center, secondary-state hospital in Türkiye. PATIENTS AND METHODS: Data from CO poisoning cases admitted to Gaziantep Abdülkadir Yüksel State Hospital Emergency Department between October 20, 2022 and October 20, 2023 were retrospectively evaluated. MAIN OUTCOME MEASURES: CO levels in venous blood obtained from patients with suspected CO poisoning. SAMPLE SIZE: 377 patients. RESULTS: Of the 377 patients, 204 (54.1%) were females, 302 (80.1%) were Turkish citizens, and 196 (52%) presented to the hospital on their own means. It was determined that 285 patients (75.6%) were poisoned by stove smoke, 90 (23.8%) by fire smoke, and two (0.5%) by natural gas. It was determined that 298 patients (79%) were discharged after treatment, 42 (11.1%) left the hospital without permission, 23 (6.1%) were taken under observation and hyperbaric oxygen (HBO) treatment was applied, 13 (3.4%) refused treatment, and 1 (0.3%) died. The need for HBO treatment increased with age and a significant association was found between age and the need for HBO treatment (=.002). CONCLUSIONS: CO poisoning remains a common public health issue, mostly linked to stove and fire smoke. Older age was significantly associated with the need for HBO therapy. It is important to prevent and raise awareness regarding CO poisoning cases, which increase particularly during the winter months in the context of earthquakes and other natural disasters. LIMITATIONS: Retrospective design.
Epidemiology of hepatitis B, hepatitis C, and syphilis co-infections in HIV-1 patients: a retrospective cross-sectional study of prevalence and viral load correlates.
Aydoğan S, Kirca F, Gozalan A … +4 more , Aslan FG, Gürler M, Toyran A, Dinç B
Ann Saudi Med · 2025 · PMID 40856990 · Full text
BACKGROUND: Co-infections with hepatitis B (HBV), hepatitis C (HCV) and syphilis complicate the clinical management of people living with HIV by influencing disease progression, treatment response, and transmission risk....
BACKGROUND: Co-infections with hepatitis B (HBV), hepatitis C (HCV) and syphilis complicate the clinical management of people living with HIV by influencing disease progression, treatment response, and transmission risk. Despite the growing HIV burden in Türkiye, data on the impact of these coinfections remain limited. OBJECTIVES: To determine the prevalence of HBV, HCV, and syphilis coinfections in adults with HIV-1 and to examine their associations with demographics and HIV-1 viral load. DESIGN: Retrospective cross-sectional study. SETTING: Single center, tertiary care hospital in Türkiye. PATIENTS AND METHODS: Adults diagnosed with HIV-1 between March 2019 and June 2024 at Ankara Bilkent City Hospital were included. Demographic information, HIV viral load measurements, and serological and molecular test results for HBV, HCV, and syphilis were retrieved from the institutional laboratory database. Coinfection status was assessed relative to age, gender, and HIV viral load. MAIN OUTCOME MEASURES: Prevalence and distribution of HBV, HCV, and syphilis coinfections and their associations with demographic variables and HIV viral load. SAMPLE SIZE: 724 patients. RESULTS: The study population was predominantly male (86%), with a median age of 40 years. Syphilis was the most common coinfection (25.6%), followed by HBV at 4.1% and HCV at 1.8%. Syphilis was significantly more prevalent among men (=.001), and HBV coinfection was associated with older age (=.005). No significant associations were observed between HIV viral load and any co-infection. Notably, a substantial proportion of patients, especially those newly diagnosed after 2019, had high HIV RNA levels, suggesting delayed diagnosis and treatment initiation. Triple coinfections were rare but remain clinically relevant. CONCLUSIONS: The high prevalence of syphilis and delayed HIV diagnoses highlight the urgent need for improved screening protocols, timely initiation of antiretroviral therapy, and broader implementation of HBV vaccination programs. An integrated multisectoral approach is critical to address the overlapping clinical and public health burdens posed by these co-infections. Healthcare strategies must consider the impact of COVID-19-related service disruptions, which likely contributed to delays in diagnosis and treatment. LIMITATIONS: Lack of data on patients' behavioral risk factors and no follow-up on treatment outcomes for syphilis.
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