Annals Of Saudi Medicine[JOURNAL]
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200 papers
Recurrent diabetic ketoacidosis in Saudi patients with type 1 diabetes mellitus: a retrospective study from a tertiary hospital.
Alshareef M, Bokhari SA, Nawaz A … +9 more , Arfaj L, Alsharif AH, Alshamrani H, Al-Bogami F, Altowairqi M, Aqabaw S, Alobisi A, Al-Ard Y, Alsharifb HT
Ann Saudi Med · 2025 · PMID 40856989 · Full text
BACKGROUND: Diabetic ketoacidosis (DKA) is a potentially fatal complication of type 1 diabetes mellitus (T1DM). To our knowledge, limited studies have examined the risk factors of recurrent DKA in the Saudi T1DM populati...
BACKGROUND: Diabetic ketoacidosis (DKA) is a potentially fatal complication of type 1 diabetes mellitus (T1DM). To our knowledge, limited studies have examined the risk factors of recurrent DKA in the Saudi T1DM population. OBJECTIVES: To identify factors contributing to recurrent DKA in Saudi patients with T1DM. By identifying the contributing factors for DKA recurrence the disease burden can be mitigated by making targeted interventions. DESIGN: Retrospective. SETTING: Tertiary care center, Jeddah, Saudi Arabia. PATIENTS AND METHODS: Saudi patients with T1DM admitted with DKA between 2021 to 2023 were included. A comparative analysis was performed between patients with a single recurrence of DKA and those with multiple recurrent admissions. MAIN OUTCOME MEASURES: Association between multiple variables and recurrent DKA. SAMPLE SIZE: 245 Saudi patients with T1DM. RESULTS: A total of 245 Saudi patients with T1DM were included. A significantly higher proportion of females were observed in the multiple recurrent DKA group (73.1% vs. 48.5%, =.0001). Also, a higher proportion of single individuals were found among the multiple recurrent DKA group (=.006). Longer duration of T1DM (≥5 years) and presence of microalbuminuria were more associated with multiple recurrent DKA than single recurrence of DKA. Among the precipitating factors, non-adherence to medications was associated with multiple recurrence of DKA (=.02). CONCLUSION: This study has identified several risk factors contributing to recurrent DKA episodes among Saudi patients with T1DM. By increasing awareness of these factors among both healthcare providers and the community, we can develop more effective prevention strategies and ultimately reduce the incidence of recurrent DKA. LIMITATIONS: A retrospective study and single-center experience.
Cirrhotic cardiomyopathy: a systematic review and meta-analysis of prevalence across various diagnostic approaches.
Ewid M, Alsagaby S, Al-Ruqi A … +4 more , Al-Shamikh O, Aljohani A, Bourgleh MS, Safwana M
Ann Saudi Med · 2025 · PMID 40753465 · Full text
BACKGROUND: Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction associated with liver cirrhosis, yet no consensus exists on standardized diagnostic criteria. We aimed to assess CCM prevalence using several guidelines...
BACKGROUND: Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction associated with liver cirrhosis, yet no consensus exists on standardized diagnostic criteria. We aimed to assess CCM prevalence using several guidelines. METHODS: A systematic search of four databases (PubMed, Embase, Google Scholar, and EBSCO) identified observational studies reporting CCM prevalence in cirrhotic patients based on the three criteria: the World Congress of Gastroenterology (Montreal 2005), the American Society of Echocardiography (ASE 2009), and the Cirrhotic Cardiomyopathy Consortium (CCC 2019). A random-effects meta-analysis and subgroup analyses were performed using R Studio. RESULTS: Seventy-six studies including 7445 patients were analyzed. Overall pooled CCM prevalence was 48% (95% CI: 44-52%, I=97%). Prevalence was highest using Montreal 2005 (51%), followed by ASE 2009 (45%) and CCC 2019 (45%). CCC 2019 better identified CCM in early-stage cirrhosis (Child-Pugh A), whereas Montreal 2005 was more sensitive in advanced stages (Child-Pugh C). CONCLUSION: CCM prevalence varies by diagnostic criteria and cirrhosis severity. Further studies are needed to determine the clinical relevance and prognostic value of each criterion. PROSPERO REGISTRATION NUMBER: CRD42024511527.
Identification and antifungal resistance profiling of in a tertiary hospital in Istanbul, Türkiye.
Akkaya Y, Erdin BN, Yılmaz AM … +2 more , Kılıç İH, Toraman ZA
Ann Saudi Med · 2025 · PMID 40753464 · Full text
BACKGROUND: is a high priority fungal pathogen due to its antifungal resistance and its association with increased morbidity and mortality in infected patients. OBJECTIVES: The aim of this study was to identify Candida...
BACKGROUND: is a high priority fungal pathogen due to its antifungal resistance and its association with increased morbidity and mortality in infected patients. OBJECTIVES: The aim of this study was to identify Candida species in clinical samples and to determine the clades and in vitro antifungal resistance of . DESIGN: Retrospective cohort. SETTINGS: Single-center tertiary hospital in Türkiye. MATERIAL AND METHODS: The study was conducted in the Medical Microbiology Laboratory of Ümraniye Training and Research Hospital between December 2023 and October 2024. Fungal samples were identified using bio-Mérieux VITEK MS v.3.2 (bio-Mérieux, France) and RT-PCR. Antifungal susceptibility testing of was performed by VITEK 2 Compact AST YS08 and SYO. MAIN OUTCOME MEASURES: Identification of Candida species, in-vitro antifungal resistance of . SAMPLE SIZE: 846 fungal isolates obtained from 746 patients were included. RESULTS: A total of 846 fungal isolates were identified, with being the most common (n=440, 52%), followed by (n=124, 14.7%), (n=85, 10.1%), (n=69, 8.2%) and (n=57, 6.7%). All isolates were susceptible to anidulafungin. Of these isolates, 47 (82%) were resistant to fluconazole, 34 (60%) to amphotericin B, four (7%) to caspofungin and three (5%) to micafungin. One isolate was resistant to amphotericin B, fluconazole, caspofungin and micafungin. A total of 31 (54%) isolates were resistant to amphotericin B and fluconazole. In accordance with the manufacturer's recommendations, 57 isolates were evaluated as Clade-1. CONCLUSION: infections are becoming increasingly common. In order to better understand antifungal-resistance of this pathogen, advanced methods should be used for rapid detection of clades and mutations in the FKS gene should be revealed. LIMITATIONS: Single center, whole genome sequence analysis were not performed.
Histopathological findings in obese patients undergoing laparoscopic sleeve gastrectomy in the Western region of Saudi Arabia.
Saharti S, Aljohani R
Ann Saudi Med · 2025 · PMID 40753463 · Full text
BACKGROUND: Metabolic and bariatric surgeries are effective interventions in reducing weight and mortality. Laparoscopic sleeve gastrectomy is the most commonly performed procedure, particularly in the Middle East and No...
BACKGROUND: Metabolic and bariatric surgeries are effective interventions in reducing weight and mortality. Laparoscopic sleeve gastrectomy is the most commonly performed procedure, particularly in the Middle East and North Africa (MENA) region. It involves resection of approximately 80% of the stomach, yielding large specimens for histopathological evaluation. OBJECTIVES: To identify histopathological findings in gastric specimens, evaluate the incidence of unexpected gastrointestinal stromal tumors (GISTs), and characterize the metabolic and bariatric surgery population in Saudi Arabia. DESIGN: Retrospective cohort. SETTINGS: Single-center tertiary care in Saudi Arabia. PATIENTS AND METHODS: The study included patients who underwent laparoscopic gastric sleeve between May 2015 and April 2021. Inclusion criteria were patients with BMI ≥ 30 kg/m who underwent surgery as treatment for obesity. MAIN OUTCO ME MEASURES: Gastric histopathological findings, unexpected GIST incidence and metabolic and bariatric surgery population. SAMPLE SIZE: 211 patients with obesity. RESULTS: Patients' mean age was 38.2 years with a mean Body mass index (BMI) of 44.24 kg/m. The majority were females (60.2%). Normal histology findings accounted for 43.1% of findings, followed by chronic inactive gastritis (35.5%). Intestinal metaplasia was found in 1 (0.5%) patient while incidental GIST was found in 2 (0.9%) patients. was identified in 12.8% of cases, with a mean patient age of 36.7 years. Among -positive patients, 48% presented with chronic active gastritis, 33% with chronic inactive gastritis, 14.8% with active follicular gastritis, and 3.7% with inactive follicular gastritis. A history of prior endoscopy was noted in 16.1% of patients, of whom 11.76% were found to have postoperatively. CONCLUSIONS: H. pylori infection was detected at a mean age of 36.7 years and showed a significant association with higher BMI (mean difference: 2.2 kg/m, =.04). While this suggests a potential link between obesity and susceptibility, the clinical significance of this small absolute difference requires further investigation. remained strongly associated with follicular gastritis (=.003) but showed no difference between males and females. LIMITATIONS: Retrospective design and Giemsa stain was not done for all specimens to investigate .
Clinicopathological features and treatment outcomes of patients with fibrolamellar hepatocellular carcinoma: a retrospective multicenter study.
Güren AK, Polat H, Çoban E … +24 more , Çerme E, Kahveci GB, Geçgel A, Ezgi Dama P, Can LŞ, Biter S, Soylu S, Majidova N, Sever N, Kocaaslan E, Erel P, Ağyol Y, Çelebi A, Arıkan R, Işık S, Ünek İT, Bayram E, Yazıcı O, Deligönül A, Turna ZH, Araz M, Bayoğlu İV, Köstek O, Sarı M
Ann Saudi Med · 2025 · PMID 40753462 · Full text
BACKGROUND: Fibrolamellar Hepatocellular Carcinoma (FLHCC) is a rare primary liver tumour that is distinct from conventional HCC in both histopathological and clinical features. There is no clear consensus on its treatme...
BACKGROUND: Fibrolamellar Hepatocellular Carcinoma (FLHCC) is a rare primary liver tumour that is distinct from conventional HCC in both histopathological and clinical features. There is no clear consensus on its treatment. OBJECTIVE: Assess the demographics, prognosis, and treatment- particularly systemic therapies-of FLHCC patients across multiple centers in Türkiye. DESIGN: Retrospective. SETTINGS: Multicenter. PATIENTS AND METHODS: Patients with histopathological diagnosis of pure fibrolamellar hepatocellular carcinoma. MAIN OUTCOME MEASURES: Treatment responses of metastatic stage patients were evaluated. Progression-free survival (PFS) and overall survival (OS) analyses of metastatic stage first-line treatments were performed. SAMPLE SIZE: 39 patients with FLHCC. RESULTS: The 5-year survival for all patients was 48%, 80% in stage 1, 57% in stage 2, 53% in stage 3 and 0% in stage 4. The median PFS for chemotherapy (n=10) and sorafenib (n=6) patients in the metastatic stage first series was 5.7 months and 2.8 months, respectively (=.031). Median OS was 12.1 months for chemotherapy and 8.8 months for sorafenib (=.853) in the metastatic stage. CONCLUSION: Conventional chemotherapies, especially gemcitabine and oxaliplatin combination can be used as systemic treatment options. Immunotherapies, chemoimmunotherapy and immunotherapy plus anti vascular endothelial growth factor combinations may be considered by clinicians. LIMITATIONS: Small sample size and the variability of the treatment modalities administered in the patients.
Alpha-1 antitrypsin in COVID-19 patients: a dual-center screening study in Malaysia.
Musa N, Wan Azman WN, Nazri NAM … +7 more , Tuan Ismail TS, Harun A, Yaacob NM, Sulong S, Sirajudeen KNS, Mat MC, Zulkeflee HA
Ann Saudi Med · 2025 · PMID 40753461 · Full text
BACKGROUND: Alpha-1 antitrypsin (A1AT) deficiency has been recognized as an adverse prognostic determinant in severe instances of COVID-19. OBJECTIVE: To determine the A1AT phenotypes and levels in individuals at various...
BACKGROUND: Alpha-1 antitrypsin (A1AT) deficiency has been recognized as an adverse prognostic determinant in severe instances of COVID-19. OBJECTIVE: To determine the A1AT phenotypes and levels in individuals at various clinical stages of COVID-19 compared to healthy controls. DESIGN: Case-control study. SETTINGS: Hospital Raja Perempuan Zainab II (HRPZ II) and Hospital Ampang, Malaysia. PATIENTS AND METHODS: The analysis included a total of 282 patients. We categorized 188 COVID-19 patients from two centres in Malaysia into two groups: mild to moderate (stages 1-3) and severe to critical (stages 4-5) and compared them with 94 healthy controls. MAIN OUTCOME MEASURES: A1AT phenotypes and levels in different COVID-19 stages compared to healthy controls. SAMPLE SIZE: 282 subjects. RESULTS: The frequency (n) and percentage (%) in the control group, 88 (93.6) exhibited PiMM phenotypes, whereas 6 (6.4) displayed PiXM/PiYM phenotypes. Within the mild to moderate COVID-19 group, 88 (93.6) had PiMM phenotypes, 3 (3.2) featured PiXM/PiYM, and 1 presented PiBM phenotypes. Among severe to critical COVID-19 patients, the PiMM phenotype was identified in 61 (64.9) with 16 (17) having PiBM phenotypes, 4 (4.5) displaying PiCM, 2 (2.1) featuring PiXM/PiYM, and 1 (1.1) presenting PiEM phenotypes. Variants such as MS, MZ, S, and Z were undetected. However, 12 COVID-19 patient samples yielded inconclusive results. Median (IQR: 25th to 75th percentile) A1AT concentrations for controls were 1.8 (1.3-2.3) g/L, for mild to moderate cases 1.9 (1.2-2.6) g/L, and for severe to critical COVID-19 cases 2.1 (1.4-2.8) g/L. CONCLUSION: This research identifies the PiMM phenotype as the predominant phenotype expression within the studied population. This prevalence underscores the potential role of genetic factors in determining the biological response to SARS-CoV-2 infection. The presence of another phenotype variant across the study population suggests a nuanced genetic landscape that warrants further exploration. LIMITATION: The absence of follow-up A1AT quantification and baseline measurements limits the assessment of disease progression. The isolectric focusing phenotyping technique used might have missed specific A1ATD variants.
Clinical profiles and mortality risk factors in pediatric pulmonary hemorrhage: a singlecenter study in Saudi Arabia.
Alabdulsalam MK, Asiry RA, Alhuthil RT … +7 more , Almusallam AS, Alhelali NK, Alayed TM, Aljofan FB, Alanzi FA, Alofisan TO, Alturkia AT
Ann Saudi Med · 2025 · PMID 40753460 · Full text
BACKGROUND: Pulmonary hemorrhage (PH) is a rare, life-threatening event characterized by bleeding into the airways and lung parenchyma. OBJECTIVES: To explore the clinical characteristics of PH patients and investigate m...
BACKGROUND: Pulmonary hemorrhage (PH) is a rare, life-threatening event characterized by bleeding into the airways and lung parenchyma. OBJECTIVES: To explore the clinical characteristics of PH patients and investigate mortality-related risk factors, providing a holistic understanding of patient outcomes in this population. DESIGN: A retrospective cohort study. SETTINGS: The Pediatric Intensive Care Unit (PICU) at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia. PATIENTS AND METHODS: Pediatric patients with PH episodes (aged 1 month to 14 years) who were admitted from January 2014 to September 2019. MAIN OUTCOMES MEASURES: Clinical characteristics, outcomes, and mortality-related risk factors. SAMPLE SIZE: 80 children. RESULTS: The cohort had a sex ratio of 1:1 and a median age of 24 months [interquartile range: 9-78]. Medical histories included bone marrow transplant (51.3%), oncology cases (40.0%), chemotherapy (61.3%), chest infection (86.3%), and immunosuppressant use (71.3%). Additionally, most patients (87.5%) had acute respiratory distress syndrome during the PH episode. The overall PICU mortality rate was 82.5% (66/80), and was associated with thrombocytopenia, sepsis, renal impairment, liver dysfunction, multiorgan dysfunction, and altered code status in univariable analysis (all <.05). Multivariate analysis identified sepsis, multiorgan dysfunction, and altered code status as key predictors of PICU mortality ( <.05). CONCLUSION: The high mortality rate reported emphasizes the need for tailored interventions and heightened vigilance, particularly in immunocompromised children. Future research will expand on these findings to refine current management protocols and further improve patient care in pediatric PH. LIMITATIONS: Retrospective study, single-center.
Length of stay in hospital and rehabilitation centers after stroke in Arab countries and Saudi Arabia: a systematic review and meta-analysis.
Alhusayni AI, Alzahrani AH
Ann Saudi Med · 2025 · PMID 40753459 · Full text
BACKGROUND: Stroke rehabilitation is a vital component of post-stroke care, and the length of stay (LOS) in hospitals and rehabilitation centers varies across healthcare systems. This systematic review and meta-analysis...
BACKGROUND: Stroke rehabilitation is a vital component of post-stroke care, and the length of stay (LOS) in hospitals and rehabilitation centers varies across healthcare systems. This systematic review and meta-analysis assessed LOS among stroke survivors in Arab countries. METHODS: A comprehensive literature search identified studies reporting LOS in stroke rehabilitation. A comprehensive literature search from the inception until March 2025 identified studies reporting LOS in stroke rehabilitation. RESULTS: A total of 18 publications (25 datasets) involving 12 690 individuals were included in the meta-analysis. The pooled mean LOS was 25.67 days [95% confidence interval (CI): 16.22-35.11]. Subgroup analyses showed a longer LOS in Saudi Arabia (37.03 days, 95% CI: 24.11-49.95) compared to other Arab countries (8.87 days, 95% CI: 4.90-12.84), and in rehabilitation centers (46.71 days, 95% CI: 33.18-60.24) compared to acute hospital settings (9.07 days, 95% CI: 5.27-12.86). LOS varies widely across Arab countries and care settings. CONCLUSION: These findings highlight the need to examine whether differences in LOS are associated with functional recovery and healthcare efficiency. However, substantial heterogeneity across studies and a lack of outcome data limit the interpretability of the results.
Impact of 3D high-definition laparoscopy on total laparoscopic hysterectomy: a body mass index-stratified retrospective analysis.
Solanki SB, Mishra VV, Dhiman AS
Ann Saudi Med · 2025 · PMID 40753458 · Full text
BACKGROUND: Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparosc...
BACKGROUND: Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored. OBJECTIVE: To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences. DESIGN AND SETTINGS: A single-center retrospective study. PATIENTS AND METHODS: Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25-29.9, ≥30.0 kg/m). MAIN OUTCOME MEASURES: Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates. SAMPLE SIZE: 60 patients (30 in each group). RESULTS: The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories ( <.001). Vault suturing time was shorter in the 3D HD laparoscopy group ( =.002), and total operative time was reduced in overweight patients ( =.015). Obese patients in the 3D group had lower haemoglobin drop ( =.01) and reduced blood loss compared to 2D laparoscopy group ( =.017). CONCLUSION: 3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis-highlighting its value in overcoming challenges of minimally invasive gynecologic surgery. LIMITATIONS: The study's retrospective design and modest sample size limit generalizability.
Indicators for early surgery in patients with intra-abdominal fistulizing Crohn's disease.
Enani GN, Al Ghamdi SS, Mimish RL … +3 more , Farsi A, Butt NS, Akeel N
Ann Saudi Med · 2025 · PMID 40482192 · Full text
BACKGROUND: The management of intra-abdominal fistulizing Crohn's disease involves surgical resection and biologic therapy. The criteria for choosing one therapy over the other are debated. OBJECTIVES: Identify factors i...
BACKGROUND: The management of intra-abdominal fistulizing Crohn's disease involves surgical resection and biologic therapy. The criteria for choosing one therapy over the other are debated. OBJECTIVES: Identify factors influencing the choice of early surgical intervention over biologic therapy. DESIGN: Retrospective. SETTING: Single center, tertiary training and research hospital. PATIENTS AND METHODS: We analyzed adult patients with Crohn's disease who had intra-abdominal fistulas and were followed for three years. Baseline data were collected from medical records, and imaging studies assessed the fistula type, number, affected segment length, and presence of strictures and abscesses. Multivariable logistic regression analysis was used to identify predictors for surgical intervention. MAIN OUTCOME MEASURES: Factors that led to early surgical intervention in patients with intra-abdominal fistulizing Crohn's disease. SAMPLE SIZE: 73 patients. RESULTS: Seventy-three patients met the inclusion criteria: 27 (37.0%) in the nonsurgical group and 46 (63.0%) in the surgical group. Early surgical intervention was done if patients had bloating or constipation (=.018), extensive disease segments (<.001), and no prior biologic treatment (0.015). In the multivariate analysis, early surgical intervention was indicated for enterocutaneous fistulas (odds ratio [OR]: 8.20, 95% confidence interval [CI]: 1.25-53.80, =.03), abscesses (OR: 5.18, 95% CI: 1.03-26.12, =.046), and strictures (OR: 6.08, 95% CI: 1.26-29.25, =.024). Nonsurgical fistula treatment resulted in complications in 55% of patients, 48% of them requiring surgical resections, whereas biologic treatment achieved a 40.7% fistula healing rate. CONCLUSIONS: Findings associated with Crohn's fistulas, including enterocutaneous fistulas, extensive disease segments, strictures, and abscesses, are associated with a higher likelihood of early surgical intervention and may suggest potential ineffectiveness of biologic therapies. LIMITATIONS: This was a retrospective analysis of a single center with a small sample size, which may involve a degree of recall bias when data are collected, thus reducing the reliability of the results.
Trends in pain management of sickle cell disease patients presenting with acute vasoocclusive crises: a multi-center retrospective study in Saudi Arabia.
Aljuaed SM, Jamjoom MK, Althubaiti AM … +1 more , Alsukhayri ME
Ann Saudi Med · 2025 · PMID 40482191 · Full text
BACKGROUND: Sickle cell disease (SCD) is a chronic condition characterized by acute vaso-occlusive crisis (AVOC), which is the primary cause of emergency department (ED) visits for SCD patients. Despite recommendations f...
BACKGROUND: Sickle cell disease (SCD) is a chronic condition characterized by acute vaso-occlusive crisis (AVOC), which is the primary cause of emergency department (ED) visits for SCD patients. Despite recommendations for opioid use to manage AVOC pain, regional variations and biases in pain management persist, particularly in Saudi Arabia, where the prevalence of SCD varies by region. OBJECTIVE: To identify national trends in pain management for AVOC in EDs across Saudi Arabia and analyze the duration and frequency of ED visits. DESIGN: A multicenter retrospective cohort study. SETTINGS: Multiple acute care centers in Saudi Arabia under the Ministry of National Guard Health Affairs, including EDs and urgent care centers in Riyadh, Jeddah, Al-Ahsa, Dhahran, and Medina. PATIENTS AND METHODS: A total of 421 SCD patients presenting with AVOC between 2016 and 2021 were included. Patients with other complications such as infections or acute chest syndrome were excluded. Data on patient demographics, ED visit frequency, length of stay, and medications administered were collected. MAIN OUTCOME MEASURES: The primary outcomes were the duration and frequency of ED visits and the types and frequency of analgesics administered. SAMPLE SIZE: The study included 421 patients accounting for 20 508 ED visits. RESULTS: The average length of stay per ED visit was 4.7 hours. Morphine was the most frequently used opioid, administered to 86% of patients, while paracetamol was the most commonly used analgesic overall (93%). Regional differences were observed, with less opioid use in the Eastern region, where the disease is less severe due to haplotype variations. Ketamine was used in 13% of cases, predominantly in the Western region. CONCLUSIONS: The study highlights a diverse approach to AVOC management across Saudi Arabia, with variations influenced by regional differences and physician practices. Paracetamol and morphine were the primary analgesics, though disparities in opioid use suggest the need for standardized pain management protocols. LIMITATIONS: This study was limited to centers under one organization and excluded patients with coexisting conditions, which may limit generalizability.
Impact of the COVID-19 pandemic on the diagnosis, tumor characteristics, and survival outcomes of colorectal cancer: a retrospective cohort study.
Yarikkaya E, Cin M, Ecin-Demezoglu S … +4 more , Noyan-Mod B, Mahsuni Sevinc M, Bozkaya Y, Dursun-Kepkep N
Ann Saudi Med · 2025 · PMID 40482190 · Full text
BACKGROUND: The coronavirus disease (COVID-19) pandemic has significantly disrupted healthcare systems, delaying the diagnosis and treatment of various diseases, including colorectal cancer (CRC). OBJECTIVES: To determin...
BACKGROUND: The coronavirus disease (COVID-19) pandemic has significantly disrupted healthcare systems, delaying the diagnosis and treatment of various diseases, including colorectal cancer (CRC). OBJECTIVES: To determine differences in patient demographics, clinical and histopathological characteristics, and survival rates in patients diagnosed with CRC before and during the first year of the pandemic. DESIGN: Retrospective cohort study. SETTING: Tertiary-care center. PATIENTS AND METHODS: We included 284 patients newly diagnosed with CRC, stratified into two cohorts: those diagnosed one year before and during the first year of the pandemic. Patient demographics, tumor characteristics (diameter, location, histological type, grade, multifocality, invasion depth, lymphovascular and perineural invasion, number of metastatic lymph nodes, tumor budding, and deposits), and clinical factors (operability, presence of distant metastases, and survival status) were evaluated. MAIN OUTCOME MEASURES: Tumor stage at diagnosis, histopathological aggressiveness, and overall survival rates. SAMPLE SIZE: 284 patients. RESULTS: Patients diagnosed during the pandemic had a significantly higher incidence of distant metastasis (14.8% vs. 5.1%, =.005), a greater proportion of pT4b stage tumors (12.9% vs. 0.6%, <.001), and a higher prevalence of rectosigmoid tumors (41.4% vs. 24.4%, =.002). Additionally, tumor budding (63.6% vs. 47.3%, =.014) and perineural invasion (35.2% vs. 24.5%, =.053) were more common in the pandemic cohort. During the pandemic, significant shifts occurred in treatment modalities (=.005), with increased utilization of neoadjuvant chemotherapy (18.8% vs. 11.5%), radiotherapy (22.7% vs. 12.2%), and palliative treatments (14.9% vs. 5.1%). Survival analysis showed no differences in survival rates between groups across all time points, including at three-year follow-up (>.05). CONCLUSIONS: The COVID-19 pandemic has led to increased metastasis and advanced tumor rates in CRC cases, possibly owing to diagnostic delays. Although survival outcomes were similar between the periods, delayed effects on prognosis may manifest, necessitating long-term follow-up. LIMITATIONS: Retrospective design, single-center study.
Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes.
Gunes A, Colapkulu-Akgul N, Akgul C … +2 more , Unlu I, Cinar S
Ann Saudi Med · 2025 · PMID 40482189 · Full text
BACKGROUND: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer. OBJECTIVE: Evaluate the diagnostic ac...
BACKGROUND: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer. OBJECTIVE: Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results. DESIGN: A retrospective cohort. SETTING: Tertiary oncology center in Turkiye. PATIENTS AND METHODS: Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (-) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared. MAIN OUTCOME MEASURES: Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome. SAMPLE SIZE: 248. RESULTS: The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (<.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (-) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results. CONCLUSION: 18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB. LIMITATIONS: Retrospective design and limited number of patients for each subtype.
Pediatric aerodigestive foreign bodies in the Qassim region: a retrospective study of epidemiology, clinical characteristics, and outcomes.
Alenezi MM, Alrashidi SH, Al-Harbi FA … +4 more , Al-Mutairi TA, Alsweed ZA, Al-Oadah EK, Alharbi AF
Ann Saudi Med · 2025 · PMID 40482188 · Full text
BACKGROUND: Aerodigestive foreign bodies (ADFBs) are a common pediatric emergency, often caused by tiny objects like toys, coins, seeds, and other foreign materials getting lodged in the airway during swallowing or breat...
BACKGROUND: Aerodigestive foreign bodies (ADFBs) are a common pediatric emergency, often caused by tiny objects like toys, coins, seeds, and other foreign materials getting lodged in the airway during swallowing or breathing. Inadequate handling and delayed treatment could lead to potentially life-threatening complications. Understanding the symptoms and dangers associated with ADFBs is crucial in implementing preventative measures to reduce their occurrences. OBJECTIVES: The study aimed to evaluate the epidemiology, clinical characteristics, management strategies, and outcomes of pediatric patients with ADFBs in the Qassim region. DESIGN: Single-center, retrospective study. SETTING: Maternal and Children's Hospital, Qassim, Saudi Arabia. PATIENTS AND METHODS: Retrospective data of pediatric patients (0-14 years) with confirmed ADFBs recorded over the past 5 years at Maternal and Children Hospital (MCH) in Buraidah, Saudi Arabia. Data was first cleaned and then analyzed using SPSS version 26 to obtain crucial insights. MAIN OUTCOME MEASURES: Common characteristics and management strategies of ADFBs in pediatric patients, including demographic factors, such as age and gender, the type and location of the foreign bodies, and the clinical presentation and outcomes following intervention. SAMPLE SIZE: 149 patients. RESULTS: Most patients were symptomatic 89 (59.7%) with frequent symptoms such as vomiting 38 (42.7%) followed by drooling 14 (15.7%) and cough 13 (14.6%). Most of the objects 122 (81.9%) were radiopaque, impacted in the upper esophagus above clavicle 90 (60.4%). The common foreign body type identified were coin 96 (64.4%); seeds 8 (5.4%) and battery 8 (5.4%). Most objects (91.94%) were visualized, and 76.5% were removed via endoscopy. Only 10 (6.7%) of the patients had complications with nearly one-third 3 (30.0%) of them presenting with erosion. CONCLUSION: Common foreign body types reported are coins, seeds, and batteries. Most objects impacted are radiopaque; with endoscopy commonly used in visualization and foreign body extraction from patients. The study highlights the need for increased awareness among caregivers regarding pediatric safety and the potential risks and complications associated with ADFBs. It recommends prompt action, including medical intervention and preventive measures, to reduce the incidence and risks of ADFBs. LIMITATION: Single-center and retrospective design limited the generalizability of the investigation.
Chromosomal abnormalities in couples with recurrent pregnancy loss: a 16-year cross-sectional study of 4030 cases from Turkey.
Aynaci S, Kocagil S, Tosumoglu E … +7 more , Susam E, Kilic B, Gokalp EE, Cilingir O, Aras BD, Tekin B, Artan S
Ann Saudi Med · 2025 · PMID 40482187 · Full text
BACKGROUND: Chromosomal abnormalities are a significant cause of miscarriages. Carriers of balanced chromosome rearrangement are often at risk of recurrent pregnancy loss (RPL), as they are more likely to produce gametes...
BACKGROUND: Chromosomal abnormalities are a significant cause of miscarriages. Carriers of balanced chromosome rearrangement are often at risk of recurrent pregnancy loss (RPL), as they are more likely to produce gametes with unbalanced chromosome rearrangements. OBJECTIVE: This study evaluated the chromosomal abnormalities detected in couples with history of primary recurrent pregnancy loss. DESIGN: Retrospective, cross-sectional study. SETTING: Single center, tertiary healthcare center in Turkey. PATIENTS AND METHODS: This study reviewed conventional cytogenetic/molecular cytogenetic analysis data of 4030 patients (2015 couples) who visited the clinic from 2008-2024. MAIN OUTCOME MEASURES: Chromosomal abnormalities in patients diagnosed with primary recurrent pregnancy loss and genetic testing results of spontaneously achieved pregnancies in 16 patients with a balanced chromosomal rearrangement. SAMPLE SIZE: 4030 individuals (2015 couples). RESULTS: Majority of couples had a history of two spontaneous miscarriages (59.4%), followed by couples with 3 miscarriages (28.1%), 4 miscarriages (7.5%), and 5 or more miscarriages (4.91%). Chromosomal abnormality was detected in 133 (3.3%) cases. Among the revealed abnormalities, 130 (97.7%) were structural chromosome anomalies, while only 3 (2.3%) numerical chromosome anomalies were observed, including sex chromosome aneuploidy in 2 cases and mosaic karyotype in one case. Among the detected 130 structural chromosome abnormalities, reciprocal translocations (86 cases, 66.2%) were most frequently observed, followed by Robertsonian translocations in 26 cases (20.0%), inversion in 11 cases (8.5%), marker chromosome in 5 cases (3.8%), and derivative chromosomes in 2 cases (1.5%). Products of conception (conceptus materials) were analyzed from 16 spontaneously conceived pregnancies in individuals identified as carriers of chromosomal rearrangements. Although reciprocal translocations involving acrocentric chromosomes are typically expected to result in 3:1 meiotic segregation, adjacent-1 segregation was observed in two female individuals carrying the translocation t(9;15)(p22;q23). This finding is likely due to the limited genetic content of the translocated segments. Additionally, a novel complex three-way translocation, t(5;7;13)(p12;p12;p11), was identified for the first time. CONCLUSION: Cytogenetic and molecular analyses are crucial components in the etiological investigations of couples with RPL. LIMITATIONS: Retrospective design.
Redo surgery for persistent hyperinsulinemic hypoglycemia of infancy in the age of laparoscopic pancreatectomy.
Alshanafey S, Almanea SS
Ann Saudi Med · 2025 · PMID 40482186 · Full text
BACKGROUND: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a rare disease but the most common cause of persistent neonatal hypoglycemia, often requiring early pancreatectomy. In cases of persistent/relapse...
BACKGROUND: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a rare disease but the most common cause of persistent neonatal hypoglycemia, often requiring early pancreatectomy. In cases of persistent/relapsed hypoglycemia, redo surgery may be necessary. OBJECTIVES: We report our experience with the redo of laparoscopic pancreatectomy at a tertiary healthcare center. DESIGN: Single-center, retrospective study. SETTING: Tertiary health care center. PATIENTS AND METHODS: We conducted a retrospective review of the patients who underwent redo laparoscopic pancreatectomy between March 2004 and April 2021. Demographic, clinical, and follow-up data were collected and analyzed. Descriptive data were generated. MAIN OUTCOME MEASURES: Feasibility and safety of the procedure. Success in controlling the PHHI. SAMPLE SIZE: 82 patients. RESULTS: We managed 82 patients with PHHI by pancreatectomy, 11 of whom (6 boys and 5 girls) required redo procedures to control hypoglycemia, with 2 needing 2 redo procedures. The mean age during the redo procedure was 21 months. The redo procedures were performed at a mean duration of 15.5 months after the primary pancreatectomy. All patients exhibited the histologically diffuse type. The mean follow-up was 7 years. All cases were managed successfully after the redo procedures. Six patients were on medical treatment, 4 developed diabetes mellitus, and 1 became euglycemic). Two patients developed severe pancreatitis postoperatively, 1 required drainage of the infected collection and 1 developed thrombosis of the inferior vena cava, which was managed with anticoagulation medication. CONCLUSIONS: Redo laparoscopic pancreatectomy is feasible, safe, and effective option for managing persistent or recurrent hypoglycemia after primary pancreatectomy in diffuse PHHI. Sufficient experience with laparoscopic pancreatectomy is required for redo surgeries. LIMITATIONS: Retrospective design of the study may introduce bias.
Prevalence and predictors of co-occurring functional seizure in patients with epilepsy at a tertiary care center in Makkah.
Alkhotani AM, Abualela H
Ann Saudi Med · 2025 · PMID 40482185 · Full text
BACKGROUND: A functional seizure (FS) is a paroxysmal event that resembles epileptic seizures (ES) but without associated changes in cortical activity. OBJECTIVE: To assess the prevalence of FS among ES patients admitted...
BACKGROUND: A functional seizure (FS) is a paroxysmal event that resembles epileptic seizures (ES) but without associated changes in cortical activity. OBJECTIVE: To assess the prevalence of FS among ES patients admitted to the epilepsy monitoring unit (EMU) in King Abdullah Medical City (KAMC). DESIGN: A retrospective cohort study. SETTING: EMU at KAMC. PATIENTS AND METHODS: EMU database from 2015 to 2023 were reviewed. Patients were included in the study if they had a diagnosis of epilepsy and recorded seizure during admission. MAIN OUTCOME MEASURES: The prevalence and the predictors of FS developments among patients with ES. SAMPLE SIZE: 198 patients. RESULTS: The prevalence of FS was 10.6%. Significant risk factors associated with FS were income (18.6% vs 8.4% =.048), focal epilepsy (66.7% vs 33.3% for generalized =.004), frontal localization (38.5 versus 14.3% of temporal localization =.041), on 5 antiseizure medications (ASMs) (75% versus 3% of on one ASM =.001), receiving phenytoin (PHY) (46.2% vs other ASMs, =.001), on psychiatric medications before EMU (29.4% vs. 8.8%) and those on the same medication after the EMU (35.6 % vs. 3.3%) (=.008 and .001, respectively). Around 33.3% of FS cases had a major depressive disorder (MDD), 19% had a generalized anxiety disorder (GAD) and 14.3% were diagnosed with both MDD and GAD compared to without FS 4%, 2.3%, and 4.5%, respectively (=.001). Multiple stepwise logistic regression analysis identified additional risk factors including male gender (odds ratio [OR] 3.0, 95% CI: 2.4-47.3; =.048), shorter epilepsy duration (OR 0.8, 95% CI: 0.6-1.0; =.046), history of head trauma (OR 5.5, 95% CI: 1.4-25.7; =.047) and intellectual disability (OR 17.5, 95% CI: 1.4-39.2; =.044). CONCLUSION: Patients with combined disorders are more likely to be male, shorter epilepsy duration, had salary income, focal epilepsy, frontal localization, history of head trauma, intellectual disability and be on higher ASMs, phenytoin as ASMs, depression, anxiety and more likely to be on psychiatric treatment. LIMITATIONS: The study was a retrospective study.
Errata.
Ann Saudi Med · 2025 · PMID 40189858 · Full text
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Sex-based outcomes of obesity in critically ill patients: a retrospective cohort study.
Alqahtani M, Alenezi F, Sadat M … +4 more , Tamim H, Humaid FB, Albaalharith NA, Arabi Y
Ann Saudi Med · 2025 · PMID 40189857 · Full text
BACKGROUND: Obesity is increasingly prevalent among critically ill patients, generally more common among females than males. Whether the patient's sex influences the outcome in these patients is unclear. OBJECTIVE: Evalu...
BACKGROUND: Obesity is increasingly prevalent among critically ill patients, generally more common among females than males. Whether the patient's sex influences the outcome in these patients is unclear. OBJECTIVE: Evaluate the outcomes of critically ill-patients with obesity admitted to the intensive care unit (ICU). DESIGN: A retrospective cohort study. SETTING: ICU of King Abdulaziz Medical City, Riyadh, Saudi Arabia. PATIENTS AND METHODS: All obese patients aged more than 18 years admitted to ICU between 2002 to 2017 were included. MAIN OUTCOME MEASURES: The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, mechanical ventilation duration, renal replacement therapy, vasopressor use, and tracheostomy. A multivariable analysis was conducted to evaluate the association of sex differences with hospital mortality. SAMPLE SIZE: 7277 patients. RESULTS: Of the included patients with obesity, 3965 were females, and 3312 were males. The females were older, more likely to be admitted for medical reasons and less likely for trauma than males. The crude hospital mortality rate was significantly higher in females than males (1056 [26.7%] vs. 744 [22.5%], <.0001). Multivariable analysis demonstrated no association between sex and hospital mortality (OR: 1.05, 95% CI: 0.94, 1.19, =.52). However, age (OR: 1.04; 95% CI: 1.01-1.02; <.0001), chronic liver disease (OR: 5.04; 95% CI: 4.19-6.06; <.0001), and chronic renal disease (OR: 2.19; 95% CI: 1.86-2.57;<.0001) were found to be associated with higher mortality while admission due to trauma showed lower mortality (OR: 0.69; 95% CI: 0.53-0.90; =.007). CONCLUSION: Obese females admitted to ICU have a higher hospital crude mortality rate than obese males. This difference does not appear to be related to sex, but rather to older age, higher comorbid conditions, and more frequent admissions related to non-trauma reasons among females. LIMITATIONS: A single-center retrospective study.
Gastrointestinal safety of semaglutide and tirzepatide vs. placebo in obese individuals without diabetes: a systematic review and meta analysis.
Safwan M, Bourgleh MS, Alotaibi SA … +3 more , Alotaibi E, Al-Ruqi A, El Raeya F
Ann Saudi Med · 2025 · PMID 40189856 · Full text
INTRODUCTION: Semaglutide and tirzepatide are newly approved glucagon-like peptide-1 receptor agonists for weight management in adults without diabetes. However, safety concerns regarding gastrointestinal (GI) adverse ou...
INTRODUCTION: Semaglutide and tirzepatide are newly approved glucagon-like peptide-1 receptor agonists for weight management in adults without diabetes. However, safety concerns regarding gastrointestinal (GI) adverse outcomes have been raised. This review comprehensively evaluates their GI safety profile in randomized controlled trials (RCTs). METHODS: Thirteen RCTs involving 26 894 obese participants without diabetes were analyzed. Pooled analysis assessed the risks for GI, biliary, hepatic, and pancreatic adverse events. RESULTS: Overall GI adverse events were 1.86 times higher with *both* agents (95% CI=1.56, 2.21), with tirzepatide showing a greater risk (RR 2.94, 95% CI=2.61, 3.32) than semaglutide (RR 1.68, 95% CI=1.46, 1.94). Semaglutide increased gallbladder-related disorders, particularly cholelithiasis, by over 2.6 times (95% CI=1.40, 4.82), while tirzepatide showed no significant biliary risk. Neither agent significantly increased hepatic or pancreatic adverse events. CONCLUSION: Compared to placebo, both Semaglutide and tirzepatide are associated with increased GI adverse outcomes, with most cases being mild. Clinicians should carefully monitor patients for potential adverse outcomes.
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