Annals Of Saudi Medicine[JOURNAL]
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200 papers
Hepatitis A virus infection and seroprevalence, Istanbul, Turkey, 2020-2023.
Karabey M, Alacam S, Karabulut N … +3 more , Uysal H, Gunduz A, Aydina OA
Ann Saudi Med · 2024 · PMID 39651919 · Full text
BACKGROUND: Hepatitis A infections continue to be a major global public health problem. The epidemiology and seroprevalence of hepatitis A virus (HAV) have important public health implications. This study aimed to retros...
BACKGROUND: Hepatitis A infections continue to be a major global public health problem. The epidemiology and seroprevalence of hepatitis A virus (HAV) have important public health implications. This study aimed to retrospectively examine the hepatitis A cases and hepatitis A seroprevalence in our region in our hospital with the highest number of inpatient and outpatient cases in Istanbul. OBJECTIVE: Determination of hepatitis A cases and seroprevalence. DESIGN: Cross-sectional. SETTING: Tertiary care. PATIENTS AND METHODS: A total of 39 385 individuals who were tested for Anti-HAV IgM and Anti-HAV Total (IgM+IgG) antibodies between May 2020 and September 2023 and were included in this study. Hepatitis A specific IgM and Total (IgM+IgG) antibodies were determined using the enzyme-linked immunosorbent assay method. MAIN OUTCOME MEASURE: Hepatitis A seroprevalence. SAMPLE SIZE: 46 721. RESULTS: The study included a total of 46 721 samples from 39 385 individuals who were tested for hepatitis A serology. The median age of the 39385 individuals included in the study was 28 (interquartile range [IQR]; 22-46), with 58.74% being female and 4.07% (n=1163) being foreign nationals. Reactivity was detected in 91 of the 25 442 patients tested for HAV-IgM. Among these patients, 33 (0.13%) had acute hepatitis A infection, while 58 (0.23%) were considered false positives. Of the acute hepatitis A patients, 13 (0.09%) were women, and 22 (0.80%) were children. Acute hepatitis A was most commonly observed in the 6-9 and 15-18 age groups, with 7 cases each. The seroprevalence rate of hepatitis A was 67.23% among 33 683 individuals. Of those tested for HAV-Total, 13 132 (64.92%) were women, and 2533 (64.88%) were children. The lowest seroprevalence rate among age groups (35.91%) was in the 15-18 age year range, while the highest seroprevalence (98.34%) was detected in individuals aged 60 years and above. CONCLUSION: With a seroprevalence rate of 67.23%, our region is still considered a medium-endemic area for hepatitis A, and it is crucial to continue administering the HAV vaccine as currently included in the childhood vaccination schedule in our country. Additionally, the significantly low hepatitis A seropositivity, particularly in the 15-18 and 19-24 age groups, indicates the need to promote catch-up vaccination for young adults. Since our study covers a large population, it can serve as a guide regarding the serological status of hepatitis A in Istanbul. LIMITATIONS: Since vaccination information for the study population was not available, it was not possible to distinguish between seropositivity due to vaccination or natural immunity. Despite being conducted in Istanbul, a cosmopolitan city, and in the largest city hospital, the results may not be representative of the entire country.
Evaluation of optic nerve sheath diameter in patients undergoing laparoscopic surgery in the Trendelenburg position: a prospective observational study.
Ömür B, Çiftçi B, Karaaslan P
Ann Saudi Med · 2024 · PMID 39368121 · Full text
BACKGROUND: The Trendelenburg position and pneumoperitoneum may cause cerebral edema and increased intracranial pressure. Non-invasive measurement of the diameter of the optic nerve sheath by ultrasonography can provide...
BACKGROUND: The Trendelenburg position and pneumoperitoneum may cause cerebral edema and increased intracranial pressure. Non-invasive measurement of the diameter of the optic nerve sheath by ultrasonography can provide early recognition of intracranial pressure. OBJECTIVE: Evaluate the optic nerve sheath diameter (ONSD) changes in patients who undergo laparoscopic surgery in the Trendelenburg position and make indirect conclusions about changes in intracranial pressure. DESIGN: Prospective, observational. SETTING: Laparoscopic surgeries. PATIENTS AND METHODS: Patients aged 18-75 years who underwent laparoscopic surgery in the Trendelenburg position under general anesthesia were included in our study. The ONSD was measured four times: Immediately after tracheal intubation, in the neutral position (baseline value) (T0), 10 minutes after pneumoperitoneum and Trendelenburg position (T1), 60 minutes after pneumoperitoneum and Trendelenburg position (T2), and 10 minutes after the pneumoperitoneum is terminated and placed in the neutral position (T3). MAIN OUTCOME MEASURES: Compare ONSD measured by ultrasonography at different times of surgery. SAMPLE SIZE: 40. RESULTS: Arterial carbon dioxide pressure increased with laparoscopy and Trendelenburg position in parallel with ONSD measurements and decreased again after returning to the neutral position. It was still higher than the baseline value at the T3. There was also a significant difference[a] between the measurement made at the T2 and the measurement made at T1. This difference showed that the prolongation of the Trendelenburg time was associated with an increase in ONSD. At the end of the operation it was observed that the decreased statistically significantly (T3) 10 minutes after the pneumoperitoneum was terminated and the position was corrected. However, the ONSD was still higher at the end of the operation (T3) compared to the baseline value measured at the beginning of the operation (T0). CONCLUSION: The ONSD increased in relation to Trendelenburg position and pneumoperitoneum. With these results, we think the ultrasonographic measurement of ONSD, a non-invasive method, can be used for clinical follow-up when performing laparoscopic surgery in the Trendelenburg position in cases requiring intracranial pressure monitoring. LIMITATIONS: There may be variations in the measurement of ONSD, even in the measurements of the same practitioner, as in all imaging with an ultrasonography device.
Estimating the prevalence of select non-communicable diseases in Saudi Arabia using a population-based sample: econometric analysis with natural language processing.
Alghnam S, Bosaeed M, Aljouie A … +4 more , Alshahrani SM, Alshenqeety O, Atun R, Alqahtani S
Ann Saudi Med · 2024 · PMID 39368120 · Full text
BACKGROUND: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally repr...
BACKGROUND: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally representative epidemiological studies. OBJECTIVES: Assess the prevalence of selected NCDs, using population-based electronic health records and applying novel analytical methods to identify cases of NCDs. DESIGN: Retrospective. SETTINGS: A large healthcare network in Saudi Arabia. PATIENTS AND METHODS: We included all beneficiaries aged 16 years or older (n=650 835[a]) and used the International Classification of Disease (ICD-10) codes, laboratory results, and associated medications to identify individuals with diabetes, obesity, hypertension, dyslipidemia, mental disorders, and injuries. For diabetes and hypertension, we used natural language processing (NLP) on clinical notes in the electronic health records. The prevalence of multimorbidity across age groups was also tabulated, and logistic regression was used to examine its association with glycemic control. MAIN OUTCOME MEASURES: The primary outcomes measured were the prevalence of diabetes, hypertension, and multimorbidity, and their association with glycemic control. SAMPLE SIZE: 650 835 individuals aged 16 years or older. RESULTS: The study population was relatively young, with 41.2% aged between 26 and 45 years, and around two-thirds were married. The prevalence of diabetes and hypertension was 18.5% (95% CI: 18.5-18.7) and 13.0% (95% CI: 12.9-13.1), respectively. Approximately 26.7% (95% CI: 26.7-26.8) of the population had multimorbidity, with levels increasing to 62.9% for those aged 65 or older. Multimorbidity was associated with a four-fold increase in the likelihood of poor glycemic control. NLP analysis suggested that the prevalence of diabetes or hypertension may be underestimated by no more than 1.5%. CONCLUSIONS: The study suggests a higher prevalence of NCDs than earlier national estimates. Electronic health records with regular analysis provide an opportunity to estimate changes in the prevalence of NCDs in Saudi Arabia. Health policies and interventions are needed to address the high levels of multimorbidity, which adversely impact glycemic control. LIMITATIONS: Retrospective design and reliance on electronic health records, which may not capture all cases of NCDs.
Impact of SARS-CoV-2 infection and vaccination on cesarean section outcomes: a retrospective analysis.
Yeniocak AS, Tercan C, Dagdeviren E … +2 more , Arabaci O, Arabaci EEG
Ann Saudi Med · 2024 · PMID 39368119 · Full text
BACKGROUND: Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes. OBJECTIVES: Investigate the morbidity and mortality as...
BACKGROUND: Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes. OBJECTIVES: Investigate the morbidity and mortality associated with SARS-CoV-2 infection among pregnant individuals, considering vaccination status and variant strains. DESIGN: Retrospective cohort. SETTING: Tertiary state hospital. PATIENTS AND METHODS: Patients who underwent cesarean sections were categorized into three periods: pre-vaccination (before 31 August 2021), early post-vaccination (from September 2021), and late post-vaccination (aligned with 70% immunization coverage by 2 September 2021). Data collected included demographic information (age, gravidity, parity count, gestational age, newborn APGAR scores), cesarean section indications, chronic diseases, vaccination status, vaccine type and doses, SARS-CoV-2 variant status, ICU admission, and mortality due to COVID-19. MAIN OUTCOME MEASURES: ICU admission and mortality rates, focusing on the impact of SARS-CoV-2 infection and vaccination status. SAMPLE SIZE: 297 COVID PCR-positive symptomatic patients who underwent cesarean sections. RESULTS: In the pre-vaccination group, there were 13 mortalities (8.1%) compared to 9 (6.6%) post-vaccination (=.610). Maternal ARDS was seen in 46.2% of pre-vaccination mortalities versus 11.1% post-vaccination (=.045). COVID-19 delta variant patients had higher ICU admission (80%) and mortality rates (40%). Rates of COVID-19 PCR-positive cesarean sections, ICU admissions, and mortality declined significantly in early (=.021, =.004, =.009), respectively and late post-vaccination periods (<.001, <.001, =.0019), respectively. Vaccinated patients had no ICU admissions or mortality. CONCLUSIONS: Vaccination against COVID-19 is crucial for pregnant individuals as it significantly reduces the risk of severe illness. While vaccines offer substantial protection, the pandemic's acute phase might be waning, yet COVID-19 remains a global threat, particularly in regions with limited vaccine access. Continued vigilance and proactive measures are essential to mitigate ongoing risks and the emergence of new variant strains. LIMITATIONS: Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.
Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study.
Al Yaqoubi IH, Al-Maqbali JS, Al Farsi AA … +3 more , Al Jabri RK, Khan SA, Al Alawi AM
Ann Saudi Med · 2024 · PMID 39368118 · Full text
BACKGROUND: Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes. OBJECTIVES: Study the prevalence of hyponatremia among medically adm...
BACKGROUND: Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes. OBJECTIVES: Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia. DESIGN: Retrospective cohort. SETTING: Medical ward at tertiary hospital setting. PATIENTS AND METHODS: The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge). SAMPLE SIZE AND BASIS: The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin. MAIN OUTCOME MEASURES: The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality. RESULTS: In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (<.01), predominantly female (=.014), and had lower serum magnesium and albumin levels (<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (<.01, <.01, =.045, <.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, <.01 [95% CI; 0.69-0.94]). CONCLUSION: Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission. LIMITATIONS: Single-centre design and retrospective nature.
Prevalence of nocturnal enuresis among children and adults in Saudi Arabia: a systematic review and meta-analysis.
Almutairi NG, Alzahrani HM, Alhomrani MA … +4 more , Alowid FK, Alghaith DM, Almutairi RH, Aljaid MS
Ann Saudi Med · 2024 · PMID 39368117 · Full text
BACKGROUND: Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first m...
BACKGROUND: Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first meta-analysis to provide an overall assessment of the prevalence of NE and the factors associated with it in Saudi Arabia. We also examined its psychological impact and mothers' behavior in dealing with this disorder. PATIENTS AND METHODS: A thorough search was conducted on PubMed, Scopus, Cochrane, and Web of Science databases for studies assessing the prevalence of NE. Comprehensive Meta-Analysis Version 3.3 was used to conduct the analysis. We evaluated NE prevalence, NE frequencies, NE by time, social shame and embarrassment in children with NE, and mothers seeking medical advice. A meta-regression analysis was performed to determine the correlation between the frequency of NE and NE in parents, NE in siblings, gender, and age. The quality of the included studies was assessed by Newcastle Ottawa Scale. RESULTS: Sixteen cross-sectional studies, totaling 14 284 participants, were included. NE prevalence was 24.8% (95% CI: 17, 34). The prevalence of NE one to two times per week was 26.8% (95% CI: 15.1, 43.0), three to four times was 31.8% (95% CI: 18.5, 48.9), and five to seven times was 33.8% (95% CI: 18.2, 54.1). NE occurring at night was 24.4% (95% CI: 22.8, 26.2) and at day and night was 16.6% (95% CI: 15.3, 17.9). A significant difference was found between the regions of Saudi Arabia in the prevalence of NE, with the southern and eastern regions having the highest prevalence and the central region having the lowest prevalence. The overall pooled prevalence of embarrassment and social shame in children with NE was 63% (95% CI: 46, 77). The percentage of mothers seeking medical advice was 54.4% (95% CI: 39.7, 68.3). The prevalence of NE is positively correlated with the prevalence of NE in parents and siblings, but no association was found with males or age. CONCLUSION: A quarter of Saudi Arabian children suffer from NE, and it is associated with feelings of embarrassment and social shame. Half of the mothers seek medical counseling. Having parents or siblings with NE increases the likelihood of NE in the child. Future research is needed to corroborate the findings of other risk factors, such as age and gender. Future research will also be required to identify the precise causes or effects within each region that contribute to the varying prevalence of NE.
Effect of different patient positions on endotracheal tube cuff pressure in patients undergoing urological procedures: a prospective study.
Tok E, Karaca N, Karakoc O … +1 more , Alper I
Ann Saudi Med · 2024 · PMID 39368116 · Full text
BACKGROUND: The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT...
BACKGROUND: The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. OBJECTIVES: Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. DESIGN: Prospective and observational study. SETTING: A university hospital in Turkey. PATIENTS AND METHODS: Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmHO and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. MAIN OUTCOME MEASURES: The effect of different patient positions on the ETT cuff pressure. SAMPLE SİZE: 200 patients. RESULTS: The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmHO). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: =.003; cough: =.047). CONCLUSION: ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety. LIMITATION: We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.
Predictors of medication regimen complexity and its impact on hemoglobin a1c in type 2 diabetes patients: a retrospective analysis in ambulatory care in Makkah City.
Khayyat SM, Ali RSA, Alrammaal HH … +5 more , Khayyat SMS, Alqurashi WA, Alsaedi R, Alotaibi W, Alahmadi A
Ann Saudi Med · 2024 · PMID 39368115 · Full text
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact...
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact on patient outcomes. OBJECTIVES: Explore the complexity level of diabetes medications among patients with T2DM and to identify the predictors of medication regimen complexity (MRC) and its correlation with hemoglobin A1C (HbA1c) levels. DESIGN: Retrospective, cross-sectional study. SETTING: An ambulatory care setting of a tertiary hospital in Makkah City, Saudi Arabia. PATIENTS AND METHODS: Patients with T2DM referred to the diabetic clinic were identified and assessed for eligibility. The data were collected from patient electronic medical records between October 2022 and September 2023. The MRC Index was used to evaluate the complexity of the patients' medication regimens. MAIN OUTCOMES MEASURES: MRC index scores and HbA1c levels. SAMPLE SIZE: 353 records of patients with T2DM. RESULTS: The analysis revealed that 61.8% (n=218) of patients had high MRC, with the dosing frequency contributing significantly to their MRC (mean=3.9, SD=1.9). Having polypharmacy and longstanding T2DM were predictors of high MRC (odds ratios=4.9 and 2.6, respectively; ≤.01). Additionally, there was an inverse association between the patients' diabetes-specific MRC index scores and their glycemic control (odds ratios=0.2, <.001). CONCLUSION: The study findings highlight the importance of considering MRC in managing T2DM. Simplifying medication regimens and optimizing medication management strategies can improve patient outcomes. Further research is needed to explore interventions to reduce MRC and enhance diabetes management in this population. LIMITATIONS: Retrospective study design measuring the MRC at a diabetes-specific level.
Diabetes mellitus and the risk of spontaneous bacterial peritonitis in patients with liver cirrhosis: a systematic review and meta-analysis.
Alhajaji R, Samkari MM, Althobaiti MA … +9 more , Al-Ahmadi BR, Bugis AM, Bugis AM, Sabbagh FY, Althobaiti SA, Bukari AS, Alqurashi SM, Mshrai HA, Abdelwahab OA
Ann Saudi Med · 2024 · PMID 39127903 · Full text
BACKGROUND: Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus...
BACKGROUND: Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus (DM) as a risk factor for SBP in liver cirrhotic patients. METHODS: Following PRISMA guidelines, fifteen studies were included, for a total of 76 815 patients. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). We represented the results as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Additionally, we pooled the hazard ratios (HR) for developing SBP in patients with DM from the included studies. RESULTS: The meta-analysis shows a significantly increased risk of SBP in cirrhotic patients with DM (HR: 1.26; 95% CI [1.05-1.51], =.01; HR: 1.70; 95% CI [1.32-2.18], <.001). CONCLUSIONS: The study signifies that DM is an independent risk factor for SBP, emphasizing the need for targeted preventive measures in this specific population.
Prevalence of discordance between femoral and lumbar bone mineral density among older adults in a community-based setting.
Alkhunizan MA, AlMasoud N, Abdulmowla MM … +3 more , Khalid Z, Alshaker M, Alendijani YA
Ann Saudi Med · 2024 · PMID 39127902 · Full text
BACKGROUND: T-score measurement via dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing and classifying the bone mineral density status of patients as normal, osteopenic, or osteoporotic according t...
BACKGROUND: T-score measurement via dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing and classifying the bone mineral density status of patients as normal, osteopenic, or osteoporotic according to the World Health Organization criteria. However, the diagnostic accuracy may be affected by the skeletal site selected for DXA. OBJECTIVES: Estimate the prevalence of femoral and lumbar BMD discordance in a community-based setting in Riyadh, Saudi Arabia. DESIGN: Cross-sectional. SETTING: Polyclinics at a tertiary care center. PATIENTS AND METHODS: This study included all patients aged ≥60 years who visited the Department of Family Medicine and underwent DXA screening between 2016 and 2022. MAIN OUTCOME MEASURES: Discordance was defined as a difference in BMD status between two skeletal sites. Minor discordance occurs when adjacent sites have different diagnoses; i.e., one site exhibits osteoporosis and the other exhibits osteopenia. In contrast, major discordance occurs when one site exhibits osteoporosis and the other exhibits normal BMD. SAMPLE SIZE: 1429 older adults. RESULTS: The study patients had a median age of 66 years (60-99, minimum-maximum). The prevalence of discordance was 41.6%, with major discordance present in 2.2% of patients and minor discordance in 39.4%. The distribution of discordance did not differ significantly among the sociodemographic factors. CONCLUSION: Discordance is prevalent among the Saudi geriatric population. During the analysis of DXA results, physicians should account for discordance when diagnosing and ruling out osteoporosis in high-risk patients. LIMITATIONS: All factors influencing discordance were not explored thoroughly; this study mainly focused on older adults. Furthermore, diverse age groups need to be investigated for a more comprehensive understanding of the analyzed factors.
Assessing risk factors for complications in computer tomography-guided lung biopsy: quantitative analysis for predicting pneumothorax.
Zhang J, An J, Jing X … +4 more , Wu J, Zhang X, Lu H, Tian Y
Ann Saudi Med · 2024 · PMID 39127901 · Full text
BACKGROUND: Computer tomography (CT)-guided lung biopsy carries the risk of pneumothorax. A variety of other risk factors affect the occurrence of pneumothorax. OBJECTIVE: Assess the incidence and risk factors associated...
BACKGROUND: Computer tomography (CT)-guided lung biopsy carries the risk of pneumothorax. A variety of other risk factors affect the occurrence of pneumothorax. OBJECTIVE: Assess the incidence and risk factors associated with pneumothorax complications in CT-guided lung biopsy, and to conduct a quantitative analysis of the variables among the significant risk factors to identify more effective indicators for predicting pneumothorax complications. DESIGN: Retrospective logistic. SETTING: Single center in China. PATIENTS AND METHODS: From June 2017 to May 2021, consecutive patients who underwent CT-guided lung biopsy were identified from the medical record system. Binary logistic regression analysis was used to identify potential risk factors for pneumothorax. Receiver operating characteristic (ROC) curves were constructed for continuous variables to determine cutoff values that optimized sensitivity and specificity. MAIN OUTCOME MEASURES: The incidence and risk factors of pneumothorax in CT-guided lung biopsy. SAMPLE SIZE: 132 patients. RESULTS: The incidence of pneumothorax was 28.9% (38/132), with 6.8% (9/132) of patients requiring chest tube insertion. Results indicated that smaller lesion size (OR 0.724; 95% CI 0.619-0.848; =.0001), longer needle tract length (OR 1.320; 95% CI 1.145-1.521; =.001), multiple passes through the pleura (OR 4.618; 95% CI 1.378-15.467; =.013), and needle tract length/lesion diameter (L/D) ratio (OR 0.028; 95% CI 0.002-0.732; =.007) were independent risk factors for pneumothorax. ROC curve analysis determined a cut-off value of 0.81 for the L/D ratio (sensitivity=89.5%, specificity=71.3%). The area under the ROC curve (AUC) values of maximum diameter, needle tract length, and L/D ratio for pneumothorax were 0.749, 0.812, and 0.850, respectively. CONCLUSIONS: The L/D ratio, multiple passes through the pleura, longer needle tract length, and smaller lesions were independent risk factors for pneumothorax. A L/D ratio of less than 0.81 may indicate a pneumothorax. It may be necessary to use the proper sealing procedure for this patient group. LIMITATIONS: Due to its retrospective nature, there may be inherent selection bias.
Evaluating the effect of histopathological parameters of prostate adenocarcinoma on prognosis in radical prostatectomy specimens.
Tercan E, Erbatu OU, Üçer O … +2 more , Metin S, Ne E N
Ann Saudi Med · 2024 · PMID 39127900 · Full text
BACKGROUND: Over the past decade, significant updates have been made regarding the classification and grading of prostate adenocarcinoma in radical prostatectomy specimens, following decisions reached in international co...
BACKGROUND: Over the past decade, significant updates have been made regarding the classification and grading of prostate adenocarcinoma in radical prostatectomy specimens, following decisions reached in international conferences and through impactful publications. These alterations are closely linked to patient prognosis. OBJECTIVES: Observe the incidence of these changes and their impact on patient prognosis. Additionally, investigate the relationship between histopathological and clinical parameters to assist in multidisciplinary treatment planning. DESIGN: Retrospective cohort study. SETTING: Tertiary university hospital. METHODS: Hematoxylin and eosin, along with immunohistochemistry stained sections, were reevaluated, and clinical information, including patient demographics, preoperative PSA levels, and patient follow-up were collected from patients who underwent radical prostatectomy at our center. SAMPLE SIZE: 182 patients. MAIN OUTCOME MEASURES: Biochemical recurrence. RESULTS: The study highlighted the negative prognostic effects of factors such as Gleason grade group, lymphovascular invasion, intraductal carcinoma, positive surgical margins, extraprostatic extension, pathological T stage, and seminal vesicle invasion. These factors are important determinants of recurrence-free survival in prostate adenocarcinoma patients. CONCLUSION: This study identified comedonecrosis and intraductal carcinoma as independent negative prognostic factors. A 3-mm cutoff for positive surgical margins was supported, while the current cutoff for extraprostatic extension may require reevaluation. The impact of cribriform pattern and ductal carcinoma appears to be influenced by the grade group. No independent relationship was found between the Gleason score/pattern on positive surgical margins or extraprostatic extension and prognosis. Further, large-scale studies with long-term follow-up are needed. LIMITATIONS: The study is limited by the relatively small number of patients for certain parameters.
Appendiceal neoplasms in Saudi Arabia: prevalence and clinicopathological profile.
AlAli MN, Zubaidi A, Traiki TAB … +7 more , Alkhayal K, Sbaih M, Aldeghaither SK, Almugrin FF, Alshammari SA, Alswayyed M, Abdullah M
Ann Saudi Med · 2024 · PMID 39127899 · Full text
BACKGROUND: The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in t...
BACKGROUND: The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. OBJECTIVES: Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. DESIGN: Retrospective cohort. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. MAIN OUTCOME MEASURES: Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. SAMPLE SIZE: 25 AN patients. RESULTS: Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. CONCLUSIONS: The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. LIMITATIONS: Data collected retrospectively, a single institution, and a small population.
Comparisons of the oncological results of transoral laser surgery and radiotherapy for early stage laryngeal squamous cell cancer: single-center long-term results.
Doluoglu S, Bayir O, Ocal B … +3 more , Tatar EC, Korkmaz MH, Saylam G
Ann Saudi Med · 2024 · PMID 39127898 · Full text
BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological result...
BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT. DESIGN: Retrospective. SETTINGS: Tertiary training and research hospital. PATIENTS AND METHODS: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS). MAIN OUTCOME MEASURES: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers. SAMPLE SIZE: 261. RESULTS: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (=.034, .065, .269, .060, respectively). CONCLUSIONS: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (=.034). LIMITATIONS: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.
The role of endocervical curettage in the diagnosis of cervical intraepithelial neoplasia in human papillomavirus positive patients.
Gulhan I, Özdemir R, İleri A … +5 more , İleri H, Özcan S, Öztürk AB, Gökçü M, Özeren M
Ann Saudi Med · 2024 · PMID 39127897 · Full text
BACKGROUND: The role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia (CIN) is a controversial topic. OBJECTIVES: Investigate the role of ECC in the diagnosis of CIN in human papillo...
BACKGROUND: The role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia (CIN) is a controversial topic. OBJECTIVES: Investigate the role of ECC in the diagnosis of CIN in human papillomavirus (HPV) positive patients. DESIGN: Retrospective. SETTING: A tertiary training and research hospital. PATIENTS AND METHODS: This study included patients who were referred for colposcopy between 2018-2022 because of abnormal screening results. ECC results, age, cytology, HPV status, and colposcopic impression of the patients were extracted from the medical records. Multinomial logistic regression analyses were performed to identify factors that could predict CIN on ECC. MAIN OUTCOME AND MEASURES: The likelihood of high-grade squamous intraepithelial lesions (HSIL) in ECC in patients with cervical biopsy results of normal and low-grade squamous intraepithelial lesion (LSIL). SAMPLE SIZE: 2895 women. RESULTS: In patients with normal and LSIL cervical biopsy results, HSILs were detected in 6.7% of ECC results. There was no difference in the detection rates of CIN in ECC among groups with smear results negative for intraepithelial lesions or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), and LSIL. The likelihood of HSIL being observed in ECC was 2.2 times higher in patients with HPV16. The probability of LSIL disanois was 2.3 times higher in women aged 50-59 years and 2.8 times higher in women ≥ 60 years compared to the reference group of <30 years. The probability of LSIL was 2.3 and HSIL by ECC was 2.2 times higher in both age categories (<.012 and =.032, respectively) than the reference group of <30 years. CONCLUSION: Regardless of colposcopic findings, ECC should be performed in patients with smear results of NILM who are positive for HPV16, in patients with smear results of ASC-US and LSIL who are positive for any oncogenic type of HPV and in patients 50 and above with any result of smear or any oncogenic HPV type. LIMITATIONS: We did not have the components of the HPV types in mixed groups.
Efficacy and safety of autologous platelet-rich plasma in anal fistula: a systematic review and meta-analysis.
Xu Y, Ma L, Jia K … +2 more , Wu X, Ge C
Ann Saudi Med · 2024 · PMID 39127896 · Full text
INTRODUCTION: This study aimed to determine the efficacy and safety of autologous PRP in anal fistula. METHODS: The search was done in electronic databases such as; PubMed, Scopus, Google Scholar, Embase, and Cochrane Li...
INTRODUCTION: This study aimed to determine the efficacy and safety of autologous PRP in anal fistula. METHODS: The search was done in electronic databases such as; PubMed, Scopus, Google Scholar, Embase, and Cochrane Library. The outcomes investigated in this study were the rate of improvement, the rate of recurrence, and the rate of fecal incontinence. RESULTS: Cure, incontinence, and recurrence rates were 68% (95% CI, .60-.76), 27% (95% CI, .12-.46), and 18% (95% CI, .12-.26), respectively. The pooled improvement ratio in patients treated with PRP compared to control group was 1.35 times, which was statistically significant (pooled OR=1.35, 95% CI, 1.14-1.60, <001). The pooled recurrence ratio in patients treated with PRP compared to control group was 1.17, which was not statistically significant (pooled OR=1.17, 95% CI, 0.44-3.11). DISCUSSION: Platelet-rich plasma is an effective method of healing people with anal fistula.
Mesenchymal stem cells and platelet rich plasma therapy for knee osteoarthritis: an umbrella review of systematic reviews with meta-analysis.
Lin F, Zhang X, Cui C
Ann Saudi Med · 2024 · PMID 38853480 · Full text
The effect of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) therapy on knee osteoarthritis (KOA) has been contradictory in previous meta-analyses. This umbrella review on published meta-analyses aimed to i...
The effect of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) therapy on knee osteoarthritis (KOA) has been contradictory in previous meta-analyses. This umbrella review on published meta-analyses aimed to investigate the effect of MSCs and PRP on KOA. We systematically searched Scopus, PubMed, and Cochrane databases to include related meta-analyses. The outcome included studies reporting visual analog scale scores, the Western Ontario and McMaster Universities Osteoarthritis Index, Whole-Organ Magnetic Resonance Imaging Scores, International Knee Documentation Committee scores, and the Knee injury and Osteoarthritis Outcome Score. A total of 28 meta-analyses with 32 763 participants. MSCs and PRP therapies were significantly associated with an improvement in KOA scores. This umbrella meta-analysis supports the beneficial health effects of MSCs and PRP in KOA.
Do single-session Epley maneuvers treat benign paroxysmal positional vertigo?
Çelik EK, Öner F, Akay HG
Ann Saudi Med · 2024 · PMID 38853479 · Full text
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life. OBJECTIVES: Examine how we...
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life. OBJECTIVES: Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver. DESIGN: Prospective. SETTINGS: Otorhinolaryngology department of a tertiary care center. PATIENTS AND METHODS: Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed. MAIN OUTCOME MEASURES: Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients. SAMPLE SIZE: 75. RESULTS: Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful. CONCLUSION: The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated. LIMITATIONS: Lack of follow-up results of patients after 7-10 days.
Association of TLR4 gene rs4986790 and rs4986791 polymorphisms with asthma susceptibility: meta-analysis and trial sequential analysis.
Guo N, Tian H, Song T … +1 more , Peng Y
Ann Saudi Med · 2024 · PMID 38853478 · Full text
BACKGROUND: The current understanding of the correlation between TLR4 gene (toll-like receptor 4) rs4986790 and rs4986791 polymorphisms and asthma susceptibility is inconclusive, with studies and populations yielding con...
BACKGROUND: The current understanding of the correlation between TLR4 gene (toll-like receptor 4) rs4986790 and rs4986791 polymorphisms and asthma susceptibility is inconclusive, with studies and populations yielding conflicting results. OBJECTIVES: Evaluate this relationship using meta-analysis and trial sequential analysis (TSA). PATIENTS AND METHODS: Databases were systematically queried for relevant articles from the establishment of the database to 19 June 2023 adhering to predefined inclusion and exclusion criteria. Two authors independently conducted screening, data extraction, and quality evaluation. Meta-analysis and TSA were carried out using RevMan 5.4, StataMP 17.0, and TSA 0.9.5.10 Beta, with α=0.05. Subgroup analyses were conducted based on racial demographics. A sensitivity analysis was conducted employing a one-by-one exclusion method. Publication bias was assessed using the Begg and Egger tests. MAIN OUTCOME MEASURES: Association of asthma susceptibility with TLR4 gene rs4986790 and rs4986791 polymorphisms. SAMPLE SIZE: 23 articles included 22 studies on the rs4986790 polymorphism and 11 studies on the rs4986791 polymorphism on the TLR4 gene. RESULTS: Out of 692 studies screened, 23 met the inclusion criteria. While the overall meta-analysis showed no significant association between the TLR4 rs4986790 polymorphism and asthma susceptibility, subgroup analysis revealed a significant link in the Caucasian population. A significant association was noted in the meta-analysis, particularly among Asian populations, on the rs4986791 polymorphism. The sensitivity analysis indicated that the meta-analysis results were relatively stable. Publication bias analysis revealed minimal influence from publication bias. However, TSA was underscored by the necessity for additional original studies to further validate specific outcomes. CONCLUSIONS: Our study underscores the ethnicity-specific impact on the relationship between TLR4 polymorphisms and asthma susceptibility. While the overall findings for rs4986790 were not significant, the association with the Caucasian population merits further investigation. Furthermore, rs4986791 demonstrated a significant correlation with asthma susceptibility, specifically among Asian populations. LIMITATIONS: Our study predominantly examined the rs4986790 and rs4986791 polymorphisms, overlooking the potential influence of other genetic variants within TLR4.
Role of body mass index in anastomotic leakage after curative treatment for rectal cancer.
Alharbi R, Almosallam O, Albastaki S … +2 more , Almughamsi A, Alsanea N
Ann Saudi Med · 2024 · PMID 38853477 · Full text
BACKGROUND: Anastomotic leakage (AL) represents a severe complication after rectal surgery, leading to significant morbidity, mortality, and increased healthcare costs. Despite improvements in surgical methods and periop...
BACKGROUND: Anastomotic leakage (AL) represents a severe complication after rectal surgery, leading to significant morbidity, mortality, and increased healthcare costs. Despite improvements in surgical methods and perioperative care, the challenge of AL persists. OBJECTIVES: Explore the impact of body mass index (BMI) on the risk of AL following curative treatment for rectal cancer, providing insight into its predictive value. DESIGN: Retrospective review. SETTINGS: Data were collected from a single tertiary center, emphasizing the specialized postoperative outcomes in a high-care setting. PATIENTS AND METHODS: The study population was comprised patients who underwent sphincter-saving surgery combined with neoadjuvant chemoradiation for rectal cancer from 2001 to 2011. Patients with anastomotic stenosis were excluded. MAIN OUTCOME MEASURES: The primary outcome investigated was the occurrence of AL post-surgery. Secondary outcomes included the assessment of local cancer recurrence rates within the AL group. SAMPLE SIZE: 224; 13 excluded. RESULTS: Of 237 patients who underwent surgery, 13 with anastomotic stenosis were excluded from this study. Of the remaining 224, 15 individuals (6.3%) developed AL. A potential association between higher BMI and increased AL risk was identified. Additionally, the study noted a higher incidence of local rectal cancer recurrence in the group that developed leakage. CONCLUSION: The findings suggest BMI as a significant predictive factor for AL after curative rectal cancer treatment. This emphasizes the need for heightened awareness and possible preoperative counseling for obese patients regarding their increased risk of postoperative leakage. LIMITATIONS: The study was retrospective with all the inherit biases of such studies. The sample size was small and this may have introduced a type 2 statistical error.
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