Annals Of Saudi Medicine[JOURNAL]
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200 papers
Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients.
Binkhamis K, Alhaider AS, Sayed AK … +3 more , Almufleh YK, Alarify GA, Alawlah NY
Ann Saudi Med · 2023 · PMID 37554024 · Full text
BACKGROUND: ICU and other patients hospitalized with corona-virus disease 2019 (COVID-19) are more susceptible to secondary infections. Undetected secondary infections tend to have a severe clinical impact, associated wi...
BACKGROUND: ICU and other patients hospitalized with corona-virus disease 2019 (COVID-19) are more susceptible to secondary infections. Undetected secondary infections tend to have a severe clinical impact, associated with prolonged hospitalization and higher rates of inpatient mortality. OBJECTIVES: Estimate the prevalence of secondary infections, determine the frequency of microbial species detected at different body sites, and measure the association between secondary infections and outcomes among hospitalized COVID-19 patients. DESIGN: Cross-sectional analytical study. SETTING: Tertiary care center in Riyadh PATIENTS AND METHODS: Data were collected through retrospective chart review of hospitalized COVID-19 patients >18 years old from March 2020 until May 2022 at King Saud University Medical City (27 months). Rates of secondary infections among hospitalized COVID-19 patients were described and data on clinical outcomes (intensive care admission, invasive management procedures and mortality) was collected. MAIN OUTCOME MEASURES: Features and rates of infection and mortality. SAMPLE SIZE: 260 RESULTS: In total, 24.2% of the study population had secondary infections. However, only 68.8% of patients had secondary infection testing, from which 35.2% had a confirmed secondary infection. These patients had a significantly higher prevalence of diabetes mellitus (<.0001) and cardiovascular diseases (=.001). The odds of ICU admissions (63.3%) among secondarily infected patients was 8.4 times higher compared to patients with only COVID-19 infection (17.3%). Secondarily infected patients were more likely to receive invasive procedures (OR=5.068) and had a longer duration of hospital stay compared to COVID-19 only patients. Overall mortality was 16.2%, with a predominantly higher proportion among those secondarily infected (47.6% vs 6.1%) (OR=14.015). Bacteria were the most commonly isolated organisms, primarily from blood (23.3%), followed by fungal isolates, which were mostly detected in urine (17.2%). The most detected organism was (17.2%), followed by (9.2%), (9.2%) and (9.2%). CONCLUSION: Secondary infections were prevalent among hospitalized COVID-19 patients. Secondarily infected patients had longer hospital stay, higher odds of ICU admission, mortality, and invasive procedures. LIMITATION: Single-center study, retrospective design and small sample size. CONFLICT OF INTEREST: None.
Predictors of disease severity in patients hospitalized with coronavirus disease 2019.
Edathodu J, Alsugair A, Al-Bugami M … +12 more , Alomar I, Alrasheed A, Fadel R, Albalawi W, Alshammary A, Alsuhaim A, Alghayti S, Alkadi A, Peedikayil M, Aldakhil H, Albedah N, Mohamed G
Ann Saudi Med · 2023 · PMID 37554023 · Full text
BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, manifests as a respiratory illness primarily and symptoms range from asymptomatic to severe respiratory syndrome and even death. During the...
BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, manifests as a respiratory illness primarily and symptoms range from asymptomatic to severe respiratory syndrome and even death. During the pandemic, due to overcrowding of medical facilities, clinical assessment to triage patients for home care or in-hospital treatment was an essential element of management. OBJECTIVES: Study the demographic features, comorbidities and bio-markers that predict severe illness and mortality from COVID-19 infection. DESIGN: Retrospective observational SETTING: Single tertiary care center PATIENTS AND METHODS: The study included all patients admitted with a positive PCR test for COVID-19 during the period from March 2020 to September 2020 (7 months). Data on demographics, clinical data and laboratory parameters was collected from medical records every 3 days during hospital stay or up until transfer to ICU. MAIN OUTCOME MEASURES: Demographic, comorbidities and biochemical features that might predict severe COVID-19 disease. SAMPLE SIZE: 372 RESULTS: Of the 372 patients, 72 (19.4%) had severe disease requiring admission to intensive care unit (ICU); 6 (1.6%) died. Individuals over 62 years were more likely to be admitted to the ICU (=.0001, while a BMI of 40 and higher increased the odds of severe disease (=.032). Male gender (=.042), hypertension (=.006) and diabetes (=.001) conferred a statistically significant increased risk of admission to ICU, while coexisting COPD, and ischemic heart disease did not. Laboratory features related to severe COVID-19 infection were: leukocytosis (=.015), thrombocytopenia (=.001), high levels of C-reactive protein (=.0001), lactic dehydrogenase (=.0001), D-dimer (=.0001) and ferritin (=.001). With the multivariate analysis, diabetes, high lac-tate dehydrogenase, C-reactive protein and thrombocytopenia were associated with severity of illness. CONCLUSIONS: Particular demographic and clinical parameters may predict severe illness and need for ICU care. LIMITATIONS: Single referral center, several cases of severe COVID-19 could not be included due to lack of consent and or data. CONFLICT OF INTEREST: None.
Effect of atmospheric pressure changes on the development of pulmonary embolism: a retrospective analysis of 8 years of data.
Aksakal A, Kerget B, Cil G … +4 more , Afsin DE, Akgun M, Ucar EY, Saglam L
Ann Saudi Med · 2023 · PMID 37554022 · Full text
BACKGROUND: Pulmonary embolism (PE) is a condition with high mortality, and determining its etiology is as important as its treatment. There are limited studies in the literature examining the effect of atmospheric press...
BACKGROUND: Pulmonary embolism (PE) is a condition with high mortality, and determining its etiology is as important as its treatment. There are limited studies in the literature examining the effect of atmospheric pressure (AP) change on PE. OBJECTIVES: Analyze the effect of AP level and the change in AP level on the development of PE according to year, season and months. DESIGN: Retrospective SETTING: Department of tertiary care center PATIENTS AND METHODS: Patients with diagnosed or presumed PE who were followed up in the Erzurum Atatürk University Medicine Chest Diseases Clinic between 2012 and 2020 (8 years) were retrospectively screened for inclusion in the study by examining hospital records. Daily AP values were obtained electronically through official correspondence with the Erzurum Regional Meteorological Directorate. Patients diagnosed with PE were recorded using the hospital database and anamnesis forms. The dates of admission to hospital were recorded. Risk factors leading to the development of PE were identified using the records. MAIN OUTCOME MEASURES: Relationship between AP values and the incidence of PE. SAMPLE SIZE: 592 RESULTS: AP, AP, and AP were significantly lower on days with PE cases compared to days without PE cases (<.001 for all). ΔAP, ΔAP, and ΔAP values were all negative on days with PE, but only the difference in ΔAP was significant (=.04). CONCLUSIONS: This study showed that lower AP values were significantly associated with the incidence of PE. In particular, a drop in AP compared to the previous day seemed to be most associated with PE development. LIMITATIONS: Retrospective design and only applicable to region. CONFLICT OF INTEREST: None.
Abdominal access in laparoscopic surgery of obese patients: a novel abdominal access technique.
Polat M, Incebiyik A, Tammo O
Ann Saudi Med · 2023 · PMID 37554021 · Full text
BACKGROUND: An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with oth...
BACKGROUND: An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with other abdominal access techniques, particularly to reduce complications in obese patients. OBJECTIVE: Compare the MESAD method and other methods we use for abdominal access in gynecologic laparoscopic surgery of obese patients DESIGN: Retrospective SETTING: Gynecology department in university hospital PATIENTS AND METHODS: Patients who underwent abdominal access by the MESAD technique, the Veress needle technique, and the Hasson technique were included in our study. In addition to demographic data, minor and major complications, number of unsuccessful attempts, conversion to another technique, and abdominal access times were collected from all patient files. MAIN OUTCOME MEASURES: Clinical data and complications SAMPLE SIZE: 66 patients, 26 by MESAD technique, 24 by the Veress needle technique, and 16 by the Hasson technique. RESULTS: There were two major complications (one in the Veress group and one in the Hasson technique group) and 7 minor complications. No significant difference was found between the groups in terms of complications (=.477, =.476, respectively). The fastest technique for abdominal access was in the MESAD technique whereas the slowest was in the Hasson (<.001). The failure of abdominal access and subsequent conversion to another technique was most common in the Veress group. However, no significant difference was found between the groups (=.092). CONCLUSIONS: The MESAD technique is an easy method to both learn and teach. We think that the low major-minor complication rates in the MESAD technique will allow surgeons to reduce their anxiety at the first entry and to perform a more comfortable operation. LIMITATIONS: Retrospective CONFLICT OF INTEREST: None.
Effect of infection with severe acute respiratory syndrome coronavirus 2 on the fetus in pregnant women who recovered from infection.
Hammad LF, Almutairi AN, Aldahlawi RH
Ann Saudi Med · 2023 · PMID 37554020 · Full text
BACKGROUND: The effect of maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the fetus is unclear, and there is no data from Saudi Arabia. OBJECTIVE: Assess the effect of maternal SAR...
BACKGROUND: The effect of maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the fetus is unclear, and there is no data from Saudi Arabia. OBJECTIVE: Assess the effect of maternal SARS-CoV-2 infection on fetal growth. DESIGN: Retrospective case-control SETTING: Tertiary care hospital, Riyadh, Saudi Arabia PATIENTS AND METHODS: We selected pregnant women who underwent an obstetric growth scan and umbilical artery Doppler ultra-sound examination between 28 and 41 weeks of pregnancy. Women with multiple pregnancy, fetal abnormalities, maternal body mass index >30, maternal hypertension, any other chronic diseases that might affect fetal growth or pregnant women suffering from cancer were excluded. Fetal growth parameters assessed included fetal biometry (biparietal diameter, head circumference, abdominal circumference and femur length). We also did an umbilical artery Doppler assessment, which includes the umbilical artery pulsatility index, resistive index and the systolic/diastolic ratio. MAIN OUTCOME MEASURE: Fetal biometry and biophysical profile SAMPLE SIZE: 48 SARS-CoV-2; 98 non-SARS-CoV-2 RESULTS: More women who had recovered from SARS-CoV-2 infection had small for gestational age fetuses compared with the control group (=.001). CONCLUSION: Maternal SARS-CoV-2 infection during pregnancy was associated with a higher prevalence of small for gestational age (SGA) fetuses. LIMITATIONS: Retrospective, middle cerebral artery and uterine artery Doppler data were not included nor were the effect of tobacco use and socioeconomic status, the relationship between the date of infection with the date of conceiving or the relationship between the severity of infection in the mother and fetal biometry and growth. CONFLICT OF INTEREST: None.
Comment on: Optic nerve sheath diameter measurement by ultrasound and age group.
Biondino D, Costigliola R, Mottola F … +2 more , Graziano M, Yılmaz F
Ann Saudi Med · 2023 · PMID 37270683 · Full text
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Prevalence of bacterial bloodstream infections and association between neutropenia and 30-day mortality among oncology inpatients at a university hospital in Saudi Arabia.
Binkhamis K, Aldakhil I, Alhawas A … +5 more , Alsaleh A, Albaroudi A, Almuhanna B, Makkawi M, Alzahrani M
Ann Saudi Med · 2023 · PMID 37270682 · Full text
BACKGROUND: Cancer patients are highly prone to develop bacterial bloodstream infections (BSI) and are also at risk of neutropenia. Knowledge of the prevalence of these infections and whether neutropenia is associated wi...
BACKGROUND: Cancer patients are highly prone to develop bacterial bloodstream infections (BSI) and are also at risk of neutropenia. Knowledge of the prevalence of these infections and whether neutropenia is associated with a change in mortality is important to more effective management and reducing mortality and morbidity. OBJECTIVES: Estimate the prevalence of bacterial BSI among oncology inpatients and assess the associations of 30-day mortality with Gram stain results and neutropenia. DESIGN: Retrospective cross-sectional SETTING: University hospital in Saudi Arabia. PATIENTS AND METHODS: We retrieved records of oncology inpatients at King Khalid University Hospital, excluding patients without malignancy and with non-bacterial BSI. The number of records included in the analysis was reduced based on a sample size calculation and systematic random sampling used to select patients to include in the study. MAIN OUTCOME MEASURES: Prevalence of bacterial BSI and association between neutropenia and 30-day mortality. SAMPLE SIZE: 423. RESULTS: The prevalence of bacterial bloodstream infections was 18.9% (n=80). Gram-negative bacteria were more prevalent (n=48, 60.0%) than gram-positive bacteria, with the most common being (n=20, 25.0%). The 23 patients (28.8%) who died included 16 (69.6%) with gram-negative infections and 7 (30.4%) with gram-positive infections. There was no statistically significant association of bacterial BSI-related 30-day mortality with Gram stain (=.32). Of 18 patients (22.5%) who were neutropenic, only one (5.6%) died. Sixty-two (77.5%) patients were non-neutropenic, of whom 22 (35.50%) died. We found a statistically significant association between the presence of neutropenia and bacterial BSI-related 30-day mortality (=.016), with mortality being lower among neutropenic patients. CONCLUSIONS: Gram-negative bacteria are more prevalent in bacterial BSI than gram-positive bacteria. No statistically significant association of Gram stain result with mortality was found. However, the 30-day mortality rate was lower among neutropenic patients than among non-neutropenic patients. We recommend further investigation with a larger sample size in multiple regions to further unravel the association of neutropenia with bacterial bloodstream infection-related 30-day mortality. LIMITATIONS: Lack of regional data and sample size. CONFLICT OF INTEREST: None.
Association of intraoperative lactate elevation and postoperative mortality and morbidity in patients undergoing craniotomy: retrospective analysis.
Kılbasanlı S, Özkalkanlı MY
Ann Saudi Med · 2023 · PMID 37270681 · Full text
BACKGROUND: Intraoperative lactate levels increase in patients undergoing craniotomy, but the reason is not yet fully known. High levels of intraoperative lactate are associated with mortality and morbidity in patients w...
BACKGROUND: Intraoperative lactate levels increase in patients undergoing craniotomy, but the reason is not yet fully known. High levels of intraoperative lactate are associated with mortality and morbidity in patients with septic shock and abdominal and cardiac surgery. OBJECTIVES: Investigate whether intraoperative lactate elevation is associated with postoperative systemic and neurological complications and mortality in craniotomy. DESIGN: Retrospective study SETTING: University hospital in Turkey. PATIENTS AND METHODS: In this study, we included patients who underwent elective intracranial tumor surgery in our hospital between 1 January 2018, and 31 December 2018. According to the level of intraoperative lactate, patients were divided into two groups: high (≥2.1 mmol/L) and normal (<2.1 mmol/L). The groups were compared by the presence of postoperative new neurological deficits, postoperative surgical and medical complications, mechanical ventilation duration, 30-day mortality, in-hospital mortality, and hospital stay length. Cox regression analysis was performed for the 30-day mortality outcome. MAIN OUTCOME MEASURES: Association between intraoperative lactate levels and postoperative 30-day mortality. SAMPLE SIZE: 163 patients with lactate data. RESULTS: While no significant difference was found between the groups regarding age, gender, ASA score, tumor location, operation time and pathology results, preoperative neurologic deficits were higher in the high intraoperative lactate group (=.017). No statically significant difference was found between the groups for postoperative neurological deficit, need for prolonged mechanical ventilation, and hospital stay length. The postoperative 30-day mortality rate was higher in the group with high intraoperative lactate (=.028). High lactate and medical complications were significant in the Cox analysis. CONCLUSION: Intraoperative lactate elevation was associated with postoperative 30-day mortality in patients undergoing craniotomy. The intraoperative level of lactate is an important mortality predictor in patients undergoing craniotomy. LIMITATIONS: Retrospective design and single-centered, missing most data for several variables. CONFLICT OF INTEREST: None.
Impact of non-pharmaceutical interventions on circulating respiratory viruses during the COVID-19 pandemic in Turkey.
Kırca F, Aydoğan S, Gozalan A … +5 more , Güler E, Uyan Erten AZ, Özşen Uygur AS, Doğan A, Dinc B
Ann Saudi Med · 2023 · PMID 37270680 · Full text
BACKGROUND: Non-pharmaceutical interventions (NPIs) applied to limit the SARS-CoV-2 pandemic also affect the circulation and seasonal characteristics of other respiratory viruses. OBJECTIVES: Assess the impact of NPIs on...
BACKGROUND: Non-pharmaceutical interventions (NPIs) applied to limit the SARS-CoV-2 pandemic also affect the circulation and seasonal characteristics of other respiratory viruses. OBJECTIVES: Assess the impact of NPIs on the spread and seasonal characteristics of non-SARS-CoV-2 respiratory viruses and examine viral respiratory co-infections. DESIGN: Retrospective cohort SETTING: Single center in Turkey. PATIENTS AND METHODS: Syndromic multiplex viral polymerase chain reaction (mPCR) panel results of patients admitted to the Ankara Bilkent City Hospital with symptoms of acute respiratory tract infection between April 1, 2020 and October 30, 2022 were evaluated. Two study periods before and after 1 July 2021, when the restrictions were discontinued, were statistically analyzed and compared to determine the effect of NPIs on circulating respiratory viruses. MAIN OUTCOME MEASURES: Prevalence of respiratory viruses as determined by syndromic mPCR panel. SAMPLE SIZE: 11300 patient samples were evaluated. RESULTS: At least one respiratory tract virus was detected in 6250 (55.3%) patients. Of these, at least one respiratory virus was detected in 5% in the first period (between April 1, 2020 and June 30, 2021, when NPIs were applied), and in 95% in the second period (between July 1, 2021 and October 30, 2022, when NPIs were relaxed). After the removal of NPIs, there was a statistically significant increase in hRV/EV, RSV-A/B, Flu A/H3, hBoV, hMPV, PIV-1, PIV-4, hCoV-OC43, PIV-2 and hCoV-NL63 (<.05). In the 2020-2021 season, when strict NPIs were applied, all respiratory viruses evaluated did not have the usual seasonal peak and there were no seasonal influenza epidemics during this period. CONCLUSIONS: NPIs resulted in a dramatic decrease in the prevalence of respiratory viruses and notable disruption of seasonal characteristics. LIMITATIONS: Single-center study and retrospective. CONFLICT OF INTEREST: None.
Can pulse wave velocity measured preoperatively predict hypotension in hypertensive patients during anesthesia induction?
Yılmaz S, Ömürlü IK
Ann Saudi Med · 2023 · PMID 37270679 · Full text
BACKGROUND: During the induction of general anesthesia, hemodynamic instability is a common occurrence in elderly hypertensive patients with increased arterial stiffness, which can cause undesirable complications. Pulse...
BACKGROUND: During the induction of general anesthesia, hemodynamic instability is a common occurrence in elderly hypertensive patients with increased arterial stiffness, which can cause undesirable complications. Pulse wave velocity (PWV) is an important indicator of arterial stiffness. OBJECTIVES: Investigate if preoperatively measured PWV is related to hemodynamic changes during induction of general anesthesia. DESIGN: Prospective, case control. SETTING: University hospital. PATIENTS AND METHODS: The study was carried out between December 2018 and December 2019 in patients 50 years or older scheduled for elective otolaryngology with endotracheal intubation and who had an American Society of Anesthesiologists (ASA) score of I or II. Patients diagnosed with hypertension (HT) or receiving treatment for hypertension for systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg were compared with non-hypertensive patients (non-HT) of matching age and gender. MAIN OUTCOME MEASURES: PWV values between HT and non-HT patients and hypotension rates at the 30th second of induction, the 30th second of intubation, and the 90th second of intubation between the HT and non-HT groups. SAMPLE SIZE: 139 (95 with HT and 44 non-HT) RESULTS: PWV was higher in the HT group than in the non-HT group (<.001). Hypotension at the 30th second of intubation in the HT group was significantly more frequent than in the non-HT group (=.025). PWV was higher in hypotensive (n=62) than in non-hypotensive patients but the difference was statistically significant only for PWV measured at 30th second of intubation (n=77) (=.018). CONCLUSIONS: The easily and non-invasively measured preoperative PWV may be an effective means of predicting hypotension during the induction of general anesthesia at the 30th second of intubation in HT patients. LIMITATIONS: Numbers of patients in the groups were not the same, and the study was not sufficiently powered to investigate the effect of hypertensive medications on PWV and arterial stiffness. CONFLICT OF INTEREST: None.
Demographic, clinical and genetic factors associated with COVID-19 disease susceptibility and mortality in a Kurdish population.
Smail SW, Babaei E, Amin K
Ann Saudi Med · 2023 · PMID 37270678 · Full text
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a devastating pandemic that causes disease with a variability in susceptibility and mortality based on variants of various clinical and demographic factors, including pa...
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a devastating pandemic that causes disease with a variability in susceptibility and mortality based on variants of various clinical and demographic factors, including particular genes among populations. OBJECTIVES: Determine associations of demographic, clinical, laboratory, and single nucleotide polymorphisms in the -α, and -γ genes to the incidence of infection and mortality in COVID-19 patients. DESIGN: Prospective cohort study SETTINGS: Various cities in the Kurdistan Region of Iraq. PATIENTS AND METHODS: This prospective cohort study compared laboratory markers (D-dimer, tumor necrosis factor-alpha [TNF-α], interferon-gamma [IFN-γ], C-reactive protein [CRP], lymphocyte and neutrophil counts) between COVID-19 patients and healthy controls. DNA was extracted from blood, and genotypes were done by Sanger sequencing. MAIN OUTCOME MEASURES: Single nucleotide polymorphisms of the -α, and -γ genes and demographic characteristics and laboratory markers for predicting mortality in COVID-19. SAMPLE SIZE: 203 (153 COVID-19 patients, 50 health control subjects). RESULTS: Forty-eight (31.4%) of the COVID-19 patients died. Age over 40 and comorbidities were risk factors for mortality, but the strongest associations were with serum IFN-γ, the neutrophil-to-lymphocyte ratio (NLR), and serum TNF-α. The AA genotype and A allele of rs2070788 decreased while the GA genotype and A allele of -α increased susceptibility to COVID-19. Patients with the GA genotype of TNF-α rs1800629 had shorter survival times (9.9 days) than those carrying the GG genotype (18.3 days) (<.0001 by log-rank test). The GA genotype versus the GG genotype was associated with higher levels of serum TNF-α. The GA genotype increased mortality rates by up to 3.8 fold. The survival rate for COVID-19 patients carrying the -γ rs2430561 TT genotype (58.5%) was lower than in patients with the TA and AA genotypes (80.3%). The TT genotype increased the risk of death (HR=3.664, <.0001) and was linked to high serum IFN-γ production. Olfactory dysfunction was a predictor of survival among COVID-19 patients. CONCLUSIONS: Age older than 40, comorbidities, the NLR and particular genotypes for and the -γ and -α genes were risk factors for death. Larger studies in different populations must be conducted to validate the possible role of particular SNPs as genetic markers for disease severity and mortality in COVID-19 disease. LIMITATIONS: Small sample size. CONFLICT OF INTEREST: None.
Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10mm: a systematic review and meta-analysis.
Zhou C, Zhang F, We Y
Ann Saudi Med · 2023 · PMID 37270677 · Full text
BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are surgical methods used for rectal neuroendocrine tumors (NETs) with diameters of ≤ 10 mm. However, which method has a higher pe...
BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are surgical methods used for rectal neuroendocrine tumors (NETs) with diameters of ≤ 10 mm. However, which method has a higher performance remains uncertain. OBJECTIVES: Evaluate which of the two methods shows a higher performance. DESIGN: Systematic review and meta-analysis METHODS: Data from PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 12 April 2022. Outcomes, including complete resection, en bloc resection, recurrence, perforation, bleeding, and procedure time, were pooled by 95% confidence intervals (95% CI) using a fixed- or random-effects model. MAIN OUTCOME MEASURES: Complete resection, en bloc resection, and recurrence. SAMPLE SIZE: 18 studies, including 1168 patients were included in the study. RESULTS: Eighteen retrospective cohort studies were included in this meta-analysis. There were no statistical differences in the rates of complete resection, en bloc resection, recurrence, perforation, and bleeding rates between EMR and ESD. However, a statistical difference was detected in the procedure time; EMR had a significantly shorter time (MD=-17.47, 95% CI=-22.31 - -12.62, <.00001). CONCLUSIONS: EMR and ESD had similar efficacies and safety profiles in resectioning rectal NETs ≤ 10 mm. Even so, the advantages of EMR included a shorter operation time and expenditure. Thus, with respect to health economics, EMR outperformed ESD. LIMITATION: Most of these studies are retrospective cohort studies instead of RCTs. CONFLICT OF INTEREST: None.
Clinical features of Omicron variant infection in 445 patients with coronavirus 19 disease.
Yang L, Zhong J, Wang W … +4 more , Zhou F, Tong Z, Zheng Y, Chen X
Ann Saudi Med · 2023 · PMID 37125962 · Full text
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can mutate frequently and many new strains have emerged thus far. The clinical and epidemiological characteristics differ with each dominant strain...
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can mutate frequently and many new strains have emerged thus far. The clinical and epidemiological characteristics differ with each dominant strain. OBJECTIVES: Obtain an understanding of the clinical characteristics of patients infected with the Omicron variants of the SARS CoV-2. DESIGN: Retrospective cohort SETTINGS: Teaching hospital in China. PATIENTS AND METHODS: Data on sociodemography, signs/symptoms, hospital stay, viral shedding period, comorbidities, treatment options and final outcome were retrieved from hospital electronic medical record. We collected nasopharyngeal samples, laboratory data, and clinical data from patients admitted to the hospital with SARS CoV-2. MAIN OUTCOME MEASURES: Clinical characteristics of the patients infected with Omicron variant of SARS CoV-2. SAMPLE SIZE: 445 patients RESULTS: The median age was 43.0 years with a range from 2 to 75 years. Two-thirds of the participants were male and one-third were female. Almost half of the participants (51.9%) had no symptoms, whereas 48.1% had at least one symptom. Of symptomatic patients, 26.7% had mild symptoms and 21.3% had moderate symptoms. No patients were admitted with severe or critical symptoms. All patients discharged from the hospital after complete recovery without any serious complications or death. The most common symptom was cough followed by sore throat and fever. Less common symptoms were having sputum, stuffy nose, and muscle pain. Rare symptoms were weakness, headache, diarrhea, hemoptysis and nausea/vomiting. CONCLUSIONS: All patients had mild to moderate symptoms. Shortness of breath was not a common symptom among the study group. No patients needed invasive oxygen therapy in this cohort. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.
Deterioration in renal function after stoma creation: a retrospective review from a Middle Eastern tertiary care center.
Al Khaldi SS, Al Harbi R, Albastaki S … +8 more , Al Turki N, Ashari L, Alhassan K, Abduljabbar A, Hibbert D, Almughamsi A, Al Homoud S, Alsanea N
Ann Saudi Med · 2023 · PMID 37031376 · Full text
BACKGROUND: Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR). OBJEC...
BACKGROUND: Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR). OBJECTIVES: Evaluate changes in GFR after stoma creation by stoma type and identify how different types of stoma affect GFR. DESIGN: Retrospective, analytical cohort SETTING: Tertiary care center in Saudi Arabia PATIENTS AND METHODS: The colorectal surgery database was reviewed for all adult patients who underwent stoma creation (permanent and temporary ileostomies and colostomies) or reversal in 2000-2015. GFR was estimated at the first encounter, before the index surgery, at the time of stoma reversal, and upon the last follow-up. Patients with renal impairment, including low GFR before stoma creation, patients who had a temporary stoma converted to a permanent stoma, and patients who died with a stoma were excluded. We studied the association of several demographic and clinical factors on changes in GFR by univariate and multivariate analysis. MAIN OUTCOME MEASURES: Estimated GFR at the last clinic visit for the permanent stoma group and at stoma closure for the temporary stoma group. SAMPLE SIZE: 394 patients (149 ileostomates, 245 colostomates) RESULTS: Thirty-three (8.4%) of the 394 patients had a low GFR: 11 (7.4%) in the ileostomy group and 22 (9%) in the colostomy group (= .579). The rate of readmissions with ileostomies was higher (11.4%) than with colostomies (3.3%) (≤.001). The number of temporary ileostomies (n=9, 7.0%) differed from temporary colostomies (n=2, 1.9%) but the difference was not statistically significant (=.06). In the multivariate analysis, stoma permanency, hypertension, chemotherapy and nephrotoxic drugs were risk factors associated with low GFR. CONCLUSION: Ileostomies were not associated with a high rate of renal function deterioration in comparison to colostomies, but had a significantly higher rate of readmission due to dehydration and electrolytes imbalance possibly due to the hot climate in Saudi Arabia. LIMITATIONS: Retrospective nature and limited sample size which may have resulted in a type 2 statistical error. CONFLICTS OF INTEREST: None.
The characteristics and distribution of emergency medical services in Saudi Arabia.
Al-Otaibi AM, Alghadeer SM, AlRuthia YS … +5 more , Mobrad A, Alhallaf MA, Alghamdi AA, Althunayyan SM, Albaqami NA
Ann Saudi Med · 2023 · PMID 37031375 · Full text
BACKGROUND: Emergency medical services (EMS) play an essential role in treating and transporting patients to hospitals or between hospitals. EMS providers must be distributed wisely across all regions of the country to m...
BACKGROUND: Emergency medical services (EMS) play an essential role in treating and transporting patients to hospitals or between hospitals. EMS providers must be distributed wisely across all regions of the country to meet healthcare needs during normal times and disasters. No previous study has investigated the characteristics and distribution of the EMS workforce in Saudi Arabia. OBJECTIVES: Examine the characteristics and distribution of the EMS workforce in Saudi Arabia to identify gaps and areas in need of improvement. Also, explore the sociodemographic and educational characteristics of licensed EMS providers in Saudi Arabia. DESIGN: Cross-sectional SETTINGS: EMS in Saudi Arabia METHODS: We included all licensed EMS providers in Saudi Arabia as of 23 December 2020 who were registered in the Saudi Commission for Health Specialties (SCFHS) database. Sociodemographics, where they earned certification, and their job affiliations were collected and categorized. MAIN OUTCOME MEASURES: EMS workforce distribution, gender, and EMS provider-to-population ratio. SAMPLE SIZE: 18 336 EMS providers; 8812 (48.1%) with documented job affiliations. RESULTS: The EMS provider-to-population ratio is very low. In Saudi Arabia, in general, the ratio is 1:3871 (based on n=8812 providers), which is low compared to the 1:1400 ratio for Australian EMS provider-to-population, for example. That makes it a challenge for EMS providers to meet the population's needs, especially in times of disaster. The low ratio may have contributed to the delayed response time in Saudi Arabia (13 minutes for critical cases) which does not meet the international standard response time (8 minutes maximum). Also, only 3.5% of the total EMS providers registered were females, and the clear majority of all EMS providers were technicians. CONCLUSIONS: The growth in the EMS workforce, including the recruitment of more females into the workforce and more EMS specialists compared to EMS technicians and health assistants, is critical to reaching a satisfactory EMS provider-to-population ratio. LIMITATIONS: Most noteworthy of the limitations of this research are the insufficient statistics describing EMS distribution in Saudi Arabia, the lack of previous studies on the research topic in Saudi Arabia, and job affiliation not accurately recorded in the SCFHS database. CONFLICT OF INTEREST: None.
Surgical outcomes and prognostic factors associated with emergency left colonic surgery.
Bawa D, Khalifa YM, Khan S … +2 more , Norah W, Noman N
Ann Saudi Med · 2023 · PMID 37031374 · Full text
BACKGROUND: Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJEC...
BACKGROUND: Mortality from emergency left-sided colorectal surgery can be substantial due to acuteness of the presentation and the urgent need to operate in the setting of a limited preparation in a morbid patient. OBJECTIVES: Determine the 30-day postoperative outcomes and identify risk factors for complications and mortality following emergency colorectal operations. DESIGN: Retrospective SETTINGS: Three tertiary hospitals in three countries. PATIENTS AND METHODS: Factors that were studied included age, sex, ASA score, type and extent of the operation, and presence/absence of malignancy. Unadjusted 30-day patient outcomes examined were complications and mortality. Differences in proportions were assessed using the Pearson chi-square test while logistic regression analyses were carried out to evaluate the correlation between risk factors and outcomes. MAIN OUTCOME MEASURES: 30-day postoperative morbidity and mortality SAMPLE SIZE: 104 patients. RESULTS: Among 104 patients, 70 (67.3%) were men, and 34 (32.7%) were women. The mean (SD) age was 57.2 (17.1) years. The most common indication for emergency colonic surgery was malignant obstruction in 33 (31.7%) patients. The postoperative complication rate was 24% (25/104), and the mortality rate was 12.5% (13/104) within 30 days of the operation. The ASA status (=.02), presence of malignancy (=.02), and the presence of complications (=.004) were significantly related to mortality in the multivariable logistic regression analysis. CONCLUSIONS: The 30-day mortality of emergency colorectal operations is greatly influenced by the presence of malignancy in the colon and physiological status at the time of the procedure. LIMITATIONS: The retrospective design and small sample size. CONFLICT OF INTEREST: None.
Comparison of general pediatric ward admissions between the COVID-19 pandemic and pre-pandemic period.
Güç M, Sözeri B
Ann Saudi Med · 2023 · PMID 37031373 · Full text
BACKGROUND: The COVID-19 pandemic has affected many aspects of life as well as hospital admissions. We hypothesized that many infectious diseases and hospitalizations in the pediatric age group might have decreased durin...
BACKGROUND: The COVID-19 pandemic has affected many aspects of life as well as hospital admissions. We hypothesized that many infectious diseases and hospitalizations in the pediatric age group might have decreased during the pandemic period. OBJECTIVE: Evaluate patients admitted to the general pediatric wards during the pandemic in comparison with the pre-pandemic period. DESIGN: Retrospective cross-sectional SETTING: General pediatrics wards of a tertiary hospital in Istanbul PATIENTS AND METHODS: The study included patients aged 0-18 years who were followed up while hospitalized in the general pediatrics wards between 11 March 2019 and 11 March 2021. The hospitalizations were grouped as pre-pandemic and pandemic based on the date when COVID-19 was declared a pandemic (11 March 2020). MAIN OUTCOME MEASURES: Hospital admissions, length of stay, diagnoses, gender, age. SAMPLE SIZE AND CHARACTERISTICS: 4343 hospitalizations. RESULTS: Of the total 4343 hospitalizations meeting the inclusion criteria, 2786 (64.1%) occurred before the pandemic and 1557 (35.9%) during the pandemic, a 44% decrease. The distribution of all hospitalization diagnoses during the two years was as follows: respiratory tract diseases, 1768 (40.7%); neurological diseases, 946 (21.8%); gastrointestinal diseases, 550 (12.7%); hematological and oncological diseases, 514 (11.8%); genitourinary system and nephrological diseases, 504 (11.6%); and soft tissue infections, 255 (5.9%). During two years, there were 1418 (32.7%) patients with lower respiratory tract infections, 316 (7.3%) with gastroenteritis, and 440 (10.1%) with urinary system infections. The median hospital stay was 6 days before the pandemic and 4 days during the pandemic (<.0001). During the pandemic, the rate of respiratory diseases decreased from 48.7 to 26.5%, and that of lower respiratory tract infections decreased from 40.5 to 18.6% (<.0001). CONCLUSION: Both previous studies and our results indicate that many infectious diseases in the pediatric age group significantly decreased, especially in the first months of the COVID-19 pandemic. LIMITATIONS: Single-center study. CONFLICT OF INTEREST: None.
Acute gastroenteritis-related acute kidney injury in a tertiary care center.
Bogari MH, Munshi A, Almuntashiri S … +5 more , Bogari A, Abdullah AS, Albadri M, Hashim A, AlZahrani MS
Ann Saudi Med · 2023 · PMID 37031372 · Full text
BACKGROUND: Acute gastroenteritis (AGE) can cause acute kidney injury (AKI) via hypoperfusion mechanisms. Early detection of AKI caused by AGE can significantly decrease mortality rates. In Saudi Arabia, studies investig...
BACKGROUND: Acute gastroenteritis (AGE) can cause acute kidney injury (AKI) via hypoperfusion mechanisms. Early detection of AKI caused by AGE can significantly decrease mortality rates. In Saudi Arabia, studies investigating the association between AGE and AKI are limited; thus, we aimed to fill this knowledge gap. OBJECTIVES: Analyze all cases of AGE reported in tertiary-care hospitals to assess the prevalence of AKI among AGE patients. DESIGN: Retrospective cohort SETTINGS: Single tertiary-care center PATIENTS AND METHODS: The study included patients treated for AGE between October 2017 and October 2022. Stool culture was used to diagnose AGE. Inclusion criteria were infective diarrhea and/ or vomiting, and availability of data (demographics, comorbidities, malignancies, length of hospital stay, vital signs at the time of diagnosis, dehydration, causative agents of diarrhea, hemodialysis status, and laboratory data. MAIN OUTCOME MEASURES: Prevalence of AKI among AGE patients and factors associated with development of AKI. SAMPLE SIZE: 300 patients diagnosed with AGE. RESULTS: Of the 300 patients with AGE, 41 (13.6%) had AKI, those older than 60 years were more likely to develop AKI. The most frequent cause of AGE was . (n=163, 53.3%), whereas AKI was most common in AGE patients (n=21, 51.2%). Furthermore, the most common comorbidity in the present study was malignancy, especially leukemia and lymphoma the risk of AKI was independently associated with mild dehydration, higher serum urea concentrations and low GFR values. CONCLUSIONS: Patients hospitalized for diarrheal disease are at an increased risk of developing AKI due to dehydration and comorbid conditions. It is crucial to keep kidney function in mind for AGE patients as this is associated with a high mortality rate and poor prognosis. LIMITATIONS: The main limitation of this study was its retrospective design. Another limitation is that it is limited to a single center. CONFLICTS OF INTEREST: None.
Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach.
Kurban LA, Almarri BK, Alshamsi MH … +5 more , Abdelrahman SS, Alwahshi SG, Alhorani Q, Syed R, Bakoush O
Ann Saudi Med · 2023 · PMID 37031371 · Full text
BACKGROUND: Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival. OBJECTIVES: Evaluate the utility of serum ferritin (SF) in the p...
BACKGROUND: Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival. OBJECTIVES: Evaluate the utility of serum ferritin (SF) in the prediction of hepatic and myocardial iron overload (HIO and MIO) compared to T2*-MRI. DESIGN: Retrospective SETTINGS: Governmental hospitals. PATIENTS AND METHODS: Patients with TDT who had T2*-MRI examinations between January 2016 to October 2019 were included. The predictive value of SF for detection of HIO and MIO was assessed by measuring area under the curve (AUC). A sample size of 123 cases was calculated to detect a correlation of 0.25 with 90% power and a two-sided type I error of 0.05. MAIN OUTCOME MEASURES: The correlation between SF and estimated hepatic iron concentration. SAMPLE SIZE: 137 TDT patients who required regular blood transfusions. RESULTS: The predictive value of SF was excellent for detection of HIO (AUC=0.83-0.87) but fair for detection of MIO (AUC=0.67). The two independent predictors of MIO were age and SF. The log of (age × SF) enhanced the SF predictive value for MIO (AUC=0.78). SF values of 700 and 1250 mg/L effectively excluded mild and moderate HIO with a sensitivity of 97.8% and 94.2%, respectively (LR-=0.1). While SF values of 1640 and 2150 mg/L accurately diagnosed mild and moderate HIO with a specificity of 95.55% and 96.4%, respectively (LR+>10). A log of (age × SF) cut-off value of 4.15 effectively excluded MIO (LR-=0.1), while a value of 4.65 moderately confirmed MIO (LR+=3.2). CONCLUSIONS: SF is an excellent predictor of hepatic IO in TDT. Age adjustment enhanced its myocardial IO predictive accuracy. Likelihood ratio-based SF cut-off values may help clinicians in risk stratification and treatment decision-making. LIMITATIONS: The laboratory data were gathered retrospectively and although the risk of selection bias for T2*-MRI examination is thought to be low, it cannot be ignored. CONFLICT OF INTEREST: None.
Gut microbiota in Chinese and Japanese patients with cardiovascular diseases: a systematic review and meta-analysis.
Liao L, Huang J, Zheng J … +3 more , Ma X, Huang L, Xu W
Ann Saudi Med · 2023 · PMID 37031370 · Full text
BACKGROUND: Cardiovascular disease (CVD) is a major threat to public health. OBJECTIVE: Compare the gut microbial composition between Chinese and Japanese patients with cardiovascular diseases and healthy subjects. STUDY...
BACKGROUND: Cardiovascular disease (CVD) is a major threat to public health. OBJECTIVE: Compare the gut microbial composition between Chinese and Japanese patients with cardiovascular diseases and healthy subjects. STUDY SELECTION: Observational studies with Chinese and Japanese populations. Reviews, duplicate, book chapters, and other irrelevant studies were excluded. DATA EXTRACTION: Independent searching by two investigators (LLJ, HJL). DATA SYNTHESIS: Data from eleven studies (with 960 subjects) were included for the meta-analysis. The meta-analysis showed that the abundance of Firmicutes in patients with cardiovascular disease was [ES=0.42, 95%CI, (0.34, 0.50), <.01], while the abundance of Firmicutes in control subjects was [ES=0.36, 95%CI, (0.23, 0.49), <.01] (ES: effect size). When compared to control subjects, the differential expression of Firmicutes abundance in patients with CVDs was [MD = 15.21, 95%CI (8.95, 21.48), <.01] (MD: mean difference). The ratio of Firmicutes abundance in patients with CVDs to the control subjects was [RR=1.28, 95%CI (0.98, 1.67), =.07]. The ratio of Firmicutes in coronary heart disease (CHD) patients and controls was [RR=1.42, 95%CI (1.05, 1.94), =.02]. Firmicutes/Bacteroidetes ratio is [OR=1.64 95%CI (1.11, 2.42), =.01]. CONCLUSION: Our data show that patients with cardiovascular disease had higher levels of gut Firmicutes when compared to healthy controls. In addition, gut microbial dysbiosis was present in patients with cardiovascular diseases. LIMITATIONS: Due to limited quality and quantity of selected studies, conclusions from the current study need to be validated by future studies. CONFLICT OF INTEREST: None.
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