Annals Of Saudi Medicine[JOURNAL]
Sun
200 papers
To Sir, With Love.
Alsanea N
Ann Saudi Med · 2023 · PMID 37031369 · Full text
In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the car...
In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the care for thousands of patients. His last station in Saudi Arabia made a huge impact on the country. I hope this article inspires others to write about their mentors who were important in their development as surgeons and physicians. Short biographies of these important figures will serve as a valuable historical record for generations to come.
Evaluation of critically ill obstetric patients treated in an intensive care unit during the COVID-19 pandemic.
Arslan K, Arslan HÇ, Şahin AS
Ann Saudi Med · 2023 · PMID 36739504 · Full text
BACKGROUND: Although obstetric morbidity and mortality have decreased recently, rates are still high enough to constitute a significant health problem. With the COVID-19 pandemic, many obstetric patients have required tr...
BACKGROUND: Although obstetric morbidity and mortality have decreased recently, rates are still high enough to constitute a significant health problem. With the COVID-19 pandemic, many obstetric patients have required treatment in intensive care units (ICU). OBJECTIVES: Evaluate critical obstetric patients who were treated in an ICU for COVID-19 and followed up for 90 days. DESIGN: Medical record review SETTING: Intensıve care unit PATİENTS AND METHODS: Obstetric patients admitted to the ICU between 15 March 2020 and 15 March 2022 and followed up for at least 90 days were evaluated retrospectively. Patients with and without COVID-19 were compared by gestational week, indications, comorbidities, length of stay in the hospital and ICU, requirement for mechanical ventilation, blood transfusion, renal replacement therapy (RRT), plasmapheresis, ICU scores, and mortality. MAIN OUTCOME MEASURES: Clinical outcomes and mortality. SAMPLE SIZE AND CHARACTERISTICS: 102 patients with a mean (SD) maternal age of 29.1 (6.3) years, and median (IQR) length of gestation of 35.0 (7.8) weeks. RESULTS: About 30% (n=31) of the patients were positive for COVID-19. Most (87.2%) were cesarean deliveries; 4.9% vaginal (8.7% did not deliver). COVID-19, eclampsia/preeclampsia, and postpartum hemorrhage were the most common ICU indications. While the 28-day mortality was 19.3% (n=6) in the COVID-19 group, it was 1.4% (n=1) in the non-COVID-19 group (<.001). The gestational period was significantly shorter in the COVID-19 group (=.01) while the duration of stay in ICU (<.001) and mechanical ventilation (=.03), lactate (=.002), blood transfusions (=.001), plasmapheresis requirements (=.02), and 28-day mortality were significantly higher (<.001). APACHE-2 scores (=.007), duration of stay in ICU (<.001) and mechanical ventilation (<.001), RRT (=.007), and plasmapheresis requirements (=.005) were significantly higher in patients who died than in those who were discharged. CONCLUSION: The most common indication for ICU admission was COVID-19. The APACHE-2 scoring was helpful in predicting mortality. We think multicenter studies with larger sample sizes are needed for COVID-19 obstetric patients. In addition to greater mortality and morbidity, the infection may affect newborn outcomes by causing premature birth. LIMITATIONS: Retrospectıve, single-center, small population size. CONFLICT OF INTEREST: None.
Efficacy of bedside optic nerve sheath diameter measurement in differentiating provoked seizure from unprovoked seizure in the emergency department.
Yılmaz F, Sonmez BM, Kavalci C … +3 more , Arslan ED, Caliskan G, Beydilli I
Ann Saudi Med · 2023 · PMID 36739503 · Full text
BACKGROUND: Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians. OBJECTIVES: Demonstrate the...
BACKGROUND: Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians. OBJECTIVES: Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED. DESIGN: Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups. MAIN OUTCOME MEASURE: Efficacy of ONSD to distinguish between provoked and unprovoked seizures. SAMPLE SIZE: 210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, <.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (<.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%. CONCLUSIONS: Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure. LIMITATIONS: Statistical significance of age on ONSD and exclusion of pediatric patients. CONFLICT OF INTEREST: None.
Efficacy and safety of empagliflozin: a "real-world" experience from Saudi Arabia.
Butt MI, Aljamei H, Riazuddin M … +5 more , AlHaqbani L, Albalwi R, Abothenain FFM, Alagla NAM, Waheed N
Ann Saudi Med · 2023 · PMID 36739502 · Full text
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are new agents for treating type 2 diabetes. In addition to the glycemic benefits, these agents provide cardiorenal protection in patients with diabetes and w...
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are new agents for treating type 2 diabetes. In addition to the glycemic benefits, these agents provide cardiorenal protection in patients with diabetes and without diabetes. There is consistent evidence that these agents increase the risk of genitourinary infections and dehydration, but randomized controlled trials have not included patients from the Middle East. OBJECTIVES: Determine the efficacy and safety of empagliflozin, specifically whether the genitourinary infection risk differs in our population and whether there is an increased risk of dehydration, ketoacidosis, hypoglycemia, and hospitalization with fasting. DESIGN: Retrospective review of medical records. SETTINGS: Department of medicine at tertiary care center. PATIENTS AND METHODS: We reviewed the electronic records of patients with type 2 diabetes who took empagliflozin from 1 December 2018 to 30 November 2019. We collected safety and efficacy data for 12 months from the initiation of treatment. MAIN OUTCOMES MEASURES: Glycemic and weight loss efficacy, risk of hospitalization due to hypoglycemia, dehydration, and genitourinary infections. SAMPLE SIZE: 637 patients. RESULTS: We observed an improvement in glycated hemoglobin, a 4.2% weight loss, improved left ventricular function, stable serum creatinine, and reduced albuminuria. Our patients did not have an increased risk of genitourinary infections, hypoglycemia, dehydration, ketoacidosis, or hospitalizations. Fasting did not increase the incidence of adverse events. CONCLUSIONS: Empagliflozin is safe and effective in our local population. We hypothesize that glycosuria induced by empagliflozin is not the sole contributor to the increased risk of genitourinary infections. Local hygiene and circumcision might reduce this risk. Empagliflozin can be used safely during fasting. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.
Comment on: Association between serum vitamin D levels and age in patients with epilepsy: A retrospective study from an epilepsy center in Saudi Arabia.
Al-Mendalawi MD
Ann Saudi Med · 2023 · PMID 36739501 · Full text
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The combined impact of hyponatremia and hematocrit on the risk for 90-day readmission and death in patients with heart failure: dilutional hyponatremia versus depletional hyponatremia.
Rao J, Ma Y, Long J … +2 more , Tu Y, Guo Z
Ann Saudi Med · 2023 · PMID 36739500 · Full text
BACKGROUND: Hyponatremia is common in hospitalized patients with heart failure (HF) and predicts a poor prognosis after discharge. In general, hyponatremia can be divided into two types: dilutional or depletional. OBJECT...
BACKGROUND: Hyponatremia is common in hospitalized patients with heart failure (HF) and predicts a poor prognosis after discharge. In general, hyponatremia can be divided into two types: dilutional or depletional. OBJECTIVE: Assess the impact of hyponatremia type on short-term outcomes. DESIGN: Retrospective cohort SETTINGS: Single center in China PATIENTS AND METHODS: We sorted patients by hyponatremia into two types: dilutional hyponatremia (DiH, with hematocrit <35%) and depletional hyponatremia (DeH, with hematocrit ≥35%). The Kaplan-Meier method and Cox regression analysis were used to identify the impact of hyponatremia types on the risk for 90-day readmission and death. MAIN OUTCOME MEASURES: 90-day readmission and death combined. SAMPLE SIZE: 1770 patients. RESULTS: Hyponatremia was present in 324/1770 patients with 182 cases classified as DiH versus 142 as DeH. Kaplan-Meier analyses showed a higher incidence of poor short-term outcomes in hyponatremia compared with normonatremia (log-rank <.001), and the risk was higher in DiH than DeH although the difference was not statistically significant (log-rank =.656). Multivariate Cox regression analyses showed that only DiH was independently associated with short-term outcomes (HR=1.34, 95%CI: 1.02-1.77, =.038), but not DeH (HR=1.32, 95%CI: 0.97-1.80, =.081). Analysis of the secondary endpoints showed that DiH increased the risk of readmission but not death (HR=1.36, =.035 for readmission; HR=1.13, =.831 for all-cause death). CONCLUSIONS: Low hematocrit, rather than high hematocrit, with hyponatremia was associated with a risk of 90-day readmission in patients with HF. LIMITATIONS: Single center, nonrandomized. CONFLICT OF INTEREST: None.
Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction.
Ozbek M, Ildirimli K, Arik B … +6 more , Aktan A, Coskun MS, Evsen A, Guzel T, Acet H, Demira M
Ann Saudi Med · 2023 · PMID 36739499 · Full text
BACKGROUND: There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or ou...
BACKGROUND: There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. OBJECTIVES: Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. DESIGN: Retrospective SETTING: Tertiary percutaneous coronary intervention center. PATIENTS AND METHODS: Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. MAIN OUTCOME MEASURES: Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. RESULTS: Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. CONCLUSIONS: While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. LIMITATIONS: More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI. CONFLICT OF INTEREST: None.
Factors associated with development of an acute ischemic event during hospitalization for COVID-19 in cancer and non-cancer patients.
Onder AH, Keskin AS, Onder KD … +2 more , Kizilates F, Heybeli C
Ann Saudi Med · 2023 · PMID 36739498 · Full text
BACKGROUND: COVID-19 and solid cancer are both associated with an increased risk of thromboembolism. OBJECTIVES: Assess whether solid cancer is a risk factor for acute ischemic event development among patients with COVID...
BACKGROUND: COVID-19 and solid cancer are both associated with an increased risk of thromboembolism. OBJECTIVES: Assess whether solid cancer is a risk factor for acute ischemic event development among patients with COVID-19. DESIGN: Retrospective cohort SETTING: A tertiary training and research hospital PATIENTS AND METHODS: Patients who were hospitalized for COVID-19 for ≥3 days between 15 March 2020 and 30 March 2021 at Antalya Training and Research Hospital, Antalya, Turkiye. were included in the study. Independent predictors of the development of acute ischemic events during hospitalization were determined using multivariable logistic regression analysis. MAIN OUTCOME MEASURES: Risk factors for acute ischemic event development. SAMPLE SIZE: 538 patients. RESULTS: Patients diagnosed with solid cancer comprised 11.3% of the cohort (n=61). Forty-one (7.6%) developed an acute ischemic event at a median of 3 (range, 1-15) days after hospitalization. The presence of a solid cancer (OR 3.80, 95% CI 1.20-12.03, =.023) along with length of hospital stay (OR 1.05 per day, 95% CI 1.01-1.09, =.025) were independent predictors of acute ischemic event development during the course of COVID-19. Mortality was reported in 200 (37%) patients at a median of 5 (range, 3-10) days after hospitalization. The presence of solid tumor increased mortality 5.83 times (95% CI 3.19-10.63, <.001) while this ratio was 4.59 (95% CI 2.29-9.23, <.001) for patients who experienced an acute ischemic event. CONCLUSION: Patients with active cancer carry a significant risk for acute ischemic event development during the course of COVID-19 and such patients may require particular attention in terms of anticoagulation therapy. LIMITATIONS: Retrospective design and small sample size. CONFLICT OF INTEREST: None.
The relationship between degree of coronary artery stenosis detected by coronary computed tomography angiography and ACEF risk score in patients with chronic coronary syndrome.
Kis M, Yurdam FS
Ann Saudi Med · 2023 · PMID 36739497 · Full text
BACKGROUND: The ACEF risk score (age, creatinine, and ejection fraction) has been associated with satisfactory predictive values not only for short-term and long-term mortality but also for major adverse cardiovascular e...
BACKGROUND: The ACEF risk score (age, creatinine, and ejection fraction) has been associated with satisfactory predictive values not only for short-term and long-term mortality but also for major adverse cardiovascular events. OBJECTIVES: Investigate the relationship between ACEF risk score and degree of coronary artery stenosis. DESIGN: Retrospective, observational study. SETTING: Tertiary percutaneous coronary intervention center. PATIENTS AND METHODS: In patients with coronary coronary artery stenosis <70% were compared with patients with stenosis ≥70%. All were diagnosed with chronic coronary syndrome (CCS) and had undergone coronary computed tomography angiography (CTA). Receiver operating characteristic analysis was performed for the cut-off value of the ACEF risk score. Univariable and multivariable regression analyses were performed for significant parameters related to degree of coronary artery stenosis in coronary CTA. MAIN OUTCOME MEASURES: Relationship between ACEF risk score and degree of coronary artery stenosis in coronary CTA. SAMPLE SIZE: 148 patients. RESULTS: In the multivariable regression analysis; left ventricular ejection fraction (OR: 0.94; 95%CI: 0.89-0.99, =.015) and ACEF risk score (OR: 5.63; 95% CI: 1.62-19.57, =.007) were independent predictors for degree of coronary artery stenosis. The ACEF risk score was statistically significantly higher in with patients with stenosis ≥70% (1.43 [0.59]) than in patients with stenosis <70% (0.98 [0.35]), <.001). An ACEF risk score value >1.04 was a predictor of the presence of severe coronary artery stenosis detected by coronary CTA in patients with CCS, with 66% sensitivity and 69% specificity. CONCLUSIONS: A high ACEF risk score (age, creatinine, ejection fraction) in patients with CCS is associated with the presence of severe coronary artery stenosis detected by coronary CTA, and was useful as an assessment tool for coronary angiography in patients with CCS. LIMITATIONS: Since we do not have long-term follow-up results, we do not know the prognostic value of the ACEF risk score in the long-term follow-up of patients with CCS. CONFLICT OF INTEREST: None.
A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence.
Altaweel W, Almesned R, Seyam R
Ann Saudi Med · 2023 · PMID 36739496 · Full text
BACKGROUND: The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each meth...
BACKGROUND: The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes. OBJECTIVE: Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS AND METHODS: We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively. MAIN OUTCOME MEASURES: Rates of dry, infection, erosion, malfunction, atrophy, revision. SAMPLE SIZE: 44 males who underwent 68 procedures. RESULTS: Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, =.042). At the last follow-up, dryness was comparable among groups. CONCLUSION: The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal. LIMITATIONS: Small sample size, single-center. CONFLICT OF INTEREST: None.
Incidence of pediatric rigid esophagoscopy for foreign body removal before and after coin currency implementation in Saudi Arabia in 2017.
Wafi A, Wafi M, Hakami T … +4 more , Alabida NW, Almutairi R, Saad A, Sumaily I
Ann Saudi Med · 2022 · PMID 36444929 · Full text
BACKGROUND: Foreign body (FB) ingestion is a common problem in children, which can lead to severe complications. Coins are the most common FB ingested. Since coin currency was recently implemented in Saudi Arabia, we dec...
BACKGROUND: Foreign body (FB) ingestion is a common problem in children, which can lead to severe complications. Coins are the most common FB ingested. Since coin currency was recently implemented in Saudi Arabia, we decided to assess whether any changes have occurred in the incidence of FB removal by esophagoscopy. OBJECTIVES: Incidence of rigid esophagoscopy for ingested FB removal before and after coin currency implementation. DESIGN: Medical record review SETTINGS: Main referral hospital in Jazan region. PATIENTS AND METHODS: Our study included pediatric patients who underwent rigid esophagoscopy for removal of FB between February 2015 and July 2020 in the otorhinolaryngology department. We reported the incidence, age, gender, and type of FB. As the coin currency implementation started on December 2, 2017, the data were analyzed before and after this date. MAIN OUTCOME MEASURES: Annual incidence of pediatric rigid esophagoscopy for removal of ingested FB and type of the FB. SAMPLE SIZE: 124 patients RESULTS: The median age and interquartile range was 6.0 (5.0) years. After implementation of coins in 2017, 104 cases were reported over 32 months; before that date, 20 cases were reported over 34 months. Coins were the FB in 2 cases (10%) before implementation of coins and in 83 cases (79.8%) after implementation (=.0001). CONCLUSIONS: The annual incidence of pediatric esophagoscopy for FB removal has increased more than five times since implementation of coin currency. This increase is exclusively related to the increase in coins as a FB. LIMITATIONS: Retrospective study. CONFLICT OF INTEREST: None.
The prevalence of strabismus and visual outcomes in children with hydrocephalus and a ventriculoperitoneal shunt: medical record review.
AlObaisi SS, Alnasser BN, Almuhawas HA … +5 more , Alhoshan SA, Alamer MA, Alshaye RM, Aldakhil SA, Alabdulmunem MM
Ann Saudi Med · 2022 · PMID 36444928 · Full text
BACKGROUND: Many ophthalmological complications have been associated with hydrocephalus (HC), including ocular motility disorders, visual field defects, optic atrophy, and loss of visual acuity. No studies have investiga...
BACKGROUND: Many ophthalmological complications have been associated with hydrocephalus (HC), including ocular motility disorders, visual field defects, optic atrophy, and loss of visual acuity. No studies have investigated the prevalence of strabismus and visual outcomes of children with congenital HC after ventriculoperitoneal (VP) shunt in Saudi Arabia. OBJECTIVES: Estimate the frequency of strabismic children diagnosed with HC who underwent a VP shunt procedure. DESIGN: Medical record review SETTING: Tertiary care center PATIENTS AND METHODS: We reviewed the files of all pediatric patients diagnosed with hydrocephalus before the age of 2 years and treated with shunts during the period 2010 to 2020 at our institution. MAIN OUTCOME MEASURES: Strabismus types and ophthalmic assessment (visual state, outcomes, and ocular motility state). SAMPLE SIZE AND CHARACTERISTICS: 190 children; 98 (51.5%) males. RESULTS: Eighty-nine (46.8%) had congenital HC followed by intraventricular hemorrhage 36 (18.9%); 74 (38.9%) patients had regular follow-ups in ophthalmology. Sixty-five (34.2%) patients had no ophthalmic assessment or fundus examination records, while 63 (33.1%) were diagnosed with strabismus. At the initial assessment, 26 (13.6%) patients had exotropia (XT). At the final assessment, 7 (3.6%) patients had XT. The association between VP shunt and strabismus was statistically significant, (χ=6.534, df=1, <.01). CONCLUSION: More than one-third of children diagnosed with HC who had surgical treatment in a tertiary hospital did not have any records of ophthalmic assessment, which highlights the need to implement a specific ophthalmological examination protocol in patients with HC. Further studies are needed to analyze the association between VP shunt and strabismus. LIMITATIONS: Evaluating the ocular state and visual function before and after VP shunt was not possible. CONFLICT OF INTEREST: None.
Accuracy of conventional disease severity scores in predicting COVID-19 ICU mortality: retrospective single-center study in Turkey.
Yildrim S, Kirakli C
Ann Saudi Med · 2022 · PMID 36444927 · Full text
BACKGROUND: Disease severity scores are important tools for predicting mortality in intensive care units (ICUs), but conventional disease severity scores may not be suitable for predicting mortality in coronavirus diseas...
BACKGROUND: Disease severity scores are important tools for predicting mortality in intensive care units (ICUs), but conventional disease severity scores may not be suitable for predicting mortality in coronavirus disease-19 (COVID-19) patients. OBJECTIVE: Compare conventional disease severity scores for discriminative power in ICU mortality. DESIGN: Retrospective cohort SETTING: Intensive care unit in tertiary teaching and research hospital. PATIENTS AND METHODS: COVID-19 patients who were admitted to our ICU between 11 March 2020 and 31 December 2021 were included in the study. Patients who died within the first 24 hours were not included. SAPS II, APACHE II and APACHE 4 scores were calculated within the first 24 hours of ICU admission. A receiver operating characteristics (ROC) analysis was performed for discriminative power of disease severity scores. MAIN OUTCOME MEASURE: ICU mortality SAMPLE SIZE AND CHARACTERISTICS: 510 subjects with median (interquartile percentiles) age of 65 (56-74) years. RESULTS: About half (n=250, 51%) died during ICU stay. Three disease severity scores had similar discriminative power, the area under the curve (AUC), SAPS II (AUC 0.79), APACHE II (AUC 0.76), APACHE 4 (AUC 0.78) (<.001). Observed mortality was higher than predicted mortality according to conventional disease severity scores. CONCLUSION: Conventional disease severity scores are good indicators of COVID-19 severity. However, they may underestimate mortality in COVID-19. New scoring systems should be developed for mortality prediction in COVID-19. LIMITATION: A single-center study CONFLICT OF INTEREST: None.
Transformation of dental services from a governmental model to a revenue-generation model of operation in a tertiary care hospital: a health economics assessment.
Alsanea R, Tawfiq WM, Alswailem OA … +2 more , Alali T, AlBarkheel AR
Ann Saudi Med · 2022 · PMID 36444926 · Full text
BACKGROUND: Healthcare in Saudi Arabia is under transformation from a national free health service to a system paid either by insurance or governmental funds. This change will impact the model of operation including dent...
BACKGROUND: Healthcare in Saudi Arabia is under transformation from a national free health service to a system paid either by insurance or governmental funds. This change will impact the model of operation including dental services. OBJECTIVES: Estimate the revenue of the Department of Dentistry based on an insurance-based billing system. DESIGN: Medical record review SETTING: An academic tertiary care hospital in Riyadh PATIENT AND METHODS: Data on outpatient visits for the period 2015-2019 was extracted from the electronic health records. The billing data was categorized by specialty and current procedure terminology (CPT) code. The revenue stream for each CPT code was estimated and compared between the actual cost of service for each CPT code billed price, and average price of the market leaders in private practice. MAIN OUTCOME MEASURE: Revenue generated by the department. SAMPLE: 339 421 outpatient visits for 22 056 patients. RESULTS: Female and males made 179 555 (52.9%) and 159 858 (47.1%) outpatient visits, respectively. Outpatient divided by the age groups: ≤14,15-65, >65 years were 58 868 (17.3%), 251 552 (74.1%), 29 001 (8.5%), respectively. The visits divided by specialty were as follows: general dentistry 28.1%, pedodontics 12.5%, orthodontics 7.1%, endodontics 7.0%, oral and maxillofacial surgery 6.9%, prosthodontics 4.4% and periodontics 3.3%. Outpatient visits to the nursing clinic and hygienist amounted to 30.7%. The median number of visits per patient per year was 5 (range, 1-63), which increased to 6 (range, 1-110) in 2019. The annual revenue plateaued in 2019 at 13 983 538 SAR (3 728 943 USD) with only a 2.2% of increase from 2018. Out of 292 CPT codes, 44.8% were priced below the actual cost. Moreover, 28.4% showed pricing below actual cost, but higher than the price of the market leaders. There was an annual loss of revenue of 10.1% due to incorrect pricing of CPT codes. Average productivity of the dentist and hygienist amounted to 2263 and 760 visits per year, respectively. CONCLUSIONS: There is a need for improvement in delivery of care, cost-containment, productivity and amendment of charge description master pricing. LIMITATIONS: The sample did not include data from the period 2020-2022 due to the restriction of dental services due to the COVID-19 epidemic. CONFLICT OF INTEREST: None.
Clinical profile, course and outcomes of adults with inflammatory bowel disease over a decade: a single center experience.
Aljohani RS, Alaklabi A, Alsitary YM … +4 more , Khunayn MAB, Hijazi SO, Alshagary RI, Rajendram R
Ann Saudi Med · 2022 · PMID 36444925 · Full text
BACKGROUND: Inflammatory bowel disease (IBD) is an important cause of morbidity in Saudi Arabia. OBJECTIVES: Determine the incidence, clinical profile, course and outcomes of IBD in Riyadh, Saudi Arabia. DESIGN: Medical...
BACKGROUND: Inflammatory bowel disease (IBD) is an important cause of morbidity in Saudi Arabia. OBJECTIVES: Determine the incidence, clinical profile, course and outcomes of IBD in Riyadh, Saudi Arabia. DESIGN: Medical record review SETTING: Tertiary care center PATIENTS AND METHODS: Data were extracted from the medical records of all patients with IBD admitted to King Abdulaziz Medical City, Riyadh, from 1 January 2009 to 31 December 2019. The complications of IBD were classified as gastrointestinal or extraintestinal. Comorbidities were classified as either systemic diseases or gastrointestinal diseases. MAIN OUTCOME MEASURES: Epidemiology, clinical manifestations and complications of IBD. SAMPLE SIZE AND CHARACTERISTICS: 435 patients with IBD, median (IQR) age at presentation 24.0 (14.0) years, 242 males (55.6%) RESULTS: The study population consisted of 249 patients with Crohn's disease (CD) (57.2%) and 186 with ulcerative colitis (UC) (42.8%). Nearly half were either overweight or obese. Abdominal pain, diarrhea and vomiting were the most common presenting symptoms. The most common extraintestinal manifestations were musculoskeletal (e.g., arthritis and arthralgia). Colorectal cancer was diagnosed in 3.2%. Patients with other gastrointestinal (GI) comorbidities were at higher risk of developing GI complications of IBD (≤.05). Biological agents were used to treat 212 patients (87%) with CD and 102 patients (57%) with UC. CONCLUSIONS: The number of patients diagnosed with IBD and their body mass index increased each year over the period of interest. However, the rate of surgical intervention and number of serious complications fell. This improvement in outcomes was associated with a higher percentage of patients receiving biological therapy. LIMITATIONS: Incomplete data. Some patients diagnosed and/or followed up at other hospitals. CONFLICT OF INTEREST: None.
The pattern of chromosomal abnormalities in recurrent miscarriages: a single center retrospective study.
Kocaaga A, Kilic H, Gulec S
Ann Saudi Med · 2022 · PMID 36444924 · Full text
BACKGROUND: Chromosomal abnormalities are more common in first trimester recurrent miscarriages (RM). Chromosomal anomalies affect approximately 2%-8% of couples with RM. OBJECTIVES: Evaluate the spectrum and the frequen...
BACKGROUND: Chromosomal abnormalities are more common in first trimester recurrent miscarriages (RM). Chromosomal anomalies affect approximately 2%-8% of couples with RM. OBJECTIVES: Evaluate the spectrum and the frequencies of chromosomal anomalies in RM. DESIGN: A retrospective hospital record-based descriptive study. SETTING: A tertiary care center in Turkey. PATIENTS AND METHODS: We studied couples with RM between October 2020 and January 2022. Relevant family and medical history, clinical examination and the results of karyotype were statistically analyzed. MAIN OUTCOME MEASURES: Prevalence and types of chromosomal aberrations in couples with RM. SAMPLE SİZE: 362 couples with a history of RM RESULTS: Among the 362 couples, 14 cases (3.86%) had chromosome abnormalities. Eight cases (57.14%) were structural anomalies and six cases (42.86%) were numerical chromosomal aberrations. We found five balanced translocations (67.5%) and three Robertsonian translocations (37.5%). The prevalence of polymorphic variants was 51/362 (14.1%). CONCLUSIONS: This study supports the conclusion that clinicians should understand the importance of chromosome analysis in these couples and direct them to karyotyping after two abortions in order to exclude the possibility of a genetic cause of RM. LIMITATIONS: Single-center study and retrospective. CONFLICT OF INTEREST: None.
Assessment of opioid administration patterns following lower extremity fracture among opioid-naïve inpatients: retrospective multicenter cohort study.
Ramadan M, Alnashri Y, Ilyas A … +4 more , Batouk O, Alsheikh KA, Alhelabi L, Alnashri SA
Ann Saudi Med · 2022 · PMID 36444923 · Full text
BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Sau...
BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Saudi Arabia have been lower extremity fractures, it is imperative to understand opioid administration patterns and correlates among opioid-naïve inpatients. OBJECTIVES: Assess opioid administration patterns and correlates among opioid-naïve inpatients with lower extremity fractures. DESIGN AND SETTINGS: Retrospective cohort PATIENTS AND METHODS: Opioid naïve individuals aged 18 to 64 years, admitted due to lower extremity fracture from 2016 to 2020 were included. Data was collected from health records of the Ministry of National Guard Health Affairs (MNG-HA) at five different medical centers. The high-dose (≥50 MME) patients were compared with low dose (<50 MME) patients. Any association between inpatient factors and high-dose opioid use was analyzed by multiple logistic regression. MAIN OUTCOME MEASURES: Opioids taken during inpatient admission as measured by milligram morphine equivalents (MME)/per day. SAMPLE SIZE: 1520 patients RESULTS: Most of the 1520 patients (88.5%) received an opioid medication, while (20.3%) received high-dose opioids at a median daily dose of 33.7 MME/per day. The proportion of patients received naloxone (20.7%) was double among high-dose opioid inpatients. High-dose opioid patients during admission were two times more likely to receive an opioid prescription after discharge (odds ratio, 2.32; 95% confidence interval, 1.53, 3.51), and three more times likely to receive ketamine during admission (odds ratio, 3.02; 95% confidence interval, 1.64, 5.54). CONCLUSION: Notable variabilities exist in opioid administration patterns that were not explained by patient factors. Evidence-based opioid prescribing practices should be developed for orthopedic patients to prevent opioid overprescribing and potential opioid overdose among orthopedic patients. LIMITATIONS: Retrospective, unmeasurable confounders might have biased our results. Since based on National Guard employees, results may not be generalizable. CONFLICT OF INTEREST: None.
Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis.
Liu Q, Zhang Y, Liu Y
Ann Saudi Med · 2022 · PMID 36444922 · Full text
BACKGROUND: Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH. OBJECTIVE: Inv...
BACKGROUND: Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH. OBJECTIVE: Investigate whether evaluation of coagulation function by preoperative TEG might help to predict PTH after tonsillectomy by coblation tonsillectomy (TE). DESIGN: Post-hoc analysis of randomized controlled study. SETTING: Otolaryngology Department between January 2017 and August 2019. PATIENTS AND METHODS: This post-hoc analysis included adults who underwent coblation TE for benign tonsillar disorders. Routine blood tests and TEG were performed preoperatively. The TEG parameters evaluated included coagulation reaction time (R) and maximum thrombus amplitude (MA). MAIN OUTCOME MEASURES: The main outcome was PTH during the 4-week postoperative period. SAMPLE SIZE AND CHARACTERISTICS: 284 RESULTS: The 19 patients (6.7%) that experienced PTH had a higher prevalence of diabetes mellitus, lower use of intraoperative suturing, fewer patients with grade I and II tonsillar enlargement, a higher white blood cell count, lower platelet count, lower fibrinogen level, lower R value, and a lower MA value than patients without PTH (all <.05). Multivariate logistic regression revealed that diabetes mellitus (<.053), fibrinogen level ≤2.735 g/L (<.027), R≤6.55 min (<.011) and MA≤59.15 mm (<.012) were independently associated with PTH. A regression model incorporating these four factors predicted PTH with a sensitivity of 73.7% and specificity of 83.8%. CONCLUSION: Preoperative evaluation of diabetes mellitus history, fibrinogen level, and TEG parameters might help to identify patients at higher risk of PTH after coblation TE. LIMITATIONS: Single-center study with a small sample size; possibly underpowered statistically. TEG measurements might not accurately reflect coagulation function, and a validation cohort was unavailable. CONFLICT OF INTEREST: None. CHINESE CLINICAL TRIAL REGISTRY NUMBER OF STUDY USED IN THIS ANALYSIS: ChiCTR2000032171. http://www.chictr.org.cn/showprojen.aspx?proj=52553.
High COX-2 immunostaining in papillary thyroid carcinoma is associated with adverse survival outcomes.
Al-Maghrabi JA, Gomaa W
Ann Saudi Med · 2022 · PMID 36444921 · Full text
BACKGROUND: Thyroid carcinoma is one of the most common malignancies worldwide. More than 70%-80% are papillary thyroid carcinoma (PTC). Many factors influence the PTC pathway of development such as genetic mutations, gr...
BACKGROUND: Thyroid carcinoma is one of the most common malignancies worldwide. More than 70%-80% are papillary thyroid carcinoma (PTC). Many factors influence the PTC pathway of development such as genetic mutations, growth factors, and radiation. More biological understanding of the genetic and molecular pathways is needed in PTC to determine tumor behavior, and initial clinical assessment. OBJECTIVES: Investigate the relation of COX-2 immunostaining in thyroid carcinoma with clinicopathological parameters to assess whether immunostaining results have prognostic significance. DESIGN: Retrospective study SETTING: Pathology department, tertiary care center METHODS: Records of PTC were retrieved and tissue microarrays were constructed. Tissue sections were stained using anti-human COX-2 monoclonal antibody. Immunostaining results were recorded and analysed. MAIN OUTCOME MEASURES: Relationship of COX-2 immunostaining in thyroid carcinoma with clinicopathological parameters. SAMPLE SIZE: 139 tissue samples from 139 patients RESULTS: High versus low COX-2 immunostaining showed no significant differences for most clinicopathological parameters. However, high COX-2 immunostaining showed borderline association with tumor multifocality (=.05), lower overall (log-rank=8.739 and =.003), and disease-free survival (log-rank=7.033, =.008). CONCLUSION: The study showed a positive association of high COX-2 immunostaining with lower survival outcomes in PTC. COX-2 immunostaining could be a potential prognostic factor for survival in PTC. Additional molecular and clinical investigations are needed for further understanding the molecular pathways of COX-2 in PTC and the feasibility of using inhibitors of COX-2 as adjuvant therapy along with current chemotherapy. LIMITATIONS: Relatively low number of PTC variants, and no testing of other thyroid carcinomas. CONFLICT OF INTEREST: None.
Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?
Tullavardhana T, Chartkitchareon A
Ann Saudi Med · 2022 · PMID 36252149 · Full text
BACKGROUND: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. OBJECTIVES:...
BACKGROUND: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. OBJECTIVES: Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI. DESIGNS: Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1. MAIN OUTCOME MEASURES: 30-day mortality, recurrent infection, and reoperation rate. SAMPLE SIZE: Eight studies, including 555 AVGI, and 528 patients. RESULTS: PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13-0.41, <.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03-0.58, <.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39-2.17, =.85). CONCLUSIONS: TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients. LIMITATION: Risk of bias due to the differences in patient characteristics. CONFLICT OF INTEREST: None.
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