Saudi Journal of Medicine & Medical Sciences最新文献

Atherosclerosis, a leading cause of cardiovascular disease, is a complex, multifactorial disorder involving lipid accumulation, chronic inflammation, immune dysregulation, and metabolic disturbances. Recent advances highlight critical roles for the Stimulator of Interferon Genes (STING) pathway, macrophage immunometabolism (the metabolic reprogramming of immune cells), oxidative DNA damage, neutrophil heterogeneity, sex disparities, and interactions with the gut microbiome and non-coding RNAs (molecules that regulate gene expression without coding for proteins). This integrative review synthesizes current knowledge from molecular, immunological, and epidemiological perspectives to illuminate key mechanisms in atherogenesis. We critically examine emerging mechanistic insights, including STING-mediated inflammation and macrophage metabolic reprogramming, and their roles in plaque initiation and progression. The review further evaluates novel therapeutic approaches, ranging from established lipid-lowering agents (e.g., statins, PCSK9 inhibitors, inclisiran, and bempedoic acid) to anti-inflammatory strategies (e.g., IL-1β and IL-6 inhibitors) and potential STING-targeted interventions. By integrating recent discoveries across basic and clinical science, this review emphasizes the need for personalized, multi-targeted therapies addressing inflammation, metabolism, and immune signaling. We propose a research roadmap prioritizing translational studies that link molecular mechanisms to clinical outcomes, ultimately aiming to improve prevention and management of atherosclerotic cardiovascular disease.

Background: Medical residents often have irregular sleep patterns, which can hamper performance and quality of life. The prevalence of insomnia among medical residents in Saudi Arabia is not fully studied.

Objective: To determine the prevalence of insomnia and its correlation with symptoms of depression and anxiety among medical residents in Saudi Arabia.

Materials and methods: This cross-sectional, online survey-based study included medical residents registered with the Saudi Commission for Health Specialties, and was conducted from January to March 2021. The Insomnia Severity Index (ISI), the Generalized Anxiety Disorder Scale (GAD-7), and the Patient Health Questionnaire (PHQ-9) were used for data collection.

Results: A total of 533 medical residents completed the questionnaire (mean age: 28.5 years; male: 52%). The prevalence of clinically significant insomnia among residents was 33% (ISI score ≥15); 74% had sleep disturbances (score ≥8). Further, 58% and 57% had anxiety and depression (GAD-7 score ≥10 and PHQ-9 score ≥10, respectively). Independent factors of insomnia were dissatisfaction with income (OR = 2.44, 95% CI: 1.39-4.27), obesity (OR = 4.44, 95% CI: 1.3-15.7), coffee consumption (>4 cups/day: OR = 13.74; 95% CI: 4.4-42.8), sleep-inducing medication use (OR = 2.40, 95% CI: 1.47-3.93), history of psychiatric illnesses (OR = 2.75, 95% CI: 1.54-4.94), depression (OR = 5.86, 95% CI: 3.1-11.3), and anxiety (OR = 3.34, 95% CI: 1.7-6.4). Clinically significant insomnia symptoms had a significant positive correlation with both depression (r = 0.462) and anxiety (r = 0.434) (for both, P = 0.0001).

Conclusion: Insomnia symptoms are common among medical residents in Saudi Arabia, significantly correlating with symptoms suggestive of depression and anxiety. This highlights the importance of support and early intervention, as well as the need for clear guidelines to improve sleep quality.

Background: Type 2 diabetes mellitus (T2DM) is often accompanied by vitamin D (VitD) deficiency, chronic inflammation, and altered bone metabolism, yet, the interplay between these comorbidities and T2DM has not been adequately determined.

Objective: This study aimed to determine the associations between serum VitD levels, bone turnover markers, and inflammatory cytokines in Emirati patients with T2DM, and their interaction in relation to glycemic control. In addition, to compare the above parameters between the well-controlled and poorly controlled glycemic groups.

Materials and methods: In this cross-sectional study, 128 Emirati adults aged 25-65 years with T2DM were recruited. Serum levels of VitD, osteocalcin, bone resorption marker β-cross-linked telopeptide (β-CTX), inflammatory markers (IL-6, TNF-α, CRP), and glycosylated hemoglobin (HbA1c) were measured. Non-parametric tests (Spearman correlation, Mann-Whitney U) and multivariate logistic regression were used for analysis.

Results: Patients with poorly controlled glycemia exhibited significantly elevated IL-6, TNF-α, and CRP levels compared to that in the well-controlled group (P < 0.001). Osteocalcin levels were markedly lower in the poorly controlled group, while β-CTX showed insignificant differences. Serum VitD was inversely correlated with IL-6 and TNF-α. In logistic regression analyses, elevated IL-6 was independently associated with low bone mineral density (P = 0.007).

Conclusion: An interplay exists between VitD, inflammatory markers, and bone health in Emirati patients with T2DM, where VitD was linked with bone density but not with bone markers. Poorly controlled glycemia was associated with low osteocalcin levels and elevated inflammatory markers.

Mental health disorders constitute a significant global health burden, with stigma creating additional barriers to care in the Middle East. Mobile health technologies present potential solutions, yet their implementation in Arab countries remains largely unexplored. This narrative review examines the current landscape of Arabic mental health mobile applications as an emerging solution to these barriers. Through a comprehensive analysis of literature, we evaluate the therapeutic and engagement features of existing Arabic mental health apps, comparing them with well-documented Western platforms. While these apps show potential for improving healthcare accessibility and reducing stigma, they lack essential features for effective mental health support. Our findings revealed minimal implementation of engagement features, particularly in visualization, gamification, and social networking capabilities. Similarly, therapeutic features showed limited customization options and insufficient integration of evidence-based interventions. This review concludes that future development of Arabic mental health apps requires collaborative efforts between healthcare professionals, policymakers, and developers to create culturally sensitive, evidence-based digital solutions that effectively serve Arab populations.

Background: Acute ischemic stroke (AIS) is a major cause of mortality and disability worldwide, requiring rapid intervention to prevent brain damage. Timely thrombolytic therapy with tissue plasminogen activator (tPA) is essential but often underutilized due to barriers in treatment delivery.

Objectives: This study aimed to identify barriers impacting the timely administration of thrombolytic therapy in AIS patients at a major tertiary care hospital in Riyadh, Saudi Arabia.

Methods: This retrospective cohort study included adult patients with AIS who were admitted to the Emergency Department (ED) of King Abdulaziz Medical City, Riyadh, between November 2015 and March 2023. Patient demographics, clinical characteristics, and records on ED arrival time were reviewed to identify barriers to thrombolysis.

Results: A total of 576 patients were included in the study (mean age: 64 ± 13 years; male: 65%). The mean National Institutes of Health Stroke Scale score at presentation to the ED was 7.3, indicating a moderate level of severity among stroke patients. The study found that delayed ED arrival (77%) and current anticoagulant use (34%) were the main barriers to thrombolysis. The most common symptoms were weakness (77%), slurred speech (62%), and facial droop (28%). Only 10% of patients received thrombolytic therapy, of which 70% received an appropriately calculated dose.

Conclusion: Delayed emergency department arrival and recent use of anticoagulants significantly impact timely thrombolysis for acute ischemic stroke in Saudi Arabia. Prospective multi-center studies are recommended to further explore these barriers across varied healthcare settings.

Background: Malnutrition is a common concern in children with cystic fibrosis, impacting their growth and lung function. Despite its significance, research on malnutrition risk factors in children with cystic fibrosis is limited in Saudi Arabia.

Objectives: This study aimed to determine the nutritional status and its associated factors in children with cystic fibrosis.

Methods: This retrospective study included all pediatric patients (aged <18 years) with cystic fibrosis who were followed in the pediatric pulmonology clinic at a tertiary care hospital in Dammam, Saudi Arabia, between January 2010 and July 2023.

Results: A total of 48 children with cystic fibrosis were included (mean age: 9.7 ± 5.6 years; females: 70.8%). The mean body mass index-for-age/weight-for-length z-score value was -1.61 ± 1.87. Most children were malnourished (60.4%). Compared to those who were not malnourished, malnourished children had significantly delayed diagnosis (P = 0.004), higher hospital admission rates (P = 0.015), uncontrolled fat malabsorption (P = 0.034), and poor appetite (P < 0.001). Independent factors associated with the risk of malnutrition were age (P = 0.014) and fair/poor appetite and intake (P = 0.008 and 0.002, respectively).

Conclusions: In this cohort from Saudi Arabia, the prevalence of malnutrition among children with cystic fibrosis was high. In addition, factors associated with malnutrition in this population were age, poor appetite and intake, delayed diagnosis, and uncontrolled fat malabsorption.

Background: Since 2015, endovascular therapy (EVT) has become the standard of care for acute ischemic stroke with large vessel occlusion (LVO).

Objectives: To study the clinical and radiological features and outcomes of patients who underwent EVT at a tertiary care center in Saudi Arabia.

Methods: This retrospective study included all patients who underwent EVT between January 2012 and December 2022 at King Abdulaziz Medical City, Riyadh. Demographic, clinical, and radiological variables were analyzed.

Results: A total of 159 patients were included (males: 61%; mean age: 56.8 ± 14.1 years). Most patients had moderate (39%) to severe (45%) stroke. The commonest LVO was right middle cerebral artery (MCA; 38%), followed by left MCA (37%), and basilar artery (19%). The initial ASPECT score was 8.2 ± 1.4. The median door-to-groin time was 126 (IQR 102-152) minutes. Most (84%) received EVT within 6 hours, and intravenous tissue plasminogen activator was used in 78 (49%) patients. Successful recanalization (TICI2b and above) was achieved in 78%, with stent retriever 137 (87%) and aspiration 62 (40%) being the most common techniques. Peri-procedural complications and intraparenchymal hemorrhage were seen in 13% and 12% of the patients, respectively, while 9% required decompressive craniectomy. At discharge, 44 (28%) had modified Rankin score of 0-2; 37 (23%) died. Cardioembolic and large vessel strokes were more common in patients aged >60 years (P < 0.001). Females were more likely to have general anesthesia (P = 0.036) and require decompressive craniectomy (P = 0.003). Patients who had EVT after >6 hours were more likely to have very severe stroke (P = 0.005) and mortality (P = 0.001).

Conclusions: EVT was associated with good procedural outcomes, despite slightly delayed door-to-groin time. Patients in whom EVT was initiated after >6 hours were significantly more likely to have very severe stroke and higher mortality.

Objectives: To evaluate clinical patterns and prognosis of gastrointestinal hemorrhage (GIH) in patients on antithrombotic therapy (AT).

Materials and methods: This retrospective study included patients hospitalized with GIH between January 2010 and January 2020 at two tertiary care centers in Riyadh, Saudi Arabia. Demographics, clinical/laboratory/endoscopic findings, and outcomes were analyzed.

Results: The study included 759 GIH patients: 354 AT users and 405 non-users. AT users were older (69.2 ± 13.9 vs 59.7 ± 17.1 years; P < 0.0001) with more cardiovascular comorbidities: hypertension (72.0% vs 38.5%), diabetes (63.3% vs 31.4%), ischemic heart disease (28.0% vs 4.7%), and stroke (15.0% vs 3.0%) (for all, P < 0.0001). Endoscopy showed AT users had higher erosive gastritis (19.2% vs 10.4%; P = 0.001) and colonic ulcers (9.9% vs 5.7%; P = 0.029), while non-users had more esophageal varices (24.4% vs 12.4%; P < 0.0001) and hemorrhoids (25.9% vs 16.4%; P = 0.001). AT users required more transfusions (1.43 ± 2.5 vs. 0.95 ± 1.8 units; P = 0.005), had lower hemoglobin (98.9 ± 29.1 vs. 105.7 ± 30.9 g/L; P = 0.002), higher creatinine (137.89 ± 138.5 vs. 111.3 ± 136.3 µmol/L; P = 0.011), more ICU admissions (28.5% vs. 19.0%; P = 0.002), and higher mortality (15.8% vs. 8.9%; P = 0.042). Independent predictors of mortality were AT (adjusted odds ratio [aOR]: 2.067, 95% CI: 1.102-3.879; P = 0.024), alongside liver cirrhosis (aOR: 2.573, 95% CI: 1.26-5.252; P = 0.009), malignancy (aOR: 2.836, 95% CI: 1.481-5.431; P = 0.002), transfusions (aOR: 1.246, 95% CI: 1.141-1.361; P < 0.001), and serum urea (aOR: 1.037; 95% CI: 1.017-1.057; P < 0.001).

Conclusion: Patients on antithrombotic therapy with gastrointestinal hemorrhage present with distinct risk profiles, severe anemia/renal impairment, higher resource utilization, and significantly increased mortality. These high-risk patients require careful management to improve their clinical outcomes.

Background: Studies from Saudi Arabia regarding the use of photorefractive keratectomies (PRK) and the optimum optical zones in the treatment of adults with mixed astigmatism are lacking.

Objective: To determine the outcome of PRK treatment in adult patients with mixed astigmatism and the difference in efficacy between different optical zones sizes.

Methods: This retrospective study included consecutive patients with mixed astigmatism who underwent PRK at an ophthalmology clinic in Dammam, Saudi Arabia, between January 2016 and December 2019. Examination of patients included uncorrected distal visual acuity and corrected distal visual acuity. All surgeries were conducted by a single surgeon using the standard PRK technique with different optical zones: ≤6.5 mm and >6.5 mm (i.e., 7 mm and 7.5 mm). Patients were followed up monthly for 3 months.

Results: This study included a total of 65 eyes of 36 consecutive patients who underwent the PRK procedure during the study period. In the Snellen chart assessment, there was a steady increase in the number of patients whose postoperative uncorrected visual acuity was within 1 line of the preoperative corrected visual acuity. In terms of the efficacy of different optical zones, the difference between both groups (i.e., the 6.5 mm and >6.5 mm groups) in each of the three follow-ups was statistically insignificant (first follow-up, P = 0.59; second follow-up, P = 0.39; third follow-up, P = 0.28).

Conclusion: This study demonstrates that the optical zone ranging from 6.5 mm to 7.5 mm yields comparable results.

Background: The use of morphine in managing vaso-occlusive crisis (VOC) in patients with sickle cell disease (SCD) can result in significant side effects. Nalbuphine, a mixed agonist-antagonist opioid, may offer an alternative with fewer complications.

Objective: To compare the efficacy and safety of nalbuphine and morphine in pain management among adult SCD patients presenting with VOC.

Methods: This retrospective study included adult patients with SCD treated at King Fahad Hospital, Hofuf, Saudi Arabia, between 2019 and 2023. Patients were classified into two groups (receiving morphine and nalbuphine). Pain levels were assessed using the Visual Analog Scale (VAS) at baseline, 1-h, 6-h, and 24-h post-administration. Additional outcomes included the need for rescue medication and discharge rates from the emergency department.

Results: A total of 234 patients were included (morphine: 120; nalbuphine: 114). The mean age of the cohort was 30.5 ± 8.7 years, and 63.8% were female. Baseline laboratory data indicated mean hemoglobin of 8.5 g/dL and elevated lactate dehydrogenase (576.9 U/L). At 6 h, 10% and 20% of patients on morphine and nalbuphine, respectively, reported no pain (P = 0.013). At 24 h, 30% and 40% of patients on nalbuphine and 15% and 25% on morphine experienced no pain and mild pain, respectively (P = 0.00002). Nalbuphine patients required less rescue medication (41% vs. 59%, P = 0.009) and had higher discharge rates from the emergency department (70% vs. 46%, P = 0.0003). No significant difference was found in the incidence of acute chest syndrome or ICU admissions between the two groups.

Conclusion: Nalbuphine can be a potential alternative for vaso-occlusive crisis pain management in sickle cell disease patients, as it demonstrated superior efficacy compared with morphine, especially at later time points, with reduced need for rescue medication and earlier discharge.