Saudi Journal of Medicine & Medical Sciences最新文献

Background: Increasing trend and spread of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical settings is a great challenge in managing patients with infections caused by this pathogen.

Objective: To determine the risk factors and outcomes of MDR-PA acquisition in the northeastern state of Malaysia. In addition, this study also reported on the susceptibility pattern and common resistant genes among MDR-PA.

Materials and methods: MDR-PA isolates obtained between March 2021 and February 2022 from all four major hospitals in the state of Kelantan, Malaysia, were submitted for susceptibility and resistant genes identification. The clinical data of the patients with MDR-PA were retrospectively reviewed. The risk factors and outcomes of MDR-PA acquired patients were analyzed by comparing with patients who acquired susceptible-PA while admitted to the same hospital during the study time.

Results: A total of 100 MDR-PA and 100 susceptible-PA cases were included. Ceftolozane-tazobactam was susceptible in 41.3% of MDR-PA compared to only 4%-8% with other β-lactams. About half (46%) of the MDR-PA isolates harbored the bla _-NDM-1 gene, but none had the bla _-OXA-48 gene. Factors independently associated with MDR-PA acquisitions were age (OR: 1.02; P = 0.028), genitourinary disorder (OR: 6.89; P = 0.001), and central venous catheter (OR: 3.18; P = 0.001). In addition, MDR-PA acquisitions were found to be associated with antimicrobial treatment failure (41.1% vs. 25.0%; P = 0.001) and mortality (40.0% versus 6.0%; P <0.001).

Conclusion: Most of the MDR-PA strains in Kelantan tertiary hospitals harbored the bla _-NDM-1 gene, which is easily transmissible and can lead to an outbreak. Nonetheless, a significant number of the MDR-PA isolates were still susceptible to ceftolozane-tazobactam.

Background: Prevalence of seropositivity following SARS-CoV-2 infection is vital in evaluating herd immunity. However, depending on illness severity, it remains unclear whether the breadth and magnitude of immune response to SARS-CoV-2 infection is for short or long term.

Objective: To test the persistence of humoral antibody responses after SARS-CoV-2 exposure in patients with different illness severity and among volunteers who had been vaccinated.

Methods: This study was conducted in two Saudi Arabian tertiary hospitals. Participants were categorized as critically ill COVID-19 patients, non-critically ill COVID-19 patients, or vaccinated volunteers. We collected demographic data, COVID-19 exposure history, symptoms, vaccination details, and serum samples to analyze antibody persistence. We evaluated SARS-CoV-2 antibody concentrations in COVID-19 patients with varying disease severity and age groups, as well as in BNT162b2-vaccinated individuals, focusing on IgG levels against the S.FL and S1 domains of the spike protein.

Results: The study included 172 adults: 92 unvaccinated hospitalized COVID-19 patients and 80 vaccinated volunteers. All vaccinated subjects demonstrated seropositivity to the SARS-CoV-2 spike protein, with nearly 80% having a median antibody titer of 13,500 AU/mL. Notably, vaccinated subjects exhibited significantly higher IgG levels than naturally infected patients (P < 0.001), including higher S.FL and S1 titers, regardless of severity. Age, comorbidities, and previous infections influenced S-specific antibody levels. Among hospitalized patients, 58% required intensive care, with 28- and 90-day mortality rates of 23% and 43%, respectively.

Conclusion: These findings shed light on the immune response dynamics following SARS-CoV-2 infection compared to vaccinated individuals, where the latter showed significantly higher level of antibodies response, providing crucial insights for evaluating short-term herd immunity and the effectiveness of natural infection-induced immunity.

Background: Cronobacter sakazakii is an opportunistic pathogen that mostly affects neonates, infants, and elderly people with weakened immune systems. No study has reported the frequency and antibiotic susceptibility patterns of C. sakazakii from Oman, and thus this study was conducted to fill this gap in the literature.

Materials and methods: This single-center retrospective study included C. sakazakii isolates identified from different clinical samples of patients treated at Sohar Hospital, Oman, between January 2017 and December 2023. Bacterial identification and antibiotic susceptibility testing were done using the VITEK II automated microbiological system in accordance with the Clinical Laboratory Standards Institute (CLSI) guidelines.

Results: A total of 185 C. sakazakii isolates were included, most commonly from patients aged >60 years (42.7%) and <1 year (11.4%). C. sakazakii strains had high susceptibility (>80%) to most of the tested antibiotics; however, for beta-lactam antibiotics, it ranged from 0% to 50%. Approximately 26.5% of the strains were multidrug resistant. Independent risk factors for increased frequency of multidrug-resistant strains were urinary catheterization (P = 0.002), surgery (P = 0.021), previous antibiotic therapy (P = 0.047), and critical care unit admission (P = 0.048). About one-fifth of the patients experienced life-threatening C. sakazakii infections such as septicemia (15%) and pneumonia (4.7%). All deaths due to septicemia occurred in the >60 years (n = 12) and <1 year (n = 4) age groups.

Conclusions: Cronobacter sakazakii isolates from the North Batinah region of Oman were most frequently isolated from elderly and infant patients and had high antibiotic susceptibility; however, the significant resistance against beta-lactams suggests their low effectiveness. The high number of multidrug-resistant strains coupled with the independent risk factors suggests the need for following stricter antibiotic stewardship protocols and infection control practices.

Background: Patients with hematological malignancies (HM) are at risk for complications, including neutropenia and admission to the intensive care unit (ICU). Granulocyte colony-stimulating factors (GCSF) can accelerate progenitor cells' proliferation and differentiation, and thus compensate for neutropenia. In patients with HM admitted to ICUs in Saudi Arabia, the outcome and impact of GCSF use on neutropenia duration and severity is understudied.

Objective: To evaluate the outcome and impact of GCSF on neutropenia in patients with HM admitted to the ICU of a tertiary care center in Saudi Arabia.

Methods: This retrospective study included all consecutive patients diagnosed with an HM admitted to the ICU at King Saud University Medical City, Riyadh, Saudi Arabia, from 2018 to 2022. Data on demographics, clinical information, ICU admission, and outcomes were collected.

Results: A total of 44 patients with HM admitted to the ICU were included, of which 43.2% were females and the mean age was 50.2 ± 21.1 years. The mean length of ICU stay was 12.3 ± 14.7 (range: 0-62) days. ICU mortality was 61.4%, with no further mortality within 90 days after discharge. There was no significant association between survival and age (P = 0.205), gender (P = 0.7), and neutropenia (P = 0.566) or the use of GCSF prior to ICU admission (P = 0.882). There was a significant association between the category of ICU intervention and survival (P = 0.007).

Conclusion: Patients with hematological malignancies who were admitted to an ICU in Saudi Arabia had a high mortality, regardless of neutropenia or the use of granulocyte colony-stimulating factor.

Objective: This study assessed the prevalence of eosinophilic chronic obstructive pulmonary disease (COPD) among a selected Saudi population and examined its correlation with baseline characteristics, clinical outcomes, exacerbation risk, and current management.

Materials and methods: This retrospective single-center study was conducted over a 2-year period. The patients were divided into two groups based on the blood eosinophil count at the time of diagnosis: eosinophilic COPD (≥300 cells/μl) and non-eosinophilic COPD (<300 cells/μl) groups.

Results: Overall, 156 patients were included, of which 76 (48.7%) and 80 (51.3%) patients belonged to the eosinophilic and non-eosinophilic COPD groups, respectively. There were no significant differences between both groups regarding age, gender, smoking status, coexisting morbidities, FEV1, FEV1/FVC, and COPD severity (for all, P >0.05). Besides, there were no significant differences between both groups regarding the frequency and numbers of exacerbations, emergency room visits, in-patient hospitalizations, and intensive care unit admissions (for all, P >0.05). Among patients with eosinophilic COPD, 64 patients (84.2%) were correctly receiving the triple therapy of long-acting β2 agonists + long-acting muscarinic antagonist + inhaled corticosteroids, whereas 4 patients (5.26%) were incorrectly receiving the dual therapy of long-acting β2 agonists + inhaled corticosteroids. Univariate regression analyses revealed that heart failure, GOLD 3 severity, use of triple therapy, and use of non-invasive ventilation were significantly correlated with a higher risk of COPD exacerbation. Conversely, higher FEV1 was significantly correlated with lower risk of COPD exacerbation. The eosinophilic COPD phenotype was not found to be a significant independent variable of COPD exacerbation.

Conclusion: This study found that among Saudi patients with COPD, there was no clinically important relationship between baseline blood eosinophil count and the rate of exacerbation.

Background: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in Saudi Arabia, yet there is a lack of studies on the usefulness of routine hematological parameters in predicting mortality.

Objective: To determine hematological parameters that can predict mortality in patients with COPD exacerbation admitted to intensive care units.

Materials and methods: This multicenter retrospective study included patients with COPD admitted at intensive care units of Ministry of National Guard Health Affairs hospitals in Saudi Arabia between 2016 to 2021. Hematological parameters were used to predict mortality. ROC curve analysis was used to establish the threshold value of variables linked to risk of mortality and optimal cut-off points, and its sensitivity and specificity were determined.

Results: The study included 323 patients with COPD, of which 61% were females and the mean age was 72.7 (±12.7) years. The median length of hospital stay was 14 days (range: 6-26 days), and the overall mortality rate was 37.2%. After adjusting for gender and length of hospital stay in the multivariate analysis, independent predictors of mortality were age (OR: 1.029, 95% CI: 1.008-1.051; P = 0.007) and low mean corpuscular hemoglobin concentration (MCHC) (OR: 0.985, 95% CI: 0.970-1.000; P = 0.047). The ROC curve analysis revealed a cut-off value of 320.5 g/L for MCHC, with an AUC of 0.576.

Conclusion: This study found that in patients with COPD exacerbation admitted to ICU, older age likely increases the risk of mortality, whereas low MCHC likely decreases the risk of mortality. Further large-scale studies are required to validate these findings.

Bipolar disorders (BP) are prevalent neuropsychiatric illnesses affecting 1%-5% of the global population and about 3% of the Saudi population. They are associated with significant comorbidities and negative consequences. Despite being common mental health conditions in Saudi Arabia, stigma persists, with weak character, supernatural beliefs, and weak faith considered as causes. In addition, Saudi patients with BP have been reported to seek help from non-psychiatric healthcare professionals and faith healers. More data are required on BP from Saudi Arabia, including the genetic aspects and their treatment approaches. This narrative review paper explores the epidemiology and clinical manifestations, etiology and biological mechanisms, public knowledge and awareness of the illnesses, and treatment of BP in Saudi Arabia.

Background: Obstructive sleep apnea (OSA) is a common condition, but there is a lack of evidence from Saudi Arabia regarding its impact on the academic performance of medical students.

Objectives: To determine the prevalence and associated factors of OSA among medical students at a Saudi Arabian university and its impact on academic performance.

Methods: This cross-sectional study was conducted between October and December 2021 and selected first- to fifth-year medical students at King Saudi University, Riyadh, using a disproportionate stratified random sampling according to gender and academic year. The questionnaire comprised two sections: the first elicited sociodemographic information, self-reported GPA, and presence of chronic diseases, while the second included the English and Arabic versions of the Berlin Questionnaire.

Results: A total of 621 responses were received, of which 61.8% were male and the mean age was 21.1 (±1.7) years. The prevalence of high-risk OSA was 14.5%. There was a significant association between being at a high risk of OSA and male gender (P < 0.001). In the multiple logistic regression model, male gender (odds ratio [OR] = 1.69, 95% CI: 1.01-3.9; P = 0.047) and overweight/obesity (OR = 2.59, 95% CI: 1.92-3.5; P = 0.001) were significant predictors of OSA. OSA was not a significant predictor of academic performance (OR: 0.7, 95% CI: 0.48-1.03; P = 0.07).

Conclusion: This study found that among first- to fifth-year medical students at a Saudi Arabian university, male gender and obesity were significant predictors of obstructive sleep apnea. On the other hand, obstructive sleep apnea was not a significant predictor of academic performance.

Idiopathic hypereosinophilic syndrome (HES) is a rare disorder characterized by persistent hypereosinophilia leading to multi-organ dysfunction. Its clinical manifestations vary widely; however, cardiac and neurological involvement are the leading causes of morbidity and mortality. Corticosteroids are the initial treatment of choice, but in idiopathic HES resistant to corticosteroids, second-line therapy should be considered. Imatinib is usually reserved for patients with a positive platelet-derived growth factor receptor A (PDGFR-A) mutation; however, its use in idiopathic HES with a negative PDGFR mutation is debatable given that such patients usually respond well to high doses of corticosteroids. Here, we present a case of a young male with corticosteroid-refractory idiopathic HES successfully treated with imatinib. The patient presented with features suggestive of acute coronary syndrome and confusion. A coronary angiogram was normal. Echocardiography showed an ejection fraction of 37%, and brain imaging showed evidence of multifocal cerebral thromboembolic infarcts. During the hospital stay, the patient developed diffuse alveolar hemorrhage. Biochemically, it was noted that the patient had hypereosinophilia. Through thorough workup, a diagnosis of idiopathic HES was established. The patient was started on high-dose corticosteroid (500 mg intravenous methylprednisolone daily) followed by a maintenance dose of prednisolone (0.5 mg/kg/day), but had no response. Second-line therapy with imatinib (400 mg per oral daily for 4 days and then down-titrated to 100 mg daily) was initiated, which resulted in drastic biochemical and clinical improvements. This case report supports the efficacy of imatinib as a second-line agent in corticosteroid-resistant idiopathic HES with a negative PDGFR mutation.

Background: Breast density is an independent risk factor for breast cancer and affects the sensitivity of mammography screening. Therefore, new breast imaging approaches could benefit women with increased breast density in early cancer detection and diagnosis.

Objectives: To assess the diagnostic performance of abbreviated breast MRI compared with mammography and other imaging modalities in screening and diagnosing breast cancer among Saudi women with dense breast tissue.

Methods: A retrospective diagnostic study was conducted using anonymized medical images and histopathology information from 55 women, aged ≥30 years, who had dense breasts (Breast Imaging and Reporting Data System [BI-RADS] breast density categories C and D) and an abnormal mammogram. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated for mammography, digital breast tomosynthesis (DBT), synthetic mammography (SM) derived from DBT, ultrasound, and abbreviated breast MRI (ABMRI).

Results: A total of 19 women had pathology-proven breast cancer. Among all methods, ABMRI showed the highest sensitivity (94.7%) and specificity (58.3%), while mammography showed the lowest (84.2% and 44.4%, respectively). AUC for ABMRI was higher than all the methods including mammography (0.751 vs. 0.643; P < 0.05).

Conclusion: ABMRI appears to be more accurate in cancer diagnosis than mammography and other modalities for women with dense breast tissue. Further research is advised on a larger sample of Saudi women to confirm the benefit of ABMRI in breast cancer screening and diagnosis for women with increased breast density.