Saudi Journal of Medicine & Medical Sciences最新文献

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.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Several prognostic scores exist in DLBCL, including the International Prognostic Index (IPI). More recently, a modification of the IPI that estimates the risk of progression to the central nervous system (CNS-IPI) was published. Whether the CNS-IPI index is sufficient to prognosticate DLBCL survival is yet untested.

Objectives: We aim to describe the outcomes of DLBCL patients based on CNS-IPI risk groups.

Methods: We retrospectively reviewed all DLBCL cases diagnosed from January 2015 until April 2022 at an academic tertiary hospital in Riyadh, Saudi Arabia. CNS-IPI was calculated at the time of diagnosis. The outcomes were compared between two CNS-IPI risk categories: low and intermediate/high-risk groups. Logrank method was used to calculate P value, and Kaplan-Meier method to estimate survival.

Results: A total of 136 patients were included (median age: 56.5 years), of which 38 (28%) died: 5 in the low-risk group and 33 in the intermediate/high-risk group. Low-risk and intermediate/high-risk CNS-IPI were found in 41 (30%) and 95 (70%) patients, respectively. The median survival in the low-risk and intermediate/high-risk CNS-IPI groups was 66 months [95% CI: 60-not-reached (NR)] and NR (95% CI: 24-NR) (P = 0.007), respectively. Only seven (5%) patients developed progression to the CNS, of which 6 (86%) were in the intermediate/high-risk group.

Conclusion: The risk of progression to the central nervous system was moderate in our diffuse large B-cell lymphoma population. Patients with intermediate/high-risk CNS-IPI had worse survival compared with low-risk patients. The CNS-IPI was found to a good model to not only estimate the risk of disease progression to the central nervous system but also overall survival.

Background: Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that adversely affects health-related quality of life (HRQoL) by causing joint damage, pain, functional impairment, and fatigue.

Objectives: The aim of this study was to assess the impact of biological disease-modifying antirheumatic drugs (bDMARDs) on fatigue, functional disability, and HRQoL in an Egyptian cohort with RA.

Methods: This observational analytical prospective cohort study included RA patients who needed to start bDMARDs immediately after the enrolment visit at two Rheumatology and Immunology Units. Clinical, therapeutic, and laboratory data were assessed at baseline and 4 months after administration of bDMARDs, along with the Functional Assessment of Chronic Illness Therapy-Fatigue 13 items, Health Assessment Questionnaire Disability Index (HAQ-DI), and Short Form-12 Health Survey (SF-12) questionnaires.

Results: A total of 85 patients with RA were included (mean age: 41.7 years). Most of the participants were female (87.1%). The most commonly administered bDMARDs were adalimumab (n = 26), golimumab (24), and etanercept (15). After bDMARD administration, there was significant improvement in the severity of fatigue (P <0.001, 95% CI: 14.59, 20.29) and median HAQ-DI scores (from 1.68 to 0.68; P <0.001, 95% CI: -1.06, -0.92). The number of patients with severe to very severe disability decreased significantly from 29 at baseline to 4 after 4 months after administration of bDMARDs (P <0.001). Additionally, the SF-12 domains showed significantly better scores after 4 months compared with baseline.

Conclusions: Administration of bDMARDs is associated with significant improvement in fatigue, functional disability, and health-related quality of life in patients with rheumatoid arthritis.

Background: Sleep disorders in the geriatric age group in Saudi Arabia are not adequately studied.

Objective: To estimate the prevalence of insomnia, excessive daytime sleepiness (EDS), and obstructive sleep apnea (OSA) among adults aged ≥60 years and to identify the predictors of these sleep disorders.

Methods: A cross-sectional study was conducted on 171 participants aged ≥60 years in a major family practice center in Riyadh, Saudi Arabia, using a self-administered questionnaire composed of previously validated Arabic versions of the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Berlin Questionnaire (BQ). Data on demographic characteristics, lifestyles, and comorbidities were collected.

Results: The prevalence of insomnia was 29.2% (95% CI: 22.6%-36.7%). The majority had severe EDS (77.8%, 95% CI: 70.8%-83.8%), and 22.2% (95% CI: 16.2%-29.2%) were considered at high risk for OSA. Gastroesophageal reflux disease was a significant risk factor for insomnia (OR = 5.72, 95% CI: 2.06-15.87, P = 0.001), while being married was significantly associated with a lower prevalence (OR = 0.18, 95% CI: 0.06-0.54, P = 0.002). Diabetes mellitus was significantly associated with a lower prevalence of EDS (OR = 0.08, 95% CI: 0.01-0.65, P = 0.018). Significant predictors of OSA were obesity (OR = 3.71, 95% CI: 1.34-10.29, P = 0.012) and hypertension (OR = 24.6, 95% CI: 4.35-139.27, P <0.001).

Conclusions: This study showed alarming levels of sleep disorders among the elderly in Riyadh, Saudi Arabia. Diabetes mellitus was significantly associated with a lower prevalence of excessive daytime sleepiness, while obesity and hypertension were significant predictors of obstructive sleep disorder.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction triggered by Aspergillus fumigatus colonization of the airways that primarily affects immunocompetent individuals, particularly those with asthma. ABPA can often be misdiagnosed as severe asthma or non-resolving pneumonia, leading to delays in appropriate management. Early recognition of ABPA is crucial to prevent disease progression and unnecessary antibiotic use. We report a case of a 28-year-old female with a long-standing history of poorly controlled asthma who presented with fever, productive cough, and radiographic findings initially suggestive of non-resolving pneumonia. Despite receiving multiple courses of antibiotics, her symptoms persisted. Further investigations, including elevated total serum IgE levels, Aspergillus-specific IgE, eosinophilia, and negative mycobacterial cultures, confirmed a diagnosis of ABPA. The patient was successfully treated with systemic corticosteroids (prednisone) and itraconazole, leading to significant clinical and radiological improvement over 2 months. Her IgE levels markedly decreased, supporting resolution of the hypersensitivity reaction. This case underscores the importance of recognizing ABPA in patients with recurrent asthma exacerbations and unexplained pulmonary symptoms. Given the potential for misdiagnosis as pneumonia, clinicians should maintain a high index of suspicion for ABPA, particularly in cases of non-resolving pneumonia where antibiotic therapy fails to achieve improvement.

Objective: This case-control study aimed to determine the correlation between single nucleotide polymorphisms (SNPs) in the neurotransmitter transporter genes SLC6A3 and SLC6A4 and childhood autism spectrum disorder (ASD), as well as the severity of the disease.

Patients and methods: Children with ASD and age- and sex-matched healthy controls were recruited from a hospital and schools, respectively. Seven SNPs in the SLC6A3 gene and three SNPs in the SLC6A4 gene were analyzed in blood cell DNA using the TaqMan probe approach. The severity of the disease was evaluated using the Childhood Autism Rating Scale (CARS).

Results: A total of 249 children with ASD and 343 controls were included. The genotype frequencies of the examined SNPs were not correlated with childhood ASD. Only the T allele of the SNP rs140700 displayed a non-significant association with a reduced risk of childhood ASD (OR = 0.6, 95% CI: 0.4-1.0, P = 0.0517). Interestingly, the C allele of rs140701 was significantly correlated with lower disease severity (OR = 0.6, 95% CI: 0.4-0.9, P = 0.0093). Additionally, the genotype of rs27072 was significantly associated with the score of the body use domain of CARS; however, no examined SNPs showed a significant association with the overall score.

Conclusion: Certain SNPs on neurotransmitter transporter SLC6A3 and SLC6A4 genes are correlated with the severity of childhood autism spectrum disorder but not with the risk of developing the disease. Further studies are needed to explore the underlying mechanisms and potential clinical applications.

Background: Perceived social support represents a key factor influencing both mental and physical health, yet brief Arabic measures are scarce.

Objectives: To assess the psychometric properties of the Arabic version of the abbreviated 6-item Medical Outcomes Study-Social Support Survey (MOS-SSS-6) among Saudi adults.

Methods: An online questionnaire was distributed via social media platforms to assess perceived social support, psychological distress, quality of life (QoL), and coping. Cronbach's alpha (α), McDonald's omega (ω), and corrected item-total correlations were used to evaluate the scale's reliability. Exploratory factor analysis (EFA) was conducted on 50% of the sample, using maximum likelihood with varimax rotation to identify factor structure. Confirmatory factor analysis (CFA) validated the model in the other 50%, with fit assessed through RMSEA, SRMR, CFI, TLI, and other indices. Concurrent validity was evaluated through Pearson's correlations with relevant psychological measures.

Results: A total of 1028 Saudi adults completed the questionnaire. Suitability of the data for EFA was supported by a strong KMO value (0.83) and significant Bartlett's test of sphericity (P < 0.001). Parallel analysis indicated that a three-factor solution was optimal, explaining 80% of the variance. CFA confirmed this model with excellent fit indices (CFI = 0.99, TLI = 0.98, RMSEA = 0.07, SRMR = 0.02, GFI = 0.99, AGFI = 0.95). Negative relationships with depression (r = -0.24, P < 0.01) and anxiety (r = -0.17, P < 0.01), and a positive correlation with QoL (r = 0.37, P < 0.01) and adaptive coping strategies provided evidence for concurrent validity. The Arabic MOS-SSS-6 exhibited high internal consistency (α = 0.90, ω = 0.90).

Conclusions: The Arabic MOS-SSS-6 is a reliable and valid instrument for measuring perceived social support among Saudi adults, demonstrating significant correlations with psychological variables relevant for psychological assessments and interventions.

Background: Calcaneal fractures are one of the most common fractures affecting the tarsal bone; however, their epidemiology and management in the United Arab Emirates (UAE) is not well studied.

Objective: To evaluate the epidemiology, injury patterns, and treatment approaches for calcaneal fractures in the UAE.

Methods: This retrospective study included adult patients (≥18 years) who were diagnosed with calcaneal fractures at Rashid Hospital, Dubai, UAE, over a 6-year period. Demographics, injury characteristics, fracture type, treatment, and associated injuries were all assessed.

Results: A total of 1082 patients with calcaneal fracture cases were included, with males comprising 87.3% (male-to-female ratio: 6.9:1). Most patients were aged 20-39 years (69.5%). The most common cause of the fracture was falls (68.6%), mostly from ≤3 meters (48.9%). Surgery was performed in 28.4% of cases, most often for closed displaced fractures (45.7%). Lower limb (48%) and spine (8.5%) were the most common associated injuries.

Conclusions: Calcaneal fractures in the UAE are predominantly seen in young males, usually resulting from falls, most commonly leading to closed displaced fractures, and commonly associated with significant comorbid injuries. The results support the necessity of providing the target populations with preventive measures and identifying the efficient management approaches to reduce the morbidity level.