Saudi Medical Journal最新文献

Objectives: To assess the prevalence and risk factors of isotretinoin-related epistaxis, among patients of acne vulgaris.

Methods: A retrospective cohort of 230 Saudi patients who received isotretinoin for treatment of acne vulgaris, was included in the study. An online questionnaire was used to collect data regarding demographics and treatment-related adverse events.

Results: The prevalence of isotretinoin-induced epistaxis was found to be 45.2%, which was a 5-fold increase in epistaxis, versus baseline. Epistaxis was reported by 90% patients who had a prior history of nasal bleeding. Patients with 'obstructed nose', reported a prevalence of 68.8%. The large majority of patients had a mild form of epistaxis, while nearly one-fourth reported moderate severity. A small subgroup of patients reported severe epistaxis warranting emergency room (ER) visits and blood transfusion. A staggering 93.5% and 61.3% patients were not advised by their dermatologists, regarding the importance of an ear-nose-throat (ENT) specialist consultation and nasal moisturization respectively, while taking isotretinoin.

Conclusion: The prevalence of isotretinoin-induced epistaxis is significantly high among Saudi patients; the complication can affect nearly half of the patients receiving this drug. Key risk factors include a prior history of nasal bleeding, nasal obstruction, poor awareness regarding the nasal adverse effects of epistaxis and its preventive measures. Isotretinoin should be prescribed judiciously by dermatologists, in consultation with ENT specialists, and with adequate patient education regarding its potential nasal adverse effects and steps to mitigate the same.

Objectives: To compare the demographic, clinical, and biochemical characteristics of newly diagnosed versus known patients with type 1 diabetes mellitus (T1DM) presenting with diabetic ketoacidosis (DKA) in a tertiary care center in the Western region of Saudi Arabia.

Methods: We retrospectively reviewed 147 children and adolescents diagnosed with T1DM who presented with DKAs between January 2019 and December 2023. Data on age, gender, nationality, economic status, episode severity, presenting symptoms, and biochemical markers were collected and analyzed.

Results: The mean patient age was 7.24 years, with known patients being older (mean age: 8.24 years) than newly diagnosed patients (mean age: 6.34 years). Most patients (55.8%) belonged to the middle-childhood age group (6 to 11 years). Among known patients, the most prevalent symptoms included vomiting, reported by 62 (88.6%) individuals, and abdominal pain, which affected 55 (78.6%). In contrast, new patients exhibited a strikingly high incidence of polyuria, with 68 (88.3%) cases, and polydipsia, affecting 65 (84.4%) individuals.

Conclusion: The DKA incidence was higher in newly diagnosed patients, particularly in the middle-childhood age group. Economic factors may contribute to disease manifestations, and newly diagnosed patients had longer DKA symptom durations. The higher DKA incidence and severity in newly diagnosed patients, particularly in certain age groups, underscores the importance of increased disease awareness and early diagnosis.

Objectives: To assess factors influencing choice of contraceptive methods among women in Mosul, Iraq.

Methods: An analytic cross-sectional study was conducted during the period extending from July 2022 to March 2023, and a convenience sample of 100 women at child-bearing age (15-49 years) was collected from those attending the Family Planning Clinic at Al-Khansaa Teaching Hospital in Mosul. A direct interview was used to collect data required by using a special questionnaire form. Data was tabulated and analyzed using Excel 2010 and Statistical Package of the Social Sciences, version 24.0. The frequency and percentage of variables have been calculated. Together with calculating factors influencing choice of contraceptive method by using the Chi-Square test to compare different factors, p-value of <0.05 was considered significant.

Results: The commonest method used was coitus interruptus (43%), follow by pills in 21%. The most important factor influenced the choice of the contraceptive method was the safety of method with fewer side effects (p=0.001).

Conclusion: Although different modern contraceptive methods are available, coitus interruptus (withdrawal) was found to be the most frequent method used awing to its safety. Adapting a national program to increase women's awareness for other method is needed to be applied in all antenatal care unit in Primary Health Center for pregnant women and encouraging them to decided using these methods after delivery.

Objectives: To compare the effectiveness of providing telepharmacy anticoagulation to on-site clinics in achieving optimal outcomes for patients newly starting warfarin.

Methods: This single-center retrospective cohort study included adult patients who started warfarin for the first time and were monitored by clinical pharmacists either on-site or via telepharmacy anticoagulation clinics between January 2017 and March 2024. The primary outcome is to compare the time in therapeutic range (TTR) between the 2 groups. The secondary outcome is the occurrence of anticoagulation therapy-related complications.

Results: We included 191 patients, with 77 in the telepharmacy group and 114 in the on-site group. The baseline characteristics were similar for both groups. The primary outcome- time in therapeutic range (TTR)-was not significantly different between thetelepharmacy and the on-site groups (50% versus 53.8%, p=0.455) and remained so after univariable and multivariable adjustments (OR [odd ratio]= 0.63, p=0.14 and OR=0.58, p=0.102). Additionally, there were no significant differences in secondary outcomes, including thromboembolism and bleeding (p=1 for both).

Conclusion: This study demonstrates that patients who receive warfarin for the first time at an anticoagulation clinic can use the telepharmacy method without the fear undesirable outcomes. Results of this study support the continued use and expansion of telepharmacy services in Saudi Arabia. However, further research larger sample sizes and multiple centers is needed to confirm these findings.

Objectives: To estimate the prevalence of hyperlipidemia in patients with psoriatic arthritis (PsA) in Riyadh, Saudi Arabia, and to investigate the relationship between PsA and hyperlipidemia.

Methods: This retrospective study examined medical records of PsA patients from January 2010 to May 2023 at 2 medical centers in Riyadh. Patients over 18 years old with a lipid profile were included. Hyperlipidemia cases were determined using Adult Treatment Panel III (ATP III) guidelines and European Association of Preventive Cardiology definitions based on lipid profile results.

Results: A total of 141 patients were included in the analysis. The prevalence of hyperlipidemia in patients with PsA was 40.7% at diagnosis, and 28.7% at the last visit. The prevalence of hyperlipidemia was significantly higher in males than females (56% versus [vs] 29.4%, p<0.005). While not statistically significant, among patients who received a biologic disease-modifying antirheumatic drugs (bDMARD), 31.6% had hyperlipidemia at the last visit, compared to 20% of those who did not receive it (p=0.317). Among patients who received conventional disease-modifying antirheumatic drugs (cDMARD), 30% had hyperlipidemia at the last visit, compared to 25.8% of those who did not it (p=0.813). The prevalence rates of hyperlipidemia at the first visit and the last visit were found to be statistically significant among patients who have comorbidities other than PsA (7.6 vs. 17.3%, p=0.004).

Conclusion: The study results are comparable to those of other studies showing no significant effect of PsA on the lipid profile. The prevalence of hyperlipidemia in PsA patients appears similar to that of the general population in Saudi Arabia, based on indirect comparison.

Objectives: To evaluate the safety and feasibility of the cable-transmitted, magnetically controlled capsule endoscopy (CT-MCCE) system for examining the esophagus and stomach.

Methods: A pilot study was carried out at the endoscopy facility of Peking University First Hospital; 30 volunteers were enrolled between September and November 2022. All participants were instructed to swallow the CT-MCCE capsule. An external magnetic robot arm was utilized to manipulate the capsule endoscope with string-facilitated control of the endoscope. This study assessed gastric preparation, safety, maneuverability, and mucosal visualization.

Results: The participants exhibited favorable reactions to the gastric preparation and examination, with no reported adverse effects, and the average duration of the gastric examination was 29.5±6.63 minutes. The gastric cavity cleanliness assessment revealed a good rating in 25 participants (83.3%) and a moderate rating in 5 participants (11.8%). TheCT-MCCE demonstrated good maneuverability in all 30 subjects (100%).The analysis of visualization indicated that more than 75% of the gastric mucosa was discerned in 79.4% of the participants (27 individuals), whereas 50% to 75% was visualized in 20.6% of the participants (7 individuals).

Conclusion: This study substantiates the feasibility and safety of employing magnetically controlled capsule endoscopy with cable transmission for the evaluation of human stomach and esophagus.