Saudi Medical Journal最新文献

Objectives: To provide an accurate estimate of autism spectrum disorder (ASD) prevalence among children in the Kingdom of Saudi Arabia (KSA) by benchmarking against international and regional data, addressing the limitations of the currently reported prevalence rate of 0.6%.

Methods: We conducted a comparative benchmarking analysis using ASD prevalence data from countries with advanced monitoring systems (United Kingdom, United States, Denmark, South Korea, Italy, Singapore) and regional comparators (United Arab Emirates, Qatar, Jordan). We assessed differences in healthcare infrastructure, diagnostic frameworks, and screening intensity, and reviewed recent KSA-based studies. Methodological limitations such as underreporting, cultural stigma, and diagnostic inconsistencies were also considered.

Results: The official General Authority for Statistics estimate of 0.6% underrepresents the actual prevalence of ASD in KSA. International benchmarks suggest higher prevalence, with the UK at 1.8%, the US at 3.2%, and South Korea at 2.6%. Regional studies in Qatar and the UAE show rates of 1.1% and 0.6%, respectively. KSA-specific studies report prevalence ranging from 1.3% (systematic review and meta-analysis across 24,000 children) to 2.5% (hospital-based screening in Riyadh). Integrating these findings, we estimate that the realistic prevalence in KSA lies between 1.7% and 1.8%.

Conclusion: The prevalence of ASD among children in KSA is substantially higher than the official estimate of 0.6%. A calibrated range of 1.7% to 1.8% better reflects the true prevalence and provides a foundation for evidence-based public health planning, early screening initiatives, and resource allocation for autism services in KSA.

Objectives: To evaluate unplanned reoperation (URO) as a quality indicator and identify its rate and associated risk factors at our institution. Parental satisfaction and patient safety are crucial, necessitating an investigation into the factors influencing unplanned return to the operating room rates. Understanding the reasons behind UROs and how to prevent them is vital for improving surgical services.

Methods: This study employs a retrospective cohort design to analyze existing patient data from King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia. It aims to evaluate clinical endpoints and factors associated with unplanned reoperations, which are defined as any secondary surgery occurring within 30 days of the initial procedure due to complications.

Results: From February 2015 to August 2023, a total of 2551 patients underwent 2963 abdominal surgeries. Among these, 75 (2.94%) patients required re-surgeries, resulting in a total of 179 surgeries. Regression analysis revealed that females had 2.1 times higher odds of requiring a reoperation compared to males (CI: 0.8-5.1, p=0.04). Furthermore, patients with a history of previous abdominal surgeries had 2.7 times greater odds of requiring reoperation (CI: 1.05-6.9, p=0.038). Other demographic variables did not demonstrate significant associations.

Conclusion: Monitoring URO rates is essential for enhancing pediatric surgical practices, improving preoperative counseling, and optimizing resource allocation.

Objectives: To classify serous effusions using the ISRSFC and assess malignancy risk across diagnostic categories, considering patient demographics and clinical features. Serous fluid cytopathology is a minimally invasive, cost-effective method for diagnosing benign and malignant conditions. The International System for Reporting Serous Fluid Cytopathology (ISRSFC) standardizes reporting, yet data from Saudi Arabia are limited.

Methods: A prospective observational study was conducted from October 2023 to June 2024. Serous fluid samples (peritoneal, pleural, pericardial) were stained with the Papanicolaou method and evaluated microscopically.

Results: Among 153 effusions, peritoneal (60.7%) was most common. Patients aged 41-66 comprised the largest group (41.2%). Cytologically, 36% were negative for malignancy, 19% atypia of undetermined significance (AUS), and 18.3% malignant. Risk of malignancy by ISRSFC category was: nondiagnostic (3.2%), negative for malignancy (5.4%), AUS (6.8%), suspicious for malignancy (52.7%), malignant (100%). Significant associations were found with clinical and demographic factors.

Conclusion: The ISRSFC effectively classifies effusions and stratifies malignancy risk. Peritoneal effusion was most frequent, highlighting cytology's diagnostic value and the need for further regional studies.

Objectives: To assess the prognostic significance of Borrmann classification subtypes in patients with stage 2-3 gastric cancer who underwent surgical treatment.

Methods: A retrospective review of 96 gastric cancer patients treated at Van Yüzüncü Yıl University Medical Faculty Hospital from 2008 to 2024 was conducted. Patients were included if they were aged >18 year (yr), had undergone surgery without neoadjuvant therapy, had no distant metastases, and had a postoperative pathological stage of 2-3. Demographic and clinicopathological data were documented, and median overall survival (OS) was analyzed according to the Borrmann classification.

Results: The median age of the 96 patients was 66 yr, and 36.4% were female. Total gastrectomy was performed in 45.8% of cases. According to the Borrmann classification, type 2 tumors (49%) were the most common. The tumor was most frequently located in the antrum and pylorus (45.8%), and adenocarcinoma was the predominant histopathological type (77.1%). Recurrence was observed in 63.5% of cases. The median OS was 54.66 months, with survival rates of 74.8% at 2 yr and 48.7% at 5 yr. Among Borrmann subtypes, type 1 tumors had the highest median OS (110.1 months) (p=0.787).

Conclusion: Although patients with Borrmann type 1 tumors had the highest OS rate, no significant prognostic differences were observed across the four Borrmann subtypes.

Objectives: To describe the utilization of the My Visit application for video calls between patients admitted to intensive care units (ICUs) and their families during the .COVID-19 pandemic as an alternative to hospital visits.

Methods: The My Visit (Zeyareti) application was launched in 2 National Guard Health Affairs hospitals in Riyadh, Saudi Arabia, in response to the COVID-19 pandemic in March 2020 and extended to all ICUs in August 2020. It allowed patients to communicate with their families using dedicated screens. This retrospective study was conducted using an automated satisfaction survey between September 2020 and September 2023.

Results: Over 37 months, 25,655 video calls were conducted in COVID-19 and non-COVID-19 ICUs, particularly during the pandemic's peaks. A total of 1,329 family members responded to the satisfaction survey, and 893 respondents identified their relationship with patients. Parents represented 58%, siblings 18%, children 15%, and spouses 7% of respondents. Most were very satisfied with the ease of registration/login (85.1%), the timing of virtual visits (76.4%), consideration for patient privacy (80.5%), staff cooperation (76%), and the hospital's video call initiative (80.4%). Feedback included 546 comments appreciating the staff and 233 remarks suggesting improvements.

Conclusion: During the COVID-19 pandemic, video calls between ICU patients and their family members were frequently conducted. Parents made up the majority of callers, and video calls were associated with high family satisfaction.

Objectives: To assess the long-term effects and mortality rates associated with GH therapy in patients with Prader-Willi Syndrome (PWS). Prader-Willi Syndrome is a rare genetic disease characterized by growth hormone (GH) deficiency among other endocrine disorders.

Methods: A systematic literature search was carried out on 4 databases including PubMed, Scopus, Web of Science, and Cochrane databases. The search was based on two keywords: "Growth hormone" AND "Prader-Willi Syndrome". Outcome data included height-standard deviation score (SDS), weight SDS, body mass index (BMI)-SDS, insulin like growth factor 1 (IGF1), mortality, low density lipoprotein (LDL)-cholesterol, and blood glucose.

Results: A total of 41 studies were included, of which 30 were involved in the meta-analysis. Following treatment with GH, height-SDS showed a significant increase compared to baseline in two timeline subgroups (≤2 years and >2 years), with a mean difference (MD) of 1.05 (95% CI: 0.92-1.18, p<0.00001) and 1.53 (95% CI: 1.23-1.82, p<0.00001), respectively. Patients on GH experienced a more pronounced increase in height-SDS compared to those who have not received GH. This was further associated with a lower BMI-SDS among GH-treated patients compared to their counterparts, with an MD of -1.02 (95% CI: -1.76 to -0.28, p=0.007; I²=84%, p=0.0003). Additionally, IGF1-SDS showed a marked increase after GH. Other metabolic effects include significant increase in LDL and blood glucose levels after GH treatment. The mortality rate in PWS patients undergoing GH treatment is estimated at 1.5% (95% CI: 0.8-2.2%), with causes including respiratory issues, cardiac arrest, infections, accidents, and gastrointestinal complications.

Conclusion: GH therapy in PWS significantly improves height and IGF-1 SDS, while relatively decreasing BMI compared to no-GH, indicative of lean mass growth and healthy development. Nonetheless, GH therapy requires careful metabolic monitoring due to its mixed effects on cholesterol and glucose levels.PROSPERO Reg. number: CRD420250649945.

Objectives: To update the national guidelines for proton therapy to reflect the evolving literature. The Saudi Particle Therapy Centre is making efforts to establish proton therapy services in the Kingdom of Saudi Arabia.

Methods: The Saudi Particle Therapy Center collaborated with the Saudi Association of Radiation Oncology to formulate a panel of radiation oncologists with proton therapy experience to refine and update our previous publication. The recommendation level was based on the overall evidence using a 4-grade scale following the World Health Organization quality of evidence recommendations. These updates focus on summarizing the literature and the level of recommendation for each disease site. The Panel identified key clinical questions to ensure that the guidelines were evidence-based, followed by a comprehensive literature review of PubMed, EMBASE, and other academic databases.

Results: The Panel reported that the body of evidence favored proton therapy for specific indications, including ocular tumors, skull and spine tumors, oropharyngeal cancer, hepatocellular carcinoma, specific genetic syndromes and mutations, pediatric rhabdomyosarcoma, pediatric central nervous system malignancies, tumors of the paranasal sinuses/nasal cavity, and for re-irradiation of all sites when curative treatment was intended. In addition, proton therapy may be considered at other sites when photon therapy exceeds the acceptable dose constraints for critical structures.

Conclusion: The Panel did not recommend the routine use of proton therapy for all cancers. Each case should be assessed individually following a multidisciplinary review and expert consultation while accounting for financial, logistical, and patient-specific factors.

Thyroid disorders encompass a variety of autoimmune conditions such as Graves' disease, Hashimoto's thyroiditis, as well as several types of thyroid cancer. Recent advancements in next-generation sequencing methodologies have elucidated significant genetic mutations, which include RET, BRAF, TPO, and more, which are associated with thyroid cancers and autoimmune disorders. BRAF V600E mutation as an indicator of prognosis in papillary thyroid carcinoma or the identification of genetic markers clarifies treatment strategies. Similarly, polymorphisms in immune regulatory genes such as CTLA-4, particularly when combined with HLA-DR, are linked to higher risk to autoimmune thyroid diseases. Molecular analysis plays a central role in achieving high diagnostic precision. Emerging molecular profiles offer further insight into the complex nature of these multifactorial conditions. This review highlights the impact of genetic and molecular research on diagnosis and management, highlighting the importance of these approaches for precision medicine in thyroid disorders.

Objectives: To investigate the incidence and nature of unusual histopathological findings in appendectomy specimens and assess their impact on post-appendectomy management.

Methods: A retrospective study was conducted on patients who underwent appendectomies at Jordan University Hospital between January 2015 and December 2024. It included patients with presumed diagnoses of acute appendicitis or those who underwent incidental appendectomies during other surgical procedures. Pathology reports with complete data and slides showing unusual findings were retrieved from the archives of the histopathology laboratory of the hospital. Statistical Package for the Social Sciences was used for statistical analysis.

Results: Of the 2,275 patients, unusual histopathological findings were identified in 171 (7.5%). These findings included fibrous obliteration (2%), serositis (1.2%), fecalith impaction (1.1%), low-grade appendiceal mucinous neoplasms (1%), mucinous adenocarcinoma (0.4%), Enterobius vermicularis infection (0.4%), well-differentiated neuroendocrine tumors (0.3%), mucosal hyperplasia (0.3%), endometriosis (0.3%), colon carcinomas involving the appendix (0.2%), high-grade appendiceal mucinous neoplasms (0.1%), diverticulosis (0.1%), ischemic changes (0.1%) and a sessile serrated polyp (0.0%).

Conclusion: Although acute appendicitis remained the primary diagnosis, appendectomy specimens revealed various incidental pathologies. Notably, mucinous neoplasms were more frequent than well-differentiated neuroendocrine tumors.