Annals of Saudi Medicine最新文献

Background: The safety and efficacy of granulocyte colony-stimulating factor (G-CSF) for the treatment of acute-on-chronic liver failure (ACLF) remain uncertain. Therefore, we conducted a meta-analysis to draw a firmer conclusion.

Methods: We searched the Cochrane library, PubMed, Embase, and China Biology Medicine disc to identify relevant RCTs performed before January 2020. Risk ratios (RRs) and their 95% confidence intervals (95% CIs) were calculated using a random effects model.

Main outcome measures: RRs (95% CI) for 1-, 2-, and 3-month survival rates.

Sample size: Six RCTs, including three open-label studies.

Results: The six studies included 246 subjects (121 in a G-CSF group and 125 in a control group). G-CSF administration significantly improved the 1-, 2-, and 3-month survival rates in patients with ACLF. The pooled RRs (95% CI, P) were 0.43 (0.27-0.69, P=.0004), 0.44 (0.32-0.62, P<.00001), and 0.39 (0.22-0.68, P=.0009), respectively.

Conclusion: G-CSF may be beneficial and effective in the treatment of ACLF, but further studies are needed to verify this conclusion.

Limitations: The sample size was small, and studies were restricted to countries in Asia.

Prospero registration number: CRD42021225681 CONFLICT OF INTEREST: None.

Background: Ultraportable or pocket handheld ultrasound devices (HUD) may be useful for large-scale abdominal aortic aneurysm screening. However, the reproducibility of measurements has not been compared with conventional cart-based ultrasound machines.

Objectives: Investigate the intra- and inter-operator reproducibility of a HUD compared with a conventional ultrasound machine for aortic screening.

Design: Analytical, cross-sectional.

Setting: Ultrasound department at a large tertiary care hospital in Riyadh.

Patients and methods: Eligible male participants aged ≥60 years were invited to participate upon arriving for a non-vascular ultrasound appointment. Three repeated anteroposterior measurements of the transverse aorta were made at the proximal and distal locations for each machine before repeating the measurements on a subset of participants by a second blinded operator. Intraclass correlation coefficients (ICC) and the Bland-Altman method were used to analyze reproducibility.

Main outcome measure: Inter-system and intra- and inter-operator ICCs.

Sample size: 114 males with repeated measurements by second operator on a subset of 35 participants.

Results: The median age (interquartile range) of participants was 68 years (62-74 years). The intra- and inter-operator ICCs were all >0.800 showing almost perfect agreement except for the inter-operator reproducibility at the proximal location using a conventional machine (ICC= 0.583, P=.007) and the Butterfly device (ICC=0.467, P=.037). The inter-system ICCs (95% CI) were 0.818 (0.736-0.874) and 0.879 (0.799-0.924) at the proximal and distal locations, respectively. The mean difference in aortic measurement between the ultrasound systems was 0.3 mm (1.7%) in the proximal location and 0.6 mm (3.6%) in the distal location. In total, >91% of the difference in measurements between the machines was <3 mm. The mean scanning time was 4:16 minutes for the conventional system and 3:53 minutes for the HUD (P=.34).

Conclusions: Abdominal aortic screening using a HUD was feasible and reliable compared with a conventional ultrasound machine. A pocket HUD should be considered for large-scale screening.

Limitations: No cases of abdominal aortic aneurysm in the sample and lack of blinding.

Conflict of interest: None.

Background: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities.

Objective: Review the outcomes of Rh alloimmunization, including indications and possible complications.

Design: Retrospective cohort (medical record review).

Setting: Tertiary care center.

Patients and methods: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations.

Main outcome measure: Complications of IUT.

Sample size: 119 mothers with 154 fetuses (154 different pregnancies).

Results: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations.

Conclusions: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization).

Limitations: Case series.

Conflict of interest: None.

Background: COVID-19 is an acute respiratory illness caused by a novel coronavirus (SARS-CoV-2). COVID-19 that might affect the eye in the form of conjunctivitis and other ocular features.

Objectives: Assess the frequency and clinical profile of conjunctivitis and other ocular findings in Iraqi patients with confirmed COVID-19 infection.

Design: Analytical cross-sectional study.

Setting: Secondary care center.

Patients and methods: This study involved patients diagnosed with SARS-CoV-2 viral infection of variable disease severity from June 2020 to December 2020. Ocular history and the severity of SARS-CoV-2 viral infection was assessed for all of the patients.

Main outcome measures: Frequency of conjunctival inflammation and other ocular findings in patients with coronavirus infection.

Sample size: 186 patients.

Results: The patients had a mean (standard deviation, range) age of 44.4 (18.8, 18-78) years. Conjunctivitis was present in 25 patients (13.4%). There was no significant association between prevalence of conjunctivitis and patient gender (P=.868). However, conjunctivitis was significantly associated with the severity of the disease (P=.018): the rate of conjunctivitis was significantly higher in cases with severe disease (28%) in comparison with those with mild to moderate clinical presentation (9.3%). The natural course of conjunctivitis seemed to be mild with no effect on visual acuity and no short-term complications.

Conclusion: Conjunctivitis can occur in patients with SARS-CoV-2 viral infection, and could be a presenting sign. Conjunctivitis is more common in cases of severe COVID-19 infection and since it could be a presenting sign it might be of benefit in the early diagnosis and treatment of COVID-19.

Limitation: Single-center study, safety limitations in the examination of the patients.

Conflict of interest: None.

Splenic abscess is an aggressive disease with a non-specific etiology and symptoms that are systemically detrimental. During the current COVID-19 pandemic, there has been a noted rise in the incidence of splenic abscesses. The aim of this article was to explore whether infection with the SARS-CoV-2 virus increases the risk of developing splenic abscesses. We reviewed three cases with SARS-CoV-2 infection who developed splenic abscess. The clinical characteristics, treatment course, management and outcome are reported. We perceived that hypercoagulability status, superimposing infections and immunosuppression were related to SARS-CoV-2 infection. These were common factors in these three observed cases of splenic abscess as a complication related to the new viral pandemic. SARS-CoV-2 infection might be a risk factor in development of splenic abscess. SIMILAR CASES PUBLISHED: To the best of our knowledge only one case similar to our case series was published.

Background: Cryptosporidium spp. is a protozoan parasite that infects many vertebrate animals, including humans. Since Cryptosporidium spp. can cause chronic life-threatening diarrhea and severe malabsorption in immunocompromised patients, we investigated the prevalence of this parasite among patients undergoing chemotherapy for malignant solid tumors.

Objective: Investigate the prevalence of Cryptosporidium spp. in stool samples.

Design: Cross-sectional.

Setting: Tertiary care.

Patients and methods: Stool samples were collected from adult patients with malignant solid tumors receiving chemotherapy and diarrhea. Cryptosporidium spp. prevalence was determined using Ziehl-Neelsen staining, ELISA, and real-time PCR targeting of the COWP gene.

Main outcome measure: The prevalence of Cryptosporidium spp. in patients undergoing chemotherapy for malignant solid tumors.

Sample size: 94 RESULTS: The prevalence was 2.1% (2/94), 5.3% (5/94), and 5.3% (5/94) as detected by Ziehl-Neelsen staining, real-time PCR and ELISA, respectively. The prevalence reached 8.5% (8/94) using all results obtained from the three methods. Among eight positive stool samples, four were positive by at least two different methods (Ziehl-Neelsen staining-ELISA or ELISA-real-time PCR) whereas the remaining four were positive by either ELISA or real-time PCR.

Conclusion: These findings show the risk of cryptosporidiosis in cancer patients and the necessity to use at least two diagnostic methods during the diagnosis of cryptosporidiosis to reach more accurate and trustworthy results.

Limitations: Further studies with a larger sample size are recommended.

Conflict of interest: None.

Background: Isolated involvement of the medial compartment of the knee in degenerative disease is encountered in about 25% of patients with gonarthrosis. We aim to show that in a well-selected group of such patients, medial unicompartmental knee arthroplasty (UKA) is a good option.

Objectives: Review the functional outcomes of patients undergoing UKA and determine the long-term survivorship of the implants and complications of the procedure.

Design: Analytical retrospective chart review.

Setting: Academic tertiary care medical center and tertiary care private hospital in the western region of Saudi Arabia.

Patients and methods: We selected patients who underwent medial UKAs by the same surgeon between December 1988 and December 2009. The life table approach and the Kaplan-Meier statistical method were used to estimate the survival rate (5-30 years) with revision as the endpoint. Functional outcome scores were determined according to the Knee Society Clinical Rating System.

Main outcome measures: Change in performance scores for pain, walking, and range of movement. Survivorship of the implants with removal of the implant as the endpoint; post-operative complications.

Sample size: 218 implants on 142 patients.

Results: The survival rate of UKA was 94.7% at 10 years (95% CI 0.906-0.970), 80.9% at 20 years (95%CI 0.724-0.871), and 77.8% at 30 years (95%CI 0.669-0.855). The average grand total functional score increased from 61 (maximum 200) at 0 months to above 150 at ≥6 months.

Conclusion: UKA is a good option for isolated medial compartment gonarthrosis with excellent functional outcome and good survivorship in selected patients.

Limitation: Single center experience, retrospective. We lost 6.0% of patients during follow-up. Comparison with other treatment modalities is based on literature review and not on our own data.

Conflict of interest: None.

Background: Adalimumab is a fully humanized monoclonal antibody inhibitor of tumor necrosis factor-a used to treat various autoimmune disorders. Adalimumab poses a risk for tuberculosis (TB) infection, especially in countries where TB is endemic.

Objective: Determine the rate of TB infection after adalimumab therapy in Saudi Arabia.

Design: Medical record review.

Settings: Tertiary care center in Riyadh.

Patients and methods: Demographic and clinical data were retrieved from the electronic healthcare records of all patients who received adalimumab treatment from 2015 to 2019.

Main outcome measures: Occurrence of TB after adalimumab therapy.

Sample size: 410 patients (median ([QR] age, 37 [28], range 4-81 years), 40% males RESULTS: Rheumatoid arthritis was the most frequent indication (n=153, 37%). The patients were followed for a mean of 36 (8.9) months. No case of TB infection or reactivation was observed. An inter-feron-gamma release assay (IGRA) was requested in 353/391 (90.3%) patients, prior to initiating therapy. The IGRA was positive in 26 cases (6.6%). The IGRA-positive patients received isoniazid prophylactically. Bacterial infectious complications of adalimumab therapy occurred in 12 (2.9%) patients. Urinary tract infection was the most frequent complication (culture requested in 48 patients, positive in 8).

Conclusion: Adalimumab treatment was not associated with a risk of TB disease or TB reactivation in our cohort over the follow-up observation period. No TB reactivation occurred with adalimumab therapy when TB prophylaxis was used. The positive IGRA rate in patients on adalimumab treatment was low (7%).

Limitations: Single center and one geographical area in Saudi Arabia.

Conflict of interest: None.

Background: Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications.

Objectives: Assess the effect of AMA on maternal and neonatal outcomes.

Design: Analytical cross-sectional study of medical records.

Settings: In-patient hospital tertiary care setting in Jeddah.

Patients and methods: All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes.

Main outcome measures: Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery.

Sample size: 1586 women.

Results: Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P<.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2-3.5, P<.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P<.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2-1.9, P=.002).

Conclusion: Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery.

Limitations: Cross-sectional design, small sample size, single hospital.

Conflict of interest: None.

Background: Breast cancer is the most common malignancy among women in Kuwait, representing 39.8% of all female cancer cases.

Objectives: Report the data of the Kuwait National Mammography Screening Program (KNMSP) for a 5-year period.

Design: Prospective data collection.

Setting: Population-based screening.

Subjects and methods: We included mammography screens done for Kuwaiti women (age 40 years and older) who attended the KNMSP from 2014 to 2019 to screen for breast cancer. A full-field digital mammography system was used to acquire the mammographic images in craniocaudal and mediolateral oblique projections. Independent double-blind reading of the mammograms was performed by two radiologists.

Main outcome measure: Early detection of breast cancer.

Sample size: 14 773 asymptomatic women met inclusion criteria (mean [SD] age, 51.8 (8.2).

Results: Lesions were detected in 551 women (3.7%). These included 233 malignant lesions (233/551, 42.3%), 57 high-risk lesions (10.3%) and 261 benign lesions (47.4%). The participation rate was 7.8% of the target population of women 40-69 years of age. The majority of breast cancer cases were reported in the age group 45-49 years (23.2%). The KNMSP study recall rate for 5 consecutive years was in a range of 11.9-16.5% (mean, 14.3%). The detection rate of ductal/lobular carcinoma in situ and invasive breast cancer were 2.5 and 13.6 per 1000 screened women, respectively. Invasive ductal carcinoma was the most common type. Only 4314 women followed up within 12-15 months of the first mammography for a retention rate of 29.2%.

Conclusions: Screening mammography improves early detection of breast cancer in women older than 40 years but poor participation is a limitation. We are aiming to increase the participation rate to 70% of the population.

Limitations: Lack of participation by women.

Conflict of interest: None.