Annals of Saudi Medicine最新文献

Background: The rise in the incidence of implantation is one of the main causes behind the increased rate of CIED infection, which is considered as a serious life-threatening complication. The need of risk factor assessment has become a necessity to prevent further complications and provide prompt management.

Objectives: Identify the risk factors of infection postoperatively among patients who have implantable cardiac devices.

Design: A retrospective case-control study.

Settings: Cardiac center for adults.

Patients and methods: The study included all adult patients (≥14 years of age) of all nationalities who underwent cardiac electronic device implantation that was managed in the cardiac center between January 2012 to December 2018.

Main outcome measures: Cardiac device infection and associated risk factors.

Sample size: 213, including 23 (10.8%) infected case patients and 190 (89.2%) non-infected controls.

Results: The mean (SD) age of non-infected patients was 45.0 (12.7) years compared with 61.7 (13.7) for infected patients (P<.0001). Anticoagulant use, hypertension, dysplipdemia and age were the most common patient-related risk factors associated with infection. For procedural and post-procedural risk factors, the risk of infection increased as the number of leads and length of procedure increased. The device most often related to infection was the pacemaker. In the multivariate analysis, longer procedure, greater number of leads, older age, anticoagulant use, and implanted pacemaker device were independently associated with infection.

Conclusion: We advise the prompt use of strict preoperative antiseptic prophylaxis measures and follow-up for post-implant patients along with patient education for early signs of infections, which will lead to improvement of both diagnosis and treatment quality for our patients in addition to reducing the economic impact on the health care system by minimizing infectious complications.

Limitations: Single tertiary center study, small sample size.

Conflict of interest: None.

Background: Globally, alcohol withdrawal syndrome (AWS) is considered a serious medical diagnosis associated with increasing morbidity and mortality. Little information has been reported on the scope of the problem in Oman.

Objective: Study clinical characteristics, management, quality of care, and health outcomes of patients managed for AWS.

Design: Retrospective medical record review.

Settings: University hospital.

Patients and methods: The study included all patients with AWS admitted from 1 October 2019 to 30 September 2020. We collected demographic and clinical characteristics and did a univariate analysis of factors related to 90-day readmission.

Main outcome measures: Length of hospital stay, 90-day read-mission, referral rate to alcohol rehabilitation center.

Sample size and characteristics: 150 male patients with median (IQR) age of 39.5 (32-48) years.

Results: Most patients (70.7%, n=106) were smokers and 44 (29.3%) had a history of drug abuse. The average length of hospital stay was 2.3 (0.9-4.6) days. Approximately 9% of total hospital bed days were used to care for patients with AWS. Chronic liver disease (35.3%), diabetes mellitus (24.7%), and hypertension (24.0%) were common among AWS patients. The 90-day readmission rate (32.7%) was high, and there was low referral to alcohol rehabilitation (16.7%). Diabetes and epilepsy were associated with 90-day readmission.

Conclusion: AWS is an important diagnosis that represents an important burden on acute medical services. Establishing a drug and alcohol service in our institution is an essential step to optimise care for patients with alcohol-related disorders.

Limitations: Retrospective, so unable to collect data on manifestations of AWS such as delirium tremens, which is the most severe form of AWS. Also, the reason for the lack of referral to an outpatient alcohol rehabilitation program was not apparent.

Conflict of interest: None.

Background: Pneumonia is among the most serious infections in the elderly. The evaluation of prognosis and predicting the outcome is essential in managing the treatment of patients with pneumonia.

Objective: Evaluate factors that might affect the mortality of elderly patients hospitalized for community-acquired pneumonia (CAP) in two age groups.

Design: Medical record review.

Settings: Tertiary care hospital.

Patients and methods: The study included CAP patients who were hospitalized during the period from January 2017 and December 2019. The CURB-65 scale was chosen to assess the severity of pneumonia on admission. Multivariate analyses were conducted separately for patients younger than 75 years and 75 years or older.

Main outcome measures: 30-day mortality, factors associated with mortality.

Sample size and characteristics: 1603 patients with a median age of 74, including 918 women (57%).

Results: The 30-day mortality rate was 6.5%. Patients with carbapenem-resistant gram-negative bacteria had lower survival rates (P<.0001). In the multivariate analysis, age, lung cancer, CURB-65, carbapenem resistance, and duration of hospital stay were associated with mortality in patients aged 75 years or older. Lung cancer, malignant disease, carbapenem resistance, duration of hospital stay and procalcitonin level were associated with mortality under the age of 75. Of 640 sputum cultures tested, P aeruginosa (42%) was the most common pathogen.

Conclusion: The risk factors that affected mortality differed among patients aged 75 years or older versus younger patients. Our findings are important in determining factors associated with mortality in managing the treatment and follow up of hospitalized CAP patients younger or 75 years of age or older.

Limitations: Single-center, retrospective.

Conflict of interest: None.

Background: Screening programs for the most prevalent conditions occurring in a country is an evidence-based prevention strategy. The burden of autosomal recessive disease variations in Saudi Arabia is high because of the highly consanguineous population. The optimal solution for estimating the carrier frequency of the most prevalent diseases is carrier screening.

Objectives: Identify the most influential recessive alleles associated with disease in the Saudi population.

Design: We used clinical whole-exome sequencing data from an in-house familial database to evaluate the most prevalent genetic variations associated with disease in a Saudi population.

Settings: King Abdullah International Medical Research Center (KAIMRC) and King Abdulaziz Medical City.

Methods: Whole exome sequencing data obtained from clinical studies of family members, a cohort of 1314 affected and unaffected individuals, were filtered using the in-house pipeline to extract the most prevalent variant in the dataset.

Main outcome measures: Most prevalent genetic variations associated with disease in the Saudi population.

Sample size: 1314 affected and unaffected individuals.

Results: We identified 37 autosomal recessive variants and two heterozygous X-linked variants in 35 genes associated with the most prevalent disorders, which included hematologic (32%), endocrine (21%), metabolic (11%) and immunological (10%) diseases.

Conclusion: This study provides an update of the most frequently occurring alleles, which support future carrier screening programs.

Limitations: Single center that might represent the different regions but may be biased. In addition, most of the families included in the database are part of the proband's genetic identification for specific phenotypes.

Conflict of interest: None.

Background: Postoperative pulmonary complications in patients who undergo open heart surgery are serious life-threatening conditions. Few studies have investigated the potentially beneficial effects of preoperative physiotherapy in patients undergoing cardiac surgery.

Objectives: Assess the effects of preoperative chest physiotherapy on oxygenation and lung function in patients undergoing open heart surgery.

Design: Randomized, controlled.

Setting: University hospital.

Patients and methods: Patients with planned open heart surgery were randomly allocated into an intervention group of patients who underwent a preoperative home chest physiotherapy program for one week in addition to the traditional postoperative program and a control group who underwent only the traditional postoperative program. Lung function was assessed daily from the day before surgery until the seventh postoperative day.

Main outcome measures: Differences in measures of respiratory function and oxygen saturation. Length of postoperative hospital stay was a secondary outcome.

Sample size: 100 patients (46 in intervention group, 54 in control group).

Results: Postoperative improvements in lung function and oxygen saturation in the intervention group were statistically significant compared with the control group. The intervention group also had a statistically significant shorter hospital stay (P<.01).

Conclusion: Preoperative chest physiotherapy is effective in improving respiratory function following open heart surgery.

Limitations: Relatively small number of patients.

Conflict of interest: None.

Registration: ClinicalTrials.gov (NCT04665024).

Percutaneous Y-shape reconstructive biliary stenting in the Klatskin tumor is typically performed through bilateral biliary access. Single access from a right-side biliary entry is the more commonly used side for biliary access in general. We present a successful Y-shaped biliary stent reconstruction through a single left-side biliary approach. Unilateral single access Y-shaped biliary stenting can be technically challenging; when performed through a left biliary approach, an additional technical challenge may arise due to the unusual combination of Y-shaped biliary stent reconstruction and the single left-side biliary approach. We concluded that percutaneous Y-shaped biliary reconstruction through a left-sided unilateral approach is a technically feasible, less invasive interventional approach in managing Klatskin tumor. SIMILAR CASES PUBLISHED: None.

Background: Our understanding of the risk factors, prevalence, incidence rate, and age distribution of bladder cancer (BC) in Saudi Arabia is insufficient due to limited data.

Objective: Describe the epidemiology and analyze factors associated with survival in patients with BC in Saudi Arabia.

Design: Retrospective medical record review.

Settings: Registry-based nationwide study.

Patients and methods: The study included all records in the Saudi Cancer Registry of patients diagnosed with a primary BC from 1 January 2008 to 31 December 2017. Collected data included year of diagnosis, gender, age, marital status, region and nationality, tumor site of origin, tumor histological subtype, tumor behavior, tumor grade, tumor extent, tumor laterality, the basis of the diagnosis, and survival status. Factors predicting survival were tested by a Kaplan-Meier and Cox proportional hazards regression analysis.

Main outcome measures: Mortality status on last contact.

Sample size: 3750 patients.

Results: The overall incidence of BC was 1.4 per 100 000 persons. Significant differences in the distribution of survival were observed by age, gender, nationality, place of residency, tumor morphology, tumor grade and extension. The adjusted predictors of decreased survival were age, squamous cell carcinoma, Grade III and IV bladder tumors, regional direct extension, regional lymph node extension, combined regional lymph node and direct extension, and distant metastasis. Male gender and being widowed were predictors of improved survival in the unadjusted analysis.

Conclusion: This study provides further understanding of BC in a region with a high prevalence of risk factorsuch as smoking. Highlighting these factors, specifically in Saudi Arabia, improves evidence-based practice in this region and may facilitate appropriate care to optimize outcomes.

Limitations: Retrospective study and underreporting.

Conflict of interest: None.

Background: Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia.

Objectives: Descriptive overview of poisoning cases at a tertiary care center.

Design: Descriptive, medical record review.

Settings: Tertiary care center in Riyadh.

Patients and methods: From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index.

Main outcome measures: Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes.

Sample size: 492 adults and 1013 children (<18 years old) were identified.

Results: The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment.

Conclusion: Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies.

Limitations: Single center, retrospective, small population size.

Conflict of interest: None.

Background: Data on human papillomavirus (HPV) prevalence and survival rates among HPV-infected women are scarce in Saudi Arabia.

Objective: Assess the prevalence of HPV genotypes in cervical biopsy specimens and its effect on survival over a 10-year timeframe.

Design: Retrospective, cross-sectional.

Settings: Saudi referral hospital.

Patients and methods: Cervical biopsy specimens were collected from women aged 23-95 years old who underwent HPV detection, HPV genotyping, p16^INK4a expression measurement using immunohistochemistry. Kaplan-Meier plots were constructed to analyze overall survival rates.

Main outcome measures: Survival rate of HPV-positive cervical cancer patients.

Sample size: 315 cervical biopsy specimens.

Results: HPV was detected in 96 patients (30.4%): 37.3% had cervical cancer; 14.2% cervical intraepithelial neoplasia (CIN) III, 4.1% CIN II, and 17.0% CIN I. A significant association was found between HPV presence and cervical cancer (χ²=56.78; P<.001). The expression of p16^INK4a was a significant predictor of survival: women who had p16^INK4a overexpression had poorer survival rates (multivariate Cox regression, hazard ratio, 3.2; 95% CI, 1.1-8.8). In addition, multivariate models with HPV status and cervical cancer diagnosis showed that HPV status was a significant predictor of survival: HPV-positive women had better survival rates than HPV-negative women.

Conclusion: These findings suggest that implementing cervical and HPV screening programs may decrease cervical cancer rates and improve survival rates of women in Saudi Arabia.

Limitation: Single center and small sample size.

Conflict of interest: None.