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, p16INK4a 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 p16INK4a was a significant predictor of survival: women who had p16INK4a 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.
Background: Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent.
Objective: Summarize the frequency of surgical complications of thyroidectomy.
Design: Retrospective.
Setting: Secondary health facility in southwestern Saudi Arabia.
Patients and methods: We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019.
Main outcome measure: Complications following thyroidectomy.
Sample size: 339 patients, 280 (82.6%) females and 59 (17.4%) males.
Results: We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma.
Conclusion: The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications.
Limitations: Retrospective design and no long-term follow up to monitor late complications.
Conflict of interest: None.
Background: The modified creatinine index (mCI), as a surrogate marker of muscle mass, has been associated with poor outcomes in patients undergoing hemodialysis. However, a single assessment may not reflect the clinical significance before an adverse clinical endpoint.
Objective: Analyze mCI trajectories and their association with all-cause mortality in incident hemodialysis patients.
Design: Retrospective observational cohort.
Setting: Outpatient dialysis facility.
Patients and methods: We followed a cohort of patients who underwent maintenance hemodialysis treatment at least three times weekly for at least three months from 19 June 2010 to 29 December 2017. Clinical and laboratory features were measured at baseline. Longitudinal changes in the mCI were modeled using a joint longitudinal and survival model adjusted for baseline covariates and body mass index trajectories.
Main outcome measure: All-cause mortality.
Sample size: 408 with 208 males (50.7%).
Results: The mean (SD) age was 62.2 (12.3) years. The mCI changes were evaluated for a median (interquartile range) follow-up of 2.16 (1.13, 3.73) years. Forty-six percent (n=188) of patients reached the endpoint. A steeper slope (per 0.1 unit increase in the decrease rate) in modified creatinine index was associated with increased risk of all-cause mortality (HR, 1.04; 95% CI, 1.02-1.07; P=.011). In addition, an annual 1 mg/kg/day decrease in modified creatinine index level increased the hazard of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.07; P=.001).
Limitations: Residual kidney function was not observed in the data. Setting was single center and thus results may not be generalizable to other populations.
Conclusion: All-cause death was significantly associated with loss of muscle mass over time. Longitudinal trajectories of nutritional markers may predict the clinical outcomes in patients undergoing hemodialysis. This may also be valuable for individual risk stratification. Furthermore, early management may provide an opportunity to improve patient survival.
Conflict of interest: None.
Background: Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.
Objective: Determine the factors associated with early and late recurrence in patients with node-negative GC.
Design: Retrospective cohort.
Setting: Academic tertiary care center.
Patients and methods: The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum P value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.
Main outcome measures: Recurrence-free survival and factors associated with survival.
Sample size: 606.
Results: After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (P=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, P=.014), advanced T stage (HR 8.804, P=.003), perineural invasion (HR 10.955, P<.001), and anemia (HR 2.351, P=.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, P=.002), advanced T stage (HR 5.066, P<.001), lymphovascular invasion (HR 5.902, P<.001), and elevated CA19-9 levels (HR 5.227, P<.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.
Conclusions: Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.
Limitations: Retrospective design, small sample size.
Conflict of interest: None.
Background: SARS-CoV2/COVID-19 emerged in China and caused a global pandemic in 2020. The mortality rate has been reported to be between 0% and 14.6% in all patients. In this study, we determined the clinical and laboratory parameters of COVID-19 related morbidity and mortality in our hospital.
Objectives: Investigate the relationship between demographic, clinical, and laboratory parameters on COVID-19-related morbidity and mortality.
Design: Retrospective observational study.
Settings: Tertiary care hospital.
Patients and methods: Patients diagnosed with COVID-19 pneumonia from March until the end of December were included in the study.
Main outcome measures: The relationship between demographic, clinical, and laboratory parameters and the morbidity and mortality rates of patients diagnosed with COVID-19.
Sample size: 124 patients RESULTS: The mortality rate was 9.6% (12/124). Coronary artery disease (P<.0001) diabetes mellitus (P=.04) fever (>38.3°C) at presentation (P=.04) hypertension (P<.0001), and positive smoking history (P<.0001) were significantly associated with mortality. Patients who died were older, had a higher comorbid disease index, pneumonia severity index, fasting blood glucose, baseline serum creatinine, D-dimer, and had lower baseline haemoglobin, SaO2, percentage of lymphocyte counts and diastolic blood pressure. Patients admitted to the ICU were older, had a higher comorbidity disease index, pneumonia severity index, C-reactive protein, WBC, D-dimer, creatinine, number of antibiotics used, longer O2 support duration, lower hemoglobin, lymphocyte (%), and baseline SaO2 (%).
Conclusions: Our results were consistent with much of the reported data. We suggest that the frequency, dosage, and duration of steroid treatment should be limited.
Limitations: Low patient number, uncertain reason of mortality, no standard treatment regimen, limited treatment options, like ECMO.
Conflict of interest: None.
Background: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs.
Objectives: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients.
Design: Retrospective.
Setting: Intensive care unit.
Patients and methods: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020.
Main outcome measures: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%).
Results: The median age (range) was 72 (21-101) years for patients who died (n=632, 64.9%) and 70 (16-99) years for patients who lived (n=432, 35.2%) (P<.001). APACHE scores, and SOFA scores were higher in patients who died than in those who survived (P<.001, both comparisons). Respiratory failure was the most common cause of hospitalization (82.5%), and respiratory failure on admission was associated with death (P=.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy.
Conclusions: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support.
Limitations: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units.
Conflict of interest: None.
A high rate of thrombotic complications have been observed in patients infected with COVID-19. These complications are related to increased blood hypercoagulabity, which can cause both venous and arterial thrombosis. We report a case of a 60-year-old man with COVID-19 pneumonia and thrombotic occlusion of the infrarenal abdominal aorta at the time of admission to the hospital. A CT scan showed a crazy-paving pattern in the lungs, consistent with COVID-19. A clinical suspicion of aortic thrombosis was confirmed by CT angiography. Embolectomy was undertaken a few hours later. At the end of the procedure, the patient was taken to the intensive care unit while intubated. The patient then worsened, developing severe renal failure, and died on day 1 after admission to the hospital. A CT scan, which is necessary for diagnosis of COVID-19, and a CT angiography, can be used to diagnose thrombotic events. It should be kept in mind that arterial thrombosis can be present not only in hospitalized COVID-19 patients but also at the time of admission. SIMILAR CASES PUBLSHED: 1.
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