Annals of Saudi medicine最新文献

Background: Intestinal parasitic infections remain prevalent in Viet Nam. Therefore, ensuring quality assurance in intestinal parasite testing is crucial for screening laboratories. The challenges associated with liquid or glass slide samples necessitate the exploration of digital slide applications, which can offer numerous benefits to program suppliers and participants.

Objectives: Compare the true and concordance rates of digital and glass slides for diagnosis.

Design: Experimental research design.

Materials and methods: In total, 30 medical professionals from 30 hospitals participated in the trial. The sets of slides encompassed a range of densities, including negative and coinfected slides. Seven types of glass slides were selected for scanning and digital slide production.

Main outcome measures: The primary outcomes were true and concordance variables. Secondary outcomes included time sample sending and time completion. The digital slides were uploaded to a secure website for participant access while glass slides were sent individually by mail. Data collection involved participants analyzing specimens and reporting their results using a scoring method based on parasite detection and identification accuracy.

Sample size: 210 glass and digital slide-reading results each.

Results: The mean true rate between original and glass slides diagnosis was 97.6% (range 90.0%-100%), and it slightly increased to 98.1% (range 90.0%-100%) when using digital slides. The average concordance diagnosis rate between glass and digital slides was 99.5%. Importantly, there were no differences in the diagnostic results between glass and digital slides. The findings revealed that the use of digital slides reduced the total time required by approximately 1.1 days compared with that of glass slides.

Conclusion: Altogether, the application of digital slides in the external quality assessment program for intestinal parasites offers convenience for users through online platforms and saves operational time process.

Limitations: The small sample size in this experimental study limited the statistical significance of the comparisons.

Background: The prevalence of trauma necessitates effective training for healthcare providers in Saudi Arabia. The Advanced Trauma Life Support (ATLS) program is pivotal, yet localized success rate data are lacking.

Objectives: Determine the failure rate and identify factors influencing ATLS course success rates among physicianss in Saudi Arabia.

Design: A retrospective cohort.

Setting: Two major accredited ATLS training centers in Riyadh.

Patients and methods: Participants who completed ATLS training at the Trauma Courses Office at the Ministry of National Guard Health Affairs from January 2019 to December 2020, and at the Clinical Skills and Simulation Center at King Saud University Medical City from December 2020 through January 2023. Particpitants were grouped as interns and all physicians other than interns, for the purpose of analysis.

Main outcome measures: Success and failure rates were the primary outcomes, with failure identified as a score of less than 75% or below standard performance in the practical session.

Sample size: 603.

Results: The overall failure rate for the ATLS courses was 36.6%. Analysis revealed age, pre-test scores, and attendance at a refresher course as significant predictors of success. Specifically, general practitioners and OMFS specialists had a higher odds of failing, while general surgeons and trauma-related specialties consultants were more likely to succeed.

Conclusion: ATLS course failure is notably high, with specific specialties and levels demonstrating increased risk. Results indicate a need for tailored pre-course preparation and an extension of the course duration for less experienced participants to improve proficiency, especially for at-risk groups.

Limitations: Retrospective design and other variables, such as emotional status, level of instructors, and level of motivation.

Background: Postoperative complications of colorectal cancer surgery contribute to increased morbidity and mortality in patients.

Objectives: Investigate the role of biochemical markers in serum and peritoneal fluid in the development of postoperative complications in patients with enteral anastomosis.

Design: Prospective.

Setting: University hospitals.

Patients and methods: The studied population consisted of patients who underwent surgical treatment with created anastomosis or Hartmann's resection from April 2022 to April 2024, conducted at the Clinical-Hospital Center Kosovska Mitrovica and the University Clinical Center Kragujevac. Spearman's correlation coefficient (r_s) was used to test associations between categorical variables.

Main outcome measures: Lactate, albumin, lactate dehydrogenase, and IgA antibodies were monitored as predictors of anastomotic dehiscence and general postoperative complications.

Sample size: 52.

Results: The concentration of lactate in the drain fluid on the third postoperative day was statistically significantly higher in patients who did not develop anastomotic dehiscence (P=.006). The concentration of IgA antibodies in the drain fluid on the third and fifth days post-surgery showed a moderate negative correlation with lactate concentration (r_s=-.670, P=.012; r_s=-.577, P=.039), repectively. There was a significantly higher concentration of albumin in the drain fluid on the third day post-surgery in patients who developed dehiscence (P=.040), and on the seventh day post-surgery in those who did not develop dehiscence (P=.001). The concentration of LDH on the third day in the drain fluid after surgery was statistically significantly higher in patients who did not develop dehiscence (P=.020). There was a statistically significant difference in lactate concentration in the drain fluid on the third (P<.001) and fifth days (P=.041) post-surgery, as well as in albumin concentration on the third day post-surgery (P=.024) with respect to the development of general postoperative complications.

Conclusion: This study revealed significant differences in the concentrations of lactate, albumin, and LDH in the drain fluid on the third and fifth days post-surgery with respect to the development of complications. These results suggest that monitoring these markers may help in the early identification of patients at risk of complications such as dehiscence.

Limitations: Limited literature on specific aspects of this study, including the absence of a control group, small sample size, and two-center study.

Background: Antenatal fetoscopic endoluminal tracheal occlusion (FETO) has been introduced as an effective intervention to improve the outcome of severe congenital diaphragmatic hernia (CDH).

Objective: We report our early experience with FETO.

Design: A retrospective chart review of case series.

Setting: Tertiary health care center.

Patients and methods: 18-45 years old, with single fetuses diagnosed with left severe CDH (lung-head ratio <1 measured between 27-29 weeks of gestational age (GA) and liver up or observed/expected lung-to-head ratio <25%, normal echocardiogram and karyotype were included. FETO was performed between 28-30 weeks of gestation and removed after 4-6 weeks or at birth during an ex utero intrapartum treatment (EXIT) procedure.

Main outcome measures: FETO represents a viable option for severe type of CDH fetuses with reasonable outcomes. FETO performance in low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies.

Sample size: 5.

Results: 14 pregnant women were referred for assessment and only 7 met the inclusion criteria. Two were excluded initially (late referral and spouse refusal) and a 3rd excluded later due to failure of FETO due to faulty balloons. The median age of the mothers was 28 years and the gestational age was 29 weeks. Median observed/expected lung-to-head ratio was 23%. Among patients who had successful FETO, one had the balloon removed fetoscopically 4 weeks after insertion and one was removed 8 weeks after insertion during an elective EXIT procedure and both have survived. The other two had premature labor after 1 and 5 weeks after FETO and balloon removed during an emergency EXIT procedures, and both died within 24 hours of birth.

Conclusion: FETO represents a viable option for severe type of CDH fetuses with reasonable outcome. FETO performance in a low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies.

Limitations: Retrospective nature of the study may imply inaccuracy, but we believe data from electronic medical records is highly accurate.

Background: Semaglutide, a glucagon-like peptide-1, is an effective antidiabetic drug promoting weight loss and providing cardiovascular protection. The original trials did not include participants from Saudi Arabia; hence, the study's findings are expected to be useful.

Objectives: Explore the efficacy, safety, and favorable effects of once-weekly subcutaneous semaglutide (1 mg) in patients with type 2 diabetes and those who received it as an off-license prescription without having diabetes.

Design: Retrospective review of medical records.

Setting: Department of medicine at our institution.

Patients and methods: This retrospective observational study evaluated patients receiving the glucagon-like peptide-1 analog semaglutide, with the trade name Ozempic. The weight, height, body mass index, blood pressure, and laboratory data, including serum creatinine and hemoglobin A1c (HbA1c) levels and urine albumin/creatinine ratio, were recorded. Moreover, any history of medical comorbidities, such as cardiovascular diseases, cerebrovascular diseases, and heart failure, was documented before and after drug administration.

Main outcome measures: Glycemic and weight loss efficacy.

Sample size: 1007 patients.

Results: The median age of the patients was 57.0 years, comprising 60.28% females. Among them, 955 and 442 patients received the medication for at least 3 and 6 months, respectively. Our results show a 4.4% weight loss and 0.4% improvement in HBA1c in patients with diabetes. Similar results were observed in the patients without diabetes in terms of weight along with a significant decrease in diastolic blood pressure. Our results also show stability in the serum creatinine and urine albumin creatinine ratio. The drug was equally effective in males and females.

Conclusion: Treatment with once-weekly subcutaneous semaglutide (1 mg) led to clinically significant weight loss and improved HbA1c level and cardiometabolic risk factors such as blood pressure.

Limitations: Retrospective design.

Background: There is still limited data on Discharge Against Medical Advice (DAMA) in the pediatric population. Most research comes from low-and middle-income countries, where the financial burden associated with medical care is often an important reason to leave a healthcare facility prematurely. Discharge against medical advice in the children's population is considered a significant issue that may lead to an increased risk of morbidity and mortality.

Objectives: Describe the characteristics and predictors of DAMA in children over ten years in in Riyadh, Saudi Arabia.

Design: Retrospective.

Setting: Tertiary care center.

Patients and methods: This study included all patients aged <14 years who had DAMA during all admissions between 1 January 2012, and 31 December 2022.

Main outcome measures: Data was retrieved from medical records and included 1) sociodemographic data, 2) medical history and clinical characteristics, 3) utilization of services during the admission leading to DAMA, and 4) interventions provided to prevent departure.

Sample size: 355 DAMA episodes.

Results: Males accounted for 45.4%, and the average age was 4.4 years. The overall DAMA prevalence of was 0.4%. At baseline, 277 children (78%) had at least a chronic illness or severe baseline condition; 59% had a potential life-limiting or life-threatening condition. Reasons for DAMA included disagreement about the treatment plan (14.9%), social reasons (12.6%), and perception that the child's condition improved (5.6%). An increased risk of DAMA recurrence was associated with pre-existing severe or chronic medical conditions (OR: 8.2, P=.004) and a discharge during the treatment phase (OR: 1.9, P=.040).

Conclusions: Despite inconsistent documentation, preventive measures included the involvement of healthcare providers, social services, and patient relations. The study highlights the need for standardized protocols and improved documentation practices to effectively address discharge against medical advice.

Limitations: Needs to moderate documentation quality of DAMA episodes. The study was limited to a single center, which may affect the generalizability. Children might also have presented to receive care in another facility post-DAMA.

Background: As a proven and preferred technique for hemoptysis, bronchial artery embolization (BAE) cannot avoid the possibility of postoperative recurrence; however, few studies have examined the causes of hemoptysis recurrence after BAE.

Objectives: Identify the risk factors for hemoptysis recurrence after BAE treatment.

Design: Retrospective.

Setting: Tertiary training and research hospital.

Patients and methods: A retrospective analysis was conducted on 406 patients with hemoptysis, 55 patients who developed with recurrent postembolization hemoptysis, covering the period from January 2011 to January 2021. Single factor analysis and multiple factor logistic regression were used to analyze high-risk factors for hemoptysis recurrence.

Main outcome measures: The incidence and risk factors for recurrence hemoptysis associated with transcatheter BAE.

Sample size: 406 patients.

Results: Multivariate logistic regression analysis showed that preoperative computed tomography angiography (CTA) (odds ratio [OR]: 0.052, 95% CI: 0.012-0.225), tumor-related hemoptysis (OR: 20.753, 95% CI: 6.778-63.545), pleural thickening (OR: 3.168, 95% CI: 1.081-9.286), and bilateral lung lesions (OR: 8.442, 95% CI: 2.449-29.101) had a statistically significant impact on the recurrence of hemoptysis after BAE.

Conclusions: Preoperative CTA serves as a protective factor against hemoptysis recurrence, whereas tumor-related hemoptysis, pleural thickening, and bilateral lung diseases are significant risk factors for hemoptysis recurrence following interventional therapy.

Limitations: This was a retrospective analysis of a single center with a small sample, which may have a certain degree of recall bias when collecting data, thus, reducing the reliability of the results.

Background: Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes.

Objectives: Investigate the morbidity and mortality associated with SARS-CoV-2 infection among pregnant individuals, considering vaccination status and variant strains.

Design: Retrospective cohort.

Setting: Tertiary state hospital.

Patients and methods: Patients who underwent cesarean sections were categorized into three periods: pre-vaccination (before 31 August 2021), early post-vaccination (from September 2021), and late post-vaccination (aligned with 70% immunization coverage by 2 September 2021). Data collected included demographic information (age, gravidity, parity count, gestational age, newborn APGAR scores), cesarean section indications, chronic diseases, vaccination status, vaccine type and doses, SARS-CoV-2 variant status, ICU admission, and mortality due to COVID-19.

Main outcome measures: ICU admission and mortality rates, focusing on the impact of SARS-CoV-2 infection and vaccination status.

Sample size: 297 COVID PCR-positive symptomatic patients who underwent cesarean sections.

Results: In the pre-vaccination group, there were 13 mortalities (8.1%) compared to 9 (6.6%) post-vaccination (P=.610). Maternal ARDS was seen in 46.2% of pre-vaccination mortalities versus 11.1% post-vaccination (P=.045). COVID-19 delta variant patients had higher ICU admission (80%) and mortality rates (40%). Rates of COVID-19 PCR-positive cesarean sections, ICU admissions, and mortality declined significantly in early (P=.021, P=.004, P=.009), respectively and late post-vaccination periods (P<.001, P<.001, P=.0019), respectively. Vaccinated patients had no ICU admissions or mortality.

Conclusions: Vaccination against COVID-19 is crucial for pregnant individuals as it significantly reduces the risk of severe illness. While vaccines offer substantial protection, the pandemic's acute phase might be waning, yet COVID-19 remains a global threat, particularly in regions with limited vaccine access. Continued vigilance and proactive measures are essential to mitigate ongoing risks and the emergence of new variant strains.

Limitations: Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.

Background: Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first meta-analysis to provide an overall assessment of the prevalence of NE and the factors associated with it in Saudi Arabia. We also examined its psychological impact and mothers' behavior in dealing with this disorder.

Patients and methods: A thorough search was conducted on PubMed, Scopus, Cochrane, and Web of Science databases for studies assessing the prevalence of NE. Comprehensive Meta-Analysis Version 3.3 was used to conduct the analysis. We evaluated NE prevalence, NE frequencies, NE by time, social shame and embarrassment in children with NE, and mothers seeking medical advice. A meta-regression analysis was performed to determine the correlation between the frequency of NE and NE in parents, NE in siblings, gender, and age. The quality of the included studies was assessed by Newcastle Ottawa Scale.

Results: Sixteen cross-sectional studies, totaling 14 284 participants, were included. NE prevalence was 24.8% (95% CI: 17, 34). The prevalence of NE one to two times per week was 26.8% (95% CI: 15.1, 43.0), three to four times was 31.8% (95% CI: 18.5, 48.9), and five to seven times was 33.8% (95% CI: 18.2, 54.1). NE occurring at night was 24.4% (95% CI: 22.8, 26.2) and at day and night was 16.6% (95% CI: 15.3, 17.9). A significant difference was found between the regions of Saudi Arabia in the prevalence of NE, with the southern and eastern regions having the highest prevalence and the central region having the lowest prevalence. The overall pooled prevalence of embarrassment and social shame in children with NE was 63% (95% CI: 46, 77). The percentage of mothers seeking medical advice was 54.4% (95% CI: 39.7, 68.3). The prevalence of NE is positively correlated with the prevalence of NE in parents and siblings, but no association was found with males or age.

Conclusion: A quarter of Saudi Arabian children suffer from NE, and it is associated with feelings of embarrassment and social shame. Half of the mothers seek medical counseling. Having parents or siblings with NE increases the likelihood of NE in the child. Future research is needed to corroborate the findings of other risk factors, such as age and gender. Future research will also be required to identify the precise causes or effects within each region that contribute to the varying prevalence of NE.