Annals of Saudi medicine最新文献

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.

Background: The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure.

Objectives: Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions.

Design: Prospective and observational study.

Setting: A university hospital in Turkey.

Patients and methods: Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH₂O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough.

Main outcome measures: The effect of different patient positions on the ETT cuff pressure.

Sample si̇ze: 200 patients.

Results: The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmH₂O). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: P=.003; cough: P=.047).

Conclusion: ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety.

Limitation: We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.

Background: Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes.

Objectives: Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia.

Design: Retrospective cohort.

Setting: Medical ward at tertiary hospital setting.

Patients and methods: The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge).

Sample size and basis: The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin.

Main outcome measures: The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality.

Results: In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]).

Conclusion: Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission.

Limitations: Single-centre design and retrospective nature.

Background: The Trendelenburg position and pneumoperitoneum may cause cerebral edema and increased intracranial pressure. Non-invasive measurement of the diameter of the optic nerve sheath by ultrasonography can provide early recognition of intracranial pressure.

Objective: Evaluate the optic nerve sheath diameter (ONSD) changes in patients who undergo laparoscopic surgery in the Trendelenburg position and make indirect conclusions about changes in intracranial pressure.

Design: Prospective, observational.

Setting: Laparoscopic surgeries.

Patients and methods: Patients aged 18-75 years who underwent laparoscopic surgery in the Trendelenburg position under general anesthesia were included in our study. The ONSD was measured four times: Immediately after tracheal intubation, in the neutral position (baseline value) (T0), 10 minutes after pneumoperitoneum and Trendelenburg position (T1), 60 minutes after pneumoperitoneum and Trendelenburg position (T2), and 10 minutes after the pneumoperitoneum is terminated and placed in the neutral position (T3).

Main outcome measures: Compare ONSD measured by ultrasonography at different times of surgery.

Sample size: 40.

Results: Arterial carbon dioxide pressure increased with laparoscopy and Trendelenburg position in parallel with ONSD measurements and decreased again after returning to the neutral position. It was still higher than the baseline value at the T3. There was also a significant difference[a] between the measurement made at the T2 and the measurement made at T1. This difference showed that the prolongation of the Trendelenburg time was associated with an increase in ONSD. At the end of the operation it was observed that the decreased statistically significantly (T3) 10 minutes after the pneumoperitoneum was terminated and the position was corrected. However, the ONSD was still higher at the end of the operation (T3) compared to the baseline value measured at the beginning of the operation (T0).

Conclusion: The ONSD increased in relation to Trendelenburg position and pneumoperitoneum. With these results, we think the ultrasonographic measurement of ONSD, a non-invasive method, can be used for clinical follow-up when performing laparoscopic surgery in the Trendelenburg position in cases requiring intracranial pressure monitoring.

Limitations: There may be variations in the measurement of ONSD, even in the measurements of the same practitioner, as in all imaging with an ultrasonography device.

Background: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally representative epidemiological studies.

Objectives: Assess the prevalence of selected NCDs, using population-based electronic health records and applying novel analytical methods to identify cases of NCDs.

Design: Retrospective.

Settings: A large healthcare network in Saudi Arabia.

Patients and methods: We included all beneficiaries aged 16 years or older (n=650 835[a]) and used the International Classification of Disease (ICD-10) codes, laboratory results, and associated medications to identify individuals with diabetes, obesity, hypertension, dyslipidemia, mental disorders, and injuries. For diabetes and hypertension, we used natural language processing (NLP) on clinical notes in the electronic health records. The prevalence of multimorbidity across age groups was also tabulated, and logistic regression was used to examine its association with glycemic control.

Main outcome measures: The primary outcomes measured were the prevalence of diabetes, hypertension, and multimorbidity, and their association with glycemic control.

Sample size: 650 835 individuals aged 16 years or older.

Results: The study population was relatively young, with 41.2% aged between 26 and 45 years, and around two-thirds were married. The prevalence of diabetes and hypertension was 18.5% (95% CI: 18.5-18.7) and 13.0% (95% CI: 12.9-13.1), respectively. Approximately 26.7% (95% CI: 26.7-26.8) of the population had multimorbidity, with levels increasing to 62.9% for those aged 65 or older. Multimorbidity was associated with a four-fold increase in the likelihood of poor glycemic control. NLP analysis suggested that the prevalence of diabetes or hypertension may be underestimated by no more than 1.5%.

Conclusions: The study suggests a higher prevalence of NCDs than earlier national estimates. Electronic health records with regular analysis provide an opportunity to estimate changes in the prevalence of NCDs in Saudi Arabia. Health policies and interventions are needed to address the high levels of multimorbidity, which adversely impact glycemic control.

Limitations: Retrospective design and reliance on electronic health records, which may not capture all cases of NCDs.

Background: Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact on patient outcomes.

Objectives: Explore the complexity level of diabetes medications among patients with T2DM and to identify the predictors of medication regimen complexity (MRC) and its correlation with hemoglobin A1C (HbA1c) levels.

Design: Retrospective, cross-sectional study.

Setting: An ambulatory care setting of a tertiary hospital in Makkah City, Saudi Arabia.

Patients and methods: Patients with T2DM referred to the diabetic clinic were identified and assessed for eligibility. The data were collected from patient electronic medical records between October 2022 and September 2023. The MRC Index was used to evaluate the complexity of the patients' medication regimens.

Main outcomes measures: MRC index scores and HbA1c levels.

Sample size: 353 records of patients with T2DM.

Results: The analysis revealed that 61.8% (n=218) of patients had high MRC, with the dosing frequency contributing significantly to their MRC (mean=3.9, SD=1.9). Having polypharmacy and longstanding T2DM were predictors of high MRC (odds ratios=4.9 and 2.6, respectively; P≤.01). Additionally, there was an inverse association between the patients' diabetes-specific MRC index scores and their glycemic control (odds ratios=0.2, P<.001).

Conclusion: The study findings highlight the importance of considering MRC in managing T2DM. Simplifying medication regimens and optimizing medication management strategies can improve patient outcomes. Further research is needed to explore interventions to reduce MRC and enhance diabetes management in this population.

Limitations: Retrospective study design measuring the MRC at a diabetes-specific level.

Background: Over the past decade, significant updates have been made regarding the classification and grading of prostate adenocarcinoma in radical prostatectomy specimens, following decisions reached in international conferences and through impactful publications. These alterations are closely linked to patient prognosis.

Objectives: Observe the incidence of these changes and their impact on patient prognosis. Additionally, investigate the relationship between histopathological and clinical parameters to assist in multidisciplinary treatment planning.

Design: Retrospective cohort study.

Setting: Tertiary university hospital.

Methods: Hematoxylin and eosin, along with immunohistochemistry stained sections, were reevaluated, and clinical information, including patient demographics, preoperative PSA levels, and patient follow-up were collected from patients who underwent radical prostatectomy at our center.

Sample size: 182 patients.

Main outcome measures: Biochemical recurrence.

Results: The study highlighted the negative prognostic effects of factors such as Gleason grade group, lymphovascular invasion, intraductal carcinoma, positive surgical margins, extraprostatic extension, pathological T stage, and seminal vesicle invasion. These factors are important determinants of recurrence-free survival in prostate adenocarcinoma patients.

Conclusion: This study identified comedonecrosis and intraductal carcinoma as independent negative prognostic factors. A 3-mm cutoff for positive surgical margins was supported, while the current cutoff for extraprostatic extension may require reevaluation. The impact of cribriform pattern and ductal carcinoma appears to be influenced by the grade group. No independent relationship was found between the Gleason score/pattern on positive surgical margins or extraprostatic extension and prognosis. Further, large-scale studies with long-term follow-up are needed.

Limitations: The study is limited by the relatively small number of patients for certain parameters.

Background: Computer tomography (CT)-guided lung biopsy carries the risk of pneumothorax. A variety of other risk factors affect the occurrence of pneumothorax.

Objective: Assess the incidence and risk factors associated with pneumothorax complications in CT-guided lung biopsy, and to conduct a quantitative analysis of the variables among the significant risk factors to identify more effective indicators for predicting pneumothorax complications.

Design: Retrospective logistic.

Setting: Single center in China.

Patients and methods: From June 2017 to May 2021, consecutive patients who underwent CT-guided lung biopsy were identified from the medical record system. Binary logistic regression analysis was used to identify potential risk factors for pneumothorax. Receiver operating characteristic (ROC) curves were constructed for continuous variables to determine cutoff values that optimized sensitivity and specificity.

Main outcome measures: The incidence and risk factors of pneumothorax in CT-guided lung biopsy.

Sample size: 132 patients.

Results: The incidence of pneumothorax was 28.9% (38/132), with 6.8% (9/132) of patients requiring chest tube insertion. Results indicated that smaller lesion size (OR 0.724; 95% CI 0.619-0.848; P=.0001), longer needle tract length (OR 1.320; 95% CI 1.145-1.521; P=.001), multiple passes through the pleura (OR 4.618; 95% CI 1.378-15.467; P=.013), and needle tract length/lesion diameter (L/D) ratio (OR 0.028; 95% CI 0.002-0.732; P=.007) were independent risk factors for pneumothorax. ROC curve analysis determined a cut-off value of 0.81 for the L/D ratio (sensitivity=89.5%, specificity=71.3%). The area under the ROC curve (AUC) values of maximum diameter, needle tract length, and L/D ratio for pneumothorax were 0.749, 0.812, and 0.850, respectively.

Conclusions: The L/D ratio, multiple passes through the pleura, longer needle tract length, and smaller lesions were independent risk factors for pneumothorax. A L/D ratio of less than 0.81 may indicate a pneumothorax. It may be necessary to use the proper sealing procedure for this patient group.

Limitations: Due to its retrospective nature, there may be inherent selection bias.

Background: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used.

Objectives: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT.

Design: Retrospective.

Settings: Tertiary training and research hospital.

Patients and methods: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS).

Main outcome measures: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers.

Sample size: 261.

Results: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (P=.034, .065, .269, .060, respectively).

Conclusions: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (P=.034).

Limitations: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.