Annals of Saudi medicine最新文献

Background: Identification of life-threatening arrhythmogenic disorders, which may present during infancy, childhood, or later stages, enables the early initiation of effective preventive therapies. Electrocardiogram (ECG) screening may detect conditions that elevate risk of sudden cardiac death (SCD) at an early stage.

Objectives: This study aims to assess the prevalence, clinical significance, and characteristics of ECG abnormalities in a large population of schoolchildren. It also aims to determine whether ECGs performed during childhood can aid in the early detection of conditions associated with the risk of SCD.

Design: Population-based cross-sectional study.

Setting: A multicenter study conducted at King Faisal Specialist Hospital & Research Centre (KFSHRC) in Riyadh and Prince Sultan Cardiac Center-Qassim (PSCC-Q), Qassim, Saudi Arabia.

Methods: The study analyzed 12-lead ECGs performed on elementary school students 6-15 years old in Buraidah, Qassim region, Saudi Arabia. ECGs were recorded and interpreted following international standards. Children with abnormal ECG results were referred for full pediatric cardiology evaluation.

Main outcome measures: Prevalence of normal and abnormal ECG findings, including long QT intervals.

Sample size: 14 403 students.

Results: During the study period, ECGs were performed on 14 403 students (53.8% females). The mean age was 9.5±1.9 years, and the mean weight was 32.1±16.1 kg. Abnormal ECGs were identified in 468 students (3.3%), 271 of whom had complete clinical evaluation, including repeat ECG and echocardiography. The most common ECG abnormality was a prolonged QTc interval. The overall prevalence of abnormal ECG findings ranged from 0.7% to 2.04%, with long QTc intervals (460 msec or more) found in 0.4% to 1.6% of students.

Conclusions: Long QTc intervals (460 msec or more) were the most common ECG abnormality in school children, with an estimated prevalence of 0.4% to 1.6%. This study may serve as a model for large-scale, community-based, 12-lead ECG screening programs for children.

Limitations: Causality cannot be derived given the design, the potential for false positive and false-negative results, and the lack of genetic studies for children with prolonged QT intervals.

Introduction: Semaglutide and tirzepatide are newly approved glucagon-like peptide-1 receptor agonists for weight management in adults without diabetes. However, safety concerns regarding gastrointestinal (GI) adverse outcomes have been raised. This review comprehensively evaluates their GI safety profile in randomized controlled trials (RCTs).

Methods: Thirteen RCTs involving 26 894 obese participants without diabetes were analyzed. Pooled analysis assessed the risks for GI, biliary, hepatic, and pancreatic adverse events.

Results: Overall GI adverse events were 1.86 times higher with *both* agents (95% CI=1.56, 2.21), with tirzepatide showing a greater risk (RR 2.94, 95% CI=2.61, 3.32) than semaglutide (RR 1.68, 95% CI=1.46, 1.94). Semaglutide increased gallbladder-related disorders, particularly cholelithiasis, by over 2.6 times (95% CI=1.40, 4.82), while tirzepatide showed no significant biliary risk. Neither agent significantly increased hepatic or pancreatic adverse events.

Conclusion: Compared to placebo, both Semaglutide and tirzepatide are associated with increased GI adverse outcomes, with most cases being mild. Clinicians should carefully monitor patients for potential adverse outcomes.

Background: Head and neck cancer (HNC) is the seventh most common malignant tumor. Herpesviruses are a significant risk factor in the multifactorial pathogenesis of HNC.

Objectives: This study aimed to investigate the association between herpesviruses and the development of head and neck squamous cell carcinoma (HN-SCC).

Design: Experimental study.

Setting: A university hospital in Turkey.

Patients and methods: Pathological archive tissue samples of 500 patients were included in the study. These samples were categorized into two groups: those diagnosed with HN-SCC (n=300, malignant group [MG]) and those diagnosed with benign head and neck lesions (n=200, benign group [BG]). The presence of herpesvirus in samples was detected using polymerase chain reaction.

Main outcome measures: Association of herpesviruses in the development of head and neck cancer.

Sample size: 500 patients.

Results: HHV-1, -2, -7, and -8 were not detected in any samples. In the malignant group (MG), EBV-DNA was detected in 1 patient (0.3%) and HHV-6 DNA in 2 patients (0.6%), while in the benign group (BG), VZV-DNA was detected in 1 patient (0.5%), EBV-DNA in 3 patients (1.5%), CMV-DNA in 5 patients (2.5%), and HHV-6 DNA in 3 patients (1.5%). While no significant difference was found between the groups for VZV, EBV, and HHV-6, a statistically significant difference was found in favor of the benign group for CMV.

Conclusion: Although herpesvirus seroprevalence is relatively high in the population, the lack of viral genome in tissue samples indicates that other factors might be prominent in developing HN-SCC.

Limitation: The storage conditions of the sample used (paraffinized sample) may have negatively affected the detection frequency of HHVs.

Background: The comorbidity of Major Depressive Disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) in adults is well recognized. The role of ADHD in the etiology of MDD, as well as the overlap of genetic and environmental factors between these two disorders, is an area of research. ADHD symptoms are considered risk factors for MDD.

Objectives: The study aimed to examine the relationship between MDD in young adults with history of ADHD.

Design: Retrospective and observational study.

Settings: Outpatient clinic of a tertiary hospital.

Patients and methods: Data of young adults diagnosed with MDD, aged 18-25 years and seen between January 2017 and May 2023, were included. Individuals with comorbidities other than ADHD in adulthood were excluded from the study. The sociodemographic and clinical data of a total of 489 cases, as well as data on childhood psychiatric referrals, diagnoses, and treatment histories, were retrospectively examined.

Main outcome measures: ADHD diagnosis history and clinical impact in adults diagnosed with MDD.

Sample size: 489.

Results: A total of 489 cases (68.9% female) with a mean age of 21.14 years were included in the study. It was determined that 8% of the cases had ADHD in adulthood, 13.3% in childhood, and 31.9% had at least one mental health diagnosis during childhood. The rate of ADHD diagnosis was significantly higher in males than females in both adulthood and childhood. Additionally, the age of diagnosis of MDD was lower in individuals with ADHD diagnosis and/or those who have discontinued ADHD treatment.

Conclusions: In young adults diagnosed with MDD, the comorbidity of ADHD should also be considered. It is important to acknowledge that ADHD is not just a childhood disorder but a lifelong disorder due to its negative consequences, and to develop appropriate strategies in this regard.

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

Background: Obesity is increasingly prevalent among critically ill patients, generally more common among females than males. Whether the patient's sex influences the outcome in these patients is unclear.

Objective: Evaluate the outcomes of critically ill-patients with obesity admitted to the intensive care unit (ICU).

Design: A retrospective cohort study.

Setting: ICU of King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Patients and methods: All obese patients aged more than 18 years admitted to ICU between 2002 to 2017 were included.

Main outcome measures: The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, mechanical ventilation duration, renal replacement therapy, vasopressor use, and tracheostomy. A multivariable analysis was conducted to evaluate the association of sex differences with hospital mortality.

Sample size: 7277 patients.

Results: Of the included patients with obesity, 3965 were females, and 3312 were males. The females were older, more likely to be admitted for medical reasons and less likely for trauma than males. The crude hospital mortality rate was significantly higher in females than males (1056 [26.7%] vs. 744 [22.5%], P<.0001). Multivariable analysis demonstrated no association between sex and hospital mortality (OR: 1.05, 95% CI: 0.94, 1.19, P=.52). However, age (OR: 1.04; 95% CI: 1.01-1.02; P<.0001), chronic liver disease (OR: 5.04; 95% CI: 4.19-6.06; P<.0001), and chronic renal disease (OR: 2.19; 95% CI: 1.86-2.57;P<.0001) were found to be associated with higher mortality while admission due to trauma showed lower mortality (OR: 0.69; 95% CI: 0.53-0.90; P=.007).

Conclusion: Obese females admitted to ICU have a higher hospital crude mortality rate than obese males. This difference does not appear to be related to sex, but rather to older age, higher comorbid conditions, and more frequent admissions related to non-trauma reasons among females.

Limitations: A single-center retrospective study.

Background: The COVID-19 pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly affected global health systems. Healthcare systems across the globe have been pushed to their limits, with intensive care units (ICUs) witnessing a sharp rise in admissions, putting a strain on resources and personnel.

Objectives: Examine ICU health outcomes, including mortality, length of stay (LOS), and discharge rates, among COVID-19 and non-COVID-19 patients.

Design: Retrospective, cross-sectional study.

Setting: A national cross-sectional dataset provided by the Ministry of Health in Saudi Arabia.

Patients and methods: All patients admitted to ICUs across Saudi Arabia between January 1, 2022, and December 31, 2022. Patients were classified as confirmed COVID-19 cases and non-COVID-19 cases. To evaluate the ICU outcomes, the study used multivariate regression models, adjusting for covariates including age, gender, region, citizenship, and comorbidity score.

Main outcome measures: ICU outcomes including mortality, LOS and discharge rate.

Sample size: 114 854 ICU patients.

Results: The study population consisted of 114 854 ICU patients across various demographic and clinical categories. Mortality was found to be higher in COVID-19 patients than non-COVID-19 patients, with COVID-19 patients showing a 7% increase in mortality (OR=1.07, 95% CI: 1.02-1.12). Also, COVID-19 patients had 78% higher odds of being discharged home than the non-COVID-19 group (OR=1.78, 95% CI: 1.71-1.84). Moreover, the average LOS in the ICU was significantly shorter for COVID-19 patients than non-COVID-19 patients by 6% on average (Coefficient=-0.06, 95% CI: -0.07 to -0.03).

Conclusion: Significant differences were seen in ICU outcomes between patients with and without COVID-19, including mortality rates, discharge rates, and LOS. COVID-19 patients exhibited higher mortality rate and discharge rate, and shorter ICU LOS than those without COVID-19.

Limitations: The data used in this study has missing critical information such as laboratory results, socioeconomic variables, and hospitalization characteristics.

Introduction: Ischemic stroke (IS) is a leading cause of disability and mortality, with fatal outcomes increased with recurrent strokes. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the safety and efficacy of high-dose statins for secondary IS prevention.

Methods: This review was regestered on PROSPERO (registration number: CRD42024574088). Cochrane methodology was followed in this review and comprehensively searched PubMed, Embase, Cochrane Library and clinicaltrial.gov, to include all RCTs conducted from 2004 to 2024, comparing high-dose statins (simvastatin ≥40 mg, atorvastatin ≥40 mg, and rosuvastatin ≥20 mg) with low-dose statins, placebo, or standard care. Outcomes of this review were recurrent IS reduction and adverse events reported in RCTs.

Results: Nine RCTs involving 5,503 patients, with male patients ranging from 25.8% to 81.6% were included. Compared to controls, high-dose statins did not significantly reduce risks for secondary IS (OR 0.78, 95% CI [0.61, 1.00], P=.05) and hemorrhagic stroke (OR 0.85, 95% CI [0.56, 1.29], P=.45). Furthermore, no differences were observed in mortality rates and adverse events between groups.

Conclusion: Treatment with high dose statins didn't reduce the risk of stroke recurrence or improve mortality, though further research is needed.

Background: Small cell lung cancer (SCLC) is a lung malignancy with a poor prognosis and metastases at the time of diagnosis. There is limited experience using positron emission tomography/computed tomography (PET/CT) for SCLC diagnosis, staging, and follow-up.

Objective: Investigate the survival effect of primary tumor standardized uptake value max (SUVmax), SUV mean, metabolic tumor volume (MTV), total lesion glucose (TLG), bone marrow SUV (BM), and bone marrow to liver ratio (BLR) in SCLC.

Design: Retrospective.

Setting: Single center in Turkey.

Patients and methods: Patients who were cyto/histologically diagnosed with SCLC and had PET/CT simultaneous with the diagnosis were included in the study.

Main outcome measures: The effect of PET/CT parameters on overall survival (OS) and progression-free survival (PFS).

Sample size: 304.

Results: The 5-year OS median value was 14.62 months, and the 5-year PFS was 13.01 months. In Kaplan-Meier analysis, SUVmax, MTV, and TLG were statistically significant variables in OS (P=.03; P<.001; P<.001, respectively). MTV and TLG were significant in PFS (P<.001; P=.0003, respectively). In the multivariate analysis, MTV was an independent PET/CT parameter associated with OS (P=.003), stage of disease (P=.012), SUVmax (P=.003), MTV (P=.016), and TLG (P=.005) were significant variables in PFS.

Conclusion: In our study, MTV was an independent parameter that can be used to predict survival in SCLC. Considering the effect of MTV, a metabolic PET/CT parameter on survival, it can be recommended for clinical use as a standard measure of evaluation in PET/CT reports, just like SUVmax.

Limitations: The first limitation was the single-center and retrospective design of the study. Due to the retrospective design of the study, weight loss, performance status, and smoking history could not be obtained from every patient. Second, inaccurate registration of PET and CT images due to patient respiratory movements may affect measurements.

Background: The incidence rate of ectopic pregnancy (EP) with assisted reproductive technology (ART) has been reported to be higher than that of spontaneous pregnancy. Endometrial thickness (EMT) is considered an independent risk factor.

Objectives: Evaluation of endometrial thickness as a predictor of ectopic pregnancy in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles.

Design: Case-control study.

Setting: Women's Health Specialist Hospital, formerly known as King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.

Patients and methods: This study was a 1:2 matched case-control study that enrolled 24 ectopic pregnancy patients and 50 matched intrauterine pregnancy patients. They were matched on maternal age, the presence of tubal factor, and parity. The estimated sample size for patients with ectopic pregnancy was 25-30, whereas that for controls was estimated to be 60 patients. The sampling technique was a purposive (nonprobability).

Main outcome measures: Endometrial thickness after IVF/ICSI is a predictor of ectopic pregnancy.

Sample: 79 patients.

Results: Multivariate logistic regression analysis was performed to analyze EP predictors, and a receiver operating characteristic (ROC) curve was used to evaluate the predictors of EP. After adjustment for other factors in the logistic regression model, we found that the tubular factor increased the risk of EP by 7.6 times, whereas the ovarian factor significantly decreased EP by 85%. Other factors, including EMT, did not significantly affect the probability of developing ectopic pregnancy.

Conclusions: EMT was not predictive nor protective of EP in women who underwent ART cycles. Nevertheless, the presence of tubular factors has strong predictive value, whereas ovarian factors have significant protective value against EP.

Limitations: The study design affects the generalizability and level of evidence provided. The small sample size and single-center inclusion had an impact on the results and statistical tests used.