Annals of Saudi medicine最新文献

Background: While the present literature emphasizes that surgical biopsies are the gold standard in diagnosing salivary gland tumors, several studies highlight the role of fine needle aspiration (FNA) due to its high diagnostic yield and minimally invasive nature. However, the role of FNA and its accuracy in diagnosing salivary gland tumors compared to surgical biopsies is poorly investigated in the Eastern region of Saudi Arabia.

Objective: Assess the diagnostic accuracy of FNA in salivary gland tumors as compared to histopathological findings from surgical specimens. Identify sources of diagnostic discrepancies between FNA and surgical biopsies.

Design: Retrospective diagnostic accuracy study.

Settings: King Fahd Hospital of the University in Eastern Province, Al Khobar, Saudi Arabia.

Patients and methods: Patients with confirmed diagnosis of salivary gland tumor who underwent both FNA and surgical biopsy between 2014-2024. FNA was performed under ultrasound (US) guidance and examined by two consultant pathologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the diagnostic accuracy of FNA.

Main outcome measures: FNA diagnostic accuracy compared to histopathological findings from surgical specimens.

Sample size: 40 cases.

Results: A total of 267 cases were considered in this study, of which only 40 cases were included. FNA had a high specificity of 100% (95% CI: 85.8%-100%) but a low sensitivity of 23.08% (95% CI: 5.0%-53.8%). The PPV is 100% (95% CI: 29.2%-100%). The NPV is 70.6% (95% CI: 64.0%-76.4%). Finally, the overall accuracy is 73% (95% CI: 55.9%-86.2%).

Conclusion: Our study supports the utility of FNA as a diagnostic modality for salivary gland tumors, demonstrating high specificity with variable sensitivity. The observed false negative rate emphasizes the need for cautious interpretation of negative results, necessitating confirmatory histopathological studies. The findings highlight the influence of sample size on cytology performance, with smaller studies reporting lower sensitivity compared to larger multi-center analyses.

Limitations: Sample size, retrospective design, data extraction, incomplete data.

Background: Carbon monoxide (CO) poisoning is one of the leading causes of mortality and morbidity among inhaled toxins worldwide. The use of chimneyless stoves, barbecues and water heaters in small areas with poor ventilation leads to CO poisoning and increases the number of emergency department admissions.

Objective: To evaluate the morbidity and mortality rates of CO poisoning cases admitted to the emergency department of our hospital.

Design: Retrospective, cross-sectional study.

Setting: Single center, secondary-state hospital in Türkiye.

Patients and methods: Data from CO poisoning cases admitted to Gaziantep Abdülkadir Yüksel State Hospital Emergency Department between October 20, 2022 and October 20, 2023 were retrospectively evaluated.

Main outcome measures: CO levels in venous blood obtained from patients with suspected CO poisoning.

Sample size: 377 patients.

Results: Of the 377 patients, 204 (54.1%) were females, 302 (80.1%) were Turkish citizens, and 196 (52%) presented to the hospital on their own means. It was determined that 285 patients (75.6%) were poisoned by stove smoke, 90 (23.8%) by fire smoke, and two (0.5%) by natural gas. It was determined that 298 patients (79%) were discharged after treatment, 42 (11.1%) left the hospital without permission, 23 (6.1%) were taken under observation and hyperbaric oxygen (HBO) treatment was applied, 13 (3.4%) refused treatment, and 1 (0.3%) died. The need for HBO treatment increased with age and a significant association was found between age and the need for HBO treatment (P=.002).

Conclusions: CO poisoning remains a common public health issue, mostly linked to stove and fire smoke. Older age was significantly associated with the need for HBO therapy. It is important to prevent and raise awareness regarding CO poisoning cases, which increase particularly during the winter months in the context of earthquakes and other natural disasters.

Limitations: Retrospective design.

Background: Diabetic ketoacidosis (DKA) is a potentially fatal complication of type 1 diabetes mellitus (T1DM). To our knowledge, limited studies have examined the risk factors of recurrent DKA in the Saudi T1DM population.

Objectives: To identify factors contributing to recurrent DKA in Saudi patients with T1DM. By identifying the contributing factors for DKA recurrence the disease burden can be mitigated by making targeted interventions.

Design: Retrospective.

Setting: Tertiary care center, Jeddah, Saudi Arabia.

Patients and methods: Saudi patients with T1DM admitted with DKA between 2021 to 2023 were included. A comparative analysis was performed between patients with a single recurrence of DKA and those with multiple recurrent admissions.

Main outcome measures: Association between multiple variables and recurrent DKA.

Sample size: 245 Saudi patients with T1DM.

Results: A total of 245 Saudi patients with T1DM were included. A significantly higher proportion of females were observed in the multiple recurrent DKA group (73.1% vs. 48.5%, P=.0001). Also, a higher proportion of single individuals were found among the multiple recurrent DKA group (P=.006). Longer duration of T1DM (≥5 years) and presence of microalbuminuria were more associated with multiple recurrent DKA than single recurrence of DKA. Among the precipitating factors, non-adherence to medications was associated with multiple recurrence of DKA (P=.02).

Conclusion: This study has identified several risk factors contributing to recurrent DKA episodes among Saudi patients with T1DM. By increasing awareness of these factors among both healthcare providers and the community, we can develop more effective prevention strategies and ultimately reduce the incidence of recurrent DKA.

Limitations: A retrospective study and single-center experience.

Background: Co-infections with hepatitis B (HBV), hepatitis C (HCV) and syphilis complicate the clinical management of people living with HIV by influencing disease progression, treatment response, and transmission risk. Despite the growing HIV burden in Türkiye, data on the impact of these coinfections remain limited.

Objectives: To determine the prevalence of HBV, HCV, and syphilis coinfections in adults with HIV-1 and to examine their associations with demographics and HIV-1 viral load.

Design: Retrospective cross-sectional study.

Setting: Single center, tertiary care hospital in Türkiye.

Patients and methods: Adults diagnosed with HIV-1 between March 2019 and June 2024 at Ankara Bilkent City Hospital were included. Demographic information, HIV viral load measurements, and serological and molecular test results for HBV, HCV, and syphilis were retrieved from the institutional laboratory database. Coinfection status was assessed relative to age, gender, and HIV viral load.

Main outcome measures: Prevalence and distribution of HBV, HCV, and syphilis coinfections and their associations with demographic variables and HIV viral load.

Sample size: 724 patients.

Results: The study population was predominantly male (86%), with a median age of 40 years. Syphilis was the most common coinfection (25.6%), followed by HBV at 4.1% and HCV at 1.8%. Syphilis was significantly more prevalent among men (P=.001), and HBV coinfection was associated with older age (P=.005). No significant associations were observed between HIV viral load and any co-infection. Notably, a substantial proportion of patients, especially those newly diagnosed after 2019, had high HIV RNA levels, suggesting delayed diagnosis and treatment initiation. Triple coinfections were rare but remain clinically relevant.

Conclusions: The high prevalence of syphilis and delayed HIV diagnoses highlight the urgent need for improved screening protocols, timely initiation of antiretroviral therapy, and broader implementation of HBV vaccination programs. An integrated multisectoral approach is critical to address the overlapping clinical and public health burdens posed by these co-infections. Healthcare strategies must consider the impact of COVID-19-related service disruptions, which likely contributed to delays in diagnosis and treatment.

Limitations: Lack of data on patients' behavioral risk factors and no follow-up on treatment outcomes for syphilis.

Background: Influenza causes substantial morbidity and mortality in older adults, and conventional inactivated vaccines often elicit suboptimal immune responses in this population. Recent phase II/III randomized controlled trials (RCTs) have evaluated mRNA-based influenza vaccines, but a quantitative synthesis of their immunogenicity in adults aged ≥65 years is lacking.

Objective: To determine whether mRNA influenza vaccines yield higher seroconversion rates (SCRs) at 29 days post-vaccination compared to licensed inactivated vaccines in adults aged ≥65 years.

Design: Systematic review and meta-analysis of RCTs.

Settings: Hospital, out-patient and community-based RCTs conducted in the USA.

Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar from database inception to July 2025 for RCTs reporting SCR at 29 days post-mRNA influenza vaccination in adults aged ≥65 years. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model.

Main outcome measure: SCR at day 29 post-vaccination for each influenza strain (A/H1N1, A/H3N2, B/Victoria, B/Yamagata).

Sample size: Seven RCTs out of 4 studies comprising 7,114 participants aged ≥65 years were included.

Results: Across the seven RCTs (100% RCTs), mRNA vaccines achieved significantly higher SCRs than controls: A/H1N1 (RR 3.41; 95% CI 2.8-4.2), A/H3N2 (RR 3.54; 95% CI 2.9-4.3), B/Victoria (RR 2.83; 95% CI 2.3-3.5), and B/Yamagata (RR 3.34; 95% CI 2.7-4.2). Heterogeneity was high for all strains (I²>80%). Sensitivity analyses omitting one study at a time confirmed robustness of the pooled estimates. Funnel plots and Egger's test indicated possible small-study effects. Meta-regression found no significant association between vaccine dose and effect size.

Risk of bias: Visual inspection of Begg's funnel plots for the A/H1N1, A/H3N2, and B/Victoria strains revealed asymmetry, suggesting the possibility of publication bias.

Heterogeneity: There was significant heterogeneity among studies for A/H1N1, A/H3N2, and B/Victoria strains but not B/Yamagata strain.

Conclusion: In adults aged ≥65 years, mRNA influenza vaccines elicit substantially higher seroconversion rates across all four seasonal strains compared with licensed inactivated vaccines, suggesting a promising strategy to enhance immune protection in this high-risk population. Findings should be interpreted with caution given the small number of studies available.

Limitations: Low number of studies included limits full assessment of heterogeneity and bias.

Registration: PROSPERO CRD420251108768.

Background: Candida (Candidozyma) auris is a high priority fungal pathogen due to its antifungal resistance and its association with increased morbidity and mortality in infected patients.

Objectives: The aim of this study was to identify Candida species in clinical samples and to determine the clades and in vitro antifungal resistance of C. auris.

Design: Retrospective cohort.

Settings: Single-center tertiary hospital in Türkiye.

Material and methods: The study was conducted in the Medical Microbiology Laboratory of Ümraniye Training and Research Hospital between December 2023 and October 2024. Fungal samples were identified using bio-Mérieux VITEK MS v.3.2 (bio-Mérieux, France) and RT-PCR. Antifungal susceptibility testing of C. auris was performed by VITEK 2 Compact AST YS08 and SYO.

Main outcome measures: Identification of Candida species, in-vitro antifungal resistance of C. auris.

Sample size: 846 fungal isolates obtained from 746 patients were included.

Results: A total of 846 fungal isolates were identified, with C. albicans being the most common (n=440, 52%), followed by Nakaseomyces glabratus (n=124, 14.7%), C. parapsilosis (n=85, 10.1%), C. tropicalis (n=69, 8.2%) and C. auris (n=57, 6.7%). All C. auris isolates were susceptible to anidulafungin. Of these isolates, 47 (82%) were resistant to fluconazole, 34 (60%) to amphotericin B, four (7%) to caspofungin and three (5%) to micafungin. One isolate was resistant to amphotericin B, fluconazole, caspofungin and micafungin. A total of 31 (54%) isolates were resistant to amphotericin B and fluconazole. In accordance with the manufacturer's recommendations, 57 isolates were evaluated as Clade-1.

Conclusion: C. auris infections are becoming increasingly common. In order to better understand antifungal-resistance of this pathogen, advanced methods should be used for rapid detection of clades and mutations in the FKS gene should be revealed.

Limitations: Single center, whole genome sequence analysis were not performed.

Background: Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored.

Objective: To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences.

Design and settings: A single-center retrospective study.

Patients and methods: Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25-29.9, ≥30.0 kg/m²).

Main outcome measures: Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates.

Sample size: 60 patients (30 in each group).

Results: The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories (P <.001). Vault suturing time was shorter in the 3D HD laparoscopy group (P =.002), and total operative time was reduced in overweight patients (P =.015). Obese patients in the 3D group had lower haemoglobin drop (P =.01) and reduced blood loss compared to 2D laparoscopy group (P =.017).

Conclusion: 3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis-highlighting its value in overcoming challenges of minimally invasive gynecologic surgery.

Limitations: The study's retrospective design and modest sample size limit generalizability.

Background: Fibrolamellar Hepatocellular Carcinoma (FLHCC) is a rare primary liver tumour that is distinct from conventional HCC in both histopathological and clinical features. There is no clear consensus on its treatment.

Objective: Assess the demographics, prognosis, and treatment- particularly systemic therapies-of FLHCC patients across multiple centers in Türkiye.

Design: Retrospective.

Settings: Multicenter.

Patients and methods: Patients with histopathological diagnosis of pure fibrolamellar hepatocellular carcinoma.

Main outcome measures: Treatment responses of metastatic stage patients were evaluated. Progression-free survival (PFS) and overall survival (OS) analyses of metastatic stage first-line treatments were performed.

Sample size: 39 patients with FLHCC.

Results: The 5-year survival for all patients was 48%, 80% in stage 1, 57% in stage 2, 53% in stage 3 and 0% in stage 4. The median PFS for chemotherapy (n=10) and sorafenib (n=6) patients in the metastatic stage first series was 5.7 months and 2.8 months, respectively (P=.031). Median OS was 12.1 months for chemotherapy and 8.8 months for sorafenib (P=.853) in the metastatic stage.

Conclusion: Conventional chemotherapies, especially gemcitabine and oxaliplatin combination can be used as systemic treatment options. Immunotherapies, chemoimmunotherapy and immunotherapy plus anti vascular endothelial growth factor combinations may be considered by clinicians.

Limitations: Small sample size and the variability of the treatment modalities administered in the patients.

Background: Metabolic and bariatric surgeries are effective interventions in reducing weight and mortality. Laparoscopic sleeve gastrectomy is the most commonly performed procedure, particularly in the Middle East and North Africa (MENA) region. It involves resection of approximately 80% of the stomach, yielding large specimens for histopathological evaluation.

Objectives: To identify histopathological findings in gastric specimens, evaluate the incidence of unexpected gastrointestinal stromal tumors (GISTs), and characterize the metabolic and bariatric surgery population in Saudi Arabia.

Design: Retrospective cohort.

Settings: Single-center tertiary care in Saudi Arabia.

Patients and methods: The study included patients who underwent laparoscopic gastric sleeve between May 2015 and April 2021. Inclusion criteria were patients with BMI ≥ 30 kg/m² who underwent surgery as treatment for obesity.

Main outco me measures: Gastric histopathological findings, unexpected GIST incidence and metabolic and bariatric surgery population.

Sample size: 211 patients with obesity.

Results: Patients' mean age was 38.2 years with a mean Body mass index (BMI) of 44.24 kg/m². The majority were females (60.2%). Normal histology findings accounted for 43.1% of findings, followed by chronic inactive gastritis (35.5%). Intestinal metaplasia was found in 1 (0.5%) patient while incidental GIST was found in 2 (0.9%) patients. Helicobacter pylori (H. pylori) was identified in 12.8% of cases, with a mean patient age of 36.7 years. Among H. pylori-positive patients, 48% presented with chronic active gastritis, 33% with chronic inactive gastritis, 14.8% with active follicular gastritis, and 3.7% with inactive follicular gastritis. A history of prior endoscopy was noted in 16.1% of patients, of whom 11.76% were found to have H. pylori postoperatively.

Conclusions: H. pylori infection was detected at a mean age of 36.7 years and showed a significant association with higher BMI (mean difference: 2.2 kg/m², P=.04). While this suggests a potential link between obesity and H. pylori susceptibility, the clinical significance of this small absolute difference requires further investigation. H. pylori remained strongly associated with follicular gastritis (P=.003) but showed no difference between males and females.

Limitations: Retrospective design and Giemsa stain was not done for all specimens to investigate H. pylori.

Background: Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction associated with liver cirrhosis, yet no consensus exists on standardized diagnostic criteria. We aimed to assess CCM prevalence using several guidelines.

Methods: A systematic search of four databases (PubMed, Embase, Google Scholar, and EBSCO) identified observational studies reporting CCM prevalence in cirrhotic patients based on the three criteria: the World Congress of Gastroenterology (Montreal 2005), the American Society of Echocardiography (ASE 2009), and the Cirrhotic Cardiomyopathy Consortium (CCC 2019). A random-effects meta-analysis and subgroup analyses were performed using R Studio.

Results: Seventy-six studies including 7445 patients were analyzed. Overall pooled CCM prevalence was 48% (95% CI: 44-52%, I²=97%). Prevalence was highest using Montreal 2005 (51%), followed by ASE 2009 (45%) and CCC 2019 (45%). CCC 2019 better identified CCM in early-stage cirrhosis (Child-Pugh A), whereas Montreal 2005 was more sensitive in advanced stages (Child-Pugh C).

Conclusion: CCM prevalence varies by diagnostic criteria and cirrhosis severity. Further studies are needed to determine the clinical relevance and prognostic value of each criterion.

Prospero registration number: CRD42024511527.