Annals of Saudi medicine最新文献

Background: Despite the beneficial effects, RBC transfusion can be associated with infectious and non-infectious complications in critically ill patients.

Objectives: Investigate current RBC transfusion practices and their effect on the clinical outcomes of patients in intensive care units (ICUs).

Design: Retrospective observational study.

Setting: Three mixed medical-surgical adult ICUs of a large academic tertiary hospital.

Patients and methods: From March 2018 to February 2020, all adult patients admitted to medical or surgical ICU. Patients who received one or more RBC transfusions during the first month of ICU admission were included in the "transfusion" group, while the remaining patients were assigned to the "non-transfusion" group.

Main outcome measures: Mortality and length of ICU and hospital stay.

Sample size: 2159 patients.

Results: Of 594 patients who recieved transfusions, 27% of patients received red blood cell (RBC) products. The mean pre-transfusion hemoglobin (Hb) level was 8.05 (1.46) g/dL. There was a significant relationship between higher APACHE II scores and ICU mortality in patients with Hb levels of 7-9 g/dL (OR adjusted=1.05). Also, ICU mortality was associated with age (OR adjusted=1.03), APACHE II score (OR adjusted=1.08), and RBC transfusion (OR adjusted=2.01) in those whose Hb levels were >9 (g/dl).

Conclusion: RBC transfusion was associated with an approximately doubled risk of ICU mortality in patients with Hb>9 g/dL. High APACHE II score and age increase the chance of death in the ICU by 8% and 3%, respectively. Hence, ICU physicians should consider a lower Hb threshold for RBC transfusion, and efforts must be made to optimize RBC transfusion practices.

Limitations: Single-center and retrospective study.

Background: West Nile virus (WNV)-related illness is a global health problem. Understanding the seropositivity rates and identifying the risk factors related to WNV in various animal species including humans is crucial for the implementation of effective prevention strategies.

Objectives: Assess the rate of seropositivity and the risk factors associated with WNV seropositivity.

Design: Descriptive, cross-sectional.

Setting: Microbiology and virology departments in a veterinary college.

Patients and methods: In a sample of healthy human participants in Alanya, located close to regions where WNV activity has been detected, anti-WNV IgG antibody detection was performed using enzyme-linked immunosorbent assays. The positive results were confirmed by virus neutralization tests (VNTs). The sample was compared with a second group of age- and gender-matched healthy subjects selected from a previous cross-sectional study.

Main outcome measures: Determination of the seropositivity and risk factors that were associated with WNV in healthy humans.

Sample size: 87 in current study; 356 in previous study.

Results: The first group of 87, which had a high risk of encountering vector mosquitoes, had a positivity rate of 8% (7/87), whereas positivity in the second group was 4.5% (16/356; P=.181). In the entire sample, the anti-WNV IgG antibody was positive in 23 out of 443 (5.2%) samples by the ELISA test. Among these 23 samples, ten were confirmed as positive using VNTs. Therefore, the WNV IgG seropositivity was 2.3% (10/442). Confirmed IgG seropositivity rates were higher among male (3.8%) than female participants (0.9%; P=.054) and among adults aged ≥45 years (4%) than those aged 18-44 years (0.8%; P=.048).

Conclusion: This study highlights the presence of WNV infection in the research region. More comprehensive and multidisciplinary studies are required to increase our knowledge about this zoonotic infection including risk factors in line with the One Health approach.

Limitations: Small sample size.

Background: Acute coronary syndrome (ACS) comprises a spectrum of diseases ranging from unstable angina (UA), non-ST elevation myocardial infarction (non-STEMI) and ST elevation myocardial infarction (STEMI). Treatment of ACS without STEMI (NSTEMI-ACS) can vary, depending on the severity of presentation and multiple other factors.

Objective: Analyze the NSTEMI-ACS patients in our institution.

Design: Retrospective observational.

Setting: A tertiary care institution with accredited chest pain center.

Patients and methods: The travel time from ED booking to the final disposition for patients presenting with chest pain was retrieved over a period of 6 months. The duration of each phase of management was measured with a view to identify the factors that influence their management and time from the ED to their final destination. The data was analyzed using descriptive statistics.

Main outcome measures: Travel time from ED to final destination.

Sample size: 300 patients.

Results: The majority of patients were males (64%) between 61 and 80 years of age (45%). The median disposition time (from ED booking to admission order by the cardiology team) was 5 hours and 19 minutes. Cardiology admissions took 10 hours and 20 minutes from ED booking to the inpatient bed. UA was diagnosed in 153 (51%) patients and non-STEMI in 52 (17%). Coronary catheterization was required in 79 (26%) patients, 24 (8%) had coronary artery bypass grafting (CABG) and 8 (3%) had both catheterization and CABG.

Conclusion: The time from ED booking to final destination for NSTEMI-ACS patients is delayed due to multiple factors, which caused significant delays in overall management. Additional interventional steps can help improve the travel times, diagnosis, management and disposition of these patients.

Limitations: Single center study done in a tertiary care center so the results from this study may not be extrapolated to other centers.

Background and objectives: Cushing's disease is a rare endocrine disorder. This review aimed to examine sex-specific differences in Cushing's disease.

Design and settings: A meta-analysis was performed on published articles discussing the gender impact of Cushing's disease.

Methods: A systematic search was conducted to identify studies from Medline, Embase, CENTRAL and Scopus. Nine studies enrolling 1047 patients diagnosed with Cushing's disease were included in this meta-analysis.

Results: Male patients presented at a younger age (MD [mean difference]=-5.43; 95% CI [-5.78, -5.08]; P<.00001) than females. Male patients had a significantly higher prevalence of osteoporosis (RR [risk ratio]=1.75; 95% CI [1.36, 225]; P<.0001) and hypokalemia (RR=1.66; 95% CI [1.27, 2.16]; P=.0002). In addition, males had significantly higher rates of negative magnetic resonance imaging (RR=1.53; 95% CI [1.18, 2.0]; P=.002). No sex difference was observed in the prevalence of diabetes (RR=0.92; 95% CI [0.70, 1.22]); P=.57) and dyslipidemia (RR=1.33; 95% CI [0.88, 2.0]; P=.17).

Conclusion: Cushing's disease has a worse clinical presentation in males and more diagnostic difficulties compared to females.

Background: Fine needle aspiration cytology (FNAC) is a standard preoperative diagnostic modality for thyroid nodules. The Bethesda Thyroid Cytopathology Reporting System (TBSRTC) defines the FNAC atypia group as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS).

Objectives: Determine the risk of malignancy after surgical resection in patients with AUS/FLUS.

Design: Retrospective.

Setting: Pathology department of a tertiary care center.

Patients and methods: All thyroid FNACs between 2015 and 2023 that were diagnosed as AUS/FLUS in Turkey. Patient demographics, preoperative ultrasonographic features, and follow-up data were collected.

Main outcome measures: Relationship between AUS/FLUS diagnosis and final histopathological diagnosis.

Sample size: 562.

Results: In total, 562 thyroid nodules were diagnosed as AUS/FLUS, and 267 (47.5%) were surgically excised. A malignant histopathological diagnosis was given in 28 cases (10.4%). Malignancy risk sensitivity of AUS/FLUS diagnosis was 75.68% (95% CI=58.80-88.23%), specificity was 55.24% (95% CI=50.91-59.52%), positive predictive value was 10.49% (95% CI=8.71-12.58%), and negative predictive value was 97.04% (95% CI=94.86-98.31%). In the ultrasonographic data, having symptomatic nodules, nodule calcification, and irregular nodule borders were all statistically significant signs of cancer in a one-variable analysis (P<.01). The presence of a family history emerged as a statistically significant prognostic marker for malignancy (P=.012). Although not statistically significant, the malignancy rate for nodules with nuclear atypia was 11.9%, significantly higher than the rate of 8.3% for nodules with architectural atypia only (P=0.32).

Conclusions: The diagnosis of AUS/FLUS has a high rate of predicting the risk of malignancy and should continue to be offered. In addition to cytopathological features, ultrasound data and family history should be taken into consideration when evaluating the case.

Limitations: Retrospective design and no molecular studies.

Background: Hyperuricemia is linked to an increased risk of various chronic diseases, but data on the prevalence and association of hyperuricemia with liver function in Saudi Arabia are scarce.

Objectives: Evaluate the prevalence, association, and risk measures of hyperuricemia and liver function in the Saudi population.

Design: Retrospective, cross-sectional analysis.

Setting: Database on large portion of Saudi population.

Patients and methods: Laboratory data, age, and gender of the studied subjects were collected from Al Borg Diagnostics. Subjects were stratified, based on their uric acid (UA) levels, into three groups: hypouricemic, normouricemic, and hyperuricemic. The association of UA with liver enzymes was examined in all three groups.

Main outcome measures: Association of serum UA levels with alanine transaminase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), and total bilirubin (TB).

Sample size: 13 314 subjects.

Results: Our study showed that the prevalence of hyperuricemia in the Saudi population is 17.3% (20.3% in males and 15.1% in females). We also found a positive correlation between ALT, AST, and TB with UA levels. The risk of being hyperuricemic was significantly increased in individuals with elevated ALT, AST, and TB. Individuals with elevated ALT, AST, and total TB had a higher chance of having hyperuricemia than those with normal activity. Notably, ALT, AST, and TB had good discriminating capacity for hyperuricemia.

Conclusions: Hyperuricemia is highly prevalent in the Saudi population and is associated with compromised liver function. However, further studies are needed to elucidate the mechanisms underlying these findings in large prospective cohort studies in different populations.

Limitations: Lack of data on other potential confounding variables.

Background: Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy.

Objectives: Determine the efficacy of APC treatment for patients suffering from SRUS.

Design: Prospective, single center.

Settings: Gastroenterology department at a military hospital in Pakistan.

Patients and methods: This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment.

Main outcome measures: Effectiveness of APC for resistant SRUS.

Sample size: 99 patients.

Results: The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications.

Conclusion: APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients.

Limitations: Single centered.

Background: and Objectives: Hypocalcemia is a commonly reported complication after thyroid surgery. Many possible risk factors have been identified. The purpose of this study is to analyze various risk factors possibly associated with development of postoperative hypocalcemia after thyroid surgery by dividing the sample population into postoperative hypocalcemia and normal calcium groups.

Design: Retrospective.

Setting: Multiple centers in the Makkah region of Saudi Arabia.

Patients and methods: Risk factors for postoperative hypocalcemia that were obtained for analysis include patient factors, perioperative blood parameters factors, disease-related factors, and surgical factors. Postoperative hypocalcemia was defined as a reduction of the total calcium level to <8.0 mg/dL. Hypocalcemic and normocalcemic patients were compared by multivariate logistic regression.

Main outcome measures: Distinguish independent risk factors for postoperative hypocalcemia after thyroidectomy.

Sample size: 215 patients.

Results: The incidence of hypocalcemia was 52.1% (112 of 215 patients). According to multivariate analysis, statistically significant risk factors for predicting postoperative hypocalcemia included postoperative parathyroid hormone level <10 pg/dL, inadvertent parathyroid gland resection, and neck dissection surgeries.

Conclusion: The causes of postoperative hypocalcemia are multi-factorial. Because many of these factors are modifiable, they should be identified postoperatively to distinguish high-risk groups and implement early preventive measures.

Limitations: Retrospective with a relatively small size. We encourage additional prospective studies with a larger sample size in multiple regions of the country, which might reveal further significant results.

Background: Adolescent pregnancies are more likely to be complicated with adverse perinatal outcomes.

Objective: Assess the sociodemographic and clinical characteristics of adolescents who have delivered singleton newborns.

Design: Retrospective cohort.

Settings: A tertiary training and research hospital in Turkey.

Patients and methods: This was a review of adolescents and adults who delivered singleton newborns at a tertiary health center between January 2018 and June 2022. Pregnant adolescents were aged <20 years.

Main outcome measures: Adverse maternal and perinatal outcomes.

Sample size: 2233 pregnant women (754 adolescents and 1479 adults).

Results: Turkish nationality was significantly less prevalent in pregnant adolescents than pregnant adults (P=.001). Oligohydramnios, fetal growth restriction, perineal injury and postpartum intravenous iron treatment were significantly more prevalent in pregnant adolescents than pregnant adults (P<.05 for all). The neonates born to adolescent mothers had significantly lower birth weight and first minute Apgar score than the neonates born to adult mothers (P=.001 for both). Small for gestational age, need for intensive care and death were significantly more prevalent in neonates born to adolescent mothers than those born to adult mothers (P=.001 for all). Compared with pregnant adults, pregnant adolescents had a significantly higher risk of oligohydramnios (P=.001), preterm delivery (P=.024), intravenous iron treatment (P=.001), and small for gestational age (P=.001).

Conclusion: Due to the refugee population received by Turkey, it would be prudent to expect more frequent adolescent pregnancies. Adolescent pregnancies are more likely to be complicated with low birth weight, oligohydramnios, preterm delivery, postpartum iron treatment, lower Apgar scores, need for neonatal intensive care and neonatal death.

Limitation: Retrospective.