Annals of Saudi medicine最新文献

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.

Background: Acute kidney injury (AKI) is a critical concern in pediatric intensive care units (PICUs) due to its high mortality rate.

Objectives: Investigate AKI incidence, outcomes, and mortality-related risk factors among critically ill children.

Design: Retrospective cohort.

Setting: A PICU.

Patients and methods: The study included children (aged 4 weeks to 14 years) who were admitted to the PICU from (2016 to 2019) and developed AKI at King Faisal Specialist Hopsital and Research Centre.

Main outcomes measures: AKI incidence, outcomes, and mortality-related risk factors.

Sample size: 111 records of patients with AKI.

Results: Of 969 PICU admissions, 111 cases developed AKI and were entered in the analysis, with an incidence rate of (11.5%). The median age was 43 months [interquartile range (IQR): 16-120], with hematology/oncology conditions being the most prevalent underlying diseases (56.8%). Septic shock and nephrotoxin medications were the leading causes of AKI, accounting for (46.8%) and (45.0%), respectively. Regarding AKI severity, (37.8%) were classified as stage 1, (25.2%) as stage 2, and (37.0%) as stage 3 AKI. As for PICU interventions, the highest was inotropic support (63.1%), followed by mechanical ventilation (56.8%) and renal replacement therapy (23.4%). The PICU mortality rate was (38.7%) (43/111), with no significant association between AKI stage and mortality. However, the multivariable analysis identified bone marrow transplant (BMT) (P=.042) and inotropic support (P=.001) as significant predictors of mortality.

Conclusion: These findings underscore the importance of early recognition and tailored management of AKI in PICU settings. Despite advancements in critical care, AKI remains a significant challenge, contributing to prolonged hospitalization, mortality, and increased health-care resource utilization. Therefore, more investigation is warranted.

Limitations: Retrospective study single-center nature.

Background: We aimed to explore the correlation between anti-hypertensive treatment and survival rates in patients with metastatic non-small cell lung cancer (mNSCLC).

Objective: In this study, we analyzed the correlation between antihypertensive treatment and survival in 300 patients with mNSCLC.

Design: Retrospective.

Settings: Medical faculty hospital.

Patients and methods: We investigated the relationship between antihypertensive treatment and survival in 300 patients who were diagnosed with mNSCLC. We also examined the relationship between histological type, performance status, gender, age and type of antihypertensive medication used and survival.

Main outcomes and measures: Survival difference between mNSCLC patients with and without antihypertensive treatment.

Sample size: 300 patients with mNSCLC.

Results: Among patients receiving concomitant antihypertensive treatment, 107 (35.7%) were prescribed angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), 64 (21.3%) beta-blockers and 36 (11%) calcium channel blockers. The study found that the overall survival rates for all patients at 36 and 60 months were 11.5% and 7%, respectively. However, the ACEi/ARB group had higher survival rates at 18.1% and 12% for 36 and 60 months, respectively, compared to the non-ACEi/ARB group with rates of 8.7% and 5% (P<.05).

Conclusion: These results strongly suggest that renin-angiotension system (RAS) inhibitors hold great promise as potential adjunctive therapies for mNSCLC due to their significant inhibitory effects on cell proliferation, angiogenesis and tumor progression.

Limitations: Retrospective and non-randomized nature. Additionally, the retrospective analysis did not allow for verification of the duration or regularity of drug use, which made it infeasible to examine dose-response relationships with reliability.

Background: Although headaches are common, only 3-21% are estimated to be secondary, with their causes ranging from non-alarming to life-threatening conditions.

Objectives: Evaluate the associated factors and predictive warning signs of intracranial pathologies in patients presenting with nontraumatic headaches to the emergency document (ED).

Design: Retrospective chart review.

Settings: Medical center in Jeddah.

Patients and methods: Data were collected from all patients who presented to the ED with nontraumatic headaches and underwent brain computed tomography (CT) scans from September 2021 to September 2022.

Main outcome measures: The associated factors and predictive warning signs of intracranial pathologies.

Sample size: 387.

Results: Sixty-seven (17.31%) patients had intracranial pathologies. The median (IQR) age of all patients was 49 (23) years and females constituted 61.8%. Patients with intracranial pathologies were significantly more likely to have severe headaches (59.7% vs. 33.7%, P<.001), to have compressing or sharp headaches (16.4% vs. 6.2%, P=.003), to have constant headaches (16.4% vs. 7.8%, P=.003), to be on chemo-therapy or radiotherapy (10.5% vs. 2.8%, P=.004), and to be smokers (13.4% vs. 6.2%, P=.042) than the other group. Multiple logistic regression of headache warning signs revealed that significant changes or progression in pattern, frequency, or severity of headache (OR: 3.2, CI: 1.5-6.6, P=.001), motor deficits, including abnormal reflexes (OR: 2.9, CI: 1.2-6.9, P=.011), personality changes, confusion, memory impairment, drowsiness, slurred speech or loss of consciousness (OR: 2.6, CI: 1.4-5.0, P=.002), and sudden onset of headache (OR: 1.9, CI: 1.0-3.6, P=.046) were predictive of intracranial pathologies.

Conclusions: Our findings suggest that these four headache warning signs can help physicians predict intracranial pathologies and subsequently decide which patients should undergo brain imaging in non-traumatic headache cases.

Limitations: Single-center study and retrospective design.

Background: Thrombocytopenia and leukopenia are common complications of alcoholic liver cirrhosis (ALC) and are associated with an increased risk of bleeding, infection and mortality.

Objectives: Evaluate the effectiveness and safety of leucogen, a cysteine derivative that increases platelet (PLT) and white blood cell (WBC) counts in ALC patients.

Design: Retrospective.

Setting: Department of hepatology, general hospital.

Patients and methods: Patients with ALC who had thrombocytopenia and/or leukopenia were enrolled between 2022 and 2023 and were divided into two groups based on their treatment: the leucogen group (20 mg, three times per day) and the non-leucogen group.

Main outcome measures: The primary endpoint was an increase in PLT or WBC of ≥5% from baseline.

Sample size: 413 patients (320 patients in the final analysis).

Results: In this retrospective study, 320 patients were analyzed post-propensity score matching: 160 patients each in the leucogen and non-leucogen groups. Following 3 months of treatment, the leucogen group experienced a median increase in PLT levels of 1.0×10⁹/L versus a decrease of 3.0×10⁹/L in the non-leucogen group (P=.003), and a median increase in WBC counts of 0.1×10⁹/L compared to a decrease of 0.1×10⁹/L (P=.006). The changes in ALT, AST, and TBIL levels were not significantly different between groups. A higher proportion of patients in the leucogen group experienced increases in both PLT (46.9% vs. 32.5%, P=.012) and WBC counts (50.0% vs. 36.2%, P=.018), and 28.1% of patients in the leucogen group had increases in both parameters, compared to 15.6% in the non-leucogen group (P=.01). The leucogen group also demonstrated greater increases in PLT (OR 1.833; P=.009) and WBC counts (OR 1.759; P=.013) compared to the non-leucogen group. The safety profile of leucogen was favorable, with no significant adverse events reported. Leucogen was particularly beneficial for patients younger than 60 years and those with lower baseline ALT and AST levels, showing significant improvements in both PLT and WBC counts in these subgroups.

Conclusions: Leucogen effectively increased PLT and WBC counts in patients with ALC, showing a favorable safety profile.

Limitations: Retrospective study.

Background: Traffic accidents are one of the most important reasons that increase the workload of emergency services all over the world. Especially in developing countries, this problem is difficult to solve due to rapid population growth.

Objective: The aim of this study was to evaluate the causes of mortality and morbidity, the organs affected by the injury, and the prognosis of the patients who are referred to the emergency department as a result of traffic accidents and underwent abdominal imaging.

Design: Retrospective, cross-sectional study.

Setting: A state hospital in Turkey.

Patients and methods: 1014 patients admitted to Gaziantep Abdulkadir Yüksel State Hospital between 15 July 2022 to 15 July 2023 due to traffic accidents and examined for abdominal trauma were retrospectively evaluated.

Main outcome measures: Evaluation of patients admitted due to traffic accidents and examined for abdominal trauma.

Sample size: 1014 patients.

Results: The mean age of the patients was 25.88 years, 79.6% were male, 67.3% were admitted to the hospital by ambulance, 47.4% were admitted as a result of a vehicular traffic accident, 34.3% were admitted as a result of a non-vehicular traffic accident, 18.2% were admitted as a result of a motorcycle accident and 36.4% were drivers, 35.3% were pedestrians and 28.3% were passengers. Intra-abdominal organ injuries were detected in 3.2% of all patients, including urinary system in 1%, hepatobiliary system in 0.9% and spleen in 0.8%. It was determined that 13% of the patients had life-threatening injuries and 40.2% had injuries that could not be treated with simple medical intervention.

Conclusion: It was determined that 21% of the patients admitted to the emergency department as a result of traffic accidents required hospitalization or resulted in death. Prevention of traffic accidents, which especially threaten the young population, is of great importance both in reducing the workload in the emergency department and in minimizing labor and financial losses.

Limitations: Since the study was based on retrospective file review, files with missing information were not included in the study.

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.