Annals of Saudi medicine最新文献

Background: Hepatitis A infections continue to be a major global public health problem. The epidemiology and seroprevalence of hepatitis A virus (HAV) have important public health implications. This study aimed to retrospectively examine the hepatitis A cases and hepatitis A seroprevalence in our region in our hospital with the highest number of inpatient and outpatient cases in Istanbul.

Objective: Determination of hepatitis A cases and seroprevalence.

Design: Cross-sectional.

Setting: Tertiary care.

Patients and methods: A total of 39 385 individuals who were tested for Anti-HAV IgM and Anti-HAV Total (IgM+IgG) antibodies between May 2020 and September 2023 and were included in this study. Hepatitis A specific IgM and Total (IgM+IgG) antibodies were determined using the enzyme-linked immunosorbent assay method.

Main outcome measure: Hepatitis A seroprevalence.

Sample size: 46 721.

Results: The study included a total of 46 721 samples from 39 385 individuals who were tested for hepatitis A serology. The median age of the 39385 individuals included in the study was 28 (interquartile range [IQR]; 22-46), with 58.74% being female and 4.07% (n=1163) being foreign nationals. Reactivity was detected in 91 of the 25 442 patients tested for HAV-IgM. Among these patients, 33 (0.13%) had acute hepatitis A infection, while 58 (0.23%) were considered false positives. Of the acute hepatitis A patients, 13 (0.09%) were women, and 22 (0.80%) were children. Acute hepatitis A was most commonly observed in the 6-9 and 15-18 age groups, with 7 cases each. The seroprevalence rate of hepatitis A was 67.23% among 33 683 individuals. Of those tested for HAV-Total, 13 132 (64.92%) were women, and 2533 (64.88%) were children. The lowest seroprevalence rate among age groups (35.91%) was in the 15-18 age year range, while the highest seroprevalence (98.34%) was detected in individuals aged 60 years and above.

Conclusion: With a seroprevalence rate of 67.23%, our region is still considered a medium-endemic area for hepatitis A, and it is crucial to continue administering the HAV vaccine as currently included in the childhood vaccination schedule in our country. Additionally, the significantly low hepatitis A seropositivity, particularly in the 15-18 and 19-24 age groups, indicates the need to promote catch-up vaccination for young adults. Since our study covers a large population, it can serve as a guide regarding the serological status of hepatitis A in Istanbul.

Limitations: Since vaccination information for the study population was not available, it was not possible to distinguish between seropositivity due to vaccination or natural immunity. Despite being conducted in Istanbul, a cosmopolitan city, and in the largest city hospital, the results ma

Background: Antenatal fetoscopic endoluminal tracheal occlusion (FETO) has been introduced as an effective intervention to improve the outcome of severe congenital diaphragmatic hernia (CDH).

Objective: We report our early experience with FETO.

Design: A retrospective chart review of case series.

Setting: Tertiary health care center.

Patients and methods: 18-45 years old, with single fetuses diagnosed with left severe CDH (lung-head ratio <1 measured between 27-29 weeks of gestational age (GA) and liver up or observed/expected lung-to-head ratio <25%, normal echocardiogram and karyotype were included. FETO was performed between 28-30 weeks of gestation and removed after 4-6 weeks or at birth during an ex utero intrapartum treatment (EXIT) procedure.

Main outcome measures: FETO represents a viable option for severe type of CDH fetuses with reasonable outcomes. FETO performance in low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies.

Sample size: 5.

Results: 14 pregnant women were referred for assessment and only 7 met the inclusion criteria. Two were excluded initially (late referral and spouse refusal) and a 3rd excluded later due to failure of FETO due to faulty balloons. The median age of the mothers was 28 years and the gestational age was 29 weeks. Median observed/expected lung-to-head ratio was 23%. Among patients who had successful FETO, one had the balloon removed fetoscopically 4 weeks after insertion and one was removed 8 weeks after insertion during an elective EXIT procedure and both have survived. The other two had premature labor after 1 and 5 weeks after FETO and balloon removed during an emergency EXIT procedures, and both died within 24 hours of birth.

Conclusion: FETO represents a viable option for severe type of CDH fetuses with reasonable outcome. FETO performance in a low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies.

Limitations: Retrospective nature of the study may imply inaccuracy, but we believe data from electronic medical records is highly accurate.

Background: Semaglutide, a glucagon-like peptide-1, is an effective antidiabetic drug promoting weight loss and providing cardiovascular protection. The original trials did not include participants from Saudi Arabia; hence, the study's findings are expected to be useful.

Objectives: Explore the efficacy, safety, and favorable effects of once-weekly subcutaneous semaglutide (1 mg) in patients with type 2 diabetes and those who received it as an off-license prescription without having diabetes.

Design: Retrospective review of medical records.

Setting: Department of medicine at our institution.

Patients and methods: This retrospective observational study evaluated patients receiving the glucagon-like peptide-1 analog semaglutide, with the trade name Ozempic. The weight, height, body mass index, blood pressure, and laboratory data, including serum creatinine and hemoglobin A1c (HbA1c) levels and urine albumin/creatinine ratio, were recorded. Moreover, any history of medical comorbidities, such as cardiovascular diseases, cerebrovascular diseases, and heart failure, was documented before and after drug administration.

Main outcome measures: Glycemic and weight loss efficacy.

Sample size: 1007 patients.

Results: The median age of the patients was 57.0 years, comprising 60.28% females. Among them, 955 and 442 patients received the medication for at least 3 and 6 months, respectively. Our results show a 4.4% weight loss and 0.4% improvement in HBA1c in patients with diabetes. Similar results were observed in the patients without diabetes in terms of weight along with a significant decrease in diastolic blood pressure. Our results also show stability in the serum creatinine and urine albumin creatinine ratio. The drug was equally effective in males and females.

Conclusion: Treatment with once-weekly subcutaneous semaglutide (1 mg) led to clinically significant weight loss and improved HbA1c level and cardiometabolic risk factors such as blood pressure.

Limitations: Retrospective design.

Background: There is still limited data on Discharge Against Medical Advice (DAMA) in the pediatric population. Most research comes from low-and middle-income countries, where the financial burden associated with medical care is often an important reason to leave a healthcare facility prematurely. Discharge against medical advice in the children's population is considered a significant issue that may lead to an increased risk of morbidity and mortality.

Objectives: Describe the characteristics and predictors of DAMA in children over ten years in in Riyadh, Saudi Arabia.

Design: Retrospective.

Setting: Tertiary care center.

Patients and methods: This study included all patients aged <14 years who had DAMA during all admissions between 1 January 2012, and 31 December 2022.

Main outcome measures: Data was retrieved from medical records and included 1) sociodemographic data, 2) medical history and clinical characteristics, 3) utilization of services during the admission leading to DAMA, and 4) interventions provided to prevent departure.

Sample size: 355 DAMA episodes.

Results: Males accounted for 45.4%, and the average age was 4.4 years. The overall DAMA prevalence of was 0.4%. At baseline, 277 children (78%) had at least a chronic illness or severe baseline condition; 59% had a potential life-limiting or life-threatening condition. Reasons for DAMA included disagreement about the treatment plan (14.9%), social reasons (12.6%), and perception that the child's condition improved (5.6%). An increased risk of DAMA recurrence was associated with pre-existing severe or chronic medical conditions (OR: 8.2, P=.004) and a discharge during the treatment phase (OR: 1.9, P=.040).

Conclusions: Despite inconsistent documentation, preventive measures included the involvement of healthcare providers, social services, and patient relations. The study highlights the need for standardized protocols and improved documentation practices to effectively address discharge against medical advice.

Limitations: Needs to moderate documentation quality of DAMA episodes. The study was limited to a single center, which may affect the generalizability. Children might also have presented to receive care in another facility post-DAMA.

Background: As a proven and preferred technique for hemoptysis, bronchial artery embolization (BAE) cannot avoid the possibility of postoperative recurrence; however, few studies have examined the causes of hemoptysis recurrence after BAE.

Objectives: Identify the risk factors for hemoptysis recurrence after BAE treatment.

Design: Retrospective.

Setting: Tertiary training and research hospital.

Patients and methods: A retrospective analysis was conducted on 406 patients with hemoptysis, 55 patients who developed with recurrent postembolization hemoptysis, covering the period from January 2011 to January 2021. Single factor analysis and multiple factor logistic regression were used to analyze high-risk factors for hemoptysis recurrence.

Main outcome measures: The incidence and risk factors for recurrence hemoptysis associated with transcatheter BAE.

Sample size: 406 patients.

Results: Multivariate logistic regression analysis showed that preoperative computed tomography angiography (CTA) (odds ratio [OR]: 0.052, 95% CI: 0.012-0.225), tumor-related hemoptysis (OR: 20.753, 95% CI: 6.778-63.545), pleural thickening (OR: 3.168, 95% CI: 1.081-9.286), and bilateral lung lesions (OR: 8.442, 95% CI: 2.449-29.101) had a statistically significant impact on the recurrence of hemoptysis after BAE.

Conclusions: Preoperative CTA serves as a protective factor against hemoptysis recurrence, whereas tumor-related hemoptysis, pleural thickening, and bilateral lung diseases are significant risk factors for hemoptysis recurrence following interventional therapy.

Limitations: This was a retrospective analysis of a single center with a small sample, which may have a certain degree of recall bias when collecting data, thus, reducing the reliability of the results.

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.