Annals of Saudi medicine最新文献

{"title":"Fascial fixation versus non-fixation in vNOTES lateral suspension after vaginal hysterectomy for pelvic organ prolapse.","authors":"Havva Betül Bacak, Enes Serhat Coşkun, Serkan Kumbasar, Hayat Terkan, Pelin Pınar, Aybüke Bulut, Batuhan Bulut, Fatih İrice, Barışcan Aldanmaz, Sinem Deligözoğlu, Süleyman Salman","doi":"10.5144/0256-4947.2026.311","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.311","url":null,"abstract":"<p><strong>Background: </strong>Mesh-based vNOTES lateral suspension is an emerging minimally invasive technique for apical pelvic organ prolapse repair, but the clinical value of fascial fixation of the lateral mesh arms remains unclear.</p><p><strong>Objectives: </strong>To compare 12-month anatomical outcomes and recurrence rates between fascial fixation and non-fixation of the lateral mesh arms during mesh-based vNOTES lateral suspension after vaginal hysterectomy.</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Settings: </strong>Tertiary referral center.</p><p><strong>Patients and methods: </strong>We reviewed women who underwent vaginal hysterectomy combined with mesh-based vNOTES lateral suspension for pelvic organ prolapse between March 2022 and March 2026. Patients were grouped according to whether the lateral mesh arms were fixed to the fascia. Preoperative and 12-month postoperative Pelvic Organ Prolapse Quantification (POP-Q) measurements, recurrence, perioperative outcomes, postoperative complications, and mesh erosion were evaluated.</p><p><strong>Main outcome measures: </strong>The primary outcome was recurrence at 12 months, defined as POP-Q point C >-1 cm, reflecting clinically significant apical prolapse. Secondary outcomes included POP-Q values and change scores, operative time, estimated blood loss, length of hospital stay, complications, and mesh erosion.</p><p><strong>Sample size: </strong>101 patients; 46 in the non-fixation group and 55 in the fixation group.</p><p><strong>Results: </strong>Both groups demonstrated significant improvement in all evaluated POP-Q points at 12 months compared with baseline (<i>P</i><.001). Recurrence occurred in four patients (8.7%) in the non-fixation group and four patients (7.3%) in the fixation group (<i>P</i>=1.0). Operative time, estimated blood loss, and length of hospital stay were comparable between groups (<i>P</i>=.347, <i>P</i>=.187, and <i>P</i>=.274, respectively). Similarly, no significant between-group differences were observed in perioperative complications (<i>P</i>=.59), postoperative complications (<i>P</i>=.426), or mesh erosion (<i>P</i>=1.0).</p><p><strong>Conclusions: </strong>Fascial fixation of the lateral mesh arms was not associated with improved short-term anatomical, perioperative, or postoperative outcomes at 12 months following mesh-based vNOTES lateral suspension after vaginal hysterectomy.</p><p><strong>Limitations: </strong>Retrospective design, single-center setting, modest sample size, and 12-month follow-up period.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"311-318"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stunting and thinness among adolescents residing in Jazan City, Saudi Arabia: a school-based cross-sectional study using WHO AnthroPlus.","authors":"Ebtihal Elameen Eltyeb, Ali Ali Al-Makramani","doi":"10.5144/0256-4947.2026.349","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.349","url":null,"abstract":"<p><strong>Background: </strong>Adolescence is a critical period of growth and development during which nutritional deficiencies may adversely affect health outcomes throughout adulthood.</p><p><strong>Objectives: </strong>To determine the prevalence of stunting and thinness among adolescents in Jazan city, Saudi Arabia, using the WHO AnthroPlus growth reference, and to identify associated sociodemographic factors.</p><p><strong>Design: </strong>School-based cross-sectional study.</p><p><strong>Setting: </strong>Governmental intermediate schools in Jazan city, Saudi Arabia, between January and May 2023.</p><p><strong>Patients and methods: </strong>A total of 324 adolescents aged 13-16 years were enrolled using a multistage cluster sampling technique. Sociodemographic data were collected using a data collection form. Anthropometric measurements, including height and weight, were obtained according to standardized World Health Organization (WHO) protocols. Height-for-age z-scores (HAZ) and body mass index-for-age z-scores (BMIZ) were calculated using WHO AnthroPlus software. Binary logistic regression analyses were performed to identify factors associated with stunting and thinness.</p><p><strong>Main outcome measures: </strong>Prevalence of stunting (HAZ <-2 standard deviations, SD), severe stunting (HAZ <-3 SD), and thinness (BMIZ <-2 SD), and their associations with sociodemographic characteristics.</p><p><strong>Sample size: </strong>A total of 324 adolescents were included in the final analysis.</p><p><strong>Results: </strong>The mean HAZ for the study population was -0.74±1.08. Stunting (HAZ <-2 SD) was identified in 40 adolescents (12.3%; 95% CI: 9.0%-16.0%), including 6 adolescents with severe stunting (1.9%; 95% CI: 0.6%-3.4%). The mean BMIZ was 0.69±1.30, and thinness (BMIZ <-2 SD) was observed in 14 adolescents (4.3%; 95% CI: 2.2%-6.5%). Increasing age was independently associated with higher odds of stunting (AOR 1.61, 95% CI 1.12-2.30; <i>P</i>=.010).</p><p><strong>Conclusions: </strong>Stunting remains a significant public health concern among adolescents in Jazan city despite the relatively low prevalence of thinness. Increasing age was independently associated with higher odds of stunting.</p><p><strong>Limitations: </strong>The cross-sectional design precludes causal inference. The study included only governmental schools from Jazan city, which may limit generalizability.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"349-357"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiology and antimicrobial resistance in biliary tract infections including acute and post-ERCP cholangitis: a systematic review and meta-analysis.","authors":"Ahmed Salman, Mohamed Abdallah Salman, Ahmed Abdallah, Ahmed Elewa, Ahmed Marwan","doi":"10.5144/0256-4947.2026.388","DOIUrl":"10.5144/0256-4947.2026.388","url":null,"abstract":"<p><strong>Background: </strong>Organisms cultured from bile in biliary tract infection, and their resistance, vary widely between settings, and pooled estimates to guide empirical therapy are lacking.</p><p><strong>Objective: </strong>Estimate bile-culture yield, organism distribution, and resistance.</p><p><strong>Design: </strong>Systematic review and random-effects meta-analysis of PubMed and reference lists.</p><p><strong>Setting: </strong>Reports spanned nine countries across Asia, Europe, Africa, and North America.</p><p><strong>Methods: </strong>We extracted ductal-bile culture data from observational studies published from 2015 to 2025 of biliary infection/cholangitis; noninfectious, gall bladder-only, microbiome-only, and nonextractable reports were excluded. DerSimonian-Laird models, subgroup analysis, and JBI appraisal were used.</p><p><strong>Main outcome measure: </strong>Culture yield; secondary organism proportions and resistance.</p><p><strong>Sample size: </strong>5147 patients (97% retrospective; 3% prospective); organisms: 35 267 observations.</p><p><strong>Results: </strong>Yield was 77.3% (95% CI, 67.8-84.6); Gram-negative organisms 69.8% (65.6-73.7), <i>E. coli</i>, 27.4% (23.5-31.7), <i>K. pneumoniae</i>, 14.1% (12.3-16.2).</p><p><strong>Heterogeneity: </strong>I²=86.0%-97.7%; all <i>P</i><.001.</p><p><strong>Risk of bias: </strong>Fourteen reports were low risk, two moderate; exclusions minimally changed estimates.</p><p><strong>Conclusion: </strong>Bile-culture yield was high and Gram-negative organisms, particularly <i>E. coli</i> and <i>K. pneumoniae</i>, predominated, but estimates were highly heterogeneous and resistance could not be pooled; culture-directed therapy guided by local antibiograms is therefore preferable to a universal empirical regimen.</p><p><strong>Limitations: </strong>PubMed-only/open-access search, retrospective designs, inconsistent definitions, one dominant dataset.</p><p><strong>Registration: </strong>Retrospectively registered on OSF (89wqs; DOI: 10.17605/OSF.IO/89WQS).</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"388-403"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between route of nutrition and serum I-FABP and MMP-9 levels in critically ill patients with acute ischemic stroke: a prospective cohort study.","authors":"Nurhayat Tugra Ulema, Sevda Onuk, Osman Ozocak, Omer Faruk Bolatturk, Memet Aslanyavrusu, Sibel Kuzuguden, Kursat Gundogan","doi":"10.5144/0256-4947.2026.376","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.376","url":null,"abstract":"<p><strong>Background: </strong>Gut barrier dysfunction and neuroinflammation are increasingly recognised as linked pathophysiological processes in acute ischaemic stroke (AIS). However, the influence of nutritional routes on these processes remains poorly characterised.</p><p><strong>Objective: </strong>To compare the longitudinal effects of enteral nutrition (EN) versus parenteral nutrition (PN) on serum intestinal fatty acid-binding protein (I-FABP), a marker of intestinal epithelial integrity, and matrix metalloproteinase-9 (MMP-9), a marker of neuroinflammatory activity, in critically ill AIS patients.</p><p><strong>Design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>A tertiary neurology intensive care unit (ICU) in Türkiye.</p><p><strong>Patients and methods: </strong>Consecutive adults (≥18 years) admitted to the neurology ICU within 24 hours of a confirmed AIS diagnosis were enrolled between October 2024 and January 2026. Nutritional route was assigned by the treating clinician according to ESPEN guidelines. Serum I-FABP and MMP-9 concentrations were measured using commercial enzyme-linked immunosorbent assay (ELISA) kits at baseline and on day 7.</p><p><strong>Main outcome measures: </strong>Longitudinal changes in serum I-FABP and MMP-9 concentrations between baseline and day 7, and their correlations with neurological severity (NIHSS).</p><p><strong>Sample size: </strong>73 patients (40 EN, 33 PN).</p><p><strong>Results: </strong>Median age was 73 years (interquartile range, 64-80) and 37 (51%) were female. At baseline, I-FABP and MMP-9 levels were comparable between groups (all <i>P</i>>.05). Over the 7-day observation period, I-FABP trajectories diverged between groups (EN: 7.22 (2.68) to 6.69 (2.78) ng/mL; PN: 6.74 (3.09) to 7.82 (2.97) ng/mL), as did MMP-9 trajectories (EN: 11.5 (1.45) to 10.9 (2.31) ng/mL; PN: 11.3 (2.41) to 11.8 (1.87) ng/mL). At day 7, both biomarkers correlated significantly with NIHSS score (ρ=0.385 and ρ=0.440, respectively; both <i>P</i><.001). Repeated measures analysis of covariance, adjusted for baseline NIHSS score, confirmed significant time × nutritional route interactions for both biomarkers (I-FABP: F[1,70]=4.22, <i>P</i>=0.044, P_FDR=.044, η²<i>p</i>=.057; MMP-9: F[1,70]= 4.76, <i>P</i>=.033, P_FDR=.044, η²<i>p</i>=0.064).</p><p><strong>Conclusion: </strong>In critically ill AIS patients, EN was associated with more favourable 7-day trajectories of gut barrier integrity and neuroinflammatory activity compared with PN, after adjustment for baseline stroke severity.</p><p><strong>Limitations: </strong>Single-center design, biomarker sampling restricted to two time points, reliance on delivered rather than utilised nutritional measures, and non-randomised nutritional route assignment with residual potential for confounding by indication.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"376-387"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-acquired <i>Escherichia coli</i> pneumonia: clinical, radiological, laboratory, and prognostic characteristics in a retrospective single-center study.","authors":"Salih Kücük, Sükran Mutlu, Coskun Dogan, Sevda Soydan","doi":"10.5144/0256-4947.2026.358","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.358","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) caused by <i>Escherichia coli (E. coli)</i> is uncommon, and its clinical features and prognosis remain insufficiently characterized.</p><p><strong>Objectives: </strong>To compare the clinical, laboratory, radiological, and prognostic characteristics of community-acquired <i>E. coli</i> pneumonia (CAECP) with CAP caused by other pathogens.</p><p><strong>Design: </strong>Single-center retrospective observational cohort study.</p><p><strong>Settings: </strong>Department of Pulmonology, Kocaeli City Hospital, İzmit, Kocaeli, Türkiye from April 2023 to March 2025.</p><p><strong>Patients and methods: </strong>Adult patients hospitalized with CAP and positive sputum cultures were reviewed. Hospital-acquired and ventilator-associated pneumonias were excluded. Patients were classified as CAECP or Other-CAP. Demographic, clinical, laboratory, radiological, CURB-65, Pneumonia Severity Index (PSI), and outcome data were compared. A targeted multivariable logistic regression model adjusted for age and malignancy evaluated 90-day mortality.</p><p><strong>Main outcome measures: </strong>In-hospital mortality, 90-day mortality, intensive care unit admission, and hospital length of stay.</p><p><strong>Sample size: </strong>Sixty-eight patients (37 CAECP, 31 Other-CAP).</p><p><strong>Results: </strong>Median age (69 [interquartile range, IQR 50.7-71] vs 67 [56-70] years; <i>P</i>=.805), sex distribution (<i>P</i>=.452), comorbidity burden (P=.094), body temperature (<i>P</i>=.970), heart rate (<i>P</i>=.592), C-reactive protein (<i>P</i>=.731), procalcitonin (<i>P</i>=.749), multilobar involvement (<i>P</i>=.246), and air bronchogram (<i>P</i>=.938) were comparable between groups. Mean CURB-65 (1.73±0.90 vs 1.45±0.99; <i>P</i>=.253) and PSI (108.6±40.6 vs 95.4±27.6; <i>P</i>=.143) were also similar. Hospital stay was significantly longer in CAECP (15.7±15.5 vs 9.6±7.0) days; <i>P</i>=.047). In-hospital mortality was numerically higher (14% vs 0; <i>P</i>=.058), while 90-day mortality was significantly higher (49% vs 16%; <i>P</i>=.005). After adjustment for age and malignancy, CAECP remained independently associated with 90-day mortality (aOR, 7.41; 95% CI, 1.85-29.71; <i>P</i>=.005).</p><p><strong>Conclusion: </strong>CAECP resembles other CAP etiologies at presentation, but is associated with longer hospitalization and markedly higher 90-day mortality despite similar baseline severity scores.</p><p><strong>Limitations: </strong>Single-center retrospective design, small sample size, and limited number of mortality events.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"358-367"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pathway implementation for adult sickle cell vaso-occlusive crises: Impact on healthcare utilization, opioid prescribing, and costs.","authors":"Ahmed M Alhartani, Lenah S Binmahfouz, Iman Alhazmi, Aseel Jambi","doi":"10.5144/0256-4947.2026.319","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.319","url":null,"abstract":"<p><strong>Background: </strong>Vaso-occlusive crisis (VOC) is the leading cause of emergency department (ED) visits and hospitalization in sickle cell disease (SCD). Standardized clinical pathways may improve care quality and reduce healthcare utilization, yet regional evidence from Saudi Arabia remains limited.</p><p><strong>Objectives: </strong>To evaluate the clinical and economic impact of a multidisciplinary clinical pathway on VOC management, opioid prescribing, and direct healthcare costs.</p><p><strong>Design: </strong>Retrospective before-and-after cohort study.</p><p><strong>Setting: </strong>Single-center, 500-bed tertiary referral hospital in Jeddah, Saudi Arabia.</p><p><strong>Patients and methods: </strong>Adults (≥12 years) with confirmed SCD (HbSS, HbSC, or HbS/β-thalassemia) presenting with isolated VOC were included. Outcomes were compared across two consecutive 12-month periods before (May 2016-April 2017) and after (May 2017-April 2018) pathway implementation.</p><p><strong>Main outcome measures: </strong>Annual ED visits, hospital admissions, 7-day readmission rate, opioid consumption, length of stay, and direct cost savings.</p><p><strong>Sample size: </strong>316 unique patients pre-implementation and 374 post-implementation.</p><p><strong>Results: </strong>VOC-related ED visits decreased by 69.7% (14,273 vs. 4,319; <i>P</i><.001), hospital admissions by 32.9% (520 vs. 349; <i>P</i><.001), and 7-day readmissions by 69.5% (151 vs. 46; <i>P</i><.001); the readmission rate fell from 29.1% to 13.2%. Median length of stay decreased from 11.0 to 4.3 days. Meperidine and tramadol utilization declined significantly, whereas morphine use increased by 41.2%. When standardized to oral morphine milligram equivalents, total opioid burden nonetheless decreased by 21.8% overall (33.9% per patient-year). Annual direct cost savings totaled 410 709 Saudi Riyals.</p><p><strong>Conclusions: </strong>Implementation of a multidisciplinary VOC clinical pathway was associated with substantial reductions in healthcare utilization, hospital stay, readmissions, and direct costs, while promoting evidence-based opioid prescribing in adults with SCD.</p><p><strong>Limitations: </strong>Single-center, uncontrolled before-and-after design without adjustment for genotype imbalance between cohorts; incomplete pathway adherence in some clinical areas; patient-reported outcomes were not collected.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"319-338"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignancy in patients with acromegaly: a multicenter study across the Gulf region.","authors":"Khaled AlDahmani, Moeber Mahzari, Tarik Abdelkareim Elhadd, Faisal Aziz, Aishah Ekhzaimy, Tania Jaber, Zeinab Dabbous, Mussa Almalki","doi":"10.5144/0256-4947.2026.368","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.368","url":null,"abstract":"<p><strong>Background: </strong>Chronic growth hormone and insulin-like growth factor 1 excess may promote tumorigenesis, but the magnitude of malignancy risk in acromegaly remains uncertain and regional data from the Gulf are limited.</p><p><strong>Objective: </strong>To describe the frequency, spectrum, detection, outcomes, and clinical correlates of malignancy among patients with acromegaly treated across Gulf tertiary centers.</p><p><strong>Design: </strong>Multicenter retrospective observational study.</p><p><strong>Setting: </strong>Five tertiary centers across Saudi Arabia, Qatar, and the United Arab Emirates.</p><p><strong>Patients and methods: </strong>Medical records of patients aged >16 years with acromegaly who were evaluated from 2010 through 2024 were reviewed. Demographic, disease, treatment, cancer-testing, and malignancy data were collected. Group comparisons were descriptive and exploratory because only 10 malignancies occurred.</p><p><strong>Main outcome measures: </strong>Documented malignancy frequency, cancer type, method of detection, stage, treatment, outcome, and clinical correlates.</p><p><strong>Sample size: </strong>157 patients.</p><p><strong>Results: </strong>The mean age was 47.1 years, 101 patients (64.3%) were male, and the mean disease duration was 9.4 years. Malignancy was documented in 10 patients (6.4%), most commonly papillary thyroid carcinoma (8/10). Two of the eight papillary thyroid carcinomas were classified as T1a (≤10 mm); exact pathology measurements were not consistently available. One patient had colorectal cancer, and one had prostate cancer. Exploratory comparisons showed that patients with malignancy were older than those without malignancy (mean age, 56.6 vs 46.5 years; <i>P</i>=.039). The remaining comparisons were inconclusive. All patients with malignancy were in remission or had an excellent response at the last documented follow-up.</p><p><strong>Conclusion: </strong>Malignancy was documented in 6.4% (10 out of 157) in this multi-center Gulf acromegaly cohort, predominantly papillary thyroid carcinoma. The findings support individualized surveillance based on population guidance, symptoms, family history, and clinical findings rather than an acromegaly-specific screening program.</p><p><strong>Limitations: </strong>Retrospective design, small number of malignancy events, missing data, lack of a population comparator, and nonstandardized cancer testing may introduce selection and detection biases.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"368-375"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed specialty consultation and hospital admission in 72-hour emergency department return visits.","authors":"Ayse Ertekin, Mehmet Soyugūzel, Usame Rakip","doi":"10.5144/0256-4947.2026.339","DOIUrl":"https://doi.org/10.5144/0256-4947.2026.339","url":null,"abstract":"<p><strong>Background: </strong>Unscheduled 72-hour emergency department (ED) return visits are key quality indicators; however, aggregate return rates alone may mask modifiable clinical vulnerabilities. In high-performing EDs with low baseline return rates, the extent of preventable revisits and the impact of missed index-visit specialty consultations remain poorly defined.</p><p><strong>Objectives: </strong>This study aimed to classify return causes using standardized criteria, determine the proportion of potentially preventable return visits, and evaluate whether missed specialty consultations at the index visit are independently associated with hospital admission.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Single-center, tertiary care university hospital emergency department.</p><p><strong>Methods: </strong>This study evaluated all ED return visits occurring within 72 hours between April 1, 2024 and April 30, 2025. Two emergency physicians independently classified causes using predefined criteria (κ=0.81). The primary outcome was hospital admission at return, analyzed via multivariable logistic regression.</p><p><strong>Main outcome measures: </strong>Patient demographics (age, sex), triage zone at both visits, presenting complaints, final diagnoses, specialty consultation status, and disposition. Triage was zone-based: green (low acuity), yellow (moderate acuity), and red (high acuity).</p><p><strong>Sample size: </strong>1505 unplanned return visits among 81390 adult ED visits.</p><p><strong>Results: </strong>The 72-hour return rate was 1.85%. While most returns were disease-related (75.5%, n=1136), 24.5% (n=369) were potentially preventable. Missed consultation opportunities occurred in 14.0% of cases (n=210), with 75.2% (n=158) of these appearing in disease-related returns. Admission rates were significantly higher in the missed-consultation group (38.1% [80/210] vs. 8.0% [103/1295]; <i>P</i><.001). After adjustment for disease severity (index-visit triage acuity and age), missed consultation showed the strongest association with hospital admission in the multivariable model (adjusted OR 6.84, 95% CI 4.70-9.95), followed by higher index-visit triage acuity (adjusted OR 4.47) and age ≥65 years (adjusted OR 2.32); the model showed good discrimination (c-statistic 0.84).</p><p><strong>Conclusions: </strong>One in four return ED visits was potentially preventable. Missed index-visit specialty consultations were independently associated with markedly higher admission risks and may warrant evaluation as quality improvement targets.</p><p><strong>Limitations: </strong>Retrospective, single-center design; the missed-consultation definition is not externally validated and is subject to information and hindsight bias; residual confounding cannot be excluded, precluding causal inference.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 5","pages":"339-348"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of hospitalization among Indonesian Hajj pilgrims in Saudi Arabia: a nationwide retrospective cohort study.","authors":"Masdalina Pane, Raharni Raharni, Asep Hermawan, Iin Nurlinawati, Made Suratri, Sarah Humaira, Aulia Rahman, Mugi Wahidin, Ekowati Rahajeng, Maria Herawati","doi":"10.5144/0256-4947.2026.258","DOIUrl":"10.5144/0256-4947.2026.258","url":null,"abstract":"<p><strong>Background: </strong>The Hajj pilgrimage is a major global gathering that poses health challenges, particularly for those with pre-existing health conditions that require hospitalization.</p><p><strong>Objectives: </strong>To examine the determinants of hospitalization among Indonesian Hajj pilgrims and quantify their relative contributions to the burden of hospitalization.</p><p><strong>Designs: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Indonesian emergency clinics and referral hospitals for Hajj in Saudi Arabia during the 2016-2019 and 2022 Hajj seasons.</p><p><strong>Patients and methods: </strong>A nationwide retrospective cohort study used data from the Integrated Hajj Computerized System for Health (Siskohatkes). Variables included demographic information, clinical profiles, and hospitalization outcomes. Multivariate logistic regression to estimate the adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated, and population-attributable fractions quantified significant determinants.</p><p><strong>Main outcome measures: </strong>Hospitalization among Indonesian Hajj pilgrims during the Hajj period.</p><p><strong>Sample size: </strong>876 700 Indonesian Hajj pilgrims were included in this study.</p><p><strong>Results: </strong>Overall, 8978 pilgrims (1.02%) were hospitalized. Age was the strongest predictor of hospitalization, with pilgrims aged ≥65 years having more than eightfold higher odds of hospitalization than those aged <45 years (aOR=8.31; 95% CI: 7.39-9.34; <i>P</i><.001), accounting for 49.8% of the attributable risk. Male sex was also independently associated with hospitalization (aOR=1.47; 95% CI: 1.39-1.56; <i>P</i><.001), contributing 11.6% of the attributable risk. Among comorbidities, diabetes (aOR=2.34; 95% CI: 2.19-2.51; <i>P</i><.001), diabetes with hypertension (aOR=2.23; 95% CI: 2.07-2.39; <i>P</i><.001), and anemia (aOR=1.56; 95% CI: 1.48-1.63; <i>P</i><.001) were significant independent predictors of hospitalization. The most common primary diagnoses among hospitalized pilgrims were pneumonia (36.7%), chronic obstructive pulmonary disease (21.4%), and myocardial infarction/coronary heart disease (12.4%).</p><p><strong>Conclusion: </strong>Older age and cardiometabolic comorbidities were the major predictors of hospitalization among Indonesian Hajj pilgrims. Strengthening pre-departure screening, chronic disease management, and risk-based interventions may reduce preventable hospitalizations and improve pilgrim safety.</p><p><strong>Limitations: </strong>Potential for information bias inherent in routinely collected administrative data and limited availability of clinical and behavioral covariates.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 4","pages":"258-267"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes of T cell lymphoma in a tertiary cancer center in Saudi Arabia.","authors":"Sultan Alqahtani, Mohammed Assiri, Abdullah Bin Abdu, Khalid Alyusif, Mohammed Alharbi, Ziyad Alharbi, Ali Alsubaie, Abdullah Alhamzani, Saud Alghamdi, Saeed Alshibani","doi":"10.5144/0256-4947.2026.249","DOIUrl":"10.5144/0256-4947.2026.249","url":null,"abstract":"<p><strong>Background: </strong>T-cell and natural-killer (T/NK)-cell lymphomas are rare and aggressive malignancies. Prior to our study, no dedicated institutional survival analyses of T/NK-cell lymphomas had been published from Saudi Arabia.</p><p><strong>Objectives: </strong>To evaluate the clinical characteristics, prognostic factors, and survival outcomes of patients with T/NK-cell lymphoma treated at a tertiary cancer referral centre in Saudi Arabia.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; January 2016 to December 2022.</p><p><strong>Patients and methods: </strong>We reviewed medical records of 89 adults with histologically confirmed T/NK-cell lymphomas, including precursor and mature subtypes. Overall survival (OS) was estimated using the Kaplan-Meier method. Prognostic factors were assessed with univariate and multivariable Cox proportional hazards regression. To maintain a robust events-per-variable ratio, the multivariable model was restricted to four predictors.</p><p><strong>Main outcome measures: </strong>Five-year overall survival and identification of variables associated with mortality.</p><p><strong>Sample size: </strong>89 patients.</p><p><strong>Results: </strong>The mean age was 49.5±20.5 years, and 62 patients (70%) were male. The most common subtypes were ALK-negative anaplastic large-cell lymphoma (n=20, 22%) and peripheral T-cell lymphoma, not otherwise specified (n=15, 17%). For the entire cohort (N=89), the 5-year OS was 56% (95% CI, 44%-67%); the Kaplan-Meier estimated mean OS over the full available follow-up was 116.4 months. In multivariable analysis restricted to 70 patients with complete data (26 deaths), elevated lactate dehydrogenase (LDH) (hazard ratio [HR]=7.66; 95% confidence interval [CI], 1.77-33.19; <i>P</i>=.006), Eastern Cooperative Oncology Group (ECOG) performance status >2 (HR=4.26; 95% CI, 1.60-11.33; <i>P</i>=.004), and renal insufficiency (HR=3.06; 95% CI, 1.34-6.97; <i>P</i>=.008) were independent predictors of worse survival. Anemia trended toward worse survival but did not reach independent significance (HR=2.30; 95% CI, 0.95-5.58; <i>P</i>=.066).</p><p><strong>Conclusion: </strong>Elevated LDH, poor performance status, and renal insufficiency are strong independent predictors of inferior survival. Stem cell transplantation did not demonstrate a survival benefit in this cohort. These findings underscore the importance of baseline laboratory and clinical variables for risk stratification and provide groundwork for multicentre studies and therapeutic optimisation in Saudi Arabia.</p><p><strong>Limitations: </strong>Sample size and single-centre retrospective design limit generalisability. Transplant-specific details in treatment regimens were not evaluated.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 4","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}