Annals of Saudi medicine最新文献

{"title":"Incidence of recurrent laryngeal nerve injury and associated risk factors after thyroidectomy: a retrospective study.","authors":"Hussein Alkaf, Sarah Abuduruk, Sara Bayounos, Sherif Kamel Abdelmonim, Jabir Alharbi, Mohammad Ali Alessa, Haddad Alkaff, Ameen Alherabid","doi":"10.5144/0256-4947.2025.295","DOIUrl":"https://doi.org/10.5144/0256-4947.2025.295","url":null,"abstract":"<p><strong>Background: </strong>Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for improving surgical outcomes.</p><p><strong>Objectives: </strong>To assess the incidence of permanent VCP after thyroidectomy and evaluate its possible associated risk factors.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>A multicenter study conducted in Makkah, Saudi Arabia.</p><p><strong>Methods: </strong>The study assessed incidence of permanent RLNI and its associated risk factors in 314 patients who underwent thyroidectomy at our centers in Makkah, Saudi Arabia, between December 2014 and December 2024. The data were gathered on general characteristics, clinical findings, and surgical details. Statistical analyses were performed to identify significant risk factors.</p><p><strong>Main outcomes measures: </strong>Incidence of permanent RLNI and the associated risk factors.</p><p><strong>Sample size: </strong>314 patients.</p><p><strong>Results: </strong>Overall incidence of permanent VCP was 9 (2.9%). The left vocal cord was affected in 3 (1%) of cases, while the right vocal cord was affected in 6 (1.9%). Significant risk factors included age over 45 years (<i>P</i>=.043), male patients (<i>P</i>=.04), prior thyroid surgery (<i>P</i>=.006), and high cumulative doses of radioactive iodine (<i>P</i>=.008). However, no significant associations with factors such as family history of thyroid disease, carcinoma, or incidental disease onset.</p><p><strong>Conclusion: </strong>Post-thyroidectomy VCP is influenced by several factors, including age, gender, previous thyroid surgery, and radioactive iodine dose. These findings highlight the importance of careful pre-operative risk assessment and the use of preventive measures, such as Intra-Operative Nerve monitoring, use of optical magnification and pre-operative predicting of thyroidectomy difficulty to reduce RLNI risk.</p><p><strong>Limitations: </strong>Possibility of selection bias due to the retrospective design. In addition to lack of use of certain analytical tests and detailed subgroup analysis due to the moderate sample size.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 5","pages":"295-303"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of pediatric <i>Acinetobacter spp</i> bacteremia at a tertiary care center in Riyadh, Saudi Arabia.","authors":"Deema Gashgarey, Raghad Alhuthil, Mohammed Alsuhaibani, Salem Alghamdi, Suliman Al Jumaah, Ohoud Al Yabes, Esam A Albanyan, Sami Al-Hajjar","doi":"10.5144/0256-4947.2025.326","DOIUrl":"https://doi.org/10.5144/0256-4947.2025.326","url":null,"abstract":"<p><strong>Background: </strong>Invasive <i>Acinetobacter</i> infection in children is associated with significant morbidity and fatality.</p><p><strong>Objectives: </strong>Investigate the clinical characteristics, antimicrobial susceptibility, outcomes, and fatality-related risk factors of <i>Acinetobacter</i> bacteremia in children.</p><p><strong>Design: </strong>A retrospective case series study.</p><p><strong>Setting: </strong>King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.</p><p><strong>Patients and methods: </strong>The study included children (aged 0-14 years) with a positive blood culture for <i>Acinetobacter</i> species from January 2015 to December 2022.</p><p><strong>Main outcomes measures: </strong>Clinical characteristics, antimicrobial susceptibility, case fatality rate, and fatality-related risk factors.</p><p><strong>Sample size: </strong>42 children.</p><p><strong>Results: </strong>17 girls (40%) and 25 boys (60%) with a median age of 10.5 months [interquartile range (IQR): 2-48]. The most common underlying conditions were hematologic/oncologic disease (n=15, 36%) and congenital heart disease (n=12, 29%). Thirty-three patients (79%) developed Acinetobacter bacteremia as a hospital-acquired infection. The predominant species were <i>A. calcoaceticus-A. baumannii</i> complex (n=34, 45%) and <i>A. baumannii</i> (n=15, 36%). Common exposures within 30 days prior to infection were previous hospitalization (n=32, 76%), antimicrobial therapy (n=26, 62%), central line insertion (n=19, 45%), mechanical ventilation (n=16, 38%), surgery (n=15, 36%), immunosuppressive therapy (n=9, 21%) and dialysis (n=9, 21%). Furthermore, 14 patients (33%) exhibited multidrug resistance, and one patient (2%) developed meningitis. Following treatment, 33 patients (79%) recovered with a median treatment duration of 15 days (IQR=12-21), two patients (5%) experienced relapse while on treatment, and two patients (5%) exhibited recurrent infection. The case fatality rate was 12% (5/42) and all died within 10 days post-infection. In the univariable analysis of fatality-related risk factors showed that younger age (median 2 months [IQR: 1-2]) (<i>P</i>=.025), congenital heart disease (<i>P</i>=.018), and dialysis within 30 days prior to infection were significantly associated with fatality (<i>P</i>=.005).</p><p><strong>Conclusion: </strong>In this study, children with <i>Acinetobacter</i> bacteremia often had a history of prior hospitalization, antimicrobial therapy, invasive procedures, and chronic underlying comorbidities, specifically congenital heart disease and hematologic/oncologic disorders. Additionally, younger age, congenital heart disease, and recent dialysis were associated with fatality in the univariable analysis.</p><p><strong>Limitations: </strong>Small sample size, lack of multivariable analysis, lack of molecular epidemiologic data.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 5","pages":"326-335"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of <i>Candida (Candidozyma) auris</i> by molecular methods and investigation of clinical symptoms of patients in a tertiary hospital in Istanbul.","authors":"Yüksel Akkaya, Begüm Nalça Erdin, İrfan Aydın, Ayşe Serra Özel, Ahmet Münir Yılmaz, Mustafa Çılkız, İbrahim Halil Kılıç, Zülal Aşçı Toraman","doi":"10.5144/0256-4947.2025.313","DOIUrl":"https://doi.org/10.5144/0256-4947.2025.313","url":null,"abstract":"<p><strong>Background: </strong><i>Candidozyma auris</i> is resistant to many antifungals, spreads rapidly and causes deaths in patient groups with comorbid factors.</p><p><strong>Objectives: </strong>The aim of this study was to determine the virulence of <i>C. auris</i>, antifungal resistance genes and clinical characteristics of the patients.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Single-center.</p><p><strong>Material and methods: </strong>This study was conducted between August 2022 and December 2023 at Ümraniye Training and Research Hospital. ITS1-5.8S-ITS2 and ITS1-ITS4 gene regions of the rDNA gene of <i>C. auris</i> isolates identified by VITEK MS v.3.2 were amplified by polymerase chain reaction (PCR) method. These regions were partially sequenced using the Sanger method. The presence of <i>C. auris</i> specific <i>CDR1, ERG11, MDR1, ACT1, SAP5, HYR3, ALS5, IFF4, FUR1, PLB3, PGA26</i> and <i>PGA52</i> gene regions were determined by PCR. Antifungal susceptibility testing of <i>C. auris</i> was performed with VITEK 2 Compact AST YS08 and SYO.</p><p><strong>Main outcome measures: </strong>Variations in <i>C. auris</i> isolates, antifungal resistance and clinical characteristics of patients.</p><p><strong>Sample size: </strong>Forty-four isolates from 31 patients.</p><p><strong>Results: </strong>According to gene regions, nine different variations were identified in our hospital, with VAR-1 being the most common. Twenty-five (80.6%) of the patients died and isolation of the causative agent was between days 1-30 in 13 (41.9%) patients. Antibiotic use, ICU admission rate, and central venous catheter use in patients were 29 (93.6%), 28 (90.3%), and 21 (67.7%), respectively. Hypertension, diabetes mellitus (DM) and septic shock were found in 14 (45.2%), 13 (41.9%) and 10 (32.3%) patients, respectively. Antifungal resistance rates of the isolates were determined as 97.7% and 84.1% for amphotericin B and fluconazole, respectively. No resistance to micafungin and caspofungin was detected. The survival rate with echinocandin use was 22% (4 patients).</p><p><strong>Conclusion: </strong>Identification of gene regions is valuable in determining the pathogenicity of <i>C. auris</i>. Due to the presence of comorbidities in patients with <i>C. auris</i>, it is not possible to determine the exact proportion of deaths attributable to <i>C. auris</i> alone.</p><p><strong>Limitations: </strong>Single center setting; gene regions could not be expressed.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 5","pages":"313-325"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of carbon monoxide exposure cases in a secondary-level state hospital emergency department.","authors":"Ahmet Münir Yılmaz, Enes Kalıntaş","doi":"10.5144/0256-4947.2025.28.08.1202","DOIUrl":"10.5144/0256-4947.2025.28.08.1202","url":null,"abstract":"<p><strong>Background: </strong>Carbon monoxide (CO) poisoning is one of the leading causes of mortality and morbidity among inhaled toxins worldwide. The use of chimneyless stoves, barbecues and water heaters in small areas with poor ventilation leads to CO poisoning and increases the number of emergency department admissions.</p><p><strong>Objective: </strong>To evaluate the morbidity and mortality rates of CO poisoning cases admitted to the emergency department of our hospital.</p><p><strong>Design: </strong>Retrospective, cross-sectional study.</p><p><strong>Setting: </strong>Single center, secondary-state hospital in Türkiye.</p><p><strong>Patients and methods: </strong>Data from CO poisoning cases admitted to Gaziantep Abdülkadir Yüksel State Hospital Emergency Department between October 20, 2022 and October 20, 2023 were retrospectively evaluated.</p><p><strong>Main outcome measures: </strong>CO levels in venous blood obtained from patients with suspected CO poisoning.</p><p><strong>Sample size: </strong>377 patients.</p><p><strong>Results: </strong>Of the 377 patients, 204 (54.1%) were females, 302 (80.1%) were Turkish citizens, and 196 (52%) presented to the hospital on their own means. It was determined that 285 patients (75.6%) were poisoned by stove smoke, 90 (23.8%) by fire smoke, and two (0.5%) by natural gas. It was determined that 298 patients (79%) were discharged after treatment, 42 (11.1%) left the hospital without permission, 23 (6.1%) were taken under observation and hyperbaric oxygen (HBO) treatment was applied, 13 (3.4%) refused treatment, and 1 (0.3%) died. The need for HBO treatment increased with age and a significant association was found between age and the need for HBO treatment (<i>P</i>=.002).</p><p><strong>Conclusions: </strong>CO poisoning remains a common public health issue, mostly linked to stove and fire smoke. Older age was significantly associated with the need for HBO therapy. It is important to prevent and raise awareness regarding CO poisoning cases, which increase particularly during the winter months in the context of earthquakes and other natural disasters.</p><p><strong>Limitations: </strong>Retrospective design.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":" ","pages":"336-344"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fine needle aspiration vs. surgical pathology specimen in salivary gland tumors: a study of diagnostic accuracy and predictive value.","authors":"Liqa Abdulrahman Almulla, Ammar Mohammed Alnujaidi, Yousef Ibrahim Alhezam, Hassan Ali Slais, Mohammed Abdulaziz Mosaqlab, Hassan Ali Khuraidah, Awadia Awadalla, Ahmed Alsayyah","doi":"10.5144/0256-4947.2025.304","DOIUrl":"https://doi.org/10.5144/0256-4947.2025.304","url":null,"abstract":"<p><strong>Background: </strong>While the present literature emphasizes that surgical biopsies are the gold standard in diagnosing salivary gland tumors, several studies highlight the role of fine needle aspiration (FNA) due to its high diagnostic yield and minimally invasive nature. However, the role of FNA and its accuracy in diagnosing salivary gland tumors compared to surgical biopsies is poorly investigated in the Eastern region of Saudi Arabia.</p><p><strong>Objective: </strong>Assess the diagnostic accuracy of FNA in salivary gland tumors as compared to histopathological findings from surgical specimens. Identify sources of diagnostic discrepancies between FNA and surgical biopsies.</p><p><strong>Design: </strong>Retrospective diagnostic accuracy study.</p><p><strong>Settings: </strong>King Fahd Hospital of the University in Eastern Province, Al Khobar, Saudi Arabia.</p><p><strong>Patients and methods: </strong>Patients with confirmed diagnosis of salivary gland tumor who underwent both FNA and surgical biopsy between 2014-2024. FNA was performed under ultrasound (US) guidance and examined by two consultant pathologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the diagnostic accuracy of FNA.</p><p><strong>Main outcome measures: </strong>FNA diagnostic accuracy compared to histopathological findings from surgical specimens.</p><p><strong>Sample size: </strong>40 cases.</p><p><strong>Results: </strong>A total of 267 cases were considered in this study, of which only 40 cases were included. FNA had a high specificity of 100% (95% CI: 85.8%-100%) but a low sensitivity of 23.08% (95% CI: 5.0%-53.8%). The PPV is 100% (95% CI: 29.2%-100%). The NPV is 70.6% (95% CI: 64.0%-76.4%). Finally, the overall accuracy is 73% (95% CI: 55.9%-86.2%).</p><p><strong>Conclusion: </strong>Our study supports the utility of FNA as a diagnostic modality for salivary gland tumors, demonstrating high specificity with variable sensitivity. The observed false negative rate emphasizes the need for cautious interpretation of negative results, necessitating confirmatory histopathological studies. The findings highlight the influence of sample size on cytology performance, with smaller studies reporting lower sensitivity compared to larger multi-center analyses.</p><p><strong>Limitations: </strong>Sample size, retrospective design, data extraction, incomplete data.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 5","pages":"304-312"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent diabetic ketoacidosis in Saudi patients with type 1 diabetes mellitus: a retrospective study from a tertiary hospital.","authors":"Muneera Alshareef, Samia A Bokhari, Arsalan Nawaz, Lama Arfaj, Al Hussein Alsharif, Haidar Alshamrani, Fahad Al-Bogami, Maram Altowairqi, Sally Aqabaw, Abdullah Alobisi, Yasir Al-Ard, Homam Talal Alsharifb","doi":"10.5144/0256-4947.2025.28.08.1200","DOIUrl":"10.5144/0256-4947.2025.28.08.1200","url":null,"abstract":"<p><strong>Background: </strong>Diabetic ketoacidosis (DKA) is a potentially fatal complication of type 1 diabetes mellitus (T1DM). To our knowledge, limited studies have examined the risk factors of recurrent DKA in the Saudi T1DM population.</p><p><strong>Objectives: </strong>To identify factors contributing to recurrent DKA in Saudi patients with T1DM. By identifying the contributing factors for DKA recurrence the disease burden can be mitigated by making targeted interventions.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Tertiary care center, Jeddah, Saudi Arabia.</p><p><strong>Patients and methods: </strong>Saudi patients with T1DM admitted with DKA between 2021 to 2023 were included. A comparative analysis was performed between patients with a single recurrence of DKA and those with multiple recurrent admissions.</p><p><strong>Main outcome measures: </strong>Association between multiple variables and recurrent DKA.</p><p><strong>Sample size: </strong>245 Saudi patients with T1DM.</p><p><strong>Results: </strong>A total of 245 Saudi patients with T1DM were included. A significantly higher proportion of females were observed in the multiple recurrent DKA group (73.1% vs. 48.5%, <i>P</i>=.0001). Also, a higher proportion of single individuals were found among the multiple recurrent DKA group (<i>P</i>=.006). Longer duration of T1DM (≥5 years) and presence of microalbuminuria were more associated with multiple recurrent DKA than single recurrence of DKA. Among the precipitating factors, non-adherence to medications was associated with multiple recurrence of DKA (<i>P</i>=.02).</p><p><strong>Conclusion: </strong>This study has identified several risk factors contributing to recurrent DKA episodes among Saudi patients with T1DM. By increasing awareness of these factors among both healthcare providers and the community, we can develop more effective prevention strategies and ultimately reduce the incidence of recurrent DKA.</p><p><strong>Limitations: </strong>A retrospective study and single-center experience.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":" ","pages":"353-360"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of hepatitis B, hepatitis C, and syphilis co-infections in HIV-1 patients: a retrospective cross-sectional study of prevalence and viral load correlates.","authors":"Sibel Aydoğan, Füsun Kirca, Aysegul Gozalan, Ferhat Gürkan Aslan, Merve Gürler, Alparslan Toyran, Bedia Dinç","doi":"10.5144/0256-4947.2025.28.08.1204","DOIUrl":"10.5144/0256-4947.2025.28.08.1204","url":null,"abstract":"<p><strong>Background: </strong>Co-infections with hepatitis B (HBV), hepatitis C (HCV) and syphilis complicate the clinical management of people living with HIV by influencing disease progression, treatment response, and transmission risk. Despite the growing HIV burden in Türkiye, data on the impact of these coinfections remain limited.</p><p><strong>Objectives: </strong>To determine the prevalence of HBV, HCV, and syphilis coinfections in adults with HIV-1 and to examine their associations with demographics and HIV-1 viral load.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting: </strong>Single center, tertiary care hospital in Türkiye.</p><p><strong>Patients and methods: </strong>Adults diagnosed with HIV-1 between March 2019 and June 2024 at Ankara Bilkent City Hospital were included. Demographic information, HIV viral load measurements, and serological and molecular test results for HBV, HCV, and syphilis were retrieved from the institutional laboratory database. Coinfection status was assessed relative to age, gender, and HIV viral load.</p><p><strong>Main outcome measures: </strong>Prevalence and distribution of HBV, HCV, and syphilis coinfections and their associations with demographic variables and HIV viral load.</p><p><strong>Sample size: </strong>724 patients.</p><p><strong>Results: </strong>The study population was predominantly male (86%), with a median age of 40 years. Syphilis was the most common coinfection (25.6%), followed by HBV at 4.1% and HCV at 1.8%. Syphilis was significantly more prevalent among men (<i>P</i>=.001), and HBV coinfection was associated with older age (<i>P</i>=.005). No significant associations were observed between HIV viral load and any co-infection. Notably, a substantial proportion of patients, especially those newly diagnosed after 2019, had high HIV RNA levels, suggesting delayed diagnosis and treatment initiation. Triple coinfections were rare but remain clinically relevant.</p><p><strong>Conclusions: </strong>The high prevalence of syphilis and delayed HIV diagnoses highlight the urgent need for improved screening protocols, timely initiation of antiretroviral therapy, and broader implementation of HBV vaccination programs. An integrated multisectoral approach is critical to address the overlapping clinical and public health burdens posed by these co-infections. Healthcare strategies must consider the impact of COVID-19-related service disruptions, which likely contributed to delays in diagnosis and treatment.</p><p><strong>Limitations: </strong>Lack of data on patients' behavioral risk factors and no follow-up on treatment outcomes for syphilis.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":" ","pages":"345-352"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humoral immune response to mRNA-based influenza vaccines in older adults: a systematic review and meta-analysis of randomized controlled trials.","authors":"Abdulrazzag Abdulaziz Othman, Hassan Albargy","doi":"10.5144/0256-4947.2025.361","DOIUrl":"https://doi.org/10.5144/0256-4947.2025.361","url":null,"abstract":"<p><strong>Background: </strong>Influenza causes substantial morbidity and mortality in older adults, and conventional inactivated vaccines often elicit suboptimal immune responses in this population. Recent phase II/III randomized controlled trials (RCTs) have evaluated mRNA-based influenza vaccines, but a quantitative synthesis of their immunogenicity in adults aged ≥65 years is lacking.</p><p><strong>Objective: </strong>To determine whether mRNA influenza vaccines yield higher seroconversion rates (SCRs) at 29 days post-vaccination compared to licensed inactivated vaccines in adults aged ≥65 years.</p><p><strong>Design: </strong>Systematic review and meta-analysis of RCTs.</p><p><strong>Settings: </strong>Hospital, out-patient and community-based RCTs conducted in the USA.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Science, and Google Scholar from database inception to July 2025 for RCTs reporting SCR at 29 days post-mRNA influenza vaccination in adults aged ≥65 years. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model.</p><p><strong>Main outcome measure: </strong>SCR at day 29 post-vaccination for each influenza strain (A/H1N1, A/H3N2, B/Victoria, B/Yamagata).</p><p><strong>Sample size: </strong>Seven RCTs out of 4 studies comprising 7,114 participants aged ≥65 years were included.</p><p><strong>Results: </strong>Across the seven RCTs (100% RCTs), mRNA vaccines achieved significantly higher SCRs than controls: A/H1N1 (RR 3.41; 95% CI 2.8-4.2), A/H3N2 (RR 3.54; 95% CI 2.9-4.3), B/Victoria (RR 2.83; 95% CI 2.3-3.5), and B/Yamagata (RR 3.34; 95% CI 2.7-4.2). Heterogeneity was high for all strains (I²>80%). Sensitivity analyses omitting one study at a time confirmed robustness of the pooled estimates. Funnel plots and Egger's test indicated possible small-study effects. Meta-regression found no significant association between vaccine dose and effect size.</p><p><strong>Risk of bias: </strong>Visual inspection of Begg's funnel plots for the A/H1N1, A/H3N2, and B/Victoria strains revealed asymmetry, suggesting the possibility of publication bias.</p><p><strong>Heterogeneity: </strong>There was significant heterogeneity among studies for A/H1N1, A/H3N2, and B/Victoria strains but not B/Yamagata strain.</p><p><strong>Conclusion: </strong>In adults aged ≥65 years, mRNA influenza vaccines elicit substantially higher seroconversion rates across all four seasonal strains compared with licensed inactivated vaccines, suggesting a promising strategy to enhance immune protection in this high-risk population. Findings should be interpreted with caution given the small number of studies available.</p><p><strong>Limitations: </strong>Low number of studies included limits full assessment of heterogeneity and bias.</p><p><strong>Registration: </strong>PROSPERO CRD420251108768.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 5","pages":"361-371"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and antifungal resistance profiling of <i>Candida (Candidozyma) auris</i> in a tertiary hospital in Istanbul, Türkiye.","authors":"Yüksel Akkaya, Begüm Nalça Erdin, Ahmet Münir Yılmaz, İbrahim Halil Kılıç, Zülal Aşçı Toraman","doi":"10.5144/0256-4947.2025.207","DOIUrl":"10.5144/0256-4947.2025.207","url":null,"abstract":"<p><strong>Background: </strong><i>Candida (Candidozyma) auris</i> is a high priority fungal pathogen due to its antifungal resistance and its association with increased morbidity and mortality in infected patients.</p><p><strong>Objectives: </strong>The aim of this study was to identify Candida species in clinical samples and to determine the clades and in vitro antifungal resistance of <i>C. auris</i>.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Settings: </strong>Single-center tertiary hospital in Türkiye.</p><p><strong>Material and methods: </strong>The study was conducted in the Medical Microbiology Laboratory of Ümraniye Training and Research Hospital between December 2023 and October 2024. Fungal samples were identified using bio-Mérieux VITEK MS v.3.2 (bio-Mérieux, France) and RT-PCR. Antifungal susceptibility testing of <i>C. auris</i> was performed by VITEK 2 Compact AST YS08 and SYO.</p><p><strong>Main outcome measures: </strong>Identification of Candida species, in-vitro antifungal resistance of <i>C. auris</i>.</p><p><strong>Sample size: </strong>846 fungal isolates obtained from 746 patients were included.</p><p><strong>Results: </strong>A total of 846 fungal isolates were identified, with <i>C. albicans</i> being the most common (n=440, 52%), followed by <i>Nakaseomyces glabratus</i> (n=124, 14.7%), <i>C. parapsilosis</i> (n=85, 10.1%), <i>C. tropicalis</i> (n=69, 8.2%) and <i>C. auris</i> (n=57, 6.7%). All <i>C. auris</i> isolates were susceptible to anidulafungin. Of these isolates, 47 (82%) were resistant to fluconazole, 34 (60%) to amphotericin B, four (7%) to caspofungin and three (5%) to micafungin. One isolate was resistant to amphotericin B, fluconazole, caspofungin and micafungin. A total of 31 (54%) isolates were resistant to amphotericin B and fluconazole. In accordance with the manufacturer's recommendations, 57 isolates were evaluated as Clade-1.</p><p><strong>Conclusion: </strong><i>C. auris</i> infections are becoming increasingly common. In order to better understand antifungal-resistance of this pathogen, advanced methods should be used for rapid detection of clades and mutations in the FKS gene should be revealed.</p><p><strong>Limitations: </strong>Single center, whole genome sequence analysis were not performed.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"207-217"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769440","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":"Histopathological findings in obese patients undergoing laparoscopic sleeve gastrectomy in the Western region of Saudi Arabia.","authors":"Samah Saharti, Reem Aljohani","doi":"10.5144/0256-4947.2025.218","DOIUrl":"10.5144/0256-4947.2025.218","url":null,"abstract":"<p><strong>Background: </strong>Metabolic and bariatric surgeries are effective interventions in reducing weight and mortality. Laparoscopic sleeve gastrectomy is the most commonly performed procedure, particularly in the Middle East and North Africa (MENA) region. It involves resection of approximately 80% of the stomach, yielding large specimens for histopathological evaluation.</p><p><strong>Objectives: </strong>To identify histopathological findings in gastric specimens, evaluate the incidence of unexpected gastrointestinal stromal tumors (GISTs), and characterize the metabolic and bariatric surgery population in Saudi Arabia.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Settings: </strong>Single-center tertiary care in Saudi Arabia.</p><p><strong>Patients and methods: </strong>The study included patients who underwent laparoscopic gastric sleeve between May 2015 and April 2021. Inclusion criteria were patients with BMI ≥ 30 kg/m² who underwent surgery as treatment for obesity.</p><p><strong>Main outco me measures: </strong>Gastric histopathological findings, unexpected GIST incidence and metabolic and bariatric surgery population.</p><p><strong>Sample size: </strong>211 patients with obesity.</p><p><strong>Results: </strong>Patients' mean age was 38.2 years with a mean Body mass index (BMI) of 44.24 kg/m². The majority were females (60.2%). Normal histology findings accounted for 43.1% of findings, followed by chronic inactive gastritis (35.5%). Intestinal metaplasia was found in 1 (0.5%) patient while incidental GIST was found in 2 (0.9%) patients. <i>Helicobacter pylori (H. pylori)</i> was identified in 12.8% of cases, with a mean patient age of 36.7 years. Among <i>H. pylori</i>-positive patients, 48% presented with chronic active gastritis, 33% with chronic inactive gastritis, 14.8% with active follicular gastritis, and 3.7% with inactive follicular gastritis. A history of prior endoscopy was noted in 16.1% of patients, of whom 11.76% were found to have <i>H. pylori</i> postoperatively.</p><p><strong>Conclusions: </strong>H. pylori infection was detected at a mean age of 36.7 years and showed a significant association with higher BMI (mean difference: 2.2 kg/m², <i>P</i>=.04). While this suggests a potential link between obesity and <i>H. pylori</i> susceptibility, the clinical significance of this small absolute difference requires further investigation. <i>H. pylori</i> remained strongly associated with follicular gastritis (<i>P</i>=.003) but showed no difference between males and females.</p><p><strong>Limitations: </strong>Retrospective design and Giemsa stain was not done for all specimens to investigate <i>H. pylori</i>.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"218-224"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769439","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}