Annals of Saudi medicine最新文献

{"title":"Impact of 3D high-definition laparoscopy on total laparoscopic hysterectomy: a body mass index-stratified retrospective analysis.","authors":"Smit Bharat Solanki, Vineet V Mishra, Arminder Singh Dhiman","doi":"10.5144/0256-4947.2025.243","DOIUrl":"10.5144/0256-4947.2025.243","url":null,"abstract":"<p><strong>Background: </strong>Three-dimensional (3D) high-definition (HD) laparoscopy is a promising tool in minimally invasive gynecologic surgery, offering enhanced depth perception and visualization. However, its role in total laparoscopic hysterectomy (TLH), particularly in patients with varying body mass index (BMI), remains underexplored.</p><p><strong>Objective: </strong>To evaluate the impact of 3D HD laparoscopy on surgical efficiency and patient outcomes in TLH, with a focus on BMI-related differences.</p><p><strong>Design and settings: </strong>A single-center retrospective study.</p><p><strong>Patients and methods: </strong>Sixty patients who underwent TLH were included: n=30 used 3D HD laparoscopy (Aesculap 3D EinsteinVision) and n=30 matched controls used 2D laparoscopy. Matching criteria included uterine weight and prior surgical history. Patients were stratified according to BMI (≤24.9, 25-29.9, ≥30.0 kg/m²).</p><p><strong>Main outcome measures: </strong>Operative time, vault suturing time, blood loss, trocar site incisions, haemoglobin drop, and complication rates.</p><p><strong>Sample size: </strong>60 patients (30 in each group).</p><p><strong>Results: </strong>The 3D HD laparoscopy group demonstrated significant improvements across multiple outcomes. Trocar site incisions were significantly reduced in all BMI categories (<i>P</i> <.001). Vault suturing time was shorter in the 3D HD laparoscopy group (<i>P</i> =.002), and total operative time was reduced in overweight patients (<i>P</i> =.015). Obese patients in the 3D group had lower haemoglobin drop (<i>P</i> =.01) and reduced blood loss compared to 2D laparoscopy group (<i>P</i> =.017).</p><p><strong>Conclusion: </strong>3D HD laparoscopy enhances surgical efficiency in TLH, especially in patients with higher BMI, by minimizing trocar site incisions, reducing vault suturing times, and improving hemostasis-highlighting its value in overcoming challenges of minimally invasive gynecologic surgery.</p><p><strong>Limitations: </strong>The study's retrospective design and modest sample size limit generalizability.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"243-248"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769441","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":"Clinicopathological features and treatment outcomes of patients with fibrolamellar hepatocellular carcinoma: a retrospective multicenter study.","authors":"Ali Kaan Güren, Hilal Polat, Eyüp Çoban, Emir Çerme, Gizem Bakır Kahveci, Aslı Geçgel, Pınar Ezgi Dama, Lamia Şeker Can, Sedat Biter, Sıla Soylu, Nargiz Majidova, Nadiye Sever, Erkam Kocaaslan, Pınar Erel, Yeşim Ağyol, Abdussamet Çelebi, Rukiye Arıkan, Selver Işık, İlkay Tuğba Ünek, Ertuğrul Bayram, Ozan Yazıcı, Adem Deligönül, Zeynep Hande Turna, Murat Araz, İbrahim Vedat Bayoğlu, Osman Köstek, Murat Sarı","doi":"10.5144/0256-4947.2025.249","DOIUrl":"10.5144/0256-4947.2025.249","url":null,"abstract":"<p><strong>Background: </strong>Fibrolamellar Hepatocellular Carcinoma (FLHCC) is a rare primary liver tumour that is distinct from conventional HCC in both histopathological and clinical features. There is no clear consensus on its treatment.</p><p><strong>Objective: </strong>Assess the demographics, prognosis, and treatment- particularly systemic therapies-of FLHCC patients across multiple centers in Türkiye.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Settings: </strong>Multicenter.</p><p><strong>Patients and methods: </strong>Patients with histopathological diagnosis of pure fibrolamellar hepatocellular carcinoma.</p><p><strong>Main outcome measures: </strong>Treatment responses of metastatic stage patients were evaluated. Progression-free survival (PFS) and overall survival (OS) analyses of metastatic stage first-line treatments were performed.</p><p><strong>Sample size: </strong>39 patients with FLHCC.</p><p><strong>Results: </strong>The 5-year survival for all patients was 48%, 80% in stage 1, 57% in stage 2, 53% in stage 3 and 0% in stage 4. The median PFS for chemotherapy (n=10) and sorafenib (n=6) patients in the metastatic stage first series was 5.7 months and 2.8 months, respectively (<i>P</i>=.031). Median OS was 12.1 months for chemotherapy and 8.8 months for sorafenib (<i>P</i>=.853) in the metastatic stage.</p><p><strong>Conclusion: </strong>Conventional chemotherapies, especially gemcitabine and oxaliplatin combination can be used as systemic treatment options. Immunotherapies, chemoimmunotherapy and immunotherapy plus anti vascular endothelial growth factor combinations may be considered by clinicians.</p><p><strong>Limitations: </strong>Small sample size and the variability of the treatment modalities administered in the patients.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"249-255"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769438","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":"Cirrhotic cardiomyopathy: a systematic review and meta-analysis of prevalence across various diagnostic approaches.","authors":"Mohammed Ewid, Suliman Alsagaby, Abdulsalam Al-Ruqi, Odi Al-Shamikh, Abdulelah Aljohani, Mariam Safwan Bourgleh, Moaz Safwana","doi":"10.5144/0256-4947.2025.270","DOIUrl":"10.5144/0256-4947.2025.270","url":null,"abstract":"<p><strong>Background: </strong>Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction associated with liver cirrhosis, yet no consensus exists on standardized diagnostic criteria. We aimed to assess CCM prevalence using several guidelines.</p><p><strong>Methods: </strong>A systematic search of four databases (PubMed, Embase, Google Scholar, and EBSCO) identified observational studies reporting CCM prevalence in cirrhotic patients based on the three criteria: the World Congress of Gastroenterology (Montreal 2005), the American Society of Echocardiography (ASE 2009), and the Cirrhotic Cardiomyopathy Consortium (CCC 2019). A random-effects meta-analysis and subgroup analyses were performed using R Studio.</p><p><strong>Results: </strong>Seventy-six studies including 7445 patients were analyzed. Overall pooled CCM prevalence was 48% (95% CI: 44-52%, I²=97%). Prevalence was highest using Montreal 2005 (51%), followed by ASE 2009 (45%) and CCC 2019 (45%). CCC 2019 better identified CCM in early-stage cirrhosis (Child-Pugh A), whereas Montreal 2005 was more sensitive in advanced stages (Child-Pugh C).</p><p><strong>Conclusion: </strong>CCM prevalence varies by diagnostic criteria and cirrhosis severity. Further studies are needed to determine the clinical relevance and prognostic value of each criterion.</p><p><strong>Prospero registration number: </strong>CRD42024511527.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"270-293"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769370","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":"Alpha-1 antitrypsin in COVID-19 patients: a dual-center screening study in Malaysia.","authors":"Norsyuhadah Musa, Wan Norlina Wan Azman, Nor Amirah Mohammad Nazri, Tuan Salwani Tuan Ismail, Azian Harun, Najib Majdi Yaacob, Sarina Sulong, K N S Sirajudeen, Mahaya Che Mat, Hani Ajrina Zulkeflee","doi":"10.5144/0256-4947.2025.225","DOIUrl":"10.5144/0256-4947.2025.225","url":null,"abstract":"<p><strong>Background: </strong>Alpha-1 antitrypsin (A1AT) deficiency has been recognized as an adverse prognostic determinant in severe instances of COVID-19.</p><p><strong>Objective: </strong>To determine the A1AT phenotypes and levels in individuals at various clinical stages of COVID-19 compared to healthy controls.</p><p><strong>Design: </strong>Case-control study.</p><p><strong>Settings: </strong>Hospital Raja Perempuan Zainab II (HRPZ II) and Hospital Ampang, Malaysia.</p><p><strong>Patients and methods: </strong>The analysis included a total of 282 patients. We categorized 188 COVID-19 patients from two centres in Malaysia into two groups: mild to moderate (stages 1-3) and severe to critical (stages 4-5) and compared them with 94 healthy controls.</p><p><strong>Main outcome measures: </strong>A1AT phenotypes and levels in different COVID-19 stages compared to healthy controls.</p><p><strong>Sample size: </strong>282 subjects.</p><p><strong>Results: </strong>The frequency (n) and percentage (%) in the control group, 88 (93.6) exhibited PiMM phenotypes, whereas 6 (6.4) displayed PiXM/PiYM phenotypes. Within the mild to moderate COVID-19 group, 88 (93.6) had PiMM phenotypes, 3 (3.2) featured PiXM/PiYM, and 1 presented PiBM phenotypes. Among severe to critical COVID-19 patients, the PiMM phenotype was identified in 61 (64.9) with 16 (17) having PiBM phenotypes, 4 (4.5) displaying PiCM, 2 (2.1) featuring PiXM/PiYM, and 1 (1.1) presenting PiEM phenotypes. Variants such as MS, MZ, S, and Z were undetected. However, 12 COVID-19 patient samples yielded inconclusive results. Median (IQR: 25th to 75th percentile) A1AT concentrations for controls were 1.8 (1.3-2.3) g/L, for mild to moderate cases 1.9 (1.2-2.6) g/L, and for severe to critical COVID-19 cases 2.1 (1.4-2.8) g/L.</p><p><strong>Conclusion: </strong>This research identifies the PiMM phenotype as the predominant phenotype expression within the studied population. This prevalence underscores the potential role of genetic factors in determining the biological response to SARS-CoV-2 infection. The presence of another phenotype variant across the study population suggests a nuanced genetic landscape that warrants further exploration.</p><p><strong>Limitation: </strong>The absence of follow-up A1AT quantification and baseline measurements limits the assessment of disease progression. The isolectric focusing phenotyping technique used might have missed specific A1ATD variants.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"225-234"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769369","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":"Length of stay in hospital and rehabilitation centers after stroke in Arab countries and Saudi Arabia: a systematic review and meta-analysis.","authors":"Abdullah I Alhusayni, Abdullah H Alzahrani","doi":"10.5144/0256-4947.2025.256","DOIUrl":"10.5144/0256-4947.2025.256","url":null,"abstract":"<p><strong>Background: </strong>Stroke rehabilitation is a vital component of post-stroke care, and the length of stay (LOS) in hospitals and rehabilitation centers varies across healthcare systems. This systematic review and meta-analysis assessed LOS among stroke survivors in Arab countries.</p><p><strong>Methods: </strong>A comprehensive literature search identified studies reporting LOS in stroke rehabilitation. A comprehensive literature search from the inception until March 2025 identified studies reporting LOS in stroke rehabilitation.</p><p><strong>Results: </strong>A total of 18 publications (25 datasets) involving 12 690 individuals were included in the meta-analysis. The pooled mean LOS was 25.67 days [95% confidence interval (CI): 16.22-35.11]. Subgroup analyses showed a longer LOS in Saudi Arabia (37.03 days, 95% CI: 24.11-49.95) compared to other Arab countries (8.87 days, 95% CI: 4.90-12.84), and in rehabilitation centers (46.71 days, 95% CI: 33.18-60.24) compared to acute hospital settings (9.07 days, 95% CI: 5.27-12.86). LOS varies widely across Arab countries and care settings.</p><p><strong>Conclusion: </strong>These findings highlight the need to examine whether differences in LOS are associated with functional recovery and healthcare efficiency. However, substantial heterogeneity across studies and a lack of outcome data limit the interpretability of the results.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"256-269"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769442","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 profiles and mortality risk factors in pediatric pulmonary hemorrhage: a singlecenter study in Saudi Arabia.","authors":"Moath K Alabdulsalam, Robayeh A Asiry, Raghad T Alhuthil, Abdulaziz S Almusallam, Nora K Alhelali, Tareq M Alayed, Fahad B Aljofan, Fawaz A Alanzi, Tariq O Alofisan, Abdullah T Alturkia","doi":"10.5144/0256-4947.2025.235","DOIUrl":"10.5144/0256-4947.2025.235","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hemorrhage (PH) is a rare, life-threatening event characterized by bleeding into the airways and lung parenchyma.</p><p><strong>Objectives: </strong>To explore the clinical characteristics of PH patients and investigate mortality-related risk factors, providing a holistic understanding of patient outcomes in this population.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Settings: </strong>The Pediatric Intensive Care Unit (PICU) at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.</p><p><strong>Patients and methods: </strong>Pediatric patients with PH episodes (aged 1 month to 14 years) who were admitted from January 2014 to September 2019.</p><p><strong>Main outcomes measures: </strong>Clinical characteristics, outcomes, and mortality-related risk factors.</p><p><strong>Sample size: </strong>80 children.</p><p><strong>Results: </strong>The cohort had a sex ratio of 1:1 and a median age of 24 months [interquartile range: 9-78]. Medical histories included bone marrow transplant (51.3%), oncology cases (40.0%), chemotherapy (61.3%), chest infection (86.3%), and immunosuppressant use (71.3%). Additionally, most patients (87.5%) had acute respiratory distress syndrome during the PH episode. The overall PICU mortality rate was 82.5% (66/80), and was associated with thrombocytopenia, sepsis, renal impairment, liver dysfunction, multiorgan dysfunction, and altered code status in univariable analysis (all <i>P</i> <.05). Multivariate analysis identified sepsis, multiorgan dysfunction, and altered code status as key predictors of PICU mortality (<i>P</i> <.05).</p><p><strong>Conclusion: </strong>The high mortality rate reported emphasizes the need for tailored interventions and heightened vigilance, particularly in immunocompromised children. Future research will expand on these findings to refine current management protocols and further improve patient care in pediatric PH.</p><p><strong>Limitations: </strong>Retrospective study, single-center.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 4","pages":"235-242"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769371","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":"Impact of the COVID-19 pandemic on the diagnosis, tumor characteristics, and survival outcomes of colorectal cancer: a retrospective cohort study.","authors":"Enver Yarikkaya, Merve Cin, Sena Ecin-Demezoglu, Beste Noyan-Mod, Mert Mahsuni Sevinc, Yakup Bozkaya, Nevra Dursun-Kepkep","doi":"10.5144/0256-4947.2025.169","DOIUrl":"10.5144/0256-4947.2025.169","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease (COVID-19) pandemic has significantly disrupted healthcare systems, delaying the diagnosis and treatment of various diseases, including colorectal cancer (CRC).</p><p><strong>Objectives: </strong>To determine differences in patient demographics, clinical and histopathological characteristics, and survival rates in patients diagnosed with CRC before and during the first year of the pandemic.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary-care center.</p><p><strong>Patients and methods: </strong>We included 284 patients newly diagnosed with CRC, stratified into two cohorts: those diagnosed one year before and during the first year of the pandemic. Patient demographics, tumor characteristics (diameter, location, histological type, grade, multifocality, invasion depth, lymphovascular and perineural invasion, number of metastatic lymph nodes, tumor budding, and deposits), and clinical factors (operability, presence of distant metastases, and survival status) were evaluated.</p><p><strong>Main outcome measures: </strong>Tumor stage at diagnosis, histopathological aggressiveness, and overall survival rates.</p><p><strong>Sample size: </strong>284 patients.</p><p><strong>Results: </strong>Patients diagnosed during the pandemic had a significantly higher incidence of distant metastasis (14.8% vs. 5.1%, <i>P</i>=.005), a greater proportion of pT4b stage tumors (12.9% vs. 0.6%, <i>P</i><.001), and a higher prevalence of rectosigmoid tumors (41.4% vs. 24.4%, <i>P</i>=.002). Additionally, tumor budding (63.6% vs. 47.3%, <i>P</i>=.014) and perineural invasion (35.2% vs. 24.5%, <i>P</i>=.053) were more common in the pandemic cohort. During the pandemic, significant shifts occurred in treatment modalities (<i>P</i>=.005), with increased utilization of neoadjuvant chemotherapy (18.8% vs. 11.5%), radiotherapy (22.7% vs. 12.2%), and palliative treatments (14.9% vs. 5.1%). Survival analysis showed no differences in survival rates between groups across all time points, including at three-year follow-up (<i>P</i>>.05).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic has led to increased metastasis and advanced tumor rates in CRC cases, possibly owing to diagnostic delays. Although survival outcomes were similar between the periods, delayed effects on prognosis may manifest, necessitating long-term follow-up.</p><p><strong>Limitations: </strong>Retrospective design, single-center study.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 3","pages":"169-176"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251256","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":"Redo surgery for persistent hyperinsulinemic hypoglycemia of infancy in the age of laparoscopic pancreatectomy.","authors":"Saud Alshanafey, Sarah Saud Almanea","doi":"10.5144/0256-4947.2025.165","DOIUrl":"10.5144/0256-4947.2025.165","url":null,"abstract":"<p><strong>Background: </strong>Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a rare disease but the most common cause of persistent neonatal hypoglycemia, often requiring early pancreatectomy. In cases of persistent/relapsed hypoglycemia, redo surgery may be necessary.</p><p><strong>Objectives: </strong>We report our experience with the redo of laparoscopic pancreatectomy at a tertiary healthcare center.</p><p><strong>Design: </strong>Single-center, retrospective study.</p><p><strong>Setting: </strong>Tertiary health care center.</p><p><strong>Patients and methods: </strong>We conducted a retrospective review of the patients who underwent redo laparoscopic pancreatectomy between March 2004 and April 2021. Demographic, clinical, and follow-up data were collected and analyzed. Descriptive data were generated.</p><p><strong>Main outcome measures: </strong>Feasibility and safety of the procedure. Success in controlling the PHHI.</p><p><strong>Sample size: </strong>82 patients.</p><p><strong>Results: </strong>We managed 82 patients with PHHI by pancreatectomy, 11 of whom (6 boys and 5 girls) required redo procedures to control hypoglycemia, with 2 needing 2 redo procedures. The mean age during the redo procedure was 21 months. The redo procedures were performed at a mean duration of 15.5 months after the primary pancreatectomy. All patients exhibited the histologically diffuse type. The mean follow-up was 7 years. All cases were managed successfully after the redo procedures. Six patients were on medical treatment, 4 developed diabetes mellitus, and 1 became euglycemic). Two patients developed severe pancreatitis postoperatively, 1 required drainage of the infected collection and 1 developed thrombosis of the inferior vena cava, which was managed with anticoagulation medication.</p><p><strong>Conclusions: </strong>Redo laparoscopic pancreatectomy is feasible, safe, and effective option for managing persistent or recurrent hypoglycemia after primary pancreatectomy in diffuse PHHI. Sufficient experience with laparoscopic pancreatectomy is required for redo surgeries.</p><p><strong>Limitations: </strong>Retrospective design of the study may introduce bias.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 3","pages":"165-168"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251269","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":"Indicators for early surgery in patients with intra-abdominal fistulizing Crohn's disease.","authors":"Ghada N Enani, Sarah S Al Ghamdi, Reem L Mimish, Ali Farsi, Nadeem Shafique Butt, Nouf Akeel","doi":"10.5144/0256-4947.2025.182","DOIUrl":"10.5144/0256-4947.2025.182","url":null,"abstract":"<p><strong>Background: </strong>The management of intra-abdominal fistulizing Crohn's disease involves surgical resection and biologic therapy. The criteria for choosing one therapy over the other are debated.</p><p><strong>Objectives: </strong>Identify factors influencing the choice of early surgical intervention over biologic therapy.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Single center, tertiary training and research hospital.</p><p><strong>Patients and methods: </strong>We analyzed adult patients with Crohn's disease who had intra-abdominal fistulas and were followed for three years. Baseline data were collected from medical records, and imaging studies assessed the fistula type, number, affected segment length, and presence of strictures and abscesses. Multivariable logistic regression analysis was used to identify predictors for surgical intervention.</p><p><strong>Main outcome measures: </strong>Factors that led to early surgical intervention in patients with intra-abdominal fistulizing Crohn's disease.</p><p><strong>Sample size: </strong>73 patients.</p><p><strong>Results: </strong>Seventy-three patients met the inclusion criteria: 27 (37.0%) in the nonsurgical group and 46 (63.0%) in the surgical group. Early surgical intervention was done if patients had bloating or constipation (<i>P</i>=.018), extensive disease segments (<i>P</i><.001), and no prior biologic treatment (0.015). In the multivariate analysis, early surgical intervention was indicated for enterocutaneous fistulas (odds ratio [OR]: 8.20, 95% confidence interval [CI]: 1.25-53.80, <i>P</i>=.03), abscesses (OR: 5.18, 95% CI: 1.03-26.12, <i>P</i>=.046), and strictures (OR: 6.08, 95% CI: 1.26-29.25, <i>P</i>=.024). Nonsurgical fistula treatment resulted in complications in 55% of patients, 48% of them requiring surgical resections, whereas biologic treatment achieved a 40.7% fistula healing rate.</p><p><strong>Conclusions: </strong>Findings associated with Crohn's fistulas, including enterocutaneous fistulas, extensive disease segments, strictures, and abscesses, are associated with a higher likelihood of early surgical intervention and may suggest potential ineffectiveness of biologic therapies.</p><p><strong>Limitations: </strong>This was a retrospective analysis of a single center with a small sample size, which may involve a degree of recall bias when data are collected, thus reducing the reliability of the results.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 3","pages":"182-189"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251257","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":"Chromosomal abnormalities in couples with recurrent pregnancy loss: a 16-year cross-sectional study of 4030 cases from Turkey.","authors":"Sabri Aynaci, Sinem Kocagil, Esfun Tosumoglu, Ezgi Susam, Betul Kilic, Ebru Erzurumluoglu Gokalp, Oguz Cilingir, Beyhan Durak Aras, Basar Tekin, Sevilhan Artan","doi":"10.5144/0256-4947.2025.154","DOIUrl":"10.5144/0256-4947.2025.154","url":null,"abstract":"<p><strong>Background: </strong>Chromosomal abnormalities are a significant cause of miscarriages. Carriers of balanced chromosome rearrangement are often at risk of recurrent pregnancy loss (RPL), as they are more likely to produce gametes with unbalanced chromosome rearrangements.</p><p><strong>Objective: </strong>This study evaluated the chromosomal abnormalities detected in couples with history of primary recurrent pregnancy loss.</p><p><strong>Design: </strong>Retrospective, cross-sectional study.</p><p><strong>Setting: </strong>Single center, tertiary healthcare center in Turkey.</p><p><strong>Patients and methods: </strong>This study reviewed conventional cytogenetic/molecular cytogenetic analysis data of 4030 patients (2015 couples) who visited the clinic from 2008-2024.</p><p><strong>Main outcome measures: </strong>Chromosomal abnormalities in patients diagnosed with primary recurrent pregnancy loss and genetic testing results of spontaneously achieved pregnancies in 16 patients with a balanced chromosomal rearrangement.</p><p><strong>Sample size: </strong>4030 individuals (2015 couples).</p><p><strong>Results: </strong>Majority of couples had a history of two spontaneous miscarriages (59.4%), followed by couples with 3 miscarriages (28.1%), 4 miscarriages (7.5%), and 5 or more miscarriages (4.91%). Chromosomal abnormality was detected in 133 (3.3%) cases. Among the revealed abnormalities, 130 (97.7%) were structural chromosome anomalies, while only 3 (2.3%) numerical chromosome anomalies were observed, including sex chromosome aneuploidy in 2 cases and mosaic karyotype in one case. Among the detected 130 structural chromosome abnormalities, reciprocal translocations (86 cases, 66.2%) were most frequently observed, followed by Robertsonian translocations in 26 cases (20.0%), inversion in 11 cases (8.5%), marker chromosome in 5 cases (3.8%), and derivative chromosomes in 2 cases (1.5%). Products of conception (conceptus materials) were analyzed from 16 spontaneously conceived pregnancies in individuals identified as carriers of chromosomal rearrangements. Although reciprocal translocations involving acrocentric chromosomes are typically expected to result in 3:1 meiotic segregation, adjacent-1 segregation was observed in two female individuals carrying the translocation t(9;15)(p22;q23). This finding is likely due to the limited genetic content of the translocated segments. Additionally, a novel complex three-way translocation, t(5;7;13)(p12;p12;p11), was identified for the first time.</p><p><strong>Conclusion: </strong>Cytogenetic and molecular analyses are crucial components in the etiological investigations of couples with RPL.</p><p><strong>Limitations: </strong>Retrospective design.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 3","pages":"154-164"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251255","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}