Annals of Saudi medicine最新文献

{"title":"Diagnostic utility and limitations of CT-guided transthoracic fine-needle aspiration biopsy in Lung-RADS 4 pulmonary nodules ≤2 cm.","authors":"Sümeyye Kodalak Cengiz, Ersin Demirer, Tamer Baysal, Rıdvan Dizman, Ali Fidan, Gonca Gül Geçmen, Recep Demirhan, Sevda Şener Cömert","doi":"10.5144/0256-4947.2026.225","DOIUrl":"10.5144/0256-4947.2026.225","url":null,"abstract":"<p><strong>Background: </strong>Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions ≤2 cm require further evaluation to optimize outcomes and reduce unnecessary surgeries.</p><p><strong>Objectives: </strong>This study aimed to evaluate the diagnostic accuracy, safety, and factors influencing the outcomes of CT-guided TTFNAB in Lung-RADS category 4 pulmonary nodules measuring ≤2 cm.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single-center, a tertiary referral center.</p><p><strong>Materials and methods: </strong>A retrospective analysis was performed on 95 patients who underwent CT-guided TTFNAB between January 2021 and April 2024. Data included demographics, lesion characteristics (size, location, density, and pleural proximity), histopathological findings, and procedural outcomes.</p><p><strong>Main outcome measures: </strong>The primary endpoints were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and factors influencing TTFNAB results, alongside procedural complications-specifically pneumothorax and chest tube requirement.</p><p><strong>Sample size: </strong>95 patients.</p><p><strong>Results: </strong>Of the 95 nodules, 26 (27%) were benign and 69 (73%) were malignant according to TTFNAB. Final pathology confirmed 18 (19%) benign and 77 (81%) malignant lesions. All biopsies yielded sufficient material. Sensitivity, specificity, and overall diagnostic accuracy were 83%, 94%, and 89%, respectively. The PPV was 98%, while the NPV was 65%. Pleural thickening was significantly more frequent in both the TTFNAB benign group (38% vs. 13%, <i>P</i>=.006) and final benign diagnosis group (44% vs. 14%, <i>P</i>=.008). Pneumothorax occurred in 30% of cases, with 24% of these requiring chest tube drainage. No significant associations were found between diagnostic accuracy or complications and variables such as age, emphysema, Lung-RADS category, or nodule size.</p><p><strong>Conclusion: </strong>CT-guided TTFNAB is an effective diagnostic method for confirming malignancy in pulmonary nodules ≤2 cm classified as Lung-RADS 4, providing an overall accuracy of 89% and a PPV of 98%. However, a benign TTFNAB result cannot be considered diagnostically safe: the NPV of 65% and false-negative rate of 35% indicate that a negative biopsy does not reliably exclude malignancy. Clinicians must not rely on a negative result alone; close radiological follow-up or surgical biopsy is essential for these high-risk lesions.</p><p><strong>Limitations: </strong>The retrospective single-center design, small sample size, and limited generalizability.</p><p><strong>Irb approval number: </strong>2024/010.99/6/23 (Date: 26.07.2024).</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"225-233"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195112","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":"Comparative overall survival in T4N0 and T2-3N1 non-metastatic colon cancer: a retrospective cohort study.","authors":"Fırat Akagunduz, Ali Kaan Güren, Erkam Kocaaslan, Burak Paçacı, Mustafa Alperen Tunç, Ahmet Demirel, Yesim Ağyol, Pınar Erel, Abdussamet Çelebi, Selver Işik, Ezgi Coban, Murat Sarı, Ibrahim Vedat Bayoğlu, Osman Köstek, Nazım Can Demircan","doi":"10.5144/0256-4947.2026.169","DOIUrl":"10.5144/0256-4947.2026.169","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of pathological T stage relative to nodal involvement in colon cancer remains controversial. Emerging evidence suggests that patients with T4N0 disease may experience outcomes comparable to or worse than those with node-positive disease.</p><p><strong>Objectives: </strong>This study aimed to compare long-term oncologic outcomes between patients with non-metastatic T4N0 colon cancer and those with T2-3N1 disease.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Settings: </strong>Single-center.</p><p><strong>Patients and methods: </strong>Retrospective analysis of patients with histologically confirmed, non-metastatic colon adenocarcinoma who underwent curative-intent surgery between 1999 and 2020. Patients were categorized into T4N0 and T2-3N1 groups.</p><p><strong>Main outcome measures: </strong>Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and compared with log-rank tests. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models.</p><p><strong>Sample size: </strong>A total of 273 patients were included, of whom 78 (28.6%) were staged as T4N0 and 195 (71.4%) as T2-3N1.</p><p><strong>Results: </strong>After a median follow-up of 72 months, patients with T4N0 disease showed significantly worse OS than those with T2-3N1 disease (HR=1.72, 95% CI 1.06-2.75; <i>P</i>=.02). Five-year OS rates were 66.6% and 79.8% in the T4N0 and T2-3N1 groups, respectively. On multivariate analysis, pathological T4N0 stage (HR=1.74, 95% CI 1.03-2.93; <i>P</i>=.03), age ≥65 years, vascular invasion, and omission of oxaliplatin-based adjuvant chemotherapy independently predicted poorer OS. Stage T4N0 was also associated with higher locoregional and distant recurrence rates, with increased peritoneal involvement.</p><p><strong>Conclusions: </strong>Non-metastatic T4N0 colon cancer is associated with less favorable long-term survival and higher recurrence rates compared with T2-3N1 disease, supporting its classification as a biologically aggressive subgroup that may benefit from treatment strategies similar to selected stage III colon cancers.</p><p><strong>Limitations: </strong>The retrospective, single-center design may introduce selection bias, and limited molecular data precluded detailed sub-group analyses.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"169-177"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195037","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":"Acute exacerbation of chronic rhinosinusitis: clinical and microbiological perspectives from a Saudi tertiary care center.","authors":"Rayan Alfallaj, Hisham Almousa, Abdullah BinGhaith, Maitha AlMaglouth, Renad Alfirm, Abdulaziz S Alrasheed, Saad Alsaleh","doi":"10.5144/0256-4947.2026.188","DOIUrl":"10.5144/0256-4947.2026.188","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic rhinosinusitis (AECRS) are increasingly recognized as a distinct clinical entity that significantly impacts quality of life. Despite its clinical relevance, data on its prevalence, clinical characteristics, and underlying bacteriology remain limited.</p><p><strong>Objectives: </strong>This study investigated the clinical features of AECRS and characterized the bacterial profile of middle meatus cultures during exacerbation episodes. Furthermore, characteristics of AECRS were compared across chronic rhinosinusitis (CRS) phenotypes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary care referral center, King Saud University Medical City (KSUMC).</p><p><strong>Patients and methods: </strong>Medical records from patients with established AECRS with positive middle meatus cultures from 2015 to 2025 were extracted. Data included demographics, CRS phenotype, comorbidities, prior treatments, microbiological findings, and clinical outcomes.</p><p><strong>Main outcome measures: </strong>Bacterial etiology and clinical characteristics of AECRS across phenotypes, including chronic rhinosinusitis with nasal polyposis, chronic rhinosinusitis without nasal polyposis, and allergic fungal rhinosinusitis.</p><p><strong>Sample size: </strong>104.</p><p><strong>Results: </strong>The study enrolled 104 patients (mean age 39.9 years); 49 (47.1%) had asthma and 21 (20.2%) had aspirin-exacerbated respiratory disease. Endoscopic pus was present in 71 (68.3%), and 77 (74%) had prior sinus surgery. The most common isolates were methicillin-sensitive <i>Staphylococcus aureus</i> 35 (33%), methicillin-resistant <i>Staphylococcus aureus</i> 26 (25%), and Pseudomonas species 24 (23.1%). Oral antibiotics were administered in 75 (72.1%) of AECRS episodes, while oral steroids were used in 27 (26%). Clinical improvement following antibiotic therapy was documented in 64 (85.3%) cases. High resistance was observed for ampicillin, penicillin, and oxacillin.</p><p><strong>Conclusion: </strong>AECRS presents considerable heterogeneity in both clinical presentation and microbiology. Therefore, culture-directed therapy is recommended due to variable antibiotic resistance patterns. Asthma was strongly associated with treatment failure. These findings emphasize the importance of individualized management strategies in AECRS.</p><p><strong>Limitations: </strong>Retrospective design, and single tertiary care center.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"188-204"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195348","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":"Establishment and validation of reference intervals for the neutrophil CD64 index in a healthy adult population from Guangxi, China.","authors":"Xiuyu Zhan, Xin Liu, Yanting Ding, Le Du, Kaijie Zhang, Jie Zeng, Shan Ren, Hongli Yu, Yijun Meng, Yu Lu","doi":"10.5144/0256-4947.2026.216","DOIUrl":"10.5144/0256-4947.2026.216","url":null,"abstract":"<p><strong>Background: </strong>The neutrophil CD64 (nCD64) index is a potent biomarker for infectious diseases; however, the lack of standardized reference intervals (RIs) limits its clinical utility.</p><p><strong>Objectives: </strong>This study aimed to establish and validate reference intervals (RIs) for the nCD64 index specifically for the Guangxi population using flow cytometry.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Settings: </strong>Conducted in Guangxi, China.</p><p><strong>Patients and methods: </strong>A total of 494 healthy adults (aged 18-83 years) were enrolled. Peripheral blood nCD64 expression was measured via flow cytometry. Reference intervals were determined using the non-parametric 95th percentile method (2.5th-97.5th) per CLSI EP28-A3c guidelines. Validation was performed in an independent cohort (n=30).</p><p><strong>Main outcome measures: </strong>The primary outcome was the 95% reference interval for the nCD64 index. Secondary outcomes included correlations between nCD64 index and sex, age, BMI, and primary hematological parameters.</p><p><strong>Sample size: </strong>494 healthy adults for establishment, plus 30 independent subjects for validation.</p><p><strong>Results: </strong>No clinically significant differences in the nCD64 index were found between sexes or across age groups, and partitioning was not required. The nCD64 index exhibited a skewed distribution. Although sex showed a weak positive correlation with nCD64 expression (r=.115, <i>P</i>=.011), the standard normal deviation test (z<z^*) indicated no requirement for sex-specific partitioning. No significant correlations were observed between nCD64 and age, BMI, or primary hematological parameters. The established 95% RI was .08-0.94, with the 90% confidence intervals (CI) for the lower and upper limits were .08-.09 and .92-1.04. Validation confirmed the RI's reliability, with 97% (29/30) of results falling within the range.</p><p><strong>Conclusions: </strong>We established a robust RI (.08-.94) for the nCD64 index in the Guangxi population, which remained consistent across age and sex groups. This provides a standardized baseline for the diagnosis of inflammatory and infectious conditions in Southern China.</p><p><strong>Limitations: </strong>The study was limited to a single regional population (Guangxi) and did not include pediatric or pregnant populations. Additionally, potential confounding from subclinical inflammation or undiagnosed chronic infections cannot be completely excluded despite strict enrollment criteria.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"216-224"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195172","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":"Association between proton pump inhibitor use and vitamin B12 deficiency: a retrospective cohort study in primary care centers in Riyadh, Saudi Arabia.","authors":"Salman Alanazi, Norah Bin Sulaiman, Sarah Khaled Aldahoul, Wafaa Khaldoun Alsawadi, Shahad Essam Alshail, Abdulmajeed Saleh Almansouf, Shammama Tul Amber","doi":"10.5144/0256-4947.2026.159","DOIUrl":"10.5144/0256-4947.2026.159","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) are widely prescribed, yet their long-term effects on vitamin B12 status remain debated with inconsistent findings across studies. Data from Saudi Arabia and the Middle Eastern primary-care context are limited.</p><p><strong>Objectives: </strong>To evaluate changes in serum vitamin B12 levels following ≥6 months of PPI therapy and assess the association between PPI use and vitamin B12 deficiency.</p><p><strong>Design: </strong>Retrospective chart-review cohort study with paired pre-post design.</p><p><strong>Settings: </strong>Family Medicine clinics at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (2016-2022).</p><p><strong>Patients and methods: </strong>Adults (≥18 years) receiving PPI therapy for ≥6 months with paired vitamin B12 measurements were included. Patients with conditions or medications affecting B12 absorption (metformin, gastrointestinal surgery, atrophic gastritis, vegetarian diet) were excluded. Paired pre-post vitamin B12 levels were compared using Wilcoxon signed-rank and McNemar tests. Neurological symptoms were documented from clinical records.</p><p><strong>Main outcome measures: </strong>Change in serum vitamin B12 concentration, incidence of vitamin B12 deficiency (<200 pg/mL), and prevalence of neurological symptoms.</p><p><strong>Sample size: </strong>376 adult PPI users.</p><p><strong>Results: </strong>Most participants were aged ≥56 years (n=282, 75%), female (n=211, 56.1%), and overweight/obese (n=308, 81.9%). Median vitamin B12 declined significantly from 312 to 297 pg/mL (<i>P</i><.001), with vitamin B12 deficiency prevalence increasing from 8.2% (n=31) to 12.2% (n=46) (<i>P</i>=.05). New-onset deficiency developed in 9.6% [Author: Please insert n for context, e.g., 9.6% (n)] of patients, with lower baseline B12 predicting greater decline. Neurological symptoms were nearly four times more common among those who developed deficiency (42.4% [95% confidence interval, CI 27.2-59.2] vs. 10.9% [95% CI 7.9-14.8], <i>P</i><.001). No significant associations were observed with age, sex, BMI, PPI type, or duration. The mean change in serum vitamin B12 was -41.3 pg/mL (95% CI -67.1 to -15.5) and the McNemar paired odds ratio for new-onset deficiency was 1.83 (95% CI 1.00 to 3.46).</p><p><strong>Conclusions: </strong>PPI use for six months or longer was associated with significant vitamin B12 decline, with neurological symptoms more frequent among deficient individuals. These findings support periodic vitamin B12 monitoring and structured deprescribing strategies, particularly for high-risk individuals.</p><p><strong>Limitations: </strong>Retrospective design, single-center setting, and inability to assess dietary B12 intake or PPI adherence.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"159-168"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195043","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":"Endotracheal tube size selection in critically ill patients: a 4-year single-center experience in Saudi Arabia.","authors":"Sara Alquorain, Rabab Hussain Alzanadi, Sundus Almukhodher","doi":"10.5144/0256-4947.2026.205","DOIUrl":"10.5144/0256-4947.2026.205","url":null,"abstract":"<p><strong>Background: </strong>Intubation is a critical aspect of airway management and supportive care for intensive care unit (ICU) patients. Inappropriate size of endotracheal tubes (ETT) affects the patient's airway, it is crucial to choose an appropriate size for each patient.</p><p><strong>Objectives: </strong>This study aimed to assess current practices of ETT size.</p><p><strong>Selection: </strong>for adult ICU patients and to explore factors associated with it.</p><p><strong>Design and settings: </strong>Single-center, retrospective cohort study at King Fahad Hospital of the University, Saudi Arabia.</p><p><strong>Patients and methods: </strong>A retrospective review was conducted for adult patients admitted to ICU from January 2020 to January 2024 at King Fahad Hospital of the University. Inclusion criteria included patients aged 18 years or older, underwent intubation and was followed by tracheostomy. Those with missing data, had laryngeal or thyroid masses, had upper airway obstruction by any cause and upper airway surgery were excluded.</p><p><strong>Main outcome and measures: </strong>The primary outcome was compliance of ETT size selection with established guidelines. Secondary outcomes included associations between ETT size (mm), patient demographics and intubation indications.</p><p><strong>Results: </strong>A total of 228 ICU patients were analysed [mean (standard deviation) age of 61.8 (19.6) years]. The median internal diameter of the ETT size was 7.5 mm, with neurological causes being the most common indication for intubation. ETT size showed a significant positive correlation with height (rs=.341; <i>P</i><.001) and weight (rs=0.190; p=0.004), but not with body mass index (rs=.050; <i>P</i>=.456). In multivariable analysis, larger ETT size was significantly associated with male sex (adjusted odds ratio, aOR 2.38, 95% confidence interval, CI 1.12-5.05), pulmonary indication for intubation (aOR 2.31, 95% CI 1.10-4.86), older age (aOR 1.20 per 10 years, 95% CI 1.02-1.42), and height (aOR 1.95 per 10 cm, 95% CI 1.20-3.16), whereas weight was not independently associated after adjustment (aOR 1.04 per 10 kg, 95% CI 0.85-1.26). Overall, 77% of ETT size selection did not comply with height-based guidelines.</p><p><strong>Conclusions: </strong>No standardized ETT size selection guidelines were followed for adult ICU patients. Male sex, height, older age, and pulmonary indication were independent predictors of larger ETT size, supporting the implementation of more structured, height-informed ETT sizing protocols.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 3","pages":"205-215"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195136","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":"Morbidity and mortality of pediatric drowning in Qatar: an epidemiological analysis of submersion encounters at a level I pediatric trauma center.","authors":"Omar Khaled Abbas, Safa Mahgoub, Nesreen Faqih","doi":"10.5144/0256-4947.2026.121","DOIUrl":"10.5144/0256-4947.2026.121","url":null,"abstract":"<p><strong>Background: </strong>Pediatric drowning is a preventable cause of mortality and morbidity worldwide, yet detailed outcome data from the Gulf region remain scarce.</p><p><strong>Objectives: </strong>To describe the epidemiology, clinical characteristics, neurological outcomes, and predictors of poor prognosis in pediatric drowning cases in Qatar.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Sidra Medicine, the only level I pediatric trauma and tertiary care center in Qatar.</p><p><strong>Patients and methods: </strong>Records of all pediatric drowning cases (0-18 years old) over a 6.5-year period from May 2018 to November 2024 were reviewed. Data included demographics, incident details, prehospital interventions, clinical presentation, laboratory findings, and outcomes using the Pediatric Cerebral Performance Category Scale (PCPCS). Predictors of mortality were analyzed.</p><p><strong>Main outcome measures: </strong>Neurological status at discharge (PCPCS), mortality, and associations between clinical variables and outcome.</p><p><strong>Sample size: </strong>225 pediatric drowning cases.</p><p><strong>Results: </strong>Median age was 3.0 years (IQR 2.0-6.0), and 65.3% were male. Incidents occurred in freshwater (76.4% [n=172]), predominantly residential pools (67.6% [n=152]). Mortality was 12.0% (n=27). Good neurological outcomes at discharge (PCPCS=1) occurred in 81.3% (n=183) of children, while 2.7% (n=6) survived with neurological disability (PCPCS 3-5). Prolonged submersion duration and lower initial arterial pH were independently associated with mortality. CPR duration and lactate were associated with mortality in univariate analysis but lost statistical significance after adjustment.</p><p><strong>Conclusion: </strong>Pediatric drowning in Qatar predominantly involves preschool-aged boys in residential pools. Mortality is strongly associated with prolonged submersion and severe acidosis at presentation. Prevention strategies should prioritize pool safety regulation, supervision, and early rescue to reduce hypoxic injury.</p><p><strong>Limitations: </strong>Retrospective single-center design with incomplete prehospital details and no long-term follow-up.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 2","pages":"121-127"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719271","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":"Safety and heterogeneity of mRNA-based seasonal Influenza vaccines: A systematic review and meta-analysis of randomized controlled trials.","authors":"Hassan Abdullah Albargy, Abdulrazzag Abdulaziz Othman","doi":"10.5144/0256-4947.2026.137","DOIUrl":"10.5144/0256-4947.2026.137","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Messenger RNA (mRNA)-based influenza vaccines represent a promising advancement in seasonal influenza prevention. However, comprehensive evaluation of their serious safety profile is essential as these vaccines progress toward widespread clinical use. While individual randomized controlled trials (RCTs) have reported low rates of serious adverse outcomes, pooled evidence is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic review and meta-analysis of RCTs aim to assess the risk of serious adverse events (SAEs) and adverse events of special interest (AESIs) associated with mRNA-based seasonal influenza vaccines in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All RCTs included in the meta-analysis were carried out in the USA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was done until December 2025. RCTs evaluating mRNA-based influenza vaccines in adults and reporting participant-level data for SAEs and/or AESIs were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Risks of SAEs and AESIs associated with mRNA-based seasonal influenza vaccines in adults, expressed as pooled risk ratios with 95% CIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample size: &lt;/strong&gt;Seven RCTs (containing 12 datasets) were included in this meta-analysis. The total number of cases in the intervention and comparator groups were 23,754 and 22,806 respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The pooled analysis demonstrated no increased risk of SAEs (RR=0.90, 95% CI: 0.64-1.27, &lt;i&gt;P&lt;/i&gt;=.56) and AESI (RR=0.76, 95% CI: 0.41-1.36, &lt;i&gt;P&lt;/i&gt;=.35) among mRNA vaccine recipients compared with controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Based on funnel plots, there is no evidence of systematic asymmetry or absence of smaller studies with null or adverse findings. Risk-of-bias assessment using the Cochrane traffic-light framework indicated low risk across all domains in all included RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Heterogeneity: &lt;/strong&gt;The heterogeneity was low-to-moderate (τ&lt;sup&gt;2&lt;/sup&gt;=0.08; I&lt;sup&gt;2&lt;/sup&gt;=27.79%; H&lt;sup&gt;2&lt;/sup&gt;=1.38) for SAEs and the Q-test indicated statistically significant heterogeneity (Q=14.46, &lt;i&gt;P&lt;/i&gt;=.21). For AESIs, heterogeneity was absent (τ&lt;sup&gt;2&lt;/sup&gt;=0.00; I&lt;sup&gt;2&lt;/sup&gt;=0.00%; H&lt;sup&gt;2&lt;/sup&gt;=1.00), with no evidence of between-study variability by the Q-test (Q=4.70, &lt;i&gt;P&lt;/i&gt;=.94).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pooled evidence shows that mRNA-based seasonal influenza vaccines are not associated with an increased risk of SAEs or AESIs compared with established influenza vaccines or placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Low absolute number of AESIs limiting detection of extremely rare events, limited long-term follow-up beyond early and intermediate risk windows, and potential differences between trial populations and real-world vaccine recipients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration: &lt;/stron","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 2","pages":"137-149"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719256","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":"Molecular characterization of Carbapenem-resistant Gram-negative bacilli associated with nosocomial infections in Hail, Saudi Arabia.","authors":"Fahad A Alkaik, Ehab B Rakha, Abdulaziz A Alkhateeb, Ibrahim A Al-Zahrani","doi":"10.5144/0256-4947.2026.75","DOIUrl":"10.5144/0256-4947.2026.75","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Enterobacteriaceae (CRE) are listed as critical priority antibiotic-resistant pathogens by the World Health Organization.</p><p><strong>Objective: </strong>This study investigated the prevalence and the molecular mechanisms underlying carbapenem resistance among four clinically relevant Gram-negative bacterial species associated with nosocomial infections.</p><p><strong>Design: </strong>Single-centre cross-sectional study.</p><p><strong>Setting: </strong>A tertiary hospital in Hail, Saudi Arabia.</p><p><strong>Methods: </strong>A total of 207 nosocomial gram-negative bacilli isolates were collected from December 2022 to July 2023. The isolates' identification and antimicrobial susceptibility testing (AST) were done using BD Phoenix M50. Isolates that showed resistance to one or more Carbapenemes agents in the antibiotic susceptibility test (AST) profile were further tested by a molecular method using Polymerase Chain Reaction (PCR) (Xpert Carba-R assay) for the detection of five most common Carbapenemases [<i>K. pneumoniae</i> carbapenemase (KPC), imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), the New Delhi metallo-β-lactamase (NDM) and oxacillinase (OXA-14)].</p><p><strong>Main outcome measures: </strong>Identification of carbapenemase producers among Gram-negative bacteria associated with nosocomial infections.</p><p><strong>Sample size: </strong>207 Gram-negative bacilli isolates.</p><p><strong>Results: </strong>Of 207 GNB isolates, 162 were carbapenem-resistant, with <i>Klebsiella pneumoniae</i> being the most prevalent isolates (n=59), followed by <i>Acinetobacter baumannii</i> (n=55), <i>P. aeruginosa</i> (n=34), and Proteus mirabilis (n=14). At least one carbapenemase gene was detected in 65 isolates, where <i>K. pneumoniae</i> has the highest rate with (n=43) followed by <i>A. baumannii</i> (n=9), <i>P. aeruginosa</i> (n=8), and <i>P. mirabilis</i> (n=5). The most predominant carbapenemase gene was bla_OXA-48 with 70.8% (n=46), followed by bla_NDM with 15.4% (n=10) and 13.8% (n=9) co-harboring bla_OXA-48 and bla_NDM.</p><p><strong>Conclusion: </strong>Carbapenemase-producing Gram-negative bacilli were prevalent among hospitalized patients in Hail, with bla_OXA-48 and blaNDM detected primarily in <i>K. pneumoniae</i>. Whole genome sequencing (WGS) is recommended to identify dominant nosocomial clones in the region.</p><p><strong>Limitations: </strong>The lack of sufficient funding has impeded the expansion of this study to perform WGS on all isolates.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 2","pages":"75-83"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719267","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":"Epidemiology of pediatric invasive group A streptococcus infection in a Saudi tertiary care center.","authors":"Anas Ali, Raghad Alhuthil, Deema Gashgarey, Maryam Altayeb, Mohammed Alsuhaibani, Duaa Al-Shareef, Rahaf Al-Ansari, Abulaziz Dahhan, Salma Adeeb, Roaa Aljumaa, Bara AlGhalayini, Salem Alghamdi, Suliman Aljumaah, Ohoud Alyabes, Esam A Albanyan, Sami Al-Hajjar","doi":"10.5144/0256-4947.2026.128","DOIUrl":"10.5144/0256-4947.2026.128","url":null,"abstract":"<p><strong>Background: </strong>Invasive group A Streptococcus (iGAS) infections in children can cause severe illness and lead to high rates of complications and death. While recent global reports show a rise in pediatric iGAS after the COVID-19 pandemic, there is limited data from Saudi Arabia.</p><p><strong>Objectives: </strong>Assess the clinical features, outcomes, and patterns of pediatric iGAS at a major tertiary center in Riyadh.</p><p><strong>Design: </strong>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>Pediatric patients aged 14 years or younger who had symptoms of iGAS confirmed by a positive culture from January 2018 to May 2025.</p><p><strong>Main outcomes measures: </strong>Clinical features, outcomes, and patterns of pediatric iGAS.</p><p><strong>Sample size: </strong>32 children.</p><p><strong>Results: </strong>Out of the 585 total infections recorded, 32 cases were classified as iGAS and included in the study. Most infections happened in winter and spring, with (433/585) 74% occurring from November to April. The highest rates of iGAS were seen during the COVID-19 pandemic years. The average age of patients was 4.1 years, and 94% (n=30) had other health problems, mainly congenital heart disease (n=9, 28%) and hematology/oncology (n=8, 25%). Bacteremia was the most common presentation (n=17, 53%), followed by cellulitis/necrotizing fasciitis (n=9, 28%) and pneumonia (n=8, 25%). Eleven children (34%) needed intensive care, and the overall death rate was 9% (3/32), with all deaths in patients who had bacteremia.</p><p><strong>Conclusion: </strong>In our center, pediatric iGAS infections carry a substantial comorbidity and disease severity burden, frequently presenting with complex and aggressive clinical manifestations. These findings underscore the urgent need for heightened vigilance in high-risk children, improved diagnostic precision, and strengthened local surveillance systems to enhance prevention and optimize management of these serious infections.</p><p><strong>Limitations: </strong>Single-center, retrospective design and absence of rapid diagnostic testing.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"46 2","pages":"128-136"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719212","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}