Annals of Saudi medicine最新文献

{"title":"Factors associated with 30-day mortality and morbidity in patients undergoing emergency colorectal surgery.","authors":"Nahar A Alselaim, Muhannad Abdulrahman Alsemari, Mesnad Alyabsi, Abrar M Al-Mutairi","doi":"10.5144/0256-4947.2023.364","DOIUrl":"10.5144/0256-4947.2023.364","url":null,"abstract":"<p><strong>Background: </strong>The 30-day period following emergency colorectal surgery (ECRS) is associated with high mortality and morbidity. There is a lack of data assessing factors associated with outcomes of ECRS in the Saudi population.</p><p><strong>Objectives: </strong>Assess factors associated with 30-day postoperative mortality and complications following ECRS.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary care center, Riyadh, Saudi Arabia.</p><p><strong>Patients and methods: </strong>Demographic characteristics (age, sex, diagnosis, American Society of Anesthesiologists classification, pre-operative septic state, smoking, and comorbidities), operative characteristics (urgency, diverting ostomy, and procedure performed), and postoperative characteristics (length of stay, 30-day mortality, intensive care unit [ICU] admission, ICU length of stay, surgical site infection [SSI], readmission, reoperation, and complications) were collected from electronic medical records. Univariate logistic regression was used to evaluate association with the outcome measures (30-day mortality and postoperative complications). Multivariate logistic regression was applied to evaluate independent variables.</p><p><strong>Main outcome measure: </strong>Thirty-day postoperative mortality and morbidity.</p><p><strong>Sample size: </strong>241 patients.</p><p><strong>Results: </strong>Among 241 patients, 145 (60.2%) were men, and 80 (33.2%) patients were between 50-64 years of age. The most common indication for surgery was malignancy 138 (57%). The overall complication rate was 26.6% and the 30-day mortality rate was 11.2%. Left hemicolectomy was the most commonly performed procedure, performed in 69 (28.6%) patients. Patients between the age of 65-74 had an increased odds of death within 30 days (OR 5.25 [95% CI 1.03-26.5]) on univariate analysis. Preoperative sepsis was associated with a fourfold increase in the likelihood of 30-day mortality (OR 4.44, 95% CI 1.21-16.24, <i>P</i>=.024) on multivariate analysis. The likelihood of hospital re-admission increased by fivefold in patients who developed a postoperative complication (OR 5.33, 95% CI 1.30-21.78, <i>P</i>=.02).</p><p><strong>Conclusion: </strong>Preoperative sepsis was independently associated with 30-day mortality in patients undergoing ECRS, while the likelihood of hospital readmission increased in patients with postoperative complications. Expeditious control of sepsis in the emergency surgical setting by both surgical and medical interventions may reduce the likelihood of postoperative mortality. Establishing discharge protocols for postoperative ECRS patients is advocated.</p><p><strong>Limitations: </strong>Retrospective design, small sample size, and single setting.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"364-372"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801512","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":"Surgical outcomes and stoma-related complications in inflammatory bowel disease in Saudi Arabia: a retrospective study.","authors":"Thamer A Bin Traiki, Sulaiman A Alshammari, Mansoor A Abdulla, Fayez G Aldarsouni, Noura S Alhassan, Maha-Hamdien Abdullah, Awadh Alqahtani, Khayal A Alkhayal","doi":"10.5144/0256-4947.2023.386","DOIUrl":"10.5144/0256-4947.2023.386","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of inflammatory bowel diseases (IBD), Crohn's (C) and ulcerative colitis (UC) has increased in Saudi Arabia during the past decade. Even though medical treatment is first-line therapy, most patients require surgery during the course of the disease. Stoma creation complications in IBD are underreported in the literature of the Middle East and especially in Saudi Arabia.</p><p><strong>Objectives: </strong>Report the postoperative, stoma and peristomal complications following stoma creation in (C) versus UC.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Tertiary care center.</p><p><strong>Patients and methods: </strong>Patients with IBD who underwent stoma creation for either UC or CD between August 2015 and July 2020 were included. The diseases were compared to assess their characteristics and association to postoperative, stoma and peristomal complications. All complications were reported over a 90-day duration from the surgery. Patients younger than 14 years of age were excluded.</p><p><strong>Main outcome measures: </strong>Postoperative complications, stoma and peristomal complications in IBD patients who underwent stoma creation.</p><p><strong>Sample size: </strong>50.</p><p><strong>Results: </strong>Of 50 IBD patients underwent stoma creation, 32 patients (64%) were diagnosed with CD and 18 patients (36%) with UC. Most of the procedures in both groups were laparoscopic and elective. Low BMI and serum albumin were more prevalent in the CD group. Postoperative complications were higher in the CD patients compared to the UC patients (CD 40.6% vs UC 11.1%, <i>P</i>=.028) with the most common complication being abdominal collection[a]. Stoma complications were comparable between the two groups (UC 16.7% vs CD 15.6%). However, peristomal complications were higher clinically in UC patients in comparison with the CD patients (UC 61.1% vs CD 37.5% <i>P</i>=.095) with the most common complication being skin excoriation (UC 44.4% vs CD 37.5%).</p><p><strong>Conclusions: </strong>CD has significantly higher postoperative complications compared to UC. Peristomal complications were high in both groups and had a negative impact on quality of life. Therefore, comprehensive stoma education and regular outpatient follow ups are recommended to improve the overall outcomes.</p><p><strong>Limitations: </strong>Retrospective and conducted in one academic institution with a small sample size.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"386-393"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801633","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":"Surgical management of neonatal severe hyperparathyroidism.","authors":"Saud Alshanafey, Sabreen Maqbol, Ali AlAmeer, Faiqa Ahmad, Abdullah Al-Ashwal","doi":"10.5144/0256-4947.2023.01.11.1200","DOIUrl":"10.5144/0256-4947.2023.01.11.1200","url":null,"abstract":"<p><strong>Background: </strong>Neonatal severe hyperparathyroidism (NSHPT) is a rare disease that can be lethal. Most patients require parathyroidectomy.</p><p><strong>Objective: </strong>Report experience in managing this severe disease.</p><p><strong>Design: </strong>Retrospective chart review of case series.</p><p><strong>Setting: </strong>Tertiary health care center.</p><p><strong>Patients and methods: </strong>We reviewed data on patients managed for NSHPT from June 2001 to January 2023. Demographic, clinical, and follow-up data were collected, and descriptive data were generated.</p><p><strong>Main outcome measures: </strong>Pre- and postoperative levels of parathyroid hormone (PTH) and serum calcium, and effect of autotransplantation.</p><p><strong>Sample size: </strong>19.</p><p><strong>Results: </strong>The 13 males and 6 females had a a mean age of 46 days at referral. The mean preoperative parathyroid hormone (PTH) and serum calcium levels were 996 ng/L and 4.54 mmol/L, respectively. Twelve patients underwent ultrasonography preoperatively. Of these, six had prominent glands, while no glands were seen in the other six. A Sestamibi scan was done for 15 patients, of which nine showed negative results and six showed positive results, with three glands observed in the neck and three in the sublingual area. Nineteen patients underwent renal ultrasonography, with nine showing nephrocalcinosis. The mean age at surgery was 5.2 months. Total parathyroidectomy (four glands) was performed in 17 patients, and 15 underwent concurrent auto-transplantation. One patient had three glands removed, in addition to auto-transplantation. Another underwent single gland excision as a redo-surgery after previous surgery elsewhere. The mean postoperative follow-up duration was 6 years. The mean postoperative PTH and calcium levels were 25 ng/L and 1.64 mmol/L, respectively. Ultimately, all the patients were required to initiate calcium and vitamin D supplements, except for two patients who had undergone auto-transplantation. Molecular genetic screening of the calcium-sensing receptor gene reported likely pathogenic/pathogenic mutations in 16 of 19 patients (13 were homozygous, two were heterozygous, one was negative, and data was unavailable for the remaining three patients).</p><p><strong>Conclusions: </strong>Surgical treatment of NSHPT is effective. Preoperative radiological localization studies did not impact the treatment plan. Auto-transplantation proved ineffective in maintaining independence from medical supplements.</p><p><strong>Limitations: </strong>The retrospective nature of the study may imply inaccuracybut since the data are gathered from electronic medical records, we believe it is highly accurate. The small sample size limits generalizability.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":" ","pages":"352-356"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430068","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":"Mortality outcomes between pregnant women booked for antenatal care and unbooked pregnant women.","authors":"Abdulrahim Rouzi, Nora Sahly, Abdullah Mohammed Kafy, Rana A Alamoudi, Renad Mazen Abualsaud, Wejdan A Alsheri, Wasayf M Almehmadi, Shahad T Khayyat, Razan M Altumaihi","doi":"10.5144/0256-4947.2023.357","DOIUrl":"10.5144/0256-4947.2023.357","url":null,"abstract":"<p><strong>Background: </strong>Perinatal fetal mortality and maternal mortality remains relatively high in Saudi Arabia. Antenatal care aims to improve outcomes; however, evidence to demonstrate its impact on outcomes in Saudi Arabia is lacking.</p><p><strong>Objectives: </strong>Investigate whether booking status for antenatal care impacted outcomes for pregnant women and identify outcomes that predicted booking status.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Settings: </strong>Tertiary care center.</p><p><strong>Patients and methods: </strong>All Saudi women admitted to the labor or delivery units between January 2011 and December 2019 were included. Outcomes were compared between booked and unbooked women, and logistic regression was used to identify outcomes that predicted booking status, adjusted for age.</p><p><strong>Main outcome measures: </strong>Booked/unbooked status and perinatal mortality of Saudi women.</p><p><strong>Sample size: </strong>10 781 women; 9546 (88.5%) booked, (11.1%) 1192 unbooked.</p><p><strong>Results: </strong>Unbooked mothers had higher incidences of meconium-stained liquor (<i>P</i>=.040), ruptured uterus (<i>P</i>=.017), and blood loss >1000 mL during cesarean deliveries (<i>P</i>=.003), but a lower episiotomy rate (<i>P</i><.001). Perinatal fetal mortality and maternal mortality were equivalent between the two groups. Episiotomy, higher birth weight, higher mother age, perinatal death, delivery mode, onset of labor, and use of analgesics were all independent predictors of the mother being booked when adjusted for all outcomes and age.</p><p><strong>Conclusions: </strong>The rate of perinatal and maternal mortality in this cohort was relatively low and equivalent between booked and un-booked mothers, contrary to our expectations. More analysis of the socioeconomic data may explain this striking result.</p><p><strong>Limitations: </strong>Retrospective chart-review with incomplete data retrieval that affected the completeness of data retrieved. The results of the multivariate analysis cannot be used to infer causality because the study is observational.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"357-363"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801517","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":"Rebound pain after interscalene brachial plexus block for shoulder surgery: a randomized clinical trial of the effect of different multimodal analgesia regimens.","authors":"Tayfun Et, Betul Basaran, Aysegul Bilge, Rafet Yarımoğlu, Muhammet Korkusuz, İbrahim Tülüce","doi":"10.5144/0256-4947.2023.339","DOIUrl":"10.5144/0256-4947.2023.339","url":null,"abstract":"<p><strong>Background: </strong>Rebound pain is characterized by sudden, significant acute postoperative pain occurring after the resolution of inter-scalene block (ISB); it affects the quality of recovery postoperatively. Dexamethasone increases ISB resolution time and decreases opioid consumption and the incidence of rebound pain.</p><p><strong>Objective: </strong>Evaluate whether multimodal analgesia including intravenous dexamethasone administration with preoperative ISB reduces the incidence of rebound pain.</p><p><strong>Design: </strong>Prospective, randomized, controlled trial.</p><p><strong>Setting: </strong>Tertiary university hospital.</p><p><strong>Sample size: </strong>60 patients.</p><p><strong>Patients and methods: </strong>Patients who underwent shoulder surgery under general anesthesia were assigned randomly to two different multimodal analgesia protocols. Thirty patients received 5 mg IV dexamethasone with non-steroid, paracetamol, and ISB with 15 mL 0.5% bupivacaine, while the control patients received the same regimen and ISB with 15 mL 0.5% bupivacaine without dexamethasone. Postoperative opioids were given to any patient on demand.</p><p><strong>Main outcomes measures: </strong>Effect of IV dexamethasone on pain score and incidence of rebound pain after ISB resolution and postoperative opioid consumption at 0-48 hours, numerical pain rating scale (NPRS) scores, sleep scale scores, and quality of recovery-15 scores (QoR-15).</p><p><strong>Results: </strong>The incidence of rebound pain was lower in the dexamethasone group than in the control group (73.3% and 30%, respectively, <i>P</i>=.001). NPRS scores after ISB resolution were lower in the dexamethasone group (5 ([4-7]), 8 ([5.75-8]), <i>P</i><.001, respectively). Those who received IV dexamethasone had less sleep disturbances (<i>P</i><.001) and higher QoR-15 on day 1 (<i>P</i><.001) and day 7 (<i>P</i>=.020) postoperatively.</p><p><strong>Conclusions: </strong>IV dexamethasone added to the ISB block resulted in a lower incidence of rebound pain. In addition, better results were obtained in postoperative sleep quality and QoR-15.</p><p><strong>Limitations: </strong>Single-center study.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"339-347"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801525","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":"Transanal minimally invasive surgery for benign and malignant rectal lesions: midterm outcomes from a tertiary center.","authors":"Mahmood Al-Dhaheri, Fajer Al-Ishaq, Ali Toffaha, Mohamed Abu Nada, Amjad Parvaiz, Mohamed Kurer","doi":"10.5144/0256-4947.2023.348","DOIUrl":"10.5144/0256-4947.2023.348","url":null,"abstract":"<p><strong>Background: </strong>Although transanal minimally invasive surgery (TAMIS) for rectal neoplasia has gained wide acceptance, the mid-term and long-term outcomes are not widely reported in the literature.</p><p><strong>Objective: </strong>Describe the mid-term outcomes of patients who underwent TAMIS for benign and malignant rectal lesions in a single center.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Tertiary referral center.</p><p><strong>Patients and methods: </strong>Demographic, clinical, and oncological outcomes of patients who underwent TAMIS between January 2015 and December 2022 were prospectively collected. The indication for TAMIS was based on the National Comprehensive Cancer Network guidelines. The follow up for the cancer patients included clinical examination, tumor markers every 6 months and MRI rectum at the end of one year. In addition, colonoscopy and CT scan at years one and three and a final CT scan and colonoscopy at year five.</p><p><strong>Main outcome measures: </strong>Mid-term oncological and clinical outcome.</p><p><strong>Results: </strong>Thirty elective TAMIS procedures included adenocarcinoma for 33.3% (n=10) of the patients, 20% (n=6) neuroendocrine tumor and the 40% (n=12) were adenomatous lesions. Negative resection margins were achieved in all malignant lesions. Perioperative complications occurred in 2 patients (6.6%), one patient had breaching into the peritoneal cavity, and postoperative hypotension occurred in another patient. The median follow-up time was 23 months (range: 5-72 months). Two patients with adenoma and positive margins developed recurrent adenoma (6.6%) and one patient with initial polypectomy biopsy of adenocarcinoma, had TAMIS with histopathology of adenoma and distant metastasis had developed.</p><p><strong>Conclusions: </strong>TAMIS for local excision of rectal neoplasia is a valid option with favorable mid-term outcomes provided there is adherence to careful selection criteria.</p><p><strong>Limitations: </strong>Retrospective nature and small number of the patients.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"348-351"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801657","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":"Selective anterior annuloplasty during inguinal herniotomy in boys: an approach to further reduce hernia recurrence.","authors":"Ayman Aljazaeri, Raghad AlKhashan, Razan Naif AlRabah, Sadem Al Zayed, Sara Al-Jazaeri","doi":"10.5144/0256-4947.2023.277","DOIUrl":"10.5144/0256-4947.2023.277","url":null,"abstract":"<p><strong>Background: </strong>Hernia recurrence is one of the most common complications after inguinal herniotomy (IH) in children. We describe a novel approach that involves adding anterior annuloplasty (AAP) during IH for selective high recurrence-risk children.</p><p><strong>Objectives: </strong>Evaluate the initial safety and effectiveness of selective AAP during IH in boys.</p><p><strong>Design: </strong>Retrospective SETTING: Tertiary care center.</p><p><strong>Patients and methods: </strong>The study included boys younger than 15 who were selected to undergo either IH with or without AAP between January 2011 and January 2022. The preoperative recurrence risks were compared for the two groups. Cases who underwent other forms of hernia repair were excluded.</p><p><strong>Main outcome measures: </strong>The frequency of recurrence and other postoperative complications and the distribution of high recurrence-risks.</p><p><strong>Sample size: </strong>315 boys; 143 underwent IH and AAP, while 172 had IH only.</p><p><strong>Results: </strong>Among all the cases, only one recurrence was reported (0.3%). Other complications were hydrocele in 29 (9.2%), scrotal hematoma/inflammation in 9 (2.9%), and wound infection in 8 (2.6%), which resolved spontaneously in all cases. Compared to IH only, those selected for an additional AAP were significantly younger (3 [16%] vs. 12 [46%] months, <i>P</i>=.038) and more likely to be premature (35 [24.5%] vs. 15 [8.7%], <i>P</i><.0001), frequently had extensive cremasteric adhesions (39.2% versus 3.5%, <i>P</i><.0001) and had a higher rate of incarcerated hernia at presentation (6.3% versus 1.2%, <i>P</i>=.026). The high-recurrence risk group was almost twice as likely to be selected for an additional AAP compared to the low-risk group (143 vs. 75, <i>P</i><.0001).</p><p><strong>Conclusion: </strong>Adding simple AAP to conventional hernia repair for high-recurrence risk boys can be a safe and effective step to reduce the overall risk of recurrence without increasing the incidence of other postoperative complications.</p><p><strong>Limitations: </strong>The study lacked a control group of patients to whom selective AAP would not be offered despite a high-recurrence risk. A prospective, controlled trial with a longer follow-up would lead to a stronger conclusion.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 5","pages":"277-282"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/88/c2/0256-4947.2023.277.PMC10560372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157700","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":"Experience with direct-acting antivirals in genotype 1-5 infected chronic hepatitis C patients in Turkey.","authors":"Ahmet Sahin,&nbsp;Ozlem Akay","doi":"10.5144/0256-4947.2023.308","DOIUrl":"10.5144/0256-4947.2023.308","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) can cause chronic liver disease, hepatic cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Early diagnosis and treatment are thus vital.</p><p><strong>Objectives: </strong>We aimed to investigate the sustained virological response (SVR) rates in chronic hepatitis C patients infected with different genotypes, receiving different direct-acting antiviral treatments (DAAs).</p><p><strong>Design: </strong>Retrospective, observational SETTING: Clinic for infectious diseases and clinical microbiology PATIENTS AND METHODS: Patients diagnosed with chronic hepatitis C who applied to our outpatient clinic between January 2016 and November 2022 and were treated with a DAA were included in the study. Treatment responses were evaluated after each patient was treated with either ledipasvir plus sofosbuvir (LDV/SOF), LDV/SOF + ribavirin (RBV), SOF+RBV, ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r±DSV) ±RBV, or glecaprevir plus pibrentasvir (GLE/PIB).</p><p><strong>Main outcome measures: </strong>Sustained virological response (SVR) rates at 12 weeks (SVR12) post-treatment.</p><p><strong>Sample size: </strong>360 patients.</p><p><strong>Results: </strong>Of 360 patients who met the inclusion criteria, 218 (60.6%) were male and 142 (39.4%) were female with no statistically significant differences in SVR between sexes (<i>P</i>=.252). Nearly all had a SVR (n=353, 98.1%). The median (IQR) age of the patients was 56 (30.3) years. There were 42 (11.7%), 199 (55.3%), 4 (1.1%), 106 (29.4%), 8 (2.2%) and 1 (0.3%) patient with genotypes 1a, 1b, 2, 3, 4 and 5, respectively, and SVR12 did not differ significantly between genotypes (<i>P</i>=.066). SVR12 response was higher in 246 (68.3%) non-injecting drug users compared to 114 (31.7%) injecting drug users (<i>P</i>=.005). The SVR12 response was achieved in 100% of patients with genotypes 1a, 2, 4, and 5. SVR12 response could not be obtained in 1 of 199 genotype 1b patients and 6 of 106 genotype 3 patients. The common feature of 6 reinfection patients with genotype 3 was that they were using intravenous drugs. These 6 patients were reinfected due to their continued intravenous drug use.</p><p><strong>Conclusion: </strong>In conclusion, DAAs provide high SVR12 rates in cirrhotic/non-cirrhotic, pegylated interferon-naive/experienced patient groups and in patients infected with all genotypes. DAAs have a high SVR12 rate in patients with chronic hepatitis C.</p><p><strong>Limitations: </strong>Retrospective, single-center.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 5","pages":"308-314"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/03/0256-4947.2023.308.PMC10560371.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41124030","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":"Overall and progression-free survival in endometrial carcinoma: A single-center retrospective study of patients treated between 2000-2018.","authors":"Khalid H Sait,&nbsp;Nisreen Anfinan,&nbsp;Hesham Sait,&nbsp;Hanan Shamrani,&nbsp;Maram Sait","doi":"10.5144/0256-4947.2023.315","DOIUrl":"10.5144/0256-4947.2023.315","url":null,"abstract":"<p><strong>Background: </strong>Investigating survival in endometrial cancer (EC) is crucial to determine the effectiveness of overall management as it will reflect on the level of care provided among this population.</p><p><strong>Objective: </strong>The study was conducted to analyze the overall survival (OS) and progression-free survival (PFS) in treated endometrial carcinoma and to determine the associated predictors.</p><p><strong>Design: </strong>Retrospective SETTING: Department of obstetrics and gynecology in university tertiary hospital PATIENTS AND METHODS: Baseline demographic and clinical data, tumor characteristics and perioperative and outcome data were collected from consecutive patients treated for EC between 2000 and 2018. Kaplan-Meier method and multivariate Cox regression were used to analyze factors and predictors of OS and PFS.</p><p><strong>Main outcome measures: </strong>OS, PFS and prognostic factors SAMPLE SIZE: 200 RESULT: Endometrioid type was the most common type accounting for 78.5% of the cases, followed by papillary serous carcinoma (18.5%). At diagnosis, 21.5% were stage III, and 12.0% were stage IV. Invasiveness features showed involvement of the myometrium (96.5%), lymph vessels (36.5%), cervix stroma (18.5%), lower segment (22.0%), and parametrium (7.0%). The majority of patients had open surgery (80.0%), while 11.5% and 7.0% had laparoscopy and robotic surgery, respectively. Staging and debulking were performed in 89.0% of patients, and 12.5% of patients had residual disease of more than 2 cm. The mean OS and PFS were 104.4 (95% CI=91.8-117.0) months and 96.8 (95% CI=83.9-109.7) months, respectively. The 5-year OS and PFS were 62.5% and 46.9%, respectively. The majority of the factors we assessed were significantly associated with OS or PFS. However, reduced OS was independently associated age ≥60 years (hazard ratio [HR]=1.99, <i>P</i>=.010), papillary serous carcinoma (HR=2.35, <i>P</i>=.021), and residual disease (HR=3.84, <i>P</i>=.007); whereas PFS was predicted by age ≥60 years (HR=1.87, <i>P</i>=.014) and residual disease (HR=3.22, <i>P</i>=.040).</p><p><strong>Conclusion: </strong>There is a need for a national strategy to tackle the growing burden of EC, by identifying the locally-specific incidence, delayed diagnosis and survival outcome.</p><p><strong>Limitations: </strong>This was a single-center study conducted at a tertiary center, which may question the generalizability of the findings, as the sample may be biased by overrepresentation with patients who were diagnosed at an advanced stage.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 5","pages":"315-328"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/cf/0256-4947.2023.315.PMC10560369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165849","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":"Screening tools for metabolic syndrome based on anthropometric cut-off values among Thai working adults: a community-based study.","authors":"Thidarat Somdee,&nbsp;Theerasak Somdee,&nbsp;Suneerat Yangyuen,&nbsp;Aravan Mungvongsa,&nbsp;Santisith Khiewkhern,&nbsp;Thanyathorn Puapittayathorn,&nbsp;Sawan Thitisutthi,&nbsp;Piyaporn Srikongpan,&nbsp;Supattra Keawmuanga","doi":"10.5144/0256-4947.2023.291","DOIUrl":"10.5144/0256-4947.2023.291","url":null,"abstract":"<p><strong>Background: </strong>The metabolic syndrome (MetS) is a universal disease of increasing prevalence, but the prevalence varies depending on ethnicity. There is a crucial need to assess the validity of anthropometric indicators and determine appropriate cut-off values for MetS screening.</p><p><strong>Objective: </strong>Determine cut-off anthropometric indicators values for screening of MetS.</p><p><strong>Design: </strong>Cross-sectional SETTING: Rural and urban areas of provinces with a high prevalence of MetS in the central region of Thailand.</p><p><strong>Subjects and methods: </strong>The subjects were recruited based on the International Diabetes Federation definition of MetS, which includes four anthropometric indicators. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity for different cut-off values of all novel indicators.</p><p><strong>Main outcome measures: </strong>The cut-off values for screening of MetS, which included neck circumference (NC), body roundness index (BRI), conicity index (C-index), and body shape index (BSI).</p><p><strong>Sample size: </strong>2520 participants RESULTS: The BRI and NC were the indices with higher areas under the curve, followed by the C-index and BSI. The optimal cut-off values for BRI and NC were 4.1 and 36.5 cm for males and 4.0 and 34.5 cm for females.</p><p><strong>Conclusions: </strong>This study defined the specific cut-off values for Thai working adults.</p><p><strong>Limitations: </strong>The participants might not be representative of all Thai adults and we may have overestimated MetS for Thai working adults because our research focus was on the highest prevalence of MetS in the central region of Thailand.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 5","pages":"291-297"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/23/0256-4947.2023.291.PMC10560367.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41144705","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}