Annals of Saudi medicine最新文献

{"title":"Risk factors for postoperative hypocalcemia following total thyroidectomy: a retrospective study.","authors":"Bayan S Jan, Ahlam H Alamri, Haddad H Alkaff, Wejdan Q Almuqati, Suhail I Sayed, Sherif K Abdelmonim, Mohammad A Alessa, Osama A Marglani, Osama A Bawazir, Ameen Z Alherabi","doi":"10.5144/0256-4947.2024.39","DOIUrl":"10.5144/0256-4947.2024.39","url":null,"abstract":"<p><strong>Background: </strong>and Objectives: Hypocalcemia is a commonly reported complication after thyroid surgery. Many possible risk factors have been identified. The purpose of this study is to analyze various risk factors possibly associated with development of postoperative hypocalcemia after thyroid surgery by dividing the sample population into postoperative hypocalcemia and normal calcium groups.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Multiple centers in the Makkah region of Saudi Arabia.</p><p><strong>Patients and methods: </strong>Risk factors for postoperative hypocalcemia that were obtained for analysis include patient factors, perioperative blood parameters factors, disease-related factors, and surgical factors. Postoperative hypocalcemia was defined as a reduction of the total calcium level to <8.0 mg/dL. Hypocalcemic and normocalcemic patients were compared by multivariate logistic regression.</p><p><strong>Main outcome measures: </strong>Distinguish independent risk factors for postoperative hypocalcemia after thyroidectomy.</p><p><strong>Sample size: </strong>215 patients.</p><p><strong>Results: </strong>The incidence of hypocalcemia was 52.1% (112 of 215 patients). According to multivariate analysis, statistically significant risk factors for predicting postoperative hypocalcemia included postoperative parathyroid hormone level <10 pg/dL, inadvertent parathyroid gland resection, and neck dissection surgeries.</p><p><strong>Conclusion: </strong>The causes of postoperative hypocalcemia are multi-factorial. Because many of these factors are modifiable, they should be identified postoperatively to distinguish high-risk groups and implement early preventive measures.</p><p><strong>Limitations: </strong>Retrospective with a relatively small size. We encourage additional prospective studies with a larger sample size in multiple regions of the country, which might reveal further significant results.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"44 1","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10839454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682051","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":"Adolescent pregnancies in Turkey: a single center experience.","authors":"Çiğdem Kunt İşgüder, Oğuz Arslan, Osman Samet Gunkaya, Mine Kanat-Pektas, Niyazi Tuğ","doi":"10.5144/0256-4947.2024.11","DOIUrl":"10.5144/0256-4947.2024.11","url":null,"abstract":"<p><strong>Background: </strong>Adolescent pregnancies are more likely to be complicated with adverse perinatal outcomes.</p><p><strong>Objective: </strong>Assess the sociodemographic and clinical characteristics of adolescents who have delivered singleton newborns.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Settings: </strong>A tertiary training and research hospital in Turkey.</p><p><strong>Patients and methods: </strong>This was a review of adolescents and adults who delivered singleton newborns at a tertiary health center between January 2018 and June 2022. Pregnant adolescents were aged <20 years.</p><p><strong>Main outcome measures: </strong>Adverse maternal and perinatal outcomes.</p><p><strong>Sample size: </strong>2233 pregnant women (754 adolescents and 1479 adults).</p><p><strong>Results: </strong>Turkish nationality was significantly less prevalent in pregnant adolescents than pregnant adults (<i>P</i>=.001). Oligohydramnios, fetal growth restriction, perineal injury and postpartum intravenous iron treatment were significantly more prevalent in pregnant adolescents than pregnant adults (<i>P</i><.05 for all). The neonates born to adolescent mothers had significantly lower birth weight and first minute Apgar score than the neonates born to adult mothers (<i>P</i>=.001 for both). Small for gestational age, need for intensive care and death were significantly more prevalent in neonates born to adolescent mothers than those born to adult mothers (<i>P</i>=.001 for all). Compared with pregnant adults, pregnant adolescents had a significantly higher risk of oligohydramnios (<i>P</i>=.001), preterm delivery (<i>P</i>=.024), intravenous iron treatment (<i>P</i>=.001), and small for gestational age (<i>P</i>=.001).</p><p><strong>Conclusion: </strong>Due to the refugee population received by Turkey, it would be prudent to expect more frequent adolescent pregnancies. Adolescent pregnancies are more likely to be complicated with low birth weight, oligohydramnios, preterm delivery, postpartum iron treatment, lower Apgar scores, need for neonatal intensive care and neonatal death.</p><p><strong>Limitation: </strong>Retrospective.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"44 1","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10839457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682047","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":"Brucellosis in Omani children: a multicenter experience over 15 years.","authors":"Lamees Al Sawafi, Amal Al Tai, Mohammed Al Reesi, Mahmood Al Subhi, Muna Al Busaidi, Sanaa Al Abri, Badria Al Waili","doi":"10.5144/0256-4947.2023.380","DOIUrl":"10.5144/0256-4947.2023.380","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis, a common zoonotic disease worldwide, can lead to serious complications in humans. In Oman, the disease occurs most often in the south, but is increasing in the north.</p><p><strong>Objectives: </strong>Describe brucellosis in children in the Northern Governorate in Oman.</p><p><strong>Design: </strong>Retrospective, observational.</p><p><strong>Settings: </strong>Hospitals in the Northern Governorate in Oman.</p><p><strong>Patients and methods: </strong>We collected data on the demographics, distribution, common clinical presentations, risk factors, laboratory findings, therapy, and complications of confirmed cases of brucellosis. We included all brucellosis cases up to the age of 13 years at the Child Health Department in Royal, Suhar, Al Rustaq and Nizwa Hospitals over a 15-year period.</p><p><strong>Main outcome measures: </strong>Descriptive findings of brucellosis.</p><p><strong>Sample size: </strong>57 confirmed cases.</p><p><strong>Results: </strong>The 57 confirmed cases of Brucella had a mean age of 6 years. Most of the cases were from Dhakhiliya 21 (36.8%) and Batinah 18 (31.6%). Consumption of raw milk was documented in 75% and 41% had animal contact. From 2010, there was a marked rise of the cases with a maximum rise was noticed in 2019 with a total of 10 cases. The main clinical manifestations were fever (92%, n=52), arthritis (44%, n=25), which involved mainly knees and hips. Forty-two had bacteremia, 41% anemia, 10% osteomyelitis/septic arthritis, one case with congenital brucellosis and one case neurobrucellosis (1.8%). Forty cases had positive serology results of which 19 had positive cultures. Most cases had received cotrimoxazole and rifampin as the primary treatment regimen 22 (40%). Four patients relapsed (7%) after treatment completion.</p><p><strong>Conclusion: </strong>This study showed the distribution and clinical characteristics of brucellosis in different regions in the Northern Governorate in Oman. Although the numbers of cases remained low, the gradual increase is concerning for public health and preventive strategies. Further studies are needed to compare this data with the Southern region.</p><p><strong>Limitation: </strong>Retrospective study with small sample size.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"380-385"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815738","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":"Ceftazidime-avibactam use for the treatment of OXA-48- and/or New Delhi metallo-β-lactamase-producing <i>Enterobacterales</i> in cancer patients: a retrospective observational study.","authors":"Ahlam Alghamdi, Hajar AlQahtani, Sara Albilal, Maram Mater Almutairi, Nouf Alobaidallah, Linah Alghamdi, Amal Alfayez, Thamer Almangour, Ahmed Al-Jedai","doi":"10.5144/0256-4947.2023.373","DOIUrl":"10.5144/0256-4947.2023.373","url":null,"abstract":"<p><strong>Background: </strong>Infection is the second-leading cause of death among cancer patients, but there have been few studies on the effectiveness of novel antimicrobial agents to treat carbapenem-resistant <i>Enterobacterales</i> in cancer patients.</p><p><strong>Objective: </strong>Evaluate the mortality and clinical outcomes of ceftazi-dime-avibactam for OXA-48- and/or New Delhi metallo-β-lactamase (NDM)-producing <i>Enterobacterales</i> infection in cancer patients.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Setting: </strong>Tertiary academic medical center in Riyadh, Saudi Arabia.</p><p><strong>Subjects and methods: </strong>This study included patients who had cancer and received ceftazidime-avibactam for at least 72 hours for infections caused by OXA-48- and/or NDM-producing <i>Enterobacterales</i>. We excluded patients who died within 72 hours of treatment, patients with polymicrobial infections, and patients who did not receive appropriate antimicrobial therapy.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were 30-day mortality and hospital mortality. Secondary outcomes included clinical cure, relapse, and reinfection.</p><p><strong>Sample size: </strong>32 cancer patients.</p><p><strong>Results: </strong>The 30-day mortality among all patients was 15/32 (47%), clinical cure was achieved in 19/32 (59%) of the patients, and the relapse and reinfection rates were 2/19 (10.5%) and 4/17 (23.5%), respectively.</p><p><strong>Conclusion: </strong>This is the largest study to evaluate clinical outcomes associated with infections caused by OXA-48- and/or NDM-producing <i>Enterobacterales</i> in cancer patients. The mortality rate remains high; however, ceftazidime-avibactam is an encouraging alternative for treating severe infections in cancer patients.</p><p><strong>Limitations: </strong>Small sample size and single center.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"43 6","pages":"373-379"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801377","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":"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}