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Predictors of Repeat Cesarean Section in Women with One Previous Lower Segment Cesarean Section: A Retrospective Study from Malaysia
(2023) Wan-Nur-Hajidah, Wan Mohd Hazman; Siti-Azrin, Ab Hamid; Norsa'adah, Bachok; Fauziah, Jummaat; Wan-Nor-Asyikeen, Wan Adnan
Background: The rates of repeat cesarean section (CS) among women with previous CS are increasing worldwide. The predictors of a repeat CS can vary across different populations. Objective: To determine the predictors of repeat CS among women from Malaysia with one previous lower segment CS (LSCS) who underwent trial of labor (TOLAC). Materials and Methods: This retrospective cohort study included women with one previous LSCS who followed up and delivered their current pregnancy at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between January 01, 2016, and December 31, 2017. Women with singleton pregnancies were included while those who had a history of classical CS, current pregnancy with preterm birth, non-cephalic pregnancy, lethal fetal anomalies, uterine rupture, and severe preeclampsia or planned for elective CS were excluded. Logistic regressions were performed. Results: The study included 388 women who underwent TOLAC and successfully gave childbirth through vaginal birth after cesarean (VBAC) (n = 194) or emergency LSCS (n = 194). Factors significantly associated with repeat CS were no history of vaginal delivery (adjusted odds ratio (aOR): 2.71; 95% confidence interval (CI): 1.60, 4.60; P < 0.001), estimated fetal weight ≥3500 grams (aOR: 4.78; 95% CI: 2.45–9.34; P < 0.001), and presence of meconium-stained liquor (aOR: 2.40; 95% CI: 1.33–4.35; P = 0.004). Conclusion: The above-mentioned predictors of a repeat CS among women from Malaysia with one previous LSCS who underwent TOLAC can be useful for clinicians in making an informed decision.
Wernicke Encephalopathy: An Updated Narrative Review
(2023) Habas, Elmukhtar; Farfar, Kalifa; Errayes, Nada; Rayani, Amnna; Elzouki, Abdel-Naser
Wernicke’s encephalopathy (WE) and Korsakoff Syndrome (KS) are distinct neurological disorders that may have overlapping clinical features. Due to the overlap, they are collectively known as Wernicke–Korsakoff syndrome. WE is related to diencephalic and mesencephalic dysfunction due to thiamine. WE typically manifests as confusion, ophthalmoplegia, nystagmus, and gait ataxia (Wernicke’s triad), although they may not consistently occur together. Although WE mostly occurs in alcoholics, other etiologies, such as post-bariatric surgery, must be considered. Early diagnosis and therapy by intravenous thiamine are essential to prevent WE complications and to reduce morbidity and mortality. Therefore, physicians’ and patients’ awareness of WE is essential for early diagnosis and therapy. Accordingly, this narrative review aimed to provide an update on WE by reviewing articles published between April 2015 to April 2022 about the etiology, pathophysiology, diagnosis, and WE management updates. EMBASE, PubMed, Google Scholar, Google, and Scopus search engines were used to conduct the literature search.
Correlation between Subclinical Hypothyroidism and Metabolic Syndrome: A Retrospective Study
(2023) Alsulami, Salhah Saleh; Baig, Mukhtiar; Albeladi, Atheer Hameed; Alyoubi, Shahad Bandar; Alsubaie, Shahad Alhumaidi; Albeladi, Samah Abdulsalam; Ghamri, Kholoud Alawi; Alraiqi, Abeer Mohammed Saeed; Alyoubi, Safa Mobarak; Almutairi, Wesam Aied
Background: Several studies worldwide have studied the correlation between subclinical hypothyroidism (SCH), and metabolic syndrome (MetS), but have reported inconsistent findings. Objectives: To assess the correlation between SCH and MetS in a population from Saudi Arabia. Methods: This retrospective study was conducted at King Abdulaziz University Hospital and analyzed all thyroid function tests conducted between January 1, 2019, to December 31, 2021. A predesigned checklist was used to collect data about patients’ characteristics such as age, gender, nationality, TSH, FT4 level, and MetS components. Results: A total of 41,519 thyroid function tests were conducted during the study period. From this, 1303 (3.1%) patients were found to have SCH, with the majority being females (74.4%). The prevalence did not differ according to gender but increased to 3.5% among those aged >60 years. MetS components between mildly and markedly elevated TSH were significant for total cholesterol (P < 0.001) and high-density lipoprotein cholesterol (P < 0.05). Male patients with SCH were at a higher risk of developing diabetes (P < 0.001) and hypertension (P < 0.02), than female patients with SCH. After adjusting for age, in the multiple stepwise linear regression analysis, a significant association was found between TSH levels and ALT (odds ratio: 0.77) and SBP (odds ratio: 0.35). Conclusion: The study demonstrated that the prevalence of SCH is similar between both genders but increases with age. MetS components were abnormal in patients aged >50 years and in males with SCH. SCH and MetS components were found to be correlated, and thus monitoring these variables in patients with SCH is advisable.
Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial
(2023) Ordahan, Banu; Yigit, Fatih; Mülkoglu, Cevriye
Background: Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. Objective: To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Trial Design: Prospective, randomized, parallel group, patient- and assessor-blinded. Methods: A total of 45 patients (aged: 18–65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18–65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. Results: A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. Conclusion: HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. Trial Registration: ClinicalTrials.gov Identifier: NCT05469672. Funding: None
Burnout, Stress, and Stimulant Abuse among Medical and Dental Students in the Western Region of Saudi Arabia: An Analytical Study
(2023) Bahlaq, Mohannad A.; Ramadan, Iman K.; Abalkhail, Bahaa; Mirza, Ahmad A.; Ahmed, Malak K.; Alraddadi, Khalid S.; Kadi, Mai
Background: High levels of burnout, stress, and stimulant abuse have been reported among medical and dental students worldwide, with country-specific factors being contributors. The association, risk factors, and predictors of these three variables have not sufficiently been reported from Saudi Arabia, especially from the Western region. Objective: To determine the prevalence, association, and predictors of burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia. Methods: This cross-sectional study included all second to sixth year medical and dental students enrolled at Taibah University, Madinah, Saudi Arabia, during the 2019–2020 academic year. A self-administered, closed online questionnaire was administered. Data regarding stress were elicited using Cohen's 10-item Self-Perceived Stress Scale and regarding burnout using the Oldenburg Burnout Inventory Student Version questionnaire. Multiple logistic regression model to identify the risk of burnout was conducted, and univariate and multiple linear regression models were carried out to identify the predictors of stress. Results: Of 1016 eligible students, 732 responded (medical: 511; dental: 221). About half of the students experienced burnout (51.5%), with both high disengagement (49%) and exhaustion (45%). Most participants (90.3%) experienced moderate levels of stress. Eight (1.1%) respondents had experienced stimulant abuse; there was a no significant association between stimulant abuse and burnout in the multivariate analysis. Stress, age, gender, body mass index, GPA, study field, smoking, family income, and birth order were significant predictors of burnout, while burnout, age, gender, GPA, and physical exercise were significant predictors of stress. Conclusion: The findings in this study highlight the need for policymakers to devise strategies that target early identification as well as reduction of the high levels of burnout and stress.
Predictors of Caries Risk among Egyptian Children Attending Pediatric Dental Clinics at a University Hospital
(2023) Aboubakr, Rabaa Mahmoud; Alkhadragy, Doaa Mohsen; Okda, Mai Monuir El Said; Rady, Hadeer Wael Mohamed; Elnagar, Rasha Mokhtar
Background: Dental caries is the most prevalent dental disease. The external validity of the available caries risk assessment (CRA) tools is not established, especially among pediatric population. Objectives: To assess caries risk using the caries management by risk assessment (CAMBRA) protocol among Egyptian children aged 3–12 years and suggest variables that could potentially be used to develop a simpler CRA model. Materials and Methods: For this cross-sectional study, we recruited 320 children aged 3 to <6 years (Group I) and 320 children aged 6–12 years (Group II). CAMBRA was used to collect data about disease indicators, biological and environmental factors, and protective factors among study participants. Each child was examined clinically to collect data about past caries experiences and to measure plaque scores. Results: The risk of caries was high in 92.5% of Group I and 83.4% of Group II participants. The overall dmft was 5.71 ± 3.18 for Group I and 4.78 ± 2.53 for Group II. In Group I, a significant positive relation was found between the overall mean caries risk score and past caries experience (dmft; r = 0.344, P < 0.001) and mean plaque index (r = 0.463, P < 0.001). In Group II, a significant positive relation was found between the overall mean caries risk score and dmft score (r = 0.511, P < 0.001), S. mutans count (r = 234, P < 0.001), Lactobacilli count (r = 0.316, P < 0.001), and plaque index (r = 0.463, P < 0.001). Participants’ age, parents’ education, and parents’ occupation had a negative significant effect on the overall mean caries risk score. Conclusion: This study suggests predictors that can be used in the development of a new CRA model for children aged 3–12 years.
Endometrioid Adenocarcinoma within an Endometriotic Cyst in the Mesosalpinx: A Case Report and Review of the Literature
(2023) Alharbi, Nouf Faisal; Hajla, Mohammed Mubarak; Elsharkawy, Tarek; Alharbi, Ashraf; Abdelsayed, Randa; Aljama, Fathia Ebrahim
Endometriosis-related neoplasms may arise within endometriotic cysts of organs of the female genital tract or other organ systems. Herein, we present a case of endometrioid adenocarcinoma arising within an endometriotic cyst in the mesosalpinx. A 27-year-old single female presented to the clinic with a history of right hypochondrial pain. Pelvic MRI revealed a bulky uterus with three intramural uterine fibroids and a complex cyst in the mesosalpinx. The excised cyst showed predominantly confluent growth of relatively well-defined glands resembling proliferative-phase endometrium in a background of endometriosis. The tumor was diagnosed as endometrioid adenocarcinoma within an endometriotic cyst, pathologic stage pT1a. She was referred to the oncology team, where a positron emission tomography scan showed unremarkable results. Although these neoplasms have been reported in various locations within the female genital tract, endometrioid adenocarcinoma arising from endometriosis in the mesosalpinx is seldom reported.
Burnout among ICU Healthcare Workers at Two Tertiary Care Hospitals in Makkah during the Hajj Season
(2023) Rugaan, Asia; Aisa, Tharwat; Alkhatib, Kasim H; Baky, Moamen Abdel; Al Tatar, Faisal; Ramadan, Ibrahim; Elmorsy, Soha; Hussein, Adel
Background: The Hajj season results in increased workload and longer shift hours for healthcare workers at the intensive care units (ICUs), which may result in burnout. Objective: To determine the point prevalence of professional burnout and its predictors among healthcare workers at the ICUs of two tertiary care hospitals in Makkah during the Hajj season. Methods: This cross-sectional descriptive study included all healthcare professionals working at the ICU departments of two of the largest tertiary care hospitals in the Makkah region during the 1439/2018 Hajj season. The original Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout. Logistic regression models were fitted to estimate the effect size of the associated risk factors. Results: A total of 354 participants completed the questionnaire. Moderate to severe burnout was found in each of the three subscales: emotional exhaustion, 56%; depersonalization, 82%, and impaired personal achievement, 72%. Nurses were significantly more likely to experience burnout compared with physicians (P = 0.017). Independent predictors of moderate or severe burnout were being aged ≤40 years (odds ratio [OR]: 2.1, 95% CI: 0.395–4.002; P = 0.045), female gender (OR: 2.2, 95% CI: 0.242–4.346; P = 0.037); work having a negative impact on family (OR: 3, 95% CI: 0.164–5.504; P = 0.019); unsatisfaction with salary (OR: 2.8, 95% CI: 0.28–5.056; P = 0.025); and working at the cardiac critical care unit (OR: 2.6, 95% CI: 0.440–4.467; P = 0.035). Conclusion: This study revealed that the point prevalence of burnout is common among ICU healthcare workers during the Hajj season. These findings can be used by policymakers to devise strategies to mitigate the risks of burnout during the Hajj season.
Prevalence, Microbiological Profile, and Risk Factors of Surgical Site Infections in Saudi Patients with Colorectal Cancer
(2023) Aldriwesh, Marwh Gassim; Alnodley, Abrar; Almutairi, Norah; Algarni, Mohammed; Alqarni, Ayyob; Albdah, Bayan; Mashraqi, Mutaib
Background: Resection surgery in patients with colorectal cancer (CRC) patients is associated with potential complications, including surgical site infection (SSI). Objectives: To estimate the prevalence rate of SSI, identify the common pathogens responsible for SSI, and determine potential risk factors for SSI development in a cohort from Saudi Arabia. Materials and Methods: Patients with CRC who underwent bowel resection surgery at King Abdulaziz Medical City, Riyadh, between January 01, 2016, and December 31, 2019, were retrospectively included. Demographics, comorbidities, surgical procedure data, and the results of preoperative laboratory tests were retrospectively collected from medical records through the health information system. The study population was divided into two groups: those who developed SSI and those who did not. Results: A total of 92 patients with CRC who underwent resection surgery were included, of which 54 (58.7%) were males. The median age was 65 (IQR 55.5–75.0) years. SSI was observed in 25 (27.2%) patients. The most frequently isolated organisms were Escherichia coli and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, vancomycin-sensitive Enterococcus faecium, and methicillin-resistant Staphylococcus aureus. Three E. coli isolates were producers of extended-spectrum beta-lactamases, and two K. pneumoniae isolates exhibited a multidrug resistance profile. Low preoperative serum albumin level was identified as a significant independent risk factor for developing SSI (AOR = 0.853, 95% CI = 0.748–0.973, P = 0.0181). Conclusion: The study found a notable prevalence of SSI among the included patients. Gram-negative bacteria were more involved in SSI events and were also associated with drug-resistance patterns. Gut microbiota bacteria were most commonly involved in SSIs. Low preoperative serum albumin levels predicted the development of postoperative SSI, and thus its close monitoring and management before surgery could reduce the SSIs.
Risk Factors for the Development of Parastomal Hernia: A Narrative Review
(2023) Manole, Teodora Elena; Daniel, Ion; Alexandra, Bolocan; Dan, Păduraru N.; Andronic, Octavian
Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient’s quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.
The Immediate Effect of Kinesio Tape on Hamstring Muscle Length and Strength in Female University Students: A Pre–post Experimental Study
(2023) Albeshri, Zainab Saeed; Youssef, Enas Fawzy
Background: Kinesio tape has been proposed to improve the muscle extensibility. However, there are contradictory results in the literature. Objective: To investigate the effect of Kinesio tape on hamstring muscle lengthening and on hamstring and quadriceps muscle strengthening in university students with hamstring muscle tightness. Methods: In this pre–post experimental study, 96 female students with hamstring muscle tightness were recruited from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, and randomly assigned to Kinesio tape, sham tape, or control groups (32 in each group). The inhibition technique was used for the Kinesio tape application, with the tape being applied from the muscle insertion to the origin. Measurements were taken before and 15 min after the intervention. Outcome measurements included active knee extension test to measure the hamstring muscle length, and isometric strength measurements of hamstring and quadriceps muscles using a handheld dynamometer. Results: A significant increase in the immediate hamstring muscle length was found in both the Kinesio (P = 0.001) and sham (P = 0.004) tape groups, while no difference was noted in the control group (P = 0.066). The muscle lengthening was significantly greater in the Kinesio tape group than the sham tape (P = 0.001) and control (P = 0.001) groups. There was no difference in the pre- and post-measurements in the quadriceps and hamstring muscle strengths in all three groups. Conclusions: These results demonstrate that applying Kinesio tape has an immediate effect on hamstring muscle extensibility, but has no effect on the quadriceps and hamstring muscle strengths. ClinicalTrials.gov identifier (NCT number): NCT03076840.
Emergency Physicians' Awareness of Medico-Legal Case Management: A Cross-Sectional Study from Saudi Arabia
(2023) Alabdulqader, Shahad; Alabdulqader, Rana; Madadin, Mohammed; Kashif, Haider; Al Jumaan, Mohammed A.; Yousef, Abdullah Abdulsalam; Menezes, Ritesh G.
Background: Emergency department physicians often encounter medico-legal cases when patients initially present to the hospital, and thus there is a strong need for them to have robust medico-legal management and reporting knowledge. Objective: To assess the awareness of emergency department physicians of two major hospitals in the Eastern Province of Saudi Arabia in managing medico-legal cases. Methods: This descriptive cross-sectional survey-based study included all adult and pediatric emergency physicians working at King Fahd Hospital of the University and King Fahd Specialist Hospital, two major government hospitals in the Eastern Province of Saudi Arabia. The questionnaire included questions about demographic information, the workload in the emergency department, previous medico-legal training, and information about physicians' perspectives regarding medico-legal situations. Results: A total of 85 physicians completed the questionnaire, with most being Saudis (78.8%) and consultants (44.7%). Most participants (84.7%) immediately notified the police authority through the official procedure on suspicion of a case being criminal. However, only 28.2% of the participants were aware of how to complete the medico-legal report, and the majority (82.4%) had not received any specific training or attended specific courses in writing medico-legal reports. Most participants (91.8%) expressed the need for additional medico-legal case training programs, with continuous education (29.4%) being the preferred mode. In addition, 60% of the consultants were dissatisfied with the current medico-legal reporting and management workflow in their hospital. About half of the participants did not obtain photographs in medico-legal cases and did not know if their workplace provided a protocol for collecting evidentiary material such as clothes, swabs, bullets, remnants of foreign bodies, etc. Conclusions: The results of the present study indicate the necessity to consider periodical continuing medical education programs and workshops for emergency department physicians in the Eastern Province of Saudi Arabia to help them in appropriately handling medico-legal cases.
Osteoid Osteoma of the Proximal Humerus: A Case Report and Literature Review
(2023) AlQahtani, Saad Mohammed; Albadran, Adeebah A; Altalib, Abdulraheem; Hamza, Wael Mostafa; Hegazi, Tarek M
Osteoid osteoma is a common benign primary bone tumor, but it is very uncommon in the proximal humerus. This case report describes the clinical course and treatment of a patient with shoulder pain and osteoid osteoma of the proximal humerus and provides a review of the literature. A 22-year-old healthy male patient presented to our clinic with a 2-year history of constant throbbing right shoulder pain. The patient was referred for orthopedic consultation. A series of plain radiographs, bone scintigraphy, and a magnetic resonance imaging were done and revealed an osseous lesion at the medial aspect of the proximal meta diaphyseal region of the right proximal humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency ablation of the tumor nidus, which was successful and resulted in resolution of symptoms with minimal pain at follow up. This case demonstrates that osteoid osteoma can present with clinical features that mimic various causes for shoulder pain.
Prevalence of Type 2 Diabetes Mellitus in the General Population of Saudi Arabia, 2000–2020: A Systematic Review and Meta-Analysis of Observational Studies
(2023) Jarrar, Mu'taman; Abusalah, Mai Abdel Haleem; Albaker, Waleed; Al-Bsheish, Mohammad; Alsyouf, Adi; Al-Mugheed, Khalid; Issa, Marwan Rasmi; Alumran, Arwa
Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased worldwide, including in Saudi Arabia. Objective: To systematically review the available literature and assess the pooled prevalence of T2DM in Saudi Arabia between 2000 and 2020. Methods: Observational studies that reported quantitative estimates of the prevalence of T2DM as their main outcome, included the general population of Saudi Arabia, and were published between 2000–2020 and in English were retrieved using three electronic databases (namely, CINAHL, Medline via PubMed, and Web of Science). Retrieved studies were screened, and relevant data were extracted. The Joanna Briggs Institute Critical Appraisal guideline was used to assess the methodological quality of included studies. A random-effects model was used to estimate the prevalence of T2DM. Results: Twenty-three studies were included in the systematic review, of which 19 were included in the meta-analysis (total pooled population: 258,283). The overall pooled prevalence of T2DM in Saudi Arabia was 16.4% (95% CI: 11.6–17.5). However, there was heterogeneity in the results of the studies [I2 = 99.31%, P < 0.0001] and the summary values varied from 3.18% (95% CI: 1.46–5.95) to 94.34% (95% CI: 89.53–97.38). Although the prevalence of T2DM by age varied across studies, in most studies, it was higher among the older age groups. In addition, the prevalence of diabetes widely varied across the different geographical regions of Saudi Arabia. Conclusions: This is the first meta-analysis that determined the pooled prevalence of T2DM in Saudi Arabia, and it revealed a high prevalence over the past two decades. However, owing to data collection inconsistencies in the identified studies, neither the modifiable (such as obesity, educational status, emotional support, etc.) nor the non-modifiable (such as gender and age) risk factors of T2DM could be determined, thereby indicating the need for a nationally collective effort in determining these factors.
Mucormycosis and Cryptococcosis with Gastrointestinal Involvement in a Patient with Poorly Managed Diabetes
(2023) Aldahash, Bader A; Alnemer, Mohammed A; Alsaad, Khaled O; Alsohaibani, Fahad I
Mucormycosis and cryptococcosis are invasive fungal infections that mostly infect immunocompromised patients and are associated with high mortality rates. Here, we report a case of a 54-year-old male with poorly controlled diabetes mellitus who was initially admitted with a complaint of right frontal headache and vomiting for 5 days. The patient was found to have paranasal sinuses mucormycosis, and later developed gastrointestinal cryptococcosis. A multidisciplinary approach and early management are important to avoid any delay in managing these life-threatening infections. To the best of the authors' knowledge, this is the first case reporting concurrent invasive fungal infections in a patient.
Prevalence of Obesity among Children and Adolescents in Saudi Arabia: A Multicenter Population-Based Study
(2023) AlEnazi, Shooq; AlAjlan, Raghad; AlKhalaf, Hamad; Abolfotouh, Mostafa; Alharbi, Omar; Alfawaz, Rasha; Aldebasi, Bader; Alghnam, Suliman
Background: Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. Objective: The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. Methods: This population-based retrospective study included children and adolescents aged 2–19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to <95th percentile as overweight. Chi-square tests were used to compare frequencies across groups. Results: A total of 351,195 children and adolescents were included, of which 337,316 (96%) were Saudis. Overall, about one-fifth of the population was overweight (11.2%) or obese (9.4%). The prevalence of obesity was highest among children aged 2–6 years (12.3%), and it was higher among boys (10.4%) than girls (8.3%). In terms of region, the prevalence of obesity among Saudis was highest in the Central and Eastern regions (9.9% for both). Conclusion: The findings highlight an urgent need for national interventions to focus on the upstream determinants of childhood obesity and to improve healthy options for children and adolescents in terms of food and physical activities.
Advances in CGRP Monoclonal Antibodies as Migraine Therapy: A Narrative Review
(2023) Aditya, Suruchi; Rattan, Aditya
Migraine is a potentially disabling disorder, yet it remains underdiagnosed and undertreated. The release of the neuropeptide calcitonin gene-related peptide (CGRP) in the trigemino-cerebrovascular system plays a vital role in the evolution of migraine. It enhances peripheral sensitization by mediating neurogenic inflammation and also influences central sensitization. The majority of the drug classes available for migraine prophylaxis are nonspecific and associated with numerous side effects and drug interactions. Anti-CGRP monoclonal antibodies (mAb) are an innovative therapeutic class that fulfills the need for more efficacious and tolerable preventive therapy. While erenumab is a mAb to the CGRP receptor, eptinezumab, fremanezumab, and galcanezumab bind to the CGRP molecule. They decrease the number of headache days and improve disability. Upper respiratory tract infection, nausea, constipation, pain at the site of injection, and fatigue are the associated side effects. CGRP mAbs are an excellent advancement in translational research and are a promising addition in migraine therapy. This article discusses the recent advances in the development of the CGRP mAbs.
The Role of Pre-bone Marrow Transplantation Pulmonary Function Test in Predicting Post-transplant Noninfectious Pulmonary Complications
(2023) Ahmed, Amani S.; Gassas, Roaa S.; Ahmed, Mohamed E.; Osman, Ghaya; Alsaeed, Ahmed S.; Absi, Ahmed N.; Alamoudi, Sameer M.; Alahmadi, Majed D.; Khalil, Manar M.; ElDadah, Saleem K.; Hemaidi, Ihab Y.; Rajkhan, Walaa A.
Background: Pulmonary function test (PFT) is used as a tool for pre-transplant risk assessment and as a predictor of post-transplant outcomes. As there are currently few studies that discuss the role of PFT in bone marrow transplantation (BMT) patients in Saudi settings, and as the number of transplant patients with benign and malignant conditions continues to increase, this study was conducted with the aim of assessing the local practice. Methods: This retrospective cohort study included all adult patients who underwent BMT at Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, between 2014 and 2020. The association between established patient-related risk factors and the incidence of pulmonary complications among autologous and allogeneic groups was assessed. Results: A total of 186 patients were included (autologous = 143; allogenic = 43), of which 115 (61.8%) were male. At the pre-BMT phase, about 30% of the patients had comorbidities and 51% had received two rounds of salvage chemotherapy, while 16.1% had received radiation therapy. In the autologous group, the only PFT parameter that was a significant predictor of post-BMT pulmonary complications was forced vital capacity <80% (P = 0.012), while in the allogenic group, no parameter was significantly associated with pulmonary complications. The patient-related factors that were associated with respiratory distress in the autologous group were lung involvement (P = 0.03) and pre-transplant radiation (P = 0.044). Conclusion: The findings of this study indicated that forced vital capacity <80% was a significant factor in predicting non-infectious complications in the autologous group. Furthermore, lung involvement and pre-transplant radiation were the patient-related factors associated with pulmonary complications.
Demographics and Clinical Characteristics of Patients with Neurocysticercosis: A Retrospective Study from Dali, China
(2023) Zhu, Han-Xiao; Li, Yang-Chao; Yang, Xue-Ping; Chu, Yu-Hao; Guo, Wang; Chen, Ruo-Xia; Guo, Dan-Dan; Cheng, Li-Jing; Li, Yun
Background: Neurocysticercosis (NCC), a predominant parasitic disease that affects the central nervous system and presents with diverse clinical manifestations, is a major contributor to acquired epilepsy worldwide, particularly in low-, middle-, and upper middle-income nations, such as China. In China, the Yunnan Province bears a significant burden of this disease. Objective: To describe the demographic, clinical, and radiological features as well as serum and cerebrospinal fluid antibodies to cysticercus in patients with NCC from Dali, Yunnan Province, China. Materials and Methods: This retrospective study included patients who were diagnosed with NCC at The First Affiliated Hospital of Dali University between January 2018 and May 2023 and were residing in Dali, Yunnan Province, China. Results: A total of 552 patients with NCC were included, of which 33.3% belonged to Bai ethnicity. The clinical presentation of NCC exhibited variability that was influenced by factors such as the number, location, and stage of the parasites. Epilepsy/seizure (49.9%) was the most prevalent symptom, with higher occurrence in the degenerative stage of cysts (P < 0.001). Compared with other locations, cysticerci located in the brain parenchyma are more likely to lead to seizures/epilepsy (OR = 17.45, 95% CI: 7.96–38.25) and headaches (OR = 3.02, 95% CI: 1.23–7.41). Seizures/epilepsy are more likely in patients with cysts in the vesicular (OR = 2.71, 95% CI: 1.12–6.61) and degenerative (OR = 102.38, 95% CI: 28.36–369.60) stages than those in the calcified stage. Seizures was not dependent on the number of lesions. All NCC patients underwent anthelminthic therapy, with the majority receiving albendazole (79.7%). Conclusion: This study provides valuable clinical insights into NCC patients in Dali and underscores the significance of NCC as a leading preventable cause of epilepsy.
Plateletcrit is a Useful Marker in the Quality of Life Assessment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study from Erbil, Iraq
(2023) Aref, Sheelan Faroz; Jalal, Aryan Mohamadfatih; Mawlood, Zhala Kakamin; Al-Nimer, Marwan Salih
Background: In patients with rheumatoid arthritis (RA), hematological indices and ratios have been reported to be related to the severity of illness, and thus could potentially be useful determinants of quality of life (QoL). Objective: To evaluate the association between hematological indices or ratios, which serve as biomarkers of disease activity, and the QoL of RA patients. Materials and Methods: This study was carried out in the Rizgary Teaching Hospital in the Kurdistan region of Iraq between December 01, 2021, and March 31, 2022. All female patients with a confirmed diagnosis of RA and aged ≥18 years were included. Data relating to the disease activity score (DAS-28), biochemical measurements of the profile, and hematological indices and ratios were assessed. The QoL of each patient was assessed using the Quality of Life-Rheumatoid Arthritis II (QoL-RA II) and the World Health Organization-Quality of Life (WHOQOL-BREF) scales. Results: A total of 81 participants were included, with a median disease duration of 9 years. The median values of the hematological indices were as follows: mean corpuscular volume, 80 fL; platelet count 282 × 103/mm3; mean platelet volume, 9.7 fL; neutrophil-to-lymphocyte ratio, 2.76; and platelet-to-lymphocyte ratio, 170.5. In six of the eight domains of the QoL-RA II scale, the median score was ≤5, indicating poor QoL. The transformed scores of WHOQOL-BREF domains were <50. Multivariate regression analysis showed significant inverse correlations between plateletcrit and the health domains. The area under the curve of the physical, psychological, and environmental domains was <0.5 at a cutoff value of plateletcrit of 0.25. Conclusions: In RA patients, hematological indices and ratios could serve as a QoL assessment tool, particularly plateletcrit, as higher plateletcrit (≥0.25) were found to negatively impact the physical health, psychological, and environmental domains.

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