Background The periprocedural management of antithrombotic medications in patients with chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE) or surgical evacuation is uncertain.Methods A systematic review was conducted across Medline, Embase, and Web of Science databases. We pooled proportions and risk ratios (RRs) for the meta-analysis with the corresponding 95% CIs. Systemic and intracranial (including recurrence) bleeding complications and thromboembolic events were evaluated.Results Of the 16 included studies with 4606 patients, 1784 were receiving antithrombotic medications. Antithrombotic therapy was resumed in 1231 patients (69.0%). Bleeding complications were similar between patients in whom antithrombotic therapy was resumed (14.1%, 95% CI 9.7% to 20.2%) and in those in whom it was discontinued (15.4%, 95% CI 7.4% to 29.3%). After MMAE, patients had similar rates of bleeding events (12.1%, 95% CI 4.9% to 27.0%) to patients with overall treated cSDH, and recurrence (RR 2.28, 95% CI 0.46 to 11.37) and reoperation (RR 1.07, 95% CI 0.40 to 2.917) risks were similar between the resumed and discontinued groups. Thromboembolic complications were significantly higher in the discontinued group (12.6%, 95% CI 6.5% to 23.0%) than in the resumption group (3.5%, 95% CI 1.8% to 6.9%). Earlier resumption (1 week to 1 month) was associated with a lower thromboembolic risk without increasing bleeding complications.Conclusions Post-procedural antithrombotic resumption may reduce thromboembolic events without significantly increasing bleeding risk. Early resumption of antithrombotics post-MMAE appears to be safe, although further data are required to confirm this observation. Future studies should aim to better define patient characteristics influencing decision-making in this context.
This study evaluated the effect of L-citrulline supplementation combined with conventional therapy on inflammatory and hepatic markers in patients with non-alcoholic fatty liver disease (NAFLD). A total of 110 patients aged 35-45 years were enrolled in a 12-week quasi-experimental study and divided into two groups: G0 (conventional treatment only) and G1 (conventional treatment plus 2 g/day L-citrulline). Anthropometric measurements and biochemical parameters, including lipid profile, liver function tests, C-reactive protein (CRP), and tumor necrosis factor (TNF)-α, as well as dietary intake, were collected at baseline and post-intervention. The mean age was 42.03±4.89 years in G0 and 44.7±4.22 years in G1. Body mass index (BMI) and weight did not change significantly in either group. L-citrulline supplementation in G1 significantly reduced low-density lipoprotein and total cholesterol levels and improved high-density lipoprotein (p<0.05). TNF-α levels also decreased significantly in the treatment group (p=0.0032), whereas CRP and aspartate aminotransferase showed no significant changes. These findings indicate that L-citrulline supplementation, as an adjunct to conventional therapy, improves inflammatory and lipid parameters in NAFLD patients, particularly TNF-α, low-density lipoprotein, and total cholesterol, without affecting BMI, weight, or CRP. Future multicenter randomized studies are recommended to confirm these results.
Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is an interesting phenomenon of drug response characterized by symmetrical, exuberant skin reactions often seen in flexural and intertriginous areas. This report describes a 35-year-old gentleman with no relevant clinical history who developed SDRIFE subsequent to the use of oral fluconazole. His skin examination showed non-scaly, erythematous to violaceous patches within the genital, antecubital, axillary, neck, and inframammary folds. The diagnosis was made based on the clinical picture. Discontinuation of fluconazole and a tapering course of oral prednisolone led to complete resolution of symptoms. This case underlines the importance of maintaining a low threshold of suspicion for rare drug reactions such as SDRIFE, even with medications that are not commonly viewed as requiring dermatological follow-up, so that the condition can be directly managed and hopefully prevented in the future.
Background:Acute respiratory tract infections place substantial strain on healthcare systems, particularly during seasonal respiratory surges and mass-gathering events. Delayed confirmation of respiratory pathogens contributes to diagnostic uncertainty, unnecessary antimicrobial use, delayed infection prevention decisions, and inefficient patient flow. Rapid molecular point-of-care testing (mPOCT) offers near-PCR-level diagnostic accuracy with turnaround times compatible with real-time clinical decision-making; however, implementation and integration into routine clinical pathways remain variable across healthcare systems. Methods:We conducted an implementation-focused mixed-methods descriptive study integrating a synthesis of published evidence with structured stakeholder engagement in Saudi Arabia. Primary data were collected through three multidisciplinary scientific meetings and a stakeholder survey (N = 35) involving physicians, point-of-care experts, and laboratory professionals from Ministry of Health (MOH), institutional, and private healthcare settings. Quantitative survey data were analyzed descriptively using R version 4.3.3, including exploratory descriptive subgroup summaries by workplace sector and stakeholder role. Qualitative findings from expert discussions were synthesized thematically and integrated with survey findings and published evidence through methodological triangulation. Results:Physicians represented 48.6% of respondents, with most participants working in MOH facilities (60.0%). Rapid mPOCT was reported to be routinely used during respiratory seasons, with 68.6% indicating daily use. Immediate treatment decision-making (74.3%) and patient management activities, including bed designation (57.1%), were the most frequently reported indications for testing. Nearly half of respondents preferred results within 15 min (45.7%), while most preferred turnaround times of 30 min or less (85.7%). Participants reported generally moderate-to-high implementation of rapid mPOCT (mean implementation score 7.69/10; range 2-10), although variability remained in guideline integration, standard operating procedures, and institutional implementation. Frequently reported implementation barriers included limited education or guidance (31.4%), perceived availability of alternative diagnostic approaches (28.6%), and financial or reimbursement constraints (28.6%). Conclusion:Saudi healthcare stakeholders perceived rapid mPOCT as a valuable diagnostic tool for respiratory infections, particularly in emergency and acute care settings where timely results may support clinical decision-making. Wider implementation will require standardized diagnostic pathways, workforce education, supportive governance, and sustainable reimbursement strategies to facilitate consistent integration into routine clinical practice.
BACKGROUND:Cardiovascular-kidney-metabolic (CKM) syndrome links heart failure (HF), myocardial infarction (MI), kidney disease, diabetes, and obesity. SGLT2 inhibitors and GLP-1 receptor agonists improve cardiovascular and renal outcomes, but mechanisms underlying combination therapy remain uncertain. We assessed whether early changes in estimated glomerular filtration rate (ΔeGFR) mediate the association between dapagliflozin plus semaglutide and HF/MI-related outcomes. RESEARCH DESIGN AND METHODS:We conducted a retrospective cohort study of 376 adults prescribed dapagliflozin, with or without semaglutide, at a Saudi tertiary hospital (2020-2024). Inverse probability of treatment weighting and causal mediation analysis evaluated whether ΔeGFR mediated treatment-outcome associations during 90-365days of follow-up. RESULTS:Combination therapy was not associated with a statistically significant difference in recorded HF/MI-related clinical status (adjusted RR 0.787; 95% bootstrap CI 0.320-1.813; p = 0.516). ΔeGFR showed minimal mediation (indirect RR 1.013; 95% CI 0.901-1.165). IPTW analyses yielded similar neutral findings (composite RR 1.12; 95% CI 0.47-2.66). CONCLUSIONS:Early ΔeGFR showed little evidence of mediating HF/MI-related risk differences between combination therapy and dapagliflozin alone. Because outcomes were not independently adjudicated, these secondary findings are exploratory. Larger prospective studies are needed.
