BACKGROUND: Unexplained infertility remains a diagnostic and therapeutic challenge. Dual trigger, combining gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG), has been proposed to more closely mimic the physiological mid-cycle gonadotropin surge than hCG alone in gonadotropin-stimulated intrauterine insemination (IUI) cycles. OBJECTIVES: To evaluate whether dual trigger improves biochemical pregnancy outcomes compared with hCG-only trigger in gonadotropin-stimulated IUI cycles DESIGN: Retrospective cohort study SETTINGS: Single-center, tertiary referral center PATIENTS AND METHODS: Between April 2021 and September 2022, 96 patients underwent IUI after ovarian stimulation with gonadotropins (53 hCG-only, 43 dual trigger). Baseline demographic and clinical characteristics included female age (29.5±2.5 vs. 27.2±3.5 years), male age (33.3±4.0 vs. 31.6±3.5 years), body mass index (BMI) (24.0 vs. 25.0 kg/m2), gonadotropin dose (median 675 IU), treatment duration (median 9 days), dominant follicle size (18 mm vs. 17 mm), and endometrial thickness (9 mm vs. 8 mm). MAIN OUTCOME MEASURES: Biochemical pregnancy, defined as serum β-hCG ≥5 mIU/mL. SAMPLE SIZE: 96 patients (53 hCG-only, 43 dual trigger) RESULTS: Biochemical pregnancy occurred in 18.6% of the dual trigger group and 11.3% of the hCG-only group (P=.315). The odds of biochemical pregnancy were higher with dual trigger but not statistically significant (OR=1.8, 95% CI: 0.6–5.6). Subgroup analysis revealed a significant association between infertility duration and biochemical pregnancy (P=.04), with 76.9% of conceptions occurring in women with 2–3 years of infertility. CONCLUSIONS: Dual trigger did not significantly improve biochemical pregnancy rates compared with hCG-only trigger (OR=1.8, 95% CI: 0.6–5.6). Infertility duration was the only significant predictor of treatment success. Larger multi-center trials are required due to the current study's limited power. LIMITATIONS: Retrospective design, single-center setting, and limited sample size may restrict generalizability.
BACKGROUND: Ramadan fasting alters neuroendocrine rhythms, nocturnal gastric acid secretion, and population-level social behaviour. Its concurrent impact on acute gastrointestinal complications and on community-level violent trauma in high-volume urban settings remains poorly quantified. OBJECTIVES: To evaluate the impact of Ramadan fasting on the frequency of surgical admissions for penetrating trauma, blunt trauma, peptic ulcer perforation (PUP), and acute appendicitis over a 10-year period. DESIGN: Retrospective chart review SETTINGS: İstanbul Bağcılar Training and Research Hospital, University of Health Sciences Türkiye (Tertiary Academic Referral Hospital). MATERIALS AND METHODS: Emergency admissions requiring surgical intervention between 2016 and 2025 were reviewed. Ramadan periods were compared with equivalent non-Ramadan periods using Poisson regression with robust standard errors, reporting incidence rate ratios (IRR) with 95% confidence intervals. Matched calendar-month, ±30-day adjacent-window, and season-stratified sensitivity analyses were performed. Bonferroni-adjusted P values are also reported; primary conclusions are based on uncorrected values (threshold P<.05). MAIN OUTCOME MEASURES: Comparative frequencies of penetrating trauma and PUP admissions during Ramadan versus non-Ramadan periods; secondary outcomes were blunt trauma and acute appendicitis admissions. SAMPLE SIZE: 20 968 emergency cases meeting the inclusion criteria (12 162 males, 8806 females). RESULTS: Cases comprised 1549 penetrating trauma, 3619 blunt trauma, 776 PUP, and 2920 acute appendicitis. Penetrating trauma admissions were significantly lower during Ramadan [9.7 (2.8) vs 13.2 (2.6) cases per month; IRR 0.73, 95% CI 0.58–0.93; P=.049], predominantly among males (P=.021) and during evening and early morning hours. PUP admissions were significantly higher during Ramadan [10.5 (4.6) vs 6.1 (2.3); IRR 1.72, 95% CI 1.24–2.39; P=.041], particularly in males (P=.048), peaking in the early morning. A significant pandemic-period interaction was identified for PUP [P=.031 (interaction test)], the excess being larger in 2022–2025. No significant differences were observed for blunt trauma [26.4 (3.2) vs 30.5 (3.1); P=.201] or acute appendicitis [22.5 (3.1) vs 24.5 (3.0); P=.392]. CONCLUSION: Ramadan fasting is associated with a reduced admission frequency of penetrating trauma and an increased admission frequency of PUP, predominantly in male patients, highlighting opportunities for targeted prevention and resource planning. Multicentre prospective studies incorporating individual fasting status are warranted. LIMITATIONS: Single-centre design. Potential unmeasured confounders, including changes in referral patterns or the COVID-19 pandemic, cannot be excluded.
BACKGROUND: Group B Streptococcus (GBS) is a leading cause of neonatal morbidity, preventable via intrapartum antibiotic prophylaxis (IAP). OBJECTIVE: To determine the proportion of GBS-positive mothers among the screened population, evaluate IAP protocol adherence, and identify clinical risk factors and outcomes. DESIGN: Single-center retrospective cohort study SETTINGS: Labor and Delivery Suite at King Saud University Medical City (KSUMC), Riyadh PATIENTS AND METHODS: Electronic medical records (July 2021–December 2022) were reviewed for pregnant women (≥35 weeks) who were screened or had GBS bacteriuria, along with their neonates. Multivariate logistic regression was used to determine risk factors. MAIN OUTCOME MEASURES: Proportion of GBS-positive mothers among the screened population, IAP timing, maternal febrile morbidity, neonatal intensive care unit (NICU) admissions, and culture-positive sepsis. SAMPLE SIZE: Of the 5292 deliveries, 688 unscreened elective cesareans were excluded, leaving 4604 screened women and 180 GBS-positive dyads. RESULTS: The proportion of GBS-positive mothers among the screened population was 3.91% (180/4604). Although 67.2% (121/180) of colonized women received IAP, only 15.6% (28/180) received it ≥4 hours before delivery. Maternal febrile morbidity was 0% (0/180). The neonatal intensive care unit (NICU) admission rate was 8.3% (15/180), and culture-positive neonatal sepsis occurred in 1.1% (2/180) of cases. GBS bacteriuria independently predicted adverse neonatal outcomes (aOR 2.35, 95% CI: 1.12–4.92, P=.024), while preterm delivery showed a negative correlation (aOR 0.29, 95% CI: 0.11–0.76, P=.012). CONCLUSIONS: The proportion of GBS-positive mothers in the screened population is low (3.91%). While perinatal outcomes were generally excellent regardless of antibiotic timing, GBS bacteriuria was identified as a significant, independent predictor of adverse neonatal outcomes. These findings highlight a biologically plausible risk pathway that warrants validation in larger, multi-center prospective studies.
BACKGROUND: Gestational diabetes mellitus (GDM) has been associated with adverse pregnancy outcomes and may influence fetal neurosensory development, particularly auditory function. However, evidence regarding its effect on neonatal hearing screening remains inconsistent. OBJECTIVES: To evaluate the association between maternal Oral Glucose Tolerance Test (OGTT) glucose levels (fasting, 60-minute, and 120-minute) and neonatal hearing screening outcomes, and to explore whether maternal glycemic status, including GDM, affects early auditory function in newborns. DESIGN: Retrospective observational study SETTING: Tertiary university hospital (Izmir University of Economics Medical Point Hospital) between 2015 and 2024. PATIENTS (MATERIALS) AND METHODS: Singleton pregnancies with available 75-g OGTT data and corresponding neonatal hearing screening results were included. Maternal glucose levels (fasting, 60-, and 120-minute) were analyzed according to hearing screening outcomes (pass or refer). Non-parametric tests were applied. MAIN OUTCOME MEASURES: Failure in neonatal hearing screening and its association with maternal OGTT parameters. SAMPLE SIZE: A total of 463 mother–newborn pairs were included. RESULTS: Sixty-minute OGTT glucose levels differed significantly across hearing screening outcome groups (P=.003). Mothers of infants with bilateral hearing screening failure had significantly higher 60-minute glucose levels compared to those whose infants passed (P=.004). No significant associations were observed for fasting or 120-minute glucose levels. In multivariable logistic regression analysis, no independent association was identified between maternal OGTT parameters and hearing screening failure after adjustment for mode of delivery and parity. Additionally, no significant associations were found between OGTT values and neonatal anthropometric measurements. CONCLUSIONS: Elevated postprandial glucose levels may be associated with early alterations in neonatal hearing screening results; however, maternal glucose parameters were not significantly associated with hearing screening failure. These findings suggest that observed abnormalities may reflect transient functional changes rather than permanent auditory impairment. LIMITATIONS: Retrospective design, lack of confirmatory auditory brainstem response testing in all cases, and potential influence of unmeasured neonatal and perinatal confounders.
BACKGROUND: Obstructive sialadenitis is a common salivary gland disorder. This retrospective study evaluated the outcomes of sialendoscopy in 90 patients treated between July 2018 and December 2023. OBJECTIVE: To evaluate the success rate, complications, and predictors of treatment outcomes of sialendoscopy in patients with obstructive sialadenitis. DESIGN: Retrospective cohort study SETTING: Security Forces Hospital, Saudi Arabia PATIENTS AND METHODS: A retrospective cohort study was conducted using patient medical records. Patients with obstructive sialadenitis were included. MAIN OUTCOME MEASURES: Success of sialendoscopy, defined as complete endoscopic stone retrieval with confirmed ductal patency on post-retrieval irrigation. Four procedures in which no sialolith was identified intraoperatively were excluded from the stone-retrieval success denominator (n=94 stone-confirmed procedures). SAMPLE SIZE: Ninety patients RESULTS: Submandibular glands accounted for 74% (67/90) of cases. Success rates for complete stone retrieval were 79% (19/24 parotid) and 79% (55/70 submandibular). Key predictors of success included stone size, location, and number: stones >10 mm (OR=0.17, 95% CI: 0.04–0.67; P=.01), intraglandular location (OR=0.13, 95% CI: 0.03–0.54; P=.005), and multiple stones (OR=0.18, 95% CI: 0.05–0.60; P=.006) significantly reduced success. Complications occurred in 11.2% (11/98) of cases, primarily ductal stenosis and postoperative swelling, with submandibular glands contributing most complications. CONCLUSION: In this one of the larger reported single-centre Saudi series, sialendoscopy demonstrated high success for obstructive sialadenitis, with stone size >10 mm, intraglandular location, and multiplicity as independent failure predictors. These findings support tailored approaches in Middle Eastern populations. LIMITATIONS: Retrospective single-center design, lack of long-term follow-up data, and absence of patient-reported outcome measures.
BACKGROUND: Lung cancer in never-smokers represents a distinct clinical and biologic entity. However, its epidemiologic characteristics remain incompletely described in the Middle East. OBJECTIVES: To characterize lung cancer in never-smokers and compare it with ever-smokers in a multicenter Saudi cohort. DESIGN: Retrospective multicenter cohort study. SETTING: Three tertiary-care centers of King Faisal Specialist Hospital & Research Centre system in Saudi Arabia. PATIENTS AND METHODS: Adults with histologically confirmed primary lung cancer diagnosed between January 2020 and December 2024 were classified as never- or ever-smokers. Carcinoid tumors were excluded from the comparative analysis. Demographic, histologic, stage, and molecular characteristics were compared. Multivariable logistic regression identified factors independently associated with never-smoker status. MAIN OUTCOME MEASURES: Clinical, histologic, stage, and molecular differences between never-smokers and ever-smokers expressed as crude and adjusted odds ratios (95% confidence interval). SAMPLE SIZE: 301 patients reviewed; 253 in the primary analytic cohort (92 never-smokers, 161 ever-smokers). RESULTS: Among 280 patients with available smoking history, 253 were included after excluding 27 carcinoid tumors (92 never-smokers [36%] and 161 ever-smokers [63.6%]). Never-smokers were mostly females (64/92 (70%) vs 12/161 (7.5%); P<.001) and younger than ever-smokers [mean age 59.2 (standard deviation 13.5) vs 62.3 (11.1) years; P=.065]. Adenocarcinoma predominated among never-smokers (81/92 (88%) vs 108/161 (67.1%); P<.001). Among patients tested, Epidermal growth factor receptor (EGFR) mutations(34/86 (39.5%) vs 12/128 (9.4%); P<.001) and Anaplastic lymphoma kinase (ALK) rearrangements [17/86 (20%) vs 9/128 (7.0%); P=.01] were significantly more frequent in never-smokers, whereas KRAS alterations were more common in ever-smokers [6/86 (7%) vs 21/128 (16.4%); P=.068]. Stage III-IV disease was common in both groups (70% vs 72%; P=.783). In multivariable analysis, female sex [adjusted odds ratio (OR) 31.9, 95% CI 14.2-71.6; P<.001] and adenocarcinoma histology (adjusted OR 5.3, 95% CI 2.0-14.2; P<.001) were independently associated with never-smoker status. CONCLUSION: In this multi-center Saudi cohort, more than one-third of lung cancers occurred in never-smokers, characterized by female predominance, adenocarcinoma histology, and frequent EGFR and ALK alterations. These findings support comprehensive molecular testing regardless of smoking history and underscore the need for strategies to improve early recognition of lung cancer in never-smokers. LIMITATIONS: Retrospective design, incomplete molecular testing, tertiary-referral setting, and potential misclassification of smoking exposure, including unrecorded waterpipe and electronic-cigarette use.
BACKGROUND: The Hajj pilgrimage is a major global gathering that poses health challenges, particularly for those with pre-existing health conditions that require hospitalization. OBJECTIVES: To examine the determinants of hospitalization among Indonesian Hajj pilgrims and quantify their relative contributions to the burden of hospitalization. DESIGNS: Retrospective cohort study SETTING: Indonesian emergency clinics and referral hospitals for Hajj in Saudi Arabia during the 2016–2019 and 2022 Hajj seasons. PATIENTS AND METHODS: A nationwide retrospective cohort study used data from the Integrated Hajj Computerized System for Health (Siskohatkes). Variables included demographic information, clinical profiles, and hospitalization outcomes. Multivariate logistic regression to estimate the adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated, and population-attributable fractions quantified significant determinants. MAIN OUTCOME MEASURES: Hospitalization among Indonesian Hajj pilgrims during the Hajj period. SAMPLE SIZE: 876 700 Indonesian Hajj pilgrims were included in this study. RESULTS: Overall, 8978 pilgrims (1.02%) were hospitalized. Age was the strongest predictor of hospitalization, with pilgrims aged ≥65 years having more than eightfold higher odds of hospitalization than those aged <45 years (aOR=8.31; 95% CI: 7.39–9.34; P<.001), accounting for 49.8% of the attributable risk. Male sex was also independently associated with hospitalization (aOR=1.47; 95% CI: 1.39–1.56; P<.001), contributing 11.6% of the attributable risk. Among comorbidities, diabetes (aOR=2.34; 95% CI: 2.19–2.51; P<.001), diabetes with hypertension (aOR=2.23; 95% CI: 2.07–2.39; P<.001), and anemia (aOR=1.56; 95% CI: 1.48–1.63; P<.001) were significant independent predictors of hospitalization. The most common primary diagnoses among hospitalized pilgrims were pneumonia (36.7%), chronic obstructive pulmonary disease (21.4%), and myocardial infarction/coronary heart disease (12.4%). CONCLUSION: Older age and cardiometabolic comorbidities were the major predictors of hospitalization among Indonesian Hajj pilgrims. Strengthening pre-departure screening, chronic disease management, and risk-based interventions may reduce preventable hospitalizations and improve pilgrim safety. LIMITATIONS: Potential for information bias inherent in routinely collected administrative data and limited availability of clinical and behavioral covariates.
BACKGROUND: T-cell and natural-killer (T/NK)–cell lymphomas are rare and aggressive malignancies. Prior to our study, no dedicated institutional survival analyses of T/NK-cell lymphomas had been published from Saudi Arabia. OBJECTIVES: To evaluate the clinical characteristics, prognostic factors, and survival outcomes of patients with T/NK-cell lymphoma treated at a tertiary cancer referral centre in Saudi Arabia. DESIGN: Retrospective cohort study SETTING: King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia; January 2016 to December 2022. PATIENTS AND METHODS: We reviewed medical records of 89 adults with histologically confirmed T/NK-cell lymphomas, including precursor and mature subtypes. Overall survival (OS) was estimated using the Kaplan–Meier method. Prognostic factors were assessed with univariate and multivariable Cox proportional hazards regression. To maintain a robust events-per-variable ratio, the multivariable model was restricted to four predictors. MAIN OUTCOME MEASURES: Five-year overall survival and identification of variables associated with mortality. SAMPLE SIZE: 89 patients RESULTS: The mean age was 49.5±20.5 years, and 62 patients (70%) were male. The most common subtypes were ALK-negative anaplastic large-cell lymphoma (n=20, 22%) and peripheral T-cell lymphoma, not otherwise specified (n=15, 17%). For the entire cohort (N=89), the 5-year OS was 56% (95% CI, 44%–67%); the Kaplan–Meier estimated mean OS over the full available follow-up was 116.4 months. In multivariable analysis restricted to 70 patients with complete data (26 deaths), elevated lactate dehydrogenase (LDH) (hazard ratio [HR]=7.66; 95% confidence interval [CI], 1.77-33.19; P=.006), Eastern Cooperative Oncology Group (ECOG) performance status >2 (HR=4.26; 95% CI, 1.60–11.33; P=.004), and renal insufficiency (HR=3.06; 95% CI, 1.34–6.97; P=.008) were independent predictors of worse survival. Anemia trended toward worse survival but did not reach independent significance (HR=2.30; 95% CI, 0.95–5.58; P=.066). CONCLUSION: Elevated LDH, poor performance status, and renal insufficiency are strong independent predictors of inferior survival. Stem cell transplantation did not demonstrate a survival benefit in this cohort. These findings underscore the importance of baseline laboratory and clinical variables for risk stratification and provide groundwork for multicentre studies and therapeutic optimisation in Saudi Arabia. LIMITATIONS: Sample size and single-centre retrospective design limit generalisability. Transplant-specific details in treatment regimens were not evaluated.
BACKGROUND: Hysterectomy indications and surgical route selection may vary with age due to shifting case mix. OBJECTIVES: To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection. DESIGN: Retrospective chart review SETTINGS: Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology. METHODS: Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age [<50, 50-59, or >= 60 years]. Indications were assigned using PALM-COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal-Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery. MAIN OUTCOME MEASURES: age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery. SAMPLE SIZE: 769 hysterectomies RESULTS: Primary indications differed significantly by age group (P<.001; Cramer's V=0.38): treatment-resistant abnormal uterine bleeding predominated in patients <50 and 50-59 years, whereas pelvic organ prolapse predominated in patients >= 60 years. Surgical route also varied by age (P<.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those >= 60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age >= 60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08-3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02-46.60). In binary regression, age >= 60 years (aOR 4.18, 95% CI 2.41-7.26) and parity (aOR 1.18 per birth, 95% CI 1.06-1.32) favored minimally invasive surgery. CONCLUSIONS: Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients. LIMITATIONS: Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.
BACKGROUND:The neutrophil CD64 (nCD64) index is a potent biomarker for infectious diseases; however, the lack of standardized reference intervals (RIs) limits its clinical utility. OBJECTIVES:This study aimed to establish and validate reference intervals (RIs) for the nCD64 index specifically for the Guangxi population using flow cytometry. DESIGN:Cross-sectional study. SETTINGS:Conducted in Guangxi, China. PATIENTS AND METHODS:A total of 494 healthy adults (aged 18-83 years) were enrolled. Peripheral blood nCD64 expression was measured via flow cytometry. Reference intervals were determined using the non-parametric 95th percentile method (2.5th-97.5th) per CLSI EP28-A3c guidelines. Validation was performed in an independent cohort (n=30). MAIN OUTCOME MEASURES:The primary outcome was the 95% reference interval for the nCD64 index. Secondary outcomes included correlations between nCD64 index and sex, age, BMI, and primary hematological parameters. SAMPLE SIZE:494 healthy adults for establishment, plus 30 independent subjects for validation. RESULTS:No clinically significant differences in the nCD64 index were found between sexes or across age groups, and partitioning was not required. The nCD64 index exhibited a skewed distribution. Although sex showed a weak positive correlation with nCD64 expression (r=.115, P=.011), the standard normal deviation test (z<z*) indicated no requirement for sex-specific partitioning. No significant correlations were observed between nCD64 and age, BMI, or primary hematological parameters. The established 95% RI was .08-0.94, with the 90% confidence intervals (CI) for the lower and upper limits were .08-.09 and .92-1.04. Validation confirmed the RI's reliability, with 97% (29/30) of results falling within the range. CONCLUSIONS:We established a robust RI (.08-.94) for the nCD64 index in the Guangxi population, which remained consistent across age and sex groups. This provides a standardized baseline for the diagnosis of inflammatory and infectious conditions in Southern China. LIMITATIONS:The study was limited to a single regional population (Guangxi) and did not include pediatric or pregnant populations. Additionally, potential confounding from subclinical inflammation or undiagnosed chronic infections cannot be completely excluded despite strict enrollment criteria.
BACKGROUND: The prognostic significance of pathological T stage relative to nodal involvement in colon cancer remains controversial. Emerging evidence suggests that patients with T4N0 disease may experience outcomes comparable to or worse than those with node-positive disease. OBJECTIVES: This study aimed to compare long-term oncologic outcomes between patients with non-metastatic T4N0 colon cancer and those with T2–3N1 disease. DESIGN: Retrospective SETTINGS: Single-center PATIENTS AND METHODS: Retrospective analysis of patients with histologically confirmed, non-metastatic colon adenocarcinoma who underwent curative-intent surgery between 1999 and 2020. Patients were categorized into T4N0 and T2–3N1 groups. MAIN OUTCOME MEASURES: Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method and compared with log-rank tests. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models. SAMPLE SIZE: A total of 273 patients were included, of whom 78 (28.6%) were staged as T4N0 and 195 (71.4%) as T2–3N1. RESULTS: After a median follow-up of 72 months, patients with T4N0 disease showed significantly worse OS than those with T2–3N1 disease (HR=1.72, 95% CI 1.06–2.75; P=.02). Five-year OS rates were 66.6% and 79.8% in the T4N0 and T2–3N1 groups, respectively. On multivariate analysis, pathological T4N0 stage (HR=1.74, 95% CI 1.03–2.93; P=.03), age ≥65 years, vascular invasion, and omission of oxaliplatin-based adjuvant chemotherapy independently predicted poorer OS. Stage T4N0 was also associated with higher locoregional and distant recurrence rates, with increased peritoneal involvement. CONCLUSIONS: Non-metastatic T4N0 colon cancer is associated with less favorable long-term survival and higher recurrence rates compared with T2–3N1 disease, supporting its classification as a biologically aggressive subgroup that may benefit from treatment strategies similar to selected stage III colon cancers. LIMITATIONS: The retrospective, single-center design may introduce selection bias, and limited molecular data precluded detailed sub-group analyses.
BACKGROUND:Intubation is a critical aspect of airway management and supportive care for intensive care unit (ICU) patients. Inappropriate size of endotracheal tubes (ETT) affects the patient's airway, it is crucial to choose an appropriate size for each patient. OBJECTIVES:This study aimed to assess current practices of ETT size. SELECTION:for adult ICU patients and to explore factors associated with it. DESIGN AND SETTINGS:Single-center, retrospective cohort study at King Fahad Hospital of the University, Saudi Arabia. PATIENTS AND METHODS:A retrospective review was conducted for adult patients admitted to ICU from January 2020 to January 2024 at King Fahad Hospital of the University. Inclusion criteria included patients aged 18 years or older, underwent intubation and was followed by tracheostomy. Those with missing data, had laryngeal or thyroid masses, had upper airway obstruction by any cause and upper airway surgery were excluded. MAIN OUTCOME AND MEASURES:The primary outcome was compliance of ETT size selection with established guidelines. Secondary outcomes included associations between ETT size (mm), patient demographics and intubation indications. RESULTS:A total of 228 ICU patients were analysed [mean (standard deviation) age of 61.8 (19.6) years]. The median internal diameter of the ETT size was 7.5 mm, with neurological causes being the most common indication for intubation. ETT size showed a significant positive correlation with height (rs=.341; P<.001) and weight (rs=0.190; p=0.004), but not with body mass index (rs=.050; P=.456). In multivariable analysis, larger ETT size was significantly associated with male sex (adjusted odds ratio, aOR 2.38, 95% confidence interval, CI 1.12-5.05), pulmonary indication for intubation (aOR 2.31, 95% CI 1.10-4.86), older age (aOR 1.20 per 10 years, 95% CI 1.02-1.42), and height (aOR 1.95 per 10 cm, 95% CI 1.20-3.16), whereas weight was not independently associated after adjustment (aOR 1.04 per 10 kg, 95% CI 0.85-1.26). Overall, 77% of ETT size selection did not comply with height-based guidelines. CONCLUSIONS:No standardized ETT size selection guidelines were followed for adult ICU patients. Male sex, height, older age, and pulmonary indication were independent predictors of larger ETT size, supporting the implementation of more structured, height-informed ETT sizing protocols.
BACKGROUND: Acute exacerbations of chronic rhinosinusitis (AECRS) are increasingly recognized as a distinct clinical entity that significantly impacts quality of life. Despite its clinical relevance, data on its prevalence, clinical characteristics, and underlying bacteriology remain limited. OBJECTIVES: This study investigated the clinical features of AECRS and characterized the bacterial profile of middle meatus cultures during exacerbation episodes. Furthermore, characteristics of AECRS were compared across chronic rhinosinusitis (CRS) phenotypes. DESIGN: Retrospective cohort study SETTING: Single tertiary care referral center, King Saud University Medical City (KSUMC) PATIENTS AND METHODS: Medical records from patients with established AECRS with positive middle meatus cultures from 2015 to 2025 were extracted. Data included demographics, CRS phenotype, comorbidities, prior treatments, microbiological findings, and clinical outcomes. MAIN OUTCOME MEASURES: Bacterial etiology and clinical characteristics of AECRS across phenotypes, including chronic rhinosinusitis with nasal polyposis, chronic rhinosinusitis without nasal polyposis, and allergic fungal rhinosinusitis. SAMPLE SIZE: 104 RESULTS: The study enrolled 104 patients (mean age 39.9 years); 49 (47.1%) had asthma and 21 (20.2%) had aspirin-exacerbated respiratory disease. Endoscopic pus was present in 71 (68.3%), and 77 (74%) had prior sinus surgery. The most common isolates were methicillin-sensitive Staphylococcus aureus 35 (33%), methicillin-resistant Staphylococcus aureus 26 (25%), and Pseudomonas species 24 (23.1%). Oral antibiotics were administered in 75 (72.1%) of AECRS episodes, while oral steroids were used in 27 (26%). Clinical improvement following antibiotic therapy was documented in 64 (85.3%) cases. High resistance was observed for ampicillin, penicillin, and oxacillin. CONCLUSION: AECRS presents considerable heterogeneity in both clinical presentation and microbiology. Therefore, culture-directed therapy is recommended due to variable antibiotic resistance patterns. Asthma was strongly associated with treatment failure. These findings emphasize the importance of individualized management strategies in AECRS. LIMITATIONS: Retrospective design, and single tertiary care center
BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed, yet their long-term effects on vitamin B12 status remain debated with inconsistent findings across studies. Data from Saudi Arabia and the Middle Eastern primary-care context are limited. OBJECTIVES: To evaluate changes in serum vitamin B12 levels following ≥6 months of PPI therapy and assess the association between PPI use and vitamin B12 deficiency. DESIGN: Retrospective chart-review cohort study with paired pre-post design. SETTINGS: Family Medicine clinics at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (2016–2022). PATIENTS AND METHODS: Adults (≥18 years) receiving PPI therapy for ≥6 months with paired vitamin B12 measurements were included. Patients with conditions or medications affecting B12 absorption (metformin, gastrointestinal surgery, atrophic gastritis, vegetarian diet) were excluded. Paired pre-post vitamin B12 levels were compared using Wilcoxon signed-rank and McNemar tests. Neurological symptoms were documented from clinical records. MAIN OUTCOME MEASURES: Change in serum vitamin B12 concentration, incidence of vitamin B12 deficiency (<200 pg/mL), and prevalence of neurological symptoms. SAMPLE SIZE: 376 adult PPI users RESULTS: Most participants were aged ≥56 years (n=282, 75%), female (n=211, 56.1%), and overweight/obese (n=308, 81.9%). Median vitamin B12 declined significantly from 312 to 297 pg/mL (P<.001), with vitamin B12 deficiency prevalence increasing from 8.2% (n=31) to 12.2% (n=46) (P=.05). New-onset deficiency developed in 9.6% [Author: Please insert n for context, e.g., 9.6% (n)] of patients, with lower baseline B12 predicting greater decline. Neurological symptoms were nearly four times more common among those who developed deficiency (42.4% [95% confidence interval, CI 27.2–59.2] vs. 10.9% [95% CI 7.9–14.8], P<.001). No significant associations were observed with age, sex, BMI, PPI type, or duration. The mean change in serum vitamin B12 was −41.3 pg/mL (95% CI −67.1 to −15.5) and the McNemar paired odds ratio for new-onset deficiency was 1.83 (95% CI 1.00 to 3.46). CONCLUSIONS: PPI use for six months or longer was associated with significant vitamin B12 decline, with neurological symptoms more frequent among deficient individuals. These findings support periodic vitamin B12 monitoring and structured deprescribing strategies, particularly for high-risk individuals. LIMITATIONS: Retrospective design, single-center setting, and inability to assess dietary B12 intake or PPI adherence.
BACKGROUND: Hysterectomy indications and surgical route selection may vary with age due to shifting case mix. OBJECTIVES: To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection. DESIGN: Retrospective chart review SETTINGS: Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology. METHODS: Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age [<50, 50–59, or ≥60 years]. Indications were assigned using PALM–COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal–Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery. MAIN OUTCOME MEASURES: age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery. SAMPLE SIZE: 769 hysterectomies RESULTS: Primary indications differed significantly by age group (P<.001; Cramer's V=0.38): treatment-resistant abnormal uterine bleeding predominated in patients <50 and 50–59 years, whereas pelvic organ prolapse predominated in patients ≥60 years. Surgical route also varied by age (P<.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those ≥60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age ≥60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08–3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02–46.60). In binary regression, age ≥60 years (aOR 4.18, 95% CI 2.41–7.26) and parity (aOR 1.18 per birth, 95% CI 1.06–1.32) favored minimally invasive surgery. CONCLUSIONS: Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients. LIMITATIONS: Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.
BACKGROUND: Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions ≤2 cm require further evaluation to optimize outcomes and reduce unnecessary surgeries. OBJECTIVES: This study aimed to evaluate the diagnostic accuracy, safety, and factors influencing the outcomes of CT-guided TTFNAB in Lung-RADS category 4 pulmonary nodules measuring ≤2 cm. DESIGN: Retrospective study SETTING: Single-center, a tertiary referral center MATERIALS AND METHODS: A retrospective analysis was performed on 95 patients who underwent CT-guided TTFNAB between January 2021 and April 2024. Data included demographics, lesion characteristics (size, location, density, and pleural proximity), histopathological findings, and procedural outcomes. MAIN OUTCOME MEASURES: The primary endpoints were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and factors influencing TTFNAB results, alongside procedural complications—specifically pneumothorax and chest tube requirement. SAMPLE SIZE: 95 patients RESULTS: Of the 95 nodules, 26 (27%) were benign and 69 (73%) were malignant according to TTFNAB. Final pathology confirmed 18 (19%) benign and 77 (81%) malignant lesions. All biopsies yielded sufficient material. Sensitivity, specificity, and overall diagnostic accuracy were 83%, 94%, and 89%, respectively. The PPV was 98%, while the NPV was 65%. Pleural thickening was significantly more frequent in both the TTFNAB benign group (38% vs. 13%, P=.006) and final benign diagnosis group (44% vs. 14%, P=.008). Pneumothorax occurred in 30% of cases, with 24% of these requiring chest tube drainage. No significant associations were found between diagnostic accuracy or complications and variables such as age, emphysema, Lung-RADS category, or nodule size. CONCLUSION: CT-guided TTFNAB is an effective diagnostic method for confirming malignancy in pulmonary nodules ≤2 cm classified as Lung-RADS 4, providing an overall accuracy of 89% and a PPV of 98%. However, a benign TTFNAB result cannot be considered diagnostically safe: the NPV of 65% and false-negative rate of 35% indicate that a negative biopsy does not reliably exclude malignancy. Clinicians must not rely on a negative result alone; close radiological follow-up or surgical biopsy is essential for these high-risk lesions. LIMITATIONS: The retrospective single-center design, small sample size, and limited generalizability. IRB APPROVAL NUMBER: 2024/010.99/6/23 (Date: 26.07.2024)
BACKGROUND: Colorectal polyps are the most important precursor lesions of colorectal cancer. Their epidemiological characteristics and risk factors exhibit substantial regional and population-based variations. Qinghai Province, located on the Qinghai–Tibet Plateau in China, is characterized by a unique hypoxic environment and a multi-ethnic population. However, large-scale epidemiological data on colorectal polyps in this region is limited. OBJECTIVE: To characterize the detection rate, temporal trends, demographic distribution, and risk factors for colorectal polyps in Qinghai Province. DESIGN: Retrospective study SETTING: A single tertiary medical center in Qinghai Province, China. PATIENTS AND METHODS: We enrolled 33059 patients who underwent colonoscopy at Qinghai University Affiliated Hospital (2021–2025). Data on demographics and endoscopic findings were collected. Temporal trends were analyzed using the linear-by-linear association LLA test, and independent risk factors were identified by binary logistic regression. MAIN OUTCOME MEASURES: Colorectal polyp detection rate and risk factors. SAMPLE SIZE: 33059 patients RESULTS: The overall colorectal polyp detection rate was 31.82% (10519/33059), with a slight upward trend over the study period. Rates were significantly higher in males (39.01%) than females (24.04%) and increased sharply with age. Multivariable analysis identified male sex (OR=2.493, 95 %CI:2.106–2.950, P<.001), age 41–64 years (OR=2.535, 95% CI:2.056–3.125, P<.001), and age ≥65 years (OR=4.379, 95% CI:3.328–5.761, P<.001) as independent risk factors. Tibetan and Hui ethnicities were associated with lower risk compared with Han (OR=0.611, 95% CI:0.448–0.833, P=.002). CONCLUSIONS: Colorectal polyp detection is high and rising in Qinghai. Male sex and advanced age are major risk factors. Notably, Tibetan or Hui ethnicity appear as potential protective factors, offering new insights into genetic interactions that may inform region-specific screening strategies. LIMITATIONS: Single-center retrospective design, potential selection bias, lack of lifestyle and metabolic data.
BACKGROUND: Silicone airway stents restore airway patency in central airway stenosis but may be complicated by migration, mucostasis, granulation tissue, and tumor overgrowth. OBJECTIVE: To compare complication profiles, timing of complications, and survival outcomes after silicone airway stent placement in malignant versus benign central airway stenosis. DESIGN: Retrospective comparative cohort study. SETTING: Single center, tertiary referral interventional bronchoscopy unit in Ankara, Türkiye. PATIENTS AND METHODS: Consecutive adults who underwent silicone airway stent placement by rigid bronchoscopy between September 2012 and July 2017 were reviewed and analyzed. MAIN OUTCOME MEASURES: Complication distribution by etiology, time to first complication, complication-free survival, and stent survival. SAMPLE SIZE: 80 patients (59 malignant, 21 benign) RESULTS: Complications occurred in 48% of benign and 30% of malignant cases, with significant differences in complication profiles between groups (P=.003). Migration was the most frequent complication in benign stenosis, whereas stent-edge granulation predominated in malignant stenosis. In benign stenosis, median time to migration, mucostasis, and granulation was 17 days (interquartile range, 6–50), 135.5 days (63–140.5), and 206 days (103.8–354.5), respectively. In malignant stenosis, the corresponding times were 25.5 (21.3–29.8), 22 (21.3–22.0), and 89 days (57.5–181.5), while stent-margin tumor overgrowth was 105 days (78.5–174.5). Median complication-free survival was 500 days (95% CI, 353–857), with no significant difference between benign (701 days) and malignant (410 days) groups (P=.5138). Median stent survival was 578 days (95% CI, 351–956), also comparable between groups (351 vs 578 days; P=.9688). CONCLUSIONS: Silicone airway stenting is associated with distinct complication patterns and timing in benign and malignant central airway stenosis. These findings support structured post-stent bronchoscopic surveillance. LIMITATIONS: Retrospective single-center design, small benign subgroup, symptom-driven follow-up, and potential confounding and immortal-time bias in survival analyses.
