Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2...Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2DM.Various considerations can make selecting and switching between different GLP-1 RAs challenging.Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.展开更多
The incidence of acute pancreatitis(AP),a condition characterized by inflammation in the pancreas,has been increasing globally and is associated with several complications.This review elaborated on the etiology,clinic...The incidence of acute pancreatitis(AP),a condition characterized by inflammation in the pancreas,has been increasing globally and is associated with several complications.This review elaborated on the etiology,clinical presentation,severity assessment,and treatment modalities of AP,mainly in the critical care setting.Patients with severe AP,as indicated by organ failure(>48 hours from onset),warrant treatment in the intensive care unit setting.The most common etiologies,biliary disease and alcohol consumption,and the advanced diagnostic tools used for the identification of the cause are highlighted.Different severity assessment tools are utilized for grading the severity of the disease,predicting patient outcomes,determining the associated risk,and guiding treatment decisions.The treatment interventions comprise various approaches,such as anti-infective therapy enteral nutrition,analgesics for pain,or minimally invasive surgical procedures,thereby demonstrating an evolving landscape of AP management.Furthermore,various complications such as necrosis,organ failure,and hemorrhage,necessitate disease monitoring and differential diagnosis and are crucial for optimal management of patients.Novel treatment modalities and advancements in multidisciplinary care emphasize the potential for reducing the burden of AP in critical care settings.展开更多
Introduction: Acute hemoperitoneum due to the spontaneous rupture of hepatocellular carcinoma (HCC) is a rare case of non-traumatic intra-abdomen bleeding that requires a high index of suspicion to approach, especiall...Introduction: Acute hemoperitoneum due to the spontaneous rupture of hepatocellular carcinoma (HCC) is a rare case of non-traumatic intra-abdomen bleeding that requires a high index of suspicion to approach, especially if no known history of HCC. It can mislead the physicians when the patient presents in an atypical way. Case Presentation: In this case report, we describe a fortuitous rupture of hepatocellular carcinoma in a 58-year-old male who was not previously diagnosed as having HCC and who came with atypical symptoms and signs of hemoperitoneum. He was then treated by trans-arterial embolectomy. Discussion: Diagnosis of hemoperitoneum in a case with bradycardia and hypotension is uncommon, as it goes more towards cardiogenic shock than hypovolemic shock, especially in a patient who is previously not symptomatic and has no risk factor for hepatocellular carcinoma. Conclusion: physicians should be alert to the possibility of encountering a hemorrhagic shock, although no trauma injury in any hypotensive patient with no clear reason for his condition.展开更多
BACKGROUND： Although cupping remains a popular treatment modality worldwide, its efficacy for most diseases, including hypertension, has not been scientifically evaluated. OBJECTIVE： We aimed to determine the effica...BACKGROUND： Although cupping remains a popular treatment modality worldwide, its efficacy for most diseases, including hypertension, has not been scientifically evaluated. OBJECTIVE： We aimed to determine the efficacy of wet-cupping for high blood pressure, and the incidence of the procedure＇s side effects in the intervention group. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a randomized controlled trial conducted in the General Practice Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2013 and February 2014. There were two groups （40 participants each）： intervention group undergoing wet-cupping （hijama） in addition to conventional hypertension treatment, and a control group undergoing only conventional hypertension treatment. Three wet-cupping sessions were performed every other day. MAIN OUTCOME MEASURE： The mean systolic and diastolic blood pressures were measured using a validated automatic sphygmomanometer. The follow-up period was 8 weeks. RESULTS： Wet-cupping provided an immediate reduction of systolic blood pressure. After 4 weeks of follow-up, the mean systolic blood pressure in the intervention group was 8.4 mmHg less than in the control group （P = 0.046）. After 8 weeks, there were no significant differences in blood pressures between the intervention and control groups. In this study, wet-cupping did not result in any serious side effects. CONCLUSION： Wet-cupping therapy is effective for reducing systolic blood pressure in hypertensive patients for up to 4 weeks, without serious side effects. Wet-cupping should be considered as a complementary hypertension treatment, and further studies are needed.展开更多
<strong>Background:</strong> Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for a...<strong>Background:</strong> Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. <strong>Materials and Methods:</strong> We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. <strong>Results:</strong> A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings;however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). <strong>Conclusion:</strong> There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.展开更多
Aim: In the present study, we analyzed 7-year clinical outcomes of patients included in the BIO degradable Polymer coated drug-eluting stent REgistry of Sahajanand Medical Technologies Pvt. Ltd. stents in Saudi Arabia...Aim: In the present study, we analyzed 7-year clinical outcomes of patients included in the BIO degradable Polymer coated drug-eluting stent REgistry of Sahajanand Medical Technologies Pvt. Ltd. stents in Saudi Arabia (BIOPRESS)-Infinnium? registry. Methods: This was multicentre, observational, non-randomized, post-marketing surveillance registry, which included 276 consecutive patients treated with Infinnium? paclitaxel-eluting stent between July-2004 and June-2006. All patients underwent single-vessel or multiple-vessel percutaneous coronary intervention with high atherosclerotic risk factors and the patients were followed up to 7 years. Baseline and post-procedure angiographic follow-up were pre-specified in 231 patients. Results: The registry included 276 consecutive patients (81.5% male) with a mean age of 56.0 ± 11.1 years. Among 276 patients, diabetes and hypertension were present in 142 (51.4%) and 172 (62.3%) of patients respectively. Of all patients studied, 186 (67.4%) had single-vessel disease, 75 (27.2%) had double-vessel disease, and 15 (5.4%) had triple-vessel disease. Total 476 Infinnium? stents were implanted with an average stent length of 21.8 ± 7.5 mm. The incidence of major adverse cardiac events (MACE) up to 1 year was 26 (9.4%). Clinical follow-up was completed in 235 patients at seven-year follow-up. The data of seven-year clinical outcomes were as follow: cumulative MACE rate of 18.1% with 7.6% of total mortality and 3.6% of restenosis. Conclusion: These 7-year results of BIOPRESS-Infinnium? registry clearly provide evidence for safety and long-term effectiveness of the Infinnium? paclitaxel-eluting stent with the biodegradable polymer in real-life patients.展开更多
Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to curre...Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.展开更多
For high risk prostate cancer, the treatment volumes and even dose levels are still a controversial issue. The aim of this study is to evaluate the dosemetric parameters and acute toxicity of dose-escalated whole pelv...For high risk prostate cancer, the treatment volumes and even dose levels are still a controversial issue. The aim of this study is to evaluate the dosemetric parameters and acute toxicity of dose-escalated whole pelvis (WP) Intensity Modulated Radiation Therapy (IMRT) and volumetric modulated arc therapy (VMAT) prostate boost following neoadjuvant and concomitant with androgen deprivation therapy in high-risk prostate cancer patients. This analysis included 73 high-risk prostate cancer patients treated with WP-IMRT followed by boost to the prostate by VMAT to total dose of 80 Gy;between January 2014 and October 2016. Androgen deprivation therapy (ADT) was given for all patients before and during radiation therapy. Drawing the dose volume histograms (DVHs) was done for planning target volumes (PTVs), including Prostate PTV & nodal PTV, and organs at risk including rectum, bladder, femoral heads, and bowel bag for the plans. Acute radiation toxicities were reported during the radiation course and the following 3 months. The DVH analysis showed good coverage of PTVs and organs at risk doses were acceptable. No recorded acute Grade ≥ 3 toxicity. Acute grade 1 toxicity for Gastrointestinal (GI) and Genitourinary (GU) were 65% and 35% respectively, while Grade 2 toxicity was 30% for both. The Proctitis and frequency were the commonest acute toxicity and were maximal during the 5th week of radiation therapy. Dose escalation in two phases utilizing Simultaneous integrated boost (SIB) combined with ADT in high risk prostate cancer patient is feasible and associated with acceptable acute GI and GU toxicity.展开更多
Background: Out-of-hospital cardiac arrest (OHCA) with ongoing CPR on arrival to emergency department still a challenge to decide how long the resuscitation should continue or when to terminate it. Case Summary: A pat...Background: Out-of-hospital cardiac arrest (OHCA) with ongoing CPR on arrival to emergency department still a challenge to decide how long the resuscitation should continue or when to terminate it. Case Summary: A patient with a 1-week history of difficulty in breathing suffered from an OHCA. The electrocardiogram upon arrival to the hospital showed pulseless electrical activity. Cardiopulmonary resuscitation was initiated and continued for a total of 90 minutes without any interruption until return of spontaneous circulation (ROSC) was achieved. Post-cardiac care was offered, and the patient was discharged with complete neurological recovery. Discussion: In non-shockable rhythms, the powerful defibrillator machine is not used during resuscitation. In such cases, identifying the offending cause, performing high quality CPR and administering epinephrine are the only effective tools in resuscitating a patient.展开更多
Cardiopulmonary resuscitation-induced consciousness (CPRIC) is increasingly being reported across the world. High quality cardiopulmonary resuscitation (CPR) may transiently generate sufficient cerebral perfusion to c...Cardiopulmonary resuscitation-induced consciousness (CPRIC) is increasingly being reported across the world. High quality cardiopulmonary resuscitation (CPR) may transiently generate sufficient cerebral perfusion to cause signs of consciousness during CPR which disappears on cessation of CPR. Here we present the case of a 56-year-old male presenting with myocardial infarction that led to cardiac arrest and initiation of CPR during which he showed signs of consciousness. This led to multiple disruptions in delivering high quality CPR. CPR providers are often unaware and inexperienced in managing these patients. However, CPRIC has an association with improved survival. Hence, more research needs to be conducted in this field and guidelines need to be developed to better manage CPRIC.展开更多
Diabetic ketoacidosis (DKA) can cause significant morbidity and mortality in patient with both type 1 and type 2 diabetes mellitus. A subset of DKA cases termed euglycemic diabetic ketoacidosis (EDKA) is characterized...Diabetic ketoacidosis (DKA) can cause significant morbidity and mortality in patient with both type 1 and type 2 diabetes mellitus. A subset of DKA cases termed euglycemic diabetic ketoacidosis (EDKA) is characterized by euglycemic (<200 mg/dl), high anion gap metabolic acidosis, and increased plasma ketone concentration. This clinical syndrome is primary related to a general state of starvation, resulting in the development of ketosis while maintaining normoglycemia. It can lead to severe complication, such as extreme dehydration, altered mental status and coma. Early recognition and treatment are essential to avoid this life-threatening complication. EDKA represents approximately 2.6% to 3.2% of total DKA admissions, making it a rare condition. In this case report, a male patient was diagnosed with type 2 DM, 1 week prior to his symptoms and admission in hospital. Despite normal glucose levels at the time of presentation to the ED, he displayed severe acidemia and ketonemia, and was diagnosed with EDKA.展开更多
Abnormal levels of plasma lipid have been linked to atherosclerosis, strokes and heart conditions. Variations in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels are considered as ri...Abnormal levels of plasma lipid have been linked to atherosclerosis, strokes and heart conditions. Variations in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels are considered as risk factors for coronary artery disease (CAD). Furthermore, triglycerides are a leading cause of cardiovascular disease. Therefore, measurement of plasma lipid levels is an important mortality predictor. Several factors were associated with irregularity in plasma lipids such as genetic alterations. Recent researches have linked single nucleotides polymorphism (SNP) in ApoA5 gene with these deviations. In this study, we reported the effects of the genetic variant c.553G>T in ApoA5 on the levels of plasma lipids. To explore these effects, a case-control study including 280 male and female subjects (44 of them were assigned as CAD cases while the remaining subjects were categorized as control) was established. All patients in the study were recruited from the western region in KSA. The results have detected minor variations in LDL, HDL and cholesterol levels between CAD patients carrying T allele and CAD patients carrying the WT allele. However, there were no significant effects due to these variations. TG levels in the wild type carriers reached up to 291 mg/dl while T allele carriers, the cases, presented lower levels of TG (170 mg/dl and 71 mg/dl). Although, T allele showed no effects on plasma lipids with the exception of TG levels. We suggest by this study that T allele in this SNP might be considered as a valuable tool in the diagnosis of CAD.展开更多
Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases ar...Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.展开更多
We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve ...We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.展开更多
Background & objectives: Coronavirus disease 19 (COVID-19) has been declared by World Health Organization as a global pandemic disease in March 2020. Acute respiratory distress syndrome is frequent complication of...Background & objectives: Coronavirus disease 19 (COVID-19) has been declared by World Health Organization as a global pandemic disease in March 2020. Acute respiratory distress syndrome is frequent complication of COVID-19 disease. Tracheostomy is needed in cases of prolonged mechanical ventilation (7 - 10 days) in patients with acute respiratory distress syndrome. Tracheostomies are highly aerosol generating procedures, Otorhinolaryngologists and Health Care Workers (HCWs) are at high risk of virus exposure. The aim of this review is to evaluate the risk of transmission of COVID-19 during tracheostomy procedure, and to review the practical recommendation and scope of the timing to reduce risk of transmission to HCW. Methods: PubMed database was searched between April 2020 to Jan 2021 using the terms “Tracheostomy AND COVID-19 AND Health Care Workers”. All the articles that shared the same aim were screened which resulted in 243 references without duplicates. The title and abstract screening excluded further 202 studies. Eventually 9 full-text studies were included. Results: Five hundred and two COVID-19 patients underwent tracheostomies during the study period. Sixty-three percent of the procedure were done through open technique, while 37% of them were done through percutaneous technique. Seventy-eight percent of them used full Personal Protective Equipment (PPE) and 44.4% used Powered Air Purifying Respirator (PAPR). Negative Pressure Rooms (NPR) were used in 67%. Conclusion: The studies showed similar negative results on HCW infection despite much variance in using PPE. However, there should be global unified recommendations and guidelines regarding tracheostomies in COVID-19 patients to prevent future HCW infection.展开更多
Pregnant women are among the high-risk population for severe coronavirus disease 2019(COVID-19)with unfavorable peripartum outcomes and increased incidence of preterm births.Hemolysis,the elevation of liver enzymes,an...Pregnant women are among the high-risk population for severe coronavirus disease 2019(COVID-19)with unfavorable peripartum outcomes and increased incidence of preterm births.Hemolysis,the elevation of liver enzymes,and low platelet count(HELLP)syndrome and severe preeclampsia are among the leading causes of maternal mortality.Evidence supports a higher odd of pre-eclampsia in women with COVID-19,given overlapping pathophysiology.Involvement of angiotensin-converting enzyme 2 receptors by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)for the entry to the host cells and its downregulation cause dysregulation of the renin-angiotensin-aldosterone system.The overexpression of Angiotensin II mediated via p38 Mitogen-Activated Protein Kinase pathways can cause vasoconstriction and uninhibited platelet aggregation,which may be another common link between COVID-19 and HELLP syndrome.On PubMed search from January 1,2020,to July 30,2022,we found 18 studies on of SARS-COV-2 infection with HELLP Syndrome.Most of these studies are case reports or series,did not perform histopathology analysis of the placenta,or measured biomarkers linked to pre-eclampsia/HELLP syndrome.Hence,the relationship between SARS-CoV-2 infection and HELLP syndrome is inconclusive in these studies.We intend to perform a mini-review of the published literature on HELLP syndrome and COVID-19 to test the hypothesis on association vs causation,and gaps in the current evidence and propose an area of future research.展开更多
Background:Glioblastoma(GBM)remains themost aggressive primary brain tumour in adults,marked by pronounced cellular heterogeneity,diffuse infiltration,and resistance to conventional treatment.In recent years,transcrip...Background:Glioblastoma(GBM)remains themost aggressive primary brain tumour in adults,marked by pronounced cellular heterogeneity,diffuse infiltration,and resistance to conventional treatment.In recent years,transcriptomic profiling has provided valuable insights into the molecular mechanisms that govern the progression of glioblastoma.This systematic review aims to synthesise the current literature on dysregulated gene expression in GBM,focusing on gene signatures associatedwith stemness,immunemodulation,extracellularmatrix remodelling,metabolic adaptation,and therapeutic resistance.Methods:We conducted a systematic search of PubMed,The Cancer Genome Atlas(TCGA),Chinese Glioma Genome Atlas(CGGA),and the GlioVis portal for studies published between January 2005 and April 2025,limited to English-language reports.Studies were eligible if they included adult glioblastoma tissue or patient-derived datasets and reported gene-level expression or clinical associations.Reviews,commentaries,and studies on non-GBM gliomas were excluded.Screening followed the PRISMA 2020 checklist,with 410 records initially identified,90 duplicates removed,and 125 studies retained after full-text review.Data were synthesised descriptively,and findings were validated against TCGA/CGGA expression datasets to ensure consistency across cohorts.Results:We categorised recurrently dysregulated genes by their biological function,including transcription factors(SOX2,ZEB2),growth factor receptors(EGFR,PDGFRA),immune-related markers(PD-L1,TAP1,B2M),extracellular matrix regulators(MMP2,LAMC1,HAS2),and metabolic genes(SLC7A11,PRMT5,NRF2).For each group,we examine the functional consequences of transcriptional alterations and their role in driving key glioblastoma phenotypes,including angiogenesis,immunosuppression,invasiveness,and recurrence.Conclusion:We further discuss the prognostic implications of these gene signatures and evaluate their potential utility in precisionmedicine,including current clinical trials that target molecular pathways identified through transcriptomic data.This review highlights the power of gene expression profiling to stratify glioblastoma subtypes and improve personalised therapeutic strategies.展开更多
文摘Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2DM.Various considerations can make selecting and switching between different GLP-1 RAs challenging.Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.
文摘The incidence of acute pancreatitis(AP),a condition characterized by inflammation in the pancreas,has been increasing globally and is associated with several complications.This review elaborated on the etiology,clinical presentation,severity assessment,and treatment modalities of AP,mainly in the critical care setting.Patients with severe AP,as indicated by organ failure(>48 hours from onset),warrant treatment in the intensive care unit setting.The most common etiologies,biliary disease and alcohol consumption,and the advanced diagnostic tools used for the identification of the cause are highlighted.Different severity assessment tools are utilized for grading the severity of the disease,predicting patient outcomes,determining the associated risk,and guiding treatment decisions.The treatment interventions comprise various approaches,such as anti-infective therapy enteral nutrition,analgesics for pain,or minimally invasive surgical procedures,thereby demonstrating an evolving landscape of AP management.Furthermore,various complications such as necrosis,organ failure,and hemorrhage,necessitate disease monitoring and differential diagnosis and are crucial for optimal management of patients.Novel treatment modalities and advancements in multidisciplinary care emphasize the potential for reducing the burden of AP in critical care settings.
文摘Introduction: Acute hemoperitoneum due to the spontaneous rupture of hepatocellular carcinoma (HCC) is a rare case of non-traumatic intra-abdomen bleeding that requires a high index of suspicion to approach, especially if no known history of HCC. It can mislead the physicians when the patient presents in an atypical way. Case Presentation: In this case report, we describe a fortuitous rupture of hepatocellular carcinoma in a 58-year-old male who was not previously diagnosed as having HCC and who came with atypical symptoms and signs of hemoperitoneum. He was then treated by trans-arterial embolectomy. Discussion: Diagnosis of hemoperitoneum in a case with bradycardia and hypotension is uncommon, as it goes more towards cardiogenic shock than hypovolemic shock, especially in a patient who is previously not symptomatic and has no risk factor for hepatocellular carcinoma. Conclusion: physicians should be alert to the possibility of encountering a hemorrhagic shock, although no trauma injury in any hypotensive patient with no clear reason for his condition.
基金funded by King Abdulaziz University(Jeddah,Saudi Arabia)Kashef Diagnostics Factory(Jeddah,Saudi Arabia)
文摘BACKGROUND： Although cupping remains a popular treatment modality worldwide, its efficacy for most diseases, including hypertension, has not been scientifically evaluated. OBJECTIVE： We aimed to determine the efficacy of wet-cupping for high blood pressure, and the incidence of the procedure＇s side effects in the intervention group. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a randomized controlled trial conducted in the General Practice Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2013 and February 2014. There were two groups （40 participants each）： intervention group undergoing wet-cupping （hijama） in addition to conventional hypertension treatment, and a control group undergoing only conventional hypertension treatment. Three wet-cupping sessions were performed every other day. MAIN OUTCOME MEASURE： The mean systolic and diastolic blood pressures were measured using a validated automatic sphygmomanometer. The follow-up period was 8 weeks. RESULTS： Wet-cupping provided an immediate reduction of systolic blood pressure. After 4 weeks of follow-up, the mean systolic blood pressure in the intervention group was 8.4 mmHg less than in the control group （P = 0.046）. After 8 weeks, there were no significant differences in blood pressures between the intervention and control groups. In this study, wet-cupping did not result in any serious side effects. CONCLUSION： Wet-cupping therapy is effective for reducing systolic blood pressure in hypertensive patients for up to 4 weeks, without serious side effects. Wet-cupping should be considered as a complementary hypertension treatment, and further studies are needed.
文摘<strong>Background:</strong> Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. <strong>Materials and Methods:</strong> We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. <strong>Results:</strong> A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings;however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). <strong>Conclusion:</strong> There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.
文摘Aim: In the present study, we analyzed 7-year clinical outcomes of patients included in the BIO degradable Polymer coated drug-eluting stent REgistry of Sahajanand Medical Technologies Pvt. Ltd. stents in Saudi Arabia (BIOPRESS)-Infinnium? registry. Methods: This was multicentre, observational, non-randomized, post-marketing surveillance registry, which included 276 consecutive patients treated with Infinnium? paclitaxel-eluting stent between July-2004 and June-2006. All patients underwent single-vessel or multiple-vessel percutaneous coronary intervention with high atherosclerotic risk factors and the patients were followed up to 7 years. Baseline and post-procedure angiographic follow-up were pre-specified in 231 patients. Results: The registry included 276 consecutive patients (81.5% male) with a mean age of 56.0 ± 11.1 years. Among 276 patients, diabetes and hypertension were present in 142 (51.4%) and 172 (62.3%) of patients respectively. Of all patients studied, 186 (67.4%) had single-vessel disease, 75 (27.2%) had double-vessel disease, and 15 (5.4%) had triple-vessel disease. Total 476 Infinnium? stents were implanted with an average stent length of 21.8 ± 7.5 mm. The incidence of major adverse cardiac events (MACE) up to 1 year was 26 (9.4%). Clinical follow-up was completed in 235 patients at seven-year follow-up. The data of seven-year clinical outcomes were as follow: cumulative MACE rate of 18.1% with 7.6% of total mortality and 3.6% of restenosis. Conclusion: These 7-year results of BIOPRESS-Infinnium? registry clearly provide evidence for safety and long-term effectiveness of the Infinnium? paclitaxel-eluting stent with the biodegradable polymer in real-life patients.
文摘Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.
文摘For high risk prostate cancer, the treatment volumes and even dose levels are still a controversial issue. The aim of this study is to evaluate the dosemetric parameters and acute toxicity of dose-escalated whole pelvis (WP) Intensity Modulated Radiation Therapy (IMRT) and volumetric modulated arc therapy (VMAT) prostate boost following neoadjuvant and concomitant with androgen deprivation therapy in high-risk prostate cancer patients. This analysis included 73 high-risk prostate cancer patients treated with WP-IMRT followed by boost to the prostate by VMAT to total dose of 80 Gy;between January 2014 and October 2016. Androgen deprivation therapy (ADT) was given for all patients before and during radiation therapy. Drawing the dose volume histograms (DVHs) was done for planning target volumes (PTVs), including Prostate PTV & nodal PTV, and organs at risk including rectum, bladder, femoral heads, and bowel bag for the plans. Acute radiation toxicities were reported during the radiation course and the following 3 months. The DVH analysis showed good coverage of PTVs and organs at risk doses were acceptable. No recorded acute Grade ≥ 3 toxicity. Acute grade 1 toxicity for Gastrointestinal (GI) and Genitourinary (GU) were 65% and 35% respectively, while Grade 2 toxicity was 30% for both. The Proctitis and frequency were the commonest acute toxicity and were maximal during the 5th week of radiation therapy. Dose escalation in two phases utilizing Simultaneous integrated boost (SIB) combined with ADT in high risk prostate cancer patient is feasible and associated with acceptable acute GI and GU toxicity.
文摘Background: Out-of-hospital cardiac arrest (OHCA) with ongoing CPR on arrival to emergency department still a challenge to decide how long the resuscitation should continue or when to terminate it. Case Summary: A patient with a 1-week history of difficulty in breathing suffered from an OHCA. The electrocardiogram upon arrival to the hospital showed pulseless electrical activity. Cardiopulmonary resuscitation was initiated and continued for a total of 90 minutes without any interruption until return of spontaneous circulation (ROSC) was achieved. Post-cardiac care was offered, and the patient was discharged with complete neurological recovery. Discussion: In non-shockable rhythms, the powerful defibrillator machine is not used during resuscitation. In such cases, identifying the offending cause, performing high quality CPR and administering epinephrine are the only effective tools in resuscitating a patient.
文摘Cardiopulmonary resuscitation-induced consciousness (CPRIC) is increasingly being reported across the world. High quality cardiopulmonary resuscitation (CPR) may transiently generate sufficient cerebral perfusion to cause signs of consciousness during CPR which disappears on cessation of CPR. Here we present the case of a 56-year-old male presenting with myocardial infarction that led to cardiac arrest and initiation of CPR during which he showed signs of consciousness. This led to multiple disruptions in delivering high quality CPR. CPR providers are often unaware and inexperienced in managing these patients. However, CPRIC has an association with improved survival. Hence, more research needs to be conducted in this field and guidelines need to be developed to better manage CPRIC.
文摘Diabetic ketoacidosis (DKA) can cause significant morbidity and mortality in patient with both type 1 and type 2 diabetes mellitus. A subset of DKA cases termed euglycemic diabetic ketoacidosis (EDKA) is characterized by euglycemic (<200 mg/dl), high anion gap metabolic acidosis, and increased plasma ketone concentration. This clinical syndrome is primary related to a general state of starvation, resulting in the development of ketosis while maintaining normoglycemia. It can lead to severe complication, such as extreme dehydration, altered mental status and coma. Early recognition and treatment are essential to avoid this life-threatening complication. EDKA represents approximately 2.6% to 3.2% of total DKA admissions, making it a rare condition. In this case report, a male patient was diagnosed with type 2 DM, 1 week prior to his symptoms and admission in hospital. Despite normal glucose levels at the time of presentation to the ED, he displayed severe acidemia and ketonemia, and was diagnosed with EDKA.
文摘Abnormal levels of plasma lipid have been linked to atherosclerosis, strokes and heart conditions. Variations in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels are considered as risk factors for coronary artery disease (CAD). Furthermore, triglycerides are a leading cause of cardiovascular disease. Therefore, measurement of plasma lipid levels is an important mortality predictor. Several factors were associated with irregularity in plasma lipids such as genetic alterations. Recent researches have linked single nucleotides polymorphism (SNP) in ApoA5 gene with these deviations. In this study, we reported the effects of the genetic variant c.553G>T in ApoA5 on the levels of plasma lipids. To explore these effects, a case-control study including 280 male and female subjects (44 of them were assigned as CAD cases while the remaining subjects were categorized as control) was established. All patients in the study were recruited from the western region in KSA. The results have detected minor variations in LDL, HDL and cholesterol levels between CAD patients carrying T allele and CAD patients carrying the WT allele. However, there were no significant effects due to these variations. TG levels in the wild type carriers reached up to 291 mg/dl while T allele carriers, the cases, presented lower levels of TG (170 mg/dl and 71 mg/dl). Although, T allele showed no effects on plasma lipids with the exception of TG levels. We suggest by this study that T allele in this SNP might be considered as a valuable tool in the diagnosis of CAD.
文摘Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.
文摘We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.
文摘Background & objectives: Coronavirus disease 19 (COVID-19) has been declared by World Health Organization as a global pandemic disease in March 2020. Acute respiratory distress syndrome is frequent complication of COVID-19 disease. Tracheostomy is needed in cases of prolonged mechanical ventilation (7 - 10 days) in patients with acute respiratory distress syndrome. Tracheostomies are highly aerosol generating procedures, Otorhinolaryngologists and Health Care Workers (HCWs) are at high risk of virus exposure. The aim of this review is to evaluate the risk of transmission of COVID-19 during tracheostomy procedure, and to review the practical recommendation and scope of the timing to reduce risk of transmission to HCW. Methods: PubMed database was searched between April 2020 to Jan 2021 using the terms “Tracheostomy AND COVID-19 AND Health Care Workers”. All the articles that shared the same aim were screened which resulted in 243 references without duplicates. The title and abstract screening excluded further 202 studies. Eventually 9 full-text studies were included. Results: Five hundred and two COVID-19 patients underwent tracheostomies during the study period. Sixty-three percent of the procedure were done through open technique, while 37% of them were done through percutaneous technique. Seventy-eight percent of them used full Personal Protective Equipment (PPE) and 44.4% used Powered Air Purifying Respirator (PAPR). Negative Pressure Rooms (NPR) were used in 67%. Conclusion: The studies showed similar negative results on HCW infection despite much variance in using PPE. However, there should be global unified recommendations and guidelines regarding tracheostomies in COVID-19 patients to prevent future HCW infection.
文摘Pregnant women are among the high-risk population for severe coronavirus disease 2019(COVID-19)with unfavorable peripartum outcomes and increased incidence of preterm births.Hemolysis,the elevation of liver enzymes,and low platelet count(HELLP)syndrome and severe preeclampsia are among the leading causes of maternal mortality.Evidence supports a higher odd of pre-eclampsia in women with COVID-19,given overlapping pathophysiology.Involvement of angiotensin-converting enzyme 2 receptors by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)for the entry to the host cells and its downregulation cause dysregulation of the renin-angiotensin-aldosterone system.The overexpression of Angiotensin II mediated via p38 Mitogen-Activated Protein Kinase pathways can cause vasoconstriction and uninhibited platelet aggregation,which may be another common link between COVID-19 and HELLP syndrome.On PubMed search from January 1,2020,to July 30,2022,we found 18 studies on of SARS-COV-2 infection with HELLP Syndrome.Most of these studies are case reports or series,did not perform histopathology analysis of the placenta,or measured biomarkers linked to pre-eclampsia/HELLP syndrome.Hence,the relationship between SARS-CoV-2 infection and HELLP syndrome is inconclusive in these studies.We intend to perform a mini-review of the published literature on HELLP syndrome and COVID-19 to test the hypothesis on association vs causation,and gaps in the current evidence and propose an area of future research.
文摘Background:Glioblastoma(GBM)remains themost aggressive primary brain tumour in adults,marked by pronounced cellular heterogeneity,diffuse infiltration,and resistance to conventional treatment.In recent years,transcriptomic profiling has provided valuable insights into the molecular mechanisms that govern the progression of glioblastoma.This systematic review aims to synthesise the current literature on dysregulated gene expression in GBM,focusing on gene signatures associatedwith stemness,immunemodulation,extracellularmatrix remodelling,metabolic adaptation,and therapeutic resistance.Methods:We conducted a systematic search of PubMed,The Cancer Genome Atlas(TCGA),Chinese Glioma Genome Atlas(CGGA),and the GlioVis portal for studies published between January 2005 and April 2025,limited to English-language reports.Studies were eligible if they included adult glioblastoma tissue or patient-derived datasets and reported gene-level expression or clinical associations.Reviews,commentaries,and studies on non-GBM gliomas were excluded.Screening followed the PRISMA 2020 checklist,with 410 records initially identified,90 duplicates removed,and 125 studies retained after full-text review.Data were synthesised descriptively,and findings were validated against TCGA/CGGA expression datasets to ensure consistency across cohorts.Results:We categorised recurrently dysregulated genes by their biological function,including transcription factors(SOX2,ZEB2),growth factor receptors(EGFR,PDGFRA),immune-related markers(PD-L1,TAP1,B2M),extracellular matrix regulators(MMP2,LAMC1,HAS2),and metabolic genes(SLC7A11,PRMT5,NRF2).For each group,we examine the functional consequences of transcriptional alterations and their role in driving key glioblastoma phenotypes,including angiogenesis,immunosuppression,invasiveness,and recurrence.Conclusion:We further discuss the prognostic implications of these gene signatures and evaluate their potential utility in precisionmedicine,including current clinical trials that target molecular pathways identified through transcriptomic data.This review highlights the power of gene expression profiling to stratify glioblastoma subtypes and improve personalised therapeutic strategies.
