Adult Saudi Patients Research Articles

Sonographic Assessment of Renal Transplantation in Adult Saudi Patients: A Cross-Sectional Retrospective Study

Kidney transplantation stands as a practical and cost-effective treatment option for end-stage renal disease patients, offering an improved quality of life with reduced morbidity when compared to hemodialysis. To evaluate the status of transplanted kidneys in Saudi patients, we conducted a retrospective single-center study at Jazan, Saudi Arabia, involving 46 adult renal recipients enrolled randomly from 2015 to December 2022. Utilizing high-frequency ultrasound, we performed Duplex ultrasound examinations to assess renal allografts. The study revealed that the renal grafts exhibited normal length, with preserved cortical medullary differentiation (CMD) in 84.8% of cases and poor CMD in 15.2%. The echogenicity of the grafts remained normal in 69.6% of instances. Interestingly, we observed a significant rise in resistance index (RI) values as the graft duration increased (p-value = 0.04), while patients with abnormal creatinine levels displayed decreased peak systolic velocity (PSV) and end diastolic velocity (EDV). Notably, sonographic graft assessments unveiled complications, including perinephric fluid accumulation (8.7%), simple renal cysts (10.86%), hydronephrosis (8.7%), and one case of graft rejection. ROC analysis for serum blood creatinine levels and abnormal parenchymal findings yielded fair to poor predictive accuracy, with varying sensitivity and specificity measures that lacked statistical significance. In conclusion, our study revealed that most Saudi renal transplant recipients exhibited grafts with normal echogenicity, preserved CMD, and limited perinephric fluid. This investigation provides valuable insights into sonographic changes and Doppler parameters of renal grafts, potentially aiding in the early detection of graft rejection and facilitating diagnostic and therapeutic planning.

Histopathological Findings in Adult Patients With Dyspepsia and Their Association With Helicobacter pylori Infection.

Helicobacter pylori infection is prevalent among Saudi adults and has been linked to gastric cancer and other tumor-like conditions. We aimed to explore the pathological characteristics of endoscopic gastric biopsies among symptomatic adult Saudi patients and their relation to H. pylori infection. Among 151 gastric biopsies, gastritis was detected in 97 (64.2%) cases, chronic active gastritis in 26 patients (17.2%), duodenitis in 20 (13.2%) patients, and total metaplasia in 14 (9.3%) patients. H. pylori was detected in 83 cases (55%), with a recurrence or reinfection rate of 9.8%. The patients with H. pylori infection were considerably young (median age: 34 (IQR: 15) vs. 35.5 (IQR: 11), p = 0.024) and had a low frequency of epigastric pain (78.3% vs. 91.2%, p = 0.031), reflux/regurgitation (7.2% vs. 20.6%, p = 0.016), and dysphagia (4.85% vs. 14.7%, p = 0.037). However, they exhibited a higher incidence of chronic active gastritis (96.2% vs. 3.8%, p < 0.001) and intestinal metaplasia (85.7% vs. 14.3%, p = 0.015). Young age (OR = 1.09, 95% CI = 1.02-1.16, p = 0.011) and H. pylori infection (OR = 30.85, 95% CI = 3.26-291.60, p = 0.003) were identified as a positive predictor of intestinal metaplasia while heartburn (OR = 0.08, 95% CI = 0.01-0.58, p = 0.012) was a negative predictor. H. pylori infection is prevalent among Saudi adults experiencing upper gastrointestinal symptoms and is associated with intestinal metaplasia. Infection rate and intestinal metaplasia were higher in patients with milder symptoms. Therefore, screening for H. pylori is highly recommended for Saudi individuals with upper gastrointestinal symptoms. Old age and H. pylori infection were identified as positive predictors of intestinal metaplasia, emphasizing the importance of early detection and management of H. pylori infection in the Saudi population.

Vitamin B12 deficiency without anemia in Saudi Arabia: a single-center experience

Abstract Objectives The study aimed to estimate the prevalence of vitamin B12 deficiency in adult Saudi patients and anemia in those patients. Furthermore, the mean level of vitamin B12 in anemic and nonanemic participants was estimated. Methodology This retrospective study involved the evaluation of medical records from adult Saudi Arabian participants who underwent vitamin B12 level testing for nonspecific symptoms during 1 years (2022–2023) at a single center in the Al Qassim region of Saudi Arabia. The data for vitamin B12 level and anemia status among B12-deficient patients were estimated to calculate the prevalence of vitamin B12 deficiency and the prevalence of anemia in those patients. Results The prevalence of vitamin B12 deficiency was 11.46% among 8365 participants. The mean age among all vitamin B12-deficient patients was significantly lower compared with those with normal vitamin B12 levels. Female patients had a lower mean vitamin B12 level than male patients. The prevalence of anemia in the vitamin B12-deficient group was 23.46% among the total participants, with female patients having a significantly higher prevalence of anemia than males. The mean value for mean corpuscular volume (MCV) in anemic vitamin B12-deficient patients was normal, and the prevalence of macrocytosis was low (1.3%). The effect of gender on vitamin B12 deficiency and anemia status was significant. Conclusion The present study has provided additional evidence regarding the lack of a causal correlation between vitamin B12 deficiency and anemia. Moreover, the prevalence of vitamin B12 deficiency and anemia was higher in female patients than in males.

Anthropometric and Cephalometric Facial Characteristics of Adult Saudi Patients with Skeletal Class III Malocclusions

Abstract Objectives: We aimed to assess adult Saudi patients’ facial anthropometry and cephalometric characteristics with skeletal Class III malocclusions compared to Class I malocclusion patients. Materials and Methods: Our cross-sectional study included a review of the orthodontic records of 108 patients: 54 patients with skeletal Class III malocclusions and 54 patients with skeletal Class I malocclusions, equally distributed between males and females. Using anthropometric landmarks, seven angular and eight linear measurements were recorded and compared between Class III and Class I patients. In addition, we compared three horizontal facial proportions and three horizontal neoclassical canons between the two groups. Finally, we used Student’s t-tests to compare continuous variables and Chi-square tests for categorical variables. Results: Class III patients had significantly larger mandibular length, mandibular plane angle, mid- and lower-anterior face height, and posterior face height (P &lt; 0.05) compared to Class I patients. Class III patients had significantly proclined upper incisors, retroclined lower incisors, and an obtuse interincisal angle (P &lt; 0.05). The mouth: nose ratio differed significantly between skeletal Class III and I patients (P = 0.008). The orbital canon was valid in 14.8% of Class I and 9.3% of Class III patients, respectively. The orbitonasal proportion applied only to 31.5% and 20.4% of Class I and III patients, respectively. The naso-oral canon occurred in 18.5% and 1.9% of Class I and III patients, respectively. Conclusion: Saudis with Class III skeletal profiles have some distinctive Class III characteristics not observed in most other ethnic groups. The established horizontal facial proportions, neoclassical facial canons, and Class III skeletal profile did not apply to Saudis with skeletal Class I malocclusions, indicating that these proportions and characteristics may not be suitable as references when planning the surgical treatment for these patients.

Hepatic Artery and Portal Vein Hemodynamics in Nonalcoholic Fatty Liver Disease in Adult Saudi Patients: A Doppler Ultrasound Study

Background: Nonalcoholic fatty liver disease (NAFLD) is a growing public health problem. With the growing severity of NAFLD, there are considerable alterations in the hemodynamics of the hepatic circulation that might affect the prognosis of the condition, according to numerous reports written to assess the vasculature of the liver in patients affected with fatty liver disease. The aim of the study was to examine hemodynamic alterations in the hepatic artery (HA) and portal vein (PV) in NAFLD patients and determine how they relate to the severity of the condition, and to classify patients into various categories of NAFLD and connect the results to liver size and body mass index (BMI). Methods and Results: One hundred and six diagnosed NAFLD patients who attended the Imaging department at King Fahad Hospital from December 2019 to January 2020 were retrospectively studied. The mean age of the patients was 45.75±15.6 years, with a range of 10-79 years. The patients were examined by a TOSHIBA Xario, SSA-660A ultrasound system utilizing a multifrequency convex transducer (2–5 MHz) for all sonographic exams. B-mode assessed the liver parenchyma, and spectral Doppler estimated the HA and PV. The US appearance of hepatosteatosis, according to the severity of echogenicity, was graded (0-3). Most participants were asymptomatic (76.4%), and diabetes and diabetes with hypertension were diagnosed in 12.3% and 11.3%, respectively. It was observed that grade 1 hepatosteatosis was more prevalent than the other grades: 54 cases versus 41 cases for grade 2 and 11 cases for grade 3. The mean values of liver size and BMI in grade 3 were higher than in grade 1 (P=0.0033 and P=0.0054, respectively). A Spearman test found that the liver size (R=0.19, P=0.05) and BMI (R=0.26, P=0.01) had weak positive, but statistically significant, correlations with the severity of the hepatosteatosis grade. Doppler indices of the HA and PV in NAFLD patients did not differ significantly in hepatosteatosis grades 1-3. Only the PSV and EDV of the main PV showed a significant decrease in the hepatosteatosis grade 2 compared to grade 1 (P=0.0065 and P=0.0234, respectively). Despite the insignificant differences, the Doppler flow parameters of the HA decreased with the severity of hepatic steatosis; for example, the hepatic artery resistive index (HARI) was 0.77±0.16 in grade 1, 0.72±0.16 in grade 2, and 0.75±0.10 in grade 3, respectively. The hepatic artery pulsatility index (HAPI) was 1.62±49 in grade 1, 1.63±.68 in grade 2, and 1.74±0.77 in grade 3. There was also a trend toward a decrease in PSV and end-diastolic velocity (EDV) of HA with the severity of hepatosteatosis. Conclusion: The severity of hepatic steatosis is significantly correlated with liver size and BMI. The blood flow parameters of PV and HA decrease with the severity of hepatic steatosis except for the pulsatility index.

The prevalence and clinical characteristics of Clostridium difficile infection in Saudi patients admitted with inflammatory bowel disease: A case-control study.

Inflammatory bowel disease (IBD) patients are at increased risk of Clostridium difficile infection (CDI), causing significant morbidity and mortality. This study examined CDI's prevalence, predisposing factors, and clinical outcomes in Saudi hospitalized IBD patients. : A retrospective case-control study was conducted at a tertiary medical city in Riyadh, Saudi Arabia. All Saudi adult patients with IBD, admitted over the preceding four years were identified from the hospital's database. Eligible patients were divided into those with CDI and those without CDI. Binary logistic regression was used to determine the predisposing factors for CDI among admitted IBD patients. During the study period, 95 patients were admitted with IBD. Crohn's disease (CD) was the predominant type (71.6%), whereas 28.4% of the patients were with ulcerative colitis (UC). Only 16 (16.8%) patients had positive CDI. CDI-positive patients tend to have hypertension and previous use of steroids. Patients with UC tend to have a higher risk of CDI than those with CD. Most patients recovered from the CDI (81.3%) with a median time to CDI clearance of 14 days. Three patients (18.8%) had recurrent CDI; among them, one died. The prevalence of CDI in Saudi IBD patients is similar to that reported elsewhere. UC, steroid treatment, and hypertension are risk factors for CDI in IBD patients. Recurrence of CDI in IBD patients is common and associated with a poor prognosis.

5566409 IMPACT OF GENETIC VARIATIONS ON THROMBOTIC RISK OF SICKLE CELL DISEASE IN SAUDI PATIENTS

Introduction: Sickle cell disease (SCD) patients are at higher risk of developing venous thromboembolism (VTE) in comparison to healthy individuals (1). The prevalence of VTE in SCD patients is 8.4-11.3% in the Saudi population (2-3), whereas rates are extremely lower in healthy people (0.1 %). This might be attributed to several risk factors, in particular genetic predisposition. Certain mutations, rs6025 (G1691A) in Factor V Leiden (FVL), rs1799963 (G20210A) in Prothrombin (PRT, FII), and rs1801133 (C677T) in Methylenetetrahydrofolate Reductase (MTHFR) are associated with hypercoagulability status involved in various thrombophilic conditions (4). Thus, we aimed to assess the impact of genetic mutations on VTE development in SCD patients. Method: 350 SCD Saudi adult patients (65 cases with a history of VTE and 285 SCD controls without VTE) were genotyped using 10x Affymetrix Axiom Array which includes 812,820 markers for Genome-Wide Association Study (GWAS). PLINK software version 1.07 was used to analyse GWAS data. Genotyping statistical differences between cases and controls were assessed using Fisher’s exact test. Calculations of means and standard deviations were performed to assess matching of the age factor using SPSS 27.0 program and the differences were measured using the 2-independent samples t-test. Institutional Review Board (IRB) approval (ref RC19-083-R) was obtained from King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. Results: Matching was confirmed for age and sex between cases and controls. No significant differences seen in genotypes of FVL (rs6025), PRT (rs1799963), and MTHFR (rs1801133) between the cases and control groups (P=0.34, 1.0, and 0.87, respectively). GWAS analysis has identified 6 association signals at threshold of P<5×10-8, rs139341092 is an indel variant located at chromosome (chr) 20, rs76076035 an intron variant at chr 9, and four variants (three intronic (rs35390334 and rs331532 in strong linkage disequilibrium (LD), and rs372091) and one exonic (rs317777 in OLFM5P) at chr 11. Eight polymorphisms with a significance P-value <5×10-7 were detected; two of them are functional variants (rs73395847, a splice acceptor variant in C11orf40 gene at chr 11 and rs6554634, a transcription factor binding site variant at chr 5). Moreover, 53 variants with an association significance (P-value) <5×10-6 were discovered, 14 of them have known clinical significance. Two of them are missense variants (rs7933549 in OR51V1 at chr 11 and rs111681839 in CEP131 at chr 17), whereas the remaining variants (n=12) are regulatory variants; five of them (rs2071348, rs73402629, and rs73402631 are in LD, in addition to rs2213170 and rs2213169) located at chr 11 and the other seven located at chr 6 (rs145017319), chr 8 (rs16904858 and rs77365846), chr 9 (rs2289658 in NTRK2), chr 16 (rs142329036), chr 20 (rs139719409), and chr 21 (rs73189215). Two of the detected intron variants located at chr 11 (rs1455957 and rs11035718) were found to be in strong LD with a missense variant (rs2472530) in OR52A5 gene at chr 11 too. Conclusion: This study showed no impact of FVL, PRT, and MTHFR on VTE induced in Saudi patients with SCD. However, significant GWAS novel associations, at levels of P<5×10-8 to P<5×10-6, between VTE in SCD with 67 variants were identified which need further replication studies to be confirmed.

CYP2D6 genetic polymorphisms in Saudi systemic lupus erythematosus patients: A cross-sectional study.

To determine the prevalence of selected single nucleotide polymorphisms (rs1080985, rs28624811, rs1065852, rs28371725, and rs1135840) in cytochrome P450 2D6 (CYP2D6) gene among Saudi systemic lupus erythematosus (SLE) patients and to investigate the association between the genetic variants and clinical features of SLE. This cross-sectional study was carried out on adult Saudi patients at King Khalid University Hospital, Riyadh, Saudi Arabia. Patients with confirmed SLE based on the 2012 Systemic Lupus International Collaborating Clinics classification criteria were included in the study. Peripheral blood was collected for genomic deoxyribonucleic acid extraction and TaqMan® technologies were used for target genotyping. For statistical analysis, differences in genotype frequencies were determined using the Chi-square test, and the association between the variant genotypes and SLE features was evaluated using logistical regression models. There were 107 participants included in this study. Overall, the most predominant (23.4%) recessive genotype was AA in rs28624811, and the least prevalent (1.9%) recessive genotype was TT in rs28371725. Moreover, the variant rs1080985 genotypes (GC or CC) were significantly associated with the presence of serositis manifestation (OR=3.15, p=0.03), even after adjusting for age and gender. However, the dominant rs28624811 genotype (GG) was associated with renal involvement (OR=2.56, p=0.03). Systemic lupus erythematosus patients carrying CYP2D6 variants might be considered at risk for certain manifestations of SLE. Further studies are needed to investigate the implication of these genetic variations in clinical outcomes and drug response.

Comparison of Findings From Fecal Occult Blood Test and Esophagogastroduodenoscopy With Histopathology Among Symptomatic Saudi Adults: A Retrospective Study.

Background A fecal occult blood test is an established way to detect blood in stool samples. However, this diagnostic test is prone to false positives and false negatives, not to mention misuse and misinterpretation of results. In this study, we aimed to compare relevant findings among three diagnostic tests: a fecal occult blood test, an esophagogastroduodenoscopy, and histopathology. Methods This study used a retrospective analysis of 74 patients' electronic medical records from September 2021 to September 2022 at the Human Clinic and Gastroenterology Specialized Clinic in Riyadh, Saudi Arabia. Symptomatic adult Saudi patients who underwent a fecal occult blood test, esophagogastroduodenoscopy, and histopathology were included in the study. Results A total of 74 patients with a mean age of 43.76 ± 15.1 years were analyzed. More than half of the patients were men (63.5%). Eighteen (18) individuals tested positive through a fecal occult blood test, and 49 individuals showed a positive finding under esophagogastroduodenoscopy. Furthermore, statistical analyses revealed a significant correlation between fecal occult blood test outcomes and histopathological outcomes (p= 0.001). Conclusion A significant proportion of the sample population presented a false negative result under the fecal occult blood test. This emphasizes the importance of confirmatory endoscopic procedures and subsequent histopathology in the diagnosis of abnormalities in the upper gastrointestinal tract.

Assessment of Pre-existing Type 2 Diabetes Mellitus Prevalence and Risk Factors Among Colorectal Cancer Patients in King Abdulaziz Medical City, Jeddah.

Diabetes mellitus (DM) and cancer are recognized as non-communicable chronic disorderswhich are among the top ten causes of death globally. In Saudi Arabia, the prevalence of type 2 DM(T2DM) and colorectal cancer (CRC) is alarmingly high. Both T2DM and CRC share common risk factors. In this study, we aim to assess the prevalence of pre-existing T2DM among CRC Saudi patients. In this cross-sectional study, data were collected from the medical records of 275 Saudi adult patients with CRC from 2009 to 2018 at King Abdulaziz Medical City, Jeddah (KAMC-J). Participants had a mean age of 57.0 years, standard deviation (SD) of 13.0, and were mostly males (60.00%) and Saudi (100.0%). Participants had a mean BMI of 26.42 (7.35) kg/m2. The prevalence of pre-existing T2DM in this study was 40.80%. 15.8% of participants were overweight and obese (BMI>30), respectively. The average age of diabetics and non-diabetics was 63.6 (10.64) and 52.73 (12.43), respectively. Diabetic patients are significantly older than non-diabetic patients (p<0.001). The average BMI for diabetics was 26.96 (7.26) kg/m2, whereas the average BMI for non-diabetics was 25.93 (7.48) kg/m2. No significant differences were found between the two groups. This study provides new insight into the high prevalence of pre-existing T2DM in CRC patientsin Saudi Arabia. In particular, the age of diagnosis of CRC in diabetic patients was significantly higher than in non-diabetics.

Efficacy and Safety of Empagliflozin in Type 2 Diabetes Mellitus Saudi Patients as Add-On to Antidiabetic Therapy: A Prospective, Open-Label, Observational Study.

The Saudi Food and Drug Authority (SFDA) approved sodium-glucose cotransporter-2 (SGLT2) inhibitors in 2018. The efficacy and safety of empagliflozin (EMPA) have been confirmed in the U.S., Europe, and Japan for patients with type 2 diabetes mellitus (T2DM); however, analogous evidence is lacking for Saudi T2DM patients. Therefore, the current study aimed to assess the efficacy and safety of EMPA in Saudi patients (n = 256) with T2DM. This is a 12-week prospective, open-label, observational study. Adult Saudi patients with T2DM who had not been treated with EMPA before enrolment were eligible. The exclusion criteria included T2DM patients less than 18 years of age, adults with type one diabetes, pregnant women, paediatric population. The results related to efficacy included a significant decrease in haemoglobin A1c (HbA1c) (adjusted mean difference −0.93% [95% confidence interval (CI) −0.32, −1.54]), significant improvements in fasting plasma glucose (FPG) (−2.28 mmol/L [95% CI −2.81, −1.75]), and a reduction in body weight (−0.874 kg [95% CI −4.36, −6.10]) following the administration of 25 mg of EMPA once daily as an add-on to ongoing antidiabetic therapy after 12 weeks. The primary safety endpoints were the change in the mean blood pressure (BP) values, which indicated significantly reduced systolic and diastolic BP (−3.85 mmHg [95% CI −6.81, −0.88] and −0.06 mmHg [95% CI −0.81, −0.88], respectively) and pulse rate (−1.18 [95% CI −0.79, −3.15]). In addition, kidney function was improved, with a significant reduction in the urine albumin/creatinine ratio (UACR) (−1.76 mg/g [95% CI −1.07, −34.25]) and a significant increase in the estimated glomerular filtration rate (eGFR) (3.54 mL/min/1.73 m2 [95% CI 2.78, 9.87]). Furthermore, EMPA reduced aminotransferases (ALT) in a pattern (reduction in ALT > AST). The adjusted mean difference in the change in ALT was −2.36 U/L [95% CI −1.031, −3.69], while it was −1.26 U/L [95% CI −0.3811, −2.357] for AST and −1.98 U/L [95% CI −0.44, −3.49] for GGT. Moreover, in the EMPA group, serum high-density lipoprotein (HDL) significantly increased (0.29 mmol/L [95% CI 0.74, 0.15]), whereas a nonsignificant increase was seen in low-density lipoprotein (LDL) (0.01 mmol/L [95% CI 0.19, 0.18]) along with a significant reduction in plasma triglyceride (TG) levels (−0.43 mmol/L [95% CI −0.31, −1.17]). Empagliflozin once daily is an efficacious and tolerable strategy for treating Saudi patients with insufficiently controlled T2DM as an add-on to ongoing antidiabetic therapy.

Impact of COVID-19 severity on health-related quality of life among Saudi adult patients.

COVID-19 patients may experience varying degrees of symptom severity, significantly impacting the health-related quality of life. As a result, the current study examines the impact of symptom severity on health-related quality of life among Saudi adult COVID- 19 patients. In this cross-sectional study 310 adult COVID-19 patients were recruited through a snowball technique in Saudi Arabia. We used a questionnaire (SF-12 RAND tool questionnaire) that included three parts: sociodemographic factors, perception of degree severity of COVID-19 symptoms, and health-related quality of life (HRQoL). Out of 310 COVID-19 adult patients, 200 (64.5%) were female, 110 (35.5%) were between 30-49 years old. The mean scores of the HRQoL, physical components summary (PCS), and mental components summary (MCS) were 58.11±17.02, 71.32±23.72, and 44.91±17.94, respectively. Patients with very severe symptoms had the lowest HRQoL mean rank (120.39, P=0.023). There was a strong positive correlation between HRQoL and PCS (0.852) and HRQoL and MCS (0.730). However, PCS and MCS had a weak positive correlation (0.292). The severity of COVID-19 symptoms had a significant impact on HRQoL. Thus, it is essential to enhance the uptake of vaccines to decrease the risk of infections and avoid impact on quality of life.

Prevalence of the anatomical variations of concha bullosa and its relation with sinusitis among Saudi population: a computed tomography scan study.

Concha bullosa (CB) is a pneumatic cavitation inside a concha in the nasal cavity. It is one of the most widely recognized nasal variations and is mostly found in the middle concha. CB is divided according to its site into three types; lamellar, bulbous and extensive. The goal of our study was to estimate the prevalence of CB among Saudi adult population and its association with sinusitis by using multidetector computed tomography (MDCT). This was a retrospective study carried out over a three-year period on 879 adult Saudi patients aged 18 years or older, referred for MDCT assessment of paranasal sinuses. Males were 540 and females were 339. Patients with facial congenital anomalies or nasal trauma were excluded from our study. CB was prevalent in both males and females among Saudi population (55.4%, 55.7%) respectively. Bilateral CB (55.5%) was more frequent than unilateral (44.5%). Extensive CB (44.0%) was the most frequent type. Sinusitis was associated more in patients with CB (48.0%) versus those who have no CB (5.9%). In conclusion, CB was prevalent among Saudi population and the most frequently recorded is the extensive type. Furthermore, the most common type associated with sinusitis was extensive CB (49.6%).

Perception of virtual clinics among Saudi adults with type 1 diabetes during the COVID-19 pandemic

Background and aimsWe aimed to assess patient perception toward the rapid implementation of virtual phone clinics among Saudi adult patients with type 1 diabetes mellitus (T1DM) during the coronavirus disease (COVID-19) pandemic. MethodsThis cross-sectional, web-based study included Saudi adult patients with T1DM who attended at least one virtual phone visit with the diabetes clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between August 1 and December 31, 2020. Patients anonymously answered a Google form-created Arabic questionnaire. Information about patient characteristics, outcome, and perception of the virtual phone visit were obtained. Data were presented using descriptive statistics, chi-square, one-way ANOVA, independent t-, and Welch's t-tests. ResultsThe questionnaire was sent to 281 patients, of whom 201 completed it. 59.2% patients were satisfied with their overall virtual phone clinic experience, and 75.6% preferred to continue attending the virtual phone clinics in the future. The average perception value of patients toward virtual phone clinics was 67.76 ± 19.9, suggesting good perception among the majority. Negative or neutral views of current health, asking to be physically seen, and missing a virtual appointment were associated with significantly lower average patient perception value (p < 0.001). ConclusionsMost Saudi patients with T1DM have adapted to virtual phone consultations, exhibiting good satisfaction and perception, and high preference to continue using this system in the future. The utilization of the service to assist patients with diabetes is highly encouraged, especially during the COVID-19 pandemic. Strategies need to be developed to further enhance the patient experience.

Patterns and Outcomes of Complementary and Alternative Medicine Use Among Adult Patients With Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination of the central nervous system. No treatment has been shown to be curative; thus, we assume that the tendency for patients with MS to use unconventional therapies, such as complementary and alternative medicine (CAM), might increase. The aim of this study was to explore the pattern of CAM use among patients with MS at a tertiary health care center in Saudi Arabia (SA).This was a questionnaire-based observational cross-sectional study that targeted adult patients diagnosed with MS at King Abdulaziz Medical City in Riyadh, SA, from 2018 to 2019. The sample size included 176 patients, and a consecutive non-probability sampling technique was used to engage them during their appointments. An Arabic questionnaire was used to evaluate patients’ use of CAM.The mean age of participants was 34.6 ± 10.9 years, females represented the majority 125 (71%) of participants, and 89% of the participants reported using CAM at least once, with one or more modalities being used. Prayer, Salat, was the most frequent modality (60%) followed by supplication, Dua'a (59%), Ruqia, reciting Holy Quran (52%), and vitamins (44%). Symptomatic improvement was reported by 49 (27.8%) of dietary supplement users and 81 (46%) of non-dietary supplement medicine users.The study found a high prevalence of CAM utilization among Saudi adult patients with MS, which exceeded internationally reported rates. Although some patients described some improvement in their symptoms, further research is needed to evaluate the effectiveness of CAM.

Knowledge, attitude, and practice toward glaucoma and its management among adult Saudi patients.

PURPOSE:To present the level of knowledge, attitude, and practice (KAP) for glaucoma management and their determinants among adult Saudi patients.METHODS:The study was conducted between January and June 2017. Glaucoma patients from the ophthalmology clinic were interviewed. Demographics and disease-related information were noted. The questionnaire included four K questions, seven A questions, and six P squestions. The correct response of questions were summed for K, A, and P, and the percentile was calculated. K and P scores were graded as excellent (more than >75%), good (51%–75%), poor (26%–50%), and very poor (≤25%). If A score was >50%, it was termed as positive.RESULTS:We interviewed 263 adult glaucoma patients. Their mean age was 61.6 ± 14.2 years. The excellent grade of knowledge about glaucoma and its management was 63 (24% [95% confidence interval (CI) 18.8–29.1]). Poor grade of knowledge was 95 (36.1% [95% CI 30.3–41.9]). The attitude toward glaucoma and its management was positive in 89 (33.8% [95% CI 28.1–39.6]). The practice to manage glaucoma was of excellent grade in 10 (3.8% [95% CI 1.5-6.1]). The overall excellent grade of KAP glaucoma patients was 17.9% (13.2–22.5). Good practice for glaucoma management was associated with a history of glaucoma surgery (P < 0.001), longer duration of glaucoma (P = 0.02), and young age (P = 0.004).CONCLUSIONS:Low KAP about glaucoma disease and medication among Saudi glaucoma patients is a matter of concern. Strategies are needed to improve the KAP of glaucoma patients.

Updated bone mineral density status in Saudi patients with inflammatory bowel disease

BACKGROUNDLittle is known about inflammatory bowel disease (IBD) burden and its impact on bone mineral density (BMD) among adult patients in Saudi Arabia. To the best of our knowledge, our study is the only study to give an update about this health problem in adult Saudi patients with IBD. IBD is a great risk factor for reduced BMD due to its associated chronic inflammation, malabsorption, weight loss and medication side effects. Consequently, screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients.AIMTo assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD.METHODSNinety adult patients with IBD - 62 Crohn’s disease (CD) and 28 ulcerative colitis (UC) - were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah, Al-Qassim. All enrolled patients were interviewed for their demographic information and for IBD- and BMD-related clinical data. All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD.RESULTSThe CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group; 44% of the CD patients had normal BMD, 19% had osteopenia, and 37% had osteoporosis, while 78% of the UC patients had normal BMD, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), lumbar z-score (r = 0.77, P < 0.05) and femur z-score (r = 0.85, P < 0.05). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05). The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59–0.84), with a sensitivity of 77%, and a specificity of 63%.CONCLUSIONSaudi patients with IBD still have an increased risk of reduced BMD, more in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.

Correlation of TTG IgA Level with Small Intestinal Histopathological Changes for Celiac Disease among Adult Saudi Patients.

Background and objectivesAccording to recent guidelines, a diagnosis of celiac disease (CD) can be made without a biopsy, especially in children. There are no enough studies despite high prevalence and differences in genetic, race, and cultures. Therefore, we examined the correlation between tissue transglutaminase (TTG) and duodenal biopsy changes in our region because we are identical and different from others in culture, environment, and habits, and the correlation is same as that in different regions.MethodsA retrospective cohort study at the Ministry of National Guard Health Affaires (NGHA) health care facilities that are distributed throughout kingdom of Saudi Arabia from April 19, 2015, till March 29, 2018. This study used the BESTCARE system that includes data from all NGHA facilities; data from 513 patients with CD were collected. All patients diagnosed with celiac disease aged 15 years or more, confirmed by improvement on gluten-free diet (GFD), and were not on GFD before endoscopy or serology test or both of them were included in the study, and the TTG IgA level was measured at the same time or within 2–3 months of biopsy date. The exclusion criteria were negative duodenal biopsy, which is less than 2; patients with negative biopsy and negative serology; patients who were on GFD before testing, and any patients known to have immunity diseases or illness causing mucosal changes. The TTG IgA level was measured in IU/ mL and was labeled as negative (<20 IU/mL) and positive (≥ 20 IU/mL) based on the cutoff value. However, Intestinal biopsy findings were identified as Marsh classification groups.ResultsOne hundred thirty-four patients who met the inclusion criteria were included in the study. Median age of our sample was 24 years (16–37 years). Among these, 99 (73.88%) were female patients, whereas male patients were only 35 (26.12%). Histopathologic investigation of intestinal biopsy were Marsh 0 group was 16 cases (11.9%), Marsh 1 group was 8 cases (6%), Marsh 2 group was 4 cases (3%), Marsh 3a group was 32 cases (23.9%), Marsh 3b group was 64 cases (47.8%), and Marsh 3c group was 10 cases (7.5%). The TTG IgA antibody serology groups were <20 IU/mL in 13 cases (9.7%) and ≥20 IU/mL in 121 cases (90.3%). Among all patients with CD who had negative biopsy (Marsh 0 group), 16 (100%) of them had positive TTG IgA antibody. However, among patients with Marsh 1 group biopsy, 5 (62.5%) cases had negative TTG IgA antibody compared with 3 (37.5%) positive cases. Of the four cases (100%) with Marsh 2 group, all of them had positive TTG IgA antibody. However, in Marsh 3a group biopsy, 3 (9.4%) cases had negative TTG IgA antibody compared with 29 (90.6%) cases with positive TTG IgA antibody. Furthermore, among the patients with Marsh 3b group biopsy, 5 (7.8%) had negative antibody and 59 (92.2%) had positive serology. Of all biopsies of Marsh 3c group, 10 (100 %) had positive TTG IgA antibody.ConclusionsIn perspective of high prevalence of CD in KSA, even more than western countries, we can pretend that positive TTG antibody tests can be applied for the diagnosis of CD without biopsy, particularly in symptomatic patients along with high titer, that is, 5–10 times the upper limit of normal (ULN). However, to validate it further, we need larger prospective studies in which duodenal biopsies should be taken according to recommended protocol and should be interpreted by experienced pathologist. Furthermore, biopsy is still needed in patients who do not show clinical improvement on a gluten-free diet and in cases with mildly or moderately elevated TTG IgA.

Outcome of CD20-positive Adult B-cell Acute Lymphoblastic Leukemia and the Impact of Rituximab Therapy

BackgroundIn adult B cell precursor acute lymphoblastic leukemia (BCP-ALL), CD20 expression has generally been associated with an adverse prognosis. Incorporating rituximab to standard of care is found to improve the outcome of CD20+ BCP-ALL. The aim of this study is to estimate the prognostic effect of CD20 expression and the impact of rituximab in BCP-ALL in Saudi Arabia. Patients and MethodsWe performed a retrospective study of 55 Saudi adult patients with BCP-ALL in King Fahad Specialist Hospital in Dammam from 2008 to 2017. ResultsThe proportion of CD20+ cases was approximately 55%. Excluding rituximab-treated patients, the 5-year overall survival (OS) rate of CD20+ patients was lower than CD20− patients (56% vs. 66%; P = .62). Among CD20+ patients, the proportion that received rituximab was approximately 27%. Comparing CD20+ patients with and without rituximab, all patients who received rituximab achieved complete remission (CR) 4 weeks post-induction. The 3-year OS rate (88% vs. 63%; P = .35) and the 2-year event-free survival rate (70% vs. 68%; P = .75) were in favor of rituximab. In univariate and multivariate analyses, CR 4 weeks post-induction is recognized as an independent predictor of outcome. However, differences in survival rates did not have a statistical significance. ConclusionCD20 expression in adult patients with BCP-ALL seems to be higher in Saudi Arabians than in Caucasians, and it seems to have a tendency towards an inferior outcome in terms of OS. Incorporating rituximab to standard of care seems to improve the outcome in terms of CR, OS, and event-free survival.

Quality of life of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia

Introduction: Measurement of quality of life (QoL) can be an important tool for the comprehensive care of the patients. This study was designed to assess the QoL of patients with cancer attending outpatient clinics at the King Abdulaziz Medical City, Riyadh, Saudi Arabia, and examined its association with sociodemographic variables and also identified the worst type of cancer. Materials and Methods: This cross-sectional study involved 178 participants who met the selection criteria: adult Saudi patients (≥18 years) who had been diagnosed with cancer, were documented in the health care system, and were cognitively able to answer the questionnaire. Those who underwent any surgical, hormonal, radiation, or chemotherapy within 2 weeks were excluded from the study. Patients are recruited by nonprobability convenience sampling between December 20, 2017, and January 1, 2018. Data were obtained using an Arabic version of the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ)-C30 developed, translated, and validated by the EORTC. QLQ-C30 measures three domains: functional, symptoms, and global QoL. Results: The younger (≤29 years) the patients, the better their global QoL. Women had a trend to score worse in all domains but only statistically significant in dyspnea (P