Medical City Research Articles

Assessment of chemotherapy-induced nausea and vomiting in adult patients with hematopoietic stem-cell transplant at a tertiary care hospital.

e24098 Background: Chemotherapy induced nausea and vomiting (CINV) is prevalent and potentially treatment-limiting side effects in cancer patients.1 Nausea and vomiting are frequent and significantly affect cancer patients' daily functioning and health-related quality of life (HRQL). A patient who experienced nausea and vomiting showed to be affected by worse physical, cognitive, social functioning, and global quality of life in comparison to patients who don’t have nausea and vomiting. Methods: We conducted a prospective cohort observational study to assess the complete response (CR) and risk factor associated with nausea and vomiting among HSCT patients at King Fahad Medical City (KFMC). All adult patient underwent Bone Morrow Transplant (BMT) were included in the study. Data was collected prospectively during admission to the hospital and receive the conditioning regimen. Patients was interviewed by clinical pharmacist and assessed using MASCC Antiemesis Tool© (MAT) to assess the effectiveness of our regimen used to prevent nausea and vomiting during active chemotherapy days and delayed phase. Results: A total of 30 patients were enrolled in the study during a one year follow up from April 2021 to April 2022. Data analysis was done and revealed as follows; out of 30 patients enrolled 18 (60%) patients were female while 12 (40%) were male. Lymphomas including (Non-Hodgkin, and Hodgkin lymphomas) were the most common diagnosis included among patients 17 (56.6%). BEAM protocol was the most common conditioning regimen protocol used 13 (43.3%). Complete response (CR) was achieved in 13 (43.3%) patients during acute nausea and vomiting, while 17 (56.7%) patients weren’t being able to achieve CR. Furthermore, out of the 30 patients observed, 6 (20.0%) experienced delayed vomiting, while 19 (63.3%) experienced delayed nausea. Similarly, Complete response (CR) was achieved in 11 (36.7%) patients during delayed nausea and vomiting, while 19 (63.3%) patients weren’t being able to achieve Complete response (CR) respectively. Breakthrough medication for nausea and vomiting was needed in all patients who didn’t have to achieve CR 19 (63.3%) patients. There was no association between age, gender, conditioning regimen, and type of transplant and achieved CR among patients (P- value; > 0.05). However, more breakthrough medication is needed when CR is not achieved (P- value; < 0.05). Conclusions: At our institution, among hematopoietic transplant recipients receiving appropriate antiemetics, approximately half (50%) achieved complete response (CR) in preventing chemotherapy-induced vomiting (CINV). Age, gender, and transplant type were not significantly associated with increased CR failure, while the specific conditioning regimen did not show a statistically significant impact.

Clinical Presentations, Diagnosis, and Genetic Features of Hemophagocytic Lymphohistiocytosis: A Single Institutional Experience With the Saudi Population.

Background Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal condition caused by high immune activation. The present study aimed to identify the clinical manifestations, geographic distribution, and associated pathogenic genetic mutations of HLH in Saudi Arabia. Method A retrospective cross-sectional study was conducted at King Fahad Medical City (KFMC), with a total of 59 patients diagnosed with HLH in the period between 2006 and 2018. All genetic results and clinical and biochemical data were retrieved and statistically analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The results revealed that 48 patients (81.4%) had 15 pathogenic mutations of primary HLH whereas 8 (13.6%) patients had no genetic mutation. The most common variant mutation identified was c.1430C>T of the STXBP2 gene (42.4% of total patients), followed by c.1122G>A of the PRF1 gene (10.2% of patients), which demonstrated a distinctive geographic and tribal association. Patients with RAB27A mutation tend to present at an older age than the others with a median age of presentation of 5.5 months vs 2 months for patients with PRF1 mutations. No significant differences in clinical features were observed among the various groups. Conclusion This study highlights the incidence of genetic mutations among the Saudi population with HLH. The STXBP2 is the most common mutation followed by PRF1 mutations, many mutation variants are associated with a distinctive tribal and geographic association.

Epidemiology and risk factors associated with bronchiolitis requiring intensive care among children admitted in King Abdulaziz Medical City

Epidemiology and risk factors associated with bronchiolitis requiring intensive care among children admitted in King Abdulaziz Medical City

Clinical laboratory and radiological findings in COVID-19 patients with variable severity: King Fahad Medical City experience

Clinical laboratory and radiological findings in COVID-19 patients with variable severity: King Fahad Medical City experience

Nurses’ Knowledge toward Nursing Care of Diabetic Foot Ulcers at Diabetic Center in Merjan Medical City

Nurses’ Knowledge toward Nursing Care of Diabetic Foot Ulcers at Diabetic Center in Merjan Medical City

Foodborne botulism outbreak with potential new management options.

To shed some light on a potential therapeutic modality that may facilitate resolution of botulism symptoms, namely 3,4-diaminopyridine (3,4-DAP). In Riyadh, Saudi Arabia, we recently encountered a foodborne botulism outbreak that, luckily, was discovered early. In Prince Sultan Military Medical city, we admitted, during a period of approximately 3 weeks, 15 probable cases, 2 of which were excluded due to more likely alternative diagnoses. We report in this case series 13 highly suspected cases of botulism that we encountered during the outbreak. A total of 12 out of 13 patients required intensive care unit (ICU) admission, one of which required intubation. Symptoms included cranial nerve palsies, gastrointestinal symptoms, limb and respiratory muscle weakness. Patients showed clinical improvement when received botulinum antitoxin and 3,4-DAP if given early in the course of the disease. Early admisntration of 3,4-DAP may facilitate recovery and prevent disease progression. Larger prospective trials should be carried out to confirm that.

Incidence, patterns, and management of frontal sinus fractures: A 10-year retrospective study at a tertiary medical center, Saudi Arabia.

To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications. A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test. A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories. Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.

Real world data of safety of immune-checkpoint inhibitors in patient with cancer at tertiary care hospital in Saudi Arabia.

e24104 Background: Immune checkpoint inhibitors (ICIs) become an integral part of many cancer therapies, such as melanoma, esophageal carcinoma, breast cancer and other malignancies. Immune checkpoint inhibitors work by activation the immune system that blocks negative regulators expressed on immune or tumor cells. Accordingly, the mechanism of action of ICI may cause autoimmunity-like symptoms called immune-related adverse events (irAEs) that affect many organs in body like skin, liver, lung, endocrine and gastrointestinal tract. These irAEs may reduce the organ function, quality of life and it may cause death. The present work addressed the knowledge gap in understanding real-world outcomes of irAEs associated with ICIs. Real-world patients are more diverse than clinical trial. Methods: This retrospective cohort study investigated the use of immune checkpoint inhibitor (ICI) therapy in an oncology and hematology patients treated at King Fahad Medical City (KFMC) comprehensive cancer center between February 2021 and February 2023. Adult patients (≥ 18 years old) diagnosed with any malignancy or hematological disorder who received at least one dose of ICI therapy during the study period have been included. Patients younger than 18 years old have been excluded. Demographic, clinical, and treatment data have been extracted from the electronic medical records (EMR). The study protocol has been reviewed and approved by the KFMC Institutional Review Board (IRB). The trial still undergoing not yet finished. Results: A total of 44 patients were included by the time preliminary data analysis was conducted on January 1st, 2024. All Patient included were receiving Pembrolizumab 44 patients. In regards to demographics, 27 (61.4%) of the patients were female. Breast cancer was the most common diagnosis (34.1%), followed by non-small cell lung cancer (22.7%). Among patients undergoing ICI, 34.1% had at least one Emergency Room (ER) visit. Notably, 25% of these patients had 1-2 ER visits. The most common reason for ER visits was patient complaints of GI toxicity related to ICI, including nausea, vomiting, and diarrhea (colitis). 12 (26.8%) patients required hospitalization, and 9 (20.5%) stayed for more than seven days.The time to first adverse event of ICI therapy was most commonly seen after nine weeks in 8 (18.2%) patients. Hypothyroidism was the most common adverse event (11.4%), followed by gastrointestinal toxicity (6.8%). Skin, grade 2 hepatotoxicity, and renal toxicity were also reported in 1 (2.3%) patient respectively. Conclusions: Overall, this initial analysis suggests that while ICI known to offers promising potential, it also carries the risk of various adverse events, including a significant rate of ER visits and hospitalizations. Further investigation with larger patient cohorts is warranted to confirm these findings and optimize IO therapy management.

The Utility of SHBG Assay in Clinical Biochemistry for Iraqi Women

Polycystic ovarian syndrome, additionally called PCOS is the most widespread endocrine illness amongst women. The aetiology of PCOS is attributed to a multi-factorial interplay among environmental and genetic effects. The overarching goal evaluates the correlation among blood concentrations of total testosterone, sex-hormone-binding globulin (SHBG), estradiol (E2), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in ladies with PCOS and the impact of obesity, age, marital popularity on the obtained results. This study was conducted at the National Center for Educational Laborites /Medical City/ Baghdad. The study comprised of a sample of 83 women, elderly between 17 -45 years, who had been selected in a random manner from a Gynaecology Clinic. The statistics collection duration spanned from November 2022 to March 2023. Women with polycystic ovary syndrome (PCOS) were based on their body mass index (BMI), age and marital status. Investigations included serum-free testosterone measurements by enzyme-linked immune sorbent assay (ELISA), total testosterone, SHBG, E2, FSH and LH by Automated Immunoassay Analyzer (AIA-2000). The current findings showed non-significant distinctions in mean values of BMI between studied groups of patients and controls which reflect matches between them. This study revealed the effect of marital status compared to PCOS and healthy control subjects. Married PCOS patients were non significantly affected (83.9% vs. 85.2%, p>0.05) as compared to married controls. Results of these studies showed a significantly higher mean rate of serum FSH level in PCOS-affected women when opposed to normal individuals.

Laparoscopic Sleeve Gastrectomy: Suture or not Suture Staple Line

Background The severity of postoperative complications is the main disadvantage of laparoscopic sleeve gastrectomy (LSG). Staple line reinforcement (SLR) is strongly advocated. Recently, oversewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. Aim of the study: To evaluate the benefit of staple lines over sewing in decreasing postoperative complications and their severity. Patients and methods: One hundred laparoscopic surgery group (LSG) patients were randomly assigned to either group (A) without staple line over sewing or (B) with staple line over sewing from January 2022 to January 2023 in a prospective study conducted at three hospitals (Alhussein Medical City, Alkafeel Private Hospital, and Zain Alabdin Private Hospital). We want to learn if laparoscopic sleeve gastrectomy patients benefited more from a staple line than a sewn one. Results: The most frequently reported complication was bleeding, which was reported in two patients in group A and one patient in group B, respectively; vomiting was reported more frequently in group B. The cross-tabulation between complications and comorbidities revealed no significant association between them. The hospital stay was the same in both groups except for patients with non-surgical complications, which need more hospital stay time. In regard to the severity of complications, we found that complicated cases in group A needed more hospital stays and more interventions to control the problem in comparison to those in group B. Conclusion: Laparoscopic sleeve gastrectomy with staple line over sewing is a technique that may decrease early complications and the severity of complications. There was no significant difference between the two groups (with and without staple line over sewing) in regard to the relation between complications on one side and the comorbidity on the other.

Assessing breast self-examination knowledge and practices among women in Iraq: A cross-sectional study.

The present study aims to shed light on the knowledge, attitude, and practice of breast self-examination with breast cancer (BC) among female patients in the oncology department of Baghdad Medical City. This cross-sectional study involved 100 female participants at the Oncology Teaching Hospital in Baghdad Medical City between June 15 and October 15, 2022. Using convenient sampling, the study targeted females aged 30-75, recently or previously diagnosed with BC, admitted for treatment and follow-ups. Regarding the assessment of knowledge, among the surveyed patients, 71 are aware of breast self-examination (BSE), primarily through social media (42 patients). The study also explores the link between BSE and education levels. While Pearson's chi-square shows no significance (0.107), the likelihood ratio suggests a significant association (0.041). Regarding the analysis of attitudes, the study assessment for the reasons for compliance showed that 19 patients cite medical reasons, and 48 patients attribute noncompliance to a lack of knowledge of how to perform BSE. Regarding the examination of practice, high statistical significance is evident in both Pearson'schi-square (0.000) and likelihood ratio (0.000) tests, emphasizing the substantial relationship between the post-diagnosis initiation timing of BSE and its correct execution. Additionally, a statistically significant association exists between performing BSE correctly and discovering BC(p = 0.000). Regarding the assessment of knowledge, our study found high awareness of BSE within the population, primarily through social media and health organizations. Regarding the analysis of attitudes, a notable proportion refrained from practicing BSE, primarily due to a perceived lack of knowledge about the methods. Regarding the examination of practice, the observed significant associations between performing BSE correctly, discovering BC, and the frequency of examinations underscore the pivotal role of consistent and accurate BSE in early detection.

Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study.

Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure. The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI. This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data. A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis. Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'. It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

Evaluation of proprotein convertase subtilsin /kexin 9(PCSK9) in serum of men hypertensive patients

High blood pressure is considered a major factor for the development of heart disease and vascular disease in elderly people, due to higher tension in arteries leading to hypertension. PCSK9 is a proprotein convertase that increases circulating LDL levels by directing hepatic LDL receptors into lysosomes for degradation. The effects of PCSK9 on hepatic LDL receptors and contribution to atherosclerosis via the induction of hyperlipidemia are well defined. Methods: The case-control study included (90) subjects divided into sixty (60) male patients. Samples were collected for patients with high blood pressure in Al-Sadr Medical City in Najaf Al-Ashraf / Iraq, and laboratory tests were conducted to measure the lipid profile in Al-Sadr Medical City laboratories. Height and weight were measured, and other information was also collected. The ELISA test was performed in the advanced animal laboratory in the college’s Department of Biology. Department of Science/University of Kufa. The study was conducted by collecting samples and measuring all factors in the period from 1/11/2023 to 2/2/2024. A control group study of 30 men was also conducted. All groups that appeared healthy were matched in age, and patients with diabetes, kidney disease and heart disease were excluded from the study, as well as any other systemic diseases. Conclusion: The present study concluded that PCSK9considered as a prognostic marker for prediction of hypertension. Also, PCSK9 was very related in hypertensive patients with hyperlipidemia (cholesterol, TG, LDL, & HDL). High biomarker level associated with ages especially at new diagnosis without treatment and with short duration of disease. Smoking plays important roles with high a level of PCSK9 in hypertensive patients. The genetic may play a role in present study by high level of This biomarker in familial hypertensive patients. Obesity has a crucial role in in hypertensive patients with high PCSK9 level.

#235 Quality of sleep and the quality of life in chronic kidney disease patients undergoing hemodialysis in a tertiary hospital in the Philippines

Abstract Background and Aims Sleep quality and quality of life are critical aspects of health and well-being, particularly for individuals undergoing hemodialysis. Hemodialysis is a life-sustaining treatment for individuals with end-stage kidney disease (ESKD), but it can significantly impact various dimensions of their health, including sleep quality and overall quality of life. Understanding the relationship between sleep and quality of life in hemodialysis patients is essential for developing effective interventions to improve their overall well-being. Studies have shown that hemodialysis patients often experience poor sleep quality, characterized by difficulty falling asleep, frequent awakenings during the night, and early morning awakening. Moreover, sleep disturbances experienced by hemodialysis patients can also affect their ability to perform daily activities which can have a negative impact on their overall quality of life. Factors that have been shown to be associated with quality of sleep and quality of life in hemodialysis patients include age, sex, comorbidity, mode and schedule of hemodialysis, hemoglobin, phosphorus and albumin. Physicians can provide patient-centered care more effectively when they have a better grasp of the quality of life. However, the quality of life is not thoroughly studied in individuals with chronic kidney disease, particularly those undergoing hemodialysis. To address these issues, it is essential to prioritize sleep quality and quality of life in hemodialysis patients. The aims of this study were to determine the prevalence of ‘poor sleepers’ in patients undergoing hemodialysis using a validated sleep quality questionnaire and to examine the relationship between patients’ sleep quality with the quality of life using a validated kidney-disease specific quality of life questionnaire. Method This was a descriptive cross-sectional study conducted at The Medical City Ortigas from May to July 2023. The subjects recruited were adult hemodialysis patients enrolled in The Medical City Ortigas. To get a 95% confidence level, a minimum population of 80 patients should be included based on 71% prevalence from the study of Iliescu in 2003. This study evaluated a total of 85 patients through random selection. Patients excluded were those <18 years of age, had been on dialysis for less than 3 months, were not competent to give informed consent, and those with diagnosed sleeping disorder prior to having chronic kidney disease. Quality of sleep and quality of life were measured using validated self-administered questionnaires; the Pittsburgh Sleep Quality Index (PSQI) and the Kidney Disease Quality of Life-Short Form v1.3 (KDQOL) respectively. Results Among the respondents 67 (78.82%) were found to be poor sleepers (PSQI >5) with a mean global PSQI of 9.25. Age appeared to be a significant factor as the percentage of bad sleepers belong to the 46-65 and >65 age groups. In contrast, sex, marital status, 150 employment, hemodialysis shift, BMI, kt/V, hemodialysis type, albumin, phosphorus, and hemoglobin levels did not have significant association with quality of sleep. There is significantly a greater number of bad sleepers that have a lower functioning due to symptoms experienced (50.65 bad sleepers vs 62.85 good sleepers). Bad sleepers also have worse quality of life in domains of cognitive function (66.67 vs 55.22), sleep (56.67 vs 46.9), patient satisfaction (57.41 vs 45.27) overall health (54.44 vs 43.28) and general health (40.83 vs 32.16). Correlations between the global PSQI score and the domains of KDQOL computed via Pearson r coefficient showing an inverse correlation between PSQI and the mental (-.392) and physical (-0.320) component summaries. Conclusion Poor sleep is common in hemodialysis patients and is associated with poorer quality of life.

Association Between Baseline Serum Lipids and Severity of Dry Eye Symptoms in Acne Patients Treated with Isotretinoin.

Isotretinoin is a commonly prescribed medication for moderate-to-severe acne. Elevated triglycerides and total cholesterol, as well as eye dryness, are frequent side effects of isotretinoin. Objective:This study aims to examine the association between serum baseline levels of triglycerides and total cholesterol with regards to the severity of dry eye symptoms in acne patients treated with isotretinoin. The study was a retrospective review of acne patients treated with isotretinoin for at least four months at the dermatology clinics of Qassim University Medical City, Saudi Arabia. Thirty patients were included in the study as they met the inclusion criteria. Baseline levels of triglycerides and total cholesterol were reviewed for these patients. The Ocular Surface Disease Index (OSDI) questionnaire was sent and filled out by the study participants to assess the severity of eye dryness. 30 patients were included in the study, with 16 (53.3%) females and 14 (46.7%) males. The average age of participants was 22.1 years. The duration of treatment was between 120 and 140 days in 13 (43.3%) participants and 140 and 180 days in 17 (56.7%) participants. The mean ± 1 standard deviation (SD) was reported for each of the three variables, with an Ocular Surface Disease Index (OSDI) score of 27.6 ± 19.2, a baseline total cholesterol of 4.4 ± 0.9 mmol/L, and a baseline triglyceride level of 0.83 ± 0.4 mmol/L. Using a multiple linear regression model, baseline triglycerides and total cholesterol were used as predictors of the OSDI score. There was a significant dependent interaction between baseline total cholesterol and triglycerides and their effect on the OSDI score, with a higher OSDI score at higher levels of both triglycerides and cholesterol and a lower OSDI score at lower levels of both triglycerides and cholesterol. The study result showed that, in acne patients treated with isotretinoin for at least four months, a higher baseline level of both triglycerides and total cholesterol is associated with worse dry eye symptoms compared to those with lower baseline levels. The study concluded that baseline levels of triglycerides and total cholesterol arebothsignificant predictors of the severity of dry eye symptoms in acne patients treated with isotretinoin. Despite study limitations due to the small sample size, we hope that, based on our findings, this will open the door to future studies with a larger sample sizeto further confirmour findingsgeneralizethe result, andapply it to clinical practice so that clinicians may identify those at higher risk of severe eye dryness before starting isotretinoin and subsequently be able to recommend specific measures to minimize symptoms of eye dryness.

Molecular Detection of Antibiotics Profile of Citrobacter freundii Isolated from Burn Infection

Fifty samples were taken for this study from burn victims receiving care at the Al-Hussien medical city between February and October 2021. In order to isolate Citrobacter freundii, two swabs were taken: one for culturing and the other for direct examination. Only12 (4.1%) of the 50 samples were isolated from burn and wound infections at the molecular level and 12 (4.1%) from culture. The results isolation and laboratory diagnosis as well as biochemical test approved that there is only 12 isolates belong to C.freundii confirmed by molecular detection by specific primers. Burn and wound is one of the rare causes of infection. Associated with sub sequent urinary tract infection and burn and wound infection. Three antibiotics were employed at the molecular level , the results showed that 10 samples were resistant to the (Tet b) gene, all samples were 100% sensitive to the PIP gene, and all samples (100% resistant to the erna gene).

Evaluation of Apixaban standard dosing in underweight patients with non-valvular atrial fibrillation: a retrospective cohort study

BackgroundRecent guidelines recommend using direct oral anticoagulants (DOACs) as first-line agents in patients with non-valvular atrial fibrillation (NVAF). Research is currently investigating the use of Apixaban in underweight patients, with some results suggesting altered pharmacokinetics, decreased drug absorption, and potential overdosing in this population. This study examined the effectiveness and safety of standard Apixaban dosing in adult patients with atrial NVAF weighing less than 50 kg.MethodsThis is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC); adult patients with a body mass index (BMI) below 25 who received a standard dose of Apixaban (5 mg twice daily) were categorized into two sub-cohorts based on their weight at the time of Apixaban initiation. Underweight was defined as patients weighing ≤ 50 kg, while the control group (Normal weight) comprised patients weighing > 50 kg. We followed the patients for at least one year after Apixaban initiation. The study’s primary outcome was the incidence of stroke events, while secondary outcomes included bleeding (major or minor), thrombosis, and venous thromboembolism (VTE). Propensity score (PS) matching with a 1:1 ratio was used based on predefined criteria and regression model was utilized as appropriate.ResultsA total of 1,433 patients were screened; of those, 277 were included according to the eligibility criteria. The incidence of stroke events was lower in the underweight than in the normal weight group at crude analysis (0% vs. 9.1%) p-value = 0.06), as well in regression analysis (OR (95%CI): 0.08 (0.001, 0.76), p-value = 0.002). On the other hand, there were no statistically significant differences between the two groups in the odds of major and minor bleeding (OR (95%CI): 0.39 (0.07, 2.03), p-value = 0.26 and OR (95%CI): 1.27 (0.56, 2.84), p-value = 0.40, respectively).ConclusionThis exploratory study revealed that underweight patients with NVAF who received standard doses of Apixaban had fewer stroke events compared to normal-weight patients, without statistically significant differences in bleeding events. To confirm these findings, further randomized controlled trials with larger sample sizes and longer observation durations are required.

The Role of Neoadjuvant Chemotherapy in Patients With Advanced Endometrial Cancer at King Abdulaziz Medical City (KAMC), Saudi Arabia From 2010 to 2022.

Endometrial cancer (EC) has multiple modalities of treatment including neoadjuvant chemotherapy (NACT). There is limited research work conducted in Saudi Arabia that shows the benefits of using NACT, followed by interval debulking surgery (IDS) for stages III-IV ECpatients. Hence, this study aims to evaluate the effectiveness of using NACT compared to other modalities of treatment in the last 11 years in Saudi Arabia. The data of the patients were collected retrospectively between 2010 and 2022 at Princess Noura Oncology Centre, Jeddah, Saudi Arabia. The population was divided based on receiving NACT or taking other modalities for the purpose of assessing the mean survival time in both groups. Best-case and worst-case scenario models were usedto illustrate the survival rate of both stages. Forty patients with stages III-IV EC were included and grouped based on the treatment modality. Fourteen (35%) patients were receiving NACT followed by IDS compared with 26 (65%) patients who were using other modalities. In both stages III-IV patients, the mean survival time in the best-case scenario was 49 months in patients treated with NACT, and 82 months in patients who received other modalities. Regarding the worst-case scenario, the average survival time for patients treated with NACT was 22.89 months, which was significantly lower than the average survival time of 56.30 months for patients treated with other therapies. In the worst-case scenario, advanced EC patients who underwent NACT had a lower mean survival time than other treatment modalities. However, using NACT is not connected to the outcome in the best-case scenario.

Detection and Quantification of Human Herpes Viruses Types-6 and Cytomegaly Viruses in Sperm Samples of Patients with Fertility Disorders

Background; Viral infections are common around the world and cause many health problems. Infertility in men is a widespread health problem that can affect lifestyle and psychological state. Aims of the study; Study of the effect of herpes virus type 6 and cytomegalovirus on infertility disorders in men. Methodology; A case control study was done for a 100 specimens collected from men. This study has been conducted in Al Sader Medical City / Infertility Center / Al-Najaf Al-Ashraf and privet Center Dr. Ali Al-Ibrahimi for Embryos and Infertility in najaf . During the period from 10/10/ 2023 to 10/4/2024. The current study consisted of a sample size of 100 males, which was subsequently separated into two groups. The control group comprised 40 fertile men, aged 25 to 45 years, who had experienced both primary and secondary fecundity for at least twelve months. The Patients Cases group, consisting of sixty infertile males aged between 22 and 46 years, was categorized into two subgroups based on the type of infertility. There were forty-six guys who were classified as main infertility. There were a total of fourteen men who experienced secondary infertility. Male participants who are reproductive age, normal seminal analysis which is healthy and have a child as a Control group (Fertile men). Name of patient, sample number, Age (years), Education, housing area, Type of work, height, weight, Smoking, chronic diseases, History of surgery, Primary infertility, Secondary infertility, Sperm count, Sperm motility and Sperm morphology. Detection of CMV in semen plasma by CMV ELISA kit and detection of HHV 6 in semen plasma by HHV 6 ELISA kit. Result; The results showed that there was no statistical significance in age between the two groups. They also showed that there was statistical significance in smoking, type of infertility, and duration of infertility. The results showed statistical significance in the results for herpes and cytomegalovirus. There is also no statistical significance regarding the number of cases of cytomegalovirus infection according to age. On the contrary, there was statistical significance regarding age in herpes. The results also indicated that there was statistical evidence in the sperm analysis between the two groups. Conclusions; The statistical evidence between the two groups in the number of infection cases for all groups or by age indicates the role of viral infections in causing infertility in men.

Efficacy and Safety of Injectable Dulaglutide 1.5 mg Among Type 2 Diabetes Patients in Clinics at King Saud Medical City, Riyadh, Saudi Arabia

IntroductionType 2 diabetes mellitus is the most common type of diabetes, characterized by varying degrees of insulin resistance and diminishing beta-cell function, which increases the risk of macrovascular and microvascular complications. Dulaglutide is a long-acting glucagon-like peptide-1 receptor agonist that is administered once weekly and approved for treating adults with type 2 diabetes mellitus. It can be used as a monotherapy or in addition to oral hypoglycemic or insulin therapy.AimThis study aims to provide information contributing to assessing the efficacy and safety of weekly 1.5 mg dulaglutide therapy in Saudi adult patients with type 2 diabetes mellitus.MethodsA retrospective single-arm cohort study using a purposive sample to recruit type 2 diabetes mellitus patients on dulaglutide from endocrine and diabetic outpatient clinics in King Saud Medical City (N = 205). Data were collected from participants’ medical profiles and through the phone using interview questionnaires.ResultsMost participants were female and married; approximately 33% had had diabetes for more than 20 years, 41.4% of the sample had third-class obesity, and more than half had used dulaglutide for the last 1–2 years. With therapy, weight, body mass index, hemoglobin A1c, and fasting blood sugar were significantly improved after 6 and 12 months from baseline. The main side effects reported were nausea (52%) and fatigue (28%).ConclusionDulaglutide is a safe and effective therapy that demonstrated favorable glycemic control and weight reduction in obese type 2 diabetes patients of Saudi origin.