Awareness of audiology and speech-language pathology services among healthcare professionals in Saudi Arabia.

BACKGROUND:  Healthcare professionals are required to work effectively together to deliver the best healthcare services. Without awareness of other healthcare professionals' roles and responsibilities, interprofessional practice (IPP) cannot be optimally achieved. OBJECTIVES:  This study aimed to investigate healthcare professionals' awareness of audiology and speech-language pathology (SLP) services in Saudi Arabia. METHOD:  This cross-sectional descriptive study consisted of two parts. The content of a 20-item paper questionnaire was firstly validated. The full-scale study addressed the aim through distributing questionnaire items among potential participants. Descriptive statistics and chi-square test were used. RESULTS:  A total of 403 participants completed the questionnaires for the main study. Most of the participants were Saudi citizens (84.1%), aged 18 years - 40 years (84.8%) years, and lived in Riyadh region (76.2%). Allied health professionals (40.2%), physicians (22.6%), nursing (15.4%) and dentistry (11.2%) were the main group of participants working mainly at governmental hospitals (69.2%). Of the total participants, 92.6% and 95.3% reported being fully aware of the services provided by audiologists and SLPs, respectively. No statistically significant association between the specialty of participants and their familiarity with the scope of practice for SLPs and audiologists was determined. CONCLUSION:  Our study examined healthcare professionals' awareness of audiology and SLP services and revealed a high level of awareness.Contribution: The existed level of awareness is expected to facilitate IPP and enhance the quality of care. Still, awareness campaigns about audiology and SLP services are needed to address the existing lack of knowledge among some healthcare professionals.

Osteolytic Lesions (Brown Tumors) of Primary Hyperparathyroidism: A Report of Two Cases.

Primary hyperparathyroidism is characterized by excessive production of parathyroid hormone. As the condition progresses, bone loss primarily occurs due to resorption. A complication of this condition is the formation of fibrotic and cystic changes in the bone, known as brown tumors. These lesions occur in areas of significant bone resorption, where fibrovascular tissue and giant cells replace bone tissue, often accompanied by hemorrhage and hemosiderin deposits. These brown lesions are rare, with an occurrence rate ranging from 1.5% to 4.5%. We present two cases of middle-aged women who had presentations consistent with hyperparathyroidism and presented with complications such as bone pain and numbness. Both underwent parathyroidectomy to manage the cause and recovered after the surgery. These cases emphasize the importance of recognizing primary hyperparathyroidism as a potential cause of abnormal lesions and highlight the diverse presentations associated with this condition.

The Prevalence and Risk Factors of Pregnancy-Related Anxiety in Bahrain.

Objectives We aim to estimate the prevalence of anxiety among pregnant women, explore the possible risk factors, and compare the presence of anxiety in each gestational trimester in all pregnant women attending the antenatal care clinics at a tertiary care hospital in Manama, Bahrain. Methods This study followed a cross-sectional research design at the antenatal clinics of Salmaniya Medical Complex in Manama, Bahrain. Direct interviews with 513 participants were conducted using the Pregnancy Anxiety Questionnaire-Revised-2 (PRAQ-R2). Results Most participants (63%) were 25-35 years old. The majority (85.6%) were Bahraini nationals, and 52.2% were university-educated. Almost two-thirds were unemployed, 28.1% had associated chronic comorbidities, 3.1% had associated psychiatric disorders, 15% had a high level of anxiety, and 38% had a moderate level of anxiety. Employed participants had a significantly higher level of anxiety (p=0.022) than housewives/unemployed participants. Participants' levels of anxiety differed significantly according to their gestational age (p=0.043), with the highest anxiety among those in their third trimester (15.7%). Participants' anxiety levels were significantly higher among those with previously complicated pregnancies (p=0.002). Moreover, those with unplanned current pregnancy had significantly higher anxiety levels (p=0.019). Conclusions This study showed that anxiety seems to be a common disorder among pregnant women in Bahrain. It was more prevalent during the third trimester, and its occurrence was associated with the pregnant woman's employment, the occurrence of previously complicated pregnancies, and unplanned current pregnancies.

Antifungal Activities of Biogenic Silver Nanoparticles Mediated by Marine Algae: In Vitro and In Vivo Insights of Coating Tomato Fruit to Protect against Penicillium italicum Blue Mold.

In an attempt to reduce such decay induced by pathogenic causes, several studies investigated the effectiveness of nanoparticles (NPs) that play a vital role in saving food products, especially fruits. Current research delves into biogenic silver nanoparticles (using marine alga Turbinaria turbinata (Tt/Ag-NPs) and their characterization using FT-IR, TEM, EDS, and zeta potential. Some pathogenic fungi, which cause fruit spoilage, were isolated. We studied the impact of using Tt/Ag-NPs to protect against isolated fungi in vitro, and the influence of Tt/Ag-NPs as a coating of tomato fruit to protect against blue mold caused by Penicillium italicum (OR770486) over 17 days of storage time. Five treatments were examined: T1, healthy fruits were used as the positive control; T2, healthy fruits sprayed with Tt/Ag-NPs; T3, fruits infected with P. italicum followed by coating with Tt/Ag-NPs (pre-coating); T4, fruits coated with Tt/Ag-NPs followed by infection by P. italicum (post-coating); and T5, the negative control, fruits infected by P. italicum. The results displayed that Tt/Ag-NPs are crystalline, spherical in shape, with size ranges between 14.5 and 39.85 nm, and negative charges. Different concentrations of Tt/Ag-NPs possessed antifungal activities against Botrytis cinerea, Rhodotorula mucilaginosa, Penicillium expansum, Alternaria alternate, and Stemphylium vesicarium. After two days of tomatoes being infected with P. italicum, 55% of the fruits were spoilage. The tomato fruit coated with Tt/Ag-NPs delayed weight loss, increased titratable acidity (TA%), antioxidant%, and polyphenol contents, and decreased pH and total soluble solids (TSSs). There were no significant results between pre-coating and post-coating except in phenol contents increased in pre-coating. A particular focus is placed on the novel and promising approach of utilizing nanoparticles to combat foodborne pathogens and preserve commodities, with a spotlight on the application of nanoparticles in safeguarding tomatoes from decay.

Simultaneous production of biofuel, and removal of heavy metals using marine alga Turbinaria turbinata as a feedstock in NEOM Region, Tabuk.

Depletion of fossil fuel and pollution by heavy metals are two major global issues. The cell wall of algae consists of polymers of polysaccharides such as cellulose, hemicellulose, alginate, starch, and many others that are readily hydrolyzed to monosaccharides and hence are amenable to fermentation into bioethanol. Moreover, algae contain lipids that may undergo trans-esterification to biodiesel, and can be absorbed by heavy metals. In this study, extraction of lipids from Turbinaria turbinata (common brown alga) from the beach of Sharma, NEOM, Tabuk, Saudi Arabia by different solvents hexane, methanol, and hexane: methanol (1:1), and trans-esterification was performed to obtain biodiesel and investigated by GC.MS. The alga residue after fats extractions by different solvents was used in bioremediation synthetic wastewater containing 50 ppm of As-3, Co+2, Cu+2, Fe+2, Mn+2, and Zn+2. The residue of defatted alga was hydrolyzed by 2% H2SO4 and then fermented to obtain bioethanol. The combination of hexane: methanol (1:1) gave the greatest amount of petroleum hydrocarbons, which contain Tetradecane, 5-methyl, Octacosane, Pentatriacontane, and a small amount of Cyclotrisiloxane, Hexamethyl. The most effective removal % was obtained with alga residue defatted by hexane: methanol (1:1), and methanol, 100% removal of As-3, 83% Co+2, 95% Cu+2, 97.25% Fe+2, Mn+2 79.69%, Zn+2 90.15% with 2 g alga /L at 3 hours. The lowest value of sugar was obtained with hexane: methanol residue but gave the highest bioethanol efficiency. Thus, it is possible to use Turbinaria turbinata, or brown alga as a feedstock to produce bio-diesel, and bioethanol, and to remove heavy metals from wastewater, which may have a great economic and environmental significance.

Retraction: Ruptured Isolated Common Iliac Artery Aneurysm Masquerading as Renal Colic.

[This retracts the article DOI: 10.7759/cureus.19752.].

Validity of the International Diabetes Federation risk stratification score of Ramadan fasting in individuals with diabetes mellitus.

OBJECTIVES: To assess the validity of the new International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) risk stratification tool for Ramadan fasting in predicting diabetic patients' ability to fast safely. METHODS: A prospective observational study was carried out during Ramadan 2022 at the Diabetes Center, King Fahad Hospital, Al-Madinah Al-Munawarah, Saudi Arabia. The IDF-DAR risk stratification tool was used to calculate fasting risk for diabetic patients pre-Ramadan. The patients were allocated into 3 categories: high, moderate, and low risk. Fasting was left up to the patients and their healthcare providers. Participants filled out a log-sheet each day of Ramadan showing whether they completed the fast. A final interview was carried out after Ramadan to assess patients' fasting experiences. RESULTS: We included 466 patients with diabetes: 79.4% with T2DM and 20.6% with T1DM. Based on the IDF-DAR score, 265 (56.9%) patients were classified as high risk, 115 (24.7%) as moderate risk, and 86 (18.4%) as low risk. Non-fasting the whole month of Ramadan was statistically relevant to the IDF-DAR risk stratification score. High-risk individuals were more likely to experience hypoglycemia and hyperglycemia than those with a moderate or low risk. But overall, 70.4% of people at moderate risk and 53.2% of the ones at high risk observed Ramadan's complete fast. CONCLUSION: The IDF-DAR has proven to be reliable and valid for predicting the risk of adverse events associated with fasting in diabetic patients. Nonetheless, it might overestimate the risk of fasting for some patients.

Predictive Factors for Critical Weight Loss in Saudi Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy.

Weight loss is a significant health problem among patients with head and neck cancer (HNC) that is attributable primarily to the tumor or tumor therapy. Critical weight loss (CWL) is defined as the unintentional loss of ≥5% of weight. Therefore, this study's goal was to investigate and determine the possible factors influencing CWL among patients with HNC who have received radiotherapy or concurrent chemoradiotherapy (CCRT). We conducted a retrospective analysis of 175 patients who received radiotherapy or CCRT as either their primary, adjuvant, or combined treatment at the Oncology Center in King Abdullah Medical City. All patients were ≥18 years of age and diagnosed with HNC with no metastasis. The study results showed that 107 patients (61%) had CWL, while 68 (39%) did not. The following factors were significantly predictive of CWL with a multivariate regression analysis: pretreatment BMI (AOR = 1.1, 95% CI = 1.02-1.17), oral cavity cancer (AOR = 10.36, 95% CI = 1.13-94.55), and male sex (AOR = 3.15, 95% CI = 1.39-7.11). In conclusion, weight loss is highly prevalent among HNC patients during treatment. Accordingly, pretreatment BMI, cancer in the oral cavity, and being male can be considered predictive factors for CWL.

Effectiveness of Telemedicine in Controlling Hyperglycemia Among Diabetic Patients on Insulin Therapy in Primary Care: A Systematic Review and Meta-Analysis.

This study investigates the effectiveness of telemedicine in managing glucose levels in insulin-treated diabetes patients compared to standard care. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria and Cochrane's risk of bias tool, an analysis of five selected studies reveals telemedicine as a potent tool in diabetes management. Fasting blood sugar (FBS) test results from two studies involving an eight-hour fast with 109 participants demonstrate a significant superiority of telemedicine over usual care (Tau2 = 1.63; Chi2 = 1.01, df = 1, P = 0.32; Z = 2.43, P = 0.02), highlighting its potential in short-term blood sugar stabilization. Postprandial plasma glucose (PPBG) test outcomes suggest comparable efficacy in managing post-meal blood glucose levels with telemedicine. Additionally, analysis of glycated hemoglobin (HbA1c) levels across all five studies indicates telemedicine's equivalence to traditional care in maintaining HbA1c levels among insulin-treated patients, affirming its efficacy in primary care. While emphasizing telemedicine's effectiveness in managing FBS levels, a critical aspect of diabetes control, among patients utilizing insulin therapy in primary care, the study underscores the need for more extensive, large-scale research to fully comprehend its impact on diabetes management.

Factors associated with 30-day mortality and morbidity in patients undergoing emergency colorectal surgery.

BACKGROUND: The 30-day period following emergency colorectal surgery (ECRS) is associated with high mortality and morbidity. There is a lack of data assessing factors associated with outcomes of ECRS in the Saudi population. OBJECTIVES: Assess factors associated with 30-day postoperative mortality and complications following ECRS. DESIGN: Retrospective cohort study. SETTING: Single tertiary care center, Riyadh, Saudi Arabia. PATIENTS AND METHODS: Demographic characteristics (age, sex, diagnosis, American Society of Anesthesiologists classification, pre-operative septic state, smoking, and comorbidities), operative characteristics (urgency, diverting ostomy, and procedure performed), and postoperative characteristics (length of stay, 30-day mortality, intensive care unit [ICU] admission, ICU length of stay, surgical site infection [SSI], readmission, reoperation, and complications) were collected from electronic medical records. Univariate logistic regression was used to evaluate association with the outcome measures (30-day mortality and postoperative complications). Multivariate logistic regression was applied to evaluate independent variables. MAIN OUTCOME MEASURE: Thirty-day postoperative mortality and morbidity. SAMPLE SIZE: 241 patients. RESULTS: Among 241 patients, 145 (60.2%) were men, and 80 (33.2%) patients were between 50-64 years of age. The most common indication for surgery was malignancy 138 (57%). The overall complication rate was 26.6% and the 30-day mortality rate was 11.2%. Left hemicolectomy was the most commonly performed procedure, performed in 69 (28.6%) patients. Patients between the age of 65-74 had an increased odds of death within 30 days (OR 5.25 [95% CI 1.03-26.5]) on univariate analysis. Preoperative sepsis was associated with a fourfold increase in the likelihood of 30-day mortality (OR 4.44, 95% CI 1.21-16.24, P=.024) on multivariate analysis. The likelihood of hospital re-admission increased by fivefold in patients who developed a postoperative complication (OR 5.33, 95% CI 1.30-21.78, P=.02). CONCLUSION: Preoperative sepsis was independently associated with 30-day mortality in patients undergoing ECRS, while the likelihood of hospital readmission increased in patients with postoperative complications. Expeditious control of sepsis in the emergency surgical setting by both surgical and medical interventions may reduce the likelihood of postoperative mortality. Establishing discharge protocols for postoperative ECRS patients is advocated. LIMITATIONS: Retrospective design, small sample size, and single setting.

Prevalence of Varicose Veins and Its Risk Factors among Nurses Working at King Khalid University Hospital Riyadh, Saudi Arabia: A Cross-Sectional Study.

This quantitative observational cross-sectional study assessed the prevalence and level of risk scores for varicose veins among nurses, and the association between varicose veins and sociodemographic, occupational, and lifestyle risk factors. Using simple random sampling, from August-December 2022, 250 nurses from different departments at King Khalid University Hospital completed a validated self-administered questionnaire and underwent an observational physical examination. Most nurses (191) had low-risk scores for varicose veins, 46 nurses had moderate-risk scores, and 13 nurses had high-risk scores. From the outpatient clinics, 61.5% of nurses had significant high-risk scores for varicose veins. Those with a statistically significant association had a family history of varicose veins (p < 0.001) and other chronic medical conditions (p = 0.04). Physical activity, especially race-walking/running (p = 0.006), showed a statistically significant association with the varicose veins score. The years as a staff nurse were statistically significant among the occupational risk factors (p = 0.003). The adjusted multivariable regression model showed three significant predictors: a positive family history, running/walking, and total years as a staff nurse (p < 0.001, p = 0.02, and p < 0.001, respectively). Nurses working at outpatient clinics, positive family history, years as a staff nurse, and other chronic conditions are risk factors for varicose veins, while race-walking/running is a protective factor.

Cone beam computed tomography analysis of the root and canal morphology of the maxillary second molars in a Hail province of the Saudi population.

Background: The goal of the present research was to employ CBCT imaging to assess the root and canal anatomy of maxillary second molars in a population from the Hail province of Saudi. The effects of gender and side were taken into account. Methods: The investigation included a sample size of 499 completely developed right and left untreated maxillary second molars obtained from 250 Saudi people. The root morphology of each tooth was evaluated. The examination also included an analysis of the canal morphology for each tooth, utilizing Vertucci's categorization. The effect of genders as well as sides was recorded. Results were analyzed using the Chi-square test. Results: 464 teeth had three roots (93.0%), whereas 20 teeth (4.0%) had two roots. One root was recorded in 7 (1.4%) of the study sample, whilst 8 (1.6%) had four roots. Although there were no significant differences between the left and right sides (p = .075), gender had a significant influence on the number of roots (p = .030). 240 M (48.1%) had three canal orifices, and 247 (49.5%) had four root canal orifices. Eight molars (1.6%) had two canal orifices, while one and five canal orifices were found in 3 (0.6%) and one (0.2%), respectively. Gender had a significant impact on the number of root canal orifices (p = .039). The observed differences in the orifices of the root canals between the left and right sides were not statistically significant (p = .059). The prevalence of MB2 in maxillary second molars was found to be 49.7%. In the mesiobuccal root, the Vertucci type I configuration had the highest canal frequency (50.3%), followed by the Vertucci types II (14.4%), IV (13.8%), V (12.0%), and III (7.6%), and VI (1.8%). The prevalence of Vertucci type I canal configurations was found to be higher in the distobuccal root (99.4%) and palatal root (98.2%) of maxillary second molars. Conclusions: Significant variations in root canal anatomy were observed within the Saudi population. The majority of the subjects from Saudi Arabia in this study exhibited the presence of maxillary second molars with three roots. Approximately half of the sample under investigation exhibited the presence of the four canals.

The effect of bariatric surgery on dietary Behaviour, dietary recommendation Adherence, and micronutrient deficiencies one year after surgery.

Bariatric surgery (BS) is associated with vitamin and mineral deficiencies, which might be augmented by low adherence to dietary guidelines and inappropriate dietary behaviours. The aim of this study was to determine the influence of BS on eating behaviour, prevalence of nutrient deficiency, level of commitment to diet, and lifestyle recommendations one-year post-BS. A cross-sectional study was conducted among adult patients who underwent BS in 2019 and had follow-up for a year. Age, gender, and clinical data were collected from the hospital system and other information was obtained from questionnaires during phone interviews. A total of 160 patients participated in the study. At 12 months, a significant increase from the baseline values in plasma levels of vitamin B12, folate, vitamin D, iron, corrected calcium, albumin, CRP, and MCV, as well as a significant decrease in BMI was observed. Adherence to dietary and lifestyle recommendations was moderate to high. Emotional, and restrained eating behaviours were moderate with 64.4%, and 77.5%, respectively. External eating was low at 58.1%. The study concluded that pre-and post-bariatric surgery nutrients should be closely monitored.

Simultaneous bioremediation of petroleum hydrocarbons and production of biofuels by the micro-green alga, cyanobacteria, and its consortium.

There are two major problems in the world, fuel deficiency and environmental pollution by fossil fuels. Microalgae are regarded as one of the most feasible feedstocks for the manufacturing of biofuels and are used in the degradation of fossil fuel spills. The present study was possessed to investigate the ability of green alga Chlorella vulgaris, blue-green alga Synechococcus sp, and its consortium to grow and degrade hydrocarbon such as kerosene (k) with different concentrations (0, 0.5, 1, and 1,5%), and also using algal biomasses to produce biofuel. The algal growth was estimated by optical density (O.D) at 600 nm, pigment contents such as Chlorophyll a,b carotenoid, and dry weight. The kerosene degradation was estimated by FT-IR analysis after and before the cultivation of algae and its consortium. The components of the methanol extract were determined by GC-MS spectroscopy. The results denote the best growth was determined by O.D, algae consortium with 1.5% Kerosene after ten days, meanwhile, the highest dry weight was with C. vulgaris after ten days of cultivation. The FT-IR demonstrated the algae and consortium possessed high efficacy to degrade kerosene. After 15 days of algae cultivation with 1% K, C.vulgaris produced the maximum amount of lipids (32%). The GC-MS profile of methanol extract of two algae and consortium demonstrated that Undecane was presented in high amounts, C.vulgaris (19.9%), Synechococcussp (82.16%), algae consortium (79.51%), and also were presented moderate amounts of fatty acid methyl ester in Synechococcus sp. Overall, our results indicate that a consortium of algae can absorb and remove kerosene from water, and at the same time produce biofuels like biodiesel and petroleum-based fuels.

Paediatric Asthma and the Microbiome: A Systematic Review.

Evidence from the literature suggests an association between the microbiome and asthma development. Here, we aimed to identify the current evidence for the association between asthma and the upper airway, lower airway and/or the gut microbiome. An electronic systemic search of PubMed, EBSCO, Science Direct and Web of Science was conducted until February 2022 to identify the eligible studies. The Newcastle-Ottawa Scale and the Systematic Review Centre for Laboratory Animal Experimentation risk of the bias tools were used to assess quality of included studies. Twenty-five studies met the inclusion criteria. Proteobacteria and Firmicutes were identified as being significantly higher in the asthmatic children compared with the healthy controls. The high relative abundance of Veillonella, Prevotella and Haemophilus in the microbiome of the upper airway in early infancy was associated with a higher risk of asthma development later in life. The gut microbiome analyses indicated that a high relative abundance of Clostridium in early childhood might be associated with asthma development later in life. The findings reported here serve as potential microbiome signatures associated with the increased risk of asthma development. There is a need for large longitudinal studies to further identify high-risk infants, which will help in design strategies and prevention mechanisms to avoid asthma early in life.

Moderate doses of dietary nitrate elicit greater effects on blood pressure and endothelial function than a high dose: A 13-week pilot study.

BACKGROUND & AIMS: Few studies have explored the prolonged effects of dietary nitrate on vascular health. This pilot study tested the effects of prolonged consumption (13 weeks) of a range of doses of dietary nitrate (NO3-), provided as beetroot juice (BJ), on blood pressure (BP) and endothelial function in overweight and obese older participants. METHODS AND RESULTS: Sixty-two overweight or obese older participants (60-75 years) were randomized to the following interventions: (1) high NO3- (2) medium NO3-, (3) low NO3-, or (4) placebo. Resting clinic and home BP were measured pre- and post-intervention. Laser Doppler iontophoresis was used to quantify changes in endothelial-dependent and independent microvascular blood flow. RESULTS: This pilot study showed that medium and low doses of NO3- were more effective in lowering resting-clinic SBP (P = 0.04 and, P = 0.03, respectively) than was PL. The lower doses of NO3- also resulted in significant increases in microvascular perfusion (medium, P = 0.02; low, P = 0.002) relative to baseline values. CONCLUSION: These findings indicate that supplementation with medium and low, but not high, doses of NO3- for 13 weeks had positive effects on BP and endothelial function in older overweight and obese adults. These findings require confirmation in larger studies.

The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs.

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.

Impact of telemedicine on glycemic control in type 2 diabetes mellitus during the COVID-19 lockdown period.

Background: The lockdown at the start of coronavirus disease 2019 (COVID-19) pandemic in Saudi Arabia (March 2020 to June 2020) shifted routine in-person care for patients with type 2 diabetes mellitus (T2DM) to telemedicine. The aim of this study was to investigate the impact telemedicine had during this period on glycemic control (HbA1c) in patients with T2DM. Methods: 4,266 patients with T2DM were screened from five Ministry of National Guard Health Affairs hospitals in the Kingdom of Saudi Arabia. Age, gender, body mass index (BMI), HbA1c (before and after the COVID-19 lockdown), duration of T2DM, comorbidities and antidiabetic medications data were obtained. Mean and standard deviation of differences in HbA1c were calculated to assess the impact of telemedicine intervention. Correlations between clinically significant variances (when change in the level is ≥0.5%) in HbA1c with demographics and clinical characteristic data were determined using chi square test. Results: Most of the participants were Saudis (97.7%) with 59.7% female and 56.4% ≥60 years of age. Obesity was 63.8%, dyslipidemia 91%, and hypertension 70%. Mean HbA1c of all patients slightly rose from 8.52% ± 1.5% before lockdown to 8.68% ± 1.6% after lockdown. There were n=1,064 patients (24.9%) whose HbA1c decreased by ≥0.5%, n =1,574 patients whose HbA1c increased by ≥0.5% (36.9%), and n =1,628 patients whose HbA1c changed by <0.5% in either direction (38.2%). More males had significant improvements in glycemia compared to females (28.1% vs 22.8%, p<0.0001), as were individuals below the age of 60 years (28.1% vs 22.5%, p<0.0001). Hypertensive individuals were less likely than non-hypertensive to have glycemic improvement (23.7% vs 27.9%, p=0.015). More patients on sulfonylureas had improvements in HbA1c (42.3% vs 37.9%, p=0.032), whereas patients on insulin had higher HbA1c (62.7% vs 56.2%, p=0.001). HbA1c changes were independent of BMI, duration of disease, hyperlipidemia, heart and kidney diseases. Conclusion: Telemedicine was helpful in delivering care to T2DM patients during COVID-19 lockdown, with 63.1% of patients maintaining HbA1c and improving glycemia. More males than females showed improvements. However, the HbA1c levels in this cohort of patients pre- and post-lockdown were unsatisfactorily high, and may be due to in part lifestyle, age, education, and hypertension.

The role of laparoscopy in emergency colorectal surgery.

OBJECTIVES: To assess the outcomes of the laparoscopic approach compared to those of the open approach in emergency colorectal surgery. METHODS: This retrospective cohort study included all patients aged >15 years who underwent emergency colorectal surgery from 2016-2021 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients were divided based on the surgical approach into laparoscopic and open groups. RESULTS: A total of 241 patients (182 open resections, 59 laparoscopic approaches) were included in this study. The length of stay in the intensive care unit was shorter in the laparoscopic than in the open group (1±3 days vs. 7±16 days). After multivariable logistic regression, patients undergoing laparoscopic resection had a 70% lower risk of surgical site infection than those undergoing open surgery (adjusted odds ratio=0.33, 95% confidence interval: [0.06-1.67]), a difference that was not significant (p=0.18). Lastly, patients who underwent open surgery had a high proportion of 30-day mortality (n=26; 14.3%), compared to those who underwent laparoscopic resection (n=2; 3.4%, p=0.023). CONCLUSION: Laparoscopy in emergency colorectal surgery is safe and feasible, with a trend toward better outcomes. Colorectal surgery specialization is an independent predictor of an increased likelihood of undergoing laparoscopy in emergency colorectal surgery.

A Case Report of Recurrent Subaortic Membrane in a 3-Year-Old Saudi Child.

INTRODUCTION: While only a few cases have been reported in pediatrics, subaortic stenosis (SAS) is a gradually progressive disorder rarely seen at birth and infancy, however, it is the most common type of aortic stenosis. It obstructs the blood flow across the left ventricular outflow tract (LVOT). Although the cause is still not well known, different etiologies have been suggested by the literature. While surgical resection is the definitive treatment, recurrence is observed in many patients, nonetheless, LVOT gradient usually progresses over years of follow-up. CASE PRESENTATION: We report the clinical and diagnostic course of a 41-months-old Saudi boy, asymptomatic child who was found to have progressive recurrent subaortic stenosis within a few months which required two redo sternotomy for sub-aortic membrane resection throughout a period of two years. DISCUSSION: SAS is usually detected incidentally in asymptomatic patients requiring an echocardiogram to assess other accompanying congenital heart defects (CHD), or rather potentially arising after repair of CHD. Patient close monitoring is important aspect given the nature of disease progression, re-operation for recurrence demonstrate significant increase over years, re-resection rate was 0 % after one year, 6 % after five years, and 8 % after 10 years. CONCLUSION: Recurrence of LVOT obstruction following sub-aortic membrane resection is common. Long-term follow-up care in postoperative patients is crucial. Majority of patients will need re-operation for recurrence at certain point during course of the disease.