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1.
Saudi Med J ; 44(8): 761-766, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37582572

ABSTRACT

OBJECTIVES: To establish local DRL (LDRL) for computed tomography (CT) examinations based on size-specific dose estimates (SSDEs), which consider patient size. The concept of diagnostic reference level (DRL) was introduced to limit patient exposure to unnecessary radiation. However, traditional DRL values do not consider patient size. METHODS: Following institutional committee approval, data were collected from CT examinations of adult patients at Madinah General Hospital, Al Madinah Al Munawwarah, Saudi Arabia from January to March 2023. The SSDE was calculated for each patient using the effective diameter (Deff). RESULTS: The LDRLs of the brain, cervical spine, chest, thoracic spine and kidneys, ureters, and bladder (KUB) examinations were 118 mGy, 12 mGy, 8 mGy, 17 mGy, and 7 mGy, respectively. A strong correlation was observed between SSDEs and the volume computed tomography dose index (CTDIvol) for all examinations except chest scans (p<0.05). Size-specific dose estimates were higher than the CTDIvol, with a greater difference for patients with smaller Deff (p<0.05). CONCLUSION: The established LDRL was within the international DRL. The use of SSDE has the potential to provide more accurate and relevant data for radiation safety practices; however, widespread adoption of SSDE in new CT scanners is necessary for promoting consistency and standardization methodologies.


Subject(s)
Diagnostic Reference Levels , Tomography, X-Ray Computed , Adult , Humans , Radiation Dosage , Retrospective Studies , Tomography, X-Ray Computed/methods , Kidney , Reference Values
2.
Cureus ; 15(1): e34152, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36843734

ABSTRACT

Purpose To study choroidal thickness (CT) and its determinants based on optical coherence tomography (OCT) in the healthy adult Saudi population. Materials and methods This cross-sectional study was conducted in 2021 at a tertiary eye hospital in Saudi Arabia. The autorefractor-based refractive status (spherical equivalent) of each eye was documented. CT was measured from the enhanced depth OCT images at the fovea to the 1500 µm nasal and temporal to the fovea. CT was defined as the distance from a hyper-reflective line representing retinal pigment epithelium (RPE)-Bruch's membrane to the choroid-scleral junction. The CT was correlated with demographic and other variables. Results The study sample included 288 eyes of 144 participants (mean age 31.5±8.3 years; males 94, 65.3%). Emmetropia, myopia, and hypermetropic spherical equivalent were noted in 53 (18.4%), 152 (52.5%), and 83 (28.8%) eyes, respectively. The mean sub-foveal (SFCT), nasal, and temporal CT were 329.4±56.7µm, 302.3±63.5 µm, and 312.8± 56.7µm, respectively. CT varied significantly by location (p <0.001). CT was negatively correlated with age (r = -0.177, P <0.001). CT in emmetropic and myopic eyes was 319.7±53 µm and 313.1±53 µm, respectively. The difference in CT based on refractive status (p = 0.49) or sex was non-significant (p = 0.6). Regression analysis suggested that age (p <0.001), refractive error (p = 0.02), scanning time (p <0.001), and scanning location (p = 0.006) were significant predictors of CT. Conclusion CT measurements of the eyes of healthy Saudis can be used as reference values for studies evaluating CT changes due to various chorioretinal diseases.

3.
Br J Ophthalmol ; 106(8): 1164-1170, 2022 08.
Article in English | MEDLINE | ID: mdl-34301612

ABSTRACT

BACKGROUND/AIMS: The reason for visual impairment in patients with nanophthalmos and posterior microphthalmos is not completely understood. Therefore, this study aims to investigate foveal structure, and the impact of demographic, clinical and imaging parameters on best-corrected visual acuity (BCVA) in these conditions. METHODS: Sixty-two eyes of 33 patients with nanophthalmos (n=40) or posterior microphthalmos (n=22), and 114 eyes of healthy controls with high-resolution retinal imaging including spectral-domain or swept-source optical coherence tomography images were included in this cross-sectional case-control study. Foveal retinal layer thickness was determined by two independent readers. A mixed-effect model was used to perform structure-function correlations and predict the BCVA based on subject-specific variables. RESULTS: Most patients (28/33) had altered foveal structure associated with loss of foveal avascular zone and impaired BCVA. However, widening of outer nuclear layer, lengthening of photoreceptor outer segments, normal distribution of macular pigment and presence of Henle fibres were consistently found. Apart from the presence of choroidal effusion, which had significant impact on BCVA, the features age, refractive error, axial length and retinal layer thickness at the foveal centre explained 61.7% of the variability of BCVA. CONCLUSION: This study demonstrates that choroidal effusion, age, refractive error, axial length and retinal layer thickness are responsible for the majority of interindividual variability of BCVA as well as the morphological foveal heterogeneity in patients with nanophthalmos or posterior microphthalmos. This might give further insights into the physiology of foveal development and the process of emmetropisation, and support clinicians in the assessment of these disease entities.


Subject(s)
Choroidal Effusions , Microphthalmos , Refractive Errors , Case-Control Studies , Cross-Sectional Studies , Fovea Centralis/blood supply , Humans , Microphthalmos/complications , Microphthalmos/diagnosis , Retrospective Studies , Tomography, Optical Coherence/methods , Visual Acuity
4.
Ocul Immunol Inflamm ; 30(7-8): 1654-1658, 2022.
Article in English | MEDLINE | ID: mdl-34124991

ABSTRACT

AIMS: To evaluate the efficacy of tacrolimus in patients with noninfectious uveitis, as well as the usefulness of serum tacrolimus concentration measurements in predicting disease control. METHODS: A retrospective review was carried out on 71 eligible patients from a single specialist uveitis center for minimum 1-year follow-up. Analysis was carried out on disease activity, visual acuity, and trough serum tacrolimus concentrations (STC). RESULTS: At 1-year follow-up, disease control was achieved in 49 patients (69.0%), this was significantly more likely in patients with trough STC levels above 5 ng/mL (88% vs 53%, p = .002). There was a significant reduction in oral prednisolone (dose ≥7.5 mg, 86% vs 54%, p < .0001). Tacrolimus was discontinued in 12 patients (17%) due to side effects. DISCUSSION: In this study cohort, oral tacrolimus was effective and well tolerated in the treatment of noninfectious uveitis. Trough STC between 5 ng/mL and 10 ng/ml was associated with better disease control at 1-year follow-up.


Subject(s)
Tacrolimus , Humans , Tacrolimus/therapeutic use
5.
J Infect Public Health ; 14(9): 1268-1273, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34479078

ABSTRACT

INTRODUCTION: Healthcare workers (HCWs) in Saudi Arabia are a unique population who have had exposures to the Middle East Respiratory Syndrome coronavirus (MERS-CoV) and Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It follows that HCWs from this country could have pre-existingMERS-CoV antibodies that may either protect from coronavirus disease 2019 (COVID-19) infection or cause false SARS-CoV-2 seropositive results. In this article, we report the seroprevalence of MERS-CoV and SARS-CoV-2 among high-risk healthcare workers in Riyadh city, Saudi Arabia. METHODS: This is a cross-sectional study enrolling 420 high-risk HCWs who are physically in contact with COVID-19 patients in three tertiary hospitals in Riyadh city. The participants were recruited between the 1st of July to the end of December 2020. A 3 ml of the venous blood samples were collected and tested for the presence of IgG antibodies against the spike proteins of SARS-CoV-2 and MERS-CoV using enzyme-linked immunosorbent assay (ELISA). RESULTS: The overall prevalence of SARS-CoV-2 in high-risk HCWs was 14.8% based on SARS-CoV-2 IgG testing while only 7.4% were positive by Polymerase Chain Reaction (PCR) for viral RNA. Most of the SARS-CoV-2 seropositive HCWs had symptoms and the most frequent symptoms were body aches, fever, cough, loss of smell and taste, and headache. The seroprevalence of MERS-CoV IgG was 1% (4 participants) and only one participant had dual seropositivity against MERS-CoV and SARS-CoV-2. Three MERS-CoV positive samples (75%) turned to be negative after using in-house ELISA and none of the MERS-CoV seropositive samples had detectable neutralization activity. CONCLUSION: Our SARS-CoV-2 seroprevalence results were higher than reported regional seroprevalence studies. This finding was expected and similar to other international findings that targeted high-risk HCWs. Our results provide evidence that the SARS-CoV-2- seropositivity in Saudi Arabia similar to other countries was due to exposure to SARS-CoV-2 rather than MERS-CoV antibody.


Subject(s)
COVID-19 , Middle East Respiratory Syndrome Coronavirus , Antibodies, Viral , Cross-Sectional Studies , Health Personnel , Humans , SARS-CoV-2 , Seroepidemiologic Studies
6.
Am J Ophthalmol ; 226: 1-12, 2021 06.
Article in English | MEDLINE | ID: mdl-33422464

ABSTRACT

PURPOSE: We sought to develop and validate a deep learning model for segmentation of 13 features associated with neovascular and atrophic age-related macular degeneration (AMD). DESIGN: Development and validation of a deep-learning model for feature segmentation. METHODS: Data for model development were obtained from 307 optical coherence tomography volumes. Eight experienced graders manually delineated all abnormalities in 2712 B-scans. A deep neural network was trained with these data to perform voxel-level segmentation of the 13 most common abnormalities (features). For evaluation, 112 B-scans from 112 patients with a diagnosis of neovascular AMD were annotated by 4 independent observers. The main outcome measures were Dice score, intraclass correlation coefficient, and free-response receiver operating characteristic curve. RESULTS: On 11 of 13 features, the model obtained a mean Dice score of 0.63 ± 0.15, compared with 0.61 ± 0.17 for the observers. The mean intraclass correlation coefficient for the model was 0.66 ± 0.22, compared with 0.62 ± 0.21 for the observers. Two features were not evaluated quantitatively because of a lack of data. Free-response receiver operating characteristic analysis demonstrated that the model scored similar or higher sensitivity per false positives compared with the observers. CONCLUSIONS: The quality of the automatic segmentation matches that of experienced graders for most features, exceeding human performance for some features. The quantified parameters provided by the model can be used in the current clinical routine and open possibilities for further research into treatment response outside clinical trials.


Subject(s)
Choroidal Neovascularization/diagnostic imaging , Deep Learning , Geographic Atrophy/diagnostic imaging , Retinal Drusen/diagnostic imaging , Wet Macular Degeneration/diagnostic imaging , Aged , Aged, 80 and over , Angiogenesis Inhibitors/therapeutic use , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/physiopathology , Female , Geographic Atrophy/drug therapy , Geographic Atrophy/physiopathology , Humans , Intravitreal Injections , Male , Middle Aged , Models, Statistical , Neural Networks, Computer , ROC Curve , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Retinal Drusen/drug therapy , Retinal Drusen/physiopathology , Sensitivity and Specificity , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/physiopathology
7.
Am J Ophthalmol ; 213: 134-144, 2020 05.
Article in English | MEDLINE | ID: mdl-31987901

ABSTRACT

PURPOSE: To investigate the prognostic value of demographic, functional, and imaging parameters on retinal pigment epithelium (RPE) atrophy progression secondary to maternally inherited diabetes and deafness (MIDD) and to evaluate the application of these factors in clinical trial design. DESIGN: Retrospective observational case series. METHODS: Thirty-five eyes of 20 patients (age range, 24.9-75.9 years) with genetically proven MIDD and demarcated RPE atrophy on serial fundus autofluorescence (AF) images were included. Lesion size and shape-descriptive parameters were longitudinally determined by 2 independent readers. A linear mixed-effect model was used to predict the lesion enlargement rate based on baseline variables. Sample size calculations were performed to model the power in a simulated interventional study. RESULTS: The mean follow-up time was 4.27 years. The mean progression rate of RPE atrophy was 2.33 mm2/year, revealing a dependence on baseline lesion size (+0.04 [0.02-0.07] mm2/year/mm2, P < .001), which was absent after square root transformation. The fovea was preserved in the majority of patients during the observation time. In the case of foveal involvement, the loss of visual acuity lagged behind central RPE atrophy in AF images. Sex, age, and number of atrophic foci predicted future progression rates with a cross-validated mean absolute error of 0.13 mm/year and to reduce the required sample size for simulated interventional trials. CONCLUSIONS: Progressive RPE atrophy could be traced in all eyes using AF imaging. Shape-descriptive factors and patients' baseline characteristics had significant prognostic value, guiding appropriate subject selection and sample size in future interventional trial design.


Subject(s)
Deafness/complications , Diabetes Mellitus, Type 2/complications , Mitochondrial Diseases/complications , Retinal Dystrophies/diagnosis , Retinal Dystrophies/etiology , Retinal Pigment Epithelium/pathology , Adult , Aged , Atrophy , Deafness/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitochondrial Diseases/diagnosis , Optical Imaging , Prognosis , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Young Adult
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