ABSTRACT
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
ABSTRACT
Background Diabetes mellitus (DM) and subclinical hypothyroidism (SCH) are prevalent metabolic and endocrine disorders. Previous studies have suggested potential associations between SCH and metabolic disorders, including DM. This study aimed to explore the relationship between SCH and DM in patients from the Qassim Region in Saudi Arabia. Methods A retrospective cohort study was conducted on patients who attended the Qassim University clinics from December 2017 to December 2021. Participants were divided into two groups: SCH patients without a history of DM and age- and sex-matched controls without SCH or DM. Parameters, such as DM occurrence, DM duration, glycosylated hemoglobin (HbA1c) values, and metformin use, were evaluated. Results The prevalence of DM was 70.4% in the SCH group and 83.3% in the non-SCH group, with no significant difference between the groups (p=0.203). The mean HbA1c values and DM duration showed no significant variations between the two groups. However, metformin use was significantly higher in the SCH group at 74.1% compared to 50.0% in the non-SCH group (p=0.047). No correlation was observed between HbA1c and thyroid-stimulating hormone (TSH) levels. Conclusions While the study indicates a potential association between SCH and DM management, especially with regard to metformin usage, there does not appear to be a significant relationship between SCH and DM development or progression in this population.
ABSTRACT
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, occurring through compression of the median nerve as it passes under the transverse carpal ligament. Symptoms include nocturnal pain and paresthesias confined to the thumb, middle, and index fingers. Objective The purpose of this study is to determine the prevalence of CTS symptoms and the associated risk factors in Qassim Province, Kingdom of Saudi Arabia. Materials and methods A total of 314 participants were recruited from Qassim Province using an online survey, which included demographic questions and the Boston Carpal Tunnel Questionnaire (BCTQ). The association between categorical variables was assessed using the Chi-square test or Fisher's exact test, as appropriate. Additionally, an independent t-test was performed to compare quantitative variables. A p-value of less than 0.05 was considered statistically significant. Result The prevalence of CTS in the Qassim population was found to be 19.7%. The most significant risk factors for CTS were age, chronic illnesses, and employment status (p < 0.001). The most frequently reported symptoms included daytime pain and weakness (82.3%), while obesity emerged as the most prevalent chronic disease (21%). The mean symptom severity score (SSS) was significantly higher for individuals who were awoken from pain (t = -5.89; p < 0.001) and for those who experienced awakening due to numbness and tingling (t = -5.59; p < 0.001). Conclusion According to our sampled cohort, 19.7% of individuals had symptoms of CTS etiology. Multiple risk factors for CTS were identified. Notably, the development of CTS symptoms was significantly associated with individuals aged 50 and older, employment status, and the presence of related chronic diseases.
ABSTRACT
Objective We aim to evaluate the prevalence and impact of allergic rhinitis comorbidity in asthmatic patients in the Qassim region and identify whether rhinitis affects asthma control. Methods This is an observational cross-sectional study on asthmatic adults who live in the Qassim region of Saudi Arabia. An online questionnaire was distributed through social media. The questionnaire is composed of the validated Arabic versions of the Score for Allergic Rhinitis (SFAR) questionnaire, the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, and the Asthma Control Test (ACT) questionnaire. Results The total number of participants was 380; however, after 98 were excluded, 282 asthmatic patients were included in this study. Of them, 33% had allergic rhinitis. Females constitute 67% of the study participants, while males comprise 33%. The findings of the study indicate that there is a significant association between allergic rhinitis and asthma control in the Qassim region. Symptoms such as runny nose, sneezing, and nasal obstruction are significantly associated with poor asthma control (p = 0.006). Having a known family history of asthma, eczema, or allergic rhinitis is significantly associated with worse asthma control (0.004). Conclusion In summary, this study found a high prevalence of rhinitis symptoms comorbidity in asthmatic patients in the Qassim region. Overall, the study established the existence of a relationship between allergic rhinitis and asthmatic control. Symptoms such as a runny nose, sneezing, and nasal obstruction are significantly associated with allergic rhinitis and asthmatic symptoms. However, there is no significant association between nose problems that occur in specific seasons or months and allergic rhinitis and asthmatic symptoms, suggesting that seasonality may not have a strong impact on asthma control. House dust mite allergies have a borderline significant association with allergic rhinitis and asthmatic symptoms. Having a family history of asthma, eczema, or allergic rhinitis is associated with allergic rhinitis and asthmatic symptoms, thereby indicating a significant impact on asthma control.
