Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

BACKGROUND: To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. METHODS: The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). RESULTS: The panel issued 12 clinical practice recommendations-one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate-high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. CONCLUSION: The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.

Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). The panel issued 12 clinical practice recommendations­one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate­high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.

Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms.

Purpose: To measure the associations of diet, psycological distress, and lifestyle factors with premenstrual symptoms (PMSx) in women in Riyadh, Saudi Arabia. Patients and Methods: An interview-based, cross-sectional study was conducted on 1831 women aged 18-50 years seen in primary healthcare centers and teaching institutes in Riyadh from December 2015 to June 2016. Question topics included sociodemographics, physical activity, smoking, and dietary habits information. PMSx were assessed using a symptom checklist with 6 domains: anxiety/mood changes; abdominal/back/joint pain; increased appetite/weight gain, breast pain/tenderness, severe headache, and ≥3 PMS symptoms (any). Multivariable logistic regression analyses were conducted to provide adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each PMSx domain. Results: Except for breast pain, drinking >5 cups of Arabic coffee was associated with increased odds of anxiety/mood [aOR 2.44 (95% CI 1.44, 4.12)], pain [1.83 (1.13, 2.98)], appetite/weight gain [1.66 (1.10, 2.50)], headache [1.57 (1.00, 2.56)] and ≥3 symptoms [1.50 (1.07, 2.11)]. A significant association was noted between sugar intake and anxiety/mood symptoms [1.53 (1.07, 2.19)] and abdominal/back pain symptoms [1.84 (1.17, 2.88)]. Increased severity of psychological distress was associated with all symptom domains: anxiety/mood [2.75 (1.92, 3.94)]; pain [1.45 (0.92, 2.28)]; appetite/weight gain [2.01 (1.53, 2.65)]; breast pain [2.19 (1.68, 2.88)]; headache [1.86 (1.37, 2.54)] and ≥3 symptoms [3.52 (2.49, 4.95)]. Low physical activity was significantly associated with odds of breast pain symptoms [1.29 (1.04, 1.59)]. Smokers were 3.41 (1.19, 9.77) times as likely to report any ≥3 symptoms compared to nonsmokers. Conclusion: Several potentially modifiable factors, such as diet and stress, were positively associated with PMSx. Thus, we suggest that increasing women's awareness of healthy lifestyles, particularly diet and stress reduction, may help to reduce the occurrence of premenstrual symptoms.

Factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia.

OBJECTIVE: To determine factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia. METHODS: In a cross-sectional study, interviews were conducted with 542 postmenopausal Saudi women, comprising sociodemographic history, social support, and the Menopause-specific Quality of Life questionnaire. RESULTS: The mean age of participants was 58 (±7.0) years, and the mean age at menopause was 49 (±4.7) years. We found that 41% (n = 224), 14.4% (n = 78), 57% (n = 307), and 12.7% (n = 69) of women reported severe/moderate impact of vasomotor, psychosocial, physical, and sexual symptoms, respectively. Multivariate logistic regression revealed that lacking emotional support was associated with severe/moderate vasomotor (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1, 2.3), psychosocial (aOR 2.0, 95% CI 1.2, 3.4), and physical (aOR 1.7, 95% CI 1.2, 2.6) symptoms. Lack of tangible social support was associated with severe/moderate sexual symptoms (aOR 1.9, 95% CI 1.0, 3.4). In addition, women who worked (aOR 1.8, 95% CI 1.1, 3.2), were obese (aOR 2.0, 95% CI 1.0, 4.1), lived in rented accommodations (aOR 3.9, 95% CI 1.2, 13.1), or had a retired spouse (aOR 1.6, 95% CI 1.0, 2.4) had higher odds for moderate/severe menopausal symptoms. CONCLUSIONS: Establishing educational and counseling programs for postmenopausal women, their spouses, and other family members could improve social support and hence quality of life of postmenopausal women. Effective preventive strategies to deal with modifiable risk factors, such as obesity and work stress, should also be implemented.

Fever of unknown origin: 98 cases from Saudi Arabia.

BACKGROUND AND OBJECTIVES: Fever of unknown origin (FUO) is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period. METHODS: We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome. RESULTS: The 98 patients who met the criteria included 44 males and 54 females with a mean (SD) age of 41.3 (18.5) years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 (32.7%). Seventeen (17.3%) patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months (range, 0-168 months). CONCLUSION: Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions.