Complications and failure rate of splenic artery angioembolization following blunt splenic trauma: A systematic review.

BACKGROUND: Over recent decades, splenic angioembolization (SAE) as an adjunct to non-operative management (NOM) has emerged as a prominent intervention for patients with blunt splenic injuries (BSI). SAE improves patient outcomes, salvages the spleen, and averts complications associated with splenectomy. This systematic review aimed to evaluate the failure rate and complications related to SAE in patients with BSI. METHODS: A systematic literature search (PubMed, SCOPUS, and Cochrane Library) focused on studies detailing splenic angioembolization in blunt trauma cases. Articles that fulfilled the predetermined inclusion criteria were included. This review examined the indications, outcomes, failure rate, and complications of SAE. RESULTS: Among 599 identified articles, 33 met the inclusion criteria. These comprised 29 retrospective studies, three prospective studies, and one randomized control trial. The analysis encompassed 25,521 patients admitted with BSI and 3,835 patients who underwent SAE. The overall failure rate of SAE was 5.3 %. Major complications predominantly were rebleeding (4.8 %), infarction (4.6 %), and abscess formation (4 %). Minor complications were fever (18.4 %), pleural effusion (13.1 %), and coil migration (3.9 %). Other complications included splenic atrophy, splenic cyst, hematoma, and access site complications such as splenic/femoral dissection. Overall, post embolization mortality was 0.08 %. CONCLUSION: SAE is a valuable adjunct in managing BSI, with a low failure rate. However, this treatment modality is not without the risk of potentially serious complications.

Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection.

Background: Catheter-induced coronary artery dissection (CICAD) is a rare complication of coronary angiography. The association between access site and CICAD remains unclear; however, transradial access (TRA) may be associated with a higher incidence of CICAD due to access vessel tortuosity and the mechanical disadvantage of catheters designed for the transfemoral access (TFA) approach. Methods: In this retrospective study, the reports of consecutive left heart catheterizations between April 2007, and December 2021 were reviewed for CICAD. Patients were excluded if the procedural report did not report an arterial access site. Identified CICAD cases were reviewed in detail. Results: There were 142/89,876 (0.16%) identified cases of CICAD. The access site was not associated with an increased risk of CICAD (0.18% with TRA vs 0.15% with TFA; relative risk [RR], 1.18; 95% CI, 0.84-1.65; P = .34) over the entire study period. With respect to TRA-related CICAD, male sex was associated with a decreased risk of dissection (RR, 0.64; 95% CI, 0.41-0.99; P = .04), but ST-elevation myocardial infarction at presentation was associated with an increased risk (RR, 3.01; 95% CI, 1.86-4.85; P < .01). In the TFA-predominant era, TRA was associated with an increased risk of CICAD (0.48% TRA vs 0.11% TFA; RR, 3.42; 95% CI, 2.05-5.69; P < .01)-an association that was not present in the TRA-predominant era. In-hospital mortality in patients with CICAD was 8.5%. Conclusions: CICAD is a rare complication of coronary angiography. Over a 15-year period, we did not demonstrate an association between access site and an increased risk of CICAD. There is substantial mortality associated with CICAD.

Prevalence of Prediabetes and Type-2 Diabetes Mellitus in Cricket Players: Multi-Cricket Clubs Cross Sectional Study.

BACKGROUND & OBJECTIVES: Sports activities are highly beneficial for improving the human health and reducing the risk of diseases. This cross sectional study aimed to investigate the prevalence of prediabetes and Type-2 diabetes mellitus in cricket players compared to population based non-elite athlete control subjects. METHODS: The present matched cross sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia during the period October 2019 to February 2020. Initially, 700 volunteer males, (300) cricket players and (400) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history, (200) nonsmoker cricket players and (300) nonsmoker control subjects were recruited. The age of cricket players was 34 (32-37) years, weight 81 (76-84) kg, height 1.79 (1.74-1.84) meters, and body mass index (BMI) was 25.09 (23.66-26.76) kg/m2. The cricket players have been playing cricket for 4 (3-4) hours per day; 3.50 (3-4) days per week; for the total period of 24 (12-36) months. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate the prediabetes and Type-2 diabetes mellitus. RESULTS: In cricket players, the prevalence of prediabetes was 23 (11.5%) and Type-2 diabetes mellitus (T2DM) was 7 (3.5%) compared to population based matched non-elite athlete control subjects the prediabetes was 73 (24.34%) and T2DM was 63 (21.1%) (p=0.001). Among cricket players, there was a 6-folds decrease in T2DM compared to control subjects. CONCLUSIONS: The cricket sports activities decrease the prevalence of prediabetes and Type-2 diabetes mellitus (T2DM) among the cricket players compared to population based matched non-elite athlete control subjects. The study findings demonstrate the urgent need for promoting sports activities, more cricket grounds as a physiological preventive strategy against the global growing diabetes epidemic.

"Is there a doctor on board?": willingness and confidence of physicians in the Kingdom of Saudi Arabia in assisting with in-flight medical emergencies.

BACKGROUND: In-flight medical emergencies (IMEs) are common, and for a traveling physician, it is very likely to encounter such a condition. Data discussing this issue are limited. Thus, this study aimed to evaluate the willingness and confidence of physicians in the Kingdom of Saudi Arabia (KSA) in responding to IMEs. As well as, to assess the associated sociodemographic, occupational, and travel-related factors, and their previous experience with such events. METHODS: This cross-sectional, online-based, study was conducted among all physicians in KSA during January 2021. The self-administered questionnaire included questions on sociodemographic, occupational, travel profiles, willingness and confidence towards IMEs. Chi-Squared or Fisher's Exact test were used for bivariate analysis followed by the multivariable binary logistic regression analysis. RESULTS: A total of 4558 physicians participated in the study. About one-third of participants reported one or more IME incidents, and the vast majority of them provided assistance. Cardiovascular diseases were the most common IMEs. About half of the participating physicians are concerned about the medico-legal consequences of providing assistance with such a condition. Among all specialties, emergency physicians reported the highest willingness and confidence toward IMEs. Predictors for a physician's willingness to assist in IMEs were being male, having been involved in a previous IME situation, attended life support and IME courses, frequent traveling, and practicing medicine in the Central region of Saudi Arabia. CONCLUSION: Findings from the current study stressed the need for establishing standardized guidelines about the roles of healthcare workers and the legal consequences of providing medical assessment in IMEs. Moreover, training programs on IMEs to all physicians, especially those who deal with a variety of cases during their practice such as internal medicine and family medicine are also suggested.

Prevalence of Prediabetes and Type 2 Diabetes Mellitus in Football Players: A Novel Multi Football Clubs Cross Sectional Study.

Sports offer great benefits, improving health and reducing the risk of illnesses. This study's aim was to investigate the prevalence of prediabetes and type 2 diabetes mellitus in football players compared to population based non-elite athlete control subjects. Initially 1100 male volunteers, (550) football players, and (550) population based non-elite athlete control subjects were interviewed. After socio-demographic and medical history analysis, 756 (378) nonsmoker male football players and (378) nonsmoker male control subjects were recruited. The control subjects were not involved in regular sports activities such as football, volleyball, badminton, cricket, hockey, and swimming. Participants with a known history of anemia, blood diseases, diabetes mellitus, and malignancy were excluded from the study. The mean age of football players was 31.80 ± 5.46 years, Body Mass Index (BMI) was 26.40 ± 2.08 (kg/m2), and the mean age of control subjects was 32.32 ± 4.37 years, and BMI was 26.66 ± 1.87 (kg/m2). The selected football players have been playing football for about 2 h a day, 3 days per week, and so the total mean duration of playing football was 1.08 years. American Diabetes Association (ADA) based criteria on Glycated Hemoglobin (HbA1c) was used to investigate prediabetes and type 2 diabetes mellitus. In football players the prevalence of prediabetes was 30 (7.93%) and type 2 diabetes mellitus (T2DM) was 6 (1.59%) compared to population based matched non-elite athlete control subjects where the prediabetes was 71 (18.78%) and T2DM was 89 (23.54%) (p = 0.001). Among football players there was a 7-fold decrease in T2DM compared to control subjects. Football recreational activities markedly reduce the prevalence of prediabetes and T2DM. The study findings demonstrate the benefits of football and other such sport activities and emphasize the urgent need for promoting football based physical activities as a physiological preventive strategy against the globally growing diabetes epidemic.

Cost effectiveness of bariatric surgery in patients with obesity related comorbidities: A retrospective study.

Background and Aim: Bariatric surgery has been reported to be an effective but expensive method for obesity management. This study aimed to determine the economic benefit for patients who underwent bariatric surgery. Methodology: We conducted a retrospective chart review of patients who underwent bariatric surgery and was on medications for obesity-related comorbidities at the Obesity Research Center in King Khalid University Hospital, Riyadh, Saudi Arabia. Data on the use and cost of medications before and after bariatric surgery were collected. Results: A total of 266 patients, 107 males (40.23%), and 159 Females (59.77%) with a mean age of 41.06 years were included in the study. There was a reduction in the mean number of medications used by patients before and 1-year post-op (before: 1.84, after: 0.52), with a significant reduction in the cost of medications (SAR5152.24 before, and SAR1695.36 after, 67% reduction, P < 0.001). Patients < 32 years old had the most reduction in medications cost (76.64% reduction). No significant difference in the cost reduction after surgery between genders (P = 0.971). There were significant reductions in numbers of out-patient clinic visits (2.26 ± 2.43 to 1.57 ± 1.42) and in-patient hospitalizations (0.31 ± 0.57 to 0.10 ± 0.36) after surgery (P < 0.001 and P < 0.001, respectively). Conclusion: Bariatric surgery can be considered as a cost-effective treatment for patients with obesity-related comorbidities. A significant reduction has been found in post-operative medications cost, out-patient clinic visits and in-patient hospitalizations after bariatric surgery.

Effect of environmental pollutants PM-2.5, carbon monoxide, and ozone on the incidence and mortality of SARS-COV-2 infection in ten wildfire affected counties in California.

Various regions of California have experienced a large number of wildfires this year, at the same time the state has been experiencing a large number of cases of and deaths from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The present study aimed to investigate the relationship of wildfire allied pollutants, including particulate matter (PM-2.5 µm), carbon monoxide (CO), and Ozone (O3) with the dynamics of new daily cases and deaths due to SARS-COV 2 infection in 10 counties, which were affected by wildfire in California. The data on COVID-19 pertaining to daily new cases and deaths was recorded from Worldometer Web. The daily PM-2.5 µm, CO, and O3 concentrations were recorded from three metrological websites: BAAQMD- Air Quality Data; California Air Quality Index-AQI; and Environmental Protection Agency- EPA. The data recorded from the date of the appearance of first case of (SARS-CoV-2) in California region to the onset of wildfire, and from the onset of wildfire to September 22, 2020. After the wildfire, the PM2.5 concentration increased by 220.71%; O3 by 19.56%; and the CO concentration increased by 151.05%. After the wildfire, the numbers of cases and deaths due to COVID-19 both increased respectively by 56.9% and 148.2%. The California wildfire caused an increase in ambient concentrations of toxic pollutants which were temporally associated with an increase in the incidence and mortality of COVID-19.

Impact of lockdown on COVID-19 prevalence and mortality during 2020 pandemic: observational analysis of 27 countries.

BACKGROUND: This study aimed to assess the impact of 15 days before, 15 days during, and 15 days after the lockdown on the trends in the prevalence and mortality in 27 countries during COVID-19 pandemic. METHODS: Twenty-seven countries were randomly selected from the different continents. The information on the trends in the prevalence and mortality due to COVID-19 pandemic in 27 countries was obtained from World Health Organization and lockdown data were obtained from concerned countries and their ministries. The impact of lockdown for 15 days before, 15 days during, and 15 days after the lockdown on the prevalence and mortality due to the COVID-19 pandemic in 27 countries was analyzed. RESULTS: The findings showed that 15 days after the lockdown there was a trend toward a decline, but no significant decline in the mean prevalence and mean mortality rate due to the COVID-19 pandemic compared to 15 days before, and 15 days during the lockdown in 27 countries. The mean growth factor for number of cases was 1.18 and for mortality rate was 1.16. CONCLUSIONS: The findings indicate that 15 days after the lockdown, daily cases of COVID-19 and the growth factor of the disease showed a declined trend, but there was no significant decline in the prevalence and mortality.

Inappropriate use of beta-blockers among medical and dental students at King Saud University, Riyadh.

AIM: Self-medication and inappropriate beta-blocker use have been commonly reported among students. This study aimed to determine the prevalence of inappropriate self-prescription of beta-blockers among medical and dental students. METHODS: We conducted a cross-sectional study using a validated self-administered questionnaire distributed via online Google document to all undergraduate medical and dental students, including interns, of King Saud University, Riyadh, Saudi Arabia. RESULTS: Out of 1,240 emails sent, 885 students (627 [70.8%] medical students and 258 [59.2%] dental students) responded to the survey (response rate, 71.4%). Beta-blockers were used by 198 students (22.4%) during their college years, of which 147 (16.6%) used it ≤5 times. The most common reason of using beta-blockers was to relieve stress and anxiety. The most common sources of information for use were their colleagues/fellow students. Self-prescribed beta-blockers were used by 123 students (13.9%). The usual dose consumed was 20 mg in 84 students (9.5%), while 15 (1.7%) experienced side effects. Although male students used beta-blockers more than females, females used beta-blockers at significantly higher doses (>20 mg). Medical students consumed more beta-blockers than dental students did (33.7% versus 0%, P = 0.001). Students in their senior years continued self-prescription and beta-blocker use longer than their juniors. Continued use was associated with their current academic level, who prescribed the drug, their usual dose, and awareness of complications. CONCLUSION: Two in ten students inappropriately used beta-blockers to relieve their anxiety and stress during examinations, and most of them were self-prescribed.

COVID-19 Pandemic: Impact of Quarantine on Medical Students' Mental Wellbeing and Learning Behaviors.

BACKGROUND AND OBJECTIVES: The novel coronavirus COVID-19 pandemic causes great public health and socioeconomic harms. Worldwide many countries implemented quarantine policies to minimize the spread of this highly contagious disease. The present study aim was to investigate the impact of quarantine on the medical students' mental wellbeing and learning behaviors. METHODS: In this descriptive study, we used a questionnaire with a Five-Point Likert Scale to collect the information. The questionnaire was distributed among 625 medical students through their emails with a response rate of 530 (84.8%), majority 294 (55.47%) being female. The survey questionnaire consisted of total 20 items; 12 items were related to psychological wellbeing and stress-allied queries and 08 items were about learning behaviors. RESULTS: The findings encompass two important characteristics related to quarantine, psychological wellbeing, and learning behaviors. A combined cohort of 234 medical students, either female or male, (which was 44.1% of the total responders) showed a sense of being emotionally detached from family, friends and fellow students, 125/ 530 (23.5%) medical students felt disheartened. Both female and male medical students showed a marked decrease in their overall work performance. Moreover, 56.2% of the total students (61.5% of the females and 49.5% of the males) felt a decrease in the time they spent studying. CONCLUSIONS: Both female and male medical students have identified that quarantine has caused them to feel emotionally detached from family, fellows, and friends and decrease their overall work performance and study period. The findings also show that one fourth of the medical students who participated in this study felt disheartened during the quarantine period. The long-term quarantine due to COVID-19 pandemics may causes further worsening in the psychological and learning behaviors of these medical students.

The Nexus between Workplace Exposure for Wood, Welding, Motor Mechanic, and Oil Refinery Workers and the Prevalence of Prediabetes and Type 2 Diabetes Mellitus.

Workplace exposure in various occupational and industrial sectors is an emerging health concern worldwide. This study aimed to investigate the nexus between workplace exposure for wood, welding, motor mechanic, and oil refinery workers and the prevalence of prediabetes and type 2 diabetes mellitus. Initially, 2500 male volunteers who were wood, welding, motor mechanic, and oil refinery workers were interviewed. After an examination of their demographics and medical history, 1408 non-smoking wood (158), welding (560), motor mechanic (272), and oil refinery workers (217), along with 201 control subjects, were selected. The participants' mean age was 36.59 ± 0.29 years and the mean body mass index was 26.14 ± 0.11 kg/m2. The selected industry workers had been exposed to their respective wood, welding, motor mechanic, and oil refinery workplaces for 8 h per day, six days per week. The American Diabetic Association (ADA)-based glycated hemoglobin (HbA1c) criterion was used to diagnose prediabetes and type 2 diabetes mellitus. Subjects with an HbA1c of less than 5.7% were regarded as non-diabetics, subjects with an HbA1c of 5.7%-6.4% were considered prediabetics, and subjects with an HbA1c of more than 6.4% were considered diabetics. In wood industry workers, the prevalence of prediabetes (PD) was 64 (40.50%) and in type 2 diabetes mellitus (T2DM), it was 21 (13.29%); in welding workers, the prevalence of prediabetes was 261 (46.60%), and for T2DM, it was 90 (16.07%); in motor mechanic workers, the prevalence of prediabetes was 110 (40.44%), and for T2DM, it was 126 (46.32%); and in oil refinery workers, the prevalence of prediabetes was 80 (36.86%), and for T2DM, it was 35 (16.12%). However; the combined prevalence of prediabetes and T2DM among wood, welding, motor mechanic, and oil refinery workers was 421 (34.79%) and 515 (42.66%), respectively. The prevalence of prediabetes and T2DM among workers increased with the duration of working exposure in the wood, welding, motor mechanic, and oil refinery industries. A one-year working exposure in these industries caused an increase of 0.03% in HbA1c. Workplace exposure in wood, welding, motor mechanic, and oil refinery industries increased the risk of prevalence of prediabetes and T2DM among the workers and affected the diabetes etiology.