Burden and Risk Factors of Postpartum Depression in Southwest Saudi Arabia.

OBJECTIVES: The burden of postpartum depression (PPD) is significant because it remains unrecognized, and it not only affects the mother adversely but also has a negative consequence on the family life and the development of the infant. The aim of the study was to measure the prevalence of PPD and identify the risk factors of PPD among mothers attending the well-baby clinic of six Primary Health Care centers in Abha city, Southwest Saudi Arabia. MATERIALS AND METHODS: A total of 228 Saudi women having a child aged between two weeks to one year were recruited in the study by using a consecutive sampling technique. The Arabic version of the Edinburgh Postnatal Depression Scale (EPDS) was used as a screening tool to measure the prevalence of PPD. The mothers were also inquired about their socio-demographic characteristics and risk factors. RESULTS: The prevalence rate of postpartum depression was 43.4%. Family conflict, and lack of support by spouse and family during pregnancy were found to be the strongest predictors of developing PPD. Women who had reported family conflict were at six times higher risk for developing PPD compared to those who did not have a family conflict (aOR = 6.5, 95% CI = 2.3-18.4). Women who reported a lack of spousal support during pregnancy encountered 2.3 fold increased risk for PPD (aOR = 2.3, 95% CI = 1.0-4.8) and women who had not received family support during pregnancy period were more than three times (aOR = 3.5, 95 % CI 1.6-7.7) likely to experience PPD. CONCLUSION: The risk of PPD among Saudi postnatal women was high. PPD screening should be an integral part of postnatal care. Awareness of women, spouses and families about potential risk factors can be a preventive strategy. The early identification of high-risk women during the antenatal and post-natal period could help to prevent this condition.

A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data.

Introduction: Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients. Methodology: This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24-48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. Results: A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94-2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88-1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88-2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83-2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23-2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79-5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26-6.80) and aHR = 3.9 (95% CI, 1.73-8.76), respectively. Conclusion: Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.

Association of Smoking with the Blood Concentration of 25-Hydroxy Vitamin D and Testosterone at High and Low Altitudes.

PURPOSE: This research examined the association of cigarette smoking and altitude with the blood levels of 25-hydroxy vitamin D, testosterone and carotid artery thickness. PATIENTS AND METHODS: This comparative cross-sectional study involved 37 non-smokers and 24 smokers from a high-altitude area (≥2245 m above sea level) and 40 smokers and 40 non-smokers from a low-altitude area (39-283 m above sea level). The blood testosterone level was determined spectrophotometrically, and the 25-hydroxy vitamin D concentration was measured by ELISA. The IMT of the right and left carotid arteries was determined using ultrasound imaging. RESULTS: Smoking notably elevated the thickness of the intima media of the right and left carotid arteries at both high and low altitudes (p ≤ 0.001). Smoking at high altitude was associated with a significant increase in the concentration of 25-hydroxy vitamin D and testosterone, while at low altitude it was associated with a significant decrease in both parameters (p ≤ 0.046). CONCLUSION: These contrasting results suggest that future studies should focus on finding out if other biochemical parameters show any significant differences in smokers or/and non-smokers when they are tested at elevated height and sea-level. This indicates that dose modifications of medicines (related to alterations in vitamin D and testosterone levels) should be kept in mind while treating smokers and non-smokers at elevated height above sea level.

Combination of (interferon beta-1b, lopinavir/ritonavir and ribavirin) versus favipiravir in hospitalized patients with non-critical COVID-19: A cohort study.

OBJECTIVES: Our study aims at comparing the efficacy and safety of IFN-based therapy (lopinavir/ritonavir, ribavirin, and interferon ß-1b) vs. favipiravir (FPV) in a cohort of hospitalized patients with non-critical COVID-19. METHODS: Single center observational study comparing IFN-based therapy (interferon ß-1b, ribavirin, and lopinavir/ritonavir) vs. FPV in non-critical hospitalized COVID-19 patients. Allocation to either treatment group was non-random but based on changes to national treatment protocols rather than physicians' selection (quasi-experimental). We examined the association between IFN-based therapy and 28-day mortality using Cox regression model with treatment as a time-dependent covariate. RESULTS: The study cohort included 222 patients, of whom 68 (28%) received IFN-based therapy. Antiviral therapy was started at a median of 5 days (3-6 days) from symptoms onset in the IFN group vs. 6 days (4-7 days) for the FPV group, P <0.0001. IFN-based therapy was associated with a lower 28-day mortality as compared to FPV (6 (9%) vs. 18 (12%)), adjusted hazard ratio [aHR] (95% Cl) = 0.27 (0.08-0.88)). No difference in hospitalization duration between the 2 groups, 9 (7-14) days vs. 9 (7-13) days, P = 0.732 was found. IFN treated group required less use of systemic corticosteroids (57%) as compared to FPV (77%), P = 0.005 after adjusting for disease severity and other confounders. Patients in the IFN treated group were more likely to have nausea and diarrhea as compared to FPV group (13%) vs. (3%), P = 0.013 and (18%) vs. (3%), P<0.0001, respectively. CONCLUSION: Early IFN-based triple therapy was associated with lower 28-days mortality as compared to FPV.

Lipid profile, random blood glucose and carotid arteries thickness in human male subjects with different ages and body mass indexes.

OBJECTIVE: This article investigated the effect of age and body mass index of male humans on the carotid arteries intima media thickness (IMT) and the blood concentration of glucose, triglycerides, total cholesterol and HDL cholesterol. METHODS: Thirty seven normal male human subjects participated in this study. The participants were classified to three groups depending on their age; 20-29 (11), 30-39 (14) and 40-49 (12). Also, the study subjects were divided to three groups according to their body mass index; normal (13), overweight (13) and obese (11). The Anova test was used for the statistical analysis of the obtained results. RESULTS: The body mass index significantly affected the blood glucose concentration while its effect on all the other parameters was insignificant. The age significantly affected all the studied parameters except the blood glucose, triglycerides and HDL cholesterol. The total cholesterol/HDL ratio was significantly affected by the age and insignificantly by the body mass index. CONCLUSIONS: The age was more effective on the studied parameters than the body mass index. Worsening of the lipid profile was seen in the overweight participants rather than the obese ones.

Assessment Awareness of Public About Breast Cancer and its Screening Measurements in Asir Region, KSA.

Breast cancer (BC) has a major impact on women's health worldwide. The Kingdom of Saudi Arabia is no exception, where it is considered the most common malignancy, embodying the second leading cause of cancer deaths after lung cancer. In today's world, people are more health conscious and more aware of different medical specialties. Despite the tremendous advancements in education, there seems to be a limited knowledge among the public regarding this issue. Various studies have been conducted in many regions to determine the perception/awareness about breast cancer. The present study is of the first of its type in our region, assessing the awareness of the public about breast cancer and its screening measurements. As per our knowledge, there is no study that estimated the awareness of breast cancer and its screening measurements among the public in the Asir region. Therefore, this study aims to estimate the awareness of breast cancer and its screening measurements among public and assess the knowledge about Breast Self-Examination (BSE) and their opinion about its effectiveness in early diagnosis of breast cancer to detect the relationship between awareness and socioeconomic status. This study is a cross-sectional prospective study, with a sample of 1046 participants aged between 12 and 80 years (male and female) from the Asir region evaluated by questionnaire after attaining consent. The selection of participants was based on the simple random sampling method. The majority of participants were of age 20 to less than 30 years (56.9%). About half of them were males (52.7%). The majority was single (61.2%). Most of them (74.0%) have a high education level (University and more). About one-third of the participants (32.7%) worked in the medical field, and most of them worked in the non-medical field (46.6%). Regarding general knowledge, the score was 60.2%, which represented a relatively good knowledge. The overall knowledge regarding breast cancer as recorded by our population reported that only 18.8% had good knowledge. Participants of this resettlement colony have poor knowledge about breast cancer, be it about risk factors, signs, and symptoms, or early detection procedures, where the overall knowledge score was only 18.8%.

Correction to: Assessment Awareness of Public About Breast Cancer and its Screening Measurements in Asir Region, KSA.

[This corrects the article DOI: 10.1007/s13193-019-00899-5.].

Endovascular Retrieval of Detached Ventriculoatrial Shunt into Pulmonary Artery in Pediatric Patient: Case Report.

The management of hydrocephalus represents a neurosurgical challenge. Ventriculoperitoneal (VP) shunts are usually the treatment of choice for hydrocephalus. However, when VP shunt is not an option, ventriculoatrial (VA) shunt becomes a second choice. VA shunts have special complications such as postoperative neck hematomas, shunt nephritis, and migration of the distal segment. There are two main techniques for the retrieval of migrated VA shunt: either by retrieval of the broken segment by thoracotomy, which is highly invasive, or by transvenous approach. A 9-year-old boy presented with severe cerebral palsy, who was VP shunt dependent since birth. The patient developed generalized cerebrospinal fluid (CSF) ascites with peritonitis. The shunt was externalized and infection was treated with intravenous antibiotics. Two weeks later, and due to previous multiple abdominal procedures, it was decided to go for VA shunt and the procedure went well without complications. One month later, the patient presented to emergency department with neck swelling; shunt x-ray showed shunt breakage at clavicular level and the tip of the shunt was dislodged into the pulmonary artery. Under general anesthesia and after getting informed consent, through femoral vein, VA shunt was retrieved successfully without complications and new VP shunt was inserted. Migration of the distal segment of a broken atrial catheter is rare, but has a significant complication and is major cause of mortality. Endovascular retrieval of migrated shunts is less invasive, is feasible, and prevents further complications. There has been similar case in the adult English literature; however, to the best of our knowledge, this is the first reported case in the English literature of a successful endovascular retrieval of migrated dislodged VA shunt in pediatrics.