The Outcomes of Cardiac Surgery in Children With DiGeorge Syndrome in a Single Center Experience: A Retrospective Cohort Study.

Background DiGeorge syndrome, a common genetic microdeletion syndrome, is associated with multiple congenital anomalies, including congenital cardiac diseases. This study aims to identify the short and midterm outcomes of cardiac surgery performed on children with DiGeorge syndrome. Methods A retrospective cohort study was conducted between the period of 2018-2022, which included children divided into two groups with a 1:2 ratio. Group one included DiGeorge syndrome patients who were diagnosed using fluorescence in situ hybridization (FISH). Group two included the control group of patients who were clear of genetic syndromes. The two groups were matched based on similar cardiac surgery, age of surgery, and Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The two groups were compared based on the demographical data and postoperative complications. Results The study consisted of 81 children; 27 were DiGeorge syndrome patients, and 54 were in the control group. DiGeorge syndrome patients showed an increase in mechanical ventilation duration (p=0.0047), intensive care unit (ICU) length of stay (p=0.0012), and hospital length of stay (p=0.0391). Moreover, they showed an increased risk for bacteremia (p=0.0414), ventilator-associated pneumonia (VAP; p=0.0036), urinary tract infections (UTI; p=0.0064), and surgical site infection (SSI; p≤0.0001). They were also more susceptible to postoperative seizures (p=0.0049). Furthermore, patients with DiGeorge syndrome had a higher prevalence of congenital renal anomalies. However, there was no mortality in either group.  Conclusion This study shows a variability in the postoperative outcomes between the two groups. The study demonstrates that patients with DiGeorge syndrome have higher risks of infections and longer hospital stay during the postoperative period. Further research with a larger sample is needed to confirm our findings.

Cardiac Morbidity and Mortality in Patients with Sarcoma: A Population-Based Study.

Background: Soft tissue sarcoma (STS) is a rare malignancy that affects soft tissues. It encompasses various subtypes and requires different treatment strategies. Doxorubicin is a commonly used anthracycline in the management of localized and metastatic STS. However, high doses of doxorubicin are associated with cardiotoxicity, which can significantly impact patients' long-term outcomes. This study aimed to evaluate doxorubicin's effect on cardiac function in patients with sarcoma and to correlate the frequency of cardiotoxicity with potential risk factors. Methods: A retrospective analysis was conducted on patients with sarcoma who were treated with doxorubicin between 2016 and 2022 at King Abdulaziz Medical City in Saudi Arabia. Patient demographic information, comorbidities, cardiac measurements, laboratory values, systemic therapy, and treatment outcomes were collected from electronic medical records. A statistical analysis was performed to assess the association between cardiotoxicity and various factors. Results: A total of 133 patients were included in the study, with a median age of 30 years. Cardiotoxicity was observed in 9% of the patients. Female patients had a significantly higher risk of developing cardiotoxicity. Patients with a higher Eastern Cooperative Oncology Group (ECOG) performance status and lower troponin I levels also had an increased risk of cardiotoxicity. However, there was no significant association between cardiotoxicity and the number of chemotherapy cycles, total cumulative dose of doxorubicin, or history of radiation. Furthermore, patients with cardiotoxicity had a higher risk of mortality. The overall survival of the patients was 18 months. Conclusion: Doxorubicin-associated cardiotoxicity is a concern for patients with sarcoma. Female patients and patients with a higher ECOG performance status are at an increased risk of developing cardiotoxicity. Careful monitoring and risk assessment are crucial for mitigating the adverse effects of doxorubicin treatment in patients with sarcoma. Future studies are warranted to validate these findings and explore preventive strategies for doxorubicin-induced cardiotoxicity in patients with sarcoma.

Evaluation of maxillary transverse dimensions in individuals with a unilaterally impacted canine.

INTRODUCTION: The aim of this study was to investigate the maxillary width within individuals with a unilaterally impacted maxillary canine and to determine any association between the impacted canine location and some canine-related variables. METHODS: A cross-sectional analytical study using a split-mouth design included 22 CBCTs of individuals with unilaterally impacted maxillary canines (a total of 44 sides). The maxillary width was measured and compared in both impacted and non-impacted sides at various levels: basal, alveolar, and dental. The following canine-related variables were analyzed and compared with impaction location: impacted canine angulation, cusp tip distance from the occlusal plane, type of impaction (vertical or horizontal), presence of root resorption, deciduous teeth, or adjacent teeth transposition. Significance was considered at P < 0.05. RESULTS: There was a significant reduction in maxillary width on the impacted side at the following levels: maxillary first premolar alveolar crest in both coronal and axial sections, dental width measured from the central fossa of maxillary first molar to the midline, and width measured from the canine cusp tip to the midline. Moreover, the distance from the palatally impacted canine cusp tip to the occlusal plane was statistically significantly lower (7.6 ± 1.5 mm) compared to buccal (10.8 ± 3.3 mm) and mid-alveolus (12.0 ± 3.9 mm) impaction, (P values = 0.02). CONCLUSIONS: There was a significant association between canine impaction and reduction in the maxillary width at least on the dental level. The palatally impacted canine cusp tip was significantly closer to the occlusal plane compared to the buccal and mid-alveolar impaction.

Comparing between HLA-matched sibling donor allogenic HSCT and non-sibling matched related donor allogenic HSCT outcome in pediatric patients; single center retrospective study.

BACKGROUND: Extended family donor search other than siblings may yield an HLA matched donor in communities with high rate of consanguinity. The outcome of patients who are transplanted from non-sibling matched related donors (NS-MRD) including engraftment and graft versus host disease (GVHD) are scarce in comparison with matched sibling donor (MSD). METHODS: We retrospectively reviewed the outcome of all our pediatric hematopoietic stem cell transplantation (HSCT) patients who had non-sibling matched related donor and controlled them with matched sibling donor HSCT (based on age, indication of HSCT, conditioning regimen, GVHD prophylaxis, serotherapy, stem cell source and cytomegalovirus status). RESULTS: A total of 76 patients were reviewed during study period. Thirty patients (39.5%) in NS-MRD arm and 46 patients in MSD (60.5%) were identified after matching in age, disease, and conditioning regimens. All patients had similar approach including stem cell source and GVHD prophylaxis (CNI + 2nd agent). Out of the NS-MRD group, 18 patients (59%) had one of their parents as a donor and the rest as second degree relatives. Both groups were equally distributed and were homogeneous. Both groups had no statistically significant difference in outcome including engraftment, GVHD and Chimerism tests results. GVHD was seen in (13%) NS-MRD patients compared to (11%) in MSD patients. All patients remain alive with median follow up of 1249 days (431-3525). CONCLUSIONS: This study showed no significant difference in allogenic HSCT outcomes between matched sibling donors and non-sibling matched related donors and support using the same management approach in terms of conditioning therapy, GVHD prophylaxis, and serotherapy only if indicated.

The effect of caffeine intake and passive smoking on umbilical cord blood unit's quality parameters.

Today cord blood (CB) is a valuable source of hematopoietic stem cells to treat many hematological disorders. One of the limitations of CB utilization is the reduced number of nucleated cells including stem cells. Therefore, CB banks around the world have developed strategies in an attempt to improve donor selection and the quality of the CB inventory. This study aimed to determine the impact of passive smoking and caffeine consumption on CB quality. CBs were obtained from mothers who gave birth at King Abdulaziz Medical City. All mothers gave their informed consent. Personal interviews about the mother's demographics, smoking status and exposure, and caffeine consumption executed, followed by a chart review to analyze maternal and neonatal factors. Laboratory testing was performed on all collected CB units. Using descriptive statistics, maternal and newborn factors were analyzed. T-test or Mann-Whitney U Test, as appropriate, for continuous variables analysis to study the effect of second hand smoking and coffee consumption for the primary outcome. Our study demonstrated a reduction in CB MNC, including lymphocytes, in caffeine consumers among pregnant donors, as well as a reduction in cell potency activities, including total CFU and BFU-E. The effect of passive cigarette smoking on the same cohort was insignificant. Outcome of this study will help in optimizing the quality and quantity of stem cell harvesting from CB to get the maximum benefit and such knowledge will raise the awareness among pregnant women.

Misoprostol-Induced Fever and Unnecessary Antibiotic Prescribing: A Retrospective Study.

INTRODUCTION: Misoprostol is widely used for medication abortion and postpartum hemorrhage. However, it has been associated with the adverse effect of fever, which can pose challenges in management and potentially contribute to unnecessary antibiotic use. The incidence of misoprostol-induced fever in the context of medical abortion has not been extensively studied. METHODS: This retrospective cohort study aimed to determine the incidence of fever following misoprostol administration at a tertiary care hospital in Saudi Arabia. The study included female patients who received misoprostol for pregnancy termination or management of missed or incomplete abortion between January 2017 and December 2019. Data on demographics, misoprostol dosage and route, fever characteristics, outcome of abortion, and antibiotic use were collected. Statistical analysis was preformed using appropriate tests. RESULTS: A total of 213 patients were included in the study. The incidence of fever post-misoprostol administration was 8%. Patients who developed fever had a higher gestational age and received higher doses of misoprostol. However, no significant associations were found between other patient variables and fever incidence. Antibiotic therapy was administered to a almost half of the patients who developed fever post-misoprostol but was determined to be unnecessary in all cases. CONCLUSION: This study contributes to the understanding of misoprostol-induced fever in the context of medical abortion. Further research is needed to explore strategies for reducing unnecessary antibiotic use in this population.

Brucellar, Pyogenic, and Tuberculous Spondylodiscitis at Tertiary Hospitals in Saudi Arabia: A Comparative Retrospective Cohort Study.

Introduction: Spondylodiscitis is rare yet the most common form of spinal infection. It is characterized by inflammation of the intervertebral disk space and adjacent vertebral body. In Western countries, the incidence of spondylodiscitis is increasing. Clinical outcomes most commonly reported in the literature are the 1-year mortality rate (range, 6%-12%) and neurologic deficits. Methods: This multicenter retrospective cohort study assessed patients diagnosed with infectious spondylodiscitis who received treatment at King Abdulaziz Medical City in Riyadh and Jeddah, Saudi Arabia. All enrolled patients were ≥18 years old and were diagnosed per radiologic and microbiological findings and clinical manifestations between January 2017 and November 2021. Results: This study enrolled 76 patients with infectious spondylodiscitis, with a median age of 61 years. All patients presented with back pain for a median 30 days. Patients were stratified into 3 groups based on the causative pathogen: brucellar spondylodiscitis (n = 52), tuberculous spondylodiscitis (n = 13), and pyogenic spondylodiscitis (n = 11). All laboratory data and biochemical markers were not significantly different. However, C-reactive protein, erythrocyte sedimentation rate, and white blood cells were significantly different in the pyogenic spondylodiscitis group, with medians of 121 mg/dL (P = .03), 82 mmol/h (P = .04), and 11.2 × 109/L (P = .014), respectively. Conclusions: Back pain is a common clinical feature associated with infectious spondylodiscitis. The immense value of microbiological investigations accompanied with histologic studies in determining the causative pathogen cannot be emphasized enough. Treatment with prolonged intravenous antimicrobial therapy with surgical intervention in some cases produced a cure rate exceeding 60%.

Comparison of Postoperative Outcome in Children Undergoing Inguinal Hernia Repair Using Regional With General Versus General Anesthesia Alone: A Single Center Study.

BACKGROUND: Inguinal hernia repair is one of the most common general surgical procedures. It has been performed under local, regional, or general anesthesia. We hypothesized that using regional plus general anesthesia rather than general anesthesia alone would improve outcomes in neonates and pediatric patients undergoing hernia repair. METHODS: This is a retrospective cohort study, including all pediatric patients who underwent inguinal hernia repair from 2015-2021. We divided patients into two groups. The first group was labeled "general anesthesia" (GA), while the second group was labeled "combined general and regional anesthesia" (GA+RA). We compared both groups in terms of demographic data, intraoperative outcome variables, and postoperative outcome variables. RESULTS:  212 children fulfilled the study criteria, with 57 in the GA group and 155 in the GA+RA group. Demographic and preoperative data were comparable between both groups except for age, which was 60.3±49.4 months in the GA group versus 26.7±33.13 months in the GA+RA group (p<.0001). Outcome variables demonstrated statistically significant improvement in postoperative pain occurrence, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation in the GA+RA group in comparison to the GA group with P values of 0.031, 0.02, 0.005, and 0.02, respectively. CONCLUSION: Using regional and general anesthesia techniques rather than general anesthesia alone is associated with a decrease in postoperative pain, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation. Further studies are still warranted to validate our conclusions.

Trends in antidote utilization at a tertiary care hospital in Saudi Arabia: A 6-year retrospective study.

Antidote stocking has been described in several studies from many countries to be problematic and constantly insufficient. During our institution's previous experience with a medication event that resulted from lack of antidote stocking, we initiated a review of all our antidotes and realized the lack of data on utilization in the literature that would help us in planning for our stocks. Therefore, we conducted this retrospective review of antidotes utilized at a large tertiary care hospital over a period of 6 years. The paper describes the types of antidotes and toxins involved, together with important patient characteristics and antidote utilization data that can be useful to other healthcare institutions in planning for their antidote stocks.

Effect of age on response to anti-VEGF agents in patients with center involving diabetic macular edema in a tertiary hospital.

PURPOSE: The aim of the current study is to evaluate the effect of age as an independent factor for the response to two anti-VEGF agents, intravitreal ranibizumab and intravitreal aflibercept, among patients presented with central-involving DME in one tertiary care center in Riyadh, Saudi Arabia. METHODS: Retrospective cohort study. RESULTS: A total of 210 eyes of 121 patients were included in the study. The mean age was 61.2 ± 11.40 years, 50.4% were males. On characterizing groups based on age, the group of patients 60 years or younger are 48 patients (mean age 51.5 ± 9.92) and 52.1% of them are females. On the other hand, the group of patients older than 60 years are 73 patients (mean age 67.6 ± 6.85) and 52.1% of them are males. The two anti-VEGF agents used were aflibercept (88.1%) and ranibizumab (11.9%). The mean BCVA using ETDRS letter score improved after treatment (5.55238095 ± 15.9538695) and the mean change in CST decreased after treatment (- 106.91 ± 117.385 µm). Regarding age, we found that there is no significant difference in mean improvement of BCVA in patients according to their age (p = 0.5429), patients younger than 60 years old gained 5.64 ETDRS letter score and those older than 60 years old gained 5.49 improvement. Similarly, mean improvement in CST was different between patients younger than 60 years old (- 125.1 µm) and those who were older than 60 years old (- 94 µm) with a trend favoring younger patients but this difference was not statistically significant (p = 0.08). CONCLUSION: Age is a clinically significant factor affecting the outcome of anti-VEGF injections. Patients' CST had a difference of > 30 µm on average between the two age groups favoring younger patients. However, it was not statistically significant, maybe a bigger sample size is needed to prove statistical significance.

Prognostic value of exercise capacity in incident diabetes: a country with high prevalence of diabetes.

BACKGROUND: Diabetes Mellitus (DM) is a fast-growing health problem that imposes an enormous economic burden. Several studies demonstrated the association between physical inactivity and predicting the incidence of diabetes. However, these prediction models have limited validation locally. Therefore, we aim to explore the predictive value of exercise capacity in the incidence of diabetes within a high diabetes prevalence population. METHODOLOGY: A retrospective cohort study including consecutive patients free of diabetes who underwent clinically indicated treadmill stress testing. Diabetic patients at baseline or patients younger than 18 years of age were excluded. Incident diabetes was defined as an established clinical diagnosis post-exercise testing date. The predictive value of exercise capacity was examined using Harrell's c-index, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS: A total of 8,722 participants (mean age 46 ± 12 years, 66.3% were men) were free of diabetes at baseline. Over a median follow-up period of 5.24 (2.17-8.78) years, there were 2,280 (≈ 26%) new cases of diabetes. In a multivariate model adjusted for conventional risk factors, we found a 12% reduction in the risk of incident diabetes for each METs achieved (HR, 0.9; 95% CI, 0.88-0.92; P < 0.001). Using Cox regression, exercise capacity improved the prediction ability beyond the conventional risk factors (AUC = 0.62 to 0.66 and c-index = 0.62 to 0.68). CONCLUSION: Exercise capacity improved the overall predictability of diabetes. Patients with reduced exercise capacity are at high risk for developing incidence diabetes. Improvement of both physical activity and functional capacity represents a preventive measure for the general population.

Radiation metrics for vascular and interventional radiology procedures in a tertiary care institution: A retrospective cohort study over 5-years.

OBJECTIVES: To evaluate the radiation metrics from frequently carried out vascular and interventional radiology (VIR) procedures at a tertiary care institution and compare them to international diagnostic reference levels (DRLs). METHODS: A retrospective study of the radiation metrics of VIR-procedures carried out from January 2015 to December 2019. The collected data included age, gender, height and weight, reference point air kerma (mGy), dose area product (DAP; Gy.cm2), and fluoroscopy time (min.) The body mass index (BMI) and peak skin dose were calculated. The study cohort included 8942 adult patients (54.4% male, 45.6% female) with a mean age of 56.96 years and mean BMI of 26.86. RESULTS: Transjugular intrahepatic portosystemic shunt (TIPS) creation recorded the highest mean fluoroscopy time of 69.41 min., followed by central venous recanalization 39.67min. TIPS creation had the highest mean DAP (1161.16 Gy.cm2), followed by trans arterial chemoembolisation (TACE) (500.63Gy.cm2). TIPS creation was associated with the highest peak skin dose (2766.81mGy), followed by TACE (1588.29mGy). Compared to other studies, TIPS creation and TACE are associated with significantly higher DAP. CONCLUSION: Majority of VIR-procedures demonstrate no significant institutional variations in dosimetry compared to other studies. Using these studied values as reference levels may help identifying procedures that need quality control to minimize unnecessary exposures.

The evolving treatment of congenital heart disease in patient with Down syndrome: Current state of knowledge.

OBJECTIVES: Children with Down syndrome are usually seen as not worthy of high-risk cardiac surgery. Through this review, we try to show the results of curative and palliative surgery for functional single ventricle syndrome in patients with Down syndrome, as there is currently no standard protocol for the treatment of this category of patients. METHODS: An exhaustive search of all related published medical literature included the following domains: Down syndrome and diagnosis, Down syndrome and taxonomy, Down syndrome, and natural history, Down syndrome and cardiovascular abnormalities, Down syndrome and pulmonary hypertension, Down syndrome and institutionalization, Down syndrome and surgical repair, Down syndrome, and single ventricle palliation, Down syndrome and Glenn, Down syndrome, and Fontan. RESULTS: 12 articles were included from 775 identified. Low-risk cardiac surgery procedure should be provided for Down syndrome with a balanced ventricular septal defect. There is no universal agreement about the surgical approach for Down syndrome with unbalanced ventricular septal defects, but it can be performed at relatively low risk. CONCLUSIONS: TCPC in Down syndrome patients could be a relatively low-risk procedure if patients are prepared well and their pulmonary vascular resistance is low. Randomized prospective studies are required to show the long-term impact of TCPC palliation and develop a better understanding of standardized care of these patients.

The trends of cancer patients' perceptions on the causes and risk factors of cancer over time.

OBJECTIVES: To evaluate patients' perceptions on the causes and outcomes of cancer and the changes observed over a decade (2006-2016) at King Abdulaziz Medical City, Riyadh, Saudi Arabia. METHODS: Patients diagnosed with cancer and treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were enrolled in a cross-sectional study. The patients were enrolled in 2 cohorts: cohort 1 from 2006-2008 and cohort 2 from 2016-2018. The trends of the perceptions related to the causes and outcomes of cancer were compared between the 2 cohorts. RESULTS: In total, 1416 patients were enrolled in the 2 cohorts: cohort 1 included 464 patients and cohort 2 included 952 patients. The patients in cohort 2 had a higher level of education, higher unemployment rate, and more solid tumors. There was a significant increase in the belief of the "evil eye" as a cause of cancer from 1.3-33.1% between cohort one and cohort 2. A higher proportion (23.5%) of cohort 2 reported scientific causes for cancer, compared to 13.6% in cohort 1 (p<0.0001). Younger age, male gender, having a job, and being in cohort 2 were significantly associated with providing a scientific answer in a multivariate analysis (modeling scientific cause). CONCLUSION: In this study, a frequent misperception related to the causes of cancer was revealed. To tackle this issue, a systematic approach towards education for patients and the public is required to minimize the potential detrimental effects on patient care and patient outcomes.

Retrospective study of post-operative infections in implantable cardiac devices in a cardiac tertiary care center.

BACKGROUND: The rise in the incidence of implantation is one of the main causes behind the increased rate of CIED infection, which is considered as a serious life-threatening complication. The need of risk factor assessment has become a necessity to prevent further complications and provide prompt management. OBJECTIVES: Identify the risk factors of infection postoperatively among patients who have implantable cardiac devices. DESIGN: A retrospective case-control study. SETTINGS: Cardiac center for adults. PATIENTS AND METHODS: The study included all adult patients (≥14 years of age) of all nationalities who underwent cardiac electronic device implantation that was managed in the cardiac center between January 2012 to December 2018. MAIN OUTCOME MEASURES: Cardiac device infection and associated risk factors. SAMPLE SIZE: 213, including 23 (10.8%) infected case patients and 190 (89.2%) non-infected controls. RESULTS: The mean (SD) age of non-infected patients was 45.0 (12.7) years compared with 61.7 (13.7) for infected patients (P<.0001). Anticoagulant use, hypertension, dysplipdemia and age were the most common patient-related risk factors associated with infection. For procedural and post-procedural risk factors, the risk of infection increased as the number of leads and length of procedure increased. The device most often related to infection was the pacemaker. In the multivariate analysis, longer procedure, greater number of leads, older age, anticoagulant use, and implanted pacemaker device were independently associated with infection. CONCLUSION: We advise the prompt use of strict preoperative antiseptic prophylaxis measures and follow-up for post-implant patients along with patient education for early signs of infections, which will lead to improvement of both diagnosis and treatment quality for our patients in addition to reducing the economic impact on the health care system by minimizing infectious complications. LIMITATIONS: Single tertiary center study, small sample size. CONFLICT OF INTEREST: None.

Non-SARS Non-MERS Human Coronaviruses: Clinical Characteristics and Outcome.

Human coronaviruses (HCoVs) have become evident sources of human respiratory infections with new emerging HCoVs as a significant cause of morbidity and mortality. The common four coronaviruses (229E, HKU1, NL63, and OC43) are known to cause respiratory illness in humans, but their clinical impact is poorly described in the literature. We analyzed the data of all patients who tested positive for at least one of the four HCoVs from October 2015 to January 2020 in a tertiary care center. HCoVs were detected in 1062 specimens, with an incidence rate of 1.01%, out of all documented respiratory illnesses. Detection of these viruses was reported sporadically throughout the years, with a peak of occurrence during winter seasons. OC43 had the highest incidence (53.7%), followed by NL63 (21.9%), HKU1 (12.6%), and 229E (11.8%). Most of these infections were community-acquired, with symptoms of both upper and lower respiratory tract. Co-detection with other viruses were observed, mostly with rhinovirus. 229E was the most frequent (26.4%) HCoV in patients requiring intensive care, while NL63 and 229E were the most common in patients requiring invasive ventilation. The highest 30-day mortality rate was observed in patients infected with 229E (6.4%). HCoVs are common circulating pathogens that have been present for decades, with 229E being the most virulent in this study cohort.

Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching.

INTRODUCTION: During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair. METHODS: Retrospectively, we studied all children who had tetralogy of Fallot repair (2003-2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course. RESULTS: One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02). CONCLUSION: Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

Incidence and Outcome of Acute Kidney Injury in Patients Hospitalized With Coronavirus Disease-19 at a Tertiary Care Medical Center in Saudi Arabia.

Introduction The systemic acute respiratory syndrome coronavirus (SARS-CoV-2) has been associated with acute kidney injury (AKI). We retrospectively studied the incidence and outcome of AKI in patients hospitalized with COVID-19 at King Abdulaziz Medical City (KAMC) Riyadh, Kingdom of Saudi Arabia. Methods A retrospective cohort study was conducted after ethical approval from the institutional review board of King Abdullah International Medical Research Center (KAIMRC). Subjects were identified by Data Management Office of KAIMRC. The data were extracted from electronic medical records using a customized data collection sheet. The study included all adult patients (>18 years) who tested positive for COVID-19 by polymerase chain reaction and were admitted at KAMC from March 2020 until the end of September 2020. Patients with a history of end-stage kidney diseases and patients where adequate data were not available to establish diagnosis of AKI were excluded. Patient demographics, comorbid conditions, medications, use of mechanical ventilation, and 30-day mortality were recorded. Results During the study period (01 March 2020 to 30 September 2020) 1293 patients were hospitalized at KAMC with the diagnosis of COVID-19. After excluding the patients who met the exclusion criteria, data were collected for 1025 patients [male 582 (56.8%); female 443 (43.2%)]. On univariate analysis, increasing age, male gender, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, and vasopressors, presence of chronic kidney disease, coronary artery disease, chronic obstructive pulmonary disease, dyslipidemia, diabetes mellitus, heart failure, and hypertension, kidney transplant status, and mechanical ventilation were associated with development of AKI. On multivariate logistic regression analysis, independent predictors of AKI were restricted to increasing age, presence of chronic kidney disease, hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation. For patients who developed AKI, 30-day mortality was 40.7% compared to 3.7% for those who did not develop AKI (p<0.001). Conclusion For hospitalized patients with COVID-19, we observed an incidence of AKI of 36%. Increasing age, presence of chronic kidney disease and hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation were independently associated with development of AKI. Presence of AKI was associated with higher 30-day mortality (40.7% vs 3.7%).

The trends of complementary alternative medicine use among cancer patients.

BACKGROUND: The use of complementary and alternative medicine (CAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. Our study aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018. METHODS: We included 2 Cohorts of patients with cancer who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of CAM used, the reasons to use them and the perceived benefits. We compared the changes in the patterns of CAM use and other variables between the two cohorts. RESULTS: A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less CAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use CAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used CAM for symptom management such as pain control and improving appetite among others. Disclosure of CAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against CAM use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively). CONCLUSION: There is a significant change in CAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.