Reducing Time to Diagnosis of Autism Spectrum Disorder Using an Integrated Community Specialty Care Model: A Retrospective Study.

OBJECTIVE: To evaluate a fast-track triage model in an integrated community specialty clinic to reduce the age of diagnosis for patients with autism spectrum disorder (ASD). STUDY DESIGN: A retrospective chart review was performed for patients seen in an integrated community specialty pediatric practice using a fast-track screening and triage model. The percentage of ASD diagnoses, age at diagnosis, and time from referral to diagnosis were evaluated. The fast-track triage model was compared with national and statewide estimates of median age of first evaluation and diagnosis. RESULTS: From January 1, 2020, through December 31, 2021, 189 children with a mean (SD) age of 32.2 (12.4) months were screened in the integrated community specialty. Of these, 82 (43.4%) children were referred through the fast-track triage for further evaluation in the developmental and behavioral pediatrics (DBP) department, where 62 (75.6%) were given a primary diagnosis of ASD. Average wait time from referral to diagnosis using the fast-track triage model was 6 months. Mean (SD) age at diagnosis was 37.7 (13.5) months. The median age of diagnosis by the fast-track triage model was 33 months compared with the national and state median ages of diagnosis at 49 and 59 months, respectively. CONCLUSIONS: With the known workforce shortage in fellowship-trained developmental behavioral pediatricians, the fast-track triage model is feasible and maintains quality of care while resulting in more timely diagnosis, and reducing burden on DBP by screening out cases who did not require further multidisciplinary DBP evaluation as they were appropriately managed by other areas.

Correlation of Bariatric Surgery Effect on Lipid Profile Among Obese Patients.

Background A considerable subpopulation of patients with morbid obesity present with dyslipidemia. It is characterized by elevated total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low high-density lipoprotein (HDL) concentrations. Sleeve gastrectomy (SG) is considered a method of treating morbid obesity and associated dyslipidemia. Objective To assess the effect of bariatric and metabolic surgery on lipid profile of morbidly obese patients. Methods We used a retrospective approach analyzing the lipid profiles of patients who underwent SG between January 2018 and July 2020. Patients were enrolled according to age (>17 years), pre-operative body mass index (BMI; >30 kg/m2), undergoing SG, and having complete follow-up records of lipid profiles. Baseline and post-operative lipid profiles, their variation, and the percentage of variation were compared. Results We analyzed data of 163 patients who underwent SG. The mean age was 36.75 ± 10.75 years, the mean BMI was 45.66 ±8.46, and the mean pre-operative TC, LDL, HDL, and TG were 4.67 ± 1.02, 2.55 ± 1.1, 1.14 ± 0.32, and 1.5 ± 1.11, respectively. There was a significant change in the mean level of TG as it was significantly higher pre-operatively compared to its mean level post-operatively. Furthermore, a significant change was observed in HDL. There was a non-significant change in levels of TC and LDL post-operatively. Conclusion SG showed to significantly reduce TG and elevate HDL in morbidly obese patients. On the contrary, TC and LDL were non-significantly affected. Further studies with longer follow-up are warranted to provide more reliable evidence.

Effect of Bariatric Surgery on Glycaemic Control in King Fahad Hospital.

BACKGROUND: Laparoscopic Sleeve Gastrectomy (LSG) is an approved procedure for weight reduction in obese patients. This outcome of weight loss is essential to achieve optimal control in patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: This study was designed to evaluate the effect of LSG on glycemic control among a sample of obese patients in Al-Madinah Al-Munawwarah, Saudi Arabia, through assessment of reduction in hemoglobin A1c (HbA1c) associated with weight loss following LSG. METHODS: In this cross-sectional study, we studied 102 patients with a body mass index (BMI) of ≥30 kg/m2 and aged ≥18 years who underwent LSG between January 2017 and December 2019. Patient age, characteristics, preoperative and postoperative records of BMI and HbA1c were collected. The data of BMI and HbA1c were analyzed based on baseline and mean postoperative readings with variable postoperative visits after LSG. RESULTS: There was a 30% reduction in BMI and a 26.4% reduction in HbA1c following LSG from baseline in all patients. We noted 44 patients achieved BMI <40kg/m2 with HbA1c <6.5% and 32 patients achieved BMI <40kg/m2 with HbA1c <5.7% within a mean follow-up time of 10 months. CONCLUSIONS: Laparoscopic Sleeve Gastrectomy (LSG) has a positive effect on glycemic control in obese patients in short term, evidenced by the significant reduction of weight and HbA1c. Larger longitudinal studies are needed to assess the long-term impact of LSG glycemic control and the related factors associated with maintaining weight reduction and optimal glycemic control in Saudi Arabia for patients with obesity.

Optic nerve sheath diameter by ultrasound is a good screening tool for high intracranial pressure in traumatic brain injury.

OBJECTIVES: This study aimed to determine the role of ONSD measurement by US for diagnosis of high ICP in TBI patients. METHODS: ONSD measurement by US was performed in adult TBI patients within 1 h of planned CT brain, while CT signs of high ICP were determined. Invasive ICP measurement was performed simultaneously in patients who had intraventricular device in situ. High ICP was determined as ICP > 22 mmHg. RESULTS: A total of 48 patients were enrolled. Twenty-eight patients had positive CT criteria for high ICP, while 20 patients were negative. The mean value of ONSD was 0.63 ± 0.06 cm in positive group compared with 0.55 ± 0.07 cm in negative one with significant difference (p < 0.001). A total of 22 patients had intraventricular device. Thirteen patients had high ICP, while 9 patients had normal ICP. The mean value of ONSD was 0.66 ± 0.05 cm in high ICP group compared with 0.58 ± 0.08 cm in normal one with significant difference (p = 0.004). ONSD with cut-off value > 0.61 cm predicted high ICP with sensitivity of 84.62% and specificity of 66.67% with significant AUC of 0.85 (p = 0.006). CONCLUSION: ONSD measurement by ultrasound is a good screening tool for high ICP in traumatic brain injury patients.