Exploration of preschool hearing screening at primary healthcare centers in Riyadh,Saudi Arabia:A cross-sectional study

The hearing status of children should be examined throughout early childhood,even if they have passed the newborn hearing loss because hearing loss can occur at any time and may affect their ability to learn.Preschool hearing screening(PHS)is vital to continue screening throughout early childhood.The current practice of PHS in the primary healthcare centers(PHCs)in Saudi Arabia is unknown.The purpose of this study was to investigate PHS in the PHCs.This cross-sectional descriptive study used an in-person-administered questionnaire to collect data.A total of 106 out of 120 participants(male=61;female=45)representing the PHCs in Riyadh were interviewed.Most of the participants were aged 31–40 years and held a bachelor’s degree as the highest academic qualification with limited years of experience.PHS was mostly performed through subjective measures by asking the parents(71.7%)and the child(65.1%).The audiometric evaluation was conducted for preschool children in only half of the PHCs.General practitioners and nurses usually perform PHS.Substantial gaps in the practice of PHS were identified.The lack of training and appropriate instruments and the need for audiological services were the main challenges.Incorporating robust and objective protocols for PHS into the educational system is a valuable strategy for identifying hearing loss early and reducing its impact through the establishment of effective intervention plans.

Knowledge and Attitude of Health Care Workers toward Human Immunodeficiency Virus Infection in King Abdulaziz Medical City

Background: Worldwide data shows that the stigma and discrimination for AIDS patients by health care providers have a negative impact on its epidemic. It discourages people from seeking care or being tested for HIV, thus reducing access to HIV/AIDS prevention. The study aims to evaluate the knowledge of the HCWs (health care workers) in King Abdulaziz Medical City about human immunodeficiency virus infection and their attitudes when?they encounter HIV/AIDS patients. Methodology: A cross-sectional study was designed to collect data using self-administered structured questionnaire from 90 health care workers. It was distributed among HCWs in different wards in King Abdulaziz Medical City in Riyadh in August 2014. Results: The study included a total number of 90 heath care workers, of which 31 were physicians and 59 were nurses. Around 81 (90%) of HCWs knew the causative agent for AIDS. Only 22 (24%) of HCWs knew the level of risk of HIV transmission following needle stick injury. Most of HCWs 66 (73%) knew that sexual practice was the most common mode of transmission. Around 27 (87%) of physicians and 33 (56%) of nurses were able to answer that antiretroviral therapy had the ability to control HIV-infection. In addition, 9 (10%) of HCWs believed that AIDS was curable. Conclusion: It was obvious from our study that there was some amount of general information and knowledge with our HCWs. However, an educational campaign will try to increase the level of awareness and clear any misconception or misleading theories about HIV infection with our health care workers.

Combined goblet cell carcinoid and mucinous cystadenoma of the vermiform appendix

Goblet cell carcinoid is an uncommon primary tumor of the vermiform appendix, characterized by dual endocrine and glandular differentiation. Whether goblet cell carcinoid represents a morphological variant of appendiceal classical carcinoid or a mucin-producing adenocarcinoma is a matter of conjecture. Rare cases of goblet cell carcinoid with other concomitant appendiceal epithelial neoplasms have been documented. In this report, we describe a rare case of combined appendiceal goblet cell carcinoid and mucinous cystadenoma, and discuss the possible histopathogenesis of this combination.

Inflammatory Bowel Disease and Quality of Life in King Abdulaziz Medical City

Background: Health Related Quality of life (HRQOL) assessment is an important outcome to measure Inflammatory Bowel Disease (IBD). The aim of this study is to evaluate the effects of IBD in patients’ quality of life in King Abdulaziz Medical City, Riyadh. Methods: This is a cohort study of 32 patients with IBD who were given the Inflammatory Bowel Disease Questionnaire (IBDQ) in the outpatient clinic at King Abdulaziz Medical City, Riyadh during the study period of three months in 2014. Results: In a comparison between patients who have Ulcerative Colitis (UC) in contrast to Crohn’s Disease (CD), we found that the mean score for the IBDQ were 170.94 and 149.69 respectively. The worst score was 65 in CD and the highest was 224 in UC. Comparing the subdivisions of the IBDQ it was found that the bowel and systemic domains were affected mostly by the disease. Conclusion: Inflammatory bowel disease has a major impact on HRQOL of patients in different aspects. CD group has worse HRQOL than UC group. The total score was impacted mostly by the systemic and bowel domains in the IBDQ. Saudi patients were more affected by the disease compared to other countries.

Saudi Consensus for GLP-1 RAs Switching Guidance: Consensus Report

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide adequate glycemic control, weight reduction, low risk of hypoglycemia, and CV risk reduction. Their usage for type 2 DM (T2DM) is recommended mainly when hypoglycemia or weight gain should be considered, also, whenever initial therapy is failed. There are many recent updates in the treatment paradigm of T2DM. There are many types of GLP-1RAs, with a knowledge gap regarding switching between the different types. A Saudi task force gathered to develop an explicit, evidence-based consensus for switching between GLP-1RAs, when, why, and how? This article contains the expert panel’s recommendations as a contribution to complement the knowledge gap in this area from the national perspective. As an alternative to intensifying therapy, switching from one GLP-1RA to another has various advantages. Improvements in glycemic control, weight loss, adherence, and medications with established cardiovascular benefits are among them. Also, switching needs to be individualized upon many discussed factors like the dose of the previous GLP1-RA and gastrointestinal adverse effects. Discussion with patients about the why and how to switch is critical.

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia:A multicenter retrospective study

BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.

Continuity of Care in Primary Health Care Affecting Control of Diabetes

Background: Continuity of care is a distinguishing feature of primary care. Better continuity of care program showed a significant effect in controlling diabetes and it is complications. This study explores the effect of continuity of care on control of diabetes mellites in primary health care centres. Objectives: 1) To assess the effect of Continuity of care on controlling haemoglobin (Hb A1C) and fasting blood Sugar (FBS);2) To compare the control of Diabetes by using (Hb A1C and FBS) indices on same patient before and after application of chronic illness clinic;3) To identify the relation between age and gender affecting continuity of care in diabetic patient. Methods: It is a Prospective cohort study design. Included both gender and diabetic patient age above 24 years old. The data extracted from health care specialty center (HCSC) clinics in National guard hospital at Riyadh, through HCSC data base on three phases: 1) Phase 1: the data extracted of diabetic patients from October to November 2022 including MRN, diabetic patient, age, Hb A1C, Fasting blood glucose. 2) Phase 2: the same MRN extracted from phase 1 was extracted again retrospectively for six months from April to September 2022, to compare the indices before implanting the chronic illness clinic including Hb A1C, Fasting blood glucose. 3) Phase 3: prospectively from December 2022 to September 2023. Results: Among diabetic patients aged 60 years old and above showed better control of HbA1C and FBS comparing to these patients below age of 60 years old, with significant improvement of HbA1C after implanting chronic illness clinic. Conclusion: The significant improvement in the control of diabetic patients followed in primary health care centers reinforce the evidence of the importance of continuity of care.

Middle East respiratory syndrome coronavirus disease is rare in children: An update from Saudi Arabia

AIM To summarize the reported Middle East respiratory syndrome-coronavirus(MERS-Co V) cases, the associated clinical presentations and the outcomes. METHODS We searched the Saudi Ministry of Health website, the World Health Organization website, and the Flutracker website. We also searched MEDLINE and Pub Med for the keywords: Middle East respiratory syndromecoronavirus, MERS-Co V in combination with pediatric, children, childhood, infancy and pregnancy from the initial discovery of the virus in 2012 to 2016. The retrieved articles were also read to further find other articles. Relevant data were placed into an excel sheet and analyzed accordingly. Descriptive analytic statistics were used in the final analysis as deemed necessary.RESULTS From June 2012 to April 19, 2016, there were a total of 31 pediatric MERS-Co V cases. Of these cases 13(42%) were asymptomatic and the male to female ratio was 1.7:1. The mean age of patients was 9.8 ± 5.4 years. Twenty-five(80.6%) of the cases were reported from the Kingdom of Saudi Arabia. The most common source of infection was household contact(10 of 15 with reported source) and 5 patients acquired infection within a health care facility. Using real time reverse transcriptase polymerase chain reaction of pediatric patients revealed that 9 out of 552(1.6%) was positive in the Kingdom of Saudi Arabia. CONCLUSION Utilizing serology for MERS-CoV infection in Jordan andSaudi Arabia did not reveal any positive patients. Thus, the number of the pediatric MERS-CoV is low; the exact reason for the low prevalence of the disease in children is not known.

Perception of persons with type 2 diabetes mellitus in Saudi Arabia

Purpose:To explore how perceptions of self-efficacy,health locus of control and outcome expectancy impact the adherence of adults with type 2 diabetes mellitus in Saudi Arabiato self-care activities.Methods:A descriptive correlation design was used to analyse self-report questionnaires completed by a convenience sample of Arabic-speaking individuals(n=30)with type 2 diabetes mellitus from King Abdulaziz Medical City in Riyadh.Results:More than half(53%)of participants reported high self-efficacy,and the majority(77%)valued health and believed that effective diabetes management was important.Although the vast majority(93%)of participants believed that their doctor influenced their diabetes management,90%and 80%also acknowledged themselves and God,respectively,as the health locus of control.Participants who perceived that they or their doctors were in control of their health condition were more likely to adhere to self-care activities,such as follow a specific diet and perform foot care(p<0.05).Furthermore,female participants reported significantly greater adherence to medication than male participants(6.91±0.29 vs 5.14±2.44;p=0.02),and unmarried participants reported greater adherence to exercise than married participants(4.15±2.22 vs 1.60±1.43;p=0.001).Finally,self-efficacy had a significant,positive correlation with participants'adherence to exercise(r=0.491;p=0.006)and performing their foot care(r=0.586;p=0.001).Conclusion:Patients'perceptions of their health should be considered by healthcare providers to maximize adherence to effective self-care management.

Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM:To evaluate the causes of phakic implantable collamer lens(ICL)exchange/explantation in patients with and without keratoconus(KC)at two tertiary hospitals in Riyadh,Saudi Arabia.METHODS:A retrospective chart review of all patients who underwent ICL(model V4 c with central port)exchange/explantation was performed using the electronic medical record systems.All available preoperative and postoperative data were documented for each patient.RESULTS:Over 7 y,2283 ICL implantation procedures were performed;46 implants(2%)required exchange(21 implants)/explantation(25 implants),of which 14 cases(30.4%)were patients with KC.Indications for ICL exchange/explantation in non-KC group were vault measurement,cataract formation,increased intraocular pressure,inaccurate refraction,and patient dissatisfaction in 22(68.75%),4(12.5%),3(9.37%),2(6.25%),and 1(3.12%)case,respectively.The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients(78.57%),inaccurate refraction in 2 patients(14.28%),and patient dissatisfaction postoperatively in 1(7.14%)case.CONCLUSION:ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature.Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.

Regional variation of pediatric inflammatory bowel disease in Saudi Arabia: Results from a multicenter study

BACKGROUND Incidence and severity variations of inflammatory bowel disease(IBD)have been reported from Western populations between continents and regions of the same countries.However,no data were available from other countries.AIM To investigate the regional differences in the IBD profiles of pediatric patients from the Kingdom of Saudi Arabia.METHODS Data from a national multicenter IBD study were used.The incidence,time trend,and clinical presentation of Crohn’s disease(CD)and ulcerative colitis(UC)in the Central region(CR),Western region(WR),and Eastern region(ER)were analyzed and compared.Statistical analysis included Poisson regression analysis for incidence variation and Chi-square test for demographic and clinical parameters.A P<0.05 was considered significant.RESULTS The prevalence of positive family history was lower in children with CD from the ER than the CR or the WR.Consanguinity rate was higher in children with CD and UC from the CR and the ER,respectively.The incidences and time trends of CD and UC were not significantly different between regions.In the ER,a significantly higher percentage of children with CD presented with abdominal pain(P<0.001),blood in stools(P=0.048),stricturing or penetrating disease(P=0.029),higher erythrocyte sedimentation rate(P<0.001),higher C-reactive protein(P<0.001),higher anemia(P=0.017),and lower albumin level(P=0.014).For children with UC from the ER,a significantly higher percentage presented with anemia(P=0.006)and a lower percentage with pancolitis(P<0.001).CONCLUSION The most important finding is the identification of significantly more severe presentation of CD in the ER of the Kingdom of Saudi Arabia.Prospective studies are needed to explain such variations.

Incidence of ocular manifestations in patients with graft versus host disease after allogeneic stem cell transplant in Riyadh, Saudi Arabia

AIM: To evaluate the incidence and severity of ocular graft versus host disease(o GVHD) in patients who underwent allogeneic stem cell transplant(SCT) in King Abdul-Aziz Medical City, Saudi Arabia.METHODS: This is a retrospective cohort study conducted in King Abdul Aziz Medical City on patients who underwent allogeneic hematopoietic cell transplant(allo-HCT) from 2010 to 2017. The ocular examination findings including visual acuity, meibomian gland dysfunction, corneal and conjunctival staining with severity, corneal scarring, tear film meniscus and breakup time, anterior and posterior segment examination findings, intraocular pressure, treatment given, punctual plugs used or not, and follow up response were collected.RESULTS: The five years cumulative incidence of o GVHD among post-transplant patients was 56.98%(95%CI 38.6%-71.7%). The potential risk factors assessed for developing ocular manifestation were age, gender, donor’s age, donor gender mismatch CD3 and CD34 infusion, while none of the correlates were identified as statistically significant risk factors of developing ocular manifestation. However, the incidence was statistically significantly different betweenpatients diagnosed with acute myelocytic leukemia and acute lymphocytic leukemia(P=0.038). The mean latent period to develop ocular symptoms was 20.5 mo. All patients had variable degree of dry eyes. None of the patients developed any posterior segment complication.CONCLUSION: The incidence of o GVHD is low in King Abdul-Aziz Medical City. This can be attributed to the preconditioning and immunosuppressive regime.

Lymphocyte recovery is an independent predictor of relapse in allogeneic hematopoietic cell transplantation recipients for acute leukemia

AIM To examine the optimal absolute lymphocyte count(ALC) cut-off utilizing receiver operator characteristics(ROC) in addition to graft characteristics associated with early ALC recovery.METHODS Patients who received T-cell replete peripheral hematopoietic cell transplantation(HCT) for acute leukemia were identified. ALC cut-off was established using ROC analysis and subsequently the cohort was stratified. Time to endpoint analysis and cox regression modelling was computed to analyze outcomes. RESULTS A total of 72 patients met the inclusion criteria andwere analyzed. Optimal ALC cut-off was established to be on day 14(D14) with ALC > 0.3 × 10~9/L. At 2 years, cumulative incidence of relapse was 16.9% vs 46.9%(P = 0.025) for early and delayed lymphocyte recovery cohorts, respectively. Chronic graft vs host disease was more prevalent in the early lymphocyte recovery(ELR) group at 70% vs 27%, respectively(P = 0.0006). On multivariable analysis for relapse, ELR retained its prognostic significance with HR = 0.27(0.05-0.94, P = 0.038).CONCLUSION ELR is an independent predictor for relapse in patients receiving allogeneic HCT for acute leukemia. ELR was influenced by graft characteristics particularly CD34 count.

Alterations in D-Dimer, Prothrombin Time and Activated Partial Thromboplastin Time as Thrombogenesis Activity Markers in Patients with Acute Myocardial Infarction

Cardiovascular disease remains the leading cause of mortality and morbidity despite the identification of major risk factors and risk reduction strategies. Myocardial infarction (MI) is a relevant cardiovascular worldwide event for morbidity and mortality. In most cases, sudden cardiac death is triggered by ischemia-related ventricular tachyarrhythmia and accounts for 50% of deaths from cardiovascular disease in developed countries. This is a descriptive analytical case control study aimed to determine D-dimer, PT and PTT level and among patients with acute myocardial infarction conducted in Sudan cardiac center hospital. Thirty patients after MI and twenty normal controls have been studied. The MI patients also include co-exist disease diabetes and hypertension, they receive different anticoagulants therapy. The result demonstrates a significant increase post MI in the mean level of D-dimer (p = 0.00) whereas none significantly compares to control group. There are no differences between INR (0.393), PTT (0.648) and PT (0.393), parameters between cases and controls. In conclusion, our study reveals higher D-dimer level among patients than the control. In conclusion, serum D-dimer levels appear to be useful for diagnosing MI and may assist in the prediction of mortality among those patients which are presented with acute chest pain or known diagnosed with MI and should be done as indicator for thrombosis risk during therapy in post MI.

Twelve-month evaluation of the atraumatic restorative treatment approach for class Ⅲ restorations:An interventional study

BACKGROUND Atraumatic restorative treatment(ART)may be appropriate for populations without accessibility and affordability.More data are required regarding the success rate of ART in anterior teeth.AIM To evaluate the clinical performance of restoring class III cavities in anterior teeth of permanent dentition using the ART approach.METHODS A longitudinal interventional field study was carried out at two rural primary health centers,Tumkur district,India.A total of 54 teeth in 39 patients were evaluated for the survival rate of class III restorations in permanent anterior teeth using the ART approach in children and adult populations.Evaluation of ART restoration was carried out using Frencken J criteria,the mean procedure time,patient acceptance and reported pain severity during the ART approach were evaluated using a visual analog scale.Calculation of the cost of ART was also performed.RESULTS The mean time taken to perform the ART procedure was 14.79±5.8 min with the majority of patients reporting only mild pain.At 6 mo follow-up,72.2%remained in a good state,but this reduced to 27%at 12 mo.The cumulative survival rate of the restorations was 94.4%at 6 mo and 80.9%at 12 mo follow-up.Estimation of the direct cost for a single class III restoration was 186.50 INR(2.64 USD).CONCLUSION ART may be a good comprehensive option for basic oral health care for underserved or inaccessible populations,and preventive care for patients.

Graft vs host disease impacts overall survival post allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia/lymphoma

AIM To examine the outcome and prognostic factors for high risk patients with acute lymphoblastic leukemia/lymphoma(ALL/LBL) who underwent allogeneic hematopoietic stem cell transplantation(HCT) at our center during the period of2010-2017 METHODS After due institutional review board approval, patients with high risk ALL/LBL post HCT were identified and included. All records were retrospectively collected. Time to event analysis was calculated from the date of HCT until event of interest or last follow up with Kaplan-Meir means. Cox regression model was used for multivariable analysis calculation.RESULTS A total of 69 patients were enrolled and examined with a median age of 21(14-61). After a median follow up of 15 mo(2-87.3), the 2-year cumulative incidence of relapse, cumulative incidence of non-relapse mortality, progression free survival and overall survival(OS) were 34.1%, 10.9%, 54.9% and 62.8%,respectively. In a multivariable analysis for OS; acute graft vs host disease(GVHD) and chronic GVHD were significant with corresponding hazard ratio 4.9(1.99-12; P = 0.0007) and 0.29(0.1-0.67; P = 0.0044), respectively.CONCLUSION Allogeneic-HCT for high risk ALL/LBL resulted in promising remissions particularly for patients with cGVHD.

Prevalence and Correlates of Dyslipidemia among Adults in Saudi Arabia: Results from a National Survey

Data were collected and analyzed from a cross-sectional study using the World Health Organization’s STEPwise approach, to estimate the prevalence of various types of dyslipidemia and determine their associated factors among adults in Kingdom of Saudi Arabia. The study population included 4490 Saudi adults aged 15 years and older who were selected by a stratified, multistage, cluster random sampling technique. Lipid profile was determined by spectrophotometrically by biochemical methods, high total cholesterol (TC) was defined as TC of 5.2 mmol/L or more, hypertriglyceridemia as serum triglycerides level 1.7 mmol/L or more and. low high-density lipoprotein cholesterol (HDL-C) as serum HDL-C 0.9 mmol/L or less, LDL-C 3.35 mmol/L or more and TC/HDL ratio 5 or more. Of the 4490 subjects (94.4 % of total sample) included in the final analysis, 51% were females, 23% of study subjects were less than 25years and 11% were 55 or more years of age. The overall prevalence of dyslipidemia ranged from about 20% to 40%. The highest prevalence was for triglycerides where about 44% of all subjects were affected. About a fifth of the subjects had high level of total cholesterol. Males had significantly higher prevalence of all types of dyslipidemia than female except LDL-C and TC. Higher dyslipidemia prevalence of total cholesterol and triglycerides were significantly found in older subjects, illiterates and housekeepers. Lower prevalence rates for HDL-C was significantly observed in retired and youngest subjects. There were significant regional variations and significantly higher prevalence of dyslipidemia among hypertensives, diabetics, obese/overweight, smokers and physically inactive subjects. There were no significant differences according to income or fruits and vegetable consumption. Logistic regression analysis revealed that obesity/overweight, gender, age, diabetes were the most important significant predictors of dyslipidemia. The findings of this study suggest that the prevalence of dyslipidemia is high in Saudi Arabia. Multisectorial intervention strategies are needed targeting the predictors and significant risk factors identified.

Impact of COVID-19 on endourology surgical practice in Saudi Arabia:A national multicenter study

Objective:To identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia.Methods:A retrospective study of seven tertiary hospitals from January 2019 to April 2019,and from January 2020 to April 2020 was performed.Records of urology outpatient department(OPD)visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019,as well as,during the full curfew time,i.e.April 2020 versus April 2019.Results:Number of OPD visits in the first third of 2020 and 2019 were 19499 and 26594,respectively(p<0.001).Number of OPD visits in April 2020 was 1512,with a 78.6%decrease compared to that in April 2019,and among them 1373(90.8%)were teleclinics.Number of elective procedures in the first third of 2020 has decreased by 34.3%(from 3025 to 1988)compared to that in the first third of 2019(p<0.001).There were 120 elective procedures in April 2020,84.1%lower than that in April 2019.Percutaneous nephrolithotomy,shockwave lithotripsy,and transurethral resection of prostate procedures declined by 94.2%,98.5%,and 93.8%,respectively.Most procedures were performed as day surgery(85.0%).Number of emergency procedures in 2020 have fallen by 9.3%compared to 2019(pZ0.286).Urolithiasis was the commonest pathology(52.6%)presented to the emergency room(52.6%).Conclusion:During COVID-19 pandemic,urology services slashed by>75%,including OPD visits and elective endourology procedures.Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.

Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience

Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.

Tuberculous Spondylitis, 14 Years’ Experience of a Tertiary Care Center in Saudi Arabia

Background: Spinal Tuberculosis is the most common and dangerous form of skeletal tuberculosis. It has the potential for serious morbidity, including permanent neurologic deficits and severe deformity. The aim of this study is to review spinal Tuberculosis (TB) cases in our tertiary care center and evaluate it from different aspects, which may provide great support to the clinical decisions of this disease. Methods: The study was a retrospective charts review of all adult spinal TB patients who were evaluated at King Abdulaziz Medical City, Riyadh, from January 2001 to March 2015. The inclusion of cases will need to meet a specific case definition. Patients demography, presenting symptoms and signs, and radiological and microbiological data for all the patients were collected and reviewed. Results: A total of 61 cases screened charts were included according to the case definition. 59% were female, and the mean age was 51.3 years. The most presenting symptom was back pain (85%), followed by lower limbs weakness and lower limbs pain. The average duration of symptoms was 170 days. The average hospital stay was 41.4 days. On physical examination, about half of the patients had bilateral lower limbs weakness. Acute phase reactants like C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were elevated, 97% and 92% respectively, however leukocytosis was not common. Out of all the patients who had a biopsy done (59 patients), 51 patients (86%) had positive AFB culture. MTB PCR was done from spine biopsy in 16 patients, and 81% were positive. Out of 53 tissue specimens, histopathology showed 45% necrotizing granuloma, 21% non-necrotizing granuloma, and 34% non-specific inflammation. Imaging (either CT scan or MRI) was performed on the patients at the time of presentation, and the most common signs seen in both were vertebral bone destruction (95%, 80%) and perivertebral collections (70%, 84%). The thoracic and lumbar vertebrae were the most common involved locations. Thirty-one patients had both modalities done (CT and MRI), and spinal compression was seen on MRI in 68% of the cases compared to 36% on the CT scan. All the patients received the first line therapy with some individual adjustment and only 39% (27 patients) underwent surgery. Conclusion: Spinal Tuberculosis is a chronic presentation illness with a non-specific clinical picture. Interventional diagnostics is the best current modality to reach a confirmatory diagnosis. The gold standard for confirming TB diagnosis probably will remain cultures in addition to early utilization of molecular TB diagnostics. Time for diagnosis of Spinal Tuberculosis is delayed despite improvement in diagnostics tests. Medical treatment is the major solution of uncomplicated spinal TB.