Prevalence of cerebral venous thrombosis with the use of oral contraceptive pills during the Holy month of Ramadan

Objectives:To identify the epidemiologic profile of cerebral vein thrombosis (CVT) among fasting women using oral contraceptive pills (OCPs) during the holy month of Ramadan.Methods:This retrospective study was conducted on all patients diagnosed with CVT and using OCPs from records at a tertiary care hospital in Riyadh, Saudi Arabia during 2016-2017. The study participants were categorized into 2 groups (an intermittently fasting group during the holy month of Ramadan and a non-fasting group).Results:Out of 108 female patients with CVT, 36.1% were secondary to OCP, of whom 41% participants were fasting. The most affected site was the transverse sinus. Holocephalic headache was more common amongst fasting group (68.8%) compared to non-fasting group (30.4%) (p=0.025). Dehydration (p=0.003) amongst the fasting group and protein S deficiency (p=0.027) in the non-fasting group were identified as the 2 prominent risk factors. Unfractionated heparin was the most common anticoagulant therapies used during the initiation phase for non-fasting (36.4%) and fasting groups (50%).Conclusion:All women who are using OCP should undergo formal written risk assessments for factors of CVT. Our study suggests that the negative effects of OCPs use might outweigh its benefits; thus, it should be prescribed with caution, more so in fasting patients.     

磁共振影像对脑静脉窦血栓形成的诊断价值研究

目的 通过分析血栓异常信号以及继发静脉性脑实质改变,探讨磁共振多对比加权序列(T1WI、T2WI、FLAIR、DWI以及TOF-MRV)在脑静脉窦血栓形成(cerebral venous thrombosis,CVT)中的诊断价值.方法 本研究纳入怀疑有CVT入院的患者,由两名有经验的放射科医生分别在磁共振多序列对比加...     

脑静脉血栓形成的临床特点及预后分析

目的:探讨脑静脉血栓形成(cerebral venous thrombosis,CVT)的诊断要点、治疗及预后.方法:回顾性分析22例CVT患者的发病年龄、起病形式、临床表现、影像学特征、治疗方法及预后.结果:(1)发病年龄15～58(33.0±8.8)岁;(2)男女比为1:1.4,育龄期女性占总数的41%;(3)多为急性起病,大部分可以找到相关病因(59%),各种因素导致的血液高凝状态为最常见原因;(4)首发症状多为头痛呕吐等颅高压表现(86%),伴或不伴局灶性神经功能缺损及癫痫发作,严重者可出现意识障碍;(5)脑脊液压力明显升高,白细胞及蛋白含量可正常或升高;(6)头颅CT,MRI,磁共振血管造影(mag-netic resonance angiography,MRA)及数字减影血管造影(digital subtraction angiogrophy,DSA)等影像学检查结果示患者均有不同程度的颅内静脉或静脉窦受累,其中上矢状窦受累程度最严重(82%);(7)应用脱水、抗凝、皮质激素及病因治疗等,22例患者中9例症状好转,7例基本痊愈,2例无变化,1例继发脑出血,3例死亡.结论:有血液黏滞度增高、感染等危险因素的中青年患者出现急起头痛、呕吐和(或)局灶性神经功能缺损及癫痫发作时,应高度怀疑CVT.MRI和MRA是早期诊断的有效手段.早期正确诊断及尽早使用肝素抗凝治疗是取得良好预后的关键.     

脑静脉血栓形成的临床特点及影像学诊断

目的 探讨脑静脉血栓形成（CVT）的临床及影像学特征。方法 回顾分析22例CVT患者的临床及影像学资料。结果 CVT临床症状可被分成5型：（1）单纯颅内压升高；（2）限局性大脑体征；（3）海绵窦综合征；（4）亚急性脑病；（5）下常见的表现。影像学检查MRV特别是DSA是诊断CVT的最佳手段。病因以妊娠产褥期、感染及口服避孕药最多见。结论 根据CVT的临床特点及彩像学表现？并辅以常见病因分析可对本病作出准确诊断。     

COVID-19 in patients with end stage kidney disease at a large community hospital in Eastern Saudi Arabia. A prospective study

Objectives:To report the outcome of patients with end stage kidney disease (ESKD) who were diagnosed with COVID-19 at a large community hospital in Eastern Saudi Arabia.Methods:A single center, prospective observational study at Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. Patients with ESKD who were maintained on dialysis and developed COVID-19 between June 15, 2020 and October 31, 2021 were enrolled.Results:In total, 30 patients with ESKD were diagnosed with severe acute respiratory syndrome coronavirus 2 infection. Twenty two (73%) patients developed the disease prior to COVID-19 vaccine rollout. The median age of the cohort was 63 (55-75) years. Most patients were diabetic (73%), hypertensive (97%) and had a median body mass index of 28 kg/m ² . Twenty seven (90%) patients required admission, 16 (52%) patients developed pneumonia, and 5 (17%) patients required mechanical ventilation. Patients who developed pneumonia were older, and the majority had diabetes mellitus and coronary artery disease. Five patients died with a total mortality of 17%.Conclusion:Patients with ESKD who developed COVID-19 had a poor outcome with high mortality compared to the general population. Presence of diabetes mellitus, coronary artery disease and older age were associated with a higher risk of severe disease. There was a sharp decline in the number of positive cases following implementation of the vaccination program.     

脑静脉窦血栓形成的CT及MRI诊断分析

目的分析运用CT及MRI诊断脑静脉窦血栓形成价值,探讨其临床适用性。方法选择从2009年5月-2012年11月于我院经临床确诊的32例脑静脉窦血栓患者的CT、MRI影像学资料进行回顾性分析。观察两种检查方法的诊断情况。结果脑静脉窦血栓发病在7d内的患者,CT检查的阳性率为52.38%,发病12d内的阳性为72.73%,总阳性率达59.38%。其中血栓位于直窦和下矢状窦6例,上矢状窦11例,累及横窦-乙状窦4例,累及脑深部大静脉及皮质引流静脉4例;其他部位7例;19例急性患者的CT平扫可见CVST患者静脉窦内条带状或三角形高密度影,结论诊断为脑水肿征象,脑梗死或出血性梗死。CVST患者MR检查,阳性检出率为97.14%,典型患者可见脑静脉窦内异常等信号或高信号影,流空效应消失,结论诊断为脑水肿征象。结论颅脑CT平扫是诊断急性CVST的简单、有效的方法,可以作为一种广泛的筛查方法;而对于亚急性以及慢性CVST患者,MRI可以显示较为特征性表现,对于诊断CVST价值高,在临床上可斟酌应用。     

Identification of RPL5 gene variants and the risk of hepatic vein thrombosis in Saudi patients

Objectives:To identify ribosome protein L5 gene variants and the risk of hepatic vein thrombosis in Saudi patients.Methods:A case-control study was conducted during the period of May 2018 to September 2019. Sixty-five patient cases of hepatic vein thrombosis (HVT) were chosen, and 50 healthy individuals of the same ages and both gender were set as a control group. The genotype of the gene RPL5 was determined by PCR please provide abbreviation in full and capillary electrophoresis. Sanger sequencing for genetically screened variants was applied for the RPL5 gene.Results:Alleles A at variant rs182018447 and T allele at variant rs559377519 were strongly corelated (p=0.009 and p=0.037, respectively) with the risk of HVT. The genotype frequencies of the RPL5 gene, the A/A genotypes at rs182018447 and T/T at rs559377519 were associated with HVT (p=0.000 and p=0.004; respectively) and an increase in risk for HVT among these patients. Please rephrase the highlighted text without using the word respectively.Conclusion:Our findings indicate that the 5 genetic novel variants examined in the RPL5 gene were associated with a risk of HVT in all our Saudi cases. Additionally, the A/A at rs182018447 and T/T at rs559377519 genotypes were substantially susceptible to HVT in all these patients.     

Functional somatic illnesses in patients with functional bowel disorders: A cross-sectional cohort study in western Saudi Arabia

Objectives:To study the prevalence of functional gastrointestinal disorders (FGID) in Saudi patients with irritable bowel syndrome (IBS).Methods:A cross-sectional study was conducted in patients with IBS treated at a private tertiary medical center in western Saudi Arabia between 2013 and 2017. We used ROME 3 criteria with data from the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire-9 (PHQ-9) depression scale, and International Classification of Headache Disorders (ICHD) to assess the prevalence of psychosomatic illness. Statistical analysis of frequency and statistical correlation was performed using Chi-square.Results:The final analysis of 307 patients revealed a combined 425 diagnoses of psychosomatic illness, including diagnoses of headache in 104 patients (34%), migraine in 93 patients (30.5%), fibromyalgia in 169 patients (55%), and depression in 59 patients (19%). There was a statistically significant correlation between patients’ ages and diagnoses of joint pain and migraines.Conclusion:Fibromyalgia and headache disorders were common in this cohort of Saudi patients with IBS. This coexistence of illness is partly explained by the functional nature of these illnesses. Collective efforts to provide multidisciplinary care is needed for these patients.     

肿瘤相关因素与胃癌患者术后下肢深静脉血栓形成的关系研究

目的 探讨肿瘤相关因素与胃癌患者术后下肢深静脉血栓形成之间的关系，为肿瘤患者术后血栓防治提供参考。方法 收集2016年10月—2018年12月于郑州大学第一附属医院胃肠外科手术的258例胃癌患者的临床资料，统计手术后患者下肢深静脉血栓形成（DVT）人数，分析肿瘤相关因素对下肢DVT的影响。结果 135例患者中，术后发生下肢DVT 60例（44.4%），其中左下肢19例（14.1%），右下肢11例（8.1%），双侧下肢30例（22.2%）。根据术后下肢DVT情况分为血栓组和非血栓组。两组术前是否行新辅助化疗和手术后CA125水平比较，差异有统计学意义（P <0.05）。多因素Logistic回归分析结果显示手术后CA125水平升高超过5 u/ml［R=3.227（95% CI：1.181，8.812）］是术后下肢DVT发生的危险因素。新辅助化疗后两组缓解率比较，差异有统计学意义（P =0.018），非血栓组缓解率更高。结论 术后CA125水平较术前升高超过5 u/ml的患者术后发生下肢DVT的人数明显增加；新辅助化疗后病情缓解的患者术后发生血栓的风险降低。     

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study

Objectives:To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population.Methods:This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations.Results:A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms.Conclusion:This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.     

Correlation of prognostic and predictive indicators in breast cancer patients from the eastern province of Saudi Arabia

Objectives:To highlight and correlate demographic and histopathological features of breast cancer along with prognostic and predictive biomarkers, in Saudi patients from the Eastern Province and compare it to a cohort of non-Saudi patients.Methods:In a retrospective study between January 1998 and December 2017, data were collected from the medical records of breast cancer patients who were admitted at King Fahd University Hospital (KFHU), Dammam, Saudi Arabia. The information included demographic, histopathological, and immunohistochemical findings.Results:Out of 482 breast cancer patients, 60% (n=286) were Saudis, and 40% (n=196) were non-Saudis. Data showed a wide age distribution; however, most cases (80%) were seen in the third through fifth decades, with a median age at diagnosis of 51 ±12 years. Over years, breast cancer in Saudi patients was increasingly seen at a younger age (p=0.003). While tumors were increasingly detected at earlier stages (p=0.003); however, stage III & IV tumors (p=0.033) and human epidermal growth factor receptor-2 overexpressed tumors (p=0.035) were more frequently seen at a younger age. Interestingly, these associations were not significant in non-Saudi patients.Conclusion:Although, the current findings might help future studies to identify variables that could lead to better management of breast cancer in this region; however, a wider investigation including other centers in the eastern province is needed.     

The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study

Objectives:To assess the neutrophil-to-lymphocyte ratio (NLR) diagnostic and prognostic value in the context of Coronavirus disease-2019 (COVID-19) infection in Saudi Arabia.Methods:A case-control study in which 701 confirmed COVID-19 patients (of which 41 were intensive care unit [ICU]-admitted) and 250 control subjects were enrolled. The study was conducted retrospectively in October on patients admitted to 3 separate hospitals in Saudi Arabia namely: King Abdullah Bin Abdulaziz University Hospital (Riyadh), Ohud Hospital (Madinah), and Nojood Medical Center (Madinah) between May and September 2020. Neutrophil-to-lymphocyte ratio was calculated based on absolute neutrophil and lymphocyte count. Institutional ethical approval was obtained prior to the study.Results:Patients (median age 35 years), of which 54.8% were females, were younger than the control cohort (median age 48 years). Patients had significantly higher NLR compared to the control group. Intensive care unit admitted patients had significantly higher platelet, WBC and neutrophil counts. The ICU patients’ NLR was almost twice as of the non-intensive patients. The NLR value of 5.5 was found to be of high specificity (96.4%) and positive predictive value (91.4%) in diagnosing COVID-19. Furthermore, it had a very good sensitivity (86.4%) in predicting severe forms of disease, such as, ICU admission.Conclusion:Neutrophil-to-lymphocyte ratio is an important tool in determining the COVID-19 clinical status. This study further confirms the prognostic value of NLR in detecting severe infection, and those patients with high NLR should be closely monitored and managed.     

Complete blood cells count abnormalities in COVID-19 patients and their prognostic significance: Single center study in Makkah,Saudi Arabia

Objectives:To evaluate the role of different peripheral blood count parameters as a cheap and rapid test in determination of coronavirus disease -19 (COVID-19) severity and patients’ outcome.Methods:The data of 462 confirmed COVID-19 patients who attended at the Security Force Hospital, Makkah, Saudi Arabia, from October 2020 to March 2021 was retrospectively reviewed and C. Patients with viral infection and respiratory diseases other than COVID-19 were excluded from the study. Complete blood count parameters were compared in accordance with the severity of the clinical presentation, age, and disease outcome.Results:A total of 277 (60%) were male and 185 (40%) female. Clinically, 32 (6.9%) had severe illness and 430 (93.1%) showed moderate clinical disease. Organ failure occurred in 2.8% of the patients. There was significant leucocytosis, neutrophilia, lymphopenia, high neutrophil-lymphocyte (N/L) ratio, and anemia in patients with severe COVID-19 diseases as well as in non-survivors’ cases (p<0.001). Similarly, the inflammatory markers (C-reactive protein [CRP] and serum ferritin) were significantly elevated in the above-mentioned 2 groups (p<0.001). Significant decrease of the platelets count was detectable in clinically severe cases and non-survivors (p<0.01). Older age (>60 years) was associated with high leucocyte, neutrophil count, lymphopenia, anemia, organ failure, and poor outcome.Conclusion:Leucocytosis, neutrophilia, lymphopenia, and high N/L ratio together with elevated serum level of ferritin and CRP are eminent features of COVID-19 severity. The inclusion of these parameters in the regimens for patients’ categorization on admission will enable early effective intervention and proper decision making during clinical case management.     

妊娠合并颅内静脉血栓形成12例分析

目的探讨妊娠合并颅内静脉血栓形成的危险因素、临床特点和母婴结局。方法回顾分析我院2005年1月至2010年1月发生的12例妊娠合并颅内静脉血栓形成患者临床表现及结局。结果 (1)有12例颅内静脉血栓形成,发生比例为0.17‰。重度子痫前期/子痫共1775例。发生颅内静脉血栓形成10例,发生比例为5.63‰。(2)临床特点:发病时间多发于术后24h内。首发症状多为头痛、呕吐、视物不清等颅内压增高表现。依据血栓形成部位不同可引起神经局灶性体征。如抽搐,肌无力,偏瘫,四肢瘫,视力障碍和病理反射征阳性。所有患者CT均为上矢状窦静脉血栓形成。结论妊娠合并颅内静脉血栓形成好发于重度子痫前期/子痫患者,多发生于术后24h内。表现为产科用药难以控制的抽搐应立即行神经影像学检查:如CT,MRI等尽早诊断,尽早治疗。血清D-二聚体、纤维蛋白原、HDL-C检测可能有一定的预测意义。     

脑静脉血栓形成的研究进展

脑静脉血栓形成（CVT）是多种病因导致的发生于颅内静脉或静脉窦的一种少见血栓形成疾病。该文就CVT的病因、机制、诊断、治疗、预后等作一综述。     

颅内静脉窦血栓形成的病例分析及文献复习

目的探讨颅内静脉窦血栓形成（CVST）的诊断及治疗措施。方法回顾性分析19例CVST患者的临床资料。结果19例患者中青年患者占78.9%。急性亚急性起病的占94.7%。临床表现以头痛多见,占73.8%。10例行腰穿检查,7例出现出现压力升高。头颅CTV、MRV及DSA均可发现受累静脉窦,以横窦、乙状窦受累多见,占89.4%,其次为上矢状窦血栓。治疗上主要采取综合治疗,抗凝治疗为最主要治疗。结论CVST临床表现多样,无特异性,早期诊断需借助头颅CTV、MRV及DSA,治疗上以抗凝治疗为主,应考虑联合介入治疗,早诊断、早治疗为关键。     

Cerebral venous sinus thrombosis: a clinical study of 23 cases

Objective To describe the etiologies, clinical features and diagnosis of cerebral venous sinus thrombosis.
Methods We reviewed the records of 23 patients admitted with a documented diagnosis of c erebral venous sinus thrombosis from 1991 through 1999 in the Beijing Tiantan Hospital.
Results Infection was the major condition associated with cerebral venous sinus thrombos is. Pseudotumor cerebri syndrome was the most common manifestation, while hemip legia, seizure and unconsciousness may occur alone or in association. The diagn ostic sensitivity of computed tomography (CT), magnetic resonance imaging (MRI) and digital subtract angiography (DSA) were 59%, 86% and 100%, respectively. Th e sensitivity of MRI with magnetic resonance angiography (MRA) reached 96%.
Conclusion As the clinical findings were found to be nonspecific, CT combined with DSA, or MRI with MRA turns out to be valuable for the early diagnosis of cerebral venous sinus thrombosis.     

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.