Cyanoacrylate glue as a novel skin substitute in periocular skin excisions: case series and literature review.

OBJECTIVE: Despite the widespread use of cyanoacrylate glue (CA) as an alternative for wound closure, its potential as a sole skin substitute material in periocular skin surgery remains unexplored. The primary objective was to determine the viability of CA as a sole skin substitute in periocular skin surgery after excision. DESIGN: Single-centre retrospective observational case series. METHODS: All patients were treated at the McGill University Health Centre from August 2023 to November 2023, where CA served as the sole skin substitute material after periocular skin excision. RESULTS: Three female and one male patient, with a mean age of 75 years, received treatment with CA after skin excision for both cancerous and benign skin lesions. Specifically, histopathology revealed 2 cases of basal cell carcinoma, 1 case of squamous cell carcinoma in situ, and 2 benign lesions. The skin defects after excision ranged from 4 × 3 mm to 15 × 30 mm. No complications were observed between CA graft insertion and final skin re-epithelization. Complete re-epithelization was achieved in all patients at final follow-up without evidence of excessive skin contraction. CONCLUSIONS: This study presents a novel approach by using CA as a skin substitute material in periocular skin excisions. Its liquid form allows for easy application and conforms well to irregular wound surfaces. CA may offer economic advantages, including lower material cost and shorter surgical operating times, compared with traditional skin substitutes. Further research is needed to comprehensively evaluate CA's role as a skin substitute in periocular skin reconstruction.

Outcomes of ST-Elevation Myocardial Infarction in Patients With Opioid Dependence: A National Inpatient Sample Study.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a critical condition characterized by the sudden obstruction of one or more coronary arteries, resulting in diminished blood flow to the heart muscle. This acute ischemic event demands swift and precise intervention to minimize myocardial damage and preserve cardiac function. Opioids, a class of potent analgesic medications, are frequently utilized in the management of STEMI-related chest pain. Despite their efficacy in alleviating discomfort, their use in this context warrants careful consideration due to potential adverse effects and interactions.  Methods: In this large nationwide retrospective observational study, we evaluated the effect of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Data was collected for 2019 from various hospitals across the United States using the National Inpatient Sample (NIS) through the Healthcare Cost and Utilization Project (HCUP). Using the International Classification of Diseases-10 codes (ICD-10), we identified a primary diagnosis of STEMI in patients over the age of 18, as well as a secondary diagnosis of opioid dependence.  Complex samples and multivariable logistic and linear regression models were used to determine the association of opioid dependence on inpatient mortality, length of hospitalization, and cost of hospitalization of patients with STEMI. Of the patients who fit our criteria, we identified other comorbidities and diagnoses associated with them as potential confounders including drug abuse, hypertension, diabetes, alcohol use, obesity, peripheral vascular disease, and chronic lung disease. Other confounders that were adjusted for include race, Charlson Comorbidity index, median household income, insurance, hospital region in the US, hospital bed size, and teaching status of the hospital.  Results: A total of 661,990 patients presented to a hospital with a primary diagnosis of STEMI in 2019. The majority of the patients were male with a mean age of 62.5+/-3.4 and were Caucasian American. Patients who were opioid dependent were found to be on average younger, earned less than the 25th percentile household income, had a higher history of illicit drug and alcohol use, and had Medicaid. They were also found to have higher rates of chronic lung disease at 39.2%, compared to 21.4.% in patients who were not opioid-dependent. Patients who were not opioid dependent were found to have higher rates of hypertension and type 2 diabetes mellitus. Inpatient mortality and cost of hospitalization in STEMI patients with opioid dependence were not statistically different compared to those who were not opioid dependent. However, STEMI patients who were opioid dependent did have an associated longer length of hospitalization.  Conclusion: Opioid use for pain relief in acute coronary syndrome, particularly STEMI, is a mainstay of treatment. Our retrospective cohort dived into assessing the relationship between opioid dependence on its effect on inpatient mortality, length of stay, and cost of hospitalization in STEMI patients. Our study showed that opioid dependence has no significant impact on inpatient mortality. However, it was associated with a longer length of hospital stay in STEMI patients. Further studies may be warranted into the effects of opioid dependence on the length of hospitalization in STEMI patients. .

Impact of Malnutrition on the Outcomes in Patients Admitted with Heart Failure.

Background: Heart failure, a major public health concern, significantly contributes to hospital admissions. This study evaluates the impact of malnutrition on both patient and hospital outcomes in heart failure admissions, with a specific focus on variations in outcomes based on the severity of malnutrition. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Malnutrition was identified using the well-validated ICD 10 codes. We compared outcomes between patients with and without malnutrition, focusing on mortality, length of stay (LOS), hospital charges, cardiac arrest, and cardiogenic shock. Results: Out of 1,110,085 heart failure patients, 36,522 (3.29%) were malnourished. Malnourished patients exhibited significantly higher adjusted in-hospital mortality rates (aOR 3.32; 95% CI 3.03-3.64), longer LOS (mean increase of 4.67 days; p < 0.001), and higher hospital charges (mean increase of USD 77,416.9; p < 0.01). Increased rates of cardiac arrest (aOR 2.39; 95% CI 1.99-2.86; p < 0.001) and cardiogenic shock (aOR 3.74; 95% CI 3.40-4.12; p < 0.001) were also noted in malnourished patients. Severely malnourished patients faced worse outcomes compared to those with mild to moderate malnutrition. Conclusions: Heart failure patients with malnutrition experience higher mortality rates, longer hospital stays, increased hospitalization charges, and greater complication rates, including cardiac arrest and cardiogenic shock, compared to non-malnourished patients. Outcomes deteriorate with the increasing severity of malnutrition. Timely and individualized nutritional interventions may significantly improve outcomes for heart failure admissions.

Delayed Inflammatory Reaction to Hyaluronic Acid Dermal Filler Following Zoledronic Acid Administration: A Case Report.

Zoledronic acid is a bisphosphonate that can be administered intravenously and used to treat several bone disorders. It decreases bone resorption, thereby improving bone mineral density (BMD) and reducing fractures. The Food and Drug Administration (FDA) has approved zoledronic acid for the prevention and treatment of osteoporosis in postmenopausal females and males and for other conditions. Zoledronic acid is generally well tolerated, with most side effects being musculoskeletal or gastrointestinal. Cutaneous side effects include maculopapular rash and other mild skin reactions. Rare severe skin rashes, such as toxic epidermal necrolysis, have been reported. Here, we report the case of a 64-year-old female with a medical history of breast cancer status post-radical mastectomy and chemotherapy presenting with delayed hypersensitivity reaction to a hyaluronic acid dermal filler two days after receiving zoledronic acid intravenously given to maintain bone density, symptoms completely resolved with oral prednisolone 20 mg once daily and cetirizine 10 mg. Cases of delayed inflammatory reaction to hyaluronic acid soft tissue filler have previously been reported in patients who have received vaccination or those with viral infections. However, to our knowledge, there have been no reports of delayed inflammatory reactions to facial hyaluronic acid injections after zoledronic acid administration.

Outcomes and complications of heart failure with iron deficiency anemia: a nationwide analysis.

INTRODUCTION: Heart failure is a pressing public health concern, affecting millions in the United States and projected to rise significantly by 2030. Iron deficiency, prevalent in nearly half of ambulatory heart failure patients, contributes to anemia and diminishes patient outcomes. In this study, we aim to evaluate the impact of iron deficiency anemia on acute heart failure hospitalizations outcomes. METHODS: Utilizing the 2019 National Inpatient Sample (NIS) database, a retrospective observational study assessed 112,864 adult patients hospitalized with heart failure and 7,865 cases also had a concomitant diagnosis of iron deficiency anemia (IDA). RESULTS: Among 112,864 heart failure hospitalizations in 2019, approximately 7% had concomitant iron deficiency anemia (IDA). Heart failure patients with IDA exhibited distinct demographic characteristics, with females comprising 51.1% (p < 0.01) and higher rates of complicated hypertension (p < 0.01), complicated diabetes (p < 0.01), and peripheral vascular disease (p < 0.01). Adjusted mean LOS for patients with IDA was significantly longer at 1.31 days (95% CI 0.71-1.47; p < 0.01), persisting in both HFpEF and HFrEF subgroups. While total hospital charges were comparable in HFpEF, HFrEF patients with IDA incurred significantly higher charges ($13427.32, 95% CI: 1463.35-$25391.29, p = 0.03) than those without IDA. Complications such as atrial fibrillation and acute kidney injury were notably more prevalent in HFpEF and HFrEF patients with IDA. CONCLUSION: The study highlighted that iron deficiency in heart failure patients leads to extended hospital stays, increased costs, and heightened risks of specific complications, particularly in HFrEF. Our study emphasized the implications of IDA in patients with heart failure ranging from prolonged hospitalizations and increased costs. Addressing iron deficiency is crucial, given its substantial impact on heart failure hospitalizations and outcomes, emphasizing the need for proactive diagnosis and management.

The impact of Libman-sacks endocarditis on inpatient outcomes with systemic lupus erythematosus: A retrospective study.

INTRODUCTION: The existing literature offers limited insights into the influence of Libman-Sacks Endocarditis (LSE) on inpatient outcomes in individuals with Systemic Lupus Erythematosus (SLE). This study aimed to explore the characteristics and prognosis of SLE patients with LSE and the impact of LSE in patients with SLE on inpatient outcomes including inpatient mortality, length of stay, acute heart failure, atrial fibrillation, and cerebrovascular accidents (CVA). METHODS: This study included adult patients who were hospitalized with SLE between the years 2019 and 2020, using the National Inpatient Sample (NIS) database. The total number of patients with a diagnosis of SLE in the years 2019 and 2020 in the NIS database was 150,411. Of those, 349 had a diagnosis of LSE. The study population was divided into two groups: one group with SLE and LSE, and another group with SLE but without LSE. RESULTS: Caucasians made up 54.9% of the patients with a diagnosis of SLE in our patient population, while African Americans made up 26.9% and the Hispanics accounted for 12.2%. Of patients with LSE, Caucasians and African Americans represented 42.9% each. Patients with a diagnosis of LSE had a higher inpatient mortality than those with SLE without LSE (aOR: 9.74 CI 1.12-84.79, p 0.04). Patients with SLE with LSE were more likely to have acute heart failure than those without LSE, although this was not statistically significant (aOR 1.18 CI 0.13-11.07, p 0.88). Similarly, patients with SLE with LSE were more likely to have atrial fibrillation than those without LSE (aOR 4.45 CI: 0.77-25.57, p 0.10). CVAs were significantly higher in SLE patients with LSE than those without LSE (aOR 141.43 CI 16.59-1205.52, p < .01). DISCUSSION: Patients who develop LSE were found to have significantly higher risks of inpatient mortality and cerebrovascular accidents. Early and precise detection of LSE in such patients may ensure timely intervention and prevention of the associated adverse outcomes. Further studies may attempt to develop screening methods for detection of LSE to effectively reduce morbidity and mortality associated with SLE.

Prevalence and Awareness of Carpal Tunnel Syndrome Among Adults in Tabuk City of Saudi Arabia: A Cross-Sectional Study.

Background Carpal Tunnel Syndrome (CTS) is a condition when the median nerve is entrapped and compressed within the wrist. It significantly affects the quality of life and work productivity of the affected individuals. Aim This study aimed to assess the prevalence of CTS and the risk factors associated with this condition among the general population in Tabuk City, Saudi Arabia, and to explore their knowledge of the causes, manifestations, and treatment options. Methods This cross-sectional study included male and female adult residents of Tabuk City aged 18 years and above who agreed to participate in the study. Data were collected using an online, self-administered questionnaire that was distributed to the public using different social media platforms. Results In this study, the prevalence of CTS was 3.4%. The presence of chronic diseases was a significant risk factor for the CTS (p = 0.003). Participants having chronic diseases were 6.370 times more likely to develop CTS (AOR: 6.370, 95% CI: 2.048 to 19.817). The participants had good levels of awareness about the causes (89.3%), clinical manifestations, and treatment of CTS (92.2%). There was a significant association between the level of knowledge about the causes of CTS and gender (p=0.014). Females (74.3%) showed a higher level of knowledge than males (25.7%). As well, the young (18-25) age group (67.9%) was more significantly aware of the causes of CTS in comparison to the other age groups (p=0.023). Conclusion The prevalence of carpal tunnel syndrome among the adult population in Tabuk City, Saudi Arabia, was 3.4%, and the significant underlying risk factors were chronic diseases such as diabetes mellitus, hypothyroidism, and rheumatoid arthritis. The level of awareness of CTS was satisfactory.

The efficacy of non-pharmacological and non-pacing therapies in preventing vasovagal syncope: Tilt training, physical counter pressure maneuvers, and yoga - A systematic review and meta-analysis.

BACKGROUND: Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural control. Recurrent episodes of VVS significantly impact the quality of life and are a common reason for emergency department visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes. RESULTS: A total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128-0.471, p-value <0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018-0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171-0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165-0.524) compared to control. CONCLUSION: Non-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment.

Safety and Efficacy of Direct Oral Anticoagulant in Addition to Antiplatelet Therapy After Acute Coronary Syndrome: A Systemic Review and Meta-analysis of 53,869 Patients.

INTRODUCTION: Significant progress has been made in the management of patients with acute coronary syndrome (ACS) during the past few decades. However, the role of direct oral anticoagulants (DOACs) in post-ACS prophylactic therapy remains unknown. This study aims to assess the efficacy and safety of DOACs plus antiplatelet treatment (APT) after ACS. METHODS: A systematic literature search was conducted to identify randomized clinical trials comparing DOACs plus APT with APT alone after ACS. The primary efficacy end points were cardiovascular mortality, myocardial infarction, all-cause mortality, and stroke and systemic embolization (SSE). The primary safety end point was major bleeding. The random-effects model was used to calculate relative risk (RR) and corresponding 95% CIs. RESULTS: Nine trials with a total of 53,869 patients were identified, with 33,011 (61.2%) in the DOACs plus APT group and 20,858 (38.8%) in the APT alone group. The use of DOACs did not decrease the risk of cardiovascular death (RR = 0.87; 95% CI, 0.75-1.01; P = 0.08; I2 = 0%) or myocardial infarction (RR = 0.90; 95% CI, 0.80-1.02; P = 0.10; I2 = 6%). However, the risk of SSE was significantly lower in patients who received DOACs plus APT compared with APT alone (RR = 0.67; 95% CI, 0.50-0.90; P = 0.008). Moreover, all-cause mortality was significantly lower in the DOACs plus APT group (RR = 0.83; 95% CI, 0.71-98; P = 0.03; I2 = 0%). However, the risk of major bleeding was significantly higher in patients treated with DOACs plus APT compared with APT alone (RR = 2.53; 95% CI, 1.96-3.26; P < 0.01; I2 = 0%), as was the risk of nonmajor bleeding (RR = 2.27; 95% CI, 1.51-3.41; P < 0.01). IMPLICATIONS: DOACs plus APT for the prevention of left ventricular thrombus in patients with ACS were associated with a lower risk of SSE and all-cause mortality but increased the risk of major and nonmajor bleeding. The benefits and risks of this approach should be weighed based on a patient's individual clinical characteristics.

The Association Between Myocardial Bridging and Hypertrophic Cardiomyopathy and Their Implications on Percutaneous Coronary Intervention Outcomes: A Retrospective Study.

Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, often associated with adverse outcomes, including sudden cardiac death. Myocardial bridging (MB), where a coronary artery segment traverses intramurally within the myocardium, complicates coronary blood flow dynamics. This retrospective study investigates the relationship between MB and HCM and their impact on percutaneous coronary intervention (PCI) outcomes. Data from the 2019 National Inpatient Sample (NIS), representing 20% of U.S. hospitalizations, was utilized. Patients with both HCM and MB undergoing PCI were identified and analyzed. The study assessed inpatient outcomes, including mortality, length of stay, hospital cost, and post-PCI complications (atrial fibrillation, acute kidney injury, bleeding, coronary dissection). Patients with HCM and MB exhibited distinct demographics. The study did not find significant associations between HCM/MB and inpatient mortality, length of stay, or hospital cost. However, HCM patients had a higher incidence of atrial fibrillation and acute kidney injury post-PCI (aOR 2.33, 95% CI 1.46 to 3.71, p ≤ 0.001). MB was linked to increased occurrences of acute heart failure (aOR 0.62, 95% CI 0.42-0.92, p = 0.02) and post-PCI bleeding (aOR 4.88, 95% CI 1.17-20.2, p = 0.03). This nationwide study reveals unique demographic profiles for HCM and MB patients. Notably, HCM patients face higher risks of post-PCI complications, including atrial fibrillation and acute kidney injury. These findings provide fresh insights into the MB-HCM relationship and its implications for PCI outcomes. They emphasize the need for tailored interventions and improved patient management in cases involving both HCM and MB.

Patients' Satisfaction With Virtual Phone Clinics During the COVID-19 Pandemic at Outpatient Clinics in a Teaching Hospital, Riyadh, Saudi Arabia.

Introduction The concept of virtual clinics, which have been in existence since the 1960s, was initially limited to military and space applications due to infrastructure limitations. However, with the evolution of communication technology and infrastructure improvements, virtual clinics became accessible to the general public, although they were not widely adopted until the coronavirus disease 2019 (COVID-19) pandemic. Virtual clinics offer several benefits, including overcoming distance-related challenges, providing healthcare services to underserved areas, reducing medical costs, and saving patients time. this research aims to assess patient satisfaction with virtual clinics in Saudi Arabia after the COVID-19 pandemic preventive measures are lifted, allowing for a comparison between virtual and traditional face-to-face clinics. This research aims to provide a more comprehensive assessment of patient satisfaction with virtual clinics. Methods We conducted a cross-sectional study and interviewed patients who had attended KKHU (King Khalid University Hospital) outpatient clinics during the COVID-19 pandemic to assess their level of satisfaction with virtual clinics through a questionnaire. Results The questionnaire was completed by 221 participants, 201 of whom met our inclusion criteria. The average score was 3.89, the standard deviation was 0.76, and the overall satisfaction ranged from 3.78 to 4. The mean and SD of the overall technical aspect satisfaction were 4.1 and 0.897, respectively. The mean and SD for the total perceived quality of care satisfaction were 3.89 and 0.95, respectively. The mean score for overall administration satisfaction was 3.74, and the SD was 0.92. The mean and SD for the virtual clinics as a whole were 3.82 and 0.73, respectively. Conclusion The overall level of satisfaction was 3.78 out of 5; however, 53% of participants did not want their next visit to be virtual and 73% of males and 63% of females were satisfied with KKHU outpatient clinics.

Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.

Prevalence and Visual Consequences of Non-adherent Patients Receiving Anti-vascular Endothelial Growth Factor (VEGF) Injections at King Fahad Specialist Hospital (KFSH), Qassim Region.

BACKGROUND: Anti-vascular endothelial growth factor (VEGF) injection treatment is a widely utilized therapy for various retinal diseases, including diabetic macular edema (DME). Therefore, the importance of compliance and follow-up should be discussed with the patient. There have been no studies conducted in the Qassim region to estimate the prevalence of patients missing their anti-VEGF appointments. To fulfill this need, we conducted this study to evaluate the compliance rate of patients treated with anti-VEGF injections for DME as well as to determine the visual consequences of the delay in anti-VEGF treatment in the Qassim region. METHODOLOGY: This observational retrospective cohort study was conducted at King Fahad Specialist Hospital (KFSH) in the Qassim region of Saudi Arabia. We extracted all file numbers of patients who were using intravitreal anti-VEGF injections to treat DME. The data were managed and analyzed using the IBM Statistical Package for the Social Sciences (SPSS) software (IBM Corp., Armonk, NY, USA). RESULTS: In the current study, we were able to collect data from 198 patients who received anti-VEGF treatment in the hospital. Among the participants, 57.6% were male, with a mean age of 61.7 years old (standard deviation (SD) = 10.23). Among the patients, we found that the rate of non-adherence to the anti-VEGF injection was 54.5%, and those patients delayed their scheduled doses for more than 56 days. In 47.5% of the patients, delaying or stopping their appointments had no known reason; however, blepharitis was the main reason for delaying or stopping the dose in 27.7% of the patients, followed by endophthalmitis in 18.7% of the patients. There is no significant difference between before and after stopping the treatment, considering visual acuity (VA) or optical coherence tomography (OCT). However, regarding the disease progression, we found that 15 out of the 30 patients had worsened in the OCT after they missed their injections (mean increase in the VA was 6.069 (SD = 97.45), t = -0.278, P = 0.783, and decrease in the OCT was -14.9667 (SD = 133.87, P = 0.454). CONCLUSION: There is a high rate of patients who missed their appointments for an anti-VEGF injection. This resulted in the worsening of OCT in half of the 30 patients who were enrolled in the visual consequences study, which had a negative impact on treatment and disease progression.

Monthly variations in acute coronary syndromes outcomes during the first year of the COVID-19 pandemic.

BACKGROUND: Cardiovascular disease, particularly acute coronary syndromes (ACS), is the leading cause of death in the United States. Minor fluctuations in hospital admissions for different conditions, including ACS, can be seen throughout the year. This study focuses on the impact of admission month on outcomes of acute coronary syndromes during the first year of the COVID-19 pandemic. METHODS: This was a retrospective observational study of patients hospitalized with ACS from the National Inpatient Sample, during the years 2020 (n = 779,895) and 2019 (n = 935,975). We compared the monthly outcomes for every month to the outcomes for the month of January of that same year. The primary outcomes of interest were in-hospital mortality and time from admission to PCI. RESULTS: Inpatient mortality for patients admitted with STEMI was significantly higher for admissions in the months of April, October and December of 2020 than January of that same year. For patients admitted with NSTEMI or UA, inpatient mortality was higher for admissions in April and December 2020 when compared to admissions in January 2020. Inpatient mortality for patients with STEMI, NSTEMI and UA was not different based on admission month in the year 2019. CONCLUSION: The month of admission significantly affected outcomes for patients admitted with ACS during the COVID-19 pandemic, with higher inpatient mortality and longer time from admission to PCI for certain months in 2020. Further studies should investigate disparities in monthly ACS outcomes for the year 2021 and onward, now that COVID-19 infections have been steadily declining.

Comparison of Hematological Parameters Between Survivors and Non-Survivors COVID-19 Patients in Saudi Arabia.

Objective: Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a communicable disease transmitted through the respiratory route and bodily contact. The severity of infection and mortality rate of COVID-19 cases was significantly high in the initial stages of the pandemic. This study aims to investigate the hematological profile of COVID-19 survivors and non-survivors. Methods: This is a single-center retrospective study. A total of 108 hospitalized patients with laboratory-confirmed COVID-19 at East Jeddah Hospital between April and August 2020 were categorized into two groups based on outcome as survivors (n = 54) and non-survivors (n = 54). Hematological parameters and clinical profiles were analyzed and compared between the two groups. Results: The mean age and standard deviation of the survived (30-71 years) and non-survived (33-83) groups was 53 ± 10.8 and 57.9 ± 12.2 years, respectively, with no statistically significant difference in age between groups (p = 0.0513). Non-survivors had a significantly longer median length of stay in the intensive care unit (ICU) (7 days, IQR: 4.24 to 12) compared to survivors COVID-19 patients (5 days, IQR: 0 to 11.75) (p = 0.0151). For the survivors group, the participant's age positively correlated with the length of hospital stay (r(52) = 0.21, p = 0.0005) and ICU length of stay r(52) = 0.18, p = 0.001). The median red blood cells (RBC) counts were significantly higher in the survived group (4.56x109/L, IQR: 4.02 to 5.11) in comparison with the non-survived (4.23x109/L, IQR: 3.75 to 4.23) group (p = 0.0011). All COVID-19 patients exhibited lymphocytopenia and a significant negative correlation was observed between the lymphocyte values and length of hospital stay among the survived group (p < 0.001) as well as length of ICU stay among the survived group (p < 0.0480). Disease-related mortality was significantly associated with reduced white blood cells (WBCs) (8.5×109/L, IQR: 6.1 to 11.7) and reduced basophils (0.09%, IQR: 0.02 to 0.19). Additionally, statistically significant differences were found between the survived and non-survived groups with respect to prothrombin time (PT) (12.5 sec. vs 14 sec., p < 0.0001) and partial thromboplastin time (PTT) (31.8 sec. vs 40 sec., p = 0.0008). Conclusion: Hematological parameters can serve as valuable indicators to identify patients with severe COVID-19 and expected poor-prognosis/outcomes upon hospital admission. Cell counts of lymphocytes, WBCs, basophils and parameters such as PT and PTT can serve as clinical indicators to assess disease severity and predict progression to critical illness.

Knowledge and Attitudes of First Aid and Basic Life Support Among Public School Teachers in Qassim, Saudi Arabia.

OBJECTIVE: This study aims to address the knowledge gap in first aid and basic life support (BLS) among teachers, expand the targeted schools to elementary and intermediate schools for boys and girls, and develop clear, focused recommendations. Furthermore, to assess the knowledge, skills, and attitude of BLS among schoolteachers in Qassim, Saudi Arabia. METHODS: This cross-sectional study was conducted in the school year of 2022 to 2023. In Buraidah city and the Uyun AlJiwa and Asyah governorates of Qassim, there are a total of 906 elementary and intermediate schools employing 12,057 teachers (5447 males and 6610 females). A stratified random sampling method was used with a self-administered Arabic questionnaire. This questionnaire included multiple parts (sociodemographic data, previous training status, knowledge and skill of BLS, and assessment of the following: attitude to learn and practice CPR; barriers to performing CPR; the presence or lack of previous resuscitation experience in BLS). Data were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were described by frequency and percentage, while continuous variables were described by mean ± SD. A normality test showed that the total knowledge and skills scale was not normally distributed. The Mann-Whitney and Kruskal-Wallis tests were used to compare the mean knowledge and skills scale across variables. The accepted level of significance was below 0.05 (p <0.05). RESULTS: Our study included 482 participants. Only 19.5% (94) had previous CPR training, and 80.9% (76) were trained more than two years prior to this study's data collection. The main reason for participants' fears of applying BLS was the lack of proper knowledge and skills (48.1%). The majority of the teachers, i.e., 71.0% (342), wanted more training in CPR, and 41.1% (198) thought CPR training should be mandatory at school. We found no statistical relationship between attitude toward training and the city or differences in knowledge and skills scores due to the difference in sociodemographic characteristics. Also, we found no statistical relationship between the question 'Did you observe CPR on a collapsed patient?' and the city, meaning that the observation of CPR on collapsed patients is independent of the respondent's school location. Significant differences in skills scores were found between those who had CPR observation and those who did not (p = 0.014), in knowledge scores between those who had previous CPR training and those who did not (p = 0.034), and in skills scores between those who had previous CPR training and those who did not (p <0.001). We found no significant differences in knowledge and skills scores according to the place of previous CPR training (p = 0.163 and p = 0.695, respectively). CONCLUSION: This study reveals that knowledge and skills in BLS among schoolteachers need to be improved. For this reason, we emphasize the inclusion of International Liaison Committee on Resuscitation (ILCOR) recommendations in the curriculum and that they are made periodic and mandatory for teachers. Especially as we found teachers to have a positive attitude and were willing to train and help.

A Systematic Review and Meta-Analysis of the Prevalence of Hallux Valgus in the General Population.

The objective of this systematic review was to determine the prevalence of hallux valgus (HV) in the general population by conducting a review and meta-analysis of existing studies. Published articles on the incidence of HV were systematically searched and evaluated on reputable medical databases such as PubMed. The keywords "the prevalence of hallux valgus and/or bunions"were used to create the search syntax on the various databases. Data were gathered on prevalence, population under study, and methodology. A total of 11 articles that met the search criteria were identified and included in this review for a total of 10,886 participants across the studies. The pooled prevalence of HV across the studies was3.75 (95% confidence interval = 0.388-0.517). Therefore, the prevalence varied widely across the studies reviewed. Prevalence was observed to be high among females and increased with risk factors such as body mass index, which were identified as significant across the studies. This review was limited by insufficient data and the lack of a standard HV diagnosis method. Therefore, a standard HV diagnosis tool is recommended.

Body Mass Index and Outcomes of Transcatheter Aortic Valve Replacement: A Retrospective Observational Study.

The influence of body mass index (BMI) on Transcatheter Aortic Valve Replacement (TAVR) outcomes has been the focus of several previous studies. In this study, we examined the relationship between BMI and various clinical outcomes following TAVR procedures. A comprehensive analysis was conducted using a large cohort of patients who underwent TAVR. In this study, we identified patients who underwent Transcatheter aortic valve replacement (TAVR) in the year 2020. Procedure Classification System (ICD-10-PCS) codes were used to identify TAVR cases. The weighted final study sample included 77319 TAVR hospitalizations. Patients were categorized into 5 groups based on their Body Mass Index (BMI. Our findings revealed that there was no significant difference in in-hospital mortality among different BMI groups when compared to patients with a normal BMI (20 to 24.9). patients with a BMI of 25 or higher demonstrated a statistically significant shorter duration of hospitalization compared to those with a normal BMI. patients with a BMI ranging between 30 and 39.9 exhibited decreased hospitalization costs when compared to patients with a normal BMI. Moreover, our study revealed a decrease in atrial fibrillation, acute heart failure and acute kidney injury complications following TAVR in patients with above-normal BMI. Despite similar in-hospital mortality across BMI groups, having a BMI of 25 or greater is associated with improved immediate outcomes following TAVR. These benefits in overweight and obese patients are consistent with findings described in recent literature. Further studies are warranted to explore the underlying mechanisms and potential implications of these associations, as well as to optimize patient selection and management strategies for TAVR procedures.

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia.

OBJECTIVES: To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications. METHODS: In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board. RESULTS: We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect. CONCLUSION: The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.