Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare.

OBJECTIVES: To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests. METHODS: A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices. RESULTS: A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001). CONCLUSION: The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.

Spectrum of medulloblastoma subtypes and frequency of MYC amplification; Experience from a tertiary care center in Saudi Arabia.

OBJECTIVE: To clarify the spectrum of morphological and molecular subtypes of medulloblastoma (MBL), in addition to MYC and MYCN amplification statuses in a cohort of Saudi patients. The latter was correlated with patient outcome. METHODS: We conducted a retrospective cohort study of 57 patients with MBL, diagnosed at the central laboratory of King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2006 and 2019. Molecular analysis for MYC and MYCN amplification was performed for the 19 most recently diagnosed patients. RESULTS: Classic MBL was the most prevalent histologic subtype and MBL with extensive nodularity was the rarest. The non-WNT/non-SHH molecular subgroup was the most common while the WNT-activated was the least common. Among 19 patients analyzed, MYC and MYCN amplifications were discovered in 2 (10.5%) and 1 (5.3%) cases, respectively, using interphase fluorescence in-situ hybridization. The 2 MYC amplified cases belonged to the large cell/anaplastic subtype and had the worst outcomes. CONCLUSION: The MYC amplification corresponded with poor prognosis, the large cell/anaplastic variant of MBL, and the non-WNT/non-SHH molecular subtype.

Native valve fungal endocarditis caused by Aspergillus fumigatus: management dilemma.

Fungal endocarditis (FE) accounts for ~50% of the mortality rate associated with predisposing host conditions. Despite optimal therapeutic strategies, the survival rate remains low. FE is mostly caused by Candida albicans and Aspergillus fumigatus. Previous valvular surgery is the most essential risk factor for Aspergillus endocarditis, which observed in 40-50% of cases. However, native valve FE caused by Aspergillus is uncommon, with only a few reported cases. We hereby report a case of native valve FE caused by A. fumigatus with complications following Wegener's disease and prostate cancer. The patient survived after successful management with the combination of surgical and medical therapy. Aspergillus endocarditis is a rare and fatal fungal infection. Despite difficulties in diagnosis and treatment, medical intervention with antifungal therapy and immediate surgical intervention are essential to achieve desirable outcomes.

Enamel demineralization around two different orthodontic bracket adhesive systems: An in vivo study.

OBJECTIVE: To compare the enamel demineralization around the two precoated adhesive bracket systems, APC Flash-Free and APC PLUS (3M Unitek, Monrovia, CA, USA), in clinical settings. MATERIAL AND METHOD: This prospective experimental in-vivo study included 40 premolar teeth, which were planned for extraction due to orthodontic purposes. They were divided into two groups (Group A; n = 20 teeth were bonded with APC Flash Free ceramic brackets and group B; n = 20 teeth were bonded with APC Plus ceramic bracket). After four weeks, the teeth were extracted, sectioned, and examined under the Scanning Electron Microscope (SEM) to evaluate the amount of demineralization from the enamel surface to the deepest point. RESULTS: Findings revealed that the mean values of demineralization under SEM were significantly higher in APC Plus compared to APC Flash Free (149.95 µm vs. 112.96 µm, respectively) (P < 0.05). The difference between the two systems was mainly found in the middle part of the facial surfaces, while there were no differences between the two systems in the proximal parts. CONCLUSION: The enamel demineralization around APC Flash-Free adhesive bracket system was significantly less than that of APC plus Adhesive bracket system, which can be due to the absence of the caries promoting adhesive flash during tooth bonding using the flash free system.

Early and late intramedullary nailing of femur fracture: A single center experience.

BACKGROUND: Femur fracture (FF) is a common injury, and intramedullary nailing (IMN) is the standard surgical fixation. However, the time of intervention remains controversial. We aimed to describe the reamed IMN (rIMN) timing and hospital outcomes in trauma patients presenting with FF. MATERIALS AND METHODS: A retrospective analysis was conducted for all patients admitted with FF and they underwent fixation at level 1 trauma unit between January 2010 and January 2012. Patients were divided into Group I with early rIMN (<12 h) and Group II with late rIMN (≥12 h). Patients' demographics, clinical presentations, mechanism of injury, pulmonary complications, organ failure, length of stay, and mortality were described. RESULTS: A total of 307 eligible patients with FF were identified (156 patients in Group I and 151 patients in Group II). Patients in Group II were older (36 ± 18 vs. 29 ± 9; P = 0.001) and had higher rate of polytrauma (35% vs. 18%, P = 0.001), head injury (5% vs. 12%, P = 0.68) and bilateral FF (10.7% vs. 5.1%; P = 0.07) in comparison to Group I. Group II had longer stay in Intensive Care Unit (7 [1-56] vs. 2 [1-17] days; P = 0.009) and hospital (13 [2-236] vs. 9 [1-367]; P = 0.001). There were no significant differences in outcomes between the two groups in terms of sepsis, renal failure, fat embolism, adult respiratory distress syndrome and death. CONCLUSIONS: Based on this analysis, we believe that early rIMN is safe in appropriately selected cases. In patients with traumatic FFs, early rIMN is associated with low hospital complications and shorter hospital stay. The rate of pulmonary complications is almost the same in the early and late group. Further prospective randomized studies with large sample size would be ideal using the information garnered from the present study.