Insight into prevalence, etiology, and modalities of pediatric chronic dialysis: a comprehensive nationwide analysis.

BACKGROUND: This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. METHODS: This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. RESULTS: The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). CONCLUSIONS: This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries.

Factors influencing the selection criteria of Saudi board orthopedic surgery applicants: a national survey of program directors.

BACKGROUND: Annually, medical students vie to secure a seat with an orthopedic residency program. This rigorous competition places orthopedic surgery as one of the most competitive specialties in the medical field. Although several international studies have been published regarding the factors that influence program directors when choosing their ideal applicant, the data for Saudi Arabia in that regard is absent. METHODS: In this cross-sectional study, we aimed to survey all orthopedic program directors regarding the factors that influence them when choosing their ideal orthopedic surgery applicant. A survey was sent to all program directors via email during the month of August 2022. A reminder was sent 2 weeks later to maximize the response rate. The survey was completed by 22 out of 36 orthopedic program directors, which gave us a response rate of 61.11%. RESULTS: In this study, 22 orthopedic surgery program directors responded to our survey. When program directors were asked to rank the factors of residency selection criteria, the top ranked factors were good impression on interviews; prior experience in orthopedic surgery with, for example, electives; and performance on ethical questions during interviews, with means of 9.18, 8.95, and 8.82 out of 10, respectively. Furthermore, program directors preferred letters of recommendation from recommenders that they personally know, clinical experience such as electives taken at the program director's institution, and the quality of publications as the most important aspects of research. Most program directors (90.9%) relied on their residents' and fellows' opinions when selecting candidates, and 77.3% did not think gender has an influence on selection of applicants. CONCLUSION: By providing comprehensive data regarding the factors that influence and attract program directors of orthopedic surgery when choosing residency candidates. With the data provided by this study, applicants for orthopedic surgery have the advantage of early planning to build a strong application that may help persuade program directors to choose them.

The prevalence of long-term rehabilitation following motor-vehicle crashes in Saudi Arabia: a multicenter study.

INTRODUCTION: In Saudi Arabia, motor-vehicle crashes (MVC) are the leading cause of disability-adjusted life years (DALYs). There is limited information locally on the magnitude and need for rehabilitation following MVC. This study examined the prevalence of MVC patients requiring long-term rehabilitation and the epidemiology of associated injuries. METHODS: A retrospective study was conducted at four hospitals of the National Guard Hospitals Affairs from January 2016 to March 2019. The study used data from an institutional trauma registry of all MVC admissions. Chi-square tests, bivariate and multivariate analyses were conducted to compare patients requiring long-term and short-term rehabilitation. RESULTS: The study included 506 patients. The study population was relatively young, with an average age was 32.8 ± 15.5 years, and the majority were males. Over two-thirds (71.3%) of patients required long-term rehabilitation. Half the patients sustained multiple fractures, and 17.0% sustained traumatic brain injuries. Overall, 53.1 and 61.8% of patients required occupational and physiotherapy, respectively. Those admitted to the intensive care unit were four times more likely to need long-term rehabilitation. CONCLUSIONS: We found a significant burden of long-term rehabilitation following MVC. Patients were relatively young, thus posing a significant burden on future healthcare utilization. Policymakers should use these findings to guide primary, secondary, and tertiary prevention to improve health outcomes.

Use of high-dose denosumab in the management of immobilization-related hypercalcemia in an end-stage renal disease patient on hemodialysis: A case report and review of the literature.

BACKGROUND: There is limited evidence on the safety and efficacy of denosumab for the management of immobilization-related hypercalcemia in hemodialysis patients. We report a case of successful treatment of immobilization-related hypercalcemia with a high dose of denosumab (120 mg). CASE PRESENTATION: A 55-year-old, bed-ridden woman was admitted to the intensive care unit with suspected catheter-related bacteremia and septic shock. 13 days following admission, the patient's corrected serum calcium levels rose from 2.52 mmol/L at baseline to 3.39 mmol/L. Cinacalcet, subcutaneous calcitonin, intravenous zoledronic acid, and subcutaneous 60-mg dose of denosumab were administered but resulted in an inadequate response. Consequently, subcutaneous 120-mg dose of denosumab was administered and resulted in a gradual decline of corrected serum calcium levels from 4.18 mmol/L to 2.45 mmol/L within 3 weeks; corrected serum calcium levels were maintained above 2.10 mmol/L and less than 2.80 mmol/L for 3 months after high-dose denosumab administration. CONCLUSION: High-dose denosumab could be a viable treatment option for end-stage renal disease patients developing immobilization-related hypercalcemia.

A cadaveric analysis of tunnel position created using flexible versus rigid instrumentation in a single-incision distal biceps tendon repair.

PURPOSE: This study was designed to determine whether the use of a flexible guide pin and reamer through an anterior single-incision approach would allow for a more anatomic insertion point on the radial tuberosity when compared with the traditional rigid instrumentation used for cortical button fixation. METHODS: Seven matched pairs of fresh-frozen cadaveric upper extremity specimens were used in this study. One specimen from each matched pair was randomly assigned to undergo a simulated repair using the standard instrumentation required for a cortical button fixation device, and the other specimens were assigned to undergo the same repair using a 42° anterior cruciate ligament femoral guide with a flexible guide pin and reamer. Each specimen from both groups was positioned with the elbow in 90° of flexion and the forearm maximally supinated during guide pin insertion. The proximal portion of the radius was then harvested from the specimen and scanned using micro-computed tomography (micro-CT). Tunnel position between the 2 techniques was compared with the center of the native tendon footprint. RESULTS: The mean percentage of the reamed entry hole within the tendon footprint was significantly less using rigid instrumentation (36.35%) compared with flexible instrumentation (67.29%) (P = .043). Furthermore, when flexible reamers were used (mean offset ratio, 0.17), the resultant tunnel was positioned in a significantly more central position within the radial shaft (i.e., the offset ratio was lower) compared with rigid reamers (mean offset ratio, 0.35) (P = .043). The entry hole was found to be significantly more posterior relative to the center of the anatomic footprint for the flexible reamer group (mean, 0.21 mm anterior) compared with the rigid reamer group (mean, 3.22 mm anterior) (P = .028). There was no difference in tunnel length between the 2 groups. CONCLUSIONS: The use of a flexible guide pin and reamer allows for a more anatomically positioned repair than does rigid instrumentation through a single-incision approach. CLINICAL RELEVANCE: This surgical technique allows for a more anatomic re-creation of the distal biceps tendon insertion while maintaining the benefits of a single limited anterior exposure.

Spontaneous knee dislocation: a rare and dreadful complication of septic arthritis.

Spontaneous knee dislocation without a history of trauma is a rare entity to witness. Herein, we report a case of a patient who presented to the emergency department (ED) with a history of fever, chills and vomiting associated with progressive right knee swelling, pain and impaired range of motion (ROM). Physical exam of her right knee showed symmetrical swelling with diffuse tenderness and limited ROM due to pain. Joint aspirate and full septic workup confirmed the diagnosis of septic arthritis. Following her management and two events of irrigation and debridement of the septic knee, the patient was discharged. However, after 1-week from discharge, she presented to ED with right leg swelling and tenderness despite being bedbound for 3 months and denying any history of trauma with radiographs showing a posterior knee dislocation. This report aimed to shed a light on this dreadful complication of septic arthritis and highlights the importance of early recognition and management.

Outcome of the Masquelet Technique for Complex Bilateral Distal Femoral Bone Defects.

Bone defects are severe conditions caused by various etiologies, including trauma, tumor resection, or chronic osteomyelitis. Different surgical interventions can be utilized to manage such cases, including autologous graft or allograft implantation, distraction osteogenesis, acute shortening, amputation, or the induced membrane technique. Herein, the case of a 39-year-old woman with complex bilateral distal femoral fractures with intra-articular extension is presented. The fractures were accompanied by a significant metaphyseal bone defect, which was managed successfully using the induced membrane Masquelet technique. The patient fully healed despite residual knee joint contractures that did not inhibit her mobility. In conclusion, the Masquelet technique successfully manages complex bone defects and restores functionality even in bilateral simultaneous open bone defects.

Clinical outcomes of percutaneous screw fixation of acetabular fracture: A minimally invasive procedure.

Objective: Open reduction with internal fixation is the surgical intervention of choice for acetabular fractures (AFs). Percutaneous screw fixation for AFs is a new procedure that is desirable because of the complex anatomy of the pelvis. In this study, we aimed to assess the functional outcomes, mobility, healing, and distal neurovascular abnormalities in patients who underwent percutaneous retrograde screw fixation. Methods: Our study included 36 patients with AFs treated with percutaneous screw fixation between January 2016 and June 2021. There were 18 cases with anterior column AF, 7 cases with transverse AF, and 11 cases with associated AF, 6 of which had a T-shaped AF. Frequencies and percentages were used to describe characteristics and clinical outcomes. Mean and standard deviation were used for continuous variables. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis. Results: The average time to regain full mobility with full weight bearing was 12.9 ± 5.4 weeks, and approximately 11.1 ± 2.8 weeks was required for patients to be pain-free with satisfactory fracture healing. Only a minority (8.3%) of patients had abnormalities affecting the distal neurovascular system, and 11.1% experienced sexual dysfunction. Pain severity was assessed with a visual analogue scale. The average pain severity on the first and third post-operative days was 4 ± 2.4 and 3.8 ± 2.6, respectively. However, the average pain intensity before discharge was 1.7 ± 2.6. Conclusion: Percutaneous screw fixation is the most efficient surgical choice for most pelvic/AFs.

Traumatic spinopelvic dissociation: A case series.

Introduction: Spinopelvic dissociation was described first in 1969. It is an injury characterized by the separation of the lumbar spine, with parts of the sacrum, from the rest of the sacrum and pelvis with the appendicular skeleton through the sacral ala. Spinopelvic dissociation has an incidence of approximately 2.9% of all pelvic disruptions and corresponds with high-energy trauma. The objective of this study was to review and analyze a case series of spinopelvic dissociations that were treated in our institution from May 2016 to December 2020. Methods: This was a retrospective study reviewing medical records of a series of cases with spinopelvic dissociating. A total of nine patients were encountered. Demographic data including gender and age were analyzed with the mechanism of injury, fracture characteristics, and classifications in addition to neurological deficits. Fractures were classified by the AO Spine Sacral Classification System. Moreover, neurological deficits were classified using the Gibbon's classification score. Finally, the Majeed score was utilized for the assessment of the functional outcome after the injury. Results: A total of nine patients with spinopelvic dissociation were encountered, seven males and two females. Seven patients were due to motor vehicle accidents, one patient was due to a suicidal attempt, and one patient was due to seizure. Four patients suffered from neurological deficits. One patient needed an intensive care unit admission. Spinopelvic fixation was done for all patients. One patient had surgical wound infection with wound dehiscence, one had infected instruments with confirmed spine osteomyelitis, and one had a focal neurological deficit. Six patients went on to heal and showed complete neurological improvements. Conclusion: Spinopelvic dissociation injuries represent a variety of injuries that are commonly associated with high-energy trauma. The triangular fixation method has proven to be a stable construct in dealing with such injuries.

Total knee replacement in a polio patient with prior extension osteotomy: a case report.

Poliomyelitis is an infectious disease characterized by a loss of motor neurons. Affected individuals usually suffer from many abnormalities predisposing them to degenerative joint disease. We report a case of a young male, with a history of poliomyelitis, distal femoral extension osteotomy and previous tendon transfer, suffering from severe knee pain. The patient underwent total knee arthroplasty with posterior stabilized Triathlon® for the femoral side reconstruction and Total-stabilizer Triathlon® for the tibia with short stem. At 2-year follow-up, his range-of-motion had improved, and he could walk without pain. This case report emphasizes the value of careful preoperative planning for a complex case with suitable implants and expecting realistic outcomes.

Adductor canal catheter block after total knee arthroplasty in patients with severe osteoarthritis and limited mobility. A single center study in Riyadh, Saudi Arabia.

Purpose: Total knee arthroplasty (TKA) is one of the most performed procedures. Postoperative pain control is an important factor for the improvement of patient's quality of life. The aim of this study is to report pain control results and functional outcome scores associated with adductor canal blockade (ACB) usage post-TKA. Methods: A prospective case series study of patients who underwent TKA for degenerative osteoarthritis with ACB postoperatively from 2018 to 2019 in a single center in Saudi Arabia, Riyadh. Assessment of functional outcome scores and pain level were measured preoperatively and postoperatively respectively using Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analog Scale (VAS). Results: Average KOOS score preoperatively for all 5 domains showed a marked improvement at 3 months compared to preoperative values. Pain score postoperatively was measured at 12, 24, and 48 h with an average of 0.7, 1.2, and 0.6 out of 10 on the VAS scale, respectively. The incidence of associated common side effects with the use of analgesic use was included as an add-on in the postoperative questionnaire. Conclusion: In conclusion, by comparing preoperative and postoperative pain levels and functional outcome scores, our study showed a significant pain control and improved functional outcome scores following TKA using ACB.

Simultaneous Surgical Management of Acute Tibial Shaft Fracture and Post-traumatic Ankle Arthritis.

The simultaneous management of tibial shaft fractures and post-traumatic ankle arthritis with ankle pain as the chief complaint can be challenging. Herein, we present a case managed with closed reduction, internal fixation, and tibiotalocalcaneal arthrodesis using a retrograde femoral nail. The patient was able to actively ambulate with full weight bearing and no pain approximately three months after the procedure. Patient consent for this case report was obtained.

Assessment of opioid administration patterns following lower extremity fracture among opioid-naïve inpatients: retrospective multicenter cohort study.

BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Saudi Arabia have been lower extremity fractures, it is imperative to understand opioid administration patterns and correlates among opioid-naïve inpatients. OBJECTIVES: Assess opioid administration patterns and correlates among opioid-naïve inpatients with lower extremity fractures. DESIGN AND SETTINGS: Retrospective cohort PATIENTS AND METHODS: Opioid naïve individuals aged 18 to 64 years, admitted due to lower extremity fracture from 2016 to 2020 were included. Data was collected from health records of the Ministry of National Guard Health Affairs (MNG-HA) at five different medical centers. The high-dose (≥50 MME) patients were compared with low dose (<50 MME) patients. Any association between inpatient factors and high-dose opioid use was analyzed by multiple logistic regression. MAIN OUTCOME MEASURES: Opioids taken during inpatient admission as measured by milligram morphine equivalents (MME)/per day. SAMPLE SIZE: 1520 patients RESULTS: Most of the 1520 patients (88.5%) received an opioid medication, while (20.3%) received high-dose opioids at a median daily dose of 33.7 MME/per day. The proportion of patients received naloxone (20.7%) was double among high-dose opioid inpatients. High-dose opioid patients during admission were two times more likely to receive an opioid prescription after discharge (odds ratio, 2.32; 95% confidence interval, 1.53, 3.51), and three more times likely to receive ketamine during admission (odds ratio, 3.02; 95% confidence interval, 1.64, 5.54). CONCLUSION: Notable variabilities exist in opioid administration patterns that were not explained by patient factors. Evidence-based opioid prescribing practices should be developed for orthopedic patients to prevent opioid overprescribing and potential opioid overdose among orthopedic patients. LIMITATIONS: Retrospective, unmeasurable confounders might have biased our results. Since based on National Guard employees, results may not be generalizable. CONFLICT OF INTEREST: None.

The Outcomes and Revision Rate of Total Hip Arthroplasty in a Single Tertiary Center: A Retrospective Study.

Introduction Total hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital. Methods A retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases. Results A total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014). Conclusion All in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision.

Cost of healthcare rehabilitation services following road traffic injuries: Results from a Level-I trauma center in Saudi Arabia.

BACKGROUND: Road traffic injuries (RTIs) are the second leading cause of mortality in Saudi Arabia. The high rate of RTIs puts a strain on rehabilitation services. Yet, little is known of the economic burden of nonfatal RTIs and rehabilitation services. This study, therefore, aims to describe the annual rehabilitation costs associated with RTIs at a local trauma center. MATERIALS AND METHODS: This study was conducted among all the 17 years or older patients hospitalized at King Abdulaziz Medical City in Riyadh following RTIs and required rehabilitation care. We included 299 patients who met the inclusion criteria and were followed for one year after discharge from the index hospital. The data was abstracted through retrospective review of patients' medical records. All rehabilitative services utilized by the healthcare system were recorded. To describe the economic burden, the mean, median, standard deviation, and interquartile range (IQR) were calculated. Total costs were aggregated for all patients to estimate overall costs. RESULTS: The study population was relatively young (31 years ± 14.4). The total annual rehabilitation cost of patients was Saudi Riyals (SAR) 6,113,781 (IQR: 20,589.3 - 3,125 = 17,464.3), and the average for each patient was SAR 20,447 (median = 7875). Patients aged 40-59 years and ≥60 years accounted for the highest average rehabilitation cost of SAR 31,563.99 and 32,639.21, respectively. Rehabilitation visits incurred the highest cost (mean SAR 1,494,124), followed by bed utilization which cost SAR 1,311,972 and radiology examination at SAR 1,032,261. The cost of motorcycle injuries was relatively higher (SAR 44,441.0) than other injury mechanisms. CONCLUSION: This study underlines the economic burden of rehabilitation services resulting from RTIs. Public health interventions are needed to reduce the burden of RTIs by dealing with their preventable causes and improving road safety measures. These findings may be useful to policymakers and researchers to support and improve rehabilitation services in Saudi Arabia.

Post-Laparoendoscopic Single-Site Donor Nephrectomy Ipsilateral Testicular Pain, Does Operative Technique Matter? A Single Center Experience and Review of Literature.

Aim: To assess incidence and characteristics of post-laparoendoscopic single-site donor nephrectomy (LESS DN) testicular pain. Materials and Methods: A prospective comparative study of all male donors post-left LESS DN (group A) vs. postopen nephrectomies (group B) was performed at our center. Patients' demographics, perioperative data, and postoperative consultation reports were reviewed. Testicular pain, swelling, numbness, urinary symptoms, and sexual dysfunction were evaluated. Patients with a history of scrotal pathology or surgical procedure were excluded. Pain and tenderness were scored on a standard 10-point scale. Results: From September 2017 to December 2020, 85 and 35 male patients of groups A and B met the evaluation criteria. Ipsilateral testicular pain developed in 11 patients (15.3%) and 2 patients (9.5%) in groups A and B, respectively. In most instances, the pain was mild to moderate in severity, started after 6 ± 2.1 and 4 ± 1.1 days postoperatively in groups A and B, respectively. Six patients in group A were evaluated with transscrotal ultrasonography that showed no abnormalities. All patients in both groups responded well to medical treatment. Conclusions: Post-LESS DN ipsilateral testicular pain is usually mild and self-limited. Preoperative patient education and discussion of the possibility of development of testicular pain and its management should be an integral component of laparoscopic donor nephrectomy informed consent.

Healthcare costs of road injuries in Saudi Arabia: A quantile regression analysis.

BACKGROUND: Road traffic injuries (RTIs) are the second leading cause of death in Saudi Arabia. Their economic burden is significant but poorly quantified, as limited literature exists locally. We aim to estimate the impact of RTIs on healthcare costs. METHODS: We included all patients from the hospital's trauma registry for the year 2017 (n = 381). Due to the availability of data, the analysis focused only on direct medical costs incurred during the hospitalization period. We computed the components of hospitalization costs and evaluated the association between patient and RTI characteristics and total hospitalization costs (the average and median) using quantile and log-linear regression techniques respectively. RESULTS: Patients were relatively young with an average age of 31 years (SD ± 14.6). Overall, patients treated for RTIs cost the hospital around 77,657 Saudi Riyal (SAR) on average. Pedestrian injuries incurred the highest costs. Motor vehicle injuries accounted for the highest procedure-related costs (SAR 19,537). The quantile regressions results suggest that Glasgow coma scale (GCS), admission to intensive care unit (ICU), and hospital length of stay were significantly associated with an increase in hospitalization cost. Hospital home disposition was however, associated with a decrease in cost. One additional day of stay in the hospital increases total hospitalization cost by SAR 3,508. Additionally, the log-linear showed injury severity score (ISS < 16) was associated with a 20% decrease in the geometric mean of the hospitalization costs (p < 0.001). CONCLUSIONS: This study underlines the economic burden of RTIs in addition to their impact on population health. The findings may be used to inform policymakers, researchers, and the public about the increasing burden of traffic crashes in the Kingdom. Public health interventions are warranted to reduce the severity and frequency of RTIs in order to improve traffic safety and reduce associated healthcare costs.

Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery.

Given the high risk of venous thromboembolism (VTE) post-orthopedic surgery and the vital role of thromboprophylaxis in preventing VTEs, this meta-analysis aimed to assess the efficacy of thromboprophylaxis post major orthopedic surgery and the relevant safety measures. In this review, we conducted a computer-aided search of Google Scholar, PubMed, CINAHL, Cochrane, Medline, and EMBASE databases. We included all published randomized clinical trials (RCTs) that utilized enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin for VTE prophylaxis in patients undergoing total hip arthroplasty (THA), hip fracture surgery, and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were performed using Review Manager Software. A total of 23 RCTs were included with a total sample of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTEs in the TKA group was significantly better than fondaparinux. In the THA group, the efficacy of enoxaparin was significantly better than apixaban. The efficacies of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin were comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.

The association between family cohesion and disability following blunt trauma: findings from a level-I trauma center in Saudi Arabia.

BACKGROUND: Injuries pose a significant burden on population health of Saudi Arabia. Even in nonfatal injuries, the burden varies from temporary to permanent disabilities. Health outcomes following injuries can vary, and predictors of recovery from disability are not well understood. In the Kingdom, family values and cohesion can differ from other countries due to several factors, including religious beliefs and cultural traditions. Learning about predictors of injury recovery can improve prevention as well as planning for rehabilitation programs. Therefore, the study aims to evaluate the association between family cohesion and recovery following blunt injuries. METHODS: This prospective study included 249 patients who were hospitalized for at least 1 day following blunt trauma in King Abdulaziz Medical City, Riyadh. Adult patients were interviewed twice: initially during admission, and a second interview via the phone 3 months after discharge. Baseline information included: demographics, injury characteristics, the five dimensions EQ-5D and family support scale. The follow-up interview captured only EQ-5D. Suboptimal family cohesion was defined as any issue with the relationship with parents, spouse, or siblings. Any disability was defined as a reported limitation in one or more domains of the EQ-5D scale. Logistic regression was used to assess the association between family cohesion and recovery at 3 months. RESULTS: Of the overall sample, 169 (67.8%) responded to the second interview, and three patients passed away. About 95.2% of patients reported disabilities at baseline, while 88.1% continued to report disabilities after 3 months. Forty patients (16.1%) reported suboptimal family cohesion. Of these patients, 37(94.87%) were in pain, 33(82.5%) reported problems with usual activities, 32(80%) faced problems with self-care, 32 (80%) patients had difficulty in mobility, and 23(57.5%) were depressed. Multivariable regression suggested that patients with suboptimal family cohesion were less likely to recover from disabilities. CONCLUSION: The prevalence of any disability 3 months after discharge is striking. This study suggests that health outcomes after blunt trauma are affected by the strength of the patient's family cohesion. More research is needed to identify effective ways through which the provision of social support can reduce short term disability after trauma.