Gender-based disparities in outcomes of coronary bifurcation stenting in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

INTRODUCTION: Around 15-20% of lesions necessitating percutaneous coronary interventions (PCI) are attributed to coronary bifurcation lesions. We aim to study gender-based differences in PCI outcomes among bifurcation stents. METHODS: 3 studies were included after thorough systematic search using MEDLINE (EMBASE and PubMed). CRAN-R software using the Metabin module was used for statistical analysis. Pooled odds ratios (OR) were calculated using the random effect model and the Mantel-Haenszel method, with a 95% confidence interval (CI) used to determine statistical significance. Heterogeneity was assessed using Higgins I2. RESULT: Women exhibited a higher risk of in-hospital mortality (OR 0.67, 95% CI 0.58-0.76, I2 = 0%, P < 0.0001), post-procedural bleeding (OR 0.53, 95% CI 0.47-0.6, I2 = 0%, P < 0.0001) and post-procedure stroke (OR 0.72, 95% CI 0.52-1.0, I2 = 0%, P < 0.06) as compared to men. However, there were no significant differences in terms of myocardial infarction (OR 0.84, 95% CI 0.22-3.27, I2 = 49.4%, P < 0.80) and cardiac tamponade (OR 0.63, 95% CI 0.06; 5.72, I2 = 0%, P < 0.6821) in both groups. CONCLUSION: Our study reveals a noteworthy increase in in-hospital mortality in women, which could be attributed to a higher rate of major bleeding, advanced age, increased co-morbidities, and complex pathophysiology of the lesion in comparison to men. Further studies are required to gain a better understanding of the precise mechanisms thus enhancing procedural outcomes.

Prevalence and Associated Factors of Eating Disorders Among Female Students at Jazan University, Kingdom of Saudi Arabia: A Survey Study.

BACKGROUND AND OBJECTIVE: Concerns about the incidence of eating disorders (EDs) among university students are spreading throughout the world. In Saudi Arabia, little is known about the prevalence and associated factors of EDs among female university students. Thus, this study investigated the prevalence, common types, and potential associated factors of EDs among female students of Jazan University.  Methods: A cross-sectional survey was conducted between August 31, 2020, and November 2, 2020. The snowball technique was used to recruit female students via an electronic survey distributed in Arabic. The survey collected information about demographic characteristics, and SCOFF (Sick, Control, One, Fat, Food) and Eating Attitudes Test (EAT-26) scales. Cronbach's alpha for the SCOFF and EAT-26 scales was calculated to be 0.78 and 0.58, respectively, in this study. RESULTS: A total of 566 female students participated in the survey, with a mean age of 22.12 ± 2.93 years. The results showed that 47.9% of participants were at risk for EDs based on SCOFF scores, while 26.5% were at risk based on EAT-26 scores. The most common types of EDs were bulimia nervosa and binge eating disorder. Furthermore, the study identified several sociodemographic characteristics, including year of study (p = 0.042), college type (p = 0.004), body weight (p = 0.001), and BMI (p = 0.001), that are significantly associated with EDs. However, no significant relationships were observed between marital status (p = 0.103), age (p = 0.147), and height (p = 0.509) with SCOFF scores. Some students reported frequent binge eating, purging, or laxative/diet pill misuse. CONCLUSIONS: The study revealed a moderate to high prevalence of risk for EDs among female university students in Jazan, Saudi Arabia, associated with higher study years, college majors, and body weight and BMI. Dangerous ED behaviors reported by some students signal an urgent need for resources to identify and support those suffering from these disorders. Targeted interventions and services may help address this critical issue on campuses and support vulnerable students in need. Continued research and public health action are needed to curb the spread of these disorders.

Evaluation of Patient Satisfaction With the New Web-Based Medical Appointment Systems "Mawid" at Primary Health Care Level in Southwest Saudi Arabia: A Cross-Sectional Study.

Background Patient satisfaction has become an influential corner in the health services process. Web-based appointment scheduling has been expanded for its benefits and has become a popular research topic. This study's objectives were to assess patients' satisfaction and perception with the new Web-Based Medical Appointment System "Mawid" program and determine the associated factors at the Primary Health Care Centers level in Jazan Southwest Saudi Arabia. Methods An observational cross-sectional survey was implemented among 424 adults aged 18 years and above, attending a randomly selected 12 primary health care centers in the Jizan region, Southwest Saudi Arabia. The study instrument included socio-demographic background information, perception, and level of satisfaction with the new appointment system. Responses were analyzed using the SPSS program by applying descriptive and inferential statistical techniques. Results The overall level of satisfaction was very high at 94.3% with 95% C.I. (91.7-96.1). A large proportion of study participants were highly satisfied with the new Web-Based Medical appointment System "Mawid" as nine satisfaction items scored a level of satisfaction of 90% and above. Regarding the perception, 89.1% of the participants agreed that the appointment booking system regulates the number of patients, while 87.7% of participants considered that the appointment system reduces clinic crowding. More than half of respondents (61.8%) agreed that the community culture might limit the scheduling system's use. Univariate and multivariate logistic regression analysis suggested that male patients were more likely to have a higher level of satisfaction as compared with female (COR= 2.95, 95% C.I.:1.15-7.60, p = 0.025) and (AOR= 3.12, 95% C.I:1.14-8.52, p = 0.026), respectively. Conclusions In conclusion, this study revealed a high level of satisfaction among study the participants with the new Web-Based Medical Appointment System "Mawid." The system effectively improved patients' satisfaction with registration and reduced waiting times. Patients' satisfaction can be assessed regularly and used systematically as a quality and benchmarking instrument in primary health care.

Awareness and perceptions regarding autism among school teachers in Jazan region, Kingdom of Saudi Arabia.

Background: Identification of Autism Spectrum Disorder (ASD) especially at early stages is highly important to improve the quality of life and help to decrease the disease burden. This study was performed to assess the school teachers' level of knowledge and perception regarding Autism. Materials and Methods: An observational cross-sectional study was carried out in the Jazan region among a random sample of school teachers (males and females) who are working at the governmental primary Schools, throughout the scholastic year 2019-2020. A structured validated self-administered questionnaire was used for data collection. It includes three sections: sociodemographic information of the participants, the Autism Knowledge Questionnaire (AKQ), and statements exploring the teachers' attitudes toward children with autism. Results: The study included 403 primary school teachers. The age of 47.1% of them ranged between 35 and 44 years. Slightly more than half (50.9%) were males. Overall, the total autism knowledge score ranged between 2 and 26, out of a possible 30 with a median (interquartile range "IQR") of 15 (12-18). Teachers who ever encountered a child with autism had higher significant knowledge scores about autism compared to their counterparts (mean ranks were 263.95 and 179.32, respectively), P < 0.001. Female compared to male teachers more significantly agreed that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.018. Teachers aged between 35 and 44 years are more willing to have an autistic child in their class in compare to those ages ≥55 years that they would not want children with autism in their class, P = 0.036 and more interested in attending training in the area of childhood developmental and behavioral disorders, P = 0.010. Postgraduate teachers were more agreed than Bachelor holders that teachers not trained in special education should not be expected to deal with a child with autism, P = 0.001. Diploma-holder teachers were more agreed than postgraduates that children with autism are too impaired to benefit from activities of a general school, P = 0.019 and students with Autism should be given every opportunity to function in the regular education classroom whenever possible, P = 0.028. Conclusion: The knowledge about autism among primary school teachers is average in general, however, they expressed mostly positive attitudes towards autistic children.

Community-level awareness of proper immediate steps regarding ocular chemical injury in the Jazan region, Saudi Arabia.

Background: Although the eyes represent 0.1% of the total human body, they are exposed to many injuries, some of which may cause blindness. Ocular chemical injury is a true ocular emergency requiring immediate assessment and initiation of treatment. The present study targeted the general population in the Jazan region, Saudi Arabia, to evaluate knowledge of chemical injuries to the eye and the immediate management of the injury. Materials and methods: A cross-sectional design was employed using a convenience sample of 536 residents of the Jazan region who completed an online, self-administered, anonymous, and pre-validated questionnaire. Results: Most of the respondents were 18-30 years of age (66.0%), and 274 (51.1%) were female. Respondents had an average score of 7.70 (standard deviation: 1.78) out of a total score of 16, indicating an overall lack of knowledge of ocular chemical burns. The majority (95.1%) agreed that ocular complications could result from ocular chemical injury. Regarding the first action in ocular chemical injuries, 317 (59.1%) thought that eye irrigation with a large amount of water, 155 (28.9%) chose to go to the emergency department, 40 (7.5%) chose irrigation of the eye with a small amount of water, 13 (2.4%) chose using eye drops, and 11 (2.1%) chose to cover the eye. Conclusion: The knowledge of ocular chemical burns is lacking in the general population of the Jazan region. There are several knowledge gaps, some of which are serious, necessitating rigorous efforts to correct them through educational programs at the community level.

Admission Grades as Predictors of Medical Students' Academic Performance: A Cross-Sectional Study from Saudi Arabia.

Background: Admission to medical school is competitive, and different countries use various tests in addition to high school grades to minimize selection bias. A few studies have been conducted to evaluate the usefulness of these tests as predictors for students' academic performance. In this article, we aimed to assess factors that influenced students' grades in medical school. Methods: A cross-sectional study included all students who graduated from the Faculty of Medicine at Jazan University between 2018 and 2020. Scores of the included participants were extracted from the registry of Jazan University, and additional questions about study habits were completed by the included students. Descriptive, univariate, and multivariate analyses were performed for the factors that impacted academic performance. Results: There were 331 included candidates, and the majority of them were female (53%). About 60% of the participants were medical residents at the time of the study, and 40% were interns. Univariate and multivariate analyses indicated that grades in high school and the pre-requisite tests were positively associated with students' academic performance. Further, studying more than two hours per day was positively correlated with better grades in medical school. Conclusion: Scores of the admission tests can serve as predictors for student performance in medical school. National studies are deemed essential to evaluate additional admission tests for medical school, an action that would minimize selection bias.

Management of Low Back Pain in Primary Health-Care Settings: Physician's Awareness and Practices Based on Red Flags.

Background: Low back pain (LBP) is one of the most common health problems. Red flags (RFs) of LBP are risk factors that are reported during clinical assessment to determine serious illness. This study aimed to assess primary health-care physicians' knowledge of and practices for RFs of LBP and identify variables associated with a high level of knowledge and awareness about it. Methods: An observational cross-sectional survey was conducted in 2021 among a random sample of 261 primary health care (PHC) physicians in the Jazan Region in southwest Saudi Arabia. A web-based questionnaire was used to collect data on LBP red flags awareness and practices. Descriptive (frequency and percentage) and inferential statistics were used for data analysis. Results: The overall mean score of RFs knowledge among physicians was 82.33 ± 36.3, with 95% confidence interval (CI); (77.7-86.9). Regarding the Physician's practices, more than 95% of the participants would refer patients to higher levels in the presence of symptoms or signs of RFs. General practitioners and residents were significantly more likely to ask for an Xray, even with symptoms that had persisted for less than 2 weeks without RF signs (p = 0.006). The overall percentage of patients with nonspecific LBP referrals was as high as 57.8%. The number of patients with LBP seen per month (fewer than 15) and female physician were associated with an increased level of knowledge (OR = 2.2, 95%, P < 0.05) and (OR = 2.2, 95%, P < 0.05) respectively. Conclusion: Overall, awareness of RFs for LBP and referring critical patients who present with LBP is good among PHC physicians in the Jazan Region. Junior physicians have a low threshold to request images. The referral rate for nonspecific LBP is still high, which could overwhelm spinal clinics. Further educational programs for back pain management are recommended.

Needlestick and sharps injuries among secondary and tertiary healthcare workers, Saudi Arabia.

AIM: The study aimed to assess the incidence of needlestick and sharps injuries among healthcare workers (HCWs) in the Jazan region of Saudi Arabia, as well as to determine whether there exists an association between hospital level and needlestick and sharps injuries rate. DESIGN: A cross-sectional survey was conducted among 609 randomly selected HCWs from nine general hospitals. METHODS: A self-administered questionnaire, which covered the structure and process of injection safety, was used for data collection. RESULTS: The overall needlestick and sharps injuries incidence rate was 24%. The needlestick and sharps injuries rates were 30% and 14% in secondary and tertiary hospitals, respectively. HCWs working in tertiary hospitals were 61% less likely to have needlestick and sharps injuries than those employed in secondary hospitals. This was mainly the impact of better and continuous training. High safety level maintenance and health education provision are vital in such settings.

Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann's procedure in acute malignant bowel obstruction in high-risk patients.

PURPOSE: The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery. METHODS: An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann's procedure, HP), and 35 patients underwent SEMS insertion. RESULTS: All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. CONCLUSION: SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.

Efficacy of immunohistochemical staining in detecting Helicobacter pylori in Saudi patients with minimal and atypical infection.

Gastric Helicobacter pylori infection is diagnosed based on histopathological evaluation of gastric mucosal biopsies, urease test, urea breath test, H. pylori culturing, or direct detection using polymerase chain reaction (PCR). This study aimed to evaluate the efficacy of immunohistochemical (IHC) staining in detecting H. pylori in gastric biopsies from patients with chronic gastritis and minimal or atypical infection. Gastric biopsies from 50 patients with chronic gastritis were subjected to routine haematoxylin and eosin (H-E), modified Giemsa, and IHC staining. The results of staining were compared with those of quantitative real-time PCR (qRT-PCR). The qRT-PCR analysis identified 32 (64%) H. pylori-positive cases, whereas IHC, H-E, and modified Giemsa staining identified 29 (58%), 27 (54%), and 21 (42%) positive cases. The sensitivity of IHC staining (87.50%) was higher than that of H-E (59.38%) and modified Giemsa (43.75%) staining. The specificity of H-E, modified Giemsa, and IHC staining was 55.56%, 61.11%, and 94.44%, respectively. IHC staining exhibited the highest diagnostic accuracy (90%), followed by H-E (58%) and modified Giemsa (50%) staining. Active gastritis, intestinal metaplasia, and lymphoid follicles were detected in 32 (64%), 4 (8%), and 22 (44%) cases, respectively, and all of these cases were H. pylori positive. In contrast to routine H-E and modified Giemsa staining, IHC allows for the accurate H. pylori detection in cases with minimal or atypical infection. Moreover, IHC can be an alternative diagnostic method to qRT-PCR for detection of H. pylori in such cases.

Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure.

INTRODUCTIONS & AIMS: Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). We sought to access the temporal trends and outcomes of TAVR or SAVR in HF patients. METHOD: The NIS database from 2011-2014 was queried for patients that underwent TAVR or SAVR and were subsequently diagnosed with HF. Temporal trends in the utilisation of TAVR or SAVR in HF patients were analysed. RESULTS: Among 27 982 patients who were diagnosed with HF of whom 17 681 (63.2%) had heart failure with reduced ejection fraction (HFrEF) while 10 301 (36.8%) had heart failure with preserved ejection fraction (HFpEF), 9049 (32.3%) underwent TAVR and 16 933 (76.7%) underwent SAVR. Patients with HFrEF and HFpEF had higher utilisation of TAVR compared with SAVR over the course of the study period (P trend < .001). TAVR was associated with lower mortality [2.8% in 2012 and 1.8% in 2014 (P .013)] compared with SAVR. Similarly, multiple logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compared with SAVR (aOR 0.634; CI 0.504, 0.798, P < .001). CONCLUSION: For patients with severe aortic valve stenosis and heart failure who undergo aortic valve intervention, TAVR is associated with less odds of in-hospital mortality compared with SAVR.

The correlation between keratoconus and eye rubbing: a review.

Keratoconus is a non-inflammatory disorder which is gradual in development; corneal thinning and ectatic protrusion characterizes it. Keratoconus prevalence varies between different regions depending on several factors that affecting its prevalence. There are risk factors for developing keratoconus such as demographic and environmental factors. It was suggested that eye rubbing was associated with the development of keratoconus. The main aim of this review was to summarize the literature data about keratoconus and to identify the role of eye-rubbing in the aetiology of the disease. A number of 24 articles was reviewed through the PubMed, Google Scholar and Research Gates. There are many keywords used such as keratoconus, aetiology of keratoconus, eye rubbing, keratoconus prevalence, keratoconus and eye rubbing correlation. We concluded that eye rubbing causes the thinning of keratocyte, and the degree of effect of eye rubbing depends on the period and force of performing eye rubbing. It is recommended to avoid eye rubbing to prevent keratoconus, this can be achieved by avoiding itching and treating dryness of the eye and avoiding wearing eye lenses.

Helicobacter pylori vacA, cagA and iceA genotypes in dyspeptic patients from southwestern region, Saudi Arabia: distribution and association with clinical outcomes and histopathological changes.

BACKGROUND: The aim of this study was to identify the common H. pylori virulence genes among dyspeptic Southwestern Saudi patients and their association with clinical outcomes and histopathological findings to help practitioners and researchers in the region for better management of infections caused by such bacteria. METHODS: Four hundred two gastric biopsy specimens were analyzed using histopathological examination and real time-PCR. The positive 187 specimens by RT-PCR were genotyped using PCR targeting cagA, vacA and iceA genes. RESULTS: One hundred twenty-eight gastric biopsy specimens were positive in genotyping PCRs. The cagA, vacA, iceA1 and iceA2 genes were detected in rates of 49.2% (63/128), 100%(128/128), 42.2% (54/128), 32.8% (42/128), respectively. The vacA s1as1bm2 subtype was the highest 23.4% (30/128), followed by m2 and s1a1b subtypes which were equally detected [16.4% (21/128) for each]. The iceA genes were significantly associated with gastritis and gastric ulcer. Overall, vacA genotypes were significantly associated with gastritis, gastric and duodenal ulcers. The vacA subtypes: s1as1bm2, s1a1b and s2 m2 showed chronic active gastritis in percentages of 90.0, 81, and 84.2%, respectively. All vacA mixed genotypes showed chronic active gastritis. CONCLUSIONS: H. pylori virulence genes are highly prevalent and diverse among patients with dyspepsia in Southwestern region of Saudi Arabia. The iceA genes and the different vacA subtypes are significantly associated with the clinical outcomes and histopathological changes especially chronic active gastritis.

Prevalence and factors associated with H. pylori infection in Saudi patients with dyspepsia.

BACKGROUND: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and chronic active gastritis that may progress to gastric cancer. Globally, it has been estimated that 50% or more of the world's population is infected by H. pylori, making it the most widespread infection across the globe. OBJECTIVES: To determine the prevalence of H. pylori infection and to identify factors associated with H. pylori infection in Saudi patients presenting with dyspepsia. METHODS: In this prospective cross-sectional study, a total of 404 gastric biopsies were endoscopically obtained from 404 patients with dyspepsia from September 2014 to April 2016 (Jazan Province, Saudi Arabia). The specimens were analyzed using the real-time polymerase chain reaction (PCR). The data was examined using descriptive statistics as well as determining the prevalence, and employing Chi square and Fisher exact test. A p-value of ≤0.05 was considered statistically significant in examining the research hypotheses. RESULTS: The overall prevalence of H. pylori in Jazan Province was 46.5% (95% CI: 41.7-51.4) and the prevalence was lower among those > 55 years old. Prevalence was higher among urban (50.0%; 95% CI: 43.1-56.8) versus rural (42.1%; 95% CI: 35.1-49.3), but with no significant difference. Prevalence did not show significant difference among different Body Mass Index (BMI) categories, ranging from 40.2% to 47.7%. The prevalence of H. pylori in females was 47.1% (95% CI: 40.4-53.9) versus 45.6% (95% CI: 38.7-52.6) in males. Histopathology findings were associated with H. pylori infection with prevalence of 58.1% among patients with chronic active gastritis, compared to 24.1% and 34.8% among mild and chronic gastritis, respectively. CONCLUSION: Our results indicate that there is a high prevalence of H. pylori among Saudi patients with dyspepsia. Prevalence of H. pylori was high in ages below 55 years. Chronic active gastritis was significantly associated with H. pylori infection. In depth studies are needed to determine associated factors with of H pylori infection in the region.

Depression and related risk factors among patients with type 2 diabetes mellitus, Jazan area, KSA: A cross-sectional study.

PURPOSE: To determine the prevalence of depression and related risk factors among type 2 diabetes mellitus patients (T2DM) in Jazan area, Saudi Arabia. METHOD: A cross sectional, self-administered questionnaire study was conducted among T2DM patients in Jazan area, Saudi Arabia. A total of 385 patients were selected at randomly. The Patient Health Questionnaire (PHQ-9) was utilized to measure symptoms and signs of depression. RESULTS: The overall prevalence of depression among T2DM patients was 37.6%. Of them, 24.2% were mildly depressed, 9.6% were moderately severely depressed, and 4.2% were severely depression. Significant predictors of depression include the presence of diabetic foot (P=0.000), cardio-vascular diseases (P=0.000), eye complication (P=0.073), and erectile dysfunction (P=0.090). The prevalence of depression was not significantly associated with the age (P=0.375) and gender (P=0.374). Similarly no association was found with duration of diabetes (P=0.475) and HbA1c (P=0.555). CONCLUSION: The study revealed that diabetes complications are strong predictors of the rate of depression among T2DM patients. Therefore, early depression screening is needed to improve the quality of life of diabetic patients.

Giant pulmonary teratoma with huge splenic lymphangiomatosis: a very rare case.

Teratomas are tumors composed of tissues derived from more than one germ cell line. They manifested with a great variety of clinical and radiological features. We report a case of a giant left hemithorax teratoma in a female with huge spleen tumor and review the relevant literature. A 38-year-old female with progressively aggravating dyspnea at rest from a mild trauma. Absent breath sounds on the left side. There was splenomegaly. Computed tomography scan revealed a huge mass (20 × 15 × 18 cm), containing elements of heterogeneous density in the left hemithorax. The spleen tumor was occupying most of the spleen without any other abdominal manifestations. The patient underwent left thoracotomy and laparoscopic splenectomy. Histopathological examination revealed a benign mature teratoma and cystic lymphangiomatosis of the spleen. To the best of our knowledge and after reviewing the available literature this is the first case of huge mature pulmonary teratoma with large cystic spleen lymphangiomatosis.

Cancellation of operations in Saudi Arabian hospitals: Frequency, reasons and suggestions for improvements.

OBJECTIVE: To identify the frequency and reasons of operations cancellation in 25 Makkah region hospitals in Saudi Arabia. METHODS: Retrospective evaluation of the rate of surgery cancellation in 25 hospitals of Makkah region was performed in this study. The data of scheduled surgeries from 15 different surgical specialties was collected from January to December 2013. Frequency and reasons of cancellation of elective surgical cases in different specialty were studied with a view to recommend suggestions for improvement. Data was analyzed on SPSS -16. RESULTS: There are 120 operating rooms (OR) in 25 Makkah region hospitals and during the year 2013, a total of 16,211 surgery cases were listed, and 1,238 (7.6%) cases were canceled. Contribution to total cancellation was highest in orthopedic 33.8% followed by general surgery 27.5%, obstetrics 7.7% and ENT 5.2%. According to category, 42.81% rate of cancellation was patient related, 20.03% facility related, 9.45% due to improper work-up, 1.45% associated with anesthesia, 7.19% related to surgeons, and 18.90% other/and not recorded reasons. CONCLUSIONS: Present study found 7.6% cancelation rate in Makkah region hospitals and three most common causes for cancellations were patients related, facility related and improper work-up.

Significance of high sensitivity C-reactive protein and D-dimer in evaluating intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography: a prospective study.

BACKGROUND: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. METHODS AND RESULTS: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. CONCLUSIONS: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.

Catastrophic failure of a modular revision total hip polyethylene insert.

Early catastrophic failure of a modular polyethylene component is a potential problem after revision total hip arthroplasty. We describe an unusual case of polyethylene failure that occurred within 18 months of implantation in which no obvious technical error or mechanical failure was identified. The acetabular polyethylene insert was prepared with gas plasma sterilization, and the shelf life was 4 months. Radiographic evaluation used generalized Hough transforms to assess the cup articulation. We identified cup penetration of 2.8 mm before revision and catastrophic destruction of the polyethylene liner at the time of revision. Possible factors implicated for failure included a thin polyethylene liner, increased hip separation, femoral head mismatch, and the high activity level of a younger patient. We believe that this case report highlights the need for future investigations of these subtle factors.

Evaluation of off-loading braces for treatment of unicompartmental knee arthrosis.

Two analyses were performed to assess the effectiveness of off-loading knee braces in producing condylar separation of degenerative compartments in patients with unicompartmental knee osteoarthritis. All patients were analyzed using video fluoroscopy under weight-bearing conditions. In the initial study, a single brace was analyzed in 2 dimensions and demonstrated that medial condylar separation was obtained, with corresponding pain relief, in 78% of patients. The brace was least effective in obese patients. The second study consisted of a 3-dimensional analysis of 5 subjects fitted with 5 different off-loading braces. Condylar separation in most patients was similarly observed with certain braces, whereas others demonstrated little to no condylar separation, suggesting that off-loading knee braces are not equally effective in treatment of unicompartmental knee arthritis.