Causes and Pattern of Chest Trauma Among Adults: A Scoping Review of Studies From the Middle East.

Chest trauma incidence is increasing worldwide, and it requires attention as it is a major cause of morbidity and mortality. Worldwide, chest trauma is the second most common cause of mortality and a major cause of disability and hospitalization. Our main aim is to systematically review the prevalence, pattern, causes, manner, morbidity, and mortality of chest trauma in the Middle East among adults. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Screening of the relevant articles was done by using databases, including PubMed, Scopus, and Web of Science. A total of 128 articles were found as a result of searching the databases and reviewing the reference lists. Finally, nine articles met the inclusion criteria. Most of the victims were males, as reported by all studies in this systemic review. The most common cause of chest trauma was road traffic accident (RTA), as described in seven out of the nine included studies. The pattern of chest trauma included pneumothorax, hemothorax, hemopneumothorax, lung contusion, flail chest, rib fracture, and diaphragmatic injury. The rate of mortality and morbidity following chest trauma varied among the studies. However, most of the studies revealed higher rates of morbidity than mortality. Chest trauma carries economic and social burdens, and it is a serious issue, especially in males in the second to third decades. Preventive measures should be considered to decrease the prevalence of chest trauma and its related complications.

Intention and practice on personal preventive measures against COVID-19 among older adults in the Kingdom of Saudi Arabia: an epidemiological study using the Theory of Planned Behaviour.

Introduction: Older adults aged 65 years and above are among the most vulnerable to adverse outcomes and death following a COVID-19 infection. The weekly epidemiological updates by the World Health Organisation show that the continued emergence of concerning subtypes of the virus indicates that the pandemic remains a public health concern and the public should continue to comply with personal preventive measures (PPMs). This study applies the Theory of Planned Behaviour (TPB) which is rooted in the field of Public Health, Epidemiology, and Preventive Medicine to Saudi older adults to predict their health behaviour. Methods: This behavioural epidemiological study recruited older adult participants aged 65 years of age and above. A tool which consisted of sociodemographic and health-related questions, as well as questions regarding the components of the TPB, namely, Attitude, Subjective Norm, Perceived Behavioural Control was used. Bivariate analyses, followed by unadjusted and adjusted multivariable logistic regression analyses were performed to derive odds ratios and 95% confidence intervals. Results: The total number of participants was 502. The mean age was 70.34 years, with similar distributions between males and females. In total, 52.2% intended to practice PPMs, whereas only 48% had a good practice. Also, 56% had a favourable Attitude towards PPMs, 61.4% had a positive Subjective Norm and 39.8% had perceived they had a high control over their behaviour. Females, and high educational status were predictors for high intention to practice PPMs (OR = 1.59, 95% CI = 1.01-2.52 and OR = 2.72, 95% CI = 1.44-5.16 respectively). Further predictors included Attitudes, Subjective Norm and Perceived Behavioural Control. Results also show that intention to practice was significantly associated with a lower odd of practicing PPMs (OR = 0.06, 95% CI = 0.04-0.10). Conclusion: Current findings highlight the need to continue with public health efforts targeting vulnerable older adults. Also, the fact that intention negatively predicted practice highlights the need for further behavioural epidemiological studies addressing the intention-behaviour gap.

Uterine Malignancy: Pathological Pattern and Changing Incidence in a Teaching Hospital in Jeddah, Saudi Arabia.

INTRODUCTION: Uterine carcinoma is one of the most common malignancies affecting women globally. It is the second most common gynecologic malignancy in impoverished countries and the most common in industrialized countries. OBJECTIVE: To describe the histopathological patterns of uterine malignancies and their changing incidence at King Abdulaziz University Hospital from 2011 to 2020. METHODOLOGY: A retrospective study was conducted to analyze female patient record files from 2011 to 2020 who underwent uterine resection surgery at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: A total of 263 patients were included. The age ranged from 30 to 95 years old; median age of 61 years. The majority (71%) presented with the complaint of abnormal uterine bleeding. The most common histopathological diagnosis was endometrioid carcinoma (70%), followed by serous carcinoma (13.7%). The lowest reported uterine cancer diagnoses were in the year of 2011 with (<5%) of the cases while the highest were in the year of 2020. These findings demonstrate a variable incidence of endometrial carcinomas in the study population over the study period. With trends of an increasing incidence till 2018 followed by a marginal reduction in 2019 and 2020. CONCLUSION: The most frequent histopathological diagnosis of uterine cancer was endometrioid carcinoma followed by serous carcinoma, (70%) and (13.7%) respectively. Type 1 endometrial carcinoma was prevalent throughout the decade surpassing the type-2 endometrial carcinoma. The trend also shows a steady increase in the frequency of uterine cancer which is alarming and prompts further research to determine factors associated with and molecular classification of reported uterine cancer cases.

Common Prognostic Biomarkers and Outcomes in Patients with COVID-19 Infection in Saudi Arabia.

Background: COVID-19 is a respiratory disease that eventually became a pandemic, with 300 million people infected around the world. Alongside the improvement in COVID-19 management and vaccine development, identifying biomarkers for COVID-19 has recently been reported to help in early prediction and managing severe cases, which might improve outcomes. Our study aimed to find out if there is any correlation between clinical severity and elevated hematological and biochemical markers in COVID-19 patients and its effect on the outcome. Methods: We have collected retrospective data on socio-demographics, medical history, biomarkers, and disease outcomes from five hospitals and health institutions in the Kingdom of Saudi Arabia. Results: Pneumonia was the most common presentation of COVID-19 in our cohort. The presence of abnormal inflammatory biomarkers (D-dimer, CRP, troponin, LDH, ferritin, and t white blood cells) was significantly associated with unstable COVID-19 disease. In addition, patients with evidence of severe respiratory disease, particularly those who required mechanical ventilation, had higher biomarkers when compared to those with stable respiratory conditions (p < 0.001). Conclusion: Identifying biomarkers predicts outcomes for COVID-19 patients and may significantly help in their management.

Practice of Placenta Submission for Histopathological Examination, Experience of a Teaching/Tertiary Care Hospital in Saudi Arabia.

Objectives The aim of this study is to determine the appropriateness of histopathologic examination of the placenta at King Abdulaziz University Hospital (KAUH), Jeddah, based on the guidelines of the College of American Pathologists (CAP). Methods It is a retrospective review of obstetric and pathologic records for all deliveries at KAUH, between January 1, 2017, and April 30, 2019. The placentae were assessed for eligibility to undergo pathologic examination. Furthermore, examined and non-examined placentae meeting the CAP criteria were compared based on their actual indications. Results There were 8,929 deliveries, of which 1,444 (16.2%) placentae met the CAP guidelines. A total of 583/1,444 placentae (40.4%; 95% confidence interval [CI] = 37.8-43) were sent for pathologic examination. Of the 7,485 placentae that did not require submission for pathological examination, as determined by the pathologist, 7,456 (99.6%; 95% CI = 99.4-99.7) were not submitted appropriately. The labor and delivery staff were more likely to submit placentae with fetal/neonatal indications rather than those with maternal indications for examination, which was statistically significant (odds ratio = 6.5; 95% CI = 5.08-8.30). Conclusion While most of the examined placentae at KAUH met the CAP guidelines, there was a substantial under-submission of eligible placentae. Further studies are advised to reveal the reasons behind this underestimation so that correctional measures may be adopted, as placenta examination is a valuable tool to understand the risk factors and pathogenesis of deleterious maternal, neonatal, and fetal events.

A Case Report of Thyroid Plasmacytoma and Literature Update.

Plasmacytomas of the thyroid gland are rare, whether or not they arise as solitary (primary) lesions or secondary to systemic multiple myeloma. Here, we present the case of a 71-year-old female presenting with goiter and Hashimoto's thyroiditis, in whom the subsequent histopathological diagnosis of plasmacytoma was a surprise. In presenting this case, we summarize the last 25 years of literature on thyroid plasmacytoma and review the salient clinicopathological characteristics, differential diagnoses, management, and outcomes of this rare condition.

Expanded Somatic Mutation Spectrum of MED12 Gene in Uterine Leiomyomas of Saudi Arabian Women.

MED12, a subunit of mediator complex genes is known to harbor genetic mutations, (mostly in exon 2), causal to the genesis of uterine leiomyomas among Caucasian, African American, and Asian women. However, the precise relationship between genetic mutations vs. protein or disease phenotype is not well-explained. Therefore, we sought to replicate the MED12 mutation frequency in leiomyomas of Saudi Arabian women, who represents ethnically and culturally distinct population. We performed molecular screening of MED12 gene (in 308 chromosomes belonging to 154 uterine biopsies), analyzed the genotype-disease phenotype correlations and determined the biophysical characteristics of mutated protein through diverse computational approaches. We discovered that >44% (34/77) leiomyomas of Arab women carry a spectrum of MED12 mutations (30 missense, 1 splice site, and 3 indels). In addition to known codon 44, we observed novel somatic mutations in codons 36, 38, and 55. Most genetically mutated tumors (27/30; 90%) demonstrated only one type of genetic change, highlighting that even single allele change in MED12 can have profound impact in transforming the normal uterine myometrium to leiomyomas. An interesting inverse correlation between tumor size and LH is observed when tumor is positive to MED12 mutation (p < 0.05). Our computational investigations suggest that amino acid substitution mutations in exon-2 region of MED12 might contribute to potential alterations in phenotype as well as the stability of MED12 protein. Our study, being the first one from Arab world, confirms the previous findings that somatic MED12 mutations are critical to development and progression of uterine leiomyomas irrespective of the ethnic background. We recommend that mutation screening, particularly codon 44 of MED12 can assist in molecular diagnostics of uterine leiomyomas in majority of the patients.

Replication of GWAS loci revealed the moderate effect of TNRC6B locus on susceptibility of Saudi women to develop uterine leiomyomas.

AIM: Uterine leiomyomas (UL) are smooth muscular nodes, whose growth is dependant up on the complex interplay of hormones with genes and uterine physiology. Global statistics indicate the role of ethnic and racial background as contributory factors for UL development. Owing to the lack of data, this study aimed to examine the association between genetic polymorphisms and susceptibility of Arab women of developing UL. METHODS: We genotyped 105 UL patients and 112 healthy controls for five genetic polymorphisms through real time PCR method. The strength of the association between genotype and allele frequencies with risk of developing UL was tested with their χ2 and odds ratio (OR) values. The synergistic cooperation between genetic polymorphisms was estimated through multifactor dimensionality reduction assay. RESULTS: We found that Saudi women with the AG genotype for the rs12484776 polymorphism are at a 2.6-fold higher risk of developing UL compared to those with other genotypes (OR, 2.69; 95% confidence interval [CI]: 1.45-5.00; P < 0.001). This significance persisted even under co-dominant models (i.e., AA vs GG + AG [OR, 2.74; 95%CI: 1.48-5.08; P = 0.001; and AG vs GG + AG [OR, 2.41; 95% CI: 1.33-4.39; P = 0.003). Genotype distribution frequencies for rs1056836, rs7913069, rs2280543, and rs4247357 were not shown to elevate the disease risk (for all tests P > 0.05). CONCLUSION: The rs12484776 significantly contributes to UL risk among Saudi women, both in single and also in synergistic cooperation with rs2280543, rs7913069, and rs1056836 markers. Our results have yielded mixed findings in replicating European- and Japanese-specific UL genetic susceptibility loci among a geographically and culturally distinct population of the Saudi Arabian Peninsula.

The value of urine cytology in the diagnosis of bladder cancer. Cytopathological correlation.

OBJECTIVE: To identify the value of urine cytology in the diagnosis of bladder cancer by comparing cytologic and histologic findings. METHODS: This study was conducted from January to December 2012 at the Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The laboratory database was retrospectively reviewed for all patients with a histopathological diagnosis of urothelial carcinoma (UC) between January 2007 and December 2011. Histopathological diagnosis was considered the gold standard, and urine cytology findings were correlated with the results of bladder biopsy. Biopsies with low- and high-grade lesions were considered positive. All data were analyzed using the Statistical Package for Social Sciences. RESULTS: We reviewed the results of 191 patients. Urine cytology results were positive for malignancy in 70 cases (36.6%) and negative in 19 (9.9%). One hundred and two cases (53.4%) were considered suspicious for malignancy. Histopathological examination revealed that there were 82 cases (42.9%) of low-grade UC, and 64 cases (33.5%) of high-grade UC. Seven cases (3.7%) were positive for malignancies other than UC. For urine cytology, the overall sensitivity was 94.1%, and 26.3% specificity. The sensitivity of urine cytology for low-grade was 18.3%, and 51.3% for high-grade UC. The specificity for both grades was 26.3%. CONCLUSION: This study shows that sensitivity of urine cytology is higher in high-grade UC than in low-grade UC. The high sensitivity of urine cytology confirms that it is still a valuable tool in bladder cancer diagnosis.

Prevalence of high-risk human papillomavirus infections in healthy Saudi women attending gynecologic clinics in the western region of Saudi Arabia.

BACKGROUND AND OBJECTIVES: Infection with human papillomavirus (HPV) is the major cause of cervical cancer. There is little published data on the prevalence of HPV infection among Saudi women. The aim of this study was to determine the prevalence of HPV in a group of women in the western region of Saudi Arabia. DESIGN AND SETTING: A prospective study of Saudi women seeking gynecologic care at King Abdulaziz University Hospital from March 2010 to January 2011. PATIENTS AND METHODS: Four hundred eighty-five Saudi women of different age groups attending gynecology clinic were tested for high-risk HPV DNA. HPV DNA was detected in cervical scrapes using Hybrid Capture 2 (HC2) high-risk HPV DNA test. The prevalence of HPV DNA positivity in different age groups was calculated. RESULTS: Out of the 485 specimens, 27 (5.6%) were positive for the high-risk HPV. The highest percentage was among women aged 60 years and older. Patients in the age group 40-49 years were more likely to accept HPV testing with a total of 188 patients. CONCLUSION: The prevalence of HPV in this group of Saudi women is similar to what was reported in some Arab countries and lower than that reported in developed countries. This information could be used to help in establishing a primary screening program using HPV DNA testing in Saudi Arabia.

Pathology of skin diseases. A study from Western Saudi Arabia.

OBJECTIVE: To describe the histopathological pattern of skin diseases in patients from the western region of Saudi Arabia and to compare this with previously published data from other regions in Saudi Arabia and worldwide. METHODS: A retrospective review of all skin biopsies received and reported by the Department of Pathology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January 2005 and December 2010. Neoplastic and non-neoplastic category were divided into melanocytic and non-melanocytic subcategories. Non-neoplastic category was divided into the following subcategories: dermatitis, infection, vascular, vesiculobullous, connective tissue disease, drugs, panniculitis, non-infectious granuloma, degenerative, metabolic, and pigmentary. RESULTS: Three hundred and sixty skin biopsies were reviewed. Out of these, 207 (57.5%) were non-neoplastic skin diseases, while 153 (42.5%) were neoplastic. Both non-neoplastic (female to male ratio of 1.3:1) and neoplastic (female to male ratio of 1.2: 1) categories were more common in females than in males. Among the non-neoplastic category, the most common diagnosed subcategory was vesiculobullous disease (n=46, 22.2%), followed by dermatitis (n=30, 14.5%). The neoplastic category was divided into melanocytic (n=31, 20.3%) and non-melanocytic neoplasms (n=122, 79.7%). Both neoplastic and non-neoplastic categories were most common in the age group of 46 years and older. CONCLUSION: Vesiculobullous diseases, dermatitis, and infections are the 3 most common non-neoplastic skin diseases and the most common neoplastic are benign non-melanocytic neoplasms. The prevalence of neoplastic and non-neoplastic skin diseases in general increases with age.

An unusual presentation of infective endocarditis.

This paper reports a case of a 22 years old young male who presented in emergency department with some non-specific symptoms such as abdominal pain, vomiting, chest heaviness and shortness of breath. Chest x-ray revealed a combined picture of pneumonia and congestive heart failure. Echocardiogram showed ventricular septal defect, aortic regurgitation and mitral stenosis. Later on diagnosed with infective endocarditis and the culprit was his native valves. He went through aortic valve replacement and discharged after full recovery.

Histopathological pattern of pediatric renal diseases: a study from a university hospital in western Saudi Arabia.

To study the clinical indications and histopathological pattern of renal biopsies and renal resection specimens in the pediatric age group (birth to 17 years) in a large academic center in western Saudi Arabia. A retrospective review of the computerized database of the Pathology Department at King Abdul Aziz University Hospital (KAUH) was carried out on the final pathology reports of all children of the age of 17 years and below who either had ultrasound-guided renal biopsies or partial or total renal resections during the period between January 1995 and December 2008. All the specimens were reported by our pathology department. The most common clinical indication in the study group (242) is nephrotic syndrome (117, 48.3%), followed by systemic lupus erythromatosis for staging (30, 12.4%), nephritic syndrome (27, 11.1%) and renal mass for histological diagnosis (17, 7.0%). The most frequently reported pathological diagnosis was renal glomerulopathies, constituting 183 cases (n = 183, 75.6%) of the total number of pathology reports reviewed. Primary glomerulopathies were more common (n = 155, 88.4%) than the secondary ones (n = 28, 11.6%). The second most common pediatric renal pathology in this study was renal neoplasms (14, 5.7%). Vascular renal diseases and renal glomerulosclerosis ranked as the third pathological diagnosis in order of frequency in this study, with ten cases (10, 4.1%). The most common clinical indication for renal tissue sampling in this study is nephrotic syndrome and the most frequently detected pathology is glomerulonephritis. Larger multicentre studies are needed to further study pediatric nephropathies.

Histopathological pattern of ovarian neoplasms and their age distribution in the western region of Saudi Arabia.

OBJECTIVE: To identify the different histopathological types of ovarian neoplasms and their age distribution. METHODS: This is a retrospective study were ovarian neoplasms received by the Pathology Department of King Abdulaziz University, Jeddah, Saudi Arabia between January 1995 and December 2010 were reviewed and their frequencies in different age groups were calculated. RESULTS: Out of 618 ovarian specimens studied, 382 (61.8%) were ovarian neoplasms while 38.2% were non-neoplastic functional cysts. Benign neoplasms (n=278; 72.8%) were more common than borderline (n=20; 5.2%) and malignant ones (n=84; 22%) in all age groups. Surface epithelial neoplasms were the most common (61%) followed by germ cell (28%), gender cord stromal (7.6%) and metastatic tumors (3.4%). The most common benign neoplasm was serous cystadenoma (44.6%) and the most common malignant was serous cystadenocarcinoma (33.3%). The most common ovarian neoplasm below the age of 20 years was surface epithelial tumors (n=24) followed by germ cell tumor (16 cases). Benign neoplasms (n=213) were more common than malignant ones (n=42) in the age group from 20-51 years. Malignant ovarian neoplasms (35 out of the 71) were more common than benign (34 cases) in the age above 52. CONCLUSION: Benign ovarian neoplasms are more common than malignant ones. The most common benign ovarian neoplasm is serous cystadenoma and the commonest malignant neoplasm is serous cystadenocarcinoma. The prevalence of malignant ovarian neoplasms increases with increasing age.

Histopathological patterns of testicular biopsy in male infertility: A retrospective study from a tertiary care center in the western part of Saudi Arabia.

OBJECTIVE: To identify and categorize various pathological changes seen in testicular biopsies of males with infertility and to compare the results with data from other local and international studies. MATERIALS AND METHODS: All testicular biopsies from males with infertility received by the Pathology Department of King AbdulAziz University Hospital, Jeddah, in the period from January 2004 until May 2010 are reviewed and histopathologically classified into seven categories as follows : Normal spermatogenesis, hypospermatogenesis, germ cell maturation arrest (GCMA), Sertoli cell only syndrome, seminiferous tubule hyalinization, mixed and discordant patterns. RESULTS: One hundred testicular biopsies were identified in the computerized records of the Department of Pathology of King AbdulAziz University Hospital in the studied period. The age ranged from 22 to 70 years with a mean age of 24.5 years. The histopathological patterns were as follows: 14 (14%) cases were reported as normal spermatogenesis;(29, 29%) cases as hypospermatogesis; and 12 (12%) cases were reported as GCMA, mostly at the level of primary spermatocytes. The Sertoli cell only syndrome and the seminiferous tubule hyalinization categories were each reported in 16 cases (16%). Nine cases (9%) showed a mixed pattern. Discordant pattern was seen in 5 (5%) cases. CONCLUSION: Our study showed that hypospermatogenesis is the commonest pattern in testicular biopsies taken from males with infertility in our region. This study supports the recommendation of bilateral testicular biopsies when investigating male infertility.

Noninsulinoma pancreatogenous hypoglycemia syndrome in a Saudi male.

Nesidioblastosis is focal or diffuse islet hyperplasia leading to hyperinsulinism with subsequent hypoglycemia in the absence of insulinoma, usually described in neonates and infancy. We described the first adult case of nesidioblastosis in Saudi Arabia and the Gulf region. The diagnosis and treatment of the condition can be very difficult and challenging. Despite the fact that our patient responded initially to surgical treatment, his hypoglycemic symptoms occasionally recurred and needed adjunctive medical treatment. Although initially thought to affect only infants and children, cases of nesidioblastosis can affect adults and pose a diagnostic and therapeutic challenge to the clinicians.

Pattern of abnormal Pap smears in developing countries: a report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System.

BACKGROUND: Reports describing the frequency and pattern of abnormal Pap smears in developing countries using the revised Bethesda system for Pap smear are few. We studied the pattern of cervical intraepithelial lesions and carcinoma detected in Pap smears of Saudi females in the western region of Saudi Arabia using the revised system. METHODS: All cervical Pap smears reported in the Department of Pathology of King Abdulaziz Medical City, Jeddah, from 1 January 1998 to 31 August 2005 were reclassified according to the revised system with age ranges identified. RESULTS: Of 5590 sufficient smears, 261 (5%) were identified as abnormal and were further classified as atypical squamous cells of undetermined significance (ASC-US) (103 cases, 40%), atypical squamous cells of high grade (6 cases, 2%), low-grade squamous intraepithelial lesions (LSIL) (56 cases, 22%), high-grade squamous intraepithelial lesions (HSIL) (31 cases, 12%), glandular cell abnormalities (30 cases, 11%) and invasive squamous cell carcinoma (21 cases, 9%). The ASC-US/SIL ratio was 1.9%. Invasive adenocarcinoma accounted for 14 cases (4%) with a similar age range as invasive squamous cell carcinoma. CONCLUSION: Although this study showed a lower incidence and a wider age range of cervical epithelial cell abnormalities than others published internationally, the results emphasize the need for a well-organized cervical screening program supplemented by larger national studies on the pattern of cervical abnormalities in this country. The information provided in this study will encourage use of the Pap smear as a screening method for cervical cancer in developing countries.

Intratesticular borderline serous tumor.

Neoplasms resembling ovarian serous tumors rarely arise in the male genital organs. Müllerian histogenesis of this tumor has been suggested. We report a case of an intratesticular borderline serous tumor accidentally discovered during the course of a preoperative workup in a 72-year-old man admitted for left upper lobectomy for squamous cell carcinoma of the lung.

Osteomalacic myopathy due to celiac disease.

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy.

Cerebellar syndromes as a late presentation of Langerhans cell histiocytosis.

We report a patient with late onset ataxia who was initially labeled as idiopathic diabetes insipidus for many years. Pathological and radiological investigations revealed Langerhans cell histiocytosis. This case report aims to draw the attention of physicians to this delayed and rare presentation.