Fibrolamellar Hepatocellular Carcinoma in the Absence of Risk Factors: A Case Report.

Cancer of the liver and intrahepatic bile ducts is the sixth most frequently diagnosed cancer worldwide. In addition, primary liver cancer is the fourth leading cause of cancer-related mortality worldwide, and the second most lethal tumor after pancreatic cancer. Early diagnosis and rapid workup for the suspected case are the only paths for treating the patient with curative intent. Hepatocellular carcinoma (HCC) is usually associated with risk factors like chronic viral hepatitis and alcohol ingestion. Since HCC typically progresses silently, clinical diagnosis can be challenging, and the diagnosis may require the use of one or more imaging modalities and liver biopsy. In this case, the patient is a 29-year-old man with no risk factors, who was diagnosed early and treated without the need for a liver transplant.

Predictors of Length of Hospital Stay, Mortality, and Outcomes Among Hospitalised COVID-19 Patients in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: COVID-19 pandemic is a major strain on health and economic systems, with rapidly increasing demand for in patients' facilities. Disease diagnosis and estimating patients at higher risk is important for the optimal management during the pandemic. This study aimed to identify the predictors of mortality and length of hospital stay in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted between March 2020 and August 2020 at Al-Noor Specialist Hospital in Mecca, Saudi Arabia. All patients who were admitted and had a confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) were included in the study. Descriptive statistics were used to describe patients' demographic characteristics, laboratory findings, and clinical outcomes. Multiple logistic/linear regression analysis was used to identify predictors of death and length of stay at the hospital. RESULTS: A total of 706 patients were hospitalised for COVID-19. The mean age was 48.0 years (SD: 15.6 years). More than half of the patients (68.5%; n= 292) were males. The median duration of stay at the hospital was 6.0 days (IQR: 300-10:00). The prevalence rate of venous thromboembolism (VTE) among the patients was 3.0% (n= 21). In the multivariate logistic regression analysis, age (AOR: 1.05; 1.02-1.09), patients with end-stage renal disease (AOR: 6.44; 2.20-18.87), low Oxygen saturation SPO2 (AOR: 9.92; 4.19-23.50), D.dimer >0.5 (AOR: 13.31; 5.45-32.49), ESR>10 mm/h (AOR: 4.08; 1.72-9.68), Ferritin>400mcg/L (AOR: 18.55; 6.89-49.96), and Procalcitonin>0.5ug/L (AOR: 8.23; 1.81- 37.40) were associated with a higher risk of death among patients with COVID-19. Patients with VTE (AOR: 12.86; 3.07- 53.92) were at higher risk of death due to COVID-19. CONCLUSION: Hospitalised COVID-19 patients have multiple negative consequences in terms of their laboratory findings, signs and symptoms. Age and end-stage renal diseases have a significant impact on the mortality rate and the length of hospital stay among COVID-19 patients.

Moyamoya Syndrome in a 32-Year-Old Male With Sickle Cell Anemia.

Moyamoya disease (MMD) is an unusual vasculopathy in which the blood vessels of the brain are occluded, resulting in thrombosis. When MMD occurs in association with an underlying pathology, it is known as moyamoya syndrome. The association of moyamoya syndrome with sickle cell disease is uncommon. Herein, we report a case of moyamoya syndrome in a 32-year-old male adult patient.

Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global pandemic. The clinical characteristics of COVID-19 have been reported; however, there is limited research investigating the clinical characteristics of COVID-19 in the Middle East. This study aims to investigate the clinical, radiological and therapeutic characteristics of patients diagnosed with COVID19 in Saudi Arabia. METHODS: This study is a retrospective single-centre case series study. We extracted data for patients who were admitted to the Al-Noor Specialist Hospital with a PCR confirming SARS-COV-2 between 12th and 31st of March 2020. Descriptive statistics were used to describe patients' characteristics. Continuous data were reported as mean ± SD. Chi-squared test/Fisher test were used as appropriate to compare proportions for categorical variables. RESULTS: A total of 150 patients were hospitalised for COVID-19 during the study period. The mean age was 46.1 years (SD: 15.3 years). The most common comorbidities were hypertension (28.8%, n = 42) and diabetes mellitus (26.0%, n = 38). Regarding the severity of the hospitalised patients, 105 patients (70.0%) were mild, 29 (19.3%) were moderate, and 16 patients (10.7%) were severe or required ICU care. CONCLUSION: This case series provides clinical, radiological and therapeutic characteristics of hospitalised patients with confirmed COVID-19 in Saudi Arabia.

Physicians' job satisfaction, ethics and burnout in Makkah, Saudi Arabia.

OBJECTIVE: To investigate the frequency of job satisfaction, burnout and ethics among physicians across specialties with varied levels of experience and seniority, in hospitals in Makkah, Saudi Arabia. METHODS: From April-May 2016, job satisfaction, burnout and ethics were assessed in 136 physicians across specialties from six government hospitals in Makkah. Data collection was via a self administered questionnaire. SPSS was used to obtain the likelihood ratio chi-square for all categorical bivariate statistical analyses. P-value <0.05 was considered significant. RESULTS: A total of 136 physicians participated in the study. Ninety five (70%) physicians were male and 41(30%) were female. Medical specialties varied between genders. There was no significant difference by gender, in job satisfaction among sphysicians (p-value 0.99). However, a high level of burnout was statistically significant among physicians (51%, p-value <0.001) and the level of burnout was significantly higher among physicians willing to change their specialty compared to those willing to repeat it (50% vs. 24%, p-value 0.02). Physicians dissatisfied with their salary had double the scores of ethics compared to satisfied physicians. Female physicians were better at resolving ethical dilemmas. CONCLUSIONS: :This study provided the first evidence of high frequency of burnout and career choice regret among physicians working in Makkah, Saudi Arabia. Preventing physician burnout not only improves the quality of healthcare but also ensures patient safety.

Outcomes of rituximab therapy in refractory lupus: A meta-analysis.

OBJECTIVE: Conventional treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) is associated with damage accrual, hence increased morbidity rate. Off-label use of rituximab (RTX) has shown significant promise in this patient group; however, data are still controversial. We aimed to analyze the outcomes of RTX therapy in refractory lupus using a meta-analysis approach. METHODS: Electronic search of the medical literature was conducted using a combination of relevant keywords to retrieve studies on the safety and efficacy of RTX in SLE and LN patients. Results were screened against our inclusion and exclusion criteria and two reviewers independently extracted the data for analysis. Comprehensive meta-analysis software was used to pool the data from individual studies and provide summary effect estimates. RESULTS: Thirty-one studies that enrolled 1112 patients were finally eligible for the meta-analysis. The overall global, complete, and partial response rates to RTX therapy were 72%, 46%, and 32%, respectively. RTX significantly decreased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and British Isles Lupus Activity Group (BILAG) scores (p<0.001). Prednisone dose was significantly reduced after RTX treatment in both SLE and LN groups (p<0.001), and proteinuria was lowered in SLE (p<0.001) than in LN patients (p=0.07). Infection and infusion-related reactions were the most common side effects. CONCLUSION: RTX therapy in refractory SLE and LN patients proved clinical efficacy and favorable safety outcomes. Larger well-designed randomized clinical trials are warranted.

Systematic review of the role of rituximab in treatment of antineutrophil cytoplasmic autoantibody-associated vasculitis, hepatitis C virus-related cryoglobulinemic vasculitis, Henoch-Schönlein purpura, ankylosing spondylitis, and Raynaud's phenomenon.

Rituximab (RTX) is established for the treatment of rheumatoid arthritis. This systematic review of the literature since 2006 summarizes evidence for the use of RTX in the treatment of additional rheumatological diseases: antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV), hepatitis C virus-related cryoglobulinemic vasculitis, Henoch-Schönlein purpura, ankylosing spondylitis, and Raynaud's phenomenon. Data from randomized controlled trials are available only for AAV, confirming efficacy for remission induction, including in disease resistant to conventional treatment, and maintenance of remission. Further studies are required to confirm optimal maintenance regimens in AAV, important questions needing to be addressed including protocol administration versus treatment in response to clinical relapse and the importance of maintaining B-cell depletion. Sufficient data are available in other diseases to suggest RTX to be useful and that randomized controlled trials should be conducted.