Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review.

Objectives: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP. Data Source: Systematic Review of three electronic databases. Review Methods: Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs. Results: A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported. Conclusion: The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03144-8.

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment.

OBJECTIVES: To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials. METHODS: We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT). RESULTS: A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014). CONCLUSION: The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

Burnout, Stress, and Stimulant Abuse among Medical and Dental Students in the Western Region of Saudi Arabia: An Analytical Study.

Background: High levels of burnout, stress, and stimulant abuse have been reported among medical and dental students worldwide, with country-specific factors being contributors. The association, risk factors, and predictors of these three variables have not sufficiently been reported from Saudi Arabia, especially from the Western region. Objective: To determine the prevalence, association, and predictors of burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia. Methods: This cross-sectional study included all second to sixth year medical and dental students enrolled at Taibah University, Madinah, Saudi Arabia, during the 2019-2020 academic year. A self-administered, closed online questionnaire was administered. Data regarding stress were elicited using Cohen's 10-item Self-Perceived Stress Scale and regarding burnout using the Oldenburg Burnout Inventory Student Version questionnaire. Multiple logistic regression model to identify the risk of burnout was conducted, and univariate and multiple linear regression models were carried out to identify the predictors of stress. Results: Of 1016 eligible students, 732 responded (medical: 511; dental: 221). About half of the students experienced burnout (51.5%), with both high disengagement (49%) and exhaustion (45%). Most participants (90.3%) experienced moderate levels of stress. Eight (1.1%) respondents had experienced stimulant abuse; there was a no significant association between stimulant abuse and burnout in the multivariate analysis. Stress, age, gender, body mass index, GPA, study field, smoking, family income, and birth order were significant predictors of burnout, while burnout, age, gender, GPA, and physical exercise were significant predictors of stress. Conclusion: The findings in this study highlight the need for policymakers to devise strategies that target early identification as well as reduction of the high levels of burnout and stress.

The Use of Artificial Intelligence in Medical Imaging: A Nationwide Pilot Survey of Trainees in Saudi Arabia.

Artificial intelligence is dramatically transforming medical imaging. In Saudi Arabia, there are a lack of studies assessing the level of artificial intelligence use and reliably determining the perceived impact of artificial intelligence on the radiology workflow and the profession. We assessed the levels of artificial intelligence use among radiology trainees and correlated the perceived impact of artificial intelligence on the workflow and profession with the behavioral intention to use artificial intelligence. This cross-sectional study enrolled radiology trainees from Saudi Arabia, and a 5-part-structured questionnaire was disseminated. The items concerning the perceived impact of artificial intelligence on the radiology workflow conformed to the six-step standard workflow in radiology, which includes ordering and scheduling, protocoling and acquisition, image interpretation, reporting, communication, and billing. We included 98 participants. Few used artificial intelligence in routine practice (7%). The perceived impact of artificial intelligence on the radiology workflow was at a considerable level in all radiology workflow steps (range, 3.64−3.97 out of 5). Behavioral intention to use artificial intelligence was linearly correlated with the perceptions of its impact on the radiology workflow and on the profession (p < 0.001). Artificial intelligence is used at a low level in radiology. The perceived impact of artificial intelligence on radiology workflow and the profession is correlated to an increase in behavioral intention to use artificial intelligence. Thus, increasing awareness about the positive impact of artificial intelligence can improve its adoption.

Survival, mortality, and related comorbidities among COVID-19 patients in Saudi Arabia: A hospital-based retrospective cohort study.

OBJECTIVES: To assess the survival of COVID-19 patients in Saudi Arabia and to investigate possible mortality predictors. METHODS: This is a retrospective cohort study involving 248 patients with severe acute respiratory syndrome coronavirus-2 who were admitted to the primary COVID-19 referral hospital in Jeddah between March and June of 2020. Socio-demographic characteristics, comorbidities, laboratory investigations, management protocols, complications, treatment options, and mortality data were extracted from electronic medical records. The time analysis began at the first signs of illness thorough discharge or death. RESULTS: Our study showed that in-hospital complications including heart failure followed by acute renal failure had the largest effect size on mortality (p<0.001). Elderly patients and those with comorbid asthma had a higher risk of death. Non-survivors presented more commonly with shortness of breath and fever than survivors. High D-Dimer level was a marginally significant indicator of mortality in the studied population (p=0.05). We did not find a significant benefit in relation to any treatment option. CONCLUSION: Age, asthma, some in-hospital complications are important survival indicators in hospitalized COVID-19 patients. The controllable co-factors should be monitored and managed by healthcare workers to reduce mortality rates in those hospitalized with COVID-19.

Patterns of self-reported recovery from chemosensory dysfunction following SARS-CoV-2 infection: insights after 1 year of the pandemic.

BACKGROUND: The coronavirus disease (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes chemosensory dysfunction. AIMS/OBJECTIVES: To determine the characteristics of chemosensory dysfunction and to identify factors associated with chemosensory complete recovery and time to recovery. MATERIALS AND METHODS: This cross-sectional study included all patients presenting with chemosensory dysfunction and confirmed SARS-CoV-2 infection from May to August 2020 who underwent telemedicine follow-up after 1 year to assess their chemosensory recovery. RESULTS: A total of 372 patients were included, of which 53.8% were male. The mean age ± SD was 37.45 ± 13.44. The majority experienced combined (olfactory and gustatory) dysfunction (85.7%), and 315 patients (84.7%) had complete loss of chemosensory function. The independent predictors associated with a low likelihood of complete recovery were parosmia (aOR 0.16, p < .001), upper respiratory tract symptoms (aOR 0.28, p = .001), and dyspnoea (aOR 0.21, p < .001), whereas the factors associated with a long recovery period were parosmia (aOR 12.04, p = .002), headache (aOR 7.19, p = .007), and hypertension (aOR 7.76, p = .039). CONCLUSIONS: A full recovery outcome was predominant. The presence of parosmia was linked to both an incomplete recovery and a long time to recovery. SIGNIFICANCE: Parosmia and respiratory symptoms are implicated in the incomplete recuperation of chemosensory function.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Comparison of Two Treatment Modalities in Overactive Bladder: A Rapid Overview.

Background: Overactive bladder is a syndrome of urgency with the absence of infection and is usually accompanied by frequency and nocturia. Both sacral neuromodulation (SNM) and intravesical botulinum toxin (BTX) injection are used contentiously in overactive bladder after failure of conservative management. Objective: We aimed to provide an updated comparative overview of BTX injection versus SNM in the treatment of overactive bladder. Methods: PubMed and Google scholar databases were explored starting from 2016 to 2022 to obtain relevant articles. English studies on adult population were included. Results: Six articles included 648 participants were included in the current overview. Both BTX and SNM are comparable for the treatment of overactive bladder, with no major complications were reported. However, the use of SNM for refractory overactive bladder after failure of BTX was more successful and effective and resulted in patient satisfaction compared to the use of BTX after failure of SNM. Conclusion: Our update provides the latest comparative overview of outcomes of BTX versus SNM in the treatment of overactive bladder.

Does Caffeine Intake Increase the Incidence of Tinnitus? A Systematic Review.

Introduction Excessive caffeine intake has been thought to be a contributory factor for tinnitus. However, there has been no systematic review to elucidate the causal relationship between caffeine intake and the incidence of tinnitus. Objectives We performed the current review aiming at evaluating the evidence from the current literature for the relationship between caffeine intake and the incidence of tinnitus. Data Synthesis Databases including PubMed, Scopus, and Google scholar were searched for relevant articles. A total of 142 studies were screened for eligibility, of which four articles met our inclusion criteria: two were prospective cohorts and two were cross-sectional studies. Although one study found no association between caffeine consumption and the incidence of tinnitus, an inverse relationship was reported by two population-based studies. Concerning patients with preexisting tinnitus, reduction of caffeine intake in a subset who consumed 150 ml to 300 ml/day of coffee yielded a favorable outcome in tinnitus severity. However, those with higher dose intake were less prone to have improvement in the severity of tinnitus. Conclusion Although the current review was inconclusive, it appears that the incidence of tinnitus in previously unaffected individuals might be prevented by a high dose of caffeine intake. However, in preexisting tinnitus, a high dose of caffeine may adversely interfere with the efficacy of caffeine reduction.

Academic and non-academic life stressors and their impact on psychological wellbeing of medical students.

OBJECTIVES: Among medical students, depression, anxiety, and stress (DAS) are key public wellbeing challenges that require epidemiological research. We aimed to evaluate potential sources of these psychological disturbances and assess the contribution of academic and non-academic life stressors in psychological morbidity among medical students. METHODS: This exploratory questionnaire-based survey was conducted in a Saudi Arabian public sector medical college. A total of 231 medical students were enrolled and completed the depression, anxiety, and stress scale-21 (DASS-21) questionnaire. RESULTS: More than half of the medical students, 129 (55.8%), had depression, 106 (45.9%) students had anxiety, and 87 (37.7%) students had stress. Academic achievement was the largest explanatory factor for depression and stress, whereas bodily appearance constituted the largest explanatory factor of anxiety among the study sample. Academic and non-academic stressors score was significantly associated with depression (adjusted Odds Ratio, aOR = 1.13, 95% CI 1.07-1.19), anxiety (aOR = 1.07, 95% CI 1.03-1.12), and stress (aOR = 1.12, 95% CI 1.08-1.17). CONCLUSIONS: Medical students have a high incidence of negative emotional states. These negative psychological states were explained by academic achievement and bodily appearance. The studied stressors influenced medical students' psychological wellbeing.

Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study.

OBJECTIVES: To quantify the extent and variation of depression, anxiety and stress among medical and non-medical Saudi Arabian students. METHODS: In this cross-sectional study, students from Umm Al-Qura University, Makkah, Saudi Arabia, were recruited. The Faculty of Education was randomly selected to represent the non-medical colleges. The depression, anxiety and stress scale-21 items (DASS-21) was used to estimate the study outcomes. RESULTS: Of the 465 undergraduates recruited in this study, 49.68% (n=231) were medical students and 50.32% (n=234) were non-medical students. Approximately 54%, 53%, and 38% of the participants were found to be suffering from depression, anxiety, and stress, respectively. The analyses showed that the two groups did not differ significantly with respect to stress and depression (p=0.934 and 0.423, respectively). However, the non-medical students exhibited a significantly higher anxiety score compared to the medical students (p=0.002). Family conflicts was a common risk factor for the studied psychological disturbances. Female gender and travel time from home to university were significant predictors of depression and anxiety, whereas a positive history of a psychological condition increased the likelihood of depression and stress. CONCLUSION: There was a high prevalence of anxiety, stress, and depression among the students, with a significantly higher anxiety levels among the non-medical students.

Depression and Anxiety Among Medical Students: A Brief Overview.

Depression and anxiety are highly prevalent conditions worldwide. This article reviews the extent of depression and anxiety among medical students and elucidates associated potential risk factors. In comparison to other countries, students from Middle East countries have a higher prevalence of depression. Females suffer from these conditions more commonly than males. Factors associated with these morbidities can be divided into academic and non-academic factors. There is an inconclusiveness of whether medical students experience these symptoms more commonly than their counterparts. The present review provided a cross-sectional picture of the students' psychological well-being, which is crucial to formulate a health policy for preventive and therapeutic purposes.

Predictors of misconceptions, knowledge, attitudes, and practices of COVID-19 pandemic among a sample of Saudi population.

This study intends to explore the predictors of misconceptions, knowledge, attitudes, and practices concerning the COVID-19 pandemic among a sample of the Saudi population and we also assessed their approaches toward its overall impact. This online cross-sectional survey was conducted at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU) in Jeddah, Saudi Arabia (SA). Participants were approached via social media (SM), and 2006 participants (953 [47.5%] females and 1053 [52.5%] males) were included in this study. SM was the leading source of information for 43.9% of the study participants. Most of the participants had various misconceptions such as "females are more vulnerable to develop this infection, rinsing the nose with saline and sipping water every 15 minutes protects against Coronavirus, flu and pneumonia vaccines protect against this virus." About one-third of participants (31.7%) had self-reported disturbed social, mental, and psychological wellbeing due to the pandemic. Many participants became more religious during this pandemic. Two-thirds of the study participants (68.1%) had good knowledge scores. Attitudes were highly positive in 93.1%, and practice scores were adequate in 97.7% of the participants. Participants' educational status was a predictor of high knowledge scores. Male gender and divorced status were predictors of low practice scores, and aged 51-61 years, private-sector jobs, and student status were predictors of high practice scores. Being Saudi was a predictor of a positive attitude, while the male gender and divorced status were predictors of a negative attitude. Higher education was a predictor of good concepts, while the older age and businessmen were predictors of misconceptions. Overall, our study participants had good knowledge, positive attitudes, and good practices, but several myths were also prevalent. Being a PhD and a Saudi national predicted high knowledge scores and positive attitudes, respectively. A higher education level was a predictor of good concepts, and students, private-sector jobs, and aged 51-61 years were predictors of high practice scores. Study participants had good understanding of the effects of this pandemic.

Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review.

OBJECTIVE: Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients. DATA SOURCES: PubMed, Embase and Cochrane Library. STUDY SELECTION: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated. DATA EXTRACTION: Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported. MAIN FINDINGS: Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia. CONCLUSION: Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.

Evaluation of the Diagnostic and Predicative Values of 8-Iso-Prostaglandin F2α as a Biomarker of Breast Cancer.

BACKGROUND: Breast cancer (BC) is a commonly reported cancer that is widely prevalent among women. Its early detection improves patient survival and results in better outcomes. For diagnosis and follow-up care, tumor markers are one of the feasible investigations to be ordered. 8-Iso-prostaglandin F2α (8-iso-PGF2α) serves as a serum marker reflecting oxidative stress and subsequent damaging of DNA. In the present study, we aimed to evaluate both diagnostic and predictive values of 8-iso-PGF2α in BC patients. MATERIALS AND METHODS: Serum levels of 8-iso-PGF2α were assessed for 66 women with benign breast tumors and 65 women who had malignant BC. To compare the patients who had breast tumors with healthy individuals, 63 women free of breast diseases were selected as controls. RESULTS: The serum level of 8-iso-PGF2α in the BC patients (57.92 pg/mL) was significantly higher compared to those with benign tumors (18.89 pg/mL) (p < 0.001). In addition, individuals with no breast diseases had less 8-iso-PGF2α (4.02 pg/mL) compared to those who had developed a tumor (p < 0.001). Serum 8-iso-PGF2α was found to be positively correlated with both carcinoembryonic antigen (r = 0.74, p < 0.001) and cancer antigen 15-3 (r = 0.80, p < 0.001). Furthermore, serum 8-iso-PGF2α showed high diagnostic performance in BC (AUC = 0.999, sensitivity = 100%, specificity = 99.2% at a cutoff value of 36.18 pg/mL). CONCLUSIONS: Our study found that the high level of serum 8-iso-PGF2α helps to provide a non-invasive indicator to detect BC. Future work with a larger sample size and various phases of BC can confirm the current results which provide insights into the early detection of cancer.

The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis.

OBJECTIVES: The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature. DATA SOURCE: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials). REVIEW METHODS: All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles. RESULTS: Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31; P = .01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78-6.88; P < .001). CONCLUSION: Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.

Piezosurgery versus conventional osteotomy in rhinoplasty: A systematic review and meta-analysis.

OBJECTIVE: Piezosurgery, used in different otolaryngology procedures, was a breakthrough in surgery. We systematically reviewed the differences in outcomes after lateral nasal osteotomy with peizosurgery and conventional osteotome and quantified the differences through a meta-analysis. METHODS: Medline, Embase, and Cochrane library databases were selected to search for randomized clinical trials (RCTs) published before January 2019 that detailed differences between piezosurgery and conventional osteotomy. The key search terms included "rhinoplasty" and "piezosurgery." Only RCTs in English with patients >18 years who underwent lateral osteotomy by percutaneous or internal approaches were included. PRISMA guidelines were followed in data extraction and study inclusion. Two independent reviewers assessed the relevance of the studies. The point of estimate in the meta-analysis was the standardized mean difference and was pooled with the random-effects model. The measured outcomes were ecchymosis, edema, postoperative pain, and duration of surgery. RESULTS: Five RCTs met our criteria and were analyzed in primary subsequent meta-analyses. Piezosurgery demonstrated significantly lower edema (SMD = -0.75; 95% CI, -1.26, -0.24) and ecchymosis scores (SMD = -0.85; 95% CI, -1.49, -0.20) on postoperative days (POD) 2 or 3 than conventional surgery. They were also significantly lower with piezosurgery than conventional surgery on POD 7 (SMD = -0.64; 95% CI, -1.21, -0.06; and SMD = -0.64; 95% CI, -1.14, -0.14, respectively). Two studies that estimated the degree of pain showed that after piezosurgery, patients experienced lesser pain than after conventional surgery. The mean difference was -0.73 (95% CI, -1.06, -0.39). CONCLUSIONS: Piezosurgery causes less ecchymosis, edema, and pain than conventional osteotomy, without extending the duration of surgery. Laryngoscope, 130:1158-1165, 2020.

Patterns of emergency department visits during Hajj period: Towards healthcare optimization in view of Saudi Arabia's vision 2030.

OBJECTIVE: This study aimed to examine the pattern of emergency department (ED) visits by Hajj patients and determine the urgency of emergency visits at an advanced healthcare center. METHODS: A retrospective review of medical records of Hajj patients visiting the ED at King Abdullah Medical City Makkah from September 1 to October 5, 2015 was conducted. RESULTS: We considered 233 visits by 199 Hajj patients. Most diseases were cardiovascular related. Approximately half of the ED visits led to hospital admission, which were largely during the evening and nighttime. Potentially avoidable visits were significantly encountered during the daytime. Average bed occupation time in the ED was similar for both cases: those admitted to inpatient care and discharged from ED. Results from the Canadian Triage and Acuity Scale revealed that most patients were triaged with a score of III (48.4%) followed by a clinically better score of IV (32%); however, scores did not change significantly throughout the Hajj day. CONCLUSIONS: During Hajj, a significant proportion of patients who visited the ED at the ultimate healthcare facility were discharged within 24 hours, with a higher rate in the morning-afternoon period. Both admitted and discharged cases required equal levels of care. Therefore, an extension in working days at primary care centers and optimization of advanced healthcare facilities during Hajj is currently warranted.

8-Hydroxy-2'-deoxyguanosine as a Discriminatory Biomarker for Early Detection of Breast Cancer.

BACKGROUND: Breast cancer (BC) is one of the most prevalent and reported cancers among Saudi women. Detection of BC in the early invasive stage (stages I, II) has an advantage in treating patients over detection in the late invasive stage (stages III, IV). Tumor markers are used to aid in diagnosis, treatment monitoring, and recurrence detection of malignant tumors. 8-hydroxy-2'-deoxyguanosine (8-OHdG) is a marker of nucleic damage owing to oxidative stress. PATIENTS AND METHODS: We studied the blood levels of 8-OHdG in 50 women with benign breast tumors, 50 women with BC, and 50 healthy women as a control group. RESULTS: The concentrations of 8-OHdG were significantly increased in the BC group (55.2 ng/dL) compared with the benign tumor group (30.2 ng/dL) and with the healthy control group (9.08 ng/dL). The same pattern was observed with other diagnostic markers, including carcinoembryonic antigen and cancer antigen 15-3. Significant positive correlations between 8-OHdG and both carcinoembryonic antigen (r = 0.63; P < .001) and cancer antigen 15-3 (r = 0.51; P < .001) were noticed. The levels of 8-OHdG were significantly higher in stage I (81 ng/dL) compared with stage II (51 ng/dL; P < .05), stage III (38 ng/dL; P < .01), and stage IV (19 ng/dL; P < .001). In addition, serum 8-OHdG had a high diagnostic performance in BC (area under the curve, 0.86; sensitivity = 82%; specificity = 80% at cutoff value 21.4 ng/mL). 8-OHdG is associated with BC risk according to logistic regression analysis. CONCLUSION: We concluded that the significant increase of serum levels of 8-OHdG in patients with BC can be used as a potential noninvasive biomarker for early detection of BC. However, large sample sizes from different stages and types of BC should be included in any future study to confirm the present findings before translating the findings into routine clinical application.