Increased frequency of cataract surgery in patients over age 50 with pituitary macroadenomas and chiasmal compression.

BACKGROUND: Patients with visual loss from macroadenomas compressing their optic apparatus may also have concomitant age-related visual pathology such as cataracts. How these two pathologies interact with each other is not well documented. OBJECTIVE: The interaction between these two pathologies in elderly patients is the subject of this study. METHODS: We identified a series of non-functioning macroadenoma patients over age 50 years with tumors compressing the chiasm who underwent transsphenoidal surgery at our institution between 2004 and 2018. Pre- and post-operative visual complaints, tumor size and extent of resection were analyzed. Prevalence of the diagnosis of cataract and prevalence of cataract surgery in each decade were compared with national averages. RESULTS: We identified 200 patients who met selection criteria. 18% of these patients had a diagnosis of cataract and 12.5% had cataract surgery. Compared with the Eye Diseases Prevalence Research Group (EDPRG) study, the prevalence of cataract surgery was 2.5 times the national average of 5.1%. 32% of these patients had no improvement in their vision after cataract surgery but 76% improved after transsphenoidal surgery. CONCLUSIONS: We reported a high prevalence of cataract surgery in patients over age 50 in patients with pituitary macroadenomas compressing the optic pathway compared with national averages in patients without adenomas. While visual loss from adenoma likely precipitated more cataract surgeries in this group of patients, some who may not have required it, those patients with cataracts who did not have their cataracts extracted were less likely to recover vision after transsphenoidal surgery. Addressing both pathologies is beneficial.

The humanistic and economic burden of atopic dermatitis among adults and adolescents in Saudi Arabia.

Aims: Atopic dermatitis (AD) is a chronic skin disease that creates a significant burden to patients and society. There is scarcity in local data about the burden of AD in the Kingdom of Saudi Arabia (KSA). We aimed to fill in this gap and quantify the humanistic and economic burden of AD among adults and adolescents in KSA.Materials and methods: A literature search and local expert interviews were conducted to assess the disease burden. Prevalence values were estimated through the literature. International data about health-related quality of life lost owing to AD was adjusted to age and prevalence in KSA. Direct and indirect costs were calculated using a bottom-up approach. Resource utilization data were collected from local dermatologists through online interviews, and indirect costs were based on absenteeism and presenteeism estimates. Validation meetings were conducted with local experts to adjust the final estimates.Results: The age-standardized health loss per patient due to AD is 0.187 quality-adjusted life-years (QALYs) annually, aggregating to 64 thousand lost QALYs in KSA. The annual average direct cost for a patient with AD was 2924 Saudi Riyal (SAR; 780 USD), totaling 373 million SAR in KSA (99.5 million USD). This value represents 0.2% of the annual health expenditure in KSA. The total productivity loss due to AD was 1.36 billion SAR (363.7 million USD). Overall, the economic burden of AD consumes up to 0.059% of the national gross domestic product.Limitations: Local quality of life and productivity lost data were not available for KSA, so global averages were used, assuming these numbers also apply to KSA.Conclusion: Indirect costs represent a large proportion of AD burden in KSA. The disease has a substantial effect on patient quality of life and social well-being. Alleviating the burden might result in significant savings in resources to society.

Atopic dermatitis is one of the most common skin diseases. Mild cases of the disease cause inflamed and itchy skin, while severe cases may cause painful episodes of itching and cracked skin. Patients with atopic dermatitis and their families suffer lower quality of life as the severity of the disease increases. In countries with hot weather like Saudi Arabia, skin is more susceptible to become dry, so the disease is very prevalent. Therefore, the disease poses a significant quality of life burden as well as an economic burden due to the direct costs of treatment and the indirect costs that arise because patients become non-productive or absent from work or school. Our study aimed to quantify the economic and quality of life burden of atopic dermatitis in Saudi Arabia to understand it's real burden and help decision makers quantify its impact on the patients and society. We conducted a literature search and interviewed local experts to determine estimates of costs and quality of life effects. The results of this study should help in prioritizing treatment disease areas in Saudi Arabia and other countries with similar circumstances.

Body mass index and pregnancy outcome after assisted reproduction treatment.

The present study aimed to evaluate the impact of body mass index (BMI) on pregnancy outcome after intracytoplasmic sperm injection (ICSI). The study analyzed pregnancy outcome of 349 women who underwent ICSI by their BMI: <25, 25-<30, and ≥30 kg/m(2). The associations were generated by applying logistic regression models. A significant reduction in positive pregnancy outcome was observed among overweight and obese women (odds ratio (OR) = 0.50; 95% confidence interval (CI) = 0.25-0.99 for overweight women and OR = 0.45; 95% CI = 0.20-0.89 for obese women). These estimates show that the pregnancy rates are reduced with increasing BMI. The effect of obesity on pregnancy outcome was absent when three and more embryos were transferred. Our study contributes to the reports linking overweight and obesity with decreased positive pregnancy outcome after ICSI and suggests women's age, infertility type, and number of embryos transferred to modify this reducing effect.

Predictive value of vascular endothelial growth factor in preterm neonates with intraventricular haemorrhage.

OBJECTIVE: Intraventricular haemorrhage (IVH) is a major problem in premature infants. Our objective is to assess the early predictive value of vascular endothelial growth factor (VEGF) for development of IVH and management of its squeal in preterm neonates. METHODS: We prospectively studied 150 preterm neonates (PT) less than 34 weeks gestation. Fifty of them completed the study. 30/50 developed IVH during follow up, and 20 did not. First 24 hours, and 3(rd) day serum samples were collected. Cerebrospinal fluid (CSF) samples were withdrawn for 10 IVH patients. RESULTS: Serum VEGF; both samples were increased in IVH compared to non-IVH group (P=0.001). PHVD-group (n=10) had higher VEGF in both samples than resolved IVH (P=0.004), (P=0.005). While, VEGF increased in the IVH group 2(nd) sample compared to 1(st) (P=0.000), it decreased in non-IVH group, P=0.033). Each 1 unit increase in 1(ST) VEGF increased the risk of occurrence of IVH by 1.6%. 3(rd) day VEGF at a cut-off value of 135 pg/ml is 96% sensitive and 100% specific to predict PHVD. Serum VEGF inversely correlated with TLC, pH, PO(2) and HCO(3), and positively correlated with PCo(2) and FiO(2). CONCLUSION: Serum VEGF predicts development of IVH and PHVD in PT neonates. Also, high CSF level of VEGF could predict the need for permanent shunt placement.