With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has ...increased, and the morbidity and mortality resulting from a delayed diagnosis or misdiagnosis is considerably high. In this article, we examine the changing trends in the epidemiology of CD and ITB, in addition to clinical features that aid in the differentiation of both diseases. The value of various laboratory, serological, and the tuberculin skin tests are reviewed as well. The use of an interferon-gamma-release assay, QuantiFERON-TB Gold, in the workup of these patients and its value in populations where the bacillus Calmette-Guérin vaccine is still administered is discussed. Different radiological, endoscopic, and pathological similarities and features that can aid the clinician in reaching a rapid diagnosis are reviewed as well. The association between mycobacteria and CD, the concerns with the practice of antituberculosis medication trials in areas where tuberculosis (TB) is endemic, as well as extrapulmonary TB induced by the use of antitumor necrosis factor-alpha agents are delineated in this article. Furthermore, we propose an algorithm for the investigation of patients in whom the differential diagnosis encompasses CD and ITB.
AbstractUpdate to this articleIn October 2022, three years after the initial publication of this guideline, the first trial of the effect of colonoscopy screening was published. The implications of ...this new evidence for the current recommendations were evaluated by the guideline panel in January 2023. The guideline panel judged that this new evidence did not alter the current recommendations, and therefore that an update of the following guideline was not needed (see table 2 for details).Clinical questionRecent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: “Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?”Current practiceNumerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy.RecommendationsThese recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids.How this guideline was createdA guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option’s practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations.The evidenceOverall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens, and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk.Understanding the recommendationBased on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.
Availability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation ...programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country.
We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990–2010 (before the health-care investments and reform) and 2010–17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries.
Age-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of −0·58%), and this decrease was further accelerated from 2010 to 2017 (–2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010–17 the decrease was not as low as in Saudi Arabia (–1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990–2010 and 2010–17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region.
Decreases in mortality continued at greater rates in Saudi Arabia during the period of 2010–17 than in 1990–2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability.
Bill & Melinda Gates Foundation.
The authors aimed to explore the relationship between the expression/polymorphisms of
and susceptibility to colon cancer development in the Saudi Arabian population.
In total, blood samples from 115 ...patients with colon cancer and 102 participants without colon cancer were analyzed in this study. Three single-nucleotide polymorphisms (SNPs) were selected from the
gene, including two sites within the
gene's promoter region (rs352144 and rs187084) and one site in a
intron region (rs5743839). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed from logistic regression models after adjusting for age, gender, and tumor localization. To investigate the differential expression of
in colon cancer,
expression was evaluated using quantitative real-time reverse transcription polymerase chain reaction on 40 matched normal and colon tissues.
The authors found that
expression was decreased in colon cancer tissues as compared with that in normal tissues. Moreover, significant associations between the
rs187084 SNP and colon cancer risk were observed in female patients only. In rs187084, the T allele had a significantly lower frequency (2.8 times) in female cancer patients than in controls (0.27 vs 0.41). The
rs352139 and rs352144 SNPs were significantly associated with colon cancer development when the tumor was located in the rectal area.
The findings support the hypothesis that
has an anticancer role in colon cancer development. Furthermore, genetic variation may influence colon cancer development, and SNPs in
could serve as biomarkers for decision making in the treatment of females with rectal cancer.
ABSTRACT
BACKGROUND:
Self-expanding metal stents (SEMS) are used as a bridge to surgery for colon cancer patients as an alternative to emergency surgery. Currently, there is a paucity of literature ...from Saudi Arabia on the preoperative usage of SEMS.
OBJECTIVE:
Determine whether SEMS are associated with a higher rate of complications.
DESIGN:
Retrospective cohort study
SETTINGS:
Tertiary care hospital in Saudi Arabia.
PATIENTS AND METHODS:
In patients diagnosed with obstructing colon cancer, up-front surgical resection was compared with insertion of SEMS followed by surgical resection between the years 2009 and 2013.
MAIN OUTCOME MEASURES:
Rate of stent-related short-term complications. Secondary endpoint, postoperative complications.
SAMPLE SIZE:
65.
RESULTS:
Twenty-four (36.9%) patients underwent SEMS placement; 41 (63.1%) underwent primary surgery. The median (interquartile range) hospital stay was significantly higher among the SEMS group (13 8.5 days versus 7 3 days in the primary surgery group,
P
<.001). Five patients (20.8%) in the SEMS group developed complications: 2 (8.3%) perforations, 2 (8.3%) obstructions, and 1 (4.2%) stent migrations.
CONCLUSION:
SEMS is associated with longer hospital stays and short-term serious complications. Further research should be conducted, preferably with a larger sample size.
LIMITATIONS:
Retrospective design, small sample size.
CONFLICT OF INTEREST:
None.
Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard method to achieve biliary drainage (BD) in cases of obstruction, some situations preclude this option. ...Alternatively, percutaneous BD is associated with a number of limitations and more recently associated risks have been found to be higher than those with nonconventional interventions such as endoscopic ultrasound-guided BD (EUS-BD). EUS-BD encompasses a number of interventions and approaches depending on the underlying cause and position of obstruction. We present a case series of six cases where EUS-BD was used when ERCP was not possible or failed at a tertiary care academic center. We also describe the different types of EUS-BD based on the nomenclature that has been proposed by the Asian EUS group (AEG). In all the cases that were presented, EUS-BD was successful with no complications or adverse events. The intervention resulted in resolution of biliary obstruction and the patients underwent the planned treatment for their underlying disease. In this case series, we introduced the concept of EUS-BD to the nonspecialist and illustrated the variability of the procedure and its agile nature when applied in the right setting and with the proper expertise and the importance of the presence a complete team approach by different specialists when caring for these patients.
The Jewel in the Crown Khalid Fouda Neel; Majid Abdulrahman Almadi
Journal of nature and science of medicine,
01/2018, Letnik:
1, Številka:
1
Journal Article
Background: Saudi Arabia has recognized the significance of scientific research in social, health-care, and economic transformation and has established a large number of advanced research institutes. ...This study aimed to investigate the research progress of various universities and research institutes of Saudi Arabia during 2006–2016. Methods: In this bibliometric analysis, we investigated research publications published by a number of well-recognized health-care institutions and research centers to authenticate the scientific research productivity in Saudi Arabia during 2006–2016. The Saudi public institutions were selected based on their research activity in the field of medical and health science. The research publications were recorded from Institute of Scientific Information-Web of Science, Thomson Reuters (Clarivate Analytics). Results: During 2006–2016, King Saud University (KSU) published the highest number of publications (9954) followed by King Faisal Specialist Hospital and Research Center (KFSHRC) (3886). Moreover, King Abdulaziz Medical City published 685 articles, King Fahad Medical City 486, King Khaled Eye Specialist Hospital 425, Riyadh Military Hospital 165, and Prince Sultan Cardiac Centre and Research Centre published 108 articles. KSU's contribution to medical and health sciences was 63.4% followed by KFSHRC at 24.7% and the rest of the institutions contributed 12% of research publications. Conclusions: In Saudi Arabia, KSU produced the highest number of research articles during 2006–2015. This high research productivity shows the leadership visionary approach, proper spending of the research funding, and their faculty members' contributions.
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