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Cardio- and neurotoxicity of amphetamines play an important role in worsening morbidity, making the initial evaluation of the patient’s status a potentially lifesaving action. The current study hypothesized that the S-100β serum level could predict the severity of acute amphetamine toxicity and the in-hospital outcome. The current study is a prospective cohort study conducted on 77 patients diagnosed with acute amphetamine exposure and referred to Aseer Poison Control Center, Saudi Arabia. The patients admitted to ICU showed significantly higher serum levels of S-100β in comparison to those not admitted (p 0.430 ug/L, the sensitivity of S-100β serum level as severity predictor was 100%, and the specificity was 74.1%. In conclusion, the current study revealed that the S-100β serum level could be used as an outcome predictor in hospital admission cases due to toxic amphetamine exposure and offers an idea about the cardiac and neuronal involvement. This can help select patients who will benefit most from ICU admission and early management and assess the severity of cases in settings where GC–MS is not available.

Background Guidelines recommend dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) placement for ≥12 months in acute coronary syndrome or 6 months in stable coronary artery disease. However, with the advent of newer-generation stents, the optimal duration of DAPT to balance bleeding and thrombotic risks has been debated. Objectives We aimed to perform a meta-analysis of randomized controlled trials (RCT) comparing P2Y12 monotherapy in short-duration group (SDG) vs. standard treatment group (STG) course of DAPT in patients undergoing PCI. Methods Electronic databases were searched for RCTs of patients undergoing percutaneous coronary intervention (PCI) with DES placement who received short (≤ 3 months) vs. standard DAPT course (≥12 months) and were followed for ≥12-months. Rates of major adverse cardiovascular events (a composite of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke) were the primary outcome. Study-specific odds ratios (OR) and corresponding 95% confidence intervals were calculated using random-effects model. Results A total of 20,706 patients (10,344 in the SDG and 10,362 in the STG) were analysed from four studies. There was no significant difference observed for MACE (OR = 0.95, 95% CI: 0.81–1.08, P = .92, I2 = 0%) myocardial infarction or stent thrombosis. However, lower rates of major bleeding were noted in the SDG (1.20 vs. 1.80%; OR: 0.61; 95% CI: 0.37–0.99; P = .04; I2 = 71%) albeit with increased heterogeneity. Conclusion A short duration of DAPT followed by P2Y12 inhibitor monotherapy was comparable to 12 months of DAPT with respect to MACE and thrombotic events, with lower rates of major bleeding events in select group of patients undergoing PCI. More data is needed to assess efficacy in patients with complex lesions and high risk ACS population including those with STEMI presentation.

Objectives: To analyze the clinical characteristics and in-hospital outcomes among coronavirus disease 2019 (COVID-19) positive medical staff compared with those of public. Methods: A total of 108 COVID-19-positive medical staff patients were included in the study from March 23, 2020 to June 15, 2020. Patients were analyzed for demographic data, clinical presentations, and in-hospital outcomes and compared against 661 COVID-19-infected patients of non-medical personel. Results: Mean age of medical staff patients was 44.05±13.9 years, most of whom were women (63.9%). The infected medical staff members consisted of 63 nurses (58.3%), 37 physicians (34.3%), 5 technicians (4.6%), and 3 pharmacists (2.8%). Smoking (60.2%) was the most frequent, followed by diabetes mellitus (37%). Of 108 COVID-19 infected medical staff, 18 (16.6%) were isolated in the intensive care unit (ICU), of which 14 (77.8%) were male, 16 (88.9%) were smokers, and 16 (88.9%) presented with pneumonia. Fatality ratio among medical staff patients was 4.6%. Male gender with odds ratios (OR) of 7.771 and 95% confidence intervals (CI) of 0.837-72.195 and a history of chronic kidney disease of (OR=10.778, 95% CI: 1.503-77.287) were predictors of death among the medical staff group. Conclusion: The incidence of COVID-19 infection among medical staff is quite high, but the occurrence of extreme illness and death is significantly low compared with the general community. Training should be implemented for all hospital staff on infection prevention techniques. Reliable and quick access for testing medical personnel is essential to maintain health, safety, and availability of health care workers during this pandemic. Saudi Med J. 2020 Dec;41(12):1336-1343 doi: 10.15537/smj.2020.12.25514 How to cite this article: Abohamr SI, Aldossari MA, Alaklobi FA, Amer HA, Alzarzour SH, Abdelhamid SW, Aljunaidi O, Badhawi OS, Siddiqui S, Jumaa H, Badwi M, Elsheikh E. Clinical characteristics and in-hospital outcome of medical staff infected with COVID-19 in Saudi Arabia. A retrospective single-center study. Saudi Med J. 2020 Dec;41(12):1336-1343. doi: 10.15537/smj.2020.12.25514. PMID: 33294892.

Objectives : To provide a detailed study of demographic, baseline comorbidities, clinical features, and outcome for Coronavirus disease 2019 (COVID-19) patients. Methods : A record-based case-series study conducted from March 23 to June 15, 2020 in King Saud Medical City, Riyadh, Saudi Arabia. Demographic data, clinical presentation, laboratory investigations, complications, and in-hospital outcome of COVID-19 patients collected with analysis of the clinical characteristics for survivors and deceased. Results : A total of 768 patients were included. The mean age was 46.36±13.7 years and 76.7% were men. Approximately 96.3% reported more than one comorbidity; diabetes mellitus was the most frequent (46.4%). Fever (84.5%), cough (82.3%), and shortness of breath (79.8%) were the main presenting symptoms. During the follow-up, pneumonia reported in 68.6%, acute respiratory distress syndrome in 32.7%, septic shock in 20.7%, respiratory failure in 20.3%, and acute kidney injury in 19.3%. Approximately 45.8% of enrolled patients required intensive care unit admission. Lung disease (odd ratio [OR]=3.862 with 95% confident interval [CI] (2.455-6.074), obesity (OR=3.732, CI=2.511-5.546), smoking (OR=2.991, CI=2.072-4.317), chronic kidney disease (OR=2.296. CI=1.497-3.521), and diabetes mellitus (OR=2.291, CI=1.714-3.063) are predictors of ICU admission. Fatality ratio was 4.27%; therefore, men were more prevalent in dead group. Conclusion : Coronavirus disease 2019 places a huge burden on healthcare facilities, particularly in patients with comorbidity. Coronavirus disease 2019 patients who are obese and smokers with history of diabetes mellitus have a high risk of death. Saudi Med J 2020; Vol. 41 (11): 1217-1226 doi: 10.15537/smj.2020.11.25495 How to cite this article: Abohamr SI, Abazid RM, Aldossari MA, Amer HA, Badhawi OS, Aljunaidi OM, Alzarzour SH, Saadeddin HM, Bhat FA, Elsheikh E. Clinical characteristics and in-hospital mortality of COVID-19 adult patients in Saudi Arabia. Saudi Med J. 2020 Nov;41(11):1217-1226. doi: 10.15537/smj.2020.11.25495.

Acute pulmonary embolism (APE) is a common and prognostically significant complication of COVID-19 infection. We investigated the clinical characteristics and chest CT findings of COVID-19 positive patients complicated with APE. A retrospective, record-based, case-series study was performed examining 483 patients admitted to King Saud Medical City during the pandemic, from April 2020 to June 2020. Of these, 92 patients who underwent chest CT scans were included in the final analysis. The incidence of APE, clinical presentations, radiological patterns, and patient outcomes were assessed and compared against those for patients without PE. The incidence of APE was 22% [95% confidence interval (95% CI): 19%-39%], detected by chest CT. Men constituted 85.0% of patients, with a mean age of 48.9 ± 16.7 years. For most patients with APE, risk factors for thromboembolism were established but did not differ significantly from those without PE. The mean D-dimer level of 9.1 (range 7.0-10.2) was significantly higher among patients diagnosed with APE (OR: 1.021; 95% CI: 1.012-1.028; P = 0.001) compared with that in patients without PE. Moreover, the mean levels of lactate dehydrogenase (LDH, 628.5; range: 494.0-928.3; OR: 1.002; 95% CI: 1.000-1.003; P = 0.02), C-reactive protein (CRP; 158.5; range: 105.3-204.5; OR: 1.025; 95% CI: 1.015-1.035; P = 0.001), and cardiac troponin (3.5; range; 2.6-3.8; OR: 1.016; 95% CI: 0.971-1.067; P = 0.01) were also significantly higher in patients with APE than those in patients with PE. The chest CT presentations of APE included massive, segmental, and sub-segmental APE. The need for Intensive Care Unit admission was higher among patients diagnosed with APE, who presented a fatality rate of 10%.. Our study pointed to the incidence and predictors of APE in COVID-19 patients. High levels of D-dimer, CRP, cardiac troponin, and LDH should alert the clinician to the possibility of APE in COVID-19 patients..

Objectives: To analyze predictors of death in elderly patients diagnosed with acute coronary syndrome (ACS). Methods: A record-based study carried out between January 2016 and January 2018 at The central province in Saudi Arabia. All elderly patients (greater than 75 years) with definite diagnosis of ACS were retrospectively included. Demographic data, echocardiographic, and angiographic parameters were reported. Results: A total of 179 patients were enrolled, 129 (72%) were male. The mean age was 79±4.7 years. Approximately 102 (57%) patients were diagnosed with ST-segment elevation myocardial infarction (STEMI). Of all 125 (70%) underwent invasive coronary angiography, we found that 43 (24%) had significant single vessel disease (1VD), 29 (16.2%) had 2 vessel disease (2VD), and 41 (22.9%) had 3 vessel disease (3VD) or left main stenosis. During hospitalization 21 (11.7%) patients died, t-test analysis showed patients who died were significantly older (82±6.7 versus [vs.] 79±4.2 years, p =0.003). In addition we found that ejection fraction was lower in death group (30.2%±10.7) vs. (36.5%±1.1) in survivors, p =0.017); STEMI was more common in death group (90.5%) vs. (52.5%) in survivors, p =0.001); similarly, the prevalence of 3VD was higher in death group (38.1%) vs. (20.9%) in survivors, p=0.018). Importantly, PCI was not significantly different between death and survival groups (40% vs. 53.8%, p =0.177). A multivariate regression analysis demonstrated that predictors of death were: age (hazard ratio [HR], 1.214; 95% confidence interval [CI], 1.122-1.384; p less than 0.0001), intubation (HR, 10.106; 95% CI, 9.844-10.792; p less than 0.0001), and raised creatinine kinase-MB (CK-MB) (HR, 1.005; 95% CI, 1.002-1.013; p =0.04) predicted in hospital death. Conclusion: Older age, mechanical ventilation and raised CK-MB can significantly predict death in elderly patients (greater than 75-year-old) diagnosed with ACS; nevertheless, PCI showed no survival benefits. Saudi Med J 2019; Vol. 40 (10): 1003-1007 doi: 10.15537/smj.2019.10.24583 How to cite this article: Ahmed OE, Abohamr SI, Alharbi SA, Aldrewesh DA, Allihimy AS, Alkuraydis SA, Alhammad IM, Elsheikh E, Azazy AS, Mohammed AA, Dar MA, Abazid RM. In-hospital mortality of acute coronary syndrome in elderly patients. Saudi Med J 2019; 40: 1003-1007. DOI: 10.15537/smj.2019.10.24583

Background Bechet’s disease (BD) is a relatively rare disease that causes recurrent oral and genital ulcers in addition to a variety of systemic manifestations. Concomitant superior-vena-cava (SVC) thrombosis and cardiac involvement with dilated cardiomyopathy (DCM) as initial presentations for BD is considered rare. Case presentation A 32-year-old-man presenting with intractable headaches and dyspnea. He was later diagnosed with SVC thrombosis and DCM. A diagnosis of BD was made after detailed history-taking. Conclusions Cardiovascular manifisations can be the initial presentation of BD. We aim to highlight the importance of early clinical recognition of BD as a cause of DCM and SVC thrombosis.

Cannabis is one of the most widely used illicit substances worldwide, and it has the highest prevalence among drugs used in Egypt.The aims were to evaluate whether the use of cannabis is a risk factor of acute coronary heart disease in low-risk, young males and to compare the cardiac pathological changes between cannabis exposed and non-exposed ischemic patients.This was a cross-sectional study that was performed on 138 male patients, aged ≤ 40 years, with acute myocardial infarction who were admitted to the Cardiac Care Unit at the University Hospital. Urine samples were submitted for toxicological analysis using a homogenous enzyme immunoassay technique to determine the substance of use. The patients were divided into three groups: group 1 (n = 23), cannabis-positive only patients; group 2 (n = 28), patients positive for any other substance of use; and group 3 (n = 34), patients negative for any substance of use.Smoking was prominent, whereas group 1 had no other risk factors. In groups 1 and 2, ST-segment elevation myocardial infarction (STEMI) was dominant, whereas no ST-segment elevation myocardial infarction (NSTEMI) was prominent in group 3. Ischemic resting wall motion abnormalities were presented in 47.8% of group 1 and in only 11.8% of group 3. None of group 1 had normal coronaries, whereas 14.3% of group 3 had normal coronaries. Significant changes in echocardiography and angiography were observed between group 1 and other groups.Cannabis smoking could be a potential risk factor for the development of cardiac ischemia.

Arterial stiffness is increasingly recognized as an important determinant of cardiovascular risk and may be directly involved in the process of atherosclerosis. As atherosclerosis leads to increased arterial resistance and decrease the flow propagation speed within the arterial lumen, a similar decrease in aortic flow propagation with increased downstream resistance is detected, so aortic flow propagation velocity AVP was evaluated in many studies as a new parameter of aortic stiffness. Aim: To measure arterial stiffness using the new parameter AVP and compare it to flow mediated dilatation FMD as a parameter of endothelial dysfunction in patients with metabolic syndrome MS. Methods: AVP (assessed by transthoracic echocardiography) and FMD (assessed by brachial artery reactivity test) were measured in 100 patients with MS (Group 1) and were compared to 14 normal subjects (Group 2). Results: Patients with MS had significantly lower values of AVP as compared to the normal subjects; 36 ± 5 cm/s vs 57 ± 5, p