Gestational diabetes prevalence and risk factors among pregnant women — Jazan Region, Saudi Arabia

Background. The gestational diabetes (GDM) is considered as a global public health problem that affects pregnant women. GDM can become chronic type II and usually it is associated with many risk factors that may lead to many serious complications for the mother and the fetus. The main objective of this study was to estimate the prevalence of GDM among pregnant women in Jazan region and to determine the possible associated factors of the GDM. Material and methods. The study involved pregnant women attending department of Obstetrics and Gynecology at government hospitals of Jazan region. A sample of 440 pregnant women were randomly selected. Interviews were conducted using a questionnaire prepared to measure the GDM prevalence, risk factors, awareness and adherence to the advice of the doctor and medications. Results. The prevalence of gestational diabetes among pregnant women in Jazan is estimated at 8.2%. The GDM prevalence was significantly higher among obese women (20.2%; 95% CI 13.2–29.2) compared with women with normal weight (7.1%; 95% CI 1.7–7.6). The analysis showed that GDM was significantly associated with child weight more than 3.5 kg (OR 4.315; p = 0.004), mother’s BMI more than 30 kg/m2 (OR 4.703; p = 0.001), and family history of GDM (OR 2.606; p = 0.046). Conclusion. In conclusion, the GDM prevalence obtained in this study is more than global prevalence and less than other studies in KSA. The BMI of mothers and having neonates that weight more than 3.5 kg are the main risk factors for GDM. Suitable interventions programs are highly required for control and risk factor modifications

Częstość występowania cukrzycy ciążowej i jej czynników ryzyka u ciężarnych kobiet w prowincji Dżazan w Arabii Saudyjskiej

Wstęp. Cukrzycę ciążową (GDM) uważa się za globalny problem zdrowotny dotyczący ciężarnych kobiet. Może ona przejść w cukrzycę typu 2 i zwykle wiąże się z wieloma czynnikami ryzyka, które mogą prowadzić do poważnych powikłań u matki i płodu. Głównym celem badania było oszacowanie częstości GDM u kobiet w ciąży mieszkających w prowincji Dżazan oraz określenie czynników, które mogą wiązać się z GDM. Materiał i metody. Badanie obejmowało kobiety w ciąży będące pod opieką oddziałów położniczo-ginekologicznych szpitali państwowych w prowincji Dżazan. Wybrano losowo próbę liczącą 440 ciężarnych kobiet. Przeprowadzając wywiady z uczestniczkami badania, korzystano z kwestionariusza opracowanego w celu oceny częstości występowania GDM, czynników ryzyka, wiedzy kobiet na temat GDM i przestrzegania zaleceń lekarskich oraz przyjmowania leków. Wyniki. Częstość GDM wśród ciężarnych kobiet w prowincji Dżazan wynosiła 8,2%. Była ona istotnie wyższa u kobiet otyłych [20,2%; 95-procentowy przedział ufności (CI) 13,2–29,2) niż u osób z prawidłową masą ciała (7,1%; 95% CI 1,7–7,6). Analiza wykazała, że GDM wiązała się istotnie z urodzeniem dziecka o masie ciała wynoszącej ponad 3,5 kg [iloraz szans (OR) 4,315; p = 0,004), wskaźnikiem masy ciała (BMI) matki wynoszącym ponad 30 kg/m2 (OR 4,703; p = 0,001) oraz dodatnim wywiadem rodzinnym dotyczącym GDM (OR 2,606; p = 0,046). Wnioski. Podsumowując, częstość GDM stwierdzona w badaniu była większa niż globalna częstość występowania GDM, lecz mniejsza niż obserwowana w innych badaniach w populacji saudyjskiej. Wskaźnik BMI matki i urodzenie dziecka o masie ciała powyżej 3,5 kg to główne czynniki ryzyka GDM. Potrzebne są odpowiednie programy interwencyjne w celu kontroli i modyfikacji czynników ryzyka

Coronary Artery Bypass Grafting (CABG) versus Percutaneous Coronary Intervention (PCI) in treatment of left main coronary artery disease

BackgroundCoronary artery bypass graft surgery (CABG) has been widely used for left main coronary artery disease (LMCAD). Percutaneous coronary intervention (PCI) has become an option for this condition.AimsTo summarize the current evidence that compare between CABG vs. PCI in regards to ‎cardiac death, stroke, and myocardial infarction.‎Methods We searched randomized trials of treatment of LMCAD with PubMed, Google Scholar, and EBSCO.Results Five randomized studies were retrieved, which compared the efficacy between CABG vs. PCI in treatment of LMCAD.ConclusionPCI may be reasonable management of patients with LM stenosis involving distal bifurcation or with coexisting multivessel disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks