Saudi Medical Horizons Journal

Case report: Intraductal papilloma in a male patient

2025-04-16T23:04:04+02:00

Introduction: In this case report, we discussed a rare case of an intraductal papilloma (IP) in a male patient. Intraductal papilloma of the breast is a benign tumor characterized by fibrovascular cores lined by an outer epithelial layer and inner myoepithelial layer.

Case Presentation: Our patient was a 36-year-old male who presented with a 6-month history of a bloody discharge from the right nipple. Mammography revealed right retroareolar, fibroglandular parenchyma with no associated discrete masses or suspicious microcalcifications. Ultrasound imaging revealed a lesion within the dilated ducts in the right breast. This was concordant with the biopsy result, which confirmed an IP with no evidence of malignancy. Although IPs are benign tumors, they can lead to atypical hyperplasia or ductal carcinoma in situ. Therefore, this patient was managed with total ductal excision, and the final histopathological examination confirmed the preoperative diagnosis.

Conclusion: IP is a rare condition in male patients and should warrant proper investigations. Surgical excision is the current mainstay of such condition.

Does Mode of Delivery Affect the Incidence of Pelvic Organ Prolapse? A Systematic Review

2025-04-09T10:38:14+02:00

The study aim is to analyze research on the link between delivery mode and pelvic organ prolapse (POP). A thorough search across four databases identified 416 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 193 publications, of which 78 full-text articles were reviewed, and 6 met the eligibility criteria for evidence synthesis. This review analyzed six studies encompassing 11,790 women. The prevalence of POP varied widely, from 3.5% to 51.3%. Across all studies comparing vaginal and cesarean deliveries, vaginal birth consistently demonstrated a higher association with POP, reinforcing its role as a significant risk factor. Vaginal delivery was associated with increased pelvic muscle strain and tearing, contributing to prolapse, while cesarean section (CS) provided some protection against advanced-stage POP postpartum. However, cesarean birth was also linked to potential long-term pelvic muscle dysfunction. Vaginal delivery was identified as a major risk factor for anterior vaginal wall prolapse, with additional contributors including sphincter damage, perineal tears, prolonged labor, and assisted delivery. This review highlights vaginal delivery as a major risk factor for POP, while cesarean section appears to offer some protective benefits. However, due to the potential risks of cesarean birth, a balanced approach to delivery planning is essential. Future research should investigate long-term pelvic floor outcomes and preventive measures to reduce prolapse risk while ensuring maternal and neonatal well-being. Clinicians should incorporate these insights into patient counseling and postpartum care to promote better pelvic health.

Does Cabergoline Prevent Ovarian Hyperstimulation Syndrome? Systematic Review

2025-04-09T10:36:51+02:00

The main objective of this study is to evaluate the available evidence on the efficacy of cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in patients undergoing fertility treatments. A comprehensive search of four databases identified 712 relevant publications. After duplicate removal using Rayyan QCRI and relevance screening, the search identified 346 publications, of which 101 full-text articles were reviewed, six of which met the eligibility criteria for the evidence synthesis. We included six studies with a total of 919 women: 440 in the cabergoline group and 479 in the control group. The prevalence of OHSS in the cabergoline group ranged from 8.3% to 65.6%, for an overall prevalence of 34.8%. In the control group, the incidence of OHSS ranged from 10.59% to 77.8%, for an overall prevalence of 32.9%. Cabergoline is effective in reducing moderate to severe OHSS, especially compared to placebo, making it a suitable choice for high-risk women. However, it is less effective than calcium gluconate in preventing mild OHSS, and the incidence of mild cases is higher. Alternative treatments, including quinagolide, diosmin, and calcium injections, have shown superior efficacy in preventing OHSS. In conclusion, cabergoline effectively reduces moderate to severe OHSS, especially compared to placebo, but is less effective than calcium gluconate in mild cases. Alternative treatments, such as diosmin, diosmin, and calcium injections, may offer better outcomes in specific cases. Tailoring treatment based on the patient's risk factors is essential.

The Impact of Minimally Invasive Surgical Techniques on Long-term Outcomes in Elderly Patients with Colorectal Cancer: A Systematic Review

2025-04-09T10:28:36+02:00

The study aimed to assess the long-term impact of minimally invasive surgical (MIS) techniques on elderly patients with colorectal cancer (CRC). A search across four databases identified 898 relevant publications, with 407 of which were reviewed. Five studies included 1743 patients, with 58.1% being males. Results showed that 3-year overall survival rates varied from 60.3% in laparoscopic surgery patients to 88.9% in transanal total mesorectal excision (TaTME) patients. Local recurrence-free survival ranged from 75% to 88.1%. Elderly patients had worse outcomes, with higher local recurrence rates and shorter OS and LRFS compared to non-EP patients. Laparoscopic surgery showed comparable five-year survival outcomes to open colectomy, indicating its viability as an alternative. Studies on TaTME demonstrated favorable long-term outcomes, with low recurrence rates and improved surgical feasibility in low rectal cancer. In patients aged 80 and older, laparoscopic surgery was associated with lower 90-day mortality, reduced hospital stays, and better survival outcomes compared to open surgery.

Association Between Vaginal Microbiota and Infertility: A Systematic Review

2025-04-09T10:37:37+02:00

The aim of this systematic review was to synthesize the available evidence on the relationship between vaginal microbiota and infertility, highlighting key microbial factors and their impact on reproductive outcomes. A comprehensive search of four databases identified 1,216 relevant publications. After duplicate removal using Rayyan QCRI and relevance screening, 605 full-text articles were reviewed, with nine studies ultimately meeting inclusion criteria. The included nine studies involving 1,768 women with vaginal infections. A significant microbial imbalance was observed in infertile women compared to non-infertile women, with a decrease in Lactobacillus and an increase in pathogenic bacteria such as Gardnerella and Mycoplasma. These findings support the inclusion of microbial assessments in infertility evaluations and highlight the potential benefits of managing bacterial imbalances to improve fertility outcomes. We conclude that vaginal microbial imbalance is associated with infertility, suggesting that targeted microbial interventions could benefit fertility treatments. Further researches are needed to explore these relationships in greater depth and apply them clinically.

The Effect of Female Obesity on Live Birth Rate Following IVF: A Systematic Review

2025-04-09T10:36:09+02:00

This study aimed to investigate the effect of female obesity on live birth rates (LBR) after in vitro fertilization (IVF). A comprehensive search of four databases identified 881 relevant publications. After duplicate removal using Rayyan QCRI and relevance screening, 475 full-text articles were reviewed, with seven studies ultimately meeting inclusion criteria. The results showed that the live birth rate in studies of obese women undergoing IVF treatment showed considerable variability, ranging from 25.2% to 64.2%, with an overall mean of 41.2%. Control groups had live birth rates between 22.6% and 72.4%, with a mean of 57.7%. Research suggests that obesity significantly impacts live birth rates, particularly among younger women, with a general trend showing that higher body mass index (BMI) is associated with lower birth rates. Some studies did not observe any effect of obesity, suggesting that other factors may also be crucial. Findings from different regions highlight a complex relationship between obesity and reproductive outcomes, with some studies suggesting a direct association, while others suggest a more subtle interaction depending on BMI level. Ultimately, this systematic review confirms a complex link between female obesity and lower LBR after IVF, emphasizing the importance of considering obesity in IVF treatment planning. The study recommends further research with more rigorous designs and consistent BMI criteria to enhance understanding and improve IVF outcomes in obese patients.

Feasibility, Safety, and Outcomes of Stereotactic Radiosurgery in Intracranial Dural Arteriovenous Fistula: A Systematic Review

2025-04-13T10:37:12+02:00

The main objective of this study is to evaluate the feasibility, safety, and clinical outcomes of stereotactic radiosurgery (SRS) in treating intracranial dural arteriovenous fistulas (dAVF). A thorough search across four databases identified 398 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 232 publications, of which 30 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. We included 5 studies with a total of 289 patients diagnosed with dAVFs, a total of 293 fistulas that underwent repair, and 168 (58.1%) were males. The median follow-up duration ranged from 17 months to 62 months. The obliteration rate ranged from 48% to 70.6%, with a total of 170 (58%). Nearly 71% of patients with pre-treatment symptoms experienced post-SRS symptom relief, particularly in cavernous sinus dAVFs. Radiation-induced changes (RIC) occurred in 14.5% of cases, with males and those with multiple arterial feeders being at higher risk. Post-SRS hemorrhage was rare, though prior hemorrhage increased susceptibility. Higher radiation doses were associated with improved obliteration rates, while new arterial feeders in adjacent sinuses led to retreatment in select cases. SRS is a safe and effective treatment for intracranial dAVFs, demonstrating high obliteration rates and symptom relief. However, long-term follow-up is essential due to the potential for new arterial feeders and delayed obliteration. Future research should focus on standardizing treatment protocols, refining patient selection, and developing predictive models to further optimize SRS outcomes for dAVFs.

Association between Gastrointestinal Symptoms and Sleep Quality: A Cross-Sectional Study

2025-04-09T10:41:32+02:00

ABSTRACT

Background: Sleep disturbances can lead to physical health issues, including functional gastrointestinal (GI) symptoms. Previous studies have highlighted the complex relationship between GI health and sleep quality. This study aims to assess the association between gastrointestinal symptoms and sleep quality in the Saudi Arabian population.

Methods: A cross-sectional study was conducted among 679 adults in Taif City, Saudi Arabia. Data were collected from May 2024 via an online questionnaire. The questionnaire assessed gastrointestinal symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). The validated questionnaire was distributed online through a social media platform.

Results: The study included 679 participants aged 18-50 years. The most common gastrointestinal symptoms reported were bloating, abdominal pain, heartburn, constipation, nausea, and diarrhea. The most common GI disorders were irritable bowel syndrome (IBS) (20.8%), gastroesophageal reflux disease (GERD) (9.9%), peptic ulcer (2.9%), and inflammatory bowel disease (IBD) (1.3%). Poor sleep quality was reported by 45.2% of participants, with the highest rate of poor sleep quality observed among those with IBS (87.2%), followed by GERD (77.6%), and peptic ulcer (70%).

Conclusion: This study found that IBS and GERD are the most prevalent gastrointestinal disorders, and poor sleep quality is common among affected individuals. The results suggest that interventions focused on improving sleep, in combination with a multidisciplinary approach involving sleep specialists and gastroenterologists, could help identify new therapeutic targets and improve sleep outcomes.

Keywords: association, gastrointestinal, symptoms, sleep, quality, Saudi

The Awareness of Developmental Dysplasia of the Hip Among Al Jouf Region Population After the Establishment of Saudi National Hip Dysplasia Program in 2018

2025-04-14T21:15:18+02:00

Introduction:

Developmental Dysplasia of the Hip (DDH), also known as congenital dislocation of the hip, occurs in infancy or early childhood and ranges from mild dysplasia to complete dislocation. Known risk factors include family history, female gender, breech presentation, and firstborn status. In Saudi Arabia, studies highlight gender and familial associations, emphasizing the importance of public awareness for early detection and intervention.

Objective:

This study aims to assess the community’s level of awareness regarding DDH among the population in the Al Jouf region of Saudi Arabia, with a focus on knowledge of risk factors, treatment options, and potential complications.

Methodology:

A cross-sectional study was conducted in Al Jouf using convenience sampling among adults aged 18 and above. Data were collected through a self-administered questionnaire and analyzed using IBM SPSS version 29.

Results:

A total of 386 participants were included, with females comprising 67.4% and the majority aged 18–25 years. Overall, 76.2% had heard of DDH. Key information sources included injured relatives (41.1%) and the internet (25.6%). Major identified risk factors were postnatal child lifestyle (41.2%) and breech presentation (39.4%). Surgical intervention was the preferred treatment for older children. Significant predictors of awareness included male gender (OR=0.449, p=0.002), Sakaka region residence (OR=1.237, p=0.016), Saudi nationality (OR=5.497, p=0.017), higher education (OR=1.646, p=0.018), health-related occupation (OR=2.322, p=0.004), and family history of DDH (OR=3.327, p<0.0001).

Conclusion:

The study shows a high level of DDH awareness in Al Jouf, with several demographic and familial factors significantly influencing knowledge levels. These findings support the need for targeted educational interventions.

Knowledge, Attitude, And Practice Towards HPV And HPV Vaccine Among Family Physicians: A Cross-Sectional Study in AlAhsa, Saudi Arabia

2025-04-09T10:42:16+02:00

Background: Human papillomavirus (HPV) is a common sexually transmitted viral infection and a major risk factor for cervical cancer. The HPV vaccines can prevent HPV infection and, ultimately, cervical cancer. Despite vaccination programs in Saudi Arabia, family medicine physicians play a crucial role in providing patients with information about the HPV vaccine. Therefore, this study aimed to assess the knowledge, attitudes, and practices of family medicine physicians towards HPV vaccination.

Method: We conducted a cross-sectional study in AlAhsa, Saudi Arabia, from June to September 2023, among family medicine physicians using a validated online questionnaire to assess their knowledge, attitudes, and practices regarding the HPV vaccine.

Results: A total of 141 physicians responded to the questionnaire. 49.6% of the respondents have knowledge about the three types of HPV vaccines, while 12.8% were unaware of any type of HPV vaccine. 73.8% of physicians recommended the HPV vaccine to sexually active patients. Moreover, 31 (22%) physicians believed that vaccination should not be mandatory.

Conclusion: To enhance family medicine physicians' knowledge and practices regarding the HPV vaccine, more effective educational programs and campaigns are necessary. These professionals play a crucial role in influencing and educating patients.