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Introduction Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use. Method We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study. Results The study sample consisted of 189 patients, 72% of whom were female. The patients’ median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of < 0.0001. Conclusion The remission of GD was achieved in approximately half of the patients treated with ATD; however, approximately one-third of them relapsed. Lower Free T4 and TRAb levels at diagnosis were associated with remission. Longer ATD use and higher thyroid uptake upon diagnosis were associated with relapse after ATD discontinuation. Future studies are necessary to ascertain the predictors of ATD success in patients with GD.

BackgroundChronic kidney disease (CKD) is a disease associated with high rate of morbidity and mortality mainly due to cardiovascular disease. Anaemia is the most common haematological abnormality in end stage renal disease.AimsThe current Study aimed to determine the laboratory characteristic and management of anaemia among haemodialysis patients.MethodsA cross sectional study conducted among 112 adult patients with the diagnosis of end stage renal disease (ESRD) on haemodialysis at King Salman Armed Forced Hospital in Tabuk, Saudi Arabia, data were collected by a pre-tested data collection sheet.ResultsThere were 112 patients with a mean age of 43 years. The mean haemoglobin value was 10.5g/dL, which was lower than the target haemoglobin range recommended by Kidney Disease Outcomes Quality Initiative (KDOQI). Twenty- eight patients (25 per cent) had haemoglobin values between 11.0 and 12.0g/dL. Only seven patients (6.3 per cent) exceeded the recommended range (>12g/dL) and seventy- seven (68.7 per cent) had less than recommended range. The majority of patients had been receiving haemodialysis for two or more years. The most common primary cause of end stage renal failure was diabetic nephropathy. Hypertension was the most common comorbidity, followed by diabetes, and ischemic heart disease.ConclusionPatients with end stage renal disease at a high risk for anaemia which should be investigated for correctable causes such as Iron-deficiency before initiating erythropoietin replacement therapy.

In the United States, following road traffic injuries, falls considered the second leading cause of unintentional injury.1 Elderly population particularly at increased risk of vitamin D deficiency as a result of several factors, including but not limited to low dietary intake and diminished sunlight exposure for these reasons, hypovitaminosis D is very frequent in the elder.2,3 The association between low level of vitamin D level and increased risk of falls were linked in several studies. Thereby, reduce the occurrence of falls and prevent it is associated morbidity.6 On the other hand, insufficient evidence to support the fact that vitamin D supplements especially alone (without supplemental calcium) may have a role in falls prevention.7 Given these controversial results, we conducted a systematic review to evaluate the effect of vitamin D administered on falls in older adults. Burieigh et al.,18 evaluate the benefit of adding 800 IU of vitamin D to 1.2g of calcium in a randomized, double-blind, controlled study among hospitalized patients, aimed to determine whether vitamin D supplementation has an effective role in falls prevention in older hospital inpatients. [...]the current evidence for the effect of supplementary vitamin D alone on fall outcomes is limited.19 On the other hand, in this review, four studies found that no reduction in risk of falls neither with vitamin D alone nor in combination with calcium.15-18 In one of these studies.

Background Autoimmune hepatitis (AIH) is a chronic liver disease characterized biochemically by elevation in serum aminotransferases (AST- ALT) and immunoglobulin G (IgG), serologically by the presence of autoantibodies such as antinuclear antibody , anti-smooth antibody , and anti -liver kidney microsomal antibody or anti -soluble liver antigen antibody and histologically by interface hepatitis.1 As a result of this chronic inflammatory process, cirrhosis and subsequently occurrence of hepatocellular carcinoma.2 Corticosteroid in the form of high dose prednisolone or a lower dose of prednisolone in combination with azathioprine is the standard treatment of AIH with remission rate reaching up to 80 per cent. Since majority of the patients will require a long-term maintenance therapy, they are at increased risk of steroid related side effect (1044 per cent).2 To avoid such a risk , budesonide, a synthetic steroid with high hepatic first pass effect and low steroid related side effects was used in clinical trials and compared with the standard treatment regarding it is efficacy and side effects profile.3 The current review aimed to summarize the available studies that investigated budesonide as a first line treatment for AIH. The efficacy of budesonide and azathioprine combination was also shown in the study by Efe et al.7 In this study authors concluded that budesonide is an effective treatment option for the management of AIH , with a low i ncidence of side effects in patients without findings of advanced liver disease. Budesonide, a synthetic steroid with a high hepatic first pass metabolism and less steroid related side effects , were evaluated in five randomized control trials as an alternative to prednisone in the treatment of AIH.4-8 Finally, with the exception of Manns et al.6 study, all included trials have very small sample size . Conclusion In absence of advance liver disease , budesonide is a promising treatment option especially for patients prone to develop steroid specific side effects such as osteoporosis in postmenopausal females.

BackgroundRecent advance of endoscopic techniques has allowed surgeons to perform thyroidectomy via an incision placement at hidden places which lead to better cosmetic acceptability compared with conventional open thyroidectomy.AimsThis study was conducted to summarize the current evidence that compare open thyroidectomy with endoscopic thyroidectomy in treatment of papillary thyroid cancer.MethodsAn electronic literature review, including PubMed, Google Scholar, and EBSCO that examining randomized trials of endoscopic thyroidectomy (ET), conventional open thyroidectomy (COT), and management of papillary thyroid carcinoma was carried out.ResultsThe review included 8 randomized studies that compare total endoscopic thyroidectomy versus conventional open thyroidectomy in treatment of papillary thyroid cancer. The findings showed endoscopic thyroidectomy had statically significant cosmetic appearance, less amount of blood loss and occurrence of transient hypocalcaemia than conventional open thyroidectomy in form of cosmetic outcome, amount lower blood loss.ConclusionThe current review showed that, ET has a better cosmetic outcome and lower blood loss compared with COT. While COT was associated with significantly low operation time, hospital stay, drainage time, amount of drainage fluid and transient recurrent laryngeal nerve (RLN) palsy.

BackgroundAnti-fibrinolytic medications decrease traumatic intracranial haemorrhage (ICH). Tranexamic acid (TXA) is an antifibrinolytic, which recently has shown effectiveness in management of traumatic haemorrhage.AimsTo summarize the randomized control trials (RCTs) that evaluates the efficacy of tranexamic acid administration in traumatic brain .njury (TBI) patients.MethodsAn electronic literature review, including PubMed, GoogleScholar, and EBSCO that examining RCTs, observational, and experimental studies which study the efficacy of TXA administration in (TBI) patients.ResultsThe current review included 7 randomized studies reported the efficacy of TXA in management of TBI. TXA limit secondary brain injury by preventing the expansion of ICH. Administration of TXA exhibited a tendency to decrease head trauma-related mortality.ConclusionTXA significantly lower the risk of ICU expansion m and prevent brain injury related deaths.

BackgroundNemolizumab (CIM331) is a monoclonal antibody that binds the IL-31 receptor a component. This inhibits IL-31 from acting on neurons that constrains the initialization of the sense of pruritus in cases of atopic dermatitis.AimsTo summarize the results of reported studies evaluating the role of nemolizumab and omalizumab in management of atopic dermatitis.MethodsThis is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized controlled trials, observational, and experimental studies which study role of nemolizumab in management of atopic dermatitis.ResultsThe review included 8 randomized studies reported efficacy of both nemolizumab and omalizumab for management of atopic dermatitis.ConclusionOther studies with large numbers of patients with AD are necessary to define the adverse effects of both drugs in the treatment of AD.

BackgroundLiothyronine combination with Levothyroxine(T4-T3) has been tried to improve the quality of life among hypothyroid patients on levothyroxine immunotherapy and normal thyroxine stimulating hormone levels. However, the efficacy of such a combination is unknown. The current review aimed to assess the effects of T4-T3 combination therapy on quality of life.AimsThe current review aimed to compare levothyroxine monotherapy versus T4-T3 combination therapy on quality of life among hypothyroid patients.MethodsThe Pub Med and Google Scholar databases were systematically searched for relevant articles. Articles published in the English language from the first available article up to March 2020 were approached. The terms hypothyroidism, levothyroxine, and liothyronine were used. Out of hundred and eight articles retrieved, only six fulfilled the inclusion and exclusion criteria.Resu ltsIn majority of randomized control trials (4 out of 6 RCTs), T4/T3combination therapy fail to show superiority over the standard levothyroxine mono-therapy.ConclusionLevothyroxine remain the standard of care in hypothyroid patient.

Methods An electronic literature review, including PubMed, Google Scholar, and EBSCO that examining randomized trials of endoscopic thyroidectomy (ET), conventional open thyroidectomy (COT), and management of papillary thyroid carcinoma was carried out. The findings showed endoscopic thyroidectomy had statically significant cosmetic appearance, less amount of blood loss and occurrence of transient hypocalcaemia than conventional open thyroidectomy in form of cosmetic outcome, amount lower blood loss. No significant differences in tumour size were recorded number of retrieved lymph nodes or postoperative hospital stay. Other previous study found that ET is associated with reduced blood loss (P<0.00001) and better cosmetic satisfaction (P<0.00001) than although OT has operation time (P=0.03) and lower hospital costs (P=0.0010).

BackgroundRevascularization for patients who suffer multivessel coronary artery disease is a common procedure around the world. Taking United about 700,000 patients have multivessel coronary revascularization per year ¼ of these patients are diagnosed with diabetes.AimsTo summarize the current evidence that compare CABG to PCI in multivessel coronary disease in form of cardiac death, stroke, MI and unplanned devascularization.MethodsThis is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized trials of treatment of multivessel coronary disease to summarize the major RCT concerning this topic.Resu ltsThe review included five randomized studies that compare coronary artery bypass grafting and percutaneous coronary intervention. The findings showed that CABG show better result with less mortality rate.ConclusionThis review concluded that there revascularization in treating coronary artery disease could be conducted either by CABG or PCI, CABG show better result as it cause less death, MI and revascularization rates, but the usage of new additions such as second generation DES, can also improve the safety and efficacy of PCI when added to it.