Othman Alabdullah

Background: Renal artery aneurysms (RAAs) are uncommon visceral arterial lesions whose management depends on symptoms, patient-specific rupture risk, and arterial anatomy. Markedly high origin renovisceral arteries may further complicate endovascular access and reconstruction. This report describes the management of a symptomatic RAA in a young woman with multifocal aneurysmal disease and unusual renovisceral arterial origins at the 11th and 12th thoracic vertebral levels (T11–T12). Case presentation: A 35-year-old woman presented with intermittent right loin pain. Computed tomography angiography demonstrated multiple right renal artery aneurysms, the largest measuring 1.7 cm, together with a 0.6-cm left renal artery aneurysm and a 0.67-cm superior mesenteric artery aneurysmal dilatation. The celiac trunk, superior mesenteric artery, and both renal arteries originated unusually high at the T11–T12 level. An initial trial of right renal artery stenting through right brachial access was technically difficult. Selective angiography after difficult cannulation demonstrated contrast extravasation from a minute right renal artery perforation. The patient remained hemodynamically stable; heparin was reversed with protamine, and repeat angiography 5 min later demonstrated complete sealing without further extravasation. The procedure was therefore aborted with close inpatient observation. Definitive treatment was achieved by ligation of the right renal artery aneurysmal segment and a retrocaval aorta-to-right renal artery bypass using a reversed great saphenous vein graft. At six months, the graft remained patent with preserved renal perfusion and no recurrence of the presenting symptom. Conclusions: This case demonstrates how extreme renovisceral anatomical variation, multifocal aneurysmal disease, and adverse arterial characteristics can limit the feasibility of endovascular treatment. In selected patients in whom secure endovascular access or renal branch preservation cannot be achieved, open reconstruction remains an effective renal-preserving option. Long-term surveillance is important because of the remaining untreated aneurysmal lesions and the limited duration of follow-up in this report.

Background: Obesity and type 2 diabetes mellitus (T2DM) are closely linked through shared pathophysiological mechanisms affecting glucose metabolism and insulin resistance. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely recommended for patients with T2DM who are overweight or obese because of their favorable effects. However, whether baseline obesity influences the glycemic response to these agents in real-world clinical practice remains unclear. Methods: This multicenter retrospective study included adults with T2DM initiated on either SGLT2i or GLP-1RA at three healthcare centers in Riyadh, Saudi Arabia. Patients were stratified into obese (BMI ≥30 kg/m²) and non-obese (BMI <30 kg/m²). Changes in HbA1c, body weight, and BMI were evaluated at 3, 6, 9, and 12 months. Between-group comparisons were performed using independent t-tests, followed by mixed-effects models for repeated measures (MMRM) to adjust for potential confounders. Secondary outcomes included the proportions of patients achieving ≥5% weight loss, HbA1c <7.0% (among those uncontrolled at baseline), and HbA1c reductions of ≥0.5% and ≥1.0%. Results: A total of 1,016 patients were included, of whom 73.4% were obese. Obese patients were associated with greater reductions in absolute body weight and BMI at 3, 6, 9, and 12 months than non-obese patients, although their higher baseline body weight may have contributed to these differences. Responder analysis showed that obesity was associated with a higher likelihood of achieving ≥5% weight loss at months 3 (21.9% vs. 12.0%, p=0.0016) and 6 (27.2% vs. 15.5%, p=0.0086). In the adjusted MMRM, obesity was associated with greater least-squares mean reductions in weight and BMI (p<0.05), whereas HbA1c reductions and responder rates (HbA1c <7.0%, ≥0.5%, and ≥1.0% reductions) were statistically comparable between groups. Conclusion: These findings suggest that baseline obesity was associated with greater reductions in anthropometric measures following SGLT2i or GLP-1RA therapy after multivariable adjustment, whereas improvements in glycemic control were similar between obese and non-obese patients. As these findings are hypothesis-generating, prospective studies are needed to determine whether baseline BMI modifies treatment response.

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data.

Background and Clinical Significance: Acute compartment syndrome is a rare but limb-threatening emergency in pediatric patients. While most cases follow high-energy trauma or displaced fractures, acute compartment syndrome precipitated by initially underestimated forearm injuries is uncommon and may create a significant diagnostic challenge, particularly in young children who exhibit atypical clinical presentations, such as escalating anxiety and analgesic requirements, rather than classic ischemic signs. Case Presentation: We report the case of a 4-year-old girl who developed severe forearm and hand compartment syndrome following a delayed presentation after a fall from a height of 2–2.5 m onto the left upper extremity. Initial evaluation revealed progressive tense swelling, severe pain with passive stretch, diminished distal perfusion, and radiographic evidence of distal radius-ulna buckle fractures associated with a proximal ulna fracture. Emergent surgical decompression via extensive volar and dorsal fasciotomies revealed markedly elevated compartment pressures. Intraoperatively, deep volar muscle ischemia and necrosis were identified, requiring carpal tunnel release, serial debridements, and complex staged wound management. Multidisciplinary care and ongoing rehabilitation were essential for limb salvage and functional recovery. Conclusions: This case underscores the profound unpredictability of pediatric compartment syndrome and demonstrates that even classically stable, benign fractures can initiate a devastating ischemic cascade. A high index of suspicion, regardless of the injury mechanism, along with early recognition and prompt surgical intervention, is absolutely critical for preventing irreversible myoneural damage and optimizing management outcomes in pediatric patients.

Background: Carotid endarterectomy (CEA) plays a critical role in stroke prevention, but assessing a patient’s preoperative physiological reserve remains challenging. This study aimed to evaluate the impact of sarcopenia and preoperative albumin on postoperative management outcomes and resource utilization in CEA patients with a high prevalence of metabolic comorbidities. Methods: This retrospective cohort study evaluated 67 patients who underwent elective or urgent CEA between January 2015 and June 2025. Sarcopenia was quantified using the Masseter Muscle Index (MMI) derived from routine preoperative head and neck computed tomography (CT) scans. Multivariable regression models were used to assess the relationships between the MMI, serum albumin levels, and surgical outcomes. Results: The cohort had a mean age of 66.8 years and demonstrated a significant metabolic burden, with a high prevalence of diabetes (71.6%) and an average body mass index (BMI) of 28.15 kg/m². Despite this predominantly overweight demographic, the MMI revealed underlying frailty and showed a strong inverse relationship with hospital resource utilization. A one-unit increase in the MMI significantly reduced total hospital length of stay (LOS) by 14.40 days (p = 0.001) and ICU LOS by 6.91 days (p < 0.001). Emergency surgery was the only independent predictor of mortality (OR 16.61, p = 0.047), while neither the MMI nor albumin significantly predicted short-term adverse clinical events. Conclusions: In a patient population where a higher BMI may mask underlying frailty, opportunistic screening for sarcopenia using routine preoperative CT scans provides important prognostic value. In this cohort study, a lower MMI showed an association with prolonged hospital and ICU stays; while it did not independently predict short-term mortality, its potential utility in forecasting resource utilization warrants further investigation in larger, prospective cohorts.

Background and Objectives: Diabetic foot disease is a major cause of lower-limb amputation and is associated with substantial morbidity and mortality. While amputation is often considered definitive treatment, postoperative outcomes and their predictors remain incompletely characterized. Materials and Methods: This retrospective cohort study included all patients who underwent diabetic foot amputation at a tertiary care center between January 2015 and August 2025. Demographic data, comorbidities, laboratory parameters, and amputation-related variables were collected. The primary outcome was postoperative complications. Secondary outcomes included readmission, re-amputation, ICU admission, length of stay, and mortality. Logistic regression was used to identify predictors of postoperative complications. Results: A total of 437 patients were included (mean age 62.0 ± 11.8 years; 65.7% male). Postoperative complications occurred in 52.1% of patients, most commonly infections (31.6%) and acute kidney injury (18.1%). Readmission occurred in 50.6%, re-amputation in 23.4%, ICU admission in 28.7%, and mortality in 17.8%. On multivariable analysis, preoperative serum albumin was the only independent predictor of postoperative complications (aOR 0.944, 95% CI: 0.913–0.976; p < 0.001). Conclusions: Postoperative complications following diabetic foot amputation are common and associated with significant healthcare utilization and mortality. Preoperative hypoalbuminemia was the only independent predictor of postoperative complications, supporting its utility as an integrated biomarker of systemic illness (including inflammatory burden/infection and hepatic synthetic function) for perioperative risk stratification.

Objectives: Infections by invasive methicillin-resistant Staphylococcus aureus (MRSA) are associated with higher morbidity and mortality compared to methicillin-susceptible Staphylococcus aureus (MSSA) infections, and have increased significantly in both healthy children and children with chronic illnesses. In our study we aimed to estimate the prevalence of invasive MSSA and MRSA among invasive Staphylococcus aureus (S. aureus) infections in the pediatric population and measure the association between management outcomes and methicillin resistance in these infections. Methods: We conducted an observational, analytical, retrospective cross-sectional, chart-review study of pediatric patients (aged ≤16 years) admitted to King Khalid University Hospital in Riyadh, Saudi Arabia during 2019–2023 with invasive S. aureus infections. Results: We identified 85 patients with invasive S. aureus infections who met our inclusion and exclusion criteria; 65.9% of all included cases had MSSA infections. Additionally, MRSA infections accounted for 62.5% of all deaths (odds ratio [OR] = 3.68; p = 0.075) suggesting a trend toward higher mortality among MRSA patients. Of those infected with S. aureus, 31.8% required admission to the intensive care unit (ICU), with similar admission rates for both MSSA and MRSA, and both groups had a median hospital stay of 25 days. Conclusion: We estimated the prevalence of MRSA infections to be 34.1%. Our study showed a trend toward higher mortality among individuals with invasive MRSA infections than among those with MSSA infections. However, the findings regarding ICU admission rates and length of hospital stay were inconclusive.