ObjectivesTo study the performance of a single test using two fecal occult blood tests with colonoscopy for the detection of colorectal cancer (CRC) for the first time in Saudi Arabia to determine possible implications for the anticipated colorectal screening program.Materials and methodsWe compared the performance of guaiac and immunochemical fecal occult blood tests for the detection of CRC among patients of 50–74 years old attending two hospitals in the Eastern Region of Saudi Arabia. Samples of feces were collected from 257 asymptomatic patients and 20 cases of confirmed CRC, and they were tested simultaneously by the guaiac-based occult blood test and monoclonal antibody-based immunoassay kit. Colonoscopy was performed on all participants and the results were statistically analyzed with both positive and negative occult blood tests of both methods.ResultsOf the 277 subjects, 79 tested positive for occult blood with at least one method. Overall, the number of those with an occult blood-positive result by both tests was 39 (14.1%), while for 198 (71.5%), both tests were negative (P<0.0001); 40 (14.4%) samples showed a discrepant result. Colonoscopy data were obtained for all 277 patients. A total of three invasive cancers were detected among the screening group. Of the three, the guaiac test detected two cases, while the immunochemical test detected three of them. Of the 20 control cases, the guaiac test detected 13 CRC cases (P=0.03), while the immunochemical test detected 16 of them (P<0.0001). The sensitivity of guaiac and immunochemical tests for the detection of CRC in the screening group was 50.00% (95% confidence interval [CI] =6.76–93.24) and 75.00% (95% CI =19.41–99.37), respectively. For comparison, the sensitivity of the guaiac fecal occult blood test for detecting CRC among the control group was 65.00% (95% CI =40.78–84.61) while that of FIT was 80.00% (95% CI =56.34–94.27). The specificity of the guaiac and immunoassay tests was 77.87% (95% CI =72.24–82.83) and 90.12% (95% CI =85.76–93.50), respectively. The positive likelihood ratio of guaiac and immunochemical tests for the detection of CRC was 2.26 (95% CI =0.83–6.18) and 7.59 (95% CI =3.86–14.94), whereas the negative likelihood ratio was 0.64 (95% CI =0.24–1.71) and 0.28 (95% CI =0.05–1.52), respectively. The positive predictive values of guaiac and immunochemical tests were 3.45% (95% CI =0.426–11.91) and 10.71% (95% CI =2.27–28.23), respectively. There was no marked difference in the negative predictive values for both methods. The sensitivity of the fecal occult blood test by FIT was significantly higher for stages III and IV colorectal cancer than for stages I and II (P=0.01) and it was insignificant for the guaiac fecal occult blood test (P=0.07).ConclusionIn areas where other advance screening methods of CRC are not feasible, the use of FIT can be considered.

HighlightsLaparotomy is the best treatment method for trichobezoare.Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.Endoscopic treatment can only be successful for small trichobezoar.

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Introduction:There is no specific anti-viral therapies for 2019 Coronavirus Diseases (COVID-19) infection. Here, we compared patients receiving steroids at different dosages versus no steroids in severe and critical COVID-19 patients. Methods:We retrospectively studied COVID-19 patients who received low-dose or high-dose corticosteroid therapy compared to no steroid. Results:The study period, June-August 2020, included 169 patients with COVID-19 were included and there were 39.1% female and 60.9% male with an average age of 53.1 years. The distribution of cases was as follows: high-dose 39 (23.1%), low-dose 54 (32.0%), and no steroid 76 (45.5%). Of all the patients, Intensive Care Unit (ICU) admission was for 31 (18.3%), nine (5.3%) required intubation, and 52 (30.8%) had no comorbidities. There is no difference in the mean age between the different groups. However, those being treated with steroid were more likely to have a high SOFA score (0.37 ± 0.68, 0.36 ± 0.67 and 0.04 ± 0.34, for low-dose, high-dose steroid and no steroid groups, respectively (p = 0.001). Cox regression was not possible as the mortality rate was very low (3/169; 1.78%) and none of the multivariate methods would be possible. However, there was a significant difference in the hospital LOS and the ICU LOS. Conclusion:Cox regression was not possible as the mortality rate was very low (1.78%) and none of the multivariate methods would be possible as the model will not converge. However, in t-test only, intubation was associated risk of mortality.

Background The connection between initial viral cycle threshold (Ct) values of the SARS-CoV-2 with symptoms and hospital course is not clearly studied. Methods This is a retrospective study of hospitalized COVID-19 patients from Jun 1st 2020 to March 30th, 2021 examining the relationship between initial viral cycle threshold (Ct) values of SARS-CoV-2 as obtained from nasopharyngeal samples. The clinical presentations and outcomes were analyzed in relation to the initial Ct values. Results The study included 202 hospitalized COVID-19 patients with a mean age (± SD) of 54.75 (± 15.93) and 123 (60.9%) males and 79 (39.1%) females. Of all the patients, the most frequent comorbidity was diabetes mellitus (95; 47%) and the most frequent symptoms were fever (148; 73.3%) and cough (141; 69.8%). There was no significant difference in relation to underlying conditions, clinical presentation, radiographic and laboratory data among those with low, medium and high Ct values. The mean Ct values showed no statistical change over the 10-month study period. Conclusions Initial SARS-CoV-2 Ct values did not show any association with clinical symptoms and did not predict the need for mechanical intubation or death.