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BACKGROUND: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population's adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non-COVID-19 health care services. OBJECTIVE: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19-positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. METHODS: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. RESULTS: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19% (51/275) of the study population being older adults ≥60 years of age; 80% (220/275) having a CURB-65 score <4; 53% (147/275) having no comorbidities; 5% (13/275) having extreme obesity; and 20% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5% (13/275), and the overall mortality rate was 1.5% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. CONCLUSIONS: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers.
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BACKGROUND: Data on pituitary Magnetic Resonance Imaging (MRI) in patients with abnormal pituitary hormones in Saudi Arabia are very scarce. OBJECTIVE: To define the frequency of normal pituitary MRI in patients with abnormal pituitary hormones in a well-defined population. DESIGN: Retrospective analysis of radiological and hormonal data of patients with pituitary MRI between January 2008 and December 2015. SETTINGS: Departments of Endocrinology and Radiology at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. PATIENTS: 459 patients with clinical, hormonal and radiological data. MAIN OUTCOME MEASURES: The frequency of normal pituitary MRI in patients with abnormal pituitary hormones. RESULTS: Over the 7-year period, Out of 459 patients; 129 (28.1 %) were males and 330 (71.9 %) were females with mean age of 35.4 ± 13.7. Positive MRI compared to normal MRI were seen in 268 (58.4 %) and 191 (41.6 %) subjects respectively. Subjects with Positive MRI were significantly older, 36.8 ± 14.1 vs. 33.5 ± 12.9, p value=0.01. Hyperfunctiong pituitary hormones were significantly associated with positive MRI, 259 (63.2%) vs. 151 (36.8) where as hypofunctiong pituitary hormones were associate with normal MRI, 40 (81.6%) vs. 9 (18.4%), p value < 0.001. Females with hyperfunctioning pituitary hormones were significantly associated with positive MRI whereas males with hyporfunctioning pituitary hormones were significantly associated with normal MRI. Three types of hyperfunctioning pituitary gland were seen such as hyperprolactinemia, somatotroph adenoma, and corticotroph adenoma were associated with more frequent positive MRI as to Five types of hypofunctioning pituitary gland were seen such as panhypopituitarism, secondary hypogonadism, growth hormone deficiency, central hypothyroidism and central adrenal insufficiency which were associated with more frequent normal MRI. CONCLUSION: The current study indicates hyperfunctioning pituitary gland was significantly associated with positive MR whereas hypofunctioning pituitary gland was associate with normal MRI. In the absence of registry data, larger cooperative studies involving diverse population samples from multiple centers could help to provide further information on the true frequency nationally. LIMITATIONS: Question of clustering of cases within the study region and limited study sample size.
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Hipófisis , Hormonas Hipofisarias , Femenino , Humanos , Espectroscopía de Resonancia Magnética , Masculino , Estudios Retrospectivos , Arabia SauditaRESUMEN
BACKGROUND: Data on pituitary adenoma (PA) prevalence in Saudi Arabia are scarce. OBJECTIVE: To estimate the epidemiology of PA in a well-defined population. DESIGN: Retrospective analysis. SETTING: Departments of Endocrinology and Radiology at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. PATIENTS AND METHODS: Radiological and hormonal data of patients with pituitary adenoma by MRI were reviewed for the period January 2008 to December 2015. MAIN OUTCOME MEASURES: Prevalence of PA and hormonal abnormalities. RESULTS: Of 537 patients; 249 subjects (46.4%), 70 (28.1%) males and 179 (71.9%) females, were diagnosed to have PA with mean age 36.3 (14.1) years. Microadenoma and macroadenoma were seen in 171 (69%) and 78 (31%) subjects, respectively. Microadenomas were more prevalent than macroadenomas (68.7% vs. 31.3%). Microadenomas were significantly more prevalent in females, 131 (73.2 %) vs. 40 (57.1%) whereas macroadenomas were significantly more prevalent in males, 30 (42.9%) vs. 48 (26.8%) (P < .001 for both comparisons). Patients with microadenomas were significantly younger than patients with macroadenomas (P < .0001). Advanced age was significantly associated with a larger PA size (r=0.39, P < .0002). Three types of hyperfunctioning PA were seen: prolactinoma, somatotroph adenoma, and corticotroph adenoma. Five types of hypofunctioning PA were seen: panhypopituitarism, secondary hypogonadism, growth hormone deficiency, central hypothroidism and central adrenal insufficiency. Non-functioning PA were within normal laboratory hormonal values in 2% of cases. CONCLUSION: Our study showed that the prevalence of PA was greater than previously reported. This increased prevalence may have important implications when prioritizing funding for research and treatment of PA. LIMITATIONS: Clustering of cases within the study region might have affected estimates and limited study sample size.