Papers by Majed N. Alnefaie
Journal of Musculoskeletal Surgery and Research, 2020
Objectives: Total knee replacement (TKR) is an increasingly common procedure worldwide with a con... more Objectives: Total knee replacement (TKR) is an increasingly common procedure worldwide with a continued projected increase in the future. Blood loss following TKR can be relatively high. Globally, the incidence rate of blood transfusion (BT) following TKR has been reported to range between 8% and 18%, whereas a higher estimate reported locally (35%). This study aims to review the indications leading to BT following TKR in a single center. Methods: This is a retrospective study of patients who had BT following primary TKR (171 patients) at a single tertiary center between 2012 and 2016. Patients were categorized into “transfusion indicated” and “transfusion not indicated” groups. Cases were considered indicated if their hemoglobin (Hb) level was ≤8 g/dL, or if there was a drop accompanied by the clinical findings. Patient's demographics, comorbidities, surgery-related data, laboratory findings, blood loss, number of blood units transfused, and their complications were compared between the two groups. Results: Of the study sample, 50 (29.24%) patients were classified as cases without a clear indication for BT. Postoperative Hb was significantly higher in the nonindicated transfusion group (Hb nonindicated 8.54 g/dL, Hb indicated 7.74 g/dL, P < 0.001). Similarly, the body mass index (BMI) was significantly higher in the nonindicated group (BMI nonindicated 35.54, BMI indicated 32.49, P = 0.0123). Conclusion: The number of cases with no clear indication for BT following TKR remains relatively high, enforcing hospital-based policies that require the documentation of rationale for BT might help reduce transfusions with no clear reasoning behind them.
BACKGROUND Background: In head and neck squamous cell carcinoma patients (HNSCC), post-treatment ... more BACKGROUND Background: In head and neck squamous cell carcinoma patients (HNSCC), post-treatment surveillance for distant disease is mostly focusing on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of the cases and a high rate of primary of the lungs can be expected due to field cancerization of the entire upper aerodigestive tract. OBJECTIVE Objective: The survey aimed to evaluate the current beliefs and pulmonary screening practices among otolaryngology-head &amp;amp;amp; neck surgeons across Saudi Arabia in the post-treatment surveillance of head and neck squamous cell carcinoma. METHODS Methods: This is a nation-wide cross-sectional survey was conducted among Head and Neck surgeon members of the Saudi Society of Otolaryngology during 1– 30 June 2020. A predesigned questionnaire was used for data collection, and descriptive analysis was carried out. RESULTS Results: The study included 22 participants with a 78% response rate. The study found that the majority, 40.9% used lung radiography, followed by 31.8%, used low dose CT for routine lung screening during the post-treatment follow-up. Regarding the duration of lung screening during follow-up, the majority (77.3%) reported five years duration, and only 9.1% performed lung screening lifelong. As regards the frequency of lung screening, 77.3% reported annual screening, 18.2% half-yearly, and 4.5% biennially. Regarding believed effectiveness of the screening procedures in reducing lung cancer mortality during the follow-up, 36.4% believed it to be very effective or somewhat effective, 18.2% don’t know, and only 9.1% believed that it was not effective. CONCLUSIONS Conclusion: the majority used lung radiography, low dose CT and PET/CT as a routine lung screening during the post-treatment follow-up of head and neck cancer for mainly five years, ten years, and only a small percent performed lung screening lifelong. Lung screening was mostly annually or half-yearly. The screening is believed to be very effective or somewhat effective. CLINICALTRIAL
Interactive journal of medical research, Mar 18, 2022
Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttrea... more Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology-head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective.
Electronic physician, Feb 25, 2019
Background: Studying the prevalence of different types of neck masses can enhance the appropriate... more Background: Studying the prevalence of different types of neck masses can enhance the appropriate and timely diagnosis of the etiology of a neck mass, which is critical in maintaining good prognosis. However, there is a paucity of studies in Saudi Arabia evaluating the prevalence of different types of neck masses. Aim: This study was conducted to assess the etiologies of neck masses presenting to a large tertiary care hospital, and assess compliance with follow-up after diagnosis. Methods: This retrospective study was carried out on all patients diagnosed with neck masses over the period from January 01, 2016 to
Journal of pediatric neurology, Nov 30, 2017
The Egyptian Journal of Hospital Medicine, Oct 1, 2017
Background: medical students and interns are exposed to training programs in the hospitals to enh... more Background: medical students and interns are exposed to training programs in the hospitals to enhance their knowledge, skills and attitudes in the different clinical situations. Their training should offer an opportunity to be aware of the safety protocols in each medical department so as to prevent the possibility of errors. Objective: this study aimed to determine the level of knowledge and perception of final year medical students and medical interns on surgical and invasive procedure protocols in a university affiliated hospital in Jeddah, Saudi Arabia. Methods: this was a questionnaire was administered to final year medical students and interns of King Abdulaziz University Hospital in Jeddah City, Saudi Arabia. The questionnaire consisted of two sections: demographic profile in addition to knowledge and perception on surgical and invasive procedure protocols. A total of 264 participants answered the researcher-administered questionnaire. Results: these results showed that there was a lack of knowledge on surgical and invasive protocols of the participants with a mean score of 65.68%, which represented their agreement to the 2009 World Health Organization guidelines for safe surgery. There was a significant association between the level of confidence of the participants and their ages and year levels (p-value <.05), but not with gender. All demographic factors investigated were significantly associated with participant"s belief on the importance of having knowledge on surgical and invasive protocols (p-value <.05). Conclusion: the results of this study call academic institutions to revisit their curriculum and training programs specifically on the area of surgery.
Saudi Journal of Gastroenterology, 2019
Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reporte... more Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reportedly overweight. Morbid obesity has been associated with an increased risk of many comorbidities and mortality. Bariatric surgery is currently considered the most effective treatment option for morbid obesity. However, there are many concerns regarding the short and long-term complications of weight reduction surgery. It is unclear whether the general population is adequately aware of these risks. Therefore, we aimed to assess awareness of the general population of bariatric surgery complications. Although effective, bariatric surgery has been associated with many acute complications, reported in a range of 0.3% to 8% of operations. We performed a cross-sectional study between July and August of 2017 in Jeddah, Saudi Arabia. We used a 26-item, Arabic, electronically distributed questionnaire, to examine public awareness of the acute complications of bariatric surgery. Hypothesis testing was used to examine associations. In total, 624 questionnaires were completed electronically. Mean age of participants was 25 (±13.2) and 66% were females. Of the surveyed population, 64% reported being aware of acute complications of bariatric surgery. Participants who had previously undergone a bariatric operation had a higher degree of awareness when compared to those who had not undergone a bariatric operation before (80.4% vs. 61.3%, P &lt; 0.001). Females had higher awareness compared to males (70.8% vs. 52.1%, P &lt; 0.001). Awareness of complications was not statistically different when stratified by level of education (P = 0.131) but occupation predicted awareness (P = 0.007). Two-thirds of the general population appears to be aware of the potential acute complications associated with bariatric surgery. Furthermore, awareness seems to be higher in females, individuals who had previously undergone weight reduction surgery, and health care workers.
The Egyptian Journal of Hospital Medicine, 2017
Background: medical students and interns are exposed to training programs in the hospitals to enh... more Background: medical students and interns are exposed to training programs in the hospitals to enhance their knowledge, skills and attitudes in the different clinical situations. Their training should offer an opportunity to be aware of the safety protocols in each medical department so as to prevent the possibility of errors. Objective: this study aimed to determine the level of knowledge and perception of final year medical students and medical interns on surgical and invasive procedure protocols in a university affiliated hospital in Jeddah, Saudi Arabia. Methods: this was a questionnaire was administered to final year medical students and interns of King Abdulaziz University Hospital in Jeddah City, Saudi Arabia. The questionnaire consisted of two sections: demographic profile in addition to knowledge and perception on surgical and invasive procedure protocols. A total of 264 participants answered the researcher-administered questionnaire. Results: these results showed that there was a lack of knowledge on surgical and invasive protocols of the participants with a mean score of 65.68%, which represented their agreement to the 2009 World Health Organization guidelines for safe surgery. There was a significant association between the level of confidence of the participants and their ages and year levels (p-value <.05), but not with gender. All demographic factors investigated were significantly associated with participant"s belief on the importance of having knowledge on surgical and invasive protocols (p-value <.05). Conclusion: the results of this study call academic institutions to revisit their curriculum and training programs specifically on the area of surgery.
Journal of pediatric neurology, 2017
Saudi Journal of Gastroenterology, 2021
Background: Crohn's disease (CD) is a progressive illness associated with high morbidity owin... more Background: Crohn's disease (CD) is a progressive illness associated with high morbidity owing to the complications associated with the condition. Patients' awareness and cognition of such complications may carry significant psychological impact. The aim of this study is to assess the illness cognition of Saudi patients diagnosed with CD and to identify clinical associations. Methods: Adult patients with CD were asked to complete an illness cognition questionnaire (ICQ) between January and December of 2019. Additional data was extracted from the medical records. The ICQ composed of three domains: Helplessness (6 items), acceptance (6 items), and perceived benefits (6 items). Descriptive statistics were used to summarize patient characteristics and a linear regression analysis was used to identify associations with the ICQ score. Results: A total of 88 patients were included, of which 55.8% were females, 18% were smokers, and 11.5% had undergone CD-related surgery. The mean age was 26.9 ± 7.7 years and the mean duration of disease was 54.7 ± 60.5 months. The mean score was 17.4 ± 3.6 for the helplessness domain, 13.4 ± 3.6 for the acceptance domain, and 13.5 ± 3.5 for the perceived benefits domain. We found associations between abdominal pain and acceptance (P = 0.048), extra intestinal manifestations and perceived benefit (P = 0.001), and treatment with mesalamine and helplessness (P = 0.03). In a linear regression analysis, albumin level was the only factor associated with helplessness (coef = 0.18, P = 0.048). Conclusions: A considerable proportion of Saudi patients diagnosed with CD generally reported a negative perception of their disease. Albumin level was associated with helplessness.
Medical Archives, 2019
Introduction: Musculoskeletal (MSK) manifestations represent a common work-related physical compl... more Introduction: Musculoskeletal (MSK) manifestations represent a common work-related physical complication that affect surgeons and impacts their life and the healthcare service negatively. Aim: The aim of this study was to determine the prevalence of work related MSK manifestations among surgeons in a tertiary care hospital and to identify the possible associated risk factors. Methods: A Web-based self-administered cross-sectional survey was conducted. This study targeted all surgeons regardless of their nationalities, ages, genders, and marital statuses. The questionnaire assessed the participants' demographic data as well as musculoskeletal manifestations. Results: Most respondents (80%) suffered from MSK manifestations that were related to performing surgeries. Back and neck areas represented the most affected body parts (71.1% and 59.8%, respectively). A significantly higher percentage of those with musculoskeletal manifestations practiced for 5-10 years (28.9%) (p = 0.006). Conclusion: MSK pain is common among Saudi surgeons in different specialties. More attention should be directed to improving the physical environments in which the surgeons are operating. Moreover, surgeons should be educated about the recommended ergonomic positions that can prevent or decrease their work related MSK manifestations.
Saudi Medical Journal, 2018
Objectives: To determine the attitudes of obstetric and gynecological patients towards medical st... more Objectives: To determine the attitudes of obstetric and gynecological patients towards medical students' participation in clinical care. Methods: Patients in an obstetric and gynecological practice in Kingdom of Saudi Arabia, completed a structured self-administered online questionnaire to assess demographic, reproductive and lifestyle variables that affected their attitude towards the acceptance of medical students' participation in outpatient clinical care.
Journal of Crohn's and Colitis, 2020
Background The prevalence of Crohn’s disease (CD) has markedly increased in Saudi Arabia over the... more Background The prevalence of Crohn’s disease (CD) has markedly increased in Saudi Arabia over the past 3 decades.Patients’ awareness of the chronic recurrent course and potential risk of disease complications can lead to a wide range of psychological and interpersonal concerns. Patients’ cognition about the disease and treatment are important mediators as they explain the occurrence of individual differences in the individuals’ adjustment to chronic diseases. The aim of this study is to assess illness cognition of Saudi patients diagnosed with CD and to identify clinical predictors. Methods Consecutive patients with confirmed CD seen in the adult outpatient gastroenterology clinic at King Abdulaziz university hospital were recruited between January and December of 2019. Data was collected from interviews conducted with the patients and from the hospitals’ electronic medical records.The primary endpoint of the study was patients’ illness cognition according to the illness cognition q...
Medical Archives, 2018
Introduction: Blood transfusion practices affect both patient's outcomes and utilization of insti... more Introduction: Blood transfusion practices affect both patient's outcomes and utilization of institutional resources. Evidence shows that liberal blood transfusion has a detrimental effect on patient's outcome. A restrictive approach of blood transfusion is recommended by current clinical guidelines. Aim: The aim of this study was to evaluate the attitudes, knowledge, and practices of general surgery (GS) staff and residents regarding peri-operative blood transfusion and anemia management. Material and Methods: A self-administered, web-based questionnaire was developed, and its link was sent to the emails of all general surgeons at King Abdul-Aziz University Hospital (KAUH), Jeddah city, Saudi Arabia. The questionnaire included four parts: 1) background of surgeons; 2) preoperative assessment and management of anemia; 3) post-operative blood transfusion and alternatives; and 4) enablers and barriers. Results: 56 surgeons responded to the questionnaire. We found variations in blood transfusion practices, notably the hemoglobin threshold. For stable non-cardiac cases, 7 g/ dL was considered the threshold by 50% of respondents. For stable patients with past cardiac disease, a higher threshold was chosen by most (9 g/dL by 43% and 10 gm/dL by 21%). Most respondents believed that transfusion had no effect on the risk of survival (73%) and on the risk of cancer recurrence (55%) after oncologic surgical resection. Recognized facilitators were the availability of scientific evidence (84%), medicolegal concerns (57%), preference (52%), and institutional protocols (50%). Conclusion: Although current clinical guidelines recommend a restrictive transfusion practice, most respondents tended to over-order blood for elective procedures and were not aware of the potential complications of liberal blood transfusion. To implement the restrictive transfusion policies, health institutions should improve the awareness of surgeons and incorporate a strong supporting evidence in formulating local institutional guidelines.
Oman Medical Journal, 2018
We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia... more We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. Methods: We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. Results: We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. Conclusions: The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.
Materia Socio Medica, 2019
Introduction: Plastic surgery is a medical specialty involving the restoration, reconstruction, o... more Introduction: Plastic surgery is a medical specialty involving the restoration, reconstruction, or alteration of the body. Knowledge about facial plastic surgery among doctors is limited according to some literatures and enriched according to others, depending on the country and study population. Aim: Aim of the study was to evaluate level of knowledge of health care professionals regarding facial plastic surgery. Methods: A cross-sectional study included total of 261 health care professionals (consultants, specialists and residents in training) at King Abdul-Aziz University Hospital (KAUH) from all subspecialties during July 2018. The data collected using pre-designed questionnaire and analyzed using professional statistics software. Results: Among 261 participants, sex distribution shows a male-female ratio of 2.78:1. The majority (62.8%) of participants were residents. Mean age (± SD) of participants was 32.28 ± 8.43. Pediatrics, internal medicine, and general surgery were the most common specialties. Among participants, 75.5% agreed that taking training in plastic surgery program is a requirement to be a facial plastic surgeon whether it should be accompanied with at least one other surgery training (23%) or more than one other training (22.2%). The majority (97.7%) have never undergone a facial plastic surgery operation and 78.2% were not willing to undergo one. Conclusion: The study concludes that the knowledge and perception among healthcare professionals in KAUH regarding facial plastic surgeries is on relatively good basis but needs more updates and trainings.
Electronic physician, 2018
Background: The use of digital devices has increased tremendously during recent years in Saudi Ar... more Background: The use of digital devices has increased tremendously during recent years in Saudi Arabia. Many concerns were raised about the safety of this technology. Objective: To develop an instrument for determining the pattern of use of digital devices, and to investigate the link between the use of digital devices and visual symptoms among students of general education schools. Methods: This cross-sectional study was carried out from the beginning of April 2017 to the end of September 2017 among students of general education schools in the Western region of Saudi Arabia. The study sample included 475 randomly selected participants. A self-administered questionnaire was used for data collection. The questionnaire had two parts: the first part was about personal information of the study participants, while the second part was about the pattern of use of digital devices, associated visual complaints after use, and recommendations to decrease visual health hazards. IBM-SPSS version 22 was used to conduct the statistical analysis. Logistic regression analysis was used to examine associations with visual and muscular complaints; odds ratios with 95% confidence intervals were generated. Chi square goodness-of-fit test was used to compare categorical variable frequencies across different groups. A p-value of < 0.05 was considered statistically significant. Results: A total of 475 students completed the questionnaire. Nearly half the respondents were males aged more than 19 years old (p<0.001). Most respondents attended secondary schools (p<0.001). Most users experienced neck or shoulder pain (n=305, 64.2%, p<0.001), followed by headaches (n=301, 63.4%, p<0.001), and visual disturbances (n = 275, 57.9%, p=0.001). The majority of students used cellular phones or tablets (n=389, 83.8%). Half the respondents spent more than 4 hours daily using digital devices (p<0.001) and had 2 or more devices. Most students agreed that decreasing the duration of usage (n=217, 45.7%) and scheduling hours (n=214, 45.1%) are the best solutions to decrease the health hazards of digital devices. Logistic regression analysis identified female gender (OR: 2.8, 95% CI: 1.6-4.8, p<0.001) and exposure to digital devices for more than 2 hours per day (OR: 2.9, 95% CI: 1.4-6.3, p=0.006) as significant predictors of symptoms. Conclusion: A significant proportion of school students were aware that prolonged use of digital devices is associated with visual and muscular complaints. Females and individuals spending more than 2 hours a day using these devices are more prone to visual and muscular complaints. Decreasing the hours of usage is necessary to avoid digital device-related health risks.
Saudi Journal of Gastroenterology, 2018
Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reporte... more Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reportedly overweight. Morbid obesity has been associated with an increased risk of many comorbidities and mortality. Bariatric surgery is currently considered the most effective treatment option for morbid obesity. However, there are many concerns regarding the short and long-term complications of weight reduction surgery. It is unclear whether the general population is adequately aware of these risks. Therefore, we aimed to assess awareness of the general population of bariatric surgery complications. Although effective, bariatric surgery has been associated with many acute complications, reported in a range of 0.3% to 8% of operations. We performed a cross-sectional study between July and August of 2017 in Jeddah, Saudi Arabia. We used a 26-item, Arabic, electronically distributed questionnaire, to examine public awareness of the acute complications of bariatric surgery. Hypothesis testing was used to examine associations. In total, 624 questionnaires were completed electronically. Mean age of participants was 25 (±13.2) and 66% were females. Of the surveyed population, 64% reported being aware of acute complications of bariatric surgery. Participants who had previously undergone a bariatric operation had a higher degree of awareness when compared to those who had not undergone a bariatric operation before (80.4% vs. 61.3%, P &lt; 0.001). Females had higher awareness compared to males (70.8% vs. 52.1%, P &lt; 0.001). Awareness of complications was not statistically different when stratified by level of education (P = 0.131) but occupation predicted awareness (P = 0.007). Two-thirds of the general population appears to be aware of the potential acute complications associated with bariatric surgery. Furthermore, awareness seems to be higher in females, individuals who had previously undergone weight reduction surgery, and health care workers.
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
Background\Aim: Consanguinity influences the phenotypic variations of some hereditary and immune-... more Background\Aim: Consanguinity influences the phenotypic variations of some hereditary and immune-mediated disorders, including inflammatory bowel disease. This study estimated the prevalence of consanguinity among the ancestors of patients with inflammatory bowel disease and examined the effect of various consanguinity levels on inflammatory bowel disease onset. Patients with inflammatory bowel disease who were seen at two gastroenterology outpatient clinics were consecutively recruited and surveyed for demographics, disease onset, and presence of ancestral consanguinity within three generations. The prevalence of different consanguinity levels was calculated. The association between age at inflammatory bowel disease onset and consanguinity was examined. Two hundred seventeen patients were recruited. The mean age, mean age at diagnosis, and mean illness duration were 32.9 ± 13.4, 18.6 ± 11.5, and 8.6 ± 7.7 years, respectively. Of the cohort, 53.5% were women, and 74.2% were native S...
The Open Cardiovascular Medicine Journal, 2017
Background:Familial hypercholesterolemia (FH) is a life-threatening inherited condition. Untreate... more Background:Familial hypercholesterolemia (FH) is a life-threatening inherited condition. Untreated patients have the risk to develop raised plasma levels of cholesterol, atherosclerosis and cardiovascular disease (CVD). If diagnosed and treated early in life, the pathological consequences due to atherosclerosis could be avoided and patients with FH can have an anticipated normal life. Mounting evidence suggests that FH is underdiagnosed and undertreated in all populations. The underlying molecular basis of FH is the presence of mutations in one or more genes in the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB) or proprotein convertase subtilisin/kexin 9 (PCSK9). However, their prevalence is largely unknown in Saudi Arabia but given the high rates of consanguinity, the prevalence appears to be higher. Furthermore, the high prevalence of obesity and diabetes mellitus in Saudi Arabia increases the vascular disease burden in FH cases by adding additional CVD risk fact...
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Papers by Majed N. Alnefaie