Saudi Journal of Medicine & Medical Sciences最新文献

The Saudi Guideline for Mechanical Ventilation in Adults presents evidence-based recommendations for the care of adults requiring invasive mechanical ventilation. Fourteen priority clinical questions address ventilatory strategies for acute respiratory distress syndrome (ARDS), adjunctive and rescue therapies, sedation and weaning practices, airway management, and supportive ICU care. Strong recommendations support low-tidal-volume ventilation and higher positive end-expiratory pressure in ARDS, as well as head-of-bed elevation to prevent ventilator-associated pneumonia. Conditional recommendations include prone positioning, venovenous extracorporeal membrane oxygenation in selected severe ARDS patients, daily sedation interruption, protocolized spontaneous breathing trials, and early tracheostomy. For several interventions, evidence remains insufficient to support definitive recommendations. This guideline aims to standardize practice and improve outcomes across Saudi intensive care units.

Background: Mechanical ventilation is a critical intervention for patients with respiratory failure. Recent advancements and quality improvement initiatives in Saudi Arabia have contributed to refining mechanical ventilation practices. This guideline represents the first national evidence-based framework developed through a multidisciplinary approach.

Objectives: This guideline provides evidence-based recommendations for the management of mechanically ventilated adults in intensive care units in Saudi Arabia, incorporating best practices to improve patient outcomes and standardize care across healthcare institutions.

Methods: The guideline development followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology, an internationally accepted approach for adopting, adapting, and developing guidelines. A multidisciplinary task force, comprising intensivists, pulmonologists, anaesthesiologists, respiratory therapists, and nursing specialists, conducted a systematic review of the literature and contextualized recommendations for local healthcare settings. The guideline addressed 14 prioritized questions.

Results: The guideline included strong recommendations for using low tidal volume ventilation for patients with ARDS, utilizing higher levels of positive end-expiratory pressure, and employing head-of-bed elevation. The guideline provided conditional recommendations for using veno-venous extracorporeal membrane oxygenation, daily sedation interruption, protocolized spontaneous breathing trials, prone positioning, using an endotracheal tube with subglottic secretion drainage, using light sedation, and early tracheostomy. The guideline also included a conditional recommendation against using nitric oxide and a neutral recommendation regarding recruitment maneuvers and early mobility.

Conclusion: This guideline serves as a foundational framework for optimizing mechanical ventilation practices in Saudi Arabia. Future research should focus on local implementation strategies, cost-effectiveness analysis, and the impact of guideline adherence on clinical outcomes.

Background: The Injury-Psychological Readiness to Return to Sport (I-PRRS) is a validated and reliable scale to assess the psychological readiness of athletes returning to sport after an injury and it has been translated and validated in several languages.

Objectives: To translate the I-PRRS scale into Arabic (I-PRRS-Ar) and evaluate its psychometric properties in Arabic-speaking athletes.

Methods: An observational, cross-sectional study was conducted among Arabic-speaking injured athletes recruited from various sports clinics and sport clubs across Saudi Arabia. Psychometric properties examined included internal consistency, test-retest reliability, content validity, convergent validity with the Arabic Tampa Scale for Kinesiophobia (TSK-Ar) and the Arabic Numerical Pain Rating Scale (NPRS-Ar), and structural validity.

Results: A total of 140 athletes completed the I-PRRS-Ar, while 34 athletes completed the scale twice to assess the test-retest reliability. The I-PRRS-Ar demonstrated excellent content validity (CVI ≥0.90), good internal consistency (Cronbach's α =0.85), and excellent test-retest reliability (ICC_2,1 = 0.83). Standard error of measurement was 3.83, and minimal detectable change was 10.64. No floor or ceiling effects were found. I-PRRS-Ar showed weak negative correlation with TSK-Ar (r = -0.28, P = 0.001) and moderate negative correlation with NPRS-Ar (r = -0.32, P < 0.001). Factor analysis confirmed a unidimensional structure.

Conclusions: The Arabic version of the Injury-Psychological Readiness to Return to Sport (I-PRRS-Ar) is a reliable and valid tool for assessing psychological readiness to return to sport in Arabic-speaking athletes after an injury.

Splenic rupture constitutes a rare yet potentially life-threatening complication following colonoscopy. We report a case of a young male patient who presented with abdominal pain for 2 days, which began 6 hours after colonoscopy. Clinical examination revealed periumbilical tenderness, with laboratory findings significant for leukocytosis (WBC: 20.32 × 10⁹/L), an initial hemoglobin of 113 g/L, and a significantly elevated D-dimer (15.25 mg/L). Abdominal computed tomography confirmed splenic rupture, perisplenic hematoma, and hemoperitoneum. Following multidisciplinary consultation involving hepatobiliary surgery and interventional radiology, the patient underwent emergent splenic artery embolization. Post-procedural management included antibiotics and supportive care. Despite achieving hemodynamic stability and symptomatic improvement, persistent leukocytosis and a significant hemoglobin decrease to 79 g/L were noted on postoperative day 1, accompanied by radiographic evidence of increased hemoperitoneum. Nonetheless, the patient remained hemodynamically stable and received ongoing supportive care, and was discharged in good condition after a hospital stay of 15 days. This case highlights the importance of maintaining a high index of suspicion for splenic injury in patients with post-colonoscopy abdominal pain, even with delayed presentation, and demonstrates the use of splenic artery embolization as a therapeutic intervention, and the need for prolonged monitoring.

Background: Sudden unexpected death in epilepsy (SUDEP) is the sudden and unexpected death of an individual with epilepsy unrelated to trauma or drowning that may or may not correlate with a recent seizure. The estimated annual prevalence of SUDEP is 1.2 per 1000 patients. Dissemination of knowledge about SUDEP helps prevent deaths in patients with epilepsy (PWE) by managing the risk factors and educating patients and their caregivers.

Objectives: This scoping review aimed to highlight the gap and address the importance of educating PWE and their caregivers about SUDEP.

Methods: We reviewed English-language studies published from 2015 to 2025 that were available in PubMed, Scopus, and Google Scholar. Qualitative, quantitative, and mixed-methods research studies were considered. Studies that lacked sufficient data or were not aligned with the conceptual framework as well as books, reviews, or animal research were excluded. Data were extracted using a standardized form.

Results: Of 318 studies retrieved in the initial search, 20 were included. SUDEP discussion by neurologists was inconsistent and often limited to high-risk cases. Awareness among PWE and caregivers was low (PWE: 12%-27%; caregivers: 5%-31.5%), with few receiving information from clinicians. Education sometimes caused short-term anxiety, although some studies reported improvements in medication adherence and lifestyle. Most studies supported universal SUDEP discussion, preferably delivered face-to-face by neurologists.

Conclusions: SUDEP education is generally well-received and could positively influence behavior. Despite low baseline awareness, patients with epilepsy and caregivers desire information regarding SUDEP, highlighting the need for clear guidelines and integration of SUDEP education into routine epilepsy care.

Background: HIV transmission trends and risk factors have not been specifically reported from the Eastern Province of Saudi Arabia.

Objective: To report epidemiological trends of HIV/AIDS in the Eastern Province of Saudi Arabia over a 10-year period.

Materials and methods: This retrospective study included all cases of HIV/AIDS in the registry of Department of Infectious Diseases of the Public Health Authority in the Eastern Province, Ministry of Health, Saudi Arabia, between January 01, 2014, and December 31, 2023.

Results: A total of 1633 new cases of HIV infections were reported in the Eastern Province of Saudi Arabia between 2014 and 2023. Most patients were males (87.1%), aged 30-44 years (49.8%), and Saudis (60.5%). There was a year-on-year increase in the number of cases each year, except in 2016 and 2020. Overall, there was a >2.5-fold increase in the number of cases between 2014 and 2023; there was a 42% increase in the number of cases between 2021 and 2023. The most common source of HIV transmission was heterosexual contact (70.8%). Other modes of transmission, such as injection drug use, homosexual contact, and vertical transmission, were low.

Conclusion: The steady rise in the number of HIV cases reported in the Eastern Province of Saudi Arabia indicates the need for developing stronger surveillance, testing, and prevention programs.

Periodontal diseases, particularly periodontitis, are chronic inflammation with complex microbial and immunological etiologies. While bacterial pathogens such as Porphyromonas gingivalis are well-known contributors, emerging evidence indicates the role of viruses, especially herpesviruses, in the onset and progression of periodontal tissue destruction. In this review, the interplay between viral infections and periodontal health was explored, with an emphasis on the immunopathological mechanisms in which different viruses such as human herpesvirus, Epstein-Barr virus, and human cytomegalovirus aggravate periodontal tissue destruction. These viruses impair host defenses, promote bacterial colonization, and alter cytokine responses, leading to periodontal tissue damage. The review also addresses the impact of systemic viral infections, such as HIV and COVID-19, on periodontal diseases. Elevation in inflammatory mediators, including interleukin-6, link periodontitis with adverse clinical outcomes in viral infections. Moreover, interactions between P. gingivalis and respiratory viruses suggest oral pathogens may also influence systemic disease severity. Advances in diagnosis using molecular technology have improved viral detection in periodontal tissues, and previous studies support the use of antiviral therapies and gene-targeted interventions as potential adjuncts to traditional periodontal care. The integration of preventive strategies, such as vaccination and enhanced oral hygiene, is crucial in reducing the systemic consequences of viral-periodontal interactions. This review highlights the need for interdisciplinary collaboration and continued research to fully comprehend the virological dimensions of periodontal disease and develop effective, targeted therapeutic approaches.

Background: Community-acquired pneumonia (CAP) is a major cause of hospitalization and mortality, especially among elderly individuals and those with chronic comorbidities. Identifying reliable prognostic markers at the time of hospital admission remains a clinical challenge.

Objectives: To evaluate the prognostic value of routinely measured hematological and biochemical parameters, specifically lymphocyte count, serum albumin, procalcitonin, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)/albumin ratio (CAR), in predicting in-hospital mortality and length of stay in patients with CAP.

Materials and methods: This retrospective, single-center cohort study included all adult patients hospitalized with radiologically and clinically confirmed CAP between September 2022 and September 2023. Demographic, clinical, and laboratory data were collected. NLR and CAR were calculated based on admission values. Statistical analyses included group comparisons, correlation analysis, and ROC curve analysis to determine prognostic accuracy.

Results: A total of 526 patients were included (mean age: 66.2 years; 53.5% female), of which in-hospital mortality occurred in 9.5%. Non-survivors had significantly lower lymphocyte and albumin levels and higher CRP, procalcitonin, NLR, and CAR values (P < 0.05). ROC analysis showed that lymphocyte count (AUC = 0.794) and albumin (AUC = 0.787) had the highest predictive accuracy, followed by procalcitonin (AUC = 0.774), NLR (AUC = 0.715), and CAR (AUC = 0.710). CRP and WBC showed lower discriminative power. Significant positive correlations were observed between CRP, procalcitonin, NLR, CAR, and length of hospital stay.

Conclusions: Lymphocyte count, serum albumin, procalcitonin, NLR, and CRP/albumin ratio are significant prognostic markers for mortality and prolonged hospitalization in patients with community-acquired pneumonia. These routinely available parameters may aid in early risk stratification and clinical decision making.

Background: Peritoneal dialysis is an effective therapy for end-stage kidney disease patients. Fungal peritonitis is a rare complication in patients on peritoneal dialysis. Data on peritoneal dialysis-associated fungal peritonitis from Oman are lacking.

Objective: To report the epidemiology, management practices, and outcomes in cases of peritoneal dialysis-associated fungal peritonitis from a tertiary hospital in Oman.

Patients and methods: This retrospective study included all patients aged ≥13 years who developed fungal peritonitis after peritoneal dialysis treatment at Nizwa Hospital, Nizwa City, Oman, between March 01, 2005, and March 31, 2023.

Results: A total of 311 patients were followed-up for peritoneal dialysis during the study period, of which 10 patients developed peritoneal dialysis-related fungal peritonitis (3.2%) (males: 80%; mean age: 54.5 ± 19.9 years). Candida spp. accounted for 80% of the cases, with a predominance of non-Candida albicans spp., while Aspergillus accounted for the remaining 20%. Previous bacterial peritonitis was noted in seven patients (70%) treated with multiple antibiotics, while six patients (60%) had received antibiotics within the past 1 month. Therapeutic approach was immediate systemic antifungal and peritoneal dialysis catheter removal with transfer to hemodialysis. The mortality rate was 20%.

Conclusions: About 3% of the patients on peritoneal dialysis at Nizwa Hospital, Oman, developed fungal peritonitis. Prior antibiotic use was a major risk factor, and thus antifungal prophylaxis is recommended. Candida spp. was the most common pathogen.