Saudi Medical Journal最新文献

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.

Objectives: To explore gender-related variations in sociodemographic factors, clinical presentations, and psychosocial characteristics among methamphetamine users in Saudi Arabia.

Methods: A retrospective cross-sectional study was conducted using the electronic health records of 1,181 patients (91% male, 9% female) treated at multiple Erada Mental and Addiction Centers across Saudi Arabia (2020-2024). Data on sociodemographic characteristics, methamphetamine use patterns, psychiatric comorbidities, and psychosocial functioning were collected and analyzed using validated tools, including the Addiction Severity Index, Beck Depression and Anxiety Inventory, and Quality of Life Scale.

Results: Female participants were younger than males (mean age 25.3 vs 28.5 years; p < 0.001) and initiated methamphetamine at a later age (21.4 vs 19.2 years; p < 0.001). Females had greater proportion of daily use (65.4% vs. 60%, p = 0.035) but consumed smaller amounts per day (1.5 vs. 1.8 g, p = 0.041). They also exhibited higher rates of psychiatric comorbidities, including depression (50% vs. 30.0%, p < 0.001) and anxiety (40% vs. 20%, p < 0.001), and reported more severe psychosocial impairments, including lower quality of life (54.8 vs. 62.4, p < 0.001), higher unemployment rates (59.8% vs. 30%, p < 0.001), and more family conflicts (65.4% vs. 50%, p < 0.001). In contrast, Legal issues were more common among males (40% vs. 29.9%, p = 0.002).

Conclusions: Female methamphetamine users demonstrate greater vulnerability with earlier onset, more psychiatric comorbidities, and worse psychosocial outcomes. Targeted interventions are needed for female methamphetamine users in Saudi Arabia.

Objectives: To establish and maintain a comprehensive, up-to-date registry of juvenile idiopathic arthritis (JIA) cases, and to outline the methodology used in creating it.

Methods: Retrospective and prospective data collection commenced in August 2021, using the Hospital Information System to identify electronic medical records of JIA patients. All individuals diagnosed with JIA and receiving follow-up care at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh were included. A broad range of variables covering sociodemographic characteristics, clinical features, laboratory results, imaging findings, and therapeutic medications were recorded in the REDCap platform. Data collection update occurs every 6 months.

Results: By December 2024, the registry included 240 patients. The median age at presentation was 8 years (IQR: 4-11). Most patients (79%) were from the central region of Saudi Arabia, while the remainder were distributed across other regions. Oligoarthritis was the most common subtype (32.9%), followed by systemic JIA (25.8%). Among the biologic agents used to treat JIA, anti-TNF agents were the most frequently administered (62.5%), followed by anakinra (17%) and tocilizumab (13%).

Conclusion: The JIAR-KASCH provides an in-depth profile of JIA epidemiology, clinical presentation, and management in Saudi Arabia. It also provides a framework that can guide the development of similar national registries, particularly in pediatric rheumatology, facilitating robust data collection and long-term disease monitoring.

Objective: To access the magnitude of these injuries in patients with pelvic fractures at King Abdullah Hospital, Bisha, Saudi Arabia. Abdominal solid organ injuries are life-threatening and results in adverse health effects particularly to patients with pelvic fracture.

Methods: An analytical cross-sectional retrospective hospital-based study that reviewed a total of 236 medical records of patients with abdominal organ injuries and pelvic fractures at King Abdullah Hospital, Bisha, Saudi Arabia. Cleaned data was coded and analyzed with the use of SPSS version 23 to drive key insights.

Results: The study comprised of 236 patients in total. Approximately 38 (16.1%) patients had solid organ injuries, while the majority, 198 (83.9%) patients, had non-solid organ injuries. Common abdominal solid organ injuries were liver lacerations (21 cases, 8.9%), followed by spleen lacerations (16 cases, 6.8%), and kidney lacerations (1 case, 0.4%). Patients who had solid organ injury were significantly younger (28.26 ± 12.494) compared to those who had non-solid organ injury (34.52 ± 18.039) with (p = 0.042). Injury Severity Score (ISS) was identified as a significant predictor for abdominal solid organs injuries among patients with pelvic fractures [AOR = 1.126; 95% CI = 1.055 - 1.201; p<0.001].

Conclusion: The study found the magnitude of abdominal solid organ injuries to be severe among pelvic fracture patients at King Abdullah Hospital in Saudi Arabia. The most common injuries were liver lacerations, spleen lacerations, and kidney lacerations. Additionally, the ISS was identified as a significant predictor of abdominal solid organ injuries among trauma patients. These findings highlight the need for urgent medical intervention to improve survival and health outcomes in patients with these injuries related to pelvic fractures.

Objective: To examine obesity research trends in Arab countries to inform policies and interventions.

Methods: A bibliometric analysis was conducted using the Web of Science database accessed via King Abdulaziz University's electronic library. Publications on obesity research in Arab countries from 2004 to 2023 were analyzed using R-Bibliometrix. Key parameters included publication volume, leading authors and institutions, funding sources, keyword co-occurrence networks, and collaboration patterns.

Results: Obesity-related research output in Arab countries demonstrated consistent growth from 2004 to 2023, with a threefold increase in publications since 2015. Regional and international collaborations have intensified, although disparities in research productivity persist across nations. Key themes include prevention strategies, socio-cultural determinants, and policy-oriented interventions.

Conclusion: The increasing number of studies shows that more academics are interested in obesity in Arab countries. However, it is still challenging to turn findings into policies and actions that will have an effect. To eradicate the obesity epidemic, future efforts should focus on more funding, collaborative research, and a multidisciplinary approach is necessary.

Objective: To synthesize research on the prevalence and distribution patterns of carbapenem-resistant Enterobacteriaceae (CRE) in Intensive Care Units (ICUs) across Saudi Arabia. It also seeks to evaluate molecular resistance profiles, identify associated risk factors, assess antimicrobial susceptibility, and examine infection control strategies within these critical care settings.

Methods: A systematic analysis was conducted, including cross-sectional, retrospective, and genomic studies from various tertiary hospitals in Saudi Arabia. The review focused on epidemiological trends, molecular characterization of CRE strains, clinical correlates, and the outcomes of implemented intervention strategies.

Results: The findings indicate a high and steadily increasing prevalence of CRE, often exceeding 40% in ICUs. The predominant carbapenemase genes identified were blaOXA-48 and blaNDM, with evidence of clonal dissemination of high-risk strains. Key risk factors for CRE colonization and infection include ICU admission, use of invasive devices, prior antibiotic exposure, and comorbidities such as chronic kidney disease and diabetes. CRE isolates demonstrate extensive multidrug resistance, with colistin and tigecycline remaining effective options; however, emerging resistance to these agents has been reported. Although infection control measures like active surveillance and environmental cleaning are prioritized, their overall effectiveness remains under-evaluated and inconsistently documented.

Conclusion: The high and rising prevalence of CRE in Saudi Arabian ICUs underscores the urgent need for standardized molecular diagnostics, comprehensive surveillance systems, and targeted antimicrobial stewardship programs. Implementing these strategies is crucial to reducing CRE transmission, overcoming resistance challenges, and improving patient outcomes in critical care environments.

Objective: To evaluate the impact of a newly established targeted neonatal echocardiography (TNE) and Neonatal Hemodynamics consultation service on the assessment and management of neonates.

Methods: This is a descriptive retrospective cohort study that included all neonates who underwent TNE consultations in the Neonatal Intensive Care Unit from October 2023 and September 2024. Clinical indications, diagnostic findings, and subsequent management were analyzed.

Result: A total of 237 TNE consultations were performed for 105 neonates. The mean gestational age was 29.9 weeks, and the mean birth weight was 1433 grams. On average, 19.8 echocardiographic scans were performed per month. The leading indications for consultation were assessment of patent ductus arteriosus (PDA) (43%), acute pulmonary hypertension (16.4%), screening for chronic pulmonary hypertension (18.6%), neonatal hypotension (17.7%), heart function (0.8%), and central line assessment (3.4%). Among the cohort, 83 neonates (79%) received targeted interventions based on TNE findings. Of these, 38 neonates (36.2%) born at <30 weeks' gestation were treated with pharmacologic agents for PDA closure. Twenty-three neonates (22%) received inhaled nitric oxide and inotropes for acute pulmonary hypertension, while 22 neonates (21%) received inotropes or vasopressors for neonatal hypotension.

Conclusion: The implementation of a dedicated TNE consultation service was associated with high utilization and had a measurable impact on clinical decision-making. While PDA assessment remained the most common indication, a substantial proportion of consultations supported management in cases of pulmonary hypertension and hypotension.

Objectives: To determine the influence of metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and hepatic fibrosis on the pattern and management of patients who had acute coronary syndrome (ACS).

Methods: Retrospective records of patients with ACS included demographic, electrocardiographic, and laboratory data of platelets count, glycated hemoglobin, lipogram, liver and cardiac enzymes. Ultrasound was used to evaluate fatty liver. Coronary angiography data included the number, site and percentage of the coronary arteries occluded. The type and outcome of treatment of ACS were recorded. Laboratory markers were measured to evaluate fibrosis.

Results: The study recruited 259 patients, and the majority were males. MASLD was detected in 123 (47.5%). The ST segment-elevation myocardial infarction (STEMI) was reported in 42.9% and non-STEMI (NSTEMI) in 30.1%. MASLD patients had frequent STEMI (38.2%) and NSTEMI (31.7%) with more involvement of left main coronary artery (10.6%). Patients with MASLD and higher fibrosis showed involvement of multiple coronary arteries and needed revascularization but without significant difference from non-MASLD. Left anterior descending and right coronary arteries were significantly involved in higher fibrosis.

Conclusion: STEMI and NSTEMI were frequent in MASLD. People with MASLD and hepatic fibrosis had more incidence of occlusion of multiple coronary arteries and needed cardiac intervention.

Objectives: To analyze and compare these stages, types, frequency, causes, and corrective actions related to medication errors (MEs) reported in Ministry of Health (MOH) hospitals in Saudi Arabia, and thereby enhance medication safety through data driven decisions.

Methods: A retrospective cross-sectional study was conducted using ME reports submitted to the Saudi MOH national reporting system from January 2023 to December 2024.Data were collected from nine hospitals, covering medication involved, reporting personnel, level of harm and corrective actions. A novel stratification framework (NSF) was used to visualize emerging risks and protective trends. Statistical analyses were conducted using relative risk (RR), risk difference (RD), Cohen's [h], Pearson's Chi-square test, and Z-adjusted column proportion comparisons.

Results: A sample of 19,645 MEs was analyzed with almost equal gender proportions (p = 0.976). MEs reporting remained stable in hospitals between years, while a few showed an upward trend (p < 10^-111). Most of the reported errors (69.1%) were intercepted before reaching the patients with no harmful effects. Prescribing (94.8%) with wrong or missed dose (18.6%) remained the leading cause. Pharmacists were at the forefront of reporting these cases (>90%). Improved documentation (p < 10^-300) and enhanced physician involvement were also observed in this study.

Conclusion: The findings highlight the importance of continuous evaluation and rigorous analysis of MEs data and the design of novel quantifiable tools for benchmarking safety and guiding targeted interventions in healthcare settings.

Background: Te evaluate the outcomes of Endovascular thrombectomy (EVT) -treated AIS patients in Jeddah, Saudi Arabia, and explores predictors of functional recovery. Endovascular thrombectomy (EVT) is the standard of care for acute ischemic stroke (AIS), though patient outcomes can vary based on regional and clinical factors.

Method: A retrospective cohort study was conducted using medical records from King Abdulaziz University Hospital (KAUH) and King Fahad Hospital Jeddah (KFHJ), including AIS patients treated with EVT between January 2020 and July 2024. Neurological status was assessed using the NIH Stroke Scale (NIHSS), and clinical outcomes were evaluated with the modified Rankin Scale (mRS) at 90 days, where scores of 0-2 indicated good outcomes. Data on demographics, treatment times, recanalization success, and peri-procedural complications were collected and analyzed.

Results: A total of 219 patients were included. Mean NIHSS scores on admission were similar across centers (14.6 ± 5 at KAUH vs. 15.5 ± 5.1 at KFHJ), while mRS scores at 90 days were slightly better at KAUH. The average time from last known well to hospital arrival was approximately 231 minutes across both centers. Door-to-puncture times were shorter at KFHJ (87.7 ± 61.2 minutes) compared to KAUH (114 ± 48.2 minutes). Successful recanalization (TICI 3) was achieved in 76.7% of cases, with higher rates at KAUH (87%) than KFHJ (72.1%). Functional independence (mRS 0-2) at 90 days was achieved in 33.5% of patients and was associated with younger age (p=0.05) and lower baseline NIHSS scores (p<0.001).

Conclusion: EVT is technically effective for AIS in the Saudi population, with recanalization rates comparable to global benchmarks. However, functional outcomes remain suboptimal due to delayed presentation, high rates of metabolic comorbidities, and post-procedural complications. Efforts to improve early stroke recognition, reduce pre-hospital delays-such as through the implementation of mobile stroke units-and control vascular risk factors are essential to improving patient outcomes.