Saudi Medical Journal最新文献

Over the past 70 years, antimicrobial resistance (AMR) has emerged as a critical public health concern in Asia. Regional challenges such as dense population, scarce resources, and diverse healthcare systems further complicate the containment efforts. To address this, Asian countries have adopted several strategies and policies. A comprehensive review of published literature was conducted to identify key policies and interventions. Findings revealed diverse approaches to AMR containment, including surveillance and monitoring systems, antibiotic stewardship programs, infection control measures, vaccination strategies, and public health awareness campaigns. However, implementation of these strategies is hindered by resource, political, and regulatory barriers. The regional offices of the WHO in Asia also support strategies to combat AMR across the region. This review serves as a valuable resource for policymakers, healthcare professionals, and researchers, offering insights into the complex landscape of AMR in Asia and informing strategies to mitigate its impact.

Chronic rhinosinusitis with nasal polyps (CRSwNP) poses significant management challenges, particularly in treatment-resistant cases, greatly affecting patients' quality of life. This paper provides consensus-based recommendations to guide clinicians in managing difficult-to-treat CRSwNP in the Gulf Cooperation Council (GCC) region. A modified Delphi method was used to gather expert opinions from GCC specialists through surveys and discussions, achieving consensus on 14 key statements for CRSwNP management. Key criteria identified for difficult-to-treat CRSwNP included early recurrence after surgery, comorbid atopic diseases, and frequent need for oral steroids. The importance of structured histopathology reporting and understanding inflammatory characteristics to differentiate patients with CRSwNP was highlighted. The advantages of using new therapies, such as biologics, were acknowledged in managing patients who do not respond to conventional therapies. A multidisciplinary approach to patient management was advocated to ensure comprehensive and effective care. Despite advancements in CRSwNP treatments, a significant subset of patients continues to exhibit symptoms, necessitating personalized treatment approaches. The investigation of clinicopathological features, patient stratification, and the use of biologics are promising strategies for improving outcomes for difficult-to-treat CRSwNP. Further region-specific clinical studies and multicenter collaborations are needed to validate these consensus recommendations, optimize biologic use, and develop tailored treatment algorithms for difficult-to-treat CRSwNP in the GCC region.

Objectives: To provide details on patient satisfaction with the Saudi healthcare system and patient characteristics associated with satisfaction levels using nationally representative survey data.

Methods: A cross-sectional secondary analysis was conducted using the Kingdom of Saudi Arabia World Health Survey (KSAWHS 2019) data, which collected information on demographics, health status, chronic conditions, and access to and use of healthcare services among Saudi adults aged ≥15 years. Descriptive statistics and logistics regression analyses were performed to identify significant predictors of satisfaction with Saudi healthcare services.

Results: Between April and July 2019, 8,912 individuals completed the KSAWHS 2019 individual questionnaire. Out of them 3,929 participants received healthcare services in the last 12 months, were aged ≥15 years, submitted completed records, and were included in this study. The majority of study participants (89.4%) were satisfied with the Saudi healthcare system. Age, marital status, language, health status, presence of chronic conditions, and number of primary healthcare centers per region were significantly and positively associated with patient satisfaction, while gender, type of clinic last visited, and number of hospitals per region were significantly and negatively associated with patient satisfaction.

Conclusion: Patient satisfaction with healthcare systems is an important assessment metric for overall system performance. Regular measurement of patient satisfaction and characteristics associated with levels of satisfaction can provide meaningful feedback for health policymakers and administrators to develop interventions to improve system performance.

Objectives: To establish a ferroptosis-related colorectal cancer (CRC) diagnostic model by integrating machine learning and gene expression analysis. Tumorigenesis is strongly linked to ferroptosis, an iron-mediated kind of cell death. The dismal prognosis of CRC, a severely malignant gastrointestinal cancer, accentuates the demand for effective diagnostic biomarkers.

Methods: The study was performed between January 2024 and 2025. The GEO database provided 2 openly searchable gene expression profiles (GSE9348 and GSE21510) from CRC as well as non-tumor tissues. Genes that were expressed differently in tumor and healthy tissues were found using the GSE9348 dataset. Distinct genetic biological functions were identified through functional enrichment analysis. SVM-RFE and LASSO regression models helped identify potential genetic markers associated with CRC.

Results: GSE9348 dataset analysis helped identify 27 differentially expressed ferroptosis-related genes. KEGG analysis suggested that these genes are primarily related to inflammatory responses, NF-κB signaling, and regulation of the interleukin family. Based on this model, CHMP2A, CYCS, HMGB1, IL18, IL1B, and GZMA were selected as potential diagnostic markers, and a novel diagnostic model was constructed. Its predictive value was examined using receiver operating characteristic analysis. We validated the expression changes of model genes using PCR assays along with a validation set (comprising TCGA and GSE21510 datasets).

Conclusion: These outcomes provide an efficient ferroptosis-related gene-based diagnostic model for CRC. Nevertheless, before its use in real-time settings, more clinical studies are required to confirm its diagnostic value.

Objectives: To analyze cancer incidence trends in Saudi Arabia from 2013 to 2022 by age group, gender, and nationality, identify significant temporal patterns or shifts, and determine the most prevalent cancer types across age groups and years.

Methods: A retrospective analysis was conducted using data from the Saudi Cancer Registry, which included 185,567 reported cancer cases between 2013 and 2022. Descriptive statistics, generalized estimating equation (GEE), and Joinpoint regression were used to examine the crude incidence rate (CIR), age-specific incidence rate (AIR), and age-standardized rate (ASR) across demographic subgroups.

Results: Saudi nationals had higher cancer rates than non-Saudi residents, with CIR of 66.86 and 66.28 per 100,000 population in 2021-2022. Saudi women showed higher CIR and ASR values with rapid AIR increase, though rates among men exceeded women's after age 70. Among Saudis, breast, colorectal, and thyroid cancers were most common, while leukemia (32.8%), brain/CNS cancers, and Hodgkin's Lymphoma dominated in children. The GEE model showed women's AIR exceeded men's by 88 per 100,000 (p=0.0115), and Saudis exceeded non-Saudis by 90 per 100,000 (p=0.0095). Joinpoint regression found Saudis has significant post-2020 cancer rate increases (APC: men 21%, women 16.5%).

Conclusion: These findings indicate the need for targeted cancer prevention strategies in high-risk groups like older people especially women. Addressing breast and colorectal cancers may help reduce cancer burden. The sharp post-2020 increase in cancer among Saudi nationals warrants investigation of contributing factors.

Objectives: To assess bedside ultrasonographic readings in conjunction with laboratory and clinical results, as well as to look into the efficacy of these measurements while evaluating patients who are being monitored for dehydration and managing their therapy.

Methods: We assessed 300 patients, 150 of whom were in the case group and 150 in the control group. Laboratory results throughout therapy, clinical dehydration, vital signs, and bedside ultrasonography results were all documented. A vena cava inferior collapsibility index of 50% or higher, dry oral mucosa, decreased skin turgor, and a fresh onset of altered consciousness were all considered clinical indicators of dehydration.

Results: There were statistically significant differences between the maximum and minimum values of the inferior vena cava diameter, inferior vena cava collapsibility index, optic nerve sheath diameters in both eyes, and transverse and anteroposterior diameters in the clinical dehydration group (p<0.001). Positive correlations that were statistically significant between plasma osmolarity and blood urea/creatinine ratio, sodium, and vena cava inferior collapsibility index, while statistically significant negative correlations were found between plasma osmolarity and central venous pressure, vena cava inferior maximum and minimum, optic nerve sheath diameters in both eyes, transverse diameter, and anteroposterior diameter.

Conclusion: Optic nerve sheath, transverse, and anteroposterior diameter measurements from ocular ultrasonographic evaluations correlated with inferior vena cava ultrasonographic measurements and can be used in appropriate patients.

Objectives: The objective of this research was to identify how common Respiratory distress syndrome (RDS) is and explore related factors in late preterm infants admitted to the neonatal intensive care unit (NICU) at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Methods: A retrospective cross-sectional study was conducted over 1 year (2021). Infants with a gestational age of 34 to 36 weeks were selected using a consecutive, non-probability sampling method. Clinical, neonatal, and maternal factors were analyzed to assess their impact on the prevalence of RDS in this gestational age group.

Results: The majority of infants in the study were born at 36 weeks of gestation (36.1%), followed by 34 weeks (34.1%) and 35 weeks (29.7%). Sex distribution showed a slight male predominance (51.7% male, 48.3% female). The prevalence of RDS was 53.0%. Statistically significant associations with RDS were observed for mode of delivery (p=0.005*), incomplete antenatal corticosteroid therapy (p=0.032*), maternal GBS colonization, and gestational diabetes (p=0.025*).

Conclusion: The study provides comprehensive insights into the prevalence of RDS and its associated factors among late preterm infants. The observed prevalence of 53% highlights the substantial burden of RDS in this population. Understanding the interplay of gestational, neonatal, and maternal factors is crucial for developing tailored interventions and improving neonatal care practices. These findings emphasize the need for ongoing research to enhance preventive strategies and management protocols for RDS in late preterm neonates.

Objectives: To investigate the incidence, parental reasons, and predictors of emergency room (ER) revisits following discharge against medical advice (DAMA) in a pediatric center in Saudi Arabia.

Methods: This retrospective cohort study was conducted between January 2020 and December 2024 at a tertiary care hospital. Pediatric patients aged 0-14 years who signed the DAMA during ER visits were included. Medical records of patients with DAMA were reviewed to collect demographic data, diagnoses, reasons for DAMA, and outcomes.

Results: Among 446,251 ER visits, 2,336 (0.52%, 95% CI: 0.50%-0.55%) involved caregiver-signed DAMA. These rates ranged from 0.45% (2020) to 0.69% (2023). The majority were Saudi (98.8%), male (55.3%), and under the age of 2 (43.5%). Most patients were triaged three/urgent (63.9%), with infections being the most frequent presenting complaint (52.8%). The documented reasons for DAMA included long waiting times (41.6%) and issues with caregiver availability (18.9%). Within 30 days, 567 patients (24.3%, 95% CI: 22.3%-26.3%) revisited the ER; of these, 33.9% required hospitalization. DAMA was associated with higher revisit risk in children <2 years (OR=1.23, 95% CI: 1.01-1.50) and those presenting with infectious symptoms (OR=1.43, 95% CI: 1.17-1.75).

Conclusion: DAMA is a significant challenge in pediatric emergency care. Targeted interventions are crucial for reducing DAMA rates, particularly among high-risk infants and children with infections. Hospitals can improve outcomes by enhancing efficiency, caregiver education, and policies to prevent premature discharge.