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Background: Polypharmacy, or the routine use of five or more medications, can result in impacting patients' quality of life.

Objective: to examine the association between multi-morbidities and polypharmacy, and to examine prescription practices in the elderly.

Methods: This is a retrospective cross-sectional study. Data were gathered from electronic medical records (EMR) at King Fahad University Hospital (KFHU) and the Family & Community Medicine Center (FCMC) of Imam Abdulrahman bin Faisal University (IAU), between January 1, 2019, and December 31, 2020. We included individuals aged 60 and above with at least one dispensed prescription in 2019 and 2020. Of the 76,216 patient records reviewed, 5,060 met the inclusion criteria. Polypharmacy was defined as a monthly average of five or more prescribed medications. The prevalence of polypharmacy was calculated by year, sex, and age group, and findings were summarized using mean medication numbers and standard deviations for each stratum. An app using R programming language was developed to help visualize patients' medication histories through interactive plots.

Results: Polypharmacy prevalence was 46% in 2019 and 44.6% in 2020. The mean and standard deviation of medications per person was 5.17 (3.42) in 2019 and 5.04 (3.37) in 2020. Females had a higher average number of medications than males, 5.17 (3.47) vs 5.04 (3.32). The age group of 80-85 had the highest number of medications at 5.6 (3.6), while those aged 90 and above had the lowest number at 4.48 (2.64). The presence of comorbidities was positively associated with the mean monthly medication count (P value < 0.01).

Conclusion: Our study revealed a high prevalence of polypharmacy among elderly patients at KFHU/FCMC, and a positive association with multi-morbidities. Consequently, measures must be taken to mitigate this globally emerging issue's impact and rapid progression.

Background: As broad-spectrum antibiotics can cause antimicrobial resistance in sepsis, there is the need for a complementary therapy to combat sepsis. Oxidative stress causes an increased severity and mortality in sepsis, whereas herbal medicines have been considered as an option due to its antioxidant potential. Coleus amboinicus Lour. has been documented for its therapeutic value due to the presence of flavonoid, an antioxidant compound.

Objective: To study the effect of Coleus amboinicus Lour. leaf extract on total antioxidant capacity (TAC) and hepatic catalase (CAT) levels in septic rat model.

Methods: Twenty-eight male Rattus norvegicus rats were divided into four groups: control (rats without sepsis induction and treatment), group 1 (septic rats treated with antibiotics), group 2 (septic rats treated with antibiotics and 250 mg/kg body weight of Coleus amboinicus Lour. leaf extract), and group 3 (septic rats treated with antibiotics and 500 mg/kg body weight of Coleus amboinicus Lour. leaf extract). The rats were sacrificed at the end of the eighth day of observation, and blood and liver tissues were gathered for examination.

Results: Compared to the septic rat groups treated with only antibiotics, there was an increase in the TAC levels and CAT expression levels in septic rat groups given antibiotics and Coleus amboinicus Lour. leaf extract. However, the increase was not significant.

Conclusion: Administering Coleus amboinicus Lour. leaf extract increases TAC levels and CAT expression levels in sepsis, decreasing oxidative stress. This will exert protective effects in the cells and therefore alleviate sepsis.

Background: Epilepsy, characterized by recurrent unprovoked seizures, poses a significant global burden on individuals and healthcare systems. Accurate identification of underlying causes is vital for optimal intervention. However, studies reveal a lack of standardized approaches, potentially resulting in unnecessary investigations.

Objective: We aimed to highlight the importance of avoiding unnecessary testing to minimize healthcare costs and resource waste.

Methods: In the Emergency Department of King Fahd Hospital of the University (KFUH) in Alkhobar, a retrospective cross-sectional study encompassed 190 patients presenting with seizures from January 1, 2020, to December 31, 2022. The study aimed to elucidate the epidemiological profile and distinguish clinical and demographic factors between new onset seizures and known cases.

Results: The study included 190 epilepsy cases, with 51.1% known and 48.9% new onset. Generalized tonic-clonic seizures were prominent (43.2%), and non-compliance (24.2%) was a leading cause. New onset seizures were associated with abnormal CT findings (p=0.025), drug use (74.2%), and intoxication (6.5%). Demographically, Saudis showed higher new onset prevalence (82.8%, p=0.001).

Conclusion: The average length of stay was 5.93 hours, and the distribution of new vs. known cases was nearly equal among the 190 patients. Laboratory findings showed no significant associations with either group, mostly falling within the normal range. To optimize care further, we recommend continued refinement of protocols, emphasis on medication compliance.

Background: Thrombomodulin (TM) is a type-1 trans-membrane glycoprotein on endothelial cells which is known to be involved in various biochemical pathways. TM can be detected in biological fluids such as blood and urine under many forms. Soluble thrombomodulin (sTM), consist of various particles of TM, is the predominant agent which is created by enzymatic or chemical catalysis of the whole protein under divergent conditions. TM plays a vital role in protein C system and is crucial in the pathogenesis of Sepsis.

Objective: To identify the serum level of soluble thrombomodulin (sTM) in groups of patients: sepsis and septic shock including their survival and fatal in-hospital outcome; and validate the death prediction of serum sTM in patients with sepsis.

Methods: This prospective observational study was conducted in 63 patients who were diagnosed with sepsis, septic shock according to Sepsis 3 criteria at the ICU Department of Hue Central Hospital, Vietnam, from 3/2022 to 3/2023.

Results: Twenty participants developed septic shock (31.7%), morality within 28-days was 19 patients (30.2%), 22 patients complicated with acute kidney injury that necessitated renal replacement therapy (34.9%), 30 patients required mechanical ventilation (47.6%), the median length of ICU stay was 8 (3-28) days. Serum level of lactate and creatinine were significantly higher in septic shock group compared with sepsis and survival group (p<0.05). The median sTM level in septic shock group and fatal group were 4.68(3.38-6.46) ng/mL and 4.68 (1.69-6.46) ng/mL, respectively. These results were significantly higher than sepsis group [3.62 (1.51-1.94) ng/mL] and survival group [3.73 (1.51-5.9) ng/mL] (p<0.05). The death predictive power of DIC score, APACHE II score, creatinine, sTM and SOFA presented with AUC values of 0.723, 0.726, 0.777, 0.803 and 0.807, respectively. There were no significant difference of serum level IL-6 and PCT between survival and fatal group. The median DIC score in fatal group was 7 (3-7), which was significantly higher than survival group 4 (2-7) (p= 0.001).

Conclusion: Sepsis is a common diagnosis among ICU settings which links the critically ill patients to higher complications and mortalities. Serum level of sTM in septic shock and fatal groups were significantly higher than sepsis and survival groups. sTM is a reliable marker and should be used in predict severity and mortality in sepsis patients.

Background: The concept of do-not-resuscitate (DNR) orders began when medical and surgical interventions increased the possibility of resuscitation in dying patients. Healthcare providers should start to care more about the quality of life rather than quantity. The acceptance of signing DNR orders varies among physicians owing to different reasons and conceptions.

Objective: The aim of this national survey was to evaluate the extent of physicians' knowledge and attitude towards do-not-resuscitate (DNR) orders in different hospitals and specialties in Saudi Arabia.

Methods: A cross-sectional study was conducted in Saudi Arabia and other Arab Gulf countries between March 2019 and May 2021.

Results: A total of 409 physicians completed the questionnaire (53.3% male, 47% of the participants were less than 30 years of age). Most participants had their residency medical training in Saudi Arabia (73.6%, n=281); 33.5% were emergency medicine (EM) physicians. Among 409 patients, 92.7% (n=379 ) were familiar with the DNR (do-not-resuscitate) ter. Half of the participants had never discussed a DNR status with the patient or family (n=215, 52.6%), however, only 38.4% had read the policy. A total of 275 (67.2%) participants were aware that their institute had a DNR policy, and a lack of patient/family understanding was the most common barrier for the majority to initiate DNR orders (53.9%, n=222). Most of the participants (65.8%, n=269) acknowledged a lack of training and understanding of the concepts of DNR orders.

Conclusion: Most physicians who participated in this study were aware of the DNR order concept; however, half of them had never discussed or signed a DNR order. Patients and their families' misunderstandings were considered the main barriers. In addition, the lack of training in the concepts of DNR orders was considered a major obstacle.

Background: Proteinuria is a significant clinical manifestation that causes edema in several diseases, including Nephrotic Syndrome (NS). Untreated proteinuria is strongly linked to the progression of kidney failure. One of the adjuvant therapies could be used to reduce proteinuria such as Angiotensin Receptor Blocker (ARB) including Losartan®. Gambier is a traditional medicinal plant widely known for its antioxidant effects. Catechin, a compound contained in Gambier Extract (GE), has been used to reduce microalbuminuria in diabetics. However, its application in NS has not been widely studied.

Objective: This study compared the effects of GE and ARB in reducing proteinuria and increasing antioxidant activity levels, as well as reported histopathological findings in the nephrotic Wistar rat model.

Methods: An experimental design study with a control group and a posttest was conducted. The experimental animals were divided into four groups: the control group (K1), the group with puromycin aminonucleoside (PAN) injection (K2), the group with PAN injection + GE (K3), and the group with PAN injection + Losartan® (K4). The standard GE used was Sarie Uncariae® by Toyo Brothers, PT while the ARB (Losartan®) was obtained from Novell, PT. Protein urine, the activity level of total superoxide dismutase (T-SOD), and malondialdehyde (MDA) were assessed using the colorimetric method. Renal histopathology was assessed based on Rollerman's criteria.

Results: Gambier extract significantly reduced proteinuria, as depicted by a decrease in protein/volume urine (p = 0.009), increased antioxidant activity, as illustrated by an elevation in T-SOD activity levels (p = 0.007), and tended to decrease MDA levels compared to Losartan®. Based on histopathological findings, GE tended to reduce the percentage of kidney damage in rats induced by puromycin.

Conclusion: Gambier extract has been shown a higher antioxidant effect by increasing T-SOD activity levels, reducing proteinuria and also exhibiting a tendency to diminish kidney damage.

Background: Posterior traumatic urethral strictures due to PFUI have a wide variety of complication, such as erectile dysfunction, incontinence, bulbar urethral necrosis, and fistula. Bulbar urethral necrosis caused by inadequate blood supply for bulbar urethra, fistula developed by many surgical attempts done by inexperience surgeon worsen the patient's condition, low vascular capability manifested as erectile dysfunction as well, and long term catheterization causes contracted bladder. This condition deteriorates the function and quality of life. Therefore this is very challenging condition to treat.

Case presentation: Thirty-years-old man presented with the chief complaint of urine leakage from rectum and cutaneous fistula since 9 years ago. Patient also come with complex PFUI, iatrogenic bulbar urethral necrosis, erectile dysfunction with EHS score of 1, contracted bladder, and prostatorectal fistula. Patient underwent eight various surgical procedures including open surgery and internal urethrotomy previously. We performed cystoprostatectomy and fistula repair transabdominally. Continent cutaneous stoma ileal neobladder with Mansoura approach was performed afterwards. Patient was counselled and educated on how to do clean intermittent self-catheterization, patient was fully satisfied with his bladder function which increase quality of life.

Conclusion: In this case of BUN with contracted bladder and prostatorectal fistula, continent cutaneous stoma is an option to improve patient's quality of life. PFUI could be treated with high success rate if treated properly from the beginning, more intervention by inexperience surgeon could deteriorate success rate and also quality of life.

Background: Fast and accurate COVID-19 identification is important to population and epidemic monitoring in hospitals. Visual triage or respiratory triage should be efficient and utilized as visual clues to alert HCWs on the case definitions.

Objective: This study aims to evaluate the diagnostic value of the respiratory triage for COVID-19 infections and to evaluate the efficacy of the MOH triage tool in identifying low risk patients.

Methods: A single-center retrospective chart review that was conducted at King Fahd Hospital of the University (KFHU), Khober, KSA on all adult patients admitted to the hospital through the ED. The visual triage checklist comprises two main sections, with one focused on the risk of exposure and the other related to patient clinical signs and symptoms, each with a defined score where any score ≥ 4 will need to isolate and assessed by the physician while a score of less than 4 means that the patient can be admitted with other patients. The hospital swabbed all admitted patients regardless of their score. We compared their PCR result with their case definition score. The collected data was entered and analyzed using the Statistical Package for the Social Science (SPSS Inc. Chicago, IL, USA) version 23.

Results: The study included 7258 participants. 20% of participants aged between 21 to 30 years old, 52.2% of sample were females, and 78% were Saudi nationality. Visual triage score was less than 4 in n= 4745 participants (65.4%) and 4 or more in n= 2513 (34.6%). The test had sensitivity of 75% and specificity 21%.

Conclusion: Most studies shows that COVID 19 has an infectivity rate of 18 to 30%. Based on this low sensitivity result, using the screening tool alone puts patients and HCWs at risk of getting infected with COVID 19.

Background: Multisystem Inflammatory Syndrome of children (MIS) is a pathological condition that occurs in response to a SARS-CoV-2 infection, the syndrome has been described as a "Kawasaki disease"-like illness and the spectrum of associated abnormalities, including vascular complications, remain to be fully defined.

Objective: The aim of this article was to present a case of MISC presented with limping and associated with large vessel vasculitis.

Case presentation: In this article we present a case of 10-year-old male presented to emergency department complaining of limping of one-week duration and left hip pain, associated with high grade prolonged fever, abdominal pain and weight loss. The patient was ill looking, couldn't bear weight and was admitted to pediatric intensive care unit. Laboratory workup have rule out infectious and malignant causes as well as known rheumatological causes. Inflammatory markers were elevated. Ultrasound, Doppler ultrasound, CT scan of the affected hip showed evidence of vasculitis extending from the left femoral artery reaching the left common iliac artery with intramural thrombus. According to WHO criteria the patient diagnoses was MIS-C. treatment was started immediately with IVIG and steroids in addition to anticoagulants, dramatic improvement was noticed within 24 hours. Patient was discharged after 10 days of hospitalization.

Conclusion: MIS-C is a new emerging medical diagnosis after the pandemic of COVID-19. it is described a Kawasaki-like syndrome that affect small to medium vessels. This case reports a large vessel vasculitis associated with MIS-C, it helps the understand the extend of this new syndrome and the variety of complaints that may result from large vessels involvement.

Background: Fluid collection in a femoral hernia sac designated as a femorocele is an extremely uncommon surgical condition. Till date 9 cases of unilateral femorocele and one case of bilateral femorocele have been reported in English literature.

Objective: Thus making the case presented the second case of bilateral femorocele in English literature.

Case report: A case of bilateral femorocele in a patient suffering from rheumatic heat disease who had undergone dual valvular replacement with ascites due to cardiac cirrhosis is presented to highlight the surgical challenges in management of such a rare case.

Discussion: Pathophysiology, clinical features, investigations and managemeny of femorocele are discussed.

Conclusion: Contrast enhanced CT scan of the abdomen and scrotum is diagnostic. Open surgery in the form of dissection of sac with high ligation followed by obliteration of femoral ring is therapeutic. There is no scope of laparoscopy in such a case.