Saudi Med J
· 2026 Jan · PMID 41628962
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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 med...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 ( = 0.976). MEs reporting remained stable in hospitals between years, while a few showed an upward trend ( < 10). 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 ( < 10) 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.
Alsharef MK, Almutairi M, Ababtain N
… +4 more, Alajmi M, Alrajhi A, Alhusain F, Al Deeb M
Saudi Med J
· 2026 Jan · PMID 41628961
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OBJECTIVE: To investigate the demographic and clinical profiles of patients presenting with amphetamine-related emergencies at a tertiary hospital in Riyadh, Saudi Arabia. Amphetamine use is an escalating public health i...OBJECTIVE: To investigate the demographic and clinical profiles of patients presenting with amphetamine-related emergencies at a tertiary hospital in Riyadh, Saudi Arabia. Amphetamine use is an escalating public health issue linked to a rise in emergency department (ED) visits. METHODS: This retrospective study encompasses 14 years and focuses on individuals diagnosed with amphetamine-related toxicity. RESULTS: Among the 659 cases studied, a predominant 96% were male, with over half (52%) aged between 19 and 30 years. Most patients (91%) were Saudi nationals. The leading cause of presentation was trauma, accounting for 24% of cases. This was followed by altered mental status (14%), seizures (10%), and acute intoxication (6%). Cardiovascular issues, such as chest pain, were noted in 6% of cases. ED stays varied in duration: 35% of patients remained in the ED for 4 to 8 h, while 28% stayed for more than 12 h. Weekend presentations made up 40% of the total cases, with a notably higher proportion of male patients presenting on weekends (99%) than on weekdays (95%). No significant differences were detected between visits during salary weeks compared to non-salary weeks. CONCLUSION: Amphetamine-related ED visits primarily involve young adult males, with trauma as the most common presenting complaint. The incidence of these visits did not differ significantly between salary and non-salary periods.
Binkhamis KM, Alhezam IA, Alabdullatif HA
… +6 more, Alabdullah OM, Alkadhi OY, Alrefaei NM, Almayah AS, Juma FA, Alangari SS
Saudi Med J
· 2026 Jan · PMID 41628960
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OBJECTIVES: Infections by invasive methicillin-resistant (MRSA) are associated with higher morbidity and mortality compared to methicillin-susceptible (MSSA) infections, and have increased significantly in both healthy...OBJECTIVES: Infections by invasive methicillin-resistant (MRSA) are associated with higher morbidity and mortality compared to methicillin-susceptible (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 ) 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 infections. RESULTS: We identified 85 patients with invasive 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; = 0.075) suggesting a trend toward higher mortality among MRSA patients. Of those infected with , 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.
Alshehri AI, Karkaman MJ, Alsoiry NA
… +1 more, Alqarni NA
Saudi Med J
· 2026 Jan · PMID 41628959
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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 eff...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 ( = 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; <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.
Saudi Med J
· 2025 Dec · PMID 41402092
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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 compl...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.
Saudi Med J
· 2025 Dec · PMID 41402091
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OBJECTIVES: To characterize the clinical and genetic spectrum of genodermatoses in Southwestern Saudi Arabia, the present study examines the impact of consanguinity on this particular population, and proposes a tailored...OBJECTIVES: To characterize the clinical and genetic spectrum of genodermatoses in Southwestern Saudi Arabia, the present study examines the impact of consanguinity on this particular population, and proposes a tailored premarital genetic screening protocol. METHODS: A retrospective cross-sectional study of 32 patients diagnosed with genodermatoses during the study period at a tertiary hospital (King Khalid Hospital, Najran) were included. Genetic screening was performed for patients with suspected genodermatoses based on clinical findings, using whole-exome sequencing (WES), specifically employing next-generation sequencing (NGS) technology. Clinical and genetic analysis data were extracted from medical records. RESULTS: Among 32 patients diagnosed with genodermatoses, the majority were aged 1-10 years (50%), male (56.3%), and Saudi nationals (87.5%). Autosomal dominant inheritance was most prevalent (56.3%), followed by autosomal recessive and X-linked patterns (each 15.6%). Consanguinity was observed in 71.9% of cases, predominantly first-degree (53.1%). Twenty distinct genodermatoses were identified, with Ichthyosis Vulgaris being the most frequent (15.6%). Consanguinity showed a strong association with genodermatosis subtype (adjusted =0.002176; Cramér's V=0.942), while inheritance patterns were significantly linked to genodermatosis subtype (adjusted =0.0000053512; Cramér's V=1.000), but not to age, sex, or nationality. Most patients (90.6%) survived with complications. CONCLUSION: Consanguinity contributes to a higher burden of autosomal dominant genodermatoses in Southwestern Saudi Arabia. Implementation of a premarital targeted genetic screening, integrated with culturally sensitive counseling and feasibility considerations, may reduce disease incidence and associated healthcare costs.
Megahed HA, Al Yousef ZM, Al Jabbary AS
… +11 more, El Wakel MF, Elmoursi LZ, Al Majhad AFM, Al-Etebi RA, Al Moallem HA, Al-Enazi NM, Al Haddad KF, Lashin AM, Al Ali MY, Marie S, Taki-Eldin A
Saudi Med J
· 2025 Dec · PMID 41402090
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OBJECTIVES: To confirm a preoperative scoring system devised by the Modified Randhawa Model. METHODS: This retrospective study was performed in the period between October 2017 to October 2023 on every patients hospitaliz...OBJECTIVES: To confirm a preoperative scoring system devised by the Modified Randhawa Model. METHODS: This retrospective study was performed in the period between October 2017 to October 2023 on every patients hospitalized for elective laparoscopic cholecystectomy in the Surgery Department, National Guard Hospital in Riyadh, Saudi Arabia. A preoperative scoring system, devised using the Modified Randhawa Model, was applied to each patient retrospectively. The preoperative score was compared to the intraoperative degree of difficulty. RESULTS: The history of previous biliary inflammation, the impacted stone, the palpable gall bladder, the more gall bladder wall thickness, the higher body mass index and older ages were significantly associated with more difficult surgeries and more operative time. The preoperative scoring system devised by the Modified Randhawa Model is valid. CONCLUSION: The study found that the Modified Randhawa Model scoring system is valid, effective and reliable predictor of LC difficulty in Saudi Arabia.
Saudi Med J
· 2025 Dec · PMID 41402089
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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 acro...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 (=0.0115), and Saudis exceeded non-Saudis by 90 per 100,000 (=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.
Alhomod AS, Abdulaziz Almowanes D, Scooter Plowman R
… +7 more, Quddus A, Mohamed H, Karakaya M, Elgebaly A, Alrahimi J, Alkutshan R, Tash A
Saudi Med J
· 2025 Dec · PMID 41402088
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OBJECTIVES: To validate the diagnostic performance of the iSelfie Heart Health tool compared to standard-of-care devices, focusing on accuracy, reliability, and classification capabilities. METHODS: Vital sign measuremen...OBJECTIVES: To validate the diagnostic performance of the iSelfie Heart Health tool compared to standard-of-care devices, focusing on accuracy, reliability, and classification capabilities. METHODS: Vital sign measurements from 579 participants were analyzed using the iSelfie tool in calibrated and non-calibrated modes. Further analyses applied the Association for the Advancement of Medical Instrumentation (AAMI) standards and criteria for cuff-based blood pressure (BP) devices. Primary endpoints included mean absolute error (MAE) and cumulative error percentages for all vital parameters. Binary and multi-class classification analyses evaluated the device's performance to categorize hypertension grades. RESULTS: In calibrated mode, the iSelfie tool demonstrated high accuracy, with MAE of 4.42 beats per minute (BPM) for heart rate (HR), 8.94 mmHg for systolic BP (SBP), 7.50 mmHg for diastolic BP (DBP), and 1.16% for oxygen saturation (SaO2). When applying AAMI criteria, MAE was reduced to 4.35 BPM for HR, 5.29 mmHg for SBP, and 3.60 mmHg for DBP. Binary classification analysis to distinguish normotensive from hypertensive states yielded 84.4% sensitivity and 84.7% specificity in calibrated mode after applying AAMI criteria. Multi-class classification accuracy was highest for normotensive cases (Grade 0), with limited representation for higher grades. CONCLUSION: The iSelfie Heart Health tool demonstrated strong performance in measuring HR and SaO2, with improved BP accuracy following calibration and application of AAMI criteria, highlighting its clinical potential as a contactless, user-friendly tool for cardiovascular health monitoring and screening.
Yousef MF, Asiri AA, Bin Dehaish SM
… +6 more, Marzuq AM, Almalki AA, Garrada MN, Khoja MA, Busaad IA, Mahrous MM
Saudi Med J
· 2025 Dec · PMID 41402087
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OBJECTIVES: To evaluate the simplified version of the Arabic matrix test in individuals with normal hearing to derive reference ranges for future measurements with the test material. METHODS: The test was conducted in 80...OBJECTIVES: To evaluate the simplified version of the Arabic matrix test in individuals with normal hearing to derive reference ranges for future measurements with the test material. METHODS: The test was conducted in 80 native Arabic individuals (20 adults and 60 children across different age groups between 5-10 years) from November 2020 to Mar 2023. Evaluation measurements were conducted in adults and children to derive the reference psychometric functions and assess the training effect. The test list equivalence was verified only in the adults group. RESULTS: The reference ranges for speech-intelligibility in noise for 80% thresholds or speech-recognition threshold (SRT80) were as follows: -0.8 ± 2.4 dB signal-to-noise ratio (SNR) (Group 1; 5-6 years), -2.4 ± 2.5 dB SNR (Group 2; 7-8 years) and -2.9 ± 2.3 dB SNR (Group 3; 9-10 years). CONCLUSION: The study demonstrated an influence of age on the measured word recognition performance in children, highlighting the test's suitability for this population. The reliability of the test was 1.1 dB for 80% threshold and 1.4 dB for 50% threshold. With promising results, this test can be used as a new tool in speech audiometry in audiological diagnostics and management with special focus on modern standard Arabic for children.
Al-Jedai AH, Almudaiheem HY, Alaama TY
… +7 more, Alsaman ASS, Abdo Bashiri F, Almuhaizae MA, Alghamdi FA, Alsakran AA, Matter EAY, Ibrahim FZ
Saudi Med J
· 2025 Dec · PMID 41402085
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OBJECTIVES: To assess the clinical and functional outcomes of 110 patients with spinal muscular atrophy (SMA) program who received nusinersen treatment in the Kingdom of Saudi Arabia (KSA). METHODS: Motor assessments wer...OBJECTIVES: To assess the clinical and functional outcomes of 110 patients with spinal muscular atrophy (SMA) program who received nusinersen treatment in the Kingdom of Saudi Arabia (KSA). METHODS: Motor assessments were performed using the Children's Hospital of Philadelphia infant test of neuromuscular disorder (CHOP-INTEND) and Hammersmith infant neurological examination (HINE) for type 1 SMA, the Hammersmith Functional Motor Scale-Expanded (HFMSE) for types 2 and 3 SMA; the 6-minute walk test (6MWT) for ambulant type 3 SMA, and the revised upper limb module (RULM) for types 2 and 3 SMA. RESULTS: Data included all SMA types (type 1, 2.72%; type 2, 27.27%; type 3, 69.09%). The median (IQR) ages at diagnosis, therapy initiation, and symptoms onset were 9.07 (3.67-17.28), 12.04 (5.39-20.29), and 2.25 (0.75-4.00) years, respectively. The median (IQR) HFMSE score was 34 (12.00-46.00) at baseline (n=58 patients) and 29.00 (14.50-50.50) at month 20 (n=33 patients). Clinically meaningful improvement was observed in 23 patients, including 12 with an improvement >4 points. CONCLUSION: The study demonstrates that baseline and follow-up data from multiple motor and functional assessment scales were essential for evaluating disease progression and treatment response in SMA.
Yilmazturk Y, Sadik Girisgin A, Alpaslan M
… +1 more, Baykan N
Saudi Med J
· 2025 Dec · PMID 41402084
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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 fo...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 (<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.
Alswayed AK, Ali K, Alharbi AO
… +2 more, Alnami GK, BinDokhi HM
Saudi Med J
· 2025 Dec · PMID 41402082
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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...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 (=0.005*), incomplete antenatal corticosteroid therapy (=0.032*), maternal GBS colonization, and gestational diabetes (=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.
Marglani OA, Razzak Juratli A, Maatouq Alwael A
… +4 more, Hussain Alokby G, Al Rayyes HYA, Alsharif SAA, Abo El Ezz TA
Saudi Med J
· 2025 Dec · PMID 41402081
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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 recom...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.
Saudi Med J
· 2025 Dec · PMID 41402080
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This review evaluates CT radiation dose levels in Saudi Arabia relative to national Diagnostic Reference Levels (DRLs) established by the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). A total of 31 studies p...This review evaluates CT radiation dose levels in Saudi Arabia relative to national Diagnostic Reference Levels (DRLs) established by the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). A total of 31 studies published between 2015 and 2025 were reviewed, covering adult and pediatric CT protocols for head, chest, abdomen, pelvis, and multiphase scans. The review highlights variations in the volumetric computed tomographic dose index (CTDIvol), and the dose-length product (DLP) values among different institutions in KSA. For adult protocols, fifteen studies reported dose metric values below the KSA NDRLs, while 8 studies reported values below the UK NDRLs. In contrast, among pediatric studies, approximately 90% of the reported dose metrics were lower than the NDRLs in both KSA and the UK. The results emphasize the importance of implementing standardized protocols to enhance the KSA national DRLs and expand the range of examination protocols, particularly for pediatric patients.
Al Qadrah BH, AlShammari EA, AlJeraibah AM
… +6 more, AlDabas HM, AlQahtani SM, AlGhamdi RS, Alsharif AM, AlYahya YK, AlMojali AI
Saudi Med J
· 2025 Dec · PMID 41402078
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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 retrospect...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.