Saudi Medical Journal[JOURNAL]
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200 papers
Molecular Mechanisms of Diffuse Large B-Cell Lymphoma and the Complexities of Tumor Development.
Alzahrani WI
Saudi Med J · 2026 Jul · PMID 42293725 · Full text
Diffuse large B-cell lymphoma (DLBCL), the most prevalent aggressive non-Hodgkin lymphoma, exhibits substantial molecular heterogeneity and arises from germinal center or post-germinal center B cells through recurrent ge...
Diffuse large B-cell lymphoma (DLBCL), the most prevalent aggressive non-Hodgkin lymphoma, exhibits substantial molecular heterogeneity and arises from germinal center or post-germinal center B cells through recurrent genetic and epigenetic dysregulation of critical signaling pathways. Aberrations involving BCL6, MYC, MYD88, and components of B cell receptor and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling play central roles in lymphomagenesis, treatment resistance, and clinical outcomes. Gene expression profiling has defined major molecular subgroups in DLBCL, including germinal center B cell-like and activated B cell-like tumors, that show distinct pathogenesis and prognosis. High-risk entities, such as double- and triple-hit lymphomas, remain therapeutically challenging despite advances in immunochemotherapy. Recent progress in molecular diagnostics and targeted therapies, including immune checkpoint inhibition, Bruton tyrosine kinase inhibitors, B-cell lymphoma 2 (BCL2) antagonists, and Chimeric antigen receptor-T cells, has expanded precision-based treatment strategies. This review summarizes advances in understanding the molecular mechanisms of DLBCL and emphasizes emerging therapeutic approaches informed by genomic and microenvironmental discoveries.
Polysomnographic and Clinical Characteristics of Narcolepsy in Saudi Arabia: .
Almalki B, Kanbr O, Afeef GB … +4 more , Hawsawi S, Alshumrani R, Alhejaili F, Wali S
Saudi Med J · 2026 Jul · PMID 42293724 · Full text
OBJECTIVE: To evaluate the clinical features, polysomnographic findings, and therapeutic outcomes of narcolepsy type 1 and type 2 patients in Kingdom of Saudi Arabia (KSA). Narcolepsy is a neurological condition marked b...
OBJECTIVE: To evaluate the clinical features, polysomnographic findings, and therapeutic outcomes of narcolepsy type 1 and type 2 patients in Kingdom of Saudi Arabia (KSA). Narcolepsy is a neurological condition marked by excessive daytime sleepiness (EDS) and associated symptoms, including cataplexy and disrupted nighttime sleep. Data on narcolepsy in KSA are still limited. METHODS: Forty-three patients diagnosed with narcolepsy from 2012 to 2024 were included in this retrospective study. Diagnosis followed the International Classification of Sleep Disorders criteria and incorporated clinical features, the epworth sleepiness scale (ESS), overnight polysomnography (PSG), and multiple sleep latency testing (MSLT). Data on demographics, clinical symptoms, PSG parameters, and treatment were analyzed. Posttreatment ESS scores were collected via an electronic survey. RESULTS: All patients reported EDS, and 53.5% had cataplexy. Time of diagnosis mean age was 28.9 ± 14.4 years, with a diagnostic delay of 5.3 ± 3.0 years. Patients with narcolepsy type (NT)1 had significantly higher baseline ESS scores (19.6 versus (vs.) 16.9, = 0.031) and shorter mean sleep latency (2.1 vs. 4.3 minutes, = 0.008). Treatment, predominantly with modafinil (69%), significantly reduced ESS scores from 18.4 ± 4.2 to 9.2 ± 2.4 ( < 0.001). CONCLUSION: Compared with NT2, NT1 is slightly more common and is characterized by more severe sleepiness and shorter sleep latency time. The diagnostic delay remains substantial, but treatment is effective in reducing EDS.
Etiology, Management, and Outcomes of Hospitalized Heart Failure Patients: .
Jumani AI, Rashwan GA, Ibrahim HO … +2 more , Almohdar SM, Alfakih KM
Saudi Med J · 2026 Jul · PMID 42293723 · Full text
OBJECTIVES: To describe the clinical characteristics, etiologies, management patterns, and outcomes of hospitalized heart failure patients in a tertiary care military hospital in United Arab Emirates (UAE), and to benchm...
OBJECTIVES: To describe the clinical characteristics, etiologies, management patterns, and outcomes of hospitalized heart failure patients in a tertiary care military hospital in United Arab Emirates (UAE), and to benchmark guideline directed medical therapy (GDMT) uptake and care models against regional and international registries. METHODS: We retrospectively reviewed all consecutive patients admitted with a primary diagnosis of heart failure between January and December 2024, at Zayed Military Hospital, UAE. Clinical data were extracted from electronic medical records. The GDMT adherence was assessed according to the 2022 American Heart Association (AHA)/ American College of Cardiology (ACC) and 2023 European Society of Cardiology (ESC) heart failure guidelines, and outcomes were compared between cardiology-led and non-cardiology services. RESULTS: Among 152 patients (69% male; mean age 68.5 years), 57% had heart failure with reduced ejection fraction (HFrEF), 24% mildly reduced, and 19% preserved ejection fraction. Ischemic heart disease was the most common etiology (58.6%). Compared with published Gulf registries, GDMT uptake in HFrEF was high: angiotensin converting enzyme inhibitors (ACEi)/ angiotensin receptor blocker (ARB)/ angiotensin receptor-neprilysin inhibitors (ARNI) (82.8%), beta-blockers (94.3%), and sodium-glucose co-transporter 2 (SGLT2) inhibitors (74.7%). In contrast, mineralocorticoid receptor antagonists were markedly underused (21.8%). HFpEF patients had the highest 180-day readmission rate (41.4%). Cardiology-led care was associated with higher GDMT uptake, shorter length of stay, and improved follow-up and readmission outcomes. CONCLUSION: This cohort demonstrates improved adoption of evidence-based heart failure therapies compared with regional data, but highlights a persistent mineralocorticoid receptor antagonists (MRA) treatment gap. Cardiology-led inpatient management is associated with superior GDMT implementation and clinical outcomes, underscoring the importance of specialist-driven care pathways.
Effect of Anesthetic Agents on Middle Ear Pressure: Systematic Review and Meta-Analysis.
Almujaiwel N, Alkublan R, Almakoshi L
Saudi Med J · 2026 Jul · PMID 42293722 · Full text
OBJECTIVE: To assess and compare the effects of these agents on middle ear pressure (MEP). Anesthetic agents can significantly alter MEP, which is a critical factor in middle ear surgeries that require stability to preve...
OBJECTIVE: To assess and compare the effects of these agents on middle ear pressure (MEP). Anesthetic agents can significantly alter MEP, which is a critical factor in middle ear surgeries that require stability to prevent complications. Different anesthetics, including inhalational and intravenous agents, have varying effects on MEP. METHODS: A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Scopus, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Studies that evaluated MEP changes before and after anesthesia using tympanometry were included. Relevant data, such as anesthetic type, patient demographics, MEP measurements, and reported complications, were extracted. A meta-analysis using a random-effects model was conducted to account for variability across studies. RESULTS: Twelve studies, including 980 patients aged 2-76 years, were analyzed. Desflurane caused the most significant increase in the MEP. Isoflurane showed minimal changes in MEP, making it a safer option for middle-ear surgery. Total intravenous anesthesia (TIVA) with propofol maintained stable MEP, highlighting its suitability for these procedures. Nitrous oxide decreased MEP postoperatively but posed risks during the early phases of administration, especially in patients with eustachian tube dysfunctions. Dexmedetomidine significantly elevated MEP, while halothane, alone or combined with nitrous oxide, had negligible effects on MEP. CONCLUSION: The findings of this study reveal that isoflurane and TIVA with propofol are suitable anesthetic options for middle ear surgery due to their minimal impact on MEPs. In contrast, desflurane and sevoflurane should be used cautiously because they can significantly elevate MEP.
Evaluation of Raqeem Health Information System in Primary Healthcare Centers in Makkah, Saudi Arabia, Using the DeLone and McLean Information System Success Model.
Alzahrani AM, Felix HC
Saudi Med J · 2026 Jul · PMID 42293721 · Full text
OBJECTIVES: To evaluate the implementation of Raqeem, a new Electronic Health Information Systems (EHIS) implemented at primary healthcare centers (PHCs) in Makkah. Implementing EHIS requires huge investments, making eva...
OBJECTIVES: To evaluate the implementation of Raqeem, a new Electronic Health Information Systems (EHIS) implemented at primary healthcare centers (PHCs) in Makkah. Implementing EHIS requires huge investments, making evaluation of systems success important. METHODS: In this cross-sectional survey design study, a developed questionnaire guided by DeLone and McLean Information System success model (D&M model) was used to collect data from PHCs' providers. Descriptive and structural equation modeling (SEM) techniques were performed to describe and examine the association between the model's constructs and assess Raqeem success. RESULTS: A total of 490 providers submitted completed records and were included in this study. The SEM revealed that system quality is significantly and positively associated with use (β = 0.38, p <0.001) and user satisfaction (β = 0.13, p <0.001); information quality is significantly and positively associated with use (β = 0.33, p <0.001) and user satisfaction (β = 0.13, p <0.001); and service quality is significantly and positively associated with use (β=0.23, p <0.001) and user satisfaction (β = 0.08, p = 0.003). Use of the system was significantly and positively associated with user satisfaction (β = 0.40, p <0.001) and perceived net benefits (β = 0.34, p <0.001). Finally, user satisfaction was significantly and positively associated with perceived net benefits (β = 0.73, p <0.001). CONCLUSION: This evaluation showed overall positive views suggesting implementation success. However, lower scores were observed for service quality, suggesting a need to address that component. Our study also found support for the D&M model of EHIS system implementation.
Integrating Traditional and Complementary Medicine into Saudi Primary Care: .
Shahrani AA
Saudi Med J · 2026 Jul · PMID 42293720 · Full text
Complementary and alternative medicine (CAM) is widely practiced in Saudi Arabia, particularly for health promotion and chronic diseases management. Despite cultural acceptance and high utilization, CAM remains largely u...
Complementary and alternative medicine (CAM) is widely practiced in Saudi Arabia, particularly for health promotion and chronic diseases management. Despite cultural acceptance and high utilization, CAM remains largely unintegrated within the formal healthcare system, particularly in primary care settings. The newly adopted World Health Organization (WHO) Traditional, complementary, and integrative medicine (TCIM) Strategy 2025-2034 offers a global framework for evidence-based, culturally appropriate integration of TCIM into national systems. This review evaluates the status of CAM in Saudi Arabia in light of strategic objectives outlined in the WHO Strategy: building the evidence base, ensuring quality and safety, integrating into health systems, and promoting cross-sectoral engagement. While regulatory foundations have been established through the National Center for Complementary and Alternative Medicine (NCCAM), challenges persist in clinical integration, research, and training. Aligning CAM with Saudi Arabia's Vision 2030 health reforms-particularly through primary care-presents a timely opportunity for strategic integration to enhance patients-centered care.
A Predictive Model for Cytomegalovirus Infection Using Routine Hematological and Biochemical Parameters: .
Shaikh AA, Alabdaly MH, Ageeli NA … +3 more , Alasmari SZ, Mansour AMA, Makkawi MH
Saudi Med J · 2026 Jul · PMID 42293719 · Full text
OBJECTIVE: To examine whether hematological and biochemical parameters assist in diagnosing cytomegalovirus (CMV) infections and differentiating between CMV-G and CMV-M. Cytomegalovirus causes distinct hematological chan...
OBJECTIVE: To examine whether hematological and biochemical parameters assist in diagnosing cytomegalovirus (CMV) infections and differentiating between CMV-G and CMV-M. Cytomegalovirus causes distinct hematological changes that can serve as markers for diagnosis. METHODS: A retrospective analysis was conducted on 54 patients infected with CMV (25 CMV-G and 29 CMV-M) and 82 healthy controls. Age, gender, and routine hematological and biochemical parameters were evaluated. Receiver operating characteristics (ROC) analysis and logistic regression were used for data analysis. RESULTS: In comparison to controls, laboratory findings of patients with CMV-G revealed characteristic decreases in red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), and platelets ( < 0.05); those with CMV-M showed reductions in the same parameters alongside elevation of monocytes, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total iron-binding capacity (TIBC) and AST-to-platelet ratio index (APRI) ( < 0.05). The most effective blood markers for differentiating CMV-G patients from controls were RBC, HGB, HCT, mean corpuscular hemoglobin (MCH), platelets, AST, ferritin, APRI and Fibrosis-4 (FIB-4) meanwhile, for CMV-M patients, distinguishing markers were RBC, HGB, HCT, MCH, monocytes, platelets, AST, TIBC, APRI and FIB-4. The best predictors for distinguishing CMV-M from CMV-G were TIBC, AST, HCT, monocytes, HGB, ALT, APRI and FIB-4 all with area under the curve values greater than 0.6 ( < 0.05). CONCLUSION: Hematological and biochemical indicators can successfully distinguish CMV infections, with TIBC, AST, HCT, monocytes, HGB, ALT, APRI and FIB-4 being potentially useful for discriminating CMV-M from CMV-G. These findings could help predict CMV-infected patients.
Identification of Risk Factors for Renal Insufficiency in Primary Membranous Nephropathy.
Qi L, Fang B, Fang X … +2 more , Yu Y, Wang Y
Saudi Med J · 2026 Jul · PMID 42293718 · Full text
OBJECTIVES: To identify possible evidence linking certain characteristics associated with primary membranous nephropathy (PMN) to renal failure progression in patients diagnosed with PMN and to establish probable evidenc...
OBJECTIVES: To identify possible evidence linking certain characteristics associated with primary membranous nephropathy (PMN) to renal failure progression in patients diagnosed with PMN and to establish probable evidence of an association between PMN and other risk factors leading to end-stage renal failure. METHODS: A historical investigation was carried out including 436 subjects with PMN, with or without renal insufficiency, who were treated at the No. 82 Division Defense Medical Center of the People's Liberation Army and Liaocheng People's Medical Center during January 2020 and December 2023. Binary logistic regression study was applied to determine possible hazard elements. Binary logistic regression analysis was employed to identify potential risk factors, while the diagnostic capabilities of statistically significant continuous variables were assessed through detector performance feature receiver operating characteristic (ROC) plots. RESULTS: Dichotomous logit regression study detected age, blood uric acid level, 24-hour urinary protein level, crescent formation, and renal tubular atrophy/interstitial fibrosis as independent risk factors for renal insufficiency, while hemoglobin level was a protective factor. The ROC analysis showed that age, 24-hour urine protein, and uric acid level had areas under the curve of 0.711 ( < 0.05), 0.652 ( < 0.05), and 0.60 ( < 0.05), with optimal threshold values of 52.5 years, 4.815 g/24 hour, and 446.5 μmol/L. CONCLUSION: Advanced age, hyperuricemia, anemia, high proteinuria, crescent formation, and renal tubular atrophy/interstitial fibrosis are significant risk factors for renal insufficiency in PMN patients. These findings may help to facilitate risk categorization and referral patterns.
Safety and Efficacy of Adalimumab Biosimilar in Psoriasis and Hidradenitis Suppurativa: .
Najjar RH, Alrashid SO, Almahfouz RF … +3 more , Alzahrani HT, Aleissa MY, Hakami AR
Saudi Med J · 2026 Jul · PMID 42293717 · Full text
OBJECTIVES: To evaluate the clinical experience, safety, and effectiveness of adalimumab biosimilars in patients with psoriasis and hidradenitis suppurativa. METHODS: We conducted a retrospective, single-center observati...
OBJECTIVES: To evaluate the clinical experience, safety, and effectiveness of adalimumab biosimilars in patients with psoriasis and hidradenitis suppurativa. METHODS: We conducted a retrospective, single-center observational study between March and September 2024 using electronic medical records from King Abdulaziz Medical City and King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Pediatric and adult patients with psoriasis or hidradenitis suppurativa who switched to adalimumab biosimilars between 2016 and 2022 were included. Variables included demographics, disease characteristics, prior therapies, biosimilar use, and adverse events. RESULTS: A total of 57 (93% adults; 50.9% female) patients were included. Obesity was present in 35.1%, and 6 (10.5%) patients had hidradenitis suppurativa. Plaque psoriasis was the most common subtype (72.5%), with psoriatic arthritis in 35.3%. Most patients (89.5%) switched to a biosimilar after treatment with the originator. The median dose and duration were 40 mg and 2-3 years, with high adherence (hidradenitis suppurativa 83.3%; psoriasis 90.2%). All patients with hidradenitis suppurativa improved, whereas 68.6% of patients with psoriasis responded, 19.6% showed no improvement, and 11.8% worsened. Adverse events were infrequent. Patients without obesity and those with prior response to adalimumab were more likely to benefit. CONCLUSION: Adalimumab biosimilars demonstrate favorable efficacy and safety, particularly in prior responders. Patients with hidradenitis suppurativa showed consistent improvement. The low rate of adverse events and absence of new safety signals support safe clinical use. Further multicenter studies are needed to confirm these findings.
Immunoinformatic based Development of a Multi-Epitope Precision Vaccine Targeting Glycoprotein and RdRp of Oropouche Virus: .
Alissa M, Suleman M
Saudi Med J · 2026 Jul · PMID 42293716 · Full text
OBJECTIVES: To design high immunogenic vaccine against the Oropouche virus (OROV). The OROV is a neglected arbovirus endemic to Central and South America, causes oropouche fever, which can progress to severe complication...
OBJECTIVES: To design high immunogenic vaccine against the Oropouche virus (OROV). The OROV is a neglected arbovirus endemic to Central and South America, causes oropouche fever, which can progress to severe complications such as meningitis and hemorrhagic symptoms. METHODS: We utilized immunoinformatic and molecular dynamic simulation approaches to design highly immunogenic vaccines against OROV. This observational study, carried out between January and August 2024 in Saudi Arabia. As it involves an in-silico method, ethical consent was not required. RESULTS: Docking analysis confirmed the stable interaction of the designed vaccines with human toll-like receptors (TLR)-3, producing binding scores of -300.78, -306.19, and -288.60 kcal/mol for the glycoprotein, ribonucleic acid (RNA)-dependent RNA polymerase (RdRp), and combined vaccine, respectively. Furthermore, molecular dynamics simulations supported the stability of the vaccine-TLR-3 complexes. The calculated total binding free energies were -107.44 kcal/mol for glycoprotein-TLR-3, -33.64 kcal/mol for RdRp -TLR-3, and -78.62 kcal/mol for the combined vaccine-TLR-3 interaction. The computed codon adaptation index (CAI) values for the vaccines were notably 0.96, with guanine-cytosine (GC) content ranging between 65% and 66%, suggesting strong potential for high expression in the pET28a+ vector. The analysis of immune simulation showed rapid antigen clearance, accompanied by sustained and elevated immunoglobulin (Ig)M and IgG responses. CONCLUSION: This study presents a potent and secure vaccine candidate to combat the emerging Oropouche virus infection, which requires further experimental validation.
Lived Experiences and Perceptions of People with Knee Osteoarthritis in Saudi Arabia: .
Alanazi SA, Alhabishi AS, Alawafi RO … +1 more , Alamrani SA
Saudi Med J · 2026 Jul · PMID 42293715 · Full text
OBJECTIVES: To explore how people with knee osteoarthritis (OA) in Kingdom of Saudi Arabia (KSA) perceive and live with their condition, how they self-manage symptoms, and how they experience physiotherapy and rehabilita...
OBJECTIVES: To explore how people with knee osteoarthritis (OA) in Kingdom of Saudi Arabia (KSA) perceive and live with their condition, how they self-manage symptoms, and how they experience physiotherapy and rehabilitation services. METHODS: A descriptive qualitative study was conducted using semi-structured interviews. Interviews were undertaken with individuals with knee OA who are aged ≥45 years. Interviews were audio-recorded, transcribed verbatim, de-identified and analyzed using reflexive thematic analysis with investigator triangulation. RESULTS: Twenty-seven (19 females) participants aged 45-74 years (mean = 61) from different regions of KSA shared lived experiences of knee OA. Four themes describing participants' experiences with knee OA were identified from interview data: i) living with the progression of knee OA: from onset to functional limitation and psychological consequences, ii) traditional remedies and medical treatments were used to manage knee OA symptoms, iii) engagement with physiotherapy: referral, adherence, perceived outcomes, and therapeutic relationships with therapist, iv) and accessibility challenges, service limitations, and patient suggestions for improvement. CONCLUSION: Study findings indicate that people with knee OA in KSA live with chronic pain, functional limitations, and fluctuating engagement across traditional, medical, and physiotherapy treatments. Providing culturally sensitive education, more flexible physiotherapy options, and service improvements aligned with patients' suggestions may support better engagement and outcomes.
Comparison of the Effects of Incubator and Radiant Environments on Physiological Criteria and Pain-Stress Levels during Heel Lance in Neonates in the Neonatal Intensive Care Unit: A Randomized Controlled Trial.
Gürsu S, Saydam BK, Kalkanlı O
Saudi Med J · 2026 Jul · PMID 42293714 · Full text
OBJECTIVES: To compare the effects of incubator and radiant heat on physiological criteria and pain-stress levels during heel prick procedures in newborns in the neonatal intensive care unit (NICU). METHODS: This randomi...
OBJECTIVES: To compare the effects of incubator and radiant heat on physiological criteria and pain-stress levels during heel prick procedures in newborns in the neonatal intensive care unit (NICU). METHODS: This randomized controlled quasi-experimental study was conducted between June and December 2023 with newborns diagnosed with IHB hospitalized at a NICU in Turkey. Prior to the heel prick procedure, 72 newborns (gestational age: 37-41 weeks) were randomly and equally assigned to either a radiant heater or an incubator setting. Physiological parameters (temperature, SpO, heart rate [HR]) and pain-stress scores of the newborns were measured and compared in both settings. RESULTS: No statistically significant differences were found in the descriptive characteristics of newborns between the incubator and radiant heater groups. When comparing physiological parameters and pain-stress scores, there were no significant differences in SpO, and HR, or pain-stress levels between the groups; however, body temperature was significantly higher in the radiant heater group. During the heel prick procedure, both groups showed significant changes in body temperature, SpO, HR, and pain-stress scores across the three time points (before, during, and after the procedure). CONCLUSION: Although body temperature increased significantly in the radiant heater environment compared with the incubator environment, this difference did not appear to play a vital role in affecting the physiological parameters of the newborn.
Prevalence of Hyperprolactinemia and Its Association with Menstrual Abnormalities and Hypothyroidism among Infertile Women: .
Alwahhabi AY, Labban RH, Alshaikh MY … +4 more , Alanazi AM, Alfaraj SS, Alsalman FM, Alrabiea HA
Saudi Med J · 2026 Jul · PMID 42293713 · Full text
OBJECTIVES: To determine the prevalence of hyperprolactinemia among infertile women and assess its association with menstrual irregularities and hypothyroidism in a tertiary-care setting in Riyadh, Saudi Arabia. METHODS:...
OBJECTIVES: To determine the prevalence of hyperprolactinemia among infertile women and assess its association with menstrual irregularities and hypothyroidism in a tertiary-care setting in Riyadh, Saudi Arabia. METHODS: A cross-sectional study was conducted between September 2022 and August 2023 at the Reproductive Endocrinology and IVF Unit, King Abdulaziz Medical City, Riyadh. Electronic medical records of 480 infertile women who met the inclusion criteria were reviewed. Data on demographic characteristics, infertility type, thyroid status, and serum prolactin levels were collected and analyzed using SAS version 9.4. Statistical significance was set at < 0.05. RESULTS: Hyperprolactinemia was identified in 27.7% of infertile women, most commonly in the age group 31-40 years ( = 0.006). Hypothyroidism was present in 17.5% of the study population, with hyperprolactinemia observed in 22.6% of these patients ( = 0.33). Although prolactin levels significantly differed between women with regular and irregular cycles ( = 0.03), the frequency of hyperprolactinemia was similar ( = 0.44). Menstrual irregularity was more closely linked with higher BMI and LH levels. CONCLUSION: Hyperprolactinemia is a common finding among infertile women in Saudi Arabia. However, no significant association was observed between hyperprolactinemia and hypothyroidism or menstrual irregularities. Routine screening for serum prolactin levels in infertility evaluations is recommended to ensure timely diagnosis and management.
Prevalence and Risk Factors of Surgical Site Infections in Hospitals Across Al Madinah Al Munawwarah, Saudi Arabia: .
Aljohani AM, Sandaqji DO, Alahmadi RA … +4 more , Ishqi RZ, Alanazi MA, Aloufi SN, Sandugji HI
Saudi Med J · 2026 Jul · PMID 42293712 · Full text
OBJECTIVES: To determine the prevalence of surgical site infection (SSI) and identify associated risk factors in hospitals in Al Madinah Al Munawwarah, Saudi Arabia. METHODS: We conducted a retrospective cohort study of...
OBJECTIVES: To determine the prevalence of surgical site infection (SSI) and identify associated risk factors in hospitals in Al Madinah Al Munawwarah, Saudi Arabia. METHODS: We conducted a retrospective cohort study of 363 adult surgical patients from major hospitals in Madinah between 2023 and 2024. We analyzed medical records using descriptive statistics, bivariate analysis, and multivariable logistic regression. RESULTS: The overall SSI rate was 5.2% (95% confidence interval [CI]: 3.3-7.9%). Infection types comprised superficial incisional (57.9%), deep incisional (36.8%), and organ/space infections (5.3%). Significant risk factors included younger age (adjusted odds ratio [aOR] = 0.94 per year, = 0.014), increased body mass index (BMI) (aOR = 1.10 per unit, = 0.043), orthopedic surgery compared with general surgery (aOR = 47.46, = 0.033), and dirty wounds compared with clean wounds (aOR = 28.07, = 0.005). Despite high rates of prophylactic antibiotic use (82.1% preoperative, 17.4% intra-operative, and 90.9% postoperative), no significant association with SSI risk was observed. CONCLUSION: The SSI rate in Al Madinah Al Munawwarah hospitals is higher than previously reported. Variations across hospitals and surgical specialties highlight the need for targeted infection prevention strategies, particularly for high-risk procedures and in facilities with elevated infection rates.
The Impact of Exercise Intervention on Pulmonary and Physical Function in Patients With Cystic Fibrosis: .
Alghamdi A, Al-Attas M, Radhi A … +8 more , Alfaqih A, Aljabri B, Alharbi R, Alsubaie S, Aljawaied R, Alenazi S, Mazi A, Qulisy E
Saudi Med J · 2026 Jul · PMID 42293711 · Full text
OBJECTIVE: To evaluate the effect of various exercise interventions on lung function, specifically forced expiratory volume in 1 second (FEV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), as...
OBJECTIVE: To evaluate the effect of various exercise interventions on lung function, specifically forced expiratory volume in 1 second (FEV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), as well as on cardiorespiratory fitness (peak oxygen uptake [VOpeak]), and muscle strength (handgrip strength). The review also considers factors such as patient adherence, follow-up duration, and statistical significance to inform clinical practice. METHODS: This systematic review followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines and was prospectively registered in international prospective register of systematic reviews. PubMed, Google Scholar, OVID, and Web of Science were systematically searched. Eligible studies were randomized controlled trials enrolling cystic fibrosis (CF) patients aged 7 or older, reporting outcomes related to pulmonary function, cardiorespiratory fitness, or muscle strength following aerobic, resistance, or mixed exercise interventions. RESULTS: A total of 1,033 articles were identified through the database search. After screening and eligibility assessment, 4 randomized controlled trials involving 156 participants met the inclusion criteria. Both supervised and wearable activity tracker (WAT)-based exercise programs significantly improved VOpeak and exercise capacity, as demonstrated by the 6-minute walk test. Home-based programs enhanced upper limb muscle strength. However, improvements in FEV were inconsistent and tended to decline without ongoing training. No adverse events were reported. CONCLUSION: Structured exercise, particularly WAT based or supervised, supports better physical fitness in CF. Standardized protocols, longer-term follow-up, diverse participant inclusion, and strategies to improve adherence are needed in future research.
Interleukin-6 Inhibition for Patients with Acute Myocardial Infarction: .
Alasmary MY, Almalki MJ, Almalki FH … +6 more , Khubzan WD, Rajab MH, Almalki MS, Almalki HA, Alsuwat OM, Alghannami HM
Saudi Med J · 2026 Jul · PMID 42293710 · Full text
OBJECTIVE: To explore the outcomes associated with interleukin-6 (IL-6) pathway blockade, using tocilizumab, in patients with ST-elevation myocardial infarction (STEMI) and non (NSTEMI). Acute myocardial infarction (AMI)...
OBJECTIVE: To explore the outcomes associated with interleukin-6 (IL-6) pathway blockade, using tocilizumab, in patients with ST-elevation myocardial infarction (STEMI) and non (NSTEMI). Acute myocardial infarction (AMI) denotes myocardial necrosis due to ischemia and presents in distinct electrocardiographic phenotypes. Inflammation driven by IL-6 contributes to ischemia-reperfusion injury, with tocilizumab showing promise in reducing myocardial damage and improving outcomes. METHODS: This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Framework and was registered in international prospective register of systematic reviews (PROSPERO). Relevant studies were identified through structured searches of PubMed, MEDLINE, the Cochrane Library, and Google Scholar up to June 2025, focusing on randomized and prospective investigations of IL-6 inhibition in AMI. Assessed outcomes included infarct size, inflammatory and cardiac biomarkers, major adverse cardiovascular events, and mortality. RESULTS: Three randomized controlled trials including 344 patients were analyzed. All evaluated tocilizumab in STEMI or NSTEMI. Pooled data showed no significant difference between tocilizumab and placebo for recurrent myocardial infarction (relative risk [RR] = 0.47, 95% confidence limit [CI] = 0.07-3.05; I = 44%; = 0.43) or infection (RR = 0.85, 95% CI: 0.29-2.53; I = 0%; = 0.77). Mechanistic analysis demonstrated lower c-reactive protein (CRP) exposure, transient N-terminal pro-B-type natriuretic peptide (NT-proßNP) reductions, and attenuated troponin release in tocilizumab groups, indicating biological modulation of inflammatory and myocardial injury pathways during the acute phase. Benefits were greatest during hospitalization but diminished over time. Long-term outcomes, including ventricular remodeling, NT-proßNP at 6 months, and mortality, showed no significant group differences. CONCLUSION: The IL-6 inhibition with tocilizumab demonstrates early anti-inflammatory and cardioprotective effects in AMI, but consistent clinical benefits remain unproven, underscoring the need for larger, long-term trials to confirm efficacy and safety.
Biomarkers of Multiorgan Failure in COVID-19: A Predictive Framework for Disease Severity and Clinical Outcomes.
Nasif WA, Mukhtar MH, Althubiti M … +1 more , Ali ASEM
Saudi Med J · 2026 Feb · PMID 42239925 · Full text
OBJECTIVE: To investigate the predictive value of inflammatory, liver, renal, and cardiac biomarkers in relation to the progression of multiorgan failure (MOF) in COVID-19 patients. A primary goal was to identify which o...
OBJECTIVE: To investigate the predictive value of inflammatory, liver, renal, and cardiac biomarkers in relation to the progression of multiorgan failure (MOF) in COVID-19 patients. A primary goal was to identify which of these markers served as the most discriminative predictors of disease severity. METHODS: A retrospective cohort study was carried out between December 2020 and February 2023 to collect data from 1,803 COVID-19 patients from data records in different hospitals in Makkah, Saudi Arabia. The ROC curve analysis evaluated the diagnostic and predictive performance of selected biomarkers. RESULTS: Inflammatory markers such as CRP and D-dimer were evaluated, but ferritin showed only a moderate discriminatory ability for disease severity with moderate predictive value (AUC 0.621). Liver enzymes, especially AST (aspartate aminotransferase), and ALT (alanine aminotransferase), emerged as strong MOF predictors, with AST achieving an AUC of 1.000, indicating perfect sensitivity and specificity as a predictor. Renal markers like creatinine and BUN showed limited predictive power. Among cardiac biomarkers, LDH (lactate dehydrogenase), showing a robust predictive capability for MOF, demonstrated high predictive capability (AUC 0.969), and CK also performed well. CONCLUSION: The AST and LDH were identified as the most reliable predictors of MOF in COVID-19 patients. These findings emphasize the importance of biomarker profiling in clinical risk assessment and early intervention. Liver and cardiac markers should be prioritized in evaluating severe COVID-19 cases to support better patient management and outcomes.
A Retrospective Review of Antimicrobial Usage and Indications at End-of-Life for Oncology Patients in a Tertiary Cancer Center in Saudi Arabia.
Almouaalamy NA, Banjar LA, Hassani HA … +7 more , Alqerafi AA, Ezzi AI, Alaslab BK, Allhybi AK, Aljohani AN, Almouaalamy NN, Almarhabi HA
Saudi Med J · 2026 Feb · PMID 42239924 · Full text
OBJECTIVES: To investigate antimicrobial usage patterns, indications, and outcomes in end-of-life (EOL) oncology patients at Princess Noorah Oncology Center (PNOC), King Abdulaziz Medical City, Jeddah, Saudi Arabia. The...
OBJECTIVES: To investigate antimicrobial usage patterns, indications, and outcomes in end-of-life (EOL) oncology patients at Princess Noorah Oncology Center (PNOC), King Abdulaziz Medical City, Jeddah, Saudi Arabia. The use of antimicrobials in oncology patients in EOL care has raised concerns about their appropriateness and the increasing issue of antimicrobial resistance. METHODS: The study is a retrospective chart review of cancer patients treated at the PNOC from January 1, 2017, to January 31, 2022. The inclusion criteria included cancer patients ≥18 years who died during their admission. The exclusion criteria included subjects who did not meet the inclusion criteria. RESULTS: Among the 503 patients analyzed, 89.7% received antimicrobial treatment. In 66.5% of cases, the antimicrobial prescriptions were justified by positive culture results, whereas 33.5% were administered without culture confirmation. The most used antimicrobials were Piperacillin-Tazobactam (20.2%) and Vancomycin (11.4%). Antimicrobial use was significantly associated with patient awareness of their diagnosis ( = 0.036) and metastatic status ( = 0.027). The median duration of antimicrobial administration was 7.0 days. CONCLUSIONS: The study highlights the prevalent use of antimicrobials for oncology patients in EOL care, with 89.7% taking antimicrobials. The findings emphasize the need for strong antimicrobial stewardship programs to optimize antimicrobial prescription, aiming to decrease antimicrobial resistance.
Role of Artificial Intelligence in Infectious Diseases and Antimicrobial Resistance: A Comprehensive Review on Diagnostic, Treatment, and Prevention Aspects.
Ahmed N, Alghamdi M
Saudi Med J · 2026 Feb · PMID 42239923 · Full text
Artificial intelligence (AI) plays a significant role in managing infectious diseases by enhancing diagnosis, treatment, and preventive measures. AI-assisted tools have predictive analysis ability for incoming outbreaks,...
Artificial intelligence (AI) plays a significant role in managing infectious diseases by enhancing diagnosis, treatment, and preventive measures. AI-assisted tools have predictive analysis ability for incoming outbreaks, including the emergence of antimicrobial resistance (AMR). AI-assisted tools facilitate the treatment methods by tailoring personalized medicine according to the specific disease history of the patient, immune response, and genetics. Advanced vaccine development by various AI-assisted tools is becoming easy, leading to faster vaccine discovery and more efficient vaccine design with a more immunogenic response. Despite huge benefits, a few limitations are also encountered, including biases in algorithms, data privacy, and ethical considerations. This review provides a thorough review of the existing uses of AI and Machine Learning in diagnosing, treating, and preventing infectious diseases, with particular focus on approaches for detecting, monitoring, and containing AMR.
Artificial Intelligence in Radiology: Hidden Fragilities and the Path to Resilience.
Alhasan MS
Saudi Med J · 2026 Feb · PMID 42239922 · Full text
Radiology artificial intelligence (AI) is advancing however its adoption faces fragile foundations that threaten sustainability. Despite bold promises of efficiency and accuracy, current deployment is undermined by weakn...
Radiology artificial intelligence (AI) is advancing however its adoption faces fragile foundations that threaten sustainability. Despite bold promises of efficiency and accuracy, current deployment is undermined by weaknesses in economics, evidence, infrastructure, human factors, regulation, security, and environmental impact. Nearly 90% of radiology AI studies report process metrics rather than patient outcomes, while hidden costs elevate ownership to 400% to 500% of subscription fees. Technical fragilities include 25% or greater performance loss with routine protocol or scanner shifts, compounded by vendor consolidation that has eliminated 63% of companies since 2020, creating migration costs averaging 180,000 dollars per exit. Human factor challenges, including automation bias and progressive deskilling, intersect with regulatory requirements that mandate continuous evidence generation. Security risks and environmental costs remain underrecognized. This review introduces frameworks including risk assessment matrices, compliance guides, procurement checklists, evidence standards, lifecycle calculators, and implementation protocols to enable sustainable, patient centered, value driven integration.
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