Background:Mechanical ventilation is a critical intervention for patients with respiratory failure. Recent advancements and quality improvement initiatives in Saudi Arabia have contributed to refining mechanical ventilation practices. This guideline represents the first national evidence-based framework developed through a multidisciplinary approach.Objectives:This guideline provides evidence-based recommendations for the management of mechanically ventilated adults in intensive care units in Saudi Arabia, incorporating best practices to improve patient outcomes and standardize care across healthcare institutions.Methods:The guideline development followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology, an internationally accepted approach for adopting, adapting, and developing guidelines. A multidisciplinary task force, comprising intensivists, pulmonologists, anaesthesiologists, respiratory therapists, and nursing specialists, conducted a systematic review of the literature and contextualized recommendations for local healthcare settings. The guideline addressed 14 prioritized questions.Results:The guideline included strong recommendations for using low tidal volume ventilation for patients with ARDS, utilizing higher levels of positive end-expiratory pressure, and employing head-of-bed elevation. The guideline provided conditional recommendations for using veno-venous extracorporeal membrane oxygenation, daily sedation interruption, protocolized spontaneous breathing trials, prone positioning, using an endotracheal tube with subglottic secretion drainage, using light sedation, and early tracheostomy. The guideline also included a conditional recommendation against using nitric oxide and a neutral recommendation regarding recruitment maneuvers and early mobility.Conclusion:This guideline serves as a foundational framework for optimizing mechanical ventilation practices in Saudi Arabia. Future research should focus on local implementation strategies, cost-effectiveness analysis, and the impact of guideline adherence on clinical outcomes.

Background:Peritoneal dialysis is an effective therapy for end-stage kidney disease patients. Fungal peritonitis is a rare complication in patients on peritoneal dialysis. Data on peritoneal dialysis-associated fungal peritonitis from Oman are lacking.Objective:To report the epidemiology, management practices, and outcomes in cases of peritoneal dialysis-associated fungal peritonitis from a tertiary hospital in Oman.Patients and Methods:This retrospective study included all patients aged ≥13 years who developed fungal peritonitis after peritoneal dialysis treatment at Nizwa Hospital, Nizwa City, Oman, between March 01, 2005, and March 31, 2023.Results:A total of 311 patients were followed-up for peritoneal dialysis during the study period, of which 10 patients developed peritoneal dialysis-related fungal peritonitis (3.2%) (males: 80%; mean age: 54.5 ± 19.9 years). Candida spp. accounted for 80% of the cases, with a predominance of non-Candida albicans spp., while Aspergillus accounted for the remaining 20%. Previous bacterial peritonitis was noted in seven patients (70%) treated with multiple antibiotics, while six patients (60%) had received antibiotics within the past 1 month. Therapeutic approach was immediate systemic antifungal and peritoneal dialysis catheter removal with transfer to hemodialysis. The mortality rate was 20%.Conclusions:About 3% of the patients on peritoneal dialysis at Nizwa Hospital, Oman, developed fungal peritonitis. Prior antibiotic use was a major risk factor, and thus antifungal prophylaxis is recommended. Candida spp. was the most common pathogen.

Background:HIV transmission trends and risk factors have not been specifically reported from the Eastern Province of Saudi Arabia.Objective:To report epidemiological trends of HIV/AIDS in the Eastern Province of Saudi Arabia over a 10-year period.Materials and Methods:This retrospective study included all cases of HIV/AIDS in the registry of Department of Infectious Diseases of the Public Health Authority in the Eastern Province, Ministry of Health, Saudi Arabia, between January 01, 2014, and December 31, 2023.Results:A total of 1633 new cases of HIV infections were reported in the Eastern Province of Saudi Arabia between 2014 and 2023. Most patients were males (87.1%), aged 30–44 years (49.8%), and Saudis (60.5%). There was a year-on-year increase in the number of cases each year, except in 2016 and 2020. Overall, there was a >2.5-fold increase in the number of cases between 2014 and 2023; there was a 42% increase in the number of cases between 2021 and 2023. The most common source of HIV transmission was heterosexual contact (70.8%). Other modes of transmission, such as injection drug use, homosexual contact, and vertical transmission, were low.Conclusion:The steady rise in the number of HIV cases reported in the Eastern Province of Saudi Arabia indicates the need for developing stronger surveillance, testing, and prevention programs.

Background:Breast cancer is a leading cause of cancer-related deaths globally, with a rising incidence in Saudi Arabia. However, limited studies from Saudi Arabia have reported the molecular subtypes and prognostic biomarkers of breast cancer.Objectives:This study aimed at comparing the clinicopathological and immunohistochemical characteristics of breast cancer among two age groups from Saudi Arabia.Methods:A retrospective study was conducted on Saudi female patients diagnosed with breast cancer between 2017 and 2022 at a tertiary care hospital in Riyadh. Patients were stratified into two age groups: aged ≤40 years and >40 years. Tumor size, grade, stage, and molecular subtypes were compared among these age groups.Results:The study comprised 300 females with breast cancer (mean age: 53.2 ± 12.6 years). Majority of patients (54.3%) were postmenopausal. The most common tumor type overall was invasive breast carcinoma of no special type (84%). In patients aged ≤40 years, most patients had T4 tumor size (39%) and were at an advanced stage (69.2%). Compared with those aged >40 years, patients aged ≤40 years had significantly higher Ki-67 index (P < 0.001), lymph node spread (P = 0.009) and poor short-term survival (P < 0.024). Luminal A tumors were more common in the older age group, while significantly higher proportion of young patients had triple negative breast cancer (TNBC) (P = 0.035). Cox regression analysis demonstrated advanced stage (hazard ratio [HR]: 12.4; P = 0.002) and TNBC (HR: 11.9; P = 0.002) as factors that raised the risk of mortality compared to early stage and luminal A type, respectively.Conclusion:Breast cancer patients aged ≤40 years exhibited more aggressive clinicopathological features, including higher grade, advanced stage, triple negative receptor status, and poorer short-term survival compared with patients aged >40 years.

Background:Community-acquired pneumonia (CAP) is a major cause of hospitalization and mortality, especially among elderly individuals and those with chronic comorbidities. Identifying reliable prognostic markers at the time of hospital admission remains a clinical challenge.Objectives:To evaluate the prognostic value of routinely measured hematological and biochemical parameters, specifically lymphocyte count, serum albumin, procalcitonin, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)/albumin ratio (CAR), in predicting in-hospital mortality and length of stay in patients with CAP.Materials and Methods:This retrospective, single-center cohort study included all adult patients hospitalized with radiologically and clinically confirmed CAP between September 2022 and September 2023. Demographic, clinical, and laboratory data were collected. NLR and CAR were calculated based on admission values. Statistical analyses included group comparisons, correlation analysis, and ROC curve analysis to determine prognostic accuracy.Results:A total of 526 patients were included (mean age: 66.2 years; 53.5% female), of which in-hospital mortality occurred in 9.5%. Non-survivors had significantly lower lymphocyte and albumin levels and higher CRP, procalcitonin, NLR, and CAR values (P < 0.05). ROC analysis showed that lymphocyte count (AUC = 0.794) and albumin (AUC = 0.787) had the highest predictive accuracy, followed by procalcitonin (AUC = 0.774), NLR (AUC = 0.715), and CAR (AUC = 0.710). CRP and WBC showed lower discriminative power. Significant positive correlations were observed between CRP, procalcitonin, NLR, CAR, and length of hospital stay.Conclusions:Lymphocyte count, serum albumin, procalcitonin, NLR, and CRP/albumin ratio are significant prognostic markers for mortality and prolonged hospitalization in patients with community-acquired pneumonia. These routinely available parameters may aid in early risk stratification and clinical decision making.

Background:Household cleaning products, when misused, are a common cause of acute poisoning and can lead to severe health issues.Objective:To assess the levels of awareness, knowledge, and attitude in the population of Saudi Arabia regarding the safe use and potential dangers of household cleaning products.Methods:In this cross-sectional study, adults (aged 18–60 years) from Saudi Arabia were invited through various social media networks between September and October 2024, to complete an online survey. The questionnaire elicited information regarding demographics, real-life experiences, knowledge, attitudes, and safe handling practices.Results:A total of 791 participants completed the survey, of which most were females (64.5%), aged 18–25 years (73.2%), Saudi nationals (89.4%), single (79.3%), and had a Bachelor’s degree as their highest education (65.1%). Almost all participants (97.3%) recognized that household cleaners may contain harmful chemicals; however, only 19.0% and 20.6% of the participants recognized sterilizers and disinfectants, respectively, as potentially harmful. In addition, 87% mistakenly believed it was safe to use cleaning products in unventilated spaces, and 77.7% incorrectly believed that inducing vomiting was necessary if these products are ingested. The level of awareness did not vary based on any studied variables. In terms of knowledge, non-Saudis and married participants had significantly higher knowledge (P = 0.002 and 0.029, respectively), while those from the Northern region had significantly positive attitude (P = 0.038).Conclusion:This study found that in Saudi Arabia, there is a high level of general awareness regarding toxicity of household cleaning products, yet significant knowledge gaps and misconceptions exist regarding its safe use and emergency responses in case of poisoning. These findings indicate the need for targeted educational interventions and public health campaigns to improve actionable knowledge.

Background:The Injury-Psychological Readiness to Return to Sport (I-PRRS) is a validated and reliable scale to assess the psychological readiness of athletes returning to sport after an injury and it has been translated and validated in several languages.Objectives:To translate the I-PRRS scale into Arabic (I-PRRS-Ar) and evaluate its psychometric properties in Arabic-speaking athletes.Methods:An observational, cross-sectional study was conducted among Arabic-speaking injured athletes recruited from various sports clinics and sport clubs across Saudi Arabia. Psychometric properties examined included internal consistency, test–retest reliability, content validity, convergent validity with the Arabic Tampa Scale for Kinesiophobia (TSK-Ar) and the Arabic Numerical Pain Rating Scale (NPRS-Ar), and structural validity.Results:A total of 140 athletes completed the I-PRRS-Ar, while 34 athletes completed the scale twice to assess the test–retest reliability. The I-PRRS-Ar demonstrated excellent content validity (CVI ≥0.90), good internal consistency (Cronbach’s α =0.85), and excellent test–retest reliability (ICC2,1 = 0.83). Standard error of measurement was 3.83, and minimal detectable change was 10.64. No floor or ceiling effects were found. I-PRRS-Ar showed weak negative correlation with TSK-Ar (r = -0.28, P = 0.001) and moderate negative correlation with NPRS-Ar (r = −0.32, P < 0.001). Factor analysis confirmed a unidimensional structure.Conclusions:The Arabic version of the Injury-Psychological Readiness to Return to Sport (I-PRRS-Ar) is a reliable and valid tool for assessing psychological readiness to return to sport in Arabic-speaking athletes after an injury.

Background:Sleep disorders are a growing global concern, with obstructive sleep apnea (OSA) being one of the most prevalent forms of sleep-related breathing disorders. OSA causes significant burden, yet the majority of OSA cases remain undiagnosed.Objectives:To evaluate the knowledge and attitudes of primary care physicians (PCPs) in the Eastern Province of Saudi Arabia toward OSA using the validated Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire.Methods:This study used a cross-sectional, survey-based quantitative design to assess the knowledge and attitudes of PCPs in the Eastern Province of Saudi Arabia towards OSA. Data were collected using a structured questionnaire and included variables across four domains: knowledge of and attitude toward OSA, demographic characteristics, and professional background information.Results:A total of 279 PCPs responded, with the majority being female (58%) and Saudi nationals (97%). The mean knowledge score was 11.1 ± 2.9, indicating the overall knowledge score of about 65%. General practitioners had significantly lower knowledge than subspecialized consultants and those who attended OSA lectures during the family medicine residency program (for both variables, P < 0.001). The mean attitude score was 3.6 ↱±↱ 0.7, indicating an overall attitude score of about 72%. Years of practice was significantly associated with attitude scores (P = 0.040). A modest yet significant correlation (r = 0.188, P < 0.001) was found between knowledge and attitude.Conclusion:Primary care physicians in the Eastern Province of Saudi Arabia have moderate level of knowledge and attitude toward obstructive sleep apnea. Knowledge level was significantly associated with qualification and attending OSA lectures during the residency program, while attitude was significantly associated with years of practice.

Background:De novo malignancies are a significant cause of mortality in liver transplant recipients. This systematic review and meta-analysis synthesized evidence regarding the incidence of de novo lymphoid and hematological malignancies.Methods:Observational studies that compared the prevalence of hematologic malignancies in liver transplant recipients with the general population were included following searches using relevant keywords in ScienceDirect, PubMed, and Google Scholar. The methodological quality of the included studies was evaluated using the Newcastle–Ottawa Scale, with the overall quality converted into the Agency for Healthcare Research and Quality standards (i.e., poor, fair, and good). The generic inverse variance method was used to pool the standardized incidence ratio (SIR) as risk ratios and their 95% confidence intervals (CI)Results:A total of 32 studies were included. Following liver transplantation, post-transplant lymphoproliferative disorder was the most common hematologic malignancy (SIR: 23.06, 95% CI: 4.08–130.04; P < 0.0004), while multiple myeloma was the least common (SIR: 3.10, 95% CI: 2.22–4.34; P < 0.0001). The incidence of non-Hodgkin lymphoma (SIR: 11.05, 95% CI: 8.54–14.28; P < 0.0001) was higher than that of Hodgkin lymphoma (SIR: 7.59, 95% CI: 5.63–11.23; P < 0.0001). The overall risk of hematologic malignancies in liver transplant recipients was significantly higher than in the general population (SIR: 5.83; 95% CI: 2.35–8.05; P < 0.0001).Conclusion:This meta-analysis found that after liver transplantation, post-transplant lymphoproliferative disorder (PTLD) is the most prevalent hematological malignancy. Although PTLD and other hematologic malignancies are less prevalent than solid organ nonlymphoid tumors, they significantly affect liver transplant recipient outcomes. Further research is necessary to identify strategies for managing these complications.Registration:PROSPERO (Reg. no.: CRD420251131279)