To evaluate the added diagnostic value of ultrasonographic risk levels to cytological diagnoses in nodules with Bethesda III and IV cytology. This retrospective study was conducted in Jeddah, Saudi Arabia, and involved analyzing thyroid nodules from patients who underwent thyroidectomy between 2016 and 2023. We focused on pathology, US risk stratification based on the 2015 American Thyroid Association (ATA) guidelines, and fine-needle aspiration cytology (FNAC) using the Bethesda system. We calculated malignancy rates for each ultrasound (US) and FNAC category, with the indeterminate cytology groups defined as follicular lesions of undetermined significance (FLUS) and follicular neoplasms (FN). In 290 patients, malignancy rates in the high-risk US group were 72%. In patients with FLUS, the malignancy rate was 36.9%, while in those with FN, it was 50%. For FLUS and FN, high-risk US features showed a sensitivity of 47%, a specificity of 81%, and a kappa of 29%. Combining FLUS with high-risk US features improved sensitivity to 50%, specificity to 80%, and kappa to 32%. For indeterminate thyroid cytology, US features can guide decision-making, supporting surgery in patients with high-risk US findings rather than follow-up or repeat FNAC.

To evaluate the association between Inflammatory bowel disease (IBD) and Ischemic heart disease (IHD). A retrospective cohort analysis included patients with and without IBD seen at the outpatient gastroenterology clinic of a large tertiary care hospital between January 2015 and October 2022. The primary outcome was the association between IBD and IHD, and the secondary outcome was predictors of IHD in patients with IBD. The study included 400 patients; 291 were IBD patients, and 109 had other non-inflammatory GI disorders. The IBD group displayed significantly lower rates of hyperlipidemia (8.6% vs. 30.3%, p<0.001), diabetes mellitus (DM) (10% vs. 24.8%, p<0.001), and hypertension (11.7% vs. 32.1%, p<0.001) compared to the non-IBD group. Only 2.7% (n=8) of IBD patients developed IHD. Logistic regression analysis did not demonstrate a significant association between IBD and IHD (p=0.932). Among classical risk factors, only hypertension (OR: 26.2, 95% CI: 2.14-661, p=0.016) and hyperlipidemia (OR: 10.5, 95% CI: 1.32-132, p=0.0405) significantly increased the risk of developing IHD among patients with IBD. In this cohort, there is no increased risk of developing IHD in patients with IBD compared to non-IBD patients.

To assess awareness of diabetes complications and knowledge of hypoglycemia. This cross-sectional study was conducted in a tertiary hospital between December 2022 and November 2023. The participants were 362 adult patients with diabetes selected using systematic random sampling. Data were collected through structured interviews using a validated questionnaire that included sections on socio-demographic characteristics, diabetes history, and knowledge of hypoglycemia and awareness about diabetes complications. Descriptive statistics and one-way ANOVA were used for data analysis. The majority of participants were female (71.3%), and 227 (62.7%) had been diabetic for more than 10 years. Approximately 37% are taking a combination of antidiabetic medications. Hypoglycemia reported in 218 (60.2%) and hypoglycemic coma reported in 37 (17.1%). Overall, 81.1% had good knowledge of hypoglycemia, and 91.4% had good awareness of diabetes complications. Better knowledge was associated with higher education, insulin treatment and other combination therapies, and previous experience with hypoglycemia. Patients with type 1 diabetes or a long duration of diabetes were more aware of diabetes complications. Patients with diabetes had a high degree of knowledge and awareness, but hypoglycemia was still a prevalent issue. Neuroglycopenic symptoms and long-term consequences are insufficiently recognized. Teaching and coaching can help prevent hypoglycemia.

To investigate how the Qassim Health Cluster (QHC) implemented population health management (PHM) in tandem with the goals of Saudi Vision 2030 and to pinpoint the main issues and lessons gained from this implementation. This research used a descriptive population study design and was conducted between November and December 2024. We collected data using a mixed-method approach, gathering qualitative data from 11 PHM implementers and secondary quantitative data from 102,946 healthcare service users. Qassim Health Cluster's PHM implementation team established a regional 5-year strategic plan to follow the national PHM framework, utilizing data-based decision-making to implement the strategy. The major challenges identified include the lack of availability of relevant comprehensive PHM policy documents and guidelines, ineffective and delayed technical support, and resistance to change among stakeholders. Lobbying and effective communication were 2 useful strategies for PHM implementation. In the coming decades, the QHC's PHM implementation will drastically shift healthcare practices toward a more sustainable healthcare system that aligns with Vision 2030. To guarantee the successful operation of PHM in the QHC and other health clusters, more advocacy for institutional support, technical assistance, adequate funding, and sponsorship is required.

To develop evidence-based national guidelines incorporating recent advancements in clinical research and therapeutic strategies for the management of patients with diabetic kidney disease (DKD) in the Kingdom of Saudi Arabia (KSA). We developed the guidelines using the GRADE methodology and a multidisciplinary expert panel comprising nephrologists, endocrinologists, clinical pharmacists, and methodologists across KSA. We conducted a systematic literature review of studies published between 2014-2024. The evidence certainty was evaluated across 5 domains using GRADEpro and categorized into 4 levels: "high", "moderate", "low", and "very low". Recommendations were formulated based on the benefit-risk ratio, evidence quality, and expert consensus, with a minimum agreement threshold of 70%. We established 39 evidence-based recommendations addressing key aspects of DKD management, including monitoring and treatment. Among the 39 recommendations, 6 focus on lifestyle interventions, 7 address glucose-lowering therapies, one discusses glycemic monitoring and targets, 8 address DKD evaluation and risk assessment, 7 emphasize comprehensive management approaches, and 10 discuss DKD pharmacological management. Two recommendations related to the comprehensive management of DKD were based on expert opinions owing to a lack of supporting evidence. These Saudi national guidelines offer an evidence-based approach for managing DKD in adults with DM and provide a comprehensive framework for monitoring and treatment. Nevertheless, further local research and data collection are warranted to refine and enhance the guidelines' effectiveness.

To identify risk factors for moderate-to-severe pain during intraosseous infusion (IOI) in non-cardiac arrest patients in the emergency department (ED). Secondary aims include evaluating pain trajectory across procedural stages and assessing the efficacy of a personalized pain management strategy. This mixed-methods study analyzed 220 ED patients undergoing IOI (150 retrospective, 70 prospective). The prospective cohort was randomized to standard care (n=35) or personalized pain management (n=35). Pain was quantified using the numeric rating scale (NRS) and critical-care pain observation tool (CPOT). During puncture, 35.33% (53/150) reported no/mild pain. Pain severity peaked during flushing, with 73.33% (110/150) experiencing moderate/severe pain. At 15-minute infusion, this decreased to 57.33% (86). Univariate analysis identified gender and BMI as pain-associated factors (p<0.05). Multivariate analysis confirmed female gender (OR=13.468) and low BMI (OR=7.250) as independent risk factors (p<0.05). Compared to the control group, the personalized strategy group demonstrated significantly lower pain scores during puncture, flushing, and early infusion, with reduced analgesic requirements in the first 2 stages. No between-group differences occurred in puncture success or complication rates. Intraosseous infusion flushing induces the most severe pain, particularly among females and low-BMI patients. Personalized, stage-targeted analgesia significantly improves pain control without compromising safety, supporting its integration into emergency IOI protocols.

To evaluate clinical trials involving pharmaceutical agents conducted in Saudi Arabia and registered on ClinicalTrials.gov. Since the early 2000s, Saudi Arabia has expanded its involvement in clinical research. Recognizing the importance of clinical trials, we aimed to analyze the clinical trial landscape in the Kingdom to identify well-covered areas and potential gaps. In this descriptive cross-sectional study, ClinicalTrials.gov was used as the primary source to collect data regarding pharmacological and biological interventions conducted in Saudi Arabia between 2002 and June 2025. A total of 474 pharmaceutical studies were included. Of these, 52.95% were completed, indicating moderate research activity but suggesting room for growth compared to global benchmarks. Among completed trials, 38.64% had their results published on ClinicalTrials.gov. Overall, 223 sponsors were identified: 23.32% were international pharmaceutical companies and 24.22% were Saudi sponsors, of which 77.78% were governmental and 22.22% private. Additionally, 239 studies were funded by international companies. Oncology (23.21%) was the most represented medical field, followed by infectious diseases (12.87%). Saudi Arabia witnessed an increase in registered clinical trials between 2002 and June 2025, with strong contributions from both international and Saudi sponsors, particularly the governmental sector. However, only one-fifth of completed trials had results published on ClinicalTrials.gov, highlighting the need for greater transparency and dissemination of findings.