Abdullah International Medical Research Center Research Articles

Intracranial Cysts: A Single-Institution Experience With 27 Surgically Managed Cases.

Introduction Intracranial cysts (ICs) are rare pathologies that are often found incidentally during radiological examinations. They may appear in various brain regions and are categorized as normal, congenital, traumatic, or tumor-associated variants. ICs can be asymptomatic or cause symptoms, such as headaches, visual impairments, or seizures, depending on their size and location. Severe complications include obstructive hydrocephalus, loss of consciousness, and intracranial bleeding. Surgical excision is the most accepted type of management in most ICs. Objectives This study aimed to evaluate 27 surgically managed ICs in a tertiary hospital focusing on their clinical, radiological, histopathological, surgical outcomes, and prognosis to enhance understanding and management of these rare, benign cysts. Methodology This retrospective cohort study included 27 surgically managed ICs with pathological confirmation in King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia, from May 2016 to May 2023. All extracranial and nonsurgically managed cysts have been excluded from this study.Data on demographics, clinical presentations, radiological features, surgical outcomes, and follow-up were retrospectively extracted and analyzed. MRI and CT scans were reviewed to determine cyst characteristics. Surgical outcomes and postoperative complications were recorded. Data were collected via Google Forms and analyzed using the JMP Pro software. Ethical approval was obtained from King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. Results The study included 27 ICs: 11 (40.74%) colloid cysts, six (22.22%) epidermoid cysts, five (18.51%) adamantinomatous craniopharyngiomas, two (7.40%) neuroepithelial cysts, and one each of Rathke's cleft cyst (3.70%), xanthogranuloma (3.70%), and dermoid cyst (3.70%). All 27 cases were surgically managed (100.00%), with gross total resection achieved in 14 (51.85%) cases.Only 12 cases (44.44%) did not develop any surgical complications. Twenty-two cases (81.48%) experienced an improvement in the preoperative presenting symptoms. During the follow-up, only three cases (11.11%) had evidence of recurrence. Conclusion This study analyzed 27 ICs of various histopathological types. Each type showed distinct clinical and radiological features. Surgical management generally improved preoperative symptoms with low mortality and recurrence rates, although complications were common. Identifying specific radiological features is crucial for an accurate preoperative diagnosis and optimal surgical outcomes.

Demographics and clinical characteristics of carbon monoxide poisoning for patients attending in the emergency department at a tertiary hospital in Riyadh, Saudi Arabia

BackgroundCarbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It can lead to the development of Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to describe the demographics and characteristics of CO poisoning patients attending at the Emergency Department (ED) and assess the association between CO intoxication and the development of DNS in a tertiary hospital, Riyadh, Saudi Arabia.MethodsA retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning and attended to the ED at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children’s Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMRC).ResultsA total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of those, 76% were adults with an average age of 32.36 (SD ± 15.20) and 51% were male adults. Five (6%) of the 85 patients developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at 2 to 10 days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, Gender was significantly associated with the development of DNS (20% male vs. 80% female, p = 0.050).ConclusionsThe findings of this study are consistent with previous published studies showing low proportions of patients who were exposed to CO poisoning at risk of developing DNS. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning.

Patterns of carbon monoxide poisoning and its association with delayed neuropsychiatric sequela at a tertiary hospital in Riyadh, Saudi Arabia.

Background: Carbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It occurs due to impaired tissue oxygenation which has a detrimental impact on systems with high oxygen demands such as cardiovascular and neurological systems. It can lead to Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to explore the development of DNS for patients exposed to CO intoxication in Saudi Arabia. Methods: A retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. The type of developed DNS and the onset time were also documented. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMARC). Results: A total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of these, 76% were adults with an average age of 32.36 (SD± 15.20) and 51% were male adults. The majority of the incidents occurred in the winter season (76%), especially in enclosed spaces (84%). 25% of the patients were smokers. Of those 85 patients, only 5 (6%) developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at two to ten days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, there was no statistically significant association between gender, age, BMI, gender, type of exposure, presence of clinical manifestations, and COHb level with the development of DNS. Only one reported death in this study. Conclusion: The findings of this study showed that few patients who were exposed to CO poisoning have developed DNS. BMI and age group were significantly associated with COHb level. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning.

Measuring Critical Thinking Ability of Respiratory Therapists Working in Critical Areas in King Abdullah Specialized Children’s Hospital, King Abdulaziz City, Riyadh, Saudi Arabia

Aim: The aim of this study was to assess the critical thinking ability of respiratory therapists working in critical care areas from King Abdullah Specialized Children Hospital (KASCH), Riyadh, Kingdom of Saudi Arabia.
 Methods: The study's design was cross-sectional. Prior to the start of the research, the protocol was reviewed and given the approval by King Abdullah International Medical Research Center in Saudi Arabia. The study was conducted in Riyadh, Saudi Arabia, at the King Abdullah Specialized Children's Hospital (KASCH). The research included all the 45 respiratory therapy ICU staff members. The critical thinking skills of the respiratory therapy staff were evaluated using the Watson Glaser Critical Thinking Appraisal (WGCTA) short form. The evaluation consisted of a total of 40 questions broken down into five distinct categories: assumptions, arguments, deductions, inferences, and information interpretation. Excel was used to enter the acquired data before it was exported to the Statistical Package for Social Sciences (SPSS) (version 22).
 Results: The results showed that most RTs (77.42%) were male and (22.58%) were female. Regarding educational level, it shows that (87.09%) had bachelor's degree. Additionally, it shows that majority (58.06%) had 3-6 years of experience. Nearly two thirds (64.52%) of RTs aged between 26 to 30 years. The critical thinking skills level among respiratory therapists in the screened hospital was average.
 Conclusion: This study revealed no correlation between respiratory therapists' critical thinking abilities and age, gender, experience, or education.
 Recommendations: ICU respiratory therapists should continuously improve their critical thinking skills. This research will help managers and supervisors understand respiratory therapists' critical thinking and build programs to improve staff skills and prepare them to manage ICU situations. The study also recommends conducting further studies to accurately measure the staff's critical thinking skills. These recommendations aim to foster a culture of critical thinking and contribute to informed decision-making within the organization.

Work-Related Shoulder Pain Among Saudi Orthopedic Surgeons: A Cross-Sectional Study.

Shoulder pain is one of the most frequently reported musculoskeletal conditions that approximately 6.9 to 26% of people experience. Numerous etiologies have been linked to causing shoulder pain, with the most frequent one being rotator cuff tendinopathy. Work-related musculoskeletal pain is prevalent in the medical field in general, but orthopaedic surgeons account for the majority of cases overall. The pain experienced is usually caused by many attributing factors that all relate to either the long hours and physically intensive procedures or the unnatural positions orthopaedic surgeons are put in during their surgeries. This study seeks to shed light on the prevalence, contributing factors, and effect of the complications of shoulder pain among orthopaedic surgeons, a topic unexpectedly understudied, particularly in Saudi Arabia. A survey has been developed to ask orthopaedic surgeons at various levels of their careers. The study was conducted in Saudi Arabia, Riyadh. It was a multi-centered study that included both governmental and private hospitals in Riyadh. The collected data included age, gender, BMI, sub-specialty, position, number of surgeries performed per week, and the average time per surgery. In our survey, we used the Shoulder Pain and Disability Index (SPADI) to assess shoulder pain. Ethical approval was obtained for this study by the Institutional Review Board of King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia (IRB/1484/23). Fifty orthopaedic surgeons participated in this study most of whom were male (88%) and fell within the age range of 31-40 years (36%). Regarding their positions, a significant proportion were consultants (54%). In terms of workload, approximately (38%) of the surgeons performed three to four surgeries per week. As for the duration of surgeries, almost half of the participants spent between three and five hours per surgery (48%). When it comes to experiencing pain or difficulties during shoulder activities, a considerable number reported occasional occurrences (36%). Moreover, a substantial majority did not have a history of specific shoulder-related disorders, as (88%) of the participants had none of the mentioned conditions, such as shoulder trauma or disorders like adhesive capsulitis and impingement. Most participants reported difficulties in performing daily activities due to their work-related shoulder pain. Mild pain was the most common reported severity level in all assessed activities. The present study showed that orthopaedic surgeons in Riyadh, Saudi Arabia, occasionally experience shoulder pain from their jobs. Most of our sample stated that mild shoulder discomfort made it difficult to conduct daily tasks. This study is limited by a relatively low response rate, which may be attributed to the demanding nature of orthopaedic surgery. To promote health among caregivers throughout the kingdom, more studies should be conducted about shoulder pain.

The Association of BMI with Outcomes in Critically Ill Patients with Covid-19

Introduction: The novel systemic acute respiratory syndrome coronavirus (SARSCoV-19) severity has been linked to many risk factors like obesity, advanced age, hypertension (HTN), diabetes mellitus (DM), chronic heart diseases, and lung diseases, with many studies showing their influence and effect on the general population and especially on critically ill patients. We retrospectively studied and correlated BMI with in-hospital mortality, the need for mechanical ventilation, renal replacement therapy (RRT), ICU and hospital length of stay (LOS), and mortality among ICU admitted patients with COVID-19 in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Methods: A retrospective cohort study was conducted after ethical approval from the institutional review board of King Abdullah International Medical Research Center (KAIMRC). Subjects were identified by the Data management office of KAIMRC. The data was extracted from electronic medical records using a customized data collection sheet. The study included all adult patients (>18 years) who tested positive for COVID-19 by polymerase chain reaction (PCR) and were admitted to the ICU at KAMC from March 2020 until the end of February 2021. Patients where adequate data was not available, and those for whom adequate data on BMI parameters could not be found were excluded. Patient demographics, comorbid conditions, medications, type of ventilation used, and mortality were recorded. Results: During the study period (2nd of March 2020 until February 28th, 2021) nearly 2000 patients were hospitalized at KAMC with the diagnosis of COVID-19. After excluding the patients who met the exclusion criteria data was collected for 469 critically ill patients, Male (70.9%); female (29.1%). The most common comorbidities in BMI groups were DM (66.5%) and HTN (66%). No significant differences were found regarding the therapies received among these patients. On the Multivariate Cox Model for Determining Predictors of Cumulative Mortality, overweight and obese patient class I had a lower risk of mortality compared to BMI<24.9 (p<0.0087) (0<0.0391, with an overall mortality of (45.6%) in this study. Conclusion: Obesity increases the risk of ICU admission and one of the major risk factors for severe-critical COVID-19 infection. For ICU patients with COVID-19, We found a lower mortality rate in COVID-19-treated ICU patients who were overweight or obese class I compared to other groups. Further studies should be done to correlate the impact of obesity on critical ill COVID-19 patients.

The Effect of COVID-19 Vaccines on Hospital Admission and Severity of Symptoms Among COVID-19 Patients in Saudi Arabia, 2021.

Introduction Following the World Health Organization (WHO) declaration of coronavirus disease 2019 (COVID-19) as a pandemic, Saudi Arabia took unpreceded precautions to prevent and control the spread of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. It is one of the first countries in the world to grant the authorization to use the Pfizer-BioNTech vaccine. This study aimed to assess the effect of one dose of COVID-19 vaccines (Pfizer-BioNTech,Manhattan, New York City, and Oxford-AstraZeneca, Cambridge, United Kingdom) among the Saudi population regarding symptom severity, hospital admission rate, and death. Methods An observational retrospective cohort study was conducted using data from COVID-19 surveillance records at King Abdulaziz Medical City (KAMC), Saudi Arabia, from January to May 2021. All confirmed COVID-19 patients who had positive tests by reverse transcription polymerase chain reaction (RT-PCR) assay of a nasopharyngeal swab were included in the study. Patients diagnosed outside KAMC and cases below 18 years old were excluded from the study. The research was approved by King Abdullah International Medical Research Center (NRJ21J/303/12). Multivariable logistic regression was conducted to estimate the odds of hospitalization among vaccinated and unvaccinated patients. Results A total of 1058 cases were included in the analysis. Two hundred sixty-five (265; 25%) patients were vaccinated with one dose of either Pfizer-BioNTech or Oxford Astra-Zeneca, and 793 (75%) were unvaccinated. The median age was 34 (IQR 25-51), primarily Saudi (94.6%) and male (59.5%). The odds of being vaccinated (CI: 1.284-2.882, P 0.002) were 1.924 times greater for males than females. Young patients below 40 had 1.997 times higher odds (CI: 1.238-3.222, P 0.004) of being vaccinated than patients above 60. The hospital admission rate was low among both groups (12.9%); however, it was significantly lower among the vaccinated group (2.3%) as compared to the unvaccinated (16.5%). The results showed significant differences in symptom severity among the groups. For vaccinated, only one patient (0.4%) died, one patient was admitted to the ICU, and one patient (0.4%) was admitted to the hospital isolation ward. On the contrary, among the unvaccinated group, 19 patients (2.4%) died, 17 patients (2.1%) were admitted to the ICU, and 114 patients (14.4%) were admitted to the hospital isolation ward. Conclusion This study demonstrates that one dose of COVID-19 vaccines, either Pfizer-BioNTech or Oxford-AstraZeneca, reduced the probability of death by 2% and hospital admission by 15% before the spread of the Delta variant (B.1.617). For generalizable results, nationwide studies using national surveillance data are recommended to assess multiple doses efficacy on different variants of the SARS-CoV-2 infection.

Causes and predictors of unplanned hospital readmission in inflammatory bowel disease patients

Background: Inflammatory bowel disease (IBD) is a chronic disease that involves ulcerative colitis (UC) and Crohn's disease (CD). Patients with IBD experience frequent admissions to the hospital. Readmission carries a potential burden to the health care system and has negative impacts on the patients. Readmissions can be reduced by identifying the causing factors. This study aimed at identifying the reasons for readmission in adult patients with IBD at King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Methods: A retrospective cohort study enrolled adult patients with confirmed IBD. The collected data included patients' demographics, co-morbidities, laboratory tests, type of IBD, number of readmissions in 1 week, 3 months, 6 months, and per year, reasons for readmission, intervention, and outcomes. Statistical Package for the Social Sciences software version 21 was used to analyze the collected data. Results: A total of 247 IBD patients were included; 58.3% had CD, and 41.7% had UC. There were 84.2% reported 1–2 times readmissions. Abdominal pain and diarrhea were the major causes of admission in the first readmission (73.7% and 58.7%, respectively), second readmission (30.8% and 17.4%, respectively), third admission (12.6% and 9.7%, respectively), and fourth admission (8.5% and 7.3%, respectively). Conclusion: There were various causes of hospital readmissions among IBD patients, yet the major and most common causes of readmission among the four studied readmissions were abdominal pain and diarrhea. The least common reasons varied between the different readmissions.

Peripapillary atrophy classification using CNN deep learning for glaucoma screening.

Glaucoma is the second leading cause of blindness worldwide, and peripapillary atrophy (PPA) is a morphological symptom associated with it. Therefore, it is necessary to clinically detect PPA for glaucoma diagnosis. This study was aimed at developing a detection method for PPA using fundus images with deep learning algorithms to be used by ophthalmologists or optometrists for screening purposes. The model was developed based on localization for the region of interest (ROI) using a mask region-based convolutional neural networks R-CNN and a classification network for the presence of PPA using CNN deep learning algorithms. A total of 2,472 images, obtained from five public sources and one Saudi-based resource (King Abdullah International Medical Research Center in Riyadh, Saudi Arabia), were used to train and test the model. First the images from public sources were analyzed, followed by those from local sources, and finally, images from both sources were analyzed together. In testing the classification model, the area under the curve’s (AUC) scores of 0.83, 0.89, and 0.87 were obtained for the local, public, and combined sets, respectively. The developed model will assist in diagnosing glaucoma in screening programs; however, more research is needed on segmenting the PPA boundaries for more detailed PPA detection, which can be combined with optic disc and cup boundaries to calculate the cup-to-disc ratio.

Conventional surgery versus botulinum toxin injection for the management of esotropia in children with Down syndrome

To compare the success rates of strabismus surgery and botulinum toxin injection (BTX) in treating esotropia in patients with Down syndrome (DS). This multicenter retrospective cohort study included all consecutive patients having DS with esotropia between 2014 and 2021 at King Abdullah Specialist Children Hospital, King Abdullah International Medical Research Center, and King Khaled Eye Specialist Hospital, Saudi Arabia. We divided the patients into two groups according to interventions. Success was defined as angle of deviation of <10Δ at final visit. A total of 53 patients were included: 23 in the surgery group and 30 in the BTX group. There were no significant differences between groups with regard to age, sex, diagnosis, spherical equivalent, and preoperative deviation angle. Before the intervention, the median angle of deviation was 30.0Δ (IQR, 30Δ-45Δ) in the surgery group and 37.5Δ (IQR, 28.8Δ-50.0Δ) in the BTX group (P = 0.802). Postoperatively, the median (IQR) deviation angle was 0.0Δ (0.0Δ-16.0Δ) in the surgery group and 22.5Δ (6.75Δ-30.0Δ) in the BTX group (P = 0.006). The success rate in the surgery and BTX groups was 65% and 30%, respectively (P = 0.011). Two patients developed dissociated vertical deviation in the surgery group. One patient presented consecutive exotropia and one inferior oblique overaction in the BTX group. In this study, conventional surgery showed a higher success rate than BTX in the management of esotropia.

Public Perception and Awareness Regarding Calorie Information in Restaurant in Saudi Arabia

ObjectivesThe provision of calorie information on restaurant menus has been identified as a cost-effective strategy for preventing obesity and related chronic disease and recently the Saudi Food and Drug Authority (SFDA) imposed calories labeling to become a requirement for all restaurants. This study was designed to assess the association between knowledge, attitude and practices on food label use and to determine the factors that influence the use of food labels during making food purchasing decision in Saudi Arabia.MethodsA cross-sectional study, using data collected via an online self-reported questionnaire, from participants living in RIYADH (n = 339 ≥ 18 years) during Fall 2020. Participants were recruited through social media and volunteered to complete a Food Label Use Questionnaire (FLUQ) which included demographic data, level of knowledge about food and nutrition, attitude and practices related to using food labels and factors affecting the use of food labelling. The questionnaire was translated from English into Arabic following guidelines for translating a questionnaire. Statistical analyses included descriptive statistics, spearman correlation was used to test for basic association between variables and using food label and independent samples t-test to examine gender differences.ResultsThe results show that 85% of the respondents think that food labeling is useful however, only 43% of the participants stated that they always or usually use the food label during food purchasing decision. About 25% of the participants indicated that time constraint was the main barrier for not using food labels, followed by difficult to use (24%). Taste was rated as being the most important factor for food choice by 33% of participants followed by nutrition value 27% and expiry date (17%). Preliminary data suggest that nutrition knowledge, age and education level are positively and significantly associated with using food label P < 0.05 and females exhibited greater knowledge and more frequent label use than male.ConclusionsThe use of nutrition labelling differ by population subgroups. The results of the present study highlight the need for nutrition awareness campaigns and education programs targeted towards promoting the use of nutrition label among male and younger adults.Funding SourcesKing Abdullah International Medical Research Center (KAIMRC).

Genetic impact of non-consanguineous marriages in Saudi Arabia.

Background: Physicians and geneticists face challenges in making accurate diagnoses during clinical evaluations; affecting patients and clinicians. The aim of this study was to estimate the hit rate of the non-consanguineous population. Moreover, prevalence of the genetic disorder in both the consanguineous and non- consanguineous population of Saudi Arabia at King Abdulaziz Medical City in Riyadh data. Methods: We reviewed 681 families and 1563 individuals with 2,565,335 variants in the King Abdullah International Medical Research Center (KAIMRC) Genomic Database (KGD), Riyadh, Saudi Arabia. All the ES requests were obtained from the physician and clinical geneticist of KAIMRC, and the test was performed either in-house or in a College of American Pathologists accredited laboratory center for clinical purposes. Results: A total of 151 non-consanguineous individuals with exome sequencing requests in the population genomic database of King Abdullah International Medical Research Center was considered for the study. In total, 27 had disease-causing variants, and the hit rate was 27/151 (18%). Among the 28 different variants in the 27 individuals, 50% were de novo variants and 50% inherited. The hit rate of the variants causing autosomal recessive disorders was 12/28 (42.8%), autosomal dominant disorders 13/28 (46.4%), and X-linked disorders 3/28 (10.7%). Conclusion: Non-consanguineous marriages have a lower risk of genetic disorders, and reducing consanguinity reduces the risk of genetic disorders by two to three times.

Benefits and challenges of fostering research-focused communities of practice at a specialised health sciences university: An exploratory study.

Structured undergraduate research, whether mandatory or elective, provides undergraduate students with a unique opportunity to develop their research skills. However, the majority of the students undertake individual research projects rather than working in a group. This study explores the perceived benefits and challenges of fostering research focused communities of practice at a specialised health sciences university in Riyadh, Saudi Arabia. This cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Riyadh, Saudi Arabia. The study was approved by the Ethics Committee at the King Abdullah International Medical Research Center (KAIMRC). A self-administered questionnaire was developed that assessed the perceived benefits and challenges of doing research in groups. Data were collected using a mixture of a dichotomous and a 5-point Likert scale and were analysed using Statistical Program for Social Scientists (SPSS). Of the 380 medical students invited to participate in this study, 307 completed the questionnaire, with a response rate of 80.7%. The majority of the medical students (87%) agreed on the importance of teamwork in conducting medical research. Almost all medical students (96%) believed patience and tolerance were required to make the team successful. Significant differences were found between junior and senior medical students regarding their perceived benefits (P-value = 0.0001) and challenges (P-value = 0.0007). Although most of the students believed that doing research in groups is essential and that working within such groups enhances their research knowledge, forming these research groups was not without problems. The need for patience and tolerance to keep the group together, the issue of free-riders and the difficulties related to which research group to join were some of the challenges students encountered.

Common disease-associated gene variants in a Saudi Arabian population.

BACKGROUND: Screening programs for the most prevalent conditions occurring in a country is an evidence-based prevention strategy. The burden of autosomal recessive disease variations in Saudi Arabia is high because of the highly consanguineous population. The optimal solution for estimating the carrier frequency of the most prevalent diseases is carrier screening.OBJECTIVES: Identify the most influential recessive alleles associated with disease in the Saudi population.DESIGN: We used clinical whole-exome sequencing data from an in-house familial database to evaluate the most prevalent genetic variations associated with disease in a Saudi population.SETTINGS: King Abdullah International Medical Research Center (KAIMRC) and King Abdulaziz Medical City.METHODS: Whole exome sequencing data obtained from clinical studies of family members, a cohort of 1314 affected and unaffected individuals, were filtered using the in-house pipeline to extract the most prevalent variant in the dataset.MAIN OUTCOME MEASURES: Most prevalent genetic variations associated with disease in the Saudi population.SAMPLE SIZE: 1314 affected and unaffected individuals.RESULTS: We identified 37 autosomal recessive variants and two heterozygous X-linked variants in 35 genes associated with the most prevalent disorders, which included hematologic (32%), endocrine (21%), metabolic (11%) and immunological (10%) diseases.CONCLUSION: This study provides an update of the most frequently occurring alleles, which support future carrier screening programs.LIMITATIONS: Single center that might represent the different regions but may be biased. In addition, most of the families included in the database are part of the proband's genetic identification for specific phenotypes.CONFLICT OF INTEREST: None.

Level and predictors of breast cancer awareness among Saudi women: A nationwide study.

Breast cancer occurs when abnormal breast cells grow rapidly and uncontrollably. Early detection and intervention have been established to significantly decrease mortality rates. There is a lack of focused research investigating the degree of breast cancer awareness among Saudi women. Thus, this study aimed to fill this gap by conducting a nationwide survey on a large pool of women. A cross-sectional web-based nationwide study. This study targeted Saudi women from all regions of the country and was conducted from 20 August to 3 September 2021. The study used the Breast Cancer Awareness Measure questionnaire to measure breast cancer awareness. This study was approved by the King Abdullah International Medical Research Center institutional review board. Overall, poor breast cancer awareness scores were demonstrated by 71% of the participants. Unemployed women were more likely to have poor breast cancer awareness. Our study reports an alarmingly high level of poor overall breast cancer awareness in Saudi women. Interventions should be implemented to combat this lack of awareness.

Safety and immunogenicity of ChAdOx1 MERS vaccine candidate in healthy Middle Eastern adults (MERS002): an open-label, non-randomised, dose-escalation, phase 1b trial

BackgroundChAdOx1-vectored vaccine candidates against several pathogens have been developed and tested in clinical trials and ChAdOx1 nCoV-19 has now been licensed for emergency use for COVID-19. We assessed the safety and immunogenicity of the ChAdOx1 MERS vaccine in a phase 1b trial in healthy Middle Eastern adults.MethodMERS002 is an open-label, non-randomised, dose-escalation, phase 1b trial. Healthy Middle Eastern adults aged 18–50 years were included in the study. ChAdOx1 MERS was administered as a single intramuscular injection into the deltoid muscle of the non-dominant arm at three different dose groups: 5·0 × 109 viral particles in a low-dose group, 2·5 × 1010 viral particles in an intermediate-dose group, and 5·0 × 1010 viral particles in a high-dose group. The primary objective was to assess the safety and tolerability of ChAdOx1 MERS, measured by the occurrence of solicited and unsolicited adverse events after vaccination for up to 28 days and occurrence of serious adverse events up to 6 months. The study is registered with ClinicalTrials.gov, NCT04170829.FindingsBetween Dec 17, 2019, and June 1, 2020, 24 participants were enrolled (six to the low-dose, nine to the intermediate-dose, and nine to the high-dose group) and received a dose; 23 were available for follow-up at 6 months. The one dose of ChAdOx1 MERS vaccine was well tolerated with no serious adverse event reported during the 6 months of follow-up. Most adverse events were mild (67, 74%) and moderate (17, 19%). Six (7%) severe adverse events were reported by two participants in the intermediate-dose group (two feverish, two headache, one joint pain, and one muscle pain). Pain at the injection site was the most common local and overall adverse event, reported by 15 (63%) of the 24 participants. The most common systemic adverse event was headache, reported by 14 (58%), followed by muscle pain reported by 13 (54%). The vaccine induced both antibody and T cell immune responses in all volunteers; antibodies peaked at day 28 and T cell responses peaked at day 14; and continued until the end of follow-up at 6 months.InterpretationThe acceptable safety and immunogenicity data from this phase 1b trial of ChAdOx1 MERS vaccine candidate in Healthy Middle Eastern adults, combined with previous safety and immunogenicity data from a trial in the UK, support selecting the ChAdOx1 MERS vaccine for advancement into phase 2 clinical evaluation.FundingUK Department of Health and Social Care, using UK Aid funding, managed by the UK National Institute for Health Research; and King Abdullah International Medical Research Center.

Incidence and Outcome of Acute Kidney Injury in Patients Hospitalized With Coronavirus Disease-19 at a Tertiary Care Medical Center in Saudi Arabia.

IntroductionThe systemic acute respiratory syndrome coronavirus (SARS-CoV-2) has been associated with acute kidney injury (AKI). We retrospectively studied the incidence and outcome of AKI in patients hospitalized with COVID-19 at King Abdulaziz Medical City (KAMC) Riyadh, Kingdom of Saudi Arabia.MethodsA retrospective cohort study was conducted after ethical approval from the institutional review board of King Abdullah International Medical Research Center (KAIMRC). Subjects were identified by Data Management Office of KAIMRC. The data were extracted from electronic medical records using a customized data collection sheet.The study included all adult patients (>18 years) who tested positive for COVID-19 by polymerase chain reaction and were admitted at KAMC from March 2020 until the end of September 2020. Patients with a history of end-stage kidney diseases and patients where adequate data were not available to establish diagnosis of AKI were excluded.Patient demographics, comorbid conditions, medications, use of mechanical ventilation, and 30-day mortality were recorded.ResultsDuring the study period (01 March 2020 to 30 September 2020) 1293 patients were hospitalized at KAMC with the diagnosis of COVID-19. After excluding the patients who met the exclusion criteria, data were collected for 1025 patients [male 582 (56.8%); female 443 (43.2%)]. On univariate analysis, increasing age, male gender, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, and vasopressors, presence of chronic kidney disease, coronary artery disease, chronic obstructive pulmonary disease, dyslipidemia, diabetes mellitus, heart failure, and hypertension, kidney transplant status, and mechanical ventilation were associated with development of AKI.On multivariate logistic regression analysis, independent predictors of AKI were restricted to increasing age, presence of chronic kidney disease, hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation.For patients who developed AKI, 30-day mortality was 40.7% compared to 3.7% for those who did not develop AKI (p<0.001).ConclusionFor hospitalized patients with COVID-19, we observed an incidence of AKI of 36%. Increasing age, presence of chronic kidney disease and hypertension, kidney transplant status, use of vasopressors, and mechanical ventilation were independently associated with development of AKI. Presence of AKI was associated with higher 30-day mortality (40.7% vs 3.7%).

Favipiravir and Hydroxychloroquine Combination Therapy in Patients with Moderate to Severe COVID-19 (FACCT): An Open-Label, Multicentre, Randomised, Controlled Trial

Background: No antiviral drug has been proven effective for the treatment of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). Favipiravir and hydroxychloroquine were introduced as potential antiviral agents to treat patients with COVID-19.Methods: We conducted an investigator-initiated, multicentre, open-label, randomised trial involving hospitalised patients with confirmed moderate-to-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at nine hospitals in Saudi Arabia. Eligible patients were adult with moderate-to-severe COVID-19 defined as oxygen saturation (Sao2) of 94% or less while breathing ambient air or significant clinical symptoms with chest X-ray changes requiring hospital admission. Randomisation was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The favipiravir loading dose was 1800 mg twice daily on day 1, then 800mg twice daily for nine days and hydroxychloroquine as 400mg twice daily, followed by 200mg twice daily for days 2-5. The primary outcome was time to clinical improvement of two points (from the status at randomisation) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population of patients to assess the primary and secondary endpoints. The trial is registered at ClinicalTrials.gov (NCT04392973).Findings: From May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 patients to the combination of favipiravir and hydroxychloroquine. The mean age was 52·65 ±13·06 years, 59·4% were men, and 229 (90·15%) required supplemental oxygen at randomisation (with or without non-invasive ventilation). The time to clinical improvement was not significantly different between the two groups; median of 9 days (95%CI: 8, 12) in the treatment group and 7 days (95%CI: 6, 10) in the control group (HR:0·845; 95% CI 0·617 to 1·157; p-value = 0·29). The median duration of hospitalisation among patients discharged on or before day 14 was 9 days (95%CI: 8, 12) for the treatment group and 8 days (95%CI: 7, 10) for the control group with a p-value of 0·42. The 28-day mortality was not significantly different between the two groups, 9 (7·63%) in the treatment group vs 13 (10·32%) in the control group; p-value=0·45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group.Interpretation: The combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19. No new safety signals were recognised for both medications.Trial Registration: This trial is registered with ClinicalTrials.gov, Identifier: NCT04392973, May 19, 2020.Funding Statement: King Abdullah International Medical Research Center, Saudi Arabia.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This trial was approved by the Saudi Food and Drug Authority (SFDA). Ethical approval was obtained from the Institutional Review Board (IRB) at the Ministry of National Guard-Health Affairs (MNGHA) and Ministry of Health (MOH). The trial was overseen by an independent data and safety monitoring board (DSMB). The trial was done according to the Declaration of Helsinki principles and the International Conference on Harmonization-Good Clinical Practice guidelines.

Genetic carrier screening for disorders included in newborn screening in the Saudi population

Background: Inborn errors of metabolism (IEM) are prevalent autosomal recessive disorders in Saudi Arabia. Socio-economic factors, such as consanguineous marriages, play a role in the high rate of diseases. The government of Saudi Arabia created a newborn screening program (NBS) for the most prevalent disorders to facilitate early intervention and the prevention of severe complications. The study aimed to determine the carried pathogenic allele of the diseases included in the NBS and the most frequently carried phenotype in the Saudi population. Methodology: We performed targeted genetic screening for the genes associated with the IEM in the NBS. We used the results of the whole exome sequencing of 1,314 affected and unaffected individuals from 650 families. The results constitute the King Abdullah International Medical Research Center Genomic Database. Results: According to the data set, four diseases occurred most frequently in the Saudi population: adrenal hyperplasia, propionic acidemia, phenylketonuria, and maple syrup urine disease. In total, 12 pathogenic variants occurred frequently. Conclusion: This study generated an updated list of the most pathogenic variants in the Saudi population, based on the National Guard Hospital dataset. Additional research with larger data sets from the different regions will provide valuable information about the allele distribution in the Saudi population, creating a carrier screening program.

Trends in Emergency Department Visits for Mental Health Disorder Diagnoses Before and During the COVID-19 Pandemic: A Retrospective Cohort Study 2016-2021

Background: As the pandemic started, Saudi Arabia applied extreme measures in responses to the public health crises. These control measures have adversely affected individuals with reported psychological illnesses such as depression, and anxiety. We aimed to describe trends, and gender-age differences in proportions of psychiatric Emergency department (ED) visits from 2016 to 2021 in two large hospitals in Saudi Arabia.Methods: This is a retrospective cohort study using data from electronic health records in the Ministry of National Guard Health Affairs’ (MNG-HA) in two major hospitals in Saudi Arabia. Individuals aged ≥12 years diagnosed with mental disorder from January 2016 to May 31, 2021, registered in MNG-HA hospitals system were included in the study.Outcomes: A total of 1171 ED psychiatric visits (52% female, 48% male). A constant annual increase in the number of psychiatric ED visits before the pandemic from 2016 to 2019 (2.91%, 6.17%, 9.64%, and 15.25%) was observed. While nearly 42% of total psychiatric visits for the study period occurred during the pandemic 2020-2021. During the pandemic, psychiatric ED visits were significantly higher in females (adjusted OR 1.46; CI 1.14, 1.86) than males. During the pandemic, generalized anxiety disorder was the most common psychiatric ED disorder with reported increase of visits by 48.44% (p-value 0.007).Interpretation: ED psychiatric visit rates have consistently increased before and during the pandemic. During the pandemic, female at greater risk of seeking psychiatric ED services than male. Interventions for mental health related disorders are urgently needed for preventing mental health problems.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Biomedical ethics committee of King Abdullah International Medical Research Center (KAIMRC) approved this study (JED-21-427780-99596)