King Abdulaziz Medical City Research Articles

Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae.

The aim of the study is to estimate the prevalence rate of carbapenem-resistant Enterobacteriaceae (CRE) and to determine the types of carbapenemase genes present in patients admitted to King Abdulaziz Medical City (KAMC-J) and King Abdulaziz University Hospital (KAUH), both in Jeddah, Saudi Arabia. A total of 180 isolates were analyzed which were included on the basis of retrospective chart review of patients from KAMC-J and KAUH between 1st April 2017 to 30th March 2019. The prevalence of carbapenemase genes( blaIMP, blaVIM, blaKPC, blaNDM-1, and blaOXA-48)was evaluated by Xpert® Carba-R (Cepheid, Sunnyvale, CA, USA). We assessed the CRE prevalence and described their susceptibility to antimicrobial agents based on antibiogram reports. Results:Klebsiella pneumoniaeshowed a higher frequency of bla OXA-48 (79%) than bla NDM (11.7%) genes (p=0.007). The CRE prevalence in KAUH was 8% in 2017 and increased to 13% in 2018. In KAMC-J, the prevalence was 57% in 2018 and 61% in 2019. K. pneumoniae was found to be the most frequently isolated causative organism followed byEscherichia coli .The bla OXA-48 (76.1%) gene was predominantamong overall isolates followed by bla NDM (13.9%); both genes coexisted in 6.1% of the isolates. During the study period, the prevalence of CRE considerably rose in the two tertiary care institutions from western Saudi Arabia. In the CRE isolates, bla OXA-48was discovered to be the most common gene. We recommend an antimicrobial resistance surveillance system to detect the emergence of resistant genes through use of new rapid diagnostic tests and monitor antimicrobial use in order to improve clinical outcomes of CRE infections given the severity of infection associated with the CRE isolates as well as the limited treatment options available.

Knowledge, Attitudes, and Perceptions toward COVID-19 Vaccinations in Saudi Population

AIM: The objective is to explore the general perception, knowledge, and attitude of people in Saudi Arabia toward the COVID-19 vaccination. METHODS: An observational and cross-sectional study was conducted with 332 Saudi adult population attending primary health centers in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia, between May and July2021 using a self-administered questionnaire. All adults, equal, or older than 18 years old of both genders during the period of the study were included and the only exclusion criteria are the age and patient with psychiatric disorder. We use convenience-sampling technique, due to the difficulty to generate sampling frame. Data are going to be entered and analyzed using Statistics Package for the Social Science version 21 software in August 2021. RESULTS: Majority of participants (93.4%) had good knowledge about COVID-19 vaccines, regarding attitude more than 50% have positive attitude toward vaccination. Despite this high level on acceptance 48.5% of the participant in this study disclosed that they are not aware of vaccine side effects. With regard to perception, 66.9% of our study subjects believed that vaccination is necessary to eradicate COVID-19 pandemic. Furthermore, 72.4% thought that everyone should be vaccinated, starting with general public 74.5%, then health worker 57.9%. CONCLUSION: Almost most of Saudi population aware about the COVID-19 vaccines. Most Saudi people knew about it through media. A long-term side effect of getting vaccines is the main obstacles toward vaccine acceptance.

Prevalence of Missed Injuries in Multiple Trauma Patients at a Level-1 Trauma Center in Saudi Arabia.

Background Missed injuries are defined as injuries neither detected in the emergency department (ED) nor after admission to the hospital. The objective of this research was to identify missed injury rates, contributing factors, and clinical outcomes. Methods A total of 657 trauma patients' records were retrospectively reviewed after admission to King Abdulaziz Medical City (KAMC) during the period from January 2016 to December 2018. Patients' demographic characteristics, presence of a missed injury, and Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) were assessed. Results Among 657 patients who were admitted to our emergency department, only 11 (1.7%) patients were reported to have a missed injury during the hospital stay. None of those missed injuries contributed to the overall mortality. Higher GCS is a protective factor for missed injury with OR=0.12-0.81 and p-value=0.01. RTS and intensive care unit (ICU) stays were borderline although p-value=0.05 and OR=9 for RTS. Both longer ICU stays and high RTS were related to a higher risk of missed injury. Conclusion In our study, the prevalence of missed injuries was on the lower end of the spectrum in comparison to multiple published data. The most common missed injuries were fractures and joint dislocations of extremities. None of those missed injuries were life-threatening or contributed to overall mortality. Higher GCS was a protective factor against missed injurieswhile high RTS and longer ICU stays were related to a higher likelihood of developing missed injuries during the hospital course.

Assessment of willingness of Saudi public to participate in a dental biorepository for research purposes

BackgroundBiobanks/biorepositories are created to collect biospecimens for therapeutic and research uses. The success of the banking concept depends predominantly on the public's understanding and desire to contribute, which triggers several social, cultural, and ethical implications. The aim of this study is (1) to assess the willingness among adults attending outpatient clinics at King Abdulaziz Medical City to donate dental tissue samples to a biorepository for research purposes, (2) to identify the significant predictors for positive attitudes and willingness to donate dental bio-specimens.MethodologyThis is a cross-sectional study that targeted 401 adult outpatients attending King Abdulaziz Medical City in Riyadh, Saudi Arabia. The questionnaire focused on three main parts: demographic and personal characteristics, and previous experience regarding biorepositories (part I), knowledge about dental biorepositories (part II), and willingness and attitudes towards donating dental biospecimens (part III). Data collected were analyzed using the statistical program SAS (version 9.4) with 0.05 level of significance to determine the willingness of donating tissue to biobanks for biomedical research purposes, measure knowledge and attitude about biobanking, find the association between the assessed variables, and identify significant predictors of positive attitude to donate dental biospecimens.Results66% of the participants were willing to donate dental biospecimens, however only 33.9% showed good level of knowledge. Despite the notable lack of knowledge, 54% respondents had favorable attitude towards donating dental biospecimens, and only 17% were negative while the remaining 29% were neutral. Previous involvement in medical research, previous blood testing or donation, female gender, higher education level, employment in a medical facility, and higher monthly income variables were found to be significantly associated with higher willingness to donate dental biospecimens.ConclusionAlthough the majority of the participants exhibited lack of knowledge about dental biorepositories, they showed high willingness and good attitude towards donating dental biospecimens. This favorable attitude is, in turn, encouraging for the future establishment of dental biorepositories in Saudi Arabia. Six factors were significantly associated with the willingness to donate dental biospecimens, out of these, female gender, previous blood testing/donation, previous involvement in medical research were found to be strong predictors.

Obesity and Kidney Transplant Candidates: An Outcome Analysis Based on Body Mass Index.

Background Obesity is a well-established risk factor for a decline in renal function and post-operative complications. Also, obese patients suffer worse outcomes such as higher rates of wound complications, longer hospital stays, and delayed graft function (DGF) when compared to nonobese patients. The correlation between having a high BMI and the postoperative outcomes of kidney transplantation has not been investigated yet in Saudi Arabia. There is scarce evidence that patients with obesity who have undergone kidney transplantation are devoid of any complications before, during, or after their procedure. Methodology A retrospective cross-sectional study was conducted using charts of nearly 142 patients in King Abdullah Specialist Children's Hospital in Riyadh, who had kidney transplant surgery in the organ transplantation department. All Obese patients with BMI >29.9 who underwent Kidney Transplant Surgery in King Abdulaziz Medical City from 2015 to 2022 were used. Details of hospital admissions were retrieved. Results A total of 142 patients fulfilling the inclusion criteria were included. There was a significant difference between patients regarding pre-surgical history where all cases(100%; 2) with class three obesity were hypertensive and on dialysis versus (77.8%; 21) and (70.4%; 19) of class two obesity and (86.7%; 98) and (78.8%; 89) of class one obesity cases, respectively (P = 0.041).Regarding medical history, hypertension was reported among 121 (85%), followed by dialysis (77%; 110), diabetes mellitus (DM) (52%; 74), dyslipidemia (24%; 35), endocrine diseases (15%; 22), and cardiovascular diseases (16%; 23). Considering post-transplant complications, 14.1% (20) of the study cases had DM(16.8% of obese class one, 3.7% of obese class two, and none of obese class three; P = 0.996) and urinary tract infection (UTI) among 7% (10) of the cases (6.2% of obese class one, 11.1% of obese class two, and none of obese class three; P = 0.996). All these differences according to patients' BMI were statistically insignificant. Conclusion Obese patients are more likely to experience difficult intraoperative management along with a complicated postoperative course due to numerous concomitant comorbidities. Post-transplant DM(PTDM) was the most prominent post-transplant complication followed by UTI. A remarkable reduction in serum creatinine and blood urea nitrogen (BUN) has been observed at the time of discharge and after six months compared to pre-transplant measurements.

Would a 6-Month Wait Time for Patients With Hepatocellular Carcinoma Improve Organ Allocation in Centers With Active Living Related Liver Transplant Activity?

The Model for End-Stage Liver Disease score is used to prioritize patients awaiting liver transplant. Since hepatocellular carcinoma does not affect the score, patients with hepatocellular carcinoma are given exception points to promote fairness. In the United States,this practice has resulted in overcorrection; hence, a 6-month delay to grant exceptions was implemented. A similar flaw may exist in Saudi Arabia. We retrospectively reviewed data for 214 adults listed for liver transplant from January 2016 to July 2020 at King Abdulaziz Medical City, Riyadh. Data included diagnoses, Model for End-Stage Liver Disease scores, wait times, and outcomes. Comparative analyses were performed to contrast patients with hepatocellular carcinoma versus patients without hepatocellular carcinoma. Mean age was 55.2 ± 11.6 years, and 61% were male patients. Outcomes were that the patient received a transplant(77%; n = 165/214), dropped out (18%; n = 38/214), or remained on the wait (5%; n = 11/214). Of the hepatocellular carcinoma group, 84% (n = 56/68) received transplant versus 74% (n = 108/146) in the control group (P = .11). There was no significant difference in dropout rates (P = .33). Patients with hepatocellular carcinoma constituted 32% (n = 68/214) ofthe waitlist, yetthey received 40% of deceased organ offers (P = .015). Most patients in the hepatocellular carcinoma group received pretransplant bridging therapy for a median of 166 days (101-329.5 days). Median time from listing to transplant was shorter for the control group, 57 days versus 148 days (P < .001). Long-term outcomes were comparable between both groups. This study suggests that implementation of the 6-month wait time for patients with hepatocellular carcinoma before granting exception points may not be necessary for active living related liver transplant programs. Nevertheless, this remains a sound strategy to follow.

The Bayesian-Based Area under the Curve of Vancomycin by Using a Single Trough Level: An Evaluation of Accuracy and Discordance at Tertiary Care Hospital in KSA.

The AUC0-24 is the most accurate way to track the vancomycin level while the Cmin is not an accurate surrogate. Most hospitals in Saudi Arabia are under-practicing the AUC-guided vancomycin dosing and monitoring. No previous work has been conducted to evaluate such practice in the whole kingdom. The current study objective is to calculate the AUC0-24 using the Bayesian dosing software (PrecisePK), identify the probability of patients who receive the optimum dose of vancomycin, and evaluate the accuracy and precision of the Bayesian platform. This retrospective study was conducted at King Abdulaziz medical city, Jeddah. All adult patients treated with vancomycin were included. Pediatric patients, critically ill patients requiring ICU admission, patients with acute renal failure or undergoing dialysis, and febrile neutropenic patients were excluded. The AUC0-24 was predicted using the PrecisePK platform based on the Bayesian principle. The two-compartmental model by Rodvold et al. in this platform and patients' dose data were utilized to calculate the AUC0-24 and trough level. Among 342 patients included in the present study, the mean of the estimated vancomycin AUC0-24 by the posterior model of PrecisePK was 573 ± 199.6 mg, and the model had a bias of 16.8%, whereas the precision was 2.85 mg/L. The target AUC0-24 (400 to 600 mg·h/L) and measured trough (10 to 20 mg/L) were documented in 127 (37.1%) and 185 (54%), respectively. Furthermore, the result demonstrated an increase in odds of AUC0-24 > 600 mg·h/L among trough level 15-20 mg/L group (OR = 13.2, p < 0.05) as compared with trough level 10-14.9 mg/L group. In conclusion, the discordance in the AUC0-24 ratio and measured trough concentration may jeopardize patient safety, and implantation of the Bayesian approach as a workable alternative to the traditional trough method should be considered.

Factors Affecting Confirmed COVID-19 Patient's Recovery Time at King Abdulaziz Medical City, Jeddah.

The COVID-19 pandemic has become a threat to the public's health, especially to the elderly and those with chronic conditions. It is capable of spreading from carriers who are both asymptomatic and symptomatic. Associated factors such as age, sex, severe symptoms of COVID-19 disease, and chronic disease have a significant impact on the recovery time of patients. The study aimed to determine associated factors on recovery time in COVID-19 patients hospitalized at King Abdulaziz Medical city. A single-center retrospective study was utilized to recruit 1776 confirmed COVID-19 patients from 13 September to 24 October 2020at King Abdulaziz Medical City (KAMC) in Jeddah. The patients were categorized into three age groups: below 5 years, 5 to 65 years, and above 65 years. The number of male patients in each group was 49, 764, and 73, and the number of female patients in each group was 54, 754, and 82, respectively. Impact recovery time on female patients was 11.75 days; with male patients was 10.95 days. Symptoms such as sore throat, diarrhea, and fever in femalepatients declined the recovery time. On the other hand, symptoms such as runny nose, diarrhea, fever, and headache in malepatients declined the recovery time. It was revealed that older aged COVID-19 patients, male sex, and some symptoms decline recovery time. The study findings show an independent predictor of particular symptoms and sign which delay the time of recovery in the COVID-19 patients enrolled in the study differently, for maleand female patients. Thus, patients who are infected with COVID-19 should be monitored keenly to prevent a prolonged rate of recovery and should be eligible for priority management to enhance a good clinical outcome.

Frequency and Demographic Profile of Odontogenic Cysts in Riyadh, Saudi Arabia: Retrospective Multicenter Study.

The study aims to assess the relative frequency, clinicopathological features, treatment, and follow-up of OCs in three tertiary medical centers. OCs were identified from King Abdulaziz Medical City, King Fahad Medical City, and Prince Sultan Military Medical City from January 2010 to December 2021. Three hundred and seventy-two cases of OCs were identified from the archive of three medical centers in Riyadh; one hundred and forty-nine (40%) cases were retrieved from Prince Sultan Military Medical City. The mean age of all OCs was 32 years (range 2-90), with 225 (60.4%) cases occurring in males. There was an almost equal distribution of OCs between the maxilla (47.0%) and the mandible (53.0%). The apical radicular cyst (ARC) accounted for half of the cases, followed by dentigerous cyst (DC) (29.3%) and odontogenic keratocyst (OKC) (14.2%). Enucleation was the most common treatment modality (52.8%), followed by excision (35.0%). Thirteen cases showed recurrence: one ARC, four DCs, and eight OKCs. This is the first large multicenter study of OCs in Riyadh, Saudi Arabia. All three centers showed that ARC was the most common, followed by DC and OKC.

The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience.

Fasting during the holy month of Ramadan is a religious ritual practiced bythe majority ofMuslims around the globe. This daytime fasting is short-term or intermittent fasting, which may be associated with valuable health benefits, particularly in cancer patients. A prospective cohort study ofpre- and post-fastingevaluationof 37 colorectal cancer(CRC)patients was conductedat King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children's Hospital (KASCH)-oncology outpatient clinics. The study aimedto assess the impact of fasting duringthe holy monthofRamadan on the tolerability of chemotherapy side effects and to assess changes in the levels of carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) tumor biomarkers, which are primarily associated with certain types of carcinomas, including CRC. A totalof33patients(89.2%) had fasted at least part of the month of Ramadan.Twenty-seven patients (73%)reported "Serenity" after fasting during Ramadan with improved tolerability of chemotherapy side effects.However,theresults did not reveal any significant difference in the measuredlaboratoryvariables betweenpre-fastingvalues and by the end of the 30 days of Ramadan. Although statistically insignificant, the levels ofCEA andLDH were reduced in46.9%and55.6%of patients, respectively. The mean level of CEA in the fasting group was substantially reduced by more than 40%, attributed to the highly significant decline of CEA levels in three patients(p=0.0283).Moreover, there were no significant differences between pre- and post-fasting blood creatinine levels or estimated glomerular filtration rates, ruling out any possible adverse effects of fasting on renal function. The current study confirms the safety and tolerability of intermittent fasting in CRC patients actively receiving chemotherapy, which is consistent with several reports. Nonetheless, the results did not reveal a significant decrease in CEA and LDH tumor biomarkers.

The Incidence of Long-Term Fatigue in Patients Who Achieved Remission From COVID-19 at King Abdulaziz Medical City.

Introduction Long-term fatigue is a common condition that involves both physical and psychiatric symptoms, and it affects multiple age groups and causes morbidity and disabling symptoms that range from mild to severe symptoms. Many patients are discharged following coronavirus disease 2019 (COVID-19) infection without proper follow-up and evaluation of long-term effects, resulting in the improper treatment of the long-term symptoms, which increases the burden on the patients and healthcare systems. Coronavirus disease 2019 (COVID-19) is a disease caused by the novel SARS-CoV-2. It results in a variety of symptoms, including fever, cough, respiratory distress, the loss of the sense of smell and taste, and long-term effects such as post-severe acute respiratory syndrome (SARS), which is characterized by chronic fatigue, sleep disturbances, myalgia, weakness, and depression. The aim of this study is to assess the incidence of long-term fatigue in patients who achieved remission from COVID-19 at King Abdulaziz Medical City (KAMC), National Guards Health Affairs, Riyadh. Methods We conducted a cross-sectional, non-probability convenience sampling study. All participants who were diagnosed with COVID-19 and achieved remission were approached in an outpatient department (OPD)setting and signed an informed consent form and were evaluated by standard questionnaires at clinics after remission from COVID-19 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A total of 343 subjects who fit the inclusion criteria of any patients who have been diagnosed with COVID-19 and achieved remission were included in the study. This study included patients from the National Guard Hospital, students, and staff members. The primary outcome variable was the incidence of long-term fatigue in patients who achieved remission from COVID-19 as measured by the Chalder fatigue scale (CFQ). The participants were approached in clinics and general OPDby one of the research teams. Results Based on the study design, 343 patients were selected from King Abdulaziz Medical City in Riyadh, the incidence of long-term fatigue in patients who achieved remission from COVID-19 was 55.7%, and the rest were normal (44.3%). The incidence of long-term fatigue was statistically significantly higher in femalesand those who had been diagnosed with COVID-19 and achieved remission for more than two months. Theage of the participants ranged from 18 to more than 45, with a predominance of females (60.6%). Regarding body mass index (BMI), 39.9% were overweight, and 29.2% were obese. Additionally, the incidence of patients with associated chronic disease was 27.4%; among these chronic diseases, hypertension was the most common one (18.1%), followed by diabetes (17%) and thyroid diseases (14.9%). Conclusion To the best of our knowledge, this is one of the few studies that were carried out in Saudi Arabia that assess long-term fatigue post COVID-19 infection. In our study, we discovered that long-term fatigue was highly prevalent (55.7%). We found that among those participants, more than half of those who reported chronic fatigue had a COVID-19 diagnosis for longer than two months. Furthermore, females made up the majority of those who had long-term fatigue. We urge that additional longitudinal and standardized studies be carried out in order to thoroughly determine the severity of long-term fatigue in patients who obtained remission from COVID-19.

Questionnaire of Research article titled ( Measuring the needs of dementia patients' caregivers: An assessment study from King Abdul-Aziz Medical City, Jeddah, Saudi Arabia)

Questionnaire of Research article titled ( Measuring the needs of dementia patients' caregivers: An assessment study from King Abdul-Aziz Medical City, Jeddah, Saudi Arabia)

Pathological Features and Clinical Characteristics of Kikuchi-Fujimoto Disease: A Tertiary Hospital Experience in Riyadh, Saudi Arabia.

Background Kikuchi-Fujimoto disease (KFD) - also known as necrotizing histiocytic lymphadenitis - is a benign histiocytic lymphadenitis known for its low incidence and misdiagnosis that occurs mostly in young Asian females more than males. This disease resolves spontaneously in a few months with a low risk of relapse (one in 30 patients) after resolution. Objectives The aim of this study is to share King Abdulaziz Medical City's (KAMC's) experience with KFDby determining its clinicopathological characteristics. Materials and methods In this study, we reviewed histopathological slides and pathological reports of all lymphadenopathy cases (683 cases) in the period between January2008 and December2018. Results Forty-four cases of KFD were found and their clinicopathological characteristics were recorded.There is a slight female predominance (59% females versus 41% males) with a wide age range from 10 months to 97 years (mean = 28.8). The majority of the cases (63.6%) are seen in young adults (between 21 and 40 years). Association with autoimmune diseases was shown by 20.5% of cases while viral infection association was shown by few cases. Most cases showed remission (59%) and no deaths were reported upon follow-up. Histopathologically, the majority of cases have proliferative type followed by the necrotic type and few cases showed xanthomatous type. Conclusions Our study has the largest number of KFD cases in this region. It is obvious that KFD has clinical, radiological, and pathological features that overlap with malignancy, especially lymphoma. Knowing this disease and careful diagnostic approach can help avoid misdiagnosis.

The Effect of the COVID-19 Lockdown on the Frequency of Acute Poisoning Presentation to Adult and Pediatric Emergency Departments.

Background The coronavirus type 2 that causes severe acute respiratory syndrome (SARS-CoV-2) was detected in December 2019 in Wuhan, China. A worldwide emergency response has been initiated because of the fast rise in the number of cases and fatalities during the early stages of the pandemic when vaccinations and efficient medical care were unavailable.Misinformation spread quickly in the early phases of the pandemic, leading to the inappropriate use of medications, chemicals, and traditional remedies for their claimed preventive or therapeutic purposes. Thus, our aim is to identify the impact of the coronavirus disease 2019 (COVID-19) lockdown on the patterns of intoxicated patients presenting to King Abdulaziz Medical City's adult and pediatric emergency departments. Methods A retrospective cohort study was conductedin the adult emergency department at King Abdulaziz Medical City and the pediatric emergency department at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia.All patients presented with poisoning as a chief complaint between March 23 to June 21 in 2019 (pre-lockdown), 2020 (the lockdown), and 2021 (post-lockdown) were included. Cases of registered poisoning complaints were reviewed and assessed with respect to patient demographics, the causative agent/substance responsible for the poisoning, management of poisoning, and particular outcomes on the approved data collection form by the research team.The data were entered and analyzed by using SPSS v26 (IBM Corp, Armonk, NY). The descriptive statistics are presented as frequency and percentage for the categorical data variables and mean and standard deviation for the numerical data. The data were further analyzed by using cross-tabulation (chi-square test), for the data that are both the predictor and the outcome was categorical. A p-value of < 0.05 was considered significant for allstatistical tests. Results Out of 318 patients identified, 164 were adults and 154 were pediatric patients. The mean age of adult and pediatric patients was 33.3±15.5 years and 4±3.6 years, respectively. The majority of patients (115; 70.1%) were males in the adult group and females (90; 58.4%) in the pediatric.The majority of self-harm cases were accidental among both adults and pediatrics, 109 (66.5%) and 144 (93.5%), respectively. The dispositionfrom the emergency department was discharged for 113 (68.7%) adult patients and134 (87.0%) pediatric patients.The number of cases presented to ER with poisoning cases during the lockdown decreased. This was further tested inferentially, but no significant association was seen among study variables, i.e., p > 0.05. Conclusion The lockdown and pandemic had a significant impact on the rate and patterns of ED visits. The establishment and operation of Drug and Poison Information Centers (DPIC) across the Kingdom, in addition to increasing awareness through campaigns addressing drug and substance safety, is recommended.

A Retrospective Single-Center Study of Sevelamer Hydrochloride for the Treatment of Hyperphosphatemia in Children With Tumor Lysis Syndrome.

Introduction Tumor lysis syndrome (TLS) is a life-threatening metabolic abnormality. The incidence of TLS depends on the underlying malignancy. In a recent analysis of hematological malignancy, the incidence of clinical TLS in children was 3.8%, laboratory TLS 46.2%, and hyperphosphatemia 32.7%. Sevelamer is effective for the treatment of hyperphosphatemia associated with renal failure; however,there is no clear data that it has the same effect in treating hyperphosphatemiawith TLS. Methods This was a retrospective study among children aged ≤14 years with hematological malignancy who developed TLS and received sevelamer to treat hyperphosphatemia at Princess Norah Oncology Center, King Abdulaziz Medical City (KAMC) in Jeddah from January 2012 to December 2016. Results A total of 34 patients received sevelamer. The majority was male (64%), with a median age of six years. The median sevelamer dose per day was 1600 mg, while the median duration of use was two days. Phosphate level was significantly decreased at different times(24 hours, 48 hours, and 72 hours) during sevelamer usage, p-value <0.001. Conclusion In our study, the use of sevelamer resulted in a significant decrease in phosphate levels. This finding further consolidates the efficacy of sevelamer in treating hyperphosphatemia with TLS. However, further research into the drug's kinetics is recommended.

Prevalence of Etiological Factors in Adult Patients With Epilepsy in a Tertiary Care Hospital in the Western Region of Saudi Arabia: A Cross-Sectional Study.

Background Epilepsy is a chronic neurologic condition with different risk factors and genetic predispositions. It is characterized by the occurrence of an epileptic seizure. To our knowledge, most studies have focused on revealing epilepsy prevalence in Saudi Arabia, but the etiological prevalence is still not well-studied in the region. Thus, this research aims to raise awareness and provide more insights into the etiological prevalence of this disorder. Methodology A cross-sectional study was performed among 431 adult patients diagnosed with epilepsy in the Neurology Department at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Patients' data were retrospectively collected from electronic medical files covering the period between May 2016 and April 2021. Epilepsy etiologies were classified as suggested by the International League Against Epilepsy 2017. Results The most commonly identified seizures were generalized (25.3%) and focal (8.9%). However, 66.1% of seizure types were unidentifiable. The most common etiology was structural (42.9%), followed by genetic (7.2%), with strokes (24.3%) and tumors (23.8%) being the most prevalent structural etiologies. However, 47.6% of the patients were classified under unknown etiology. Conclusions This study suggested that epilepsy diagnosed as generalized was by far the most common seizure type in our cohort. Structural etiology was evident in most patients, with stroke being the highest presented etiology.

Awareness of Radiation Protection and Common Radiation Dose Levels Among Healthcare Workers.

Access to ionizing radiation has become widely available for diagnosis and treatment. The increased use of ionizing radiation has been associated with radiation exposure hazards for patients and radiation workers. Raising the level of radiation protection awareness is important to maintain the safety of healthcare settings. Online questionnaires were distributed to 755 healthcare workers and students at King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. The questionnaire consisted of 14 multiple-choice questions divided into two sections (questions related to radiation protection and common radiologic examination doses). In total, 443 participants completed the questionnaire, including 142 (32%) medical students, 107 (24%) radiology technologists, 105 (24%) radiography students, and 89 (20%) physicians. Of the participants, 245 (55%) were men. A total of 74 (84%) physicians and 51 (47%) radiology technologists had more than 5 years of experience. Eleven (12%) physicians and 44 (41%) radiology technologists had 1-4 years of experience, whereas the rest had less than 1 year of experience. Only 16% of participants attended training courses on a regular basis. However, 15% of the participants thought that they had excellent knowledge of radiation protection, whereas 18% admitted that they did not have sufficient knowledge. Sixty-two percent of the questions related to radiation protection awareness were answered correctly. Forty-five percent of the participants correctly answered questions related to doses from common radiologic examinations. Only 23% and 16% of participants were aware of the noncontrast chest CT and lumbar x-ray doses, respectively. Moreover, 35% and 24% of participants did not know that pelvic MRI and abdominal ultrasound do not contribute any radiation dose, respectively. The results showed a knowledge gap regarding radiation protection and dose levels; therefore, periodic refresher courses are recommended for healthcare workers in order to increase the level of awareness.

Knowledge, perception, and beliefs of Saudi physicians at King Abdulaziz Medical City, Riyadh related to medical cannabis: Literature review and a cross-sectional survey.

To explore the medical cannabis-related level of knowledge of physicians at King Abdulaziz Medical City, including patient needs, perceptions of therapeutic effects, potential harm, and the willingness to prescribe if legalized in future. The study was a cross-sectional questionnaire-based survey. It was conducted at King Abdulaziz Medical City in Riyadh from February 2020 to February 2021. All physicians from the different specialties, who consented to participate, were included in this study. Descriptive statistics are presented as mean and standard deviation and proportions. An ANOVA test was applied to measure the association of the beliefs regarding the right to prescribe with overall knowledge. All tests were considered significant at P < 0.05. A total of 249 physicians participated with the majority (70%) male. The sample was similar regardless of the physician's position in the medical hierarchy, with a mean work experience of 8 years. Almost half of the participants indicated that they do not have good knowledge regarding the effects of MC products and more than half that they are unaware of the different MC products and formulations currently available. The majority of the sample lacked knowledge about the medicinal use of cannabis for specific indications and felt uncomfortable to discuss the medicinal use of cannabis with their patients.

Describing the lived experiences of nurses and midwives in caring for mothers and families during a fetal loss

Background: Pregnancy is often anticipated as a positive experience for women with the expectation of having a healthy infant in the end. However, some pregnancies end in fetal loss, which can have profound effects on parents and families and is characterized by shock, anger, emptiness, helplessness, and loneliness. Aims: The study aimed to describe the lived experiences of nurses and midwives regarding care provided for mothers and families during the fetal loss at King Abdul-Aziz Medical City, Western region. Setting and Design: The study setting was the labor and delivery units at King Abdul-Aziz Medical City, Western region, Saudi Arabia. Husserl's phenomenological approach was used. Materials and Methods: Purposive sampling included 11 nurses and midwives were included. Data were collected through in-depth interviews that were audio reordered and then transcribed verbatim. Statistical Analysis: Thematic analysis using Giorgi's data analysis steps was used. Results: Two themes emerged regarding the experiences of nurses in caring for mothers and families who experience fetal loss, namely emotional turmoil with subthemes, heavy heart, feeling helpless, lack of self-control, feeling guilty, feeling extreme sadness, feeling isolation; and barriers with subthemes culture, lack of nursing care, and limited skill. Conclusion: Two major themes emerged from the study that highlighted that nurses found caring for patients and families after a fetal loss a challenging experience and, at times, were unable to manage their own emotions.

Safety of labor induction by dinoprostone (PROPESS) among grand multipara in King Abdulaziz Medical City, Jeddah, Saudi Arabia

Background: Dinoprostone is a synthetic prostaglandin (PG) that induces labor. In multiparity, the use of dinoprostone could be stressful and dangerous. Thereby, this study aimed to evaluate the safety of vaginal dinoprostone (PROPESS) Prostaglandins E2 (PGE2) used for the induction of labor in grand multiparous women and great grand multipara (GMP). Methods: This was a retrospective chart review that was conducted on all GMP and great GMP women whose labor was induced by dinoprostone. The study was conducted at King Abdulaziz Medical City, the National Guard Hospital located in Jeddah in the Western region of Saudi Arabia, in the period from 2018 to 2020. Results: The grand multiparous women were 353 from the total deliveries observed with a mean ± SD age of 36.6 ± 5 years. Results showed that 95.75% labor induction success was achieved by dinoprostone, and 92.1% was delivered via spontaneous vaginal delivery. The major causes of labor induction included gestational diabetes mellitus (45.6%) and post-date (34.3%). The success of dinoprostone was significantly influenced by maternal age (p = 0.006) and gestational age (p = 0.03). No severe maternal complications were observed such as infection or uterine rupture, or cesarean hysterectomy or maternal death. Conclusion: There were no major complications reported after inducing by dinoprostone. Thus, as no adverse events were reported in this study, it is safe to use vaginal PGE2 Dinoprostone for the induction of labor in grand multiparous women and in great grand multiparous women. However, randomized controlled trial for further validation of these findings is recommended.