King Abdullah Medical City Research Articles

Palliative Care Knowledge among Physicians in King Abdullah Medical City, Makkah, Saudi Arabia: A Cross Section Study

Aims: To estimate the level of understanding of non-palliative physicians regarding the palliative approach and to identify areas of weakness in their management of advanced terminal symptoms. Study Design: An observational study was conducted among physicians at a single center using a cross-sectional design. Location and Duration of Study: King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia. Methodology: The sample size was determined using ROA software based on the number of physicians. A validated survey was used from a comparable study conducted in Vietnam. The data was transmitted via an electronic iteration of the authorized survey. Statistical significance will be assessed using a significance level of P < 0.05 and a confidence range of 95%. Results: The study included a sample size of 80 individuals, with the highest proportion (37.5%) belonging to the age group of 31-40 years. The findings revealed that 57.5% of the participants have knowledge about comprehensive and appropriate palliative care. The study found significant positive correlations between healthcare provider practices and education (r: 0.360, P <0.001), as well as comprehensive Palliative Care Practices (r: 0.476, P <0.001). A negative correlation was seen between knowledge and belief of end- of-life (r = -0.358, P <0.001). Statistically significant correlations were observed between knowledge of palliative care and age (p =0.028), degree (P <0.001), and clinical practice area (P =0.004). The pain management category showed a significant positive correlation with healthcare providers and practices (r: 0.316, P =0.004). Conclusion: The findings revealed that physicians possessed insufficient knowledge in the areas of pain management and palliative care. Knowledge levels are associated with age, educational attainment, and beliefs about end-of-life care. The study recommended the implementation of additional specialized facilities and the establishment of more efficient palliative care education programs.

Patient safety culture in a tertiary care hospital in Makkah, Saudi Arabia, a cross-sectional study

BackgroundPatient safety remains an area of global concern, and patient safety culture among healthcare staff is one of its most important determinants. Saudi Arabia is investing much effort in enhancing patient safety. Assessment of patient safety culture is enlightening about the impact of such efforts and invaluable in informing policy makers about future directions. This study aimed to assess patient safety culture in King Abdullah Medical City (KAMC), a tertiary referral center in Makkah, Saudi Arabia.MethodsIn this cross-sectional study the Hospital Survey on Patient Safety Culture (HSOPSC) version 2.0 was distributed electronically to all staff of KAMC. The HSOPSC version 2.0 Data Entry and Analysis Tool was used to compare results obtained from KAMC to those obtained from global data. Additional analyses were performed on SPSS to explore the presence of associations between responses and participant characteristics.ResultsA total of 350 participants completed the questionnaire, 58.6% of whom were nurses. A comparison of the composite measure of all 10 domains of the HSOPSC showed 62% positive responses at KAMC versus 70% in the global database. This difference was statistically significant, with a chi-square of 10.64 and a p value of 0.001. The percentages of positive responses from the KAMC data exceeded those from the global data in the “Organizational learning and continuous improvement” and the “Communication about error” domains (p = 0.002 and 0.003, respectively).ConclusionAlthough safety culture seems to score lower at KAMC than globally, accelerated improvement in the future is expected based on improvement trends in the literature and the national efforts focused on patient safety.

Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery: Two-center retrospective cohort study.

Over the past two decades, endoscopic endonasal skull base surgery (EESBS) has revolutionized the treatment of skull base tumors by enabling minimal access to resect significant pathologies such as meningiomas, pituitary adenomas, and chordomas. Despite its efficacy, complications such as cerebrospinal fluid (CSF) leak pose significant challenges, with an average incidence of 8.9% following EESBS. Therefore, our study aims to investigate the risk factors associated with postoperative CSF leak after employing an endoscopic endonasal approach for skull base surgery, focusing on patients treated at King Abdul-Aziz Medical City in Jeddah and King Abdullah Medical City in Makkah, Saudi Arabia. A retrospective review of patients who underwent an endoscopic endonasal approach for the resection of intradural skull base pathology between January 2016 and December 2022 was performed with a total of 51 patients. Basic demographic data were collected, along with patient comorbidities, presenting symptoms, tumor pathology, tumor site, the extent of resection, and outcomes. 51 participants were analyzed, with a mean age of 43.41. Male participants comprised (58.8%), while headaches were the most common symptom (74.5%), followed by visual disturbances (51.0%). Nonsecretory tumors predominated, primarily located in the sellar and suprasellar regions (58.8%). Gross total resection was performed in the majority (56.9%), with a 9.8% incidence of postoperative CSF leak. Notably, all four patients with CSF leak experienced preoperative headaches. Hypertension was prevalent in Cases 1 and 4, with Case 4 having a history of neurological disease and radiation therapy. Anterior skull base tumors were most frequent in Cases 3 and 4. The incidence of CSF leakage after surgery in this study was similar to that previously reported. It is worth noting that repeated surgeries may increase the risk of postoperative CSF leakage. Therefore, it is important to carefully evaluate the surgical approach for tumor removal and skull base reconstruction, considering the tumor characteristics and the patient's overall condition.

Real-world treatment patterns and clinical outcomes in patients with prostate cancer.: A single institution experience in Saudi Arabia.

To describe the current real-world treatment landscape, sequence of therapies, and outcomes in patients with prostate cancer (PC). A retrospective cohort study for PC patients diagnosed at King Abdullah Medical City Cancer Center in Makkah, Saudi Arabia, between January 2011 and December 2021. Data extracted from electronic medical records. A total of 282 patients with PC, with a mean age of 70 years and body mass index of 27. Among them, 274 (99%) had no family history of cancer, while 164 (58%) had hypertension and 125 (44%) had diabetes mellitus. Adenocarcinoma was the most common histology, found in 275 (97%) patients, with 99 (35%) having a Gleason score of 9. Notably, 184 (65%) patients presented with metastatic disease, and 147 (52%) with bone metastasis. While 198 (70%) patients underwent surgery, 184 (65%) did not receive radiotherapy. The most common first-line metastatic therapy was abiraterone in 23 (8%) patients, followed by enzalutamide in 7 (2.5%). During the study period, 167 (59%) patients survived, with an average treatment duration of 2.5 years. This study provides insights into real-world treatment patterns and clinical outcomes in patients with PC. The findings of this study highlight the importance of adhering to treatment standards and making informed clinical decisions.

Predictive Factors for Critical Weight Loss in Saudi Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy.

Weight loss is a significant health problem among patients with head and neck cancer (HNC) that is attributable primarily to the tumor or tumor therapy. Critical weight loss (CWL) is defined as the unintentional loss of ≥5% of weight. Therefore, this study's goal was to investigate and determine the possible factors influencing CWL among patients with HNC who have received radiotherapy or concurrent chemoradiotherapy (CCRT). We conducted a retrospective analysis of 175 patients who received radiotherapy or CCRT as either their primary, adjuvant, or combined treatment at the Oncology Center in King Abdullah Medical City. All patients were ≥18 years of age and diagnosed with HNC with no metastasis. The study results showed that 107 patients (61%) had CWL, while 68 (39%) did not. The following factors were significantly predictive of CWL with a multivariate regression analysis: pretreatment BMI (AOR = 1.1, 95% CI = 1.02-1.17), oral cavity cancer (AOR = 10.36, 95% CI = 1.13-94.55), and male sex (AOR = 3.15, 95% CI = 1.39-7.11). In conclusion, weight loss is highly prevalent among HNC patients during treatment. Accordingly, pretreatment BMI, cancer in the oral cavity, and being male can be considered predictive factors for CWL.

Optimizing Door-to-Balloon Time for Patients Undergoing Primary Percutaneous Coronary Intervention at King Abdullah Medical City.

The acute myocardial infarction mortality risk rises by 8% per year for every 30-minute delay in early coronary intervention following the onset of symptoms. Thus, it is important to reduce the door-to-balloon time as much as possible, especially in hospitals where early coronary intervention is carried out within 90 minutes. The purpose of this study was to determine the impact of King Abdullah Medical City's strategies on balloon time for patients with ST elevation myocardial infraction. Prospective observational research was conducted in King Abdullah Medical City. This study included 67 patients who had a primary percutaneous coronary intervention. Data were collected in Hajj 2023 through direct observation using a checklist that included two parts: (I) patients' demographic characteristics and relevant time intervals. The data were analyzed using descriptive statistics (frequency and percentage; median and interquartile range) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test, Spearman correlation coefficient test). It was noted that the median overall door-to-balloon time was 68 minutes for direct admission patients and 100 minutes (median) for interhospital transferred patients, with a statistically significant P value of 0.001. DTBT had no significant correlation with either the length of stay or hospital mortality rates (P > 0.05). King Abdullah Medical City accomplished an international benchmark in door-to-balloon time for ST elevation myocardial infraction patients visiting the hospital for percutaneous coronary intervention during the hajj season. Healthcare organizations can take proactive steps to optimize the management of STEMI cases. This includes establishing efficient communication channels, standardizing protocols, and facilitating seamless transitions between healthcare facilities.

Functional Outcome of Subvastus versus Medial Parapatellar Approaches for Total Knee Replacement in Patients with Knee Osteoarthritis: A Prospective Cohort Study.

Subvastus approach and medial parapatellar approach are two major approaches for total knee replacement (TKR). There is no global consensus on the superiority of either approach in terms of functional outcomes. The present study aimed to evaluate the functional outcome of TKR through subvastus approach and medial parapatellar approach by using patient-reported scores at 3-, 6-, and 12-month post-operative follow-ups. This prospective cohort follow-up study included patients with knee osteoarthritis who underwent elective primary TKR either through the subvastus or medial parapatellar approaches at King Abdullah Medical City, Makkah city, Kingdom of Saudi Arabia, from January 2019 to December 2022. Scores from the self-reported Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared in the two groups of patients at 3-, 6-, and 12-month post-operative follow-ups. A total of 98 patients were included, of which 37 underwent TKR through the subvastus approach and 61 through the medial parapatellar approach. There was an overall significant change over time in both WOMAC and OKS scores (P < 0.001). Patients who underwent the subvastus approach had significantly higher mean of WOMAC and OKS than patients with the medial parapatellar approach at the 3- and 6-month follow-ups (P < 0.05), but not at the 12-month follow-up. For TKR, the medial parapatellar approach results in better functional outcomes at the 3- and 6- month follow-up periods compared with the subvastus approach.

Potential drug-drug interactions between discharge medication from the emergency department and home medication in tertiary hospital

Objective: This retrospective analysis aimed to comprehensively examine the age distribution, gender prevalence, comorbidity patterns, and potential drug-drug interactions among discharged emergency department (ED) patients. By elucidating these factors, the study would contribute valuable insights for improving patient care and medication safety. Methods: The study used retrospective data collection and analyzed cross-sectional data of patients discharged from the ED at King Abdullah Medical City from January to February 2023. Results: The results showed that the majority of discharged patients were between the ages of 36 and 50 years (56.4%) and had a balanced gender distribution. The most common department of discharge was cardiology (42.1%). The analysis also revealed that 68.5% of patients had 3 to 6 comorbidities. The study found significant associations between discharge status and potential drug-drug interactions (DDIs), with patients discharged against medical advice having a higher incidence of potential DDIs (p = 0.037). Conclusion: The study highlighted the importance of training emergency physicians to use hospital systems to identify and prevent potential DDIs. The prevalence of DDIs between prescribed ED medication and home medication was found to be high. The study suggested that discharge status and DDI severity are significant factors influencing the frequency of potential DDIs.

A National Study of Olfactory Dysfunction among COVID-19 Patients in Saudi Arabia

Abstract Introduction: COVID-19 has different symptomatology reported in the literature, including olfactory and/or gustatory dysfunction. The evidence now points to smelling loss as one of the most common symptoms, and in some patient is the only symptom. The prevalence of smelling loss has various bases in the literature. Over time, many centers realized the potential of olfactory and/or gustatory dysfunction to be early symptoms of COVID-19. Recently, the Centers of Disease Control and Prevention added smell or taste loss to symptoms that may appear after exposure to COVID-19. In this study, we are the first national project to report anosmia in COVID-19 patients in Saudi Arabia. Methods: This is the first national cross-sectional study from the Saudi Ministry of Health’s database. Ethics and written approval from the Institutional Review Board was obtained from the King Abdullah Medical City Research Center, Makkah, Saudi Arabia. Results: There were 5492 patients with a positive COVID-19 enrolled in this study. The most common comorbidity among positive COVID-19 patients is bronchial asthma (8.6%), followed by diabetes mellitus (7.5%). Approximately 30% had olfactory and taste dysfunction during the COVID-19 infection period. We found the presence of comorbidities, such as cognitive disorder (54.9%), immunodeficiency (46.8), and diabetes mellitus (23%), as significantly related to olfactory and taste dysfunction (P &lt; 0.05). Conclusion: The olfactory and gustatory dysfunction may be the only presenting symptoms of COVID-19 in diabetic and immunocompromised patients, such that awareness of COVID-19 is crucial for early diagnosis, treatment, and prevention.

Caregiver Knowledge About Palliative Care in King Abdullah Medical City, Makkah, Saudi Arabia: A Cross-Sectional Study (2023).

Background Understandingpalliative care (PC) can hinderaccess to it. To address this, further research into the factors influencing knowledge and awareness of PC is required to develop effective public health campaigns. This study aimed to estimate the knowledge and awareness of PC among primary family caregivers of patients present to the palliative department at King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia (KSA), in 2023, and to determine the factors affecting the family caregiver's awareness about PC. Materials and methods This cross-sectional study was conducted in 2023 among patients' family caregivers in the palliative department of King Abdullah Medical City, Makkah, KSA. The patient was evaluated by palliative service as an inpatient or outpatient presentation. A score, namely "caregivers' general knowledge of palliative care," was used as a study variable. Each of the questions was converted to points and calculated using a simple additive method. The total score was converted to a categorical variable. To discard the null hypothesis, a conventional p-value <0.05 was used. Results The 378 family primary caregivers completed the self-administered questionnaire. The majority (73.8%) were unaware of PC until their family member was admitted to the hospital. The mean score of caregivers' general knowledge is 2.75+0.9, indicating that they have limited knowledge about PC. Age, employment status, relation to the patient, and duration of receiving PC are significantly associated with their knowledge. No associations were found on gender, level of education, and tumor site. Participants aged 26-35 years old (p<0.001), those who are students (p=0.002), who are brother/sister of the patient (p<0.001), and less than one year of PC (p<0.001) significantly related to caregivers' knowledge. Conclusion A low knowledge mean score was found in this study. This indicated that participants had limited knowledge of PC. This study suggested that effective PC education programs and increasing specialized facilities be developed to raise the awareness of both caregivers and patients.

Shortening Door-to-Balloon Time: The Use of Ambulance versus Private Vehicle for Patients with ST-Segment Elevation Acute Myocardial Infarction.

Time is critical when dealing with acute myocardial infarction (AMI) patients in the Emergency Department (ED), as 90 min is crucial for overall health. Using non-EMS transportation for critical patients, such as patients with acute myocardial infarction, to a hospital might delay the rapid identification of the underlying medical disease and initiating definitive treatment. We aim to evaluate the association between the mode of transportation and the D2B time in patients presenting at the ED with AMI. We conducted a retrospective cohort study with patients who presented at ED with AMI and underwent percutaneous coronary intervention (PCI). The participants were patients with confirmed AMI at the ED of King Abdullah Medical City (KAMC) from January 2019 to December 2019. In total, 162 AMI patients were enrolled in the study and divided based on the method of transportation. Less than half (n=65, 40.1%) were transported with an ambulance and 97 (59.9%) patients with a private car. The door-to-balloon (D2B) time for the ambulance group was 93.6±38.31 minutes, and the private car group was 93.8±30.88 minutes. There was no statistical significance when comparing the D2B time between the private car group and the ambulance group (P = 0.1870). Finally, ambulance transport significantly shortened the time to first ED physician contact. However, it was not associated with shortened D2B time when compared to private vehicle transport.

Unveiling the Complexity of Medication Errors: A Nursing Perspective on Contributing Factors to Medication Errors

Context: Medication errors have long been associated with poor medical care quality, lengthy hospital stays, substantially increased medical costs, and a decline in patient confidence in the hospital's ability to provide quality care. Additionally, it is imperative to acknowledge that nurses serve as the final defense in mitigating medication errors and ensuring patient safety.&#x0D; Aim: To identify the factors contributing to King Abdullah Medical City's medication errors.&#x0D; Methods: A descriptive cross-sectional study was conducted in King Abdullah Medical City from January 2023 till March 2023. A total number of 262 nurses were included in this study. Data were collected through an online questionnaire of 28 questions, including nurses' demographics, work-related characteristics, and factors contributing to medication errors from nursing perspectives.&#x0D; Results: It was observed that overworked or exhausted healthcare professionals had the highest responses, with a mean score of 4.46±0.78, followed by insufficient staffing, with a mean score of 4.43±0.88. Regarding patient-related factors, the complexity of the clinical case, including multiple health conditions, polypharmacy, and high-risk medications, had the highest responses with a mean score of 4.20±0.83. Concerning work environment contributing factors for medication errors, it was found that the highest responses were to workload and time pressure factors, with a mean score of 4.50±0.71.&#x0D; Conclusion: Based on the results of this study, the main contributory factors to medication errors were overworked or exhausted healthcare professionals, insufficient staffing, violation of the eight rights of medication administration by nurses, inadequate drug knowledge and experience, nurses' failure to record the administered drug on the patient's record, and inadequate communication between healthcare providers and patients.

Assessing the psychometric properties of a questionnaire evaluating the residents’ perception of peer assisted learning in emergency medicine residency program

PurposeThis study aims to measure the perception of the residents regarding peer assisted learning in emergency medicine residency program as well as assessing the psychometric properties of the questionnaire used as the research tool.Design/methodology/approachA descriptive cross-sectional study was conducted at King Abdullah Medical City, Saudi Arabia, Makkah on a Convenience sample of Emergency Medicine residents who completed peer assisted learning sessions. Data were collected through a questionnaire evaluating the residents’ perception of Peer Assisted Learning. Descriptive statistics were used and statistical significance was set at p &lt; 0.05. The Peer Assisted Learning (PAL) satisfaction questionnaire was tested for construct validity and reliability. Exploratory Factor Analysis (EFA) was conducted. The reliability of the used questionnaire was assessed using Cronbach’s coefficient alpha.FindingsThe study showed that the PAL questionnaire yielded four factors. The four factors are labeled as the following: Factor 1: Cognitive congruence, Factor 2: Social congruence; Factor 3: Teaching skills in Peer Assisted Learning (PAL) session; and Factor 4: Professional development. These results indicated that questionnaire has a good structure validity. In addition, the study showed high internal consistency of the questionnaire. Cronbach’s alpha coefficient value for the total scale was 0.88. The perception of residents was assessed and results revealed residents’ satisfaction regarding Peer Assisted Learning.Originality/valueUp to the authors’ knowledge, this is the first study which assessed the psychometric properties of a questionnaire measuring the residents’ perceptions regarding Peer Assisted Learning. The study contributed to improving information regarding the psychometric properties and usefulness of PAL questionnaire.

Prevalence of Stigma among medical care providers towards patients with Schizophrenia and Obsessive Compulsive Disorders

OBJECTIVE: This study aimed to identify the stigma among medical care providers towards people with Schizophrenia and Obsessive-Compulsive Disorder and the factors associated with increased stigma among them. METHODOLOGY: A cross-sectional study design was used to determine the prevalence of stigma among medical professionals toward patients with Schizophrenia and obsessive-compulsive disorders (OCD). Participants were from one of the best hospitals in Makkah, Saudi Arabia, King Abdullah Medical City (KAMC), in which 283 of their medical care providers were randomly selected using the RAOSOFT calculator technique. All medical care providers at King Abdullah Medical City were included. Medical care providers who refused to participate were excluded. Data entered, cleaned, and analyzed using the Statistical Package for Social Sciences (SPSS) Version 22. RESULTS: The study clarified that medical care providers have less stigmatization towards patients suffering from OCD (53%) than their stigma towards patients with Schizophrenia (54.4%). The study found that (26.4%), and (1.4%) of physicians felt comfortable dealing with OCD and schizophrenic patients, respectively, while (28.2%) and (11.2%) of nurses felt comfortable dealing with OCD and schizophrenic patients, respectively. CONCLUSION: The study concluded that the stigma towards patients with Schizophrenia is higher than it is towards patients with OCD; this stigma is higher among physicians than nursing staff. KEYWORDS: Cross-sectional, Stigma, Schizophrenia, Obsessive-compulsive disorder (OCD), Medical care providers, Medical City.

Breast Cancer Management Timelines in a Tertiary Care Center During the COVID-19 Pandemic, Makkah City, Saudi Arabia: A Retrospective Study.

Breast cancer (BC) is a prevalent form of cancer and a leading cause of death among women worldwide. In Saudi Arabia, it accounted for 31.8% among females of all new cancer cases reported in 2018. Following the declaration of COVID-19 as a global pandemic, there was a complete redistribution of healthcare resources to face this crisis, which caused a significant delay in the management of various diseases, including BC. There is currently a lack of research in our region on the facility time interval in BC management. Therefore, this study aimed to fill this gap by determining the timelines of diagnosis, management, and factors influencing the delay. This observational retrospective study included all female patients diagnosed with BC at or referred to King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia, between January 2020 and August 2021. The data for this study were obtained from a centralized electronic chart review of all included patients at the KAMC center. A total of 76 patients were included in the study, with a mean age of 50 ± 11 years. In terms of the disease management duration, 20 patients (26.3%) completed their management within 30 days, 28 patients (36.8%) had a management duration between 31 and 60 days, and the management duration of 28 patients (36.8%) exceeded 60 days. Patient deposition showed a significant association with delay (p = 0.033).A higher incidence of delays at the initiation of treatment was observed in patients who failed to attend appointments (p < 0.001). Among patients who skipped two or more appointments, 12 individuals (80%) experienced a delay of more than 60 days. Moreover, appointment cancellation was associated with delayed treatment initiation (p = 0.03). Patients' age and comorbidity showed no significant association (p = 0.49, p= 0.24, respectively). Our findings highlight the significant impact of patient deposition and canceled or skipped appointments on delayed initiation of therapy for BC patients. Further research should be conducted to evaluate the impact of COVID-19 on other malignancies.

Evaluation of the Most Visible Symptoms Associated with COVID-19 Vaccines Among the Residents of Makkah, Saudi Arabia: An Observational, Cross-Sectional Study.

This research evaluated the most visible symptoms associated with coronavirus (COVID-19) vaccines among residents in Makkah of Saudi Arabia. A cross-sectional study was conducted in 2021 among a representative sample of residents receiving COVID-19 vaccination at King Abdullah Medical City, ‏Al Ukayshiyyah, and Umm Al-Qura University vaccination centers. A total of 805 participants selected by a census sampling method were included. Data regarding characteristics, medical history, and post-vaccination symptoms were obtained with an interview-based questionnaire. The participants' mean age was 25.20 ± 15.5 years. Of them, 61.7% and 38.3% received one and two doses of the COVID-19 vaccine, respectively. 2.2% have an allergic reaction to the COVID-19 vaccine. 25.3% were infected with COVID-19, 23% were infected before the first dose, and only 1.6% were infected after the first dose. Significant statistical associations were found between males and females in smoking status, age, body mass index, history of diabetes mellitus, and types of COVID-19 vaccines (P-value < 0.05). After adjustment for confounding variables, male participants had lower odds of having swelling, redness, or pain at the injection site, muscle or joint pain, headache, dizziness, and nausea compared to female participants [OR = 0.596, 95% CI = (0.388-0.916)], [OR = 0.272, 95% CI = (0.149-0.495)], [OR = 0.529, 95% CI = (0.338-0.828)], [OR = 0.263, 95% CI = (0.125-0.554)], and [OR = 0.145, 95% CI = (0.31-0.679), P < 0.05 for all], respectively. The female participants may have a higher risk of post-COVID-19 vaccination symptoms than males among Makkah residents of Saudi Arabia.

EFFICACY OF TRANS-ARTERIAL RADIO EMBOLIZATION WITH YATTRIUM-90 FOR HEPATIC MALIGNANCIES

Objective: to assess the efficacy of trans-arterial radio embolization with yattrium-90 for end-stage unresectablehepato-cellular carcinoma HCC. Methods:End stage HCC patients who were treated with TARE between May 2019 and January 2023 at King Abdullah Medical City in Makkah, Saudi Arabia, were enrolled in this retrospective cohort study. TARE was performed with resin (SIR-Spheres®) loaded with Yttrium-90 microspheres (SIR-Spheres). 3 and 6 months after the completion of TARE, patients underwent a contrast-enhanced CT or MRI to evaluate their treatment responses, after which imaging follow-up was performed at 2- or 3-weeks intervals.All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS version 25.0 IBM, Armonk, NY, USA). Results:The study included 29 patients. Among them (65.5%) were Males. Interval decrease in size was found in (27.6%), Interval increase in size was observed in (24.1%). furthermore, the tumor was Stable in size in (48.3%).LR-TR Viable was found in (61.9%), LR-TR Nonviable was observed in (19%). Also LR-TR Equivocal was in (19%). Conclusion:TARE is safe and effective in the treatment of unresectable HCC, as it has a safer toxicity profile than chemoembolization, longer time-to-progression, greater ability to downsize and/or bridge patients to liver transplant, and utility in tumor complicated by portal vein thrombosis. TARE can also serve as an alternative to ablation and chemotherapy.

Disparity Analysis for Cardiac Surgical Outcomes: The Citizenship Factor.

(1) Background: Disparity in clinical care on the basis of gender, socioeconomic status, ethnic and racial variation is an established phenomenon. The focus on health disparities was led on by the report of the Secretary's Task Force on Black & Minority Health, which emphasized that the burden of death and illness was in excess among black people and other minorities. In Saudi Arabia, cardiac health care is being provided to a heterogeneous group of patients during pilgrimage time. This mixed population comprises different socio-economic backgrounds, demographics, ethnicities and languages. This study was carried out to assess for any disparities in cardiac surgical outcomes after isolated CABG surgery between Saudi citizens and non-Saudi patients. (2) Methods: The data of 2178 patients who underwent isolated coronary artery bypass surgery at King Abdullah Medical City from December 2014 to July 2020 were extracted. Patient demographics, clinical features, comorbidities, diagnoses, surgical procedures, complications, length of hospital stay and mortality were included in the data. The primary outcome was mortality after coronary artery bypass grafting surgery. (3) Results: A total of 2178 isolated CABG procedures were conducted during the study period with almost 57.5% of patients being Saudi citizens in comparison with 42.5% of non-Saudi citizens. The male gender represented the majority of the population, with a total of 1584 patients, representing 72.7% of the total study population. The rate of mortality had no statistical significance with the mortality rate of 5% vs. 5.3% (p < 0.786). The postoperative morbidities were comparable for all the parameters except for postoperative extracorporeal membrane oxygenation (ECMO). (4) Conclusions: In the present study, the chances of survival and postoperative outcomes are not associated with nationality per se, but with underlying comorbidities.

Impact of implementing a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia.

To assess the impact of a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia. Stroke is one of the most common medical problems globally. Tissue plasminogen activator is an effective treatment in patients with acute ischemic stroke. However, its efficacy is time-dependent. We conducted a retrospective study on acute ischemic stroke patients who presented within the study window and were eligible for intravenous thrombolysis therapy at King Abdullah Medical City in Makkah between September 1, 2015 and July 2020. Sixty-nine patients received intravenous tissue plasminogen activator and enrolled in this study, 28 patients of which presented during the Hajj period. We found a statistically significant reduction in both the door to needle time and the door to computed tomography time during the Hajj period. In addition, the length of hospital stay reduced significantly in the same period CONCLUSION: We observed a 44% reduction in the door to needle time during the implementation of the stroke code. However, we did not observe a significant difference in clinical outcomes. This study is limited by its small sample size and it lacks a long follow-up for clinical conditions.

Role of single nucleotide polymorphism rs2383206 on coronary artery disease risk among Saudi Population: a case-control study.

We aim to investigate the relationship between genetic variation and biological function on a genomic scale, focusing on identifying genes responsible for complex diseases using single nucleotide polymorphisms. Specifically, the study explores the association between the rs2383206 gene located on chromosome 9p21.3 and the development of coronary artery disease (CAD) in a specific Saudi population. This case-control study was conducted between September 2013 and May 2015 at King Abdullah Medical City (KAMC) and Al-Noor Specialist Hospital targeting the Saudi Population residing in the western region of Saudi Arabia. The study enrolled 315 cases with documented CAD and 205 controls with normal coronary arteries on coronary angiography. Genomic DNA was extracted from peripheral blood samples of both groups, and genotyping of rs2383206 was performed using the tetra-primer amplification-refractory mutation system-polymerase chain reaction (ARMS-PCR) method. In this study, the prevalence of the GG genotype in rs2383206 was found to be higher in patients with CAD than in controls, with an odds ratio of 1.997 [95% confidence interval (CI): 1.176-3.394, p = 0.007]. Additionally, individuals with the GG genotype who had sedentary lifestyles, hyperlipidemia, and smoked were found to be at a higher risk for developing CAD (p = 0.003, 0.009, and 0.003, respectively). The G allele also increased the risk of CAD with an odds ratio of 1.413 (95% CI: 1.099-1.817; p = 0.004). In conclusion, this study demonstrated a significant association between the rs2383206 variant located on chromosome 9p21 and the development of CAD. The findings of this study provide valuable insights into the genetic susceptibility to CAD and highlight the potential of this variant as a target for future functional studies.