King Khalid University Hospital Research Articles

Antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated at tertiary care hospital in Riyadh, Saudi Arabia.

Staphylococcus aureus is an important human pathogen that has a major impact on public health. The objective of the present work was to determine the prevalence and the pattern of antibiotic susceptibility in S aureus (MRSA) isolates from the King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. The isolates were collected from different body sites of infection and the antibiotic susceptibility was confirmed on the Vitek 2 system. A total of 371 MRSA isolates from clinical samples were received over a 12-month period from January 2021 to December 2021. The results showed that infection was predominant among males (55.8%) and most of the isolates occurred in the older age groups, with a mean age of 43.7 years and an age span from <1 to 89 years old. The majority (34.5%) recovered from wound infection followed by (14.6%) from blood. We have observed peaks of MRSA infections during the autumn, especially in September and November. All MRSA isolates were resistant to Amoxicillin + clavulanic acid, Ampicillin, Imipenem, Oxacillin, Cloxacillin, and Penicillin while all isolates were sensitive to Daptomycin and Nitrofurantoin. Furthermore, Vancomycin was resistant in (0.3%) of MRSA isolates, and (2.9%) was resistant to Linezolid. The current study concluded that MRSA strains had developed resistance toward 24 tested antibiotics, including the previous effective drugs vancomycin and linezolid. Therefore, there is an urgent need for continuous review of infection control practices to prevent any further spread of resistant strains.

Fears, Beliefs and Practices of Pregnant Women in Saudi Arabia regarding their Sexual Health during Pregnancy and after Birth

Background: A woman’s sexual life during pregnancy is subject to many physiological and psychological changes. In this regard, there are inconsistencies in some aspects, while some are yet to be explored. This study aimed to obtain a detailed account of the fears, beliefs and practices of pregnant women and their associated factors in Saudi Arabia regarding their sexual life during pregnancy and after birth. Methods: A convenience sample of pregnant women (n=439) attending antenatal clinics at purposefully selected hospitals completed a self-report questionnaire of her fears, beliefs and practices regarding her sexual life during pregnancy. This was a cross-sectional study performed by a team of researchers at King Khalid University Hospital from August 2021 to August 2022. Results The majority of the pregnant women recorded • A decrease in libido • That Kegel exercises improved sexual function • That vaginoplasty is important after vaginal delivery • Fear of dyspareunia, vaginal laxity, and changes in the sexual relationship • Dependence on unverified sources for information regarding female sexual issues. A large proportion of the participants • Thought that delivery-related vaginal laxity needed medical consultation • Thought that vaginal laxity was associated with episiotomy • Relied on traditional herbs for managing sexual health issues. Among pregnant women in Saudi Arabia, sexual health-related fears, attitudes and practices were associated with age, marital status and educational level, and participants relied on past experience and social media for information. Conclusion: Decreased libido and painful intercourse are common among pregnant women regardless of parity. Sexual health concerns and education should be part of antenatal care visits.

Clinicians' Attitudes Toward Electronic Health Records in Saudi Arabia.

This study explored physicians' and nurses' attitudes towardan electronic health record (EHR) system and examined the features and factors that clinicians associated with the implementation of EHR systems. A self-administered anonymous questionnaire with high reliability and validity was adopted from existing research to gather clinicians' attitudes towardthe EHR system implemented at King Khalid UniversityHospital, one of the biggest hospitals in Riyadh, Saudi Arabia. A total of 438 questionnaire responses were received from the participants; 240 of them were physicians and 198 were nurses. The participants had a mean age of 43.7 years (standard deviation (SD) 17.1), 213 (52.7%) were femaleand 207 (47.3%) were male. Most participants (424, 96.8%) had one or more years of experience using computers, and a majority (304, 69.4%) had one or more years of experience using EHR systems.Most physicians and nurses (214, 89.5%vs. 174, 87.9%) were satisfied with their hospital's EHR systemand felt that the system was highly usable and had the potential to improve communication between staff, facilitate easy storage of and access to informationand lead to improved health outcomes for patients. The study found positive attitudes among clinicians concerning the quality of training and education around the new system (178, 74.2%of physiciansvs. 142, 71.7%of nurses; p > 0.05) and towardleadership during the transition to HER (222, 92.5%vs. 183, 92.4%). On the other hand, a majority of nurses reported that the EHR system took longer to use and increased their workload compared with the previous analogue system (115 (47.9%) vs. 133 (67.2%); p ≤ 0.01and 46.7% vs. 112 (64.1%)). A large majority of physicians and nurses surveyed (214(89.2%) vs. 167 (84.3%)) stated that clinicians should be consulted in the design of such systems as a way to maximise the potential benefits of EHRand mitigate extra workload demands. Most clinicians expressed overall satisfaction with the EHR system, but there were some areas of dissatisfaction among the respondents, such as increasing workload and stress among nurses. There is scope for further research to continue to explore physicians' and nurses' attitudes towardEHRsand for future experimental studies that examine the impact of EHRs on clinician workloads, patient health outcomesand quality of care.

Prevalence of Vitamin D Deficiency among Children Visiting King Khalid University Hospital in Riyadh, Saudi Arabia

Background: Vitamin D deficiency (VDD) is a widespread issue, especially in Saudi Arabia, with implications for various health conditions. The study aimed to evaluate VDD's prevalence and associated factors among children visiting King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia, to inform public health strategies. Methods: Employing a retrospective study design, medical records from 391 pediatric patients aged 1-14 who visited KKUH from April 2023 to October 2023 were analyzed for vitamin D levels, demographic data, comorbidities, and supplementation status. Based on established thresholds, vitamin D levels were categorized into normal, insufficiency, and deficiency. Statistical analyses, including chi-square tests, assessed the association between vitamin D levels and independent variables. Results: Out of the 391 subjects, 56.8% had normal vitamin D levels, 17.6\% were deficient, and 25.6\% were insufficient. Treatment or prophylaxis was reported in 75.2% of those with normal levels. The prevalence of VDD was not significantly related to gender (p = 0.635) but was significantly associated with age (p &lt; 0.001), with higher deficiency rates observed in older children (10-14 years). Most children (84.4%) were asymptomatic, while specific symptoms like bone ache and fatigue were less commonly reported. Conclusions: The study highlighted a substantial prevalence of vitamin D insufficiency and deficiency among children in a Saudi Arabian tertiary care setting, with age identified as a significant correlate. These findings emphasize the need for regular screening and targeted vitamin D supplementation strategies in pediatric healthcare practice to mitigate the risks associated with VDD.

Prevalence of The Arterial Hand Dominance Using the Modified Allen Test and Pulse Oximetry among Plastic Surgery Patients.

The ulnar and radial arteries are the major source of blood supply in the hand, as they form the superficial and deep palmar arches. Arterial hand circulation is one of the most complicated arterial trees and connections in the body, with tremendous variations in its structure. This study aimed to evaluate whether the ulnar artery or radial artery is the dominant artery in hand circulation among plastic surgery patients at King Khalid University Hospital and to correlate the arterial hand dominance with handedness and gender. This is an analytical cross-sectional study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, on plastic surgery patients. The sampling method is purposive sampling. The calculated sample size is 28; however, 100 participants have been enlisted in the study. The data have been collected using the modified Allen test with a pulse oximeter. The collective prevalence of dual arterial dominance in our study was 69% compared with 56% and 30% for Little et al (P = 0.013) and Fuhrman et al (P < 0.001), respectively. With regard to gender, women were more likely to have a dual arterial blood supply than men, with the frequency values of 85% and 58.3% for women and men, respectively (P = 0.017). Our study found that dual arterial supply is predominant among our participants, with 69% of our participants possessing a dual arterial supply, while 18% and 13% constitute the prevalence of radial and ulnar dominance, respectively. This contrasts with what has been reported previously in the literature.

Characteristics of Patients Undergoing Electrophysiologic Procedures in a Tertiary Hospital in Saudi Arabia.

The electrophysiology field has progressed rapidly over the last 2 decades. No study has examined the characteristics of patients and types of electrophysiology procedures performed in the Kingdom of Saudi Arabia. This is important given our distinctly different demographic composition and health system. As such, we sought to describe the characteristics of consecutive patients presenting for electrophysiology procedures in our tertiary care hospital. Data was collected from the electrophysiology database at King Khalid University Hospital for procedures performed between April 2016 and November 2022. Patients' characteristics were retrieved from the electronic medical record. Procedures were categorized into supraventricular tachycardia, premature ventricular contraction and "complex ablations", which included atrial fibrillation and scar-mediated ventricular tachycardia ablation. If no abnormality was found, the procedure was labeled as "normal EP study". Multivariate regression analysis was performed to assess predictors of atrioventricular nodal reentry tachycardia among patients presenting with undifferentiated supraventricular tachycardia. A total of 459 patients were included in the study. The mean age was 42.06 years (±14.89 years), and 256 (55.77 %) were females. The most common procedure was supraventricular tachycardia (n = 289/459, 63.24 %), and only 5 % had complex ablations. The most common type of supraventricular tachycardia ablated was found to be atrioventricular nodal reentry tachycardia (n = 157/289, 54 %). Multivariate logistic regression revealed female sex and age to be independently associated with atrioventricular nodal reentry tachycardia (OR = 2.27 95 % CI [1.40-3.67]) for female sex and (OR = 1.02 95 % CI [1.01-1.04]) for every increase in age by 1-year. We reported a younger average age than other countries and less complex ablations. In addition, we reported 2 independent predictors of atrioventricular nodal reentry tachycardia in patients presenting with undifferentiated supraventricular tachycardia. Larger studies including multiple centers should be performed to confirm our findings.

Patients&amp;apos; comprehension and satisfaction with informed consent at day surgery unit at King Khalid University Hospital, Riyadh, Saudi Arabia

Background: Informed Consent (IC) is a crucial element in medical practice and research. However, additional research is needed to assess the quality of IC in Middle Eastern regions, including Saudi Arabia. This study aimed to measure surgical patients&amp;apos; comprehension and satisfaction with IC and related factors at King Khalid University Hospital (KKUH). Methods: This cross-sectional study investigated postsurgical patients&amp;apos; satisfaction and comprehension of IC at the day surgery unit at KKUH from August to December 2022. Data collection was done through an online questionnaire. Results: A total of 387 patients participated in this study, with over half (56.1%) being women (mean age = 41.4 ± 13.4). More than 88% of the patients were satisfied with all IC components. Patients aged 26-45 reported the highest levels of IC understanding (54.9%, p &amp;lt; 0.05), and female patients demonstrated higher overall comprehension compared to male patients (p = 0.088). Those with higher education and income had the highest comprehension scores (61.2%, p &amp;lt; 0.05) and (28.4%, p &amp;lt; 0.05), respectively. Only 54% of patients read the IC form and were aware of who provided them with the forms. Approximately 92% of the patients signed the IC form themselves, and 72% required less than an hour to consent. Conclusion: Middle-aged patients, women, and those with a high level of education exhibited the highest overall IC comprehension and satisfaction. The findings underscore the importance of personnel delivering therapy introducing themselves and indicating their involvement in the team. The future of the IC process lies in electronic standardization through the use of \&amp;quot;Esihi,\&amp;quot; KKUH&amp;apos;s current electronic record system.

Application of Aviation Risk Management Policy in Medical Error Cases at King Khalid University Hospital

Abstract Objectives: Cognitive errors are believed to be responsible for the majority of medical errors in clinical practice. We set to identify the prevalence and the types of cognitive errors among cases reviewed by the Morbidity and Mortality (M and M) Committee at King Khalid University Hospital (KKUH). Methods: A cross-sectional, descriptive study conducted at KKUH, in Riyadh, Saudi Arabia from January 2017 to December 2019. All consecutive cases of adult patients that have had a full review by the M and M committee were included. We applied the adapted (aviation risk management criteria to medicine) to detect any cognitive error among our cases. The cases were classified into three classes based on the number of present errors (A; 3 or more errors, B; 2 errors, and C; 1 error). Descriptive statistics (frequencies and percentages) were used to describe the categorical study variables. Results: A total of 16 cases were included in this analysis. Eight cases (50%) fulfilled the criteria for category “A” (3 or more cognitive errors). Cases categorized as “B” with 2 errors was seen in 43.8% and cases categorized as “C” with 1 error was seen in 6.2% of cases. The most commonly observed errors were diagnostic flaws such as diagnostic errors in the face of patients’ symptoms. Conclusion: We used the aviation risk management approach to identify cognitive errors in medical cases. We observed that ≥3 errors were more prevalent in the reviewed cases, and the majority of these errors were due to diagnostic flaws.

Presenting Symptoms of Colorectal Cancer in a Tertiary University Hospital in Saudi Arabia

Abstract Background: Colorectal cancer (CRC) is the most common cancer among Saudi males with age standardized rate (SAR) of 12.9 and 12.5/100,000 in 2016 and 2017, respectively, and the third most common cancer among Saudi females with (SAR) of 9.5 and 10.9/100,000 in 2016 and 2017, respectively. Aim: The aim of this study is to identify the presenting symptoms of CRC in our population and to improve our ability to diagnose it and treat it as early as possible. Materials and Methods: In this retrospective analysis, the medical records of all patients diagnosed with CRC in King Khalid University Hospital during 2016 and 2017 (n = 266), were reviewed. Results: The median age at diagnosis was 59 years (standard deviation = 13.6), 52 (22%) of those patients were younger than 50 years old, and 20 (9.9%) were younger than 40 years old. 137 (58%) of them are males. The most common presenting symptoms were abdominal pain (n = 115, 54.8%), weight loss (n = 96, 45.7%), and hematochezia (n = 88, 41.9), For more than half of the patients, bleeding per rectum was not reported, and for the majority of the patients younger than 50 years old, only (n = 24, 49%) presented with bleeding per rectum, abdominal pain (n = 32, 65.3%) and weight loss (n = 21, 42.9%). 87 patients (48%) had stage III tumor at presentation while 44 (24%) had stage IV. Conclusion: diagnosis of CRC should have a high index of suspicion to diagnose it at an earlier stage and have a better outcome, especially in the younger population.

Risk Factors for Opioid Misuse, Abuse, and Dependence Among Pain Clinic Patients: A Cross-Sectional Study at King Khalid University Hospital during 2020.

BACKGROUND Physicians are faced with the risk of patients developing opioid use disorders (OUDs) when prescribing patients opioids for long periods of time. Therefore, it is highly recommended to continuously monitor and evaluate long-term non-cancer pain patients who are prescribed opioids. This study aims to estimate the prevalence of OUDs in 103 patients with active opioid prescriptions attending the Pain Clinic at King Khalid University Hospital. MATERIAL AND METHODS A cross-sectional study was conducted at King Khalid University Hospital's pain clinic from 2020 to 2022. A list of all patients attending the Pain Clinic with an opioid prescription was provided by the hospital. Through telephone interviews, consent was secured followed by the collection of demographic variables and prescription-related variables. Additionally, patients were asked to complete the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.1) opioid questionnaire. RESULTS Most of the 103 patients were at moderate risk for abuse (91.3%), while a smaller percentage were at high risk (dependence) (5.8%) and low risk (misuse) (2.9%). Tramadol was the most-prescribed opioid (43.7%). Young age (<50) (Z=2.534; P=0.011), opioid use for more than 90 days (Z=2.788; P=0.005), and the prescription of tramadol (Z=4.124; P<0.001) were associated with higher risk of OCDs. CONCLUSIONS Younger patients, opioid use >90 days, and tramadol are associated with a higher risk of opioid misuse. However, further studies on a larger scale and in various settings are needed to provide evidence accurately reflecting the general population, as this study focused on the population of pain clinic attendees.

Overlap Between Gastroesophageal Reflux Disease and Irritable Bowel Syndrome and Its Impact on Quality of Life.

Background Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are common gastrointestinal disorders that can negatively affect quality of life and healthcare costs. The co-occurrence of these conditions can lead to more complex symptomatology and therapeutic challenges. Therefore, understanding the extent of overlap between GERD and IBS is paramount. This study aims to estimate the overlap between GERD and IBS in Saudi Arabia and its impact on quality of life. Methods Patients with GERD at primary care clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, were the subjects of cross-sectional research. The patients were selected using a simple random sampling technique, and an electronic questionnaire was utilized to collect data. Symptoms of IBS were assessed based on Rome IV criteria, and quality of life was evaluated using the GERD quality of life tool. Results Of the 293 GERD patients, the prevalence of co-occurrence of IBS among GERD patients was 35.8%. The GERD health-related quality of life (GERD- HRQL) scores ranged from 0 to 50, with a median and interquartile range (IQR) of 14 (8.5-20). Those with GERD and IBS had a significantly higher GERD-HRQL score than the patients with GERD alone (11 vs. 9, p-value: 0.049). Furthermore, patients with GERD and IBS had a significantly higher GERD-HRQL score than the patients with IBS alone (15 vs. 11, p-value: 0.001). Of the total participants, 29.4% reported having abdominal pain in the last three months. The majority of the participants (55.6%) reported experiencing abdominal pain one to two times per week, while 22.2% reported experiencing it two to three days per month. Conclusion The high prevalence of IBS co-existence among GERD patients highlights the importance of considering both diseases in clinical practice to improve patient outcomes. The study also found that patients with both GERD and IBS had a significantly lower quality of life than those with GERD or IBS alone.

Prevalence of Varicose Veins and Its Risk Factors among Nurses Working at King Khalid University Hospital Riyadh, Saudi Arabia: A Cross-Sectional Study.

This quantitative observational cross-sectional study assessed the prevalence and level of risk scores for varicose veins among nurses, and the association between varicose veins and sociodemographic, occupational, and lifestyle risk factors. Using simple random sampling, from August-December 2022, 250 nurses from different departments at King Khalid University Hospital completed a validated self-administered questionnaire and underwent an observational physical examination. Most nurses (191) had low-risk scores for varicose veins, 46 nurses had moderate-risk scores, and 13 nurses had high-risk scores. From the outpatient clinics, 61.5% of nurses had significant high-risk scores for varicose veins. Those with a statistically significant association had a family history of varicose veins (p < 0.001) and other chronic medical conditions (p = 0.04). Physical activity, especially race-walking/running (p = 0.006), showed a statistically significant association with the varicose veins score. The years as a staff nurse were statistically significant among the occupational risk factors (p = 0.003). The adjusted multivariable regression model showed three significant predictors: a positive family history, running/walking, and total years as a staff nurse (p < 0.001, p = 0.02, and p < 0.001, respectively). Nurses working at outpatient clinics, positive family history, years as a staff nurse, and other chronic conditions are risk factors for varicose veins, while race-walking/running is a protective factor.

Description of Candida auris Occurrence in a Tertiary Health Institution in Riyadh, Saudi Arabia.

Candida auris is an emerging multidrug-resistant fungal pathogen that represents a current serious threat to healthcare settings. The objective was to determine the prevalence of C. auris in a Riyadh hospital since its initial detection in late 2019. Using an adapted risk assessment tool, we reviewed the charts and medical files of all suspected and confirmed cases of C. auris infections reported at King Khalid University Hospital, Riyadh, between November 2019 and December 2022. Anonymized data were retrieved in a pre-established datasheet and analyzed to determine the epidemiological characteristics of C. auris infections in our facility. We analyzed prevalence by age, gender, risk factors, and according to sampling source. Of the 53 confirmed C. auris-positive cases during the study period, 33 (62%) were males. Their ages ranged between 15 and 98, with most positive cases occurring in those aged 50 and above. Only one of the confirmed cases was hospital-acquired. All patients had at least one risk factor, and urine samples yielded the greatest number of positive cases, while admission to healthcare facilities constituted the highest risk in our study. Establishing a local prevalence pattern could serve as a baseline/benchmark to compare with regional and international benchmarks.

Abstract #1608326: Higher Prevalence of Vitamin D Deficiency is Seen in the Clinical, Biochemical, and Radiological Studies of Low-Trauma Colles’ Fracture Among Patients Aged 40 and Above Attending King Khalid University Hospital 2009-2019 Compared With Other Populations

Abstract #1608326: Higher Prevalence of Vitamin D Deficiency is Seen in the Clinical, Biochemical, and Radiological Studies of Low-Trauma Colles’ Fracture Among Patients Aged 40 and Above Attending King Khalid University Hospital 2009-2019 Compared With Other Populations

2572. Adherence to Evidence-based Guidelines for the Management of Pneumonia in a Tertiary Teaching Hospital in Saudi Arabia

Abstract Background Abstract: Background Adherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh. Methods Methods A single-centered, retrospective observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) who have been diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included. Results A total of 148 patients were included in this study, with an average age of 65 ± 20 years. Demographics and baseline characteristics of the included patients are shown in Table 1. The data showed that only 74 (50%) were treated according to the guidelines' recommendations, while the other 74 (50%) were not. The former group had a statistically higher cure rate and lower mortality compared to the latter (95% vs. 84%; p = 0.034) and (5% vs. 14%; p = 0.022), respectively (Figure 1). Nevertheless, patients who were treated according to the guidelines had a higher CURB-64 score for pneumonia severity and Average Calculated Charlson comorbidity index than patients who were treated irrespectively of the guidelines (1.86 vs 1.39) and (4.62 vs 3.28), respectively, yet, no statistically significant difference was observed (Table 1 and 2). Demographics and Clinical outcomes of included patients n=148 Conclusion Conclusion Non-adherence to the evidence-based guidelines has been observed in 50% of patients treated for pneumonia. In addition, higher clinically cure rate, shorter length of stay and lower mortality rate have been observed in patients who were treated based on the evidence-based guidelines. Disclosures All Authors: No reported disclosures

Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia

Outcomes and appropriateness of colonoscopy referrals at King Khalid University Hospital, Saudi Arabia

Mental Illnesses and Quality of Sleep Among Nurses Working at a Tertiary Hospital in Riyadh During the COVID-19 Pandemic.

Objectives This study primarily aimed to estimate the prevalence of mental illnesses (depression, anxiety, and stress) along with the poor quality of sleep, with a secondary focus on determining whether there was an association between mental health and quality of sleep among nurses working at King Khalid University Hospital,Riyadh, Saudi Arabia, during the COVID-19 pandemic. Methods A cross-sectional study was conducted from June to December 2021 during the COVID-19 pandemic on 309 nurses from different departments at King Khalid University Hospital. Depression, anxiety, and stress were measured by the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21), and sleep quality was measured by the Pittsburg Sleep Quality Index (PSQI) via an online survey. Results The prevalence of depression, anxiety, and stress was 30.4%, 43.7%, and 16.5%, respectively, while 61.5% showed poor sleep quality. The association between poor quality of sleep and the other outcome variables of mental health (depression, anxiety, and stress) was highly significant (p<0.0001). Conclusion Nurses have reported an increased prevalence of depression, anxiety, stress, and poor quality of sleep during the COVID-19 pandemic, making them particularly vulnerable to mental illnesses and sleep difficulties in the event of future pandemics. There is a clear link between mental health issues and poor quality of sleep, necessitating the provision of psychological support for nurses. Enhancing sleep quality is recommended as a way to decrease the prevalence of mental health concerns.

Prescribing pattern of antipsychotics for patients with schizophrenia using the total daily dose online tool

This study aimed to investigate the prescribing pattern of antipsychotic medications for schizophrenia using the British National Formulary total daily dose (TDD) online tool. We analysed data from the electronic medical records at King Khalid University Hospital (KKUH) of 272 patients diagnosed with schizophrenia who were prescribed both typical and atypical antipsychotic medications. The results showed that aripiprazole was the most commonly prescribed antipsychotic drug, followed by haloperidol then risperidone. The TDD online tool was used to calculate the TDD of each prescribed antipsychotic medication. Most patients were prescribed doses within the recommended range for each medication, although some were prescribed doses above or below the recommended range. Moreover, a high recommended TDD was associated with the combined use of antipsychotics rather than monotherapy. Additionally, high TDD levels were associated with the following antipsychotics: haloperidol, olanzapine, paliperidone, and quetiapine. Our findings highlight the importance of using evidence-based tools such as the TDD online tool to guide prescribing practices and ensure optimal dosing of antipsychotic medications for patients with schizophrenia.

Association of Nutritional Status and Diet Diversity with Skeletal Muscle Strength and Quality of Life among Older Arab Adults: A Cross-Sectional Study.

There is little research evaluating skeletal muscle strength, nutritional status, and quality of life in older Arab adults. This study examined the association of nutritional status with skeletal muscle strength and quality of life among older adults living in Saudi Arabia. A cross-sectional study was conducted among older adults (n = 166 older adults; 57.8% females) who visited primary outpatient clinics at King Khalid University Hospital in Riyadh City. Sociodemographic data, Mini Nutritional Assessment short-form (MNA-SF), diet variety score (DVS), and health-related quality of life (HR-QoL) were assessed. Furthermore, handgrip strength (HGS) and knee extension strength (KES) were measured to evaluate skeletal muscle strength. Malnourishment and risk of malnutrition were found in 16.9% of our sample. Nutritional status was significantly associated with muscle strength and HR-QoL (p < 0.05). The well-nourished group had higher HGS, KES, and total HR-QoL scores compared to the at risk of malnutrition or malnourished group. Moreover, there was a moderate positive correlation between MNA-SF and total HR-QoL scores (r = 0.40). The percentage of individuals in the well-nourished group categorized with a high or moderate DVS was significantly higher than those at risk of malnutrition or are malnourished; however, DVS was not associated with muscle strength and HR-QoL. The MNA-SF score had a significant positive correlation with HGS (r = 0.30) and KES (r = 0.23). An increase in the MNA-SF score was significantly associated with higher odds of being moderate/high (HGS and HR-QoL) in the crude and adjusted models. In conclusion, maintaining adequate nutritional status is beneficial for preserving skeletal muscle strength and promoting better HR-QoL among older individuals. Therefore, applications of appropriate nutritional and muscle strength assessments in geriatric care institutions are recommended.

Non-alcoholic Fatty Liver in Children and Adolescents in Saudi Arabia.

Objectives This study aims to describe the disease parameters of children and adolescents diagnosed with non-alcoholic fatty liver disease (NAFLD) in Saudi Arabia. It also investigates the disease's progression and compares clinical, biochemical, and radiological parameters at baseline and follow-up of patients with NAFLD. This study was done between two groups of patients: obese and those of average body weight. Methods A retrospective cohort study was conducted between 2014 and 2018 through retrieved data from medical records. It included all children aged between six to 18 years diagnosed with NAFLD. Medical history was taken from each medical record, liver function test results, cholesterol, blood pressure readings, and body weight. Data have been restored from King Abdullah Specialist Children's Hospital (KASCH)​, Security Forces Hospital (SFH), and King Khalid University Hospital (KKUH). Results A total of 116 subjects met the inclusion criteria; 65 (56%) were male, and 81 (70%) were obese. The majority of subjects (n=112) had mild NAFLD, with (71%) obese and(29%) non-obese, followed by moderate NAFLD with 50% among obese and non-obese (N=2), and non-alcoholic steatohepatitis (NASH) with 100% non-obese (N=2). Data showed that patients' proportion of obese to non-obese is 70% (N=81) to 30%(N=35), respectively. Conclusion NAFLDwas found to affect obese children and adolescents more than non-obese, and male patients had a higher proportion of NAFLD than females. Also, obese patients had more advanced stages of NAFLD than non-obese patients. Finally, most subjects had been diagnosed with mild stage while a few had developed NASH.