King Saud Medical City Research Articles

Impact of High Troponin Level on the Outcome in COVID-19 Positive Patients.

COVID-19 is a new disease caused by the recently discovered SARS-CoV-2 virus. The COVID-19 disease manifests in several ways and it may affect various systems, including the gastrointestinal, musculoskeletal, neurological, cardiovascular, and pulmonary systems. Individuals who have ad-additional health conditions, such as cardiovascular disorders, are particularly more likely to experience illness and death. This study aimed to assess the clinical effect of COVID-19 on myocardial injury, as measured by troponin elevation, and to determine if this effect has an impact on the outcome. This retrospective study was conducted at King Saud Medical City. The electronic medical records used to identify all admitted patients between March 23 and June 15, 2020, with a laboratory-confirmed positive COVID-19 diagnosis who had troponin I measured. During the study period, 768 COVID-19-positive patients were hospitalized. Of those, 187 patients were excluded because the troponin level was not measured. The remaining 581 (75.7%) had troponin I measured. Overall, 89 of 581 (15.3%) patients died. Of those, 67.8% were in the markedly elevated cTnI group, 8.5% were in the mildly elevated cTnI group, whereas no deaths were reported in the group with normal cTnI levels. Myocardial injury was observed in COVID-19-admitted patients at a significant level that warrants attention to this consequence. In older individuals with pre-existing cardiovascular comorbidities, the diagnosis of myocardial injury was linked to a higher likelihood of being admitted to the intensive care unit, experiencing a worse prognosis, and ultimately, death.

Association of early dysglycemia with intraventricular hemorrhage and mortality in very low birth weight infants.

To investigate the combined effect of hyperglycemia and hypoglycemia on intraventricular hemorrhage (IVH) and mortality recognizing that previous research has predominantly focused on examining these conditions independently. This study included very preterm infants who were born at King Saud Medical City, a tertiary referral center, and admitted to a level 3 neonatal intensive care unit between January 2020 and January 2024. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used to adjust for potential confounding factors. A total of 554 infants met the inclusion criteria. Hyperglycemia and/or hypoglycemia developed in 75.5% (418) patients within the first postnatal week. During the study period, IVH occurred in 28.5% (N = 158), and severe IVH occurred in 13% (72) infants. In addition, 13.7% (76) of infants died during the study period. The multivariate regression revealed an association between the isolated hyperglycemia, combined exposure of hypo- and hyperglycemia, and development of IVH (relative risk [RR], 2.10; 95% confidence interval [CI], 1.36, 3.25; RR, 2.33; 95% CI, 1.34, 4.06, respectively). Severe IVH was significantly associated with isolated hyperglycemia (adjusted relative risk [aRR], 2.46; 95% CI, 1.16, 5.23). Death was associated with combined hypo- and hyperglycemia (adjusted hazardous ratio [aHR], 3.19; 95% CI, 1.23, 8.26).Conclusion: Combined hyper- and hypoglycemia in the first week of life of premature babies increases the risk and severity of IVH and neonatal mortality.

Copy Number Variants in 30 Saudi Pediatric Patients with Neurodevelopmental Disorders: From Unknown Significance to Diagnosis.

Structural variants (SVs), such as copy number variants (CNVs), insertions, deletions, inversions, and translocations, contribute significantly to genetic diversity and disease etiology. CNVs, which involve the duplication or deletion of DNA segments, are particularly impactful on genes crucial for biological functions and disease processes. To reassess unclassified SVs that may be underlying unresolved neurodevelopmental disorders among Saudi patients. In this retrospective study conducted at King Saud Medical City, Riyadh, Saudi Arabia, 30 probands with neurodevelopmental disorders and congenital malformations were examined using next-generation sequencing methods-exome sequencing, gene panels, or SNP arrays (the Illumina platform). Reclassification was aided by online tools such as VarSome and ClinVar, with pathogenicity assessments using the ClinGen CNV Pathogenicity Calculator based on American College of Medical Genetics and Genomics criteria for CNV loss and gain, and dosage sensitivity. A total of 31 CNVs were analyzed, of which 2 were reclassified: one as benign and the other as pathogenic. The pathogenic CNV, [3p13p12.3 (70411134_75249376) x1], included a deletion of the FOXP1 gene and was associated with an intellectual developmental disorder, language impairment, possible autistic features, psychomotor impairment, developmental regression, and epilepsy. This study underscores the importance of continuously documenting and revisiting unclassified CNVs in accessible databases to enhance the diagnosis and understanding of complex genotype-phenotype relationships. Reclassifying these CNVs not only accelerates diagnostic processes but also enriches our insight into their significant roles in health and disease.

The Role of Internal Control in Improving Financial Performance: A Case Study of King Saud Medical City in Riyadh

The Role of Internal Control in Improving Financial Performance: A Case Study of King Saud Medical City in Riyadh

Prevalence of Low Bone Mineral Density and Associated Risk Factors among Patients with Systemic Lupus Erythematosus: A Retrospective Observational Study

Abstract Objectives: The objective of this study was to determine the prevalence of low bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE) and evaluate potential risk factors. Methods: A retrospective observational study of 144 patients with SLE who had at least one BMD test through dual-energy X-ray absorptiometry (DEXA) scan was conducted at King Saud Medical City and Prince Sultan Military Medical City in Riyadh, Saudi Arabia, between April 19, 2022, and April 18, 2023. Multivariate linear regression analyses were performed to determine the risk factors for low BMD. Results: The study included 144 SLE patients. The prevalence of low BMD was 53.3%. Low bone mass prevalence (defined as a Z-score <−2.0 in premenopausal women and men younger than 50 years), osteopenia, and osteoporosis were 29.9%, 13.2%, and 10.4%, respectively. There were 5.6% patients with fragility fractures, 75% vertebral fractures, and 25% peripheral fractures. Older age, postmenopausal status, arthritis, and high cumulative glucocorticoid dose were associated with low BMD. Immunosuppressive agents are protected against low BMD. In multivariate linear regression analyses, postmenopausal status remained a risk factor for low BMD. Conclusions: Patients with SLE are at a high risk of having low BMD. The majority exhibit low bone mass rather than osteopenia or osteoporosis, with the most common fractures occurring in the vertebrae. Notably, postmenopausal status represents a major risk factor for low BMD in patients with SLE.

Health Education Resources Favored by Out-Patients Attending King Saud Medical City, Riyadh.

Background Health education, primarily through printed materials, is crucial for promoting preventive healthcare. It is essential to understand patients' preferences and ensure patient engagement in healthcare decisions. Health literacy challenges persist, and web-based platforms are expanding access. Tailoring materials to target populations, considering content, layout, and cultural appropriateness, maximizes effectiveness. This study aimed to determine the preferred health education resources for patients visiting King Saud Medical City, Riyadh. Methodology A cross-sectional study was conducted at King Saud Medical City, Riyadh, targeting adults in outpatient and staff clinic waiting areas. Data were collected using a validated questionnaire and analyzed with IBM SPSS Statistics for Windows, Version 29.0 (Released 2023; IBM Corp., Armonk, New York, United States). Results The study included 210 participants and revealed key preferences in health education. Notably, 57.6% preferred social media platforms, while 49.1% favored a doctor as their primary source. Participants prioritized pictures/photos (27.8%) and labels (56.2%) for printed materials. Most participants (91.4%) chose formats based on the comprehensive content provided. Participants sought general health guidance (26%) and preferences were significantly associated with education levels (p=0.010) and different sources (p<0.001). Additionally, students showed a significant association with receiving health education (p=0.046). Conclusion The current study revealed diverse preferences for health education resources among patients at King Saud Medical City. The most favored method was social media platforms (57.6%, n=121), with participants ranking it as their first preference. Understanding these preferences is crucial for tailored and effective health education strategies.

Patient Contentment Regarding Health Education Services at King Saud Medical City in Riyadh, Saudi Arabia.

Health education enhances healthcare outcomes and patient satisfaction, and with digitalized methods, it is gaining popularity in high-income nations. Effective education promotes behavioral change, treatment adherence, and overall satisfaction while maintaining interpersonal communication.Despite the strides made in medical advancements for diagnosis and treatment, interpersonal communication remains the primary conduit for information exchange, particularly manifested through health education dialogues between medical practitioners and patients. A cross-sectional study was conducted at King Saud Medical City (KSMC), Riyadh, Saudi Arabia, to assess patient satisfaction with health education services. Data were collected through a structured questionnaire. Data were analyzed by IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States). This study on patient satisfaction with health education at KSMC in Riyadh included 225 participants, predominantly females (67.6% (n=152), mean age 38.5 years). Diabetes was the most prevalent (21.3%, n=48) among participants. Doctors were the primary source of health advice (46.2%, n=104). Structural aspects received high satisfaction (mean score of 31.8), surpassing healthcare provider delivery (mean score of 24.9) and print materials (mean score of 22.7). Demographically, occupation significantly impacted contentment (p-value=0.002), with students exhibiting the highest scores. Logistic regression highlightedpatients' occupation (aOR=1.498) and patients' level of education (aOR=0.420) as predictors of contentment. This study highlighted high satisfaction with structural aspects of health education. Occupation, particularly among students, significantly impacts contentment. Tailoring education strategies based on occupation and education levels is crucial for improved patient satisfaction.

Risk Factors of Gestational Diabetes Mellitus Among Pregnant Women Attending Antenatal Care in King Saud Medical City, Riyadh, Saudi Arabia.

Gestational diabetes mellitus (GDM) is a common prenatal condition. Many risk factors have been linked to its occurrence. This study aimed to assess the risk factors of GDM among pregnant women attending antenatal care (ANC) in King Saud Medical City (KSMC), Riyadh, Saudi Arabia, and explore the relationship between risk factors and different socio-demographic factors. This cross-sectional observational study was conducted on a total of 184 participants usinga self-administered questionnaire distributed among pregnant women attending ANC. The collected data included sociodemographic information, medical history, obstetric history, and family history of GDM and its associated risk factors. Qualitative data was expressed in the form of numbers and percentages (N and %). The chi-square (χ2) test was used to examine qualitative data between two groups. The associations of GDM with these risk factors and other comorbidities were assessed, with a p-value of less than 0.05 considered significant. The prevalence of GDM was 23.9%. There was a significant association between GDM and family history of diabetes (n=39, p-value=0.0218), above normal glucose tolerance test (n=19, p-value≤0.001), and the last trimester of pregnancy (n=24, p-value=0.0139). There were no significant associations between GDM and smoking, hypertension, and adherence to health advice (p-value>0.05). GDM exhibited a high prevalence among pregnant women in KSMC, Riyadh, Saudi Arabia. It showed significant associations with family history of diabetes, abnormal glucose tolerance test results, and the last trimester of pregnancy.

Identifying the key characteristics, trends, and seasonality of pedestrian traffic injury at a major trauma center in Saudi Arabia: a registry-based retrospective cohort study, 2017–2022

BackgroundPedestrian traffic injuries are a rising public health concern worldwide. In rapidly urbanizing countries like Saudi Arabia, these injuries account for a considerable proportion of trauma cases and represent a challenge for healthcare systems. The study aims to analyze the key characteristics, seasonality, and outcomes of pedestrian traffic injuries in Riyadh, Saudi Arabia.MethodsThis study was a retrospective cohort analysis of all pedestrian traffic injuries presented to King Saud Medical City, Riyadh, and included in the Saudi Trauma Registry (STAR) database between August 1, 2017, and December 31, 2022. The analysis of metric and nominal variables was reported as mean (standard deviation, SD) or median (interquartile range, IQR) and frequencies (%), respectively. A logistic regression analysis was performed to examine the influence of patients’ pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation and in-hospital mortality.ResultsDuring the study period, 1062 pedestrian-injured patients were included in the analysis, mostly males (89.45%) with a mean (SD) age of 33.44 (17.92) years. One-third (35.88%) of the patients were Saudi nationals. Two-thirds (67.04%) of the injuries occurred from 6 p.m. until 6 a.m. Compared to other years, a smaller % of injury events (13.28%) were noticed during the COVID-19 pandemic (2020). Half (50.19%) of the patients were transported to the emergency department by the Red Crescent ambulance, and 19.68% required intubation and mechanical ventilation. Most of the patients (87.85%) were discharged home after completion of treatment, and our cohort had a 4.89% overall mortality. The logistic regression analysis showed the influence of patients’ pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation (Chi2 = 161.95, p < 0.001) and in-hospital mortality (Chi2 = 63.78, p < 0.001) as a whole significant.ConclusionThis study details the demographic, temporal, and clinical trends of pedestrian traffic injuries at a major Saudi trauma center. Identifying high-risk individuals and injury timing is crucial for resource allocation, targeting road safety interventions like public awareness campaigns and regulatory reforms, and improving prehospital care and patient outcomes.

Assessment of the services provided at the family medicine staff clinics in King Saud Medical City, Riyadh.

Patient satisfaction is the subjective evaluation of a patient's cognitive and emotional responses. This reflects their expectations regarding the ideal healthcare to be provided. This study aims to assess the satisfaction level of the attendees to the family medicine staff clinics at King Saud Medical City, Riyadh. A descriptive cross-sectional study recruited 378 participants. An adapted and piloted questionnaire was used to gather the data. The questionnaire enquires about the communication skills of the receptionist, the triage nurse, and the assigned physician. It included questions regarding the structure of the clinics. Females represent the majority of about 255 (67.5%). About 2/3 of the respondents were within the age group of 18-34 years, 245 (64.8%). A high level of satisfaction was reported by the participants regarding the professionalism, kindness, interest of the staff member, and waiting time. Gender, marital status, and age group have no significant effect on the satisfaction level; the P value was uniformly more than 0.05. The result of this study identified high satisfaction responses regarding the communication skills of the receptionist, triage nurse, and physicians. The overall evaluation of the experience during staff clinic visits was satisfactory. Periodic evaluation of these attributes and other indicators that promote patient-centered care should be undertaken to improve the overall quality of care.

The Prevalence and Associated Risk Factors of Pressure Injury among Adults at King Saud Medical City, Riyadh

Background: Pressure injuries rank among the top five most frequent causes of patient injury worldwide. Usually, these ulcers develop in the body's bony regions where there is a higher chance of pressure and tissue deformation. Pressure injuries are still a common and severely incapacitating ailment, even with advances in medical understanding and the development of efficient therapies and preventative measures. They result in large socioeconomic consequences since they place a heavy load on the healthcare system and the affected individuals. Objectives: To assess the occurrence rate, identify correlated risk factors, and analyze additional indicators related to pressure injuries diagnosed within the care units of King Saud Medical City throughout the study period. Methodology: A descriptive cross-sectional study was undertaken at King Saud Medical City in Riyadh during the months of August and September 2023. The study focused on patients with newly identified pre-existing pressure injury lesions. Demographic information and associated risk factors were recorded in the study's data extraction sheet after obtaining participants' consent to engage in the research. The study commenced following approval from the institutional review board of king Saud medical city research and Innovation center, Riyadh. The gathered data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 26. Descriptive statistics, bivariate and multivariate logistic regression were computed to assess the statistical association, using odds ratio. Significance of statistical association was assured and tested using 95% confidence interval and P-Value of &lt; 0.05 is considered statistically significant. Results: A total of 250 patients with pressure ulcers were identified during the study period. Most of the study participants were male, and the mean age of the participants was 59.2 years. The prevalence of pressure injuries in the hospital units included in the study was 18.8%. The sacral region was the most affected site, with 121 patients (48%) having pressure injuries in that area, while 83 patients (33%) had pressure injuries in the gluteal area. The most frequently associated comorbidities were hypertension, present in 140 patients (56%), and diabetes mellitus, present in 123 patients (49.2%). Conclusion: The prevalence of pressure ulcers was high among admitted patients at King Saud Medical City, Riyadh. Primary prevention health promotion programs should be implemented to prevent the occurrence of pressure injuries in our healthcare facilities and the community at large.

The Associated Factors with the Occurrence of Patients Falling in a Government Hospital in Saudi Arabia: A Cross-Sectional Study of Nurses

Introduction: Patient falls are a global concern that has been identified as one of the most common adverse events affecting patient safety in healthcare institutions around the world. In this study, factors associated with the occurrence of patients falling were investigated and classified into three categories: patient-related factors, environment conditions and nurse-related factors. Methods: The study was descriptive and cross-sectional. It was conducted between 15 February and 15 March 2024 in King Saud Medical City. A self-administered questionnaire was personally sent to staff nurses. The total nurses participating in the study was 504. Results: The most common factors leading to patient falls are wet floors, an absence of warning signs, a lack of safety grab bars, unsafe corridors, and a shortage of staff nurses, as well as distributing patients in different rooms, making it difficult to observe all of them simultaneously. Moreover, a patient who starts walking after an extended period in bed will be at increased risk of falling. Nurses also agreed that polypharmacy can be a risk factor for patient falls. Conclusion: The results present a clear picture of the various factors that healthcare professionals perceive as contributing to patient falls. Environmental conditions, operational issues and patient-related factors all play significant roles.

Thyroid dysfunction and autoantibodies in rheumatoid arthritis patients at King Saud Medical City: A retrospective cohort study

Abstract: BACKGROUND: Autoimmune thyroid diseases often coexist with conditions such as Sjögren’s syndrome and rheumatoid arthritis (RA). Studies have shown that patients with RA are at an increased risk of thyroid dysfunction. Studies conducted in Egypt and Jeddah have demonstrated a higher prevalence of thyroid dysfunction in patients with RA. This study aimed to determine the prevalence of thyroid dysfunction and its characteristics in patients with RA treated at a single center in Saudi Arabia. METHODS: This was a retrospective cohort study conducted at King Saud Medical City, Riyadh, Saudi Arabia. All patients with RA who qualified for the American Rheumatism Association criteria between 2016 and 2021 were eligible for inclusion. All patients underwent clinical examination and tests for thyroid function and RA-specific autoantibodies. The primary outcome was the presence or absence of thyroid disorders. RESULTS: A total of 158 RA patients were included. Eighty-five patients (53.8%) were seropositive, including 65 (41.1%) positive for rheumatoid factor and 58 (36.7%) positive for anti–citrullinated protein antibody. Erythrocyte sedimentation rate was elevated in 108 (72%) patients and 28 (19%) patients had significant Disease Activity Score (DAS 28). Vitamin D deficiency was observed in 100 patients (66.7%). Sixteen percent of patients in this cohort had hypothyroidism and 4.2% had hyperthyroidism. Vitamin D deficiency was associated with hyperthyroidism (2.1% vs. 8.9%, P = 0.048). Vitamin D deficiency was not significantly linked to seropositive RA (50% vs. 60%, P = 0.247) but was significantly associated with higher DAS 28 (15% vs. 30%, P = 0.030). CONCLUSION: Our study provides insights into thyroid patterns in Saudi Arabian patients with RA, highlighting the role of Vitamin D in thyroid disorders and disease activity. CATEGORIES: Internal Medicine, Rheumatology.

Incidence, Knowledge, Attitude and Practice of Healthcare Workers Regarding Needle Stick Injuries at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background: A needle stick injury is a serious occupational health hazard in health care settings. Health care workers are at risk of bloodborne diseases and the psychological consequences of these injuries. Objectives: we aimed in this study to assess the prevalence of NSI among health care workers in King Saud Medical City and to assess their knowledge, attitude and practices regarding needle stick injuries. Methods: A cross-sectional study was conducted from 17th August 2022 until 30th November 2023. A structured questionnaire from Saudi Ministry of Health guidelines was used to collect the data. The content validity was evaluated by four academics from King Khalid University in Abha, and some minor changes were made. Results: As regard the prevalence of NSI, out of 220 participants, 132 individuals did not report any needle-stick injuries (NSI). While 92.3% of participants accurately defined NSI and acknowledged blood-borne disease transmission risks, only 39.1% followed preventive measures like recapping needles and proper disposal. There were knowledge gaps observed, with varying awareness levels on Hepatitis B and C prevention. Participants demonstrated awareness of post-exposure guidelines but lacked knowledge on immediate actions to take post-injury. Attitudes towards NSI varied, with a significant percentage 44.1% prioritizing patient care over healthcare worker safety. Interestingly, significant support was shown for immediate reporting of sharp injuries and the belief that NSIs are preventable. In terms of practice, adherence to safe needle practices varied, with the majority 90.9% using assigned disposal containers and being vaccinated against Hepatitis B, but not all receiving recent training on safe devices. Conclusion: This study revealed that NSIs remain a prevalent occupational health hazard among healthcare workers. Although a significant number of participants demonstrated adequate knowledge and awareness of NSIs and bloodborne disease transmission risks, there were noticeable gaps in their implementation of preventive measures and immediate post-injury actions. Attitudes towards NSIs varied, with some prioritizing patient care over healthcare worker safety. However, there was strong support for the immediate reporting of sharp injuries and belief in the preventability of NSIs.

Implementation of effective strategies to prevent Candida auris transmission in a Quaternary Care Center, Riyadh, Saudi Arabia

This study outlines the results of an investigation of a large C. auris outbreak at King Saud Medical City (KSMC), a quaternary hospital in Saudi Arabia. We identified 122 cases of C. auris (colonization, 74; infection, 48) from June 2021 to June 2022. The mean patient age was 48.4 years, and the median duration of stay before diagnosis was 32.7 days. A significant proportion of patients (87.70%) were diagnosed with C. auris more than 3 days after admission to KSMC. The source of exposure was either nosocomial (from KSMC, 28.68%; from other hospitals, 16.39%) or unknown (54.91%). The hospitalization mortality rate was 45.90%. This report highlights the challenges in investigating and managing C. auris outbreaks, emphasizing the need for a comprehensive approach incorporating strategies for screening and early identification, effective environmental cleaning, and the implementation of stringent infection control measures such as hand hygiene, isolation of patient, standard and contact precaution and decolonization.

Incidence, patterns, and management of frontal sinus fractures: A 10-year retrospective study at a tertiary medical center, Saudi Arabia.

To assess the prevalence of various frontal sinus fractures (FSF) and examine the relationships between these fractures, types of treatments, and potential complications. A retrospective study was carried out in King Saud Medical City, Riyadh, Saudi Arabia. The study analyzed the records of patients who were diagnosed and treated with FSF from 2011-2021. Files with missing documents or incomplete treatment were excluded. The retrieved data includes: patients age, gender, types, locations, treatment, and complications of FSF. Data was analyzed by the statistical Package for the Social Sciences Statistics, version 23.0 using descriptive statistics and Chi-square test. A total of 72 cases were included, 94.4% males and 5.6% females. Road traffic accidents were the common cause of trauma (91%). Frontal sinus fractures were unilateral in 59.7% and associated other injuries in 80.6% of cases. Anterior table fractures were the largest proportion (58.3%), followed by anterior and posterior table (37.5%). The carried out surgical procedures were obliteration (23.9%), cranialization and obliteration (23.9%), and fixation only (52.2%). The post-operative complications were categorized into; neurological (22.2%), ophthalmic (15.3%), infection (2.8%), and deformity (16.7%). Anterior and posterior table had the highest percentage among these categories. Frontal sinus fractures were mostly required surgical treatment (63.9%) and post-operative complications occurred especially the neurological and ophthalmic. We recommend studies on the association of complications and different types of obliteration materials.

Efficacy and Safety of Injectable Dulaglutide 1.5 mg Among Type 2 Diabetes Patients in Clinics at King Saud Medical City, Riyadh, Saudi Arabia

IntroductionType 2 diabetes mellitus is the most common type of diabetes, characterized by varying degrees of insulin resistance and diminishing beta-cell function, which increases the risk of macrovascular and microvascular complications. Dulaglutide is a long-acting glucagon-like peptide-1 receptor agonist that is administered once weekly and approved for treating adults with type 2 diabetes mellitus. It can be used as a monotherapy or in addition to oral hypoglycemic or insulin therapy.AimThis study aims to provide information contributing to assessing the efficacy and safety of weekly 1.5 mg dulaglutide therapy in Saudi adult patients with type 2 diabetes mellitus.MethodsA retrospective single-arm cohort study using a purposive sample to recruit type 2 diabetes mellitus patients on dulaglutide from endocrine and diabetic outpatient clinics in King Saud Medical City (N = 205). Data were collected from participants’ medical profiles and through the phone using interview questionnaires.ResultsMost participants were female and married; approximately 33% had had diabetes for more than 20 years, 41.4% of the sample had third-class obesity, and more than half had used dulaglutide for the last 1–2 years. With therapy, weight, body mass index, hemoglobin A1c, and fasting blood sugar were significantly improved after 6 and 12 months from baseline. The main side effects reported were nausea (52%) and fatigue (28%).ConclusionDulaglutide is a safe and effective therapy that demonstrated favorable glycemic control and weight reduction in obese type 2 diabetes patients of Saudi origin.

Pregnancy Outcomes in Patients with Prosthetic Heart Valves in Saudi Arabia

Background: Pregnancies in women with heart prostheses are high-risk pregnancies with increased maternal and fetal adverse outcomes. Advances in prosthetic heart valve design and anticoagulation have improved these outcomes over the past decades. Objectives: To study the pregnancy outcomes in pregnancies with heart prostheses and to compare these outcomes between mechanical and biosynthetic heart prostheses in Saudi patients. Methods: In this single centered retrospective study conducted at King Saud Medical City (KSUMC) between January 2011 and February 2020, we have reviewed all pregnant women’s heart prostheses. Fetal and maternal data were obtained, and outcomes were compared between pregnancies with mechanical heart prostheses and bioprostheses. Results: A total of 111 pregnancies were reviewed. A total of 51.4% of pregnancies had bioprostheses, 48.6% had mechanical prostheses, and 64.0% of participants were obese. The majority of the participants had a parity in the range of 2-9 (N=107, 96.4%). The most frequent type of rheumatic heart disease was mitral regurgitation (N=49, 44.1%), followed by mitral stenosis (N=32, 28.8%). There was no maternal mortality and no structural valve failure. There was a high rate of hospital admission in both groups, up to 55% of pregnancies. The rates of abortion, postpartum hemorrhage and transfusions were higher than those in general pregnancies; however, there was no difference in maternal and fetal complications between the two types of prostheses, i.e., bioprostheses and mechanical. Conclusion: Although women with prosthetic heart valves have higher rates of adverse outcomes, they generally tolerate pregnancy well. There was no difference in adverse outcomes between bioprosthetic and mechanical prostheses

The Correlation Between Vitamin D Levels and the Glycemic Marker HbA1c and Lipid Profile in Patients With Type 2 Diabetes Mellitus: A Study at the King Saud Medical City, Riyadh.

Background and objective Vitamin D, a fat-soluble vitaminalso called the sunshine vitamin, is produced in plants, and animals when exposed to sunlight. It plays a crucial role in musculoskeletal development, immune system regulation, and glucose metabolism, thereby reducing the risk of diabetes. This study aimed to investigate the association of vitamin D levels with glycemic control markers [glycated hemoglobin (HbA1c)] and lipid profile, as well as sociodemographic factors and comorbidities. Methodology A cross-sectional study was conducted at the King Saud Medical City in Riyadh, Saudi Arabia, among adult diabetic patients aged 20 years and above. The sociodemographic characteristics, vitamin D levels, HbA1c, and lipid profilesof 472 participantswere studied. Data were analyzed using SPSS Statisticsversion 27 (IBM Corp., Armonk, NY). Results The majority of the participants were women (n=296, 62.7%); the mean age of the cohort was 56.5 ±13.13 years. Most participants were Saudi nationals (n=361, 76.5%). Lab tests revealed vitamin D deficiency (71.41 ±36.88 nmol/l) and elevated HbA1c(9.49 ±9.85%) in the cohort. Low-density lipoprotein (LDL) cholesterol levels were higher than normal (2.71 ±4.26 mmol/l), while high-density lipoprotein (HDL) was slightly lower (1.23 ±0.39 mmol/l). Bivariate correlations showed weak negative and positive associations between vitamin D and HbA1c(r=-0.093, p<0.05) and HDL (r=0.114, p<0.05), respectively. HbA1ccorrelated positively with triglycerides (r=0.168, p<0.01). Conclusions We found an association between deficiency of vitamin D and levels of HbA1cand lipid profile in type 2 diabetes patients. The association was marked by low vitamin D levels and characterized by high HbA1c, LDL cholesterol, and lipid profile. Elevated HbA1c, LDL cholesterol, and triglyceride levels suggested vitamin D's role in lipid homeostasis. Variations in biomarker levels across sociodemographic factors highlight the needfor personalized interventions for diabetes prevention and management.

Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises

Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1–14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.