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[This corrects the article DOI: 10.15537/smj.2025.46.10.20250181.].
[This corrects the article DOI: 10.15537/smj.2025.46.9.20240970.].
[This corrects the article DOI: 10.15537/1658-3175.1001.].
To analyze and compare temporal trends, demographic characteristics, and stage at diagnosis for thyroid cancer (TC) between Saudi and non-Saudi populations in order to identify potential population-specific etiological drivers. We conducted a national retrospective cohort study of TC cases in Saudi Arabia from 2013-2022. To assess population-level trends, we computed age-standardized incidence rates (ASIRs) and multivariable Poisson regression alongside piecewise regression models for comparative analysis. Among 14,159 total cases, TC incidence increased disproportionately in Saudi nationals, rising from 884 to 1,677 (90%), significantly outpacing the 184 to 275 (49%) increase observed in non-Saudis. The incidence rate ratio for Saudis versus non-Saudis was 5.67 (95% CI [5.41, 5.94]). Saudis presented with a significantly younger median age at diagnosis (5-10 years earlier, p < 0.001) and demonstrated a steeper annual increase in ASIRs (Interaction β = 0.0307, p < 0.001). A marked stage migration was concurrently observed among Saudi nationals, with localized diagnoses increasing from 55% to 71%. The recent period of the study (post-pandemic) revealed an acceleration in the Saudi cohort (+316.50 cases annually), a pattern absent in non-Saudis. The profound divergence in incidence trends provides compelling evidence consistent with distinct, population-specific etiological drivers. This suggests a need to investigate genetic and environmental factors unique to the Saudi population. However, the heterogeneity of the non-Saudi comparator group necessitates cautious interpretation of the observed incidence rates.
One of the optimal asthma management goals is to improve patients' quality of life. Limited Saudi studies assessed quality of life (QoL) among vulnerable groups like schoolchildren. This study conducted quantitative and qualitative approaches to examine asthma-related QoL in Saudi adolescent students. A mixed-approach study was conducted among guardians of Saudi schoolchildren with confirmed asthma disease during May and November 2025. Based on in-depth asthma QoL interviews, a qualitative approach was completed, and quantitative methods were applied for comprehensiveness. Both approaches were influenced by the reliable and verified Arabic PedsQL Asthma Module. MAXQDA was used to assess guardians' comprehensive responses, and the PedsQL Asthma Module scale was used to categorize and analyze the conclusion responses. Qualitative and quantitative analyses include 46 interviews. As some feelings of anxiety and worry among children were shown to be linked with asthmatic symptoms and complications, it appears that this nervousness impacts guardians and might affect their QoL. Some found asthma to be challenging to manage, leading to anxiety and fear of complications. The quantitative approach revealed a substantial effect size of high asthma QoL compared to moderate to poor QoL (Hedges' g = - 0.690, p 0.001). Conclusion: This study shows that Saudi asthmatic adolescents have moderate QoL, but clinical and school-based care gaps exist. QoL is driven by asthma symptoms and management, which may create worry in children and parents. Furthermore, environmental differences in Saudi Arabia may affect asthmatic students' respiratory health. These issues should be addressed to improve asthmatic adolescents' QoL.
To analyze the most cited plastic surgery articles from Saudi Arabia, focusing on publication trends, leading contributors, collaboration patterns, and thematic areas. We conducted a bibliometric analysis using the Web of Science Core Collection (1990-2025). Keywords covering plastic surgery subfields were combined with geographic identifiers ("Saudi Arabia," "KSA," "Kingdom of Saudi Arabia") using Boolean operators. Only English-language original and review articles were included. Citation metrics, authorship networks, and keyword co-occurrence were analyzed with VOSviewer and the bibliometrix R package. We identified 1,013 Saudi-affiliated plastic surgery publications, receiving 7,929 citations. The top 100 most-cited articles averaged 39.3 citations (range: 19-283). King Saud University was the leading institution, contributing 59 articles. Dr. Mohammad M. Al-Qattan was the most prolific author, with first authorship on 52 publications. Hand surgery dominated the thematic spectrum (36%), followed by peripheral nerve (14%) and aesthetic surgery (12%). International collaboration occurred in 21 articles (22.8%), mainly with the United States and Canada. Nearly half of the studies (49%) were Level IV evidence. Saudi Arabia has achieved a notable presence in plastic surgery literature, especially in hand and peripheral nerve surgery. However, the concentration of authorship and reliance on lower-level evidence highlight the need for broader collaboration, prospective study designs, and greater methodological rigor to strengthen future contributions.
To investigate antimicrobial usage patterns, indications, and outcomes in end-of-life (EOL) oncology patients at Princess Noorah Oncology Center (PNOC), King Abdulaziz Medical City, Jeddah, Saudi Arabia. The use of antimicrobials in oncology patients in EOL care has raised concerns about their appropriateness and the increasing issue of antimicrobial resistance. The study is a retrospective chart review of cancer patients treated at the PNOC from January 1, 2017, to January 31, 2022. The inclusion criteria included cancer patients ≥18 years who died during their admission. The exclusion criteria included subjects who did not meet the inclusion criteria. Among the 503 patients analyzed, 89.7% received antimicrobial treatment. In 66.5% of cases, the antimicrobial prescriptions were justified by positive culture results, whereas 33.5% were administered without culture confirmation. The most used antimicrobials were Piperacillin-Tazobactam (20.2%) and Vancomycin (11.4%). Antimicrobial use was significantly associated with patient awareness of their diagnosis (p = 0.036) and metastatic status (p = 0.027). The median duration of antimicrobial administration was 7.0 days. The study highlights the prevalent use of antimicrobials for oncology patients in EOL care, with 89.7% taking antimicrobials. The findings emphasize the need for strong antimicrobial stewardship programs to optimize antimicrobial prescription, aiming to decrease antimicrobial resistance.
To assess the feasibility of integrating a motivational interviewing approach with a comprehensive diabetes care program in Saudi primary care clinics. Approximately 23.1% of the adult Saudi population is diabetic, yet only 22.5% of these diabetic individuals maintain adequate glycemic control as defined by Hemoglobin A1c (HbA1c) levels <7%. This quasi-experimental study employed pre- and post-evaluation methods to compare HbA1c levels among persons with uncontrolled diabetes before and after implementing a motivational interviewing (MI) and comprehensive care program. Adults with type 2 DM were included. The MI approach was used to educate and motivate the patients. Starting from November 2023, all included patients were followed up for six months with the assessment of the HbA1c, blood pressure, and body mass index at each visit. Furthermore, a multivariate logistic regression was performed to determine variables that predict good glycemic control. Overall, 187 participants were included in the final analysis. The HbA1c was significantly reduced from 9.9% (baseline) to 8.9% (3 months), then 8.3% (6 months). A multivariate logistic regression showed that baseline HbA1c interpretation and baseline diastolic blood pressure were the only predictors of poor glycemic control. MI represents a valuable component of diabetes care, with the potential to improve clinical and psychological outcomes for patients. However, additional research is required to validate these findings.
This study aims to identify risk factors linked to the increasing prevalence of multiple sclerosis (MS) in Saudi Arabia. Multiple sclerosis is a chronic autoimmune condition affecting the central nervous system, marked by inflammation and damage to nerves and the myelin sheath. A case-control study conducted from September 2022 to January 2024 included 832 participants-263 diagnosed with MS and 569 controls. Controls were matched by age, gender, residence, and employment status. Data was collected using a validated questionnaire, with written consent obtained from participants aged 18 and older. Logistic regression analysis was used to ascertain risk factors. Out of 832 participants, 263 (31.6%) were diagnosed with MS. The greatest percentage of MS cases occurred in the 25-34 age range (37.7%). After adjusting for potential confounders, smoking was significantly associated with increased MS risk (AOR = 2.34, 95% CI: [1.22-4.48], p = 0.01), as were vitamin D deficiency (AOR = 1.97, 95% CI: [1.31-2.98], p<0.00), and a history of childhood sexual abuse (AOR = 1.96, 95% CI: [1.11-3.45], p = 0.02). Conversely, vitamin D supplementation was associated with a substantial reduction in MS risk (AOR = 0.17, 95% CI: [0.10-0.28], p < 0.001), as was coffee consumption (AOR = 0.53, 95% CI: [0.30-0.96], p < 0.04). Smoking, vitamin D deficiency, and a history of childhood sexual abuse increase MS risk, while vitamin D supplementation and coffee consumption reduce it. Further research is essential to confirm these findings.
This study aimed to evaluate the effectiveness and safety of dulaglutide in individuals with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). This retrospective cohort study included 212 patients with CKD (stages 1-4) and T2DM treated with once-weekly dulaglutide (1.5 mg) for either 12 or 24 months at three tertiary care centers in Saudi Arabia from January 2021 to December 2023. Safety was assessed based on the presence of adverse events. Efficacy was measured using the changes in estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI). Changes in efficacy outcomes were assessed using paired t-tests. Baseline HbA1c was 9.1% (±1.8%), BMI was 33.0 (±6.4) kg/m2, and eGFR was 68.2 (±28.5) mL/min/1.73 m2. At 12 and 24 months, HbA1c decreased by 1.2% (95% confidence interval [CI]: 1.0-1.4, p < 0.001) and BMI by 1.1 kg/m2 (95% CI: 0.9-1.3, p < 0.001). Further, eGFR remained stable at 12 months (change: $-$0.1, 95% CI: $-$2.2 to 2.0, p = 0.937) but increased by 2.8 mL/min/1.73 m2 (95% CI: 0.3-5.3, p = 0.029) at 24 months, particularly in stage 3 CKD (p = 0.041). By multivariable regression analysis, with adjustment for concomitant medications, dulaglutide was associated with a significant increase in eGFR increase at 24 months (adjusted mean change: 2.6 mL/min/1.73 m2, 95% CI: 0.2-5.0, p = 0.034). Patients aged <60 years (p = 0.049) and with HbA1c of ≤9.0% (p = 0.002) demonstrated greater eGFR increases. Adverse events occurred in 31.6% of patients, mainly nausea (10.8%), vomiting (8.0%), and diarrhea (10.8%). Dulaglutide was associated with a modest increase in eGFR and improved glycemic control in patients with T2DM and CKD, particularly among younger individuals with moderate-stage CKD. The treatment demonstrated an acceptable safety profile.
Bifurcation lesions are among the most challenging in percutaneous coronary intervention (PCI), with outcomes affected by anatomy, side-branch disease, and procedural variability. Existing European definitions and strategies require adaptation for Middle Eastern populations, where diabetes, obesity, and hypertension are highly prevalent and present earlier. The Middle East Bifurcation Club (MEBC), with the National Heart Center, used the Nominal Group Technique to standardize bifurcation PCI terminology, techniques, and treatment pathways tailored to regional demographics. The consensus provides evidence-based recommendations on imaging, provisional and 2-stent strategies, POT, and left main versus non-left main bifurcations, alongside practical algorithms and heart team guidance, highlighting the need for regional outcome data to optimize care.
Ovarian cancer represents the most lethal gynecologic malignancy, the epithelial type (EOC) being the most common. BRCA gene mutations are associated with ovarian cancer, younger age at presentation, strong family history of EOC, and multiple malignancies in a single patient. This study calculated the rate of BRCA-positive EOC and compared BRCA-mutated vs non-mutated EOC cases. This retrospective cohort study, conducted at Princess Noura Oncology Center between May 2016 and December 2023, explored outcomes in BRCA-positive EOC patients. The inclusion criteria covered all EOC cases. A total of 70 patients were selected. Of the 70 patients, 27 (38.6%) exhibited BRCA gene mutations. BRCA-positive patients demonstrated significant associations with familial history of cancer (p < 0.001) and lower diabetes mellitus rates (p = 0.02). However, our findings revealed no significant differences in treatments, prognosis, or outcomes between BRCA-positive and BRCA-negative patients. Subgroup analyses of different BRCA mutation types yielded no significant differences. Intriguingly, we found no significant variations in recurrence rates, comorbid cancers, or therapy duration between BRCA-positive and BRCA-negative cases (p > 0.01). Contrary to previous studies, we identified no differences in prognosis and survival rates between the cohorts. We identified BRCA gene mutations in 38.6% of our patients. Most comparisons revealed no significant differences between BRCA-positive and BRCA-negative patients, highlighting the need for additional studies to determine the prognostic and clinical value of gene testing in EOC.
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To guide medical students and interns interested in neurology by identifying the key attributes of an ideal neurology candidate from the perspectives of neurology program directors (PDs). In this cross-sectional study, former and current neurology PDs were contacted across Saudi Arabia to complete a self-administered survey sent via email or text. The survey included seven questions: six on PD demographics and a seventh with 51 items evaluating candidate attributes on a 7-point Likert scale from disadvantage to advantage. Thirty-two neurology PDs filled out the questionnaire. Among the key attributes PDs prioritized in a candidate is their letter of recommendation, preferably from a neurologist working at the same center where the candidate applied (mean = 2.44 ± 1.01); this was followed by the teamwork traits demonstrated by the candidate during their interview (mean = 2.34 ± 1.00) and, finally, clerkships completed as an intern in neurology at the same hospital where the candidate applied (mean = 2.28 ± 1.11). A significant regional difference was found regarding candidates who undertook international medical licensing examinations, which was observed as a disadvantage in the central region but as an advantage in the eastern and western regions (p = 0.002) of Saudi Arabia. The PDs prioritized candidates' skills, educational background, and genuine interest in neurology. Regional differences in the importance of international licensing exams reflect varied expectations. Future global studies could help refine and unify selection criteria for a fairer process.
To investigate the risk factors, clinical manifestations, and treatment outcomes in patients with Primary Bone Sarcomas (PBS). This retrospective study included all patients with PBS treated between June 2016 and December 2023 at King Abdulaziz Medical City, excluding patients with incomplete data, presence of other malignancies, diagnosis at autopsy, or unknown metastasis. Data were analyzed using SPSS software version 27. A p-value of less than 0.05 was considered statistically significant. Log Rank test was used for survival analysis. The study included 127 patients. Common past medical history included diabetes (7%), hypertension (5.5%), and metastasis at presentation (15%). Joint pain (76%) and bone swelling (75%) were common clinical presentations. The median overall survival was 5 years, with a 42% mortality rate. The presence of diabetes, hypertension, high Charlson score, high histological grading, and metastasis were more common among patients with osteosarcoma than other types (p < 0.05). Significant predictors of mortality included older age (HR: 1.03, p = 0.009), metastasis at presentation (HR: 8.19, p = 0.042), and metastasis (HR: 2.92, p = 0.010). Male gender (HR: 0.47, p = 0.020) had a lower risk of mortality. This study highlights the significant burden of PBS in Saudi Arabia. Key risk factors such as age and metastasis at diagnosis significantly impact survival, underscoring the necessity for improved surveillance and follow-up strategies. Further research is needed to develop effective, risk-stratified treatment to improve outcomes for patients.
To assess burnout (BU) and sleep deprivation (SD) among neurology residents and their impact on clinical performance (CP). This study is based on a neurology residents from Saudi Arabia. This multi-centric, cross-sectional study invited 214 registered neurology residents in the country; 179 participated in the study. The Maslach Burnout Inventory (MBI), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Council of Canada's Physicians' Self-Assessment Questionnaire (PSAQ) were used to evaluate burnout (BU) and sleep deprivation (SD) among neurology residents and their impact on clinical performance (CP). Of the total 214 registered neurology residents, 179 participated in the study. About 50% reported irregularity in daily meals, while >50% failed to exercise due to time constraints. More than 80% of residents had moderate-to-high levels of emotional exhaustion (EE) and depersonalisation (DP), and 90% had low personal accomplishment (PA). The global PSQI score of 9.3 resulted from mediocre sleep quality, poor sleep duration, high sleep latency and daytime dysfunction. Moreover, 83.2% of residents complained of SD and opined that it affects their mental capability at work. Regarding residents' CP, 49.44% were high performers, while the proportion of low performers was marginally higher at 50.56%. The rampant prevalence of moderate-to-high EE and DP and poor PSQI scores had a significantly negative correlation with residents' CP (p= 0.0168, 0.0011 and 0.0441, respectively), CP correlated positively with PA levels (p=0.0045). Moderate to high levels of BU prevail among neurology residents in Saudi Arabia. A high number of neurology residents suffer from sleep disturbances. Both BU and SD exert a detrimental impact on neurology residents' CP, which adversely affects the quality of neurological care delivered by the burned-out and sleep-deprived residents.
To establish the first national standards and guidelines for best practice in perfusion for patients undergoing cardiothoracic surgery in Saudi Arabia. Cardiopulmonary bypass (CPB) enables complex cardiac surgeries; however, it poses risks of potential complications. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop these guidelines and assess the certainty of evidence through a collaborative process. A panel of 16 Cardiovascu- lar perfusion experts across Saudi Arabia formulated 22 key clinical questions relevant to local practice. PubMed, Scopus, and Embase databases were searched for each question to identify relevant systematic reviews, randomized controlled trials (RCTs), non-randomized trials, post hoc analyses, and pooled analyses published from 2010 to 2024. The guideline panel voted for every question using the GRADEpro system, requiring a minimum consensus of 70% for approval. A total of 16 conditional recommendations and 6 good practice statements were finally approved, categorized into 5 key domains. Of these, 4 addressed guidelines, protocols, and general practices; 2 focused on surgical techniques; 8 covered heart-lung machine hardware; 3 centered on cardioplegia and Priming Solutions; and 5 emphasized monitoring and perioperative management. Six statements were based on expert opinion due to insufficient supporting evidence. Using a standardized pre-bypass checklist to enhance safety and implementing perioperative glycemic management to control glucose levels and reduce complications were strongly recommended by the panel. Conditional recommendations focus on pump selection, biocompatible oxygenators, and continuous cerebral oxygenation monitoring. Anticoagulation, myocardial protection, and transfusion management were also highlighted. These Saudi guidelines provide evidence-based recommendations to enhance the care of patients undergoing cardiac surgery with CPB, offering clear guidance for clinicians to achieve optimal outcomes. Nevertheless, future locally relevant research and regular updates are essential to bridge existing evidence gaps.
To determine regional radiation dose in adults head computed tomography (CT) examinations in Jeddah by assessing the volume computed tomography dose index (CTDIvol) and dose length product (DLP) values. A retrospective study was conducted from February to April 2025 across 10 CT scanners from 5 governmental hospitals in Jeddah. Data for 20 head CT examinations per scanner were collected. Dose metrics including CTDIvol and DLP (mGy·cm), were extracted from digital imaging and communications in medicine (DICOM) images. Mean values per scanner and the 75th percentile were calculated across centres to identify the regional DRL. The values were compared with the national diagnostic reference levels (NDRLs) using a bootstrapping method. Data analysis was performed using IBM SPSS Statistics (v26). A total of 200 patients derived from the study showed a significant difference in radiation doses across hospitals (p = 0.001). The 75th percentile of the mean CTDIvol and DLP values were 52.69 mGy and 979.19 mGy·cm, respectively, slightly lower than the national average (55 mGy and 1026 mGy·cm). Median CTDIvol and the DLP values ranged from 27.38-60.48 mGy, 485.50-1191.16 mGy·cm, with the highest differences reaching 120% and 145% for CTDIvol and DLP median values. Substantial variation in radiation doses across hospitals were observed, highlighting inconsistencies in scanning protocols. Enhancing technologists' training and regular dose audits are required to comply with the standards of Saudi Food and Drug Authority guidelines as a practice in every hospital in the Kingdom of Saudi Arabia.
To advise evidence-based strategies and healthcare policies to optimize the management of older adults with colorectal cancer (CRC) in the region. Older adults are disproportionately affected by CRC but are underrepresented in clinical trials. Hence, real-world data are crucial in guiding treatment in this population. We conducted a retrospective cohort study involving patients aged ≥65 years diagnosed with CRC between 2015 and 2021 at King Abdullah Medical City, Makkah, Saudi Arabia. Clinical data, treatment patterns, and survival outcomes were analyzed. Among 256 patients (mean age 74.7; 61.7% male), 75% had an Eastern Cooperative Oncology Group performance status of ≥2, and 31.2% presented with metastatic disease. Curative surgery was performed in 66.4% of patients, and 37.9% received adjuvant chemotherapy. Among patients experiencing metastatic disease, only 36% of patients received first-line therapy, and this proportion declined to 2% by fourth-line therapy. The median overall survival was 42 months, with a 5-year survival rate of 45%. Adjuvant chemotherapy (hazard ratio [HR] = 0.20; p = 0.001) and curative surgery were associated with improved survival, whereas late-stage disease (HR = 4.22; p = 0.003) predicted poorer outcomes. Age, sex, and body mass index were not significant predictors of survival. Despite functional limitations, older patients benefit from standard therapies. These findings support function-based decision-making and routine integration of geriatric assessments into clinical care to improve outcomes in older patients with CRC.