Significance of Scapular Fracture Existence in Blunt Chest Trauma: A Retrospective Cohort Study.

Background: Scapular fracture is a rare encounter in blunt trauma patients. The scapula is surrounded by strong groups of muscles offering good protection for the bone. Therefore, a high-energy trauma is needed to cause a scapular fracture. We aim to study scapular fractures and their relation to injury severity and mortality in blunt chest trauma (BCT) patients. Methods: We retrospectively collected data from all patients with BCT who were admitted to our hospital from December 2014 through January 2017. The injury details of all BCT patients were retrieved from the trauma registry of the hospital and were supplemented by patients' electronic files for missing information. Collected data included demography, mechanism of injury, vital signs, Glasgow Coma Score (GCS) on admission, injured body regions, management, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of hospital stay (LOS), and mortality. Results: During the study period, 669 patients had BCT. Scapular fracture was present in 29 (4.3%) of the BCT patients. The scapular fracture was missed by chest X-ray in 35.7% of the patients; however, it was accurately diagnosed by computed tomography (CT) scan of the chest. Neck injury was significantly higher in patients with scapular fracture compared with patients without fracture (p < 0.001). ISS and NISS were significantly higher in patients with scapular fractures compared to other patients without fractures (p=0.04 and p=0.003 Mann-Whitney U test, respectively). Two patients with scapular fractures died due to severe associated injuries (the overall mortality was 9.6%). Conclusions: Scapular fracture in BCT patients indicates a high-energy type of trauma. Compared to a chest X-ray, CT scan was more accurate for the diagnosis of scapular fracture. Associated injuries are the main cause of trauma-related mortality rather than the direct effect of the fractured scapula. Particular attention and meticulous evaluation should be paid to head and neck injuries to avoid missing injuries.

Durability of COVID-19 humoral immunity post infection and different SARS-COV-2 vaccines.

BACKGROUND: The global challenge posed by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been a major concern for the healthcare sector in recent years. Healthcare workers have a relatively high risk of encountering COVID-19 patients, making protective immunity against SARS-CoV-2 is a priority for them. This study aims to evaluate the longitudinal measurement of SARS-CoV-2 IgG spike protein antibodies in healthcare workers (HCWs) after COVID-19 infection and after receiving the first and second doses of SARS-CoV-2 vaccines, including Pfizer-BioNTech (BNT162b2) and Oxford-AstraZeneca (AZD1222). METHODS: This longitudinal cohort study involved 311 healthcare workers working in two tertiary hospitals in Saudi Arabia. All participants were followed between July 2020 and July 2022 after completing the study questionnaire. A total of 3 ml of the blood samples were collected at four intervals: before/after vaccination. RESULTS: HCWs post-infection had lower mean SARS-CoV-2 IgG levels three months post-infection than post-vaccination. 92.2% had positive IgG levels two weeks after the first dose and reached 100% after the second dose. Over 98% had positive antibodies nine months after the second dose, regardless of vaccine type. The number of neutralizing antibodies decreased and was around 50% at nine months after the second dose. CONCLUSION: The results show different antibody patterns between infected and vaccinated HCWs. A high proportion of participants had positive antibodies after vaccination, with high levels persisting nine months after the second dose. Neutralizing antibodies decreased over time, with only about 50% of participants having positive antibodies nine months after the second dose. These results contribute to our understanding of immunity in healthcare workers and highlight the need for the continuous monitoring and possible booster strategies.

Returning to Work After Traumatic Spine Fractures: Current Status in a Military Hospital.

INTRODUCTION: The consequences of traumatic spine fracture (TSF) are complex and have a major burden on patients' social life and financial status. In this study, we aimed to investigate the return to work (RTW) after surgically treated TSFs, develop eventual predictors of delayed or failure to RTW, and assess narcotics use following such injuries. METHODS: This was a single-center retrospective cohort study that was performed in a tertiary care center. TSF patients who required surgical intervention from 2016 to 2021 were enrolled. Demographic, operative, and complication data, as well as narcotics use, were recorded. RTW was modeled using multivariate logistic regression analysis. RESULTS: Within the 173 patients with TSF, male patients accounted for 82.7%, and motor vehicle accidents were the most common mechanism of injury (80.2%). Neurologically intact patients represented 59%. Only 38.15% returned to work after their injury. Majority of the patients didn't use narcotics more than 1 week after discharge (93.1%). High surgical blood loss, operation time, and hospital length of stay were significantly associated with not returning to work. In multivariant regression analysis, every increase of 100 ml of surgical blood loss was found to decrease the chance of RTW by 25% (P = 0.04). Furthermore, every increase of one hour in operation time decreases the chance of RTW by 31% (P = 0.03). CONCLUSION: RTW is an important aspect that needs to be taken into consideration by health care providers. We found that age and high surgery time, blood loss, and hospital stay are significantly impacting patients' RTW after operated TSF.

Breast Cancer in Young Women: Is It Different? A Single-Center Retrospective Cohort Study.

Introduction: Breast cancer (BC) is one of the commonest cancers among women worldwide. Differences regarding tumor biology, presentation, genetics, and molecular subtypes may contribute to the relatively poorer prognosis among younger women. Limited information exists regarding pathologic characteristics and long-term outcomes among this group. Methods: This retrospective cohort study included 695 BC patients diagnosed over a 10-year period and investigated the clinicopathological characteristics and long-term disease outcomes among patients diagnosed at age less than or equal to 40 years compared with older ones. Cox regression analysis was performed, and Kaplan-Meier curves were generated to assess overall survival (OS). Results: Compared with the younger patients (⩽40 years) estrogen receptor (ER) and progesterone receptor (PR) expression was mainly positive in older patients (>40 years) (76.2% vs 61.3% and 64.2% vs 49.6%, respectively). The most common molecular subtype in both age groups was luminal B (44.1% in older and 40.3% in younger). A clinical complete remission after neoadjuvant therapy was observed more frequently in older patients (76.7%; N = 442) in comparison with the younger patients (66.4%; N = 79) (P = .018). Recurrence and disease progression were significantly more likely to occur among younger patients accounting for 12.6% and 29.4% of the cases, compared with 6.3% and 18.2% in older patients (P = .016 and P = .006, respectively). The overall mortality was 132 (19%) of 695, with 88% cancer-related deaths. Estrogen receptor and PR expression (P ⩽ .001 and P = .003, respectively), molecular subtype (P = .002), tumor grade (P = .002), and N stage (P = .038) were the variables that were found to be significantly influenced by age. The OS was not statistically different among 2 age groups, but younger patients with luminal A molecular subtype showed significantly poor outcome (P = .019). Conclusion: Overall survival in women diagnosed with BC at age less than or equal to 40 years is not significantly worse than older patients. However, among patients with luminal A subtype, younger women had relatively poor survival. Further research is needed to understand this age-based disparity in outcomes.

Correlation analysis between cytokines' profile, autoimmune antibodies and the duration of type 1 diabetes: A case control study in a specialized children's centre in Riyadh.

OBJECTIVE: The aim of this study was to investigate the role of cytokines in children with T1D living in Saudi Arabia and their correlation with disease duration and autoimmune antibody markers. METHODS: A case-control study was conducted in the endocrine clinic of King Abdullah Specialized Children's Hospital in Riyadh. A total of 274 T1D and healthy control children were enrolled in the study. 5 mL of venous blood samples were collected in the morning after 9 to 12 h of fasting in BD Vacutainer® EDTA tubes and centrifuged at 250g for 15 min at. Plasma was then stored at -20°C for detection of anti-islet, anti-GAD antibodies (Abs), and C-peptide using commercial ELISA kits from Thermo Fisher Scientific. The levels of cytokines were measured using commercial sandwich ELISA kits from Abcam. RESULTS: Median differences in cytokine levels (IFN-γ, TNF-α, IL-1ß, IL-2, IL-4, IL-6, IL-10, IL-13, IL-18, IL-21, IL-35, and IL-37) were significantly higher in T1D patients compared with healthy controls (p-value < .001). Spearman's Rho correlation indicated that TNFα, IL-1ß, IL-4, IL-10, IL-13, and IL-21 correlated significantly with T1D Abs (p-value = .01). HbA1C correlated negatively with IL-35 and IL-37, and positively with IL-18 (p-value = .01). Linear regression analysis showed a significant increase in anti-glutamic acid antibodies (GAD) in patients with >3 years of T1D duration. CONCLUSION: Autoantibodies remained positive at high levels in our patients over a 3-year duration of the disease and correlated with specific cytokines. The clear correlations with disease duration and profile of specific cytokines could be targets for future therapeutic interventions.

Assessing the Correlation of Rate of Pathological Complete Response and Outcome in Post Neoadjuvant Chemotherapy Setting and Molecular Subtypes of Breast Cancer.

Background Neoadjuvant chemotherapy (NAC) is being widely used in treating breast cancer (BC). This study aimed to analyze the correlation between clinicopathological features, immunohistochemistry (IHC)-based molecular subtypes, and the pathological response to NAC and its relationship with disease-free survival (DFS) and overall survival (OS). Materials and methods A retrospective analysis of 211 breast cancer patients who received NAC between 2008 and 2018 was performed. Tumors were classified by IHC into luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative subtypes. The chi-square test was used to assess the association between pathological response and clinicopathological parameters. Cox regression analysis was used to assess factors related to DFS and OS. Results Post NAC, 19.4% of patients achieved a pathologic complete response (pCR). Estrogen receptor (ER), progesterone receptor (PR), HER2 (p<0.001, 0.005, and 0.02), Ki67 (p=0.03), molecular subtypes (p<0.001), T stage (p=0.04), and N stage (p=0.01) were significantly associated with pathological response. The rate of pCR was highest among HER2-enriched and triple-negative tumors (45.2% and 28%, respectively) with OR=0.13 and p<0.001 for the HER2-enriched subtype. Patients with pCR were 61% less likely to develop metastasis (adjusted hazard ratio [aHR]=0.39, p=0.06, 95% CI=0.14-1.06) and were significantly associated with better OS (aHR=0.07, p=0.02, 95% CI=0.01-0.61). Patients who were ≤40 years old (aHR=2.1, p=0.01), with T4 (aHR=3.4, p=0.02), grade 3 (aHR=2.5, p=0.01), and node-positive disease (HR=2.24, p=0.02) were at an increased risk of developing metastasis. High Ki67 was found to be significantly associated with better DFS (p=0.006). Conclusion HER2-enriched and triple-negative BC were associated with a higher rate of pCR. Patients with pCR had significantly better DFS and OS. Younger age, advanced stage, higher grade, and lymph node involvement were risk factors for metastasis.

Increased Prevalence of EBV Infection in Nasopharyngeal Carcinoma Patients: A Six-Year Cross-Sectional Study.

Epstein Barr Virus (EBV) is implicated in the carcinogenesis of nasopharyngeal carcinoma (NPC) and currently associated with at least 1% of global cancers. The differential prognosis analysis of NPC in EBV genotypes remains to be elucidated. Medical, radiological, pathological, and laboratory reports of 146 NPC patients were collected retrospectively over a 6-year period between 2015 and 2020. From the pathology archives, DNA was extracted from tumor blocks and used for EBV nuclear antigen 3C (EBNA-3C) genotyping by nested polymerase chain reaction (PCR). We found a high prevalence of 96% of EBV infection in NPC patients with a predominance of genotype I detected in 73% of NPC samples. Histopathological examination showed that most of the NPC patients were in the advanced stages of cancer: stage III (38.4%) or stage IV-B (37.7%). Only keratinized squamous cell carcinoma was significantly higher in EBV negative NPC patients compared with those who were EBV positive (OR = 0.01, 95%CI = (0.004-0.32; p = 0.009)), whereas the majority of patients (91.8%) had undifferentiated, non-keratinizing squamous cell carcinoma, followed by differentiated, non-keratinizing squamous cell carcinoma (7.5%). Although NPC had metastasized to 16% of other body sites, it was not associated with EBV infection, except for lung metastasis. A statistically significant reverse association was observed between EBV infection and lung metastasis (OR = 0.07, 95%CI = (0.01-0.51; p = 0.008)). Although 13% of NPC patients died, the overall survival (OS) mean time was 5.59 years. Given the high prevalence of EBV-associated NPC in our population, Saudi could be considered as an area with a high incidence of EBV-associated NPC with a predominance of EBV genotype I. A future multi-center study with a larger sample size is needed to assess the true burden of EBV-associated NPC in Saudi Arabia.

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

Background Kikuchi-Fujimoto disease (KFD) - also known as necrotizing histiocytic lymphadenitis - is a benign histiocytic lymphadenitis known for its low incidence and misdiagnosis that occurs mostly in young Asian females more than males. This disease resolves spontaneously in a few months with a low risk of relapse (one in 30 patients) after resolution. Objectives The aim of this study is to share King Abdulaziz Medical City's (KAMC's) experience with KFD by determining its clinicopathological characteristics. Materials and methods In this study, we reviewed histopathological slides and pathological reports of all lymphadenopathy cases (683 cases) in the period between January 2008 and December 2018. Results Forty-four cases of KFD were found and their clinicopathological characteristics were recorded. There is a slight female predominance (59% females versus 41% males) with a wide age range from 10 months to 97 years (mean = 28.8). The majority of the cases (63.6%) are seen in young adults (between 21 and 40 years). Association with autoimmune diseases was shown by 20.5% of cases while viral infection association was shown by few cases. Most cases showed remission (59%) and no deaths were reported upon follow-up. Histopathologically, the majority of cases have proliferative type followed by the necrotic type and few cases showed xanthomatous type. Conclusions Our study has the largest number of KFD cases in this region. It is obvious that KFD has clinical, radiological, and pathological features that overlap with malignancy, especially lymphoma. Knowing this disease and careful diagnostic approach can help avoid misdiagnosis.

Perceptions and Attitudes Regarding Hematopoietic Stem Cell Donation Among Blood Donors in Riyadh, Saudi Arabia.

Introduction In recent years, there has been a growing trend toward using stem cell transplantation for therapeutic purposes, making a positive impact in the medical field. Access to a compatible and willing donor is essential for those therapeutic purposes, yet the current number of registered donors remains inadequate. The present study aimed to investigate the attitude and perception of stem cell donation among blood donors in Saudi Arabia while also exploring their knowledge of hematopoietic stem cells, willingness towards donation, and fear of complications after stem cell donation. Methods A cross-sectional study was implemented to investigate the perception and attitude toward stem cell donation among blood donors in Riyadh, Saudi Arabia, through a validated self-administered questionnaire. The questionnaire comprised 35 questions divided into five sections, namely, demographics, knowledge, attitude, willingness, and fear of stem cell donation. Results The survey was distributed to 400 subjects. Out of the 400 respondents, 98.8% (n=395) were male, and 90.8% (n=363) were Saudi nationals. The majority had a high school level of education (n=259, 64.75%). Only 10.8% (n=43) of the participants were knowledgeable about stem cells. Knowledge of stem cells was highest among females aged 40-49 years, participants knowledgeable of platelet donation, and participants who donated blood more than 10 times (p-value <0.05). Participants with a bachelor's or master's degree had significantly more fear of stem cell donation complications, with a p-value of 0.003. The attitude toward stem cell donation was highly positive. Most participants strongly agreed to donate stem cells to a family member or anyone in need, 94.5% (n=378) and 62% (n=248), respectively. Conclusion Knowledge about stem cell donation among blood donors was scarce, while their willingness to donate after conversing was high. We highly recommend the initiation and establishment of educational programs to increase the knowledge of the public and, specifically, blood donors.

Epidemiological and clinical profiles of Saudi patients with hyperprolactinemia in a single tertiary care center.

BACKGROUND: Prolactin is a hormone of the pituitary gland whose main function is the production of milk. Hyperprolactinemia is defined as an increase in prolactin levels above 25 µg/L in women and 20 µg/L in men. Causes of hyperprolactinemia include pituitary tumors, especially prolactinomas. Hyperprolactinemia can manifest clinically with a variety of symptoms, including galactorrhea and menstrual irregularities in women and erectile dysfunction in men. There are limited data on the epidemiology of hyperprolactinemia in the Middle East region. OBJECTIVES: Description of the epidemiology and clinical features of hyperprolactinemia in a cohort from Saudi Arabia. DESIGN: Medical record review SETTING: Tertiary medical center in Riyadh PATIENTS AND METHODS: The study included adult patients with hyperprolactinemia in King Abdulaziz Medical City in Riyadh. The patients were treated in endocrinology clinics from 2015 to 2019. Patients of both sexes older than 14 years were enrolled in the study. Patients with insufficient follow-up were excluded. Data were collected on demographic characteristics, symptoms, prolactin level, cause of high prolactin level, and treatment. MAIN OUTCOME MEASURES: The frequency of different etiologies and symptoms in patients with hyperprolactinemia. SAMPLE SIZE: 295 patients RESULTS: The majority of patients with hyperprolactinemia were female 256 (86.8%). Hyperprolactinemia was diagnosed more frequently in patients in the age groups 21-30 years (42.6%) and 31-40 years (24.1%). The majority of the study population was obese or overweight: 136 (46.3%) and 74 (25.2%), respectively. Most of the cases were symptomatic (192, 65.1%). In women, the most common symptom was oligomenorrhea (35%). In men, infertility and erectile dysfunction were the most common clinical symptoms (50% and 44.7%, respectively). Idiopathic causes were the most common etiology (108, 36.6%), followed by pituitary adenomas (81, 27.5%). The majority of patients were treated (184,62.4%), with cabergoline being the most commonly used medication (173, 94.0%). CONCLUSION: The demographic and clinical presentations and causes of hyperprolactinemia in male and female Saudi patients were similar to that in studies in other populations. LIMITATIONS: Single-center retrospective chart review study. CONFLICT OF INTEREST: None.

The Prevalence of Associated Autoimmune Diseases Among Adults With Type 1 Diabetes Mellitus: A Cross-Sectional Study.

Background The relationship between type 1 diabetes mellitus (T1DM) and other autoimmune diseases has been known; however, the actual prevalence in the adult population nor clinical symptoms has not been determined locally. Objectives We aim to determine the prevalence of associated autoimmune diseases (Hashimoto's thyroiditis, celiac disease (CD), and adrenal insufficiency (AI)) and evaluate the most reporting symptoms and glycemic control assessment, as well as microvascular complications and hypoglycemia episodes. Methods A cross-sectional study of 251 patients with T1DM at the diabetic clinic of King Abdulaziz Medical City in Riyadh (KAMC-RD), Saudi Arabia, was conducted. Autoimmune serologies including thyroid peroxidase (TPO) antibody and tissue transglutaminase IgA (tTG-IgA) antibody were checked with hormonal studies such as thyroid-stimulating hormone (TSH), morning serum cortisol, and short Synacthen test (SST) with duodenal biopsy results all were reviewed if present. Patients were directly interviewed to evaluate for the most common symptoms (including hypoglycemia episodes) for the preceding two weeks. Glycemic control was assessed by measuring glycated hemoglobin (HbA1c). Microvascular complications (i.e., nephropathy and retinopathy) were estimated by looking at the urine albumin/creatinine ratio (ACR) besides the ophthalmology's visit notes. Results The mean age was 26.3 ± 7.7 years, and the mean duration of diabetes at the time of data collection was 12.2 ± 7.6 years, whereas the mean HbA1c was 8.9% ± 1.8%. The prevalence of hypothyroidism was 16.3%, and TPO positivity was discovered in 58.6% of the tested patients (n = 70) with equal prevalence among both genders (p = 0.685). tTG-IgA were noticed among 16.4% of the patients (n = 164) without significant difference among gender. Serum cortisol test was performed among 128 patients; 28.1% had suboptimal levels, and 5.5% were deficient. Only four patients (n = 15) had suboptimal responses after SST. Nervousness and anxiety (p < 0.001), fatigue with weakness (p = 0.018), weight gain (p = 0.017), and cold intolerance (p = 0.005) were noted, which were statistically significantly higher among females. Weight gain was statistically significantly higher among the age group of >30 years (p = 0.036). For microvascular complication screening, ACR was collected in 199 (79.2%) participants, with a mean of 27.7 ± 155.9 mg/mmol. Only 10 (5%) patients had microalbuminuria, and 16 (8%) had macroalbuminuria; it was correlated significantly with diabetes duration (p = 0.045). A total of 132 (52.8%) patients were seen by ophthalmology, 28 (21.4%) had nonproliferative diabetic retinopathy (NPDR), and 10 (7.6%) has proliferative diabetic retinopathy (PDR) that significantly correlated with the duration of diabetes (p = 0.027). During patient interviews, 187 (74.5%) reported symptomatic hypoglycemia events that correlated significantly with glycemic control (p = 0.029). Conclusion Autoimmunity in Saudi adults with type 1 diabetes mellitus was significant with equal prevalence among both genders and age groups with no or slight difference. Clinical manifestations of autoimmunity were higher in women. Diabetes chronicity and poor glycemic control were the major complications; therefore, early glycemic control is advocated. Regular screening for autoimmunity and its complications is recommended for type 1 diabetic patients. Autoimmunity was found almost similar to previous literature.

Postoperative intensive care management and residual endocrinopathy of pediatric supratentorial brain tumors: a retrospective cohort study.

OBJECTIVES: Endocrinopathy can occur as a postoperative sequel in children treated for supratentorial tumors (STTs). We assessed prediction of a residual hypothalamic/pituitary insufficiency (HPI) in these patients and factors associated with prolonged length of hospital stay (LOS). METHODS: This is a retrospective cohort study of children who had surgery for STTs in two tertiary centers in Saudi Arabia (2009-2019). We assessed PICU postoperative management and risk of HPI. Data were analyzed using SPSS V24.0 and a logistic regression model for a prediction of a prolonged LOS. RESULTS: Data included 55 children (1-18 years, mean 9.5 ± 4.9 years) who required STT surgeries, 32 (54%) females. Craniopharyngioma (27.3%) was the commonest STTs and 20% of patients had initial symptoms of HPI. PICU management included the use of different types of intravenous fluids (IVFs) and medications such as steroids and desmopressin (DDAVP). An early postoperative DI was reported in 21.8% (n=12/55). Residual HPI included 24 (43.6%) presumed cortisol deficient and 18 (32.7%) central DI patients. Risk factors for postoperative HPI were female gender, age <6 years, headache and preoperative pituitary symptoms. LOS (Median=25.5 ± 12.2 days) was significantly prolonged in patients who required two or more doses of DDAVP [B=13; 95% CI= (1.7-24.3) days] and reduced in patients who had suspected preoperative HPI [B=-19.6; 95% CI= (-31.1, -8.2) days]. CONCLUSIONS: Prediction of postoperative HPI in pediatric STTs enhances an early initiation of treatment in PICU and reduces LOS. A meticulous use of IVF and medications supervised by a multidisciplinary team is essential for a favorable outcome.

Depression and Quality of Life Among Caregivers of Pediatric Cancer Patients.

Background This study aimed to assess the prevalence of depression, depressive symptoms, and quality of life among caregivers of pediatric cancer patients and the associated risk factors. Methodology In total, 73 participants were recruited for this cross-sectional study in King Abdullah Specialist Children Hospital. Two self-administered questionnaires were used, the Patient Health Questionnaire 9 (PHQ9) and World Health Organization Quality of Life (WHOQOL), to assess the depressive symptoms as well as the prevalence of clinical depression and quality of life, respectively. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA) to assess the level of depression and quality of life and the associated factors using Fisher's exact and Mann-Whitney tests. Results It was found that 90.4% were females and 9.6% were males, with 49.3% being between the ages of 31 and 40. Regarding the level of depression, 47.80% had mild depression. There were no significant associations between the baseline characteristics and the level of depression. Gender was significantly associated with all four domains of quality of life, age was significant in physical health and environmental domains, duration of illness was significant only in the physical health domain, while education level was found to be not significantly associated with any of the domains. Conclusions This study found that nearly half of the participants had mild levels of depression, and the four domains of the WHOQOL were significantly affected by several risk factors. We recommend further research into this topic with larger sample sizes, as well as a follow-up assessment of caregivers for a more accurate representation of caregivers' depression and quality of life. We recommend that in addition to the assessment of pediatric cancer patients, caregivers must also be assessed due to the burden associated with the task of being a caregiver.

The use of olive oil for skin health in a Saudi population: A cross-sectional study.

The use of topical olive oil (OO) for skin health is common among Saudis and worldwide. Therefore, this cross-sectional study is aimed at assessing the use of topical OO for skin health among Saudis in Riyadh, Saudi Arabia. The questionnaire was administered to Saudis at four different malls in Riyadh, Saudi Arabia. A total of 401 participants were enrolled in the study. The results showed that the average knowledge score of the participants was 3.4±0.3 (out of 5) and 87% had fair knowledge. The top source of knowledge among the participants was friends/relatives. In the attitude section, the average score was 4.1±0.5 (out of 5). Females had a higher attitude score 4.2±0.5 as compared to males 4±0.5 (P=0.03). The most common reason for using topical OO among the participants was skin moisturizing (73%). Female gender was the only significant factor associated with the use of topical OO (P<0.001). The use of topical OO for skin health is highly prevalent in Riyadh, Saudi Arabia. Therefore, more awareness of the benefits and adverse effects of topical OO use is required especially from health educational organizations. The preliminary results of this study suggest further research with a larger sample in an academic setting across the nation.

Do Parental Comorbidities Affect the Severity of Autism Spectrum Disorder?

Background Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by defective social communication and interaction with a repetitive pattern of monotonous or stereotyped behavior. Although the exact etiology of ASD is unknown, many factors may be implicated in the development of ASD. We aimed to determine the correlation between specific parental factors and Autism Treatment Evaluation Checklist (ATEC) scores. Methods This cross-sectional study was conducted at the Prince Nasser Bin Abdulaziz Center for Autism, Autism Center for Excellence, and Academy of Special Education for Autism in Riyadh, Saudi Arabia. We enrolled children diagnosed with ASD and their parents from these centers. Data were collected through self-administered questionnaires to the patients' parents. Results All included children were <18 years old. In total, 71 (92.2%) children were male and six (7.8%) were female. Further, 77 (100%) patients were diagnosed with autistic disorder. Children of consanguineous parents, underweight mothers and obese fathers, mothers with a history of depression during pregnancy, and mothers aged ≥31 years during pregnancy tend to have a higher mean ATEC score. The health domain was the most significantly correlated with ATEC scores, with a Pearson correlation of 0.880. In linear regression analysis, only maternal depression during pregnancy was significantly correlated with ATEC scores. Conclusion Our patients had a mean ATEC score of 86.2. The health domain was the most significantly correlated with ATEC scores, with a Pearson correlation of 0.880. Linear regression analysis revealed that consanguinity, parental chronic disease, parental allergy, smoking, drug use during pregnancy, paternal and maternal body mass index (BMI), and sibling number were not significantly correlated with ATEC scores (P=0.701, 0.693, 0.133, 0.874, 0.982, 0.255, 0.778, and 0.502, respectively). However, maternal depression during pregnancy was significantly correlated with ATEC scores (P=0.055).

Clinical characterization of pediatric supratentorial tumors and prediction of pituitary insufficiency in two tertiary centers in Saudi Arabia.

Background: Post-operative pituitary insufficiency (PI) occurs in children with supra-tentorial tumors (STT) because of surgery or the mass effect of the tumor. We assessed the prevalence and clinical characteristics of STTs and predicted postoperative PI in our patients. Methods: This retrospective cohort study included children who underwent surgery for STT in two tertiary hospitals in Saudi Arabia (2009-2019). We focused on clinical, radiological, and histopathological features of STTs. We also used a linear regression model to predict post-operative PI. Results: The study included 55 children (1-18 years, mean: 9.5 ± 4.9 years, 32 [54%] females) with an initial presentation of STT that required surgery excluding recurrent episodes. The calculated period prevalence of STT was 18.2%, and the prevalence of postoperative PI was 58.2% (n = 32/55). The most common symptoms were headache and visual disturbances, and 20% patients had preoperative symptoms of PI. Baseline preoperative investigations for PI were performed in 60% of patients, and dynamic tests were conducted in only seven patients. A residual cortisol deficiency was presumed in 24 (43.7%) patients and 18 (32.7%) patients who developed central diabetes insipidus (DI) post-operatively. Overall, the brain imaging correlated well with the histopathological diagnosis (kappa = 0.48; P < .001). Craniopharyngioma (n = 15/55, 27.3%) was the commonest STT. Predictive factors for a postoperative residual PI included age (10.9 ± 4.8 years; p-value = .027), female gender (p-value = .016 [OR = 8.31; 95% CI (1.48-46.71)], presentation with headache (P value = .039 [OR = 9.27; 95% CI (1.12-76.72)]), and visual disturbances (p-value = .044 [OR = 5.07; 95% CI (1.04-24.61)]. Conclusion: STTs commonly occurred in our study population, and females were more prone to develop a residual PI. On-time surveillance of an intact endocrine system during the perioperative period is essential for the prediction and early management of PI.

The outcome and complications of total parenteral nutrition in pediatric hematopoietic stem cell transplantation.

BACKGROUND: Nutritional support posthematopoietic stem cell transplantation (HSCT) with total parenteral nutrition (TPN) or nasogastric tube feeding (NGT) in pediatric patients is associated with benefits and risks. METHODS: We retrospectively reviewed the indication of TPN use in our pediatric HSCT patients and its impact on survival and possible related complications. RESULTS: A total of 228 HSCTs were performed during the study period. TPN was used in 144 patients (63.2%) for a median of 14 days, while 8.8% had NGT feeding and 28% were able to tolerate oral feeding. Severe mucositis was seen in 104 TPN patients (72.2%) in comparison with 22 patients (26.2%) who were on Enteral Nutrition (EN) (p = <.001). Sinusoidal obstruction syndrome (SOS) was seen in 19 (13.2%) patients who had TPN compared to none in the patients who received EN (p = .001). The majority of patients who had SOS received myeloablative conditioning (MAC) therapy for hemoglobinopathy. Acute graft-versus-host disease (aGVHD) was seen in 24.8% of TPN patients and 9.1% of non-TPN patients (p = .01). However, there were no statistically significant differences in chronic GVHD, bacteremia, and patients' survival between both groups. CONCLUSIONS: TPN is commonly used after pediatric HSCT in cases of severe mucositis. NGT feeding was found to be the least used nutritional support method. SOS and aGVHD were associated more frequently in TPN patients compared to EN patients. This suggests the possible disadvantages of TPN and importance of SOS preventative measures in high-risk patients.

Public awareness of early symptoms of acute myocardial infarction among Saudi population.

INTRODUCTION: Globally speaking, cardiovascular disease is the leading cause of mortality, with coronary artery disease (CAD) contributing to half of the cases. A major complication of CAD is myocardial infarction (MI). The clinical outcomes of MI are predominantly time-dependent; therefore, it is paramount that the general public is familiar with the early symptoms of MI. AIM: The main objective is to gauge the local public awareness of the early symptoms of MI, and their knowledge of the best course of action to be taken from the onset of symptoms. METHOD: A cross-sectional study was conducted using google forms. Participants were randomly selected through multiple social media platforms. The study included Saudi citizens who were 18 years or older, with no current or prior experience in the health care field. The questionnaire assessed the participants' awareness of 14 risk factors for CAD. The variables investigated were participants' knowledge of the symptoms, causes, appropriate course of action to be taken, and the risk factors of CAD. RESULTS: A total of 1689 participants were involved in this study. Sixty percent were females, and 29.2% were in the age group of 18-24 years. Seventy-three percent of the participants knew the definition of heart attack, and 90% knew that chest pain is a symptom of a heart attack. Approximately, 75% of the participants recognized that hypertension, cigarette smoking, and high cholesterol are the risk factors of MI. In terms of knowledge, Al Madinah province obtained the highest score when compared with other regions. CONCLUSION: This study showed the overall knowledge and awareness of CAD was suboptimal, indicating that awareness initiatives and patient education of CAD need more work in Saudi Arabia, especially in high-risk groups and lower education groups. More studies are needed to identify the efficiency and population access of different approaches for CAD awareness.

Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study.

BACKGROUND: Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). METHODS: A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). RESULTS: A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 106/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (p = 0.02), but not with mortality. CONCLUSIONS: Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.

Medical Students' Insights Towards Patient Safety.

OBJECTIVES: This study aimed to explore Saudi Arabian medical students' perceptions of patient safety. METHODS: A cross-sectional descriptive study was conducted in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, in September 2019. The Attitudes to Patient Safety Questionnaire (APSQ III) was used to explore undergraduate medical students' attitudes towards and knowledge of PS. The main outcomes measured were the APSQ III's nine domains. Data were analysed using Statistical Package for the Social Sciences and students' attitudes were communicated as mean scores ± standard deviations. RESULTS: A total of 301 participants were included in this study (response rate: 85.75%). Six domains reflected a positive attitude while three domains showed a neutral attitude. The domain of 'team functioning' had the highest mean score (5.8) followed by 'working hours as a cause of error' (5.6) and 'error inevitability' (5.4). There was a significant difference between gender in the domain 'patient involvement in reducing error' (P = 0.012) and 'importance of patient safety (PS) in the curriculum' (P = 0.001). In addition, the 'importance of PS in the curriculum' domain was significantly different across different age groups (P = 0.039). CONCLUSION: Medical students were highly interested in PS and recommended implementing a comprehensive undergraduate PS programme to fulfil their educational needs.