Cardiovascular Morbidity in Systemic Lupus Erythematosus: A Single-Center Retrospective Study.

BACKGROUND: Systemic Lupus Erythematosus (SLE) is an autoimmune inflammatory condition affecting multiple systems. Cardiovascular morbidity is a significant concern, with around 25% of SLE patients experiencing cardiac complications. OBJECTIVE: This study aims to determine the prevalence of cardiovascular morbidity in SLE patients in King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. METHODOLOGY: This retrospective record-based research was conducted at KFMC from January 2015 to October 2023. A review of the medical files of all SLE patients was accomplished. RESULTS: The vast majority of the patients (90.9%) were females. The mean age for the patients was 36.5 years. The most common comorbidities were lupus nephritis (34.6%), hypothyroidism (18.4%), and anti-phospholipid syndrome (9.2%). The most commonly used medications were hydroxychloroquine (81.8%), corticosteroids (prednisolone) (43.0%), and mycophenolate mofetil (27.9%). Around 45.2% (n= 176) of the patients with SLE developed cardiovascular complications. The most commonly reported cardiovascular diseases that developed after diagnosing patients with SLE were hypertension (22.4%), valvular heart diseases (13.2%), and dyslipidemia (9.2%). The study also found that anti-dsDNA antibodies can reduce the likelihood of developing hypertension by 40%. This research contributes to the medical literature on SLE and sets the stage for future research on personalized healthcare strategies for managing SLE and its complications. CONCLUSION: This study highlights that a considerable proportion of SLE patients(~50%) develop cardiovascular complications, with hypertension, valvular heart diseases, and dyslipidemia being the most common. We also discovered that anti-double-stranded deoxyribonucleic acid antibodies (Anti-dsDNA) reduce the likelihood of developing hypertension.

Examining the Effects of Social Media on Mental Health Among Adolescents in Saudi Arabia.

BACKGROUND: Adolescents are immersed in a highly advanced technology setting, characterized by extensive availability of personal devices, the internet, and other social media platforms, which greatly impact their mental development. Concerns arise around potential negative consequences, including social isolation, internet addiction, exposure to improper content, depression, cyberbullying, and sleeping difficulty. The impact of social media on the mental well-being of adolescents has emerged as an escalating concern. The continuous exposure to carefully selected content, online harassment, and the expectation to comply with unrealistic standards all contribute to the development of depression and anxiety. This research aims to explore the impact of social media on the mental health of adolescents in the Saudi Arabian context. METHODS: This online cross-sectional study was conducted on Saudis aged 10 to 24 years old who have social media accounts in Saudi Arabia between August and November 2023. Binary logistic regression analysis was conducted to identify factors that make the study participants more likely to be mentally affected by social media. RESULTS: A total of 2856 participants were involved in this study. The most commonly used social media platform by the study participants was Twitter (30.3%). The majority of the study participants (77.4%) reported that they have tried to reduce their social media usage for mental health reasons. The most commonly agreed-upon statements were that "they feel that excessive social media use has negatively affected their sleep patterns," "they often sleep late in the night because of social media usage," and "they check their social media account before they sleep in the night," accounting for 71.0%, 66.1%, and 58.3%, respectively. Overall, the study participants showed a low level of being mentally affected due to social media with a mean score of 7.8 (SD: 3.9) out of 21, which is equal to 37.1%. Older participants (aged 16-24 years) were more prone to be mentally affected due to social media compared to younger ones (aged 10-15 years; p < 0.05). On the other hand, participants who were married, had a middle school education level, or lived in the northern, western, or eastern regions were less likely to be mentally affected due to social media compared to others (p < 0.05). CONCLUSION: The study participants showed a low level of being mentally affected due to social media. Individuals in the 16-24 years age group show a higher susceptibility to mental impacts resulting from social media usage. The primary duty for reducing the potential negative effects of social media should not rest only on parents and caregivers. Advocating for the creation of technology-free zones and fostering in-person friendships among teens could be a beneficial approach that policymakers should support.

Physicians' Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia.

Purpose: To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components. Methods: A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia. Results: The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0-21.0), followed by Internal Medicine at 17.0 (IQR: 13.0-20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0-10.0) and 7.5 (IQR: 4.0-13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0-22.0), while Fellows had the lowest at 8.5 (IQR: 7.0-13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0-23.0) and 19.0 (IQR: 17.0-22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5-16.5) (p < 0.001). Conclusion: Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice.

Knowledge, Attitudes, and Practice Patterns of Lung Cancer Screening Among Physicians in Saudi Arabia.

BACKGROUND: Lung cancer remains the primary cause of death connected to cancer on a worldwide scale. Obtaining a deep understanding of the knowledge, attitudes, and behavior patterns of doctors is essential for developing successful strategies to improve lung cancer screening. This study aims to identify the attitudes, beliefs, referral practices, and knowledge of lung cancer screening among physicians in Saudi Arabia. METHODS: An online survey was conducted from July to December 2023 to investigate the attitudes, beliefs, referral practices, and knowledge of lung cancer screening, and adherence to lung cancer screening recommendations among physicians in Saudi Arabia. Internal medicine, family medicine, and pulmonology physicians of all levels (consultants, senior registrars, and residents) who are currently practicing medicine in Saudi Arabia formed the study population. This study employed a previously developed questionnaire. Binary logistic regression analysis was employed to identify factors that indicate a better degree of knowledge and a positive attitude toward lung cancer screening. RESULTS: This study involved a total of 96 physicians. The study participants demonstrated a significant degree of understanding regarding lung cancer screening, with an average knowledge score of 5.8 (SD: 1.7) out of 8, equivalent to 72.5% of the highest possible score. The accuracy rate for knowledge items varied from 44.8% to 91.7%. The study participants had a moderately favorable attitude toward lung cancer screening, as shown by a mean attitude score of 14.4 (SD: 3.7) out of a maximum possible score of 30, which corresponds to 48.0% of the highest achievable score. Around 36.5% of the survey participants reported engaging in the practice of discussing the results of lung cancer screening with patients. The primary obstacles frequently cited were challenges in patient scheduling, insufficient time to discuss lung cancer screening during clinic appointments, and patient refusal, constituting 59.4%, 53.1%, and 53.1% of the identified barriers, respectively. Physicians in Saudi Arabia, particularly those employed in private hospitals, demonstrated a higher level of knowledge of lung cancer screening compared to others (p < 0.05). In contrast, individuals with 11-15 years of experience were shown to have a 78.0% lower likelihood of being educated about lung cancer screening compared to their counterparts (p < 0.05). CONCLUSION: The study's results indicate that there is a need for the development of specialized educational initiatives aimed at Saudi Arabian physicians, particularly those with 11 to 15 years of experience who exhibit a limited understanding of lung cancer screening. Utilizing programs that provide continuing medical education would aid in their education. There is a need to facilitate communication between physicians and patients. It is critical to address the identified issues, such as streamlining the appointment scheduling process and ensuring patients have sufficient time during clinic visits. Furthermore, it is critical for the success of nationwide screening initiatives to foster collaboration between the public and private healthcare sectors.

Attitude, Practices, and Barriers to Menopausal Hormone Therapy Among Physicians in Saudi Arabia.

BACKGROUND: To guarantee the delivery of thorough and scientifically supported menopausal care, it is imperative to allocate resources towards ongoing education and training for physicians. Therefore, it is essential to assess the attitudes, practices, and obstacles faced by physicians in Saudi Arabia when it comes to menopausal hormone replacement therapy (HRT). METHOD: An online survey was conducted from June to September 2023 to investigate the attitudes, practices, and barriers of physicians in Saudi Arabia, regarding menopausal HRT. The study population consisted of practicing physicians in Saudi Arabia specializing in gynecology, endocrinology, family medicine, internal medicine, and general practice at various levels, including consultants, senior registrars, and residents. The survey link was distributed to the intended research participants in Saudi Arabia using several social media platforms (Facebook, Twitter, Snapchat, WhatsApp, and Instagram) utilizing a Google Form hyperlink. RESULTS: A total of 95 physicians participated in this study. A total of 60.0% of the study participants agreed that in general, HRT should be offered to menopausal women who have menopausal symptoms. Besides, around 24.2% of them agreed that in general, HRT should be offered to menopausal women who do not have menopausal symptoms. The most commonly reported methods of obtaining up-to-date information about HRT were Ministry of Health in Saudi Arabia publication and journal articles, contributing 36.8% (n=35) and 24.2% (n=23), respectively. The most commonly reported type of systemic (i.e. non-vaginal) HRT for women with premature menopause (menopause <40 years) without contraindications was combined oral contraceptive pill accounting for 33.7% (n=32). More than half of the study participants (53.6%; n=51) reported experiencing difficulty or barriers related to prescribing HRT. The most commonly reported difficulties and barriers related to HRT prescribing were consumer preferences for complementary/alternative therapies, difficulty explaining HRT risks and benefits to women, and lack of suitable HRT products accounting for 27.4% (n=26), 21.1% (n=20), and 16.8% (n=16), respectively. CONCLUSION: The nuanced perspectives of Saudi Arabian physicians regarding HRT for postmenopausal women are revealed in this study. Electronic published societal guidelines and Ministry of Health publications are examples of vital information resources that physicians must have access to. Difficulties associated with the prescription of HRT, including product shortages and consumer preferences, underscore the criticality of confronting obstacles in clinical practice. Additional investigation is suggested in order to enhance physicians' knowledge and implementation of guidelines, specifically for patient cohorts whose medical histories are unique.

Assessment of Burden in Caregivers of Patients Undergoing Hemodialysis and Peritoneal Dialysis: A Cross-Sectional Study in Riyadh, Saudi Arabia.

A caregiver attends to the needs or concerns of someone limited by disease, injury, or disability to enhance the patient's quality of life, which can be assessed in three areas: social, physical, and psychological. This cross-sectional study assessed the extent of burden experienced by the caregivers of patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) therapy in King Fahad Medical City in Riyadh, Saudi Arabia. The Zarit Burden Interview Arabic Abridged version (ZBI-A) was used to assess the level of burden experienced by caregivers. The data was collected and examined by professionals using the SPSS version 23. Based on the data of 50 participants, a mean ZBI-12 score of 12.22 ± 7.2 was reported. According to the ZBI scale, "No to mild burden," "Mild to moderate burden," and "High burden" were reported as 46% (n = 23), 38% (n = 19), and 16% (n = 8) of participants, respectively. The internal consistency of the ZBI-12 scale, assessed using Cronbach's alpha, was 0.664, indicating a satisfactory level of internal consistency. It was determined that caregivers of individuals undergoing PD and HD encounter different degrees of burden, with a significant proportion of caregivers experiencing a substantial burden.

Knowledge and Awareness About Risk Factors, Clinical Manifestations, and Prevention of Thyroid Disorders in the Era of COVID-19 and Their Association With Socioeconomic Status Among the General Population in Riyadh, Saudi Arabia.

Background Thyroid dysfunction represents the most commonly observed endocrine illness within the population of Saudi Arabia. Thyroid cancer has been recognized as the second most commonly occurring malignant neoplasm among women in Saudi Arabia. Furthermore, there is evidence suggesting that COVID-19 and, to a certain degree, immunization may have an impact on thyroid function. The aim of this study was to evaluate the level of public knowledge, awareness, and attitudes pertaining to the manifestations and risk factors of thyroid disease. Additionally, the study sought to examine the potential role of COVID-19 as a risk factor and explore preventive measures in the context of Riyadh, Saudi Arabia. Methods A cross-sectional online survey was conducted targeting the Saudi population living in Riyadh aged 18 years and older. A self-administered questionnaire constructed on Google Forms was distributed to the general population using an online platform. The questionnaire consisted of five sections: demographic data, risk factors for thyroid disorders, clinical manifestations, prevention, and history of thyroid disease. Binary logistic regression analysis was used to identify predictors of better knowledge of thyroid diseases.  Results Among the 693 participants enrolled, 57.7% were female, and 31.7% were aged between 18 and 25 years. The overall mean knowledge score was 12.2 (SD = 6.57) out of 23 points. Poor knowledge of the risk factors, clinical manifestations, and prevention was observed in 50.4% of the participants. A total of 27.6% had moderate knowledge, and 22.1% had good knowledge levels. Furthermore, only 33.9% of the participants believed that COVID-19 infection was a risk factor. The results of the binary logistic regression analysis revealed that individuals within the age range of 36-45 years, females, and students had a significantly higher level of knowledge compared to other participants (p<0.05). Conclusion This study revealed that the general population of Riyadh, Saudi Arabia, lacked adequate knowledge, awareness, and attitudes regarding the risk factors, clinical symptoms, and prevention of thyroid problems. However, middle-aged individuals, females, and those who were enrolled as students showed a higher level of knowledge. Regarding the pathogenesis of COVID-19, it was observed that all participants had a limited understanding and a lack of awareness. Insufficient public awareness may result in misunderstandings, insufficient identification, and potential oversight of COVID-19-infected patients with thyroid dysfunction. Therefore, it is imperative that healthcare authorities intensify their efforts to broaden the dissemination of information throughout the population.

Awareness, Attitude, and Beliefs Regarding Organ Donation Among the General Public in Saudi Arabia.

Background: Organ donation is a lifesaving option to rescue many patients with end-stage organ failure from possible morbidities and mortalities. Unfortunately, due to a shortage of donors, many patients suffering from their illnesses are waiting for an organ. This study aimed to determine the awareness, attitude, and beliefs toward organ donation among the Saudi population. Patients and Methods: This is an online cross-sectional survey that was conducted in Saudi Arabia between July and September 2022. A self-administered questionnaire was distributed to the general public using an online platform. The questionnaire consists of two sections: the first is about demographic data, and the second is about questions to assess awareness, attitude, and beliefs regarding organ donation. The Chi-squared test was used to examine the differences in participants' awareness, attitude, and beliefs towards organ donation. A binary logistic regression analysis was used to identify predictors of a positive attitude towards organ donation. Results: A total of 3507 individuals participated in this study. Around 68.1% were aged between 18 and 30 years. Twenty-four percent of them knew of the legislative body for organ donation; 58.5% believed that organ donation should be promoted; and 66.1% had a positive attitude toward donating body organs. Younger age (31-50 years), male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. Conclusion: Although there was a positive attitude and belief about organ donation, awareness was suboptimal. Younger age, male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. It is necessary to address the gaps in knowledge, and social media as well as mass media may have an important role in bridging the gaps.

Public Awareness Regarding Corticosteroid Use and Side Effects: A Cross-Sectional Study in Riyadh, Saudi Arabia.

The administration of corticosteroids may have possible hazards, ranging from minor adverse medication reactions to more serious considerations. We aimed to assess levels of public awareness concerning corticosteroid use, side effects, and predictors of its use. A cross-sectional study was conducted online throughout the period of May to July 2023. The present investigation utilized a previously developed questionnaire tool. The study encompassed a cohort of 732 individuals. Upon inquiry regarding the adverse effects of corticosteroid treatment, the participants predominantly reported weight gain, skin alterations, and fluid retention leading to breathing difficulties, constituting 44.4%, 30.3%, and 27.7% of the responses, respectively. The prevailing adverse effects observed in individuals using corticosteroids were weight gain, alterations in mood, and changes in skin characteristics, which accounted for 38.1%, 25.7%, and 21.8% of reported cases, respectively. Individuals within the age range of 41-50 years and those who are currently not working show a higher propensity for utilizing corticosteroids in comparison to other demographic groups (p < 0.05). The level of general public knowledge about corticosteroids and the side effects connected with them in Saudi Arabia was adequate. Demographic factors, such as age, gender, and education, have an impact on the use of corticosteroids.

Quality of Life among Peritoneal and Hemodialysis Patients: A Cross-Sectional Study.

BACKGROUND: The quality of life (QoL) of patients with end-stage kidney disease (ESKD) who undergo dialysis is a reliable predictor of their long-term survival. Hemodialysis is the most common form of kidney replacement therapy for ESKD, followed by peritoneal dialysis. This study aimed to identify the factors affecting QoL in ESKD patients treated with peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. METHODS: A cross-sectional study was conducted between June and July 2021 to assess the QoL of patients with ESKD who underwent peritoneal dialysis and hemodialysis. Patients who had been on dialysis for at least one year were included. The Arabic version of the Quality of Life Index-Dialysis (QLI-D) version III was used to measure the QoL. RESULTS: A total of 210 patients completed the questionnaire. The overall QLI score was 21.73 ± 4.2, with subscales for health and functioning (20.35 ± 5.2), social and economic (20.20 ± 4.8), psychological/spiritual (23.94 ± 4.9), and family (24.95 ± 4.5). The QLI scores for PD and HD patients were 21.80 ± 4.4 and 21.72 ± 4.1, respectively. SOCSUB (p = 0.031) was significantly associated with group and income, whereas QLI (p = 0.003), HFSUB (p = 0.013), SOCSUB (p = 0.002), and PSPSUB (p = 0.003) were significantly correlated with group and years of dialysis. CONCLUSION: The study found that patients were most satisfied with their family, health and functioning, and social/economic subscales. Income and years of dialysis were found to be predictive factors of QoL. Overall, peritoneal patients in this study demonstrated a better QoL than HD patients.

The Perspective of the General Population in Saudi Arabia towards Do-Not-Resuscitate (DNR) Orders: A Cross-Sectional Study.

OBJECTIVES: In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is an emergency procedure used to maintain the heart and lungs functional simultaneously. The do-not-resuscitate (DNR) order prohibits CPR and is therefore legally required. Despite this, a DNR remains a delicate and contentious issue that places physicians in morally ambiguous situations. This study aimed to assess Saudi citizens' understanding of DNR orders, prior exposure to them, and preferences for DNR conversations. METHODS: This was an online cross-sectional study that was conducted between January and April 2023 and aimed to assess the knowledge regarding DNR orders among Saudi populations. This study adapted a previously developed questionnaire tool by Al Ahmadi et al., which examined the knowledge and attitude toward do-not-resuscitate among patients and their relatives visiting outpatient clinics. Binary logistic regression analysis was the mean knowledge score for the study participants. RESULTS: A total of 920 participants were involved in this study. Almost half of the study participants (49.6%) reported that they had heard of DNR before. The most commonly reported source of their information on DNR was healthcare providers (58.2%). The mean knowledge score of the study participants was 1.9 (1.3) out of 6, which is equal to 31.7% of the total maximum score. This demonstrates the weak level of knowledge about DNR among the general public. Females, divorced, and those who had a post-graduate level of education were more likely to be knowledgeable of DNR compared to others (p < 0.05). Around one-quarter of the study participants showed agreement with DNR. More than half of them (59.5%) believe that physicians should be involved in DNR decision making. CONCLUSIONS: Saudi Arabia's general community has limited knowledge of DNR. It is recommended that healthcare professionals increase patients' and caregivers' understanding of this concept. This will improve the planning and the provision of end-of-life care.

Knowledge, Attitude, and Practice Toward Diabetes Mellitus and Their Association With Socioeconomic Status Among Patients With Type 2 Diabetes Mellitus in Saudi Arabia.

OBJECTIVES:  The objective is to assess knowledge, attitude, and practice toward diabetes mellitus (T2DM) and its association with socioeconomic status among adult patients with T2DM. METHODS:  This cross-sectional study used the validated "Diabetes Knowledge Test (DKT)" questionnaire obtained from the Michigan Diabetes Research Center. A translated copy into Arabic has been validated and used in another study. The questionnaire was created on Google Forms and distributed through digital platforms to collect data from patients with T2DM in Saudi Arabia. RESULTS:  In this study, the majority were female (63.4%), and Saudi Arabians (96.5%), among them 23.7% lived in Riyadh, and 42.8% were from the central region. As for marital status, 60.5% were married, 28.4% were single, and 11.1% were divorced or widowed. 58.9% had college/higher degrees, and 45.8% were unemployed. Furthermore, the majority (47.1%) reported having a salary of less than 5,000 Saudi Riyals per month. 55.1% of participants lived in villas, while 46.6% had 6-10 people living in their household. Generalized linear model (GLM) findings showed that age, marital status, level of education, monthly income, and accommodation are significantly correlated with the level of knowledge. CONCLUSION:  Findings indicated a high level of knowledge, positive behavior, and good adherence to practice among patients with T2DM. GLM findings showed that age, marital status, level of education, monthly income, and accommodation are significantly correlated with the level of knowledge. Researchers suggest that effective health education interventions are needed to improve diabetes knowledge, behavior, and practices, particularly regarding lifestyle modifications and dietary management.

Knowledge and Perception of Physicians of Different Specialties in Saudi Arabia Toward Helicobacter pylori.

Background: Helicobacter pylori (H. pylori) is a key pathogen causing several gastrointestinal diseases. Fortunately, H. pylori infection is treatable, which can lower its comorbidities. However, data assessing physicians' awareness of H. pylori is lacking in Saudi Arabia. Objective: To assess the knowledge and awareness of physicians of different specialties who practice in Saudi Arabia about H. pylori infection. Methods: This is a cross-sectional study conducted between May and September 2022 on physicians across all regions in Saudi Arabia using a validated online questionnaire covering their knowledge and awareness of H. pylori infection. An independent t-test, one-way ANOVA, and Games-Howell as a post hoc test were used to analyze the data. A General Linear Model was also employed to determine significant predictors among the variables reliant on H. pylori awareness. Results: The results showed that the mean awareness score of 474 physicians was 76.99± 6.9, indicating that participants had sufficient knowledge about H. pylori infection. In general, the internal medicine specialists (28.3%) had better awareness of H. pylori infection than the other specialties. Moreover, the university hospital sector performed the best, scoring 80.68±13.3, and the southern region had the highest-ranked physicians with a score of 81.56 ±13.7 in terms of H. pylori awareness. Furthermore, the general linear model revealed a statistical significance (p<0.05) for the following demographic aspects concerning H. pylori awareness: the physicians' age group of 30-39 years, duration of experience of 11-15 years, the hospital sectors of Nation Guards (NGH) and Security Forces (SFH), and the southern and central regions of practice in Saudi Arabia. Conclusion: Physicians in Saudi Arabia have relatively sufficient awareness of H. pylori; however, they are highly influenced by age, years of experience, the hospital sector involved, and the region where the physicians practice.

Knowledge, Attitudes, and Practices of High-Risk Patients towards Prevention and Early Detection of Chronic Kidney Disease (CKD) in Saudi Arabia.

CONTEXT: Chronic kidney disease (CKD) is characterized by the presence of kidney damage or decreased kidney function. In the Kingdom of Saudi Arabia, the prevalence of CKD is at 5.7%, which represents a high burden on health care systems. AIMS: This study aimed to assess the knowledge, attitudes, and practices of high-risk patients towards prevention and early detection of chronic kidney disease in Saudi Arabia. SETTING AND DESIGN: Descriptive cross-sectional study in Saudi Arabia. METHODS AND MATERIAL: This study was designed using a newly developed instrument, the CKD Screening Index. It was conducted from December 2021 to May 2022 by a self-administered questionnaire. The questionnaire has three parts: socio-demographic data, clinical factors, and the CKD screening index tool. STATISTICAL ANALYSES USED: Independent t-test, One-Way ANOVA, LSD, Games-Howell tests. RESULTS: Knowledge of kidney function had a significant difference across patient groups with varying employment status. Monthly income is a significant factor for the patient attitude on healthcare towards preventing kidney disease. On the other hand, educational level significantly affects the overall attitude of patients towards preventing kidney disease. CONCLUSION: Understanding knowledge, attitudes, and practices associated with CKD is vital to informing optimal policy and public health responses in the country.

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia.

Background The presence of critical illness-induced corticosteroid insufficiency (CIRCI) is correlated with elevated concentrations of circulating biomarkers associated with inflammation and coagulation in multiple domains. The management of adrenal insufficiency remains a topic of ongoing debate and disagreement among endocrinologists and intensivists. This study aimed to assess the extent of understanding regarding CIRCI among endocrinologists and intensivists who are actively practicing in Saudi Arabia. Methods This is an online cross-sectional survey study that was conducted between June and August 2023 to assess knowledge of CIRCI among endocrinologists and intensivists working in Saudi Arabia. The questionnaire tool for this study was constructed based on a previous literature review. Binary logistic regression analysis was used to define factors that affect participants' knowledge of CIRCI. Results A total of 76 physicians were involved in this study. Around 32.9% (n= 25) of the participants described CIRCI correctly as an impairment of the hypothalamic-pituitary axis during critical illness. Around 35.5% (n=27) of the participants identified that widespread use of corticosteroids in critically ill patients prompted the need to revisit the concept, diagnosis, and management of CIRCI, and a similar proportion of the participants (35.5%) (n=27) identified that the role of corticosteroids in the management of CIRCI in critically ill patients may be beneficial in selected cases. Around 42.1% (n=32) of the participants identified that CIRCI is specific to critically ill patients while AI can occur in any individual. Around 17.1% (n=13) of the participants confirmed that there is no task force agreement on whether corticosteroids should be used in adult patients with sepsis but without shock. The mean knowledge score of the study participants was 3.6 (sd: 2.2) out of 10, which demonstrates a weak level of knowledge of CIRCI (36.0%). Binary logistic regression analysis identified that physicians from the southern and western regions were less likely to be knowledgeable of CIRCI compared to physicians from the central region (p< 0.05). Conclusion The study revealed that the level of familiarity with CIRCI among endocrinologists and intensivists in Saudi Arabia fell short of the desired benchmark. Clinicians may opt to utilize delta cortisol levels following cosyntropin administration and random plasma cortisol levels as diagnostic measures for CIRCI, instead of relying on plasma-free cortisol or salivary cortisol levels in conjunction with plasma total cortisol. Adherence to customized treatment protocols is crucial to attain the most favorable results for patients.

Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study.

BACKGROUND: Diabetic foot disease (DFD) is a significant complication associated with diabetes, characterized by the potential for progressive amputation of specific foot segments or the entire lower limb in the absence of timely identification of infection and intervention. The aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia. METHODS: This cross-sectional study utilized an online survey previously validated in Australia. The mean foot care prioritization score was used to identify the dummy variable for binary logistic regression analysis, which was used to identify predictors of foot care prioritization. RESULTS: A total of 222 participants were involved in this study. Assessing for the risk of developing foot complications, visually inspecting feet for wounds, and providing or recommending footwear to prevent foot complications were the most commonly reported practices, accounting for 80.60% (n = 178), 76.10% (n = 169), and 75.20% (n = 167), respectively. The most commonly referred patients to a specialist tertiary multi-disciplinary foot care team were patients with ulcers in patients with absent foot pulses, ulcers with ascending cellulitis, and diabetic ulceration, accounting for 73.50% (n = 163), 71.60% (n = 159), and 66.70% (n = 148), respectively. The mean foot care prioritization score for the study participants was 54.1 (standard deviation: 11.7) out of 78 (69.4%), which demonstrates a moderately high level of foot care prioritization. Binary logistic regression analysis identified that healthcare professionals who are aged 35-44 years, those who have 5-10 years of experience, those who work at private hospitals, those who have a higher number of practice clinics per week, and those who have to manage a higher number of patients with diabetes in each clinic were more likely to prioritize foot care in their practices (p < 0.05). CONCLUSION: Our study found that healthcare professionals in Saudi Arabia place a moderate degree of emphasis on foot care. Healthcare professionals falling within the age range of 35-44 years, possessing 5-10 years of experience, employed at private hospitals, overseeing a greater number of practice clinics weekly, and managing a greater number of patients with diabetes per clinic exhibited a greater propensity to prioritize foot care within their respective practices. Policymakers should consider the integration of continuous glucose monitoring technologies, the establishment of standardized foot screening protocols, and the implementation of targeted educational programs for healthcare professionals.

Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study.

Objective: To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. Methods: A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. Results: A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reported they were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Conclusion: Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and management of IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.

Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19.

BACKGROUND: Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a life-threatening condition first described in children (MIS-C). It is characterized by a hyperinflammatory state that involves the cardiovascular, gastrointestinal, dermatologic, and neurologic systems without severe respiratory system involvement. Myocarditis is one of the cardiovascular presentations of MIS that might be complicated with cardiogenic shock. There are few case reports describing SARS-CoV-2-related MIS in adults (MIS-A). CASE SUMMARY: Three cases of healthy young adults diagnosed with severe acute respiratory syndrome-CoV-2 related (MIS-A). The main presentation was cardiogenic shock secondary to histologically proven myocarditis, which resolved rapidly after initiation of medical therapy including anti-inflammatory and immunosuppressive drugs. All the cases, however, required mechanical circulatory support (MCS) as a bridge to recovery. CONCLUSIONS: It appears reasonable to treat the patient with fulminant myocarditis in SARS-CoV-2-associated MIS-A with high-dose corticosteroid "pulse" therapy in order to suppress the inflammatory response and MCS to correct initial metabolic derangement and reestablish/maintain vital organ perfusion. Addition of IV immunoglobulin and other immunomodulators should be assessed in a case-by-case basis especially considering the associated cost resource allocation.

Allogeneic Hematopoietic Stem Cell Transplant Infusion During Venovenous Extracorporeal Membrane Oxygenation Support.

Management of hematopoietic stem cell transplant complicated by respiratory failure has been facilitated by the use of extracorporeal membrane oxygenation as a bridge to curative chemotherapeutic options. This is the first report of hematopoietic stem cell transplantation on extracorporeal membrane oxygenation in the adult population. CASE SUMMARY: A 28-year-old woman diagnosed with idiopathic aplastic anemia complicated by acute respiratory distress syndrome secondary to pneumonia required venovenous extracorporeal membrane oxygenation to supplement oxygenation and ventilation. She received hematopoietic stem cell transplantation while she was on extracorporeal membrane oxygenation support. MAIN RESULTS AND CONCLUSION: Delivery of the stem cell through extracorporeal membrane oxygenation circuit was successful in the described patient. There was no sequestered stem cell in extracorporeal membrane oxygenation circuit, and she was found to have 90% donor chimerism suggesting successful engraftment. This report showed that infusion of stem cell through extracorporeal membrane oxygenation circuit is safe and feasible, and our results suggest that successful engraftment is possible.

Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure.

Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an "awake approach," may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach. DESIGN: Retrospective case series. SETTING: Monocenter study. PATIENTS: Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao2/Fio2 ratio at implantation of 76 (interquartile range, 59-92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation. CONCLUSIONS: This report demonstrates that in a selected group of patients, an "awake" venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes.