King Abdulaziz Hospital

Background/Objectives: Bariatric surgery has emerged as an effective intervention for severe obesity; however, post-operative dizziness remains poorly characterized in the literature. This study aimed to determine the prevalence of dizziness, imbalance, and hearing problems following bariatric surgery and to identify associated risk factors. Methods: A cross-sectional study was conducted among 156 patients who underwent bariatric surgery at multiple centers in Saudi Arabia. Data were collected through structured questionnaires assessing demographic characteristics, surgical details, and post-operative vestibular symptoms. Bivariate and multivariate logistic regression analyses were performed to identify predictors of dizziness. Results: The prevalence of post-operative dizziness was 77.3% (95% CI: 70.0-83.3%), imbalance was 38.0% (95% CI: 30.6-46.0%), and hearing problems were 10.7% (95% CI: 6.7-16.6%). Bivariate logistic regression identified weight loss was significantly associated with dizziness (OR = 1.063, 95% CI: 1.024-1.103, p = 0.001). In the multivariate model, each percentage point increase in weight loss was associated with a 6.1% increased dizziness (adjusted OR = 1.061, 95% CI: 1.017-1.107, p = 0.006). Dizziness was strongly associated with imbalance (chi-square = 14.325, p < 0.001) and falls (chi-square = 7.085, p = 0.008). Conclusions: Vestibular complications, particularly dizziness, are highly prevalent following bariatric surgery and demonstrate a significant dose-response relationship with the magnitude of weight loss. Enhanced awareness and systematic screening for dizziness in post-bariatric patients are warranted.

Acute care surgery (ACS) was developed as a consultant led organizational framework designed to enhance the promptness and quality of emergency general surgical care. Appendectomy and cholecystectomy are considered standard ACS procedures; nevertheless, the reported rates of postoperative complications are varied, attributed to differences in patient demographics, illness severity, surgical care, and institutional policies. This meta-analysis, executed in alignment with PRISMA 2020 recommendations, assessed publications published from January 2010 to December 2025 that investigated postoperative outcomes following emergency appendectomy and cholecystectomy within the contexts of ACS or emergency general surgery. Eligible trials comprised adult or mixed-age groups with recorded perioperative outcomes. Independent reviewers did the data extraction and quality check. When it made sense, random-effects meta-analyses were done, and the I² statistic was used to measure heterogeneity. Evidence synthesis demonstrated that the application of ACS typically improves surgical speed, reduces hospital length of stay, and yields comparable or diminished postoperative complication rates in contrast to conventional on call systems. Infections at the surgical site, damage to the bile duct, bile leaks, and abscesses in the abdomen were all common problems. Comorbidity, illness severity, operating delay, and open surgical conversion were all factors that led to bad outcomes. On the other hand, early intervention and minimally intrusive methods were always linked to better results. In general, ACS-based care is a good and flexible way to handle emergency appendectomy and cholecystectomy. It follows the rules of quality, safety, and efficient use of resources. The ongoing diversity among studies highlights the necessity for defined care pathways and sustained high-quality research focused on ACS.

The advancement of X-ray computed tomography coronary angiography (CTCA) has facilitated the acquisition of dynamic CTCA images within a single cardiac cycle, achieving a very low radiation dose while maintaining acceptable image quality. This study aimed to evaluate the radiation dose and cancer risk in patients who underwent computed tomography coronary angiography ( CTCA). The radiation data and related parameters were analyzed in 232 patients who underwent CTCA at a single hospital. Dose data were retrospectively extracted from the hospital information system using the DoseWatch software. The effective dose (E) values were determined using CT-expo 2.5 software, while the Lifetime Attributable Risk (LAR) was estimated using sex- and age-specific risk coefficients provided by the International Commission on Radiological Protection (ICRP). The reported doses in CTCA were as follows: median (interquartile range) CT dose-length product (DLP) and volume CT dose index (CTDI vol ), which were 268 mGy cm (100–492) and 2.92 mGy (1.57–20.01), respectively, while the E was 5.21 mSv (2.16–10.7). The LAR values (per 10 6 ) ranged between 58–426 and 260–1025 for male and female patients, respectively. The CTCA doses obtained using a 256-row scanner with dual-energy technology were comparable to the previously reported values, demonstrating significantly improved dose performance through the incorporation of dose reduction features of modern CT scanners. However, risk-benefit analyses should be conducted before CTCA examinations, particularly for young female patients, to mitigate the associated cancer risk.

Background: Healthcare organizations are experiencing continuous transformation driven by digitalization, workforce challenges, quality improvement initiatives, and increasing service complexity. While strategic change is often initiated by senior leadership, its successful implementation largely depends on middle managers who operate at the intersection of strategy and frontline practice. Despite their pivotal role, the literature on middle management's leadership and sustainability of change in healthcare remains fragmented and underexplored. Aim: This systematic review aimed to critically synthesize empirical evidence on the role of middle managers in leading and implementing change within healthcare organizations. Method: A systematic review design was employed. A comprehensive literature search was conducted across selected electronic databases for peer-reviewed studies published between 2020 and 2025. Studies focusing on middle managers in healthcare settings and their involvement in change leadership were included. Following duplicate removal, title and abstract screening, and full-text assessment, ten primary studies met the inclusion criteria. Data were extracted systematically and synthesized using a narrative and thematic approach. Results: The findings revealed that middle managers played a central role in translating strategic directives into operational practice, facilitating communication, and supporting staff engagement during change processes. Key themes included change translation and implementation, leadership behaviors influencing workforce engagement, cultural and accountability leadership, digital transformation readiness, and constraints on leadership capacity. Transformational and supportive leadership styles were consistently associated with positive change outcomes, while resource limitations, workload pressures, and role ambiguity emerged as persistent barriers. Conclusion: The review demonstrated that middle managers are critical drivers of successful change in healthcare organizations. Strengthening leadership development, organizational support, and enabling conditions at the middle-management level is essential for achieving sustainable transformation and improving healthcare system performance.

Background: Bilateral traumatic hip dislocation is a rare and severe orthopedic injury that is typically associated with high-energy trauma. Asymmetric bilateral dislocations are particularly uncommon and may pose diagnostic challenges, especially when presentation or evaluation is delayed. Case Presentation: We report the case of a patient who sustained asymmetric bilateral traumatic hip dislocation following a high-energy road traffic accident. The patient presented with severe bilateral hip pain and inability to bear weight. Due to delayed diagnosis, orthopedic evaluation occurred more than nine hours after presentation. Imaging revealed anterior dislocation of the right hip and posterior dislocation of the left hip. Closed reduction of both hips was successfully performed under conscious sedation. On examination, the patient demonstrated left-sided foot drop consistent with sciatic nerve involvement. Post-reduction imaging confirmed concentric reduction of both hips. Conclusion: This case highlights the diagnostic challenges associated with asymmetric bilateral traumatic hip dislocation and underscores the importance of early recognition, comprehensive trauma assessment, and timely reduction to minimize complications such as avascular necrosis and neurological injury. Reporting such rare presentations contributes to increased clinical awareness and reinforces key principles in the management of traumatic hip dislocations.

Acute type A aortic dissection (ATAAD) is a time-sensitive and life-threatening emergency that usually presents as sudden, severe pain radiating to the back. Atypical presentations such as acute coronary syndromes make it challenging to diagnose, hence delaying the management. We report a case of a 57-year-old male with a history of hypertension, diabetes, dyslipidemia, and chronic smoking who presented to the emergency department with central chest heaviness that radiated to the left hand associated with diaphoresis. Normal cardiac enzymes and an electrocardiogram (ECG) led to the initial diagnosis of unstable angina. As a result, he was given dual antiplatelets, which provided temporary relief of his symptoms. However, before discharge, a bedside transthoracic echocardiography found a retrograde ATAAD with the double aortic valve sign, a rare echocardiographic finding, along with severe aortic regurgitation. Further imaging with CT angiography confirmed the diagnosis despite the patient not complaining of any pain. Due to the involvement of the aortic root, valve, and right coronary artery, he underwent the Bentall procedure. Postoperative management emphasized initiation of anticoagulation, controlling the blood pressure, and management of cardiovascular risk factors to prevent aortic dissection and aneurysm. The patient recovered from the postoperative course without complications and remained stable upon follow-up. ATAAD should remain in the differential diagnosis for acute chest pain even in the absence of a typical presentation. Bedside echocardiography is a useful initial diagnostic tool, and early multidisciplinary management supports successful patient outcomes.

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. Evidence-based education is critical for improving healthcare professionals’ knowledge and promoting optimal clinical practice. However, no study has evaluated COPD-related knowledge among primary healthcare professionals in Saudi Arabia. Thus, this study aimed to assess the level of COPD knowledge in this group and to identify factors associated with higher scores.MethodsAn online cross-sectional survey was conducted from October 2024 to May 2025 among licensed primary healthcare providers in Saudi Arabia, using the Bristol COPD Knowledge Questionnaire (BCKQ). One-way ANOVA was used to compare mean scores across demographic and professional groups, followed by multivariable linear regression to identify independent factors of knowledge.ResultsA total of 1686 responses were received, of which 92 incomplete submissions were excluded, leaving 1594 fully completed questionnaires for analysis. Nurses accounted for 40.4%, general practitioners for 35.8%, and family medicine physicians for 24.0%. The mean (SD) total BCKQ score was 28.2 ± 8.15 out of 65 (43.4%), indicating moderate knowledge overall. The highest-scoring domain was Phlegm (2.96 ± 1.39), while the lowest was Inhaled Steroids (1.26 ± 0.86). Significant differences in knowledge were observed by profession (p = 0.004), region (p = 0.001), workplace (p < 0.001), clinic type (p < 0.001), prior COPD training (p = 0.010), and self-reported knowledge (p < 0.001). In multivariable linear regression, self-reported adequate knowledge (β = 3.99; p < 0.001), prior COPD training (β = 1.89; p = 0.011), and being a family medicine physician versus a general practitioner (β = 1.99; p = 0.027) were independently associated with higher knowledge.ConclusionPrimary healthcare professionals in Saudi Arabia showed moderate COPD knowledge, with gaps in prevention and pharmacological management. Higher scores were linked to prior COPD training, self-reported adequate knowledge, and being a family medicine physician. Expanding structured, evidence-based training could address these gaps and enhance COPD care nationwide.