King Fahd Military Medical Complex

Reflection-based lensing is used to focus or collimate extreme ultraviolet (EUV)/x rays (x-ray optics) propagating in grazing incidence small-angle x-ray scattering (GISAXS) inside poly-capillary glass. In the process, the refractive index of silica is slightly less than that of vacuum (1.0) for EUV/x rays, leading to total external reflection with a critical angle slightly less than 90°. Here, we examine the feasibility of widening the total external reflection window by coating the capillary interior surface with a silicon nanofilm that assumes the shape of the polycapillary, which may enhance the collection and collimation power. We use slow dynamic self-assembly via circulation of the nanoparticles through the capillary. Electromagnetic scattering computations are conducted using the model of a flat glass substrate decorated with closely packed Si nanoparticles. Optical, luminescent, and SEM imaging techniques, as well as spectroscopy, show that the polycapillary coating is uniform and luminescent under UV irradiation. The computations show that, for visible wavelengths, a 3 nm silicon nanoparticle film reduces the grazing reflectivity at the visible/UV band-to-band transitions E1 and E2. For EUV/x ray, there is a significant reflectivity enhancement of ∼10% due to a larger index dip below that of vacuum, affording a smaller critical angle. Widening the external reflection regime promises superior collection and focusing power, improving the intensity and resolution. Being luminescent under UV makes it useful for imaging, therapy, and other clinical procedures, while also enabling the development of more compact and versatile instruments.

Low platelet count is rarely caused by inherited thrombocytopenia. May-Hegglin anomaly is an uncommon condition that falls under the umbrella of familial thrombocytopenia. The condition is under-reported in Saudi Arabia; therefore, we report the current case. This is a 24-year-old Saudi lady, presented to the emergency room with vaginal bleeding. No bleeding occurred at any other sites. She has a positive family history of thrombocytopenia among her father and 2 of her siblings. Her platelet count was 16 × 103/µL with normal other blood count as well as renal and liver panels. She was admitted to the regular bed for investigation as sever thrombocytopenia with suspicion of either familial or immune thrombocytopenia. Further studies showed normal hemostatic, virology, and connective tissue disease markers. Peripheral blood film showed low platelet distribution with occasional large/giant platelets and basophilic inclusion bodies in some neutrophils (Dohle body-like). A picture suggestive of May-Hegglin related thrombocytopenia that was confirmed by the presence of a positive myosin heavy chain 9 (MYH9) gene mutation. In conclusion, there are many difficulties in diagnosing and treating May-Hegglin disorders in females of reproductive age. More research and guidelines are needed to manage inherited thrombocytopenia before and throughout pregnancy.

Abstract Background: The management of anticoagulation therapy during continuous renal replacement therapy (CRRT) presents a complex clinical challenge for patients who are critically ill. The selection of an optimal anticoagulation method for CRRT circuit maintenance remains a subject of ongoing critical care discussion because it needs to achieve both safety and effectiveness. The research evaluated the safety outcomes and treatment success rates between regional citrate anticoagulation (RCA) and systemic heparin anticoagulation (SHA) and anticoagulation-free CRRT for patients with acute kidney injury (AKI). Methods: A prospective comparative observational study was conducted over 24 months starting from April 2022 until March 2024. The study took place in two tertiary care intensive care units which operated in Egypt and Saudi Arabia during this multicenter study. The research included 150 adult patients with AKI who needed CRRT treatment which were distributed into three equal groups (n=50) based on their anticoagulation methods. Results: Primary endpoints focused on the incidence of circuit clotting and circuit life span (CLS). Secondary endpoints included bleeding complications, metabolic disturbances, and cost-effectiveness assessment. The study results showed that patients receiving regional citrate anticoagulation experienced fewer circuit clotting events (0.58±1.4) than patients who received heparin (0.86±1.4) or no anticoagulation (1.4±2.4) (p = 0.03). The circuit life span results indicated a positive trend for RCA at 26.4±20.5 hours but did not reach statistical significance when compared to heparin at 20.6±18.6 hours and no anticoagulation at 16±16.3 hours (p = 0.23). The heparin treatment group experienced all bleeding complications which affected 10% of patients while ionized hypocalcemia reported only within citrate group (p < 0.001). Conclusions: Despite both RCA and anticoagulation-free CRRT represent viable therapeutic options for patients at increased risk of bleeding, the use of regional citrate anticoagulation provides better circuit performance and lower costs than other methods while eliminating all bleeding risks.

Heatstroke is a life-threatening condition resulting from prolonged exposure to high temperatures or intense physical activity, especially during the summer. Pilgrims performing Hajj are particularly vulnerable because of factors such as advanced age, chronic health conditions, and failure to follow safety guidelines. Health volunteers play a key role in prevention and response. This study aimed to assess health volunteers' knowledge and identify predictors of such knowledge. A cross-sectional study was conducted among 772 health volunteers during Hajj 2024 in Saudi Arabia. A self-designed questionnaire was developed and utilized to assess participants' knowledge of heatstroke and to identify predictors of such knowledge. Data were collected electronically and analyzed via Jeffrey's Amazing Statistics Program (JASP). Analysis revealed that (n=576) 74.6% of health volunteers had satisfactory heatstroke knowledge, though critical gaps persisted. While recognition of specific symptoms (e.g., lethal temperatures >39.5°C; 90.8%) and preventive measures was strong, pathophysiological understanding was poor, with only 5.2% correctly interpreting body temperature thresholds. Logistic regression identified significant predictors: a medical educational background (odds ratio (OR) = 4.51, p<.001), employment (OR = 2.45, p<.001), and previous first aid training (OR = 2.51, p=.003) increased odds of satisfactory knowledge. Significant regional disparities existed, with the Middle Region associated with higher odds (OR = 2.14, p=.019) and the Southwest Region with lower odds (OR = 0.31, p=.004). In conclusion, this study found that while a majority of Hajj health volunteers possess satisfactory heatstroke knowledge, significant and systematic disparities exist. The findings robustly demonstrate that knowledge is not uniformly distributed but is significantly predicted by educational background, occupational status, and geographic region. To ensure a uniformly high standard of care, preparedness initiatives must be strategically refined. Resources should be deliberately channeled into enhancing the training of non-medical volunteers and addressing the pronounced knowledge gaps in underperforming regions, thereby fortifying the overall resilience of the health volunteer system against the formidable threat of heatstroke.

Contemporary healthcare faces the critical challenge of managing complex patient needs that extend beyond isolated biological pathology to encompass psychological, social, and environmental dimensions. The traditional, siloed biomedical model is increasingly inadequate for this task. This research paper argues that holistic patient care is only achievable through a deeply integrated, multidisciplinary approach. It examines the indispensable and synergistic roles of eight core pillars: Nursing, Laboratory Services, Pharmacy, Radiology, Anesthesia, Dentistry, Social Work, and Administrative Support. The paper traces the theoretical foundation for this shift from biomedical reductionism to patient-centered holism. It then analyzes the operational synergy within the clinical core (nursing, diagnostics, and therapeutics) and the vital integration of often-overlooked domains like dentistry and social work to address comprehensive well-being. Furthermore, it explores the enabling administrative framework and the practical mechanisms of integration, such as structured communication and shared rounds. Finally, the paper reviews the measurable positive outcomes of this model on patient safety, satisfaction, and systemic efficiency. The conclusion asserts that investing in robust multidisciplinary collaboration is essential for achieving the Quintuple Aim of healthcare, representing a necessary evolution from fragmented intervention to coordinated, person-centered healing.