King Khaled Hospital

BackgroundThe rapid integration of telemedicine into cardiovascular care requires a comprehensive understanding of patient satisfaction to maintain service quality and equity. Although telemedicine adoption is increasing in Saudi Arabia, patient-centered evaluations, particularly for specialized services such as cardiology in non-urban regions, are lacking. This study assessed patient satisfaction and identified its key predictors within a cardiac telemedicine service in Najran, Saudi Arabia.Patients and methodsA prospective cross-sectional study was conducted among 109 consecutive patients attending the Najran Cardiac Virtual Clinic between June and August 2024. Participants completed a validated electronic survey that collected sociodemographic data, clinical history, and satisfaction levels across 12 domains of telemedicine care, rated on a four-point Likert scale from Poor to Excellent. High overall satisfaction was defined as a composite score at or above the 75th percentile of the sample distribution. Predictors of satisfaction were identified using univariate and multivariable logistic regression models.ResultsThe mean age of participants was 47.1±17.2 years, and 60 (55.0%) were female. Overall satisfaction was very high, with 104 patients (95.4%) rating their experience as "Good" or "Excellent." The highest-rated domains were confidentiality and privacy (104/109, 95.4% Good/Excellent) and ease of use (104/109, 95.4%). Multivariable analysis identified two independent predictors of high satisfaction: higher educational attainment (associated with 3.1 times higher odds of high satisfaction; adjusted odds ratio (aOR): 3.1, 95% CI: 1.2-8.0; p=0.019) and a lower count of comorbidities (fewer than three versus three or more comorbidities; aOR: 2.8, 95% CI: 1.1-7.3; p=0.034).ConclusionCardiac telemedicine services in Najran achieved high patient satisfaction and demonstrated broad acceptability across age, gender, and residential settings. This study provides one of the first patient-centered evaluations of a dedicated cardiac telemedicine service in a non-urban region of Saudi Arabia. However, significantly lower satisfaction was reported by patients with lower educational attainment and those with multiple comorbidities. To ensure equitable delivery, these groups require prioritized interventions such as tailored digital literacy support, simplified interfaces, and integrated care pathways.

Primary cardiac angiosarcoma is a rare and aggressive malignancy most commonly arising from the right atrium. We report a 43-year-old male patient who had no known comorbidities and was not receiving any regular medications. He presented with abdominal and epigastric pain and was found to have severe pericardial effusion, cardiac tamponade, a large right atrial mass, hemorrhagic pericardial effusion, and bilateral pulmonary emboli. He underwent urgent pericardiocentesis followed by open-heart surgery for excision of the right atrial mass, pericardial window creation, and mediastinal lymph node biopsy. Histopathology confirmed angiosarcoma infiltrating the right atrium, pericardium, and associated thrombus. Postoperative recovery was uneventful, and oncology recommended systemic chemotherapy. This case highlights atypical presentations of cardiac angiosarcoma and outlines the surgical and diagnostic approach.

The aim of this study is to explore the challenges encountered by Jordanian female journalists, focusing on their experiences in the journalistic work environment (including the workplace and the field) in addition to the challenges faced from society and family. Through using a qualitative and inductive approach by conducting in-depth interviews with Jordanian female journalists who are registered professionals working in a variety of media environments, including daily, weekly, and electronic media. The research findings explore a wide range of challenges female journalists face in Jordan, including workplace issues and external challenges from family and society. The following main themes were emerged in the study, at the workplace level: harassment and newsroom safety; pay inequalities, organizational culture and leadership this point leads to subthemes as bullying, framing female Journalists, and stigmatization, On the other hands challenges themes found at the level of the society and family security which emerged several subthemes as party affiliation, security harassment, and cultural beliefs, as well as family, parents and relatives perspectives. The findings highlight persistent gender‑based discrimination shaped by workplace practices and cultural expectations. Strengthening protections, ensuring fair pay and promotion, and shifting societal attitudes are essential to supporting female journalists. Further research is needed to better understand these challenges and inform effective solutions.

Background: Cervical radiculopathy is a common cause of neck and upper-extremity pain, often resulting from degenerative cervical spine conditions. While many patients respond to conservative management, a substantial proportion experience persistent symptoms requiring interventional treatment. Cervical epidural corticosteroid injections have emerged as a widely used option for short-term pain relief in refractory cases. Aim: This article aims to review the indications, anatomical considerations, procedural techniques, complications, and nursing roles associated with cervical epidural corticosteroid injections in the management of cervical radiculopathy. Methods: A narrative review approach was used, integrating anatomical knowledge, clinical indications, injection techniques, imaging guidance, complication profiles, and interprofessional nursing responsibilities. Evidence from clinical studies and established procedural practices was synthesized to provide a comprehensive clinical overview. Results: Cervical epidural injections, particularly via the interlaminar approach, demonstrate effective short-term pain relief for selected patients, with approximately half achieving significant symptom reduction for up to three months. Fluoroscopic guidance enhances procedural accuracy and safety. Although generally safe, these injections are associated with potential complications, especially with transforaminal techniques, underscoring the importance of meticulous patient selection and skilled execution. Nursing involvement is critical in pre-procedural preparation, intra-procedural monitoring, and post-procedural care. Conclusion: Cervical epidural corticosteroid injections represent a valuable interventional modality for cervical radiculopathy when conservative therapies fail. Optimal outcomes depend on appropriate patient selection, precise technique, and coordinated interprofessional care.

Background: Induction of labor is a common obstetric intervention used to initiate uterine contractions when continuation of pregnancy poses greater maternal or fetal risk than delivery. Its global use has increased substantially, requiring safe, evidencebased clinical practice and effective interprofessional collaboration. Aim: This article aims to review the clinical considerations of labor induction and highlight the essential nursing roles in ensuring maternal and fetal safety during the induction process. Methods: A narrative review of current obstetric guidelines, clinical trials, and systematic reviews was conducted to examine indications, contraindications, methods, complications, and nursing interventions related to induction of labor. Results: Induction of labor is indicated for various maternal and fetal conditions such as hypertensive disorders, diabetes, fetal growth restriction, and postterm pregnancy. Mechanical and pharmacological methods are widely used, each with specific benefits and risks. Evidence demonstrates that appropriately managed induction does not increase cesarean section rates and may improve perinatal outcomes. Nurses play a pivotal role in assessment, medication administration, continuous fetal monitoring, early detection of complications, and patient education. Conclusion: Induction of labor is a complex yet essential obstetric intervention that requires comprehensive clinical assessment and skilled nursing care. Adherence to evidencebased protocols and effective teamwork is critical to optimizing outcomes.

Background: Portal hypertension is a major hemodynamic consequence of chronic liver disease and other hepatic or extrahepatic disorders. It drives complications such as variceal bleeding, ascites, and encephalopathy, significantly impacting morbidity and mortality. Aim: To provide an integrated review of portal hypertension, emphasizing pathophysiology, diagnostic strategies, and multidisciplinary management. Methods: A comprehensive synthesis of current evidence and guidelines was performed, covering hemodynamic principles, etiologic classification, laboratory and imaging evaluation, and therapeutic approaches including pharmacologic, endoscopic, and interventional strategies. Results: Portal hypertension arises from increased intrahepatic resistance and augmented splanchnic inflow, leading to collateral formation and systemic circulatory changes. Clinically significant portal hypertension (HVPG ≥10 mm Hg) predicts decompensation, while ≥12 mm Hg correlates with variceal bleeding risk. Noninvasive tools such as elastography and Doppler ultrasound complement invasive HVPG measurement. Management integrates etiologic therapy, nonselective beta-blockers (preferably carvedilol), endoscopic prophylaxis, and escalation to TIPS or transplantation for refractory complications. Preventive strategies—alcohol abstinence, metabolic optimization, and early antiviral therapy—remain pivotal. Conclusion: Portal hypertension is a multifactorial syndrome requiring early detection, risk stratification, and coordinated care across specialties. Evidence-based interventions targeting both underlying disease and portal pressure reduction improve survival and quality of life.

Background:Urethroplasty may influence ejaculatory function due to the potential for nerve injury during perineal dissection. It is essential to understand postoperative ejaculatory outcomes for effective patient counseling and surgical planning.Objectives:To compare ejaculatory function and satisfaction following excision and primary anastomosis (EPA) versus substitution urethroplasty (SU), and to identify independent predictors of these outcomes.Design:Retrospective cohort study.Methods:A total of 63 sexually active men who underwent anterior urethroplasty between July 2017 and July 2022 at two tertiary centers were evaluated. Group I (EPA, n = 33) underwent transecting end-to-end urethroplasty, while Group II (SU, n = 30) underwent substitution urethroplasty utilizing buccal mucosa grafts. Ejaculatory function and satisfaction were assessed using the Male Sexual Health Questionnaire (MSHQ).Results:The mean stricture length was 3.3 ± 7 cm, and the overall urethroplasty success rate was 87% after a mean follow-up of 45.6 ± 21 months. The mean score on the MSHQ Erection Scale differed significantly between groups (EPA = 10.13 ± 4.66 vs SU = 12.69 ± 3.12, p = 0.008). Conversely, scores on the Ejaculation Scale (EPA = 27.24 ± 7.63 vs SU = 27.57 ± 6.84, p = 0.443) and Satisfaction Scale (EPA = 24.17 ± 6.73 vs SU = 25.79 ± 5.64, p = 0.790) were comparable. Multivariate analysis identified age as the sole independent predictor of Ejaculation Scale scores (β = −0.219, 95% CI: −0.351 to −0.087, p = 0.001).Conclusion:Postoperative ejaculatory function showed no significant difference between EPA and SU urethroplasty. Younger age was associated with improved ejaculatory outcomes, whereas no surgical or stricture-related factors predicted patient satisfaction. These findings underscore the importance of considering patient age during postoperative counseling and expectation management.

Background: Testicular torsion is a time-critical urologic emergency characterized by twisting of the spermatic cord, leading to compromised blood flow and rapid ischemia. Delay in diagnosis can result in irreversible testicular loss, making early recognition essential.Aim: To review the clinical presentation, diagnostic strategies, and management principles of testicular torsion in the emergency department, emphasizing time-sensitive interventions.Methods: A comprehensive analysis of current emergency practices was conducted, focusing on history, physical examination, imaging modalities, and surgical management. Evidence-based guidelines and validated scoring systems such as TWIST were examined to optimize diagnostic accuracy and expedite care.Results: Testicular viability declines sharply after six hours of ischemia, with salvage rates highest when detorsion occurs early. Doppler ultrasonography demonstrated high sensitivity (≈93%) and specificity (100%) for torsion detection, though clinical judgment remains paramount. Manual detorsion may serve as a temporizing measure when surgical intervention is delayed, but definitive management requires scrotal exploration and bilateral orchiopexy. Neonatal torsion presents unique challenges due to extravaginal mechanisms and limited salvage potential.Conclusion: Testicular torsion demands immediate recognition and surgical intervention to prevent organ loss and preserve fertility. Emergency workflows should prioritize rapid triage, early urologic consultation, and judicious imaging without delaying operative readiness.

This study explores antibiotic resistance profiles in Pseudomonas aeruginosa infections among patients in a tertiary hospital in a developing nation. It aims to identify associated factors to enhance treatment strategies in the face of increasing resistance challenges. A retrospective observational study conducted at King Khalid Hospital, Saudi Arabia, from January 2019 to December 2020 analysed patients admitted with positive Pseudomonas aeruginosa cultures. It investigated Pseudomonas infection epidemiology, patient clinical characteristics, and antibiotic susceptibility patterns in 817 samples. A total of 817 patients were included, with a male predominance (63.8%). Common comorbidities included cardiovascular disease (53.7%), diabetes mellitus (36.3%), and cancer (14.8%). Invasive device use was frequent, with 41.1% having Foley catheters, 44.8% central lines, and 22.9% undergoing prolonged intubation. Most P. aeruginosa isolates (70.8%) were identified within three days of admission. Among 1,619 processed samples, sputum was the most common clinical specimen, while rectal swabs predominated among surveillance samples. Colistin (84.5%), amikacin (83.0%), and cefepime (73.2%) showed the highest susceptibility rates, while ceftazidime had the lowest (34.6%). MDR was observed in 73% of isolates and was significantly associated with tracheal intubation (p = 0.0003), central lines (p = 0.032), and hospital-onset infection (p < 0.001). Diabetes mellitus was linked to community-onset cases (p = 0.0457). Hospital-acquired cases were significantly associated with device use and dialysis. Phenotypically, phospholipase C was associated with non-MDR isolates, while biofilm formation correlated with MDR strains. Hemolysin and alkaline protease were not significantly linked to resistance. Genotypically, toxA and plcH were more prevalent in non-MDR isolates, while other virulence genes showed no significant differences. Biofilm production was significantly associated with the plcN gene. The study emphasises the critical prevalence of MDR Pseudomonas aeruginosa (73%), which is strongly linked to invasive medical devices and hospital-onset cases. High resistance to common antibiotics demands enhanced infection control, antimicrobial stewardship, and targeted strategies for high-risk patients to mitigate nosocomial infections and improve outcomes.

ABSTRACT Pseudomonas aeruginosa is a highly adaptable Gram-negative opportunistic pathogen and a major contributor to nosocomial infections, particularly in immunocompromised and critically ill patients. Its pathogenicity is mediated through an array of virulence determinants, including lipopolysaccharide (LPS), outer membrane proteins (OMPs), flagella, pili, and exopolysaccharides (alginate, Psl, Pel), which facilitate adhesion, immune evasion, and strong biofilm formation. The bacterium deploys an arsenal of secreted effectors such as exotoxins (ExoS, ExoT, ExoU, ExoY), pyocyanin, and elastases via specialized secretion systems (T1SS – T6SS) to disrupt host defenses and establish persistent infections. Resistance to antibiotics is multifactorial, encompassing restricted membrane permeability, efflux systems (e.g. MexAB-OprM), enzymatic inactivation (e.g. ESBLs, aminoglycoside-modifying enzymes), spontaneous mutations (e.g. gyrA, AmpC), and horizontal gene transfer. Biofilm-associated persister cells further complicate treatment by adopting metabolically dormant states. Innovative therapeutic approaches, including ceftolozane–tazobactam and small molecules with enhanced membrane permeability, are under investigation to circumvent resistance. Concurrently, vaccine development targeting key antigens such as LPS, flagella, T3SS proteins, and OMVs, along with nanoparticle-based platforms and monoclonal antibodies (e.g. IgY, DMAbs), has demonstrated potential in eliciting protective immunity. However, high antigenic variability and serotype diversity hinder broad efficacy. Future strategies must integrate Immunotherapeutics with antivirulence compounds targeting quorum sensing, iron acquisition, and biofilm disruption. A multidisciplinary approach involving translational research and clinical validation is imperative to combat multidrug-resistant P. aeruginosa and improve patient outcomes.