King Khalid University 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 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.

BackgroundCaudal septal deviation is a challenging condition that affects nasal function and aesthetics.ObjectivesThe aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches.MethodsA cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207).ResultsSixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively.ConclusionsOtolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations.Level of Evidence: 5 (Therapeutic)

Background and ObjectivesGlobal demand for health economics/pharmacoeconomics (HE/PE) has significantly increased, leading to a greater need for competent and skilled healthcare professionals in this field. However, the current literature indicates a lack of research regarding HE/PE among healthcare professionals, including those in the Kingdom of Saudi Arabia (KSA), particularly among registered nurses. Hence, this study assessed registered nurses’ levels of awareness and knowledge of HE/PE and their sociodemographic and HE/PE-related predictors.MethodsA descriptive–correlational, cross-sectional design was used. The study was conducted on a convenience sample of 324 registered nurses working at the three hospitals within King Saud University Medical City, Riyadh, KSA. Data were collected from May 2025 to June 2025, and analyzed using SPSS v.30. Binary logistic regression analyses were conducted for HE/PE awareness, and multiple linear regression analyses were performed for knowledge about HE/PE. The significance level was established at p <0.05.ResultsRegistered nurses demonstrated an overall low level of knowledge (2.39/5), while showing a good level awareness about HE/PE across four awareness items (52.8% to 84.6%) but suboptimal for the remaining two items (38.6% and 38.9%). Several sociodemographic and HE/PE-related factors were identified as significant predictors of the registered nurses’ awareness and knowledge regarding HE/PE. Notably, four out of the six awareness items: “have heard about HE/PE” (p =0.040), “read articles related to HE/PE regularly” (p <0.001), “participate in HE/PE decisions at work” (p <0.042), and “implement HE/PE techniques to make decisions” (p <0.001) were revealed as significant predictors of registered nurses’ knowledge about HE/PE.ConclusionThe findings indicate that the knowledge level regarding HE/PE among registered nurses was low; nevertheless, their awareness was acceptable. It is crucial to develop and implement targeted educational strategies and interventions aimed at enhancing both awareness and knowledge about HE/PE among registered nurses in the KSA, while meticulously considering pertinent sociodemographic and HE/PE-related factors.

Introduction: Hyperuricemia is increasingly recognized as a metabolic disorder linked to dyslipidemia, insulin resistance, and vascular complications. In Saudi Arabia, the prevalence of hyperuricemia is rising with obesity and diabetes, yet its relationship with lipid-derived cardiometabolic indices remained understudied. This study aimed to examine the associations between uricemia status and lipid-derived cardiometabolic indices in a large adult cohort. Methods: This retrospective cross-sectional study analyzed data from 7652 adults, including 5385 normouricemic (NU) and 2267 hyperuricemic (HU). Key cardiometabolic indices, including the triglyceride-glucose index (TyG), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), atherogenic index of plasma (AIP), and Castelli risk indices I and II (CRI-I, CRI-II), were calculated. Associations were evaluated treating HU as the exposure and the lipid-derived cardiometabolic indices as the outcomes. Multivariable regression analyses, receiver operating characteristic (ROC) curves, and prevalence-based association estimates were used to assess these relationships. Results: HU individuals exhibited significantly higher TG along with lowered HDL-C. Median TyG (4.61), AIP (0.38), non-HDL-C (147 mg/dL), RC (18 mg/dL), CRI-I (4.30), and CRI-II (2.85) were higher in the HU group compared to NU group, with non-HDL-C and CRI-I falling within the abnormal range, AIP in the high-risk range, and TyG and CRI-II at borderline levels. Across the separately adjusted models, hyperuricemia showed consistent positive associations with RC, AIP, CRI-I, and CRI-II, whereas associations with TyG and non-HDL-C diminished after adjustment for renal or liver markers. ROC analysis demonstrated modest discriminatory ability of uric acid for elevated indices, with AIP (AUC = 0.641) and CRI-I (AUC = 0.640) exhibiting the highest performance. The prevalence of elevated indices was substantially higher in HU, particularly for CRI-II (44.0% vs. 25.9%) and CRI-I (28.2% vs. 13.7%). Conclusions: These findings highlight associations between HU and lipid-derived cardiometabolic indices, but further longitudinal research is required to determine whether HU has a clinical predictive value in cardiovascular risk assessment.

Abstract Background Surgical site infections (SSIs) are common but preventable complications of abdominal surgery, influenced by patient, procedural, and systemic factors. The COVID-19 pandemic introduced new perioperative protocols that may have altered infection patterns. This is the first retrospective cohort study of 809 abdominal surgery patients from a large tertiary center in Saudi Arabia to assess changes in SSI timing using survival analysis during the pandemic. Objectives To determine SSI incidence, identify independent risk factors, and examine the impact of the COVID-19 pandemic on infection timing and outcomes in patients undergoing abdominal surgery. Methods We conducted a retrospective cohort study of 809 patients who underwent abdominal surgery between January 2019 and December 2022. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted from electronic health records. SSIs were defined per CDC criteria. We compared SSI trends before and during the pandemic using multivariable logistic regression and time-to-event analyses (Kaplan-Meier and Cox regression). Results Among 809 patients, 47 (5.8%) developed SSIs—consistent with international benchmarks. Independent risk factors included diabetes (OR: 2.14; 95% CI: 1.05–4.34), contaminated wounds (OR: 3.67; 95% CI: 1.58–8.54), and postoperative glucose ≥ 7 mmol/L (OR: 2.95; 95% CI: 1.32–6.57). SSIs occurred later during the pandemic period, with survival analysis indicating delayed onset, despite a similar median time (8 days). Model diagnostics confirmed stability, with no significant multicollinearity. Conclusion SSIs remain a significant postoperative risk, with diabetes, wound contamination, and hyperglycemia as key predictors. The observed delay in infection onset during the COVID-19 pandemic underscores the need for extended postoperative surveillance and adaptable infection control strategies during healthcare disruptions. These findings suggest that pandemic-related changes in surgical protocols may delay SSI onset, necessitating extended postoperative monitoring.

Bladder cancer, particularly urothelial carcinoma, is the most common malignancy of the urinary tract and is associated with several risk factors, including smoking, advanced age, and exposure to environmental toxins. Angelman syndrome is a rare neurodevelopmental disorder caused by a defect in the UBE3A gene, leading to characteristic neurological and behavioral manifestations. Although no clear association exists between these two conditions, we report a case of a 36-year-old man with Angelman syndrome who developed urothelial carcinoma of the urinary bladder despite the absence of identifiable risk factors or a family history of urothelial cancer, followed by two subsequent recurrences.