King Saud Medical City

Surgery is a well-known trigger of Diabetes Ketoacidosis, DKA. Post-surgical DKA is poorly studied in the current literature. This study investigated post-surgical DKA association with poor glycemic control before surgery. Unmatched case–control study sampling all post-surgical DKA cases admitted to ICU during the period from 1st of March 2019 to 1st of December 2022 in King Saud Medical City, Riyadh, Saudi Arabia. The control group comprises all other adult post-surgical subjects admitted to ICU without DKA during the same period. Poor glycemic control was considered when the glycosylated hemoglobin, HbA1C, was equal to or more than 7%. Details of surgery were collected from patients’ records. Fifty-seven post-surgical DKA cases were included and the control group consists of 114 subjects. Poor glycemic control was more frequent among postoperative DKA cases with a statistically significant difference (OR 48.2 95% CI: 12.1 – 267.4; p value < 0.001). Sensitivity analysis of fifty-four pairs of cases and controls matched for age and sex had odds ratio of 48.6 (95% CI: 12.1 – 267.4, p < 0.001). Multivariable logistic regression was done for independent predictor of postoperative DKA. Intraoperative catecholamine and insulin usage along with prolonged duration of surgery were statistically significant predictors (p values < 0.05). Post-surgical DKA was ascribed to poor glycemic control. The usage of catecholamine during surgery associated with postsurgical DKA and should be considered in future research.

Background: Disaster preparedness is important for emergency medicine residents because they should respond quickly and effectively during disasters. In this study we aimed to compare disaster preparedness knowledge, attitude, and practice in emergency medicine residents in the Riyadh region. Methods: A multicenter cross-sectional study was conducted 2025 using an electronic self-administered questionnaire. Emergency medicine residents from R1 to R4 from nine training centers in Riyadh were included. The questionnaire assessed demographic data and disaster preparedness knowledge, attitude, and practice. Scores were calculated for the three domains. Non-parametric tests and Spearman correlation were used in the analysis. Results: 111 residents were included, and 69.4% were male. The median knowledge score was 64.3% (IQR 57.1–78.6), median attitude score 87.5% (IQR 81.2–93.8), and the median practice score 33.3% (IQR 16.7–55.0). Knowledge was higher in males than females (p=0.013). Practice score differed by training level (p&lt;0.001), with higher scores in senior residents, mainly R3 and R4 compared with R1. Knowledge showed a positive correlation with attitude (rho=0.378, p&lt;0.001) and practice (rho=0.665, p&lt;0.001), while attitude had a weak positive correlation with practice (rho=0.215, p=0.024). Conclusion: Emergency medicine residents in Riyadh had a strong attitude, moderate knowledge, and weak practice toward disaster preparedness. Practical training and regular drills are needed for junior residents.

Background: Ovarian cystectomy is standard treatment for endometrioma but is associated with decreased ovarian reserve. Catheter-directed sclerotherapy (CDS) is an ovary-sparing image-guided alternative; however, supporting evidence comprises retrospective comparative and prospective single-arm studies. Objective: To compare CDS and ovarian cystectomy in terms of therapeutic efficacy and effect on ovarian function in women with ovarian endometrioma through a randomized controlled trial. Methods: This prospective pilot study enrolled women evaluated for unilateral unilocular endometrioma measuring >3 cm from March 20221 to July 2024. Participants were randomized to treatment by fluoroscopic and ultrasound-guided CDS or laparoscopic cystectomy. The primary endpoint was percentage decline from baseline to 12 months in serum anti-Müllerian hormone (AMH) (an ovarian functional reserve marker). Additional procedural and 12-month outcomes were assessed including the Endometriosis Health Profile-30 (EHP-30) questionnaire addressing endometriosis-related symptoms and quality of life (lower score: better status). Results: The analysis included 40 participants: 20 randomized to CDS (mean age, 32.8 years), and 20 (mean age, 35.1.1 years) to cystectomy. Mean 12-month percentage decline in AMH (primary outcome) was smaller for CDS than cystectomy (14.9% vs 39.8%, P=.02). No complications occurred after CDS; one complication occurred after cystectomy. Hospital length of study was significantly shorter after CDS (2.3±0.5 days) than cystectomy (4.2±0.7 days) (P<.001). From baseline to 12 months, ultrasound-based cyst size significantly decreased for CDS (5.8±1.5 to 0.6±0.7 cm; P<.001) and cystectomy (5.3±1.4 to 0.0±0.0 cm; P<.001); mean AMH was not significantly different for CDS (3.1±2.2 to 2.7±1.7 ng/mL; P=.08) but decreased significantly for cystectomy (3.3±3.0 to 2.0±1.8 ng/mL; P<.001); mean CA-125 decreased significantly for CDS (69.2±61.7 to 17.3±14.2 U/mL; P<.001) and cystectomy (54.6±35.8 to 14.8±8.2 U/mL; P<.001); and mean EHP-30 score decreased significantly for CDS (31.3±12.8 to 6.3±6.9; P<.001) and cystectomy (34.5±18.0 to 8.1±4.3; P<.001). CA-125 and EHP-30 score were not significantly different between groups at 12 months (P>.05). No 12-month recurrence occurred in either group. Conclusion: CDS was associated with better preservation of ovarian reserve versus cystectomy, without significant difference for therapeutic efficacy measures. Clinical Impact: These results advance the level of evidence supporting CDS as an ovary-sparing cystectomy alternative for appropriately selected patients.

[This corrects the article DOI: 10.3389/fmed.2026.1763735.].

Influenza B virus (IBV) undergoes continuous genetic mutations that can affect vaccine effectiveness and immune evasion. Although considerable research on IBV epidemiology exists globally, understanding of its genetic behavior in Saudi Arabia remains limited. This study characterized the molecular epidemiology of IBV in Riyadh, Saudi Arabia, during the 2024-2025 influenza season and evaluated compatibility with the current vaccine strain. Nasopharyngeal samples (n = 363) were collected from individuals presenting with influenza-like illness at King Khalid University Hospital in Riyadh. Detection and subtyping of IBV were performed using RT-PCR. Complete sequencing of the hemagglutinin (HA) and neuraminidase (NA) genes was conducted on confirmed IBV isolates (n = 7), followed by phylogenetic analysis, amino acid substitution mapping, and glycosylation site prediction. Of the 363 samples analyzed, 68 (18.7%) tested positive for IBV, with the majority occurring in adult females aged 15-64 years. Phylogenetic analysis revealed that all seven IBV isolates belonged to the Victoria lineage under subclade V1A.3a.2, corresponding to the current vaccine strain and strains from the 2022-2023 epidemic season. However, molecular analysis identified two substitutions (D129N and D197E) located in antigenic loop-150 and 190-helix, respectively, in the HA polypeptide that distinguished our strains from vaccine strain B/Austria/1359417/2021. Importantly, the N-glycosylation site at position 169 (NKT), which was present in B/Riyadh/1/2010, has been lost in the IBV strains circulating during 2020-2025. While phylogenetic clade compatibility indicates potential vaccine efficacy, the identified amino acid variations and loss of the glycosylation site underscore the necessity for ongoing molecular surveillance to monitor antigenic changes and evaluate vaccine effectiveness within the Saudi Arabian population.

Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definitive diagnosis cannot always be reached with imaging alone, it can be particularly useful in assisting with identifying benign and malignant features and therefore guiding appropriate further investigation and management. We perform a detailed literature review and describe the radiological features of various lacrimal gland pathologies.

Amylase, an enzyme with significant industrial applications, can be produced sustainably and economically using agricultural waste. This study investigates amylase production from Bacillus species utilizing potato peel substrates, aiming to achieve both environmental and economic benefits. Bacterial strains capable of producing amylase were isolated and characterized. Using response surface methodology, key variables, substrate concentration, pH, and temperature, were optimized to enhance enzymatic activity. The effects of acidic and alkaline pretreatments on potato peel substrates were also assessed. Amylase was purified through dialysis and salting out and analyzed using sodium dodecyl sulfate-polyacrylamide electrophoresis (SDS-PAGE). Enzyme immobilization in calcium alginate beads was performed to evaluate stability for industrial reuse. Optimal production was achieved at a substrate concentration of 17.4%, pH 10.8, and temperature 54.2°C, with alkaline pretreatment significantly improving yield. Purification increased enzyme concentration and purity, confirmed by the presence of a distinct 55kDa band in SDS-PAGE. Immobilization enhanced enzyme stability, indicating potential for repeated industrial applications. These findings highlight the viability of producing amylase from agricultural waste while reducing costs and environmental impact. The results also emphasize the value of substrate pretreatment and enzyme immobilization in developing efficient and sustainable biotechnological processes.