King Abdulaziz Medical City in Riyadh, the capital city of Saudi Arabia, was established by a royal decree in May 1983. With a bed capacity of 690 beds, it provides all types of care to all National Guard soldiers and their families, starting from primary health care up to tertiary specialized care. In 2012, It became a recognized center on the international level in conjoined twin separation surgery. It is the first center all over the world with 100% success rate in twin separation surgery.Recently, King Fahad National Guard Hospital with many other medical centers has been united to be part of the King Abdulaziz Medical City. Since its inauguration in February 2001; and within a short period, KAMC has been called a distinguished healthcare provider. In September 2004 there has been an expansion of the Rehabilitation Department with both occupational and physiotherapy units along with the IVF clinic and OB in 2003, and Medical Imaging, Laboratory, Pharmacy, and continuous renovation of patients’ wards. The facility includes Cardiac and Liver Center; Adult Intensive Care Unit (ICU), neuro ICU, Trauma ICU, Surgical ICU, Burn ICU, Intermediate Medical ICU, Medical Cardiac and the newly build Respiratory ICU; Dental, Ambulatory (Outpatient) Care, Long Term Care/ Rehabilitation, Emergency Care and Trauma Centers. Other adult and pediatric services provided include: Surgical and Medical wards, Obstetrics and Gynecology (Labor and Delivery, Oncology, Antenatal and Post Partum wards); Pediatric Oncology and Pediatric ICU, Neonatal ICU, Operating Rooms, Ambulatory Care Center, Home Health Care Program, VIP Wards, Royal Suite, College of Medicine and Nursing College..
Background and objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In light of the COVID-19 pandemic that emerged in late 2019, the World Health Organization (WHO) has endorsed mass immunization to enhance the population’s immunity against the virus. However, certain concerns have been raised about the safety of COVID-19 vaccines among patients with autoimmune disorders, including those with multiple sclerosis (MS). Further research is required to address these concerns and to gain deeper insights into the possible complications of COVID-19 vaccines among MS patients. This study aimed to assess the side effects of COVID-19 vaccines among MS patients. Methods An observational cross-sectional study was conducted between May and November 2023 at the National Guard Hospital, Jeddah, Saudi Arabia. All MS patients enrolled in our local registry system and provided phone numbers were included in the study. A total of 208 MS patients were surveyed via phone interviews, and data were collected regarding their demographics, MS history, COVID-19 history, SARS-CoV-2 vaccination status, and their exposure to disease-modifying therapies (DMTs). All results were analyzed using Stata software. Statistical significance was set at a CI of 95% and a p-value <0.05. Results In our cohort, 128 (61.5%) patients had received three doses of the COVID-19 vaccine, while 68 (32.7%) had received two doses; four patients (2.0%) had received only one dose, five (2.4%) had not received the vaccine, and the number of doses was unknown for the remaining three patients (1.4%). The BNT162b2 mRNA COVID-19 Vaccine from Pfizer-BioNTech was the most commonly administered (n=136 patients, 66.0%), followed byChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca (n=47 patients, 22.8%), and mRNA-1273 SARS-CoV-2 Vaccine from Moderna (n=5 patients, 2.4%). Of note, 139 patients (69.5%) reported experiencing adverse events after receiving the vaccine, and the ChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca was significantly associated with higher rates of side effects, in 87.8% of the patients. Conclusion A sizable proportion of MS patients experienced self-limiting side effects from exposure to the COVID-19 vaccine. The rates and incidence of side effects were similar to those encountered in the general population. None of the adverse effects recorded in our population of MS patients were serious or life-threatening. We recommend that physicians encourage patients with MS who have never received COVID-19 vaccination to get promptly vaccinated as the risks of COVID-19 infection far outweigh the minor risks associated with COVID-19 vaccination.
OBJECTIVE:To test whether a unit-level nutrition care bundle that accelerates enteral feed and optimises early caloric delivery improves in-hospital growth in preterm infants. DESIGN:Single-centre pre-post observational study. SETTING:Tertiary neonatal intensive care unit. PARTICIPANTS:Infants born at less than 32 weeks' gestation admitted during two epochs: baseline (1 January 2023-30 April 2024) and post-quality improvement (QI) (1 May 2024-31 August 2025). Complete cases were analysed for each endpoint (growth velocity (GV) cohort: pre n=163, post n=149). INTERVENTION:A multicomponent nutrition care bundle promoting earlier initiation and advancement of enteral feeds, protocolised fortification and higher early energy delivery. MAIN OUTCOME MEASURES:Primary outcome was infant-level average GV (g/kg/day) calculated from weekly GV from week 3 onwards. Secondary outcomes included week-specific GV, change in weight Z-score from birth to discharge (Δ weight Z), discharge anthropometry, feeding process measures (time to full feeds, week 1 calories) and safety outcomes (feeding intolerance and necrotising enterocolitis). RESULTS:Average GV increased from 12.52±2.49 pre-QI to 15.50±2.30 g/kg/day post-QI (mean difference+2.98, 95% CI 2.45 to 3.52; p<0.001). Weekly GV was higher post-QI across weeks 3-12, with the largest difference at week 8 (+4.31 g/kg/day, 95% CI 2.34 to 6.27; p<0.001). Δ weight Z was less negative post-QI (-1.21±0.75 vs -1.43±0.81; difference+0.22, 95% CI 0.05 to 0.39; p=0.012). Discharge weight was higher post-QI (+152 g, 95% CI 13 to 290; p=0.033), while discharge length and head circumference Z-scores were similar between epochs. Time to full feeds decreased by 6.05 days (95% CI -11.77 to -0.33), and mean week 1 caloric intake increased by 11.38 kcal/kg/day (95% CI 6.16 to 16.60). Feeding intolerance and necrotising enterocolitis rates did not differ between periods. CONCLUSIONS:Implementation of a care bundle was associated with improved GV and earlier feeding milestones without increased feeding intolerance or necrotising enterocolitis.
Recent randomized trials showed neutral results for distal medium vessel occlusion (DMVO) thrombectomy, but real-world effectiveness across diverse healthcare settings remains unknown. We evaluated DMVO thrombectomy outcomes in the Middle East and North Africa (MENA) region. The MEMENTO registry retrospectively analyzed consecutive DMVO thrombectomy patients (M2, M3, A2-3, P2-3 segments) across 15 centers (2022–2024). DMVOs were classified as primary, baseline secondary, or iatrogenic secondary. Primary outcome was 90-day functional independence (mRS 0–2). Secondary outcomes included successful recanalization (TICI ≥ 2b), mortality, and symptomatic hemorrhage. Among 164 patients (median age 72, NIHSS 10), subtypes included primary (25
Background The Peritoneal Cancer Index recorded at laparotomy is based on visual and palpable inspection of peritoneal surfaces for disease. This study aimed to analyze interobserver variation in assigning the lesion score (LS) and morphologic term (MT) to characterize peritoneal lesions (PL) and predict the probability of malignancy (POM) among surgeons with expertise in cytoreductive surgery (CRS) for peritoneal malignancies. Methods The study selected 80 intraoperative images of PLs depicting different morphologic appearances of PLs arising from different primary tumors in various peritoneal regions. In the study, 50 expert peritoneal malignancy surgeons were asked to assign an LS to the region in question, select the MT or MTs to describe the PL, and predict the POM. Information on the presence of disease on histopathology was not provided at this point. Inter-observer reliability was evaluated using Krippendorff's alpha (alpha). A consensus was reached if any option received more than 75% of the votes. Results The study participants comprised 41 (82%) of 50 experts. Consensus on LS was achieved for 18 images (22.5%), with low agreement (alpha = 0.174). For MTs, a consensus was reached for 21 images (26.5%; alpha = 0.0902, denoting low and unreliable agreement. Of these 21 images, the MT used was "tumor nodule" for 90.4% of the images (p < 0.001). The POM was accurately predicted in 52.5% of the cases (alpha = 0.155). Administration of neoadjuvant chemotherapy had no impact on the surgeons' assessment of the three parameters. Conclusions Even the most experienced CRS surgeons showed high interobserver variation and unreliable agreement in the description and accurate characterization of PLs on pictorial records. A Delphi consensus to standardize the MT used and scoring of PL could reduce discordance.
BackgroundEmapalumab, an interferon-γ (interferon-gamma)–blocking monoclonal antibody, has emerged as a targeted therapy for refractory hemophagocytic lymphohistiocytosis (HLH). This scoping review summarizes real-world evidence of its clinical use across HLH subtypes.MethodsA comprehensive search of PubMed, Scopus, and Web of Science through September 2025 identified studies reporting emapalumab use outside clinical trials. Case reports, series, and observational studies describing clinical outcomes were included.ResultsThirty-one publications comprising 86 patients were analyzed. Disease contexts included familial/genetic HLH (n = 11), rheumatology-associated macrophage activation syndrome (MAS; n = 12), malignancy-associated HLH (n = 25), infection-associated HLH (n = 22), CAR-T/IEC-HS or cytokine-release-syndrome–related HLH (chimeric antigen receptor T-cell/immune effector cell–associated hemophagocytic syndrome; n = 11), and other secondary HLH (n = 5). Across all categories, emapalumab achieved rapid suppression of hyperinflammation, typically within 1–2 weeks. Clinical response rates were 100% in familial HLH, 91.7% in rheumatology-associated MAS, 72.7% in infection-associated HLH, 90.9% in CAR-T/IEC-HS–related HLH, and 80% in other secondary HLH. In contrast, only 6 of 25 patients with malignancy-associated HLH (24%) showed partial or complete responses, reflecting inferior outcomes due to underlying disease progression. Overall survival was highest in familial and infection-associated subgroups. The reported adverse events were generally infrequent and mild in the published cases, but causality cannot be reliably established given the complexity of the underlying disease and concurrent therapies.ConclusionReal-world evidence demonstrates that emapalumab induces rapid and durable disease control across diverse HLH subtypes, with a favorable tolerability profile. However, outcomes remain markedly inferior in malignancy-associated HLH, where response rates are limited to approximately 24%, primarily due to the impact of underlying malignancy. Its role as rescue or bridging therapy to hematopoietic stem-cell transplantation (HSCT) is increasingly supported in both pediatric and adult populations.
