The King Faisal Specialist Hospital and Research Centre (Arabic: مستشفى الملك فيصل التخصصي ومركز الأبحاث) (KFSH&RC) is tertiary referral hospital. As a tertiary referral hospital, it offers primary and highly specialized inpatient and outpatient medical care and participates in many clinical and research studies. It is consistently recognized as one of the nation's top hospital specializing in Oncology, Organ Transplantation, Cardiovascular Diseases, Neurosciences and Genetic Diseases. A large portion of the patient population are referrals from other hospitals from across Saudi Arabia as a whole and the surrounding regions. The hospital handles around 10,000 thousand outpatient visits each year and houses over 1,600 beds and has 28 health outreach centers. It has a staff of over 1,000 doctors with over 13,500 total employees of 67 different nationalities. KFSH&RC is accredited by the Joint Commission International (JCI), the Magnet Recognition Program (American Nurses Credentialing Center ANCC) any many more.
Abstract Background Intrauterine devices (IUDs) are among the most effective long-acting reversible contraceptive methods. Although their placement is generally straightforward, procedure-related pain is frequently reported and may deter individuals from choosing this contraceptive method. This systematic review and meta-analysis aimed to evaluate the effectiveness of paracervical block in reducing pain during IUD placement. Methods Four electronic databases were systematically searched from inception through January 31, 2026, without language or date restrictions, to identify relevant randomized controlled trials (RCTs). A meta-analysis was performed using RevMan software, with pain during IUD placement as the primary outcome. Secondary outcomes included pain during tenaculum placement, uterine sounding, and post-IUD placement, as well as patient satisfaction. Pain scores were measured using a 100-mm Visual Analog Scale (VAS). Results Seven RCTs involving 664 participants were included. Paracervical block significantly reduced pain scores during IUD placement, tenaculum placement, uterine sounding, and post-IUD placement (p < 0.001). Furthermore, overall patient satisfaction with the procedure was notably higher in the paracervical block group (80%) compared with the control group (63%). Conclusion Paracervical block appears to be an effective and accessible strategy for reducing procedural pain during IUD placement and enhancing patient satisfaction. Incorporating this technique into routine practice could improve the patient experience and potentially increase the acceptability and uptake of IUDs as a contraceptive method. Nevertheless, findings should be interpreted with caution given the limited number of included studies and observed heterogeneity. Future large-scale standardized trials are warranted to consolidate these findings and inform evidence-based clinical guidelines.
Cardiac rhabdomyomas (CRHM) are the most common primary cardiac tumors in neonates and are closely linked to tuberous sclerosis complex (TSC). While many tumors regress spontaneously, large or strategically located lesions may require intervention. Everolimus, an mTOR inhibitor, has shown efficacy in managing TSC-associated tumors, though its use in neonatal CRHM remains largely supported by case reports. We report a term male neonate diagnosed with multiple CRHMs and found to have a heterozygous variant of uncertain significance in the TSC2 gene. The tumor size and location led to early initiation of oral everolimus at 0.06 mg/kg twice daily. Therapeutic drug monitoring revealed supratherapeutic levels during the first week, requiring stepwise dose reduction. Over five weeks of treatment, serial echocardiograms demonstrated marked regression of all tumor masses without adverse effects. A clinical pharmacist supervised the extemporaneous preparation, dose adjustment, and caregiver education to ensure treatment accuracy and safety. This case highlights the role of early, closely monitored everolimus therapy as a safe, non-surgical alternative for managing neonatal CRHM. To our knowledge, this is the first reported case from Saudi Arabia describing early everolimus treatment for neonatal CRHM and highlighting the critical role of the clinical pharmacist in individualized dosing, therapeutic monitoring, and caregiver education.
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
The coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems worldwide. The prediction of disease prognosis has a critical role in confronting the burden of COVID-19. We aimed to investigate the feasibility of predicting COVID-19 patient outcomes and disease severity based on clinical and hematological parameters using machine learning techniques. This multicenter retrospective study analyzed records of 485 patients with COVID-19, including demographic information, symptoms, hematological variables, treatment information, and clinical outcomes. Different machine learning approaches, including random forest, multilayer perceptron, and support vector machine, were examined in this study. All models showed a comparable performance, yielding the best area under the curve of 0.96, in predicting the severity of disease and clinical outcome. We also identified the most relevant features in predicting COVID-19 patient outcomes, and we concluded that hematological parameters (neutrophils, lymphocytes, D-dimer, and monocytes) are the most predictive features of severity and patient outcome.
Rare genetic factors have been shown to substantially contribute to mental illness, but so far, no precision treatments for mental disorders have been described. It was recently identified that rare variants in GRIN2A encoding the GluN2A subunit of the N-methyl-D-aspartate receptor (NMDAR) confer a substantial risk for schizophrenia. To determine the prevalence of mental disorders among individuals with GRIN2A-related disorders, we enquired the presence of psychiatric symptoms in 235 individuals with pathogenic variants in GRIN2A who had previously enrolled in our global GRIN registry. We identified null variants in GRIN2A (GRIN2Anull) to be significantly associated with a broad spectrum of mental disorders including schizophrenia compared to a longitudinal population cohort (FinRegistry) as well as missense variants (GRIN2Amissense). In our cohort, GRIN2Anull-related mental disorders manifest in early childhood or adolescence, which is substantially earlier than the average adult onset in the general population. In 68% of co-incident epilepsy and mental disorder, mental disorders start after epilepsy offset and the age of epilepsy offset correlated with mental disorder onset. GRIN2Anull-related phenotypes appear to occasionally even manifest as isolated mental disorder, i.e. as schizophrenia or mood disorder without further GRIN2A-specific symptoms, such as intellectual disability and/or epilepsy. As L-serine is known to mediate co-agonistic effects on the NMDAR, we applied it to four individuals with GRIN2Anull-related mental disorders, all of whom experienced improvements of their neuropsychiatric phenotype. GRIN2Anull appears to be the first monogenic cause of early-onset and even isolated mental disorders, such as early-onset schizophrenia. Genetic testing should be considered in the diagnostic work-up of affected individuals to improve diagnosis and potentially offer personalized treatment as increasing brain concentrations of NMDAR co-agonists appears to be a promising precision treatment approach successfully targeting deficient glutamatergic signaling in individuals with mental disorders, i.e. due to GRIN2Anull.
