عن المجلة مجلة Journal of Tazeez for Public Health هي مجلة علمية محكّمة متخصصة في مجال الصحة العامة، تصدر تحت مظلة الجمعية السعودية للتعزيز والتثقيف الصحي بجامعة الملك سعود، وتهدف إلى دعم البحث العلمي ونشر المعرفة المتخصصة في مجالات تعزيز الصحة، التثقيف الصحي، والوقاية من الأمراض، بما يسهم في تطوير الممارسات الصحية وتحقيق مستهدفات رؤية المملكة 2030. وقد صدر اعتماد المجلة رسميًا بموجب قرار مجلس جامعة الملك سعود رقم (4/7) وتاريخ 27/04/1441هـ، والمتضمن الموافقة على إنشاء الجمعية السعودية للتعزيز والتثقيف الصحي، والتي تعمل المجلة تحت مظلتها وفق الأنظمة واللوائح المنظمة للجمعيات العلمية في الجامعات السعودية. تسعى المجلة إلى أن تكون منصة علمية رائدة لنشر الأبحاث الأصيلة، والمراجعات العلمية، والدراسات التطبيقية ذات الأثر في مجال الصحة العامة، محليًا وإقليميًا ودوليًا، مع الالتزام بأعلى معايير التحكيم العلمي والأخلاقيات البحثية. لمزيد من المعلومات عن الجمعية السعودية للتعزيز والتثقيف الصحي، يرجى زيارة الموقع الرسمي: https://tazeez.ksu.edu.sa (موقع الجمعية والأنشطة العلمية)
Serious illness care in emergency departments: a systematic review of palliative care pathways for older adults with advanced noncancer conditions
Background: Older adults with advanced heart failure, chronic obstructive pulmonary disease, kidney disease, dementia, frailty, and non-cancer conditions reach emergency departments during deterioration, creating an opportunity for serious-illness care. Objective: This systematic review synthesized emergency-department palliative-care pathways for older adults with advanced non-cancer illness, emphasizing identification, communication, referral, transitions, and patient-centered outcomes. Methods: A PRISMA-aligned search framework covered PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library from inception to July 2026. Original studies evaluating emergency-department screening, prognostic triggers, advance-care-planning interventions, palliative-care consultation, or post-emergency palliative follow-up were eligible when older adults with advanced noncancer conditions were included. Cancer-only studies were excluded. Owing to clinical and methodological heterogeneity, findings were synthesized narratively. Results: We include eighteen original studies. Screening pathways included the Surprise Question, P-CaRES, serious-illness criteria, and electronic-record mortality prediction. Communication pathways used brief negotiated interviews and nurse-led serious-illness conversations. System-level programs increased palliative-care referrals in some settings, whereas a large cluster-randomized implementation trial did not change admission, intensive-care use, revisits, hospice use, readmission, or mortality. Post-emergency nurse-led telephonic palliative care produced outcomes similar to specialty outpatient palliative care. Conclusions: Emergency-department pathways are feasible and increasingly scalable. The strongest pathway architecture combines automated or brief identification, focused goals-of-care communication, and dependable linkage to longitudinal palliative services.
Copyright (c) 2026 Omran Mohammad Jan (Author)
Acute Care Diagnostics and Emergency Triage Workflows: A Systematic Review of Interprofessional Coordination Among Emergency Consultants, Laboratory Specialists, and Patient Care Technicians
Background: Emergency department flow depends on rapid assessment, diagnostic testing, specimen handling, and coordinated transfer of information in professional roles. Fragmentation between emergency clinicians, laboratory personnel, and technical support staff creates avoidable delays across the diagnostic pathway. Objective: This review synthesized data on acute-care triage and diagnostic workflows that redistribute tasks or integrate emergency consultants, laboratory services, phlebotomy or technical assistants, and point-of-care testing. Methods: The review was structured according to PRISMA 2020. PubMed/MEDLINE and the Cochrane Library were searched directly through 9 August 2024, with equivalent Scopus and Web of Science concept blocks prespecified for database-native verification. Eligible original studies evaluated emergency department workflow interventions and reported waiting time, length of stay, laboratory turnaround time, time to result, or incomplete visits. Results: We include ten original studies in this synthesis. Senior clinician involvement at triage consistently shortened time to initial assessment, while effects on total length of stay varied with downstream diagnostic demand. Dedicated phlebotomy and technical-assistant models improved selected waiting-time, specimen-quality, and incomplete-visit outcomes. Point-of-care testing markedly reduced analytical turnaround time, with smaller and less consistent effects on total emergency department stay. Conclusion: Effective acute-care diagnostics depend on coordination across the entire testing pathway rather than isolated acceleration of one step. Workflow redesign is strongest when roles, escalation routes, specimen ownership, test governance, and result communication are explicitly defined.
Copyright (c) 2024 Osamah Mohammed Bin Bakheet, Abdulrahman Ali Hamithi, Mashael Abdulrahman Mahzari (Author)
Patient outcomes in severe acute respiratory distress syndrome: a systematic review of critical care interventions managed by ICU respiratory therapists
Background: Severe acute respiratory distress syndrome is associated with profound hypoxemia, prolonged mechanical ventilation, multiorgan dysfunction, and substantial mortality. Respiratory therapists contribute directly to ventilator adjustment, lung-protective ventilation, recruitment assessment, prone-positioning procedures, secretion management, oxygen titration, extracorporeal support monitoring, and liberation planning. Objective: This systematic review evaluated the effects of respiratory and supportive critical care interventions on mortality, ventilator-free days, oxygenation, intensive care length of stay, and intervention-related complications among adults with moderate-to-severe or severe acute respiratory distress syndrome. Methods: A systematic search framework was developed for PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. Randomized trials and comparative original studies evaluating invasive ventilation strategies, positive end-expiratory pressure, prone positioning, neuromuscular blockade, fluid restriction, recruitment maneuvers, high-frequency oscillation, corticosteroids, airway pressure release ventilation, or extracorporeal membrane oxygenation were eligible. Screening, extraction, risk-of-bias assessment, and narrative synthesis followed PRISMA principles. Results: Fourteen original studies were included in the draft synthesis. Low-tidal-volume ventilation and prolonged prone positioning produced the clearest mortality benefits. Conservative fluid management increased ventilator-free and intensive-care-free days without a significant mortality reduction. Higher positive end-expiratory pressure produced inconsistent overall survival effects, while aggressive recruitment increased mortality. Routine early neuromuscular blockade produced conflicting trial results. High-frequency oscillatory ventilation offered no survival advantage and caused harm in one major trial. Dexamethasone increased ventilator-free days and reduced mortality in persistent moderate-to-severe disease. Extracorporeal membrane oxygenation provided a clinically important rescue option despite an inconclusive primary mortality comparison. Conclusion: Effective severe acute respiratory distress syndrome care depends on timely delivery of lung protection, prolonged proning, conservative fluid management, individualized adjunctive treatment, and avoidance of harmful recruitment or oscillatory strategies.
Copyright (c) 2026 Talal Mohammed Alhumaid, Abdulaziz Saeed Almutairi, Nasser Hamoud Alosaimi, Reem Yahya Alhiqwi, Maha Bandar Alotaibi, Sultan Saad Alotaibi, Mohammed bin Huwayshil (Author)
Fetal growth restriction in IVF pregnancies: outcomes and risk factors: a systematic review
Background: Fetal growth restriction (FGR) in in vitro fertilization pregnancies is a clinically important concern because assisted conception linked with altered placentation, singleton low birth weight, small-for-gestational-age birth, hypertensive disorders, and medically indicated preterm delivery. Objective: This systematic review evaluated outcomes and risk factors for FGR or related small-for-gestational-age birth in singleton pregnancies conceived through in vitro fertilization or intracytoplasmic sperm injection. Methods: A PRISMA-guided systematic review designed using PubMed, Scopus, Web of Science, and Cochrane Library searches. Eligible studies were original human studies evaluating FGR, small-for-gestational-age birth, birthweight percentile, or fetal growth trajectory after in vitro fertilization or intracytoplasmic sperm injection. Data synthesized qualitatively because exposure definitions, embryo-transfer protocols, comparator groups, and outcome definitions differed across studies. Results: Ten original studies were included in the results synthesis. Data linked fetal growth impairment with fresh embryo transfer, supraphysiologic estradiol, higher total gonadotrophin dose, vanishing twin syndrome, multiple embryo transfer, female infertility factors, and thin endometrium. Frozen embryo transfer was generally associated with higher birthweight and lower small-for-gestational-age frequency than fresh transfer, although it was linked with larger infants and hypertensive disorders in wider literature. Conclusion: FGR risk in in vitro fertilization pregnancies appears multifactorial. Clinical surveillance needs individualized attention to infertility background, stimulation intensity, embryo-transfer strategy, early multifetal loss, placental disease, and maternal vascular risk.
Copyright (c) 2026 Alhussain Sagr Al Hazmi, Shuaa Talal Alamri, Saad Khaleel Alonze, Saad Khaleel Alonze, Muneerah A. Aljumah, Faisal Talal Alsharif, Salem Abdulaziz Salem Islam, Fatimah Assari, Faya Awad Alshammari, Ghadah Abdulrahman Bukhari, Saeed Tariq Saloom, Ibrahim Sulaiman Alduraywish (Author)
Clinical Outcomes of Delayed Versus Immediate Source Control in Intra-Abdominal Sepsis Presenting to the Emergency Department: A Systematic Review
Background: The clinical impact of delayed source control in intra-abdominal sepsis is difficult to quantify because of heterogeneity in timing definitions, infection sources, and procedural approaches. This review evaluated delayed versus immediate or early source control mortality and other clinical outcomes in adults with intra-abdominal sepsis. Methods: PubMed, Scopus, Web of Science, and Embase were searched from inception to January 2026. Eligible studies compared early with delayed operative, percutaneous, or endoscopic source control, or assessed time to intervention. Risk of bias was evaluated using ROBINS-I. Random-effects meta-analyses pooled odds ratios for mortality when studies were comparable. Results: Seven observational studies including 1,835 participants were included; three contributed to quantitative synthesis. Delayed drainage was associated with higher in-hospital mortality in the adjusted meta-analysis (pooled OR 2.92, 95% CI 1.51–5.66; I²=0%). In the harmonized comparison of source control after versus within 12 hours, the random-effects estimate was not significant (OR 1.92, 95% CI 0.44–8.39) and heterogeneity was substantial (I²=87.8%). Individual studies suggested worse outcomes with prolonged delay, although findings varied by source, threshold, and comparator. Conclusion: Delayed source control increase mortality in biliary sepsis, but current evidence does not support a universal timing threshold. Prompt source control is clinically important, while better standardized prospective studies are needed.
Copyright (c) 2026 Mazi Mohammed Alanazi, Najwa Ahmad M Alqurashi, Maram Mohammad Alawwad, Marah Asaad Murad, Naif Ayidh R Alaklabi, Seigha Mohammed AlShobai (Author)
Airway management and invasive ventilation protocols in critical care: a systematic review of clinical practices and workflows led by ICU respiratory therapists
Background: Invasive mechanical ventilation is vital in critical care, although inconsistent practices expose patients to ventilator-induced lung injury, oxygen toxicity, delayed liberation, airway complications, and infection. Respiratory therapists are positioned at the ventilator and lead protocolized assessment, adjustment, spontaneous breathing trials, airway surveillance, and interdisciplinary communication. Method: This review analyze studies on practices and workflows led by intensive care unit respiratory therapists for airway management and invasive ventilation. PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library were targeted from inception to Jun 2026. Original studies enrolled invasively ventilated critical care patients and evaluated a respiratory therapist driven protocol. Outcomes included ventilation duration, weaning time, extubation success, reintubation, intensive care length of stay, protocol adherence, ventilator-associated pneumonia, acute respiratory distress syndrome, mortality, and workflow performance. Result: Eleven original studies were analyzed. Therapist-led daily screening, spontaneous breathing trials, standardized weaning, and protocolized ventilator adjustment generally shortened ventilation or weaning duration without higher reintubation or mortality. Implementation studies demonstrated high screening completion and interpretation accuracy, while extubation pathways improved autonomy and standardization. Lung-protective ventilation protocols increased adherence and were associated with lower acute respiratory distress syndrome incidence. Evidence for direct therapist-led intubation workflows remained limited. Conclusion: Respiratory therapist–led protocols strengthen consistency, timely liberation, and lung-protective care. Effectiveness depends on authority, physician collaboration, competency assessment, audit, education, and reliable interdisciplinary governance systems.
Copyright (c) 2026 Abdullah Hatim Alshihry, Yousef Rashed Alhudaithi, Abdulmohsen Abdullah Alqadhi, Abdullah Hamoud Alanazi, Ali Riyadh Alqasir, Rashed Abdulaziz Batrfe, Saad Hamad Althawadi, Hisham Hussain Aljurays (Author)
Mechanical ventilation management and ICU workflows: a systematic review of clinical practices led by ICU respiratory therapists and respiratory care education supervisors
Background: Mechanical ventilation requires adjustment, timely liberation assessment, and coordination in intensive care unit teams. Respiratory therapists occupy important operational position, while respiratory care education supervisors influence protocol competence, audit readiness, and practice consistency. This review evaluated therapist-led clinical practices for improving ventilation management and intensive care outcomes. Methods: A systematic review framework followed PRISMA principles. PubMed, Scopus, Web of Science Core Collection, and Cochrane sources were searched for adult or pediatric intensive care studies evaluating respiratory therapist-led ventilation protocols, liberation pathways, standardized order sets, ventilator bundles, or structured competency support. Eligible studies reported clinical, process, safety, or implementation outcomes. Results: Thirteen studies published between 1995 and 2024 were included. Therapist-led protocols shortened ventilation or weaning time, accelerated spontaneous breathing assessment, improved adherence to lung-protective targets, and strengthened protocol execution. Several studies reported unchanged mortality, reintubation, intensive care length of stay, or total ventilation duration, especially where baseline staffing was strong or protocol adherence was limited. Education, repeated feedback, electronic decision support, and clearly delegated authority were prominent implementation components. Conclusion: Respiratory therapist-led ventilation management improves workflow reliability and selected clinical outcomes without consistent evidence of harm. Effects depend on local staffing, protocol fidelity, multidisciplinary agreement, and ongoing competency supervision. Respiratory care education supervisors provide infrastructure for training, performance feedback, and sustained implementation.
Copyright (c) 2026 Khalid Obaid Alanazi, Khalid Hamdan Alanazi, Mohammed Saad Aldosari, Osama Ibrahim Almujalli, Yazeed Mohammed Alkhalifah, Abdullah Hassan Asiri, Alwaleed Ahmed Amri, Mohammed Ahmed Alasmari (Author)
Leadership and Neonatal Transport in Saudi Arabia: A Comparative Health Systems Analysis
Background: Neonatal transport links initial stabilization with definitive neonatal intensive care, yet Saudi Arabia lacks a unified national framework. Regional variation in resources, staffing, equipment, and transfer coordination may contribute to inequitable access and inconsistent care. This study examined neonatal transport in Saudi Arabia from a health leadership perspective and compared the current system with international models to identify governance gaps and reform priorities. Methods: A qualitative, comparative, policy-oriented review was conducted using peer-reviewed literature, government reports, and institutional documents published between 2000 and 2024. Evidence from Saudi Arabia was compared with neonatal transport systems in the United Kingdom, Australia, Canada, and the United States. The analysis focused on governance, accountability, workforce capacity, system integration, quality standards, data monitoring, telemedicine, and equity. Results: The Saudi system was characterized by decentralized coordination, concentration of neonatal intensive care resources in major regions, reliance on general emergency medical services in peripheral areas, and absence of a national transport registry. International models consistently demonstrated centralized dispatch, specialized teams, standardized protocols, accreditation, continuous monitoring, and mechanisms supporting rural access. A phased pilot centered at King Saud Medical City was proposed to test coordination, training, digital communication, and performance monitoring. Conclusion: Leadership-driven national coordination, standardized training, telemedicine integration, and systematic data collection could strengthen neonatal transport, reduce regional disparities, and support Saudi Vision 2030 priorities.
Copyright (c) 2026 Majed Abdullah Alruaydi (Author)
Enhancing diagnostic accuracy and pre-analytical efficiency: a systematic review of workflow coordination among laboratory specialists, medical laboratory technologists, and patient care technicians
Background: Pre-analytical failures during test ordering, patient identification, specimen collection, labeling, handling, and transport threaten diagnostic accuracy and delay clinical decisions. This review evaluated workflow coordination in laboratory specialists, medical laboratory technologists, and patient care technicians and collectors. Methods: PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library were searched for studies published from 2000 through Jun 2026. Eligible studies evaluated coordinated interventions or factors linked to specimen identification errors, rejection, hemolysis, turnaround time, or collection knowledge. Findings were synthesized narratively because interventions, settings, denominators, and outcome definitions were heterogeneous. Results: Seventeen original studies were included. Bedside barcode identification, electronic ordering, and mobile specimen-labeling systems produced the most consistent reductions in mislabeled specimens and wrong-blood-in-tube events. Multidisciplinary programs combining standardized procedures, competency assessment, consumable redesign, surveillance, and feedback also reduced rejection and hemolysis. Education improved knowledge more than specimen outcomes, with one quasi-experimental study reporting no significant reduction in rejection. Most studies used uncontrolled before-after or retrospective designs, limiting causal certainty. Conclusions: Closed-loop coordination connecting clinical ordering, bedside collection, immediate labeling, transport, laboratory acceptance, and feedback strengthens pre-analytical performance. Technology achieved greater benefit when integrated with role clarity, monitoring, and recurrent competency assessment. Future controlled studies need standardized indicators and direct measures of diagnostic delay, treatment change, patient harm, and cost.
Copyright (c) 2026 Abdulrahman Ali Hamithi, Nedaa Ali Aldowasari, Mashael Abdulrahman Mahzari (Author)
Assessment of Emergency Medical Technician (EMT) Preparedness and Confidence in Managing Out of Hospital Mass Casualty Incidents: A Systematic Review
Background: Mass casualty incidents (MCIs) place significant stress on Emergency Medical Services (EMS) and frontline Emergency Medical Technicians (EMTs) due to high patient demand and resource constraints. Effective prehospital MCI management is dependent on EMT preparedness, which includes the necessary knowledge, skills, and organizational structures. In addition to objective skills, professional self-confidence is critical for performance under high stress. The purpose of this systematic review was to analyze current literature regarding the preparedness levels and self-reported confidence of EMTs in managing out-of-hospital MCIs. Methods: This systematic review was conducted in accordance with PRISMA guidelines, searching databases including PubMed, MEDLINE, and Scopus for original articles from 2010 to the present. The research focused on EMTs and other prehospital providers concerning preparedness (knowledge, training, drills) and confidence. Study selection and quality assessment were performed by two independent reviewers, and the data was analyzed using a qualitative synthesis. Results: Ten original studies were included in the review. Findings indicated significant gaps in system preparedness, mainly concerning interagency coordination, surge capacity, and role-specific training. A national assessment in Saudi Arabia showed a median benchmark score of 60% for prehospital MCI preparedness. Simulation studies highlighted the decline in triage skills over time, which suggest the need for annual refresher training. Training interventions, mainly scenario-based methods like gamification and immersive virtual reality (VR), were shown to increase perceived preparedness and self-reported confidence of participants. Conclusion: EMTs and EMS systems show moderate levels of MCI preparedness, but deficiencies still in coordination, surge capacity, and sustained skill retention. Active, scenario based training, especially using innovative technologies like VR, is effective in improvement of objective performance and professional confidence in managing prehospital MCIs.
Copyright (c) 2026 Hiba Khalid Alshareef, Abdulaziz Abdulrahman Alrabiah (Author)
Procainamide versus synchronized cardioversion for hemodynamically stable pre-excited atrial fibrillation: a systematic review
Background: Hemodynamically stable pre-excited atrial fibrillation represents an emergency rhythm in which rapid atrial impulses bypass the atrioventricular node through an accessory pathway. Objective: This systematic review compared intravenous procainamide with synchronized cardioversion for acute rhythm control in stable patients with pre-excited atrial fibrillation. Methods: PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Cochrane CENTRAL were searched for cohort studies, and randomized trials relevant to Wolff-Parkinson-White syndrome, pre-excited atrial fibrillation, procainamide, accessory pathway conduction, and electrical cardioversion. Eligible evidence included adult or mixed-age populations with manifest pre-excitation, acute atrial fibrillation, or emergency department cardioversion data. Results: No randomized trial directly compared procainamide with synchronized cardioversion in hemodynamically stable pre-excited atrial fibrillation. Procainamide evidence consisted mainly of electrophysiology studies and small acute-treatment cohorts showing accessory pathway refractoriness, longer pre-excited RR intervals, and pharmacological conversion in selected patients. Cardioversion evidence consisted mainly of guideline recommendations, observational pre-excited atrial fibrillation cohorts, and acute atrial fibrillation trials outside the pre-excitation population. The overall certainty remained low for direct comparative effectiveness and moderate for the principle that accessory pathway blocking is central to pharmacological safety. Conclusion: Procainamide is the best-supported drug option for stable pre-excited atrial fibrillation, while synchronized cardioversion remains the most definitive immediate rhythm-control strategy when rapid conversion is prioritized or drug therapy is unsuitable.
Copyright (c) 2026 Mazi Mohammed Alanazi, Sultan Menwer Almutairi, Khalid Fahad Alotaibi (Author)
Paramedic-Led Prehospital Emergency Care Interventions and Their Impact on Patient Outcomes: A Systematic Review
Background: Paramedic-led prehospital emergency care is a central component of time-sensitive emergency systems, and the clinical value of advanced procedures and drug treatment varies by condition, training model, and endpoint. Objective: This systematic review evaluated the impact of paramedic-led prehospital interventions on survival, neurological recovery, physiological improvement, hospital use, and safety. Methods: A PRISMA-aligned systematic search plan covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Cochrane CENTRAL. Eligible studies enrolled emergency patients managed before hospital arrival by paramedics or ambulance clinicians and reported patient-level outcomes after a defined intervention. Randomized trials, cluster trials, controlled before–after studies, and large prospective clinical studies were prioritized. Results: Ten studies were selected for synthesis. Evidence showed context-specific benefit rather than universal benefit from prehospital care. Advanced life support improved outcomes in respiratory distress, while systemwide advanced life support did not improve survival after cardiac arrest or major trauma. Epinephrine improved 30-day survival after out-of-hospital cardiac arrest without an increase in favorable neurological recovery. Supraglottic airway approaches achieved easier ventilation, with mixed survival findings. Plasma improved 30-day survival in air-medical trauma patients, whereas tranexamic acid and combined red-cell/plasma resuscitation produced neutral primary results. Prehospital antibiotics for suspected sepsis shortened treatment time without mortality reduction. Conclusion: Paramedic-led interventions improve outcomes when matched to precise clinical phenotype, rapid protocol execution, and outcome-focused quality systems.
Copyright (c) 2025 Abdulaziz Dhafer Alqahtani, Abdulrahman Saeed Aljandabi, Abduulah Ali Altuwaijri, Nawaf Mohammed Alanazi, Fares Abdullah Alshahrani, Naif Ali Alshmrani, Turki Athab Alrwaili, Mohammed Mari E Alnami (Author)
Sedation Strategies from the Emergency Interface to ICU Liberation: A Systematic Review of Agent Selection and Weaning Outcomes
Background: Sedation for mechanically ventilated adults begins at the emergency interface and continues through intensive care liberation, where depth, drug class, analgesia, delirium prevention, and awakening trials interact. Objective: This systematic review evaluated how sedative selection and sedation-minimization strategies influence delirium, ventilator liberation, intensive care duration, mortality, and adverse events. Methods: PubMed/MEDLINE, Scopus, Web of Science Core Collection, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews were searched for adult studies of invasive mechanical ventilation, emergency department or intensive care sedation, sedative agent comparison, sedation interruption, no-sedation protocols, and liberation outcomes. Original randomized trials and prospective cohorts were prioritized for the results synthesis. Results: Ten original studies were included in the qualitative results synthesis. Benzodiazepine-based sedation was consistently linked with less favorable delirium or extubation profiles than dexmedetomidine-based strategies in several randomized trials. Dexmedetomidine improved arousability and communication, reduced delirium in comparisons with benzodiazepines, and shortened extubation time in selected populations, although large trials showed similar mortality and ventilator-free outcomes compared with usual care or propofol. Daily awakening, paired awakening-breathing trials, no-sedation protocols, and targeted emergency department sedation reduced unnecessary deep sedation and aligned sedation with liberation readiness. Conclusion: The evidence favors early light sedation, avoidance of benzodiazepine accumulation, protocolized awakening, and agent selection matched to delirium and liberation goals.
Copyright (c) 2025 Sultan Saad Alotaibi, Reem Yahya Alhiqwi, Maha Bandar Alotaibi, Rana Fawaz Almutairi, Nedaa Ali Aldowasari, Abdulrahman Ali Hamithi, Mohammed Faisal Alajmi (Author)
The Impact of Video Laryngoscopy Versus Direct Laryngoscopy on First-Pass Intubation Success Rates in the Intensive Care Unit: A Systematic Review
Background: Endotracheal intubation in the intensive care unit is a high-risk procedure because critically ill patients frequently have hypoxemia, shock, acidosis, full stomach risk, limited physiologic reserve, and urgent airway indications. First-pass intubation success is clinically important because repeated laryngoscopy attempts increase airway trauma, oxygen desaturation, aspiration risk, esophageal intubation, and hemodynamic deterioration. Video laryngoscopy improves indirect glottic visualization, while direct laryngoscopy remains widely used because of cost, availability, familiarity, and speed in trained hands. Objective: This systematic review evaluated the impact of video laryngoscopy compared with direct laryngoscopy on first-pass intubation success in adult intensive care unit patients. Methods: A PRISMA-guided systematic review framework was used. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were selected as target databases. Original comparative studies involving adult critically ill or ICU patients undergoing tracheal intubation with video laryngoscopy or direct laryngoscopy were eligible. Results: Ten original studies were included in the results synthesis, including randomized trials, prospective comparative studies, and observational ICU airway studies. Most observational studies and some randomized trials favored video laryngoscopy for first-pass success, while the MACMAN and FELLOW randomized trials showed no significant first-pass advantage. The large DEVICE randomized trial showed higher first-pass success with video laryngoscopy without an increase in severe complications. Conclusion: Video laryngoscopy generally improves glottic visualization and often improves first-pass intubation success in critically ill adults, with the clearest benefit in recent large trials and in anticipated difficult airway situations.
Copyright (c) 2025 Abdullah Hatim Alshihry, Yousef Rashed Alhudaithi, Abdulmohsen Abdullah Alqadhi, Abdullah Hamoud Alanazi, Faisal Sattam Alruwaishid, Ali Riyadh Alqasir, Rashed Abdulaziz Batrfe, Saad Hamad Althawadi (Author)
High-flow nasal cannula versus non-invasive ventilation following planned extubation in critically ill adults: a systematic review of clinical outcomes
Background: Planned extubation in critically ill adults remains followed by clinically important rates of respiratory failure, reintubation, pneumonia, prolonged intensive care stay, and death. High-flow nasal cannula provides heated humidified gas, stable oxygen delivery, washout of upper airway dead space, and low-level positive airway pressure, while non-invasive ventilation provides pressure support and expiratory pressure through a mask interface. Objective: This systematic review compared high-flow nasal cannula with non-invasive ventilation, including alternating strategies, after planned extubation in critically ill adults. Methods: PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception to 2025 for adult studies evaluating high-flow nasal cannula versus non-invasive ventilation after planned extubation. Randomized trials and comparative observational studies were eligible. Outcomes included reintubation, postextubation respiratory failure, treatment failure, mortality, gas exchange, comfort, intolerance, complications, and intensive care length of stay. Results: Fourteen original studies were included. In broad high-risk intensive care populations, high-flow nasal cannula showed similar reintubation outcomes to non-invasive ventilation in one large trial, while combined high-flow nasal oxygen plus non-invasive ventilation reduced reintubation compared with high-flow nasal oxygen alone. In COPD, hypercapnia, obesity, and very high-risk groups, evidence favored individualized selection rather than a single universal device. Conclusion: High-flow nasal cannula represents a practical alternative after planned extubation for many critically ill adults, while non-invasive ventilation is important for hypercapnic, obese, and very high-risk phenotypes.
Copyright (c) 2025 Khalid Obaid Alanazi, Khalid Hamdan Alanazi, Mohammed Saad Aldosari, Osama Ibrahim Almujalli, Yazeed Mohammed Alkhalifah, Abdullah Hassan Asiri, Alwaleed Ahmed Amri, Reem Yahya Alhiqwi, Maha Bandar Alotaibi (Author)
Predictors of survival in adult patients receiving VA-ECMO in the emergency setting: a systematic review
Background: Venoarterial extracorporeal membrane oxygenation is used in ER as support for adult patients with refractory cardiogenic shock and cardiac arrest. Survival differs because candidates age varieties, arrest profile, shock etiology, low-flow duration, metabolic injury, and early complications. This systematic review analyzed predictors of survival in adults receiving VA-ECMO or ECPR during emergency presentation. Methods: We conduct a systematic review according to PRISMA principles. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for adult studies evaluating VA-ECMO or ECPR in ER (emergency department cannulation, refractory cardiac arrest, out-of-hospital cardiac arrest, in-hospital cardiac arrest, and acute cardiogenic shock requiring urgent circulatory support). We consider original studies reporting survival or neurological survival with clinical, biochemical, procedural, or scoring predictors. Results: Ten original studies were included in the final synthesis. The strongest predictors were younger age, witnessed arrest, shockable rhythm, shorter CPR or low-flow duration, lower lactate, higher pH or bicarbonate, preserved organ function, successful early revascularization in ischemic shock, and higher SAVE scores. Adverse predictors included older age, prolonged low-flow duration, asystole, severe acidosis, high lactate, renal injury, coagulopathy, major bleeding, vascular complications, and need for renal replacement therapy. Data in infarct-related cardiogenic shock found no survival advantage from routine early VA-ECMO in unselected patients. Conclusion: Survival after emergency VA-ECMO is determined by a cluster of pre-ECMO, intra-resuscitation, and early post-cannulation factors rather than a single variable. Candidate selection using age, arrest rhythm, low-flow time, lactate, pH, organ dysfunction, and validated scores offers a practical approach for emergency decision-making.
Copyright (c) 2026 Mazi Mohammed Alanazi, Saleh Ali Alzahrani, Wed Yasser Mulla, Albatool Mohammad Baz (Author)
Predictors of Neurosurgical Intervention in Mild Traumatic Brain Injury Patients Presenting to the Emergency Department: A Systematic Review
Background: Mild traumatic brain injury (TBI) represents a large share of emergency department head trauma presentations, although a smaller subgroup has intracranial injury that requires neurosurgical treatment. Early identification is central to safe imaging, admission, transfer, and specialist consultation decisions. Objective: This systematic review synthesized original studies evaluating clinical, demographic, physiologic, and radiologic predictors of neurosurgical intervention in emergency department patients with mild TBI. Methods: A PRISMA-based review framework was used. PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library were searched for adult studies of mild TBI, Glasgow Coma Scale 13–15, emergency presentation, and neurosurgical intervention or equivalent acute neurosurgical outcome. Original cohort, validation, registry, and decision-rule studies were prioritized. Results: Ten main original studies and additional validation studies were included in the narrative synthesis. The most consistent predictors were acute intracranial hemorrhage pattern, subdural hematoma thickness, midline shift, epidural hematoma, depressed or basal skull fracture signs, failure to normalize Glasgow Coma Scale, vomiting, older age, coagulopathy or anticoagulant exposure, and early neurologic worsening. Decision instruments achieved high sensitivity for ruling out intervention, although specificity varied widely. Conclusion: Neurosurgical intervention after mild TBI is uncommon overall, although risk increases sharply with specific radiologic and neurologic features. Risk stratification that combines computed tomography findings with serial neurologic assessment provides the most clinically useful approach for emergency disposition and transfer decisions.
Copyright (c) 2026 Mazi Mohammed Alanazi, Abdulrahman Yahya Jaber Gumiry, Abdulaziz Abdullah Mohammed AL-Zaydi, Abdelelah Mohammed Safhi, Faisal Ali M. Alshahrani, Maryam Alkhedrr, Salma Ismail Daffa, Sultan Farraj Alrajhi (Author)
Evaluating Knowledge Gaps, Attitudes, and Practices Toward Alzheimer’s Disease: A Community-Based Study in Bisha Province
Background: Alzheimer’s disease is a progressive neurodegenerative disorder and the leading cause of dementia worldwide. Public awareness of its symptoms, risk factors, and management is essential for early detection and appropriate care. This study assessed the knowledge, attitudes, and practices (KAP) regarding Alzheimer’s disease among adults in Bisha Province. Methods: A cross-sectional study was conducted among 403 adults using a structured questionnaire assessing sociodemographic characteristics, knowledge, attitudes, and practices related to Alzheimer’s disease. Descriptive statistics summarized participant responses, while multiple linear regression identified factors associated with knowledge and attitude scores. Results: Of the participants, 52.1% were female, with a median age of 25 years (IQR: 21–45), and most had Bachelor’s/Diploma education (68.7%). Most participants correctly identified amnesia as an early symptom (81.1%), recognized the impact of malnutrition on symptoms (62.8%), and knew patients are prone to depression (58.3%). However, only 16.4% knew the disease cannot be prevented and 32.3% recognized that no cure currently exists. Positive attitudes were common, with most agreeing that patients require continuous monitoring and can still enjoy a good quality of life with proper care. Regarding practices, 83.4% stated they would advise suspected patients to seek medical care. Overall, 42.2% had high knowledge, 42.2% moderate knowledge, and 15.6% low knowledge. Marital status was significantly associated with knowledge scores (B = −0.503, p = 0.032). Conclusion: Adults in Bisha Province demonstrated moderate to high knowledge and positive attitudes toward Alzheimer’s disease; however, notable gaps remain regarding prevention and treatment. Community-based educational programs are recommended to improve awareness and early recognition.
Copyright (c) 2026 Mansour Abdullah Alghamdi, Layan Abdullah Monahi, Basmah Abdulrahman Alshamrani, Nada Abdulrahman Alahmari, Lina Abdullah Monahi, Amani Nasser Alotibi, Lamya Monyf Alotybi, Shehanah Saleh Alshahrani, Hazim Saleh Almousa, Ali Salem Alkebiri, Fahad Almotawa, Saeed Mansour Alqahtani (Author)
Efficacy and safety of hypertonic saline versus mannitol in the acute management of traumatic brain injury in the emergency department: a systematic review
Background: Hypertonic saline (HTS) and mannitol are used widely for raised intracranial pressure (ICP) after traumatic brain injury (TBI), but the preferred agent remains uncertain. This systematic review evaluated the efficacy and safety in acute TBI management. Methods: This review followed PRISMA principles. PubMed, Embase, Scopus, and Web of Science were searched for original studies comparing HTS or related hyperosmolar sodium solutions with mannitol in TBI. Eligible designs included randomized trials, prospective studies, retrospective cohorts, case-control studies, and multicenter observational studies. Outcomes included ICP reduction, cerebral perfusion pressure, neurological outcome, mortality, treatment failure, and adverse effects. Results: Thirteen original studies were included, most enrolled severe TBI patients with raised ICP. Both agents reduced ICP. Several studies reported physiological advantages with HTS, including lower ICP burden, improved cerebral perfusion pressure, better brain tissue oxygenation, faster target achievement, or lower treatment failure. Studies using similar osmotic burdens found comparable short-term ICP reduction. HTS increased serum sodium or osmolality in some studies, and mannitol was associated with greater urine output. Conclusion: HTS had physiological advantages, and the included studies does not prove better clinical outcome than mannitol.
Copyright (c) 2026 Mazi Mohammed Alanazi, Jumana Safwan Gassem, Amjad Ahmed Alharthi (Author)
Prehospital Delay and its Associated Factors in Time-Sensitive Emergencies (Myocardial Infarction and Stroke) Among Residents of Bisha, Saudi Arabia: A Cross-Sectional Study
Background: Early recognition and timely response to myocardial infarction (MI) and stroke are critical for reducing morbidity and mortality. Public awareness and behavioral factors play a key role in prehospital delay. This study aims to assess awareness, intended response toward MI and stroke, and identify sociodemographic and behavioral predictors of delayed decision to seek urgent medical care among adult residents of Bisha, Saudi Arabia. Methods: A community-based analytic cross-sectional study was conducted in Bisha, Saudi Arabia, among 476 adults using convenience sampling with age and gender stratification. Data were collected using a structured questionnaire covering demographics, knowledge of warning symptoms, perceived confidence, behavioral attitudes, and intended help-seeking practices. Chi-square tests were used to identify factors associated with delayed care and intention to call emergency medical services (EMS). Results: Most participants recognized MI 416 (87.4%) and stroke symptoms 398 (83.6%). Immediate help-seeking was reported for MI by 412 (86.6%) and stroke by 420 (88.2%). Although 411 (86.3%) intended to call an ambulance, 129 (27.1%) preferred private transport. Knowledge of the stroke therapeutic window was limited 246 (51.7%). Confidence in symptom recognition was modest. Comorbidity was the only factor significantly associated with EMS use (p<0.001). For MI, delayed decision-making was mainly predicted by the belief in waiting for symptom improvement (p<0.001). For stroke, female gender (p=0.046) and the same behavioral belief (p<0.001) were significant predictors, while knowledge and most sociodemographic variables were not. In regression model, male gender reduced delay heartcare seeking for both conditions; comorbidities predicted stroke delay. Waiting for symptom improvement strongly increased delayed decision-seeking in MI and stroke (p<0.05). Conclusion: Our study shows that despite good general awareness, gaps in detailed knowledge and delay-promoting beliefs persist. Behavioral factors, rather than knowledge alone, were the main determinants of delayed care. Targeted interventions addressing attitudes toward ambulance use and the risks of waiting are essential to reduce prehospital delay and improve outcomes.
Copyright (c) 2026 Mohammed Turki Almuawi, Hasan M Alzahrani, Abdulaziz A Alzahrany, Mansour Abdullah Alghamdi, Basil Eid Alosaimi, Abeer Adel Alshaer, Fatima Hijab Alsibiey, Ahmed Bandar Alghamdi, Mohammed Abdulrahman Alshamrani, Ghala Abdulrahman Almoawi, Muneerah Braih Almoawi, Masoud Mohammed Alqahtani (Author)
Extra-corporeal cardiopulmonary resuscitation in the emergency department for refractory cardiac arrest: a systematic review
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue strategy for RCA, and its value in emergency department (ED) settings still uncertain as outcomes depend on patient selection, timing, and system organization. Methods: This systematic review followed PRISMA principles and included original studies evaluating ECPR or ED extracorporeal membrane oxygenation for refractory cardiac arrest (RCA). PubMed/MEDLINE, Scopus, and Web of Science were searched. Eligible studies reported survival, neurological outcomes, workflow measures, or ECPR-related process outcomes. Data were analyzed narratively because of clinical and methodological heterogeneity. Results: We include seven original studies published between 2012 and 2025. Studies were conducted in the United States, South Korea, Austria, China, and Japan, with sample sizes ranging from 29 to 192 patients. Emergency ECPR was feasible when delivered through structured protocols and trained teams. Survival to discharge or longer-term survival varied in studies, and neurological recovery was reported in selected patients with witnessed arrest, shockable rhythm, shorter low-flow or ACLS duration, and rapid access to extracorporeal support. Dedicated ECLS teams and hybrid ED systems shortened ECPR initiation times. Conclusion: Emergency ECPR benefit highly selected RCA patients when delivered within organized and experienced systems.
Extracorporeal cardiopulmonary resuscitation
Copyright (c) 2026 Mazi Mohammed Alanazi, Maram Saad Alshahrani, Noura Ali Alshahrani (Author)
Comparison of respiratory and cardiac etiologies of adult cardiac arrest in emergency settings: A systematic review
Background: Adult cardiac arrest (CA) in emergency department (ED) has different etiologies, mainly primary cardiac disease and respiratory failure. Etiology is important because rhythm profile, airway needs, post-resuscitation treatment, and survival differ between these groups. This systematic review compared respiratory and cardiac etiologies of adult CA in prehospital and ED settings. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane for adult CA studies reporting cause, setting, rhythm, resuscitation variables, or outcomes. Original studies were included in the results. Results: We found wide variation in etiologic reporting. Regional Arab studies mainly classified arrest as medical, presumed cardiac, or non-traumatic, while respiratory causes were less separated. The Saudi SOHAR registry was the clearest regional source reporting presumed cardiac and respiratory categories. International etiologic cohorts showed that respiratory failure formed a large subgroup in resuscitated patients and that presumed respiratory arrest differed from presumed CA in rhythm pattern and neurologic outcome. Conclusion: Cardiac etiologies dominate registry coding in emergency CA, while respiratory etiologies are hidden inside medical or non-cardiac categories. Future registries need clearer cause definitions, stronger airway-event documentation, standardized reporting of respiratory, traumatic, and other causes.
Copyright (c) 2026 Ghadah AlSaleh, Fatemah AlSaleh (Author)
Operative versus imaging-based pathways for penetrating abdominal trauma with hemodynamic instability in the emergency department: a systematic review
Background: Penetrating abdominal trauma (PAT) with hemodynamic instability (HI) requires rapid triage between immediate operative intervention (OI) and imaging-based pathways (IBP). The role of computed tomography (CT) or focused assessment with sonography for trauma in unstable or initially abnormal patients still not determined. Methods: This systematic review evaluated original studies reporting OI versus IBPs for patients presenting to the ED with PAT or thoracoabdominal trauma and HI, hypotension, or shock. MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library were searched, with additional screening of relevant reference lists. Reviews, case reports, editorials, conference abstracts without extractable data, blunt-only studies, and stable-only penetrating trauma studies were excluded. Results: We include three retrospective observational studies, one study focused on abdominal gunshot wounds, and two reported extractable PAT subgroups within HI trauma cohorts. CT-based pathways were used selectively, mainly in patients who responded to resuscitation or were considered stable enough for monitored imaging. In the eligible comparative cohorts, CT was not associated with higher mortality, and no deaths occurred in the CT scanner or during intrahospital transfer in one study. Imaging-based triage helped avoid OI in some patients and was associated with lower transfusion requirements, shorter hospitalization, or fewer additional procedures in some cohorts. Persistent nonresponse, peritonitis, and suspected major bleeding are indications for OI. Conclusion: CT-based evaluation support triage in selected unstable PAT patients during active resuscitation, and current studies does not justify routine imaging in unselected HI nonresponders.
Copyright (c) 2026 Ghadah Alsaleh, Fatemah AlSaleh (Author)
Non-operative management of low-grade (grade I–II) splenic injury in hemodynamically stable adults
Blunt splenic injury (BSI) commonly managed without surgery in hemodynamically stable (HDS) patients. This systematic review aimed to evaluate the outcomes of non-operative management (NOM) in adults with grade I–II BSI. A literature search was conducted in PubMed, Scopus, Web of Science, and Embase using search terms related to splenic trauma, blunt splenic injury, conservative treatment, observation, and NOM. Original studies which include adults with low-grade splenic injury managed non-operatively were eligible. We extract data on study design, patient characteristics, management approach, success or failure of NOM, delayed intervention, complications, transfusion requirement, and hospital stay, then this extracted data was synthesized narratively. Eight studies published between 1989 and 2024 were included. The findings showed a high success rate of NOM in HDS adults with grade I–II injury. Failure in low-grade injury was rare and occurred usually early after admission. Failure was associated with worsening hemodynamic condition, higher transfusion need, increasing abdominal signs, and greater trauma burden. Patients with contrast extravasation represented a higher-risk subgroup, with one study showing a 20% failure rate. We conclude that NOM is effective for low-grade BSI in stable adults, and careful monitoring is important, when vascular blush or early clinical deterioration is present.
Copyright (c) 2026 Mazi Mohammed Alanazi, Abdulrahman Mohammed Alqarni, Marwah Mohammed Alsadoun, Fai Ali Alsadun, Ghina Mazen AlZidan (Author)
Patterns of Opioid Utilization and Aberrant Opioid-Related Behaviors (AORB) in Pediatric Sickle Cell Anemia Patients: A Systematic Review
Background: Sickle cell disease (SCD) causes recurrent vaso-occlusive pain in childhood which requires opioid analgesia. Opioid utilization and aberrant opioid-related behaviors (AORB) still poorly defined in pediatric Gulf Cooperation Council (GCC) populations. Objective: This systematic review analyzed data on opioid utilization patterns, AORB, opioid use disorder (OUD), and related psychosocial factors in pediatric patients with SCD. Methods: Searches were conducted in PubMed, Web of Science, Scopus, and Embase using terms related to SCD, opioid analgesics, AORB, and pediatric. We consider original cohort, cross-sectional, retrospective, and qualitative studies involving pediatric SCD populations and reporting opioid utilization or AORB. We extract data on study setting, population, opioid-related outcomes, and main findings. Results: Seven studies were included. GCC studies was limited to one Saudi tertiary emergency department study, where morphine was used commonly for acute painful crises and administration within 60 -minutes was associated with higher chance of discharge. International claims data showed that 40% of SCD patients used opioids annually, while 3% of pediatric patients were high-dose users. OUD prevalence in adolescents with SCD was reported as 5.3% in Uganda. Additional opioid use was associated with older age, previous healthcare utilization, depression, pain catastrophizing, caregiver factors, and family support. Conclusion: Opioid utilization in pediatric SCD is affected by recurrent vaso-occlusive pain and acute care needs, data on AORB in GCC children are very limited.
Copyright (c) 2026 Mazi Mohammed M. Alanazi, Renad Nasser Alqahtani, Ghaida Khaled Alsaeed, Sarah Abdullah Almohanna, Ghadah A. Aleissa (Author)
Sleep disturbance and its association with depression and anxiety among Saudi adolescents and young adults: a systematic review
Background: Sleep disturbance is increasingly reported among adolescents and young adults and is its linked with psychological symptoms. In Saudi Arabia, university and healthcare students represent an important young adult group exposed to academic stress, digital screen use, and irregular sleep habits. Objective: This systematic review aimed to analyze the association between sleep disturbance and depression or anxiety in Saudi adolescents and young adults. Methods: Our systematic review was guided by PRISMA principles. Electronic databases were searched, including PubMed, Web of Science, PubMed Central, MEDLINE, Scopus, and Embase. Eligible studies were original observational studies conducted in Saudi Arabia, included adolescents or young adults, assessed sleep disturbance, poor sleep quality, or insomnia, and reported depression or anxiety outcomes. We exclude reviews, editorials, commentaries, case reports, non-Saudi studies, and studies without relevant sleep or mental health outcomes. Data were extracted on study characteristics, population, sample size, assessment tools, sleep outcomes, depression, anxiety, and reported associations. Results: We include eight original cross-sectional studies. All studies were conducted among Saudi university, medical, or healthcare students, so the data mainly represented young adults rather than school adolescents. Poor sleep quality ranged from 63.2% to 80.3% in PSQI-based studies, while insomnia ranged from 19.3% to 34.9% in ISI-based studies. Depression and anxiety were common in the included studies. Most studies reported significant associations between poor sleep quality or insomnia and higher depression, anxiety, or stress symptoms. Conclusion: Sleep disturbance is common in Saudi young adults and is associated with depression and anxiety.
Copyright (c) 2026 Abdullah Saleh Altuhayni, Mosaad Ibrahim A. Alshahwan, Abdulmajeed Mousa M. Alzahrani, Yaser Sulaiman Aljumaah (Author)
Advances in Minimally invasive oculoplastic surgery: Current Techniques and Outcomes: a systematic review
Background: Minimally invasive oculoplastic surgery (MIOS) aims to reduce scarring, tissue trauma, morbidity, and recovery time while preserving periocular function and cosmesis. Our systematic review synthesized techniques and outcomes in selected MIOS. Methods: A PRISMA-based systematic review was conducted using PubMed, Scopus, Web of Science, and Embase. Original studies evaluating MIOS with postoperative outcome data were included. Data on study characteristics, procedures, populations, follow-up, and outcomes were extracted and synthesized qualitatively because of heterogeneity. Results: Six eligible original studies were included, covering transconjunctival (TC) lower eyelid blepharoplasty, TC orbitotomy for intraconal orbital hydatid cysts, and endoscopic dacryocystorhinostomy (DCR). TC blepharoplasty showed good recovery, scar-free access, and low rates of major complications, with most short-term symptoms resolving within 1 to 2 weeks. TC orbitotomy had successful cyst removal in all reported cases, with early symptom improvement and no recurrence during follow-up. In endoscopic DCR studies, success rates were high, silicone tubing did not show significant benefit in primary cases, kerrison punch (K-punch) shortened operative time compared with powered drill, and the double-flap technique reduced recurrence compared with the single-flap technique. Conclusion: MIOS showed good effectiveness and safety in selected indications, and the data remained limited by small study numbers, retrospective designs, and heterogeneity.
Copyright (c) 2026 Ahmed Abou El Fotouh, Meshal Abdulrahman Ogran, Ziyad Mohammed Alkhammash, Abdulrahman Nasser Alqahtani, Faisal Nasser M. Alahmari (Author)
Artificial intelligence-assisted diagnosis and surgical planning in oculoplastic disorders: a systematic review
Background: Artificial intelligence (AI) is increasingly used to oculoplastic disorders, where diagnosis and surgical planning rely on imaging and objective periocular measurements. Our review summarizes studies on AI-assisted diagnosis, quantification, and surgical planning in oculoplastic. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. We conduct a literature search on PubMed (MEDLINE), Scopus, and Web of Science were searched from inception to the final search date for original human studies which evaluate AI for oculoplastic diagnosis, assessment, or surgical planning. Eligible studies reported quantitative performance metrics. Results: Twelve studies were included, computed tomography based thyroid eye disease models showed high discrimination for disease severity and compressive optic neuropathy screening (area under the receiver operating characteristic curve (AUC) 0.99; independent test AUC 0.92). Automated orbital segmentation achieved Dice values 0.90. Ptosis detection models achieved strong performance on high quality images (AUC 0.92) but degraded on low quality images. Automated eyelid measurement errors were sub millimeter, and postoperative appearance prediction systems reported eye overlap ratios 0.85 to 0.87. Eyelid tumor models using clinical images or histopathology shoe high diagnostic accuracy (AUCs 0.92 to 1.00). Conclusions: AI shows strong potential for oculoplastic diagnosis and planning, but external validation, and clinical impact evaluation were the important gaps.
Copyright (c) 2026 Meshal Abdulrahman Ogran, Ahmed Abou El Fotouh, Bandar Mohammed Asiri, Turki Bijad Alotaibi, Faisal Nasser M. Alahmari (Author)
Women’s Age as a Determinant of Pregnancy Outcomes in ICSI Treatment: A Retrospective Cohort Study
<span style="font-size: 10.0pt; line-height: 117%; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; color: black; mso-style-textoutline-type: none; mso-style-textoutline-outlinestyle-dpiwidth: 1.0pt; mso-style-textoutline-outlinestyle-linecap: flat; mso-style-textoutline-outlinestyle-join: miter; mso-style-textoutline-outlinestyle-pctmiterlimit: 400.0%; mso-style-textoutline-outlinestyle-dash: solid; mso-style-textoutline-outlinestyle-align: center; mso-style-textoutline-outlinestyle-compound: simple; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Background:<span style="font-size: 10.0pt; line-height: 117%; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; color: black; mso-style-textoutline-type: none; mso-style-textoutline-outlinestyle-dpiwidth: 1.0pt; mso-style-textoutline-outlinestyle-linecap: flat; mso-style-textoutline-outlinestyle-join: miter; mso-style-textoutline-outlinestyle-pctmiterlimit: 400.0%; mso-style-textoutline-outlinestyle-dash: solid; mso-style-textoutline-outlinestyle-align: center; mso-style-textoutline-outlinestyle-compound: simple; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> Female age is a major determinant of assisted reproductive technology outcomes, and data on intracytoplasmic sperm injection (ICSI) outcomes in women aged 40 years and older is limited. This study evaluated the association between maternal age and reproductive outcomes after IVF/ICSI. Methods: A retrospective cohort study was conducted at the Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia, including IVF/ICSI cycles performed between January 2022 and December 2024. Women were grouped as ≤34 years, 35–39 years, and >39 years, with additional analysis using ≤35 and >35 years. Demographic, clinical, stimulation, embryological, and reproductive outcome data were analyzed. Results: A total of 2,507 cycles were included; 1,280 (51.1%) were in women aged ≤34 years, 741 (29.6%) in women aged 35–39 years, and 486 (19.4%) in women aged >39 years. Embryo transfer rates declined significantly with age (77.9%, 75.6%, and 60.3%, respectively; p<0.001). Older women had lower baseline antral follicle count, higher baseline FSH, required higher gonadotropin doses, and had fewer retrieved oocytes, mature oocytes, fertilized oocytes, and cleaved embryos (all p<0.001). Clinical pregnancy rates decreased from 28.0% to 21.3% and 14.3%, while miscarriage increased and live birth significantly decreased with age (p<0.001). Conclusion: Advancing maternal age was associated with reduced ovarian response and poorer reproductive outcomes after IVF/ICSI, among women older than 39 years.
Copyright (c) 2026 Lama Alshwairikh, Nora Alrazeyg, Tariq Wani, Dania Al-Jaroudi (Author)
Road traffic accident patients presenting to the emergency department: clinical predictors of severe outcomes and mortality; a systematic review
Background: Road traffic accidents (RTA) are a major cause of death, disability, and emergency care burden worldwide. This review synthesizes clinical predictors of severe outcomes and mortality in RTA patients presenting to emergency departments or related acute hospital settings. Methods: A systematic review was conducted using PubMed, Web of Science, Scopus, and Embase. Original studies reporting mortality, severe injury, disability, poor outcome, or related severe consequences in RTA patients were eligible. Screening followed a PRISMA-style process. Data were extracted on study characteristics, outcomes, and reported predictors. Findings were synthesized qualitatively. Results: Eight studies were included. Most were prospective, retrospective, cross-sectional, or cohort designs. Sample sizes ranged from 211 to 1,471 participants. Mortality ranged from 3.6% to 14.69%. Severe injury prevalence reached 36.4%, while permanent disability ranged from 4.6% to 6.1% in reported studies. Important predictors of poor outcome included low Glasgow Coma Scale, hypotension or systolic blood pressure ≤89 mmHg, head injury, multiple trauma, high injury severity, ICU admission, complications during treatment, delayed presentation, lack of first aid, lack of ambulance transport, comorbidity, rural residence, and pedestrian status. Conclusion: Predictors of severe outcomes and mortality in the included studies were severe neurological impairment, hemodynamic instability, advanced injury burden, and delayed access to care.
Copyright (c) 2026 Mazi Mohammed Alanazi, Dana Sulaiman AlSayyari, Fahad Dhawi Nasser Almutairi (Author)