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)
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)
Outcomes of elderly trauma patients discharged from the emergency department: predictors of revisit, admission, and mortality; systematic review
Background: Older trauma patients discharged from the emergency department (ED) remain at risk of adverse outcomes. Predictors of revisit, admission, and mortality are not well studied. Methods: This systematic review identified studies of adults aged 65 years or older discharged from the ED after trauma-related presentations. A total of 190 records were identified from electronic databases. After removal of duplicates and other ineligible records, 33 full-text reports were assessed and 6 observational studies were included in the qualitative synthesis. Results: Included studies focused on fall-related trauma. Follow-up ranged from 3 days to 1 year. Reported outcomes included ED revisit, later hospital admission, recurrent falls, and mortality. ED revisits reached 25% at 1 year in one cohort, while another study reported 42.6% revisits and 31.1% later hospitalization within 6 months. Early 7-day revisits were reported in 11.7% of discharged fall patients. Mortality ranged from 1.2% at 3 days to 15% at 1 year in one study, and 10.4% 30-day mortality in another. Important predictors included male sex, higher comorbidity burden, older age, injury severity, abdominal or extremity injury, sedative or psychological medication use, psychiatric diagnosis, and alcohol or substance use disorder. Conclusion: Elderly trauma patients discharged from the ED were a high-risk group and benefit from discharge planning and transitional care.
Copyright (c) 2026 Mazi Mohammed Alanazi, Shahad Tariq Sarhan, Linah Abdulrahman Alhamdani (Author)
Success pregnancy rate after use of intralipid in recurrent pregnancy loss
Background: Recurrent pregnancy loss (RPL) is a multifactorial condition, and immunological therapies have been explored in women with recurrent miscarriage or RPL when immune dysregulation is suspected. This review evaluated pregnancy outcomes after intralipid therapy in women with RPL. Methods: A systematic review based on PRISMA principles was conducted using PubMed, Embase, Scopus, and the Cochrane Library. We consider original studies evaluating intralipid or lipid emulsion therapy in women with RPL, recurrent miscarriage, or related reproductive failure populations and reporting pregnancy outcomes. Data on study characteristics, treatment regimens, and outcomes were extracted and analyzed qualitatively. Results: Four studies published between 2015 and 2025 were included, conducted in China, the United States, France, and Japan. Study designs included one prospective randomized trial, one comparative study, and two retrospective cohort studies. One study focused on an unexplained recurrent spontaneous abortion population, while the others included mixed recurrent pregnancy loss miscarriage and recurrent implantation failure populations. Intralipid showed outcomes comparable to intravenous immunoglobulin in two studies, a significantly higher live birth frequency than controls in one recurrent miscarriage subgroup, and no clear improvement versus historical controls in another study. Conclusions: intralipid have benefit in selected women with RPL, and results remain inconsistent and limited by heterogeneous populations and study designs.
Copyright (c) 2026 Nada Abdulaal, Yosra Boudjelal, Noreen Ijz, Mohamed Alamro (Author)
The Role of Neuromodulation (PTNS/ SNS) in Refractory Overactive Bladder: Long-Term Outcomes
Background: Overactive bladder (OAB) imposes a significant global health and economic burden. While behavioral and pharmacological treatments are standard, many patients become refractory. Neuromodulation, specifically Sacral Nerve Stimulation (SNS) and Percutaneous Tibial Nerve Stimulation (PTNS), offers a third-line alternative, but data on their long-term durability is still varied. Methods: Following PRISMA guidelines, a systematic review was conducted in PubMed, Scopus, and Web of Science for studies from 2007 to 2026 reporting clinical outcomes for refractory OAB with a minimum 24-month follow-up. Methodological quality was assessed using the Newcastle Ottawa Scale. Results: Nine studies met the inclusion criteria. SNS show high long-term success rates, ranging from 47% at nearly 10 years to 82% at 5 years. SNS was associated with surgical revision rates up to 33% due to lead migration or loss of efficacy. PTNS show a strong durability in responders, with 77% maintaining improvement at three years. Long-term PTNS adherence is a challenge, with one study reporting 25% patient retention at three years. Both modalities improved Qol. Conclusion: SNS and PTNS provide effective long-term management for refractory OAB. SNS offers high durability but requires surgical revisions, while PTNS provides a better safety profile and it heavily dependent on patient adherence to maintenance schedules.
Copyright (c) 2026 Noor Hussain Almousa, Duaa Shafiq Alwahidi, Somaya Ibrahim Alghamdi, Maram Jarallah, Ghada Saleh H Albalawi, Reema Faleh Mohammed Alanazi, Hind Mousa Ahmad Faqeeh, Adnan Alhazmi, Malak Dhaifallah Alanazi, Gofran Mohammed Al Braheem, Salem Abdulaziz Salem Islam, Saad Khaleel Alonze (Author)
Urethral catheterization outcomes and complications in acute urinary retention: a systematic review of emergency department studies
Background: Acute urinary retention (AUR) is a common emergency condition managed by immediate urethral catheterization (UC), and data on catheter-related complications is less developed than post-catheter voiding outcomes. This systematic review aims to analyze original studies on outcomes and complications of UC in adults with AUR. Methods: Original studies were identified from PubMed, Web of Science, Scopus, and Embase. Eligible studies included adults with AUR managed with UC in ED or acute-care settings and reporting catheter-related complications, trial without catheter (TWOC), re-catheterization, or related clinical outcomes. Findings were synthesized qualitatively. Results: Eight original studies were included. Most studies focused on TWOC success and predictors rather than direct catheter harms. Reported TWOC success ranged from 28.3% to 68.6%, and improved in some studies with alpha-blocker therapy. Factors associated with better voiding outcomes include lower retained urine volume, smaller prostate size, younger age, and lower intravesical prostatic protrusion. Direct complications were less reported, and one comparative cohort showed higher rates of urinary tract infection (UTI), urethral stricture (US), epididymo-orchitis, and septicemia after UC than suprapubic drainage (SPD). Rapid bladder decompression was not associated with important excess hypotension or severe hematuria. Conclusion: UC effectively relieves AUR, and direct complication outcomes still underreported. Future emergency-based studies should assess catheter-related infective and traumatic complications more systematically alongside TWOC outcomes in practice.
Copyright (c) 2026 Ghadah Alsaleh (Author)
Diagnostic accuracy of rapid molecular tests for detecting antimicrobial resistance in bloodstream infections: a systematic review
Background: Rapid molecular tests (RMTs) accelerate antimicrobial resistance detection in bloodstream infections, and accuracy differs by target. This systematic review evaluated diagnostic performance. Methods: We searched PubMed, Scopus, Web of Science, and Embase for original studies assessing RMTs for resistance detection in bloodstream infections (BSIs) using positive blood cultures or whole blood. Eligible studies compared assays with conventional microbiology, phenotypic susceptibility testing, molecular methods, or combined standards. We extract data on assay characteristics, resistance targets, diagnostic outcomes, turnaround time, and clinical impact. Results: We include nine studies involving 2,439 samples. Platforms included FilmArray/BCID, Verigene BC-GP/BC-GN, BIOFIRE BCID2, T2Resistance, and the Molecular Mouse System. Performance was high for covered organisms and resistance markers. BCID2 showed 98.9% sensitivity and 99.6% specificity for organism targets, with 97.9% positive percent agreement and 99.9% negative percent agreement for resistance determinants. T2Resistance showed 100% sensitivity for several genes and shorter time to detection than conventional methods. Lower performance was reported in polymicrobial cultures and when resistance mechanisms were outside assay panels. Conclusion: RMTs are adjuncts for early resistance detection in BSIs and shorten time to results. They should complement conventional culture and susceptibility testing because limited target coverage, off-panel organisms, and imperfect genotype-phenotype correlation is important constraints.
Copyright (c) 2026 Mazi Mohammed Alanazi, Duha Ahmed Momen (Author)
Live birth outcomes after cleavage-stage (day 3) versus blastocyst-stage (day 5) embryo transfer in IVF/ICSI cycles: a systematic review
Background: The optimal timing of embryo transfer in IVF/ICSI is controversial. Although blastocyst transfer improve fresh-cycle success through embryo selection, its effect on cumulative live birth rate (CLBR) is uncertain. In this study we aimed to compare live birth outcomes after Day 3 cleavage-stage versus Day 5 blastocyst-stage embryo transfer in IVF/ICSI cycles. Methods: A PRISMA-guided systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Eligible studies included women undergoing fresh or frozen-thawed IVF/ICSI cycles comparing Day 5/6 blastocyst transfer with Day 2/3 cleavage-stage transfer. Results: Seven studies were included. In women with a good prognosis blastocyst transfer was associated with higher live birth rates in fresh cycles. Recent large studies showed no significant difference in CLBR between blastocyst and cleavage-stage policies. In women with four or fewer zygotes, blastocyst transfer provided no advantage, while cleavage-stage quality is a predictive of success among transferred blastocysts. Conclusion: Blastocyst transfer benefit good-prognosis patients, but it does not improve cumulative live birth outcomes in IVF/ICSI populations. Embryo transfer timing should be individualized, with cleavage-stage transfer favored in patients with low embryo yield to reduce cycle cancellation risk.
Copyright (c) 2026 Ibtesam Fawaz Alshammari, Renad Abdussalam Alshehri, Noura Hamad Rasheed Alshurtan, Shumukh Okab K AlSalem, Fatmah Saleh Mohammed, Muneerah A. Aljumah, Amani Mohammed Awaji, Hadeel Abbas Katib, Areej Mohammad Baz, Tahani Mahmoud Thabit, Saad Khaleel Alonze (Author)
Outcomes of fertility-sparing surgery in early-stage ovarian cancer; systematic review
Background: Fertility sparing surgery (FSS) is used in women with early-stage ovarian malignancies who aim to preserve fertility, but its oncologic safety still debated. Our review examined oncologic and reproductive outcomes after FSS. Methods: We conduct A PRISMA 2020-based systematic review in PubMed, Web of Science, Scopus, Embase, and the Cochrane Library from inception to early 2024. We include observational and registry-based analyses of reproductive-age women with early-stage epithelial ovarian cancer (EOC), malignant ovarian germ cell tumors (MOGCT), or sex cord-stromal tumors (SCST) treated with FSS. Primary outcomes were OS, disease-free survival, and recurrence; secondary outcomes were pregnancy, menstrual recovery, and live birth. Results: We include 24 studies published between 2002 and 2024, mainly retrospective and included EOC, MOGCT, and SCST. In stage I EOC, large population-based studies showed no significant survival disadvantage with FSS, with 5-year overall survival above 95%. Recurrence after FSS ranged from 2.0% to 27.8%, with higher risk in grade 3 tumors, clear-cell carcinoma, and selected stage IC cases. In women attempting conception, pregnancy rates reached 91.2% in MOGCT and 92.3% in EOC, with live birth rates of 65% to 100% in those who conceived. Conclusion: FSS provide positive oncologic and reproductive outcomes in some women, although epithelial high-risk subgroups and SCST require special counseling and long surveillance.
Vasopressor therapy for septic shock after adequate fluid resuscitation in the emergency department: a systematic review and meta-analysis
Background: Septic shock is a critical emergency, and vasopressor timing after initial fluid resuscitation is under debate. Data from emergency department, prehospital, and intensive care studies benefit from earlier norepinephrine initiation. Methods: We performed a systematic review and meta-analysis of studies evaluating vasopressor therapy, norepinephrine in septic shock after fluid resuscitation, with focus on timing of initiation. Nine studies were included in the qualitative analysis, while studies with extractable event counts were entered into the mortality meta-analysis. Pooled risk ratios (RRs) were calculated for short-term and 28-day mortality. Results: Earlier vasopressor initiation was associated with better hemodynamic and clinical outcomes in the included studies, including faster shock control, lower fluid exposure, and less organ failure progression. In the pooled short-term mortality analysis of four studies, early vasopressor initiation was associated with lower mortality (RR 0.72, 95% CI 0.56–0.92; I²=0%). In the stricter 28-day mortality analysis of three studies, early initiation also favored survival (RR 0.66, 95% CI 0.51–0.86; I²=0%). Conclusion: Early norepinephrine initiation improved short-term outcomes in septic shock. More high-quality emergency department studies are needed to define the best timing threshold and confirm the effect on mortality.
Copyright (c) 2026 Mazi Mohammed Alanazi, Rayan Ahmed Bahmaid, Reema Meshal Aldera (Author)
Comparing disaster preparedness knowledge, attitudes, and practices between emergency medicine residents in Riyadh region
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<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<0.001) and practice (rho=0.665, p<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.
Copyright (c) 2026 Abdulaziz Alrabiah, Falwah Alharthi, Yara BinSaleh, Razan Imad Bahkali, Lama Faisal AlDhawi (Author)
Analgesic benefits of single-shot versus continuous adductor canal block for total knee arthroplasty; systematic review
Background: Postoperative pain after total knee arthroplasty (TKA) delay mobilization and rehabilitation. Adductor canal block (ACB) is widely used because it provides analgesia while preserving quadriceps strength, but it’s uncertain whether single-shot Adductor canal block (SACB) or continuous Adductor canal block (CACB) had the better postoperative outcomes. This review evaluated their effects on pain, opioid consumption, and early functional recovery after TKA. Methods: This systematic review followed PRISMA guidance. MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to 2025 for original studies comparing SACB with CACB in TKA. Two reviewers screened studies, and assessed full texts. We found heterogeneity in study design, block protocols, and outcome reporting, so the findings were analyzed qualitatively rather and meta-analysis not done. Results: We initially identified 172 records, 106 were screened, 28 full texts were assessed, and 9 studies involving 1,307 patients were included. CACB provided more steady analgesic benefit than SACB, especially after 12 to 24 hours, with several studies showing lower pain scores at 24 and 48 hours, and reduced opioid use. Some trials found equivalent early analgesia, mainly when SACB was combined with adjuvants or multimodal analgesia. Functional outcomes were mixed, with some studies favoring CACB for ambulation or range of motion and others showing no significant differences. Conclusion: CACB provide more sustained analgesia and opioid-sparing benefit after TKA, whereas functional advantage over SACB still not confirmed and context dependent.
Copyright (c) 2026 Mazi Mohammed Alanazi, Nourah Mushwah Alharbi, Sarah Abdullah Almohanna, Taif Abdullah Almoqaiteb, Rand Abdullah Almoshaiti, Shaden Akram Alanzi, Bushra Abdullah Alhosayani (Author)
Clinical predictors of severe outcomes in adult and pediatric poisoning patients presenting to emergency departments: a systematic review
Background: Poisoning is a common emergency department presentation and range from mild exposure to life-threatening intoxication. Early identification of patients at high risk for severe outcomes is important because some of the patients look stable at first and then deteriorate later. In this study we aimed to identify clinical predictors associated with severe outcomes in adult and pediatric poisoning patients presenting to emergency departments. Methods: This systematic review included original studies evaluated predictors of severe outcomes in acute poisoning patients. We conduct the literature search in PubMed, Web of Science, Scopus, and Embase from database inception until 2025. Screening was done in two stages, including title and abstract review followed by full-text assessment. Data extracted on study design, population, poisoning type, predictors, severe outcomes, and main findings. Results: A total of 10 studies were included. The studies involved adult, pediatric, and mixed-age populations with different poisoning types, including acute drug overdose, salicylate poisoning, amitriptyline poisoning, diphenhydramine toxicity, and general acute poisoning. Severe outcomes included mortality, intensive care unit admission, intubation, and adverse cardiovascular events. Predictors include clinical findings, lactate, electrocardiographic abnormalities, age-related factors, inflammatory biomarkers, and clinical prediction models. Conclusion: Severe outcomes in poisoning predicted by a combination of clinical, laboratory, ECG, and age-related factors rather than one single predictor.
Copyright (c) 2026 Mazi Mohammed Alanazi, Ghidah Zouhair Altabsh, Osama Sameer Almaghrabi (Author)
Early potassium assessment and replacement during emergency department treatment of diabetic ketoacidosis: a systematic review
Background: Diabetic ketoacidosis (DKA) causes metabolic and electrolyte disturbances. Although total-body potassium is depleted, serum potassium at presentation appears normal or even elevated because of transcellular shifts, which create a risk of underestimating impending hypokalemia during treatment. Objective: we aimed to synthesize the available studies on early potassium assessment and replacement during ED and ICU management of DKA. Methods: A systematic review was conducted according to PRISMA 2020. We searched PubMed, Embase, Scopus, Web of Science, and CENTRAL from inception to 2026. Eligible studies included patients with DKA receiving early potassium assessment and replacement during ED or ICU management. Randomized, prospective, and retrospective original studies were included. Qualitative synthesis was performed. Results: Eleven studies published between 1972 and 2025 were included. Hypokalemia at presentation was uncommon, with reported prevalence of 1.3% to 5.6% in adult cohorts. Potassium measurement methods impact clinical interpretation, and pH-adjusted potassium reflects physiological risk rather than unadjusted values. Early protocolized supplementation was associated with more stable potassium levels and better clinical outcomes. Conclusions: In DKA, the principal potassium-related danger is hypokalemia developing after treatment begins. Early assessment, frequent monitoring, and quick replacement are essential, and stronger comparative studies are needed to define replacement strategies.
Copyright (c) 2026 Mazi Mohammed Alanazi, Abdulhadi Ali Alomran, Hassan Ali Alsinan (Author)
Diagnostic accuracy of serum lipase for acute pancreatitis in adults presenting to the emergency department: a systematic review
Background: Acute pancreatitis (AP) requires rapid emergency department diagnosis, and LPS is widely used; uncertainty exist regarding optimal interpretation, especially for mild elevations. Our systematic review examined the diagnostic utility of serum lipase (LPS) for identifying AP in adults presenting with acute abdominal pain. Methods: This systematic review was conducted according to PRISMA guidelines to examine the diagnostic accuracy of LPS for AP in adults presenting to the ED with acute abdominal pain. Our data searches were performed in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Prospective and retrospective diagnostic accuracy and cohort studies were eligible when AP was diagnosed using the Revised Atlanta Criteria. We assessed quality using QUADAS-2 on study design, population, lipase thresholds, and diagnostic performance, and methodology. Results: Seven studies were included, and LPS showed high diagnostic accuracy, with reported sensitivity/specificity of 93.9%/99.4% in one prospective study and 96.6%/99.0% in another study. Lipase reached 100% sensitivity within the first 24 hours of symptom onset and have higher sensitivity than amylase on days 2-3 (85% vs 68%). Data favored lipase over amylase because of its longer diagnostic window. Mild elevations represented an important gray zone among patients with lipase 80-240 IU/L, only 6.36% had AP, while 64% of emergency lipase orders in another study were redundant. Conclusions: LPS is a highly accurate first-line biomarker for diagnosing AP in adults in the ED. Its value is greatest when interpreted with clinical findings and the 3× upper-limit-of-normal threshold and selective imaging when presentation is inconclusive.
Copyright (c) 2026 Mubarak Falah Alshahrani, Hytham Amer AlShehri, Mohammed Saeed Malhan, Ghadah Ageel Almiglad, Turki Ali Alamri, Ahmed Hussein Alali, Razan Mohammed Alshehri (Author)
High-Flow Nasal Cannula for Respiratory Support in Adult ICU Patients: A Systematic Review
Background: High-flow nasal cannula (HFNC) is increasingly used for non-invasive respiratory support in adult ICU patients, mainly after extubation and in hypoxemic respiratory failure. Out study aim to evaluate the effectiveness of HFNC compared with conventional oxygen therapy, non-invasive ventilation (NIV), or non-invasive positive pressure ventilation in adult ICU patients requiring respiratory support. Methods: This systematic review followed PRISMA principles. We searched PubMed, Cochrane, Google Scholar, and other electronic databases for randomized controlled trials published between 2017 and 2025. Adult ICU studies comparing HFNC with conventional oxygen therapy, NIV, or non-invasive positive pressure ventilation were included. Overall, 466 records were identified, 421 remained after duplicate removal, 51 full texts were assessed, and 5 randomized controlled trials were included. Results: The included trials reported heterogeneous outcomes, including hospital length of stay, PaO2/FiO2 ratio, post-extubation vital signs, arterial blood gases, respiratory failure within 3 days after extubation, and 28-day mortality. HFNC associated with shorter hospital stay and fewer ICU readmissions in postoperative cardiac patients, improved oxygenation and reduced NIV use in severe hypoxemia after cardiac surgery, and provided comparable physiological Conclusion: HFNC is effective respiratory support option in selected adult ICU populations, mainly for oxygenation, comfort, and some post-extubation outcomes.
Copyright (c) 2025 Alaa Ahmed Alqattan, Reem Dhafer Alahmari, Waad Mohammed Hajib, Zahra Anwar Almarhoon, Yara Anwar Almutairy, Lamya Dhaifallah Alnakhli (Author)
Lumbar facet joint steroid injection versus Radiofrequency denervation for chronic low back pain: systematic review
Study aim: The study aimed to compare the clinical efficacy and safety of radiofrequency denervation versus corticosteroid injection for chronic low back pain originating from the lumbar facet joints. Methods: According to PRISMA 2020 guidelines we searched PubMed, Web of Science, Scopus, CENTRAL, and Embase from inception to 2025. Eligible studies included adults with chronic lumbar facet mediated pain treated with RFD or corticosteroid-based facet interventions. Pain reduction was the primary outcome; disability, treatment success, and adverse events were secondary outcomes. Results: We include 16 primary studies involving more than 1,900 participants, with follow-up from 3 to 24 months. Both interventions reduced pain, and corticosteroid injections produced faster short-term relief, whereas radiofrequency techniques showed more durable pain control and better long-term functional improvement in several comparative studies. Sham-controlled trials and the MINT trials did not show clinically important advance of routine radiofrequency over control strategies, which indicate that patient selection, diagnostic rigor, and procedural technique impact outcomes. Both treatments were safe, with minor adverse events reported. Conclusion: Facet steroid injection is useful for early symptom control, whereas RFD provide longer-lasting benefit in carefully selected patients with confirmed facetogenic pain.
Copyright (c) 2026 Saeed Abubakr Balubaid, Abdurahman Talal Bahha, Abeer Abdullah Algarmoshi, Razan Saleh Aljawi, Abdullah Alhashmi Alameer, Eyad Jamil Algahwaji, Abdullatif Ahmad Maimny (Author)