Saudi Medical Journal

Objectives: To establish the[-28pc]AU: Add abbreviated academic degree for authors Fareed A. Khouqeer and Yasser A. Alheraish. first national standards and guidelines for best practice in perfusion for patients undergoing cardiothoracic surgery in Saudi Arabia. Cardiopulmonary bypass (CPB) enables complex cardiac surgeries; however, it poses risks of potential complications. Methods: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop these guidelines and assess the certainty of evidence through a collaborative process. A panel of 16 Cardiovascu- lar perfusion experts across Saudi Arabia formulated 22 key clinical questions relevant to local practice. PubMed, Scopus, and Embase databases were searched for each question to identify relevant systematic reviews, randomized controlled trials (RCTs), non-randomized trials, post hoc analyses, and pooled analyses published from 2010 to 2024. The guideline panel voted for every question using the GRADEpro system, requiring a minimum consensus of 70% for approval. Results: A total of 16 conditional recommendations and 6 good practice statements were finally approved, categorized into 5 key domains. Of these, 4 addressed guidelines, protocols, and general practices; 2 focused on surgical techniques; 8 covered heart-lung machine hardware; 3 centered on cardioplegia and Priming Solutions; and 5 emphasized monitoring and perioperative management. Six statements were based on expert opinion due to insufficient supporting evidence. Using a standardized pre-bypass checklist to enhance safety and implementing perioperative glycemic management to control glucose levels and reduce complications were strongly recommended by the panel. Conditional recommendations focus on pump selection, biocompatible oxygenators, and continuous cerebral oxygenation monitoring. Anticoagulation, myocardial protection, and transfusion management were also highlighted. Conclusion: These Saudi guidelines provide evidence-based recommendations to enhance the care of patients undergoing cardiac surgery with CPB, offering clear guidance for clinicians to achieve optimal outcomes. Nevertheless, future locally relevant research and regular updates are essential to bridge existing evidence gaps.

OBJECTIVES: To compare complications of third and second generation oral contraceptive pills (OCPs). METHODS: In a randomized clinical trial from October 2007 to October 2008, 100 healthy women of reproductive age referred to Amir Hospital Family Planning Clinic and some heath centers in Semnan, Iran were randomized in 2 equal groups. They received either a third generation OCP (150 microgram desogestrel [DSG] + 30 microgram ethinylestradiol [EE]) or a second generation type (150 microgram levonorgestrel [LNG] + 30 microgram EE). Six months later, changes of weight, acne, and hirsutism severity, as well as serum titers of sex hormone-binding globulin (SHBG) and free testosterone were compared between the 2 groups. RESULTS: Forty-five women were evaluated in the DSG+EE OCP group, and 46 women in the LNG+EE OCP group. The BMI was significantly higher in the second group (p=0.000) after 6 months duration. Likewise, the decrement of acne and hirsutism severity was significantly higher in the DSG+EE users (p=0.000). Mean changes of serum free testosterone (p=0.967) and SHBG (p=0.916) were comparable between the 2 groups. CONCLUSIONS: In comparison with the LNG+EE OCP, the DSG+EE OCP is a contraceptive pill that significantly decreases the severity of acne and hirsutism, without any significant change in weight.

There have been a marked rise in the prevalence and incidence of end stage chronic kidney disease (CKD) in Saudi Arabia over the last 3 decades. This rise exceeds those reported from many countries. The enormous and rapid changes in lifestyle, high population growth, and fast increase in life expectancy, and massive urbanization that has occurred over the last 3 decades combined to make the current CKD status different to what it was. The 2 major factors that influence the CKD status are the very high rate of diabetic nephropathy and shift in age demographics.

Objective: To evaluate the literature based on the relationship between orphaned children and mental health, compared to non-orphaned children. Mental well-being of orphaned children is a profound intricate topic that connects with broader concerns of childcare. This systematic review aims to evaluate the literature regarding the relationship between mental health and parental absence. Methods: We conducted a systematic search of PubMed, MEDLINE, and Science Direct in October 2025, with 1017 screened studies. Six studies met the inclusion criteria. Independent reviewers performed quality assessments using the Newcastle-Ottawa scale (NOS). Subsequently, a meta-analysis was performed when possible. Results: Findings indicate that orphaned children demonstrated higher levels of aggressive behavior (1 study: p = 0.05), depression (2 studies: p<0.001 and p<0.001), and PTSD symptoms (1 study: p<0.001). Anxiety was also higher among orphans (3 studies: p = 0.038, p = 0.006 and p<0.001). Orphans also had poorer psychological well-being (1 study: p<0.001), greater somatic symptoms (1 study: p<0.001), and higher social dysfunction (1 study: p<0.001). There were no statistically significant differences in resilience (1 study: p = 0.16), self-efficacy (1 study: p = 0.58), or internalizing and externalizing problems (1 study: p = 0.64). Meta-analysis of studies evaluating depression yielded non-significant increased standardized mean differences (SMD) of 0.77 (p = 0.10). While the meta-analysis of studies evaluating anxiety showed a significant increased SMD of 0.68 (p = 0.02) among children with parental absence. Conclusion: Orphaned children may exhibit elevated levels of depression, anxiety, aggression, and poorer psychological well-being compared to their non-orphaned peers. However, they also possess internal strengths such as resilience and self-efficacy. These findings should be interpreted with caution due to the limited number of studies and the high degree of heterogeneity across studies and cultural contexts.