Saudi Medical Journal

Saudi Medical Journal was established in 1979 through the vision and initiative of His Royal Highness Prince Sultan bin Abdulaziz, Second Deputy Prime Minister, Minister of Defense and Aviation, and Inspector General, whose support laid the foundation for the journal’s continued development. Since its inception, the Journal has been published regularly and has maintained a strong commitment to scientific rigor and editorial quality.

Over the years, Saudi Medical Journal has evolved in scope, reach, and operational efficiency. Its editorial and publishing activities have been continuously refined to ensure timely publication while upholding high standards of peer review and content quality. The journal has attracted submissions from both within and outside the Kingdom and serves a broad readership across the Middle East and beyond.

The Editorial Office has been led by distinguished editors and supported by dedicated staff who have contributed to building the journal’s international reputation and credibility. Ongoing improvements in editorial processes and publishing practices reflect the journal’s commitment to excellence and continuous development.

As the longest-running medical journal in the Kingdom, Saudi Medical Journal plays an important role in bridging medical scholarship between the Middle East and the global research community. In addition to publishing original scientific research, the journal actively supports capacity building by offering medical publication workshops aimed at junior doctors and health researchers.

Current Issue

Volume 47, Issue 9 (2026)View issue

Featured Content

  • Original Study
    8 August 2026

    Bibliometric Analysis of the Top 100 Most Cited Publications from Saudi Arabia Reveals the Predominance of Medical Fields

    Mahmoud Kandeel, Abdulla Al-Taher
    Objectives: To explore the citation impact, journals, international collaborations, trends of research topics and gain more visibility for the Saudi contribution to the global scientific landscape. Methods: This bibliometric study analyzes the top 100 cited publications affiliated with Saudi Arabia in Scopus, from inception to January 2026. The extracted bibliometric indicators include total citation metrics, sources, collaboration maps, and co-occurrence networks of keywords and collaborations. Results: The results indicate a strong predominance for medicine and health sciences as the subjects of the most prolific and significant number of citations. A substantial proportion of the most cited papers originates from major global health projects, in particular the Global Burden of Disease (GBD) consortium, which focuses on mortality, morbidity, and epidemiological metrics. Clinical and public health fields are highly represented, including obesity and cardiovascular risk, disease burden, and population health metrics. The most frequent journals include the leading medical journals in the field, namely The Lancet, Nature, Science and the New England Journal of Medicine. Keyword analysis confirms the dominance of medical themes; the most prominent keywords included epidemiology, risk factors, and global health indicators. Within the biomedical predominance, bioinformatics tools such as MEGA software contribute to the citation impact. Conclusions: Saudi Arabia's citation impact is predominantly driven by international consortia participation and bioinformatics tool development, highlighting the opportunities for strengthening independent and nationally led research programs of global significance.
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  • Original Study
    8 August 2026

    Comparison of the Effects of Spinal Versus General Anesthesia on the Perioperative Intraocular Pressure: A prospective, randomized clinical trial

    Muzaffer GENCER, Mehmet YALVAÇ
    Objectives: To evaluate the effects of spinal and general anesthesia on the intraocular pressure (IOP) in patients, who had lumbar spine and lower extremity orthopedic surgeries Methods: Sixty adult were randomly classified into Group spinal anesthesia (SA) and Group general anesthesia (GA). The IOP, mean systemic arterial pressure, and heart rhythm were measured at 6 pre-determined timepoints (T0: Baseline, T1: Before spinal procedure or anesthesia induction, T2: After injection with intrathecal or anesthesia induction, T3: 5th minutes (min) after spinal procedure or tracheal intubation, T4: 30th min intraoperative, T5: At the end of surgery, T6: 5th min after surgery or tracheal extubation in the operation room Results: The baseline IOP and IOP1 measurements during were not significantly different between the groups (SA = 14.28 ± 0.8 mmHg; GA = 14.62 ± 0.9 mmHg, p = 0.923; and IOP1: SA = 15.83 ± 0.9 mmHg; GA = 15.88 ± 0.9 mmHg, p = 0.929). The most significant decrease in IOP in both groups was recorded at T2 (SA: 12.37 ± 0.6. GA: 12.24 ± 0.4, p < 0.001). The decrease in IOP2 was more significant in the GA group. The IOP3 was significantly higher in GA group after intubation (GA: 19.82 ± 1.2, SA: 12.86 ± 1.0)(p < 0.05). The IOP4 and IOP5 in the SA group were lower than those in the GA group. The IOP6 in both groups was higher (SA: 15.20 ± 0.8, GA: 16.50 ± 1.0) than the baseline IOP values, albeit not significant (p > 0.05). In prone position, IOP at the T4 and T5 timepoints were significantly higher than the initial values in both the SA and the GA groups; however, the increase in the GA group was more higher than that of the SA group. Conclusion: In intraoperative period, intraocular pressure may increase in both management of anesthesia, but this increase is higher in the general anesthesia group.
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Current Articles

    • Original Study8 August 2026

      The Role of F-18 FDG PET/CT in the Evaluation of Solitary Pulmonary Nodules

      Erdal Cetinkaya, Fatih Guzel, Sadiye Altun Tuzcu, Ilbey Erkin Cetin, Ibrahim Ibiloglu, Esref Argin, Feray Altun Cetin, Bekir Tasdemir
      Objective: Fluorine-18 fluorodeoxyglucose positronemissiontomography/computedtomography (F-18 FDG PET/CT) is commonly used in the evaluation of solitary pulmonary nodules (SPNs). This study aimed to investigate the predictive value of maximum standardized uptake value (SUVmax) and its ratios to liver and mediastinal blood pool SUVmax values for malignancy in SPNs, using histopathological findings as the reference standard. Methods: The study included 130 patients who underwent F-18 FDG PET/CT and had either histopathological confirmation or at least two years of radiological follow-up. Demographic data (age and sex), nodule size, location, contour characteristics, nodule SUVmax, nodule-to-liver SUVmax ratio (NLR), and nodule-to-mediastinal blood pool SUVmax ratio (NBR) were recorded. Nodules were classified as benign or malignant based on histopathological results. Results: Among the 83 patients with histopathological diagnosis, 54% (n = 44) had malignant lesions and 46% (n = 39) had benign lesions. The mean size of malignant nodules was approximately 20 mm. Receiver operating characteristic (ROC) analysis demonstrated that an SUVmax cutoff value of 4.02 provided the highest diagnostic accuracy for predicting malignancy. Both NLR and NBR showed significant diagnostic value in malignancy prediction. These parameters demonstrated high sensitivity (84–91%) and negative predictive value (76–84%), indicating their usefulness in excluding benign nodules. Conclusion: The F-18 FDG PET/CT is a valuable imaging modality in the evaluation of solitary pulmonary nodules. In addition to SUVmax, the use of NLR and NBR may improve diagnostic accuracy and contribute to clinical decision-making.
    • Original Study8 August 2026

      Preoperative Urine Albumin-to-Creatinine Ratio Predicts Acute Kidney Injury After Coronary Artery Bypass Grafting

      Ahmed M. Alkhunaizi, Jumana A. Al Naser, Khaled D. Algarni, Suhaib M. Ahmed, Amro M. Moubarak, Haralabos D. Parissis
      Objective: To prospectively evaluate whether baseline urine albumin-to-creatinine ratio (uACR) predicts acute kidney injury (AKI) and postoperative decline in kidney function in elective, isolated coronary artery bypass grafting (CABG) patients and explore the magnitude of effect across clinically relevant uACR strata. Preoperative uACR is a marker of glomerular endothelial dysfunction and systemic microvascular injury that may identify patients at increased risk for AKI after CABG. Methods: In this single-center prospective cohort study, 111 adults undergoing elective, isolated CABG between January 2020 and December 2024 were stratified by baseline uACR (< 30, 30–300, > 300 milligram/gram[mg/g]). The primary outcome was AKI defined by Kidney Disease Improving Global Outcomes creatinine criteria. Secondary outcomes included peak postoperative creatinine, 6-month estimated glomerular filtration rate (eGFR), ventilator duration, and hospital length of stay. Regression models were adjusted for diabetes, hypertension, body mass index, and baseline eGFR. Log-transformations were applied to skewed variables to improve model performance. Results: The AKI incidence increased across uACR strata: 14.1% (< 30 mg/g), 23.5% (30–300 mg/g), and 66.7% (> 300 mg/g). In adjusted logistic regression (n = 109), each doubling of log-transformed uACR was associated with higher AKI odds (odds ratio 1.44; 95% confidence level 1.03–2.01). Macroalbuminuria (>300 mg/g) conferred a sixfold increase in AKI risk compared with <30 mg/g. Macroalbuminuric patients experienced a 0.75 mg/dL greater rise in postoperative creatinine and a 16.2 mL/min/1.73 m2 larger decline in 6-month eGFR. No significant associations were observed with ventilator duration or hospital stay. Conclusion: In this single center cohort, elevated preoperative uACR, particularly in the macroalbuminuric range, was associated with AKI and early renal dysfunction after CABG and remained an independent predictor after adjustment. Routine preoperative uACR measurement may aid risk stratification and identify patients for nephroprotective strategies; however, these findings require confirmation in larger, adequately powered studies.
    • Original Study8 August 2026

      The Al-Bahah Paradox: Divergent Patterns of Increased and Decreased Infectious Disease Incidence Relative to National Saudi Rates Over 12 Years of Surveillance

      Mohammed A. A. Alqumber
      Objective: To identify statistically significant deviations in notifiable infectious disease incidence between Al-Bahah region and national Saudi averages, and to generate hypotheses that may inform future epidemiological, microbiological, and public health investigations. Methods: In April 2026, a 12-year retrospective ecological study (2013–2024) was conducted using surveillance data from the Saudi Ministry of Health for 37 notifiable infectious diseases across 20 health regions. Cumulative incidence rates, standardized morbidity ratios (SMRs), and Z-tests compared observed cases in Al-Bahah against national estimates. Results: Overall incidence was 15.8% lower in Al-Bahah than nationally (86.42 versus 102.68; incidence rate ratios = 0.842; p = 1.6× 10-31), but this aggregate reduction concealed a bidirectional divergence. Reduction anomalies: dengue fever absent; amoebic dysentery reduced by 95%; measles by 76%; malaria by 60%. Excess anomalies: schistosomiasis increased 713%; pneumococcal meningitis 600%; Salmonella food poisoning 232%; brucellosis 73%. A 2021 Salmonella outbreak reached 155.95/100,000 (>20-fold national peak). Conclusion: Al-Bahah exhibited lower incidence of diseases including vector-borne and fecal–oral diseases but higher incidence of several other diseases like zoonotic, foodborne, and freshwater-associated infections relative to national rates. These ecological observations generate hypotheses regarding regional differences in disease transmission, diagnosis, surveillance, and healthcare utilization that warrant further investigation using individual-level data. If confirmed, such findings may have implications for region-specific public health planning, laboratory preparedness, and clinical decision-making.
    • Original Study8 August 2026

      Patient Safety Culture Among Healthcare Professionals in Jeddah First Health Cluster: A Multi-Professional Cross-Sectional Study

      Saad S. Alyazidi, Salah S. Alshagrawi
      Objective: Patient safety culture (PSC) is essential to improve healthcare quality and reduce preventable harm. Despite ongoing healthcare transformation in Saudi Arabia, there is limited evidence on healthcare professionals' (HCPs) perceptions of PSC in newly established health clusters. Methods: We conducted a cross-sectional study among HCPs in 6 government hospitals within the Jeddah First Health Cluster, Saudi Arabia. Data were gathered utilizing the Hospital Survey on PSC (HSOPSC). Descriptive measurement sand multiple linear regression analyses were used to evaluate perceptions of PSC and associated factors. Results: A total of 256 HCPs participated in the study. Overall, PSC was perceived as moderately positive (mean = 3.40, SD = 0.41). Teamwork within units of reported events received the highest scores, indicating positive collaboration among staff. Staffing, less punitive response to error, and handoffs and transitions scores were low, highlighting concerns related to workforce adequacy, communication during care transitions, and fear of blame when reporting incidents. Regression analysis showed that demographic and professional characteristics were not significant predictors of overall PSC scores. Conclusion: The HCPs generally reported positive experiences of PSC; however, challenges related to staffing, communication, and non-punitive error reporting remain. Strengthening organizational communication and promoting a just culture may improve patient safety practices across healthcare facilities.
    • Original Study8 August 2026

      Patient Experiences and Safety Concerns Regarding GLP-1 Receptor Agonists for Obesity: A Cross-Sectional Survey in Jeddah, Saudi Arabia

      Mansour A Tobaiqy, Sulafa T. Alqutub, Mohammed A. Alzahrani, Renad H. Alazwari, Faisal A. Asiri
      Objective: To evaluate the perceptions, experiences, and safety concerns of patients regarding the glucagon-like peptide-1 (GLP-1) receptor agonists. Obesity is a significant public health issue. The newer anti-obesity medications: GLP-1 receptor agonists, with an increase in therapeutic options. However, little is known about the perceived benefits, safety, cost, and accessibility. Methods: Cross-sectional survey included adults who previously used at least 1 anti-obesity medication and conducted in 3 general hospitals in Jeddah, Kingdom of Saudi Arabia (KSA) during June 2025 to February 2026. The questionnaire was created after reviewing the current evidence and validated the contents. It included questions on demographic and clinical information, medication use patterns, perceptions, and safety experiences. Data were analyzed using descriptive statistics. Results: A total of 365 participants (median age: 41 years; 55.3% female) included, with a median body mass index (BMI) of 29.59 kg/m2 and 48.6% were obese. Current medication use was 63.3%, associated with diabetes, hypertension, hypercholesterolemia, family obesity history, and higher BMI. Duration of use was statistically significant (p = 0.001), with tirzepatide used for longer durations and semaglutide for shorter durations. Perceived safety was significantly associated with the duration of use (p = 0.001). Despite adverse effects reporting, many questioned effectiveness, information adequacy and safety. Conclusion: Substantial gaps in perceived effectiveness, safety confidence, affordability, and therapy continuity of GLP-1 receptor. This highlights need for structured education, improved access, and system interventions to improve anti-obesity pharmacotherapy adherence.
    • Original Study8 August 2026

      Gender Differences in Primary Care Utilization and Determinants of General Practitioner Visits Among Saudi Females: A Cross-Sectional Analysis Using World Health Survey in the Kingdom of Saudi Arabia 2019

      Ali M. Alzahrani, Holly C. Felix, Abdulrhman A. Alzhrani
      Objective: To document the number of visits Saudi adults have with general practitioners (GP) or family medicine doctors (FD), determine if there is an association between GP/FD visits and sex, and then identify factors associated with GP/FD visits among Saudi females. Methods: A cross-sectional analysis was conducted using data from the 2019 World Health Survey in the Kingdom of Saudi Arabia (KSAWHS 2019), a nationally representative household survey. The outcome variable was number of visits to GP/FD. Survey-weighted negative binomial regression was applied. Results: From April to July 2019, 8,912 individuals participated in the KSAWHS 2019 individual questionnaire, of whom 7,677 were Saudi nationals aged 15 years and older, had completed responses and were included in this study. Females had more GP visits than males (incidence rate ratio [IRR] = 1.26; 95% confidence interval [CI] 1.06–1.49). Among females, higher use associated with having access to a private car (IRR 3.87, 95% CI 3.20–4.68, p < 0.001), living in rural areas (IRR 1.30, 95% CI 1.08–1.57, p = 0.005), being currently married (IRR 1.58, 95% CI 1.17–2.13, p = 0.003), and being separated/divorced/widowed (IRR 2.11, 95% CI 1.44–3.07, p < 0.001). Conclusion: These nationally representative findings provide a baseline for monitoring future trends and evaluating health-system reforms.
    • Original Study8 August 2026

      Patterns and Determinants of Medication Errors Across the Medication-Use Process: A 3-Year Retrospective Study in a Saudi Tertiary Hospital

      Nawaf S. Alqurashi, Mazen S. Alshehri, Mohammed J. Almalki, Mustafa M. Muradkhudhari, Rozan M. Radwan, Mohammed M. Aldurdunji, Saleh A. Almazam, Ohood K. Almuzaini, Saad M. Wali
      Objective: To characterize medication errors across the full workflow and identify stage-specific predictors in a tertiary care setting. Medication errors remain a major global patient safety concern, with limited comprehensive analyses across all stages of the medication-use process in Saudi Arabia. Methods: A retrospective observational study was conducted using medication error reports from Al-Noor Specialist Hospital, Makkah, between January 2023 and August 2025. Errors were classified by stage and severity using the National Coordinating Council for Medication Error Reporting and Prevention index. Multivariable logistic regression was performed to identify predictors associated with each stage. Results: A total of 6,546 errors were analyzed. Most occurred during prescribing (65.5%), followed by transcribing (26.5%) and monitoring (4.4%). Incorrect or missing dose was the most common error (38.2%). Ordering-stage incidents accounted for 95.5% of reports. Pharmacists identified 86.3% of errors, and 93.5% did not reach patients (Category B). Antibiotics (32.8%) and cardiovascular medications (22.5%) were most frequently involved. Stage-specific predictors varied, with nurse detection strongly associated with administration-stage errors (odds ratio = 7.10; 95% Confidence Intervals: 2.94–16.9). Conclusion: Prescribing errors predominated, while pharmacists played a key role in error interception. Targeted, system-level interventions addressing prescribing practices and stage-specific risks are essential to improving medication safety.
    • Original Study8 August 2026

      Establishment of a Specialized Pectus Clinic: Referral Patterns, Diagnostic Characteristics, and Early Management Experience at a University Hospital

      Zeead M. AlGhamdi
      Objectives: To describe the establishment and early impact of a dedicated pectus clinic at a university hospital, focusing on patient characteristics, referral pathways, clinical presentation, and initial management strategies. Methods: A retrospective observational study was conducted at a university hospital between January 2020 and April 2025, with 153 patients included in the final analysis. Data collected included demographic characteristics, referral sources, clinical presentation, deformity type, and treatment options. Descriptive statistical analysis was performed. Results: The mean patient age was 18.3 (range 1–44) years, with males accounting for 83.9% of cases. Pectus carinatum was the most common diagnosis (48.1%), followed by pectus excavatum (42.3%). Patient-initiated referrals, including those influenced by digital and social media platforms, represented 63.2% of referrals. Psychosocial concerns were the main presenting complaint in 60.6% of patients, whereas isolated functional symptoms were reported in 9%. Annual visits increased progressively throughout the study period. Non-operative treatment was commonly used for pectus carinatum, while surgical management was more frequent for pectus excavatum. Conclusions: A dedicated pectus clinic improved access to specialized care and supported structured management. The high proportion of patient-initiated referrals highlights the growing role of non-traditional referral pathways. The specialized clinic improved awareness, standardized the care, and addressed unmet needs in patients with pectus deformities.
    • Original Study8 August 2026

      Comparison of the Effects of Spinal Versus General Anesthesia on the Perioperative Intraocular Pressure: A prospective, randomized clinical trial

      Muzaffer GENCER, Mehmet YALVAÇ
      Objectives: To evaluate the effects of spinal and general anesthesia on the intraocular pressure (IOP) in patients, who had lumbar spine and lower extremity orthopedic surgeries Methods: Sixty adult were randomly classified into Group spinal anesthesia (SA) and Group general anesthesia (GA). The IOP, mean systemic arterial pressure, and heart rhythm were measured at 6 pre-determined timepoints (T0: Baseline, T1: Before spinal procedure or anesthesia induction, T2: After injection with intrathecal or anesthesia induction, T3: 5th minutes (min) after spinal procedure or tracheal intubation, T4: 30th min intraoperative, T5: At the end of surgery, T6: 5th min after surgery or tracheal extubation in the operation room Results: The baseline IOP and IOP1 measurements during were not significantly different between the groups (SA = 14.28 ± 0.8 mmHg; GA = 14.62 ± 0.9 mmHg, p = 0.923; and IOP1: SA = 15.83 ± 0.9 mmHg; GA = 15.88 ± 0.9 mmHg, p = 0.929). The most significant decrease in IOP in both groups was recorded at T2 (SA: 12.37 ± 0.6. GA: 12.24 ± 0.4, p < 0.001). The decrease in IOP2 was more significant in the GA group. The IOP3 was significantly higher in GA group after intubation (GA: 19.82 ± 1.2, SA: 12.86 ± 1.0)(p < 0.05). The IOP4 and IOP5 in the SA group were lower than those in the GA group. The IOP6 in both groups was higher (SA: 15.20 ± 0.8, GA: 16.50 ± 1.0) than the baseline IOP values, albeit not significant (p > 0.05). In prone position, IOP at the T4 and T5 timepoints were significantly higher than the initial values in both the SA and the GA groups; however, the increase in the GA group was more higher than that of the SA group. Conclusion: In intraoperative period, intraocular pressure may increase in both management of anesthesia, but this increase is higher in the general anesthesia group.
    • Original Study8 August 2026

      Bibliometric Analysis of the Top 100 Most Cited Publications from Saudi Arabia Reveals the Predominance of Medical Fields

      Mahmoud Kandeel, Abdulla Al-Taher
      Objectives: To explore the citation impact, journals, international collaborations, trends of research topics and gain more visibility for the Saudi contribution to the global scientific landscape. Methods: This bibliometric study analyzes the top 100 cited publications affiliated with Saudi Arabia in Scopus, from inception to January 2026. The extracted bibliometric indicators include total citation metrics, sources, collaboration maps, and co-occurrence networks of keywords and collaborations. Results: The results indicate a strong predominance for medicine and health sciences as the subjects of the most prolific and significant number of citations. A substantial proportion of the most cited papers originates from major global health projects, in particular the Global Burden of Disease (GBD) consortium, which focuses on mortality, morbidity, and epidemiological metrics. Clinical and public health fields are highly represented, including obesity and cardiovascular risk, disease burden, and population health metrics. The most frequent journals include the leading medical journals in the field, namely The Lancet, Nature, Science and the New England Journal of Medicine. Keyword analysis confirms the dominance of medical themes; the most prominent keywords included epidemiology, risk factors, and global health indicators. Within the biomedical predominance, bioinformatics tools such as MEGA software contribute to the citation impact. Conclusions: Saudi Arabia's citation impact is predominantly driven by international consortia participation and bioinformatics tool development, highlighting the opportunities for strengthening independent and nationally led research programs of global significance.

Most Popular Articles

  • Journal Article
    1 January 2011

    Desogestrel+ethinylestradiol versus levonorgestrel+ethinylestradiol. Which one has better affect on acne, hirsutism, and weight change.

    Moradan Sanam, Omidvar Ziba
    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.
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  • Clinical Practice Guideline
    7 February 2026

    National Heart Center Perfusion Guidelines

    Fareed A. Khouqeer, Abdulaziz S. Albaradei, Ahmed A. Jamjoom, Husain H. Jabbad, Khalid A. Iskander, Omar M. Zainalabdeen, Yasser A. Alheraish, Ebtesam M. Alanazi, Abdulrahman F. Alhumiany, Areej S. Al Buraiki, Muhammad W. Rana, Muhamad I. Jelaldin, Zainab A. ZainAldeen, Bander A. Zamzami, Budoor S. Al Aujan, Ahmed M. Galal Elsherbeny
    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.
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  • Review
    1 April 2011

    End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene

    Abdulla A. Al-Sayyari, Faissal A. Shaheen
    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.
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  • Systematic Review
    28 April 2026

    Mental Health in Relation to Parental Absence: A Systematic Review

    Mohammed Barry, Abdulaziz Alyahyawi, Heba Jafar Sabbagh
    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.
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