Clinical Practice Guideline
7 February 2026
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.
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Volume 47, Issue 2 (2026)View issue
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7 February 2026
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Clinical Practice Guideline
7 February 2026
National Heart Center Perfusion Guidelines
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.Review
7 February 2026
Artificial Intelligence in Radiology: Hidden Fragilities and the Path to Resilience
Radiology artificial intelligence (AI) is advancing however its adoption faces fragile foundations that threaten sustainability. Despite bold promises of efficiency and accuracy, current deployment is undermined by weaknesses in economics, evidence, infrastructure, human factors, regulation, security, and environmental impact. Nearly 90% of radiology AI studies report process metrics rather than patient outcomes, while hidden costs elevate ownership to 400% to 500% of subscription fees. Technical fragilities include 25% or greater performance loss with routine protocol or scanner shifts, compounded by vendor consolidation that has eliminated 63% of companies since 2020, creating migration costs averaging 180,000 dollars per exit. Human factor challenges, including automation bias and progressive deskilling, intersect with regulatory requirements that mandate continuous evidence generation. Security risks and environmental costs remain underrecognized. This review introduces frameworks including risk assessment matrices, compliance guides, procurement checklists, evidence standards, lifecycle calculators, and implementation protocols to enable sustainable, patient centered, value driven integration.Original Study
7 February 2026
Risk Factors and Outcomes of Acute Kidney Injury in Children With Congenital Heart Disease Following Cardiac Surgery
Objectives: To investigate the incidence and risk factors for Acute kidney injury (AKI) following cardiac surgery in children with congenital heart diseases, and to identify modifiable factors that remain insufficiently studied. Acute kidney injury is common after cardiac surgery for children with congenital heart disease (CHD). Children with AKI are known to have complicated hospital courses, including their need for kidney replacement therapy, and have increased mortality. Methods: We conducted a retrospective analysis of children admitted to the pediatric cardiac intensive care unit (PCICU) at King Abdulaziz University Hospital over 7 years (2014–2021), using the Kidney Disease Improving Global Outcome (KDIGO) definitions and stages of AKI. Results: The cohort included a total of 628 children who had cardiac surgery for congenital heart disease, of whom 186 (29.6%) developed AKI. Children with AKI had significant difference than children without AKI in the following factors: (preoperative characteristics) age younger than one year, advanced score in risk adjustment for congenital heart surgery scores (RACHS-1 score), existing renal anomalies, hypoalbuminemia, and needed cardiac catheterization, (intraoperative factors) longer median cardiopulmonary bypass and aorta cross-clamping durations, had cardiac arrest and required ECMO and respiratory support. The most predictive variables for AKI development in these children were RACHS-1 score, cardiopulmonary bypass duration, cardiac catheter insertion, and presence of renal anomalies. Conclusions: This study provides valuable insights into the risk factors for AKI development in children with CHD following their cardiac surgery. These factors should be addressed in this patient population to reduce the risk of AKI and its following complications.Original Study
7 February 2026
A Bibliometric Analysis of the Most Influential and Impactful Plastic Surgery Publications From Saudi Arabia
Objective: To analyze the most cited plastic surgery articles from Saudi Arabia, focusing on publication trends, leading contributors, collaboration patterns, and thematic areas. Methods: We conducted a bibliometric analysis using the Web of Science Core Collection (1990–2025). Keywords covering plastic surgery subfields were combined with geographic identifiers (“Saudi Arabia,” “KSA,” “Kingdom of Saudi Arabia”) using Boolean operators. Only English-language original and review articles were included. Citation metrics, authorship networks, and keyword co-occurrence were analyzed with VOSviewer and the bibliometrix R package. Results: We identified 1,013 Saudi-affiliated plastic surgery publications, receiving 7,929 citations. The top 100 most-cited articles averaged 39.3 citations (range: 19–283). King Saud University was the leading institution, contributing 59 articles. Dr. Mohammad M. Al-Qattan was the most prolific author, with first authorship on 52 publications. Hand surgery dominated the thematic spectrum (36%), followed by peripheral nerve (14%) and aesthetic surgery (12%). International collaboration occurred in 21 articles (22.8%), mainly with the United States and Canada. Nearly half of the studies (49%) were Level IV evidence. Conclusion: Saudi Arabia has achieved a notable presence in plastic surgery literature, especially in hand and peripheral nerve surgery. However, the concentration of authorship and reliance on lower-level evidence highlight the need for broader collaboration, prospective study designs, and greater methodological rigor to strengthen future contributions.Original Study
7 February 2026
Evaluating Diagnostic Capability of Computed Tomography and Role of Bronchoscopy in Admitted Cases With Pulmonary Diseases
Objective: To evaluate capability of CT scan in diagnosing pulmonary diseases, identifying malignancy, and role of bronchoscopy in confirming or changing imaging diagnosis. Method: A retrospective record-based cross-sectional study was performed evaluating data of all consecutive adult patients who had CT and bronchoscopies performed in a period of 2 years (between Jan. 2023 to Jan. 2025). Demographic, clinical symptoms, CT chest and bronchoscopy findings were recorded. Final diagnoses were based on clinical (improvement with time or resolution of symptoms with specific antimicrobial drugs), laboratory (bronchoalveolar lavage and biopsy, blood or sputum cultures) and imaging guided biopsies (where performed). Patients without imaging or bronchoscopy data were excluded. Data was collected on SPSS version 22. A 2×2 contingency table was used to determine diagnostic capability of CT in identifying malignancy. Also, multivariate analysis (for certain variables), receiver operating characteristic (ROC) curve and area under curve (AUC) were acquired. Results: Of 97 patients, majority were males (n = 64, 66%) with mean age of 54.4 (range, 13-93, Std deviation- 18). Cough with other symptoms (CO; n = 43) and hemoptysis (H; n = 25) constituted most clinical presentations. More than half of patients (50/97) were smokers. Benign findings were mostly recorded (n = 78, 80%) and that too were mainly infections (69/78). A changed diagnosis was made on bronchoscopy in 18 cases. Sensitivity, specificity, and accuracy of CT in diagnosing malignancy was calculated as 75% (Confidence Interval/ CI, 50.90-91.34), 95% (87.23-98.57), and 91% (CI, 83.12-95.67) respectively, with a high performance (AUC, 0.753). Conclusion: Computed tomography of the chest is highly useful for identifying pulmonary lesions however bronchoscopy remains essential for definitive diagnosis in a notable proportion of cases.Original Study
7 February 2026