The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students' and physicians' professional identity formation.

Objectives:To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia.Methods:This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences.Results:The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008).Conclusion:Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes.

Importance Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome that is caused by a novel coronavirus 2 (SARS-CoV-2). It originated in China late December 2019 and was declared a global pandemic on March 12, 2020. Most reports of COVID-19 cases either presented with neurological manifestations or complications involve adults. Only few cases were reported in pediatric patients Objective To report COVID-19 pediatric cases with neurological manifestations and identify the wide spectrum of its manifestations. Design, setting, and participants This was a retrospective, observational case series. Data of pediatric patients infected by SARS-CoV-2 presenting with neurological manifestations at King Abdullah Specialized Children Hospital in King Abdulaziz Medical City in Riyadh were collected from May 23 to June 30, 2020. Results We encountered 5 COVID-19 cases with neurological manifestations. Three patients who were previously healthy had new-onset neurological symptoms. Symptoms and signs included encephalopathy, ataxia, headache, seizure, papilledema, ophthalmoplegia, hyporeflexia, and different clinical spectra, such as Miller Fisher syndrome, meningoencephalitis, and idiopathic intracranial hypertension. Other patients attending our center were incidentally found to be SARS-CoV-2-positive, which caused a delay in the investigations required to reach diagnosis. Conclusions and relevance Our cases highlight the wide clinical spectrum of neurological manifestations in COVID-19 patients. Given the paucity of information about pediatric COVID-19 cases with neurological symptoms, we here reported these cases to shed light on the association between SARS-CoV-2 and neurological presentation. Moreover, our study indicates that many investigations are being delayed and could affect diagnosis and treatment.

Objectives:To determine the perceptions of patients on whether they receive sufficient information about their medical problems, their preferences to obtain information, and factors that may influence their preferences.Design and Settings:Cross-sectional, questionnaire-based study conducted in a primary health-care center affiliated with the National Guard Hospital, Riyadh, Saudi Arabia.Patients and Methods:Patients attending the center between October and December 2010 were interviewed using a questionnaire developed to meet the objectives of the study.Results:A total of 245 patients participated in the study. The mean (±standard deviation) age of the participants was 43 (±16) years. Reported cases of dyslipidemia, diabetes mellitus, and hypertension among participants were 42%, 39%, and 31%, respectively. A minority of the participants indicated that they had a sufficient knowledge of their medical problems. The vast majority of the patients (92%) indicated that their preference to be informed about available treatment options and the plan for their future treatment. However, only 38% indicated that they had been told about the available treatment options, and less than half (48%) were informed about their future treatment plan. The proportion of male patients who preferred to know the treatment plan for their medical problems was significantly more than that of females (P < 0.001); nevertheless, female participants perceived that they had been better informed about their treatment plan than the male participants (P = 0.003).Conclusion:This study demonstrates that patients receive information about their medical problems much less than their expectations. Measures to promote patient education and their involvement in shared care process should be considered and implemented to minimize serious health outcomes.

Objectives: To report the efficacy of intravenous )IV( synthetic ACTH )Tetracosactide( in the treatment of infantile spasms.Methods: This is a retrospective chart review of patients with a diagnosis of infantile spasms conducted at the

Objective This study aimed to determine the clinical characteristics and factors associated with neonatal hypoxic-ischaemic encephalopathy (HIE) and its neurodevelopmental outcomes. Methods We conducted retrospective case-control research to investigate the clinical and labour-related risk factors for HIE. In addition, a single-centre cohort study was conducted on infants with HIE to describe their neurodevelopment from birth to 24 months. For this investigation, cases with a diagnosis of HIE who were born at King Abdullah Children’s Specialist Hospital (KASCH), Riyadh, Saudi Arabia, between 2015 and 2019 were identified and matched with controls from the same facility (1:4). Each case’s clinical information was extracted using electronic medical records. In addition, 24-month follow-up HIE cases were included in a cohort study to describe their neurodevelopmental outcomes. Results The sample includes 60 infants diagnosed with HIE and 234 infants serving as controls, with a mean gestational age of 38.8 weeks (SD 1.6) and a predominance of males (56.4%). Around one-third of the HIE cases (36.6%) had moderate HIE (stage 2), whereas 35.1% of infants had severe HIE (stage 3), according to Sarnat staging. Compared to the control group, children with HIE were twice as likely to be born to mothers with maternal comorbidities and more likely to have prepartum and intrapartum complications. A 24-month follow-up of neurodevelopmental outcomes for HIE babies revealed that approximately 24% exhibited delays in gross motor skill development, 22% in fine motor skill development, 33% in language skill development, and 22% in social skill development. Conclusion In the HIE group, maternal comorbidities and prepartum or intrapartum complications were more common. The severity grade of HIE can be used to predict neurodevelopmental consequences. Enhancing patient care and rehabilitation requires a minimum of 24 months of neurodevelopmental follow-up.

Background Anti-N-methyl-d-aspartate “anti-NMDA” receptor encephalitis is one of the most common autoimmune encephalitis for which first- and second-line therapies have been recommended following international consensus. However, some refractory cases do not respond to the first- and second-line therapy and require further immune-modulatory therapies such as intra-thecal methotrexate. In this study, we reviewed six confirmed cases of refractory anti-NMDA receptor encephalitis from two tertiary centers in Saudi Arabia that required escalation of treatment and received a six-month course of intra-thecal methotrexate. The aim of this study was to evaluate the effectiveness of intra-thecal methotrexate as immunomodulatory therapy for refractory anti-NMDA receptor encephalitis. Methods We retrospectively evaluated six confirmed cases of refractory anti-NMDA receptor encephalitis who did not improve after first- and second-line therapy and received monthly intra-thecal methotrexate treatment course for six consecutive months. We reviewed patient demography, underlying etiologies, and compared their modified Rankin score prior to receiving intra-thecal methotrexate and six months after completing the treatment. Results Three of the six patients showed a marked response to intra-thecal methotrexate with a modified Rankin scale of 0–1 at 6-month follow-up. None of the patients experienced any side effects during or after intra-thecal methotrexate treatment, and no flareups were observed. Conclusion Intra-thecal methotrexate may be a potentially effective and relatively safe escalation option for immunomodulatory therapy of refractory anti-NMDA receptor encephalitis. Future studies on intra-thecal methotrexate -specific treatment regimens may further support its utility, efficacy, and safety in treating refractory anti-NMDA receptor encephalitis.

Purpose This study aimed to determine the factors associated with Neonatal hypoxic-ischemic encephalopathy (HIE) and its neurodevelopmental outcomes. Methods A case-control study of infants delivered at King Abdulaziz Medical City, Riyadh, Saudi Arabia, was carried out from 2015 to 2019. Newborns with an admission diagnosis of HIE were identified, and controls were matched for the case. The electronic medical records were used to extract the clinical data for each case. The HIE cases were followed for 24 months to determine their neurodevelopmental outcomes. Results The sample included 60 infants diagnosed with HIE and 234 infants as controls, primarily males (56%) with mean gestational age of 38 weeks (SD 1.6). According to Sarnat staging, 36% of the HIE cases (22 patients) had stage 2 encephalopathy, while 35% of infants were at stage 3. Children with HIE were twice as likely to be born to mothers with maternal comorbidities, and more likely to have prepartum and intrapartum complications than the control group. The follow-up of neurodevelopmental outcomes at 24 months for the HIE infants indicated no delays in development of gross motor skills (76%), fine motor skills (78%), language skills (67%), and social skills (78%). Conclusion Maternal comorbidities and prepartum or intrapartum complications were more prevalent in the HIE group. HIE severity grade can be used as a prognostic, predictive tool for neurodevelopmental outcomes. Neurodevelopment follow up for at least 24 months is necessary to enhance care and rehabilitation of the patients.