Background: Scoring systems can be used to define critically ill patients, estimate their prognosis, help in clinical decision making, guide the allocation of resources and estimate the quality of care in the ICU.Purpose: This study compared the predictive accuracy of four predictive scoring systems in the ICU.Methods: A prospective cohort study including consecutively admitted 110 adult ICU patients (88 males) with ARDS from Saudi German Hospital, Madinah, was performed from June 2013 to January 2015. The median age of the patients was 38 years, the median duration of illness before ICU admission was 6 days, and the median duration of ICU admission was 27 days. The APACHE II, APACHE III, SAPS II, and SOFA scores were calculated based on the worst values during the first 24 h of admission.Results: The actual mortality rate (27.3%) was higher than the estimated mortality rates, with the highest predicted rate of 11.3% obtained using the APACHE II. All four severity scores were significantly associated with mortality (F = 62.772, p = 0.000) and explained 83% of its variability (R 2 = 0.834). However, after adjustment, only the APACHE III scoring system was a significant predictor (Beta = À0.753, p = 0.000). Three scoring systems were significantly associated with mortality (F = 42.055, p = 0.000) and explained almost 70% of its variability (R 2 = 0.712), but after adjustment, only the APACHE II was a significant predictor (Beta = À0.631, p = 0.041).

Background The coronavirus (COVID-19) pandemic has created an unprecedented problem in people's lives around the world. Lockdown measures altered the routine lifestyle aspects of people including diet, exercise, sleep, stress, smoking, job status, recreation, and application of modern technologies. Understanding the lifestyle profile of individuals could help in designing effective interventions to minimize the risk factors of COVID-19-related health problems. Objectives The aim of this research is to investigate the lifestyle changes among adults living in Saudi Arabia (SA) during the COVID-19 pandemic. Methods A cross-sectional survey study was done to investigate the lifestyle changes during the COVID-19 pandemic in Saudi Arabia from August to September 2020. A pre-designed questionnaire was used for data collection and distributed online through social media. The questionnaire included items about sleep patterns, dietary habits, physical activity, employment status, recreation activities, use of social media, and screen time before and during the pandemic. Results A total of 338 adults with a median age of 40 years participated in the study. During the pandemic, employment, smoking decreased significantly (53.3 vs. 55.6%, p<0.001 & 15.7% vs. 18.3%, p=0.049) with significant increases in daily intake of fruits or vegetables (47% to 60.2%, p<0.001), caffeinated beverages (seven or more times caffeine, 3% vs. 0.9%, p<0.001), and water (more than eight water cups daily, 18.4 vs. 11.9, p<0.001). Overweight group increased significantly from 28.5% to 32% (p=0.009). Sleeping more than nine hours increased significantly from 8.3% to 21.8% (p<0.001) with increasing sleeping aids from 11.6% to 15.7% (p<0.001). Both the screen and the social media times increased significantly for six or more hours daily (14.8% vs. 35.3% and 9.5% vs. 28.2% respectively, p=<0.001 for both). There were significant decreases in socialization (91.4% vs. 37.8%) and fast food (71.98% vs. 47.04%), and increases in physically inactivity (19% vs. 5.3%) and stress (90.8% vs. 85.2%) (p<0.001 for all). Most participants perceived stress during the pandemic (307, 90.8%). Conclusion There were remarkable behavioral changes in all aspects of the lifestyle of the participants living in SA during the COVID-19 pandemic with some positive effects on smoking and dietary habits. However, negative changes included unemployment, physical inactivity, sleep disturbances, social isolation, and excessive weight gain. There is a need to study the possible consequences of such changes on the future population health in SA.

Background: Pfizer-BioNTech vaccine was the first of all coronavirus disease (COVID) vaccines to be used in Saudi Arabia. There have been over 17 million doses already administered to the general public in order to successfully reach herd immunity. Objective: The study aimed to explore the side effects of the Pfizer-BioNTech vaccine. Materials and methods: This is a cross-sectional study comprising a sample of 386 participating adults of different age groups and genders. A validated modified questionnaire was distributed as a Google form to residents of the kingdom via social networking sites from February to March 2021. The questionnaire included questions regarding participants’ socio-demographic details, vaccination details, and symptom analyses items. Results: The most common to least reported symptoms were local pain (79.3%), fatigue (42%), muscle pain (39.1%), local swelling (27.7%), joint pain (23.1%), headache (21.8%), fever (21.0%), chills (15.5%), local redness (14.8%), nausea (7.3%), with no reports of anaphylaxis, facial paralysis or syncope. There were more side effects after the second dose than the first (p<0.001). Significant predictors of a higher number of side effects after both doses of the vaccine were the female gender ((p<0.001)) and the presence of allergies (p=0.044). Conclusion: Pfizer/BioNTech vaccination was quite safe with no reported anaphylaxis or serious events. The most common reported side effects were local pain and fatigue. Symptoms began within 24 hours and were mild to moderate in nature with a regressive course, especially after analgesics. More side effects were experienced after the second dose than the first. The significant predictors of side effects were the female gender and a history of allergies.

Objective:Vitamin D receptor (VDR) gene polymorphism have a role in diabetes mellitus pathogenesis. Present study was conducted to determine VDR gene variants among Saudi gestational diabetics (GDM) in Madina, KSA.Methods:This cross sectional study was conducted on 112 GDM patients and 218 normal healthy control. Age, body mass index and blood pressure levels were recorded. Serum triglycerides (mg/dl), total cholesterol, HDL-cholesterol, LDL-cholesterol, fasting blood glucose FBG and post-prandial blood glucose PPBG were estimated. Extracted DNA template was amplified by PCR reaction and genotyped for single nucleotide polymorphism of BsmI and FokI by restriction fragment length polymorphism-PCR (RFLP-PCR) analysis.Results:FBG and PPBG levels in GDM patients were significantly elevated by +48.6% and +50%, respectively (P=0.005). Serum triglycerides, total cholesterol and LDL-cholesterol (mg/dl) levels in GDM patients were elevated significantly by +40.5% (P=0.005), +16% (P=0.01) and +30.8% (P=0.005), respectively. Serum HDL-cholesterol (mg/dl) showed significant decline by -10.5%. FokI VDR genotypes showed association with PPBG (P=0.05) among GDM patients. The Ff, FF and ff genotype percentage among GDM patients was 48.2%, 30.4% and 21.4%, respectively. FokI (F and f) and BsmI (B and b) alleles frequency showed no significant difference between GDM patients and control. Percentage BsmI and FokI total homozygous and heterozygous variants among GDM was 45.5% and 81.4%, respectively.Conclusion:VDR BsmI and FokI polymorphic marker not associated with Saudi GDM.

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The ISARIC4C consortium developed and internally validated the 4C Score for prediction of mortality only in hospitalized patients. We aimed to assess the validity of the 4C Score in mortality prediction of patients with COVID-19 who had been home isolated or hospitalized.This retrospective cross-sectional study was performed after the first wave of COVID-19. Data of all PCR-positive COVID-19 patients who had been discharged, hospitalized, or died were retrospectively analyzed. Patients were classified into four risk groups according to the 4C Mortality Score. A total of (506) patients were classified as follows: low (57.1%), intermediate (27.9%), high (13%), and very high (2%) risk groups. Clinical, radiological, and laboratory data were significantly more severe in the high and very high-risk groups compared with other groups (p<0.001 for all). Mortality rate was correctly estimated by the model with 71% sensitivity, 88.6% specificity, and area under the curve of 0.9. The mortality rate was underestimated among the very high-risk group (66.2% vs 90%). The odds of mortality were significantly greater in the presence of hypoxia (OR 2.6, 95% CI 1.5 to 4.6, p<0.001) and high respiratory rate (OR 5.3, 95% CI 1.6 to 17.9, p<0.007), C reactive protein (CRP) (OR 3.5, 95% CI 1.8 to 6.8, p<0.001), and blood urea nitrogen (BUN) (OR 1.9, 95% CI 1.3 to 3.1, p<0.002). Other components of the model had non-significant predictions. In conclusion, the 4C Mortality Score has good sensitivity and specificity in early risk stratification and mortality prediction of patient with COVID-19. Within the model, only hypoxia, tachypnea, high BUN, and CRP were the independent mortality predictors with the possibility of overlooking other important predictors.

Introduction The robotic surgery and procedures are increasing worldwide. It is unknown whether medical students are well prepared for their future exposure to such technology. Objectives This study aimed to explore the knowledge and attitude of medical students from Saudi Arabia (SA) towards the robotic surgery. Methods We performed a cross-sectional survey of medical students at different colleges of medicine in SA. A web-based self-administered questionnaire using google forms was completed over a 2-month period starting on June 2021. Comparison between those with and without background about robotic surgery was performed. Results A total of 239 medical students from both governmental (46%) and private colleges (54%) responded to the questionnaire. 51.9% were interested in the surgical field and 37.7% considered themselves tech-savvy persons. Only (22.6%) had previous background about robotic surgery mainly from internet. Many (63.2%) showed positive attitude towards robotic surgery and expected that using robots will improve surgical outcomes. 48.5% of the students expected that patients in SA will not accept the robotic surgeries. Some (51.1%) concerned that robots could replace the surgeons and could make them less professional. Many believed that SA should invest and expand the robotic surgeries (69.1%). Students with background in robotic surgery had significantly younger median age (p < 0.030), earlier academic years (p < 0.001), higher GPA (p < 0.025), and more tech-savvy personality (p < 0.000) compared to those without background. Conclusion Most medical students are unaware of robotic surgery, but they have positive attitude with some concerns. Young students who consider themselves tech-savvy persons are in a better position, but they access their knowledge from internet rather than from their medical education. Medical curricula and residency training program should take these findings into consideration for preparing the future surgeons in SA.

Barotrauma is the most prevalent medical problem associated with airplane travel (traveling) and has been a causal factor in the aviation accident. This study aimed to explore the prevalence of otic barotrauma and its risk factors among the aircrew members. This cross sectional study included 267 aircrew members (116 pilots and 151 flight attendants) who presented themselves to the outpatient clinic at "Saudi Airlines Medical Services" for assessment of their fitness before the flight. The participants were selected using a non-probability consecutive sample over the study period from January to September 2018. They were interviewed face to face about their socio-demographic and job characteristics, the risk factors for barotrauma, as well as the symptoms of ear trauma. Otic barotrauma was found in 39% and 14.4 % had repeated barotrauma. Increased odds ratios of barotrauma were detected among Saudis (OR 2.5 (95% CI: 1.4-4.4)) (p=0.002), smokers (OR 1.8 (95% CI: 1.13-3.1)) (p=0.015), pilots (OR 1.8 (95% CI: 1.1-2.9))(p=0.026), those with allergy (OR 2.6 (95% CI: 1.2-5.5)(p=0.012), members working for > 70 hours per month (OR 2.5 (95% CI: 1.5-4.2))(p=0.000), and in females with hormonal disturbance (OR 2.9 (955 CI: 1.2-6.7)) (p=0.016) or on hormonal therapy (OR 2.6 (95% CI: 1.1-6.4)) (p=0.028). 39% of aircrew members at Saudi airlines had ear barotrauma and 14.4% had repeated heart attacks. The risk of barotrauma was increased among pilots, Saudis, smokers, those with allergy or hormonal disturbance, or working for >70 hours/month. We recommend to limit smoking on flights, decrease total hours of duties <70 per month (especially for pilots), and to do regular ENT exam for all aircrew members.