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The use of AI in the healthcare sector is facing some formidable concerns raised by the practitioners themselves. This study aimed to establish the concerns that surround the adoption of AI among Saudi Arabian healthcare professionals. Materials and methods: This was a cross-sectional study using stratified convenience sampling from September to November 2024 across health facilities. This study included all licensed healthcare professionals practicing for at least one year, whereas interns and administrative staff were excluded from the research. Data collection was conducted through a 33-item validated questionnaire that was provided in paper form and online. The questionnaire measured AI awareness with eight items, past experience with five items, and concerns in four domains represented by 20 items. Four hundred questionnaires were distributed, and the response rate was 78.5% (n = 314). The majority of the participants were females (52.5%), Saudis (89.2%), and employees of MOH (77.1%). The mean age for the participants was 35.6 ± 7.8 years. Quantitative analysis revealed high AI awareness scores with a mean of 3.96 ± 0.167, p < 0.001, and low previous experience scores with a mean of 2.65 ± 0.292. Data management-related worries came out as the top worry, with a mean of 3.78 ± 0.259, while the poor data entry impact topped with a mean of 4.15 ± 0.801; healthcare provider-related worries with a mean of 3.71 ± 0.182; and regulation/ethics-related worries with a mean of 3.67 ± 0.145. Health professionals’ main concerns about AI adoption were related to data reliability and impacts on clinical decision-making, which significantly hindered successful AI integration in healthcare. These are the particular concerns that, if addressed through robust data management protocols and enhanced processes for clinical validation, will afford the best implementation of AI technology in an optimized way to bring better quality and safety to healthcare. Quantitative validation of AI outcomes and the development of standardized integration frameworks are subjects for future research.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). It occurs due to a decrease in the level of insulin and an increase in the level of glucose in the blood, which makes cells unable to use glucose as an energy source and begin to break fat into ketones; an overload of ketones levels in the blood can lead to DKA. The aim of the study is to assess awareness of DKA among diabetic patients and their caregivers in Makkah City, Saudi Arabia. This study is a cross-sectional study collected through an online questionnaire of diabetic patients and their caregivers in Makkah City. A self-reported questionnaire designed in Arabic and English through the use of Google Forms, it distributed electronically via social media to the target population with the objectives of the survey. A total of 400 participants were included, 73% of them were males, while 27% were females. A 9% of the participants have been diagnosed with DKA. A high awareness level about DKA was found in 32.5% of participants, while 67.5% had a poor awareness level. Factors associated with a high level of awareness towards DKA are young age, being single, students and having a previous DKA diagnosis. Regarding our participants who have poor awareness of DKA, further education for diabetic patients and their caregivers about DKA is crucial to prevent life-threatening complications, and improve quality of life for these patients.

Background: Insulin pump therapy improves glycemic control in children with type 1 diabetes but is associated with technical and dermatological complications that can impact adherence. Research on these adverse effects in pediatric populations is limited. Objectives: This study aimed to evaluate short- and long-term complications of insulin pump therapy in pediatric patients in Saudi Arabia, focusing on technical malfunctions, dermatological issues, and patient satisfaction. Design: A cross-sectional survey-based study conducted in multiple centers in Taif, Saudi Arabia. Methods: Fifty-nine parents of children with type 1 diabetes who used insulin pumps provided data for the study. Participants reported technical issues, skin-related complications, and overall satisfaction. IBM SPSS Statistics version 27.0.1 was used to conduct the statistical analysis. Results: Technical complications were frequent, with 64.4% experiencing tube blockages, 39.0% reporting needle dislodgment, and 39.0% observing air bubbles in the tubing. Dermatological issues included discomfort at the infusion site (54.2%), skin pigmentation (45.8%), and scarring (55.9%), with lipohypertrophy (22.0%) posing a concern for insulin absorption. Longer pump use was significantly associated with increased complications, particularly tube blockages and skin pigmentation. Despite these challenges, 84.7% of participants recommended insulin pumps over multiple daily injections. Conclusion: Technical and dermatological complications were common, increasing with longer pump use. Proper infusion site rotation, infusion set management, and improved patient education are key to reducing adverse effects. To improve safety and efficacy, future studies should concentrate on infusion set change patterns, newer pump technologies, and standardized guidelines. Plain language summary Understanding complications of insulin pump therapy in children and teens with type 1 diabetes: insights from Saudi Arabia Insulin pumps are increasingly used to manage type 1 diabetes in children, but there is limited knowledge about their complications in Saudi Arabia. This study investigated the challenges associated with insulin pump use among children and adolescents in Taif. Conducted over a year, the study included participants aged 18 or younger who used insulin pumps and excluded those who did not meet these criteria. Findings revealed that technical issues were common. Users who preferred pumps over injections frequently reported login problems (71.4%), and Medtronic MiniMed 670G users faced difficulties with data downloading and login (42.9%). Longer pump use (over one year) was linked to higher rates of occlusion (66.7%). Females experienced more synchronization issues, while males reported increased water damage. Abdominal pain at injection sites was a prevalent skin issue. Complications such as login errors, data download challenges, and catheter kinking were associated with lower satisfaction scores. The results underscore the importance of improved support and design for insulin pumps to enhance user experience and outcomes for young patients managing type 1 diabetes.

Introduction: For many years, congenital panhypopituitarism has been recognized to cause infantile cholestasis. However, the isolated cortisol deficiency as a cause of cholestasis and liver failure was rarely reported. Case description: A 32-days old male infant presented to the hepatology clinic with infantile cholestasis. His initial workup revealed alanine transaminase (ALT) level of 138 U/L, aspartate transaminase level of 76 U/L, total bilirubin (T.Bil) of 103 mmol/L, direct bilirubin of (D.Bil) 83 mmol/L, gamma-glutamyl transpeptidase (GGT) level of 28 U/L with normal prothrombin time (PT) of 13 seconds. One week later, the patient developed severe bronchiolitis necessitating mechanical ventilation associated with acute liver failure and worsening cholestasis. His ALT increased to 303.5 U/L and direct bilirubin increased to 204 mmol/L with prolongation of PT to 18.9 seconds reflecting derangement in synthetic liver functions. There was associated hypoglycemia, hyponatremia and high normal potassium level with a picture of adrenal insufficiency. Hormonal workup and genetic testing revealed isolated cortisol deficiency with a novel homozygous mutation c.763_764delAT (p. Met255ValfsX17) in Melanocortin 2 receptor gene (MC2R) and the patient was diagnosed as familial primary glucocorticoid deficiency. The patient was maintained on cortisol replacement therapy with the resolution of cholestasis and normalization of liver functions. Conclusions: Patients presenting with infantile cholestasis associated with documented hypoglycemia should alert pediatricians about the possibility of familial glucocorticoid deficiency and prompt investigation of adrenal function should be considered. Cortisol replacement therapy leads to the resolution of cholestasis.

Lipoid congenital adrenal hyperplasia (LCAH) is characterized by disturbance of adrenal and gonadal steroidogenesis (OMIM:201710). It is caused by mutation in the Steroidogenic Acute Regulatory Protein (StAR). We report a classic case of LCAH in a neonate (46, XY) with phenotypic female genitalia who presented with significant salt loss with a novel homozygous variant mutation c.745-1G>C p. in StAR gene.

Background/Objectives: The emergence of artificial intelligence (AI) has revolutionized the healthcare industry. However, its integration into clinical practices raises ethical and practical concerns. This study aims to explore ethical and practical considerations perceived by physicians and nurses in Saudi Arabia. Methods: It employed a cross-sectional design with 400 physicians and nurses, using a pre-established online questionnaire. Descriptive data were analyzed through means and standard deviations, while inferential statistics were performed using the independent samples t-test. Results: Most participants were male (57%) and physicians (73.8%), with most employed in governmental organizations (87%). The participants’ use and awareness of AI was low, as 34.0% said they had never used it, but 74.5% of respondents were willing to use AI in clinical practices. Also, 80.5% of participants were aware of the AI benefits, and 71.0% had background knowledge about the ethical concerns related to AI’s implementation in their clinical practices. Moreover, (62.0%) of respondents recognized the applicability of AI in their specialty. Key findings revealed significant concerns: participants perceived a lack of skills to effectively utilize AI in clinical practice (mean = 4.04) and security risks such as AI manipulation or hacking (mean = 3.83). The most pressing ethical challenges included AI’s potential incompatibility with all populations and cultural norms (mean = 3.90) and uncertainty regarding responsibility for AI-related errors (mean = 3.84). Conclusions: These findings highlight substantial barriers that hinder the effective integration of AI in clinical practices in Saudi Arabia. Addressing these challenges requires leadership support, specific training initiatives, and developing practical strategies tailored to the local context. Future research should include other healthcare professionals and qualitatively explore further underlying factors influencing AI adoption.

Human Cytomegalovirus (HCMV) infection is a significant public health concern, with congenital HCMV (cHCMV) infection affecting approximately 1% of all live births. Of these infected infants, 10-15% develop symptomatic disease with complications including microcephaly, neurodevelopmental delay, and sensorineural hearing loss (SNHL). However, the long-term consequences of cHCMV infection are variable, with an additional 10-15% of asymptomatic infants developing SNHL later in life. The underlying mechanisms driving these diverse outcomes could be multifactorial but remain unknown. One potential factor contributing to these variations is the diversity of glycoproteins on HCMV envelope. It has been suggested that differences in glycoprotein genotypes may influence the virus's virulence. The HCMV virion is a complex structure, and the pentamer complex, essential for viral entry and replication in various cells, is a key component. The UL128 gene encodes a protein integral to this complex. This study aimed to investigate the role of UL128 in HCMV pathogenesis and to identify novel viral and host factors involved in cHCMV infection. To investigate the role of UL128, three UL128 variants derived from published HCMV whole genome isolates were introduced into a recombinant HCMV BAC (RCMV111) using a two-step Red-mediated recombination system. The resulting recombinant viruses were characterised phenotypically through infectivity assays, cytokine response, and glycosylation patterns via enzyme-linked lectin assay analysis. For transcriptional analysis, published RNA sequencing HCMV infected monocytes data was used to identify differentially expressed genes and gene fusion. Furthermore, selected in-silico predicted gene fusions were experimentally tested in MRC-5 and ARPE-19 cells. Recombinant HCMV strains expressing the different UL128 variants successfully regained tropism for epithelial cells. However, these viruses exhibited no significant phenotypic differences compared to the parental strain in cytokine response and lectin assays, while infectivity showed decreased infectivity in fibroblasts compared to the wild type. RNA sequencing of HCMV infected monocytes revealed differential expression of several genes, including EPHB2. Further analysis demonstrated a similar pattern of EPHB2 gene expression in HCMV infection of MRC-5 cells. Experimental validation of in-silico predicted gene fusions yielded variable results in MRC-5 and ARPE-19 cells. This study provides new insights into the complex nature of HCMV pathogenesis. While UL128 is essential for viral tropism, our findings suggest that the specific UL128 variant does not significantly impact viral phenotype in the RCMV1111 model. The identification of differentially expressed genes and gene fusions in HCMV infected monocytes highlights the potential of transcriptomic analysis for uncovering novel viral and host factors involved in infection. Further investigation of these factors is warranted to understand their precise roles in HCMV pathogenesis.

Healthcare organizations worldwide tend to implement hospital accreditation programs to improve the quality of care they provide. However, the literature shows inconsistent findings on the impact of such programs on the quality of care due to improper implementation of accreditation programs. This study explored the enabling factors for the effective implementation of the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) program in the Ministry of Health (MOH) hospitals in Madinah, Saudi Arabia. This qualitative study involved 22 professionals from five CBAHI-accredited MOH hospitals in Madinah, Saudi Arabia. A purposive sampling technique was applied, and data were collected through in-depth, semi-structured interviews. A thematic analysis approach was applied to the interview transcripts. Four themes and 11 subthemes emerged. The emerging themes included the development of human capital, resolving quality management issues, ensuring the availability of resources, and strategizing CBAHI-specific solutions. The current study fills this knowledge gap by identifying the factors leading to the effective implementation of the CBAHI accreditation program in the MOH hospitals. Only the effective execution of the CBAHI will increase healthcare quality and, as a result, justify the significant resources and efforts invested in these programs. Future research should replicate similar study in other governments or private hospitals.

Although hospital accreditation is recognized as a tool for improving healthcare, there are inconsistent results regarding its impact on healthcare quality. In Saudi Arabia, it is mandatory for all Ministry of Health (MOH) hospitals to be accredited by the Central Board for Accreditation of Healthcare Institutions (CBAHI). This study measured the impact of the CBAHI accreditation program on the Institute of Medicine's (IOM) safety dimension in Madinah. A cross-sectional study was conducted using retrospective data gathered from a review of hospital records over 60 months (ie, 12 months before, 36 during, and 12 post-accreditation). The data were analyzed using piecewise (segmented) regression analysis. The three indicators (ie: incident reports, medication errors, and nosocomial infection) were continuously improved compared to the data before accreditation, as a results of implementing the CBAHI accreditation program. Therefore, the CBAHI had a significantly positively impacts on MOH hospitals' safety dimension. Complying with the CBAHI standards can help reduce the rates of incident reports, medication errors, nosocomial infections, and post-admission mortality. This study provides insight for MOH hospitals and opportunities to expand the accreditation program to improve the quality of healthcare services.

Biofilm-associated infections pose a significant challenge in clinical settings due to their increased resistance to antibiotics and evasion of host immune responses. These infections are responsible for a large proportion of chronic and recurrent infections, leading to prolonged hospital stays, increased healthcare costs, and elevated morbidity and mortality rates. Vancomycin, a glycopeptide antibiotic, has long been a cornerstone in the treatment of infections caused by Gram-positive bacteria, particularly methicillin-resistant (MRSA). In addition, vancomycin-resistant Enterococcus (VRE) represents an important group of biofilm-forming pathogens, further complicating treatment strategies. However, its efficacy against biofilms remains a subject of ongoing research and debate. The ability of vancomycin to target biofilm-embedded bacteria is often hindered by multiple resistance mechanisms, including poor antibiotic penetration, metabolic adaptation of biofilm-associated cells, and the presence of persister cells. The aim of this review is to evaluate vancomycin's antibiofilm activity by examining its mechanism of action, pharmacokinetics, effectiveness, limitations, and potential strategies to enhance its therapeutic outcomes. Several novel approaches have been explored to augment vancomycin's antibiofilm activity, including combination therapies, adjuvant strategies, and nanotechnology-based drug delivery systems. Understanding these factors is crucial for optimizing therapeutic strategies and overcoming the persistent challenge of biofilm-related infections. This review synthesizes current evidence and highlights areas requiring further research to enhance vancomycin's efficacy against biofilm-associated infections.