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Salhah Alsulami,1 Nouf Althagafi,1 Eman Hazazi,1 Razan Alsayed,1 Majd Alghamdi,1 Thikra Almohammadi,1 Saleh Almurashi,2 Mukhtiar Baig3 1Department of Medicine, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia; 2Family Medicine Academy Eastern Health Cluster, Dammam, Saudi Arabia; 3Department of Clinical Biochemistry, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Salhah Alsulami, Department Internal Medicine, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, 23765, Saudi Arabia, Tel +966563681890, Email salhasolami@hotmail.comBackground: This study investigated the prevalence of obesity among university students in Saudi Arabia’s western region, as well as its association with gender, smoking, consumption of sugary drinks, and hours of sleep.Methods: A cross-sectional study recruited a simple random sample of students from King Abdulaziz University (KAU) in Saudi Arabia’s western region. In this study, the Arab Teens Lifestyle (ATLS) questionnaire was used. The survey was conducted between April and June 2022.Results: In total, 659 students participated (313 males [37.3%] and 437 females [66.2%]). One-fourth of the students, 158 (24%), were overweight, and 83 (12.7%) were obese. Male participants were overweight or obese by a rate of 32.6% and 19.4%, respectively. Female overweight and obese rates were 16.2% and 6.6%, respectively. Moreover, obesity/overweight rates were 43.6% in the urban area and 36.9% in the rural area (P=0.03). A total of 370 participants (56.14%) slept less than 8 hours per day, 185 (28.1%) spent more than five hours per day watching television or using the internet, and 303 (46%) ate breakfast on a regular basis. Obesity/overweight was more common in smokers than in nonsmokers (59.7% vs 32.8%, P=0.01). The prevalence of obesity was lower among those who walked three days or more per week (28.1% vs 44.1%; P=0.01) and ran/jogged outside or on a treadmill three days or more per week (29.5% vs 39.8%; P=0.03) than among those who ran/jogged less than three days per week. Student obesity was independently predicted by being male (P=0.01), drinking more sugary drinks (P=0.01), smoking (P=0.03), and sleeping for fewer hours (P=0.03).Conclusion: Obesity was more prevalent in male students, with a prevalence of 24%. Male gender, consumption of more sugary beverages, smoking, and sleeping for fewer hours were all independent predictors of obesity among university students.Keywords: obesity, overweight, BMI, young adults, physical activity, dietary habits, lifestyle factors, sedentary behaviors

Saleh Alsulami, Zaid Al Omar, Mohammed S Binnwejim, Fahad Alhamdan, Amr Aldrees, Abdulkarim Al-bawardi, Meshary Alsohim, Mohammed Alhabeeb Departments of Family Medicine and Medical Education, College of Medicine, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia Abstract: The Health Science Preparatory Program (HSPP) is a special program that aims to enhance the educational preparedness of students for participation in a health sciences career. Students spend their first university year in a combined extensive teaching program before they can be assigned to a particular health science specialty. It is thought that students enrolled in a highly competitive environment such as HSPP with a long list of potential stressors, including developmental, academic overload, language barriers and competition, are more disposed to stress and stress-related complications. This study aims to measure the level of academic stress and to determine its risk factors in students enrolled in HSPP-adapted local universities in Saudi Arabia. The study was conducted at two Saudi universities, King Saud University (KSU) and Imam Mohammad ibn Saud Islamic University (IMSU) with competition-based and non-competition-based HSPP learning models, respectively. Both universities adopt the HSPP system. The scale for assessing academic stress (SAAS) was used to assess students’ perceived stress. A total of 290 students successfully completed the questionnaire (N=290), with a mean age of 18.66 years. Mean SAAS scores for KSU and IMSU students were 8.37 (SD = 4.641) and 7.97 (SD = 5.104), P=0.480, respectively. Only “satisfaction” and “associated social and health problems” have shown statistically significant correlation with university (P=0.000 and P=0.049, respectively). This study has found mean SAAS score for two local universities with competition-based versus non-competition-based HSPP learning models. Academic stress correlation with age, gender and universities was discussed, and valuable future work guidance was recommended. Keywords: academic stress, HSPP, competition, stress mediators, SAAS score

This paper introduced a new definition of rough fuzzy sets based on a fuzzy ideal l defined on a fuzzy approximation space (X, R). This definition considered the degree r ∈ [0, 1] in defining the after sets and the before sets of the arbitrary fuzzy relation R on the finite set of objects X. It is shown that this new type of roughness is a generalization to many of previous definitions in the fuzzy case and also in the ordinary case. As an application, it is given a rough fuzzy‐connected set notion depending on some degree r ∈ [0, 1]. [ABSTRACT FROM AUTHOR]

Shaymaa A Abdalal,1 Hatoon A Niyazi,2 Soa’ad M Alsulami,3 Ala A Azhari,2 Hanouf A Niyazi,2 Jawahir A Mokhtar,2 Dalya M Attallah,3 Faten A Al Braikan,2 Moroj A Aldarmasi1 1Community Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 2Clinical Microbiology and Immunology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Clinical and Molecular Microbiology Laboratories, King Abdulaziz University Hospital, Jeddah, 21589, Saudi ArabiaCorrespondence: Shaymaa A Abdalal, Email sabdalal@kau.edu.saPurpose: Parasitic infections are a primary cause of illness worldwide and a public health problem. This study highlighted the prevalence of intestinal parasitic (IP) infections and their updated epidemiologic status from 2019 to 2023 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.Patients and Methods: A retrospective study was conducted from 2019 to 2023 at King Abdulaziz University Hospital. The laboratory results, socio-demographic information, and the year of data collection were collected from the hospital’s parasitology laboratory. The data were analyzed using SPSS version 26. Ethical approval was obtained from the National Committee of Bioethics (NCBE) - King Abdul Aziz City for Science and Technology, with an approval number of 258-22.Results: During the study period, 7673 stool samples were requested for intestinal parasite examination. The prevalence of IP infection from 2019 to 2023 was 212/7673, with a percentage of 2.8%. Infected patients had a mean (SD) age of 37.68 (17.27) years. Most infected patients were females (61%) and from Saudi Arabia (37.1%). Most stool samples were brown (79.1%), and about half were soft (51.7%). 2019 had the highest number of infected cases (28.3%), while the number of cases decreased in 2023 (8.8%), the lowest during five years. The most predominant parasite among study subjects was Blastocystis hominis (48.11%).Conclusion: The prevalence of IP infection is lower than in previous comparable surveys. Maintaining personal hygiene, conducting epidemiological surveillance, and enhancing environmental sanitation can prevent and control infections.Keywords: intestinal parasites, infection, prevalence, Saudi Arabia

Salhah S Alsulami,1 Kholoud A Ghamri2 1Department of Medicine, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia; 2Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Salhah S Alsulami, Department of Medicine, Faculty of Medicine Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia, Tel +966563681890, Email salhasolami@hotmail.comBackground: Pregnant women with diabetes are strongly advised against Ramadan fasting and have religious exemption, but a large proportion still choose to fast. Unfortunately, there is little information about glycemic control in these patients. This study aims to determine the fasting and postprandial blood glucose levels and to predict the risk factors for hypoglycemia in pregnant women with type 2 diabetes mellitus (DM) and gestational DM (GDM) who fast during Ramadan.Methods: A prospective cohort research was conducted at a single tertiary hospital between 2021 and 2023 on 70 pregnant women with GDM (n = 53) and type 2 DM (n = 17) in their second and third trimester. Their fasting and postprandial blood glucose levels during Ramadan were compared to those of the previous month, and hypoglycemia was defined as blood glucose levels less than 60 mg/dl. Binary regression was used to predict the risk variables for hypoglycemia.Results: The GDM and type 2 DM groups were similar in terms of age, parity, number of fasting days, and number of daily fasting hours. Only 26.9% of the women who were permitted to fast were given special instructions for Ramadan fasting. Dietary intervention was more common in the GDM group, whereas insulin and metformin treatment were more common in the type 2 DM group. The fasting glucose level decreased significantly after Ramadan fasting in both groups, from 92.5 (17.4) mg/dl to 90 (17.13) mg/dl (p = 0.033). However, there were a significantly higher number of hypoglycemia events in the type 2 DM group. Further, type 2 DM was identified as a risk factor for hypoglycemia (OR = 6.23; 95% CI = 1.04– 37.54; P = 0.046.Conclusion: The present findings indicate that Ramadan fasting may improve fasting glucose control. In addition, type 2 DM was identified as a risk factor for hypoglycemia.Keywords: gestational diabetes, type 2 diabetes, pregnant women, cohort study, Ramadan fasting

Mohamed Magdi Atta,1,2 Mohamed Hisham Sayed,3,4 Mohamed A Zayed,5,6 Sultan A Alsulami,1 Ahmed T Al-Maghrabi,1 Abdulhfeez Y Kelantan11Department of Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 2Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Benha University, Benha, Egypt; 3Department of Pediatrics, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 4Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; 5Department of Physiology, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 6Department of Physiology, Faculty of Medicine, Menoufia University, Shibīn Al Koum, EgyptCorrespondence: Mohamed A ZayedFaculty of Medicine in Rabigh, King Abdulaziz University, building 13, P.O. BOX 80205, Jeddah 21589, Saudi ArabiaTel +966 56 260 3213Fax +966 12 640 0000Email mazayed@kau.edu.saBackground and aims: Gastro-oesophageal reflux disease (GERD) is a common gastrointestinal disease worldwide that is associated with impaired quality of life and higher risk of complications. The identification of risk factors is necessary for preventive measures. The aim of this study is to evaluate the prevalence of GERD symptoms as well as its relation to body mass index (BMI) and other risk factors among medical students of Jeddah and Rabigh branches, King Abdul-Aziz University, Saudi Arabia.Subjects and methods: A cross-sectional study was conducted at the Faculty of Medicine in Rabigh, King Abdul-Aziz University, Saudi Arabia. The study included 197 medical students from Rabigh and Jeddah branches of the university. The study employed a Gastroesophageal Reflux Disease Questionnaire which is derived from a self-administered validated GERD questionnaire (GerdQ).Results: The prevalence of GERD symptoms was 25.9%. The most frequent symptoms were regurgitation and burning sensation. High BMI, family history, energy drinks and fried food were found to be statistically significant risk factors (p

Abstract Using the notion of compatible mappings in the setting of a partially ordered metric space, we prove the existence and uniqueness of coupled coincidence points involving a (ϕ, ψ)-contractive condition for a mappings having the mixed g-monotone property. We illustrate our results with the help of an example.

This paper presents the generation of a Q-set for two Q studies investigating the perspectives of (1) patients with multiple sclerosis and (2) their healthcare professionals on the use of wearable technology. It describes the adopted Q methodology and how it was applied in different phases. The concourse is derived from the relevant literature, based on the unified theory of acceptance and use of technology (UTAUT2) model, with privacy as a moderator, and Hofstede's "Cultural Dimensions" framework, incorporates statements drawn from the concourse following review by experts This is followed by a pilot study involving 4 stakeholders to improve the relevance and quality of the research. A 43-statement Q-sample was developed for the first Q study, and a 32-statement Q-sample was developed for the second Q study. This preliminary study reported the development of a legitimate and reliable concourse in a transparent and comprehensive manner. The lessons learnt from developing the concourse in this study could be beneficial for future research when conducted in a similar digital healthcare context and in the context of MS where individuals often experience symptoms related to vision, sensation, coordination, and movement.

Background: Down syndrome (DS), or Trisomy 21, is defined by the existence of an additional chromosome 21. Various physiological considerations in DS patients might lead to challenges in adequate pain management and sedation after surgery. The aim of this systematic review and meta-analysis is to evaluate the variations of the requirement needed for pain management and sedation in patients with DS who have undergone surgery compared to patients without DS., Methods: A systematic review and meta-analysis of studies were conducted, focusing on critically ill patients with DS who were admitted to Intensive care units (ICUs) post-surgery and received opioids and/or benzodiazepines. Searches were conducted in four databases from their inception to November 18, 2023 (Pubmed, Scopus, Cochrane Library, and Web of Science). The primary outcome measured was the dosage of Oral Morphine Equivalent (OME) administered in the days following surgery. Fixed-effect models were used, an approach advisable when only a limited number of studies are available., Results: Out of the 992 studies initially screened, the systematic review included ten studies, encompassing 730 patients, while the meta-analysis consisted of seven studies, encompassing 533 patients. Of the seven studies included in the analysis, 298 patients were identified to have DS, and 235 patients served as controls. Patients with DS showed a slight increase in OME needs on the first day, but this increase was not statistically significant (mean difference [MD] = 0.09; 95% Confidence Interval [CI]: [-0.02, 0.20]; P = 0.11). There was also no significant difference in the requirement for Midazolam on the first day among DS patients (MD = 0.01; CI [-0.16, 0.19]; P = 0.88). In addition, the duration of mechanical ventilation was not statistically significant in patients with DS compared with the control group (MD = -1.46 hours; 95% CI [-9.74, 6.82]; P = 0.73)., Conclusion: Patients with Down syndrome did not require more sedation or analgesia in the first three days after surgery than patients without Down syndrome. Additionally, the two groups showed no significant difference in the duration of mechanical ventilation., (© 2024. The Author(s).)

Background: Pregnancy introduces significant physiological changes, notably impacting respiratory dynamics, especially during the second trimester. Data remain inconclusive about how body posture might influence lung function in pregnant women. We aimed to examine the impact of body position on slow vital capacity in pregnant women during their second trimester., Methods: This observational study was carried out at King Khalid Hospital in Saudi Arabia, involving pregnant women in their second trimester, from 14 to 26 weeks of gestation. We utilized the KoKo® Legend Portable Office Spirometer to measure slow vital capacity (SVC) in both sitting and standing positions. Participants' demographic details were recorded, ensuring a comprehensive analysis that accounted for age, BMI, and gestational age., Results: 136 pregnant women participated in this study, a paired-sample t -test revealed no statistically significant difference between sitting (M = 2.31, SD = 0.49) and standing (M = 2.33, SD = 0.5) positions, p  = 0.24, However; the mean value of SVC in sitting position was significantly different between 4th month of pregnancy (M = 2.17, SD = 0.44) and 6th month of pregnancy (M = 2.45, SD = 0.48), p  = 0.016., Conclusion: The performance of the SVC in both positions was not significantly affected. However, an increase in gestational age had a notable impact on SVC performance, particularly during sitting positions, due to the changes in respiratory physiology during pregnancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Al Zhranei, Alsulami, Alfaydi, Alzahrani, Alsulami and Al Nufaiei.)

Introduction: Multiple sclerosis (MS) is an increasingly prevalent chronic, autoimmune, and inflammatory central nervous system illness, whose common symptoms undermine the quality of life of patients and their families. Recent technical breakthroughs potentially offer continuous, reliable, sensitive, and objective remote monitoring solutions for healthcare. Wearables can be useful for evaluating falls, fatigue, sedentary behavior, exercise, and sleep quality in people with MS (PwMS)., Objective: This scoping review of relevant literature explores studies investigating the perceptions of patients and healthcare professionals (HCPs) about the use of wearable technologies in the management of MS., Methods: The Joanna Briggs Institute methodology for scoping reviews was used. The search strategy was applied to the databases, MEDLINE via Ovid, Embase, APA PsycInfo, and CINAHL. Further searches were performed in IEEE, Scopus, and Web of Science. The review considered studies reporting quantitative or qualitative data on perceptions and experiences of PwMS and HCPs concerning wearables' usability, satisfaction, barriers, and facilitators., Results: 10 studies were included in this review. Wearables' usefulness and accessibility, ease of use, awareness, and motivational tool potential were patient-perceived facilitators of use. Barriers related to anxiety and frustration, complexity, and the design of wearables. Perceived usefulness and system requirements are identified as facilitators of using wearables by HCPs, while data security concerns and fears of increased workload and limited effectiveness in the care plan are identified as barriers to use wearables., Conclusions: This review contributes to our understanding of the benefits of wearable technologies in MS by exploring perceptions of both PwMS and HCPs. The scoping review provided a broad overview of facilitators and barriers to wearable use in MS. There is a need for further studies underlined with sound theoretical frameworks to provide a robust evidence-base for the optimal use of wearables to empower healthcare users and providers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background  The word "atopy" is frequently used to describe immunoglobulin E (IgE)-mediated diseases. The prevalence of atopic dermatitis, allergic rhinitis, and asthma is increasing and disconcerting in Saudi Arabia. This study aims to investigate the association between allergic rhinitis, atopic dermatitis, asthma, and oral health among adults in the Makkah region of Saudi Arabia. Methods A cross-sectional study of 726 adults using an electronic questionnaire was adopted. The study was carried out from January to December 2022. The questionnaire included demographic data, patients' diseases in response to inclusion and exclusion criteria, oral health status and symptoms, and dental health-related behaviors. Results Most participants were aged from 18 to <40 years (79.1%). More than half of the participants were females (53.6%); 39.7% of participants had poor oral health. Poor health was significantly higher among obese subjects as well as those with lower levels of physical activity, higher perceived levels of stress, those who received a sealant, and those who brushed their teeth for ≤ one time per day. The results showed that the individual symptoms of oral health did not associate significantly with being diagnosed with allergic rhinitis or asthma in the past 12 months. However, atopic dermatitis was independently associated with a chipped or broken tooth (OR = 1.52) and pain in the tongue or inside the cheeks (OR = 3.57). Conclusion Poor oral health was significantly associated with atopic dermatitis in Saudi adults. Some systemic diseases are considered chronic diseases, and they are multifactorial; thus, we cannot claim that periodontal pathogens are the definite cause of systemic infections. More studies are necessary to find a definitive association., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alsulami et al.)

Introduction: The current study evaluated obesity prevalence, physical activity, and dietary practices among Saudi adults in the Makkah region of the Kingdom of Saudi Arabia (KSA). The current survey was accomplished between November 2021 and March 2022., Method: A validated questionnaire, Arab Teens Lifestyle Study (ATLS), was used to evaluate all participants' physical activities, sedentary behaviors, and nutritional habits in addition to demographic data., Result: A total of 2,115 people [1,238 (58.5%) women and 877 (41.5%) men] participated in this survey. Being overweight was prevalent in 32.8% of the population (41% of men and 28.9% of women), obesity was prevalent in 23% of the population (males 23.1% and females 24.2%). Obese people consumed more soft drinks, and overweight people did not consume enough vegetables (fresh/cooked). Obese people consumed fast food (e.g., burgers, sausage, pizza, or Arabic shawarma) over three times each week. The mean (SD) number of days of practice walking was 2.51 (2.05) vs. 1.3 (1.87) ( p < 0.001) for lean and obese individuals, respectively. In addition, individuals with normal BMI had more days of jogging, moderate and high-intensity exercise, dancing, and strength training than those with obesity. The odds of being obese increased with age (OR: 1.07; p < 0.001), in males (OR: 2.16; p < 0.001), in participants earning <5,000 SR/month (1.3 thousand $) and 10-15 thousand SR/month (1.34-2.66 thousand $) (OR: 2.36; P = 0.01). Obesity was inversely associated with moderate-intensity exercise (OR: 0.802; p = 0.009), and regular walking (OR: 0.685; CI: 0.624-0.752; p < 0.001)., Discussion: Overweight and obesity were prevalent in 32.8% and 23% of the population, respectively. Sociodemographic factors associated with obesity. Focused intervention strategies are needed to overcome the obesity issue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alsulami, Baig, Ahmad, Althagafi, Hazzazi, Alsayed, Alghamdi and Almohammadi.)

Objective This study aimed to analyze and determine the clinical features and characteristics of patients diagnosed with Behçet's disease (BD) in Saudi Arabia. Methods This single-center study was conducted in a tertiary care center in the western region of Saudi Arabia. Electronic medical records of patients with BD aged 14 years and older were reviewed and their demographic and clinical data were collected by trained rheumatologists. Between comparisons, Fisher's exact test, independent t-test, or Mann-Whitney U test was applied. The normality of variables was tested using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Results The mean age of symptom onset was 29.6 ± 11.4 years, and mean age at the time of diagnosis was 31.1 ± 11.9 years. Most patients were overweight (mean body mass index 26.7 ± 5.60 kg/m2). The most associated medical comorbidities were diabetes mellitus and hypertension. The most common clinical manifestations were oral ulcers (91.2%), genital ulcers (81.3%), arthritis (41.8%), and pseudofolliculitis (34.1%). Colchicine was the most prescribed treatment (95.6%), followed by prednisolone (72.5%), and azathioprine (36.3%). Male patients were significantly more likely to have pseudofolliculitis (p=0.011) and take a tumor necrosis factor alpha (TNF-α) inhibitor (p=0.045). Female patients were more likely to have neurological involvement (p=0.029). Conclusion Awareness of BD symptoms and early recognition can help provide timely and effective treatment to avoid disease complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharthy et al.)

Background: In addition to developing effective therapeutic approaches, the maintenance of health also constitutes lifestyle and behavioral aspects related to being more resilient in the event of future illness. Reduced immune health has been linked to reports of more frequent and severe infections as well as a variety of non-communicable diseases, both of which may eventually place a significant burden on the healthcare system. Several lifestyles and behaviors can influence immune health, both positively and negatively. Accordingly, this study aimed to evaluate the immune health status and investigate its relationship with widely practiced lifestyle behaviors that are thought to affect immunological functioning., Design and Method: Saudi Arabian citizens and international residents of the Western Province were invited to participate in this cross-sectional web-based survey through an online advertisement. The integrated questionnaire on lifestyle (Arab Teens Lifestyle Study) and immune health status (Immune Status Questionnaire (ISQ)) was completed in November 2022 by 1230 participants. Descriptive analysis, Mann-Whitney U test, chi-square, or Fisher's exact test was utilized to investigate the relationships between study variables and immune health status groups. Spearman's or Pearson's correlation coefficients were used to determine correlations between the overall ISQ scores and study variables., Results: Of the 925 study participants, 34.7% scored below 6 on the ISQ. Of the respondents, 50% had a body mass index of 25 or higher, and 46.3% reported sleeping less than four hours each night. Of the participants, 62-82% did not engage in any form of physical activity. The associations between the ISQ score and weight (p = 0.006), total sleep time per night (p = 0.001), duration of household activities (p < 0.001), and smoking status (p = 0.001) were statistically significant., Conclusions: According to the data presented here, reduced immune health as measured by ISQ < 6 was prevalent among residents of Saudi Arabia's Western Province and correlated significantly with obesity, sleep duration, and smoking status. Various measures to mitigate the negative impact of an unhealthy lifestyle on public health and to reverse the observed poor immune health and their economic consequences are highly required., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Background: The number of reports of menstrual changes after COVID-19 vaccination in the Saudi population is still unknown. Therefore, this study aimed to assess the effect of the COVID-19 vaccine(Pfizer, AstraZeneca, and Moderna) on the menstrual cycle among females in Saudi Arabia., Methods: This descriptive cross-sectional study was conducted in Saudi Arabia at Umm Al-Qura University (UQU) from August 2021 to February 2022. Data was collected through a previously validated online questionnaire., Results: A total of 2338 participants who received the first dose of the COVID-19 vaccine participated in this study; 1606 (68.7%) of them received the second dose in addition to the first. The mean age of the study participants was 35.4±9.5 years. No significant associations were found between the type of COVID-19 vaccine and the impact on the menstrual cycle, either for the first or second dose (P-values > 0.05). A significant association was found only between the first dose vaccination day and the impact on the menstrual cycle in the second question of "After receiving the COVID-19 vaccine, your next period was" (P-value ≤ 0.05). Significant associations were found between the second dose vaccination day and the impact on the menstrual cycle in the first and second questions of "After receiving the COVID-19 vaccine, your next period was", and "After receiving the first dose, your next period was," respectively (P-values ≤ 0.05)., Conclusion: The study found a potential association between the COVID-19 vaccine and menstrual cycle irregularities, which could impact females' quality of life., (© 2022 Fadi S. I., et al.)

Background Many international studies have reported the outcomes and predictors of coronavirus disease 2019 (COVID-19); however, only a few national studies have reported predictors of poor outcomes among adult hospitalized patients with COVID-19. Therefore, this study aimed to describe the clinical characteristics and complications of COVID-19 and identify predictors of poor outcomes. Methods This was a retrospective cohort study. All adult patients confirmed with COVID-19 who were admitted at the King Abdulaziz Medical City (KAMC)-Jeddah between March 1, 2020, and December 31, 2020, were included; pediatric and pregnant patients were excluded. The clinical features and complications of COVID-19 were tested for association with poor outcomes (intensive care unit [ICU] admission or death) using chi-square and Fisher's exact tests. In addition, logistic regression analysis was performed to identify the predictors of poor outcomes. Results A total of 527 patients were included in this study. Forty-two patients (8%) (6-10, 95% confidence interval [CI]) died: 13 in the general wards and 29 in the ICU. Of the 84 patients admitted to the ICU, 65 underwent invasive mechanical ventilation. Poor outcome affected 97 patients (18%) (15-22, 95% CI). Shortness of breath, oxygen saturation <92%, and abnormal chest x-ray findings were associated with poor outcomes (P-value < 0.001). In addition, lymphocyte counts were significantly lower, while c-reactive protein levels were significantly higher among patients with poor outcomes (P-value < 0.001). The most common complications were acute cardiac (83 patients, 16%), acute kidney (78 patients, 15%), and liver injuries (76 patients, 14%). Predictors of poor outcome were the updated Charlson comorbidity index (CCI) (odds ratio [OR] 1.2 [95% CI 1.1-1.4]), liver injury (OR 2.6 [95% CI 1.3-4.9]), acute kidney injury (OR 4.3 [95% CI 2.3-7.8]), and acute cardiac injury (OR 5.1 [95% CI 2.8-9.4]). Conclusions COVID-19 disease is associated with significant morbidity and mortality. Predictors of poor outcomes among COVID-19 hospitalized patients were the updated CCI, liver injury, acute kidney, and acute myocardial injuries. Subsequently, the risk of poor COVID-19 outcomes is increased among patients with multiple comorbidities and/or multiple COVID-19 complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tabbakh et al.)

Bictegravir (BIC) is included in international guidelines as the first line of therapy for patients living with Human Immunodeficiency Virus (HIV), either as initial therapy or as a replacement for patients with prior antiretroviral therapy (ART). Due to limited efficacy and safety data, BIC is currently not recommended during pregnancy. Data on the safety and efficacy of BIC during pregnancy were unavailable at the time of drug approval. In our case, BIC/TAF/FTC was effective in suppressing viral load (VL) in pregnancy, and there were no reported safety issues for the mother or the baby.

Purpose : Studies have shown that children with Down syndrome (DS) are at high risk for physical inactivity and obesity. This study aimed to explore mother's perceptions of the physical activity levels, needs, benefits, facilitators, and barriers in their children with DS. Methods : For this descriptive qualitative study, 17 participants were recruited through centres for children with DS in the Kingdom of Saudi Arabia. Semi-structured interviews were conducted with mothers who were able speak Arabic or English and have a child with a confirmed diagnosis of Trisomy 21 (DS) between ages three and 17 years. Thematic analysis was used to analyse the study data. Results : Data analysis revealed the following themes regarding children with DS: 1) their physical functioning level; 2) daily physical activity at home; 3) physical activity at school; 4) physical activity benefits; 5) physical activity facilitators; and 6) physical activities barriers. Conclusion : Findings from this study can help health professionals gain insight on the physical activity facilitators and barriers for children with DS in order to design tailored intervention programmes to improve the support and the engagement of children with DS into regular physical activities.

The increasing prevalence of type 2 diabetes among South Asians is caused by a complex interplay between environmental and genetic factors. We aimed to examine the impact of dietary and genetic factors on metabolic traits in 1062 Asian Indians. Dietary assessment was performed using a validated semi-quantitative food frequency questionnaire. Seven single nucleotide polymorphisms (SNPs) from the Transcription factor 7-like 2 and fat mass and obesity-associated genes were used to construct two metabolic genetic risk scores (GRS): 7-SNP and 3-SNP GRSs. Both 7-SNP GRS and 3-SNP GRS were associated with a higher risk of T2D ( p = 0.0000134 and 0.008, respectively). The 3-SNP GRS was associated with higher waist circumference ( p = 0.010), fasting plasma glucose (FPG) ( p = 0.002) and glycated haemoglobin (HbA1c) ( p = 0.000066). There were significant interactions between 3-SNP GRS and protein intake (% of total energy intake) on FPG (P interaction = 0.011) and HbA1c (P interaction = 0.007), where among individuals with lower plant protein intake (<39 g/day) and those with >1 risk allele had higher FPG ( p = 0.001) and HbA1c ( p = 0.00006) than individuals with ≤1 risk allele. Our findings suggest that lower plant protein intake may be a contributor to the increased ethnic susceptibility to diabetes described in Asian Indians. Randomised clinical trials with increased plant protein in the diets of this population are needed to see whether the reduction of diabetes risk occurs in individuals with prediabetes.

Purpose: The development of metabolic diseases such as type 2 diabetes (T2D) is closely linked to a complex interplay between genetic and dietary factors. The prevalence of abdominal obesity, hyperinsulinemia, dyslipidaemia, and high blood pressure among Brazilian adolescents is increasing and hence, early lifestyle interventions targeting these factors might be an effective strategy to prevent or slow the progression of T2D., Methods: We aimed to assess the interaction between dietary and genetic factors on metabolic disease-related traits in 200 healthy Brazilian young adults. Dietary intake was assessed using 3-day food records. Ten metabolic disease-related single nucleotide polymorphisms (SNPs) were used to construct a metabolic-genetic risk score (metabolic-GRS)., Results: We found significant interactions between the metabolic-GRS and total fat intake on fasting insulin level (P interaction  = 0.017), insulin-glucose ratio (P interaction  = 0.010) and HOMA-B (P interaction  = 0.002), respectively, in addition to a borderline GRS-fat intake interaction on HOMA-IR (P interaction  = 0.051). Within the high-fat intake category [37.98 ± 3.39% of total energy intake (TEI)], individuals with ≥ 5 risk alleles had increased fasting insulin level (P = 0.021), insulin-glucose ratio (P = 0.010), HOMA-B (P = 0.001) and HOMA-IR (P = 0.053) than those with < 5 risk alleles., Conclusion: Our study has demonstrated a novel GRS-fat intake interaction in young Brazilian adults, where individuals with higher genetic risk and fat intake had increased glucose and insulin-related traits than those with lower genetic risk. Large intervention and follow-up studies with an objective assessment of dietary factors are needed to confirm our findings., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-021-00863-7., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© The Author(s) 2021.)

Background: End-stage renal disease, as one of the most serious and major health problems, does not have many treatment options available. One of the best treatment modalities used to cure this debilitating disease is kidney transplantation. However, with the continuous increase in number of patients diagnosed with it, there is not enough supply of the organ. The aim of our study is to assess knowledge about, attitude toward, and willingness to donate kidney among health science students at King Saud bin Abdulaziz University in comparison to the general population in Jeddah and to investigate the factors that play a role on their willingness. Methods: This is an observational, analytical, cross-sectional study design conducted in 2019. Two target populations were included: King Saud bin Abdulaziz University for Health Sciences students and the general population in Jeddah. Data were collected via a self-administered, close-ended, structured, and previously validated questionnaire that contained 39 items divided into four sections. SPSS program version 22 was used in data analysis. Results: Out of 685 surveyed participants, 179 (26.1%) were willing to donate their kidney, with students showing a higher rate of willingness ( N = 101; 32.3%) than the general population ( N = 78; 21%). However, only 46 (6.7%) out of the total population hold an organ donor card. In bivariate analysis, it was found that knowledge significantly associated with a higher rate of willingness among the student population than the general population, while positive beliefs were associated with increased willingness in the general population than students. Positive attitude appeared to play a role in higher willingness among the general population and student population. Conclusion: There is a low perception of awareness regarding kidney donation in both populations of this study. The willingness rate of health science students at King Saud bin Abdulaziz University and the general population was low when compared with other studies conducted internationally., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sharaan, Alsulami, Arab, Alzeair, Elamin, Alsaywid and Lytras.)

The purpose of this systematic review was to describe the characteristics of clinical trials that focused on COVID-19 patients with cytokine release syndrome (CRS) and the variability in CRS definitions. Two authors independently searched three clinical trial registries and included interventional clinical trials on COVID-19 hospitalized patients that required at least one elevated inflammatory biomarker. Relevant data, including the type and cutoff of the measured biomarker, oxygen/respiratory criteria, fever, radiologic criteria, and medications, were summarized. A total of 47 clinical trials were included. The included studies considered the following criteria: oxygen/respiratory criteria in 42 trials (89%), radiologic criteria in 29 trials (62%), and fever in 6 trials (18%). Serum ferritin was measured in 35 trials (74%), CRP in 34 trials (72%), D-dimer in 26 trials (55%), LDH in 24 trials (51%), lymphocyte count in 14 trials (30%), and IL-6 in 8 trials (17%). The cutoff values were variable for the included biomarkers. The most commonly used medications were tocilizumab, in 15 trials (32%), and anakinra in 10 trials (24.4%). This systematic review found high variability in CRS definitions and associated biomarker cutoff values in COVID-19 clinical trials. We call for a standardized definition of CRS, especially in COVID-19 patients.

The aim of the study was to investigate whether lifestyle factors modify the association between fat mass and obesity-associated (FTO) gene single nucleotide polymorphisms (SNPs) and obesity in a Turkish population. The study included 400 unrelated individuals, aged 24-50 years recruited in a hospital setting. Dietary intake and physical activity were assessed using 24-hour dietary recall and self-report questionnaire, respectively. A genetic risk score (GRS) was developed using FTO SNPs, rs9939609 and rs10163409. Body mass index and fat mass index were significantly associated with FTO SNP rs9939609 ( p  = 0.001 and p  = 0.002, respectively) and GRS ( p  = 0.002 and p  = 0.003, respectively). The interactions between SNP rs9939609 and physical activity on adiponectin concentrations, and SNP rs10163409 and dietary protein intake on increased waist circumference were statistically significant ( P interaction  = 0.027 and P interaction  = 0.044, respectively). Our study has demonstrated that the association between FTO SNPs and central obesity might be modified by lifestyle factors in this Turkish population.

Purpose: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is recommended for patients with acute coronary syndrome and after percutaneous coronary intervention with stenting in stable coronary artery disease to help prevent further thromboembolic events. However, there is limited guidance on appropriate strategies for switching between oral P2Y12 inhibitors. The aim of this study was to evaluate safety of switching modalities at our institution and compare them to the recently published expert consensus recommendations., Methods: This was a retrospective, descriptive analysis of patients admitted to Brigham and Women's Hospital from January 2015 to December 2018. Patients were included if they were at least 18 years of age and had documented administrations of two or more oral P2Y12 inhibitors during the same admission. The major safety endpoint was incidence of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, stroke, and non-coronary artery bypass grafting (CABG)-related bleeding) at seven days or until hospital discharge. Minor endpoints included the incidence of in-stent thrombosis, number of patients who received appropriate loading doses (LD) before and after the recently published recommendations, and documented reason for switching between agents., Results: There were 253 patients included in the final analysis. Of these, 83 patients were on clopidogrel as the first agent prior to switching, 9 patients were on prasugrel, and 161 were on ticagrelor. There was no incidence of the primary safety endpoint observed in any group. However, the number of patients who received a LD when switching between oral P2Y12 inhibitors increased from 80.0% to 87.0% after publication of the expert consensus paper. The most common reasons for switching from one agent to another were cost/insurance coverage (19.0%), need for triple therapy (16.0%), and bleeding risk (11.0%)., Conclusion: Different switching modalities were not associated with an increase in MACE at our institution; however, larger randomized controlled trials are warranted., Competing Interests: None., (AJCD Copyright © 2021.)

Background: This study aimed to investigate the relationship between patients with severe sepsis or septic shock being transported to the Emergency Department (ED) by Emergency Medical Services (EMS) and the compliance with the 3-h sepsis resuscitation bundle [Surviving Sepsis Campaign (SSC)], and to compare the management and laboratory results of patients transported by EMS or non-EMS transport., Methods: A retrospective cohort study was conducted using data from a quality-improvement project at King Abdulaziz Medical City in Riyadh. The data for patients who presented to ED with sepsis (severe sepsis or septic shock) was categorized as being transported with EMS or non-EMS. The two groups were compared in terms of compliance with the SSC bundle and 30-day mortality., Results: In a sample of 436 patients with severe sepsis or septic shock presented at the ED during the study period, EMS transported almost one-third of the patients (134, 31%) and 302 patients (69%) used non-EMS transport. For the EMS group, adherence to intravenous fluid was 91.4% compared with 87% for the non-EMS group ( p = 0.19), antibiotics (EMS 50.7% vs non-EMS 52%, p = 0.81), blood cultures before antibiotics (EMS 53% vs non-EMS 47.4%, p = 0.21), and measuring lactate levels (EMS 73.1% vs non-EMS 57%, p = <0.01). The mortality rate was 48.5% for the EMS group and 54% for the non-EMS group, which was not statistically significant., Conclusion: Whether transported with or without EMS did not result in a statistically significant difference in patients presenting with sepsis, in terms of the adherence to the SSC bundle elements or the 30-day hospital mortality rate. The only statistically significant difference was the time to lactate measurement., Competing Interests: The authors declare they have no conflicts of interest., (© 2019 Atlantis Press International B.V.)

Background: Cardiometabolic diseases are complex traits which are influenced by several single nucleotide polymorphisms (SNPs). Thus, analysing the combined effects of multiple gene variants might provide a better understanding of disease risk than using a single gene variant approach. Furthermore, studies have found that the effect of SNPs on cardiometabolic traits can be influenced by lifestyle factors, highlighting the importance of analysing gene-lifestyle interactions., Aims: In the present study, we investigated the association of 15 gene variants with cardiometabolic traits and examined whether these associations were modified by lifestyle factors such as dietary intake and physical activity., Methods: The study included 110 Minangkabau women [aged 25-60 years and body mass index (BMI) 25.13 ± 4.2 kg/m 2 ] from Padang, Indonesia. All participants underwent a physical examination followed by anthropometric, biochemical and dietary assessments and genetic tests. A genetic risk score (GRS) was developed based on 15 cardiometabolic disease-related SNPs. The effect of GRS on cardiometabolic traits was analysed using general linear models. GRS-lifestyle interactions on continuous outcomes were tested by including the interaction term (e.g. lifestyle factor*GRS) in the regression model. Models were adjusted for age, BMI and location (rural or urban), wherever appropriate., Results: There was a significant association between GRS and BMI, where individuals carrying 6 or more risk alleles had higher BMI compared to those carrying 5 or less risk alleles (P = 0.018). Furthermore, there were significant interactions of GRS with protein intake on waist circumference (WC) and triglyceride concentrations (P interaction = 0.002 and 0.003, respectively). Among women who had a lower protein intake (13.51 ± 1.18% of the total daily energy intake), carriers of six or more risk alleles had significantly lower WC and triglyceride concentrations compared with carriers of five or less risk alleles (P = 0.0118 and 0.002, respectively)., Conclusions: Our study confirmed the association of GRS with higher BMI and further showed a significant effect of the GRS on WC and triglyceride levels through the influence of a low-protein diet. These findings suggest that following a lower protein diet, particularly in genetically predisposed individuals, might be an effective approach for addressing cardiometabolic diseases among Southeast Asian women.

Objectives: To investigate the prevalence and severity of maxillofacial fractures resulting from motor vehicle accidents (MVAs) at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia., Materials and Methods: A cross-sectional study of 325 males (89%) and 47 females (9%) was conducted that retrospectively reviewed records of patients referred to oral and maxillofacial surgery department from emergency department from 1st January 2016 to 31st December 2017 at KAMC, Riyadh., Results: A total of 372 subjects were included in the study. MVAs (80%) were the most prevalent cause of trauma. The age range most susceptible to MVAs was between 20 and 24 years old (28%). The most common site of fracture was the midface (64%), specifically orbit (32%). For mandibular fractures, the subcondylar was the most common site of fractures (19%). The most common treatment approach was conservative (65%). In terms of severity, approximately half of patients needed admission to the intensive care unit (ICU) (50%); the mean score on the Glasgow Coma Scale (GCS) was 11.34, but most scores fell in the mild range; and (68%) of subjects presented with other associated systemic injuries, especially orthopedic injuries (36%)., Conclusions: MVAs were the main cause of trauma and affected mainly young males. The most common site of fracture was midface, specifically orbit. Subcondylar was the most prevalent fracture site for mandibular fractures. The severity of MVAs injuries was significantly higher compared to non-MVAs injuries. We suggest enforcing legislation and regulations on road safety such as the use of compulsory seat belts., Competing Interests: None., (© 2019 The Authors.)

Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, P interaction = 0.01; saturated fatty acids (SFA), P interaction = 0.02; polyunsaturated fatty acids (PUFA), P interaction = 0.01 and monounsaturated fatty acids (MUFA), P interaction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity., Competing Interests: The authors declare no conflict of interest.

Background: To search for new prevention markers for early detection of the diseases caused by tobacco, we aimed to investigate the polymorphisms in TSLP and TSLPRs associated with cigarette smoking in the Saudi population., Materials and Methods: Samples were collected from 177 smokers and 126 healthy controls. Three TSLP SNPs [rs3806933, rs2289276, and rs10043985], three TSLPR SNPs [rs36133495, rs36177645, and rs36139698], and two IL7R SNPs rs1053496 and rs12516866 were analyzed by genotyping., Results: Two TSLP SNPs (rs10043985 and rs3806933) and one TSLPR SNP (rs36139698) showed significant correlations with smoking behavior, but not IL7R rs12516866 and rs1053496. rs10043985 showed a clear association with long-term smoking regardless of daily cigarette consumption. rs2289276 was associated with short-term smoking but not with daily cigarette consumption. rs3806933 was highly associated with different smoker subgroups. Rs36139698 was highly associated with long-term smokers who consumed ≥20 cigarettes/day, and the "T" allele was associated only with individuals who smoked ≤20 cigarettes/day. Rs36139698 corresponds to a P195L substitution and produces a TSLPR mutant with a predicted ΔΔG increase of 2.15 kcal/mol and has a more stable structure than the wild-type variant., Conclusions: Investigating TSLP and TSLPR polymorphisms is crucial for elucidating the mechanisms underlying tobacco-induced diseases., (© 2019 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.)

Importance: Many patients with an open radical mastoid cavity experience therapy-resistant otorrhea. Little is known about the underlying histopathological substrate of unstable cavities and the correlation with treatment failure., Objective: To study the histopathological and inflammatory features of chronically discharging open radical mastoid cavities and the influence of different treatments., Design, Setting, and Participants: This secondary analysis of a randomized clinical trial was a histopathology study of tissue samples of a cohort of 30 patients with a chronically discharging open mastoid cavity. Samples were taken from the cavities, which were treated with either honey gel or conventional eardrops in a tertiary center between 2012 and 2013. Tissue staining was performed in May 2014; final computer analysis/correlation studies were performed in June 2016., Main Outcomes and Measures: Differences of epithelial tissue coverage, infiltration of T cells (CD3, CD4, CD8) and macrophage (CD68, isoenzyme nitric oxide synthase, arginase 1) (sub-)populations, infection status, and the correlation with clinical presentation., Results: There were 30 patients (24 [80%] male; mean [SD] age, 59 [14] years). Cavities were covered with either stratified squamous (keratinized) epithelium (n = 10), respiratory columnar epithelium (n = 9), or granulation tissue (n = 10). The presence of respiratory epithelium was associated with lower treatment success (posttreatment VAS improvement of 3.1 [95% CI, 0.5 to 5.8] for discomfort and 3.6 [95% CI, 0.2 to 6.9] for otorrhea in the group with granulation tissue coverage vs 4.9 [95% CI, 0.2 to 9.6] and 5.8 [95% CI, -0.1 to 11.6] in the group with squamous [keratinized] epithelium coverage and 1.4 [95% CI, -1.2 to 4.1] and 2.5 [95% CI, -1.3 to 6.2] in the group with respiratory columnar epithelium coverage). In all 3 tissue types of cavity-covering tissues, T-cell infiltrates consisted of helper T cells and cytotoxic T cells, together with a lower number of macrophages. The immunopositivity for isoenzyme nitric oxide synthase and arginase 1 was high and not restricted to a macrophage subpopulation, but seen in various cell types. Inflammatory infiltrations varied strongly in all 3 tissue modalities., Conclusions and Relevance: Discharging open mastoid cavities can be classified histologically into 3 different types, based on their coverage: squamous epithelium, respiratory epithelium, or granulation tissue. Treatment is less successful in cavities covered with respiratory epithelium, possibly explained by the status of bacterial infection and local immunological differences.

Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular or interstitial disease, and pregnant women were excluded. Thirty-eight patients were enrolled from March 2012 to December 2013. The primary outcome was LOS. Secondary outcomes included: 30-day readmission, in-hospital mortality, determinants of LOS, and patient-centered outcomes. Eighteen patients were randomized to PC, and 20 to UC. Baseline characteristics were comparable in both groups. Using an intention-to-treat analysis, the median LOS was 4.96 [interquartile range (IQR) 6.57] and 4.80 days (IQR 6.84) for PC and UC, respectively (P = 0.770). Of the five readmissions, none were for AKI. No in-hospital mortality was reported. The CHAMP-Path AKI pragmatic trial demonstrated that PC was not different than UC in reducing LOS. There was no difference in 30-day re- admission, in-hospital mortality, and patient-centered outcomes.