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Background: Palliative care (PC) plays a crucial role in improving the quality of life for terminally ill patients and their families. In Saudi Arabia, the Reform of Healthcare Vision 2030 has recognized the importance of PC and aimed to enhance its availability and quality. Objectives: This study evaluates the current state of PC in Saudi Arabia post-Vision 2030 reforms. Design: A cross-sectional survey-based research was conducted at a ministry of health health care facility to assess the accessibility and quality of PC services. Setting/Subjects: The survey collected quantitative and qualitative data from PC managers in Saudi Arabia. Retrospective analysis of annual death records determined the demand for PC. Results: The results indicate notable progress in developing PC services in Saudi Arabia, including increased number of PC units, community home care services, outpatient services, and consultations. However, challenges persist in terms of geographical distribution, resource allocation, and availability of pain medications, particularly opioids. The study highlights the substantial need for PC for both cancer and noncancer patients, emphasizing the importance of expanding these services. Conclusions: To further improve PC, policymakers and stakeholders should prioritize resource allocation, health care workforce, and access to pain medications. These efforts will address the growing demand for PC and benefit terminally ill patients and their families in Saudi Arabia. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into 'pre-COVID-19' and 'during COVID-19' groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83–0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37–0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions. [ABSTRACT FROM AUTHOR]

Background: Organ transplantation is inherently dependent on the availability of organ donors. There is a noticeable paucity of literature addressing the rates of organ donation registration and the awareness of Islamic regulations (Fatwa) regarding organ donation within Saudi Arabia. Our study aimed to evaluate the level of organ donation registration, awareness of Islamic regulations, and knowledge of the Saudi Center for Organ Transplantation (SCOT) within the Saudi society. Methods: We conducted a cross-sectional survey from 30 March to 9 April 2023. This survey aimed to assess the awareness of Islamic (Fatwa) guidance on organ donation, the role of SCOT, and the rate of organ donation registration facilitated through the Tawakkalna app, the official health passport application in Saudi Arabia. Results: Out of 2329 respondents, 21% had registered as potential deceased organ donors, despite 87% acknowledging the importance of organ donation. Awareness of the Islamic Fatwa regarding organ donation was reported by 54.7% of respondents, and 37% recognized the Fatwa's acceptance of brain death criteria. The likelihood of registration as organ donors was higher among Saudi citizens under 45 years of age, females, healthcare workers (HCWs), individuals with higher education, relatives of patients awaiting organ donations, those informed about the Islamic Fatwas, and those willing to donate organs to friends. Conversely, being over the age of 25, Saudi nationality, employment as an HCW, awareness of SCOT, and prior organ donation registration were predictive of a heightened awareness of Islamic Fatwas. However, perceiving the importance of organ donation correlated with a lower awareness of the Fatwas. Significant positive correlations were found between awareness of SCOT, awareness of Fatwas, and registration for organ donation. Conclusions: While the Saudi population exhibits a high regard for the importance of organ donation, this recognition is not adequately translated into registration rates. The discrepancy may be attributable to limited awareness of SCOT and the relevant Islamic Fatwas. It is imperative to initiate organ donation awareness campaigns that focus on religious authorization to boost organ donation rates and rectify prevalent misconceptions. [ABSTRACT FROM AUTHOR]

Background and objectives Obesity is a major global health concern linked with increased risk of chronic diseases. This study aimed to assess the levels of fibroblast growth factor 21 (FGF21) in subjects with obesity after gastric sleeve surgery and explore its correlation with lipid and glycemic parameters. Methods This retrospective cohort study included 28 obese male subjects aged 25 to 50 years, undergoing gastric sleeve surgery. Plasma levels of FGF21 were measured by enzyme-linked immunosorbent assay (ELISA) before and six to 12 months after surgery. Other parameters including body mass index (BMI), fasting glucose, lipid profile, and insulin were also assessed and homeostatic model assessment (HOMA) was used to estimate insulin resistance. Results There was a significant increase in systemic FGF21 levels after surgery (45.12 vs. 126.16 pg/mL, p = 0.007). There was also a notable reduction in BMI (51.55 vs. 39.14, p < 0.001), insulin levels (20.06 vs. 8.85 mIU/L, p < 0.001), HOMA scores (6.94 to 2.49, p < 0.001), and glucose levels (7.33 vs. 6.08, p = 0.039). Lipid profile analysis post-surgery showed an increase in total cholesterol (4.38 vs. 5.09 mmol/L, p < 0.001) and high-density lipoprotein (HDL) (0.88 vs. 1.52 mmol/L, p < 0.001), with a decrease in triglycerides (1.75 vs. 1.01 mmol/L, p = 0.007). FGF21 positively correlated with growth hormone (GH), p = 0.0015, r = 0.59, and with insulin like growth factor 1 (IGF-1), p = 0.03, r = 0.431. Conclusion FGF21 levels were increased following gastric sleeve surgery in obese male patients and were positively correlated with growth hormone and insulin IGF-1. These findings provide insights into the metabolic alterations following bariatric surgery and highlight the potential role of FGF21 as an important molecule in obesity management and treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB), College of Medicine, King Saud University issued approval E-21-6147. Dear Dr. Khalid Abdullah Alregaiey, I am pleased to inform you that your above-mentioned research project submitted to the IRB was reviewed and approved on 27 November 2022 (3 Jumada I 1444). You are now granted permission to conduct this study given that your study does not disclose participant’s identity and poses no risk to the patients. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Regaiey et al.)

Background: Artificial intelligence (AI) chatbots have recently gained use in medical practice by health care practitioners. Interestingly, the output of these AI chatbots was found to have varying degrees of hallucination in content and references. Such hallucinations generate doubts about their output and their implementation., Objective: The aim of our study was to propose a reference hallucination score (RHS) to evaluate the authenticity of AI chatbots' citations., Methods: Six AI chatbots were challenged with the same 10 medical prompts, requesting 10 references per prompt. The RHS is composed of 6 bibliographic items and the reference's relevance to prompts' keywords. RHS was calculated for each reference, prompt, and type of prompt (basic vs complex). The average RHS was calculated for each AI chatbot and compared across the different types of prompts and AI chatbots., Results: Bard failed to generate any references. ChatGPT 3.5 and Bing generated the highest RHS (score=11), while Elicit and SciSpace generated the lowest RHS (score=1), and Perplexity generated a middle RHS (score=7). The highest degree of hallucination was observed for reference relevancy to the prompt keywords (308/500, 61.6%), while the lowest was for reference titles (169/500, 33.8%). ChatGPT and Bing had comparable RHS (β coefficient=-0.069; P=.32), while Perplexity had significantly lower RHS than ChatGPT (β coefficient=-0.345; P<.001). AI chatbots generally had significantly higher RHS when prompted with scenarios or complex format prompts (β coefficient=0.486; P<.001)., Conclusions: The variation in RHS underscores the necessity for a robust reference evaluation tool to improve the authenticity of AI chatbots. Further, the variations highlight the importance of verifying their output and citations. Elicit and SciSpace had negligible hallucination, while ChatGPT and Bing had critical hallucination levels. The proposed AI chatbots' RHS could contribute to ongoing efforts to enhance AI's general reliability in medical research., (©Fadi Aljamaan, Mohamad-Hani Temsah, Ibraheem Altamimi, Ayman Al-Eyadhy, Amr Jamal, Khalid Alhasan, Tamer A Mesallam, Mohamed Farahat, Khalid H Malki. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 31.07.2024.)

Background: The integration of artificial intelligence (AI) chatbots like Google's Bard, OpenAI's ChatGPT, and Microsoft's Bing Chatbot into academic and professional domains, including cardiology, has been rapidly evolving. Their application in educational and research frameworks, however, raises questions about their efficacy, particularly in specialized fields like cardiology. This study aims to evaluate the knowledge depth and accuracy of these AI chatbots in cardiology using a multiple-choice question (MCQ) format., Methods: The study was conducted as an exploratory, cross-sectional study in November 2023 on a bank of 100 MCQs covering various cardiology topics that was created from authoritative textbooks and question banks. These MCQs were then used to assess the knowledge level of Google's Bard, Microsoft Bing, and ChatGPT 4.0. Each question was entered manually into the chatbots, ensuring no memory retention bias., Results: The study found that ChatGPT 4.0 demonstrated the highest knowledge score in cardiology, with 87% accuracy, followed by Bing at 60% and Bard at 46%. The performance varied across different cardiology subtopics, with ChatGPT consistently outperforming the others. Notably, the study revealed significant differences in the proficiency of these chatbots in specific cardiology domains., Conclusion: This study highlights a spectrum of efficacy among AI chatbots in disseminating cardiology knowledge. ChatGPT 4.0 emerged as a potential auxiliary educational resource in cardiology, surpassing traditional learning methods in some aspects. However, the variability in performance among these AI systems underscores the need for cautious evaluation and continuous improvement, especially for chatbots like Bard, to ensure reliability and accuracy in medical knowledge dissemination., Competing Interests: The authors report no personal or financial conflict of interests to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The electrophysiology field has progressed rapidly over the last 2 decades. No study has examined the characteristics of patients and types of electrophysiology procedures performed in the Kingdom of Saudi Arabia. This is important given our distinctly different demographic composition and health system. As such, we sought to describe the characteristics of consecutive patients presenting for electrophysiology procedures in our tertiary care hospital., Methods: Data was collected from the electrophysiology database at King Khalid University Hospital for procedures performed between April 2016 and November 2022. Patients' characteristics were retrieved from the electronic medical record. Procedures were categorized into supraventricular tachycardia, premature ventricular contraction and "complex ablations", which included atrial fibrillation and scar-mediated ventricular tachycardia ablation. If no abnormality was found, the procedure was labeled as "normal EP study". Multivariate regression analysis was performed to assess predictors of atrioventricular nodal reentry tachycardia among patients presenting with undifferentiated supraventricular tachycardia., Results: A total of 459 patients were included in the study. The mean age was 42.06 years (±14.89 years), and 256 (55.77 %) were females. The most common procedure was supraventricular tachycardia (n = 289/459, 63.24 %), and only 5 % had complex ablations. The most common type of supraventricular tachycardia ablated was found to be atrioventricular nodal reentry tachycardia (n = 157/289, 54 %). Multivariate logistic regression revealed female sex and age to be independently associated with atrioventricular nodal reentry tachycardia (OR = 2.27 95 % CI [1.40-3.67]) for female sex and (OR = 1.02 95 % CI [1.01-1.04]) for every increase in age by 1-year., Conclusion: We reported a younger average age than other countries and less complex ablations. In addition, we reported 2 independent predictors of atrioventricular nodal reentry tachycardia in patients presenting with undifferentiated supraventricular tachycardia. Larger studies including multiple centers should be performed to confirm our findings., Competing Interests: Conflicts of interest: None declared., (© 2023 Saudi Heart Association.)

Background: Snakebites, particularly from venomous species, present a significant global public health challenge. Access to accurate and timely information regarding snakebite prevention, recognition, and management is crucial for minimizing morbidity and mortality. Artificial intelligence (AI) language models, such as ChatGPT (Chat Generative Pre-trained Transformer), have the potential to revolutionize the dissemination of medical information and improve patient education and satisfaction., Methods: This study aimed to explore the utility of ChatGPT, an advanced language model, in simulating acute venomous snakebite consultations. Nine hypothetical questions based on comprehensive snakebite management guidelines were posed to ChatGPT, and the responses were evaluated by clinical toxicologists and emergency medicine physicians., Results: ChatGPT provided accurate and informative responses related to the immediate management of snakebites, the urgency of seeking medical attention, symptoms, and health issues following venomous snakebites, the role of antivenom, misconceptions about snakebites, recovery, pain management, and prevention strategies. The model highlighted the importance of seeking professional medical care and adhering to healthcare practitioners' advice. However, some limitations were identified, including outdated knowledge, lack of personalization, and inability to consider regional variations and individual characteristics., Conclusion: ChatGPT demonstrated proficiency in generating intelligible and well-informed responses related to venomous snakebites. It offers accessible and real-time advice, making it a valuable resource for preliminary information, education, and triage support in remote or underserved areas. While acknowledging its limitations, such as the need for up-to-date information and personalized advice, ChatGPT can serve as a supplementary source of information to complement professional medical consultation and enhance patient education. Future research should focus on addressing the identified limitations and establishing region-specific guidelines for snakebite management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Altamimi et al.)