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Faten A AlRadini,1 Abdulrahman Y Sabbagh,2 Fahad A Alamri,3 Yasir Almuzaini,4 Yousef M Alsofayan,5 Ahmed A Alahmari,4 Anas A Khan,6 Samar A Amer,7 Reem C Alanazi,8 Ibrahim F Alanazi,8 Ahmed A Shubayli,9 Rola M Alkenani,10 Bandr Mzahim,11 Nisreen Maghraby,12 Abdulaziz M Salamah,13 Muna Aljahany1 1Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Emergency Medicine, King Fahad Medical City, Second Health Cluster, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 3Global Center of Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia, Family Medicine Department, Primary Health Center, Riyadh, Saudi Arabia; 4Global Center of Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia; 5General Directorate of Data and Research, Saudi Red Crescent Authority, Riyadh, Saudi Arabia; 6Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Department of Chronic Diseases, Ministry of Health, Riyadh, Saudi Arabia; 8Vision College of Medicine, Vision Colleges, Riyadh, Saudi Arabia; 9Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 10Department of Nephrology Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia; 11Emergency Medicine, EMS and Disaster Department, King Fahad Medical City, Riyadh, Saudi Arabia; 12Emergency Medicine Department, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 13Mohammadiah Primary Healthcare, Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Muna Aljahany, Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966118238711, Email msaljahany@pnu.edu.saBackground: The likelihood of survival of an out-of-hospital cardiac arrest quadruples with the rapid application of basic life support (BLS). The public’s ability to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AEDs) is extremely important. This study aimed to assess the public knowledge, attitudes, and practices (KAP) of utilizing AEDs and to understand barriers to AED application.Methods: We conducted a cross-sectional study from March 1– 30, 2022. An electronic questionnaire was constructed and validated to measure the KAP for public AED utilization and its barriers.Results: Of the 406 participants, 244 (60.10%) were males. Male respondents had 17% less knowledge and poorer attitude towards using an AED as compared to female respondents. Knowledge and attitudes on using AEDs were low (70.7%) among Saudi nationals compared to those of foreign nationals. Those who were BLS/CPR trained had a 2.5 times greater understanding and willingness to use AEDs in public than those who were not. Barriers to AEDs in CPR/BLS-trained participants were: (1) accidentally hurting the victim (14.3%), (2) duty as a bystander to just call the ambulance and wait for help (12.1%), (3) never taught what to do (n = 41, 18.4%), (4) did not want to be scolded if performed wrong (3.1%), and (5) never witnessed such a situation (51.6%).Conclusion: There is a strong association between knowledge of and willingness to use AEDs in emergency situations among the public. Misconceptions about AEDs hinder their use. This calls for urgent training programs through accessible technology to reach the public.Keywords: automated external defibrillator, AED, public, cardiac arrest

Nisreen H Maghraby,1 Hassan M Alshaqaq,2 Abdullah Saleh AlQattan,3 Adnan Fawzi Alfaraj,4 Omar A Alghamdi,2 Malak J Alzawad,5 David A Farcy6 1Department of Emergency Medicine, King Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, AlKhobar, Kingdom of Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 3Department of General Surgery, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia; 4Department of Emergency Medicine, King Fahad Specialist Hospital-Dammam, Kingdom of Saudi Arabia; 5Department of Psychiatry, Ministry of Health, Dammam, Kingdom of Saudi Arabia; 6Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida, USACorrespondence: Nisreen H MaghrabyKing Fahd University Hospital-College of Medicine, Imam Abdulrahman Bin Faisal University, 6844 King Faisal University City, Dammam 3026-34211, Saudi ArabiaTel +966504807318Email nhmaghraby@iau.edu.saBackground: Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients.Patients and Methods: A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥ 18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients.Results: A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥ 3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation < 94% and GCS ≤ 8 were associated with positive CT scans.Conclusion: Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.Keywords: negative rate, whole-body, selective, computed tomography, multiple, polytrauma, MVCs

Doxorubicin (DOX) is a commonly used chemotherapeutic medication for treating malignancies, although its cardiotoxicity limits its use. There is growing evidence that alteration of the mitochondrial fission/fusion dynamic processes accompanied by excessive reactive oxygen species (ROS) production and alteration of calcium Ca 2+ homeostasis are potential underlying mechanisms of DOX-induced cardiotoxicity (DIC). Metformin (Met) is an AMP-activated protein kinase (AMPK) activator that has antioxidant properties and cardioprotective effects. The purpose of the study is to assess Met's possible cardioprotective benefits against DOX-induced cardiotoxicity. The study included 32 adult male rats. They were randomly divided into four groups: administered saline, DOX, Met, or DOX combined with Met respectively. Heart tissues were used for biochemical assays that measured oxidative stress markers, malondialdehyde (MDA), reduced glutathione (GSH), mitochondrial dynamics markers, optic atrophy-1(OPA-1) and dynamin-1-like protein (Drp1), calcineurin and caspase-3. Serum levels of myocardial injury markers, cardiac troponin I (cTn-I), and aspartate aminotransferase (AST), were also measured. The results revealed that DOX intoxication was associated with a significant increase in the levels of serum cTn-I and AST, increased cardiac MDA level, increased cardiac Drp1, calcineurin, and caspase-3 expressions, as well as reduced cardiac GSH level and cardiac OPA-1 expression. On the other hand, Met treatment significantly reduced DIC by decreasing oxidative stress, apoptosis, and improving mitochondrial and calcium balance. Finally, this study shows that Met may be able to protect the heart from damage caused by DOX by working as an antioxidant and anti-apoptotic agent and keeping the balance of calcium and mitochondria., Competing Interests: Declarations. Ethics Approval: This study was performed according to the principles and guidelines given by the Animal Research Ethics Committee, Faculty of Medicine, Assiut University (26/6/2023, IRB local approval number 04–2023-300201). Consent to Participate: Not applicable. Consent for Publication: Not applicable. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Anaphylaxis is known as an acute, severe hypersensitivity reaction that rapidly initiates after exposure to a triggering agent. It is a life-threatening condition, and early recognition and swift intervention are crucial to saving patients' lives. Objective: The objective of this study is to assess the ability of certified non-critical care physicians to recognize, manage, and dispose cases of anaphylaxis., Methods: A survey consisting of 19 questions was developed by expert emergency consultants to evaluate physicians' knowledge regarding the recognition, management, and disposition of anaphylactic episodes. Responses were collected through in-person surveys conducted with physicians from various specialties and varying clinical experience levels at a tertiary care center in the Eastern Province of Saudi Arabia., Results: In this cross-sectional study, a total of 173 physicians completed the survey, with 81.5% being consultants and 18.5% specialists. Only 5.2% correctly identified all three proposed anaphylaxis clinical scenarios, 16.8% identified two scenarios correctly, and 51.4% identified only one scenario. While 42.8% recognized the first-line management of anaphylaxis, only 24.3% and 24.9% knew the correct epinephrine dose and route, respectively. Regarding the disposition of patients experiencing an anaphylactic episode, 61.9% of responders opted to dispose the case to the emergency department., Conclusion: Our study reveals a knowledge gap among non-critical care physicians practicing in a tertiary care center concerning the identification and management of anaphylaxis. Raising awareness of this life-threatening condition is imperative to address this serious issue., Competing Interests: There are no conflicts of interest., (© 2024 Dalal Almarri, Fatimah Badghaish, Dalal Albaiji, Areen Alamri, Rawan Alghamdi, Rehab Alghamdi, Nisreen Maghraby,, Faisal Alkhadra.)

Background: COVID-19 pandemic has thrown the healthcare systems into confusion worldwide, resulting in major modifications on the practice due to fear of exposure to this virus and its fatal consequences., Objective: the study aimed to establish the prevalence of COVID-19 in cardiac arrest patients., Methods: single-centered, Retrospective, observational cohort study that included all patients who presented to ED during the period of the pandemic from January 2021 to May 2022 and documented to have either IN-hospital cardiac arrest (IHCA), specifically within the ED, or OUT-hospital cardiac arrest (OHCA)., Results: This study analyzed 177 patients. Out of which, 30.5% of the patients were aged more than 70 years old. Those with associated comorbidities, the most frequently mentioned comorbidity was hypertension (40.7%). It was found that the prevalence of positive COVID-19 infection was significantly more common among non-Arab (p=0.019), patients with associated chronic kidney disease (p=0.019) and those who had an in-hospital cardiac arrest (p=0.010). No significant associations were observed between COVID-19 infection in terms of age, gender, nationality, associated comorbidities, symptoms, and trauma (all p>0.05)., Conclusion: This study showed the prevalence of COVID-19 among cardiac arrest patients within ED and outside the hospital in our study population. Based on the study's results, the major adjustments in practice were not absolutely needed. Also, this study could help in establishing a good mitigation strategy for at-risk patients., Competing Interests: Authors declare that there are no potential conflicts of interest., (© 2023 Nisreen Maghraby, Abdullah Alshahrani, Mohannad Alghamdi, Abdullah Alzahid, Mohammad Almulhim, Khalid Alshahrani.)

Background: Saudi Arabia has made extensive efforts to manage disasters using unique national approaches; however, challenges and obstacles concerning disaster health handling persist. The nation has a reactive strategy to disaster management with a need for increased involvement of health professionals in disaster management and improvement of healthcare facilities emergency preparedness including competency-based education training., Objective: A comprehensive and consistent approach of disaster education programs for short and intermediate training of health professionals involved in disaster responses in Saudi Arabia is still not evident. Therefore, it is vital to explore and map the current state of the disaster education framework in Saudi Arabia., Methods: The Joanna Briggs Institute approach for scoping reviews was used to assess research articles and preprints between January 2000 and September 2021 from Saudi Digital Library; PubMed, CINAHL, and Google Scholar. Five experts identified key aspects of the disaster education approach and eligibility criteria to facilitate identification of relevant articles., Results: Only five articles met the specified criteria and described two short and three intermediate courses on disaster health management in Saudi Arabia. All courses involved competency-specific training aimed at basic or foundational level and involved a range of activities and learning types. None had refresher courses within 12 months., Conclusion: The review highlights the obvious scarcity of short and intermediate term evidence-based disaster health programs in Saudi Arabia. Adoption of the education framework proposed by the authors based on international frameworks could improve the quality and consistency of the disaster education curriculum in Saudi Arabia., 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 © 2022 Bajow, Mortelmans, Maghraby, Alatef Sultan, Mani and Aloraifi.)

Background: Mass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia., Methods: A mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment., Results: The overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents., Conclusion: Delivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims., (© 2022. The Author(s).)

Uterine fibroids (UF) represent an immense health burden throughout the world. Obesity is considered one of the risk factors for UF development; however, the underlying mechanisms remain largely unexplored. We investigated the effect of obesity on fibroblast activation and its association with inflammation, autophagy dysfunction, and oxidative stress in UF patients. Thirty-five pre-menopausal UF patients were included in this study and classified into non-obese group (BM1 ≤ 30 kg/m 2 , n = 15) and obese group (BMI > 30 kg/m 2 , n = 20). Tissue samples were collected from fibroids and adjacent normal myometrium. Our results showed increased expression of fibroblast activation protein (FAP) together with markers of autophagy, inflammation, and oxidative stress in UF patients, which were all more markedly upregulated in obese compared to non-obese patients. In addition, BMI was significantly positive correlated with FAP and autophagy markers. In conclusion, the results of the present study suggest that obesity-associated autophagy dysregulation together with increased FAP expression may increase the risk of UFs in obese women., (© 2021. Society for Reproductive Investigation.)

Background: To illustrate the impact of the implementation of a multidisciplinary TTL program in 2005 on the mortality of trauma patients in a level 1 trauma center as well as admission rates and length of stay., Methods: Retrospective observational study of all trauma patients included in the provincial trauma database at the Montreal General Hospital between 1998 and 2015. The primary outcome studied was in-hospital mortality. The secondary outcomes studied were hospital and intensive care unit (ICU) rates of admission and hospital and ICU length of stay., Results: 24,107 patients were included. We observed a statistically significant reduction in mortality of 1.25% or a relative reduction of 16% ( p value = 0.0058; rate ratio 0.844 (95% CI 0.747-0.952)). ICU admissions were also significantly reduced where we observed a statistically significant absolute reduction of 4.46% or a relative reduction of 14% ( p value = 8.38 × 10 -7 ; rate ratio 0.859 (95% CI 0.808-0.912)). The ICU length of stay was increased by 0.91 days or 19.03% ( p value = 0.016 (95% CI 0.167-1.655)). There was no observed change in overall length of stay (13.97 days pre-TTL and 12.91 post-TTL ( p value = 0.13; estimate -1.053 (95% CI -2.424-0.318)))., Conclusions: This article suggests that multidisciplinary TTL model may be beneficial in the care of trauma patients. Further subgroup analysis may help determine which patients could benefit more., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Olivier Lavigueur et al.)

IntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility's human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method., Methods: This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form., Results: There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as "less personal" than the manual triage method, but they also perceived the former as "better organized.", Conclusion: Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs. BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273-278.

Accumulating evidence indicates that leukotriene B4 (LTB4) via its receptors BLT1 and/or BLT2 (BLTRs) could have an important role in regulating infection, tumour progression, inflammation, and autoimmune diseases. In the present study, we showed that LTB4 not only augments cytotoxicity by NK cells but also induces their migration. We found that approximately 30% of fresh NK cells express BLT1, 36% express BLT2, and 15% coexpress both receptors. The use of selective BLTR antagonists indicated that BLT1 was involved in both LTB4-induced migration and cytotoxicity, whereas BLT2 was involved exclusively in NK cell migration, but only in response to higher concentrations of LTB4. BLT1 and BLT2 expression increased after activation of NK cells with IL-2 and IL-15. These changes of BLTR expression by cytokines were reflected in enhanced NK cell responses to LTB4. Our findings suggest that BLT1 and BLT2 play differential roles in LTB4-induced modulation of NK cell activity.

Patients requiring airway management in the emergency department present an enormous challenge. It requires not only a firm concept of techniques for securing the airway but also of dealing with the potential difficult airway (DA) in which establishing a definite airway is not possible with techniques routinely used. This article highlights the importance of recognition and management of the DA in emergent situations. Both awake and nonawake intubation are discussed, and indications and guidelines are given for the use of nonsurgical and surgical airway interventions., (Copyright © 2012 Elsevier Inc. All rights reserved.)