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Alsabri MAH, Alqeeq BF, Elshanbary AA, Soliman Y, Zaazouee MS, Yu R. Knowledge and skill level among non-healthcare providers regarding cardiopulmonary resuscitation (CPR) training in the Middle East (Arab countries): a systematic review and meta-analysis. BMC Public Health 2024; 24:2081. [PMID: 39090594 PMCID: PMC11295602 DOI: 10.1186/s12889-024-19575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Effective education is considered by the American Heart Association (AHA) as a vital variable in improving outcomes of cardiac arrest. Studies have shown that the level of knowledge and attitude of non-healthcare providers towards resuscitation training varies widely across the globe. While some training methods and barriers to training have been discussed, the literature is still quite vague and unclear regarding resuscitation training, particularly in the Middle East. This study's focus on the efficacy of resuscitation training in this region of the world may help dictate how to better implement education initiatives aimed towards non-healthcare providers in developing countries. METHODOLOGY A systematic review and meta-analysis were conducted on studies published from inception until March 2023. Observational studies assessing CPR knowledge and skills among non-healthcare workers in Arab countries were included. Data were extracted from PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus. Data analysis was performed using Rstudio with a random effects model. RESULTS 50 studies were included in this review and meta-analysis, revealing that 55% of participants had prior knowledge of CPR, while only 28% considered their knowledge sufficient. The majority (76%) supported mandatory CPR training, and 86% were willing to attend training if offered. This study found that prior knowledge of cardiopulmonary resuscitation (CPR) varied among populations. This meta-analysis also compiled results regarding CPR technique defined by correct compression to ventilation ratio, compression depth, compression rate, location of chest compression, and correct sequence. The overall results from this meta-analysis showed that, of these factors, compression rate and depth were the two factors that were most often administered incorrectly. In all, the results from this study demonstrated that CPR training in Arab countries was favorably viewed overall, with the majority of participants indicating both support for mandatory CPR training and general willingness to attend training if offered the opportunity. CONCLUSION Given the overall positive view and willingness to learn CPR skills, healthcare policy makers should adopt a more comprehensive focus on strategies that enhance the accessibility and opportunity for CPR training for non-healthcare populations in Arab countries. Future training programs should implement strategies to highlight the ideal combination of compression rates and depth to learners to ensure correct and efficacious delivery of CPR with increased focus on the practical portion during refresher courses to promote retention.
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Affiliation(s)
- Mohammed Alsabri Hussein Alsabri
- Emergency Department, Al-Thawra Modern General Hospital, Sana'a, Yemen.
- Pediatric Emergency Department, Department of Pediatrics, St. Christopher's Hospital, Philadelphia, PA, USA.
| | - Basel F Alqeeq
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | | | - Rebecca Yu
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
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Alzelfawi LA, Alhumaidan NI, AlDosari LM, Aldayel GF, Alzoum NM, Alsliham RB, Alawadh AA, AlMazyad DM, Alrizqi AA, Abdelrahman DS, Fayed AA, Goda AM. Readiness of University Students in Riyadh to Participate in Basic Life Support Programs: A Cross-Sectional Study. Cureus 2024; 16:e64749. [PMID: 39156297 PMCID: PMC11329184 DOI: 10.7759/cureus.64749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Out-of-hospital cardiac arrest is one of the greatest causes of death in the world. When basic life support (BLS) techniques are performed rapidly, the odds of survival increase. The aim of this research is to assess the university students' preparation and knowledge level regarding their interest in participating in BLS. Methods A cross-sectional study using an online self-administered questionnaire was conducted between January 20 and March 20, 2022. The questionnaire addressed awareness about BLS, willingness to participate in such courses, perceived barriers and incentives, and course uptake, in addition to the sociodemographic profile of participants. Logistic regression analysis was used to identify the factors significantly associated with the willingness to participate in BLS courses and the associations are reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results A total of 1,546 students completed the questionnaire; almost half of them (n=761, 49.2%) were aged 17 to 21 and the majority were females (n=1,132, 73.2%). Only one-third of the population had heard about BLS (n=519, 33.6%), 27.1% (n=419) recognized where to register for BLS training, and 20.3% (n=314) had taken a BLS course. Most participants (n=1,081, 69.9%) demonstrated a low level of awareness. Conversely, a substantial portion (n=1,204, 77.9%) expressed a personal interest in undertaking the course. It was observed that participants who are affiliated with healthcare specialties (AOR = 5.96, 95% CI = 4.66-7.63, p<0.05) exhibited greater knowledge about BLS, while females (OR = 2.49, 95% CI = 1.52-4.08, p<0.05) and those in healthcare specialties (OR = 2.23, 95% CI = 1.29-3.82, p<0.05) displayed a notably higher inclination to enroll in BLS courses compared to their counterparts. Conclusion Despite the limited awareness of BLS among university students, there is a strong willingness to engage in BLS courses. It is crucial to motivate students to partake in these courses and emphasize the availability of accredited centers for their education institutes.
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Affiliation(s)
- Lama A Alzelfawi
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | | | - Lena M AlDosari
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Ghadah F Aldayel
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Nora M Alzoum
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Rahaf B Alsliham
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Afnan A Alawadh
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Dimah M AlMazyad
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Amjad A Alrizqi
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Doaa S Abdelrahman
- Clinical Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Amel A Fayed
- Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Amal M Goda
- Public Health, Faculty of Medicine, Ain Shams University, Riyadh, SAU
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Hasnain S, Hussan J, Khan L, Muhammad S, Kamal K, Sawaira, Hayat U, Abbasi A, Akhlaq M, Ahmad A, Ahmad K. Factors affecting knowledge and attitude of healthcare workers towards basic life support in Khyber Teaching Hospital, Peshawar, Pakistan: a cross-sectional analysis. BMJ Open 2023; 13:e073369. [PMID: 37666556 PMCID: PMC10481732 DOI: 10.1136/bmjopen-2023-073369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE This study was conducted to assess the knowledge and attitude of healthcare workers towards basic life support (BLS) in Khyber Teaching Hospital, Peshawar, and to investigate the factors affecting them. DESIGN Cross-sectional study. SETTING This study was carried out in a tertiary care hospital in Peshawar, Pakistan. PARTICIPANTS 201 healthcare professionals were recruited for this study through simple convenience sampling which included house officers (HOs), trained medical officers, postgraduate residents, professors, specialty registrars and nurses. Healthcare professionals who were reluctant to give consent were excluded from the study. RESULTS Among the chosen participants, only 16.4% had good knowledge whereas 63% had a good attitude towards BLS. Knowledge of participants was found to be positively associated with less time elapsed between the training sessions (p=0.041). On the other hand, factors such as age(p=0.004), designation (p=0.05), number of BLS sessions attended (p=0.012) and the time elapsed since the last BLS session attended (p=0.015), were positively associated with the attitude of healthcare professionals. CONCLUSION The level of knowledge and attitude towards BLS by healthcare professionals was suboptimal. Those individuals who had attended BLS training sessions frequently had better knowledge and attitude as compared with their counterparts.
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Affiliation(s)
| | - Jehan Hussan
- Community Medicine, Khyber Medical College, Peshawar, Pakistan
| | - Laiba Khan
- Student, Khyber Medical College, Peshawar, Pakistan
| | | | - Khkula Kamal
- Student, Khyber Medical College, Peshawar, Pakistan
| | - Sawaira
- Student, Khyber Medical College, Peshawar, Pakistan
| | - Umair Hayat
- Student, Khyber Medical College, Peshawar, Pakistan
| | - Areej Abbasi
- Student, Khyber Medical College, Peshawar, Pakistan
| | | | - Ali Ahmad
- Student, Khyber Medical College, Peshawar, Pakistan
| | - Khizar Ahmad
- Student, Khyber Medical College, Peshawar, Pakistan
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Shaheen N, Shaheen A, Diab RA, Mohmmed A, Ramadan A, Swed S, Wael M, Kundu M, Soliman S, Elmasry M, Shoib S. Basic Life Support (BLS) Knowledge Among General Population; a Multinational Study in Nine Arab Countries. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e47. [PMID: 37609539 PMCID: PMC10440750 DOI: 10.22037/aaem.v11i1.1975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Basic Life Support (BLS) is a medical treatment used in life-threatening emergencies until the sufferer can be properly cared for by a team of paramedics or in a hospital. This study aimed to assess the level of knowledge regarding BLS and the contributing factors among the Arab non-medical population. Methods An online survey-based cross-sectional study was conducted among non-medical populations in nine Arab countries between April 13, 2022, and June 30, 2022. The utilized questionnaire consisted of two parts: part one included socio-demographic characteristics and part two measured knowledge of BLS through an online survey. Results The research included a total of 4465 participants. 2540 (56.89%) of the participants were knowledgeable about BLS. The mean basic life support knowledge scores of participants who received training were higher than those who had not (20.11 ± 4.20 vs. 16.96 ± 5.27; p< 0.01). According to the nations, Yemen scored the highest, while Morocco had the lowest levels of BLS knowledge (19.86 ± 4.71 vs. 14.15 ± 5.10, respectively; p< 0.01). Additionally, individuals who resided in urban areas scored on average higher than those who did in rural areas (17.86 ± 5.19 vs. 17.13 ± 5.24, p= 0.032) in understanding basic life support. Age, information sources, and previous training with theoretical and practical classes were significant predictors of BLS knowledge. Conclusion The level of BLS knowledge among non-medical people in Arab nations is moderate but insufficient to handle the urgent crises that we face everywhere. In addition to physicians being required to learn the BLS principles, non-medical people should also be knowledgeable of the necessary actions to take in emergency events.
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Affiliation(s)
- Nour Shaheen
- Alexandria University, Alexandria Faculty ofMedicine, Alexandria, Egypt
| | - Ahmed Shaheen
- Alexandria University, Alexandria Faculty ofMedicine, Alexandria, Egypt
| | - Rehab Adel Diab
- Al-Azhar University, Al-Azhar Faculty ofMedicine, Cairo, Egypt
- Medical Research Group of Egypt, Cairo, Egypt
| | | | | | - Sarya Swed
- Faculty ofMedicine, Aleppo University, Aleppo, Syria
| | - Muhannad Wael
- An Najah National University, Faculty ofMedicine, Nablus, Palestine
| | - Mrinmoy Kundu
- Institute ofMedical Sciences & SUM Hospital, Bhubaneswar, India
| | - Sama Soliman
- The Pavlov First StateMedical University of St. Petersburg, Faculty ofMedicine, St. Petersburg, Russia
| | - Mohamed Elmasry
- Alexandria University, Alexandria Faculty ofMedicine, Alexandria, Egypt
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal NehruMemorial Hospital, Srinagar, Jammu & Kashmir, India
- Department of Health Services, Srinagar, 190001 India
- Sharda University, Greater Noida, India (SSh)
- Psychosis Research Centre, University of SocialWelfare and Rehabilitation Sciences, Tehran, Iran
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Alrasheedi SM, Alrashdi MN, Almutairi KF, Alruways AF, Almutairi IN, Alfehaid SN, Alrashdi OA, Alkhdairi A, Alrashidi AS, Aloraini YN. Awareness, Knowledge, and Attitudes Regarding Basic Life Support Among the Population With Relatives Suffering From Heart Diseases in the Al-Qassim Region, Saudi Arabia. Cureus 2022; 14:e31530. [DOI: 10.7759/cureus.31530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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Kaya U, Aslay S. A University Hospital Healthcare Personnel’s Knowledge Levels About Adult Basic Life Support: A Descriptive Study. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2020.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Alsofayan YM, Althunayyan SM, Mohamed MA, Alhabeeb SH, Altuwaijri MI, Alhajjaj FS, Alowais JM. Out of Hospital Cardiac Arrest: Saudi Red Crescent Experience Throughout COVID-19 Era. Open Access Emerg Med 2021; 13:431-438. [PMID: 34588825 PMCID: PMC8473018 DOI: 10.2147/oaem.s334808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The quality of resuscitation for out hospital cardiac arrest (OHCA) during the COVID-19 era could be affected. We aim to describe prehospital healthcare providers' resuscitative efforts for OHCA cases and their definitive outcomes. PATIENTS AND METHODS This retrospective cross-sectional study included all OHCA cases between April and June 2021 across all regions in the Kingdom of Saudi Arabia (KSA). Demographic variables, response times, CPR providers, initial rhythm, use of AED/Defibrillator, medical interventions, ROSC data, and dispatch codes were extracted from a central electronic platform. RESULTS A total of 1307 OHCA cases were included in this study, males constituted 65% and 42% were ≥65 years. Although the median response time to initiate CPR was 13 min, 11% of OHCA cases had a response time between 0 and 6 min. About 75% of CPR was provided on scene by BLS units, 78% of OHCA cases had asystole as their initial rhythm, an AED/Defibrillator was used more than 90% of the time for pulseless VT/VF rhythm, and ROSC was achieved in 8% of OHCA patients. CONCLUSION During the COVID-19 pandemic, maintaining resuscitative efforts for OHCA continues in KSA. Closing knowledge gaps in the community and a better description of OHCA for the dispatcher could guide dispatch-assisted CPR and minimize OHCA response times.
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Affiliation(s)
- Yousef M Alsofayan
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Saqer M Althunayyan
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed A Mohamed
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Saud H Alhabeeb
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Mohammad I Altuwaijri
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Fahad S Alhajjaj
- Department of Emergency Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, Saudi Arabia
| | - Jalal M Alowais
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Khashaba A, Alharbi M, Alghunaim M, Alsemari L, Almohaimeed W. Knowledge and awareness of basic life support among nonhealth-care providers in Riyadh. SAUDI JOURNAL OF ORAL SCIENCES 2021. [DOI: 10.4103/sjos.sjoralsci_61_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mekonnen CK, Muhye AB. Basic Life Support Knowledge and Its Associated Factors Among a Non-Medical Population in Gondar Town, Ethiopia. Open Access Emerg Med 2020; 12:323-331. [PMID: 33177892 PMCID: PMC7650026 DOI: 10.2147/oaem.s274437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background Different life-threatening accidents can happen anywhere at any time in our daily livings. In this study, the knowledge about basic life support was below average among the non-medical population. Objective The aim of the study was to assess basic life support knowledge and its associated factors among non-medical population attending the outpatient department. Methods An institutional-based cross-sectional study was conducted from January 15/2020 to February 30/2020. Systematic random sampling was employed to get representative samples. Data were collected by using a structured interviewer-administered questionnaire. The data were analyzed by using a binary logistic regression model. Crude and adjusted odds ratios with the corresponding 95% confidence intervals were computed. Those variables with P-values of ≤0.05 were considered significantly associated with the outcome variable. Results A total of 412 participants took part in the study with a response rate of 97.4%. Among the participants, 183 (44.4%) [95% CI (39.8–49.5)] were knowledgeable about basic life support. Age of 30–40 years was 50% [AOR=1.50, 95% CI (1.15–1.97)], the age of >40 years was 2.45 [AOR=2.45, 95 CI (1.53–3.91)], being male [AOR=2.22, 95% CI (1.41–3.49)], lived in the urban [AOR=1.66, 95% CI (1.25–3.56)], being trained [AOR=4.65, 95% CI (1.85–11.67)], ever heard about BLS and having exposure with the person in need of BLS [AOR=3.02, 95% CI (2.05–4.74)], and [AOR=2.59, 95% CI (1.69–3.98)] times more to be knowledgeable as compared with their counterparts. Conclusion The finding of this study demonstrated that knowledge score of the participants was below average. Therefore, there has to be more to do so as to scale up the knowledge of the community for reducing preventable deaths from unexpected emergency situations.
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Affiliation(s)
- Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addis Bilale Muhye
- Department of Pediatric Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Subki AH, Almalki MA, Butt NS, Alsallum MS, Almutairi HM, Khatib HA, Alzahrani AM, Babaker AS, Addas FA, Mashat AA, Jad AY, Zafar ZA, Nogali BW, Alghamdi AA, Alghamdi NA, Dakhakhni MF, Asaad OT, Alghalayini KW. Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia. Int J Gen Med 2020; 13:281-288. [PMID: 32606892 PMCID: PMC7294109 DOI: 10.2147/ijgm.s251924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Heart failure (HF) affects about 320,000 Saudi individuals and is associated with a considerable negative impact on the patients’ quality of life. In literature, there is a lack of data about the echocardiographic abnormalities of HF patients in Saudi Arabia. Aim of Work To describe the echocardiographic findings of HF patients in Western Saudi Arabia. Methodology This was a retrospective record review study conducted on 2000 patients with chronic HF in Saudi Arabia. Demographic, clinical and echocardiographic data were collected and compared among patients with HF with reduced ejection fraction (HFrEF), ie, EF≤40%; HF with mid-range EF (HFmrEF), ie, EF=41–49%; and HF with preserved EF (HFpEF), ie, EF≥50%. Results Among the 2000 patients studied, females constituted 46.3% of the sample. About 52% of females had HFpEF, whilst 70% of males had HFrEF (p<0.0001). Diastolic dysfunction occurred in 98% of HFpEF versus 78% of HFrEF (p<0.0001). Patients with HFrEF had higher left-ventricular diastolic (LVd) volume (1536 versus 826), higher left-ventricular systolic (LVs) volume (1660 vs 772), higher left atrial volume (1344 vs 875), higher aortic root dimension (1144 vs 929) and lower fractional shortening (FS) (267 vs 1213) than patients with HFpEF (p<0.0001). Conclusion HFpEF was more common among females and was associated with higher rates of diastolic dysfunction and higher FS. HFrEF was prevalent among males and associated with higher LVd, LVs, left atrium volume and aortic root dimensions.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammed Ali Almalki
- Department of Internal Medicine, King Faisal Medical Complex, Taif, Saudi Arabia
| | | | | | | | - Hazim Abdulkarim Khatib
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdullah Salem Babaker
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Firas Abdulrahman Addas
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ammar Yasser Jad
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zohair Abdulwahab Zafar
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Baraa Waleed Nogali
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Nasser Adel Alghamdi
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohanad Fahad Dakhakhni
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Tamer Asaad
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kamal Waheeb Alghalayini
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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