Paediatric organ donation following neurological determinants of death in intensive care units in Saudi Arabia: a retrospective cross-sectional study.

OBJECTIVES: The aim of this retrospective cross-sectional study was to assess the performance of paediatric organ donation in intensive care units following neurological determinants of death in Saudi Arabia. DESIGN: Retrospective cross-sectional study. SETTING: Paediatric intensive care units at three tertiary centres over 5 years. PARTICIPANTS: 423 paediatric deaths (<14 years) from January 2017 to December 2021. PRIMARY OUTCOME: Patients were identified as either possible, potential, eligible, approached, consented or actual donors based on organ donation definitions from the WHO, Transplantation Society and UK potential donor audit. SECONDARY OUTCOME: Secondary outcome was causative mechanisms of brain injury in possible donors. Demographics of the study cohort (age, sex, hospital length of stay (LOS), paediatric intensive care unit LOS, pre-existing comorbidities, admission type and diagnosis category) were compared between possible and non-possible donors. Demographics were also compared between patients who underwent neurological determination of death and patients who did not. RESULTS: Among the 423 paediatric deaths, 125 (29.6%) were identified as possible donors by neurological criteria (devastating brain insult with likelihood of brain death, Glasgow Coma Score of 3 and ≥2 absent brainstem reflexes). Of them, 41 (32.8%) patients were identified as potential donors (neurological determination of death examinations initiated by the treating team), while only two became actual donors. The eligible death conversion rate was 6.9%. The reporting rate to organ procurement organisation was 70.7% with a consent rate of 8.3%. The most common causes of brain insult causing death were cardiac arrest (44 of 125 patients, 35.2%), followed by traumatic brain injury and drowning (31 of 125 patients, 24.8%), and intracranial bleeding (13 of 125 patients, 11.4%). CONCLUSION: Major contributors to low actual donation rate were consent, donor identification and donor referral.

The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience.

BACKGROUND:  Fasting during the holy month of Ramadan is a religious ritual practiced by the majority of Muslims around the globe. This daytime fasting is short-term or intermittent fasting, which may be associated with valuable health benefits, particularly in cancer patients. METHODS:  A prospective cohort study of pre- and post-fasting evaluation of 37 colorectal cancer (CRC) patients was conducted at King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children's Hospital (KASCH)-oncology outpatient clinics. The study aimed to assess the impact of fasting during the holy month of Ramadan on the tolerability of chemotherapy side effects and to assess changes in the levels of carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) tumor biomarkers, which are primarily associated with certain types of carcinomas, including CRC. RESULTS: A total of 33 patients (89.2%) had fasted at least part of the month of Ramadan. Twenty-seven patients (73%) reported "Serenity" after fasting during Ramadan with improved tolerability of chemotherapy side effects. However, the results did not reveal any significant difference in the measured laboratory variables between pre-fasting values and by the end of the 30 days of Ramadan. Although statistically insignificant, the levels of CEA and LDH were reduced in 46.9% and 55.6% of patients, respectively. The mean level of CEA in the fasting group was substantially reduced by more than 40%, attributed to the highly significant decline of CEA levels in three patients (p=0.0283). Moreover, there were no significant differences between pre- and post-fasting blood creatinine levels or estimated glomerular filtration rates, ruling out any possible adverse effects of fasting on renal function. CONCLUSION: The current study confirms the safety and tolerability of intermittent fasting in CRC patients actively receiving chemotherapy, which is consistent with several reports. Nonetheless, the results did not reveal a significant decrease in CEA and LDH tumor biomarkers.