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Thyroid storm is a rare but life-threatening complication of hyperthyroidism that requires urgent management. While propylthiouracil (PTU) is a key treatment, it carries multiple risks, including potentially fatal risk of agranulocytosis. We report a 40-year-old female with Graves' disease who presented with thyroid storm and compressive goiter. High-dose PTU (1 g loading dose followed by 200 mg every 4 hours) was initiated; however, severe neutropenia (ANC: 0.22×10ˆ3/µL) developed within 48 hours, necessitating immediate drug discontinuation. Bridging therapy with hydrocortisone, cholestyramine, Lugol's solution, was implemented once available, and low-dose carbimazole was cautiously reintroduced under close monitoring without recurrence of neutropenia. Once a euthyroid state was achieved, definitive management with a total thyroidectomy was performed without complications. This case highlights three key learning points: (1) agranulocytosis can occur very early during high-dose PTU therapy; (2) careful bridging strategies are essential to prevent rebound thyroid storm after antithyroid drug withdrawal; and (3) timely transition to definitive surgical management can be lifesaving when antithyroid drug intolerance occurs.

Obstructive sleep apnoea (OSA) is the recurring folding of the upper airway during sleep, resulting in complete or partial airway obstruction leading to apnoea, hypopnea, or both. Left undiagnosed and untreated, it can lead to several complications; for instance, neurocognitive dysfunction, such as dizziness and impaired quality of life, due to reduced sleep and increased fatigue, as well as cardiovascular diseases such as hypertension, stroke, myocardial infarction, and heart failure. Obstructive sleep apnoea is generally diagnosed in a sleep laboratory over the course of a night and can also be detected at home following alternative approaches. In addition to the conventional treatment modalities such as adenotonsillectomy and continuous positive airway pressure, orthodontists play a vital role in the management of OSA via a multidisciplinary approach. Specifically, orthodontists can influence craniofacial anatomy through both surgical and non-surgical approaches. This review aims to establish the relationship between orthodontic interventions, both surgical and non-surgical, and the management of OSA. In addition, it explores the pathophysiology and diagnosis of OSA, various treatment options, and the use of novel technology to assist in the management of OSA.

This research intends to address the problems of identifying gifted students, supporting their excellence and promoting their care. Identifying gifted students is a challenge for individual teachers and for educational institutions, particularly in terms of developing programs that suit and contribute to the development of their skills. This article provides a comprehensive exploration of the characteristics of gifted students and the relationship of these characteristics to the identification of talent. The characteristics of the gifted have already attracted the attention of researchers and others interested in educational matters, and the current article therefore seeks to answer some of the most important questions arising from previous work in the field. These questions revolve around defining the criteria for systematically identifying gifted students, establishing the best strategies for developing their talents, and developing the most effective teaching methods that meet their educational needs. In response to these research questions, this article follows a systematic process of defining relevant concepts, theories and existing strategies for developing student talent. More specifically, this research reviews the descriptive methodologies of educational studies that have been conducted in the field of gifted students. Therefore, this work can be considered a conceptual framework the characteristics of gifted students which aims to demonstrate the importance of these features and their impact on the design and implementation of talented curricula as well as highlight the most important strategies for teaching gifted students and the use of modern technologies in their education.

MERS-CoV seronegative and seropositive camels received a single intramuscular dose of ChAdOx1 MERS, a replication-deficient adenoviral vectored vaccine expressing MERS-CoV spike protein, with further groups receiving control vaccinations. Infectious camels with active naturally acquired MERS-CoV infection, were co-housed with the vaccinated camels at a ratio of 1:2 (infected:vaccinated); nasal discharge and virus titres were monitored for 14 days. Overall, the vaccination reduced virus shedding and nasal discharge (p = 0.0059 and p = 0.0274, respectively). Antibody responses in seropositive camels were enhancedby the vaccine; these camels had a higher average age than seronegative. Older seronegative camels responded more strongly to vaccination than younger animals; and neutralising antibodies were detected in nasal swabs. Further work is required to optimise vaccine regimens for younger seronegative camels.

Dexmedetomidine may be used in patients managed by noninvasive ventilation (NIV), but its associations with intubation, mortality and health-related quality of life (HRQoL) are unclear. Thus, we aimed to assess the use of dexmedetomidine in patients with COVID-19-induced acute hypoxemic respiratory failure requiring NIV and its associations with the 28-day intubation rate, 28- and 180-day mortality rate, and HRQoL. This post-hoc study of the Helmet-COVID trial analyzed data from NIV-managed patients who did and did not receive dexmedetomidine and assessed the association of dexmedetomidine with clinical outcomes. We evaluated HRQoL on day 180 using EuroQoL-5D-5L index values and the EQ visual analog scale (EQ-VAS). Non-survivors were assigned a value of 0 on the EQ-5D-5L and EQ-VAS. We used a generalized linear mixed model adjusted for the enrollment center and other baseline covariables. Of 290 patients managed with NIV, 107 (36.8%) were treated with dexmedetomidine. The median highest daily dose was 0.6 mcg/kg/h (interquartile range [IQR] 0.4, 0.9) for a median of 2.5 days (IQR: 1, 5). Baseline demographics and severity of respiratory failure, including the PaO 2 :FiO 2 and degree of hypercapnia were largely comparable between both groups. During the ICU stay, dexmedetomidine-treated patients were more likely to have received helmet NIV (70 of 107, 65.4%), awake proning (45 of 107, 42.1%), vasopressors and renal replacement therapy (57.9 and 17.8%, respectively). Dexmedetomidine-treated patients had higher ICU and hospital mortality, higher intubation rate, and fewer ICU-free days compared to those not receiving dexmedetomidine; differences that could not be fully explained by confounding alone. There were no significant differences in HRQoL outcomes at 180 days. Median EQ-5D-5L index values and EQ-VAS median scores showed no significant differences between the dexmedetomidine and non-dexmedetomidine groups. Among patients with COVID-19-induced acute hypoxemic respiratory failure managed with NIV, dexmedetomidine use was common. Dexmedetomidine-treated patients had a different disease trajectory than non-dexmedetomidine-treated patients. The worse outcomes observed with dexmedetomidine were not entirely explained by differences in baseline characteristics, suggesting effects of time-varying confounders. Randomized controlled trials are required to assess effects of dexmedetomidine on patient-centered outcomes. Trial registration: NCT04477668; registered on July 20, 2020.

Malocclusion is one of the most common oral health problems that affects quality of life. It is important to understand how different types of malocclusion can affect the oral health-related quality of life (OHRQoL). Vertical discrepancy in occlusion is highly prevalent, yet there are no studies evaluating its impact on OHRQoL in the Saudi population. Therefore, in this study, we aim to investigate the impact of vertical discrepancy in occlusion on patients' OHRQoL. A cross-sectional evaluation of 109 patients with open and deep bites who attended the orthodontics screening clinic at King Abdulaziz University Dental Hospital was carried out. The OHRQoL of each participant was assessed using the shortened, Arabic-version of the oral health impact profile-14 questionnaire. Chi-squared and Fisher's exact tests were used for analysis. The findings indicated a statistically significant association between anterior vertical discrepancy in occlusion and embarrassment ( = 0.001), followed by being self-conscious about their appearance, discomfort while eating ( = 0.009), generalized mouth aching ( = 0.012), and speech problems ( = 0.049). This Impact was significantly higher in participants with open bites. Regarding gender variables, female patients were found to be significantly more embarrassed ( = 0.005), while male patients were more self-conscious ( = 0.018). Vertical discrepancy in occlusion has a negative impact on OHRQoL and its domains in both genders. The negative impact is highlighted in the psychological disability, psychological discomfort, physical pain, and functional limitation domains.

Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients' clinical status. Representative samples are needed to inform service planning and research. To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. Retrospective review of 50 consecutive referrals. Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.

Background Middle East Respiratory Syndrome coronavirus (MERS-CoV) is an emerging virus that infects humans and camels with no approved antiviral therapy or vaccine. Some vaccines are in development for camels as a one-health intervention where vaccinating camels is proposed to reduce human viral exposure. This intervention will require an understanding of the prior exposure of camels to the virus and appropriate vaccine efficacy studies in camels. Methods We conducted a cross sectional seroprevalence study in young dromedary camels to determine the rate of MERS-CoV seropositivity in young camels. Next, we utilised naturally infected camels as a natural challenge model that can be used by co-housing these camels with healthy naive camels in a ratio of 1 to 2. This model is aimed to support studies on natural virus transmission as well as evaluating drug and vaccine efficacy. Results We found that 90% of the screened camels have pre-existing antibodies for MERS-CoV. In addition, the challenge model resulted in MERS-CoV transmission within 48 h with infections that continued for 14 days post challenge. Conclusions Our finding suggests that the majority of young dromedary camels in Saudi Arabia are seropositive and that naturally infected camels can serve as a challenge model to assess transmission, therapeutics, and vaccine efficacy.

Background Noninvasive respiratory support is frequently needed for patients with acute hypoxemic respiratory failure due to coronavirus disease 19 (COVID-19). Helmet noninvasive ventilation has multiple advantages over other oxygen support modalities but data about effectiveness are limited. Methods In this multicenter randomized trial of helmet noninvasive ventilation for COVID-19 patients, 320 adult ICU patients (aged ≥14 years or as per local standards) with suspected or confirmed COVID-19 and acute hypoxemic respiratory failure (ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 200 despite supplemental oxygen with a partial/non-rebreathing mask at a flow rate of 10 L/min or higher) will be randomized to helmet noninvasive ventilation with usual care or usual care alone, which may include mask noninvasive ventilation, high-flow nasal oxygen, or standard oxygen therapy. The primary outcome is death from any cause within 28 days after randomization. The trial has 80% power to detect a 15% absolute risk reduction in 28-day mortality from 40 to 25%. The primary outcome will be compared between the helmet and usual care group in the intention-to-treat using the chi-square test. Results will be reported as relative risk  and 95% confidence interval. The first patient was enrolled on February 8, 2021. As of August 1, 2021, 252 patients have been enrolled from 7 centers in Saudi Arabia and Kuwait. Discussion We developed a detailed statistical analysis plan to guide the analysis of the Helmet-COVID trial, which is expected to conclude enrollment in November 2021. Trial registration ClinicalTrials.gov NCT04477668 . Registered on July 20, 2020

Background Pressure ulcers are significant health issues affecting elderly patients, leading to severe complications, prolonged hospital stays, and high healthcare costs. Preventive care by home caregivers plays a crucial role in mitigating the development of pressure ulcers. Objective This study aims to assess home caregivers' knowledge of pressure ulcer prevention and investigate the factors associated with knowledge levels in elderly patients in Al Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted involving 231 home caregivers of elderly patients registered in Home Health Care, Al-Ahsa Health Cluster. Data were collected using an online questionnaire assessing demographic information and knowledge of pressure ulcer prevention, adapted from the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data analysis was performed using SPSS version 29.0 (IBM Corp., Armonk, USA), with a Chi-square test used for bivariate analysis of categorical outcomes. Results The majority of caregivers were female (64.5%), aged between 35 and 50 years (47.6%), and primarily family members (83.5%). Most caregivers had been providing care for 5 years or less (79.7%), with 67.5% never having received training in pressure ulcer prevention. Knowledge levels were generally sufficient, with 87.0% of caregivers showing adequate knowledge of pressure ulcer prevention. Significant associations were found between knowledge levels and caregiving duration (p=0.006) as well as training in pressure ulcer prevention (p=0.001). However, other demographic factors, such as age and gender, were not significantly associated with knowledge levels. Conclusion The study found that most home caregivers possess sufficient knowledge of pressure ulcer prevention, although training and caregiving duration significantly influence knowledge levels. These findings underscore the need for comprehensive training programs to improve caregivers' knowledge and practice, thereby enhancing the quality of care for elderly patients and reducing the incidence of pressure ulcers.