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Background Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) are rare, severe, and potentially life-threatening complications associated with asthma exacerbation. Most of these conditions are benign and self-limiting. However, the overlapping symptoms between asthma exacerbation and pneumomediastinum (PM) may delay diagnosis. These conditions can usually be managed through conservative treatment, although unfamiliarity with this presentation may lead some physicians to consider surgical intervention. Case presentation We report a unique case involving a 9-year-old patient experiencing a severe bronchial asthma attack and right lobe atelectasis complicated by PM and severe SE that extended to his left eye. The condition was successfully treated conservatively, with aggressive management of asthma exacerbation and close monitoring in the intensive care unit. Conclusion This case highlights the effectiveness of conservative management of PM and SE with appropriate asthma exacerbation treatment. Early diagnosis and management can lead to a favorable prognosis and a relatively brief hospital stay. Clinical trial number Not applicable.

Obesity and sleep issues are pressing health challenges that are closely tied together. Poor sleep can lead to weight gain, and in turn, obesity can make sleep problems worse. In Saudi Arabia, lifestyle habits-like having late-night meals, excessive screen time, and a lack of physical activity-might worsen these relationships at every age. This review explores the relationship between obesity and sleep disorders across different stages of life in Saudi populations. Methods: We conducted a systematic review following the PRISMA 2020 guidelines. From December 2023 to March 2024, we searched PubMed, Scopus, Web of Science, and ScienceDirect for English-language observational studies related to obesity and sleep among Saudi populations. We evaluated the risk of bias using the ROBINS-I tool. Results: We included fourteen studies, involving 14,876 participants (49.8% male). The findings consistently indicated that obesity is linked to poor sleep quality, shorter sleep duration, insomnia, excessive daytime sleepiness, and breathing issues during sleep such as obstructive sleep apnea. Most studies showed a moderate risk of bias, mainly due to their cross-sectional designs and reliance on self-reported sleep data. Obesity and sleep disturbances are closely linked across all age groups in Saudi Arabia. Most studies reported associations between higher body weight and poorer sleep outcomes, including shorter duration, lower quality, and increased risk of sleep-disordered breathing. These findings underscore the need for age-specific public health strategies that encourage healthy sleep habits and lifestyle behaviors. Variability in measurement methods across studies prevented us from conducting a meta-analysis. No funding; review not registered.

The World Health Organization and the Centers for Disease Control and Prevention recommend seasonal influenza vaccination for all individuals aged 6 months and older. Despite high national immunization rates, the influenza vaccination coverage among Saudi children remains unclear. Parental knowledge and attitudes significantly impact children’s vaccination rates. Purpose: This study aims to evaluate parental knowledge, awareness, and attitudes regarding influenza vaccination and identify barriers to vaccination uptake among children in Al-Madinah City, Saudi Arabia. Methods: The population includes parents having children aged 6 months to 14 years. A cross-sectional survey utilizing a 33-item validated questionnaire was conducted to evaluate parental awareness, knowledge, and attitudes toward the influenza vaccine. Inferential statistics were employed to evaluate demographic factors influencing parental knowledge and attitudes toward vaccination. Results: This study surveyed 407 parents from Al-Madinah, focusing on their awareness, knowledge, and attitudes towards seasonal influenza vaccination. The sample was primarily Saudi (86.7%), with a mean age of 34 years. Most parents (95.6%) were aware of the vaccine, primarily through media and campaigns. Despite this, only 44.5% had vaccinated themselves or their children, citing perceptions of influenza as mild, vaccine ineffectiveness, and availability issues as primary reasons for non-vaccination. Knowledge about influenza varied, with most parents aware of its contagiousness (64.4%) and symptoms, but misconceptions persisted, such as believing the vaccine could cause the flu. Parental attitudes towards vaccination were mostly positive, with high trust in health information sources and a mean attitude score of 22.48 out of 35. Positive attitudes were correlated with better knowledge and more frequent infection control practices. Age, education, and medical profession status significantly influenced knowledge, while vaccine attitudes were most favorable among those vaccinated (p < 0.001). Conclusions: Most parents in Al-Madinah recognize the importance of vaccination; however, misconceptions about vaccine safety, perceived low need, and barriers such as vaccine availability persist. Sociodemographic factors, including education, income, and profession, are linked to better knowledge and more positive attitudes toward vaccination.

PurposeCombined immunodeficiency (CID), due to mutations in TFRC gene that encodes the transferrin receptors (TfR1), is a rare monogenic disorder. In this study, we further characterize the clinical and immunological phenotypes in a cohort of eight patients.MethodsA retrospective review of clinical and immunological features of patients diagnosed with a TFRC gene mutation between 2015 and 2019 in three tertiary centers.ResultsEight patients from six unrelated families were enrolled. The patients had a median age of 7 years (4–32 years). All patients presented with recurrent sinopulmonary infections, chronic diarrhea, and failure to thrive in early life. Less common features were skin abscesses, conjunctivitis, global developmental delay, optic nerve atrophy, vitiligo, multinodular goiter, and hemophagocytic lymphohistiocytosis-like symptoms. All patients had intermittent neutropenia and 87% of the patients had recurrent thrombocytopenia. Anemia was found in 62%. All patients had hypogammaglobinemia and one had a persistent high IgM level. All patients had impaired function of T cells. The same homozygous missense mutation c.58T>C:p.Y20H, in the TFRC gene, was detected in all patients. Stem cell transplantation from matched donors was successful in two patients. Five patients did not receive stem cell transplantation, and they are on prophylactic treatment. One patient died due to severe sepsis and neurological complications.ConclusionThis report provides a large cohort with a long follow up of patients with this disease. Our cohort showed variable disease severity.

A global concern about a possible association between COVID-19 vaccines and menstrual disturbance has been raised. Moreover, women who have experienced menstrual changes are worried about the length of the side effects and are hesitant to receive booster doses. Therefore, the aim of this study is to evaluate the impact of the COVID-19 vaccine on all features of the menstrual cycle, including cycle length, amount of bleeding, and pain. We retrospectively analyzed menstrual cycles following at least two doses of COVID-19 vaccines; the cycle changes within the individual pre-vaccination and post-vaccination were compared. All reproductive-aged females from 18 to 45 years who fit the inclusion criteria were included in the study and categorized into five sub-categories based on age to investigate whether certain age groups were most affected. The data were collected through a well-structured self-administered questionnaire. Participants obtained their vaccination information (date, type of vaccine) from Tawakkalna, the official COVID-19 application in the Kingdom of Saudi Arabia. IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp was performed in data entry and statistical analysis. Variables were described as frequency and percentage, as all were categorical. To investigate the association between menstrual changes and its possible associated factors, we used the Chi-square test, and the statistical significance was determined at p<0.05. The online questionnaire received responses from a total of 1092 reproductive females. However, out of which, 419 were not fitting into the inclusion criteria. Thus, a total of 673 females were included in the final report. Overall, the changes in the menstrual cycles after both COVID-19 vaccine doses were observed among 46.7%, mainly more menstrual pain in 22.9% following the first dose compared with 21.4% after the second. Menstrual changes were observed among almost two-thirds of women in the age groups 18-22 years (65.2%) and 38-45 years (65.4%) compared with only 43.5% of those in the age group 23-27 years, p<0.001. The Moderna vaccine was associated with the highest rate of menstrual changes (65.4%), whereas Oxford-AstraZeneca was associated with the lowest rate (44.9%), p=0.040. The duration of changes in the cycles after the COVID-19 vaccine (one dose or both) was less than one month among 42.5% of females, whereas it was three months or more among 27.1%. The COVID-19 vaccination is associated with a minor and transient change in the menstrual cycle, resulting mainly more menstrual pain and increased bleeding.

Background A considerable subpopulation of patients with morbid obesity present with dyslipidemia. It is characterized by elevated total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low high-density lipoprotein (HDL) concentrations. Sleeve gastrectomy (SG) is considered a method of treating morbid obesity and associated dyslipidemia. Objective To assess the effect of bariatric and metabolic surgery on lipid profile of morbidly obese patients. Methods We used a retrospective approach analyzing the lipid profiles of patients who underwent SG between January 2018 and July 2020. Patients were enrolled according to age (>17 years), pre-operative body mass index (BMI; >30 kg/m2), undergoing SG, and having complete follow-up records of lipid profiles. Baseline and post-operative lipid profiles, their variation, and the percentage of variation were compared. Results We analyzed data of 163 patients who underwent SG. The mean age was 36.75 ± 10.75 years, the mean BMI was 45.66 ±8.46, and the mean pre-operative TC, LDL, HDL, and TG were 4.67 ± 1.02, 2.55 ± 1.1, 1.14 ± 0.32, and 1.5 ± 1.11, respectively. There was a significant change in the mean level of TG as it was significantly higher pre-operatively compared to its mean level post-operatively. Furthermore, a significant change was observed in HDL. There was a non-significant change in levels of TC and LDL post-operatively. Conclusion SG showed to significantly reduce TG and elevate HDL in morbidly obese patients. On the contrary, TC and LDL were non-significantly affected. Further studies with longer follow-up are warranted to provide more reliable evidence.Background A considerable subpopulation of patients with morbid obesity present with dyslipidemia. It is characterized by elevated total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low high-density lipoprotein (HDL) concentrations. Sleeve gastrectomy (SG) is considered a method of treating morbid obesity and associated dyslipidemia. Objective To assess the effect of bariatric and metabolic surgery on lipid profile of morbidly obese patients. Methods We used a retrospective approach analyzing the lipid profiles of patients who underwent SG between January 2018 and July 2020. Patients were enrolled according to age (>17 years), pre-operative body mass index (BMI; >30 kg/m2), undergoing SG, and having complete follow-up records of lipid profiles. Baseline and post-operative lipid profiles, their variation, and the percentage of variation were compared. Results We analyzed data of 163 patients who underwent SG. The mean age was 36.75 ± 10.75 years, the mean BMI was 45.66 ±8.46, and the mean pre-operative TC, LDL, HDL, and TG were 4.67 ± 1.02, 2.55 ± 1.1, 1.14 ± 0.32, and 1.5 ± 1.11, respectively. There was a significant change in the mean level of TG as it was significantly higher pre-operatively compared to its mean level post-operatively. Furthermore, a significant change was observed in HDL. There was a non-significant change in levels of TC and LDL post-operatively. Conclusion SG showed to significantly reduce TG and elevate HDL in morbidly obese patients. On the contrary, TC and LDL were non-significantly affected. Further studies with longer follow-up are warranted to provide more reliable evidence.

Monkeypox is a rare disease but is increasing in incidence in different countries since the first case was diagnosed in the UK by the United Kingdom (UK) Health Security Agency on 6 May 2022. As of 9 August, almost 32,000 cases have been identified in 89 countries. In endemic areas, the monkeypox virus (MPXV) is commonly transmitted through zoonosis, while in non-endemic regions, it is spread through human-to-human transmission. Symptoms can include flu-like symptoms, rash, or sores on the hands, feet, genitalia, or anus. In addition, people who did not take the smallpox vaccine were more likely to be infected than others. The exact pathogenesis and mechanisms are still unclear; however, most identified cases are reported in men who have sex with other men (MSM). According to the CDC, transmission can happen with any sexual or non-sexual contact with the infected person. However, a recent pooled meta-analysis reported that sexual contact is involved in more than 91% of cases. Moreover, it is the first time that semen analysis for many patients has shown positive monkeypox virus DNA. Therefore, in this review, we will describe transmission methods for MPXV while focusing mainly on potential sexual transmission and associated sexually transmitted infections. We will also highlight the preventive measures that can limit the spread of the diseases in this regard.

Objectives: To assess the validity of the new International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) risk stratification tool for Ramadan fasting in predicting diabetic patients' ability to fast safely. Methods: A prospective observational study was carried out during Ramadan 2022 at the Diabetes Center, King Fahad Hospital, Al-Madinah Al-Munawarah, Saudi Arabia. The IDF-DAR risk stratification tool was used to calculate fasting risk for diabetic patients pre-Ramadan. The patients were allocated into 3 categories: high, moderate, and low risk. Fasting was left up to the patients and their healthcare providers. Participants filled out a log-sheet each day of Ramadan showing whether they completed the fast. A final interview was carried out after Ramadan to assess patients' fasting experiences. Results: We included 466 patients with diabetes: 79.4% with T2DM and 20.6% with T1DM. Based on the IDF-DAR score, 265 (56.9%) patients were classified as high risk, 115 (24.7%) as moderate risk, and 86 (18.4%) as low risk. Non-fasting the whole month of Ramadan was statistically relevant to the IDF-DAR risk stratification score. High-risk individuals were more likely to experience hypoglycemia and hyperglycemia than those with a moderate or low risk. But overall, 70.4% of people at moderate risk and 53.2% of the ones at high risk observed Ramadan's complete fast. Conclusion: The IDF-DAR has proven to be reliable and valid for predicting the risk of adverse events associated with fasting in diabetic patients. Nonetheless, it might overestimate the risk of fasting for some patients. Keywords: Ramadan, fasting, diabetes mellitus, IDF-DAR risk stratification, validity

Background ASEAN (Association of Southeast Asian Nations) is composed of ten Southeast Asian countries bound by socio-cultural ties that promote regional peace and stability. South Asia, located in the southern subregion of Asia, includes nine countries sharing similarities in geographical and ethno-cultural factors. Chikungunya is one of the most significant problems in Southeast and South Asian countries. Much of the current chikungunya epidemic in Southeast Asia is caused by the emergence of a virus strain that originated in Africa and spread to Southeast Asia. Meanwhile, in South Asia, three confirmed lineages are in circulation. Given the positive correlation between research activity and the improvement of the clinical framework of biomedical research, this article aimed to examine the growth of chikungunya virus-related research in ASEAN and South Asian countries. Methods The Scopus database was used for this bibliometric analysis. The retrieved publications were subjected to a number of analyses, including those for the most prolific countries, journals, authors, institutions, and articles. Co-occurrence mapping of terms and keywords was used to determine the current state, emerging topics, and future prospects of chikungunya virus-related research. Bibliometrix and VOSviewer were used to analyze the data and visualize the collaboration network mapping. Results The Scopus search engine identified 1280 chikungunya-related documents published by ASEAN and South Asian countries between 1967 and 2022. According to our findings, India was the most productive country in South Asia, and Thailand was the most productive country in Southeast Asia. In the early stages of the study, researchers investigated the vectors and outbreaks of the chikungunya virus. In recent years, the development of antivirus agents has emerged as a prominent topic. Conclusions Our study is the first to present the growth of chikungunya virus-related research in ASEAN and South Asian countries from 1967 to 2022. In this study, the evaluation of the comprehensive profile of research on chikungunya can serve as a guide for future studies. In addition, a bibliometric analysis may serve as a resource for healthcare policymakers.

Optimal power flow (OPF) is one of the most significant electric power network control and management issues. Adding unreliable and intermittent renewable energy sources to the electrical grid increase and complicates the OPF issue, which calls for using modern optimization techniques to solve this issue. This work presents the optimal location and size of some FACTS devices in a hybrid power system containing stochastic wind and traditional thermal power plants considering OPF. The FACTS devices used are thyristor-controlled series compensator (TCSC), thyristor-controlled phase shifter (TCPS), and static var compensator (SVC). This optimal location and size of FACTS devices was determined by introducing a multi-objective function containing reserve costs for overestimation and penalty costs for underestimating intermittent renewable sources besides active power losses. The uncertainty in the wind power output is predicted using Weibull probability density functions. This multi-objective function is optimized using a hybrid technique, gradient-based optimizer (GBO), and moth–flame optimization algorithm (MFO).