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Biomarkers to identify ICU COVID-19 patients at high risk for mortality are urgently needed for therapeutic care and management. Here we found plasma levels of the glycolysis byproduct methylglyoxal (MG) were 4.4-fold higher in ICU patients upon admission that later died (n = 33), and 1.7-fold higher in ICU patients that survived (n = 32),compared to uninfected controls (n = 30). The increased MG in patients that died correlated inversely with the levels of the MG-degrading enzyme glyoxalase-1 ( r 2  = − 0.50), and its co-factor glutathione ( r 2  = − 0.63), and positively with monocytes ( r 2  = 0.29). The inflammation markers, SSAO ( r 2  = 0.52), TNF-α ( r 2  = 0.41), IL-1β ( r 2  = 0.25), CRP ( r 2  = 0.26) also correlated positively with MG. Logistic regression analysis provides evidence of a significant relationship between the elevated MG upon admission into ICU and death (P < 0.0001), with 42% of the death variability explained. From these data we conclude that elevated plasma MG on admission is a novel independent biomarker that predicts mortality in ICU COVID-19 patients.

Backgrounds The incidence of diabetes mellitus (DM) in people living with human immunodeficiency virus (HIV) receiving highly active antiretroviral therapy (HAART) is thought to be higher than that in noninfected people. The aim of this study was to investigate the prevalence of DM among people living with HIV in Dammam, Saudi Arabia (SA). Methods This was a cross-sectional study that included adult patients with HIV who were followed at Dammam Medical Complex. The electronic medical records of the patients were reviewed for their demographic data, comorbid conditions, and HIV history (e.g., duration and medications). The patients were categorized based on their glycated hemoglobin (A1C) levels into nondiabetic patients (A1C < 5.7%), prediabetic patients (A1C between 5.7% and 6.4%), and diabetic patients (A1C ≥ 6.5). Results A total of 769 HIV patients were assessed. The A1C of 325 patients could not be retrieved. The remaining 444 patients were included in the analysis. These consisted of 71 female patients (15.99%) and 373 male patients (84.01%). The average age of the patients was 38.62±11.33 years. Their duration for living with HIV was on average 3.76±3.15 years. The cohort consisted of 290 nondiabetic patients (65.32%), 107 prediabetic patients (24.1%), and 47 diabetic patients (10.59%). The nondiabetic patients were generally younger than the prediabetic patients (35.97 vs 40.72 years on average, P value < 0.001). They were infected with HIV for shorter durations (3.45 vs 4.19 years on average, P value < 0.05) with a higher percentage of patients receiving antiretroviral therapy (97.93% vs 84.11%, P value < 0.001). Similarly, the nondiabetic patients were generally younger than the diabetic patients (35.97 vs 50.19 years on average, P value < 0.001). They were also infected with HIV for shorter durations (3.45 vs 4.65 years on average, P value < 0.05) with, also, a higher percentage of patients receiving antiretroviral therapy (97.93% vs 89.36%, P value < 0.01). Conclusions The prevalence of DM among people living with HIV in Dammam, SA, was high with DM remaining highly underdiagnosed in this population. However, the prevalence of DM in this study involving mostly HIV patients treated with newer HAART agents was lower than what was reported in multiple previous studies that included patients using older agents.

Angiotensin-converting enzyme 2 (ACE2) receptor serves as a receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, to enter the lungs. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the expression of ACE2, resulting in concerns that patients with COVID-19 who are receiving these agents may be at increased risk of severe disease. This study was conducted to further investigate the effects of ACEIs and ARBs on the severity of COVID-19 in hospitalized hypertensive patients. The study was a retrospective observational study. The medical records of all adult hypertensive patients who were hospitalized at Dammam Medical Complex (DMC) between March 1, 2020, and December 31, 2020, due to COVID-19 were reviewed. The hypertensive patients who were receiving ACEIs or ARBs were compared with the other hypertensive patients who were not on ACEIs or ARBs. A total of 148 hypertensive patients were included in the analysis. They consisted of 106 male and 42 female patients (72% and 28%, respectively). Nearly half of the patients were Saudi (75 patients, 50%). A total of 81 patients were in the ACEI/ARB group, and 67 patients were in the control group. There were no differences between the two groups in age, diabetic status, history of chronic kidney disease, initial blood pressure measurements, and initial oxygen requirements, but the control group contained fewer female patients (18% versus 37%) and Saudi patients (36% versus 63%) than the ACEI/ARB group (p-values = 0.017 and 0.002, respectively). The use of ACEIs or ARBs was associated with significant reductions in ICU admission (9% versus 31%, p-value = 0.001), need for intubation (7% versus 28%, p-value = 0.002), and death (2% versus 24%, p-value = 0.000). A significant negative association between the use ACEIs or ARBs and mortality was also observed in the multivariate analysis after the adjustment for the possible confounders, with an odds ratio (OR) of 0.087 and a 95% confidence interval (CI) of 0.017-0.449. ACEIs and ARBs have no adverse effects on the clinical prognosis of COVID-19 patients with hypertension. Their use might be even beneficial and protective, but future larger studies are needed to confirm these effects. In the meanwhile, they should be continued in COVID-19 hypertensive patients unless their use is contraindicated for other reasons (e.g., hypotension, hyperkalemia, or acute kidney injury (AKI)).

Melanoma is known as one of the most aggressive types of malignant skin carcinoma. The development of melanoma is most commonly associated with excessive sun exposure, a family history of the disease, and genetic predisposition. Melanoma can metastasize to various anatomical sites; the lungs are a frequent site of metastatic involvement, and when pulmonary metastasis develops, respiratory failure becomes the leading cause of mortality. The predominant pathway of metastatic spread in primary cutaneous melanoma is through the regional lymph nodes. We report a case of a young male with a history of resected cutaneous melanoma one year prior to presentation, who developed gradually worsening shortness of breath and pleuritic chest pain over two weeks. An initial chest X-ray revealed a unilateral pleural effusion, and subsequent pleural tapping confirmed the presence of exudative fluid. Further evaluation with a chest CT scan demonstrated a left-sided loculated pleural effusion and a lobulated nodule with spiculated margins in the upper outer quadrant of the left breast, prompting additional evaluation via mammography and tissue biopsy. ‎Mammography revealed a dense, lobulated mass in the upper left breast, measuring 2 × 1.5 cm and located approximately 2.7 cm from the nipple. An ultrasound-guided biopsy of the lesion was performed. Histopathological analysis showed infiltrating large atypical cells and numerous pigmented cells. Immunostaining revealed positive staining for mesothelial cells (HBME-1) and a high proliferative index (Ki-67). Following pleural aspiration and gradual drainage of pleural fluid over several days, the patient exhibited marked clinical improvement. The case was referred to a tertiary care facility for further staging and comprehensive management. This case highlights the importance of maintaining a high index of suspicion for pleural metastatic melanoma in patients with a history of resected cutaneous melanoma.

Cryptogenic organizing pneumonia (COP) is a rare form of idiopathic interstitial lung disease that often presents with non-specific respiratory symptoms and radiographic findings that mimic infectious pneumonia. Due to these overlapping clinical features, COP is frequently misdiagnosed, leading to delays in appropriate management. We report the case of a 23-year-old female patient who presented with dyspnea, productive cough, and fever. Despite receiving broad-spectrum antimicrobial therapy, there was no clinical or radiographic improvement. Imaging revealed bilateral pulmonary opacities and pleural effusions, and diagnostic bronchoscopy with transbronchial biopsy confirmed organizing pneumonia. Secondary causes, including infections, autoimmune diseases, and malignancy, were excluded. The patient started on oral prednisolone, resulting in significant improvement in both symptoms and radiological findings. This case underscores the importance of considering COP in patients with non-resolving pneumonia, particularly when there is no response to adequate antibiotic therapy. A combination of radiological assessment, histopathological confirmation, and exclusion of secondary causes is essential for accurate diagnosis. Clinicians should maintain a high index of suspicion for COP in such scenarios, as timely diagnosis and initiation of corticosteroid therapy are critical for symptom resolution and prevention of disease progression.

Chemical pneumonitis is frequently encountered in patients following the siphoning of diesel fuel, which can lead to severe complications, including acute respiratory distress syndrome (ARDS). This is a 33-year-old male patient who presented with a history of dyspnea, a non-productive cough, and heartburn. His symptoms commenced five days earlier following an inadvertent aspiration of diesel while refueling vehicles. This patient was admitted to our intensive care unit as a case of ARDS related to chemical pneumonitis following siphoning of diesel fuel. This patient was treated with intravenous steroids, along with empirical antibiotics, and intravenous furosemide was utilized for the management of non-cardiogenic pulmonary edema, as seen a few days post-admission and noted on chest radiography. As the patient's clinical condition improved, he was discharged after achieving a stable oxygen saturation of 97% on room air, accompanied by significant clinical recovery. Aspiration pneumonitis occurs following the inhalation of chemical irritants, including hydrocarbons, which can cause direct injury to the alveoli without significant systemic absorption, primarily through the disruption of surfactant function, leading to an inflammatory response and bronchial edema that can progress to ARDS. This patient was then transferred to the regular ward after marked clinical improvement, where a CT scan of the chest was done, which shows bilateral segmental and sub-segmental consolidations with air bronchograms, along with peripheral patchy ground-glass opacities and atelectatic bands observed in the right middle lobe, lingula, and both lower lobes. Empirical antimicrobial therapy was initiated with intravenous piperacillin/tazobactam to provide coverage against potential anaerobic pathogens that may contribute to aspiration pneumonia. Systemic corticosteroids were also used as it has potential benefits in cases of ARDS. Siphoning of diesel fuel can cause serious complications, including aspiration pneumonitis, which can end up with ARDS. Physicians should understand the pathophysiology by which diesel fuel can result in severe lung injury, aiming for early diagnosis and effective appropriate management.

The influenza vaccine is recommended annually for patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This study aimed to report the influenza vaccination rate among RA and SLE patients who are following up at Dammam Medical Complex (DMC), Dammam, Saudi Arabia, to evaluate their understanding of the influenza vaccine and its benefits, and to assess their attitudes regarding it, including any concerns or misconceptions. This was a cross-sectional study. It included all patients with RA and SLE who were following up in the rheumatology clinic at DMC. The study was conducted between November 2024 and February 2025. Data was collected through a self-administered paper questionnaire in the clinic. Descriptive statistics, including mean, standard deviation, counts, and percentages, were computed as required. For comparative analyses, the Chi-square test was employed for categorical variables, while the two-sample t-test was used for continuous variables. A total of 261 patients participated in the study, including 191 RA patients (73.2%) and 70 SLE patients (26.8%). Out of the total, 131 patients (50.2%) reported that they had been vaccinated against influenza in the past. However, only 72 patients (27.6%) confirmed they had received the vaccine within the last two seasons, whereas a significant majority, 189 patients (72.4%), had not been vaccinated during this timeframe. Regarding the perception of the influenza vaccination's safety and effectiveness, 133 patients (51.0%) affirmed that they believed it to be safe and effective. When asked if the seasonal influenza vaccine is the best method to avoid complications from influenza, 153 patients (58.6%) agreed. Most patients (n = 140, 53.6%) were aware that seasonal influenza vaccination is recommended for individuals with chronic diseases.  Our study revealed a low vaccination rate among RA and SLE patients in the last two seasons. To minimize the risk of complications, it is crucial to increase awareness about the benefits of influenza vaccination.

Candida albicans (C. albicans) adhering to denture-based resins (DBRs) is a known cause of denture stomatitis. A new approach to prevent denture stomatitis is to include antimicrobial substances within DBRs. Here, we examined the mechanical performance and antifungal properties of DBRs containing benzyldimethyldodecyl ammonium chloride (C12BDMA-Cl) as an antimicrobial compound. C12BDMA-Cl is a quaternary ammonium compound, and its antifungal properties have never been investigated when combined with dental acrylic resin. Therefore, we modified a commercially available heat-polymerized acrylic DBR to contain 3 and 5 wt.% of C12BDMA-Cl. Unmodified DBR was used as a control group. Specimens were prepared using the conventional heat processing method. The specimen’s flexural strength, elastic modulus, microhardness, and surface roughness were evaluated. C. albicans biofilm was grown on the specimens and assessed via colony-forming units (CFUs) and scanning electron microscopy (SEM). In silico molecular docking was applied to predict the potential C12BDMA-Cl inhibition activity as an antifungal drug. The 3% C12BDMA-Cl DBR demonstrated antifungal activities without a deterioration effect on the mechanical performance. SEM images indicated fewer colonies in DBR containing C12BDMA-Cl, which can be a potential approach to managing denture stomatitis. In conclusion, C12BDMA-Cl is a promising antifungal agent for preventing and treating denture stomatitis.

There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation. This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their pre-bariatric-surgery evaluation. A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m , respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have infection. The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Roux-en-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of infections in obese patients are important but it is not clear whether eradication should be done before bariatric surgery.