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Background: The coexistence of sickle cell disease (SCD), vascular Ehlers–Danlos syndrome (vEDS), primary ciliary dyskinesia (PCD), and Phelan–McDermid syndrome (PMS) in a single pediatric patient is extremely rare and poses substantial diagnostic and management challenges. Case presentation: We report an 8-year-old male from Jazan, Saudi Arabia, born to consanguineous parents, with early-onset SCD, followed by the identification of vEDS, PCD, and PMS through clinical presentation and whole exome sequencing. His disease course has been exceptionally severe, marked by monthly hospitalizations, multiple PICU admissions, and a wide spectrum of systemic complications. Conclusions: The coexistence of SCD, vEDS, PCD, and PMS may lead to synergistic vascular, pulmonary, and neurodevelopmental compromise, demanding multidisciplinary long-term management. This case underscores the need for a comprehensive targeted genetic assessment in patients with unusually aggressive or syndromic SCD phenotypes, particularly in regions with high levels of consanguineous marriages.

Background Cyberbullying is becoming common in inflicting harm on others, especially among adolescents. This study aims to assess the prevalence of cyberbullying, determine the risk factors, and assess the association between cyberbullying and the psychological status of adolescents facing this problem in the Jazan region, Saudi Arabia. Methods A cross-sectional study was conducted on 355 students, aged between 12–18 years, through a validated online questionnaire to investigate the prevalence and risk factors of cyberbullying and assess psychological effects based on cyberbullying questionnaire and Mental Health Inventory-5 (MHI-5) questions. Results The participants in this study numbered 355; 68% of participants were females compared to 32% were males. Approximately 20% of the participants spend more than 12 h daily on the Internet, and the estimated overall prevalence of cyberbullying was 42.8%, with the male prevalence slightly higher than females. In addition, 26.3% of the participants were significantly affected in their academic Performance due to cyberbullying. Approximately 20% of all participants considered leaving their schools, 19.7% considered ceasing their Internet use, and 21.1% considered harming themselves due to the consequences of cyberbullying. There are essential links between the frequency of harassment, the effect on academic Performance, and being a cyber victim. Conclusions Cyberbullying showed a high prevalence among adolescents in the Jazan region with significant associated psychological effects. There is an urgency for collaboration between the authorities and the community to protect adolescents from this harmful occurrence.

Background. Although meningitis caused by Salmonella species is relatively rare and accounts for <1% of the confirmed cases in neonates, it is associated with case complications and fatality rates up to 50–70% when compared to other forms of Gram-negative bacilli meningitis. Objectives. We conducted an investigation into the first reported case of neonatal meningitis caused by nontyphoidal S. enterica in Jazan, a region in the southwestern part of Saudi Arabia. Methods. CSF and blood culture were collected from a female neonate patient to confirm the presence of bacterial meningitis. WGS was conducted to find out the comprehensive genomic characterization of S. enterica isolate. Results. A 3-week-old infant was admitted to a local hospital with fever, poor feeding, and hypoactivity. She was diagnosed with Salmonella meningitis and bacteremia caused by S. enterica, which was sensitive to all antimicrobials tested. WGS revealed the specific strain to be S. enterica serotype Johannesburg JZ01, belonging to ST515 and cgMLST 304742. Conclusions. We presented a genomic report of rare case of NTS meningitis in an infant who is living in a rural town in Jazan region, Saudi Arabia. Further research is required to understand the impact of host genetic factors on invasive nontyphoidal Salmonella infection.

Background: Massive vaccination campaigns have been undertaken globally to combat the spread of the Coronavirus Disease 2019 (COVID-19). While most COVID-19 vaccines have shown excellent efficacy and safety profiles in clinical studies, real-world monitoring of vaccine safety is still important. In this study, we aimed to investigate the early side effects of Pfizer-BioNTech (BNT162b2) mRNA vaccine in children between 12–18 years old in Saudi Arabia. Method: To investigate the side effects in children in this age range following the administration of either one or two doses of Pfizer-BioNTech (BNT162b2) mRNA vaccine, we conducted a retrospective, cross-sectional study using a self-administered online survey. General and demographic data were collected, and vaccine-associated side effects following vaccination were evaluated. Results: The study recruited a total of 965 eligible participants. Overall, 571 (60%) of the study participants reported at least one side effect following Pfizer-BioNTech (BNT162b2) mRNA vaccination. The most frequently reported side effects were pain or redness at the site of injection (90%), fatigue (67%), fever (59%), headache (55%), nausea or vomiting (21%), and chest pain and shortness of breath (20%). Joint or bone pain were reported less frequently among our participants (2%). Our data showed that more female participants reported side effects compared to male participants, with 52% and 48%, respectively. Side effects were more common after the second dose compared to the first dose in our study cohort. Conclusions: While 60% of the children (12–18 years old) who received Pfizer-BioNTech (BNT162b2) mRNA vaccine reported side effects, our data showed that these side effects were not different from those that were reported in the clinical trials which lasted only for a few days. Side effects were more common after the second dose. Larger epidemiological and molecular studies are needed to evaluate the safety and the effectiveness of COVID-19 vaccine in protection of children against SARS-CoV-2 reinfections.

This study estimated the prevalence of burnout and its determinants among medical students at Jazan University during the COVID-19 pandemic. A total of 444 medical students completed an online survey containing the Maslach burnout inventory. The prevalence of burnout was 54.5%. Burnout reached its peak during the fourth year whereas it was the lowest in the internship year. Being a resident in mountain areas, being delayed in college-level, being divorced, and having divorced parents were all associated with an increased risk of burnout. During their time at medical school, students generally showed a trend of consistently high scores in the personal accomplishment subscale, a decreasing trend in the emotional exhaustion subscale, and an increasing trend in the depersonalization subscale. The most important predictive factor was having separated parents. Perceived study satisfaction appeared to be a significant protective factor in a dose–response manner. These findings suggest that burnout among medical students during the COVID-19 pandemic is a concern that should be monitored and prevented.

Background and Objectives: Neonates can show subtle signs of illness that could be overlooked by their mothers and caregivers. Therefore, basic knowledge regarding neonatal health and early detection of neonatal diseases can help improve survival. We assessed nursing students’ knowledge and attitudes toward the danger signs of neonatal illnesses. Materials and Methods: We performed a descriptive cross-sectional study using a structured online questionnaire based on danger signs categorized by the World Health Organization to assess knowledge of neonatal illness danger signs among nursing students. Results: We assessed 342 students, of which 67.0% (95% CI: 61.8–71.7) had good knowledge regarding neonatal illness danger signs, and 71.6% received information about neonatal care. About 33% of the participants had a basic knowledge of neonatal care, such as breastfeeding, immunization, routine postnatal care, and eye care. Students who received information on neonatal care were three times (AOR = 2.95, 95% CI: 11.59–5.47, p = 0.001) more likely to have good knowledge than those who did not. The students also showed a positive attitude towards the importance of knowledge regarding neonatal illness danger signs, teaching this subject in their college, participating in studies involving the practice and knowledge of mothers regarding neonatal illness danger signs, and the importance of knowledge in reducing neonatal mortality in the region. Conclusions: More training programs on neonatal care should be implemented to enhance knowledge and raise nursing students’ awareness of the dangerous signs of neonatal illnesses.

Background Hypovitaminosis D or vitamin D deficiency is a significant public health issue. Several vitamin D preparations are currently available. However, there is no consensus on the optimal dose and duration of vitamin D supplementation. This study aimed to evaluate the effects of vitamin D supplementation on symptoms and clinical outcomes in adults with insufficient or deficient baseline vitamin D levels. Method A pre-post two-month intervention with 50,000 IU vitamin D3 supplementation for adults with documented insufficient or deficient baseline vitamin D levels, presented at Jazan University Hospital from August to December 2022. Results Of the 204 participants, 65.1% had baseline vitamin D levels < 30 nmol/L. Vitamin D insufficiency is more prevalent among females, older adults, married individuals, and those with low income. However, these differences were not statistically significant ( p  > 0.5). The symptoms and clinical outcomes were significantly improved after 2 months of vitamin D3 supplementation for the participants who achieved vitamin D levels > 50 nmol/L ( p  = 0.000). After adjusting for multiple confounders, the significant determinants of symptom improvement and clinical outcomes post-supplementation included education level, income, smoking status, and baseline vitamin D level. Conclusions Hypovitaminosis D or vitamin D deficiency was observed in study participants. The use of a 50,000 IU cholecalciferol (vitamin D3) orally once per week for two months is sufficient to improve the symptoms and clinical outcomes of vitamin D deficiency. However, long-term follow-up could better assess the sustainability of benefits and explore long-term outcomes, such as the risk of deficiency recurrence. Clinical trial number Not applicable

[Please see PDF for full article text] [Please see PDF for full article text] Objectives: To examine the relationship between neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) and the length of hospital stay (LOS) in children with bronchial asthma Methods: This hospital-based study examined the records of children with asthma admitted to Jazan Hospitals, Jazan, Kingdom of Saudi Arabia. Data were extracted at the time of admission. Length of hospital stay and laboratory parameters were acquired from blood. Results: This study involved 489 children, with a mean age of 5.8[+ or -]3.5 years, of which 59.7% were male. Notably, 77.7% of the patients resided in rural areas of Jazan. The mean LOS was 3.38[+ or -]0.35 days, with 2.9% having a short stay (<24 hours) and 64.2% categorized as having a medium stay (1-3 days). The mean NLR was 5.33[+ or -]1.20, with 46.8% falling within the normal range. Similarly, the mean PLR was 184.84[+ or -]16.55, with 42.7% classified as normal. The PLR and LOS were shown to be significantly correlated (p=0.021), while no such association existed for NLR or RDW with LOS. Among the blood biomarkers assessed, PLR demonstrated the highest predictive value for LOS in children with asthma, yielding an area under the curve of 0.664 (confidence interval: 0.606-0.723; p=0.000). Conclusion: The findings showed no significant association between NLR and RDW with LOS. Conversely, a notable correlation was observed between PLR and LOS, suggesting that PLR may serve as a valuable predictive marker for LOS in pediatric patients with asthma. Keywords: asthma, length of hospital stay, NLR, PLR, RDW

Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors.The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms: “Medical error(s)” AND “Teaching”. Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education. doi: https://doi.org/10.12669/pjms.37.7.4506 How to cite this:Gohal G. Models of teaching medical errors. Pak J Med Sci. 2021;37(7):---.  doi: https://doi.org/10.12669/pjms.37.7.4506 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Southern region of Saudi Arabia has one of the highest prevalence of sickle cell disease and thalassemia in the kingdom. This study aims to assess the factors associated with the rejection of premarital clinical counselling in the Jazan region. This is a cross-sectional investigation conducted in the Jazan region of Saudi Arabia. The investigation targeted subjects who performed premarital screening and, with their screened partners, were identified as high-risk couples and proceeded with their marriage. Data were collected via a web-based self-administered questionnaire. A section of the questionnaire targeted those who attended the premarital counselling clinic in the Jazan region and assessed the factors that led to the rejection of premarital counselling advice. A total of 413 participants were recruited. The mean age of the respondents was 33 years, and the majority of the respondents were female (62.5%). The majority of the respondents were related to their partners (66.8%) and were carriers of sickle cell disease (67.8%). Among the respondents, only 192 had attended premarital counselling clinics in the Jazan region. More than half of the attendees rejected the premarital counseling advice because they believed that their marriage was their unavoidable destiny. About 30% of the attendees reported that disease complications were not well explained during the counselling. Thirty-five attendees (18.2%) proceeded with the marriage because they thought the risk of transmitting the disease to their children was small and 10 attendees (5.2%) proceeded with their marriage because they believed their children's lives would not be affected by the disease. The findings explain the limited influence of the premarital counselling advice in raising the awareness of the attendees about inherited blood disorders. The findings indicate a strong cultural influence leading to the reduced effectiveness of premarital counselling in the Jazan region.