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To estimate the rate of scabies diagnostic recurrence and identify factors associated with the high likelihood of frequent scabies recurrences among adults in Saudi Arabia.  Methods: This multi-center retrospective study was conducted in adult patients who were diagnosed with one or multiple recurrent infestations of scabies between January 2016 and September 2018 at the Ministry of National Guard-Health Affairs hospitals and clinics, Saudi Arabia. The number of scabies recurrences during the study period was recorded and modeled using a Poisson model. Results: A total of 468 adult patients (39.8±17.8, range: 14.2-105.7 years) were included in the study, resulting in 645 scabies diagnoses in which 302 (46.8%) were recurrences. The multivariate Poisson model revealed that male gender (adjusted rate ratios [aRR]: 1.465; 95% CI: 1.064 - 2.017; p=0.019), first tertile (January to April) (aRR: 3.021; 95% CI: 1.484 - 6.149; p=0.002), and high humidity (aRR: 1.066; 95% CI: 1.002 - 1.133; p=0.043) had a higher likelihood of frequent scabies recurrences. Conclusion: The rate of scabies recurrence among adult patients in Saudi Arabia was high, and is comparable with previous report in Japan. The study suggests that male gender, first tertile, and high humidity were independently associated with the high rate of scabies recurrences among adults. An interventional program to lower the rate of scabies recurrences and prevent outbreak should be undertaken.

Background Despite the fact that several scabies outbreaks emerged in schools in Saudi Arabia in 2018, no study has investigated the risk of scabies recurrence among children in Saudi Arabia. This study aimed to estimate the rate of scabies recurrence and identify factors that were associated with an increased risk of recurrence among children. Methods This is a multi-center retrospective study of children (age < 14 years) who were diagnosed between May 20, 2015 and September 12, 2018 with one or multiple recurrent scabies at the Ministry of National Guard Health Affairs (MNGHA) hospitals and clinics in Saudi Arabia. Data were obtained from an electronic health system, BestCare database. Results A sample of 264 children analyzed (mean age of 6.7 years) resulted in a cumulative number of 316 scabies diagnoses in which 86 (27.2%) experienced scabies recurrence (at least once). Independent factors associated with a high risk of scabies recurrence: older children (adjusted hazard ratio [aHR], 1.036; 95% CI, 1.002–1.072; P  = 0.039), female gender (aHR, 1.734; 95% CI, 1.329–2.262; P  = 0.001), Western region of Saudi Arabia (aHR, 1.548; 95% CI, 1.115–2.151; P  = 0.009), and 2nd tertile season [May to August] (aHR, 2.368; 95% CI, 1.706–3.288; P = 0.001). Conclusions The study demonstrated that the recurrence rate of scabies among children is high. Older children, the female gender, the Western region of Saudi Arabia, and the seasonality were independently associated with an increased risk of scabies recurrence. High temperature and low humidity should be explored as leading factors for scabies infestations in Saudi Arabia. Findings derived from this study may be useful for clinicians and governments in optimizing clinical management of scabies cases and contacts.

Foodborne diseases (FBDs) pose significant challenges to public health and the food industry worldwide, including Saudi Arabia, where rapid urbanization, changes in dietary habits, and a growing food service sector have increased the risk of contamination. As a result, this study analyzed bacterial contamination in food samples from Riyadh, Saudi Arabia, and investigated food poisoning outbreaks in the city. A total of 7897 food samples and swabs collected between 2015 and 2018 were analyzed for coliforms, Salmonella , Staphylococcus aureus , and Bacillus cereus . Clinical data on food poisoning cases and outbreaks were also gathered to assess incidence rates and epidemiological trends. Bacterial identification followed ISO Standards and AOAC Official Methods. The results showed that 7.4% of the samples tested positive for the target pathogens: Salmonella (12.6%), Bacillus cereus (9.8%), and Staphylococcus aureus (3.4%). Females were found to have a slightly higher likelihood of food poisoning compared to males, with the highest incidence observed in the 20–49 age group. Common sources of foodborne illness included poultry ( n = 93 cases), unclassified foods ( n = 67), meat products ( n = 45), rice ( n = 38), vegetables ( n = 36), and salads ( n = 30). Food poisoning cases peaked in June, followed by April and August. This study highlights a significant gap in regional data on FBDs and emphasizes the need for improved surveillance and monitoring systems to reduce the incidence of foodborne illness in the region.

Introduction Acute otitis media (AOM) is an infection of the middle ear that produces pain, fever, and discharge, as well as hearing loss. It is one of the most common problems that pediatricians encounter. Almost 80% of children have had at least one episode of AOM, and between 80% and 90% have had at least one episode of otitis media with effusion before entering school. Methods The cross-sectional study is conducted among male and female patients, adults, and children who visited two of the largest government hospitals in the Aseer region in Southern Saudi Arabia (Aseer Central Hospital and Khamis Mushait General Hospital). The children and adults with AOM who visited the hospitals were traced by searching the medical record system by the keyword \"acute otitis media.\" Two authors extracted data from the medical record and patients. After extracting data, the patient will be called through mobile phone to invite them to participate in the study. If the patient agrees to participate, she/he would be sent through email link containing an encrypted and high-security electronic signature to obtain his/her consent. Conclusion One of the most common pediatric infections is otitis media (inflammation of the middle ear). Children are more often than adults to get otitis media, and the majority of cases are treated with antibiotics. Clinicians commonly miss the acute stage of the disease, especially in children under the age of five. Delay or omission of diagnoses leads to inefficient management and an increased risk of negative effects.

Diaphragmatic pacing has been shown to play a significant role in adult patients with diaphragmatic paralysis and facilitates mechanical ventilation weaning. However, reports on its use in paediatric patients are scarce. This report is about a 4-year-old child with a spinal cord injury secondary to a motor vehicle accident that led to quadriplegia and diaphragm paralysis. The patient underwent a diaphragmatic pacing procedure, which helped start gradual weaning from mechanical ventilation. We reviewed the concept of the diaphragmatic pacer and its types depending on the site of the implantation. In addition, we reviewed who can benefit from using a diaphragmatic pacer and compared its use in adults versus paediatric patients. Our case showed that diaphragmatic pacing appears to be effective, as it facilitates mechanical ventilation weaning and improves the quality of life outcome in paediatric patients with diaphragmatic paralysis.

Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT). Setting. Pediatric multidisciplinary ICU in tertiary care center. Patients. Thirty-six pediatric patients 2–14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales. Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo ( p = 0.127 ). Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.

Fazio-Londe syndrome is a rare neurological disorder presenting with sensorineural deafness, bulbar palsy and respiratory compromise that is caused by mutation in the SLC52A3 gene, which encodes the intestinal (hRFT2) riboflavin transporter. We report a patient with early onset of Fazio-Londe syndrome as the first case report in Saudi Arabia with rapid regression to death at 24 months of age.

Objective For further evaluating the feasibility and safety of wire-in-needle (WIN) technique application for ultrasound-guided central venous catheter (USG-CVC) insertion in a pediatric intensive care unit (PICU). Methods We prospectively monitored all patients who underwent central line insertion guided by ultrasound from March 2018 to March 2019. An independent nurse recorded the patient's age, gender, weight and BMI, diagnosis, indication for insertion, blood pressure state, insertion time, line size, number of pricks, and arterial punctures. Results A central line was inserted in 141 patients. The author applied the WIN technique in 16 patients, while in 125 patients, the central line was inserted via the traditional technique. The success rate was 100% for the WIN technique arm with zero arterial pricks, and the mean number of needle pricks was 1.1. For the traditional technique arm, the success rate was 90% with three arterial pricks. The mean number of needle pricks was 1.38. The insertion time was 86.25 seconds and 304 seconds for the WIN technique and the standard technique, respectively; this difference was statistically significant (p <0.001). Conclusion The WIN technique is feasible and could provide a safe and relatively fast alternative technique for real-time USG-CVC insertion in the PICU. The WIN technique is feasible and not inferior to the standard short-axis technique. A good level of experience related to USG-CVC insertion provides a safe and rapid alternative technique for real-time USG-CVC insertion in the PICU.

Background Spinal Muscular Dystrophy (SMA) is one of the leading causes of death in infants and young children from heritable diseases. Although no large‐scale popultion‐based studies have been done in Saudi Arabia, it is reported that the incidence of SMA is higher in the Saudi population partly because of the high degree of consanguineous marriages. Methods The final analysis included 4198 normal volunteers aged between 18 and 25 years old, 54.7% males, and 45.3% females. Whole blood was spotted directly from finger pricks onto IsoCode StixTM and genomic DNA was isolated using one triangle from the machine. To discern the SMN1 copy number independently from SMN2, Multiplex PCR with Dral restriction fragment analysis was completed. We used the carrier frequency and population‐level data to estimate the prevalence of SMA in the population using the life‐table method. Results This data analysis showed the presence of one copy of the SMN1 gene in 108 samples and two copies in 4090 samples, which resulted from a carrier frequency of 2.6%. The carrier frequency was twofold in females reaching 3.7% compared to 1.6% in males. 27% of participants were children of first‐cousin marriages. We estimated the birth incidence of SMA to be 32 per 100,000 birth and the total number of people living with SMA in the Kingdom of Saudi Arabia to be 2265 of which 188 are type I, 1213 are type II, and 8,64 are type III. Conclusion The SMA carrier rate of 2.6% in Saudi control subjects is slightly higher than the reported global frequency of 1.25 to 2% with links to the high degree of consanguinity. The birth incidence of SMA was estimated to be 32 per 100,000 birth and the total number of people living with SMA in KSA to be 2265 of which 188 are type I, 1213 are type II, and 864 are type III. The SMA carrier rate of 2.6% in Saudi subjects is slightly higher than the reported global frequency with links to the consanguineous marriages.

Most of the inferior ST-elevation myocardial infarctions (STEMIs) are due to the occlusion of the dominant right coronary artery, but there are few exceptions. In order to diagnose the actual life-threatening STEMI, we should be aware of the exceptional causes. Here, we present a case of a 69-year-old female with the first diagnostic electrocardiogram report interpreted as inferior STEMI, but the culprit occlusion was later found to be by left anterior descending artery in coronary angiography. All these observed circumstances are reported accordingly.