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Sara A Assiri,1 Raad MM Althaqafi,2 Khaled Alswat,2 Ahmed Abdullah Alghamdi,3 Naif E Alomairi,2,4 Dalal M Nemenqani,2 Zein S Ibrahim,5 Ahmed Elkady4 1Otolaryngology-Head and Neck Surgery Department, King Faisal Hospital, Taif, Saudi Arabia; 2College of Medicine, Taif University, Taif, Saudi Arabia; 3College of Medicine, Al-Baha University, Al Baha, Saudi Arabia; 4Neurology Department, Saudi German Hospital, Jeddah, Saudi Arabia; 5Department of Physiology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, EgyptCorrespondence: Sara A Assiri, Email saraassiriiii@gmail.comPurpose: Neurological sequelae after COVID-19 vaccination are rare. We investigated the possible pathogenesis behind the development of neurological complications within a short period after Saudi residents received a COVID-19 vaccine.Patients and Methods: We evaluated 18 patients who recently received a COVID-19 vaccine (Comirnaty and Vaxzevria vaccines) and presented with neurological complications to the Saudi German Hospitals in Jeddah, Saudi Arabia. Neurologists assessed the patients’ clinical presentation, radiological investigations, and laboratory findings.Results: Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain–Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty.Conclusion: Neurological complications after COVID-19 vaccinations are very rare, and only a few cases have been reported worldwide. The shared pathophysiological basis between COVID-19 viral infection and COVID-19 vaccines stands behind the very rare neurological complications resulting from the hypercoagulable state triggered by the general inflammatory condition. We suspect some differences in the pathogenesis of ischemic stroke caused by COVID-19 infection and COVID-19 vaccines, which render COVID-19 vaccine-associated ischemic stroke more responsive to treatment. To date, no definitive association between the vaccine and GBS has been proven by any strong evidence, but it has recently been added as a very rare side effect of the Janssen COVID-19 vaccine. No possible links of Miller Fisher syndrome to COVID-19 vaccines have been reported before the one reported in this study.Keywords: vaccine, ischemic stroke, cerebral venous thrombosis, seizures, optic neuritis

Albaraa Alsini,1 Ishraq Alkhodaidi,2 Yasir Alsini,3 Sarh Alsseeni,4 Shrooq Alkhodaidi,5 Ehsan Alsini,6 Asim Alsini,7 Hamzah Sindi,8 Khaled Alswat9 1Resident, Department of Otolaryngology Head & Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia; 2Medical Student, Faculty of Medicine, Taif University, Taif, Saudi Arabia; 3PharmD, Alhada Armed Forces Hospital, Taif, Saudi Arabia; 4PharmD Student, Taif University, Taif, Saudi Arabia; 5Resident, Department of Dermatology, King Abdulaziz Hospital, Makkah, Saudi Arabia; 6PharmD, Medical Representative in Eli Lilly and Company, Taif, Saudi Arabia; 7Medical Intern, Faculty of Medicine, Taif University, Taif, Saudi Arabia; 8Medical Student, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia; 9Professor of Medicine, Department of Medicine, School of Medicine, Taif University, Taif, 21944, Saudi ArabiaCorrespondence: Albaraa AlsiniDepartment of Otolaryngology Head & Neck Surgery, Alhada Armed Forces Hospital, Alhada District, Taif, Saudi ArabiaTel +966530006201Email Dr.albaraa2015@gmail.comBackground: The development of beta-blocker (BB) medications is considered one of the most critical milestones of drug research. Several trials showed possible anti-anxiety effects of BBs. Our primary goal is to investigate the prevalence of anxiety disorder and the use of BBs as anxiolytic without medical prescription among medical and pharmacological students in Saudi Arabia.Methods: A cross-sectional study was conducted at multiple universities in Saudi Arabia. Students were given a questionnaire containing 44 questions that included demographic data, school location, BB usage behavior, GPA status before and after using BBs, and a GAD-7 anxiety screening questionnaire.Results: A total of 3326 mainly female senior students participated in the study with a mean age of 21.9± 1.7 years. According to the GAD-7 score, half of the sampled students did not meet criteria indicative of anxiety disorder, and one-third were considered to have mild anxiety with a significant positive correlation between the BB usage and the GAD-7 score. A total of 6.4% of the sample reported usage of BBs. Therapeutics and Internal Medicine were the most common subjects for which BBs were used. When compared to pharmacy students, medical students were more likely to be male, smokers, diagnosed with psychiatric illness, having a higher mean GAD-7 score, report BB usage, and correctly identified common and serious BB side effects.Conclusion: The inappropriate use of BB drugs without medical advice might have short- and long-term effects, and those may be more vulnerable to have psychological issues in the future. Our findings shed light on the need to identify students who are taking BBs as being at high risk of underlying anxiety disorders.Keywords: beta-blocker, anxiety, student anxiety, self-prescription, undiagnosed anxiety

Objective: Fibromyalgia syndrome (FMS) is a chronic disorder associated with severe pain. According to the National Fibromyalgia Association, the prevalence of FMS is between 3% and 6% in the general population, with about 90% of the patients being women. The primary goal of this study was to evaluate the relationship between vitamin D and serotonin levels and FMS severity. Methods: Forty participants with fibromyalgia (mean age: 37.8±9.5 years) were included and had their medical history taken, a physical examination, and laboratory testing in the Rheumatology Department at Al-Ameen Hospital in Taif, Saudi Arabia. The revised Fibromyalgia Impact Questionnaire (FIQR) was used to determine the FMS severity. Results: The results showed that 42.5% of the patients were considered to have mild/moderate fibromyalgia, with the remainder having severe/extreme fibromyalgia. The latter were more likely to have lower serotonin levels. The results showed a significant dose-dependent negative relationship between the serotonin levels and FIQR scores (P=0.002). However, no significant correlations were found between the vitamin D levels and FIQR scores (P=0.112). Conclusion: The findings of this study show that the improved health of FMS patients is associated with normal serotonin levels.

Omar A Amin,1 Saleh M Abouzeid,2 Siham A Ali,3 Bashir A Amin,4 Khaled A Alswat51Department of Orthopedic, Al Noor Specialist Hospital, Makkah, Saudi Arabia; 2Department of Rheumatology, Al Azhar University, Cairo, Egypt; 3Department of Neurology, Banha University, Banha, Egypt; 4Department of Medicine, Taif University, School of Medicine, Taif, Saudi Arabia; 5Department of Medicine and Endocrinology, Taif University School of Medicine, Taif, Saudi ArabiaObjective: Fibromyalgia syndrome (FMS) is a chronic disorder associated with severe pain. According to the National Fibromyalgia Association, the prevalence of FMS is between 3% and 6% in the general population, with about 90% of the patients being women. The primary goal of this study was to evaluate the relationship between vitamin D and serotonin levels and FMS severity.Methods: Forty participants with fibromyalgia (mean age: 37.8±9.5 years) were included and had their medical history taken, a physical examination, and laboratory testing in the Rheumatology Department at Al-Ameen Hospital in Taif, Saudi Arabia. The revised Fibromyalgia Impact Questionnaire (FIQR) was used to determine the FMS severity.Results: The results showed that 42.5% of the patients were considered to have mild/moderate fibromyalgia, with the remainder having severe/extreme fibromyalgia. The latter were more likely to have lower serotonin levels. The results showed a significant dose-dependent negative relationship between the serotonin levels and FIQR scores (P=0.002). However, no significant correlations were found between the vitamin D levels and FIQR scores (P=0.112).Conclusion: The findings of this study show that the improved health of FMS patients is associated with normal serotonin levels.Keywords: fibromyalgia, vitamin D, serotonin, Saudi Arabia, Taif