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Background In contexts where certifying causes of death (COD) is inadequate – either in industrialized or non-industrialized countries – verbal autopsy (VA) serves as a practical method for determining probable COD, helping to address gaps in vital data. Objective This study aimed to validate the diagnostic accuracy of medical certifications at a population level by comparing COD obtained from medical records against those derived from VA in Saudi Arabia. Method Death records from 2018 to 2021 were collected from a type 2 diabetes mellitus register at a major specialist hospital in Makkah. Three hundred and two VA interviews were completed with deceased patients’ relatives, and the probable COD was determined using InterVA-5 software. Lin’s concordance correlation coefficient was applied to examine similarities of the cause-specific mortality fractions (CSMFs) based on International Classification of Diseases chapters from both verbal autopsy causes of death (VACOD) and the physician review causes of death (PRCOD). Results Overall, the findings demonstrated a moderate level of concordance of COD at the population between VACOD and PRCOD. However, the CSMFs for various COD categories derived from both sources showed a broad spectrum of absolute differences, with the largest disparities observed among the most prevalent COD categories. Conclusion PRCOD was found to overestimate population-level endocrine/metabolic and respiratory disease COD while underestimating circulatory disease, demonstrating medical certification challenges. Conversely, affirming previous literature on prevalent COD in Saudi Arabia, VA appears to deliver a plausible assessment, further strengthening its potential to integrate within the Saudi health system towards an augmented medical certification process.

Background: Multiple sclerosis (MS) is considered the most prevalent neurological disorder in young adults with many patients manifesting sleep-related disorders (SRD) due to its pathomechanisms. This is subsequently reflected in patients’ quality of life and physical activities. Material and Methods: This is a cross-sectional study at a tertiary care center. Patients diagnosed with MS were enrolled, and assessment of their sleep patterns and related disorders were measured using pre-validated scales. A questionnaire consisting of 38 items was used, and the obtained data were analyzed using RStudio software. Results: A total of 260 patients participated in the study. Most participants were aged 31–40 (n = 112) with a mean age of 36.49 ± 8.41 (age range: 18–56 years). The most used medications were rituximab (27%) and ocrelizumab (25%). Shapiro–Wilk Test was significant (P = 0.04) and just below the significance level of α = 0.05, suggesting potential significant deviation in the distribution of age. Logistic regression model was applied, and the female probability of sleeping more than six hours was 3.60 times the probability of sleeping six hours or less. Conclusion: Sleep quality is multifaceted and requires intensive investigation in patients with chronic disorders including MS. In this study, several novel data have been presented in a population that has very little literature data.

Background: The illnesses associated with changes in barometric pressure can be classified into three types: acute mountain sickness, high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema. HAPE is a rare form of pulmonary edema that occurs in susceptible individuals after arriving at altitudes over 2500 m above sea level (m). Only a few studies have reported classical HAPE among children with underlying cardiopulmonary comorbidities. In this study, we report two pediatric cases of classical HAPE that occurred immediately upon arriving at Abha city (with an average elevation of 2270 m above sea level). Notably, both patients possessed underlying chronic lung diseases, raising crucial questions about susceptibility factors and the early onset manifestations of HAPE. Case: Two pediatric cases of HAPE are presented. The first patient, with a medical history of repaired right congenital diaphragmatic hernia and subsequent right lung hypoplasia, developed HAPE following their ascent to a high altitude. The second patient, diagnosed with diffuse lung disease of unknown etiology, experienced HAPE after a rapid high-altitude ascent. Both patients resided in low-altitude areas prior to ascent. The initial emergency room assessment revealed that both patients had severe hypoxia with respiratory distress that mandated the initiation of respiratory support and 100% oxygen therapy. They required intensive care unit admission, improved after 5 days of hospitalization, and were sent home in good condition. Conclusion: HAPE is a complex, potentially life-threatening high-altitude illness with diverse clinical presentations and variable risk factors. This case report sheds light on a potential predisposition factor—pre-existing lung disease—in children experiencing severe HAPE. While further validation is crucial, this valuable insight opens doors for improved preventative strategies and informed medical decisions for children with pre-existing lung conditions traveling to high altitudes.

ABSTRACT: Background: Multiple sclerosis (MS) is considered the most prevalent neurological disorder in young adults with many patients manifesting sleep-related disorders (SRD) due to its pathomechanisms. This is subsequently reflected in patients' quality of life and physical activities. Material and Methods: This is a cross-sectional study at a tertiary care center. Patients diagnosed with MS were enrolled, and assessment of their sleep patterns and related disorders were measured using pre-validated scales. A questionnaire consisting of 38 items was used, and the obtained data were analyzed using RStudio software. Results: A total of 260 patients participated in the study. Most participants were aged 31–40 (n = 112) with a mean age of 36.49 ± 8.41 (age range: 18–56 years). The most used medications were rituximab (27%) and ocrelizumab (25%). Shapiro–Wilk Test was significant (P = 0.04) and just below the significance level of α = 0.05, suggesting potential significant deviation in the distribution of age. Logistic regression model was applied, and the female probability of sleeping more than six hours was 3.60 times the probability of sleeping six hours or less. Conclusion: Sleep quality is multifaceted and requires intensive investigation in patients with chronic disorders including MS. In this study, several novel data have been presented in a population that has very little literature data. [ABSTRACT FROM AUTHOR]

Infectious diseases are among the most frequent causes of hospital admission and a substantial contributor to morbidity and mortality. These diseases pose a persistent concern, particularly within the pediatric population, where delays or inappropriate management can result in serious harm. Additionally, infectious diseases contribute to overcrowding in pediatric emergency departments (EDs). This study aimed to explore the epidemiology, clinical presentation, diagnostics, outcome, and social and behavioral impacts of infectious diseases on child health. We conducted a retrospective, single-hospital study at a tertiary care center that is publicly funded and owned to serve the entire community. Pediatric patients with at least one or more chief complaints related to the respiratory system or infectious etiology were included. Data analysis was performed using SPSS to assess relationships between variables. A total of 15,106 patients were included, with a mean age of 3.80 years. The largest age group was toddlers (42.8%). Most cases (71.9%) were classified as urgent (Priority 3). Regarding patient outcomes, 76.1% were discharged after receiving appropriate treatment in the ED, and 22.9% required admission for further management. Nearly 38% of patients presented with a single complaint. Fever was the most frequent complaint across all groups. In summary, this study provides insights into the presentation of pediatric respiratory infectious diseases in the emergency room. The study revealed that toddlers were the most affected age group, with fever and cough being the common symptoms. [ABSTRACT FROM AUTHOR]

Background: The illnesses associated with changes in barometric pressure can be classified into three types: acute mountain sickness, high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema. HAPE is a rare form of pulmonary edema that occurs in susceptible individuals after arriving at altitudes over 2500 m above sea level (m). Only a few studies have reported classical HAPE among children with underlying cardiopulmonary comorbidities. In this study, we report two pediatric cases of classical HAPE that occurred immediately upon arriving at Abha city (with an average elevation of 2270 m above sea level). Notably, both patients possessed underlying chronic lung diseases, raising crucial questions about susceptibility factors and the early onset manifestations of HAPE. Case: Two pediatric cases of HAPE are presented. The first patient, with a medical history of repaired right congenital diaphragmatic hernia and subsequent right lung hypoplasia, developed HAPE following their ascent to a high altitude. The second patient, diagnosed with diffuse lung disease of unknown etiology, experienced HAPE after a rapid high-altitude ascent. Both patients resided in low-altitude areas prior to ascent. The initial emergency room assessment revealed that both patients had severe hypoxia with respiratory distress that mandated the initiation of respiratory support and 100% oxygen therapy. They required intensive care unit admission, improved after 5 days of hospitalization, and were sent home in good condition. Conclusion: HAPE is a complex, potentially life-threatening high-altitude illness with diverse clinical presentations and variable risk factors. This case report sheds light on a potential predisposition factor—pre-existing lung disease—in children experiencing severe HAPE. While further validation is crucial, this valuable insight opens doors for improved preventative strategies and informed medical decisions for children with pre-existing lung conditions traveling to high altitudes. [ABSTRACT FROM AUTHOR]

Context: Despite the vast developments in medical sciences in recent decades, seizures remain a common occurrence among neonates, associated with high rates of morbidity and mortality. Aims: The aim of this study was to assess and analyze the presentation and outcome of neonates who were previously exposed to seizures. Subjects and Methods: Following a retrospective research design, this study included 50 cases of neonatal seizures (29 males and 21 females), who were admitted to the neonatal intensive care unit at King Abdulaziz University Hospital, Jeddah City, Saudi Arabia. Data were collected from the hospital records and included all visits between January 2022 and December 2022. Results: The most common types of neonatal seizures were clonic and myoclonic seizures (44% and 28%, respectively). Apgar score at 5 min was <7 in 30% of cases. The main diagnosis was hypoxic‑ischemic encephalopathy (HIE) in 28 children (56%), and central nervous system (CNS) infection in 18 children (36%). Children with neonatal seizures mainly received phenobarbital, benzodiazepines, or levetiracetam (48%, 46%, and 36%, respectively). Mechanical ventilation was applied to 20 children (40%). A total of 15 children (30%) had developmental delays, being global delay in 7 children (14%), or motor in 8 children (16%), while 6 children died (12%). Seizures could be controlled in 37 children (74%). Children who presented early (during the 1st week of life) and those who had Apgar scores <7 at 5 min had significantly worse outcomes, with higher case fatality and less seizure control than those who had Apgar scores of 7–10 (P < 0.001). Conclusions: Seizures are a common occurrence among neonates, especially males during the 1st week of their lives. HIE and CNS infections are the main diagnoses. The most administered medications are phenobarbital, benzodiazepines, and levetiracetam. Children who present during their 1st week of life and those who have 5‑min Apgar scores <7 have significantly higher case fatality and less seizure control. [ABSTRACT FROM AUTHOR]

Medical students face uncertainty in choosing their future careers, which is influenced by personal and professional factors and can have a direct impact on the healthcare system and society. In this study, we aimed to analyze the magnitude of influence of personal and professional factors on students' choices of a future specialty, among medical students in Saudi Arabia and other Arab countries. This cross-sectional exploratory study used cluster sampling and collected demographic data, influencing factors, preferred specialty, and engagement level, using a 20-item questionnaire. The study included 1,105 students, of which 60.5% were women. Income was the most influential factor for both sexes (68.5%) and was statistically significant for men (P < 0.0001), with personal experience and type of patients served being more important for women. Many students (42.6%) were undecided about their future specialty. However, general surgery was the most preferred specialty, followed by internal medicine (10.9%) and obstetrics and gynecology (5.5%). Women had a significantly higher mean personal score than men, indicating a preference for surgery (3.07 ± 2.2 vs. 2.78 ± 2.1; P = 0.029). In this study, we found that income significantly influenced medical students' choices of specialty, with surgery being the most common, and that many students are undecided about their specialty, needing career counseling and mentoring programs. [ABSTRACT FROM AUTHOR]

Pediatric neurological emergencies are a significant concern, often leading to high rates of admission to pediatric intensive care units and increased mortality rates. In Saudi Arabia, the emergency department (ED) is the main entry point for most patients in the healthcare system. This study aimed to provide a comprehensive overview of pediatric neurology visits to the ED, analyzing patient demographics, clinical presentations, and outcomes. The retrospective study was conducted at a large tertiary care center and examined 960 pediatric patients with neurological emergencies out of 24,088 pediatric ED visits. The study population consisted mainly of male participants (56.5%) and 43.5% female participants, with a mean age of 5.29 ± 4.19 years. School-age children (6-12 years) represented the largest population group (29.1%), and over a third of patients were triaged as 'resuscitation' (n = 332, 34.6%). Seizures (n = 317, 33.0%) and postictal states (n = 187, 19.5%) were the most common reasons for seeking emergency care, accounting for over half of all cases. There were statistically significant differences in provisional diagnosis and chief complaints across different age groups (P >0.001 and P <0.001, respectively). The most common outcome was discharge (n = 558; 58.1%), and the mean length of stay was 10.56 ± 20.33 hours. Neuro-emergencies in pediatrics are a concern and a leading cause of mortality, morbidities, and increased hospital visits. The observed variations in presentation and outcomes across age groups further emphasize the importance of tailored approaches. [ABSTRACT FROM AUTHOR]

Background: The medical workforce plays a pivotal role in advancing human health, particularly within the healthcare system of Saudi Arabia. While government-employed healthcare providers form the central structure of the system and offer free healthcare services, the private healthcare sector is also witnessing significant growth. In parallel, the field of child neurology has experienced notable transformations in recent years, with continued expansion. This expansion brings forth a range of challenges for both current and future pediatric neurologists, necessitating careful consideration and proactive measures to address them. Aim of the study: To investigate and analyze the current characteristics of the workforce, with a specific focus on their employment status and related data. Methods: This is a cross-sectional analysis, using a survey to assess the distribution of pediatric neurologists in Saudi Arabia (SA). The final analytical sample included 82 subjects, working in 13 regions in SA. A descriptive analysis was used to address the study question. Results: The survey received responses from a total of 82 pediatric neurologists in Saudi Arabia (response rate 55%), with 38 (46%) being men and 44 (54%) being women. The mean age was 33 ± 1.225 years. The majority of participants practiced in major cities such as Riyadh and Jeddah. Nearly 50% of pediatric neurologists experienced some form of delay in obtaining their first job, ranging from 1 to 36 months. Conclusion: The landscape of the pediatric neurology workforce is currently witnessing noteworthy demographic shifts. With the majority of practitioners concentrated in major cities, there is an ongoing demand for qualified professionals in peripheral areas. This study describes the real-life challenges faced by pediatric neurologists, particularly the delay in securing employment after graduation, and underscores the critical importance of addressing these persistent issues along the journey of pediatric neurology. [ABSTRACT FROM AUTHOR]