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Rania M Fahmy,1,2 Ramesa S Bhat,3 Manar Al-Mutairi,4 Feda S Aljaser,5 Afaf El-Ansary4 1Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt; 3Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia; 4Central Laboratory, Female Center for Medical Studies and Scientific Section, King Saud University, Riyadh, Saudi Arabia; 5Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia Objective: To evaluate the effect of diabetes mellitus (DM), diabetic retinopathy, and degree of glycemic control (glycosylated hemoglobin [HbA1c]) on peripapillary retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography.Methods: The study included 126 eyes of healthy controls (n=32) and diabetics patients (n=31), whose ages ranged from 40 to 70 years. The diabetic group was divided into: Subgroup 1: with HbA1c

This study analyzes livestock breeders' attitudes and experiences with compound feed in Saudi Arabia. A total of 108.901 livestock breeders were selected from the Ministry of Environment, Water and Agriculture roll, by using random sampling. Over 442 breeders participated, mostly male approximately 58.9% with an average age of 39 and around 9 years of education. The main occupation was livestock were (83.0 %). Sheep and goats were common (82% and 63%), in the Badia system (59.5 %). The main purpose of raising was commercial uses (62.4 %). but traditional feeding (Roughages and barley) and pasture systems dominated (59%). Only 27% used compound feed with barley and Roughages, and 34% never used it, citing concerns about cost, availability, and animal health. Those who used compound feed for over 7 years were the highest group (16.7%), suggesting slow adoption. Though 63% didn't observe health problems, others reported issues like 73% of the livestock breeder's changes in meat color, tumors, diarrhea, and reduced milk production. Further research is needed to understand these health concerns and improve compound feed usage in Saudi Arabia. [ABSTRACT FROM AUTHOR]

The importance of the study lies in the fact that feed has a direct impact on animal and human health. The failure of breeders to use healthy and suitable fodder for the animal that meets the nutritional needs is due to several reasons, including the culture and education of the breeder, and some reasons related to the fodder itself, such as being of lower quality that does not meet the animal's nutritional and productive needs. The main objective of the study is to identify the feeding practices followed by livestock breeders, to assess their attitudes towards compound feed, and to determine the relationship between the personal and social characteristics of the breeders and their attitudes towards compound feed. The descriptive method was used. This study was conducted on livestock breeders in the Saudi Arabia, whose number is about (901,108 breeders). The questionnaire was used as a means of data collection, and (442) completed questionnaires representing the study sample were obtained. Descriptive statistical analyzes were used, and the chi-square test was used to measure the relationship between the personal and social characteristics of breeders and their attitudes towards compound feed. The analysis was done using the SPSS, v.26). The results of the study revealed that 52.5% of livestock breeders do not use compound feed in feeding livestock. The study also showed that 62.9% of livestock breeders did not notice the emergence of health problems in their livestock when using compound feed, while 37.1% noticed several problems, including: changing the color of the meat, disease, problems in milk production, diarrhea, and abscesses. ...etc.) when using compound feed, as it was found that the vast majority of livestock breeders, by 86.4%, had a neutral attitude towards compound feed. Finally, a significant relationship was found between the gender variable, the number of years of experience, and the feeding system variable with the breeders' attitudes towards the use of compound feed. [ABSTRACT FROM AUTHOR]

Background/Aim. In the past three decades, focal segmental glomerulosclerosis (FSGS) was commonly regarded as a part of obesity-related glomerulopathy (ORG), a distinct entity featuring proteinuria, glomerulomegaly, progressive glomerulosclerosis, and a decline of renal function. The present study aimed to evaluate the glomerular morphometry, clinical features, and a two-year outcome in the obese and non-obese FSGS patients. Methods. The study included 35 FSGS patients (23 males, aged 46.5 ± 15.2 years) divided into two groups: obese [body mass index (BMI) ≥ 27 kg/m2 (18 patients, aged 47.2 ± 15.5 years)] and non-obese [BMI < 27 kg/m2 (17 patients, aged 45.7 ± 15.2 years)]. The serum concentrations of proteins, albumin, cholesterol, tri-glyceride, and creatinine were determined at the time of the biopsy, and 6, 12, and 24 months after the biopsy. Cock-croft-Gault (BMI < 27 kg/m2) and Cockcroft-GaultLBW (BMI ≥ 27 kg/m2) formulas were calculated. Glomerular radius (GR), glomerular volume (GV), and glomerular density (GD) were compared morphometrically between the two groups. Results. At the time of the kidney biopsy and 6 months later, the obese had significantly lower glomerular filtration rate (GFR) compared to the non-obese. After 24 months of follow-up, there were not any differences between the groups. The obese had a significantly higher GR (109.44 ± 6.03 μm vs. 98.53 ± 14.38 μm) and GV (3.13 ± 0.49 × 106 μm3 vs. 2.26 ± 0.83 × 106 μm3), and only slightly lower GD (1.91 ± 0.39/mm2 vs. 1.95 ± 0.61/mm2) compared to the non-obese. A significant positive association between GV and BMI (r = 0.439) was found. After 12 months of follow-up, a significantly higher percentage of the non-obese patients reached complete remission compared to the obese (71.4% vs. 37.5%, respectively; p = 0.041), but after 24 months there were no significant differences. Conclusion. Obese patients, at the time of the kidney biopsy and 6 months later, had already a significantly lower kidney function compared to the non-obese ones. However, 12 and 24 months after, this difference was not statistically significant. Also, 24 months after, there was no significant difference between the two groups in the percentage of patients with complete remission of the nephrotic syndrome.

The article presents the study which examined the differences in morphological parameters of lesser jerboa (Jaculus jaculus L.) populations living in intact habitat with abundant food resources against those living in degraded habitats with scarce food resources. It analyses the effect of season and gender on the morphological parameters of the rodent. The study was conducted in the semi-arid lands of the state of Kuwait. Among the measured features of the jerboas are body weight, body length and tail length.

Fissure sealants commonly exhibit weak mechanical and physical properties, potentially compromising their effectiveness in preventing dental caries. Therefore, this laboratory study aimed to synthesize and characterize experimental pit and fissure sealants in comparison with a commercially available sealant. Three different formulations of experimental pit and fissure sealing materials were synthesized using a blend of bisphenol A-glycidyl methacrylate (Bis-GMA) and triethylene glycol dimethacrylate (TEGDMA) monomers. The resin composition encompassed 70 wt.%, with 30 wt.% fillers comprising 10 wt.% silica in each composition, while 20 wt.% bioactive glasses. Specifically, group G1 employed Biomin F powder, group G2 utilized Biomin C powder, and group G3 incorporated S53P4 powder. The control group (GC) was a commercially available pit and fissure sealant (Seal-Rite). Ten disk-shaped specimens from each study group were fabricated (n = 10/group). The surface roughness, water contact angle, nanohardness (nH), elastic modulus (EM), water solubility and sorption were statistically evaluated using a one-way analysis of variance ( p < 0.05). The surface roughness of the G1 & G2 groups and the water contact angle of G1, G2 & G3 groups were significantly lower compared to the control group ( p < 0.05). However, nH, EM, water solubility, and sorption were notably higher in the control group compared to the experimental groups, except G1, which exhibited no significant difference from the control group ( p > 0.05). The inclusion of micron-sized Biomin F powder in the experimental Bis-GMA/TEGDMA resin formulation demonstrated advantageous effects in reducing surface roughness and forming a lower contact angle without compromising the mechanical attributes., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Background: Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to the risk of harmful adverse effects unnecessarily. Therefore, the study aimed to evaluate the current behaviour of antibiotic usage, storage, re-usage and misuse among the residents of Saudi Arabia., Methods: This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS., Results: A total of 738 participants answered the online questionnaire from all ages, genders, nationalities, and socioeconomic backgrounds residing in different regions across the Kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when they started using antibiotics, to which 95.66% (n=706) responded after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. A total of 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and reuse them later on for symptoms like sore throat and fever., Conclusions: The results indicated that nearly half of the participants used leftover antibiotics. Participants having children in their homes significantly reuse antibiotics. However, one-third of the participants didn't complete the antibiotics course. A large portion of the population, regardless of age, level of education, or professional background, have continued to store leftover antibiotics after an infection treatment and reuse them once they think they need them for new symptoms. This advice further revises the current measures to fill those gaps and reduce this habit., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Al-Mehmadi B et al.)

Background: The objective of this study was to evaluate the association between noninvasive ventilation (NIV) compared with invasive ventilation and mortality in subjects with severe acute respiratory infection., Methods: This was a retrospective multi-center study of subjects with severe acute respiratory infection treated with ventilatory support between September 2012 and June 2018. We compared the 90-d mortality of subjects managed initially with NIV (NIV group) with those managed with invasive ventilation only (invasive ventilation group), adjusting by propensity score., Results: Of 383 subjects, 189 (49%) were in the NIV group and 194 (51%) were in the invasive ventilation group. Of the subjects initially treated with NIV, 117 (62%) were eventually intubated. Crude 90-d mortality was lower in the NIV group versus the invasive ventilation group (42 [22.2%] vs 77 [39.7%]; P < .001). After propensity score adjustment, NIV was associated with lower 90-d mortality than invasive ventilation (odds ratio 0.54, 95% CI 0.38-0.76; P < .001). The association of NIV with mortality compared with invasive ventilation was not different across the studied subgroups., Conclusions: In subjects with severe acute respiratory infection and acute respiratory failure, NIV was commonly used. NIV was associated with a lower 90-d mortality. The observed high failure rate suggests the need for further research to optimize patient selection and facilitate early recognition of NIV failure., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Today, the Arabian gazelle ( G. arabica ) occurs only in small, scattered populations on the Arabian Peninsula and is classified as 'vulnerable', due to intensive hunting and competition with livestock. The taxonomy of this threatened species is still under debate, hampering conservation efforts while ex-situ breeding programs could be an appropriate conservation measure to prevent the species from going extinct. In our study, we attempted to elucidate the radiation of G. arabica on the Arabian Peninsula, and to ask whether the population genetic structure allows to distinguish between discrete conservation units. We used mitochondrial markers, microsatellite markers, and three intron markers to identify conservation units, to match them with genotypes found in the captive breeding stock held in Saudi Arabia, and to ensure that genotype diversity of potential founder individuals corresponds to that prevailing at targeted reintroduction sites. The sequence divergence was low among nuclear and mitochondrial markers, with gazelles originating from the north of the Arabian Peninsula showing the largest diversity, while south-western and eastern populations showed a decreased diversity. A haplotype network based on the relatively heterogeneous cytochrome b gene found no signs of a prolonged separate evolutionary history of any investigated mainland population, suggesting limitations of gene-flow after the colonization of the Arabian Peninsula leading to a founder effect-like distribution of mitochondrial haplotypes. The ex-situ breeding population held in Saudi Arabia showed a good haplotype diversity, underlining its general suitability for reintroductions. However, it is recommended that genetic data of founders should be assessed prior to future reintroduction., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Reptiles are considered an important element of Saudi Arabia's wildlife to be conserved as a priority. However, the status and distribution of the Kingdom's reptile fauna is not well understood, thus hindering the conservation initiatives. Better understanding of the taxonomy and distribution of the Kingdom's reptile fauna is important for implementing effective conservation measures. Here, we provide the new distribution record of Pristurusminimus (Arnold, 1977; common name, Arnold's Gecko) from southern Saudi Arabia. The species was recorded from the Uruq Bani Ma'arid Protected Area (UBM) of southern Saudi Arabia. Four individuals were captured from different survey sites across the UBM and their species identification was confirmed through a mixture of physical and genetic examination. These results increase the number of species from the Pristurus genus to five for Saudi Arabia and improve the understanding of the Kingdom's reptile fauna and its distribution., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. I want to declare a conflict of interest Disclaimer: This article is (co-)authored by any of the Editors-in-Chief, Managing Editors or their deputies in this journal., (Mohammed Al Mutairi, Abdulaziz R Alqahtani, Zaffar Rais Mir, Riyaz Ahmad, Saad Alsubaie, Michael Smith.)

Purpose: To evaluate whether helmet noninvasive ventilation compared to usual respiratory support reduces 180-day mortality and improves health-related quality of life (HRQoL) in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia., Methods: This is a pre-planned follow-up study of the Helmet-COVID trial. In this multicenter, randomized clinical trial, adults with acute hypoxemic respiratory failure (n = 320) due to coronavirus disease 2019 (COVID-19) were randomized to receive helmet noninvasive ventilation or usual respiratory support. The modified intention-to-treat population consisted of all enrolled patients except three who were lost at follow-up. The study outcomes were 180-day mortality, EuroQoL (EQ)-5D-5L index values, and EQ-visual analog scale (EQ-VAS). In the modified intention-to-treat analysis, non-survivors were assigned a value of 0 for EQ-5D-5L and EQ-VAS., Results: Within 180 days, 63/159 patients (39.6%) died in the helmet noninvasive ventilation group compared to 65/158 patients (41.1%) in the usual respiratory support group (risk difference - 1.5% (95% confidence interval [CI] - 12.3, 9.3, p = 0.78). In the modified intention-to-treat analysis, patients in the helmet noninvasive ventilation and the usual respiratory support groups did not differ in EQ-5D-5L index values (median 0.68 [IQR 0.00, 1.00], compared to 0.67 [IQR 0.00, 1.00], median difference 0.00 [95% CI - 0.32, 0.32; p = 0.91]) or EQ-VAS scores (median 70 [IQR 0, 93], compared to 70 [IQR 0, 90], median difference 0.00 (95% CI - 31.92, 31.92; p = 0.55)., Conclusions: Helmet noninvasive ventilation did not reduce 180-day mortality or improve HRQoL compared to usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Arabi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Helmet noninvasive ventilation has been used in patients with COVID-19 with the premise that helmet interface is more effective than mask interface in delivering prolonged treatments with high positive airway pressure, but data about its effectiveness are limited., Objective: To evaluate whether helmet noninvasive ventilation compared with usual respiratory support reduces mortality in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia., Design, Setting, and Participants: This was a multicenter, pragmatic, randomized clinical trial that was conducted in 8 sites in Saudi Arabia and Kuwait between February 8, 2021, and November 16, 2021. Adult patients with acute hypoxemic respiratory failure (n = 320) due to suspected or confirmed COVID-19 were included. The final follow-up date for the primary outcome was December 14, 2021., Interventions: Patients were randomized to receive helmet noninvasive ventilation (n = 159) or usual respiratory support (n = 161), which included mask noninvasive ventilation, high-flow nasal oxygen, and standard oxygen., Main Outcomes and Measures: The primary outcome was 28-day all-cause mortality. There were 12 prespecified secondary outcomes, including endotracheal intubation, barotrauma, skin pressure injury, and serious adverse events., Results: Among 322 patients who were randomized, 320 were included in the primary analysis, all of whom completed the trial. Median age was 58 years, and 187 were men (58.4%). Within 28 days, 43 of 159 patients (27.0%) died in the helmet noninvasive ventilation group compared with 42 of 161 (26.1%) in the usual respiratory support group (risk difference, 1.0% [95% CI, -8.7% to 10.6%]; relative risk, 1.04 [95% CI, 0.72-1.49]; P = .85). Within 28 days, 75 of 159 patients (47.2%) required endotracheal intubation in the helmet noninvasive ventilation group compared with 81 of 161 (50.3%) in the usual respiratory support group (risk difference, -3.1% [95% CI, -14.1% to 7.8%]; relative risk, 0.94 [95% CI, 0.75-1.17]). There were no significant differences between the 2 groups in any of the prespecified secondary end points. Barotrauma occurred in 30 of 159 patients (18.9%) in the helmet noninvasive ventilation group and 25 of 161 (15.5%) in the usual respiratory support group. Skin pressure injury occurred in 5 of 159 patients (3.1%) in the helmet noninvasive ventilation group and 10 of 161 (6.2%) in the usual respiratory support group. There were 2 serious adverse events in the helmet noninvasive ventilation group and 1 in the usual respiratory support group., Conclusions and Relevance: Results of this study suggest that helmet noninvasive ventilation did not significantly reduce 28-day mortality compared with usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. However, interpretation of the findings is limited by imprecision in the effect estimate, which does not exclude potentially clinically important benefit or harm., Trial Registration: ClinicalTrials.gov Identifier: NCT04477668.

Background: Ventricular septal defect (VSD) is the most common congenital cardiac defect for which outcomes are not uniform. There is a lack of consensus on the risk factors for the unfavorable outcomes following surgical VSD closure., Aim: The aim of this study was to determine the risk factors and the predictors of major adverse events (MAEs) and complications following surgical closure of VSD in children weighing less than 10 kg., Methods: This retrospective cohort study included children less than 10 kg who underwent surgical closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated major cardiac anomalies were excluded. Preoperative, operative and postoperative data were collected from medical records., Results: This study included 127 patients 52.8% were males, the median age was 8.0 months (IQR = 6.0-11.0 months), and their median weight was 5.7 kg (IQR = 4.8-7.0). Mortality was in one patient (0.8%) Multivariable logistic regression analysis revealed that male sex group (observational data), previous pulmonary artery banding (PAB), and significant intraoperative residual VSD were significant risk factors for the development of MAEs (odds ratios were 3.398, 14.282, and 8.634, respectively). Trisomy 21 syndrome (odds ratio: 5.678) contributed significantly to prolonged ventilation. Pulmonary artery banding (odds ratio: 14.415), significant intraoperative (3 mm) residual VSD (odds ratio: 11.262), and long cross-clamp time (odds ratio: 1.064) were significant predictors of prolonged ICU stay, whereas prolonged hospital stay was observed significantly in male sex group (odds ratio: 12.8281), PAB (odds ratio: 2.669), and significant intraoperative (3 mm) residual VSD (odds ratio: 19.551)., Conclusions: Surgical VSD repair is considered a safe procedure with very low mortality. Trisomy 21 was a significant risk factor for prolonged ventilation. Further, PAB, significant intraoperative residual of 3 mm or more that required a second pulmonary bypass, and a greater cross-clamp time were significant predictors of MAE and associated complications with prolonged ICU and hospital stay., (© 2022. The Author(s).)

Developing an enterprise approach to imaging technology rather than a radiology focus has recently increased. The communicator needs to be aware of this shift.The Middle East countries participated in the survey have confirmed the following major benefits of Medical Image Exchange: ✔ Fast access to both image and report ✔ Enable tele-services for second opinion, consulting and reporting ✔ Improve patient journey, workflow and diagnosis ✔ Allowed more patient engagement to be in place The Middle East countries that participated in this survey have agreed on the following shared challenges regarding Medical Imaging Exchange: ✔ Lack of enterprise imaging governance at the early stage of implementation. It will organize the who, when, and how. In addition, any fees and or payment involved for physicians ✔ Infrastructure availability to handle such large volume of data. Growing from mega-byte to petabyte per year is challenge for infrastructure. Cloud against On Premises-Installation implementation model ✔ Interoperability and integration to connect multi specialties from different systems. In addition, how far existing systems are ready for that. A standard-based framework is mature for image exchange, but what follows for other domains? There is a need to move beyond radiology images so as to include images from pathology, ophthalmology, and dermatology There are other countries in the region requiring guidance, support, and funding to move forward from the compact disc into internet-based interoperable image exchange. This should be considered part of the World Health Organization and the United Nation development to the region in the healthcare sector., (© 2022. The Author(s) under exclusive licence to Society for Imaging Informatics in Medicine.)

Background: Huge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children's rates of COVID-19 Vaccination as reported by parents, to explore parents' attitudes towards children's COVID-19 vaccination, and to examine the factors associated with parents' hesitancy towards children's vaccination in several countries in the Eastern Mediterranean Region (EMR)., Methods: This study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders., Results: The prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents' attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children's vaccination was significantly correlated with parents' age, education, occupation, parents' previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children's vaccination in the participating Arab countries is still not promising., Conclusion: To encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels., (© 2022. The Author(s).)

Obesity has reached global epidemic proportions and it affects the development of insulin resistance, type 2 diabetes, fatty liver disease and other metabolic diseases. Membrane lipids are important structural and signaling components of the cell membrane. Recent studies highlight their importance in lipid homeostasis and are implicated in the pathogenesis of fatty liver disease. Here, we discuss the numerous membrane lipid species and their metabolites including, phospholipids, sphingolipids and cholesterol, and how dysregulation of their composition and physiology contribute to the development of fatty liver disease. The development of new genetic and pharmacological mouse models has shed light on the role of lipid species on various mechanisms/pathways; these lipids impact many aspects of the pathophysiology of fatty liver disease and could potentially be targeted for the treatment of fatty liver disease.

The emergency state caused by COVID-19 saw the use of immunomodulators despite the absence of robust research. To date, the results of relatively few randomized controlled trials have been published, and methodological approaches are riddled with bias and heterogeneity. Anti-SARS-CoV-2 antibodies, convalescent plasma and the JAK inhibitor baricitinib have gained Emergency Use Authorizations and tentative recommendations for their use in clinical practice alone or in combination with other therapies. Anti-SARS-CoV-2 antibodies are predominating the management of non-hospitalized patients, while the inpatient setting is seeing the use of convalescent plasma, baricitinib, tofacitinib, tocilizumab, sarilumab, and corticosteroids, as applicable. Available clinical data also suggest the potential clinical benefit of the early administration of blood-derived products (e.g. convalescent plasma, non-SARS-CoV-2-specific immunoglobins) and the blockade of factors implicated in the hyperinflammatory state of severe COVID-19 (Interleukin 1 and 6; Janus Kinase). Immune therapies seem to have a protective effect and using immunomodulators alone or in combination with viral replication inhibitors and other treatment modalities might prevent progression into severe COVID-19 disease, cytokine storm and death. Future trials should address existing gaps and reshape the landscape of COVID-19 management.

Background: Noninvasive respiratory support is frequently needed for patients with acute hypoxemic respiratory failure due to coronavirus disease 19 (COVID-19). Helmet noninvasive ventilation has multiple advantages over other oxygen support modalities but data about effectiveness are limited., Methods: In this multicenter randomized trial of helmet noninvasive ventilation for COVID-19 patients, 320 adult ICU patients (aged ≥14 years or as per local standards) with suspected or confirmed COVID-19 and acute hypoxemic respiratory failure (ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 200 despite supplemental oxygen with a partial/non-rebreathing mask at a flow rate of 10 L/min or higher) will be randomized to helmet noninvasive ventilation with usual care or usual care alone, which may include mask noninvasive ventilation, high-flow nasal oxygen, or standard oxygen therapy. The primary outcome is death from any cause within 28 days after randomization. The trial has 80% power to detect a 15% absolute risk reduction in 28-day mortality from 40 to 25%. The primary outcome will be compared between the helmet and usual care group in the intention-to-treat using the chi-square test. Results will be reported as relative risk  and 95% confidence interval. The first patient was enrolled on February 8, 2021. As of August 1, 2021, 252 patients have been enrolled from 7 centers in Saudi Arabia and Kuwait., Discussion: We developed a detailed statistical analysis plan to guide the analysis of the Helmet-COVID trial, which is expected to conclude enrollment in November 2021., Trial Registration: ClinicalTrials.gov NCT04477668 . Registered on July 20, 2020., (© 2022. The Author(s).)

Objective: The aim of this study was to examine the impact of timing of a childhood-onset systemic lupus erythematosus (SLE) diagnosis relative to menarchal status, on final height, accounting for disease-associated factors., Methods: We conducted a cohort study of female patients age <18 years at childhood-onset SLE diagnosis, followed at a tertiary care pediatric center from July 1982 to March 2016 and restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre- and postmenarche. We tested the association of the timing of childhood-onset SLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow-up, additionally adjusting for average daily corticosteroid dose and disease activity., Results: Of 401 female childhood-onset SLE patients in the study, 115 patients (29%) were diagnosed premenarche and 286 (71%) postmenarche. Patients diagnosed premenarche were older at menarche compared with patients diagnosed postmenarche (mean ± SD age 13.5 ± 1.4 versus 12.5 ± 1.3 years; P < 0.001). The mean ± SD final height for girls diagnosed postmenarche (161.4 ± 6.9 cm) was greater than for those diagnosed premenarche (158.8 ± 7.3 cm; P = 0.001). In regression analysis, those diagnosed postmenarche were significantly taller than those diagnosed premenarche, as adjusted for ethnicity and disease severity (mean ± SD β = 2.6 ± 0.7 cm; P = 0.0006)., Conclusion: In this large cohort study of girls with childhood-onset SLE, patients diagnosed postmenarche achieved a taller final height than those diagnosed premenarche, even after accounting for ethnicity and disease severity., (© 2020, American College of Rheumatology.)

The objective of this study was to review the outcome of patients who underwent transcatheter closure of ventricular septal defect (VSD) using Nit-Occlud ® Leˆ VSD-Coil.A retrospective study was carried out at King Abdulaziz Cardiac Center on all paediatric patients who underwent interventional VSD closure, during the period from 2011 and 2016. Data were collected, including demographic information, cardiac diagnosis, pre-operative diagnosis, intra-operative findings and postoperative events. Out of 46 patients, who were evaluated for VSD device closure, 17 of them were excluded; 24 patients out of 29 had successful closure of VSD using Nit-Occlud Leˆ VSD-Coil (success rate of 83%), and five cases were referred to surgery. The age group was from 2 years up to 18 years. Almost 90% of VSD was the perimembranous (PM) type (26 patients) and 3 patients (10%) with muscular VSD. Ten of the 26 PM VSDs had TV accessory tissue partially covering the VSD defects. The hemodynamic assessment showed pulmonary blood flow to systemic blood flow ratio (Qp:Qs) > 1.5 in almost all the patients who underwent defect closure. Immediate closure of the defect was achieved in 11/24 patients (45%). In five additional patients, there was a tiny residual and eight with a small residual. With 6 months of follow-up, only six patients remained with tiny residual VSD defects.The Nit-Occlud ® Leˆ VSD-Coil device has minimal effects on the aortic and tricuspid valves, and there was no permanent atrioventricular block, especially in patients with PM VSDs. Patients with a residual shunt should be followed, especially for haemolysis., Competing Interests: The authors declare no conflicts of interest., (Copyright © Sudanese Association of Pediatricians.)

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA., (© 2021. The Author(s).)