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We explore the local dynamical characteristics, chaos and bifurcations of a two-dimensional discrete laser model in $ \mathbb{R}_+^2 $. It is shown that for all $ a $, $ b $, $ c $ and $ p $, model has boundary fixed point $ P_{0y}(0, \frac{p}{c}) $, and the unique positive fixed point $ P^+_{xy}(\frac{ap-bc}{ab}, \frac{b}{a}) $ if $ p > \frac{b c}{a} $. Further, local dynamical characteristics with topological classifications for the fixed points $ P_{0y}(0, \frac{p}{c}) $ and $ P^+_{xy}(\frac{ap-bc}{ab}, \frac{b}{a}) $ have explored by stability theory. It is investigated that flip bifurcation exists for the boundary fixed point $ P_{0y}(0, \frac{p}{c}) $, and also there exists a flip bifurcation if parameters vary in a small neighborhood of the unique positive fixed point $ P^+_{xy}(\frac{ap-bc}{ab}, \frac{b}{a}) $. Moreover, it is also explored that for the fixed point $ P^+_{xy}(\frac{ap-bc}{ab}, \frac{b}{a}) $, laser model undergoes a Neimark-Sacker bifurcation, and in the meantime stable invariant curve appears. Numerical simulations are implemented to verify not only obtain results but also exhibit complex dynamics of period $ -2 $, $ -3 $, $ -4 $, $ -5 $, $ -8 $ and $ -9 $. Further, maximum lyapunov exponents along with fractal dimension are computed numerically to validate chaotic behavior of the laser model. Lastly, feedback control method is utilized to stabilize chaos exists in the model.

Introduction: COVID-19 disease is currently pandemic, and its prevalence in Saudi Arabia is concerning. The SARS-CoV-2 virus primarily affects the lungs, but it also affects the haematopoietic system. The atypical lymphocytes on peripheral blood film that have a distinct morphological appearance were of particular interest in this study. Our goal was to see a link between atypical lymphocytes and COVID-19 patient mortality. Methods: This four-month single-centered prospective descriptive study was conducted in Makkah, Saudi Arabia. COVID-19 patients of both genders were randomly selected based on inclusion criteria. The data from the patient’s electronic medical record was extracted. All patients’ peripheral blood film parameters were recorded on days 3, 7, and 14 after admission. The statistical data was analysed using SPSS version 23. The Fisher’s exact test was used to determine the relationship with mortality. A p value of 0.05 was considered significant. Results: The total number of cases enrolled in the study was 226. The patients’ average age was 58 years (SD 0.5289). On the third day of admission, 88.2 % of patients with COVID-19 had atypical lymphocytes, with a mean of 2.35 ± 0.927. A significant correlation (p < 0.001) exists between atypical lymphocytes decreasing percentage number on the 3rd, 7th, and 14th days of admission and death. Conclusion: The decrease in the number of atypical lymphocytes on peripheral blood film has a significant association with the patients’ mortality. This fact can be used to develop a tailored management strategy based on the observation of peripheral blood film.

Faisal Minshawi,1 Mohammed Samannodi,2 Hassan Alwafi,3 Hamza M Assaggaf,1 Mohammed A Almatrafi,4 Emad Salawati,5 Radi Alsafi,1 Ruba A Alharbi,3 Raghad F Alduais,3 Muruj Alrehaili,3 Shahad Tariq,3 Rahaf Alghamdi,3 Shumok Almatrfi3 1Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 3Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia; 5Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Mohammed Samannodi, Email mssamannodi@uqu.edu.saIntroduction: Influenza vaccination is the primary control measure for severe complications caused by influenza viruses. Moreover, in the face of the COVID-19 pandemic, Saudi Arabia recommends vaccinating people at risk against influenza to minimise co-infection risk with SARS-CoV2. Therefore, this study aims to assess the Saudi population’s knowledge, attitude, and practice toward influenza vaccination during the COVID-19 pandemic. Moreover, we evaluate the impact of the COVID-19 pandemic on seasonal influenza vaccination.Methods: This cross-sectional study was conducted using an online survey in Saudi Arabia between July to August 2021. Participants were invited to complete the questionnaire through a survey link sent to social media platforms.Results: A total of 2410 participants were included in this study. Our data demonstrate a lack of practice, attitude, and knowledge, especially on the influenza virus’s symptoms, viral transmission, and vaccine efficacy. Moreover, this study showed that the COVID-19 pandemic significantly impacted seasonal influenza vaccination in the Saudi population by 1.5-times compared to the previous years.Conclusion: COVID-19 pandemic has increased the hesitancy of Saudi participants in influenza vaccination due to the lack of knowledge. As the pandemic of COVID-19 is fading, awareness campaigns are needed to encourage the public about the importance of receiving the influenza vaccine, especially for those at high risk each year.Keywords: COVID-19 pandemic, influenza vaccine, vaccine hesitancy

Hearing impairment is a prevalent disabling condition among children; all newborns should undergo a universal newborn hearing screening (UNHS). Unfortunately, many newborns who fail the screening test are lost to follow-up. Our study aims to evaluate parents’ perceptions of UNHS and to identify predictors for newborn hearing screening recall in Saudi Arabia. A cross-sectional study involving Saudi parents with 0-to-18-year-old children born in Saudi Arabia was conducted. Descriptive statistics and binary logistic regression were used to describe the participants’ characteristics and to identify UNHS recall predictors. A total of 1533 parents were surveyed. Overall, 29.9% of them recalled a hearing screening at birth, while 22.2% reported no hearing screening, and 47.8% were unable to remember. Only (6.9%) participants reported a failed hearing screening, of which 75.9% recalled a follow-up recommendation. Females, parents aged 30–34 years, consanguineous parents, and parents of newborns who were treated with antibiotics were more likely to recall hearing screening compared to others. This study highlights inadequate awareness of UNHS among parents. Our findings support the need to improve the reporting system of UNHS results and implement educational programs to increase parents’ recall of hearing test results and ensure early follow-ups for neonates with failed test results.

In organisms’ bodies, the activities of enzymes can be catalyzed or inhibited by some inorganic and organic compounds. The interaction between enzymes and these compounds is successfully described by mathematics. The main purpose of this article is to investigate the dynamics of the activator–inhibitor system (Gierer–Meinhardt system), which is utilized to describe the interactions of chemical and biological phenomena. The system is considered with a fractional-order derivative, which is converted to an ordinary derivative using the definition of the conformable fractional derivative. The obtained differential equations are solved using the separation of variables. The stability of the obtained positive equilibrium point of this system is analyzed and discussed. We find that this point can be locally asymptotically stable, a source, a saddle, or non-hyperbolic under certain conditions. Moreover, this article concentrates on exploring a Neimark–Sacker bifurcation and a period-doubling bifurcation. Then, we present some numerical computations to verify the obtained theoretical results. The findings of this work show that the governing system undergoes the Neimark–Sacker bifurcation and the period-doubling bifurcation under certain conditions. These types of bifurcation occur in small domains, as shown theoretically and numerically. Some 2D figures are illustrated to visualize the behavior of the solutions in some domains.

Background Human brucellosis is an infectious multisystem disease that varies in severity and clinical course. Bacteremia in brucellosis is common; however, data on epidemiology and management of Brucella bacteremia are scarce. The World Health Organization recommends using doxycycline with rifampicin or an aminoglycoside for brucellosis. This study aims to compare the efficacy of the two treatment regimens (oral doxycycline/rifampicin or ciprofloxacin versus IV gentamicin plus oral doxycycline/rifampicin or ciprofloxacin) in Brucella bacteremia. Methods In this single-center, retrospective cohort study, we analyzed the outcomes of 93 adults with confirmed Brucella bacteremia from 2017 to 2020. The diagnosis of brucellosis was based on positive blood culture for Brucella species. The patients were divided into two cohorts according to the treatment regimen received (oral versus IV). Blood culture negativity after four weeks and clinical cure rate at end of therapy were the co-primary endpoints, while side effects were secondary endpoints. Fisher's exact test and Pearson's chi-square test were applied to compare the two groups. The data were analyzed using SPSS version 23. A P-value < .05 was considered significant. Results A total of 93 cases of Brucella bacteremia were enrolled, with 64 (68.8%) patients being male, and the group mean age being 44.3 ± 19.2 years. Overall, 37 (39.8%) patients received IV regimen, while 56 (60.2%) received oral treatment. Follow-up blood culture negativity after four weeks for both groups was 90.3% (n=84) with no difference between the oral and IV regimens (87.5% (n=49) versus 94.6% (n=37); P= .348, respectively). The overall clinical cure rate was 93.5% (n=87) for both groups combined, with no significant difference between the oral and IV groups (91% (n=51) versus 97.3% (n=36); P= .397, respectively). Transaminitis (7.1% vs. 5.4%), vomiting (5.4% vs. 8.1%), and acute kidney injury (0% vs. 2.7%) were all reported in the oral and IV groups, respectively, with no statistically significant difference between the two groups (P =.590). No deaths were reported over this period. Conclusion Oral and IV antimicrobial regimens have the same response rates in Brucella bacteremia patients. Disclosures All Authors: No reported disclosures.

Background Functional gastrointestinal disorders (FGIDs) are syndromes identified based on a group of symptoms defined according to the criteria of the Rome Foundation. The most commonly observed disorders among the pediatric population are functional abdominal pain disorders and functional constipation. This study aims to identify the patterns of FGIDs among children in Makkah, Saudi Arabia. Methods A retrospective cohort study was conducted at pediatric gastroenterology clinics from 2015 to 2019 in a tertiary centre in Makkah, Saudi Arabia. The FGID outcomes were compared with the patient's gender, age, and other characteristics using Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) software to analyze the data. Results One hundred and fifty-two participants met the inclusion criteria, with a mean age of 5.49 ± 3.27 and an average weight of 20.68 ± 12.15 kg. Male patients account for 59.2% of the total population. The prevalence of abdominal pain was 17.84%, while constipation was 50.93%. There was a statistically significant association between abdominal pain and independent variables such as family history (p=0.004) and age, particularly in older children (5-12 years; p=0.001). A statistically significant correlation was found between constipation with gender (p=0.032) and family history (p0.001). Conclusion The prevalence of functional constipation and abdominal pain increased with age among children in Makkah City, with constipation being significantly more prevalent than functional abdominal pain. There is a significant relationship between age and family history with abdominal pain, whereas gender and family history are associated with a greater likelihood of constipation.

To summarize the current evidence regarding the prevalence of Allergic rhinitis (AR) and its symptoms, triggers, and impact on the quality of life of the Saudi population.A Computerized Search in MEDLINE via PubMed, MEDLINE Core database, Scopus, and Web of Science was conducted using relevant keywords. A two-stage screening process, data extraction, and quality assessment were conducted by four independent reviewers. Comprehensive Meta-analysis was used for all statistical analyses (CMA; USA: version 3.3.070).Sixteen articles (n= 31,990 patients) were included. The overall estimated prevalence of AR was 21.2%, 95% CI (12.8-33.1%). Males had a higher prevalence of AR than females (31.7% vs 27.1%), although the difference was not significant (OR=1.24, 95% CI: 0.78-1.953; p=0.356). Children and adolescents exhibited a lower prevalence of AR than adults (13.7% vs 31.1%). Urban AR prevalence was much greater than rural (38.4% vs 13.0%). Asthma, atopic dermatitis, and eczema are all associated with AR. The most common signs and symptoms of AR were headache 33.9%, watery discharge 28.6%, sneezing 24.6%, itchy nose, runny nose 22.2%, nasal obstruction or congestion 22.0%, loss of smell 21.9%, and wheezing 17.2%. The most prevalent triggers of AR were perfume 36.8%, dust 27.3%, air conditioning 23.4%, weather or temperature changes 17.8%, air pollution 14.5%, drugs or chemicals 13.8%, tobacco 10.8%, atopy 10.3%, and insects 10.2%.The overall prevalence of AR in Saudi Arabia is 21.2%. The prevalence of AR was comparable in both males and females. However, it was higher in adults than in children and adolescents, and in urban areas than rural areas. Asthma, atopic dermatitis, and eczema co-occurrence with AR are common. AR has a negative impact on the quality of life of the patients in the form of interference with daily activities, sleep problems, difficulty of breath, and school absenteeism.

Rafat Mosalli,1,2 Gamal A Aboumoustafa,1 Wed Khayyat,3 Aziza N Bokhari,3 Mohammed A Almatrafi,2 Mohammed Ghazi,1,4 Bosco Paes5 1Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia; 2Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia; 3Medical College, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Pediatrics, Division of Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, CanadaCorrespondence: Rafat Mosalli, Department of Pediatrics, Umm Al-Qura University, P.O. Box 7607, Makkah, Saudi Arabia, Tel +966 561182222, Fax +966 252-70000 Ext 4110, Email rmmosalli@uqu.edu.saBackground: The incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement.Methods: A cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value < 0.05 calculated by t-Test, was considered significant.Results: Among 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P < 0.05).Conclusion: Deficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.Keywords: pediatric nurses, tracheostomy, training skills, children, extended care, Jeddah

Mohammed A Almatrafi,1 Lama Sindi,2 Malak Alshehri,2 Esraa Sendi,2 Ghufran Sindi,2 Ghaida Alzahrani,2 Joud Alwan,2 Emad Salawati,3 Hassan Alwafi,4 Faisal Minshawi,5 Rafat Mosalli,1 Mohammed Samannodi6 1Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia; 2Medical College of Umm Al-Qura University, Makkah, Saudi Arabia; 3Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, Saudi Arabia; 5Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 6Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Mohammed Samannodi, Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia, Tel +966548293937, Fax +966125502188, Email Samannodi@gmail.comBackground: Parent’s misconceptions or lack of knowledge about childhood urinary tract infections (UTIs) can negatively impact their children’s health. Therefore, the present study aimed to determine the childhood urinary tract infections awareness and understanding among parents in Saudi Arabia.Patients and Methods: An online validated cross-sectional survey of parents in Saudi Arabia was conducted from August to September 2021. Study participants who met the inclusion criteria were selected using a convenience sampling technique. A questionnaire with two domains was used to assess parental awareness of childhood urinary tract infection symptoms, complications, treatment, prevention, epidemiology, and diagnosis. The total childhood urinary tract infections awareness scores were classified into three categories: low awareness, moderate awareness, and high awareness. Descriptive statistics were used to determine the data distribution. A chi-square test was used to evaluate the relationship between parental awareness about urinary tract infections in children and other variables. Statistical significance was established at 0.05.Results: Of the 1688 parents who completed the survey, 1289 (76.4%) were female, 1581 (93.7%) were married, and 1161 (68.8) had a university degree. Parent’s total awareness scores were high; however, individual domain scores indicate a moderate level of knowledge. Statistically significant relationship were observed between total awareness and gender, occupation, and level of educational level ((P=0.004, P=0.001, P=0.007, respectively). Another statistically significant relationship was noted between the history of urinary tract infections and awareness of disease prevention (P=0.009).Conclusion: In Saudi Arabia, parental knowledge about childhood urinary tract infections is moderate to high. However, future studies are needed to investigate gender, educational, and occupational variations in childhood UTI knowledge among parents in Saudi Arabia.Keywords: urinary tract infections, awareness, parents, childhood

Mohammed Samannodi,1 Adeeb Bulkhi,1 Hassan Alwafi,2 Rahaf Bukhari,2 Emad Salawati,3 Bayan Hafiz,2 Faisal Minshawi,4 Maryam Dahlawi,2 Sara Kamfar,5 Hanan Halawani,6 Abdallah Y Naser,7 Roaa Mandora,2 Mohamad Alshekh Ali,8 Mohammed A Almatrafi9 1Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; 3Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 5Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Computer Science Department, College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia; 7Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Al-Isra University, Amman, Jordan; 8Department of Medicine, Batterjee Medical College, Jeddah, Saudi Arabia; 9Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Hassan Alwafi, Faculty of Medicine, Umm Al-Qura University, Mecca, 24381, Saudi Arabia, Tel +966555544319, Email hhwafi@uqu.edu.saBackground: As the Coronavirus Disease 2019 (COVID-19) outbreak has made a tremendous impact on medical education and healthcare institutions, we aimed to measure effects of online classes on medical students’ comprehension in comparison with attending campus classes during the COVID-19 pandemic.Methods: A cross-sectional survey has been conducted between September 2020 and June 2021 in the western region of Saudi Arabia. The Convenience sampling technique was conducted to collect the data from medical students in their basic and clinical years, using a questionnaire that involved 45 multiple-choice and multiple-answer questions.Results: Out of 3700 questionnaires, 922 completed the questionnaires from 11 different medical schools. Umm AL-Qura University had the highest response rate with 232 responses (25.2%), followed by King Abdulaziz University with 186 responses (20.2%). The majority of institutions preferred Blackboard and Zoom as platforms for e-learning. A total of 355 (38.5%) believed that it resulted in higher academic achievement, whereas 555 (60.2%) of students believed the limitation of clinical access was one of the biggest disadvantages of e-learning. Overall, 518 (56.2%) of students did not want to continue using e-learning on its own in the future. Whereas 668 (72.5%) wished to keep using e-learning in combination with traditional learning.Conclusion: According to our findings, advantages of e-learning vary among students. Most of the students thought e-learning to be an interactive system that provides a learning opportunity. In contrast, many of the students believed that there were many disadvantages regarding online teaching methods.Keywords: COVID-19, e-learning, students, online, learning

Rafat Mohammed Mosalli,1,2 Ahmed Hafez Mousa,3 Asim Muhammed Alshanberi,3,4 Mohammed A Almatrafi2 1Department of Pediatrics, Batterjee Medical College, Jeddah, Saudi Arabia; 2Department of Pediatrics, Um Al-Qura University, Makkah, Saudi Arabia; 3College of Medicine, Batterjee Medical College, Jeddah, Saudi Arabia; 4Department of Community Medicine and Pilgrims Health Care, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Ahmed Hafez Mousa, College of Medicine, Batterjee Medical College, Jeddah, Saudi Arabia, Tel +966 548458786, Email drahmedhafezmousa@gmail.comBackground: Palliative care is the branch of medicine which has a target of setting focus on the improvement of the quality of life of patients, particularly toward their end of life, such as cases of terminal diseases with low prognosis. Despite growing recognition of the importance of palliative care, a gap remains in medical education. Our study aims to evaluate the current level of knowledge of medical students in regard to palliative care.Methods: A cross-sectional descriptive study was conducted in Batterjee Medical College, Jeddah, Saudi Arabia, through a period of three months from December 2021 to March 2022.Results: A total of 254 students participated in our study. Psychosocial and spiritual needs of the patient alongside definition of palliative care were perceived the most important by the students with a mean score of 3.9 each.Conclusion: Our study concludes that there is an overall lack of confidence among medical students in providing palliative care. We recommend further enhancement and implementation of palliative care as part of undergraduate mandatory courses.Keywords: medical education, palliative care, undergraduate education, end of life care, medical students, curriculum improvement

Background: Antibiotic (AB) resistance is caused partly by overuse, varies by region, and is influenced by prescriber perspectives. This study sought to determine physicians’ knowledge and attitudes toward AB prescribing, particularly in the Hail region of Saudi Arabia. Methods: An interdisciplinary team created and validated an electronic questionnaire via the test–retest method that measured reliability and consistency. The 19 questions covered the following subjects: demographic information (7), experience with AB resistance in daily work (3), AB prescribing behavior (2), communication with patients regarding AB resistance (3), and prescribing practices (4). The revised questionnaire was prepared and distributed to physicians in the Hail region via multiple electronic communication channels. Inferences were drawn based on descriptive statistics and multivariate regression analysis. Results: The questionnaire responses of 202 participants were eligible for analysis. A total of 70 (34.80%) participants were general practitioners, 78 (38.12%) were engaged in daily work that was only mildly related to AB resistance, and 25 (12.37%) performed work that was substantially related to AB resistance. A total of 88 (43.56%) physicians believed that prescribing behavior contributed to the emergence of AB resistance, whereas 68 (33.66%) did not. Regarding exposure, 51 (25.24%) physicians reported encountering instances of AB resistance monthly, whereas 104 (51.48%) reported seeing cases of AB resistance very rarely. In terms of prescribing practices, 99 (49.0%) physicians prescribed ABs to patients daily and 73 (36.13%) weekly. Regarding AB-resistance-related communication with patients, 73 (36.13%) physicians frequently discussed AB resistance with patients suffering from infections, whereas 13 (6.4%) never discussed it with patients. Conclusion: General practitioners in the Hail region exhibited comprehensive awareness of the elements that contribute to AB resistance but only rarely communicated about the issue with their patients, presuming the latter to be oblivious to the science behind AB resistance. Our findings suggest that the features underlying practitioners’ AB prescribing behavior could be a powerful strategy for lowering AB resistance.

Emad Salawati,1 Hassan Alwafi,2,3 Mohammed Samannodi,4 Faisal Minshawi,5 Atheer Gari,6 Suhail Abualnaja,6 Mohammed A Almatrafi7 1Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, Saudi Arabia; 3Alnoor Specialist Hospital, Makkah, Saudi Arabia; 4Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 5Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 6Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Emad SalawatiDepartment of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi ArabiaTel +966560058585Fax +966126400855Email esalawati@kau.edu.saPurpose: To explore the impact of the novel coronavirus (COVID-19) pandemic on caregivers’ willingness to vaccinate their children against influenza in 2021 in Saudi Arabia and the factors influencing this decision.Patients and Methods: An online survey of 2501 caregivers in Saudi Arabia with children aged 6 months– 18 years was conducted between July 15, 2021, and August 2, 2021. A convenience sample of participants that met the inclusion criteria was used as the study sample. Social Science Package Statistical (SPSS) was used for the statistical analysis. Categorical variables were reported as frequencies and percentages. The Chi-square test was used for categorical variables to assess the difference between the variables and the parents’ willingness to vaccinate their children against seasonal influenza after the COVID-19 pandemic.Results: Of the 2501 respondents to the survey, 1185 (47.3%) parents plan to give their children the influenza vaccine next year, which is an increase from 745 (29.8%) in the previous year. The following were the main reasons for not giving children the vaccine: children were less likely to get seasonal flu (617, 24.7%), fear of side effects (491, 19.6%), and fear of needles and syringes (484, 19.4%). Among the parents, 1222 (48.9%) were more likely to receive the seasonal flu vaccine themselves the following year, and 1361 (54.4%), which is more than half, were concerned about their children contracting seasonal influenza.Conclusion: Parents’ decision-making to vaccinate their children against seasonal influenza has been influenced by the COVID-19 pandemic. Numerous factors including a caregiver who had received the seasonal influenza vaccine themselves, who had vaccinated or planned to vaccinate their children during the previous or current seasonal influenza season, and/or who had a higher education level were associated with increased willingness to receive the flu vaccine.Keywords: seasonal flu, novel coronavirus, immunization, COVID-19

Enterobius vermicularis (E. vermicularis), also called pinworm or threadworm, is a widespread parasitic infection that has infected approximately 40 million individuals in the United States. However, the infection is rarely seen in the adult population. An atypical presentation of Enterobius vermicularis (E. vermicularis) infection has been reported previously in children and infants. However, there are no previous reports of this infection among adults in the Middle East. We present a case of a 30-year-old Saudi male patient who presented with significant weight loss, diarrhea, and vomiting. A colonoscopy revealed E. vermicularis in the cecum. The patient received one dose of oral albendazole 400 mg and then a repeat dose in two weeks based on his colonoscopy findings. The patient was seen in an outpatient clinic and reported complete resolution of postprandial vomiting. Asking about risk factors if there is any contact with contamination is essential. In addition, colonoscopy and stool analysis may also be considered to confirm the diagnosis. However, future studies investigating the incidence and risk factors of this infection are warranted as similar studies reporting this infection in Saudi Arabia are limited. Proper diagnosis and treatment are also essential to prevent complications of the infection.

Infective endocarditis in neonates can be fatal. Adjunctive rifampin therapy might be effective as salvage therapy in critically ill patients with Staphylococcus aureus native valve endocarditis (NVE). We present a case of a full‐term neonate with NVE who had a favorable clinical outcome after adding rifampin to standard therapy., Adding rifampin in a critically ill neonate with native valve Staphylococcus aureus endocarditis might be effective and lifesaving. Further studies are needed to determine rifampin's effect on neonatal Staphylococcus aureus native valve endocarditis.

Objectives: To determine the risk factors for the development of anorectal malformations (ARM). Methods: This case-control study was conducted in the Maternity and Children Hospital (MCH), Al Madinah Al Munnawarah, Saudi Arabia. The sample was taken from the ARM cases admitted at MCH between January 2013 and December 2017. The controls were selected from well-baby clinics in primary health care centers. Parents of the cases and the controls were interviewed based on a questionnaire. Descriptive, univariate, and multivariate logistic regression were used in the analysis. Results: The study included 48 cases and 96 controls with 31 (64.6%) cases of isolated ARM and 17 (35.4%) cases of associated ARM. Among the ARM cases, 27 (56.3%) were males and 21 (43.8%) were females. In multivariate analysis, we found consanguinity to be associated with an increased risk of developing ARM with odds ratio (OR): 2.43, 95% CI: 1.12-5, and p =0.025, in addition to maternal obesity, with OR: 4.36, 95% CI: 1.2-15.8, and p =0.025. Conclusion: Consanguinity and maternal obesity (body mass index more than 30) were found to be risk factors for ARM development. Saudi Med J 2020; Vol. 41 (2): 157-162 doi: 10.15537/smj.2020.2.24882 How to cite this article: Mohammed A. Almatrafi, Abdulmohsen H. Al-Zalabani, Hamdi H. Almaramhy, Sami A. Al-Dubai. Risk factors associated with anorectal malformations development. A case-control study. Saudi Med J 2020; 41: 157-162. doi: 10.15537/smj.2020.2.24882

Endometriosis is the ectopic presence of endometrial tissue outside of the uterus. Bladder involvement of these lesions is not uncommon and has been reported and studied extensively. Mullerianosis is a term that describes the ectopic presence of tissues from the endocervix and endosalpinx in extrauterine sites. Only a few cases of Mullerianosis involving the urinary tract system have been reported in literature. We report a case of a 32-year-old lady with bladder mass and periodic hematuria and dysuria. She underwent TURBT 1and on histopathology was found to have bladder Mullerianosis. Patient was later treated with oral contraceptives with improvement.

Patient: Female, 14-month-old Final Diagnosis: Viridans group streptococcus meningitis Symptoms: Fever • irritability • vomiting Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Viridans group streptococci (VGS) are commensal organisms in humans that are considered contaminants when isolated from culture specimens. However, VGS can be pathogenic when recovered multiple times from blood cultures or when in immunocompromised hosts. VGS are the leading cause of dental abscesses and infective endocarditis in children with underlying congenital heart diseases. They are not commonly involved in meningeal infections, but meningitis due to VGS can be fatal if not treated. The onset is usually preceded by an upper respiratory tract infection or in association with neurological surgical procedures. Case Report: Our patient was a 14-month-old girl with no significant past medical history who presented with fevers and irritability for 2 weeks. A full sepsis workup, including blood, urine, and cerebrospinal fluid (CSF) cultures, was obtained. Culture results were notable for the abundant growth of VGS in the CSF. However, brain imaging and echocardiogram were normal, with no evidence of brain abscesses or cardiac vegetations, respectively. The patient had shown marked clinical improvement after receiving 2 weeks of intravenous ceftriaxone, which was selected based on the VGS susceptibility profile. Conclusions: Bacterial meningitis is one of the most burdensome infectious diseases worldwide, despite improvements in diagnostic methods, management, and national immunization programs. Clinicians should consider VGS in the differential diagnosis of potential infections that can cause meningitis.

ObjectivesTo carry out meta-analysis and systematic review on the association between soft drinks consumption and asthma prevalence among adults and children.DesignSystematic review and meta-analysis of observational research.Data sourcesMedline, Scopus, ISI Web of Science and the Cochrane Library were searched up to December 2018.Eligibility criteriaWe included observational studies investigating the association between soft drinks consumption (including maternal consumption during pregnancy) and asthma or wheeze.Data extraction and synthesisData were extracted by one author and reviewed independently by two other authors. The most adjusted estimate from each original study was used in the meta-analysis. Meta-analysis was conducted using random-effects model. The quality of studies was assessed using the Newcastle–Ottawa scale and heterogeneity was evaluated using I2statistic.ResultsOf 725 publications originally identified, 19 were included in this systematic review, including 3 cohort studies and 16 cross-sectional studies. Ten articles reported on children up to 18 years, 5 articles on adults (>18 years) and 2 articles on prenatal exposure. In total, 468 836 participants were included, with more than 50 000 asthma cases. Soft drinks consumption was associated with significantly increased odds of asthma in both adults (OR=1.37; 95% CI, 1.23 to 1.52) and children (OR=1.14; 95% CI, 1.06 to 1.21). Prenatal exposure had marginally statistically significant association (OR=1.11; 95% CI, 1.00 to 1.23) with asthma in children. In subgroup analysis for childhood exposure, the association persists for sugar-sweetened soft drinks but not for carbonated drinks.ConclusionOur findings show a positive association between soft drinks consumption and asthma prevalence, mostly from cross-sectional studies. Therefore, more longitudinal research is required to establish causality.