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Bashayer Farhan ALruwail,1 Afrah Muteb Alshalan,2 Ashokkumar Thirunavukkarasu,1 Alaa Alibrahim,3 Anfal Mohammed Alenezi,4 Tahalil Zamil A Aldhuwayhi5 1Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 2Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 3Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 4Department of Surgery, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 5Medical Intern, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi ArabiaCorrespondence: Bashayer Farhan ALruwail, Department of Family and Community Medicine, College of Medicine Jouf University, Sakaka, 72388, Saudi Arabia, Tel +966551913665, Email bfalrwili@ju.edu.saBackground and Aim: As the integration of artificial intelligence (AI) in healthcare delivery becomes increasingly prevalent, understanding the knowledge, attitudes, and practices of health science students towards AI is crucial. However, limited evidence exists regarding the readiness of health science students, particularly in northern Saudi Arabia (KSA), to integrate AI into their future practices, highlighting the need for focused evaluation. We evaluated northern Saudi health science students’ knowledge, attitude, practice, and associated factors toward AI.Participants and Methods: The present cross-sectional study was conducted among 384 health science students aged 18 years and above from Jouf University, KSA. The study employed a validated data collection form with four sections: demographics, knowledge (AI principles and applications), attitudes (perceptions and ethical concerns), and practices (usage and confidence in AI tools). The three domains’ scores were categorized as low (< 60%), medium (60– 80%) and high (> 80%) based on their total scores. We utilized Spearman correlation test to ascertain the strength and direction of correlation among each subscale. Additionally, multivariate analysis was employed to identify associated factors.Results: The present study demonstrated low knowledge, attitude, and practices among 55.7%, 37.0%, and 50.3% of health science students. We observed a positive correlation between knowledge and attitude (rho = 0.451, p = 0.001), knowledge and practice (rho = 0.353, p = 0.001), and attitude and practice (rho = 0.651, p = 0.001). Knowledge (p = 0.001) and practice (p = 0.002) were significantly higher among the students who participated in a formal AI training program. Females had a significantly higher level of attitude (p = 0.001) and practice (p = 0.030) than males.Conclusion: In light of these findings, refining the curriculum to incorporate AI emerges as a critical strategy for addressing gaps in AI knowledge, attitudes, and practices among health science students. Therefore, formal and integrated training programs tailored to suit the local setting can effectively prepare health science students to adopt AI technologies in ways that enhance patient care.Keywords: artificial intelligence, Vision 2030, curriculum refinement, AI training program, nursing, AI readiness

Bashayer Farhan Alruwaili,1 Duaa Fahad Bayyumi,1 Ohud Saud Alruwaili,1 Razan Saud Alsadun,1 Amal Sulaiman Alanazi,2 Amal Hadi,2 Nada Kareem S Alruwaili,3 Ashokkumar Thirunavukkarasu,1 Norah Farhan Aldaghmani,4 Aljawharah Abdulrahman Alrayes4 1Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 2Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Primary Healthcare, Ministry of Health, Aljouf Health Cluster, Sakaka, Saudi Arabia; 4College of Medicine, Jouf University, Sakaka, Saudi ArabiaCorrespondence: Bashayer Farhan Alruwaili, Department of Family and Community Medicine, College of Medicine, Jouf University, Aljouf, Saudi Arabia, Tel +00966 55 191 3665, Email bfalrwili@ju.edu.saAbstract: In recent years, the countries of the Middle East and North Africa (MENA) region have experienced alarming increases in the prevalence of childhood overweight and obesity. This updated systematic review sought to measure the prevalence and determinants of obesity and overweight among children and adolescents in MENA countries. A literature search for relevant observational studies published in English was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Twenty-one published articles during the past five years were included in the systematic review. Varied approaches were used to diagnose childhood overweight and obesity, including the International Obesity Taskforce (IOTF), Centre for Disease Control (CDC), World Health Organization (WHO), and Saudi Growth Pattern Curves. We found that the combined prevalence of childhood overweight and obesity in the Middle East is up to 49.4%, depending on the methods applied in their studies. Risk factors identified were age, male gender, lack of sufficient physical activity, consumption of fried food, perceived stress level, number of family members, family size, mother’s occupation, education level, family history of obesity, high energy consumption from carbohydrates, ≥ 2 hours spent on watching television on weekend days with overweight, and always eating breakfast while watching television with obesity. The results of this review indicate that the issue of childhood and adolescent overweight and obesity in the Middle East is substantial and concerning. Most of the risk factors identified are modifiable and, if given appropriate attention, could significantly reduce the burden of associated chronic complications.Keywords: childhood obesity, screen time, adolescents, Saudi growth pattern, WHO, CDC

Fiber Metal Laminates (FML) are hybrid composites comprising metals and Fiber Reinforced Plastics (FRP). FMLs are the most widely used in aerospace, defence and automotive sectors due to their superior qualities like light weight, tensile, compression, flexural, excellent fatigue and impact resistance. The properties like strength-to-weight ratio, susceptibility to corrosion and good heat conduction of FML make it suitable for subsea applications. Commonly, FML with a combination of aluminium (Al), titanium (Ti), stainless steel (SS) alloys and FRP are widely used for ocean applications. Compared to other FML, the SS alloy-based FML is typically used in subsea applications as it has more creep and excellent corrosion resistance. In India, under the Ocean Acoustics programme of the National Institute of Ocean Technology (NIOT), an autonomous underwater Ambient Noise Measurement System (ANMS) has been developed and deployed in the shallow waters of Indian seas for the past 12 years to study the background noise prevailing in the sea. To accommodate electronics and power packs for the measurement of ambient noise at an ocean depth of 100 m, subsea housing with stainless steel 316L (SS316L) material for a pressure rating of 1 MPa has been developed. The objective of this study is to develop the FML with SS316L and FRP for reducing the weight of the housing. Based on the literature studies and Classical Laminate Theory (CLT), the FML has been fabricated as a 0.45 m (450 mm) panel with a sequence of SS316L as outer layers and E-glass fibre and carbon as the inner layers. The total thickness of the laminates is 0.006 m (6 mm). The developed FMLs are processed with water jet cutting machines to carry out various testing such as tensile, compression and flexural, which are relevant to the characterization of FML and the experimental results are described in the paper.

Sager Holyl Alruwaili,1 Ashokkumar Thirunavukkarasu,2 Raghdah Muharib Alanazi,3 Amani Yasr Alsharari,3 Danah Khalid Alruwaili,3 Hanaa Abdalkreem Alenzi,3 Aryam Nafea Alruwaili,3 Ghadah Qasem Alruwaili3 1Department of Surgery, Division of Orthopedic Surgery, College of Medicine, Jouf University, Sakaka, Al-Jouf, Saudi Arabia; 2Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Al-Jouf, Saudi Arabia; 3Medical Student, College of Medicine, Jouf University, Sakaka, Al-Jouf, Saudi ArabiaCorrespondence: Sager Holyl Alruwaili, Department of Surgery, Division of Orthopedic Surgery, College of Medicine, Jouf University, Sakaka, Al-Jouf, Saudi Arabia, Tel +966- 591112218, Email shalruwaili@ju.edu.saBackground: Musculoskeletal disorders (MSDs) have emerged as a pressing concern among healthcare workers (HCWs), gaining significant attention, particularly in the aftermath of the COVID-19 pandemic. This study evaluated the prevalence, pattern, and associated factors for MSDs among HCWs in northern Saudi Arabia.Participants and Methods: Employing a cross-sectional study design, the standardized Nordic Musculoskeletal Questionnaire (NMQ) was used to collect data from participants. Systematic sampling method was employed to select 384 HCWs from diverse healthcare settings. Multivariate logistic regression analysis was conducted to identify factors associated with MSDs.Results: Among the participants, 72.4% reported one or more NMQ-listed MSDs. The most commonly affected body regions were the neck, shoulder, and lower back. MSDs showed significant associations with physical activity (adjusted odds ratio [AOR]= 0.72, 95% confidence interval [CI] = 0.53– 0.93, p = 0.024), obesity status (AOR = 3.08, 95% CI = 1.56– 4.71, p = 0.003), and ergonomic training (AOR = 0.38, 95% CI = 0.23– 0.55, p < 0.001).Conclusion: Implementing preplacement and periodic ergonomic training for HCWs is recommended. This proactive measure holds the potential to alleviate MSD-related discomfort, reduce sickness absenteeism, and enhance overall productivity. Future longitudinal studies across different regions of Saudi Arabia are essential to establish causal links between risk factors and MSDs.Keywords: healthcare workers, neck pain, ergonomics, Saudi Arabia, musculoskeletal disorders

Ashokkumar Thirunavukkarasu,1 Mohammed Falji A Alanazi,2 Ahmad Homoud Al-Hazmi,1 Bashayer Farhan ALruwaili,1 Aseel Awad Alsaidan,1 Thamer Alshami M Alruwaili,3 Majed Abdulaziz M Algaed,4 Areej Kaseb Alsharari,4 Ragad Humaidi Alenazi,4 Amal Muteb Alshalan,5 Sultan Muteb Alshalan6 1Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 2Department of Public Health, Hafr Al Batin Health Affairs, Hafr Al Batin, Saudi Arabia; 3Department of Pediatrics, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 4College of Medicine, Jouf University, Sakaka, Saudi Arabia; 5Department of Medicine, King Abdulaziz Specialist Hospital, Sakaka, Saudi Arabia; 6Medical Department, North Medical Tower hospital, Arar, Saudi ArabiaCorrespondence: Ashokkumar Thirunavukkarasu, Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, 72388, Saudi Arabia, Tel +966-599739619, Email ashokkumar@ju.edu.saBackground: Consumer perception of and satisfaction with vaccination services is a critical and commonly used indicator for evaluating the quality of services provided by concerned authorities. The present survey assessed maternal perceptions, hesitancy, satisfaction, and factors associated with childhood immunization services provided at the primary health centers (PHCs) of eastern Saudi Arabia.Methods: The current analytical cross-sectional study included mothers of childhood vaccine beneficiaries attending PHCs in Hafr Al-Batin. We collected data related to mothers’ perceptions, hesitancy, and satisfaction using a validated Arabic version of the data collection tool. Factors associated with low and high satisfaction with the immunization services were evaluated using logistic regression analysis. We performed Spearman correlation test to identify the correlation between the perception and satisfaction scores.Results: Of the 675 participants, 87.4% were satisfied with the immunization services provided at the PHCs. The participants’ satisfaction was significantly associated with the immunized child’s age group (adjusted odds ratio [AOR] = 1.89, 95% CI = 1.39– 2.89, p = 0.037) and occupation status (AOR = 1.42, 95% CI = 1.17– 1.74, p = 0.024). Vaccine hesitancy was significantly associated with the mother’s age group (AOR = 1.89, 95% CI of AR = 1.35– 3.39, P = 0.003) and number of children (AOR = 1.42, 95% CI of AR = 1.17– 1.74, P = 0.024), Additionally, we found a significant positive correlation (Spearman’s rho = 0.207, p < 0.001) between perception and satisfaction scores.Conclusion: We recommend targeted health education programs for mothers to improve their perceptions and the importance of all recommended childhood vaccines. Additionally, we suggest continuing maternal satisfaction assessments to enhance and maintain the quality of vaccination services.Keywords: childhood vaccines, adverse effect, satisfaction, hesitancy, perception, Saudi Arabia

Microorganisms associated with medicinal plants are of great interest as they are the producers of important bioactive compounds effective against common and drug-resistant pathogens. The characterization and biodiversity of fungal endophytes of the Petiveria alliacea plant and their antimicrobial production potential are of great interest as they are known for their antimicrobial and anticancer properties. In this study, we investigated the endophytic fungal microbiome associated with P. alliacea, and the endophytic fungal isolates were classified into 30 morphotypes based on their cultural and morphological characteristics. Ethyl acetate extract of fungal endophytes was obtained by liquid–liquid partitioning of culture broth followed by evaporation. The crude extract dissolved in dimethyl sulfoxide was screened for antimicrobial activity against three bacterial strains (Escherichia coli ATTC 25902, Staphylococcus aureus ATTC 14775, Bacillus subtilis NRRL 5109) and two fungal strains (Candida albicans ATTC 10231 and Aspergillus fumigatus NRRL 5109). Among the crude extracts from endophytes isolated from leaves, 65% of them showed antimicrobial activity against the bacteria tested. Similarly, 71 and 88% of the fungal crude extracts from endophytes isolated from root and stem, respectively, showed inhibitory activities against at least one of the bacterial strains tested. Crude extracts (at a concentration of 10 mg/mL) from ten of the fungal isolates have shown a zone of inhibition of more than 12 mm against both Gram-positive and negative bacteria tested. Sequenced data from isolates showing strong inhibitory activity revealed that Fusarium solani, F. proliferatum, and Fusarium oxysporium are the major endophytes responsible for bioactive potential. These results indicate that Petiveria alliacea harbors fungal endophytes capable of producing antimicrobial metabolites. Future studies need to focus on testing against drug-resistant bacteria (ESKAPE group) and other pathogenic bacteria and fungi.

Abstract Background Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in neonatal period. Most of neonatal sepsis-related morbidity and mortality can be prevented by early diagnosis and treatment with appropriate antimicrobial agents. Micro-erythrocyte sedimentation rate (m-ESR) is a simple, inexpensive, and rapid screening test for neonatal sepsis that can be done even in resource limited setups. Objectives To compare the efficacy of m-ESR with C-reactive protein (CRP) as a screening tool in neonatal sepsis. Methodology A retrospective chart-based analysis was done in division of neonatology, of our tertiary care hospital over a period of 21 months. A total of 202 suspected cases of neonatal sepsis with documented CRP and micro-ESR values were included. We evaluated the role of micro-ESR as a screening tool in neonatal sepsis in comparison with CRP. The validity and reliability of micro-ESR in comparison to CRP were estimated and its sensitivity, specificity, positive, and negative predictive value to diagnose sepsis were calculated. Results There was a significant correlation between micro-ESR and CRP with a moderate degree of agreement, especially in ‘late onset sepsis’ group. The overall sensitivity, specificity, positive predictive value and negative predictive value of micro-ESR were 67%, 84%, 58%, and 89% respectively. Conclusion Micro-ESR is a simple, inexpensive test comparable to CRP in screening for neonatal sepsis.

Muhannad Faleh Alanazi,1 Ashokkumar Thirunavukkarasu,2 Maily Alrowily,3 Nouf Alaqel,4 Abdulelah Alaqel,5 Mutlaq Alruwaili,5 Nouf Nashmi M Alazmi,5 Osamah Alhassan,5 Mona Fahad M Aljarallah,5 Afrah Mohaimeed Altaymani5 1Division of Radiology, Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 2Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 3Aljouf Health Cluster, Ministry of Health, Sakaka, Aljouf, Saudi Arabia; 4Department of Diagnostic Radiology, Prince Mutab Bin Abdulaziz Hospital, Sakaka, Aljouf, Saudi Arabia; 5College of Medicine, Jouf University, Sakaka, Aljouf, Saudi ArabiaCorrespondence: Muhannad Faleh Alanazi, Division of Radiology, Department of Internal Medicine, College of Medicine, Jouf University, Sakaka, 72388, Saudi Arabia, Tel +966555 393 871, Email mfalanazi@ju.edu.saBackground: Mammogram screening (MS) is the gold-standard method for early detection of breast cancer (BC), and its use has been proven to minimize BC-related deaths and reduce treatment costs. However, recent epidemiological surveys have reported that rates of mammogram uptake by the Saudi female population are low. Here, we assessed the knowledge of BC and perceived barriers to MS uptake among pre-eligible northern Saudi women.Participants and Methods: We administered a standard and validated Arabic questionnaire to 400 women aged 40– 69 years. SPSS version 21.0 (IBM Corporation, Armonk, NY, USA) was used for data analysis. We applied logistic regression analysis to find the factors associated with participants’ knowledge of BC and MS. Spearman correlation test was applied to find the correlation between knowledge and barrier scores.Results: The study participants reported that smoking habits (61.3%) and unhealthy food habits (57.8%) were the most common risk factors for BC. Of the studied participants, 56.3% had low or medium degrees of knowledge about BC risk factors and MS. The degree of knowledge was significantly associated with education level (adjusted odds ratio [aOR], 2.35; 95% confidence interval [CI]. = 1.61– 3.13; P = 0.008) and a family history of BC (aOR, 3.66; 95% CI, 1.94– 5.49; P < 0.001). Fear of a BC diagnosis (50.8%) and concerns regarding test procedures were the most common barriers to MS uptake. We also found a negative correlation between participants’ knowledge and perceived barriers to MS (rho = − 0.389, P < 0.001).Conclusion: We recommend that concerned authorities offer women multiple health education sessions covering BC risk factors and the necessity for pre-eligible women to undergo MS spaced at regular intervals at different facilities. Furthermore, a multicentric mixed-methods survey is warranted to find the qualitative aspects of barriers to MS.Keywords: breast cancer, screening, risk factors, mammogram, knowledge

Mohammed Jayed Alenzi,1,&ast; Ahmed S Alshalash,1 Abdulmohsen Nayef Al-enzi,2 Fahad Suhayman Al-anazi,2 Nawaf Mohammed Al-anzi,2 Khalid Omar Alsharari,2 Abdulhadi Abdullah Alanazi,2 Sultan Mohammed Alanazi,2 Ashokkumar Thirunavukkarasu3,&ast; 1Department of Surgery, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 2Medical Student, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia; 3Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Ashokkumar Thirunavukkarasu, Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, 72388, Saudi Arabia, Tel +966-599739619, Email ashokkumar@ju.edu.saBackground: Assessment of parents’ awareness of testicular torsion (TT) is essential to plan for necessary awareness-raising campaigns by policymakers. Hence, the preventable loss of testis due to inadequate awareness can be avoided. We aimed to evaluate the awareness of TT amongst parents from the Aljouf region, KSA, and to assess their response to a potential torsion.Methods: We conducted a cross-sectional study among parents from the Aljouf region. The sample population was obtained using a consecutive sampling method. The present study used a pretested Arabic questionnaire. We used a statistical package for social science software for data analysis.Results: There were 320 parents who participated in different public places for the present study. Of the respondents, 10.6% of their children had sudden pain in the scrotum. More than half (52.2%) had never heard of testicular torsion, and 72.5% of parents agreed that they would seek immediate medical attention for severe testicular pain, but a low (42.5%) proportion of parents responded that they would seek help immediately. Nearly one-fourth of them responded that less than 6 hours is the critical time for repair. Parents who were knowledgeable at the critical time had more odds of presenting to a healthcare facility immediately for both mild (OR = 2.77, CI = 1.55– 4.03, p = 0.001) and severe (OR = 1.92, CI = 1.03– 3.63, p = 0.032).Conclusion: We found a lack of awareness of TT among Saudi parents. It is suggested to improve the knowledge among them through awareness-raising campaigns by the concerned health authorities through feasible methods. Furthermore, we recommend conducting a futuristic multicenter and exploratory study to find province-specific awareness.Keywords: testicular torsion, awareness, Saudi, pain, parents, critical time

Background: Needle pain due to routine vaccination is an important factor contributing to low vaccine adherence and immunization coverage. Prophylactic oral analgesics can address this important issue of needle pain related to vaccination. Paracetamol and mefenamic acid are commonly used nonsteroidal anti-inflammatory drugs for pain relief, but there is little published literature on whether the same can be used for needle pain related to vaccination. Objectives: This study was planned to compare the efficacy of oral mefenamic acid and paracetamol over placebo as a prophylactic analgesic during vaccination and prophylactic antipyretic during the post-vaccination period. Designs: Three-arm, triple-blind, randomized controlled trial. Methods: This study was conducted at the outpatient department of a tertiary-level medical college in South India from January 2021 to June 2022. In this three-arm interventional trial, each arm had either a single dose of placebo or mefenamic acid (4 mg/kg/dose) or paracetamol (10 mg/kg/dose). These medicines were administered orally 30 min before vaccination to reduce needle pain. Main outcome and measures: Outcome was measured with the change of FLACC (Face, Leg, Activity, Cry, Consolability) scoring at the time of vaccination, subsequently at 15 and 30 min of vaccination in all three groups. Appearance of fever, grade of fever, and need for antipyretics 24 h after vaccination were also noted. Results: There was a significant difference in FLACC scores at the time of administration ( p = 0.010) and at 15 min ( p = 0.014) with mefenamic acid compared to placebo. Although the paracetamol group showed a difference when compared to the placebo, it was not significant at the time of administration ( p = 0.401), at 15 min ( p = 0.451), or 30 min ( p = 0.892) post-vaccination. The appearance of fever, grade of fever, and use of antipyretic up to 24 h post-vaccination had no significant difference among any of the three groups. Conclusion: Mefenamic acid was more potent than placebo for pre-vaccination pain prophylaxis in children. There was no difference in the appearance of fever and its grade among the three groups. The promising results from this trial warrant further large-scale studies to recommend a single oral dose of mefenamic acid to tackle needle pain related to vaccination in children to improve vaccine adherence and coverage. Trial registration: CTRI (Clinical trials registry-India) (CTRI/2021/01/030239). [Date of Commencement: 13 Jan 2021, Date of last recruitment: 30 June 2022 (now closed for new participants)]

Background: This study was planned to estimate the effect of lockdown on psychosomatic problems and sleep of children and their association with screen the time during the lockdown. Methods: A cross-sectional study was conducted among 1–12-year-old children at a tertiary care hospital in South India. A pre-validated questionnaire with 20 related questions was disseminated through pediatric OPD, telemedicine service, and social media to eligible parents. Results: A total of 278 children aged 1–12 years with a mean (SD) age of 6.92 (3.01) years were studied. Most under 5-year-oldchildren had screen time of ≤2 hours/day, whereas 58.16% of children between 5 and 12 years spent >4 hours/day (P < 0.000). A significant proportion of participants aged 5–12 years had vision problems (P = 0.019), whereas under 5-year-old children had significant associated behavioral changes (P = 0.016) and sleep problems (P = 0.043). Conclusion: Behavioral and sleep problems were significantly high and correlated with an increase in screen time among under 5-year-old children. Vision problems were more in 5–12-year-old children.

Clinical diagnosis of grouped vesicular lesions in pediatric age group needs a detailed history and meticulous dermatological assessment of the morphology. Lymphangioma circumscriptum (LC) is one rare condition suspected with classic clinical presentation. Frog spawn appearance and black vesicles are two clues for making a clinical diagnosis. Here, we report a case of LC over thigh in an adolescent girl in view of its rare age of presentation and unusual location.

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious sequelae of acute COVID-19 infection affecting children. This study was done over a period of 12 months from December 2020 to November 2021 to describe the clinical presentation, laboratory abnormalities, and outcome of children with MIS-C. Methods Seventy-eight children below 12 years of age who satisfied the WHO diagnostic criteria for MIS-C were included in the study. Clinical parameters were recorded at admission. Relevant laboratory investigations, radiological studies, and outcome were documented. Results The most commonly affected age group was 6–12 years with a female predominance. COVID RTPCR was negative in all patients. Most cases presented 2–6 weeks after the onset of acute COVID-19 infection. Lethargy, poor feeding, vomiting, abdominal pain, loose stools, cough, and cold are common symptoms of MIS-C syndrome in children and the common signs were rash, conjunctival congestion, hypotension, tachycardia, tachypnea, and hypoxemia. Gastrointestinal system was the commonly affected followed by the hepatic, renal, and cardiovascular systems. Coronary artery abnormalities were seen in 20% of cases. IVIg was the mainstay of therapy used in 95% of patients. Mortality was 1.3%. Cases responded well to IVIg and steroids. Conclusion Overall, the short-term outcome was favorable with low mortality in our study cohort. One-fifth of children had coronary artery abnormalities during acute phase underscoring the need for long-term follow-up.

Ashokkumar Thirunavukkarasu,1 Abdullah Naser Abdullah Alshahrani,1,2 Doaa Mazen Abdel-Salam,3 Ahmad Homoud Al-Hazmi,1 Bashayer Farhan ALruwaili,1 Aseel Awad Alsaidan,1 Bayapa Reddy Narapureddy,3 Aliyah Muteb AL-Ruwaili,4 Fahad Ghuwayli aljabri,5 Rahaf Khalaf Albalawi,5 Khaled Abdulrahman F Alanazi5 1Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia; 2Department of Public Health, Asir Health Affairs, Asir Region, Saudi Arabia; 3Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Department of Public Health, Ministry of Health, Jouf Health Affairs, Sakaka, Aljouf, Saudi Arabia; 5College of Medicine, Jouf University, Sakaka, Saudi ArabiaCorrespondence: Ashokkumar Thirunavukkarasu, Email ashokkumar@ju.edu.saBackground and Objectives: Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA).Methods: A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman’s test to find the correlation between overall B-IPQ score and medication adherence score.Results: A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93– 0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33– 0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14– 1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62– 5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence.Conclusion: The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.Keywords: medication adherence, hypertension, illness perception, primary health centers, Saudi Arabia

Abstract Introduction Platelets are not only involved in hemostasis and coagulation, but play a significant role in innate immunity and inflammatory response. Excess production of cytokines and acute phase reactants affect megakaryopoiesis resulting in the release of immature platelets from the bone marrow altering platelet indices. Aim To study platelet indices in RT-PCR-proven COVID patients and non-COVID patients. Methods A case-control study was conducted on 199 COVID-19 patients and 198 normal individuals. Blood samples were analyzed in an automated hematology analyzer. The platelet indices like platelet count, mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell count (PLCC), and platelet large cell ratio (P-LCR) were compared among two groups. Results Platelet count in COVID-19 patients were significantly low (p

Background: An acute abdomen in children is often a challenging scenario for clinicians as it is caused by various medical and surgical conditions. Although symptomatology and specific clinical findings point directly to few causes, thorough history and in-depth clinical examination help to systematically narrow down the differential diagnosis. Clinical Description: We report a rare case of acute salpingitis in an 8-year-old prepubertal female child presenting with acute abdominal pain and fever for 3 days. Examination revealed diffuse abdominal tenderness with guarding and rigidity along with an ill-defined, tender mass in the right iliac fossa. Management: Abdominal ultrasound showed a hyperechoic mass in the right iliac fossa and the appendix was not visualized. The child was kept nil oral and started on broad-spectrum antibiotics. However, the child developed abdominal distension and worsening of pain over the next 24 h. The child was taken up for emergency laparotomy, and a complex mass in the right iliac fossa adherent to small bowel and covered by omentum was noted. Histopathological examination of the excised right iliac fossa mass showed acutely inflamed right fallopian tube. Normal appendix was noted in the postoperative ultrasonogram. Conclusion: It is important to differentiate surgical causes from nonsurgical ones to avoid unnecessary surgery and its complications. Salpingitis may mimic acute appendicitis because of nonspecific symptomatology and radiological signs and should be considered as a differential diagnosis for acute abdomen, even in a prepubertal female child.

Only about half the multi-drug resistant tuberculosis (MDR-TB) cases are successfully cured. Thus, there is an urgent need of new TB treatment against a novel target. Mycobacterium tuberculosis (Mtb) topoisomerase I (TopA) is the only type IA topoisomerase in this organism and has been validated as an essential target for TB drug discovery. Toxin-antitoxin (TA) systems participate as gene regulators within bacteria. The TA systems contribute to the long-term dormancy of Mtb within the host-cell environment. Mtb’s toxin MazF4 (Rv1495) that is part of the MazEF4 TA system has been shown to have dual activities as endoribonuclease and topoisomerase I inhibitor. We have developed a complementary assay using an Escherichia coli strain with temperature-sensitive topA mutation to provide new insights into the MazF4 action. The assay showed that E. coli is not sensitive to the endoribonuclease activity of Mtb MazF4 but became vulnerable to MazF4 growth inhibition when recombinant Mtb TopA relaxation activity is required for growth. Results from the complementation by Mtb TopA mutants with C-terminal deletions showed that the lysine-rich C-terminal tail is required for interaction with MazF4. Site-directed mutagenesis is utilized to identify two lysine residues within a conserved motif in this C-terminal tail that are critical for MazF4 inhibition. We performed molecular dynamics simulations to predict the Mtb TopA-MazF4 complex. Our simulation results show that the complex is stabilized by hydrogen bonds and electrostatic interactions established by residues in the TopA C-terminal tail including the two conserved lysines. The mechanism of Mtb TopA inhibition by MazF4 could be useful for the discovery of novel inhibitors against a new antibacterial target in pathogenic mycobacteria for treatment of both TB and diseases caused by the non-tuberculosis mycobacteria (NTM).

Excessive menstruation after attaining menarche during adolescent age group is known as puberty menorrhagia (PM). The most common presentation includes anemia due to excessive blood loss. We are reporting a rare case of PM secondary to a congenital bleeding disorder.

Background: Scrub typhus is a mite-borne infection caused by the bacterium, Orientia tsutsugamushi. It is re-emerging in many parts of South East Asia, particularly in rural India. Although no age group is immune to this infection, scrub typhus in neonates is rarely suspected and reported. Here, we report a neonate with scrub typhus who was initially misdiagnosed as “late-onset neonatal sepsis.” Clinical Description: A 26-day-old exclusively breastfed infant presented with fever, vomiting, loose stools, abdominal distension, and refusal of feeds for 3 days. Examination revealed an irritable, febrile, and pale infant. She had tachycardia and facial puffiness. On abdominal examination, generalized distension with hepatosplenomegaly was noted. Blood investigations were suggestive of lymphocytic leukocytosis, thrombocytopenia, toxic granules in peripheral smear, and elevated C-reactive protein. Management: The infant was promptly started on empirical antibiotics for “late-onset sepsis.” However, in view of poor response, other possible differential diagnoses were considered. Careful reexamination revealed a necrotic ulcer covered by a yellow scab with erythematous rim on the left lower eyelid. Based on the clinical presentation and an eschar-like lesion, scrub typhus was suspected. The neonate was started on oral azithromycin and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) testing for scrub typhus came back positive. Fever subsided immediately within 48 h and the infant was discharged after 7 days. Conclusion: Acute febrile illness due to scrub typhus can affect newborns. A high index of suspicion is required for early diagnosis. Timely treatment leads to prompt clinical response and reduced complications.

Ectodermal dysplasia is a rare genetic disorder due to defects in structures derived from ectoderm. It occurs due to mutation in genes that encode proteins involved in the development of ectodermal structures. Males show full expression of the disorder, whereas females show minimal signs of disorder because of the usual X-linked recessive pattern of inheritance. Common defects include hypodontia, onychodysplasia, hypotrichosis, and reduced or absence of sweat glands. The incidence of ectodermal dysplasia is seven in 10,000 live births. It is important to prevent hyperpyrexia, a life-threatening complication in hypohidrotic ectodermal dysplasia patients. Here, we are reporting a rare case of anhidrotic ectodermal dysplasia in a 16-year-old male patient with a positive family history of the same condition.

BACKGROUND: COVID-19 (Coronavirus disease-19) is an ongoing pandemic. COVID vaccine administration in adults has provided some degree of protection from infection but children are still susceptible So, we have to be prepared to handle COVID-19 infection in children by training our healthcare workers by updating both their knowledge and skills. We developed a training module to train our healthcare workers in all domains of learning and also planned related assessment methods to know the effectiveness of the module. MATERIALS AND METHODS: This was a quasi-experimental study with pre- and post-intervention conducted at a tertiary-level teaching medical college in southern India from July to September 2021. The training module was developed as per the “ADDIE” model of the development process module. It was further validated by five experts before implementation. In addition to the quasi-experimental method of evaluation like pre- and post-test, Observed Skill clinical examination (OSCE) had been also used as an assessment tool at the completion of training. A total of 92 participants have been trained as per this module in our tertiary-level care hospital. The association between continuous and categorical variables was assessed using an independent t-test and ANOVA, and paired t-test was used for comparing the difference between pre- and post-test scores. RESULTS: Pre-test scores had no association with years of experience (P = 0.803) and previous training status of participants (P = 0.350). The mean difference of pre- and post-test scores was 3.8 and it was statistically significant (P value < 0.001) A weak positive correlation between pre- and post-test was present by the Spearmen correlation test (r = 0.337). The correlation between post-test score and OSCE score does not have a significant correlation. CONCLUSION: Structured training module was effective in training the participants. Multimode assessment method (Pre-test, Post-test, and OSCE) is an important step to evaluate any training program as compared to only the pre- and post-test methods of evaluation.

BACKGROUND: The COVID-19 pandemic greatly impeded the provision of public healthcare within a healthcare system that was already under considerable strain. Routine patient care services were impacted during that time, leading to the promotion of telemedicine as a means of maintaining uninterrupted healthcare services. Telemedicine involves the utilization of electronic technology and communication to provide health-related information and medical care to individuals who are physically separated from healthcare professionals. MATERIALS AND METHODS: To assess the feasibility of utilizing telemedicine for providing women's health services, we conducted a six-month analysis of data collected from the Department of Obstetrics and Gynecology's teleconsultation application at AIIMS, Mangalagiri. Our objective was to evaluate the practicality of telemedicine in delivering diverse healthcare services to women. Our institution offered two types of telehealth services: a “call-based”approach and an “app-based”approach. We examined several parameters within the data, including the distribution of ages, the geographic locations of teleconsultation registrations, whether the registrations were new or follow-up cases, the various presenting complaints, the recommended treatments, the number of consultations (single or multiple), and whether cases required in-person or hospital visits. Additionally, we also compared patient responses between these two modalities. RESULTS: The “call-based”consultation method was preferred by the majority of our patients (94%). The registered cases included both related to obstetrics and gynecology, with a higher proportion of complaints relating to gynecological issues (82.5%). We were able to make a diagnosis in 77% of cases, while in 20% of cases, additional physical examinations and diagnostic tests were necessary. Follow-up appointments were recommended for 53% of patients. The success rate of consultations for patients seeking obstetrics and gynecology services showed a statistically significant difference (P value < 0.001). The vast majority of patients (99%) expressed high satisfaction with the consultation process. CONCLUSION: During the COVID-19 pandemic, telemedicine proved to be an effective approach in mitigating the overcrowding of hospitals and preventing the spread of infection. Its success suggests that telemedicine can be a viable option for managing elective gynecology matters and low-risk obstetric cases in the future, thereby alleviating the strain on healthcare systems.

Iron deficiency anemia in pregnancy can lead to significant adverse effects on the mother and fetus. Patients with iron deficiency anemia are treated with parenteral iron therapy when oral iron therapy is ineffective or in case of non-compliance due to side effects. Parenteral iron preparations such as iron dextran and sodium ferric gluconate complex can cause side effects including life-threatening anaphylactic reactions. However, parenteral iron sucrose has a favorable safety profile and anaphylactic reactions are extremely rare. We report a rare case of near-fatal anaphylaxis following intravenous iron sucrose therapy in a postnatal mother with iron deficiency anemia.

Progressive pallor with hepatosplenomegaly is an alarming constellation of signs in children indicating a serious, ongoing disease process which has to be investigated for. Anemia and hepatosplenomegaly can be caused by a wide spectrum of conditions ranging from benign to life-threatening ones. We report the case of a 4-year-old child who presented with progressive pallor and hepatosplenomegaly along with diagnostic approach and review of literature. The child was diagnosed to have Gaucher disease.

Cutaneous nodules in children arise from variety of pathologic conditions. Thorough history taking and clinical examination helps in narrowing down the differential diagnosis and reducing the need for an extensive panel of investigatons. Here, we report a case of cutaneous nodules in an adolescent male which posed diagnosed challenge and finally diagnosed with cytology.

Background: Inhibition of human topoisomerase I (TOP1) by camptothecin and topotecan has been shown to reduce excessive transcription of PAMP (Pathogen-Associated Molecular Pattern)-induced genes in prior studies, preventing death from sepsis in animal models of bacterial and SARS-CoV-2 infections. The TOP1 catalytic activity likely resolves the topological constraints on DNA that encodes these genes to facilitate the transcription induction that leads to excess inflammation. The increased accumulation of TOP1-DNA covalent complex (TOP1cc) following DNA cleavage is the basis for the anticancer efficacy of the TOP1 poisons developed for anticancer treatment. The potential cytotoxicity and mutagenicity of TOP1 targeting cancer drugs pose serious concerns for employing them as therapies in sepsis prevention. Methods: In this study we set up a novel yeast-based screening system that employs yeast strains expressing wild-type or a dominant lethal mutant recombinant human TOP1. The effect of test compounds on growth is monitored with and without overexpression of the recombinant human TOP1. Results: This yeast-based screening system can identify human TOP1 poisons for anticancer efficacy as well as TOP1 suppressors that can inhibit TOP1 DNA binding or cleavage activity in steps prior to the formation of the TOP1cc. Conclusions: This yeast-based screening system can distinguish between TOP1 suppressors and TOP1 poisons. The assay can also identify compounds that are likely to be cytotoxic based on their effect on yeast cell growth that is independent of recombinant human TOP1 overexpression.

Round cell tumors are group of tumors exhibiting hyperchromatic round nucleus, scant cytoplasm, and high nuclear–cytoplasmic ratio in histopathological examination. These tumors need the application of immunohistochemical panel for accurate diagnosis. We are presenting a rare case of small round cell tumor in retroperitoneum in a 3-year-old male child because of rarity in this site and age.