Recent reports found that the prevalence of multiple sclerosis (MS) in Saudi Arabia shows an increasing pattern but still less than that recorded in the West. The article will discuss the prevalence, pathology, risk factors, diagnostic modalities, and treatment of MS in Saudi Arabia. In this review, we searched PubMed/Medline database, and all studies that reported the prevalence, pathological and clinical types, diagnostic criteria, diagnostic modalities, and methods of treatment of MS in Saudi Arabia were included. the risk factors included consanguinity, Vitamin D deficiency, viral infection, and change in lifestyle. The presentation is similar to that recorded in western reports, but the course is different. KSA neurologists use the McDonald 2010 criteria for diagnosing MS. In the Kingdom, treatment of MS involves several disease-modifying drugs and these drugs are given according to the clinical course and form of the disease.

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Multiple sclerosis (MS) is an inflammatory demyelinating disorder of the central nervous system. The pathophysiology of MS has been correlated with low serum Vitamin D levels as one of the risk factors. However, limited evidence of the specific role of Vitamin D in managing MS cases has been reported. A literature search was performed in October 22, 2019, on PubMed database using search terms: “multiple sclerosis,” “Vitamin D,” “deficiency,” “therapeutic use,” “administration and dosage,” and “adverse effects.” Eligibility criteria: All study designs written in English language, applied on human, in the previous 0 years, related to the research question, a clinical diagnosis of MS and interventions containing Vitamin D supplementation (Vitamin D3 or calcitriol). Fourteen articles matched the criteria and were included in this review article. In this review article, we are discussing the effectiveness of Vitamin D supplementation in MS patients, the ideal dose, the duration of treatment, and to highlight the main adverse effects of the supplements.

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Background: Iron deficiency anemia (IDA) is one of the most common and potentially treatable health problems. The platelet behavior is often unpredictable and complicated in IDA. The present study was aimed to evaluate significance of platelet parameters in IDA, effect of iron therapy on them, and complications related to platelet parameters in such cases. Patients and Methods: It was a prospective observational study. A total of 85 outdoor and indoor consecutive patients of pure IDA with low ferritin levels were enrolled as cases. Platelet parameters – mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (Pct) obtained by automated blood cell counter were studied at the time of presentation and after 1 month of oral iron therapy. Results: IDA was diagnosed more in females (65, 76.5%). All the basic hematological parameters were significantly altered in cases (P < 0.005) except WBC and Pct. Red blood cell parameters have a linear relationship with MPV and inverse with platelet count and PDW. 35 out of 85 IDA cases (41%) showed reactive thrombocytosis (RT). Mild RT was significantly associated with mild anemia (8.1–10 gm%; n = 11) as compared to moderate RT. Six thromboembolic complications were encountered which presented mostly with mild RT, less MPV, high PDW and Pct linearly increasing with platelet count. On follow-up, cases with RT after 1 month of oral iron therapy, platelets showed significant reduction (P = 0.00015) and rise in Hb levels (P = 0.025). Conclusions: RT is common finding in IDA. Thromboembolic central nervous system complications should always be kept in mind because they may deteriorate the clinical picture in otherwise benign course of IDA.

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Background: Having a high quality primary health-care (PHC) system leads to a more efficient health-care system, which lower rates of hospitalization and leads to better health outcomes. One of the main criteria for assessing the quality of PHC services is the assessment of patient satisfaction, so the study aims to assess the chronic disease patients' satisfaction with PHC services provided by centers. Methods: A descriptive cross-sectional study conducted on patients with chronic diseases who follow-up in PHC centers within the Second Health Cluster in Riyadh using a questionnaire to assess their satisfaction level. A total 210 patients with different chronic diseases from the seven PHC centers (30 patients from each PHC center) who agreed to participate were included in the study. Results: In the study, 126 (60%) participants were females and 96 (45.7%) participants were in the age group more than 50 years. The survey showed that patients were satisfied with services offered by physicians, nurses, laboratory, and pharmacy with weighted means (3.81, 3.54, 3.59, and 3.88, respectively), while they were not satisfied with waiting time and services offered by receptionists with weighted means (3.22 and 3.27, respectively). The patient satisfaction showed a significant association with gender and level of education (P = 0.003 and 0.005, respectively). Conclusions: The survey showed that patients with chronic diseases were satisfied with services provided by PHC centers of the Second Health Cluster in Riyadh except receptionists' services, appointments, and waiting time. This survey will guide the policymakers for improving the services provided at the PHC centers.

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Context: Every year the Ministry of Health in Saudi Arabia announces the opening of applications to those who wish to work on Hajj. A certain number of applicants are nominated, yet many nurses continue to apply to participate during Hajj ever year. Although nurses are under great work pressure during Hajj, many nurses still apply for the approval to participate in Hajj. Aims: The aim of this study is to identify the motivations of nurses to work during Hajj. Furthermore, to explore the motivations that lead nurses to participate in the Hajj season and to explore the challenges faced during the Hajj season. Settings and Design: The study used a descriptive qualitative study design. Twelve nurses participated in this study from Mina hospitals in Makkah, Saudi Arabia. Subjects and Methods: In-depth semi-structured interview with 12 nurses. Data were collected from November 2020 to January 2021. Statistical Analysis Used: The data were analyzed using the thematic analysis. Results: This study showed four themes motivating nurses to participate in Hajj: taking part in Hajj is an honor and they are proud of it; great rewards will be received from ALLAH; team spirit; and the fact that it is a good experience. This study also showed two of challenges that nurses face in Hajj which are pilgrims' low awareness and language barriers. Conclusions: The stakeholder should consider these themes and reinforce them to show to all nurses, as this may increase the quality of the applicants asking to work as nurses in Hajj.

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In the context of the ongoing global pandemic of coronavirus disease 2019 (COVID-19), most scientific evidence related to disease transmission and clinical outcomes, especially in the first wave, originated from observational studies. Those studies have provided a basic understanding of various aspects of this disease, including clinical manifestations, pathogenesis, diagnosis, and treatment. However, the accuracy and credibility of some such studies have been questioned because of the presence of bias, which is occasionally addressed in the published research. In this review, the principal types of bias in COVID-19 research are discussed, namely selection and misclassification bias. For this mini literature search, Medline database had used to identify the related articles. Many studies have shown some selection bias in sampling their population, leading to an over-or underestimation of true results. Understanding the effect of bias in the context of COVID-19, research is important for two reasons. First, it enables a discussion of the findings of such biases, especially those that occurred in studies contributing to evidence-based medicine. Second, it helps ensure that researchers avoid such bias in future research and any subsequent infectious pandemic. The key points in avoiding such bias are study design and the need for care in collecting information on both exposure and outcome; however, in the real world, these are very challenging matters.

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Background: The health-care professionals are at high risk of getting infection of COVID-19 due to the highly interactivity of the disease. The virulence of the disease causes huge stress among health-care professionals. Aim: Our study aimed to find out the level of stress and fear among health-care professionals due to COVID-19 outbreak in Bangladesh. Materials and Methods: A cross-sectional study was conducted by using a structured questionnaire containing demographic data, Fear of COVID-19 Scale (FCV-19S), Kessler Psychological Distress Scale, and factor causing stress. A total number of 146 participants, both male and female, were participated in this study. We utilized Google Platform to construct the questionnaire and virtual snowball sampling method to collect the data. Results: The mean age, height, and weight of the participants were 27.52 ± 6.10, 162.53 ± 10.67, and 64.75 ± 10.89, respectively. The mean score of Kessler Psychological Distress Scale was 23.57 ± 5.38, ranging from 27 to 38 and the mean score of FCV-19S was 24.27 ± 6.27, ranging from 7 to 35. The participants those who are living with their family are at significant level of stress (P = 0.041) that they can affect their family members. Conclusion: The health-care professionals are in highly stressed due to the COVID-19 outbreak. Stress management strategies should be taken as a preventive measure to overcome the further serious situation.

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Background: Physical inactivity and sedentary lifestyles among pregnant women have shown significant health risks that threaten the life of the mother and the child. Aim: This study aimed to assess the prevalence and barriers to regular physical activity (PA) during pregnancy among Saudi women in the western region. Materials and Methods: A cross-sectional study was done with 463 pregnant women using the Pregnant Physical Activity Questionnaire. A standardized questionnaire was used to collect the demographic details and information about the PA before and during pregnancy, work-related barriers, pregnancy-related barriers, and other barriers. Results: Only 22.9% of the participants engaged in PA during pregnancy, and not having enough time and intense exhaustion from work were the most common work-related reasons for not exercising during pregnancy. The most reported barriers to PA related to pregnancy were fear of injuring the fetus, feeling sick in the morning, muscle and joint pain, feeling exhausted after exercise, and lack of motivation. Younger pregnant women (<20 years of age) and those who participated in a certain form of PA before pregnancy were comparatively more engaged in PA during pregnancy (P < 0.05). Conclusion: The PA during pregnancy, as reported by the participants, was poor and the most commonly reported barrier to do PA among pregnant women was fear of injuring the fetus. Pregnant women should receive appropriate prenatal advice on the benefits of PA, and they should be made aware of the significance of PA in the promotion of healthy lifestyle practices.

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We report a fatal case of typhoid acute respiratory distress syndrome (ARDS) in a 32-year-old man who was hospitalized with fever, cough, and chills lasting 12 days. While waiting for the results of cultures, his condition rapidly deteriorated within 2 days, and he developed ARDS. The patient was transferred to the medical intensive care unit. Subsequently, his blood, urine, and stool cultures returned positive for Salmonella Typhi. The sensitivities showed that the organism was resistant to nalidixic acid, ampicillin, and ciprofloxacin but was sensitive to ceftriaxone. The patient was intubated, and mechanical ventilation was initiated, while ceftriaxone, vasoactive amines, and hydrocortisone were administered. Unfortunately, the patient died despite escalation to intensive care and the care provided thereof. This interesting case was selected from our previous study entitled Epidemiological and Clinical Features of Salmonella Typhi Infection Among Adult Patients in Qatar: A hospital-based study. Different aspects of typhoid ARDS including clinical presentation, pathogenesis, diagnosis, and treatment are discussed and the literature has been reviewed.

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Background: Nonadherence to the medication schedule is common in patients with cardiovascular diseases (CVDs) and may have serious consequences including increased costs, hospital admissions, and death. Aim: In this study, we investigated the prevalence and associated factors of nonadherence in cardiovascular patients in Al-Madinah/Saudi Arabia. Settings and Design: This was a descriptive cross-sectional study carried out at tertiary cardiac center in Al-Madinah. Subjects and Methods: Study variables including sociodemographic characteristics and disease factors were collected from a random sample of patients attending the CVDs the clinic using a structured questionnaire. Adherence was assessed using the Culig's medication adherence scale. Statistical Analysis: Chi-square test and logistic regression analysis were used to evaluate factors associated with nonadherence. Results: A total of 200 adult cardiovascular patients completed the study; 100 (50.0%) were males and 186 (93.0%) resided in the city. The result showed that 26.0% (52/200) of the patients were nonadherent to medications, missing between 1 and 4 days of medication per week. Overall, 177 (88.5%) of the patients indicated that a healthcare worker explained the medications to them before dispensing. The most common reasons for nonadherence were: not being at home at the drug-taking time (84.6%), forgetfulness (82.7%), and fear of side effects (46.2%). Independent predictors of nonadherence were being retired (odds ratio [OR] 3.4; 95% confidence interval [C. I.] 1.3–9.4) and being uneducated or having general education (OR 4.7; 95% C. I. 2.0–11.2). Conclusion: Nonadherence rate was high and was found to be dependent upon patient-level factors. The study recommends improved patient education interventions to boost medication adherence in cardiovascular patients. Further studies are recommended.

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Background: The numbers of musculoskeletal injuries and related risk factors are high, especially in military representatives, since they perform constant physical activities. One of the most common injuries is the knee injury. Although there are many studies relating to knee injuries in the military personnel, none of them have been conducted to estimate the incidence of this injury in the Kingdom of Saudi Arabia. Objectives: This study aimed to explore the incidence of knee injuries and risk factors among the military personnel on active duty in Saudi Arabia. Materials and Methods: This study included n = 2230 patients with knee injuries with a mean age 42.73 and standard deviation ± 16.343 from military branches of the Kingdom of Saudi Arabia (KSA) between 2010 and 2016. Data were collected from Saudi military hospitals and statistically analyzed using descriptive statistics and regression models. During the study, no injuries aggravations of existing injuries or conditions were reported. Results: The frequency distribution showed that anterior cruciate ligament (ACL) injuries were the most common of knee injuries (45.2%) followed by meniscus injury (24.9%) and internal derangement (10.1%) with an incidence rate 4.57, 0.25, and 0.10 respectively. Chi-square test revealed that sports are the most significant factor relating to all knee injuries (30.5%), followed by twisting injuries at 25% (P = 000). Conclusion: Future studies are recommended to generate effective measures to reduce the influence of preventable risk factors, such as sports and related physical activities, that contribute to knee injuries.

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Brugada syndrome, a rare genetic disease increases the risk of arrhythmias and sudden cardiac death. Various trigger factors has been associated with Brugada syndrome. Arrhythmias have been reported in COVID 19. We report a patient with transient Brugada like pattern in ECG triggered by COVID 19.

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Infliximab is a monoclonal antibody that works by inhibiting the proinflammatory cytokine and tumor necrosis factor-alpha. Systemic lupus erythematosus is an autoimmune disease that affects multiple organs, and its pathogenesis involves abnormal immune complexes, environment factors, and genetics. Several reports have documented a controversy regarding infliximab-induced lupus disease. This paper reports on infliximab-induced lupus in an 18-year-old Saudi female having short stature, hypogonadism, and Crohn's disease with ileocolonic fistula. The patient developed reactive arthritis, and serology showed positive anti-double strand DNA and antihistone antibodies after infliximab administration, suggesting drug-induced lupus. More cohort studies are recommended to monitor the presentation and reversibility of infliximab-induced lupus disease.

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Retroperitoneal nonfunctional extraadrenal paragangliomas are uncommon neoplasms arising from the aorticosympathetic chain of paraganglia. Biopsy of these tumors shows diverse cytomorphological features which can pose a significant diagnostic challenge to the histopathologist. We report a case of a 36-year-old male presenting with abdominal pain and a retroperitoneal mass anterior to the left kidney observed on ultrasound and computed tomography (CT) scan. CT-guided needle core biopsy was carried out which revealed varied cytological features suggesting a wide spectrum of differential diagnosis. Knowledge of the histological features along with immunohistochemistry helped us to diagnose this case. Since surgical excision is the preferred treatment of choice, early and accurate diagnosis is of utmost importance.

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