Background: The Hajj is one of the largest recurrent mass gatherings in the world, bringing millions of pilgrims into a confined setting under extreme heat, overcrowding, and physical exertion. Religiosity is generally protective for mental health, yet negative religious coping can worsen depressive symptoms, and the psychological consequences of Hajj remain fragmented across quantitative and qualitative studies. This review synthesised the evidence on how Hajj participation relates to psychological wellbeing. Methods: This mixed-methods systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Embase, Scopus, and Web of Science were searched to June 2026 for quantitative and qualitative studies. Two reviewers independently screened records, extracted data, and appraised quality using the Mixed Methods Appraisal Tool (MMAT). Because of substantial heterogeneity, findings were combined through narrative synthesis rather than meta-analysis, with certainty assessed... Continue Reading

Background: Irritable bowel syndrome (IBS) is a common chronic gastrointestinal condition that significantly affects quality of life and imposes a considerable economic burden. Despite the availability of ROME IV diagnostic criteria, gaps in PHC physician knowledge and practice have been reported. PHC physicians play a central role in the diagnosis, management, and follow-up of patients with IBS, making their awareness and application of ROME IV criteria critical. Methods: A descriptive cross-sectional study was conducted among PHC physicians in Al-Ahsa, Saudi Arabia, between June 2025 and September 2025. A structured, self-administered questionnaire adapted from a previously validated tool was used to assess knowledge, attitudes, and practices regarding IBS and ROME IV criteria. Results: A total of 99 physicians participated, most of whom were aged ≤40 years (95.0%), with residents (40.4%) and general practitioners (32.3%) forming the majority. Awareness of ROME IV criteria was high, with 89.9% reporting familiarity and 82.8% having... Continue Reading

Background: Self-medication (SM) is a widespread global health concern. While it offers convenience and rapid relief for minor conditions, it may lead to misdiagnosis, adverse effects, and drug interactions when used without proper guidance. This study aimed to assess the prevalence, patterns, and perceptions of SM using conventional and herbal medicines among ENT patients in Bisha, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted among adult residents of Bisha using a structured, self-administered online questionnaire. Data were analyzed using IBM SPSS Statistics version 27. Descriptive and inferential analyses were performed, with statistical significance set at p < 0.05. Results: A total of 422 participants were included. Self-medication was highly prevalent, with 83% reporting use without medical consultation. Analgesics were the most commonly used medications (72.6%). Herbal medicine use was reported by 65.1% of participants, particularly ginger (69.5%) and lemon (61.1%) for symptoms such as cold, sore throat, and cough.... Continue Reading

Background: Kidney stones are a common urological condition influenced by environmental and lifestyle factors and are reported to be prevalent in hot climates, including Saudi Arabia. This study assessed knowledge and awareness of kidney stone prevention among the general population of Taif, Saudi Arabia.Methods: This cross-sectional study included 363 adult residents of Taif City between 25 July 2025 and 15 November 2025; data were collected using an adapted questionnaire pilot-tested for clarity. Associations were assessed using chi-square tests; independent predictors were identified using multivariable logistic regression.Results: A self-reported history of kidney stones was present in 28.7% (104/363) of participants. Awareness of common symptoms was high (95.6% recognized pain), while misconceptions about dietary risk factors persisted (58.6% incorrectly believed calcium-rich foods increase risk). Female sex (OR = 0.54, 95% CI 0.32–0.91) and a healthcare-related occupation or field of study (OR = 0.23, 95% CI 0.11–0.49) were independently associated with lower odds... Continue Reading

Background: Vaccine hesitancy remains a critical public health challenge that impedes herd immunity and disease mitigation. This study aims to evaluate the knowledge, perceived severity, and attitudes toward COVID-19 vaccines among a convenience sample of adults in Riyadh, Saudi Arabia, and to identify demographic determinants influencing vaccine acceptance. Methods: A cross-sectional observational study was conducted utilizing convenience sampling across two commercial centers in Riyadh. A validated, self-administered questionnaire was distributed to 379 adult participants aged 18-60 years. Descriptive statistics and chi-square tests were used for statistical evaluations. Results: Among 379 participants, 88.9% had received a COVID-19 vaccine, and 60.7% reported prior COVID-19 infection. Participants demonstrated significantly higher confidence in locally manufactured vaccines (67.6%) compared to imported options (49.1%). Key barriers to immunization included concerns regarding adverse effects (69.2%) and the belief that natural infection grants sufficient immunity (71.5%). Higher educational attainment and professional occupational status were significantly associated with increased... Continue Reading

Background: Comorbidities contribute substantially to morbidity and treatment complexity in rheumatoid arthritis (RA), but regional data from Saudi Arabia are limited. This study assessed the prevalence, patterns, and factors associated with documented comorbidities among patients with RA in Qassim. Methodology: This retrospective cross-sectional medical-record study included 793 eligible adults with RA followed or treated at King Fahad Specialist Hospital during 2015–2025. Comorbidities were identified from documented physician diagnoses and relevant clinical or laboratory information. Multivariable logistic regression assessed factors associated with the presence of at least one comorbidity using complete-case analysis. Results: Overall, 538 patients (67.8%) had at least one comorbidity. Hypertension (233, 29.4%), diabetes mellitus (203, 25.6%), and hypothyroidism (169, 21.3%) were most frequent. One comorbidity was present in 199 patients (25.1%), two in 151 (19.0%), and three or more in 188 (23.7%). In the expanded model (n=777), age was independently associated with comorbidity presence (adjusted odds ratio 1.076... Continue Reading

Background: Pneumonia caused by Streptococcus pneumoniae is a major health problem worldwide. Vaccines are available to prevent pneumococcal pneumonia, but their effectiveness depends on public awareness and acceptance. In Al-Ahsa, Saudi Arabia, limited evidence exists regarding adults’ awareness and acceptance of pneumococcal vaccination.Methods: A cross-sectional, questionnaire-based study was conducted among adults aged 18 years and older in Al-Ahsa. A total of 305 participants were recruited through online and in-person convenience sampling. Data were collected using a structured, prevalidated questionnaire covering demographics, awareness, attitudes, and vaccine uptake and were analyzed using IBM SPSS Statistics (version 26.0; IBM Corp., Armonk, NY, USA). Descriptive and inferential statistics, including chi-square tests, were used.Results: Most participants (68.5%) had poor overall awareness of pneumococcal disease and vaccination. Only 3.6% had ever received the pneumococcal vaccine. The most common reason for not receiving the vaccine was lack of awareness (66.8%), followed by waiting for a doctor’s recommendation... Continue Reading

Background: Preoperative anesthesia-related anxiety is a widespread issue that can negatively impact surgical outcomes. Despite its importance, there is limited data on patient perceptions in regional settings like King Abdullah Hospital in Bisha, Saudi Arabia. This study aimed to assess patients' knowledge, perceptions, preferences, and concerns regarding anesthesia in this population. Methods: A hospital-based, quantitative cross-sectional study was conducted with 405 adult preoperative patients. Data were collected via face-to-face interviews using a structured questionnaire covering sociodemographic details, perceptions of anesthesiologists, anesthesia preferences, and preoperative concerns. Concern levels were assessed using a 16-item Likert scale and categorized as low, moderate, or high. Data were analyzed in SPSS using chi-square tests. Results: The mean age of participants was 36.5 years; 62.7% were female and 54.3% were university-educated. Most (69.1%) had previous surgical experience. A considerable proportion experienced moderate (46.4%) or high (25.2%) preoperative concern. Prominent fears included postoperative pain, paralysis, failure to... Continue Reading

Background: Delayed management of pediatric inguinal hernias can lead to serious complications. We sought to determine the effect of delayed elective surgery on uncomplicated inguinal hernias in children and parents’ emotional perspectives and anxiety levels during the COVID-19 pandemic. Methods: This multicenter prospective cohort study included all pediatric patients ≤ 14 years of age with inguinal hernia who were initially scheduled for surgery but were postponed during the national lockdown between March and September 2020. The incidence of all hernia-related complications while awaiting surgery was analyzed. We also surveyed the patients’ parents regarding their perspectives, anxiety, and the impact of delayed surgery on their children’s well-being. Results: Forty-eight patients were included in the study. Primary inguinal hernias were noted in 45 (93.8%) patients. Half of the patients had one or more hernia-related emergency room (ER) visits, 18 (37.5%) had one or more hernia incarcerations, and 13 (27.1%) needed emergency hernia... Continue Reading

Background: Corticosteroids are widely prescribed medications because of their potent anti-inflammatory and immunosuppressive properties and are commonly used to treat a broad range of pediatric inflammatory conditions. Despite their therapeutic benefits, misuse, misconceptions, and reliance on non-medical information sources have contributed to poor public awareness, corticophobia, and reduced adherence to prescribed treatment. Previous studies in Saudi Arabia have reported inadequate awareness regarding corticosteroid use and its adverse effects. Therefore, this study aimed to assess public awareness regarding the side effects of corticosteroids used in the treatment of pediatric inflammatory diseases. Methods: A cross-sectional study was conducted in Makkah, Saudi Arabia, between January 15 and December 25, 2025. In this study, 401 adults aged ≥18 years who met the inclusion criteria and consented to participate were included. Data were collected from the participants using a structured online questionnaire distributed from March 13 to June 9, 2025. The questionnaire assessed sociodemographic characteristics,... Continue Reading

Background: The magnesium depletion score (MDS) combines diuretic use, proton pump inhibitor use, heavy alcohol consumption, and reduced kidney function as an indirect indicator of systemic magnesium status. We evaluated the association between MDS and cardiovascular disease (CVD) mortality. Methods: Following PRISMA 2020, four databases were searched from inception through March 2025. Fully adjusted hazard ratios (HRs) were synthesized with inverse-variance random-effects models. Analyses were stratified according to whether the reference category was MDS = 0 or MDS = 0–1. Results: Nine observational reports based on U.S. National Health and Nutrition Examination Survey cohorts met the eligibility criteria; eight contributed to quantitative synthesis. Among five reports using MDS = 0 as the reference, pooled HRs were 1.37 (95% CI, 1.11–1.69) for MDS = 1, 1.64 (95% CI, 1.28–2.10) for MDS = 2, and 2.59 (95% CI, 1.97–3.41) for the highest MDS category, with I² = 0% for each analysis. Among... Continue Reading

Background: Esophageal atresia (EA), frequently associated with tracheoesophageal fistula (TEF), is the most common congenital anomaly of the esophagus. Although survival after surgical repair has improved substantially, gastroesophageal reflux disease (GERD) remains a frequent postoperative complication. Proton pump inhibitors (PPIs) are commonly prescribed to reduce GERD-related complications, including anastomotic stricture; however, evidence supporting their effectiveness is conflicting. This study evaluated the association between postoperative PPI use and outcomes, including esophageal stricture formation, in children undergoing EA repair at a tertiary center. Methodology: This retrospective cohort study included patients with EA managed at King Fahad Medical City, Riyadh, Saudi Arabia, between January 1, 2010, and December 30, 2021. Patients treated initially at another institution, those who died before or after repair because of unrelated comorbidities, patients with long-gap EA or complex surgical procedures, and those with type E TEF were excluded. Demographic, clinical, operative, postoperative, and follow-up data were abstracted from... Continue Reading

Introduction: Chronic kidney disease (CKD) attributable to high fasting plasma glucose (HFPG) is rising globally, particularly in regions with rapidly increasing dysglycemia such as the Middle East and North Africa (MENA). We assessed long-term trends in HFPG-attributable CKD burden across 21 MENA countries from 1990 to 2023. Methods: Using estimates from the Global Burden of Disease (GBD) 2023 study, we quantified deaths and disability-adjusted life years (DALYs) attributable to HFPG-related CKD at regional, national, age-group, and sex-specific levels. We derived age-standardized mortality rates (ASMRs) and age-standardized DALY rates (ASDRs) and evaluated temporal changes using joinpoint regression to identify significant shifts in burden across the study period. Results: The absolute burden of HFPG-attributable CKD increased substantially across the region, with large rises in both deaths and DALYs. In contrast, ASMRs and ASDRs showed only modest changes, suggesting that population growth and ageing were major contributors to the rising burden. Older adults... Continue Reading

Background: Radiology underpins diagnosis across clinical specialties, yet remains underrepresented in many undergraduate curricula. This study assessed knowledge of imaging appropriateness and image interpretation among medical students and interns in Riyadh, compared performance between pre-clinical and clinical training stages, and described awareness of appropriateness frameworks. Methods: Analytical cross-sectional study conducted September 2025–January 2026 at universities in Riyadh, Saudi Arabia. A self-administered online questionnaire assessed perceptions of radiology education, awareness of appropriateness frameworks, and knowledge through six scenario-based and six image-based single-best-answer items. Participants were classified as pre-clinical (years 1–3) or clinical (year 4 to internship). Analyses used Welch's t-tests, chi-square tests, and mixed-effects regression with a random intercept for university. Results: Of 495 responses, 493 were analysed (257 pre-clinical, 236 clinical). Clinical-stage participants scored higher on total knowledge (7.14 ± 2.48 versus 4.38 ± 2.43; mean difference 2.76, 95% CI 2.33 to 3.20; Hedges' g = 1.12; p < 0.001),... Continue Reading

Background: Reproductive tract infections (RTIs) are among the most common causes of maternal morbidity and unwanted pregnancy outcomes. Limited data are available regarding the knowledge of pregnant women in Saudi Arabia towards RTIs. This study aimed to assess the awareness and knowledge of RTIs among pregnant women attending antenatal clinics at King Abdulaziz University Hospital, Jeddah. Methods: This cross-sectional study was conducted between April and June 2025 with 330 pregnant women attending antenatal care clinics. Data were collected using a structured questionnaire onsociodemographic characteristics and knowledge of RTI symptoms, transmission, prevention, and treatment. Data were analyzed using SPSS version 21. Chi-square and logistic regression tests were used to identify the associations between various levels of knowledge and participant characteristics. Results: Most participants were Saudi, with a median age of 33 years. While 65% had high knowledge scores, awareness of transmission routes and preventive measures remained limited. Only 31% identified sexual contact... Continue Reading

Background: To assess whether sham procedures offer comparable outcomes in pain relief, function, quality of life, and adverse events. Methods: The literature search was conducted across the PubMed, Scopus, and Cochrane Library databases (2014-2024). Eligible studies included randomized controlled trials and observational studies comparing sham and actual orthopedic surgeries. Data was extracted and pooled using Review Manager 5.1.4, with standardized mean difference (SMD) as the effect size metric. A random-effects model accounted for heterogeneity. Risk of bias was assessed using the Cochrane tool. Results: Seven studies were included. The meta-analysis showed a statistically significant difference favoring real surgery for pain outcomes (SMD = -0.73; 95% CI: -1.23 to -0.22; p = 0.005), with high heterogeneity (I² = 89%). Functional outcomes (185 participants across 3 studies) showed no significant difference (SMD = -0.07; 95% CI: -1.04 to 0.89; p = 0.88; I² = 90%). For quality of life (342 participants across... Continue Reading

Background: The effectiveness of topical tranexamic acid (TXA) for spontaneous anterior epistaxis remains uncertain. We evaluated its efficacy and safety compared with placebo or standard care. Methodology: PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through November 2025 for randomized controlled trials (RCTs) and comparative observational studies in adults with spontaneous anterior epistaxis. The primary outcome was bleeding cessation; secondary outcomes included overall hemostasis, rebleeding, resource utilization, and adverse events. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using the Hartung–Knapp–Sidik–Jonkman random-effects model. Results: Eleven studies (10 RCTs and 1 observational study; 1,811 patients) were included. TXA was associated with greater bleeding cessation within 10 minutes (RR 2.26, 95% CI 1.59–3.21), but this effect became non-significant after adjustment for publication bias, indicating uncertainty in rapid hemostatic efficacy. TXA improved overall hemostasis (RR 1.25, 95% CI 1.11–1.40), reduced rebleeding within 3 days (RR 0.39, 95% CI 0.28–0.55),... Continue Reading

Background: Urolithiasis in pregnancy poses clinical challenges due to maternal physiological changes and the limiting of treatment options. Ureteroscopy is the preferred minimally invasive intervention, but optimal anesthesia selection remains debated. General, spinal, and local anesthesia each carry distinct benefits and risks regarding maternal and fetal safety. This systematic review and meta-analysis aim to compare these techniques across maternal, fetal, and operative outcomes to guide clinical decision-making in this population. Methods:  A systematic literature search was conducted, reporting items for Systematic Reviews and Meta-Analyses 26 records across PubMed, Web of Science, and Google Scholar from 2014 till 2025. Inclusion criteria were the studies involving pregnant patients undergoing ureteroscopy with focusing on anaesthesia modality and maternal, foetal, and procedural outcomes. Methodological quality was assessed using the Newcastle–Ottawa Scale. Results: Five observational studies encompassing 311 ureteroscopy (URS) procedures across 387 pregnant women met the inclusion criteria. Pooled data demonstrated a low incidence... Continue Reading

Background: Laparoscopic cholecystectomy (LC) is frequently associated with early postoperative pain and opioid-related adverse effects. We evaluated the efficacy and safety of perioperative low-dose esketamine in adults undergoing LC. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, PubMed, the Cochrane Library, Embase, and Web of Science were searched from inception to February 2026 for randomized controlled trials comparing esketamine with placebo or a standard anesthetic regimen. Random-effects meta-analyses generated mean differences, standardized mean differences, or risk ratios with 95% confidence intervals (CIs). Results: Nine trials involving 699 participants were included. Esketamine reduced pain within 2 hours (MD-0.67; 95% CI -0.90 to -0.45) and reduced pain at rest and with movement through 72 hours, although several later estimates were highly heterogeneous. Intraoperative remifentanil consumption (SMD -0.74; 95% CI -1.31 to -0.18) and propofol consumption (SMD -0.55; 95% CI -0.98 to -0.11) were lower. Awakening time, postanesthesia care unit... Continue Reading

Background: The HEART score is widely used for rapid risk stratification of patients presenting to emergency departments with chest pain. However, a small proportion of patients classified as low risk (score ≤3) still experience major adverse cardiac events (MACE). This review evaluated the residual MACE risk and the diagnostic performance of the HEART score ≤3 threshold. Methods: A systematic review and meta-analysis was conducted using studies identified in PubMed and Embase from database inception to January 1, 2026. Eligible studies included adults (≥18 years) presenting with chest pain and reporting outcomes for a low HEART score group (0-3). Risk of bias was assessed using the Quality In Prognosis Studies tool. Random-effects models were used to pool event rates and diagnostic accuracy measures. Results: Five observational studies including 4,072 participants were included. The pooled MACE rate among low-risk patients was 0.56% [95% confidence interval (CI), 0.04%-1.52%]. The pooled sensitivity was 0.90,... Continue Reading

Introduction: Artificial intelligence (AI) and machine learning (ML) are revolutionizing surgical fields, including oculoplastic surgery. In blepharoplasty, these technologies offer objective analysis of eyelid morphology, age estimation, and surgical outcomes, potentially enhancing both cosmetic and functional results. This systematic review and meta-analysis aimed to evaluate the diagnostic performance and applications of AI/ML in blepharoplasty procedures. Methods: Following PRISMA guidelines, four databases (PubMed, Embase, Scopus, and Web of Science) were searched through June 2025. Eligible studies included original research evaluating AI/ML tools for blepharoplasty-related assessments. Data extraction and quality assessment (NIH tool) were independently conducted by two reviewers. A diagnostic test accuracy meta-analysis was performed using MetaDisc 2.0 and RevMan 5.4.1 to pool sensitivity and specificity data, with heterogeneity assessed via I². Results: Of 944 records identified, 12 studies met inclusion criteria. Eight were rated as good quality. Pooled analysis of four studies assessing AI-based blepharoptosis detection showed a sensitivity of... Continue Reading

Background: Fahr disease and Fahr syndrome are two clinical conditions that are related by clinical and radiological findings. They are characterized by the incidental finding of progressive bilateral calcium deposits in various brain regions. Patients may present with a wide spectrum of symptoms. Treatment is individualized and is based on the patient’s symptoms. Case presentation: This is a case series of three patients presenting with neurological symptoms and Fahr syndrome secondary to hypoparathyroidism who were admitted to the hospital and managed symptomatically. The first patient is a 22-year-old female, known case of hypoparathyroidism, who presented with headache, numbness, and dizziness. She was found to have hypocalcemia, and head computed tomography showed bilateral symmetrical dense calcifications. The patient was managed with intravenous calcium during admission and discharged on oral calcium supplementation. The second patient is a 37-year-old female who presented with abnormal body movements, with findings of Fahr disease on head... Continue Reading