Background: Adolescent major depressive disorder (MDD) is associated with substantial impairment, suicide risk, and limited response to standard treatments. Intravenous ketamine has rapid antidepressant effects in adults, but pediatric evidence remains limited. This systematic review and meta-analysis evaluated the short-term efficacy and safety of intravenous ketamine for adolescents with MDD, including treatment-resistant depression (TRD).Methods: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-based review was registered in PROSPERO (CRD420251123304). PubMed, Web of Science, and Google Scholar were searched from inception to October 2025. Eligible studies included patients aged 18 years or younger treated with intravenous ketamine for MDD or TRD. Outcomes included changes in Montgomery–Åsberg Depression Rating Scale (MADRS), Children’s Depression Rating Scale–Revised (CDRS-R), Children’s Depression Inventory (CDI), and adverse events. Risk of bias (RoB) was assessed using RoB 2 and methodological index for non-randomized studies. Random-effects meta-analyses were performed where appropriate.Results: Four prospective studies were included: two randomized... Continue Reading

Background: The use of social media has become an integral part of the current adolescent’s living, which raises concerns over the psychological health and quality of life (QoL). The addictive use was associated with emotional distress, poor academic achievement, and reduced physical QoL. The objective of the study was to determine the prevalence of such usage in Saudi Arabian adolescents and to investigate its relationship with the QoL.Methods: A web-based descriptive cross-sectional study was conducted among adolescents aged 12-18 at intermediate and secondary schools in Makkah and Riyadh. Data were collected via a self-administered online questionnaire using a snowball sampling method. The survey included sociodemographic variables, pediatric QoL inventory, and Bergen Social Media Addiction Scale. Statistical analysis was performed using SPSS, including descriptive statistics, chi-square tests, t-tests, and Pearson correlation analysis.Results: Of the 689 participants, 31.2% were identified as high-risk or problematic social media users. A strong negative relationship was... Continue Reading

Background: Propofol is a key component of contemporary anaesthesia due to its rapid onset and recovery. Despite decades of research, the fundamental studies shaping its clinical use have never been fully mapped. This study provides a citation-based landscape by identifying and analysing the top 50 most cited articles on propofol use in anaesthetic induction, highlighting key developments, topics, and influential authors. Methods: We performed a bibliometric analysis using the Web of Science with the keywords “propofol” and “anaesthesia,” without year restrictions. Articles were screened for relevance focusing on efficacy, safety, and innovations. The top 50 articles by citation count were selected. Data on citations, publication metrics, geographic origin, study design, and level of evidence were extracted and analysed descriptively. Results: The 50 papers totaled 5,252 citations (mean: 104.1; h-index: 50). The top 10% accounted for 40% of citations, largely from European research. Randomized controlled trials comprised 46%, establishing basic safety,... Continue Reading

Background: Unplanned emergency department (ED) readmissions within 30 day remain a major challenge in geriatric care, contributing to increased morbidity, mortality, and healthcare utilization. The triage risk screening tool (TRST) is frequently used to identify older adults at risk of adverse outcomes. However, its predictive accuracy at the conventional cutoff score of ≥2 remains uncertain, raising concerns about its standalone reliability. To systematically evaluate the diagnostic performance of the TRST (cutoff ≥2) in identifying elderly inpatients at risk of unplanned 30-day ED readmissions.Methods: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Searches were performed in PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Eligible studies included cohort designs assessing the TRST in adults aged ≥65 years for predicting 30-day unplanned ED readmissions. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios were obtained... Continue Reading

Background: Tension-type headache (TTH) is the most prevalent neurological disorder globally, affecting over 2 billion individuals and posing a substantial public health and socioeconomic burden. Although pharmacological treatments, such as non-steroidal anti-inflammatory drugs, offer symptomatic relief, concerns regarding long-term efficacy and medication overuse have driven interest in physical therapy as an alternative or adjunctive intervention.Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search from inception to December 2024 was conducted in the following electronic databases: PubMed, Google Scholar, Web of Science, the Cochrane Library, and DOAJ. Randomized controlled trials investigating the effect of physiotherapy on TTH were included.Results: Fifty-one randomized controlled trials involving 3,404 participants were included in this review. The studies investigated various physical therapy interventions, including manual therapy, therapeutic exercise, and multimodal approaches. The majority of the included studies demonstrated statistically significant improvements in headache intensity, frequency, and duration compared... Continue Reading

Background: Dengue fever (DF) is caused by the dengue virus, which manifests with systemic features such as fever, malaise, and headache. More than 50% of cases present with a variety of skin lesions.Case Presentation: We present a series of three cases that presented to the clinic with fever associated with gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. Other systematic reviews were unremarkable. The patients subsequently developed a pruritic skin rash characterized by diffuse confluent erythema with petechiae and rounded islands of sparing. After excluding alternative etiologies such as malaria, HIV, and hepatitis C, all three patients were diagnosed with DF.Conclusion: This case series highlights the presence of a characteristic rash in DF. We emphasize the clinical description of this cutaneous manifestation, which is not well-described in previous literature. Although cutaneous manifestations are common in dengue, identifying these specific rash patterns can contribute to accurate and early diagnosis. Patients presenting... Continue Reading

Background: Cardiogenic shock (CS) is the leading cause of mortality in ST-segment elevation myocardial infarction (STEMI). Patients with acute coronary syndrome in Saudi Arabia present a decade younger than Western cohorts and have a higher diabetes burden, yet contemporary local data on CS are limited. We aimed to determine the incidence, characteristics, and predictors of CS in a Saudi STEMI cohort.Methods: Single-center retrospective cohort study of consecutive adult patients with acute STEMI admitted to King Abdulaziz Cardiac Center, Riyadh, from January 2019 to December 2024. CS was defined by the SHOCK trial criteria. Univariate and multivariate logistic regression identified independent predictors.Results: A total of 878 patients were included (mean age 57.2 ± 13.6 years; 86.6% male); 80 (9.1%) developed CS. Compared with patients without CS, those with CS had a higher prevalence of dyslipidemia (58.8% vs. 44.6%, p = 0.016) and ventricular arrhythmia (17.5% vs. 5.5%, p < 0.001), higher... Continue Reading

Background: Wearable devices such as smartwatches are increasingly used for self-monitoring of physical activity; however, evidence regarding their association with physical activity levels in Middle Eastern settings remains limited. This study examined the relationship between smartwatch use and physical activity among adults in Saudi Arabia, using the World Health Organization Global Physical Activity Questionnaire.Methods: A cross-sectional online survey was conducted between August 2024 and February 2025 among Saudi adults aged ≥18 years (n = 1,082), recruited through social media platforms. Data collected included sociodemographic characteristics, smartwatch ownership and usage patterns, and physical activity quantified as metabolic equivalent task minutes per week (MET-minute/week). Multivariable linear regression models were used to identify factors independently associated with physical activity level.Results: The mean participant age was 27 ± 11 years, and 51% were female. Overall, 56% reported smartwatch use, with Apple Watch being the most commonly reported device (40.8%). Smartwatch users had higher physical... Continue Reading

Background: While relatively rare in type 2 diabetes mellitus (T2DM), diabetic ketoacidosis (DKA) is a serious complication that occurs due to absolute or relative insulin deficiency. Euglycemic DKA (EDKA) is a variant of DKA where patients present with normal blood sugar levels. Recently, studies have reported increased incidence of EDKA associated with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors, medications used to manage blood glucose.Case Presentation: A 53-year-old man with newly diagnosed T2DM presented with severe nausea and vomiting 4 days after the initiation of empagliflozin/metformin. Laboratory evaluation revealed metabolic acidosis (pH 7.16, bicarbonate 12 mmol/l), elevated anion gap (21 mmol/l), and increased serum ketones, despite near-normal blood glucose levels (7.8 mmol/l, approximately 140 mg/dl). A diagnosis of EDKA was made. The patient was treated with intravenous fluids, insulin therapy, and electrolyte replacement, with discontinuation of the SGLT2 inhibitor. He showed rapid clinical and biochemical improvement and was discharged... Continue Reading

Background: Herbal medicine use has become an area of interest due to the dependence on evidence-based medicine. In Saudi Arabia, medical curricula focus on evidence-based medicine, raising questions about the influence of modern medicine teaching on students’ use of herbal remedies. However, no previous study has been conducted in the Eastern Region of Saudi Arabia, particularly in Al-Ahsa. Methods: A cross-sectional study was conducted among 332 medical students at King Faisal University using a structured questionnaire adapted from a previous study. The questionnaire assessed herbal medicine use and perceptions towards it. Data were collected electronically and analyzed using SPSS version 29. Results: The majority of students reported prior use of herbal medicine (82.2%), and 54.5% expressed interest in it. Herbal medicine was used for both therapeutic and cosmetic purposes. Additionally, 41.9% of students reported that sometimes they avoid manufactured medicine in favor of herbal remedies, and 33.7% believed that herbal... Continue Reading

Background: Hair tourniquet syndrome is a potentially serious condition in which a strand of hair or thread tightly encircles a body part, leading to progressive swelling and possible ischemia if not promptly recognized and treated. Management depends on the depth and severity of the constriction, ranging from chemical dissolution or simple mechanical removal to more invasive techniques when the fiber is deeply embedded.Case presentation: A 24-day-old female infant presented with a 4-hour history of persistent irritability and inconsolable crying. Examination revealed a swollen toe with a deeply embedded hair tourniquet and no signs of ischemia. Initial manual removal was unsuccessful. But a novel needle-assisted technique was used to hook and cut the embedded hair without incision, achieving complete release.Conclusion: Deeply embedded hair tourniquets can be difficult to detect and manage, often requiring invasive procedures to relieve the constriction and prevent tissue damage. This case highlights a minimally invasive technique as... Continue Reading

Background: Smoking may modify systemic lupus erythematosus (SLE) activity, damage, and phenotype. This review aims to summarize associations between smoking exposure and SLE outcomes.Methods: Systematic review of primary studies assessing smoking in SLE and reporting clinical or biomarker outcomes. Five eligible studies (2002–2021) were included (total N=1,079). Participants were predominantly female (87–96.2%); where reported, most were Caucasian (73.7–92%) with mean/median age 37–49 years and disease duration ~9–13.5 years. Smoking exposure definitions varied substantially, limiting direct quantitative pooling and precluding meta-analysis across studies. Results: Ever-smoking prevalence ranged ~37–51%. In one observational study, current smokers had higher disease activity than never smokers (mean total SLEDAI 15.63±1.63 vs 9.03±0.99; p=0.0024) and a dose–response by packs/day (p=0.001). In a retrospective cohort, never exposure to active or second-hand smoke reduced risk of damage accrual (SDI>0: RR 0.78, 95% CI 0.62–0.97; p=0.0228). Heavy smoking (>20 pack-years) was associated with discoid rash (OR 2.22), photosensitivity (OR 2.19) and... Continue Reading

Background: Plasmablastic lymphoma (PBL) is an uncommon and highly aggressive variant of diffuse large B-cell lymphoma, which was first recognized in association with human immunodeficiency virus (HIV). Although an increasing number of cases occurring in HIV-negative immunocompetent individuals have been described, thereby expanding the clinical picture of this tumor.Methods: We present a case of a 27-year-old HIV negative, medically fit male who came with a rapidly enlarging gingival mass. Clinical, radiographic, and histopathological assessments were done, plus immunohistochemical staining for plasma cell and B-cell markers. We also checked for Epstein-Barr virus (EBV) and then the Ki‑67 proliferation index, basically.Results: The patient had about a 2-week history of progressive swelling on the left lower jaw. On examination, there was a lobulated 1.5 × 2.0 cm red to violaceous mass, sitting on the buccal gingiva. Radiographs suggested minimal involvement of the bone. Histopathology showed a diffuse sheet-like infiltrate of atypical plasmablastic cells. In... Continue Reading

Background: Smartwatches are increasingly used as personal health-monitoring tools, but evidence regarding their relationship with mental wellbeing remains limited in Middle Eastern populations. This study investigated the association between smartwatch use, specific smartwatch functions, and mental health symptoms among Saudi adults. Methods: This cross-sectional study included 1,217 Saudi adults aged ≥18 years recruited through social media. An online questionnaire assessed sociodemographic characteristics, smartwatch use, and mental health outcomes using the validated Arabic Depression, Anxiety, and Stress Scale-21 (DASS-21). Multiple linear regression analyses identified predictors of depression, anxiety, and stress scores. Results: Smartwatch use was reported by 48.9% of participants. Depression, anxiety, and stress symptoms above normal levels were reported by 49.1%, 56.1%, and 53.1% of participants, respectively. Among smartwatch functions, only activity tracking was significantly associated with mental health outcomes, showing lower anxiety scores (β = −2.14; 95% CI: −4.54 to −0.26; p = 0.035). Ex-smoking status was the strongest... Continue Reading

Background: Hajj in Makkah is a major mass gathering posing healthcare challenges. Emergency departments (EDs) rely on medical student volunteers during this season. This study assessed triage knowledge and associated factors among medical students volunteering in EDs during the Hajj. Methods: We conducted a descriptive cross-sectional survey among 600 medical students who volunteered. Data were collected using a structured online questionnaire that assessed knowledge across five domains: principles and ethics, clinical application, standardized systems, color coding and acuity classification, and operational preparedness. Data were analyzed using SPSS version 28 and descriptive statistics, independent samples t-tests, one-way ANOVA, and chi-square tests. A p-value < .05 indicated statistical significance. Results: The mean overall awareness score percentage was 65.6%, and 83.2% of participants demonstrated good overall knowledge. The highest mean score was observed in color coding and acuity classification (78.4%), followed by operational preparedness (71.6%) and standardized systems (67.3%). Lower scores were noted... Continue Reading

Background: Parental anxiety surrounding pediatric magnetic resonance imaging (MRI) under sedation or anesthesia is poorly characterized, and its relationship with parental satisfaction is unclear. Understanding these constructs is essential to refining pre-procedural counseling. Methods: A cross-sectional survey was conducted among parents of pediatric patients undergoing MRI with sedation or anesthesia at a tertiary hospital. Of 211 questionnaires distributed, 153 were completed (response rate 72.5%). Anxiety was assessed with a six-item Likert scale (Cronbach's alpha 0.759), and satisfaction with a single 5-point item. Mann–Whitney U, Kruskal–Wallis, chi-square/Fisher's exact tests, and Spearman correlations were used. Results: Composite anxiety was moderate to high (mean 3.22 ± 0.85). Mothers reported higher anxiety than fathers (3.54 ± 0.70 vs. 3.08 ± 0.87; P = 0.002). Leading drivers were fear of anesthetic risks (56.9%) and the child's young age (49.0%). Most parents (91.5%) did not know the planned anesthetic type, and 29.4% incorrectly believed MRI involves... Continue Reading

Background: Procedural sedation in children remains a complex clinical challenge. Midazolam has served as the conventional standard, yet intranasal dexmedetomidine has emerged as an attractive alternative offering potential advantages regarding respiratory safety alongside improved behavioral recovery. Objectives: To systematically review and meta-analyze the evidence from randomized controlled trials comparing the efficacy and safety of intranasal dexmedetomidine versus midazolam for procedural sedation in children aged 0-18 years. Methods: Adhering strictly to PRISMA guidelines, a systematic search of major databases identified relevant randomized controlled trials comparing these agents. Two independent reviewers selected eligible studies, extracted data, and conducted formal risk of bias assessments. Meta-analytic data pooling utilized random-effects models. Results: Eight trials encompassing 716 children were included. Primary endpoints proved not statistically significant: sedation onset trended faster towards midazolam (SMD=1.22; I²=96.7%), whereas satisfactory sedation trended favorably toward dexmedetomidine (RR=1.23; I²=78.4%). Importantly, dexmedetomidine significantly reduced postoperative anxiety (MD=-0.81; I²=0%), emergence delirium (RR=0.31; I²=0%),... Continue Reading

Background: Parents are important in limiting exposure to environmental toxicants, but little evidence exists about parental awareness and preventive behaviors in Saudi Arabia. This study aimed to evaluate the awareness and preventive measures of parents in the Western region of Saudi Arabia about toxicants affecting children in their environment. Methods: A community-based cross-sectional study was conducted among parents living in Jeddah, Makkah, Madinah, Yanbu, and Taif. The validated 18-item Prevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT) was used to obtain data for this study, assessing knowledge and preventive behaviors in five domains. Results: A total of 434 parents were included. The mean total PRoTECT score was 87.98 ± 4.02 (range 61–90), and 51.2% of participants obtained the highest possible score. The level of agreement was over 95% with 14 out of 18 questionnaire items. The greatest consensus was found regarding support for more stringent environmental policies,... Continue Reading

This systematic review and meta-analysis evaluated preoperative patient factors associated with adverse outcomes after primary total knee arthroplasty (TKA). PubMed and Crossref were searched from 2010 to 2025 according to PRISMA guidance, and the protocol was registered in PROSPERO (CRD420261297849). Eligible studies included adults undergoing primary TKA and reported diabetes mellitus, hypertension, obesity, morbid obesity, or sex in relation to readmission, revision surgery, or deep infection. Random-effects generic inverse variance meta-analyses were performed using odds ratios from adjusted models when available; unadjusted or calculated estimates were used only when adjusted estimates were unavailable. Twelve cohort studies including 1,586,680 patients were included. Diabetes mellitus was associated with higher odds of readmission (OR 1.17, 95% CI 1.05-1.30) and revision surgery (OR 1.17, 95% CI 1.03-1.32). Morbid obesity (BMI ≥40 kg/m²) was associated with readmission, revision surgery, and deep infection. Male sex was associated with readmission and revision surgery, while non-morbid obesity and... Continue Reading

Background: Shaken Baby Syndrome (SBS), or Abusive Head Trauma (AHT), is a preventable cause of serious head injury in infants carrying high morbidity and mortality. Despite its severity, community awareness in Saudi Arabia remains limited, with no prior data from the Al-Baha region. Methods: A cross-sectional study was conducted in the Al-Baha region of Saudi Arabia from December 2023 to April 2024. A validated Arabic-language questionnaire (content validity index 0.91) was distributed via a Google Form link to residents aged 18–60 years. The platform’s mandatory e-mail verification prevented duplicate responses, and a regional residency question was included to filter non-residents at the analysis stage. Healthcare professionals and non-residents were excluded. The minimum required sample size was 384 participants. Descriptive statistics and chi-squared or Fisher’s exact tests were used to assess associations between sociodemographic variables and SBS awareness; statistical significance was set at P < 0.05. No multivariable analysis was performed.... Continue Reading