Search Results (162)

Background/Objectives: Limited research has evaluated the association between the triglyceride-to-high-density lipoprotein (TG/HDL) ratio and premature coronary artery disease (PCAD), particularly in Saudi Arabia. Therefore, this study aimed to investigate the association of the TG/HDL ratio with PCAD and to assess its sensitivity and specificity in a young Saudi population. Methods: This comparative retrospective case–control study utilized data collected from patients’ electronic medical records at King Saud University Medical City (KSUMC) between 2015 and 2023. The vessel score and Gensini score were used to evaluate the severity of coronary occlusion. The study population was divided into two groups: (1) a healthy control group consisting of blood bank donors, selected to exclude individuals with chronic diseases such as metabolic disorders and hypertension, with no evidence of coronary artery disease and aged ≤50 years (as confirmed by a cardiologist to rule out cardiovascular disease); and (2) patients with PCAD, aged ≤51 years, who underwent selective coronary angiography using the standard hospital procedure (right femoral artery approach). Coronary angiographic images were evaluated using right and left oblique views with cranial and caudal angulations. Results: A total of 898 subjects were included in the study, comprising 440 healthy controls and 458 patients with PCAD. Higher HbA1c levels were significantly associated with PCAD (adjusted OR = 13.03, 95% CI [7.32, 23.18], p < 0.001). Importantly, the TG/HDL ratio, the primary biomarker of interest, remained significantly associated with PCAD after full adjustment. Each unit increase in the TG/HDL ratio was associated with more than a threefold increase in the odds of PCAD (adjusted OR = 3.39, 95% CI [2.22, 5.16], p < 0.001), independent of age, sex, BMI, HbA1c, smoking, and total cholesterol levels. Among females, the TG/HDL ratio demonstrated an area under the curve (AUC) of 0.796, with an optimal cut-off value of 0.91, yielding 77.8% sensitivity and 71.4% specificity. Among males, the TG/HDL ratio yielded an AUC of 0.786, with a higher optimal cut-off value of 1.09 providing 73.4% sensitivity and 65.4% specificity. Conclusions: Our study indicates that the TG/HDL ratio and HbA1c are significantly associated with PCAD in young Saudi male and female populations, demonstrating good sensitivity and specificity. Females exhibited a lower cut-off value than males. Smoking and elevated cholesterol levels were also identified as prominent risk factors. However, the TG/HDL ratio did not distinguish between moderate and severe coronary stenosis, as assessed by the Gensini score. Full article

Background and objectives: Social media use has become pervasive among the general population, with growing concern regarding its potential effects on mental health and sleep. While existing studies report associations between social media engagement and psychological outcomes, limited attention has been given to users’ self-perceived impact. To assess the self-perceived impact of social media use on mental health and sleep-related outcomes among healthy adolescents and adults aged 16–50 years old, and to identify associated demographic and behavioral factors. Methods: A cross-sectional survey was conducted among residents of Jeddah, Saudi Arabia, aged 16–50 years without a history of psychiatric or chronic sleep disorders, using a structured online questionnaire. Perceived mental health impact was assessed using a six-item study-specific questionnaire evaluating participants’ subjective perceptions regarding emotional and psychological responses to social media exposure. Higher perceived impact was defined as a composite score of 12–24 points on the study-specific scale. Data included sociodemographic characteristics, patterns of social media use, perceived mental health impact assessed through a 6-item Likert scale, and sleep-related outcomes. Associations were evaluated using chi-square tests and logistic regression analysis. Results: Most participants reported daily social media use exceeding 3 h, with 44.9% engaging in late-night use and 87.6% using devices within 30 min before sleep. Overall, 18.6% exhibited higher perceived mental health impact. Higher odds were observed among younger participants, students, and single individuals. Snapchat and YouTube use, and late-night engagement were independently associated with increased perceived impact. Approximately one-third reported insomnia after social media use, and 44.3% perceived improved sleep with reduced usage. Conclusions: Social media use is widely prevalent and commonly perceived to negatively affect mental well-being and sleep, particularly with intensive and late-night use. Self-awareness of these effects may represent a valuable leverage point for prevention, supporting the need for targeted digital wellness strategies and public health interventions. Full article

Background: Accurate endotracheal tube (ETT) insertion depth is critical in infants and young children, where tracheal malposition carries significant risk. Formula-based depth estimation is widely used at the bedside, but the performance of published formulas in children under two years of age admitted to a general PICU remains poorly characterized. Methods: A retrospective, single-center study was conducted at the PICU of King Saud Medical City, Riyadh. A total of 115 patients aged 1–24 months requiring orotracheal intubation were included. ETT depth was predicted using five established formulas: height-based [(H/10)+5], weight-based [W+6], ETT size-based [ETT×3], Lee weight-based [5.5+0.5W], and Lee height-based [3+0.1H]. Agreement between predicted and radiographically confirmed insertion depth was assessed using Lin’s concordance correlation coefficient (CCC), Bland–Altman analysis, and clinical classification of predictions. Results: None of the five formulas achieved acceptable concordance (CCC < 0.75 for all). The height-based formula performed best among published formulas, with negligible bias and the highest proportion of clinically acceptable predictions. Both Lee formulas showed near-universal systematic underestimation and are not suitable for this age group. Over half of all intubations resulted in non-ideal ETT position on the first post-intubation chest X-ray. Novel cohort-derived regression equations outperformed all published formulas, with the weight-based equation (Depth = 0.385 × Weight + 9.145) emerging as the strongest predictor of insertion depth. Conclusions: No published formula achieved reliable concordance with radiographic ETT depth in children aged 1–24 months. The cohort-derived weight-based formula represents a more accurate bedside tool for this population and warrants prospective external validation. Post-intubation radiographic verification remains essential. Full article

Background: Cardiovascular disease (CVD) is the leading cause of global mortality, necessitating its early detection. Carotid intima-media thickness (CIMT) is a validated biomarker of CVD. In Saudi Arabia (SA), population-specific CIMT data for young adults are lacking. This pilot study aimed to generate single-institution preliminary CIMT data using the Butterfly iQ+ handheld ultrasound device (HHUD) and identify CVD risks. Methods: A cross-sectional observational study was conducted on 63 medical students. CIMT was measured bilaterally on common carotid artery (CCA), using the Butterfly iQ+ HHUD. Data on sex, age, ethnicity, BMI, mean arterial pressure (MAP), family history, and dietary habits were collected and analysed using t-tests, one-way ANOVA, Chi-square tests, Spearman’s rho (ρ) correlation, and stepwise multiple linear regression. Results: Mean age was 19.19 ± 1.89 years, and mean BMI was 24.93 ± 4.72 kg/m². Mean CIMT was 0.053 ± 0.006 cm. Males demonstrated thicker right CIMT (0.055 cm; 95% CI: 0.053–0.058 cm) than females (0.051 cm; 95% CI: 0.048–0.053 cm; mean difference: 0.005 cm, 95% CI: 0.001–0.008 cm; p = 0.012) and higher mean CIMT (0.0548 vs. 0.0513 cm; mean difference: 0.004 cm, 95% CI: 0.000–0.007 cm; p = 0.031). Height (ρ = 0.266; p = 0.035) and weight (ρ = 0.320; p = 0.011) correlated with right CIMT. Stepwise regression identified sex as the sole independent predictor (R² = 0.105; F = 6.541; p = 0.013). Conclusions: This pilot study establishes preliminary single-institution CIMT data for young healthy medical students at a single university in Riyadh, Saudi Arabia. Sex, height, and body weight are key early determinants of carotid wall thickness. The Butterfly iQ+ HHUD is a feasible point-of-care tool for CIMT measurement, supporting community-based CVD screening in the region. Full article

Food insecurity has been associated with poorer diet quality; however, limited evidence exists on the association between food insecurity and adherence to the Mediterranean diet in Saudi Arabia. This cross-sectional study, conducted among 577 Saudi adults between February and June 2025, examined the association between food security status and adherence to the Mediterranean diet in this region. Data were collected through a self-administered questionnaire that included sociodemographic characteristics, the Food Insecurity Experience Scale, and the Mediterranean diet adherence score. Most participants were food secure (73.0%), and only 12.7% demonstrated high adherence to the Mediterranean diet. The food insecurity score was inversely related to Mediterranean diet adherence (B = −0.107, 95% CI −0.191 to −0.024; p = 0.012); however, the magnitude of the association was small. Age, marital status, and monthly income were also significantly associated with food security status (p < 0.005). Although most of the participants were food secure, overall adherence to the Mediterranean diet was low, with only a small proportion demonstrating high adherence. These findings suggest that socioeconomic factors, particularly income, may be associated with both food access and diet quality. Further research is needed to inform strategies aimed at improving access to affordable healthy foods and promoting healthier dietary patterns, especially among young adults and low-income individuals. Full article

Background/Objectives: Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection. This study reviews the clinical profile, diagnostic pathways, treatment strategies, and outcomes of AK cases managed over a 34-year period. Methods: We conducted a retrospective analysis of 52 microbiologically AK cases from 1983 to 2017. Results: The mean age at presentation was 27.7 ± 9.4 years, with a female predominance (63.5%). The majority (82.7%) were contact lens users, almost exclusively soft lens wearers, with documented risk behaviors such as poor hygiene and sleeping with lenses. 44.2% were initially misdiagnosed as nonspecific microbial keratitis. Common clinical findings included epithelial defects (30.8%), ring infiltrates (44.2%), superficial infiltrates (53.8%), hypopyon (30.8%), and corneal thinning (13.5%). Diagnosis was confirmed by culture/stain in 61.5% of cases, while others required confocal microscopy or corneal biopsy. Co-infections with bacteria were noted in ~20%. Prior to referral, 82.7% of patients had received empirical topical therapy. At KKESH, all received dual anti-Acanthamoeba therapy, and 69.2% underwent surgical intervention, including tectonic PKP (46.2%) and optical PKP (19.2%). Visual acuity improved from a mean logMAR of 1.51 at presentation to 0.87 at last follow-up. Anti-Acanthamoeba therapy was discontinued in 95.9% of patients by the end of follow-up, with steroid use tapering from 61.5% at 3 months to 16.3% at final visit. Conclusions: Acanthamoeba keratitis in Saudi Arabia predominantly affects young female contact lens users and often presents with diagnostic delays and misclassification as herpetic or bacterial keratitis. Despite aggressive medical and surgical therapy, visual outcomes remain suboptimal in many cases. Full article

Background/Objectives: Palpitations are among the most common reasons for cardiology referrals. Despite widespread use of ambulatory cardiac monitoring, contemporary data from the Middle East are scarce. Extended Holter monitoring provides detailed evaluation of arrhythmia burden, autonomic regulation, and symptom–rhythm correlation in routine clinical practice. Methods: We conducted a prospective observational study of consecutive patients presenting with palpitations who underwent 24–96 h ambulatory Holter monitoring at a cardiology outpatient clinic in Saudi Arabia in 2025. Demographic and clinical characteristics, comorbidities, medication use, echocardiographic parameters, heart rate variability (HRV), ventricular and supraventricular ectopy, tachyarrhythmias, and symptom diary activations were systematically evaluated. Results: Among 251 patients (mean age 41.9 ± 16.4 years; 35.5% male), Holter monitoring showed excellent recording quality (mean analyzable time 98.7 ± 9.5%). Premature ventricular contractions (PVCs) were detected in 53.4% of patients, but burden was low (median 0.0%, IQR 0–0.1%), with only 4.4% exceeding 10%. Atrial premature contractions (APCs) were common (92.0%), though usually low-burden (median burden 0.0%, IQR 0–0.1%); atrial fibrillation and supraventricular tachycardia were rare (0.8% each). Symptom diary activation occurred in 116 patients (46.2%), with 996 events; most (87.9%) correlated with sinus tachycardia, while only 8.6% correlated with PVCs and 2.6% with APCs. In the remaining 53.8% of patients, no symptom–rhythm correlation was documented during monitoring. Heart rate variability showed expected age-related changes. Conclusions: In this predominantly young cohort, Holter monitoring revealed frequent low-burden atrial and ventricular ectopy, whereas clinically significant tachyarrhythmias were uncommon. Holter monitoring up to 96 h provided a diagnostic yield in approximately 50% of patients and should be considered a first-line screening tool. Patients without diagnostic findings may require prolonged monitoring using external or implantable devices. Full article

Background: Saudi Arabia has made significant progress toward malaria elimination; however, imported cases continue to occur, particularly in the southwestern regions. This study aimed to describe the clinical characteristics and outcomes of patients with malaria in the Aseer Region, Saudi Arabia. Methods: A retrospective observational study was conducted at Khamis Mushait General Hospital, Aseer Region, Saudi Arabia, including all patients with malaria from January 2022 to December 2025. Demographic, clinical, laboratory, and outcome data were extracted from the electronic medical records. Severe malaria was defined according to the World Health Organization criteria. Multivariate logistic regression using Firth’s penalized maximum likelihood estimation was performed to identify independent predictors of severe malaria (≥1 WHO criterion). Statistical analysis was performed using R software (version 4.2.1). Results: A total of 311 patients were included, predominantly male (90.0%), with a mean age of 28.8 ± 11.3 years. Ethiopian nationals comprised nearly half the cases (48.2%), followed by Saudi (16.4%) and Yemeni (15.1%) nationals. Plasmodium vivax was the most common species (51.1%), followed by Plasmodium. falciparum (40.2%). Fever was the most frequent symptom (89.4%), followed by fatigue (50.8%), chills (46.9%), and vomiting (39.5%). Low parasitemia (<1%) was the most frequent finding (33.8%), followed by moderate (27.3%) and mild (18.3%) levels, while high (4.2%) and very high parasitemia (1.9%) were uncommon. Severe malaria (≥1 criterion) was diagnosed at 43.7%, with severe anemia (26.0%) and jaundice (23.2%) being the most frequent WHO severity criteria. Notably, 84% of the cases occurred during 2024–2025, indicating a recent outbreak, with a sharp peak of 43 cases in October 2024. Multivariate logistic regression identified two independent predictors of having at least one WHO severity criterion: higher parasitemia level (adjusted OR = 1.70 per 1% increase, 95% CI: 1.40–2.11, p < 0.001) and non-Saudi nationality (adjusted OR = 2.40, 95% CI: 1.10–5.62, p = 0.027). Conclusions: Malaria in the Aseer Region predominantly affects young adult male expatriates, suggesting its imported nature. The predominance of P. vivax represents a shift from historical patterns. Parasitemia level and being of non-Saudi nationality independently predict severe malaria and may therefore support risk stratification and clinical decision-making. The dramatic case surge in 2024–2025 highlights regional vulnerability to outbreaks despite control progress. These findings support enhanced screening for at-risk populations, maintenance of clinical capacity for severe malaria management, and robust surveillance systems for early outbreak detection. Full article

Background/Objectives: Poor diet quality is common among young Saudi adults, characterised by high fast-food intake and low fruit and vegetable consumption. This study investigated the association between diet quality and lifestyle factors using a validated short Healthy Eating Index (sHEI). Methods: This study adopted a cross-sectional design, gathering responses through a self-completed online questionnaire. Demographic data were collected. Diet quality was assessed using the Arabic version of the sHEI, physical activity was evaluated with the Arabic short form of the International Physical Activity Questionnaire (IPAQ), and sleep quality was measured using the Athens Insomnia Scale (AIS). Saudi residents aged 18–25 years were eligible; pregnant or lactating individuals and those with chronic conditions affecting dietary intake were excluded. Results: Among 478 participants (mean age 21.1 ± 1.9 years), 88.1% were female, 24.7% were overweight or obese, and half reported poor diet quality. Moderation scores were slightly higher (54.2% high), whereas adequacy scores were nearly equal (49.8% high and 50.2% low). Most participants reported low physical-activity levels (78.5%) and poor sleep quality (55.2%). Sleep quality was significantly associated with all diet quality measures, increasing the odds of good total sHEI (OR = 1.74, p = 0.003), adequacy (OR = 1.49, p = 0.034), and moderation (OR = 1.54, p = 0.021). Conclusions: Sleep quality is significantly associated with diet quality among young Saudi adults. While body mass index and physical activity showed no significant associations, improving sleep quality may promote healthier dietary behaviours. Future studies should explore pathways linking sleep and diet. Full article

Although alcohol consumption is prohibited in Saudi Arabia, methanol poisoning outbreaks continue to occur, largely through surrogate or non-beverage alcohols. To date, systematic forensic documentation of methanol-related fatalities in Saudi Arabia remains limited. This study presents a comprehensive post-mortem series of methanol-related deaths investigated in Jeddah and characterizes the demographic patterns, circumstances of death, post-mortem interval (PMI), and methanol distribution across multiple biological matrices. In total, 34 post-mortem cases with toxicologically confirmed methanol exposure were retrospectively examined. Methanol and ethanol levels in blood, urine, vitreous humor, bile, gastric contents, and selected tissues were quantified using a validated headspace gas chromatography–flame ionization detection method. Decedents were aged 18–73 years (median, 34.5 years), with a marked predominance of young-to-middle-aged men. PMI ranged 1–15 days (median, 2 days), and evidence of putrefaction was present in approximately one-third of the cases. Most deaths were classified as accidental and primarily occurred in private residences. Two distinct outbreak periods (2018 and 2022) were identified; values tended to be higher in 2018, but the differences were not statistically significant. NaF-preserved blood, urine, and vitreous humor were informative in non-decomposed cases, whereas vitreous humor and solid organs, particularly the liver and kidneys, retained quantifiable methanol in putrefied bodies. Ethanol was detected in a minority of cases and was considered a secondary or contributory finding. This study provides an important forensic baseline dataset for methanol-related fatalities in Saudi Arabia and underscores the need for continued surveillance and preventive measures. Full article

Cyber-trauma has emerged as an important concern within online gaming environments, with growing implications for children’s mental health and well-being. Multiplayer games increasingly function as routine spaces for interaction, competition, and informal learning, which may expose young players to hostile behaviours such as harassment, hate speech, exclusion, and repeated targeting. Understanding the psychological consequences of these experiences and the protective role of family support is therefore essential. This study investigates the relationship between cyber-trauma victimisation (CV) and four mental health outcomes—depressive symptoms (DS), anxiety symptoms (AS), perceived stress (PS), and emotional distress (ED)—among Generation Alpha student gamers, while examining parental support as a moderating factor. Survey data were collected from 1223 students of diverse Arab nationalities enrolled in schools in Saudi Arabia, with Saudi nationals representing approximately 15% of the sample. The results indicate that CV is a strong and consistent predictor of all examined mental health outcomes. Higher levels of CV are significantly associated with increased depressive symptoms (β = 0.58), anxiety symptoms (β = 0.55), perceived stress (β = 0.52), and emotional distress (β = 0.60) (all p < 0.001). Parental support significantly moderates these relationships, weakening the association between cyber-trauma exposure and adverse psychological outcomes. These findings contribute to the growing literature on children’s digital well-being by demonstrating that online gaming environments can serve as meaningful psychosocial stressors for young players. The results further highlight the importance of family-centred protective mechanisms, suggesting that parental emotional support, guidance, and communication can play a critical role in buffering the mental health risks associated with hostile online interactions. Full article

Background/Objectives: Emergency department healthcare professionals are often the first to provide treatment, yet studies indicate limited knowledge in Traumatic Dental Injuries (TDIs) management among these providers. While research on TDI management in emergency departments exists globally, recent data from Saudi Arabia is lacking. This study aims to assess the knowledge, attitude, and practice of emergency department physicians, nurses, and Emergency Medical Services (EMS) regarding TDIs in three major hospitals in Riyadh, Saudi Arabia. Results: Physicians (46.4%) were significantly (p = 0.02) more likely to respond that they have sufficient knowledge about TDIs compared to nurses and EMS personnel. Of the 221 respondents, 136 (62%) were in the age group of 30–40 years, while females (OR 4.23, p = 0.00, CI 2.29–23.13) and nurses (OR 4.88, p = 0.00, CI 2.39–9.96) were more likely to say ‘No’ for any form of training they received in dental trauma during their education. Young (20–30 years old) professionals (OR 3.70, p = 0.04, CI 1.53–8.92) were less likely to feel confident in managing cases of dental trauma compared to their senior colleagues. Conclusions: In this study, nurses’ and EMS personnel’s knowledge of dental trauma management was poorer than that of physicians. Most respondents reported that dental trauma management was not part of their curriculum or training, which, in turn, was reflected in their low confidence in managing such cases. Full article

Saudi Arabia is experiencing interactions between ongoing urbanization, tourism growth, infrastructure projects in western regions along the Red Sea, and volcanic hazards. The area contains extensive monogenetic volcanic fields with hundreds of volcanoes formed during the Quaternary period. The large scale of the region often limits and fragments volcanological research, resulting in insufficient age and chemical data to understand the spatial and temporal development of many volcanic fields. Increased tourism has created a need for volcanic hazard assessments, particularly since some volcanic fields are considered possible tourist destinations. Harrat Lunayyir, in northwestern Saudi Arabia, is an example where such assessments have been conducted. Hazard assessments seek to provide information about potential future eruption types, locations, and impacts over timeframes relevant to urban planning and risk management. Due to rapid local development, these assessments may be required on short notice for specific small areas within larger volcanic fields, even when geological data are limited. This report presents a deterministic, scenario-based method for addressing such requests in the Lunayyir Volcanic Field. Results indicate a young Holocene eruption site characterized by a complex scoria cone associated with lava spattering, Strombolian, violent Strombolian activity and extensive transitional-type lava effusion. Full article

Background and Objectives: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder that significantly affects quality of life. Night eating syndrome (NES), characterized by evening hyperphagia and nocturnal eating, may worsen reflux through delayed gastric emptying and increased nocturnal acid exposure, yet evidence in young adults remains limited. This study aimed to estimate the prevalence of GERD and NES, examine their association, and identify clinically relevant predictors among adults in southern Saudi Arabia. Methods: A cross-sectional study was conducted among 831 adults (≥18 years) in the Jazan region between November 2024 and April 2025. Data were collected using a validated 54-item online questionnaire assessing sociodemographic characteristics, lifestyle behaviors, dietary habits, and medical history. GERD was defined using the GerdQ (score ≥ 8), and NES using the night eating questionnaire (NEQ ≥ 25). Multivariable logistic and linear regression analyses were performed to identify independent predictors. Results: The prevalence of GERD was 25.6%, and 9.7% of participants met the criteria for NES. Higher NEQ scores were independently associated with increased odds of GERD (OR = 1.05, 95% CI: 1.02–1.07; p = 0.001). GERD was predicted by tea consumption, middle income (10,000–14,999 SAR), asthma, hiatal hernia, and a family history of GERD. NES was independently associated with GERD, smoking, and frequent intake of fatty foods, chocolate, salty foods, and soft drinks, while male sex, employment or student status, higher income, and fiber-rich food intake were protective. Conclusions: NES is significantly associated with GERD among young adults. Integrating screening for disordered eating behaviors and dietary counseling into routine GERD care may improve clinical outcomes. Full article