Background: Choking is a life-threatening medical emergency that requires immediate recognition and appropriate first aid intervention to prevent serious complications or death. Despite its clinical importance, public awareness regarding choking recognition and appropriate first aid management remains limited, particularly in differentiating first aid measures for adults and children. In Saudi Arabia, evidence on public awareness of choking is scarce, highlighting the need for a nationwide assessment. Methods: A descriptive cross-sectional community-based study was conducted across all regions of Saudi Arabia using a self-administered online questionnaire in Arabic. Adults aged 18 years and above were included. The questionnaire, adapted from a previously validated instrument, assessed knowledge and first aid practices related to choking. Data were analyzed using descriptive statistics, Chi-square and Fisher's exact tests, and binary logistic regression to identify factors associated with awareness. Results: A total of 387 participants were included. Overall, 49.9% demonstrated good awareness, while 50.1% had poor... Continue Reading

Background: Reproxalap, a reactive aldehyde species inhibitor, has been proposed for dry eye disease (DED), but trial findings are inconsistent and no quantitative synthesis exists. We assessed the efficacy and safety of reproxalap 0.25% ophthalmic solution versus vehicle in adults with DED. Methods: PubMed, Web of Science, ClinicalTrials.gov, gray literature, and manufacturer sources were searched to 30 July 2025 (PROSPERO CRD420251069765; PRISMA 2020). Two reviewers independently screened, extracted data, and assessed risk of bias (Cochrane RoB 2). Fixed-effects models pooled standardized mean differences (SMDs) for ocular dryness, mean differences (MDs) for conjunctival redness and tear production, and risk ratios (RRs) for adverse events, with 95% confidence intervals (CIs). Certainty was rated using GRADE. Results: Eight randomized controlled trials (1,436 participants) were included. Reproxalap did not improve ocular dryness (SMD −0.07; 95% CI −0.24 to 0.10; I² = 47%; P = 0.43) or conjunctival redness (MD −0.03; 95% CI −0.08 to... Continue Reading

Background:  Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common hemolytic enzyme disorder posing a significant public health concern in Saudi Arabia. Despite inclusion in the national newborn screening program, community awareness in Madinah Munawwarah remains underexplored. Objectives: To assess community knowledge of G6PD deficiency in Madinah and identify factors associated with decreased awareness. Methods: A descriptive cross-sectional study was conducted among 436 adults in Madinah using a 24-item validated electronic questionnaire. Knowledge was scored as good/fair (>50%) or poor (≤50%). Descriptive statistics, chi-square tests, multivariate logistic regression, and stepwise regression were applied (p < 0.05). Results: Knowledge levels were low, with 78.4% of participants demonstrating poor knowledge and 21.6% demonstrating good/fair levels. Awareness of triggers was limited: henna (5.7%), naphthalene (12.6%), and menthol (9.2%). Chronic fatigue was falsely identified as a clinical symptom (8.9%). Multivariate analysis revealed four predictors of higher knowledge: age 21–30 years (OR = 2.25), female gender (OR = 2.10),... Continue Reading

Background: Metabolic dysfunction-associated steatohepatitis (MASH), the progressive inflammatory form of metabolic dysfunction-associated steatotic liver disease (MASLD), is associated with fibrosis progression, cirrhosis, and liver-related morbidity and mortality. The growing burden of MASLD/MASH has accelerated development of targeted therapies, including thyroid hormone receptor beta (THR-β) agonists. This study aimed to characterize the registered clinical trial landscape of THR-β agonists for MASLD/MASH and identify major development trends and evidence gaps. Methods: A registry-based descriptive analysis was conducted using a ClinicalTrials.gov dataset current through July 2026. Thirty-two candidate records were manually screened, and 18 interventional trials involving MASLD/MASH-spectrum populations were included after excluding healthy-volunteer pharmacology studies, non-liver indications, observational studies, and unrelated records. Trials were characterized by study status, start period, clinical phase, drug family, therapeutic strategy, clinical focus, sponsorship, geographic distribution, and results-posting status. Categorical variables were summarized using frequencies and percentages, and Fisher’s exact test assessed the association between study status... Continue Reading

Background: Relapsing-remitting multiple sclerosis is a chronic immune-mediated disorder of the central nervous system associated with recurrent inflammatory activity and long-term disability accumulation. Although escalation therapy has traditionally been used, early initiation of high-efficacy disease-modifying therapies may provide stronger inflammatory control and improve long-term outcomes. Objective: This systematic review and meta-analysis aimed to compare early initiation of high-efficacy disease-modifying therapies with escalation or delayed treatment strategies in adults with relapsing-remitting multiple sclerosis. Methods: PubMed, Scopus, and Web of Science were systematically searched. Eligible studies included adults with relapsing-remitting multiple sclerosis treated with either early high-efficacy disease-modifying therapies or escalation/delayed strategies. Outcomes included annualized relapse rate, Expanded Disability Status Scale change, and delta-Expanded Disability Status Scale. Study quality was assessed using the Newcastle-Ottawa Scale, and pooled analyses were performed using random-effects models. Results: Ten observational cohort studies were included. Early initiation of high-efficacy treatment was associated with lower annualized relapse rate... Continue Reading

Background: Misophonia is characterized by intense emotional and behavioral responses to specific sounds and may interfere with daily functioning. Its relationship with insomnia remains insufficiently studied, particularly among adults in Saudi Arabia. Objectives: To examine DVMSQ-based misophonia symptom profiles, trigger phenomenology, functional impairment, and the association between misophonia and insomnia among Saudi adults participating in an online survey. Methods:  A cross-sectional online survey was completed by 1,001 adults residing in Saudi Arabia. After removing three duplicate responses, 998 participants were included in the primary analysis. Misophonia was classified using the Duke-Vanderbilt Misophonia Screening Questionnaire as no profile, subclinical profile, or clinically significant profile. Insomnia Severity Index (ISI) was used to assess insomnia. Descriptive statistics, chi-square tests, multinomial and ordinal logistic regression and sensitivity analyses were conducted. Adjusted models included demographic, socioeconomic, mental-health, chronic-illness, and auditory variables. Results: Of the participants, 61.1% had no misophonia screening profile, 15.1% had a subclinical profile, and 23.7%... Continue Reading

Background:Temporomandibular disorder (TMD) is considered one of the most common musculoskeletal conditions that affect the masticatory system. The consequences of TMD include pain and functional limitations. Early diagnosis and proper management are important for avoiding chronic pain and permanent tissue damage. Our cross-sectional study aimed to evaluate the level of awareness and knowledge in terms of TMD examination and diagnosis, as well as treatment, among dental students, postgraduate students, and dental practitioners at Qassim University, Saudi Arabia. Methods: A cross-sectional study using a structured, validated online questionnaire was distributed to 98 participants. The eligible participants include fourth-year students (27.6%), postgraduate students (9.2%), fifth-year students (12.2%), interns (15.3%), and dental practitioners (35.7%). The survey investigated the general demographics and the 25 items classifying knowledge and awareness of TMD etiology, diagnosis, treatment, and prognosis. For comparing scores with respect to genders and their academic/professional statuses, non-parametric tests (Mann-Whitney U and Kruskal-Wallis tests)... Continue Reading

Background: Long-term corticosteroid use remains central to managing autoimmune blistering diseases (AIBDs) but carries substantial toxicity, prompting wider use of steroid-sparing agents ranging from conventional immunosuppressants to biologics. Comparative evidence on the efficacy and safety of these agents remains heterogeneous. Methods: We systematically searched PubMed, Web of Science, and Scopus for studies published from 2015 to 2025 evaluating steroid-sparing therapies in pemphigus and bullous pemphigoid. After duplicate removal and two-reviewer screening against predefined eligibility criteria, nine studies totaling 396 patients (randomized trials, prospective comparisons, and retrospective cohorts) were included. Methodological quality was appraised using ROBINS-I for non-randomized studies and Cochrane RoB2 for randomized trials. Results: Rituximab (RTX) was associated with higher long-term remission and faster corticosteroid tapering than conventional immunosuppressants, but with a higher rate of serious adverse events (approximately 15% to 22% vs. 10% to 15%). Short-term dexamethasone-cyclophosphamide pulse therapy performed comparably to RTX in some studies, though its... Continue Reading

Background: Aspirin has traditionally been the standard antiplatelet therapy after discontinuation of dual antiplatelet therapy following percutaneous coronary intervention. However, emerging evidence suggests that clopidogrel may offer comparable or potentially better outcomes. This study compared the efficacy and safety of aspirin versus clopidogrel monotherapy in patients with coronary artery disease. Methods: We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251101793). PubMed, Google Scholar, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials and observational studies comparing aspirin with clopidogrel monotherapy after dual antiplatelet therapy. Outcomes included myocardial infarction, stroke, major and minor bleeding, cardiovascular mortality, revascularization, and stent thrombosis. Risk ratios with 95% confidence intervals were pooled using a random-effects model. Results: Seven studies involving more than 15,000 patients were... Continue Reading

Background: Stroke is a leading cause of mortality and long-term disability, and poor glycemic control may influence recurrence and clinical outcomes. This study compared HbA1c levels among patients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA), and examined their associations with risk factor burden and in-hospital survival. Methods: This retrospective cohort study included 903 patients diagnosed with stroke at King Fahad Specialist Hospital, Qassim, Saudi Arabia, between 2018 and 2025. Demographic and clinical data were extracted from electronic medical records and analyzed using SPSS version 27. Results: Of the 903 patients, 715 (79.2%) had ischemic stroke, 80 (8.9%) hemorrhagic stroke, and 108 (12.0%) TIA. Overall, 503 (55.7%) had HbA1c ≥6.5%. Mean HbA1c was highest in ischemic stroke (7.59 ± 2.32%), followed by hemorrhagic stroke (7.25 ± 1.86%) and TIA (7.12 ± 1.89%), although the difference was not significant (p = 0.068). HbA1c correlated positively with risk factor burden... Continue Reading

Background: Hip fractures in patients with dementia or cognitive impairment are associated with increased morbidity, mortality, complications, and functional decline. Arthroplasty is generally preferred to internal fixation in older adults with a displaced femoral neck fracture, but the optimal strategy in this population remains uncertain because of frailty, limited rehabilitation potential, and the frequent exclusion of patients with dementia from comparative trials. We compared the outcomes of internal fixation and arthroplasty after hip fracture surgery in patients with dementia or cognitive impairment. Methods: PubMed/MEDLINE, Web of Science, and Google Scholar were searched from inception to July 2026 for comparative studies of internal fixation (IF), hemiarthroplasty (HA), or total hip arthroplasty (THA) in patients with dementia or cognitive impairment who sustained a hip fracture. Randomized, quasi-randomized, and observational studies were eligible. Studies comparing two arthroplasty constructs were analysed separately from internal fixation versus arthroplasty comparisons. Dichotomous outcomes were pooled as risk... Continue Reading

Community-acquired pneumonia (CAP) remains the primary cause of infectious mortality worldwide. Bedside severity scores (CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65) and the Pneumonia Severity Index [PSI]) provide static triage risk but lack dynamic sensitivity to progressive clinical deterioration. We synthesized evidence on the prognostic accuracy of the neutrophil-to-lymphocyte ratio (NLR) across adult CAP cohorts. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, four databases were searched for adult CAP cohorts reporting NLR-associated outcomes. Area under the curve (AUC) values were descriptively summarized across heterogeneous thresholds, and a random-effects meta-analysis of complete dichotomous mortality data was performed with pre-specified sensitivity analyses. A total of 19 adult cohorts (N = 19,188) were included. Across 14 studies reporting discriminative accuracy, NLR demonstrated moderate prognostic discrimination (descriptive mean AUC 0.736 ± 0.107, range 0.570-0.940). Across the 12 composite models, adding NLR yielded a descriptive mean AUC gain of... Continue Reading

The long-term comparative outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) remain disputed. We performed a random-effects meta-analysis of 25 randomized controlled trials (18,729 patients) comparing on-pump versus off-pump CABG, searching MEDLINE/PubMed, Cochrane CENTRAL, Web of Science, ProQuest, ClinicalTrials.gov, Scopus, and grey literature through 7 June 2025. Outcomes (repeat revascularization, late myocardial infarction, stroke/TIA, late mortality, major adverse cardiovascular events [MACE], and composite endpoints) were pooled as hazard ratios (HR) with 95% confidence intervals (CI), expressed as on-pump versus off-pump. On-pump CABG significantly reduced late myocardial infarction (HR 0.58; p = 0.01). Off-pump CABG was associated with significantly lower MACE (HR 1.62; p = 0.003), with the greatest benefit at 5–10 years (HR 2.18; p < 0.00001) and persisting beyond 10 years (HR 1.89; p = 0.03), and with a lower composite-endpoint risk (HR 1.24; p = 0.04). No significant differences were found for late mortality, repeat revascularization, or stroke/TIA. Risk of bias was moderate to high, and the... Continue Reading

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes severe postoperative pain; thoracic epidural analgesia is recommended, but the optimal epidural bupivacaine concentration has not been studied in this setting. We compared 0.25% and 0.125% epidural bupivacaine after CRS + HIPEC. Methodology: This retrospective cohort study included 77 adults who underwent CRS + HIPEC at a tertiary care center between January 2017 and December 2021. All received epidural fentanyl 2 mcg/ml with 0.125% (n = 59) or 0.25% (n = 18) bupivacaine (non-randomized). Pain severity was categorized from visual analog scale assessments. Secondary outcomes were sensory block level, supplementary intravenous (IV) analgesia, patient-controlled analgesia (PCA), and adverse effects. Groups were compared using Fisher’s exact or Fisher–Freeman–Halton exact tests. Results: Mild pain occurred in 11/18 patients (61.1%) receiving 0.25% and 19/59 (32.2%) receiving 0.125% bupivacaine (exploratory risk difference 28.9 percentage points; 95% confidence interval 3.1–50.3), moderate pain in 7 (38.9%)... Continue Reading

Icotrokinra (JNJ-2113) is a first-in-class targeted oral peptide that selectively binds to the interleukin-23 (IL-23) receptor and blocks IL-23 signaling. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of Icotrokinra to assess its efficacy and safety versus control in moderate-to-severe plaque psoriasis. We performed a PRISMA-adherent systematic literature search across Scopus, PubMed, and Web of Science from their inception up to January 2026. Screening, data extraction, and risk of bias assessment were made by two independent authors. A meta-analysis was conducted in R with sensitivity and subgroup analyses. We included four studies comprising five RCTs. Oral icotrokinra significantly improved physician-assessed and psoriasis area and severity index (PASI) responses compared with control in RCTs. For Investigator’s Global Assessment (IGA) 0/1, benefit was evident by week 2 (risk ratios (RR) = 3.24%, 95% confidence interval (CI) 1.01–10.46) and remained consistent through week 16 (RR = 7.35%, 95% CI... Continue Reading

Background: Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition that can lead to long-term morbidity if not detected early. This study assessed knowledge, awareness, and perceptions of DDH among medical students in Madinah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted among a convenience sample of 319 medical students from the second to sixth academic years using a self-administered online questionnaire. Knowledge was scored out of 16 and categorized as good, moderate, or poor. Associations were analyzed using chi-square or Fisher’s exact, Mann–Whitney U, and Kruskal–Wallis tests (p < 0.05). Results: More than half of the participants (50.8%) had poor knowledge, and 30.1% had good knowledge (mean score 7.52 ± 5.28 out of 16). Although 53.6% were familiar with DDH, only 26.3% had encountered a case, and most rated their confidence ≤3 on a 5-point scale. Academic year and prior orthopedics/pediatrics training were associated with... Continue Reading

Background: Poor sleep and gastrointestinal symptoms are each common in the general population. Studies from Korea, Japan and Norway link the two conditions, but the mechanism remains unclear, and no data exist from an Arab population. Methods: This cross-sectional, community-based study surveyed adults aged 18 years and above in the Jazan region, Saudi Arabia. Sleep quality was measured with the Pittsburgh Sleep Quality Index, and gastrointestinal symptoms with the Gastrointestinal Symptom Rating Scale. Rome IV screening items and the PHQ-4 were also administered. Associations were tested by multivariable logistic regression. Results: Of 422 responses submitted, 416 were analysed. Poor sleep quality affected 88 participants (21.15%, 95% CI 17.50–25.33). Mean Gastrointestinal Symptom Rating Scale total score was 1.48 (SD 0.29). Each standard deviation increase in this score raised the adjusted odds of poor sleep by 84% (OR 1.84, 95% CI 1.35–2.50, p<.001). Abdominal pain carried the strongest cluster association (OR 1.79), not reflux (OR... Continue Reading

Background: Uncorrected refractive error remains a leading, preventable cause of visual impairment worldwide, yet adult-level data on spectacle and contact lens perceptions in Jazan are lacking. Methodology: A descriptive cross-sectional study surveyed adults aged 18 years and above in Jazan, Saudi Arabia, in 2026. A self-administered Arabic online questionnaire, covering sociodemographic and ocular characteristics, knowledge and misconceptions about spectacles and contact lenses, attitude toward spectacle use, and practices including spectacle use, eye examination and refractive intervention, was distributed through social media platforms. Data were analyzed in SPSS using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: 513 adults completed the survey. Mean age was 25.83±9.23 years; 62.4% were female. Composite knowledge score averaged 6.42±1.67 of 10; 26.1% scored good, 47.0% moderate, and 26.9% poor. Awareness of spectacles reached 95.5%, and 97.7% perceived a benefit. Current spectacle use was 43.1%, annual eye examination 36.5%, and refractive-intervention interest 29.6%. Contact lens... Continue Reading