Objectives: Burnout syndrome is a condition that is well-documented globally among medical students and affects their academic performance due to high levels of associated stress and psychiatric morbidities. This study aimed to assess burnout prevalence and predictors along with its association with academic performance among medical students at Hail University, Saudi Arabia. Methods: A questionnaire-based cross-sectional survey of medical students was conducted between May and June 2019 at the Medical College at Hail University. The English version of the Maslach Burnout Inventory (MBI)-Student Survey was used to assess the three components of burnout syndrome— cynicism, emotional exhaustion and professional efficacy. A fixed-model multivariate logistic regression analysis was conducted for each of the three MBI components’ levels and for total burnout to identify factors significantly associated with burnout syndrome. Results: A total of 218 students were included in this study (response rate: 53.8%). The majority of participants were female (n = 121; 55.5%) medical students ranging between 21–24 years of age. High emotional exhaustion, high cynicism and low professional efficacy was found among 79.4%, 61.0%, and 37.6%, respectively, of respondents. The overall prevalence of high burnout was 27.1% (n = 59). Female students were at almost double the risk for high emotional exhaustion compared to male students (adjusted odds ratio [AOR] = 2.14, 95% confidence interval [CI]: 1.06–4.34; P = 0.034). Students with grade point averages (GPA; on a four-point scale) ranging between 3.51–4.0 were considerably less prone (83% less risk) to experience burnout as compared to students with a GPA ≤2.0 (AOR = 0.17, 95% CI = 0.03–0.91, P = 0.039). Conclusion: High levels of overall burnout were reported among Hail University medical students. Students with a higher GPA, however, were found to be less prone to burnout. Keywords: Burnout Syndrome; Medical Students; Fatigue; Stress; Saudi Arabia.

BackgroundIn recent years, the use of electronic devices has become an important part of the lives of adolescents who regularly use computers for academic activities and leisure. The excessive use of these devices has been associated with several health problems, such as obesity, headaches, anxiety, stress, sleep disorders, and musculoskeletal pain. This study aimed to assess the prevalence and awareness of musculoskeletal injuries associated with competitive video gaming in Saudi Arabia. MethodologyThis descriptive, cross-sectional study targeted all individuals involved in competitive video gaming aged 18 years or older in Saudi Arabia. The data were collected using a researcher-initiated online questionnaire. The final electronic questionnaire contained questions on participants' data, frequency and pattern of playing competitive video gaming, the associated musculoskeletal injuries, the most reported sites, and the associated consequences. The final questionnaire was sent to the participants via social media platforms and no more answers were obtained. ResultsA total of 116 competitive video gaming participants were included. Participants' ages ranged from 18 to 48 years, with a mean age of 22.5. The majority of the participants were males (86.2%; 100). A total of 100 (86.2%) participants had at least one site-associated musculoskeletal injury, while only 16 (13.8%) had none. Regarding sites, the most reported sites included the lower back (63.8%), neck (50%), hand/wrist (44.8%), and shoulder (35.3%). A total of 58 (50.4%) thought that competing in electronic game tournaments negatively affects the musculoskeletal system, and 43 (37.1%) had an idea that competing in electronic gaming tournaments is linked to conditions such as tendinopathy, carpal tunnel syndrome, and repetitive stress injuries. ConclusionsThis study showed that the majority of competitive video gamers had musculoskeletal injuries mainly at the lower back, neck, hand/ wrist, and shoulder. A higher pain rate was reported among females and new gamers.

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.

The devastating SARS-CoV2 pandemic is worsening with relapsing surges, emerging mutants, and increasing mortalities. Despite enormous efforts, it is not clear how SARS-CoV2 adapts and evolves in a clonal background. Laboratory research is hindered by high biosafety demands. However, the rapid sequence availability opened doors for bioinformatics. Using different bioinformatics programs, we investigated 6305 sequences for clonality, expressions strategies, and evolutionary dynamics. Results showed high nucleotide identity of 99.9% among SARS-CoV2 indicating clonal evolution and genome. High sequence identity and phylogenetic tree concordance were obtained with isolates from different regions. In any given tree topology, ~50% of isolates in a country formed country-specific sub-clusters. However, abundances of subtle overexpression strategies were found including transversions, signature-sequences and slippery-structures. Five different short tracks dominated with identical location patterns in all genomes where Slippery-4 AAGAA was the most abundant. Interestingly, transversion and transition substitutions mostly affected the same amino acid residues implying compensatory changes. To ensure these strategies were independent of sequence clonality, we simultaneously examined sequence homology indicators; tandem-repeats, restriction-site, and 3′UTR, 5′ UTR-caps and stem-loop locations in addition to stringent alignment parameters for 100% identity which all confirmed stability. Nevertheless, two rare events; a rearrangement in two SARS-CoV2 isolates against betacoronavirus ancestor and a polymorphism in S gene, were detected. Thus, we report on abundance of transversions, slippery sequences, and ON/OFF molecular structures, implying adaptive expressions had occurred, despite clonal evolution and genome stability. Furthermore, functional validation of the point mutations would provide insights into mechanisms of SARS-CoV2 virulence and adaptation.

Background One of the most essential goals in managing complex limb defects is obtaining adequate soft tissue coverage with excellent functional and aesthetic outcomes. Free perforator skin flaps represent an optimal option for such defects. Therefore, our intention was to reconstruct these kinds of defects with thin fasciocutaneous flaps without the need for debulking. Herein, we define the legitimate use of the medial sural artery perforator (MSAP) flaps for small-moderate size defect coverage of the hand and foot. Patients and Methods Seven patients received MSAP flaps for reconstruction of different hand and foot defects, of which the majority were males (4/7). Age, sex, flap size, location, number of perforators, recipient vessel, type of anastomosis, technique of donor site closure, and postoperative morbidity were recorded. Patients' age ranged from 48 to 84 years. Results Single-stage debridement followed by reconstruction was performed. Flap sizes ranged from 6 to 18 cm in length and 4 to 10 cm in width. The pedicles of 6 flaps were anastomosed to the tibial artery system (three posterior tibial artery, three dorsalis pedis artery) and one to the ulnar artery. Conclusion MSAP flap can be a versatile option for single-stage reconstruction of small-moderate size defects of the extremities, where thin, soft tissue envelope is required. This flap has lower donor site morbidity, more tedious elevation process, and has a good reconstructive and aesthetic result without the need for debulking in the future.