The corona virus disease of 2019 (COVID-19) pandemic has vastly impacted individuals worldwide. Millions have contracted the disease thus far; however, the ramifications of containment measures such as quarantine and lockdown have affected many more. This study aimed to explore the prevalence of self-reported anxiety and depression among a cohort of Saudi medical students, as well as graduating medical students’ concerns, during this pandemic. This cross-sectional study utilized an online survey that collected demographic data, scores on validated anxiety, and depression scales, as well as the graduates’ concerns. The Generalized Anxiety Disorder 7-item (GAD-7) and the Public Health Questionnaire 9-item (PHQ-9) scales were used. Cutoff scores for anxiety symptoms were (GAD-7 ≥ 8) and for depression (PHQ-9 ≥ 10). Out of 83 graduates, 55 completed the online survey. Anxiety symptoms were present in 34%, depression was present in 26%, and 19% had both depression and anxiety symptoms. Female graduates experienced higher anxiety symptoms (54 vs. 15%, p = 0.004 ). The highest-ranked concerns were the possible effect of the pandemic on the forthcoming internship year and on the impact on the current academic course. We found high levels of anxiety and depression symptoms during the pandemic among our cohort of medical students in their final year of study. Our findings suggest that medical students in their final years may be negatively affected by the pandemic, where high levels of depression and anxiety coincide with concerns about the effect of the pandemic on the next phase of their vocation.

Surfactant protein D (SP-D) is an important component of pulmonary innate immunity. It is mainly produced by type 2 alveolar and bronchial epithelial cells, but is also found in extra pulmonary tissues and blood. It acts as a primary host defense against inhaled microorganisms. It also enhances adaptive immunity by activating T cells. SP-D deficiency can lead to upper and lower respiratory tract infections. Obesity has reached global epidemic proportions in both adults and children and is associated with numerous co-morbidities and insulin resistance. Type 2 diabetes & obesity are highly associated with recurrent pulmonary & extra pulmonary infections. The primary objective of this study was to determine the association of serum surfactant protein D levels with obesity and type 2 diabetes mellitus.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha’il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants’ files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.

Background Systemic juvenile idiopathic arthritis (sJIA) is a diagnosis of exclusion. The complex nature and clinical variety of the disease, as well as the vast clinical variation of disease presentation, may lead to difficulties in disease detection and subsequent delays in treatment. Aim To provide a consensus guidance on the management of newly diagnosed sJIA patients among pediatric rheumatologists in Arab countries. Methods This work was conducted in two phases. The first phase utilized an electronic survey sent through an email invitation to all pediatric rheumatologists in Arab countries. In the second phase, a Task Force of ten expert pediatric rheumatologists from Arab countries met through a series of virtual meetings. Results obtained in phase one were prioritized using a nominal group and Delphi-like techniques in phase two. Results Seven overarching principles and a set of recommendations were approved by the Task Force to form the final consensus. Conclusion This is the first consensus on a clinical approach for pediatric rheumatic diseases among Arab pediatric rheumatologists. It is presented as a guidance on the clinical approach to sJIA that requires further evidence, and future updates are anticipated.

A substantial number of COVID-19 survivors describe ongoing symptoms long after the acute phase. This so-called post-COVID-19 syndrome or long COVID occurs irrespective of initial disease severity. Objectives: This cross-sectional study aims to describe and characterise the prevalence of persistent COVID-19 symptoms beyond three months and to evaluate the risk factors for the delayed return to the usual state of health. Methods: An electronic survey was developed, piloted, and conducted during the first wave of the COVID-19 pandemic. The survey consisted of questions exploring socio-demographic data, comorbidities, COVID-19 disease (diagnosis, presenting symptoms, management, and persistent symptoms), and the return to the usual state of health. Participants were users of social media platforms. We received results from 746 respondents. One hundred thirty-six responses were excluded due to a self-diagnosis of COVID-19. Respondents reporting a COVID-19 diagnosis 3 months or more prior to the study (N = 213) were included in the analysis. Predictors of the delayed return to the usual state of health were identified by logistic regression. Results: Three months or more after a COVID-19 diagnosis, almost half of the respondents, 109 (51.2%), had residual symptoms. The five most prevalent persistent symptoms were fatigue (13.6%), altered sense of smell (12.7%), muscle aches (10.3%), headache (9.9%), and body aches (8.5%). When questioned regarding the return to baseline health, 152 (71.4%) answered in the affirmative. The total number of chronic medical conditions was determined as a statistically significant predictor for the delayed return to the usual state of health. Conclusion: Three months or more after acute COVID-19 infection, 5 out of 10 survivors experienced persistent symptoms, and 3 out of 10 reported a delayed return to baseline health. Considering the overall burden of COVID-19 disease, this can pose health and socio-economic challenges. Therefore, health systems need support in managing long COVID and improving long-term COVID-19 outcomes.

Background: Breast-feeding practice is one of the main determinants that influence Infant Mortality Rate (IMR). To adopt this practice, mothers’ attitude plays a pivotal role. Attitude depends upon socio-cultural and economical factors. Objective: To assess factors affecting the attitude of primigravida towards Breastfeeding in Ha’il City, Kingdom of Saudi Arabia. Method: In this cross-sectional study, 156 primigravida were recruited by using predefined inclusion and exclusion criteria. Data was collected by awell-structured, closed-ended questionnaire. Results: Majority (51.3%) of our respondents were working ladies (employed, labor, self-employed), and had a high educational level (40.3%). More than half (54.5%) of the primigravida were willing to breastfeed their newborns. Thirty percent of respondents had the intention to practice exclusive breast feeding until 6 months. Majority (43.6%) hadplanned to give mixed feed as a large percentage, considered breast-feeding practices embarrassing and old fashioned. Higher educational level was significantly associated with; number of antenatal visits (according to the prescribed schedule), willingness to breastfeed after resuming the job, right time to have the 1st antenatal visit and willingness to continue exclusive breast feeding until 6 months of the newborn’s age. Although 90% of respondents were breast fed by their own mothers but there was a highly significant association (p≤0.001) of willingness to breastfeed newborns in those respondents whose mother in law breast-fed. Conclusion: Education is found as a main determinant that affects the attitude of primigravida towards breastfeeding. Other variable that influences attitude is the attitude of surrounding people regarding breast-feeding practices. Hence, it is recommended that health education programs on breastfeeding should be incorporated in female adolescent education programs, which will result in the building up of a positive attitude of future mothers towards breastfeeding practices. Keywords: Attitude, Primigravida, Breast-Feeding

In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study’s parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35–39.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.

Human immunodeficiency virus (HIV) infection is associated with a myriad of musculoskeletal manifestations. Inflammatory arthritis has been described in association with HIV in both adults and children. Biologic disease‐modifying anti‐rheumatic drugs, particularly tumor necrosis factor inhibitors (TNFi), have been reported to manage inflammatory arthritis in adults with HIV when conventional therapy fails to control arthritis. In this report, we describe the management of arthritis and enthesitis in a 12‐year‐old adolescent male with HIV using the TNFi adalimumab. At the time of presentation, the patient was on highly active antiretroviral therapy for 1 year. His viral load was <40 copies/mL, and the CD4+ T‐cell count was 1280 cells/mm3. He had a positive antinuclear antibody and HLA‐B27. Rheumatoid factor was negative. After screening for hepatitis B and C and latent tuberculosis, the patient was started on adalimumab. This report describes the successful control of recalcitrant arthritis and enthesitis in a pediatric patient with HIV infection using adalimumab.