Background: Restless Legs Syndrome (RLS) is a common but underdiagnosed neurological disorder that negatively affects sleep quality, mood, cardiovascular health, and quality of life. Aim: This systematic review and meta-analysis aimed to estimate the pooled prevalence of RLS among adults in Saudi Arabia and explore variation across population subgroups.

Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Ovid databases up to October 2025. Observational studies that reported RLS prevalence among adults (≥ 16 years) were considered. The pooled prevalence was calculated using a random-effects model (DerSimonian–Laird method), with heterogeneity assessed by the I² statistic and subgroup analyses conducted by population type and diagnostic criteria.

Results: Twenty studies with a total of 22,383 participants were included.The pooled prevalence of RLS in the general adult population of Saudi Arabia was 12.13% (95% CI, 8.13-16.79%) with high heterogeneity (I² = 98.3%). Subgroup analyses revealed markedly higher prevalence rates in specific clinical groups: 26% among patients with chronic conditions, 26% in pregnant women, and 18% among students. Studies using the International RLS Study Group criteria reported a pooled prevalence of 22%. Heterogeneity persisted within subgroups.

Conclusion: RLS is relatively common among adults in Saudi Arabia, particularly among highrisk and pregnant populations. These findings highlight the need for increased awareness, standardized screening, and further research to improve diagnosis and management of RLS across the Kingdom.

Background and Aim: Thyroid cancer incidence has been increasing in Saudi Arabia, with variation by age and sex. This study aimed to evaluate the association of age and sex with clinicopathologic characteristics and outcomes of thyroid cancer.

Methods: We conducted a retrospective medical record review of adult patients with confirmed thyroid cancer diagnosed and/or treated at King Abdulaziz University Hospital, Jeddah, between January 2010 and December 2023. Demographic data, tumour characteristics, treatment, and outcomes were extracted. Statistical analyses were performed using SPSS version 26.

Results: Among 331 patients, papillary carcinoma was the most common histologic subtype. Older age at diagnosis was associated with more advanced stage, larger tumour size, and documented distant metastasis. Male patients were older at diagnosis and had larger tumours, and sex was associated with lymph node metastasis and invasion of adjacent structures.

Conclusion: In this single-center retrospective cohort, age and sex were associated with thyroid cancer characteristics and selected outcomes. These findings support considering age and sex when interpreting disease extent and planning follow-up, while recognizing the limitations of retrospective observational data.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome resulting from uncontrolled activation of cytotoxic T cells and macrophages. It often mimics sepsis, severe viral infections, or autoimmune hepatitis, leading to delayed diagnosis. While primary HLH arises from genetic defects in cytotoxic function and typically manifests in childhood, most adult cases are secondary, triggered by infection, malignancy, or autoimmune disease. Acute liver failure (ALF) as the predominant presentation of HLH is rare and diagnostically challenging, particularly when no clear trigger is identified.

Case summary: We describe a 24-year-old previously healthy Saudi woman with no significant past medical history, who presented with a monthlong history of fever, jaundice, dark urine, and right upper quadrant abdominal pain. Laboratory evaluation revealed acute fulminant liver failure with coagulopathy, bicytopenia (Hb 9.0 g/dL, platelets 54 × 10⁹/L), and extreme hyperferritinemia (>33,511 µg/L).Despite extensive evaluation, infectious, autoimmune, and metabolic causes were excluded. Her neurological status deteriorated, with EEG showing subclinical status epilepticus, requiring ICU admission and intubation. The H-Score was 259, indicating >99% probability of HLH, and bone marrow biopsy confirmed hemophagocytosis. She was treated with Emapalumab (anti–IFN-γ), intravenous immunoglobulin, and corticosteroids. Despite therapy, her condition progressed to multiorgan failure, and she died after 22 days of admission.

Conclusion: This case illustrates an unusual presentation of secondary HLH manifesting as acute liver failure, without an identifiable trigger. We highlight the importance of early consideration of HLH in adults with unexplained ALF and hyperferritinemia, as delayed diagnosis may preclude life-saving immunotherapy.

Background: Shewanella algae is a halophilic, oxidase-positive, non-fermenting Gram-negative bacillus distributed in marine and other aquatic environments. It is an uncommon opportunistic human pathogen, most often causing skin and soft-tissue infection, hepatobiliary infection, and bacteremia, and is classically associated with marine or estuarine exposure. Respiratory involvement is rare.

Case Presentation:

A 67-year-old man with primary Sjögren syndrome maintained on long-term hydroxychloroquine and prednisolone, and usual interstitial pneumonia (UIP)-pattern interstitial lung disease, presented with a one-day history of productive cough, fever to 39 °C, rigors, and fatigue. He was febrile, tachycardic, tachypneic, and hypotensive, requiring 1 L/min of supplemental oxygen. Investigations showed a neutrophilic leukocytosis (white cell count 16.10 ×10⁹/L), C-reactive protein 89.90 mg/L, and procalcitonin 1.08 ng/mL. CT pulmonary angiography excluded pulmonary embolism and demonstrated new bilateral lower-lobe consolidation and ground-glass opacity superimposed on known interstitial lung disease. A multiplex respiratory panel detected parainfluenza virus 3 (PIV-3). Blood cultures grew Shewanella algae, which was resistant to meropenem, intermediate to piperacillin-tazobactam, and susceptible to ceftazidime, ciprofloxacin, and trimethoprim-sulfamethoxazole. A directed exposure history, obtained only after the organism was identified, revealed recent swimming in an inland sulfur-rich spring near Al-Kharj, Saudi Arabia. Empirical ceftriaxone and azithromycin were changed to intravenous piperacillin-tazobactam for 14 days, followed by oral trimethoprim-sulfamethoxazole for 14 days. The patient improved clinically, with resolution of the leukocytosis.

Conclusion:

S. algae should be considered in community-acquired pneumonia with bacteremia following recreational water exposure, including inland, non-marine sources such as sulfur springs. To our knowledge, this is the first report of S. algae respiratory infection and bacteremia occurring with concurrent PIV-3. In a host with structural lung disease and chronic immunomodulatory therapy, a targeted water-exposure history can point to the diagnosis, and the carbapenem resistance found here supports susceptibility-guided therapy.

Background: Insulinomatosis is a rare and underrecognized cause of endogenous hyperinsulinemic hypoglycemia (EHH) defined by multicentric insulinsecreting pancreatic neuroendocrine tumors (PanNETs) accompanied by diffuse neuroendocrine microadenomatosis. Neuroglycopenic manifestations of hypoglycemia frequently mimic primary neurological and psychiatric disorders, leading to substantial diagnostic delays that adversely affect patient outcomes.

Case Presentation: We report a 32-year-old woman who carried a diagnosis of refractory frontal lobe epilepsy for approximately one year before the true etiology was identified. Her recurrent episodes of hypermotor activity, emotional lability, and facial twitching had been attributed to frontal lobe seizures and managed with escalating doses of lamotrigine. The pivotal diagnostic clue emerged when a seizure was documented in association with hypoglycemia (glucose 40–50 mg/dL; 2.2–2.8 mmol/L), prompting continuous glucose monitoring that confirmed recurrent hypoglycemic episodes. A supervised 72-hour fasting test established endogenous hyperinsulinemic hypoglycemia, with inappropriately elevated insulin (66 pmol/L), C-peptide (0.90 nmol/L), and markedly elevated proinsulin (36.01 pmol/L). Contrast-enhanced computed tomography and endoscopic ultrasound identified a dominant lesion in the pancreatic head; however, Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT) revealed at least four somatostatin receptor–avid lesions distributed across the head, body, and tail of the pancreas. The patient underwent A Whipple procedure (pancreaticoduodenectomy) with enucleation and resection of additional pancreatic lesions. Final histopathology demonstrated multiple well-differentiated PanNETs of variable sizes with neuroendocrine microadenomatosis throughout the pancreatic parenchyma, consistent with insulinomatosis. Multiple endocrine neoplasia type 1 (MEN1) was excluded on biochemical screening. Postoperatively, hypoglycemia resolved completely and antiseizure medication was discontinued.

Conclusion: This case underscores the critical importance of excluding hypoglycemia in patients presenting with atypical or drug-resistant seizures and highlights insulinomatosis as a rare yet clinically significant differential diagnosis. Early recognition of Whipple's triad, coupled with the strategic use of functional imaging such as Ga-68 DOTATATE PET/CT, is essential for guiding timely and definitive surgical management to achieve biochemical cure.

Background:   In family medicine, point-of-care ultrasound (POCUS) is fast becoming an indispensable tool for both diagnosis and procedure. By providing focused bedside imaging that complements the history and physical examination, it enables clinicians to form a more complete clinical picture. Its adoption in primary care has been driven by advances in portable technology, the expansion of residency training, and a growing evidence base supporting clinician-performed ultrasound. However, the existing evidence remains fragmented across the domains of clinical application, education, governance, and emerging technology. We set out to review the current literature to establish where POCUS stands in family medicine and what supports its integration into day-to-day practice.

Methods:

We conducted a narrative review of the literature. We searched PubMed using six complementary thematic strategies spanning clinical applications, education, training, quality assurance, and emerging technology. Consistent with a narrative review, studies were selected purposively for their relevance to these themes rather than through an exhaustive search. Peer-reviewed studies were screened against predefined relevance criteria, and key data were extracted using a structured template. Given the methodological heterogeneity of the included studies, the findings were synthesised narratively.

Results:

The literature indicates that POCUS is being adopted across a broad range of indications in family medicine, including musculoskeletal, abdominal, cardiovascular, and respiratory assessment, as well as vascular access, preventive screening, and office-based procedures. Across studies, POCUS was consistently associated with improved bedside assessment and greater procedural accuracy, supporting more confident clinical decision-making. Successful implementation, however, depends on more than equipment: the evidence highlights the need for structured, competency-based education with supervised training, institutional support, and sustainable reimbursement models. Emerging innovations — including handheld devices, tele-ultrasound, artificial intelligence for image interpretation, and digital learning — may further support the use of POCUS in primary care.

Conclusion:

Contemporary evidence supports POCUS as an increasingly valuable component of comprehensive family medicine practice. However, sustainable integration requires more than access to technology; it depends on coordinated investment in physician education, clinical governance, and supportive health policy. Future research should prioritise economic evaluation, patient-centred outcomes, and the validation of emerging technologies to support the safe and equitable expansion of POCUS in primary care.

Minimally invasive fixation is used to reduce surgical disruption of the soft-tissue envelope around ankle and distal-tibial fractures. This narrative review examines distal-fibular minimally invasive plate osteosynthesis, distal-tibial minimally invasive plate osteosynthesis and fibular intramedullary nailing, with intra-articular pilon fractures considered separately from extra-articular metaphyseal injuries.

Minimally invasive surgery is not a single intervention. The reviewed evidence supports lower wound morbidity with some fibular-nail and limited-plating protocols, but it does not establish general functional equivalence or superiority. Existing syntheses overlap in their primary studies and combine different devices and patient groups. Distinct healing, reduction and reoperation endpoints should remain separate.

Limited exposure increases the importance of confirming length, coronal and sagittal alignment, axial rotation and syndesmotic position. The reviewed distal-tibial evidence does not define a safe malrotation threshold. Conventional radiography and fluoroscopy can miss syndesmotic displacement, while CT classification is itself sensitive to landmarks, thresholds and side-to-side variation. The association between syndesmotic malreduction and function remains unresolved.

The average short-term wound-infection risk after ankle ORIF is low, so the soft-tissue rationale for minimally invasive fixation is strongest in selected patients with compromised tissue or medical risk. Direct comparative evidence in these high-risk groups remains limited. Technique selection should be based on fracture morphology, soft-tissue condition and the ability to obtain and verify reduction. Future trials should use contemporary implants, preserve randomized allocation in analysis, separate fracture populations and report prespecified functional, radiological and complication outcomes. Multicentre comparative research should document technical failures, crossovers, conversions to open fixation and surgeon experience.

Food allergy is one of the more common chronic immune-mediated disorders of early childhood, and clinical advice about it has changed markedly over the past decade. Guidance that once favoured delaying allergenic foods now favours introducing them during infancy, a shift that rests on a small number of randomised trials whose main findings have held up under long-term follow-up and pooled analysis. Here we set out what that evidence supports and where it remains thin. The strongest case is for early introduction of peanut and of cooked egg, which produced large reductions in relative risk among infants at high risk, with protection extending into adolescence in the peanut trials; in unselected populations the effect is smaller and depends heavily on adherence. Evidence for the measures usually grouped with early introduction is weaker and more uneven. Breastfeeding aids gastrointestinal and immune maturation but has not been shown, on its own, to prevent IgE-mediated food allergy, and restricting the maternal diet in pregnancy or lactation confers no benefit. Emollient-based skin barrier interventions did not prevent eczema in two large trials, and pooled analysis raises the possibility that they increase, rather than reduce, food allergy and skin infection. Routine probiotic or prebiotic supplementation is not supported for primary prevention. Many of the remaining difficulties are practical: guideline uptake is incomplete, counselling varies between providers, and the detail that determines whether introduction is done safely is often missing from summary advice. We consider these questions with attention to Saudi Arabia, where local data on primary prevention are scarce.

Background: Lemmel syndrome is an uncommon cause of obstructive jaundice due to a periampullary duodenal diverticulum. Its diagnosis can be challenging when the diverticulum mimics an ampullary mass.

Case Presentation:

A 77-year-old man presented with jaundice, anorexia, fever, chills, and right upper quadrant pain. Laboratory investigations showed a mixed cholestatic and hepatocellular pattern of liver injury with elevated inflammatory markers. Computed tomography (CT) demonstrated an enhancing polypoid lesion involving the ampulla, distal common bile duct dilatation with a filling defect read as a stone, mild pancreatic duct dilatation, and multiple large gallbladder stones, raising concern for an ampullary tumor and choledocholithiasis. Initial endoscopic retrograde cholangiopancreatography (ERCP) failed because the suspected mass obstructed access to the papilla. With recurrent fever, tachycardia, blood cultures positive for Gram-negative coccobacilli, and worsening inflammatory and cholestatic markers, percutaneous transhepatic biliary drainage was performed after limited improvement with cholecystostomy. A subsequent cholangiogram and cholangioscopy demonstrated a distal common bile duct outpouching without a stone. A dedicated repeat magnetic resonance cholangiopancreatography (MRCP) identified a non-enhancing, non-restricting periampullary cystic structure consistent with an inverted duodenal diverticulum, supporting the diagnosis of Lemmel syndrome. A subsequent rendezvous ERCP was successfully performed with common bile duct stent placement, and he was discharged in good condition.

Conclusion:

This case shows the diagnostic challenge of Lemmel syndrome when a periampullary diverticulum mimics malignancy on initial imaging, and the role of repeat dedicated imaging, cholangioscopy, percutaneous biliary drainage, and rendezvous ERCP when conventional ERCP is unsuccessful.

Background: Migraine is a common and disabling primary headache disorder. Evidence from Saudi Arabia includes national surveys and numerous population subgroups, but differences in sampling and case ascertainment complicate interpretation of prevalence, associated factors, and management outcomes.

Aim:

To synthesise evidence on the prevalence, risk factors, and management of migraine among adults living in Saudi Arabia.

Methods:

PubMed, Scopus, and Web of Science were searched for English-language primary studies published from 2016 to 10 July 2026. Findings were synthesised narratively because populations, diagnostic methods, and outcomes differed. Methodological limitations were assessed descriptively. Two reports with mixed adolescent–adult samples were separated from the adult-focused synthesis when adult-only findings could not be established.

Results:

Of 652 records, 25 reports were retained; 23 contributed to the adult-focused synthesis and two were retained only as mixed-age context. Two national reports analysed the same 2,316 participants. The population-based survey estimated an adjusted one-year migraine prevalence of 25.0%. Other estimates reflected different populations and measures and were not combined into a single prevalence range. Female sex and psychiatric symptoms were associated with migraine in several surveys, without establishing causal direction. Two retrospective onabotulinumtoxinA reports described reductions in headache frequency or disability, but lacked untreated comparison groups. Medication-overuse headache and reported analgesic use were associated with poorer migraine-related quality of life.

Conclusion:

Migraine places a substantial burden on adults living in Saudi Arabia. Population-based estimates should be distinguished from screening positivity and clinic or occupational proportions. Saudi observational treatment reports describe improvement but do not independently establish comparative effectiveness. Heterogeneous, predominantly cross-sectional primary studies limit the certainty of the synthesis.

Necrotizing pneumonia (NP) is a rare but severe complication of bacterial pneumonia that is associated with high morbidity and mortality. It is characterized by lung parenchymal destruction and cavitation. Although uncommon in patients with sickle cell disease (SCD), it can progress rapidly when it occurs. We report a case of a young female with SCD who initially presented with acute chest syndrome (ACS) and pleural effusion. Despite the use of broad-spectrum antibiotics and an exchange transfusion, her symptoms worsened, which made clinical decisions more challenging. However, after correct diagnosis, she responded well to prolonged antibiotic therapy along with surgical care. This case highlights the importance of early recognition of NP, which can develop in SCD patients while resembling other potential diagnoses related to ACS. Delayed diagnosis may lead to significant complications. Imaging, aggressive medical therapy, and close monitoring are essential to improve outcomes.

Introduction:

Osteoarthritis is the most common type of arthritis. It is characterized by degenerative changes in the articular cartilage and other joint tissues, with variable synovial inflammation. Its prevalence is rising worldwide, and an estimated 528 million people were affected in 2019.

Methods:

A descriptive cross-sectional study was conducted among residents of Bisha aged 18 years or older. Data were collected with an Arabic, self-administered online questionnaire using convenience sampling. A total of 442 respondents took part. Statistical analysis was performed with SPSS version 26.

Results:

Cartilage degeneration was identified as the mechanism of osteoarthritis by 47.5% of respondents, while 52.5% chose another response or were unsure. Osteoarthritis was recognized as a chronic disease by 62.0%, and 64.7% recognized that it is not rare. Knowledge of symptoms varied: 48.4% knew that joint pain is not the only symptom and 64.9% were aware that osteoarthritis can reduce joint mobility. For risk factors, 30.8% did not know whether genetics contributes, 74.4% recognized aging as a contributor, and 48.0% correctly rejected equal prevalence in males and females. For diagnosis, 58.8% stated that physical examination and X-rays are used. No statistically significant association was found between knowledge category and sex (p = 0.615), age (p = 0.522) or education level (p = 0.839).

Conclusion:

Respondents showed substantial gaps and misconceptions in their knowledge of osteoarthritis. Many understood that the disease is chronic, but misunderstandings about its causes, risk factors and diagnostic methods persisted.

Background:

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by fever, arthritis, and hyperferritinemia. It may be complicated by macrophage activation syndrome (MAS), a life-threatening hyperinflammatory state that can mimic severe sepsis, especially in the presence of concurrent infection. Early recognition is critical but often challenging.

Case Presentation:

We report a 22-year-old previously healthy female who presented with a five-month history of quotidian fever, significant weight loss, and inflammatory polyarthritis. Her clinical course was complicated by septic shock in the setting of confirmed Clostridioides difficile colitis. Extensive workup excluded infectious, malignant, and autoimmune etiologies. Laboratory findings revealed extreme hyperferritinemia (peaking >33,511 ng/mL), progressive cytopenias, hypertriglyceridemia, hypofibrinogenemia, and elevated soluble IL-2 receptor levels, consistent with MAS/secondary hemophagocytic lymphohistiocytosis. The diagnosis of AOSD was established using Yamaguchi criteria. Despite initial management for sepsis, persistent fevers and worsening laboratory parameters prompted escalation to pulse-dose corticosteroids, anakinra, and intravenous immunoglobulin. The patient demonstrated significant clinical and biochemical improvement, was transitioned to tocilizumab for maintenance therapy, and was discharged in stable condition.

Conclusion:

This case highlights the diagnostic complexity of AOSD complicated by MAS in the setting of concurrent infection. Extreme hyperferritinemia, evolving cytopenias, and lack of response to antimicrobial therapy should prompt consideration of MAS. Early recognition and timely initiation of immunomodulatory therapy are crucial for improving outcomes in this potentially fatal condition.

Introduction: Total Knee Replacement (TKR) is a surgical intervention that is widely accepted for the management of severe knee joint conditions such as osteoarthritis, joint deterioration, and deformities. Despite the growing prevalence, community-level awareness of its benefits and associated risks remains unclear in many regions in Saudi Arabia, including Bisha city.

Methods: Data were collected using a structured questionnaire distributed through social media (WhatsApp) and statistically analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive statistics were generated using mean, standard deviation and frequency tables. Data were presented in percentages (%) and depicted in charts, graphs and tables. Analysis to determine knowledge levels, perceptions of benefits and risks, and demographic influences was performed, and associations between socio-demographic characteristics and knowledge scores were explored.

Results: Among the total of 441 respondents, awareness of Total Knee Replacement (TKR) surgery was moderate, with 73% having heard of the procedure and 54.4% describing themselves as somewhat knowledgeable. Knee joint deterioration (64.6%) and knee injuries (44.9%) were the most cited conditions treated by TKR. Improved mobility (77.3%), improved quality of life (43.0%), and pain relief (42.9%) were the most recognized benefits, while long recovery time (48.8%) and surgical failure (46.7%) were the most cited risks. Family and friends (46.5%) and social media (34.2%) were the leading sources of information. A doctor’s recommendation (68.0%) was the main factor influencing the decision to undergo surgery. No statistically significant associations were found between socio-demographic factors and knowledge scores (p > 0.05).

Conclusion: Awareness of TKR surgery among the surveyed sample of Bisha residents is moderate, with notable gaps in understanding key risks and benefits. There is a clear reliance on informal sources of information. These findings highlight the need for targeted health education interventions and community-based awareness programs to improve public knowledge and informed decision-making regarding TKR.

We report a 98-year-old morbidly obese woman with severe iron deficiency anemia (hemoglobin 59 g/L) and multiple comorbidities who developed two consecutive severe anaphylactic reactions to ABO-compatible packed red blood cells, occurring within 10–30 minutes of transfusion and requiring intramuscular epinephrine. Serum IgA was normal, total IgE was elevated (444 IU/mL), and there was no biochemical evidence of hemolysis, supporting an IgE-mediated, non–IgA-related mechanism. Further transfusion was avoided. A transfusion-sparing strategy using intravenous ferric carboxymaltose combined with darbepoetin alfa normalized hemoglobin to 122 g/L within four weeks. This case shows that a normal serum IgA does not exclude an anaphylactic transfusion reaction and that high-dose intravenous iron with an erythropoiesis-stimulating agent is an effective, life-saving alternative in elderly, multi-morbid patients with transfusion hypersensitivity.

Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality globally and represent a major public health burden in Saudi Arabia. Awareness of both modifiable and genetic cardiovascular risk factors plays a crucial role in prevention and early risk reduction. This study aimed to assess knowledge of cardiovascular disease risk factors and genetic risk awareness among adults in Riyadh, Saudi Arabia.

Methods:

A cross-sectional study was conducted using an online questionnaire distributed via Google Forms between November and December 2025 among adults aged ≥18 years residing in Riyadh, Saudi Arabia. The questionnaire collected data on sociodemographic characteristics, family history, knowledge of cardiovascular risk factors, and awareness of genetic susceptibility. Data were analyzed using descriptive statistics, and associations were evaluated using the Pearson chi-square test (or Fisher's exact test, where appropriate). Statistical significance was set at p < 0.05.

Results:

A total of 485 participants completed the study (49.5% aged 18–24 years, 56.3% female). Overall, 75.9% of respondents exhibited good knowledge (≥70%) regarding cardiovascular disease (CVD) risk factors. High awareness was observed for smoking (97.3%), obesity (92.6%), and hypertension (89.7%) as risk factors, whereas knowledge gaps were noted for the protective role of HDL cholesterol (62.9%) and excessive salt intake (62.7%). Most participants acknowledged genetic factors increased CVD risk (67.2%) and expressed interest in further genetic education (78.0%). Good knowledge was significantly higher among males compared to females (83.0% vs. 70.3%; p = 0.001) and among never smokers compared to current and former smokers (77.7% vs. 57.1% and 58.8%, respectively; p = 0.019). Knowledge levels did not differ significantly by age, education, occupation, income, physical activity, or family history of CVD (p > 0.05).

Conclusion:

The findings indicate that adults in Riyadh have good awareness of general cardiovascular disease risk factors, particularly lifestyle-related behaviors. However, important gaps remain in understanding metabolic risk factors, genetic susceptibility, and personal health risk assessment. The observed knowledge–action gap highlights the need for targeted public health interventions that emphasize individualized risk awareness, improved health literacy, and better integration of genetic and clinical risk communication within primary healthcare services.

Bone stress injuries of the lower extremity are among the most consequential overuse conditions in sports medicine and military occupational health, arising when repetitive submaximal loading outpaces bone's capacity to repair and adapt. This review draws together contemporary evidence on the epidemiology, risk factors, diagnosis, and management of these injuries in athletes and physically active populations, with emphasis on work published since 2021, together with foundational earlier literature. Biomechanical exposures are prominent: in a four-year cohort of 1,772 military cadets, each additional movement error on the Landing Error Scoring System raised stress fracture incidence by 15% (IRR 1.15; 95% CI, 1.02-1.31), while flat-footed and asymmetric landings carried more than twofold higher incidence. Foot structure contributes independently, with a higher arch and reduced toe-off angle distinguishing injured recruits. Energy availability, menstrual function, and vitamin D status form a second, modifiable domain: female runners with repeated injuries showed higher cumulative Triad risk and more restrictive eating, and 74% of military trainees with stress fractures were vitamin D insufficient or deficient. Magnetic resonance imaging is the diagnostic reference standard, and MRI grade predicts time to return to sport. Management follows the distinction between low-risk sites, which respond to activity modification, and high-risk sites, where delayed union and progression to complete fracture justify a more aggressive approach. Among professional basketball players, return-to-play time after high-risk fractures did not differ significantly between operative and nonoperative treatment. Screening that combines movement quality, energy availability, and vitamin D status offers a practical route to reducing injury burden.

Background: Crohn's disease (CD) and ulcerative colitis (UC) are the two main subtypes of inflammatory bowel disease (IBD) and are usually explored as a single entity, obscuring the specific sociodemographic and comorbidity patterns of each entity.

Aim: To explore and compare the sociodemographic and chronic comorbidity patterns of United States (US) adults with a self-reported diagnosis of CD versus UC.

Methods: This nationally representative, cross-sectional analysis utilized data from the 2023–2024 National Health Interview Survey (NHIS) on a total of 62,151 adults. The diagnosis of CD (n = 351) and UC (n = 861) was established by self-reported physician diagnosis and analyzed as two independent case groups, with each group compared against respondents without that diagnosis. Weighted chi-square and t-tests were utilized to compare sociodemographic and comorbidity profiles; univariate and multivariate regression analyses (adjusted for age, sex, body mass index, smoking status, and univariably significant comorbidities) were used to estimate crude and adjusted odds ratios (aOR) for 15 comorbidities.

Results: In our sample, individuals with a diagnosis of CD and UC were significantly older than their comparators (52.6 ± 17.8 years and 56.8 ± 17.3 years, respectively, both p < 0.001). In unadjusted analysis, UC was significantly associated with female sex. Worse self-rated health and a significantly higher unadjusted prevalence of most comorbidities examined were reported by both groups. After multivariate adjustment, CD remained independently associated with asthma (aOR 1.41), psoriasis (aOR 1.96), hepatitis (aOR 2.41), arthritis (aOR 1.59), and colorectal cancer (aOR 2.14). UC, on the other hand, remained independently associated with eight comorbidities, including stroke, angina, dyslipidemia, psoriasis, depression, anxiety, arthritis, and chronic obstructive pulmonary disease (aORs 1.25–2.50). Obesity showed an independent association with lower odds of UC after adjustment (aOR 0.77), whereas the association with female sex was no longer significant (aOR 1.14).

Conclusions: Both CD and UC showed a significant presence of chronic comorbidity, but their adjusted comorbidity profiles differed, with UC showing independent associations with more comorbidities than CD, although the two diseases were not compared directly. These findings support the importance of disease-specific approaches rather than combined ones in the screening of IBD patients.

Background: Tonsillitis is common and often viral; group A streptococcus (Streptococcus pyogenes) is its principal bacterial cause and the main reason to prescribe antibiotics. Saudi data on medical students' knowledge of it are lacking. We assessed perceived and actual knowledge of tonsillitis among undergraduate medical students at the University of Bisha, Saudi Arabia, and factors associated with awareness.

Methods: In a cross-sectional online survey (March–April 2025) of 320 consenting medical students recruited by convenience sampling, an adapted, pilot-tested questionnaire (Cronbach's alpha = 0.832) covered sociodemographic data, eleven self-rated (perceived) and five multiple-choice (actual) knowledge items; a score of at least 9 of 16 defined awareness. Associations were examined with chi-square or Fisher's exact tests and binary logistic regression (adjusted odds ratios [aOR] with 95% confidence intervals [CI]).

Results: In total, 204 students (63.8%) were classified as aware, and 93.1% agreed that the tonsils have a defensive immune role. Self-ratings exceeded test scores on three of four comparable topics: 61.9% said they knew the bacterial causes, but 45.0% identified S. pyogenes, and 62.5% said they knew the symptoms of streptococcal tonsillitis, but 43.4% recognized all of them. Only 46.9% agreed that tonsillitis is infectious. Awareness was associated with age (p = 0.004) and academic year (p = 0.041) but not significantly with gender (p = 0.057). After adjustment, age 24–28 years (aOR 4.84; 95% CI 1.54–15.26) and female gender (aOR 1.90; 95% CI 1.15–3.14) were independently associated with higher awareness and a monthly income of 5,000–10,000 Saudi riyals with lower awareness (aOR 0.36; 95% CI 0.14–0.94); academic year was not.

Conclusion: Students' self-rated knowledge of tonsillitis exceeded their tested knowledge on three of four topics, most clearly for its bacterial cause and the symptoms of streptococcal tonsillitis. Teaching should target these gaps, and knowledge should be tested with objective questions.

Background: Rotator cuff–related shoulder pain is among the most common problems in athletes whose sport demands repeated overhead loading. Rehabilitation is first-line care, yet clinicians have little guidance on how to sequence it or on when an athlete is ready to compete again.

Aim: To provide clinicians with a practical framework for assessing rotator cuff–related shoulder pain in the overhead athlete, staging rehabilitation and structuring the return-to-sport decision.

Methods: This clinical practice review draws on seven clinical studies of rehabilitation in overhead athletes and four guideline, consensus and narrative sources. Outcome values were extracted from the published tables of each study and compared with published minimal clinically important differences where these were available. The review is not systematic and does not aim for exhaustive coverage.

Results: Trials comparing exercise with no treatment or a weak comparator reported benefit. On patient-reported outcomes, no comparison between two active programmes produced a difference that was both statistically significant and larger than the published minimal clinically important difference: physio-yogic versus scapular recruitment exercise, p=0.180; scapular dyskinesis–based versus multimodal therapy, 5.98 points on the Shoulder Pain and Disability Index against published thresholds of 8 to 20.6 points; kinesiotaping added to rehabilitation versus rehabilitation alone, all differences below threshold. After arthroscopic supraspinatus repair in 17 Olympic volleyball athletes, all returned to their pre-injury level, at a mean of 6.9 months to sport and 12.4 months to performance. None of the 22 return-to-sport criteria drawn from current guideline and consensus sources is a validated threshold for the overhead shoulder.

Conclusion: Supervised, progressively loaded exercise appears to be the effective component of rehabilitation in these athletes, and no specific exercise programme has outperformed another credible programme on patient-reported outcomes. Clinicians are better served by a framework for sequencing and progressing rehabilitation, with explicit return-to-sport criteria, than by a fixed protocol.

Purpose: To describe uncorrected distance visual acuity over the first 6 months, and postoperative intermediate and near acuity, refraction, spectacle use, photic phenomena and satisfaction, after cataract surgery with an extended depth-of-focus (EDOF) intraocular lens (IOL).

Setting: Private eye centre, Dammam, Saudi Arabia.

Design: Retrospective single-centre case series.

Methods: Forty-five eyes of 25 patients (mean age 53.4 ± 9.6 years) underwent phacoemulsification with implantation of one of two EDOF IOLs (Bi-Flex ELON, Medicontur; Synthesis+, Cutting Edge) between August 2022 and September 2023. Uncorrected distance visual acuity (UDVA) was recorded before surgery and at 2 weeks and 1, 3 and 6 months. Intermediate and near acuity, binocular acuity, refraction, satisfaction, spectacle use and photic phenomena were recorded at one further postoperative assessment. Inferential analyses used the first operated eye of each patient (n = 25); results for all 45 eyes are descriptive.

Results: In first eyes, mean UDVA improved from 0.45 ± 0.23 to 0.07 ± 0.09 logMAR (change −0.38, 95% confidence interval [CI] −0.47 to −0.28; p < 0.001), and 85% of this change had occurred by 1 month. At 6 months, 73% of all eyes had UDVA of 20/25 or better. Uncorrected intermediate and near acuity were 20/25 or better in 67% and 76% of eyes (84% and 89% with distance correction). Postoperative spherical equivalent was −0.30 ± 0.72 D and was within ±0.50 D of emmetropia in 58% of eyes. Twenty-two of 25 patients (88%) reported needing no spectacles for daily activities, and 24 (96%) were fully or fairly satisfied with distance vision. Eleven patients (44%) reported at least one photic phenomenon, most often halos (28%). The eight eyes with previous radial keratotomy, vitrectomy or amblyopia had a mean 6-month UDVA of 0.23 logMAR, compared with 0.06 logMAR in the other 37 eyes.

Conclusions: After EDOF IOL implantation, about three quarters of eyes reached uncorrected acuity of 20/25 or better at distance and near, and most patients reported not needing spectacles. Photic phenomena were reported by 44% of patients. Without a control group, these outcomes cannot be attributed to the lens designs.

Background: Cervical spine injuries can result in permanent neurological impairment, and inappropriate first-aid management may aggravate spinal cord damage. Public recognition of these injuries and knowledge of safe initial responses are therefore essential for preventing secondary harm.

Aim: This study aimed to assess awareness, attitudes, and intended first-aid practices regarding cervical spine injuries among adults in Al-Ahsa, Saudi Arabia, and to identify the factors associated with these outcomes.

Methods: A cross-sectional survey was conducted among 389 adults residing in Al-Ahsa. Data were collected electronically using a structured questionnaire covering sociodemographic characteristics, awareness, attitudes, and intended first-aid practices. Descriptive statistics and multiple linear regression analyses were used to summarize participants’ responses and identify associated factors.

Results: The mean awareness score was 63.8%, and 60.4% of participants had good awareness (score ≥60%). The mean attitude and intended practice score was 87.7%, and 92.8% of participants had a positive score. The importance of early recognition in preventing complications was correctly identified by 84.1% of participants; however, only 39.3% recognized all listed complications. Most participants reported that they would maintain head, neck, and spinal alignment (94.3%), contact emergency services before initiating first aid (93.8%), and avoid unnecessary patient movement while seeking emergency assistance (93.6%). First-responder training was independently associated with higher awareness and more favorable attitude and intended practice scores (both P<0.001). Female gender was also independently associated with a higher attitude and intended practice score (P=0.001).

Conclusion: Participants reported highly positive intended first-aid responses, but important knowledge gaps remained, particularly regarding the complications of cervical spine injuries. Expanding structured, practical first-responder training may improve public knowledge and promote safer early management of suspected cervical spine injuries.

Introduction: Bowel ischemia is a time-sensitive vascular emergency that can cause intestinal necrosis and death when diagnosis and treatment are delayed. Public understanding of this condition in Saudi Arabia remains poorly characterized. This study assessed awareness and knowledge of bowel ischemia among adults in Al-Ahsa and identified factors associated with knowledge.

Methodology: This community-based cross-sectional study included 390 non-healthcare adults residing in Al-Ahsa. Data were collected electronically through an expert-reviewed, pilot-tested, self-administered questionnaire. Ten knowledge items generated a score of 0–10; scores below 6 represented poor knowledge. Multiple linear regression was used to identify associated factors.

Results: Only 43 participants (11.0%) had previously heard of bowel or intestinal ischemia. The mean knowledge score was 3.76 ± 3.56 out of 10, demonstrating poor knowledge. Healthcare professionals were the leading information source among aware participants (32.6%). The best-recognized concepts were the need for urgent assessment of sudden severe unexplained abdominal pain (mean item score = 0.57) and the benefit of early diagnosis and treatment (0.56). The least-recognized concepts were blood in the stool as a possible manifestation (0.25) and the definition of bowel ischemia (0.29). Previous awareness independently predicted a higher knowledge score (B = 4.332, p < 0.001); gender, age, and educational level were not significant predictors.

Conclusion: Adults in Al-Ahsa had limited awareness and important knowledge gaps regarding bowel ischemia. Clinician-led education delivered through trusted digital platforms should emphasize its definition, warning manifestations, risk factors, and need for urgent evaluation.