Riyadh Armed Forces Hospital

Background: Patients with latent tuberculosis infection are mainly asymptomatic, but they still carry a notable risk of developing active TB, particularly when the host becomes immunosuppressed. Hence, appropriate diagnosis and management for LTBI are essential. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are among the most commonly utilized methods for detecting LTBI. Until now, no agreement has been established regarding the most effective diagnostic test, either TST or IGRA, so our study aims to evaluate the diagnostic utility of TST versus IGRA in detecting LTBI. Methods: An extensive literature search was executed in several databases from inception till June 2024. We included all the available studies that compared TST versus IGRA concurrently applied to the same study participants, utilizing one of the following proxy reference standards: previous contact with a tuberculosis patient, tuberculosis history, chest x-ray suggestive of tuberculosis, or a combination of them. The sensitivity (SN) and specificity (SP) were imputed with their 95% confidence interval (CI). A bivariate random-effects model within the OpenMeta-Analyst software was utilized for data analysis. Results: We included 39 studies, and our primary analysis regarding LTBI revealed that TST has an SN of 0.320 (95% CI [0.254-0.393]) and an SP of 0.808 (95% CI [0.752-0.854]). Nevertheless, the IGRA exhibited a higher SN estimated at 0.362 (95% CI [0.295-0.434]) and a lower SP estimated at 0.758 (95% CI [0.700-0.808]). Regarding the adult population, TST consistently showed a lower SN and a higher SP relative to IGRA. However, within the pediatric population, TST showed higher SN and lower SP when compared to IGRA. Furthermore, TST also showed a lower SN and a higher SP within hemodialysis and organ transplant patients than IGRA. Conclusions: Our diagnostic test meta-analysis revealed that TST was associated with a lower SN and a higher SP than IGRA. Clinicians should interpret these findings with caution, considering the substantial heterogeneity observed across the included studies, the reliance on proxy reference standards, the potential influence of BCG vaccination status, and the considerable overlap in confidence intervals between TST and IGRA estimates across most analyses.

Background/Objectives: Stroke is a leading cause of mortality and disability in Saudi Arabia; however, national estimates of stroke-related rehabilitation needs remain limited. This study quantified temporal trends in stroke incidence, prevalence, premature mortality, and disability from 1990 to 2021. It also examined disparities in stroke-related disability by subtype, sex, and age in 2021 and projected rehabilitation demand to 2030 to inform health system planning under Vision 2030. Methods: We conducted a secondary analysis of Global Burden of Disease (GBD) 2021 estimates for Saudi Arabia. Age-standardized rates for incidence, prevalence, years of life lost (YLLs), and years lived with disability (YLDs) were extracted for overall stroke and three subtypes: ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Temporal trends were evaluated using log-linear regression to estimate the average annual percentage change (AAPC). YLDs were mapped to severity levels and four rehabilitation modalities, physiotherapy (PT), occupational therapy (OT), speech-language therapy (SLT), and multidisciplinary comprehensive rehabilitation (MCR), using utilization probabilities informed by the literature. Projections to 2030 incorporated national population forecasts and included 95% prediction intervals and sensitivity analyses. Results: From 1990 to 2021, age-standardized stroke incidence declined from 166.3 to 130.7 per 100,000 (-21.4%; AAPC, -0.86%, p = 0.004), prevalence from 982.4 to 965.2 per 100,000 (-1.8%; AAPC, -0.10%, p = 0.056), and YLL rates from 3209.0 to 1893.4 per 100,000 (-41.0%; AAPC, -1.76%, p < 0.001). In contrast, YLD rates declined modestly from 133.5 to 129.9 per 100,000 (-2.7%; AAPC, -0.13%; p = 0.032). Despite these reductions in age-standardized rates, absolute stroke-related YLDs more than tripled, increasing from approximately 10,900 (95% UI: 8100-13,900) in 1990 to 36,245 (95% UI: 26,600-46,100) in 2021, largely driven by population growth and aging. In 2021, ischemic stroke accounted for 71.1% of total YLDs, followed by ICH (20.3%) and SAH (8.5%). Among adults aged 15-49 years, females had higher hemorrhagic YLD rates than males, with particularly pronounced differences for SAH (female-to-male ratio, 1.5-1.7). By 2030, the projected YLD-equivalent workload, a standardized proxy measure of relative service demand rather than a direct headcount of required therapists, is expected to increase to 29,758 for PT, 21,809 for OT, 14,879 for SLT, and 15,083 for MCR. Sensitivity analyses showed that rehabilitation demand estimates were sensitive to assumptions regarding severity distribution, with a hemorrhagic-weighted scenario increasing projected MCR demand by 6.8%. Conclusions: The increasing absolute burden of stroke-related disability in Saudi Arabia, despite declining age-standardized rates and substantial reductions in premature mortality, highlights the necessity to expand rehabilitation capacity. Scaling community-based, outpatient, and telerehabilitation services in alignment with the Health Sector Transformation Program and integrating disability-informed planning into Vision 2030 should be prioritized.

Pediatric asthma is a prevalent chronic respiratory condition requiring effective management strategies to prevent exacerbations and improve long-term outcomes. Inhaled corticosteroids (ICS) remain the foundation of asthma control, often combined with long-acting beta-2 agonists (LABAs) to enhance symptom relief. However, adherence challenges with separate maintenance and reliever inhalers have led to the emergence of maintenance and reliever therapy (MART) as an alternative approach. MART combines ICS and formoterol into a single inhaler for both maintenance and symptom relief, simplifying treatment regimens and ensuring consistent anti-inflammatory therapy. Recent studies demonstrate that MART reduces exacerbations, improves asthma control, and enhances adherence, compared with traditional ICS-LABA therapy. However, concerns remain regarding its long-term safety, potential overuse, and effects on growth and development. This review explores the rationale, clinical efficacy, and special considerations for MART in pediatric asthma, emphasizing the need for further research to refine its role in individualized treatment strategies.

The digital revolution-including smartphones, wearable devices, mobile applications, and online platforms- has fundamentally transformed modern human lifestyle and health behaviors. This narrative review synthesizes evidence on the positive and negative impacts of social media and smart technologies on the six pillars of lifestyle medicine: nutrition, physical activity, stress management, substance use, restorative sleep, and social connection. We conducted a narrative review of English-language, peer-reviewed literature from 2010 to 2025. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO, supplemented by Google Scholar and reference-list screening. Across pillars, (SMAT) can enable self-monitoring, goal-setting, personalized feedback, and remote coaching. Evidence is strongest for physical activity and dietary self-management, particularly when interventions include behaviour change techniques (e.g., prompts, gamification, and social support) and clinician input. Digital mindfulness and cognitive-behavioral programs show modest reductions in perceived stress and improvements in sleep outcomes in selected populations. However, excessive screen time and evening device use are consistently associated with poorer sleep, digital fatigue, and reduced wellbeing. Social platforms can enhance peer support and accountability, but can also amplify misinformation, unhealthy comparison, and exposure to marketing or norms that promote risky substance use. Healthcare professionals, educators, and policymakers should promote evidence-based and balanced SMAT use by assessing digital health literacy, guiding purposeful engagement, monitoring for harms such as sleep disruption and anxiety, and addressing inequities in access. Hybrid models that combine digital tools with counseling, education, and family- or community-based support appear most promising for sustained behavior change. Regulatory oversight, app validation, data privacy protections, and long-term research in diverse populations are essential to ensure safe, effective, and equitable implementation.

Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited. We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes. Of 4080 CIED recipients, 114 (2.8 %) developed device infections (incidence 98.8 per 10,000 person-years). CRT-P (cardiac resynchronization therapy pacemaker) devices had the highest infection rate (7.7 %). Revision procedures carried higher infection rates than initial implants or generator replacements (10.0 % vs 2.1 % vs 2.7 %; P < 0.001). The most common pathogens were Staphylococcus aureus (30.1 %), coagulase-negative staphylococci (10.6 %), and Pseudomonas aeruginosa (8.8 %); 38.9 % of infections were culture-negative. Systemic infections and patients managed without device removal had significantly higher mortality (32.3 % vs 8.2 % for systemic vs pocket; 48.4 % vs 12.0 % for no extraction vs extraction; P < 0.001 for both). In this large Saudi cohort, CIED infection occurred in 2.8 % of patients, particularly following revision procedures and in CRT-P recipients. Infections were often culture-negative and associated with substantial mortality, especially in systemic cases or when devices were not removed. These findings highlight the importance of strict infection-prevention protocols, early recognition, and prompt complete device extraction to improve patient outcomes.

Background & Objective: Alterations in global DNA methylation levels and repetitive elements are commonly observed in various cancers and in response to environmental pollutants, particularly petroleum products such as benzene. Long-term benzene exposure is harmful to human health and is associated with an increased risk of hematological malignancies. This study aimed to investigate the association between chronic occupational exposure to benzene and DNA methylation status in TGFβ2, MAGE-A1, and LINE-1 repetitive elements among gasoline station workers. Material and Methods: This case–control study included 30 male gasoline station workers and 30 male controls. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Mini Kit (QIAGEN) and treated with sodium bisulfite via the EpiTect Fast DNA Bisulfite Kit. Singleplex MethyLight PCR was performed to assess methylation status of MAGE-A1, TGFβ2, and LINE-1. Results: Significant differences were observed in working hours (p = 0.004) and direct benzene exposure (p < 0.0001) between workers and controls. Percent MethyLight Reference (PMR) values were significantly different between the two groups for LINE-1 (p < 0.0001), TGFβ2 (p = 0.0194), and MAGE-A1 (p < 0.0001). Conclusion: Chronic benzene exposure is associated with altered DNA methylation patterns. Singleplex MethyLight analysis revealed significant PMR differences for MAGE-A1, LINE-1, and TGFβ2 between benzene-exposed workers and controls, highlighting the potential of DNA methylation profiling in occupational health risk assessment.

Shoulder dislocations are among the most frequently encountered joint injuries in emergency and orthopedic care, with anterior dislocations accounting for the majority of cases. The timing of reduction following dislocation plays a critical role in influencing short-term outcomes, procedural success, and long-term joint stability. Early reduction is often associated with decreased pain, improved ease of reduction, and lower sedation requirements. Delayed reduction, particularly beyond several hours post-injury, may increase the likelihood of reduction failure, nerve injury, or the need for operative intervention. Studies have shown that recurrence rates are higher in younger patients, especially when treatment is delayed or conservative methods are used without close follow-up. Functional recovery, including return to sport or daily activity, is significantly affected by the management approach and timing of reduction. Structural injuries such as Bankart lesions, Hill-Sachs defects, and rotator cuff tears further complicate outcomes and are more common in delayed or recurrent cases. The presence of risk factors like hyperlaxity, previous subluxations, and improper immobilization also contribute to instability. Imaging strategies, early rehabilitation protocols, and patient education are essential to support recovery and prevent re-dislocation. Variability in emergency department protocols, clinician experience, and resource availability can influence treatment timing and outcomes. Understanding how early versus delayed intervention shapes both immediate and extended recovery allows for more effective decision-making in both acute and follow-up care.

Child mental health disorders, such as ADHD, ASD, and anxiety, represent a growing global public health concern. These conditions often emerge in early childhood and are frequently identified first in primary care settings [1,2]. Without early recognition and treatment, these disorders can impair social, academic, and emotional development [3]. This study assesses the prevalence of these disorders among children attending AlWazarat Health Center at Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, and explores associated gender and sociodemographic patterns. A cross-sectional and follow-up study included patterns of mental health Disorders among children attending Al Wazarat Healthcare Center at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia, between October 2023 to November 2024. Patients who did not attend the clinic on their appointment time were excluded. Data were collected through structured interviews with either parent, father, mother, or the guardian attending the appointment. Diagnosis was established using DSM-5-aligned clinical tools by qualified practitioners. Data were collected on sociodemographic variables (gender, family status, parental education) and diagnosed mental health conditions, including ADHD, anxiety, autism spectrum disorder (ASD), learning disabilities, and speech delay. Chi-square tests were used to examine associations, with p-values &lt; 0.05 considered statistically significant. A total of 251 children were included in this study. The most prevalent diagnosis was ADHD (59.8%), followed by ASD (13.9%), anxiety (11.6%), speech delay (8.8%), and learning disabilities (6.0%). Males represented 72.1% of the sample and had significantly higher rates of ADHD (63.5% vs. 50%) and speech delay (11.0% vs. 2.9%) compared to females. Anxiety was more common in females (22.9%) than males (7.2%), with p &lt;0.05 [4,5]. Parental education and family status were not significantly associated with diagnostic categories (p&gt;0.05) [6]. This study highlights the high burden of neurodevelopmental and emotional conditions in children seen in primary healthcare. ADHD is the most commonly diagnosed child mental health disorder in this primary care setting, with notable gender differences. These findings support the urgent need for integrated mental health screening and training for primary care physicians in Saudi Arabia.

Breast cancer accounts for 31.8% of female cancers in Saudi Arabia, with 56% of cases diagnosed before age 50, 14 years younger than in Western countries. Aggressive subtypes (TNBC: 18-24%; HER2+: 25-28%) are common, and dense breast tissue reduces the effectiveness of mammography. Currently, no age-specific screening protocols exist for this unique epidemiological profile. This study aimed to assess the age-specific diagnostic accuracy of mammography, ultrasound, and magnetic resonance imaging (MRI), and to characterize molecular subtype distribution in Saudi breast cancer patients to guide personalized screening guidelines. A retrospective cohort study was conducted at a tertiary care center in Riyadh, Saudi Arabia (January 2021-December 2023). Medical records of 148 women aged 30-70 with histopathologically confirmed breast cancer (BI-RADS 4/5) were analyzed. The sensitivity and specificity of imaging modalities were assessed across age groups (30-39, 40-49, 50-59, ≥60 years). Subtype distribution and breast density (BI-RADS A-D) were correlated with imaging performance using chi-square tests and logistic regression (SPSS v28, STARD 2015 guidelines). The mean age was 48 years, with 56.4% of cases occurring in women under 50 (peak incidence: 40-49 years, 34.1%). Ultrasound sensitivity exceeded mammography in women under 50 (85.3% vs. 74.5%, p<0.01), while MRI demonstrated the highest overall accuracy (91.7%, 95% confidence interval 89.2-93.5). TNBC prevalence decreased with age (24.7% in 30-39 years to 12.0% in ≥60 years, p<0.01), while invasive lobular carcinoma incidence doubled (8.2% to 18.0%, p<0.001). Delayed diagnosis (>60 days) lowered 2-year survival by 21% (p=0.003). Ultrasound is more effective than mammography for early detection in Saudi women under 50 years old, while MRI remains highly accurate across all age groups. National screening guidelines should adopt biennial ultrasound-first screening starting at age 40, with MRI reserved for high-risk cases and BI-RADS 3-4 lesions.