Background: Normal sleep duration is crucial for maintaining brain homeostasis. Sleep disorders in Parkinson's disease are numerous, multifactorial, and result in significant morbidity. Objective: The aim of the study was to investigate the association between gender and the duration of therapy on sleep quality in patients with Parkinson's disease. Methods: The study is prospective, and includes 40 consecutively hospitalized patients with verified Parkinson's disease. The study included subjects of both genders and all age groups. To analyze the data on the subjects, we used: medical histories, nursing documentation of patients, a questionnaire with sociodemographic data, and the Parkinson's Disease Sleep Assessment Scale. We divided all subjects into two groups: subjects who have been using therapy for up to 5 years and those who have been using therapy for more than 5 years. Results: Among subjects who have been taking medication for less than 5 years, 33.3% were female and 66.6% were male. Of the total number of respondents who have been taking therapy for more than 5 years, 36.3% are female and 63.6% are male. The duration of the therapy has a statistically significant effect on the quality of sleep in patients with Parkinson's disease (p < 0.05). The subject's gender does not have a significant independent influence on the quality of sleep in patients with Parkinson's disease (p > 0.05). The interaction of gender and length of therapy use has no significant separate effect on the quality of sleep in Parkinson's disease patients (p > 0.05). The quality of sleep is better in male and female subjects who take the therapy until the age of 5. Conclusion: The duration of therapy use has a significant impact on the quality of sleep in Parkinson's disease patients. The gender of the subject has no significant independent influence on the quality of sleep in patients with Parkinson's disease.
Background: Acute spontaneous urticaria (ASU) is a common inflammatory skin condition that is encountered in emergency and primary healthcare. Around 20% of people experience an episode of ASU at some point in their lives. Objective: This study aims to assess the knowledge and awareness of management of acute spontaneous urticaria among emergency and family medicine physicians of tertiary care center in Saudi Arabia Methods: A web-based survey, validated by expert consultants in the field, was used, which was followed by another validation by calculating the Cronbach’s alpha for the data collected from the emergency medicine and family medicine staff for the period November, 2021 to January, 2022. Results: In this study, 123 doctors responded to the survey. Approximately 83% of the doctors knew the morphology of urticaria and 79.7% knew the pathophysiological mediator of urticaria. More than 90% knew that blood tests are not required in the management of acute urticaria. While nearly 80% knew the mainstay of urticaria treatment (79.7%) and whether topical treatment is effective (80.5%), only 44.7% could correctly pinpoint how long urticarial lesions usually last before they are completely resolved. Conclusion: Emergency medicine physicians were noted to be more adept in the management of acute spontaneous urticaria compared to family medicine physicians and general practitioners. No significant association was seen between physicians’ knowledge and their response rate levels.
Background: Breast cancer is the most prevalent cancer among women worldwide and a major public health concern in Saudi Arabia, where cases are increasingly diagnosed at younger ages and advanced stages. Early detection through screening is essential to improve survival outcomes. Objective: This study aimed to assess the level of awareness and screening practices related to breast cancer among women in Hafar Al-Batin, Saudi Arabia. Methods: A cross-sectional study was conducted among 411 adult women residing in Hafar Al-Batin using a self-administered electronic questionnaire distributed via social media and healthcare networks. The survey assessed socio-demographic characteristics, knowledge about breast cancer risk factors and symptoms, and screening practices, including mammography and clinical breast examination. Data were analyzed using SPSS version 26, with chi-square and Fisher’s exact tests applied to examine associations between knowledge, practices, and socio-demographic factors. Results: Most participants (97.8%) had heard about breast cancer, and 79.1% reported receiving health education. However, only 17.5% had ever undergone mammography screening, and 22.1% had received a clinical breast examination. Higher education and a positive family history were significantly associated with better knowledge levels (p < .05). Age, marital status, and employment were significantly linked to mammography screening uptake, with older, married, and employed women more likely to participate. Conclusion: Although awareness of breast cancer was generally high, participation in preventive screening remained low. Targeted health education and outreach programs focusing on younger, unmarried, and unemployed women are needed to enhance early detection and reduce breast cancer mortality in Saudi Arabia.
Background: Polycystic Ovary Syndrome (PCOS) is a widespread endocrine disorder affecting women of reproductive age, often associated with hormonal imbalances that disrupts the normal functioning of the ovaries. Key reproductive hormones involved include Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Oestrogen (E2), and Prolactin. These disruptions can contribute to symptoms like irregular periods, infertility, weight gain, and emotional distress. Understanding the delicate balance of these hormones is essential for diagnosis and managing PCOS. Objective: The aim of this study was to evaluate and compare reproductive hormone levels including FSH, LH, E2, and prolactin in woman with PCOS and those with normal ovarian morphology. Methods: A total of 100 reproductive-age woman from Bosnia and Herzegovina were included, divided in control group (n=50) normal ovaries and PCOS group (n=50). Hormonal levels were measured and statistically analysed. Results: According to the obtained results, a statistically significant difference in LH levels and FSH/LH ratio between the PCOS and control group was observed. Women with PCOS exhibited elevated LH levels and a decreased FSH/LH ratio, indicating a hormonal shift in favour of LH. Although FSH levels in PCOS patients were lower, they remained within the lower reference range. No statistically significant differences were observed in E2 and Prolactin levels between the two groups. Conclusion: PCOS is characterized by altered reproductive hormone profiles, particularly elevated LH and a disrupted FSH/LH ratio, while E2 and Prolactin remain largely unaffected. These findings contribute to a better understanding of PCOS pathophysiology.
Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are the venous thromboembolism (VTE) events that together present a major healthcare problem in the world, which results in significant morbidity, mortality and economic outflow. VTE is a multifactorial disorder, determined by a combination of risk factors including hospitalization, surgery, critical care, and one or more isolated medical conditions. Objective: The objective of the study is to provide a comprehensive assessment of the prevalence of VTE and to identify key risk factors across various clinical and demographic conditions, in order to inform prophylactic measures. Methods: A literature search was conducted on PubMed, Scopus, and Google Scholar among the studies that were published between 1998 and 2022 in the English language. The keywords were used as “venous thromboembolism”, “deep vein thrombosis”, “pulmonary embolism”, “incidence”, and “risk factors”. The observational, cohort studies, and systematic reviewed research on the VTE epidemiology and risk factors among human populations were considered as the eligible studies. Studies with improper methodologies and editorials, non-English studies were eliminated. Results: The incidence of VTE varies worldwide, ranging from 2 cases per 1,000 person-years, with higher prevalence in hospitalized patients (15-30%) and critically ill patients (up to 20 %). The main risk factors include advanced age, hospitalisation, and surgical intervention, as well as malignant tumours (4-7-fold increased risk), obesity, immobility, inherited thrombophilia with a common genetic background, and rare diseases such as KILT syndrome. Additionally, ethnic and gender differences influence the incidence. Conclusion: VTE is a complex condition that must be prevented on an individual basis, considering different risk profiles. Future research should focus on prospective studies across various groups to enhance risk assessment models and enable personalised thromboprophylaxis, thereby reducing the burden of VTE.
BACKGROUND:Duffy-negative individuals were long considered resistant to Plasmodium vivax, yet emerging infections challenge this assumption, underscoring the need to examine Duffy antigen receptor for chemokines (DARC) gene polymorphisms and clarify evolving susceptibility patterns. OBJECTIVE:This study investigated the association between DARC genetic variants and susceptibility to P. vivax infection to elucidate transmission patterns and explain the rising incidence of P. vivax infection in Sudan. METHODS:A total of 405 participants were recruited for the study, including 202 patients with a confirmed diagnosis of P. vivax malaria and 203 blood donors serving as the control group. DNA was extracted from the peripheral blood, and DARC polymorphic variants were analyzed using polymerase chain reaction- sequence specific primer (PCR-SSP). RESULTS:The study showed that the Duffy-negative homozygous genotype FYBES/FYBES was present in both P. vivax-infected patients and the control group; however, it was significantly more frequent in healthy blood donors. The frequencies of the homozygous FYB/FYB genotype and the two heterozygous genotypes FYB/FYA and FYB/FYBES were substantially higher among the patients with P. vivax malaria than in the control group. The homozygous genotype FYA/FYA was more frequent among P. vivax malaria patients, while the heterozygous genotype FYA/FYBES was more common in the control group; however, the differences were not statistically significant. The FYAES allele was not detected in either group. CONCLUSION:There was a potential association between FYA and FYB alleles and susceptibility to P. vivax infection. The FYBES allele confers partial resistance to P. vivax malaria, as some infected individuals were found to carry the homozygous Duffy-negative genotype (FYBES/ FYBES).
Background:The clinical manifestations of cerebrovascular diseases (CVD) depend on the localization of the damaged region in the brain. Cognitive functions are often impaired following a stroke. Initially, CVD was referred to as atherosclerotic dementia, and was distinguished from senile dementia. Objective:The aim of this study was to examine how stroke severity and localization influence the development of vascular dementia (VD) and to identify which cognitive functions are impaired in certain types of VD. Methods:This prospective study included patients with acute stroke who were hospitalized at the Department of Neurology Tuzla, Bosnia and Herzegovina, over a one-year period. Patients were divided into the following groups: dementia of strategic infarct (DSI), cortical dementia (CD), subcortical dementia (SCD), haemorrhagic dementia (HD) and non-demented patient (NDP). Stroke localization, side and number of lesions were analyzed. Results:A total of 274 stroke patients were analyzed, of whom 190 (69%) were diagnosed with some type of VD. The odds ratio (OR) for the occurrence of dementia per point increase in NIHSS on admission was 1.131 (95% CI; 1.056 - 1.210). CD was more common in patients with right hemisphere lesions (p<0.000), whereas SCD was more frequent in those with bihemispheric lesions (p<0.0001). All assessed cognitive functions were significantly associated with CD and SCD (p<0.000). Visual perceptual (p=0.007) and visual constructive (p=0.016) functions were significantly impaired in patients with DSI. Executive functions were significantly impaired in all demented patients (p<0.0001). Conclusion:Stroke localization has a significant impact on the development of vascular dementia. All analyzed cognitive functions are significantly impaired in cortical and subcortical dementia. Visual perceptual and visual constructive functions are particularly impaired in patients with dementia of strategic infarct.
Background:Multidrug-resistant (MDR) Klebsiella pneumoniae is an emerging cause of severe pneumonia in Southeast Asia. However, data on MDR K. pneumoniae in elderly patients with community-acquired pneumonia (CAP) remain limited. Objective:To determine MDR K. pneumoniae prevalence among elderly CAP patients, identify risk factors, and evaluate resistance to empiric antibiotics. Methods:A prospective cohort study was conducted at a tertiary geriatric hospital in Vietnam from January 2023 to June 2024. We analyzed a subgroup of 181 patients aged ≥ 60 years with culture-confirmed K. pneumoniae CAP. Results:The median age was 81 years. The prevalence of MDR K. pneumoniae was 26.5% (48/181). Resistance rates to first-line empiric agents were high: ciprofloxacin (50.6%), levofloxacin (30.0%), ceftazidime (38.7%), and ceftriaxone (31.1%). Amikacin remained highly effective (1.5% resistance). In univariable analysis, Chronic Obstructive Pulmonary Disease (COPD) (OR 2.16; 95% CI 1.03-4.53; p = 0.039), prior intravenous antibiotic use within 90 days (OR 3.32; 95% CI 1.49-7.42; p = 0.002), and hospitalization within the preceding 30 days (OR 2.28; 95% CI 0.99-5.21; p = 0.048) were associated with MDR K. pneumoniae. In the multivariable model, prior intravenous antibiotic use within 90 days (OR 3.00; 95% CI 1.32-6.80; p = 0.009) was identified as the independent risk factor for MDR acquisition. Conclusion:A substantial proportion of elderly CAP patients harbor MDR K. pneumoniae at admission. Given high resistance to fluoroquinolones and cephalosporins, empiric guidelines require re-evaluation for patients with recent intravenous antibiotic exposure.
Background: Adequate knowledge and positive attitudes toward OSA are essential for critical care nurses to identify and manage this underdiagnosed condition. Structured educational interventions can bridge knowledge gaps and enhance clinical confidence, ultimately improving patient outcomes. Objective: The aim of this study was to evaluate the impact of an online educational program on critical care nurses’ knowledge and attitudes toward obstructive sleep apnea (OSA). Design of this study was Quasi-experimental pre-test/post-test study. Methods: Critical care nurses in Saudi Arabia participated in an online teaching program delivered via Zoom. Data were collected using the validated OSA Knowledge and Attitude (OSAKA) questionnaire pre- and post-intervention. Statistical analysis included the Wilcoxon Signed-Rank Test and correlation assessments. Results: Of the 54 participants, only 8.3% demonstrated adequate OSA knowledge pre-intervention, compared to 51.7% post-intervention. Median knowledge scores significantly improved (Z = 5.955, p = 0.000). Attitude scores also increased, with participants reporting enhanced confidence in identifying at-risk patients (mean = 4.3, SD = 0.72) and managing CPAP therapy (mean = 4.467, SD = 0.566). Training showed a significant positive correlation with post-test attitudes (ρ = 0.286, p = 0.030). Conclusion: The study highlights the effectiveness of structured educational programs in improving OSA knowledge and attitudes among critical care nurses. Integrating such training into nursing curricula and continuing education is recommended to enhance patient care quality.
Background:Gastrointestinal (GI) health significantly impacts overall well-being. Probiotics, defined as live microorganisms that confer health benefits when consumed in adequate amounts, have been associated with improvements in digestion, immunity, and gut microbiota balance. Despite evidence supporting their role in managing conditions like bloating, irritable bowel syndrome (IBS), and antibiotic-associated symptoms, awareness and clinical use of probiotics remain limited in many populations, including Saudi Arabia. Objective:The aim of this study was to evaluate the association between probiotic consumption and gastrointestinal health outcomes among adults in Saudi Arabia, and to explore factors influencing probiotic intake. Methods:A web-based, cross-sectional study was conducted using an online questionnaire targeting adults across Saudi Arabia. Data on demographics, dietary habits, probiotic use, and gastrointestinal symptoms were collected and analyzed using chi-square tests and multivariate logistic regression. Results:Among 442 participants, the majority were young adults (18-30 years), female, and students. Most (87%) had heard of probiotics, though only 16.6% used them regularly. Yogurt and pickled foods were common sources; supplements were less used (13.8%). A significant association was observed between frequent probiotic use and better self-reported digestive health (χ2 = 20.93, p = 0.013), though this did not persist in multivariate analysis. Employment status and higher fruit/vegetable intake were significant predictors of probiotic use (OR = 1.60 and OR = 2.08, respectively). Conclusion:Although awareness of probiotics is high, regular usage is limited and influenced by lifestyle and dietary behaviors. These findings underscore the need for targeted public health initiatives to improve probiotic literacy and promote their integration into dietary strategies for digestive health support.
Background:Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and early detection is essential for improving outcomes. Pediatricians are often the first point of contact; however, their knowledge of ASD in Saudi Arabia remains unclear. Objective:The aim of this sudy was to evaluate the knowledge of pediatricians in Saudi Arabia regarding childhood autism using the validated Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. Methods:A cross-sectional study was conducted among 357 pediatricians practicing in Saudi Arabia from September 2021 to August 2022. Participants completed the 19-item KCAHW questionnaire, which covered four knowledge domains: social interaction impairments, communication impairments, repetitive behaviors, and classification/comorbidities. Descriptive statistics and inferential analyses (t-tests, analysis of variance, and regression models) assessed associations between participant characteristics and knowledge scores. Results:The mean overall knowledge score was 15.24 ± 2.23 out of 19. While most participants performed well in the communication domain (90.5% scored above average), only 49.6% scored above average in social interaction knowledge. Pediatricians trained abroad scored significantly higher in domains 1 and 2. Subspecialists, particularly those in developmental/behavioral pediatrics and neurology, scored the highest. Pediatricians with 4-6 years of experience showed a positive association with overall knowledge. Conclusion:Pediatricians in Saudi Arabia demonstrated above-average knowledge of ASD, significant gaps remain - particularly in social interaction and comorbidities. These findings highlight the need for enhanced ASD-focused training, particularly for locally trained and early-career pediatricians.
Background: HLA-A gene is one of the most polymorphic loci in human genome and its variants influence disease susceptibility and immune checkpoint inhibitor (ICI) therapy response. HLA-A*03 allele has been identified as a biomarker associated with poor ICI response. Objective: This study aimed to characterize HLA-A allele and genotype frequencies in the Bosnian population, assess sex specific differences, and evaluate the prevalence of HLA-A*03. Methods: Blood samples from 75 individuals were analyzed. Genomic DNA was isolated using the Miller method, and HLA-A typing was performed using PCR with sequence specific primers (PCR-SSP). Polymorphism parameters were calculated using PowerMarker v3.25. Differences between males and females were assessed using chi square and Fisher’s exact tests. Results: Twelve HLA-A allelic groups and 28 genotypes were identified. The most frequent alleles were HLA-A*02 (33.33%), A*01 (16.67%), A*24 (11.33%), A*03 (10%), and A*11 (8%). The most common genotypes were HLA-A*01/*02 (12%), A*02/*02 (12%), and A*02/*03 (8%). Females showed significantly higher frequencies of HLA-A*02, A*03, and A*31, as well as genotypes HLA-A*02/*03, A*02/*11, and A*02/*31. The population exhibited high polymorphism (heterozygosity 0.8667; gene diversity 0.8232; PIC 0.8054). Strong similarity with European and Western groups and substantial divergence from East Asian and African populations were detected. Conclusion: The Bosnian population demonstrates high HLA-A polymorphism, with HLA-A*02 as the most common allele. Females more frequently carry the HLA-A*03 allele and several related genotypes, suggesting potential sex specific implications for ICI therapy response. These findings provide a foundation for future studies investigating the clinical relevance of HLA-A variation in Bosnian cancer patients undergoing immunotherapy.
Background: Sleeve gastrectomy is a widely used intervention for obesity, a major global and national concern. However, public awareness and surveillance remain limited, especially in Saudi Arabia. Aim: To determine the knowledge and awareness of indications and complications of sleeve gastrectomy in Saudi adults. Methods: A descriptive cross-sectional study was conducted using a structured and self-administered online questionnaire which is based on prior literature between July and December 2024. The questionnaire had 26 questions and was in either Arabic or English and was based on sociodemographic information, awareness of obesity, body mass index and sleeve gastrectomy. Results: A total of 809 adults participated, with a mean age of 29.9 years; most were female (68.5%), Saudi nationals (93.1%), and had education beyond high school (78.7%). Notably, 83.7% knew someone who had undergone sleeve gastrectomy, mainly a family member (62.3%). Although 98.9% were aware of the procedure, only 63% recognized potential complications, including hemorrhage (44.7%) and iron deficiency (43.5%). Shockingly, 34.7% were unsure of complications, indicating education gaps. Knowledge levels correlated significantly with demographic factors (p < 0.05). Conclusion: Although there is high awareness of sleeve gastrectomy, there is limited knowledge about its dangers and signs. The dependency of social media reflects the necessity of the effective educational interventions to resolve misconceptions and enhance health literacy. To facilitate informed decision-making and to have a positive influence on the obesity management, it is possible to enhance education strategies.
Background:The biomedical sciences associated with the behavior of humans dissipate diseases and its development is called behavioral medicine. Drawing together insights from medicine, neuroscience, psychoneuroimmunology, psychology, sociology epidemiology, anthropology, and health education, it looks at health in the biological, psychological social environmental and spiritual. Objective:The objectives of this study were: a) to specify the scope and domains of modern behavioral medicine, b) to clarify prevention, diagnosis, treatment, and outcomes, c) to specify the patient-physician relationship and technology use, and d) to describe how behavioral medicine links delivery, utilization, education, and reform of health and social systems. Methods:The methodology involves looking at differing complex comprehensive models as well as the models that control functioning in illness and disease. Results:Today's behavioral medicine has multiple applications (e.g. clinical care, prevention, health promotion, systems innovation)." It promotes a patient-physician relationship that is socially adept and facilitated by technology. It also addresses health problems of the individual and social problems at the community level. Furthermore, it integrates life and social sciences in order to influence etiology, diagnosis, treatment and health outcome through the cognitive, emotional, psychosocial and environmental pathways. The discipline seeks to unite the health system family, focusing on wellness rather than illness. Conclusion:Behavioral medicine acts as an integrative platform for disciplines and health systems that further prevention, diagnosis, treatment, and population health. This allows for comprehensive, scalable approaches to enhance health outcomes and inform health system reform by focusing on the patient-physician relationship, utilizing appropriate technology and acting at the level of individuals and communities.
Background:An initial presentation of ovarian carcinoma with brain metastasis has been reported in the literature in a limited number of cases, as ovarian cancer rarely metastasizes to the brain. Objective:This study aims to a) Systematically review the literature to identify studies on ovarian carcinoma presenting initially as cerebral metastasis and b) to investigate cases of ovarian carcinoma that were initially presented with cerebral metastasis. Methods:A PRISMA-guided systematic review was conducted, coupled with a retrospective study at the King Abdullah University Hospital from 2005 to 2020. Two hundred sixty-three ovarian carcinoma cases were analyzed for the presence of brain metastasis, out of which 25 were positive for brain metastasis, and seven of them presented initially with neurological symptoms. Demographics, clinical features, histopathology, and treatments were identified. Results:Eight out of 215 studies conducted between 1999 and 2024 satisfied the criteria for ovarian cancer initially manifesting with neurological symptoms. In the retrospective analysis, 85% and 71% of patients, with a mean age of 41, exhibited headache and impaired vision. Serous cancer manifested in 58%, with solitary brain lesions observed in 71%; surgical intervention yielded improved outcomes. Multimodal treatments involving craniotomy, radiation, and chemotherapy resulted in a median survival of 18.7 months. Fertility drugs utilization was recorded in 57%, indicating a possible association with aggressive illness. Conclusion:This study illustrates that ovarian cancer presenting as brain metastases at its initial presentation is rare and should be considered in younger women with fertility drugs usage. Long-term risks of fertility drugs should be assessed as use increases. Multimodal therapy improves survival and results.
Background:Emergency departments (EDs) in Saudi Arabia are seeing more patients and facing a shortage of resources. Prioritizing care based on medical urgency requires triage systems. Understanding triage and raising public awareness are key for improving ED effectiveness and patient satisfaction. However, few studies have examined these issues among Saudi citizens, particularly in the Najran area. Objective:The purpose of this study is to evaluate the overall attitudes, degree of awareness, and depth of knowledge regarding the emergency triage system in the Najran population. Despite the significance of triage, little research has been done in Saudi Arabia to determine how the general public views this approach. Methods:A cross-sectional descriptive study with analytical components was conducted from February to August 2025 targeting residents of Najran, Saudi Arabia. An online self-administered Arabic questionnaire was filled up by 452 participants. The survey assessed awareness, knowledge, and attitudes toward the ED triage system in addition to demographic data. SPSS version 26.0 was used to analyze the data. Results:The results showed that 58.8% of participants had strong or excellent knowledge of the triage system, and 82.9% had high or very high awareness of it. A strong majority, 88.1%, had positive views on triage and recognized its role in providing fair and efficient emergency care. Age and education were significant predictors of higher awareness, knowledge, and understanding. Knowledge was also found to have a strong positive correlation with both awareness and attitudes. Conclusion:Despite a lack of specific information, most Najran locals support and are aware of the ED triage procedure. To increase public awareness, maximize ED utilization, and improve patient experience, educational programs aimed at demographic groups - especially younger and less educated people, are advised.
Background:Aphasia is an acquired communication disorder that affects language comprehension and production, typically occurring after brain damage. It is a frequent clinical manifestation of both benign and malignant brain tumors, particularly when lesions are localized in language-dominant areas. Objective:To assess the prevalence and characterize the types of aphasia in patients with intracranial tumors, emphasizing its clinical significance and the importance of early speech-language evaluation. Methods:This prospective study included patients with confirmed brain tumors diagnosed through neuroimaging (CT or MRI of the neurocranium), who were hospitalized at the Clinic of Neurosurgery, University Clinical Center Tuzla, over a one-year period. Patients with pre-existing aphasia of any etiology, as well as those who had not acquired reading and writing skills, were excluded. All assessments were performed prior to surgical intervention using the Boston Diagnostic Aphasia Examination. Results:Aphasia was diagnosed in 25 patients (27.5%). The most common type was anomic aphasia in 10 patients (40%), followed by Broca's aphasia in 7 patients (28%), transcortical motor aphasia in 3 patients (12%), and transcortical sensory aphasia in 1 patient (4%). The highest number of patients with aphasia had tumors localized in the left temporal lobe, followed by the parietal and temporoparietal regions. Conclusion:Aphasia is a common clinical finding in patients with intracranial tumors, affecting more than one-quarter of the studied population. The distribution of aphasia types is consistent with the localization of lesions in language-dominant areas, particularly the left temporal lobe. Early recognition and detailed speech-language assessment are essential for timely intervention, rehabilitation planning, and optimizing functional outcomes.
Background:SARS-CoV-2, though primarily a respiratory pathogen, exhibits multi-organ tropism, with the liver among the commonly affected organs. Elevations in liver enzymes are frequent in hospitalized COVID-19 patients, yet acute and pronounced hepatocellular injury in young, clinically stable individuals is uncommon. The underlying mechanisms may include direct viral cytopathic effects mediated by ACE2 receptors, immune-mediated injury, systemic inflammation, and metabolic stress. Notably, hepatic involvement can develop independently of respiratory compromise. Objective:The aim of this case report was to describe three adult patients with serologically confirmed SARS-CoV-2 infection and mild respiratory symptoms who presented with acute liver injury in the absence of other identifiable causes. Case report:During a confirmed COVID-19 wave in Bosnia and Herzegovina, a targeted outpatient study was performed in a family medicine setting. Routine liver testing was conducted for all suspected COVID-19 cases. Laboratory evaluation included liver enzymes, hepatitis serology, autoimmune markers, and inflammatory parameters, with imaging (ultrasound or MRI) to exclude structural pathology. Three previously healthy male patients (aged 25-45) developed acute liver injury during mild febrile illness, all with serologically confirmed SARS-CoV-2 infection (positive IgM and IgG). Retrospective assessment revealed unrecognized metabolic dysfunction-associated steatotic liver disease (MASLD) in all cases. Initial symptoms were fatigue and myalgia without respiratory distress. Laboratory findings demonstrated marked elevations of AST and ALT (>1000 U/L), GGT (>900 U/L), and raised ferritin and D-dimer, while bilirubin remained normal. This biochemical profile - disproportionately elevated transaminases and GGT with preserved bilirubin - was consistent across cases, suggesting SARS-CoV-2-related hepatocellular injury. All patients recovered rapidly with supportive outpatient care, without progression to liver failure. Conclusion:Clinically stable COVID-19 patients may experience acute hepatocellular injury, particularly those with underlying metabolic dysfunction such as MASLD. The recurring biochemical pattern of significantly elevated AST, ALT, GGT, and ferritin with normal bilirubin suggests a distinctive SARS-CoV-2-associated liver injury phenotype. Recognition of this presentation is essential for appropriate evaluation and management. Routine liver function monitoring should be considered in COVID-19 patients, regardless of respiratory symptom severity, especially in those with metabolic risk factors.
Background:Combined hormonal contraception (CHC) is a widely accepted contraceptive method for women of reproductive age. It is considered a safe and user-friendly option for women without risk factors for cardiovascular diseases; however, it is contraindicated in women with established cardiovascular disease or overt risk factors. CHC increases the incidence of cardiovascular events through higher risk for thromboembolic events and potential increases of blood pressure. Objective:The aim of this article was to explain when and how arterial hypertension should be addressed as absolute and relative contraindication for CHC use as well as a possible consequence of CHC therapy. Methods:This is descriptive method which should be crucial to identify women who are not suitable candidates for CHC by thoroughly assessing their medical history, including current and previous conditions, evaluating potential risk factors, calculating body mass index (BMI), and regularly monitoring blood pressure and weight. Results and Discussion:Several explanations have been proposed to explain blood pressure elevations. The estrogenic component in CHC stimulates renin-angiotensin-Aldosterone system (RAAS) through increased hepatic production of angiotensinogen. The regulation of anti-diuretic hormone (ADH) through osmoreceptors may also be altered. Before prescribing CHC, gynecologists should conduct a thorough cardiovascular risk assessment. This should include a targeted questionnaire addressing cardiovascular disease history and risk factors, such as smoking and elevated lipid levels. Additionally, BMI calculation and blood pressure measurement should be performed. It is advisable to assess thyroid function by measuring THS levels at the initiation of CHC and every five years thereafter, as thyroid dysfunction is associated with increased cardiovascular risk, particularly arterial hypertension Laboratory testing should include lipid profiles, glucose levels and thyroid function assessment performed prior to initiating CHC and at regular intervals during its use. This article focuses on arterial hypertension addressing its role as both an absolute and relative contraindication for CHC use as well as a possible consequence of CHC therapy. Conclusion:Women with well-controlled arterial hypertension may, in certain circumstances, safely use CHC. The combination of estetrol and drospirenone holds promise as an ideal choice for women with arterial hypertension seeking CHC.
Background:Early recognition of developmental milestones is vital for timely detection of delays. While studies in Saudi Arabia have assessed parental awareness, little is known about the general adult population's knowledge. Objective:The aim of this study was to evaluate the awareness and knowledge of developmental milestones among adults in Saudi Arabia. Methods:A cross-sectional study was conducted from July to November 2024 using an online questionnaire in Arabic and English. The survey assessed knowledge across five devel-opmental domains. A total of 924 adults aged 18-65 years participated. Knowledge scores were categorized into high, moderate, and low levels. Data were analyzed with SPSS version 29, and associations with sociodemographic variables were tested. Results:Overall, 31% of participants demonstrated high knowledge, 44.8% moderate, and 24.2% low. Awareness was stronger for gross motor skills in older children but weaker for infant and early speech/language milestones. Only 43.3% recognized the expected vocabulary at 24 months, and many expressed uncertainty about early infancy mile-stones. Knowledge was significantly associated with gender, age, marital status, educa-tion, occupation, and income (p < 0.05). Informal sources, particularly family and friends, were the most common source of information, while healthcare professionals and formal resources were less utilized. Conclusion:Substantial gaps in developmental milestone knowledge exist among Saudi adults, especially regarding infant and speech/language development. Targeted public health education and greater involve-ment of healthcare providers are needed to strengthen awareness and support early in-tervention.
