Ghadah Sulaiman Alsaleh

Background and objectives: Adhesive small bowel obstruction (ASBO) is a serious complication following abdominal surgery in children, yet its presenting symptoms often mimic non-surgical conditions such as viral mesenteric adenitis and functional constipation. This diagnostic challenge is particularly acute in young children with a history of neonatal intestinal surgery who cannot reliably communicate their symptoms. This case report describes a former extreme preterm infant with surgical history of necrotizing enterocolitis (NEC) who presented with acute abdominal pain and was found to have complete mechanical small bowel obstruction due to postoperative adhesions. The objective is to highlight the diagnostic pitfalls in this population and to describe an unusual postoperative course complicated by three concurrent infections. Case presentation: A 3-year-7-month-old former preterm girl (23 weeks gestation) with a history of necrotizing enterocolitis (NEC) requiring jejunal resection and stoma closure presented with one day of colicky abdominal pain, vomiting, and constipation. Initial ultrasound showed reactive mesenteric lymph nodes and fecal loading, suggesting mesenteric adenitis and constipation. However, given her surgical history, she was admitted for observation. Abdominal x-ray revealed small bowel dilatation with air-fluid levels, and contrast-enhanced CT confirmed complete mechanical small bowel obstruction with pneumatosis intestinalis. She underwent emergent laparotomy, which revealed extensive adhesive bands causing obstruction without volvulus, and adhesiolysis was performed without complication. On postoperative day 17, she developed a one-day fever. Workup revealed three concurrent infections: ESBL-producing Escherichia coli urinary tract infection, adenovirus, and Entamoeba histolytica/dispar. She was treated with intravenous meropenem and metronidazole and recovered fully. Conclusion: Children with prior intestinal surgery can present with acute abdominal pain that mimics non-surgical conditions such as mesenteric adenitis and constipation while having a complete adhesive small bowel obstruction requiring emergent surgery. Normal or equivocal ultrasound findings do not exclude this diagnosis, and a low threshold for CT is essential. Postoperative fever in such patients warrants a broad infectious workup, as multiple concurrent pathogens may coexist.

Background and objectives: Traumatic intra-abdominal testicular migration is an exceptionally rare urological emergency in pediatric patients, with limited literature to guide management. We present a case of a 9-year-old boy with post-traumatic intra-abdominal testicular displacement mimicking torsion, highlighting the diagnostic challenges and multidisciplinary approach required for optimal outcomes. Case presentation: A previously healthy 9-year-old male presented with severe right scrotal pain and empty hemiscrotum following blunt trauma during football. Initial ultrasound revealed a non-scrotal right testis with diminished vascularity, while CT confirmed intraperitoneal localization near the right inferior epigastric artery. Emergency laparoscopic exploration identified a viable intra-abdominal testis, managed successfully with combined laparoscopic mobilization, herniotomy, and open orchidopexy. The patient recovered uneventfully with normal testicular position at discharge. Conclusion: This case demonstrates that traumatic intra-abdominal testicular migration requires high clinical suspicion, timely imaging, and urgent surgical intervention . Despite the absence of pre-existing cryptorchidism, violent trauma can cause complete testicular displacement, emphasizing the need for thorough evaluation of pediatric scrotal trauma.

Background: Endotracheal intubation is a critical life-saving procedure in emergency medicine. However, data on training characteristics, perceived proficiency, and educational gaps among emergency medicine residents in Saudi Arabia remain limited. This study aimed to describe the demographic and training characteristics of emergency medicine residents in Saudi Arabia, including their self-estimated first-pass success rates, device preferences, and perceived facilitators of intubation, and to compare these factors across postgraduate year levels. Methods: A multi-center cross-sectional study was conducted among emergency medicine residents enrolled in the Saudi Board of Emergency Medicine training program across multiple centers in Saudi Arabia. Data were collected using a structured electronic survey distributed between mid-June and mid-September 2025. Results: A total of 100 residents completed the survey, with an even distribution across postgraduate year (PGY) levels. The median self-estimated first-pass success rate was 80% (IQR = 70%–90%). Video laryngoscopy was the preferred device (66%), and the most frequently cited facilitators were proper positioning (85%) and video laryngoscope use (71%). Notably, 19% of residents reported lacking confidence in intubating alone, and 24% perceived insufficient supervised opportunities. A significant association was found between PGY level and intubation confidence ( p < 0.001), with 36.7% of PGY-1 residents lacking confidence compared to none among PGY-3 and PGY-4 residents. The perceived importance of good supervision declined significantly with advancing training ( p < 0.001), from 66.7% among PGY-1 to 12.5% among PGY-4. Significant differences were also observed in perceptions of sufficient supervised opportunities across PGY levels ( p = 0.048), with PGY-2 residents reporting the lowest satisfaction (60.9%) and PGY-3 the highest (95.7%). Conclusion: This study provides a preliminary characterization of intubation training among emergency medicine residents in Saudi Arabia. Although most residents ultimately develop confidence, a notable minority lack confidence and perceive insufficient supervised opportunities. The findings suggest the PGY-2 year may be a transitional phase that could benefit from targeted support. Video laryngoscopy is strongly preferred, though device versatility appears to increase with seniority. It is important to note that these results reflect residents’ self-reported perceptions and should not be equated with objective measures of procedural competence.

Background: The COVID-19 pandemic precipitated a critical global shortage of mechanical ventilators, life-saving devices essential for managing patients with severe respiratory complications. The objective of this Community Case Study is to describe the operational process, stakeholder coordination, and outcomes of a national initiative in the Kingdom of Saudi Arabia to rehabilitate decommissioned ventilators, providing a practical model for other health systems facing similar resource constraints during public health emergencies. Methods: This retrospective case study analyzed a national initiative to rehabilitate decommissioned ventilators during the COVID-19 pandemic. A systematic, multi-phase operation was executed, starting with a comprehensive inventory that identified 183 decommissioned ventilators across the Kingdom's health regions. A detailed technical assessment was subsequently conducted in collaboration with 13 equipment agents. A zero-cost rehabilitation strategy was implemented, whereby functional parts from non-repairable devices were used to restore others. Each device underwent a rigorous two-stage testing and quality assurance protocol before being cleared for clinical use. Results: From the initial 183 devices, the initiative successfully restored 57 ventilators (31.1%) to full operational status at zero cost, creating an immediate and critical boost to ICU capacity. These devices were deployed to high-need regions, including the Eastern Region (14), Madinah (11), and the Northern Borders (9). The project achieved a calculated cost avoidance of 6,678,116 SAR, equivalent to the price of 57 new ventilators. Furthermore, 80 non-repairable devices were donated to support local industrial manufacturing, fostering national self-sufficiency. Conclusion: This initiative demonstrates a highly effective model for rapid crisis response and resource optimization in healthcare. By strategically rehabilitating decommissioned medical equipment, the project not only alleviated a critical shortage during a pandemic but also yielded substantial financial savings and advanced strategic goals for local industry and sustainable maintenance, setting a benchmark for innovation in public health logistics.

Background: Emergency medicine residency training requires rapid acquisition of diverse clinical competencies in high-pressure environments. Understanding residents’ learning preferences and curriculum satisfaction is essential for optimizing training outcomes, yet limited research exists on how demographic factors influence these variables in emergency medicine education, particularly in non-Western contexts. Objectives: This study aims to investigate the VARK (Visual, Aural, Reading/Writing, Kinesthetic) learning preferences of emergency medicine residents at multiple training centers in Riyadh, evaluate their satisfaction with the academic curriculum, and examine the influence of demographic factors including gender and residency year on both learning preferences and curriculum satisfaction. Methods and materials: A cross-sectional study was conducted with 121 emergency medicine residents from multiple training centers in Riyadh. Participants completed the validated VARK questionnaire (Version 8.01), which consists of 16 scenario-based items assessing four sensory modalities. Each item presents a learning situation with four response options corresponding to visual (e.g., diagrams, charts), aural (e.g., discussions, lectures), reading/writing (e.g., manuals, notes), and kinesthetic (e.g., hands-on practice) preferences. The questionnaire also identifies multimodal combinations (bimodal, trimodal, quadmodal). Additionally, residents completed a 4-item curriculum satisfaction survey using a 4-point Likert scale (1 = Disagree, 2 = Neutral, 3 = Agree, 4 = Strongly agree) evaluating key domains including simulation quality and clinical skill development. Results: Among 121 emergency medicine residents (61.2% male, 38.8% female), VARK preferences revealed near-universal use of visual (97.5%) and kinesthetic (96.7%) modes, with 68.6% preferring quadmodal (all four) learning. Residents predominantly relied on maps (74.4%) for navigation, videos (51.2%) for online learning, and hands-on practice (42.1%) for skill acquisition. Satisfaction with the curriculum was high: 79.4% (agreed/strongly agreed), and 71.9% (agreed/strongly agreed) endorsed simulation/practical sessions. However, no significant association existed between VARK preferences and satisfaction scores ( p > 0.05). Males scored higher in kinesthetic preference than females ( p = 0.005), but neither gender nor residency year significantly influenced satisfaction ( p > 0.05). Conclusion: Emergency medicine residents demonstrate consistent visual-kinesthetic learning dominance throughout training, with gender-based differences in preference and satisfaction. These findings support curriculum redesigns emphasizing multimodal, hands-on teaching while addressing gender-specific needs. Future research should examine how these preferences correlate with clinical performance.

Objective: To describe the demographic profiles, clinical characteristics, and meteorological context of heat-related illnesses among Hajj pilgrims in 2023. Methods: A retrospective cross-sectional study was conducted using data from 1,129 pilgrims diagnosed with HRIs across healthcare facilities in Mecca, Mina, and Arafat. Demographic and clinical data were extracted from the Hajj Health Information System, while temperature, humidity, wind speed, and rainfall records were obtained from the National Center for Meteorology. Results: Heat exhaustion (48.2%) and heatstroke (37.4%) were the most common diagnoses, with 24.9% of the cases requiring hospitalization. Males represented 55.4% of cases and accounted for 51.2% of hospitalizations. Pilgrims aged 55–74 years comprised 64.2% of severe cases, while Egyptians were disproportionately affected (32.2% of cases). Meteorological data revealed high temperatures reaching 44°C during the Day of Arafah, accompanied by low humidity (14%) and moderate wind speeds of approximately 7 km/h, with no rainfall (0 mm). Conclusion: The findings underscore the need for targeted interventions, including heat-adaptive rituals, real-time environmental monitoring, and age-specific cooling strategies, to protect pilgrims as climate change intensifies. This study provides a benchmark for future research on mass gatherings in warming environments.

Background: Internal hernias are a rare but critical cause of small bowel obstruction, with paraduodenal hernias being the most common subtype. They pose a significant diagnostic challenge due to non-specific symptoms and can lead to catastrophic outcomes like bowel strangulation. Objectives: This report details a case of acute small bowel obstruction secondary to a paraduodenal Treitz hernia to highlight the diagnostic and therapeutic challenges and discuss key management decisions. Case presentation: A 53-year-old male, smoker, with no surgical history, presented with severe progressive abdominal pain, vomiting, and constipation. Examination revealed abdominal tenderness and rigidity. Laboratory findings showed leukocytosis with neutrophilia, a markedly elevated creatine kinase and C-reactive protein. CT scan confirmed a small bowel obstruction with a tight transition point. An initial laparoscopic exploration was converted to open laparotomy due to poor visualization, revealing a non-strangulated paraduodenal Treitz hernia, which was successfully reduced. The patient's postoperative course was uncomplicated, with a rapid return to a liquid diet by postoperative day one. Conclusion: This case underscores that internal hernias must be considered in patients with small bowel obstruction and no prior abdominal surgery. Timely CT imaging is crucial for diagnosis, and surgical flexibility, with a readiness to convert to open laparotomy, is essential for safe management and optimal outcomes.

Background Heat-related illnesses (HRIs) remain a significant health concern during mass gatherings (MGs), where high temperatures and physical exertion exacerbate physiological stress. This study examines the clinical spectrum, management practices, and treatment outcomes of HRIs among pilgrims during the 2024 Hajj season, to inform public health responses and mitigation strategies. Methods A cross-sectional study was conducted across nine healthcare facilities in Makkah and the Mashaer region during the 2024 Hajj. Data were retrospectively extracted from medical health care facilities registries using a standardized form to capture demographic characteristics, clinical presentation, management interventions, and in-hospital outcomes of patients diagnosed with heat-related illness. Results Of the 2,785 screened patients, 2,551 had complete clinical records, and 1,576 met the diagnostic criteria for heat exhaustion or heatstroke, with outcome data available. Most of the patients were male (1,171; 74.3%), with nearly half aged 60 years or older (776; 49.2%) and a large proportion aged 39–59 years (693; 44.0%). The majority were non-Saudi pilgrims (1,419; 90%), primarily from Arab countries, with 793 (50.3%) from these regions. A total of 1,094 patients (69.4%) had no prior history of HRIs. Common symptoms included altered mental status in 635 (40.3%) patients, dizziness in 486 (30.8%), and management interventions included intravenous fluid administration in 569 cases (36.1%) and the application of cooling measures in emergency settings for 1,105 patients (70.1%). The overall mortality rate was 77 (4.9%) cases. Intensive care unit (ICU) admission and elevated lactic acid levels were significantly associated with poor outcomes. Conclusion Heat-related illness during the Hajj remains a major public health concern, with a substantial clinical burden and potentially severe outcomes. Early recognition, timely intervention, and targeted education are essential for high-risk groups. Strengthening frontline preparedness and resource deployment is crucial to reducing its potential impact.

Background: The Hajj pilgrimage in Saudi Arabia poses significant healthcare challenges due to overcrowding and high demand. Stroke, a leading cause of morbidity and mortality, necessitates timely management, with telemedicine providing crucial remote access to specialized care. Objectives: This study aimed to evaluate the demographic and clinical characteristics of pilgrims who experienced strokes and utilized telemedicine during the Hajj seasons of 2023 and 2024, focusing on identifying changes in patient profiles and treatment patterns over time. Methods and materials: A cross-sectional study was conducted using data from SEHA Virtual Hospital (SVH) during the Hajj seasons of 2023 and 2024. The study included 459 adult stroke patients (207 in 2023 and 252 in 2024) who completed telemedicine consultations. Demographic and clinical data, including stroke types and treatment details, were retrospectively analyzed. Statistical comparisons were performed using chi-square and Mann–Whitney U tests, with significance set at p < 0.05. Results: The mean age of patients was 64.13 years in 2023 and 62.43 years in 2024. Non-Saudi patients constituted 69% in 2023, decreasing to 62% in 2024, while Saudi patients increased from 31 to 38%. Male patients rose from 57% in 2023 to 62% in 2024. Diagnoses showed significant variation: ischemic strokes increased from 46% in 2023 to 73% in 2024, while hemorrhagic strokes and other miscellaneous conditions decreased, and TIAs showed a slight increase. TPA administration remained stable at 23% in both years, and the median time to TPA administration showed no significant difference. Conclusion: The consistent application of a centralized telestroke service during the Hajj demonstrates that telemedicine is a viable and scalable strategy for delivering specialized stroke care in mass gathering settings. This model successfully managed a large, diverse patient cohort and maintained stable acute treatment rates, underscoring its potential to enhance health system resilience and equity during the most logistically challenging events.

Background: The Hajj pilgrimage, a significant religious event, presents unique health challenges due to the large number of participants and the physical demands of the pilgrimage. Despite efforts by Saudi health authorities to provide comprehensive health services, the effectiveness of these interventions relies heavily on pilgrims’ knowledge of available services and emergency measures. Objectives: The aim of this study is to assess the level of knowledge of health services among Hajj pilgrims in Saudi Arabia during the 1445 H (2024 G) season and its associated demographic and health-related factors. Methods and Materials: This cross-sectional study was conducted during the 1445 H (2024 G) Hajj season with 1215 pilgrims, 51.7% male. Participants were randomly selected from selected pilgrimage accommodations or passing through the airport in Jeddah. Data were collected through face-to-face interviews using a structured questionnaire covering demographics, health characteristics, and knowledge of health services. Results: The study found that 62.1% of participants correctly believed that health services during Hajj were free of charge. Furthermore, 44.4% were aware of the emergency health number, with 31.5% exhibiting good knowledge. Bivariate analysis showed that younger participants had better knowledge (p < 0.001), and males were more likely than females to demonstrate partial or good knowledge (p = 0.011). Participants with university education were significantly more likely to have good knowledge, with 29.6% demonstrating good knowledge compared to 7.4% of illiterate participants (p < 0.001). Geographic region was also a factor, with 48.9% of Middle Eastern participants exhibiting good knowledge, compared to 27.1% of African and 23.6% of Asian participants (p < 0.001). However, multivariable logistic regression, revealed that only younger age (OR = 0.98, p = 0.005), university education (OR = 1.96, p = 0.024), and being from the Middle East (OR = 1.61, p = 0.009) were significant predictors of good knowledge of health services. Conclusions: The study identified significant gaps in pilgrims’ knowledge of health services during Hajj, with younger age, higher education, and Middle Eastern geographic region identified as independent predictors of better knowledge. These findings suggest the need for targeted health education initiatives, particularly for older pilgrims, those with lower educational attainment, and individuals from regions with lower awareness levels, to improve knowledge and potentially enhance health outcomes during Hajj.