Background: In the Kingdom of Saudi Arabia, various COVID-19 vaccines were administered during the pandemic. However, region-specific real-word comparative data on their immunogenicity remain limited. This study aimed to assess the serological responses to Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and AstraZeneca (ChAdOx1 nCoV-19) vaccines in a diverse population living in KSA. Methods: This observational study included 236 adults recruited from vaccination sites in Riyadh. Participants provided serum samples at predefined intervals: before the first dose, after the first dose, after the second dose, and post-vaccination infection (if applicable). IgG and neutralising antibodies were quantified using ELISA assays. Demographic and vaccination data, and their associations with antibody responses, were evaluated. Results: At baseline, 75.4% of participants were positive for SARS-CoV-2 IgG, suggesting high prior exposure. Marked incremental increases in IgG levels were observed after each vaccine dose. Both Moderna and Pfizer elicited stronger responses, with Pfizer inducing the strongest early response and Moderna achieving the highest overall titres. Among IgG-positive individuals, neutralising antibodies were detected in 98.1%. There were no statistically significant differences by age or gender, although males tended to show higher mean titres. Heterologous vaccine schedules induced comparable or enhanced immunogenicity relative to homologous schedules, supporting their use in flexible immunisation strategies. Conclusions: All COVID-19 vaccines administered in Saudi Arabia elicited robust antibody responses, particularly the mRNA-based vaccines. Our findings support their continued use and justify varied vaccination approaches, including mix-and-match booster strategies, to enhance community immunity.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Although various viruses have been proposed to contribute to MS pathology, the etiology of MS remains unknown. Since intrathecal antibody synthesis is well documented in chronic viral infection and neuroinflammatory diseases, we hypothesized whether the patterns of antigen-specific antibody responses associated with various viral exposures may define patients with CNS chronic immune dysregulation. The pan-viral antibody profiling in cerebrospinal fluid (CSF) and serum of patients with MS showed significant differences from those in healthy volunteers and a pattern of antibody responses against multiple viruses, including the previously identified Epstein-Barr virus. These findings demonstrate that virus-specific antibody signatures might be able to reflect disease-associated inflammatory milieu in CSF of subjects with neuroinflammatory diseases.

Lurasidone is a second-generation antipsychotic approved for the treatment of bipolar depression. Although effective, antipsychotics may precipitate manic episodes in susceptible individuals. This report aims to describe a unique case of a patient with bipolar I disorder who developed acute mania following lurasidone titration, highlighting the need for vigilance during treatment initiation. We present the case of a 43-year-old man with a history of bipolar I disorder who presented with a severe depressive episode, characterized by depressed mood, insomnia, anhedonia, and suicidal ideation. Laboratory investigations revealed a subtherapeutic serum valproate level of less than 13 µg/mL (reference range: 50–100 µg/mL). Lurasidone therapy was initiated and gradually titrated to 120 mg daily. After 1 week, the patient exhibited increased energy and decreased sleep needs. By the second week, he developed a full manic episode, presenting an elevated mood, irritability, intrusive behavior, and sleeping only one to two hours per night. Following the immediate discontinuation of Lurasidone, alongside the optimization of his sodium valproate dosage and the reinitiation of paliperidone, the patient experienced a dramatic reduction in his manic symptoms. His clinical condition stabilized, and he was subsequently discharged. This case emphasizes the critical importance of close monitoring for manic symptoms following lurasidone initiation in patients with bipolar I disorder and inadequate mood stabilization.

Background: Burnout among medical professionals is recognized globally, with significant implications for mental health and patient care. This study evaluates the prevalence of burnout among postgraduate medical trainees in the Eastern Health Cluster of Saudi Arabia, aiming to fill the research gap in this region, where specific cultural and training factors may contribute uniquely to burnout. Methods: A cross-sectional study was conducted from March to June 2024 across various healthcare facilities within the Eastern Health Cluster. A total of 422 postgraduate medical trainees participated, providing data through a Google Form survey, which included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS(MP)). Results: The study found a high prevalence of burnout symptoms among trainees: 30.3% reported high levels of emotional exhaustion, 24.9% reported high levels of depersonalization, and a significant 86.3% felt low levels of personal accomplishment. Burnout rates varied significantly across specialties and training levels, suggesting targeted interventions were needed. Conclusions: The high prevalence of burnout underscores the critical need for tailored preventive strategies and interventions within the training environments to effectively address and mitigate burnout among medical trainees. Future research should explore longitudinal interventions to reduce burnout and enhance trainee well-being.

Background: Humoral immune responses to SARS-CoV-2 are well documented, yet the immunopathogenic mechanisms distinguishing severe from critical disease remain incompletely defined, particularly in Middle Eastern populations. We investigated antibody responses across levels of clinical severity in a Saudi Arabian cohort. Methods: In this multicentre study, we analysed 406 participants stratified into five clinical groups: controls, asymptomatic, mild, severe, and critically ill requiring intensive care unit (ICU) admission. SARS-CoV-2-specific IgG and IgM levels were quantified alongside surrogate ACE2-RBD neutralisation activity. Associations between humoral markers, demographic factors, comorbidities, and disease severity were assessed. Results: SARS-CoV-2-specific IgG and IgM levels differed significantly across disease severity groups (p < 0.001), with higher levels observed in groups with greater clinical severity. No significant difference in IgG or IgM levels was observed between the severe and ICU groups (IgG p = 0.384; IgM p = 0.768). While binding antibody levels were associated with severity, surrogate ACE2-RBD neutralising activity did not differ significantly across groups (p = 0.209). Increasing age (χ² = 44.5) and the presence of comorbidities (χ² = 31.9) were associated with more severe clinical categories, whereas sex was not. Conclusions: These findings suggest that antibody levels provide useful information about exposure and immune activation, but antibody quantity alone does not fully explain the transition from severe to critical disease. The results support interpreting serological measures alongside clinical factors such as age and chronic illness.