Inguinal hernia repair (IHR) is a common surgical procedure among neonates and infants; the time of surgery is one of the major factors affecting its outcomes. Our systematic review aims to evaluate the effects of surgical timing on outcomes in inguinal hernia repairs in the newborn and infant population to establish evidence-based guidelines for optimal surgical timing. A systematic search was performed in PubMed, MEDLINE, and Web of Science databases, following PRISMA guidelines. Studies evaluating neonates and infants undergoing IHR with outcomes of recurrence, complications, and postoperative recovery were included. Data were collaboratively extracted, including patient demographics, surgical approaches, perioperative complications, and long-term outcomes. Early repair (0–28 days of life) decreased the risk of hernia incarceration but also increased the risk of preoperative complications. Delayed repair (29 days to 1 year of life) showed fewer preoperative complications but increased the risk of incarceration. The outcomes were affected by variables including patient maturity and comorbidities, along with hernia severity. Neonates with a high risk for incarceration are best treated with early repair, while stable infants can be managed safely with delayed repair. More randomized trials are needed to develop standardized guidelines that balance the associated risks of neonatal versus infant repair strategies to maximize benefits.

Vaccine hesitancy remains a challenge to achieving optimal childhood immunization coverage. This systematic review examined parental vaccine hesitancy in Saudi Arabia, with emphasis on paternal determinants and their association with vaccination uptake. Following PRISMA 2020 guidelines, databases were searched between January 2000 and January 2025. Hesitancy toward routine childhood vaccines was generally low (3%-20%), whereas hesitancy toward newer or non-mandatory vaccines, including COVID-19, influenza, and HPV, exceeded 50% in some settings. Studies reporting father-specific data indicated higher hesitancy among fathers, particularly regarding safety, novelty, and possible long-term effects. Common determinants included safety concerns, misinformation, social media influence, and low confidence in vaccine effectiveness. Hesitancy was associated with delayed schedules, incomplete immunization, and reduced uptake of optional vaccines. Vaccine hesitancy in Saudi Arabia appears vaccine-specific and influenced by sociocultural factors, with paternal attitudes playing a measurable role in immunization decision-making.

Objectives: To assess the safety and efficacy of adenotonsillectomy (AT) for treating uncomplicated pediatric obstructive sleep apnea (OSA) in children of different ages. Methods: A systematic search was conducted in four electronic databases, and 71 studies with a total of 9087 participants were included in the analysis. The studies were all before-and-after studies, cohort studies, and randomized controlled trials. Surgical results were analyzed according to age, disease severity, and follow-up duration. Results: Children younger than 7 years at the time of AT had a significantly greater decrease in disease severity, a greater decrease in hypoxemic burden, improved sleep quality, and improved cardiovascular function than children older than 7 years. Both cognitive and behavioral performance improved postoperatively, although these changes were more significantly associated with the duration of follow-up than with age at surgery. Notably, the rate of surgical complications was much greater in children under the age of 3. Conclusions: The current evidence indicates that AT is performed optimally between the ages of 3 and 7 years, offering the greatest chance of disease resolution and remission of associated conditions, balanced with a reduction in surgical risk. We highly recommend conducting high-quality randomized controlled trials to further inform the clinical guidelines for pediatric AT.

Background: Adenotonsillectomy (AT) is a common surgical procedure among pediatrics, usually performed to treat obstructive sleep apnea (OSA), recurrent tonsillitis, and chronic adenoid hypertrophy. The aim of our systematic review is to evaluate the relationship between AT and postoperative weight gain in children to guide clinicians in optimizing surgical outcomes. Methods: A systematic search was conducted following the PRISMA guidelines in PubMed, MEDLINE, and Web of Science databases. Studies evaluating weight, BMI, and growth parameters before and after AT were included. Data were collaboratively extracted, including patient demographics, baseline weight status, comorbidities, and long-term outcomes. Results: Underweight children (less than the 3rd percentile on the growth chart) who underwent AT often experienced “catch-up growth” in weight, while obese children (above the 95th percentile on the growth chart) had postoperative weight gain that exacerbated pre-existing obesity. These outcomes were affected by factors such as baseline weight, age, and comorbid conditions. Conclusions: AT can improve the quality of life in underweight children, while overweight or obese children need careful monitoring and nutrition counseling postoperatively to mitigate excessive weight gain. More randomized trials are needed to better understand the metabolic and growth implications of AT and to refine clinical guidelines.

Introduction Post-thyroidectomy hypocalcemia remains a significant surgical complication with varying reported incidence rates. While traditional focus has centered on surgical factors, the role of metabolic predictors in calcium homeostasis disturbances remains incompletely understood. Methods We conducted a single-center retrospective analysis of 1,760 thyroidectomy patients based on data obtained from King Abdullah International Medical Research Center (KAIMRC), Saudi Arabia, evaluating metabolic predictors and long-term calcium homeostasis patterns. Preoperative assessment included thyroid function tests, glycemic control, vitamin D status, and anthropometric measurements. We have followed the TRIPOD + AI statement which provide updated guidance for reporting clinical prediction models that use regression or machine learning methods, We developed a risk stratification model using multivariate logistic regression and implemented mixed-effects modeling for longitudinal analysis. Recovery patterns were evaluated through standardized follow-up at immediate postoperative, one-month, three-month, six-month, and one-year timepoints. Results Post-thyroidectomy hypocalcemia occurred in 585 patients (33.2%, 95% CI: 31.0-35.4%). Preoperative thyroid stimulating hormone (TSH) levels appeared to be the strongest predictor (OR 2.24, 95% CI 1.71-2.93, p<0.0001), followed by T3 (OR 1.34, 95% CI 1.19-1.51) and glycated hemoglobin (Hemoglobin A1C), (OR 1.18, 95% CI 1.07-1.30). Our risk stratification system, including TSH, vitamin D, and immediate postoperative calcium, achieved superior discrimination (AUC=0.921) and effectively categorized patients into low (6.5%), intermediate (14.6%), and high-risk (83.2%) groups. Recovery patterns revealed a non-linear trajectory, with an unexpected decline at six months (79.71%) before maximal improvement at one year (88.61%). Conclusions Our findings highlight and demonstrate the significant role of metabolic factors in post-thyroidectomy hypocalcemia risk and challenge the current standard recovery assumptions, suggesting the need for extended monitoring protocols and comprehensive metabolic assessment in perioperative management.

Background: Malnutrition is an underlying factor in many diseases in both children and adults, and it contributes greatly to the disability-adjusted life years worldwide. It is a major public health concern in developing countries among children since it places a heavy burden on already disadvantaged communities. Methods: This is systematic review was carried out, including PubMed, Google Scholar, and EBSCO using the following terms in different combinations: Malnutrition, overweight, underweight, systemic review, primary school children, Saudi Arabia. Results: The review included 9 studies from different countries that assess the level of malnutrition and associated factors among school children. Many of studies reported high prevalence of malnutrition among school children which included overweight, stunting, wasting and underweight. The studies reported that age, gender, regularity of father’s employment, and dietary factors were associated with malnutrition. Also, the type of school attended was found to be associated with malnutrition. Conclusion: This review concluded that there was high malnutrition prevalence among school children in different parts and its affected by many factors like age and gender.