Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) became a major concern since the announcement that it is a pandemic in early 2020. Vaccine trials were started in November 2020, and completed rapidly due to the urgency to get over the infection. Side effects to vaccines started to be reported. There were minor side effects including site of injection pain and heaviness and constitutional symptoms like fever which are considered minor. One of the rare adverse events is post vaccine new onset autoimmune diseases. Methods: Data were obtained from one center in the eastern province of Saudi Arabia (King Fahd Hospital of University). All patient events reported occurred in the study period March 2021 to February 2022. We identified patients presenting with autoimmune diseases with exclusively new onset presentations. Results: We identified 31 cases of immune-mediated disease: 18 females (58%); 13 males (42%). Only 4 of them (13%) had an autoimmune background before COVID-19 vaccination. The average time between vaccination and new-onset disease symptoms was 7 days. Among all the cases in our study, 7 patients (22.5%) had new-onset vasculitis, 2 cases had IgA vasculitis and 5 cases had ANCA vasculitis, 6 cases had neurological diseases (19.3%), 4 cases (12.9%) had new-onset systemic lupus erythematosus (SLE), 3 cases (9.6%) presented with new-onset inflammatory arthritis, and one had Sjogren’s syndrome (3.2%). Conclusion: Our study is unique as it is the first study to include the largest number (31 patients) of new onsets of confirmed autoimmune diseases related to Covid-19 vaccines.

One key area of interest in gastroenterology research is the relationship between Helicobacter pylori (H. pylori) and Inflammatory bowel disease (IBD). Several studies have shown varying results regarding the prevalence of H. pylori in IBD patients and its impact on disease progression, severity, and overall outcome. This is a prospective cohort study conducted at King Fahad University Hospital in Al Khobar, Saudi Arabia from November 2023 to May 2024 to determine the prevalence of H. pylori in IBD patients and its association with severity. The study included 2 arms for comparison which are IBD patients and control group, IBD will be further classified to CD and UC. Prevalence of H. pylori infection and severity of the disease was compared between these groups. A total of 360 patients were included in the study which were divided equally into IBD group and control group. The IBD was subdivided into CD with 91 cases and UC with 89 cases. H. Pylori was significantly higher in control group (23.3%) compared with UC cases (13.2%) p value: 0.048. H. pylori infection was significantly high in smokers p value = < 0.0001. The presence of autoimmune disease was significantly associated with H. Pylori infection (16.4%) p value: 0.023. H. pylori infection was significantly higher in the control group in comparison to IBD group. In addition, smoking and autoimmune disease were significantly associated with H. pylori infection. Finally, the overall association between severity of CD, UC and medication use with H. Pylori were insignificant.

Burkholderia cepacia complex bacteria are intrinsically multidrug-resistant opportunistic pathogens that pose a growing threat in hospital settings, particularly among immunocompromised patients. Despite its clinical significance, data on sporadic Burkholderia cepacia complex infections outside cystic fibrosis populations and hospital outbreaks remain limited. A 22-year retrospective observational cohort study (May 2001-April 2023) was carried out at a tertiary care academic center in the Eastern Province of Saudi Arabia. Adults hospitalized with confirmed Burkholderia cepacia infection and ≥ 72 h of antibiotic therapy were included. Demographics, comorbidities, infection type, microbiological resistance profiles, treatment outcomes, and mortality predictors were analyzed using logistic regression and Kaplan-Meier survival estimates. Of 189 identified cases, 151 patients met the inclusion criteria (mean age 53 ± 21 years; 57.6 % male). The majority of infections were hospital-acquired (84.8 %), with bloodstream infections (33.1 %) and ventilator-associated pneumonia (26.5 %) being the most prevalent. Resistance was high to piperacillin/tazobactam (73.6 %), ceftazidime (58.6 %), levofloxacin (57.4 %), carbapenems (42.0 %), and trimethoprim-sulfamethoxazole (30.3 %). Clinical resolution was achieved in 82.1 %, but bacteriological eradication occurred in only 56.9 %, with a recurrence rate of 17.2 %. Mortality reached 9.9 % at 14 days, 17.2 % at 30 days, and 35.8 % at one year. Independent predictors of 30-day mortality included advanced age, critical care admission, central venous catheter insertion, mechanical ventilation, and resistance to fluoroquinolones or carbapenems. Our findings indicate that Burkholderia cepacia complex infections represent a significant clinical challenge due to antibiotic resistance and elevated mortality rates. The data highlight the importance of improving diagnostic and treatment approaches, as well as implementing effective infection control policies, especially for vulnerable hospitalized populations.

Background: Coronavirus disease 2019 (COVID-19) is a rapidly spreading infection that is on the rise. New variants are continuously appearing with variable degrees of lethality and infectivity. The extensive work since the start of the pandemic has led to the evolution of COVID-19 vaccines with varying mechanisms. We aim to determine real-world data by looking at the different clinical outcomes associated with COVID-19 vaccination, focusing on the rate of hospitalization, severity, and mortality. Methodology: A retrospective observational study included 624 patients with COVID-19 infection who were hospitalized at King Fahad Hospital of the University and King Fahad Military Medical City between April and July 2021. The cohort was divided into 3 groups: unvaccinated, partially vaccinated (PV), and fully vaccinated (FV). The severity and outcome of COVID-19 disease were compared among the three groups. Among the vaccinated group, we studied the effect of vaccine type on the severity and outcome of COVID-19 disease. Results: We found that 70.4% of patients with COVID-19 disease who required hospitalization were unvaccinated. Un-vaccination was a significant predictor of critical COVID-19 disease (OR 2.31; P < 0.001), whereas full vaccination was associated with significantly milder disease severity (OR 0.36; P 0.01). Moreover, un-vaccination status was an independent predictor of longer hospitalization (OR 3.0; P < 0.001), a higher requirement for ICU admission (OR 4.7; P < 0.001), mechanical ventilation (OR 3.6; P < 0.001), and death (OR 4.8; P < 0.001), whereas the FV group had a lower risk of ICU admission (OR 0.49; P 0.045). Unvaccinated patients with comorbidities had worse severity and outcome of COVID-19 infection (P< 0.05). Both vaccine types (Pfizer and AstraZeneca) had similar protective effects against the worst outcomes of COVID-19 disease. Conclusion: COVID-19 vaccination has been shown to be effective in reducing hospitalization, the severity of COVID-19 infection, and improving outcomes, especially in high-risk group patients. COVID-19 vaccination programs should continue to improve the outcome of such a disease.

Background/Objectives: Hypoparathyroidism (HPT) is a common complication following thyroid surgery with an incidence reaching up to 29%, potentially resulting in significant long-term morbidity. To improve its early identification and patient outcomes, we investigated the prevalence and predictors of postoperative HPT. Methods: This retrospective, multicenter observational study included patients who underwent thyroid surgery from 2016 to 2022 in four centers located in Saudi Arabia’s Eastern Province. We analyzed demographic data, underlying thyroid or parathyroid conditions, surgical indications, types of procedures, pathology results, and preoperative corrected calcium and vitamin D levels, along with postoperative corrected calcium and parathyroid hormone (PTH) levels. For data analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics 22 was used, with categorical variables presented as frequencies/percentages and non-normal continuous variables as the median/first quartile (Q1) and third quartile (Q3). Associations were tested with chi-square/Fisher exact tests, medians with Mann–Whitney U-tests, and odds ratios (ORs) with 95% confidence intervals (CIs) via multivariate analysis with statistical significance set at p < 0.05. Results: A total of 679 cases were included. The median age of patients was 43 years (with 48.9% of them aged 41–60 years), and 82% were female. HPT occurred in 228 cases (35.3%), with 115 (81.0%) experiencing transient HPT and 27 (19.0%) permanent HPT. Multivariate analysis identified total thyroidectomy (OR 2.7, p = 0.005), completion thyroidectomy (OR 8.4, p = 0.004), and low immediate postoperative PTH level (OR 3.1, p < 0.001) as independent predictors of HPT. Central lymph node dissection (CLND; OR 4.03, p = 0.004) and low postoperative PTH level (OR 2.56, p = 0.049) were significant predictors of permanent HPT. Conclusions: Key predictors of HPT include surgical extent and low postoperative PTH level, while CLND and low postoperative PTH level are the strongest predictors of permanent HPT. Careful assessment of these risks when determining the extent of surgery and avoiding unnecessary aggressive procedures can help to minimize the occurrence of HPT. Measuring the PTH level immediately after surgery may aid in identifying high-risk patients for early intervention and appropriate follow-up.

Delayed Hemolytic Transfusion Reaction in Sickle Cell Disease: A Case Series - Article abstract #934681